FitSugar

New Terra Chips: Stripes & Blues

FitSugar — Tue, 25 Sep 2007 02:30:00 -0700

How very patriotic of Terra to introduce a red, white, and blue chip medley they call Stripes and Blues. They are much healthier than the Lays chips I ate as a kid since they are made with 3 kinds of harvested veggies, not just your average potato. The red chips are made from sweet potatoes, the blue chips are made from blue potatoes, and the striped chips are striped beets.

These Stripes & Blues chips take my favorite Sweets & Beets to an entirely new visual level. I love that they're made with no trans fat or cholesterol, and contain hardly any saturated fat (the kind that is bad for your heart). Plus these chips have a much zestier flavor so they don't need a whole lot of sodium.

To check out the nutritional info and see what these delectable chips really look like, read more

Serving Size	1 oz (about 14 chips)
Calories	140
Total Fat	8g
Saturated Fat	.5g
Cholesterol	0mg
Sodium	110mg
Carbs	16g
Fiber	2g
Sugar	5g
Protein	2g
Ingredients	A seasonal mix of root vegetables (sweet potato, blue potato, beets), canola oil and/or safflower oil and/or sunflower oil, beet juice concentrate, sea salt.

Well I'm just amazed that these chips are actually as pretty as the photo on the outside of the bag, plus I can actually pronounce all the ingredients!

With only 110mg of sodium, these still taste salty and definitely satisfied my craving. Plus they have 2g of fiber (you can aways use more), 2g of protein, and 4% of your daily iron needs (I know it's not much, but every little bit counts).

I love that there are 3 different chips in this bag, so your taste buds never get bored. I definitely recommend looking for these chips in a health food store near you, or in the health food section of your grocery store.

Fit's Tip: Just remember, even though these chips are healthier than potato chips, they are still chips! So keep your portions under control.

Terra Chips: Potato Chips with a Twist

FitSugar — Mon, 19 Feb 2007 10:30:00 -0800

Sometimes a girl craves potato chips - it happens. When those moments come, who wants a boring greasy potato chip when you could have Terra Vegetable Chips?

Not only do they make delicious chips out of potatoes, but they also use exotic root vegetables like taro, ruby taro, sweet potato, batata, parsnip, and yuca.

These chips are all natural, made with root vegetable, canola and safflower oil, beet juice for color, and salt. And that means NO trans fat.

They're colorful, light, and each root vegetable has its own unique flavor. All mixed together, they achieve a satisfying balance of flavors - complex, nutty, rich, and delicate.

Not into the mixed vegetable chips? They also make Sweets & Beets chips - a mix of sweet potato and beets chips. Their Red Bliss Garlic & Parmesan potato chips are really unique.

But my favorite have to be the White, Russet & Sweet Potato Kettle chips.

But see for yourself. You can find Terra Chips at your local health food or specialty foods shop.

Terra Chips Sweets & Beets = YUM!

FitSugar — Fri, 24 Aug 2007 14:30:00 -0700

I took a flight on JetBlue last week and was loving their Terra Blue Chips. When I went to the health food store to pick some up, I came upon Terra's Sweets & Beets.

These krinkle-cut chips are made out of my favorite root veggies - delicious sweet potatoes and bold, beautiful beets. Sweets & Beets chips offer a hearty crunch, with a robust burst of sweet goodness.

Want to know what they're made with? The ingredients are simple - sweet potatoes, beets, canola oil and/or safflower oil and/or sunflower oil. That's right - no salt, no hydrogenated oils, no sugar or corn syrup (many a chip has this), and nothing but veggies and oil. I will happily recommend these Terra chips for a snack any day.

Want to see what they really look like? How about the nutritional info? Then read more

Serving Size	1 oz (16 chips)
Calories	150
Total Fat	9g
Saturated Fat	.5g
Cholesterol	0mg
Sodium	5mg
Carbs	15g
Fiber	1g
Sugar	0g
Protein	2g

Can you believe that? The serving size is pretty big compared to some other chips (Pico de Gallo), and there's no sodium, no cholesterol, and no sugar. I love it! These are a much healthier snack than say those Pita Chips I was tricked into buying (damn advertising), because these are made of actual vegetables instead of crappy enriched wheat flour. These Sweets & Beets could be my new favorite thing.

Learn to Love: Summer Squash

FitSugar — Thu, 18 Jun 2009 06:00:00 -0700

I have always held Winter squash in greater esteem than the Summer variety, since zucchini and crook neck squash seem to pale in comparison nutritionally. But it looks like I was wrong, because Summer squash has a lot to offer.

One cup of zucchini provides about 15 percent of the recommended daily intake for vitamin C and 10 percent of vitamin A. This veggie is high in manganese, a trace mineral that supports an active metabolism as well as brain function and bone health. One cup of Summer squash also provides two and a half grams of fiber, and every little bit of fiber adds up to make a healthy diet. Plus, you get around 10 percent of your daily intake requirements for potassium, folate, and vitamin K with a cup of squash, as well as a bit of omega-3 fatty acids. This variety of squash is also high in phytonutrients, though not quite as high as root vegetables, which have cancer-fighting effects.

Now that I have convinced us both of the nutritional merits this versatile vegetable, I am sure you are going to want to cook some up tonight. You can check out my serving suggestions when you read more.

Here are some of my favorite ways to enjoy green and yellow zucchini, crook neck squash, patty pan, and butter blossom squash:

Chop up a variety of Summer squash and saute in olive oil with garlic and red pepper flakes for an easy side dish.
Slice zucchini lengthwise, dip in olive oil, and grill.
For a veggie entree, cook up some creamy zucchini boats.

Love Summer squash? How do you like to cook you zucchini?

Getty

Periodontal disease

FitSugar — Wed, 08 Oct 2008 17:35:31 -0700

HEALTH GUIDE REFERENCE FROM A.D.A.M

Highlights

Symptoms of Periodontal Disease

Symptoms of periodontal disease include red and swollen gums, persistent bad breath, and gum recession and loose teeth. Smoking, certain types of illnesses (diabetes), older age, and other factors increase the risk for periodontal disease. If you have periodontal disease, your dentist may refer you to a periodontist, a dentist who specializes in treating this condition.

Practice Good Dental Hygiene

Consistent good dental hygiene can help prevent gingivitis and periodontitis. The American Dental Association recommends that everyone:

Brush twice daily with a fluoride toothpaste (be sure to replace toothbrushes every 3 - 4 months).
Clean between the teeth with floss or an interdental cleaner.
Eat a well-balanced diet and limit between meal snacks.
Have regular visits with a dentist for teeth cleaning and oral examinations.

Mouthwashes

In 2007, the American Dental Association stated that antimicrobial mouthwashes may provide additional oral health benefits for preventing and reducing gingivitis and plaque. However, they are not a substitute for daily brushing and flossing.

Research

Intensive treatment of periodontal disease may help reduce inflammation and improve blood flow throughout the body, according to a small study published in 2007 in the New England Journal of Medicine. In the study of patients with severe periodontitis, intensive treatment ultimately resulted in improved endothelial function. Poor endothelial function is associated with increased risk for atherosclerosis and heart disease. Researchers are investigating the connection between periodontal disease and heart disease, and whether treatment of periodontal disease can reduce heart disease risk.

Introduction

Periodontal disease refers to a group of problems that arise in the sulcus, the gap between the gum and the tooth.

The part of the mouth that consists of the gum and supporting structures is called the periodontium. It is made up of the following parts:

Gum (gingiva). When healthy, the gingiva is pale pink, firm, and does not move. It has a smooth or speckled texture. The gingival tissue between teeth is shaped like a wedge.
The space between the gum and tooth, called the sulcus
Root surface (the cementum)
Connective tissue
Bone. The crest of the supporting bone, which can be viewed on x-rays, is normally 2 mm below the point where the crown of the tooth meets the root (the cementoenamel junction).

The structure of the tooth includes dentin, pulp and other tissues, blood vessels, and nerves imbedded in the bony jaw. Above the gum line, the tooth is protected by the hard enamel covering.

Periodontal diseases are generally divided into two groups:

Gingivitis, which causes lesions (wounds) that affect the gums
Periodontitis, which damages the bone and connective tissue that supports the teeth

The process starts with bacteria. Even in healthy mouths, the sulcus is teeming with bacteria, but they tend to be harmless varieties. Periodontal disease develops usually because of two events in the oral cavity: an increase in bacteria quantity and a change in balance of bacterial types from harmless to disease-causing bacteria. These harmful bacteria increase in mass and thickness until they form a film called plaque.

Click the icon to see an image of plaque and damaged gum tissue.

In healthy mouths, plaque itself actually provides some barrier against outside bacterial invasion. When it accumulates to excessive levels, however, plaque sticks to the surfaces of the teeth and adjacent gums and causes cellular injury, with subsequent swelling, redness, and heat.

When plaque is allowed to remain in the periodontal area, it transforms into calculus (commonly known as tartar ). This material has a rock-like consistency and grabs onto the tooth surface. It is much more difficult to remove than plaque, which is a soft mass.

The most important component leading to the disease process, however, is the body's persistent immune response to the bacterial plaque. Specific immune factors are released that cause inflammation and damage that eventually destroys the support structures and bone and can lead to tooth loss.

Gingivitis is an inflammation of the gingiva, or gums. Is nearly always chronic, but an acute form infrequently occurs.

Chronic Gingivitis. Ordinary chronic gingivitis affects over 90% of the population. It is characterized by tender, red, swollen gums that bleed easily and may be responsible for bad breath (halitosis) in some cases. Treatment is very effective if initiated early in the course of gingivitis. Without good management, however, the problem can progress.

Periodontitis is characterized by the following:

Gum inflammation, with redness and bleeding.
Deep pockets (greater than 3 mm in depth) form between the gum and the tooth.
Loose teeth, caused by loss of connective tissue structures and bone.

Gingivitis precedes periodontitis, although it doesn't always lead to this more severe condition. In fact, some experts believe it is an entirely different disease. There are different categories of periodontal disease, including:

Chronic Periodontitis. Chronic periodontitis (also referred to as adult periodontitis) may begin in adolescence as a slowly progressing disease that becomes clinically significant in the mid-30s and continues throughout life. Some experts question whether it is a chronic, unrelenting condition and instead suggest that it waxes and wanes depending on the response of the immune system.

Aggressive Periodontitis. Aggressive periodontitis (also referred to as early onset periodontitis) often occurs in young people. It is subdivided according to whether it begins before or after puberty. Immune deficiencies and a genetic link have been shown to be possible factors for all types of aggressive periodontitis. If the condition is localized and treated, the outlook is positive. People with severe and widespread aggressive periodontitis are at high risk for tooth loss.

Periodontitis that occurs before puberty is very rare. It begins with the eruption of primary teeth in the first year and causes severe inflammation and bone and tooth loss.
Juvenile periodontitis begins at puberty and is defined by severe bone loss around the first molars and incisors. It is more common in girls than in boys. The clinical signs -- such as inflammation, bleeding, and heavy plaque accumulation -- are not present in this relatively rare disease. The treatment is the same as in chronic periodontitis.
Rapidly progressive periodontitis occurs in the early 20s to mid-30s. Severe inflammation and rapid bone and connective tissue loss occur, and tooth loss is possible within a year of onset.

Disease-Related Periodontitis. Periodontitis can also be associated with a number of systemic diseases, including type 1 diabetes, Down syndrome, AIDS, and several rare disorders of white blood cells.

Acute Necrotizing Periodontal Disease. Acute necrotizing periodontal disease is an acute infection in the gums. It is characterized by:

Black, dead tissue (necrosis)
Spontaneous bleeding
Rapid onset of pain
Bad odor
Blunted gum tissue (tissue is normally cone-shaped)

Stress, poor diet, smoking, and viral infections are predisposing factors for this acute necrotizing periodontal disease.

Symptoms

In general, symptoms progress over time and include:

Red and Swollen Gums
Gum Bleeding. Bleeding of the gums, even during brushing, is a sign of inflammation and the major marker of periodontal disease. One exception is juvenile periodontitis, in which symptoms are mild or even absent. It should be noted that the gums of smokers with periodontal disease tend to bleed less than nonsmokers.
Bad Breath. Debris and bacteria can cause a bad taste in the mouth and persistent bad breath.
Gum Recession and Loose Teeth. As the disease advances the gums recede, and supporting structure of bone is lost. Teeth loosen, sometimes causing a change in the way the upper and lower teeth fit together when biting down or a change in the fit of partial dentures.

Abnormally bulging, protruding, or swollen gums are a possible sign of disease.

Click the icon to see an image of recessed gums.

Abscesses. Deepening periodontal pockets between the gums and bone can become blocked by tartar or food particles. Infection-fighting white blood cells become trapped and die. Pus forms, and an abscess develops. Abscesses can destroy both gum and tooth tissue, cause nearby teeth to become loose and painful, and may cause fever and swollen lymph nodes.

Click the icon to see an image of a tooth abscess.

Pain is usually not a symptom, which partly explains why the disease may become advanced before treatment is sought and why some patients avoid treatment even after periodontitis is diagnosed.

Causes

Periodontal disease is marked by bacterial overgrowth. However, a persistent immune response to chronic infections in the mouth is believed to play a major role in gum destruction.

In the healthy mouth, more than 350 species of microorganisms have been found. Periodontal infections are linked to fewer than 5% of these species. Healthy and disease-causing bacteria can generally be grouped into two categories:

The harmless or helpful bacteria are usually known as gram positive aerobic bacteria.
In periodontal disease, the bacterial balance shifts over to gram negative anaerobic bacteria. Inflammatory disease and injury cannot develop without these bacteria.

Following are some of the bacteria most implicated in periodontal disease and bone loss:

Actinobacillus actinomycetemcomitans and Porphyromonas gingivalis. These two bacteria appear to be particularly likely to cause aggressive periodontal disease. Both P. gingivalis and A. actinomycetemcomitans, along with multiple deep pockets in the gum, are associated with resistance to standard treatments for gum disease. P. gingivalis may double the risk for serious gum disease. P. gingivalis produces enzymes, such as one called arginine-specific cysteine proteinase, which may be the specific destructive factors that disrupt the immune system and lead to subsequent periodontal connective tissue destruction.
Bacteroides forsythus is also strongly linked to periodontal disease.
Other bacteria associated with periodontal disease are Treponema denticola, T. socranskii, and P. intermedia. These bacteria, together with P. gingivalis, are frequently present at the same sites, and are associated with deep periodontal pockets.

Some bacteria are related to gingivitis, but not plaque development. They include various streptococcal species.

Evidence now suggests that periodontal disease is an autoimmune disorder, in which immune factors in the body attack the person's own cells and tissue -- in this case, those in the gum. It appears to work as follows:

The bacteria that form plaque and tartar release toxins that stimulate the immune system to overproduce powerful infection-fighting factors called cytokines.
Ordinarily, cytokines are important for healing. In excess, however, they can cause inflammation and severe damage. Cytokines of particular importance in periodontal disease are known as tumor necrosis factor-alpha (TNF-alpha) and interleukin-1beta, which are very active in the mouth, and are important in causing destructive inflammation.
In addition, white blood cells produced by the immune response to bacteria also release a family of enzymes called matrix metalloproteinases (MMPs), which break down connective tissue.

Studies suggest that this inflammatory response may have damaging effects not only in the gums but also in organs throughout the body, including the heart.

Certain herpes viruses (herpes simplex and varicella-zoster virus, the cause of chickenpox and shingles) are known causes of gingivitis. Other herpes viruses (cytomegalovirus and Epstein-Barr) may also play a role in the onset or progression of some types of periodontal disease, including aggressive and severe chronic periodontal disease. All herpes viruses go through an active phase followed by a latent phase and possibly reactivation.

Some experts theorize that these viruses may cause periodontal disease in different ways, including release of tissue-destructive cytokines, overgrowth of periodontal bacteria, suppressing immune factors, and initiation of other disease processes that lead to cell death.

Risk Factors

More than 75% of American adults have some form of gum disease, but according to a major survey, only 60% have any significant knowledge about the problem. Gum inflammation and ulcers are common, and not all people with these problems develop periodontal disease. Still, about 30% of people are genetically susceptible to periodontal disease. Other factors also put individuals at higher risk.

Lack of Oral Hygiene. Lack of oral hygiene encourages bacterial buildup and plaque formation.

Sugar and Acid. The bacteria that cause periodontal disease thrive in acidic environments. Therefore, eating sugars and other foods that increase the acidity in the mouth increase bacterial counts.

Poorly Contoured Restorations. Poorly contoured restorations (fillings or crowns) that provide traps for debris and plaque can also contribute to its formation.

Anatomical Tooth Abnormalities. Abnormal tooth structure can increase the risk.

