FitSugar

Probiotics: Beneficial or a Waste of Money?

FitSugar — Tue, 04 Nov 2008 09:00:00 -0800

Probiotics certainly were a health buzzword of 2008. These healthy bacteria can now be found in all sorts of products from dairy products to energy bars, from cereals to dietary supplements. These probiotic products claim to help with high blood pressure, digestive problems such as irritable bowel syndrome (IBS), and constipation. The question is, are they worth the money?

Many of the probiotic products on the market don't contain enough of the types of bacteria that studies have found offer health benefits, so they're not worth buying. Products worth your money should contain purified strains of specific microbes, such as B. Animalis (found in Dannon's Activia yogurt), or other specific strains of Bifidobacterium, or Lactobacillus. Check amounts as well. Studies show that doses between 100 million and 1 billion colony forming units (CFU) are effective for improving immune function, intestinal infections, and digestion. Acidophilus Pearls contain 1 billion CFU of Lactobacillus acidophilus and Bifidobacterium longum bacteria, so they're a great option. Since needs differ among people, some folks may benefit from one strain of microbes over another; if the Pearls aren't working for you, here's a list of some other probiotics to try.

Fit's Tip: While probiotics are in no way necessary for normal body function, if you're having digestive issues, you may benefit from taking them. Just so you know, in order to feel the effects you need to take them daily, and it may take a week or two to experience results.

If you have a probiotic product that you use, tell me about it in the comment section below.

Source

Probiotics and Prebiotics: Bugs You Should Love

FitSugar — Wed, 28 Mar 2007 08:45:00 -0700

Are you a fan of probiotics? Maybe prebiotics? What's the difference anyway?

Probiotics - dietary supplements/foods containing good bacteria - are a big trend in supplements today. This is because they can help regulate your digestive system by managing lactose intolerance, preventing colon cancer, lowering cholesterol, lowering blood pressure, improving immune function and preventing infections, reducing inflammation, improves mineral absorption, prevents harmful bacterial growth under stress and improving systems of Irritable Bowel Syndrome and Colitis. That is quite a list!!!

The reason is because probiotics assist the body's naturally occurring gut flora (useful microorganisms that live in the digestive tract) that often get out of whack from the foods we eat to the antibacterial soap we use. That's one good bug. Probiotics can be found in yogurt (live & active cultures) and yeast, but they are most commonly consumed in supplement form. You can buy probiotic supplements from The Vitamin Shoppe.

While probiotics are getting increasing popular in the United States, evidence supports that the benefits of prebiotics - Non-digestible food ingredients that selectively stimulate the growth and/or activity of one or a limited number of bacteria in the colon, and improve host health- are a better way to increase good bacterial growth in the gut. Prebiotic foods include soybeans, Jerusalem artichokes, raw oats, unrefined wheat and unrefined barley. Prebiotics naturally occur in breast milk and are believed to play an important role in the development of a healthy immune system in infants.

Lactobacillus acidophilus

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

HEALTH GUIDE REFERENCE FROM A.D.A.M

Overview

Lactobacillus acidophilus (L. acidophilus) is the most commonly used probiotic, or "friendly," bacteria. Such healthy bacteria inhabit the intestines and vagina and protect against the entrance and growth of "bad" organisms that can cause disease. This is accomplished through a variety of mechanisms. For example, the breakdown of food by L. acidophilus leads to production of lactic acid, hydrogen peroxide, and other byproducts that make the environment hostile for undesired organisms. L. acidophilus also produces lactase, the enzyme that breaks down milk sugar (lactose) into simple sugars. People who are lactose intolerant do not produce this enzyme. Symptoms such as gas, bloating, and discomfort develop. For this reason, L. acidophilus supplements may be beneficial for these individuals.

Other potential probiotics include a variety of Lactobacillus species (spp.), such as the caseiGG, rhamnosus, NCFM, DDS-1, and johnsonii strains, Bifidobacterium longum, Bifidobacterium bifidum, Streptococcus thermophilus, Enterococcus faecium, Saccharaomyces boulardii, Bacillus spp., and Escherichia coli.

Prebiotics refers to the soluble fiber component found in certain foods or supplements that stimulate the growth of probiotics in the gastrointestinal tract. Examples include fructooligosaccharides (FOS).

Uses

Probiotics offer a variety of potential therapeutic uses. These include the following:

Vaginal infections

Several clinical studies support the use of Lactobacillus acidophilus vaginal suppositories in the treatment of bacterial vaginosis and candida (yeast) infections. A small number of clinical studies suggest that eating yogurt enriched with Lactobacillus acidophilus may be beneficial. Additional clinical research is needed.

Diarrhea prevention

Some clinical research exists that suggests Lactobacillus acidophilus may be effective when used to prevent diarrhea in travelers or in people taking antibiotics, although there are also some negative studies. Several probiotics (Saccharomyces boulardii and a mixture of Lactobacillus acidophilus and Bifidobacterium bifidum) had significant efficacy on treating traveler's diarrhea. No serious adverse reactions were reported in 12 clinical trials for this condition. Additional human studies are needed in these areas.

Other uses

Other uses of Lactobacillus acidophilus includes:

Replacing the "friendly" intestinal bacteria destroyed by antibiotics.
Aiding digestion and suppressing disease-causing bacteria.
Used in the treatment of chronic constipation.
Treating overgrowth of "bad" organisms in the gastrointestinal tract (a condition that tends to cause diarrhea and may occur from use of antibiotics).
Alleviating symptoms of irritable bowel syndrome and, possibly, inflammatory bowel disease (such as Crohn's disease and ulcerative colitis).
Preventing or reducing the recurrence of urinary tract infections, and cystitis (bladder inflammation).
Improving lactose absorption digestion in people who are lactose intolerant.
Enhancing the immune response. Studies have suggested that consumption of yogurt or milk that contains specific strains of Lactobacillus or supplements with Lactobacillus or Bifidobacterium may improve the natural immune response. Further research is needed to confirm these early findings and to best understand how the improved immune function may or may not help in warding off infections.
Aiding the treatment of respiratory infections such as sinusitis, bronchitis, and pneumonia. More research is needed in this area.
Lowering risk of allergies. Examples include asthma, hay fever, food allergies to milk, and skin reactions such as eczema.
Helping to treat high cholesterol.
Reducing the risk of recurring bladder tumors once this cancer has been treated.
Other conditions under investigation for use of probiotics include colon cancer, human immunodeficiency virus (HIV) related diarrhea, and Helicobacter pylori (an organism that can lead to development of ulcers).

Dietary Sources

The primary dietary sources of L. acidophilus include milk enriched with acidophilus, yogurt containing live L. acidophilus cultures, miso, and tempeh.

Prebiotics are found in breast milk, onions, tomatoes, bananas, honey, barley, garlic, and wheat.

Available Forms

L. acidophilus preparations consist of dried or liquid cultures of living bacteria. These cultures are usually grown in milk but can sometimes be grown in milk-free cultures. L. acidophilus is available in the following forms:

Freeze-dried granules
Freeze-dried powders
Freeze-dried capsules
Liquid L. acidophilus preparations
Yogurt enhanced with probiotics

L. acidophilus supplements should be refrigerated for best quality. However some preparations are in a spore form which is resistant to breakdown under normal temperatures and are often used by travelers who do not have access to refrigeration who use probiotics supplements to help prevent intestinal infections. Check the package label for storage instructions.

Prebiotics occur naturally in foods, but supplements provide a more concentrated source of this substance. Prebiotics are oligosacchrides, chains of sugar units linked together. Inulin is a long-chain oligosacchride (from 2 - 60 sugars) and fructooligosaccharides (FOS) are short-chain oligosaccharides (from 2 - 7 sugars). It is not clear at this time which type of prebiotic is most effective, although fructoligosaccarhides (FOS) are the most commonly used.

How to Take It

Pediatric

Newborns and Infants (0 - 1 year): Liquid preparations may be used as a lotion and applied topically to diaper area for yeast infections and diaper rashes. If the child is on antibiotic therapy, ¼ tsp or ¼ capsule can be taken orally, 2 hours after each dose of antibiotics to replace beneficial bacteria. Use products specifically formulated for infants. Always check with your pediatrician before giving dietary supplements to an infant or child.

Add ¼ tsp or ¼ capsule to water for the treatment of oral infections.

Adult

Recommended doses of L. acidophilus vary depending on the health condition being treated. Check the specific dosage recommendations on the product label. The following list provides guidelines for the most common uses:

For prevention or treatment of diarrhea: Take 1 -2 billion viable cells per day, called colony-forming-units or CFUs. Some health care providers may recommend up to 10 - 15 billion cells per day).

For vaginal infections: Take 8 ounces of yogurt (with live active cultures containing one of the Lactobacillus or Bifidobacterium strains listed above) daily or an oral daily supplement containing at least 1 - 2 billion live organisms. Clinical experience also suggests that placing yogurt with live acidophilus cultures directly to the vaginal area, using a disposable spatula and wearing a sanitary pad, helps to relieve itching and inflammation. Similarly, lactobacillus capsules or tablets may be inserted directly into the vagina.

For cystitis: Use 1 - 2 capsules or tablets inserted into the vagina nightly for 2 weeks.

For maintaining normal intestinal flora: Take 1 - 15 billion viable cells daily. If using for prevention of antibiotic associated diarrhea, start taking the probiotic supplement after conclusion of the antibiotic treatment.

If diarrhea occurs with the dosage you are taking, decrease the dosage or stop taking the product and talk with your health care provider.

Precautions

Because of the potential for side effects and interactions with medications, dietary supplements should be taken only under the supervision of a knowledgeable health care provider.

Mild gastrointestinal upset and diarrhea may occur in some individuals (not on antibiotic therapy) who take more than 1 - 2 billion L. acidophilus cells daily.

There has been one report of anaphylaxis (a serious allergic reaction accompanied by shortness of breath and loss of consciousness) in a person taking inulin, a type of prebiotic.

Possible Interactions

If you are currently being treated with any of the following medications, you should not use Lactobacillus or other probiotics without first talking to your health care provider.

Sulfasalazine -- A laboratory study suggests that L. acidophilus speeds up metabolism of sulfasalazine, a medication used to treat ulcerative colitis. The significance of this information is unknown.

Supporting Research

Alvarez-Olmos MI. Probiotic agents and infectious diseases: a modern perspective on a traditional therapy. Clin Infect Dis. 2001;32(11):1567-1576.

Cunningham-Rundles S, Ahrne S, Bengmark S, et al. Probiotics and immune response. Am J Gastroenterol. 2000;95(1 Suppl):S22-25.

de Roos NM, Katan MB. Effects of probiotic bacteria on diarrhea, lipid metabolism, and carcinogenesis: a review of papers published between 1988 and 1998. Am J Clin Nutr. 2000;71(2):405-411.

de Vrese M, Marteau PR. Probiotics and prebiotics: effects on diarrhea. J Nutr. 2007;137(3 Suppl 2):803S-11S.

Donnet-Hughes A, et al. Modulation of nonspecific mechanisms of defense by lactic acid bacteria: effective dose. J Dairy Sci. May 1999; 82(5):863-869.

Elmer GW, Surawicz CM, McFarland LV. Biotherapeutic agents. A neglected modality for the treatment and prevention of selected intestinal and vaginal infections. [Review]. JAMA. 1996;275(11):870-876.

Ewaschuk JB, Dieleman LA. Probiotics and prebiotics in chronic inflammatory bowel diseases. World J Gastroenterol. 2006;12(37):5941-50.

