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What is addiction?

 

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Many people consider addiction to be a problem of personal weakness, initiated for self-gratification and continued because of an unwillingness or lack of sufficient willpower to stop. However, within the medical and scientific communities, the notion that pleasure-seeking exclusively drives addiction has fallen by the wayside. Clinicians and scientists alike now think that many people engage in potentially addictive activities to escape discomfort — both physical and emotional. People typically engage in psychoactive experiences to feel good and to feel better. The roots of addiction reside in activities associated with sensation seeking and self-medication.

People allude to addiction in everyday conversation, casually referring to themselves as “chocolate addicts” or “workaholics.” However, addiction is not a term clinicians take lightly. You might be surprised to learn that until the current Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5), the term addiction did not appear in any version of the American Psychiatric Association’s diagnostic manual, the reference book that physicians and psychotherapists use to identify and classify mental health disorders. In this most recent edition, addiction is included as a category and contains both substance use disorders and non-substance use disorders, such as alcohol use disorder and gambling disorder, respectively.

 

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Enjoy restful sleep once again!

Harvard doctors share top strategies to defeat insomnia, snoring, obstructive sleep apnea, and 11 other common sleep disturbances!

Learn anytime, anywhere!
You can access your Improving Your Sleep course whenever it’s convenient for you from your smartphone, laptop, tablet, or desktop computer. Easy login and simple-to-navigate screens make this online course perfect for adults of all ages.

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Although our sleep patterns change over time, our need for sleep doesn’t. A good night’s sleep is essential for your good health, for keeping you alert and energetic, and for building your body’s defenses against infection, chronic illness, and even heart disease.

Improving Your Sleep, the newest interactive course from Harvard Health Publishing, will show you how to overcome the obstacles interfering with the good night’s rest you want and your body needs.

You’ll find why sleep often eludes us as adults. You’ll explore habits and conditions that can rob you of peaceful slumber. And most important, you’ll learn the changes you can make and steps you can take to restore consistently restful and restorative sleep.

Is snoring causing strife? Could sleep apnea be threatening a loved one’s life — or yours? The course provides instructive guidance to address these sleep breathing disorders as well as other common sleep disturbances including Restless Leg Syndrome, sleep/wake cycle disorders, narcolepsy, jet lag, and even sleepwalking.

You don’t have to dream of a good night’s sleep. This new course will make it a reality!

In this course, you’ll discover...

  • the advanced PAP machine bringing sleep apnea sufferers greater relief

  • an effective topical alternative to daily pills for restless leg syndrome

  • the easy lifestyle change that can restore more REM sleep

  • a 30-minute outpatient procedure to silence snoring

  • the one insomnia-beating therapy that offers the greatest long-term success

  • a smart and simple pre-flight trick to defeat jet lag

  • an unbiased guide to 32 prescription and OTC sleep medications

  • And more!

A course you may want to take in your PJs! Improving Your Sleep will smooth and speed your way to a great night’s sleep!

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This course is packed with tips, techniques and advances that will make your sleep more restful and rewarding.

  • 6 self-help strategies that can reduce — or eliminate — episodes of sleep apnea

  • the one (and only) proven way for healthy adults to boost the deep sleep they get

  • how to use the “early-to-bed-early to rise” syndrome to your advantage

  • the best time of day for your scheduled nap — and just how long that nap should be

  • the #1 symptom of narcolepsy — and today’s two first-line treatments

  • 3 tips for preventing “Sunday night insomnia”

You can have your nights back. You can end tossing and turning and staring at the ceiling. You can fall asleep more easily, sleep more soundly, and wake more refreshed. And you can do it starting now!

Enjoy the bliss and benefits of a sound night’s sleep once again! Let this course from Harvard Health Publishing be your guide!

Look. Listen. AND LEARN!

Improving Your Sleep is a dynamic, interactive, audio-visual course packed with content and designed for convenience. You choose the time and you set the pace. The course lets you:

  • Get information you can use from a source you can trust

  • Enjoy guidance from America’s top sleep experts when and where it’s most convenient for you

  • Watch, pause, and watch again as often as you want

  • Share the learning experience with your spouse and loved ones

  • Includes downloadable charts, quizzes, video presentations, a resource library, bonus coverage, and more!

