NMT 150 Final Prep PDF

FINAL prep Week 8 non specific low back pain Bot Med Siberian Ginseng Primary Actions: Adaptogen. (Eleutherococcus Senticosus) Constituents: Eleutherosides A-E:...

FINAL prep Week 8 non specific low back pain Bot Med Siberian Ginseng Primary Actions: Adaptogen. (Eleutherococcus Senticosus) Constituents: Eleutherosides A-E: Saponins (eleuthroside A), propanoid glycosides (eleuthroside B, syringin), lignanas (eleuthroside E, syringaresinol) Indications: Stress, exhaustion, insomnia, mild depression Cautions/Contraindications: None significant, may potentiate cardiac medications. Extra Information: Eleuthro (along with Ashwagandha) is our archetypal adaptogen. Increases resistance to oxygen deprivation of the heart. Considered useful for conditions influenced by the stress response such as angina, HTN, hypotension, chronic bronchitis, and cancer. Panax ginseng Primary Actions: Stimulating (Korean red adaptogen, immune stimulant, libido ginseng) stimulant, cardiotonic Constituents: Triterpene glycosides (ginsenosides), steroidal saponins Indications: Debility and convalescence (low dose), depression, end-of-life care Cautions/Contraindications: Non-toxic, but can be overstimulating to some individuals, particularly where yin has been weakened through excessive use of stimulants. CI in hypertension and other heat conditions. Preg A, Lact C. Extra Information: An excellent herb,  often underused out of fear of its stimulating properties or overused because of its stimulating properties. A truly fortifying and whole-system adaptogen when used appropriately (by matching dose to condition and vitality), especially in combo with other herbs. Traditionally used in TCM to mobilize the essence of an elder near death so that the family would have time to gather for farewells. Part Used: Root. Red ginseng is the steamed root, while white ginseng is the unprepared root of the same species. The steamed red root is preferred. Daily Therapeutic Dose Tincture: 2–10 mL (1:5 in 40%) Daily Therapeutic Dose Infusion or Decoction: 3–10 g dried root Pairs Well With: Astragalus membranaceus and Rehmannia glutinosa for convalescence after blood loss. Ganoderma lucidum for depression. Centella asiatica for mental clarity and focus. Closest Substitute: Rhodiola rosea Panax Primary Actions: Immune stimulant, quinquefolius immune modulator, antiviral, (American ginseng) adaptogen, mild lymphatic Constituents: Triterpene glycosides (ginsenosides), steroidal saponins Indications: Chronic infections, convalescence, debility, ME Cautions/Contraindications: Considered safe. Safety rating during pregnancy and lactation not established. Extra Information: Tonic-adaptogen. Generally considered one of the best immune stimulating herbs. Debate exists as to whether this herb is cooling, neutral, or slightly warming and as to whether it is drying or moistening. Current commercially available varieties tend to be slightly warming, slightly stimulating, and moistening.  Part Used: Root Daily Therapeutic Dose Tincture: 6–12 mL (1:5 in 40%) Daily Therapeutic Dose Infusion or Decoction: 3–6 g dried root Pairs Well With: Echinacea spp. for acute viral infections Closest Substitute: Codonopsis pilosula, Panax ginseng Rehmannia Primary Actions: Adaptogen glutinosa (Rehmannia) Constituents: Starches, iridoids, organic acids, sterols Indications: Convalescence and patterns of deficiency, anxiety, insomnia, palpitations, secondary amenorrhea Cautions/Contraindications: Considered safe, can be eaten in small amounts as food. Quite dense and rich, Rehmannia is cautioned in those with weak digestion. Safety rating during pregnancy and lactation not established Extra Information: A fundamental convalescence herb, Rehmannia is best used when there is deficiency but no stagnation. Rehmannia is prepared by cooking the root in rice wine until soft, then drying it in the sun. The result is a sweet and tasty preparation used in TCM to nourish the Blood, Yin, and augment the Essence. Part Used: Prepared root Daily Therapeutic Dose Tincture: 6–12 mL (1:5 in 40%) Daily Therapeutic Dose Infusion or Decoction: 9–30 g prepared root Pairs Well With: Angelica sinensis for deficient female hormone patterns. Urtica dioica leaf and Avena sativa as nutritive restoratives. Closest Substitute: Polygonum multiflorum Rhodiola rosea Primary Actions: Adaptogen, vascular (Rhodiola) tonic Constituents: Polyphenols (rosavin,  salidroside), proanthrocyanidins, quercitin Indications: Fatigue from overwork, lowered libido, ongoing physical or mental stress, altitude sickness, ischemic heart disease Cautions/Contraindications: Though not considered toxic, like Panax ginseng, rhodiola may be too stimulating for individuals showing signs of restlessness, insomnia, dizziness, or anxiety. Safety rating during pregnancy and lactation not established. Extra Information: A potent adaptogen. Works best when used in three-week cycles. Used acutely during or preceding times of known physical or mental stress. Part Used: Root Daily Therapeutic Dose Tincture: 6–15 mL (1:5 in 40%) Daily Therapeutic Dose Infusion or Decoction: 4–12 g dried herb or powder Pairs Well With: Centella asiatica and Bacopa monnierii for cognitive enhancement. Eleutherococcus senticosus as fortifying adaptogen. Closest Substitute: Smilax officinalis Smilax officinalis Primary Actions: Adaptogen, alterative, (Sarsaparilla) anti-inflammatory Constituents: Saponins based on the aglycone sarsapogenin, sterols, volatile oils Indications: Eczema, psoriasis, BPH, waning libido, RA, gout Cautions/Contraindications: Considered safe. Safety rating during pregnancy and lactation not established. Extra Information: Excellent tonic, useful in cases of fatigue following intense physical activity, especially when associated with joint pain. One of the original roots in root beer. Part Used: Root and rhizomes Daily Therapeutic Dose Tincture: 3–12 mL (1:5 in 40%) Daily Therapeutic Dose Infusion or  Decoction: 6–12 g dried root Botanicals in General LBP Pairs Well With: Polygonum multiflorum and Urtica dioica root as a male tonic. Vanilla extract, soda water, and a tsp of honey as a pleasant fortifying beverag Withania somnifera Primary Actions: Adaptogen, (Withania) hypotensive, immune modulator, anti-inflammatory, nootropic Constituents: Steroidal lactones (withanolides), alkaloids Indications: Fatigue, nervous exhaustion, chronic inflammatory disease, anemia, lowered libido, convalescence, hypothyroid