Tyramine Health Dictionary

Tyramine: From 2 Different Sources


A variety of the chemical compound amine, which is derived from ammonia. A sympathomimetic agent with an action which resembles that of ADRENALINE, tyramine occurs in mistletoe, mature cheese, beers, red wine and decaying animal matter. This adrenaline e?ect is potentially dangerous for patients taking MONOAMINE OXIDASE INHIBITORS (MAOIS) – ANTIDEPRESSANT DRUGS – because, when combined with tyramine, the blood pressure rises sharply. Such patients should avoid taking cheese, beers and red wine.
Health Source: Medical Dictionary
Author: Health Dictionary
n. an amine naturally occurring in cheese. It has a similar effect in the body to that of *adrenaline. This effect can be dangerous in patients taking *MAO inhibitors (antidepressants), in whom blood pressure may become very high. Cheese is therefore not advised when such drugs are prescribed.
Health Source: Oxford | Concise Colour Medical Dictionary
Author: Jonathan Law, Elizabeth Martin

Moclobemide

A reversible monoamine oxidase inhibitor (see MONOAMINE OXIDASE INHIBITORS (MAOIS)), this drug is used as second-line treatment for patients with severe DEPRESSION. As with all MAOIs, those taking moclobemide should avoid too much tyramine-rich food – mature cheese, yeast extracts, fermented soya-bean products – and they should not take the drug with another antidepressant (see ANTIDEPRESSANT DRUGS).... moclobemide

Avocados

Nutritional Profile Energy value (calories per serving): Moderate Protein: Low Fat: High Saturated fat: High Cholesterol: None Carbohydrates: Moderate Fiber: High to very high Sodium: Low Major vitamin contribution: Vitamins A, folate, vitamin C Major mineral contribution: Potassium

About the Nutrients in This Food The avocado is an unusual fruit because about 16 percent of its total weight is fat, primarily monounsaturated fatty acids. Like many other fruits, avo- cados are high in fiber (the Florida avocado is very high in fiber), a good source of the B vitamin folate, vitamin C, and potassium. The edible part of half of one average size avocado (100 g/3.5 ounces) provides 6.7 g dietary fiber, 15 g fat (2.1 g saturated fat, 9.7 g monoun- saturated fat, 1.8 g polyunsaturated fat), 81 mcg folate (20 percent of the R DA), 20 mg vitamin C (26 percent of the R DA for a woman, 22 percent for a man), and 485 mg potassium (the equivalent of one eight-ounce cup of fresh orange juice). The edible part of one-half a Florida avocado (a.k.a. alligator pear) has eight grams dietary fiber, 13.5 g fat (2.65 g saturated fat), 81 mcg folate (41 percent of the R DA for a man, 45 percent of the R DA for a woman), 12 mg vitamin C (20 percent of the R DA), and 741 mg potassium, 50 percent more than one cup fresh orange juice.

Diets That May Exclude or Restrict This Food Controlled-potassium diet Low-fat diet

Buying This Food Look for: Fruit that feels heavy for its size. The avocados most commonly sold in the U.S. are the Hass—a purple-black bumpy fruit that accounts for 85 percent of the avocados shipped from California—and the smooth-skinned Florida avocado (“alligator pear”). The oval, midwinter Bacon; the pear-shaped, late-fall Fuerte; the Gwen, a slightly larger Hass; Pinkerton, pear-shaped with a smaller seed; the round summer Reed; and the yellow-green, pear-shaped Zutano. Avoid: Avocados with soft dark spots on the skin that indicate damage underneath.

Storing This Food Store hard, unripened avocados in a warm place; a bowl on top of the refrigerator will do. Avocados are shipped before they ripen, when the flesh is hard enough to resist bruising in transit, but they ripen off the tree and will soften nicely at home. Store soft, ripe avocados in the refrigerator to slow the natural enzyme action that turns their flesh brown as they mature even when the fruit has not been cut.

Preparing This Food When you peel or slice an avocado, you tear its cell walls, releasing polyphenoloxidase, an enzyme that converts phenols in the avocado to brownish compounds that darken the avocado’s naturally pale green flesh. You can slow this reaction (but not stop it completely) by brushing the exposed surface of the avocado with an acid (lemon juice or vinegar). To store a cut avocado, brush it with lemon juice or vinegar, wrap it tightly in plastic, and keep it in the refrigerator—where it will eventually turn brown. Or you can store the avocado as guacamole; mixing it with lemon juice, tomatoes, onions, and mayonnaise (all of which are acidic) is an efficient way to protect the color of the fruit.

Medical Uses and/or Benefits Lower risk of some birth defects. As many as two of every 1,000 babies born in the United States each year may have cleft palate or a neural tube (spinal cord) defect due to their moth- ers’ not having gotten adequate amounts of folate during pregnancy. The current R DA for folate is 180 mcg for a healthy woman and 200 mcg for a healthy man, but the FDA now recommends 400 mcg for a woman who is or may become pregnant. Taking folate supple- ments before becoming pregnant and through the first two months of pregnancy reduces the risk of cleft palate; taking folate through the entire pregnancy reduces the risk of neural tube defects. Lower risk of heart attack. In the spring of 1998, an analysis of data from the records for more than 80,000 women enrolled in the long-running Nurses’ Health Study at Harvard School of Public Health/Brigham and Woman’s Hospital, in Boston, demonstrated that a diet providing more than 400 mcg folate and 3 mg vitamin B6 daily, from either food or supplements, more than twice the current R DA for each, may reduce a woman’s risk of heart attack by almost 50 percent. Although men were not included in the analysis, the results are assumed to apply to them as well. However, data from a meta-analysis published in the Journal of the American Medical Association in December 2006 called this theory into question. Researchers at Tulane Univer- sity examined the results of 12 controlled studies in which 16,958 patients with preexisting cardiovascular disease were given either folic acid supplements or placebos (“look-alike” pills with no folic acid) for at least six months. The scientists, who found no reduction in the risk of further heart disease or overall death rates among those taking folic acid, concluded that further studies will be required to ascertain whether taking folic acid supplements reduces the risk of cardiovascular disease. Lower levels of cholesterol. Avocados are rich in oleic acid, a monounsaturated fat believed to reduce cholesterol levels. Potassium benefits. Because potassium is excreted in urine, potassium-rich foods are often recommended for people taking diuretics. In addition, a diet rich in potassium (from food) is associated with a lower risk of stroke. A 1998 Harvard School of Public Health analysis of data from the long-running Health Professionals Study shows 38 percent fewer strokes among men who ate nine servings of high potassium foods a day vs. those who ate less than four servings. Among men with high blood pressure, taking a daily 1,000 mg potas- sium supplement—about the amount of potassium in one avocado—reduced the incidence of stroke by 60 percent.

Adverse Effects Associated with This Food Latex-fruit syndrome. Latex is a milky fluid obtained from the rubber tree and used to make medical and surgical products such as condoms and protective latex gloves, as well as rubber bands, balloons, and toys; elastic used in clothing; pacifiers and baby-bottle nipples; chewing gum; and various adhesives. Some of the proteins in latex are allergenic, known to cause reactions ranging from mild to potentially life-threatening. Some of the pro- teins found naturally in latex also occur naturally in foods from plants such as avocados, bananas, chestnuts, kiwi fruit, tomatoes, and food and diet sodas sweetened with aspar- tame. Persons sensitive to these foods are likely to be sensitive to latex as well. NOT E : The National Institute of Health Sciences, in Japan, also lists the following foods as suspect: A lmonds, apples, apricots, bamboo shoots, bell peppers, buckwheat, cantaloupe, carrots, celer y, cherries, chestnuts, coconut, figs, grapefruit, lettuce, loquat, mangoes, mushrooms, mustard, nectarines, oranges, passion fruit, papaya, peaches, peanuts, peppermint, pine- apples, potatoes, soybeans, strawberries, walnuts, and watermelon.

Food/Drug Interactions MAO inhibitors. Monoamine oxidase (M AO) inhibitors are drugs used as antidepressants or antihypertensives. They inhibit the action of enzymes that break down the amino acid tyramine so it can be eliminated from the body. Tyramine is a pressor amine, a chemical that constricts blood vessels and raises blood pressure. If you eat a food such as avocado that contains tyramine while you are taking an M AO inhibitor you cannot eliminate the pressor amine, and the result may be abnormally high blood pressure or a hypertensive crisis (sus- tained elevated blood pressure). False-positive test for tumors. Carcinoid tumors (which may arise from tissues in the endo- crine system, the intestines, or the lungs) secrete serotonin, a natural chemical that makes blood vessels expand or contract. Because serotonin is excreted in urine, these tumors are diagnosed by measuring the levels of serotonin by-products in the urine. Avocados contain large amounts of serotonin; eating them in the three days before a test for an endocrine tumor might produce a false-positive result, suggesting that you have the tumor when in fact you don’t. (Other foods high in serotonin are bananas, eggplant, pineapples, plums, tomatoes, and walnuts.)... avocados

Bananas

Nutritional Profile Energy value (calories per serving): Moderate Protein: Low Fat: Low Saturated fat: Low Cholesterol: None Carbohydrates: High Fiber: Moderate Sodium: Low Major vitamin contribution: B vitamins, vitamin C Major mineral contribution: Potassium, magnesium

About the Nutrients in This Food A banana begins life with more starch than sugar, but as the fruit ripens its starches turn to sugar, which is why ripe bananas taste so much better than unripe ones.* The color of a banana’s skin is a fair guide to its starch/ sugar ratio. When the skin is yellow-green, 40 percent of its carbohydrates are starch; when the skin is fully yellow and the banana is ripe, only 8 per- cent of the carbohydrates are still starch. The rest (91 percent) have broken down into sugars—glucose, fructose, sucrose, the most plentiful sugar in the fruit. Its high sugar content makes the banana, in its self-contained packet, a handy energy source. Bananas are a high-fiber food with insoluble cellulose and lignin in the tiny seeds and soluble pectins in the flesh. They are also a good source of vitamin C and potassium. One small (six-inch) banana or a half-cup of sliced banana has 2.6 g dietary fiber and 8.8 mg vitamin C (12 percent of the R DA for a woman, 10 percent of the R DA for a man), plus 363 mg potassium.

The Most Nutritious Way to Serve This Food Fresh and ripe. Green bananas contain antinutrients, proteins that inhibit the actions of amylase, an enzyme that makes it possible for us to digest * They are also more healt hful. Green bananas contain proteins t hat inhibit amy- lase, an enzyme t hat makes it possible for us to digest complex carbohydrates. starch and other complex carbohydrates. Raw bananas are richer in potassium than cooked bananas; heating depletes potassium.

Buying This Food Look for: Bananas that will be good when you plan to eat them. Bananas with brown specks on the skin are ripe enough to eat immediately. Bananas with creamy yellow skin will be ready in a day or two. Bananas with mostly yellow skin and a touch of green at either end can be ripened at home and used in two or three days. Avoid: Overripe bananas whose skin has turned brown or split open. A grayish yellow skin means that the fruit has been damaged by cold storage. Bananas with soft spots under the skin may be rotten.

Storing This Food Store bananas that aren’t fully ripe at room temperature for a day or two. Like avocados, bananas are picked green, shipped hard to protect them from damage en route and then sprayed with ethylene gas to ripen them quickly. Untreated bananas release ethylene natu- rally to ripen the fruit and turn its starches to sugar, but natural ripening takes time. Artificial ripening happens so quickly that there is no time for the starches to turn into sugar. The bananas look ripe but they may taste bland and starchy. A few days at room temperature will give the starches a chance to change into sugars. Store ripe bananas in the refrigerator. The cold air will slow (but not stop) the natural enzyme action that ripens and eventually rots the fruit if you leave it at room temperature. Cold storage will darken the banana’s skin, since the chill damages cells in the peel and releases polyphenoloxidase, an enzyme that converts phenols in the banana peel to dark brown compounds, but the fruit inside will remain pale and tasty for several days.

Preparing This Food Do not slice or peel bananas until you are ready to use them. When you cut into the fruit, you tear its cell walls, releasing polyphenoloxidase, an enzyme that hastens the oxidation of phenols in the banana, producing brown pigments that darken the fruit. (Chilling a banana produces the same reaction because the cold damages cells in the banana peel.) You can slow the browning (but not stop it completely) by dipping raw sliced or peeled bananas into a solution of lemon juice or vinegar and water or by mixing the slices with citrus fruits in a fruit salad. Overripe, discolored bananas can be used in baking, where the color doesn’t matter and their intense sweetness is an asset.

What Happens When You Cook This Food When bananas are broiled or fried, they are cooked so quickly that there is very little change in color or texture. Even so, they will probably taste sweeter and have a more intense aroma than uncooked bananas. Heat liberates the volatile molecules that make the fruit taste and smell good.

How Other Kinds of Processing Affect This Food Drying. Drying removes water and concentrates the nutrients and calories in bananas. Bananas may be treated with compounds such as sulfur dioxide to inhibit polyphenoloxi- dase and keep the bananas from browning as they dry. People who are sensitive to sulfites may suffer severe allergic reactions, including anaphylactic shock, if they eat these treated bananas. Freezing. Fresh bananas freeze well but will brown if you try to thaw them at room tem- perature. To protect the creamy color, thaw frozen bananas in the refrigerator and use as quickly as possible.

Medical Uses and/or Benefits Lower risk of stroke. Various nutrition studies have attested to the power of adequate potassium to keep blood pressure within safe levels. For example, in the 1990s, data from the long-running Harvard School of Public Health/Health Professionals Follow-Up Study of male doctors showed that a diet rich in high-potassium foods such as bananas, oranges, and plantain may reduce the risk of stroke. In the study, the men who ate the higher number of potassium-rich foods (an average of nine servings a day) had a risk of stroke 38 percent lower than that of men who consumed fewer than four servings a day. In 2008, a similar survey at the Queen’s Medical Center (Honolulu) showed a similar protective effect among men and women using diuretic drugs (medicines that increase urination and thus the loss of potassium). Improved mood. Bananas and plantains are both rich in serotonin, dopamine, and other natural mood-elevating neurotransmitters—natural chemicals that facilitate the transmis- sion of impulses along nerve cells. Potassium benefits. Because potassium is excreted in urine, potassium-rich foods are often recommended for people taking diuretics. In addition, a diet rich in potassium (from food) is associated with a lower risk of stroke. A 1998 Harvard School of Public Health analysis of data from the long-running Health Professionals Study shows 38 percent fewer strokes among men who ate nine servings of high potassium foods a day vs. those who ate less than four servings. Among men with high blood pressure, taking a daily 1,000 mg potas- sium supplement—about the amount of potassium in one banana—reduced the incidence of stroke by 60 percent.

Adverse Effects Associated with This Food Digestive Problems. Unripe bananas contain proteins that inhibit the actions of amylase, an enzyme required to digest starch and other complex carbohydrates. Sulfite allergies. See How other kinds of processing affect this food. Latex-fruit syndrome. Latex is a milky fluid obtained from the rubber tree and used to make medical and surgical products such as condoms and protective latex gloves, as well as rub- ber bands, balloons, and toys; elastic used in clothing; pacifiers and baby bottle-nipples; chewing gum; and various adhesives. Some of the proteins in latex are allergenic, known to cause reactions ranging from mild to potentially life-threatening. Some of the proteins found naturally in latex also occur naturally in foods from plants such as avocados, bananas, chestnuts, kiwi fruit, tomatoes, and food and diet sodas sweetened with aspartame. Persons sensitive to these foods are likely to be sensitive to latex as well. NOTE : The National Insti- tute of Health Sciences, in Japan, also lists the following foods as suspect: Almonds, apples, apricots, bamboo shoots, bell peppers, buckwheat, cantaloupe, carrots, celery, cherries, chestnuts, coconut, figs, grapefruit, lettuce, loquat, mangoes, mushrooms, mustard, nectar- ines, oranges, passion fruit, papaya, peaches, peanuts, peppermint, pineapples, potatoes, soybeans, strawberries, walnuts, and watermelon.

Food/Drug Interactions Monoamine oxidase (MAO) inhibitors. Monoamine oxidase inhibitors are drugs used to treat depression. They inactivate naturally occurring enzymes in your body that metabolize tyra- mine, a substance found in many fermented or aged foods. Tyramine constricts blood vessels and increases blood pressure. If you eat a food containing tyramine while you are taking an M AO inhibitor, you cannot effectively eliminate the tyramine from your body. The result may be a hypertensive crisis. There have been some reports in the past of such reactions in people who have eaten rotten bananas or bananas stewed with the peel. False-positive test for tumors. Carcinoid tumors—which may arise from tissues of the endo- crine system, the intestines, or the lungs—secrete serotonin, a natural chemical that makes blood vessels expand or contract. Because serotonin is excreted in urine, these tumors are diagnosed by measuring the levels of serotonin by-products in the urine. Bananas contain large amounts of serotonin; eating them in the three days before a test for an endocrine tumor might produce a false-positive result, suggesting that you have the tumor when in fact you don’t. (Other foods high in serotonin are avocados, eggplant, pineapple, plums, tomatoes, and walnuts.)... bananas

Beans

(Black beans, chickpeas, kidney beans, navy beans, white beans) See also Bean sprouts, Lentils, Lima beans, Peas, Soybeans.

Nutritional Profile Energy value (calories per serving): Moderate Protein: High Fat: Low Saturated fat: Low Cholesterol: None Carbohydrates: High Fiber: Very high Sodium: Low Major vitamin contribution: Vitamin B6, folate Major mineral contribution: Iron, magnesium, zinc

About the Nutrients in This Food Beans are seeds, high in complex carbohydrates including starch and dietary fiber. They have indigestible sugars (stachyose and raffinose), plus insoluble cellulose and lignin in the seed covering and soluble gums and pectins in the bean. The proteins in beans are limited in the essential amino acids methionine and cystine.* All beans are a good source of the B vitamin folate, and iron. One-half cup canned kidney beans has 7.5 g dietary fiber, 65 mcg folate (15 percent of the R DA), and 1.6 mg iron (11 percent of the R DA for a woman, 20 percent of the R DA for a man). Raw beans contain antinutrient chemicals that inactivate enzymes required to digest proteins and carbohydrates. They also contain factors that inactivate vitamin A and also hemagglutinins, substances that make red blood cells clump together. Cooking beans disarms the enzyme inhibi- tors and the anti-vitamin A factors, but not the hemagglutinins. However, the amount of hemagglutinins in the beans is so small that it has no mea- surable effect in your body. * Soybeans are t he only beans t hat contain proteins considered “complete” because t hey contain sufficient amounts of all t he essent ial amino acids. The Folate Content of ½ Cup Cooked Dried Beans

  Bean   Folate (mcg)
Black beans 129
Chickpeas 191
Kidney beans canned 65
Navy beans 128
Pinto beans 147
  Source: USDA Nut rient Database: w w w.nal.usda.gov/fnic/cgibin /nut _search.pl, Nutritive Value of Foods, Home and Gardens Bullet in No. 72 (USDA, 1989).

The Most Nutritious Way to Serve This Food Cooked, to destroy antinutrients. With grains. The proteins in grains are deficient in the essential amino acids lysine and isoleucine but contain sufficient tryptophan, methionine, and cystine; the proteins in beans are exactly the opposite. Together, these foods provide “complete” proteins. With an iron-rich food (meat) or with a vitamin C-rich food (tomatoes). Both enhance your body’s ability to use the iron in the beans. The meat makes your stomach more acid (acid favors iron absorption); the vitamin C may convert the ferric iron in beans into ferrous iron, which is more easily absorbed by the body.

Diets That May Restrict or Exclude This Food Low-calcium diet Low-fiber diet Low-purine (antigout) diet

Buying This Food Look for: Smooth-skinned, uniformly sized, evenly colored beans that are free of stones and debris. The good news about beans sold in plastic bags is that the transparent material gives you a chance to see the beans inside; the bad news is that pyridoxine and pyridoxal, the natural forms of vitamin B6, are very sensitive to light. Avoid: Beans sold in bulk. Some B vitamins, such as vitamin B6 (pyridoxine and pyridoxal), are very sensitive to light. In addition, open bins allow insects into the beans, indicated by tiny holes showing where the bug has burrowed into or through the bean. If you choose to buy in bulk, be sure to check for smooth skinned, uniformly sized, evenly colored beans free of holes, stones, and other debris.

Storing This Food Store beans in air- and moistureproof containers in a cool, dark cabinet where they are pro- tected from heat, light, and insects.