 

 

 

Fusing good taste and good nutrition


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Every spring, Harvard Medical School's Department of Continuing Education, The Osher Institute at Harvard Medical School, and The Culinary Institute of America present a special event called "Healthy Kitchens, Healthy Lives."

This four-day conference brings together doctors, dietitians, and health care professionals for an experience that combines the latest nutrition research with healthy cooking demonstrations and hands-on workshops.

Get your copy of Lose Weight and Keep It Off
 
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Successful weight loss depends largely on becoming more aware of your behaviors and starting to change them. Instead of relying on willpower, this process demands skill power. This Special Health Report, Lose Weight and Keep It Off, offers a range of solutions that have worked for many people and can be tailored to your needs.

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Here are some practical tips for nutritious and delicious home-cooking from a recent Healthy Kitchens, Healthy Lives.

Make plants the main attraction

A substantial amount of research shows that people who eat a plant-based diet — mainly fruits, vegetables, whole grains, and legumes — live longer and enjoy better health than people whose diets consist mainly of animal-based foods like meat.

Many cultures developed their cuisines around plant foods out of necessity. Traditionally, animal protein was expensive, so limited quantities were available. Mediterranean, Latin American, and Asian cultures are known for pairing healthy plant foods with lean protein (fish, chicken) and monounsaturated fat (olive oils, nuts).

These diets can have substantial health benefits. For example, a Mediterranean-style diet has been found responsible for:

  • longer life expectancy

  • reduced heart disease

  • relief from rheumatoid arthritis

  • lower rates of Parkinson's disease

  • lower rates of Alzheimer's disease

Here are three tips to get creative with your plant-based meals:

  1. Follow the motto "If it grows together, it goes together." For example, try the Spanish sauce called romesco over grilled vegetables. It's made from roasted red peppers, olive oil, and nuts.

  2. Make olive oil really shine by matching a bold olive oil, such as a Tuscan varietal, with other bold flavors, such as rosemary and pine nuts.

  3. Complement a milder olive oil, such as a French varietal, with subtly flavored foods.

Eat locally

Locally grown foods may be fresher and have higher nutrient content. Since they spend less time being shipped and handled, they may look and taste better.

Spice it up

Despite the lack of research on their health benefits, spices, herbs, and aromatics (any plant, herb, or spice that adds lively scent to a beverage or food) make other plant foods mouth-watering treats. And they are definitely a healthier option than piling on the salt. Unlike salt, spices have not been linked to high blood pressure, heart disease, or stroke.

Here are four ways to ensure the quality and flavor of your spices:

  1. Buy them in small quantities and in their whole form to ensure freshness.

  2. Store them in a cool, dry space.

  3. Grind them right before use.

  4. Toast them dry in a hot skillet or stir-fry them in oil over medium-high heat (both for just 10-20 seconds).

Get excited about whole grains

Rich in fiber, vitamin E, and magnesium, whole grains (such as whole-wheat bread or pasta, or brown rice) are far better nutritionally than refined grains (such as white bread or white rice). And they make you feel fuller longer. Because the starch inside of them is absorbed more slowly, they're less likely than refined grains to quickly be stored as fat. Regular consumption of whole grains also reduces the risk of:

  • diabetes

  • cancer

  • heart disease

  • stroke

  • diet-related depression (usually associated with very low-carbohydrate diets)

Here are five ways to incorporate different types of whole grains into your diet:

  1. Use whole-grain bread, pasta, and brown or wild rice.

  2. Try grains from around the world such as teff, spelt, farro, kamut, and amaranth.

  3. Blend whole grains with colorful vegetables, spices, and olive oil.

  4. Eat whole-grain cold or hot cereals, adding fruit, low-fat milk, or nuts.

  5. Season whole grains with sweet spices like nutmeg, allspice, cardamom, and masala spice.

Go a little nuts

In a large trial of men and women, eating nuts five times a week or more lowered diabetes risk by 27%. In another large study, women who ate nuts just about every day lowered their risk of heart disease by 32%.