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.

Fedorak RN, Madsen KL. Probiotics and the management of inflammatory bowel disease. Inflamm Bowel Dis. 2004;10(3):286-299.

Friedrich MJ. A bit of culture for children: probiotics may improve health and fight disease. JAMA. 2000;284(11):1365-1366.

Gill HS, Rutherford KJ, Cross ML. Dietary probiotic supplementation enhances natural killer cell activity in the elderly: an investigation of age-related immunological changes. J Clin Immunol. 2001;21(4):264-271.

Gill HS, Rutherford KJ, Cross ML, Gopal PK. Enhancement of immunity in the elderly by dietary supplementation with the probiotic Bifidobacterium lactis HN019. Am J Clin Nutr. 2001;74(6):833-839.

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

Gismondo MR, Drago L, Lombardi A. Review of probiotics available to modify gastrointestinal flora. Int J Antimicrob Agents. 1999;4:287-292.

Gorbach SL. Probiotics in the third millennium. Dig Liver Dis. 2002;34 Suppl 2:S2-S7.

Hatakka K, Savilahti, Ponka A, et al. Effect of long term consumption of probiotic milk on infections in children attending day care centers: double-blind, randomized trial. BMJ. 2001;322(7298):1327.

Hilton E, Isenberg HD, Alperstein P, France K, Borenstein MT. Ingestion of yogurt containing Lactobacillus acidophilus as prophylaxis for candidal vaginitis. Ann Intern Med. 1992;116(5): 353-357.

Hilton E, Kolakowski P, Singer C, Smith M. Efficacy of Lactobacillus GG as a diarrheal preventive in travelers. J Travel Med. 1997;4(1):41-43.

Hove H, Norgaard H, Mortensen PB. Lactic acid bacteria and the human gastrointestinal tract [Review]. Eur J Clin Nutr. 1999;53(5):339-350.

Ishida Y, Nakamura F, Kanzato H, et al. Effect of milk fermented with Lactobacillus acidophilus strain L-92 on symptoms of Japanese cedar pollen allergy: a randomized placebo-controlled trial.Biosci Biotechnol Biochem. 2005;69(9):1652-60.

Jang T, Saviano DA. In vitro fermentation by human colonic bacteria is modified by Lactobacillus acidophilus supplementation. J Nutr. 1997;127(:1489-1495.

Kalliomaki M, Salminen S, Arvilommi H, Kero P, Koskinen P, Isolauri E. Probiotics in primary prevention of atopic disease: a randomized placebo controlled trial. Lancet. 2001;357(9262):1076-1079.

Kontiokari T, Sundqvist K, Nuutinen M, Pokka T, Koskela M, Uhari M. Randomised trial of cranberry-lingonberry juice and Lactobacillus GG drink for the prevention of urinary tract infections in women. BMJ. 2001;322:1571-1573.

McFarland LV. Meta-analysis of probiotics for the prevention of traveler's diarrhea. Travel Med Infect Dis. 2007;5(2):97-105.

Malin M, Suomalainen H, Saxelin M, Isolauri E. Promotion of IgA immune response in patients with Crohn's disease by oral bacteriotherapy with Lactobacillus GG. Ann Nutr Metab. 1996;40:137-145.

Marteau PR, de Vrese M, Cellier CJ, Schrezenmeir J. Protection from gastrointestinal diseases with the use of probiotics. Am J Clin Nutr. 2001;73(2 Suppl):430S-436S.

Meydani SN, Ha WK. Immunologic effects of yogurt. Am J Clin Nutr. 2000;71(4):861-872.

Michetti P, Dorta G, Wiesel PH, et al. Effect of whey-based culture supernatant of Lactobacillus acidophilus (johnsonii) La1 on Helicobacter pylori infection in humans. Digestion. 1999;60(3):203-209.

Pradhan A, Majumdar MK. Metabolism of some drugs by intestinal lactobacilli and their toxicological considerations. Acta Pharmacol Toxicol (Copenh). 1986;58(1):11-15.

Rani B, Khetarpaul N. Probiotic fermented food mixtures: possible applications in clinical anti-diarrhea usage. Nutr Health. 1998; 12(2): 97-105.

Reid G. Probiotic agents to protect the urogenital tract against infection. [Review]. Am J Clin Nutr. 2001;73(2 Suppl):437S-443S.

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

Rolfe RD. The role of probiotic cultures in the control of gastrointestinal health. J Nutr. 2000;130(2S Suppl):396S-402S.

Sazawal S, Hiremath G, Dhingra U, Malik P, Deb S, Black RE. Efficacy of probiotics in prevention of acute diarrhoea: a meta-analysis of masked, randomised, placebo-controlled trials. Lancet Infect Dis. 2006;6(6):374-82.

Scarpignato C, Rampal P. Prevention and treatment of traveler's diarrhea: a clinical pharmacological approach. [Review]. Chemotherapy. 1995;41 Suppl 1:48-81.

Schiffrin EJ, Brassart D, Servin AL, Rochat F, Donnet-Hughes A. Immune modulation of blood leukocytes in humans by lactic acid bacteria: criteria for strain selection. Am J Clin Nutr. 1997;66(2):515S-520S.

Shalev E, Battino S, Weiner E, Colodner R, Keness Y. Ingestion of yogurt containing Lactobacillus acidophilus compared with pasteurized yogurt as prophylaxis for recurrent candidal vaginitis and bacterial vaginosis. Arch Fam Med. 1996;5(10):593-596.

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

Sheih YH. Systemic immunity-enhancing effects in health subjects following dietary consumption of the lactic acid bacterium Lactobacillus rhamnosus HN001. J Am Coll Nutr. 2001;20(2):149-156.

Szajewska H, Kotowska M, Mrukowicz JZ, Armanska M, Mikolajczyk W. Efficacy of Lactobacillus GG in prevention of nosocomial diarrhea in infants. J Pediatr. 2001;138(3):361-365.

Szajewska H, Mrukowicz JZ. Probiotics in the treatment and prevention of acute infectious diarrhea in infants and children: a systematic review of published randomized, double-blind, placebo-controlled trials. J Pediatr Gastroenterol Nutr. 2001;33 Suppl 2;S17-S25.

Tejada-Simon MV, Lee JH, Ustunol Z, Pestka JJ. Ingestion of yogurt containing Lactobacillus acidophilus and Bifidobacterium to potentiate immunoglobulin A responses to cholera toxin in mice. J Dairy Sci. 1999;82(4):649-660.

Van Niel CW, Feudtner C, Garrison M, Christakis DA. Lactobacillus thearpy for acute infections diarrhea in children: a meta-analysis. Pediatrics. 2002;109(4):678-684.

Vanderhoof JA, Whitney DB, Antonson DL, Hanner TL, Lupo JV, Young RJ. Lactobacillus GG in the prevention of antibiotic-associated diarrhea in children. J Pediatr. 1999;135(5):564-568.

Review Date:
6/7/2007
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.

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adam.com

Food Review: Yakult Probiotic Drink

FitSugar — Wed, 01 Jul 2009 09:32:49 -0700

I first said "yeah" to Yakult because I love saying the word "Yakult." I also love probiotics to promote healthy digestion. Plus, this probiotic drink comes in cute little bottles about the size of a shot glass, so it seemed like a fun way to drink healthy.

Yakult isn't a yogurt; it's a "fermented dairy drink" first produced in Japan and contains live, probiotic cultures to help boost your immune system and the good bacteria in your tummy. Sold in packs of five, the 2.7-fluid-ounce bottles can be downed as drinks, but I also enjoyed it poured over cereal in place of milk. So how does it taste?

Cough

FitSugar — Wed, 08 Oct 2008 17:35:26 -0700

Overview

Signs and Symptoms
Causes
Diagnosis
Treatment Approach
Other Considerations
Supporting Research

HEALTH GUIDE REFERENCE FROM A.D.A.M

Having a cough is one of the most common reasons for seeing your doctor. Normal coughing is important to keep your throat and airways clear by getting rid of mucus or other irritating particles. However, an ongoing (chronic) or severe cough may mean you have an underlying disease or disorder.

Coughs can be dry or "productive," which means that you are bringing up sputum or phlegm when you cough. Coughs can be either acute (typically not lasting longer than two to three weeks) or chronic (lasting longer than two to three weeks).

A number of illnesses can cause cough. Acute coughs usually begin suddenly and are often due to a cold, flu, or sinus infection. Coughs from a lung infection such as bronchitis can start out suddenly and then linger on. Other common causes of chronic or ongoing coughs include asthma, allergies, chronic obstructive pulmonary disease (COPD from emphysema or chronic bronchitis), sinusitis with drainage into the throat, smoking cigarettes or exposure to secondhand smoke, pollutants, and gastroesophageal reflux disease (GERD).

If your cough lasts more than two weeks, be sure to see your doctor to determine what may be causing it.

Signs and Symptoms

The symptoms that accompany your cough depend on what’s causing it:

A runny nose or nasal congestion, headache, or postnasal drip from chronic sinusitis (sinus inflammation), cold, or flu
Wheezing from asthma
Heartburn from GERD
Fever, chills, night sweats from bronchitis, pneumonia, tuberculosis, or other lung infection
Chest pain, shortness of breath, or swelling of your legs from fluid retention (called edema) due to congestive heart failure
In rare cases, coughing up blood, which can be a sign of a serious illness such as lung cancer

Causes

Respiratory tract infection: cold, flu, pneumonia, bronchitis, sinusitis
Postnasal drip (from allergies or a cold)
Certain medications called ACE inhibitors used to treat high blood pressure and heart disease:
- Captopril (Capoten)
- Benazepril (Lotensin)
- Enalapril (Vasotec)
- Lisinopril (Prinivil, Zestril)
- Fosinopril (Monopril)
- Ramipril (Altace)
- Perindopril (Aceon)
- Quinapril (Accupril)
- Moexipril (Univasc)
- Trandolapril (Mavik)
Allergies
Asthma
Chronic obstructive pulmonary disease (COPD), which is from either emphysema or chronic bronchitis or both
Aspiration (foreign matter drawn into the lungs)
Congestive heart failure
Gastroesophageal reflux disease, where stomach acid backs up into the esophagus
Lung cancer (rarely)

Diagnosis

Your doctor will take a detailed medical history, gathering information about the quality of the cough, how long you have had it, symptoms associated with the cough, etc. He or she will also conduct a thorough physical examination, paying particular attention to your nasal passages, throat, lungs, heart, and legs. Your doctor may order tests such as a culture of the sputum (if you have a productive cough that may be bacterial), an electrocardiogram (EKG), lung function tests, or x-rays of your chest or sinuses.

Treatment Approach

The goal of treatment is not only to soothe your cough, but to treat the underlying cause.

If your doctor suspects a certain illness, he or she may suggest you try certain medications that can help pinpoint the cause. For example, if your doctor suspects your cough is due to GERD, he or she may prescribe medications to reduce your stomach acid. If your cough gets better, the diagnosis will be confirmed.

Other medications that may be prescribed either to relieve your cough or treat the underlying disorder include cough suppressants, inhalers, antibiotics, antihistamines, or expectorants. Some herbs and supplements may also be helpful in relieving your cough.

Lifestyle

If you smoke, stop.
Stay away from secondhand cigarette smoke and airborne irritants that may be present in your home or workplace.
If medications are causing your cough, your doctor may change your prescription. If you take an ACE inhibitor or other medication that seems to bring on your cough, do not stop taking it without instructions from your doctor.
If you have allergies, there are steps you can take to avoid the allergic trigger (called an allergen). See Allergic Rhinitis for details.
Sucking on cough lozenges or hard candy can help dry, tickling coughs. These should never be given to a child under 3 years old because of the risk of choking.

