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Supplement Forms/Alternate Names
- Bromelain
- Chymotrypsin
- Digestive Enzymes
- Pancreatin
- Papain
- Serrapeptase
- Trypsin
- Dyspepsia
- Pancreatic Insufficiency
Other Proposed Uses
- Breast Engorgement
- Food Allergies
- Reducing Side Effects of Radiation Therapy for Cancer
- Rheumatoid Arthritis
- Sports and Fitness Support: Enhancing Recovery
Proteolytic enzymes (proteases) help you digest the proteins in food. Although your body produces these enzymes in the pancreas, certain foods also contain proteolytic enzymes.
Papaya and pineapple are two of the richest plant sources, as attested by their traditional use as natural "tenderizers" for meat. Papain and bromelain are the respective names for the proteolytic enzymes found in these fruits. The enzymes made in your body are called trypsin and chymotrypsin.
The primary use of proteolytic enzymes is as a digestive aid for people who have trouble digesting proteins. However, proteolytic enzymes may also be absorbed internally to some extent and may reduce pain and inflammation.
You don't need to get proteolytic enzymes from food, because the body manufactures them (primarily trypsin and chymotrypsin). However, deficiencies in proteolytic enzymes do occur, usually resulting from diseases of the pancreas (pancreatic insufficiency). Symptoms include abdominal discomfort, gas, indigestion, poor absorption of nutrients, and passing undigested food in the stool.
For use as a supplement, trypsin and chymotrypsin are extracted from the pancreas of various animals. You can also purchase bromelain extracted from pineapple stems and papain made from papayas.
Therapeutic Dosages
When you purchase an enzyme, the amount is expressed not only in grams or milligrams but also in activity units or international units. These terms refer to the enzyme's potency (specifically, its digestive power).
Recommended dosages of proteolytic enzymes vary with the form used. Because of the wide variation, we suggest following label instructions.
Proteolytic enzymes can be broken down by stomach acid. To prevent this from happening, supplemental enzymes are often coated with a substance that doesn't dissolve until it reaches the intestine. Such a preparation is called enteric coated.
Therapeutic Uses
The most obvious use of proteolytic enzymes is to assist digestion. However, a small double-blind, placebo-controlled trial found no benefit from proteolytic enzymes as a treatment for dyspepsia (indigestion). 1
Proteolytic enzymes can also be absorbed into the body whole and may help reduce inflammation and pain; 2,44-46 however, the evidence is inconsistent. Several studies found that proteolytic enzymes might be helpful for neck pain , osteoarthritis , and post-herpetic neuralgia (an aftereffect of shingles). 15,16,41-43,51 However, all of these studies suffer from significant limitations (such as the absence of a placebo group ), and none provide substantially reliable information.
Studies performed decades ago suggest that proteolytic enzymes may help reduce the pain and discomfort that follows injuries (especially sports injuries ). 3-7,14 However, a more recent, better-designed, and far larger study failed to find benefit. 50
Proteolytic enzymes have also been evaluated as an aid to recovery from the pain and inflammation caused by surgery , but most studies are decades old and, in any case, the results were mixed. 8-13,36-40
A double-blind, placebo-controlled trial published in the 1960s found that use of proteolytic enzymes helped reduce the discomfort of breast engorgement in lactating women . 47
A study tested bromelain for enhancing recovery from heavy exercise by decreasing delayed-onset muscle soreness, but found no benefits. 48 Another study, this one using a mixed proteolytic enzyme supplement, also failed to find benefits. 56
Two studies failed to find proteolytic enzymes helpful for reducing side effects of radiation therapy for cancer. 49, 55
Some alternative medicine practitioners believe that proteolytic enzymes may help reduce symptoms of food allergies , presumably by digesting the food so well that there is less to be allergic to; however, there is no scientific evidence for this proposed use.
Another theory popular in certain alternative medicine circles suggests that proteolytic enzymes can aid rheumatoid arthritis , multiple sclerosis , lupus , and other autoimmune diseases. Supposedly, these diseases are made worse when whole proteins from foods leak into the blood and cause immune reactions. Digestive enzymes are said to help foil this so-called leaky gut problem. Again, however, there is no meaningful evidence to substantiate this theory. Furthermore, one fairly large (301-participant) study failed to find proteolytic enzymes helpful for multiple sclerosis. 52
What Is the Scientific Evidence for Proteolytic Enzymes?
