Miscarriage (Spontaneous Abortion)

Miscarriage facts

• Spontaneous miscarriage is the loss of a pregnancy that ends spontaneously before the fetus can survive.
• Exercise, working, and intercourse do NOT increase risk of miscarriage for women without underlying specific medical conditions that place them at risk.
• Causes for miscarriage include genetic abnormalities, infection, medications, hormonal effects, structural abnormality of the uterus, and immune abnormalities.
• After an isolated miscarriage, the probability of having a normal term pregnancy in the future is high.
• Treatment of recurrent miscarriage is directed toward the underlying cause.

What is a miscarriage?

A miscarriage is any pregnancy that ends spontaneously before the fetus can survive. A miscarriage is medically referred to as a spontaneous abortion. The World Health Organization defines this unsurvivable state as an embryo or fetus weighing 500 grams or less, which typically corresponds to a fetal age (gestational age) of 20 to 22 weeks or less. Miscarriage occurs in about 8% to 20% of all recognized pregnancies, and usually occurs before the 13th week of pregnancy. With the development of highly sensitive assays for hCG levels that can detect an early pregnancy even prior to the expected next period (menstruation), researchers have been able to show that around half of all pregnancies (recognized and unrecognized) are lost. Because the loss occurs so early, many miscarriages occur without the woman ever having known she was pregnant. Of those miscarriages that occur before the eighth week, a portion have no fetus associated with the sac or placenta. This condition is called blighted ovum, and many women are surprised to learn that there was never an embryo inside the sac.

Chances of miscarriage decrease significantly once fetal heart function is detected in a given pregnancy.

A woman who may be showing the signs of a possible miscarriage (such as vaginal bleeding) may have her pregnancy referred to as a "threatened abortion."

What causes a miscarriage, and what are the tests for the different causes?

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The cause of a miscarriage cannot always be determined. The most common known causes of miscarriage in the first third of pregnancy (1st trimester) are chromosomal abnormalities, collagen vascular disease (such as lupus), diabetes, other hormonal problems, infection, and congenital (present at birth) abnormalities of the uterus. Chromosomal abnormalities of the fetus are the most common cause of early miscarriages, including blighted ovum (see above). Each of the causes will be described below.

Chromosomal abnormalities

Chromosomes are microscopic components of every cell in the body that carry all of the genetic material that determines hair color, eye color, and our overall appearance and makeup. These chromosomes duplicate themselves and divide many times during the process of development, and there are numerous points along the way where a problem can occur. Certain genetic abnormalities are known to be more prevalent in couples that experience repeated pregnancy losses. These genetic traits can be screened for by blood tests prior to trying to conceive.

Half of the fetal tissue from 1st trimester miscarriages contain abnormal chromosomes. This number drops to 24% with 2nd trimester miscarriages. In other words, abnormal chromosomes are more common with 1st trimester than with 2nd trimester miscarriages. First trimester miscarriages are so very common that unless they occur more than once, they are not considered "abnormal" per se. They do not prompt further evaluation unless they occur more than once. In contrast, 2nd trimester miscarriages are more unusual, and therefore may trigger evaluation even after a first occurrence. It is therefore clear that causes of miscarriages seem to vary according to trimester.

Chromosomal abnormalities also become more common with aging, and women over age 35 have a higher rate of miscarriage than younger women. Advancing maternal age is the most significant risk factor for early miscarriage in otherwise healthy women.

Collagen vascular diseases

Collagen vascular diseases are illnesses in which a person's own immune system attacks their own organs. These diseases can be potentially very serious, either during or between pregnancies. In these diseases, a woman makes antibodies to her own body's tissues. Examples of collagen vascular diseases associated with an increased risk of miscarriage are systemic lupus erythematosus, and antiphospholipid antibody syndrome. Blood tests can confirm the presence of abnormal antibodies and are used in the diagnose of these conditions.

Diabetes

Diabetes generally can be well managed during pregnancy, if a woman and her health care professional work closely together. However, if the diabetes is insufficiently controlled, not only is the risk of miscarriages higher, but the baby can have major birth defects. Other problems can also occur in relation to diabetes during pregnancy. Good control of blood sugars during pregnancy is very important.

Hormonal factors

Hormonal factors may be associated with an increased risk of miscarriage, including Cushing's Syndrome, thyroid disease, and polycystic ovary syndrome (PCOS). It also has been suggested that inadequate function of the corpus luteum in the ovary (which produced progesterone necessary for maintenance of the very early stages of pregnancy) may lead to miscarriage. Termed "luteal phase defect," this is a controversial issue, since several studies have not supported the theory of luteal phase defect as a cause of pregnancy loss.

Infections

Maternal infection with a large number of different organisms has been associated with an increased risk of miscarriage. Fetal or placental infection by the offending organism then leads to pregnancy loss. Examples of infections that have been associated with miscarriage include infections byListeria monocytogenes, Toxoplasma gondii, parvovirus B19, rubella, herpes simplex, cytomegalovirus, and lymphocytic choriomeningitis virus.

Abnormal structural anatomy

Abnormal anatomy of the uterus can also cause miscarriages. In some women there can be a tissue bridge (uterine septum), that acts like a partial wall dividing the uterine cavity into sections. The septum usually has a very poor blood supply, and is not well suited for placental attachment and growth. Therefore, an embryo implanting on the septum would be at increased risk of miscarriage.

Other structural abnormalities can result from benign growths in the uterus called fibroids. Fibroid tumors (leiomyomata) are benign growths of muscle cells in the uterus. While most fibroid tumors do not cause miscarriages, (in fact, they are a rare cause of infertility), some can interfere with the embryo implantation and the embryo's blood supply, thereby causing miscarriage.

Other causes

Invasive surgical procedures in the uterus, such as amniocentesis and chorionic villus sampling, also slightly increase the risk of miscarriage.

What does NOT cause miscarriage?

It must be emphasized that exercise, working, and sexual intercourse do not increase the risk of pregnancy loss in routine (uncomplicated) pregnancies. However, in the unusual circumstance where a woman is felt by her physician to be at higher risk of spontaneous abortion, she may be advised to stop working and refrain from having sexual intercourse. Women with past history of premature delivery and other specific obstetrical conditions might fall under this category.

Are there lifestyle factors associated with miscarriage?

Smoking more than 10 cigarettes per day is associated with an increased risk of pregnancy loss, and some studies have even shown that the risk of miscarriage increases with paternal smoking. Other factors, such as alcohol use, fever, use of nonsteroidal anti-inflammatory drugs around the time of embryo implantation, and caffeine use have all been suggested to increase the risk of miscarriage, although more studies are needed to fully clarify any potential risks associated with these factors. Of course, alcohol is a known teratogen (a chemical that can damage the developing fetus), so pregnant women are advised to abstain from drinking alcoholic beverages.

What are the symptoms of a miscarriage?

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Cramping and vaginal bleeding are the most common symptoms noticed with spontaneous abortion. The cramping and bleeding may be very mild, moderate, or severe. There is no particular pattern as to how long the symptoms will last.

Vaginal bleeding during early pregnancy is often referred to as a "threatened abortion." The term threatened abortion is used since miscarriage does not always follow vaginal bleeding in early pregnancy, even after repeated episodes or large amounts of bleeding. Studies have shown that most pregnancies with demonstrated fetal cardiac activity that have vaginal bleeding at 7 to 11 weeks of gestation will result in an ongoing pregnancy.

What will the doctor look for during an examination with suspected miscarriage?

A woman's cervix might have some bloody discharge, but nothing else unusual will be characteristic of threatened abortion. Some women will have mild uterine tenderness during the manual examination of the uterus. The doctor may look to see if the cervix is dilated and will check to see if the uterus is enlarged to an extent appropriate for gestational age of the pregnancy.

How is threatened abortion evaluated?

Pelvic ultrasound is used to visualize fetal heartbeat and to determine whether a pregnancy is still viable. The ultrasound examination can also distinguish between intrauterine and ectopic pregnancies. The doctor may also order blood levels of serial human chorionic gonadotrophin (HCG) to help determine the viability of a pregnancy if the ultrasound examination is not conclusive. During the evaluation, the woman may be advised to rest and avoid sexual intercourse (activity).

What are common terms a woman might hear during evaluation for miscarriage?

