Is alcohol more dangerous than ecstasy?

Scientists in Britain are proposing a complete revamping of drug classifications in the wake of findings that reveal some major discrepancies between a drug's legality and its safeness. A study surveying health, crime and science professionals regarding the dangers of a set of 20 legal and illegal drugs, published in The Lancet in March 2007, found that alcohol and tobacco, which are legal in Britain and the United States, are considered by experts to be more dangerous than ecstasy and marijuana, which are illegal in both countries.
In Britain, under the Misuse of Drugs Act, illegal drugs (including prescription drugs sold on the street) are classified as A, B or C. Class A is supposed to be the most harmful, and Class C is supposed to be the least harmful. For instance, heroin is a class A drug, and marijuana is a class C drug. The study was intended to achieve harm rankings for 20 drugs, 15 illegal substances and five legal substances that have shown potential for harm, using a systematic, scientific approach. The researchers surveyed two separate groups of experts including medical doctors, mental health professionals, scientists and forensics experts. Each group returned similar ranking results for the 20 drugs based on three primary features:
· physical harm to the person using the drug
· the drug's potential for abuse and/or dependence
· the drug's ill effects on society
Probably the most notable discrepancy is the position of alcohol, a legal drug, at 13 places above ecstasy, an illegal, class A drug. And LSD, also a class A drug, was ranked considerably less harmful than benzodiazepines, a class C group of drugs.
The results seem to call into question exactly which method the British government is using to determine the relative harmfulness of drugs. According to the authors of the study, "Tobacco and alcohol together account for about 90 percent of all drug-related deaths in the U.K." Yet both of those substances are legal. In the United States, a study published in the journal of the American Medical Association in 2000 shows that 95 percent of drug-related deaths in the United States are from alcohol and tobacco use.
With little documentation that attempts to explain the current governmental ranking criteria, the study proposes a method for classifying drugs that uses scientific assessment. The classifications would be based on the three indicators of harm as presented to experts in the study -- personal, physical harm; abuse/dependence potential; and social harm. In the study, the rankings for each of the criterion were combined, with the researchers taking the mean of the three scores, to obtain the overall rankings listed above.
Of course, the legal status of drugs like alcohol and tobacco skews the results. Their legal status makes them far more available, so an accurate side-by-side comparison with a drug like heroin on all three criteria is impossible. Availability will always affect social effects of any given drug. Drugs that are easily available, legal and non-stigmatized logically will result in more widespread use, more adverse reactions and more money spent on police assistance and/or hospital care as a result of those adverse reactions.
Still, availability most likely wouldn't skew the abuse potential or the personal, physical harm associated with a drug. So the study does at least reveal some possible inconsistencies in British (and U.S.) drug law. Ultimately, the researchers believe that the foundations of drug policy need to be more transparent, since those foundations effect everything from public education to criminal sentences to treatment programs to methods of control and enforcement. They point out that without a clear, scientific basis for determining a drug's legal status and harmfulness, it's hard to establish credibility in the policies that dictate how a "drug war" is carried out, and it's hard to determine how effective those policies really are.

Sources
·"Alcohol, tobacco among worst drugs." CNN.com. Mar. 23, 2007.http://www.cnn.com/2007/HEALTH/03/23/drugs.report.ap/index.html
·"Annual Causes of Death in the United States." Drug War Facts.http://www.drugwarfacts.org/causes.htm
·"New 'matrix of harm' for drugs of abuse." Bristol University. Mar. 23, 2007.http://www.bris.ac.uk/news/2007/5367.html
· Nutt, David, et al. "Development of a rational scale to assess the harm of drugs of potential misuse." The Lancet, 2007; 369:1047-1053.http://www.thelancet.com/journals/lancet/article/ PIIS0140673607604644/fulltext
·"Scientists want new drug rankings." BBC News. Mar. 23, 2007.http://news.bbc.co.uk/1/hi/health/6474053.stm?ls
· HSW team http://recipes.howstuffworks.com/alcohol1.htm
· Photo courtesy: Carolina Brewing Company

In case of any queries please feel free to contact Dr Anil K Dhull

How can nicotine be good for me?

