Nutrition can be defined as the science that interprets the interaction of nutrients and other substances in food as well as their relationship to the maintenance, growth, reproduction, health and disease in an organism. It encompasses various stages of food intake including absorption, assimilation, biosynthesis, catabolism and excretion. The major sources of nutrients include foods, drinks, fruits, vegetables and multivitamin capsules. To ensure the preservation and retention of nutrients, foods must be prepared and stored using methods that prevent nutrients from oxidation, and that reduces risk of foodborne illnesses.

The lack of nutrients in humans is called under-nutrition or malnutrition and may result in deficiency-related diseases such as blindness, anemia, scurvy, preterm birth, stillbirth and cretinism. On the other hand, having some nutrients in excess may cause health-threatening conditions such as obesity, metabolic syndrome and chronic systemic diseases such as cardiovascular disease, diabetes and osteoporosis.

The importance of good nutrition is obvious and cannot be overemphasized. The association between good nutrition and healthy weight, reduced chronic disease risk, and overall health is also too important to be ignored. Good nutrition is a vital part of a healthy lifestyle and food choices affect mood and health. In combination with physical activity, good nutrition helps in the maintenance of a healthy weight, decreases the risk of chronic diseases such as heart disease and cancer and promotes overall health. One of the major impacts of poor nutrition is obesity; for example, about one-third of adults (33.8%) in the United States are obese and approximately 17%- about 12.5 million children and adolescents between the ages of 2 to 9 years are also obese. Irrespective of one’s body mass index, poor nutrition is associated with major health risks that can lead to morbidity or mortality. Some associated diseases include heart disease, hypertension (high blood pressure), type 2 diabetes, osteoporosis, and certain types of cancer.

The great news is, these health problems and diseases are mostly preventable by making wise food choices. It remains important to instill healthy eating habits in children who more often than not carry these habits into adulthood- teaching children how to eat healthy at a young age will more likely help them stay healthy throughout their life. Conclusively, eating healthy balanced diets, which is the only source of good nutrition gives the body the nutrients it needs to stay healthy, active, and strong.

Energy drinks are those beverages that boost or accelerate physical and mental performance. They are functional beverages that are formulated and enjoyed by a range of people especially those in need of additional mental and physical stimulation for a short period of time. Second to multivitamins, energy drinks are the most popular dietary supplement consumed worldwide particularly by teens and young adults since they are widely promoted as products that increase energy and enhance mental alertness and physical performance. Due to their function, energy drinks contain some stimulants, the most common being Caffeine. Other stimulants contained in some brands of energy drinks include guarana and ginseng which are plant-based stimulants. According to the Substance Abuse and Mental Health Services Administration (SAMHSA), the quantity of caffeine in one energy drink can range from 80mg- which is similar to the amount in one cup of coffee, to over 500mg. Energy drinks also contain high amounts of sugar, usually about 30grams in a 250 ml bottle or can.

Several studies have reported that energy drinks have negative health effects and consequences. More specifically, a 2013 study reported by Medical News Today, found that energy drinks alter the heart function of healthy adults. Additionally, another study found an association between energy drink consumption and other unhealthy behaviors, such as smoking.

Irrespective of the specific contents of energy drinks, they are generally not recommended for children, pregnant or breastfeeding women and people who are sensitive to caffeine. Energy drinks begin to act once caffeine is absorbed into the bloodstream. This happens within 10 minutes of consumption and this causes a rise in heart rate and blood pressure. Afterward, the level of caffeine in the blood stream peaks within an hour resulting in increased alertness and improved concentration. The negative effects of energy drinks are based on the fact that caffeine is a sly drug that temporarily blocks adenosine pathways. Adenosine is important because it is the chemical that communicates ones level of tiredness to the brain. As caffeine levels increase, it triggers the increased release of dopamine- the ‘feel good’ molecules in the brain. Consequently, the individual feels more alert and better about him/herself. However, caffeine withdrawal which causes headaches and tiredness can occur about 20 hours after consumption. In addition, the liver soaks up more sugar in response to energy drinks which is unhealthy.  It is noteworthy that in 2014, World Health Organization branded energy drinks a “danger to public health,” following the discovery that consuming such drinks increased.

Alcohol is a clear, colorless liquid produced by fermenting or distilling various fruits, vegetables or grains. It is a type of depressant that slows down parts of the brain affecting thinking, behavior, breathing and heart rate. Millions of men and women of all ages, from adolescents to adults, engage in alcohol use because it is legal in most countries and is an essential component of many beverages or drinks. The color of alcoholic beverages depend their ingredients and the process of fermentation or distillation employed. Fermented beverages include beer and wine, which usually have a maximum alcohol content of about 15%. Distilled beverages on the other hand, also known as hard liquor or spirit such as rum, whisky and vodka, have much higher alcohol content.

Despite being available in different forms, alcohol has the same narcotic effects and should be consumed moderately. Alcohol abuse, also known as alcohol use disorder is a pattern of alcohol use that involves problems controlling one’s drinking, causing preoccupation with alcohol and continuation of use even in the face of problems. Unhealthy and unsafe consumption of alcohol includes binge drinking and any use that puts an individual’s health or safety at risk or causes other alcohol-related problems. Individuals with alcohol use disorder exhibit patterns of drinking that result in repeated significant distress and problems in performing daily life functions. These disorders can be mild to severe; however, mild disorders have the capacity to escalate and result in serious problems, hence early treatment is crucial.

Globally, alcohol abuse is the seventh leading risk factor for injury, disease and death. Besides tobacco, alcohol accounts for higher burden of disease than any other drug- it is the major cause of preventable liver disease. Common signs and symptoms of alcohol use disorder include inability to control the amount consumed, spending too much time drinking or recovering from alcohol use, craving alcohol, failing to fulfill responsibilities at work or home or school due to alcohol use, continuing to drink alcohol even when it causes significant physical or social problems, compromising other activities and hobbies because of alcohol, using alcohol in unsafe situations such as when driving, developing a higher tolerance to alcohol and experiencing withdrawal symptoms such as nausea, sweating and shaking.

Short term effects of alcohol abuse are memory loss, hangovers, slurred speech and blackouts. Long-term effects include stomach and heart problems, addiction, intoxication, cancer, brain damage, permanent memory loss, pancreatitis, high blood pressure and cirrhosis or scarring on the liver.

Abstention from or drinking alcohol in moderation are the only ways to prevent the negative consequences that results from alcohol abuse. Drinking in moderation means having no more than one drink daily for women and not more than two for men. One drink equals:

• 1.5 ounces of liquor (like whisky, rum, or tequila)
• 5 ounces of wine
• 12 ounces of beer

Assisted Reproductive Technology (ART) refers to the treatments and procedures that are carried out in order to achieve pregnancy. These complex procedures are options for people who have infertility problems or genetic diseases and therefore require a form of assistance for a healthy and successful conception. According to Centers of Disease Control and Prevention (CDC), ART comprises all fertility treatments where eggs and embryos are handled. Generally, ART procedures involve the surgical removal of eggs from a woman’s ovaries, mixing them with sperm in the laboratory to be fertilized, and then transferring them to the woman’s, or another woman’s uterus for implantation.

There are different types of ART and some of them include:

1. Intrauterine Insemination (IUI): This is a procedure where a man’s sperm is injected into a woman’s uterus with the aid of a long, narrow and hollow tube similar to a straw. IUI is most effective for treating infertility in the following situations:  scarring or defects on the cervix, low sperm counts or mobility, erectile dysfunction, retrograde ejaculation and in couples who experience difficulty having intercourse. IUI can be used in combination with medications that stimulate ovulation to increase the chances of pregnancy. The success of IUI usually depends on the cause of infertility, use of fertility medications, age of the female and other factors that could impact the success of the cycle.
2. In-vitro Fertilization (IVF): IVF represents the most common method of ART with a higher success rate compared to others. During IVF procedure, eggs and sperm from the couple are mixed and incubated in the laboratory for fertilization to occur. Following fertilization and the subsequent production of an embryo, a health care provider places the embryo into the woman’s uterus, where it may implant and result in a successful pregnancy. Stages of IVF include superovulation, egg retrieval, fertilization and embryo transfer.
3. Third Party Assisted ART: In situations where couples do not achieve pregnancy from the above options, they may choose to use a third party–assisted ART method to get pregnant. Third party assistance can consist of one or more of the following: sperm or egg donation, surrogates or gestational carriers and embryo donation.

