| |  | Comments(0) | 1) First of all decide that you want to quit and once your mind decides that you will manage to quit smoking anyhow.
2) Whenever you feel like smoking a cigarette, take a deep breathe and inhale air and slowly exhale it. Repeat this for three times.
3) Start taking lot of fluids in your diet like, juices.
4) Try and avoid alcohol, sugar and coffee.
5) Give some time to exercising, go to gym and change your routine.
6) Take substitutes for cigarette like nicotine patches, chewing gum or herbal cigarette.
7) Go for more effective therapies like hypnotherapy.
8) Come in contact with those who are also trying to stop smoking cigarettes. They will motivate you.
9) Keep yourself busy in interesting activities and your hobbies.
10) Join some anti tobacco program or cessation programs that will help you to quit.
11) Be prepared for nicotine withdrawal symptoms.
These are the 10 ways to quit smoking that will surely help you in giving up cigarettes and get benefits of quitting smoking .
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| | | Comments(0) | 10 Ways to Lose Weight Without Dieting
Simple changes to your lifestyle can help you lose weight and keep it off.
Sure, you can lose weight quickly. There are plenty of fad diets that work to shed pounds rapidly -- while leaving you feeling hungry and deprived. But what good is losing weight only to regain it? To keep pounds off permanently, it's best to lose weight slowly. And many experts say you can do that without going on a "diet." Instead, the key is making simple tweaks to your lifestyle.
One pound of fat -- is equal to 3,500 calories. By shaving 500 calories a day through dietary and exercise modifications, you can lose about a pound a week. If you only need to maintain your current weight, shaving 100 calories a day is enough to avoid the extra 1-2 pounds most adults gain each year.
Adopt one or more of these simple, painless strategies to help lose weight without going on a "diet":
- Eat Breakfast Every Day. One habit that's common to many people who have lost weight and kept it off is eating breakfast every day. "Many people think skipping breakfast is a great way to cut calories, but they usually end up eating more throughout the day, says Elizabeth Ward, MS, RD, author of The Pocket Idiot's Guide to the New Food Pyramids. "Studies show people who eat breakfast have lower BMIs than breakfast-skippers and perform better, whether at school or in the boardroom." Try a bowl of whole-grain cereal topped with fruit and low-fat dairy for a quick and nutritious start to your day.
- Close the Kitchen at Night. Establish a time when you will stop eating so you won't give in to the late-night munchies or mindless snacking while watching television. "Have a cup of tea, suck on a piece of hard candy or enjoy a small bowl of light ice cream or frozen yogurt if you want something sweet after dinner, but then brush your teeth so you will be less likely to eat or drink anything else," suggests Elaine Magee, MPH, RD, WebMD's "Recipe Doctor" and the author of Comfort Food Makeovers.
- Choose Liquid Calories Wisely. Sweetened drinks pile on the calories, but don't reduce hunger like solid foods do. Satisfy your thirst with water, sparkling water with citrus, skim or low-fat milk, or small portions of 100% fruit juice. Try a glass of nutritious and low-calorie vegetable juice to hold you over if you get hungry between meals. Be careful of alcohol calories, which add up quickly. If you tend to drink a glass or two of wine or a cocktail on most days, limiting alcohol to the weekends can be a huge calorie saver.
- Eat More Produce. Eating lots of low-calorie, high-volume fruits and vegetables crowds out other foods that are higher in fat and calories. Move the meat off the center of your plate and pile on the vegetables. Or try starting lunch or dinner with a vegetable salad or bowl of broth-based soup, suggests Barbara Rolls, PhD, author of The Volumetrics Eating Plan. The U.S. government's 2005 Dietary Guidelines suggest that adults get 7-13 cups of produce daily. Ward says that's not really so difficult: "Stock your kitchen with plenty of fruits and vegetables and at every meal and snack, include a few servings," she says. "Your diet will be enriched with vitamins, minerals, phytonutrients, fiber, and if you fill up on super-nutritious produce, you won't be reaching for the cookie jar."
- Go for the Grain. By substituting whole grains for refined grains like white bread, cakes, cookies, and pretzels, you add much-needed fiber and will fill up faster so you're more likely to eat a reasonable portion. Choose whole-wheat breads and pastas, brown rice, bran flakes, popcorn, and whole-rye crackers.
