Important Constituents of tea

There is lot of important constituents found in tea. These constituents of tea are important in many ways. Some constituents are toxic while others have some health benefits as well. It is very important to know about importance of constituents of tea as it is one of the popular beverages in modern day as well as in the past.

List of important constituents of tea

1. carbohydrates, proteins and lipids
2. Vitamins (thiamin, riboflavin, niacin, folic acid, pantothenic acid, biotin, inositol, vitamin K)
3. Minerals (sodium, fluoride, )
4. polyphenols
5. Alkaloids (caffeine, theobromide, theophylline)

Recent reports on sporadic cases of liver disorders (acute hepatitis, icterus, hepatocellular necrosis) after ingestion of dietary supplements based on hydro-alcoholic extracts from green tea leaves led to restrictions of the marketing of such products in certain countries of the EU. Since green tea is considered to exert a number of beneficial health effects, and, therefore, green tea products are widely used as dietary supplements.

A glass of black tea

Vegetables and cancer risk

“Vegetables which reduce the cancer risk” is a debatable topic and it is also an interesting topic to be discussed. A decreased incidence of cancer correlates with the frequent ingestion of cabbage, Brussels sprouts and broccoli (Brassica oleracea). Members of the Brassica family as well as spinach, dill and celery (Apium graveolens) are potent inducers of the microsomal mixed function oxidase system. Flavors in citrus fruits have similar action.

Brassica oleracea

A lower incidence of cancer of the lung, breast, gastrointestinal tract and urinary bladder has been reported in those on a high carotene intake. However, no effort has yet been made to study the effect of constituents of green and yellow vegetables other than carotene.

While FDA acknowledges that high intakes of fruits and vegetables rich in beta-carotene or vitamin C have been associated with reduced cancer risk, it believes the data are not sufficiently convincing that either nutrient by itself is responsible for the association. Nevertheless, since most fruits and vegetables are low-fat foods and may contain vitamin A (as beta-carotene) and vitamin C, the agency authorized a health claim relating diets low in fat and rich in these foods to a possibly reduced risk of some cancers.

Approximately 200 studies that examined the relationship between fruit and vegetable intake and cancers of the lung, colon, breast, cervix, esophagus, oral cavity, stomach, bladder, pancreas, and ovary are reviewed. A statistically significant protective effect of fruit and vegetable consumption was found in 128 of 156 dietary studies in which results were expressed in terms of relative risk. For most cancer sites, persons with low fruit and vegetable intake (at least the lower one-fourth of the population) experience about twice the risk of cancer compared with those with high intake, even after control for potentially confounding factors. For lung cancer, significant protection was found in 24 of 25 studies after control for smoking in most instances. Fruits, in particular, were significantly protective in cancers of the esophagus, oral cavity, and larynx, for which 28 of 29 studies were significant. Strong evidence of a protective effect of fruit and vegetable consumption was seen in cancers of the pancreas and stomach (26 of 30 studies), as well as in colorectal and bladder cancers (23 of 38 studies). For cancers of the cervix, ovary, and endometrium, a significant protective effect was shown in 11 of 13 studies, and for breast cancer a protective effect was found to be strong and consistent in a meta analysis. It would appear that major public health benefits could be achieved by substantially increasing consumption of these foods.

Recommended daily allowances of some vitamins

Recommended daily allowances of vitamins depend on several factors. Age of the individual and the physiological state (pregnancy and lactation) are the leading factors which determine the daily requirement of vitamins. If somebody takes low or high amount of vitamins than the recommended daily allowance, it will lead to disease conditions such as osteoporosis, anemia and growth retardation. A balance diet, a diet consists of adequate carbohydrates, protein, lipid, vitamin and mineral is capable of providing recommended daily allowance of vitamins. Daily consumption of leafy vegetables, green leaves and milk will supply the recommended daily allowances of vitamin.

