Dandruff and Prevention

Authors: Gupta S, Dhull AK

Don't toss out all those dark suits just yet. There's a better way to deal with dandruff. As a matter of fact, you may be able simply to wash it away.

You may not realize it, but you are constantly shedding dead skin cells from all over your body. It's the skin's natural way to rejuvenate itself. In fact, you get a whole new suit of skin about every 27 or 28 days. The old stuff just sort of flakes away. You just don't tend to notice the tiny skin cells dropping off your arms, your legs, and even your scalp.Dandruff results from the same shedding of skin cells. But if the shedding process is normal, what happens to make dandruff so embarrassingly noticeable?Scientists have discovered that dandruff occurs when a yeast-like fungus called malassezia goes wild on your scalp. The microscopic malassezia fungus, a normal inhabitant on a healthy human head, feeds on the fatty oils secreted by hair follicles in the scalp. But sometimes, for reasons that are as yet unclear, the fungus grows out of control, causing irritation that actually speeds up cell turnover on the scalp. As a result, the normal process of cell turnover, which usually takes a month, may take less than two weeks when out-of-control malassezia has irritated the scalp. So many dead cells are shed at the same time that, when they mix with the oil from the hair follicles, they tend to form greasy clumps big enough to be clearly visible to the naked eye. The oil also makes the clumps more likely to get stuck in your hair (and on your shoulders), rather than floating quickly away.

Scientists have discovered that dandruff occurs when a yeast-like fungus called malassezia multiplies on your scalp.

How to Get Rid of Dandruff
Even if your malassezia has multiplied like wildfire, you don't have to live with the resulting dandruff. Take the following steps to sweep those flakes away once and for all.

Shampoo each day to keep it away

What easier way to get rid of dandruff than to wash it down the drain? Getting rid of excess oils (which may contribute to the overgrowth of malassezia in the first place) and flakes through daily shampooing may be the easiest way to tame your mane.

Switch shampoos

If your regular shampoo isn't doing the trick, even with daily washing, it's time to switch to an antidandruff shampoo. Check the ingredients in over-the-counter dandruff shampoos, and look for one that contains zinc pyrithione, which can reduce the fungus; selenium sulfide, which can limit cell turnover and possibly even decrease the amount of fungus; salicylic acid, which works as a sort of scrub to slough off dead skin; or ketoconazole, which works against a broad array of fungi.

Go for three

Your favorite dandruff shampoo may stop working after a while, and those little flakes may return. Don't blame the shampoo. You simply may have built up a resistance to its active ingredient. To prevent this, try rotating three brands of dandruff shampoo (each with a different formulation), using each for a month. In other words, use one shampoo for a month, then switch to a second brand for a month, then to a third brand for a month, then back to the original shampoo for a month, and so on.

Lather twice

The first lathering and rinsing gets rid of the loose flakes and the oily buildup on your hair and scalp. It sort of clears the area so the second lathering can get to work. Leave the second lathering of shampoo on your hair at least five minutes before rinsing it off. That gives the shampoo a chance to penetrate the skin cells and do what it's supposed to do.

Try tar

If the antidandruff shampoos aren't working, it's time to bring out the big guns, namely the tar shampoos, which have been a proven remedy for more than 200 years. The tar decreases cell turnover quite effectively, though there are some drawbacks. Tar shampoos have a strong odor, may stain the shaft of lighter-colored hair (it can take weeks of using a milder shampoo to get rid of the discoloration), and may irritate the skin.

Use a rinse

If you decide to go with a tar shampoo, rinse your hair with lemon juice, a conditioner, or creme rinse to get rid of any lingering odor from the shampoo. Using a hair conditioner after washing with any antidandruff shampoo is a good idea anyway, because the medicated shampoos tend to stiffen hair and make it less manageable. Many of them also dry the scalp, which can add to flaking; a conditioner can help seal in nourishing moisture.

Be sensitive to your sensitivity

There are some people who just shouldn't use a tar shampoo. Why? Because they're so sensitive. Rather, their scalp is, and a tar shampoo can irritate and inflame their hair follicles, causing a condition called folliculitis. The cure? Switch to a milder shampoo.

Stop those itchy fingers

Try to resist the temptation to go after those itchy patches like a dog chasing fleas. You may end up with wounds to your scalp caused by your fingernails. If you break the skin on your scalp, discontinue use of medicated shampoo for a while. Switch to a mild shampoo, such as a baby shampoo, and use it daily until the scratches are healed.

Shower away sweat

After exercise or strenuous work that makes you perspire, shower and shampoo as soon as possible. Sweat irritates the scalp and speeds up the flaking of skin cells.

Go easy on the sticky stuff

Although you needn't give up the various mousses, sprays, and gels that hold your hairstyle in place, try to use them less often. These hair products can contribute to oily buildup.

Is It Dandruff?
You may have something that's like dandruff, but isn't dandruff. Flaking of the skin may also be caused by seborrheic dermatitis or psoriasis.

Seborrheic dermatitis is a chronic disorder characterized by inflammation of the skin, along with scaling. It may strike the eyebrow and hairline areas, the sides of the nose, the ears, and the central chest.

Psoriasis is characterized by red, scaly patches on the skin and is the result of unusually rapid turnover of cells. Prescription medications are available to control both conditions.So if you still have trouble with dandruff after attempting the home remedies discussed here, see your doctor.

Dandruff can be an embarrassing problem, but you can shake those pesky flakes for good by following a careful regimen.

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 please feel free to contact the authors or write to Health Mirror

Cholesterol and Preventive Measures

What is Cholesterol?
Cholesterol is a waxy, fat-like compound that belongs to a class of molecules called steroids. It's found in many foods, in your bloodstream and in all your body's cells. If you had a handful of cholesterol, it might feel like a soft, melted candle. Cholesterol is essential for:
· Formation and maintenance of cell membranes (helps the cell to resist changes in temperature and protects and insulates nerve fibers)
· Formation of sex hormones (progesterone, testosterone, estradiol, cortisol)
· Production of bile salts, which help to digest food
· Conversion into vitamin D in the skin when exposed to sunlight.

