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By X. Jerek. University of Southern Maine. 2018.

If your diet lacks fiber 25mg atarax visa anxiety klonopin, try adding the following foods over a period of several weeks: METABOLISM generic 10 mg atarax free shipping anxiety 2015, NUTRITION, AND BODY TEMPERATURE ✦ 413 Foods high in fiber, such as whole grains, fruits, and ture, such as butter and lard. Diets Fats high in saturated fats are associated with a higher than normal incidence of cancer, heart disease, and cardiovas- Fats are subdivided into saturated and unsaturated forms cular problems, although the relation between these fac- based on their chemical structure. These are listed on food labels as par- are from animal sources and are solid at room tempera- tially hydrogenated (HI-dro-jen-a-ted) vegetable oils and are found in baked goods, processed peanut butter, veg- Saturated Unsaturated etable shortening, and solid margarine. Evidence shows fatty acid fatty acid that components of hydrogenated fats, known as trans- (stearic acid) (linoleic acid) fatty acids, may be just as harmful, if not more so, than natural saturated fats and should be avoided. HO O HO O C C Proteins H C H H C H Because proteins, unlike carbohydrates and fats, are not H H stored in special reserves, protein foods should be taken C H C H in on a regular basis, with attention to obtaining the es- H C H H C H sential amino acids. Table 20-5 demon- strates the principles of combining two foods, legumes H C H C H and grains, to supply essential amino acids that might be missing in one food or the other. Traditional ethnic diets H C H C H reflect these healthy combinations, for example, beans with corn or rice in Mexican dishes or chickpeas and H C H H C H lentils with wheat in Middle Eastern fare. Most fatty acids contain the maximum numbers of hydrogen atoms agree, however, that children, elderly people, pregnant and attached to carbons and no double bonds between carbon lactating women, and teenagers, who often do not get atoms. Consumed at a more rapid rate, alcohol enters the ture) developed a pyramid to represent the quantities of bloodstream and affects many cells, notably in the brain. When deliv- sion, and some suggested improvements include: ered in excess to the liver, alcohol can lead to the accu- mulation of fat as well as inflammation and scarring of liver ◗ Distinguish between unrefined and refined carbohy- tissue. Alcohol ◗ Distinguish between healthful unsaturated fats, which metabolism ties up enzymes needed for oxidation of nu- can be eaten in moderation, and less healthful saturated trients and also results in byproducts that acidify body flu- and processed (trans-) fats, which should be restricted. Fats, oils, sweets Although alcohol consumption is compatible with good health and may even have a beneficial effect on the Use sparingly cardiovascular system, alcohol should be consumed only Meat, poultry, in moderation. Milk, yogurt fish, dry beans, and cheese eggs, and nuts Checkpoint 20-7 What are typical recommendations for the rel- ative amounts of carbohydrates, fats, and proteins in the diet? Common food allergens are METABOLISM, NUTRITION, AND BODY TEMPERATURE ✦ 415 wheat, nuts, milk, shellfish, and eggs, but almost any food Calculation of body mass index (BMI) might cause an allergic reaction in a given individual. A low pro- nate method is to divide weight in pounds by the square of tein level in the blood plasma interferes with fluid return height in inches and multiply by 703. It is Underweight common knowledge that overweight and obesity have in- People who are underweight have as much difficulty creased in the past several decades in many countries. It is asso- shortens the life span and is associated with cardiovascular ciated with low reserves of energy, reproductive distur- disease, diabetes, some cancers, and other diseases. Scientists are studying the nervous and hormonal ◗ Nutrition and Aging controls over weight, but so far they have not found any effective and safe drugs for weight control. Because metabo- orous exercise at least four times a week is recommended lism generally slows, and less food is required to meet en- for health and weight control. Exercise helps to boost appetite and 416 ✦ CHAPTER TWENTY Box 20-3 • Health Professions Dietitians and NutritionistsDietitians and Nutritionists ietitians and nutritionists specialize in planning and su- anatomy and physiology. Most dietitians and nutritionists in Dpervising food programs for institutions such