RESHAPING BRAIN N LIFE-2

Evidence is gathering by the day that the brain isn't really an object but a continuous and active process. Thoughts and experiences create new pathways in the brain.

Brain health comes down to a simple-seeming formula: maximize the positive input and minimize the negative input. The result will be positive rather than negative output. To some extent the difference between positive and negative input isn't hard to define:

It's positive to maintain balanced diet, negative to eat an imbalanced one.
It's positive to take regular exercise; it's negative to be sedentary.
It's positive to have good relationships, negative to have stressful ones.

Anyone who has kept pace with the public campaign in prevention can make the list longer; the risk factors for a healthy lifestyle are well known. But this is where the difference between positive and negative get trickier. Information isn't the same as compliance. That Americans are getting more obese and sedentary while consuming massive quantities of sugar and fatty junk food isn't due to lack of information. Non-compliance is about inspiring your brain to function in a better way. This is a role assigned to the mind; the brain can't inspire itself.

But only you can sustain meaning and purpose. For all of its brilliant discoveries, neuroscience can't give your brain meaning, and if you feel that you lack purpose, there is no drug or surgery that will bring it back. At present, the main breakthroughs in neuroscience are medical. Curing organic disorders like Alzheimer's and depression are urgent goals since they undermine anyone's chance to find meaning and purpose.

But our emphasis is to raise the everyday functioning of the brain to a higher level. The baseline brain, as we call it, passively handles everyone's life given the input that is provided. Super brain, on the other hand, goes beyond the baseline brain to actively optimize what the brain can do -- it brings to life hidden potential that exists in everyone's brain. 

                     RESHAPING BRAIN N LIFE

 There are few things one must know about brain-
Your brain is constantly renewing itself.
Your brain can heal its wounds form the past.
Experience changes the brain every day.
The input you give your brain causes it to form new neural pathways.
The more positive the input, the better your brain will function.

  The old view of the brain as fixed for life, constantly losing neurons and declining in function, has been all but abolished. The new brain is a process, not a thing, and the process heads in the direction you point it in. A Buddhist monk meditating on compassion develops the brain circuitry that brings compassion into reality. Depending on the input it receives, you can create a compassionate brain, an artistic brain, a wise brain, or any other kind.

However, as we see it, the agent that makes these possibilities become real is the mind. The brain doesn't create its own destiny. Genetics delivers the brain in a functioning state so that the nervous system can regulate itself and the whole body. It doesn't take your intervention to balance hormone levels, regulate heartbeat, or do a thousand other autonomic functions. But the newest part of the brain, the neocortex, is where the field of possibilities actually lies. Here is where decisions are made, where we discriminate, worship, assess, control, and evolve.

If you think of everyday experience as input for your brain, and your actions and thoughts as output, a feedback loop is formed. The old cliché about computer software - garbage in, garbage out - applies to all feedback loops. Toxic experiences shape the brain quite differently from healthy ones. This seems like common sense, but neuroscience has joined forces with genetics to reveal that right down to the level of DNA, the feedback loop that embraces mind and body is profoundly changed by the input processed by the brain.

Our aim was to cut to the chase. If input is everything, then happiness and well-being are created by giving the brain positive input. Without realizing it, you are here to inspire your brain to be the best it can be. This is much more than positive thinking, which is often too superficial and masks underlying negativity. The input that inspires the brain includes a wide array of things. Everyone wants to experience positive feelings (love, hope, optimism, appreciation, approval) without knowing how to get them. For all the theories that proliferate about happiness, from the brain's perspective, the formula is to maximize the positive messages being received by the cortex and minimize the negative ones.

What this implies isn't a brave new world of thought control or pretending that life is rosy. Life will always present challenges, setbacks, and crises. The point is to create a matrix that will allow you to best adapt to both sides, the light and the dark, of experience. In our book, we were particularly focused on a setup that would take people into old age with a brain that remains dynamic and resilient.

Here is our recommendation, having considered the most up-to-date neuroscience.

Matrix for a Positive Lifestyle
Have good friends.
Don’t isolate yourself.
Sustain a lifelong companionship with a spouse or partner.
Engage socially in worthwhile projects.
Be close with people who have a good lifestyle – habits are contagious.
Follow a purpose in life.
Leave time for play and relaxation.
Keep up satisfying sexual activity.
Address issues around anger.
Practice stress management.
Deal with the reactive mind’s harmful effects: When you have a negative reaction, stop, stand back, take a few deep breaths, and observe how you’re feeling.

Your brain will thrive in such a matrix, even as life brings its ups and downs. But by the same token, the brain can't arrive at any of these things on its own. You are the leader of your brain. We’ll expand on this theme in the next post, since the whole issue of feedback loops turns out to be vital for all kinds of brain functions, including memory and the prevention of feared disorders like Alzheimer's.

LIFE WITHOUT INFLAMATION
How to know you have inflamation--
    A simple test called C reactive protein in blood is raised.
INFLAMATION -GOOD-BAD-UGLY
Everyone who has had a sore throat, rash, hives, or a sprained ankle knows about inflammation. These are normal and appropriate responses of the immune — your body’s defense system — to infection and trauma. This kind of inflammation is good. We need it to survive — to help us determine friend from foe. The trouble occurs when that defense system runs out of control, like a rebel army bent on destroying its own country. Many of us are familiar with an overactive immune response and too much inflammation. It results in common conditions like allergies, rheumatoid arthritis, autoimmune disease, and asthma. This is bad inflammation, and if it is left unchecked it can become downright ugly. What few people understand is that hidden inflammation run amok is at the root of all chronic illness we experience—conditions like heart disease, obesity, diabetes, dementia, depression, cancer, and even autism. A study of a generally “healthy” elderly population found that those with the highest levels of C-reactive protein and interleukin 6 (two markers of systemic inflammation) were 260% more likely to die during the next 4 years. The increase in deaths was due to cardiovascular and other causes. 
CAUSES OF INFLAMATION-
* Poor diet—mostly sugar, refined flours, processed foods, and inflammatory fats such as trans and saturated fats
* Lack of exercise
* Stress
* Hidden or chronic infections with viruses, bacteria, yeasts, or parasites
* Hidden allergens from food or the environment
* Toxins such as mercury and pesticides
* Mold toxins and allergens

7 Steps to Living an Anti-inflammatory Life

So once you have figured out the causes of inflammation in your life, gotten rid of them, the next step is to keep living an anti-inflammatory lifestyle. But how do you do that?

Here is what I recommend. It’s a disarmingly simple but extraordinarily effective way to achieve UltraWellness:

1. Whole Foods - Eat a whole foods, high-fiber, plant-based diet, which is inherently anti-inflammatory. That means choosing unprocessed, unrefined, whole, fresh, real foods, not those full of sugar and trans fats and low in powerful anti-inflammatory plant chemicals called phytonutrients.

2. Healthy Fats – Give yourself an oil change by eating healthy monounsaturated fats in olive oil, nuts and avocadoes, and getting more omega-3 fats from small fish like sardines, herring, sable, and wild salmon.

