Wednesday, December 31, 2008

IS CRESTOR FOR EVERYONE?

IS CRESTOR FOR EVERYONE?

A recent study on Crestor, implies that millions of people with even low cholesterol would be helped with Crestor, since it lowers heart attacks and strokes by almost 50%.  This study was to be for 5 years but was stopped with less than 2 years.  

Stopping the trial early limited getting more meaningful details on  the long-term safety of taking this drug.  The number of patients that were saved by going on the statins had much more details in their studies.   Other reports in 2007 showed that taking the statins to lower LDL had no effect on whether you lived longer or died sooner.

The Crestor study showed that if 120 people take the drug, one would be helped. Twenty-five people would need to take the drug, and only one heart attack in 5 years would be prevented.  Your chances of dying would be the same.

So, who should take the C reactive protein, CRP, blood test?  At what high level of the protein should one start statins? The role of the protein, CRP, and inflammation in heart disease is hotly debated. Dr. Ridker believes inflammation plays an important role, probably by causing plaque in the arteries to rupture.   CRP can rise with short-term infections unrelated to chronic inflammation. It is no t a standard test that everyone should have.

Heart disease is a complex illness and is affected by many risk factors, such as smoking, high blood pressure, and obesity.  

If you don't have these risk factors, should you take the CRP test? You should be counseled about diet and exercise.

Just because you have a high CRP does not justify taking statins if you never had a heart attack or don't have high cholesterol.  Statins have been linked to muscle deterioration and  kidney problems, and some patients reported fogginess of memory loss.

Cost is also a factor.  The CRP test costs up to $50. Name brand stains cost $3 ad day.  To put healthy patients on statins would cost the health system billions of dollars.

Dr. Ridker, a co-inventor of a CRP test, said he first sought federal financing for the study and was turned down. The pharmaceutical company AstraZeneca, who made the drug in the trial, called Crestor on the market, sponsored this study, called Jupiter.

Maybe we should just put statins in our drinking water like we do fluoride.   We all want to believe every new drug is the answer to our health problems.

Source NY Times Nov.9, 2008

Visit www.drneedles.com for more blogging on medical controversial issues.  Your comments are always appreciated.


NEW FOOD FACTS JAN.08


FOOD FACTS JANUARY  08 NEWS FLASHES

Its bad news for dietary supplements: A new study shows that vitamin C and vitamin E supplements don't protect men against cancer or heart disease. Of course, both vitamins still play a role in good nutrition: Get 60-90 milligrams of C daily by eating vitamin-C rich foods like red peppers, kiwi fruit, and citrus. For your daily vitamin E, try sunflower seeds and almonds.

 

Federal advisory board has finally issued criteria for labeling farmed fish as organic, a big and long-awaited step. But critics say the new standards allow the fish too much inorganic feed and aren't strict enough regarding disposition of their waste. At stake: consumers' confidence in the "organic" label.

Did you know that black-licorice Twizzlers contain lots of sodium? That's one of the surprising tidbits that turned up when Consumer Reports evaluated the salt content of 37 nationally available snack and restaurant foods. The report found that many sweet-tasting foods have high sodium content -- sometimes more than salty-tasting foods such as peanuts.

 Coca-Cola will be the first to market with drinks made with a new zero-calorie sweetener called Stevia.   Rival PepsiCo Inc., though, said it is holding off until the FDA officially approves the herb's use.

 

DID YOU KNOW:

Peanuts aren't actually nuts: They're legumes. But like walnuts and almonds, they contain heart-healthy menstruated fats. They're also great sources of antioxidants, vitamin E, and folic acid. Try to go easy on the salted varieties, though, as too much sodium may contribute to high blood pressure.

Beets are nutritional powerhouses, packing plenty of fiber and folate plus chemicals that fight cancer (particularly colon cancer). They promote heart health, reduce inflammation and more. 

November issue of the Journal of the American Dietetic Association identified a 7 percent lower risk of heart failure among those who added just one serving per day of whole grain to their diets; those who ate an extra daily serving of high-fat dairy foods saw an increased risk of 8 percent, while those who ate an added serving of egg each day upped their risk by 23 percent. Other food groups, including fruits and vegetables, fish, and red meat, did not appear to directly affect risk of heart failure.