- Control Your Environments. Another simple strategy to help cut calories is to control your environment -- everything from stocking your kitchen with lots of healthy options to choosing the right restaurants. That means avoiding the temptation by staying away from all-you-can-eat restaurants. And when it comes to parties, "eat a healthy snack before so you won't be starving, and be selective when you fill your plate at the buffet," suggests Ward. Before going back for more food, wait at least 15 minutes and have a big glass of water.
- Trim Portions. If you did nothing else but reduce your portions by 10%-20%, you would lose weight. Most of the portions served both in restaurants and at home are bigger than you need. Pull out the measuring cups to get a handle on your usual portion sizes, and work on paring them down. Get instant portion control by using small bowls, plates, and cups, says Brian Wansink, PhD, author of Mindless Eating. You won't feel deprived because the food will look plentiful on dainty dishware.
- Add More Steps. Get yourself a pedometer and gradually add more steps until you reach 10,000 per day. Throughout the day, do whatever you can to be more active -- pace while you talk on the phone, take the dog out for an extra walk, and march in place during television commercials. Having a pedometer serves as a constant motivator and reminder.
- Have Protein at Every Meal and Snack. Adding a source of lean or low-fat protein to each meal and snack will help keep you feeling full longer so you're less likely to overeat. Try low-fat yogurt, small portion of nuts, peanut butter, eggs, beans, or lean meats. Experts also recommend eating small, frequent meals and snacks (every 3-4 hours), to keep your blood sugar levels steady and to avoid overindulging.
- Switch to Lighter Alternatives. Whenever you can, use the low-fat versions of salad dressings, mayonnaise, dairy products, and other products. "You can trim calories effortlessly if you use low-fat and lighter products, and if the product is mixed in with other ingredients, no one will ever notice," says Magee. More smart substitutions: Use salsa or hummus as a dip; spread sandwiches with mustard instead of mayo; eat plain roasted sweet potatoes instead of loaded white potatoes; use skim milk instead of cream in your coffee; hold the cheese on sandwiches; and use a little vinaigrette on your salad instead of piling on the creamy dressing.
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Are you Constipated??
You are suffering from constipation if your bowel movements are infrequent, uncomfortable, and the stools are small and hard. Frequency of bowel movements varies, but regularity is important. For optimum health you should generally have one to three good bowel movements daily. It is quite surprising, however, that many people have a bowel movement only every few days, or even once a week. This is certainly not good, as decaying fecal material and toxins in your intestines can contribute to many other diseases. For your health, it is vital to get fecal material out as quickly as possible.
We firmly believe the old adage "death begins in the colon." Constipation also inhibits the flow and absorption of vital nutrients in the body, and thereby may affect one's overall health.
Prolonged bouts with constipation can lead to other health problems, such as Hemorrhoids, Varicose Veins, indigestion, Bad Breath, Headaches and Body Odor. The blockage caused by the constipation forces the blood under more pressure than normal through certain veins and capillaries, causing the hemorrhoids and varicose veins.
As mentioned above, the waste matter in the colon may contain toxins, and the longer they are in your intestines the greater the chance they have to develop other diseases, such as colon and colorectal cancer. Other intestinal problems caused by constipation are diverticulosis - pouches in the intestinal walls that catch waste material and hold it while it putrefies - and diverticulitis, the swelling and inflammation of these pouches.
If you suddenly become constipated and the condition doesn't clear up within a week, consult your health care professional as you may have a potentially serious underlying medical condition. Also, if you have a sudden change in bowel habits or experience abdominal pain or bleeding, see a doctor at once.
Take this simple test to see if you have a bowel problem: if your stools float, they have enough fiber; if they sink, you don't.
Causes
Constipation has many causes. Discovering the cause will point the way toward using the appropriate remedy.
- Poor dietary habits.
- Lack of exercise and a sedentary lifestyle.
- Lack of fiber in your diet. Fiber will add bulk to your stools, stimulate proper bowel contractions, and promote healthy bacteria in the colon. A healthy colon will aid in the assimilation of nutrients. One of the problems here is the high intake of refined white flour in the modern diet. Products with refined flour have little or no fiber, and subsequently the intestines have nothing to help the normal wave-like (peristalsis) motion pass digested material through the body. However, make sure you drink water, too, as the fiber will absorb water like a sponge and cause constipation.
- An insufficient amount of fluid intake. In this case, coffee, tea and sodas do not count and can actually exacerbate the problem. Drinking 8 eight ounce glasses of water is recommended for everyone, not just those with constipation. Constipation is a sign of chronic dehydration. One of the main functions of the large intestine is to take excess water out of the excrement so that it is not too loose. When the body does not consume enough water, the excrement becomes hardened, leading to constipation.
- Avoid ice-cold drinks as they reduce the digestive process.
- Many of today's over-the-counter laxatives may cause you even more problems than the constipation, such as killing friendly intestinal bacteria, lessening the absorption of nutrients and/or getting rid of necessary vitamins, and creating addicts out of users. They are easy to get hooked on!
- Medications such as some of the ones used to reduce blood pressure and the cholesterol-lowering ("statin") drugs, among others.
- Bowel diseases
- Vaginitis or other vaginal ecological issues, are sometimes associated with constipation.
- Metabolic disorders
- Exposure to toxic substances, such as pesticides, insecticides and heavy metals, etc.
- Too much calcium in supplemental form can cause constipation. If you eat the normal American diet you get about 500 mg of calcium, so add only 500 mg in supplemental form if you are under 50 years old and 1,000 mg if you are over. Don't take your calcium supplement with a high fiber cereal as it may interfere with absorption.
- Some people who are anemic and take iron supplements or eat lots of iron-rich foods may become constipated due to poor mineral absorption. In many cases the anemia is caused by low stomach acidity which can cause poor absorption of iron and other nutrients.
- Poor liver function. The liver, which produces about a liter of bile a day to help digestion, removes the toxins from our body, and may become congested by exposure to toxic substances, alcohol, prescription or recreational drugs, or hepatitis. Nutrients that can spur better liver function include: choline, dandelion, milk thistle (silymarin), turmeric and artichoke. A liver flush would be beneficial.
- Lack of certain digestive enzymes produced by the pancreas. This problem often occurs as we age.
- Having Heartburn, indigestion or Gas may be indicative of low stomach acidity. As we age we under-produce hydrochloric acid and pepsin which are important in the digestive process. Also, have a hair analysis done, which will indicate your mineral levels. Many people with low stomach acidity are also low in minerals. Once you have the hair analysis report back, a healthcare practitioner can determine which minerals to take to bring your mineral levels back in to balance. By increasing the absorption of minerals, especially iron, you should alleviate your constipation problems. If you have had low stomach acidity problems for a long time, have yourself checked for allergies.
- Lack of certain kinds of fat in the diet may be another cause of constipation. Many people who try to avoid all fats in their diet end up with a deficiency of essential, unsaturated fats, such as the omega 3 and omega 6 fatty acids. Dry skin, scaly skin around the eyes and red eyes are other symptoms you may exhibit if you are deficient in the essential fats.
- An overdose (over time) of vitamin D
- Pregnancy
- Food allergies
- A deficiency in folic acid sometimes causes constipation.
- Endocrine problems, especially hypothyroidism, or low thyroid function. Hypothyroidism slows down many body functions, including contractions necessary to make the bowels function properly.
- Bad bathroom habits
Types of Constipation
There are two basic kinds of constipation: atonic (lazy bowel) and spastic (narrowing of the colon, with small, ribbon-like stools). For atonic constipation, a high fiber diet and increased fluid intake is recommended. Once the problem has gone away it will be necessary to retrain the bowel, as explained below. Spastic constipation may be caused by an obstruction or nervousness or anxiety. See your doctor if you can rule out the last two causes.
Wellness Program
For constipation, we suggest you try some of the remedies listed below and follow the wellness program.
As a general rule, if you are prone to being constipated you will need to make some dietary and lifestyle changes to get your bowels to function properly. Take these steps:
- Exercise. Start some sort of exercise program. Exercise brings more blood, oxygen and nutrients to the intestines which helps them function properly. Exercise, combined with recommended dietary changes and supplements, will be the foundation of your wellness program.
- Fiber (25-35 grams, the equivalent of 2-3 tablespoons, in divided doses). Fiber in general is needed to add bulk to your stool, and bran is the most effective form. Fiber will also help develop regular bowel contractions.
