The following chart shows the results of the American 2005 Sleep Poll that relate to symptoms of insomnia. More than half of those polled reported experiencing symptoms of insomnia (indicated by the Dragging Duos, Overworked, Overweight, and Overcaffeinated, and the Sleepless and Missin' the Kissin' groups).

​Insomnia can involve difficulty in falling asleep, waking up frequently at night, waking up too early in the morning, or waking up and not feeling refreshed. Insomnia is not a disease but a symptom. It can be caused by an underlying sleep disorder, or might be brought on by something as simple as a change in schedule, a stressful event at work, or an afternoon cup of coffee. Insomnia becomes more common as people grow older, and is also more common in women.

Sleep: Why Do We Need it?
Sleep plays an important role in our overall well-being. Many body functions suffer if we don't have regular sleep:

Growth of new tissue and healing
Control of body temperature
Control of how energy is used (the body's metabolism)
Immune system performance (defending the body against illness)
Brain function and memory performance.
People who don't sleep well are also more apt to have accidents, abuse substances such as alcohol, and even suffer greater illness and disease.

Normal Sleep Cycle
In falling asleep and sleeping, people go through predictable stages -

Light sleep (approximately 50%)
Deep sleep, called "slow wave" sleep, associated with feeling refreshed and restored (25%)
REM (Rapid Eye Movement Sleep or Dream Sleep), during which dreams occur, rapid eye movements, and changes in breathing and muscle tone (25%)

​
​The Effects of Aging on Sleep
With normal aging, people spend more time in light sleep, less time in deep sleep and have less REM sleep.

With age, sleep becomes less "efficient." People take longer to fall asleep, wake up more frequently and spend more time awake. Older people also:

Wake up more often throughout the night
Have less total sleep time
Spend more time in bed

If You Are Having Trouble Sleeping
Are you dissatisfied with your sleep? Do you routinely become sleepy during the day? Does your bed partner notice any unusual behavior while you sleep? Answering "yes" to any of these questions may mean that you have a sleep disorder. Before considering non-prescription or prescription sleep medications, try the following:
Figure out the Cause and Try to Reduce its Effect
Practice Good "Sleep Hygiene"

Figure out the Cause and Try to Reduce its Effect
Are Medications and Drugs Causing Your Insomnia?
Are There Patterns Associated With Your Insomnia?
Are You Depressed?

Are Medications and Drugs Causing Your Insomnia?
Certain medications can interfere with normal sleep patterns. Following is a list of drugs that can cause insomnia:

​Are There Patterns Associated With Your Insomnia?
If you consult with your health care provider about your insomnia, he/she may ask you to keep a sleep diary. Your diary could look something like this:

My Sleep Diary:

​Are You Depressed?
Depression can take a toll on your ability to sleep. The self-administered Patient Health Questionnaire 9 is a test for diagnosing depression that you can take yourself. If you are concerned about depression, ask you health care provider about taking this test.

Practice Good "Sleep Hygiene"
Good sleep hygiene describes methods you can use to encourage drifting off into quality sleep. Some examples follow:

Wind down prior to bedtime
Do not smoke (nicotine is a stimulant) or consume caffeine
Try warm milk or a light snack before bed (if this doesn't interfere with another treatment you are using)
Exercise daily, but not right before bedtime
Take a warm bath, but not right before bedtime
Keep a regular bedtime and rising time
Get in the habit of going to bed when you are sleepy and sleeping where you sleep best
Reserve your bed for sleeping only
Don't have any clocks visible to you
Reduce the amount of time you allow yourself to sleep until you fall asleep easily (your health care provider can help with this form of "sleep restriction therapy"
Schedule worry time during the day and put worries out of your head when it is time to sleep; you can write them down on 3x5 cards, and then let go of them
Get up if you have not fallen asleep in 15 minutes and practice a relaxing activity (e.g. handwork, reading a boring book) until you feel sleepy

Over-the-Counter Sleep Aids
Non-prescription medications for insomnia are usually antihistamines and may have significant side effects including:

"Carry over sedation" (fatigue and tiredness the day after taking them).
Falls
Difficulty with urination (especially in older men).
Additional concerns with both non-prescription and prescription sleep medications are that they can be habit-forming and addictive. More recently, natural remedies have been promoted to help people sleep. Examples include valerian and melatonin:

Valerian is believed to aid sleep by sedating the central nervous system.
Melatonin is a hormone produced in the body by the pineal gland in the brain. Melatonin supplements are thought to be particularly effective in patients with jet lag and disorders of the sleep-wake cycle. A relatively new prescription brand of melatonin is available.
There are downsides to over-the-counter melatonin and valerian, too. Because melatonin is an animal product, it can be contaminated with viruses or other problems. In addition, the FDA does not regulate valerian and over-the-counter melatonin, so the purity and potency may vary widely. Many researchers are skeptical of the effectiveness of either valerian or over-the-counter melatonin in relieving insomnia.

While there are varying opinions on the over-the-counter sleeping aids mentioned above, all experts agree: You should never use alcohol, illicit drugs or medications prescribed for a friend for your sleep problems.

