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indigestion

  • Dear Readers,

    Welcome to the Spring and the April 2017 issue of TotalHealth Online.

    We begin with an article by Hannah Hunt, Senior Analyst, American Wind Energy Association on, "Wind Power Grows America's Economy And Keeps Our Air Clean." Letting us know the value of the wind industry in employment numbers, its reach across 50 states, and the environmental impact.

    For a short summary we quote from Dallas Clouatre's, PhD, article, "Aging And The Mitochondria,"—"Although the importance of the mitochondria as a central point of health has been accepted for decades, over the last few years the understanding of the mechanisms involved has changed significantly. Twenty or ten years ago, antioxidants and the free radical theory of aging largely dominated thinking. Today, the importance of mitochondrial biology linking basic aspects of aging and the pathogenesis of agerelated diseases remains strong, yet the emphasis has changed. The focus has moved to mitochondrial biogenesis and turnover, energy sensing, apoptosis, senescence, and calcium dynamics."

    Jacob Teitelbaum, MD, states in, "The Food—Mood Connection" that the Standard American Diet is causing widespread nutritional deficiencies, along with an epidemic of anxiety and depression. In addition to a diet including fish, meats, and fruits and vegetables, he shares with readers the key nutrients, "which I take myself each day to turbocharge energy and optimize health, while also leaving me being a calm, happy soul."

    Elson Haas, MD, presents, "Ten Tips For A Healthy Spring." The Five Keys to Staying Healthy—your Nutrition, Exercise, Stress, Sleep and Attitude. He suggests focusing on those five keys—those areas of your life that need improvement. Haas is also an advocate of Detoxification and through his books has addressed this topic.

    Gene Bruno, MS, MHS, RH(AHG), in "Heartburn & Indigestion," addresses the frequently occurring symptoms of diarrhea, heartburn, abdominal cramps and pain, gas distress, and nausea. Included is a list of primary and secondary supplements, which may offer relief if you suffer from the symptoms mentioned above.

    Gloria Gilbère, CDP, DAHom, PhD, shares her recipe for "Green Banana Soup (Repe Lojano)." She explains being located in Ecuador they use plantains but if they are unavailable bananas will do. Gilbère includes all the health benefits of the ingredients and we hope all this information will give you the motivation to try her recipes.

    Charles Bens, PhD, in "The Early Diagnosis And Treatment of Alzheimer's," contributes information on things for Prevention, Detection and a New Treatment. It's engaging.

    In Pet Care, Shawn Messonnier, DVM, contributes Part 4 of the four part series on cancer. This month's article focuses on, "Antioxidants and Conventional Therapies." Pet owners will find this information helpful.

    Best in health,

    TWIP The Wellness Imperative People

    Click here to read the full April issue.

    Click here to read the full April issue.

  • You're going to fall in love with this soup and all it's healthy variations. I love its vibrant orange color and the mild sweet aroma of the anise-flavored liquor. I am not a fan of licorice flavor, but this recipe gained the respect of my taste buds. It's an amazing addition that transforms what can be a bland soup into a gourmet mouth-watering one.

    Again, our recipes are created and tested in our health sciences kitchen in Cotacachi, Ecuador. As more people, here and the U.S., learn how to substitute and create tasty gourmet recipes that DO NOT induce inflammation, they're e-mailing asking for more. Don't let the small amount of alcohol deter you; it's cooked out, leaving a gentle and palate-pleasing aroma and taste that you'll want to experiment using in other recipes—we are.

    I'm sharing options for this same recipe for those of you with special dietary needs other than avoiding nightshades. It's winter, what can be more of a comfort than a nice bowl of soup? Enjoy.

    Ingredients:
    • 2 tsp. anise seeds—finely ground—we use a coffee grinder
    • 3 Tbsp. unsalted butter or ghee
    • 1 large yellow onion, chopped
    • 2 pounds carrots, peeled and cut into pieces
    • 6 cups vegetable stock, chicken stock, or water
    • Kosher salt and freshly ground black pepper
    • 1 cup heavy whipping cream
    • 6 Tbsp. anise-flavored liqueur, such as sambuca, ouzo, or Pernod, reserve 2 Tbsp.
    • 1/4 cup crème fraiche
    • 2 tablespoons chopped chives
    Directions:
    • Toast anise seeds in a small frying pan over medium heat until fragrant, about 2 minutes. Transfer to a spice or coffee grinder and finely grind.
    • In a soup pot, melt butter over medium heat. Add onion and anise seeds and cook, stirring occasionally, until onion is soft, 7 to 10 minutes.
    • Add carrots and cook, stirring occasionally, 10 minutes. Pour in stock, bring to a simmer, and cook until carrots are tender, about 15 minutes. Remove from heat.
    • In batches, purée soup in the pan with a hand-held blender or transfer to a freestanding blender until very smooth.
    • Check for salt and pepper and adjust to your taste.
    • Place over medium heat, stir in cream, and heat until hot.
    • Stir in 6 Tbsp. liqueur.
    • In a bowl, stir together crème fraiche and remaining 2 Tbsp. liqueur.
    • Ladle soup into warmed bowls. Drizzle with crème fraiche and sprinkle with chives.
    Dr. G's Notes
    Gluten-Free option is to use gluten-free stock.