By now the health hazards of smoking and tobacco use are well known. Smoking is the chief preventable cause of death in the United States and a major contributor to many types of cancer, heart disease and other serious or potentially fatal conditions. Cigarettes are also expensive, addictive and they leave a bad odor. However, medical researchers have begun to show interest in one of the most reviled components of cigarettes -- nicotine. And they're interested in this potent, powerfully addictive substance for its health benefits.
Over the past decade, new research has taught us more about how nicotine affects the brain and the body. Some of it is good news -- for example, a lower incidence of Alzheimer's disease in smokers. Research has pointed to a compound called acetylcholine as the reason. Nicotine is structurally similar to acetylcholine, a naturally-occurring compound that serves as a neurotransmitter. Nicotine binds to nerve receptors and makes nerve cells fire more frequently. In one study, a group of Alzheimer's patients were given nicotine patches, while another received a placebo. Those with nicotine patches maintained their cognitive abilities longer and sometimes even recovered lost cognitive function. A follow-up study indicated that nicotine may also boost cognitive abilities in elderly people who aren't suffering from Alzheimer's but who are experiencing the typical mental decline associated with old age.
Nicotine is the highly addictive substance found in tobacco that gives users a buzz. It may also have some health benefits.
The transformation with nicotine happened when the nicotine patch was introduced. Intended to help smokers quit, the nicotine patch also opened up a whole new way of studying the drug. Suddenly scientists had a reliable delivery system -- one without the numerous carcinogens found in cigarettes -- that could be standardized across various studies. A 1982 study revealed that patients with ulcerative colitis had fewer flare-ups when taking nicotine. However, side effects proved nicotine to be a poor long-term treatment.

In 2000, a study performed at Stanford revealed surprising results about nicotine's effects on blood vessels. Contrary to popular opinion, the study showed that nicotine actually boosts the growth of new blood vessels. The discovery may lead to new treatments for diabetes. Many people with severe diabetes experience poor circulation, which can lead to gangrene and ultimately, limb amputation.

Researchers from the Scripps Research Institute published a study in 2002 that revealed a connection between nornicotine -- a chemical found in tobacco and also created when the body breaks down nicotine -- and a reduction of Alzheimer's symptoms. However, nornicotine is toxic, pointing to the need for a nontoxic substitute.

­­In 2006, Duke scientists found that people with depression who were treated with nicotine patches reported a decrease in their depressive feelings. The results were perhaps not surprising for a drug associated with imparting a "buzz." However, the research also showed a direct link between nicotine and an increase in the release of dopamine and serotonin, two vital neurotransmitters. A lack of dopamine or serotonin is a common cause of depression.

Warning: Cigarette smoking & tobacco chewing are injurious to health.

In Case of any queries please contact Dr Anil K Dhull

How Caffeine Works

Around 90 percent of Americans consume caffeine in one form or another every single day. More than half of all American adults consume more than 300 milligrams (mg) of caffeine every day, making it America's most popular drug by far. The caffeine comes in from things like coffee, tea, cola, chocolate, etc.
Have you ever wondered what it is that makes caffeine so popular? What does this drug do that causes its use to be so widespread? In this article, you will learn all about caffeine. ­
The caffeine from your morning coffee changes your ­brain's chemistry.

What is Caffeine?
Caffeine is known medically as trimethylxanthine, and the chemical formula is C8H10N4O2. When isolated in pure form, caffeine is a white crystalline powder that tastes very bitter. The chief source of pure caffeine is the process of decaffeinating coffee and tea.
Medically, caffeine is useful as a cardiac stimulant and also as a mild diuretic (it increases urine production). Recreationally, it is used to provide a "boost of energy" or a feeling of heightened alertness. It's often used to stay awake longer -- college students and drivers use it to stay awake late into the night. Many people feel as though they "cannot function" in the morning without a cup of coffee to provide caffeine and the boost it gives them.
Caffeine is an addictive drug. Among its many actions, it operates using the same mechanisms that amphetamines, cocaine, and heroin use to stimulate the brain. On a spectrum, caffeine's effects are more mild than amphetamines, cocaine and heroin, but it is manipulating the same channels, and that is one of the things that gives caffeine its addictive qualities. If you feel like you cannot function without it and must consume it every day, then you are addicted to caffeine.

Q: How is caffeine used medically?
A: Medically, caffeine is useful as a cardiac stimulant and also as a mild diuretic (it increases urine production).