 

Combining folic acid and Vitamins B6 and B12 doesn't seem to protect women against cancer. So says a study in the Nov. 5 issue of the Journal of the American Medical Association that found no difference in cancer incidence between women were given the three supplements for more than 7 years and those who weren't. The finding contradicts the standing belief that the supplements can help ward off cancer.   B vitamins still contribute to good health in other ways, though: B6 helps your body break down protein and keep red blood cells and the immune and nervous systems healthy; B12 plays a big role in growth and development, among other things, and B9 -- folic acid or folate -- helps cells make and maintain DNA.

 

Exposure to light reduces milk's riboflavin and Vitamin A content. That's why it's usually packaged in opaque plastic or paper cartons.

Experts say the rate of new cases of diabetes has almost doubled in the past decade. Nearly 90 percent of those cases were Type 2 diabetes, which is strongly linked to obesity.

Gobbling your food is bad for your diet, and eating until your belly feels full is not so hot, either. But together they pack a triple whammy.   A study in the online British Medical Journal shows that that combination of eating habits triples a person's risk of being overweight.

Soymilk generally has a fraction of the calcium that you find in milk -- 6 percent of the Daily Value per cup versus 30 percent for skim.  Even fortified soymilk has less calcium than skim milk, and the body may not as easily absorb the calcium it contains.  Eating lots of leafy greens and broccoli provide good calcium sources. Why not add some sardines or salmon (both with the bones in), almonds, and green beans? And make sure to get at least the recommended 1000 International Units of Vitamin D3 a day. It works with calcium to make your bones strong. 

Obesity and overweight are linked to an increased risk of several kinds of cancer. But a survey in the October issue of the Journal Obstetrics & Gynecology shows that many women aren't aware of that link.  Overweight women are four times more likely to develop endometrial cancer, a malignancy of the uterine lining, than slimmer women.  Obese women are six times as likely to get endometrial cancer,  yet only 42 percent of 1,545 women surveyed knew of that risk.  Overweight and obesity are also tied to increased risk of breast and colon cancer.  So slim down ladies.

Injuries can sideline anyone and throw you a curve when you're trying to stay active. Anterior cruciate ligament knee injuries are one of the most common knee injuries, particularly among girls and women. But a surprisingly simple set of exercises is being tested to see if they can help prevent this painful injury.  Plyometrics and other exercises that could make the difference between staying healthy and active--or winding up in the ER.

Visit www.drneedlees.com for more blogging on current controversial medical issues.  Your comments are always appreciated.

RECESSION HURTS HEALTH CARE

LESS MONEY HURTS HEALTH CAREText Color

Increased poverty and loss of jobs are proving harmful to our health care.  A 1990 study showed people who earned under 50K lived shorter lives, and their social behavior of smoking and alcohol resulted in need for more health care.

The Poverty rate is up to 12.6% and those in severe poverty, earning under 10K, increased to 22.6%.  Seniors receiving Medicare helped this.  Personal Income is down except for the very rich.  The median real income dropped 4% between 1999-2004.  With the current recession the gap is widening.    Pretax income for the very rich increased from 31% to 44%.  The richest 1% earning over 250K, had their income doubled from 8% to 17% between 1980-2005.  A Corporative CEO median compensation was 33 million. 

Because everyone is seeing their income dropping with the current economic environment except for the most affluent, everyone’s health is being  affected.  This destabilizes civic health of the communities and increases demands on our health care system.  We should soon see more severe diseases and see them more often now that we all have fewer dollars.

Family budgets are hurt by rising medical costs, unemployment,  and rising medical insurance.  Losing your insurance results means not getting needed medications and not having health tests done.  Higher hospital admissions and increased cancer rates should result.

It may take a lifetime of poor eating, smoking, and inactivity to lead to cancer and other diseases.  We see unhealthy life styles in our youth today.  Lack of knowledge makes it difficult for them to change their behaviors. 

