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Pueraria mirifica

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Botanical Name : Pueraria mirifica
Family: Fabaceae
Subfamily: Faboideae
Genus: Pueraria
Species: P. mirifica
Kingdom: Plantae
Order: Fabales

Common Name :Kwao Krua, Khao Krua Kao, or Kwao Kreu Kao (white root) and Kwao Krua Dang (red root Butea Superba),

Habitat :Pueraria mirifica  is a native herb abundant in the jungles of the north Thailand and Burma.

Description:
The Pueraria mirifica plant is found only in Thailand. Even though there have been reports of findings of plants in the same family of “Pueraria” in Asian countries, these plant are of different species and possess different qualities from Pueraria mirifica. From the study, there are nine species [as many as thirteen have now been reported] of Pueraria in Thailand. This article discussing the efficacy and safety study of Pueraria mirifica refers only to Pueraria candollei var. mirifica from central part of the country. Pueraria mirifica is a climbing plant, usually grows in a mountainous area by tiding with trees. There are three small leaves on each branch and purple blooms on the top. The tubers on its root are round, and stay underground. When cut, white liquid like skim milk would come out. The Shape and size of Pueraria mirifica are diverse up to the environment in which it exists. Active ingredients are found at the roots from which extracts are made.
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History:
Arimuttama was the old capital of the Pookham City of Myanmar. They had a sacred Buddhist precinct and one-day the sacred Buddhist precinct was broken down. The Buddhist monks found this ingredient that was inscribed on the palm leaf and placed it in the sacred Buddhist precinct.

To take the tuberous root of Pueraria with big leaves, pound and blend with cow’s milk. The benefits of this medicine is to support memory, talk big, and be able to remember three books of the astrology, make the skin smooth like six year old kid, live more than 1,000 years and parasite diseases are not able to be of trouble

There are 4 varieties of kwao krua that are considered beneficial and can be used for medicinal, food supplementary and cosmetic purposes. They are White Kwao Krua (Pueraria mirifica), Red Kwao Krua (Butea superba), Black Kwao Krua and Dull Grey Kwao Krua. Local communities in Thailand have used Pueraria mirifica for well over one hundred years, specifically for its supposed rejuvenating qualities

Uses:
Pueraria mirifica, also known as ‘white kwao krua’, is a natural tuberous herbal root and contains high levels of natural phytoestrogens including miroestrol, deoxymiroestrol, daidzein, genistin, genistein, B-Sitosterol, stigmasterol, coumestrol, pueraria, campesterol, mirificoumestan, kwakhurin, and mirificine.

Some cosmetic products and herbal supplements claim various health benefits of the extracts of Pueraria mirifica including increasing appetite, enlarging breasts, improving hair growth, and other rejuvenating effects; however, there is no scientific evidence to support any these claims.   The U.S. Federal Trade Commission has taken action against manufacturers who make such fraudulent claims

Medicinal Uses:
Preliminary data from a clinical trial conducted in Thailand to study the beneficial effect of Pueraria mirifica supplement have recently been obtained. Eight female subjects who were having menopausal symptoms received Pueraria mirifica in the form of capsule once daily at the dose of 200 mg for 4 months followed by the dose of 100 mg, for 8 months. Improvement of menopausal symptoms was observed in 5 out of 8 subjects throughout the study period. Physical examinations and biochemical studies revealed that all subjects were healthy. The dietary supplement dose of Pueraria mirifica recommended by the physician for its estrogenic effect in this case is 100 mg per day.

A series of studies involving breast cell lines and the activity of Pueraria mirifica in vitro have been performed by the Emory University School of Medicine in Atlanta, Georgia, USA, and the Department of Obstetrics and Gynecology, Phramongkutklao College of Medicine, Bangkok, Thailand. These studies have shown that Pueraria mirifica root extract (Smith Naturals Co Ltd., Bangkok) has potent anti-estrogenic properties against aggressive cell cancer lines in vitro, especially the proliferative estrogen receptor-positive (ER+) breast cancer lines (T47-D, MCF-7, and ZR-75-1) obtained from the MD Anderson Cancer Institute (Texas) and the National Cancer Institute (NCI) at the U.S. National Institutes of Health (NIH).

Tectorigenin, an isoflavone present in kudzu, demonstrated antiproliferative activity against human cancer (HL-60) cells. The proposed mechanisms are induction of differentiation in the cells and a reduction in the expression of Bcl-2, an antiapoptotic protein. In addition, isoflavones in Pueraria mirifica are thought to be involved in alleviating symptoms such as hot flashes and night sweats in perimenopausal women and affect cognitive function in postmenopausal women. The isoflavones present in kudzu root extract are also thought to suppress alcohol intake and alcohol withdrawal symptoms in mice although the mechanism is unclear. The anti-inflammatory property of kudzu is attributed to its ability to decrease Prostaglandin E2 and tumor necrosis factor (TNF)-alpha release, both of which are involved in inflammatory process. The flowers of Pueraria thunbergiana exhibit protective effects against ethanol-induced apoptosis in human neuroblastoma cells by inhibiting the expression of a protease, caspase-3 that is responsible for proteolytic cleavage of many proteins.

