Hospice, Cancer Pain Management, and Symptom Control
Mark V. Boswell, B. Eliot Cole in Weiner's Pain Management, 2005
Starting with the NSAIDs makes good sense for most pain problems, as these medications work to relieve pain in the periphery, where the nociceptive experience originates (Kanner, 1987). NSAIDs interfere with the manufacture of local pain-sensitizing and inflammation-mediating components (prostaglandins) and thereby limit pain transmission from the periphery to the central nervous system (CNS) and eventual consciousness (Insel, 1996). While aspirin irreversibly interferes with platelet aggregation, most of the other NSAIDs decrease platelet aggregation only while therapeutic levels are maintained (APS, 1989). Notable exceptions are the selective COX-2 inhibitors, nabumetone, and choline magnesium trisalicylate. Choline magnesium trisalicylate is a nonacetylated aspirin derivative that does not appear to affect the aggregation of platelets (APS, 1989; Kanner, 1987). Choline magnesium trisalicylate is a generic medication that can be used orally, as tablets or as a liquid suspension, with the same or milder side-effect profile as aspirin and the ability to follow salicylate levels if desired.
Emerging ergogenic aids for strength/power development
Jay R Hoffman in Dietary Supplementation in Sport and Exercise, 2019
Phosphatidylcholine (PC) is a phospholipid with choline as its head group located in the external leaflet of the cell membrane (Figure 14.6). It is the most abundant phospholipid (~50% of total phospholipid pool) and a major component of cell membranes, assists enzymes in carrying out functions, secretion of plasma lipoproteins and membrane-mediated cell signalling. Skeletal muscle PC is higher in endurance-trained athletes (45), showing a chronic benefit to aerobic training. It is the phospholipid in highest concentrations in lecithin and is the principal phospholipid in circulation. PC may be synthesized in two major ways: 1) the main pathway from choline in a series of reactions involving the enzymes choline kinase and cytidine diphosphate-choline (CDP-choline):1,2-diacylglycerol cholinephosphotransferase; and 2) from methylation of PE via the enzyme PE N-methyltransferase (mostly in the liver). PC supplementation is beneficial for increasing plasma choline concentrations or maintaining it during exercise (33). Choline is a precursor to acetylcholine, a major neurotransmitter in the nervous system. PC supplementation may assist in supporting healthy cholesterol levels, liver and brain function (33). Sources of dietary PC include eggs, chicken breast, salmon, soybeans and other meats (14). Acute exercise has been shown to not affect skeletal muscle PC; however, two hours into recovery muscle PC is acutely reduced in endurance athletes (45).
Chicken Eggs and Human Health
Robert E.C. Wildman, Richard S. Bruno in Handbook of Nutraceuticals and Functional Foods, 2019
Choline is an essential nutrient65 that serves two major purposes, including acting as a source of methyl groups for various components of metabolism and to serve as substrate for the synthesis of two phospholipids that are essential for cell membranes, phosphatidylcholine and sphingomyelin.65 In 2016, for the first time, in FDA's final rule for the revision of nutrition and supplement facts panels (81 FR 33741), FDA published a reference daily intake for choline of 550 mg.66 Almost 90% of individuals 2 years or older fail to consume adequate choline on a daily basis.67 A single yolk from a large egg contains 126 mg choline,11 which is approximately 23% of the daily value (DV). Choline is readily available as a dietary supplement.
Choline: The Neurocognitive Essential Nutrient of Interest to Obstetricians and Gynecologists
Published in Journal of Dietary Supplements, 2020
Taylor C. Wallace, Jan Krzysztof Blusztajn, Marie A. Caudill, Kevin C. Klatt, Steven H. Zeisel
High intakes of choline are associated with a fishy body odor, vomiting, excessive sweating and salivation, hypotension, and liver toxicity. The NAM defined a UL for adults based on a study in seven patients with Alzheimer’s disease, where oral administration of 7.5 g/d of choline resulted in a hypotensive effect accompanied by nausea and diarrhea (Boyd et al. 1977). Similar gastrointestinal effects and a fishy body odor were observed among participants in studies administering 8–20 g/d (Growdon et al. 1977; Gelenberg et al. 1979; Lawrence et al. 1980). The NAM considered 7.5 g/d of choline as the lowest observed adverse effect level; after application of an uncertainty factor of 2 and rounding, the NAM set a UL of 3.5 g/d for adults. The NAM FNB was unable to establish ULs for infants due to the lack of data on adverse effects in this age group, and the ULs for children were derived from the adult value by allometric scaling (exponent 0.75) according to reference body weights (Institute of Medicine 1998) (Table 1). The European Food Safety Authority Nutrition Dietetics and Allergies Panel (2016) did not define a UL for choline in 2016.
Intake of eggs, choline, lutein, zeaxanthin, and DHA during pregnancy and their relationship to fetal neurodevelopment
Published in Nutritional Neuroscience, 2023
Danielle N. Christifano, Lynn Chollet-Hinton, Dirk Hoyer, Alexander Schmidt, Kathleen M. Gustafson
Experts agree choline is essential for proper fetal and infant development; however, nearly all pregnant women in the United States fall short of the Adequate Intake (450 mg/day), with only ∼10% of Americans meeting recommendations.1 Eggs are one of the richest sources of choline in the human diet, providing 115 mg of choline per one yolk, yet most women get their choline primarily from milk which contains fewer mg of choline per serving.2 Furthermore, eggs contain a variety of nutrients in addition to choline, including lutein, zeaxanthin, and docosahexaenoic acid (DHA), which have been implicated in infant memory and cognition.3 While each of these nutrients have been studied in isolation in terms of infant outcomes, together they have the potential to act synergistically to promote healthy brain development early in life.
Cholinergic Medication for Antipsychotic‐Induced Tardive Dyskinesia
Published in Issues in Mental Health Nursing, 2019
Janice Christie
The authors of this systematic review sought evidence from Randomised Controlled Trials (RCTs) which recruited people with a serious mental health disorder who had been prescribed an antipsychotic for more than three months, had been taking the same drug treatment for at least one month, and developed tardive dyskinesia when using these pharmacological therapies. To be included, such trials needed to compare the use of a cholinergic drug (7-methoxytacrine, Arecoline, Cevimeline, Choline, Deanol, Donepezil, Eptastigmine, Galantamine, Ipidacrine, Lecithin Metrifonate, Meclofenoxate, Physostigmine, Rivastigmine, RS 86, Tacrine or Xanomeline) with either a placebo or any other intervention. Short, medium and long-term primary outcomes were extracted for improvement to a clinically important extent (50% or more improvement on any tardive dyskinesia measurement scale) and adverse extrapyramidal effects. A range of secondary outcomes were also reviewed: any change in tardive dyskinesia, global health or mental health wellbeing, acceptability of the treatment, other adverse effects, health service use, economic impact, social wellbeing indicators, behaviour or cognitive change. All studies were assessed for risk of bias and GRADE was used to summarise the quality of the evidence for the most important outcomes.
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