Caffeine in the Diet
Caffeine occurs naturally in many plants, including coffee beans, tea leaves and cocoa nuts. It is therefore found in a wide range of food products. Caffeine is added artificially to many others, including a variety of beverages. Here are the most common sources of caffeine for Americans:
· Typical drip-brewed coffee contains 100 mg per 6-ounce cup. If you are buying your coffee at Starbucks or a convenience store or drinking it at home or the office out of a mug or a commuter's cup, you are consuming it in 12-, 14- or 20-ounce containers. You can calculate the number of milligrams based on your normal serving size.
· Typical brewed tea contains 70 mg per 6-ounce cup.
· Typical colas (Coke, Pepsi, Mountain Dew, etc.) contain 50 mg per 12-ounce can. Things like Jolt contain 70 mg per 12-ounce can.
· Typical milk chocolate contains 6 mg per ounce.
· Anacin contains 32 mg per tablet. No-doz contains 100 mg per tablet. Vivarin and Dexatrim contain 200 mg per tablet.
By looking at these numbers and by knowing how widespread coffee, tea and cola are in our society, you can see why half of adults consume more than 300 mg of caffeine per day. Two mugs of coffee or a mug of coffee and a couple of Cokes during the day are all you need to get you there. If you sit down and calculate your caffeine consumption during a typical day, you may be surprised. Many people consume a gram or more every single day and don't even realize it.

Caffeine and Adenosine
Why do so many people consume so much caffeine? Why does caffeine wake you up? By understanding the drug's actions inside the body you can see why people use it so much.
As adenosine is created in the brain, it binds to adenosine receptors. The binding of adenosine causes drowsiness by slowing down nerve cell activity. In the brain, adenosine binding also causes blood vessels to dilate (presumably to let more oxygen in during sleep).
To a nerve cell, caffeine looks like adenosine. Caffeine therefore binds to the adenosine receptor. However, it doesn't slow down the cell's activity like adenosine would. So the cell cannot "see" adenosine anymore because caffeine is taking up all the receptors adenosine binds to. So instead of slowing down because of the adenosine level, the cells speed up. You can see that caffeine also causes the brain's blood vessels to constrict, because it blocks adenosine's ability to open them up. This effect is why some headache medicines like Anacin contain caffeine -- if you have a vascular headache, the caffeine will close down the blood vessels and relieve it.
So now you have increased neuron firing in the brain. The pituitary gland sees all of the activity and thinks some sort of emergency must be occurring, so it releases hormones that tell the adrenal glands to produce adrenaline (epinephrine). Adrenaline is the "fight or flight" hormone, and it has a number of effects on your body:
· Your pupils dilate.
· Your breathing tubes open up (this is why people suffering from severe asthma attacks are sometimes injected with epinephrine).
· Your heart beats faster.
· Blood vessels on the surface constrict to slow blood flow from cuts and also to increase blood flow to muscles. Blood pressure rises.
· Blood flow to the stomach slows.
· The liver releases sugar into the bloodstream for extra energy.
· Muscles tighten up, ready for action.
This explains why, after consuming a big cup of coffee, your hands get cold, your muscles tense up, you feel excited and you can feel your heart beat increasing.

Caffeine and Dopamine
Caffeine also increases dopamine levels in the same way that amphetamines do (heroine and cocaine also manipulate dopamine levels by slowing down the rate of dopamine re-uptake). Dopamine is a neurotransmitter that, in certain parts of the brain, activates the pleasure center. Obviously, caffeine's effect is much lower than heroin's, but it is the same mechanism. It is suspected that the dopamine connection contributes to caffeine addiction.
So you can see why your body might like caffeine in the short term, especially if you are low on sleep and need to remain active. Caffeine blocks adenosine reception so you feel alert. It injects adrenaline into the system to give you a boost. And it manipulates dopamine production to make you feel good.
The problem with caffeine is the longer-term effects, which tend to spiral. For example, once the adrenaline wears off, you face fatigue and depression. So what are you going to do? You take more caffeine to get the adrenaline going again. As you might imagine, having your body in a state of emergency all day long isn't very healthy, and it also makes you jumpy and irritable.
The most important long-term problem is the effect that caffeine has on sleep. Adenosine reception is important to sleep, and especially to deep sleep. The half-life of caffeine in your body is about 6 hours. That means that if you consume a big cup of coffee with 200 mg of caffeine in it at 3:00 PM, by 9:00 PM about 100 mg of that caffeine is still in your system. You may be able to fall asleep, but your body probably will miss out on the benefits of deep sleep. That deficit adds up fast. The next day you feel worse, so you need caffeine as soon as you get out of bed. The cycle continues day after day.
This is why 90% of Americans consume caffeine every day. Once you get in the cycle, you have to keep taking the drug. Even worse, if you try to stop taking caffeine, you get very tired and depressed and you get a terrible, splitting headache as blood vessels in the brain dilate. These negative effects force you to run back to caffeine even if you want to stop.

In Case of any queries, contact Dr Anil K Dhull

Can AIDS spread through mosquito bite?