Preparing This Food Wash dried beans and pick them over carefully, discarding damaged or withered beans and any that float. (Only withered beans are light enough to float in water.) Cover the beans with water, bring them to a boil, and then set them aside to soak. When you are ready to use the beans, discard the water in which beans have been soaked. Some of the indigestible sugars in the beans that cause intestinal gas when you eat the beans will leach out into the water, making the beans less “gassy.”

What Happens When You Cook This Food When beans are cooked in liquid, their cells absorb water, swell, and eventually rupture, releasing the pectins and gums and nutrients inside. In addition, cooking destroys antinutri- ents in beans, making them more nutritious and safe to eat.

How Other Kinds of Processing Affect This Food Canning. The heat of canning destroys some of the B vitamins in the beans. Vitamin B is water-soluble. You can recover all the lost B vitamins simply by using the liquid in the can, but the liquid also contains the indigestible sugars that cause intestinal gas when you eat beans. Preprocessing. Preprocessed dried beans have already been soaked. They take less time to cook but are lower in B vitamins.

Medical Uses and/or Benefits Lower risk of some birth defects. As many as two of every 1,000 babies born in the United States each year may have cleft palate or a neural tube (spinal cord) defect due to their moth- ers’ not having gotten adequate amounts of folate during pregnancy. The current R DA for folate is 180 mcg for a woman and 200 mcg for a man, but the FDA now recommends 400 mcg for a woman who is or may become pregnant. Taking a folate supplement before becoming pregnant and continuing through the first two months of pregnancy reduces the risk of cleft palate; taking folate through the entire pregnancy reduces the risk of neural tube defects. Lower risk of heart attack. In the spring of 1998, an analysis of data from the records for more than 80,000 women enrolled in the long-run ning Nurses Health Study at Har vard School of Public Health/ Brigham and Woman’s Hospital in Boston demonstrated that a diet providing more than 400 mcg folate and 3 mg vitamin B6 a day from either food or supple- ments, more than t wice the current R DA for each, may reduce a woman’s risk of heart attack by almost 50 percent. A lthough men were not included in the analysis, the results are assumed to apply to them as well. NOT E : Beans are high in B6 as well as folate. Fruit, green leaf y vegetables, whole grains, meat, fish, poultr y, and shellfish are good sources of vitamin B6. To reduce the levels of serum cholesterol. The gums and pectins in dried beans and peas appear to lower blood levels of cholesterol. Currently there are two theories to explain how this may happen. The first theory is that the pectins in the beans form a gel in your stomach that sops up fats and keeps them from being absorbed by your body. The second is that bacteria in the gut feed on the bean fiber, producing short-chain fatty acids that inhibit the production of cholesterol in your liver. As a source of carbohydrates for people with diabetes. Beans are digested very slowly, produc- ing only a gradual rise in blood-sugar levels. As a result, the body needs less insulin to control blood sugar after eating beans than after eating some other high-carbohydrate foods (such as bread or potato). In studies at the University of Kentucky, a bean, whole-grain, vegetable, and fruit-rich diet developed at the University of Toronto enabled patients with type 1 dia- betes (who do not produce any insulin themselves) to cut their daily insulin intake by 38 percent. Patients with type 2 diabetes (who can produce some insulin) were able to reduce their insulin injections by 98 percent. This diet is in line with the nutritional guidelines of the American Diabetes Association, but people with diabetes should always consult with their doctors and/or dietitians before altering their diet. As a diet aid. Although beans are high in calories, they are also high in bulk (fiber); even a small serving can make you feel full. And, because they are insulin-sparing, they delay the rise in insulin levels that makes us feel hungry again soon after eating. Research at the University of Toronto suggests the insulin-sparing effect may last for several hours after you eat the beans, perhaps until after the next meal.

Adverse Effects Associated with This Food Intestinal gas. All legumes (beans and peas) contain raffinose and stachyose, complex sug- ars that human beings cannot digest. The sugars sit in the gut and are fermented by intestinal bacteria which then produce gas that distends the intestines and makes us uncomfortable. You can lessen this effect by covering the beans with water, bringing them to a boil for three to five minutes, and then setting them aside to soak for four to six hours so that the indigestible sugars leach out in the soaking water, which can be discarded. Alternatively, you may soak the beans for four hours in nine cups of water for every cup of beans, discard the soaking water, and add new water as your recipe directs. Then cook the beans; drain them before serving. Production of uric acid. Purines are the natural metabolic by-products of protein metabo- lism in the body. They eventually break down into uric acid, sharp cr ystals that may concentrate in joints, a condition known as gout. If uric acid cr ystals collect in the urine, the result may be kidney stones. Eating dried beans, which are rich in proteins, may raise the concentration of purines in your body. Although controlling the amount of purines in the diet does not significantly affect the course of gout (which is treated with allopurinol, a drug that prevents the formation of uric acid cr ystals), limiting these foods is still part of many gout regimens.

Food/Drug Interactions Monoamine oxidase (MAO) inhibitors. Monoamine oxidase inhibitors are drugs used to treat depression. They inactivate naturally occurring enzymes in your body that metabolize tyramine, a substance found in many fermented or aged foods. Tyramine constricts blood vessels and increases blood pressure. If you eat a food containing tyramine while you are taking an M AO inhibitor, you cannot effectively eliminate the tyramine from your body. The result may be a hypertensive crisis. Some nutrition guides list dried beans as a food to avoid while using M AO inhibitors.... beans

Beef

Nutritional Profile Energy value (calories per serving): Moderate Protein: High Fat: Moderate Saturated fat: High Cholesterol: Moderate Carbohydrates: None Fiber: None Sodium: Low Major vitamin contribution: B vitamins Major mineral contribution: Iron, phosphorus, zinc

About the Nutrients in This Food Like fish, pork, poultry, milk, and eggs, beef has high-quality proteins, with sufficient amounts of all the essential amino acids. Beef fat is slightly more highly saturated than pork fat, but less saturated than lamb fat. All have about the same amount of cholesterol per serving. Beef is an excellent source of B vitamins, including niacin, vitamin B6, and vitamin B12, which is found only in animal foods. Lean beef pro- vides heme iron, the organic iron that is about five times more useful to the body than nonheme iron, the inorganic form of iron found in plant foods. Beef is also an excellent source of zinc. One four-ounce serving of lean broiled sirloin steak has nine grams fat (3.5 g saturated fat), 101 mg cholesterol, 34 g protein, and 3.81 mg iron (21 percent of the R DA for a woman, 46 percent of the R DA for a man). One four-ounce serving of lean roast beef has 16 g fat (6.6 g saturated fat), 92 mg cholesterol, and 2.96 mg iron (16 percent of the R DA for a woman, 37 percent of the R DA for a man).

The Most Nutritious Way to Serve This Food With a food rich in vitamin C. Ascorbic acid increases the absorption of iron from meat. * These values apply to lean cooked beef.

Diets That May Restrict or Exclude This Food Controlled-fat, low-cholesterol diet Low-protein diet (for some forms of kidney disease)

Buying This Food Look for: Fresh, red beef. The fat should be white, not yellow. Choose lean cuts of beef with as little internal marbling (streaks of fat) as possible. The leanest cuts are flank steak and round steak; rib steaks, brisket, and chuck have the most fat. USDA grading, which is determined by the maturity of the animal and marbling in meat, is also a guide to fat content. U.S. prime has more marbling than U.S. choice, which has more marbling than U.S. good. All are equally nutritious; the difference is how tender they are, which depends on how much fat is present. Choose the cut of meat that is right for your recipe. Generally, the cuts from the cen- ter of the animal’s back—the rib, the T-Bone, the porterhouse steaks—are the most tender. They can be cooked by dry heat—broiling, roasting, pan-frying. Cuts from around the legs, the underbelly, and the neck—the shank, the brisket, the round—contain muscles used for movement. They must be tenderized by stewing or boiling, the long, moist cooking methods that break down the connective tissue that makes meat tough.

Storing This Food Refrigerate raw beef immediately, carefully wrapped to prevent its drippings from contami- nating other foods. Refrigeration prolongs the freshness of beef by slowing the natural multi- plication of bacteria on the meat surface. Unchecked, these bacteria will convert proteins and other substances on the surface of the meat to a slimy film and change meat’s sulfur-contain- ing amino acids methionine and cystine into smelly chemicals called mercaptans. When the mercaptans combine with myoglobin, they produce the greenish pigment that gives spoiled meat its characteristic unpleasant appearance. Fresh ground beef, with many surfaces where bacteria can live, should be used within 24 to 48 hours. Other cuts of beef may stay fresh in the refrigerator for three to five days.

Preparing This Food Trim the beef carefully. By judiciously cutting away all visible fat you can significantly reduce the amount of fat and cholesterol in each serving. When you are done, clean all utensils thoroughly with soap and hot water. Wash your cutting board, wood or plastic, with hot water, soap, and a bleach-and-water solution. For ultimate safety in preventing the transfer of microorganisms from the raw meat to other foods, keep one cutting board exclusively for raw meats, fish, and poultry, and a second one for everything else. Finally, don’t forget to wash your hands.

What Happens When You Cook This Food Cooking changes the appearance and flavor of beef, alters nutritional value, makes it safer, and extends its shelf life. Browning meat after you cook it does not “seal in the juices,” but it does change the fla- vor by caramelizing sugars on the surface. Because beef’s only sugars are the small amounts of glycogen in the muscles, we add sugars in marinades or basting liquids that may also con- tain acids (vinegar, lemon juice, wine) to break down muscle fibers and tenderize the meat. (Browning has one minor nutritional drawback. It breaks amino acids on the surface of the meat into smaller compounds that are no longer useful proteins.) When beef is cooked, it loses water and shrinks. Its pigments, which combine with oxygen, are denatured (broken into fragments) by the heat and turn brown, the natural color of well-done meat. At the same time, the fats in the beef are oxidized. Oxidized fats, whether formed in cooking or when the cooked meat is stored in the refrigerator, give cooked meat a character- istic warmed-over flavor. Cooking and storing meat under a blanket of antioxidants—catsup or a gravy made of tomatoes, peppers, and other vitamin C-rich vegetables—reduces the oxidation of fats and the intensity of warmed-over flavor. Meat reheated in a microwave oven also has less warmed-over flavor. An obvious nutritional benefit of cooking is the fact that heat lowers the fat content of beef by liquif ying the fat so it can run off the meat. One concrete example of how well this works comes from a comparison of the fat content in regular and extra-lean ground beef. According to research at the University of Missouri in 1985, both kinds of beef lose mass when cooked, but the lean beef loses water and the regular beef loses fat and cholesterol. Thus, while regular raw ground beef has about three times as much fat (by weight) as raw ground extra-lean beef, their fat varies by only 5 percent after broiling. To reduce the amount of fat in ground beef, heat the beef in a pan until it browns. Then put the beef in a colander, and pour one cup of warm water over the beef. Repeat with a second cup of warm water to rinse away fat melted by heating the beef. Use the ground beef in sauce and other dishes that do not require it to hold together. Finally, cooking makes beef safer by killing Salmonella and other organisms in the meat. As a result, cooking also serves as a natural preservative. According to the USDA, large pieces of fresh beef can be refrigerated for two or three days, then cooked and held safely for another day or two because the heat of cooking has reduced the number of bacteria on the surface of the meat and temporarily interrupted the natural cycle of deterioration.

How Other Kinds of Processing Affect This Food Aging. Hanging fresh meat exposed to the air, in a refrigerated room, reduces the moisture content and shrinks the meat slightly. As the meat ages enzymes break down muscle pro- teins, “tenderizing” the beef. Canning. Canned beef does not develop a warmed-over flavor because the high tempera- tures in canning food and the long cooking process alter proteins in the meat so that they act as antioxidants. Once the can is open, however, the meat should be protected from oxygen that will change the flavor of the beef. Curing. Salt-curing preserves meat through osmosis, the physical reaction in which liquids flow across a membrane, such as the wall of a cell, from a less dense to a more dense solution. The salt or sugar used in curing dissolves in the liquid on the surface of the meat to make a solution that is more dense than the liquid inside the cells of the meat. Water flows out of the meat and out of the cells of any microorganisms living on the meat, killing the microor- ganisms and protecting the meat from bacterial damage. Salt-cured meat is much higher in sodium than fresh meat. Freezing. When you freeze beef, the water inside its cells freezes into sharp ice crystals that can puncture cell membranes. When the beef thaws, moisture (and some of the B vitamins) will leak out through these torn cell walls. The loss of moisture is irreversible, but some of the vitamins can be saved by using the drippings when the meat is cooked. Freezing may also cause freezer burn—dry spots left when moisture evaporates from the surface of the meat. Waxed freezer paper is designed specifically to hold the moisture in meat; plastic wrap and aluminum foil are less effective. NOTE : Commercially prepared beef, which is frozen very quickly at very low temperatures, is less likely to show changes in texture. Irradiation. Irradiation makes meat safer by exposing it to gamma rays, the kind of high- energy ionizing radiation that kills living cells, including bacteria. Irradiation does not change the way meat looks, feels or tastes, or make the food radioactive, but it does alter the structure of some naturally occurring chemicals in beef, breaking molecules apart to form new com- pounds called radiolytic products (R P). About 90 percent of R Ps are also found in nonirradiated foods. The rest, called unique radiolytic products (UR P), are found only in irradiated foods. There is currently no evidence to suggest that UR Ps are harmful; irradiation is an approved technique in more than 37 countries around the world, including the United States. Smoking. Hanging cured or salted meat over an open fire slowly dries the meat, kills micro- organisms on its surface, and gives the meat a rich, “smoky” flavor that varies with the wood used in the fire. Meats smoked over an open fire are exposed to carcinogenic chemicals in the smoke, including a-benzopyrene. Meats treated with “artificial smoke flavoring” are not, since the flavoring is commercially treated to remove tar and a-benzopyrene.

Medical Uses and/or Benefits Treating and/or preventing iron deficiency. Without meat in the diet, it is virtually impossible for an adult woman to meet her iron requirement without supplements. One cooked 3.5- ounce hamburger provides about 2.9 mg iron, 16 percent of the R DA for an adult woman of childbearing age. Possible anti-diabetes activity. CLA may also prevent type 2 diabetes, also called adult-onset diabetes, a non-insulin-dependent form of the disease. At Purdue University, rats bred to develop diabetes spontaneously between eight and 10 weeks of age stayed healthy when given CLA supplements.

Adverse Effects Associated with This Food Increased risk of heart disease. Like other foods from animals, beef contains cholesterol and saturated fats that increase the amount of cholesterol circulating in your blood, raising your risk of heart disease. To reduce the risk of heart disease, the National Cholesterol Education Project recommends following the Step I and Step II diets. The Step I diet provides no more than 30 percent of total daily calories from fat, no more than 10 percent of total daily calories from saturated fat, and no more than 300 mg of cholesterol per day. It is designed for healthy people whose cholesterol is in the range of 200 –239 mg/dL. The Step II diet provides 25– 35 percent of total calories from fat, less than 7 percent of total calories from saturated fat, up to 10 percent of total calories from polyunsaturated fat, up to 20 percent of total calories from monounsaturated fat, and less than 300 mg cho- lesterol per day. This stricter regimen is designed for people who have one or more of the following conditions: •  Existing cardiovascular disease •  High levels of low-density lipoproteins (LDLs, or “bad” cholesterol) or low levels of high-density lipoproteins (HDLs, or “good” cholesterol) •  Obesity •  Type 1 diabetes (insulin-dependent diabetes, or diabetes mellitus) •  Metabolic syndrome, a.k.a. insulin resistance syndrome, a cluster of risk fac- tors that includes type 2 diabetes (non-insulin-dependent diabetes) Increased risk of some cancers. According the American Institute for Cancer Research, a diet high in red meat (beef, lamb, pork) increases the risk of developing colorectal cancer by 15 percent for every 1.5 ounces over 18 ounces consumed per week. In 2007, the National Can- cer Institute released data from a survey of 500,000 people, ages 50 to 71, who participated in an eight-year A AR P diet and health study identif ying a higher risk of developing cancer of the esophagus, liver, lung, and pancreas among people eating large amounts of red meats and processed meats. Food-borne illness. Improperly cooked meat contaminated with E. coli O157:H7 has been linked to a number of fatalities in several parts of the United States. In addition, meats con- taminated with other bacteria, viruses, or parasites pose special problems for people with a weakened immune system: the very young, the very old, cancer chemotherapy patients, and people with HIV. Cooking meat to an internal temperature of 140°F should destroy Salmo- nella and Campylobacter jejuni; 165°F, the E. coli organism; and 212°F, Listeria monocytogenes. Antibiotic sensitivity. Cattle in the United States are routinely given antibiotics to protect them from infection. By law, the antibiotic treatment must stop three days to several weeks before the animal is slaughtered. Theoretically, the beef should then be free of antibiotic residues, but some people who are sensitive to penicillin or tetracycline may have an allergic reaction to the meat, although this is rare. Antibiotic-resistant Salmonella and toxoplasmosis. Cattle treated with antibiotics may pro- duce meat contaminated with antibiotic-resistant strains of Salmonella, and all raw beef may harbor ordinary Salmonella as well as T. gondii, the parasite that causes toxoplasmosis. Toxoplasmosis is particularly hazardous for pregnant women. It can be passed on to the fetus and may trigger a series of birth defects including blindness and mental retardation. Both Salmonella and the T. gondii can be eliminated by cooking meat thoroughly and washing all utensils, cutting boards, and counters as well as your hands with hot soapy water before touching any other food. Decline in kidney function. Proteins are nitrogen compounds. When metabolized, they yield ammonia, which is excreted through the kidneys. In laborator y animals, a sustained high-protein diet increases the flow of blood through the kidneys, accelerating the natural age-related decline in kidney function. Some experts suggest that this may also occur in human beings.

Food/Drug Interactions Tetracycline antibiotics (demeclocycline [Declomycin], doxycycline [ Vibtamycin], methacycline [Rondomycin], minocycline [Minocin], oxytetracycline [Terramycin], tetracycline [Achromycin V, Panmycin, Sumycin]). Because meat contains iron, which binds tetracyclines into com- pounds the body cannot absorb, it is best to avoid meat for two hours before and after taking one of these antibiotics. Monoamine oxidase (MAO) inhibitors. Meat “tenderized” with papaya or a papain powder can interact with the class of antidepressant drugs known as monoamine oxidase inhibi- tors. Papain meat tenderizers work by breaking up the long chains of protein molecules. One by-product of this process is tyramine, a substance that constructs blood vessels and raises blood pressure. M AO inhibitors inactivate naturally occurring enzymes in your body that metabolize tyramine. If you eat a food such as papain-tenderized meat, which is high in tyramine, while you are taking a M AO inhibitor, you cannot effectively eliminate the tyramine from your body. The result may be a hypertensive crisis. Theophylline. Charcoal-broiled beef appears to reduce the effectiveness of theophylline because the aromatic chemicals produced by burning fat speed up the metabolism of the- ophylline in the liver.... beef

Beer

(Ale)

Nutritional Profile Energy value (calories per serving): Low Protein: Moderate Fat: None Saturated fat: None Cholesterol: None Carbohydrates: High Fiber: None Sodium: Low Major vitamin contribution: B vitamins Major mineral contribution: Phosphorus

About the Nutrients in This Food Beer and ale are fermented beverages created by yeasts that convert the sugars in malted barley and grain to ethyl alcohol (a.k.a. “alcohol,” “drink- ing alcohol”).* The USDA /Health and Human Services Dietary Guidelines for Americans defines one drink as 12 ounces of beer, five ounces of wine, or 1.25 ounces of distilled spirits. One 12-ounce glass of beer has 140 calo- ries, 86 of them (61 percent) from alcohol. But the beverage—sometimes nicknamed “liquid bread”—is more than empty calories. Like wine, beer retains small amounts of some nutrients present in the food from which it was made. * Because yeasts cannot digest t he starches in grains, t he grains to be used in mak ing beer and ale are allowed to germinate ( “malt” ). When it is t ime to make t he beer or ale, t he malted grain is soaked in water, forming a mash in which t he starches are split into simple sugars t hat can be digested (fermented) by t he yeasts. If undisturbed, t he fermentat ion will cont inue unt il all t he sugars have been digested, but it can be halted at any t ime simply by raising or lowering t he temperature of t he liquid. Beer sold in bott les or cans is pasteurized to k ill t he yeasts and stop t he fermentat ion. Draft beer is not pasteurized and must be refrigerated unt il tapped so t hat it will not cont inue to ferment in t he container. The longer t he shipping t ime, t he more likely it is t hat draft beer will be exposed to temperature variat ions t hat may affect its qualit y—which is why draft beer almost always tastes best when consumed near t he place where it was brewed. The Nutrients in Beer (12-ounce glass)

  Nutrients   Beer   %R DA
Calcium 17 mg 1.7
Magnesium 28.51 mg 7–9*
Phosphorus 41.1 mg 6
Potassium 85.7 mg (na)
Zinc 0.06 mg 0.5– 0.8*
Thiamin 0.02 mg 1.6 –1.8*
R iboflavin 0.09 mg 7– 8*
Niacin 1.55 mg 10
Vitamin B6 0.17 mg 13
Folate 20.57 mcg 5
  * t he first figure is t he %R DA for a man; t he second, for a woman Source: USDA Nut rient Database: w w w.nal.usda.gov/fnic/cgi-bin /nut _search.pl.

