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Cobalamin, also known as B12, is a member of the water-soluble family of B vitamins. It is a key factor in the body’s proper use of iron and formation of red blood cells.

The nervous system also relies on an adequate supply of cobalamin to function appropriately, as it is an essential component in the creation and maintenance of the myelin sheath that lines nerve cells.

Other roles of cobalamin include working with pyridoxine (vitamin B6 and folic acid to reduce harmful homocysteine levels, participating in the metabolization of food, and keeping the immune system operating smoothly.

General use

Very small amounts of cobalamin are needed to maintain good health. The RDA value is 0.3 micrograms (mcg) for infants under 6 months, 0.5 mcg for those 6 months to 1 year old, 0.7 mcg for children 1-3 years old, 1.0 mcg for children 4-6 years old, 1.4 mcg for children 7-10 years old, and 2 mcg for those 11 years of age and older. Requirements are slightly higher for pregnant (2.2 mcg) and lactating (2.6 mcg) women.

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The primary conditions that benefit from supplementation with cobalamin are megaloblastic and pernicious anemia. Megaloblastic anemia is a state resulting from an inadequate intake of cobalamin, to which vegans are particularly susceptible because of the lack of animal food sources. Vegans, who do not consume any animal products including meat, dairy, or eggs, should take at least 2 mcg of cobalamin per day in order to prevent this condition.

In the case of pernicious anemia, intake may be appropriate but absorption is poor due to a lack of normal stomach substance, called intrinsic factor, that facilitates absorption of vitamin B12. Large doses are required to treat pernicious anemia, which occurs most commonly in the elderly population as a result of decreased production of intrinsic factor by the stomach.

Supplements are generally effective when taken orally in very large amounts (300-1000 mcg/day) even if no intrinsic factor is produced. These supplements require a prescription, and should be administered with the guidance of a health care provider. Injections, instead of the supplements, are often used.

Those who have infections, burns, some types of cancer, recent surgery, illnesses that cause decay or loss of strength, or high amounts of stress may need more than the RDA amount of B12 and other B vitamins. A balanced supplement is the best approach.

Male infertility can sometimes be resolved through use of cobalamin supplements. Other conditions that may be improved by cobalamin supplementation include: asthma, atherosclerosis (hardening of the arteries caused by plaque formation in the arteries), bursitis (inflammation of a bodily pouch, especially the shoulder or elbow), Crohn’s disease (chronic recurrent inflammation of the intestines), depression, diabetes, high cholesterol, osteoporosis, and vitiligo (milky-white patches on the skin). There is not enough evidence to judge whether supplementation for these diseases is effective.

Preparations

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Vitamin B12 foods

Natural sources

Usable cobalamin is only found naturally in animal source foods. Fresh food is best, as freezing and exposure to light may destroy some of the vitamin content.

Clams and beef liver have very high cobalamin levels. Other good sources include chicken liver, beef, lamb, tuna, flounder, liverwurst, eggs, and dairy products. Some plant foods may contain cobalamin, but it is not in a form that is usable by the body.

Supplemental sources

Cobalamin supplements are available in both oral and injectable formulations. A nasal gel is also made. Generally a balanced B-complex vitamin is preferable to taking high doses of cobalamin unless there is a specific indication for it, such as megaloblastic anemia. Strict vegetarians will need to incorporate a supplemental source of B12 in the diet.

Cyanocobalamin is the form most commonly available in supplements. Two other, possibly more effective, types are hydrocobalamin and methyl-cobalamin. As with all supplements, cobalamin should be stored in a cool, dry, dark place and out of the reach of children.

Deficiency

Cobalamin deficiency may be manifested as a variety of symptoms since cobalamin is so widely used in the body. Severe fatigue may occur initially.

Effects on the nervous system can be wide-ranging, and include weakness, numbness and tingling of the limbs, memory loss, confusion, delusion, poor balance and reflexes, hearing difficulties, and even dementia. Severe deficiency may appear similar to multiple sclerosis.

Nausea and diarrhea are possible gastrointestinal signs. The anemia that results from prolonged deficiency may also be seen as a pallor, especially in mucous membranes such as the gums and the lining of the inner surface of the eye.

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Vitamin B12 Deficiency.

Megaloblastic anemia is a common result of inadequate cobalamin. This condition can also result if a person stops secreting enough intrinsic factor in the stomach, a substance essential for the absorption of cobalamin.

In adequate intrinsic factor leads to pernicious anemia, so called because it persists despite iron supplementation. Long-term deficiencies of cobalamin also allow homocysteine levels to build up. Negative effects of large amounts of circulating homocysteine include heart disease, and possibly brain toxicity.

Taking high levels of folic acid supplements can mask cobalamin deficiency and prevent the development of megaloblastic anemia, but neurological damage can still occur. This damage may become permanent if the cobalamin deficiency persists for a long period of time.

Risk factors for deficiency

The primary groups at risk for cobalamin deficiency are vegans who are not taking supplements, and the elderly. Older adults are more likely to have both insufficient intrinsic factor secreted by the stomach and low levels of stomach acid, causing cobalamin to be poorly absorbed. Malabsorptive diseases and stomach surgery can also predispose to a deficiency.

Precautions

People who are sensitive to cobalamin or cobalt should not take cobalamin supplements. Symptoms of hypersensitivity may include swelling, itching, and shock.

Adverse effects resulting from B12 supplementation are rare. Cobalamin should also be avoided by those who have a type of hereditary optic nerve atrophy known as Leber’s disease.

Side effects

Very high doses of cobalamin may sometimes cause acne.

Interactions

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The Power of B12

Large amounts of vitamin C taken within an hour of vitamin B supplements will destroy the cobalamin component. Absorption of cobalamin is also impaired by deficiencies of folic acid, iron, or vitamin E. Improved absorption occurs when it is taken with other B vitamins or calcium. Some medications may also cause an increased use or decreased absorption of this vitamin.

Those on colchicine, corticosteroids, methotrexate, metformin, phenformin, oral contraceptives, cholestyramine, colestipol, clofibrate, epoetin, neomycin, or supplemental potassium may need extra cobalamin. Use of nicotine products or excessive alcohol can deplete B12.

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Vitamin A
Vitamin A is one of four fat-soluble vitamins necessary for good health. It serves an important role as an antioxidant by helping to prevent free radicals from causing cellular damage.

Adequate levels are important for good eyesight, and poor night vision may be one of the first symptoms of a deficiency. It is also necessary for proper function of the immune, skeletal, respiratory, reproductive, and integumentary (skin) systems.

General use

An adequate level of vitamin A unquestionably contributes to good health. It is essential for the proper function of the retina, where it can act to prevent night blindness, as well as lower the odds of getting age-related macular degeneration (AMD), which is the most common cause of blindness in the elderly.

There is also evidence that good levels of vitamin A in the form of carotenoids may decrease the risk of certain cancers, heart attacks, and strokes. The immune system is also strengthened.