presentations Cautions/Contraindications: Considered safe. Preg B, Lact C. Extra Information: An excellent non-stimulating adaptogen useful in promoting performance and recovery without the symptoms of overstimulation. Sometimes thought of specifically as being useful as an adaptogen for the thyroid. Part Used: Root Daily Therapeutic Dose Tincture: 6–12 mL (1:5 in 40%) Daily Therapeutic Dose Infusion or Decoction: 6–10 g dried herb or powder Pairs Well With: Schisandra sinensis and Zingiber officinalis as non-stimulating tonic for weakened vitality (Qi) with excess fluids, especially of the digestive system. Rumex crispus, Centella asiatica, and Ganoderma spp. for physical endurance and improving red and white blood cell counts. Closest Substitute: Eleutherococcus senticosus Chaga (Inonotus Primary Actions: Tonic, particularly obliquus) male tonic; anti-tumour, anti-viral, anti-inflammatory Constituents: Steroidal triterpenenoids, Inositol, Protein-polysaccharides, betulin (concentrated from the host),  ergosterol, melanin Indications: Active cancers, particularly cervical; viral infections, HIV, decreased libido Cautions/Contraindications: Considered safe. Extra Information: Becoming commercially popular for its tonic properties, an effective mushroom in combo formulas. Grows on ailing birch trees. Shiitake (Lentinula Primary Actions: Potent edodes) immunomodulator, immune stimulant, hepatic, anti-tumour, anti-viral Constituents: B-Glucans, lentinan, ergosterol, Eritadenine Indications: Anemia of chronic disease, long term infections, some active cancers, HIV, ME, general convalescence, elevated cholesterol, possibly herpes infections. Cautions/Contraindications: Considered safe, long history of culinary use Extra Information: Safe, tasty, relatively inexpensive, effective medicine. Turkey tail Primary Actions: Anti-tumour, immune (Trametes stimulant, anti-microbial versicolor) Constituents: B-Glucans, PSK, PSP, ergosterol Indications: Active cancers, particularly gastric cancers; active infections, convalescence Cautions/Contraindications: Considered safe. Extra Information: Pairs well with other mushrooms in combo. Requires long decoction for optimal extraction. Nutrition TREATMENT Anti Inflammatory diet GOALS Fruits and veggies: High consumption - Lower of vegetables: large diversity, including bodily variety of colors to increase  inflammatio phytonutrients n Address Protein: More fatty fish and some lean presenting animal protein symptoms and Plant sources of protein: legumes, soy, improve nuts, and seeds patient comfort Support full and Carbs: Whole grains in small amounts, speedy recovery to high fiber, reduced refined return to carbohydrates regular activities Patient education Fats: Olive oil for added fat source Monitor and Prevent sequelae Other Features: Spices: turmeric, garlic, ginger, and other antiinflammatory herbs and spices - Mindful eating approach; quality over quantity HOMEOPATHY (For SEPIA AFFINITIES Circulation EXTREMITIES Depression) OFFICINALIS - COLDNESS - Hands - alternating with (CUTTLEFISH) – heat venous stasis + heaviness of the organs = prolapse/ptosis FEMALE GENITALIA/SEX – PROLAPSUS Keynote: Bearing down sensation Disposition: mild and easy-going SEPIA-GENERALITIES Left-sided symptoms Heaviness or "ball" sensation, or empty "gone" feeling Hungry with pains Food Desires: chocolate: more in chronic stage pickles, sour especially in acute stage (Vinegar) children love vinegar, can drink it sweets, bitter foods, cheese , spicy, salty NATRUM Hateful; to persons who had offended MURIATICUM him. (SODIUM Sad : during menses; without cause. CHLORIDE) Weeps involuntarily, without a cause or cannot weep. Dwells on past unpleasant memories.. Fear or dreams of robbers.  Pain in the back, with desire for some firm support. [Rhus; Sep.] Knees feel weak. Numbness and tingling in fingers and lower extremities. Ankles weak and turn easily. [Nat-c.] Painful contraction of hamstrings. [Caust.] Cracking in joints on motion Worse: In the morning around 9 to 11 am (=forenoon in repertory) At seashore and Sun exposure Consolation, heat, talking Better: Open air From widely-applied pressure, pressure against back (Lumbago, when lying supine) Tight clothing. Rhus TOX (indications in earlier week) Bryronia (indications in earlier week) PHARM Morphine The principal alkaloid of opium poppy Well absorbed from the GI tract but (OPIOIDS) (standard of extensively metabolized during comparison for all first-pass Principal metabolite (~90%) is other opioids) morphine-3-glucuronide which is inactive Morphine-6-glucuronide (~10%) is more active than morphine with a longer half-life and contributes to analgesic effectiveness Duration of action: 4 hours Tramadol Analgesic effect mediated by the M1 metabolite (Odesmethyltramadol) which is dependent on CYP2D6Side effects include: hypoglycemia, decreases seizure threshold, orthostatic hypotension, hallucinations Interacts with antidepressants (SSRIs, TCAs) and increased risk of serotonin syndrome Duration of action: 4 hrs Half life: 6 hrs Naloxone Administered intravenously Half life: 2  hrs Repeated administration often needed for longer-lasting opioid agonists Low bioavailability so not given orally on its own Sometimes added to oral opioid agonists to curb crushing tablets and using them intravenously Indicated for opioid overdose treatment Week 10 IBS BOTMED Peppermint Main indications: Latin: Mentha piperita Bloating and gas Indigestion Nausea Intestinal cramping Irritable bowel syndrome ACTIONS Carminative Antispasmodic Antiemetic SAFETY GRAS (Generally Recognized As Safe) Reflux - may aggravate Pregnancy: SAFE! :) Lemon Balm MAIN INDICATIONS Latin: Melissa officinalis Nervous stomach Indigestion Colic Irritable bowel syndrome (IBS) Anxiety Insomnia ACTIONS Carminative Antispasmodic Sedative  SAFETY GRAS (Generally Recognized As Safe) Side-Effects: May aggravate GERD. Pregnancy: Caution. May be harmful. FENNEL MAIN INDICATIONS Latin: Foeniculum vulgare Indigestion Bloating and gas Infantile colic ACTIONS Carminative Antispasmodic Antiinflammatory SAFETY Generally recognized as safe (GRAS) Side-Effects: May aggravate GERD. Pregnancy: Caution. It may be harmful. PSYLLIUM MAIN INDICATIONS Latin: Plantago ovata Constipation Diarrhea ACTIONS Bulk laxative SAFETY Side-Effects: Bloating and gas. It must be consumed with lots of water! Esophageal blockage & bowel obstruction- has occurred when taken with insufficient water. Acute constipation - may aggravate Pregnancy: No restrictions known. Drugs: May delay absorption. FLAX SEED MAIN INDICATIONS Latin: Linum usitatissimum Chronic constipation Irritable bowel syndrome Blood sugar Cholesterol ACTIONS Bulk laxative Demulcent Phytoestrogen Antioxidant Anti-inflammatory SAFETY Side-Effects: None known. Drugs: May delay absorption. Pregnancy: Caution. It may be harmful (contains phytoestrogens). SENNA MAIN INDICATIONS Latin: Senna alexandrina Acute constipation ACTIONS Stimulating laxative SIDE-EFFECTS: Cramping Diarrhea Discoloration of urine (red/brown) Hypokalemia (↓ potassium) Melanosis (bowel staining) Dependency (limit use 7-10 days) CAUTION: Inflammatory bowel disease (IBD) Children under 12 y.o. Kidney disease Heart medications Nursing - might cause loose stools in breastfed infants.  