Heartburn is a painful burning pain in the esophagus just below the breastbone. The pain often rises in the chest and may radiate to the neck or throat.

Heartburn is also called acid reflux or pyrosis.

Heartburn is caused by the stomach’s acid that enters the lower esophagus (the muscular tube through which ingested food passes from the mouth area to the stomach). That occurs when the lower esophageal sphincter doesn’t work properly as a valve and stomach contents, mixed with gastric acid, can return into the esophagus.

This return is also known as reflux, and may progress to GastroEsophageal Reflux Disease (GERD) if it occurs frequently.

Heartburn is also identified as one of the causes of asthma and chronic cough.

If heartburn occurs when lying down, raising the head with pillows or sitting up frequently provides relief.
To avoid such reflux attacks it is adviced to refrain from food shortly before bedtime.

Since 90-95% of sufferers of pyrosis can associate their symptoms to specific foods it is important that sufferers choose the kinds of foods and drinks which have little risk of causing acid reflux, while some kinds of foods or drinks should be avoided as they are major heartburn triggers.

Diabetes is a serious disease and should not be ignored. If you have it, correct treatment can help you live a long and healthy life. This booklet tells how.

What is Diabetes?
If you have diabetes, your body can’t make or use insulin. Insulin helps change sugar into energy to keep you alive.

There are different kinds of diabetes. The main ones are Type 1 and Type 2.

Type 1 Diabetes
This type of diabetes is mostly found in children and young adults. If you have type 1 diabetes, your body does not make insulin and you must take insulin shots every day.
You May:

• urinate often
• be very thirsty
• be very hungry
• lose a lot of weight
• be very tired
• be irritable
• have blurred vision
• have trouble seeing

Type 2 Diabetes
Most people with diabetes have this form of the disease. Type 2 is usually found in people over 45, who have diabetes in their family, who are overweight, who don’t exercise and who have cholesterol problems. It is also common in certain racial and ethnic groups (blacks, American Indians, Hispanics) and in women who had diabetes when they were pregnant. If you have type 2 diabetes, your body cannot make enough insulin or correctly use it. Treatment is diabetes pills and sometimes insulin injections, as well as diet and exercise.
You May Have:

• any of the symptoms of type 1 diabetes
• a lot of infections
• cuts or bruises that heal slowly
• tingling or numbness in the hands or feet
• skin, gum or bladder infections that keep coming back

Controlling Diabetes
Daily monitoring and careful control of blood sugar levels are the most important steps to take for people with diabetes. If not treated, diabetes can cause:

• High blood sugar (which could make you thirsty, tired, lose weight, urinate often, give you
  infections that won’t go away)
• Many serious health problems
  (which could hurt your eyes, kidneys, nerves, heart)

Warning: Low Blood Sugar
People with diabetes may develop low blood sugar because their blood has too much insulin or other blood sugar-lowering medication or from not eating enough food. It is important to follow the eating and medication schedule your doctor
has prescribed to avoid low blood sugar.

Low blood sugar could make you shaky, dizzy, sweaty, hungry, have a headache, have pale skin color, have sudden mood or behavior changes, have clumsy or jerky movements, have difficulty paying attention, feel confused, or have tingling sensations around the mouth.

Taking Care Of Your Diabetes
The best way to take care of your diabetes is to make sure the levels or amount of sugar in your blood are near the normal range. This will make you feel better and help you stay healthy.

Your doctor will tell you how often to check your blood sugar level. To do this you will need to take a drop of your blood and place it on a special test strip. Then a device called a blood glucose meter, which measures the amount of sugar in your blood, reads the strip.

Writing down this level, along with the time and date, will help you see how well your treatment plan is working.

(Self Test Diary-This sample blood monitoring chart has spaces for recording sugar levels for a week’s worth of testing at breakfast, lunch, dinner and evening.)

Remember:
A person’s blood sugar level rises after eating any meal that contains carbohydrates or protein. Table sugar (also called sucrose) counts as a carbohydrate. Artificial sweeteners, such as saccharin and aspartame (NutraSweet), do not count as carbohydrates or fats. They make food taste sweet, but they do not raise blood sugar levels and have little or no calories.

What Else Can You Do?
Eat well, balanced meals, healthy foods in the right amounts, will keep your weight under control and help manage your diabetes.

Your body needs foods from the four main food groups every day:

• Fruits and vegetables
  (oranges, apples, bananas, carrots, and spinach)
• Whole grains, cereals, and bread
  (wheat, rice, oats, bran, and barley)
• Dairy products
  (whole or skim milk, cream, and yogurt)
• Meats, fish, poultry, eggs, dried beans, and nuts.

Remember:
Too much fat and cholesterol in your diet can be very harmful to people with diabetes. Foods that are high in fat include red meat, dairy products (whole milk, cream, cheese and ice cream), egg yolks, butter, salad dressings, vegetable oils and many desserts.

Can You Do Anything Else?
Exercise
-is important for good diabetes control. It usually lowers blood sugar and may help insulin work better. Exercise and a healthy diet can also help you take off extra pounds if you are overweight.

Warning:
Check with your doctor before starting any exercise program. You may need a snack before or during the activity to avoid having low blood sugar while you exercise.