Most of the studies described in this section used combination products containing various proteolytic enzymes plus other substances, such as the bioflavonoid rutin.
Osteoarthritis and Other Forms of Chronic Musculoskeletal Pain
Several studies provide preliminary evidence that proteolytic enzymes might be helpful for various forms of chronic pain, including neck pain and osteoarthritis.
A double-blind, placebo-controlled trial of 30 people with chronic neck pain found that use of a proteolytic enzyme mixture modestly reduced pain symptoms as compared to placebo. 41
Studies enrolling a total of more than 400 people compared proteolytic enzymes to the standard anti-inflammatory drug diclofenac for the treatment of osteoarthritis -related conditions of the shoulder, back, or knee. 42-43,53-54 The results generally showed equivalent benefits with the supplement as with the medication. However, all of these studies suffered from various flaws that limit their reliability; the most important was the absence of a placebo group .
Shingles (Herpes Zoster)
Herpes zoster ( shingles ) is an acute, painful infection caused by the varicella-zoster virus, the organism that causes chickenpox. Proteolytic enzymes have been suggested as treatment. However, there is little evidence to support their use.
A double-blind study of 190 people with shingles compared proteolytic enzymes to the standard antiviral drug acyclovir. 32 Participants were treated for 14 days and their pain was assessed at intervals. Although both groups had similar pain relief, the enzyme-treated group experienced fewer side effects. However, since acyclovir offers minimal benefit at most, these results don't mean very much.
Similar results were seen in another double-blind study in which 90 people were given either an injection of acyclovir or enzymes, followed by a course of oral medication for 7 days. 33
Sports Injuries
Several small studies have found proteolytic enzyme combinations helpful for the treatment of sports injuries . However, the best and largest trial by far failed to find benefit.
A double-blind, placebo-controlled study of 44 people with sports-related ankle injuries found that treatment with proteolytic enzymes resulted in faster healing and reduced the time away from training by about 50%. 17 Based on these results, a very large (721-participant), double-blind, placebo-controlled trial of people with sprained ankles was undertaken. 50 Unfortunately, this study failed to find benefit with rutin, bromelain, or trypsin, separately or in combination.
Three other small, double-blind studies, involving a total of about 80 athletes, found that treatment with proteolytic enzymes significantly speeded healing of bruises and other mild athletic injuries as compared to placebo. 18-20 In another double-blind trial, 100 people were given an injection of their own blood under the skin to simulate bruising following an injury. Researchers found that treatment with a proteolytic enzyme combination significantly speeded up recovery. 21 In addition, a double-blind, placebo-controlled trial of 71 people with finger fractures found that treatment with proteolytic enzymes significantly improved recovery. 22 However, these studies were performed decades ago and are not quite up to modern standards.
Numerous studies have evaluated various proteolytic enzymes as an aid to recovery from surgery , but the results have been mixed. Again, most of these studies are not up to modern standards.
A double-blind, placebo-controlled trial of 80 people undergoing knee surgery found that treatment with mixed proteolytic enzymes after surgery significantly improved rate of recovery, as measured by mobility and swelling. 23
Another double-blind, placebo-controlled trial evaluated the effects of a similar mixed proteolytic enzyme product in 80 individuals undergoing oral surgery. 24 The results showed reduced pain, inflammation, and swelling in the treated group as compared to the placebo group. Benefits were also seen in another trial of mixed proteolytic enzymes for dental surgery, 36 as well as in one study involving only bromelain. 13
A double-blind, placebo-controlled study of 204 women receiving episiotomies during childbirth found evidence that a mixed proteolytic enzyme product can reduce inflammation. 37 Bromelain was also found helpful for reducing inflammation following episiotomy in one double-blind, placebo-controlled trial of 160 women, 11 but a very similar study found no benefit. 38
Other double-blind, placebo-controlled studies have found that bromelain reduces inflammation and pain following nasal surgery, 25 cataract removal, 12 and foot surgery. 39 However, a study of 154 individuals undergoing facial plastic surgery found no benefit. 40
A small double-blind, placebo-controlled trial of 24 people having surgical extraction of third molars found serrapeptase given during the procedure reduced postoperative pain and swelling (significant differences on days 2, 3 and 7). 57
Safety Issues
In studies, proteolytic enzymes are believed to have proven to be quite safe, although they can occasionally cause digestive upset and allergic reactions.