Most of the body's cholesterol is manufactured in the liver

The formation of cholesterol involves a series of complicated biochemical reactions that begin with the widespread 2-carbon molecule Acetyl CoA: Acetyl CoA (C2) --> mevalonate (C6) --> isopentenyl pyrophosphate (C5) --> squalene (C30) --> cholesterol (C27). Cholesterol is made primarily in your liver (about 1,000 milligrams a day), but it is also created by cells lining the small intestine and by individual cells in the body.

Functioning of Cholesterol
Have you ever been about to take a big bite of your triple chocolate fudge cake when someone leaned over and said "you better watch your cholesterol"? That's happening to all of us more frequently. According to The American Heart Association, high levels of cholesterol are a risk factor for coronary heart disease, the nation's number one killer. Over 100 million Americans have cholesterol levels that exceed the recommended total and 20 percent of Americans have levels that are considered high.

You can check nutrition labels, like this one from a can, for cholesterol information.

What we don't often hear is the important fact that some cholesterol is vital to human life. In this article, we will take a look at cholesterol, both why it is needed for normal human--and animal--functions and why at high levels and in many individuals, it can be deadly.
Blood Cholesterol vs. Dietary Cholesterol
It may surprise you to know that our bodies make all the cholesterol we need. When your doctor takes a blood test to measure your cholesterol level, the doctor is actually measuring the amount of circulating cholesterol in your blood, or your blood cholesterol level. About 85 percent of your blood cholesterol level is endogenous, which means it is produced by your body. The other 15 percent or so comes from an external source -- your diet. Your dietary cholesterol originates from meat, poultry, fish, seafood and dairy products. It's possible for some people to eat foods high in cholesterol and still have low blood cholesterol levels. Likewise, it's possible to eat foods low in cholesterol and have a high blood cholesterol level.
So, why is there so much talk about cholesterol in our diet? It's because the level of cholesterol already present in your blood can be increased by high consumption of cholesterol and saturated fat in your diet. This increase in dietary cholesterol has been associated with atherosclerosis, the build-up of plaques that can narrow or block blood vessels. If the coronary arteries of the heart become blocked, a heart attack can occur. The blocked artery can also develop rough edges. This can cause plaques to break off and travel, obstructing blood vessels elsewhere in the body. A blocked blood vessel in the brain can trigger a stroke.
The average American man eats about 360 milligrams of cholesterol a day; the average woman eats between 220 and 260 milligrams daily. So how are we doing? The American Heart Association recommends that we limit our average daily cholesterol intake to less than 300 milligrams. Obviously, people with high levels of cholesterol in the blood should take in even less.
Good vs Bad Cholesterol
Comments about "good" and "bad" cholesterol refer to the type of carrier molecule that transports the cholesterol. These carrier molecules are made of protein and are called apoproteins. They are necessary because cholesterol and other fats (lipids) can't dissolve in water, which also means they can't dissolve in blood. When these apoproteins are joined with cholesterol, they form a compound called lipoproteins. The density of these lipoproteins is determined by the amount of protein in the molecule. "Bad" cholesterol is the low-density lipoprotein (LDL), the major cholesterol carrier in the blood. High levels of these LDLs are associated with atherosclerosis. "Good" cholesterol is the high-density lipoprotein (HDL); a greater level of HDL--think of this as drain cleaner you pour in the sink--is thought to provide some protection against artery blockage.
A high level of LDL in the blood may mean that cell membranes in the liver have reduced the number of LDL receptors due to increased amounts of cholesterol inside the cell. After a cell has used the cholesterol for its chemical needs and doesn't need any more, it reduces its number of LDL receptors. This enables LDL levels to accumulate in the blood. When this happens, the LDLs begin to deposit cholesterol on artery walls, forming thick plaques. In contrast, the HDLs--the "good" guys--act to remove this excess cholesterol and transport it to the liver for disposal.
A third group of carrier molecules, the very low-density lipoproteins (VLDL) are converted to LDL after delivering triglycerides to the muscles and adipose (fat) tissue.
The levels of HDL, LDL and total cholesterol are all indicators for atherosclerosis and heart attack risk. People who have a cholesterol level of 275 or greater (200 or less is desirable) are at significant risk for a heart attack, despite a favorable HDL level. In addition, people who have normal cholesterol levels but low HDL levels are also at increased risk for a heart attack.
Risk Factors
There are a number of factors that influence a person's cholesterol levels. They include diet, age, weight, gender, genetics, diseases and lifestyle.
Diet

There are two dietary factors associated with increases in blood cholesterol levels:
Eating foods that are high in saturated fats, even if the fats themselves do not contain cholesterol. (These include foods containing high levels of hydrogenated vegetable oils, especially palm and coconut oils, avocados and other high-fat foods of vegetable origin).
Eating foods containing high levels of cholesterol. (This group includes eggs and red meat--the most maligned of the cholesterol culprits--as well as lard and shrimp. These foods can significantly raise blood cholesterol levels, especially when combined with foods that are high in saturated fat).
It's important to note that only foods of animal origin contain cholesterol. Lack of awareness of this fact has led to some confusing labels at the grocery store. For example, some items that are high in saturated fats from plant sources bear labels claiming that they are 100 percent cholesterol free. The statement may be true, but it's generally misleading because it implies that the product is definitely beneficial to your health.
Age

The blood levels of cholesterol tend to increase as we age--a factor doctors consider when deciding treatment options for patients with certain cholesterol levels.
Weight

People who are overweight are more likely to have high blood cholesterol levels. They also tend to have lower HDL levels. The location of the excess weight also seems to play a role in cholesterol levels. A greater risk of increased cholesterol levels occurs when that extra weight is centered in the abdominal region, as opposed to the legs or buttocks.
Gender

Men tend to have higher LDL levels and lower HDL levels than do women, especially before age 50. After age 50, when women are in their post-menopausal years, decreasing amounts of estrogen are thought to cause the LDL level to rise.
Genetics

Some people are genetically predisposed to having high levels of cholesterol. A variety of minor genetic defects can lead to excessive production of LDLs or a decreased capacity for their removal. This tendency towards high cholesterol levels is often passed on from parents to their children. If your parents have high cholesterol, you need to be tested to see if your cholesterol levels are also elevated.
Diseases

Diseases such as diabetes can lower HDL levels, increase triglycerides and accelerate the development of atherosclerosis. High blood pressure, or hypertension, can also hasten the development of atherosclerosis, and some medications used to treat it can increase LDL and triglycerides and decrease HDL levels.
Lifestyle
Factors that negatively affect cholesterol levels also include high levels of stress, which can raise total cholesterol levels, and cigarette smoking, which can lower a person's HDL level as much as 15 percent. On the other hand, strenuous exercise can increase HDL levels and decrease LDL levels. Exercise also can help reduce body weight, which, in turn, can help reduce cholesterol. Recent research has shown that moderate alcohol use (one drink per day for women, two drinks a day for men) can raise HDL cholesterol and therefore reduce the risk of heart attack. Despite such research, it is difficult to recommend the habitual use of alcohol, because there are also negative health consequences associated with alcohol use and a high potential for abuse.
Always remember that risk factors for high cholesterol and cardiovascular disease don't exist in a vacuum--they tend to amplify each other. Reducing the risk of a cardiovascular disease involves eliminating all of the risk factors that we can control and seeking medical advise for those we can't.
Testing and Prevention
You should get your cholesterol tested every three to five years, more often if you have high cholesterol levels. Please refer to the table below for guidelines for total cholesterol, LDL and HDL levels.

Blood Type Relationships

Type of Cholestrol & Desirable Values in IU

Total Cholesterol Below 200

HDL Cholesterol Above 45

LDL Cholestrol Below 130

LDL/HDL Ratio Below 3.0

What can I do to reduce my cholesterol?
There are several steps you can take to reduce your cholesterol levels. The first is to eat a low-fat, low-cholesterol diet. That means keeping your total fat consumption--saturated, polyunsaturated and monounsaturated--to fewer than 30 percent of your daily intake of calories. Remember to keep your cholesterol intake to fewer than 300 milligrams per day. Saturated fats contained in butter, whole milk, hydrogenated oils, chocolate shortening, etc. should comprise no more than one third of your total fat consumption. To reduce your total fat and cholesterol intake, limit your consumption of meats such as beef, pork, liver and tongue (always trim away excess fat). In addition, avoid cheese, fried foods, nuts and cream, and try to curb your intake of eggs to no more than four per week. Try to eat meatless meals several times a week, use skim milk and include fish in your diet. Eat a wide variety of vegetables, pasta, grains and fruit. Another good tip is to look at the package label of the foods you buy, and restrict your choices to foods containing 3 grams of fat or less per serving.
There is evidence that water-soluble fibers can aid in lowering cholesterol; these foods include the fiber in oat or corn bran, beans and legumes, pectin found in apples and other fruits, and guar that is used as a thickener. Although highly touted by the media and health food stores, the phospholipid Lecithin has not been confirmed as a reducer of blood cholesterol levels.
If you are overweight, trying to lose weight and including aerobic exercise in your routine can help raise those desirable HDL levels. Diet and exercise alone can decrease cholesterol levels by up to 15 percent.
It probably comes as no surprise to you that, if you smoke, you should quit to avoid a wide range of health problems, including lower HDL levels and increased risk of heart attack.

Foods That Lower Cholesterol Overview
A diet rich in fruits and vegetables is a great start toward lowering cholesterol.
The first line of defense against too much blood cholesterol is a diet that is rich in foods that lower cholesterol. A healthy diet should include plenty of vegetables, fruits, whole grains, and fiber, and be low in saturated fat, trans fat, and cholesterol. For the vast majority of Americans, eating healthy and losing excess weight are ideal ways to lower elevated cholesterol levels and keep those levels within a healthy range for life.
Even those foods or supplements that may have a beneficial effect on cholesterol need to be part of an overall heart-smart diet. Having oatmeal for breakfast and a glass of wine at dinner is fine, but if you add whole milk and butter to the oatmeal or have a Porterhouse steak with the wine, you're not doing your heart any favors.
So choose your foods wisely, and if a particular food or supplement appears to help, be sure to include it. But remember: Moderation is key. Don't overdo it with any supplement or food because, in some cases, that can cause just as many problems as high blood cholesterol.
Foods That Claim to Lower Cholesterol
Many foods and supplements claim to lower cholesterol. But do they really? Sometimes the answer is no, and sometimes the answer is that we don't know. In some instances, studies that support claims that a food lowers cholesterol are conducted by the very people who are selling the product, or the studies are poorly designed. In other instances, the studies conducted to test whether a food lowers cholesterol are just inconclusive.
The foods discussed on the following pages are ones that doctors don't recommend for a variety of reasons. If you are interested in taking a chance that these foods will work for you, talk with your doctor first. And keep a record every time you have your blood cholesterol tested to see if you experience any progress while taking these foods or supplements.
Flaxseed is a plant-based supplement that contains omega-3 fatty acids.

Foods That Claim to Lower Cholesterol
Flaxseed
Guggul
Lecithin
Policosanol
Red Yeast Rice Soy Garlic
Olive Oil
Fish oil
Plant Sterols
Whole grains
Dietary fibre
However studies are going on to rule out the authenticity of the claims for different food ingredients.

