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The current state of knowledge in regard to nutritional requirements for pregnant and lactating women and for women who are taking oral contraceptives is reviewed. During pregnancy caloric intake should be moderately increased, and the consumption of 30-60 mg of iron and 800-1200 mg of calcium is recommended. Phosphorus intake should also be increased, but this increase should be balanced by a corresponding increase in calcium intake. Consumption of vitamins A and D should be increased but excessive increases should be avoided. Vitamin E should be slightly increased. The desirability of increasing vitamin K is till a matter of dispute. Pregnant women have a slightly increased need for most water soluble vitamins. Research has adequately demonstrated the need to increase folic acid and B6 consumption. There is some evidence that iodine, chromium, and zinc deficiencies may be teratogenic. Some care should be taken not to overconsume sodium, but the need for stringest restriction is unwarranted. Heavy consumption of alcohol and caffeine should definitely be discouraged during pregnancy. Certain problems experienced by pregnant women, such as nausea, may be managed through nutritional modification. The increased nutritional needs for lactating women can, in most cases, be met by increasing milk consumption by 3-3 1/2 cup/day and by consuming a well balanced diet. The content of maternal milk may to some extent be altered by the consumption patterns of the mothers. Ingestion of certain drugs and chemicals may also alter maternal milk. The use of oral contraceptives apparently affects metabolism, but the consequences of these effects are largely unknown. Oral contraceptive usage generally increases the serum levels of triglycerides, iron, copper, and vitamin A and reduces levels of some B vitamins of vitamin C and of zinc and albumin. These effects vary from woman to woman and at the present time there is no agreement on the need for dietary supplementation. The effects of a variety of drugs on lactating women and the effects of oral contraceptive usage on nutritional status are presented in tabular form.
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PMID:Nutrition during pregnancy, lactation, and oral contraception. 25 28

Vitamin E appears to be a safe, simple, and inexpensive means of reducing the number of postoperative capsular contractures following breast augmentation. The synthetic form of vitamin E (alpha-tocopherol) is recommended to avoid nausea or skin eruptions in patients with oily skin, which are frequently encountered when the natural form is taken. No harmful side effects have been noted in any of the patients to date. Vitamin E has no effect on coagulation systems and does not cause excessive bleeding either during or after surgery. The recommended dosage of synthetic vitamin E is 1000 IU, b.i.d., for 2 years beginning 1 week before surgery. If no contracture exists at that time, the dosage may be reduced to 1000 IU daily thereafter.
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PMID:The effectiveness of alpha-tocopherol (vitamin E) in reducing the incidence of spherical contracture around breast implants. 729 41

Gastrointestinal complaints and occult bleeding have been commonly described in marathon runners. We hypothesized that these complaints may arise from intestinal ischemia caused by the shunting of blood away from the splanchnic circulation during endurance racing followed by reperfusion injury. Studies in animal models have suggested prophylactic vitamin E supplementation may prevent this type of injury. We sought to determine if prerace vitamin E supplementation would prevent intestinal ischemia/reperfusion injury in humans. Forty subjects who planned to complete the 1996 Houston-Tennaco Marathon were randomized to receive vitamin E (1000 IU daily) or placebo (soya lecithin) for 2 wk before the race in a double-blinded trial. Inclusion criteria included no use of non-steroidal anti-inflammatory drugs (NSAIDs) within 24 d of the race or vitamin or mineral supplements containing vitamins C or E or selenium within 30 d of the race. Subjects were studied 2 wk before the race and immediately following the race. Blood was obtained for serum vitamin E and total lipid and salicylate concentrations. A solution of lactulose (5 g) and mannitol (2 g) was consumed and urine was collected for 6 h. Aliquots were assayed for lactulose and mannitol concentration. Stool samples were tested for occult blood and following the race subjects rated their nausea, abdominal pain, and cramping on a 1-5 scale. Twenty-six subjects (24 male, 2 female) completed the marathon. Finish times ranged between 2 h 43 min and 5 h 28 min. All subjects had heme-negative stool prerace and four developed heme-positive stool postrace, with no difference between vitamin E and placebo groups (Fisher's exact = 0.63). All had non-detectable salicylate concentrations pre- and postrace. Serum vitamin E concentration increased in botPP = 0.02 in the vitamin E group and 1.45 +/- 0.40 to 1.66 +/- 0.48 mg/dL in the placebo group, P = 0.02). However, the serum vitamin E: total lipid ratio increased significantly in the vitamin E-supplemented group (0.0022 +/- 0.0002 to 0.0051 +/- 0.0015, P = 0.02), but not in the placebo group (P = 0.25). Overall, the urinary lactulose:mannitol ratio increased from 0.03 +/- 0.02 to 0.06 +/- 0.08 postrace (P = 0.06) without difference between vitamin E or placebo groups. Intestinal permeability increased significantly more in those who developed occult bleeding. More subjects in the placebo group developed abdominal cramping (Fisher's exact = 0.04) and abdominal pain (Fisher's exact = 0.06), although there was no difference in severity between groups. There was no difference in the incidence of nausea and no diarrhea was reported by any subject. Intestinal permeability tends to increase and occult gastrointestinal bleeding occurs during endurance running, suggesting the occurrence of intestinal ischemia/reperfusion injury. Prerace supplementation with the antioxidant vitamin E had no effect on performance, intestinal injury, occult bleeding, or the severity of postrace gastrointestinal complaints. Vitamin E supplementation was associated with a decreased incidence of these complaints but had no effect on their severity.
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PMID:Short-term vitamin E supplementation before marathon running: a placebo-controlled trial. 1031 59

