A Call for Help

“I can’t wake my wife up!” The voice on the phone was panicked. The couple were lying in bed when the 43-year-old woman began to snore, something she’d never done before. Her husband tried to wake her, but she didn’t respond. He shouted her name; he shook her shoulder. Nothing. Terrified, he called 911.

An Otherwise-Ordinary Night

He couldn’t imagine what was wrong with his healthy, active wife, he told the medics when they arrived. That day had been pretty normal. His wife got home from work in the late afternoon. She made dinner and then went to her kickboxing class. She got home, put the kids to bed and had a drink — vodka and cranberry juice. Then the couple went to bed, too. Normally the husband stayed up later than she did, but this evening they turned in at the same time. As they lay in bed, talking, his wife began to snore. It was so sudden and unexpected that, at first, he thought it was a joke.

The medics tried to wake her. They called her name; they shook her. They gave her Narcan, a drug that counteracts narcotics, even though her husband told them she didn’t use drugs. All they got from her was a moan. They loaded her in the ambulance and hurried her to the University of Michigan Medical Center emergency room.



At the Emergency Room

Dr. Robert Silbergleit, the doctor on duty at the E.R. that night, met the ambulance on arrival. “Comatose 43-year-old woman found by husband,” the E.M.T.’s reported as they moved the patient into the area reserved for the critically ill. “Snoring. Unresponsive except to pain.”

The patient, a thin woman, seemed to Silbergleit to be perfectly fit and healthy, except that she was asleep. He rubbed her chest hard with his knuckle — a sternal rub, it’s called — a very painful maneuver, designed to elicit a response. “Stop,” she moaned, but she didn’t open her eyes. And she didn’t wake up.

What is the most common cause of a sudden loss of consciousness in a young person?


What NYT Readers Voted





Drugs or alcohol



Possible Diagnoses


Drug overdose: A common cause of a sudden loss of consciousness in an otherwise-healthy adult. Her husband said she didn’t use drugs and the Narcan didn’t do any good, so narcotics were unlikely. Silbergleit sent off blood and urine to look for other sedating drugs or alcohol.

Traumatic brain injury: Had she been hit in the head during her kickboxing class? A well-placed blow could cause bleeding inside the skull, resulting in a loss of consciousness hours later. She hadn’t complained of a headache or mentioned an injury. Still, Silbergleit ordered a CT scan of the head. Untreated, bleeding around the brain can cause permanent injury or death.

Stroke: The sudden onset of symptoms sounded like a stroke, even though the symptom itself, a sudden loss of consciousness, did not. Still, stroke needed to be considered, because the damage caused by a stroke can be reduced or even prevented by medications that open the clogged artery and restore blood flow throughout the brain. But these drugs have to be given within four and a half hours of the onset of symptoms. And because these are powerful drugs that can cause life-threatening bleeding, a definitive diagnosis of a stroke is important.

Test Results

The drug tests were all negative. Her blood-alcohol level was consistent with the reported single drink after dinner. The CT scan of her head didn’t show any evidence of bleeding or a stroke. Silbergleit ordered a CT angiogram — an image that outlines the arteries of the brain — to look for any obstruction that would suggest a stroke. It, too, was normal.

Given the results of the testing, what do you think caused this woman to become comatose?

What Others Voted

  • Trauma that wasn’t seen in the imaging ordered by the E.R. doctor


  • An overdose of a drug that wasn’t tested for


  • A seizure


  • A stroke


  • An infection




A Neurologist Gets Involved

Silbergleit spoke with Lesli Skolarus, a neurologist with special training in strokes. It was late, and Skolarus was at home. Silbergleit described the case and explained that he was planning to get an EEG to see if the young woman was having continuing seizures.

Skolarus arrived at the hospital around 1 a.m. By the time she finished reviewing the E.R. test results, two hours had passed since the patient first fell asleep.

