Oxytocin: What Is It? What Does It Do?

e in the brain, in the hypothalamus, and it is transported to, and secreted by, the pituitary gland, which is located at the base of the brain.¹

Chemically it is known as a nonapeptide (a peptide containing nine amino acids), and biologically, as a neuropeptide. It acts both as a hormone and as a brain neurotransmitter.

The release of oxytocin by the pituitary gland acts to regulate two female reproductive functions:^1,2

• Childbirth
• Breast-feeding.

The release of the hormone during labor makes the muscles of the uterus, womb, contract - in other words, it increases uterine motility. The release of oxytocin is triggered by the widening of the cervix and vagina during labor, and this effect is in turn increased by the subsequent contractions.³

The main role of oxytocin is summed up nicely in a research paper by obstetric and gynecology specialists Navneet Magon and Sanjay Kalra:²

"It is released in large amounts during labor, and after stimulation of the nipples. It is a facilitator for childbirth and breast-feeding."

Stimulation of the nipples results in oxytocin release and milk let-down.

Other researchers sum up the reproductive importance of oxytocin by saying it "serves the continued propagation of a species," adding that through evolution its "repertoire has expanded to maintain a central role in more complicated aspects of reproductive behavior. For these reasons, we call oxytocin the great facilitator of life."¹

Oxytocin, used as a prescription drug, is also known by the brand name Pitocin (and Syntocinon, although this is no longer on the market).⁴

Doctors prescribe oxytocin to start birth contractions or strengthen them during labor. It is also used to reduce bleeding after child delivery.^4,5 The drug also has a role in the medical termination of pregnancy or during miscarriage.⁵

Oxytocin's effects on emotion

Oxytocin is released into the bloodstream to produce its classic effects on the uterus and breast milk, but it is also released into defined regions of the brain that are involved in emotional, cognitive, and social behaviors.⁶

One review of the evidence says oxytocin "has attracted intense attention" after the discovery of its "amazing variety of behavioral functions."⁶

The review, by Inga Neumann, says oxytocin has an impact on "pro-social behaviors" and emotional responses that contribute to:⁶

• Relaxation
• Trust
• Psychological stability.

However, another review notes that the hormone does not act alone in the chemistry of love, but is "just one important component of a complex neurochemical system that allows the body to adapt to highly emotive situations."⁷

Oxytocin has been the focus of research into the biology of love.

Another review has also sounded caution, calling for research to look more to the general effects than to the specific effects of oxytocin that are being interpreted.

"After all, it is rather unlikely that any widely acting hormone or neurotransmitter will be narrowly funneled to modulate complex, high-order mental processes that are specific to social cognition," say the authors of a 2013 paper.⁸

Scientific research has nonetheless uncovered brain oxytocin's specific ability to modulate social behavior, including effects on motherly care and aggression, bonding between couples, sexual behavior, social memory, and trust.⁶

Brain oxytocin also reduces stress responses, including anxiety - and these anxiolytic effects have been demonstrated in a number of species.^6,8

One of the so-called 'love hormone' studies was published in 2012, and it examined oxytocin levels in new lovers versus those in single people. It found that there were high levels of the hormone in the first stages of romantic attachment, and these were sustained for six months.⁹

Oxytocin released during sex

In both men and women, sexual intercourse stimulates the release of oxytocin, which has a role in erection and orgasm. The reason for this is not fully understood, although in women, it has been proposed that the increased uterine motility may help sperm to reach their destination.³

Some researchers believe oxytocin may play a part in the experience of sexual orgasm, proposing a correlation between the concentration of oxytocin and the intensity of orgasm.¹⁰

Behavioral effects of oxytocin

As shown in the recent developments listed here, scientists are still busy testing the behavioral effects of oxytocin and its role in human emotions.

Recent developments about oxytocin's effects on emotion

Oxytocin: the monogamy hormone? This study, published in the journal PNAS in November 2013, examined brain scans of men who had received oxytocin or placebo via a nasal spray. The oxytocin was associated with activation of the men's reward centres in their brains, and with greater feelings of attraction to their partners versus other women in photographs. This followed a very similar study in The Journal of Neuroscience in November 2012: A hormone can help keep men faithful.

