Philosophy

Moderation Management

When you have made the healthy decision to drink less, and you stay within moderate limits, you should not experience any health, personal, family, social, job-related, financial, or legal problems due to alcohol. The suggested guidelines below allow for a degree of individual interpretation, because moderation is a flexible principle and is not the same for everyone. The suggested limits, however, are more definite.

A Moderate Drinker:

• considers an occasional drink to be a small, though enjoyable, part of life.
• has hobbies, interests, and other ways to relax and enjoy life that do not involve alcohol.
• usually has friends who are moderate drinkers or nondrinkers.
• generally has something to eat before, during, or soon after drinking.
• usually does not drink for longer than an hour or two on any particular occasion.
• usually does not drink faster than one drink per half-hour.
• usually does not exceed the .055% BAC moderate drinking limit. (see Note 1 below)
• feels comfortable with his or her use of alcohol (never drinks secretly and does not spend a lot of time thinking about drinking or planning to drink).

The MM Limits:

• Strictly obey local laws regarding drinking and driving.
• Do not drink in situations that would endanger yourself or others.
• Do not drink every day. MM suggests that you abstain from drinking alcohol at least 3 or 4 days per week.
• Women who drink more than 3 drinks on any day, and more than 9 drinks per week, may be drinking at harmful levels.
(See Note 2 below for definition of a "standard" drink)

• Men who drink more than 4 drinks on any day, and more than 14 drinks per week, may be drinking at harmful levels.

  Notes:

  Standard drink: one 12 oz-beer (5% alcohol), one 5-oz glass wine (12% alcohol), or 1 and 1/2 oz of 80-proof liquor (40% alcohol).

These "number of drinks" limits are LIMITS and not TARGETS. Blood Alcohol Concentration (BAC) charts are more accurate than number of drink limits because they take into account weight, sex, and rate of drinking. If you are very light in weight use the BAC upper limit of .O55%. Some researchers advise a limit of one drink per day for older adults (55+).

The limits used by MM are based on research published in 1995 in the American Journal of Public Health, by Dr. Martha Sanchez-Craig, Addiction Research Foundation, Toronto, Canada and other published limits.

PLEASE CHECK WITH FAMILY AND FRIENDS WHETHER OR NOT THIS PROGRAM IS SUITABLE FOR YOUR INDIVIDUAL SITUATION. Consider consulting a trained Drug and Alcohol Treatment Program/Counsellor or AA.

Coeliac Disease Diet

Treatment

The only treatment for CD/DH is the lifelong adherence to a gluten-free diet. When gluten is removed from the diet, the small intestine will start to heal and overall health improves. Medication is not normally required. Because osteoporosis is common and may be profound in patients with newly diagnosed CD, bone density should be measured at or shortly after diagnosis. Consult your physician regarding specific nutritional supplementation to correct any deficiencies. The diagnosed celiac should have medical follow-up to monitor the clinical response to the gluten-free diet. Dietary compliance increases the quality of life and decreases the likelihood of osteoporosis, intestinal lymphoma and other associated illnesses.

Adapting to the gluten-free diet requires some lifestyle changes. It is essential to read labels which are often imprecise, and to learn how to identify ingredients that may contain hidden gluten.

Be aware that hidden gluten can be found in some unlikely foods such as: cold cuts, soups, hard candies, soy sauce, many low or non-fat products, even licorice and jelly beans.

Gluten may also be used as a binder in some pharmaceutical products. Request clarification from food and drug manufacturers when necessary.

Potential harmful ingredients include:

• unidentified starch
• modified food starch
• hydrolyzed vegetable protein - HVP
• hydrolyzed plant protein - HPP
• texturized vegetable protein - TVP
• binders
• fillers
• excipients
• extenders
• malt

Coeliac Disease

Coeliac disease, also known as gluten intolerance, is a genetic disorder that affects 1 in 133¹ Americans. Symptoms of coeliac disease can range from the classic features, such as diarrhea, weight loss, and malnutrition, to latent symptoms such as isolated nutrient deficiencies but no gastrointestinal symptoms. The disease mostly affects people of European (especially Northern European) descent, but recent studies show that it also affects Hispanic, Black and Asian populations as well¹. Those affected suffer damage to the villi (shortening and villous flattening) in the lamina propria and crypt regions of their intestines when they eat specific food-grain antigens (toxic amino acid sequences) that are found in wheat, rye, and barley³. Oats have traditionally been considered to be toxic to coeliacs, but recent scientific studies have shown that this is not the case.

