FitSugar

You Asked: Mood Swings and Exercise, What Gives?

FitSugar — Wed, 01 Aug 2007 04:00:00 -0700

You're asking and I'm answering...

Dear Fit,
I am usually pretty good at working out but recently I've been skipping a few days because work's been super busy. I find that on those days I get super moody... What's up with that? Is it all in my head?
- Moody Mandy

Actually it is all in your head, but not the way in which you're thinking. Here's the deal, according to Peak Performance Online: Your pituitary gland (a gland located at the base of your brain) releases substantial quantities of 'endorphins' - chemicals which can block sensations of pain and produce overall feelings of euphoria - when you preform strenuous activities like running or biking. In other words, exercise makes you feel and look good, it's scientifically proven. This is why some people can get 'addicted' to exercise or feel a 'runners high'. Just like any addiction, withdrawal symptoms are normal, so don't worry. Get back on the ~~horse~~ treadmill as soon as you can and you're sure to be feeling great all over again.

How Many Days a Week Do You Work Out?

FitSugar — Tue, 17 Nov 2009 08:00:38 -0800

I'm a bear if I don't exercise. I get moody and irritable and cranky. If I've gone too long without working out, my family is the first to know and it's not pretty. Luckily my husband knows the warning signs of exercise withdrawal, and shoos me out the door with sneakers in hand. To keep my sanity, I aim to exercise at least five days a week. What about you?

Are Occasional Breaks From the Pill Necessary?

FitSugar — Tue, 27 Oct 2009 05:50:05 -0700

Almost every woman I know has been on the pill at some point in her life, and many of us started when we were under 20 years old. It has many health benefits, such as preventing unwanted pregnancies, decreasing the risk of ovarian cancer, and alleviating PMS symptoms. The one big negative about the pill is that statistics show being on it for longer than 10 years puts you at a higher risk for breast cancer. Women may also be worried that taking hormones for so long may affect their chances of having a baby in the future. So does it make sense to take regular vacations from the pill to give your body some hormone-free time?

To find out if this is a good idea, read more.

While it's common to think that taking occasional breaks from the pill is beneficial for your body, it's actually not necessary. It's a myth that may have started a while back, since the very first birth control pills contained high doses of hormones. Today's pills contain a much lower amount so they're completely safe to take for years at a time. Doctors actually think it's healthier for your body to remain on the pill. The fluctuations in hormones can have a negative effect on your body, both physically and emotionally. Plus, all the symptoms you experienced when you first started the pill such as moodiness, sore breasts, or yeast infections may show up again.

What about your fertility? You may be worried that staying on the pill continuously for many years will make it harder to get pregnant when you decide to start a family. There's no evidence that being on the pill has any effect on a woman's future ability to conceive - it merely prevents pregnancy while a woman is on it. In fact, regularly going on and off the pill may increase your chances of having an unplanned pregnancy since your protection isn't consistent.

Most importantly, if you've been on the pill forever, you'll be happy to know that as soon as you go off it your risk for developing breast cancer begins to go back to normal over time. If you're worried about your risk, or the whole idea of putting hormones in your body doesn't sit well with you, talk to your doctor about hormone-free alternatives such as the ParaGard IUC. A permanent vacation from the pill might be the better option, as opposed to a break.

Healthy Recipe: PMS Banana Oatmeal Cookies

FitSugar — Wed, 19 Aug 2009 05:50:05 -0700

When monthly moodiness strikes, I fight back with baking. Having fought the symptoms of PMS in the past by making a batch of banana muffins, I went to the kitchen to see if I could bake a cookie to ease my symptoms. I created a pretty healthy oatmeal cookie that you can eat relatively guilt-free when the craving strikes.

Calcium, magnesium, and vitamin B6 have been found to fight the moodiness that often rides in on the "crimson wave," along with breast tenderness and bloating. Aside from the cramp-busting mineral potassium, bananas contain vitamin B6, as does oatmeal. Peanuts are high in magnesium and add a little protein to these cookies as well as a bit of calcium. Omega-3s ease cramping, so I added some flax meal into the mix. Flax also adds a bit more B6. Nothing related to PMS would be complete without a bit of chocolate, so I added some chocolate chips too.

Check out the recipe and the nutritional information on these cookies when you read more.

Banana Oatmeal Cookies For PMS
Inspired by Cooking Light

Ingredients

2 ripe bananas
1/2 cup butter softened
1/2 cup dark brown sugar
1/4 cup white sugar
1 1/2 teaspoons vanilla
2 large eggs
1 cup whole wheat flour
1/2 cup flax meal
1 teaspoon baking soda
1/2 teaspoon salt
1 teaspoon cinnamon
3 cups old fashioned oats
1 cup peanuts
1 cup chocolate chips

Directions

Pre-heat oven to 325 degrees. Spray cookie sheets with cooking spray.
Cream together bananas, butter, and sugars with a mixer. Add vanilla and eggs, stir until well combined.
In a separate bowl whisk together flour, flax meal, baking soda, salt, and cinnamon.
Add dry ingredients to banana mixture and mix well. Stir in oats, peanuts, and chocolate chips.
Drop tablespoon-size balls of dough onto greased cookie sheets. Bake for 12 to 15 minutes, or until browned. Cool on sheet for two minutes before moving to a cooling rack.

Makes 48 cookies.

Print recipe with images | without images

I halved the sugar content in these cookies, since it is best to avoid simple sugars in the battle with PMS. The banana provides sweetness and lowers the fat content, so the cookies require only one stick of butter rather than two. Enjoy one or two cookies with a glass of milk to get even more calcium. Sure do hope they help stabilize your mood and satisfy your craving for something sweet.

Healthy Eating Tip: Set Up Daily Snack Times

FitSugar — Wed, 29 Jul 2009 14:30:54 -0700

Snacks are an important part of a healthy diet. If you only eat three meals a day, you'll be starving by mealtimes, which most likely will result in overeating. Plus living with hunger pangs is a surefire way to become tired and moody, and you may not end up making it to your next meal before devouring the first unhealthy snack you set your eyes on. So while snacking is healthy, mindlessly snacking all day long isn't good either, since you'll end up consuming tons of extra calories and we all know what that means.

The best way to handle snacking is to set up a snack time (yes, just like when you were in preschool). Plan a morning snack for around 10:30 and an afternoon pick-me-up around 3:00. This way you will eat a little something in between meals without ruining your appetite. You also need to plan what you're going to eat during your snack time. Choose something that contains fiber and protein to fill you up and give you energy.

Don't know what to snack on? Here are some suggestions for the next time you have a Snack Attack.

The Anatomy of a Hangover

FitSugar — Thu, 01 Jan 2009 03:00:00 -0800

It happens to all of us at some time or another but maybe to more of us on New Year's Eve. We drink too much and then we pay for it the next day. Are you hung up by your hangover?

Let me take a moment to explain what that excess of alcohol does to your body once the party is over:

Your throat and mouth are dry due to dehydration, which is caused by the diuretic properties of alcohol. The dehydration also affects your muscles, making them feel weak. So drink up! And I don't mean booze. Keep yourself well hydrated today to fight last night's excesses.
The excessive alcohol also irritates the lining of the stomach, causing nausea and sour stomach. The inflammation delays digestion, which in turn contributes to the feelings of nausea.
Your liver gets backed up trying to metabolize all the alcohol, so you might be experiencing symptoms of hypoglycemia, meaning you are highly irritable and moody. Some folks end up feeling ravenously hungry after a night of partying due to whacked out blood sugar levels too. If you can eat, you should eat.

Unfortunately, there are a few more symptoms of a hangover. To learn those, if you are not already experiencing them, read more.

Your central nervous system becomes chemically overexcited, causing sensitivity to light, sound, and touch.
Blood vessels in the brain dilate, and that is what is causing that throbbing headache, which is only exacerbated by your dehydration mentioned above.
Your pituitary gland becomes confused and releases the wrong amounts of the hormones that regulate sleep. So while you may want to sleep it off, your sleep pattern is severely disrupted.

On the bright side of things, it is not clear whether hangovers affect cognitive abilities. But fear not, the aftereffects of your partying should only linger about for about 24 hours. Tomorrow is another day and it is a fresh new year too. Here are some recovery tips if you need them.