Herbal Breast Enlargement by Pueraria mirifica. In 90% of women, the phytoestrogen from Pueraria herbal will induce the increasing of the cell turgidity but not cell multiplication or proliferation.

Disclaimer:
The information presented herein is intended for educational purposes only. Individual results may vary, and before using any supplements, it is always advisable to consult with your own health care provider.

Resources:

Siam Natural ‘Kwao Krua Kao’ (Pueraria mirifica)


http://en.wikipedia.org/wiki/Pueraria_mirifica
http://www.paradisemoon.com/herbal/kwao_krua.htm
http://www.herbnet.com/Herb%20Uses_IJK.htm

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Restless Legs Syndrome(RLS)

Alternative Name : Wittmaack–Ekbom syndrome

Definitipon:
Restless legs syndrome (RLS)  is a neurological disorder characterized by an irresistible urge to move one’s body to stop uncomfortable or odd sensations.  It most commonly affects the legs, but can affect the arms, torso, and even phantom limbs.  Moving the affected body part modulates the sensations, providing temporary relief.
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RLS sensations can most closely be compared to an itching or tickling in the muscles, like “an itch you can’t scratch” or an unpleasant “tickle that won’t stop.” The sensations typically begin or intensify during quiet wakefulness, such as when relaxing, reading, studying, or trying to sleep.  In addition, most individuals with RLS have limb jerking during sleep, which is an objective physiologic marker of the disorder and is associated with sleep disruption. Some controversy surrounds the marketing of drug treatments for RLS. It is a “spectrum” disease with some people experiencing only a minor annoyance and others experiencing major disruption of sleep and significant impairments in quality of life

Restless legs syndrome can begin at any age and generally worsens as you get older. Women are more likely than men to develop this condition.

A number of simple self-care steps and lifestyle changes may help you. Medications also help many people with restless legs syndrome.

Symptoms:
Commonly described sensations
People typically describe restless legs syndrome (RLS) symptoms as unpleasant sensations in their calves, thighs, feet or arms, often expressed as:

*Crawling

*Tingling

*Cramping

*Creeping

*Pulling

*Painful

*Electric

*Tense

*Uncomfortable

*Itchy

*Tugging

*Gnawing

*Aching

*Burning

Sometimes the sensations seem to defy description. Affected people usually don’t describe the condition as a muscle cramp or numbness. They do, however, consistently describe the desire to move or handle their legs.

It’s common for symptoms to fluctuate in severity, and occasionally symptoms disappear for periods of time.

NIH criteria
In 2003, a National Institutes of Health (NIH) panel modified their criteria to include the following:

1.An urge to move the limbs with or without sensations.

2.Improvement with activity. Many patients find relief when moving and the relief continues while they are moving. In more severe RLS this relief of symptoms may not be complete or the symptoms may reappear when the movement ceases.

3.Worsening at rest. Patients may describe being the most affected when sitting for a long period of time, such as when traveling in a car or airplane, attending a meeting, or watching a performance. An increased level of mental awareness may help reduce these symptoms.

4.Worsening in the evening or night. Patients with mild or moderate RLS show a clear circadian rhythm to their symptoms, with an increase in sensory symptoms and restlessness in the evening and into the night.
RLS is either primary or secondary.

*Primary RLS is considered idiopathic or with no known cause. Primary RLS usually begins slowly, before approximately 40–45 years of age and may disappear for months or even years. It is often progressive and gets worse with age. RLS in children is often misdiagnosed as growing pains.

*Secondary RLS often has a sudden onset after age 40, and may be daily from the beginning. It is most associated with specific medical conditions or the use of certain drugs

Causes:
Disease mechanism
Most research on the disease mechanism of restless legs syndrome has focused on the dopamine and iron system.   These hypotheses are based on the observation that iron and levodopa, a pro-drug of dopamine that can cross the blood-brain barrier and is metabolized in the brain into dopamine (as well as other mono-amine neurotransmitters of the catecholamine class) can be used to treat RLS, levodopa being a medicine for treating hypodopaminergic (low dopamine) conditions such as Parkinson’s disease, and also on findings from functional brain imaging (such as positron emission tomography and functional magnetic resonance imaging), autopsy series and animal experiments.  Differences in dopamine- and iron-related markers have also been demonstrated in the cerebrospinal fluid of individuals with RLS.  A connection between these two systems is demonstrated by the finding of low iron levels in the substantia nigra of RLS patients, although other areas may also be involved.