Diets That May Restrict or Exclude This Food Bland diet Gluten-free diet Low-purine (antigout) diet

Buying This Food Look for: A popular brand that sells steadily and will be fresh when you buy it. Avoid: Dusty or warm bottles and cans.

Storing This Food Store beer in a cool place. Beer tastes best when consumed within two months of the day it is made. Since you cannot be certain how long it took to ship the beer to the store or how long it has been sitting on the grocery shelves, buy only as much beer as you plan to use within a week or two. Protect bottled beer and open bottles or cans of beer from direct sunlight, which can change sulfur compounds in beer into isopentyl mercaptan, the smelly chemical that gives stale beer its characteristic unpleasant odor.

When You Are Ready to Serve This Food Serve beer only in absolutely clean glasses or mugs. Even the slightest bit of grease on the side of the glass will kill the foam immediately. Wash beer glasses with detergent, not soap, and let them drain dry rather than drying them with a towel that might carry grease from your hands to the glass. If you like a long-lasting head on your beer, serve the brew in tall, tapering glasses to let the foam spread out and stabilize. For full flavor, serve beer and ales cool but not ice-cold. Very low temperatures immo- bilize the molecules that give beer and ale their flavor and aroma.

What Happens When You Cook This Food When beer is heated (in a stew or as a basting liquid), the alcohol evaporates but the flavor- ing agents remain intact. Alcohol, an acid, reacts with metal ions from an aluminum or iron pot to form dark compounds that discolor the pot or the dish you are cooking in. To prevent this, prepare dishes made with beer in glass or enameled pots.

Medical Uses and/or Benefits Reduced risk of heart attack. Data from the American Cancer Society’s Cancer Prevention Study 1, a 12-year survey of more than 1 million Americans in 25 states, shows that men who take one drink a day have a 21 percent lower risk of heart attack and a 22 percent lower risk of stroke than men who do not drink at all. Women who have up to one drink a day also reduce their risk of heart attack. Numerous later studies have confirmed these findings. Lower risk of stroke. In January 1999, the results of a 677-person study published by researchers at New York Presbyterian Hospital-Columbia University showed that moder- ate alcohol consumption reduces the risk of stroke due to a blood clot in the brain among older people (average age: 70). How the alcohol prevents stroke is still unknown, but it is clear that moderate use of alcohol is a key. Heavy drinkers (those who consume more than seven drinks a day) have a higher risk of stroke. People who once drank heavily, but cut their consumption to moderate levels, can also reduce their risk of stroke. Numerous later studies have confirmed these findings. Lower cholesterol levels. Beverage alcohol decreases the body’s production and storage of low-density lipoproteins (LDLs), the protein and fat particles that carr y cholesterol into your arteries. As a result, people who drink moderately tend to have lower cholesterol levels and higher levels of high density lipoproteins (HDLs), the fat and protein particles that carr y cholesterol out of the body. The USDA /Health and Human Services Dietar y Guidelines for Americans defines moderation as two drinks a day for a man, one drink a day for a woman. Stimulating the appetite. Alcoholic beverages stimulate the production of saliva and the gastric acids that cause the stomach contractions we call hunger pangs. Moderate amounts of alcoholic beverages, which may help stimulate appetite, are often prescribed for geriatric patients, convalescents, and people who do not have ulcers or other chronic gastric problems that might be exacerbated by the alcohol. Dilation of blood vessels. Alcohol dilates the capillaries (the tiny blood vessels just under the skin), and moderate amounts of alcoholic beverages produce a pleasant flush that temporar- ily warms the drinker. But drinking is not an effective way to warm up in cold weather since the warm blood that flows up to the capillaries will cool down on the surface of your skin and make you even colder when it circulates back into the center of your body. Then an alco- hol flush will make you perspire, so that you lose more heat. Excessive amounts of beverage alcohol may depress the mechanism that regulates body temperature.

Adverse Effects Associated with This Food Increased risk of breast cancer. In 2008, scientists at the National Cancer Institute released data from a seven-year survey of more than 100,000 postmenopausal women showing that even moderate drinking (one to two drinks a day) may increase by 32 percent a woman’s risk of developing estrogen-receptor positive (ER+) and progesterone-receptor positive (PR+) breast cancer, tumors whose growth is stimulated by hormones. No such link was found between consuming alcohol and the risk of developing ER-/PR- tumors (not fueled by hor- mones). The finding applies to all types of alcohol: beer, wine, and spirits. Increased risk of oral cancer (cancer of the mouth and throat). Numerous studies confirm the American Cancer Society’s warning that men and women who consume more than two drinks a day are at higher risk of oral cancer than are nondrinkers or people who drink less. Note: The Dietary Guidelines for Americans describes one drink as 12 ounces of beer, five ounces of wine, or 1.5 ounces of distilled spirits. Increased risk of cancer of the colon and rectum. In the mid-1990s, studies at the University of Oklahoma suggested that men who drink more than five beers a day are at increased risk of rectal cancer. Later studies suggested that men and women who are heavy beer or spirits drinkers (but not those who are heavy wine drinkers) have a higher risk of colorectal cancers. Further studies are required to confirm these findings. Fetal alcohol syndrome. Fetal alcohol syndrome is a specific pattern of birth defects—low birth weight, heart defects, facial malformations, and mental retardation—first recognized in a study of babies born to alcoholic women who consumed more than six drinks a day while pregnant. Subsequent research has found a consistent pattern of milder defects in babies born to women who consume three to four drinks a day or five drinks on any one occasion while pregnant. To date, there is no evidence of a consistent pattern of birth defects in babies born to women who consume less than one drink a day while pregnant, but two studies at Columbia University have suggested that as few as two drinks a week while preg- nant may raise a woman’s risk of miscarriage. (“One drink” means 12 ounces of beer, five ounces of wine, or 1.25 ounces of distilled spirits.) Alcoholism. Alcoholism is an addiction disease, the inability to control one’s alcohol consumption. It is a potentially life-threatening condition, with a higher risk of death by accident, suicide, malnutrition, or acute alcohol poisoning, a toxic reaction that kills by para- lyzing body organs, including the heart. Malnutrition. While moderate alcohol consumption stimulates appetite, alcohol abuse depresses it. In addition, an alcoholic may drink instead of eating. When an alcoholic does eat, excess alcohol in his/her body prevents absorption of nutrients and reduces the ability to synthesize new tissue. Hangover. Alcohol is absorbed from the stomach and small intestine and carried by the bloodstream to the liver, where it is oxidized to acetaldehyde by alcohol dehydrogenase (ADH), the enzyme our bodies use to metabolize the alcohol we produce when we digest carbohydrates. The acetaldehyde is converted to acetyl coenzyme A and either eliminated from the body or used in the synthesis of cholesterol, fatty acids, and body tissues. Although individuals vary widely in their capacity to metabolize alcohol, on average, normal healthy adults can metabolize the alcohol in one quart of beer in approximately five to six hours. If they drink more than that, they will have more alcohol than the body’s natural supply of ADH can handle. The unmetabolized alcohol will pile up in the bloodstream, interfering with the liver’s metabolic functions. Since alcohol decreases the reabsorption of water from the kidneys and may inhibit the secretion of an antidiuretic hormone, they will begin to urinate copiously, losing magnesium, calcium, and zinc but retaining more irritating uric acid. The level of lactic acid in the body will increase, making them feel tired and out of sorts; their acid-base balance will be out of kilter; the blood vessels in their heads will swell and throb; and their stomachs, with linings irritated by the alcohol, will ache. The ultimate result is a “hangover” whose symptoms will disappear only when enough time has passed to allow their bodies to marshal the ADH needed to metabolize the extra alcohol in their blood. Changes in body temperature. Alcohol dilates capillaries, tiny blood vessels just under the skin, producing a “flush” that temporarily warms the drinker. But drinking is not an effective way to stay warm in cold weather. Warm blood flowing up from the body core to the surface capillaries is quickly chilled, making you even colder when it circulates back into your organs. In addition, an alcohol flush triggers perspiration, further cooling your skin. Finally, very large amounts of alcohol may actually depress the mechanism that regulates body temperature. Impotence. Excessive drinking decreases libido (sexual desire) and interferes with the ability to achieve or sustain an erection. “Beer belly.” Data from a 1995, 12,000 person study at the University of North Carolina in Chapel Hill show that people who consume at least six beers a week have more rounded abdomens than people who do not drink beer. The question left to be answered is which came first: the tummy or the drinking.

Food/Drug Interactions Acetaminophen (Tylenol, etc.). The FDA recommends that people who regularly have three or more drinks a day consult a doctor before using acetaminophen. The alcohol/acetamino- phen combination may cause liver failure. Disulfiram (Antabuse). Taken with alcohol, disulfiram causes flushing, nausea, low blood pressure, faintness, respiratory problems, and confusion. The severity of the reaction gener- ally depends on how much alcohol you drink, how much disulfiram is in your body, and how long ago you took it. Disulfiram is used to help recovering alcoholics avoid alcohol. (If taken with alcohol, metronidazole [Flagyl], procarbazine [Matulane], quinacrine [Atabrine], chlorpropamide (Diabinase), and some species of mushrooms may produce a mild disulfi- ramlike reaction.) Anticoagulants. Alcohol slows the body’s metabolism of anticoagulants (blood thinners) such as warfarin (Coumadin), intensif ying the effect of the drugs and increasing the risk of side effects such as spontaneous nosebleeds. Antidepressants. Alcohol may increase the sedative effects of antidepressants. Drinking alcohol while you are taking a monoamine oxidase (M AO) inhibitor is especially hazard- ous. M AO inhibitors inactivate naturally occurring enzymes in your body that metabolize tyramine, a substance found in many fermented or aged foods. Tyramine constricts blood vessels and increases blood pressure. If you eat a food containing tyramine while you are taking an M AO inhibitor, you cannot effectively eliminate the tyramine from your body. The result may be a hypertensive crisis. Ordinarily, fermentation of beer and ale does not produce tyramine, but some patients have reported tyramine reactions after drinking some imported beers. Beer and ale are usually prohibited to those using M AO inhibitors. Aspirin, ibuprofen, ketoprofen, naproxen, and nonsteroidal anti-inflammatory drugs. Like alcohol, these analgesics irritate the lining of the stomach and may cause gastric bleeding. Combining the two intensifies the effect. Insulin and oral hypoglycemics. Alcohol lowers blood sugar and interferes with the metabo- lism of oral antidiabetics; the combination may cause severe hypoglycemia. Sedatives and other central nervous system depressants (tranquilizers, sleeping pills, antidepres- sants, sinus and cold remedies, analgesics, and medication for motion sickness). Alcohol inten- sifies sedation and, depending on the dose, may cause drowsiness, respiratory depression, coma, or death.... beer

Cabbage

(Bok choy [Chinese cabbage], green cabbage, red cabbage, savoy cabbage) See also Broccoli, Brussels sprouts, Cabbage, Cauliflower, Lettuce, Radishes, Spinach, Turnips.

Nutritional Profile Energy value (calories per serving): Low Protein: Moderate Fat: Low Saturated fat: Low Cholesterol: None Carbohydrates: High Fiber: Low Sodium: Low Major vitamin contribution: Vitamin A, folate, vitamin C Major mineral contribution: Calcium (moderate)

About the Nutrients in This Food All cabbage has some dietary fiber food: insoluble cellulose and lignin in the ribs and structure of the leaves. Depending on the variety, it has a little vitamin A, moderate amounts of the B vitamin folate and vitamin C. One-half cup shredded raw bok choy has 0.1 g dietary fiber, 1,041 IU vitamin A (45 percent of the R DA for a woman, 35 percent of the R DA for a man), and 15.5 mg vitamin C (21 percent of the R DA for a woman, 17 percent of the R DA for a man). One-half cup shredded raw green cabbage has 0.5 g dietary fiber, 45 IU vitamin A (1.9 percent of the R DA for a woman, 1.5 percent of the R DA for a man), 15 mcg folate (4 percent of the R DA), and 11 mg vitamin C (15 percent of the R DA for a woman, 12 percent of the R DA for a man). One-half cup chopped raw red cabbage has 0.5 g dietary fiber, 7 mcg folate (2 percent of the R DA), and 20 mg vitamin C (27 percent of the R DA for a woman, 22 percent of the R DA for a man). One-half cup chopped raw savoy cabbage has one gram dietary fiber, 322 IU vitamin A (14 percent of the R DA for a woman, 11 percent of the R DA for a man), and 11 mg vitamin C (15 percent of the R DA for a woman, 12 percent of the R DA for a man). Raw red cabbage contains an antinutrient enzyme that splits the thiamin molecule so that the vitamin is no longer nutritionally useful. This thiamin in hibitor is inactivated by cooking.

The Most Nutritious Way to Serve This Food Raw or lightly steamed to protect the vitamin C.

Diets That May Restrict or Exclude This Food Antiflatulence diet Low-fiber diet

Buying This Food Look for: Cabbages that feel heavy for their size. The leaves should be tightly closed and attached tightly at the stem end. The outer leaves on a savoy cabbage may curl back from the head, but the center leaves should still be relatively tightly closed. Also look for green cabbages that still have their dark-green, vitamin-rich outer leaves. Avoid: Green and savoy cabbage with yellow or wilted leaves. The yellow carotene pig- ments show through only when the cabbage has aged and its green chlorophyll pigments have faded. Wilted leaves mean a loss of moisture and vitamins.

Storing This Food Handle cabbage gently; bruising tears cells and activates ascorbic acid oxidase, an enzyme in the leaves that hastens the destruction of vitamin C. Store cabbage in a cool, dark place, preferably a refrigerator. In cold storage, cabbage can retain as much as 75 percent of its vitamin C for as long as six months. Cover the cabbage to keep it from drying out and losing vitamin A.

Preparing This Food Do not slice the cabbage until you are ready to use it; slicing tears cabbage cells and releases the enzyme that hastens the oxidation and destruction of vitamin C. If you plan to serve cooked green or red cabbage in wedges, don’t cut out the inner core that hold the leaves together. To separate the leaves for stuffing, immerse the entire head in boiling water for a few minutes, then lift it out and let it drain until it is cool enough to handle comfortably. The leaves should pull away easily. If not, put the cabbage back into the hot water for a few minutes.

What Happens When You Cook This Food Cabbage contains mustard oils (isothiocyanates) that break down into a variet y of smelly sulfur compounds (including hydrogen sulfide and ammon ia) when the cabbage is heated, a reaction that occurs more strongly in aluminum pots. The longer you cook the cabbage, the more smelly the compounds will be. Adding a slice of bread to the cooking water may lessen the odor. Keeping a lid on the pot will stop the smelly molecules from floating off into the air, but it will also accelerate the chemical reaction that turns cooked green cabbage drab. Chlorophyll, the pigment that makes green vegetables green, is sensitive to acids. When you heat green cabbage, the chlorophyll in its leaves reacts chemically with acids in the cabbage or in the cooking water to form pheophytin, which is brown. The pheophytin gives the cooked cabbage its olive color. To keep cooked green cabbage green, you have to reduce the interaction between the chlorophyll and the acids. One way to do this is to cook the cabbage in a large quantity of water, so the acids will be diluted, but this increases the loss of vitamin C.* Another alternative is to leave the lid off the pot so that the volatile acids can float off into the air, but this allows the smelly sulfur compounds to escape too. The best way may be to steam the cabbage ver y quickly in ver y little water so that it keeps its vitamin C and cooks before there is time for the chlorophyll/acid reaction to occur. Red cabbage is colored with red anthocyanins, pigments that turn redder in acids (lemon juice, vinegar) and blue purple in bases (alkaline chemicals such as baking soda). To keep the cabbage red, make sweet-and-sour cabbage. But be careful not to make it in an iron or aluminum pot, since vinegar (which contains tannins) will react with these metals to create dark pigments that discolor both the pot and the vegetable. Glass, stainless-steel, or enameled pots do not produce this reaction.

How Other Kinds of Processing Affect This Food Pickling. Sauerkraut is a fermented and pickled produce made by immersing cabbage in a salt solution strong enough to kill off pathological bacteria but allow beneficial ones to sur- vive, breaking down proteins in the cabbage and producing the acid that gives sauerkraut its distinctive flavor. Sauerkraut contains more than 37 times as much sodium as fresh cabbage (661 mg sodium/100 grams canned sauerkraut with liquid) but only one third the vitamin C and one-seventh the vitamin A. * According to USDA, if you cook t hree cups of cabbage in one cup of water you will lose only 10 percent of t he vitamin C; reverse t he rat io to four t imes as much water as cabbage and you will lose about 50 percent of t he vitamin C. Cabbage will lose as much as 25 percent of its vitamin C if you cook it in water t hat is cold when you start. As it boils, water releases ox ygen t hat would ot her wise dest roy vitamin C, so you can cut t he vitamin loss dramat ically simply by lett ing t he water boil for 60 seconds before adding t he cabbage.

Medical Uses and/or Benefits Protection against certain cancers. Naturally occurring chemicals (indoles, isothiocyanates, glucosinolates, dithiolethiones, and phenols) in cabbage, brussels sprouts, broccoli, cauli- flower, and other cruciferous vegetables appear to reduce the risk of some cancers, perhaps by preventing the formation of carcinogens in your body or by blocking cancer-causing substances from reaching or reacting with sensitive body tissues or by inhibiting the trans- formation of healthy cells to malignant ones. All cruciferous vegetables contain sulforaphane, a member of a family of chemicals known as isothiocyanates. In experiments with laboratory rats, sulforaphane appears to increase the body’s production of phase-2 enzymes, naturally occurring substances that inac- tivate and help eliminate carcinogens. At Johns Hopkins University in Baltimore, Maryland, 69 percent of the rats injected with a chemical known to cause mammary cancer developed tumors vs. only 26 percent of the rats given the carcinogenic chemical plus sulforaphane. In 1997, Johns Hopkins researchers discovered that broccoli seeds and three-day-old broccoli sprouts contain a compound converted to sulforaphane when the seed and sprout cells are crushed. Five grams of three-day-old broccoli sprouts contain as much sulforaphane as 150 grams of mature broccoli. The sulforaphane levels in other cruciferous vegetables have not yet been calculated. Vision protection. In 2004, the Johns Hopkins researchers updated their findings on sulfora- phane to suggest that it may also protect cells in the eyes from damage due to ultraviolet light, thus reducing the risk of macular degeneration, the most common cause of age-related vision loss. Lower risk of some birth defects. As many as two of every 1,000 babies born in the United States each year may have cleft palate or a neural tube (spinal cord) defect due to their moth- ers’ not having gotten adequate amounts of folate during pregnancy. The current R DA for folate is 180 mcg for a woman and 200 mcg for a man, but the FDA now recommends 400 mcg for a woman who is or may become pregnant. Taking a folate supplement before becom- ing pregnant and through the first two months of pregnancy reduces the risk of cleft palate; taking folate through the entire pregnancy reduces the risk of neural tube defects. Possible lower risk of heart attack. In the spring of 1998, an analysis of data from the records for more than 80,000 women enrolled in the long-running Nurses’ Health Study at Harvard School of Public Health/Brigham and Women’s Hospital, in Boston, demonstrated that a diet providing more than 400 mcg folate and 3 mg vitamin B6 daily, either from food or supple- ments, might reduce a woman’s risk of heart attack by almost 50 percent. Although men were not included in the study, the results were assumed to apply to them as well. However, data from a meta-analysis published in the Journal of the American Medical Association in December 2006 called this theory into question. Researchers at Tulane Univer- sity examined the results of 12 controlled studies in which 16,958 patients with preexisting cardiovascular disease were given either folic acid supplements or placebos (“look-alike” pills with no folic acid) for at least six months. The scientists, who found no reduction in the risk of further heart disease or overall death rates among those taking folic acid, concluded that further studies will be required to verif y whether taking folic acid supplements reduces the risk of cardiovascular disease.

