How alcohol addiction occurs: the brain 'learns' alcohol

Running into a former drinking buddy or passing a once-favourite bar can cause recovering alcoholics to relapse.

But the biology behind why those setbacks happen was a mystery to scientists until just recently.

Researchers from the Perelman School of Medicine at the University of Pennsylvania (Penn), Uni-ted States, found that alcohol directly affects the brain’s learning and memory system through a test on mice.

Drinking actually helps people’s brains “learn” alcohol – the bar they’re drinking in, the street they’re on and the people they’re with – said Dr Shelley Berger, a cell and developmental biology professor, who is the study’s senior author.

This learning can make people want to drink more when they’re in certain environments or with groups of people.

And unravelling how the learning happens opens the possibility of someday having treatments to block that action.

Prof Berger’s research is the latest addition to a growing body of research that alcohol and drugs can cause genetic changes that may reinforce addiction and affect future generations.

Earlier this year (2019), researchers from Rutgers University found that binge drinking can trigger genetic changes that make people crave alcohol even more.

In the new study, published recently in the journal Nature, researchers found that when alcohol is consumed, it goes to the liver, where it’s processed into the by-product acetate.

Acetate then travels to the brain, where it turns certain genes on and off in a cell by attaching to histones, the proteins that package DNA in a cell’s nucleus, said Prof Berger.

“DNA is about two feet long in every cell and it’s all folded up into the nucleus,” she said.

“There’s a packaging material that organises it in a really orderly way, and it turns the right genes on and off through these little chemical groups. Acetate is one of those chemical groups.”

It turns out that the enzyme responsible for depositing acetate into cells, called ACSS2, activates key memory genes important for learning.

To test this, researchers exposed mice to two differently patterned chambers – one with alcohol and one without.

After a “learning period”, the mice were allowed to roam freely between the two. They preferred the chamber that was paired with alcohol.

But after lowering the levels of ACSS2 in the mice’s brains, the researchers found that they spent an equal amount of time in both chambers.

Researchers also found that when a pregnant mouse consumed alcohol, acetate was delivered through the placenta and into the foetus’ developing brain.

This finding could lead to better understanding of foetal alcohol syndrome, said Prof Berger.

She said that this was the first empirical evidence showing that alcohol consumption affects how genes are expressed in the brain.

She’s now interested in using the information to make a drug that could be used to stop people from “learning” alcohol.

“When we learn something, there’s a process called reconsolidation,” Prof Berger said.

“That’s when something is really solidified and we feel that we really understand it now.

“We want to disrupt that after someone has been exposed to alcohol, but before they reconsolidate the information.”

Penn’s Center for Studies on Addiction director Dr Henry Kranzler said Prof Berger’s research is “intriguing” because it offers the potential of “filling in a missing piece in our understanding of the development and maintenance of heavy drinking”.

“Her research is consistent with the idea that addiction is a learned process,” he said.

“Importantly, it opens up the potential to identify specific targets in the brain to be modified therapeutically with medications, and perhaps also genetically, at some point.”

In other words, researchers may be able to make drugs to treat addiction that target specific areas of the brain that are affected by alcohol.

However, the next step is to conduct more research using animals before eventually moving on to humans.

“This is a really exciting, unexpected finding, that alcohol consumed would end up in the brain,” Prof Berger said.

“What this tells us is that acetate may be a very good thing for memory, but a lot might not be good, especially if you’re getting it in the context of something that’s not good for you.” – The Philadelphia Inquirer/Tribune News Service

Source: https://www.thestar.com.my/lifestyle/health/2019/11/13/this-is-how-alcohol-addiction-occurs#6obX73K09hkxaVGq.99

Breakfast, The Happy Meal

By Sakina Mohamed

KUALA LUMPUR, March 15 (Bernama) -- Want to know the secret to a smarter, happier and slimmer you? Eat breakfast!

Many people do not realise this, but eating the first meal of the day is vital in helping them think, feel and even look better. It also sets the tone for the rest of the day.

"Recent studies indicate that people who eat breakfast regularly enjoy a more positive attitude, and they are slimmer and have better mental performance," says Nestle Malaysia's Nutritionist Cher Siew Wei to Bernama.

This is because our body uses sugar, or glucose, in the blood for energy. When we wake up, our blood sugar level is low because we've been fasting overnight. So, eating a nutritious and balanced breakfast helps to provide enough energy to kick-start the day.

BREASFAST BRINGS POSITIVE IMPACT

Cher says starting the day with a nutritious balanced breakfast has a positive impact on alertness, concentration and helps students and employees establish a positive attitude towards studies or work.

"This is not surprising, given breakfast, especially one that is rich in complex carbohydrates such wholemeal bread, whole grain cereal drinks and whole grain breakfast cereals, boost brain glucose levels," she says.

Furthermore, micronutrients such as B vitamins are commonly added to whole grain cereal drinks and breakfast cereals. These vitamins encourage production of brain chemicals like serotonin, which send "feel good" messages that ultimately make you happier throughout the day.

In contrast, those who skip breakfast may find themselves moody and irritable throughout the day.

EATING TO LOSE THE KILOS

Eating to lose weight may be a paradoxical concept to some. But studies have proven time and again that eating breakfast helps curb your appetite for the rest of the day and revs up your metabolism. These will undoubtedly help you shed the kilos.

Cher says a revved up metabolism helps to burn the maximum number of calories to fuel your activities.

Are you a carb-addict trying to lose weight? Breakfast is the best time to eat carbohydrates since you will have the rest of the day to burn them off and use them as fuel to keep your body and your brain working. Just be sure to opt for whole grains with lots of fiber.

It is an easy, guilt-free way to sneak in some carbohydrates into your day without jeapordising your slimming efforts.

BREAKFAST SKIPPERS AT THE LOSING END

But that is not all. Have you noticed how some people tend to have "cravings" and load up on lunch because they have missed breakfast? Eating breakfast may correct this as it curbs the hunger seen later in the day, which usually results in overeating.

Conversely, those who skipped breakfast may trick their bodies into believing that it is starving, and thus cause the body to go into "survival mode" and start storing fat. This makes it easier to gain weight.

Cher says breakfast skippers also tend to choose higher-calorie foods at the next meal. In the long term, this may lead to the development of chronic health issues.

"Many studies have shown the association between breakfast consumption and weight management. The Journal of Obesity Research in 2002 reported that of the 3000 volunteers studied in the United States, 78 percent who successfully lost excess body weight and then maintained their weight ate breakfast every day of the week.

"This result suggested that eating breakfast on a regular basis is one of the common behaviours to maintaining weight loss," she says.

In addition to that, a study by the University of Texas, El Paso in U.S. also shows that eating breakfast can increase the output of leptin, a hormone that suppresses appetite.

BUT I HAVE NO APPETITE IN THE MORNINGS

So breakfast is indeed the most important meal of the day but many people still claim that they could never eat breakfast, although they know how important it is.

The Malaysian Adults Nutrition Survey (2003) showed that 1 out of 10 Malaysian adults skipped breakfast.

A joint research conducted by Universiti Kebangsaan Malaysia (UKM) and Nestle on the Nutritional Status and Dietary Habits of Primary School Children in Malaysia (2007-2008) revealed that 1 out of 3 Malaysian primary school children leaves home for school with empty stomach.

The reason? Of the 11,371 primary school children surveyed, 45 per cent said they missed breakfast because they had "no time", 22.2 percent cited "not hungry" as their reason while 17.6 percent said they had no appetite.

"The "no appetite" or "no time" for breakfast excuse is similar to the "I've got no time for exercise" excuse," says Cher.

"If you want to re-establish the breakfast-eating habit, but "no appetite" is the obstacle, start with something small and easy to prepare, and concentrate first on making it part of the morning routine."

Parents can buy buns and leave it on the table for the kids or themselves to grab in the morning, she says.

For those unable to eat something solid in the morning, Cher suggests them to start the habit by having a cup of hot drink like milk, Milo, or even a cereal drink.

"The fibre content in cereal drinks can keep you full for some time. It may not be as heavy as a full meal, but something is better than nothing."

SPONSOR BREAKFAST TO BOOST PERFORMANCE

The 2007-2008 Nutritional Status and Dietary Habits of Primary School Children in Malaysia survey revealed that 10.6 percent of the children said they skipped breakfast because there was no food available.

Lack of food for energy in the morning may not only adversely affect a child's learning and performance in school, but studies show that it can also cause behavioural problems among them.

Similarly, employees'performance and productivity in the workplace will also be affected if they missed breakfast.