Medicating High Cholesterol
Sometimes positive changes in diet, lifestyle and exercise are not enough. In these cases, doctors may consider the use of medication that lowers cholesterol. The decision to have a patient begin medication is often based on high levels of LDL cholesterol and other risk factors for cardiovascular disease. For example, medication may be indicated if your LDL level is over 190 or is over 160 and you have several other risk factors for cardiovascular disease.
Drugs that reduce LDL blood levels can prevent or reduce the build-up of artery blocking plaques and can limit the possibility of the release of those plaques as dangerous blood clots. There are several types of drugs that can help reduce blood cholesterol levels. The most commonly prescribed are the statins, HMG-CoA reductase inhibitors, including:
· Lovastatin
· Simvastatin
· Atorvastatin, a new, highly potent drug

These drugs work within the liver to directly prevent the formation of cholesterol and can lower LDL cholesterol by as much as 40 percent. Research also shows that these drugs can reduce the risk of death from cardiovascular disease. Another major drug category is the resins, which bind bile acids, causing the liver to produce more of them and using up cholesterol in the process. By "tying" it up, these drugs make cholesterol less available in the blood. They include:
· Cholestyramine
· Colestipol
· The B vitamin Niacin, in high doses, can lower triglycerides and LDL levels and increase HDL levels. Niacin has been proven to reduce a person's risk of having a second heart attack.
Last are the drugs in the fibrates category, which lower triglycerides and can increase HDL levels. These include:
· Gemfibrozil
· Fenofibrate
The decision to take cholesterol- or lipid-lowering drugs is not taken lightly by your doctor. These drugs can be fairly expensive and are often required for many years or even the rest of your life. It is also important to note that some of these drugs can have dangerous side effects, such as damage to the liver.
Adopting a healthy lifestyle and visiting your doctor regularly can help curb your risks of problem cholesterol. Have your cholesterol levels checked by a physician, rather than risk incorrectly interpreting numbers in self test kits currently on the market. Remember, cholesterol is necessary for life but it can also be very harmful and requires monitoring. So, watch your cholesterol and keep in mind that, for every 1 percent drop in your cholesterol level, your risk of heart attack is lowered by 2 percent.

How Alcohol Lowers Cholesterol
For many people, a little alcohol, such as the ritual evening cocktail, is a sure cure for the day's troubles. These same individuals might not be surprised to learn that when consumed in moderation, alcohol may also offer some protection against heart disease. Research has shown that moderate consumption of alcohol can raise HDL cholesterol.
It may also decrease blood clotting and insulin resistance and is linked to lower levels of certain markers of inflammation, such as C-reactive protein, all of which may reduce the risk of heart disease. A modest alcohol intake may also reduce the risk of diabetes. This should be good news for those who imbibe in moderation -- that is, up to one drink per day for women and up to two drinks per day for men. (One drink consists of 1.5 ounces of hard liquor, 5 ounces of wine, or 12 ounces of beer.)
In the early 1990s, epidemiologists -- experts who specialize in the study of large populations to determine how various diseases occur and spread and how they can be controlled -- looked at data from countries around the globe and noticed that the coronary death rate for people in France was considerably lower than for people in the United States, despite French people's well-known love of high-fat foods.
In fact, the phenomenon called the French Paradox relates to the fact that the French have fewer heart attacks than Americans. This is a situation that could not be explained simply by comparing cholesterol levels in the two countries. Experts felt that this difference was due primarily to the French diet, which contains more red wine, fruits, and vegetables. Although red wine contains antioxidants and other compounds that may help prevent blood clots or the oxidation of LDL cholesterol, it has not been shown that only red wine is protective. In fact, most studies have linked moderate consumption of alcohol in general -- including wine, beer, and hard liquor -- to a reduced risk of heart disease.
But experts raise a red flag at the idea of encouraging the consumption of alcohol in order to raise HDL cholesterol or lower coronary rates. Not only are there better ways to raise HDL cholesterol (for example, regular physical exercise), but also not everyone can handle alcohol well.
Many doctors are concerned about safe levels of alcohol consumption for patients. They point out that consumption of as few as three to five alcoholic drinks per day is associated with adverse health effects, and heavy alcohol consumption may raise blood pressure, increase blood triglycerides, damage the liver, cause birth defects (when alcohol is consumed during pregnancy), and increase the risk of developing certain forms of cancer. Also, the majority of those who develop drinking problems drink relatively small amounts.


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 please feel free to contact Dr Anil K Dhull

Sleep Functioning and Great Tips

Sleep is one of those funny things about being a human being -- you just have to do it. Have you ever wondered why? And what about the crazy dreams, like the one where a bad person is chasing you and you can't run or yell. Does that make any sense?
If you have ever wondered about why people have to sleep or what causes dreams, then read on. In this article, you'll find out all about sleep and what it does for you.

Dreaming occurs in the fifth stage of sleep.

Characteristics of Sleep

We all know how sleep looks -- when we see someone sleeping, we recognize the following characteristics:
If possible, the person will lie down to go to sleep.
The person's eyes are closed.
The person doesn't hear anything unless it is a loud noise.
The person breathes in a slow, rhythmic pattern.
The person's muscles are completely relaxed. If sitting up, the person may fall out of his or her chair as sleep deepens.
During sleep, the person occasionally rolls over or rearranges his or her body. This happens approximately once or twice an hour. This may be the body's way of making sure that no part of the body or skin has its circulation cut off for too long a period of time.
In addition to these outward signs, the heart slows down and the brain does some pretty funky things.
In other words, a sleeping person is unconscious to most things happening in the environment. The biggest difference between someone who is asleep and someone who has fainted or gone into a coma is the fact that a sleeping person can be aroused if the stimulus is strong enough. If you shake the person, yell loudly or flash a bright light, a sleeping person will wake up.
For any animal living in the wild, it just doesn't seem very smart to design in a mandatory eight-hour period of near-total unconsciousness every day. Yet that is exactly what evolution has done. So there must be a pretty good reason for it!
Reptiles, birds and mammals all sleep. That is, they become unconscious to their surroundings for periods of time. Some fish and amphibians reduce their awareness but do not ever become unconscious like the higher vertebrates do. Insects do not appear to sleep, although they may become inactive in daylight or darkness.
By studying brainwaves, it is known that reptiles do not dream. Birds dream a little. Mammals all dream during sleep.
Different animals sleep in different ways. Some animals, like humans, prefer to sleep in one long session. Other animals (dogs, for example) like to sleep in many short bursts. Some sleep at night, while others sleep during the day.

Really?
Cows can sleep while standing up, but they only dream if they lie down.
Whales and dolphins are "conscious breathers," and they need to keep breathing while they sleep, so only one half of the brain sleeps at a time.