Wisdom Teeth. Wisdom teeth, also called third molars, can be a major breeding ground for the bacteria that cause periodontal disease. In fact, for patients in their 20s, periodontal disease is most likely to occur around the wisdom teeth. Research suggests that periodontitis can occur in wisdom teeth that have broken through the gum as well as teeth that are impacted (buried). Periodontal disease can also be present even in patients with wisdom teeth who do not have any symptoms. Experts recommend that adolescents and young adults with wisdom teeth should have a dentist check for signs of periodontal disease

Children and Adolescents. Gingivitis, in varying degrees, is nearly a universal finding in children and adolescents. In rare genetic cases, children and adolescents are subject to destructive forms of the disease. Researchers have also observed some of the organisms seen in periodontal disease in young children without signs of gum problems. Healthy children, however, do not generally harbor two primary periodontal bacteria, P. gingivalis and T. denticola. The disease is also uncommon in teenagers.

Adults. One survey reported that 3.6% of adults between the ages of 18 - 34 had periodontal disease. As people age, the risk for periodontal disease increases. Over half of American adults have gingivitis surrounding 3 - 4 teeth, and 30% have significant periodontal disease surrounding 3 - 4 teeth. In a study of people over 70 years old, 86% had at least moderate periodontitis and over a quarter of them had lost their teeth.

About three-quarters of periodontal office visits are made by women, even though women tend to take better care of their teeth than men. Female hormones affect the gums, and women are particularly susceptible to periodontal problems. Hormone-influenced gingivitis appears in some adolescents, in some pregnant women, and is occasionally a side effect of birth control medication.

Before Menstruation. Gingivitis may flare up in some women a few days before they menstruate, when progesterone levels are high. Gum inflammation may also occur during ovulation. Progesterone dilates blood vessels causing inflammation, and blocks the repair of collagen, the structural protein that supports the gums.

Pregnancy. Hormonal changes during pregnancy can aggravate existing gingivitis, which typically worsens around the second month and reaches a peak in the eighth month. Pregnancy does not cause gum disease, and simple preventive oral hygiene can help maintain healthy gums. Any pregnancy-related gingivitis usually resolves within a few months of delivery. Because periodontal disease can increase the risk for low-weight infants and cause other complications, it is important for pregnant women to see a dentist.

Oral Contraceptives. Some studies report that oral contraceptives containing the synthetic progesterone desogestrel (but not dienogest, another common progesterone) increase the risk for periodontal disease.

Menopause. Estrogen deficiency after menopause reduces bone mineral density, which can lead to bone loss. Bone loss is associated with both periodontal disease and osteoporosis. Bone loss in the alveolar bone (which holds the tooth in place) may be a major predictor of tooth loss in postmenopausal women. Periodontal disease is the main cause of alveolar bone loss. During menopause, some women may also develop a rare condition called menopausal gingivostomatitis, in which the gums are dry, shiny, and bleed easily. Women may also experience abnormal tastes and sensations (such as salty, spicy, acidic, burning) in the mouth.

Periodontal disease often occurs in members of the same family. Genetics, intimacy, hygiene, or a mixture of factors may be responsible. Studies have found that children of parents with periodontitis are 12 times more likely to have the bacteria thought to be responsible for causing plaque and, eventually, periodontal disease.

Genetic Factors. Genetic factors may play the critical role in half the cases of periodontal disease. Up to 30% of the population may have some genetic susceptibility to periodontal disease. For example, some people with severe periodontal disease have genetic factors that affect the immune factor interleukin-1 (IL-1), a cytokine involved in the inflammatory response. Such individuals are up to 20 times more likely to develop advanced periodontitis than those without these genetic factors. Early onset and rapidly progressive periodontal disease also have strong genetic components.

Intimacy. Intimate partners and spouses of people with periodontal disease may also be at risk. Researchers have found that the bacteria P. gingivalis may be contagious after exposure to an infected person over a long period of time. There is no risk from short exposure such as after a fast kiss or when sharing an eating utensil.

Smoking is the single major preventable risk factor for periodontal disease. The habit can cause bone loss and gum recession even in the absence of periodontal disease. A number of studies indicate that smoking and nicotine increase inflammation by reducing oxygen in gum tissue and triggering an over-production of immune factors called cytokines (specifically ones called interleukins). In excess, cytokines are harmful to cells and tissue.

Furthermore, when nicotine combines with oral bacteria, such as P. gingivalis, the effect produces even greater levels of cytokines and eventually leads to periodontal connective tissue breakdown. Studies suggest that smokers are 11 times more likely than nonsmokers to harbor the bacteria that cause periodontal disease and four times more likely to have advanced periodontal disease. In one study more than 40% of smokers lost their teeth by the end of their lives.

The risk of periodontal disease increases with the number of cigarettes smoked per day. Smoking cigars and pipes carries the same risks as smoking cigarettes. Exposure to secondhand smoke is also associated with a 50 - 60% increased risk for developing periodontal disease, according to one study. Fortunately, when smokers quit, their periodontal health gradually recovers to a state comparable to that of nonsmokers.

Diabetes. Much evidence exists on the link between type 1 and 2 diabetes and periodontal disease. Diabetes causes changes in blood vessels, and high levels of specific inflammatory chemicals such as interleukins, that significantly increase the chances of periodontal disease. High levels of triglycerides (which are common in type 2 diabetes) also appear to impair periodontal health. Obesity, common in people with type 2 diabetes, may also predispose a person to gum disease. Controlling both type 1 and 2 diabetes may help reduce periodontal problems. For children with diabetes, good oral hygiene should begin at a young age. A 2006 study suggested that gum problems can start as early as 6 years of age in children with diabetes.

Osteoporosis and Osteonecrosis. Osteoporosis (loss of bone density) has been associated with periodontal disease in postmenopausal women. There have also been a few reports of osteonecrosis (bone decay) of the jaw in patients who take oral bisphosphonate drugs such as alendronate (Fosamax). Symptoms of osteonecrosis of the jaw include loose teeth, exposed jawbone, pain or swelling in the jaw, gum infections, and poor healing of the gums. As a precaution, the American Dental Association (ADA) recommends that patients who are prescribed bisphosphonate drugs get a thorough dental exam before beginning drug therapy, or as soon as possible after beginning therapy. The ADA also recommends that patients who take oral bisphosphonate drugs should discuss with their dentists any potential risks from dental procedures (such as extractions and implants) that involve the jawbone. In any case, be sure to inform your dentist if you are taking a bisphosphonate drug.

Osteoporosis is a condition marked by progressive loss of bone density, thinning of bone tissue, and increased risk of fractures. Osteoporosis may result from disease, dietary or hormonal deficiency, or advanced age. Regular exercise and vitamin and mineral supplements can reduce and may even reverse loss of bone density.

Giving intravenous bisphosphonates to patients being treated for bone cancer, or other cancers that have spread to the bone, increases their risk for developing osteonecrosis by 1 - 10%. Patients who take oral bisphosphonate drugs also have a slight risk, but 94% of osteonecrosis of the jaw cases involve patients who received bisphosphonates intravenously. If possible, see a dentist for a complete oral exam before beginning bisphosphonate therapy. In any case, be sure to inform your dentist if you are receiving intravenous bisphosphonates. Your dentist or oral surgeon may need to take special precautions when performing dental surgery

Herpes-Related Gingivitis. Herpes virus is a common cause of gingivitis in children and has become increasingly common in adults. It typically starts out with a purplish color and "boggy" sensation in the gums. Multiple blisters may form across the mucus membranes in the mouth and gums, followed by ulcers. They usually resolve in 7 - 14 days.

HIV-Associated Gingivitis. HIV-associated gingivitis has been reported in 15 - 50% of patients with HIV or AIDS. HIV-positive individuals harbor larger numbers of periodontal bacteria (candida albicans, P. gingivalis, black-pigmented anaerobic rods, and A. actinomycetemcomitans) than people without HIV. Severe pain is characteristic, along with odor, spontaneous bleeding, ulcers, and swollen, bright red gums. The inflammation never recedes, but halitosis and acute episodes can be managed by conventional cleaning treatments. Its severest form, known as necrotizing stomatitis, can be diagnostic for AIDS. In addition to bleeding, the gums in the front of the mouth are a yellowish-gray color, and bone thrusts out.

Autoimmune Diseases. Autoimmune conditions (Crohn's disease, multiple sclerosis, rheumatoid arthritis, lupus erythematosus, CREST syndrome) have been associated with a higher incidence of periodontal disease. Some research suggests that periodontal disease may even play some causal role. For example, one study suggested that P. gingivalis, one of the major bacteria in periodontal disease, was associated with destructive processes in the brain leading to multiple sclerosis. Still, more research is needed to determine a definitive association between these diseases.

Other Diseases. People with tuberculosis, syphilis, Wegener's granulomatosis, amyloidosis, and many genetic disorders are also at higher risk for periodontitis.

Vitamin C helps the body repair and maintain connective tissue, and its antioxidant effects are important in the presence of tissue-destroying oxidants in periodontal disease. Research indicates that vitamin C deficiency contributes to periodontal disease. A study of more than 12,000 adults found that people who consumed less than the recommended daily allowance of vitamin C, 60 mg (about one orange) were 1.5 times more likely to develop severe gingivitis than those who consumed more than 180 mg each day. Vitamin C levels are especially depleted in smokers. Eating citrus fruits high in vitamin C (such as grapefruit) may be helpful for patients with periodontitis.

Click the icon to see an image of the benefits of vitamin C.

Click the icon to see an image of the sources of vitamin C.

Dental disease is most likely to affect the poor. Children and the elderly suffer the worst oral care, and ethnic minorities follow. In the United States, the lack of access to dental insurance is a contributing factor. In a survey of residents of five states (Arizona, California, Hawaii, Oregon, and Wisconsin), the rate of total tooth loss was less than 20%. In three states (Kentucky, Louisiana, and West Virginia) it was greater than 40%.

Gingival overgrowth can be a side effect of nearly 20 different drugs, most commonly phenytoin (Dilantin), cyclosporine (Sandimmune), and a short-acting form of the calcium channel blocker nifedipine (Procardia).

Several other conditions can also cause gum inflammation, and some have been associated with periodontal disease. They include:

Mouth breathing
Psychologic stress. Stress can affect the immune system. Some studies suggest that stress can influence the development of chronic inflammatory diseases, like periodontitis.
Alcohol abuse. One study reported a higher incidence of periodontal disease, tooth decay, and possibly precancerous areas in patients who abuse alcohol.
Canker sores (aphthous ulcers)

Click the icon to see an image of a canker sore.

Self-injury in psychologically disturbed patients
Hereditary gingival fibromatosis. A rare genetic disease associated with both gum overgrowth and hairiness. It is often associated with gingivitis and periodontal disease.
Desquamative gingivitis. With this condition the outer layer of the gum tissue desquamates (peels away), exposing an acutely red surface. It usually occurs as a result of an allergic reaction or of skin diseases such as lichen planus, benign mucous membrane pemphigoid, bullous pemphigoid, and pemphigus vulgaris. (Bacteria may also play a role in this gum disease.) This condition generally resolves when the underlying problem is treated. It is fairly common in middle-aged women.

Complications

The ultimate outcome of uncontrolled periodontal disease is tooth loss. As the destructive factors cause the breakdown of bone and connective tissue, teeth lose their anchor.

A much less severe but nevertheless distressing problem caused by periodontal disease is bad breath, although coatings on the tongue may contribute more to bad breath than periodontal disease.

Studies have reported that people who have heart disease have a 1.5 - 4 times increased risk for periodontal disease. (The risk is highest for patients with extensive gum disease, bleeding from every tooth.) Acute coronary syndrome, high blood pressure (hypertension), and high cholesterol have also been associated with periodontal disease.

Periodontal disease has also been linked to stroke and coronary artery disease (CAD). The more severe the periodontitis, the greater the risk for heart problems. Many experts, however, are still not sure whether periodontal disease is a risk factor for stroke or a marker that reflects various risk factors common to both conditions.

A stroke is caused by a loss of blood circulation to areas of the brain. The blockage usually occurs when a clot or piece of atherosclerotic plaque breaks away from another area of the body and lodges within the blood vessels of the brain.

Recent evidence suggests that the inflammatory response may be the common element. This is an over-reaction of the immune system that causes injury to tissues in the body. A common link between patients with heart conditions and periodontal disease may be elevated levels of C-reactive protein (CRP), a marker for the inflammatory response. Some experts believe that immune factors causing this response are released into the bloodstream during periodontal disease and cause injury in the arteries supplying blood to the heart.

Other evidence suggests that the periodontal disease bacteria themselves -- particularly P. gingivalis, T. denticola, T. forsythia, and streptococci species -- may be the main culprit. In 2005, results from the NIH-sponsored Oral Infections and Vascular Disease Epidemiology Study (INVEST) determined an association between cardiovascular disease and the bacteria that cause periodontal disease. In this study, higher levels of periodontal bacteria were associated with thicker carotid arteries (a predictor of heart attack and stroke), regardless of C-reactive protein levels. While this study's findings are an important advance in understanding the relationship between periodontal and heart disease, it is still not clear if periodontal disease actually causes heart disease. Researchers hope that future results from INVEST will clarify this issue.

Experts are still not sure if treating gum disease can reduce the risks of heart disease and improve health outcomes for patients with periodontal disease and vascular heart problems. Studies have been mixed, but research is ongoing.

Diabetes is not only a risk factor for periodontal disease -- periodontal disease itself can worsen diabetes. Some evidence suggests that the bacteria that causes periodontal disease may enter the bloodstream and activate cytokines (damaging immune system factors), which then destroy cells in the pancreas where insulin is produced. Some studies indicate that treating periodontal disease can reduce the need for insulin and improve blood sugar control in some people with diabetes.

Bacteria that reproduce in the mouth can also be carried into the airways in the throat and lungs, increasing the risks for respiratory diseases and worsening chronic lung conditions, such as emphysema.

Click the icon to see an image of emphysema.

Many studies strongly indicate that bacterial infections that cause moderate-to-severe periodontal disease in pregnant women can increase the risk for premature delivery and low birth weight infants. The more severe the infection, the greater the risk to the baby. Research indicates that bacteria from gum disease and tooth decay may trigger the same factors in the immune system as genital and urinary tract infections. These biologic substances, called prostaglandins and tumor necrosis factor, produce inflammation in the cervix and uterus that can cause premature dilation and contractions. Research also suggests that periodontal disease increases the risk for preeclampsia, a life-threatening disorder that occurs in mid- to late pregnancy and is characterized by high blood pressure.

Experts recommend that women have a periodontal examination before becoming pregnant or as soon as possible thereafter. Because women with diabetes are at higher risk for periodontal disease, it is especially important that they see a dentist early in pregnancy. Experts are still not sure if treating periodontal disease can improve birth outcomes. A 2006 study in the New England Journal of Medicine indicated that the treatment does not affect pre-term birth or birth weight. However, the researchers reported that periodontal treatment is definitely safe for pregnant women.

Prevention

Healthy habits and good oral hygiene are critical in preventing gum disease. Regular and effective tooth brushing and mouth washing, however, are effective only above and slightly below the gum line. Once periodontal disease develops, more intensive treatments are needed.

It is important to reduce both the quantity and, in particular, the frequency of sugar intake. Avoid snacks and drinks with sugar (other than natural sugars found in fruits and vegetables). Eat sugar-containing foods with meals, ideally followed by brushing. Since fruit juices can also cause tooth erosion in children, parents should emphasize milk and water.

Smoking may play a significant role in over half the cases of chronic periodontal disease, according to research published in 2000. For smokers, quitting is one of the most important steps toward regaining periodontal health.

Fluoride treatment in children has helped to account for the decline in periodontal disease in adults. Because fluoride prevents decay, back molars, which keep the teeth in place, are spared, and are thus less vulnerable to bacteria. Even before teeth first erupt, babies' gums should be wiped clean with a bit of gauze bearing a dab of fluoride toothpaste. Supplementation with fluoride tablets or drops may be recommended for children 6 months or older who drink unfluoridated water or who are at risk for dental problems. A prescription from the child's pediatrician or dentist is required.

Some dentists recommend a fluoride gel for adult patients who are still at risk for tooth decay or sensitivity, but extra fluoride is generally not necessary for adults who use fluoride toothpaste.

Periodontitis is a silent disease. People with the disease rarely experience pain and may not be aware of the problem. A periodontal examination by a general dentist once or twice a year should reveal any incipient or progressive problems. A full mouth series of x-rays is advised every 2 - 3 years. This will alert the dentist to early bone loss and other disorders of the oral cavity.