Medications

Different drugs, listed below, may be used to either relieve your cough or treat the underlying condition.

Cough medicines - cough suppressants (for a dry cough) or expectorants (for a wet, productive cough that brings up mucous) are available over the counter and by prescription. An FDA advisory panel recently recommended that over-the-counter cough suppressants not be given to children under 6 due to lack of proven effectiveness and the potential for adverse side effects.

Decongestants - help open your nasal passages so you can breathe easier; may help if your cough is due to postnasal drip. 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. Decongestants are often combined in cold medicines with antihistamines, cough suppressants, and pain relievers. People with heart disease, high blood pressure, diabetes, or glaucoma should not take decongestants. Popular brands of decongestants include Sudafed, Afrin, and Neo-Synephrine.

Antihistamines - can temporarily relieve a runny nose by drying up nasal secretions; may help if your cough is due to allergies. Non-drowsy antihistamines available over the counter include loratadine (Claritin); others, such as fexofenadine (Allegra) and cetirizine (Zyrtec), are available by prescription.

Bronchodilators - increase airflow by opening airways and help make it easier to breathe; may help if your cough is due to asthma or COPD

Corticosteroids - reduce inflammation; either inhaled with an inhaler or taken by mouth, they are usually used to treat moderate to severe asthma or COPD

Nasal corticosteroids - These prescription sprays reduce inflammation of the nose and help relieve sneezing, itching, and runny nose.

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

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.

For cough from respiratory infections, sinusitis, or allergies:

Honey - A 2007 study found that honey was more effective the over-the-counter cough medicines, including those containing dextromethorphan or DM, at treating cough and easing sore throat. Honey can be mixed with an herbal tea or just warm water. Never give honey to an infant under the age of 1.
Probiotics (Lactobacillus acidophilus) - While probiotics won’t directly relieve your cough, they may help underlying conditions. Some evidence suggests that Lactobacillus may help prevent colds and flu, and possibly reduce allergy to pollen. One study found that children in daycare centers who drank milk fortified with Lactobacillus had fewer and less severe colds. Several studies that examined probiotics combined with vitamins and minerals also found a reduction in the number of colds caught by adults, although it’s not possible to say whether the vitamins, minerals, or probiotics were most responsible for the benefit. One small study suggests that Lactobacillus might help reduce allergic reaction to pollen. More studies are needed to say for sure whether it is effective.
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.
Spirulina - Preliminary test tube and animal studies suggest that spirulina, a type of blue-green algae, may help protect against harmful allergic reactions. Spirulina prevents the release of histamines, which contribute to allergic symptoms. Research on people is needed.
Bromelain - Some studies show that bromelain may help reduce symptoms of sinusitis and relieve swelling and inflammation caused by allergies (hay fever). Not all studies show a benefit, however. It is often combined with quercetin. 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).

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.

Peppermint (Mentha x piperita) - Peppermint is widely used to treat cold symptoms. Its main active agent, menthol, is a good decongestant. Menthol also thins mucus and works as an expectorant, meaning that it helps loosen and break up mucus. It is soothing and calming for sore throats and dry coughs as well.
Eucalyptus (Eucalyptus globulus) - Like peppermint, eucalyptus is used in many remedies to treat cold symptoms, particularly cough. It can be found in many lozenges, cough syrups, and vapor baths throughout the United States and Europe. Ointments containing eucalyptus leaves are also applied to the nose and chest to relieve congestion and loosen phlegm.
Marshmallow (Althea officinalis) - Although there isn’t any scientific evidence that it works, marshmallow has been used traditionally to treat sore throat and cough. It contains mucilage, which helps coat the throat and act as a cough suppressant.
Slippery elm (Ulmus fulva) - Slippery elm may help ease sore throat and cough, and has been used traditionally for this purpose, although scientific evidence is lacking. Like marshmallow, it contains mucilage.
Licorice (Glycyrrhiza glabra) - Licorice root is a traditional treatment for sore throat and cough, although scientific evidence is lacking. Licorice interacts with a number of medications, so ask your doctor before taking it. People with high blood pressure or heart disease, women who are pregnant or breast-feeding, and those who take anticoagulants (blood-thinners) should not take licorice.
Lobelia (Lobelia inflata) - Also called Indian tobacco, lobelia has a long history of use as an herbal remedy for respiratory problems including cough. It is an effective expectorant, meaning that it helps clear mucus from your lungs. However, lobelia can be toxic and should only be used under a doctor’s supervision.
Mullein (Verbascum densiflorum) - Mullein is an expectorant, meaning it helps clear your lungs of mucus. Traditionally, it has been used to treat respiratory illnesses and coughs with lung congestion. However, studies are lacking.
Sundew (Drosera spp.) - Sundew has traditionally been used as a cough suppressant, although scientific studies are lacking. It is often used in Europe to treat dry coughs.
Stinging nettle (Urtica dioica, 600 mg per day for one week) - Stinging nettle has been used traditionally for treating a variety of conditions, including allergies (hay fever). But studies so far are lacking. Only one small study suggested that stinging nettle might help relieve symptoms of hay fever, including cough. Pregnant women and young children should not take stinging nettle. Talk to your doctor before taking stinging nettle if you take blood pressure medication, anticoagulants (blood-thinners), diuretics (water pills), or have diabetes.
Thyme (Thymus vulgaris) - Thyme has traditionally been used to treat respiratory illnesses such as bronchitis and to treat cough. Two preliminary studies indicate that thyme may help treat acute bronchitis and relieve cough, and thyme is approved by the German Commission E to treat those conditions. Thyme oil is considered toxic and should not be taken by mouth.

Homeopathy

Although very few studies have examined the effectiveness of specific homeopathic therapies, professional homeopaths may consider the following remedies for the treatment of coughs based on their knowledge and experience. 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 treatment for each individual.

Aconitum - taken within the first 24 hours of a cough that comes on suddenly, particularly if symptoms develop following exposure to cold weather; this remedy is considered most appropriate for individuals with a hoarse, dry cough who complain of dry mouth, thirst, restlessness, and symptoms that worsen in the cold or when the individual is lying on his or her side.

Antimonium tartareicum - for wet, rattling cough (although the cough is usually too weak to bring up mucus material from the lungs) that is accompanied by extreme fatigue and difficulty breathing; symptoms usually worsen when the person is lying down; this remedy is generally used during the later stages of a cough and is particularly useful for children and the elderly.

Bryonia - for dry, painful cough that tends to worsen with movement and deep inhalation; this remedy is most appropriate for individuals who are generally thirsty, chilly, and irritable.

Causticum - for laryngitis and a cough that cannot dislodge mucus in the chest and may cause the individual to leak urine during coughing fits; symptoms tend to improve with sips of cold water but worsen with cold air.

Drosera - for dry, spasmodic cough accompanied by sharp chest pain and a tickling sensation in the throat that may cause the individual to gag, choke or vomit; the individual may be hoarse or may perspire in the evenings and symptoms may worsen when the individual is lying down.

Ipecacuanha - for deep, wet cough, often with gagging, nausea, and vomiting; this remedy is especially useful for bronchitis in infants.

Phosphorous - for chest tightness associated with a variety of coughs, particularly a dry, harsh cough with a persistent tickle in the chest and significant chest pain; symptoms tend to worsen in cold air and when the individual is talking; this remedy is most appropriate for individuals who are often worn out and exhausted, suffer from unnecessary anxiety (even fear of death), and require a lot of reassurance.

Rumex - for dry, shallow cough that begins with a tickling sensation in the throat or with the inhalation of cold air.

Spongia - for harsh, barking cough without mucus production; this type of cough is associated with a tickling in the throat or chest; it tends to worsen when the person is lying down and improves when the individual eats or drinks warm liquids; this remedy is often used if a trial of Aconite was not successful.

Other Considerations

It is important to determine the underlying reason for your cough and to treat that condition.

Warnings and Precautions

Call your doctor right away if you have any of the following characateristics to or symptoms accompanying your cough:

Violent cough that begins suddenly
High pitched sound (called stridor) when inhaling
Cough that produces blood
Cough in an infant less than 3 months old
Shortness of breath or difficulty breathing
Fever
Abdominal swelling
Unintentional weight loss
Thick, foul-smelling, green phlegm

Prognosis and Complications

Most causes of cough are very treatable. The prognosis depends on the underlying reason for your cough.

Supporting Research

Barrett B, Vohmann M, Calabrese C. Echinacea for upper respiratory infection. J Fam Pract. 1999;48:628-635.

Belongia EA, Berg R, Liu K. A randomized trial of zinc nasal spray for the treatment of upper respiratory illness in adults. Am J Med. 2001;111(2):103-108.

Blumenthal M, Goldberg A, Brinckmann J. Herbal Medicine: Expanded Commission E Monographs. Newton, MA: Integrative Medicine Communications; 2000:110-117, 118-123, 153-159, 233-239, 240-243, 244-248, 297-303.

Brinkeborn RM, Shah DV, Degenring FH. Echinaforce and other Echinacea fresh plant preparations in the treatment of the common cold. A randomized, placebo controlled, double-blind clinical trial. Phytomedicine. 1999;6(1):1-6.

Cummings S, Ullman D. Everybody's Guide to Homeopathic Medicines. 3rd ed. New York, NY: Penguin Putnam; 1997: 67-74.

de Vrese M, Winkler P, Rautenberg P, Harder T, Noah C, Laue C, et al. Probiotic bacteria reduced duration and severity but not the incidence of common cold episodes in a double blind, randomized, controlled trial. Vaccine. 2006 Nov 10;24(44-46):6670-4.

Eby GA. Zinc ion availability-the determinant of efficacy in zinc lozenge treatment of common colds. J Antimicrob Chemother. 1997;40:483–493.

Eccles R. Menthol: effects on nasal sensation of airflow and the drive to breathe. Curr Allergy Asthma Rep. 2003;3(3):210-214.

Fischer C. Nettles-an aid to the treatment of allergic rhinitis. Eur Herbal Med. 1997;3(2):34-35.

Frank LG. The efficacy of Echinacea compound herbal tea preparation on the severity and duration of upper respiratory and flu symptoms: a randomized, double blind, placebo-controlled study. J Comp Alt Med. 2000;6(4):327-334.

Garland ML, Hagmeyer KO. The role of zinc lozenges in treatment of the common cold. Ann Pharmacother. 1998;32:63–69.

Guo R, Pittler MH, Ernst E. Complementary medicine for treating or preventing influenza or influenza-like illness. Am J Med. 2007 Nov;120(11):923-929.e3. Review.

Hirt M, Nobel Sion, Barron E. Zinc nasal gel for the treatment of common cold symptoms: A double-blind, placebo-controlled trial. ENT J. 2000;79(10):778-780, 782.

Jonas WB, Jacobs J. Healing with Homeopathy: The Doctors' Guide. New York, NY: Warner Books; 1996: 210-211.

Josling P. Preventing the common cold with a garlic supplement: a double blind, placebo-controlled survey. Adv Ther. 2001;18(4):189-193.

Lindenmuth GF, Lindenmuth EB. The efficacy of echinacea compound herbal tea preparation on the severity and duration of upper respiratory and flu symptoms: a randomized, double-blind placebo-controlled study. J Altern Complement Med. 2000;6(4):327-334.