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It is unclear, however, if supplemental forms of vitamin A have the same benefit as consuming the nutrient in natural foods in the case of a person without deficiency. Taking high levels of vitamin A in any supplemental form is not advisable without the counsel of a healthcare professional.

Preparations

Natural sources

There are two basic forms of vitamin A. Retinoids, the active types, are contained in animal sources, including meat, whole milk, and eggs. Liver is particularly rich in vitamin A, since it is one of the storage sites for excess.

Precursor forms of the vitamin (carotenoids) are found in orange and leafy green produce such as sweet potatoes, carrots, collard greens, spinach, winter squash, kale, and turnip greens. Very fresh foods have the highest levels, followed by frozen foods. Typically, canned produce has little vitamin A.

Preparing vegetables by steaming, baking, or grilling helps them to release the carotenes they contain. Alpha and beta carotene, as well as some of the other lesser-known carotenoids, can be converted to vitamin A in the small intestine. This is done by the body on an as-needed basis, so there is no risk of overdose as there is with the active form.

Supplemental sources

Supplements may contain either the active or precursor forms of vitamin A. The active form may be more desirable for those who may have some difficulty in converting the carotenoids into the active vitamin. This is more often true in those over age 55 or who have a condition that impairs the absorption of fat.

There is a water-soluble form of the vitamin, retinyl palmitate, which may be better utilized in the latter case. Carotenes are also available either as oil-based or natural water-based formulas. Be sure to store both away from light and heat, which will destroy them.

Units

There are several units that can express the amount of vitamin A activity in a product. Many supplements are still labeled with the old International Unit (IU), although the more current and most accurate unit is the Retinol Equivalent (RE). The new measurement distinguishes between the differences in absorption of retinol and beta carotene. One RE is equal to one microgram (MICROg) of retinol, or six MICROg of beta carotene.

Dose limits

Adults should take no more than 25,000 IU (5,000 RE) per day of vitamin A in its active form, except in the case of women who are pregnant or may become pregnant. The latter group should not exceed 10,000 IU (2,000 RE) per day in order to avoid potential toxic effects to the fetus.

The best way to get vitamins is in the natural food form, as the complexities are not always either known or reproducible in a supplement. A diet rich in foods containing carotenoids is optimal, but in the event of nutritional deficiencies, supplements may be needed.

Mixed carotenoids are preferable to either large doses of vitamin A or pure beta carotene supplements to avoid toxicity and maximize healthful benefits. Some of the minor carotenoids appear to have beneficial effects that are still being explored.

A good mixture will contain alpha and beta carotene, as well as lycopene and xanthophylls. Eating foods high in many carotenoids may confer some benefits—such as a lower risk of cancer, heart attacks, and strokes—which a supplement may not.

Deficiency

Levels of vitamin A low enough to cause symptomatic deficiency are uncommon in people of normal health in industrialized nations.

Symptoms of deficiency may include, but are not limited to, loss of appetite, poor immune function causing frequent infections (especially respiratory), hair loss, rashes, dry skin and eyes, visual difficulties including night blindness, poor growth, and fatigue. Generally symptoms are not manifested unless the deficiency has existed for a period of months.

Deficiencies are more likely in people who are malnourished, including alcoholics, the chronically ill, and those with impaired fat absorption. Another group at increased risk of vitamin A deficiency are persons with type 1 diabetes whose disorder is poorly controlled. People with normal health and nutritional status have a considerable vitamin A reserve.

In countries where nutritional status tends to be poor and deficiency is more common, vitamin A has been found to reduce the mortality rate of children suffering from a number of different viral infections.

Experts in plant genetics have been working on a strain of rice that contains beta carotene, hoping to help people in developing countries avoid the risk of vitamin A deficiency. Known as Golden Rice, the new strain is being sent to research institutes in developing countries for further study.

Risk factors for deficiency

Taking the RDA level of a nutrient will prevent a deficiency in most people, but under certain circumstances, an individual may require higher doses of vitamin A.

Those who consume alcoholic beverages may be more prone to vitamin A deficiency. People taking some medications, including birth control pills, methotrexate, cholestyramine, colestipol, and drugs that act to sequester bile will also need larger amounts.

Those who are malnourished, chronically ill, or recovering from surgery or other injuries may also benefit from a higher than average dose. Patients undergoing treatments for cancer, including radiation and chemotherapy, typically have compromised immune systems that may be boosted by judicious supplementation with vitamin A.

Other conditions that may impair vitamin A balance include chronic diarrhea, cystic fibrosis, and kidney or liver disease. Diabetics are often deficient in vitamin A, but may also be more susceptible to toxicity. Any supplementation for these conditions should be discussed with a healthcare provider.

Supplements are best taken in the form of carotenoids to avoid any potential for toxicity. There is not an established RDA for beta carotene. Recommendations for how much to take vary between 6 and 30 mg a day, but the middle range—around 15 mg—is a reasonable average.

Precautions

Overdose can occur when taking megadoses of the active form of this vitamin. Amounts above what is being utilized by the body accumulate in the liver and fatty tissues.

Symptoms may include dry lips and skin, bone and joint pain, liver and spleen enlargement, diarrhea, vomiting, headaches, blurry or double vision, confusion, irritability, fatigue, and bulging fontanel (soft spot on the head) in infants; these are most often reversible, but a doctor should be contacted if a known overdose occurs. Very high levels of vitamin A may also create deficiencies of vitamins C, E, and K.

Symptoms will generally appear within six hours following an acute overdose, and take a few weeks to resolve after ceasing the supplement. Children are more sensitive to high levels of vitamin A than adults are, so instructions on products designed for children should be followed with particular care. Vitamin supplements should always be kept out of reach of children.

It is especially important to avoid overdoses in pregnancy, as it may cause miscarriage or fetal malformations. Using supplements that provide carotenoids will avoid the potential of overdose.

Those with kidney disease are also at higher risk for toxicity due to either vitamin A or beta carotene, and should not take these supplements without professional healthcare advice.

There is some evidence that taking beta carotene supplements puts smokers at a higher risk of lung cancers. The CARET (Beta Carotene and Retinol Efficacy Trial) study is one that demonstrated this effect. Clarification through more study is needed, as evidence also exists showing that beta carotene, along with other antioxidants, can be a factor in cancer prevention.

For example, a team of American researchers has recently reviewed evidence that vitamin A protects against bladder cancer, and a group in Germany is testing an aerosol form of vitamin A to prevent lung cancer.

Some of the lesser known carotenoids may be key factors in the relationship between vitamin intake and cancer. Whole sources of vitamin A are better obtained from foods than from supplements. Smokers should consult with a healthcare provider before taking supplemental beta carotene.

Side effects

Very high levels of carotenoids (carotenemia) may cause an orange discoloration of the skin, which is harmless and transient.

Interactions

Vitamin A supplements should not be taken in conjunction with any retinoid medications, including isotretinoin (Accutane), a drug used to treat acne. There is a higher risk of toxicity.