1. "Miscarriage" (spontaneous abortion) is termination of pregnancy before the fetus is viable (able to survive).
2. "Complete abortion" describes spontaneous (not intentionally induced by medication or procedures) passage of all fetal and placental tissue. This is common prior to 12 weeks' gestation.
3. "Incomplete abortion" is when some, but not all, the fetal and placental tissue is expelled.
4. "Products of conception" refers to the combination of fetal and placental tissue.
5. "Threatened abortion" is when a miscarriage does not actually occur, but there is vaginal bleeding from the uterus. The cervix will not be dilated and does not show signs of imminent passage of fetal and placental tissue.
6. "Missed abortion" describes a fetal death in the uterus prior to viability, but the products of conception are not passed.
7. A "septic (infectious) abortion" is caused by bacterial infection and accompanied by fever, chills, pain, and a pus-containing discharge.

What treatment can a woman expect when she has had a miscarriage?

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The central goal of the doctor in this situation will be to try to figure out whether the woman has passed all of the tissue from the fetus and placenta. If she has passed all the tissue, she may only require observation by medical personnel. On the other hand, a woman who has not passed all of the tissue (incomplete abortion) will usually need suction dilation and curettage (D&C) of the uterus to remove any retained products of the pregnancy. This procedure is done with local anesthesia, and sometimes antibiotics may be prescribed for the woman to prevent infection.

When should a woman receive evaluation for underlying causes of pregnancy loss?

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Currently, most practitioners will not initiate an extensive medical evaluation for a single pregnancy loss, because a woman has a high probability of having a normal pregnancy even after two consecutive miscarriages.

Recurrent pregnancy loss (RPL) has been inconsistently defined. When defined as 3 consecutive pregnancy losses prior to 20 weeks from the last menstrual period, it affects approximately 1% to 2% of women. Because of the risk of subsequent miscarriages is similar among women that have had 2 versus 3 miscarriages, and the probability of finding a treatble etiology is similar among the two groups, most experts agree there is a role for evaluation after two losses.

For women with recurrent pregnancy loss, an evaluation will focus on the pattern and history of the prior miscarriages. Three consecutive miscarriages would suggest a woman should receive further evaluation.

Thus, the following tests are considered for women with three consecutive miscarriages.

Blood testing can be ordered to identify chromosomal abnormalities in the couple that could be transmitted to the fetus. The couple can each appear completely normal but still carry chromosomal defects, which, when combined, can be lethal to the embryo. This type of testing is called karyotyping, and it is performed on both members of the couple. A hysterosalpingogram (HSG) can identify anatomical abnormalities within the uterus.

Antinuclear antibody, anticardiolipin antibody, VDRL, RPR, and lupus anticoagulant are some of the blood tests used to diagnose autoimmune diseases that can cause recurrent miscarriage.

As described above, some of these illnesses will already by apparent to the woman and her doctor, but not all cases. Other antibody tests may be performed as well.

Can something be done to prevent future miscarriages?

The treatment of recurrent miscarriage depends on what is believed to be the underlying cause. This often is not as simple as it sounds. Careful evaluation may turn up several potential factors which alone or together may be responsible for the pregnancy losses. If a chromosomal problem is found in one or both persons, then counseling as to future risks is the only option for the couple, since there is currently no method to correct genetic problems.

If a structural problem is encountered with the uterus, surgical correction could be contemplated. It should be emphasized that just because a structural abnormality is found, it does not necessarily mean that it caused the miscarriage. Removal of a fibroid or uterine septum does not guarantee a future successful pregnancy, since the fibroid or uterine septum may not have been the cause of miscarriage in the first place.

Adequate control of diabetes and thyroid disease is critical in trying to prevent recurrent pregnancy loss in women with those conditions. For women with immunologic problems, such as such as systemic lupus erythematosus and antiphospholipid antibody syndrome, certain medications are being studied that may be useful in achieving successful pregnancy outcomes. Blood thinners such as aspirin and heparin can, in some cases, prevent further pregnancy loss.

The use of progesterone to increase the blood levels of this hormone is sometimes used for patients with recurrent pregnancy loss, although large-scale controlled studies that confirm the utility of progesterone supplementation have not been carried out. However, many physicians report success with progesterone therapy. Progesterone may be given as vaginal suppositories, or in tablet or gel form.

In dealing with recurrent pregnancy loss, it is important to realize that even though apparently obvious problems can be corrected, a miscarriage can still occur. This is not to say that attempts should not be taken to correct identified abnormalities that have been historically associated with miscarriage. However, no treatment can be guaranteed. Even with repeated miscarriages, there is still a very good chance of achieving a successful pregnancy. Early pregnancy and pre-pregnancy counseling can help identify risk factors and allow the practitioner to provide any special care that may be needed.

source:medicinenet.com

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Getting Too Much of Vitamins And Minerals The health consequences of going overboard on vitamins and minerals.

Nowadays, everything from bottled water to orange juice seems to have souped-up levels of vitamins and minerals in it. That may sound like a way to help cover your nutritional bases, especially if your diet is less than stellar.

But are you in danger of getting too much of these important nutrients? And can these overloads hurt you?

Yes, if you're routinely taking megadoses. For instance, too much vitamin C or zinc could cause nausea, diarrhea, and stomach cramps. Too much selenium could lead to problems including hair loss, gastrointestinal upset, fatigue, and mild nerve damage.

Most people aren't getting megadoses. Still, if you eat a fortified cereal at breakfast, grab an energy bar between meals, have enriched pasta for dinner, and take a daily multivitamin, you could easily be over the recommended daily intake of a host of nutrients.

When it comes to vitamins and minerals, more is not necessarily better. Here's what you need to know to avoid overdoing it.

Look Beyond Your Plate

Chances are, the unfortified foods you eat aren't a problem. "It's pretty hard to overdo it from food alone," says Johanna Dwyer, DSc, RD, a senior research scientist with the National Institutes of Health's Office of Dietary Supplements.

A few rare cases in medical journals have described, for example, an overload of vitamin A in a person who ate polar bear liver, a meat with extremely high amounts of this vitamin. Signs of a surplus of vitamin A may include nausea, blurred vision, and dizziness.

And if you eat handfuls of Brazil nuts every day, you could be way over the Tolerable Upper Intake Limit (the maximum per day that is unlikely to cause harm, as determined by the Institute of Medicine) for selenium. Just one ounce of Brazil nuts contains 544 micrograms of selenium. The Tolerable Upper Intake Limit is 400 micrograms per day -- and less if you're younger than 14.

Since polar bear liver and sacks of Brazil nuts are probably not on your menu, you'll want to think about the supplements you take and fortified foods or drinks.

Supplements: Check the Dose

"Most people don't realize there's no real advantage to taking more than the recommended amounts of vitamins and minerals, and they don't recognize there may be disadvantages," Dwyer says.

"If you're taking a supplement, stick to one that's no more than the Daily Value," Dwyer says.

Talk with your doctor about any supplements you're taking, including vitamins and minerals, and the dose you're taking, too. That way, your doctor can help you keep doses in a safe range.

"If you're taking a basic multivitamin, there's no need to fear taking too much," says Andrew Shao, PhD, senior vice president of scientific and regulatory affairs for the Council for Responsible Nutrition, a trade group for the supplements industry.

"Most multivitamins have such a wide margin of safety that even when you're combining them with fortified foods, it's still not going to cause you to keel over," Shao says.

"I have not seen someone off the street who was taking a toxic level of vitamin A or D -- those are very unusual," says David Katz, MD, MPH, director of the Yale University Prevention Research Center in New Haven, Conn., whose medical practice specializes in nutrition. "What I'm more likely to see is a person with a dosing level of supplements that's higher than optimal."

Scientists don't yet know if routinely getting a little bit too much of a vitamin or mineral (as opposed to a megadose) is a problem, Katz says.

"There might be hints of concern, but they would be very subtle signs," he says.

These fairly mild symptoms may include difficulty sleeping or concentrating, nerve problems such as numbness or tingling, or feeling more irritable -- depending on the nutrient that's going overboard.

Katz tells WebMD that a bigger concern is that we're "garnishing the food supply with overfortification."

He says manufacturers have shifted their focus from what they've taken out of food -- such as its fat, sugar, or salt -- to what they're putting in, whether it's vitamin D, probiotics, or omega-3 fats -- whatever nutrient is in vogue.

"When more and more foods are enhanced, it becomes impossible for consumers to know what dose they're getting over the course of a day," says Katz. "Clinicians have to realize we might be introducing new dietary imbalances because of this practice."

Three Nutrients to Watch

Dwyer says vitamin D, calcium, and folic acid are three nutrients you may get too much of through a combination of food and supplements.