Like Silbergleit, Skolarus was struck by the sudden onset of symptoms. Was this a stroke? If it was, it was an odd one. Because of the way arteries course through the brain, any obstruction will cut off blood and oxygen to only one side of the brain. So the typical stroke causes weakness or paralysis on one side of the body, and the patient is usually wide awake. The part of the brain that keeps us awake is known as the reticular activating system, or R.A.S. The R.A.S. is usually fed by one artery on each side of the brain, a redundancy that provides important protection if either of these vessels should be blocked. A small segment of the population, however, has only one vessel delivering blood to the R.A.S., and a well-positioned clot to this single vessel, called the artery of Percheron, could completely block blood flow to the R.A.S. and cause unconsciousness. Could that be the case with this patient?


Deadline Testing



MRI image.



Skolarus had seen this kind of stroke once before, when she was in training. It took days to figure out why an older man had suddenly lost consciousness. By the time they discovered this rare stroke, the damage was permanent.

Skolarus looked at the clock. Three hours had passed since the young woman’s symptoms started. If she had a clot in the artery of Percheron, there was still time to use a clot buster to reopen the vessel before the injury became permanent. But first they would need an M.R.I. for a closer look.

A half-hour later the scanner clattered as the patient’s brain slowly came into view on the monitor. Skolarus watched as the skull, then the top of the brain and finally the midbrain appeared before her. And there it was — a bright spot indicating damage to the R.A.S. from a blockage to the artery of Percheron. Skolarus called the E.R. to get the clot-busting drug ready.



Concern About Brain Damage

The medication was started just moments before the four-and-a-half-hour deadline. As the medicine dripped in, Skolarus showed the husband the damaged region. Then she had to tell him the bad news: even if the medicine worked, there was still a chance she would not wake up. And if she did, she would probably have residual damage. Chances were, she would never be the same.

Suddenly the husband heard his wife’s voice. He and Skolarus rushed to the bedside. She looked a little scared, but her eyes were open and she was talking. She knew her name. She knew his name. She knew the name of the current president. She was back.


Searching for the Cause



The patient stayed in the hospital for the next several days. She felt fine, but the doctors needed to figure out why she had this stroke. A sonogram of the patient’s heart provided the answer. It showed that there was an opening in the wall that separated the right side of the heart from the left. Normally blood comes into the right side of the heart, then passes through the lungs, where it is oxygenated, before going into the left side of the heart. From there it’s pumped into the rest of the body. Because lungs also serve as a kind of filter, trapping clots and other particles in its tiny capillaries, the hole in this patient’s heart allowed a tiny clot from somewhere in the body to travel through the heart and into the brain.



I spoke to the patient recently. She says she feels back to her old self and is amazed and grateful.

“There were so many ways I was lucky that night. If my husband had come to bed at his usual time, he might not have noticed anything. If the neurologist hadn’t come in, if the M.R.I. hadn’t been available — ” She stopped, unwilling to even talk about the possibility. “It’s all a little scary.”

Source: The New York Times, February/March 2012

Target Health Champions eTrial Master File (eTMF)



Target Document® is now being used for all Target Health clinical trials to manage the eTrial Master File (eTMF). Not only is it being used by both the clinical sites and Target Health CRAs and Project Managers to manage the entire eTMF, several CROs and Sponsors have brought it in-house for their own use.


Features include:


  1. Web-based
  2. Advanced user management
  3. Electronic signatures to groups and individuals
  4. Document check-in and check-out
  5. Active Bulletin Board
  6. Document expiration notification
  7. Extraordinary ROI
  8. etc


For more information about Target Health contact Warren Pearlson (212-681-2100 ext. 104). For additional information about software tools for paperless clinical trials, please also feel free to contact Dr. Jules T. Mitchel or Ms. Joyce Hays. The Target Health software tools are designed to partner with both CROs and Sponsors. Please visit the Target Health Website at www.targethealth.com

Sleeplessness Agitates the Brain



As fatigue grows, electrical activity mounts. Sleep deprivation makes the 1) ___ groggy, but as waking hours mount nerve cells grow increasingly jumpy, a new study shows. This amped-up state may explain why seizures and 2) ___ can accompany an all-nighter. More generally, the results help clarify what goes wrong in a brain deprived of sleep. “It’s an important finding,” says neuroscientist Christopher Colwell of UCLA. “Sleep deprivation is an area of huge interest because most of us do not get enough 3) ___.”