Prescription Sleep Medications
There are three commonly recognized classes of sleep medications. The oldest of these classes is the benzodiazepines (e.g. triazolam, flurazepam). These medications are effective for short-term treatment of insomnia, but should always be used under a physician's supervision. Side effects typically include sedation the next day, impairment of performance, and particularly in elders, dizziness and falls. Newer, non-benzodiazepine medications, such as zolpidem, zaleplon, and eszopiclone, work similar to the benzodiazepines but may avoid some of the benzodiazepine side effects. Because these medications have different duration of action, some are more suited for treating sleep disturbance in the middle of the night. The newest prescription class of medication is the melatonin agents such as ramelteon. Ramelteon is not a controlled substance. Other medications, such as sedatives and antidepressants (e.g. trazodone) are also used as sleep aids.

The benefits, side effects and contraindications (non-compatible drugs) vary for each class of sleep medication. Your healthcare provider can help you select the best sleep medication for your needs.

Christiaan Janssens
CRO Akwa Wellness

Sources and References:
Pierre A. A. Maquet et al., "Brain Imaging on Passing to Sleep"; Chapter 6 in Parmeggiani & Velluti (2005).
Eve Van Cauter & Karine Spiegel (1999). "Circadian and Sleep Control of Hormonal Secretions", in Turek & Zee (eds.), Regulation of Sleep and Circadian Rhythms, pp. 397–425.
Tassi, P; Muzet, A (2000). "Sleep inertia". National Center for Biotechnology Information, U.S. National Library of Medicine. 4 (4): 341–353.
American Academy of Sleep Medicine. International classification of sleep disorders, diagnostic and coding manual. Westchester, IL, American Academy of Sleep Medicine. 2nd Edition 2005.
Fuller PM, Gooley JJ, Saper CB. Neurobiology of the sleep-wake cycle: sleep architecture, circadian, regulation, and regulatory feedback. J. Biol. Rhythms. 2006;21:482–493.
​​Kryger, Meir H., Thomas Roth, and William C. Dement (eds). Principles and practice of sleep medicine, 4th ed. Philadelphia, PA: Elsevier/Saunders, 2005.
​
Websites:
Sleep Foundation
​Home Remedies to Help You Sleep
Nederlandse Vereninging Voor Waak- en Slaaponderzoek
​Sleeping Disorders (Dutch)
Sleep disorders: Latest Research and Reviews

Hypertension is the medical term for high blood pressure. The pressure in a person's arteries (blood vessels) is determined by the pumping action of the heart and the resistance (degree of stiffness) in the arteries. When the heart contracts and pushes the blood through the arteries, the pressure rises and reaches a peak, called the systolic pressure. During the relaxation of the heart muscle, the pressure falls and reaches a low level, called the diastolic pressure. Blood pressure is always recorded as the systolic reading over the diastolic reading. Normal blood pressure is usually below 130/80 mmHg.

With the development of atherosclerosis and with age, arteries lose elasticity ("hardening of the arteries"). This makes it more difficult for the heart to deliver blood through the blood vessels and the pressure rises. The higher pressure, in turn, can cause further hardening of the arteries. This situation leads to hypertension. Hypertension is a sign of vascular disease (arteries that have lost their natural elasticity), as well as a cause of further vascular disease. Individuals with elevated blood pressure have a greater risk of suffering from the consequences of vascular damage, such as heart failure, heart attack, stroke and kidney failure.

Lowering the blood pressure with diet, exercise, weight loss and smoking cessation is beneficial. In many cases of hypertension, such life style changes are not enough to lower blood pressure enough, and medications are needed. High blood pressure medicines are usually easy to take and well tolerated. This is even more important for individuals with other cardiovascular risk factors, such as diabetes, high cholesterol, family history of stroke or heart disease and cigarette smoking.
​
Problems in the treatment of hypertension include the fact that many people are unaware of their elevated blood pressure. Every adult should know his or her blood pressure, and should seek medical advice if it is elevated.

Christiaan Janssens
CRO Akwa Wellness
​

You're familiar with the scenario: A colleague in the next cubicle is hacking and sneezing, and you are afraid to breathe for fear of being infected with a nasty bug.
Although working sick may have been deemed a no-no in the past, it's a reality, and people often don't have a choice. 

If You Have to Work
If you have to work sick, the best thing you can do to avoid spreading germs is to regulary wash your hands. Germs are everywhere. We live in a germy world, and there is no way to ever get rid of all of them, but the most important prevention tactic is washing your hands or, even better, using an alcohol-based cleanser regularly.

In addition, sick employees should consider rescheduling meetings, avoid close contact with other individuals or even work from home, if permitted.

Everyone feels that their work is important, but you still have to pay attention to your own health and the health of others around you.

People are most infectious around 24 hours before symptoms of the cold or flu even begin. Washing your hands regularly will prevent those germs from being spread.

Even though you may feel the effects of the illness three to five days later, you are less likely to be infectious. You may feel crummy, but it is less likely you will spread the infection. However, a day or two at home in bed is the best option.

If you are ill and feel so bad that you can't concentrate and do your job to the best of your ability, then you should stay home. Just be reasonable, and if you are lucky enough to have sick days, definitely take advantage of them so that you can get back on your feet in the fastest manner possible.