Adults who regularly far exceed the 4,000 international units (IUs) daily safe upper limit for vitamin D might be setting themselves up for kidney stones down the road -- a health problem that may also occur with excessive intake of calcium, whose upper limit range is 2,000-2,500 milligrams daily.

Folic acid is added to enriched grain products -- white flours, pasta, rice, breads, and cereals -- to help prevent birth defects in babies due to folic acid deficiency in pregnant women..

While folic acid fortification has successfully cut the number of birth defects by 25% to 50%, it might have created other health concerns in people getting too much. (There's no need to worry about foods naturally rich in folate.)

It's not that hard to get more than 1,000 micrograms of folic acid a day (the safe upper limit for adults) from fortified foods and supplements on a regular basis. Doing so might hide the signs of a vitamin B12 deficiency in older adults. Vitamin B12 deficiency can sometimes lead to permanent nerve damage if left untreated.

What's more, some recent studies have hinted that high levels of folic acid may be linked with a greater risk for lung and prostate cancers. These studies do not prove cause and effect, however.

"Most people can now get enough folic acid without having to rely on supplements," Dwyer says.

In fact, she says, "most people have no problem [with getting too much vitamins or minerals] if they start with food, which is the healthiest and safest way to get them."

SOURCE:WEBMD

Tips to Strengthen Your Immune System,Top supplements

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enjoy Regular Sex

It turns out that sex doesn't just make you feel good -- it's good for you, too. Studies have shown that a good sex life can be a boost to health. One study looked at the connection between sexual activity and health in people middle-aged and older. The researchers found that those who had frequent sex were in better overall health than those who had sex less often.

Reduce Your Stress

Some stress can be a good thing. It's your body's way of preparing for a challenge, such as giving a presentation. But a steady stream of stress can be bad for your health. Studies show it can even weaken your immune system -- your body's system for fighting off disease and illness. Reduce your stress by avoiding whatever stressors you can. Take the time to relax and do things you enjoy.

Get a Pet

There's a reason dogs are called "man's best friend." Dogs and other pets can offer us companionship, exercise, and even good health. Studies have found that having a pet can help reduce blood pressure, lower cholesterol levels, and improve heart health. One study showed that having a dog can help improve immune system development and may reduce the risks of allergies in children.

Build a Strong Social Network

We all know friends are important, but strong social ties can also have a big effect on your health. A recent study found that people with strong relationships were 50% more likely to survive than those with poor social ties. To broaden your social network, try volunteering, taking a class, or joining a group that interests you. And be sure to nurture the bonds you already have.

Keep a Positive Attitude

Positive thoughts can give your immune system a healthy boost. One study of law students found that when they were feeling more optimistic, their immune system was stronger. To increase your optimism, take time to savor the things you enjoy, look for the silver lining in difficult situations, and try not to dwell on negative thoughts.Have a Laugh

A good belly laugh might be good for you. While there's some evidence that laughter may help boost our immune system, overall research results have been mixed. A group of researchers who looked at several studies about laughter and immune function found that people who laughed out loud at funny videos had higher immune function after watching the video. But more studies are needed to prove whether laughter actually helps prevent or minimize illness.

eat Your Antioxidants

Eating plenty of fruits and vegetables can help you get a healthy dose of antioxidants. These substances in foods help protect your cells from free radicals, molecules that can damage cells. To get a wide range of antioxidants, choose fruits and vegetables of different colors, such as oranges, green peppers, broccoli, kiwi, strawberries, carrots, watermelon, papaya, leafy greens, and cantaloupe.

Take Your Vitamins

If you have a feeling your diet is lacking, consider taking a multivitamin. A daily multivitamin will help ensure that your body is getting all of the building blocks for a healthy immune system. Some nutrients that may be especially important for immune system health include selenium, vitamins A, C, D, and E, zinc, and magnesium.

Avoid Empty Calories

Processed foods such as fast foods, snack foods, candy, and soda don't provide much in the way of vitamins, fiber, or other nutrients. And they often contain other additives and chemicals that may not be good for your body. When you choose these foods over more nutrient-rich foods such as vegetables, fruits, and whole grains, you risk depleting your body of essential nutrients.

Consider Herbs and Supplements

Many people take herbs or supplements to improve their overall health. Some supplements have been shown to affect the immune system. But more well-designed studies are needed to learn their beneficial effects on humans. These include garlic, ginseng, milk thistle, astragalus, and probiotics such as lactobacillus and bifidobacterium. Talk with your doctor if you have questions about which supplements may be good for you.

Keep Your Body Moving

One simple way to strengthen your immune system is by exercising. Getting regular exercise can also reduce stress and help lower your risk of osteoporosis, heart disease, and certain types of cancer. You get the most benefit when you exercise at a moderate level a few times a week. Any type of movement is helpful, including bicycling, walking, yoga, swimming, or playing golf.

Get a Good Night's Sleep

Without enough sleep, your immune system may not have the resources it needs to fight off illness. Most adults need about seven to nine hours of sleep each night. You can help yourself to a more restful sleep by keeping a regular schedule, getting exercise, avoiding caffeine and alcohol close to bedtime, relaxing before bedtime, and keeping your bedroom at a comfortable temperature.

Limit Alcohol

Drinking alcohol is part of our culture. Many people drink at meals and at parties as a way to socialize and celebrate. But drinking too much alcohol can weaken your immune system and cause you to get sick more often. To minimize risk, men should have no more than two drinks per day. Women should not have more than one drink per day.

Kick the Nicotine Habit

Here's another reason to give up smoking -- it weakens your immune system. Even if you're just an occasional smoker, you're still at risk. According to the U.S. surgeon general, even low levels of exposure to tobacco can cause health problems, including heart attack, stroke, and asthma. If you need help quitting, talk with your doctor.

Wash Your Hands

One of the easiest ways to help your immune system fight illness is to wash your hands regularly. It's also one of the best ways to keep yourself and others healthy. Be sure to use soap and clean, running water, and wash for at least 20 seconds. If you don't have access to soap and water, use an alcohol-based hand sanitizer that has at least 60% alcohol.

TOP SUPPLEMENTS

• Alpha Lipoic Acid (ALPHA-LIPOIC ACID) Overview Information

  Alpha-lipoic acid is a vitamin-like chemical called an antioxidant. Yeast, liver, kidney, spinach, broccoli, and potatoes are good sources of alpha-lipoic acid. It is also made in the laboratory for use as medicine.
  
  Alpha-lipoic acid is used for diabetes and nerve-related symptoms of diabetes including burning, pain, and numbness in the legs and arms. High doses of alpha-lipoic acid are approved in Germany for the treatment of these symptoms.
  
  Some people use alpha-lipoic acid for memory loss, chronic fatigue syndrome (CFS), HIV/AIDS, cancer, liver disease, diseases of the heart and blood vessels (including a disorder called cardiac autonomic neuropathy) and Lyme disease.
  
  Alpha-lipoic acid is also used to treat eye-related disorders, such as damage to the retina, cataracts, glaucoma, and an eye disease called Wilson’s disease.
  
  

  How does it work?

  Alpha-lipoic acid seems to help prevent certain kinds of cell damage in the body, and also restores vitamin levels such as vitamin E and vitamin C. There is also evidence that alpha-lipoic acid can improve the function and conduction of neurons in diabetes.
  
  Alpha-lipoic acid is used in the body to break down carbohydrates and to make energy for the other organs in the body.
  
  Alpha-lipoic acid seems to work as an antioxidant, which means that it might provide protection to the brain under conditions of damage or injury. The antioxidant effects might also be helpful in certain liver diseases.

• APPLE CIDER VINEGAR Overview Information

  Apple cider vinegar is fermented juice from crushed apples. Like apple juice, it probably contains some pectin; vitamins B1, B2, and B6; biotin; folic acid; niacin; pantothenic acid; and vitamin C. It also contains small amounts of the minerals sodium, phosphorous, potassium, calcium, iron, and magnesium. Apple cider vinegar can also contain significant quantities of acetic acid and citric acid. It is used to make medicine.
  
  Apple cider vinegar is used alone or with honey for weak bones (osteoporosis), weight loss, leg cramps and pain, upset stomach, sore throats, sinus problems, high blood pressure, arthritis, to help rid the body of toxins, stimulate thinking, slow the aging process, regulate blood pressure, reduce cholesterol, and fight infection.
  