- Fluid (eight 8 ounce glasses daily). It has also been noted that five glasses of hot water drunk daily has been beneficial.
- Change your bathroom habits as suggested under Habits.
- Revitalize your liver function with nutrients, as mentioned above under "causes." This should be done in cases of chronic constipation or where other habits have been changed and the desired results have not occurred. Do a liver flush to clean out built-up toxins and help the liver function at optimum efficiency.
Dietary Changes
- Begin your dietary changes by eating a high-fiber diet with plenty of fresh fruits and leafy green vegetables, legumes, whole grains, nuts and seeds. This is the basis of your healthy diet and long-term wellness program. However, make sure you drink water, too, as mentioned above, as the fiber will absorb water like a sponge and cause constipation.
- Eliminate sugar and white flour from your diet. These may add to your digestion problems and be a source of constipation. The really beneficial part of wheat, the bran, has been processed out of white flour during the milling process and needs to be added back in. Take one tablespoon each of unprocessed wheat bran and wheat germ daily, as they are good sources of fiber and add bulk to your diet. Don't use bran sold as breakfast cereal, as it has been processed. Add it to cereal, soups, drinks, or other foods, depending on taste. Your body may initially have difficulty becoming accustomed to the extra fiber and you may experience gas or stomach distention. These problems will pass in a week or two. Start with a tablespoon of bran and increase the amount until you become regular. Drink plenty of liquid when you take bran as it absorbs eight times its own weight in water and needs fluid to work its magic. Your stool should become smooth and come at regular intervals. As side benefits, you may also get relief from cramps, abdominal pain, gas and heartburn.
- If you are on a low or no fat diet, add some of the essential fats, such as omega 3 or omega 6. These are important for many body functions. Start by taking one or two tablespoons of cold-pressed flaxseed oil every day. You can add it to a blender drink, such as a smoothie or shake, or in cottage cheese. Ground flaxseed can also be used as it contains mucilage which is soothing and coats the intestinal tract. It provides both bulk and softness in the stool. If you use flaxseed, be sure to drink plenty of water, too, as it can cause constipation. The omega 6 fatty acids are found in Evening Primrose Oil (take 500 mg three times daily), black currant seed oil, and Borage Seed Oil.
- Avoid constipating foods and drinks, such as white flour, cheese, fried foods, sweets, salt, beef, pasteurized milk, all junk food, wine, carbonated drinks, and coffee. Certain berries with a large amount of seeds, such as strawberries, huckleberries, raspberries and blackberries, should be avoided, too, as they have a tendency to constipate.
- For problems of constipation as well as diarrhea, it is important to maintain a good bacterial flora in the intestines so they can function properly. Overuse of laxatives, antibiotics and enemas can remove the beneficial bacteria from the intestines. Take yogurt containing live cultures, or whey, kefir or buttermilk to enhance the presence of friendly bacteria. In place of these, acidophilus tablets or lactic acid yeast can also help in this process. We strongly recommend a good probiotic supplement to restore and maintain good intestinal flora.
- Some people are allergic to wheat products, so they have to use another source of fiber, such as unbolted white, yellow corn meal or buckwheat flour. If you are unsure whether or not you are allergic to wheat, have a good allergy test done. Many people are unaware that they are allergic.
- For spastic constipation it may be necessary to decrease your fiber intake until the situation is corrected. Drink fruit and vegetable juices to get your supply of vital nutrients.
- If you have a child who has chronic constipation, milk may be the culprit because it tends to replace other solids in the diet. Cut back on the milk and add other liquids and fresh fruits and vegetables.
- One of the traditional remedies has been the use of prune juice. This is not recommended on a long term basis because it acts as a mild laxative and the intestines become dependent on it to function properly. To eliminate your constipation problem the intestines must function properly on their own. Use of prune juice doesn't allow this to happen.
- Juice fasting is one suggested way to eliminate toxins from the body and get various systems going again. There are a number of good books out on juicing.