BARBERRY MAIN INDICATIONS Latin: Berberis vulgaris Infections Infectious diarrhea Indigestion Liver congestion and gallstones Constipation Skin conditions (eczema, psoriasis) Parasites ACTIONS Antimicrobial (antibacterial, antiparasitic, antifungal) Digestive Bitter Antidiarrheal Laxative SAFETY Contra-Indications: Gastritis & stomach ulcers, obstructed gallbladder Side-Effects: May cause GI irritation leading to nausea, vomiting and diarrhea. Pregnancy & lactation - unsafe Nutrition Low FODMAP Diet Several randomized controlled trials have shown that a low FODMAP diet can - Fermentable improve IBS symptoms in up oligosaccharides, to 75% of patients. - A disaccharides, systematic review and monosaccharides, and meta-analysis of 22 studies polyols - Can be effective in found that a low FODMAP managing symptoms of SIBO diet was effective in reducing in patients with IBS. - This IBS symptoms, specially diet eliminates certain types bloating and abdominal pain. of carbohydrates that are poorly absorbed in the small intestine and can be fermented by bacteria, leading to symptoms like bloating, gas, and diarrhea. Alcohol If alcohol exacerbates the symptoms it should be reduced. IBS patients should be advised to consume alcohol in compliance with recommended safe limits. Caffeine intake -Caffeine intake should be assessed in IBS patients. If related to symptoms, daily intake should be less than 400 mg caffeine, which is the safe limit for most adults Spicy foods intake If the IBS symptoms are triggered by spicy foods, the intake should be restricted. IBS triggers in spicy foods other than hot spices (e.g., fructans in onion and garlic) should also be assessed. Fiber intake Some studies have suggested that increasing fiber intake may improve IBS symptoms, especially constipation. However, the evidence is mixed, and some people with IBS may find that high fiber diets exacerbate their symptoms. Fat Intake If related to IBS symptoms during or after eating, fat intake should be assessed. According to FAO/WHO dietary  recommendations, the total fat intake for an adult should range from 30% to 35% of total energy, without being under 15% of total energy. Patients with IBS should be advised to limit fat intake to no more than 40-50 g/d. Dairy intake Low-lactose diet only if they have a positive lactose hydrogen breath test. Gluten-free Diet Conflicting evidence Consider nutritional deficiencies HOMEOPATHY NUX VOMICA Too much stress, food drugs, muscle spasms Stomahc liver, bowel, brains Sensitive, emotional outbursts Ignatia Amara Mind, nervous syststem grief , anger Ignatia wants to be Controlling emotions Sensitive, emotional outbursts PODO PHYLLUM - Bowels, liver, female organs - Triggers teething pregnancy, liver issues - Shows alternating  diahherea/vomitting, headaches - Sensitive to fruit, bad or poor quality food Cina MArtitima \ INTESTINAL WORMS Coughs, Colds, Fever Also known as: Twitching muscles, spasms Levant wormseed, European Behaviour problems in wormwood, children, ADHD or santonica (source of santonin) Teeth grinding (bruxism) Temper tantrums Irritability, touchiness Itchy nose, constantly rubs it Insomnia and/or restless sleep Yawning is a concomitant of many symptoms, can aggravate the symptoms, or can trigger them. May yawn even when not tired Jerking, twitching muscles Especially in hands and feet, often with irritability Triggered by touch, or being reprimanded Convulsions are triggered the same way > motion/rocked violently, being carried, bending, lying on abdomen, daytime < touched, stared at, summer heat, night, getting up, seeing stranger, at full moon, yawning Week 11 (GERD) Bot med GENTIAN MAIN INDICATIONS Latin: Gentiana lutea Indigestion Gastroesophageal reflux disorder (GERD) Cholestasis leading to gallstones Liver disease and jaundice ACTIONS Bitter tonic (Sialogogue, Stomachic, Cholagogue, Choleretic, Hepatic) SAFETY Caution: Heartburn & GERD Contra-Indications: Gastritis, heartburn & stomach ulcers, obstructed gallbladder Side-Effects: May cause GI irritation leading to nausea, vomiting and diarrhea. Pregnancy: Caution. May be harmful. CENTAURY MAIN INDICATIONS Latin: Centaurium erythraea Indigestion Cholestasis leading to gallstones Gastroesophageal reflux disorder (GERD) Liver disease and jaundice ACTIONS Bitter tonic (Sialogogue, Stomachic, Cholagogue, Choleretic, Hepatic) Hepatoprotective Anticancer (stomach, liver) Antimicrobial SAFETY Caution: Heartburn & GERD Contra-Indications: Gastritis, heartburn & stomach ulcers, obstructed gallbladder Side-Effects: May cause GI irritation leading to nausea,  vomiting and diarrhea. Pregnancy: Caution. May be harmful. Globe Artichoke MAIN INDICATIONS Latin: Cynara scolymus Indigestion Gallbladder disease and stones Cardiovascular disease Gout ACTIONS Bitter Hepatoprotective Hypolipidemic SAFETY Side-Effects: Generally recognized as safe. Contra-Indications: Gastritis & stomach ulcers, obstructed gallbladder Pregnancy: Unsure. Probably safe? Risk asteraceae allergy: contains sesquiterpene lactones MARSHMALLOW MAIN INDICATIONS Latin: Althaea officinalis Protect and soothe irritated mucous membranes Heartburn (GERD esophagitis and gastritis) Dry cough Diarrhea ACTIONS Demulcent SAFETY Side-Effects: None known. Very safe. Pregnancy: No restrictions known. Drugs: May delay absorption. SLIPPERY ELM MAIN INDICATIONS Latin: Ulmus rubra Inflammation and irritation of the No research gastrointestinal tract (esophagitis, heartburn, colitis) Constipation Diarrhea Topically: poultice for boils, absence Cough ACTIONS Demulcent Bulk laxative Nutritive SAFETY Side-Effects: None known. Very safe. Pregnancy: No restrictions known. Drugs: May delay