Sleep and the Brain
If you attach an electroencephalograph to a person's head, you can record the person's brainwave activity. An awake and relaxed person generates alpha waves, which are consistent oscillations at about 10 cycles per second. An alert person generates beta waves, which are about twice as fast.
During sleep, two slower patterns called theta waves and delta waves take over. Theta waves have oscillations in the range of 3.5 to 7 cycles per second, and delta waves have oscillations of less than 3.5 cycles per second. As a person falls asleep and sleep deepens, the brainwave patterns slow down. The slower the brainwave patterns, the deeper the sleep -- a person deep in delta wave sleep is hardest to wake up.
At several points during the night, something unexpected happens -- rapid eye movement (REM) sleep occurs. Most people experience three to five intervals of REM sleep per night, and brainwaves during this period speed up to awake levels. If you ever watch a person or a dog experiencing REM sleep, you will see their eyes flickering back and forth rapidly. In many dogs and some people, arms, legs and facial muscles will twitch during REM sleep. Periods of sleep other than REM sleep are known as NREM (non-REM) sleep.
REM sleep is when you dream. If you wake up a person during REM sleep, the person can vividly recall dreams. If you wake up a person during NREM sleep, generally the person will not be dreaming.
You must have both REM and NREM sleep to get a good night's sleep. A normal person will spend about 25 percent of the night in REM sleep, and the rest in NREM. A REM session -- a dream -- lasts five to 30 minutes.
Medicine can hamper your ability to get a good night's sleep. Many medicines, including most sleeping medicines, change the quality of sleep and the REM component of it.
Missing out on a good night's sleep can seriously affect what happens when you're awake.

Dreams and Improving Sleep Habits
Why do we have such crazy, kooky dreams? Why do we dream at all for that matter? According to Joel Achenbach in his book Why Things Are:
The brain creates dreams through random electrical activity. Random is the key word here. About every 90 minutes the brain stem sends electrical impulses throughout the brain, in no particular order or fashion. The analytic portion of the brain -- the forebrain -- then desperately tries to make sense of these signals. It is like looking at a Rorschach test, a random splash of ink on paper. The only way of comprehending it is by viewing the dream (or the inkblot) metaphorically, symbolically, since there's no literal message.
This doesn't mean that dreams are meaningless or should be ignored. How our forebrains choose to "analyze" the random and discontinuous images may tell us something about ourselves, just as what we see in an inkblot can be revelatory. And perhaps there is a purpose to the craziness: Our minds may be working on deep-seated problems through these circuitous and less threatening metaphorical dreams.
Here are some other things you may have noticed about your dreams:
Dreams tell a story. They are like a TV show, with scenes, characters and props.
Dreams are egocentric. They almost always involve you.
Dreams incorporate things that have happened to you recently. They can also incorporate deep wishes and fears.
A noise in the environment is often worked in to a dream in some way, giving some credibility to the idea that dreams are simply the brain's response to random impulses.
You usually cannot control a dream -- in fact, many dreams emphasize your lack of control by making it impossible to run or yell. (However, proponents of lucid dreaming try to help you gain control.)
Dreaming is important. In sleep experiments where a person is woken up every time he/she enters REM sleep, the person becomes increasingly impatient and uncomfortable over time.

How Much Sleep Do I Need?

Most adult people seem to need seven to nine hours of sleep a night. This is an average, and it is also subjective. You, for example, probably know how much sleep you need in an average night to feel your best.
The amount of sleep you need decreases with age. A newborn baby might sleep 20 hours a day. By age four, the average is 12 hours a day. By age 10, the average falls to 10 hours a day. Senior citizens can often get by with six or seven hours a day.

Tips to Improve Your Sleep
Exercise regularly. Exercise helps tire and relax your body.
Don't consume caffeine after 4:00 p.m. or so. Avoid other stimulants like cigarettes as well.
Avoid alcohol before bedtime. Alcohol disrupts the brain's normal patterns during sleep. Try to stay in a pattern with a regular bedtime.

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

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

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 B Vitamins Work

We've all stared at the cereal box label during breakfast and wondered what words like riboflavin, folic acid and pyridoxine mean. Has your mom ever reminded you to eat a balanced diet and "make sure you eat your greens"? The words on your cereal box and your mother's good advice both involve vitamin B. The B vitamins are a group of eight individual vitamins, often referred to as the B-complex vitamins. In this article, we will take a look at how the B vitamins work so you can begin to understand why Kellogg's and your mother made sure you included these essential vitamins in your diet. We'll also look at some of the more serious conditions that can result from B vitamin deficiencies.
The word vitamin is derived from a combination of words -- vital amine -- and was conceived by Polish chemist Casimir Funk in 1912. Funk isolated vitamin B1, or thiamine, from rice. This was determined to be one of the vitamins that prevented beriberi, a deficiency disease marked by inflammatory or degenerative changes of the nerves, digestive system and heart.
You know that vitamins are organic (carbon containing) molecules that mainly function as catalysts for reactions within the body. A catalyst is a substance that allows a chemical reaction to occur using less energy and less time than it would take under normal conditions. If these catalysts are missing, as in a vitamin deficiency, normal body functions can break down and render a person susceptible to disease.
The body requires vitamins in tiny amounts (hundredths of a gram in many cases). We get vitamins from these three primary sources:
· Foods
· Beverages
· Our bodies -- Vitamin K and some of the B vitamins are produced by bacteria within our intestines, and vitamin D is formed with the help of ultraviolet radiation, or sunshine, on the skin.
Vitamins are either fat-soluble or water-soluble. The fat-soluble vitamins can be remembered with the mnemonic (memory aid) ADEK, for the vitamins A, D, E and K. These vitamins accumulate within the fat stores of the body and within the liver. Fat-soluble vitamins, when taken in large amounts, can become toxic. Water-soluble vitamins include vitamin C and the B vitamins. Water-soluble vitamins taken in excess are excreted in the urine but are sometimes associated with toxicity. Both the B vitamins and vitamin C are also stored in the liver.
The B-complex vitamins are actually a group of eight vitamins, which include:
· thiamine (B1)
· riboflavin (B2)
· niacin (B3)
· pantothenic acid (B5)
· pyridoxine (B6)
· cyanocobalamin (B12)
· folic acid
· biotin
These vitamins are essential for:
· The breakdown of carbohydrates into glucose (this provides energy for the body)
· The breakdown of fats and proteins (which aids the normal functioning of the nervous system)
· Muscle tone in the stomach and intestinal tract
· Skin
· Hair
· Eyes
· Mouth
· Liver
Some doctors and nutritionists suggest taking the B-complex vitamins as a group for overall good health. However, most agree that the best way to get our B vitamins is naturally -- through the foods we eat!