Do You Need More Information?
If you need more information on diabetes, these groups may be of help:

American Diabetes Association
Attn: Customer Service
1701 N. Beauregard St.

Alexandria, VA 22311
1-800-DIABETES
(1-800-342-2383)
www.diabetes.org

National Center for Chronic Disease Prevention and Health Promotion
Centers for Disease Control and Prevention (CDC)

Division of Diabetes Translation
P.O. Box 8728
Silver Spring, MD 20910
1-877-CDC-DIAB
(1-877-232-3422)
www.cdc.gov/diabetes

Juvenile Diabetes Foundation International
120 Wall Street
New York, NY 10005
1-800-533-CURE
(1-800-533-2873)
www.jdfcure.org

National Institute of Diabetes and Digestive and Kidney Diseases
National Diabetes Information Clearinghouse
1 Information Way
Bethesda, MD 20892
1-800-860-8747
www.niddk.nih.gov/health/diabetes/diabetes.htm

Do You Have More Questions About Diabetes?
Ask your doctor or other member of your health-care team-dieticians, nurse educators and even family members and friends.

Source: Food and Drug Administration

Acne is a disorder resulting from the action of hormones on the skin’s oil glands (sebaceous glands), which leads to plugged pores and outbreaks of lesions commonly called pimples or zits. Acne lesions usually occur on the face, neck, back, chest, and shoulders. Nearly 17 million people in the United States have acne, making it the most common skin disease. Although acne is not a serious health threat, severe acne can lead to disfiguring, permanent scarring, which can be upsetting to people who are affected by the disorder.

How Does Acne Develop?

Doctors describe acne as a disease of the pilosebaceous units (PSUs). Found over most of the body, PSUs consist of a sebaceous gland connected to a canal, called a follicle, that contains a fine hair (see “Normal Pilosebaceous Unit” diagram, below). These units are most numerous on the face, upper back, and chest. The sebaceous glands make an oily substance called sebum that normally empties onto the skin surface through the opening of the follicle, commonly called a pore. Cells called keratinocytes line the follicle.

Normal Pilosebaceous Unit

The hair, sebum, and keratinocytes that fill the narrow follicle may produce a plug, which is an early sign of acne. The plug prevents sebum from reaching the surface of the skin through a pore. The mixture of oil and cells allows bacteria Propionibacterium acnes (P. acnes) that normally live on the skin to grow in the plugged follicles. These bacteria produce chemicals and enzymes and attract white blood cells that cause inflammation. (Inflammation is a characteristic reaction of tissues to disease or injury and is marked by four signs: swelling, redness, heat, and pain.) When the wall of the plugged follicle breaks down, it spills everything into the nearby skin–sebum, shed skin cells, and bacteria–leading to lesions or pimples.

People with acne frequently have a variety of lesions, some of which are shown in the diagrams below. The basic acne lesion, called the comedo (KOM-e-do), is simply an enlarged and plugged hair follicle. If the plugged follicle, or comedo, stays beneath the skin, it is called a closed comedo and produces a white bump called a whitehead. A comedo that reaches the surface of the skin and opens up is called a blackhead because it looks black on the skin’s surface. This black discoloration is not due to dirt. Both whiteheads and blackheads may stay in the skin for a long time.

Types of Lesions

Other troublesome acne lesions can develop, including the following:

* Papules–inflamed lesions that usually appear as small, pink bumps on the skin and can be tender to the touch
* Pustules (pimples)–papules topped by pus-filled lesions that may be red at the base
* Nodules–large, painful, solid lesions that are lodged deep within the skin
* Cysts–deep, painful, pus-filled lesions that can cause scarring.

What Causes Acne?

The exact cause of acne is unknown, but doctors believe it results from several related factors. One important factor is an increase in hormones called androgens (male sex hormones). These increase in both boys and girls during puberty and cause the sebaceous glands to enlarge and make more sebum. Hormonal changes related to pregnancy or starting or stopping birth control pills can also cause acne.

Another factor is heredity or genetics. Researchers believe that the tendency to develop acne can be inherited from parents. For example, studies have shown that many school-age boys with acne have a family history of the disorder. Certain drugs, including androgens and lithium, are known to cause acne. Greasy cosmetics may alter the cells of the follicles and make them stick together, producing a plug.

Factors That Can Make Acne Worse

Factors that can cause an acne flare include:

* Changing hormone levels in adolescent girls and adult women 2 to 7 days before their menstrual period starts
* Friction caused by leaning on or rubbing the skin
* Pressure from bike helmets, backpacks, or tight collars
* Environmental irritants, such as pollution and high humidity
* Squeezing or picking at blemishes
* Hard scrubbing of the skin.

Myths About the Causes of Acne

There are many myths about what causes acne. Chocolate and greasy foods are often blamed, but foods seem to have little effect on the development and course of acne in most people. Another common myth is that dirty skin causes acne; however, blackheads and other acne lesions are not caused by dirt. Finally, stress does not cause acne.

Who Gets Acne?

People of all races and ages get acne. It is most common in adolescents and young adults. Nearly 85 percent of people between the ages of 12 and 24 develop the disorder. For most people, acne tends to go away by the time they reach their thirties; however, some people in their forties and fifties continue to have this skin problem.

Source: National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS)