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Break the smoking habit!

The World Health Organization estimates that smoke related-diseases kill one in ten adults globally, and by 2030, if current trends prevail, smoking will kill one in six people. Health, Body and Mind interviews Dr Yousuf Kamal in this regard

For most smokers, quitting smoking is a daunting task. But for seriously motivated quitters, quitting may be a little tough initially, but is quite doable. To successfully quit smoking, smokers have to have the motivation and the drive to not go back to smoking after going through a relapse.

Health, Body and Mind interviewed Dr Yousuf Kamal, Consultant Physician, AKU and Medilink who spoke about various aspects of cigarette smoking. The following are excerpts from the interview.

H,B&M: Is smoking merely a habit or is it an addiction?

Dr YK: Smoking is an addiction. In the beginning it is a habit but gradually this habit becomes an addiction, reason being its pleasurable effects which slowly increase smokersí dependency on cigarette.

H,B&M: Does smoking have any real health benefits?

Dr YK: Well, if there are any, I am sure they are so miniscule that the benefits can not outnumber the dangers associated with smoking. I categorically say that smoking is not beneficial but is indeed, injurious to health.

H,B&M: Is quitting smoking as easy as it sounds? What kind of emotional or physical problems does one experience when one gives up smoking?

Dr YK: No, it is not so easy. In fact, no addiction or old habit is easy to break. If doctors give proper counselling to smokers, their counselling could help them gradually reduce their reliance on cigarette and finally quit.

Initially, when smokers try to quit smoking, they have strong bouts of craving for a smoke and feel uneasy and restless as a result of suppressing the craving; some do not have a bowel motion while others complain of uneasiness and lack of concentration. These problems occur as a result of the fixity that certain body organs develop on cigarette smoke.

H,B&M: What are some of the most common diseases associated with cigarette smoking?

Dr YK: The 44,000 chemicals present in cigarette smoke could cause a number of diseases, most common of which are the diseases of the heart, lung and brain. Long-time smokers run the risk of suffering from Chronic Bronchitis, COPD (Chronic Obstructive Pulmonary Disease), coronary heart disease and hypertension.

H,B&M: What are the benefits of quitting smoking?

Dr YK: There are manifold benefits of quitting smoking. Quitting helps smokers reverse changes in different organs of the body, improve lung function and lung capacity, lessen respiratory problems and reduce chances of coronary hear diseases. Smoking often becomes the cause of prolonged coughing; quitting smoking could help people get rid of persistent cough.

H,B&M: Is physical and psychological dependency on cigarettes a medical condition, requiring counselling or treatment?

Dr YK: As I said before, smoking is an addiction, which affects the hippocampal region of the brain. There are receptors in the brain which become dependent on nicotine (an addictive chemical in cigarette), and when the nicotine levels reduce, the person gets the craving to smoke to feed nicotine to the brain. This dependency on cigarette requires both counselling and treatment.

H,B&M: Why do smokers often fail their attempts at quitting despite their wish to quit?

Dr YK: There are many reasons why smokers can not successfully quit smoking. The absence of anti-smoking clinics in Pakistan, lack of follow-up by the social support system, lackluster interest of physicians in forcing smokers to stay quit and weak will power of smokers are some common factors that contribute to smokersí failure to quit.

In my opinion, the primary driving force could be the physician. They should conduct PFTs (Pulmonary function test) of smokers to show them tangible results of smoking on their lungs and tell them how well their lungs could work if they quit.

H,B&M: Tobacco control policies laws exist but are not enforced in Pakistan. What steps would you recommend to the government for effective implementation of these laws?

Dr YK: It is true that government earns plenty of revenue from tobacco companies. A responsible government, should, however, think not of immediate gains but the cost of disease burden on the nation.

Being a developing nation, we can ill-afford the economic burden of diseases associated with cigarette smoking. Government should recognise the disease burden and educate people about the health risks of smoking. The government should stop tobacco advertisements, and also ban smoking in public places, which they have done to a large extent. Government should also consider increasing excise duty on tobacco products to make them more expensive for a large majority.

H,B&M: What are the responsibilities of healthcare professionals in reducing smoking prevalence in Pakistan?

Dr YK: First of all, health professionals should create awareness amongst people about the hazards of smoking; then comes proper counselling of patients and their families and recommendation of medical treatment to overcome the addiction.

H,B&M: How far, in your opinion, do socio economic pressures contribute towards smokersí failure to quit? How can a smoker fight off these challenges in his/her quitting journey?

Dr YK: There is no denying the fact that social economic pressures exist. Smoking is viewed as a means of escape from the problems of life. People are inclined to take an easy route to release tension and stress through smoking rather than using other useful means. Smokers should understand that cigarette smoking is not a necessity; it is a useless luxury that adds to their financial burden. They should seek other forms of relaxation, such as recreational activities, sports etc. Also, smokers should exercise their will power and avoid surroundings where they are more tempted to smoke.

H,B&M: What kind of medical support is available for motivated quitters in Pakistan?