One proteolytic enzyme, pancreatin, may interfere with folate absorption. 34 In addition, the proteolytic enzyme papain might increase the blood-thinning effects of warfarin and possibly other anticoagulants. 35
The proteolytic enzyme bromelain might also cause problems if combined with drugs that thin the blood. In addition, there are concerns that bromelain should not be mixed with sedative drugs. Finally, bromelain may increase blood concentrations of certain antibiotics. For more information, see the full Bromelain article.
Interactions You Should Know About
If you are taking:
- The proteolytic enzyme pancreatin: You may need extra folate.
- Warfarin (Coumadin), aspirin , or other drugs that "thin" the blood: You should not take the proteolytic enzymes papain or bromelain except under a doctor's supervision.
- Sedative drugs: Do not take bromelain, except under a physician's supervision.
Revision Information
- Reviewer: EBSCO CAM Review Board
- Review Date: 12/2015 -
- Update Date: 12/15/2015 -


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The Indian rupee's free-fall continued on Tuesday, now down 22% against the dollar since January. So is it a good buying opportunity?
Sort of, according to Mark Mobius, chairman of Templeton Emerging Markets Group.
In comments heavy on qualifiers, the emerging and frontier market expert told India's CNBC-TV18 that "I think the worst is over. The currency has moved probably too far and we have a situation where there could be a pullback on the currency."
He argued a combination of hedge funds and other derivative instruments have played a big role in the rupee's dramatic decline, and that it's "probably over."
The subcontinent's currency has accelerated since June when the U.S. Federal Reserve announced it was considering tapering its monthly bond-buying program, which has helped boost emerging markets and their currencies.
CNBC-TV18 noted the decline has left members of India's government scratching their heads as to how to stop the rout. In a move screaming "move along, nothing to see here," Prime Minister Manmohan Singh tried to put a positive spin on the situation, telling parliament the rupee's fall in value was part of "a needed adjustment that would make Asia's third-largest economy more competitive."
For his part, Mobius told the network that the government needed to focus on boosting economic sentiment and strengthening the rupee and had to get "its act together."
Mobius dismissed concerns that any Fed tapering could hurt emerging markets, and said that foreign investments into countries like India could even pick up again.
"I do not think there will be much change because a lot of this has been discounted," he concluded. "The big story would be of course to take shoulder from Bernanke and if funds do come in there could be quite a dramatic shift towards direct financing and very rapid increase in money supply, which will be quite bullish for markets around the world. But at this stage it is not clear if that will happen."
Check out Roubini: 6 Reasons BRICS Are Taking a Beating on ThinkAdvisor.

subset: commoncrawl


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Pusheen Coin Purse
Sorry, this product has been archived…meaning it's currently out of stock and may or may not make a return. If you'd like to know *if* we are able to restock this product feel free to send us an email to firstname.lastname@example.com and we'll let you know if we might be able to get it back. Thanks!
Pusheen is not only super chubby and cute, he's also super useful! Keep all of your change and other small items in this super cute coin purse.
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Over the next couple of years, the sun will reach its period of maximum activity and solar flares will be at their highest point in years. The last time there was a high period of solar activity, there were few people that relied on things like GPS in their daily lives. Today GPS is a very common technology that millions rely on each day for getting around all over the world. The military also relies on GPS for combat operations.
The coming period of high solar activity and solar flares has some scientists worried that GPS signals will be interfered with in a way that could cause minor issues for some users. The researchers point out that the military uses a much more complex GPS system than consumers have access to and military use of GPS should not be affected.
BBC News reports that what is likely to happen when solar activity reaches its peak is that the low-power GPS signals the navigation device in a car relies on for positioning information won't be able to pick the GPS signal from orbiting satellites due to radiation from solar flares. Ultimately, GPS receivers in consumer devices may be blinded for tens of minutes a few times a year when the sun is at maximum activity.
Throwing another issue into the mix for GPS receivers is that the ionosphere changes in composition depending on the amount of solar radiation hitting it and can lengthen the time it takes GPS signals to make it to the ground adding more of a chance of errors for GPS devices.
Professor Cathryn Mitchell from the University of Bath said, "We can look at the measurements from the last solar maximum. If we project those forward, it varies quite a lot across the Earth; looking at the UK it will be about 10-meter errors in the positioning."
Scientists at Cornell University warned about the potential for adverse effects on GPS systems caused by solar flares in 2006. They warned that the effects could have big problems for emergency services that rely on GPS.