However, since a one-ounce portion of nuts can pack 160 calories or more, eat them in moderation to help prevent weight gain. Two tasty suggestions: toasted pine nuts sprinkled over whole-grain pasta, or almonds on cereal.

Following the above advice will not only make your meals nutritious, but will also allow you to enjoy some of the most delicious food you've ever eaten.

For 39 delicious heart-healthy recipes, buy Lose Weight and Keep It Off from Harvard Medical School.

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Dealing with diabetic emergencies


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With proper care, most people with diabetes can achieve and maintain blood glucose levels as close to normal as safely possible. But people with the disease need to be wary of the severe problems that can occur on both ends of the spectrum. Hypoglycemia, or too-low blood sugar, is a side effect of some glucose-lowering medications. In rare situations, blood sugar can also escalate to a dangerously high level, causing problems such as ketoacidosis and hyperosmolar coma.

Hypoglycemia

Hypoglycemia is a potential problem for anyone who takes insulin or several other glucose-lowering medications, including sulfonylureas or glinides, either alone or in combination with other antidiabetic drugs. Hypoglycemia is far less common among people with type 2 diabetes than among those with type 1, but it can be serious when it occurs. Blood sugar may become abnormally low in people who take too high of a dose of medication in the setting of exercise, too little food or carbohydrates, a missed or delayed meal, or a combination of these factors. As you pursue near normal blood sugar control more aggressively, your risk for hypoglycemia increases.

Get your copy of Diabetes
 
Diabetes
This Special Health Report will help you better understand and manage your diabetes. It includes detailed, updated information about medications and alternative treatments for diabetes, and a special section on weight-loss strategies. You’ll also learn the basics of how your body metabolizes sugar, how and when to monitor your blood sugar, and how to cope with both short- and long-term complications of the disease. Most importantly, you’ll see that it’s not just possible to live with diabetes — it’s possible to live well.

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It’s important that people with diabetes, and those who live and work with them, learn to recognize and understand hypoglycemia so it can be prevented and treated before it becomes a life-threatening crisis.

Spotting the signs of hypoglycemia

Many experts associate hypoglycemic reactions with blood sugar levels below 60 mg/dL, but it’s difficult to pinpoint the level at which hypoglycemia symptoms will affect an individual because each person responds differently. For instance, your blood sugar might fall below 40 mg/dL without causing any symptoms, while someone else might feel symptoms coming on when his or her blood glucose falls below 70 mg/dL.

Over time, the symptoms may become subtler. You may or may not experience

  • palpitations

  • sweating

  • anxiety

  • fuzzy thinking

  • hypoglycemia unawareness, in which a person experiences no warning symptoms even when their blood sugar levels are very low.

Low blood sugar usually sets off alarms in many organ systems. The brain, which relies on glucose to function, is especially sensitive to sugar deprivation. The first signs of hypoglycemia resemble those of an anxiety attack because a decline in blood sugar stimulates the autonomic nervous system. Epinephrine (also known as adrenaline) is secreted, causing sweating, nervousness, trembling, palpitations, a fast heart rate, lightheadedness, and often hunger. The release of epinephrine is a corrective response to hypoglycemia not only because it signals you to eat, but also because it prompts your liver to make more sugar.

If hypoglycemia is not treated rapidly, it may get worse and affect brain function, leading to

  • blurred vision
  • slurred speech
  • confusion
  • other behavior that resembles drunkenness, such as belligerence or silliness.

A further drop in blood sugar levels or failure to treat the condition promptly may result in loss of consciousness, seizures, and even death. An episode of hypoglycemia while driving can cause a serious car accident, especially if you postpone treating yourself, thinking you can make it to your destination. Don’t risk it: stop and get something sweet right away if you don’t have anything handy in your car.

Not everyone experiences all these symptoms, and it can be hard to tell the difference between hypoglycemia and anxiety over a problem at work or an argument with your spouse. In addition, beta blockers (used to treat high blood pressure and heart disease) can mask the early symptoms and result in more severe hypoglycemia. That’s why doctors often look for alternatives to beta blockers in people with diabetes. Alcohol can also mask the symptoms of hypoglycemia, which is one reason it must be used cautiously. If hypoglycemia occurs during sleep, the only clues may be damp pajamas (from sweating), vivid nightmares, or a nagging headache on awakening. It’s important to be attuned to these early signs and to know what blood sugar levels set off hypoglycemia.