One of the most prevalent myths about HIV transmission is that mosquitoes or other bloodsucking insects can infect you. There is no scientific evidence to support this claim. To see why mosquitoes don't aid in the transmission of HIV, we can look at the insect's biting behavior.
When a mosquito bites someone, it does not inject its own blood or the blood of an animal or person it has bitten into the next person it bites. The mosquito does inject saliva, which acts as a lubricant so that it can feed more effectively. Yellow fever and malaria can be transmitted through the saliva, but HIV does not reproduce in insects, so the virus doesn't survive in the mosquito long enough to be transmitted in the saliva.
Additionally, mosquitoes don't normally travel from one person to another after ingesting blood. The insects need time to digest the blood meal before moving on.

In Case of any queries, contact Dr Anil K Dhull

How do antibiotics work?

Antibiotics work to kill bacteria. Bacteria are single-cell organisms. If bacteria make it past our immune systems and start reproducing inside our bodies, they cause disease. We want to kill the bacteria to eliminate the disease.
An antibiotic is a selective poison. It has been chosen so that it will kill the desired bacteria, but not the cells in your body.
Certain bacteria produce chemicals that damage or disable parts of our bodies. In an ear infection, for example, bacteria have gotten into the inner ear. The body is working to fight the bacteria, but the immune system's natural processes produce inflammation. Inflammation in your ear is painful. So you take an antibiotic to kill the bacteria and eliminate the inflammation.
An antibiotic is a selective poison. It has been chosen so that it will kill the desired bacteria, but not the cells in your body. Each different type of antibiotic affects different bacteria in different ways. For example, an antibiotic might inhibit a bacterium's ability to turn glucose into energy, or its ability to construct its cell wall. When this happens, the bacterium dies instead of reproducing. At the same time, the antibiotic acts only on the bacterium's cell-wall-building mechanism, not on a normal cell's.
Antibiotics do not work on viruses because viruses are not alive. A bacterium is a living, reproducing lifeform. A virus is just a piece of DNA (or RNA). A virus injects its DNA into a living cell and has that cell reproduce more of the viral DNA. With a virus there is nothing to "kill," so antibiotics don't work on it.

DISCLAIMER: This information is solely for informational purposes. IT IS NOT INTENDED TO PROVIDE MEDICAL ADVICE. Neither the Editors of Health Mirror, the author nor publisher take responsibility for any possible consequences from any treatment, procedure, exercise, dietary modification, action or application of medication which results from reading or following the information contained in this information. The publication of this information does not constitute the practice of medicine, and this information does not replace the advice of your physician or other health care provider. Before undertaking any course of treatment, the reader must seek the advice of their physician or other health care provider.

In case of any queries feel free to contact Dr Anil K Dhull

Weight Control, Diet & Cancer

Stable weight depends on an even balance between energy intake from food and energy expenditure. Energy expenditure occurs during the day in three ways:
· As energy expended during rest (basal metabolism)
· As energy used to metabolize food (thermogenesis)
· As energy expended during physical activity
Basal metabolism accounts for about two-thirds of expended energy, which is generally used to maintain body temperature and muscle contractions in the heart and intestine.
Thermogenesis accounts for about 10% of expended energy.
When a person's consumes more calories than energy that is used, the body stores the extra calories in fat cells. Fat cells function as energy reservoirs. They enlarge or contract depending on how people use energy. If people do not balance energy input and output by eating right and exercising, fat can builds up. This can lead to weight gain.

When energy input is equal to energy output, there is no expansion of fat cells (lipocytes) to accommodate excess. It is only when more calories are taken in than used that the extra fat is stored in the lipocytes and the person begins to accumulate fat.

What is Obesity?
People who are obese have an abnormally high and unhealthy proportion of body fat. To measure obesity, researchers commonly use a formula based on weight and height known as the body mass index (BMI). BMI is the ratio of weight (in kilograms) to height (in meters) squared. BMI provides a more accurate measure of obesity or being overweight than does weight alone.
Measurement of Obesity
Obesity is determined by measuring body fat, not just body weight. People might be over the weight limit for normal standards, but if they are very muscular with low body fat, they are not obese. Others might be normal or underweight, but still have excessive body fat. The following measurements and factors are used to determine whether or not a person is overweight to a degree that threatens their health:
· Body mass index (BMI) (a measure of body fat)
· Waist circumference
· Waist-hip ratio
· Anthropometry (skin fold measurement)
· The presence or absence of other disease risk factors (e.g., smoking, high blood pressure, unhealthy cholesterol levels, diabetes, relatives with heart disease)
A person's disease risk factors plus BMI may be the most important components in determining health risks with weight.