absorption. PSYLLIUM MAIN INDICATIONS Latin: Plantago ovata Constipation Diarrhea GERD Blood sugar Cholesterol ACTIONS Bulk laxative Demulcent SAFETY Side-Effects: Bloating and gas. It must be consumed with lots of water! Esophageal blockage & bowel obstruction- has occurred when taken with insufficient water. Acute constipation - may aggravate Pregnancy: No restrictions known. Drugs: May delay absorption. ALOE VERA GEL MAIN INDICATIONS Latin: Aloe barbadensis Gel - Burns, wounds, diarrhea Resin - Constipation  ACTIONS Bulk laxative Demulcent Vulnerary Anti-inflammatory SAFETY ALOE GEL Side-Effects: None known. Drugs: May delay absorption. Pregnancy: Caution. It may be harmful. ALOE RESIN Side-effects: see Senna (similar phytochemicals) LICORICE / LIQUORICE MAIN INDICATIONS Latin: Glycyrrhiza glabra Inflammation in the GI tract (Gastritis, ulcers) Hepatitis and cirrhosis of the liver Respiratory tract infections (cough, sore throat) Adrenal fatigue ACTIONS Demulcent (Indirect) Antiulcer SIDE-EFFECTS: Pregnancy: Caution. May be harmful. Hypertension: can raise blood pressure Electrolytes - can causes potassium loss. Caution with medications for the cardiovascular system. MEADOWSWEET MAIN INDICATIONS Latin: Filipendula ulmaria Heartburn Stomach ulcers Fever Rheumatic diseases ACTIONS Antacid Anti-ulcer Astringent  SIDE-EFFECTS: Contra-Indicated - Salicylate sensitivities Caution: may potentiate blood thinners Pregnancy: Likely unsafe Research summary Nutrition Stratagies Avoiding trigger foods (e.g., acidic, spicy, fatty)(spicy or fatty foods, acidic foods (such as citrus fruits and tomatoes), caffeine, and chocolate). Eating smaller, more frequent meals Consuming low-allergen, nutrient-dense foods Limit alcohol and carbonated beverages Avoid eating before bed Eat slowly and chew thoroughly Sit up straight while eating Wait to exercise after eating Recommendations Avoid eating before bedtime: eating a large meal GERD is related to irregular before bedtime can increase dietary and lifestyle the likelihood of acid habits, such as midnight reflux symptoms. It's best to snacking, skipping avoid eating at least breakfast, eating quickly, three hours before bedtime. eating very hot foods, Raise the head of the bed and eating beyond fullness. Chew gum Drink water Intermittent fasting may be Vegetarian diets and no recommended, especially in intake of meat were overweight-obese patients negatively with related to GERD, while daily GERD symptoms who are meat, fish, and egg intake, poor as well as high-fat diet responders to gastric acid consumption, were positively inhibitors. related to GERD. An interval of less than three hours between dinner and bedtime was positively related to GERD, while proper physical exercise was negatively correlated with GERD. Smoking, alcohol consumption, and poor mental state were positively correlated with GERD. Antioxidant intake was generally negatively correlated with GERD. Magnesium A population-based case–control study: individuals consuming the highest amounts of Mg from foods had significant reductions in the odds of reflux oesophagitis and Barrett’s oesophagus compared with individuals consuming the lowest amounts of Mg. Zinc Carnosine Zinc carnosine supports the gastrointestinal system by protecting its mucus membrane , aiding in the repair of damaged epithelial cells, inhibiting inflammation, and exhibiting antioxidant-like properties.  VITAMIN B12 Some studies have found an association between heartburn medications and increased risk of vitamin B-12 deficiency. ROLE OF Specific strains for GERD PROBIOTICS management Lactobacillus acidophilus and other Lactobacillus strains including: L. gasseri L. casei L. plantarum L. rhamnosus L. reuteri Bifidobacterium strains Homeo CARBO VEGETABILIS Skin is pale, cyanotic, blue, cold and cold sweat but wants fanning GI: flatulence esp.in upper abdomen pushes upward, pains if trapped > burping, passing gas Fears of evil, bad things < closing the eyes, dark Sensitive, irritable, dull, lazy, confused, slow GRAPHITES KALI CARBONICUM CALCAREA CARBONICA Pharmacology ALGINATES Natural polysaccharide polymers derived from seaweed Precipitate into a gel on contact with gastric acid Gel floats on top of stomach contents forming a physical barrier between acid and the lower esophageal sphincter Gel refluxes instead of acid ALGINATE/MAGNESIUM Tablet form HYDROXIDE Typically 2 – 4 tablets chewed PRN after meals followed by a glass of water Adverse effects include nausea, vomiting, eructation, flatulence ANTACIDS just acid-neutralizing agents Aluminum and magnesium hydroxides, in combination, are one of the most common Aluminum hydroxide causes constipation Magnesium hydroxide causes diarrhea Often only work for a short time as acid is involved in the negative feedback of acid regulation ALUMINUM AND Typically administered PRN MAGNESIUM HYDROXIDE after meals COMBINATION Adverse effects include constipation and diarrhea RANITIDINE Have no effect on gastric emptying time, esophageal sphincter pressure, or pancreatic enzyme secretion Indications: Dyspepsia/GERD/heartburn Peptic ulcer disease: at doses that raise gastric pH above 4 for at least 13 hours a day Require 6-8 weeks of continuous therapy to heal 90% of ulcers Adverse effects include diarrhea, constipation, headache, fatigue, confusion (most commonly in elderly patients with reduced renal function), cardiac effects,  rash Dose: 150 mg BID – QID PO or 300 mg QHS PO PROTON PUMP Generic naming convention: INHIBITORS -prazole Prodrugs administered orally as sustained-release, enteric- coated preparations as they are inactivated by stomach acid Activated by protonation, which occurs in areas of the body below their pKa (~4.0) The only place that happens is in the parietal cell canaliculi Once activated they bind to H+/K+ ATPase and irreversibly inactivate the pump OMEPRAZOLE Must be taken 30 minutes (best peptic ulcer treatment) before a meal to ensure pumps are active when peak Indications concentration of PPI are Peptic ulcer disease present in the blood Better than H2 antagonists Takes about 3 days to reach Heal 80-90% of ulcers in 2 steady state inhibition (after weeks or less factoring in the inactivation of Drug of choice for active pumps, stimulation Zollinger-Ellison syndrome of inactive pumps, and Most effective for treating creation of new pumps) dyspepsia/GERD/heartburn Rapid CYP2C19 May be used to prevent metabolizers may require ulcers in patients taking higher doses NSAIDs Common