Age and sex	Vitamin A (µg)	Vitamin D (µg)	Thiamin (mg)	Riboflavin (mg)	Niacin (mg)	Folic (µg)	Vitamin B12 (mg)	Vitamin C (mg)
Infants
6-8 months	300	10	0.4	0.5	5.9	60	0.3	20
9-11 months	300	10	0.4	0.6	6.5	60	0.3	20
Children
1-2 y	250	10	0.5	0.8	9.0	100	0.9	20
4-6y	300	10	0.7	1.1	12.1	100	1.5	20
7-9y	400	2.5	0.9	1.3	14.5	100	1.5	20
Adolescents
Male
10-12y	575	2.5	1.0	1.6	17.2	100	2.0	20
13-15y	725	2.5	1.2	1.7	19.2	200	2.0	30
16-17y	750	2.5	1.2	1.8	20.3	200	2.0	30
Female
10-12y	575	2.5	0.9	1.4	15.5	100	2.0	20
13-15y	725	2.5	1.0	1.5	16.4	200	2.0	20
16-17y	750	2.5	2.5	0.9	15.2	200	2.0	30
Adults
Male	750	2.5	1.2	1.8	19.8	200	2.0	30
Female	750	2.5	0.9	1.3	14.5	200	2.0	30

Can vitamin c cure cancer?

Vitamin C and cancer is an interesting topic to talk as there are lot of evidence which suggest that vitamin c has n ability to cure some cancers. There have been reports of massive doses of vitamin C curing cancers. However, there is no reliable evidence that doses up to 10 g per day have any beneficial effect on survival or on the general condition of the patient. Patients having cancer of the breast with metastases in bone have obtained some relief of deep bone the pain associated with the condition. There has been no cure or regression of the cancer. Even with these patients ascorbic acid (vitamin C) does not have an advantage over analgesics.

Vitamin C prevents the formation of nitrosocarcinogens from nitrites. This prevention can occur in vivo, in the alimentary tract. It can also be used as a means of preventing formation of nitrosocarcinogens in food.

The conventional wisdom of how antioxidants such as vitamin C help prevent cancer growth is that they grab up volatile oxygen free radical molecules and prevent the damage they are known to do to our delicate DNA.

Injections of high doses of vitamin C have almost halved the rate of tumour growth in mice, leading US researchers to believe it may be useful in the treatment of cancer in humans.

The idea that vitamin C, also known as ascorbic acid, could be used to treat cancer was advanced in the 1970s by American scientist Linus Pauling, who was awarded the Nobel Prize in chemistry in 1954.
The notion was controversial and studies failed to show a benefit. But those studies involved vitamin C given orally.
In the latest study researchers injected the vitamin C to enable greater concentrations of it to get into the system.
Injections were necessary because the body regulates vitamin C when ingested, so that higher doses cannot be attained.
The claim that vitamin C is useful in the treatment of cancer is largely attributable to Linus Pauling, Ph.D. In 1976 and 1978, he and a Scottish surgeon, Ewan Cameron, M.B., Ch.B., reported that patients treated with high doses of vitamin C had survived three to four times longer than similar patients who did not receive vitamin C supplements. The study was conducted during the early 1970s at the Vale of Leven Hospital in Loch Lomonside, Scotland. Dr. Cameron treated 100 advanced cancer patients with 10,000 milligrams grams of vitamin C per day. The clinical course of these patients was then compared with that of 1,000 patients of other doctors whose records were obtained from the same hospital, but who had received no vitamin C. The findings were published in 1976, with Pauling as co-author, in the Proceeding of the National Academy of Sciences

Vegetables and cancer risk

can you die from vitamin c toxicity?

can you die from excess vitamin?

Vitamin B2 toxicity

Food supplements that have high toxicity

Food supplements are the component of food apart from the main component of food. Carbohydrates, proteins and lipids are the major component of food whereas vitamin and minerals are the major supplements of food. These are essential for the life. Excess amount of those supplements and deficiency of those supplements can give rise to several disease conditions such as osteoporosis and anemia.

Here, the main concern is the toxicity which can be due to food supplements. Sometimes those toxicity of food supplements can lead to death as well. Therefore, it is very important to have a good knowledge on toxicity of food supplements.
There are several main groups of food supplements which can be considered:
• Vitamins and co-vitamins
• Essential minerals
• Essential fatty acids
• Essential amino acids
• Glyconutrients
• Phytonutrients

Definition of dietary supplements is;
As defined by Congress in the Dietary Supplement Health and Education Act , which became law in 1994, a dietary supplement is a product (other than tobacco) that
• is intended to supplement the diet;
• contains one or more dietary ingredients (including vitamins; minerals; herbs or other botanicals; amino acids; and other substances) or their constituents;
• is intended to be taken by mouth as a pill, capsule, tablet, or liquid; and
• is labeled on the front panel as being a dietary supplement.
It is very important to know the safety level of dietary supplements.Scientists use several approaches to evaluate dietary supplements for their potential health benefits and safety risks, including their history of use and laboratory studies using cell or animal studies. Studies involving people (individual case reports, observational studies, and clinical trials) can provide information that is relevant to how dietary supplements are used. Researchers may conduct a systematic review to summarize and evaluate a group of clinical trials that meet certain criteria. A meta-analysis is a review that includes a statistical analysis of data combined from many studies.

