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Overview

Benefits of Beer And Its Side Effects

The health benefits of beer are vast, ranging from prevention of cancer and diabetes, to aiding the digestive system, as well as for treating osteoporosis and hypertension. Beer is very effective in preventing the formation of kidney stones. Beer is rich in vitamins, which helps prevent anemia, as well as promotes skin and hair health. Consumption of beer on a moderate basis has been proved to drastically reduce cholesterol levels, and keep the heart healthy, as well as prevent the onset of cardiovascular diseases.

Benefits of Beer And Its Side Effects

Table of Content

Beer
Nutritional Value of Beer
Health Benefits of Beer
Helps prevent cancer
Reduces risk of cardiovascular diseases
Helps control diabetes
Prevents Alzheimer’s disease
Prevents formation of kidney stones
Helps reduce cholesterol levels
Helps strengthen bones
Treats dandruff
Prevents anemia
Improves skin health
Cleanses gastro-intestinal tract
Uses of Beer
Side-Effects & Allergies of Beer
Cultivation of Beer

Beer

One of the most widely consumed alcoholic beverages in the world, beer is brewed from malted barley, and occasionally from wheat and maize. During the brewing process, fermentation of the starch sugars in the wort produces ethanol and carbonation in the resulting beer. In commercial brewing, the natural carbonation effect is often removed during processing and replaced with forced carbonation.

Nutritional Value of Beer

A regular bottle of beer is loaded with around 145 calories and around 11-15 grams of carbs. The water used to make beer is boiled very early on in the brewing process, as a result of which any present pathogens are killed off. The presence of folate in beer helps lower the risk of heart disease when consumed in moderation. Beer also reduces blood clots and it has been shown to improve mental function in women as well as increasing bone density.

Health Benefits of Beer

Mentioned below are the best health benefits of Beer
Health Benefits of Beer

Helps prevent cancer

A flavonoid compound called Xanthohumol is found in the hops commonly used in brewing beer. It has been seen to play a major role in the prevention of cancer, including prostate cancer. Beer also contains polyphenols, which – similar to red wine – are very effective in fighting cancer.

Reduces risk of cardiovascular diseases

Beer is rich in Vitamin B6, which helps protect against heart diseases by preventing the build-up of a compound called homocysteine. It has a thinning effect on the blood and prevents the formation of clots, which cause blocks in the coronary arteries. Consumption of beer in moderate amounts also reduces the risk of inflammation, which is the root cause of atherosclerosis.

Helps control diabetes

Studies have reported that people who drink a moderate amount of beer have a lower risk of developing Type 2 diabetes. A moderate intake of beer, combined with exercise and a diet rich in vitamins, can help combat diabetes. Beer significantly reduces blood glucose levels, thus helping patients suffering from diabetes.

Prevents Alzheimer’s disease

Perhaps one of the most remarkable health benefits of beer is its ability to protect against Alzheimer’s. Studies have reported that moderate beer drinkers are 23% less likely to develop different forms of dementia and cognitive impairment, including Alzheimer’s. The silicon content in beer is thought to protect the brain from the harmful effects of high amounts of aluminum in the body, which are one of the possible causes of Alzheimer’s.

Prevents formation of kidney stones

Moderate daily consumption of beer can greatly reduce the risk of developing kidney stones. Beer has a high-water content, which helps flush out harmful toxins from the body, and keeps the kidneys functioning properly. Also, compounds in hops used in brewing help slow the release of calcium from bones, which in turn prevents buildup of lost calcium in the kidney in the form of stones.

Helps reduce cholesterol levels

Moderate consumption of beer is one of the most unorthodox, yet a very effective way of cutting down on your cholesterol levels. The barley used in brewing of beer contains a type of soluble fiber known as beta-glucans that has been shown to help in lowering cholesterol levels.

Helps strengthen bones

Beer contains pretty high amounts of silicone. Silicone is very intricately linked to bone health. People who drink beer in moderate amounts are less prone to fractures owing to a higher bone density, than people who do not drink beer.

Treats dandruff

Beer is considered one of the best natural treatments for dandruff. Beer has high levels of yeast and Vitamin B, which makes it very effective against dandruff. Rinsing your hair with beer, or a shampoo that contains beer is enough to get rid of dandruff and make your hair healthy and shiny.