Christiaan Janssens
CRO Akwa Wellness

Although nothing will ever be able to give you a 100-percent, money-back guarantee that you'll never develop cancer, there are things you can do to reduce your risk. According to the American Institute for Cancer Research (AICR), focus on four areas to reduce your risk of cancer.

The first is, simply put: don't use tobacco in any form. According to the National Cancer Institute, tobacco use is the single-most preventable cause of death. Cigarette smoking alone causes 30 percent of all cancer deaths every year. Other forms of tobacco also significantly increase cancer risk.

The AICR says that most people have gotten that message: 98 percent of respondents to a recent survey were aware of cancer-related risks from tobacco. But fewer than half were aware of other ways to reduce risk:

- Crowd your plate with fruits, vegetables, whole grains, beans, soy and other plant-based foods. Scientists are still discovering the exact links between these foods and reduced cancer rates, but it appears that the vitamins, minerals and phytochemicals they provide help the body prevent or slow the cancer process. The National Cancer Institute recommends up to 10 servings of plant-based foods each day.
- Maintain a healthy weight. It appears that fat cells actually release hormones and other growth factors into the bloodstream, prompting an acceleration of cell division. More fat cells mean more opportunity for cell division, and that alone could increase the risk of cancer.
- Get regular exercise. This works two ways: First, it can help you maintain your weight, curbing that risk factor. But research also indicates that physical activity also seems to regulate the hormones and insulin-like growth factors released from the fat cells you do have.

According to the AICR, a diet based primarily on plant foods can reduce your risk of cancer by 20 percent. Combine that with physical activity and weight management, and you can reduce your risk by 30 percent.

Christiaan Janssens
CRO Akwa Wellness

Websites:
​American Institute for Cancer Research
​National Cancer Institute

High fat diets…low fat diets…which is healthier? Research has shown that the type of fat in the diet, rather than the quantity, may be important in the prevention of chronic disease. Population studies and some controlled research studies indicate that the Mediterranean diet may be beneficial in improving health in many ways, such as improving lipid levels, reducing inflammation, and improving glycemic control. The diet is high in nutrients, fiber, and phytochemicals which contribute to overall health. Also, the diet is high in monounsaturated fat, a specific type of fat that may lower blood cholesterol. More research is needed to determine the long-term effects of Mediterranean-type diets and the mechanisms responsible for those effects.

What is a Mediterranean diet?
A Mediterranean diet is based on the food habits of those countries bordering the Mediterranean Sea, such as Greece, Southern Italy, Spain, Southern France, Tunisia, Morocco, and Lebanon. People in this region eat an abundance of fruits, vegetables, nuts, legumes, and whole grains and moderate amounts of fish, poultry, dairy products, and red wine. They eat very small amounts of red meat and refined grains.

The Mediterranean diet is moderately high in fat (about 35-40% of its calories from fat) with the main type of fat being monounsaturated fat from olive oil and nuts. The diet has been known for being very flavorful and satisfying!

How do I change to a Mediterranean-type diet?
You can convert your diet to a Mediterranean-type diet by making the following changes:

- Increase the amount and variety of fruits, vegetables, and whole grains.
- Include good sources of monounsaturated fat such as olive, canola, or peanut oil, nuts, peanut butter, seeds, avocado, and olives.
- Choose poultry or fish instead of red meats. Eat lean cuts of red meat no more than a few times a month; avoid processed meats such as bacon, sausage, and luncheon meats.
- Choose low-fat and fat-free varieties of dairy products.
- Avoid refined white flour products, white rice, and sugar.
- Avoid butter, lard, mayonnaise, and creamy salad dressings.

Start with small changes to your diet, such as adding olive oil to cooked vegetables; adding avocado or nuts to salad; dipping whole wheat bread in olive oil; eating nuts and seeds as a quick snack; and using peanut butter as a fruit dip.
Since the Mediterranean-type diet includes foods that are high in fat and calories, remember to watch your portion sizes! And don’t forget to include physical activity in your daily routine.

Christiaan Janssens
CRO Akwa Wellness

Websites, sources and references:
Mediterranean Diet 101: A Meal Plan and Beginner's Guide
Mediterranean diet: A heart-healthy eating plan
​Primary Prevention of Cardiovascular Disease with a Mediterranean Diet

​Singh RB, Rastogi SS, Verma R, Laxmi B, Singh R, Ghosh S, Niaz MA.
Randomised controlled trial of cardioprotective diet in patients with
recent acute myocardial infarction: results of one year follow-up. BMJ.
1992; 304: 1015–1019.
De Lorgeril M, Renaud S, Mamelle N, Salen P, Martin JL, Monjaud I,
Guidollet J, Touboul P, Delaye J. Mediterranean alpha-linolenic acid-rich
784 Mediterranean Diet and Coronary Heart Disease. Lancet. 1994; 343:
1454–1459.
Willett WC, Sacks F, Trichopoulou A, et al. Mediterranean diet pyramid: a cultural model for healthy eating. Am J Clin Nutr 1995;61:Suppl:1402S-1406S.
Sofi F, Abbate R, Gensini GF, Casini A. Accruing evidence on benefits of adherence to the Mediterranean diet on health: an updated systematic review and meta-analysis. Am J Clin Nutr 2010; 92: 1189-1196.