Increasing need for health care will make treatment more expensive for our aging population who are living longer.  Our health delivery system must plan for a greater volume of patients who are not insured.

The solutions are tough.  We need helpful economic measures, increased technical skill, more education, job retraining, improved school conditions, and more new family skills in caring for their aged relatives.

Yet there are powerful financial interests not to improve our personal income.  They must be prepared to deal with diseases that occur when people have money problems.

What do you think?  Visit www.americanacupuncture for more more blogging on controversial medical issues.  SOURCE: JAMA 10.24.07

 

 

 

 

 

GENES CONTROL YOUR PERSONALITY

GENES DICTATE YOUR PERSONALITY

Genes influence how we act and interact in unpredictable ways. Your genes cause half of your behavioral traits. Scientists are trying to nail down the genes that give you your unique personality.

How can your social behavior be linked at a genomic level? Genes do not directly dictate your behavior. Brain development, and behavior depend on what you inherited and also how your environment has influenced you. You produce, receive, and interpret social signals that all influence how you act.

How do your genes respond to social stimuli? Social stimuli lead you to change your behavior. This alters the pathways of your brain's gene expression. Thousands of genes are involved at once in different brain regions. There are shifts in your neurogenic state rather than activation of special genes in your local circuits.

Environment can bring out, neutralize, or negate the influence of genes.   Differences in stress responses from generation to generation can be passed along. This is not an inheritance of a particular gene, but is due to changes in your DNA methylation.

It's hard to tell what genes make you verbally fluent, make you outgoing, or give you spirituality. Behavioral genes are not solo players. It takes many genes to orchestrate each trait. The same gene may make you overeat, be depressed, or be impulsive.

Each gene comes in a variety of flavors (called alleles). These sequences vary. One allele may give you a wrong personality and another may increase your risk for mental illness.

GENES THAT RECENTLY MADE THE NEWS:

MARITAL SUCCESS GENE

You can get your vasopressin checked for $99 by Genesis Biolabs.  This is a hormone test that checks your degree of attachment to your mate and your children. The more vasopressin you have, the more likely you will not be promiscuous.

The DNA preceding your vasopressin gene is responsible for fidelity.   If your DNA has a short variant, your relationships will be less stable and you will lack the feeling for attachment.  The vasopressin receptors are distributed differently and you will not get a reward feeling when you love or are giving of yourself.  These short variants are implicated in autism since connections can't be made in autism.

RESILIENT GENE  SEROTONIN

This gene is linked to everything from heart disease to autism, sleeping disorders and depression. It really is a very general gene.

 WARRIOR GENE

This gene called MAO-A (monanineoxidase-A) causes risk taking and aggressive behavior, gambling and addictions. Sixty percent of Asians have this gene and 40% of Caucasians also carry the gene. The amygdala region of the brain is overactive and individuals have trouble regulating their emotions. Trauma in childhood, like child abuse, can trigger this violent behavior and lead to a life of crime. High testosterone with low MAO-A results in antisocial behavior.

BOUNCE BACK GENE

This gene makes you thick skinned and you can fight life's slings and arrows.   It is a gene for protein that regulates serotonin brain messages.  It is called the SERT gene, short for serotonin transporter.  The length of the regulating DNA at the beginning of SERT affected your behavior. 

 A short version of the gene puts more serotonin in the synapses and causes anxiety and negative emotions. Four percent of us have this gene.  With major stresses, depression runs high, around 43%.  Two thirds of these depressions are in people abused as children.

CAN'T GET  SATISFACTION GENE

This gene prevents you from getting excited about pleasurable things. Less dopamine is fired up in the reward circuits. This leads to drug abuse, sensation seeking, and impulsive and antisocial behavior in forming relationships. Having this gene leads to early sexual activity.

There is no social bonding when dopamine receptors are at a low level. If you have more A2 alleles, your are more trusting. Boys who have only one a 1 allele have have more delinquencies than those who have two copies of A2 allele.