3. Regular Exercise – Mounting evidence tells us that regular exercise reduces inflammation. It also improves immune function, strengthens your cardiovascular systems, corrects and prevents insulin resistance, and is key for improving your mood and erasing the effects of stress. In fact, regular exercise is one among a small handful of lifestyle changes that correlates with improved health in virtually ALL of the scientific literature. So get moving already!

4. Relax - Learn how to engage your vagus nerve by actively relaxing. This powerful nerve relaxes your whole body and lowers inflammation when you practice yoga or meditation, breathe deeply, or even take a hot bath.

5. Avoid Allergens - If you have food allergies, find out what you’re allergic to and get stop eating those foods—gluten and dairy are two common culprits.

6. Heal Your Gut - Take probiotics to help your digestion and improve the balance of healthy bacteria in your gut, which reduces inflammation.

7. Supplement - Take a multivitamin/multimineral supplement, fish oil, and vitamin D, all of which help reduce inflammation.

Taking this comprehensive approach to inflammation and balancing your immune system addresses one of the most important core systems of the body.

In the future, medicine may no longer have specialties like cardiology or neurology or gastroenterology, but new specialists like “inflammologists”.

But by understanding these concepts and core systems that are the basis of healthy living now, you don’t have to wait.

CELLS & ORGANS OF IMMUNE SYSTEM

ADAPTIVE  IMMUNITY

1.GRANULOCYTIC CELLS-

                -Neutrophils

                -Eosinophils

                -Basophils

2-MONONUCLEAR PHAGOCYTES

                Enter from bone marrow as MONOCYTES and migrate to tissue as

                -Microglial cells of CNS

                -Kupffer cells of liver and vascular lining

                -Alveolar macrophages of Lung

3-DENDRITIC CELLS-

                In skin,gut mucosa, alveoli

4-LYMPHOCYSTES

                A-B LYMPHOCYTES-From Bone marrow-Produce antibody as mature plasma cells

                B-T LYMPHOCYTES-Develop in Thymus

                                1-T helper cell with CD4

                                2-CTL-Cytotoxic T lymphocytes with CD8

5-NATURAL KILLER CELLS-Large granular lymphocytes bearing CD16 and CD56-

BONE MARROW,THYMUS,LYMPH NODES,SPLEEN and various Mucosa associated Lymph tissue are associated with development of immune responce.

All cells develop in bone marrow except for follicular dendritic cells.

INNATE IMMUNE RESPONSES

Lack Antigen specificity and same set of diffence mechanism for all pathogens.

Earliest barriers to pathogens entry are physical and chemical as cilliary action of bronchial mucosa, enzymes in saliva and sweat, acidity of stomach

PAMP-Pathogen associated Molecular pattern

PRRs- PATTERN recognition Receptors-most important is TLR

                                                                                -NOD-1, NOD-2

When activated lead to production of proinflamatory cytokines ,antiviral cytokines,interferon alfa,

COMPLEMENT SYSTEM

20 SERUM PROTEINS WHICH AMPLIFIES the immune response and a single molecule can trigger thousands of terminal effector molecules.

3 pathways

1-Classical pathway-activated by antigen-antibody complex

2-alternate pathway-activated by polysaccharides of yeasts and gram negative bacteria

3-Mannon binding lecithin pathway-activated by mannose containg protein of bacteria

All pathway activation culminates in activation of C3 and generation of C5-C9 complexes(Membrane attack complex or MAC)

FUNCTION-

1-Lysis of invading bacteria

2-Opsonisation of organisms

3-Clearence of antigen-antibody complex

4-Trigegring specific cell function

               

SOCIAL JUSTICE

What the majority of people need in this country is a financial system that incorporates social justice. In calling it "just capital,"
three aspects of social justice must be addressed:
1. Income inequality -- Capitalism has been described as the best system for building wealth and the worst for distributing it. The right wing uses "redistribution of wealth" as a curse leveled at the Obama administration. Yet their howls of protest mask sheer greed and moral callousness. The upper 0.1 percent of income earners, who largely live off dividends, should do their part in keeping society fair. Wealth carries moral responsibility. Arguments against this principle, although couched as conservatism, are pure injustice of the kind that leads to a society unraveling at the seams.
2. Cronyism, corruption, influence peddling and power mongering -- Delhi has always looked corrupt from outside its borders, but the rise of influence peddling and cronyism under congress has become institutionalized. Government posts are simply the gateway to riches earned as a lobbyist and consultant. The fact that a power brokers can brazenly thrive through influence peddling is a sign that an immoral, unjust system has reached the breaking point.
3. Anti-democracy -- In some countries like Japan and Russia, the ruling elite is unchallenged in their role as managers of corporate, government, and military life.  India isn't supposed to be one of those societies. Our democratic ideals demand a more open system, in which every person has the opportunity to rise through merit and success. But rise of money power in politics has been anti democracy.
Money without merit
Power without resposibility and government without open system of redress is useless.

IN PURSUIT OF UNHAPPINESS

Driven sometimes by ambition and other times by a sense of inner incompleteness, we instinctively immerse ourselves in a myriad of pursuits. We often act out of the fear of losing out, compared to our peers or our social network.

We would rather be overwhelmed than miss out on the slightest chance to please the boss, make more money, enhance our status, accumulate more clothes or gadgets, or go to the extra social event. We also find it hard to let up on instantly responding to text messages, checking our e-mails or facebook accounts multiple times a day or randomly watching television.

What suffers in the process is our attention to our most important priorities – the ones that actually make us feel fulfilled and happier.

STRESS -KILLER

Marital disharmony and job dissatisfaction are the two main mental risk factors for the causation of heart attack. Many studies in the past have linked that there is a strong correlation between a nagging wife and early heart attacks in men. Similarly, literature has shown that work related stress is related to early onset of high blood pressure, diabetes, stroke and heart attacks.
A study from University College, London has shown that chronically stressed workers have a 68% higher risk of developing heart disease, especially in people under the age of 50.

Is stress-related chemical change or stress-related behavior linked to heart disease, is yet to be answered.
Stress-related lifestyle involves eating unhealthy food, smoking, drinking and skipping exercises.
Chemical changes related to chronic stress are increased levels of cortisol, epinephrine and norepinephrine.
Amongst stress, negative stress is more dangerous than positive stress and of negative stress, jealousy, anger and cynicism are associated with heart attack.
The answer lies in managing stress by acting on a personal situation and not reacting to it. In children the same type of stress, especially during exam days, can cause anxiety, insomnia and suicidal attempts.

PARADE AT DYSNEYLAND,HONGKONG

MIND vs BRAIN

Most of us belive that  the brain is in charge, having evolved to control certain fixed behaviors. Why do men see other men as rivals for a desirable woman? Why do people seek God? Why does snacking in front of the TV become a habit? We are flooded with articles and books reinforcing the same assumption: The brain is using you, not the other way around. Yet it's clear that a faulty premise is leading to gross overreach.