Source

Otitis media

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

HEALTH GUIDE REFERENCE FROM A.D.A.M

Otitis media is an infection of the middle ear, the area just behind the eardrum. It happens when the eustachian tubes, which connect the middle ear to the nose, become blocked with fluid. With the infection, mucus, pus, and bacteria can also pool behind the eardrum, causing pressure and pain. Ear infections usually begin with a cold. Although adults can get ear infections, they are most common in infants and young children. That's because a child's eustachian tubes are narrower and shorter than an adults, and it's easier for fluid to get trapped in the middle ear. Ear infections usually clear up on their own. Although it was common for doctors to give antibiotics to children with ear infections, now guidelines from the American Academy of Pediatricians suggest taking a wait-and-see approach for the first 72 hours.

With a severe ear infection, pressure may build up and cause the eardrum to rupture. Pus and blood may drain out. This usually relieves pain and pressure, and in most cases the eardrum heals on its own.

Signs and Symptoms

There are two main types of ear infections: acute otitis media (AOM), and otitis media with effusion (OME), where fluid remains trapped in the ear even after the infection is gone.

Acute otitis media causes pain, fever, and difficulty in hearing. If a child is too young to talk, signs of an ear infections can include crying, irritability, trouble sleeping, and pulling on the ears.

Other symptoms that may be associated with an ear infection include sore throat (pharyngitis), neck pain, nasal congestion and discharge (rhinitis), headache, and ringing (tinnitus), buzzing, or other noise in the ear.

Causes

Blockage of the eustachian tubes may be caused by:

Respiratory infection (cold)
Allergies
Exposure to cigarette smoke
Infected or overgrown adenoids (tonsils)
For infants, being fed lying down (drinking a bottle while lying on the back)

Ear infections occur most often in the winter. They are not contagious, but a cold may spread among a group of children and cause some of them to get ear infections.

Risk Factors

Age (children between six and 18 months are most likely to get ear infections)
Attending daycare
Recent illness (such as a cold or sinus infection)
History of allergies (like hay fever, also called allergic rhinitis, or sinusitis)
Exposure to secondhand smoke
Having family members who are prone to ear infections
Using a pacifier

Diagnosis

The doctor will ask questions about whether you (or your child) have had ear infections in the past and ask you to describe the current symptoms. He or she will use an otoscope to look inside the ear. If infected, there may be areas of dullness or redness or there may be air bubbles or fluid behind the eardrum. The fluid may be bloody or filled with pus. The doctor will also check for any sign of perforation (hole or holes) in the eardrum.

Your doctor may also do other tests:

Tympanometry, which uses a small handheld instrument to measure changes in air pressure in the ear and can indicate if the eardrum is ruptured

Reflectometry, in which a small instrument is placed near the ear and makes a sound, allowing the doctor to see if fluid is present behind the eardrum.

A hearing test may be recommended if your child has had persistent ear infections.

Preventive Care

You can reduce your child's risk of ear infection. Here are some tips:

Don't expose your child to secondhand smoke.
Keep your child away from other children who are sick.
Always hold your infant in an upright, seated position during bottle feeding.
Breastfeeding for at least six months can make a child less prone to ear infections.
Don't use a pacifier.
The pneumococcal vaccine (Prevnar) prevents infections such as pneumonia and meningitis, and studies show it slightly reduces the risk of ear infections.

Treatment Approach

The goals for treating ear infections include curing the infection, relieving pain and other symptoms, and preventing future ear infections. If a bacterial infection is present, your doctor may prescribe antibiotics (see section entitled Medications).

However, most ear infections clear up on their own. Because antibiotics tend to be overused for treating ear infections, the Academy of Pediatricians and the American Academy of Family Physicians guidelines suggest taking a wait-and-see approach for 72 hours if

The child is older than six months
Are otherwise healthy
Have mild symptoms or an unclear diagnosis.

Your doctor may suggest using an over-the-counter pain reliever (see Medications). There are also alternative ways to treat the symptoms of ear infections and to prevent persistent and recurrent ear infections. For example, herbal ear drops and homeopathic remedies can be helpful for treating or preventing ear infections.

Before giving any medication to a child, whether over-the-counter, and herbal remedy, or a dietary supplement, you should talk to your pediatrician.

Lifestyle

Applying a warm, moist cloth over the affected ear may help relieve pain.

Medications

Antibiotics - If your doctor prescribes antibiotics, be sure to give your child the entire course. The antibiotic most often prescribed for an ear infection is amoxicillin, unless your child is allergic to penicillin. If that's the case. there are several others for your doctor to choose from.
Ear drops - If your child has recurring ear infections, a perforated eardrum, or develops infection after ear tubes have been placed (see Surgery and Other Procedures), your doctor may prescribe antibiotic ear drops instead of oral antibiotics, to be used over a period of time (like a few months). If your child doesn't have ear tubes in place and doesn't have any drainage from the ear, your doctor may also prescribe anesthetic ear drops to relieve pain.
Ibuprofen, acetaminophen - Ask your doctor about using over-the-counter oral medications for pain and/or fever, such as ibuprofen (Advil, Motrin) or acetaminophen (Tylenol). Children under 18 should not take aspirin, due to the risk of developing a rare but serious illness called Reye's syndrome.

Surgery and Other Procedures

Drainage tubes (myringotomy) - If your child has recurring ear infections that don't respond to antibiotics or if the fluid in the child's ear affects his hearing, your doctor may suggest putting in drainage tubes. During this surgery, which requires general anesthesia, the surgeon inserts a small drainage tube through the eardrum. Fluid behind the eardrum can drain out, equalizing the pressure between the middle and outer ear, which should improve your child's hearing. The tubes usually come out on their own as your child grows and the drainage holes heal.

If ear infections persist after age 4, your doctor may suggest having your child's adenoids (tonsils) removed.

Nutrition and Dietary Supplements

Because supplements (like those described below) may have side effects or interact with medications, they should be taken only under the supervision of a knowledgeable healthcare provider. If you think your child has an ear infection, you should always talk to your doctor - don't try to treat the child yourself.

Lactobacillus - A probiotic or "friendly" bacteria, it may help reduce the number of colds your child gets (and thus reduce the number of ear infections). One study found that children in daycare centers who drank milk fortified with Lactobacillus had fewer and less severe colds.
Xylitol – A sugar alcohol produced naturally in birch, strawberries, and raspberries, it may help fight a type of bacteria that's associated with ear infections. In one study, children who chewed sugarless gum sweetened with xylitol reduced their risk of developing and ear infection by more than a third. However, children in the study were given the gum five times a day, which makes it hard to be compliant. Another study found that taking xylitol three times per day didn't work. More research is needed.
Elimination diet - Some doctors believe food allergies contribute to chronic ear infections. Your doctor may ask you to try an elimination diet, which cuts out common food allergens such as wheat or dairy. If symptoms improve, you gradually add back the foods until an ear infection returns. Then you are able to identify and avoid the particular food.

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. Before giving any herbs to a child to treat an ear infection, talk to your pediatrician.

Herbal ear drops (Calendula officinalis, Hypericum perfoliatum, Verbascum thapsus, Allium sativum) - A few studies suggest that ear drops containing calendula, mullein, St. John's wort, and garlic were as effective at relieving pain as prescription ear drops. However, using oily ear drops can make it hard for the doctor to examine your child's middle ear, so always talk to your doctor first before using them.
Echinacea (Echinacea purpurea) - Although it has not been studied for ear infections, some doctors may suggest echinacea to help prevent recurring ear infections. Only give echinacea to a child under your doctor's supervision.
Belladonna (Atropa belladonna) - Belladonna is used as a homeopathic remedy for ear infections (see Homeopathy). Although herbal belladonna is toxic, it is safe when prescribed by a homeopath because homeopathic solutions use extremely diluted amounts. Do not use belladonna without the supervision of a trained homeopath.