By subjecting six people to a night of sleep 4) ___ and measuring their brain responses, Marcello Massimini of the University of Milan and colleagues found that people’s brains become more reactive as hours awake accumulate. To look for signs of altered brain function, the team delivered a jolt of magnetic current to the participants’ skulls that kicked off an electrical response in the 5) ___ cells (an effect like the noise made when a hammer strikes a bell). With electrodes on the scalp, the team measured the strength of this electrical response in the frontal cortex, a brain region that’s involved in making executive 6) ___. After a night of sleep deprivation, participants’ 7) ___ responses were stronger than they were the previous day, the scientists report online February 7 in Cerebral Cortex. This overreaction disappeared after a night’s sleep.


The results offer support for a theory of why people sleep: During waking hours, the brain accumulates connections between nerve cells as new things are learned. Sleep, the theory says, sweeps the brain of extraneous clutter, leaving behind only the most important 8) ___. Enhanced excitability in the brain may explain why sleep deprivation can trigger seizures, events marked by massive nerve cell excitation. When doctors want to induce 9) ___ in patients in the clinic, one of the most effective ways is to keep a person awake all night. The new results also have an intriguing link to depression. For some people, sleep deprivation can quickly reverse symptoms of depression, an effect that may be due to the brain’s boosted excitability. The team plans on studying people with 10) ___ to see if their brains show similar responses to sleep deprivation.


ANSWERS: 1) brain; 2) hallucinations; 3) sleep; 4) deprivation; 5) nerve; 6) decisions; 7) electrical; 8) connections; 9) seizures; 10) depression

Egyptian Medical Text: The Edwin Smith Papyrus



The Edwin Smith Papyrus is an Ancient Egyptian medical text on surgical trauma. It dates to Dynasties 16-17 of the Second Intermediate Period in Ancient Egypt, ca. 1600 BCE. The Edwin Smith papyrus is unique among the medical papyri that survive today. While other papyri, such as the Ebers Papyrus and London Medical Papyrus, are medical texts based in magic, the Edwin Smith Papyrus presents a rational and scientific approach to medicine in Ancient Egypt.


The Edwin Smith papyrus is 4.68 m in length, divided into 17 pages. The recto, the front side, is 377 lines long, while the verso, the backside, is 92 lines long. Aside from the fragmentary first sheet of the papyrus, the remainder of the papyrus is fairly intact. The papyrus is written in hieratic, the Egyptian cursive form of hieroglyphs, in black and red ink. The vast majority of the papyrus is concerned with trauma and surgery. On the recto side, there are 48 cases of injury. Each case details the type of the injury, examination of the patient, diagnosis and prognosis, and treatment. The verso side consists of eight magic spells and five prescriptions. The spells of the verso side and two incidents in Case 8 and Case 9 are the exceptions to the practical nature of this medical text.


Authorship of the Edwin Smith Papyrus is debated. The majority of the papyrus was written by one scribe, with only small sections written by a second scribe. The papyrus ends abruptly in the middle of a line, without any inclusion of an author. It is believed that the papyrus is based upon an earlier text from the Old Kingdom. Form and commentary included in the papyrus give evidence to the existence of an earlier document. The text is attributed by some to Imhotep, an architect, high priest, and physician of the Old Kingdom, 3000-2500 BCE.


The rational and practical nature of the papyrus is illustrated in the 48 cases. The papyrus begins by addressing injuries to the head, and continues with treatments for injuries to neck, arms and torso. The title of each case details the nature of trauma, such as Practices for a gaping wound in his head, which has penetrated to the bone and split the skull. Next, the examination provides further details of the trauma. The diagnosis and prognosis follow the examination. Last, treatment options are offered. In many of the cases, explanations of trauma are included to provide further clarity.