FAILURE TO PLAN AND REASON GENE

This is the COMT gee (catechol O-methyl transferase) gene). It is linked with an enzyme that breaks down dopamine in the cortex that prevents planning and reasoning. High COMT means there are low  dopamine levels in the synapses. This results in poor memory and less sensitivity to pain. There is also more negative thinking and anxiety.

THE STARTLE REFLEX GENE

An involuntary blinking when you hear a sudden noise or see unpleasant pictures.  A low COMT activity results in an exaggerated startle response.  This low COMT could be an asset, since there are denser nerve connections present that lead to better concentration.  But there is also less ability to shift one's focus. You also dwell on stressful thoughts for a long time.

These theories are intellectually appealing but can we blame our social awkwardness on having an anxiety gene? 

But the mechanisms for personality traits are still one of science's biggest mysteries and challenges. 

SCIENCE IS RAPIDLY UNRAVELING THE MYSTERY OF THE GENETIC MECHANISM FOR PERSONALITY AND SOCIAL TRAITS.

Source: Science, Nov. 7, 2008

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Monday, December 22, 2008

SHORTER RESIDENCY HOURS WEAKENS PATIENT CARE

RESIDENT WORK SCHEDULES LIGHTENED

The current residency training programs are creating a legion of shift-worker physicians who leave when the clock strikes a certain hour rather than when the job has been completed.

In 2003 the Accreditation Council for Graduate Medical Education (ACGME), which accredits U.S. medical training programs, instituted rules for resident work hours, sometimes called "the eighty-hour workweek.  The new rules limit residents' duty hours to no more than eighty hours a week.

Besides ensuring excellent medical treatment for patients, the ACGME work rules are intended to keep residents alert so that they could fully engage in the work and education needed to become fine physicians.

COMPLIANCE TO THE NEW RULES

These rules govern the working conditions of the 100,000 young doctors-in-training in teaching hospitals across the United States and were developed both to protect patients from potentially unsafe medical practices by sleep-deprived physicians and to improve working and learning conditions for residents. The work rules, among other stipulations, limit both the number of consecutive days in a week and the number of consecutive hours in a shift that a physician-in-training can work; in addition, the rules require rest periods of at least ten hours between shifts.

Compliance with the new work rules reduces wandering attention on the part of the residents, might reduce actual or near-miss car accidents involving exhausted residents who've worked extended hours, and appears to reduce serious medical errors in the ICU. 

Young physicians learning to be clinical specialists, have long been the mainstay of medical care in teaching hospitals. Because residents traditionally worked in hospitals in the name of receiving education and because altruism is a hallmark of doctors, physicians-in-training have provided a considerable amount of clinical care while working long hours for relatively short pay.

HOW TO CARE FOR ALL THE PATIENTS 24/7

Nobody wants procedures or important decisions to be made by exhausted, blurry-eyed, muddle-brained doctors, so the intent was to form medical teams that would work in rotating shifts, thus providing the physicians with adequate time off. As a result, several times a day, responsibility for patient care shifts as it is passed from team member to team member.

Residents aren't available to examine their patients, to learn about new symptoms from the parents, to review the results of the most recent lab and radiographic tests, to review the nursing assessments for the past twenty-four hours or to make recommendations for ongoing care for their patients.

Resident physician work schedules now look more like Bingo cards than a comprehensive system for providing coordinated medical care or educating future medical specialists. The erratic schedules are the unintended consequences of the new rules on resident work hours.

Stopgap measures designed to provide physician care to all patients around the clock, seven days a week, are found in every teaching hospital in the United States.  By limiting the number of work hours of each resident, however, the new ACGME rules have effectively decreased the hospital's resident physician workforce by 25 percent—in other words, a full quarter of them have gone missing.

At the same time that the new rules have come into effect, the resources to pay for medical care are vanishing.   Medicaid and Medicare payments for health care services are decreasing, and insurance payments are following this lead.  Furthermore, more and more patients—forty-seven million currently—have no insurance, which means that they don't pay—because they can't pay—the bill.

 

Many physician extenders, as physician assistants, command salaries similar to those of physicians-in-training yet work only forty hours a week. Hiring them as replacements would mean a 100 percent increase in costs.    The ACGME requires training programs to report the actual hours spent in the hospital.   It leaves it up to the training programs to figure out how to get the work done in the time allotted.

 WHO IS GOING TO DO THE WORK?

The resident is up against the limits of the work rules and is told to leave the hospital. There's no wiggle room. If the resident continues on duty beyond the dictates of the rules, his training program might be cited for noncompliance. The penalty for too many citations: probation for the training program or possibly withdrawing the program's ACGME accreditation. A training program on probation or without accreditation has an extremely hard time attracting excellent resident physicians.

Losing 25 percent of the workforce hasn't been accompanied by hiring additional physicians. As a regulatory agency, the ACGME issues mandates to ensure that young physicians receive excellent clinical training.  It usually doesn't approve adding increased numbers of residents to a training program just to plug a hole in a hospital's need for clinicians.  A hospital's inability to increase the number of resident physicians isn't the only barrier to improved staffing.  Most hospitals can't afford increased numbers of residents anyway.

The RULES ARE BACKFIRING

Residents no longer are able to observe the timing of a patient's response to an intervention.   They can't follow the tempo of a fever or the bloom-and-fade cycles of a rash even when, as responsible physicians would, they sincerely want to.  Their heads are crammed with the facts they've learned during medical school, but they can't see firsthand the course of a birth or a gall bladder attack or the phases of recovery from a surgical procedure and then integrate those facts into informed decision making.

Instead of producing physicians with high professional standards who see their patients through to the end (of labor, of an operation, of an illness, of a life), the current system is creating a legion of shift-worker physicians who leave when the clock strikes a certain hour rather than when the job has been completed.

Residents often ask for increased autonomy. Yet with their current here-today-and-gone-tomorrow schedules, they can't be given increased autonomy.  They won't be around for the next step or haven't been around for the last step. They don't get the big picture.

HOW TO WORK SMARTER!

In terms of the new ACGME regulations and providing medical care we can't seem to figure out the money part.  Programs might be able to work” smarter" with new technologies and information systems and must figure out how to streamline communication among the many team members.  Resources are needed to create real teams and that takes money.

What's more important than healthy patients and well-educated physicians? We know the answer: Nothing.  What is being done to meet the challenge of having enough doctors for enough hours in all of our hospitals?   Nothing.

sources: New York Times, Wall Street Journal, Dec 8,2008

What do you think?  Your comments are always appreciated.

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Friday, December 19, 2008

BIG BELLIES LEAD TO EARLY DEATHS

DANGERS OF MIDDLE AGE BELLY SPREAD

After 40 your waist tends to have a middle age spread.  Your belly will get hard like a summa wrestler or soft like jelly. The jelly fat under the abdominal skin only sits in storage waiting to be burned for energy.  Not all fat cells work alike.

 The hard belly fat is under the abdominal muscle and is much more dangerous than soft jelly fat under the skin.  Fat accumulation inside the abdomen is more dangerous to your health than fat anywhere else in your body 

It is very biologically active and doubles your risk of an early death.   This fat produces more inflammation than fat found in other areas of the body.  Inflammation is thought to play a key role in heart disease and a host of other chronic diseases.

Visceral fat wraps around your inner organs (stomach, pancreas, liver, and gall bladder) and is very metabolically active, unlike the soft fat right under the abdominal skin

A sizable stomach seems to double your risk of death from type 2 diabetes, cancer, stroke, heart disease, chronic diseases, and even age-related dementias.  Your risk increases even if you are not obese or even overweight.

People who have big bellies in their 40s are much more likely to get Alzheimer's and other forms of dementia in their 70s.  This risk for dementia increases steadily with the amount of fat in the abdomen, even after accounting for alternative explanations, such as other diseases, bad habits and lower education.

 The secretions from visceral fat must go to the liver before they can get into the circulation, and release very potent toxins, noxious chemicals, constricting blood vessels and triggering other inflammatory processes.   It is the cause of type2 diabetes and insulin resistance.  The lipid fat release from abdominal fat is substantially elevated during the night, which is a primary mechanism leading to insulin resistance, a strong risk factor for type 2 diabetes."

Males with waists over 40 inches and females over 35 inches are in danger of early deaths.  Every 2-inch increase results in 15% more mortality. 

Why is there an overnight elevation of abdominal fat release, and what role does this plays in the development of obesity and insulin resistance is to still be determined.

 In the meantime folks, get that belly down by exercising and cutting out all the empty calories in your lattes, snacks, and high sugar beverages.

Source Science Daily, July 12, 2008,   Science,Nov. 12, 2008 –

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Wednesday, December 17, 2008

ALCOHOL AND SEX

ALCOHOL AND SEX

The pattern on the American scene is changing with more young people drinking, and more alcohol consumed, especially among women.   The more affluent our society the more we can afford hard drinks, which is very destructive. 

A large amount of alcohol is a deterrent on sexual performance and is the major cause of impotence in middle-aged men.  We are not talking necessarily about being an alcoholic, but just an excessive use of alcohol by anyone.

DRINKING IN MARRIAGE

Drinking increases, marital situations deteriorate.  One of the spouses is repelled by the other’s drinking, cease to enjoy sex, and tries to avoid sex as much as possible. This also may block the husband’s agility to maintain or get an erection.   Both parties feel a lack of esteem at losing their masculinity or femininity.  They feel it is the other’s fault and start quarreling and shy away from further attempts at sex.  This makes a good sexual life almost impossible.  The family often becomes closer and pushes the alcoholic out. 

Each spouse may feel trapped in such a marriage and neither really cares about the other.  Though there is impotence at home, it may result in extramarital relationships out of the home.

Alcohol is a great releaser of aggression.  Happy drunks after many years develop increased hostility.  What starts as a verbal abuse progresses to actual physical abuse to the wife and the kids.  It is as though they put all their past and present woes and frustrations, anger and disappointment into one big huge ball and throw it at the nearest person, usually the closest being the wife, husband, mother or father.  Most cases of child abuse are caused by drunkenness.  Most people who say they drink moderately, actually  drink excessively. 

 

Stopping alcohol results often in improvement in the marriage, better sexual performance, more self-esteem and tolerance, more giving, and less egocentricity.  Often the pleasure of sex between the couple returns. 

TEENAGE DRINKING

People do what they wouldn’t do if they were not drunk.  Alcohol is often a means for seduction, especially in our teenagers.  After getting drunk they don’t know what happened to them, and they can’t behave responsibly in the sexual field.  With condoms and the pill,  they have license to have sex.  Most girls today are now actually ashamed of being virgins.

If you a parent get drunk consider it normal behavior, and get pleasure from it, your kids are going to imitate you.  It will be hard for or kids to identify with you, even if you are loving and generous when sober, but mean and punishing when drunk, and pitiful when hung over.  Your kids are angry and confused when they witness quarreling between you and your spouse.  They see what you have done with your life with alcohol.

Being young, and fairly healthy, many can still get away with their drinking.  They think they drink like all their friends do and see the pleasure of drinking outweighing  the painful consequences.  There is now a lack of commitment to the norms of our culture, to unwanted pregnancies, and even to psychosis.   Our young have to decide for themselves.  They are allowed to make mistakes.  But this is a hard way to learn.

Things have changed and we the older generation are slow to appreciate this. The norm we offer to our kids often doesn’t make sense to them  When they have lost control and have blackouts and personality changes they may see they are in a progressive disease, need help and seek therapy.  They started drinking to expand their awareness of people, become more outgoing and friendly.  Yet it is so easy to overstep the bounds of moderation, where alcohol is an impediment rather than a help to social relationships.

We have a danger of a lost generation if we don’t help our kids in some way.  We can’t impose our attitudes and beliefs on them, but need a dialogue, not a telling.   We need guidelines on how to use alcohol and how to use sex.

WHAT ARE THE LIMITS OF NORMAL DRINKING?