adverse effects include headache, nausea, diarrhea, abdominal pain, constipation, dizziness, fatigue, rash, pruritis May cause allergic reactions, kidney disorders, dementia (inconclusive) Long-term use associated with pneumonia, GI infections, vitamin and  mineral deficiencies (B12, iron, Mg), osteoporosis, and fractures MISOPROSTOL Prostaglandin E1 analog Binds to prostaglandin CYTOPROTECTIVE DRUGS receptors in the stomach and enhances mucus production, mucosal blood flow, and bicarbonate secretion in epithelial cells Binds to prostaglandin receptors on parietal cells and inhibits adenylate cyclase (decreases cAMP) which downregulates H+/K+ ATPase and decreases acid secretion Indicated for gastric and duodenal ulcers in patients taking NSAIDs long-term. Rather expensive and typically reserved for high-risk patients (elderly and those with a previous history of ulcer disease) Contraindicated in pregnancy as it can stimulate uterine contractions and induce labour H. Pylori treatment QUADRUPLE THERAPY First-line Most infections are PPI BID asymptomatic When Amoxicillin BID symptoms do occur, they are Metronidazole BID typically related to gastritis or Clarithromycin BID peptic ulcers Infection First-line or prior treatment significantly increases the risk failure of gastric cancer First line PPI BID management for eradication Bismuth subsalicylate QID is “quadruple therapy” for 14 Metronidazole TID - QID days Tetracycline QID Both regimens achieve a minimum eradication rate of  at least 85% Risk of reinfection after successful eradication is about 1% a year Week 12 - Hypertension BotMed Allium sativum (Garlic) Primary Actions: Vascular tonic, antimicrobial, hypotensive, stink-producer. Constituents: Organosulfur compounds (allicin), flavonoids, volatile oils Indications: Digestive infections, skin infections, URTI, CVD, hypertension. Cautions/Contraindications: Considered safe, widely used as food. In large doses of fresh bulb, skin irritation and photosensitization may occur. May interact with anticoagulant medications. Extra Information: Effective, though can be difficult to administer due to lingering pungency emitted from the skin and breath. Most effective if taken as raw bulb (or clove), but roasted bulb still useful, especially in treating vascular conditions. Makes an excellent (and delicious) infused oil (usually in olive oil) for ear infections in kids. Part Used: Bulb Daily Therapeutic Dose Tincture: 6–15 mL (1:5 in 40%) Daily Therapeutic Dose Infusion or Decoction: 2–4 bulbs fresh or roasted Capsicum frutescens (Cayenne) Primary Actions: Stimulant, circulatory tonic, rubefacient, sialagogue, libido tonic Constituents: Capsaicinoids (capsaicin), steroidal saponins Indications: Circulatory deficiencies, arthritic conditions, pain relief, depression Cautions/Contraindications: Non-toxic, but large doses will cause sweating and possible syncope. Safety rating during pregnancy and lactation not established. Extra Information: Acts as pain relief via local topical substance-P depletion. Excellent in salves for arthritis. Avoid contact with mucus membranes; internal use effective, but must be used in low doses. Part Used: Dried or powdered fruit Daily Therapeutic Dose Tincture: 1–5 mL (1:5 in 25%) Daily Therapeutic Dose Infusion or Decoction: 1–2 g powder (potency of starting material can vary considerably) Convallaria majalis Primary Actions: Cardiotonic, (Lily of the valley) hypotensive Constituents: Cardiac glycosides (convallarin, convallamarin, convallatoxin) Indications: Hypertension, CHF, any cardiovascular conditions Cautions/Contraindications: All parts of this plant contain cardiac glycosides and should be considered toxic, though toxicity reports are rare, and the specific cardiac glycosides of Convallaria are non-cumulative. Avoid in pregnancy. Extra Information: Perhaps one of the most reliable and abundant hypotensives in North America. Although of indispensable use in the cardiovascular system, this is a strong medicine, and should be used with moderate caution. Positive  inotropic, negative chronotropic, improves coronary contractility and circulation. Part Used: Leaf Daily Therapeutic Dose Tincture: 3–12 mL (1:5 in 40%) Daily Therapeutic Dose Infusion or Decoction: 2–4 g dried leaf Crataegus Primary Actions: Cardiotonic, oxyacantha hypotensive, vascular tonic, nutritive (Hawthorn) Constituents: Flavonoids Indications: Hypertension, CHF, any cardiovascular conditions Cautions/Contraindications: Considered safe and nutritious, berries may be consumed as food. Extra Information: Positive inotropic, improves coronary contractility and circulation. Ripe berries are delicious and make a tasty therapeutic jam. Part Used: Berry, leaf Daily Therapeutic Dose Tincture: 8-12 mL (1:5 in 40%) Daily Therapeutic Dose Infusion or Decoction: 5–15 g dried fruit Gingko biloba Primary Actions: Circulatory tonic, (Gingko) vasodilator, anti-inflammatory, anticoagulant (as an antiplatelet activator factor [PAF]) nootropic, mild astringent. Constituents: Flavonoid glycosides, terpene lactones (gingkolides) Indications: Poor perfusion of tissues, especially cerebral; inflammation, clot formation, cognitive decline, erectile dysfunction, BPH. Cautions/Contraindications: Though not toxic, may cause stomach discomfort or cramping. Extra Information: At 200 million years old, Gingko trees are the most ancient species of tree on the planet and the only remaining member of their genus. They are also thought to be the hardiest tree species and are among the most resilient trees in  urban environments. Gingko trees have a distinct male and female. The females produce a characteristically unpleasant smelling, but edible fruit. Part Used: Leaf and fruit Daily Therapeutic Dose Tincture: 3–9 mL (1:5 in 40%) Daily Therapeutic Dose Infusion or Decoction: 4–10 g dried leaf Hibiscus sabdariffa Primary Actions: Hypotensive, (Hibiscus) antioxidant, mild nervine, astringent, cooling, mild diuretic, mild alterative, mild emmenagogue. Constituents: Flavonoids, vitamin C, anthocyanidins, tannins Indications: Hypertension, inflammation and heat patterns Cautions/Contraindications: Long history of use as pleasure tea, broadly considered safe. Safety rating during pregnancy and lactation not established. Extra Information: Excellent infusion and often used to improve palatability of a formula. As a mild uterine tonic it may be indicated for recurrent miscarriages, but it should be cautioned in cool patterns or