Prevents anemia

Beer is a good source of vitamin B12 and folic acid, a deficiency of which may lead to anemia. Vitamin B12 is also essential for maintaining normal growth, good memory and concentration.

Improves skin health

Beer contains vitamin E, which is a very effective antioxidant. Thus, beer helps maintain healthy skin. Studies have also shown that regular consumption of beer in moderate amounts can help slow down the aging process of skin.

Cleanses gastro-intestinal tract

Beer is a good source of soluble fibers that promote general health. These soluble fibers are good for the heart, and they are also very helpful in cleaning up the digestive tracts.

Uses of Beer

Beer is not only the world’s most-widely consumed alcoholic beverage, it also a huge variety of other uses. Beer is often used to help prevent heart and circulatory diseases, and is also effective in treating congestive heart failure. Studies have reported that people who drink a moderate amount of beer have a lower risk of developing Type 2 diabetes. Beer contains antioxidant compounds as well as vitamins and proteins which help improve skin and hair health. Beer is a great addition to your daily beauty routine, as it contains a variety of acids, enzymes as well as other healthy compounds that are derived from the process of fermentation.

Side-Effects & Allergies of Beer

When consumed in moderation, beer can actually be good for health. However, excessive drinking can have a negative impact on health. Drinking too much beer can adversely affect blood sugar levels. Beer works as a diuretic, so while it may be extremely refreshing to drink on a hot day, drinking in excess can make you lose fluid both through urine and sweat in such situations. Also, a majority of beer variants found in the market contain malted barley. Barley contains gluten, a type of protein. Some people are allergic to gluten, so you need to double check the compounds present in your beer, in that case. Beer contains some stimulants that work with gastric acid, which may lead to the onset of gastro-esophageal reflux and result in heartburn.

Cultivation of Beer

Beer is one of the oldest beverages in the world. The ancient Egyptians first documented the brewing process on papyrus scrolls around 5,000 B.C. These first beers were brewed with things like dates, pomegranates, and other indigenous herbs. The Egyptians used beer for religious ceremonies, with the Pharaoh directing the brewing schedule and distribution to the masses. Beer eventually made its way from the Middle East across the Mediterranean to Europe, where it became an integral part of life. Along with Northern European countries like Germany and Belgium, the British Isles too, became a brewing center. Many styles of beer familiar to drinkers today have their roots in Britain; pale ales, porters, and stouts have been brewed in England and Ireland for hundreds of years. Details of the brewing process depend very much on the type of beer to be produced and can also differ considerably from country to country and even from brewery to brewery.

Popular Questions & Answers

I just had high bp one day due to excessive drinking one day I wake up after some time I felt something in my right head side I felt very uneasy I went to doctor and he told me your bp is high then he given me telvas 3d I taken that medication regularly for 2 months. Then I stopped taking it and maintain good life style like eating and stopped drinking also .previously my weight was 120 now it is 89 in 2 years good diet. I regularly walk for 45 min daily now .but some times I have beer after long time my heath get worse other day also I am facing this problem like I feel unstable while standing or sitting can you just provide me some right information what should I do.

MBBS
General Physician, Delhi
Hi lybrate-user, there could be many reasons for your leg weakness. This could be your body’s way of saying you are walking too much, or it could be a symptom of a medical condition. I have discussed some of them here: 1. Muscle Fatigue - During any physical activity, you run the risk of tiring your muscles out and overexerting yourself. Although walking might not seem like a challenging activity, if you walk a long distance, wear unsupportive shoes, walk on pavement or other hard surface, or walk on a steep incline, you can wear your legs out. Dehydration, muscle strain and overuse can create aching and tiredness in your legs while you walk. 2. Medical Conditions - Certain medical conditions can lead to aching and tiredness in your legs while you walk as well. Atherosclerosis, blood clots, arthritis, nerve damage and varicose veins affect the nerves or blood supply to your legs. If you have spinal-nerve damage or leg-nerve damage, you might feel tingling or numbness that makes your legs feel tired. Medications such as diuretics and statins can also cause leg pain. Solutions: Symptom Relief - You can manage your symptoms and help your legs at home with rest and elevation. Use pillows to prop your legs up, above the level of your heart if possible. If they are feeling tired, avoid standing or strenuous activity for the remainder of the day. Place ice on your aching leg muscles to help relieve pain immediately. If there is no redness or swelling present, take a warm bath to soothe your muscles. If your pain persists, try an over-the-counter anti-inflammatory pain medication such as aspirin or ibuprofen. Another helpful treatment at home is to use wrap an elastic bandage around your legs. The compression from the bandage will help reduce pain and improve blood flow. Hope this helps. Good Luck.