  Some people apply apple cider vinegar to the skin for acne, as a skin toner, to soothe sunburn, for shingles, insect bites, and to prevent dandruff. It is also used in the bath for vaginal infections.
  
  In foods, apple cider vinegar is used as a flavoring agent.
  
  It can be hard to know what’s in some apple cider vinegar products. Laboratory analysis of commercially available apple cider vinegar tablets shows wide variation in what they contain. Amounts of acetic acid ranged from about 1% to 10.57%. Amounts of citric acid ranged from 0% to about 18.5%. Amounts of ingredients listed on the product labels didn’t match the laboratory findings. In the US, there is no real definition in the law of what apple cider vinegar must contain to be called apple cider vinegar. So, it is impossible to tell from these analyses whether these commercial products actually contain any apple cider vinegar.
  
  

  How does it work?

  Apple cider vinegar is the fermented juice of crushed apples. It contains acetic acid and nutrients such as B vitamins and vitamin C. Apple cider vinegar might help lower blood sugar levels in people with diabetes by changing how foods get absorbed from the gut. Apple cider vinegar might prevent the breakdown of some foods. 

• BLACK COHOSH Overview Information

  Black cohosh is an herb. The root of this herb is used for medicinal purposes. Black cohosh was first used for medicinal purposes by Native American Indians, who introduced it to European colonists. Black cohosh became a popular treatment for women’s health issues in Europe in the mid-1950s.
  
  Since that time, black cohosh has commonly been used to treat symptoms of menopause, premenstrual syndrome (PMS), painful menstruation, acne, weakened bones (osteoporosis), and for starting labor in pregnant women.
  
  Black cohosh has also been tried for a lot of additional uses, such as anxiety, rheumatism, fever, sore throat, and cough, but it is not often used for these purposes these days.
  
  Some people also apply black cohosh directly on the skin. This is because there was some thought that black cohosh would improve the skin’s appearance. Similarly, people used black cohosh for other skin conditions such as acne, wart removal, and even the removal of moles, but this is seldom done anymore.
  
  Black cohosh also goes by the name “bugbane” because it was once used as an insect repellent. It is no longer used for this purpose. Frontiersmen had said that black cohosh was useful for rattlesnake bites, but no modern researchers have tested this.
  
  Do not confuse black cohosh with blue cohosh or white cohosh. These are unrelated plants. The blue and white cohosh plants do not have the same effects as black cohosh, and may not be safe.
  
  
  

  How does it work?

  The root of black cohosh is used for medicinal purposes. Black cohosh root contains several chemicals that might have effects in the body. Some of these chemicals work on the immune system and might affect the body’s defenses against diseases. Some might help the body to reduce inflammation. Other chemicals in black cohosh root might work in nerves and in the brain. These chemicals might work similar to another chemical in the brain called serotonin. Scientists call this type of chemical a neurotransmitter because it helps the brain send messages to other parts of the body.
  
  Black cohosh root also seems to have some effects similar to the female hormone, estrogen. In some parts of the body, black cohosh might increase the effects of estrogen. In other parts of the body, black cohosh might decrease the effects of estrogen. Estrogen itself has various effects in different parts of the body. Estrogen also has different effects in people at different stages of life. Black cohosh should not be thought of as an “herbal estrogen” or a substitute for estrogen. It is more accurate to think of it as an herb that acts similar to estrogen in some people.

• CALCIUM Overview Information

  Calcium is a mineral that is an essential part of bones and teeth. The heart, nerves, and blood-clotting systems also need calcium to work.
  
  Calcium is used for treatment and prevention of low calcium levels and resulting bone conditions including osteoporosis (weak bones due to low bone density), rickets (a condition in children involving softening of the bones), and osteomalacia (a softening of bones involving pain). Calcium is also used for premenstrual syndrome (PMS), leg cramps in pregnancy, high blood pressure in pregnancy (pre-eclampsia), and reducing the risk of colon and rectal cancers.
  
  Some people use calcium for complications after intestinal bypass surgery, high blood pressure, high cholesterol, Lyme disease, to reduce high fluoride levels in children, and to reduce high lead levels.
  
  Calcium carbonate is used as an antacid for “heartburn.” Calcium carbonate and calcium acetate are also used for reducing phosphate levels in people with kidney disease.
  
  Calcium-rich foods include milk and dairy products, kale and broccoli, as well as the calcium-enriched citrus juices, mineral water, canned fish with bones, and soy products processed with calcium.
  
  Calcium can interact with many prescription medications, but sometimes the effects can be minimized by taking calcium at a different time. See the section titled “Are there any interactions with medications?"
  
  

  How does it work?

  The bones and teeth contain over 99% of the calcium in the human body. Calcium is also found in the blood, muscles, and other tissue. Calcium in the bones can be used as a reserve that can be released into the body as needed. The concentration of calcium in the body tends to decline as we age because it is released from the body through sweat, skin cells, and waste. In addition, as women age, absorption of calcium tends to decline due to reduced estrogen levels. Calcium absorption can vary depending on race, gender, and age.
  
  Bones are always breaking down and rebuilding, and calcium is needed for this process. Taking extra calcium helps the bones rebuild properly and stay strong.

• CHROMIUM Overview Information

  Chromium is a metal. It is called an “essential trace element” because very small amounts of chromium are necessary for human health.
  
  Chromium is used for improving blood sugar control in people with prediabetes, type 1 and type 2 diabetes, and high blood sugar due to taking steroids.
  
  It is also used for depression, polycystic ovary syndrome (PCOS), lowering “bad” cholesterol, and raising “good” cholesterol in people taking heartmedications called beta blockers.
  
  Some people try chromium for body conditioning including weight loss, increasing muscle, and decreasing body fat. Chromium is also used to improve athletic performance and to increase energy.
  
  Chromium was discovered in France in the late 1790s, but it took until the 1960s before it was recognized as being an important trace element.
  
  

  How does it work?

  Chromium might help keep blood sugar levels normal by improving the way our bodies use insulin.

• Coenzyme Q10 (COENZYME Q-10) Overview Information

  Coenzyme Q-10 (CoQ-10) is a vitamin-like substance found throughout the body, but especially in the heart, liver, kidney, and pancreas. It is eaten in small amounts in meats and seafood. Coenzyme Q-10 can also be made in a laboratory. It is used as medicine.
  
  Many people use coenzyme Q-10 for treating heart and blood vessel conditions such as congestive heart failure (CHF), chest pain (angina), high blood pressure, and heart problems linked to certain cancerdrugs. It is also used for diabetes, gum disease (both taken by mouth and applied directly to the gums), breast cancer, Huntington’s disease, Parkinson’s disease, muscular dystrophy, increasing exercise tolerance, chronic fatigue syndrome (CFS), and Lyme disease. Some people think coenzyme Q-10 will treat hair loss related to taking warfarin (Coumadin), a medication used to slow blood clotting.
  
  Some people also think coenzyme Q-10 might help increase energy. This is because coenzyme Q-10 has a role in producing ATP, a molecule in body cells that functions like a rechargeable battery in the transfer of energy. Coenzyme Q-10 been tried for treating inherited or acquired disorders that limit energy production in the cells of the body (mitochondrial disorders), and for improving exercise performance.
  
  Some people have also used coenzyme Q-10 for strengthening the immune systems of people with HIV/AIDS, male infertility, migraineheadache, and counteracting muscle pain sometimes caused by a group of cholesterol-lowering medications called “statins.”
  
  Coenzyme Q-10 has even been tried for increasing life span. This idea got started because coenzyme Q-10 levels are highest in the first 20 years of life. By age 80, coenzyme-Q10 levels can be lower than they were at birth. Some people thought that restoring high levels of coenzyme-Q10 late in life might cause people to live longer. The idea works in bacteria, but not in lab rats. More research is needed to see if this works in people.
  
  It’s not only time that uses up the body’s store of coenzyme Q-10. Smoking does, too.
  
  Coenzyme Q-10 was first identified in 1957. The “Q-10” refers to the chemical make-up of the substance. These days coenzyme Q-10 is used by millions of people in Japan for heart disease, especially congestive heart failure. Coenzyme Q-10 is also used extensively in Europe and Russia. Most of the coenzyme Q-10 used in the US and Canada is supplied by Japanese companies. Coenzyme Q-10 is manufactured by fermenting beets and sugar cane with special strains of yeast.
  
  

  How does it work?