Habits
Since you haven't been going to the bathroom on a regular basis, you will need to retrain your bowels to get into a regular habit. Follow these steps in the retraining process: 1) go to the bathroom at the same time each day, even if nothing happens; relax and don't try to force the stool; 2) don't spend more than five minutes sitting on the toilet without producing any results. If you go into the bathroom to read, remove the reading material; 3) don't suppress the urge to defecate; 4) don't strain to have a movement. Prolonged straining can injure nerves and muscles of the colon and rectum, resulting in hemorrhoids and fecal incontinence; 5) exercise at least four times per week for a minimum of twenty minutes each time; 6) stop using enemas or laxatives or other products used to relieve constipation. The idea is to make the bowel function on its own with no other aids. After a week or two with the necessary dietary and habit changes, your stools should come at a regular time and frequency.
Supplements
Folic Acid Take 60 mcg of folic acid daily. There are not dietary sources that contain enough, so supplements are necessary.
Iron If you don't get enough iron-rich food in your diet, we suggest taking chelated iron supplements for better absorption.
MSM Take MSM - methylsulfonylmethane - a natural organic sulphur, one of the essential structural minerals. It reduces inflammation and helps the digestive system work better. MSM has a soothing, healing influence on the mucous membrane that lines the GI tract.
Triphala This supplement, widely used in Ayurvedic medicine, is a mixture of three fruits which help tone the musculature of the GI system without acting as an irritant laxative. Best used regularly rather than for symptomatic treatment as it has greater benefit the longer it is used.
Vitamin B1 (Thiamin), if you have a deficiency.
Vitamin C Taking vitamin C and betaine hydrochloride or glutamic acid hydrochloride with meals will help digestion and absorption, thereby helping to alleviate the anemia and constipation.
Remedies
Folk
Apples Apples contain pectin which will add bulk to your stools and their cleansing action will encourage bowel movements. They have a laxative effect.
Apple cider vinegar As a fermented version of apples they have some of the same beneficial properties. Take two teaspoons twice a day with a glass of water.
Bananas Bananas are high in fiber and can help restore normal bowel function.
Bran Put at least 1/3 cup of bran on your cereal each morning.
Flaxseed oil Flaxseed oil is a traditional folk remedy. Take 1 to 2 tablespoonsful with lots of water right after lunch or dinner.
Flaxseed Combined with apple cider vinegar, this mixture is another remedy. Boil two cups of water and add two tablespoons of flaxseed; boil for fifteen minutes; strain off the flaxseed, leaving a jelly-like substance. Drink a cup of this on an empty stomach, adding one teaspoon of apple cider vinegar. Take daily until you get regular bowels. Flaxseed is an excellent source of essential fatty acids which are necessary for proper bowel functioning, among other benefits.
- A similar remedy is to soak 1 tablespoon of flaxseeds in 6 ounces of water and drink this mixture once or twice daily.
- Eat three or four tablespoons of ground flaxseed daily. They can be mixed in a smoothie, put on salads, or mixed with cottage cheese.
Beets Take two small beets, scrub them clean, and eat them in the morning. You should have a bowel movement 12 hours later.
Brewer's Yeast/Wheat Germ Take half a teaspoonful each of brewer's yeast and wheat germ with all meals. After several days if you haven't gotten the needed results, increase the amount by 1/4 teaspoon two or three times until you do.
Carrot juice The essential oils in carrot juice have an effect on the mucous membranes in the stomach and help get the bowels functioning properly. Take juice several times daily. This will help regain proper digestion. This is good for children, too.
Dates Soak six dates in a glass of hot water; when cool, drink the water and eat the dates.
Elderflower Drink an infusion of elderflower once daily, as needed.
Epsom or Rochelle salts Drink a mixture of one teaspoonful in a half glass of water before bed. This is very bitter, but very efficient.
Fruit Eat at least three raw fruits daily. The citrus helps promote regularity. Strawberries, prunes and spinach are laxatives.
Garlic Garlic is effective for three reasons: it soothes, cleanses and reduces inflammation. Garlic is also very rich in potassium which is essential for proper contractions of muscles, including the intestines. Without proper contractions the muscles become partially paralyzed, resulting in constipation. The potassium is also important in the body's electrolyte system. Dice some garlic and take with juice, milk, soup or honey two or three times a day. You may also cook the garlic. Garlic tablets are also effective and can be used by people who have problems digesting raw garlic. Take two tablets once or twice daily for mild cases, three times for bad cases, and up to five times daily for severe cases. The doses should be two grams each. Several cloves of raw garlic eaten in a salad or other food often produces good results quickly.