Dentists now often perform Periodontal Screening and Recording (PSR) using a probe to measure gum pockets. Previously performed only by periodontists, this procedure is now encouraged as part of a regular dental examination. The dentist will identify any areas where deep pocketing has occurred, where the health of the gingiva appears compromised, and where there is undue mobility of teeth. It is the general dentist's responsibility to identify periodontal disease and inform the patient. If the condition is severe, the dentist may want to refer the patient to a periodontist.

Correct tooth brushing, mouth cleansing, and flossing should be everyone's defense against periodontal disease. (However, good hygiene is probably not sufficient to prevent periodontal disease in many people. Regular visits to a dentist are extremely important, especially for high-risk individuals.)

Brushing Guidelines. The following are some recommendations for brushing:

Use a dry brush. One study reported that when people brushed their teeth without toothpaste first, using a soft dry brush, their plaque deposits were reduced by 67%, and gum bleeding dropped by 50%.
No brush of any size, shape, or gimmick is effective if it is incorrectly positioned in the mouth. Place the brush where the gum meets the tooth, with bristles resting along each tooth at a 45-degree angle.
Begin by dry brushing the inside the bottom row of teeth, then the inner top teeth, and last the outer surfaces.
Wiggle the brush back and forth so the bristles extend under the gum line.
Scrub the broad, biting surfaces of the back teeth.
Dry brushing should take about a minute and a half.
A paste is then applied, and the teeth should again be brushed in the same way.
The tongue should be scrubbed for a total of about 30 seconds. A tongue scraper used with an anti-bacterial mouthwash (such as Listerine) is more effective than a toothbrush in removing bacteria.
Rinse the toothbrush thoroughly and then tap it on the edge of the sink at least five times to get rid of debris.
Flossing should finish the process. A mouthwash may also be used.

If brushing after each meal is not possible, rinsing the mouth with water after eating can reduce bacteria by 30%.

Toothbrushes. A vast assortment of brushes of varying sizes and shapes are available, and each manufacturer makes its claim for the benefits of a particular brush. Look for the American Dental Association (ADA) seal on both electric and regular brushes.

In spite of the wide variety of nonelectric toothbrushes, both in shape and bristle design, a study of eight brands found no significant differences in effectiveness among them.

Electric toothbrushes, particularly those with a stationary grip and revolving tufts of bristles, can be advantageous for some people with physical disabilities. Electric toothbrushes with heads that move back and forth up to 4,200 times a minute remove significantly more plaque than ordinary brushes. Even more high-tech brushes are now available that use sound waves to remove plaque.

In general, studies have reported no differences between electric and manual toothbrushes in their ability to remove plaque. (One study showed considerable improvement in groups using sonic toothbrushes, particularly in those with moderate periodontal disease.) Experts recommend, however, that if a regular toothbrush works, it isn't necessary to buy an expensive electric one.

For individuals with average dexterity, a four- or five-rowed, soft, nylon-bristled toothbrush is sufficient. The most important factor in buying any toothbrush, electric or manual, is to choose one with a soft head. Soft bristles get into crevices easier and do not irritate the gums, thereby reducing the risk of exposing teeth below the gum line compared to hard brushes.

Experts generally recommend replacing toothbrushes every 1 - 3 months. Not only do they become breeding grounds for bacteria, but the worn bristles are less effective at removing plaque.

Toothpaste. The object of a good toothpaste is to reduce the development of plaque and eliminate periodontal-causing microorganisms without destroying the organisms that are important for a healthy mouth. All brands should show ADA approval. Even a good toothpaste, however, cannot be delivered past 3 mm below the gum line, where periodontitis develops.

Toothpastes are a combination of abrasives, binders, colors, detergents, flavors, fluoride, humectants, preservatives, and artificial sweeteners. Avoid highly abrasive toothpastes, especially for individuals whose gums have receded.

Ingredients contained in toothpastes may include:

Fluoride. Most commercial toothpastes contain fluoride, which both strengthens tooth enamel against decay and enhances remineralization of the enamel. Fluoride also inhibits acid-loving bacteria, especially after eating, when the mouth is more acidic. This antibacterial activity may help control plaque.
Triclosan. Triclosan is an anti-bacterial substance that may help reduce mild gingivitis.
Metal salts. Metal salts, such as stannous and zinc, serve mostly as anti-bacterial substances in toothpastes. Stannous fluoride gel toothpastes do not reduce plaque, however, even though they have some effect against the bacteria that cause it, but slightly reduce gingivitis.
Peroxide and baking soda. Toothpastes with these ingredients claim to have a whitening action, but while they may help remove stains there is little evidence they whiten the actual color of the teeth. In addition, these substances appear to offer no benefits against gum disease.
Antibacterial sugar substitutes (xylitol), and detergents (delmopinol)

Mouthwashes. The American Dental Association recommends (in addition to daily brushing and flossing) antimicrobial mouthwash to help prevent and reduce plaque and gingivitis, and fluoride mouthwashes to help provide additional protection against tooth decay.

Chlorhexidine (Peridex or PerioGard) is an antimicrobial mouthwash available by prescription only. It reduces plaque by 55% and gingivitis by 30 - 45%. Patients should rinse for 1 minute twice daily. They should wait at least 30 minutes (and preferably 2 hours) between brushing and rinsing since chlorhexidine can be inactivated by certain compounds in toothpastes. It has a bitter taste. It also binds to tannins, which are in tea, coffee, and red wine, so it has tendency to stain teeth in people who drink these beverages. Studies are mixed as to its effectiveness for preventing or reducing periodontal disease.
Listerine is another antimicrobial mouthwash. It is composed of essential oils and is available over the counter. It reduces plaque and gingivitis, when used for 30 seconds twice a day. It leaves a burning sensation in the mouth that most people better tolerate after a few days of use. The usual regimen is to rinse twice a day. (Listerine PocketPaks, which are strips that dissolve on the tongue, have no proven effects on plague and gingivitis.)
Mouthwashes containing cetylpyridinium (Scope, Cepacol) have moderate antimicrobial effect on plaque, but only if they are used an hour after brushing. None are as effective as Listerine or chlorhexidine, but they may still have some value for people who cannot tolerate the other mouthwashes.
Mouthwashes containing stannous fluoride and amine fluoride (Meridol) are moderately effective, but are also not as effective as effective as Listerine or chlorhexidine.
Fluoride mouthwashes (Act) are helpful in preventing cavities.
Mouthwashes that contain alcohol are dangerous for children and should be kept away from them.

Flossing. The use of dental floss, either waxed or unwaxed, is critical in cleaning between the teeth where the toothbrush bristles cannot reach. In spite of this, nearly two-thirds of people do not floss.

To floss correctly, the following steps may be helpful:

Break off about 18 inches of floss and wind most of it around the middle finger of one hand and the rest around the other middle finger.
Hold the floss between the thumbs and forefingers and gently guide and rub it back and forth between the teeth.
When it reaches the gum line, the floss should be curved around each tooth and slid gently back and forth against the gum.
Finally, rub gently up and down against the tooth. Repeat with each tooth, including the outside of the back teeth.
If, on repeated flossing attempts, the floss becomes shredded or cannot be removed easily from between the teeth, a rough crown or overhanging filling may be the cause. In such cases, the restoration should be redone. Such areas create spaces for the collection of food debris, plaque, and calculus.

Here are some tips in choosing the right floss or flossing device:

Use a floss that does not shred or break.
Avoid a very thin floss, which can cut the gum if brought down with too much force or not guided along the side of the tooth.
A floss threader is an invaluable aid for the person who has bridgework. Made of plastic, it looks like a needle with a huge eye, or loop. A piece of floss is threaded into the loop, which can then be inserted between the bridge and the gum. The floss that is carried through with it can then be used to clean underneath the false tooth or teeth and along the sides of the abutting teeth.
Another handy device for cleaning under bridges is a Proxabrush, which is an interdental cleaner. This is a tiny narrow brush that can be worked in between the natural teeth and around the attached false tooth or teeth.
Special toothpicks such as Stim-U-Dent may be effective for wide spaces between teeth but should never replace flossing. Standard toothpicks should never be used for regular hygiene.
Electronic products, such as water piks, are also helpful. These devices are expensive but may improve flossing compliance.

Producing Saliva and Drinking Water. Saliva is important for diluting the toxins created by plaque. Drinking at least 7 glasses of water a day helps reduce inflammation in the mouth by producing more saliva. Increasing water intake is particularly important as one ages, when less saliva is produced.

Diagnosis

The dental practitioner typically performs a number of procedures to determine a diagnosis of periodontal disease.

The dentist will first take a medical history to reveal any past or present periodontal problems, any underlying diseases that might be contributing to the problem, and any medications the patient is taking. After noting the general state of oral hygiene, the dentist may ask about the quality of home dental care.

Inspection of the Gum Area. The dentist inspects the color and shape of gingival tissue on the cheek (buccal) side and the tongue (lingual) side of every tooth and compares these qualities to the healthy ideal. Redness, puffiness, and bleeding upon probing indicate inflammation. If the gum formation between teeth is blunt and not pointed, acute necrotizing periodontal disease may be indicated.

Periodontal Screening and Recording (PSR). PSR is a painless procedure used to measure and determine the severity of periodontal disease:

The dentist uses a mirror and a periodontal probe, a fine instrument calibrated in millimeters (mm), which is used to measure pocket depth. (A new automatic probing device may prove to be even more sensitive and accurate than the standard manual probe that most dentists use.)
The probe is held along the length of the tooth with the tip placed in the pocket. The tip of the probe will then touch the point where the connective tissue attaches to the tooth.
The dentist will "walk" the probe to six specified points on each tooth, three on the buccal (cheek) and three on the lingual (tongue) sides. The dentist measures the depth of the probe at each point.
Pocket depths greater than 3 mm indicate disease.

These measurements help determine the condition of the connective tissue and amount of gingival overgrowth or recession. PSR appears to be even more reliable than x-rays in diagnosing gum disease.

Testing Tooth Movement. Tooth mobility is determined by pushing each tooth between two instrument handles and observing any movement. Mobility is a strong indicator of bone support loss.

X-rays. X-rays are taken to show any loss of bone structure supporting the teeth. Eighteen x-rays make up the full mouth series necessary for diagnosis.

Treatment

Studies support the effectiveness of active treatment combined with a strict maintenance program for patients with periodontal disease. In one study, for example, people with periodontal disease who were inconsistent in caring for their gums after treatment had 5.6 times the risk for tooth loss as those who were very vigilant.

Some dentists have reported a success rate of 85% when professional treatment and good home maintenance are combined. Treatment helps nonsmokers more than smokers, particularly when pockets are deep and persistent. Some studies suggest that periodontal treatment in people with type 2 diabetes helps improve blood sugar levels. Whether treatment will help reduce other health risks, including heart attack and stroke, is unknown.

Treatment Goals. Once periodontal disease has been identified, the goals of treatment are:

To arrest and control the progress of the disease
To leave the periodontal tissues in an easily maintainable state
If possible, to restore the supporting structures, which include bone, gum tissue, and ligaments

Treatment Phases. To achieve these goals, there are various approaches:

Initial cleaning, scaling, and curettage
Surgery -- if needed for reducing deep pockets that remain underneath the gum after extensive cleaning sessions
Low-dose oral or topical antibiotics
Maintenance

After the active treatment is completed and the mouth is in a relative state of health, the patient should have regular cleanings lasting 45 minutes to 1 hour, approximately every 3 months. These may be done by the dental hygienist, the periodontist, or the general dentist. The patient may alternate between them. Home care, of course, must be continued.

Antibiotics Before Treatment. In cases where the individual has a mitral valve prolapse or history of rheumatic heart disease, pretreatment with an appropriate antibiotic is required before any dental work, including cleaning. This is necessary to prevent the possibility of bacterial endocarditis, which can be life threatening.

Scaling, polishing, and sometimes curettage are used to manage periodontal disease. They are usually accomplished in a series of three to four visits spaced about a week apart. (Patients might ask their dentist about the gas nitrous oxide, which is helpful for many patients and may reduce the visits to a single one.) The dental hygienist or practitioner generally uses both ultrasonic and manual instruments to remove calculus.

Calculus above the gum is easily seen. The dental professional usually detects calculus below the gum by careful probing with an instrument.
The hygienist or dentist may use an ultrasonic instrument for removal of the more accessible calculus. This probe-like device vibrates at a frequency range higher than is audible to the human ear. Some people with low tolerance for the ultrasonic probe may wish to request nitrous oxide.
A spray of water is used with ultrasound to prevent overheating and to flush out the debris that is dislodged.
The dental professional will scrape the plaque from above and below the gum line (called scaling). When the probe contacts the rock-like calculus, deposits fracture off the tooth fairly efficiently.
The hygienist or dentist will then smooth the rough spots on the tooth. Smoothing the surface helps remove bacteria that collect there (root planing) and also helps the gums reattach.
Polishing is the finishing procedure. It uses a rubber cup with an abrasive paste to remove plaque and stains on the crown portion of the tooth. It produces a smooth surface, making it temporarily harder for plaque to adhere.

After the cleaning procedure, the dentist will check the pocket depths around the teeth after the cleaning process has been completed. Further treatment needs are determined by the results of these initial sessions:

If the cleaning processes have reduced inflammation, observation only is needed.
If an abscess is present, surgery may be required.

Finally, the dental hygienist or practitioner should offer thorough instructions on home care to insure the removal of bacteria on a daily basis. This includes proper use of the toothbrush, paste, mouth rinses, floss, floss threaders, and proxabrushes. Home care can effectively eliminate the plaque above the gums and down to 2 mm below the gums.

Gingival curettage removes the soft tissue lining of the periodontal pockets in order to completely eliminate bacteria and diseased tissue. It may be used along with scaling and root planing, but achieves a deeper and more complete cleaning. Evidence indicates, however, that it does not contribute any additional benefits beyond simple scaling and planing.

Surgery allows access for deep cleaning of the root surface, removal of diseased tissue, and repositioning and shaping of the bones, gum, and tissues supporting the teeth. Surgical procedures vary depending on the individual diagnosis and needs of the patient. The basic procedure is known as open flap curettage. It involves:

The periodontal surgeon lifts, or flaps, the gums away from the tooth and surrounding bone.
The diseased root surfaces are cleaned and curetted (scraped) to remove deposits.
Gum tissue is replaced into positions to minimize pocket depth.
The periodontist may also contour the remaining bone and attempt to regenerate lost bone and gingival attachment through bone grafts and guided tissue regeneration or the use of enamel matrix protein derivatives.

There is some debate about whether this procedure is any more effective in preventing disease progression than non-surgical therapies, such as low-dose doxycycline, short-term antibiotics, or antibiotic gels. Some studies have reported that although surgical treatment reduced pocket depth more than non-surgical therapies for at least a year after the procedure, benefits from surgery do not persist beyond 5 years, except in very deep pockets.

Postsurgery Pain and Discomfort. Post-surgery discomfort is usually managed easily with over-the-counter medications such as ibuprofen. If discomfort is severe, stronger analgesics may be prescribed. Some patients experience sensitivity to hot or cold temperatures from exposed roots. These problems can be managed with topical fluoride treatments or, in severe cases, with dental restoration.

Guided Tissue Regeneration. A more advanced technique, called guided tissue regeneration, is used to stimulate bone and gum tissue growth:

First, the root surfaces and diseased bone are meticulously cleaned out. Preventing bacterial contamination is very important. The more residual bacteria, the greater the chance that the treatment will fail.
A specialized piece of fabric is sewn around the tooth to cover the crater in the bone left after the cleaning. It is either absorbable or nonabsorbable. (Some studies report highly beneficial results with new absorbable materials, including those coated with the antibiotic doxycycline.)
The gum is then sewn over the fabric. The fabric prevents the gum tissue from growing down into the bone defect and allows the bone and the attachment to the root to regenerate.
After 4 - 6 weeks, the nonabsorbable fabric must be removed using a minor surgical procedure. The absorbable membrane may be left in. In general, there is little difference in outcome between absorbable and nonabsorbable procedures. The absorbable fabric may not be as effective as standard grafts if gum tissue is thin, although newer materials may prove to produce better results.

Bone Grafting. In some cases of severe bone loss, the surgeon may attempt to encourage regrowth and restoration of bone tissue that has been lost through the disease process. This involves bone grafting:

The surgeon places bone graft material into the defect.
The material may be either bone from the same patient or a substance called decalcified freeze-dried bone allografts (DFDBA) which is obtained from a donor.
This material then stimulates new bone growth in the area.

Enamel Matrix Protein Derivative. Amelogenin is a derivative of a major protein in the structure (the matrix) of enamel that helps stimulate gum tissue growth. A gel containing amelogenin (Emdogain) is applied during surgery and forms a coat over the roots of the teeth. The gel itself dissolves after 2 days, leaving the active substance behind. Studies report that it is safe and may significantly reduce the effects of periodontal disease. One study suggested that the benefits, as indicated by bone attachment, can persist for at least 4 years. (Results were similar to guided tissue regeneration.)