Despite the benefits of ART in alleviating the burden of infertility on individuals and families, it presents significant challenges to public health. ART increases the risks and rates of multiple pregnancies, preterm delivery, and low birth-weight. Multiple pregnancy babies have a much higher risk of being born prematurely, as well as having a low birth weight and disabilities. Additionally, the risk of certain complications is higher when pregnant with multiples and this requires a closer and more frequent prenatal care.

Globally, ART has presented ethical, legal, and social challenges and concerns that society must address. Many countries have therefore taken steps to regulate certain aspects of ART. Consequently, monitoring the outcomes of technologies that affect reproduction, such as contraception and ART, is an important public health activity 

Secondhand smoke can be described as any smoke from burning tobacco products, such as cigarettes, cigars, or pipes. It also includes smoke exhaled or breathed out by smokers. Tobacco smoke contains over 7,000 chemical, most of which are either toxic or carcinogenic. Non-smokers exposed to second hand smoke are referred to as involuntary or passive smokers. They inhale nicotine and toxic chemicals from tobacco the same way smokers do.  There is currently no risk-free level of exposure to second hand smoke and it affects every organ in the body. Some individuals may experience severe health problems and physical reactions may occur despite short periods or low levels of exposure. Immediate reactions including heart attack and stroke are not uncommon. Other reactions include increased heart rate, reduced supply of oxygen to the heart and narrowed blood vessels which upsurge blood pressure and cause greater burden or workload for the heart. In pregnant women, second-hand smoke may result in greater risks of miscarriages, premature birth and babies with low birth weight.

Regular exposure to second-hand smoke can cause as much harm as that found in smokers, however, the risk and severity of harm are dependent on the amount and length of exposure.

The long term effects of second-hand smoke include:

• Heart disease
• Stroke
• Nasal sinus cancer
• Lung cancer
• Breathing problems, such as coughing, wheezing, pneumonia and asthma

Secondhand smoke has been associated with cancer even in people who have never smoked. More specifically, it has been linked to certain cancers in adults such as cancers of the larynx, pharynx, brain, breast, bladder and rectum. In children, it has been associated with, lymphoma, leukemia, liver cancer and brain tumors. Additionally, several studies have found a link between second hand smoke and mental or emotional challenges such as depression. More research is however needed to better understand this link. The only way to avoid the effects of second hand smoke is by creating a smoke-free environment: making homes, work places, schools and cars smoke-free. Using air purifiers and ventilation systems will not remove all the toxins and chemicals found in second-hand smoke. These substances remain in rooms for hours, even with open windows and one can still be exposed because the particles are either suspended in air or settled on surfaces such as carpets, curtains, furniture and clothes.

To help reduce second hand smoke, some countries have laws that ban smoking in buildings, as well as public and shared spaces.

Stroke is a medical emergency which occurs when blood flow to the brain is disrupted, denying brain tissues oxygen and nutrients. In this situation, brain cells begin to die in a few minutes. It is important to take immediate action when stroke occurs so as to reduce brain damage and associated possible complications. This is because the longer stroke goes untreated, the greater the potential for brain damage and disability.

Thankfully, stroke is both preventable and treatable. Some symptoms associated with stroke include:
• Slurring of speech, difficulties communicating and comprehending
• Paralysis on one side of the body including face and some body parts
• Blurred vision in one or both eyes
• Sudden severe headache accompanied by vomiting and dizziness
• Loss of balance or coordination.

Causes of stroke include blockage of an artery and leakage or bursting of a blood vessel. In addition, some people experience a temporary disruption of blood flow to the brain which does not cause permanent brain damage.