A very low fat diet or use of fat substitutes impairs absorption of all the fat-soluble vitamins, including A. Mineral oil and aluminum-containing antacids may also inhibit absorption, as do the cholesterol-lowering drugs cholestyramine and colestipol.

Vitamin A reserves of the body are depleted by a number of substances, including alcohol, barbiturates, caffeine, cortisone, tobacco, and very high levels of vitamin E. Overuse of alcohol and vitamin A together may increase the possibility of liver damage.

Taking appropriate doses of vitamin C, vitamin E, zinc, and selenium optimizes absorption and use of vitamin A and carotenoids. As vitamin A is fat-soluble, a small amount of dietary fat is also helpful.

Studies of both children and pregnant women with iron deficiency anemia show that this condition is better treated with a combination of iron supplements and vitamin A than with iron alone.

Venom
Bee sting

Venom immunotherapy is the process of injecting venom to treat various conditions. The most common form of venom immunization is bee venom therapy (BVT), with honeybee venom or stingers used to treat conditions.

BVT is one form of apitherapy, which is the therapeutic use of products made by honeybees. Other products used in apitherapy include bee pollen and royal jelly.

Origins

Apitherapy is thousands of years old. In ancient Egypt, venom from bee stings was used to treat arthritis. Hippocrates, the Greek physician known as the “father of medicine,” used bee stings for treatments several centuries before the birth of Christ. Descriptions of apitherapy are found in 2,000-year-old Chinese writings, the Bible, and the Koran.

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Bee venom therapy has remained part of folk medicine throughout the centuries. The modern study of apitherapy is said to have started in 1888, with Austrian physician Phillip Terc’s research titled “Report about a Peculiar Connection between the Beestings and Rheumatism.”

Benefits

Although a bee sting is painful for most people, the sting can be fatal to some. Approximately 15% of the population is allergic to the sting of such insects as bees and wasps. Allergic reactions range from mild to life-threatening.

In mainstream allopathic medicine, honeybee venom is used to treat people who are allergic to bee stings. A small amount of venom is injected during desensitization treatments to help patients develop a tolerance to stings.

Honeybee venom immunotherapy is used to treat many other conditions in alternative medicine. BVT is regarded as an effective treatment for arthritis, asthma.

Bee venom is also said to relieve premenstrual syndrome (PMS) and conditions related to menopause. However, BVT is most commonly used as an anti-inflammatory remedy for arthritis and MS. Advocates maintain that it will provide relief for rheumatoid arthritis when injected into the joints.

Bee venom is also used to lessen the pain and swelling of osteoarthritis as well as such inflammations and injuries as tendinitis and bursitis. Furthermore, people diagnosed with MS say that BVT significantly reduces symptoms that include muscle spasms and tiredness.

Description

Bee venom therapy involves the injection of venom by a needle, insertion of the stinger, or stinging by live bees. While a licensed physician must give injections, other treatments can be done by a bee venom therapist, a beekeeper, the patient, or a friend or relative.

The cost and length of treatment depends on the condition, as well as when and where a person is treated. If a physician provides the treatment, the doctor’s appointment may be covered by health insurance. Rates for other therapies are set by beekeepers and bee venom therapists. Information about these providers can be found through organizations such as the American Apitherapy Society.

The society’s resources include an extensive web site with information about BVT. Apitherapy resources include books and videos about home treatment. Live bees can be ordered by mail; one business in June 2000 charged $50 for four boxes, each containing about 60 bees.

When live bees are utilized, tweezers are used to remove one bee from a container such as a box, jar, or hive. The bee is held over the area to be treated until it stings the patient. The stinger is removed after three to five minutes.

Patients receive an average of two to five stings per session. The number of stings and the number of sessions varies with the condition treated. Tendinitis might require two to three stings per session for two to five sessions. Arthritis is sometimes treated with several stings per session at two to three weekly sessions.

MS may take months to treat. While BVT advocates say MS patients are more energetic after several sessions, they maintain that treatment should be done two to three times weekly for six months.

Preparations

Before beginning venom immunotherapy, a person should be tested for allergies. If a relative or friend plans to help with the therapy, that person should be tested too. Bee venom may cause a severe allergic reaction called anaphylaxis.

The symptoms of anaphylaxisVenom include shock, respiratory distress, and in some cases, death. Even if tests indicate that a person isn’t allergic to bee stings, it is important to obtain an emergency bee-sting allergy kit before beginning treatment.

Precautions

People should check with their doctor or practitioner before beginning bee venom immunotherapy. The therapy is not recommended for pregnant women, diabetics, people with heart conditions, tuberculosis, or infections.

An allergy test is a must before starting bee venom therapy. A person who is allergic to bee stings should not start venom treatment. In some cases, scarring and infections have resulted when the stinger was left in too long.

Side effects

If there is an allergic reaction to bee venom therapy, emergency treatment should be started. Such symptoms as minor itching and swelling, however, are not causes for alarm. They are signs of the healing process.

Research and general acceptance

During the late 1990s, researchers in countries including the United States, France, and Russia began researching the effect of bee venom immunotherapy on humans. Before that, research with such animals as mice indicated that venom could be beneficial for treating inflammatory conditions.

Anecdotal reports by people with MS indicated that venom immunotherapy is effective. Those supporting the study of this therapy include the Multiple Sclerosis Association of America and the American Apitherapy Society. As of June 2000, it remains to be seen whether bee venom immunotherapy is effective.

Training and certification

Although a doctor can administer bee venom therapy, no specific training or certification is required to perform the therapy. Training in handling bees is recommended. Organizations such as the American Apitherapy Society can provide information about training and therapy providers.

Vegetarianism
Vegetarianism

Vegetarianism refers to voluntary abstinence from eating meat. Vegetarians refrain from eating meat for various reasons, including religious, health, and ethical ones. Lacto-ovo vegetarians supplement their diet with dairy (lactose) products and eggs (ovo). Vegans (pronounced vee-guns) do not eat any animal-derived products at all.

Origins

The term vegetarian was coined in 1847 by the founders of the Vegetarian Society of Great Britain, but vegetarianism has been around as long as people have created diets. Some of the world’s oldest cultures advocate a vegetarian diet for health and religious purposes. In India, millions of Hindus are vegetarians because of their religious beliefs.

One of the ancient mythological works of Hinduism, the Mahabharata, states that, “Those who desire to possess good memory, beauty, long life with perfect health, and physical, budbahasa and spiritual strength, should abstain from animal foods.” The yoga system of living and health is vegetarian, because its dietary practices are based on the belief that healthy food contains prana.

VegetarianismVegetarianism

Prana is the universal life energy, which yoga experts believe is abundant in fresh fruits, grains, nuts and vegetables, but absent in meat because meat has been killed. Yogis also believe that spiritual health in influenced by the practice of ahimsa, or not harming living beings.

The principle of ahimsa (non-violence) appears in the Upanishads (Vedic literature) from c. 600–300 B.C. Taking of animal life or human life under any circumstances is sinful and results in rebirth as a lower organism. It became a fundamental element of Jainism, another religion of India.