constitutions. Hibiscus rosa-sinensis is used similarly, and the two species are generally thought to be interchangeable. Part Used: Flower Daily Therapeutic Dose Tincture: 6–15 mL (1:5 in 25%) Daily Therapeutic Dose Infusion or Decoction: 6–12 g dried flower Leonurus cardiaca Primary Actions: Nervine, (Motherwort) hypotensive, cardiotonic, mild emmenagogue. Constituents: Iridoids, flavonoids, alkaloids Indications: Anxiety, insomnia, delayed menses Cautions/Contraindications: Considered safe. Extra Information: Used especially in cases of anxiety with concomitant cardiovascular conditions, or irregular menses from nervous tension. Part Used: Aerial parts Daily Therapeutic Dose Tincture: 3–12 mL (1:5 in 40%) Daily  Therapeutic Dose Infusion or Decoction: 4–6 g dried leaf Lobelia inflata Primary Actions: Antispasmodic, (Lobelia) CNS acting relaxing nervine, emetic, diffusive pulmonary tonic. Constituents: Piperidine alkaloids (lobeline). Indications: Smoking cessation support, asthma, anxiety, panic attacks, persistent cough. Cautions/Contraindications: Non-toxic, but may cause emesis in doses larger than 1 tablespoon. Safety rating during pregnancy and lactation not established. Extra Information: Usually used as 10% or less of a formula, often paired with mint for dispersal through the CNS, excellent in anxiety formulas. Used acutely for panic attacks. Part Used: Aerial parts, seeds, seed powder. Daily Therapeutic Dose Tincture: 1–2 mL (1:5 in 40%) Daily Therapeutic Dose Infusion or Decoction: 1-3 g Passiflora incarnata Primary Actions: Sedative, nervine, (Passionflower) hypotensive, antispasmodic, anti-inflammatory Constituents: Alkaloids, flavonoids Indications: Insomnia, general anxiety and restlessness, hypertension, neuralgia Cautions/Contraindications: Considered safe. May potentiate other anxiolytics. Extra Information: Slightly spicy in flavour similar to Lobelia inflata or Nicotiana tabacum, but overall cooling. Effective nervine-sedative, used especially in conditions presenting with nervous anxiety. Part Used: Leaf Daily Therapeutic Dose Tincture: 3–12 mL (1:5 in 40%) Daily Therapeutic Dose Infusion or Decoction: 1–4 g dried herb Rauwolfia serpentina Primary Actions: Hypotensive, CNS (Snake root) depressant, sedative Constituents: Indole alkaloids (reserpine, serpentine, yohimbine) Indications: Hypertension, anxiety  Cautions/Contraindications: Cautioned in patients concurrently taking other hypotensive medications, especially beta-blockers and calcium channel blockers. Although uncommon, prudence suggests patients should be monitored for mood changes. Similarly, many practitioners suggest Rauwolfia is CI in patients with a history of depression. Rauwolfia is CI in pregnancy and lactation. Extra Information: There are many herbs commonly called snakeroot, and it is specifically the Indian snakeroot being referred to here. Primarily an Ayurvedic herb, Rauwolfia was traditionally used to treat “lunacy and insanity” or what is now thought to be schizophrenia and other forms of psychosis. Still used as an effective hypotensive, it is currently regaining popularity as a new generation of practitioners discover it is safe and effective in therapeutic dose. Part Used: Root Daily Therapeutic Dose Tincture: 0.5–2 mL (1:5 in 40%) Scutellaria lateriflora Primary Actions: Nervine, (Skullcap) hypotensive, mild antispasmodic Constituents: Flavonoids, iridoids, volatile oils Indications: Anxiety, particularly worrisome anxiety. Digestive, nervous, or menstrual symptoms associated with worry. Cautions/Contraindications: Considered safe. Extra Information: Excellent nervine with minimal soporific properties, often thought of as tonic and mild adaptogen. Note: Not interchangeable with Scutellaria baicalensis. Part Used: Leaf, aerial parts Daily Therapeutic Dose Tincture: 6–12 mL (1:5 in 40%) Daily Therapeutic Dose Infusion or Decoction: 3–6 g dried herb Tilia cordata (Linden) Primary Actions: Cardiotonic, circulatory tonic, nervine,  hypotensive Constituents: Volatile oils, flavonoids, mucilage, tannins Indications: Nervous tension, cardiovascular conditions associated with stress or anxiety, hypertension, respiratory congestion, URTIs. Cautions/Contraindications: Considered safe. May interfere with iron absorption, so best taken away from meals or iron supplementation in some cases. Extra Information: Reliable hypotensive and cardiotonic with anxiolytic properties, best in combo with other primaries. Other Tilia species such as T. europaea, T. platyphyllos, and T. americana are at present considered interchangeable. Part Used: Flower Daily Therapeutic Dose Tincture: 8–15 mL (1:5 in 40%) Daily Therapeutic Dose Infusion or Decoction: 2–6 g dried blossom Urtica dioica (Nettle Botanicals in Hypertension Primary leaf) Actions: Nutritive, alterative, diuretic Constituents: Indoles, flavonoids, formic acid Indications: Skin conditions, weakened kidneys, nutritive in pregnancy, seasonal allergies Cautions/Contraindications: Considered safe. Preg B, Lact C. Extra Information: Will create significant urtication when harvested fresh (primarily due to the presence of formic acid), though drying and cooking inactivates the sting. Useful in all conditions related to the kidneys, and an excellent general alterative. Nettle is nutritious as a food, and makes excellent cordage if lost in the woods. Considered interchangeable with Urtica urens. Part Used: Leaf Daily Therapeutic Dose Tincture: 6–12 mL (1:5 in 30%) Daily Therapeutic Dose Infusion or Decoction: 8–15 g dried herb Valeriana officinalis Primary Actions: Sedative, nervine, (Valerian) hypotensive, anodyne, antispasmodic, emmenagogue, decongestant, mild carminative.  