​Introduction
Eating is undoubtedly one of life's greatest pleasures. The sight, smell, taste, and texture of food are just a few characteristics that entice us eat what we eat. History, religion, culture, friends, family and the environment also influence our food choices. And hopefully, we also base our food choices on nutrition and health.

A healthy diet provides the right balance of carbohydrates, fats, protein, vitamins and minerals. This balance can be obtained from eating a variety of foods that are available, affordable, and enjoyable. Knowing how to select and plan a healthy meal can be important for staying healthy and/or improving your health.

​How to maintain a healthy diet
To maintain a healthy diet, consider the following:

Variety: Eat a variety of foods from all groups of The Food Triangle. No single food contains all of the nutrients your body needs to function properly. Eating foods from the five food groups ensures that your body is getting all the nutrients it needs. It also provides a large variety of tastes and textures to enjoy!

Balance: All adults need to consume at least the minimum number of servings from each food group every day. The goal is to obtain adequate amounts of nutrients by making food choices from each food group in The Food Triangle. Children, adolescents and seniors have different nutrient requirements. Triangles are available for these specific populations as well: for children or adolescents click here.
Moderation: Remember, there are no good foods or bad foods. Watching portion sizes of some of your favorite "not so healthy" foods or beverages will help you to maintain the appropriate weight for your age, gender, and activity level.

Safety: Be sure to keep foods safe to eat through proper handling, storage and cooking methods. Also, use proper handwashing techniques and sanitation.

To maintain good health, use the Food Triangle to guide your food choices.
​



​Nutrients and Other Food Components
All foods contain nutrients and other components. Nutrients can be broken down into two groups- macronutrients and micronutrients.
Macronutrients include carbohydrates (starches and sugars), proteins (meat, dry beans, eggs), and fats (oils and margarine). Macronutrients provide energy (calories).
Micronutrients include vitamins and minerals. These are needed in much smaller amounts, and unlike macronutrients do not provide energy. It is best to obtain these nutrients from whole foods rather than vitamin or other supplements.
Other components found in foods that are not classified as nutrients include water, fiber and phytochemicals. Fiber is the indigestible part of plants that helps maintain bowel health and may reduce the risk of diabetes, heart disease and some cancers. 

Plant foods also contain several phytochemicals that may aid in the prevention of cancer, heart disease and other chronic conditions. Phytochemicals make up the taste, texture and smell of foods. Ongoing research is being done to determine the roles that these substances play in maintaining health. Like vitamins and minerals, phytochemicals should be obtained from a variety of plant-based foods, rather than supplements.

You Are What You Eat
Studies show that a healthy lifestyle, which includes balanced meals and regular physical activity, can play a role in reducing the risks of several chronic diseases and premature death.

Poor eating habits and lack of physical activity are risk factors for several chronic diseases among adults including:

- Obesity
- Heart disease
- Stroke
- Hypertension
- Diabetes
- Some cancers
- Osteoarthritis

​While the focus of the media is so often on weight loss, people concerned about health should focus on healthier eating habits and physical fitness for a lifetime. You can learn more about adopting a healthier lifestyle by talking to a registered dietitian and your health care provider.

Christiaan Janssens
CRO Akwa Wellness

Sources and References:
Belin, R.J., et al., Diet quality and the risk of cardiovascular disease: the Women’s Health Initiative (WHI). Am J Clin Nutr, 2011. 94(1): p. 49-57.
World Cancer Research Fund and American Institute for Cancer Research, Continuous Update Project Report Summary. Food, Nutrition, Physical Activity, and the Prevention of Colorectal Cancer, 2011.
​"Nutrition Plate Unveiled, Replacing Food Pyramid". The New York Times. 2 June 2011. 

Websites:
The Food Pyramid
​Healthy Eating Plate & Healthy Eating Pyramid
Healthy Living 2017
Healthy Eating

​Introduction
The skin is a fascinating organ, unmatched in its complexity, yet necessary for all aspects of daily life. Much of the time, the skin functions so well that we only notice it when we are uncomfortable. The skin is our interface or boundary between us and the environment and us and other people. We are always looking for new and better products, practices and solutions to the stress which everyday life places on our skin. This topic covers:

- How the Skin Functions
- Aging and Its Effects on the Skin
- How to Care for and Protect Your Skin
- Strategies for Achieving Skin Health

​How the Skin Functions
The skin is the largest single organ of the body, critical for survival, and covers an average area of 21 square feet (think of the floor area of a closet that is 4 feet deep by 5 feet wide). It is the largest organ of immunity from disease and protects by:

- Keeping water and essential nutrients inside and unwanted, toxic substances outside
- Regulating the temperature for warming and cooling
- Repairing damage from cuts, burns, environmental insults, or other trauma

The skin differs from organs like the heart or lungs because it constantly mends itself by replacing the outer layer daily. It is continually ready to respond to harm. Cuts close over, producing new, pink skin. Sunburned skin becomes dry and peels, giving way to a pink, soft, smooth, and supple replacement layer. The environmental insults signal through the surface to layers below which, in turn, begin the restoration process. The skin's outer layer is a "biological space suit" for life on earth, much like space suits protecting astronauts from the hazardous conditions in outer space.

These environmental insults include:

- Sun exposure
- Climatic changes: heat, cold, high or low humidity (moisture level in the air)
- Physical abuse: frictional forces in chafing, rubbing, weight bearing, and shaving hair from the skin
- Products like soaps, dish washing detergents, household cleaning products, paint, grease, solvents, rubbing alcohol, and cosmetics
- Skin-tight clothing
- Water in some situations: extended exposure to water has been shown to damage the skin
- Lifestyle or habits: smoking, drinking alcohol, lack of sleep

These insults, including sun exposure, can suppress the immune system which can result in skin cancer. Protection of the skin from these insults is, therefore, critical for good health.

Skin Structure
An understanding of the skin structure and function is essential for the health care consumer to provide the proper care for his/her skin. The skin has three major layers:

- Epidermis
- Dermis
- Subcutaneous tissue

Each layer has unique functions. This diagram shows a cross section:

The epidermis is the outermost layer and it directly interacts with the environment. The epidermis protects by providing a barrier to outside materials (products, water, etc.) and by filtering sunlight. The epidermis is self-renewing. It replaces itself continually, unlike any other organ of the body.
The dermis is beneath the epidermis. It contains the major structure-providing tissue fibers, collagen and elastic. It also contains the vascular system to provide a blood supply and nerve cells to process information to and from the brain.
The subcutaneous tissue contains the fat pad and muscle.

The Epidermis
Like all tissues, the epidermis is made up of cells which have specific functions in the skin. A cell called the keratinocyte makes up most of the epidermis. The functions of the stratum corneum, the middle epidermis, the basal layer, and the dermal-epidermal junction are highlighted.

​The Stratum Corneum
The stratum corneum is the outermost layer, directly in contact with the environment. It is about half the thickness of a piece of notebook paper. On average, the stratum corneum is about 20 cell layers thick. Despite its thin dimensions, the stratum corneum is incredibly strong. The cells are in a very well organized pattern.

​The stratum corneum is the outermost layer, directly in contact with the environment. It is about half the thickness of a piece of notebook paper. On average, the stratum corneum is about 20 cell layers thick. Despite its thin dimensions, the stratum corneum is incredibly strong. The cells are in a very well organized pattern.

The stratum corneum has been described as a "brick and mortar" structure, as shown here:

The cells are the bricks and the lipids are the mortar. Lipids are "oily" materials that do not easily mix with water, such as cooking oil, petroleum jelly, baby oil, and grease. The skin lipids are mixtures of materials that form a very well organized structure between the cells. The lipid layer helps keep water in the stratum corneum by limiting passage of water from beneath. The lipids also keep water and water loving substances out of the body. The stratum corneum contains water that is associated with the protein materials in the cells. The cells hold onto water to keep them flexible and to allow the body's movement without cracking the upper layer.

Neighboring stratum corneum cells are joined together through small attachments, called desmosomes. In a sense, these are like small "rivets". Each cell is attached at many points to nearby cells (cells above, beneath, adjacent). These multiple attachments provide considerable strength to this tissue.
​
​The very top layer of the stratum corneum normally comes off or "sheds", about one cell layer per day. You can observe this layer by placing a piece of clear tape and put it on the back of your hand for a few minutes. Remove the tape and notice the flaky material, which is the top layer of cells. The desmosomes need to break in order to free the cells. This process, called desquamation, is carefully programmed to occur at the proper time.

​The Middle Epidermis
Right below the bottom of the stratum corneum lies the middle epidermis. At the top, the cells are flatter than the rest of the layer. These top cells contain lipids and release them as they move upward. These lipids then become the stratum corneum lipids. The remaining cells are keratinocytes which have a cube shape and contain bundles of filaments that help protect the skin from the friction during movement and rubbing. Over time, the cells move upward to the top of the middle epidermis and eventually become stratum corneum cells. Their features change over time during this renewal and replacement process.

The Basal Layer
The basal layer rests at the bottom of the middle epidermis. The basal cells are different, however, because they actively divide to create new basal cells. The older cells move up to form the middle epidermis. All cells of the epidermis begin at this point by the process of cell division. The cell division process needs protein and other nourishment that are supplied by the functions of the dermis.

The basal layer contains a unique type of cell called the melanocyte or pigment cell. Unlike other basal cells, the melanocyte does not move upward. The melanocyte's job is to make a substance called pigment, or melanin, which contributes to the coloration of the skin. Melanocytes go into action to make melanin when ultraviolet radiation interacts with the skin. The melanin is transferred from the melanocyte to the keratinocytes of the middle epidermis, to protect the nuclei of these cells from being damaged by radiation. Dark spots on the skin, such as freckles, are clusters of epidermal keratinocytes with melanin concentrated in them. Sun tanned skin has a more uniform distribution of keratinocytes with melanin. Both conditions are the response of the skin to sun exposure.

As the name suggests, the dermal-epidermal junction is right between the epidermis and the dermis. This layer of the skin holds the epidermis onto the dermis. It provides support to the entire tissue to help hold it in place.

​Epidermal Cell Summary
The epidermis performs a wide variety of functions. Epidermal cells, or keratinocytes, move from the basal cell layer to the top of the stratum corneum in about 28 days. The specific time depends on the location on the body, the overall state of health, and the type and severity of environmental insult. The outermost layer of the stratum corneum comes off each day. When injury to the skin occurs, again from some sort of damage, the whole replenishment process works overtime to restore the skin to its proper condition and to ensure a protective barrier. In the case of serious injury, such as a major burn, the healing process requires a long time. The melanocytes, or pigment cells, housed in the bottom of the epidermis, produce melanin to protect the epidermal cells from ultraviolet damage.