  Coenzyme Q-10 is an important vitamin-like substance required for the proper function of many organs and chemical reactions in the body. It helps provide energy to cells. Coenzyme Q-10 also seems to have antioxidant activity. People with certain diseases, such as congestive heart failure, high blood pressure, periodontal disease, Parkinson’s disease, certain muscular diseases, and AIDS, might have lower levels of coenzyme Q-10.

• DHEA Overview Information

  DHEA is a hormone that is naturally made by the human body. It can be made in the laboratory from chemicals found in wild yam and soy. However, the human body cannot make DHEA from these chemicals, so simply eating wild yam or soy will not increase DHEA levels. Don’t be misled by wild yam and soy products labeled as “natural DHEA.”
  
  DHEA is used for slowing or reversing aging, improving thinking skills in older people, and slowing the progress of Alzheimer’s disease.
  
  Athletes and other people use DHEA to increase muscle mass, strength, and energy. But DHEA use is banned by the National Collegiate Athletic Association (NCAA).
  
  DHEA is also used by men for erectile dysfunction (ED), and by healthy women and women who have low levels of certain hormones to improve well-being and sexuality.
  
  Some people try DHEA to treat systemic lupus erythematosus (SLE), weak bones (osteoporosis), multiple sclerosis (MS), low levels of steroid hormones (Addison’s disease), depression, schizophrenia, chronic fatigue syndrome (CFS), and to slow the progression of Parkinson’s disease. It is also used for preventing heart disease, breast cancer, diabetes, and metabolic syndrome.
  
  DHEA is used for weight loss, for decreasing the symptoms of menopause, and for boosting the immune system.
  
  People with HIV sometimes use DHEA to ease depression and fatigue.
  
  Women who have passed menopause sometimes use DHEA inside the vagina for strengthening the walls of the vagina and for increasing bone mineral density.
  
  Like many dietary supplements, DHEA has some quality control problems. Some products labeled to contain DHEA have been found to contain no DHEA at all, while others contained more than the labeled amount.
  
  DHEA is being investigated and may eventually be approved by the Food and Drug Administration (FDA) as a prescription drug for treating systemic lupus erythematosus (SLE) and improving bone mineral density in women with lupus who are taking steroid drugs for treatment. The FDA is still studying the pharmaceutical company’s application for approval.
  
  

  How does it work?

  DHEA is a “parent hormone” produced by the adrenal glands near the kidneys and in the liver. In men, DHEA is also secreted by the testes. It is changed in the body to a hormone called androstenedione. Androstenedione is then changed into the major male and female hormones.
  
  DHEA levels seem to go down as people get older. DHEA levels also seem to be lower in people with certain conditions like depression. Some researchers think that replacing DHEA with supplements might prevent some diseases and conditions.

• FLAXSEED Overview Information

  Flaxseed is the seed from the plant Linum usitatissimum. The seed or the seed oil is used to make medicine. The information on this page concerns medicine made from the SEED only. There is a separate listing for flaxseed OIL.
  
  People use flaxseed for many conditions related to the gastrointestinal (GI) tract, including ongoing constipation, colon damage due to overuse of laxatives, diarrhea, inflammation of the lining of the large intestine (diverticulitis), irritable bowel syndrome (IBS) or irritable colon, sores in the lining of the large intestine (ulcerative colitis), inflammation of the lining of the stomach (gastritis), and inflammation of the small intestine (enteritis).
  
  Flaxseed is also used for disorders of the heart and blood vessels, including high cholesterol, “hardening of the arteries” (atherosclerosis), high blood pressure (hypertension), and coronary artery disease.
  
  Flaxseed is also used for acne, attention deficit-hyperactivity disorder (ADHD), kidney problems in people with a disease called systemic lupus erythematosus (SLE), symptoms of menopause, and breast pain. It is also used for diabetes, obesity and weight loss, HIV/AIDS, depression, bladder infections, malaria, and rheumatoid arthritis.
  
  Other uses include treatment of sore throat, upper respiratory tract infections (URTI), and cough.
  
  Some people use flaxseed to lower their risk of getting weak bones (osteoporosis) and to protect against breast cancer, lung cancer, colon cancer, and prostate cancer.
  
  Flaxseed is sometimes applied to the skin for acne, burns, boils, eczema, psoriasis, and to soothe inflammation.
  
  

  How does it work?

  Flaxseed is a good source of dietary fiber and omega-3 fatty acids. The fiber in flaxseed is found primarily in the seed coat. Taken before a meal, flaxseed fiber seems to make people feel less hungry, so that they might eat less food. Researchers believe this fiber binds with cholesterol in the intestine and prevents it from being absorbed. Flaxseed also seems to make platelets, the blood cells involved in clotting, less sticky. Overall, flaxseed’s effects on cholesterol and blood clotting may lower the risk of “hardening of the arteries” (atherosclerosis).
  
  Flaxseed is sometimes tried for cancer because it is broken down by the body into chemicals called “lignans.” Lignans are similar to the female hormone estrogen - so similar, in fact, that they compete with estrogen for a part in certain chemical reactions. As a result, natural estrogens seem to become less powerful in the body. Some researchers believe that lignans may be able to slow down the progress of certain breast cancers and other types of cancers that need estrogen to thrive.
  
  For systemic lupus erythematosus (SLE), flaxseed is thought to improve kidney function by decreasing the thickness of blood, reducing cholesterol levels, and reducing swelling. 

• FOLIC ACID Overview Information

  Folic acid is a water-soluble B vitamin. Since 1998, it has been added to cold cereals, flour, breads, pasta, bakery items, cookies, and crackers, as required by federal law. Foods that are naturally high in folic acid include leafy vegetables (such as spinach, broccoli, and lettuce), okra, asparagus, fruits (such as bananas, melons, and lemons) beans, yeast, mushrooms, meat (such as beef liver and kidney), orange juice, and tomato juice.
  
  Folic acid is used for preventing and treating low blood levels of folic acid (folic acid deficiency), as well as its complications, including “tired blood” (anemia) and the inability of the bowel to absorb nutrients properly. Folic acid is also used for other conditions commonly associated with folic acid deficiency, including ulcerative colitis, liver disease, alcoholism, and kidney dialysis.
  
  Women who are pregnant or might become pregnant take folic acid to prevent miscarriage and “neural tube defects,” birth defects such as spina bifida that occur when the fetus’s spine and back don’t close during development.
  
  Some people use folic acid to prevent colon cancer or cervical cancer. It is also used to prevent heart disease and stroke, as well as to reduce blood levels of a chemical called homocysteine. High homocysteine levels might be a risk for heart disease.
  
  Folic acid is used for memory loss, Alzheimer’s disease, age-related hearing loss, preventing the eye disease age-related macular degeneration (AMD), reducing signs of aging, weak bones (osteoporosis), jumpy legs (restless leg syndrome), sleep problems, depression, nerve pain, muscle pain, AIDS, a skin disease called vitiligo, and an inherited disease called Fragile-X syndrome. It is also used for reducing harmful side effects of treatment with the medications lometrexol and methotrexate.
  
  Some people apply folic acid directly to the gum for treating gum infections.
  
  Folic acid is often used in combination with other B vitamins.
  
  

  How does it work?

  Folic acid is needed for the proper development of the human body. It is involved in producing the genetic material called DNA and in numerous other bodily functions.
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  Ginko (GINKGO) Overview Information

  Ginkgo is an herb. The leaves are generally used to make “extracts” that are used as medicine. However, a few medicines are made from the seed, but these are not well studied.
  
  Ginkgo is often used for memory disorders including Alzheimer’s disease. It is also used for conditions that seem to be due to reduced blood flow in the brain, especially in older people. These conditions include memory loss, headache, ringing in the ears, vertigo, difficulty concentrating, mood disturbances, and hearing disorders. Some people use it for other problems related to poor blood flow in the body, including leg pain when walking (claudication), and Raynaud’s syndrome (a painful response to cold, especially in the fingers and toes).
  
  Ginkgo leaf is also used for thinking disorders related to Lyme disease and depression.
  
  Some people use ginkgo to treat sexual performance problems. It is sometimes used to reverse the sexual performance problems that can accompany taking certain antidepressants called SSRIs.
  
  Ginkgo been tried for eye problems including glaucoma, diabetic eye disease, and age-related macular degeneration (AMD).
  
  The list of other uses of ginkgo is very long. This may be because this herb has been around for so long. Ginkgo biloba is one of the longest living tree species in the world. Ginkgo trees can live as long as a thousand years. Using ginkgo for asthma and bronchitis was described in 2600 BC.
  