Adverse Effects Associated with This Food Enlarged thyroid gland (goiter). Cruciferous vegetables, including cabbage, contain goitrin, thiocyanate, and isothiocyanate. These chemicals, known collectively as goitrogens, inhibit the formation of thyroid hormones and cause the thyroid to enlarge in an attempt to pro- duce more. Goitrogens are not hazardous for healthy people who eat moderate amounts of cruciferous vegetables, but they may pose problems for people who have a thyroid condition or are taking thyroid medication. Intestinal gas. Bacteria that live naturally in the gut degrade the indigestible carbohydrates (food fiber) in cabbage, producing gas that some people find distressing.

Food/Drug Interactions Anticoagulants Cabbage contains vitamin K, the blood-clotting vitamin produced natu- rally by bacteria in the intestines. Consuming large quantities of this food may reduce the effectiveness of anticoagulants (blood thinners) such as warfarin (Coumadin). One cup of shredded common green cabbage contains 163 mcg vitamin K, nearly three times the R DA for a healthy adult; one cup of drained boiled common green cabbage contains 73 mcg vita- min K, slightly more than the R DA for a healthy adult. Monoamine oxidase (MAO) inhibitors. Monoamine oxidase inhibitors are drugs used to treat depression. They inactivate naturally occurring enzymes in your body that metabolize tyra- mine, a substance found in many fermented or aged foods. Tyramine constricts blood vessels and increases blood pressure. If you eat a food such as sauerkraut which is high in tyramine while you are taking an M AO inhibitor, you cannot effectively eliminate the tyramine from your body. The result may be a hypertensive crisis.... cabbage

Capsella Bursa-pastoris

(Linn.) Moench.

Family: Cruciferae; Brassicaceae.

Habitat: Throughout India as a weed in cultivated areas and waste places, particularly in the temperate regions up to an altitude of 4,200 m.

English: Shepherd's Purse, St. James's Wort.

Folk: Mumiri.

Action: The herb or its juice extracts are employed to check menorrhagia and haemorrhages from renal and genitourinary tract. Also used in diarrhoea and dysentery and as a diuretic.

Key application: In symptom-based treatment of mild menorrhagia and metrorrhagia. (German Commission E.) The British Herbal Pharmacopoeia reported antihaem- orrhagic action.

Aerial parts contain flavonoids, polypeptides, choline, acetylcholine, histamine and tyramine.

The extract of dried or green plant causes strong contraction of the small intestines and uterus of guinea pigs. A quarternary ammonium salt has been isolated from the herb which is reported to be responsible for its pharmacological activity.

Young leaves contain vitamin A (5,000 IU/100 g) and ascorbic acid (91 mg/100 g); among other constituents are hesperidin and rutin, which reduced permeability of blood vessel walls in white mice. A neoplasm inhibitory substance has been identified as fumaric acid. An inhibitory effect of the extracts of the herb on Ehrlich solid tumour in mice was found to be due to the fumaric acid.

Major constituent of the essential oil is camphor.... capsella bursa-pastoris

Caviar

Nutritional Profile Energy value (calories per serving): High Protein: High Fat: High Saturated fat: Low Cholesterol: High Carbohydrates: Low Fiber: None Sodium: High Major vitamin contribution: B vitamins Major mineral contribution: Calcium, iron, phosphorus

About the Nutrients in This Food Caviar is a high-fat, high-cholesterol, high-protein, low-carbohydrate food. It is extremely high in sodium (650 mg/oz.) and, ounce for ounce, contains twice as much calcium as milk.

Diets That May Restrict or Exclude This Food Low-cholesterol, controlled-fat diet Low-salt/low-sodium diet

Buying This Food Look for: Shiny, translucent, large-grained gray fresh caviar (sturgeon roe) with a clean aroma. Look for: Tightly sealed tins and jars of less expensive roe. Lumpfish roe is small-grained and usually black. Cod, salmon, carp, pike, and tuna roe are large-grained and orangey red or pinkish.

Storing This Food Store fresh caviar in the coldest part of the refrigerator; it will spoil within hours at tempera- tures above 39°F. Store jars of caviar in a cool, dark place.

Preparing This Food Always serve caviar in a dish (or jar) nestled in ice to keep it safe at room temperature. The roe contains so much salt that it will not freeze. When making canapés, add the caviar last so that the oil does not spread and discolor the other ingredients.

How Other Kinds of Processing Affect This Food Pressing. Pressed caviar is caviar with 10 percent of its moisture removed. As a result it con- tains more nutrients per ounce than regular caviar and is even higher in sodium.

Medical Uses and/or Benefits Omega-3 fish oils. Caviar contains the same protective oils found in other fish (see fish).

Food/Drug Interactions MAO inhibitors. Monoamine oxidase (M AO) inhibitors are drugs used as antidepressants or antihypertensives. They inhibit the action of enzymes that break down tyramine, a natural by-product of protein metabolism. Tyramine is a pressor amine, a chemical that constricts blood vessels and raises blood pressure. If you eat a food that contains tyramine while you are taking an M AO inhibitor, the pressor amine cannot be eliminated from your body and the result could be a hypertensive crisis (sustained elevated blood pressure). Caviar contains small amounts of tyramine.... caviar

Cheese

Nutritional Profile Energy value (calories per serving): Moderate to high Protein: Moderate to high Fat: Low to high Saturated fat: High Cholesterol: Low to high Carbohydrates: Low Fiber: None Sodium: High Major vitamin contribution: Vitamin A, vitamin D, B vitamins Major mineral contribution: Calcium

About the Nutrients in This Food Cheese making begins when Lactobacilli and/or Streptococci bacteria are added to milk. The bacteria digest lactose (milk sugar) and release lactic acid, which coagulates casein (milk protein) into curds. Rennet (gastric enzymes extracted from the stomach of calves) is added, and the mixture is put aside to set. The longer the curds are left to set, the firmer the cheese will be. When the curds are properly firm, they are pressed to squeeze out the whey (liquid) and cooked. Cooking evaporates even more liquid and makes the cheese even firmer.* At this point, the product is “fresh” or “green” cheese: cottage cheese, cream cheese, farmer cheese. Making “ripe” cheese requires the addition of salt to pull out more moisture and specific organisms, such as Penicil- lium roquefort for Roquefort cheese, blue cheese, and Stilton, or Penicillium cambembert for Camembert and Brie. The nutritional value of cheese is similar to the milk from which it is made. All cheese is a good source of high quality proteins with sufficient amounts of all the essential amino acids. Cheese is low to high in fat, mod- erate to high in cholesterol. * Natural cheese is cheese made direct ly from milk. Processed cheese is natural cheese melted and combined wit h emulsifiers. Pasteurized process cheese foods contain ingredients t hat allow t hem to spread smoot hly; t hey are lower in fat and higher in moisture t han processed cheese. Cholesterol and Saturated Fat Content of Selected Cheeses Mozzarella Source: USDA, Nutritive Value of Foods, Home and Garden Bullet in No. 72 (USDA, 1989). All cheeses, except cottage cheese, are good sources of vitamin A. Orange and yellow cheeses are colored with carotenoid pigments, including bixin (the carotenoid pigment in annatto) and synthetic beta-carotene. Hard cheeses are an excellent source of calcium; softer cheeses are a good source; cream cheese and cottage cheese are poor sources. The R DA for calcium is 1,000 mg for a woman, 1,200 mg for a man, and 1,500 mg for an older woman who is not on hormone- replacement therapy. All cheese, unless otherwise labeled, is high in sodium.

Calcium Content of Cheese  
  Cheese   Serving   Calcium (mg)
Blue oz. 150
Camembert wedge 147
Cheddar oz. 204
Cottage cheese    
creamed cup 135
uncreamed cup 46
Muenster oz. 203
Pasteurized processed American oz. 174
Parmesan grated tbsp. 69
Provolone oz. 214
Swiss oz. 272
  Source: Nutritive Value of Foods, Home and Gardens Bullet in No. 72 (USDA, 1989).

The Most Nutritious Way to Serve This Food With grains, bread, noodles, beans, nuts, or vegetables to add the essential amino acids miss- ing from these foods, “complete” their proteins, and make them more nutritionally valuable.

Diets That May Restrict or Exclude This Food Antiflatulence diet Controlled-fat, low-cholesterol diet Lactose- and galactose-free diet (lactose, a disaccharide [double sugar] is composed of one unit of galactose and one unit of glucose) Low-calcium diet (for patients with kidney disease) Sucrose-free diet (processed cheese)

Buying This Food Look for: Cheese stored in a refrigerated case. Check the date on the package. Avoid: Any cheese with mold that is not an integral part of the food.

Storing This Food Refrigerate all cheese except unopened canned cheeses (such as Camembert in tins) or grated cheeses treated with preservatives and labeled to show that they can be kept outside the refrigerator. Some sealed packages of processed cheeses can be stored at room temperature but must be refrigerated once the package is opened. Wrap cheeses tightly to protect them from contamination by other microorganisms in the air and to keep them from drying out. Well-wrapped, refrigerated hard cheeses that have not been cut or sliced will keep for up to six months; sliced hard cheeses will keep for about two weeks. Soft cheeses (cottage cheese, ricotta, cream cheese, and Neufchatel) should be used within five to seven days. Use all packaged or processed cheeses by the date stamped on the package. Throw out moldy cheese (unless the mold is an integral part of the cheese, as with blue cheese or Stilton).

Preparing This Food To grate cheese, chill the cheese so it won’t stick to the grater. The molecules that give cheese its taste and aroma are largely immobilized when the cheese is cold. When serving cheese with fruit or crackers, bring it to room temperature to activate these molecules.

What Happens When You Cook This Food Heat changes the structure of proteins. The molecules are denatured, which means that they may be broken into smaller fragments or change shape or clump together. All of these changes may force moisture out of the protein tissue, which is why overcooked cheese is often stringy. Whey proteins, which do not clump or string at low temperatures, contain the sulfur atoms that give hot or burned cheese an unpleasant “cooked” odor. To avoid both strings and an unpleasant odor, add cheese to sauces at the last minute and cook just long enough to melt the cheese.

How Other Kinds of Processing Affect This Food Freezing. All cheese loses moisture when frozen, so semisoft cheeses will freeze and thaw better than hard cheeses, which may be crumbly when defrosted. Drying. The less moisture cheese contains, the less able it is to support the growth of organ- isms like mold. Dried cheeses keep significantly longer than ordinary cheeses.

Medical Uses and/or Benefits To strengthen bones and reduce age-related loss of bone density. High-calcium foods protect bone density. The current recommended dietary allowance (R DA) for calcium is still 800 mg for adults 25 and older, but a 1984 National Institutes of Health (NIH) Conference advisory stated that lifelong protection for bones requires an R DA of 1,000 mg for healthy men and women age 25 to 50 ; 1,000 mg for older women using hormone replacement therapy; and 1,500 mg for older women who are not using hormones, and these recommendations have been confirmed in a 1994 NIH Consensus Statement on optimal calcium intake. A diet with adequate amounts of calcium-rich foods helps protect bone density. Low-fat and no-fat cheeses provide calcium without excess fat and cholesterol. Protection against tooth decay. Studies at the University of Iowa (Iowa City) Dental School confirm that a wide variety of cheeses, including aged cheddar, Edam, Gouda, Monterey Jack, Muenster, mozzarella, Port Salut, Roquefort, Romano, Stilton, Swiss, and Tilsit—limit the tooth decay ordinarily expected when sugar becomes trapped in plaque, the sticky film on tooth surfaces where cavity-causing bacteria flourish. In a related experiment using only cheddar cheese, people who ate cheddar four times a day over a two-week period showed a 20 percent buildup of strengthening minerals on the surface of synthetic toothlike material attached to the root surfaces of natural teeth. Protection against periodontal disease. A report in the January 2008 issue of the Journal of Periodontology suggests that consuming adequate amounts of dairy products may reduce the risk of developing periodontal disease. Examining the dental health of 942 subjects ages 40 to 79, researchers at Kyushu University, in Japan, discovered that those whose diets regularly included two ounces (55 g) of foods containing lactic acid (milk, cheese, and yogurt) were significantly less likely to have deep “pockets” (loss of attachment of tooth to gum) than those who consumed fewer dairy products.

Adverse Effects Associated with This Food Increased risk of heart disease. Like other foods from animals, cheese is a source of choles- terol and saturated fats, which increase the amount of cholesterol circulating in your blood and raise your risk of heart disease. To reduce the risk of heart disease, the USDA /Health and Human Services Dietary Guidelines for Americans recommends limiting the amount of cholesterol in your diet to no more than 300 mg a day. The guidelines also recommend limit- ing the amount of fat you consume to no more than 30 percent of your total calories, while holding your consumption of saturated fats to more than 10 percent of your total calories (the calories from saturated fats are counted as part of the total calories from fat). Food poisoning. Cheese made from raw (unpasteurized) milk may contain hazardous microorganisms, including Salmonella and Listeria. Salmonella causes serious gastric upset; Lis- teria, a flulike infection, encephalitis, or blood infection. Both may be life-threatening to the very young, the very old, pregnant women, and those whose immune systems are weakened either by illness (such as AIDS) or drugs (such as cancer chemotherapy). In 1998, the Federal Centers for Disease Control (CDC) released data identif ying Listeria as the cause of nearly half the reported deaths from food poisoning. Allergy to milk proteins. Milk is one of the foods most frequently implicated as a cause of allergic reactions, particularly upset stomach. However, in many cases the reaction is not a true allergy but the result of lactose intolerance (see below). Lactose intolerance. Lactose intolerance—the inability to digest the sugar in milk—is an inherited metabolic deficiency that affects two thirds of all adults, including 90 to 95 percent of all Orientals, 70 to 75 percent of all blacks, and 6 to 8 percent of Caucasians. These people do not have sufficient amounts of lactase, the enzyme that breaks the disaccharide lactose into its easily digested components, galactose and glucose. When they drink milk, the undi- gested sugar is fermented by bacteria in the gut, causing bloating, diarrhea, flatulence, and intestinal discomfort. Some milk is now sold with added lactase to digest the lactose and make the milk usable for lactase-deficient people. In making cheese, most of the lactose in milk is broken down into glucose and galactose. There is very little lactose in cheeses other than the fresh ones—cottage cheese, cream cheese, and farmer cheese. Galactosemia. Galactosemia is an inherited metabolic disorder in which the body lacks the enzymes needed to metabolize galactose, a component of lactose. Galactosemia is a reces- sive trait; you must receive the gene from both parents to develop the condition. Babies born with galactosemia will fail to thrive and may develop brain damage or cataracts if they are given milk. To prevent this, children with galactosemia are usually kept on a protective milk- free diet for several years, until their bodies have developed alternative pathways by which to metabolize galactose. Pregnant women who are known carriers of galactosemia may be advised to give up milk and milk products while pregnant lest the unmetabolized galactose in their bodies cause brain damage to the fetus (damage not detectable by amniocentesis). Genetic counseling is available to identif y galactosemia carriers and assess their chances of producing a baby with the disorder. Penicillin sensitivity. People who experience a sensitivity reaction the first time they take penicillin may have been sensitized by exposure to the Penicillium molds in the environment, including the Penicillium molds used to make brie, blue, camembert, roquefort, Stilton, and other “blue” cheeses.

Food/Drug Interactions Tetracycline. The calcium ions in milk products, including cheese, bind tetracyclines into insoluble compounds. If you take tetracyclines with cheese, your body may not be able to absorb and use the drug efficiently. Monoamine oxidase (MAO) inhibitors. Monoamine oxidase inhibitors are drugs used to treat depression. They inactivate naturally occurring enzymes in your body that metabolize tyra- mine, a substance found in many fermented or aged foods. Tyramine constricts blood ves- sels and increases blood pressure. If you eat a food such as aged or fermented cheese which is high in tyramine while you are taking an M AO inhibitor, your body may not be able to eliminate the tyramine. The result may be a hypertensive crisis.

Tyramine Content of Cheeses High Boursault, Camembert, Cheddar, Emmenthaler, Stilton Medium to high Blue, brick, Brie, Gruyère, mozzarella, Parmesan, Romano, Roquefort Low Processed American cheese Very little or none Cottage and cream cheese Sources: The Medical Letter Handbook of Adverse Drug Interactions (1985); Handbook of Clinical Dietetics ( The A merican Dietet ic Associat ion, 1981). False-positive test for pheochromocytoma. Pheochromocytomas (tumors of the adrenal glands) secrete adrenalin that is converted by the body to vanillyl-mandelic acid ( VM A) and excreted in the urine. Tests for this tumor measure the level of VM A in the urine. Since cheese contains VM A, taking the test after eating cheese may result in a false-positive result. Ordinarily, cheese is prohibited for at least 72 hours before this diagnostic test.... cheese

Chocolate

(Cocoa, milk chocolate, sweet chocolate)

Nutritional Profile Energy value (calories per serving): Moderate Protein: Low (cocoa powder) High (chocolate) Fat: Moderate Saturated fat: High Cholesterol: None Carbohydrates: Low (chocolate) High (cocoa powder) Fiber: Moderate (chocolate) High (cocoa powder) Sodium: Moderate Major vitamin contribution: B vitamins Major mineral contribution: Calcium, iron, copper

About the Nutrients in This Food Cocoa beans are high-carbohydrate, high-protein food, with less dietary fiber and more fat than all other beans, excepting soy beans. The cocoa bean’s dietary fiber includes pectins and gums. Its proteins are limited in the essential amino acids lysine and isoleucine. Cocoa butter, the fat in cocoa beans, is the second most highly saturated vegetable fat (coconut oil is number one), but it has two redeeming nutritional qualities. First, it rarely turns rancid. Second, it melts at 95°F, the temperature of the human tongue. Cocoa butter has no cholesterol; neither does plain cocoa powder or plain dark chocolate. Cocoa beans have B vitamins (thiamine, riboflavin, niacin) plus min- erals (iron, magnesium, potassium, phosphorus, and copper). All chocolate candy is made from chocolate liquor, a thick paste pro- duce by roasting and grinding cocoa beans. Dark (sweet) chocolate is made of chocolate liquor, cocoa butter, and sugar. Milk chocolate is made of choc- olate liquor, cocoa butter, sugar, milk or milk powder, and vanilla. White * These values apply to plain cocoa powder and plain unsweetened chocolate. Add- ing other foods, such as milk or sugar, changes these values. For example, there is no cholesterol in plain bitter chocolate, but there is cholesterol in milk chocolate. chocolate is made of cocoa butter, sugar, and milk powder. Baking chocolate is unsweetened dark chocolate. The most prominent nutrient in chocolate is its fat. Fat Content in One Ounce of Chocolate

Saturated fat (g) Monounsaturated fat (g) Polyunsaturated fat (g) Cholesterol (mg)
Dark (sweet)
chocolate 5.6 3.2 0.3 0
Milk chocolate 5.9 4.5 0.4 6.6
Baking chocolate 9 5.6 0.3 0
White chocolate 5.5 2.6 0.3 0
  Source: USDA Nut rient Data Laborator y. Nat ional Nut rient Database for Standard Reference. Available online. UR L : http://w w w.nal.usda.gov/fnic/foodcomp/search /. Because chocolate is made from a bean, it also contains dietary fiber and measurable amounts of certain minerals. For example, one ounce of dark chocolate, the most nutritious “eating” chocolate, has 1.6 g dietary fiber, 0.78 mg iron (4 percent of the R DA for a woman, 10 percent of the R DA for a man), 32 mg magnesium (11 percent of the R DA for a woman, 8 percent of the R DA for a man), and .43 mg zinc (5 percent of the R DA for a woman, 4 percent of the R DA for a man). Cocoa beans, cocoa, and chocolate contain caffeine, the muscle stimulant theobro- mine, and the mood-altering chemicals phenylethylalanine and anandamide (see below).

The Most Nutritious Way to Serve This Food With low-fat milk to complete the proteins without adding saturated fat and cholesterol. NOTE : Both cocoa and chocolate contain oxalic acid, which binds with calcium to form cal- cium oxalate, an insoluble compound, but milk has so much calcium that the small amount bound to cocoa and chocolate hardly matters. Chocolate skim milk is a source of calcium.

Diets That May Restrict or Exclude This Food Antiflatulence diet Low-calcium and low-oxalate diet (to prevent the formation of calcium oxalate kidney stones) Low-calorie diet Low-carbohydrate diet Low-fat diet Low-fat, controlled-cholesterol diet (milk chocolates) Low-fiber diet Potassium-regulated (low-potassium) diet

Buying This Food Look for: Tightly sealed boxes or bars. When you open a box of chocolates or unwrap a candy bar, the chocolate should be glossy and shiny. Chocolate that looks dull may be stale, or it may be inexpensively made candy without enough cocoa butter to make it gleam and give it the rich creamy mouthfeel we associate with the best chocolate. (Fine chocolate melts evenly on the tongue.) Chocolate should also smell fresh, not dry and powdery, and when you break a bar or piece of chocolate it should break cleanly, not crumble. One exception: If you have stored a bar of chocolate in the refrigerator, it may splinter if you break it without bringing it to room temperature first.