Mahady GB. Echinacea: recommendations for its use in prophylaxis and treatment of upper respiratory tract infections. Nutr Clin Care. 2001;4(4):199-208.

Maurer HR. Bromelain: biochemistry, pharmacology and medical use. Cell Mol Life Sci. 2001;58(9):1234-1245.

Melchart D, Walther E, Linde K, Brandmaier R, Lersch C. Echinacea root extracts for the prevention of upper respiratory tract infections: a double-blind, placebo-controlled randomized trial. Arch Fam Med. 1998;7:541–545.

Melchart D, Linde K, Fischer P, Kaesmayr J. Echinacea for preventing and treating the common cold. [Review]. Cochrane Database Syst Rev. 2000;(2):CD000530.

Mittman P. Randomized, double-blind study of freeze-dried Urtica dioica in the treatment of allergic rhinitis. Planta Medica. 1990;56:44-47.

Norregaard J, Lykkegaard JJ, Mehlsen J, Danneskiold-Samsoe B. Zinc lozenges reduce the duration of common cold symptoms. Nutr Review. 1997;55(3):82-85.

Paul IM, Beiler J, McMonagle A, Shaffer ML, Duda L, Berlin CM. Effect of honey, dextromethorphan, and no treatment on nocturnal cough and sleep quality for coughing children and their parents. Arch Pediatr Adolesc Med. 2007;161(12):1140-1146.

Prasad AS, Fitzgerald JT, Bao B, Beck FW, Chandrasekar PH. Duration of symptoms and plasma cytokine levels in patients with the common cold treated with zinc acetate. A randomized, double-blind, placebo-controlled trial. Ann Intern Med. 2000;133(4):245-252.

Rotblatt M, Ziment I. Evidence-Based Herbal Medicine. Philadelphia, PA: Hanley & Belfus, Inc; 2002:160-165, 259-261, 337-338.

Roxas M, Jurenka J. Colds and influenza: a review of diagnosis and conventional, botanical, and nutritional considerations. Altern Med Rev. 2007 Mar;12(1):25-48. Review.

Sazawal S, Black RE, Jalla S, et al. Zinc supplementation reduces the incidence of acute lower respiratory infections in infants and preschool children: a double-blind, controlled trial. Pediatr. 1998;102(part 1):1–5.

Ullman D. Homeopathic Medicine for Children and Infants. New York, NY: Penguin Putnam; 1992: 70-73.

Ullman D. The Consumer's Guide to Homeopathy. New York, NY: Penguin Putnam; 1995: 228.

Ziment I. Herbal antitussives. Pulm Pharmacol Ther. 2002;15(3):327-333.

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

Irritable bowel syndrome

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

Overview

Signs and Symptoms
What Causes It?
What to Expect at Your Provider's Office
Treatment
Following Up
Supporting Research

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.

A.D.A.M. Copyright

adam.com

Food poisoning

FitSugar — Wed, 08 Oct 2008 17:35:25 -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
Following Up
Supporting Research

HEALTH GUIDE REFERENCE FROM A.D.A.M

Food poisoning is the result of eating food contaminated with bacteria or other toxins. Symptoms include diarrhea, vomiting, and stomach cramps, and generally start 4 - 36 hours after eating contaminated food. While many cases are caused by bacteria, some cases can result from eating poisonous plants (some mushrooms, for instance) and animals (pufferfish). Food poisoning is not uncommon, especially during summer when food may not be kept cold enough to prevent bacteria from growing.

Signs and Symptoms

The typical signs of food poisoning are nausea, vomiting, abdominal cramping, and diarrhea. Specific bacteria may cause these signs and symptoms:

Clostridium botulinum (C. botulinum, or botulism): weakness, blurred vision, sensitivity to light, double vision, paralyzed eye nerves, difficulty speaking, trouble swallowing, paralysis that spreads downward, respiratory failure, death
Salmonella spp., Shigella spp., and Campylobacter jejuni (C. jejuni): fever, chills, bloody diarrhea
Escherichia coli (E. coli): hemorrhagic colitis (diarrhea with very little stool and large amounts of blood). E. coli symptoms may appear as long as 3 days after eating contaminated food.
Mushroom poisoning can affect the liver, the neurological system (brain), or the gastrointestinal tract. Symptoms include stomach flu, delirium (confusion), vision difficulties, heart muscle problems, kidney failure, and death of liver tissue. It causes death in about half of the people affected unless treated right away.

Fish poisoning causes nausea, vomiting, diarrhea, abdominal pain, dizziness, and headache. Specific types of fish poisoning can cause other signs and symptoms, such as:

Ciguatera: numbness or tingling around the mouth, feeling of loose teeth, impaired touch sensation of hot as cold and cold as hot, itching, muscle and joint pain, slow heart rate, low blood pressure. Caused by toxins in some fish, including grouper, snapper, mackerel, barracuda.
Pufferfish poisoning: numbness or tingling around the mouth, trouble coordinating movement, difficulty swallowing, excess saliva, twitching, loss of ability to talk, convulsions, paralysis that spreads upward, respiratory failure, death
Shellfish poisoning: numbness or tingling around the mouth or in the arms and legs, trouble swallowing, difficulty speaking. Caused by toxins in algae that are then eaten by shellfish.

What Causes It?

Usually bacteria and algae cause food poisoning. But sometimes poisonous plants and animals are the cause.

Common bacterial toxins include:

E. coli in undercooked hamburger, unpasteurized apple juice or cider, raw milk, contaminated water (or ice), vegetables fertilized by cow manure; can be spread from person to person.
Listeria monocytogenes (L. monocytogenes) in cole slaw, dairy products (mostly soft cheeses from outside the United States), and cold, processed meats
Salmonella spp. in poultry, beef, eggs, or dairy products
Shigella spp. from raw vegetables or cool, moist foods (such as potato and egg salads) that are handled after cooking
Staphylococcus aureus(S. aureus) in salad dressing, ham, eggs, custard-filled pastries, mayonnaise, and potato salad. Usually from the hands of food handlers.
C. jejuni in raw milk and chicken
C. botulinum in improperly home-canned foods. In children under 1 year of age, mostly from honey but also from corn syrup.
Clostridium perfringens(C. perfringens) in meat and poultry dishes and gravies, mostly foods that were cooked more than 24 hours before eating and were not reheated well enough
V. cholerae in bivalve (two-shelled) shellfish (such as mussels, clams, oysters, and scallops), raw shellfish, and crustaceans (such as lobsters, shrimp, and crabs)

Common types of fish poisoning include:

Scombroid poisoning from bacteria in dark-meat fish (tuna, bonito, skipjack, mahi-mahi, mackerel) that are not refrigerated well
Ciguatera poisoning in tropical fish (grouper, surgeonfish, snapper, barracuda, moray eel) that have eaten toxic plankton
Puffer fish poisoning from the organs and flesh of puffer fish
Poisoning from shellfish that feed on certain algae

Mushroom poisoning occurs from eating wild poisonous mushrooms, especially Amanita phalloides.

Who's Most At Risk?

Infants and the elderly are at greater risk for food poisoning. Other risk factors include:

Having a pre-existing medical condition, such as chronic kidney failure or diabetes
Taking antibiotic or antihistamine medicines
Having sickle-cell anemia and other problems with red blood cells
Weakened immune system
Traveling in an area where contamination is more likely

Listeriosis is most common in pregnant women, fetuses, and people with immune problems. When a fetus is infected with listeria, the fetus may be born prematurely or die.

What to Expect at Your Provider's Office

Your health care provider will examine you for signs and symptoms of food poisoning, such as stomach problems, and of dehydration. Your health care provider may also ask about foods you have eaten recently, where you may have traveled, and if you have had contact with people showing similar symptoms. Tests of your vomit, blood, and stool can identify the cause. In the case of botulism, electromyography (a test to measure electric impulses in the muscles) may be done to confirm the diagnosis. A lumbar puncture (spinal tap) may be done to check for signs and symptoms related to central nervous system disorders.

Treatment Options

Prevention

These steps can help prevent food poisoning:

Wash your hands and clean any dishes or utensils when you are making or serving food.
Promptly refrigerate any food you will not be eating right away.
If you take care of young children, wash your hands often and dispose of diapers carefully so that bacteria can't spread to other surfaces or people.
If you make canned food at home, make sure to follow proper canning techniques to prevent botulism.
Don't feed honey to children under 1 year of age.
Don't eat wild mushrooms.
When traveling where contamination is more likely, eat only hot, freshly cooked food. Boil water before drinking. Don't eat raw vegetables or unpeeled fruit.
Always refrigerate fish.
Don't eat tropical fish caught during blooms of poison plankton.
Eat pufferfish only in specially licensed restaurants with chefs trained to cook it.
Don't eat shellfish exposed to red tides.

If others also may have eaten a food that made you sick, let them know. If you think the food was contaminated when you bought it from a store or restaurant, tell the staff and your local health department.

Treatment Plan

Treatment for most cases consists of rehydration -- replacing fluids and electrolytes (such as sodium, potassium, magnesium, and chloride). While experiencing vomiting and diarrhea, the person should avoid solid food but increase clear liquids. In more severe cases, a person may need help either breathing or stopping vomiting. In most cases, health care providers do not prescribe antibiotics because they may prolong diarrhea. If you have eaten certain toxins (such as from mushrooms or shellfish), your health care provider may take steps to clean out your stomach (a process called lavage, or pumping the stomach) and administer activated charcoal, which can help absorb the remaining toxin.

Drug Therapies

Depending on the symptoms and the cause of food poisoning, a health care provider may prescribe drugs, including:

Antibiotics, in certain cases
Antitoxin to neutralize toxins from C. botulinum (only given within the first 72 hours)
Amitriptyline to control the numbness and tingling from ciguatera poisoning
Apomorphine or ipecac syrup to cause vomiting and help rid the body of toxin
Atropine for mushroom poisoning
Diphenhydramine and cimetidine for fish poisoning
Mannitol for nerve-related symptoms of ciguatera poisoning

Complementary and Alternative Therapies

Anyone suffering from severe food poisoning should seek conventional medical treatment. Complementary and alternative therapies are best used to strengthen the body and aid in the prevention of food poisoning. For example, animal studies have shown that certain vitamins and nutrients may be effective in protecting against some food toxins while others may actually worsen the effects of toxins. Milk thistle is an herb commonly used in Europe as a primary treatment for mushroom poisoning. Homeopathy may help in the treatment of diarrhea in children (which is sometimes caused by food poisoning) in developing countries.

Nutrition

The following general nutritional guidelines may be helpful in the case of food poisoning:

Drink plenty of fluids (to prevent dehydration).
Drink barley or rice water (to soothe inflamed stomach or intestine).
Probiotics, such as Lactobacillus acidophilus and Lactobacillus bulgaricus, can help restore the balance of good bacteria in the intestine. If you are traveling to an area where the food and water may be contaminated, in addition to taking the precautions above, taking probiotics both before and during your trip may help maintain intestinal health.
Apple cider vinegar is a traditional remedy that has not been studied scientifically, but may have some antimicrobial properties. Mix 2 tsp. in one cup warm water and drink several times a day.