Gum grafting techniques can also be very useful for improving the looks of the gum as well as adding support to the teeth. During this procedure, the periodontist takes gum tissue from the palate or another donor source to cover the exposed root in order to even the gum line and reduce sensitivity. Other procedures are available to improve the look of the gums and teeth. The gum line can be sculpted to improve uneven or excess gums and to cover exposed roots as gums recede.

Periodontists report that they are achieving great success with tooth implants in patients who have lost teeth due to periodontal disease. The average cost for a single implant is high, however, and one implant requires 5 - 7 months for completion.

Medications

Antibiotics are often used in combination with surgery, curettage, or alone to eliminate or prevent disease-causing bacteria after periodontal procedures. They are being investigated in oral forms as well as in topical forms that are applied directly to the gum. Increasingly, dental professionals are finding that local application of antibiotics is more effective than periodontal surgery alone. They may even prove to be an alternative to surgery.

Some experts are concerned, however, that long-term use of antibiotics increases the risk of bacterial resistance to these drugs, which is a growing health problem in general. Of some encouragement was a 2000 review, which indicated that low-dose antibiotics do not increase the risk of bacterial resistance. However, long-term studies are still needed

Antibiotics given orally and at standard doses have some limited applications for periodontal disease. They are typically given for an acute infection. Long-term use of antibiotics is advised for the control of juvenile periodontitis, refractory periodontitis, rapidly progressing periodontitis, and prepubertal periodontitis. Specific antibiotics used in periodontal disease include:

Tetracycline antibiotics -- which include tetracycline hydrochloride, doxycycline, and minocycline -- are the primary drugs used. They not only have anti-bacterial actions but also reduce inflammation and help block collagenase, the protein that destroys connective tissue and bone, even in low doses. In fact, these two actions seem to contribute most to periodontal protection, rather than their antibacterial properties. Short-term use of standard-dose doxycycline (a 10-day treatment) is used for treating acute periodontal infections and for eliminating inflammation. Topical application and long-term use of these antibiotics are showing particular promise.
Some macrolide antibiotics (roxithromycin) may have actions against inflammation and growth involved in periodontal disease.
Some quinolone antibiotics (moxifloxacin, ciprofloxacin) may specifically target A. actinomycetemcomitans, an important bacteria in periodontal disease.
Metronidazole (Flagyl) in combination with tetracycline or amoxicillin (a penicillin) may be used for severe and chronic periodontal disease.

There is growing bacterial resistance to many of these antibiotics, such as roxithromycin and metronidazole, therefore limiting their use in periodontal disease. One study indicated, however, that 3 months after antibiotic administration, the percentage of bacteria that could be eliminated with standard antibiotics returned to normal.

Topical application of antibiotics to the gum surface does not affect the entire body like oral antibiotics do, and they are preferred whenever possible. Studies suggest that, in combination with scaling and planing, any of these approaches are very effective for periodontal health.

Several different topical applications are showing promise, including:

Atridox is a doxycycline gel that conforms to the gum surface and then solidifies. Over the next few days, it releases the antibiotics.
Elyzol is a gel or strip applied to the gum that is composed of metronidazole. It has unique actions that are effective against parasites as well as bacteria. Studies suggest that Atridox, which contains doxycycline, may be more effective than Elyzol. (In one study, however, the doxycycline gel worked faster, but metronidazole achieved a greater bacterial reduction.)
PerioChip is a chip that is placed into the gum pocket after scaling. Over time, it slowly releases chlorhexidine, a powerful bacteria-killing antiseptic. Early studies report benefits in reducing pocket depths, but it is still not known whether these improvements are sustained.
Minocycline microspheres (Arestin) contain antibiotics in tiny capsules, which are applied to the gums after scaling and planing. Studies report that they are more effective in reducing pocket depth and bone loss than standard periodontal maintenance. Patients obtain these benefits regardless of their smoking status, age gender, or extent of the periodontal disease.
Actisite is a thin strip similar to dental floss, which is treated with tetracycline hydrochloride. The treated thread is temporarily inserted between the tooth and gum. (Using multiple strips may be more beneficial than using a single strip.) This was one of the first topical applications of antibiotics. Other topical approaches are being increasingly used.

Subantimicrobial Dose Doxycycline (Periostat). Subantimicrobial dose doxycycline (SDD) is a term used for a treatment that uses very low doses (20 mg) of doxycycline (Periostat). Although doxycycline is a tetracycline antibiotic, the doses used are too low to affect bacteria. However, at these dose levels, the drug blocks matrix metalloproteinases (MMPs) -- enzymes that destroy the connective tissues holding the teeth. Periostat is taken twice a day for months. There is some concern that such long-term use may pose a risk for the development of antibiotic-resistant bacteria or other, still unknown, adverse effects. The doses used in this treatment, however, are too low to have any effect on bacteria, so some experts believe this risk is very low. In fact, several 12-month studies report significant improvements in tooth attachment and pocket depth with no increased incidence of side effects. [Taking a common nonsteroidal anti-inflammatory drug, such as aspirin or ibuprofen (Advil) along with doxycycline, may enhance the effectiveness of this treatment.]

Chemically Modified Tetracyclines. Other tetracyclines are being developed that inhibit MMPs but have no antibiotic properties, which would, theoretically, avoid possible long-term problems with antibiotic resistance.

Other Treatments

Nonsteroidal Anti-inflammatory Drugs (NSAIDs). NSAIDs are drugs that block factors that cause inflammation and pain.

Over-the-counter NSAIDs include aspirin, ibuprofen (Motrin IB, Advil, Nuprin, Rufen), naproxen (Aleve), ketoprofen (Actron, Orudis KT).
Prescription NSAIDs include naproxen (Naprosyn, Anaprox), diclofenac (Voltaren), tolmetin (Tolectin), ketoprofen (Orudis, Oruvail), indomethacin (Indocin).

These drugs are used not only for relieving pain in periodontal disease but also for slowing the disease process. NSAIDs block inflammatory enzymes triggered by cytokines, which are important immune factors in periodontal disease. A number of NSAIDs have been investigated and have been shown to reduce gingivitis and slow progression of periodontal disease.

In one study, long-term use of oral flurbiprofen (Ansaid) resulted in significantly lower bone loss, although disease progression returned when the drug was stopped.

Investigators are also studying rinses, creams, and other topical forms of NSAIDs. For example, a cream containing ketoprofen appears to reduce bone loss. (Ketoprofen is of particular interest because it blocks not only COX-2 but also another pathway involved in the disease process.)

Warning about NSAIDs: Although NSAIDs work well, long-term use can cause stomach problems, such as ulcers and bleeding, and possible heart problems. In April 2005, the FDA asked drug manufacturers of NSAIDs to include a warning label on their product that alerts users of an increased risk for cardiovascular events and gastrointestinal bleeding.

Gels containing growth factors -- including substances called recombinant human (rh), platelet-derived growth factor-BB (PDGF-BB), and (rh) insulin-like growth factor-I (IGF-I) -- are showing promise for restoring bone.

Research is underway to find a vaccine against periodontal disease. To date, animal studies show promise, but an effective vaccine for people is years away.

Researchers are investigating the use of photodynamic therapy (PDT) as an alternative to antibiotic drugs. PDT destroys periodontal bacteria by applying photosensitive drugs to oral regions and exposing the drug-treated area to a light or laser. Research appears promising but is still in its preliminary stages.

Resources

www.nidcr.nih.gov -- National Institute of Dental and Craniofacial Research
www.perio.org -- American Academy of Periodontology
www.ada.org -- American Dental Association
www.aaoms.org -- American Association of Oral and Maxillofacial Surgeons

References

Amaliya , Timmerman MF, Abbas F, Loos BG, Van der Weijden GA, Van Winkelhoff AJ, et al. Java project on periodontal diseases: the relationship between vitamin C and the severity of periodontitis. J Clin Periodontol. 2007 Apr;34(4):299-304.

de Oliveira RR, Schwartz-Filho HO, Novaes AB Jr, Taba M Jr. Antimicrobial photodynamic therapy in the non-surgical treatment of aggressive periodontitis: a preliminary randomized controlled clinical study. J Periodontol. 2007 Jun;78(6):965-73.

Kolahi J, Soolari A. Rinsing with chlorhexidine gluconate solution after brushing and flossing teeth: a systematic review of effectiveness. Quintessence Int. 2006 Sep;37(:605-12.

Persson GR, Yeates J, Persson RE, Hirschi-Imfeld R, Weibel M, Kiyak HA. The impact of a low-frequency chlorhexidine rinsing schedule on the subgingival microbiota (the TEETH clinical trial). J Periodontol. 2007 Sep;78(9):1751-8.

Staudte H, Sigusch BW, Glockmann E. Grapefruit consumption improves vitamin C status in periodontitis patients. Br Dent J. 2005 Aug 27;199(4):213-7, discussion 210.

Review Date:
1/26/2008
Reviewed By:
Harvey Simon, MD, Editor-in-Chief, Associate Professor of Medicine, Harvard Medical School; Physician, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

A.D.A.M., Inc. is accredited by URAC, also known as the American Accreditation HealthCare Commission (www.urac.org). URAC's accreditation program is an independent audit to verify that A.D.A.M. follows rigorous standards of quality and accountability. A.D.A.M. is among the first to achieve this important distinction for online health information and services. Learn more about A.D.A.M.'s editorial policy, editorial process and privacy policy. A.D.A.M. is also a founding member of Hi-Ethics and subscribes to the principles of the Health on the Net Foundation (www.hon.ch).

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Colorectal cancer

FitSugar — Wed, 08 Oct 2008 17:35:04 -0700

Overview

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

HEALTH GUIDE REFERENCE FROM A.D.A.M

Colorectal cancer -- cancer of the colon and rectum -- is the second most commonly diagnosed cancer in American men and women. Colorectal cancer develops in the digestive system, which processes food for energy and rids the body of solid waste. Together, the colon and rectum form a muscular tube about 5 feet long known as the large intestine. The colon (the first and largest part of the large intestine) absorbs water and nutrients from food and serves as a storage place for solid waste. The waste moves from the colon into the rectum (the final 6 inches of the large intestine) where it passes out of the body through the anus. Cancers affecting either of these organs are called colorectal cancer. Most colorectal cancers arise from benign polyps (abnormal masses of tissue) that begin growing on the inner lining of the colon or rectum. These growths spread very slowly, taking from 10 - 20 years to become cancerous. Once colorectal cancer is diagnosed, the prognosis depends on how far the cancer has spread.

The American Cancer Society estimates that about 150,000 cases of colorectal cancer are diagnosed every year in the United States. Most cases of colorectal cancer occur in people older than 50 years of age. Although colorectal cancer is expected to be responsible for about 56,000 deaths this year, the death rate from this form of cancer has been dropping steadily for the past 15 years. Some researchers speculate that the lowering death rate is due to prevention and early treatment of the disease.

Signs and Symptoms

Unfortunately, most people with colorectal cancer will not begin to experience symptoms until the disease is already at a late stage. In fact, some people may experience no symptoms at all. This is the reason that screening tests, such as a colonoscopy, are so important.

In general, signs and symptoms of colorectal cancer can include the following:

Changes in bowel habits
Blood in the stool
Problems related to blood loss (anemia, weakness, fatigue, shortness of breath, pounding or racing heart, chest pain, and intolerance to exercise)
Abdominal discomfort (frequent gas, bloating, fullness, cramps, and pain)
Unexplained weight loss
Pain with defecation
Stools that are narrower than usual
Urgent desire to defecate (and the passage of little matter)

These symptoms may be caused by colorectal cancer or by other conditions such as infections, hemorrhoids, and inflammatory bowel disease. It is important to bring any of these symptoms to the attention of your health care provider to determine the cause of your symptoms.

Causes

Although more than half of all colorectal cancers occur without any clear cause, studies suggest that genetic factors may play an important role in the development of the disease. For example, many people with colorectal cancer carry specific genetic mutations (genes that normally suppress cancer growth are mutated and actually promote cancer growth) or have relatives with the condition. Those with a family history of specific genetic syndromes -- such as familial adenomatous polyposis, Lynch syndrome, juvenile polyposis, and Peutz-Jeghers syndrome -- are also at an increased risk for developing colorectal cancer. Dietary and lifestyle factors, such as smoking and high-fat intake, also influence the development of colorectal cancer. Some researchers speculate that genetic factors predispose a person to colorectal cancer, but that dietary and lifestyle factors play a strong role in determining which "at-risk" individuals go on to develop the disease.

Risk Factors

Family history of colorectal cancer or polyps in the colon
Older age (over 50 years)
Living in an industrialized country like the United States
Polyps on the inner lining of the colon or rectum
African-American descent
Diets high in meat and low in fruits and vegetables
Overweight or obesity
Regular consumption of alcohol
Smoking cigarettes regularly
Inflammatory bowel disease (such as irritable bowel syndrome, Crohn's disease, and ulcerative colitis)

Diagnosis

After obtaining a complete medical history, a health care provider will perform a physical exam and may order one or more tests to diagnose colorectal cancer. As mentioned in the Preventive Care section, standard tests used to diagnose colorectal cancer include the sigmoidoscopy, colonoscopy, and barium enema. At the time of either a sigmoidoscopy or a colonscopy, a biopsy (sample of tissue) is removed from the colon or rectum and examined under a microscope in order to detect abnormal growths. If the doctor finds cancer, a series of tests (chest x-ray, abdominal CT scan, and blood tests to check liver function) will be performed to determine if the cancer has spread and to help determine the stage (or extent) of the disease. Stages of colorectal cancer include:

Stage A: The earliest stage; cancer is found only in the innermost lining of the colon and/or rectum.
Stage B1: Involves the muscular part of the colon and/or rectum.
Stage B2: Cancer has spread to deeper layers of the wall of the colon and/or rectum.
Stage C: Cancer has spread to nearby lymph nodes but not to other parts of the body.
Stage D: Cancer has spread to other parts of the body, such as the liver and lungs.

Preventive Care

Screening

Colorectal cancer is highly preventable, even curable, when detected early. Regular screening for colorectal cancer helps detect the presence of polyps before they become cancerous. The American Cancer Society recommends the following standard screening practices for individuals who are not at high risk for colorectal cancer and who have no symptoms of the disease:

Annual digital rectal exams starting at age 40: The doctor inserts a lubricated, gloved finger into the rectum to feel for abnormal areas.
Annual fecal occult blood tests starting at age 50: Stool samples are tested in the doctor's office for the presence of hidden blood.
Visualization of the colon via one of the following:
- Sigmoidoscopy (examination of the rectum and lower colon using a lighted instrument)
- Colonoscopy (examination of the rectum and entire colon using a lighted instrument)
- Barium enema (examination using a series of x-rays that reveal barium-stained outlines of the colon and rectum) every 3 -5 years starting at age 50

Those with a family history of colorectal cancer should undergo colonoscopy every 3 - 5 years, starting at least 10 years before the age of the relative at the time of his or her diagnosis. Those with a family history of familial adenomatous polyposis (a condition causing thousands of polyps along the inner lining of the colon) or other similar genetic syndromes (listed under Causes) should start having colonoscopies at age 10.

Diet and Exercise

People may also lower their chances of developing colorectal cancer by managing the risk factors they can control, such as diet and exercise. For example, eating plenty of fruits and vegetables as well as foods rich in omega-3 fatty acids (such as salmon and halibut) and calcium (such as sea vegetables and kale) can help reduce the risk of colorectal cancer. Limiting alcohol consumption, quitting smoking, and reducing the intake of high-fat and fried foods, particularly red meats, may also protect developing colorectal cancer.

Physical activity also will decrease the risk factors associated with developing colorectal cancer. Obesity and a sedentary lifestyle increases the risk of colorectal cancer. Even small amounts of exercise on a regular basis can be helpful, and the American Cancer Society recommends at least 30 minutes of physical activity on most days.

Other Preventive Measures

Preliminary studies also suggest that aspirin may prevent tumor growth and that hormone replacement therapy (HRT) may reduce the risk of colorectal cancer in women. However, HRT may increase the chances of developing other cancers, such as breast and ovarian. It is recommended to choose diet and lifestyle changes along with dietary supplements to protect against the risk factors associated with colorectal cancer.

Treatment

Surgery to remove the tumor is the only way to cure the disease, and early detection is the best preparation for successful treatment. Depending on the stage of the cancer, surgery is generally followed with chemotherapy. If the tumor is particularly large, radiation may be necessary before or after surgery.

Certain medications or supplements may help prevent the development of polyps and/or colorectal cancer. Modifying lifestyle, particularly avoiding red meat, losing weight, quitting smoking, and increasing physical activity, may help prevent the disease -- even in individuals with a family history of the condition.