I'm 55 years old doing exercise for making body muscles. I'm diabetic. In control. Shell I use beer everyday. Please suggest me.

Bachelor of Ayurveda, Medicine and Surgery (BAMS)
Ayurveda, Davanagere
Dear lybrate-user. Little quantity of beer you can take i.e 30 to 90 ml. If you drink more it may cause liver problem etc.

My mom age 45 suffering with joint pains knee pains etc so naturally which is better either MILK OR EGG. I also heard that having limit of alcohol { beer } regularly is good for health. please kindly let me know .Thank you.

Diploma in Naturopathy & Yogic Science (DNYS), MD - Acupuncture
Acupressurist, Delhi
dear I m happy that you are so concerned for your mom. joints pain are simply linked with Liver& gallbladder ask your mother to eat her meals on time 8 am, 2 pm, 8pm that makes proper haemoglobin that goes to liver liver stores blood and creates bile which stores in gall bladder gallbladder nourishes/controls all joints actually her weight is 9 kg excess then normal according to her height this will help her in controlling her weight also

I have dry allergic cough no phelgum feeling bronchitis give your best treatment.

MBBS, PG Diploma In Emergency Trauma Care, Fellowship in Diabetes
General Physician, Delhi
URTI-Take warm or hot drinks often – hot tea , hot coffee,hot Soups, hot milk. Avoid Fried/Oily foods like –Samosa, Dosa, Pakora, Papad, Namkeens, Potato Chips , Namkeens . Avoid Hotel Food, Avoid Fast food,Hamburgers, Pizza.Do not take any COLD drinks , cold water, ice cream, chilled food from refrigerator. Take soft foods like rice Gurrel (Khichdi), Plain daal, boiled vegetables.Avoid Chillies completely. Take plain warm water, Cocunut water, Enerzal in warm water.Avoid Cold Milk , Meat Products ,Fried rice and noodles. Avoid Sour fruits like Citrus fruits, grapes . Avoid heavy meals, eat small frequent meals. Avoid Alcoholic drinks of all kinds like Beer, Wine,whisky,vodka etc.Warm saline gargles thrice daily. Steam inhalation thrice daily.Rest for 5 days private consult me for proper details

Popular Health Tips

Empty Stomach - 8 Food Types That You Must Avoid!

Bachelor of Science in Nutrition and Dietetics, Diploma in Diet and Nutrition
Dietitian/Nutritionist, Delhi
Empty Stomach - 8 Food Types That You Must Avoid!

Do you know not all foods can be consumed on an empty stomach? So, it is imperative that you should be aware of such foods and restructure your breakfast menu accordingly. Here is a list of foods to avoid on an empty stomach.

Stay away from the following foods when you eat after a considerable gap

  1. Citrus fruits: Citrus fruits contain fruit acids. When these acids enter an empty stomach, they can lead to heartburn. Hence, if eaten after a prolonged period post meal, a person is at risk of gastritis and stomach ulcers.
  2. Soda: Consuming cold soda drinks on an empty stomach may cause damage to the mucosal membrane while reducing blood flow to the stomach. This may lead to a slow digestive process and difficulty in the abdomen.
  3. Spicy foods: Spicy foods are known to cause irritation and damage to the digestive tract, and are especially not recommended for people who suffer from acid reflux issues since very spicy food leads to consequences such as acid reflux in the food pipe.
  4. Cucumber and other green vegetables: Green vegetables and cucumber are rich in amino acids. If consumed on an empty stomach it may very well lead to pain and bitterness in the upper abdomen.
  5. Tomato: Tomato is a fruit containing high levels of tannin. Tannin causes acidity in an empty stomach and leads to consequences and appearance of gastritis if frequently consumed in such a manner.
  6. Fermented milk products: Fermented milk products such as yogurt typically come with loads of health benefits being full of probiotics. But if consumed on an empty stomach it can interfere with the balance of healthy bacteria as the hydrochloric acid produced tends to be destructive.
  7. Sweets: Items such as candy or sweetmeats contain high levels of sugar and cause a sudden and sharp surge of insulin levels in the blood. Over a long period, this has a bad effect on the pancreas.
  8. Products containing yeast: Edible items such as biscuits, puff pastry, vinegar and beverages such as beer and wine contain yeast which can significantly irritate the stomach and cause bloating.