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 please feel free to contact Dr Anil K Dhull

How Alcohol / Beer Works

What is Alcohol?
In order to understand alcohol's effects on the body, it is helpful to understand the nature of alcohol as a chemical, so let's take a look...
Here are several facts:
· Alcohol is a clear liquid at room temperature.
· Alcohol is less dense and evaporates at a lower temperature than water (this property allows it to be distilled -- by heating a water and alcohol mixture, the alcohol evaporates first).
· Alcohol dissolves easily in water.
· Alcohol is flammable (so flammable that it can be used as a fuel).

Alcohol can be made by three different methods:
· Fermentation of fruit or grain mixtures. This is often followed by distillation of fermented fruit or grain mixtures (Spirits such as whiskey, rum, vodka and gin are distilled.)
· Chemical modification of fossil fuels such as oil, natural gas or coal (industrial alcohol)
· Chemical combination of hydrogen with carbon monoxide (methanol or wood alcohol)
In 1997, Americans drank an average of 2 gallons (7.57 liters) of alcohol per person. This translates roughly into one six-pack of beer, two glasses of wine and three or four mixed drinks per week (see MMWR: Apparent Per Capita Ethanol Consumption for details). About 35 percent of adults don't consume alcohol, so the numbers are actually higher for those who do -- alcohol is an amazingly popular social phenomenon.If you have ever seen a person who has had too much to drink, you know that alcohol is a drug that has widespread effects on the body, and the effects vary from person to person. People who drink might be the "life of the party" or they might become s­ad and droopy. Their speech may slur and they may have trouble walking. It all depends on the amount of alcohol consumed, a person's history with alcohol and a person's personality.
How Beer Works
Have you ever wondered what "malt" really is, and how you get malt from barley? And what about hops, and why do we need yeast? Barley, water, hops and yeast -- brewers combine these four simple ingredients to make beer.
But it's not just a matter of mixing the right amount of each ingredient and voila!...you have beer. A complex series of biochemical reactions must take place to convert barley to fermentable sugars, and to allow yeast to live and multiply, converting those sugars to alcohol. Commercial breweries use sophisticated equipment and processes to control hundreds of variables so that each batch of beer will taste the same.
In this article, we'll learn how events like Prohibition and World War II influenced the taste of the beer we still drink today. Then we'll take a tour through a regional brewery, the Carolina Brewing Company, to learn how they make beer, picking up some of the amazing technology and terminology of beer making along the way.
People have been brewing beer for thousands of years. Beer especially became a staple in the Middle Ages, when people began to live in cities where close quarters and poor sanitation made clean water difficult to find. The alcohol in beer made it safer to drink than water.

In the 1400s in Germany, a type of beer was made that was fermented in the winter with a different type of yeast. This beer was called a lager, and, in part due to Prohibition, a variation of this type of beer is dominant in the United States today.
For 13 years, starting in 1920, a constitutional amendment banned the production of alcoholic beverages in the United States. Before Prohibition, America had thousands of breweries producing many different types of beer. But Prohibition forced most breweries out of business. By the time the laws were repealed in 1933, only the largest breweries had survived. These breweries sought to brew a beer with universal appeal so that it could be sold everywhere in the country. And then came World War II. With food in short supply and many of the men overseas, breweries started brewing a lighter style of beer that is very common today. Since the early 1990s, small regional breweries have made a comeback, popping up all over the United States, and variety has increased.

What's in Beer
As we learned in the introduction, there are four main ingredients in beer: barley, water, hops and yeast. Each has many complexities. We'll start with malted barley.
Malted BarleyBarley is the seed of a grain that looks a lot like wheat. Before barley can be used to make beer, it must be malted, which involves a natural conversion process.
First, the barley must be allowed to germinate, or start to sprout. This is done by soaking the barley in water for several days, and then draining the barley and holding it at about 60 degrees Fahrenheit (15.5 C) for five days. This allows the husk to open and barley to start to sprout -- at this point it is called green malt. Like all seeds, the barley contains nutrients that can sustain the growing seed until it can produce its own nutrients using photosynthesis. During the germination process, enzymes released by the plant convert these nutrients (which are starches) into sugars that can feed the plant while it grows. The key to the malting process is to stop the germination of the barley at a point when the sugar-producing enzymes are present but most of the starch is still unconverted. Eventually, these enzymes will produce the sugars that will feed the yeast to make the alcohol in the beer.
Malted barley
After this natural process has released the enzymes, the green malt is dried by gradually raising the temperature. The intensity of the malt flavor and color depends on how high the temperature is raised during the drying process. One final step must be completed -- removing any small roots that formed during germination -- and the malted barley is ready to begin the brewing process. Most breweries buy barley that has already been malted to their specifications.
Hops
The hops used to make beer are the flower of the hop vine, which is a member of the hemp family (Cannabaceae). Hops are closely related to another member of the hemp family that you may have heard of -- cannabis, or marijuana, although hops do not have the psychoactive effects associated with marijuana.
Hops contain acids, which give beer its bitterness, as well as oils that give beer some of its flavor and aroma. Adding hops to beer also inhibits the formation of certain bacteria that can spoil the beer.
There are many different kinds of hops, each of which gives a different taste, aroma and amount of bitterness to the beer it is used in. In the United States, hops are grown mainly in Washington state. Hops are also grown in Germany, Southern England and Australia.
Yeast is the single-celled micro-organism that is responsible for creating the alcohol and carbon dioxide found in beer. There are many different kinds of yeasts used to make beer; and just as the yeast in a sourdough starter gives sourdough bread its distinctive flavor, different types of beer yeast help to give beer its various tastes.
There are two main categories of beer yeast: ale yeast and lager yeast. Ale yeast is top fermenting, meaning it rises near the surface of the beer during fermentation, and typically prefers to ferment at temperatures around 70 F (21 C). Lager yeasts are bottom fermenting. They ferment more slowly and prefer colder temperatures, around 50 F (10 C).
Brewing
The Mash
The mash is the process that converts the starches in the malted barley into fermentable sugars. At the Carolina Brewery, they start by crushing the malted barley between rollers to break up the kernel.
There is a fine tradeoff in the rolling process: the more the kernel is broken up, the more sugars can be extracted from the grains; but if it is broken up too much, the husk that surrounds the kernel may get broken down, which can cause a stuck mash. If the kernel is broken up just enough, then when the mash is finished, the whole husks form a filter bed that captures any solids from the liquid; but if the husks are broken down too much, they clog up and don't let the liquid through -- a stuck mash.
Next, the crushed grains pass through a feed pipe into the mash-lauter-tun. This insulated vessel has a device called a hydrator, which sprays heated water onto the grains as they enter. This eliminates any dry spots in the mash -- dry spots mean wasted sugars. The wet grains stay in the mash-lauter-tun for an hour. Since the vessel is insulated, the temperature stays at around 150 F (65 C).
The mash-lauter-tun
The purpose of the mash is to convert the starches in the malted barley into fermentable sugars to be used in the next step of the brewing process. Starches are strings of many glucose molecules chained together -- these chains must be broken down into chains of only two or three glucose molecules before they can be fermented. We learned earlier that the malted barley contains enzymes, which can convert the starches.
There are two different types of enzymes in the malted barley: alpha-amylase and beta-amylase. The alpha enzymes break up the long chains of starches by splitting them in half. The beta enzymes break down the starches by chopping them off a couple at a time from the ends of the chain. Only if these two enzymes work together can the conversion be accomplished in a reasonable amount of time. There is a catch though: The alpha enzymes are most active at 149 to 153 F (65 to 67 C), and the beta enzymes are most active at 126 to 144 F (52 to 62 C). So the temperature and duration of the mash must be carefully controlled to get a good conversion.
The last steps needed to complete the mash are lautering and sparging. The liquid is drained from the bottom of the mash-lauter-tun and then recirculated to the top so that it is filtered through the husks of the spent grains. Additional heated water is then poured over the grains -- a process called sparging -- to make sure all of the sugars are removed.
The mash is an amazing process. Before the mash starts, the grains don't taste at all sweet, but the liquid that is drained off from the grains at the end of the mash is very sweet and sticky. This liquid, which now contains mostly fermentable sugars, goes on to the boil.
The Wort The next step in the beer brewing process is called the boil. At the end of the boil we will have a finished wort (pronounced wert).
To start, the liquid from the mash is put into a huge brew kettle. The one used at the Carolina Brewery holds more than 600 gallons (2,270 L). It is a steam jacketed brew kettle. This kettle has double walls with a gap between them through which steam is circulated. This provides very even heating, since both the bottom and the sides are heated. The temperature is raised until the liquid comes to a vigorous rolling boil, and it is held there for 90 minutes.
A boiling wort
At the beginning of the boil, hops are added. These are called the boiling hops, and their job is to add bitterness to the beer. The acids that produce bitterness in the beer are not easy to extract from the hops, which is why they need to be boiled for up to 90 minutes. The oils that produce the hop flavor and aroma are very volatile and evaporate quickly, so the boiling hops only contribute bitterness to the beer -- the flavor and aroma are added later.
Depending on what type of beer is being brewed, more hops may be added near the end of the boil -- these are called finishing hops. Generally, hops that are added about 15 minutes before the end contribute flavor to the beer. Hops added just a few minutes before the end contribute aroma to the beer. The oils in the hops that give the beer a distinctive hop smell are the most volatile, so these hops really just need to steep in the hot wort for a few minutes, like tea leaves, to extract the oils. Some of the beers brewed at the Carolina Brewery get finishing hops added at three different times. In order for each batch of beer to taste the same, exactly the same amount of the same type of hops must be added at exactly the same time during each boil.
Separating the Solids
Before the wort can go on to the next step, all of the solids must be separated from the liquid. This is done in a very neat way. The wort is pumped from the kettle, and forced back into the kettle through a jet nozzle. This flow of liquid causes a whirlpool to form; and if you've ever stirred tea leaves in a cup, you know that they move to the center of the whirlpool. When this whirlpool forms in the brew kettle, all of the hops and other solids move to the center. The pump is then turned off, and over the next 20 minutes the whirlpool gradually stops and the solids settle to the bottom, forming a fairly solid cone.
The whirlpool pump that swirls the beer
When the wort is drained, the solids stay in the kettle. Next, the wort must be cooled down to the proper temperature for the yeast. This is done in a liquid-to-liquid heat exchanger. The wort is circulated through one set of tubes while chilled water is circulated through another set. The tubes with hot wort running through them transfer heat to the tubes holding the chilled water.
Heat exchanger
The cooling water is chilled first, so that the volume of water that is required to cool down one entire batch of wort is about equal to the volume of wort. The cooling water ends up at a temperature of about 170 F (76 C), and is stored in an insulated tank and used to brew the next batch of beer. This way both the water and the heat energy are saved.
Hot and cold water storage tanks
It is important to cool the wort quickly so that the yeast can be added right away and fermentation can begin. This reduces the chance of contamination by stray yeasts floating around in the air.
Fermentation
Fermentation is the process by which yeast converts the glucose in the wort to ethyl alcohol and carbon dioxide gas -- giving the beer both its alcohol content and its carbonation. To begin the fermentation process, the cooled wort is transferred into a fermentation vessel to which the yeast has already been added. If the beer being made is an ale, the wort will be maintained at a constant temperature of 68 F (20 C) for about two weeks. If the beer is a lager, the temperature will be maintained at 48 F (9 C) for about six weeks. Since fermentation produces a substantial amount of heat, the tanks must be cooled constantly to maintain the proper temperature.
Fermentation tanks
These fermentation tanks hold more than 2,400 gallons (9,085 L), which means that it takes four batches of wort to fill one tank. Since fermentation takes at least two weeks, the capacity of the brewery is limited by how many tanks they have.
When the wort is first added to the yeast, the specific gravity of the mixture is measured. Later, the specific gravity may be measured again to determine how much alcohol is in the beer, and to know when to stop the fermentation.
The fermenter is sealed off from the air except for a long narrow vent pipe, which allows carbon dioxide to escape from the fermenter. Since there is a constant flow of CO2 through the pipe, outside air is prevented from entering the fermenter, which reduces the threat of contamination by stray yeasts.
When fermentation is nearly complete, most of the yeast will settle to the bottom of the fermenter. The bottom of the fermenter is cone shaped, which makes it easy to capture and remove the yeast, which is saved and used in the next batch of beer. The yeast can be reused a number of times before it needs to be replaced. It is replaced when it has mutated and produces a different taste -- remember, commercial brewing is all about consistency.
While fermentation is still happening, and when the specific gravity has reached a predetermined level, the carbon dioxide vent tube is capped. Now the vessel is sealed; so as fermentation continues, pressure builds as CO2 continues to be produced. This is how the beer gets most of its carbonation, and the rest will be added manually later in the process. From this point on, the beer will remain under pressure (except for a short time during bottling).
When fermentation has finished, the beer is cooled to about 32 F (0 C). This helps the remaining yeast settle to the bottom of the fermenter, along with other undesirable proteins that come out of solution at this lower temperature.
Now that most of the solids have settled to the bottom, the beer is slowly pumped from the fermenter and filtered to remove any remaining solids. From the filter, the beer goes into another tank, called a bright beer tank. This is its last stop before bottling or kegging. Here, the level of carbon dioxide is adjusted by bubbling a little extra CO2 into the beer through a porous stone.
How Yeast Makes Alcohol and Carbon Dioxide
When the yeast first hits the wort, concentrations of glucose (C6H12O6) are very high, so through diffusion, glucose enters the yeast (in fact, it keeps entering the yeast as long as there is glucose in the solution). As each glucose molecule enters the yeast, it is broken down in a 10-step process called glycolysis. The product of glycolysis is two three-carbon sugars, called pyruvates, and some ATP (adenosine triphosphate), which supplies energy to the yeast and allows it to multiply. The two pyruvates are then converted by the yeast into carbon dioxide (CO2) and ethanol (CH3CH2OH, which is the alcohol in beer). The overall reaction is:
C6H12O6 => 2(CH3CH2OH) + 2(CO2)