Dr YK: Until a few months back, the only option one had was an anti-anxiety drug (Zyban) which controlled the craving and replacement of nicotine through gradually reducing the need by using nicotine chewing gum or nicotine patches. Now there is another powerful anti-smoking drug (Chantix) which acts directly on the brain receptors affected by Nicotine, ìdisplaces nicotine but does not produce the same pleasurable effects of smokeî and therefore addiction is reduced.

H,B&M: What advice would you give to smokers who have smoked for the most part of their life and think that quitting at an older age will not benefit them?

Dr YK: I will say that quality of life is more important than quantity. Smokers should seriously think about quitting smoking, regardless of their age. They should look at their PFT, lung function test and ECG to see how seriously they need to quit smoking. The best part is that most of these changes can be reversed and quality of life could improve.

Scientists learn how food affects the brain

In addition to helping protect us from heart disease and cancer, a balanced diet and regular exercise can also protect the brain and ward off mental disorders

Food is like a pharmaceutical compound that affects the brain," said Fernando Gomez-Pinilla, a UCLA professor of neurosurgery and physiological science who has spent years studying the effects of food, exercise and sleep on the brain. "Diet, exercise and sleep have the potential to alter our brain health and mental function. This raises the exciting possibility that changes in diet are a viable strategy for enhancing cognitive abilities, protecting the brain from damage and counteracting the effects of aging."

Gomez-Pinilla analysed more than 160 studies about food's affect on the brainl. Omega-3 fatty acids, found in salmon, walnuts and kiwi fruit, provide many benefits, including improving learning and memory and helping to fight against such mental disorders as depression and mood disorders, schizophrenia, and dementia, said Gomez-Pinilla. Synapses in the brain connect neurons and provide critical functions; much learning and memory occurs at the synapses, Gomez-Pinilla said.

"Omega-3 fatty acids support synaptic plasticity and seem to positively affect the expression of several molecules related to learning and memory that are found on synapses," he said. "Omega-3 fatty acids are essential for normal brain function. Children who had increased amounts of omega-3 fatty acids performed better in school, in reading and in spelling and had fewer behavioural problems, he said.

Preliminary results from a study in England show that school performance improved among a group of students receiving omega-3 fatty acids. In an Australian study, 396 children between the ages six and 12 who were given a drink with omega-3 fatty acids and other nutrients (iron, zinc, folic acid and vitamins A, B6, B12 and C) showed higher scores on tests measuring verbal intelligence and learning and memory after six months and one year than a control group of students who did not receive the nutritional drink. This study was also conducted with 394 children in Indonesia. The results showed higher test scores for boys and girls in Australia, but only for girls in Indonesia.

Getting omega-3 fatty acids from food rather than from capsule supplements can be more beneficial, providing additional nutrients, he said.

Scientists are learning which omega-3 fatty acids seem to be especially important. One is docosahexaenoic acid, or DHA, which is abundant in salmon. DHA, which reduces oxidative stress and enhances synaptic plasticity and learning and memory, is the most abundant omega-3 fatty acid in cell me A healthy diet and exercise can also reduce the effect of brain injury and lead to a better recovery, he said.

Recent research also supports the hypothesis that health can be passed down through generations, and a number of innovative studies point to the possibility that the effects of diet on mental health can be transmitted across generations.

A long-term study that included more than 100 years of birth, death, health and genealogical records for 300 Swedish families in an isolated village showed that an individual's risk for diabetes and early death increased if his or her paternal grandparents grew up in times of food abundance rather than food shortage.

Controlled meal-skipping or intermittent caloric restriction might provide health benefits, he said.

Excess calories can reduce the flexibility of synapses and increase the vulnerability of cells to damage by causing the formation of free radicals. Moderate caloric restriction could protect the brain by reducing oxidative damage to cellular proteins, lipids and nucleic acids, GÛmez-Pinilla said.

The brain is highly susceptible to oxidative damage. Blueberries have been shown to have a strong antioxidant capacity, he noted.

In contrast to the healthy effects of diets that are rich in omega-3 fatty acids, diets high in trans fats and saturated fats adversely affect cognition, studies indicate.

Junk food and fast food negatively affect the brain's synapses, said GÛmez-Pinilla, who eats fast food less often since conducting this research. Brain synapses and several molecules related to learning and memory are adversely affected by unhealthy diets, he said.

Emerging research indicates that the effects of diet on the brain, combined with the effects of exercise and a good night's sleep, can strengthen synapses and provide other cognitive benefits, he added.

In Okinawa, an island in Japan where people frequently eat fish and exercise, the lifespan is one of the world's longest, and the population has a very low rate of mental disorders.

Folic acid is found in various foods, including spinach, orange juice and yeast. Adequate levels of folic acid are essential for brain function, and folate deficiency can lead to neurological disorders such as depression and cognitive impairment. Folate supplementation, either by itself or in conjunction with other B vitamins, has been shown to be effective in preventing cognitive decline and dementia during aging and enhancing the effects of antidepressants. The results of a recent randomised clinical trial indicate that a three-year folic acid supplementation can help reduce the age-related decline in cognitive function.