Lifestyle

An unhealthy lifestyle may increase the risk of colorectal cancer even in people who have no family history of the condition. Some experts believe that adjusting lifestyle habits may decrease the likelihood of developing colorectal cancer by as much as 70% in some individuals.

Findings from studies support the association between colorectal cancer and physical inactivity and obesity. Research continues to point to the idea that exercise and low-calorie diets can help to prevent colorectal cancer.

A large, population-based study of men and women in Hawaii found that the following lifestyle factors were linked with colorectal cancer:

Smoking
Alcohol consumption
History of diabetes
Frequent constipation
High-calorie diet
Obesity
Physical inactivity
Low vegetable fiber intake (this association is controversial)
High levels of insulin (hormone that controls blood sugar levels)
Meat consumption

Medications

After surgery, chemotherapy (the use of anticancer drugs to destroy cancer cells) may be given to kill any cancerous cells that remain in the body. Chemotherapy controls the spread of the disease and improves survival rates over time. The following chemotherapeutic medications are used alone or in combination to treat colorectal cancer:

Fluorouracil (5-FU) -- often used in combination with leucovorin for 6 months after surgery. Reduces the rate of recurrence and improves chances of survival. Common side effects include nausea, diarrhea, inflammation of the skin and lining of the mouth, and lowered white blood cell count, which increases the chance of developing an infection and anemia.
Leucovorin -- a form of folic acid often used in combination with 5-FU. Side effects are rare but can include rash, itching, and wheezing.
Levamisole -- can be used in combination with 5-FU. Potential side effects are numerous and include nausea, vomiting, diarrhea, loss of appetite, abdominal pain, lower extremity swelling, insomnia, fatigue, headache, hair loss, dizziness, muscle and joint paints, and depression.

For colorectal cancer that has metastasized, or spread, doctors generally use 5-FU in combination with other drugs. One regimen approved by the United States Food and Drug Administration for metastatic colorectal cancer is 5-FU, leucovorin, and irinotecan. With the addition of irinotecan, the progression of the disease significantly slowed and survival improved compared to the 5-FU-leucovorin combination. However, an unexpectedly high death rate in two recent studies by the National Cancer Institute has brought the addition of irinotecan into question. There are other medications currently under investigation for metastatic colon cancer.

Long-term use of aspirin, other nonsteroidal anti-inflammatory drugs (NSAIDs), and hormone replacement therapy have shown promise in the prevention and treatment of colorectal cancer.

Aspirin -- may reduce the risk of polyps and colorectal cancer by up to 44%.
NSAIDs -- reduced the number of polyps by 90% and colon tumors by 55% in animals.
Hormone-replacement therapy (HRT) -- over the past 20 years, the rate of death from colorectal cancer among women has decreased far more than the rate among men. Studies suggest that this may be due to the increasing use of hormone-replacement therapy by women after menopause. However, HRT is not without risks, and your health care provider will help you determine which treatment is best for you.

Surgery and Other Procedures

Surgery is the treatment of choice for colorectal cancer, and is best when the disease is detected at an early stage. Before becoming cancerous, polyps can be removed during a colonoscopy. Depending on the severity and location of the cancer, including whether or where it has spread, an individual may need a partial or total removal of the colon (colectomy) and rectum (rectal resection). During surgery, the surgeon also examines other abdominal organs for signs of cancer. If cancer has spread to the liver, a portion of this organ may be removed as well. After removing the tumor and nearby tissue, the surgeon reconnects the healthy portions of the colon or rectum. If the healthy portions of the colon or rectum cannot be reconnected, a temporary or permanent opening (stoma) is made through the wall of the abdomen into the colon to provide a new path for waste material to leave the body. This procedure is called a colostomy. Radiation may also be used before or during surgery (called intraoperative radiotherapy) to shrink the tumor, and it may be recommended following surgery for certain stages of colorectal cancer to reduce the risk of recurrence. Following surgery, colonoscopies are performed every 3 - 6 months for 3 years to detect recurrence.

Nutrition and Dietary Supplements

A comprehensive treatment plan for colorectal cancer may include a range of complementary and alternative therapies. Nutrients and herbs may protect against side effects from conventional therapies as well as enhance chemotherapy and support anticancer activities. Mind-body therapies such as meditation, relaxation techniques, yoga, and qi gong may reduce the effects of stress and enhance your quality of life and your response to treatment. Ask your team of health care providers about the best ways to incorporate these therapies into your overall treatment plan.

Always tell your health care provider about the herbs and supplements you are using or considering, as some supplements may interfere with conventional cancer treatments.

Following these nutritional tips may help reduce symptoms:

Try to eliminate potential food allergens, including dairy, wheat (gluten), corn, preservatives, and food additives. Your health care provider may want to test for food sensitivities.
Eat antioxidant foods, including fruits (such as blueberries, cherries, and tomatoes), and vegetables (such as squash and bell peppers).
Eat foods high in B-vitamins and calcium, such as almonds, beans, whole grains (if no allergy), dark leafy greens (such as spinach and kale), and sea vegetables.
Avoid refined foods such as white breads, pastas, and especially sugar.
Eat fewer red meats and more lean meats, cold-water fish, tofu (soy, if no allergy) or beans for protein. Quality protein sources, such as organic meat and eggs, whey, and vegetable protein shakes, should be used as part of balanced program aimed at gaining muscle mass and preventing wasting that can sometimes be side effects of cancer therapies.
Use healthy 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 at least 30 minutes daily, 5 days a week.

You may use nutritional deficiencies 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 - 3 tablespoonfuls oil daily, to help decrease inflammation and help with immunity. Cold-water fish, such as salmon or halibut, are good sources.
Vitamin C, 500 - 1,000 mg, one to three times daily, as an antioxidant and for immune support.
L-glutamine, 500 - 1,000 mg three times daily, for support of gastrointestinal health and immunity.
Probiotic supplement (containing Lactobacillus acidophilus), 5 - 10 billion CFUs (colony forming units) a day, when needed for maintenance of gastrointestinal and immune health. You should refrigerate your probiotic supplements for best results.
Grapefruit seed extract (Citrus paradisi), 100 mg capsule or 5 - 10 drops (in favorite beverage) three times daily when needed, for antibacterial, antifungal, and antiviral activity, and for immunity.
Astaxanthin, 2 - 6 mg daily, for immune and antioxidant support.
Alpha-lipoic acid, 25 - 50 mg twice daily, for antioxidant support.
Resveratrol (from red wine), 50 - 200 mg daily, to help decrease inflammation and for antioxidant effects.
Coenzyme Q10, 100 - 200 mg at bedtime, for antioxidant and immune activity.
Melatonin, 2 - 6 mg at bedtime as needed, for immune support and sleep. Higher doses may be needed in cancer. Consult your health care provider.

Herbs

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

Green tea (Camellia sinensis) standardized extract, 250 - 500 mg daily, for antioxidant, anticancer and immune effects. Use caffeine-free products. You may also prepare teas from the leaf of this herb.
Reishi mushroom (Ganoderma lucidum) standardized extract, 150 - 300 mg two to three times daily, for anticancer and immune effects. You may also take a tincture of this mushroom extract, 30 - 60 drops two to three times a day.
Maitake mushroom (Grifola frondosa) standardized extract (D-fraction), 600 mg twice daily, for immune and anticancer effects. 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 anticancer and immune effects.
Turmeric (Curcuma longa) standardized extract, 300 mg three times a day, for pain and inflammation.
Milk thistle (Silybum marianum) seed standardized extract, 80 - 160 mg two to three times daily, for detoxification support.
Fermented wheat germ extract, 1 packet dissolved in favorite beverage once daily, for anticancer and immune effects.

Acupuncture

While acupuncture is not used as a treatment for cancer itself, evidence suggests it can be a valuable therapy for cancer-related symptoms (particularly nausea and vomiting that often accompanies chemotherapy treatment). Studies have indicatedthat acupuncture may help reduce pain and shortness of breath. Acupressure (pressing on rather than needling acupuncture points) has also proved useful in controlling breathlessness. Patients can learn this technique and use to treat themselves.

Some acupuncturists prefer to work with a patient only after the completion of conventional medical cancer therapy. Others will provide acupuncture or herbal therapy during active chemotherapy or radiation. Acupuncturists treat cancer patients based on an individualized assessment of the excesses and deficiencies of qi located in various meridians. In many cases of cancer-related symptoms, a qi deficiency is usually detected in the spleen or kidney meridians.

Mind-Body Medicine

Relaxation techniques are beneficial for individuals undergoing surgery. In one study it was observed that patients who received standard care plus relaxation techniques in the form of guided imagery audiotapes before, during, and after surgery experienced significantly better sleep and less pain following the surgery than patients who received only standard care.

Other Considerations

Pregnancy

Colorectal cancer may be detected late in pregnant women because symptoms of the disease, such as rectal bleeding, nausea, and vomiting, resemble the symptoms of pregnancy. Pregnant women should avoid chemotherapy and radiation therapy. Surgery puts the fetus at risk, therefore folic acid and nutritional needs are usually maintained during pregnancy, and treatment is postponed until after the baby is delivered.

Prognosis and Complications

Follow-up care after treatment for colorectal cancer is very important. If the cancer returns or if new cancer develops, it should be treated as soon as possible. If left untreated, colorectal cancer can spread to the liver or lungs, or a tumor may block the colon. In some cases, individuals with colorectal cancer may need to have their entire colon or rectum removed. If the surgeon cannot reconnect healthy portions of the colon or rectum, a temporary or permanent surgical opening (stoma) is made through the wall of the abdomen into the colon to provide a new path for waste material to leave the body. After this procedure, a special bag is worn to collect body waste. Individuals who wear the bag may need counseling on how to care for the stoma as well as how to deal with the emotional difficulties associated with this procedure.

The outlook in cases of colorectal cancer depends on how deeply the tumor has penetrated into the tissue and whether the cancer has spread to lymph nodes in the abdominal region or to other areas of the body. Following are the proportions of individuals who survive at least 5 years based on the stage of their disease when it was first diagnosed:

Stage A -- more than 90%
Stages B1 and B2 -- 85%
Stage C -- 70% to 80%
Stage D -- 5%

Supporting Research

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Review Date:
10/12/2006
Reviewed By:
Ernest B. Hawkins, MS, BSPharm, RPh, Health Education Resources; and Steven D. Ehrlich, N.M.D., private practice specializing in complementary and alternative medicine, Phoenix, AZ. Review provided by VeriMed Healthcare Network.

A.D.A.M. Copyright

adam.com

Prostate cancer

FitSugar — Wed, 08 Oct 2008 17:35:04 -0700

Overview

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

HEALTH GUIDE REFERENCE FROM A.D.A.M

Prostate cancer is a cancerous (malignant) tumor that originates in the prostate gland and can eventually spread to other organs, bones, and tissues. The prostate is a cluster of small glands located beneath the bladder that surrounds the urethra, the tube that carries urine from the bladder out through the penis. Its principle function is to manufacture fluid that constitutes a portion of the semen.

Prostate cancer is the third most common cause of death from cancer in men of all ages and is the most common cause of death from cancer in men over 75 years old. Prostate cancer is rarely found in men younger than 40. Men at higher risk include African-America men older than 60, farmers, tire plant workers, painters, and men exposed to cadmium. The lowest number of cases occurs in Japanese men and those who do not eat meat (vegetarians).

Fortunately, prostate cancer tends to be slow-growing compared to many other cancers -- the majority of prostate cancers either do not spread or cause harm for decades.

Signs and Symptoms

Many people with prostate cancer experience no symptoms at all.

Some symptoms that may indicate prostate cancer include:

Difficult and painful urination
Frequent urination and a feeling that one has to urinate even when the bladder is empty
Incomplete emptying of the bladder, which may lead to dribbling of urine
Awakening frequently in the night to urinate
Decreased force of urine stream
Blood in the urine
Hip and back pain

When the cancer has spread to other parts of the body, symptoms can include:

Bone pain
Weakness or paralysis caused by compression of the spinal cord
Weight loss
Anemia
Kidney failure

Causes

The cause of prostate cancer is unknown, although some studies have shown a relationship between high dietary fat intake and increased testosterone levels.. The influence of genes on the development of prostate cancer is suggested by the fact that prostate cancer tends to occur in men who are related to one another (see Risk Factors section). In addition, researchers have identified a gene that is associated with 30% of family-related prostate cancers.

Reports also indicate that farmers as well as men who work in tire, rubber, and sheet metal factories tend to have high rates of prostate cancer or more aggressive forms of the cancer. Some researchers speculate that environmental exposure to cadmium (present in commercial fungicides) and other harmful substances may be responsible for the high rates of prostate cancer in these men.

Nutrition has been implicated in the development of prostate cancer because disease rates among men from countries with low prostate cancer rates (such as Japan) increase when they immigrate to the United States. This rise in incidence is thought to be due to the switch to a typical American diet, which is high in saturated fat. Elevated levels of male sex hormones, such as testosterone, may also play a role in the development of prostate cancer.

Risk Factors

The following factors may increase a man's risk for prostate cancer:

Older age -- prostate cancer is most common among men who are older than 55.
Race -- African-Americans have a greater risk of developing prostate cancer than Caucasians who, in turn, have a greater risk than Native and Latin Americans.
Family history of prostate cancer -- having a brother with prostate cancer makes a man 4.5 times more likely to develop the disease. Having a father with prostate cancer makes a man 2.3 times more likely to develop prostate cancer.
High-fat diet -- foods rich in saturated fat may increase testosterone levels.
Lack of exercise may increase the risk in those who eat a high-fat diet.
Occupation -- people who are regularly exposed to the chemicals dimethyl formamide and acrylonitrate, and the metal cadmium (such as metal workers and farmers), have high rates of prostate cancer.

Diagnosis

Two standard tests are used for early detection of prostate cancer:

Digital rectal exam (DRE) -- in this test, the physician inserts a gloved, lubricated finger into the patient's rectum in order to feel the prostate for bumps or other abnormalities. Many malignant tumors originate in the outer part of the prostate where they may be detected by this exam. Some men find this test embarrassing, but the DRE is quick and relatively painless, and helps detect many prostate cancers. Although some tumors identified using DRE have already spread outside of the prostate gland, studies indicate that regular DREs still save lives.
PSA test -- blood test measuring the level of prostate-specific antigen (PSA), a protein produced in the prostate gland that keeps semen in liquid form. Prostate cancer cells produce elevated quantities of PSA, so measuring PSA levels allows physicians to detect cancer while it is still microscopic. Unfortunately, the test is not accurate enough to definitively rule out or confirm cancer. For example, advancing age and benign conditions such as enlarged prostate can also elevate PSA levels.

If either the DRE or PSA test suggests the possible presence of cancer, the following tests will be performed to make a definite diagnosis:

Transrectal Ultrasound -- a visual image of the prostate is obtained by using ultrasound.
Biopsy of the prostate -- a tissue sample is obtained through the rectum and examined for cancerous cells under the microscope.

If the biopsy confirms the presence of cancer, several tests will be performed to detect any spread of the disease. This information gauges how serious the prostate cancer is at the time of diagnosis. Likely tests include the following:

Imaging tests (CT and MRI) -- computerized tomography (CT) or magnetic resonance imaging (MRI) scans may pinpoint the location of cancer that has spread beyond the prostate.
Bone scans and x-rays -- these techniques look for spread of cancer to the bones.
Lymph node dissection -- this is part of a surgical procedure to determine if the cancer has spread to the lymphatic system.

Preventive Care

Regular screening with the DRE and PSA exams by a doctor may help detect prostate cancer in the early stages, before it has spread. Both the American Cancer Society and the American Urological Association recommend that men between the ages of 50 - 70 should have annual DRE or PSA tests. African-American men or those with a family history of prostate cancer should begin screening at age 40.

Studies also suggest that the following lifestyle modifications may minimize the risk of prostate cancer:

Consuming a low-fat diet, rich in fruits and vegetables
Eating foods rich in selenium (such as brewer's yeast, wheat germ, chicken liver, nuts and seeds, tuna and herring) and vitamin E (such as wheat germ, organ meats, sweet potatoes, leafy vegetables including spinach, nuts and seeds, eggs, soybeans, and lima beans)
Exercising regularly, because exercise temporarily lowers testosterone

Treatment

Treatment for prostate cancer depends on the stage of the disease, the age of the individual, the presence of other medical conditions, and the man's preferences in conjunction with the physician's recommendations.

If prostate cancer is detected early, treatment usually involves either surgical removal of the prostate or radiation therapy. For more advanced cases of prostate cancer, or if cancer spreads beyond the prostate, hormone medications are the preferred treatment.

If the man is older than 70 and has only a slow-growing tumor, the physician may adopt a strategy called "watchful waiting," in which the man returns frequently for check-ups. Treatment occurs only if the man's condition worsens.