Homeopathy

Although not many studies have examined the effectiveness of specific homeopathic therapies in general, there have been several studies evaluating homeopathy for ear infections. Some of the homeopathic remedies included in such studies or that a professional homeopath might consider for the treatment of ear infections are listed below. 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 throbbing ear pain that comes on suddenly after exposure to cold or wind; and in children with high fever and whose ears have a bright red coloring
Belladonna - for sudden onset of infection with piercing pain that often spreads to the neck, flushed face including reddened ears, agitation (even impaired consciousness and nightmares), wide-eyed stare, high fever, and swollen glands; this remedy is most appropriate for children who feel relief when sitting upright and from warm compresses to the ear; this remedy should not be used in children whose symptoms have persisted for more than 3 days
Chamomilla - for intense ear pain and extreme irritability and anger (including screaming); this remedy is most appropriate for children who are difficult to comfort unless being rocked or carried by a person who is walking back and forth
Hepar Sulphuricum - for sharp pains and a smelly, yellowish-green discharge that occur in the middle and late stages of an ear infection, particularly when the child is extremely moody and clearly angry; this remedy is most appropriate for individuals whose symptoms are worsened by cold air and improved by warmth
Lycopedium - for right-side ear pain that is worse in the late afternoon and early evening; the child will generally say that his ears feel stuffed up and he may hear a ringing or buzzing sound; the appropriate individual tends to be insecure and need others around, although the personality type may act like a bully as a defense mechanism
Mercurius - good for chronic ear infections; for acute or chronic pain that is worse at night and may extend down into the throat; relief comes from nose blowing; and the appropriate child may sweat or drool a lot and have bad breath
Pulsatilla - for infection following exposure to cold or damp weather; the ear is often red and may have a yellowish/greenish discharge; ear pain worsens when sleeping in a warm bed and is relieved somewhat by cool compresses; this remedy is most appropriate for children who tend to be gentle, weepy, and mildly whiny and are easily soothed by affection
Silica - for chronic or late stage infection when the child feels chilly, weak and tired; sweating may also be present.

Other Considerations

Warnings and Precautions

If you think your child has an ear infection, especially if your child is under 2, call your pediatrician.

Let your doctor know if your child's symptoms (pain, fever, or irritability) do not get better within 24 to 48 hours.

If severe pain suddenly stops, it may indicate a ruptured eardrum.

Swimming and diving underwater may make an ear infection worse. If your child has a ruptured eardrum, he should avoid swimming or diving completely. If your child has ear tubes, use earplugs or cotton balls coated with petroleum jelly when swimming to prevent infection.

Prognosis and Complications

Generally, an ear infection is a simple, non-serious condition without complications. Most children will have minor, temporary hearing loss during and right after an ear infection. Permanent hearing loss is extremely rare, but the risk increases if the child has a lot of ear infections. Other potential complications include:

Ruptured or perforated eardrum (usually heals on its own)
Chronic, recurrent ear infections
Enlarged adenoids or tonsils
Mastoiditis (an infection of the bones around the skull)
Speech or language delay in a child who suffers lasting hearing loss from multiple, recurrent ear infections; very rare

Supporting Research

Altunç U, Pittler MH, Ernst E. Homeopathy for childhood and adolescence ailments: systematic review of randomized clinical trials. Mayo Clin Proc. 2007 Jan;82(1):69-75. Review.

Barnett ED, Levatin JL, Chapman EH, et al. Challenges of evaluating homeopathic treatment of acute otitis media. Pediatr Infect Dis J. 2000;19(4):273-275.

Bitnun A, Allen UD. Medical therapy of otitis media: use, abuse, efficacy and morbidity. J Otolaryngol. 1998;27(suppl 2):26-36.

Bizakis JG, Velegrakis GA, Papadakis CE, Karampekios SK, Helidonis ES. The silent epidural abscess as a complication of acute otitis media in children. Int J Pediatr Otorhinolaryngol. 1998;45:163-166.

Blazek-O'Neill B. Complementary and alternative medicine in allergy, otitis media, and asthma. Curr Allergy Asthma Rep. 2005 Jul;5(4):313-8. Review.

Blumenthal M, Goldberg A, Brinckmann J. Herbal Medicine: Expanded Commission E Monographs. Newton, MA: Integrative Medicine Communications; 2000:118-123.

Brown CE, Magnuson B. On the physics of the infant feeding bottle and middle ear sequela: ear disease in infants can be associated with bottle feeding. Int J Pediatr Otorhinolaryngol. 2000;54(1):13-20.

Cohen R, Levy C, Boucherat M, Langue J, de la Rocque F. A multicenter, randomized, double-blind trial of 5 versus 10 days of antibiotic therapy for acute otitis media in young children. J Pediatr. 1998;133:634-639.

Cummings S, Ullman D. Everybody's Guide to Homeopathic Medicines. 3rd ed. New York, NY: Penguin Putnam; 1997: 127-129.

Eskola J, Kilpi T, Palmu A, et al. Pneumococcal conjugate vaccine against acute otits media. NEJM. 2001;344(6):403-409.

Fallon JM. The role of the chiropractic adjustment in the care and treatment of 332 children with otitis media. J ClinChiropractic Pediatr. 1997;2(2):167-183.

Foxlee R, Johansson A, Wejfalk J, Dawkins J, Dooley L, Del Mar C. Topical analgesia for acute otitis media. Cochrane Database Syst Rev. 2006 Jul 19;3:CD005657. Review.

Frei H, Thurneysen A. Homeopathy in acute otitis media in children: treatment effect or spontaneous resolution? Br Homeopath J. 2001;90(4):178-179.

Friese KH. Acute otitis media in children: a comparison of conventional and homeopathic treatment. Biomedical Therapy. 1997;15(4):462-466.

Gehanno P, Nguyen L, Barry B, et al. Eradication by ceftriaxone of streptococcus pneumoniae isolates with increased resistance to penicillin in cases of acute otitis media. Antimicrob Agents Chemother. 1999;43:16-20.

Hatakka K, Blomgren K, Pohjavuori S, Kaijalainen T, Poussa T, Leinonen M, et al. Treatment of acute otitis media with probiotics in otitis-prone children-a double-blind, placebo-controlled randomised study. Clin Nutr. 2007 Jun;26(3):314-21. Epub 2007 Mar 13.

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

Ilicali OC, Keles N, Deger K, Savas I. Relationship of passive cigarette smoking to otitis media. Arch Otolaryngol Head Neck Surg. 1999;125(7):758-762.

Jacobs J, Springer DA, Crothers D. Homeopathic treatment of acute otitis media in chiildren: a preliminary ransomized placebo-controlled trial. Pediatr InfectDis J. 2001;20(2):177-183.

Jonas WB, Jacobs J. Healing with Homeopathy: The Doctors' Guide. New York, NY: Warner Books; 1996: 171-172.

Kruzel T. The Homeopathic Emergency Guide. Berkeley, Calif: North Atlantic Books; 1992:243-245.

Kemper AR, Krysan DJ. Reevaluating the efficacy of naturopathic ear drops. Arch Pediatr Adolesc Med. 2002;156(1):88-89.

Klein JO.Changes in management of otitis media: 2003 and beyond. Pediatr Ann. 2002;31(12):824-826, 829.

Klein JO. Pneumococcal vaccines for infants and children – past, present, and future. Curr Clin Top Infect Dis. 2002;22:252-265.

Sarrell EM, Mandelberg A, Cohen HA. Efficacy of naturopathic extracts in the management of ear pain associated with acute otitis media. Arch Pediatr Adolesc Med. 2001;155(7):796-799.

Stathis SL, O'Callaghan DM, Williams GM, Najman JM, Andersen MJ, Bor W. Maternal cigarette smoking during pregnancy is an independent predictor for symptoms of middle ear disease at five years' postdelivery. Pediatrics. 1999;104(2):e16.

Uhari M, Kontiokari T, Koskela M, Niemela M. Xylitol chewing gum in prevention of acute otitis media: double-blind randomised trials. Br Med J. 1996;313:1180-1184.

Ullman D. Homeopathic Medicine for Children and Infants. New York, NY: Penguin Putnam; 1992: 78-81.

Ullman D. The Consumer's Guide to Homeopathy. New York, NY: Penguin Putnam; 1995: 178-179.

Wright ED, Pearl AJ, Manoukian JJ. Laterally hypertrophic adenoids as a contributing factor in otitis media. Int J Pediatr Otorhinolaryngol. 1998;45:207-214.

Review Date:
12/18/2007
Reviewed By:
Steven D. Ehrlich, N.M.D., private practice specializing in complementary and alternative medicine, Phoenix, AZ. Review provided by VeriMed Healthcare Network.

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The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997-2009 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.

adam.com

Sleep apnea

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

Overview

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

HEALTH GUIDE REFERENCE FROM A.D.A.M

People with sleep apnea stop breathing for short periods of time while they are asleep. You generally don't wake up fully when this happens, but in the morning you don't feel rested, and you feel sleepy during the day. Sleep apnea can be caused by a blocked upper airway (called obstructive apnea), by your brain not signaling your lungs to breathe (central apnea), or by a combination of these two problems. Obstructive sleep apnea is the most common form.

Signs and Symptoms

The symptoms of sleep apnea include the following.