The flaws in current reasoning can be summarized with devastating force:

1. Brain activity isn't the same as thinking, feeling, or seeing.

2. No one has remotely shown how molecules acquire the qualities of the mind.

3. It is impossible to construct a theory of the mind based on material objects that somehow became conscious.

4. When the brain lights up, its activity is like a radio lighting up when music is played. It is an obvious fallacy to say that the radio composed the music. What is being viewed is only a physical correlation, not a cause.

It's a massive struggle to get neuroscientists to see these flaws. They are king of the hill right now, and so long as new discoveries are being made every day, a sense of triumph pervades the field. "Of course" we will solve everything from depression to overeating, crime to religious fanaticism, by tinkering with neurons and the kinks thrown into normal, desirable brain activity. But that's like hearing a really bad performance of "Rhapsody in Blue" and trying to turn it into a good performance by kicking the radio.

We've become excited by a flawless 2008 article published by Donald D. Hoffman, professor of cognitive sciences at the University of California Irvine. It's called "Conscious Realism and the Mind-Body Problem," and its aim is to show, using logic, philosophy, and neuroscience, that we are not our brains. We are "conscious agents" -- Hoffman's term for minds that shape reality, including the reality of the brain. Hoffman is optimistic that the thorny problem of consciousness can be solved, and science can find a testable model for the mind. But future progress depends on researchers abandoning their current premise, that the brain is the mind. We urge you to read the article in its entirety, but for us, the good news is that Hoffman's ideas show that the tide may be turning.

It is degrading to human potential when the brain uses us instead of vice versa. There is no doubt that we can become trapped by faulty wiring in the brain -- this happens in depression, addictions, and phobias, for example. Neural circuits can seemingly take control, and there is much talk of "hard wiring" by which some activity is fixed and preset by nature, such as the fight-or-flight response. But what about people who break bad habits, kick their addictions, or overcome depression? It would be absurd to say that the brain, being stuck in faulty wiring, suddenly and spontaneously fixed the wiring. What actually happens, as anyone knows who has achieved success in these areas, is that the mind takes control. Mind shapes the brain, and when you make up your mind to do something, you return to the natural state of using your brain instead of the other way around.

It's very good news that you are not your brain, because when your mind finds its true power, the result is healing, inspiration, insight, self-awareness, discovery, curiosity, and quantum leaps in personal growth. The brain is totally incapable of such things. After all, if it is a hard-wired machine, there is no room for sudden leaps and renewed inspiration. The machine simply does what it does. A depressed brain can no more heal itself than a car can suddenly decide to fly. Right now the golden age of brain research is brilliantly decoding neural circuitry, and thanks to neuroplasticity, we know that the brain's neural pathways can be changed. The marvels of brain activity grow more astonishing every day. Yet in our astonishment it would be a grave mistake, and a disservice to our humanity, to forget that the real glory of human existence is the mind, not the brain that serves it.

WORLD TB DAY

World TB Day

Even singing can spread TB

1. Person–to–person transmission of TB occurs via inhalation of droplet nuclei (airborne particles 1 to 5 microns in diameter).
2. Coughing and singing facilitate formation of droplet nuclei.
3. Persons with active untreated respiratory tract disease (pulmonary or laryngeal) are contagious, particularly when cavitary disease is present or when the sputum is AFB smear–positive.
4. Patients with sputum smear–negative, culture–positive lung TB can transmit infection.
5. Extra pulmonary TB is not contagious unless the person also has lung TB.
6. Many procedures can result in the dispersal of droplet nuclei like endo–tracheal intubation, bronchoscopy, sputum induction, aerosol treatments, irrigation of a TB abscess, and autopsy.
7. Suspect TB if there is persistent (>3 weeks) cough and constitutional symptoms (fever, drenching night sweats, unintentional weight loss).
8. In HIV, the clinical and X–ray presentations of TB are often atypical. Such patients have an increased frequency of extrapulmonary TB and can have pulmonary disease despite a normal chest x–ray.
9. Results of acid–fast smears should be available within 24 hours.
10. Suspected or confirmed cases of TB should be reported promptly to the local public health department in order to expedite contact investigation and to help plan outpatient follow–up.
11. Suspicion of active pulmonary TB should prompt placement in an AII room. Such patients should be educated about the purpose of such isolation and instructed to cover their nose and mouth when coughing or sneezing, even when in the room. Whenever possible, procedures should be performed in the AII room to minimize exposure to the rest of the hospital. If the patient must leave the room, a surgical mask must be worn. All other persons entering the room must use respiratory protection, usually an N95 mask.
12. Anti–TB treatment administered during hospitalization should be directly observed therapy (DOT).
13. TB isolation rooms: Negative pressure is employed to prevent the escape of droplet nuclei. To accomplish this goal, doors must be kept closed and negative pressure should be verified daily. There must be 6–12 six air exchanges per hour. If recirculation to general ventilation is unavoidable, HEPA filters must be installed in the exhaust ducts.
14. Respiratory protection masks must filter particles 1 micron in diameter with at least 95% efficiency (N95) given flow rates up to 50 L per minute, must fit to a person’s face with less than 10% seal leakage. Health care workers should use these masks.
15. N 95 mask is designed to filter air before it is inhaled; thus, patients with known or suspected TB should not wear these masks. For the surgical masks are sufficient.
16. A patient may be transferred from an AII room once TB is ruled out or on treatment 3 consecutive sputum samples, obtained on different days, are smear–negative for AFB.
17. For patients with initially positive AFB smears, at least 2 weeks of TB treatment should be administered before isolation is discontinued.
18. For patients with MDR–TB, maintaining isolation throughout hospitalization is prudent.
19. Ideally a TB OPD clinic should be an AII room. If unavailable, an enclosed area should be used and a surgical mask (not an N95 mask) should be placed on the patient. The patient should be instructed to cover the mouth and nose with tissues when sneezing or coughing. If an area other than an AII room is used, it should not be used again for one hour once the patient has left.
20. An individual with AFB smear–positive involving the respiratory tract is generally considered to have been contagious starting three months before the first smear–positive sputum or onset of pertinent symptoms, whichever is earlier.
21. For persons with AFB smear–negative disease, the contagious period is considered to have begun one month before the onset of symptoms.
22. HCWs and patients with potential exposure should be screened (by symptoms and, unless positive at baseline, TST or IGRA) as soon as possible after the exposure. If initial screening is negative testing should be repeated 8 to 10 weeks following the end of the exposure.

URINARY TRACT INFECTION

Urinary tract infection is the most common bacterial infection encountered in the ambulatory care setting in the United States, accounting for 8.6 million visits in 2007. The self-reported annual incidence of urinary tract infection in women is 12%, and by the age of 32 years, half of all women report having had at least one urinary tract infection.