High oxytocin levels "trigger oversensitivity to emotions of others." Released in January 2014, this study in Emotionfound that people receiving oxytocin nasal spray saw facial expression of emotions in others more intensely.

Oxytocin makes you feel more extroverted. This 2011 research paper in Psychopharmacology gave results from intranasal oxytocin improving self-perception in social situations, amplifying personality traits such as warmth, trust, altruism and openness.

The hormone that allows us to love may also encourage us to lie. This 2014 study found participants given oxytocin were more likely to lie for the benefit of the group.

Oxytocin as potential psychiatric therapy

The research to uncover oxytocin's "anxiolytic and pro-social influences, beneficial to relief, reproduction, and love" is what has led scientists to describe it as a one of the "most promising neuromodulator/neurotransmitter systems of the brain for psychotherapeutic intervention and treatment of numerous psychiatric illnesses, for example social phobia, autism, andpostpartum depression."⁶

In another research paper, from 2011, the conclusion reads:¹¹

"Oxytocin is of potential use in enhancing interpersonal and individual wellbeing, and might have more applications in neuropsychiatric disorders, especially those characterized by persistent fear, repetitive behavior, reduced trust and avoidance of social interactions."

Recent development on oxytocin as potential therapy

Oxytocin activates "social" brain regions in children with autism. A research study involving 17 children with autism spectrum disorders, published in December 2013, used functional magnetic resonance imaging (fMRI) to see differences created by oxytocin in brain responses to social and non-social pictures. Albeit in a small study, the researchers found "oxytocin temporarily normalized brain regions responsible for the social deficits seen in children with autism."

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Prostate Cancer: Causes, Symptoms and Treatments

Prostate cancer is a disease which only affects men. Cancer begins to grow in the prostate - a gland in the male reproductive system.

The word "prostate" comes from Medieval Latin prostate and Medieval French prostate. The ancient Greek word prostates means "one standing in front", from proistanai meaning "set before". The prostate is so called because of its position - it is at the base of the bladder.

Contents of this article:

1. What is the prostate?
2. Prostate cancer
3. Classification of prostate cancer
4. Signs and symptoms of prostate cancer
5. Causes of prostate cancer
6. Prostate cancer treatments
7. Possible complications

Fast facts on prostate cancer

Here are some key points about prostate cancer. More detail and supporting information is in the main article.

• After non-melanoma skin cancer, prostate cancer is the most common cancer among men in the US.
• Prostate cancer is one of the leading causes of cancer death among men of all races and Hispanic origin populations.
• In the US around 209,292 men are diagnosed with prostate cancer per year.
• Around 27,970 men die from prostate cancer in the US each year.
• According to the American Cancer Society about 1 man in 7 will be diagnosed with prostate cancer during his lifetime.
• Prostate cancer mainly occurs in older men - about 6 cases in 10 are diagnosed in men 65 years or older.
• Almost all prostate cancers are adenocarcinomas - cancers that begin in cells that make and release mucus and other fluids.
• Prostate cancer often has no early symptoms.
• Advanced prostate cancer can cause men to urinate more often or have a weaker flow of urine.
• Most men diagnosed with prostate cancer do not die from it. More than 2.9 million men in the US diagnosed with prostate cancer at some point are still alive today.

What is the prostate?

The prostate is an exocrine gland of the male reproductive system, and exists directly under the bladder, in front of the rectum. An exocrine gland is one whose secretions end up outside the body e.g. prostate gland and sweat glands. It is approximately the size of a walnut.

Diagram of the location of the prostate gland and nearby organs

The urethra - a tube that goes from the bladder to the end of the penis and carries urine and semen out of the body - goes through the prostate.

There are thousands of tiny glands in the prostate - they all produce a fluid that forms part of the semen. This fluid also protects and nourishes the sperm. When a male has an orgasm the seminal-vesicles secrete a milky liquid in which the semen travels. The liquid is produced in the prostate gland, while the sperm is kept and produced in the testicles. When a male climaxes (has an orgasm) contractions force the prostate to secrete this fluid into the urethra and leave the body through the penis.