Can you die from vitamin C TOXICITY (HYPERVITAMINOSIS C)?

Vitamin C toxicity is a rare case as Vitamin c is water soluble, excess amount will be exceretd via kidneys. But stil there is a chance of vitamin c toxicity and death.
Anything in excess can kill you. for an example, water toxicity can kill a person. If you exceed the normal requirement of vitaqmin c, you are running a risk of vitamin c.
The upper limit for vitamin C intake is 2000 mg/day. Up to 10 g/day of vitamin C are sometimes taken for unproven health benefits, such as preventing or shortening the duration of viral infections or slowing or reversing the progression of cancer or atherosclerosis. Such doses may acidify the urine, cause nausea and diarrhea, interfere with the healthy antioxidant-prooxidant balance in the body, and, in patients with thalassemia or hemochromatosis, promote iron overload. Intake below the upper limit does not have toxic effects in healthy adults.




Clinical features of vitamin c toxicity are as follows:

Common side-effects vitamin c toxicity

1. Indigestions
2. Diarrhhoea
3. Nausea
4. Vomiting
5. Headache
6. Fatigue
7. Disturebed sleep
8. Skin rashes

Possible side-effects of vitamin toxicity

1. Iron poisoning as vitamin c enhances the absorption of iron.
2. Heamochromatosis
3. Heamolytic anemia can be precipitated if the patient is enzyme glucose-6-phosphate dehydrogenase (G6PD) deficient one.
4. Kidney stone
5. May precipitate abortions

Chance of overdose

As discussed previously, vitamin C exhibits remarkably low toxicity. The LD50 (the dose that will kill 50% of a population) in rats is generally accepted to be 11.9 grams per kilogram of body weight when taken orally. The LD50 in humans remains unknown, owing to medical ethics that preclude experiments which would put patients at risk of harm. However, as with all substances tested in this way, the LD50 is taken as a guide to its toxicity in humans and no data to contradict this has been found.

Effects of toxicity of weedicides on fishes

Effect of toxicity of weedicides on fishes CAN be varying according to the type of weedicides use in the field. Some of the toxic effects of weedicides on fish are;

1. death of fish
2. mutations

The results of studies on weedicides toxicity to fish and freshwater Ectoprocta are reported.

Lantana camara is one of the ten most noxious weeds in the world. It is toxic to animals and exerts allelopathic action on neighboring vegetation.this weed can be fatal for the fish as well.

The in vitro inhibitory effects of various weedicides and pesticides on goat brain cathepsin B and their labilizing potency on the lysosomal membrane were quantitated in several studies.

There are several classifications available for weedicides

By activity:
• Contact herbicides destroy only the plant tissue in contact with the chemical.
• Systemic herbicides are translocated through the plant, either from foliar application down to the roots, or from soil application up to the leaves.

By use:
• Soil-applied herbicides are applied to the soil and are taken up by the roots and/or hypocotyl of the target plant. There are three main types of soil-applied herbicides:
• 1. Pre-plant incorporated herbicides are soil applied prior to planting and mechanically incorporated into the soil. The objective for incorporation is to prevent dissipation through photo decomposition and/or volatility.
• 2. Preemergent herbicides are applied to the soil before the crop emerges and prevent germination or early growth of weed seeds.
• 3. Post-emergent herbicides are applied after the crop has emerged

Importance of Troponin test

Troponin test is very important in diagnosis of myocardial infarctions. Troponin is a complex protein which consists of three components. Troponin is found in cardiac, smooth and skeletal muscles. Troponin is importance as a contractile component of the muscle.
Importance of Troponin test Importance of Troponin test Importance of Troponin test
Importance of Troponin test Importance of Troponin tes