Types of stroke depend on the causes and they include:
Ischemic stroke: Most strokes- up to 80%, fall into this category. They occur when the arteries to the brain become narrowed or blocked, causing severely reduced blood flow (ischemia). Forms of Ischemic stroke include Thrombotic and Embolic strokes.
Hemorrhagic stroke: This type of stroke occurs when a blood vessel in the brain leaks or ruptures. Brain hemorrhages result from many conditions that affect the blood vessels including hypertension, blood thinning and aneurysm. Form of hemorrhagic stroke include Intracerebral hemorrhage and Subarachnoid hemorrhage.
Transient ischemic attack (TIA): TIA- sometimes referred to as a mini-stroke, is caused by a brief decrease in blood supply to the brain lasting as short as five minutes. Similar to ischemic stroke, TIA occurs when a clot or debris blocks blood flow to part of the nervous system but there is no permanent tissue damage and no lasting symptoms. Having a TIA increases the risk of having a full-blown stroke, causing permanent damage later.

Risk factors for stroke include:
• Lifestyle factors such as physical inactivity, smoking, obesity, alcohol and drug abuse.
• Medical factors such as hypertension, high cholesterol, diabetes, sleep apnea, heart problems and personal or family history of stroke.
• Other factors such as age, race and gender.

Stroke prevention strategies focus on general, healthy lifestyle recommendations which include:
• Controlling high blood pressure (hypertension)
• Lowering the amount of cholesterol and saturated fat in your diet
• Quitting tobacco use
• Controlling diabetes
• Maintaining a healthy weight
• Eating a diet rich in fruits and vegetables
• Exercising regularly
• Drinking alcohol in moderation, if at all
• Treating obstructive sleep apnea (OSA)
• Avoiding illicit drugs

Preventive medications such as anti-platelets and anti- coagulants may be recommended and prescribed by a doctor to prevent the recurrence of a stroke.

According to World Health Organization, there are about 32.4 million myocardial infarctions and strokes worldwide every year. People who have had a previous episode of myocardial infarction (MI) or stroke are at the highest risk of having another episode. MI survivors are at increased risk of recurrent infarctions and have an annual death rate of 5 percent- 6 times that of people of the same age who do not have a history of MI. In the United States, someone suffers a heart attack every 40 seconds. A total of about 790,000 Americans suffer a heart attack yearly, and of these cases, 580,000 are a first heart attack while up to 210,000 are recurrent.

By definition, Myocardial infarction (MI), also known as heart attack is the irreversible death (necrosis) of heart muscle due to prolonged lack of oxygen supply (ischemia). MI is a medical emergency that occurs when a part of the heart muscle does not receive sufficient blood flow such that the heart muscle is unable to receive oxygen. The more the time that elapses before treatment to restore the blood flow, the greater the damage that will be done to the heart muscle- in severe cases, the affected section of the heart begins to die and this can be fatal. The major cause of heart attack is Coronary artery disease (CAD). Other causes include severe spasm which may be caused by tobacco and illicit drug use or sudden contraction of a coronary artery that can interfere with blood flow to the heart muscle. A heart attack occurs when one or more of the coronary arteries are blocked due to narrowing from the buildup of various substances, including cholesterol in a condition called atherosclerosis.

Risk factors for heart attack are those factors that contribute to atherosclerosis. They may include:

• Age
• Tobacco
• High blood pressure
• Obesity
• Diabetes
• High levels of low-density lipoprotein (LDL) blood cholesterol or triglyceride levels
• Metabolic syndrome
• Family history of heart attack
• Lack of exercise and Stress
• Use of Illicit drugs such as cocaine or amphetamines, can trigger a spasm of your coronary arteries that can cause a heart attack.
• History of preeclampsia or an autoimmune condition

There are two types of heat attack; the first is STEMI (ST-elevation myocardial infarction) where there is a complete obstruction of blood flow in a coronary artery supplying the heart with oxygen-rich blood. This results in damage to the width of the heart wall. The second type of heart attack is the Non-STEMI (Non-ST-elevation myocardial infarction) in which there is a partial obstruction of blood flow in a major coronary artery supplying the heart with oxygen-rich blood. In this case, only part of the heart wall thickness is damaged.