Heredity
RLS runs in families in up to half the people with RLS, especially if the condition started at an early age. Researchers have identified sites on the chromosomes where genes for RLS may be present.

Pregnancy
Pregnancy or hormonal changes may temporarily worsen RLS signs and symptoms. Some women experience RLS for the first time during pregnancy, especially during their last trimester. However, for most of these women, signs and symptoms usually disappear quickly after delivery.

Related conditions
For the most part, restless legs syndrome isn’t related to a serious underlying medical problem. However, RLS sometimes accompanies other conditions, such as:

*Peripheral neuropathy. This damage to the nerves in your hands and feet is sometimes due to chronic diseases such as diabetes and alcoholism.

*Iron deficiency. Even without anemia, iron deficiency can cause or worsen RLS. If you have a history of bleeding from your stomach or bowels, experience heavy menstrual periods or repeatedly donate blood, you may have iron deficiency.

* Kidney failure. If you have kidney failure, you may also have iron deficiency, often with anemia. When kidneys fail to function properly, iron stores in your blood can decrease. This, along with other changes in body chemistry, may cause or worsen RLS.

Risk Factors:
RLS can develop at any age, even during childhood. Many adults who have RLS can recall being told as a child that they had growing pains or can remember parents rubbing their legs to help them fall asleep. The disorder is more common with increasing age.

Complications:
Although RLS doesn’t lead to other serious conditions, symptoms can range from barely bothersome to incapacitating. Many people with RLS find it difficult to get to sleep or stay asleep. Insomnia may lead to excessive daytime drowsiness, but RLS may prevent you from enjoying a daytime nap.

Diagnosis:
The diagnosis of RLS relies essentially on a good medical history and physical examination. Sleep registration in a laboratory (polysomnography) is not necessary for the diagnosis. Peripheral neuropathy, radiculopathy and leg cramps should be considered in the differential diagnosis; in these conditions, pain is often more pronounced than the urge to move. Akathisia, a side effect of several antipsychotics or antidepressants, is a more constant form of leg restlessness without discomfort. Doppler ultrasound evaluation of the vascular system is essential in all cases to rule out venous disorders which is a common etiology of RLS. A rare syndrome of painful legs and moving toes has been described, with no known cause.

Treatment:
Treatment of restless legs syndrome involves identifying the cause of symptoms when possible. The treatment process is designed to reduce symptoms, including decreasing the number of nights with RLS symptoms, the severity of RLS symptoms and nighttime awakenings. Improving the quality of life is another goal in treatment. This means improving overall quality of life, decreasing daytime somnolence, and improving the quality of sleep. All of these goals are taken care of through nonpharmacologic and pharmacologic therapies. Pharmacotherapy involves dopamine agonists as first line drugs for daily restless legs syndrome; gabapentin (Horizant™) and opioids for treatment of resistant cases.

An algorithm created by Mayo Clinic researchers and endorsed by the RLS Foundation, provides guidance to the treating physician and patient, including non pharmacological and pharmacological treatments. Treatment of primary RLS should not be considered until possible precipitating medical conditions are ruled out, especially venous disorders. RLS Drug therapy is not curative and has side effects such as nausea, dizziness, hallucinations, orthostatic hypotension and daytime sleep attacks. In addition, it can be expensive (about $100–150 per month for life), and needs to be considered with caution.

Secondary RLS may be cured if precipitating medical conditions (anemia, venous disorder) are managed effectively. Secondary conditions causing RLS include iron deficiency, varicose veins, and thyroid problems. Karl-Axel Ekbom in his 1945 doctoral thesis on RLS suspected venous disease in about 12.5% of cases. But due to the unavailability of Doppler ultrasound imaging technology (the diagnostic tool detecting abnormal blood flow in the veins, “Venous Reflux”, the pathological basis for varicose veins) at that time, Ekbom may have underestimated the role of venous disease. In uncontrolled prospective series, improvement of RLS was achieved in a high percentage of patients presenting with a combination of RLS and venous disease and had sclerotherapy or other treatment for the correction of venous insufficiency.   In Nonpharmacologic treatments there are ways patients may be able to reduce the symptoms or decrease the severity of the symptoms. One thing that may worsen the symptoms is fatigue. Therefore using relaxation techniques, soaking in a warm bath or massaging the legs can all help aid in relaxation and relief of symptoms. Another technique is avoiding caffeine, alcohol, and tobacco. Also exercising every day and maintaining a schedule of relaxation and avoiding heavy meals before bed will all help with relief of symptoms. These techniques can be used with medication or just by themselves for those who do not want medication. For symptoms that occur in the evening patients may find that activities that alert the mind like crossword puzzles, and video games may reduce symptoms. Many patients may also benefit from RLS support groups.

Stretching and shaking legs
Stretching the leg muscles can bring relief lasting from seconds to days.   Walking around brings relief also. Tiredness can be a factor and some sufferers may find going to bed usually stops the discomfort. Bouncing or shaking the legs/feet in an up and down motion, with the ball of the foot on the floor when sitting down may bring temporary relief.