Therefore, Cher points out that it would be a good idea for schools or workplaces to sponsor simple, nutritious breakfast.

"This can be just a sachet of instant cereal drink, a bun, a cup of yogurt or a sandwich. Even a glass of milk will help," she says.

BUT I WOKE UP TOO LATE..

Never too late for breakfast! Breakfast is defined as the first meal of your day, which you should have within an hour of waking up.

"So even if you wake close to lunch time, eat something. It's still considered breakfast," says Cher.

Some of us may opt to wait for lunch time and go for "brunch". Cher advises against this.

"You cannot compensate breakfast by eating a bit more at lunch, because it doesn't work that way. This can be dangerous to your figure and health," she says.

VARIETY AND MODERATION IS KEY

Although eating breakfast is encouraged, some breakfasts may tip the scales the other way.

Cher says popular Malaysian breakfasts like nasi lemak and roti canai can be dangerous to the health if taken regularly.

"It is okay to have nasi lemak occasionally. But make sure you take the basic nasi lemak, and avoid adding on rendang meat, fried chicken or other fat-laden condiments," she advises.

Cher also advises people to take different types of food for breakfast so that they may benefit from different types of nutrients.

For those rushing in the early mornings, she recommends taking with them a muesli bar, a fruit or a wholegrain bun. They can also opt for dairy products like cheese and yogurt or choose wholewheat crackers and biscuits.

-- BERNAMA

Why holidays can be bad for your health

Eddy said: May be this is THE reason for me not being to ANY vacation for the past few years.


World Health Organisation issues warning on stress and offers tips for travellers

By Jeremy Laurance, Health editor


Anxiety caused by fear of flying causes 3.5 per cent of in-flight emergencies

Travel is said to broaden the mind – but it can also damage it, experts say.

In an unprecedented move, the World Health Organisation (WHO) has issued a warning that the stress of international travel can lead to mental disorder in vulnerable people.

For the first time, the global health agency has included detailed guidance on the psychological impact of travel in its annual publication International Travel And Health.

Simon Calder: Travelling overseas can be a cure, not a curse
Almost one billion people leave home to venture abroad each year, just over half of them tourists going on holiday, and mental problems are "among the leading causes of ill-health among travellers", it says.

"Psychiatric emergency" is one of the most common medical reasons for evacuation by air ambulance, along with injury and heart disease, the WHO report says. Up to 100 patients a week are brought back to the UK by air ambulance, according to the British Ambulance Association, and many more are returned on commercial aircraft, mostly accompanied by medical staff.

FlyMeNow, an air charter company based in York, said it had flown a man with bipolar disorder from Egypt back to Manchester last October, after he became manic while on holiday with his wife. "He had to be sedated for the flight; he was stretchered on to the plane and police were waiting when it landed in Manchester. He was taken to hospital where he was stabilised on drugs and discharged the next day," said Andrew Whitney, the commercial director. The cost of £25,000 was paid by the family, who did not have travel insurance.

Dan Sanders, of Oxford-based Air Medical, said the company had flown a woman from Ireland back to Germany last year accompanied by "four to five" security escorts. "There had been some violence on an earlier flight but when she got in a light plane she was fine. I think she realised no one was watching – she had no audience," he added.

Extreme anxiety such as phobia of flying is a key problem faced by travellers, and is involved in 3.5 per cent of all medical in-flight emergencies. People who suffer panic attacks may feel more comfortable in an aisle seat when travelling by plane, the WHO adds.

It warns anxiety sufferers to avoid caffeine, certain over-the-counter cold medications and the anti-malarial drug mefloquine (brand name Lariam), which has been linked with psychotic episodes in some people.

Air and road rage are on the rise, it says, and travellers arriving in exotic places, freed from the social constraints of home, are at greater risk from drink and illicit drugs, which can trigger mental breakdown. One study showed that more than half of backpackers had used illicit drugs and another found the proportion of individuals who drank alcohol more than five times a week doubled from 20 to 40 per cent.

Pilgrimages to places with historical or religious significance carry particular risks for the mentally fragile. "A traveller may become overwhelmed at pilgrimage centres such as Mecca, Jerusalem and Santiago de Compostela, as well at holy places in India," it says.

Adjustment to different cultures, lifestyle and languages can cause distress in some people. Equally, returning home can present a challenge for younger people after long-term trips, such as those taken by gap year students who have identified strongly with the new culture and may experience a sense of loss on leaving.

The WHO says medical staff should include an "enquiry into psychiatric history" as a standard part of any pre-travel consultation for vaccinations or health advice.

The triumph of curves

There's no ignoring it — women everywhere are finally saying goodbye to the skinny-thinny and celebrating the fuller figure

By Shane Watson

It’s taken roughly 15 years, but at long last, after a couple of false alarms, we are officially over skinny. And here is how you can tell: women have started to envy other women, not for their jutting hip bones and the amount of daylight visible between their thighs, but for their soft and shapely bodies. We’re not talking about recognising that hips, thighs and breasts are a normal part of the female package. (We’ve always known that, and it hasn’t stopped us from wanting to look like malnourished girls.) We’re talking about, once again, finding the shapely form desirable. We look at pictures of Daisy Lowe in her leotard and opaque tights and think — yes, that’s what youth should look like: blooming and rounded and bee-stung. We look at Joan in Mad Men, in those curve-packing dresses, and feel the strange sensation that, for the first time in more than a decade, we are seeing the womanly form as God intended it. Up to this point, there have been odd breakthrough moments when we’ve been reminded of the power of shape (Scarlett Johansson’s arrival on the scene, for example), but the novelty always wore off pretty quickly when we were faced with the prospect of fitting into this season’s fashion. For as long as anyone can remember, thin has been the aspirational body type — the one that went hand in hand with success and glamour and money and, above all, looking good in clothes.

Women don’t necessarily want to look as thin as Agyness Deyn (no offence, Agyness), and the fashion industry is waking up to the idea of a proper womanly shape. Look at the fabulous curve-enhancing clothes of Roland Mouret: the global success of the ubiquitous Galaxy dress was partly down to its ability to flatter a fuller figure. Even Anna Wintour, the editor of American Vogue and notorious scourge of fat, seems to be coming round to the idea of curves. Recently, she featured the shapely British singer Adele in the magazine. Okay, she was photographed lying down, but at least Wintour didn’t ask her to lose weight for the shoot, as she famously did with Oprah Winfrey. The emaciated look has simply run its course for a whole host of reasons, and now we are ready for something completely different.

In the first place, thin has got boring. Not just boring, but grindingly predictable. Along with long blonde hair, skinny-as- nothing has become the default position of anyone who wants to get noticed (or photographed), with the result that anyone good-looking who breaks the mould now appears twice as striking and original. Beth Ditto is naked on the cover of Love not because her size makes the image shockingly avant-garde (that was last year). She’s there because she represents the end of fashion’s blind allegiance to the Identikit clothes model, and the beginning of a new love affair with the parts that make women different from indie boys.

The timing of this shift towards a new aesthetic is no accident. Whippet-thin is the standard body type of the high-maintenance woman with a husband in corporate finance, and those sharp shoulders jutting through cashmere have started to look decidedly last year. A reality check is happening across the board (in fashion, Karl Lagerfeld has christened it “the new modesty”). Now a real figure looks a lot more appealing and sexier than a starved one in the same way that driving a Hummer seems hilariously out of touch with the mood of the times. In Hollywood, it’s already noticeable: the likes of Jennifer Aniston have got a bit more flesh on their bones, and the disciples of Rachel Zoe (the Zoebots) are no longer setting the agenda.

Still, it would be naive to pretend we can just erase all these years of brainwashing overnight. Shape is making a comeback, but our perspective has adjusted and now the curvier figure has to obey certain rules. You need a small waist and a flat stomach to contrast with those fuller hips. A pair of nice arms, good ankles and a well-defined clavicle make all the difference. Above all, shape has to be dressed right for it to work, and that means finding the fashions that need filling out: the silhouette-hugging dresses, not the billowing harem pants. Every time Christina Hendricks (Joan in Mad Men) is interviewed and photographed in contemporary clothes, you are reminded that casual, undone and edgy do no favours for the hourglass figure. In that early 1960s look, with asset-packing sheath and immaculate up-do, any woman would die to look like her. But in a thigh-skimming asymmetric number with a frill down the front or, God forbid, jeans and T-shirt, she looks like the big girl who doesn’t quite have what it takes.

In the end, shape has been out of favour for too long because so many of the clothes in the forefront of fashion simply don’t work for women with curves. Now change is coming.