    Substitute coconut cream and coconut milk for dairy.

    Butter can be replaced with coconut oil.

    Sprinkle before serving with grated cheese of your choice; we liked Parmesan.

    Top with croutons if not avoiding gluten.

    For a white soup, substitute parsnips or combine with carrots.

    Health Benefits

    Health Benefits of Anise
    • Anise, an exotic spice, holds some of the important plant-derived chemical compounds known to have antioxidant, disease preventing, and health promoting properties.
    • The primary essential volatile oil that gives the characteristic sweet, aromatic flavor to anise seed is anethole. Other important compounds found in these grains include estragol, p-anisaldehyde, anise alcohol, acetophenone, pinene, and limonene.
    • Anise seed oil obtained from extraction of the seeds has found application in many traditional medicines as a general digestive aid, antiseptic, anti-spasmodic, carminative, expectorant, stimulant and tonic agent.
    • The seeds are an excellent source of many essential B-complex vitamins such as pyridoxine, niacin, riboflavin, and thiamin. Pyridoxine (vitamin B-6) helps increase GABA neurochemical levels in the brain.
    • The spicy seeds are one of the important source of minerals like calcium, iron, copper, potassium, manganese, zinc and magnesium. 100 g dry seeds contain 36.96 mg or 462 percent daily required levels of iron. Potassium is an important component of cell and body fluids that helps control heart rate and blood pressure.
    • Copper is a cofactor for many vital enzymes, including cytochrome C-oxidase and superoxide dismutase (other minerals that function as cofactors for this enzyme are manganese and zinc). Copper is also required for the production of red blood cells.
    • The spice also contains good amounts of antioxidant vitamins such as vitamin-C and vitamin-A.

    Medicinal Uses
    Anise seed, as well as its oil, found application in many traditional medicines for their unique health-promoting and disease-preventing roles, examples follow:

    • Anise preparations are an excellent remedy for asthma, cough associated with bronchitis, as well as digestive disorders such as flatulence, bloating, colicky stomach pain, nausea, and indigestion.
    • The essential oil "anethole" (anise seeds comprise 75.90 percent) has been found to have an estrogenic effect. The decoction obtained from the seeds is often prescribed to nursing mothers to help promote breast-milk production.
    • Anise seed water is very helpful in relieving running nose condition in infants.
    • Its seeds are traditionally chewed after the meal in India and Pakistan to refresh post-meal mouth breath and assist digestion.

    Disclaimer:The information references in this article are intended solely for general information for the reader. The contents of this article, or its author, are not intended to offer personal medical advice, diagnose health problems or for treatment purposes. It is not a substitute for medical care provided by a licensed and qualified health professional. Please consult your health care provider for any advice on medications.

  • You really shouldn’t…but that piece of cheesecake looks so good, and it’s been so long since you last had a slice — so you go for it. But shortly thereafter, you feel the rumbling of stomach and intestinal discontent, and — groan — you wish you had resisted.

    A cast-iron stomach no more
    When you were younger it seemed like you had a castiron stomach and could eat almost anything without having to pay the piper — but that’s not the case anymore, right? Now, indigestion, including heartburn, bloating and gas, seem to be the mainstay. And it’s especially true if you consume dairy products, grainbased foods (bread, pasta, etc.) containing gluten, or beans and greens (especially cruciferous vegetables like broccoli, cabbage and cauliflower). Look, it’s really not your fault. It’s due to your aging pancreas.