So, be a little conscious and avoid consuming these items on an empty stomach since a little effort goes a long way. In case you have a concern or query you can always consult an expert & get answers to your questions!

10652 people found this helpful

Home Remedies For Diabetes

Diploma in Naturopathy & Yogic Science (DNYS), bachelor Of Science in Nursing
Yoga & Naturopathy Specialist, Ahmedabad
Home Remedies For Diabetes


Natural hone remedies to treat diabetes at home

Diabetes treatment: 15 home remedies to treat diabetes at home (thinkstock photos/getty images)

India is said to be the diabetes capital of the world. With nearly 50 million people in india suffering from diabetes, the country has a big challenge to face. First, let's know what is diabetes. The elevated sugar in the blood is called diabetes. There are two primary reasons behind diabetes - one is when our body stops producing insulin and second is when the body does not respond to insulin that is produced by the body. Insulin is broken down by the body and used as energy, which is transported to the cells. There are two types of diabetes - type I diabetes and type ii diabetes. Let's know about them in a little detail: 

Type I diabetes 


Type I diabetes usually occurs in people who are below the age 20 and that is why it is also called as juvenile diabetes. In this type, the body becomes partially or completely unable to produce insulin. Type I diabetes is an autoimmune disease. In this, your immune system attacks the pancreas from where the insulin is produced, thereby making the pancreas inefficient or unable to produce insulin. Type I diabetes cannot be prevented, it can only be controlled with healthy lifestyle changes.

Type ii diabetes

Type ii diabetes is more common than type I diabetes in india. Type ii diabetes usually happens to people who are above the age of 40. This type of diabetes is caused due to insulin resistance. In this case, the pancreas produces insulin but the body is not able to respond to it properly. There can be many reasons behind type ii diabetes. Some of the reasons can be being overweight, high blood pressure, having a poor diet, taking too much stress, hormone imbalance, certain medications and leading a sedentary lifestyle. Though type ii diabetes can be reversed. 

Let's us know some natural ways by which we can treat diabetes at home: 

What not to eat: 

There are some foods which can negatively impact your diabetes. So, the first thing you need to do is to remove these foods from your diet. 


1. Refined sugar - we all know that sugar, until it is in its most natural form, is bad for people suffering from diabetes. When consumed, refined sugar spikes the blood sugar rapidly. Sometimes even the natural form like honey can cause a sudden spike in the blood sugar levels. So, it's better to avoid refined sugar by all means if you are a diabetic. 


2. Whole grains - grains that have gluten in them should be avoided. Gluten is associated with diabetes as its intake can cause leaky gut leading to inflammation which in turn can lead to auto immune diseases. 


3. Alcohol - alcohol consumption is directly related to diabetes. Alcohol not only damages your liver but also attacks the pancreas that produces insulin. Diabetes is linked with consumption of heavy alcohol which is two to three glasses a day. Beer should especially be avoided as it has a lot of carbohydrates. 


4. Cow's milk - just like whole grains, cow milk can trigger the immune system which can lead to inflammation. Milk coming from sheep and goat is not harmful in fact it helps to maintain the blood sugar level. But the conventional cow milk can be dangerous for you if you are suffering from diabetes. 


5. Gmo foods - gmo foods have the capability to promote diabetes along with causing liver and kidney diseases. Go for products which are labeled as gmo-free. 

What to eat and do 

Cinnamon 

Cinnamon contains a bioactive compound that can help to fight and prevent diabetes. Cinnamon is known to stimulate the insulin activity and thus regulate the blood sugar level. As excess of anything is bad, likewise cinnamon if taken in excess can increase the risk of liver damage due to a compound called coumarin present in it. The true cinnamon, not the one buy from shops (cassia cinnamon) is safer to have.

How to consume cinnamon 

- mix half or one teaspoon of grounded cinnamon with warm water and have it once daily. 

- boil raw cinnamon in 2 glasses of water. Let it cool for 30 minutes and have it daily.

