Are you getting enough Sleep?

We spend one third of our life in sleep. Experts feel that 6-8 hours of sleep every day is required for the restorative functions of the body. In recent times our attempts to gain more waking hours at the cost of sleep time is posing a hazard for our generation.

The acute, or short term, form of sleep deprivation is common, often before examinations, during travel or festivities, or after late-night parties. The effects observed the next day are frequent yawning, micosleeps or dozing, lack of attention, impaired reflexes, altered mood and tiredness.

The dangers of sleep deprivation are nowhere more apparent than on the road. Our reflexes are impaired, reaction time prolonged and judgement distorted. The American Academy of Sleep Medicine reports that one in every five serious motor vehicle injuries is caused by driver fatigue. Alcohol trebles the effect of sleep deprivation, making highways so dangerous at night. Surgeons who sleep less are also more prone to commit fatal mistakes during operations.

Chronic, or long-term sleep deprivation, causes serious changes to our brains and body. Lack of adequate rest impairs our ability to think, handle stress, maintain a healthy immune system and moderate our emotions. In fact, sleep is so important to our overall health that total sleep deprivation can be fatal: lab rats denied the chance to rest die within two to three weeks.

Typical effects of sleep deprivation include:

• depression
• heart disease
• hypertension
• irritability, depression, mental disorders
• slower reaction times
• slurred speech
• tremors.
• Weight gain or loss

 There are 2 forms of sleep: the rapid eye movement (REM) and the non-REM patterns, that alternate during our 7 hours of normal sleep. REM sleep is usually asociated with dreaming and is an esential component. Many sleeping pills reduce REM sleep and hence do not provide the kind of sleep that makes you feel refreshed when you wake up.

Insomnia, or lack of sleep, is often observed in several underlying conditions: people who are tense and anxious find it difficult to fall asleep (initial insomnia. In contrast  some wake up in the middle of the night or very early, and then find it difficult to get back to sleep (terminal insomnia), a pattern ofen seen in depression.

What is causing concern to scientists in recent times is the observation that chronic sleep deprivation in young children can lead to growth retardation. More exams, more late night parties or cell phone chats could mean lower physical growth and brain development in them!

And as for adults, recent studies are linking chronic sleep deprivation with weight gain, high blood pressure, diabetes and heart disease. It is during the sleeping hours that our blood levels of excitatory chemicals like adrenaline, cortisol, prothrombin and C-reactive protein revert to normal. Their prolonged presence leads to tissue breakdown. Imagine a car kept running continuously, without switching the engine off or servicing it periodically.

Thomas Edison was famous for cat naps, nowadys called micro-sleeps, that some fortunate people are good at, but nothing really to replace the 7 hours of good restorative sleep to recharge your body and brain, and keep you healthy in the long run. Bon nui!

Young Hearts are Under Attack

What is causing considerable concern to cardiologists in recent years is the observation that young, apparently healthy men in their 30s and 40s are falling prey to heart disease. Once considered a malady of the elderly, it is emerging as a major health problem in young Indians.

When Shailender, a cheerful 41-year-old clerk of our department complained of “gas” and heaviness in the upper abdomen one morning 2 years ago, he was prescribed the customary Digene tablets. When he insisted on showing the cardiologist, his colleagues called him a hypochondriac. A day later, we were startled on hearing that he had to undergo an emergency angiography and stenting the previous evening for an acute myocardial infarction!

There are 9 conventional risk factors for heart disease that cardiologists talk about: obesity, diabetes, smoking, high blood pressure, alcohol, lack of physical exercise, abnormal blood lipids, strong family history of heart disease, and stress. The interesting fact is that the risk increases from 2 fold for 1 risk factor to 300 fold for all 9, implying that as risk factors get added, the actual risk literally multiplies! The optimist would however realize that with the exception of family history, all the other risks could be controlled with life style changes or medicines!

 There were however no obvious risk factors in Shailender’s case. He looked and weighed normal (Body mass index 23), had a normal blood pressure, was a vegetarian and did not have diabetes. Like many, he had been a smoker for 5 years but had quit since marriage. His blood lipids were normal. Why then did he have a heart problem?

The rather common occurence these days of heart disease in young people without any of the conventional risks is challenging this neat theory of 40 years. The country was shocked a few months ago on the sudden death of one of the youngest CEOs and health freaks Mr Ranjan Das at 42 in Mumbai. He ate right, was a marathon runner, had regular executive health check-ups and was considered a model of perfect health in the corporate world.

Indian cardilogists admit that the frequency of heart disease in India is one of the highest in the world; further, it occurs around 10 years earlier, is more often fatal at 1^st presentation, and tends to be more severe (all 3 coronary arteries affected).

Three theories are doing the rounds. Some “pundits” are driving down the upper limits of lipids, claiming that blood levels of cholesterol and triglyceride exceeding 160 and 150 could damage Indian hearts. Also an LDL-Cholesterol of more than 70 or a HDL-Cholesterol of less than 40, or increase apolopoprotein A could be damaging.

Physicians that are more pragmatic have however started to look beyond. Stress and sleep deprivation are emerging as a major contributors, with lack of reliable methods of quantifying them posing major hurdles to scientific research. 7 hours of sleep every night might help the stress related body changes to revert to normal, and protect our hearts. It is time we got ourselves more sleep!

Do Genes Trigger Alcohol ADDICTION ?

Scientists are still grappling with the question why only some people develop undue fondness for alcohol and become addicts, while others are able to keep within healthy limits. While alcoholism is known to run in families, it is not clear whether it is the effect of the environmental exposure from childhood or our genetic make up that makes us so.The role of genes became suspect when studies on identical twins, separated early in life and brought up in different homes were found to have a much higher chance of showing a similar pattern when traced in adulthood. If one was an alcoholic, then the other had a very high chance of being one too, even if separarted over long distances!

The search for the addiction gene has however not been easy: it has become increasingly clear in recent years that there me be as many as 20 genes that determine addiction, just as there could be severasl reasons why people drink.

It is common knowledge that anxious people find relaxation in drinks, and often tend to drink more during stress. Researchers from University of Illinois, Chicago have shown that inborn levels of anxiety, governed by some genes, could play a role in alcohol addiction. Says researcher Subhas Pandey, “Some 30-70% of alcoholics suffer from anxiety or depression, and drinking is a way for these individuals to self medicate”.

Pandey’s research focusses on the CREB gene, so called because it produces the protein CREB, that regulates brain function during development and learning and is involved in the process of alcohol tolerance, dependence and withdrawal symptoms. When there is less CREB protein in the part of the brain called amygdala, one experiences increased anxiety-like behaviour and preference for alcohol. Further, his study showed that rats deficient in CREB protein drank about 50% more alcohol than normal rats, and showed higher prefernce to alcohol over water.

Another mechanism for alcohol dependence could be sheer pleasure rather than anxiety-reduction. A group of researchers led by Dr Wofgang Sadee have found how differences in one gene can make the brain more sensitive to alcohol, narcotics and nicotine. The gene studied codes for a brain protein called opioid receptor, which acts like a switch turning on pleasure and blocking pain when triggered by alcohol or certain drugs. The 2 variations of the mu-opioid receptor gene A118G and G118, determine our response to morphine like drugs or morphine like chemicals naturally produced in the body that determine our individual sensitivities to pain and pleasure, and could well explain why some people find so much pleasure in alcohol while others do not. The increased sensitivity to alcohol and opioids could make these individuals highly susceptibe to addiction to these agents, and make withdrawal extremely painful.

These recent scientific revellations help explain why the same beer or whisky evokes such wide variations in response among individuals consuming them. Time has still not come for scientists to predict who might become an addict if he starts drinking and who should stay away. However the question of addiction was irrelevant when alcohol was a social taboo, but with its growing presence in parties and clubs, the “mother’s fear” has reasons for its return.

As published in HT City ( Hindustan Times) dated 4 april , 2010.

Quest For ETERNAL YOUTH

As more people in developed countries are living longer and the elderly comprising a significant proportion of the population, the best brains and laboratories are researching why we grow old. Divisions are sometimes made between the young old (65–74), the middle old (75–84) and the oldest old (85+). However, chronological age does not correlate well with functional age, i.e. two people may be of the same age, but differ in their mental and physical capacities, and  some at 85 may  play golf and be mentally alert, while another at 65 may be bedridden with diabetes, stroke and dementia.

The term "ageing" is somewhat ambiguous, but refers to a multidimensional process of physical, psychological, and social change. Some dimensions of ageing grow and expand over time, while others decline. Reaction time, for example, may slow with age, while knowledge of world events and wisdom may expand, explaining why the proportion of elderly among politicians tends to be high. Research shows that even late in life potential exists for physical, mental, and social growth and development.