Storing This Food Store chocolate at a constant temperature, preferably below 78°F. At higher temperatures, the fat in the chocolate will rise to the surface and, when the chocolate is cooled, the fat will solidif y into a whitish powdery bloom. Bloom is unsightly but doesn’t change the chocolate’s taste or nutritional value. To get rid of bloom, melt the chocolate. The chocolate will turn dark, rich brown again when its fat recombines with the other ingredients. Chocolate with bloom makes a perfectly satisfactory chocolate sauce. Dark chocolate (bitter chocolate, semisweet chocolate) ages for at least six months after it is made, as its flavor becomes deeper and more intense. Wrapped tightly and stored in a cool, dry cabinet, it can stay fresh for a year or more. Milk chocolate ages only for about a month after it is made and holds its peak flavor for about three to six months, depending on how carefully it is stored. Plain cocoa, with no added milk powder or sugar, will stay fresh for up to a year if you keep it tightly sealed and cool.

What Happens When You Cook This Food Chocolate burns easily. To melt it without mishap, stir the chocolate in a bowl over a pot of hot water or in the top of a double boiler or put the chocolate in a covered dish and melt it in the microwave (which does not get as hot as a pot on the store). Simple chemistry dictates that chocolate cakes be leavened with baking soda rather than baking powder. Chocolate is so acidic that it will upset the delicate balance of acid (cream of tartar) and base (alkali = sodium bicarbonate = baking soda) in baking powder. But it is not acidic enough to balance plain sodium bicarbonate. That’s why we add an acidic sour-milk product such as buttermilk or sour cream or yogurt to a chocolate cake. Without the sour milk, the batter would be so basic that the chocolate would look red, not brown, and taste very bitter.

How Other Kinds of Processing Affect This Food Freezing. Chocolate freezes and thaws well. Pack it in a moistureproof container and defrost it in the same package to let it reabsorb moisture it gave off while frozen.

Medical Uses and/or Benefits Mood elevator. Chocolate’s reputation for making people feel good is based not only on its caffeine content—19 mg caffeine per ounce of dark (sweet) chocolate, which is one-third the amount of caffeine in a five-ounce cup of brewed coffee—but also on its naturally occurring mood altering chemicals phenylethylalanine and anandamide. Phenylethylalanine is found in the blood of people in love. Anandamide stimulates areas of your brain also affected by the active ingredients in marijuana. (NOTE : As noted by the researchers at the Neurosci- ences Institute in San Diego who identified anandamide in chocolate in 1996, to get even the faintest hint of marijuana-like effects from chocolate you would have to eat more than 25 pounds of the candy all at once.) Possible heart health benefits. Chocolate is rich in catechins, the antioxidant chemicals that give tea its reputation as a heart-protective anticancer beverage (see tea). In addition, a series of studies beginning with those at the USDA Agricultural Research Center in Peoria, Illinois, suggest that consuming foods rich in stearic acid like chocolate may reduce rather than raise the risk of a blood clot leading to a heart attack. Possible slowing of the aging process. Chocolate is a relatively good source of copper, a mineral that may play a role in slowing the aging process by decreasing the incidence of “protein glycation,” a reaction in which sugar molecules ( gly = sugar) hook up with protein molecules in the bloodstream, twisting the protein molecules out of shape and rendering them unusable. This can lead to bone loss, rising cholesterol, cardiac abnormalities, and a slew of other unpleasantries. In people with diabetes, excess protein glycation may be one factor involved in complications such as loss of vision. Ordinarily, increased protein glyca- tion is age-related. But at the USDA Grand Forks Human Nutrition Research Center in North Dakota, agricultural research scientist Jack T. Saari has found that rats on copper-deficient diets experience more protein glycation at any age than other rats. A recent USDA survey of American eating patterns says that most of us get about 1.2 mg copper a day, considerably less than the Estimated Safe and Adequate Daily Dietary Intake (ESADDI) or 1.5 mg to 3 mg a day. Vegetarians are less likely to be copper deficient because, as Saari notes, the foods highest in copper are whole grains, nuts, seeds, and beans, including the cocoa bean. One ounce of dark chocolate has .25 mg copper (8 –17 percent of the ESADDI).

Adverse Effects Associated with This Food Possible loss of bone density. In 2008, a team of Australian researchers at Royal Perth Hos- pital, and Sir Charles Gairdner Hospital published a report in the American Journal of Clinical Nutrition suggesting that women who consume chocolate daily had 3.1 percent lower bone density than women who consume chocolate no more than once a week. No explanation for the reaction was proposed; the finding remains to be confirmed. Possible increase in the risk of heart disease. Cocoa beans, cocoa powder, and plain dark chocolate are high in saturated fats. Milk chocolate is high in saturated fats and cholesterol. Eating foods high in saturated fats and cholesterol increases the amount of cholesterol in your blood and raises your risk of heart disease. NOTE : Plain cocoa powder and plain dark chocolate may be exceptions to this rule. In studies at the USDA Agricultural Research Center in Peoria, Illinois, volunteers who consumed foods high in stearic acid, the saturated fat in cocoa beans, cocoa powder, and chocolate, had a lower risk of blood clots. In addition, chocolate is high in flavonoids, the antioxidant chemicals that give red wine its heart-healthy reputation. Mild jitters. There is less caffeine in chocolate than in an equal size serving of coffee: A five- ounce cup of drip-brewed coffee has 110 to 150 mg caffeine; a five-ounce cup of cocoa made with a tablespoon of plain cocoa powder ( 1/3 oz.) has about 18 mg caffeine. Nonetheless, people who are very sensitive to caffeine may find even these small amounts problematic. Allergic reaction. According to the Merck Manual, chocolate is one of the 12 foods most likely to trigger the classic food allergy symptoms: hives, swelling of the lips and eyes, and upset stomach.* The others are berries (blackberries, blueberries, raspberries, strawberries), corn, eggs, fish, legumes (green peas, lima beans, peanuts, soybeans), milk, nuts, peaches, pork, shellfish, and wheat (see wheat cer ea ls).

Food/Drug Interactions Monoamine oxidase (MAO) inhibitors. Monoamine oxidase inhibitors are drugs used to treat depression. They inactivate naturally occurring enzymes in your body that metabolize tyra- mine, a substance found in many fermented or aged foods. Tyramine constricts blood vessels and increases blood pressure. Caffeine is a substance similar to tyramine. If you consume excessive amounts of a caffeinated food, such as cocoa or chocolate, while you are taking an M AO inhibitor, the result may be a hypertensive crisis. False-positive test for pheochromocytoma. Pheochromocytoma, a tumor of the adrenal gland, secretes adrenalin, which the body converts to VM A (vanillylmandelic acid). VM A is excreted in urine, and, until recently, the test for this tumor measured the level of VM A in the urine. In the past, chocolate and cocoa, both of which contain VM A, were eliminated from the patient’s diet prior to the test lest they elevate the level of VM A in the urine and produce a false-positive result. Today, more finely drawn tests usually make this unnecessary. * The evidence link ing chocolate to allergic or migraine headaches is inconsistent. In some people, phenylet hylamine (PEA) seems to cause headaches similar to t hose induced by t yramine, anot her pressor amine. The PEA-induced headache is unusual in t hat it is a delayed react ion t hat usually occurs 12 or more hours after t he chocolate is eaten.... chocolate

Coffee

Nutritional Profile Energy value (calories per serving): Low Protein: Trace Fat: Trace Saturated fat: None Cholesterol: None Carbohydrates: Trace Fiber: Trace Sodium: Low Major vitamin contribution: None Major mineral contribution: None

About the Nutrients in This Food Coffee beans are roasted seeds from the fruit of the evergreen coffee tree. Like other nuts and seeds, they are high in proteins (11 percent), sucrose and other sugars (8 percent), oils (10 to 15 percent), assorted organic acids (6 percent), B vitamins, iron, and the central nervous system stimulant caffeine (1 to 2 percent). With the exceptions of caffeine, none of these nutrients is found in coffee. Like spinach, rhubarb, and tea, coffee contains oxalic acid (which binds calcium ions into insoluble compounds your body cannot absorb), but this is of no nutritional consequence as long as your diet contains adequate amounts of calcium-rich foods. Coffee’s best known constituent is the methylxanthine central ner- vous system stimulant caffeine. How much caffeine you get in a cup of coffee depends on how the coffee was processed and brewed. Caffeine is Caffeine Content/Coffee Servings Brewed coffee 60 mg/five-ounce cup Brewed/decaffeinated 5 mg/five-ounce cup Espresso  64 mg/one-ounce serving Instant  47 mg/rounded teaspoon

The Most Nutritious Way to Serve This Food In moderation, with high-calcium foods. Like spinach, rhubarb, and tea, coffee has oxalic acid, which binds calcium into insoluble compounds. This will have no important effect as long as you keep your consumption moderate (two to four cups of coffee a day) and your calcium consumption high.

Diets That May Restrict or Exclude This Food Bland diet Gout diet Diet for people with heart disease (regular coffee)

Buying This Food Look for: Ground coffee and coffee beans in tightly sealed, air- and moisture-proof containers. Avoid: Bulk coffees or coffee beans stored in open bins. When coffee is exposed to air, the volatile molecules that give it its distinctive flavor and richness escape, leaving the coffee flavorless and/or bitter.

Storing This Food Store unopened vacuum-packed cans of ground coffee or coffee beans in a cool, dark cabinet—where they will stay fresh for six months to a year. They will lose some flavor in storage, though, because it is impossible to can coffee without trapping some flavor- destroying air inside the can. Once the can or paper sack has been opened, the coffee or beans should be sealed as tight as possible and stored in the refrigerator. Tightly wrapped, refrigerated ground coffee will hold its freshness and flavor for about a week, whole beans for about three weeks. For longer storage, freeze the coffee or beans in an air- and moistureproof container. ( You can brew coffee directly from frozen ground coffee and you can grind frozen beans without thawing them.)

Preparing This Food If you make your coffee with tap water, let the water run for a while to add oxygen. Soft water makes “cleaner”-tasting coffee than mineral-rich hard water. Coffee made with chlorinated water will taste better if you refrigerate the water overnight in a glass (not plastic) bottle so that the chlorine evaporates. Never make coffee with hot tap water or water that has been boiled. Both lack oxygen, which means that your coffee will taste flat. Always brew coffee in a scrupulously clean pot. Each time you make coffee, oils are left on the inside of the pot. If you don’t scrub them off, they will turn rancid and the next pot of coffee you brew will taste bitter. To clean a coffee pot, wash it with detergent, rinse it with water in which you have dissolved a few teaspoons of baking soda, then rinse one more time with boiling water.

What Happens When You Cook This Food In making coffee, your aim is to extract flavorful solids (including coffee oils and sucrose and other sugars) from the ground beans without pulling bitter, astringent tannins along with them. How long you brew the coffee determines how much solid material you extract and how the coffee tastes. The longer the brewing time, the greater the amount of solids extracted. If you brew the coffee long enough to extract more than 30 percent of its solids, you will get bitter compounds along with the flavorful ones. (These will also develop by let- ting coffee sit for a long time after brewing it.) Ordinarily, drip coffee tastes less bitter than percolator coffee because the water in a drip coffeemaker goes through the coffee only once, while the water in the percolator pot is circulated through the coffee several times. To make strong but not bitter coffee, increase the amount of coffee—not the brewing time.

How Other Kinds of Processing Affect This Food Drying. Soluble coffees (freeze-dried, instant) are made by dehydrating concentrated brewed coffee. These coffees are often lower in caffeine than regular ground coffees because caffeine, which dissolves in water, is lost when the coffee is dehydrated. Decaffeinating. Decaffeinated coffee is made with beans from which the caffeine has been extracted, either with an organic solvent (methylene chloride) or with water. How the coffee is decaffeinated has no effect on its taste, but many people prefer water-processed decaf- feinated coffee because it is not a chemically treated food. (Methylene chloride is an animal carcinogen, but the amounts that remain in coffees decaffeinated with methylene chloride are so small that the FDA does not consider them hazardous. The carcinogenic organic sol- vent trichloroethylene [TCE], a chemical that causes liver cancer in laboratory animals, is no longer used to decaffeinate coffee.)

Medical Uses and/or Benefits As a stimulant and mood elevator. Caffeine is a stimulant. It increases alertness and concentra- tion, intensifies muscle responses, quickens heartbeat, and elevates mood. Its effects derive from the fact that its molecular structure is similar to that of adenosine, a natural chemical by-product of normal cell activity. Adenosine is a regular chemical that keeps nerve cell activ- ity within safe limits. When caffeine molecules hook up to sites in the brain when adenosine molecules normally dock, nerve cells continue to fire indiscriminately, producing the jangly feeling sometimes associated with drinking coffee, tea, and other caffeine products. As a rule, it takes five to six hours to metabolize and excrete caffeine from the body. During that time, its effects may vary widely from person to person. Some find its stimu- lation pleasant, even relaxing; others experience restlessness, nervousness, hyperactivity, insomnia, flushing, and upset stomach after as little as one cup a day. It is possible to develop a tolerance for caffeine, so people who drink coffee every day are likely to find it less imme- diately stimulating than those who drink it only once in a while. Changes in blood vessels. Caffeine’s effects on blood vessels depend on site: It dilates coronary and gastrointestinal vessels but constricts blood vessels in your head and may relieve headache, such as migraine, which symptoms include swollen cranial blood vessels. It may also increase pain-free exercise time in patients with angina. However, because it speeds up heartbeat, doc- tors often advise patients with heart disease to avoid caffeinated beverages entirely. As a diuretic. Caffeine is a mild diuretic sometimes included in over-the-counter remedies for premenstrual tension or menstrual discomfort.

Adverse Effects Associated with This Food Stimulation of acid secretion in the stomach. Both regular and decaffeinated coffees increase the secretion of stomach acid, which suggests that the culprit is the oil in coffee, not its caffeine. Elevated blood levels of cholesterol and homocysteine. In the mid-1990s, several studies in the Netherlands and Norway suggested that drinking even moderate amounts of coffee (five cups a day or less) might raise blood levels of cholesterol and homocysteine (by-product of protein metabolism considered an independent risk factor for heart disease), thus increas- ing the risk of cardiovascular disease. Follow-up studies, however, showed the risk limited to drinking unfiltered coffees such as coffee made in a coffee press, or boiled coffees such as Greek, Turkish, or espresso coffee. The unfiltered coffees contain problematic amounts of cafestol and kahweol, two members of a chemical family called diterpenes, which are believed to affect cholesterol and homocysteine levels. Diterpenes are removed by filtering coffee, as in a drip-brew pot. Possible increased risk of miscarriage. Two studies released in 2008 arrived at different conclusions regarding a link between coffee consumption and an increased risk of miscar- riage. The first, at Kaiser Permanente (California), found a higher risk of miscarriage among women consuming even two eight-ounce cups of coffee a day. The second, at Mt. Sinai School of Medicine (New York), found no such link. However, although the authors of the Kaiser Permanente study described it as a “prospective study” (a study in which the research- ers report results that occur after the study begins), in fact nearly two-thirds of the women who suffered a miscarriage miscarried before the study began, thus confusing the results. Increased risk of heartburn /acid reflux. The natural oils in both regular and decaffeinated coffees loosen the lower esophageal sphincter (LES), a muscular valve between the esopha- gus and the stomach. When food is swallowed, the valve opens to let food into the stomach, then closes tightly to keep acidic stomach contents from refluxing (flowing backwards) into the esophagus. If the LES does not close efficiently, the stomach contents reflux and cause heartburn, a burning sensation. Repeated reflux is a risk factor for esophageal cancer. Masking of sleep disorders. Sleep deprivation is a serious problem associated not only with automobile accidents but also with health conditions such as depression and high blood pres- sure. People who rely on the caffeine in a morning cup of coffee to compensate for lack of sleep may put themselves at risk for these disorders. Withdrawal symptoms. Caffeine is a drug for which you develop a tolerance; the more often you use it, the more likely you are to require a larger dose to produce the same effects and the more likely you are to experience withdrawal symptoms (headache, irritation) if you stop using it. The symptoms of coffee-withdrawal can be relieved immediately by drinking a cup of coffee.

Food/Drug Interactions Drugs that make it harder to metabolize caffeine. Some medical drugs slow the body’s metabolism of caffeine, thus increasing its stimulating effect. The list of such drugs includes cimetidine (Tagamet), disulfiram (Antabuse), estrogens, fluoroquinolone antibiotics (e.g., ciprofloxacin, enoxacin, norfloxacin), fluconazole (Diflucan), fluvoxamine (Luvox), mexi- letine (Mexitil), riluzole (R ilutek), terbinafine (Lamisil), and verapamil (Calan). If you are taking one of these medicines, check with your doctor regarding your consumption of caf- feinated beverages. Drugs whose adverse effects increase due to consumption of large amounts of caffeine. This list includes such drugs as metaproterenol (Alupent), clozapine (Clozaril), ephedrine, epinephrine, monoamine oxidase inhibitors, phenylpropanolamine, and theophylline. In addition, suddenly decreasing your caffeine intake may increase blood levels of lithium, a drug used to control mood swings. If you are taking one of these medicines, check with your doctor regarding your consumption of caffeinated beverages. Allopurinol. Coffee and other beverages containing methylxanthine stimulants (caffeine, theophylline, and theobromine) reduce the effectiveness of the antigout drug allopurinol, which is designed to inhibit xanthines. Analgesics. Caffeine strengthens over-the-counter painkillers (acetaminophen, aspirin, and other nonsteroidal anti-inflammatories [NSAIDS] such as ibuprofen and naproxen). But it also makes it more likely that NSAIDS will irritate your stomach lining. Antibiotics. Coffee increases stomach acidity, which reduces the rate at which ampicillin, erythromycin, griseofulvin, penicillin, and tetracyclines are absorbed when they are taken by mouth. (There is no effect when the drugs are administered by injection.) Antiulcer medication. Coffee increases stomach acidity and reduces the effectiveness of nor- mal doses of cimetidine and other antiulcer medication. False-positive test for pheochromocytoma. Pheochromocytoma, a tumor of the adrenal glands, secretes adrenalin, which is converted to VM A (vanillylmandelic acid) by the body and excreted in the urine. Until recently, the test for this tumor measured the levels of VM A in the patient’s urine and coffee, which contains VM A, was eliminated from patients’ diets lest it elevate the level of VM A in the urine, producing a false-positive test result. Today, more finely drawn tests make this unnecessary. Iron supplements. Caffeine binds with iron to form insoluble compounds your body cannot absorb. Ideally, iron supplements and coffee should be taken at least two hours apart. Birth control pills. Using oral contraceptives appears to double the time it takes to eliminate caffeine from the body. Instead of five to six hours, the stimulation of one cup of coffee may last as long as 12 hours. Monoamine oxidase (MAO) inhibitors. Monoamine oxidase inhibitors are drugs used to treat depression. They inactivate naturally occurring enzymes in your body that metabolize tyra- mine, a substance found in many fermented or aged foods. Tyramine constricts blood vessels and increases blood pressure. Caffeine is a substance similar to tyramine. If you consume excessive amounts of a caffeinated beverage such as coffee while you are taking an M AO inhibitor, the result may be a hypertensive crisis. Nonprescription drugs containing caffeine. The caffeine in coffee may add to the stimulant effects of the caffeine in over-the-counter cold remedies, diuretics, pain relievers, stimulants, and weight-control products containing caffeine. Some cold pills contain 30 mg caffeine, some pain relievers 130 mg, and some weight-control products as much as 280 mg caffeine. There are 110 –150 mg caffeine in a five-ounce cup of drip-brewed coffee. Sedatives. The caffeine in coffee may counteract the drowsiness caused by sedative drugs; this may be a boon to people who get sleepy when they take antihistamines. Coffee will not, however, “sober up” people who are experiencing the inebriating effects of alcoholic beverages. Theophylline. Caffeine relaxes the smooth muscle of the bronchi and may intensif y the effects (and/or increase the risk of side effects) of this antiasthmatic drug.... coffee

Distilled Spirits

(Brandy, gin, rum, tequila, whiskey, vodka)

Nutritional Profile Energy value (calories per serving): Moderate to high Protein: None Fat: None Saturated fat: None Cholesterol: None Carbohydrates: None (except for cordials which contain added sugar) Fiber: None Sodium: Low Major vitamin contribution: None Major mineral contribution: Phosphorus

About the Nutrients in This Food Spirits are the clear liquids produced by distilling the fermented sugars of grains, fruit, or vegetables. The yeasts that metabolize these sugars and convert them into alcohol stop growing when the concentration of alcohol rises above 12–15 percent. In the United States, the proof of an alcoholic beverage is defined as twice its alcohol content by volume: a beverage with 20 percent alcohol by volume is 40 proof. This is high enough for most wines, but not high enough for most whiskies, gins, vodkas, rums, brandies, and tequilas. To reach the concentra- tion of alcohol required in these beverages, the fermented sugars are heated and distilled. Ethyl alcohol (the alcohol in beer, wine, and spirits) boils at a lower temperature than water. When the fermented sugars are heated, the ethyl alcohol escapes from the distillation vat and condenses in tubes leading from the vat to a collection vessel. The clear liquid that collects in this vessel is called distilled spirits or, more technically, grain neutral spirits. Gins, whiskies, cordials, and many vodkas are made with spirits American whiskeys (which include bourbon, rye, and distilled from grains. blended whiskeys) and Canadian, Irish, and Scotch whiskies are all made from spirits aged in wood barrels. They get their flavor from the grains and their color from the barrels. (Some whiskies are also colored with caramel.) Vodka is made from spirits distilled and filtered to remove all flavor. By law, vodkas made in America must be made with spirits distilled from grains. Imported vodkas may be made with spirits distilled either from grains or potatoes and may contain additional flavoring agents such as citric acid or pepper. Aquavit, for example, is essentially vodka flavored with caraway seeds. Gin is a clear spirit flavored with an infusion of juniper berries and other herbs (botanicals). Cordials (also called liqueurs) and schnapps are flavored spirits; most are sweetened with added sugar. Some cordials contain cream. Rum is made with spirits distilled from sugar cane (molasses). Tequila is made with spirits distilled from the blue agave plant. Brandies are made with spirits distilled from fruit. (Arma- gnac and cognac are distilled from fermented grapes, calvados and applejack from fermented apples, kirsch from fermented cherries, slivovitz from fermented plums.) Unless they contain added sugar or cream, spirits have no nutrients other than alcohol. Unlike food, which has to be metabolized before your body can use it for energy, alcohol can be absorbed into the blood-stream directly from the gastrointestinal tract. Ethyl alcohol provides 7 calories per gram.