Dietary modifications may slow the growth of the cancer in men undergoing watchful waiting, as well as those who have had surgery or are being treated iwth with medication or radiation. For example, eating a low-fat diet, rich in fruits, vegetables, soy, selenium, and fiber has been associated with a decreased risk of prostate cancer.

Saw palmetto, a widely studied herb, appears to significantly reduce symptoms associated with benign prostatic hypertrophy (BPH) and may be used in prostate cancer, but only under the supervision of a doctor.

Acupuncture can relieve pain and the side effects of surgery while meditation and massage may reduce stress and anxiety associated with having prostate cancer.

Medications

Medications are considered the best therapy for people with advanced stages of prostate cancer or when cancer spreads from the prostate to other parts of the body. Drugs may also be prescribed prior to radiation therapy or when surgical procedures fail to lower PSA levels. Most medications for prostate cancer lower levels of male sex hormones (such as testosterone). Lowering testosterone levels can cause tumors to shrink or slow their growth.

Some commonly prescribed medications include:

Luteinizing Hormone-Releasing Hormone (LH-RH) agonists (such as leuprolide, goserelin, and buserelin) -- LH-RH is natural hormone, released by the hypothalamus in the brain, that lowers the production of testosterone, and the medication encourages the release of this natural hormone. Side effects can include hot flashes, weight gain, development of male breast tissue, breast pain, and nausea.
Hormones including antiandrogens (such as flutamide, bicalutamide, and nilutamide) and estrogens (such as diethylstilbestrol) -- these medications reduce testosterone levels, but side effects can include reduced sex drive, fatigue, nausea, impotence, diarrhea, and hot flashes.
Chemotherapeutic medications (such as mitoxantrone and estramustine) -- improve symptoms in advanced cancer but do not increase life expectancy

Surgery and Other Procedures

Removal of the prostate (prostatectomy) -- offers an excellent cure for men with prostate cancer that is completely confined to the prostate, and is performed if life expectancy is at least 10 years and cancer is confined to the prostate. Side effects include incontinence and impotence, but new procedures that spare nerves near the prostate preserve sexual function in 25 - 90 % of men.
Surgical exploration of lymph nodes -- may be performed to evaluate whether prostate cancer has spread to the lymphatic system.
Resection of the prostate (called TURP or transurethral resection of the prostate) -- removal of all or part of the prostate gland to eliminate cancer and to relieve obstruction of urine.
Removal of the testes (orchiectomy) -- lowers testosterone levels, but side effects can include impotence and hot flashes.

In addition to these surgical procedures, radiation therapy may be effective for cancer confined to the prostate, particularly for older men. Radiation can be administered through an external source, or irradiated seeds can be placed internally near the prostate. Using irradiated seeds actually lowers the risk of damage to organs surrounding the prostate from radiation because administration can be more precise in both amount and location. Side effects can include proctitis (inflammation of the lining of the rectum), urinary tract infections, and impotence.

Nutrition and Dietary Supplements

A comprehensive treatment plan for support of the health of men living with prostate cancer may include a range of complementary and alternative therapies. Preliminary studies suggest that nutritional supplements may reduce the symptoms of some prostate cancer. Ask your team of health care providers about the best ways to incorporate these therapies into your overall treatment plan. Always tell your health care provider about the herbs and supplements you are using or considering using.

Following these nutritional tips may help reduce symptoms:

Eat foods high in B-vitamins and calcium, such as almonds, beans, whole grains (if no allergy), dark leafy greens (such as spinach and kale), and sea vegetables. A study found that men who consumed 28 or more servings of vegetables per week were 35% less likely to develop prostate cancer than those who had less than 14 servings per week.
Eat antioxidant foods, including fruits (such as blueberries, cherries, and tomatoes) and vegetables (such as squash and bell peppers).
Avoid refined foods, such as white breads, pastas, and especially sugar.
Quality protein sources, such as organic meat and eggs, whey, and vegetable protein shakes, may be used as part of balanced program aimed at gaining muscle and preventing weight loss that can sometimes be a side effect of cancer therapy. Try to eat fewer red meats and more lean meats such as chicken and fish, tofu (soy, if no allergy), or beans for protein.
Eat cruciferous vegetables (such as broccoli, cabbage, and cauliflower) -- they contain special cancer fighting chemicals.
Use healthy oils in foods, such as olive oil or vegetable oil.
Reduce or eliminate trans-fatty acids, found in commercially baked goods such as cookies, crackers, cakes, French fries, onion rings, donuts, processed foods, and margarine.
Avoid coffee and other stimulants, alcohol, and tobacco.
Drink 6 - 8 glasses of filtered water daily.
Exercise at least 30 minutes daily, 5 days a week.

You may address nutritional deficiencies with the following supplements:

A daily multivitamin, containing the antioxidant vitamins A, C, E, the B-complex vitamins, and trace minerals such as magnesium, calcium, and selenium.
Calcium D-glucarate, 200 - 400 mg daily, for support of immunity and anticancer effects.
Omega-3 fatty acids, such as fish oil, 1 - 2 capsules or 1 - 3 tablespoonfuls oil, one to three times daily, to help decrease inflammation and help with immunity. Cold-water fish, such as salmon or halibut, are good sources but not substitutes for supplementation.
Whey protein, 10 - 20 grams daily mixed in favorite beverage, when needed as a protein supplement for support of immunity and weight gain; or creatine, 5 - 7 grams daily, when needed for muscle weakness and wasting. Talk with your health care provider.
N-acetyl cysteine, 200 mg one to three times daily, for antioxidant effects.
Probiotic supplement (containing Lactobacillus acidophilus among other strains), 5 - 10 billion CFUs (colony forming units) a day, when needed for maintenance of gastrointestinal and immune health. You should refrigerate your probiotic supplements for best results.
Astaxanthin, 2 - 6 mg daily, for immune and antioxidant support.
Coenzyme Q10, 100 - 200 mg at bedtime, for antioxidant and immune activity.
Vitamin C, 500 - 1,000 mg one to three times daily, as an antioxidant and for immune support. Some doctors will use higher doses in alternative cancer therapies. Check with your health care provider.
Lycopene, 5 mg one to three times daily, for antioxidant and anticancer activity. In a large study, lycopene levels were significantly lower in those with prostate cancer compared to those without.
L-glutamine, 500 - 1,000 mg three times daily, for support of gastrointestinal health and immunity.
Melatonin, 2 - 5 mg one hour before bedtime, for sleep and immune protection. Ask your health care provider about potential drug interactions with the use of melatonin.

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.
Saw palmetto (Serenoa repens) standardized extract, 160 mg two times daily, for hormonal support. There has been some concern that saw palmetto could mask prostate cancer by lowering prostate-specific antigen (PSA) levels. However, a randomized study of more than 1,000 patients did not demonstrate this effect on PSA levels. Talk to your health care provider about using saw palmetto for your condition.
Fermented wheat germ extract, 1 packet dissolved in favorite beverage once daily, for anticancer and immune effects. Ask your health care provider for more about this supplement.
Bitter Melon (Momordica charantia) standardized extract, 200 mg two to three times daily, for anticancer and immune support.
Maitake mushroom (Grifola frondosa) standardized extract (D-fraction), 600 mg twice daily, for immune and antiviral effects. You may also take a tincture of this mushroom extract, 30 - 60 drops two to three times a day.
Garlic (Allium sativum), standardized extract, 400 mg two to three times daily, for antibacterial or antifungal and immune activity.

Acupuncture

Acupuncture may provide relief from side effects of orchiectomy (removal of the testes). Studies also support the use of acupuncture for the pain that often occurs when cancer has spread beyond the prostate (particularly to the bones). A National Institutes of Health statement released in 1997 also supports the use of acupuncture to alleviate nausea associated with chemotherapy.

Evidence suggests acupuncture can be a valuable therapy for cancer-related symptoms (particularly nausea and vomiting that often accompanies chemotherapy treatment). Studies have also indicated that acupuncture may help reduce pain and shortness of breath. Acupressure (pressing on rather than needling acupuncture points) has also proved useful in controlling breathlessness and is a technique that patients can learn and then use to treat themselves.

Massage and Physical Therapy

Studies suggest that massage reduces stress and boosts immune function, so it may help relieve anxiety for men undergoing treatment for prostate cancer.

Pelvic floor exercises -- the repetitive use of muscles that start and stop the flow of urine -- may help decrease incontinence caused by prostatectomy (removal of the prostate). This therapeutic approach is often combined with biofeedback.

Mind-Body Medicine

Meditation

Meditation may benefit men with prostate cancer by helping them to reduce stress, ease anxiety, and regain a sense of self-control.

Biofeedback and Pelvic Muscle Training (PMT)

Several studies have found that learning to start and stop the flow of urine by repeatedly using the muscles of the pelvis (PMT) in combination with biofeedback can reduce the duration of incontinence after prostate cancer surgery. Other studies suggest however, that PMT alone, with or without biofeedback, is responsible for the beneficial effects. Either way, both PMT and biofeedback are safe, noninvasive therapies that may benefit men who suffer from incontinence following either surgical removal of the prostate or other treatments for prostate cancer.

Other Considerations

Prognosis and Complications

Most complications from prostate cancer result from specific treatments. These include:

Prostatectomy -- can cause incontinence and impotence
Radiation therapy -- can cause proctitis (inflammation of the lining of the rectum), bladder infections, and impotence
Hormone medications -- can cause loss of libido, impotence, hot flashes, excessive development of male breasts, and tenderness in male breast tissue
Removal of testes -- can cause impotence and hot flashes

The outlook for a man with prostate cancer depends on his age, the stage of tumor growth, whether he has any underlying medical illnesses, and his PSA levels. The prognosis for men with cancer that has not spread beyond the prostate is quite good. Most of these cancers are curable with appropriate treatment, and after 15 years the same number of these men will be alive as those who never had prostate cancer. If the cancer spreads beyond the prostate and does not respond to hormone medications, however, there is little hope for a cure. Still, prostate tumors are slow-growing, and even men with advanced prostate cancer can survive for 5 years or more.

Supporting Research

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Bairati I, Meyer F, Fradet Y, Moore L. Dietary fat and advanced prostate cancer. J Urol. 1998;159:1271-1275.

Bales GT, Gerber GS, Minor TX, et al. Effect of preoperative biofeedback/pelvic floor training on continence in men undergoing radical prostatectomy. Urology. 2000;56(4):627-630.

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Chan JM, Giovannucci E, Andresson SO, Yuen J, Adami HO, Wolk A. Dairy products, calcium, phosphorous, vitamin D, and risk of prostate cancer (Sweden). Cancer Causes Control. 1998;9(6):559-566.

Clark LC, Combs GF, Turnbull BW, et al. Effects of selenium supplementation for cancer prevention in patients with carcinoma of the skin. A randomized controlled trial. Nutritional Prevention of Cancer Study Group. JAMA. 1996;276(24):1957-63.

Cohen JH, Kristal AR, Stanford JL. Fruit and vegetable intakes and prostate cancer risk. J Nat Can Inst. 2000;92(1):61-68.

Coker KH. Meditation and prostate cancer: Integrating a mind/body intervention with traditional therapies. Sem Urol Oncol. 1999;17(2):111-118.

Cook NR, Stampfer MJ, Ma J, et al. Beta-carotene supplementation for patients with low baseline levels and decreased risks of total and prostate carcinoma. Cancer. 1999;86(9):1783-1792.

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Ezzo J, Berman B, Hadhazy VA, Jadad AR, Lao L, Singh BB. Is acupuncture effective for the treatment of chronic pain? A systematic review. Pain. 2000;86:217-225.

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Fleshner NE, Klotz LH. Diet, androgens, oxidative stress and prostate cancer susceptibility. Cancer and Metastasis Reviews. 1999;17:325-330.

Franke JJ, Gilbert WB, Grier J, Koch MO, Shyr Y, Smith JA. Early post-prostatectomy pelvic floor biofeedback. J Urol. 2000;163:191-193.

Fraschini F, Demartini G, Esposti D, Scaglione F. Melatonin involvement in immunity and cancer. Biol Signals Recept. 1998;7(1):61-72.

Freeman VL, Meydani M, Yong S, Pyle J, Flanigan RC, Waters WB, Wojcik EM. Prostatic levels of fatty acids and the histopathology of localized prostate cancer. J Urol. 2000;164(6):2168-2172.

Gann PH, Ma J, Giovannucci E, et al. Lower prostate cancer risk in men with elevated plasma lycopene levels: results of a prospective analysis. Cancer Research. 1999;59:1225-1230.

Giovannucci E, Rimm EB, Wolk A, et al. Calcium and fructose intake in relation to risk of prostate cancer. Cancer Res. 1998;58(3):442-447.

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Hayes RB, Ziegler RG, Gridley G, et al. Dietary factors and risks for prostate cancer among blacks and whites in the United States. Cancer Epidemiol Biomarkers Prev. 1999;8(1):25-34.

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Review Date:
11/7/2006
Reviewed By:
Ernest B. Hawkins, MS, BSPharm, RPh, Health Education Resources; and Steven D. Ehrlich, N.M.D., private practice specializing in complementary and alternative medicine, Phoenix, AZ. Review provided by VeriMed Healthcare Network.

A.D.A.M. Copyright

adam.com

Cirrhosis

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

Overview

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

HEALTH GUIDE REFERENCE FROM A.D.A.M

Cirrhosis is a condition that causes scarring of the liver as a result of chronic liver disease. Scarring blocks blood and bile flow through the liver and keeps it from working properly.

As the largest internal organ in the body, the liver performs many vital tasks. For example, it gets rid of or neutralizes toxins (such as poisons, germs, and bacteria) in the blood and controls infection. The liver also produces proteins that regulate blood clotting and bile that helps your body absorb fats and fat-soluble vitamins.

Cirrhosis is irreversible, but it progresses slowly, so early treatment can help prevent more damage. As liver function worsens, you may experience fatigue, weight loss, swelling in your legs and abdomen, and jaundice. If the disease is severe enough, it can be fatal.

The most common causes of cirrhosis in the United States are excessive use of alcohol and chronic infection with the hepatitis C virus.

Signs and Symptoms

Symptoms of cirrhosis can range from an absence of symptoms to outright liver failure.

The most common symptoms include:

Fatigue and weakness
Loss of appetite, weight loss, and nausea
Small, red spider-like blood vessels under the skin
Yellowing of the skin and eyes (jaundice)
Redness of the palms of the hands (palmar erythema)
Swelling of the belly caused by fluid retention (ascites)
Swelling of the legs, feet, and back caused by fluid buildup (edema)
Whole body itching (called pruritus)
Mental confusion (called hepatic encephalopathy), caused by a buildup in the blood of harmful toxins
Vomiting blood (from enlarged veins in the esophagus due to portal hypertension; see Complications section).

Causes

The most common cause of liver disease in the United States is alcohol abuse.

Drinking excessive amounts of alcohol on a regular basis almost always causes liver damage, although not necessarily cirrhosis. Consuming 32 - 48 oz. of beer, 4 - 8 oz. of liquor, or 16 - 32 oz. of wine every day for 10 - 15 years or longer increases your chances significantly of developing cirrhosis. How much alcohol you drink, how often, and for how many years are more important factors what kind of alcohol you drink.

Other causes of cirrhosis include:

Chronic hepatitis B and hepatitis C
Inherited diseases -- such as cystic fibrosis
Autoimmune inflammation of the liver (the body's own immune system attacks the liver)
Blocked bile ducts
Nonalcoholic fatty liver disease (where fat deposits build up in the liver and cause scar tissue to form)
Metabolic disorders of iron and copper (hemochromatosis and Wilson's disease respectively) each of which can deposit in the liver
Medications or exposure to toxic substances.

Risk Factors

Related to alcohol:

Women can develop liver disease even though they may drink less than men.
Obesity may increase your chances of developing alcoholic liver disease because of fatty deposits in the liver.

Other factors:

Inherited diseases, such as hemochromatosis and Wilson's disease
Certain medical conditions
Chronic hepatitis B or C

Diagnosis

Your doctor will take a detailed history to try to determine the cause of your liver disease and to see if your symptoms might be related to something else. Then, the doctor will examine you closely for signs of liver disease, including yellowing (jaundice) of your eyes and skin, red spider-like blood vessels just under the surface of your skin, and redness of your palms.

Your doctor will press on your abdomen to feel the size of your liver. In the early stages of liver disease, the liver may be enlarged and firm, but it shrinks as scar tissue forms.

Your doctor may order other tests, such as blood tests to look for certain liver enzymes, a bilirubin test, an ultrasound, CT scan, or MRI, or a liver biopsy.