Urine control

As the urethra goes through the prostate: the prostate gland is also involved in urine control (continence) with the use of prostate muscle fibers. These muscle fibers in the prostate contract and release, controlling the flow of urine flowing through the urethra.

The Prostate Produces Prostate-specific antigen (PSA)

The epithelial cells in the prostate gland produce a protein called PSA (prostate-specific antigen). The PSA helps keep the semen in its liquid state. Some of the PSA escapes into the bloodstream. We can measure a man's PSA levels by checking his blood. If a man's levels of PSA are high, it might be an indication of either prostate cancer or some kind of prostate condition.

It is a myth to think that a high blood-PSA level is harmful to you - it is not. High blood PSA levels are however an indication that something may be wrong in the prostate.

Male hormones affect the growth of the prostate, and also how much PSA the prostate produces. Medications aimed at altering male hormone levels may affect PSA blood levels. If male hormones are low during a male's growth and during his adulthood, his prostate gland will not grow to full size.

In some older men the prostate may continue to grow, especially the part that is around the urethra. This can make it more difficult for the man to pass urine as the growing prostate gland may be causing the urethra to collapse. When the prostate gland becomes too big in this way, the condition is called Benign Prostatic Hyperplasia (BPH). BPH is not cancer, but must be treated.

Prostate cancer

In the vast majority of cases, the prostate cancer starts in the gland cells - this is called adenocarcinoma. In this article, prostate cancer refers just to adenocarcinoma.

Prostate cancer is mostly a very slow progressing disease. In fact, many men die of old age, without ever knowing they had prostate cancer - it is only when an autopsy is done that doctors know it was there. Several studies have indicated that perhaps about 80% of all men in their eighties had prostate cancer when they died, but nobody knew, not even the doctor.

Experts say that prostate cancer starts with tiny alterations in the shape and size of the prostate gland cells - Prostatic intraepithelial neoplasia (PIN).

Doctors say that nearly 50% of all 50-year-old men have PIN. The cells are still in place - they do not seem to have moved elsewhere - but the changes can be seen under a microscope. Cancer cells would have moved into other parts of the prostate. Doctors describe these prostate gland cell changes as low-grade or high-grade; high grade is abnormal while low-grade is more-or-less normal.

Any patient who was found to have high-grade PIN after a prostate biopsy is at a significantly greater risk of having cancer cells in his prostate. Because of this, doctors will monitor him carefully and possibly carry out another biopsy later on.

Classification of prostate cancer

It is important to know the stage of the cancer, or how far it has spread. Knowing the cancer stage helps the doctor define prognosis - it also helps when selecting which therapies to use. The most common system today for determining this is the TNM (Tumor/Nodes/Metastases). This involves defining the size of the tumor, how many lymph nodes are involved, and whether there are any other metastases.

When defining with the TNM system, it is crucial to distinguish between cancers that are still restricted just to the prostate, and those that have spread elsewhere. Clinical T1 and T2 cancers are found only in the prostate, and nowhere else, while T3 and T4 have spread outside the prostate.

There are many ways to find out whether the cancer has spread. Computer tomography will check for spread inside the pelvis, bone scans will decide whether the cancer has spread to the bones, and endorectal coil magnetic resonance imaging will evaluate the prostatic capsule and the seminal vesicles.

The Gleason Score

A pathologist will look at the biopsy samples under a microscope. If cancer tissue is detected, the pathologist then grades the tumor. The Gleason System of grading goes from 2 to 10. The higher the number, the more abnormal the tissues are compared to normal prostate tissue.

Two numbers are added up to get a Gleason score:

1. A number from 1 to 5 for the most common pattern observed under the microscope. This is the predominant grade and must be more than 51% of the sample.
2. A number from 1 to 5 for the second most common pattern. This is the secondary grade and must make up more than 5% but less than 50% of the sample.

A Gleason score of 7 can have two meanings. Look at these two examples below:

1. If the predominant grade is 3 and the secondary grade is 4, the Gleason score is 7.
2. If the predominant grade is 4 and the secondary grade is 3, the Gleason score is also 7.

However, the first example, with a predominant score of 3, has a less aggressive cancer than the second example, with a predominant score of 4.