Body-Mass Index/ BMI
The body-mass index, a measure of adiposity, has been categorized as follows: 18.5 to 24.9, 25.0 to 29.9, 30.0 to 34.9, 35.0 to 39.9, and 40.0 or more. These categories correspond to those proposed by the World Health Organization6 for “normal range,” “grade 1 overweight,” (25.0 to 29.9) “grade 2 overweight” (30.0 to 39.9), and “grade 3 overweight,” (40.0 or more). For many analyses, especially for cancers in specific sites and among participants who had never smoked, the upper categories of body-mass index were combined, because of the small numbers. In oncology, for analyses and discussion, it is customary to we refer to the range of 25.0 to 29.9 as corresponding to “overweight” and to values of 30.0 or more as corresponding to “obesity.”
Waist Circumference and Waist-Hip Ratio
The extent of abdominal fat can also be used in assessing risk of disease. Some studies suggest that:
· Women whose waistlines are over 31.5 inches and men whose waists measure over 37 inches should watch their weight.
· A waist size greater than 35 inches in women and 40 inches in men is associated with a higher risk for heart disease, diabetes, and impaired functioning.
Evidence strongly suggests that more body fat around the abdomen and hips (the apple-shape) is a more consistent predictor of heart problems and health risks than BMI.
The distribution of fat can be evaluated by dividing waist size by hip size. For example, a woman with a 30-inch waist and 40-inch hip circumference would have a ratio of 0.75; one with a 41-inch waist and 39-inch hips would have a ratio of 1.05. The lower the ratio the better. The risk of heart disease rises sharply for women with ratios above 0.8 and for men with ratios above 1.0.

Anthropometry

Anthropometry is the measurement of skin fold thickness in different areas, particularly around the triceps, shoulder blades, and hips. This measurement is useful in determining how much weight is due to muscle or fat.

Obesity and Cancer
Link between cancer and obesity appears paradoxical as cancer is classically seen as illness producing anorexia and massive weight loss. To measure obesity, researchers commonly use a formula based on weight and height known as the body mass index (BMI). According to WHO approximately 1.6 billion of the world’s adult are overweight and over 400 million are obese. Cancers of the endometrium, kidney, gallbladder, breast, colon and adenocarcinoma of the esophagus have been linked to obesity. Obesity and physical inactivity may account for 25 to 30 percent of several major cancers. Those with a body-mass index of at least 40 had death rates from all cancers combined that were 52 percent higher (for men) and 62 percent higher (for women) than the rates in men and women of normal weight. On the basis of associations observed in some studies, it has been estimated that current patterns of overweight and obesity could account for 14 percent of all deaths from cancer in men and 20 percent of those in women. Women with large abdominal fat (apple shaped) have high risk of breast cancer than those having ‘pear’ shaped distribution. Data on link between obesity & cancers of the pancreas, prostate, liver, cervix, ovary and on hematopoietic cancers are scarce or inconsistent. Obesity and physical inactivity may account from 25-30% of several major cancers. For grade-III obesity, relative risk for dying by cancer is 1.70 for breast cancer, 1.63 for esophageal cancer, 1.94 for gastric cancer, 1.84 for colon cancer, 1.70 for renal cancer, 4.52 for liver cancer, 1.76 for gall bladder cancer, 1.49 for pancreatic cancer and 1.34 for prostate cancer.