Clinical Pearls

• What are the risk factors for uncomplicated sporadic and recurrent cystitis and pyelonephritis?
Risk factors for uncomplicated sporadic and recurrent cases of cystitis and pyelonephritis include sexual intercourse, use of spermicides, previous urinary tract infection, a new sex partner (within the past year), and a history of urinary tract infection in a first-degree female relative. Case-control studies have shown no significant associations between recurrent urinary tract infection and precoital or postcoital voiding patterns, daily beverage consumption, frequency of urination, delayed voiding habits, wiping patterns, tampon use, douching, use of hot tubs, type of underwear, or body-mass index.
• Which organisms cause the majority of uncomplicated cystitis and pyelonephritis in women?
In women, E. coli causes 75 to 95% of episodes of uncomplicated cystitis and pyelonephritis; the remaining cases are caused by other Enterobacteriaceae, such as Klebsiella pneumoniae, and gram-positive bacteria such as Staphylococcus saprophyticus, Enterococcus faecalis, and Streptococcus agalactiae (group B streptococcus). However, the latter two organisms, when isolated from voided urine from women with uncomplicated cystitis, often represent contamination of the voided specimen.

Morning Report Questions

Q: What are the classic symptoms of cystitis versus pyelonephritis and how does one approach the diagnosis?
A: Cystitis is usually manifested as dysuria with or without frequency, urgency, suprapubic pain, or hematuria. Clinical manifestations suggestive of pyelonephritis include fever (temperature >38 degrees C), chills, flank pain, costovertebral-angle tenderness, and nausea or vomiting, with or without symptoms of cystitis. Dysuria is also common with urethritis or vaginitis, but cystitis is more likely when symptoms include frequency, urgency, or hematuria; when the onset of symptoms is sudden or severe; and when vaginal irritation and discharge are not present. The only finding on physical examination that increases the probability of urinary tract infection is costovertebral- ngle tenderness (indicating pyelonephritis). Results of a dipstick test for leukocyte esterase or nitrites provide little useful information when the history is strongly suggestive of urinary tract infection, since even negative results for both tests do not reliably rule out the infection in such cases. A urine culture is indicated in all women with suspected pyelonephritis but is not necessary for the diagnosis of cystitis. Studies have shown that the traditional criterion for a positive culture of voided urine (10(5) colony-forming units [CFUs] per milliliter) is insensitive for bladder infection, and 30 to 50% of women with cystitis have colony counts of 10(2) to 10(4) CFUs per milliliter in voided urine. Since most clinical laboratories do not quantify bacteria below a threshold of 10(4) CFUs per milliliter in voided urine specimens, a culture report of “no growth” or “less than 10,000 CFU” in a woman with urinary symptoms should be interpreted with caution.
Q: How should episodes of recurrent cystitis be treated?
A: Episodes of cystitis that occur at least 1 month after successful treatment of a urinary tract infection should be treated with a first-line short-course regimen. If the recurrence is within 6 months, one should consider a first-line drug other than the one that was used originally, especially if trimethoprim-sulfamethoxazole was used, because of the increased likelihood of resistance. The authors’ recommendations for first-line therapy include nitrofurantoin, trimethoprim-sulfamethoxazole, fosfomycin, and pivmecillinam. Urinary symptoms that persist or recur within a week or two of treatment for uncomplicated cystitis suggest infection with an antimicrobial-resistant strain or, rarely, relapse. In such women, a urine culture should be performed, and treatment initiated with a broader-spectrum antimicrobial agent, such as a fluoroquinolone.

FDA WARNING ON STATINS

Statins may cause drug-drug interactions for patients taking drugs to treat HIV/AIDS or hepatitis C. FDA singled out atorvastatin, rosuvastatin, and simvastatin for the new warnings and restated a warning about mixing lovastatin with HIV and HCV drugs.
The FDA said that protease inhibitors taken with atorvastatin, rosuvastatin, simvastatin, or lovastatin increase the concentration of statins in the blood, which increases the risk for muscle injuries, including risk for rhabdomyolysis, which can cause permanent damage to the kidneys.
Atorvastatin is contraindicated with tipranavir plus ritonavir, and telaprevir and should be used with caution — at the lowest effective dose — among patients taking lopinavir plus ritonavir.
For patients taking darunavir plus ritonavir, fosamprenavir, forsamprenavir plus ritonavir, or saquinavir plus ritonavir, the atorvastatin dose should be limited to 20 mg daily. In patients taking nelfinavir, daily atorvastatin should not exceed 40 mg.
Rosuvastatin should be limited to 10 mg daily in patients taking altazanavir with or without ritonavir or lopinavir plus ritonavir.
Simvastatin  is contraindicated in patients taking “HIV protease inhibitors, boceprevir or telaprevir.”

CARE FOR CALORIES

Time to eat 100 grams of peanuts: 5-10 minutes
Calories in 100 grams of peanuts: 622
Fat in 100 grams of peanuts: 49 grams
Recommended daily fat intake: 40 grams (approx.)
Time to walk off peanut calories: 2 hours, 21 minutes

Time to eat 100 grams of fresh apricot: 3-5 minutes
Calories in 100 grams of fresh apricot: 45
Sugar in 100 grams of fresh apricot: 8 grams
Time to walk off fresh apricot calories: 10 minutes

TYPE 2 DIABETES

  Diabetes begins when cells that normally respond to insulin, such as muscle and liver cells, become insulin resistant. Insulin is a hormone, a chemical "password" that tells a cell to admit glucose (blood sugar). When cells don't admit glucose into their interiors, sugar builds up in the blood, which has dire consequences for tissues and organs throughout the body. Diabetes is especially pernicious, then, because the damage it causes can crop up almost anywhere. Insulin resistance usually occurs several years before true diabetes develops. Insulin is secreted by the pancreas and "talks" to cells via insulin receptors on the cell membrane. Once these receptors allow glucose to enter the cell, it is either used immediately as fuel or stored for later use.  We now know that our bodies are nothing less than a constant conversation among chemicals that communicate with a trillion cells thousands of times per second.
To really understand what is happening, however, we must move from the molecular level to a person's lifestyle. In the sixth century BCE, an Indian physician, Susruta, is recorded as the first to diagnose diabetes and to prescribe a treatment. His analysis seems remarkably modern. Susruta wrote that diabetes was either congenital (what we would call Type 1 diabetes) or a result of poor diet and a sedentary lifestyle, often resulting in obesity (Type 2 diabetes). His prescribed treatment sounds familiar today: eating a healthier diet, taking long walks, engaging in sports such as wrestling and riding on a horse or elephant.
Your cells grow accustomed to the messages they receive; they have habits that reflect your habits. At present, those habits are trending the wrong way. About 80 millionINDIANS have diabetes -- that's about 6 percent of the population. About a third of these, 27 million people, are undiagnosed. Experts believe that diagnosed diabetes will increase 165 percent by 2050. That means that one in three people born in 2050 will be affected by the disease. Type 2 diabetes used to be called adult-onset diabetes because it almost never developed in children. Now, however, a disturbing number of cases are appearing in young people.
Ironically, as more people gain access to a comfortable way of living, lifestyle disorders create a backlash. Type 2 diabetes has become a global epidemic, too. The World Health Organization estimates that over 220 million people around the world have Type 2 diabetes (90 percent of people with diabetes worldwide), and it is among the top five causes of death in most developed countries. The economic cost of diabetes is enormous, not just to the individual, but to society as well. In the U.S., the total costs (direct and indirect) of diabetes in 2007 were estimated to be $174 billion.
Science still doesn't understand exactly how and why Type 2 diabetes develops, and this problem is the subject of intense research all over the world. It may be that something goes wrong with the insulin receptors or with the glucose transporting process. Whatever the causes, the pancreas responds to the increased levels of glucose in the blood by producing ever-greater amounts of insulin. For a while the increased levels of insulin do work to force the target cells to accept more glucose. This temporarily keeps blood sugar levels within their normal range. But over time the overworked pancreatic beta cells lose their ability to produce extra insulin -- they "burn out." Then blood sugar levels remain elevated, a condition termed hyperglycemia. Blood levels of insulin can also become very high: this is known as hyperinsulemia.
Type 2 diabetes can progress for months or years without symptoms, an insidious reason for the disorder being so dangerous. So it's important to be tested by a doctor if you have symptoms or risk factors for Type 2 diabetes.
Symptoms include:

• Frequent urination
• Increased thirst
• Slow-healing sores or frequent infections
• Constant hunger
• Unintentional weight loss
• Tingling hands and feet
• Blurred vision
• Fatigue and irritability
• Swollen gums

Risk factors for Type 2 diabetes
As we saw, prevention of Type 2 diabetes is simple and straightforward, or should be. What looks simple theoretically can turn out to be quite difficult. About 90 percent of people with Type 2 diabetes are obese or overweight: it's the number one risk factor for Type 2 diabetes. The number two risk factor is having a sedentary lifestyle (exercising fewer than three times a week). Other risk factors are being over the age of 45, belonging to certain races (including African American, Hispanic, American Indian, and Asian American), having a parent or sibling with the disease, and having had gestational diabetes (diabetes developed during pregnancy).
Because diabetes can progress for months or years without symptoms, anyone who is overweight or obese and who has one or more additional risk factors should be tested. With or without risk factors and symptoms, all adults should be tested for prediabetes or diabetes starting at age 45. Children or teens who are overweight or obese and have other risk factors, such as a family history of diabetes, should be tested starting at age 10 or at puberty, whichever comes first.
Widespread harm
Since prevention is obviously the main goal, I won't dwell on the damage caused by diabetes. Most of this damage is through its effects on blood vessels, both large and small. At high levels, glucose acts as a toxin on the cells that line blood vessels.

• Cardiovascular disease (disease of the heart and blood vessels) is the main cause of death in people with diabetes. About three-quarters of people with diabetes die of cardiovascular disease. People with diabetes have a two to four times higher risk of developing atherosclerosis and of having a stroke than people without diabetes
• Kidney disease. Because the kidneys are densely packed with millions of tiny filtering capillaries, they are especially likely to be damaged by diabetes. Symptoms may not appear until only 10 percent of the kidney's filtering function remains.
• Vision damage. The retina, the delicate membrane that lines the back of the eyeball, may be damaged by diabetes. High glucose levels injure the tiny capillaries in the retina, which start to break and bleed. Diabetes also increases the risk of developing cataracts and glaucoma.

Nerve damage, or neuropathy, is also involved. The myelin sheaths that surround nerve cells are very sensitive to changes in glucose concentration. Nerves can also be damaged when damage to the capillaries that feed them cuts off their blood supply.
Monitoring glucose levels
As standard practice, it's considered important for diabetics to monitor their glucose levels. Keeping track of your blood sugar allows quick responses to levels that are too low (hypoglycemia) or too high (hyperglycemia). It also helps in planning meals, activities, and medication times. The latest glucose monitors require only a tiny drop of blood, and it doesn't necessarily have to come from a finger.

But we also need to consider the stress caused by constantly monitoring any condition, whether it is diabetes or high blood pressure. In the body's feedback loops, all messages are received by the cell membrane, including messages relating to stress, your work environment, relationships, mood and general sense of well-being.  You cannot "feel" your blood sugar levels, and once you begin to change your lifestyle, there is every reason to focus on how your life is going in general, with much less focus on chemical monitoring. Blood sugar follows cycles, like everything else in the body. One day's high reading may be meaningless, but it can lead to panic and worry. Is it worth ruining a whole day in order to fixate on a number?
The key to getting past any lifestyle disorder, including Type 2 diabetes, is to move in the direction of balance and moderation. This doesn't mean grim discipline. Instead, you ask yourself on a daily basis:

• Am I doing something that makes me happy?
• Can I give up a little of what isn't good for me?
• How do I feel about my progress toward well-being?
• Can I foresee the weak or tempting moments I need to be most careful about?