Loud, irregular snoring, then quiet periods of at least 10 seconds when breathing stops. These episodes can happen up to 100 times or more each hour.
Daytime sleepiness, always feeling tired
Morning headaches, sore throat, dry mouth, cough
Feeling depressed, moody, irritable
Unable to concentrate or remember
Possible impotence or high blood pressure

What Causes It?

Many physical conditions (such as obesity, or large tonsils and adenoids) can cause sleep apnea. The typical person with sleep apnea is an overweight, middle-aged man who has allergies, but apnea can occur at any age and in women as well as men. Sometimes drugs such as alcohol, sleeping pills, or heart medications can trigger apnea. It can also be inherited.

What to Expect at Your Provider's Office

People who have sleep apnea often seek medical help because they feel tired all the time or because their partner complains of loud snoring. Your health care provider will check your weight and blood pressure and ask about allergies. Your healthy care provider may send you home with a device to check your oxygen levels while you sleep. They may also refer you to a sleep clinic for overnight testing.

Treatment Options

The most effective treatment is called Continuous Positive Airway Pressure (CPAP), which uses a machine and mask to blow air through the airway at a pressure high enough to make sure the airway stays open.
A few drugs hold promise, but most have some undesirable side effects.
Some dental appliances, worn in your mouth, are available. They work by pushing the lower jaw forward, by keeping the tongue from obstructing the airway, or by a combination of both. These may be uncomfortable at first.
Sometimes surgery is needed, but your health care provider will most likely recommend that you try devices or drugs first.

Making the following lifestyle changes can help obstructive apnea:

Lose weight. Often this will cause obstructive apnea to go away completely.
Minimize your use of alcohol, antihistamines, or tranquilizers.
Get treatment for allergies and colds or sinus problems.
Gargle with salt water (without swallowing) to shrink your tonsils.
Develop regular sleep habits, and especially make sure you get enough sleep at night.
Sleep on your side rather than on your back or with your body elevated from the waist up. You can use foam wedges (rather than soft pillows, which tend to make apnea worse by pushing the chin toward the chest) to raise your upper body.
Use an air humidifier at night.
Don't smoke or expose yourself to other irritants (such as dust or perfumes).
Raise the head of your bed by placing bricks under the headboard.

Drug Therapies

There is no drug that completely treats sleep apnea. Some of the drugs used in combination with CPAP include:

Medications used to treat central apnea:

Acetazolamide
Clomipramine -- side effects may include impotence

Medications used to treat obstructive apnea:

Medroxyprogesterone -- side effects may include nausea, depression, excess hair growth, breast tenderness, and fluid retention.
Protriptyline -- this medication is used rarely. Side effects may include dry mouth, constipation, frequent urination, impotence, and confusion (in the elderly).
Modafinil -- sometimes prescribed in combination with CPAP to treat excessive daytime sleepiness.

Complementary and Alternative Therapies

Alternative therapies may be useful in treating sleep apnea caused by allergies. Homeopathy and nutrition are most likely to have a positive effect. While many supplements are touted as good for weight loss, none have proved to be as effective as eating less and exercising more.

Nutrition and Supplements

Diet: Try eliminating mucus-producing foods (dairy and bananas) for 2 weeks, then reintroducing them and noticing any difference.
Essential fatty acids (EFAs) moderate inflammatory response and decrease allergic response. EFAs are found to be low in obese people. Fish oil, evening primrose oil, flaxseed oil, and borage oil all contains essential fatty acids.
Chromium helps regulate insulin and decrease insulin resistance. Chromium may not be effective at burning fat, but it is effective at stabilizing blood sugar and decreasing sugar cravings. The adequate intake is 45 mcg per day. Studies suggest amounts of 200 mcg per day for up to 6 months are safe. Do not take chromium if you are pregnant. If you have diabetes, do not take chromium without your doctor's supervision.

Homeopathy

There have been few studies examining the effectiveness of specific homeopathic remedies, though it may be helpful as a supportive therapy. Professional homeopaths, however, may recommend one or more of the following treatments for sleep apnea based on their knowledge and clinical experience. Before prescribing a remedy, homeopaths take into account a person's constitutional type -- your constitution is his or her physical, emotional, and intellectual makeup. An experienced homeopath assesses all of these factors when determining the most appropriate remedy for a particular individual.

Arsenicum album -- for respiratory disorders that worsen at night and are accompanied by fear, agitation, restlessness, weakness, and exhaustion.
Lachesis -- for conditions that get worse while trying to sleep. This remedy is most appropriate for those who are intense, talkative, jealous, and may feel depressed (particularly in the morning). It is may help people who may be frightened of going to sleep.
Opium -- this remedy may be prescribed for individuals with sleep apnea and narcolepsy (inability to control falling asleep during the daytime). This remedy is appropriate for individuals who may be somewhat confused due to the sleep disorder.
Sambucus -- for difficulty breathing at night. This remedy is most appropriate for individuals who may have nasal obstruction or asthma and actually jump up out of bed with a feeling of suffocation.
Spongia -- for respiratory symptoms that are worsened by cold air and lying down. This remedy is appropriate for individuals often feel a tightness in the chest area.
Sulphur -- for chronic conditions accompanied by sleep disturbances and nightmares, especially if the individual also has skin rashes that become worse with heat. This remedy is most appropriate for individuals who prefer cold temperatures and strongly dislike any kind of restriction.

Acupuncture

Some evidence suggests that a type of acupuncture called auriculotherapy acupoint pressure may help treat sleep apnea.

Following Up

Sleep apnea is a serious condition that can cause fatal heart problems, so it's crucial to stick with your treatment plan. If you are using a mask and ventilator equipment, be sure to take care of them. Keep in contact with your health care provider or sleep clinic to make sure your treatment is working.

Special Considerations

If you are pregnant, you may have nasal congestion that makes you snore in a way that people with apnea do, but this is not apnea. If you have apnea and become pregnant, be sure to continue your treatment so that your condition will not affect your baby.

Supporting Research

Caldwell JP. Sleep: Everything You Need to Know. Buffalo, NY: Firefly Books; 1997.

Cummings S, Ullman D. Everybody's Guide to Homeopathic Medicines. 3^rd ed. New York, NY: Penguin Putnam; 1997: 237-239, 306, 320-321, 331-332.

Faccenda JF, Mackay TW, Boon NA, et al. Randomized placebo-controlled trial of continuous positive airway pressure on blood pressure in the sleep apnea-hypopnea syndrome. Am J Respir Crit Care Med 2001;163(2):344-8

Flemons WW. Clinical practice: obstructive sleep apnea. N Engl J Med 2002;347(7):498-504

Jonas WB, Jacobs J. Healing with Homeopathy: The Doctors' Guide. New York, NY: Warner Books; 1996: 260-264.

Morrison R. Desktop Guide to Keynotes and Confirmatory Symptoms. Albany, Calif: Hahnemann Clinic Publishing; 1993.

Pascualy RA, Soest SW. Snoring and Sleep Apnea: Personal and Family Guide to Diagnosis and Treatment. 2nd ed. New York, NY: Demos Vermande; 1996.

Smolley LA, Bruce DF. Breathe Right Now: A Comprehensive Guide to Understanding and Treating the Most Common Breathing Disorders. New York, NY: WW Norton & Co; 1998.

Wang XH, Yuan YD, Wang BF. Clinical observation of effect of auricular acupoint pressing in treating sleep apnea syndrome. Zhongguo Zhong Xi Yi Jie He Za Zhi. 2003 Oct;23(10):747-9.

Review Date:
6/30/2006
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

Calcium

FitSugar — Wed, 08 Oct 2008 17:35:15 -0700

Overview

Overview
Dietary Sources
Available Forms
How to Take It
Precautions
Possible Interactions
Supporting Research

HEALTH GUIDE REFERENCE FROM A.D.A.M

Overview

Calcium is the most abundant mineral in the body. It is essential for the development and maintenance of strong bones and teeth, the location of about 99% of the body's calcium. Calcium also helps the heart, nerves, muscles, and other body systems work properly. It is probably best known for its effects in preventing osteoporosis. Your body needs several other nutrients in order for calcium to be absorbed and used properly, including magnesium, phosphorous, and especially vitamins D and K.

The best way to get calcium is through food (see Dietary Sources). But although many foods are fortified with calcium, some people may still need to take calcium supplements. In fact, according to the National Institutes of Health, many Americans consume less than half the amount of calcium recommended to build and maintain healthy bones. It is especially important to get enough calcium as you age. Postmenopausal women, people who consume large amounts of caffeine, alcohol, or soda, and those who take corticosteroid medications may need calcium supplements. Calcium deficiency can be found in people with malabsorption problems, such as Crohn's disease, celiac disease, and surgical intestinal resection.