    The old pancreas ain’t what it used to be The pancreas is the gland that secretes most of the enzymes you need to digest your food effectively. However, as you age, your pancreas begins to shrink.1 Not surprisingly, clinical research has shown that the effectiveness of the pancreas also reduces with age.2 The fact is, digestive enzyme secretion decreases in concentration as well as in output starting around age 303 — although it’s really after 40 that these changes become more noticeable. In one study, middle-aged subjects (40–70 years) had 30 percent less frequent secretion of digestive enzymes than subjects less than 40 years old, and elderly subjects (over 70) had 108 percent less frequent secretion of digestive enzymes than subjects less than 40 years old! Oh well, there’s nothing you can do about it. You just have to accept indigestion, right? Wrong. In fact, there’s a great deal you can do about it.

    If your vision isn’t what it used to be, do you just accept it? Of course not — you get glasses or contacts and you see better again! Why wouldn’t you do the same thing with your enzymes? If you don’t make as much digestive enzymes as you used to, with indigestion being the result, don’t accept it as inevitable. You can compensate, with outstanding results!

    Digestive enzymes
    Supplementation with the right type of digestive enzymes can help you digest virtually any foods you eat, including those with dairy products and gluten. Ideally, you can use enzymes that act in two locations in your gastrointestinal tract: 1) your stomach, and 2) your small intestine. The result will likely be more optimum digestion with a happy stomach and gut.

    Digestion in your stomach While most digestive enzymes work in the more alkaline environment of your intestines, pepsin is different. Pepsin is the digestive enzyme produced in the stomach and released there to work alongside hydrochloric acid to begin the process of digesting complex proteins in smaller protein chains. Without sufficient pepsin to perform this role, further digestion by pancreatic protein enzymes will be far less effective. However, as with pancreatic enzymes, pepsin secretion also decreases with age. In fact, people 65 and older were shown in research to have a 40 percent reduction in pepsin secretion. Consequently, supplementation with pepsin will help assure that this vital first step in protein digestion is optimized.

    Digestion in your small intestine
    The inadequate production of digestive enzymes from the pancreas can be addressed by supplementing with proteases (protein-digesting enzymes), amylases (starch-digesting enzymes) and lipases (fat-digesting enzymes). One popular source of such enzymes is pancreatin, an extract from the pancreas of cows or pigs. However, another effective sources are microbial enzymes, which have activities similar to pancreatin. Microbial enzymes have been the subject of various studies evaluating their effects on lactose intolerance, impaired pancreatic enzyme production, excess fat in the feces, celiac disorder and a variety of other digestive issues, with positive results.4,5,6,7,8,9

    One of the most valuable attributes of microbial enzymes is that they appear to possess unusually high stability and activity throughout a wide range of pH conditions (from a pH of 2–10).10 This enables them to be more consistently active and functional for a longer distance as they are transported through the digestive tract. Also, since microbial enzymes are not derived from animal sources, they are perfectly appropriate for use by vegetarians — and research shows that are virtually non-toxic.11,12,13 Supplementation with a broad range of microbial proteases, amylases and lipases will safely and effectively assist in the digestion of protein, carbohydrates and fats from many food sources, including foods that contain dairy products, gluten, beans and greens.

    Gluten sensitivity
    Gluten (from Latin gluten, “glue”) is a mixture of proteins found in wheat, barley and rye.14 For many, gluten can be difficult to digest; with the result being gastrointestinal upset (abdominal pain and tenderness, irregular bowel habits: constipation or diarrhea or alternating bowel movements) as well as nongastrointestinal issues.15 The good news is that there is a combination of gluten digesting enzymes called Glutalytic, which has been tested in a double-blind, placebo-controlled study16 (the “gold standard” in research). The results showed a statistically significant improvement when compared to the placebo group in the following categories: pain, bloating, emptying of bowels, hunger pains, rumbling of stomach, lower energy levels, headaches, and food cravings.

    Dairy sensitivity
    Dairy sensitivity can be due to lactose intolerance, the inability to digest the milk sugar lactose, and/or difficulty in digesting milk proteins. The result may include gas, cramps, diarrhea or constipation.

    Lactose intolerance is the result of the body discontinuing the production of the digestive enzyme lactase, which digests lactose. Since only one-third of all people retain the ability to digest lactose into adulthood, lactose intolerance is prevalent.17 Research has shown that supplementing with the lactase enzyme can reduce pain, bloating and total symptoms associated with lactose intolerance.18,19,20

    The digestion of some milk proteins can take time. In fact, some research shows that a milk protein may remain in the stomach up to six hours before it is released into the intestines for further digestion.21 Difficulty in digesting milk proteins can result in constipation for some individuals.22 Luckily, supplementation with protease enzymes can help effectively digest milk proteins, thereby avoiding the effects of inadequate milk protein digestion.

    Alpha-galactosidase
    Bloating and gas are not fun to experience. Nevertheless, this experience is not unusual after eating beans and cruciferous vegetables (e.g. broccoli, cabbage and cauliflower). The reason is that these healthy foods contain goodly amounts of fiber, which can ferment in our gut. However, if these fibers can be broken down effectively, you’re less likely to experience bloating and gas. That’s where the enzyme alpha-galactosidase comes into play. In a double-blind, placebo-controlled study23 on intestinal gas production and gas-related symptoms, the microbial enzyme alpha-galactosidase was given to healthy volunteers after a meal containing about 15 ounces of cooked beans. The result was that there was a reduction in gas formation, severity of bloating, abdominal pain, discomfort, flatulence, and diarrhea. Beneficial results were also seen in a similar study.24

    Conclusion
    Indigestion, including heartburn, bloating and gas, are not fun. Avoiding foods that contain dairy and gluten, or even beans and cabbage, is likewise not fun. It may be possible to make your digestion more like it was when you were younger, with the use of a broad range of digestive enzymes.

    Endnotes:
    1. Chantarojanasiri T, Hirooka Y, Ratanachu-Ek T, Kawashima H, Ohno E, Goto H. Evolution of pancreas in aging: degenerative variation or early changes of disease? J Med Ultrason (2001). 2015 Apr;42(2):177–83.
    2. Herzig K-H, Purhonen A-K, Räsänen KM, Idziak J, Juvonen P, Phillps R, Walkowiak J. Fecal pancreatic elastase-1 levels in older individuals without known gastrointestinal diseases or diabetes mellitus. BMC Geriatrics. 2011;11:4.
    3. Laugier R, Bernard JP, Berthezene P, Dupuy P. Changes in pancreatic exocrine secretion with age: pancreatic exocrine secretion does decrease in the elderly. Digestion. 1991;50(3-4):202–11.
    4. Alternative Medicine, the Definitive Guide. Future Medicine Publishing: Puyallup, WA. 1993;215–22.
    5. Griffin SM, et al. Acid resistant lipase as replacement therapy in chronic pancreatic exocrine insufficiency: a study in dogs. Gut 1989;30:1012–15.
    6. Schneider MU, et al. Pancreatic enzyme replacement therapy: comparative effects of conventional and enteric-coated microspheric pancreatin and acid-stable fungal enzyme preparations on steatorrhea in chronic pancreatitis. Hepato-gastroenterol 1985;32:97–102.
    7. Rosado JL, et al. Enzyme replacement therapy for primary adult lactase deficiency. Gastoenterol 1984;87:1072–82.
    8. Barillas C, Solomons NW. Effective reduction of lactose maldigestion in preschool by direct addition of beta-galactosidases to milk at mealtime. Pediatrics 1987;79(5):766–72.
    9. Phelan JJ, et al. Celiac disease: the abolition of gliadin toxicity by enzymes from Aspergillus niger. Clin Sci & Mol Med 1977;53:35–43.
    10. Griffin SM, et al. Acid resistant lipase as replacement therapy in chronic pancreatic exocrine insufficiency: a study in dogs. Gut 1989;30:1012–15.
    11. Garvin, P.J. & Merubia, J. Unpublished report. Submitted to WHO by Baxter Laboratories, Inc; 1959.
    12. Garvin, P.J., Willard, R., Merubia, J., Huszar, B., Chin, E., & Gilbert, C. Unpublished report. Submitted to WHO by Baxter Laboratories, Inc; 1966.
    13. Garvin, P.J., Ganote, C.E., Merubia, J., Delahany, E., Bowers, S., Varnado, A., Jordan, L., Harley, G., DeSmet, C., & Porth, J. Unpublished report from Travenol Laboratories, Inc., Morton Grove, IL, USA. Submitted to WHO by Gist-brocades NV, Delft, Holland; 1972.
    14. Lamacchia C, Camarca A, Picascia S, Di Luccia A, Gianfrani C. Cereal-based gluten-free food: how to reconcile nutritional and technological properties of wheat proteins with safety for celiac disease patients. Nutrients. 2014 Jan 29;6(2):575–90.
    15. Mansueto P, Seidita A, D’Alcamo A, Carroccio A. Non-celiac gluten sensitivity: literature review. J Am Coll Nutr. 2014;33(1):39–54.
    16. Hudson M, King C. Glutalytic Clinical Trial for Normal Consumption of Gluten Containing Foods. Department of Biology, Kennesaw State University, Kennesaw Georgia. 2015: 4 pgs.
    17. Gudmand-Hoyer E. The clinical significance of disaccharide maldigestion. Am J Clin Nutr 1994; 59(3):735S–41S.
    18. Ramirez FC, Lee K, Graham DY. All lactase preparations are not the same: results of a prospective, randomized, placebo-controlled trial. Am J Gastroenterol 1994;89:566–70.
    19. Sanders SW, Tolman KG, Reitberg DP. Effect of a single dose of lactase on symptoms and expired hydrogen after lactose challenge in lactoseintolerant subjects. Clin Pharm 1992;11:533–8.
    20. Lin MY, Dipalma JA, Martini MC, et al. Comparative effects of exogenous lactase (beta-galactosidase) preparations on in vivo lactose digestion. Dig Dis Sci 1993;38:2022–7.
    21. Ross RP, Fitzgerald GF, Stanton C. Unraveling the digestion of milk protein. Am J Clin Nutr. 2013 Jun;97(6):1161–2.
    22. Daher S, Tahan S, Solé D, Naspitz CK, Da Silva Patrício FR, Neto UF, De Morais MB. Cow’s milk protein intolerance and chronic constipation in children. Pediatr Allergy Immunol. 2001 Dec;12(6):339–42.
    23. Di Stefano M, Miceli E, Gotti S, Missanelli A, Mazzocchi S, Corazza GR.The effect of oral alpha-galactosidase on intestinal gas production and gas-related symptoms. Dig Dis Sci 2007;52(1):78–83.
    24. Patil AG, Kote NV, Mulimani V. Enzymatic removal of flatulence-inducing sugars in chickpea milk using free and polyvinyl alcohol immobilized alpha-galactosidase from Aspergillus oryzae. J Ind Microbiol Biotechnol
    2009;36(1):29–33.
  • "Many clinicians have discovered that in the overwhelming majority of individuals with heartburn, indigestion, etc., it is underproduction of stomach acid (hydrochloric acid) that is the problem, not overproduction."