In the spirit of making your life better, the preventive steps for Type 2 diabetes fall into place more naturally.
Weight loss
Anyone with prediabetes or diabetes who is overweight has a number of very good reasons to lose weight. For someone with prediabetes, losing just 5 to 10 percent of body weight significantly reduces blood sugar levels and reduces insulin resistance. For someone who weighs 200 lbs, that means losing as little as 10 lbs. When losing weight is combined with regular exercise, the risk of developing diabetes is cut by 58 percent. And there's another, very significant benefit: losing 5 to 10 percent of body weight lowers the chances of having a heart attack or stroke. If you already have diabetes, studies have found that weight loss can significantly reduce symptoms of diabetes and insulin resistance.
The American Diabetes Association recommends a slow-but-steady weight loss goal of .5 to one pound per week. It's very useful to consult a registered dietitian for help in changing eating habits, controlling overeating, and designing a diet plan you can live happily with and that provides the right sort of nutrition for diabetes.
Eating right for diabetes
There is no specific "diabetes diet."  A healthy diet for diabetes is the same as a healthy diet for anyone: rich in nutrients and fiber and low in refined carbohydrates, high-glycemic-index foods (like potatoes), and saturated and trans fats. The glycemic index (GI) classifies carbohydrates based on how quickly and how much they boost blood sugar compared to pure glucose. Foods that have a low GI are absorbed slowly in the digestive tract, raising blood sugar evenly over a long period of time.
Exercise
Exercising regularly is one of the best things you can do for diabetes. Exercise, whether anerobic or aerobic, induces both your muscles and your liver to take up more glucose, lowering your blood sugar levels. Exercise decreases insulin resistance, normalizes blood pressure, improves sleep and decreases stress.
Talk to your healthcare practitioner before starting a new exercise regimen. Choose something you enjoy and that's at the right level for your current fitness. It's best to exercise every day, at the same time.
Quit smoking
If you smoke, quit now. Smoking is especially bad for people with prediabetes or diabetes. If you don't now have diabetes, smoking makes it three times as likely that you will develop it. Smoking further damages already compromised blood vessels, constricting them and injuring them. It causes complications, like kidney disease, retinal disease and foot problems, to occur sooner, and increases risk of death. What's more, nicotine has been found to directly increase blood sugar levels.
De-stress
Being stressed stimulates the production of corticosteroids, the "stress hormones," which increase blood glucose levels. By the same token, studies show that reducing stress can lower blood sugar levels. Try meditation, biofeedback, or focused breathing techniques. Just doing something you enjoy, like gardening or reading, can be a good way to de-stress. Exercise (aerobic exercise, yoga, tai chi) is an excellent de-stressor. Support groups and therapy may prove very helpful as well.
Supplements and botanicals
These come into play only after you have seriously considered lifestyle changes; they are not a substitute, much less a cure-all. Some people with diabetes have found chromium or alpha-lipoic acid (ALA) to be helpful in controlling their blood sugar. ALA, an antioxidant, may also be useful in treating nerve damage.
Certain botanicals, including cinnamon, fenugreek, ginseng, bitter melon, aloe vera, prickly pear cactus, gurmar (an Indian herb whose name means "sugar destroyer") and Coccinia indica (ivy gourd) may help to control blood glucose levels. In Chinese and Indian traditional medicine, combinations of botanicals are used to treat diabetes, and there is some evidence that this results in a synergistic effect. Consult with an experienced practitioner of Chinese or Indian medicine if you would like to investigate these treatments.
Acupuncture
Some people with peripheral neuropathy -- pain in the hands and feet due to nerve damage from diabetes -- have found that acupuncture helps to relieve their pain. Acupuncture has few if any dangerous side effects, so it may be worth investigating this form of treatment.
Medications
If lifestyle measures don't sufficiently reduce blood sugar levels, then medications may be prescribed. Medications may lower glucose levels by increasing insulin production by the pancreas, boosting cell sensitivity to insulin, and delaying absorption of glucose from the intestines. Numerous medications are available, and often more than one is prescribed.
Insulin may be prescribed if taking noninsulin glucose-lowering drugs doesn't get blood sugar levels under control. Insulin must be injected using a syringe, an insulin pen, or with an insulin pump.
In mainstream medicine, diabetes is a circle of chemicals, leading from the insulin produced naturally by the pancreas to the insulin injections prescribed for millions of diabetics. Yet a much larger circle is actually involved. The circle of life embraces who you are and how you want to live. Diabetes, like every other lifestyle disorder, is an indicator that change is required. This doesn't mean chemical change. It means redefining how you want to achieve well-being in the healthiest possible way.
Around the Web: Type 2 - American Diabetes Association
Type 2 Diabetes: Symptoms, Causes, Treatments, and More
Type 2 diabetes - MayoClinic.com
Type 2 - American Diabetes Association
Diabetes mellitus type 2 - Wikipedia, the free encyclopedia
Type 2 Diabetes: Symptoms, Causes, Treatments, and More
Type 2 diabetes - MayoClinic.com
Type 2 Diabetes - Symptoms, Diagnosis, Treatment of Type 2 ...
Type 2 Diabetes: What Is It?
Type 2 Diabetes - Causes, Symptoms, Treatment, Complications ...
Diabetes Risks, Symptoms, Treatment - eMedicineHealth.com

DEPRESSION

It's not news that depression has become a kind of invisible epidemic, afflicting millions of people. We live at a time when depression is approached as a disease. That has a good side. Depressed people are not judged against as weak or self-indulgent, as if they only need to try harder to lift themselves out of their sadness. Yet depression, for all the publicity surrounding it, remains mysterious, and those who suffer from it tend to hide their condition -- the medical model hasn't removed a sense of shame. When you're in the throes of depression, it's hard to escape the feeling that you are a failure and that the future is hopeless.

Before considering how to handle depression, let's ask the most basic question: Are you depressed? The bad side of the medical model arises when people rush to be medicated because they don't like how they feel. Doctors barely bother to get a correct diagnosis, because the easiest thing to do -- and the thing that patients demand -- is to write a prescription.

Let's see if we can get beyond this knee-jerk reaction.

Becoming sad or blue isn't a sure sign of depression. Life brings difficulties that we respond to with a wide range of normal emotions: sadness, anxiety, resignation, grief, defeated acceptance, helplessness. Moods are cyclical, and if these feelings are your response to a tough event, they will subside on their own in time. If they linger, however, and there seems to be no definite cause or trigger, such as losing your job or the death of a loved one, depression is accepted as the conventional diagnosis.

Depression isn't one disorder, and even though an array of antidepressants have been thrown at the problem, the basic cause for depression remains unknown. For a diagnosis of major depression, which is more serious than mild to moderate depression, at least five of the following symptoms must be present during the same two-week period:

• Depressed mood (feeling sad or empty; being tearful)
• Markedly diminished interest or pleasure in all, or almost all, activities
• Significant weight loss when not dieting, or weight gain, or decrease or increase in appetite
• Insomnia or hypersomnia (sleeping too little or too much)
• Slowing of thoughts and physical movements
• Fatigue or loss of energy
• Feelings of worthlessness or excessive or inappropriate guilt
• Diminished ability to think or concentrate, or indecisiveness
• Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or specific plan for committing suicide

If you can count five or more of these as being present, know that your list must contain "depressed mood" or "diminished interest or pleasure" before you'd be considered medically depressed. We've come to recognize different kinds of depression that fit certain circumstances:

• Dysthymia is mild, chronic depression. It must present for at least two years for a diagnosis of dysthymia.
• Seasonal affective disorder (SAD) is a form of depression that generally arises as the days grow shorter in the autumn and winter.
• Postpartum depression begins after a woman has given birth and may get worse as time goes on.

Even though no one knows exactly what causes depression, it is clearly a state of internal imbalance. Balance is essential for the healthy functioning of both your body and your mind. The upsetting factors that make it more likely you will get depression form a long list: genetic predisposition, being female, death or loss of loved one, major life events (even happy ones, like a graduation), other mental illnesses, substance abuse, childhood trauma, certain medications, serious illness, and personal problems such as financial troubles. What these things have in common is that they disrupt the normal balancing mechanisms of mind and body. A treatment that aims at restoring balance therefore makes the most sense, and you can participate in these.

Re-balancing yourself forms its own long list of things you can do:

• Be aware that you are depressed and seek help.
• Treat your body well, including exercise.
• Reduce stress.
• Get enough sleep meaning a minimum of eight hours a night.
• Address situations that would make anyone sad, such as the wrong job, a bad relationship, normal grief, and serious loss. Don't passively wait for time to heal your wounds.
• Regain a sense of control.
• Examine your reactions to difficult situations. You will often find that reacting with helplessness, passivity, retreating inside, and turning passive lie at the root of your depressed state.
• Spend time with people who give you a reason to feel alive and vibrant. Avoid people who share your negative responses and attitudes. Depression in some sense is contagious.
• Rely to a minimum on antidepressants and apply your main efforts to other therapies. Pills should be as short-term as possible. They work best in removing the top layer of sadness so that you have a clear space to address the real underlying issues.
• Talk about your problems and share your feelings with those who can listen with empathy and offer positive steps.
• Make friends with someone who has recovered from depression or is handling the condition well.