Getting enough calcium can help prevent or treat the following conditions:

Osteoporosis

Calcium is necessary to help build and maintain healthy bones and strong teeth. Studies have shown that calcium, particularly in combination with vitamin D, can help prevent bone loss associated with menopause, as well as the bone loss experienced by older men. If you do not get enough calcium in your diet, taking a supplement may be necessary.

Hypoparathyroidism

People with this condition have underactive parathyroid glands, which are four small glands that sit on the four corners of the thyroid in the neck and produce a hormone that regulates calcium, phosphorous, and vitamin D levels in the body. People with this condition should follow a high-calcium, low-phosphorous diet as prescribed by their doctor. Most often, they will also need to take calcium supplements.

Premenstrual Syndrome (PMS)

One large, well-designed study showed that women who took 1,200 mg of calcium per day reduced their symptoms of PMS by 50%, including headache, moodiness, food cravings, and bloating. A smaller study suggested that calcium may help reduce menstrual pain.

High Blood Pressure

People who do not get enough calcium may be at higher risk for hypertension, and there is some mixed evidence that suggests increasing calcium levels may lower blood pressure slightly. However, not all studies have found that benefit; and researchers aren’t sure whether calcium supplements would have any benefit, or whether it’s the effects of a diet that includes low-fat dairy products (which contain calcium) that is responsible. If you want to try calcium supplements, do not stop taking your blood pressure medication; talk to your doctor and let the doctor determine the proper dose of calcium for you. You may need to take calcium for 6 - 8 weeks before you see any improvement in blood pressure.

Some studies suggest that calcium supplementation may play a role in the prevention of pregnancy-induced high blood pressure and preeclampsia (a combination of high blood pressure, fluid retention, and high levels of protein in the urine that some women develop in the last trimester of pregnancy). However, not all studies show the same benefit. A prenatal vitamin, which provides magnesium, folic acid, and many other nutrients, together with adequate calcium intake through the diet, may lower the risk of developing high blood pressure during pregnancy.

Obesity

Some animal and human studies have found that consuming low-fat dairy products may help you lose or maintain a proper weight. However, researchers aren’t sure whether the calcium in the dairy products affects weight, some other nutrient -- or even a combination of nutrients. In addition, not all studies have found any benefit; and there’s no sound evidence that calcium supplements (as opposed to dairy products) would help in losing weight. More research is needed.

High Cholesterol

Preliminary studies in animals and people suggest that calcium supplements, in the range of 1,500 to 2,000 mg per day, may help to lower cholesterol slightly. From these studies, it appears that calcium supplements (along with exercise and proper diet) may be better at keeping cholesterol at normal levels than at lowering them once cholesterol is already high. More research in this area is needed.

Rickets

Rickets causes softening and weakening of the bone in children. Although virtually eliminated in North America and Western Europe, where milk consumption is common, it still occurs in many parts of the world. Researchers have thought that rickets is caused by a lack of vitamin D; however, a study in 2000 showed that calcium supplementation is an effective treatment.

Other Uses

Stroke -- In a population-based study (one in which large groups of people are followed over time), women who take in more calcium, both through their diet and with supplements, were less likely to have a stroke over a 14-year period. More research is needed.

Colon Cancer -- Although not all studies agree, some show that people who consume higher amounts of calcium, vitamin D, and milk in their diets are less likely to develop colorectal cancer than those who consume low amounts of the same nutrients. But researchers are not sure whether calcium supplements would have the same effect as calcium in the diet, or even whether calcium itself is responsible for the benefit.

Dietary Sources

The richest dietary sources of calcium include cheeses (such as parmesan, Romano, gruyere, cheddar, American, mozzarella, and feta), low-fat dairy products (milk, yogurt), tofu, and blackstrap molasses. Some other good sources of calcium include almonds, brewer's yeast, bok choy, Brazil nuts, broccoli, cabbage, dried figs, kelp, dark leafy greens (dandelion, turnip, collard, mustard, kale, Swiss chard), hazelnuts, oysters, sardines, and canned salmon,.

Foods that are fortified with calcium, such as juices, soy milk, rice milk, tofu and cereals, are also good sources of this mineral.

Available Forms

There are a number of forms of calcium available as dietary supplements. They differ in the amount of calcium they contain, how well they are absorbed by the body, and how much they cost. The two most popular forms are calcium citrate and calcium carbonate.

Calcium citrate: Easily absorbed and digested by the body, particularly in the elderly. It does not contain as much elemental calcium (the amount your body actually absorbs) as calcium carbonate. It is more costly than calcium carbonate, however. Also, calcium citrate should not be used with aluminum-containing antacids (see Possible Interactions).
Calcium carbonate: Less expensive than calcium citrate and contains more elemental calcium. Requires a certain amount of stomach acid to be absorbed, so it is usually taken with a glass of orange juice. Many antacids contain calcium carbonate.

Calcium supplements that are derived from oyster shells, dolomite, and bone meal are best avoided as they may contain lead, a toxic metal (particularly worrisome in children and those with kidney disease) that can harm the brain and kidneys, cause anemia, and raise blood pressure.

How to Take It

Calcium supplements should be taken in small doses (no more than 500 mg at a time -- that’s all your body can absorb in one dose) throughout the day with 6 - 8 cups of water to avoid constipation.

The following are daily dietary recommendations for general health and prevention of disease.

Pediatric

Talk to your pediatrician before giving a child any nutritional supplement.

Infants birth to 6 months: 210 mg
Infants 7 months to 1 year: 270 mg
Children 1 - 3 years: 500 mg
Children 4 - 8 years: 800 mg
Adolescents 9 - 18 years: 1,300 mg

Adult

19 - 50 years: 1,000 mg
51 years and older: 1,200 mg
Pregnant and breastfeeding females under 19 years: 1,300 mg
Pregnant and breastfeeding females 19 years and older: 1,000 mg

For prevention of colon cancer, 1,800 mg per day may be required.

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. Total calcium intake, from combined dietary and supplemental sources, should not exceed 2,500 mg per day.

Side effects can include constipation and stomach upset. Very high doses can cause nausea, vomiting, loss of appetite, increased urination, kidney toxicity, confusion, and irregular heart rhythm.

More generally, such high levels of calcium in the body occur when the body produces too much calcium. People with hyperparathyroidism, kidney failure, sarcoidosis, or cancer could be at risk for elevated levels of calcium and should not take calcium supplements.

People with a history of kidney stones should not take calcium supplements. However, some research suggests that calcium in the diet may not increase the risk of kidney stones. If you have or have had kidney stones, talk to your doctor about whether you should restrict calcium in your diet.

Men at risk for prostate cancer should avoid calcium supplements and also talk to their doctor about restricting low-fat dairy in their diets. Several studies have shown that higher intakes of calcium, whether from supplements or dairy products, are associated with greater risk of prostate cancer.

Possible Interactions

If you are currently being treated with any of the following medications, you should not use calcium supplements without first talking to your doctor.

Alendronate -- Calcium may interfere with the absorption of alendronate, a medication used to treat osteoporosis. Calcium-containing products should be taken at least 2 hours before or after alendronate.

Antacids that contain aluminum -- When calcium citrate is taken with aluminum-containing antacids, the amount of aluminum absorbed into the blood may be increased significantly. This is a particular problem for people with kidney disease, for whom the aluminum levels may become toxic.

Blood pressure medications -- Taking calcium with a beta-blocker (such as atenolol) may interfere with blood levels of both the calcium and the beta-blocker. Study results are conflicting, however. Similarly, it has been reported that calcium interferes with calcium channel blockers (such as verapamil), but these study results are also controversial. If you take a beta-blocker or calcium-channel blocker, do not take calcium supplements without your doctor’s supervision.

Cholesterol-lowering medications -- A class of medications known as bile acid sequestrants (including cholestyramine, colestipol, and colesevelam), used to treat high cholesterol, may interfere with normal calcium absorption and increase the loss of calcium in the urine. Supplementation, therefore, with calcium and vitamin D may be recommended by your health care provider.

Corticosteroids -- If you take corticosteroids on a long-term basis, you may need to take calcium supplements.

Digoxin -- High levels of calcium may increase the risk of a toxic reaction to digoxin, a medication used to treat irregular heart rhythms. On the other hand, low levels of calcium cause digoxin to be ineffective. If you take digoxin, your doctor should monitor your calcium levels closely.

Diuretics -- Different types of diuretics interact with calcium in opposite ways.

Thiazide diuretics (such as hydrochlorothiazide) can raise calcium levels in the blood.
Loop diuretics (such as furosemide and bumetanide) can decrease calcium levels.
Amiloride (a potassium-sparing diuretic) may decrease the amount of calcium excreted in the urine (thus increasing calcium levels in the blood), especially in people with kidney stones.

Estrogens -- Estrogens may contribute to an overall increase in calcium blood levels. Taking calcium supplements with estrogens improves bone density significantly.

Gentamicin -- Taking calcium during treatment with the antibiotic gentamicin may increase the potential for toxic effects on the kidneys.

Antibiotics -- Different types of antibiotics interact with calcium.

Quinolones: Calcium can interfere with the body's ability to absorb quinolone antibiotics (such as ciprofloxacin or Cipro; levofloxacin, norfloxacin or Noroxin; and ofloxacin). Take calcium supplements 2 - 4 hours before or after taking quinolone antibiotics
Tetracyclines: Calcium can interfere with the body's ability to absorb tetracycline antibiotics (including doxycycline, minocycline, and tetracycline). Take calcium supplements 2 -4 hours before or after taking quinolone antibiotics.

Anti-seizure medications -- Some seizure medications, such as phenytoin (Dilantin), carbamazepine, phenobarbitol, and primidone, may lower levels of calcium in the body. Some doctors recommend vitamin D along with anti-seizure drugs to try to keep calcium levels up. In addition, you should take doses of calcium and anti-seizure medications at least 2 hours apart, because each interferes with the absorption of the other.

Supporting Research

Allender PS, Cutler JA, Follmann D, Cappuccio FP, Pryer J, Elliott P. Dietary calcium and blood pressure: a meta-analysis of randomized clinical trials. Ann Intern Med. 1996;124(9):825-831.

Appel L, Moore T, Obarzonek E, et al. A clinical trial of the effects of dietary patterns on blood pressure. DASH Collaborative Research Group. N Engl J Med. 1997;336:1117-1124.

Baeksgaard L, Andersen KP, and Hyldstrup L. Calcium and vitamin D supplementation increases spinal BMD in healthy, postmenopausal women. Osteoporos Int. 1998;8:255-260.

Balfour JA, Wiseman LR. Moxifloxacin. Drugs. 1999;57(3):363-374.

Baron JA, Beach M, Mandel JS, et al. Calcium supplements for the prevention of colorectal adenomas. N Eng J Med. 1999;340:101-107.

Bauman WA, Shaw S, Jayatilleke E, Spungen AM, Herbert V. Increased intake of calcium reverses vitamin B12 malabsorption induced by metformin. Diabetes Care. 2000;23(9):1227-1231.

Bendich A. The potential for dietary supplements to reduce premenstrual syndrome (PMS) symptoms [review]. J Am Coll Nutr. 2000;19(1);3-12.

Blanch J, Pros A. Calcium as a treatment of osteoporosis. Drugs Today. 1999;35:631-639.

Bonithon-Kopp C, Kronborg O, Giacosa A, Rath U, Faivre J. Calcium and fibre supplementation in prevention of colorectal adenoma recurrence: a randomised intervention trial. European Cancer Prevention Organisation Study Group. Lancet. 2000;356:1300-1306.

Boonen S, Lips P, Bouillon R, Bischoff-Ferrari HA, Vanderschueren D, Haentjens P. Need for additional calcium to reduce the risk of hip fracture with vitamin d supplementation: evidence from a comparative metaanalysis of randomized controlled trials. J Clin Endocrinol Metab. 2007 Apr;92(4):1415-23.

Borghi L, Schianchi T, Meschi T, et al. Comparison of two diets for the prevention of recurrent stones in idiopathic hypercalciuria. N Engl J Med. 2002;346(2):77-84.

Bostick RM, Fosdick L, Grandits GA, Grambsch P, Gross M, Louis TA. Effect of calcium supplementation on serum cholesterol and blood pressure. Arch Fam Med. 2000;9:31-39.

Brouwers JR. Drug interactions with quinolone antibacterials. Drug Safety. 1992;7(4):268-281.

Bryant RJ, Cadogan J, Weaver CM. The new dietary reference intakes for calcium: implications for osteoporosis. J Am Coll Nutr. 1999;18:406S-412S.

Caan B, Neuhouser M, Aragaki A, Lewis CB, Jackson R, LeBoff MS, et al. Calcium plus vitamin D supplementation and the risk of postmenopausal weight gain. Arch Intern Med. 2007 May 14;167(9):893-902.

Chan JM, Stampfer MJ, Ma J, Gann PH, Gaziano JM, Giovannucci EL. Dairy products, calcium, and prostate cancer risk in the Physicians' Health Study. Am J Clin Nutr. 2001;74(4):549-554.

Coburn JW, Mischel MG, Goodman WG, Salusky IB. Calcium citrate markedly enhances aluminum absorption from aluminum hydroxide. Am J Kidney Dis. 1991;17(6):708-711.

Consensus Opinion. The role of calcium in peri- and postmenopausal women: consensus opinion of the North American Menopause Society. Menopause. 2001;8:84-95.

Davies KM, Heaney RP, Recker RR, et al. Calcium intake and body weight. J Clin Endocrinol Metab. 2000;85(12):4635-4638.

Garland CF, Garland FC, Gorham ED. Calcium and vitamin D: their potential roles in colon and breast cancer prevention. Ann NY Acad Sci. 1999;889:107-119.

Grau MV, Baron JA, Sandler RS, Wallace K, Haile RW, Church TR, et al. Prolonged effect of calcium supplementation on risk of colorectal adenomas in a randomized trial. J Natl Cancer Inst. 2007 Jan 17;99(2):129-36.

Gulson BL, Mizon KJ, Palmer Jm, Korsch MJ, Taylor AJ. Contribution of lead from calcium supplements to blood lead. Environ Health Perspect. 2001;109(3):283-288.

Haft JJ, Habbab MA. Treatment of atrial arrhythmias. Effectiveness of verapamil when preceeded by calcium infusion. Arch Intern Med. 1986; 146(6):1085-1089.

Heaney RP. Lead in calcium supplements: cause for alarm or celebration [editorial]? JAMA. 2000;284(11):1432-1433.

Heaney RP, Dowell SD, Bierman J, Hale CA, Bendich A. Absorbability and cost effectiveness in calcium supplementation. J Am Coll Nutr. 2001;20(3):239-246.

Heller HJ, Stewart A, Haynes S, Pak CYC. Pharmacokinetics of calcium absorption from two commercial calcium supplements. J Clin Pharmacol. 1999;39:1151-1154.

Hermensen K. Diet, blood pressure and hypertension. Br J Nutr. 2000;83(Suppl 1):S113-S119.

Hiller JE, Crowther CA, Moore VA, Willson K, Robinson JS. Calcium supplementation in pregnancy and its impact on blood pressure in children and women: follow up of a randomised controlled trial. Aust N Z J Obstet Gynaecol. 2007 Apr;47(2):115-21.

Hines Burnham T, et al, eds. Drug Facts and Comparisons. St. Louis, MO:Facts and Comparisons; 2000.

Hofmeyr G, Duley L, Atallah A. Dietary calcium supplementation for prevention of pre-eclampsia and related problems: a systematic review and commentary. BJOG. 2007 Jun 12; (Epub ahead of print)

Holt PR. Dairy foods and prevention of colon cancer: human studies. J Am Coll Nutr. 1999;18(suppl 5):379S-391S.

Institute of Medicine. Standing Committee on the Scientific Evaluation of Dietary Reference Intakes. Dietary Reference Intakes: Calcium, Phosphorus, Magnesium, Vitamin D, and Fluoride. Washington, DC: National Academy Press; 1997.

Iso H, Stampfer MJ, Manson JE, et al. Prospective study of calcium, potassium, and magnesium intake and risk of stroke in women. Stroke. 1999;30(9):1772-1779.

Jänne PA, Mayer RJ. Chemoprevention of colorectal cancer. N Engl J Med. 2000;342(26):1960-1968.

Joint National Committee. Sixth Report of the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure. Arch Int Med. 1997;157:2413-2446.

Kampman E, Slattery ML, Caan B, Potter JD. Calcium, vitamin D, sunshine exposure, dairy products and colon cancer risk (United States). Cancer Causes Control. 2000:11:459-466.

Kara M, Hasinoff BB, McKay DW, et al. Clinical and chemical interactions between iron preparations and ciprofloxacin. Br J Clin Pharmacol. 1991;31(3):257-261.

Krall EA, Wehler C, Garcia RI, et al. Calcium and vitamin D supplements reduce tooth loss in the elderly. Am J Med. 2001 Oct 15;111(6):452-456.

Krauss RM, Eckel RH, Howard B, et al. AHA dietary guidelines. Revision 2000: A statement for healthcare professionals from the Nutrition Committee of the American Heart Association. Circulation. 2000;102:2284-2299.

Lappe JM, Travers-Gustafson D, Davies KM, Recker RR, Heaney RP. Vitamin D and calcium supplementation reduces cancer risk: results of a randomized trial. Am J Clin Nutr. 2007 Jun;85(6):1586-91.

Li RC, Lo KN, Lam JS, et al. Effects of order of magnesium exposure on the postantibiotic effect and bactericidal activity of ciprofloxacin. J Chemother. 1999;11(4):243-247.

Lin Y-C, Lyle RM, McCabe LD, et al. Dairy calcium is related to changes in body composition during a two-year exercise intervention in young women. J Am Coll Nutr. 2000;19(6):754-760.

Lobo RA, Roy S, Shoupe D, et al. Estrogen and progestin effects on urinary calcium and calciotropic hormones in surgically-induced postmenopausal women. Horm Metab Res. 1985;17(7):370-373.

Lukert BP, Raisz LG. Glucocorticoid-induced osteoporosis: pathogenesis and management. Ann Intern Med. 1990;112(5):352-364.

McCarron D, Reusser M. Finding Consensus in the Dietary Calcium-Blood Pressure Debate. J Am Coll Nutr. 1999;18:398S-405S.

Myers VH, Champagne CM. Nutritional effects on blood pressure. Curr Opin Lipidol. 2007 Feb;18(1):20-4.

NAMS Consensus. Consensus Opinion: the role of calcium in peri-and postmenopausal women: consensus opinion of The North American Menopause Society. Menopause. 2001;8(20):84-95.

Napoli N, Thompson J, Civitelli R, Armamento-Villareal RC. Effects of dietary calcium compared with calcium supplements on estrogen metabolism and bone mineral density. Am J Clin Nutr. 2007 May;85(5):1428-33.

Neuvonen PJ. Interactions with the absorption of tetracyclines. Drugs. 1976;11(1):45-54.

Nieves JW, Komar L, Cosman F, Lindsay R. Caclium potentiates the effect of estrogen and calcitonin on bone mass: review and analysis. Am J Clin Nutr. 1998;67(1):18-24.

NIH Consensus Development Panel. Osteoporosis prevention, diagnosis, and therapy. JAMA. 2001;285(6):785-795.

Nolan CR, DeGoes JJ, Alfrey AC. Aluminum and lead absorption from dietary sources in women ingesting calcium citrate. South Med J. 1994;8(9):894-898.

Nutrients and Nutritional Agents. In: Kastrup EK, Hines Burnham T, Short RM, et al, eds. Drug Facts and Comparisons. St. Louis, Mo: Facts and Comparisons; 2000:4-5.

Peacock M, Liu G, Carey M, et al. Effect of calcium or 25OH vitamin D3 supplementation on bone loss at the hip in men and women over the age of 60. J Clin Endocrinol Metabol. 2000;85(9):3011-3019.

Petti S, Cairella G, Tarsitani G. Nutritional variables related to gingival health in adolescent girls. Community Dent Oral Epidemiol. 2000 Dec;28(6):407-413.

Physicians' Desk Reference. 55th ed. Montvale, NJ: Medical Economics Co., Inc; 2000:1418-1422.

Pietinen P, Malila N, Virtanen M, et al. Diet and risk of colorectal cancer in a cohort of Finnish men. Cancer Causes Control. 1999;10:387-396.

Reid IR, Veale AG, France JT. Glucocorticoid osteoporosis. J Asthma. 1994;31(1):7-18.

Ross EA, Szabo NJ, Tebbett IR. Lead content of calcium supplements. JAMA. 2000;284(11):1425-1429.

Ruml LA, Sakhaee K, Peterson R, et al. The effect of calcium citrate on bone density in the early and mid-postmenopausal period: a randomized placebo-controlled study. Am J Ther. 1999;6:303-311.

Sacks FM, Svetkey LP, Volmer WM, et al. Effects on blood pressure of reduced dietary sodium and the Dietary Approaches to Stop Hypertension (DASH) Diet. N Engl J Med. 2001;344:3-10.

Sakhaee K, Bhuket T, Adams-Huet B, Rao DS. Meta-analysis of calcium bioavailability: a comparison of calcium citrate with calcium carbonate. Am J Ther. 1999;6:313-321.

Sakhaee K, Nicar M, Glass K, Zerwekh J, Pak C. Reduction in intestinal calcium absorption by hydrochlorothiazide in postmenopausal osteoporosis. J Clin Endocrinol Metab. 1984;59(6):1037-1043.

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Review Date:
6/25/2007
Reviewed By:
Steven D. Ehrlich, N.M.D., private practice specializing in complementary and alternative medicine, Phoenix, AZ. Review provided by VeriMed Healthcare Network.

A.D.A.M. Copyright

adam.com

Menstrual pain

FitSugar — Wed, 08 Oct 2008 17:34:56 -0700

Overview

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

HEALTH GUIDE REFERENCE FROM A.D.A.M

Menstrual pain is a common gynecological complaint in adolescents, but the majority of cases are not associated with a disease.

Primary dysmenorrhea is the medical term for menstrual pain.

Primary dysmenorrhea usually begins 2 - 3 years after the first period, once ovulation is established. Pain usually begins a day or two before menstrual flow, and may continue through the first 2 days of menstruation. Discomfort tends to decrease over time and after pregnancy.

Secondary dysmenorrhea is caused by underlying conditions, such as endometriosis and pelvic inflammatory disease.

Signs and Symptoms

Symptoms and degree of pain vary, but may include the following:

Abdominal cramping or dull ache that moves to lower back and legs
Heavy menstrual flow
Headache
Nausea
Constipation or diarrhea
Frequent urination
Vomiting (not common)

What Causes It?

Primary dysmenorrhea is caused by strong uterine contractions brought on by an increase in prostaglandin. Prostaglandin is a hormone that causes muscle spasms of the uterus (endometrium).

Secondary dysmenorrhea can be caused by:

Endometriosis (inflammation of the lining of the uterus)
Blood and tissue being discharged through a narrow cervix
Uterine fibroid or ovarian cyst
Infections of the uterus
Pelvic inflammatory disease (PID)
Intrauterine device (IUD)

What to Expect at Your Provider's Office

A pelvic examination may include an internal examination, laparoscopy, and ultrasound. You may need a Pap test or D&C to analyze tissue. Blood and urine samples may be required.

Treatment Options

Drug Therapies

Initial treatment is focused on relief of pain. Anti-inflammatory medications can be helpful. This includes over-the-counter (OTC) medications such as aspirin, nonsteroidal anti-inflammatory medications (NSAIDs) such as ibuprofen (Motrin, Advil), and prescription medications. (Note: Long-term use of NSAIDs can lead to gastrointestinal bleeding.)

Oral contraceptives may be prescribed in severe cases for disorders such as endometriosis.

If menstrual pain results from pelvic inflammatory disease (PID), antibiotics will be prescribed.

Complementary and Alternative Therapies

Dysmenorrhea may be effectively treated with nutritional support and mind-body techniques (such as meditation) and exercises (such as yoga and tai chi).

Nutrition and Supplements

Eliminate potential food allergens, including dairy, wheat (gluten), corn, soy, preservatives, and food additives. Your health care provider may want to test for food sensitivities.
Eat calcium-rich foods, including beans, almonds, and dark green leafy vegetables (such as spinach and kale).
Eat antioxidant foods, including fruits (such as blueberries, cherries, and tomatoes), and vegetables (such as squash and bell pepper).
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.
Drink soy milk for bone health and symptoms of menstrual pain.
Reduce or eliminate trans-fatty acids, found in commercially baked goods such as cookies, crackers, cakes, French fries, onion rings, donuts, processed foods, and margarine.
Avoid coffee and other stimulants, alcohol, and tobacco.
Drink 6 - 8 glasses of filtered water daily.
Exercise at least 30 minutes daily, 5 days a week.