Introduction
According to WHO 1.6 billion of the world’s adult were overweight in 2005 and over 400 million were obese. By 2015 the numbers are expected to nearly double.1,2 A recent study from United States reports 14% of deaths from cancer in men and 20% deaths in women were due to overweight and obesity.1 Obesity is not just a problem of west but it is a global phenomenon. According to WHO, figures for obesity in America are 35% for women and 20% for men, in China it is over 20% for both men and women. Even desperately poor countries like Nigeria and Uganda are struggling with the problem of obesity. There is substantial evidence that adipose tissue particularly visceral adipose tissue is a metabolically active endocrine organ. This leads to the release of insulin – like growth factors that are linked to increased cancer risk.3 The mechanism of this link may not be clear at present but there is enough evidence to say that link exists. As the prevalence of obesity is increasing worldwide, we can expect proportional increase in cancer cases. This will not only add to the high cost of cancer treatment but also add to human suffering as well.
Although we have known for some time that excess weight is also an important factor in death from cancer,4 our knowledge of the magnitude of the relation, both for all cancers and for cancers at individual sites, and the public health effect of excess weight in terms of total mortality from cancer is limited. The biological mechanism that explains how obesity worsens risk of cancer may be different for different cancers. The exact mechanisms by which obesity induces or promotes tumor genesis vary by cancer site. However, possible mechanisms include alterations in sex hormones and insulin. Insulin resistance is been associated with cancers of colon and rectum, breast and pancreas. Whatever may be the causes, the obesity still is seen as life style disease and by that definition it is largely preventable. It may be an oversimplified view as many people believe that obesity is genetic (there is evidence for that). It is right time to educate people and emphasize the need for life style changes to keep the weight in check.5 Life style choices that can check weight will not only help in preventing cancer but also help in preventing other diseases such as heart diseases, diabetes and many nervous and mental disorders.
Relationship between Obesity and Cancer?
In 2001, it was concluded that cancers of the colon, breast (postmenopausal), endometrium (the lining of the uterus), kidney, and esophagus are associated with obesity. Some studies have also reported links between obesity and cancers of the gallbladder, ovaries, and pancreas.7 Obesity and physical inactivity may account for 25 to 30 percent of several major cancers—colon, breast (postmenopausal), endometrial, renal and cancer of the esophagus.7
In 2002, about 41,000 new cases of cancer in the United States were estimated to be due to obesity. This means that about 3.2 percent of all new cancers are linked to obesity.1,8,9 The contribution of excess body weight to the total burden of mortality from cancer depends on two factors: the relative risk of death due to cancer among overweight or obese persons as compared with persons of normal weight and the prevalence of overweight and obesity in a given population. The very high prevalence of obesity in the United States explains why small elevations in mortality due to cancer translate into substantial fractions of mortality due to cancer that are related to overweight or obesity. Calle et al. point out how much cancer-related mortality could be reduced among nonsmokers if body weight were adequately controlled. It is intriguing that the positive association between excess body weight and mortality due to cancer is not limited to a few forms of cancer indeed, positive associations represent the rule rather than the exception. The biologic mechanisms that are regularly invoked to explain the association between overweight or obesity and cancer concern steroid hormones, insulin, the insulin-like growth factor system, and mechanical processes such as the contribution of abdominal obesity to gastresophageal reflux and esophageal adenocarcinoma.1, 10
In both men and women, body-mass index was also significantly associated with higher rates of death due to cancer of the esophagus, colon and rectum, liver, gallbladder, pancreas, and kidney; the same was true for death due to non-Hodgkin’s lymphoma and multiple myeloma. Significant trends of increasing risk with higher body-mass-index values were observed for death from cancers of the stomach and prostate in men and for death from cancers of the breast, uterus, cervix, and ovary in women. Previous studies have consistently shown associations between adiposity and increased risk of cancers of the endometrium, kidney, gallbladder (in women), breast (in postmenopausal women), and colon (particularly in men).11-15 Adenocarcinoma of the esophagus has been linked to obesity. 14,16,17 Data on cancers of the pancreas, prostate, liver, cervix, ovary and on hematopoietic cancers are scarce or inconsistent.11-14, 18-21 The lack of consistency may be attributable to the limited number of studies, the limited range and variable categorization of overweight and obesity among studies, bias introduced by reverse causality with respect to smoking related cancers, and possibly real differences between the effects of overweight and obesity on the incidence of cancer and on the rates of death from some cancers.22,23 Experts have concluded that the chief causes of obesity are a sedentary lifestyle and overconsumption of high-calorie food.7,24, 25
In the last 50 years there are marked changes in dietary and work habits. People eat too much and do too little exercise. There is reduction in physical activity and more people have sedentary life styles. Since the beginning of the 20th century, obesity is being linked to diabetes, hypertension and myocardial infarction. In late 1940’s French researcher divided obesity into android type – predominant abdominal obesity particularly seen in males and described it is ‘apple’ shaped whereas gynoid type – with distribution of fat to the hips is characteristic of females and described as ‘pear’ shaped.5 But it took quite some time when in 1980’s abdominal fat was implicated as risk factor for IHD, diabetes and stroke. The distribution of fat is important risk determinant of breast cancer. Women with large abdominal fat (apple shaped) have high risk of breast cancer than those having ‘pear’ shaped distribution.24, 26, 27
Obesity has been studied extensively as risk factor for various cancers. According to American Institute of Cancer Research (AICR), obesity increases likelihood of developing breast, colon, endometrial, esophageal, renal and prostate cancers by 25-33%.
Abdominal fat has a sensitive system for releasing free fatty acids which are transported directly via the portal vein into the liver where it produces 3 important effects as insulin clearance, Glucogenesis and VLDL synthesis which leads to hyperinsulinaemia, hyperglycemia and hyperlipidaemia respectively. Free Fatty Acids (FFA) are synthesized in liver into VLDL predominantly triglycerides. Insulin resistance in liver cells increases glucose products to cause high blood glucose. Hyperinsulinaemia resultant from insulin resistance worsens as insulin level increase further as Liver’s ability to break the hormone decreases.