Report warns of problems with multivitamins

NEW YORK (Reuters Health) - More than 30 percent of multivitamins tested recently by ConsumerLab.com contained significantly more or less of an ingredient than claimed, or were contaminated with lead, the company reports.

ConsumerLab.com, based in White Plains, New York, is privately held and provides consumer information and independent evaluations of products that affect health and nutrition. According to the company, it is neither owned by nor has a financial interest in any companies that make, distribute or sell consumer products.

Several multivitamin products tested, including three for children, exceeded tolerable upper limits established by the Institute of Medicine for ingredients such as vitamin A, folic acid, niacin and zinc, according to the report posted on www.ConsumerLab.com.

For example, the Institute of Medicine sets a recommended daily allowance (RDA) of 1,300 international units (IU) of vitamin A for children ages 4 to 8 years and an upper tolerable limit of 3,000 IU. However, one multivitamin tested provided 5,000 IU of vitamin A.

In the short term, too much vitamin A may cause nausea and blurred vision, and, in the long-term, may lead to bone softening and liver problems.

Upper tolerable limits for niacin and zinc were also exceeded by some of the supplements for young children tested. Excess niacin may cause skin tingling and flushing and high levels of zinc may cause immune deficiency and anemia.

Tests turned up problems with some men's multivitamin products as well. Two of three men's multivitamins failed to pass testing. One contained too much folic acid, which may increase the risk of prostate cancer, while another was contaminated with lead.

Among four women's multivitamins tested, one provided only 66 percent of its claimed vitamin A; one of five seniors' multivitamins selected contained only 44 percent of its vitamin A; and among three prenatal vitamins, one was short on vitamin A.

Two out of five general multivitamins were short on ingredients: one provided only 50 percent of its claimed folic acid and the other was missing 30 percent of its calcium.

A vitamin water tested by ConsumerLab.com had 15 times its stated amount of folic acid, so drinking one bottle would exceed the tolerable limit for adults; less than half a bottle would put children over the limit, the company warns on its website.

Children who eat porridge for breakfast 'get better exam results'

Eddy said: Less power to process foods and more to stream to brain?





Feeding children high energy breakfast foods such as porridge at a young age boosts their exams results at school, new research suggests.

By Graeme Paton


Children who followed such a diet before their third birthday had improved scores in reading and problem-solving tests compared to their peers, it was revealed.

In a study that provides some of the strongest links yet between nutrition and academic performance, academics said it also increased the likelihood of remaining in education for longer. It had a particular effect on girls.


The latest study, based on research using a kind of porridge eaten in Guatemala but made with corn rather than oats, suggests a wider link between food and brain power.

John Maluccio, lead author and assistant professor of economics at Middlebury College, Vermont, said: "Before this study, only limited evidence spanning childhood to adulthood existed to support claims about the long-term effects of early childhood nutrition.

"This study confirms that the first three years of life represent a window of opportunity when nutrition programs can have lifelong benefits on a child's development, particularly in education."

The study was based on children in Guatemala eating "atole". It was made with corn, rather than the traditional British oats used in porridge, although they share high protein levels. It was mixed with dry skimmed milk and sugar.

Children received supplements between 1969 and 1977, the study, published in the Economic Journal, said.

In 2002 and 2004, researchers returned to Guatemala and collected information on school results.

Men and women who received atole as children achieved higher scores on reading comprehension tests and on non-verbal cognitive tests, it was revealed. Women taking part in the study were more likely to remain in education for another year.

The research was conducted in Guatemala by the Institute for Nutrition in Central America and Panama, Emory University, the International Food Policy Research Institute (IFPRI), the University of Pennsylvania and Middlebury College.

John Hoddinott, a co-author and IFPRI senior research fellow, said: "We have long known that nutrition interventions can provide significant benefits in terms of a child's health and development.

"This study in Guatemala is important because it shows that improving nutrition in early childhood can have significant educational payoffs into adulthood."

Jacqui Lowdon, a paediatric dietician from the British Dietetic Association, said the food used in the study would have a similar protien content to normal porridge, but added that poor diet among the children tested may be responsible for the dramatic results.

“We already know that good nutrition is important for long-term health and especially important for brain development in the first few years of life,” she said.

When All You Have Left Is Your Pride

By BENEDICT CAREY

Look around you. On the train platform, at the bus stop, in the car pool lane: these days someone there is probably faking it, maintaining a job routine without having a job to go to.

“I have a new client, a laid-off lawyer, who’s commuting in every day — to his Starbucks,” said Robert C. Chope, a professor of counseling at San Francisco State University and president of the employment division of the American Counseling Association. “He gets dressed up, meets with colleagues, networks; he calls it his Western White House. I have encouraged him to keep his routine.”

The fine art of keeping up appearances may seem shallow and deceitful, the very embodiment of denial. But many psychologists beg to differ.

To the extent that it sustains good habits and reflects personal pride, they say, this kind of play-acting can be an extremely effective social strategy, especially in uncertain times.

“If showing pride in these kinds of situations was always maladaptive, then why would people do it so often?” said David DeSteno, a psychologist at Northeastern University in Boston. “But people do, of course, and we are finding that pride is centrally important not just for surviving physical danger but for thriving in difficult social circumstances, in ways that are not at all obvious.”

For most of its existence, the field of psychology ignored pride as a fundamental social emotion. It was thought to be too marginal, too individually variable, compared with basic visceral expressions of fear, disgust, sadness or joy. Moreover, it can mean different things in different cultures.

But recent research by Jessica L. Tracy of the University of British Columbia and Richard W. Robins of the University of California, Davis, has shown that the expressions associated with pride in Western society — most commonly a slight smile and head tilt, with hands on the hips or raised high — are nearly identical across cultures. Children first experience pride about age 2 ½, studies suggest, and recognize it by age 4.

It’s not a simple matter of imitation, either. In a 2008 study, Dr. Tracy and David Matsumoto, a psychologist at San Francisco State, analyzed spontaneous responses to winning or losing a judo match during the 2004 Olympic and Paralympic games. They found that expressions of pride after a victory were similar for athletes from 37 nations, including for 53 blind competitors, many of them blind from birth.

“It’s a self-conscious emotion, reflecting how you feel about yourself, and it has this important social component,” Dr. Tracy said. “It’s the strongest status signal we know of among the emotions; stronger than a happy expression, contentment, anything.”

In one continuing experiment, Dr. Tracy, along with Azim Shariff, a doctoral student at British Columbia, have found that people tend to associate an expression of pride with high status — even when they know that the person wearing it is low on the ladder. In their study, participants impulsively assigned higher status to a prideful water boy than to a team captain who looked ashamed.

The implications of this are hard to exaggerate. Researchers tend to split pride into at least two broad categories. So-called authentic pride flows from real accomplishments, like raising a difficult child, starting a company or rebuilding an engine. Hubristic pride, as Dr. Tracy calls it, is closer to arrogance or narcissism, pride without substantial foundation. The act of putting on a good face may draw on elements of both.

But no one can tell the difference from the outside. Expressions of pride, whatever their source, look the same. “So as long as you’re a decent actor, and people don’t know too much about your situation, all systems are go,” said Lisa A. Williams, a doctoral candidate in psychology at Northeastern University.

The various flavors of pride may even feel similar on the inside, when the stakes are high enough. “She was always scrupulous about keeping up appearances to herself,” wrote Edith Wharton of her tragic heroine Lily Bart in “The House of Mirth.” “Her personal fastidiousness had a moral equivalent, and when she made a tour of inspection in her own mind there were certain closed doors she did not open.” If you believe it, so will they.

A feeling of pride, when it’s convincing, acts something like an emotional magnet. In a recent study, Ms. Williams and Dr. DeSteno of Northeastern had a group of 62 undergraduates take tests supposedly measuring their spatial I.Q. The patterns flashed by too fast for anyone to truly know how well they did.

The researchers manipulated the amount of pride each participant felt in his or her score. They either said nothing about the score; remarked, in a matter-of-fact tone, that it was one of the best scores they had seen; or gushed that the person’s performance was wonderful, about as good as they had ever seen.

The participants then sat down in a group to solve similar puzzles. Sure enough, the students who had been warmly encouraged reported feeling more pride than the others. But they also struck their partners in the group exercise as being both more dominant and more likable than those who did not have the inner glow of self-approval. The participants, whether they had been buttered up or not, were completely unaware of this effect on the group dynamics.

“We wondered at the beginning whether these people were going to come across as arrogant jerks,” Dr. DeSteno said. “Well, no, just the opposite; they were seen as dominant but also likable. That’s not a combination we expected.”