Three types of Troponin can be found;
• Troponin C binds to calcium ions to produce a conformational change in TnI
• Troponin T binds to tropomyosin, interlocking them to form a troponin-tropomyosin complex
• Troponin I binds to actin in thin myofilaments to hold the troponin-tropomyosin complex in place
The most important thing of Troponin is that it’s importance as a diagnostic test for myocardial infarction. It is important to note that cardiac troponins are a marker of all heart muscle damage, not just myocardial infarction. Other conditions that directly or indirectly lead to heart muscle damage can also increase troponin levels.[2][3] Severe tachycardia (for example due to supraventricular tachycardia) in an individual with normal coronary arteries can also lead to increased troponins for example, presumably due to increased oxygen demand and inadequate supply to the heart muscle.
Cardiac troponin T and I are measured by immunoassay methods.[18]
• Due to patent regulations a single manufacturer (Boehringer Mannheim) distributes cTnT.
• A host of diagnostic companies make cTnI immunoassay methods available on many different immunoassay platforms

Raised troponin levels are prognostically important in many of the conditions in which they are used for diagnosis.In a community-based cohort study indicating the importance of silent cardiac damage, troponin I has been shown to predict mortality and first coronary heart disease event in men free from cardiovascular disease at baseline.
In patients with non-ST elevation ACS, the short-term odds of death are increased three- to eightfold for patients with an abnormal troponin test. Data from clinical trials suggest a lower prognostic value for troponin than do data from cohort studies.

Assessment of risk and appropriate management of patients with acute pulmonary embolism (PE) remains a challenge. Cardiac troponins I (cTnI) and T (cTnT) are reliable indicators of myocardial injury and may be associated with right ventricular dysfunction in PE.
After the loss of integrity of cardiac myocyte membranes, intracellular macromolecules (cardiac biologic markers) diffuse into the cardiac interstitium, lymphatics, and microvasculature; eventually, they are detected in the peripheral circulation. The release kinetics of the various cardiac biologic markers depend in part on their location in the myocyte, their molecular weight, and the route by which they are cleared from the circulation. Cardiac-specific troponins are useful not only because they come close to fulfilling many of the criteria for an ideal biologic marker, but also because they convey prognostic information and can help frame therapeutic decisions regarding patients with

Medications (drugs) causing constipation

Medication causing constipation is one of the major clinical problems. There are many drugs/medications which can cause constipation. The following drugs, medications, substances or toxins are some of the possible causes of Constipation as a symptom.

Analgesics ,Anticholinergics, Antihistamines, Antispasmodics, Antidepressants, Antipsychotics Cation-containing agents, Iron supplements, Aluminum (antacids, sucralfate) ,Neurally active agents, Opiates, Antihypertensives ,Ganglionic blockers, Vinca alkaloids ,Calcium channel blockers, 5HT3 antagonists,Acita with codeine

• Aluminium Carbonate
• Aluminium Hydroxide
• Aluminium Hydroxide and Magnesium Hydroxide
• Amantadine
• Amantadine Hydrochloride
Beta blockers
• Calcium
• Calcium Acetate
• Calcium Glubionate
• Calcium Lactate
• Calcium Sandoz (1000)
• Calcium supplements

Some combinations of medications/drugs can also induce constipation. When combined, certain drugs, medications, substances or toxins may react causing Constipation as a symptom.

• Amitriptyline (Elavil) and Bupropion (Wellbutrin) interaction
• Amitriptyline (Elavil) and Cimetidine (Tagamet) interaction
• Amitriptyline (Elavil) and Cinacalcet (Sensipar) interaction
• Amitriptyline (Elavil) and Diphenhydramine (Benadryl) interaction
• Amitriptyline (Elavil) and Duloxetine (Cymbalta) interaction
• Amitriptyline (Elavil) and Fluoxetin (Prozac) interaction
• Codeine Contin (timed release) and Atropinelike drug interaction
• Codone and Atropinelike Drug interaction
• Imipramine (Tofranil) and Paroxetine (Paxil) interaction
• Imipramine (Tofranil) and Propafenone (Rythmol) interaction
• Imipramine (Tofranil) and Propoxyphene (Darvon) interaction
• Imipramine (Tofranil) and Quinidine (Quinidex) interaction
• Imipramine (Tofranil) and Ritonavir (Norvir) interaction

Vitamin B2 (riboflavin) acute toxicity in children

Acute toxicity of vitamin B2 or riboflavin is an extremely rare occurrence as vitamin B2 is a non toxic compound. But it can still happen.

Effects of acute toxicity of vitamin B2 or riboflavin are usually minimal. Most of the time, the commonest feature of acute toxicity of vitamin b2 or riboflavin is the yellowish discoloration of the urine.

