Sugar is as bad for you as cigarettes

 

Although sugar does not have the same stigma attached to it as smoking, the truth is indulging on sweet treats or dessert could be as bad for you as lighting up a cigarette. According to research by a University of California team, sugar is as damaging as both alcohol and cigarettes and, according to the researchers, should therefore be regulated to control consumption.

Brian Regan: Brookside star to cocaine addict

 

Brian Regan found fame playing loveable rogue Terry Sullivan in the Liverpool soap opera Brookside. In the show's 1980s heyday, his character's antics were regularly watched by up to seven million viewers a week. But when Regan left the soap in 1997, his acting career petered out and he plunged into a life of drug dealing and addiction. Now he is behind bars, serving a five-year jail sentence for lying to police over his role in the murder of Iranian doorman Bahman Faraji and selling drugs. Regan's jail sentence can now be reported following the conviction of Jason Gabbana, 29, for ordering Faraji's murder. Details emerged in court of the actor's descent into drugs and supplying members of Liverpool's criminal underworld. During the trial, Regan told Liverpool Crown Court how he started taking cocaine at weekends at the end of his Brookside career. It was through his use of cocaine he became involved with Edward Heffey, convicted of murdering Mr Faraji with a sawn-off shotgun in a quiet Liverpool street. Simon O'Brien, who played Damon Grant in Brookside, said Regan's involvement with drugs was a "slow burn". Snorting cocaine "It is a very difficult place when you're acting, particularly on something as high-profile as a soap, because fame and infamy attract each other," he said. "Actors and gangsters, for some reason, almost get off on each other. It's a really strange mutual attraction because I think the hard man gives the actor a kind of security out in public and the actor gives the gangster kudos. "The two worlds often get intertwined and when that happens, inevitably drugs become involved. So it was kind of a slow thing from what I remember, it was a slow burn." Regan was charged with Mr Faraji's murder and was cleared - but he was convicted of giving a false alibi to police about where he was on the night in February 2011. Actor and presenter Simon O'Brien said actors and gangsters get off on each other" During the trial, he told Liverpool Crown Court he supplied Heffey with cocaine "about three or four times a day". When Heffey asked him for a lift on the night of the killing, he said he thought he was taking him to collect a debt so he could pay for the drugs. In fact, once they arrived in Aigburth in Regan's Ford Escort, Heffey got out, walked round the corner and shot Mr Faraji in the face with a sawn-off shotgun. Regan told the court he knew nothing about the incident - because he was waiting in the car, snorting a line of cocaine. He said he then "drove away normally" from the scene and took Heffey home. Regan was cleared of murder at his trial which ended in January. 'Lose control' However, when he was first interviewed by police he lied about driving Heffey to the pub, but CCTV evidence put him at the scene and he was found guilty of perverting the course of justice. Mr O'Brien, 46, who was friends with Regan in their Brookside days, said getting involved in drugs was a tragedy that is "not uncommon" in the entertainment industry. "Brian is just one example of what happens when you're in the limelight and everything is flying and you lose control," he said. "You feel you're invincible when you're at the top of the game and you're not. "Sadly, if anyone wants to know what happens if you get involved in taking cocaine, this is an example of someone who was at the top of the tree and because of cocaine, he ends up behind bars."

Study Suggests Link Between Narcissism And Facebook

There may be a direct link between the number of friends you have on Facebook and just how much of a “socially disruptive” narcissist you are, according to a recent study published in the journal of Personality and Individual Differences. Facebook habits of 294 students between the age of 18 and 65 were studied by researchers at Western Illinois University. They also measured two of what they describe as  ”socially disruptive” elements of narcissism- grandiose exhibitionism (GE- having to be at the center of attention), and entitlement/exploitativeness (EE-  having a sense of self entitlement/deserving of respect) of the students. The study found that those who scored highly on the Narcissistic Personality Inventory questionnaire changed their profile pictures more often, responded more aggressively to negative comment about them on their Facebook walls, tagged themselves more often, and updated their news feeds more regularly. Carol Craig, a social scientist and chief executive of the Centre for Confidence and Well-being stated: “Facebook provides a platform for people to self-promote by changing profile pictures and showing how many hundreds of friends you have. I know of some who have more than 1,000.” According to the Guardian, Christopher Carpenter, who ran the study, said: “If Facebook is to be a place where people go to repair their damaged ego and seek social support, it is vitally important to discover the potentially negative communication one might find on Facebook and the kinds of people likely to engage in them. Ideally, people will engage in pro-social Facebooking rather than anti-social me-booking.” Are we really narcissistic? Or could it simply be we are just bored? Or maybe just really friendly and outgoing, looking to meet new people? Do you think these researchers are reading just a little too much into it?

Minimum price for alcohol introduced in bid to tackle Britain's binge crisis

The cost of a pint of beer will be at least 80p and a pint of strong cider would be at least £1.60. Mr Cameron said he was trying to tackle the country’s binge drinking culture and was targeting those who ‘pre-load’ on cheap supermarket drink before going out. He wants a 40p minimum charge for each unit of alcohol, following similar moves in Scotland. The prime minister said: ‘We’re consulting on the actual price but, if it is 40p, that could mean 50,000 fewer crimes each year and 9,000 fewer alcohol-related deaths over the next decade.’ The minimum price was welcomed by police and health campaigners, who say drink was behind 1.2million hospital admissions and 1million crimes last year, and  cost Britain £21billion a year. Critics, however, say it will unfairly punish the vast majority, who are sensible drinkers and comes just hours after a five per cent rise in duty on drink was confirmed in the budget. Mr Cameron also wants to give pubs more powers not to serve people who are drunk, a zero tolerance approach to drunken behaviour in hospitals, a ban on multi-buy discounts and a late night levy on pubs and clubs to help pay for policing. A consultation will take place in the summer, with a new law introduced by the end of the year. He said: ‘Binge drinking is a serious problem. And I make no excuses for clamping down on it.’ Supermarkets will oppose a minimum price. At Asda, a can of Smartprice lager costs 22p. The supermarket is also selling wine at £2.30 a bottle. It contains 8.3 units of alcohol, meaning it will rise in price by at least £1.

Whitney Houston drowned after cocaine use, says coroner

Whitney Houston's death was caused by accidental drowning, but drug abuse and heart disease were also factors, a coroner has ruled. Coroner's spokesman Craig Harvey said drug tests indicated the 48-year-old US singer was a chronic cocaine user. The announcement ends weeks of speculation over the cause of Houston's death. She was found submerged in the bath of her Los Angeles hotel room on the eve of the Grammy Awards on 11 February. In a statement, the LA County Coroner's office described Houston's manner of death as an "accident", adding that "no trauma or foul play is suspected". The cause was cited as drowning and "effects of atherosclerotic heart disease and cocaine use". Other drugs found in her blood included marijuana, as well as an anti-anxiety drug, a muscle relaxant and an allergy medication. But these were not factors in her death, the coroner's statement said. Patricia Houston, the singer's sister-in-law and manager, told the Associated Press news agency: "We are saddened to learn of the toxicology results, although we are glad to now have closure." The pop star was laid to rest at a cemetery in her home state of New Jersey after a funeral that was attended by celebrities including Oprah Winfrey, Alicia Keys, Mariah Carey and Mary J Blige. The singer, who was one of the world's best selling artists from the mid-1980s to late 1990s, had a long battle with drug addiction.

Liver deaths at all-time high

 

Liver disease is killing more people than ever before in England, especially in deprived areas, shows a report out today. Deaths from liver disease: implications for end of life care in England, the first national report into the problem, finds that between 2001 and 2009, deaths from liver disease rose by 25% – and that more than a third of these were from alcohol-related liver disease. In England in 2001, 9321 people died from liver disease, but by 2009 this had risen to 11,575; at the same time, deaths from other major causes fell. The report, from the National End of Life Care Intelligence Network, also showed that liver disease was a disproportionate killer of younger people, accounting for one in ten of all deaths in people in their 40s. Death from liver disease, especially alcohol-related, was much more common in men than in women – 60% of all deaths from liver disease occurred in men. Alcohol-related liver disease was responsible for 41% of deaths from liver deaths in men, and 30% of liver disease deaths in women. The most economically deprived areas of England were the most likely to have high levels of death from alcohol-related liver disease, where it accounted for 44% of all liver disease deaths, compared with 28% in the least deprived areas. Mortality also varied between regions: it was highest in North West, North East and London, and lowest in East of England, South West and South East. Professor Martin Lombard, national clinical director for liver disease, said: “The key drivers for increasing numbers of deaths from liver disease are all preventable, such as alcohol, obesity, hepatitis C and hepatitis B. We must focus our efforts and tackle this problem sooner rather than later.” Professor Julia Verne, lead author of the report and clinical lead for the National End of Life Care Intelligence Network, said: “It is crucial that commissioners and providers of health and social care services know the prevalence of liver disease in their local areas, so that more people can receive the care they need to allow them to die in the place of their choosing.”

A Nation 'Addicted' To Statins...

Dear Reader,

In the UK alone, more than 7 million people are taking cholesterol-lowering statins. This is extremely worrying when you consider the damage these over-prescribed drugs can inflict, with side effects ranging from liver dysfunction and acute renal failure to fatigue and extreme muscle weakness (myopathy).

Slowly tearing us apart

Even more concerning are the side effects that crop up after long-term use, which are often not linked to statins. For example, one study monitored the symptoms of 40 asthma patients for a year. 20 of these patients started statins at the outset of the study, while the remaining 20 did not.

The results showed that those patients on statins used their rescue inhaler medications 72 per cent more often than they had at the start of the study, compared to a 9 per cent increase in those who were not taking statins. The researchers also reported that patients taking statins had to get up more frequently at night because of their asthma and also had worse symptoms during the day...

Worsening asthma symptoms is just the beginning. More recent research has linked statins with an increased risk of developing type 2 diabetes, depression, Alzheimer's disease and dementia.

Still, doctors are very quick to reach for their prescription pads and push these drugs. There appears to be an unofficial (but widely practiced) 'statins for all' approach... especially if you are aged 50 and over.

Luckily, some mainstreamers are slowly catching on to what we've been saying for nearly a decade. In 2011, research published in the Archives of Internal Medicine drew attention to the fact that there is inadequate medical data available that proves the benefits of statins, and that many studies fail to acknowledge the most commonly reported adverse effects of statins.

The fact remains (and your doctor may still deny this) that in total, statins cause serious damage in about 4.4 per cent of those taking them, in comparison to the 2.7 per cent statin users benefiting from them... and it looks as if this message is finally getting through to medical authorities.

A case in point is simvastatin or Zocor. After being on the market for almost 3 decades and causing havoc and distress with its horrendous side effects, the American Food and Drug Administration (FDA) finally issued a warning about the use of this drug... saying that even the approved dosage can harm or even kill you!

Yep! Kill you!

All well and good

It's all fair and well and good that the FDA flagged this warning, but what's the point if doctors continue to prescribe these drugs left, right and centre?

Professor Sarah Harper, director of Oxford University's institute of population ageing, recently said that the UK's "love affair" with prescription medicine, shows how people choose to pop pills rather than follow a healthy lifestyle.

She cited the widespread use of statin drugs to 'help' protect against heart disease and lower cholesterol, instead of eating healthily, quitting smoking, reducing alcohol intake and taking regular exercise.

By all means, I applaud Prof Harper for pushing the message that living a healthy life plays a big part in preventing disease, but why blame patients for being a bunch of pill poppers when doctors hand out drugs with reckless abandon... and recommend taking preventative drugs to ever younger age groups. So in fact, the white coats should be labelled as Big Pharma's drug pushers, because they're part of the problem... especially considering that so many people put their entire trust in their doctor and would never dream of questioning their advice. Most people take what they say as gospel.

Then there's the media, inundating Joe Public with inflammatory headlines like: 'Statins could help fight breast cancer' or 'Statins can prevent infections like pneumonia'... Not to mention their reporting on botch studies showing the 'unintended benefits' of statins, like their potential to prevent pneumonia, combat diabetes, reduce the risk of oesophageal cancer, breast cancer and prostate cancer — all of these so-called benefits are of course not yet proven, and highly unlikely. Still, they reach the front pages!

So, yes we might have turned into a pill popping public, but it's the mainstream and the media that have created this monster all with the help and backing of the puppet master: Big Pharma. Because as you and I know all too well, it's all about the money. 

Premier League footballer Fabrice Muamba is in intensive care after collapsing during an FA Cup tie.

 

 The 23-year-old was said to be critically ill in the London Chest Hospital after falling to the ground at White Hart Lane in front of millions of television viewers watching the sixth round tie between Tottenham Hotspur and his club, Bolton Wanderers. Outside the hospital, the club's manager Owen Coyle said the following 24 hours were "absolutely crucial" and urged people to pray for the player's recovery. A Bolton spokesman said: "Bolton Wanderers can confirm that Fabrice Muamba has been admitted to the heart attack centre at London Chest Hospital where he is currently in a critically ill condition in intensive care. No further information will be issued at this stage. The club has requested the media to respect his family's privacy at this time." A packed White Hart Lane looked on with a worldwide audience watching live coverage on ESPN as the Trotters midfielder suddenly fell to the floor. Confusion turned to horror as medics sprinted on to the pitch to begin resuscitating the young man. Players looked shocked and watched in disbelief as the former England Under 21 star was treated with a defibrillator for several minutes before being stretchered off wearing an oxygen mask and taken to hospital. World Cup referee Howard Webb abandoned the game. As the message was relayed around the stadium with the score at 1-1, the fans applauded and chanted Muamba's name. Premier League chief executive Richard Scudamore said: "The thoughts of the Premier League, its clubs and players are with Fabrice Muamba, his family and Bolton Wanderers. We would like to praise the players, match officials, coaching staff and medical teams of both clubs at White Hart Lane for their swift actions in attending Fabrice. "The league would also like to commend the compassion shown by the fans of Bolton Wanderers and Tottenham Hotspur. We hope to hear positive news about Fabrice who is and has been a wonderful ambassador for the English game and the league at Arsenal, Birmingham City and Bolton Wanderers." Manchester United star Rio Ferdinand wrote on Twitter: "Come on Fabrice Muamba, praying for you." England striker Wayne Rooney wrote: "Hope fabrice muamba is ok. Praying for him and his family. Still in shock." Muamba's team-mate Stuart Holden, added: "Still praying for Fab, the guy is a fighter on and off the field. We love you bro."

Facebook's 'dark side': study finds link to socially aggressive narcissism

 

Researchers have established a direct link between the number of friends you have on Facebook and the degree to which you are a "socially disruptive" narcissist, confirming the conclusions of many social media sceptics. People who score highly on the Narcissistic Personality Inventory questionnaire had more friends on Facebook, tagged themselves more often and updated their newsfeeds more regularly. The research comes amid increasing evidence that young people are becoming increasingly narcissistic, and obsessed with self-image and shallow friendships. The latest study, published in the journal Personality and Individual Differences, also found that narcissists responded more aggressively to derogatory comments made about them on the social networking site's public walls and changed their profile pictures more often. A number of previous studies have linked narcissism with Facebook use, but this is some of the first evidence of a direct relationship between Facebook friends and the most "toxic" elements of narcissistic personality disorder. Researchers at Western Illinois University studied the Facebook habits of 294 students, aged between 18 and 65, and measured two "socially disruptive" elements of narcissism – grandiose exhibitionism (GE) and entitlement/exploitativeness (EE). GE includes ''self-absorption, vanity, superiority, and exhibitionistic tendencies" and people who score high on this aspect of narcissism need to be constantly at the centre of attention. They often say shocking things and inappropriately self-disclose because they cannot stand to be ignored or waste a chance of self-promotion. The EE aspect includes "a sense of deserving respect and a willingness to manipulate and take advantage of others". The research revealed that the higher someone scored on aspects of GE, the greater the number of friends they had on Facebook, with some amassing more than 800. Those scoring highly on EE and GG were also more likely to accept friend requests from strangers and seek social support, but less likely to provide it, according to the research. Carol Craig, a social scientist and chief executive of the Centre for Confidence and Well-being, said young people in Britain were becoming increasingly narcissistic and Facebook provided a platform for the disorder. "The way that children are being educated is focussing more and more on the importance of self esteem – on how you are seen in the eyes of others. This method of teaching has been imported from the US and is 'all about me'. "Facebook provides a platform for people to self-promote by changing profile pictures and showing how many hundreds of friends you have. I know of some who have more than 1,000." Dr Viv Vignoles, senior lecturer in social psychology at Sussex University, said there was "clear evidence" from studies in America that college students were becoming increasingly narcissistic. But he added: "Whether the same is true of non-college students or of young people in other countries, such as the UK, remains an open question, as far as I know. "Without understanding the causes underlying the historical change in US college students, we do not know whether these causes are factors that are relatively specific to American culture, such as the political focus on increasing self-esteem in the late 80s and early 90s or whether they are factors that are more general, for example new technologies such as mobile phones and Facebook." Vignoles said the correlational nature of the latest study meant it was difficult to be certain whether individual differences in narcissism led to certain patterns of Facebook behaviour, whether patterns of Facebook behaviour led to individual differences in narcissism, or a bit of both. Christopher Carpenter, who ran the study, said: "In general, the 'dark side' of Facebook requires more research in order to better understand Facebook's socially beneficial and harmful aspects in order to enhance the former and curtail the latter. "If Facebook is to be a place where people go to repair their damaged ego and seek social support, it is vitally important to discover the potentially negative communication one might find on Facebook and the kinds of people likely to engage in them. Ideally, people will engage in pro-social Facebooking rather than anti-social me-booking."

It's Not Dementia, It's Your Heart Medication: Cholesterol Drugs and Memory

 

One day in 1999 Duane Graveline, then a 68-year-old former NASA astronaut, returned home from his morning walk in Merritt Island, Fla., and could not remember where he was. His wife stepped outside, and he greeted her as a stranger. When Graveline’s memory returned some six hours later in the hospital, he racked his brain to figure out what might have caused this terrifying bout of amnesia. Only one thing came to mind: he had recently started taking the statin drug Lipitor. Cholesterol-lowering statins such as Lipitor, Crestor and Zocor are the most widely prescribed medications in the world, and they are credited with saving the lives of many heart disease patients. But recently a small number of users have voiced concerns that the drugs elicit unexpected cognitive side effects, such as memory loss, fuzzy thinking and learning difficulties. Hundreds of people have registered complaints with MedWatch, the U.S. Food and Drug Administration’s adverse drug reaction database, but few studies have been done and the results are inconclusive. Nevertheless, many experts are starting to believe that a small percentage of the population is at risk, and they are calling for increased public awareness of the possible cognitive side effects of statins—symptoms that may be misdiagnosed as dementia in the aging patients who take them. Fat and the Brain It is not crazy to connect cholesterol-modifying drugs with cognition; after all, one quarter of the body’s cholesterol is found in the brain. Cholesterol is a waxy substance that, among other things, provides structure to the body’s cell membranes. High levels of cholesterol in the blood create a risk for heart disease, because the molecules that transport cholesterol can damage arteries and cause blockages. In the brain, however, cholesterol plays a crucial role in the formation of neuronal connections—the vital links that underlie memory and learning. Quick thinking and rapid reaction times depend on cholesterol, too, because the waxy molecules are the building blocks of the sheaths that insulate neurons and speed up electrical transmissions. “We can’t understand how a drug that affects such an important pathway would not have adverse reactions,” says Ralph Edwards, former director of the World Health Organization’s drug-monitoring center in Uppsala, Sweden. Two small trials published in 2000 and 2004 by Matthew Muldoon, a clinical pharmacologist at the University of Pittsburgh, seem to suggest a link between statins and cognitive problems. The first, which enrolled 209 high-cholesterol subjects, reported that participants taking placebo pills improved more on repeated tests of attention and reaction time taken over the course of six months—presumably getting better because of practice, as people typically do. Subjects who were on statins, however, did not show the normal improvement—suggesting their learning was impaired. The second trial reported similar findings. And a study published in 2003 in Reviews of Therapeutics noted that among 60 statin users who had reported memory problems to MedWatch, more than half said their symptoms improved when they stopped taking the drugs. But other studies have found no significant link between statins and memory problems. Larry Sparks, director of the Laboratory for Neurodegenerative Research at the Sun Health Research Institute in Sun City, Ariz., goes so far as to say that “you’ve got a better chance of buying a winning lottery ticket, walking outside and getting hit by lightning and dying” than you do of suffering a cognitive side effect from statins. Vulnerable Genes? Many experts agree that for most people the risk is quite low, but they are beginning to believe the effects are real. “A subset of the population is vulnerable,” argues Joe Graedon, co-founder of the consumer advocacy Web site the People’s Pharmacy, which has collected hundreds of reports of cognitive-related statin side effects in the past decade. Some researchers believe these people have a genetic profile that puts them at risk.

Statin side effects: How common are memory loss, diabetes, and muscle aches?

 

When the US Food and Drug Administration told the makers of cholesterol-lowering statins to add new side effect warnings to their labels last week, many of the 40 million statin users may have been unaware of the extent of the risks associated with these drugs that have been touted by some cardiologists to be safer than aspirin. No question, statins -- which include Lipitor (atorvastatin), Zocor (simvastatin), and Crestor (rosuvastatin) -- are relatively safe drugs, and they’ve saved thousands of lives over the past 20 years, particularly in men with established heart disease. But like any drug they can cause problems in some, including muscle aches, an increased risk of diabetes, and, gaining recent attention, memory loss. University of California-San Diego researcher Beatrice Golomb published a paper two years ago describing 171 statin users who reported that they had developed memory problems and dementia-like symptoms that the statin users attributed to their use of the medications. The vast majority experienced an improvement in their symptoms after stopping the drugs and many saw their symptoms return after going back on statins. Robert Grindell, a state employee from Makinen, Minn., told me his short-term memory began to deteriorate after he started taking Zocor in his early 50s. (He contacted Golomb after hearing about her research.) “My co-workers told me I was coming in to ask them the same question three times in one day,” he said. “I had a CT scan to determine if I had a stroke, but it came back fine; the next day, I couldn’t even remember where I had the test performed.” After learning that Zocor caused memory problems, Grindell decided to go off it and said within a few days he noticed an improvement in his memory, not having to glance down several times at a printed phone number as he dialed it to remember the digits. Unfortunately, the exact incidence of these memory problems isn’t known. Manufacturer-sponsored clinical trials show that they occur in fewer than 1 percent of users, but statin researcher Dr. Paul Thompson, chief of cardiololgy at Hartford Hospital, said the real incidence is probably much higher. He has a study expected to be published sometime this year that measured cognitive effects in statin users compared with those on placebos that he said will provide a better estimate; the findings can’t be disclosed until the study is published. The diabetes risks of statins are more well-established. One review study published last year calculated an extra two cases of type 2 diabetes in every 1,000 patients who took a high-dose statin (80 milligrams per day) compared with those who took a lower dose (20 to 40 milligrams). And one clinical trial found that statin users had about a 25 percent increased risk of developing diabetes over a two-year period compared with those who took placebos. Experts, though, agree that in people at high risk for heart disease, the increased diabetes risk is outweighed by the statin’s protection against heart attacks and deaths from any cause. The danger of muscle destruction from statins -- which can damage the liver and kidneys -- is also clear but slight. According to Thompson, about 1 in every 1,000 statin users will develop severely elevated levels of the enzyme creatine kinase, which indicates muscle death, and only 1 in 10 million die from developing an extremely severe case of the condition called rhabdomyolysis. Muscle aches are far more common: occuring in about 1 in 10 users, according to Thompson. “It seems to be more common in people who do a lot of exercise.” In fact, a study he conducted found that marathon runners taking statins developed a greater increase in creatine kinase right after their race compared with runners who weren’t on statins. “We also see more muscle aches in older people and women since they have less muscle mass,” he said. Lowering the statin dose or switching to a different statin doesn’t always help, Thompson said. “In our studies, those who develop statin myalgia tend to get it again and again; they’re body may get sensitized to statins.” There may also be a genetic component, with statin muscle aches occuring more often in those whose parents also had them. And there may be a link between memory loss and muscle aches. “In our database, the majority of patients who had cognitive problems also had muscle problems,” Golomb said. She recommends that those who are having memory loss or muscle aches speak to their doctor about going off statins -- especially if they’re not in a high-risk group for heart attacks. Those who get the most benefits are men under 65 who’ve already had a heart attack, she said. Women, elderly people, and those without heart disease get much smaller benefits from statins, and it’s unclear whether the drugs extend their lives. “Many patients have told me that their doctor said going off statins would kill them,” Golomb said, “but that’s not an accurate representation of the evidence.”

Shisha cafes should have prominent notices saying, “Smoking shisha can kill” - just like you would on a cigarette packet

 puffing on a Turkish waterpipe is the latest trend to hit British bars and cafes.

The flavoured tobacco, which is smoked via a long pipe connected to a vessel filled with water, is particularly fashionable among young people, with the number of specialist bars rising 210 per cent since 2007.

But the World Health Organisation has warned that a one-hour shisha session can be as harmful as smoking 100 cigarettes.

Trend: Zaky Ali ,40, owner of Marhaba Cafe in Birmingham, with a hookah pipe for smoking shisha, which is becoming more popular among the young. But experts warn it can do more damage than cigarettes because users take more puffs of smoke

This is because a cigarette smoker typically takes between eight and 12 puffs, inhaling 0.5 to 0.6 litres of smoke.

But during hour-long shisha sessions smokers may take up to 200 drags, ranging from 0.15 to 1 litre of smoke each. 

 

 

More...

• Britain's drink death capital: How more people die from alcohol in Sunderland than anywhere else

 

‘Shisha smoking is a growing concern because people aren’t aware of the risks like they are with cigarette smoking,’ says Professor Robert West, director of tobacco studies at University College London.

‘The greater the exposure in terms of duration and amount smoked, the greater the risk to your health’

That’s because although shisha tobacco tastes nicer than cigarettes, it contains all the same toxicants known to cause lung cancer and heart disease.

Risk: Smokers typically take in 12 puffs on a cigarette compared to up to 200 for hookah pipes

Among the risks are heart disease, respiratory problems, lung and mouth cancer and problems during pregnancy.

‘Smoke from tobacco contains a number of carcinogens which damage the DNA in cells,’ explains Professor West. ‘Just one damaged cell can divide and multiply uncontrollably and quite quickly develop into a large tumour. This is what causes lung cancer,’ explains Professor West

Enthusiasts claim that as the smoke passes through water most of the harmful chemicals are absorbed, however there is no evidence to support this.

‘If people think it’s safer than cigarettes, when it’s not, they need to be informed otherwise,’ said Professor West.

There are other risks. As the mouthpiece is passed around from person to person, this raises the risk of transmitting diseases such as tuberculosis and hepatitis.

The waterpipe has been used to smoke tobacco for centuries, primarily in Africa, Asia and the Middle East.

A rise in travel to countries such as Egypt and Turkey has seen the pipe transported to the UK.

The waterpipe is heavily sold as a souvenir, and is popular with tourists who like to take it back home as a gift or decorative object.

The waterpipe can also be purchased in various shops in London for as little as £20, with shisha tobacco costing £5-£10.

The tobacco is burned with charcoal in a bowl that sits above the vessel.

The smoke it produces passes through the water in the container and goes down the pipe so the user can sit by the vessel and an inhale it with their mouth. 

Middle Eastern inspired: A shisha user in Iraq, the pipe's traditional home

The smoke is cooled by the water and makes it feel less ‘harsh’ - and experts warn that as a result people inhale it more deeply into their lungs, which increases the risks even further.

Shisha tobacco is flavoured with fruit molasses such as apple and strawberry, so the residual redolent smoke is sweet.

Because it doesn’t taste like a cigarette, people often think of it as being safer or better. Many young people who don’t usually smoke are attracted to this seemingly harmless activity.

It’s also a cheaper option than buying a round at the pub. One shisha usually costs between £7-£20, and is often shared by two or three people throughout an evening.

In the borough of Westminster, London, the number of shisha cafes have gone up approximately by 68 per cent since 2007.

The smoking ban hasn’t stopped this trend from growing. Restaurant and café owners offering shisha have been able to flout the ban by creating garden terraces or patio seating outdoors.

But as the weather gets warmer, and shisha becomes more and more fashionable, experts are calling for better health warnings.

Professor West suggests: ‘Shisha cafes should have prominent notices saying, “Smoking shisha can kill” - just like you would on a cigarette packet.’

Having a cocaine binge at the weekend followed by three or four diazepam to get to sleep on Sunday messes up the brain's chemistry

 

Having a cocaine binge at the weekend followed by three or four diazepam to get to sleep on Sunday messes up the brain's chemistry, a consultant psychiatrist says.Many people who use drugs recreationally also take prescription medicines such as tranquillisers, sleeping pills and painkillers to deal with the effects of a weekend high and get back to work on Monday, new research reveals. An international survey carried out by the Guardian and Mixmag magazine found that about a third of the 7,700 people from the UK who revealed their illegal drug use also took prescription sleeping pills – 22.4% had taken benzodiazepines such as temazepam in the last year and 7.2% had taken the newer "z-drugs" – zopiclone and zolpidem. Those taking part in the survey were predominantly well-educated working people who felt they were in control of their lives. But Dr Richard Bowskill, consultant psychiatrist and medical director of the Priory rehabilitation centre in Brighton, said he saw the fallout years later from this pattern of illegal and prescription drug-taking among "highly functioning" clients. "People think they are being their own pharmacist. They have a major binge of cocaine over the weekend and three or four diazepam to get to sleep on Sunday night. They think they understand what it is doing to their body and they think they are in control, but their brain chemistry is getting messed up," he said. "They know the effects of the drug. It's often being used following cocaine to self-medicate for the downswing and it causes chaos. It's a really common scenario. Then they can't get to sleep on Monday and they take some more sleeping tablets." While recreational drug users think prescription medicines are safe, because GPs hand them out and the tablets are what they purport to be, benzodiazepines and opioid painkillers are highly addictive if taken regularly for any length of time. Anna, who had a high-pressured job requiring her to make frequent long-haul flights, was not a recreational drug taker but started taking zopiclone to help her sleep on the plane or when she arrived in a different time zone and needed to be fresh for work in the morning. "Your body gets accustomed to the drugs. I didn't really understand their addictive nature," she said. "They weren't having an effect so I was having to up the dosage." She ended up taking five tablets at a time, but they just made her more anxious, irritable and sleepless. "I lost a lot of friends." She talked of the societal "pressure to perform" and her regret that there was so little help. GPs did not want to know, she said. With the help of the Council for Information on Tranquillisers, Antidepressants and Painkillers (CITA), a support group, she had been switched to a different drug and was slowly cutting down. Against expectations, most people in the Guardian/Mixmag survey did not get their prescription drugs from the internet, but from their own GP or a friend who had been prescribed them. GPs were in a bind, said Dr Peter Swinyard, national chairman of the Family Doctor Association. When people arrived in the surgery complaining of pain or insomnia "we are predisposed to believe what people tell us", he said. "We always work from the premise that they are being honest with us." Nonetheless, a survey the association did last summer showed that 52% of GPs were worried about prescription drug abuse in their area. Eight out of 10 of the 197 GPs who responded to the survey said they were aware of prescribing to people who they thought were addicted. Half were aware of occasions when prescriptions had been sold on. "People tell us they lose their prescription or it got eaten by the dog. A lot of general practices have systems like a book at reception recording those who say they have lost their prescription," Swinyard said. But there are people who GPs would not characterise as liars or cheats. "There is the traditional little old lady who is taking her sleeping pill prescription and selling it down the pub. I'm sure there is a cohort of elderly people supplementing their pension by selling their prescription drugs," he said. Although the Guardian/Mixmag survey responders mostly said they used sleeping tablets for sleep and painkillers for pain, they had often tried them to get high – 57.8% in the case of the anti-hyperactivity drug Ritalin, nearly 40% in the case of the benzos and 28% who had taken opioid painkillers. In the US, prescription opioids have caused a huge problem since oxycodone – better known by its brand name OxyContin – was licensed for use outside cancer treatment in the mid-1990s. In 2008, 15,000 Americans died from overdosing on prescription opiates, according to the Centres for Disease Control (CDC), which is more than on heroin and cocaine combined. The opioid epidemic appears not to have hit the UK. "There has been a rise in oxycodone deaths, but it is pretty small," said James Bell, addiction consultant at the South London and Maudsley NHS trust. "I have been trying to look for evidence here and it is not a big problem." Demand was fuelled in the US by direct advertising to the public. In the UK this is not allowed and most people are registered with a single NHS GP so cannot shop around. The Guardian/Mixmag study, which was conducted by Global Drug Survey, shows that a quarter of responders had taken prescription opioid painkillers and 9% had taken other painkillers. More than three-quarters said they took them for pain relief, 24% said they took them to get to sleep and 18% said they took them for mood-changing purposes.

Alcoholic hepatitis is a severe form of alcohol-related liver disease associated with significant short-term mortality.