  In manufacturing, ginkgo leaf extract is used in cosmetics. In foods, roasted ginkgo seed, which has the pulp removed, is an edible delicacy in Japan and China. Remember, though, the whole seed is LIKELY UNSAFE to eat.
  
  Ginkgo interacts with many medicines. Before taking it, talk with your healthcare provider if you take any medications.
  
  

  How does it work?

  Ginkgo seems to improve blood circulation, which might help the brain, eyes, ears, and legs function better. It may slow down Alzheimer’s disease by interfering with changes in the brain that interfere with thinking.
  
  Ginkgo seeds contain substances that might kill the bacteria and fungi that cause infections in the body. The seeds also contain a toxin that can cause side effects like seizure and loss of consciousness.

• GLUCOSAMINE HYDROCHLORIDE Overview Information

  Glucosamine is usually made from seashells, or it can be made in the laboratory. Glucosamine hydrochloride is one of several forms of glucosamine.
  
  Glucosamine hydrochloride is used for osteoarthritis, knee pain, back pain, and glaucoma. However, no one knows yet whether it is effective for any of these conditions. There have been some preliminary studies, but more research is needed.
  
  It is important to read the labels of glucosamine products carefully since several different forms of glucosamine are sold as supplements. These products may contain glucosamine sulfate, glucosamine hydrochloride, or N-acetyl-glucosamine. These different chemicals have some similarities; however, they may not have the same effects when taken as a dietary supplement. Most of the scientific research done on glucosamine has been done on glucosamine sulfate. See the separate listing for glucosamine sulfate. The information on this page is about glucosamine hydrochloride.
  
  Dietary supplements that contain glucosamine often contain additional ingredients. These additional ingredients are frequently chondroitin sulfate, MSM, or shark cartilage. Some people think these combinations work better than taking just glucosamine alone. So far, researchers have found no proof that combining the additional ingredients with glucosamine adds any benefit.
  
  Products that contain glucosamine and glucosamine plus chondroitin vary a great deal. Some do not contain what the label claims. The difference can range from 25% to 115%. Some products in the US that are labeled glucosamine sulfate are actually glucosamine hydrochloride with added sulfate. This product will likely have different effects than one which contains glucosamine sulfate.
  
  

  How does it work?

  Glucosamine in the body is used to make a “cushion” that surrounds the joints. In osteoarthritis, this cushion becomes thinner and stiff. Taking glucosamine hydrochloride as a supplement might help to supply the materials needed to rebuild the cushion.
  
  Some researchers believe that glucosamine hydrochloride might not work as well as glucosamine sulfate. They think the “sulfate” part of glucosamine sulfate is the important factor because sulfate is needed by the body to produce cartilage.

• MELATONIN Overview Information

  Melatonin is a hormone found naturally in the body. Melatonin used as medicine is usually made synthetically in a laboratory. It is most commonly available in pill form, but melatonin is also available in forms that can be placed in the cheek or under the tongue. This allows the melatonin to be absorbed directly into the body.
  
  People use melatonin to adjust the body’s internal clock. It is used for jet lag, for adjusting sleep-wake cycles in people whose daily work schedule changes (shift-work disorder), and for helping blind people establish a day and night cycle.
  
  Melatonin is also used for the inability to fall asleep (insomnia); delayed sleep phase syndrome (DSPS); insomnia associated with attention deficit-hyperactivity disorder (ADHD); insomnia due to certain high blood pressuremedications called beta-blockers; and sleep problems in children with developmental disorders including autism, cerebral palsy, and mental retardation. It is also used as a sleep aid after discontinuing the use of benzodiazepine drugs and to reduce the side effects of stopping smoking.
  
  Some people use melatonin for Alzheimer’s disease, ringing in the ears, depression, chronic fatigue syndrome (CFS), fibromyalgia, migraine and other headaches, irritable bowel syndrome (IBS), bone loss (osteoporosis), a movement disorder called tardive dyskinesia (TD), epilepsy, as an anti-aging agent, for menopause, and for birth control.
  
  Other uses include breast cancer, brain cancer, lung cancer, prostate cancer, head cancer, neck cancer, and gastrointestinal cancer. Melatonin is also used for some of the side effects of cancer treatment (chemotherapy) including weight loss, nerve pain, weakness, and a lowered number of clot-forming cells (thrombocytopenia).
  
  It is also used to calm people before they are given anesthesia for surgery.
  
  The forms of melatonin that can be absorbed through the cheek or under the tongue are used for insomnia, shift-work disorder, and to calm people before receiving anesthesia for surgery.
  
  Sometimes people apply melatonin to the skin to protect against sunburn.
  
  

  How does it work?

  Melatonin’s main job in the body is to regulate night and day cycles or sleep-wake cycles. Darkness causes the body to produce more melatonin, which signals the body to prepare for sleep. Light decreases melatonin production and signals the body to prepare for being awake. Some people who have trouble sleeping have low levels of melatonin. It is thought that adding melatonin from supplements might help them sleep.

• Niacin (NIACIN AND NIACINAMIDE (VITAMIN B3)) Overview Information

  Niacin and niacinamide are forms of Vitamin B3. Vitamin B3 is found in many foods including yeast, meat, fish, milk, eggs, green vegetables, beans, and cereal grains. Niacin and niacinamide are also found in many vitamin B complex supplements with other B vitamins.
  
  Niacin is used for high cholesterol. It is also used along with other treatments for circulation problems, migraineheadache, dizziness, and to reduce the diarrhea associated with cholera. Niacin is also used for preventing positive urine drug screens in people who take illegal drugs.
  
  Niacinamide is used for treating diabetes and two skin conditions called bullous pemphigoid and granuloma annulare.
  
  Niacin or niacinamide is used for preventing vitamin B3 deficiency and related conditions such as pellagra. Each of these forms of vitamin B3 is used for schizophrenia, hallucinations due to drugs, Alzheimer’s disease and age-related loss of thinking skills, chronic brain syndrome, depression, motion sickness, alcohol dependence, and fluid collection (edema).
  
  Some people use niacin or niacinamide for acne, leprosy, attention deficit-hyperactivity disorder (ADHD), memory loss, arthritis, preventing premenstrual headache, improving digestion, protecting against toxins and pollutants, reducing the effects of aging, lowering blood pressure, improving circulation, promoting relaxation, improving orgasm, and preventing cataracts.
  
  Niacinamide is applied to the skin for treating a skin condition called inflammatory acne vulgaris.
  
  

  How does it work?

  Niacinamide can be made from niacin in the body. Niacin is converted to niacinamide when it is taken in amounts greater than what is needed by the body. Niacin and niacinamide are easily dissolved in water and are well-absorbed when taken by mouth.
  
  Niacin and niacinamide are required for the proper function of fats and sugars in the body and to maintain healthy cells. At high doses, niacin and niacinamide can have different effects. Niacin might help people with heart disease because of its beneficial effects on clotting. It may also improve levels of a certain type of fat called triglycerides in the blood. Niacinamide has no beneficial effects on fats and should not be used for treating high cholesterol or high fat levels in the blood.
  
  Niacin deficiency can cause a condition called pellagra, which causes skin irritation, diarrhea, and dementia. Pellagra was common in the early twentieth century, but is less common now, since foods are now fortified with niacin. Pellagra has been virtually eliminated in western culture.
  
  People with poor diet, alcoholism, and some types of slow-growing tumors called carcinoid tumors might be at risk for niacin deficiency.

• MAGNESIUM Overview Information

  Magnesium is a mineral that is present in relatively large amounts in the body. Researchers estimate that the average person’s body contains about 25 grams of magnesium, and about half of that is in the bones. Magnesium is important in more than 300 chemical reactions that keep the body working properly. People get magnesium from their diet, but sometimes magnesium supplements are needed if magnesium levels are too low. Dietary intake of magnesium may be low, particularly among women.
  
  An easy way to remember foods that are good magnesium sources is to think fiber. Foods that are high in fiber are generally high in magnesium. Dietary sources of magnesium include legumes, whole grains, vegetables (especially broccoli, squash, and green leafy vegetables), seeds, and nuts (especially almonds). Other sources include dairy products, meats, chocolate, and coffee. Water with a high mineral content, or “hard” water, is also a source of magnesium.
  
  People take magnesium to prevent or treat magnesium deficiency. Magnesium deficiency is not uncommon in the US. It’s particularly common among African Americans and the elderly.
  
  Magnesium is also used as a laxative for constipation and for preparation of the bowel for surgical or diagnostic procedures. It is also used as an antacid for acid indigestion.
  
  Some people use magnesium for diseases of the heart and blood vessels including chest pain, irregular heartbeat, high blood pressure, high levels of “bad” cholesterol called low-density lipoprotein (LDL) cholesterol, low levels of “good” cholesterol called high-density lipoprotein (HDL) cholesterol, heart valve disease (mitral valve prolapse), and heart attack.
  
  Magnesium is also used for treating attention deficit-hyperactivity disorder (ADHD), anxiety, chronic fatigue syndrome (CFS), Lyme disease, fibromyalgia, leg cramps during pregnancy, diabetes, kidney stones, migraineheadaches, weak bones (osteoporosis), premenstrual syndrome (PMS), altitude sickness, urinary incontinence, restless leg syndrome, asthma, hayfever, multiple sclerosis, and for preventing hearing loss.
  
  Athletes sometimes use magnesium to increase energy and endurance.
  
  Some people put magnesium on their skin to treat infected skin ulcers, boils, and carbuncles; and to speed up wound healing. Magnesium is also used as a cold compress in the treatment of a severe skin infection caused by strep bacteria (erysipelas) and as a hot compress for deep-seated skin infections.
  
  Some companies that manufacturer magnesium/calcium combination supplements promote a 2:1 or 3:1 ratio as being ideal for absorption of these elements. However, there is no credible research to support this claim. Claims that coral calcium products have ideal combinations of magnesium and calcium to cure a variety of diseases and conditions are being carefully evaluated by the US Food and Drug Administration (FDA) and US Federal Trade Commission (FTC).
  
  

  How does it work?

  Magnesium is required for the proper growth and maintenance of bones. Magnesium is also required for the proper function of nerves, muscles, and many other parts of the body. In the stomach, magnesium helps neutralize stomach acid and moves stools through the intestine.

• Probiotics (LACTOBACILLUS) Overview Information

  Lactobacillus is a type of bacteria. There are lots of different species of lactobacillus. These are "friendly" bacteria that normally live in our digestive, urinary, and genital systems without causing disease. Lactobacillus is also in some fermented foods like yogurt and in dietary supplements.
  
  Lactobacillus is used for treating and preventing diarrhea, including infectious types such as rotaviral diarrhea in children and traveler's diarrhea. It is also used to prevent and treat diarrhea associated with using antibiotics.
  
  Some people use lactobacillus for general digestion problems; irritable bowel syndrome (IBS); colic in babies; Crohn's disease; inflammation of the colon; and a serious gut problem called necrotizing enterocolitis (NEC) in babies born prematurely. Lactobacillus is also used for infection with Helicobacter pylori, the type of bacteria that causes ulcers, and also for other types of infections including urinary tract infections (UTIs), vaginal yeast infections, to prevent the common cold in adults, and to prevent respiratory infections in children attending daycare centers. It is also being tested to prevent serious infections in people on ventilators.
  
  Lactobacillus is used for skin disorders such as fever blisters, canker sores, eczema (allergic dermatitis); and acne.
  
  It is also used for high cholesterol, lactose intolerance, Lyme disease, hives, and to boost the immune system.
  
  Women sometimes use lactobacillus suppositories to treat vaginal infections and urinary tract infections (UTIs).
  
  There are concerns about the quality of some lactobacillus products. Some products labeled to contain Lactobacillus acidophilus actually contain no lactobacillus acidophilus, or they contain a different strain of lactobacillus such as Lactobacillus bulgaricus. Some products are contaminated with “unfriendly” bacteria.
  
  

  How does it work?

  Many bacteria and other organisms live in our bodies normally. "Friendly" bacteria such as lactobacillus can help us break down food, absorb nutrients, and fight off "unfriendly" organisms that might cause diseases such as diarrhea.

• Red Yeast Rice (RED YEAST) Overview Information

  Red yeast is the product of rice fermented with Monascus purpureus yeast. Red yeast supplements are different from red yeast rice sold in Chinese grocery stores. People use red yeast as medicine.
  
  Red yeast is used for maintaining desirable cholesterol levels in healthy people, reducing cholesterol in people with high cholesterol, for indigestion, diarrhea, improving blood circulation, and for spleen and stomach health.
  
  In foods, red yeast is used as a food coloring for Peking duck.
  
  The active ingredient in red yeast is the same as the active ingredient in prescription drugs called statins used for high cholesterol. That’s why red yeast has all the possible side effects, drug interactions, and precautions associated with this type of drug. The American Heart Association warns against using red yeast until the results of long-term studies are in. You should talk with your healthcare provider if you plan to take red yeast.
  
  You may have come across a red yeast product called Cholestin, manufactured by Pharmanex. It was one of the most widely studied red yeast products. Originally, Cholestin contained the same active ingredient found in statin drugs. This caused the U.S. Food and Drug Administration (FDA) to call Cholestin an unapproved drug. Cholestin was reformulated so that its active ingredient is now something else.
  
  

  How does it work?

  Red yeast supplements are manufactured by culturing Monascus purpureus yeast on rice at carefully controlled temperature and growing conditions to increase the concentrations of chemicals that lower blood cholesterol and triglycerides. These chemicals are similar to the prescription drugs known as "statins," including lovastatin (Mevacor) and others.

• ST. JOHN'S WORT Overview Information

  St. John’s wort is an herb. Its flowers and leaves are used to make medicine.
  
  St. John’s wort is most commonly used for depression and conditions that sometimes go along with depression such as anxiety, tiredness, loss of appetite and trouble sleeping. There is some strong scientific evidence that it is effective for mild to moderate depression.
  
  Other uses include heart palpitations, moodiness and other symptoms of menopause, attention deficit-hyperactivity disorder (ADHD), obsessive-compulsive disorder (OCD), and seasonal affective disorder (SAD).
  
  St. John’s wort has been tried for exhaustion, stop-smoking help, fibromyalgia, chronic fatigue syndrome (CFS), migraine and other types of headaches, muscle pain, nerve pain, and irritable bowel syndrome. It is also used for cancer, HIV/AIDS, and hepatitis C.
  
  An oil can be made from St. John’s wort. Some people apply this oil to their skin to treat bruises and scrapes, inflammation and muscle pain, first degree burns, wounds, bug bites, hemorrhoids, and nerve pain. But applying St. John’s wort directly to the skin is risky. It can cause serious sensitivity to sunlight.
  
  St. John’s wort is native to Europe but is commonly found in the US and Canada in the dry ground of roadsides, meadows, and woods. Although not native to Australia and long considered a weed, St. John’s wort is now grown there as a crop. Today, Australia produces 20 percent of the world’s supply.
  
  The use of St. John’s wort dates back to the ancient Greeks. Hippocrates recorded the medical use of St. John’s wort flowers. St. John’s wort was given its name because it blooms about June 24th, the birthday of John the Baptist. “Wort” is an old English word for plant.
  
  France has banned the use of St. John’s wort products. The ban appears to be based on a report issued by the French Health Product Safety Agency warning of significant interactions between St. John’s wort and some medications. Several other countries, including Japan, the United Kingdom, and Canada, are in the process of including drug-herb interaction warnings on St. John’s wort products.
  
  The active ingredients in St. John’s wort can be deactivated by light. That’s why you will find many products packaged in amber containers. The amber helps, but it doesn’t offer total protection against the adverse effects of light.
  
  

  How does it work?

  For a long time, investigators thought a chemical in St. John’s wort called hypericin was responsible for its effects against depression. More recent information suggests another chemical, hyperforin, may play a larger role in depression. Hypericin and hyperforin act on chemical messengers in the nervous system that regulate mood.

• Vitamin C (VITAMIN C (ASCORBIC ACID)) Overview Information

  Vitamin C is a vitamin. Some animals can make their own vitamin C, but people must get this vitamin from food and other sources. Good sources of vitamin C are fresh fruits and vegetables, especially citrus fruits. Vitamin C can also be made in a laboratory.
  
  Most experts recommend getting vitamin C from a diet high in fruits and vegetables rather than taking supplements. Fresh-squeezed orange juice or fresh-frozen concentrate is a better pick than ready-to-drink orange juice. The fresh juice contains more active vitamin C. Drink fresh-frozen orange juice within one week after reconstituting it for the most benefit. It you prefer ready-to-drink orange juice, buy it 3 to 4 weeks before the expiration date, and drink it within one week of opening.
  