Among the treatments are closing wounds with sutures (for wounds of the lip, throat, and shoulder), preventing and curing infection with honey, and stopping bleeding with raw meat. Immobilization is advised for head and spinal cord injuries, as well as other lower body fractures. The papyrus also describes anatomical observations. It contains the first known descriptions of the cranial sutures, the meninges, the external surface of the brain, the cerebrospinal fluid, and the intracranial pulsations. The procedures of this papyrus demonstrate an Egyptian level of knowledge of medicines that surpassed that of Hippocrates, who lived 1000 years later. Due to its practical nature and the types of trauma investigated, it is believed that the papyrus served as a textbook for the trauma that resulted from military battles.


Edwin Smith purchased the papyrus in Luxor, Egypt in 1862, from an Egyptian dealer named Mustafa Agha. The papyrus was in the possession of Smith until his death, when his daughter donated the papyrus to New York Historical Society. From 1938 through 1948, the papyrus was at the Brooklyn Museum. In 1948, the New York Historical Society and the Brooklyn Museum presented the papyrus to the New York Academy of Medicine, where it remains today.


The first translation of the papyrus was by James Henry Breasted, with the medical advice of Dr. Arno B Luckhardt, in 1930 Breasted¹s translation changed the understanding of the history of medicine. It demonstrates that Egyptian medical care was not limited to the magical modes of healing demonstrated in other Egyptian medical sources. Rational, scientific practices were used, constructed through observation and examination.


From 2005 through 2006, the Edwin Smith Papyrus was on exhibition at the Metropolitan Museum of Art in New York. James P. Allen, curator of Egyptian Art at the museum, published a new translation of the work, coincident with the exhibition. This was the first complete English translation since Breasted¹s in 1930. This translation offers a more modern understanding of hieratic and medicine.

First-in-Human Testing of a Wirelessly Controlled Drug Delivery Microchip



Human parathyroid hormone fragment [hPTH(1-34)] is the only approved anabolic osteoporosis treatment, but requires daily injections, making patient compliance an obstacle to effective treatment. Furthermore, a net increase in bone mineral density requires intermittent or pulsatile hPTH(1-34) delivery, a challenge for implantable drug delivery products.


As a result, a study published online in Science Translational Medicine Rapid Publication (16 February 2012), reports the results of a clinical trial where a microchip-based device, containing discrete doses of lyophilized hPTH(1-34), were implanted in 8 osteoporotic postmenopausal women for 4 months. The device was wirelessly programmed to release doses once daily for up to 20 days. A computer-based programmer, operating in the Medical Implant Communications Service band, established a bidirectional wireless communication link with the implant to program the dosing schedule and receive implant status confirming proper operation. Each woman subsequently received hPTH(1-34) injections in escalating doses and the pharmacokinetics, safety, tolerability, and bioequivalence of hPTH(1-34) were assessed.


Results showed that device dosing produced similar pharmacokinetics to multiple injections, and had lower coefficients of variation. Bone marker evaluation indicated that daily release from the device increased bone formation. There were no toxic or adverse events due to the device or drug, and patients stated that the implant did not impact quality of life.

Intracoronary Cardiosphere-Derived Cells For Heart Regeneration After Myocardial Infarction


According to an article published in The Lancet, Early Online Publication (14 February 2012), infusion of cardiosphere-derived stem cells (CDCs) into patients who had had heart attacks can help regenerate healthy heart muscle.


For the study, between May 5, 2009, and Dec 16, 2010, the CADUCEUS (CArdiosphere-Derived aUtologous stem CElls to reverse ventricUlar dySfunction) study assessed 25 patients, average age of 53 years, who experienced an MI 2-4 weeks prior (with left ventricular ejection fraction of 25 to 45%). Of the 25 patients, eight received standard care while 17 received infusions of CDCs, which are cardiac stem cells created using the patient’s own heart tissue. The primary endpoint was the proportion of patients at six months who died due to ventricular tachycardia, ventricular fibrillation, sudden unexpected death or had an MI after cell infusion, new cardiac tumor formation on MRI, or a major adverse cardiac event – defined as composite of death and hospital admission for heart failure or non-fatal recurrent MI.


The procedure is minimally invasive and involves removing pieces of living heart muscle around half the size of a raisin using a catheter under local anesthetic; this tissue was then used to create the supply of cardiac stem cells. Each patient received an infusion of around 12 to 25 million of his or her own stem cells during a second minimally invasive procedure.


Results showed that patients who had the stem cell infusion saw their scar size drop from 24% to 12% of the heart on average (a reduction by about 50%), while controls saw no reduction in scar size. Changes in end-diastolic volume, end-systolic volume and left ventricular ejection fraction did not differ between groups by six months. Four patients (24%) in the stem cell group had serious adverse events compared with one control (13%), although of the four events in the stem cell group, only one was regarded as possibly related to the treatment. One patient developed recurrent MI and four patients received additional cardiac interventions (including one patient who had coronary revascularization and three who needed implantation of prophylactic defibrillators) in the CDC group.


The authors concluded that intracoronary infusion of autologous CDCs after MI is safe, warranting the expansion of such therapy to phase II study. The unprecedented increases we noted in viable myocardium, which are consistent with therapeutic regeneration, merit further assessment of clinical outcomes.

Midlife Psychological Distress Associated With Late-Life Brain Atrophy and White Matter Lesions



Long-standing psychological distress increases the risk of dementia, especially Alzheimer’s disease. As a result, a study published in Psychosomatic Medicine (2012;74: 120-125), was performed to examine the relationship between midlife psychological distress and late-life brain atrophy and white matter lesions (WMLs), which are common findings on neuroimaging in elderly subjects.


For the study, a population-based sample of 1,462 women, aged 38 to 60 years, was examined in 1968, with subsequent examinations in 1974, 1980, 1992, and 2000. Computed tomography (CT) of the brain was done in 379 survivors in 2000, and of those, 344 had responded to a standardized question about psychological distress in 1968, 1974, and 1980. WMLs, cortical atrophy, and central atrophy (ventricular sizes) were measured at CT scans.


Results showed that compared with women reporting no distress, those reporting frequent or constant distress at one examination or more (in 1968, 1974, and 1980) more often had moderate-to-severe WMLs (odds ratio = 2.39) and moderate-to-severe temporal lobe atrophy (odds ratio = 2.51) on brain CT in 2000. Frequent/constant distress was also associated with central brain atrophy, that is, higher bicaudate ratio, higher cella media ratio, and larger third-ventricle width.


According to the authors, long-standing psychological distress in midlife increases risks of cerebral atrophy and WMLs on CT in late life, but more studies are needed to confirm these findings and to determine potential neurobiological mechanisms of these associations.

TARGET HEALTH excels in Regulatory Affairs. Each week we highlight new information in this challenging area.



FDA Approves Korlym for Patients with Endogenous Cushing’s Syndrome



Endogenous Cushing’s syndrome is a serious, debilitating and rare multisystem disorder. It is caused by the overproduction of cortisol (a steroid hormone that increases blood sugar levels) by the adrenal glands. This syndrome most commonly affects adults between the ages of 25 and 40.


FDA approved Korlym (mifepristone) to control high blood sugar levels (hyperglycemia) in adults with endogenous Cushing’s syndrome. who have type 2 diabetes or glucose intolerance and are not candidates for surgery or who have not responded to prior surgery. Korlym should never be used (contraindicated) by pregnant women. About 5,000 patients will be eligible for Korlym treatment, which received an orphan drug designation by the FDA in 2007. Korlym blocks the binding of cortisol to its receptor. It does not decrease cortisol production but reduces the effects of excess cortisol, such as high blood sugar levels.Prior to FDA’s approval of Korlym, there were no approved medical therapies for the treatment of endogenous Cushing’s syndrome.