Case A 53-year-old man with a history of daily alcohol use presents with one week of jaundice. His blood pressure is 95/60 mmHg, pulse 105/minute, and temperature 38.0°C. Examination discloses icterus, ascites, and an enlarged, tender liver. His bilirubin is 9 mg/dl, AST 250 IU/dL, ALT 115 IU/dL, prothromin time 22 seconds, INR 2.7, creatinine 0.9 mg/dL, and leukocyte count 15,000/cu mm with 70% neutrophils. He is admitted with a diagnosis of acute alcoholic hepatitis. How should he be treated? KEY POINTS Alcoholic hepatitis is a severe form of alcohol-related liver disease associated with significant short-term mortality. The diagnosis of alcoholic hepatitis is usually made on the basis of typical clinical and laboratory features. Fever is common in alcoholic hepatitis but should prompt an evaluation for infection. Treatment should include abstinence from alcohol and supplemental nutrition in all patients with alcoholic hepatitis. Prognostic prediction models are used to select patients for treatment with prednisolone or pentoxifylline. Background Hospitalists frequently encounter patients who use alcohol and have abnormal liver tests. Regular, heavy alcohol consumption is associated with a variety of forms of liver disease, including fatty liver, inflammation, hepatic fibrosis, and cirrhosis. The term “alcoholic hepatitis” describes a more severe form of alcohol-related liver disease associated with significant short-term mortality. Alcoholic hepatitis typically occurs after more than 10 years of regular heavy alcohol use; average consumption in one study was 100 g/day (the equivalent of 10 drinks per day).1 The typical patient presents with recent onset of jaundice, ascites, and proximal muscle loss. Fever and leukocytosis also are common but should prompt an evaluation for infection, especially spontaneous bacterial peritonitis. Liver biopsy in these patients shows steatosis, swollen hepatocytes containing eosinophilic inclusion (Mallory) bodies, and a prominent neutrophilic inflammatory cell infiltrate. Because of the accuracy of clinical diagnosis, biopsy is rarely required, relying instead on clinical and laboratory features for diagnosis (see Table 1, below). click for large version Table 1. Typical clinical and laboratory features of alcoholic hepatitis Prognosis can be determined with prediction models. The most common are Model for End-Stage Liver Disease (MELD) and Maddrey’s discriminate score (see Table 2). Several websites allow quick calculation of these scores and provide estimated 30-day or 90-day mortality. These scores can be used to guide therapy. click for large version Table 2. Common scoring systems used to predict prognosis in alcoholic hepatitis Review of the Data How should hospitalists treat this serious illness? The evidence-based literature supporting the efficacy of treatments for alcoholic hepatitis is limited, and expert opinions sometimes conflict. Abstinence has been shown to improve survival in all stages of alcohol-related liver disease.2 This can be accomplished by admitting this patient population to the hospital. A number of interventions and therapies are available to increase the chance of continued abstinence following discharge (see Table 3). click for large version Table 3. Treatment considerations in alcoholic hepatitis Nutritional support. Protein-calorie malnutrition is seen in up to 90% of patients with cirrhosis.3 The cause of malnutrition in these patients includes decreased caloric intake, metabolic derangements that accompany liver disease, and micronutrient and vitamin deficiencies. Many of these patients rely almost solely on alcohol for caloric intake; this contributes to potassium depletion, which is frequently seen. After admission, these patients are often evaluated for other conditions (such as gastrointestinal bleeding and altered mental status) that require them to be NPO overnight, thus further confounding their malnutrition. Enteral nutritional support was shown in a multicenter study to be associated with reduced infectious complications and improved one-year mortality.4 Little clinical data support specific recommendations for the amount of nutritional support. The American College of Gastroenterology (ACG) recommends 35 calories/kg to 40 calories/kg of body weight per day and a protein intake of 1.2 g/kg to 1.5g/kg per day.5 In an average, 70-kg patient, this is 2,450 to 2,800 calories a day. For patients who are not able to meet these nutritional needs by mouth, enteral feeding with a small-bore (Dobhoff) feeding tube can be used, even in patients with known esophageal varices. Most of these patients have anorexia and nausea and do not meet these caloric recommendations by eating. Nutritional support is a low-risk intervention that can be provided on almost all inpatient medical care areas. Hospitalists should be attentive to nutritional support early in the hospitalization of these patients. Corticosteroid therapy is recommended by the ACG for patients with alcoholic hepatitis and a Maddrey’s discriminant function greater than 32.5 There is much debate about this recommendation, as conflicting data about efficacy exist. Man suffering from jaundice, showing marked yellowing of the skin on his upper body. A 2008 Cochrane review included clinical trials published before July 2007 that examined corticosteroid use in patients with alcoholic hepatitis. A total of 15 trials with 721 randomized patients were included. The review concluded that corticosteroids did not statistically reduce mortality compared with placebo or no intervention; however, mortality was reduced in the subgroup of patients with Maddrey’s scores greater than 32 and hepatic encephalopathy.6 The review concluded that current evidence does not support the use of corticosteroids in alcoholic hepatitis, and more randomized trials were needed. Another meta-analysis demonstrated a mortality benefit when the largest studies, which included 221 patients with high Maddrey’s scores, were analyzed separately.7 Contraindications to corticosteroid treatment include active infection, gastrointestinal bleeding, acute pancreatitis, and renal failure. Other concerns about corticosteroids include potential adverse reactions (hyperglycemia) and increased risk of infection. Prednisolone is preferred over prednisone because it is the active drug. The recommended dosage is 40 mg/day for 28 days followed by a taper (20 mg/day for one week, then 10 mg/day for one week). ADDITIONAL READING Amini M, Runyon BA. Alcoholic hepatitis 2010: a clinician’s guide to diagnosis and therapy. World J Gastroenterol. 2010;16:4905-4912. Lucey MR, Mathurin P, Morgan TR. Alcoholic hepatitis. N Engl J Med. 2009;360:2758-2769. O’Shea RS, Dasarathy S, McCullough AJ. Practice Guideline Committee of the American Association for the Study of Liver Diseases, Practice Parameters Committee of the American College of Gastroenterology. Alcoholic liver disease. Hepatology. 2010;51:307-328. Some data suggest that if patients on corticosteroid therapy do not demonstrate a decrease in their bilirubin levels by Day 7, they are at higher risk of developing infections, have a poorer prognosis, and that corticosteroid therapy should be stopped.8 Some experts use the Lille model to decide whether to continue corticosteroids. In one study, patients who did not respond to prednisolone did not improve when switched to pentoxifyline.9 Patients discharged on corticosteroids require very careful coordination with outpatient providers as prolonged corticosteroid treatment courses can lead to serious complications and death. Critics of corticosteroid therapy in these patients often cite problems related to prolonged steroid use, especially in patients who do not respond to therapy.10 Pentoxifylline, an oral phosphodiesterase inhibitor, is recommended by the ACG, especially if corticosteroids are contraindicated.5 In 2008, 101 patients with alcoholic hepatitis were enrolled in a double-blind, placebo-controlled trial comparing pentoxifylline and placebo. This study demonstrated that patients who received pentoxifylline had decreased 28-day mortality (24.6% versus 46% receiving placebo). Of those patients who died during the study, only 50% (versus 91% in the placebo group) developed hepatorenal syndrome.11 However, a Cochrane review of all studies with pentoxifylline concluded that no firm conclusions could be drawn.12 One small, randomized trial comparing pentoxifylline with prednisolone demonstrated that pentoxifylline was superior.13 Pentoxifylline can be prescribed to patients who have contraindications to corticosteroid use (infection or gastrointestinal bleeding). The recommended dose is 400 mg orally three times daily (TID) for four weeks. Common side effects are nausea and vomiting. Pentoxifylline cannot be administered by nasogastric tubes and should not be used in patients with recent cerebral or retinal hemorrhage. Other therapies. Several studies have examined vitamin E, N-acetylcystine, and other antioxidants as treatment for alcoholic hepatitis. No clear benefit has been demonstrated for any of these drugs. Tumor necrosis factor (TNF)-alpha inhibitors (e.g. infliximab) have been studied, but increased mortality was demonstrated and these studies were discontinued. Patients are not usually considered for liver transplantation until they have at least six months of abstinence from alcohol as recommended by the American Society of Transplantation.14 Discharge considerations. No clinical trials have studied optimal timing of discharge. Expert opinion based on clinical experience recommends that patients be kept in the hospital until they are eating, signs of alcohol withdrawal and encephalopathy are absent, and bilirubin is less than 10 mg/dL.14 These patients often are quite sick and hospitalization frequently exceeds 10 days. Careful outpatient follow-up and assistance with continued abstinence is very important. Back to the Case The patient fits the typical clinical picture of alcoholic hepatitis. Cessation of alcohol consumption is the most important treatment and is accomplished by admission to the hospital. Because of his daily alcohol consumption, folate, thiamine, multivitamins, and oral vitamin K are ordered. Though he has no symptoms of alcohol withdrawal, a note is added about potential withdrawal to the handoff report. An infectious workup is completed by ordering blood and urine cultures, a chest X-ray, and performing paracentesis to exclude spontaneous bacterial peritonitis. A dietary consult with calorie count is given, along with a plan to discuss with the patient the importance of consuming at least 2,500 calories a day is made. Tube feedings will be considered if the patient does not meet this goal in 48 hours. Clinical calculators determine his Maddrey’s and MELD scores (50 and 25, respectively). If he is not actively bleeding or infected, pentoxifylline (400 mg TID for 28 days) is favored due to its lower-side-effect profile. His MELD score predicts a 90-day mortality of 43%; a meeting is planned to discuss code status and end-of-life issues with the patient and his family. Due to the severity of his illness, a gastroenterology consultation is recommended. Bottom Line Alcoholic hepatitis is a serious disease with significant short-term mortality. Treatment options are limited but include abstinence from alcohol, supplemental nutrition, and, for select patients, pentoxifylline or corticosteroids. Because most transplant centers require six months of abstinence, these patients usually are not eligible for urgent liver transplantation. Dr. Parada is a clinical instructor and chief medical resident in the Department of Internal Medicine at the University of New Mexico School of Medicine and the University of New Mexico Hospital, Albuquerque. Dr. Pierce is associate professor in the Division of Hospital Medicine at the University of New Mexico School of Medicine and the University of New Mexico Hospital. References Naveau S, Giraud V, Borotto E, Aubert A, Capron F, Chaput JC. Excess weight risk factor for alcoholic liver disease. Hepatology. 1997;25:108-111. Pessione F, Ramond MJ, Peters L, et al. Five-year survival predictive factors in patients with excessive alcohol intake and cirrhosis. Effect of alcoholic hepatitis, smoking and abstinence. Liver Int. 2003;23:45-53. Mendenhall CL, Anderson S, Weesner RE, Goldberg SJ, Crolic KA. Protein-calorie malnutrition associated with alcoholic hepatitis. Veterans Administration Cooperative Study Group on alcoholic hepatitis. Am J Med. 1984;76:211-222. Cabre E, Rodriguez-Iglesias P, Caballeria J, et al. Short- and long-term outcome of severe alcohol-induced hepatitis treated with steroids or enteral nutrition: a multicenter randomized trial. Hepatology. 2000;32:36-42. O’Shea RS, Dasarathy S, McCullough AJ, Practice Guideline Committee of the American Association for the Study of Liver Diseases, Practice Parameters Committee of the American College of Gastroenterology. Alcoholic liver disease. Hepatology. 2010;51:307-328. Rambaldi A, Saconato HH, Christensen E, Thorlund K, Wetterslev J, Gluud C. Systematic review: Glucocorticosteroids for alcoholic hepatitis—a Cochrane hepato-biliary group systematic review with meta-analyses and trial sequential analyses of randomized clinical trials. Aliment Pharmacol Ther. 2008;27:1167-1178. Mathurin P, Mendenhall CL, Carithers RL Jr., et al. Corticosteroids improve short-term survival in patients with severe alcoholic hepatitis (AH): individual data analysis of the last three randomized placebo controlled double blind trials of corticosteroids in severe AH. J Hepatol. 2002;36:480-487. Louvet A, Naveau S, Abdelnour M, et al. The Lille model: A new tool for therapeutic strategy in patients with severe alcoholic hepatitis treated with steroids. Hepatology. 2007;45:1348-1354. Louvet A, Diaz E, Dharancy S, et al. Early switch topentoxifylline in patients with severe alcoholic hepatitis is inefficient in non-responders to corticosteroids. J Hepatol. 2008;48:465-470. Amini M, Runyon BA. Alcoholic hepatitis 2010: A clinician’s guide to diagnosis and therapy. World J Gastroenterol. 2010;16:4905-4912. Akriviadis E, Botla R, Briggs W, Han S, Reynolds T, Shakil O. Pentoxifylline improves short-term survival in severe acute alcoholic hepatitis: A double-blind, placebo-controlled trial. Gastroenterology. 2000;119:1637-1648. Whitfield K, Rambaldi A, Wetterslev J, Gluud C. Pentoxifylline for alcoholic hepatitis. Cochrane Database Syst Rev. 2009;(4):CD007339. De BK, Gangopadhyay S, Dutta D, Baksi SD, Pani A, Ghosh P. Pentoxifylline versus prednisolone for severe alcoholic hepatitis: A randomized controlled trial. World J Gastroenterol. 2009;15:1613-1619. Lucey MR, Brown KA, Everson GT, et al. Minimal criteria for placement of adults on the liver transplant waiting list: a report of a national conference organized by the American Society of Transplant Physicians and the American Association for the Study of Liver Diseases. Liver Transpl Surg. 1997;3:628-637.

Case A 53-year-old man with a history of daily alcohol use presents with one week of jaundice. His blood pressure is 95/60 mmHg, pulse 105/minute, and temperature 38.0°C. Examination discloses icterus, ascites, and an enlarged, tender liver. His bilirubin is 9 mg/dl, AST 250 IU/dL, ALT 115 IU/dL, prothromin time 22 seconds, INR 2.7, creatinine 0.9 mg/dL, and leukocyte count 15,000/cu mm with 70% neutrophils. He is admitted with a diagnosis of acute alcoholic hepatitis. How should he be treated? KEY POINTS Alcoholic hepatitis is a severe form of alcohol-related liver disease associated with significant short-term mortality. The diagnosis of alcoholic hepatitis is usually made on the basis of typical clinical and laboratory features. Fever is common in alcoholic hepatitis but should prompt an evaluation for infection. Treatment should include abstinence from alcohol and supplemental nutrition in all patients with alcoholic hepatitis. Prognostic prediction models are used to select patients for treatment with prednisolone or pentoxifylline. Background Hospitalists frequently encounter patients who use alcohol and have abnormal liver tests. Regular, heavy alcohol consumption is associated with a variety of forms of liver disease, including fatty liver, inflammation, hepatic fibrosis, and cirrhosis. The term “alcoholic hepatitis” describes a more severe form of alcohol-related liver disease associated with significant short-term mortality. Alcoholic hepatitis typically occurs after more than 10 years of regular heavy alcohol use; average consumption in one study was 100 g/day (the equivalent of 10 drinks per day).1 The typical patient presents with recent onset of jaundice, ascites, and proximal muscle loss. Fever and leukocytosis also are common but should prompt an evaluation for infection, especially spontaneous bacterial peritonitis. Liver biopsy in these patients shows steatosis, swollen hepatocytes containing eosinophilic inclusion (Mallory) bodies, and a prominent neutrophilic inflammatory cell infiltrate. Because of the accuracy of clinical diagnosis, biopsy is rarely required, relying instead on clinical and laboratory features for diagnosis (see Table 1, below). click for large version Table 1. Typical clinical and laboratory features of alcoholic hepatitis Prognosis can be determined with prediction models. The most common are Model for End-Stage Liver Disease (MELD) and Maddrey’s discriminate score (see Table 2). Several websites allow quick calculation of these scores and provide estimated 30-day or 90-day mortality. These scores can be used to guide therapy. click for large version Table 2. Common scoring systems used to predict prognosis in alcoholic hepatitis Review of the Data How should hospitalists treat this serious illness? The evidence-based literature supporting the efficacy of treatments for alcoholic hepatitis is limited, and expert opinions sometimes conflict. Abstinence has been shown to improve survival in all stages of alcohol-related liver disease.2 This can be accomplished by admitting this patient population to the hospital. A number of interventions and therapies are available to increase the chance of continued abstinence following discharge (see Table 3). click for large version Table 3. Treatment considerations in alcoholic hepatitis Nutritional support. Protein-calorie malnutrition is seen in up to 90% of patients with cirrhosis.3 The cause of malnutrition in these patients includes decreased caloric intake, metabolic derangements that accompany liver disease, and micronutrient and vitamin deficiencies. Many of these patients rely almost solely on alcohol for caloric intake; this contributes to potassium depletion, which is frequently seen. After admission, these patients are often evaluated for other conditions (such as gastrointestinal bleeding and altered mental status) that require them to be NPO overnight, thus further confounding their malnutrition. Enteral nutritional support was shown in a multicenter study to be associated with reduced infectious complications and improved one-year mortality.4 Little clinical data support specific recommendations for the amount of nutritional support. The American College of Gastroenterology (ACG) recommends 35 calories/kg to 40 calories/kg of body weight per day and a protein intake of 1.2 g/kg to 1.5g/kg per day.5 In an average, 70-kg patient, this is 2,450 to 2,800 calories a day. For patients who are not able to meet these nutritional needs by mouth, enteral feeding with a small-bore (Dobhoff) feeding tube can be used, even in patients with known esophageal varices. Most of these patients have anorexia and nausea and do not meet these caloric recommendations by eating. Nutritional support is a low-risk intervention that can be provided on almost all inpatient medical care areas. Hospitalists should be attentive to nutritional support early in the hospitalization of these patients. Corticosteroid therapy is recommended by the ACG for patients with alcoholic hepatitis and a Maddrey’s discriminant function greater than 32.5 There is much debate about this recommendation, as conflicting data about efficacy exist. Man suffering from jaundice, showing marked yellowing of the skin on his upper body. A 2008 Cochrane review included clinical trials published before July 2007 that examined corticosteroid use in patients with alcoholic hepatitis. A total of 15 trials with 721 randomized patients were included. The review concluded that corticosteroids did not statistically reduce mortality compared with placebo or no intervention; however, mortality was reduced in the subgroup of patients with Maddrey’s scores greater than 32 and hepatic encephalopathy.6 The review concluded that current evidence does not support the use of corticosteroids in alcoholic hepatitis, and more randomized trials were needed. Another meta-analysis demonstrated a mortality benefit when the largest studies, which included 221 patients with high Maddrey’s scores, were analyzed separately.7 Contraindications to corticosteroid treatment include active infection, gastrointestinal bleeding, acute pancreatitis, and renal failure. Other concerns about corticosteroids include potential adverse reactions (hyperglycemia) and increased risk of infection. Prednisolone is preferred over prednisone because it is the active drug. The recommended dosage is 40 mg/day for 28 days followed by a taper (20 mg/day for one week, then 10 mg/day for one week). ADDITIONAL READING Amini M, Runyon BA. Alcoholic hepatitis 2010: a clinician’s guide to diagnosis and therapy. World J Gastroenterol. 2010;16:4905-4912. Lucey MR, Mathurin P, Morgan TR. Alcoholic hepatitis. N Engl J Med. 2009;360:2758-2769. O’Shea RS, Dasarathy S, McCullough AJ. Practice Guideline Committee of the American Association for the Study of Liver Diseases, Practice Parameters Committee of the American College of Gastroenterology. Alcoholic liver disease. Hepatology. 2010;51:307-328. Some data suggest that if patients on corticosteroid therapy do not demonstrate a decrease in their bilirubin levels by Day 7, they are at higher risk of developing infections, have a poorer prognosis, and that corticosteroid therapy should be stopped.8 Some experts use the Lille model to decide whether to continue corticosteroids. In one study, patients who did not respond to prednisolone did not improve when switched to pentoxifyline.9 Patients discharged on corticosteroids require very careful coordination with outpatient providers as prolonged corticosteroid treatment courses can lead to serious complications and death. Critics of corticosteroid therapy in these patients often cite problems related to prolonged steroid use, especially in patients who do not respond to therapy.10 Pentoxifylline, an oral phosphodiesterase inhibitor, is recommended by the ACG, especially if corticosteroids are contraindicated.5 In 2008, 101 patients with alcoholic hepatitis were enrolled in a double-blind, placebo-controlled trial comparing pentoxifylline and placebo. This study demonstrated that patients who received pentoxifylline had decreased 28-day mortality (24.6% versus 46% receiving placebo). Of those patients who died during the study, only 50% (versus 91% in the placebo group) developed hepatorenal syndrome.11 However, a Cochrane review of all studies with pentoxifylline concluded that no firm conclusions could be drawn.12 One small, randomized trial comparing pentoxifylline with prednisolone demonstrated that pentoxifylline was superior.13 Pentoxifylline can be prescribed to patients who have contraindications to corticosteroid use (infection or gastrointestinal bleeding). The recommended dose is 400 mg orally three times daily (TID) for four weeks. Common side effects are nausea and vomiting. Pentoxifylline cannot be administered by nasogastric tubes and should not be used in patients with recent cerebral or retinal hemorrhage. Other therapies. Several studies have examined vitamin E, N-acetylcystine, and other antioxidants as treatment for alcoholic hepatitis. No clear benefit has been demonstrated for any of these drugs. Tumor necrosis factor (TNF)-alpha inhibitors (e.g. infliximab) have been studied, but increased mortality was demonstrated and these studies were discontinued. Patients are not usually considered for liver transplantation until they have at least six months of abstinence from alcohol as recommended by the American Society of Transplantation.14 Discharge considerations. No clinical trials have studied optimal timing of discharge. Expert opinion based on clinical experience recommends that patients be kept in the hospital until they are eating, signs of alcohol withdrawal and encephalopathy are absent, and bilirubin is less than 10 mg/dL.14 These patients often are quite sick and hospitalization frequently exceeds 10 days. Careful outpatient follow-up and assistance with continued abstinence is very important. Back to the Case The patient fits the typical clinical picture of alcoholic hepatitis. Cessation of alcohol consumption is the most important treatment and is accomplished by admission to the hospital. Because of his daily alcohol consumption, folate, thiamine, multivitamins, and oral vitamin K are ordered. Though he has no symptoms of alcohol withdrawal, a note is added about potential withdrawal to the handoff report. An infectious workup is completed by ordering blood and urine cultures, a chest X-ray, and performing paracentesis to exclude spontaneous bacterial peritonitis. A dietary consult with calorie count is given, along with a plan to discuss with the patient the importance of consuming at least 2,500 calories a day is made. Tube feedings will be considered if the patient does not meet this goal in 48 hours. Clinical calculators determine his Maddrey’s and MELD scores (50 and 25, respectively). If he is not actively bleeding or infected, pentoxifylline (400 mg TID for 28 days) is favored due to its lower-side-effect profile. His MELD score predicts a 90-day mortality of 43%; a meeting is planned to discuss code status and end-of-life issues with the patient and his family. Due to the severity of his illness, a gastroenterology consultation is recommended. Bottom Line Alcoholic hepatitis is a serious disease with significant short-term mortality. Treatment options are limited but include abstinence from alcohol, supplemental nutrition, and, for select patients, pentoxifylline or corticosteroids. Because most transplant centers require six months of abstinence, these patients usually are not eligible for urgent liver transplantation. Dr. Parada is a clinical instructor and chief medical resident in the Department of Internal Medicine at the University of New Mexico School of Medicine and the University of New Mexico Hospital, Albuquerque. Dr. Pierce is associate professor in the Division of Hospital Medicine at the University of New Mexico School of Medicine and the University of New Mexico Hospital. References Naveau S, Giraud V, Borotto E, Aubert A, Capron F, Chaput JC. Excess weight risk factor for alcoholic liver disease. Hepatology. 1997;25:108-111. Pessione F, Ramond MJ, Peters L, et al. Five-year survival predictive factors in patients with excessive alcohol intake and cirrhosis. Effect of alcoholic hepatitis, smoking and abstinence. Liver Int. 2003;23:45-53. Mendenhall CL, Anderson S, Weesner RE, Goldberg SJ, Crolic KA. Protein-calorie malnutrition associated with alcoholic hepatitis. Veterans Administration Cooperative Study Group on alcoholic hepatitis. Am J Med. 1984;76:211-222. Cabre E, Rodriguez-Iglesias P, Caballeria J, et al. Short- and long-term outcome of severe alcohol-induced hepatitis treated with steroids or enteral nutrition: a multicenter randomized trial. Hepatology. 2000;32:36-42. O’Shea RS, Dasarathy S, McCullough AJ, Practice Guideline Committee of the American Association for the Study of Liver Diseases, Practice Parameters Committee of the American College of Gastroenterology. Alcoholic liver disease. Hepatology. 2010;51:307-328. Rambaldi A, Saconato HH, Christensen E, Thorlund K, Wetterslev J, Gluud C. Systematic review: Glucocorticosteroids for alcoholic hepatitis—a Cochrane hepato-biliary group systematic review with meta-analyses and trial sequential analyses of randomized clinical trials. Aliment Pharmacol Ther. 2008;27:1167-1178. Mathurin P, Mendenhall CL, Carithers RL Jr., et al. Corticosteroids improve short-term survival in patients with severe alcoholic hepatitis (AH): individual data analysis of the last three randomized placebo controlled double blind trials of corticosteroids in severe AH. J Hepatol. 2002;36:480-487. Louvet A, Naveau S, Abdelnour M, et al. The Lille model: A new tool for therapeutic strategy in patients with severe alcoholic hepatitis treated with steroids. Hepatology. 2007;45:1348-1354. Louvet A, Diaz E, Dharancy S, et al. Early switch topentoxifylline in patients with severe alcoholic hepatitis is inefficient in non-responders to corticosteroids. J Hepatol. 2008;48:465-470. Amini M, Runyon BA. Alcoholic hepatitis 2010: A clinician’s guide to diagnosis and therapy. World J Gastroenterol. 2010;16:4905-4912. Akriviadis E, Botla R, Briggs W, Han S, Reynolds T, Shakil O. Pentoxifylline improves short-term survival in severe acute alcoholic hepatitis: A double-blind, placebo-controlled trial. Gastroenterology. 2000;119:1637-1648. Whitfield K, Rambaldi A, Wetterslev J, Gluud C. Pentoxifylline for alcoholic hepatitis. Cochrane Database Syst Rev. 2009;(4):CD007339. De BK, Gangopadhyay S, Dutta D, Baksi SD, Pani A, Ghosh P. Pentoxifylline versus prednisolone for severe alcoholic hepatitis: A randomized controlled trial. World J Gastroenterol. 2009;15:1613-1619. Lucey MR, Brown KA, Everson GT, et al. Minimal criteria for placement of adults on the liver transplant waiting list: a report of a national conference organized by the American Society of Transplant Physicians and the American Association for the Study of Liver Diseases. Liver Transpl Surg. 1997;3:628-637.