The epidermis is unusual in that it does not contain nerve endings. Yet, the outer surface of our skin, the stratum corneum, can very easily detect events, including changes in heat, cold and humidity. We can also tell when the skin is touched. Even though it does not have nerve endings, the epidermis is thought to play an important role in signaling between the outside 

​The Dermis
The dermis is below the epidermis and above the subcutaneous tissue.

The epidermis is unusual in that it does not contain nerve endings. Yet, the outer surface of our skin, the stratum corneum, can very easily detect events, including changes in heat, cold and humidity. We can also tell when the skin is touched. Even though it does not have nerve endings, the epidermis is thought to play an important role in signaling between the outside world and the brain.
Collagen and elastin fibers make up a large part of the dermis. The thick fibers of collagen support the skin. Elastin fibers are very flexible and impart mechanical strength and resiliency to the skin by allowing it to stretch. When the elastin is in good condition, the skin returns to its original shape readily when it is flexed or stretched. If the elastin and collagen are in poor condition, the skin lacks resiliency, sags, and develops noticeable wrinkles.

The major functions of the dermis are to support the epidermis, to provide bulk and to anchor the skin. Importantly, the dermis contains blood vessels that bring oxygen and other nutrients to the basal layer for the cell division process. Nerve endings are also found in the dermis. Presumably they take signals from the epidermis, including the stratum corneum, and transmit them to the brain. This signaling function is unique because there are no nerve cells in the epidermis. The major parts are shown here:

​The diagram shows that the dermis has a compact array of fibrous material, the collagen and elastin, necessary for support, resistance to damage, and overall health.

Aging and Its Effects on the Skin
The effects of aging on the skin are currently of great interest. People are living longer and more active lives than ever before. The "baby boomers" are now in their 30s, 40s and 50s. They have large disposable incomes and no intention of looking old. For them, "looking good" and "feeling good" go hand in hand.

The process of skin aging process has two parts: natural aging, due to increasing chronological age, and solar aging, due to the effects of the sun.

Natural Aging
Natural aging includes all of the environmental and genetic factors that impact the skin, other than those due to solar damage. As the skin ages, the cell movement from the bottom of the epidermis (basal layer) to the top (outermost stratum corneum) becomes slower. The skin surface becomes rougher, with a more uneven texture, because the cells are shed more slowly. Often the slowed desquamation process (remember the tape on your hand experiment?) results in the formation of large clumps of cells, observed as scales or dry skin flakes. The uneven texture and scaling tend to make your skin look duller. The epidermis becomes thinner and the skin becomes more fragile.

In the dermis, the elastic fibers become coarse and then disappear. The coarseness makes them less elastic. The skin returns to its original state much more slowly when it is stretched. The blood vessels decrease in size and number. This change influences the nutrient supply to the basal layer and accounts in part for the slower rate of epidermal replenishment. Some of the factors in natural aging are determined by the genetic make up of the individual. Much more needs to be learned about specific genetic influences.

Photoaging & Sun Damage
Sunlight causes significant damage to the skin which, unfortunately, does not show up right away. In fact, many people believe sun or tanning bed exposure equals a healthy appearance and healthy skin. This "socially desirable appearance" comes at the expense of poor appearance and poor skin health as one gets older. Tanning beds provide ultraviolet radiation through special bulbs and damage the skin as much as the sun itself. Individuals who spend most of their time indoors are still exposed to damaging rays when they do go outside.

Sun damage takes two forms, photoaging and skin cancer.

The majority of a lifetime sun exposure occurs before the age of 20. Children receive three times more exposure to the sun than adults. The damage process starts early in life unless the skin is protected.

Many non-melanoma skin cancers could be prevented with proper protection from the sun.

Photoaging: The Epidermis
Ultraviolet radiation from the sun penetrates the stratum corneum. It affects the epidermal cells and causes a change in thickness. Some areas of the epidermis increase in size and others decrease to produce an irregular, non-uniform structure. The normal, orderly processes of the epidermis are disrupted. As a result, the epidermis cannot produce a proper stratum corneum. The "defective" stratum corneum is irregular and the very top layer does not slough off properly. Consequently, the skin surface texture becomes rough and irregular.

The skin pigmentation, or coloration, becomes blotchy and irregular. This happens because the melanocytes are forced, by the ultraviolet radiation of the sun, to produce pigmentation. The pigment is transferred to the keratinocytes of the middle epidermis and these spots become visible when we view the skin surface. In addition, the skin tone becomes sallow and appears to lack the vitality of a healthy state.

Photoaging: The Dermis
Sunlight breaks down the collagen and elastin fibers in the dermis. These structures become irregular. This irregularity in the dermal support tissue leads to visible wrinkles. The fibers also lose their elasticity, causing the skin to sag. Sun damage leads to chronic inflammation of the dermis. As a consequence, the epidermis does not function properly. The chronic inflammation causes the epidermis to become thicker as it attempts to repair the damage.

Levels of Photoaging
Photoaging occurs to varying levels.