Aloe vera

Aloe vera is easily found in indian households. Though it's bitter in taste, but combing it with buttermilk makes it taste better. Usually, aloe vera is used for beauty purposes but as it has anti-inflammatory properties it can heal the wounds. Due to its anti-inflammatory properties, it is said to control the blood sugar levels. 

Jamun 

Jamun and its leaves have proven to be helpful in lowering the blood sugar levels. Consuming approximately 100 grams of jamun every day is said to show tremendous improvement in your blood sugar levels.

Vitamin c

Vitamin c is not only good for skin but also for diabetes. Recent studies have shown that consuming approximately 600 mg of vitamin c daily can improve the blood sugar level significantly. People who have chronic diabetes should consume foods rich in vitamin c every day. Some foods rich in vitamin c are amla, orange, tomato and blueberry. 

Exercise

One of the main reasons behind type ii diabetes is being overweight. Any kind of physical activity, be it yoga, zumba, aerobics, gymming, playing sports can significantly improve blood sugar level by maintaining your weight. Not only this, walking every day can help to reduce the blood sugar level tremendously. 

3 people found this helpful

Know More About Allergies

BHMS
Homeopath, Delhi
Know More About Allergies

 What is An Allergy or Seasonal Allergic Rhinitis?

An allergy is an exaggerated immune response to substances (allergens) that are generally not harmful, such as tree or grass pollen, molds, pet dander, food or dust mites. Your immune system overreacts to these allergens by producing antibodies called Immunoglobulin E (IgE). IgE antibodies travel to cells and release certain chemicals that cause allergy symptoms. Seasonal allergic rhinitis is also called 'hay fever' or 'allergic rhinitis'. Rhinitis is another word for stuffy or runny nose. Other symptoms, such as a scratchy throat, cough, sneezing, and red and itchy eyes are also common with seasonal allergies.

When Does Hay Fever Most Frequently Occur?

Allergies that occur throughout the year (perennial allergic rhinitis) are often due to a year-round sensitivity to animal dander, dust mites or cockroaches. Seasonal allergic rhinitis, or hay fever, most often occurs in the spring and fall seasons.

Trees, grasses and ragweed release airborne pollen during spring and summer, while concentrations of mold spores are higher in summer and fall. An individual’s specific hay fever season is fairly predictable and may occur year after year.

How Do I Know Which Allergy I Have?

A doctor can evaluate your allergy, help pinpoint the most likely cause, and advise on the most appropriate treatment. Your doctor will check your family history of allergies, ask about specific symptoms and when they occur, and question you about other allergy-related disorders, such as asthma, hives or eczema. Your nose, eyes and throat will be checked during a physical exam.

Pinpointing the actual allergy may be easy in those with a predictable response to a given substance. In others, a blood test or referral to a specialist may be needed.

Is There Any Way to Prevent Hay Fever?(PREVENTION)

Yes! One way to help prevent allergies is to stay away from the allergen, but in many cases, this is not practical or possible.

1)staying indoors as much as possible during the allergy season,
2) keeping doors and windows closed, 
3)using the dryer to dry clothes, and cooling the house down with an air conditioner may help.
4) Wear a face mask if you can't avoid yard work or ask somebody to do it for you.
5) Always shower and wash your hair before bedtime to remove any pollen that may have accumulated on your skin and hair during the day. 
6)The use of HEPA filters in the home to trap particles such as pollen and dust can also be effective.

How HOMOEOPATHY is Available For Allergy Prevention?

HOMOEOPATHY do wonders in allergy. 

  • Histamine – allergic to dust, strong perfumes
  • Natrum Mur – allergic to bread; acidic food
  • Kali Bich – allergic to beer; malt liquor
  • Sepia – allergic to warm boiled milk
  • Hepar Sulph – allergic to cod liver oil
  • Carbo Veg – Allergic to aspirin; bad liquors, salt butter, bad eggs, poultry items
  • Sulphur – allergic to antibiotic
  • Bryonia – allergic to castor oil
  • Nux Vom – allergic to coffee
  • Apis Mel – allergic to heat
  • Arsenic Album -Allergic to cold drinks; fruits; rotten foods, iodine
  • Dulcamara – allergic to dampness
  • Ailanthus – allergic to smell of flowers
  • Thuja – allergic to sweets; fatty meats, onion
  • Argentum nit – allergic to sugar
  • Tellurium – allergic to rice
  • Petrolium – allergic to cabbage
  • Nitri-spiritus dulcus – allergic to cheese
  • Justicia adhatoda – allergic to dust; coryza with profuse nasal discharge and sneezing in the evening.
3 people found this helpful

8 Foods That Can Cause Your Belly To Bloat!

Diploma in Diet and Nutrition -, Diploma in Dietitics , Health & Nutrition
Dietitian/Nutritionist, Delhi
8 Foods That Can Cause Your Belly To Bloat!