Preventing hypoglycemia is preferable to treating it. If you’re taking insulin, you may experience hypoglycemia at some time, most likely because of a change in eating patterns, such as missing a meal. But if you engage in binge drinking of alcohol, have irregular eating patterns, or have liver or kidney disease, you are at particular risk.

Treating low blood sugar

While it’s a good idea to test your blood glucose level if you suspect you’re having a hypoglycemic reaction, often there just isn’t time. Once you start to feel strange, don’t put off treatment. Follow the 15/15 rule, as explained by the U.S. National Library of Medicine:

Eat 15 grams of carbohydrate and wait 15 minutes. The following foods will provide about 15 grams of carbohydrate:

  • 3 glucose tablets

  • Half cup (4 ounces) of fruit juice or regular soda

  • A glass of milk

  • 6 or 7 hard candies

  • 2 tablespoons of raisins

  • 1 tablespoon of sugar

After the carbohydrate is eaten, wait about 15 minutes for the sugar to get into your blood. If you do not feel better within 15 minutes, more carbohydrate can be consumed. Your blood sugar should be checked to make sure it has come within a safe range.

Diabetic ketoacidosis

Diabetic ketoacidosis (DKA) — in which blood sugar levels soar very high — is far more common among people with type 1 diabetes than those with type 2. It develops when insulin falls to a critically low level, often when you miss insulin injections or use too little insulin during a period of illness or unusual stress. Illness and stress increase your vulnerability because the hormones released in these situations oppose the action of insulin. Unless insulin doses are maintained or increased, insulin insufficiency develops.

When your insulin levels are very low, cells can’t absorb glucose from the bloodstream to make energy. Instead, they begin to break down stored fat. A natural byproduct of this fat breakdown are acids called ketones. When they reach high levels, the body can’t metabolize them fast enough. As a result, the ketones accumulate in your bloodstream, making your blood acidic. At the same time, your kidneys excrete large amounts of glucose-rich urine, causing dehydration.

Symptoms of DKA include

  • increased thirst

  • frequent urination

  • rapid breathing

  • nausea, vomiting

  • fatigue

  • abdominal pain

  • “fruity” breath.

As the condition progresses, blood pressure falls because of dehydration. Confusion and even coma can develop if blood sugar levels become extremely high. Because the warning signs often develop over several days, regular blood glucose tests can alert you when levels are becoming high enough to increase the risk for DKA. You can also detect the development of DKA by monitoring ketones in your urine. This test is easily performed at home using a urine dipstick for ketones. Urine ketones should be checked whenever your blood sugar levels become unusually high or when you’ve developed a new illness, especially one with gastrointestinal symptoms such as abdominal pain, nausea, or vomiting. Call your doctor immediately if your urine test shows more than a moderate level of ketones (30 to 40 mg/dL). Treatment involves insulin, fluids, and electrolytes (minerals such as sodium, potassium, and chloride) given through a vein. Untreated, DKA can be fatal.

Hyperosmolar coma

In rare cases, blood glucose levels may rise to extremely high levels (over 800 mg/dL), leading to severe dehydration and confusion or coma. This most commonly occurs in elderly people when blood sugar increases because of an impaired ability to recognize thirst, illness, or stress. If the person affected can’t respond by drinking more liquids — either because he or she doesn’t feel thirsty (not uncommon in the elderly) or because neurological damage (for example, after a stroke) makes drinking fluids difficult — blood sugar levels can skyrocket.

As the problem worsens, confusion, sleepiness, and seizures follow dehydration, resulting in a condition called hyperosmolar coma. This rare condition, which occurs most often in elderly people with type 2 diabetes, can be fatal and requires hospitalization, often in an intensive care unit. Again, careful glucose monitoring and strict adherence to your treatment program can help you prevent hyperosmolar coma.

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Working on addiction in the workplace


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When unaddressed, alcohol and other drug use disorders in the workplace are costly and dangerous for organizations, as well as individuals. There are many good examples of successful programs and resources available that can help, and with over 22 million Americans currently in recovery from alcohol and other drug use disorders, creating a drug-free workplace is entirely possible.