Some Buddhists in Japan and China are also vegetarian because of spiritual beliefs. In the Christian tradition, the Trappist Monks of the Catholic Church are vegetarian, and some vegetarians argue that there is evidence that Jesus and his early followers were vegetarian.

Other traditional cultures, such as those in the Middle East and the Mediterranean regions, have evolved diets that frequently consist of vegetarian foods. The Mediterranean diet, which a Harvard study declared to be one of the world’s healthiest, is primarily, although not strictly, vegetarian.

The list of famous vegetarians forms an illustrious group. The ancient Greek philosophers, including Socrates, Plato, and Pythagoras, advocated vegetarianism.

In modern times, the word to describe someone who likes to feast on food and wine is “epicure,” but it is little known that Epicurus, the ancient philosopher, was himself a diligent vegetarian. Other famous vegetarians include Leonardo da Vinci, Sir Isaac Newton, Leo Tolstoy, Ralph Waldo Emerson, and Henry Thoreau.

Vegetarianism
Vegetarianism and your health

This century’s celebrated vegetarians include Gandhi, the physician Albert Schweitzer, writer George Bernard Shaw, musician Paul McCartney, and champion triathlete Dave Scott. Albert Einstein, although not a strict vegetarian himself, stated that a vegetarian diet would be an evolutionary step for the human race.

Vegetarianism in America received a lot of interest during the last half of the nineteenth century and the beginning of the twentieth century, during periods of experimentation with diets and health practices. Vegetarianism has also been a religious practice for some Americans, including the Seventh-day Adventists, whose lactoovo vegetarian diets have been studied for their health benefits.

Vegetarianism has been steadily gaining acceptance as an alternative to the meat-and-potatoes bias of the traditional American diet. In 1992, Vegetarian Times magazine performed a poll that showed that 13 million Americans, or 5% of the population, identified them-selves as vegetarians.

Several factors contribute to the interest in vegetarianism in America. Outbreaks of food poisoning from meat products, as well as increased concern over the additives in meat such as hormones and antibiotics, have led some people and professionals to question meat’s safety. There is also an increased awareness of the questionable treatment of farm animals in factory farming.

But the growing health consciousness of Americans is probably the major reason for the surge in interest in vegetarianism. Nutrition experts have built up convincing evidence that there are major problems with the conventional American diet, which is centered around meat products that are high in cholesterol and saturated fat and low in fiber.

Heart disease, cancer, and diabetes, which cause 68% of all deaths in America, are all believed to be influenced by this diet. Nutritionists have repeatedly shown in studies that a healthy diet consists of plenty of fresh vegetables and fruits, complex carbohydrates such as whole grains, and foods that are high in fiber and low in cholesterol and saturated fat.

Vegetarianism, a diet that fulfills all these criteria, has become part of many healthy lifestyles. In alternative medicine, vegetarianism is a cornerstone dietary therapy, used in Ayurvedic medicine, detoxification treatments, macrobiotics, the Ornish diet for heart disease, and in therapies for many chronic conditions.

Benefits

Vegetarianism is recommended as a dietary therapy for a variety of conditions, including heart disease, high cholesterol, type 2 diabetes, and stroke. Vegetarianism is a major dietary therapy in the alternative treatment of cancer.

Other conditions treated with a dietary therapy of vegetarianism include obesity, osteoporosis, arthritis, allergies, asthma, environmental illness, hypertension, gout, gallstones, hemorrhoids, kidney stones, ulcers, colitis, premenstrual syndrome, anxiety, and depression. Vegetarians often report higher energy levels, better digestion, and mental clarity. Vegetarianism is an economical and easily implemented preventative practice as well.

Preparations

Some people, particularly those with such severe or chronic conditions as heart disease or cancer, may be advised by a health practitioner to become vegetarian suddenly. For most people, nutritionists recommend that a vegetarian diet be adopted gradually, to allow people’s bodies and lifestyles time to adjust to new eating habits and food intake.

Some nutritionists have designed transition diets to help people become vegetarian in stages. Many Americans eat meat products at nearly every meal, and the first stage of a transition diet is to substitute just a few meals a week with wholly vegetarian foods. Then, particular meat products can be slowly reduced and eliminated from the diet and replaced with vegetarian foods.

Red meat can be reduced and then eliminated, followed by pork, poultry, and fish. For those wishing to become strict vegetarians or vegans, the selesai step would be to substitute eggs and dairy products with other nutrient-rich foods.

Individuals should be willing to experiment with transition diets, and should have patience when learning how to combine vegetarianism with such social activities as dining out. Fortunately, the number of restaurants that offer vegetarian dishes, or even all-vegetarian menus, is growing in the United States, particularly along the West Coast.

The transition to vegetarianism can be smoother for those who make informed choices with dietary practices. Sound nutritional guidelines include decreasing the intake of fat, increasing fiber, and emphasizing fresh fruits, vegetables, legumes, and whole grains in the diet while avoiding processed foods and sugar.

Everyone can improve their health by becoming familiar with recommended dietary and nutritional practices, such as reading labels and understanding such basic nutritional concepts as daily requirements for calories, protein, fat, and nutrients. Would-be vegetarians can experiment with meat substitutes, foods that are high in protein and essential nutrients. Thanks to the growing interest in vegetarianism, many meat substitutes are now readily available.

Tofu and tempeh are products made from soybeans that are high in protein, calcium, and other nutrients. There are “veggie-burgers” that can be grilled like hamburgers, and vegetarian substitutes for turkey and sausage with surprisingly authentic textures and taste. There are many vegetarian cookbooks on the market as well.

A set of guidelines for North American vegetarian diets, updated for 2004, is available from the American Dietetic Association and the Dietitians of Canada. The new guidelines are intended to promote variety within vegetarian diets and to meet the needs of different stages in the life cycle as well as incorporate the most recent findings of medical research.

One remaining drawback to the widespread practice of vegetarianism is the unpleasant taste or smell of many vegetables. A number of phytonutrients have a bitter, astringent, or acrid taste that they impart to products made from vegetables that contain them.

Some experts think that people tend to reject such strong-smelling or bitter-tasting vegetables as turnips, cabbage, brussels sprouts, or broccoli because humans have been programmed in the course of evolution to associate bitter taste with poisonous plants. It is increasingly recognized that the major barrier to dietary change for the sake of health is taste.

One recommendation for improving the taste appeal of vegetarian diets is more frequent use of spices. In addition to pleasing the human palate, spices derived from plants have been shown to have chemoprotective effects, boosting the immune system, reducing inflammation, and fighting harmful bacteria and viruses.

Precautions

In general, a well-planned vegetarian diet is healthful and safe; in the summer of 2003, a position paper endorsed by the American Dietetic Association and the Dietitians of Canada referred to vegetarian diets as “healthful, nutritionally adequate, and [able to] provide health benefits in the prevention and treatment of certain diseases.”