It is crucial that the tumor is graded properly, as this decides what treatments should be recommended.

Signs and symptoms of prostate cancer

During the early stages of prostate cancer there are usually no symptoms. Most men at this stage find out they have prostate cancer after a routine check up or blood test. When symptoms do exist, they are usually one or more of the following:

• The patient urinates more often
• The patient gets up at night more often to urinate
• He may find it hard to start urinating
• He may find it hard to keep urinating once he has started
• There may be blood in the urine
• Urination might be painful
• Ejaculation may be painful (less common)
• Achieving or maintaining an erection may be difficult (less common).

If the prostate cancer is advanced the following symptoms are also possible:

• Bone pain, often in the spine (vertebrae), pelvis, or ribs
• The proximal part of the femur can be painful
• Leg weakness (if cancer has spread to the spine and compressed the spinal cord)
• Urinary incontinence (if cancer has spread to the spine and compressed the spinal cord)
• Fecal incontinence (if cancer has spread to the spine and compressed the spinal cord).

Causes of prostate cancer

Nobody is really sure of what the specific causes are. There are so many possible factors, including age, race, lifestyle, medications, and genetics, to name a few.

1) Age

Age is considered as the primary risk factor. The older a man is, the higher is his risk. Prostate cancer is rare among men under the age of 45, but much more common after the age of 50.

2) Genetics

Statistics indicate that genetics is definitely a factor in prostate cancer risk. It is more common among certain racial groups - in the USA prostate cancer is significantly more common and also more deadly among Afro-Americans than White-Americans. A man has a much higher risk of developing cancer if his identical twin has it. A man whose brother or father had/had prostate cancer runs twice the risk of developing it, compared to other men.

Studies indicate that the two faulty genes - BRCA 1 and BRCA 2 - which are important risk factors for breast cancer and ovarian cancer, have also been implicated in prostate cancer risk.

In a study scientists found seven new sites in the human genome that are linked to men's risk of developing prostate cancer.

Faulty BRCA2 gene linked to aggressive form of prostate cancer - researchers at the The Institute of Cancer Research, UK, reported in the Journal of Clinical Oncology (April 2013 issue) that men who have inherited the faulty BRCA2 gene are more likely to have the faster-spreading type of prostate cancer. The scientists say these men should receive treatment immediately after diagnosis with surgery or radiation therapy, rather than receive the "watchful waiting" approach.

Senior author Ros Eeles wrote that experts have already known that those with the faulty BRCA2 gene have a higher risk of developing prostate cancer. This is the first large study to demonstrate that the faulty gene is also linked to a faster spread of the disease and poorer survival.

This new discovery will make some health authorities around the world rethink their policies and procedures. In the United Kingdom, the National Health Service offers the same prostate cancer treatment for both carriers and non-carriers of the faulty BRCA2 gene.

Prof. Eeles said "It must make sense to start offering affected men immediate surgery or radiotherapy, even for early-stage cases that would otherwise be classified as low-risk. We won't be able to tell for certain that earlier treatment can benefit men with inherited cancer genes until we've tested it in a clinical trial, but the hope is that our study will ultimately save lives by directing treatment at those who most need it."

3) Diet

A review of diets indicated that the Mediterranean diet mayreduce a person's chances of developing prostate cancer.Another study indicates that soy, selenium and green tea, offer additional possibilities for disease prevention - however, a more recent study indicated that combination therapy of vitamin E, selenium and soy does not prevent the progression from high-grade prostatic intraepithelial neoplasia (HGPIN) to prostate cancer. A diet high in vegetable consumption was found in a study to be beneficial.

A US pilot study on men with low risk prostate cancer found that following an intensive healthy diet and lifestyle regime focusing on low meat and high vegetable and fruit intake, regular exercise, yoga stretching, meditation and support group participation, can alter the way that genes behave and change the progress of cancer, for instance by switching on tumor killers and turning down tumor promoters.

Other studies have indicated that lack of vitamin D, a diet high in red meat may raise a person's chances of developing prostate cancer.

A study published in the journal Clinical Cancer Research suggests vitamin D deficiency may predict aggressive prostate cancer.