The safety and efficacy of Korlym in patients with endogenous Cushing’s syndrome was evaluated in a clinical trial with 50 patients. A separate open-label extension of this trial is ongoing. Additional evidence supporting the agency’s approval included several safety pharmacology studies, drug-drug interaction studies and published scientific literature. Results from the clinical trial showed that patients experienced significant improvement in blood sugar control during Korlym treatment, including some patients who had marked reductions in their insulin requirements. Improvements in clinical signs and symptoms were reported by some patients.


The most common side effects in clinical trials were nausea, fatigue, headache, arthralgia, vomiting, swelling of the extremities, dizziness and decreased appetite. Other side effects included adrenal insufficiency, low potassium levels, vaginal bleeding and a potential for heart conduction abnormalities. Certain drugs used in combination with Korlym may increase its drug level. Health care professionals must be aware of the potential for drug-drug interactions and adjust dosing or avoid using certain drugs with Korlym.


Korlym should never be used by pregnant women. Although pregnancy is an extremely rare, occurrence in Cushing’s syndrome patients because of the suppressive effect of excess cortisol on female reproductive function, Korlym will carry a Boxed Warning advising health care professionals and patients that the therapy will terminate a pregnancy.


The FDA has determined that a Risk Evaluation and Mitigation Strategy (REMS) is not necessary for Korlym to ensure that the benefits outweigh the risks for patients with endogenous Cushing’s syndrome. Several factors were considered in this determination including the following:


  • There are no other approved medical therapies for this debilitating form of Cushing’s syndrome and very sick patients would suffer if impediments to access were imposed.
  • The number of Cushing’s syndrome patients who will require treatment with Korlym is small, with an estimated 5,000 patients being eligible for treatment.
  • The number of health care professionals in the United States who would potentially prescribe Korlym is very small and highly specialized. They are familiar with the risks of Korlym treatment in the endogenous Cushing’s syndrome population and frequently monitor patient status.
  • The risks of Korlym treatment in the intended population can be managed through physician and patient labeling. The risks associated with Korlym will be outlined in a medication guide for patients.


The company has voluntarily proposed distributing Korlym through a central pharmacy to ensure the timely, convenient and appropriate delivery of the drug to Cushing’s patients or to the health care institutions where this therapy may be initiated. Most retail pharmacies are unlikely to keep adequate supplies of the drug for this rare condition and central distribution will give patients with Cushing’s syndrome better access to Korlym.


Korlym is manufactured by Corcept Therapeutics of Menlo Park, Calif.

Let the “Sunshine” In…



By Mark L. Horn, MD, MPH, Chief Medical Officer, Target Health Inc.



This past Friday was the final opportunity to comment on CMS’ proposed rule implementing the “Sunshine” provisions in the Affordable Care Act. Briefly, and with acknowledged “editorializing”, these provisions seem predicated on the assumption that there are irremediable conflicts of interest created by payments from industry to providers (physicians, teaching hospitals, and certain others) which they seek to address by creating a searchable database of most (there are some exemptions) of these payments. The presumed objective is captured in a famous quote from Supreme Court Justice Louis Brandeis…”Sunlight (per Justice Brandeis) is the best disinfectant”.


Interestingly, the financial penalties for non-compliance fall on manufacturers; providers are offered the chance to review the data before these go ‘live’ on the web, but apparently suffer reputational risk only, e.g., no financial liability, for failure to examine and correct the information. The (admittedly unverifiable) assumption seems to be that the potential embarrassment of receiving support from product manufacturers will prove sufficient motivation for providers to review and correct erroneous entries or, in the extreme, entirely avoid engaging with industry.


The rule and its proposed implementation have, unsurprisingly, proven contentious. It’s worth asking if, in addition to the basic work and associated expense involved in collecting and reporting the data, there are potential downsides and unintended consequences.


There have indeed been (too) many highly publicized allegations of financially motivated provider-manufacturer misbehavior. At the same time, both society and the overall business community have come to appreciate that more interaction and communication are generally better than less, especially in highly technical matters. Given that, might the medicine prescribed in this case, which may well result in diminished interactions among industry and the medical and scientific communities, reflect (to borrow and slightly twist a cliché) an example of “tough cases making bad law”.