Because of the broad range of symptoms coeliac disease presents, it can be difficult to diagnose. The symptoms can range from "mild weakness, bone pain, and aphthous stomatitis to chronic diarrhea, abdominal bloating, and progressive weight loss.³" If a person with the disorder continues to eat gluten, studies have shown that he or she will increase their chances of gastrointestinal cancer by a factor of 40 to 100 times that of the normal population⁴. Further, "gastrointestinal carcinoma or lymphoma develops in up to 15 percent of patients with untreated or refractory coeliac disease³." It is therefore imperative that the disease is quickly and properly diagnosed so it can be treated as soon as possible.

Based on the figure mentioned above we can extrapolate the total number of people in the United States with coeliac disease: 2.18 million (based on the total population: 290,356,028⁵). It is very important that doctors understand just how many people have this disease so that routine testing for it is done to bring the diagnosis rate in line with the disease's epidemiology. Testing is fairly simple and involves screening the patient's blood for antigliadin (AGA) and endomysium antibodies (EmA), and/or doing a biopsy on the areas of the intestines mentioned above, which is still the standard for a formal diagnosis.

The only acceptable treatment for coeliac disease is strict adherence to a 100% gluten-free diet for life. An adherence to a gluten-free diet can prevent almost all complications caused by the disease³. A gluten-free diet means avoiding all products that contain wheat, rye and barley, or any of their derivatives. This is a difficult task as there are many hidden sources of gluten found in the ingredients of many processed foods.

Symptoms

Celiac Disease may appear at any time in a person's life. The disease can be triggered for the first time after surgery, viral infection, severe emotional stress, pregnancy or childbirth. CD is a multi-system, multi-symptom disorder. Symptoms are extremely varied and can often mimic other bowel disorders. Infants, toddlers, and children often exhibit growth failure, vomiting, bloated abdomen and behavioral changes.

Classic symptoms may include:

• abdominal cramping, intestinal gas, distention and bloating
• chronic diarrhea or constipation (or both)
• steatorrhea -- fatty stools
• anemia - unexplained, due to folic acid, B12, or iron deficiency (or all)
• weight loss with large appetite, or weight gain

Other symptoms:

• dental enamel defects
• osteopenia, osteoporosis
• bone or joint pain
• fatigue, weakness and lack of energy
• infertility - male/female
• depression
• Aphthous ulcers

Dermatitis Herpetiformis (DH) is skin manifestation of celiac disease characterized by blistering, intensely itchy skin. The rash has a symmetrical distribution and is most frequently found on the face, elbows, knees and buttocks. DH patients can have gastrointestinal damage without perceptible symptoms.

Putting Brains on the Couch

By Sharon Begley

Newsweek

"The American Psychiatric Association is updating its immense (911 pages) diagnostic manual, which offers 20 forms of bipolar disorder alone. "But it's still just a checklist of symptoms, which different physicians can interpret differently," says psychiatrist James Greenblatt, who directs the eating-disorders unit at Waltham Hospital in Massachusetts. For him and a growing number of psychiatrists, the search for a modern, objective diagnostic tool has led to the past: the electroencephalogram, first used in 1929 to record the brain's electrical activity. "EEGs let you look at patients the way cardiologists do with EKGs, focusing on physiology, not symptoms," says psychiatrist William Richardson, who is at Overlook Hospital and in private practice in Summit, N.J. Brain measurements like EEGs not only offer the possibility of better treatment for mental illness, however. They also show that the line from brain to mind can meander like a mountain stream.