as hospi- the United States receive their training from a college or uni- tals, schools, and nursing care facilities. Dietitians and nutritionists also work in community the American population continues to age, the need for nutri- settings, educating the public about disease prevention tional planning in hospital and nursing care settings is ex- through healthy eating. In addition, many people now place an empha- food and nutrition has also led to new opportunities in the sis on healthy eating and may consult nutritionists privately. To perform their duties, dieti- For more information about this career, contact the American tians and nutritionists need a thorough understanding of Dietetic Association. These responses do ◗ Body Temperature not account for all the increase, however, nor do they ac- count for the much greater increase in metabolism after a Heat is an important byproduct of the many chemical ac- meal containing a large amount of protein. Under normal conditions, a number of regulatory devices keep body temperature constant within quite narrow lim- Checkpoint 20-8 What are some factors that affect heat pro- its. Factors Affecting Heat Production The rate at To illustrate evaporation, rub some alcohol on your which heat is produced is affected by a number of factors, skin; it evaporates rapidly, using so much heat from the including exercise, hormone production, food intake, and skin that your arm feels cold. The rate of heat loss and epinephrine (adrenaline) from the adrenal medulla, through evaporation depends on the humidity of the sur- increase the rate of heat production. When it exceeds 60% or so, perspiration METABOLISM, NUTRITION, AND BODY TEMPERATURE ✦ 417 does not evaporate so readily, making one feel generally lation because variations in the activity of these large tis- miserable unless some other means of heat loss is avail- sue masses can readily increase or decrease heat genera- able, such as convection caused by a fan. Because muscles form roughly one-third of the body, either an involuntary or an intentional increase in Prevention of Heat Loss Factors that play a part in their activity can form enough heat to offset a consider- heat loss through the skin include the volume of tissue able decrease in the temperature of the environment.

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Activated platelets be- tiny structures are not cells in them- selves but rather fragments constantly Platelets released from giant bone marrow cells called megakaryocytes (meg-ah-KAR- Erythrocytes e-o-sites) (Fig discount atarax 25mg with visa anxiety symptoms urinary. Serum contains all the com- The many substances necessary for blood clotting buy cheap atarax 25mg on line anxiety 7 scoring interpretation, or co- ponents of blood plasma except the clotting factors, as ex- agulation, are normally inactive in the bloodstream. A pressed in the formula: balance is maintained between compounds that promote clotting, known as procoagulants, and those that prevent Plasma serum clotting factors clotting, known as anticoagulants. The final step in these reac- ◗ Blood Types tions is the conversion of a plasma protein called If for some reason the amount of blood in the body is se- fibrinogen (fi-BRIN-o-jen) into solid threads of fibrin, verely reduced, through hemorrhage (HEM-eh-rij) (ex- which form the clot. One possible measure to tion are described below and diagrammed in Figure 13-8: take in such an emergency is to administer blood from ◗ Substances released from damaged tissues result in the another person into the veins of the patient, a procedure formation of prothrombinase (pro-THROM-bih-nase), called transfusion. There are many types of such than the lining of a blood vessel, for example, a glass or proteins, but only two groups are particularly likely to cause a transfusion reaction, the so-called A and B anti- gens and the Rh factor. Injury or removal of blood from vessels The ABO Blood Type Group There are four blood types involving the A and B antigens: Preliminary steps in clotting A, B, AB, and O (Table 13-3). THE BLOOD ✦ 271 Table 13•3 The ABO Blood Group System BLOOD RED BLOOD REACTS WITH PLASMA CAN TAKE CAN TYPE CELL ANTIGEN ANTISERUM ANTIBODIES FROM DONATE TO A Anti-A Anti-B A, O A, AB B Anti-B Anti-A B, O B, AB AB A, B Anti-A, Anti-B None AB, A, B, O AB O None None Anti-A, Anti-B O O, A, B, AB Testing for Blood Type Blood sera containing anti- Anti-A serum Anti-B serum bodies to the A or B antigens are used to test for blood type. Blood serum