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Am Fam Physician. 2000;62(5):1176

Is Caffeine Safe During Pregnancy?

(Canada—Canadian Family Physician, April 2000, p. 801.) Although caffeine clearance from the body is usually normal during the first trimester of pregnancy, it is significantly delayed later in pregnancy, extending the half-life of caffeine to more than 10 hours from a normal of 2.5 to 4.5 hours. Caffeine easily crosses the placenta and may accumulate in the fetus because of low fetal levels of the enzymes that metabolize caffeine. High levels of caffeine could harm the developing fetus through multiple actions at the cellular level. While epidemiologic studies suggest a small increased risk of miscarriage and retarded fetal growth, the research is complicated by difficulty in measuring caffeine intake and the action of confounding factors, especially cigarette smoking. A meta-analysis of research studies concludes that there is a small but significant increased risk of miscarriage and low birth weight associated with a very high intake of caffeine. The effect appears to occur at levels greater than 150 mg per day, which is the equivalent of more than six cups of coffee.

Social Phobia

(Australia—Australian Family Physician, April 2000, p. 337.) Approximately 3 percent of adults in Australia meet the diagnostic criteria for social phobia. In this condition, anxiety in social situations is so intense that patients develop physical symptoms and/or avoid interacting with others. Social phobia usually begins in adolescence and is dominated by the fear of saying or doing “something stupid,” or appearing incompetent or unattractive to others. Cognitive therapy can help up to 75 percent of persons with social phobia. This type of therapy provides insight and teaches breathing control, muscle relaxation and graded exposure to challenging situations. The therapy also teaches patients to use positive thought patterns rather than irrational negative patterns. In the past, benzodiazepines and beta blockers have been used to relieve symptoms of social phobia; currently, selective serotonin reuptake inhibitors are the drugs of choice if medication is indicated.

Practical Dietary Advice for Lowering Cholesterol

(Australia—Australian Family Physician, March 2000, p. 215.) An elevated cholesterol level is the leading modifiable risk factor for the development of coronary artery disease (CAD). Lowering serum cholesterol levels by more than 10 percent triples the rate of regression of atherosclerosis. Although dietary changes can have a profound impact on cholesterol levels, many patients find low-fat diets to be too restrictive or difficult to follow. The Mediterranean diet appears to successfully lower serum cholesterol levels and is more acceptable to patients. In one randomized study, the CAD mortality rate dropped by 76 percent and the incidence of minor coronary events fell by 30 percent in the subjects following the Mediterranean diet, compared with those on a low-fat diet. At baseline, there was little difference in serum cholesterol levels between the two groups. Researchers speculate that Mediterranean diets may have beneficial cardiac effects apart from their effect on serum lipid levels. Rather than insisting that patients follow strict diets, some researchers advocate the following “10 dietary commandments”: eat multigrain bread every day, eat fruit every day, do not use cream or butter, eat more fish and less meat, use olive oil every day, consume a variety of vegetables daily, have a handful of nuts every day, use more garlic and fresh herbs, drink one glass of wine per day and eat in a pleasant, relaxed atmosphere.

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