For an EEG, which typically costs about $150 and takes 45 minutes, a patient has about 20 electrodes pasted to his scalp, where they measure the electrical activity of neurons—brain waves—directly beneath. In the 1980s, researchers tried to base diagnoses on EEGs, but it didn't work. The same squiggles could mean different illnesses, and one illness could be marked by different EEGs. The new use of EEGs skips the diagnosis (a label like "anxiety disorder") and goes straight to a recommended treatment. An EEG is compared with a database that includes 13,000 pairings of EEGs with which drugs helped in each case. A California company called CNS Response, which runs the database, finds a match and sends the physician an analysis indicating which drugs patients with that EEG are sensitive or resistant to.

That would be humdrum if, say, the analysis said "Prozac" for a patient with depression. But according to studies of hundreds of patients—CNS Response is launching larger trials this fall—"in some three quarters of patients the EEG database leads the physician to something he wouldn't have thought of," says CNS president Len Brandt. One middle-aged woman, for instance, suffered from depression for years, even after Richardson prescribed one antidepressant after another, marching through Wellbutrin, Cymbalta, Zoloft and more. Her EEG, it turned out, matched those of patients who had responded to Depakote, which is used for bipolar disorder and impulse-control disorders. She showed no signs of either. Yet on the drug and continued psychotherapy, her depression lifted in a week.

The EEG matches aren't perfect. For about one quarter of patients, the $500 analysis suggests treatments that work no better than what they'd already tried. It has proved most beneficial in stubborn cases and in those with no obvious first-line drug, such as eating disorders and addictions. A 16-year-old was repeatedly hospitalized for bulimia, purging up to 10 times a day despite being on the usual antidepressants, for instance. But her EEG pointed Greenblatt toward an anticonvulsant and a stimulant—not a duo anyone would have prescribed. She overcame her bulimia and is now in college.

Still, EEGs have not exactly taken psychiatry by storm. "It's a gross oversimplification to believe that the sum total of neuronal firing could give you anything worthwhile in terms of diagnosis," says Michael First of Columbia University, who is leading the team updating the diagnostic manual. "The scans are not specific for the illness." He's right: that's what those 1980s studies, trying to match symptoms to EEG, found.

But rather than being a fatal flaw, maybe it sheds light on the age-old conundrum of how brain gives rise to mind. One reason for the sometimes-odd pairings of illnesses and drugs is that many different brain states can produce the same mental symptoms, and many different symptoms can arise from the same brain state. Now replace "symptoms" with "mind." The path from electrical firings to mind is less mechanical than neuroscience dogma suggests. The mind has not yielded all its mysteries quite yet."

With Jeneen Interlandi

© 2007 Newsweek, Inc. | Subscribe to Newsweek

21st Century Psychiatry

Referenced EEG/Brainwave Testing

EEG & Psychiatry

Souvenir

Abandoned cars
"One of the tragedies about this car park is that for many weeks after when I returned to my apartment, many of these cars were still there. They belonged to a lot of the people who would drive in from Jersey and upstate and go to the Trade Center. It's rather sad how many of those cars were there."

Dom Foulsham was in New York on business on 11 September 2001. He was staying in a Manhattan apartment, just south of the World Trade Center, and was woken when the second hijacked plane hit the south tower. His first instinct was to pick up his camera and begin taking pictures.

This post will be removed when appropriate.

Candida

Candida is a little fungus that occurs naturally in the blood and which eats and processes excess sugar. Unfortunately, in doing so it also causes a craving for more sugar in the person ----- and this in turn can result in some very dramatic mood and behavior manifestations. Candida species are ubiquitous fungi found throughout the world as normal body flora. Unfortunately, candidiasis is also the most common mycotic infection, causing a variety of diseases.
A hefty dose of inexpensive yeast-fighters and some help in weaning off excess sugar works well to restore a healthy balance.
Sugar is a problem because it occurs in all foods and one does not have to be addicted to candy to have this problem. Often notice if people are having panic that sometimes looks like rage, this can be a sign of candidiasis.
species: Candida albicans, C albicans, Candida tropicalis, C tropicalis, Candida parapsilosis, C parapsilosis, Candida guilliermondi, C guilliermondi, Candida lusitaniae, C lusitaniae, Candida krusei, C krusei, Torulopsis glabrata, T glabrata,

Candida Control Five-Point Plan

This needs to be followed for at least three months.