Find a wise person who can help you to undo your most negative beliefs by showing you that life has other, better possibilities.

Because everything on this list requires a choice, bringing yourself back into balance means that you are aware enough to make decisions and have the ability to put them into practice. Quite often depressed people feel too helpless and hopeless to face the right choices, in which case outside help is needed, meaning a therapist or counselor who specializes in depression.

Here's a general picture of how to make a plan for your own healing.

Psychotherapy, or talk therapy, works as well as medication for many people. It may be used alone or in combination with other forms of treatment. Studies have shown that psychotherapy can cause changes in brain function similar to those produced by medications. Focused, goal-oriented forms of therapy such as cognitive-behavior therapy appear to be the most effective in treating depression.

Diet may play a part in protecting against depression. Mediterranean countries have low rates of depression compared to countries farther to the north--and it isn't just because they get more sunlight or have a more relaxed way of life. One large-scale study tracked almost 3,500 people living in London for five years and found that those who ate a Mediterranean diet were 30 percent less likely to develop depression. Researchers speculate that the foods in the Mediterranean diet may act synergistically together. Olive oil, nuts and fatty fish are rich in omega-3 and other unsaturated fatty acids, and fresh fruits and vegetables contain flavonoids and phytochemicals that are full of antioxidants and folates (B vitamins).

Aerobic exercise is a very effective for depression. It's been shown that moderate aerobic exercise done just 30 minutes a day, three times a week, can reduce or eliminate symptoms of mild-to-moderate depression and can help with severe depression.

It's well known that exercise stimulates the release of endorphins, the "feel-good" chemicals (which function as neurotransmitters). Less well known is the startling effect of exercise on the structure of your brain. Exercise stimulates the creation of new nerve cells in the hippocampus, your brain's center of learning and memory, so that it actually increases in size. This is especially relevant because depression, unless countered with effective therapy, causes the hippocampus to shrink in size. Exercise has also been shown to raise levels of serotonin and norepinephrine and to multiply the number of dendrite connections in neurons.

Yoga has been shown to lessen stress and anxiety and promote feelings of well-being. Communication between your body and your mind is a two-way street. Certain yogic practices can signal the brain that it's all right to relax and prompt the parasympathetic nervous system to initiate the relaxation response. For instance, slow, deep, conscious breathing is also a vital element of yogic practice. This form of breathing is very effective in prompting the relaxation response to counter elevated levels of stress hormones. Someone with depression might be advised to practice "heart-opening" postures that elongate their thoracic spine. They may be told to stand with their shoulder blades drawn together so that their lungs are lifted and they are able to breathe more freely. An important component of yoga is paying close attention to what's going on in the body at all times and locating and releasing any areas of tension. Yoga should ideally be practiced with the guidance of an experienced teacher.

Meditation can be a useful treatment for both stress and mild-to-moderate depression. Numerous studies have examined the effects of mindfulness meditation, designed to focus the meditator's attention on the present moment. One study measured electrical activity in the brain found increased activity in the left frontal lobe during mindfulness meditation. Activity in this area of the brain is associated with lower anxiety and a more positive emotional state. Subsequently, the researchers tested both a group that hadn't meditated as well as the meditators for immune function. They did this by measuring the level of antibodies they produced in response to a flu vaccine. The meditators had a significantly greater reaction, which indicates they had better immune function.

I know that the easiest solution is to pop a pill, and in this country powerful forces back up the promise that drugs are the answer. Keep in mind that antidepressants only alleviate symptoms, and that in the long run couch therapy has proven just as effective in changing the brain responses associated with depression. The real goal should be to re-balance your life, gain control over the disorder, understand who you are, and elevate your vision of possibilities for yourself. All of that is harder than opening a pill bottle, but every positive choice leads to real healing and a much better life in the future.

PLATELETS REVISISTED

 

1. The normal platelet count in adults ranges from 150,000 to 450,000/microL.
2. The mean value in males is 237,000/microL.
3. The mean value in females is 266,000/microL.
4. Thrombocytopenia or low platelet count is defined as a platelet count less than 150,000/microL.
5. About 2.5 percent of the normal population has platelet count lower than 150,000 /microl (as a normal variant).
6. A recent fall in the platelet count by one–half is abnormal even though it may still be in the normal range.
7. Thrombocytopenia is not usually detected clinically until the platelet count has fallen to levels below 100,000/microL.
8. Variation of the platelet count in a given individual is limited. Differences in the absolute platelet count greater than 70 to 90,000/microL will occur by chance less than one percent of the time.
9. Surgical bleeding due solely to a reduction in the number of platelets does not generally occur until the platelet count is less than 50,000/microL, and clinical or spontaneous bleeding does not occur until the platelet count is less than 10,000 to 20,000/microL.
10. Platelets survive in the circulation for 8 to 10 days, after which they are removed from the circulation by cells of the monocyte–macrophage system, as a result of programmed apoptosis.
11. The youngest platelets in the circulation are larger and more hemostatically active. Thrombocytopenic patients, who do not have serious bleeding, suggest that the small numbers of young platelets in these patients are more hemostatically active than mixed age platelets in normal subjects.
12. In dengue no transfusion is needed unless the count is lower than 2% of the baseline levels.
13. Platelet count can be falsely low in a number of clinical situations:
    • If anticoagulation of the blood sample is inadequate, the resulting thrombin–induced platelet clumps can be counted as white cells by automated cell counters. The WBC count is rarely increased by more than 10 percent.
    • Approximately 0.1 percent of normal subjects have EDTA–dependent agglutinins which can lead to platelet clumping and spurious thrombocytopenia and spurious leukocytosis.
    • Pseudothrombocytopenia can also occur after the administration of the abciximab.
    • EDTA–induced platelet clumping can be diagnosed by examination of the peripheral smear. One should do a repeat count in a non–EDTA anticoagulant.
    • If platelet clumping is observed, the platelet count is repeated using heparin or sodium citrate as an anticoagulant. If citrate is used, one should remember to correct the platelet count for dilution caused by the amount of citrate solution used; no such correction is needed for heparin. Alternatively, one can use freshly–shed non–anticoagulated blood pipetted directly into platelet counting diluent fluid.
    • Patients with cirrhosis, portal hypertension, and spleen enlargement may have significant degrees of "apparent" thrombocytopenia (with or without low white cells and anemia), but rarely have clinical bleeding, since their total available platelet mass is usually normal.

BOMB BLAST INJURIES

Blast injuries can be of four types.
 

1.Primary blast injuries are the injuries to the hollow gas-filled organs like the lungs, ear drum or intestines leading to their rupture. These occur as a direct result of the impact of the over pressurized blast wave on the body. 

2. Secondary blast injuries occur due to flying debris and bomb fragments leading to penetration or penetrating injuries such as to the eyes.

3. Tertiary blast injuries occur when individuals are thrown by the blast wind leading to fractures as a result of the fall.