Iron supplements
According to some guidelines, all people with RLS should have their serum ferritin level tested. The ferritin level, a measure of the body’s iron stores, should be at least 50 µg for those with RLS. Oral iron supplements, taken under a doctor’s care, can increase ferritin levels. For some people, increasing ferritin will eliminate or reduce RLS symptoms. A ferritin level of 50 µg is not sufficient for some sufferers and increasing the level to 80 µg may further reduce symptoms. However, at least 40% of people will not notice any improvement. Treatment with IV iron is being tested at the US Mayo Clinic and Johns Hopkins Hospital. It is dangerous to take iron supplements without first having ferritin levels tested, as many people with RLS do not have low ferritin and taking iron when it is not called for can cause iron overload disorder, potentially a very dangerous condition

Medication therapy:
Several prescription medications, most of which were developed to treat other diseases, are available to reduce the restlessness in your legs. These include:

*Medications for Parkinson’s disease. These medications reduce the amount of motion in your legs by affecting the level of the chemical messenger dopamine in your brain. Two drugs, ropinirole (Requip) and pramipexole (Mirapex), are approved by the Food and Drug Administration for the treatment of moderate to severe RLS.

Doctors commonly also use other Parkinson’s drugs to treat restless legs syndrome, such as a combination of carbidopa and levodopa (Sinemet). People with RLS are at no greater risk of developing Parkinson’s disease than are those without RLS. Side effects of Parkinson’s medications are usually mild and include nausea, lightheadedness and fatigue.

*Opioids. Narcotic medications can relieve mild to severe symptoms, but they may be addicting if used in too high doses. Some examples include codeine, oxycodone (Roxicodone), the combination medicine oxycodone and acetaminophen (Percocet, Roxicet), and the combination medicine hydrocodone and acetaminophen (Lortab, Vicodin).

*Muscle relaxants and sleep medications. This class of medications, known as benzodiazepines, helps you sleep better at night. But these medications don’t eliminate the leg sensations, and they may cause daytime drowsiness. Commonly used sedatives for RLS include clonazepam (Klonopin), triazolam (Halcion), eszopiclone (Lunesta), ramelteon (Rozerem), temazepam (Restoril), zaleplon (Sonata) and zolpidem (Ambien).

*Medications for epilepsy. Certain epilepsy medications, such as gabapentin (Neurontin), may work for some people with RLS.It may take several trials for you and your doctor to find the right medication and dosage for you. A combination of medications may work best.

Caution about medications:
One thing to remember with drugs to treat RLS is that sometimes a medication that has worked for you for a while becomes ineffective. Or you notice your symptoms returning earlier in the day. For example, if you have been taking your medication at 8 p.m., your symptoms of RLS may start at 6 p.m. This is called augmentation. Your doctor may substitute another medication to combat the problem.

Most of the drugs prescribed to treat RLS aren’t recommended for pregnant women. Instead, your doctor may recommend self-care techniques to relieve symptoms. However, if the sensations are particularly bothersome during your last trimester, your doctor may approve the use of pain relievers.

Some medications may worsen symptoms of RLS. These include most antidepressants and some anti-nausea drugs. Your doctor may recommend that you avoid these medications if possible. However, should you need to take these medications, restless legs can still be controlled by adding drugs that manage the condition.

Lifestyle and home remedies

Making simple lifestyle changes can play an important role in alleviating symptoms of RLS. These steps may help reduce the extra activity in your legs:

*Take pain relievers. For very mild symptoms, taking an over-the-counter pain reliever such as ibuprofen (Advil, Motrin, others) when symptoms begin may relieve the twitching and the sensations.

*Try baths and massages. Soaking in a warm bath and massaging your legs can relax your muscles.

*Apply warm or cool packs. You may find that the use of heat or cold, or alternating use of the two, lessens the sensations in your limbs.

*Try relaxation techniques, such as meditation or yoga. Stress can aggravate RLS. Learn to relax, especially before going to bed at night.Establish good sleep hygiene. Fatigue tends to worsen symptoms of RLS, so it’s important that you practice good sleep hygiene. Ideally, sleep hygiene involves having a cool, quiet and comfortable sleeping environment, going to bed at the same time, rising at the same time, and getting enough sleep to feel well rested. Some people with RLS find that going to bed later and rising later in the day helps in getting enough sleep.

*Exercise. Getting moderate, regular exercise may relieve symptoms of RLS, but overdoing it at the gym or working out too late in the day may intensify symptoms.

*Avoid caffeine. Sometimes cutting back on caffeine may help restless legs. It’s worth trying to avoid caffeine-containing products, including chocolate and caffeinated beverages such as coffee, tea and soft drinks, for a few weeks to see if this helps.