Medications can reduce the risk of a subsequent heart attack and help damaged heart function better. In addition, lifestyle changes such as maintaining a healthy weight, eating heart-healthy foods, quitting smoking, exercising regularly, managing stress and controlling conditions that can lead to heart attack, such as high blood pressure, high cholesterol and diabetes can prevent heart attack or its recurrence.

Arteries are blood vessels that carry blood from the heart, they are lined by a thin layer of cells called endothelium, which keep them smooth and allow blood to flow easily. Arteriosclerosis is a situation where these blood vessels that carry blood-containing oxygen and nutrients, from the heart to other parts of the body thicken and become stiff, causing restrictions in blood flow to body organs and tissues. Usually, the structure of arteries allows them to be flexible and elastic; however, the arterial walls can harden and become narrow in another condition commonly known as Atherosclerosis. In this condition, the arteries become narrowed and hardened due to a buildup of plaque around the artery wall; it is also known as arteriosclerotic vascular disease.

Similar to Atherosclerosis, Arteriosclerosis disrupts blood flow around the body, posing the risk of serious complications. It occurs when the endothelium becomes damaged, allowing harmful cholesterol to build up in walls of the artery. To fight this problem, the body sends white blood cell to flush out the cholesterol, however, these cells may become stuck at the affected site building up plaque. In extreme cases, the plaque may break open, cause blood clots and result in life-threatening complications, such as stroke and heart attack.

Risk factors for arteriosclerosis (Arteriosclerosis is the stiffening or hardening of the artery walls) and Atherosclerosis (narrowing of the artery because of plaque build-up- a specific type of arteriosclerosis) include high blood pressure, high levels of cholesterol, smoking, diabetes, air pollution, genetics,  and high levels of sugar in the blood. Symptoms of these conditions depend on whether it’s the carotid, coronary or renal arteries that are affected. General symptoms include weakness, difficulty breathing, headache, facial numbness, paralysis, vomiting, anxiety, chest pain, coughing, loss of appetite, swelling of the hands and feet and difficulty concentrating

Diagnosis and treatment of atherosclerosis are important to prevent complications. Common methods of diagnosis include:

• Blood tests which measure sugar, fat and protein content in the blood
• Physical exams used to detect plaques, weak pulse, low blood pressure, aneurysm and wounds that don’t heal properly
• Ultrasound scanner can be used to check blood pressure at distinct parts of the body- pressure changes may indicate arteries that have an obstructed blood flow.
• CT scan is used to find arteries that are hardened and narrowed.

Treatment options include lifestyle changes including maintaining a healthy weight, medications that have antiplatelet capacity and surgical interventions such as angioplasty or coronary artery bypass grafting (CABG). However, it is important that atherosclerosis is accurately diagnosed, and on time, to ensure the functions of the arteries are returned to full capability. It is always better to prevent the development of by eating a good diet, frequent exercise and not smoking.

Pruritus, also known as itchy skin, is an uncomfortable, tingling and irritating sensation that stimulates an individual to scratch. Pruritus or itchy skin can be associated with some disorders, including dry skin, skin disease, pregnancy, and rarely, cancer. It is also more common in older adults because the skin has a tendency to become drier with age. Itchy skin may appear normal, red, rough or bumpy depending on the cause or trigger. It may occur on certain small areas, such as on some parts of the arm or leg, or it can occur over the whole body. It can also occur with or without any other noticeable changes on the skin. In some cases, itchiness can last for a long time and can be intense- the more the itchy area is rubbed or scratched, the itchier it gets; And the more it itches, the more it is scratched causing an itch-scratch cycle can be very difficult to discontinue. Continuous itching can result in inflamed or swollen areas on the skin leading to wounds or infection.

Self-care and homemade measures such as moisturizing frequently, use of gentle cleansers and warm water bath can bring temporary relief. Permanent relief requires a diagnosis and treatment of the factor underlying the itchiness. The major characteristic of Pruritus is a continued urge to itch some or most parts of the body. Identified and common symptoms include redness, bumps or blisters, dry cracked skin and scaly skin.