Therapists say that in time, people usually do better when they come clean. “In some ways it’s easier to do this now, with so many people out of work,” said Michael C. Lazarchick, an employment counselor in southern New Jersey. “You may very well find out that others are going through the same thing, or something like it — ‘Oh yeah, I just took a big cut in pay.’ ”

But in the short term, projecting pride may do more than help manage others’ impressions. Psychologists have found that wearing a sad or happy face can have a top-down effect on how a person feels: Smile and you may feel fleetingly happier. The same most likely is true for an expression of pride. In a 2008 study, the Northeastern researchers found that inducing a feeling of pride in people solving spatial puzzles motivated them to try harder when they tackled the next round.

Pride, in short, begets perseverance. All of which may explain why, when the repo man is at the door, people so often remind themselves that they still have theirs, and that it’s worth something. Because they do, and because it is.

However much pride may go before a fall, it may be far more useful after one

Allergic babies

By Dr M. YADAV


Allergy is becoming an increasingly prevalent problem in many countries, especially among our young.

ALLERGIC diseases represent a major and increasing health problem in industrialised countries. Over the past five decades, the prevalence of allergic diseases has increased dramatically and the incidence has doubled in the last 20 years in most industrialised countries.

In some countries, for example Australia and Sweden, 40% of young children have allergic disorders.

In Malaysia, about 30% of young children are likely to develop allergic disorders in the first five years of life.

The most common allergic conditions in children and infants are food allergies, eczema, asthma and allergic rhinitis. Allergies are often life-long and although treatable, they tend to recur if the triggers are not strictly avoided. Some food allergies spontaneously improve within three years but are often replaced by respiratory allergies. Thus, it makes sense to try to prevent the development of allergies in early life than trying to treat them later.

Hence, there is great interest to identify the risk factors associated with the development of allergic disorders in early life and modify them to reduce subsequent risks for development of allergy.


Many studies show that breast milk decreases the incidence of allergic eczema compared to cow’s milk.

Risk factors for allergy

The development and appearance of allergic symptoms depends on poorly-understood complex interactions between genetic and environmental factors.

It is evident historically that changing environmental factors have played a major role for the increasing trends in allergy and asthma. Obviously, we have some control over the environmental risk factors but we have practically no control over genetic factors, which have an equal role in the development of allergic disorders.

Families often ask how allergy can be prevented in future offspring. The American Academy of Pediatrics published a clinical report in 2008 with recommendations for those infants at high risk of developing allergic disease. Avoidance of the major risk factors could reduce or prevent the development of allergic disease in most infants. For the avoidance measures to work, the first two years of life are critical and the measures must be applied before the development of allergy in the neonate.

These recommendations do not apply to babies already having food allergy. The major risk factors for the development of allergy in infancy are:

· Strong family history of allergic disease (both parents or one parent plus one sibling with allergy) may significantly increase the risk for allergy in the newborn.

· Exclusive breast feeding is desirable for least four months compared with feeding with intact cow’s milk. Many studies show that breast milk decreases the incidence of allergic eczema compared to cow’s milk.

Partially hydrolysed whey formula, which is hypoallergenic (reduced ability to stimulate and induce an IgE-mediated immune response) formula is preferred as supplementary feed for babies. The hypoallergenic formula is the preferred feed for the baby when the mother is unable to breastfeed. There is no role for soy-based formula in allergy prevention.

· Solid foods should not be introduced before ages four to six months. Early introduction of solid foods increases the risk, but delayed introduction of solid foods beyond six months provides no advantage.

· Exposure as a child or infant to high levels of house dust-mite allergens (allergens are substances, usually proteins, that cause allergy) increases risk to respiratory allergies. Anti-dust mite barrier encasing of mattress and pillows may provided some protection. Regular use of anti-dust mite sprays to reduce the level of dust mite allergens in the home environment is desirable. These procedures are specifically important for Malaysia, which has high dust-mite allergens levels in the home environment.

· Exposure to some indoor mammalian pets (e.g. cat) increases risk in the baby. Keep the pets strictly outside the house away from the baby’s play area and bedroom or remove the pets until the baby is older.

· No smoking should be permitted in the house during pregnancy and lactation. Passive exposure to cigarette smoke during pregnancy or infancy increases the risk for allergy significantly in early life.

· Passive exposures to cigarette smoke during pregnancy or infancy increases the risk for allergy significantly in early life.

· Exposure to environmental pollution as a child or infant (e.g. high levels of car exhaust fumes or fumes from gas heaters) increases the risk.

Maternal diet during pregnancy and lactation The earliest possible nutritional influence on allergy in the infant is the diet of the pregnant mother.

It is well known that food allergens in the diet of the mother can appear in the circulation and be transmitted to the amniotic fluid during pregnancy or breast milk during lactation. The foetus in late pregnancy (when the immune system is immature but functional) can be sensitised (develop the capacity to react to allergens on subsequent exposure) to the food allergens present in the amniotic fluid. In families with a genetic predisposition, there is a good chance that the newborn, when re-exposed to the provoking foods (e.g. cow’s milk), will react with symptoms (e.g. diarrhoea, vomiting, colic, eczema) to the sensitising foods. In families without a genetic allergic-background, the sensitised baby will not react to the provoking allergens.

Prior to 2008, the American Academy of Pediatrics had recommended avoidance of peanuts, cow’s milk, soy milk, fish and eggs during pregnancy and lactation to reduce the risk for allergy to these foods in the baby.



However, in January 2008, the American Academy of Pediatrics reversed their position on maternal avoidance of specific foods. The current position, based on evidence from large number of research studies, does not support maternal avoidance of allergenic foods during pregnancy or lactation. Moreover, maternal avoidance of specific nutrition during pregnancy may not be conducive for the healthy growth of the baby.

Low levels of maternal dietary food-allergens present in breast milk may cause allergic symptoms (e.g. eczema) in exclusively breastfed babies. Our studies in Malaysia show that exclusively breastfed babies with skin symptoms are mostly reactive to cow’s milk and egg white proteins. However, in some babies, additional allergens such as wheat, peanuts, soy bean, sesame seeds, banana, chicken meat, garlic and many others were also contributory to the development of allergic eczema. In all these babies, there was a family history of allergy.

The continued breastfeeding and maternal avoidance of the provoking foods is normally advised when the infant is less than four to six months. In older infants, breast milk can be stopped and the weaning diet should exclude the provoking foods.

In all such cases it is essential to identify the provoking food allergens through blood allergy tests on the baby based on the maternal diet. Any delay in seeking allergy services may potentially lead to adverse clinical outcome due to unacceptable diagnostic oversight.

Food allergy in Malaysian children Investigations into food allergy in Malaysia were pioneered by Dr N. Iyngkaran and his colleagues, including myself, in the mid-70s at the then University Hospital.

At that time, chronic diarrhoea in infants was a major cause of morbidity and mortality. In a series of experimental studies, it was demonstrated that cow’s milk was the primary cause of the chronic gastroenteritis diarrhoea in young infants. These infants suffered from symptoms of vomiting, diarrhoea and colic. Moreover, the associated lactose intolerance was recognised as secondary to the intestinal mucosal damage inflicted by the cow’s milk allergic reaction. This was an important contribution because for the first time the relationship between cow’s milk allergy, intestinal mucosal damage, lactose intolerance and clinical symptoms became clear. The group went on to demonstrate that many other proteins, such as egg protein and soy protein, which caused allergic reactions in young infants and children, were also responsible for marked intestinal mucosal aberrations.

One interesting study performed by the group showed that about 40% of infants with cow’s milk allergy developed allergic reaction to soy milk even if the baby had not been exposed to soy products previously. Only in recent years has it become clear that cow’s milk casein shares common allergens with soy protein and hence infants sensitised to casein will eventually react to soy if it is used as a substitute in infants allergic to cow’s milk.

Adverse reactions to cow’s milk are frequently seen in the first year of life in infants on bottle feed. Cow’s milk allergy is present in 3-5% of infants and 85% will outgrow the milk allergy by the third year.

However, in some children, particularly those with high titres of IgE antibody and severe symptoms, the milk allergy will persist longer, usually into adolescence and sometimes into adulthood.

The symptoms of cow’s milk allergy usually starts in the first weeks of life. The main symptoms of cow’s milk allergy are:

gastrointestinal in about half the infants; skin eczema in two-third of infants; and respiratory problems in about quarter of infants. In many infants, all three symptoms may be present.

Young children with eczema are at a higher risk of developing food allergy, particularly those infants and toddlers whose skin disease is more severe or recalcitrant to therapy. Generally, the younger the patient and the more severe the eczema, the more likely food allergy is a causative factor.