Among the reportable types of compensation (limiting this discussion to issues most relevant to Target Health clients) are payments to investigators conducting clinical research. Presumably, (and again, acknowledging that some will disagree) many readers of On-Target would consider this an honorable and societally beneficial activity. Therefore, the question emerges; does the proposed reporting requirement create a risk to the research enterprise? Do we, by potentially embarrassing providers who participate in clinical research, risk meaningfully diminishing participation in the process? If so, does it matter; is the risk of losing investigators real, and is it justified by the benefits of broad disclosure?


Finally, if the risk is justified is there anything we can do to mitigate it?


Some creative thinking is justified.


Imagine if industry supported a public education effort focused on the value of clinical trials overall and specifically the critical importance of participation by motivated, well trained physicians. The goal is to make these relationships with industry sources of pride, not shame. Imagine if patients actively sought out clinical investigators for care, if physician investigators and teaching hospitals conducting trials proactively directed patients to the CMS website confirming their role in industry sponsored clinical investigations. That would be, for all parties, a salutary outcome from this rule, one which supports the goal of transparency while concurrently acknowledging the virtue of (at least some) industry-physician relationships.


An idea, perhaps, for industry trade associations to consider?

Love  Makes  the  World  Go-Round




Eat Your Way to a Spicier Sex Life



These reputed aphrodisiacs may liven up your love life



Reviewed by Laura J. Martin, MD


WebMD.com, by Elizabeth M. Ward MS, RD  —  If your love life needs a tune-up, and you’re tempted to try certain foods to reignite the spark, edible aphrodisiacs can turn up the heat in more ways than one.

“For centuries, the smell, taste, and appearance of food has been touted as passion-producing,” says Sari Greaves, RD, spokeswoman for the American Dietetic Association and co-author of the Cardiac Recovery Cookbook.

Some foods are reputed to strip away inhibitions. Others claim to put you in the mood for lovemaking, and still others boast of improving blood flow to your genitals, enhancing performance and pleasure.

There’s more folklore than scientific proof to substantiate the link between food and passionate sex. But that’s no reason why you and your partner should shy away from these so-called natural love potions.

It’s a win-win situation. The most notorious food aphrodisiacs are a treasure trove of nutrients necessary for sexual prowess and good health.

Sexually Suggestive Fruits and Vegetables

Some people find produce erotic. Bananas, asparagus, cucumbers and carrots speak for themselves on that score.

Avocados, Greaves says, were prized by the Aztecs, who called them “testicle trees” because they grow in pairs. Ancient Greeks and Romans feasted on figs to promote potency.  And let’s not forget pomegranates, also known as “love apples.”

Those ancient civilizations were on to something. Fruits and vegetables are loaded with vitamins and minerals required to produce sex hormones necessary for sexual arousal and pleasure.


Ever wonder where the term “honeymoon” came from?

Centuries ago, newlyweds in Europe drank honey wine during the first month of marriage to improve their sexual stamina. As a bonus, the long-ago lovebirds also got small amounts of beneficial vitamins, minerals, and antioxidants from honey.


The Aztec emperor Montezuma’s chocolate consumption is legendary. Rumor has it that he drank 50 glasses of honey-sweetened chocolate a day in the name of virility.

Perhaps Montezuma valued chocolate for its feel-good qualities, too.  Cocoa beans contain phenylethamine, a compound that triggers the release of endorphins, compounds associated with pleasure.

Nowadays, cocoa powder processed without alkaline provides the biggest bang for the buck. It contains the highest levels of the antioxidants associated with lower blood cholesterol levels, reduced inflammation in blood vessels, and maximum blood flow. Darker chocolate contains more cocoa powder.


Oysters are dripping with dopamine, a compound that stirs feelings of sexual desire, and pleasure. These mollusks are also bursting with zinc, a mineral that fosters the production of testosterone, necessary for arousal and pleasure in men and women.