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AUD can affect people of all ages including adolescents. Symptoms are different for everyone, though common threads exist. These include:
- Increase in amount of alcohol that is being consumed to try to reach same effects
- Inability to stop or limit drinking despite associated problems
- Significant amount of time doing activities to obtain or use alcohol
- Craving or urge to use alcohol
- Repeated home, school, or work problems
- Difficulty in relationships with family members, friends, and coworkers
- Missing previously favored activities in order to drink alcohol or recover from alcohol
- Alcohol use even if it creates physically unsafe situations or leads to legal trouble
- Alcohol use that continues even when it causes or worsens health problems
Dependence may also cause physical symptoms (withdrawal) when alcohol is stopped. Withdrawal may cause:
- Shaking
- Rapid pulse
- Sweating
- Nausea or vomiting
- Lack of appetite
- Anxiety and agitation
- Hallucinations
- Disorientation
- Seizures that may result from delirium tremens (DTs)
Complications Associated with AUD
Complications of AUD cover a wide range of personal, family, social, and health problems such as:
- Accidents and injury—including motor vehicle accidents and falls
- Violence, murder, and suicide
- Domestic violence
- Family problems
- Failed relationships
- Lost jobs
- Problems with the law, including drunk driving arrests and jail time
Some common physical problems associated with AUD include:
- Red palms, flushed face
- Spidery veins showing through the skin around the umbilicus and on the face
- Rapid heart rate
- Yellowing of the whites of the eyes and/or skin—jaundice, which indicates liver problems
- Enlarged liver and/or spleen
- Nausea, bloating, indigestion, and ulcers
- Pancreatitis
- Easy bruising and/or bleeding
- Peripheral neuropathy or nerve damage, which can cause muscle weakness, numbness, or tingling
- Impaired memory and cognitive function
- Infertility in both men and women
- Sexual dysfunction
- Increased susceptibility to infections and cancer
Medical complications include:
- Nutritional deficiencies
- Certain cancers, especially of the liver, esophagus, mouth, throat, larynx, and pancreas
- Acute and chronic pancreatitis
- Liver damage, which can occur with hepatitis and cirrhosis
- Gastrointestinal problems such as bleeding, diarrhea, hemorrhoids, ulcers, and inflammation of the esophagus
- Heart and circulatory problems, including arrhythmias
- Mental health problems, including depression
- High blood pressure, which can lead to a hemorrhagic stroke
- Obesity
- Diabetes
- Pneumonia and acute respiratory distress syndrome (ARDS)
- Osteoporosis
- Neurological problems and brain damage (with long-term use)
- Postoperative complications, including infections, bleeding, and delayed healing
- Fetal alcohol syndrome in the babies of women who drank during pregnancy
- Early death
Revision Information
- Reviewer: EBSCO Medical Review Board Adrian Preda, MD
- Review Date: 03/2018 -
- Update Date: 04/09/2015 -


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CASE 7 - Yakusan Takes the High Seat
Taigu couldn't be bothered to say something about this Koan today, so he asked me.
There are many hidden meanings in the Preface and Appreciatory Verse, so let me explain ...
Gassho, J
PS - If that is still not enough for you, please try the 'Random Deepak Chopra Quote Generator':
It has been said by some that the thoughts and tweets of Deepak Chopra are indistinguishable from a set of profound sounding words put together in a random order. ... [So] This site aims to test that claim! Each "quote" is generated from a list of words that can be found in Deepak Chopra's Twitter stream randomly stuck together in a sentence.
Click on this a few times ...
... and try the accompanying "real quote/fake quote" quiz ...


text:
Puzzle Levels
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Cupid's Dart
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|Remove the string
|Level 9 - Gruelling
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|Puzzle Master Wire / Metal Puzzles
|5 in x 2 3/8 in / 12.7 cm x 6.7 cm
|Clam Shell
Product Description
Don't let the cute name and design fool you. This can be a really tough challenge. Made with 3mm wire and nickel plated, this puzzle can withstand almost anything, even frustration. Can you find a way to remove the string and then put it back as it were? The two rings can't move much around, but the top of the arrow slides freely up and down. Take advantage of these characteristics to successfully solve it. The Cupid's Dart is one of many Wire Puzzles found in our PuzzleMaster selection.
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These drugs are the most powerful medications for reducing stomach acid levels; in fact, they almost completely shut down the stomach's ability to produce acid. (Their science fiction–sounding name comes from the last stage of the acid-secreting process, called the "proton pump.") Proton pump inhibitors are used for ulcers as well as for the treatment of moderate to severe esophageal reflux, commonly known as heartburn.