Parental perceptions with regards to food allergy in their children are notoriously inaccurate. Parents often have very strongly held beliefs that certain foods cause a variety of symptoms, many of which are inconsistent with an immune-mediated process.

In fact, when the diagnosis of IgE-mediated food allergy are performed in an established laboratory using approved allergy tests, only about 40% of patients’ histories of food-induced reactions can be verified. Thus it is very important to conduct an allergy test at a centre managed by professionals.

Food allergy in children is most likely to manifest between one and three years. In Malaysian infants less than one year old, the foods causing allergy in order of importance are cow’s milk, soy milk, chicken eggs and fish.

On the other hand, in children more than two years old, the foods causing allergy in order of importance are shellfish (prawns/shrimp), cow’s milk, chicken eggs, wheat, soy and peanuts. In 70% of children, chicken egg allergy lasts until the twelfth year.

Peanut allergy tends to be long-lasting, with 20% infants resolving by the ninth year, but in the rest, it may be life-long. Avoidance of the provoking foods is essential for success in treating food allergy.

The only objective method of measuring IgE antibodies is to use technology that is calibrated against established reference preparations. The CAP RAST blood test is scientifically considered superior to any other allergy test for the detection of the provoking allergen in the infant’s diet. It is a quantitative test with each run incorporating controls which are standardised against WHO standards. The blood allergy test is not affected by medications, including anti-histamines.

Elimination of the food allergen is the only proven effective therapy at this time. Strict dietary avoidance is generally recommended once a food allergy is diagnosed.

If the mother is breastfeeding, she must also strictly eliminate the causal foods from her diet. Clinical tolerance can develop over time, more commonly to some foods (milk, egg, soy, wheat) over others (peanut, tree nuts, seafood). In time, the baby will outgrow the allergy brought on by the provoking food (e.g. cow’s milk or chicken eggs) and show no food-specific IgE-antibody. Only then can the problematic food be successfully reintroduced into the diet of the child without worrying about the development of adverse reactions. In rare cases, some food (e.g. chicken egg, shrimp/prawn, bird’s nest soup) may cause severe systemic life-threatening reaction (called anaphylaxis) within minutes of ingestion of the provoking food. The symptoms appear rapidly, usually with minutes of exposure to the provoking food. The symptoms include: (1) skin or mucosal involvement (e.g. generalised hives or swelling of oral mucosa), (2) respiratory compromise (e.g. dyspnea, wheeze), (3) persistent gastrointestinal symptoms (e.g. vomiting), (4) hypotension (e.g. hypotonia, fainting).

Epinephrine, which is dispensed in special syringes called Epipen, is clearly the treatment of choice for anaphylaxis. Following epinephrine treatment, the individual should be rushed to the hospital.

Certainly, having signs of hypotension (even without accompanying symptoms) is an indication for epinephrine administration, particularly in a child with known food allergy. It is important to identify the provoking foods through food allergy tests if any one has had this experience of anaphylaxis since such episodes tend to reappear in reactive individuals. Avoiding the trigger resolves the problem.

Food allergy in infancy predicts respiratory allergy in mid-childhood.

Food allergy in infants less than one year old predicts the development of respiratory allergy and asthma in children five to eight years old.

There are ways for physicians to increase the predictive value of the allergy test. One factor is the level of specific IgE antibody in serum, which can affect the presence, persistence and severity of the allergic disease. Thus the risk of developing asthma increases with increasing specific antibody levels.

A sensitised infant with specific IgE antibody to food allergens (e.g. cow’s milk, chicken egg) and/or aeroallergens (e.g. cat dander, dust mite) summing up to a total of 0.5 kilounits per litre (kU/L) has 20% risk of developing persistent wheezing/asthma, but if the summed antibody level is greater than 10 kU/L in early life, the predictive value for wheezing/asthma increases to 90% at five years of age.

This definitely calls for quantification of IgE antibody levels if allergy is suspected in the young baby for assessing the severity of the disease. Allergy is not a simple yes or no phenomenon of allergy tests. Recent studies show that prediction and diagnosis of allergy needs to be based on several factors, including quantitative of IgE antibody levels.

Conclusion

In Malaysia, food allergies in infancy are increasing rapidly. In young infants, the most common foods causing allergies are cow’s milk and chicken eggs. The next commonest are soy milk, wheat, fish and peanuts.

In older children, shellfish (e.g. shrimp/prawns, crab), in addition to the other foods noted in infancy, is most important.

The majority of children with food allergy in the first year of life will develop respiratory allergy to house dust mites during mid-childhood. Thus, early measures to prevent the risk for development of allergy are desirable.

For further information, e-mail starhealth@thestar.com.my. The information provided is for educational and communication purposes only and it should not be construed as personal medical advice. Information published in this article is not intended to replace, supplant or augment a consultation with a health professional regarding the reader’s own medical care. The Star does not give any warranty on accuracy, completeness, functionality, usefulness or other assurances as to the content appearing in this column. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.

Memory pill that could help with exam revision could be available soon

A "memory pill" that could aid exam revision and help to prevent people forgetting important anniversaries may soon be available over the counter.

By Lucy Cockcroft


Memory-enhancing pills, created to treat Alzheimer's disease, could be redeveloped as a 'lifestyle pill' to combat memory loss and help exam revision.

The medicine has been designed originally to help treat Alzheimer's disease, but could be adapted and licensed for sale in a weaker form within the next few years.

One brand of memory-enhancing pill is being developed by the multinational company AstraZeneca in collaboration with Targacept, an American company, while Epix Pharmaceuticals, also from the US, is developing another.

Both have "cognitive-enhancing effects" which are aimed at treating patients with age-related memory loss.

Steven Ferris, a neurologist and former committee member of the Food and Drug Administration in the US, has predicted that a milder version will be available for healthy consumers as a "lifestyle pill" available over the counter.

Dr Ferris said: "My view is that one could gain approval, provided you showed the drugs to be effective and safe. It could be a huge market."

There is anecdotal evidence that mind-improving drugs are already being taken in Britain by healthy users.

Provigil, used to treat narcolepsy, is being taken by some students to help them stay awake, while Adderall XR and Ritalin, treatments for attention deficit disorder, are being used to help promote concentration.

A spokesman Adderall XR said: "We get a lot of calls from college campuses asking about it.

"There are risks though. It can raise blood pressure, people shouldn't do it."

The Department of Health said it was not illegal to buy the medicines over the internet, but it was not recommended.

Barbara Sahakian, professor of clinical neuropsychology at Cambridge, said: "It's hard to quantify the scale of the phenomenon but it's definitely catching on.

"The reality is we're not always at our best. After being up at night looking after the kids or travelling, many people would love to have something to sharpen them up. It's not taboo to drink Red Bull. The principle with cognition enhancers is not so different."

Coffee may protect against oral cancers

Study: Drinking a cup a day reduces risk of developing the disease

NEW YORK - New research indicates that drinking coffee lowers the risk of developing cancer of the oral cavity or throat, at least in the general population of Japan.

The consumption of coffee in Japan is relatively high, as is the rate of cancer of the esophagus in men. To look into any protective effect of coffee drinking, Dr. Toru Naganuma of Tohoku University, Sendai, and colleagues, analyzed data from the population-based Miyagi Cohort Study in Japan.

The study included information about diet, including coffee consumption. Among more than 38,000 study participants aged 40 to 64 years with no prior history of cancer, 157 cases of cancer of the mouth, pharynx and esophagus occurred during 13 years of follow up.

Compared with people who did not drink coffee, those who drank one or more cups per day had half the risk of developing these cancers, Naganuma's group reports in the American Journal of Epidemiology.

They note that the reduction in risk included people who are at high risk for these cancers, namely, those who were current drinkers and/or smokers at the start of the study.

"We had not expected that we could observe such a substantial inverse association with coffee consumption and the risk of these cancers," Naganuma commented to Reuters Health, "and the inverse association in high-risk groups for these cancers as well."

The researchers conclude in their article, "Although cessation of alcohol consumption and cigarette smoking is currently the best known way to help reduce the risk of developing these cancers, coffee could be a preventive factor in both low-risk and high-risk populations."

What to Do With Leftover Champagne

No matter how much you imbibe on New Year’s Eve, chances are you’ll have some already-opened bubbly still left over on the morning after.

While mimosas, bellinis and other champagne cocktails are always an option on New Year’s Day, a more-healthful choice may be to use the uncorked bubbly in creative home cooking. Champagne is an excellent accompaniment to seafood and salads, and several Web sites offer recipes for starting the new year in a healthy way.