In patients with major depression and schizophrenia, levels of a signalling molecule known as brain-derived neurotrophic factor, or BDNF, are reduced. Antidepressants elevate BDNF levels, and most treatments for depression and schizophrenia stimulate BDNF. Here, too, omega-3 fatty acids are beneficial, as is the curry spice curcumin, which has been shown to reduce memory deficits in animal models of Alzheimer's disease and brain trauma. BDNF is most abundant in the hippocampus and the hypothalamus - brain areas associated with cognitive and metabolic regulation.

The high consumption of curcumin in India may contribute to the low prevalence of Alzheimer's disease on the subcontinent. In humans, a mutation in a BDNF receptor has been linked to obesity and impairments in learning and memory.GÛmez-Pinilla said. "BDNF levels are reduced in the plasma of patients with major depression."

Smaller food portions with the appropriate nutrients seem to be beneficial for the brain's molecules, such as BDNF, he said. GÛmez-Pinilla showed that exercise can have an effect on the brain by elevating levels of BDNF. He noted that while some people have extremely good genes, most of us are not so lucky and need a balanced diet, regular exercise and a good night's sleep.

--www.bbc.co.uk

Obese men should lose weight before trying for a baby

Obese men should consider losing weight if they want to have children, a scientist told the 24th annual conference of the European Society of Human Reproduction and Embryology recently. Dr A Ghiyath Shayeb, from the University of Aberdeen, Aberdeen, UK, said that his research had shown that men with a higher body mass index (BMI) had lower volumes of seminal fluid and a higher proportion of abnormal sperm. Dr. Shayeb and colleagues looked at the results of seminal fluid analysis in 5316 men attending Aberdeen Fertility Centre with their partners for difficulties in conceiving. 2037 of these men had complete data on their BMIs. "We felt that it was possible that male overweight might contribute to fertility problems," he said, "particularly since it is a known risk factor for problems in conceiving among women."

For those who feel going on a diet is tough, an alternative is doing exercises. Though these make one feel fresh but a little carelessness may lead to an injury. Health, Body & Mind takes a look how these can be avoided 

TThe surest way to experience a setback in your exercise programme is to get injured. When you have a sprain, strain or other injury, it is hard to work out at the same intensity as you normally do, and of course, sometimes you can't work out at all. This can cause you to lose fitness, gain weight or both -- and that's not only frustrating but very unmotivating as well.

There are two types of injuries: acute and chronic. Acute injuries occur suddenly and are often a result of an unexpected take-off, landing or abrupt movement during an activity or sport. Some examples of acute injuries include a sprained ankle, strained back or broken arm. Chronic injuries, such as persistent knee pain or aching lower back, are usually the result of overuse, over training or repeated improper execution of an exercise or movement.

 These five simple steps can help you reduce the risk of both types of injuries:

 Warm up properly

Always start by doing an easier version of whatever exercises or movements you are about to do. For example, if you are going for a run, you should walk for a few minutes then go for a slow jog and finally a run. If you are lifting weights, start each exercise by lifting a lighter weight than you intend to finish with. If you are going to play soccer, spend some time running the field and kicking the ball before jumping immediately into the game.

Progress at a reasonable rate

Try not to increase the intensity or duration of an exercise by more than 10 percent to 15 percent of what you are used to in any one exercise session. For instance, if you are training for a longer run and you can easily run 30 minutes now, you should not run too much farther than 33 to 35 minutes on future extended runs until the longer time feels comfortable. Or, if you currently lift 30 pounds doing biceps curls, you should not increase the weight by much more than three to five pounds, until the heavier weight begins to feel easier.

Monitor fatigue

If you become tired or sore during an exercise session or sporting event, it is a good idea to slow down, take a break or stop. Many injuries occur when the exerciser or athlete is simply too tired to keep good form or attention to the activity. So if you are playing basketball but are noticing that your jumping, running and shooting is getting more and more difficult, it is much more likely you will sprain your ankle or fall during the game. Take a time-out until you get your energy back, and your chances of getting hurt will be reduced.

Practice proper technique

If you are doing an exercise incorrectly or playing a sport with improper form, your chances of getting hurt can increase. Make sure you pay careful attention to your movements (go slowly, allow practice time, don't allow momentum to take over, etc.). When learning a new exercise, get tips from a personal trainer or coach to ensure your technique is well formed.

Stretch

Many people forget to include flexibility training in their workout routines or sport training. While stretching won't guarantee that you will not get injured, being more flexible and mobile can help keep your body feeling comfortable, looser, more agile and less prone to long-term injury and recovery issues. Be smart when stretching. Save it for the end of a workout or game and then stretch gently.

Whether an injury is acute or chronic, you should never try to "work through" the pain. When you feel pain, it is your body's way of telling you to slow down or stop the activity you are doing. If you are experiencing severe pain, swelling, numbness, joint instability or you can't tolerate normal weight on the area, it's best to seek immediate medical attention.

----   jang.com.pk/thenews/apr2008-weekly/health-08-04-2008/index.html