However, vegetarians, and particularly vegans who eat no animal products, should be aware of particular nutrients that may be lacking in non-animal diets. These are amino acids, vitamin B12, vitamin D, calcium, iron, zinc, and essential fatty acids. Furthermore, pregnant women, growing children, and those with health conditions have higher requirements for these nutrients.

Vegetarians should be aware of getting complete protein in their diets. A complete protein contains all of the essential amino acids, which are the building blocks for protein essential to the diet because the body cannot make them.

Meat and dairy products generally contain complete proteins, but most vegetarian foods such as grains and legumes contain incomplete proteins, lacking one or more of the essential amino acids. However, vegetarians can easily overcome this by combining particular foods in order to create complete proteins.

For instance, beans are high in the amino acid lysine but low in tryptophan and methionine, but rice is low in lysine and high in tryptophan and methionine. Thus, combining rice and beans makes a complete protein. In general, combining legumes such as soy, lentils, beans, and peas with grains like rice, wheat, or oats forms complete proteins.

Eating dairy products or nuts with grains also makes proteins complete. Oatmeal with milk on it is complete, as is peanut butter on whole wheat bread. Proteins do not necessarily need to be combined in the same meal, but generally within four hours.

Getting enough vitamin B12 may be an issue for some vegetarians, particularly vegans, because meat and dairy products are the main sources. Vitamin supplements that contain vitamin B12 are recommended, particularly for older vegetarians. Spirulina, a nutritional supplement made from algae, is also a vegetarian source, as are fortified soy products and nutritional yeast.

Vitamin D can be obtained by vitamins, fortified foods, and sunshine. Calcium can be obtained in enriched tofu, seeds, nuts, legumes, dairy products, and dark green vegetables including broccoli, kale, spinach, and collard greens.

Iron is found in raisins, figs, legumes, tofu, whole grains (particularly whole wheat), potatoes, and dark green leafy vegetables. Iron is absorbed more efficiently by the body when iron-containing foods are eaten with foods that contain vitamin C, such as fruits, tomatoes, and green vegetables.

Zinc is abundant in nuts, pumpkin seeds, legumes, whole grains, and tofu. For vegetarians who don’t eat fish, getting enough omega-3 essential fatty acids may be an issue, and supplements such as flaxseed oil should be considered, as well as eating walnuts and canola oil.

Vegetarians do not necessarily have healthier diets. Some studies have shown that some vegetarians consume large amounts of cholesterol and saturated fat. Eggs and dairy products contain cholesterol and saturated fat, while nuts, oils, and avocados are vegetable sources of saturated fat.

To reap the full benefits of a vegetarian diet, vegetarians should be conscious of cholesterol and saturated fat intake. Vegetarians may also consider buying organic foods, which are grown without the use of synthetic chemicals, as another health precaution.

Lastly, consuming large quantities of vegetables without other carbohydrates and sources of protein can produce its own kind of dietary imbalance. Cases have been reported of carotenemia, which is a yellowish discoloration of the skin caused by high levels of carotene, a fat-soluble plant pigment turned into vitamin A in the liver.

In one instance, the patient developed blood carotene levels nine times higher than normal values after putting himself on a diet that involved eating 2–3 pounds of vegetables every day. While carotenemia resulting from high vegetable intake has no known lasting consequences to health, it is still an indication of the importance of balance in vegetarian diets.

Research and general acceptance

A vegetarian diet has many well-documented health benefits. It has been shown that vegetarians have a higher life expectancy, as much as several years, than those who eat a meat-centered diet.

The U.S. Food and Drug Administration (FDA) has stated that data have shown vegetarians to have a strong or significant probability against contracting obesity, heart disease, lung cancer, colon cancer, alcoholism, hypertension, diabetes, gallstones, gout, kidney stones, and ulcers. However, the FDA also points out that vegetarians tend to have healthy lifestyle habits, so other factors may contribute to their increased health besides diet alone.

Vegetarianism has been associated with for many decades with abstinence from other habit-forming substances, including alcohol and tobacco. There is evidence, however, that this long-standing connection between vegetarianism and other health-conscious practices is breaking down.

A recent study of Scandinavian teenage vegetarians found that there was no difference between their lifestyles and those of meat-eating peers with regard to smoking, alcohol consumption, exercise, or weight. Partly because of this trend, physicians in family practice as well as those in sports medicine are increasingly recommending nutritional counseling for vegetarian teens.

A vegetarian diet, as prescribed by Dr. Dean Ornish, has been shown to improve heart disease and reverse the effects of atherosclerosis, or hardening of the arteries. It should be noted that Dr. Ornish’s diet was used in conjunction with exercise, stress reduction, and other holistic methods. The Ornish diet is lacto-ovo vegetarian, because it allows the use of egg whites and non-fat dairy products.

Vegetarians have a resource of statistics in their favor when it comes to presenting persuasive arguments in favor of their eating habits. Vegetarians claim that a vegetarian diet is a major step in improving the health of citizens and the environment.

Americans eat over 200 lbs (91 kg) of meat per person per year. The incidence of heart disease, cancer diabetes, and other diseases has increased along with a dramatic increase in meat consumption during the past century.

Many statistics show significantly smaller risks for vegetarians contracting certain conditions. The risks of women getting breast cancer and men contracting prostrate cancer are nearly four times as high for frequent meat eaters as for those who eat meat sparingly or not at all.

For heart attacks, American men have a 50% risk of having one, but the risk drops down to 15% for lacto-ovo vegetarians and to only 4% for vegans. For cancer, studies of populations around the world have implied that plant-based diets have lower associated risks for certain types of cancer.

Vegetarians claim other reasons for adopting a meat-free diet. One major concern is the amount of pesticides and synthetic additives such as hormones that show up in meat products.

Chemicals tend to accumulate in the tissue of animals that are higher in the food chain, a process called bioaccumulation. Vegetarians, by not eating meat, can avoid the exposure to these accumulated toxins, many of which are known to influence the development of cancer.

One study showed that DDT, a cancercausing pesticide, was present in significant levels in mother’s milk for 99% of American women, but only 8% of vegetarian women had significant levels of the pesticide. Women who eat meat had 35 times higher levels of particular pesticides than vegetarian women.

The synthetic hormones and antibiotics added to American cattle has led some European countries to ban American beef altogether. The widespread use of antibiotics in livestock has made many infectious agents more resistant to them, making some diseases harder to treat.

Vegetarians resort to ethical and environmental arguments as well when supporting their food choices. Much of U.S. agriculture is dedicated to producing meat, which is an expensive and resource-depleting practice.

It has been estimated that 1.3 billion people could be fed with the grain that America uses to feed livestock, and starvation is a major duduk perkara in world health. Producing meat places a heavy burden on natural resources, as compared to growing grain and vegetables.

One acre of land can grow approximately 40,000 lbs (18,000 kg) of potatoes or 250 lbs (113 kg) of beef, and it takes 50,000 gal (200,000 l) of water to produce 1 lb (0.45 kg) of California beef but only 25 gal (100 l) of water to produce 1 lb (0.45 kg) of wheat.