MyRecipe.com offers seven things to do with leftover champagne, including a 10-minute dish, Scallops in Champagne Sauce.

Chef Bryan Voltaggio from Volt in Frederick, Md., suggests putting leftover champagne in an ice-cream maker. The resulting sorbet will have a bubbly effect and can be served atop raw oysters for brunch. He offers several more ambitious ideas as well at FrederickNewsPost.com.

The Galveston County Daily News offers recipes for a tantalizing dish of Gulf shrimp, curry powder, cilantro and champagne as well as champagne truffles and a champagne vinaigrette.

Planet Green suggests using leftovers to make champagne vinegar.

And Epicurious.com suggests using leftover champagne or any leftover white wine to cook mussels.

Blood Sugar Control Linked to Memory Decline, Study Says

Spikes in blood sugar can take a toll on memory by affecting the dentate gyrus, an area of the brain within the hippocampus that helps form memories, a new study reports.

Researchers said the effects can be seen even when levels of blood sugar, or glucose, are only moderately elevated, a finding that may help explain normal age-related cognitive decline, since glucose regulation worsens with age.

The study, by researchers at Columbia University Medical Center and funded in part by the National Institute on Aging, was published in the December issue of Annals of Neurology.

“If we conclude this is underlying normal age-related cognitive decline, then it affects all of us,” said lead investigator Dr. Scott Small, associate professor of neurology at Columbia University Medical Center. The ability to regulate glucose starts deteriorating by the third or fourth decade of life, he added.

Since glucose regulation is improved with physical activity, Dr. Small said, “We have a behavioral recommendation — physical exercise.”

In the study, researchers used high-resolution functional magnetic resonance imaging to map brain regions in 240 elderly subjects. They found a correlation between elevated blood glucose levels and reduced cerebral blood volume, or blood flow, in the dentate gyrus, an indication of reduced metabolic activity and function in that region of the brain.

By manipulating blood sugar levels in mice and monkeys, researchers said, they tried to confirm a cause-and-effect relationship between the glucose spikes and the reduced blood volume, Dr. Small said.

Bruce S. McEwen, who heads the neuroendocrinology lab at Rockefeller University in New York and was not involved in the research, said the study’s findings were “compelling,” with important implications not just for the elderly but for the growing number of overweight children and teens at risk of Type 2 diabetes.

“When we think about diabetes, we think about heart disease and all the consequences for the rest of the body, but we usually don’t think about the brain,” he said. “This is something we’ve got to be really worried about. We need to think about their ultimate risks not only for cardiovascular disease and metabolic disorders, but also about their cognitive skills, and whether they will be able to keep up with the demands of education and a fast-paced complex society. That’s the part that scares the heck out of me.”

Previous observational studies have shown that physical activity reduces the risk of cognitive decline, and studies have also found that diabetes increases the risk of dementia. Earlier studies had also found a link between Type 2 diabetes and dysfunction in the dentate gyrus.

Sheri Colberg-Ochs, an associate professor of exercise science at Old Dominion University in Norfolk, Va., said her research has found that regular exercise, even light physical activity, can offset the potentially negative effects of Type 2 diabetes on cognitive function. It is not clear what the mechanism is, she said, but may have something to do with the effect of insulin.

“This new study is interesting in that it allows for a greater understanding of which region of the hippocampus is likely most affected by poorly controlled diabetes,” she said.

But the elevations in blood glucose seen in the new study are more subtle and would not be considered a disease state, Dr. Small said.

“It’s part of the normal process of aging, much like wrinkling of skin,” he said. “It happens to all of us inexorably, and it worsens progressively across the life span

Do patients trust doctors too much?

Eddy said: Darn true. But what to do?　That industry is like a total black box to patients who usually rely on a hunch or words-of-mouth to decide which practitioner to be engaged with and putting their life at stake. This sucks and we do heard lots of bad stories like money-minded doctors who tell patients to go for surgery regardless of whether it is absolutely necessary or maybe there's exist better alternative. Anyway, nonetheless, the health care system in Malaysia sucks too.

Knowledge is power. Who doesn't know that. The issue lies at the information asymmetry that makes the profession profitable in a maximum sense.


By Pauline W. Chen, M.D.

When a doctor friend of mine recently heard a radio ad for a Web site where patients could rate their doctors, he almost drove off the road.

"I can't believe they've added doctors to the list," he said of the site, Angie's List, perhaps best known for its user-generated report cards on local contractors. "Why do patients want to assess my relationship with them in the same way they evaluate a roofing job?" he asked, shaking his head over what he interpreted to be more evidence of the disintegrating doctor-patient relationship.

I agreed with my friend and, not long after our conversation, curiosity piqued, I paid for a subscription to the site.

The pages seemed to overflow with information. There were reviews of roofers, childcare providers, dog walkers and tattoo and piercing shops. One of the newest and most popular categories was doctors, where reviewers could grade their doctors by answering the site's specific questions and elaborate with additional comments.

Doctors, like every other business, service, and facility listed, were evaluated using the same generic report card. Everyone received a grade for each of five categories — price, quality, responsiveness, punctuality, and professionalism — as well as an answer to the all-important bottom line question: Hire again?

So much for Marcus Welby, I thought, after going through a couple of the reviews.

But the more I read, the more I realized that there was a correlation between good grades and attentiveness. Reviewers gave less-than-passing, and even failing, grades to those physicians who seemed rushed, brusque or distracted; and they uniformly gave "A's" and "B's" to doctors who were warm, concerned and focused.

Even more could be gleaned from what went unsaid. Amongst the many comments I read, I found almost no mention of a doctor's actual medical skill.

That was not the case with roofers, for example, where in addition to grades, reviewers' comments offered great specifics — and even photographs — regarding the quality of the handiwork, the types of supplies used and the aesthetics of the finished product. All the detailed commentaries fleshed out each company's final grades, and it was easy to get a pretty good sense of an individual roofer's skill and craftsmanship.

With doctors, however, there were no detailed descriptions of medical skill beyond the overall grade. Instead, the playing field seemed oddly level. One surgeon, it appeared, could operate much like another; pediatricians and internists could diagnose and manage with similar abilities; and obstetricians could deliver babies regardless of shape, size, or form. All doctors, whatever their grades, seemed to possess similar and interchangeable skills that they could then apply to you. You just might not like the way they treated you in the process.

I found this extraordinary degree of trust astonishing. When I look for a doctor, of course I am concerned about how that doctor relates to me as a patient. But there are a whole host of other issues I consider as well, such as the physician's training, board certification, experience, membership in a respected professional society, safety records and hospital affiliations. And I admit that I don't feel comfortable as a patient in another doctor's hands until I learn the answers to at least some of my questions.

But as it turns out, most patients don't feel the same way. And many of them are just as trusting when it comes to treatment specifics.

Earlier this year, the American College of Surgeons, the national scientific and educational organization of surgeons, conducted a nationwide survey that found that the average patient devotes an hour or less to researching his or her surgery or surgeon. While prospective patients worry about the costs or complications of an operation, they don't necessarily look for information that would address their concerns.

In fact, more than a third of patients who had an operation in the last five years never reviewed the credentials of the surgeon who operated. Patients are more likely to spend time researching a job change (on average, about 10 hours) or a new car (8 hours) than the operation they are about to submit to or the surgeon who wields the knife. And many patients are satisfied with the answers they receive from their surgeon or primary care doctor, whoever those individuals happen to be.

I was intrigued by the survey, so I called Dr. Thomas Russell, executive director of the American College of Surgeons. "There is a tendency, probably more so now than in the era of Marcus Welby, for patients not to get particularly involved and not to feel compelled to look into their surgery or surgeons," he told me.

There are consequences to that kind of blind trust. "Today, medicine and surgery are really team sports," Dr. Russell continued, "and the patient, as the ultimate decision maker, is the most important member of the team. Mistakes can happen, and patients have to be educated and must understand what is going on."

Dr. Russell has made it part of his personal mission to educate patients and recently wrote a book, "I Need an Operation...Now What? A Patient's Guide to a Safe and Successful Outcome," as a response to the survey. "Patients and their families need to be armed with the fortitude and the right questions in order to find the best doctors for their problems," he said.

In other words, a healthy doctor-patient relationship does not simply entail good bedside manners and responsible office management on the part of the doctor. It also requires that patients come to the relationship educated about their doctors, their illnesses and their treatment.

"If we are truly going to reform the health care system in the U.S.," Dr. Russell said, "everybody has to participate actively and must educate themselves. That means doctors, nurses, other health care professionals, lawyers, pharmaceutical companies, and insurance companies. But most of all, it means the patient."