More than 70% of individuals with alcohol or illicit drug use continue to maintain employment, as many employees with alcohol or other drug problems can continue to remain “functioning.” Companies and organizations can no longer ignore the realities and repercussions of alcohol and other drugs in the workplace. Instead, there are many ways in which employers can create a drug-free work environment.

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Stress Management

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Understanding the stress response
The importance of stress reduction
The different faces of stress
Managing your stress through the relaxation response
Boosting your resilience
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Habits for a healthy back

If you find yourself dealing with back problems on a regular basis, it’s worth making sure that your everyday habits are “back-friendly.”

Get your copy of Back Pain
 
Back Pain
Treatment of low back pain has undergone a recent sea change. Experts now appreciate the central role of exercise to build muscles that support the back. This Special Health Report, Back Pain: Finding solutions to heal your aching back, helps you understand why back pain occurs and which treatments are most likely to help. This report describes the different types of back problems and the tailored treatments that are more likely to help specific conditions.

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When done without proper form, routine activities — vacuuming the house, working at your desk, driving, gardening, or even sleeping — can take a toll on your back. Be kind to your back by following these tips:

  • Choose good seating. Your office chair should provide good back support — ideally, with an adjustable backrest, lumbar support, armrests, and wheels). Arrange your workspace so you don’t have to do a lot of twisting to reach for frequently used items.

  • Travel light. Don’t overload briefcases, purses, or backpacks.

  • Drive with your back in mind. Sit back in your seat and, if necessary, use a rolled blanket or towels behind your lower back for lumbar support. Shift your weight occasionally. If you have cruise control, use it when you can. Also consider using a foam seat cushion to absorb some of the vibration. When driving long distances, take frequent breaks to stretch.

  • Sleep in alignment. If you can, sleep on your side with your knees bent and pulled slightly toward your chest. Your pillow should keep your head level with your spine — you don’t want your head propped up too high. Choose a mattress that’s firm enough to support your spine.

For more on healing your aching back, buy the Special Health Report Back Pain: Finding solutions for your aching back from Harvard Medical School.

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Back Pain

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Why does your back hurt?
The anatomy of your back
Causes of back pain
Diagnosing back pain
Creating a treatment strategy
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Gentle Core Exercises

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The importance of your core
Tailoring gentle core exercises to your abilities
Structuring your workout: Four commonly asked questions
Posture and alignment
Choosing which gentle core exercises to do
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A strong core: The simple, flexible, and portable workout

Strengthening your core muscles doesn’t have to be overwhelming. You can do these simple exercises anywhere and adapt them as you gain fitness.

The office workout

The following routine is a great way to ease into core work. You can do these four exercises at work, without your colleagues being any the wiser. You can do these exercises at home, too, thanks to simple variations. The front plank, for example, can be done while either leaning on your desk or using the kitchen counter to support your weight.

Get your copy of Gentle Core Exercises: Start toning your abs, building your back muscles, and reclaiming core fitness today
 
Core Exercise
Gentle core exercises are specially designed for people who aren't up to tackling regular core exercises, perhaps because they are out of shape or possibly due to an injury or health problem. This Special Health Report will show you how to build your core with workouts that are gentle and rewarding. You’ll be introduced to more than three dozen exercises designed to strengthen core muscles, increase flexibility and stability, improve balance, and tone your silhouette.
 
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Equipment needed: Desk (a table or countertop is also fine), exercise mat, and sturdy chair.

Chair Stand

Chair Stand

Front Plank on Desk

Front Plank on Desk

Bridge

Bridge

Abdominal Contraction

Abdominal Contraction

To learn more about building a strong core, buy Gentle Core Exercises: Start toning your abs, building your back muscles, and reclaiming core fitness today, a Special Health Report from Harvard Medical School.

 

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Gentle Core Exercises

Featured content:

 
The importance of your core
Tailoring gentle core exercises to your abilities
Structuring your workout: Four commonly asked questions
Posture and alignment
Choosing which gentle core exercises to do
... and more!

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