The management of dementia patients encompasses pharmacologic, behavioral, and psychosocial intervention strategies. Before pharmacologic intervention is instituted, it is important that sources of excess disability and comorbidity be eliminated or reduced. Identification of comorbid medical and psychiatric conditions, such as depression and delirium, should be identified and appropriately treated. Providing caregivers with education, support, and practical advice is a critical component of the management of the demented patient. The current standard of care for pharmacologic management of the cognitive and functional disabilities of AD consists of the combination of a cholinesterase inhibitor and high-dose vitamin E. This standard is based on the results of large-scale, double-blind, placebo-controlled trials. Cholinesterase inhibitors are the only FDA-approved pharmacologic treatments for AD. Cholinesterase inhibitors have been shown to be effective in the treatment of the cognitive, behavioral, and functional deficits of AD. Large-scale placebo-controlled trials of tacrine, donepezil, rivastigmine, and galantamine have demonstrated moderate benefits in patients with mild to moderate AD. Donepezil, rivastigmine, and galantamine are the first-line choices in the treatment of AD because of their lack of hepatotoxicity, ease of administration, few significant drug-drug interactions, and mild to moderate side effects. There are few contraindications to the use of cholinesterase inhibitors. Known hypersensitivity to a specific drug or its derivatives is the only true contraindication. Cautious administration of cholinesterase inhibitors is advised in patients who have a previous history of allergy or adverse reactions to prior cholinesterase inhibitors, severe liver disease, preexisting bradycardia, peptic ulcer disease, current alcoholism, asthma, or chronic obstructive pulmonary disease. Nausea, vomiting, diarrhea, and anorexia are the most common side effects of cholinesterase inhibitors. These gastrointestinal side effects can be minimized by gradual dose increases, administration with food, adequate hydration, and judicious use of an antiemetic. Vitamin E has been demonstrated to slow the progression of AD in several small and one large placebo-controlled trials. Because of its low cost and safety, it is recommended in addition to a cholinesterase inhibitor for the treatment of AD. There are no FDA-approved treatments for DLB and VaD. One small placebo-controlled trial demonstrated that rivastigmine may be effective in the treatment of DLB. More large-scale placebo-controlled trials are needed to confirm the results of this study. Treatment of VaD focuses on the control, identification, and management of cerebrovascular disease and vascular risk factors. Although there are no peer-reviewed reports on the efficacy of cholinesterase inhibitors for VaD or mixed AD/VaD, early reports suggest that these agents may also be effective for mixed AD/VaD. The indications for the use of cholinesterase inhibitor drugs are eventually likely to broaden to include DLB, mixed AD/VaD, and AD in its more advanced stages.
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PMID:Pharmacologic treatments of dementia. 1217 Oct 61