containing antibodies that can agglutinate and destroy red cells with A antigen is called anti-A serum; blood serum containing antibodies that can destroy red cells with B antigen is called anti-B serum. When combined with a blood sample in the laboratory, each antiserum Type A causes the corresponding red cells to clump together in a process known as agglutination (ah-glu-tih-NA-shun). In an emergency, type O blood can be given to any ABO type because the cells lack both A and B antigens and will not react with either A or B antibodies (see Table 13-3). Con- versely, type AB blood contains no antibodies to agglutinate red cells, and people with this blood type can therefore re- Type O ceive blood from any ABO type donor. People with this antigen are said to be Rh there is loss of a large volume of blood, for example: positive; those who lack this protein are said to be Rh neg- ◗ In the treatment of massive hemorrhage from serious ative. If Rh-positive blood is given to an Rh-negative per- mechanical injuries son, he or she may produce antibodies to the “foreign” Rh ◗ For blood loss during internal bleeding, as from bleed- antigens. A mother who is Rh negative may develop ◗ For blood replacement in the treatment of hemolytic antibodies to the Rh protein of an Rh-positive fetus (the disease of the newborn fetus having inherited this factor from the father). When a container of blood is spun rapidly, all the formed Checkpoint 13-13 What are the blood antigens most often in- elements of the blood are pulled into a clump at the bot- volved in incompatibility reactions? To keep the blood from clotting, a solution such (hem-ah-fer-E-sis) (from the Greek word apheresis mean- as citrate-phosphate-dextrose-adenine (CPDA-1) is ing “removal”) If the plasma is removed and the formed added. Such autol- various components, such as plasma protein fraction, ogous (aw-TOL-o-gus) (self-originating) blood is stored serum albumin, immune serum, and clotting factors. Further separation yields Whole Blood Transfusions serum albumin that is available in solutions of 5% or 25% The transfer of whole human blood from a healthy person concentration. Possi- creased because these blood components can be treated ble causes of chronic blood loss include bleeding ulcers, with heat to prevent transmission of viral diseases. When frozen plasma is thawed, a white precipitate called cryoprecipi- Hemolytic anemia Anemia caused by the excessive de- tate (kri-o-pre-SIP-ih-tate) forms in the bottom of the struction of red cells is called hemolytic (he-mo-LIH-tik) container. Certain inherited diseases that cause the production Antibodies play an important role in the immune system of abnormal hemoglobin may also result in hemolytic (see Chap. When these cells give up their oxygen to the tissues, they are transformed from the normal disk Checkpoint 13-14 How is blood commonly separated into its shape into a sickle shape (Fig. Anemia Anemia may result from loss of red cells, as through ex- Sickle- cessive bleeding (hemorrhage), or from conditions that shaped cause the cells to hemolyze (rupture). It is only when the involved gene is that may injure the marrow include x-rays, atomic radia- transmitted from both parents that the clinical disease tion, radium, and radioactive phosphorus. One drug or white cells, so that the anemia is accompanied by has been found to reduce the frequency of painful crisis leukopenia (lu-ko-PE-ne-ah), a drop in the number of in certain adults. Removal of the toxic agent, followed by blood some hemoglobin of an alternate form (fetal hemoglo- transfusions until the marrow is able to resume its activ- bin) so that the red cells are not as susceptible to sick- ity, may result in recovery. Some Impaired Production of Red Cells or Hemoglo- medications are now available to stimulate bone marrow bin Many factors can interfere with normal red cell pro- production of specific types of blood cells. The average diet usually provides It is characterized by an enormous increase in the num- enough iron to meet the needs of the adult male, but this ber of white cells. Although the cells are high in number, diet often is inadequate to meet the needs of growing they are incompetent and cannot perform their normal children and women of childbearing age. If this wild proliferation of white cells stems ficiency anemia occurs in people with alcoholism, in eld- from cancer of the bone marrow, the condition is called erly people on poor diets, and in infants or others suffer- myelogenous (mi-eh-LOJ-en-us) leukemia.