1. Kill it - Orally - Caprylic acid or raw garlic, Pau d'Arco herb, Nystatin (from your GP¹). Tea tree oil applied (diluted) to skin, and a few drops added to laundry conditioner, to help prevent the rest of the family becoming afflicted. Underwear can also be microwaved if you can't use tea tree oil, eg, if you're seeing a homeopath. You can also add a couple of drops of tea tree oil to bath water.

2. Starve it - Eliminate from diet all sugars (including fruit sugar) on which it feeds, and all yeasts, moulds and fungi (which encourages its growth).

3. Scrub it Out - Using Psyllium Hulls or Slippery Elm. These gently remove the dead candida cells from your gut and help absorb the toxins released by them - especially when they are dying, which can cause 'die back'. This is an exacerbation of your symptoms when you start to eliminate the candida. These toxins, re-absorbed, cause your symptoms in the first place. Psyllium and Slippery Elm can be bought in capsules or loose.

4. Replace it - Using multi-bifidus available in capsules, or from live plain yoghurt². When candida proliferates, the yeast cells clump together to form fungal sheets on your mucous membranes. In the gut, this slows down absorption of vital nutrients. When the fungal sheets are killed and scrubbed off, it leaves patches bare of the normal healthy gut flora which help us digest our food. Multi-bifidus or yoghurt encourages the re-growth of these.

5. Strengthen Your Immune System - With regular treatments from your homeopath. Herbs like Echinacea are extremely helpful, as are multi-vitamins and vital minerals, to replenish those lost by malabsorptions due to Candida.

Don't encourage its re-growth. It will come back quickly if you re-introduce sugars, yeasts and moulds too quickly. Avoid IS inhibitors - herbicides and pesticides on food, steroids, etc.

It is worth noting that in the case of Candida Albicans, or thrush, which is sexually transmittable, both partners should be treated, whether or not symptoms show in the other partner.

Twin Labs: Yeast Fighters:

• High Potency Freeze Dried Lactobacillus acidophilus probiotic (milk free) (supplying 2.5 billion viable cells) 1000 mg

• Concentrated Odorless Garlic Extract Powder (equivalent to 1500 mg of fresh garlic) 100 mg

• Natural Caprylic Acid 100 mg

• Biotin 900 mcg

• Fiber Blend (psyllium seed husks, guar gum, apple pectin) 3000 mg

• In a concentrated specially prepared herbal tea extract base of pau d'arco, onion, black walnut, echinacea and golden seal root.

Symptoms include:

• Tired or lethargic
  
• Poor memory
  
• Feel drained, depleted or exhausted
  
• Numbness, burning, tingling
  
• Stomach pain
  
• Joint pain or swelling
  
• Muscle aching or weakness
  
• Constipation, diarrhea, bloating, gas, or belching
  
• Bothersome or persistent vaginal itching, burning, or discharge
  
• Prostatitis
  
• Erectile dysfunction
  
• Loss of sexual desire
  
• Endometriosis or infertility
  
• Menstrual irregularity or cramping
  
• Anxiety attacks or crying
  
• Cold hands and feet, feel chilly
  
• Irritable or shaking when hungry
  

Natural Remedies

Alternative practitioners recommend individualized programs that usually combine diet and supplements. Supplements are introduced gradually to avoid a temporary worsening of symptoms called a "die-off" or Herxheimer reaction. This is because when candida are killed, they release protein fragments and toxins that can trigger an antibody response from the immune system.

Improvement in symptoms is usually noticed after two to four weeks.

Acidophillus
The beneficial bacteria acidophillus is thought to control candida by making the intestinal tract more acidic, discouraging the growth of candida, and by producing hydrogen peroxide, which directly kills candida.

Reasearch has shown that supplementing with a hydrogen peroxide-producing strain of acidophillus, DDS-1 greatly reduced the incidence of antibiotic-induced yeast infections.