The current burst of articles on metabolic syndrome shows the relevance of obesity in the contemporary society. It is the gift of modern western life style with its negative features of physical inactivity, excessive intake of energy and stress.
The International Agency for Research on Cancer (IARC) has concluded that there is sufficient evidence of a cancer-preventive effect of avoidance of weight gain for cancers of the colon, breast (in post menopausal women), endometrium, kidney (renal cell carcinoma), and esophagus (adenocarcinoma).14 Potential biologic mechanisms include increased levels of endogenous hormones (sex steroids, insulin, and insulin-like growth factor I) associated with overweight and obesity and the contribution of abdominal obesity to gastresophageal reflux and esophageal adenocarcinoma.14 Moderate relative risks (less than 2.0) associated with overweight and obesity both for colon cancer and for breast cancer in postmenopausal women have been documented consistently.11 Much higher relative risks have been observed for uterine cancer (2 to 10) and kidney cancer (1.5 to 4), and the increased risk of kidney cancer associated with excess weight is higher in women than in men in majority studies.11, 28, 29 Increases by a factor of two to three in the risk of adenocarcinoma of the esophagus in association with high body-mass index have been reported16, 17, and the magnitude of this association has been found by other investigators to be greater in nonsmokers.16
Conclusion
International experts in the field of nutrition, cancer biology and public health are working on this link between life style and cancer and have come out with health recommendations for prevention of cancer. Their recommendations need to be incorporated in management plans and advising people how they can reduce their own cancer risk.91 It may take time to establish the exact link between obesity and cancer but the time has come to start talking to patients about the link between life style and cancer prevention through healthy weight, healthy eating habits and increasing physical activity.
An apple a day keeps the doctor away, but if you remain in a pear, you can avoid either of them.

References
1. Calle EE, Rodriguez C, Walker-Thurmond K, Thun MJ. Overweight, obesity, and mortality from cancer in a prospectively studied cohort of U.S. adults. New England Journal of Medicine. 2003; 348(17):1625–38.
2. The Tribune, Thursday 4th October 2007.
3. Martin G Healthy eating V Cancer GMC Today. 2007, 6, 6-7.
4. Lew EA, Garfinkel L. Variations in mortality by weight among 750,000 men and women. J Chronic Dis 1979; 32 : 563-76.
5. Berne C, Bjorntrop P. The Metabolic Syndrome. In: ArnetzBB, Ekman R,editors. Stress in health and disease. Weinheim:WILEY-VCH Verlag GmbH&Co.KGaA;2006.p317-332.
6. Thun MJ, Calle EE, Namboodiri MM. Risk factors for fatal colon cancer in a large prospective study. J Natl Cancer Inst.
7. Vainio H, Bianchini F. IARC handbooks of cancer prevention. Volume 6: Weight control and physical activity. Lyon, France: IARC Press, 2002.
8. Polednak AP. Trends in incidence rates for obesity-associated cancers in the U.S. Cancer Detection and Prevention 2003; 27(6):415–421.
9. McLaughlin JK, Blot WJ, Devesa SS, Fraumeni JF Jr. Renal cancer. In: Schottenfeld D, Fraumeni JF. Cancer epidemiology and prevention. 2nd ed. New York: Oxford University Press. 1996: 1142-55.
10. Obesity and Mortality from Cancer N Engl J Med.2008; 348; 17.
11. World Cancer Research Fund. Food, nutrition and the prevention of cancer: a global perspective. Washington, D.C.: American Institute for Cancer Research. 1997:371-3.
12. Carroll K. Obesity as a risk factor for certain types of cancer. Lipids 1998; 33:1055-9.
13. Bergstrom A, Pisani P, Tenet V, Wolk A, Adami H-O. Overweight as an avoidable cause of cancer in Europe. Int J Cancer. 2001; 91:421-30.
14. IARC handbooks of cancer prevention. Vol. 6. Weight control and physical activity. Lyons, France: International Agency for Research on Cancer, 2002.
15. Peto J. Cancer epidemiology in the last century and the next decade. Nature. 2001; 411: 390-5.
16. Chow W-H, Blot WJ, Vaughan TL. Body mass index and risk of adenocarcinomas of the esophagus and gastric cardia. J Natl Cancer Inst. 1998; 90: 150-5.
17. Vaughan TL, Davis S, Kristal A, Thomas DB. Obesity, alcohol, and tobacco as risk factors for cancers of the esophagus and gastric cardia: adenocarcinoma versus squamous cell carcinoma. Cancer Epidemiol Biomarkers Prev. 1995; 4: 85-92.
18. Lew EA, Garfinkel L. Variations in mortality by weight among 750,000 men and women. J Chronic Dis. 1979; 32: 563-76.
19. Michaud DS, Giovannucci E, Willett WC, Colditz G, Stampfer M, Fuchs C. Physical activity, obesity, height, and the risk of pancreatic cancer. JAMA. 2001; 286: 921-9.
20. Wolk A, Gridley G, Svensson M. A prospective study of obesity and cancer risk (Sweden). Cancer Causes Control. 2001; 12: 13-21.
21. Moller H, Mellemgaard A, Lindvig K, Olsen J. Obesity and cancer risk: a Danish record-linkage study. Eur J Cancer. 1994; 30: 344-50.
22. Calle EE, Terrell DD. Utility of the National Death Index for ascertainment of mortality among Cancer Prevention Study II participants. Am J Epidemiol. 1993; 137: 235-41.
23. Physical status: the use and interpretation of anthropometry: report of a WHO Expert Committee. World Health Organ. 1995; 854:1-452.
24. Friedenreich CM. Physical activity and cancer prevention: From observational to intervention research. Cancer Epidemiology, Biomarkers and Prevention.2001; 10(4): 287–301.
25. Kritchevsky D. Diet and cancer: What’s next? Journal of Nutrition. 2003; 133(11):3827–29.
26. Kaaks R, Van Noord PAH, Den Tonkelaar I. Breast cancer incidence in relation to height, weight and body-fat distribution in the Dutch “DOM” cohort. International Journal of Cancer. 1998; 76(5): 647–51.
27. Männistö S, Pietinen P, Pyy M. Body-size indicators and risk of breast cancer according to menopause and estrogen-receptor status. International Journal of Cancer. 1996; 68(1): 8–13.
28. Hill HA, Austin H. Nutrition and endometrial cancer. Cancer Causes Control. 1996; 7: 19-32.
29. Wolk A, Lindblad P, Adami H-O. Nutrition and renal cell cancer. Cancer Causes Control. 1996; 7: 5-18.