In Level I, ultraviolet radiation causes changes in the epidermis only. The alterations result in a dull, rough outer layer and in pigmented spots.
In Level II, changes are caused in both the epidermis and the upper part of the dermis. Injury from the sun leads to increased wrinkling, and alterations in pigmentation and texture that are greater than those in Level I. Consequently, the skin's features are not uniform, thereby exaggerating the effects.
​In Level III, changes occur in the epidermis and throughout the dermis. The wrinkling is more pronounced and the skin texture is much less uniform, often pebbly in appearance. The skin takes on a leathery appearance.

​How to Care for and Protect Your Skin
Skin care begins with a healthy lifestyle. Strive to do the following, wherever possible: drink plenty of water, eat a balanced diet with sufficient vitamins, exercise regularly, get enough sleep, avoid smoking and the use of tanning beds, minimize alcohol consumption, and manage daily stress. Some of these lifestyle techniques are easier to sustain than others, but they represent useful goals. Care for your skin in each of the following areas.

Skin Cleansing
For daily hygiene, use a mild cleanser. Remove facial make up completely. Use lukewarm water for all cleansing. Rinse the skin thoroughly to remove cleansing materials from the skin surface. Gently pat dry and avoid rubbing.

Skin Moisturizing
In "moisturizing," water is added to the skin. Moisturized skin is more flexible than dry skin. Application of moisturizer immediately after washing helps keep water within the skin. Skin moisturizers:
1 improve hydration (moisture content)
2 add a "protective" layer on the skin surface to help hold moisture within the top layers. A large number of emollient creams and lotions are available. The protective layer provides a barrier to water loss. Therefore, water remains in the upper layers of the epidermis and makes the stratum corneum more flexible. Read product labels to check for certain ingredients. One of the most common ingredients for increasing hydration is glycerin, which holds onto water within the outer layers following application. A second type of ingredient serves as a barrier when applied to the skin. These materials include petrolatum, mineral oil, and certain plant oils. They are lipid in nature and protect the skin by minimizing water loss from the epidermis and by providing a barrier to intrusion.

​A second group of skin care materials is alpha hydroxy acids, known as the fruit acids (glycolic acid, lactic acid, etc.), and beta hydroxy acids (salicylic acid). These materials create a smoother skin surface by hydrating the surface layers and weakening and breaking the attachments between the stratum corneum cells. This process, known as exfoliation, assists in the removal of surface dry, scaly patches.

​Cancer Awareness
We advise periodic evaluations of any marks, moles, or pigmented areas by a trained health care professional. Any mole that changes in size or has an irregular border must be checked. Prevention of skin cancer involves avoiding sun damage and detecting trouble spots early. Be aware of changes in your skin and have them evaluated.

Adult Skin Care
An individual's skin care regimen should include basic elements, as well as those tailored to specific needs and lifestyles. For the early adult (20-35 years), we recommend cleansing with a non-soap product and rinsing well and moisturizing, particularly in cold weather. Application of sun screens and sun blocks on a daily basis at an SPF value of 15 is essential. For early signs of damage, such as uneven pigmentation or fine wrinkles, a retinoid product should be considered. Control of acne is often an important element.

For the middle adult years (35-65), cleansing, moisturizing, sun protection, and use of retinoids are recommended. Acne can be problematic for this group, as well as early adults and teenagers. For persistent acne, various medications and treatments are available. Individuals may consider restorative techniques, such as the chemical peel, dermabrasion, or laser resurfacing, to correct the damage caused by sun exposure.

For the older adult (over 65 years), the cleansing, moisturizing, and sun protection routines should be followed. Restorative techniques can provide noticeable improvement in skin damaged by sun exposure. Regardless of age, sun exposure should be minimized and sun screens and sun blocks applied routinely. They will prevent additional damage.

Infant Skin Care
At birth, the full-term human newborn is well-suited for life in a dry environment. The infant's skin provides an efficient and protective barrier during the transition from the water environment to life outside. The full-term infant's skin functions very well. The stratum corneum barrier protects against water loss and infection. The effective functioning of this barrier is surprising, particularly because the infant has spent nine months in a very wet environment. Nature has provided mechanisms to protect the infant's skin in utero and to allow the stratum corneum to develop properly.
For infants born prematurely, the skin barrier is immature. The more premature the infant is, the poorer the skin barrier. Poor barrier function results in high evaporative water loss, which has negative consequences for temperature control and metabolism. Infants born less than 30 weeks gestation have a significantly poorer stratum corneum barrier than those born at term and at 32-34 weeks gestation. Once the baby is born and exposed to dry conditions, the barrier forms rapidly. This maturation takes place within the first five days of life for the preterm infant of less than 27 weeks.

Bathing
For routine bathing of the infant's skin, we suggest a liquid product. Several brands are commercially available. The product should be diluted with water before it is applied. The infant should be rinsed thoroughly with water to minimize any cleanser residue left on the skin that may disrupt barrier function.