Constituents: Iridoids, valpotriates, baldrinals, essential oils, valerianic acid Indications: Deficient pattern anxiety and insomnia, sinus congestion, pain conditions. Cautions/Contraindications: Considered safe. May potentiate other anxiolytics, particularly benzodiazepines. Extra Information: Has an especially strong smell reminiscent of dirty socks. Effective sedative, may induce grogginess the next morning if used in high dose. Best prepared using a strong infusion (30+ min). Some individuals experience a “paradoxical reaction” in which valerian makes them feel restless and stimulated; this is seen especially in people with TCM heat/empty heat patterns. Valerian is generally considered a warm, dry herb. Notably useful in attenuating the symptoms of benzodiazepine withdrawal. Mexican valerian (Valeriana edulis) is considered interchangeable. Of note, valerian is considered safe in pregnancy, and it may be thought of as the treatment of choice in insomnia or anxiety during pregnancy. Part Used: Root Daily Therapeutic Dose Tincture: 8–18 mL (1:5 in 40%) Daily Therapeutic Dose Infusion or Decoction: 6–9 g dried root Viscum album Primary Actions: Hypotensive, (Mistletoe) cardiotonic, vascular tonic, antineoplastic Constituents: Lectins, polypeptides, polysaccharides Indications: Hypertension, angina pectoris, CHF Cautions/Contraindications: Cytotoxic ribosomal inhibitor (phoratoxin), must be used with caution, if at all. However, eclectic traditional use suggests infusion of the leaves was used in large doses without side effect. All parts of the mistletoe plant are considered toxic and not to be ingested. CI in  pregnancy and lactation. Extra Information: Semi-parasitic plant. Injectable mistletoe extract has been used in trials in the treatment of various cancers, as the drug Iscador or Helixor. Traditionally an herb used for kissing at Christmas, mistletoe is, humorously, in the Santalaceae family. Part Used: Whole plant Daily Therapeutic Dose Tincture: 3–6 mL (1:5 in 45%) Daily Therapeutic Dose Infusion or Decoction: 10 g dried herb Nutrition Fibers FIBER & FIBER-RELATED COMPOUNDS Gums Mucilage b-glucans Fructans Cellulose Hemicellulose Lignins & lignans Pectins PROPERTIES & CELLULOSE Cellulose is a PHYSIOLOGICAL polysaccharide molecule, consisting EFFECTS OF FIBER of carbon, hydrogen and oxygen Important properties atoms. (Unbranched polymer of long of fiber include: chains) helping plants to remain stiff Solubility in water and upright Insoluble in water Water-holding Humans cannot digest cellulose, capacity & viscosity Increases fecal volume Sources: Adsorption or binding bran, legumes, root veg, seeds ability Fermentability Water Soluble Fiber HEMICELLULOSE Mixture of linear & highly branched polymers Dissolves in hot containing various sugars (short water Mostly pectin chains) Digested better than & gums Delays cellulose Most are insoluble but gastric emptying some are soluble Sources: Bran, Increases intestinal whole grains, nuts, legumes, some transit time fruits and vegetables Decreases nutrient absorption Higher hydration capacity Higher adsorption capacity Higher fermentability Fruits, oats, barley, legumes Water Insoluble fiber PECTIN Complex group of polysaccharides called Does not dissolve in galacturonoglycans Found between hot water Cellulose, plant cell walls & the intracellular lignin, & most layers and acts like a “glue” holding hemicelluloses cells together Completely digested Decreases intestinal through microbial action Forms a transit time Increase viscous gel when mixed with water, fecal bulk Lower used in marmalades, jams, and hydration capacity jellies Sources: Apples, pears, Lower adsorption strawberries, and citrus fruit capacity Lower fermentability Vegetables & most grains FIBER AND LIGNINS Highly-branched polymer CARDIOMETABOLIC composed of phenol units with strong SYNDROME bonding cell walls, especially in wood Higher dietary fiber and bark (rigidity) Structural intake was components of plants found in stems, significantly seeds, and bran layer Antioxidant & associated phytoestrogenic properties Sources: with improved tumor Flax and other seeds, wheat, root necrosis factor-alpha veg, serum levels while no significant effect was observed for C-reactive protein. Blood pressure was significantly improved following higher dietary fiber intake. LIGNINS Highly-branched polymer composed of phenol units with strong bonding cell walls, especially in wood and bark (rigidity) Structural components of plants found in stems, seeds, and bran layer Antioxidant & phytoestrogenic properties Sources: Flax and other seeds, wheat, root veg, CLINICAL NOTE: FLAX SEED Linum usitatissimum § Contains 35–45 % of fiber: two-third is insoluble (cellulose, hemicellulose and lignin) and one third is soluble fiber (mucilage of seed coat). § Highest natural source of lignins  (contains phytoestrogen) § One of the richest plant sources of the ω-3 fatty acid alpha-linolenic acid (ALA, C18:3 ω-3) GUMS Group of substances secreted at site of plant injury e.g. tree exudate - gum arabic Composed of sugars & derivatives Sources: Oats, barley, legumes MUCILAGES & ALGAL POLYSACCHARIDES Thick glutinous substances, secreted by seed covers such as psyllium, flax, and certain seaweeds Storage of water and food, seed germination, and thickening membranes Water soluble Food additive to give foods a firmer texture: guar, carageenan, agar Homeo CALCAREA Growth: infants, children and CARBONICA adolescence General (OYSTER SHELL) metabolism Deformation or decalcification The bone tissue Hypertrophic lymph nodes, tonsils, etc Large, round, square head Wide anterior fontanel which takes a long time to close Apprehensive; worse towards evening; fears loss of reason, misfortune, contagious diseases. They are slow, shy, fearful with a depressive tendency Week 13 - Erectile dysfunction BotMed Capsicum frutescens (see above for charts detail) (Cayenne) Ceanothus americanus Primary Actions: Lymphatic, (Red root) alterative, decongestant, antimicrobial, astringent Constituents: Alkaloids, tannins Indications: URTIs, enlarged spleen, palpable lymph nodes, edema, circulatory congestion, lethargy and melancholy, GI bleeding and loose stools Cautions/Contraindications: Considered safe, has been used as a tea substitute. Safety in pregnancy and lactation not established. Extra Information: An effective lymphatic used especially where there is confirmed enlargement or induration of lymph nodes, particularly during acute infections. Part Used: Root, root bark, twigs Daily Therapeutic Dose Tincture: 9–12 mL (1:5 in 40%) Daily Therapeutic Dose Infusion or Decoction: 4–6 g dried root Cinnamomum (Cinnamon) Primary Actions: zeylanicum Diaphoretic, astringent, antimicrobial, antispasmodic, carminative, endocrine modulator (diabetes) Constituents: Cinnamyl acetaldehyde and ester (only bark), phellandrene (only leaf) Indications: Uterine hemorrhage, diarrhea, nausea, vomiting, URTI Cautions/Contraindications: Considered safe as spice used in food in doses less than 5 g. Generally CI in pregnancy and lactation. Extra Information: An excellent warming carminative, but can be too spicy for some individuals. In TCM, warms the individual, increases flow through  the meridians, removes obstructions to the flow of Qi, and