    Indigestion, or dyspepsia, commonly refers to general abdominal discomfort during and after meals and may be the result of specific diseases of the stomach or the intestines. The most frequently occurring symptoms are diarrhea, heartburn, abdominal cramps and pain, gas distress, and nausea. Heartburn is a mild to severe burning pain in the upper abdomen or beneath the breastbone. It usually results from spasms of the esophagus or the regurgitation into the esophagus of the stomach contents, the gastric acid levels of which cause irritation. Heartburn typically occurs after meals, often after those containing fatty foods, or when a person is lying down. The following natural substances may be helpful in the treatment of heartburn and indigestion.

    Heartburn and indigestion treatments

    Dietary Supplements: Primary Recommendations

    Betaine Hydrochloride and Pepsin
    If our stomachs are normal, they digest food with very strong hydrochloric acid and pepsin, an enzyme active only in an acid environment. Without normal, adequate acid and pepsin production by our stomachs, we don't get all the nourishment we should from food. Many clinicians have discovered that in the overwhelming majority of individuals with heartburn, indigestion, etc., it is underproduction of stomach acid (hydrochloric acid) that is the problem, not overproduction. Consequently, the use of betaine hydrochloride, a safe supplemental form of hydrochloric acid, may be a good choice for many heartburn/ indigestion sufferers.

    Multi-Digestive Enzyme
    Both human and animal research has demonstrated that certain digestive enzymes produced by the pancreas reduces with age.1,2 In addition, pancreatic insufficiency may occur for other reasons, including pancreatic and non-pancreatic diseases— both of which may cause an impaired production of pancreatic digestive enzymes, resulting in poor digestion and malnutrition. The use of a pancreatic enzyme supplement containing has been successful in improving digestion in these situations.

    Licorice
    Licorice root is a botanical with an extensive history of medicinal use. Research shows that it protects the mucous membranes lining the digestive tract by increasing production of mucin, a substance that protects against stomach acid and other harmful substances.3

    Peppermint, Fennel, Caraway, and Wormwood
    Certain herbs are classified as carminatives—substances that relieve gas and gripping (severe pain in the bowel). Some carminatives herbs, including Peppermint, Fennel, Caraway, and Wormwood, have had good research conducted on them. For example, double-blind studies have shown that combinations of Peppermint and Caraway oil, as well as a combination of Peppermint, Fennel, Caraway, and Wormwood could help people with indigestion.4,5 It is believed that carminative agents work, at least in part, by relieving spasms in the intestinal tract.6

    Artichoke
    Besides being and healthy and delicious food (especially with a little bit of warm dipping butter—yum!), Artichoke is also a plant with medicinal qualities. In double-blind studies, extracts of Artichoke have been repeatedly shown to be beneficial for people with indigestion.7 Artichoke is particularly useful when the problem is lack of bile production by the liver.8 If you're going to try Artichoke for this purpose, it is recommended that you look for an extract providing 500–1,000 mg per day of cynarin, the main active constituent of Artichoke.