Do you feel your stomach bloat after meals? If you notice, this doesn't happen after every meal? Only at times. And at other times when you eat specific foods. Well, there are foods cause your stomach to bloat, so the wise thing to do is to know about them and avoid them!

Here are a few of the biggest criminals:

1. Cold drinks: Yes, these carbonated drinks have numerous side effects on your health. One of them is that they bloat your tummy. Beer happens to fall in this category too.

2. Dairy Products: For the lactose intolerant, dairy products are almost like poison. The intolerance can be mild, moderate of severe, but one of the symptoms is gas. You can try to limit your consumption of dairy products.

3. Apples: Apples and pears are known to contain a high percentage of fiber. While they are important for us and should be eaten, if is good to know that they can affect sensitive tummies. Eat bit by bit, and if it helps, peel the skin and then eat.

4. Few Vegies: While they are excellent health foods, asparagus, cabbage and broccoli are the vegetables which cause gas in the stomach, which in turn leads to bloating of the tummy.

5. Sodium: Sodium is also another reason for bloated tummies, so it is advised to limit salt intake.

6. Fast Foods: Fast foods like sausages, fried foods, ice cream, sweetened products , etc are known to cause the belly to bloat.

7. Rice Preparations: Rice is known to swell up inside the stomach once it gets water, hence making the stomach feel bloated.

8. Hard Drinks: Alcohol is also said to add weight near the stomach and make it feel bloated. If you wish to discuss about any specific problem, you can consult a Dietitian/Nutritionist.

4451 people found this helpful

Foods That Bloat Your Belly!

M. Sc. Foods, Nutrition & Dietetics, B.Sc-Home Science
Dietitian/Nutritionist, Visakhapatnam
Foods That Bloat Your Belly!

Do you feel your stomach bloat after meals? If you notice, this doesn't happen after every meal? Only at times. And at other times when you eat specific foods. Well, there are foods cause your stomach to bloat, so the wise thing to do is to know about them and avoid them!

Here are a few of the biggest criminals:

1. Cold drinks: Yes, these carbonated drinks have numerous side effects on your health. One of them is that they bloat your tummy. Beer happens to fall in this category too.

2. Dairy Products: For the lactose intolerant, dairy products are almost like poison. The intolerance can be mild, moderate of severe, but one of the symptoms is gas. You can try to limit your consumption of dairy products.

3. Apples: Apples and pears are known to contain a high percentage of fiber. While they are important for us and should be eaten, if is good to know that they can affect sensitive tummies. Eat bit by bit, and if it helps, peel the skin and then eat.

4. Few Vegies: While they are excellent health foods, asparagus, cabbage and broccoli are the vegetables which cause gas in the stomach, which in turn leads to bloating of the tummy.

5. Sodium: Sodium is also another reason for bloated tummies, so it is advised to limit salt intake.

6. Fast Foods: Fast foods like sausages, fried foods, ice cream, sweetened products , etc are known to cause the belly to bloat.

7. Rice Preparations: Rice is known to swell up inside the stomach once it gets water, hence making the stomach feel bloated.

8. Hard Drinks: Alcohol is also said to add weight near the stomach and make it feel bloated. If you wish to discuss about any specific problem, you can consult a Dietitian/Nutritionist.

4104 people found this helpful

Table of Content

Beer
Nutritional Value of Beer
Health Benefits of Beer
Helps prevent cancer
Reduces risk of cardiovascular diseases
Helps control diabetes
Prevents Alzheimer’s disease
Prevents formation of kidney stones
Helps reduce cholesterol levels
Helps strengthen bones
Treats dandruff
Prevents anemia
Improves skin health
Cleanses gastro-intestinal tract
Uses of Beer
Side-Effects & Allergies of Beer
Cultivation of Beer