Prevention

Drink only in moderation.
Take precautions to avoid contracting hepatitis B and C (such as being careful if your occupation exposes you to blood or blood products, practicing safe sex, getting a hepatitis B vaccine).
See your doctor regularly if you have chronic hepatitis.

Treatment

Cirrhosis is irreversible, but you can slow down the progression of the disease. Treatment depends on the underlying cause. For example, abstaining from alcohol, or taking interferon or other medications to build up your immune system if you have chronic viral hepatitis. Your doctor will also treat complications, such as giving you blood pressure medications to control portal hypertension or drugs to stop bleeding veins. In certain cases liver transplant will be necessary.

Lifestyle

If you have cirrhosis from any cause, it is vital to abstain from drinking alcohol to prevent further damage to the liver. If your cirrhosis is caused by alcoholism, your doctor may suggest Alcoholics Anonymous as a good place to start your rehabilitation and maintain your abstinence.

Medications that may cause liver damage must also be stopped. For example, acetaminophen (Tylenol) can cause liver damage if taken in large quantities or by people who drink alcohol regularly. Nonsteroidal anti-inflammatory drugs can also damage the liver, as can some herbs and supplements. If you have liver disease, do not take any over-the-counter medication, herbs, or supplements without first checking with your doctor.

Making changes in your diet, such as lowering salt intake, may be necessary to treat complications of cirrhosis.

Medications

Medications can treat complications such as bleeding from veins, infections in fluid accumulated in the abdomen, and damage to the brain (encephalopathy) caused by toxins circulating in the blood.

Blood pressure medications (beta-blockers) -- to help lower portal hypertension, an increase in blood pressure in the portal vein, which brings blood to the liver from the intestine. Beta-blockers include propranolol (Inderal) and nadolol (Coregard).
Sandostatin -- may be given to stop bleeding vessels in the esophagus or stomach by causing blood vessels to narrow.
Diuretics (water pills) -- to help reduce the amount of fluid in your abdomen or legs. Diuretics include spironolactone (Aldactone) and furosemide (Lasix).
Lactulose -- given for hepatic encephalopathy, brain and nervous system damage caused by a build up of ammonia in the blood. A damaged liver may not be able to cleanse the blood of ammonia, and lactulose, a synthetic sugar, can help stop your intestines from creating ammonia.

Surgery and Other Procedures

You may need a liver biopsy to determine the cause of cirrhosis and to assess the extent of liver damage. Generally this procedure involves inserting a needle through the abdominal wall to the liver to obtain tissue samples.

Surgery may be required to stop and prevent certain complications of cirrhosis:

Endoscopic procedures to stop bleeding from blood vessels in the esophagus
Placing a shunt to reroute blood from the liver, to lower portal hypertension
Draining fluid from the abdomen (called paracentesis)
Liver transplant

Nutrition and Dietary Supplements

Malnutrition is often a problem for people with cirrhosis. One of the liver’s important functions is to help convert food into stored energy, as well as to rid the body of toxins. For these reasons, eating a healthy diet is an important part of treatment for cirrhosis. You should be eating a well-balanced diet with plenty of fruits, vegetables, and whole grains. Your doctor may also talk with you about proper protein balance, and limiting your fluid and salt intake.

Dietary Restrictions

Protein

High-quality dietary protein may be particularly important for you if you have buildup of fluid in the abdomen or swelling of the feet, legs, or back. Protein also helps to repair muscle mass. But too much protein can raise ammonia levels and trigger hepatic encephalopathy (see Complications). In general, your doctor needs to determine how much protein is right for you. Your doctor may recommend eating vegetable protein (such as soy) instead of animal protein.

Sodium (salt)

If you have fluid retention, you may be asked to lower the amount of salt you consume, since salt encourages the body to retain water. Remember that lowering your salt intake will involve more than passing up the salt shaker; the foods highest in salt are processed and prepared foods. Examples of such foods are canned meats, soups, and vegetables, crackers, and cold cuts. Eat good amounts of fresh foods because they contain very little sodium. Instead of adding salt to your food, try lemon juice or black pepper to add taste.

Shellfish

Avoid raw shellfish, which may carry a bacteria called Vibrio vulnificus that can be dangerous to people with cirrhosis. If you are not sure how well shellfish is cooked, do not eat it.

Dietary Supplements

It is very important that you talk to your doctor before taking any supplement if you have liver disease, including the following:

Antioxidants -- There is some preliminary evidence that antioxidants, like vitamin E and selenium, might help in treating primary biliary cirrhosis, a condition in which the bile ducts of the liver are slowly destroyed. However, a later double-blind, placebo controlled study found no benefit from a combination of vitamins A, C, E, plus selenium, methionine, and co-enzyme Q10. While there is no evidence that taking these supplements will help, you can boost the amount of antioxidants you get by eating lots of fresh fruits, vegetables, and whole grains.
Betaine (20 g per day in two doses) -- Betaine is a nutrient that reduces homocysteine levels in the body, which are associated with heart disease and are higher in people with liver disease. Preliminary studies have suggested that betaine might be helpful in treating nonalcoholic fatty liver disease and alcohol-induced cirrhosis. In one preliminary study, 10 people with fatty liver disease took betaine for up to 1 year and had improvement in liver function tests and a reduced amount of fat and other changes in the liver itself. More research is needed.
S-adenosylmethionine (SAMe, 1,200 - 1,600 mg per day) -- SAMe, a naturally occurring antioxidant that is involved in many chemical processes in the body, is best known for its antidepressant effects. But it is also involved in the processes of the liver. People with liver disease have low levels of SAMe, and this may in turn lead to low levels to glutathione. Several studies seem to indicate that taking SAMe may reduce symptoms of liver disease and normalize bilirubin and liver enzyme levels. However, most of the studies have been small and some have used intravenous (IV) SAMe. More studies are needed to determine what benefits SAMe might provide. SAMe interacts with a number of medications, including prescription antidepressants.
Branched chain amino acids (BCAAs) -- BCAAs, which are involved in synthesizing protein in the body, have shown promise is treating hepatic encephalopathy, a brain disorder caused by a buildup of toxins in the blood. Some studies suggest that taking BCAAs can help people with chronic hepatic encephalopathy improve liver function tests and motor ability. However, not all studies show any benefit.

Herbs

The use of herbs is a time-honored approach to strengthening the body and treating disease. Herbs, like medications, contain active substances that can trigger side effects and interact with other herbs, supplements, or medications. People with liver disease must be particularly careful because the liver processes almost everything you ingest. For these reasons, you should take herbs with extreme care and only under the supervision of your doctor.

Bupleurum (Bupleurum chinese) -- The Chinese herb bupleurum has anti-inflammatory properties and has been used historically to treat liver disorders. In one study, a formulation that contained bupleurum appeared to reduce the risk of liver cancer in people with cirrhosis.
Licorice root (Glycyrrhiza glabra) -- Licorice root has been used in both Eastern and Western medicine to treat a variety of illnesses, including liver disease. Some preliminary data from Japanese researchers suggests that taking glycyrrhizin (an active component of licorice root) along with cysteine and glycerine might help reduce the risk of cirrhosis if you have hepatitis C. However, the formula was delivered intravenously (IV). It is not known whether taking these substances by mouth would have any effect. More studies are needed. People with high blood pressure or those who take steroids, digoxin (Lanoxin), diuretics (water pills), or anticoagulants (blood thinners such as warfarin (Coumadin) should not take licorice. Pregnant women should avoid licorice.
Milk thistle (Silybum marianum, 420 mg per day standardized to 70 - 80% silymarin for cirrhosis; 240 mg two times per day of silibinin for chronic hepatitis) -- Milk thistle has been used since Greco-Roman times to treat liver problems. Several scientific studies lend support to this traditional use. They suggest that a substance in milk thistle (silymarin) can protect the liver from damage caused by viruses, toxins, alcohol, and certain drugs such as acetaminophen. However, the evidence is stronger for some conditions than others:
- Studies are mixed as to whether milk thistle improves liver function tests or the death rate for people with alcohol-induced cirrhosis.
- Studies are also mixed as to whether milk thistle improves liver function tests or quality of life for people with chronic active hepatitis B or C.
- Milk thistle may reduce liver damage caused by mushroom poisoning (due to Amanita phalloides, or death’s cap mushroom)
- Milk thistle may help protect the liver against damage from exposure to industrial toxins.

In a comprehensive review of studies on milk thistle by the U.S. Agency for Healthcare Research and Quality (AHRQ), milk thistle improved liver function in people with mild liver disease but was less effective for those with severe liver disease such as cirrhosis.

Homeopathy

Although few studies have examined the effectiveness of specific homeopathic therapies, professional homeopaths may consider remedies, based on their knowledge and experience, for reducing the physical addiction to alcohol and for helping to treat hepatitis. Before prescribing a remedy, homeopaths take into account a person's constitutional type -- your physical, emotional, and psychological makeup. An experienced homeopath assesses all of these factors when determining the most appropriate treatment for each individual.

Remedies that may be recommended for alcoholism include:

Nux vomica
Staphysagria
Belladonna
Stramonium
Chelidonium
Zincum
Carduus marianus

Remedies that may be recommended for hepatitis include:

Aconitum
Belladonna
Chelidonium
China
Lycopodium
Mercurius
Phosphorus

Other Considerations

Your doctor will use caution when prescribing medications if you have cirrhosis because many medications cause complications in someone with a weakened liver.

Similarly, certain herbs and supplements are known to cause harm to the liver or cause complications that affect those with liver disease. A short list is below; talk to your doctor before taking any herb or supplement if you have liver disease.

Kava kava (an herb used for anxiety and tension) can be toxic to the liver and cause severe hepatitis and even liver failure in high doses.
Vitamin A in high doses can be toxic to the liver.
Mistletoe (Phoradendron leucarpum)
Germander (Teucrium chamaedrys)
European barberry (Berberis vulgaris)

Pregnancy

Pregnant or breastfeeding women should not use milk thistle or licorice.

Prognosis and Complications

Complications from cirrhosis include:

Portal hypertension (buildup of pressure in the large vein supplying blood to the liver)
Bleeding esophageal varices (enlarged veins at the lower end of the esophagus that have a tendency to bleed; caused by portal hypertension)
Hepatic encephalopathy (brain disorder caused by buildup of toxins), which causes forgetfulness and mental confusion; may lead to coma
Ascites (abdominal fluid retention) and bacterial peritonitis (infection of the fluid)
Sepsis (presence of harmful organisms or their toxins in the blood or tissues)
Liver cancer
Kidney failure
Osteoporosis
Insulin resistance

Cirrhosis can be serious and life-threatening, particularly if you continue to drink alcohol. The good news is that with proper diet, medical management, and avoidance of alcohol, you can drastically slow down the rate of progression of liver damage.

Supporting Research

Abittan CS, Lieber CS. Alcoholic liver disease. Curr Treat Options Gastroenterol. 1999;2(1):72-80.

Agency for Healthcare Research and Quality. Milk thistle: effects on liver disease and cirrhosis and clinical adverse effects. Summary, evidence report/technology assessment: number 21, September 2000. American Liver Foundation. Cirrhosis. Accessed on September 14, 2007.

Angulo P, Lindor KD. Treatment of nonalcoholic fatty liver: present and emerging therapies. Semin Liver Dis. 2001;21(1):81-88.

Barak AJ, Beckenhauer HC, Tuma DJ. Betaine, ethanol, and the liver: a review. Alcohol. 1996; 13(4): 395-398.

Cave M, Deaciuc I, Mendez C, Song Z, Joshi-Barve S, Barve S, McClain C. Nonalcoholic fatty liver disease: predisposing factors and the role of nutrition. J Nutr Biochem. 2007 Mar;18(3):184-95. Review.

Chitturi S, Farrell GC. Herbal hepatotoxicity: an expanding but poorly defined problem. J Gastroenterol Hepatol. 2000;15(10):1093-1099.

Day CP. Who gets alcoholic liver disease: nature or nurture? J R Coll Physicians Lond. 2000;34(6):557-562.

Ferenci P, Dragosics B, Dittrich H, et al. Randomized controlled trial of silymarin treatment in patients with cirrhosis of the liver. J Hepatol. 1989;9:105-113.

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

Fukushima H, Miwa Y, Shiraki M, Gomi I, Toda K, Kuriyama S, et al. Oral branched-chain amino acid supplementation improves the oxidized/reduced albumin ratio in patients with liver cirrhosis. Hepatol Res. 2007 Sep;37(9):765-70.

Gruenwald J, Brendler T, Jaenicke C, et al., eds. PDR for Herbal Medicines. Montvale, NJ: Medical Economics Co; 1998:1138-1139.

Imai K, Nakachi K. Cross sectional study of effects of drinking green tea on cardiovascular and liver diseases. BMJ. 1995;310(6981):693-695.

Kalaitzakis E, Bjornsson E. Renal function and cognitive impairment in patients with liver cirrhosis. Scand J Gastroenterol. 2007 Apr 30:1-7.

Langmead L, Rampton DS. Review article: herbal treatment in gastrointestinal and liver disease -- benefits and dangers. [Review]. Aliment Pharmacol Ther. 2001;15(9):1239-1252.

Lieber CS. Liver disease by alcohol and hepatitis C: early detection and new insights in pathogenesis lead to improved treatment. Am J Addict. 2001;10 Suppl:29-50.

Lirussi F, Azzalini L, Orando S, Orlando R, Angelico F. Antioxidant supplements for non-alcoholic fatty liver disease and/or steatohepatitis. Cochrane Database Syst Rev. 2007 Jan 24;(1):CD004996. Review.

Liu CT, Chuang PT, Wu CY, Weng YM, Chen W, Tseng CY. Antioxidative and in vitro hepatoprotective activity of Bupleurum kaoi leaf infusion. Phytother Res. 2006 Nov;20(11):1003-8.

Loguercio C, Nardi G, Argenzio F, et al. Effect of S-adenosyl-L-methionine administration on red blood cell cysteine and glutathione levels in alcoholic patients with and without liver disease. Alcohol Alcohol. 1994;29(5):597-604.

Luper S. A review of plants used in the treatment of liver disease: part two. [Review]. Altern Med Rev. 1999;4(3):178-188.

Mato JM, Camara J, Fernandez de Paz J. S-adenosylmethionine in alcoholic liver cirrhosis: a randomized, placebo-controlled, double-blind, multicenter clinical trial. J Hepatol. 1999;30:1081-1089.

Moriarty KJ, Platt H, Crompton S, Darling W, Blakemore M, Hutchinson S, et al. Collaborative care for alcohol-related liver disease. Clin Med. 2007 Apr;7(2):125-8.

Nakaya Y, Okita K, Suzuki K, Moriwaki H, Kato A, Miwa Y, et al; Hepatic Nutritional Therapy (HNT) Study Group. BCAA-enriched snack improves nutritional state of cirrhosis. Nutrition. 2007 Feb;23(2):113-20.

National Digestive Diseases Information Clearinghouse. Cirrhosis of the liver. 2003; NIH Publication No. 04-1134. Accessed on September 14, 2007.

Seeff LB, Lindsay KL, Bacon BR, Kresina TF, Hoofnagle JH. Complementary and alternative medicine in chronic liver disease. Hepatology. 2001 Sep;34(3):595-603.

Ullman D. The Consumer's Guide to Homeopathy. New York, NY: Penguin Putnam; 1995:314-317.

Urata Y, Okita K, Korenaga K, Uchida K, Yamasaki T, Sakaida I. The effect of supplementation with branched-chain amino acids in patients with liver cirrhosis. Hepatol Res. 2007 Jul;37(7):510-6.

Verma S, Thuluvath PJ. Complementary and alternative medicine in hepatology: review of the evidence of efficacy. Clin Gastroenterol Hepatol. 2007 Apr;5(4):408-16. Review.

Vintro AQ, Krasnoff JB, Painter P. roles of nutrition and physical activity in musculoskeletal complications before and after liver transplantation. AACN Clin Issues. 2002;13(2):333-347.

Wang R, Kong J, Wang D, Lien LL, Lien EJ. A survey of Chinese herbal ingredients with liver protection activities. Chin Med. 2007 May 10;2:5.

Yen MH, Weng TC, Liu SY, Chai CY, Lin CC. The hepatoprotective effect of Bupleurum kaoi, an endemic plant to Taiwan, against dimethylnitrosamine-induced hepatic fibrosis in rats. Biol Pharm Bull. 2005 Mar;28(3):442-8.

Review Date:
9/30/2007
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

Vaginitis

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

Forty percent of all types of vaginitis are caused by candida, a yeast-like fungus. When it multiplies in the vaginal tract, the disorder is called vulvovaginitis. Women often refer to it as a "yeast infection." About 75 percent of women get candida vaginitis at some time in their lives.