Family alcoholism linked to kid risks

 

A family history of alcoholism might be a factor in risky choices by teens regarding alcohol use. According to a study published in the journal Alcoholism: Clinical and Experimental Research, brain scans of ages 13 to 15 with family histories of alcoholism showed a weaker response in the process of making risky decisions compared to teens without such history. Researchers used magnetic resonance imaging on 31 teens’ brains while they played a game akin to the TV show “Wheel of Fortune.” Of these teens, 18 had family histories of alcoholism. Two areas of the brain responded differently with the teens who had a family history of alcoholism. The brain areas are important for planning, decision-making and response control, according to the study. “Atypical brain activity in regions implicated in executive functioning could lead to reduced cognitive control, which may result in risky choices regarding alcohol use,” the researchers said in a press release.

Teenage drinking is a real problem

 

Teenage drinking is very real — unfortunately, parents may not be able to see the warning signs that most teenagers will exhibit. Binge drinking is the most common type of drinking problem for people under 21. Recognizing and understanding that your child may be abusing alcohol can take months of arguments, denial and failed attempts to get them to stop drinking. You may have tried on several occasions to talk with your teenager about your concerns, but have made no progress. One of the main symptoms of alcoholism is having an uncontrollable desire to drink, along with being a progressive disease. Some symptoms of alcoholism include: • Neglecting responsibilities. Failing grades, skipping classes or problems at home can be indicators of a drinking problem. • Taking risks while intoxicated. Excessive drinking can lead to impaired cognitive functioning such as driving while drunk or having unprotected sex. • Problems with maintaining relationships. Fighting with family members or friends and beginning to isolate yourself from activities can also be a sign of alcoholism. Alcoholism can affect not only the person drinking, but also family and friends of the alcoholic. It is imperative for the alcoholic to recognize just how drinking is affecting their life. This may be difficult for them to do as most alcoholics are in denial about even having a drinking problem. Some tips to help someone with a drinking problem include: • Talking to your loved one about your concerns. Attempt to discuss your concerns with your loved one but try to stay away from giving advice. Tell them how their behaviors are affecting your life. • Offer to get them help. Tell them that you will get them professional help if they are willing. Talk to them when they are sober and have not been drinking. • Set boundaries with your loved one. It is important to set emotional and physical boundaries with the alcoholic. Do not “enable” them to continue drinking or support their drinking behaviors. Examples include: giving them money, letting them live at your house or being around them when they are drinking. • Provide support. Let your loved one know that you are there for them but will not support their drinking habits. Tell them that you love them no matter what and will help them if they are willing to get help.

LSD 'helps alcoholics to give up drinking'

 

One dose of the hallucinogenic drug LSD could help alcoholics give up drinking, according to an analysis of studies performed in the 1960s. A study, presented in the Journal of Psychopharmacology, looked at data from six trials and more than 500 patients. It said there was a "significant beneficial effect" on alcohol abuse, which lasted several months after the drug was taken. An expert said this was "as good as anything we've got". LSD is a class A drug in the UK and is one of the most powerful hallucinogens ever identified. It appears to work by blocking a chemical in the brain, serotonin, which controls functions including perception, behaviour, hunger and mood. Benefit Researchers at the Norwegian University of Science and Technology analysed earlier studies on the drug between 1966 and 1970. Patients were all taking part in alcohol treatment programmes, but some were given a single dose of LSD of between 210 and 800 micrograms. Continue reading the main story Dangers of LSD During a trip the person may put themselves in danger without realising it such as thinking they can fly and trying to jump off a high building. In some people, especially if LSD is taken in high doses, the drug can cause intense anxiety and panic attacks. Some people experience flashbacks, reliving a bad trip weeks or even months after it happened. In those already vulnerable, LSD may be the trigger for psychotic illness. Paranoia and other symptoms typical of schizophrenia may occur. BBC Health: LSD For the group of patients taking LSD, 59% showed reduced levels of alcohol misuse compared with 38% in the other group. This effect was maintained six months after taking the hallucinogen, but it disappeared after a year. Those taking LSD also reported higher levels of abstinence. The report's authors, Teri Krebs and Pal-Orjan Johansen, said: "A single dose of LSD has a significant beneficial effect on alcohol misuse." They suggested that more regular doses might lead to a sustained benefit. "Given the evidence for a beneficial effect of LSD on alcoholism, it is puzzling why this treatment approach has been largely overlooked," they added. Prof David Nutt, who was sacked as the UK government's drugs adviser, has previously called for the laws around illegal drugs to be relaxed to enable more research. He said: "Curing alcohol dependency requires huge changes in the way you see yourself. That's what LSD does. "Overall there is a big effect, show me another treatment with results as good; we've missed a trick here. "This is probably as good as anything we've got [for treating alcoholism]."

A diet consisting of 20 per cent of calories as almonds over a 16-week period is effective in improving markers of insulin sensitivity

 

Diabetes is caused when there is deficiency of insulin hormone, which controls blood sugar level. Its symptoms include fatigue, excessive thirst and frequent urination. "With an estimated 50.8 million people living with the disease, India has the world's largest population of diabetics in the world, followed by China with 43.2 million," says the World Health Organisation(WHO). The number in India is expected to go up to 87 million - 8.4 per cent of the country's adult population - by 2030. With India staring at a major public health threat due to diabetes and other lifestyle diseases, almond is now being hailed as the health nut. "Indians are more prone to lifestyle diseases like diabetes. The increasingly sedentary lifestyle and fast food double up the risk. Almond, which has traditionally been part of our diet, is a high source of nutrition and helps push these diseases away," says Snoop Misran, director of Diabetes Foundation (India). "A handful of almonds contain 164 calories and 7 gm. of protein, which helps in fighting hunger pangs and helps you control what you eat. Almonds also help growing children in developing strong bones," he adds. A study done by scholars from the University of Medicine and Dentistry of New Jersey, West Chester University, Pennsylvania, and Loma Linda University of California, all in the US, and published in the Journal of the American College of Nutrition also confirms that the nut can control diabetes if consumed regularly. "A diet consisting of 20 per cent of calories as almonds over a 16-week period is effective in improving markers of insulin sensitivity and yields clinically significant improvements in LDL-C (low density lipoprotein cholesterol) in adults with pre-diabetes," the study said.

Regular drinking habit comes with age

 

PEOPLE over 45 are three times more likely to drink almost every day as those who are younger, according to new figures. Some 13 per cent of adults over 45 drink almost every day compared with 4 per cent of those under 45, Office for National Statistics’ data shows. And as people get older they tend to drink more – with over a fifth of men aged 65 and over drinking almost every day compared with just 3 per cent of men aged 16 to 24. Among women, 12 per cent of over-65s consume alcohol almost every day compared with just 1 per cent of 16 to 24-year-olds. However, the survey, of more than 13,000 adults in 2010, found younger people were more likely to binge drink.

LSD could treat alcoholism

 

The new study published in the Journal of Psychopharmacology found that LSD had a positive effect on alcohol misuse in each of the trials, with 59 per cent of patients who took the drug having improved at follow-up, compared with 38 per cent who took a placebo.  A single dose of LSD produces benefits which last between six and 12 months, and repeated doses along with modern treatments could ensure longer term results, the researchers said. The drug, which causes hallucinations that make users experience the world in a distorted way, is not physically addictive but some experte believe users can become dependant on its effects, for example from a need to distance themselves from reality. Pål-Ørjan Johansen, a Norwegian researcher and fellow of Harvard Medical School, who led the research, said: "Given the evidence for a beneficial effect of LSD on alcoholism, it is puzzling why this treatment approach has been largely overlooked." Dr David Nutt, former advisor on drugs to the government, said: "I think this study is very interesting and it is a shame the last of these studies were done in the 1960s. "I think these drugs might help people switch out of a mindset which is locked into addiction or depression and be a way of helping the brain switch back to where it should be, in a similar way that Alcoholics Anonymous programmes do."