You may need to resist the temptation to ply your paramour with raw oysters – your romantic interlude could end with a severe case of food poisoning. Most raw oysters in the U.S. carry a bacterium called Vibrio vulnificus.  Healthy people are unlikely to have adverse affects from eating raw oysters, but those with diabetes, liver disease, immune systems disorders, AIDS, and other chronic diseases can end up with a severe infection that may be fatal.


You can’t get down when you’re uptight. Eating salmon can help brighten your disposition.

“Salmon harbors an abundance of omega-3 fats, which qualifies it as a natural mood booster,” says Susan Kleiner, PhD, RD, author of The Good Mood Diet: Feel Great While You Lose Weight.

Salmon also supplies large amounts of vitamin D.  Researchers at the University of Toronto have found that vitamin D appears to work in the brain like many antidepressantmedications do: by raising levels of serotonin, a neurotransmitter that induces feelings of calm and banishes bad moods.


Rich in antioxidants that protect against cell damage, garlic is said to stir sexual desire and increase blood flow, says Greaves.

Just be sure to eat as much as your bed partner, as the effects of garlic can linger on your breath for hours.


Nothing says seduction like popping the cork on the best bottle of bubbly money can buy, if that’s what you enjoy.

A drink a day may help reduce the risk of heart disease in healthy people, but more than that may turn your tryst into a snooze fest.

Alcohol is a central nervous system downer.  Chronic drinking is linked to erectile dysfunction, which will put a damper on lovemaking.

The Couple that Eats Together, Sleeps Together?

If you enjoy foods with a reputation for making you hot to trot, you may be thinking about whipping up meals that will knock your socks off, and your partner’s.

“A delicious meal can be a prelude to sex,” Kleiner says.

The act of cooking together can be a form of foreplay, and the smell of food can ignite intimacy, too.

According to Greaves, research has shown that the aroma of pumpkin pie, cheese pizza, and buttered popcorn induced blood flow to the penis, and the combination of pumpkin pie and lavender did the best job.  Women, on the other hand, responded to a combination of Good & Plenty and cucumber.

The smell of vanilla is particularly alluring.  “Add vanilla extract to whole grain French toast or drop a vanilla bean into your champagne,” she recommends.

If you’re not interested in any of the foods with a reputation for enhancing your love life, are you doomed to a lust-free existence? Not at all.

What matters most is that you and your partner dine on meals that include foods that you both enjoy, as long as you don’t overeat or drink yourself into a stupor, Kleiner says. She puts it this way: “What you eat on a daily basis is far more important to overall sexual satisfaction that a single meal.”

Good Health, the Ultimate Aphrodisiac


In the long run, peak physical and emotional well-being is key to a satisfying sex life.

“If you want better sex, take care of your health,” advises Judith Reichman, MD, author of I’m Not In the Mood: What Every Woman Should Know About Improving Her Libido.


You don’t need to be model-thin to have a wonderful sex life, but if you’re uncomfortable with your weight, you may not be at your best in the bedroom for a few reasons.

“Being overweight may deflate your libido, especially if you don’t feel attractive,” says Kleiner.

Extra body fat raises the specter of elevated blood glucose levels that can damage the blood vessels and nerves that allow for arousal and sexual pleasure.  It also increases the risk for high blood pressure and clogged arteries.

Clear, flexible arteries allow maximum blood flow to all the right places during sex, enhancing your pleasure.

A balanced diet rich in whole grains, fruits, vegetables, legumes, and other lean protein foods helps to control your blood pressure, blood cholesterol levels, and your weight.

But don’t cut too many calories.

According to Reichman, upon menopause, women lose 90% of their circulating estrogen, which may result in less blood flowing to the genitals and diminished capacity for arousal.  Body fat offers some protection, because, like your ovaries, it produces estrogen.

Whatever your weight, exercise may help to ignite your love life by improving circulation, managing blood pressure, increasing energy levels, and helping you to look better, which can have a positive effect on your sex life.




H  a p p y        V a l e n t I n e s          D a y           E v e r y o n e !


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