Honey Honey has mild laxative properties. Start by taking a tablespoon three times a day or add to foods or drinks.
Licorice Licorice is a laxative. Make a tea of licorice and drink before meals to enhance production of stools. Not recommended for use by pregnant women as it may increase the risk of premature delivery.
Molasses Add 1 to 2 tablespoons a day to hot cereal or mix with warm water and drink it.
Olive oil Take one tablespoonful of olive oil in the morning and one tablespoonful an hour after dinner.
Pepper Make a massage oil of black pepper, marjoram and rosemary (one drop of each in a light carrier oil) and rub into the abdominal area.
Persimmon Eat a persimmon if they are available.
Psyllium Mix one or two rounded teaspoons of psyllium seed husks in a glass of water and take after meals. This is a safe laxative.
Rhubarb helps with regularity because it is a good source of water and fiber. Adding bulk to your stool will keep your bowels moving. Use it stewed or in pies, but only the stalks. Or, take 2-3 capsules of Chinese rhubarb root at one time. Another way is to make a tea by bringing a cup of water to a boil then adding 1 2/3 teaspoons of cut dried rootstock; simmer for 3 minutes; remove to steep, covered for half an hour; drink only 1/4 to 1/2 cup. If you continue to have constipation, increase the dosage, as too little rhubarb can cause constipation. This may seem odd, but rhubarb is used for constipation and diarrhea, but in different doses.
Sauerkraut Drink an 8 ounce glass of warm sauerkraut juice followed immediately by an 8 ounce glass of grapefruit juice(unsweetened).
Senna Drink an infusion of senna once daily, as needed. Not recommended for use by pregnant women. Senna contains anthraquinone which may increase the risk of uterine contractions.
Spinach Drinking a pint of spinach juice daily has often corrected constipation in a short period of time.
Sunflower seeds Sunflower seeds promote regularity. Take a handful of raw shelled, unsalted seeds every day.
Triphala, or "three fruits" in Ayurvedic, has been used for centuries as a mild laxative, digestive tract toner and bowel cleanser. It also stimulates the liver which helps eliminate toxins from the body. Compounds in the fruits that make up triphala, known as anthraquinones, stimulate intestinal contractions which speeds the digestive process. Due to its mildness, it can be used over long periods without fear of overuse as is the case with most laxatives. If you experience diarrhea, stomach pain or nausea after taking this remedy, stop using it. Use one teaspoon of powder in 1/4 cup of water two to three times daily, or take 1,500 mg at night. Once your constipation problem has ended, either stop using triphala or cut the dose in half to maintain a healthy digestive system.
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| | | Comments(0) | What is Tourette syndrome?
Tourette syndrome (TS) is a neurological disorder characterized by repetitive, stereotyped, involuntary movements and vocalizations called tics. The disorder is named for Dr. Georges Gilles de la Tourette, the pioneering French neurologist who in 1885 first described the condition in an 86-year-old French noblewoman.
The early symptoms of TS are almost always noticed first in childhood, with the average onset between the ages of 7 and 10 years. TS occurs in people from all ethnic groups; males are affected about three to four times more often than females. It is estimated that 200,000 Americans have the most severe form of TS, and as many as one in 100 exhibit milder and less complex symptoms such as chronic motor or vocal tics or transient tics of childhood. Although TS can be a chronic condition with symptoms lasting a lifetime, most people with the condition experience their worst symptoms in their early teens, with improvement occurring in the late teens and continuing into adulthood.
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What are the symptoms?
Tics are classified as either simple or complex. Simple motor tics are sudden, brief, repetitive movements that involve a limited number of muscle groups. Some of the more common simple tics include eye blinking and other vision irregularities, facial grimacing, shoulder shrugging, and head or shoulder jerking. Simple vocalizations might include repetitive throat-clearing, sniffing, or grunting sounds. Complex tics are distinct, coordinated patterns of movements involving several muscle groups. Complex motor tics might include facial grimacing combined with a head twist and a shoulder shrug. Other complex motor tics may actually appear purposeful, including sniffing or touching objects, hopping, jumping, bending, or twisting. Simple vocal tics may include throat-clearing, sniffing/snorting, grunting, or barking. More complex vocal tics include words or phrases. Perhaps the most dramatic and disabling tics include motor movements that result in self-harm such as punching oneself in the face or vocal tics including coprolalia (uttering swear words) or echolalia (repeating the words or phrases of others). Some tics are preceded by an urge or sensation in the affected muscle group, commonly called a premonitory urge. Some with TS will describe a need to complete a tic in a certain way or a certain number of times in order to relieve the urge or decrease the sensation.