For specific types of food poisoning:

Alpha-lipoic acid -- Several reports indicate that alpha-lipoic acid, an antioxidant commonly found in broccoli, spinach, and beef, may be helpful in the treatment of Amanita (mushroom) poisoning, especially when combined with milk thistle (Silybum marianum). It is important to receive medical treatment if you suspect mushroom poisoning. Do not try to self-treat.
Vitamin A -- Studies with rats seem to show that vitamin A offered some protection against salmonella. Rats infected with Salmonella appeared to eliminate the bacteria from their bodies faster when pretreated with vitamin A than with placebo, according to one study. They also gained more weight and had a greater immune response than rats given placebo.
Calcium phosphate -- One animal study suggests that rats receiving calcium phosphate supplements may be protected from Salmonella poisoning. Researchers theorize that calcium phosphate helps boost Lactobacillus, the good bacteria found in the intestine, which helps fight off Salmonella.

Supplements to avoid:

Fish oil -- In a study of mice infected with the bacteria Listeria, animals that regularly consumed diets rich in fish oil had significantly more bacteria in their spleens than animals that consumed diets rich in lard or soybean oil. Until researchers can determine what these results mean to humans, people with Listeria infection should avoid foods containing fish oil.

Herbs

Various herbs have been used traditionally to treat different types of food poisoning, though in most cases scientific studies on their effectiveness are lacking.

Milk thistle (Silybum marianum) is often used for liver disorders and is widely used in Europe to treat Amanita mushroom poisoning. Studies have shown that patients with Amanita poisoning can be effectively treated with silibinin (the primary active component of milk thistle) up to 48 hours after eating the deadly mushrooms.

Animal studies of Chinese and Japanese combination herbal remedies used for Listeria suggest they may be effective for food poisoning. A few of the active ingredients include:

Asian ginseng (Panax ginseng)
Astragalus root (Astragalus membranaceus)
Chinese cinnamon bark (Cinnamomum aromaticum)
Ginger root (Zingiber officinale)
Licorice ( Glycyrrhiza glabra)
Peony root (Paeonia officinalis)
Skullcap (Scutellaria lateriflora)

Seek the advice of a trained and licensed herbalist or practitioner of Traditional Chinese Medicine who will guide your individual treatment. Do not self-treat with these herbs. Some of these herbs should not be taken if you have heart disease or high blood pressure or take blood-thinning medication. In addition, some of these herbs interact with other herbs, supplements, and prescription medications, so it is important to make sure all your health care providers know what you are taking.

Laboratory (test tube) studies suggest that the following herbs have antibacterial or antimicrobial properties, although there is no evidence they are effective for treating food poisoning in humans.

Bittervine (Mikania micrantha)
Goldenseal (Hydrastis canadensis)
Oregon grape (Mahonia aquifolium)
Chamomile (Matricaria recutita)

Barberry (Berberis vulgaris) has also been used traditionally to treat diarrhea from infectious causes such as E. coli and V. cholera.

Homeopathy

No studies have examined the effectiveness of homeopathic remedies for food poisoning. Before prescribing a remedy, homeopaths take into account a person's constitutional type -- your physical, emotional, and intellectual makeup. An experienced homeopath assesses all of these factors when determining the most appropriate remedy for a particular individual. Below are some more common remedies for food poisoning or diarrhea.

Arsenicum album -- for foul-smelling diarrhea from food poisoning or traveler's diarrhea with burning sensation in the abdomen and around the anus. This remedy is most appropriate for individuals who feel exhausted yet restless and whose symptoms tend to worsen in the cold and improve with warmth. Vomiting may also occur. Arsenicum may also be used to prevent diarrhea when traveling.
Chamomilla -- for greenish, frothy stool that smells like rotten eggs. Used primarily for children, especially those who are irritable, argumentative, and difficult to console.
Calcarea carbonica -- for children who fear being in the dark or alone and who perspire heavily while sleeping. Sools have a sour odor.
Podophyllum -- for explosive, gushing, painless diarrhea that becomes worse after eating or drinking. Exhaustion often follows bowel movements, and the individual for whom this remedy is appropriate may experience painful cramps in lower extremities.
Sulphur -- for irritable and weepy children. May have a red ring around the anus and diarrhea with the odor of rotten eggs.

Prognosis/Possible Complications

Most cases of food poisoning are mild and clear up on their own. However, with mushroom poisoning, up to half of people may die. With botulism, less than 10% die. Some people may need help breathing for months afterwards. More than half of poisonings from pufferfish are fatal. Death is rare in other fish poisonings, but nerve-related symptoms can continue for months.

The following are some possible after-effects of food poisoning:

After shigellosis, white blood cell problems and kidney problems
After E. coli infection, kidney problems and bleeding problems
After botulism, long hospital stays (1 - 10 months) with fatigue and difficulty breathing for 1- 2 years or respiratory failure
After salmonellosis, Reiter syndrome (an arthritis-like disease) and inflammation of the heart lining
After campylobacteriosis, Guillain-Barré syndrome (a nerve disease)

Following Up

For a severe case of food poisoning, you may need to stay in the hospital to receive fluids and electrolytes, and so health care providers can monitor your breathing. Doctors may need to intubate (insert a tube down the throat) or connect you to a machine to help with breathing. Dialysis may be required. Cathartics (substances that help the body remove waste), enemas, and lavage may help eliminate toxins.

Supporting Research

Beers MH, Porter RS, et al. The Merck Manual of Diagnosis and Therapy. 18th ed. Whitehouse Station, NJ: Merck Research Laboratories; 2006:1642-1644.

Blumenthal M, Goldberg A, Brinckmann J, eds. Herbal Medicine: Expanded Commission E Monographs. Boston, Mass: Integrative Medicine Communications; 2000:257.

Bovee-Oudenhoven IM, Wissink ML, Wouters JT, Van der Meer R. Dietary calcium phosphate stimulates intestinal lactobacilli and decreases the severity of a salmonella infection in rats. J Nutr. 1999;129:607-612.

Duncan SH, Flint HJ, Stewart CS. Inhibitory activity of gut bacteria against Escherichiacoli 0157 mediated by dietary plant metabolites. FEMS Microbiol Lett. 1998;164:238-288.

Facey PC, Pascoe KO, Porter RB, Jones AD. Investigation of plants used in Jamaican folk medicine for anti-bacterial activity. J Pharm Pharmacol. 1999;51:1455-1460.

Fauci AS, Braunwald E, Isselbacher KJ, et al., eds. Harrison's Principles of InternalMedicine. 14th ed. Vol. 1. New York, NY: McGraw-Hill; 1998:796-801, 876-880, 904-905.

Fritsche KL, Shahbazian LM, Feng C, Berg JN. Dietary fish oil reduces survival and impairs bacterial clearance in C3H/Hen mice challenged with Listeria monocytogenes. Clin Sci. 1997;92:95-101.

Gabriel EP, Lindquist BL, Abud RL, Merrick JM, Lebenthal E. Effect of vitamin A deficiency on the adherence of fimbriated and nonfimbriated Salmonella typhimurium to isolated small intestinal enterocytes. J Ped Gastroenterol Nutr. 1990;10:530-535.

Hatchigian EA, Santon JE, Broitman SA, Vitale JJ. Vitamin A supplementation improves macrophage function and bacterial clearance during experimental Salmonella infection. PSEBM. 1989;191:47-54.

Hruby K, Csomos G, Fuhrmann M, Thaler H. Chemotherapy of Amanita phalloides poisoning with intravenous silibinin. Hum Exp Toxicol. 1983;2(2):183-195.

Irons R, Anderson MJ, Zhang M, Fritsche KL. Dietary fish oil impairs primary host resistance against Listeria monocytogenes more than the immunological memory response. J. Nutr. 2003 Apr;133:1163-1169.

Jacobs J, Jiménez M, Malthouse S, Chapman E, Crothers D, Masuk M, Jonas WB. Homeopathic treatment of acute childhood diarrhea: results from a clinical trial in Nepal. J Altern Complement Med. 2000;6(2):131-139.

Jonas WB, Jacobs J. Healing with Homeopathy: The Doctors' Guide. New York, NY: Warner Books; 1996: 218-220.

Murray PR, et al. Manual of Clinical Microbiology. 7th ed. Washington, DC: ASM Press; 1999:356-359.

Rabbani GH, Butler T, Knight J, Sanyal SC, Alam K. Randomized controlled trial of berberine sulfate therapy for diarrhea due to enterotoxigenic Escherichia coli and Vibrio cholerae. J Infect Dis. 1987 May;155(5):979-984.

Rosen P, et al. Emergency Medicine: Concepts and ClinicalPractice. 4th ed. Vol. 3. St. Louis, Mo: Mosby; 1998:1931-1938, 2513-2516, 2178-2179.

Sabeel AI, Kurkus J, Lindholm T. Intensive hemodialysis and hemoperfusion treatment of Amanita mushroom poisoning. Mycopathologia. 1995;131(2):107-114.

Ullman D. Homeopathic Medicine for Children and Infants. New York, NY: Penguin Putnam; 1992: 75-77.

Ullman D. The Consumer's Guide to Homeopathy. New York, NY: Penguin Putnam; 1995: 243-245.

Verma RJ, Shalini M. Ochratoxin A-induced cytotoxicity to human red blood cells and its prevention by certain vitamins. Med Sci Res. 1997;25(12):833-834.

Yonekura K, Kawakita T, Mitsuyama M, Miura O, Yumioka E, Suzuki A, Nomoto K. Induction of colony-stimulating factor(s) after administration of a traditional Chinese medicine, xiao-chai-hu-tang (Japanese name: shosaiko-to). Immunopharmacol Immunotoxicol. 1990;12(4):647-667.

Yonekura K, Kawakita T, Saito Y, Suzuki A, Nomoto K. Augmentation of host resistance to Listeria monocytogenes infection by a traditional Chinese medicine, ren-shen-yang-rong-tang (Japanese name: ninjin-youei-to). Immunopharmacol Immunotoxicol. 1992;14(1-2):165-190.

Review Date:
12/17/2006
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

adam.com

Diverticular disease

FitSugar — Wed, 08 Oct 2008 17:35:33 -0700

Overview

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

HEALTH GUIDE REFERENCE FROM A.D.A.M

Diverticular disease occurs when pouches (diverticula) in the intestine, usually the large intestine or colon, become inflamed. Most diverticula occur in the sigmoid colon, the curved part of the large intestine closest to the rectum, and they tend to become more numerous as we age.

Diverticulosis is the presence of many diverticula along the intestinal wall. It occurs more commonly as people get older and in countries such as the U.S. where the diet is generally low in fiber. It is a fairly common condition. More than 50% of adults over the age of 60 have diverticula, and it may not cause any symptoms.

Diverticulitis occurs when one or more diverticula become inflamed. The inflammation may be local (just in the area of the diverticulum), or may spread to the abdominal lining (peritoneum), called peritonitis. Small (microscopic) or large perforations (holes in the intestinal wall) occur in 15 - 20% of people who have diverticula.

Signs and Symptoms

Often diverticula cause no symptoms, although you may experience irregularities in bowel habits. If symptoms do appear, they may include the following:

Abdominal pain, especially pain low on the left side of the abdomen after a meal
Either painless rectal bleeding or passing of blood in stool
Fever
Nausea
Vomiting
Irregular bowel movements including constipation or diarrhea
Gas

Some people with diverticulitis develop fistulas, or abnormal passageways from the intestines into the abdomen or to another organ such as the bladder. This may lead to a urinary tract infection, gas in the urine, pain while urinating, or a more frequent need to urinate.

Some people develop peritonitis, an inflammation of the lining of the abdomen. Symptoms of peritonitis may include sudden abdominal pain, muscle spasms, guarding (involuntary contraction of muscles to protect the affected area), and possibly sepsis, the term for an infection that has spread to the blood. Peritonitis is a serious condition that can be life-threatening if not treated.

What Causes It?