*Cut back on alcohol and tobacco. These substances also may aggravate or trigger symptoms of RLS. Test to see whether avoiding them helps.

*Stay mentally alert in the evening. Boredom and drowsiness before bedtime may worsen RLS. Mentally stimulating activities such as video games or crossword puzzles can help you stay alert and may reduce symptoms of RLS.

Alternative Medication:
Because restless legs syndrome is sometimes due to an underlying nutritional deficiency, taking supplements to correct the deficiency may improve your symptoms. Your doctor can order blood tests to pinpoint nutritional deficiencies and give you a good sense of which supplements may help.

Doctor may also tell you whether certain dietary supplements can interfere with the way your prescription medications work or may pose health risks for you.

If blood tests show that you are deficient in any of the following nutrients, your doctor may recommend taking dietary supplements as part of your treatment plan:

*Iron
*Folic acid
*Vitamin B
*Magnesium

More research is needed to reliably establish the safety and effectiveness of all of these supplements in the treatment of RLS.

Prognosis:
RLS is generally a lifelong condition for which there is no cure. Symptoms may gradually worsen with age, though more slowly for those with the idiopathic form of RLS than for patients who also suffer from an associated medical condition. Nevertheless, current therapies can control the disorder, minimizing symptoms and increasing periods of restful sleep. In addition, some patients have remissions, periods in which symptoms decrease or disappear for days, weeks, or months, although symptoms usually eventually reappear. Being diagnosed with RLS does not indicate or foreshadow another neurological disease.

Prevention:
Other than preventing the  causes, no method of preventing RLS has yet been established or studied.

Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose

Resources:
http://www.mayoclinic.com/health/restless-legs-syndrome/DS00191
http://en.wikipedia.org/wiki/Restless_legs_syndrome
http://www.sleepdisordersguide.com/restless-leg-syndrome-causes.html

Homeopathy for Restless Legs Syndrome

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Diverticular disease

Alternative Name:   Diverticulosis…………..click for picture

Definition:
Over a lifetime, it’s estimated the human gut digests more than 65 tonnes of food and drink. Much of this food will be low in fibre, putting the gut under strain.

One common outcome of this is diverticular disease, a condition affecting the large bowel, or colon, believed to be the result of too little fibre in the diet.

A diet low in fibre creates the ideal conditions for constipation to develop. When this happens, the pressure in the large part of the gut increases, which forces small parts of the gut lining outwards through the muscles surrounding the gut. This causes the lining to form small balloon-like pouches called diverticula..

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Author: U.S. National Institute of Diabetes an...
Author: U.S. National Institute of Diabetes and Digestive and Kidney Disease (NIDDK), National Institutes of Health (NIH) Source URL: http://win.niddk.nih.gov/publications/gastric.htm Copyright tag: Why? Because it’s from an NIH department. Category:Obesity images (Photo credit: Wikipedia)

Diverticula are pockets that develop in the colon wall, usually in the sigmoid or left colon, but may involve the entire colon. Diverticulosis describes the presence of these pockets. Diverticulitis describes inflammation or complications of these pockets.

click to see the picture

About one in two adults over 50 is affected, and most adults are affected by the time they reach 80 to 90. Men and women are affected equally.

Diverticular disease is very uncommon in countries such as Africa, where diets are high in fibre. In Western countries, where many people still don’t eat enough fibre, it becomes more common as people get older.

Symptoms:
Signs and symptomsMost people with colonic diverticulosis are unaware of this structural change. When symptoms do appear in a person over 40 years of age it is important to obtain medical advice and exclude more dangerous conditions such as cancer of the colon or rectum.

The clinical forms of colonic diverticulosis are

*Symptomatic colonic diverticulosis………..click to see the picture
This is the most common complication of colonic diverticulosis. This is when the motility (that is, the onward propulsive nature of contractions) of the bowel becomes disorganized. Sometimes, spasm can develop. This results in pain in the left lower abdomen and often is accompanied by the passage of small pelletty stools and slime which relieves the pain. Symptoms can consist of (1) bloating, (2) changes in bowel movements (diarrhea or constipation), (3) Non-specific chronic discomfort in the lower left abdomen, with occasional acute episodes of sharper pain, (4) abdominal pain, often aftick to see the pictureer meals often in the left lower abdomen. If these persist clinical investigation is advised.

*Complicated colonic diverticulosis
This is very uncommon but highly dangerous. The diverticulae may bleed, either rapidly (causing bleeding through the rectum) or slowly (causing anaemia). The diverticulae can become infected and develop abscesses, or even perforate. These are serious complications and medical care is needed. Infected diverticulae and development of abscesses merits the term diverticulitis. First time bleeding from the rectum, especially in individuals aged over age 40, could be due to colon cancer, colonic polyps and inflammatory bowel disease rather than diverticulosis and requires clinical investigation.