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Approximately one baby in 115 atarax 25mg with visa anxiety symptoms body zaps,000 Causes and symptoms will be born with Hurler-Scheie syndrome order atarax 25 mg visa anxiety questionnaire. These indi- Each type of MPS is caused by a deficiency of one viduals tend to be shorter than expected, and they can of the enzymes involved in breaking down GAGs. It is have normal intelligence, however, some individuals with the accumulation of the GAGs in the tissues and organs MPS I H/S will experience learning difficulties. These in the body that cause the wide array of symptoms char- individuals may develop some of the same physical fea- acteristic of the MPS conditions. The accumulating mate- tures as those with Hurler syndrome, but usually they are rial is stored in cellular structures called lysosomes, and not as severe. The prognosis for children with MPS I H/S these disorders are also known as lysosomal storage is variable with some individuals dying during childhood, diseases. MPS I MPS I S (SCHEIE SYNDROME) Scheie syndrome is considered the mild form of MPS I. It is estimated that MPS I is caused by a deficiency of the enzyme approximately one baby in 500,000 will be born with alpha-L-iduronidase. Individuals with MPS I S usually have Scheie, and Scheie syndromes, are all caused by a defi- ciency of this enzyme. Initially, these three conditions normal intelligence, but there have been some reports of were believed to be separate because each was associated individuals with MPS I S developing psychiatric prob- with different physical symptoms and prognoses. Common physical problems include corneal cloud- However, once the underlying cause of these conditions ing, heart abnormalities, and orthopedic difficulties was identified, it was realized that these three conditions involving their hands and back. The gene involved do not develop the facial features seen with MPS I H and with MPS I is located on chromosome 4p16. All individuals with Cardiomyopathy—A thickening of the heart Hunter syndrome are male, because the gene that causes muscle. Like many MPS conditions, Hunter syn- Enzyme—A protein that catalyzes a biochemical drome is divided into two groups, mild and severe. It has reaction or change without changing its own been estimated that approximately one in 110,000 males structure or function. Males with the cells, containing many hydrolytic enzymes; where mild form of Hunter syndrome develop physical differ- large molecules and cellular components are bro- ences similar to males with the severe form, but not as ken down. Men with mild Hunter syndrome can have a nor- Mucopolysaccharide—A complex molecule made mal life span and some have had children. Most males of smaller sugar molecules strung together to form with Hunter syndrome develop joint stiffness, chronic a chain. Found in mucous secretions and intercel- diarrhea, enlarged liver and spleen, heart valve problems, lular spaces. These symptoms tend to progress at a different Recessive gene—A type of gene that is not rate depending on if an individual has the mild or severe expressed as a trait unless inherited by both form of MPS II. X-linked gene—A gene carried on the X chromo- MPS III (Sanfilippo syndrome) some, one of the two sex chromosomes. MPS III, like the other MPS conditions, was initially diagnosed by the individual having certain physical char- acteristics. It was later discovered that the physical symp- MPS IIIA (SANFILIPPO SYNDROME TYPE A) MPS IIIA toms associated with Sanfilippo syndrome could be is caused by a deficiency of the enzyme heparan N-sulfa- caused by a deficiency in one of four enzymes. Type IIIA is felt to be the most severe of the four of MPS III is now subdivided into four groups, labeled A- types, in which symptoms appear and death occurs at an D, based on the specific enzyme that is deficient. A study in British Columbia estimated that of these enzymes are involved in breaking down the same one in 324,617 live births are born with MPS IIIA. Heparan sulfate is mainly found in IIIA is the most common of the four types in the central nervous system and accumulates in the brain Northwestern Europe. The gene that causes MPS IIIA is when it cannot be broken down because one of those four located on the long arm of chromosome 17 (location enzymes are deficient or missing. MPS III is a variable condition with symptoms MPS IIIB (SANFILIPPO SYNDROME TYPE B) MPS IIIB beginning to appear between ages two and six years of is due to a deficiency in N-acetyl-alpha-D-glu- age. This type of MPS III is not felt to the central nervous system, the central nervous system is be as severe as Type IIIA and the characteristics vary. In MPS III, signs that the central nerv- Type IIIB is the most common of the four in southeastern ous system is degenerating are usually evident in most Europe.