The Most Nutritious Way to Serve This Food The USDA /Health and Human Services Dietary Guidelines for Americans defines one drink as 12 ounces of beer, five ounces of wine, or 1.25 ounces of distilled spirits, and “moderate drinking” as two drinks a day for a man, one drink a day for a woman.

Diets That May Restrict or Exclude This Food Bland diet Lactose-free diet (cream cordials made with cream or milk) Low-purine (antigout) diet

Buying This Food Look for: Tightly sealed bottles stored out of direct sunlight, whose energy might disrupt the structure of molecules in the beverage and alter its flavor. Choose spirits sold only by licensed dealers. Products sold in these stores are manufac- tured under the strict supervision of the federal government.

Storing This Food Store sealed or opened bottles of spirits in a cool, dark cabinet.

Preparing This Food All spirits except unflavored vodkas contain volatile molecules that give the beverage its characteristic taste and smell. Warming the liquid excites these molecules and intensifies the flavor and aroma, which is the reason we serve brandy in a round glass with a narrower top that captures the aromatic molecules as they rise toward the air when we warm the glass by holding it in our hands. Whiskies, too, though traditionally served with ice in America, will have a more intense flavor and aroma if served at room temperature.

What Happens When You Cook This Food The heat of cooking evaporates the alcohol in spirits but leaves the flavoring intact. Like other alcoholic beverages, spirits should be added to a recipe near the end of the cooking time to preserve the flavor while cooking away any alcohol bite. Alcohol is an acid. If you cook it in an aluminum or iron pot, it will combine with metal ions to form dark compounds that discolor the pot and the food you are cooking. Any recipe made with spirits should be prepared in an enameled, glass, or stainless-steel pot.

Medical Uses and/or Benefits Reduced risk of heart attack. Data from the American Cancer Society’s Cancer Prevention Study 1, a 12-year survey of more than 1 million Americans in 25 states, shows that men who take one drink a day have a 21 percent lower risk of heart attack and a 22 percent lower risk of stroke than men who do not drink at all. Women who have up to one drink a day also reduce their risk of heart attack. Numerous later studies have confirmed these findings. Lower cholesterol levels. Beverage alcohol decreases the body’s production and storage of low density lipoproteins (LDLs), the protein and fat particles that carry cholesterol into your arteries. As a result, people who drink moderately tend to have lower cholesterol levels and higher levels of high density lipoproteins (HDLs), the fat and protein particles that carry cholesterol out of the body. Numerous later studies have confirmed these findings. Lower risk of stroke. In January 1999, the results of a 677-person study published by researchers at New York Presbyterian Hospital-Columbia University showed that moderate alcohol consumption reduces the risk of stroke due to a blood clot in the brain among older people (average age: 70). How alcohol prevents stroke is still unknown, but it is clear that moderate use is a key. Heavy drinkers (those who consume more than seven drinks a day) have a higher risk of stroke. People who once drank heavily, but cut their consumption to moderate levels, reduce their risk of stroke. Stimulating the appetite. Alcoholic beverages stimulate the production of saliva and the gastric acids that cause the stomach contractions we call hunger pangs. Moderate amounts of alcoholic beverages, which may help stimulate appetite, are often prescribed for geriatric patients, convalescents, and people who do not have ulcers or other chronic gastric problems that might be exacerbated by the alcohol. Dilation of blood vessels. Alcoholic beverages dilate the tiny blood vessels just under the skin, bringing blood up to the surface. That’s why moderate amounts of alcoholic beverages (0.2–1 gram per kilogram of body weight, or two ounces of whiskey for a 150-pound adult) temporarily warm the drinker. But the warm blood that flows up to the surface of the skin will cool down there, making you even colder when it circulates back into the center of your body. Then an alcohol flush will make you perspire, so you lose more heat. Excessive amounts of beverage alcohol may depress the mechanism that regulates body temperature.

Adverse Effects Associated with This Food Alcoholism. Alcoholism is an addiction disease, the inability to control one’s alcohol consumption. It is a potentially life-threatening condition, with a higher risk of death by accident, suicide, malnutrition, or acute alcohol poisoning, a toxic reaction that kills by para- lyzing body organs, including the heart. Fetal alcohol syndrome. Fetal alcohol syndrome is a specific pattern of birth defects—low birth weight, heart defects, facial malformations, learning disabilities, and mental retarda- tion—first recognized in a study of babies born to alcoholic women who consumed more than six drinks a day while pregnant. Subsequent research has found a consistent pattern of milder defects in babies born to women who drink three to four drinks a day or five drinks on any one occasion while pregnant. To date there is no evidence of a consistent pattern of birth defects in babies born to women who consume less than one drink a day while preg- nant, but two studies at Columbia University have suggested that as few as two drinks a week while pregnant may raise a woman’s risk of miscarriage. (One drink is 12 ounces of beer, five ounces of wine, or 1.25 ounces of distilled spirits.) Increased risk of breast cancer. In 2008, scientists at the National Cancer Institute released data from a seven-year survey of more than 100,000 postmenopausal women showing that even moderate drinking (one to two drinks a day) may increase by 32 percent a woman’s risk of developing estrogen-receptor positive (ER+) and progesterone-receptor positive (PR+) breast cancer, tumors whose growth is stimulated by hormones. No such link was found between consuming alcohol and the risk of developing ER-/PR- tumors (not fueled by hor- mones). The finding applies to all types of alcohol: beer, wine, and distilled spirits. Increased risk of oral cancer (cancer of the mouth and throat). Numerous studies confirm the A merican Cancer Societ y’s warn ing that men and women who consume more than t wo drinks a day are at higher risk of oral cancer than are nondrinkers or people who drink less. Increased risk of cancer of the colon and rectum. In the mid-1990s, studies at the University of Oklahoma suggested that men who drink more than five beers a day are at increased risk of rectal cancer. Later studies suggested that men and women who are heavy beer or spirits drinkers (but not those who are heavy wine drinkers) have a higher risk of colorectal cancers. Further studies are required to confirm these findings. Malnutrition. While moderate alcohol consumption stimulates appetite, alcohol abuses depresses it. In addition, an alcoholic may drink instead of eating. When an alcoholic does eat, excess alcohol in his/her body prevents absorption of nutrients and reduces the ability to synthesize new tissue. Hangover. Alcohol is absorbed from the stomach and small intestine and carried by the bloodstream to the liver, where it is oxidized to acetaldehyde by alcohol dehydrogenase (ADH), the enzyme our bodies use every day to metabolize the alcohol we produce when we digest carbohydrates. The acetaldehyde is converted to acetyl coenzyme A and either eliminated from the body or used in the synthesis of cholesterol, fatty acids, and body tis- sues. Although individuals vary widely in their capacity to metabolize alcohol, an adult of average size can metabolize the alcohol in four ounces (120 ml) whiskey in approximately five to six hours. If he or she drinks more than that, the amount of alcohol in the body will exceed the available supply of ADH. The surplus, unmetabolized alcohol will pile up in the bloodstream, interfering with the liver’s metabolic functions. Since alcohol decreases the reabsorption of water from the kidneys and may inhibit the secretion of an antidiuretic hormone, the drinker will begin to urinate copiously, losing magnesium, calcium, and zinc but retaining uric acid, which is irritating. The level of lactic acid in the body will increase, making him or her feel tired and out of sorts; the acid-base balance will be out of kilter; the blood vessels in the head will swell and throb; and the stomach, its lining irritated by the alcohol, will ache. The ultimate result is a hangover whose symptoms will disappear only when enough time has passed to allow the body to marshal the ADH needed to metabolize the extra alcohol in the person’s blood. Changes in body temperature. Alcohol dilates capillaries, tiny blood vessels just under the skin, producing a “flush” that temporarily warms the drinker. But drinking is not an effective way to stay warm in cold weather. Warm blood flowing up from the body core to the surface capillaries is quickly chilled, making you even colder when it circulates back into your organs. In addition, an alcohol flush triggers perspiration, further cooling your skin. Finally, very large amounts of alcohol may actually depress the mechanism that regulates body temperature. Impotence. Excessive drinking decreases libido (sexual desire) and interferes with the ability to achieve or sustain an erection. Migraine headache. Some alcoholic beverages contain chemicals that inhibit PST, an enzyme that breaks down certain alcohols in spirits so that they can be eliminated from the body. If they are not broken down by PST, these alcohols will build up in the bloodstream and may trigger a migraine headache. Gin and vodka appear to be the distilled spirits least likely to trigger headaches, brandy the most likely.

Food/Drug Interactions Acetaminophen (Tylenol, etc.). FDA recommends that people who regularly have three or more drinks a day consult a doctor before using acetaminophen. The alcohol/acetaminophen combination may cause liver failure. Anti-alcohol abuse drugs (disulfiram [Antabuse]). Taken concurrently with alcohol, the anti- alcoholism drug disulfiram can cause flushing, nausea, a drop in blood pressure, breathing difficulty, and confusion. The severity of the symptoms, which may var y among individu- als, generally depends on the amount of alcohol consumed and the amount of disulfiram in the body. Anticoagulants. Alcohol slows the body’s metabolism of anticoagulants (blood thinners), intensif ying the effect of the drugs and increasing the risk of side effects such as spontane- ous nosebleeds. Antidepressants. Alcohol may strengthen the sedative effects of antidepressants. Aspirin, ibuprofen, ketoprofen, naproxen and nonsteroidal anti-inflammatory drugs. Like alco- hol, these analgesics irritate the lining of the stomach and may cause gastric bleeding. Com- bining the two intensifies the effect. Insulin and oral hypoglycemics. Alcohol lowers blood sugar and interferes with the metabo- lism of oral antidiabetics; the combination may cause severe hypoglycemia. Sedatives and other central nervous system depressants (tranquilizers, sleeping pills, antide- pressants, sinus and cold remedies, analgesics, and medication for motion sickness). Alcohol intensifies the sedative effects of these medications and, depending on the dose, may cause drowsiness, sedation, respiratory depression, coma, or death. MAO inhibitors. Monoamine oxidase (M AO) inhibitors are drugs used as antidepressants or antihypertensives. They inhibit the action of natural enzymes that break down tyramine, a substance formed naturally when proteins are metabolized. Tyramine is a pressor amine, a chemical that constricts blood vessel and raises blood pressure. If you eat a food that contains tyramine while you are taking an M AO inhibitor, the pressor amine cannot be eliminated from your body and the result may be a hypertensive crisis (sustained elevated blood pressure). Brandy, a distilled spirit made from wine (which is fermented) contains tyramine. All other distilled spirits may be excluded from your diet when you are taking an M AO inhibitor because the spirits and the drug, which are both sedatives, may be hazard- ous in combination.... distilled spirits

Fish

See also Shellfish, Squid.

Nutritional Profile Energy value (calories per serving): Moderate Protein: High Fat: Low to moderate Saturated fat: Low to moderate Cholesterol: Moderate Carbohydrates: Low Fiber: None Sodium: Low (fresh fish) High (some canned or salted fish) Major vitamin contribution: Vitamin A, vitamin D Major mineral contribution: Iodine, selenium, phosphorus, potassium, iron, calcium

About the Nutrients in This Food Like meat, poultry, milk, and eggs, fish are an excellent source of high- quality proteins with sufficient amount of all the essential amino acids. While some fish have as much or more fat per serving than some meats, the fat content of fish is always lower in saturated fat and higher in unsaturated fats. For example, 100 g/3.5 ounce cooked pink salmon (a fatty fish) has 4.4 g total fat, but only 0.7 g saturated fat, 1.2 g monounsaturated fat, and 1.7 g polyunsaturated fat; 100 g/3.5 ounce lean top sirloin has four grams fat but twice as much saturated fat (1.5 g), plus 1.6 g monounsatu- rated fat and only 0.2 g polyunsaturated fat. Omega-3 Fatty Acid Content of Various Fish (Continued) Fish  Grams/ounce Rainbow trout  0.30 Lake whitefish  0.25 Source: “Food for t he Heart,” American Health, April 1985. Fish oils are one of the few natural food sources of vitamin D. Salmon also has vita- min A derived from carotenoid pigments in the plants eaten by the fish. The soft bones in some canned salmon and sardines are an excellent source of calcium. CAUTION: do not eat the bones in r aw or cook ed fish. the only bones consider ed edible ar e those in the canned products.

The Most Nutritious Way to Serve This Food Cooked, to kill parasites and potentially pathological microorganisms living in raw fish. Broiled, to liquify fat and eliminate the fat-soluble environmental contaminants found in some freshwater fish. With the soft, mashed, calcium-rich bones (in canned salmon and canned sardines).

Diets That May Restrict or Exclude This Food Low-purine (antigout) diet Low-sodium diet (canned, salted, or smoked fish)

Buying This Food Look for: Fresh-smelling whole fish with shiny skin; reddish pink, moist gills; and clear, bulging eyes. The flesh should spring back when you press it lightly. Choose fish fillets that look moist, not dry. Choose tightly sealed, solidly frozen packages of frozen fish. In 1998, the FDA /National Center for Toxicological Research released for testing an inexpensive indicator called “Fresh Tag.” The indicator, to be packed with seafood, changes color if the product spoils. Avoid: Fresh whole fish whose eyes have sunk into the head (a clear sign of aging); fillets that look dry; and packages of frozen fish that are stained (whatever leaked on the package may have seeped through onto the fish) or are coated with ice crystals (the package may have defrosted and been refrozen).

Storing This Food Remove fish from plastic wrap as soon as you get it home. Plastic keeps out air, encouraging the growth of bacteria that make the fish smell bad. If the fish smells bad when you open the package, throw it out. Refrigerate all fresh and smoked fish immediately. Fish spoils quickly because it has a high proportion of polyunsaturated fatty acids (which pick up oxygen much more easily than saturated or monounsaturated fatty acids). Refrigeration also slows the action of microorgan- isms on the surface of the fish that convert proteins and other substances to mucopolysac- charides, leaving a slimy film on the fish. Keep fish frozen until you are ready to use it. Store canned fish in a cool cabinet or in a refrigerator (but not the freezer). The cooler the temperature, the longer the shelf life.

Preparing This Food Fresh fish. Rub the fish with lemon juice, then rinse it under cold running water. The lemon juice (an acid) will convert the nitrogen compounds that make fish smell “fishy” to compounds that break apart easily and can be rinsed off the fish with cool running water. R insing your hands in lemon juice and water will get rid of the fishy smell after you have been preparing fresh fish. Frozen fish. Defrost plain frozen fish in the refrigerator or under cold running water. Pre- pared frozen fish dishes should not be thawed before you cook them since defrosting will make the sauce or coating soggy. Salted dried fish. Salted dried fish should be soaked to remove the salt. How long you have to soak the fish depends on how much salt was added in processing. A reasonable average for salt cod, mackerel, haddock (finnan haddie), or herring is three to six hours, with two or three changes of water. When you are done, clean all utensils thoroughly with hot soap and hot water. Wash your cutting board, wood or plastic, with hot water, soap, and a bleach-and-water solution. For ultimate safety in preventing the transfer of microorganisms from the raw fish to other foods, keep one cutting board exclusively for raw fish, meats, and poultry, and a second one for everything else. Finally, don’t forget to wash your hands.

What Happens When You Cook This Food Heat changes the structure of proteins. It denatures the protein molecules so that they break apart into smaller fragments or change shape or clump together. These changes force moisture out of the tissues so that the fish turns opaque. The longer you cook fish, the more moisture it will lose. Cooked fish flakes because the connective tissue in fish “melts” at a relatively low temperature. Heating fish thoroughly destroys parasites and microorganisms that live in raw fish, making the fish safer to eat.

How Other Kinds of Processing Affect This Food Marinating. Like heat, acids coagulate the proteins in fish, squeezing out moisture. Fish marinated in citrus juices and other acids such as vinegar or wine has a firm texture and looks cooked, but the acid bath may not inactivate parasites in the fish. Canning. Fish is naturally low in sodium, but can ned fish often contains enough added salt to make it a high-sodium food. A 3.5-ounce ser ving of baked, fresh red salmon, for example, has 55 mg sodium, while an equal ser ving of regular can ned salmon has 443 mg. If the fish is can ned in oil it is also much higher in calories than fresh fish. Freezing. When fish is frozen, ice cr ystals form in the flesh and tear its cells so that mois- ture leaks out when the fish is defrosted. Commercial flash-freezing offers some protec- tion by freezing the fish so fast that the ice cr ystals stay small and do less damage, but all defrosted fish tastes drier and less palatable than fresh fish. Freezing slows but does not stop the oxidation of fats that causes fish to deteriorate. Curing. Fish can be cured (preser ved) by smoking, dr ying, salting, or pickling, all of which coagulate the muscle tissue and prevent microorganisms from growing. Each method has its own particular drawbacks. Smoking adds potentially carcinogenic chemicals. Dr ying reduces the water content, concentrates the solids and nutrients, increases the calories per ounce, and raises the amount of sodium.

Medical Uses and/or Benefits Protection against cardiovascular disease. The most important fats in fish are the poly- unsaturated acids k nown as omega-3s. These fatt y acids appear to work their way into heart cells where they seem to help stabilize the heart muscle and prevent potentially fatal arrhythmia (irregular heartbeat). A mong 85,000 women in the long-run n ing Nurses’ Health Study, those who ate fatt y fish at least five times a week were nearly 50 percent less likely to die from heart disease than those who ate fish less frequently. Similar results appeared in men in the equally long-run n ing Physicians’ Health Study. Some studies suggest that people may get similar benefits from omega-3 capsules. Researchers at the Consorzio Mario Negri Sud in Santa Maria Imbaro ( Italy) say that men given a one-gram fish oil capsule once a day have a risk of sudden death 42 percent lower than men given placebos ( “look-alike” pills with no fish oil). However, most nutrition scientists recom- mend food over supplements. Omega-3 Content of Various Food Fish Fish* (3 oz.)  Omega-3 (grams) Salmon, Atlantic  1.8 Anchovy, canned* 1.7 Mackerel, Pacific 1.6 Salmon, pink, canned* 1.4 Sardine, Pacific, canned* 1.4 Trout, rainbow  1.0 Tuna, white, canned* 0.7 Mussels  0.7 * cooked, wit hout sauce * drained Source: Nat ional Fisheries Inst itute; USDA Nut rient Data Laborator y. Nat ional Nut ri- ent Database for Standard Reference. Available online. UR L : http://w w w.nal.usda. gov/fnic/foodcomp/search /.