Infection in the diverticula, possibly caused by an impacted piece of faeces, is responsible for the inflammation that develops. When this happens – called diverticulitis – the pain is very severe and usually felt in the lower left side of the abdomen.

A person will often feel feverish and have nausea and vomiting. They may pass blood rectally.

Risk factors:
1.increasing age
2.constipation
3.a diet that is low in dietary fiber content or high in fat
4.high intake of meat and red meat
5.connective tissue disorders (such as Marfan syndrome) that may cause weakness in the colon wall.

The exact aetiology of colonic diverticulosis has yet to be fully clarified and many of the claims are only anecdotal.  The modern emphasis on the value of fiber in the diet began with Cleave. A strong case was made by Neil Painter  and Adam Smith  that a deficiency of dietary fiber is the cause of diverticular disease. They argued that the colonic muscles needed to contract strongly in order to transmit and expel the small stool associated with a fiber deficient diet. The increased pressure within the segmented section of bowel over years gave rise to herniation at the vulnerable point where blood vessels enter the colonic wall. Denis Burkitt had suggested that the mechanical properties of the colon may be different in the African and the European subjects. Because Africans eat a diet containing much more fiber than Europeans and use the natural squatting position for defecation, they pass bulky stools, and hence rarely if ever develop colonic diverticulosis. The US National Institutes of Health (NIH) considers the fiber theory “unproven.”

However, change in the strength of the colonic wall with age may be an aetiological factor. Connective tissue is a significant contributor to the strength of the colonic wall. The mechanical properties of connective tissue depend on a wide variety of factors, the type of tissue and its age, the nature of the intramolecular and intermolecular covalent cross links and the quantity of the glycosaminoglycans associated with the collagen fibrils. The submucosa of the colon is composed almost entirely of collagen, both type I and type III. Several layers of collagen fibres make up the submucosa of the human colon. The collagen fibril diameters and fibril counts are different between the left and right colon and change with age and in colonic diverticulosis,. The implication being that changes which are normally associated with ageing are more pronounced in colonic diverticulosis. Iwasaki found that the tensil strength of the Japanese colon obtained at postmortem declined with age. Similarly the mechanical properties of the colon are stronger in African than European subjects. However, this race-based claim is contradicted by the virtually identical incidence of diverticular disease in black and white Americans.

The strength of the colon decreases with age in all parts of the colon, except the ascending colon. The fall in tensile strength with age is due to a decrease in the integrity of connective tissue. Cross linkage of collagen is increased in colonic diverticulosis. The mucosal layer is possibly more elastic and it is likely that the stiffer external layers break and allow the elastic mucosa to herniate through forming a diverticulum. Collagen has intermolecular and intramolecular cross links which stabilise and give strength to the tissue in which it is located. Accumulation of covalently linked sugar molecules and related increasing cross linking products are found in a variety of tissues with ageing, skin, vascular tissue, the cordae tendinae of heart valves and the colon.  This reduces the strength and pliability of the collagen. Colonic diverticulosis increases in frequency with age.  There is a reduction in the strength of the colonic mucosa with age, and that increased contractions in the descending and sigmoid colon secondary to an insufficient fibre content of the diet cause protrusion through this weakened wall. Colonic diverticulosis is in general a benign condition of the bowel which uncommonly becomes symptomatic and even less commonly becomes a truly clinical complicated problem.

Diagnosis:
In cases of asymptomatic Diverticulosis, the diagnosis is usually made as an incidental finding on other investigations.

While a good history is often sufficient to form a diagnosis of Diverticulosis or Diverticulitis, it is important to confirm the diagnosis and rule out other pathology (notably colorectal cancer) and complications.

Investigations:-

*Plain Abdominal X-ray may show signs of a thickened wall, ileus, constipation, small bowel obstruction or free air in the case of perforation. Plain X-rays are insufficient to diagnose Diverticular Disease.

*Contrast CT is the investigation of choice in acute episodes of Diverticulitis and where complications exist.

*Colonoscopy will show the diverticulum and rule out malignancy. A Colonoscopy should be performed 4–6 weeks after an acute episode.

*Barium enema is inferior to colonoscopy in terms of image quality and is usually only performed if the patient has strictures or an excessively tortuous sigmoid colon where colonoscopy is difficult or dangerous.

*MRI provides a clear picture of the soft tissue of the abdomen, however its expense often outweighs the benefits when compared to contrast CT or colonoscopy.

*There is no blood test for Diverticulosis.

It is important to note that both Barium enema and Colonoscopy are contraindicated during acute episodes of diverticulitis.