4) Medication

Some studies say there might be a link between the daily use of anti-inflammatory medicines and prostate cancer risk. A study found that statins, which are used to lower cholesterol levels, may lower a person's risk of developing prostate cancer.

5) Obesity

A study found a clear link between obesity and raised prostate cancer risk, as well as a higher risk of metastasis and death among obese people who develop prostate cancer.

6) Sexually transmitted diseases (STDs)

Men who have had gonorrhea have a higher chance of developing prostate cancer, according to research from the University of Michigan Health System.

7) Agent Orange

Veterans exposed to Agent Orange have a 48% higher risk of prostate cancer recurrence following surgery than their unexposed peers, and when the disease comes back, it seems more aggressive, researchers say. Another study found that Vietnam War veterans who had been exposed to Agent Orange have significantly increased risks of prostate cancer and even greater risks of getting the most aggressive form of the disease as compared to those who were not exposed.

8) Enzyme PRSS3 linked to aggressive prostate cancer

Scientists from the Mayo Clinic, Florida, reported in Molecular Cancer Research that PRSS3, an enzyme, changes the environment of prostate cancer cells, making the cancer much more likely to metastasize.

Senior researcher, Evette Radisky, Ph.D., said "This molecule is a protease, which means it digests other molecules. Our data suggests PRSS3 activity changes the environment around prostate cancer cells - perhaps by freeing them from surrounding tissue - to promote malignancy and invasiveness. I don't think PRSS3 is the only factor involved in driving aggressive prostate cancer, but it may be significant for a certain subset of this cancer - the kind that is potentially lethal."

Recent developments on prostate cancer causes from MNT news

Chronic prostate inflammation tied to nearly double risk of prostate cancer - a study reported in the journal Cancer Epidemiology, Biomarkers & Prevention, finds that compared to men with no such signs, men with chronic inflammationin non-cancerous prostate tissue may have nearly double the risk of developing prostate cancer.

Vasectomy linked with aggressive prostate cancer risk - In the largest and most comprehensive study of its kind, researchers from Harvard School of Public Health in Boston, MA, find that vasectomy is associated with a small increased risk of prostate cancer, and a larger increased risk for advanced or lethal prostate cancer.

Prostate cancer: high cholesterol, triglyceride levels may raise risk of recurrence - Among men who have surgery for prostate cancer, those who have high total cholesterol and triglyceride levels - two types of fat found in blood - may be at increased risk of disease recurrence. This is according to a study published in the journal Cancer Epidemiology, Biomarkers & Prevention.

Western diet could be fatal for prostate cancer patients - A new study has suggested that following a Western diet - high in red and processed meats, refined grains and high-fat dairy products - could increase the risk of death for people with prostate cancer from both prostate cancer and all causes.

Prostate cancer treatments

The following treatments are separated into early stage and advanced stage prostate cancers.

Early stage prostate cancer

If the cancer is small and contained - localized - it is usually managed by one of the following treatments:

• Watchful waiting - not immediate treatment is carried out. PSA blood levels are regularly monitored.
• Radical prostatectomy - the prostate is surgically removed.
• Brachytherapy - radioactive seeds are implanted into the prostate.
• Conformal radiotherapy - the radiation beams are shaped so that the region where they overlap is as close to the same shape as the organ or region that requires treatment, thus minimizing healthy tissue exposure to radiation.
• Intensity modulated radiotherapy - beams with variable intensity are used. An advanced form of conformal radiotherapy usually delivered by a computer-controlled linear accelerator.
  Treatment recommendations really depend on individual cases. In general, if there is a good prognosis and the cancer is in its early stages, all options can be considered. However, they all have their advantages and disadvantages. The patient should discuss available options thoroughly with his doctor.

More advanced prostate cancer

If the cancer is more aggressive, or advanced, the patient may require a combination of radiotherapy and hormone therapy. Radiotherapy requires treatment on an everyday basis for up to about eight weeks. Radical surgery is also an option - the prostate is removed. Traditional surgery requires a hospital stay of up to ten days, with a recovery time that can last up to three months. Robotic keyhole surgery has the advantage just a couple of days in hospital, followed by a much shorter recover period. However, even robotic keyhole surgery may not be ideal for very elderly patients.

In advanced prostate cancer hormone therapy is very effective in slowing down, and even stopping the growth of cancer cells. Even if the hormone therapy stops working after a while, there are still other options the patient will be able to discuss with his doctor, such as participating in clinical trials.

Radioactive injection helps advanced prostate cancer patients live longer - scientists at The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, UK, reported in NEJM (New England Journal of Medicine) that radium-233, a radiation injection, directly targets tumors in the bone delivering short range radiation, causing minimal damage to healthy tissue. Radium, like calcium, is absorbed by the bone.

Delivering estrogen through skin patches may be an easier and safer way to treat prostate cancer than the hormone therapies that are currently used, British researchers explained in Lancet Oncology (March 2013 issue).

In May 2013, the US FDA approved Xofigo (radium Ra 223 dichloride) for metastatic castration-resistant prostate cancer that has reached bones but not other organs. Enzalutamide is taken in combination with docetaxel, another cancer medication.

Richard Pazdur, M.D., from the FDA, said "Xofigo binds with minerals in the bone to deliver radiation directly to bone tumors, limiting the damage to the surrounding normal tissues. Xofigo is the second prostate cancer drug approved by the FDA in the past year that demonstrates an ability to extend the survival of men with metastatic prostate cancer."

Xtandi (enzalutamide) was approved by the FDA in August 2012 for patients with metastatic castration-resistant prostate cancer that has spread or recurred.

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Mint: Health Benefits, Uses and Risks

When discussing the world's healthiest foods, fruits and vegetables are often highest on the list because of their high antioxidant capacity,vitamins, minerals and bevy of health benefits associated with consuming them. Fresh herbs are often forgotten on that list, however they can be just as essential to a healthy diet as fruits and vegetables and also offer a wide array of health benefits as well.

Mint has one of the highest antioxidant capacities of any food. Learning how to use fresh herbs and spices like mint when cooking can also help to cut down on sodium intake.

Mint, also known as mentha, is actually a genus or group of around 15-20 types of plants including peppermint and spearmint. Mint oil is often used in toothpaste, gum, candy and beauty products while the leaves are used either fresh or dried for teas and food.

This MNT Knowledge Center feature is part of a collection of articles on the health benefits of popular foods. It provides a nutritional breakdown of mint and an in-depth look at its possible health benefits, how to incorporate more mint into your diet and any potential health risks associated with consuming mint.

Nutritional breakdown of mint

Two tablespoons of mint provides 2 calories, 0.12 grams of protein, 0.48 grams carbohydrates, 0.03 grams of fat and 0.30 grams of fiber. Mint contains small amounts of potassium, magnesium, calcium, phosphorus, vitamin C and vitamin A.³

Possible health benefits of mint

Mint, also known as mentha, is actually a genus or group of around 15-20 types of plants including peppermint and spearmint.

Allergies: Mint plants contain an antioxidant known as rosmarinic acid, which has been studied for its effectiveness in relieving seasonal allergy symptoms. Because of rosmarinic acid's anti-inflammatory properties, rosmarinic acid has been shown to be a promising treatment.⁴

Common cold: Mint contains menthol, which is a natural decongestant that helps to break up phlegm and mucus. Mint can also be effective, especially when combined with tea for relievingsore throats.

Indigestion: Mint is a calming and soothing herb that has been used for thousands of years to aid with upset stomach orindigestion. Mint is thought to improve the flow of bile through the stomach, which helps to speed and ease digestion.

Irritable bowel syndrome (IBS): The use peppermint oil has been found to be an effective and safe treatment for those suffering from abdominal pain or discomfort associated with IBS.^2,5

Skin: When applied topically in oil, ointment or lotion, mint has the effect of calming and cooling skin affected by insect bites, rash or other reactions.

How to incorporate more mint into your diet

Mint can be used to flavor dishes accompanying lamb, soups and vegetable salads.

Adding mint is a great way to add flavor to a dish or beverage without adding extra calories, fat or sodium. Mint leaves are a tender herb (along with cilantro and basil) that have gentle stems and are best to add either raw or near the end of cooking in order to maintain their delicate flavor and texture. Mint is relatively easy to grow and can even be grown in small pots on a sunny windowsill.