Signs and Symptoms

Itching in the vagina and vulva
Vaginal discharge (small amounts are normal, however)
Red, swollen, painful vaginal mucous membranes and external genitalia
Satellite lesions (tender, red, pus-filled bumps, which can spread to thighs and anus)

What Causes It?

Candida is a yeast-like fungus that grows in the vagina. When there is too much, the fungus causes infection. The following increase your chance of getting a yeast infection:

Antibiotics
Pregnancy -- from increased heat and moisture and hormonal shifts
Diabetes
Corticosteroid use
Human immunodeficiency virus (HIV) infection
Taking birth control pills
Being overweight
High sugar intake
Wearing panty hose, tight clothing, or noncotton underwear

What to Expect at Your Provider's Office

Your health care provider will give you a pelvic examination and swab your vagina to check for candida. You probably will also have a Pap smear. Some women have chronic yeast infections. If this happens, your health care provider may want to do additional tests.

Treatment Options

Treatment Plan

Usually topical treatments are started before oral medications. In the case of chronic infection, the dosage and length of treatment may be increased. If you have vaginitis, you should avoid excessive exertion and sweating, keep the vaginal area as dry as possible, and avoid sex until symptoms clear. Take showers instead of baths, use unscented soap, and always wipe from front to back after bowel movements. Wearing cotton underwear and avoiding pantyhose and tight-fitting pants can help prevent infection.

Drug Therapies

Topical and oral therapies are considered to be almost equally effective.

Topical therapies: may initially cause burning from inflammation:
- Polyenes (nystatin) -- one tablet twice a day for 2 weeks placed high in the vagina with applicator. This treatment is 70 - 80% effective and causes no side effects on other parts of the body.
- Azole derivatives such as imidazole (such as miconazole, butoconazole) and triazole (such as fluconazole, terconazole) -- vaginal cream 1 -5 days, also may be used externally. This treatment is 85 - 90% effective and causes no side effects on other parts of the body.
Oral therapies:
- Fluconazole -- 75 - 92% effective. 150 mg once. This is often considered the treatment of choice. It should not be used during pregnancy. Appears to help HIV infected women.
- Ketoconazole -- 83% effective. 400 mg/day for 5 days, or for 2 weeks with recurring infection. Oral nystatin helps reduce intestinal problems.

Complementary and Alternative Therapies

Alternative therapies may help to treat acute and chronic vaginitis. Always tell your health care provider about the herbs and supplements you are using.

Douches:

Use only one of the following douches at one time. Do not douche during menstrual periods. For first time or acute infection try the vinegar douche or boric acid capsules. For chronic vaginitis, use the herbal combination douche. For recurrent vaginitis, use the Betadine douche. Stop douching if you are in pain or your symptoms get worse.

White vinegar: 1 - 2 tbs. to 1 pint of water. Douche daily for 10 - 14 days.
Boric acid: One capsule (600 mg) inserted daily for 10 - 14 days. May cause irritation or problems from absorption into the bloodstream.
Herbal combination: Mix equal parts of oregano leaf (Oreganum vulgare), goldenseal root (Hydrastis canadensis), and coneflower (Echinacea purpurea). Steep 1 heaping tbs. of herbal mixture in 1 pint of water. Cool and douche daily for 10 - 14 days.
Povidone iodine (Betadine): Douche with one part iodine to 100 parts water twice daily for 10 - 14 days. Prolonged use can suppress thyroid function.

Suppositories:

Tea tree oil (Melaleuca alternifolia ) vaginal suppository, insert one suppository vaginally daily, for symptoms of vaginitis. Ask your health care provider about the use of tea tree oil, as it can be irritating if not used properly.

Nutrition and Supplements

Following these nutritional tips may help reduce symptoms:

Try to eliminate potential food allergens, including dairy, wheat (gluten), corn, preservatives, and food additives. Your health care provider may want to test for food sensitivities.
Eat foods high in B-vitamins and calcium, such as almonds, beans, whole grains (if no allergy), dark leafy greens (such as spinach and kale), and sea vegetables.
Eat antioxidant foods, including fruits (such as blueberries, cherries, and tomatoes), and vegetables (such as squash and bell peppers).
Eat more high fiber foods, including beans, oats, root vegetables (such as potatoes and yams), and psyllium seed.
Avoid refined foods such as white breads, pastas, and sugar.
Eat fewer red meats and more lean meats, cold-water fish, tofu (soy) or beans for protein.
Use healthy cooking oils, such as olive oil or vegetable oil.
Reduce or eliminate trans-fatty acids, found in such commercially baked goods 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.

You may address nutritional deficiencies 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 tbs. of oil one to two times daily, to help decrease inflammation and help with immunity. Cold-water fish, such as salmon or halibut, are good sources.
Vitamin C, 500 - 1,000 mg one to two times daily, as an antioxidant, immune support and to protect the vaginal lining.
Zinc lozenge, 1 lozenge one to two times daily, when needed for immune support during vaginitis outbreak.
L-glutamine, 500 - 1,000 mg three times daily, for support of gastrointestinal health and immunity.
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. You should refrigerate your probiotic supplements for best results.
Grapefruit seed extract (Citrus paradisi), 100 mg capsule or 5 - 10 drops (in favorite beverage) three times daily, for antibacterial, antifungal, and antiviral activity, and for immunity.

Herbs

Green tea (Camellia sinensis) standardized extract, 250 - 500 mg daily, for antioxidant, anticancer and immune effects. You can 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 anticancer, immune and antibacterial or antifungal activity.
Milk thistle (Silybum marianum) seed standardized extract, 80 - 160 mg two to three times daily, for detoxification support.
Relora, 250 mg 1 - 3 times a day, for stress and related adrenal insufficiency.
Garlic (Allium sativum), standardized extract, 400 mg two to three times daily, for antifungal and immune activity.

Homeopathy

Some of the most common remedies for vaginitis are listed below. Usually, the dose is three to five pellets of a 12X to 30C remedy every 1 - 4 hours until your symptoms get better.

Calcarea carbonica for intense itching with thick white or yellowish discharge that is worse before you start your period
Borax for burning pains with egg-white colored discharge
Sepia for burning pains with milky white discharge and pressure in vaginal area, especially if you feel depressed and irritable
Graphites for backache with thin white discharge that is worse in the morning and when walking
Arsenicum album for when you have burning, discharge
Homeopathic combinations are available as creams to apply vaginally.

Acupuncture

Acupuncture may be helpful in improving immune function.

Following Up

To prevent recurrence of infection, take showers instead of baths, use unscented soap, and always wipe from front to back after bowel movements. Wearing cotton underwear and avoiding pantyhose and tight-fitting pants can help prevent infection.

Special Considerations

Yeast infections occur twice as often during pregnancy.

Supporting Research

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

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

Cummings S, Ullman D. Everybody's Guide to Homeopathic Medicines. 3^rd ed. New York, NY: Penguin Putnam; 1997: 268.

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

Crook WG. Diet changes may aid vaginitis prophylaxis. Nurse Pract. 1993;18(2):13.

Dambro MR, ed. Griffith's 5 Minute Clinical Consult. Baltimore, Md: Lippincott Williams & Wilkins; 1999:358-361.

Edman J, Sobel JD, Taylor ML. Zinc status in women with recurrent vulvovaginal candidiasis. Am J Obstet Gynecol. 1986;155(5):1082-5.

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

Friedrich EG Jr. Vaginitis. Am J Obstet Gynecol. 1985;152(3):247-51.

Habif TP. Clinical Dermatology. 3rd ed. St. Louis, Mo: Mosby-Year Book; 1996.

Heggers JP, Cottingham J, Gussman J, et al. The effectiveness of processed grapefruit-seed extract as an antibacterial agent: II. Mechanism of action and in vitro toxicity. J Altern Complement Med. 2002;8(3):333-40.

Heitzman ME, Neto CC, Winiarz E, Vaisberg AJ, Hammond GB. Ethnobotany, phytochemistry and pharmacology of Uncaria (Rubiaceae). Phytochemistry. 2005;66(1):5-29.

JAMA Patient Page. How much vitamin C do you need? JAMA. 1999;281(15):1460.

Johnston CS. Recommendations for vitamin C intake. JAMA. 1999;282(22):2118-2119.

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

Levine M, Rumsey SC, Daruwala R, Park JB, Wang Y. Criteria and recommendations for vitamin C intake. JAMA. 1999;281(15):1415-1453.

Morrison R. Desktop Guide to Keynotes and Confirmatory Symptoms. Albany, Calif: Hahnemann Clinic Publishing; 1993:43, 69, 85, 171, 346.

Reid G, Burton J, Hammond JA, Bruce AW. Nucleic acid-based diagnosis of bacterial vaginosis and improved management using probiotic lactobacilli. J Med Food. 2004;7(2):223-8.

Scnitzler P, Schon K, Reichling J. Antiviral activity of Australian tea tree oil and eucalyptus oil against herpes simplex virus in cell culture. Pharmazie.2001;56(4):343-7.

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

Sufka KJ, Roach JT, Chambliss WG Jr, et al. Anxiolytic properties of botanical extracts in the chick social separation-stress procedure. Psychopharmacology (Berl). 2001;153(2):219-24.

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

Review Date:
8/11/2006
Reviewed By:
Ernest B. Hawkins, MS, BSPharm, RPh, Health Education Resources; and Steven D. Ehrlich, N.M.D., private practice specializing in complementary and alternative medicine, Phoenix, AZ. Review provided by VeriMed Healthcare Network.

A.D.A.M. Copyright

adam.com

Transient ischemic attacks

FitSugar — Wed, 08 Oct 2008 17:35:07 -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

Transient ischemic attacks (TIAs), sometimes called "mini-strokes," are caused by temporary reduction of blood flow to the brain. Generally, TIAs occur when platelets in the blood clump together in your arteries, blocking blood flow. Symptoms usually last only 10 - 15 minutes and clear up within 24 hours. TIAs sometimes happen before strokes, and they are considered a warning sign of stroke.

Signs and Symptoms

You may experience the following signs and symptoms during a TIA:

Blurred vision in both eyes, brief blindness, or double vision
Difficulty speaking
Weakness, sometimes on only one side of the body
Vertigo (a whirling or spinning feeling)
Strange sensations, such as burning or tingling
Trouble with coordination, clumsiness
Loss of consciousness
Temporary memory problems
Headache

What Causes It?

TIAs are commonly caused by emboli -- materials that block your blood vessels. These may include clumps of platelets and fibrin (a component of blood involved in clotting), plaque (often called atherosclerosis) that has collected in your arteries, or blood clots. Some other conditions that can cause TIAs include:

A weakened, bulging heart wall (ventricular aneurysm)
A rapid, irregular heartbeat (atrial fibrillation)
Narrowing of the main artery in your neck (carotid artery) together with low blood pressure
Blood clotting problems

Who's Most At Risk?

These characteristics increase your risk for TIA:

Over 65 years of age
Male
Family history of TIA
African-American or Japanese-American
High blood pressure
High cholesterol
Heart disease
History of stroke
Diabetes
Smoking
Heavy alcohol consumption
Lack of regular physical exercise
Hypercoagulability -- an inherited condition that increases the likelihood of developing blood clots, including during pregnancy

What to Expect at Your Provider's Office

If you have symptoms of TIA, see your health care provider. Your health care provider will ask about your symptoms, examine you, and may perform tests, such as blood tests, computed tomography (CT) scan or magnetic resonance imaging (MRI) of your head, or ultrasound of the blood vessels to your brain. If the ultrasound shows some blockage, your provider may consider a test called an angiogram to view the blood vessels more clearly. These tests will help your health care provider determine whether you had a TIA or another event and what the cause may have been.

Treatment Options

Prevention

You can take the following steps to help prevent TIA:

Don't smoke.
Get regular exercise, eat a healthy diet, and maintain a healthy weight.
Use dietary supplements when appropriate (see Nutrition and Supplements).
Don't drink alcohol excessively.
Work with your health care provider to control high blood pressure, high cholesterol, or diabetes.
Work with your health care provider to treat carotid artery disease, coronary artery disease, irregular heartbeat, congestive heart failure, or heart valve disease.
Stay on hormone replacement therapy if you are already taking it.

Treatment Plan

Treatment will depend on your signs and symptoms, exams, and tests. Your health care provider may admit you to the hospital to evaluate your condition more thoroughly and to treat you if your condition becomes worse. You may need oxygen to help you breathe and to lessen the effects of blocked blood flow.

Drug Therapies

To help prevent TIA, stroke, or heart attack, your health care provider may prescribe antiplatelet agents (drugs that prevent platelets from clumping), or anticoagulants (drugs that prevent blood from clotting). These include aspirin, ticlopidine, clopidogrel, dipyridamole, and warfarin. There can be many drug or dietary supplements interactions with these types of medications. Ask your pharmacist.

Surgical and Other Procedures

If your carotid artery is narrowed, your health care provider may recommend a type of surgery called carotid endarterectomy to clean deposits from inside the artery. While examining your carotid artery, your provider may perform angioplasty (inserting a balloon, a tube-like structure called a stent, or another device into your artery to open it). Depending on your condition, your health care provider may recommend an extracranial-intracranial bypass, surgery that connects a blood vessel outside your skull with a blood vessel inside to improve blood flow.

Complementary and Alternative Therapies

Diet is very important in preventing and treating blood vessel (vascular) diseases. Some nutrients and herbs may protect against injury from reduced blood flow and damage from oxidation (a process that occurs in the body with age and in response to exposure to certain agents such as cigarette smoke and fatty foods).

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 potential food allergens, including dairy, wheat (gluten), corn, preservatives, and food additives. Your health care provider may want to test for food sensitivities.
Eat antioxidant foods, including fruits (such as blueberries, cherries, and tomatoes), and vegetables (such as squash and bell peppers).
Eat foods high in B-vitamins and calcium, such as almonds, beans, whole grains (if no allergy), dark leafy greens (such as spinach and kale), and sea vegetables.
Eat more high fiber foods, including beans, oats, root vegetables (such as potatoes and yams), and psyllium seed.
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 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-complex vitamins, and trace minerals, such as magnesium, calcium, zinc and selenium.
Magnesium citrate, 200 - 400 mg daily, for heart health.
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 for heart health. Cold-water fish, such as salmon or halibut, are good sources.
Vitamin C, 500 - 1,000 mg one to three times daily, as an antioxidant, and for blood vessel support.
Acetyl-L-carnitine, 500 mg daily, for antioxidant and heart protective activity.
Coenzyme Q10, 100 - 200 mg at bedtime, for antioxidant, immune, and heart support.
Resveratrol (from red wine), 50 - 200 mg daily, for antioxidant effects and heart support.
Melatonin, 2 - 5 mg before bed, when needed for sleep, and for antioxidant support.

Herbs

Green tea (Camellia sinensis) standardized extract, 250 - 500 mg daily, for antioxidant and heart protective effects. Use caffeine-free products. You may also prepare teas from the leaf of this herb.
Grape seed (Vitis vinifera) standardized extract, 100 - 200 mg three times daily, for antioxidant effects, and heart and blood vessel protection.
Policosanol (from sugar cane wax), 10 - 40 mg daily, for cholesterol and blood vessel protection.
Ginkgo (Ginkgo biloba) standardized extract, 40 - 80 mg three times daily, for antioxidant and blood vessel support.
Garlic (Allium sativum), standardized extract, 400 mg two to three times daily, for heart and antioxidant protection.

Homeopathy

Scientific literature does not support the use of homeopathy for TIAs. An experienced homeopath would consider your individual case and may recommend treatments to address both your underlying condition and any current symptoms.

Acupuncture

Acupuncture plays a role in the circulation of blood in your head and in reducing adverse effects when blood flow returns.

Chiropractic

Chiropractors do not treat TIAs, and high velocity manipulation of the upper spine is considered inappropriate in individuals who are taking blood-thinning medications or other medications used to reduce the risk of stroke.

Prognosis/Possible Complications

The shorter the amount of time between TIAs, the more likely it is that you will have a stroke. This seems to be the most important predictor of stroke risk. Narrowing of the carotid arteries also indicates likelihood of suffering a stroke. The location or length of symptoms do not appear to be indications of stroke risk.

TIAs are a warning sign of stroke. But more patients with TIA die from heart attack than stroke. If you have a stroke and are not treated right away, you may be more likely to have complications, such as pneumonia, hypothermia, dehydration, or serious skeletal muscle problems. Damage to the brain may lead to breathing problems. Bleeding or swelling in the head may occur days after a stroke. Multiple strokes increase the risk of seizure, blood clots to the legs or lungs, and impaired memory or judgment (dementia).

Following Up

Follow your health care provider's advice on getting checkups after a TIA to prevent stroke and heart attack. In people who have strokes after TIAs, half the strokes occur within a year, and 20% occur within 5 months.

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Review Date:
9/8/2006
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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