Drugs in this family include lansoprazole (Prevacid), omeprazole (Prilosec), and others.
The herb St. John's wort is known to interact with numerous drugs. There are two potential harmful interactions between St. John's wort and proton pump inhibitors.
One study found that use of St. John's wort greatly decreases levels of omeprazole in the body. 13 This would be expected to lead to markedly reduced efficacy.
The other potential risk is more theoretical. When taken to excess, the herb St. John's wort can cause an increased risk of sunburn. Some evidence hints that proton pump inhibitors might increase this risk. 12
Vitamin B 12 deficiency is a concern with the use of all drugs that reduce stomach acidity.
In food, vitamin B 12 is always accompanied by proteins, and it must be separated from them before it can begin to be absorbed. Following separation, B 12 is then attached to a substance called intrinsic factor, which allows B 12 to be absorbed in the intestines.
Stomach acid plays a role in this separation. If you don't have enough stomach acid, the process of freeing vitamin B 12 from protein so that it can be bound to intrinsic factor may be impaired. 1,2
Studies suggest that treatment with proton pump inhibitors might significantly reduce the absorption of vitamin B 12 . 3,4,5
Interestingly, there is some evidence that cranberry juice might increase B 12 absorption in individuals taking proton pump inhibitors, 6 possibly because the juice is somewhat acidic.
Research on related medications suggests that proton pump inhibitors may slightly reduce the body's absorption of folate. 7 The decrease in folate absorption should be quite small, but since folate deficiency is quite common and potentially harmful, taking extra folate might make sense as insurance.
By reducing stomach acid levels, proton pump inhibitors might interfere with the absorption of iron , zinc , and perhaps other minerals. 8-11 Taking mineral supplements to meet the US Dietary Reference Intake (formerly known as the Recommended Dietary Allowance) levels for these nutrients should help.
Revision Information
- Reviewer: EBSCO CAM Review Board
- Review Date: 12/2015 -
- Update Date: 12/15/2015 -


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Rutland Herald and Montpelier (Barre) Times Argus
Sunday July 7th, 2013
By Barrie Dunsmore
I can't easily explain it but the news coverage this past week marking the 150th anniversary of the battle of Gettysburg left me with a feeling of disquiet.
It wasn't as though this seminal Union victory which marked a turning point in the Civil War had been ignored. Generally, the main stream media gave more than passing mention to the anniversary. There have been good reviews for a new book on the subject- "Gettysburg: The Last Invasion," by Allen C. Guelzo, a distinguished Lincoln scholar who teaches at Gettysburg College.
I look forward to reading it because I have developed a special interest in the Gettysburg story. As a foreign correspondent virtually all of my attention had focused on the Cold War and the conflicts of the Middle East which were products of the two World Wars of the 20th century. However shortly after my retirement I was invited by the then Chief of Staff of the Army, General Dennis Reimer to join him and his senior staff and a few old war correspondents for a weekend conference at the Army War College in Carlisle, Pennsylvania.
Our discussions about the military and the media were of little consequence. What was significant was a day-long field trip our group of about dozen made to the nearby battlefields of Gettysburg. Our guides were the commandant of the War College and its chief historian. After visiting the sites and hearing the stories of the first two days of the battle, we walked side by side onto the once blood-drenched field of General George Pickett's infamous charge on the climactic third day. For an hour we strode up the long grade as our guides shouted out from either end of our line, describing what would have been happening at that moment on that 3rd day of July in 1863. One could easily imagine the sights, sounds and smells of thousands of soldiers being killed and maimed on this very ground. Of all the world's famous historical sites I have been privileged to visit, this moved me the most. It also inspired me to learn much more about this battle and this war.
Over the ensuing years of reading and research I came to appreciate that you cannot truly understand this country until you recognize just how profound the impact of the Civil War has been on the American psyche. How else to explain that from the Confederate surrender at Appomattox to this very day, many Americans in their heart of hearts, do not accept the outcome of that war.