  Historically, vitamin C was used for preventing and treating scurvy. Scurvy is now relatively rare, but it was once common among sailors, pirates, and others who spent long periods of time onboard ships. When the voyages lasted longer than the supply of fruits and vegetables, the sailors began to suffer from vitamin C deficiency, which led to scurvy.
  
  These days, vitamin C is used most often for preventing and treating the common cold. Some people use it for other infections including gum disease, acne and other skin infections, bronchitis, human immunodeficiency virus (HIV) disease, stomach ulcers caused by bacteria called Helicobacter pylori, tuberculosis, dysentery (an infection of the lower intestine), and skin infections that produce boils (furunculosis). It is also used for infections of the bladder and prostate.
  
  Some people use vitamin C for depression, thinking problems, dementia, Alzheimer's disease, physical and mental stress, fatigue, and attention deficit-hyperactivity disorder (ADHD).
  
  Other uses include increasing the absorption of iron from foods and correcting a protein imbalance in certain newborns (tyrosinemia).
  
  There is some thought that vitamin C might help the heart and blood vessels. It is used for hardening of the arteries, preventing clots in veins and arteries, heart attack, stroke, high blood pressure, and high cholesterol.
  
  Vitamin C is also used for glaucoma, preventing cataracts, preventing gallbladder disease, dental cavities (caries), constipation, Lyme disease, boosting the immune system, heat stroke, hay fever, asthma, bronchitis, cystic fibrosis, infertility, diabetes, chronic fatigue syndrome (CFS), autism, collagen disorders, arthritis and bursitis, back pain and disc swelling, cancer, and osteoporosis.
  
  Additional uses include improving physical endurance and slowing aging, as well as counteracting the side effects of cortisone and related drugs, and aiding drug withdrawal in addiction.
  
  Sometimes, people put vitamin C on their skin to protect it against the sun, pollutants, and other environmental hazards. Vitamin C is also applied to the skin to help with damage from radiation therapy.
  
  

  How does it work?

  Vitamin C is required for the proper development and function of many parts of the body. It also plays an important role in maintaining proper immune function.

• VITAMIN D Overview Information

  Vitamin D is a vitamin. It can be found in small amounts in a few foods, including fatty fish such as herring, mackerel, sardines and tuna. To make vitamin D more available, it is added to dairy products, juices, and cereals that are then said to be “fortified with vitamin D.” But most vitamin D – 80% to 90% of what the body gets – is obtained through exposure to sunlight. Vitamin D can also be made in the laboratory as medicine.
  
  Vitamin D is used for preventing and treating rickets, a disease that is caused by not having enough vitamin D (vitamin D deficiency). Vitamin D is also used for treating weak bones (osteoporosis), bone pain (osteomalacia), bone loss in people with a condition called hyperparathyroidism, and an inherited disease (osteogenesis imperfecta) in which the bones are especially brittle and easily broken. It is also used for preventing falls and fractures in people at risk for osteoporosis, and preventing low calcium and bone loss (renal osteodystrophy) in people with kidney failure.
  
  Vitamin D is used for conditions of the heart and blood vessels, including high blood pressure and high cholesterol. It is also used for diabetes, obesity, muscle weakness, multiple sclerosis, rheumatoid arthritis, chronic obstructive pulmonary disease (COPD), asthma, bronchitis, premenstrual syndrome (PMS), and tooth and gum disease.
  
  Some people use vitamin D for skin conditions including vitiligo, scleroderma, psoriasis, actinic keratosis, and lupus vulgaris.
  
  It is also used for boosting the immune system, preventing autoimmune diseases, and preventing cancer.
  
  Because vitamin D is involved in regulating the levels of minerals such as phosphorous and calcium, it is used for conditions caused by low levels of phosphorous (familial hypophosphatemia and Fanconi syndrome) and low levels of calcium (hypoparathyroidism and pseudohypoparathyroidism).
  
  Vitamin D in forms known as calcitriol or calcipotriene is applied directly to the skin for a particular type of psoriasis.
  
  If you travel to Canada, you may have noticed that Canada recognizes the importance of vitamin D in the prevention of osteoporosis. It allows this health claim for foods that contain calcium: "A healthy diet with adequate calcium and vitamin D, and regular physical activity, help to achieve strong bones and may reduce the risk of osteoporosis.” But the US version of this osteoporosis health claim does not yet include vitamin D.
  
  

  How does it work?

  Vitamin D is required for the regulation of the minerals calcium and phosphorus found in the body. It also plays an important role in maintaining proper bone structure.
  
  Sun exposure is an easy, reliable way for most people to get vitamin D. Exposure of the hands, face, arms, and legs to sunlight two to three times a week for about one-fourth of the time it would take to develop a mild sunburn will cause the skin to produce enough vitamin D. The necessary exposure time varies with age, skin type, season, time of day, etc.
  
  It’s amazing how quickly adequate levels of vitamin D can be restored by sunlight. Just 6 days of casual sunlight exposure without sunscreen can make up for 49 days of no sunlight exposure. Body fat acts like a kind of storage battery for vitamin D. During periods of sunlight, vitamin D is stored in fatty fat and then released when sunlight is gone.
  
  Nevertheless, vitamin D deficiency is more common than you might expect. People who don’t get enough sun, especially people living in Canada and the northern half of the US, are especially at risk. Vitamin D deficiency also occurs even in sunny climates, possibly because people are staying indoors more, covering up when outside, or using sunscreens consistently these days to reduce skin cancer risk.
  
  Older people are also at risk for vitamin D deficiency. They are less likely to spend time in the sun, have fewer “receptors” in their skin that convert sunlight to vitamin D, may not get vitamin D in their diet, may have trouble absorbing vitamin D even if they do get it in their diet, and may have more trouble converting dietary vitamin D to a useful form due to aging kidneys. In fact, the risk for vitamin D deficiency in people over 65 years of age is very high. Surprisingly, as many as 40% of older people even in sunny climates such as South Florida don’t have enough vitamin D in their systems.
  
  Vitamin D supplements may be necessary for older people, people living in northern latitudes, and for dark-skinned people who need extra time in the sun, but don’t get it.

• VITAMIN E Overview Information

  Vitamin E is a vitamin that dissolves in fat. It is found in many foods including vegetable oils, cereals, meat, poultry, eggs, fruits, vegetables, and wheat germ oil. It is also available as a supplement.
  
  Vitamin E is used for treating vitamin E deficiency, which is rare, but can occur in people with certain genetic disorders and in very low-weight premature infants.
  
  Some people use vitamin E for treating and preventing diseases of the heart and blood vessels including hardening of the arteries, heart attack, chest pain, leg pain due to blocked arteries, and high blood pressure.
  
  Vitamin E is also used for treating diabetes and its complications. It is used for preventing cancer, particularly lung and oral cancer in smokers; colorectal cancer and polyps; and gastric, prostate, and pancreatic cancer.
  
  Some people use vitamin E for diseases of the brain and nervous system including Alzheimer’s disease and other dementias, Parkinson’s disease, night cramps, restless leg syndrome, and for epilepsy, along with other medications. Vitamin E is also used for Huntington’s chorea, and other disorders involving nerves and muscles.
  
  Women use vitamin E for preventing complications in late pregnancy due to high blood pressure (pre-eclampsia), premenstrual syndrome (PMS), painful periods, menopausal syndrome, hot flashes associated with breast cancer, and breast cysts.
  
  Sometimes vitamin E is used to lessen the harmful effects of medical treatments such as dialysis and radiation. It is also used to reduce unwanted side effects of drugs such as hair loss in people taking doxorubicin and lung damage in people taking amiodarone.
  
  Vitamin E is sometimes used for improving physical endurance, increasing energy, reducing muscle damage after exercise, and improving muscle strength.
  
  Vitamin E is also used for cataracts, asthma, respiratory infections, skin disorders, aging skin, sunburns, cystic fibrosis, infertility, impotence, chronic fatigue syndrome (CFS), peptic ulcers, for certain inherited diseases and to prevent allergies.
  
  Some people apply vitamin E to their skin to keep it from aging and to protect against the skin effects of chemicals used for cancer therapy (chemotherapy).
  
  The American Heart Association recommends obtaining antioxidants, including vitamin E, by eating a well-balanced diet high in fruits, vegetables, and whole grains rather than from supplements until more is known about the risks and benefits of taking supplements.
  
  

  How does it work?

  Vitamin E is an important vitamin required for the proper function of many organs in the body. It is also an antioxidant. This means it helps to slow down processes that damage cells.
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• webmd