    Turmeric
    Turmeric is a bright yellow herb used in preparing some very tasty culinary dishes. Medicinally, turmeric has also been demonstrated in double-blind research to relieve indigestion problems in subjects in Thailand.9

    Dietary Supplements: Secondary Recommendations

    Lactase
    Lactose intolerance can cause many digestive problems, including gas, cramps, and diarrhea. Although lactose intolerant individuals would do best to avoid dairy products, if there are occasions when they do plan to consume some, then they should use a supplement containing the lactase enzyme. Research has shown that lactase preparations can reduce pain, bloating and total symptoms associated with lactose intolerance.10 However, one study demonstrated that various lactase products differ in their effectiveness,11 so you may need to try a two or three before you find the one that works best for you.

    Chamomile
    Traditionally, the herb Chamomile can be effective at relieving irritated or inflamed mucous membranes within digestive tract. Furthermore, since heartburn sometimes involves reflux of stomach acid into the esophagus, the anti-inflammatory properties of chamomile can also be useful in this regard.12 In addition, chamomile has been recognized for its ability to promote normal digestion.13

    Ginger
    Ginger is also a traditional carminative herb.14 Animal research has shown that ginger is capable of enhancing the activity of fat and carbohydrate digestive enzymes.15

    Aloe Vera
    Aloe Vera can be helpful for people with indigestion. In fact, Aloe Vera is one of the natural substances employed in inflammatory bowel disease therapy that has shown promise.16 Of course Aloe Vera is one of the oldest known medicinal herbs. The mucilaginous gel, the source of "Aloe Vera Juice" and "Aloe Vera Gel," is used internally as a healer and tonic, and applied externally as a burn and wound remedy.

    Diet and/or other considerations
    In a very small minority of individuals with heartburn and indigestion, stomach testing is normal or shows over acidity. In these few people, both diet changes and supplemental items can help. Elimination of caffeine, refined sugar, alcohol and cigarette smoking are all recommended, even though sometimes hard to do. For a very few, identification and elimination of food allergies or sensitivities reduces heartburn and indigestion. There are other problems that may cause or be associated with heartburn, bloating and belching after meals, and indigestion. These can include peptic ulcer, malfunction of the sphincter muscle at the end of the esophagus and other much more rare problems. If you have these symptoms, it's best to work with a doctor to establish what the cause might be before accepting the popular but usually-mistaken belief that indigestion, bloating and heartburn are all just due to "too much stomach acid."

    References:

    1. Laugier R, et al, Digestion (1991) 50(3 4):202 11.
    2. Wang CS, Floyd RA, Kloer HU, Pancreas (1986) 1(5):438 42.
    3. Goso Y, et al, Biochem Physiol (1996) 113C:17–21.
    4. May B, et al, Arzneim Forsch (1996) 46:1149–53.
    5. Westphal J, Hörning M, Leonhardt K, Phytomedicine (1996) 2:285–91.
    6. Forster HB, Niklas H, Lutz S, Planta Med(1980) 40:303–19.
    7. Kraft K., Phytomedicine(1997) 4:370–78 [review].
    8. Kirchhoff R, et al, Phytomedicine(1994) 1:107 15.
    9. Thamlikitkul V, et al, J Med Assoc Thai (1989) 72:613–20.
    10. Lin MY, et al, Dig Dis Sci (1993) 38(11):2022 7.
    11. Ramirez FC, Lee K, Graham DY, Am J Gastroenterol(1994) 89(4):566 70.
    12. Matricaria flos. ESCOP monograph, Oct 1990.
    13. Mills SY. Out of the Earth: The Essential Book of Herbal Medicine.(1991) London: Viking Press, pp. 448–51.
    14. Blumenthal M, et al, (eds), The Complete German Commission E Monographs: Therapeutic Guide to Herbal Medicines. (1998) Austin: American Botanical Council and Boston: Integrative Medicine Communications, 425–26.
    15. Platel K, Srinivasan K, Int J Food Sci Nutr (1996) 47(1):55 9.
    16. Robinson M, Eur J Surg Suppl (1998) (582):90 8