The Thirteenth Amendment to the Constitution abolishes slavery. The Fourteenth Amendment requires states to provide equal protection under the law to all their citizens. The Fifteenth Amendment bans race-based voting qualifications. These are the Civil War Reconstruction Amendments meant to secure the rights of former slaves. But then came a notorious political deal to break the deadlock of the 1876 presidential election. Republican candidate Rutherford Hayes became president by obtaining electoral votes from three Southern states in return for a promise that the occupying Union Army in those states would be pulled out. Not only was that the end of Reconstruction. It marked the beginning of the Jim Crow era- when Southern and border states mandated "separate but equal" status for African Americans. At the same time black voting rights were negated by a web of insidious laws and regulations that throughout the South effectively blocked black participation in the political process. Segregation would prevail for the next ninety years.
There was virtually no improvement in civil rights for black Americans until after World War II. In 1947 Jackie Robinson broke the color barrier in major league baseball. In 1948 President Harry Truman signed an executive order to desegregate the U.S. military (which took another six years.) In 1954 in a unanimous decision the Supreme Court ruled that "separate but equal" education was unconstitutional. That gave the legal footing for the civil rights protests of the late fifties and early sixties. But it wasn't until 1964 and '65 when the Civil Rights and Voting Rights Acts were passed, that the promise of the Civil War Constitutional Amendments were finally realized. For this we owe an enormous debt to Martin Luther King and the thousands of brave black and white people willing to risk everything to march with him- and to President Lyndon Johnson who had to use all of his persuasive skills on his fellow Southerners to ultimately get both laws passed.
Which brings me back to my unease about coverage of the 150th anniversary of the battle of Gettysburg. As important as this battle was, it still cannot be seen as "mission accomplished." Of course much has changed in America. An African American is now president - which without the victory in Gettysburg would never have happened. But race remains ingrained in American politics as evidenced by just last year's election when new state and local laws to suppress the minority vote kept being enacted. Meanwhile, there have been more threats to Barack Obama's life than any previous president. The opposition to him is offered as ideological - but the level of vituperation seems much more visceral than political.
Yet frankly, it is not the Obama haters I worry about so much as I do the current Supreme Court. The latest 5-4 decision to strip crucial parts from the 1965 Voting Rights Act seriously weakens the one law that finally brought the aims of the Civil War to fruition- albeit one hundred years after the fact. Yet now, Congress must re-write the key enforcement clause of the VRA- something which looks virtually impossible given the dysfunctional make-up of the current Congress and its likely successors in the foreseeable future. That then, would seem to guarantee that for minorities, voting is going to become more difficult again, which raises the question for this Court, why in God's name would you want to do that?
I welcome your comments. To post your thoughts, click the word "comments" below.


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Pleasure Craft / Yacht Horns
Pleasure Craft / Yacht Horns
Certified to international requirements for yachts up to 200 Meters in length, Kahlenberg air horns for yachts and pleasure craft are all built to extremely high standards of quality. They offer owners and captains a highly reliable means of complying with IMO/USCG sound signaling requirements and an aesthetically pleasing item of deck hardware with a distinctive sound that is the envy of everyone who hears it. With a worldwide reputation for durability, distinctive sound, and exceptional finish, Kahlenberg Air Horns are found on the majority of the world's superyachts.
All Kahlenberg sound signals are tested in an in-house anechoic chamber and certified to ensure conformance to industry standards established by the International Maritime Organization (IMO) (72 COLREGS). Type approvals from various classification societies are available for all models.
If you have questions on any Kahlenberg pleasure craft and Yacht horns, please contact us.
Items 1-12 of 26
Items 1-12 of 26


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von Brunn Media
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von Brunn Media is a Los Angeles, California based production company. We provide services to European and Non-US clients planning a production in the USA.
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The term "antacid" is used to describe certain compounds that directly neutralize stomach acid. Tums, Maalox Advanced Regular Strength, and Mylanta all fall into this category. The active ingredients in most antacids are various forms of calcium, magnesium, and aluminum. Antacids are useful mostly for symptomatic relief of uncomfortable "acid stomach" and also may be helpful for heartburn.