These beneficial bacteria also help to restore the microbial balance within the digestive tract.

Fiber
One teaspoon to one tablespoon of soluble fiber containing guar gum, psyllium husks, flaxseeds or pectin can be mixed in an 8 oz glass of water two times per day on an empty stomach.

Enteric-coated essential oils
Enteric-coated capsules containing oregano oil, peppermint oil, and other volatile oils are thought to prevent the overgrowth of candida. It is usually recommended for at least several months. A standard dosage is two capsules two times a day with water, in between meals. Pure volatile oils can be quite toxic in this amount so the liquid form of these oils should never be ingested, and the capsules should not be broken open before ingesting.

Enteric-coated garlic
Garlic capsules that have been enteric-coated to open when they reach the intestines are often be used in combination with the volatile oils. Once capsule two times per day taken with the enteric-coated volatile oil is a typical recommendation.

Other valuable supplements are caprylic acid from coconuts, oleic acid from olive oil, oregano oil, and pau d'arco. There are many combination products formulated for candida that contain these herbs and supplements.


Some experts suggest that an elimination diet is useful. It allows one to pinpoint what foods are exactly causing the reactions. Elimination diets should be followed for a month to allow for accuracy. Not only do they work with excess candida but also for ADD/ADHD, yeast infections, diabetes and IBS - to name but a few disorders.

• Eat only range-fed turkey and lamb, baked or boiled potatoes and sweet potatoes (with salt and pepper only), rice and millet as your only grain, cooked green and yellow squash for your vegetable, and for fruit, pears and diluted pear juice. Drink a rice-based beverage drink in place of milk on cereal or in cooking. Do not yet use soy beverage. Take a calcium supplement. (Rice products, such as rice beverage, rice-based frozen dessert, rice pasta, rice flour, and millet are available in nutrition stores.)
• At the end of two weeks, or sooner if symptoms subside, gradually add other foods to your diet, one every four days, starting with those less commonly allergenic (such as sunflower seeds, carrots, beets, salmon, oats, grapes, avocado, peaches). Wait a while before you add wheat, beef, eggs, nuts, and corn. Avoid for the longest time dairy products, soy products, peanuts, shellfish, coffee, tea, colas and other beverages containing caffeine, chocolate, gas-producing vegetables (broccoli, cauliflower, cabbage, onions, green peppers), tomatoes, and citrus fruits. Vegetables and fruits are often tolerated in cooked form sooner than in raw form.
• Keep a record of the foods you eat and the problem behaviors; try to correlate re-emergence of symptoms with what you've eaten in the past day or so. This gives you a clearer perspective and helps you stay objective.

Do not starve yourself. It may feel, the first day or two, as though there is not enough for you to eat; but you can still eat a nutritious diet. You just have to eat more of the "safe" types of food until you determine what you can tolerate. Make written notes as you go along. Remember that a successful final eating regimen may even include "problem foods" on a treat basis! Good Luck.

Anxiety Redux: Theanine

There are many studies concerning the efficacy of L-Theanine on anxiety and/or emotional agitation. In general they indicate that it is a supplement that is worth the research and exploration.

"The results showed some evidence for relaxing effects of L-theanine during the baseline condition on the tranquil-troubled subscale of the VAMS. Alprazolam did not exert any anxiolytic effects in comparison with the placebo on any of the measures during the relaxed state. Neither L-theanine nor alprazalam had any significant anxiolytic effects during the experimentally induced anxiety state. The findings suggest that while L-theanine may have some relaxing effects under resting conditions, neither L-theanine not alprazolam demonstrate any acute anxiolytic effects under conditions of increased anxiety in the AA model.

The acute effects of L-theanine in comparison with alprazolam on anticipatory anxiety in humans. Hum Psychopharmacol. 2004 Oct;19(7):457-65.

Natural Remedies for Erectile Dysfunction

Preliminary research on a few herbal supplements — such as DHEA, ginseng and propionyl-L-carnitine — suggests that they may provide benefit as an erectile dysfunction treatment in some men. But no adequate clinical trials have evaluated either the effectiveness or the safety of supplements in treating erectile dysfunction.

Natural treatment can support erectile function by improving overall health. Erectile dysfunction due to vascular disease may readily respond to nutritional changes and herbal support.

Nutrition
Good nutrition may help improve erectile dysfunction.

• Eat whole, fresh, unrefined, and unprocessed foods. Include fruits (lots of richly pigmented berries to support vascular integrity), vegetables, whole grains, soy, beans, seeds, nuts, olive oil, and cold-water fish (salmon, tuna, sardines, halibut, and mackerel).
• Avoid sugar, dairy products, refined foods, fried foods, junk foods, and caffeine.
• Eliminate food sensitivities. Use an elimination and challenge diet elimination and challenge diet to determine food sensitivities.
• Drink 50% of your body weight in ounces of water daily (e.g., if you weigh 150 lbs, drink 75 oz of water daily).

Supplements
Supplements are intended to provide nutritional support. Because a supplement or a recommended dose may not be appropriate for all persons, a physician (i.e., a licensed naturopathic physician or holistic MD or DO) should be consulted before using any product.

Recommended doses follow:

• Bioflavonoids – Take 1000 mg daily.
• Flaxseed meal – Grind 2-4 tablespoons daily. Flaxseed meal is a better choice due to its fiber, lignan, and vitamin content, but flaxseed oil (1 tbsp daily) can be substituted.
• Inositol hexaniacinate – Take 1000-3000 mg daily to improve circulation and lower cholesterol. Diabetics should not take this supplement.
• Selenium – Take 200 mcg daily.
• Vitamin C – Take 1000 mg 3 times daily with meals.
• Vitamin E – Take 400 IUs daily.
• Zinc – Take 30 mg daily.

Herbal Medicine
Herbal medicines usually do not have significant side effects when used appropriately and at suggested doses. Occasionally, an herb at the prescribed dose causes stomach upset or a headache. This may reflect the purity of the preparation or added ingredients, such as synthetic binders or fillers. For this reason, it is recommended that only high-quality products be used. As with all medications, more is not better and overdosing can lead to serious illness and death.

These herbs may be used to treat erectile dysfunction:

• Asian ginseng (Panax ginseng) – Traditionally used for male impotence, though no current studies support this usage.
• Damiana (Turnera diffusa) – Traditionally used as an aphrodisiac and for various sexual disorders; however, there are no current studies to confirm its effectiveness.
• Ginkgo biloba – Increases arterial blood flow, which may have a positive effect on male sexual function.
• Muira puama (Ptychopetalum olacoides) – Used for erectile dysfunction and lack of libido.

In addition, one popular herbal medicine called yohimbe — which is marketed as a sexual stimulant — can be dangerous if used in excessive amounts. Adverse side effects include high blood pressure and heart failure.

Here are five natural remedies that are used for erectile dysfunction.

1) L-Arginine

L-arginine is an amino acid that the body uses to make nitric oxide, a substance signals smooth muscle surrounding blood vessels to relax, which dilates the blood vessels and increases blood flow. Relaxation of smooth muscle in the penis allows for enhanced blood flow, leading to an erection.

L-arginine is found naturally in foods such as meat, dairy, poultry and fish.

It is also available as oral L-arginine supplements, which some product manufacturers market as a "natural Viagra").

There have only been two studies to date, however, evaluating the effectiveness of L-arginine for erectile dysfunction.

One study involved 50 men who took L-arginine (5 grams a day) or a placebo. After six weeks, significantly more men taking L-arginine experienced an improvement in sexual function compared with men taking the placebo. Interestingly, it only benefited men who had initially low levels of nitric oxide.

Another study using a smaller dose of L-arginine and a shorter treatment duration found no benefit with L-arginine use. The study involved 32 men with erectile dysfunction who took oral L-arginine supplements (500 milligrams three times per day) or a placebo for 17 days. Oral L-arginine was no better than the placebo.

Side effects may include digestive complaints. High dosees of L-arginine may stimulate the body's production of gastrin, a hormone that increases stomach acid. For this reason, L-arginine may be harmful for individuals with ulcers and people taking drugs that are hard on the stomach.

L-arginine may also alter potassium levels in the body, especially in people with liver disease. It should not be taken by people who are on medications that alter potassium levels, such as potassium sparing diuretics and ACE inhibitors. For more information about L-arginine, read the L-Arginine Fact Sheet.

2) Propionyl-L-Carnitine

One study examined the use of two forms of carnitine, propionyl-L-carnitine and acetyl-L-carnitine in 96 men who with erectile dysfunction after prostate surgery. One group were given a placebo, another group took propionyl-L-carnitine (2 grams per day) plus acetyl-L-carnitine (2 grams per day) and sildenafil (Viagra) when needed, and the third group used Viagra alone.

Propionyl-L-carnitine and acetyl-L-carnitine were found to enhance the effectiveness of sildenafil, and result in improved erectile function, sexual intercourse satisfaction, orgasm, and general sexual well-being compared to Viagra alone.

Another study examined the effectiveness of propionyl-L-carnitine supplements plus sildenafil in men with erectile dysfunction and diabetes who were previously unresponsive to Viagra alone.

Participants in the study received either propionyl-L-carnitine (two grams per day) plus Viagra (50 milligrams twice a week) or Viagra alone. After 24 weeks, propionyl-L-carnitine plus Viagra was significantly more effective than Viagra alone.

3) Gingko

The herb ginkgo is used for erectile dysfunction, particularly in people who experience sexual dysfunction as a side effect of antidepressant drugs. It appears to relax smooth muscle and enhance blood flow in the penis.

In one study of 60 men with erectile dysfunction, there was a 50 percent success rate after six months of ginkgo treatment. Two additional studies, however, found that ginkgo was no better than a placebo.

For more information about ginkgo, read the Ginkgo Fact Sheet.

4) Zinc

Siginificant depletion of the mineral zinc, associated with long-term use of diuretics, diabetes, digestive disorders, and certain kidney and liver diseases, has been shown to lead to erectile dysfunction.

5) Ashwagandha

The herb ashwagandha (Withania somnifera) is sometimes called Indian Ginseng because it is thought to have similar effects on the body. It is thought to increase energy, stamina, and sexual function. No studies, however, have examined whether it is effective for erectile dysfunction in humans.

Side effects of ashwagandha may include drowsiness. It should not be combined with sedative drugs.

Yohimbe (Not Recommended)

The bark of the west African yohimbe tree is a source of yohimbine, a compound that has been found to stimulate blood flow to the penis, increase libido, and decrease the period between ejaculations.

Yohimbe is not recommended, however, because it is potentially dangerous, even in small doses. Side effects may include dizziness, anxiety, nausea, a severe drop in blood pressure, abdominal pain, fatigue, hallucinations, and paralysis.

Kegel Excercises

The first step is to properly identify the muscle group to be exercised.

1. As you begin urinating, try to stop the flow of urine without tensing the muscles of your legs. It is very important not to use these other muscles, because only the pelvic floor muscles help with bladder control.
2. When you are able to slow or stop the stream of urine you have located the correct muscles. Feel the sensation of the muscles pulling inward and upward.

Helpful hint . . . If you squeeze the rectal area as if not to pass gas, you will be using the correct muscles.

Now you are ready to begin exercising regularly.

Once you have located the correct muscle, set aside two times each day for exercising. Morning and evening are good times for most people, but the important thing is to choose times that are convenient for you so you can develop a routine.

• Set 1: Quick Contractions (QC) -- tighten and relax the sphincter muscle as rapidly as you can.
• Set 2: Slow Contractions (SC) -- contract the sphincter muscle and hold to a count of 3 (gradually work at increasing the count to 10). Make sure you relax completely between contractions.

In the beginning you should check yourself frequently by placing a hand over your abdomen and buttocks during your exercises. You should not feel the muscles of your abdomen, buttocks, or thighs tighten. If there is movement of these muscles you should continue experimenting until you are able to isolate the pelvic floor muscles.

You should see improvement of your bladder control in 3 to 6 weeks. Keep a record of urine leakage to monitor your progress.