Half of all water used in America is for livestock production. Vegetarians argue that the American consumption of beef may also be contributing to global warming, by the large amounts of fossil fuels used in its production.

The South American rainforest is being cleared to support American’s beef consumption, as the United States yearly imports 300 million lbs (136 million kg) of meat from Central and South America. The production of meat has been estimated as causing up to 85% of the loss of topsoil of America’s farmlands.

A German researcher in the field of nutrition ecology has summarized the environmental benefits of vegetarian diets: “Research shows that vegetarian diets are well suited to protect the environment, to reduce pollution, and to minimize global climate changes.”

Despite the favorable statistics, vegetarianism does have its opponents. The meat industry in America is a powerful organization that has spent millions of dollars over decades advertising the benefits of eating meat.

Vegetarians point out that life-long eating habits are difficult to change for many people, despite research showing that vegetarian diets can provide the same nutrients as meat-centered diets.

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Varicose veins

Varicose veins are dilated, tortuous, elongated superficial veins that appear most often in the legs.

Varicose veins, also called varicosities, are seen most often in the legs, although they can be found in other parts of the body. Most often, they appear as lumpy, winding vessels just below the surface of the skin.

There are three types of veins: superficial veins that are just beneath the surface of the skin; deep veins that are large blood vessels found deep inside the muscles; and perforator veins that connect the superficial veins to the deep veins. The superficial veins are the blood vessels most often affected by this condition and are the veins that are visible when the varicose condition has developed.

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The inside walls of veins have valves that open and close in response to the blood flow. When the left ventricle of the heart pushes blood out into the aorta, it produces the high pressure pulse of the heartbeat and pushes blood throughout the body. Between heartbeats, there is a period of low blood pressure.

During this period blood in the veins is affected by gravity and wants to flow downward. The valves in the veins prevent this from happening. Varicose veins start when one or more valves fail to close. The blood pressure in that section of vein increases, causing additional valves to fail.

This allows blood to pool and stretch the veins, further weakening the walls of the veins. The walls of the affected veins lose their elasticity in response to increased blood pressure. As the vessels weaken, more and more valves are unable to close properly.

The veins become larger and wider over time and begin to appear as lumpy, winding chains underneath the skin. Varicosities can also develop in the deep veins. Varicose veins in the superficial veins are called primary varicosities, while varicose veins in the deep veins are called secondary varicosities.

Causes and symptoms

Varicose veins have a number of different causes; lifestyle and hormonal factors play a role. Some families seem to have a higher incidence of varicose veins, indicating that there may be a genetic component to this disease.

Varicose veins are progressive; as one section of a vein weakens, it causes increased pressure on adjacent sections of the vein. These sections often develop varicosities. Varicose veins can appear following pregnancy, thrombophlebitis, congenital blood vessel weakness, or obesity, but they are not limited to these conditions.

Edema of the surrounding tissue, ankles, and calves is not usually a complication of primary (superficial) varicose veins. When edema develops, it usually indicates that the deep veins may have varicosities or clots.

Varicose veins are a common problem. More than 80 million Americans experience the symptoms and complications of varicose veins, including 10%–15% of men and 20%–25% of women. The symptoms can include aching, pain, itchiness, or burning sensations, especially when standing.

In some cases, with chronically bad veins, there may be a brownish discoloration of the skin or ulcers (open sores) near the ankles. A condition that is frequently associated with varicose veins is spider-burst veins. Spider-burst veins are very small veins that are enlarged.

They may be caused by back-pressure from varicose veins, but can be caused by other factors. They are frequently associated with pregnancy and there may be hormonal factors associated with their development. They are primarily of cosmetic concern and do not present any medical concerns.

Diagnosis

Varicose veins can usually be seen. In cases where varicose veins are suspected, a physician may frequently detect them by palpation (pressing with the fingers). The physician will examine the veins while the patient is first in a standing position and a second time while the patient is lying down.

X rays or ultrasound tests can detect varicose veins in the deep and perforator veins and rule out blood clots in the deep veins. A handheld Doppler instrument is now the preferred diagnostic tool for evaluating the leg veins.

Treatment

There is no cure for varicose veins. Treatment falls into two classes: relief of symptoms and removal of the affected veins. Symptom relief includes such measures as wearing support stockings, which compress the veins and hold them in place. This pressure keeps the veins from stretching and limits pain.

Other measures include sitting down, using a footstool to support the feet when sitting, avoid standing for long periods of time, and raising the legs whenever possible. These measures work by reducing the blood pressure in leg veins. Prolonged standing allows the blood to collect under high pressure in the varicose veins.

Exercise such as walking, biking, and swimming, is beneficial. When the legs are active, the leg muscles help pump the blood in the veins. This limits the amount of blood that collects in the varicose veins and reduces some of the symptoms but does not stop the disease.

Herbal therapy can be helpful in the treatment of varicose veins. Essential oils of cypress and geranium or extracts from horse chestnut seeds (Aesculus hippocastanum) are massaged into the legs, stroking upwards toward the heart. Application to broken skin and massage directly on the varicose veins should be avoided. Horse chestnut may also be taken orally and biothavenoids are used to increase vascular stability.

In late 2001 a new product derived from aescinate, a chemical found in horse chestnut, was approved by the Food and Drug Administration (FDA) for topical use in the treatment of varicose and spider veins. The new product, sold under the name of Essaven gel, reduces edema. It can be applied underneath support hosiery if desired.

Drinking fresh fruit juices, particularly those of dark colored berries (cherries, blackberries, and blueberries) can help tone and strengthen the vein walls. The enzyme bromelain, found in pineapple juice, can aid in the prevention of blood clots associated with the pooling of blood in the legs.

Deep breathing exercises performed while lying down with the legs elevated can assist gravity in circulating blood from the legs. The flow of fresh blood into the legs can help relieve any pain.

Allopathic treatment

Surgery can be used to remove varicose veins from the body. It is recommended for varicose veins that are causing pain or are very unsightly, and when hemorrhaging or recurrent thrombosis appear.

Surgery involves making an incision through the skin at both ends of the section of vein being removed. A flexible wire is inserted through one end and extended to the other. The wire is then withdrawn, pulling the vein out with it.

This is called “stripping” and is the most common method to remove superficial varicose veins. As long as the deeper veins are still functioning properly, a person can live without some of the superficial veins. Because of this, stripped varicose veins are not replaced.

Injection therapy is an alternate therapy used to seal varicose veins. This prevents blood from entering the sealed sections of the vein. The veins remain in the body, but no longer carry blood.

This procedure can be performed on an out-patient basis and does not require anesthesia. It is frequently used if people develop more varicose veins after surgery to remove the larger varicose veins and to seal spider-burst veins for people concerned about cosmetic appearance.

Injection therapy is also called sclerotherapy. At one time, a method of injection therapy was used that did not have a good success rate. Veins did not seal properly and blood clots formed. Modern injection therapy is improved and has a much higher success rate.