Many antacids are available today, including
- Aluminum carbonate (Basaljel)
- Aluminum hydroxide (ALternaGEL, Alu-Cap, Alu-Tab, Amphojel, Dialume, Nephrox)
- Aluminum hydroxide/magnesium carbonate (Duracid)
- Aluminum hydroxide/magnesium hydroxide (Alamag, Almacone, Aludrox, Gaviscon Liquid, Gelusil, Kudrox, Maalox Advanced Regular Strength, Magalox, Mintox, Mylanta, Rulox)
- Aluminum hydroxide/magnesium hydroxide/calcium carbonate (Tempo)
- Aluminum hydroxide/magnesium trisilicate (Alenic Alka, Gaviscon, Genaton, Foamicon)
- Calcium carbonate (Alkets, Amitone, Chooz, Equilet, Gas-Ban, Mallamint, Mylanta Lozenges, Titralac, Tums)
- Calcium carbonate/magnesium carbonate (Marblen, Mi-Acid Gelcaps, Mylanta Gelcaps, Mylagen Gelcaps)
- Magnesium hydroxide (Milk of Magnesia, Phillips' Chewable)
- Magaldrate or aluminum magnesium hydroxide sulfate (Iosopan, Riopan)
- Magnesium oxide (Mag-Ox, Maox, Uro-Mag)
- Sodium bicarbonate (Bell/ans, Bromo Seltzer)
- Sodium citrate (Citra pH)
Other drugs work by reducing the stomach's production of acid. These are discussed separately in the articles on H 2 Blockers (eg, Zantac [ranitidine], Axid [nizatidine], Tagamet [cimetidine], Pepcid [famotidine]) and Proton Pump Inhibitors (Prilosec [omeprazole], Prevacid [lansoprazole]). These drugs produce a more powerful effect than antacids and are used for ulcers as well as for the treatment of esophageal reflux, commonly known as heartburn.
Research suggests that antacids physically bind to folate and reduce its absorption by the body. 1 However, the decrease in folate absorption is relatively small, and this interaction may be clinically significant only in individuals who take antacids regularly and whose diets are low in folate content.
Different types of antacids can interfere with the absorption of various minerals. Supplements containing the US Dietary Reference Intake (formerly known as the Recommended Dietary Allowance) of these minerals should be helpful, especially if you take them at a different time of day from when you take antacids, at least 2 hours before or after taking your antacid.
Any antacid can interfere with the absorption of iron , zinc , and possibly other minerals by neutralizing stomach acid. 2
Aluminum-containing antacids can bind with phosphorus and interfere with its absorption, and this can further lead to calcium depletion. 3,4
Antacids that contain calcium may also compete for absorption with iron. 5-9 Although calcium antacids may alter the absorption of magnesium , the clinical importance of this effect appears to be minimal. 10,11 Calcium-containing antacids, when taken with zinc supplements, might substantially decrease zinc absorption. 12-16 However, the presence of a meal appears to mitigate this effect. Finally, calcium antacids might also impair the absorption of manganese and chromium . 17,18,19
Concerns have been raised that the aluminum in some antacids may not be good for you. 20 Since there is some evidence that calcium citrate supplements might increase the absorption of aluminum, 21-25 it might not be a good idea to take calcium citrate at the same time of day as aluminum-containing antacids. Another option is to use other forms of calcium, or to avoid antacids containing aluminum.
Revision Information
- Reviewer: EBSCO CAM Review Board
- Review Date: 08/2013 -
- Update Date: 08/22/2013 -


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Famous Trick Donkeys - Small
Product Information
|Level 6 - Tricky
|Sam Loyd
|Paper Puzzles
|3 1/8 in x 2 1/8 in / 8 cm x 5.5 cm
Product Description
One of the most popular puzzles ever created is the "Trick Donkeys" puzzle. Invented by America's premier puzzlist, Sam Loyd, and patented in 1871, there have been millions of copies produced and distributed.
Through the years the puzzle has had various names including 'P.T. Barnum's Trick Mules' and was used to promote anything, from the famous Barnum's circus to department stores.
Printed are two donkeys and two jockeys. Cut along the lines and lay the three pieces down so as to show the jockeys racing.
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A classic! Tests your ability to see beyond the obvious configuration. Should provide everyone with a few minutes of puzzling fun.


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Sepsis is a systemic inflammatory response to a severe infection. The inflammatory response triggers a rapid series of events, such as leaking blood vessels and impaired blood flow.
Severe sepsis is associated with a drop in blood pressure. Low blood pressure reduces the amount of oxygen and nutrients going to the body's organs. This drop causes damage to the body's major organs.
Septic shock occurs when adequate blood pressure cannot be restored despite treatment with IV fluids. Septic shock may lead to multiple organ failure and death.