Bottling, Kegging and Homebrewing
The most important thing about the bottling and kegging process is to keep the beer from being contaminated by stray yeasts, and to keep oxygen away from the beer. These are the main things that can reduce the shelf-life of beer.
The ways that the beer is transferred into bottles and kegs is pretty similar; but bottling has a few extra steps, so we'll talk about bottling.
The bottling line at the Carolina Brewery can fill up to 100 12-oz (355 ml) bottles of beer every minute. To start the process, the empty bottles are loaded onto the bottling line, where they are first rinsed with a chlorine solution, and then blasted with CO2 to remove the solution.
Bottle rinse -- this section of track inverts the bottles, rinses them with a cleaning solution, dries them with CO2 and then flips them back over.
Next, the bottles enter a turret-like mechanism that can hold 12 bottles at once. Each bottle rides around the turret once. During its ride, the bottle is purged with CO2 several times before it is filled. The bottles are pressurized with CO2 so that when the beer is forced into the bottles under pressure it doesn't foam up too much. After the beer has been added to the bottles, the pressure is slowly relieved until the beer is at ambient pressure. As each filled bottle leaves the turret, an empty one takes its place.
Bottle filling station
Next comes the capping machine -- but now there is a little bit of air space at the top of the bottle that needs to be purged. To do this, the bottle is passed under a very narrow, high-pressure jet of water that hits the beer, causing it to foam up and drive the air out of the bottle. The cap is then applied before any air can re-enter the bottle.

Bottle capping machine
After the cap is applied, the outside of the bottle is rinsed to remove any beer that may have foamed out during the process.

Bottle rinsing -- note the foam in the bottle
Surprisingly, the most difficult part of the bottling process is applying the label to the bottle. Getting a label to stick to a cold wet beer bottle is no easy trick.
The labels are fed into the labeling machine, which has a spinning device that rolls glue onto the labels and then sticks them to the bottles as they pass by. If all goes well, the label will be properly positioned, smooth and well-adhered.
Labeling machine
A special inkjet printer squirts the date onto the label as it moves past the print head. The date the beer was bottled and also a "best before" date (three months after the bottling date) are printed on the label.
Label printer

Homebrewing If this all sounds very complicated, then you might be wondering how people ever manage to brew their own beer. But as you may have gathered, most of the complexity of the brewing process is due to the need for a commercial brewery to turn out beer that tastes exactly the same batch after batch, year after year.
A typical set of homebrewing equipment
Most homebrewers have no such requirement -- it doesn't matter if the beer tastes exactly the same each time they make it. There are so many different types of beer to brew that many homebrewers never make the same type of beer twice anyway.
At homebrewing stores you can buy malt extract, which is the fermentable sugars extracted from the mash. That eliminates one fairly complicated step (although it is entirely possible to do a mash in your home). A basic set of homebrewing equipment consists of:
· Fermentation vessels (a bucket or glass water jug)
· Various hoses for siphoning beer from one container to another or to fill bottles
· An airlock so that carbon dioxide can escape the fermentation vessel but air cannot get in
· Some cleaning equipment for washing your fermenters, bottles and hoses
· Floating thermometer
· Floating hydrometer
· Bottle capper
· Funnel
All of these supplies and any ingredients you need are available at homebrewing stores, and are sometimes packaged as a kit.

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

For further queries please feel free to contact Dr Anil K Dhull