reinforces yang. A related (and sweeter tasting) species Cinnamomum cassia has recently been associated with some hepatotoxicity in large amounts, so C. zeylanicum is generally favored for medicinal use. Part Used: Bark, twig, occ leaf Daily Therapeutic Dose Tincture: 6–12 mL (1:5 in 40%) Daily Therapeutic Dose Infusion or Decoction: 5–20 g dried bark or powder Crataegus oxyacantha Primary Actions: Cardiotonic, (Hawthorn) hypotensive, vascular tonic, nutritive Constituents: Flavonoids Indications: Hypertension, CHF, any cardiovascular conditions Cautions/Contraindications: Considered safe and nutritious, berries may be consumed as food. Extra Information: Positive inotropic, improves coronary contractility and circulation. Ripe berries are delicious and make a tasty therapeutic jam. Part Used: Berry, leaf Daily Therapeutic Dose Tincture: 8-12 mL (1:5 in 40%) Daily Therapeutic Dose Infusion or Decoction: 5–15 g dried fruit Ginkgo biloba (Gingko) (see charts above) Lepidium meyenii Primary Actions: Endocrine (Maca) modulator (testosterone), adaptogen, anti-inflammatory Constituents: Carbohydrates, proteins, sterols, linoleic and oleic acid, micronutrients including zinc glucosinolates Indications: Debility, lowered libido, convalescence Cautions/Contraindications: Considered safe, consumed as food. Safety in pregnancy and lactation not established. Panax Ginseng (korean See above charts Ginseng) Passiflora incarnata Primary Actions: Sedative, nervine, (Passionflower) hypotensive, antispasmodic, anti-inflammatory Constituents: Alkaloids, flavonoids Indications: Insomnia, general anxiety and restlessness, hypertension, neuralgia Cautions/Contraindications: Considered safe. May potentiate other anxiolytics. Botanicals in ED Extra Information: Slightly spicy in flavour similar to Lobelia inflata or Nicotiana tabacum, but overall cooling. Effective nervine-sedative, used especially in conditions presenting with nervous anxiety. Part Used: Leaf Daily Therapeutic Dose Tincture: 3–12 mL (1:5 in 40%) Daily Therapeutic Dose Infusion or Decoction: 1–4 g dried herb Pausinystalia yohimbe Primary Actions: Endocrine a.k.a. Coryanthes modulator (testosterone), mild yohimbe (Yohimbe) stimulant Constituents: Indole alkaloids (yohimbine, corynanthine) Indications: Lowered libido, improved sexual performance, possibly BPH Cautions/Contraindications: In larger doses, can cause flushing, dizziness, and elevated blood pressure. Priapism is uncommon but has been reported. CI in pregnancy. Extra Information: Used commonly as a performance enhancer for physical exertion and sexual performance. Effects are significant but transient and diminish with recurrent use. Best used acutely, and cautioned in individuals with tendency to fainting and dizziness. Also common in weight loss formulas, though the research suggests limited efficacy. Part Used: Bark Daily Therapeutic Dose Tincture: 4–12 mL (1:5 in 40%) Daily Therapeutic Dose Infusion or Decoction: 4–9 g dried  bark Serenoa repens (Saw Primary Actions: Endocrine palmetto) modulator (male), decongestant, diuretic, possible libido tonic Constituents: Volatile oils, fixed oils, fatty acids, sterols, saponins Indications: BPH, edema, PCOS with androgen dominance Cautions/Contraindications: Considered safe, berries have been eaten as food. May interact to enhance efficacy of other 5-a reductase inhibitors. Smilax officinalis Primary Actions: Adaptogen, (Sarsaparilla) alterative, anti-inflammatory Constituents: Saponins based on the aglycone sarsapogenin, sterols, volatile oils Indications: Eczema, psoriasis, BPH, waning libido, RA, gout Cautions/Contraindications: Considered safe. Safety rating during pregnancy and lactation not established. Tribulus terrestris (Puncture vine) Primary Actions: Endocrine modulator (androgen) Constituents: Alkaloids (harmane and norharmane) Indications: Lowered libido, erectile function, fatigue and debility, BPH Cautions/Contraindications: May cause paresis in large doses. Perilous to bicycle tires Valeriana officinalis Primary Actions: Sedative, nervine, (Valerian) hypotensive, anodyne, antispasmodic, emmenagogue, decongestant, mild carminative. Constituents: Iridoids, valpotriates, baldrinals, essential oils, valerianic acid Indications: Deficient pattern anxiety and insomnia, sinus congestion, pain conditions. Cautions/Contraindications: Considered safe. May potentiate other anxiolytics, particularly benzodiazepines. Nutrition VASCULAR HEALTH T2DM incidence in the US has Erectile dysfunction increased. This increase is (ED) is common in associated with sedentary lifestyle, patients with obesity, and an aging population. cardiovascular disease Obesity is a major risk factor for ED (CVD). in diabetics, with a prevalence of ED affects quality of life 32.2% in the US. Testosterone and is an independent deficiency and Metabolic syndrome risk factor for are strongly associated. future cardiovascular events. A 3-year time period between onset of ED symptoms and CVD event allows for risk mitigation. Sexual function should be included in CVD risk assessment for all men. DIET Eating a balanced diet help maintain sexual function and decrease the risk of ED. A study found that men who more strictly followed a Mediterranean diet had a reduced risk of developing ED. In particular, they consumed less red or processed meat and primarily ate: Fruits, vegetables, legumes, nuts, Fish Another study similarly found that eating more fruits, vegetables, and flavonoids lowered the risk of ED in men ages 18 to 40. FREE RADICALS Oxidative stress is involved in arteriogenic ED, which may result from lack of perfusion, antioxidant deficiency, and waste product accumulation. Oxidative radicals contribute to impaired endotheliumdependent smooth muscle relaxation, mitochondrial injury, endothelial structural damage, and erectile tissue fibrosis in arteriogenic ED.  - Antioxidant therapy can efficiently improve molecular and ultrastructural alterations in erectile tissue, but it may not have a significant effect on fibrosis and functional deficit. Long-term consumption of dietary antioxidants may improve erectile function by removing oxidative products and preserving NO bioavailability and endothelial and mitochondrial structural integrity. DIET & PAD (Peripheral artery disease) A diet without the right balance of nutrients can contribute to the development and progression of Peripheral Artery Disease Following a heart-healthy diet is key, which involves reducing intake of