Adverse Effects Associated with This Food Allergic reaction. According to the Merck Manual, fish is one of the 12 foods most likely to trigger classic food allergy symptoms: hives, swelling of the lips and eyes, and upset stom- ach. The others are berries (blackberries, blueberries, raspberries, strawberries), chocolate, corn, eggs, legumes (green peas, lima beans, peanuts, soybeans), milk, nuts, peaches, pork, shellfish, and wheat (see wheat cer ea ls). NOTE : Canned tuna products may contain sulfites in vegetable proteins used to enhance the tuna’s flavor. People sensitive to sulfites may suf- fer serious allergic reactions, including potentially fatal anaphylactic shock, if they eat tuna containing sulfites. In 1997, tuna manufacturers agreed to put warning labels on products with sulfites. Environmental contaminants. Some fish are contaminated with methylmercury, a compound produced by bacteria that chemically alters naturally occurring mercury (a metal found in rock and soil) or mercury released into water through industrial pollution. The methylmer- cury is absorbed by small fish, which are eaten by larger fish, which are then eaten by human beings. The larger the fish and the longer it lives the more methylmercury it absorbs. The measurement used to describe the amount of methylmercury in fish is ppm (parts per mil- lion). Newly-popular tilapia, a small fish, has an average 0.01 ppm, while shark, a big fish, may have up to 4.54 ppm, 450 times as much. That is a relatively small amount of methylmercur y; it will soon make its way harmlessly out of the body. But even small amounts may be hazardous during pregnancy because methylmercur y targets the developing fetal ner vous system. Repeated studies have shown that women who eat lots of high-mercur y fish while pregnant are more likely to deliver babies with developmental problems. As a result, the FDA and the Environ men- tal Protection Agency have now warned that women who may become pregnant, who are pregnant, or who are nursing should avoid shark, swordfish, king mackerel, and tilefish, the fish most likely to contain large amounts of methylmercur y. The same prohibition applies to ver y young children; although there are no studies of newborns and babies, the young brain continues to develop after birth and the logic is that the prohibition during pregnancy should extend into early life. That does not mean no fish at all should be eaten during pregnancy. In fact, a 2003 report in the Journal of Epidemiology and Community Health of data from an 11,585-woman study at the University of Bristol (England) shows that women who don’t eat any fish while pregnant are nearly 40 percent more likely to deliver low birth-weight infants than are women who eat about an ounce of fish a day, the equivalent of 1/3 of a small can of tuna. One theory is that omega-3 fatty acids in the fish may increase the flow of nutrient-rich blood through the placenta to the fetus. University of Southern California researchers say that omega-3s may also protect some children from asthma. Their study found that children born to asthmatic mothers who ate oily fish such as salmon at least once a month while pregnant were less likely to develop asthma before age five than children whose asthmatic pregnant mothers never ate oily fish. The following table lists the estimated levels of mercury in common food fish. For the complete list of mercury levels in fish, click onto www.cfsan.fda.gov/~frf/sea-mehg.html. Mercury Levels in Common Food Fish Low levels (0.01– 0.12 ppm* average) Anchovies, butterfish, catfish, clams, cod, crab (blue, king, snow), crawfish, croaker (Atlantic), flounder, haddock, hake, herring, lobster (spiny/Atlantic) mackerel, mul- let, ocean perch, oysters, pollock, salmon (canned/fresh frozen), sardines, scallops, shad (American), shrimp, sole, squid, tilapia, trout (freshwater), tuna (canned, light), whitefish, whiting Mid levels (0.14 – 0.54 ppm* average) Bass (salt water), bluefish, carp, croaker ( Pacific), freshwater perch, grouper, halibut, lobster (Northern A merican), mackerel (Spanish), marlin, monkfish, orange roughy, skate, snapper, tilefish (Atlantic), tuna (can ned albacore, fresh/frozen), weakfish/ sea trout High levels (0.73 –1.45 ppm* average) King mackerel, shark, swordfish, tilefish * ppm = parts per million, i.e. parts of mercur y to 1,000,000 parts fish Source: U.S. Food and Drug Administ rat ion, Center for Food Safet y and Applied Nut rit ion, “Mercur y Levels in Commercial Fish and Shellfish.” Available online. UR L : w w w.cfsan.fda. gov/~frf/sea-mehg.ht ml. Parasitical, viral, and bacterial infections. Like raw meat, raw fish may carry various pathogens, including fish tapeworm and flukes in freshwater fish and Salmonella or other microorganisms left on the fish by infected foodhandlers. Cooking the fish destroys these organisms. Scombroid poisoning. Bacterial decomposition that occurs after fish is caught produces a his- taminelike toxin in the flesh of mackerel, tuna, bonito, and albacore. This toxin may trigger a number of symptoms, including a flushed face immediately after you eat it. The other signs of scombroid poisoning—nausea, vomiting, stomach pain, and hives—show up a few minutes later. The symptoms usually last 24 hours or less.

Food/Drug Interactions Monoamine oxidase (MAO) inhibitors. Monoamine oxidase inhibitors are drugs used to treat depression. They inactivate naturally occurring enzymes in your body that metabolize tyramine, a substance found in many fermented or aged foods. Tyramine constricts blood vessels and increases blood pressure. If you eat a food such as pickled herring, which is high in tyramine, while you are taking an M AO inhibitor, your body may not be able to eliminate the tyramine and the result may be a hypertensive crisis.... fish

Game Meat

(Bison, rabbit, venison)

Nutritional Profile Energy value (calories per serving): Moderate Protein: High Fat: Low Saturated fat: High Cholesterol: Moderate Carbohydrates: None Fiber: None Sodium: Low Major vitamin contribution: B vitamins Major mineral contribution: Iron, zinc

About the Nutrients in This Food Like other animal foods, game meat has high-quality proteins with suf- ficient amounts of all the essential amino acids. Some game meat has less fat, saturated fat, and cholesterol than beef. All game meat is an excellent source of B vitamins, plus heme iron, the form of iron most easily absorbed by your body, and zinc. For example, one four-ounce serving of roast bison has 28 g protein, 2.7 g fat (1.04 g saturated fat), 93.7 mg cholesterol, 3.88 mg iron (25.8 percent of the R DA for a woman of childbearing age), and 4.1 mg zinc (27 percent of the R DA for a man). The Nutrients in Roasted Game Meat (4-ounce serving)

The Most Nutritious Way to Serve This Food With a food rich in vitamin C. Vitamin C increases the absorption of iron.

Diets That May Restrict or Exclude This Food Low-protein diet (for kidney disease)

Buying This Food In American markets, game meats are usually sold frozen. Choose a package with no leaks or stains to suggest previous defrosting.

Storing This Food Keep frozen game meat well wrapped in the freezer until you are ready to use it. The packaging protects the meat from oxygen that can change its pigments from reddish to brown. Freezing prolongs the freshness of the meat by slowing the natural multiplication of bacteria that digest proteins and other substances on the surface, converting them to a slimy film. The bacteria also change the meat’s sulfur-containing amino acids methionine and cystine into smelly chemicals called mercaptans. When the mercaptans combine with myoglobin, they produce the greenish pigment that gives spoiled meat its characteristic unpleasant appearance. Large cuts of game meat can be safely frozen, at 0°F, for six months to a year.

Preparing This Food Defrost the meat in the refrigerator to protect it from spoilage. Trim the meat to dispose of all visible fat, thus reducing the amount of fat and cholesterol in each serving. When you are done, clean all utensils thoroughly with hot soap and hot water. Wash your cutting board, wood or plastic, with hot water, soap, and a bleach-and-water solution. For ultimate safety in preventing the transfer of microorganisms from the raw meat to other foods, keep one cutting board exclusively for raw meats, fish, and poultry, and a second one for everything else. Finally, don’t forget to wash your hands.

What Happens When You Cook This Food Cooking changes the way meat looks and tastes, alters its nutritional value, makes it safer, and extends its shelf life. Browning meat before you cook it does not “seal in the juices,” but it does change the flavor by caramelizing proteins and sugars on the surface. Because meat’s only sugars are the Game Meat  

63 small amounts of glycogen in muscle tissue, we add sugars in marinades or basting liquids that may also contain acids (vinegar, lemon juice, wine) to break down muscle fibers and tenderize the meat. (NOTE : Browning has one minor nutritional drawback. It breaks amino acids on the surface of the meat into smaller compounds that are no longer useful proteins.) When meat is heated, it loses water and shrinks. Its pigments, which combine with oxygen, are denatured (broken into fragments) by the heat. They turn brown, the natural color of well-done meat. At the same time, the fats in the meat are oxidized, a reaction that produces a characteristic warmed-over flavor when the cooked meat is refrigerated and then reheated. Cooking and storing the meat under a blanket of antioxidants—catsup or a gravy made of tomatoes, peppers and other vitamin-C rich vegetables—reduces fat oxidation and lessens the warmed-over flavor. Meat reheated in a microwave oven is also less likely to taste warmed-over.

How Other Kinds of Processing Affect This Food Aging. Hanging fresh meat exposed to air in a cold room evaporates moisture and shrinks the meat slightly. At the same time, bacterial action on the surface of the meat breaks down proteins, producing an “aged” flavor. (See below, Food/drug interactions.) Curing. Salt-curing preserves meat through osmosis, the physical reaction in which liquids flow across a membrane, such as the wall of a cell, from a less dense to a more dense solu- tion. The salt or sugar used in curing dissolve in the liquid on the surface of the meat to make a solution that is more dense than the liquid inside the cells of the meat. Water flows out of the meat and out of the cells of any microorganisms living on the meat, killing the micro-organisms and protecting the meat from bacterial damage. Salt-cured meat is higher in sodium than fresh meat. Smoking. Hanging fresh meat over an open fire slowly dries the meat, kills microorgan- isms on its surface, and gives the meat a rich, smoky flavor. The flavor varies with the wood used in the fire. Meats smoked over an open fire are exposed to carcinogenic chemicals in the smoke, including a-benzopyrene. Artificial smoke flavoring is commercially treated to remove tar and a-benzopyrene.

Medical Uses and/or Benefits Treating and/or preventing iron deficiency. Without meat in the diet, it is virtually impossible for an adult woman to meet her iron requirement without supplements.

Adverse Effects Associated with This Food Increased risk of cardiovascular disease. Like all foods from animals, game meats are a source of cholesterol. To reduce the risk of heart disease, the National Cholesterol Education Project recommends following the Step I and Step II diets. The Step I diet provides no more than 30 percent of total daily calories from fat, no more than 10 percent of total daily calories from saturated fat, and no more than 300 mg of cholesterol per day. It is designed for healthy people whose cholesterol is in the range of 200 –239 mg/dL. The Step II diet provides 25– 35 percent of total calories from fat, less than 7 percent of total calories from saturated fat, up to 10 percent of total calories from polyunsaturated fat, up to 20 percent of total calories from monounsaturated fat, and less than 300 mg cho- lesterol per day. This stricter regimen is designed for people who have one or more of the following conditions: •  Existing cardiovascular disease •  High levels of low-density lipoproteins (LDLs, or “bad” cholesterol) or low levels of high-density lipoproteins (HDLs, or “good” cholesterol) •  Obesity •  Type 1 diabetes (insulin-dependent diabetes, or diabetes mellitus) •  Metabolic syndrome, a.k.a. insulin resistance syndrome, a cluster of risk fac- tors that includes type 2 diabetes (non-insulin-dependent diabetes) Food-borne illness. Improperly cooked meat contaminated with E. coli O157:H7 has been linked to a number of fatalities in several parts of the United States. In addition, meat con- taminated with other bacteria, viruses, or parasites poses special problems for people with a weakened immune system: the very young, the very old, cancer chemotherapy patients, and people with HIV. Cooking meat to an internal temperature of 140°F should destroy Salmo- nella and Campylobacter jejuni; to 165°F, E. coli, and to 212°F, Listeria monocytogenes. Decline in kidney function. Proteins are nitrogen compounds. When metabolized, they yield ammonia that is excreted through the kidneys. In laboratory animals, a sustained high-pro- tein diet increases the flow of blood through the kidneys, accelerating the natural age-related decline in kidney function. Some experts suggest that this may also occur in human beings.

Food/Drug Interactions Monoamine oxidase (MAO) inhibitors. Meat “tenderized” with papaya or a papain powder can interact with the class of antidepressant drugs known as monoamine oxidase inhibi- tors. Papain meat tenderizers work by breaking up the long chains of protein molecules. One by-product of this process is tyramine, a substance that constructs blood vessels and raises blood pressure. M AO inhibitors inactivate naturally occurring enzymes in your body that metabolize tyramine. If you eat a food such as papain-tenderized meat, which is high in tyramine, while you are taking an M AO inhibitor, you cannot effectively eliminate the tyramine from your body. The result may be a hypertensive crisis.... game meat

Ergot

ERGOT of rye. Secale. Claviceps purpurea, Tulasne.

Constituents: indole alkaloids, tyramine, acetylcholine.

Action: abortifacient, parturient, haemostatic, hypertensive, uterine stimulant, oxytocic. Uses. Obstetrics.

Difficult childbirth. Applied to excite uterine contractions in the third stage of labour. Preparations. Liquid Extract. BPC 1954, dose, 0.6 to 1.2ml.

Registered medical practitioner only. ... ergot

Cereus Grandiflorus

Mill.

Family: Cactaceae.

Habitat: Indian gardens.

English: Cereus, Night Blooming Cereus, Sweet Scented Cactus.

Folk: Nivadung Paanchkoni (Maharashtra).

Action: Fresh, young shoots—cardiac stimulant, anti-inflammatory.

The plant contains glucose, fructose, starch, amino acids and citric, fumar- ic, maleic, malonic and oxalic acids. Tyramine, a cardiotonic amine, can strengthen heart muscle action.

The flower, stem and young shoots of cereus can stimulate heart and dilate peripheral vessels, as well as stimulate spinal cord motor neurons. The reputed digitalis effect of cereus is claimed to be non-cumulative. (Natural Medicines Comprehensive Database, 2007.)... cereus grandiflorus

Claviceps Purpurea

(Fr.) Tul.

Family: Hypocreaceae.

Habitat: A fungous parasite on a number of grasses particularly in rye, cultivated in the Nilgiris and at Chakrohi farm in Jammu.

English: Ergot of Rye. Fungus of Rye.

Ayurvedic: Annamaya, Sraavikaa.

Unani: Argot.

Siddha/Tamil: Ergot.

Action: Uterine stimulant. Oxy- tocic, abortifacient, parturient, vasoconstrictor, haemostatic. Used in obstetrics (difficult childbirth, for exciting uterine contractions in the final stages of parturition). Also used after abortion for removal of the placenta. It is no more employed in internal haemorrhages, as it has been found to raise blood pressure in pulmonary and cerebral haemorrhage. Included among unapproved herbs by German Commission E.

The fungus gave indole alkaloids. The ergometrine or ergonovine group includes ergometrine and ergometri- nine. The ergotamine group includes ergotamine and ergotaminine. The er- gotoxine group includes ergocristine, ergocristinine, ergocryptine, ergo- cryptinine, ergocornine and ergo- corninine. The fungus also contains histamine, tyramine and other amines, sterols and acetylcholine.

The alkaloids of ergot are being used independently (not as a herbal medicine). Ergotamine is used to relieve migrainous headaches as it is a vasoconstrictor and has antisero- tonin activity. Ergometrine is used after childbirth in the third stage of labour and for post-partum haemorrhage, as it is a powerful uterine stimulant, particularly of the puerperal uterus. (Both the constituents are used under medical supervision). Er- gocornine significantly inhibited the development of induced mammary tumours in rats. The derivatives of ergot alkaloids are known to have suppressing effect on human breast cancer in initial stages. This activity is linked to prolactin inhibitory action.

The extract is toxic at 1.0-3.9 g, ergot alkaloids at 1 g in adults, 12 mg in infants. (Francis Brinker).

Dosage: Whole plant—10-30 ml infusion. (CCRAS.)... claviceps purpurea

Cytisus Scoparius

(L.) Link.

Synonym: Sarothamnus scoparius (L.) Koch.

Family: Papilionaceae, Fabaceae.

Habitat: Mild climatic regions of south and central Europe, north Africa and West Asia. C. scoparius is fairly common in and around Oatacmund (Nilgiris) and is found wild as a garden escape. It grows also in Simla and neighbouring places. An allied species, C. monspessulanus Linn., White Broom, also occurs in the Nilgiri hills.

English: Broom, Scotch Broom, Yellow Broom.

Folk: Broom.

Action: Green twigs of the plant, collected before flowering, either fresh or after drying, are used as diuretic and cathartic. Emetic in large doses. The seeds are also used similarly. The herb is used chiefly in the form of sulphate in tachycardia and functional palpitation. (The action of the whole plant is stated to be different from that of isolated alkaloids.) The whole herb has been used to treat tumours.

Key application: For functional heart and circulatory disorders. Aqueous-ethanolic extracts are used internally. Simultaneous administration of MAO-inhibitors contraindicated due to the tyramine content. (German Commission E.) The British Herbal Pharmacopoeia reported antiarrhythmic and diuretic action of the herb.

The herb contains quinolizidine alkaloids; main alkaloids are (-)-spar- teine, lupanine, ammodendrine and various derivatives; biogenic amines, including tryramine, epinine, dopa- mine; isoflavone glycosides including genistein, scoparin; flavonoids; essential oil; caffeic acid and p-coumaric acids; tannins. Seeds contain lectins (phytohaemagglutinins).

The herb contains over 2% tyramine. Tyramine acts as an indirect sympa- thomimetic, vasoconstrictive and hy- potensive.

The herb is contraindicated in high blood pressure, A-V block and pregnancy.

Scoparin's action on renal mucous membrane is similar to that of Buchu and Uva-ursi. (A decoction or infusion of broom is used in dropsical complaints of cardiac origin.)

Sparteine produces a transient rise in arterial pressure followed by a longer period of decreased vascular tension (contradictory observations have been recorded). Some researchers are of the opinion that sparteine is a regulator in chronic vulvar disease. It showed no cumulative action like digitalis. In large doses, it is highly toxic and impairs the activity of respiratory organs.

C. monopessulanus (a related species) contains. 9% alkaloids.

Sparteine is toxic at more than 300 mg dose. (Francis Brinker.)... cytisus scoparius

Persistent Idiopathic Facial Pain

(atypical facial pain, chronic idiopathic facial pain) a chronic pain in the face that has no known cause and does not fit the classic presentation of other cranial neuralgias. It may be stress-related, and in some cases appears to be associated with defective metabolism of *tyramine. Treatment may involve the use of antidepressants.... persistent idiopathic facial pain

Cucumbers

(Pickles)

Nutritional Profile Energy value (calories per serving): Low Protein: Moderate Fat: Low Saturated fat: Low Cholesterol: None Carbohydrates: High Fiber: Low Sodium: Low Major vitamin contribution: Vitamin C Major mineral contribution: Iron, potassium

About the Nutrients in This Food Cucumbers are mostly (96 percent) water. Their dietary fiber is unique in that it can hold up to 30 times its weight in water compared to the fiber in wheat bran, which holds only four to six times its weight in water. But cucumbers have so much water that there is little room for anything else. Two ounces of fresh cucumber slices has less than one gram dietary fiber—and no significant amounts of vitamins or minerals.

The Most Nutritious Way to Serve This Food Raw, fresh-sliced, with the unwaxed skin.

Diets That May Restrict or Exclude This Food Antiflatulence diet Low-fiber diet

Buying This Food Look for: Firm cucumbers with a green, unwaxed skin. In the natural state, the skin of the cucumber is neither shiny nor deep green, characteristics it picks up when the cucumber is waxed to keep it from losing moisture during shipping and storage. The wax is edible, but some people prefer not to eat it, which means missing out on fiber. To get your cucumbers without wax, ask for pickling cucumbers, and note the difference in color and texture. Choose cucumbers with a clean break at the stem end; a torn, uneven stem end means that the cucumber was pulled off the vine before it was ready. Technically, all the cucum- bers we buy are immature; truly ripe cucumbers have very large, hard seeds that make the vegetable unpalatable. Avoid: Cucumbers with yellowing skin; the vegetable is so old that its chlorophyll pigments have faded and the carotenes underneath are showing through. Puff y, soft cucumbers are also past their prime.