The commonest way by which children get acute toxicity of vitamin B2 (riboflavin) is the excessive injecting of vitamin B2 supplement.

There is no specific antidote for the vitamin b2 or riboflavin toxicity.

The only treatment option available for acute toxicity of vitamin B2 (riboflavin) is the detection of the cause and elimination it.

Serum ferritin test

Serum Ferritin is a complex protein which has a globular shape. Serum ferritin test is basically done in order to identify the iron level of the blood. This serum ferritin test is done in suspected anemic patients.


Normal serum ferritin level in healthy male is 30-300 ng/mL whereas serum ferritin level in healthy female is 15-200 ng/mL

Measurement of serum ferritin is a sensitive lab test for iron deficiency anemia.

Serum ferritin is also used as a marker for iron overload disorders, such as hemochromatosis and porphyria in which the ferritin level may be abnormally raised.

High serum ferritin found in following conditions;

• Alcoholic liver disease
• Hemochromatosis
• Hemolytic anemia
• Hodgkin's lymphoma
• Megaloblastic anemia

Low serum ferritin found in following conditions;

• Long-term digestive tract bleeding
• Heavy menstrual bleeding
• Iron deficiency anemia

Health benefits of minerals

Minerals are essential component of human nutrition. Minerals have various functions. Some of the minerals act as enzyme cofactor, which is an important function of mineral. The mineral composition of the human body is very different from the mineral composition of the earth. The major minerals of the earth are silica and alumina.
But in human body, iron and calcium are the major minerals.

The health benefits are depending on the type of minerals. Deficiency of minerals can lead to some disease conditions such as osteoporosis and anemia.

According to the body’s requirement, there are two types of minerals.

1. macro-minerals
2. micro minerals

The minerals which required in relatively large amount are known as macro-minerals whereas the minerals which required in small quantities are called micro-minerals.

Calcium, magnesium, iron, sodium, potassium and phosphorus are the some of macro-minerals.

Zinc, selenium and chromium are the some of micro-minerals.

Some health benefits of minerals are;

1. prevent anemia(iron)
2. prevent osteoporosis (calcium)
3. healthy growth during childhood (zinc, selenium and nickel)
4. maintaining a healthy prostate (zinc)
5. minimize the risk of bipolar disorders(vanadium)
6. preventing the onset of bone related illnesses such as osteoporosis or osteoarthritis (silicon)

Different minerals have different benefits and no mineral can be termed as more beneficial or less beneficial. All minerals are critical for proper functioning of the body. Most of the minerals aid in body metabolism, water balance, and bone health.

1. Boron: bone health, brain function, anti aging, sexual health, cancer, Alzheimer’s disease, muscle pain
2. Calcium: bone health (osteoporosis), arthritis, dental care, insomnia, menopause, premenstrual syndrome, cramps, weight loss, colon cancer, acidity, heart diseases, high blood pressure
3. Copper: brain function, arthritis, skin care, throat infections, hemoglobin deficiency, heart diseases, immunity
4. Iodine: Goitre, fibrocystic breast disease, dermatology, cancer, haircare, pregnancy, body metabolism
5. Iron: haemoglobin formation, body metabolism, muscle activity, anemia, brain function, immunity, insomnia, restless leg syndrome, regulation of body temperature
6. Magnesium: high blood pressure, heart attack, alcoholism, bone health, cramps, diabetes, menopause, pregnancy, asthma
7. Manganese: body metabolism, osteoporosis, fatigue, reproduction, sprains, inflammation, brain function, Epilepsy
8. Phosphorus: weakness, bone health, brain function, sexual weakness, dental care, body metabolism
9. Potassium: low blood sugar, regulate blood pressure, heart diseases, water flow in the body, muscle disorders, cramps, brain function, diabetes, kidney disorders, arthritis
10. Silicon: Bone health, skin care, hair care, nail health, sleep disorders, Atherosclerosis, tissue development, dental care, tuberculosis
11. Sodium: water balance, sunstroke, brain function, muscle cramps, anti aging
12. Zinc: skin care, eczema, acne, healing of wounds, postrate disorders, cold, weight loss, pregnancy, reproduction, hair care, appetie loss, eye care, night blindness

What is constipation?