Trust is important. But as Sir Francis Bacon, who was among the first to understand the importance of gathering data in science, once observed, knowledge is power.

Low carb diets 'can cause memory loss'

Scientists found that dieters who cut out high energy foods such as pasta, bread and potatoes could end up starving their brain of the fuel it needs to function properly.

Their study on women aged 22 to 55 showed that those on a low carbohydrate meals suffered impaired memory function after just one week.

Psychology professor Holly Taylor, of Tufts University, Massachusetts, said that when carbohydrates were re-introduced the women's mental function returned to normal.

She added: "This study demonstrates that the food you eat can have an immediate impact on cognitive behaviour. The popular low-carb, no-carb diets have the strongest potential for negative impact on thinking and cognition."

The reason for the women performing poorly in the memory tests is because the brain uses glucose, which is obtained from carbohydrates in food, for fuel.

It cannot store the glucose, so a low carbohydrate diet means less fuel to power the brain cells. In the study, participants included 19 women who were allowed to select either a low-carbohydrate diet or a "low-calorie, macronutrient balanced diet." Nine women chose a low-carbohydrate diet.The others selected low-calorie meals.

All the dieters were tested for "cognitive skills" including attention, long-term and short-term memory, visual attention, and spatial memory which helps with everyday tasks and details about surroundings.

Low-carb dieters "showed a gradual decrease on the memory-related tasks compared with the low-calorie dieters". Their reaction times were also slower. However, they did do better on short-term attention tests.

Professor Taylor said: "Although the study had a modest sample size, the results showed a clear difference in cognitive performance as a function of diet.

"The data suggests that after a week of severe carbohydrate restriction, memory performance, particularly on difficult tasks, is impaired. It suggests that diets can affect more than just weight.

"The brain needs glucose for energy and diets low in carbohydrates can be detrimental to learning, memory and thinking." The findings will appear in the February 2009 edition of the journal Appetite.

Study: Malaysian women shop to relieve stress

Eddy said: A new paradox paradigm, shopping ignites stress or stress causes shopping madness. Let see what'll happen when they receive their card statement. LOL


By : Irdiani Mohd Salleh

KUALA LUMPUR: Malaysian women believe in "retail therapy", with most of them spending an average of RM180 each on shopping in a month.

Almost three-quarters of women surveyed recently said shopping was therapeutic and a stress-reliever.

These were the findings of a survey conducted by global market research company Synovate on more than 1,000 Malaysian women recently.

The respondents, aged between 15 and 64, were from all income levels. They were asked on their retail preferences and spending habits for clothing, accessories, skin care products and cosmetics as well as electronic gadgets.

Synovate Malaysia managing director Steve Murphy said 74 per cent admitted that shopping was therapeutic and helped to relieve stress.

However, most are not extravagant as they only spent 17 per cent of their monthly income on shopping.

"We found that Malaysian women hold back most of their income for savings, which is timely in the current economic situation."

Financial independence of Malaysian women was also reflected in the survey results.

Close to half of the respondents said they could afford to pay for what they wanted without having to ask for money from their partners or husbands.

"We also made comparisons across the region and found that women in Hong Kong (87 per cent) were the most financially independent, followed by China (75 per cent) and Singapore (74 per cent)."

The majority of Malaysian women also felt that they were on equal terms with their partners or husbands.

More than two-thirds (68 per cent) acknowledged that they had an equal say in the purchase of big-ticket items such as property and cars.

Women in Hong Kong (87 per cent) and China (76 per cent), however, were found to have a bigger say.

The survey also revealed that Malaysian women did not compromise on quality when buying goods and services.

A total of 640 women agreed that they would pay extra for quality.

"The quality factor was confirmed again as we asked each respondent what would make them loyal to a retailer apart from lower prices."

The survey also showed that most Malaysian women cared for the environment and 490 of the respondents were willing to pay more to buy environmental-friendly products.

Eddy said: Thinking of saving the planet by blindly buying environmental-friendly goods? Think thrice. Some so called friendly products don't necessarily being produced in environmental-friendly method.

Drink more waters. Think Thrice

Mother awarded £800,000 after 'six pints of water a day detox diet' left her brain damaged

By Luke Salkeld

A dieter suffered permanent brain damage after being advised to drink six pints of water a day and cut salt intake to lose weight.

Dawn Page, 52, has been awarded £810,000 in damages from her nutritionist, although the practitioner denies fault.

Mother of two Mrs Page, who weighed 12st, became ill within days of taking up the Amazing Hydration Diet.


Brain damaged: Dawn Page became ill within days of taking up the Amazing Hydration Diet

She had been told by the nutritionist to drink four extra pints of water a day and drastically reduce her salt intake.

The first stage of the regime left her suffering from severe vomiting and stomach cramps, but she was told these were just part of the detoxification process.


She was then told by her nutritionist to increase the amount of water to six pints and consume still less salt.

Days later she suffered a massive epileptic fit and brain damage caused by severe sodium deficiency.


Settlement: Nutritional therapist Barbara Nash
It has left her with 'cognitive deficit' which affects her memory, concentration and speech and she suffers frequent mood swings.


She has been forced to give up her job as a conference organiser and has relied on her husband Geoff, 54, for help since going on the diet in 2001.

Practitioner Barbara Nash, who refers to herself as a 'nutritional therapist and life coach', continues to deny any fault following the payout from her insurance company, which was made without mention of liability.

The award was ratified by High Court in London at a hearing on Friday.

Yesterday Mr Page warned others of the dangers of 'fad' diets.


Speaking from the family home in Faringdon, Oxfordshire, he said: 'She was not obese or even mildly obese, but like a lot of women, Dawn liked to look after her weight.

'She had tried Weight Watchers and calorie control diets.

This was just another potential route for her to lose weight. Her life has been seriously affected, perhaps ruined, by this fad-type way of losing weight, which I can only say is a
dangerous method of weight loss.'


Mrs Page had paid £50 for a consultation with Mrs Nash. But less than seven days later she was struck down with stomach cramps and sickness.

She contacted the nutritionist about the side effects, but was assured that vomiting was a normal part of the detox programme.




In October 2001, Mrs Page collapsed at home with a serious epileptic fit and was rushed to hospital in Swindon where doctors diagnosed a shortage of plasma sodium levels.

The salt-rich plasma acts as a protective layer around the brain, but because Mrs Page's contained such low levels of the mineral, water had entered the brain, causing permanent damage.


Dependent: Dawn Page has relied on husband Geoff since her severe epileptic fit in 2001


Since the fit, she has had to rely on written notes to remember basic instructions, and finds it hard to recall simple information.

Mr Page, a project manager for a packaging company, said: 'Everything's so difficult for her now. She can't comprehend what's being said or relate to what's going on around her.

'She can't drive, can't work, and takes medication every day and will for the rest of her life.'

Mr Page, who launched the six and a half year legal action, added: 'It's important that people understand how dangerous diets like these are, and not to enter into them without knowing all the dangers.'

Mrs Nash, who is based in Wheatley, Oxfordshire, has a diploma of natural nutrition gained from the College of Natural Nutrition, based in Tiverton, Devon. She was unavailable to comment last night.

Plexus Law, the firm which represented her in court, released a statement after the hearing, which read: 'We wish to make it clear that all allegations of substandard practice made on behalf of Mrs Page in the litigation have always been and continue to remain firmly denied.

'In our view as a recognition of this, the settlement amount agreed to be paid was less than half of the total amount claimed and the compromise which was offered and accepted was on the basis of no admission of liability.'

Warning on 'Hydration'
Hydration diets are sometimes prescribed to those suffering from fluid retention, which can cause weight gain in the fingers, ankles and legs.


Fluid retention can be caused by the kidneys not working properly and it is thought some nutritionists claim additional water can ‘kick start’ the kidneys.


But registered dietician Nigel Denby said: ‘If hydration ever leads to weight loss, it is simply because the extra water makes you less inclined to eat because you feel full.


Hydration diets do not work. I have no idea what the reduction of sodium is supposed to achieve, but no qualified professional would recommend this sort of diet.’


A serious loss of sodium can lead to weakness, dizziness, memory loss and nausea.


If the deficiency becomes severe, the circulatory system can collapse and the body can go into shock, causing fatigue, muscle twitching and fits.

Thai green curry: Could pep up your libido

By Polly Buchanan

NEVER mind the oysters – if you want to boost your libido, tuck into a takeaway.


A Thai green curry is the best bet because it’s packed full of aphrodisiacs, according to a league table of the sexiest dial-a-meals.