Nutritional deficiencies may be addressed with the following supplements:

A multivitamin daily, containing the antioxidant vitamins A, C, E, the B-complex vitamins and trace minerals such as magnesium, calcium, zinc and selenium.
Omega-3 fatty acids, such as fish oil, 1 - 2 capsules or 1 tbsp. oil daily, to help decrease inflammation.
Acidophilus (Lactobacillus acidophilus), 5 - 10 billion CFUs (colony forming units) a day, for maintenance of gastrointestinal and vaginal health. Some acidophilus products may require refrigeration. It is important to read the label carefully.
Calcium citrate, 500 - 1,000 mg daily, for bone support and symptoms of menstrual pain.
Vitamin D, 400 IU daily, for bone support and symptoms of menstrual pain.
Ipriflavone (soy isoflavones) standardized extract, 200 mg three times a day, for bone loss and symptoms of menstrual pain.
Progesterone cream, 1/8 - ¼ teaspoonful (depending upon extract strength) applied topically daily on days 7 - 28 of cycle, for symptoms of menstrual pain.
Omega-3 fatty acids, such as flaxseed and fish oils, 1 - 2 capsules or 1 tbsp. oil daily, to help decrease inflammation.
Melatonin, 2 - 5 mg before bed, for sleep regulation. Talk to a health care provider before using melatonin if you are taking antidepressant medications.

Herbs

Herbs are generally available as standardized dried extracts (pills, capsules, or tablets), teas, or tinctures/liquid extracts (alcohol extraction, unless otherwise noted). Mix liquid extracts with favorite beverage. Dose for teas is 1 - 2 heaping teaspoonfuls/cup water steeped for 10 - 15 minutes (roots need to be steeped longer).

The following herbal remedies may provide relief from symptoms:

Chaste tree (Vitex agnus castus) standardized extract, 20 - 40 mg daily before breakfast, for symptoms of menstrual pain.
Black cohosh (Actaea racemosa) standardized extract, 20 - 40 mg two times a day, for symptoms of pre-menstrual syndrome.
Evening primrose oil (Oenothera biennis) standardized extract, 500 - 1000 mg daily, as a source of gamma linolenic acid (GLA), for symptoms of menstrual pain.
Cat's claw (Uncaria tomentosa) standardized extract, 20 mg three times a day, for inflammation.
Bromelain (Ananus comosus) standardized extract, 40 mg three times daily, for pain and inflammation.
Turmeric (Curcuma longa) standardized extract, 300 mg three times a day, for inflammation.

Homeopathy

Few studies have examined the effectiveness of specific homeopathic remedies. However, a professional homeopath may recommend one or more of the following treatments for menstrual pain 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.

Belladonna -- for acute menstrual pain that often resembles labor pains; for pain often described as sharp, throbbing pressure in the pelvis accompanied by heavy bleeding; and for pain that may extend to the back and tends to worsen with walking or moving.
Chamomilla -- for menstrual pain with mood changes, including irritability and anger, and pain occuring after bouts of anger. The individual may have the sensation of a weight on her pelvis.
Cimicifuga -- for pain that moves from one side of the abdomen to the other and that is worsened by movement.
Colocynthis -- for sharp pain accompanied by anger and irritability.
Lachesis -- for pain and pressure that extend to the back. Symptoms tend to worsen at night.
Magnesia phos -- for cramps or sharp, shooting pains that are relieved by warmth, pressure, and bending forward.
Nux vomica -- for cramping pains that extend to the lower back; these pains are often accompanied by nausea, chills, irritability, and a sensitivity to light, noise, and odors.
Pulsatilla -- for menstrual pains accompanied by irritability, moodiness (including feelings of sadness), dizziness, fainting, nausea, diarrhea, back pain, and headaches; there may be more pain when there is no menstrual flow.

Physical Medicine

The following methods can relieve pelvic pain:

Castor oil pack. Apply oil directly to skin, cover with a clean soft cloth (for example, flannel) and plastic wrap. Place a heat source (hot water bottle or heating pad) over the pack and let sit for 30 - 60 minutes. For best results use 3 consecutive days in 1 week.
Contrast sitz baths. Use two basins that you can comfortably sit in. Sit in hot water for 3 minutes, then in cold water for 1 minute. Repeat three times to complete one set. Do one to two sets per day, 3 - 4 days per week.

Acupuncture

The National Institutes of Health recommend acupuncture as either a supplemental or alternative treatment for dysmenorhea. This recommendation is supported by a well-designed trial involving 43 women with dysmenorrhea. Women treated with acupuncture showed a dramatic reduction in both pain and the need for pain medication

Acupuncture has become a popular treatment for dysmenorrhea. Acupuncturists treat people with dysmenorrhea based on an individualized assessment of the excesses and deficiencies of energy (called qi) located in various meridians. In the case of dysmenorrhea, a qi deficiency is usually detected in the liver and spleen meridians. Moxibustion (a technique in which the herb mugwort is burned over specific acupuncture points) is often added to enhance needling treatment, and qualified practitioners may also recommend herbal or dietary treatments.

Acupressure is also effective at reducing the pain. A study of 216 female students found that acupressure and ibuprofen were significantly better than a placebo, or “dummy pill,” at reducing pain.

Chiropractic

Some people with dysmenorrhea may benefit from spinal manipulation (particularly in areas that supply sensory and motor impulses to the uterus and lower back). Studies of women with a diagnosis or history of primary dysmenorrhea have found that spinal manipulation improves symptoms, but no more effectively than sham manipulation. Sham manipulation refers to maneuvers that shift soft tissues surrounding the bone but do not actually adjust the spine or joint. Sham manipulation has been compared to placebo because both procedures look and feel the same. Interestingly, however, experts are now questioning whether sham is a fair placebo because the massage quality of the manipulation may also have a beneficial effect.

Following Up

If your symptoms change, or treatment does not help, tell your provider.

Special Considerations

Avoid caffeine, alcohol, and sugar prior to onset of your period.

Supporting Research

Balbi C, Musone R, Menditto A, et al., Influence of menstrual factors and dietary habits on menstrual pain in adolescence age. Eur J Obstet Gynecol Reprod Biol. 2000;91(2):143-8.

Barnard ND, Scialli AR, Hurlock D, Bertron P. Diet and sex-hormone binding globulin, dysmenorrhea, and premenstrual symptoms. Obstet Gynecol. 2000;95(2):245-50.

Dennehy CE. The use of herbs and dietary supplements in gynecology: an evidence-based review. J Midwifery Womens Health. 2006;51(6):402-9.

Fjerbaek A, Knudsen UB. Endometriosis, dysmenorrhea and diet -- what is the evidence? Eur J Obstet Gynecol Reprod Biol. 2007;132(2):140-7.

Grimes DA, Hubacher D, Lopez LM, Schulz KF. Non-steroidal anti-inflammatory drugs for heavy bleeding or pain associated with intrauterine-device use. Cochrane Database Syst Rev. 2006;(4):CD006034.

Habek D, Cortez Habek J, Bobic-Vukovic M, Vujic B. Efficacy of acupuncture for the treatment of primary dysmenorrheal. Gynakol Geburtshilfliche Rundsch. 2003 Oct;43(4):250-253.

Letzel H, Megard Y, Lamarca R, Raber A, Fortea J. The efficacy and safety of aceclofenac versus placebo and naproxen in women with primary dysmenorrhoea. Eur J Obstet Gynecol Reprod Biol. 2006;129(2):162-8.

Nagata C, Hirokawa K, Shimizu N, Shimizu H. Associations of menstrual pain with intakes of soy, fat and dietary fiber in Japanese women. Eur J Clin Nutr. 2005;59(1):88-92.

Pouresmail Z, Ibrahimzadeh R. Effects of acupressure and ibuprofen on the severity of dysmenorrheal. J Tradit Chin Med 2002 Sep;22(3):205-210.

Proctor ML, Murphy PA, Pattison HM, Suckling J, Farquhar CM. Behavioural interventions for primary and secondary dysmenorrhea. Cochrane Database Syst Rev. 2007;(3):CD002248.

Proctor ML, Hing W, Johnson TC, Murphy PA. Spinal manipulation for primary and secondary dysmenorrhea. Cochrane Database Syst Rev. 2006;3:CD002119.

Proctor ML, Latthe PM, Farquhar CM, Khan KS, Johnson NP. Surgical interruption of pelvic nerve pathways for primary and secondary dysmenorrhea. Cochrane Database Syst Rev. 2005 Oct 19; (4):CD001896.

Tugay N, Akbayrak T, Demirturk F, et al. Effectiveness of transcutaneous electrical nerve stimulation and interferential current in primary dysmenorrhea. Pain Med. 2007;8(4):295-300.

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

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