4. Quaternary blast injuries are due to direct effect of burn or crush injuries. 

The most important triage to manage blast injuries is not to waste energies and resources on patients with non-serious injuries.  The first thing is to check for eardrum rupture and signs of respiratory imbalance. Their absence indicates a non-serious injury. 

All patients exposed to a blast must have eardrum examination as the first step. If the ear drums are intact, the patient can be discharged with first-aid treatment. If ear drum is ruptured, an X-ray chest should be done immediately. All such patients should be observed for eight hours as primary blast injuries are notorious for delayed presentation. 

Doctors should therefore focus only on two exams: otoscopic ear exam and pulse oximetry. Blast lung injury is unlikely without tympanic or ear membrane rupture. This is used as a screening procedure for admitting a patient. Decreased oxygen saturation on pulse oximetry signals early blast lung injury, even before symptoms become apparent. 

Half of all initial casualties seek medical care over first hour. Double this number after one hour and you will know the total casualties. This formula is often used by the media to predict the tolls. It is also useful to predict demand for care and resource needs. 

Always expect upside down triage as the most severely injured arrive after the less injured who self-transport to the closest hospitals. 

With the increasing use of explosives in terrorist events in our country in recent times, doctors, especially Emergency Doctors, should undergo orientation training every six months so that they are prepared and better equipped to manage several casualties all at one time.

UNDERSTANDING NICOTINE/TOBACCO

Understanding and Coping With Nicotine Withdrawal

 

 

More people die from tobacco use than suicides and murders combined. So why do smokers continue to light up when statistics like these make it clear that they should quit? Nicotine addiction is powerful, which makes quitting difficult--but it is possible. There are now 45 million smokers, but 47 million successful quitters. By understanding nicotine addiction and withdrawal, you can be better prepared to crush out this destructive habit for good.

Understanding the Addiction

When you smoke, nicotine speeds to receptors that trigger the release of dopamine, your body's feel-good chemical. Nicotine causes dopamine to be released in several parts of the brain: the mesolimbic pathway, the corpus striatum, the nucleus accumbens and the frontal cortex . Over time, the receptors where nicotine can connect become desensitized. This means that they lose some of their ability to send signals that result in the release of dopamine, and other neurotransmitters. As a result, more nicotine receptor sites are created. The overall effect is that smokers who have developed additional receptors need more nicotine to avoid having withdrawal symptoms.

The longer you smoke, and the more you smoke each day, the more severe nicotine addiction becomes. The craving for nicotine intensifies and becomes more frequent. Ignoring the cravings brings on unpleasant withdrawal symptoms. And what alleviates those? Yes, more nicotine.

The Rewards of Nicotine

Let's face it: If there were no positive outcomes to smoking, no one would ever do it. "There are many motivations to smoke," says Michael D. Stein, M.D., Professor of Medicine and Community Health at Brown University and author of The Lonely Patient and The Addict. "The dominant one is physical dependence--that is, smokers who try to stop have withdrawal symptoms, and cigarettes relieve the symptoms. But nicotine can also improve attention and vigilance. Smokers smoke when they need to concentrate or focus. Smoking helps some people feel in a better mood, or they feel a high, a buzz. Some smokers enjoy the taste and smell of a cigarette. Finally, smoking serves as an appetite suppressant. People smoke to control their weight." While all medical experts agree that the health risks are not worth these beneficial aspects, many smokers have a real fear of losing the sense of control and other pleasurable sensations when they stop. So, how can quitters learn to conduct their daily routine smoke-free? Understanding what to expect and planning for withdrawal symptoms is a great place to start.

Managing Nicotine Withdrawal

The physical symptoms of nicotine withdrawal are rough stuff. The brain and body still crave nicotine's positive effects, so its absence causes quite an uproar. Quitters can experience any combination of irritability, anxiety, depression, sweating, headaches, insomnia, confusion, cramps and weight gain. Understanding what feelings and symptoms accompany nicotine withdrawal is important, because there are steps you can take to manage your symptoms.

1. Craving for nicotine If you aren't using a nicotine replacement treatment, you may have cravings. Cravings last only a few minutes, but will feel much longer at first. Stay busy, especially during the times when you used to smoke. Plan a small snack or distracting task during these times.

2. Irritability The frustration of leaving your desire for nicotine unfulfilled affects your mood. Know that your emotions will be intensified for the first few weeks after you quit. Talk about your mood, and the fact that you've quit smoking, to anyone in the line of fire. Going for a walk or other exercise can take the edge off.

3. Anxiety Smokers with pre-existing anxiety disorders have a harder time quitting. Other quitters may have new feelings of anxiety. Anticipating this frame of mind, and knowing that it's related to quitting is the first step. Try to wait it out, or take a break to talk to a friend who knows what you are going through.

4. Depression Some of the prescription drugs for smoke cessation treatment also treat depression. If you are quitting without those, realize that you may start to feel down. If you have planned a support system and engaging distractions for your transition to the non-smoking life, rely on them.

5. Sweating Metabolic changes and increased circulation after quitting smoking may bring on sweating. Dress to stay cool, and drink plenty of water.

6. Tingling in hands and feet Your circulatory system is making positive adjustments after you quit, which can create some new sensations. A tingle in the extremities is a good thing. Just wait it out.

7. Headache Could be a circulatory effect, or a result of tension and anxiety from craving. Take ibuprofen or acetaminophen if you usually do. Try deep breathing or meditation to relieve tension.

8. Cramps and nausea Smoking can cause peptic ulcers and other digestive ailments. As your digestive tract recovers from your time as a smoker, you can feel temporary discomfort. Avoid spicy, irritating foods as you wait for this phase to pass.

9. Insomnia Nicotine is a stimulant, so it has definitely affected your sleep-wake cycle. Treat yourself to extra soothing activities before bedtime: a warm bath, a massage, total quiet.

10. Mental confusion Nicotine gives smokers focus and clarity. Its absence can make you feel a bit foggy. When confusion takes over, stop. If you're in the middle of a task, take a break. Confusion gradually dissipates as you adjust to the absence of nicotine.

11. Weight gain Some smokers fear gaining weight so much they don't attempt to quit. Most quitters gain fewer than 10 pounds.  "Weight gain following smoking cessation is mostly due to decreased metabolic rate, increased food intake, and decreased physical activity" after quitting, says Michael D. Stein, M.D., Professor of Medicine and Community Health at Brown University. "Also, an enzyme called lipoprotein lipase (LPL), which affects fat cells' metabolism, becomes more active after you quit. And some appetite control agents, including leptin and neuropeptide Y, are influenced by nicotine." Dr. Stein notes that those who are concerned about gaining weight are more likely to relapse after quitting. Exercise would be a great substitute for smoking, if you're concerned about gaining weight.

Most of the nicotine withdrawal symptoms are short-lived, and symptoms pass in time, usually in less than a week. Withdrawal is the most uncomfortable part of quitting, but getting past this rough patch is the first real challenge in staying away from tobacco for good!