The Next Frontier: Emotional Sobriety

 

"The Next Frontier: Emotional Sobriety" by Bill W I think that many oldsters who have put our AA "booze cure" to severe but successful tests still find they often lack emotional sobriety. Perhaps they will be the spearhead for the next major development in AA -- the development of much more real maturity and balance (which is to say, humility) in our relations with ourselves, with our fellows, and with God. Those adolescent urges that so many of us have for top approval, perfect security, and perfect romance -- urges quite appropriate to age seventeen -- prove to be an impossible way of life when we are at age forty-seven or fifty-seven. Since AA began, I've taken immense wallops in all these areas because of my failure to grow up, emotionally and spiritually. My God, how painful it is to keep demanding the impossible, and how very painful to discover finally, that all along we have had the cart before the horse! Then comes the final agony of seeing how awfully wrong we have been, but still finding ourselves unable to get off the emotional merry-go-round. How to translate a right mental conviction into a right emotional result, and so into easy, happy, and good living -- well, that's not only the neurotic's problem, it's the problem of life itself for all of us who have got to the point of real willingness to hew to right principles in all our affairs. Even then, as we hew away, peace and joy may still elude us. That's the place so many of us AA oldsters have come to. And it's a hell of a spot, literally. How shall our unconscious -- from which so many of our fears, compulsions and phony aspirations still stream -- be brought into line with what we actually believe, know and want! How to convince our dumb, raging and hidden "Mr. Hyde" becomes our main task. I've recently come to believe that this can be achieved. I believe so because I begin to see many benighted ones -- folks like you and me -- commencing to get results. Last autumn [several years back -- ed.] depression, having no really rational cause at all, almost took me to the cleaners. I began to be scared that I was in for another long chronic spell. Considering the grief I've had with depressions, it wasn't a bright prospect. I kept asking myself, "Why can't the Twelve Steps work to release depression?" By the hour, I stared at the St. Francis Prayer..."It's better to comfort than to be the comforted." Here was the formula, all right. But why didn't it work? Suddenly I realized what the matter was. My basic flaw had always been dependence -- almost absolute dependence - on people or circumstances to supply me with prestige, security, and the like. Failing to get these things according to my perfectionist dreams and specifications, I had fought for them. And when defeat came, so did my depression. There wasn't a chance of making the outgoing love of St. Francis a workable and joyous way of life until these fatal and almost absolute dependencies were cut away. Because I had over the years undergone a little spiritual development, the absolute quality of these frightful dependencies had never before been so starkly revealed. Reinforced by what Grace I could secure in prayer, I found I had to exert every ounce of will and action to cut off these faulty emotional dependencies upon people, upon AA, indeed, upon any set of circumstances whatsoever. Then only could I be free to love as Francis had. Emotional and instinctual satisfactions, I saw, were really the extra dividends of having love, offering love, and expressing a love appropriate to each relation of life. Plainly, I could not avail myself of God's love until I was able to offer it back to Him by loving others as He would have me. And I couldn't possibly do that so long as I was victimized by false dependencies. For my dependency meant demand -- a demand for the possession and control of the people and the conditions surrounding me. While those words "absolute demand" may look like a gimmick, they were the ones that helped to trigger my release into my present degree of stability and quietness of mind, qualities which I am now trying to consolidate by offering love to others regardless of the return to me. This seems to be the primary healing circuit: an outgoing love of God's creation and His people, by means of which we avail ourselves of His love for us. It is most clear that the current can't flow until our paralyzing dependencies are broken, and broken at depth. Only then can we possibly have a glimmer of what adult love really is. Spiritual calculus, you say? Not a bit of it. Watch any AA of six months working with a new Twelfth Step case. If the case says "To the devil with you," the Twelfth Stepper only smiles and turns to another case. He doesn't feel frustrated or rejected. If his next case responds, and in turn starts to give love and attention to other alcoholics, yet gives none back to him, the sponsor is happy about it anyway. He still doesn't feel rejected; instead he rejoices that his one-time prospect is sober and happy. And if his next following case turns out in later time to be his best friend (or romance) then the sponsor is most joyful. But he well knows that his happiness is a by-product -- the extra dividend of giving without any demand for a return. The really stabilizing thing for him was having and offering love to that strange drunk on his doorstep. That was Francis at work, powerful and practical, minus dependency and minus demand. In the first six months of my own sobriety, I worked hard with many alcoholics. Not a one responded. Yet this work kept me sober. It wasn't a question of those alcoholics giving me anything. My stability came out of trying to give, not out of demanding that I receive. Thus I think it can work out with emotional sobriety. If we examine every disturbance we have, great or small, we will find at the root of it some unhealthy dependency and its consequent unhealthy demand. Let us, with God's help, continually surrender these hobbling demands. Then we can be set free to live and love; we may then be able to Twelfth Step ourselves and others into emotional sobriety. Of course I haven't offered you a really new idea -- only a gimmick that has started to unhook several of my own "hexes" at depth. Nowadays my brain no longer races compulsively in either elation, grandiosity or depression. I have been given a quiet place in bright sunshine.

There is something beautiful about the essence of Step 12 in recovery

 There is something beautiful about the essence of Step 12 in recovery. It is about the "joy of living" and talks about how working the previous 11 steps now gives the person in recovery a new compass in which to live by: their spiritual beliefs and principles. One moves from the experience of being driven, to more consciousness about who they are, what they are doing, and why they are doing it. If taken directly from the program, the spiritual principles that correspond to each step, and that serve as a guide are as follows:

1. Honesty

2. Hope

3. Faith

4. Courage

5. Integrity

6. Willingness

7. Humility

8. Brotherly Love

9. Justice

10. Perseverance

11. Unity and Spirituality

12. Service and Gratitude

One of the gifts of living according to principles is that they can support us no matter what our history, our patterning, or our circumstances. They can orient us when objective realities have lost their command. Spiritual principles become the ultimate navigation system. You may have lost a job or a promotion, you might be in an argument with a friend or partner, but you can always turn to the principles for a soft place to land, to serve as a guide, and to put your current position in context.

Step 1 for example, "Admitted we were powerless over alcohol and that our lives had become unmanageable," starts with the poignant word, "admit." I've always appreciated the double meaning—it implies that we have to be honest but it additionally signals admittance, as in "admit one." So, right off the bat, the navigation system orients the person in recovery over a threshold that had been previously impassable. Denial begins to be shed and honesty becomes something to strive for.

Each of the principles are not only guides, but anchors, allowing for an experience of grounding in what can often be a challenging and chaotic ride. The spiritual path becomes the perfect container for the ups and downs we all experience. This means that sometimes, the direction we are given is to stay put. In times of loss, doubt, and uncertainty—courage allows us to lean in to such experiences, to face our fears and our demons when all we want to do is flee. Hope and faith provide additional support by reminding us that the dark places aren't static states and that we will survive the ride.

Integrity is something I talk about a great deal in Recovering Spirituality. To me, it is about embracing the fullness of the human condition, being intimately and integrally connected to the whole. It allows for greater compassion for ourselves and others because we understand that we will never overcome our humanness, which means that we are all perfectly flawed.

So, when life steers you in a direction that you never imagined going, or when you feel like you can't find the purpose or meaning in your life, see if you can find some grounding and direction in the principles. They are perfect when our lives are not—the ideal GPS (Global Positioning System). Maybe the task at hand is to orient yourself towards service to others, or perhaps the unity of the fellowship can provide some laughterright when you thought it was impossible to smile. No matter the challenge, there is a guiding principle that can shine some light on the darkened path. 

And if all is going well, don't let this discourage you from leaning in even further to the principle driven life. Pain may be the touchstone to spiritual growth, but the path is always available to us.

Ice cream as 'addictive as drugs' says new study

 

Researchers concluded that cravings for the dessert were similar to those experienced by drug addicts. They found that the brain was left wanting more while eating ice cream in the same way as a person who regularly uses cocaine. Their study, published online in the American Journal of Clinical Nutrition, appears to add weight to previous studies that people can be left feeling "addicted" to some foods. Dr Kyle Burger, from the Oregon Research Institute, in Eugene, about 110 miles south of Portland, said overeating "high-fat" or "high-sugar" foods appeared to change how the brain responded and in turn downgraded the mental "reward". "This down-regulation pattern is seen with frequent drug use, where the more an individual uses the drug, the less reward they receive from using it," said Dr Burger, the study's co-author.

Cannabis memory effects examined

 

Scientists believe they are closer to understanding how taking cannabis disrupts short-term memory. The Canadian team from Ottawa University narrowed the effect down to a particular type of brain cell called an astrocyte. Writing in the journal Cell, they said it might be possible to block it in medicines based on cannabis. A UK researcher said it could reveal more about natural brain chemicals. Cannabis floods the brain with a host of chemicals which mimic one of its own subtle signalling systems, leading to pronounced changes in mood and memory. Scientists are trying to harness the power of these chemicals, called cannabinoids, in pharmaceuticals aimed at conditions such as multiple sclerosis and chronic pain. The doses of cannabinoid are carefully controlled to avoid the "high" feeling. The work by the Ottawa University researchers may shed light on how one of the best known cannabinoids, THC, acts on the brain. Memory matters Their work suggests that, when it comes to affecting memory, THC is acting not, as might be expected, on the brain's neurons, but on a brain cell called an astrocyte. Continue reading the main story “ Start Quote We may find a way to deal with working memory problems in Alzheimer's.” Dr Xia Zhang They bred mice whose astrocytes could not be affected by THC, and found that their spatial memory was unaffected by the dose. This discovery could help drug companies reduce the risk of unwanted side effects when using THC in their products, they suggested. However, possibly more importantly, it could shed light on the brain's own chemical pathways, the "endocannabinoid" system. Dr Xia Zhang, one of the researchers, said: "Just about any physiological function you can think of in the body, it's likely at some point endocannabinoids are involved." Understanding how this system works could lead to ways to make it work better, he suggested. "We may find a way to deal with working memory problems in Alzheimer's," he said. Prof Heather Ashton, from the University of Newcastle, said that memory problems were an established feature of cannabis use, and understanding the mechanism behind them was "interesting". She said: "When someone is taking cannabis, in some cases you find that they cannot even remember starting a sentence by the time they reach the end." But she agreed that the practical benefits of such research might ultimately lie in a better understanding of the body's own endocannabinoid system, rather than the effects of cannabis itself.