Constipation is a common complaint in clinical practice
and usually refers to persistent, difficult, infrequent, or seemingly incomplete
defecation. Because of the wide range of normal bowel habits,
constipation is difficult to define precisely. Most persons have at
least three bowel movements per week; however, stool frequency
alone is not a sufficient criterion for the diagnosis of constipation because
many constipated patients describe a normal frequency of defecation
but subjective complaints of excessive straining, hard stools,
lower abdominal fullness, and a sense of incomplete evacuation. The
individual patient’s symptoms must be analyzed in detail to ascertain
what is meant by “constipation” or “difficulty” with defecation.
Stool form and consistency are well correlated with the time
elapsed from the preceding defecation. Hard, pellety stools occur with
slow transit, while loose watery stools are associated with rapid transit.
Small, pellety stools are more difficult to expel than large ones.
The perception of hard stools or excessive straining is more difficult
to assess objectively, and the need for enemas or digital disimpaction
is a clinically useful way to corroborate the patient’s perceptions of
difficult defecation.

Psychosocial factors may also be important. A person whose parents
attached great importance to daily defecation will become greatly
concerned when he or she misses a daily bowel movement; some children
withhold stool to gain attention; and some adults are simply too
busy or too embarrassed to interrupt their work when the call to have
a bowel movement is sensed.

Further readings

Common causes of constipations

Investigation of severe constipation

Treatment for constipation

Dietary fibers and constipation

Herbal medicine (complementary/alternative medicine) for constipation

Common causes of constipation

Pathophysiologically, chronic constipation generally results from inadequate fiber intake or from disordered colonic transit or anorectal function as a result of a neurogastroenterologic disturbance, certain drugs, or in association with a large number of systemic diseases that affect the gastroinestinal tract . Constipation of recent onset may be a symptom of significant organic disease such as tumor or stricture. In idiopathic constipation, a subset of patients exhibit delayed emptying of the ascending and transverse colon with prolongation of transit (often in the proximal colon) and a reduced frequency of propulsive colonic contractions (HAPCs). Outlet obstruction to defecation (also called evacuation disorders) may cause delayed colonic transit, which is usually corrected by biofeedback retraining of the disordered defecation. Constipation of any cause may be exacerbated by chronic illnesses that lead to physical or mental impairment andresult in inactivity or physical immobility.

Types of Constipation and Causes	Examples
Recent onset
Colonic obstruction	Neoplasm: stricture: ischemic, diverticular, inflammatory
Anal sphincter spasm	Anal fissure, painful hemorrhoids Medications
Chronic
Irritable bowel syndrome
Medications	Calcium blockers, antidepressants
Colonic pseudo-obstruction	Slow transit constipation, megacolon (rare Hirschsprung’s, Chagas)
Disorders of rectal evacuation	Pelvic floor dysfunction, anismus, descending perineum syndrome, rectal mucosal prolapse, rectocele
Endocrinopathies	Hypothyroidism, hypercalcemia, pregnancy
Psychiatric disorders	Depression, eating disorders
Neurologic disease	Parkinsonism, multiple sclerosis, spinal cord injury
Generalized muscle disease
Progressive systemic sclerosis

Further readings

what is constipation?

Investigation of severe constipation

Treatment for constipation

Dietary fibers and constipation

Herbal medicine (complementary/alternative medicine) for constipation

Dietary fibers and constipation

People differ in their definition of constipation but there are several features constituting satisfactory or unsatisfactory defecation. The call for the stool should be regular. Most subjects regard once or twice daily as preferable. Defecation should not require straining, nor take 15 minutes to achieve. Motions should be soft but formed and of reasonable bulk, about 150 to 200g wet weight. The stool should be passed without pain or discomfort, and, afterwards, there should not be a feeling of incomplete emptying of the rectum. A high fiber diet improves each of these bowel functions

The main constituent of feces is water which forms 70-80% of stool weight. The dry matter is predominantly unfermented fiber and bacteria.

On a low fiber diet the dry matter consists of about 36% protein and about 18% of each of the following; fats and sterols; minerals; short chain fatty acids and carbohydrates. On a high fiber diet the solid fractions may contain about 30% of carbohydrate, at least 70% of the total sugars are being in the form of cellulose, xylose and arabinose.