Storing This Food Store cucumbers in the refrigerator and use them as soon as possible. The cucumber has no starch to convert to sugar as it ages, so it won’t get sweeter off the vine, but it will get softer as the pectins in its cell wall absorb water. You can make a soft cucumber crisp again by slic- ing it and soaking the slices in salted water. By osmotic action, the unsalted, lower-density water in the cucumber’s cells will flow out across the cell walls out into the higher-density salted water and the cucumber will feel snappier.

Preparing This Food R inse the cucumber under cold, running water. Check to see if the cucumber has been waxed by scraping the skin gently with the tip of your fingernail and then looking for waxy resi- due under the nail. If the skin is waxed, you can peel it off—but not until you are ready to use it, since slicing the cucumber tears its cell walls, releasing an enzyme that oxidizes and destroys vitamin C.

How Other Kinds of Processing Affect This Food Pickling. Cucumbers are not a good source of iron, but pickles may be. If processed in iron vats, the pickles have picked up iron and will give you about 1 mg per pickle. Pickles made in stainless steel vats have no iron, nor do pickles made at home in glass or earthenware.

Adverse Effects Associated with This Food Intestinal gas. Some sensitive people find cucumbers “gassy.” Pickling, marinating, and heating, which inactivate enzymes in the cucumber, may reduce this gassiness for certain people—although others find pickles even more upsetting than fresh cucumbers.

Food/Drug Interactions False-positive test for occult blood in the stool. The active ingredient in the guaiac slide test for hidden blood in feces is alphaguaiaconic acid, a chemical that turns blue in the presence of blood. Alphaguaiaconic acid also turns blue in the presence of peroxidase, a chemical that occurs naturally in cucumbers. Eating cucumbers in the 72 hours before taking the guaiac test may produce a false-positive result in people who not actually have any blood in their stool. Monoamine oxidase (MAO) inhibitors. Monoamine oxidase inhibitors are drugs used to treat depression. They inactivate naturally occurring enzymes in your body that metabolize tyramine, a substance found in many fermented or aged foods. Tyramine constricts blood vessels and increases blood pressure. If you eat a food, such as pickles, containing tyramine while you are taking an M AO inhibitor, you cannot effectively eliminate the tyramine from your body. The result may be a hypertensive crisis.... cucumbers

Desmodium Triflorum

(Linn.) DC.

Synonym: Hedysarum triflorum Linn.

Family: Fabaceae.

Habitat: Throughout India, in the plains ascending to 1,200 m in Kumaon and 1,800 m in Kashmir.

Ayurvedic: Tripaadi, Hamsapaadi (Kerala).

Siddha/Tamil: Seruppadi.

Folk: Jangali Methi, Ran-methi.

Action: Fresh leaves—used internally as galactagogue and for diarrhoea; applied externally to wounds and abscesses. Root— diuretic. Also used for cough, asthma.

The leaf contains alkaloids (0.010.15%), major being beta-phenylethyl- amine; also contains tyramine and hy- paphorine. Hypaphorine is present in roots as well. Root contains 0.010.02% alkaloids.... desmodium triflorum

Desmodium

Desmodium gangeticum

Fabaceae

San: Anshumati, Salaparni;

Hin,

Ben: Salpani;

Mal: Orila;

Tam:Pulladi;

Tel: Gitanaram

Kan: Murelehonne; Mar: Darh;

Guj: Salwan; Ori: Salaparni Pun: Shalpurhi

Importance: Desmodium is a small shrub which is the chief of the ten ingredients in the Dasamula kwatha of Hindu medicine. Roots are useful in vitiated conditions of vata, anorexia, dyspepsia, haemorrhoids, dysentery, strangury, fever, gout, inflammations, cough, asthma, bronchitis, cardiopathy and debility. The unani preparation “Arq dashmul” contains these roots. It is considered a curative for leucorrhoea and for pains due to cold (Warrier et al, 1995).

Distribution: The plant is widely distributed in the tropics and subtropics. It grows wild in the forests of India up to 1500m. It is also cultivated in the plains and in the lower Himalayas.

Botany: Desmodium gangeticum (Linn.) DC. syn. Hedysarum gangeticum Linn., Desmodium gangeticum var. maculatum (Linn.) Baker., belongs to the family Fabaceae (Papilionaceae). It is an erect diffusely branched undershrub, 90-120cm in height with a short woody stem and numerous prostrate branches provided with soft grey hairs. Leaves are unifoliate, ovate- lanceolate, membranceous and mottled with grey patches. Flowers are white, purple or lilac in elongate lax, terminal or axillary racemes. Fruits are moniliform, 6-8 jointed, glabrescent pods, joints of pods separately pubescent with hooked hairs, joint separating when ripe into indehiscent one seeded segments. Seeds are compressed and reniform.

Agrotechnology: Desmodium can grow in a variety of climate and soils. However, it prefers tropical and subtropical climatic conditions. Although it can grow on all types of soils, waterlogged and highly alkaline soils are not suitable. Light sandy loam is preferred for commercial cultivation.

It is propagated through seeds. Seeds can be planted directly in the field or seedlings raised on the nursery beds and transplanted. Transplanting always gives better results in commercial cultivation, as it gives assured crop stand. Planting is done at a spacing of 40x20cm on flat beds or ridges. Organic manures are applied at the time of land preparation and thoroughly mixed with the soil. A little quantity of phosphatic and nitrogenous fertilizers are also applied for better crop growth. The inter-row spaces between plants, both in the field and nursery should be kept free from weeds by frequent weeding and hoeing as the plant suffers from weed competition, especially during early stages of growth. Manual hand weeding is usually done. Irrigation of seedlings just after planting is good for crop establishment. Although it can be cultivated as a rainfed crop under humid tropical conditions, irrigation every month is beneficial during summer. The root is the economic part and harvesting can be commenced after 8-9 months. About 500- 700kg roots can be harvested from a hectare of land per year.

Properties and activity: The root contains gangetin, gangetinin, desmodin, N,N-dimethyl tryptamine, hypaphorine, hordenine, candicine, N-methyl tyramine and -phenyl ethyl amine. The total alkaloid fraction showed hypotensive activity. The root is bitter, antiinflammatory, analgesic, aphrodisiac, constipating, diuretic, cardiotonic, expectorant, astringent, antidiarrhoeal, carminative, antiemetic, febrifuge and anti-catarrhal (Thakur et al, 1989).... desmodium

Monoamine Oxidase Inhibitors (maois)

These are drugs that destroy, or prevent the action of, monoamine oxidase (MAO). Monoamines, which include NORADRENALINE and tyramine, play an important part in the metabolism of the BRAIN, and there is some evidence that excitement is due to an accumulation of monoamines in the brain. MAO is a naturally occurring ENZYME which is concerned in the breakdown of monoamines. MAOIs were among the earliest ANTIDEPRESSANT DRUGS used, but they are now used much less than tricyclic and related antidepressants, or SELECTIVE SEROTONIN-REUPTAKE INHIBITORS (SSRIS) and related antidepressants, because of the dangers of dietary or drug interactions – and because MAOIs are less e?ective than these two groups.

An excessive accumulation of monoamines can induce a dangerous reaction characterised by high blood pressure, palpitations, sweating and a feeling of su?ocation. Hence the care with which MAOI drugs are administered. What is equally important, however, is that in no circumstances should a patient receiving any MAOI drug eat cheese, yeast preparations such as Marmite, tinned ?sh, or high game. The reason for this ban is that all these foodstu?s contain large amounts of tyramine which increases the amount of certain monoamines such as noradrenaline in the body. (See MENTAL ILLNESS.)

There are also certain drugs, such as AMPHETAMINES and PETHIDINE HYDROCHLORIDE, which must not be taken by a patient who is receiving an MAOI drug. The MAOIs of choice are phenelzine or isocarboxazid because their stimulant effects are less than those of other MAOIs, making them safer.... monoamine oxidase inhibitors (maois)

Eggplant

Nutritional Profile Energy value (calories per serving): Low Protein: Moderate Fat: Low Saturated fat: Low Cholesterol: None Carbohydrates: High Fiber: High Sodium: Low Major vitamin contribution: Vitamin C (low) Major mineral contribution: Potassium (low)

About the Nutrients in This Food Eggplant is a high-fiber food with only minimum amounts of vitamins and minerals. One cup (100 g/3.5 ounces) boiled eggplant has 2.5 mg dietary fiber and 1.3 mg vitamin C (2 percent of the R DA for a woman, 1 percent of the R DA for a man). In 1992, food scientists at the Autonomous University of Madrid studying the chemistry of the eggplant discovered that the vegetable’s sugar content rises through the end of the sixth week of growth and then falls dramatically over the next 10 days. The same thing happens with other flavor chemicals in the vegetable and with vitamin C, so the researchers concluded that eggplants taste best and are most nutritious after 42 days of growth. NOTE : Eggplants are members of the nightshade family, Solanacea. Other members of this family are potatoes, tomatoes, and red and green peppers. These plants produce natural neurotoxins (nerve poisons) called glycoalkaloids. It is estimated that an adult would have to eat 4.5 pounds of eggplant at one sitting to get a toxic amount of solanine, the glycoalkaloid in eggplant.

The Most Nutritious Way to Serve This Food The eggplant’s two culinary virtues are its meaty texture and its ability to assume the flavor of sauces in which it is cooked. As a result, it is often used as a vegetarian, no-cholesterol substitute for veal or chicken in Italian cuisine, specifically dishes ala parmigiana and spaghetti sauces. However, in cooking, the egg- plant absorbs very large amounts of oil. To keep eggplant parmigiana low in fat, use non-fat cheese and ration the olive oil.

Buying This Food Look for: Firm, purple to purple-black or umblemished white eggplants that are heavy for their size. Avoid: Withered, soft, bruised, or damaged eggplants. Withered eggplants will be bitter; damaged ones will be dark inside.

Storing This Food Handle eggplants carefully. If you bruise an eggplant, its damaged cells will release polyphe- noloxidase, an enzyme that hastens the oxidation of phenols in the eggplant’s flesh, produc- ing brown compounds that darken the vegetable. Refrigerate fresh eggplant to keep it from losing moisture and wilting.

Preparing This Food Do not slice or peel an eggplant until you are ready to use it, since the polyphenoloxidase in the eggplant will begin to convert phenols to brown compounds as soon as you tear the vegetable’s cells. You can slow this chemical reaction (but not stop it completely) by soaking sliced egg- plant in ice water—which will reduce the eggplant’s already slim supply of water-soluble vita- min C and B vitamins—or by painting the slices with a solution of lemon juice or vinegar. To remove the liquid that can make a cooked eggplant taste bitter, slice the eggplant, salt the slices, pile them on a plate, and put a second plate on top to weight the slices down. Discard the liquid that results.

What Happens When You Cook This Food A fresh eggplant’s cells are full of air that escapes when you heat the vegetable. If you cook an eggplant with oil, the empty cells will soak it up. Eventually, however, the cell walls will collapse and the oil will leak out, which is why eggplant parmigiana often seems to be served in a pool of olive oil. Eggplant should never be cooked in an aluminum pot, which will discolor the eggplant. If you cook the eggplant in its skin, adding lemon juice or vinegar to the dish will turn the skin, which is colored with red anthocyanin pigments, a deeper red-purple. Red anthocyanin pigments get redder in acids and turn bluish in basic (alkaline) solutions. Cooking reduces the eggplant’s supply of water-soluble vitamins, but you can save the Bs if you serve the eggplant with its juices.

Adverse Effects Associated with This Food Nitrate/nitrite reactions. Eggplant—like beets, celery, lettuce, radish, spinach, and collard and turnip greens—contains nitrates that convert naturally into nitrites in your stomach, and then react with the amino acids in proteins to form nitrosamines. Although some nitrosamines are known or suspected carcinogens, this natural chemical conversion presents no known problems for a healthy adult. However, when these nitrate-rich vegetables are cooked and left to stand at room temperature, bacterial enzyme action (and perhaps some enzymes in the plants) convert the nitrates to nitrites at a much faster rate than normal. These higer-nitrite foods may be hazardous for infants; several cases of “spinach poisoning” have been reported among children who ate cooked spinach that had been left standing at room temperature.

Food/Drug Interactions MAO inhibitors. Monoamine oxidase (M AO) inhibitors are drugs used as antidepressants or antihypertensives. They inhibit the action of enzymes that break down tyramine, a natu- ral by-product of protein metabolism, so that it can be eliminated from the body. Tyramine is a pressor amine, a chemical that constricts blood vessels and raises blood pressure. If you eat a food rich in tyramine while you are taking an M AO inhibitor, the pressor amine can- not be eliminated from your body, and the result may be a hypertensive crisis (sustained elevated blood pressure). Eggplants contain small amounts of tyramine. False-positive urine test for carcinoid tumors. Carcinoid tumors (tumors that may arise in tis- sues of the endocrine and gastrointestinal systems) secrete serotonin, which is excreted in urine. The test for these tumors measures the level of serotonin in your urine. Eating egg- plant, which is rich in serotonin, in the 72 hours before a test for a carcinoid tumor might raise the serotonin levels in your urine high enough to cause a false-positive test result. (Other fruits and vegetables rich in serotonin are bananas, tomatoes, plums, pineapple, avo- cados, and walnuts.)... eggplant

Figs

Nutritional Profile Energy value (calories per serving): Moderate (fresh figs) High (dried figs) Protein: Low Fat: Low Saturated fat: Low Cholesterol: None Carbohydrates: High Fiber: Very high Sodium: Low (fresh or dried fruit) High (dried fruit treated with sodium sulfur compounds) Major vitamin contribution: B vitamins Major mineral contribution: Iron (dried figs)

About the Nutrients in This Food Figs, whether fresh or dried, are high-carbohydrate food, an extraordinarily good source of dietary fiber, natural sugars, iron, calcium, and potassium. Ninety-two percent of the carbohydrates in dried figs are sugars (42 percent glucose, 31 percent fructose, 0.1 percent sucrose). The rest is dietary fiber, insoluble cellulose in the skin, soluble pectins in fruit. The most important mineral in dried figs is iron. Gram for gram, figs have about 50 percent as much iron as beef liver (0.8 mg/gram vs. 1.9 mg/gram). One medium fresh fig has 1.4 g dietary fiber, six grams sugars, and 0.18 mg iron (1 percent of the R DA for a woman, 2 percent of the R DA for a man). A similar size dried, uncooked fig has 0.8 g fiber, four grams sugars and the same amount of iron as a fresh fig.

The Most Nutritious Way to Serve This Food Dried (but see How other kinds of processing affect this food, below).

Diets That May Restrict or Exclude This Food Low-fiber, low-residue diets Low-sodium (dried figs treated with sulfites)

Buying This Food Look for: Plump, soft fresh figs whose skin may be green, brown, or purple, depending on the variety. As figs ripen, the pectin in their cell walls dissolves and the figs grow softer to the touch. The largest, best-tasting figs are generally the ones harvested and shipped in late spring and early summer, during June and July. Choose dried figs in tightly sealed airtight packages. Avoid: Fresh figs that smell sour. The odor indicates that the sugars in the fig have fer- mented; such fruit is spoiled.

Storing This Food Refrigerate fresh figs. Dried figs can be stored in the refrigerator or at room temperature; either way, wrap them tightly in an air- and moistureproof container to keep them from los- ing moisture and becoming hard. Dried figs may keep for several months.

Preparing This Food Wash fresh figs under cool water; use dried figs right out of the package. If you want to slice the dried figs, chill them first in the refrigerator or freezer: cold figs slice clean.

What Happens When You Cook This Food Fresh figs contain ficin, a proteolytic (protein-breaking) enzyme similar to papain in papayas and bromelin in fresh pineapple. Proteolytic enzymes split long-chain protein molecules into smaller units, which is why they help tenderize meat. Ficin is most effective at about 140 –160°F, the temperature at which stews simmer, and it will continue to work after you take the stew off the stove until the food cools down. Temperatures higher than 160°F inac- tivate ficin; canned figs—which have been exposed to very high heat in processing—will not tenderize meat. Both fresh and dried figs contain pectin, which dissolves when you cook the figs, mak- ing them softer. Dried figs also absorb water and swell.

How Other Kinds of Processing Affect This Food Drying. Figs contain polyphenoloxidase, an enzyme that hastens the oxidation of phenols in the fig, creating brownish compounds that darken its flesh. To prevent this reaction, figs may be treated with a sulfur compound such as sulfur dioxide or sodium sulfite. People who are sensitive to sulfites may suffer serious allergic reactions, including potentially fatal ana- phylactic shock, if they eat figs that have been treated with one of these compounds. Canning. Canned figs contain slightly less vitamin C, thiamin, riboflavin, and niacin than fresh figs, and no active ficin.

Medical Uses and/or Benefits Iron supplementation. Dried figs are an excellent source of iron. As a laxative. Figs are a good source of the indigestible food fiber lignin. Cells whose walls are highly lignified retain water and, since they are impossible to digest, help bulk up the stool. In addition, ficin has some laxative effects. Together, the lignin and the ficin make figs (particularly dried figs) an efficient laxative food. Lower risk of stroke. Potassium lowers blood pressure. According to new data from the Harvard University Health Professionals Study, a long-running survey of male doctors, a diet rich in high-potassium foods such as bananas may also reduce the risk of stroke. The men who ate the most potassium-rich foods (an average nine servings a day) had 38 percent fewer strokes than men who ate the least (less than four servings a day).

Adverse Effects Associated with This Food Sulfite allergies. See How other kinds of processing affect this food.

Food/Drug Interactions MAO inhibitors. Monoamine oxidase (M AO) inhibitors are drugs used as antidepressants or antihypertensives. They inhibit the action of natural enzymes that break down tyramine, a nitrogen compound formed when proteins are metabolized, so it can be eliminated from the body. Tyramine is a pressor amine, a chemical that constricts blood vessels and raises blood pressure. If you eat a food rich in one of these chemicals while you are taking an M AO inhibitor, the pressor amines cannot be eliminated from your body, and the result may be a hypertensive crisis (sustained elevated blood pressure). There has been one report of such a reaction in a patient who ate canned figs while taking an M AO inhibitor.... figs

Carob Bean

St John’s Bread. Ceratonia siliqua L. Food and medicine. Fruit is a hard woody pod containing a sweet yellow pulp that is made into a flour. Came into prominence as effective treatment for acute (summer) diarrhoea during the Spanish Civil War when it was observed that poorer children who ate the bean, also known as locust, did not contract the disease. Stools of gastro-enteritis, colitis and ‘gippy tummy’ are known to solidify within 48 hours. May be boiled in skimmed milk or rice water. An excellent substitute for chocolate and sugar, being taken in cocoa-like drinks. Low fat content. Does not contain tyramine, a known cause of migraine, as is found in cocoa. A favourite base for fruit or snack bars; flavoured with molasses, cherry, yoghurt, ginger. Rich source of pectin and calcium which have binding properties. Carob flour is given for diarrhoea in babies. ... carob bean

Antidepressant Drugs

Drugs used in the treatment of depression.Most of the commonly used antidepressant drugs belong to one of the following groups: tricyclic drugs, selective serotonin reuptake inhibitors (SSRIs), and monoamine oxidase inhibitors (MAOIs). These drugs are usually successful at relieving the symptoms of depression but often take 2–3 weeks before benefit is felt. Treatment usually lasts for at least 6 months, and the dosage is reduced gradually before being stopped altogether.

Tricyclics may cause drowsiness, dry mouth, constipation, blurred vision, urinary difficulty, and irregular heartbeat.

SSRIs may cause nausea, indigestion, and loss of appetite, or allergic reactions but are less dangerous in overdose than other antidepressants.

MAOIs may interact with foods containing tyramine (for example, cheese) and other drugs to cause a dangerous rise in blood pressure, although one , moclobemide, is less likely to cause problems.

Antidepressants are not addictive, but abrupt withdrawal of some types can result in physical symptoms and should be avoided.... antidepressant drugs

Mao Inhibitor

(MAOI) a drug that prevents the activity of the enzyme *monoamine oxidase (MAO). MAO inhibitors include phenelzine, isocarboxazid, and tranylcypromine. These drugs are irreversible inhibitors of monoamine oxidase A, whose use as antidepressants is now restricted because of the severity of their side-effects. These include interactions with other drugs (e.g. ephedrine, phenylephrine) and with foods or drinks containing *tyramine (e.g. cheese or red wine) to produce a sudden and dangerous increase in blood pressure. *Moclobemide is a reversible inhibitor of monoamine oxidase A (RIMA), with less severe side-effects. See also selegiline.... mao inhibitor



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