There is certainly more drinking in both sexes.  Most people are drinking and more are becoming alcoholics. Women alcoholics now are overtaking the men in large numbers. Alcohol increases the rate of promiscuity, and increased sexuality seems to promote alcoholism.  Some drink to work up their sexual drive or their courage our culture seems to look at the capacity to drink as a mark of virility, just as being active sexually is a mark of manliness. 

We have become too permissive of drunken behavior.  We often just laugh about it and make a joke of it.  Yet may people finally get to the point where they can’t stand to have a real drunk around them any more and reject them or no longer invite them out.  We in America never have spelled out the limits of normal drinking. 

IT’S ABOUT TIME WE DO!

What do you think?  Your comments are always appreciated.

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Saturday, December 13, 2008

IS ROMANTIC LOVE TRUE LOVE?

WHAT REALLY IS LOVE?

The spark of romantic love is far different than the love of long-term attachment.  What then is true love?  Are you looking for true love or just want sex?

Must passion lessen over time?  Is your passion is replaced with friendship or economic partnership?  It’s hard to sustain the high romance of courtship.  Money, mortgages, and children all can weaken your romance. 

Science has found where love lies in the brain and the chemical components that make you in love.  With the aid of MRI machine, it seems the ventral segmental area of the brain and the caudate nucleus are lit up by dopamine that triggers what we call LOVE. 

Being in love has an awful power.  Seratonin is the key transmitter.  Its imbalance results in a need for psychiatric medication like Prozac and Paxil. 

Some of us fall in love over and over again, each time you are caught in a runaway passion.  Why do you fall in love with whom you do?  Our roots of romantic love are tied up with intimacy and unconflictng comfort as a child.  Your brain gets engraved and you try to capture that feeling now as an adult.  Love takes us back to the just right feeling, the familiar comfortable sense that activates your buried memory 

Loving should aim for the happiness of your beloved to your own happiness.   Love cannot exist with jealousy, possessiveness, and perfectionism and over control.  The more you can overcome these traits the better lover you will become.

You choose a mate who looks attractive and healthy.  You follow your instincts.  You often will choose a mate who complements your genotype. 

Why doesn’t the passion of courting last?  Relationships break up often after four years,  the time it takes to raise the child you have.  The feeling of attachment takes over as you and your mate bond to raise a helpless infant.  If you can leave the child with sisters or friends, you may be free to meet another mate at the office and have more children The neurons kicking off the surge of dopamine becomes desensitized and need more to produce the high you had when dating.

Non-westerners have more cultural sanctions and social obligations.  The cultural expression of romantic love is not universal.  It is, for example, seen in India aw a dange4rous threat to a powerful caste system where marriages ar4e arrange to preserve bold lines and lineage. They still believe arranged marriages have a better chance to make it than love marriage.  Marriage is too important to leave it to chance.

As your marriage ages, you move from a dopamine activated state to an oxytocin-induced attachment.  Oxytocin is a hormone that makes you feel connected.  This hormone is high in long-term relationships.  You can raise your oxytocin level by making love, massaging and having enough orgasms, which makes your mate feel more attached to you.

Its possible in marriage to have an intimate and affectionate relationship without always having sexual desires.  When you care a lot for each other, are honest and open, you can have tremendous love for each other with minimum passion.

Passion can evaporate from you marriage when husband and wife become entirely preoccupied in their role as parents in a family.  If you spend even a ½ hour together without the children present, relaxing and discuss your feelings that you want to share, you might revitalize the sexual relationship.

Doing some activity together without the children can awaken the romantic aspect of your relationship.  It could be a walk, bike ride or shopping trip.  As long as you are alone together.  you can relate more as lovers than just mom and dad.   An overnight or long weekend at a nearby motel can energize into a sexual relationship.  If you struggle in your marriage, change the routine situation and have more passion in your marriage

Kissing moves energy through various charkas.  It embraces all your sense.  Novelty can also trigger your brain’s dopamine. Go for walks together and stimulate serotonin.  Share a hot fudge sundae at dinner to get your carbs up and stimulated dopamine.  Put some baby powder behind your ear and your mate will think of breeding.  Massage your mate’s shoulders.   Above all, don’t be quick to the draw.

Source: National Geographic, Feb. 2006

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