The magnitude of stool bulking by fiber depends on the source of the fiber. Dietary fibers may be considered as a hydrated spong passing along the gastrointestinal tract. Vegetables and fruits fibers (pectic and mucilaginous substances) with a water holding capacity (a measure of the ability to of a fiber to immobilize water in a matrix) of about 50g water per g, are more accessible for fermentation and therefore by themselves produce little change in the bulk of the stool. On the other hand, cereal fiber with low water holding capacity will be relatively inert in the aqueous medium of the gut, be less readily available for fermenatation andproduce a significant change in stool bulk. This ability is reduced when cereal bran is made more digestible to bacterial enzymes by fine grinding and cooking.

The colonic mucosa recovers sodium and water from the lumen. The colon absorbs about 5 liters of water per day. The only force resisting this is the osmotic pressure of gut contents. Bacterial metabolism results in small molecules with high osmotic pressure. If these substrates are also catabolised by bacteria, water will be absorbed readily. A slow continuous release of metabolites, by maintaining an osmotic gradient, could slow absorption of water, decrease MTT and increase fecal out put.

Further readings

What is constipation?

Common causes of constipation

Investigation of severe constipation

Treatment for constipation

Herbal medicine (complementary/alternative medicine) for constipation

Investigation of severe constipation

A small minority (probably5%) of all patients with constipation have cases that are considered
severe or “intractable”; these are the patients most likely to be seen
by gastroenterologists or in referral centers. Further observation of the
patient may occasionally reveal a previously unrecognized cause, such
as an evacuation disorder, laxative abuse, malingering, or psychiatric
disorder. In these patients, recent studies suggest that evaluations of
the physiologic function of the colon and pelvic floor and of psychological
status aid in the rational choice of treatment. Even among these
highly selected patients with severe constipation, a cause can be identified
in only about 30%.

1. Measurement of Colonic Transit

A)Radiopaque marker transit tests

are easy,
repeatable, generally safe, inexpensive, reliable, and highly applicable
in evaluating constipated patients in clinical practice. There are several
validated methods that are very simple. For example, radiopaque
markers are ingested, and an abdominal flat film taken 5 d later should
indicate passage of 80% of the markers out of the colon. This test does
not provide useful information about the transit profile of the stomach
and small bowel, and avoidance of laxatives or enemas during the
testing period is essential.

B)Radioscintigraphy

with a delayed-release capsule containing radiolabeled
particles has been used to noninvasively characterize normal,
accelerated, or delayed colonic function over 24 to 48 h with low
radiation exposure. This approach simultaneously assesses gastric,
small-bowel, and colonic transit. The disadvantages are the greater cost
and the need for specific materials prepared in a nuclear medicine
laboratory.

2.Anorectal and Pelvic Floor Tests

Pelvic floor dysfunction is suggested by
the inability to evacuate the rectum, a feeling of persistent rectal fullness,
rectal pain, the need to extract stool from the rectum digitally,
application of pressure on the posterior wall of the vagina, support of
the perineum during straining, and excessive straining. These signifi-
cant symptoms should be contrasted with the sense of incomplete rectal
evacuation, which is common in irritable bowel syndrome.
Patients with clinically suspected obstruction of defecation should
also be evaluated by a psychologist to identify eating disorders or a
“need to control,” to provide stress management or relaxation training,
and to identify depression.

3.Neurologic testing (electromyography)

is more helpful in the evaluation
of patients with incontinence than of those with symptoms suggesting
obstructed defecation. The absence of neurologic signs in the
lower extremities suggests that any documented denervation of the
puborectalis results from pelvic (e.g., obstetric) injury or from stretching
of the pudendal nerve by chronic, long-standing straining.
Ultrasonography identifies sphincter or rectal wall defects and may
help select patients for surgical correction. Spinal-evoked responses
during electrical rectal stimulation or stimulation of external anal
sphincter contraction by applying magnetic stimulation over the lumbosacral
cord identify patients with limited sacral neuropathies with
sufficient residual nerve conduction to attempt biofeedback training.
In summary, a balloon expulsion test is an important screening test
for anorectal dysfunction. If positive, an anatomic evaluation of the
rectum or anal sphincters and an assessment of pelvic floor relaxation
are the tools for evaluating patients in whom obstructed defecation is
suspected

What is constipation?
Common causes of constipation
Treatment for constipation
Dietary fibers and constipation
Herbal medicine (complementary/alternative medicine) for constipation

Treatment for constipation

After the cause of constipation is characterized, a treatment decision
can be made. Slow transit constipation requires aggressive medical or
surgical treatment; anismus or pelvic floor dysfunction usually responds
to biofeedback management . However, only about
30% of patients with severe constipation are found to have such a
physiologic disorder.