DISCLAIMER: This information is solely for informational purposes. IT IS NOT INTENDED TO PROVIDE MEDICAL ADVICE. Neither the Editors of Health Mirror, the author nor publisher take responsibility for any possible consequences from any treatment, procedure, exercise, dietary modification, action or application of medication which results from reading or following the information contained in this information. The publication of this information does not constitute the practice of medicine, and this information does not replace the advice of your physician or other health care provider. Before undertaking any course of treatment, the reader must seek the advice of their physician or other health care provider.

Authors: Dhull AK, Gupta R, Gupta A, Kaushal V

How Dreams Work

Our dreams combine verbal, visual and emotional stimuli into a sometimes broken, nonsensical but often entertaining story line. We can sometimes even solve problems in our sleep. Or can we? Many experts disagree on exactly what the purpose of our dreams might be. Are they strictly random brain impulses, or are our brains actually working through issues from our daily life while we sleep -- as a sort of coping mechanism? Should we even bother to interpret our dreams? Many say yes, that we have a great deal to learn from our dreams.
In this article, we'll talk about the major dream theories, from Freud's view to the hypotheses that claim we can control our dreams. We'll find out what scientists say is happening in our brains when we dream and why we have trouble remembering these night-time story lines. We'll talk about how you can try to control your dreams -- both what you're dreaming about and what you do once you're having the dream. We'll also find out what dream experts say particular scenarios signify. Finding yourself at work naked may not mean at all what you think it does!
Perchance to Dream
For centuries, we've tried to figure out just why our brains play these nightly shows for us. Early civilizations thought dream worlds were real, physical worlds that they could enter only from their dream state. Researchers continue to toss around many theories about dreaming.

Those theories essentially fall into two categories:
• The idea that dreams are only physiological stimulations
• The idea that dreams are psychologically necessary
Let's take a closer look at these theories.

Dream Philosophy
According to Nietzsche, "In the ages of the rude beginning of culture, man believed that he was discovering a second real world in dream, and here is the origin of all metaphysics. Without dreams, mankind would never have had occasion to invent such a division of the world. The parting of soul and body goes also with this way of interpreting dreams; likewise, the idea of a soul's apparitional body: whence all belief in ghosts, and apparently, too, in gods."

In case of any queries please feel free to contact Dr Anil K Dhull