Pruritus can be caused by pruritogens and several factors; however, it is sometimes difficult to determine the exact cause. Skin conditions such as dry skin (xerosis), eczema (dermatitis), psoriasis, scabies, insect bites, atopic dermatitis, urticaria, mastocytosis, dermatitis herpetiformis, pemphigoid and hives result in itchiness. Other factors include:

• Internal diseases: Liver disease, kidney failure, iron deficiency anemia, thyroid problems and certain cancers
• Nerve disorder: Multiple sclerosis, diabetes, pinched nerves and shingles
• Psychiatric problems: Anxiety, obsessive-compulsive disorder and depression
• Irritants and allergies: Poison ivy, parasites, cosmetics, opioids, wool, chemicals and some soap

It is important to see a dermatologist if:

• Itchy skin persists for over two weeks
• Doesn’t improve with self-care measures
• Doesn’t improve despite treatment
• Is severe and distracting
• Starts suddenly without cause
• Causes sleep interruptions
• Affects the whole body
• Is accompanied by signs and symptoms such as extreme tiredness, weight loss, changes in bowel habits, or urinary frequency, fever or redness of the skin

A physical examination and inquiries about a patient’s medical history are essential to diagnosing and treating Pruritus. Blood tests, x-rays, thyroid, liver and kidney function tests are important for diagnosis. Itchy skin treatment focuses on determining the underlying the cause of the itch and treating it. If self-care and homemade remedies don’t ease itchiness, medications may be used as prescribed by a doctor. Some medications include corticosteroid creams; ointments such as tacrolimus, pimecrolimus, capsaicin, doxepin and oral medications such as fluoxetine and sertraline. In addition to medications, light therapy (phototherapy) which involves exposing the skin to a specific type of light at several times may be used to treat Pruritus.

Insomnia is a sleep disorder characterized by difficulty falling and staying asleep, sleep interruptions at night, waking up earlier than necessary and feeling exhausted when awake. According to Centers for Disease Control and Prevention, about 50 to 70 million Americans experience some form of sleep disorder. Insomnia can sometimes lead to depression by influencing the mood and attentiveness of people who it affects. Lack of sleep can also lead to household injuries, car accidents, problems at work, marital issues, social problems, alcohol abuse and poor health. Symptoms of Insomnia include sleepiness during the day, general tiredness, irritability and problems with concentration and memory. Insomnia is caused by several factors and may include one or more of the following:

• Health problems such as pain, sleep apnea and restless legs syndrome
• Lack of sufficient physical activity
• Substance abuse
• Reactions to bad nights of sleep
• Shift work and Jet lag
• Insufficient exposure to sunlight
• Overheating the bedroom
• Emotional conditions such as stress, depression, worry and anxiety
• Poor sleep habits, such as watching TV in bed
• Lack of a regular bedtime schedule or significant physical discomfort
• Changes in sleep habits or surroundings including noise, light, or bed change
• Tobacco, alcohol, drugs, caffeine and certain medicines

There are two major types of insomnia; primary and secondary insomnia. Primary insomnia occurs when a person suffers sleep problems that are not directly associated with any other health condition. On the other hand, secondary insomnia is a situation where a person experiences sleep problems because of an underlying problem such as a health condition or factor.

Insomnia can also be categorized based on how often it occurs and how long it lasts when it occurs; these are acute and chronic Insomnia. Acute Insomnia may or may not occur frequently but lasts for a short time while chronic Insomnia occurs more frequently and lasts for a long time. Additionally, acute insomnia can last from one night to a few weeks; it can also come and go with periods of no sleep problems. Chronic Insomnia, on the other hand lasts at least three nights a week for three months or longer. Treating Insomnia focuses on the reasons and factors underlying one’s inability to sleep well. Certain personal and lifestyle changes may relieve Insomnia. These include:

• Going to bed and waking up at the same time
• Avoiding caffeine, nicotine and alcohol use hours before bedtime
• Exercising regularly
• Avoiding prolonged use of phones or devices that give off light before bed,
• Making the bedroom comfortable
• Avoiding naps at daytime

Prescription drugs and counseling can also be used, however, it is important to note that medication doesn’t work as well over time as lifestyle and behavior changes do.