Two new allopathic treatments have been developed since 1999 that are much less invasive than stripping the veins. One is called radio frequency closure, or the closure technique.

In radio frequency closure, the surgeon inserts a catheter into the varicose vein through a small puncture. The catheter is used to deliver radio frequency energy to the wall of the vein, which causes the vein to contract and seal itself shut. The nearby veins then take over the flow of venous blood from the legs.

The second new treatment is called the endovascular laser procedure. The doctor uses a diode laser wire or fiber that is inserted directly into the vein. Energy transmitted from a laser heats the varicose vein and seals it shut. The patient can go back to work the next day, although a support stocking must be worn for two weeks after the laser procedure.

Expected results

Untreated varicose veins become increasingly large and more obvious with time. Surgical stripping of varicose veins is successful for most patients.

Most do not develop new, large varicose veins following surgery. Surgery does not decrease a person’s tendency to develop varicose veins. Varicose veins may develop in other locations after stripping.

Prevention

While genetic factors play a significant role in the development of varicose veins, swimming and other exercises to increase circulation in the legs help to prevent varicose veins. Preventive measures are especially important during pregnancy, when the additional weight of the fetus and placenta can exert pressure on the mother’s legs and feet.

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Vanadium

Named after the Scandinavian goddess of youth and beauty, vanadium is a trace element that has gained attention in recent years as a possible aid in controlling diabetes.

While such macrominerals as calcium , magnesium, and potassium have become household names because they make up over 98% of the body’s mineral content, certain trace minerals are also considered essential in very tiny amounts to maintain health and ensure proper functioning of the body. They usually act as coenzymes, working as a team with proteins to facilitate important chemical reactions.

Even without taking vanadium supplements, people have about 20–25 micrograms (mcg) of the mineral in their bodies, which is derived from an average balanced diet. Despite the fact that vanadium has been studied for over 40 years, it is still not known for certain if the mineral is critical for optimal health. Whether taking extra amounts of vanadium is therapeutic or harmful is even more controversial.

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Like chromium, another trace mineral, vanadium has become the focus of study as a possible aid in lowering blood sugarNamed levels in people with diabetes. Vanadium has also been touted as a potential treatment for osteoporosis. Some athletes and weight lifters take it to build muscle or improve performance.

Studies in animals suggest that vanadium may be necessary for the formation of bones, teeth, and cartilage. The mineral may also play a role in growth and reproduction as well as affect the processing of cholesterol and insulin in the body. In one animal study, goat kids whose mothers received a diet deficient in vanadium showed skeletal damage; they died within days of their birth.

In studies of mice, vanadium has been shown to lower blood sugar and levels of low-density lipoprotein (LDL) cholesterol and triglycerideNamed. It is not certain, however, that such study results as these confirm the nutritional importance of the mineral for human beings.

The effects of a vanadium-free diet have not been studied in people. Even if vanadium supplements prove to be effective for certain purposes, such as helping to control diabetes, animal studies suggest that the high dosages of vanadium necessary to produce results may be harmful.

High dosages are often necessary because vanadium is not well absorbed by the body. As of 2000, a significant amount of research is still required to determine if vanadium can in fact produce significant health benefits safely and effectively. The proper dosage of the mineral supplement has also yet to be determined.

General use

Vanadium has been investigated most often as a possible aid in controlling diabetesNamed. Studies in animals with type 1 (insulin-dependent) and type 2 (non-insulin-dependent) diabetes indicate that vanadium can help to improve blood sugar levels.

Studies using human subjects have produced encouraging if preliminary results. Vanadium is used by some athletes and weight lifters to build muscleNamed despite the fact that it does not appear to be effective for this purpose.

Moreover, the potential usefulness of vanadium in treating osteoporosis is considered highly speculative. All of the human studies discussed below were conducted in small numbers of people for short periods of time and involved relatively high dosages of the mineral.

Diabetes

Several studies conducted in people suggest that vanadium may help to control blood sugar levels in diabetics. The mineral appears to work by mimicking the effects of insulin or by increasing the body’s sensitivity to the hormone.

This mechanism could allow diabetics to effectively control their blood sugar while using lower dosages of insulin medication. In a placebo-controlled study published in 1996 in the medical journal Metabolism, eight people with type 2 diabetes received vanadium for one month.

Researchers found that vanadium was moderately successful in lowering blood sugar levels and had few side effects. Six of the eight patients taking vanadium during the study experienced gastrointestinal side effects during the first week of treatment, but these disappeared with continued use.

In another small study of vanadium involving people with type 2 diabetes, published in the Journal of Clinical Investigation in 1995, researchers from the Albert EinsteinNamed College of Medicine reported that three weeks of treatment with the mineral improved the body’s sensitivity to insulin. The effects of vanadium in lowering blood sugar levels persisted for up to two weeks after the drug was discontinued.

A study published in the journal Diabetes in 1996, which involved seven people with type 2 diabetes as well as six nondiabetics, reported that vanadium improved insulin sensitivity in the diabetic subjects. Interestingly, the mineral did not improve sensitivity in the subjects who did not have the disease.

Sports medicine

The use of vanadium by body builders appears to stem from a misunderstanding of the mineral’s effects. Because insulin is a hormone that plays a role in increasing muscle mass, some weight lifters have taken vanadium in high dosages because they believe it will act like insulin and make them stronger.

The duduk perkara is that vanadium does not appear to mimic insulin or increase its efficiency in healthy people, only in diabetics. For people considering vanadium as an aid in strengthening muscles, the scientific evidence is not very convincing.

In one double-blind, placebo-controlled study published in the International Journal of Sport Nutrition in 1996, high dosages of vanadium were given to a few dozen weight trainers for 12 weeks. The bench press and leg extension weight-training exercises were used to measure results.

Researchers found that there was no difference in body composition between those who took vanadium and those in the placebo group. Vanadium appeared to slightly enhance performance during the leg extension aspect of the study, but this advantage can be explained by other factors and can not be attributed to the mineral itself with any certainty.

Osteoporosis

It is important not to confuse vanadium with calcium. Calcium is considered an essential building block of bone, and calcium supplements are often an important part of a bone-strengthening agenda in women with osteoporosis.

Studies in mice indicating that vanadium is also deposited in bone have led to suggestions that the mineral may be effective as a potential treatment for osteoporosis. It is known, however, that minerals can be added to bones without actually making them stronger. There is no evidence that taking vanadium supplements can increase bone density in humans.

Preparations

The estimated dosage of vanadium, which is available as an over-the-counter dietary supplement, generally ranges from 10–30 mcg a day. It is important to remember, however, that safe and effective dosages for the mineral have not yet been established.

Some practitioners of complementary medicine, such as Dr. Robert AtkinsNamed, have recommended dosages as high as 25–50 mg (milligrams, not micrograms) daily for people with diabetes. The long-term health risks associated with taking dosages in this range are unknown.