Diaper Area Care
Diaper rash is a common occurrence among infants and young children. Most of the time, the rash is relatively minor and appears as reddened areas within the diaper region. For mild irritation, we suggest cleansing the skin with warm water and a soft cloth. The skin should be dried thoroughly before diapering the baby. A hair drier on a very low setting is effective for drying the skin. At other times, particularly if the infant has been taking antibiotics and experiences diarrhea, the rash can be more severe. The area should be cleansed with warm water and a soft cloth. Apply a diaper rash product to the affected areas. This will provide a "protective" barrier between the skin and the next soiling. Use a product that is easy to cleanse away and do not rub the skin. Ideally, only remove the soiled material. Leave the remaining cream in place to avoid scrubbing the skin. Reapply the rash cream as needed. If the rash does not clear up or if it gets worse, seek medical attention.
​

Christiaan Janssens
​CRO Akwa Wellness

Sources and References:
Marks, James G; Miller, Jeffery (2006). Lookingbill and Marks' Principles of Dermatology. (4th ed.).
Proksch, E; Brandner, JM; Jensen, JM (2008). "The skin: an indispensable barrier". Experimental Dermatology. 17 (12): 1063–72.
Maton, Anthea; Jean Hopkins; Charles William McLaughlin; Susan Johnson; Maryanna Quon Warner; David LaHart; Jill D. Wright (1893). Human Biology and Health. Englewood Cliffs, New Jersey, USA: Prentice Hall.
Jablonski, N.G. (2006). Skin: a Natural History. Berkeley: University of California Press. 
Shapiro SS, Saliou C (2001). "Role of vitamins in skin care". Nutrition. 17 (10): 839–844. 
McGrath, J.A.; Eady, R.A.; Pope, F.M. (2004). Rook's Textbook of Dermatology (7th ed.). 
Martin, P. Wound Healing-aiming for perfect skin regeneration. Science (1997), 276, 75-81.

Websites:
The Aging Skin
The Human Skin
Skin Information and Facts

Asthma is an inflammatory condition of the lungs, characterized by narrowing of the airway passages. This disease is at least partially reversible if treated with appropriate medications.

Symptoms
Asthma, which is estimated to afflict over 9 million Americans, has many patterns of presentation and can occur at any age. Commonly experienced symptoms of asthma include:

• Shortness of breath
• Chest tightness
• Wheezing and coughing

Since other diseases can cause similar symptoms, it is always important to be examined by a physician.

Causes
Asthma may be caused or triggered by allergic and non-allergic factors. Allergic factors or challenges include:

• Seasonal pollens (from things like trees, grasses, and ragweed)
• Mold spores
• Dust mites
• Animal danders
• Cockroaches

Upon repeated exposure to these substances, the body forms allergic antibodies called IgE, directed toward specific allergens. An important part of evaluating allergic asthma includes skin testing to allergens to determine if any allergic antibodies are responsible for aggravating symptoms of asthma. Skin tests are always interpreted in light of the patient's history, since falsely positive tests occasionally occur.

Non-allergic factors that can trigger asthma include:

• Wood smoke and tobacco smoke
• Cold air
• Exercise
• Upper respiratory viral infections
• Abrupt changes in weather
• Strong irritants such as cleaning solutions or other fumes
• Pollutants

Patients may have a combination of allergic and non-allergic asthma. Stress and anxiety can make both forms of this disease worse.
There are some patients who develop allergic asthma after exposure to certain proteins and chemicals in their work environment. Some workers develop asthma in the workplace after exposure to irritating fumes.

Treatment
Two principles guide asthma treatment:

1. Avoidance of precipitating factors (factors that cause asthma to flare up)
2. Control of the inflammatory processes within the lungs and airways

​When possible, factors which cause asthma to flare up should be identified and avoided if at all possible. It is very important that patients with asthma learn to recognize the early warning signs and symptoms of asthma attacks, and take appropriate actions before the disease gets worse.
Patients whose symptoms are frequent (more than twice a month) and/or who have evidence of airway obstruction should take anti-inflammatory asthma medications on a regular basis. When a treatment program is recommended, it is very important that the physician's instructions be followed in order to get the most relief and best control of asthma symptoms.

If asthma should worsen in the future for whatever reason, it is very important to call a physician immediately for advice regarding required changes in your treatment. When these flares of asthma are treated early, severe asthma attacks, emergency room visits, and hospitalizations can usually be avoided.
If managed and treated properly, the vast majority of individuals with asthma can lead normal, active, and productive lives.

Christiaan Janssens
​CRO Akwa Wellness 

Sources and References:

Holgate ST. The epidemic of allergy and asthma. Nature 1999; 402 (6760 suppl): B2-4.
Strachan DP. Hay fever, hygiene, and household size.  BMJ  1989; 299: 1259-60.
Martinez FD, Holt PG. Role of microbial burden in aetiology of allergy and asthma. Lancet 1999; 354 (suppl 2): 12-15.
Moore, W.C., Meyers, D.A., Wenzel, S.E., Teague, W.G., Li, H., Li, X. et al. Identification of asthma phenotypes using cluster analysis in the Severe Asthma Research Program. Am J Respir Crit Care Med. 2010; 181: 315–323.
Ober, C. and Hoffjan, S. Asthma genetics 2006: the long and winding road to gene discovery. Genes Immun. 2006; 7: 95–100.
​
Websites:
Guidelines for Diagnosis Management of Asthma 
​Asthma: Causes, Symptoms & Treatment
Asthma - Symptoms and causes
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