Septic shock is caused by an infection that overwhelms the body. Sepsis can be triggered by many different kinds of infections including:
- Bacterial—most common
- Fungal infections
- Viral
- Parasitic
Risk Factors
Septic shock is more common in infants and in people over 50 years old. Other factors that may increase your chances of septic shock include:
- Weakened immune system
- Absence of your spleen
- Cancer
- Low white blood cell counts
- Chronic diseases
- Previous surgery
Septic shock may cause:
- Fever, which may be followed by a drop in body temperature to below normal
- Warm, flushed skin
- Chills
- Rapid, pounding heartbeat
- Rapid breathing or trouble breathing
- Confusion
- Reduced alertness
- Irregular blood pressure
- Reduced urination
- Severe bleeding— disseminated intravascular coagulation
Complications from septic shock may cause symptoms of:
Your doctor will ask about your symptoms and medical history. A physical exam will be done.
Tests may include the following:
- Blood tests to assess white blood cell counts and inflammatory markers that might indicate how serious the infection is, as well as oxygen levels and kidney function to assess damage to specific organs.
- Cultures to check for infectious organisms
- ECG to check for heart rhythm irregularities
- Imaging tests may be used to look for specific sources of infection, such as pneumonia
Sepsis and septic shock require immediate care. Treatment includes the following:
Supportive Measures for Shock
If you have septic shock, you will be admitted to the intensive care unit. There you will be given:
- IV fluids
- Medications to increase blood pressure and blood flow to your organs
- Extra oxygen
- Corticosteroids may be needed to reduce the inflammatory response, especially if fluids aren't working
If your lungs fail, you may be put on a mechanical ventilator to help you breathe. Other therapies or supportive measures may be used.
You will be given high doses of one or more antibiotics or antifungal medications. The medications may be changed once the specific cause of the infection is identified.
Surgery may be performed to remove any dead tissue or drain infections.
Most cases of septic shock cannot be prevented. Promptly treating bacterial and other infections may help.
Revision Information
- Reviewer: EBSCO Medical Review Board Marcie L. Sidman, MD
- Review Date: 11/2018 -
- Update Date: 01/09/2017 -


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|Within the next couple of seasons, the Marlins anticipate Colin Moran becoming their everyday third baseman. On Saturday afternoon, the 20-year-old got his first taste of hitting at Marlins Park.
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More»Meadows, Huntington discuss the Draft pick's signing
|On the last day Cleveland could sign its selections from the 2013 First-Year Player Draft, the club agreed to terms with a national champion. Adam Plutko, a right-hander out of UCLA, was selected by the Indians in the 11th round last month.
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|The Blue Jays did not come to terms with their first-round pick, Phil Bickford, the 10th overall selection from June's MLB First-Year Player Draft, by Friday's 5 p.m. ET deadline. But they did reach a deal with 11th-round selection Jacob Brentz and 30th-round selection Rowdy Tellez.
More» Jacob Brentz, HS Pitcher
|Baltimore signed every one of its picks from the first 14 rounds, 15 total players, including its top pick, high school right-hander Hunter Harvey.
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|The Cubs and Kris Bryant, the second player taken overall in the 2013 First-Year Player Draft, finalized a deal on Friday, with the third baseman agreeing to a $6.7 million signing bonus.
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|The deadline for signing picks from the 2013 Draft passed at 5 p.m. ET on Friday, but the Yankees had already gotten a majority of their players under contract by that point. The last to sign was outfielder Aaron Judge, the second pick of the first round. New York has not announced the signing yet, but a source confirmed to MLB.com that Judge signed a contract on Thursday worth $1.8 million.
More» Yankees draft 3B Eric Jagielo No. 26
|The Yankees have agreed on a contract with Aaron Judge, their second pick in the first round of the First-Year Player Draft, a baseball source told MLB.com on Thursday.
More» First-round Draft pick Aaron Judge takes BP
|The signing deadline for players selected in the 2013 First-Year Player Draft passed quietly Friday at 5 p.m. ET. A plethora of early signings meant only nine players picked in the first 10 rounds entered Friday without having at least agreed to terms.
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|The Brewers singed two more selections from the 2013 First-Year Player Draft in left-handed pitcher Hobbs Johnson (University of North Carolina, 14th round) and outfielder Johnny Davis (West Los Angeles Community College, 22nd round).
|The Pirates have signed Adam Frazier from Mississippi State, their sixth-round pick in the 2013 First-Year Player Draft. The shortstop led the NCAA in hits this season with 107.
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|The Astros have reached an agreement with third-round pick Kent Emanuel, a left-handed pitcher from North Carolina. The team announced the move Thursday.
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