What causes the body, with all its organs and tissues, to grow old? Why does the skin wrinkle, hair gray,  list of diseases like diabetes, blood pressure, cataract, and heart problems grow long, why do we start slowing down, and also why do we become prone to a variety of cancers?  The process seems to start with cells of our body showing signs of ageing, called senescence, that occurs due to the progressive shortening of one of its parts called telomere, each time the cell divides; when the telomere becomes too short, the cell dies. The length of telomeres is therefore the "molecular clock". And what maintains the telomere length is an enzyme called telomerase.

Why then does the telomere shorten quickly in some, and how can we keep our telomerase enzyme levels high? In 2007 researchers at the Salk Institute for Biological Studies, identified a critical gene that specifically links eating fewer calories with living longer and showed that the gene pha-4 regulates the longevity response to calorie restriction. Semi-starved rats live much longer than their well-fed ones, and slim beauty pageants may actually live longer than their wholesome counterparts!

Apart from the role of longevity determining genes (LDG), cumulative tissue stress arising from liberation of oxygen radicals during cell metabolism has been another suspect. Aging tissues are deficient in anti-oxidants such as tocopherol, ascorbic acid and retinol that are normally found in fresh fruits and vegetables; hence the recommendation of 5 helpings of these every day. Whether the synthetic anti-oxidants sold as capsules do any good to keep our tissues young is yet to be proven.

Researchers have now identified compounds that can actually increase telomerase levels, and therby stop the process of ageing. Resveratrol, Rapamycin, acetyl-L-carnitine and alpha-lipoic acid are some of them currently undergoing research. As the quest for the etrnal youth continues, the 2 ancient “Parijaat” trees standing majestically in Barabanki and Sultanpur, and fabled to have provided agelessness to our gods and godesses, could hold the secret!

As published in HT City ( Hindustan Times) dated 11 april , 2010.

Calorie Labels on Fast Foods

One of the non-controversial aspects of President Barrack Obama’s recently passed Health Care Law is a requirement that fast food chains and restaurants disclose the calories contained in their products. With obesity and life stye disorders resulting from consumption of excess calories becoming the new epidemic in USA, politicians of varying hues seem to have agreed to this recent necessity.

From 2011, every time one walks into MacDonald’s and orders a Big Mac burger, the consumer will find a label, stating that it contains 500 Kilocalories, staring at him. With the daily calorie requirement being around 1500 to 2000 Kcals, you will be reminded that you are about to consume a quarter to a third of your daily requirement at just one go. Add an ice-cream and you may have downed half of your daily amount with that post-movie snack!

Restaurant and fast food giants are unhappy, but have had to yield after years of resistance and lobbying. The devil now is in the detail; how prominent and revealing the labels will be, and whether they will serve to alert consumers before binging. If the skull-and-bones and “Smoking is Injurious to Health” labels displayed on cigarette packets is any indicator, they often soon stop being noticed by the regular consumer.

A similar move in India may be worth considering. Several recent surveys, including one in Lucknow conducted by the Endocrinology Department of Sanjay Gandhi PG Institute have shown that around a half of our middle class urban citizen are overweight, hypertensive or diabetic. And a visit to these lresidential localities will reveal that fast food outlets are generously strewn in these parts. Also, it may be prudent to focus attention on our Indian sweets and our custom of feeding, gifting and eating them. If ‘Barfis’ and ‘son papris’ started coming with labels of 250 Kcals a piece, and better still, mentioning that one needs to run a mile for burning one piece, it might drive some health and calorie consciousness in us when we indulge and binge around our numerous festivals.

Researchers have found that eating out nd take-aways have become very common in Indian cities, and that people tend to eat more and consume far excess calories when they do so, rather than eat home food. With growing urbanization requiring people to work outdoor long hours, and with women increasingly joing the workforce, this trend is expected to grow. Labels on foods telling consumers about the nutritional value of what they are eating, might help make many choose better options. Low calorie foods, salads and soups could become popular and more often available at these outlets, and taste and choices might change to adapt to health needs and health consciousness.

I wonder whether our health and food departments will take note and move. India already has the largest number of diabetics in the world. A timely innovative move could spare our youngsters much hazards in their later life, by making us more nutrition conscious.