The cause of diverticular disease is unknown, but several factors may contribute to changes in the wall of the colon. These include aging, the movement of waste through the colon, changes in intestinal pressure, a low-fiber diet, and physical abnormalities.

Who's Most At Risk?

These factors increase the risk for developing diverticular disease:

Low-fiber diet
Advanced age
Obesity
Male gender, for diverticulitis

The following may contribute as well:

High fat intake
Lack of regular physical activity

What to Expect at Your Provider's Office

Your health care provider will examine your abdomen for tenderness, swelling, and guarding and may try to detect any unusual mass around the intestines. Yor health care provider may also test your blood, urine, and stool for signs of infection or blood. A computed tomography (CT) scan, ultrasound, and other imaging techniques may help locate diverticula and any inflammation, fistulae, abscesses, or other abnormalities.

Treatment Options

Prevention

To help prevent diverticular disease:

Eating a high-fiber (15 g of fiber per day), low-fat diet that contains lots of vegetables may lessen the risk of diverticular disease. Such a diet is also beneficial for overall health and may reduce the risk of heart disease and cancer, too.
Avoid red meat.
If you have diverticula, avoid foods such as seeds that may block the opening of a diverticulum and lead to inflammation.
Exercise regularly.

Treatment Plan

For mild symptoms, your health care provider may recommend a clear liquid diet and prescribe antibiotics. More serious cases may require hospitalization, intravenous (IV) feeding to rest the intestine, IV antibiotics, and IV antispasmodics, which relax the intestine. Eating a high-fiber diet and taking psyllium supplements may help following an attack.

For repeated attacks, your doctor may recommend surgery to remove the part of the colon that is affected. Those who have severe complications, or whose condition becomes worse within a day or two of an attack, may need surgery right away.

Drug Therapies

Your doctor may prescribe antibiotics to fight infection, antispasmodics to relieve cramping, and analgesics to relieve pain.

Surgical and Other Procedures

If the condition is severe or leads to complications, or if attacks recur, a health care provider may recommend removing part of the colon.

Complementary and Alternative Therapies

Nutrition plays an important role in preventing and treating gastrointestinal disease, especially diverticulosis. You may help minimize attacks and improve treatment results by following some specific recommendations about your diet.

Nutrition and Supplements

Eat a diet that is high in fiber (15 g per day). Food is the best source of fiber. One study suggested that the following foods were associated with a lower risk of diverticular disease: cucumber, lettuce, spinach, and brown bread. You may also use fiber supplements to increase the amount of fiber you take in every day. Common kinds of fiber supplements include insoluble fiber supplements such as psyllium and glucomannan (3 - 5 g per day of either supplement). Your doctor may also suggest soluble fiber supplements such as flax seed and oat bran, which can be less irritating than insoluble supplements. Talk to your doctor to find the right combination for you.

Glutamine (400 mg four times per day, between meals) is an amino acid found in the body that helps the intestine function properly. While there is no evidence that glutamine specifically helps reduce symptoms of diverticular disease, it may be beneficial for overall intestinal health. Do not take glutamine if you are diabetic or have seizures.

Omega-3 fatty acids, such as those found in fish oil, may help fight inflammation. (On the other hand, omega-6 fatty acids, found in meats and dairy products, tend to increase inflammation.) For a condition such as diverticulitis, it may be wise to eat a diet rich in omega-3 fatty acids, or take a supplement (1,000 mg one to two times per day). This type of diet may also help prevent colon cancer. Do not take high doses of a fish oil supplement if you are on blood-thinning medication.

Probiotics, such as Lactobacillus acidophilus, Lactobacillus plantarum, Saccharomyces boulardii (250 mg, taken one time per day between meals) and bifidobacteria, help maintain the health of the intestines.

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.

The following herbs are often used to treat gastrointestinal illness:

Flaxseed (Linum usitatissimum) may be helpful in treating diverticulosis. It contains fiber and works as a bulk-forming laxative, softening stool and speeding transit time through the intestine. Use ground flaxseed, 15 g per day. Do not take flaxseed if you take blood-thinning medication or have diabetes.
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.
Cat's claw (Uncaria tomentosa, 250 mg per day) is an anti-inflammatory.
Wild yam (Dioscorea villosa, 2 - 4 g per day in two or three divided doses). Do not take wild yam if you have or are at risk of having breast cancer, prostate cancer or any hormonally influenced condition.
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), one to three cups of tea per day. To make tea, steep 3 g flower heads in one cup boiling water, strain, and cool.
Licorice (Glycyrrhiza glabra, 380 - 1,140 g per day) can reduce spasms and inflammation in the gastrointestinal tract. Do not take licorice for a long period of time or if you have high blood pressure or heart failure. Look for products that say they contain mostly DGL, which has the majority of the blood-pressure raising component of licorice removed.

Homeopathy

While there have been few studies examining the effectiveness of specific homeopathic remedies, professional homeopaths may recommend one or more of the following treatments for diverticular 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. An experienced homeopath assesses all of these factors when determining the most appropriate remedy for a particular individual.

Belladonna -- used for abdominal pain and cramping that comes on suddenly and feels better with firm pressure. It is particularly helpful if constipation accompanies the pain.
Bryonia -- used for abdominal pain that worsens with movement and is relieved by heat. It is particularly useful if vomiting or constipation with dry, hard stools accompanies the pain.
Colocynthis -- used for sharp, cramping abdominal pains that improve with pressure. It is particularly useful if pain is accompanied by restlessness and diarrhea.

Acupuncture

Acupuncture may help relieve pain and other symptoms. Acupuncturists treat people with diverticular disease based on an individualized assessment of the excesses and deficiencies of qi located in various meridians. Acupuncture and Chinese medicine in general can be used to promote gastrointestinal health.

Following Up

If you develop a fever, tenderness in the abdomen, or bleeding from the rectum or in the stool, alert your health care provider right away. You may be hospitalized for a fever higher than 101°F, worsening symptoms, signs of peritonitis, or increased white blood cell count found in laboratory tests.

Prognosis/Possible Complications

About one-third of those who develop diverticulitis have a second episode, and of this group, half generally have a third attack. Twenty percent of patients develop complications after the first attack, 60% after a second attack. Complications may include:

An abscess (pocket of pus)
Blocked intestine
A perforation (hole) in the intestine leading to peritonitis, sepsis, and even shock
Fistulas, which may also lead to sepsis
Bleeding

Those who have experienced bleeding once are at high risk for developing bleeding again.

Supporting Research

Aldoori WH, Giovannucci EL, Rimm EB, Wing AL, Trichopoulos DV, Willett WC. A prospective study of alcohol, smoking, caffeine, and the risk of symptomatic diverticular disease in men. Ann Epidemiol. 1995;5(3):221-228.

Aldoori W, Ryan-Harshman M. Preventing diverticular disease. Review of recent evidence on high-fibre diets. Can Fam Physician. 2002 Oct;48:1632-7.

Ambrosetti P, Robert JH, Witzig JA, et al. Acute left colonic diverticulitis: a prospective analysis of 226 consecutive cases. Surgery. 1994;115(5):546-550.

Blumenthal M, Goldberg A, Brinckmann J, eds. Herbal Medicine: Expanded Commission E Monographs. Newton, Mass: Integrative Medicine Communications; 2000:134-138, 314-321.

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

Feldman M, ed. Sleisenger & Fordtran's Gastrointestinal and Liver Disease. 6th ed. Philadelphia, Pa: W.B. Saunders; 1998.

Ferzoco LB, Raptopoulos V, Silen W. Acute diverticulitis. N Engl J Med. 1998;338(21):1521-1526.

Hinchey EJ, Schaal PG, Richards GK. Treatment of perforated diverticular disease of the colon. Adv Surg. 1978;12:85-109.

Kohler L, Sauerland S, Neugebauer E. Diagnosis and treatment of diverticular disease: results of a consensus development conference. Surg Endosc. 1999;13(4):430-436.

Manousos O, Day NE, Tzonou A, et al. Diet and other factors in the aetiology of diverticulosis: an epidemiological study in Greece. Gut. 1985;26(6):544-549.

Murray M. Encyclopedia of Nutritional Supplements. Rocklin, Calif: Prima Publishing; 1996:315.

Nair P, Mayberry JF. Vegetarianism, dietary fibre and gastro-intestinal disease. Dig Dis. 1994;12(3):177-185.

O'Keefe SJ. Nutrition and gastrointestinal disease. Scand J Gastroenterol Suppl. 1996;220:52-59.

Sabiston DC, Lyerly HK, eds. Textbook of Surgery. 15th ed. Philadelphia, Pa: W.B. Saunders; 1998.

Review Date:
12/2/2006
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

adam.com

Bronchitis

FitSugar — Wed, 08 Oct 2008 17:35:33 -0700

Overview

Signs and Symptoms
Causes
Diagnosis
Preventive Care
Treatment Approach
Supporting Research

HEALTH GUIDE REFERENCE FROM A.D.A.M

Bronchitis occurs when the air passages in your lungs become inflamed. Bronchitis can be acute or chronic. Acute bronchitis is usually due to a viral infection – such as a cold – that starts in your nose or sinuses and spreads to the airways. Acute bronchitis usually lasts a few days, although you may have a cough for weeks afterward. Chronic bronchitis, on the other hand, occurs most often in people who smoke and, together with emphysema, is known as chronic obstructive pulmonary disease (COPD). Chronic bronchitis is characterized by a productive (wet) cough that is persistent. The mucus that’s produced by the inflamed airways eventually causes scar tissue to form in the lungs, making breathing difficult. For more information, see the article on Chronic Obstructive Pulmonary Disease.

Signs and Symptoms

Acute bronchitis:

Cough that produces yellow or green mucus
Burning sensation in the chest
Wheezing
Sore throat
Fever
Fatigue

Chronic bronchitis:

Chronic cough that produces mucus
Wheezing, shortness of breath
Blue-tinged lips
Ankle, feet, and leg swelling

Causes

Acute bronchitis is usually caused by the same viruses that cause colds. But exposure to cigarette smoke or pollution, a condition called gastroesophageal reflux disease (GERD), and bacterial infections can also cause bronchitis.

The main causes of chronic bronchitis are cigarette smoking and prolonged exposure to air pollution or dust.

Diagnosis

Your doctor will listen to your chest and back, look at your throat, and may draw blood and take a culture of the sputum from your lungs. If your doctor is concerned about possible pneumonia or COPD, a chest X-ray might be ordered or a lung function test (which measures the amount of air in your lungs) may be ordered.

Preventive Care

The best way to avoid chronic bronchitis is to not smoke and to stay away from air pollutants. For acute bronchitis, take steps to avoid colds and respiratory infections, such as washing your hands frequently, getting an annual flu shot, and (if you are over 65 or have a chronic illness) asking your doctor about the pneumococcal vaccine (Prevnar).

Treatment Approach

Acute bronchitis from a virus generally clears up on its own within 7 to 10 days. Using a humidifier, taking a cough medicine that contains an expectorant (something that helps you "bring up" mucus), and drinking plenty of fluids can help relieve symptoms. If a bacterial infection is the culprit, your doctor may prescribe antibiotics.

Lifestyle

Do not smoke, and avoid secondhand smoke.
Use a humidifier or inhale steam from a bowl.
Drink plenty of fluids.
Rest.
If you have low oxygen levels from chronic bronchitis, you may need home oxygen therapy.

Medications

For chronic bronchitis:

Bronchodilators - increase airflow by opening airways and help make it easier to breathe

Corticosteroids - reduce inflammation; either inhaled with an inhaler or taken by mouth, they are usually used to treat moderate to severe COPD

For acute bronchitis:

Antibiotics - for bacterial infection

Cough medicines - Two types of cough medicines, cough suppressants (for a dry cough) or expectorants (for a wet, productive cough that brings up mucus), are available over the counter and by prescription. Usually doctors recommend not suppressing a cough in cases of acute bronchitis, unless your cough is keeping you from sleeping at night.

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. Be sure to talk to your physician about any supplements you are taking or considering taking.

For chronic bronchitis:

N-acetylecysteine (NAC, 400 to 1,200 mg per day) - NAC is a modified form of a dietary amino acid that works as an antioxidant in the body. Several studies using it to treat COPD indicate that it may help relieve symptoms by acting as an antioxidant to reduce oxidative stress on the lungs (damage caused by free radicals, particles that harm cells and DNA). Although not all the studies agree, some suggest that taking NAC can reduce the number of attacks of severe bronchitis.

For acute bronchitis:

Because bronchitis often follows a cold, some of the same supplements used to prevent or treat a cold may be helpful.

Probiotics (Lactobacillus) - So-called “good” bacteria or probiotics help prevent infections in the intestines, and there is preliminary evidence that they might help prevent respirator infections, too. One study found that children in daycare centers who drank milk fortified with Lactobacillus had fewer and less severe colds. Several studies that examined probiotics combined with vitamins and minerals also found a reduction in the number of colds caught by adults, although it’s not possible to say whether the vitamins, minerals, or probiotics were most responsible for the benefit.
Chicken soup - It’s about as traditional a remedy for a cold as you can find (at least in modern history). In fact, chicken soup and warm liquids (broth, tea) can help soothe a sore throat and loosen mucus, which in turn helps ease congestion from a cold.

Herbs

For acute bronchitis/Preventing respiratory infections:

Echinacea (Echinacea purpurea, 300 mg three times per day) - Echinacea may help prevent colds, which can lead to bronchitis. An analysis of 14 scientific studies found that people who took echinacea reduced their risk of getting a cold by 58 percent and reduced the duration of a cold by an average of a day and a half. However, many of the studies used echinacea in combination with another herb or vitamin, so it’s impossible to say which one was responsible for the benefit. Echinacea should not be used by women who are pregnant or breastfeeding, or by anyone taking drugs that suppress the immune system (such as corticosteroids or methotrexate).
Andrographis (Andrographic paniculata) - Andrographis may also help lessen cold symptoms and possibly reduce your risk of getting bronchitis. One study found that andrographis, an herb used in Ayurvedic medicine, combined with eleuthero (Eleutherococcus senticosus) in a formula called Kan Jang, helped reduce cold symptoms.
Garlic (Allium sativum) - In one study, people who took garlic for 12 weeks between November and February had 63 percent fewer colds than people who took placebo. Those who did get a cold recovered about one day faster. Because garlic can increase the risk of bleeding, people who take anticoagulants (blood-thinners, such as aspirin or warfarin) should not take garlic. Women who are pregnant or breastfeeding should talk to their doctor before taking garlic supplements.
Ginseng (Panax quinquefolius, 400 mg per day) - At least two studies suggest that taking American ginseng may help prevent colds, as well as reduce the number of colds experienced and the severity of symptoms.

For acute and chronic bronchitis/Expectorants for cough:

Essential oil monoterpenes - A combination of essential oils, including eucalyptus (Eucalyptus globulus), a citrus oil, and an extract from pine, has been suggested for several respiratory illnesses, including both acute and chronic bronchitis. One study found that people with acute bronchitis treated with essential oil monoterpenes did better than people who took placebo. Another study found that people who took the herbal treatment did as well as those who took antibiotics. However, more studies are needed.
Lobelia (Lobelia inflata) - Also called Indian tobacco, lobelia has a long history of use as an herbal remedy for respiratory problems including bronchitis. It is an effective expectorant, meaning that it helps clear mucus from your lungs. However, lobelia can be toxic and should only be used under a doctor’s supervision.
Mullein (Verbascum densiflorum, 3 g per day) - Mullein is an expectorant, meaning it helps clear your lungs of mucus. Traditionally, it has been used to treat respiratory illnesses and coughs with lung congestion. However, it has not been studied for bronchitis.
Peppermint (Mentha x piperita) - Peppermint is widely used to treat cold symptoms. Its main active agent, menthol, is a good decongestant. Menthol also thins mucus and works as an expectorant, helping loosen and break up phlegm.

For acute bronchitis:

South African geranium (Pelargonium sidoides ) - Although scientific evidence is preliminary, a specific extract from South African geranium did show positive results in a few studies. In one study, people with acute bronchitis recovered faster when taking this extract than those who took placebo. In another study, people who took the extract did as well as those who took antibiotics, but without some side effects of the antibiotics. More studies are needed.

Homeopathy

Although very few studies have examined the effectiveness of specific homeopathic therapies, professional homeopaths may consider the following remedies for the treatment of bronchitis in addition to standard medical care. 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 treatment for each individual.

Aconitum - for early stages of bronchitis or other respiratory disorders; this remedy is most appropriate for people with a hoarse, dry cough who complain of dry mouth, thirst, restlessness, and being awakened by their own coughing; symptoms tend to worsen in cold air or when when lying on one's side

Antimonium tartaricum - for wet, rattling cough (although the cough is usually too weak to bring up mucus material from the lungs) that is accompanied by extreme fatigue and difficulty breathing; symptoms usually worsen when lying on one's back; this remedy is particularly good for children and the elderly and is generally used during the later stages of bronchitis

Bryonia - for dry, painful cough that tends to worsen with movement and deep inhalation; this remedy is most appropriate for individuals who are generally thirsty, chilly, and irritable

Hepar sulphuricum - for later stages of bronchitis, accompanied by wheezing, scant mucus production, and coughing that occurs when any part of the body gets cold

Ipecacuanha - for the earliest stages of bronchitis accompanied by a deep, wet cough, nausea and vomiting; this remedy is commonly prescribed for infants

Phosphorus - for several different types of cough but usually a dry, harsh cough accompanied by a persistent tickle in the chest and significant chest pain; this remedy is most appropriate for individuals who are often worn out and exhausted, tend to be anxious and fear death, and require a lot of reassurance

Massage and Physical Therapy

Aromatherapy

Running a humidifier with an essential oil such as cedarwoord, bergamot, eucalyptus, myrrh, sweet fennel, jasmine, lavender, tea tree, or marjoram at night may help thin mucus and ease cough. Talk to an experienced aromatherapist to learn which oil, alone or in combination, is best for you.

Prognosis and Complications

For acute bronchitis, symptoms usually resolve within 7 to 10 day; however, a dry, hacking cough can linger for a number of weeks.

The chance for recovery is poor for advanced chronic bronchitis. Early treatment, combined with stopping smoking, can stop lung damage from progressing and improve quality of life.

Supporting Research

Barrett B, Vohmann M, Calabrese C. Echinacea for upper respiratory infection. J Fam Pract. 1999;48:628-635.

Belongia EA, Berg R, Liu K. A randomized trial of zinc nasal spray for the treatment of upper respiratory illness in adults. Am J Med. 2001;111(2):103-108.

Blumenthal M, Goldberg A, Brinkman J, ed. Herbal Medicine. Expanded Commission E Monographs. Boston, Mass: Integrative Medicine Communications; 2000:33-35, 297-303, 335-340.

Cummings S, Ullman D. Everybody's Guide to Homeopathic Medicines. 3rd ed. New York, NY: Penguin Putnam; 1997: 68.

Guo R, Pittler MH, Ernst E. Complementary medicine for treating or preventing influenza or influenza-like illness. Am J Med. 2007 Nov;120(11):923-929.e3. Review.

Jackson IM, et al. Efficacy and tolerability of oral acetylcysteine (Fabrol) in chronic bronchitis: a double-blind placebo controlled study. J Int Med Res. 1984; 12(3): 198-206.

Hasani A, Pavia D, Toms N, Dilworth P, Agnew JE. Effect of aromatics on lung mucociliary clearance in patients with chronic airways obstruction. J Altern Complement Med. 2003 Apr;9(2):243-9.

Jonas WB, Jacobs J. Healing with Homeopathy: The Doctors' Guide. New York, NY: Warner Books; 1996: 210.

Kruzel T. The Homeopathic Emergency Guide. Berkeley, Calif: North Atlantic Books; 1992:40-43.

Lizogub VG, Riley DS, Heger M. Efficacy of a pelargonium sidoides preparation in patients with the common cold: a randomized, double blind, placebo-controlled clinical trial. Explore (NY). 2007 Nov-Dec;3(6):573-84.

Mahady GB. Echinacea: recommendations for its use in prophylaxis and treatment of upper respiratory tract infections. Nutr Clin Care. 2001;4(4):199-208.

Matthys H, Heger M. Treatment of acute bronchitis with a liquid herbal drug preparation from Pelargonium sidoides (EPs 7630): a randomised, double-blind, placebo-controlled, multicentre study. Curr Med Res Opin. 2007 Feb;23(2):323-31.

Pittler MH, Ernst E. Clinical effectiveness of garlic (Allium sativum). Mol Nutr Food Res. 2007 Nov;51(11):1382-5.

Reichling J, Fitzi J, Furst-Jucker J, Bucher S, Saller R. Echinacea powder: treatment for canine chronic and seasonal upper respiratory tract infections. Schweiz Arch Tierheilkd. 2003;145(5):223-231.

Rotblatt M, Ziment I. Evidence-Based Herbal Medicine. Philadelphia, PA: Hanley & Belfus, Inc; 2002:160-165, 252-256, 259-261, 337-338.

Roxas M, Jurenka J. Colds and influenza: a review of diagnosis and conventional, botanical, and nutritional considerations. Altern Med Rev. 2007 Mar;12(1):25-48. Review.

Schulz V. Liquid herbal drug preparation from the root of Pelargonium sidoides is effective against acute bronchitis: results of a double-blind study with 124 patients. Phytomedicine. 2007;14 Suppl 6:74-5.

Shah SA, Sander S, White CM, Rinaldi M, Coleman CI. Evaluation of echinacea for the prevention and treatment of the common cold: a meta-analysis. Lancet Infect Dis. 2007 Jul;7(7):473-80. Review. Erratum in: Lancet Infect Dis. 2007 Sep;7(9):580.

Stead LF, Hughes JR. Lobeline for smoking cessation (Cochrane Review). In: The Cochrane Library, 1, 2002. Oxford: Update Software.

Stey C, Steurer J, Bachmann S, Medici TC, Tramer MR. The effect of oral N-acetylcysteine in chronic bronchitis: a quantitative systematic review. Eur Respir J. 2000 Aug;16(2):253-262.

Ullman D. Homeopathic Medicine for Children and Infants. New York, NY: Penguin Putnam; 1992: 70-72.

Ullman D. The Consumer's Guide to Homeopathy. New York, NY: Penguin Putnam; 1995: 227-228.

Yildirim A, Mavi A, Oktay M, Kara AA, Algur OF, Bilaloglu V. Comparison of antioxidant and antimicrobial activities of tilia (Tilia argentea Desf ex DC), sage (Salvia triloba l.), and black tea (Camellia sinensis) extracts. J Agric Food Chem. 2000;48(10):5030-5034.

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

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Mononucleosis

FitSugar — Wed, 08 Oct 2008 17:35:26 -0700

Overview

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

HEALTH GUIDE REFERENCE FROM A.D.A.M

Infectious mononucleosis, also referred to as "mono" or "the kissing disease," causes symptoms that include fever, sore throat, and swollen glands. A person is infectious several days before symptoms appear and for some time after, possibly for months or, rarely, even years. Direct contact with virus-infected saliva, mainly through kissing, can transmit the virus and cause mono. Mono affects about 45 of 100,000 people.

Signs and Symptoms

The following signs and symptoms may accompany mono:

Fever
Fatigue
Sore throat, often severe
Swollen tonsils
Swollen lymph nodes in the neck
Enlargement of the spleen
Enlargement of the liver
Rash
Headache

Symptoms may take between 4 - 7 weeks to develop after exposure to the virus. Symptoms can last only a few days or as long as several months. In most cases, they disappear in 2 - 6 weeks.

What Causes It?

The Epstein-Barr virus (EBV) causes the vast majority of mono cases. Ninety percent of adults have antibodies to the virus reflecting former exposure and immunity against EBV. EBV infects and reproduces in the salivary glands. Direct contact with virus-infected saliva, such as by kissing, can transmit the virus and cause mono. You can also get mono through transfusions with infected blood products.

Who's Most At Risk?

The following factors can put a person at higher risk for developing mono:

Age -- the incidence peaks in the 15 - 19 year age group. After age 35, the rate is low.
Delayed exposure -- mono is more prevalent in areas with higher standards of hygiene, where infection with EBV is often delayed until adulthood.
Blood transfusion.
Diminished or suppressed immune function.

What to Expect at Your Provider's Office

Your health care provider will do a physical examination, checking for fever, sore throat, swollen glands, and for swelling of your spleen or liver. A blood test is performed to make the diagnosis of mono.

Treatment Options

Prevention

Since mono is not generally spread through the air, a person who has mono does not need to be isolated. Household members or college roommates have only a slight risk of being infected unless they kiss the person.

Treatment Plan

Rest is necessary when symptoms are severe. Increased activity is allowed as the symptoms improve, generally after about 2 weeks. Contact sports and heavy lifting should be avoided for 2 months due to the risk of rupturing the spleen.

Drug Therapies

Your health care provider may prescribe the following medications:

Acetaminophen
Corticosteroids, such as prednisone, are used only to treat airway obstruction from enlarged tonsils

Children with EBV should not take aspirin because of the risk of developing Reye's syndrome, a rare condition that can cause vomiting and can affect the liver, brain, and other organs.

Surgical and Other Procedures

In the case of a ruptured spleen associated with mono, surgical removal of the spleen may be necessary.

Complementary and Alternative Therapies

Several studies report that stress and relaxation affect our immune systems. Stress can increase susceptibility to infection. Steps that reduce stress may help prevent infection with viruses such as EBV.

There is some evidence that nutrition and plant-based medicines may help reduce the long-term effects of EBV infection and complications linked to EBV.

Always tell your health care provider about the herbs and supplements you are using or considering using.

Nutrition and Supplements

Following these nutritional tips may help reduce symptoms:

Try to eliminate all suspected food allergens, including dairy, wheat (gluten), soy, chocolate, corn, preservatives, and food additives. Your health care provider may want to test you for food allergies.
Eat more antioxidant-rich foods (such as green, leafy vegetables and peppers) and fruits (such as blueberries, tomatoes, and cherries).
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.
Avoid coffee and other stimulants, alcohol, and tobacco.
Drink 6 - 8 glasses of filtered water daily.
Exercise moderately, if tolerated, at least 30 minutes daily, 5 days a week.

You may be able to address nutritional deficiencies with the following supplements:

A multivitamin daily, containing the antioxidant vitamins A, C, E, the B-vitamins, and trace minerals, such as magnesium, calcium, zinc, and selenium.
Omega-3 fatty acids, such as fish oil, 1 - 2 capsules or 1 tablespoonful oil two to three times daily, to help decrease inflammation and improve immunity. Cold-water fish, such as salmon or halibut, are good sources.
Coenzyme Q10, 100 - 200 mg at bedtime, for antioxidant, immune, and muscular support.
N-acetyl cysteine, 200 mg daily, for antioxidant effects.
Acetyl-L-carnitine, 500 mg daily, for antioxidant and muscle protective activity.
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.
Resveratrol (from red wine), 50-200 mg daily, for antioxidant and antiviral effects.
L-theanine, 200 mg one to three times daily, for nervous system support.
Melatonin, 2 - 5 mg one hour before bedtime, for sleep and immune protection.

Herbs

Green tea (Camellia sinensis) standardized extract, 250 - 500 mg daily, for antioxidant, anti-inflammatory, and immune effects. Use caffeine free products. You may also prepare teas from the leaf of this herb.
Rhodiola (Rhodiola rosea) standardized extract, 100 - 600 mg daily, for antioxidant, anti-stress, and immune activity.
Milk thistle (Silybum marianum) seed standardized extract, 80 - 160 mg two to three times daily, for detoxification support.
Elderberry (Sambucus nigra) extract, 1 tablespoonful two times daily, for antiviral and immune activity. Ask your health care provider about doses of elderberry extract for your children.
Reishi mushroom (Ganoderma lucidum), 150 - 300 mg two to three times daily, for inflammation and immunity. You may also take a tincture of this mushroom extract, 30 - 60 drops two to three times a day.
Cat's claw (Uncaria tomentosa) standardized extract, 20 mg three times a day, for inflammation and antiviral activity.

Homeopathy

Few studies have examined the effectiveness of specific homeopathic remedies. A professional homeopath, however, may recommend one or more of the following treatments for mono based on his or her knowledge and clinical experience. Before prescribing a remedy, homeopaths take into account a person’s constitutional type -- your 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 remedies may be effective for fever related to EBV:

Belladonna -- for early stages of mononucleosis with sudden onset of fever.
Ferrum phosphoricum -- for individuals with the early stages of a fever accompanied by a painful cough and sore chest.
Kali muriaticum -- typically used for individuals with extremely swollen tonsils, but may also be useful for treating infectious mononucleosis when administered in conjunction with Ferrum phosphoricum

Professional homeopaths may also recommend the following remedies:

Mercurius -- for individuals with a fever accompanied by profuse sweating, alternating hot and cold body temperature, weakness in the limbs and painful, aching bones, a bluish-red throat with a constant desire to swallow, excessive salivation, teeth marks around the edges of a swollen tongue, and tremendous thirst.
Phytolacca -- for pain caused by throat inflammation that radiates to the ears upon swallowing.

Other helpful remedies include Lachesis, Conium, Hepar sulphuricum, and Baryta carbonica.

Research also suggests that a combination of homeopathy and Traditional Chinese Medicine (TCM) may effectively improve symptoms of mononucleosis. The most common homeopathic remedies used with TCM include Lycopodium, Silicea, Phosphorous, Sulphur, Mercurius, Nux vomica, Sepia, and Pulsatilla.

Acupuncture

Although no scientific studies have reviewed the use of acupuncture for mono, it may help to reduce symptoms, to improve immune function, and to relieve congestion (blockage of qi, or energy flow) of the liver, spleen, and lymph.

Traditional Chinese Medicine

Studies have reported that individuals with Epstein-Barr virus experience an improvement in symptoms when given a combination of homeopathic remedies noted in the section on homeopathy and TCM remedies including Atractylodes alba, Glycyrrhiza recens, Rehmannia preparata, Bupleurum, Cortex magnolia, Phragmites, Belamcanda, Sophora, subprostrata, Siler, Angelica dahurica, Paeonia alba, Dendrobium, Polygonatum officinal, and Cnidium.

Massage

No scientific studies have reviewed the use of massage for mono. However, it may help relieve the muscle aches and pains associated with chronic EBV infection and reduce stress. As discussed earlier, stress can increase a person's susceptibility to infections.

Prognosis and Possible Complications

Most people with mono recover uneventfully and can return to school or work in a few weeks. Fatigue can continue for months for a small percentage of people. Severe complications are uncommon, and may include problems with the central nervous system or liver, rupture of the spleen, or difficulty breathing.

Supporting Research

Auwaerter PG. Infectious mononucleosis in middle age. JAMA. 1999; 281(5):454-459.

Beers MH, Berkow R, eds. The Merck Manual of Diagnosis and Therapy. Whitehouse Station, NJ: Merck & Co.; 1999:2336-2339.

Bhat KPL, Kosmeder JW 2nd, Pezzuto JM. Biological effects of resveratrol. Antioxid Redox Signal. 2001;3(6):1041-64.

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

Carillo-Vico A, Reiter RJ, Lardone PJ, et al., The modulatory role of melatonin on immune responsiveness. Curr Opin Investig Drugs. 2006;7(5):423-31.

Chiang LC, Ng LT, Cheng PW, Chiang W, Lin CC. Antiviral activities of extracts and selected pure constituents of Ocimum basilicum. Clin Exp Pharmacol Physiol. 2005;32(10):811-6.

Clancy RL, Gleeson M, Cox A, et al. Reversal in fatigued athletes of a defect in interferon gamma secretion after administration of Lactobacillus acidophilus. Br J Sports Med. 2006;40(4):351-4.

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

Eo SK, Kim YS, Lee CK, Han SS. Antiviral activities of various water and methanol soluble substances isolated from Ganoderma lucidum. J Ethnopharmacol. 1999;68(1-3):129-36.

Gaby AR. The role of coenzyme Q10 in clinical medicine: Part 1. Alt Med Rev. 1996; 1(1):11-17.

Hunton M. The homoeopathic treatment of glandular fever. Br Homeopath J. 1986; 75(2):66-68.

Jacobson W, Wreghitt TG, Saich T, Nagington J. Serum folate in viral and mycoplasmal infections. J Infect. 1987; 14(2):103-111.

Mayer KE, Myers RP, Lee SS. Silymarin treatment of viral hepatitis: a systematic review. J Viral Hepat. 2005;12(6):559-67.

Omori M. Mononucleosis. In: Adler J, Brenner B, Dronen S, et al., eds. Emergency Medicine: An On-line Medical Reference. Accessed on January 19, 2000.

Reiche EM, Morimoto HK, Nunes SM. Stress and depression-induced immune dysfunction: implications for the development and progression of cancer. Int Rev Psychiatry. 2005;17(6):515-27.

Rotsein OD. Oxidants and antioxidant therapy. Crit Care Clin. 2001;17(1):239-47.

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

Schooley RT. Epstein-Barr virus (infectious mononucleosis). In: Mandell GL, Bennett JE, Dolin R, eds. Mandell, Douglas and Bennett's Principles and Practices of Infectious Diseases. 4th ed. New York, NY: Churchill Livingstone Inc; 1995:1364-1377.

Van Benschoten MM. Clinical cases of Epstein Barr Virus infection treated with homeopathic and Chinese herbal therapeutics. Am J Acupunct. 1988; 16(1):19-25.

Van Rood YR, Bogaards M, Goulmy E, van Houwelingen HC. The effects of stress and relaxation on the in vitro immune response in man: a meta-analytic study. J Behav Med. 1993; 16(2):163-181.

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

Williams JE. Review of antiviral and immunomodulating properties of plants of the Peruvian rainforest with a particular emphasis on Una de Gato and Sangre de Grado. Altern Med Rev. 2001;6(6):567-79.

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

Zakay-Rones Z, Thom E, Wollan T, Wadstein J. Randomized study of the efficacy and safety of oral elderberry extract in the treatment of influenza A and B virus infections. J Int Med Res. 2004;32(2):132-40.

Review Date:
9/6/2006
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.

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