Ingredients including cardamom, ginseng, garlic, ginger, basil, lemon grass and asparagus – all found in a typical green curry – are widely believed to enhance the sex drive.


Women in need of some spice should opt for a korma – the Indian dish contains a potent mix of coconut, garlic, chilli, ginger and almonds, all of which are said particularly to improve the female libido.


What if you want to spice up your love life, but you’re not quite so keen on spicing up your dinner?


Not to worry, a pizza can be just as effective. And if it’s topped with the winning combination of tomatoes, onions, garlic, basil and olives – or even with a hint of chilli or spicy meatballs – it ought to perk up any evening in.


The top-10 list of takeaway meals based on the number of aphrodisiac ingredients per meal was compiled by takeaway company Just-Eat.


Marketing chief Ali Ash said: “We wanted to let the public in on this well-kept secret in a bid to heat up their own sex lives. Thai green curry has long been known in the East to provide a boost to sex drive, due to the ingredients, but the British public are far less aware and instead only aware of the common, more expensive aphrodisiacs, such as oysters and caviar.”


Perhaps less familiar is the fourth on the list, seafood laksa – a spicy, coconut-based Malaysian noodle soup made with shrimps.


Mole poblano, which proved to be the fifth sexiest takeaway, is a Mexican sauce that combines chilli, almonds, garlic, tomatoes and chocolate to create a potent Latin aphrodisiac meal.


The distinct sauce, with its hint of endorphin-boosting chocolate, is used to dress chicken or turkey, to form Mexico’s national dish and is popular as a takeaway in some countries.


It seems it certainly pays to keep things spicy.

Chinese diet is so healthy

Use your noodle: The real Chinese diet is so healthy it could solve the West's obesity crisis

Sophie Morris explains how it works - and nutritionists give their verdict

Chinese food has a bad reputation in the UK. The rice-heavy meals and fatty meat dishes are thought to lead straight to obesity and heart disease. But properly prepared, says Chinese food expert Lorraine Clissold, the very opposite is true: the Chinese way of eating is healthy and fulfilling, fights illness and prolongs life. She also insists, in her book Why the Chinese Don't Count Calories, that a real Chinese diet won't make you fat, and that the rising levels of obesity observable in China are in fact caused by sugary, overprocessed Western food. Here are some of her Chinese dietary secrets – and the verdict of two Western nutrition experts, Patrick Holford and Ian Marber.


1. Stop counting calories

The Chinese don't have a word for "calories". They view food as nourishment, not potential weight gain. A 1990 survey found that Chinese people consumed 30 per cent more calories than Americans, but were not necessarily more active. Clissold says their secret is avoiding the empty calories of sugary, nutrient-free foods.

Holford says: "The latest research into weight loss shows that calorie-controlled, low-fat diets are less effective than low glycemic load diets, which is exactly what a traditional Chinese diet is."

Marber says: "There is one calorie in a Diet Coke, and 340 calories in an avocado. Which one is actually good for you? It's a no-brainer. The avocado supplies you with monounsaturated fats and omega-6, which actually help increase metabolic rate."

2. Think of vegetables as dishes

Rather than an uninspiring accompaniment to meat or fish, the Chinese treat vegetables as meals in their own right, rather than add-ons, as in the West.

Marber says: "I'm a great believer in combining protein and carbohydrate. There aren't many complex carbohydrates in vegetables, but they should count as a dish. If the majority of your meal is vegetables, and you add some protein, you'll always have a perfect meal."

Holford says: "Vegetables should make up half of what's on your plate in any given meal, so this fits perfectly with the Chinese diet."

3. Fill up on staple foods

Without rice, which is low in fat and high in nutrients and fibre, claims Clissold, it is impossible to eat until you are full. Low-carb diets promise to burn fat, but Clissold says that replacing carbs with food that is higher in fat and lower in nutrients is not a long-term answer to weight loss.

Marber says: "I don't agree. That Chinese person shovelling rice down is slightly pudgy because they eat too much rice. But from a financial point of view it's very useful, because Atkins-style diets are very expensive."

4. Eat until you are full

The Chinese eat until they are full, and then stop. Westerners often take a feast-and-famine approach to eating that is ridden with guilt – purging during the week and binging over the weekend, or skipping lunch to make room for cake, The Chinese tend to eat three good meals every day.

Holford says: "Provided that a meal has a high intake of fibre-rich vegetables and a balance of protein and carbohydrate, which a typical Chinese meal would, then you should eat until you are full. But the combination of high sugar, refined carbs (the white stuff) and high fat allows for more food to be eaten in a short space of time before the body's 'appestat' kicks in and tells you to stop."

Marber says: "What does 'full' mean? I think so much of that message is lost in the conspicuous consumption of the Western world. But be careful: it takes a while for the brain to recognise CCK, the hormone released when you are full, so you're actually full quite a lot earlier than you realise."

5. Take liquid food

Soup, or a soup-based dish, is present at every Chinese meal, often in the form of a watery porridge, zhou. Western diets can be very dry, and nutritionists compensate by urging us to drink more water, which the Chinese would never do with a meal. Instead, they make a nourishing liquid food part of the meal. And it's a great way of using up leftovers.

Holford says: "Thirst is often confused with hunger. Also, drinking does tend to fill you up. So soups help you control your appetite."

Marber says: "I'm a great believer in soups before food. Miso soup, for instance, or anything fermented – these are probiotics, which help release nutrients from the food you are about to eat."

6. Bring yin and yang into your kitchen

A good Chinese diet balances yin (wet and moist) and yang (dry and crisp) ingredients. Yin foods cool the body down, while yang foods – meat, spicy dishes, wine, coffee – heat it up. The sharing, multi-dish approach to eating in China means most meals contain yin and yang in equilibrium.

Marber says: "You should have complex carbs, a protein and a grain together for many different reasons, one of which is the experience of eating. The typical English bastardisation of Chinese food, chicken and cashew nuts, is a good example: you've got the softness of the chicken, the crunch of the nut and the satisfying rice."

Holford says: "Most protein foods are seen as yang, carbohydrates as yin. The combination of these two helps stabilise blood sugar, which is the key to good energy and minimising weight gain."

7. Raw power? not necessarily

Chinese people don't eat raw salad. While raw food has a higher concentration of vitamins than cooked food, Clissold says the research ignores that lightly cooking food makes its nutrients easier for the body to take on. This way, it can conserve energy for other tasks. The stomach is unable to digest too much raw food; this can lead to bloating and weight gain.

Holford says: "The rawer the better. In almost all cases, raw food has more nutrients, though lightly cooking some vegetables can make those nutrients more bio-available."

Marber says: "I don't hold with this one. Eating a big salad with lots of different raw vegetables in it is very satisfying, and I can't believe your average Brit is going to blanch salad."

8. Use food to keep fit

Chinese medicine prescribes various foods as medical treatments: chillies to promote digestion and dispel cold; garlic to counteract toxins. The ultimate purpose is to ensure all the organs are working correctly to allow energy, or chi, to circulate smoothly around the body.

Holford says: "Two thousand years ago, Hippocrates said, 'Let food be your medicine.' But we in the West forgot. Peasant communities tend to have more respect for the cycle of food and how it supports life."

9. Drink green tea

Green tea eliminates toxins, aids digestion and allays hunger. Scientists have found that it also fights free radicals, which cause cancer and heart disease.

Marber says: "I'm a great believer in green and herbal teas. Green tea is an important antioxidant, but it will only help you lose weight if you drink 40 cups a day. I'm also a great believer in a skinny latte once in a while – or every morning, in my case."

Holford says: "Traditionally, when the Chinese want another cup of tea, they'll keep the same leaves and add water to the pot. That's like only using one teabag a day – which means much less caffeine."

10. Take restorative exercise

Try regular, gentle exercise such as tai chi. A sweaty workout might shed fat, but it is stressful for your body. Energetic, aerobic workouts are yang – they heat us up – while breathing exercises are yin.

holford says: "Exercise after a meal promotes an active metabolism and helps control appetite. Although no one has worked out how to measure chi, the vital energy that these exercises promote, it's a real thing that can easily be experienced. Many trials now show benefits to energy levels and immunity from these chi-generating exercises."

Marber says: "Tai chi gives you a sense of balance, calm and peacefulness. Sweating it out at the gym is the precise opposite, but I can't help it – I'm vain, shallow and modern. I think we've got a really fucked-up view of how the body should look, and that it's how we look, rather than how we feel, that matters."

'Why the Chinese Don't Count Calories' is out Thursday (Constable, £8.99).