Management  & Treatment:
Many patients with diverticulosis have minimal or no symptoms, and do not require any specific treatment. A high-fiber diet and fiber supplements are advisable to prevent constipation  . The American Dietetic Association recommends 20-35 grams each day. Wheat bran has much to commend it as this has been shown to reduce intra colonic pressure  Ispaghula is also effective at 1-2 grams a day. Colonic stimulants should be avoided. The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) says foods such as nuts, popcorn hulls, sunflower seeds, pumpkin seeds, caraway seeds, and sesame seeds have traditionally been labelled as problem foods for people with this condition; however, no scientific data exists to prove this hypothesis. The seeds in tomatoes, zucchini, cucumbers, strawberries, raspberries, and poppy seeds, are not considered harmful by the NIDDK. Treatments, like some colon cleansers, that cause hard stools, constipation, and straining, are not recommended. Some doctors also recommend avoidance of fried foods, nuts, corn, and seeds to prevent complications of diverticulosis. Whether these diet restrictions are beneficial is uncertain; recent studies have stated that nuts and popcorn do not contribute positively or negatively to patients with diverticulosis or diverticular complications. When the spasm pain is troublesome the use of peppermint oil (1 drop in 50 ml water), or peppermint tablets (e.g., colpermin), can be helpful. Complicated diverticulosis requires treatment of the complication. These complications are often grouped under a single diagnosis of diverticulitis and require skilled medical care of the infection, bleeding and perforation which may include intensive antibiotic treatment, intravenous fluids and surgery. Complications are more common in patients who are taking NSAIDS or aspirin. As diverticulosis occurs in an older population such complications are serious events.

Someone with diverticulitis may be treated at home with painkillers, antibiotics, laxatives and dietary advice. But diverticulitis is often severe, and can need hospital treatment with antibiotics and fluids given through a drip.

In some cases, the bowel may perforate, become obstructed or bleed heavily. When this happens, the situation becomes an emergency and an operation may be needed.

Surgery is reserved for patients with recurrent episodes of diverticulitis, complications or severe attacks when there’s little or no response to medication. Surgery may also be required in individuals with a single episode of severe bleeding from diverticulosis or with recurrent episodes of bleeding.

Surgical treatment for diverticulitis removes the diseased part of the colon, most commonly, the left or sigmoid colon. Often the colon is hooked up or “anastomosed” again to the rectum. Complete recovery can be expected. Normal bowel function usually resumes in about three weeks. In emergency surgeries, patients may require a temporary colostomy bag. Patients are encouraged to seek medical attention for abdominal symptoms early to help avoid complications.

Complications:
Infection of a diverticulum can result in diverticulitis. This occurs in 10-25% of persons with diverticulosis (NIDDK website). Tears in the colon leading to bleeding or perforations may occur; intestinal obstruction may occur (constipation or diarrhea does not rule this possibility out); and peritonitis, abscess formation, retroperitoneal fibrosis, sepsis, and fistula formation are also possible occurrences. Rarely, an enterolith may form.

Low fiber, high fat diet, constipation and use of stimulant laxatives increase the risk of bleeding, also history of diverticulitis increases the chance to bleed.

Infection of a diverticulum often occurs as a result of stool collecting in a diverticulum.

More than 10% of the US population over the age of 40 and half over the age of 60 has diverticulosis. This disease is common in the US, Britain, Australia, Canada, and is uncommon in Asia and Africa . Large-mouth diverticula are associated with scleroderma.

Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose.

Resources:
http://www.bbc.co.uk/health/physical_health/conditions/diverticulardisease1.shtml
http://en.wikipedia.org/wiki/Diverticulosis
http://www.fascrs.org/patients/conditions/diverticular_disease/

http://www.procto-med.com/images/2009/05/diverticular-disease.gif

Understanding Diverticular Disease

http://www.advgastro.com/diverticulitis.htm

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Memory Loss Does Not Wipe Out Emotions

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New research from the US suggests that emotions triggered by events can endure longer than factual recollection in patients with severe amnesia; the researchers hope their findings will increase understanding of Alzheimer’s and related diseases and also bring comfort to caregivers and families in the knowledge that their loved ones may continue to feel the warmth of visits and conversations even if they can’t remember what happened.

………..CLICK & SEE

You can read about the research by scientists at the University of Iowa (UI) in Iowa City in the 12 April early online edition of the Proceedings of the National Academy of Sciences, PNAS.

Lead author Justin Feinstein, a student in the UI graduate programs of neuroscience and psychology, told the media that:

“A simple visit or phone call from family members might have a lingering positive influence on a patient’s happiness even though the patient may quickly forget the visit or phone call.”

However, he also described the downside:

“On the other hand, routine neglect from staff at nursing homes may leave the patient feeling sad, frustrated and lonely even though the patient can’t remember why,” said Feinstein.

Feinstein and colleagues studied five patients with a rare case of memory loss due to damage to their their hippocampus that caused new memories to disappear.

The hippocampus is critical for transferring memories from short-term to long-term storage, and is one of the first regions of the brain to suffer damage in Alzheimer’s disease.