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Definition Other studies have concentrated on the benefits of eating fruits and vegetables buy 10mg atarax with mastercard anxiety symptoms gad. Gladys Laryngitis is caused by inflammation of the larynx effective atarax 10mg anxiety vs heart attack, Block, who was at one time an epidemiologist at the Na- often resulting in a temporary loss of voice. She con- Description cluded that as people ate more fruits and vegetables, the risk of cancer decreased. Those who ate the most vegeta- When air is breathed in, it passes through the nose bles and fruits had half the risk for cancer as those who and the nasopharynx or through the mouth and the ate the least. These are both connected to the larynx, a fiber, which vegetarian diets tend to be, reduce the risk tube made of cartilage. The vocal cords, responsible for for heart disease, cancer, and other conditions including setting up the vibrations necessary for speech, are locat- digestive disorders, appendicitis, and osteoporosis ed within the larynx. The trachea then splits into two branches, the left and Dean Ornish, has been shown to improve heart disease right bronchi (bronchial tubes). These bronchi branch and reverse the effects of atherosclerosis, or hardening into smaller air tubes that run within the lungs, leading to of the arteries. GALE ENCYCLOPEDIA OF ALTERNATIVE MEDICINE 2 1181 However, the primary medical cause of laryngitis is a viral infection. The same viruses that cause the majori- ty of simple colds are responsible for laryngitis. In ex- tremely rare cases, more harmful bacteria or the bacteria that causes tuberculosis (TB) may cause laryngitis. In people with faulty immune systems (like AIDS patients), infections with fungi may be responsible for laryngitis. The person may have a sore, scratchy throat, as well as a fever, runny nose, aches, and fatigue. Difficulty swallowing some- times occurs, and the patient may have a ticklish cough or wheeze. Most characteristically, the patient suffers voice loss or the voice will sound strained, hoarse, and raspy. This is more common in infants because the diameter of their airways Either food, liquid, or air may be taken in through is so small. While air goes into the larynx and the respira- creased respiratory rate and exhibit loud, high-pitched tory system, food and liquid are directed into the tube sounds with breathing (called stridor). Because food or liquid in the bronchial tubes or lungs could cause a block- Diagnosis age or lead to an infection, the airway must be protected. Laryngitis could be the next phase over the larynx when someone is eating or drinking, pre- of the flu or the result of cheering too energetically dur- venting these substances from entering the airway. In addition to being an easily recog- In laryngitis, the tissues below the level of the epiglot- nizable condition, laryngitis is a self-limiting condition tis are swollen and inflamed. Hoarse sounds or loss of voice are characteristic of laryngi- However, a doctor should be consulted if the laryn- tis. Laryngitis is a very common problem, and often occurs gitis occurs for no apparent reason or if hoarseness lasts during an upper respiratory tract infection (cold). Symptoms of underactive thyroid include tiredness, constipation, Causes & symptoms aches, and dry skin. Laryngitis is primarily caused by overuse of the Diagnosis is usually made by learning the history of voice, a condition faced by people ranging from teachers a cold that is followed by hoarseness. Listening to the • strain on the larynx from talking or singing for long pe- chest, neck, and back with a stethoscope (an instrument riods used to hear heart and lungs sounds) may reveal some • shouting or cheering for an extended time harsh wheezing sounds when the person breathes. Using an instrument called a laryngoscope, a doctor can • colds or cough examine the airway for redness, swelling, small bumps • smoking of tissue called nodules, and irritated pits in the tissue called ulcerations. Special skin testing (TB testing) will • alcohol consumption reveal if the person has been exposed to TB. Resting the voice is especially for a tent-like effect, leans over the pot, and breathes in important, as is consulting a doctor or practitioner if steam through the mouth.

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