Patients with slow transit constipation are treated with bulk, osmotic,
and stimulant laxatives, including fiber, psyllium, milk of magnesia,
lactulose, polyethylene glycol (colonic lavage solution), and bisacodyl.
If a 2- to 3-month trial of medical therapy fails and patients
continue to have documented slow transit constipation unassociated
with obstructed defecation, colectomy with ileorectostomy is indicated.
The decision to resort to surgery is facilitated in the presence
of megacolon and megarectum. The complications after surgery include
small-bowel obstruction (11%) and fecal soiling, particularly at
night during the first postoperative year.

Patients who have a combined disorder should pursue pelvic floor
retraining (biofeedback and muscle relaxation), psychological counseling,
and dietetic advice first, followed by colectomy and ileorectosomy
if colonic transit studies do not normalize with biofeedback
alone. In patients with pelvic floor dysfunction alone, biofeedback
training has a 70 to 80% success rate, measured by the acquisition of
comfortable stool habits. Attempts to manage pelvic floor dysfunction
with operations (internal anal sphincter or puborectalis muscle division)
have achieved only mediocre success and have been largely
abandoned.

Further readings

What is constipation?
Common causes of constipations
Investigation of severe constipation
Dietary fibers and constipation
Herbal medicine (complementary/alternative medicine) for constipation

Herbal medicine (complementary/alternative medicine) for constipation

Description

A person who complains of constipation passes dry and hard stools less frequently than once a day. Constipation may be acute, developing suddenly or long standing (chronic). Acute constipation may be a part of a more serious illness. Such cases should be referred to the hospital immediately. Constipation may also occur following an attack of diarrhea or the day after taking a purgative. Constipation in children is due to faulty dietary habits.

Associated symptoms

Abdominal discomfort
Pain
Loss of appetite
Headache

Management

Any one of the following remedies should be used for the management of constipation.

1. constipation in babies; give 1g of ispaghula husk(Plantago ovata) three times per day with warm milk or warm water by adding a pinch ofsugar.
2. Constipation in pregnant women; give 2 teaspoonfuls (10g) of the ispaghula husk twice daily with warm milk or warm water.
3. Constipation in adults; give 1teaspoonful (5g) of the powder of Terminalia chebula or 2 teaspoonfuls of the ispaghula husk at bed time with hot water or hot milk. The former is more powerful than the latter.
4. Constipation associated with pain in the abdomen; give 1 teaspoonful (5g) of the powder of Terminalia chebula, together with 1g of ginger. It can also be given as a decoctioncontaining Terminalia chebula.Give 2 teaspoonfuls decoction to which 1g of ginger (Zingiber officinale) is added.

Warning

Constipated patients having vomiting and abdominal pain should be referred to the near by primary health center or hospital immediately.

Diet and regimens

The patient should take less meat, egg and fried food. He/she should take more of leafy vegetables and fruits (high fiber diet). The common cause of constipation is carelessness about going to toilet regularly, especially when there is an urge for defecation. The patient should be regular in his/her habits.


Further readings

What is constipation?
Common causes of constipation
Investigation of severe constipation
Treatment for constipation
Dietary fibers and constipation

thevetia peruviana (yellow oleander)

Yellow oleander has a flamboyant trumpet shaped yellow flower. Poisoning is common in third world countries like sri lanka and India. The fruits are broadly triangular or ovate of about the size of a small lemon. They are first green, and then become yellow and finally black. The seeds are used as a suicidal agent. Consuming 2-8 seeds may cause death of an adult. Lesser doses may kill a child. Accidental poisoning may occur especially in children after consuming any part of the plant. Inhaling smoke of burning oleander wood is dangerous. The poisonous effect is due to the cardiac glycosides (thevetin, cerberine) which have a somewhat similar effect to that of digitalis.



Sings and symptoms

1. Asymptomatic; still, the patient has to be admitted and observed for 24 hours.
2. vomiting
3. giddiness
4. diarrohea
5. faintishness
6. sinus bradycardia
7. hypotension
8. sino-atrial block
9. 1st and 2nd degree heart block
10. atrial and ventricular ectopics
11. ST depression
12. yellow vision (xanthopsia)
13. anxiety
14. convulsion
15. coma

Management

Induce vomiting
Gastric lavage
Monitor (pulse rate, blood pressure, respiration, ECG)
Treat arrhythmias and convulsion