The researchers showed the patients short extracts of sad and happy films; although they couldn’t remember details of the films, they retained the emotions elicited by what they had watched.

Each patient watched 20 minutes of a sad film, underwent memory and mood tests, then on another day, they watched 20 minutes of a happy film and had the same tests.

The researchers observed that the films induced the appropriate emotion in the patients, ranging from laughing out loud while watching the happy films to tears during the sad films.

About 10 minutes after watching a film clip, Feinstein and colleagues tested the patients’ factual memories to see how much they could remember about it.

A person with a non-impaired memory would be expected to remember about 30 details from each film clip, but these patients’ memories were severely imparied: one patient couldn’t recall a single detail.

Then they asked the patients another set of questions to gauge their emotional state.

Feinstein said that they still felt the emotion, explaining that “sadness tended to last a bit longer than happiness, but both emotions lasted well beyond their memory of the films”.

“With healthy people, you see feelings decay as time goes on. In two patients, the feelings didn’t decay; in fact, their sadness lingered,” he added.

The researchers concluded that the findings suggest “both positive and negative emotional experiences can persist independent of explicit memory for the inducing event,” and provide “direct evidence that a feeling of emotion can endure beyond the conscious recollection for the events that initially triggered the emotion”.

These results appear to challenge the idea that wiping out a painful memory abolishes the associated emotional suffering, and stress the importance of attending to the needs of people with Alzheimer’s disease.

According to a 2009 report from Alzheimer’s Disease International (ADI), 35 million people worldwide will have dementia this year, and the number is set to double every 20 years, reaching 115.4 million by 2050.

The greatest risk factor for Alzheimer’s is age, and there is currently no cure, said Feinstein.

“What we’re about to face is an epidemic. We’re going to have more and more baby boomers getting older, and more and more people with Alzheimer’s disease. The burden of care for these individuals is enormous,” he added, urging that:

“… we need to start setting a scientifically-informed standard of care for patients with memory disorders. Here is clear evidence showing that the reasons for treating Alzheimer’s patients with respect and dignity go beyond simple human morals.”

The Fraternal Order of Eagles, the National Institutes of Health, the National Science Foundation and the Kiwanis International Foundation, funded the research.

“Sustained experience of emotion after loss of memory in patients with amnesia.”

Source: Today’s Health News: 13th. April.2010

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Drinking Beer Could Be Good For Your Bones


A new study suggests that beer is a significant source of dietary silicon, a key ingredient for increasing bone mineral density. Researchers from the Department of Food Science & Technology at the University of California, Davis studied commercial beer production to determine the relationship between beer production methods and the resulting silicon content, concluding that beer is a rich source of dietary silicon. Details of this study are available in the February issue of the Journal of the Science of Food and Agriculture, published by Wiley-Blackwell on behalf of the Society of Chemical Industry.
………………
“The factors in brewing that influence silicon levels in beer have not been extensively studied” said Charles Bamforth, lead author of the study. “We have examined a wide range of beer styles for their silicon content and have also studied the impact of raw materials and the brewing process on the quantities of silicon that enter wort and beer.”
Silicon is present in beer in the soluble form of orthosilicic acid (OSA), which yields 50% bioavailability, making beer a major contributor to silicon intake in the Western diet. According to the National Institutes of Health (NIH), dietary silicon (Si), as soluble OSA, may be important for the growth and development of bone and connective tissue, and beer appears to be a major contributor to Si intake. Based on these findings, some studies suggest moderate beer consumption may help fight osteoporosis, a disease of the skeletal system characterized by low bone mass and deterioration of bone tissue.
The researchers examined a variety of raw material samples and found little change in the silicon content of barley during the malting process. The majority of the silicon in barley is in the husk, which is not affected greatly during malting. The malts with the higher silicon contents are pale colored which have less heat stress during the malting process. The darker products, such as the chocolate, roasted barley and black malt, all have substantial roasting and much lower silicon contents than the other malts for reasons that are not yet known. The hop samples analyzed showed surprisingly high levels of silicon with as much as four times more silicon than is found in malt. However, hops are invariably used in a much smaller quantity than is grain. Highly hopped beers, however, would be expected to contain higher silicon levels.
No silicon was picked up from silica hydrogel used to stabilize beer, even after a period of 24 hours and neither is there pick up from diatomaceous earth filter aid.
The study also tested 100 commercial beers for silicon content and categorized the data according to beer style and source. The average silicon content of the beers sampled was 6.4 to 56.5 mg/L.
“Beers containing high levels of malted barley and hops are richest in silicon,” concludes Dr. Bamforth. “Wheat contains less silicon than barley because it is the husk of the barley that is rich in this element. While most of the silicon remains in the husk during brewing, significant quantities of silicon nonetheless are extracted into wort and much of this survives into beer.”

Source:Medical News Today. Feb.9.2010

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