When preparing mint, use a sharp knife and cut gently. Using a dull knife or over-chopping will bruise the herb and much of the flavor will be misplaced onto the cutting board surface.¹

Mint is commonly used to flavor Middle Eastern dishes, such as lamb, soups and vegetable salads.

Try a mint limeade by mixing together your lime juice, sugar or stevia and muddled mint leaves. Top off with filtered water and ice cubes.

Incorporate mint into a fresh fruit salsa with chopped apples, pear, lemon or lime juice, jalapeno and honey. Serve with cinnamon pita chips or on top of baked chicken.

Jazz up your water by adding mint leaves and cucumber for a refreshing treat.

Potential health risks of consuming mint

Do not use mint in an attempt to soothe digestive issues if your symptoms of are related to a gastroesophageal reflux disease or GERD, which may exacerbate your condition.

Peppermint oil, if taken in large doses, can be toxic. Pure menthol is poisonous and should never be taken internally.

Do not apply mint oil to the face of an infant or small child, as it may cause spasms that inhibit breathing.

Use caution with mint products if you have or have previously had gallstones.

Speak with your health care provider to determine whether any of your medications could interact with mint or mint oil.

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Desk-based employees 'should work standing up'

A group xperts have advised that people working in office environments stand for at least 2 hours a day during working hours, as part of a number of recommendations to protect those engaged with typically sedentary forms of work.

Breaking up long periods of sitting with activity is considered by most experts to be advantageous to the health of workers.

Workers whose jobs are predominantly desk-based should eventually progress to a total of 4 hours standing, advises the panel.

The recommendation comes as part of a set of guidelines, published in the British Journal of Sports Medicine, with the aim to provide guidance to employers and office workers to counteract the health risks that come with long periods of seated office work.

"For those working in offices, 65-75% of their working hours are spent sitting, of which more than 50% of this is accumulated in prolonged periods of sustained sitting," write the authors. "The evidence is clearly emerging that a first 'behavioral' step could be simply to get people standing and moving more frequently as part of their working day."

An increasing number of studies associate sedentary living - including time spent at work - with an increased risk of several serious illnesses and causes of death, including cardiovascular disease, diabetes and some forms of cancer.

Although much of the evidence the panel used to inform its recommendations comes from observational and retrospective studies, they state that "the level of consistent evidence accumulated to date, and the public health context of rising chronic diseases, suggest initial guidelines are justified."

The key recommendations of the guidelines for office workers during working hours are:

• Two hours daily, eventually progressing to 4 hours, of standing and light activity (such as light walking)
• Breaking up periods of seated work with standing work using adjustable sit-stand desks and workstations
• Avoiding prolonged static standing, which may also be harmful
• Altering posture and light walking to reduce fatigue and musculoskeletal pain while adapting to new work practices
• Employers should inform staff of the dangers of spending too much time sitting down, both at work and at home
• Employers should also promote the benefits of other healthful behaviors such as eating a balanced diet and not smoking.

Guidelines 'pose no significant physical or cognitive challenges' for workers

There is a growing interest in changing working environments so that they are no longer wholly sedentary. Many companies now provide office furniture with sit-stand attachments for desks or fully adjustable sit-stand desktops, allowing office employees to work without having to be seated.

While a number of companies have already begun investing in changes to enable their employees to work in a more active environment, many have not. The panel state those that have yet to do so should begin to evaluate how best they can implement these recommendations.

Potential measures that can be taken include making provisions for breaks that involve standing and movement and investing in desks and office designs that allow employees to work easily while standing up.

The panel warns, however, that simply changing a working environment may not be enough to alter behaviors in the long term. "Strategies and programs for implementing change will need careful organizational and behavioral support and public education to prevent current interests in active office environments from simply being a passing fad," they write.

"On the basis that there are a large number of occupations which involve people standing and moving for considerably more than 4 [hours a day] (e.g., hospital staff, teachers, factory workers, retail and catering staff), it is expected that for office-based workers, in general, this should not pose too many significant physical or cognitive challenges," the authors conclude.

The panel of international experts was commissioned by Public Health England and a British community interest company, Active Working CIC.

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