Even without taking supplements, most adults get anywhere between 10–60 mcg of vanadium through a normal diet. Some authorities believe it is safer for people to avoid vanadium supplements altogether and increase their intake of foods known to contain the mineral. These include meat, seafood, whole grains, vegetable oil, canned fruit juices, soy products, and such vegetables as green beans, corn, carrots, and cabbage.

Alcoholic beverages such as wine and beer also contain vanadium. Overdosing on the vanadium contained in food is not considered a significant risk because the mineral is present only in very small amounts in plants and animals.

Precautions

It is important not to exceed the recommended intake of vanadium without medical supervision. Studies conducted in rats suggest that high dosages of vanadium can be harmful. This results from the fact that the mineral tends to build up in the body, reaching dangerously high levels when taken in excess.

The reader should keep in mind that high dosages of vanadium have not yet been proven to have significant health benefits. The long-term health risks associated with taking vanadium supplements (in any dosage) are unknown.

Side effects

When taken in recommended dosages, vanadium has not been associated with any significant or bothersome side effects. At high dosages, vanadium has been known to cause stomach cramping and diarrhea as well as a green tongue.

Interactions

No drugs are known to interact adversely with vanadium. Smokers may absorb less of the mineral.

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Valerian (Valeriana officinalis)

Valerian (Valeriana officinalis) is one of about 200 members of the Valerianaceae family. This plant is native to Europe and west Asia; it is naturalized throughout North America.

A common name for this hardy perennial is garden heliotrope. Valerian has been valued for its soothing qualities for at least a millennium. The name valerian may have come from the Latin valere meaning “to be strong” or “to be in good health.” Chaucer called the herb setewale.

Other common names include all-heal, vandal root, and Capon’s tail. The Greek doctor Galen called a particularly odorous species of valerian “phu,” referring to the distinctively unpleasant smell of the dried root. The strong odor appeals to earthworms, intoxicates cats, and attracts rats.

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According to legend, the Pied Piper of Hamlin, with the assistance of the odorous valerian root, lured the town’s rats to the river to drown. Some Asian species of valerian have a more pleasant aroma and may have included spikenard (the biblical name for valerian), which was known as a perfume from the East.

In ancient times, valerian was believed to be under the influence of the god Mercury. The herb grows in lime-rich soil near streams, or in damp, low meadows where it may reach a height of 5 ft (1.5 m). It is also found in drier environments at higher elevations, where it grows to just 2 ft (0.6 m). Roots harvested from the drier environment may be more medicinally potent. This variety is sometimes known as sylvestus.

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valerian (picture)

Valerian’s short vertical rhizome is dark yellow-brown in color and has round rootlets. These rootlets produce hollow, fluted stems with opposite leaves and a single leaflet at the tip, and as many as eight to 10 pairs of toothed leaflets.

The upper leaves are attached at their base and emerge from a white sheath along the stem. The stems remain erect and unbranched until the very top, were the small, white flowers, tinged with pink, bloom in clusters in the middle of summer. Seeds are winged with tufts of white hair, and they scatter on the wind.

General use

As of 2003, researchers have identified some of the active ingredients in valerian that are responsible for its medicinal properties. A team of pharmacologists in Argentina reported in the spring of 2003 that they had isolated two new flavonoids, 6-methylapigenin and hesperidin, as compounds with sedative and sleep-enhancing properties.

In addition to these flavonoids, valerian contains volatile oil, valepotriates, glycosides, alkaloids, choline, tannins, and resins. Valerian’s rhizome and root are the medicinal part of this herb. Fresh root will produce the highest quality of medicinal extract.

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Valerian whole plant

Valerian acts as a pain reliever, antispasmodic, sedative, carminative, and can help support nerve tissue. A British study published in 2002 suggests that valerian’s effectiveness in relieving stress is related to its ability to lower the body’s reactivity in stressful situations. Valerian can also help to promote menstrual flow. As a natural tranquilizer, valerian can soothe anxiety, nervous tension, insomnia, and headache.

It acts on the peripheral nerves and relaxes both the smooth and skeletal muscle tissue to reduce tension. It also strengthens the heart and provides relief from menstrual cramps, stomach cramps, irritable bowel, and upset stomach caused by nerves.

Valerian has also been shown to lower blood pressure. One study found that valerian tends to sedate the agitated person and stimulate the fatigued person, bringing about a balancing effect on the system. Externally, a lotion prepared with valerian extract will ease irritation of skin rashes and soothe swollen joints.

The plant has been used as a medicinal herb for more than a thousand years, especially for mild cases of insomnia. Research shows that proper use of valerian promotes sleep, reduces night awakenings, and increases dream recall in most people. Historically, valerian has been highly regarded as a tranquilizer that acts without narcotic effects.

It is particularly popular with women; a recently introduced herbal formula for menopausal women contains valerian along with hops and black cohosh as an active ingredient. The herb has also been used to treat illnesses as diverse as epilepsy and the plague. In the sixteenth century, valerian was reported to have cured a case of epilepsy.

It was also used to treat hysteria, migraine, and vertigo. Culpeper recommended the herb for “driving away splinters or thorns from the flesh.” Valerian was listed in the United States Pharmacopoeia from the early seventeenth century until the mid-twentieth century.

During World War I, soldiers traumatized by the constant bombing and those suffering from “shell shock” were treated with valerian. The herb was listed in the U.S. National Formulary until 1950, and continues to be listed in the official pharmacopoeias of Germany, Belgium, and France.

More recently, valerian is being studied as a possible chemopreventive for cancer. Further research is necessary, however, to determine its effectiveness in this regard.

Preparations

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Valerian root

Valerian root should be harvested in the autumn of its second year. Valerian works well in combination with other tranquilizing herbs such as passionflower (Passiflora incarnata) to safely induce sleep, or skullcap (Scutellaria laterifolia) to relieve nervous tension.

The somewhat bitter, unpleasant taste of the tea may be masked by adding peppermint oil, or the user can take the herb in capsule form. Combinations contain equal parts of each herb. The herb may be drunk as an herbal tea, used as a tincture, or swallowed in capsule form one hour before bedtime.

Precautions

Valerian should not be used in large doses or for an extended period. People should not take it continuously for more than two to three weeks. Users of valerian may become tolerant to its effects with prolonged use.

Increasing the dose of the herb to achieve desired effects may result in negative side effects. Prolonged use, according to some research, could result in liver damage and central nervous system impairment.

Side effects

Large doses of valerian may occasionally cause headache, muscle spasm, heart palpitations, dizziness, gastric distress, sleeplessness, and confusion. Uninterrupted use may cause depression.

Interactions

Although valerian has been regarded as a relatively safe herb because few interactions with prescription medications have been reported, newer research indicates that it should be used cautiously following surgery. Like St. Johnís wort, valerian can interact with anesthetics and other medications given to patients after surgery.

Because valerian has a mild sedative effect, it should not be taken together with alcoholic beverages, benzodiazepines, barbiturates, or antihistamines. Long-term safety studies of valerian have not been done as of early 2003.

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