Tics are often worse with excitement or anxiety and better during calm, focused activities. Certain physical experiences can trigger or worsen tics, for example tight collars may trigger neck tics, or hearing another person sniff or throat-clear may trigger similar sounds. Tics do not go away during sleep but are often significantly diminished.
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What is the course of TS?
Tics come and go over time, varying in type, frequency, location, and severity. The first symptoms usually occur in the head and neck area and may progress to include muscles of the trunk and extremities. Motor tics generally precede the development of vocal tics and simple tics often precede complex tics. Most patients experience peak tic severity before the mid-teen years with improvement for the majority of patients in the late teen years and early adulthood. Approximately 10 percent of those affected have a progressive or disabling course that lasts into adulthood.
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Can people with TS control their tics?
Although the symptoms of TS are involuntary, some people can sometimes suppress, camouflage, or otherwise manage their tics in an effort to minimize their impact on functioning. However, people with TS often report a substantial buildup in tension when suppressing their tics to the point where they feel that the tic must be expressed. Tics in response to an environmental trigger can appear to be voluntary or purposeful but are not.
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What causes TS?
Although the cause of TS is unknown, current research points to abnormalities in certain brain regions (including the basal ganglia, frontal lobes, and cortex), the circuits that interconnect these regions, and the neurotransmitters (dopamine, serotonin, and norepinephrine) responsible for communication among nerve cells. Given the often complex presentation of TS, the cause of the disorder is likely to be equally complex.
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What disorders are associated with TS?
Many with TS experience additional neurobehavioral problems including inattention; hyperactivity and impulsivity (attention deficit hyperactivity disorder—ADHD) and related problems with reading, writing, and arithmetic; and obsessive-compulsive symptoms such as intrusive thoughts/worries and repetitive behaviors. For example, worries about dirt and germs may be associated with repetitive hand-washing, and concerns about bad things happening may be associated with ritualistic behaviors such as counting, repeating, or ordering and arranging. People with TS have also reported problems with depression or anxiety disorders, as well as other difficulties with living, that may or may not be directly related to TS. Given the range of potential complications, people with TS are best served by receiving medical care that provides a comprehensive treatment plan.
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How is TS diagnosed?
TS is a diagnosis that doctors make after verifying that the patient has had both motor and vocal tics for at least 1 year. The existence of other neurological or psychiatric conditions [1] can also help doctors arrive at a diagnosis. Common tics are not often misdiagnosed by knowledgeable clinicians. But atypical symptoms or atypical presentation (for example, onset of symptoms in adulthood) may require specific specialty expertise for diagnosis. There are no blood or laboratory tests needed for diagnosis, but neuroimaging studies, such as magnetic resonance imaging (MRI), computerized tomography (CT), and electroencephalogram (EEG) scans, or certain blood tests may be used to rule out other conditions that might be confused with TS. It is not uncommon for patients to obtain a formal diagnosis of TS only after symptoms have been present for some time. The reasons for this are many. For families and physicians unfamiliar with TS, mild and even moderate tic symptoms may be considered inconsequential, part of a developmental phase, or the result of another condition. For example, parents may think that eye blinking is related to vision problems or that sniffing is related to seasonal allergies. Many patients are self-diagnosed after they, their parents, other relatives, or friends read or hear about TS from others.
[1] These include childhood-onset involuntary movement disorders such as dystonia, or psychiatric disorders characterized by repetitive behaviors/movements (for example, stereotypic behaviors in autism and compulsive behaviors in obsessive-compulsive disorder — OCD).
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How is TS treated?
Because tic symptoms do not often cause impairment, the majority of people with TS require no medication for tic suppression. However, effective medications are available for those whose symptoms interfere with functioning. Neuroleptics are the most consistently useful medications for tic suppression; a number are available but some are more effective than others (for example, haloperidol and pimozide). Unfortunately, there is no one medication that is helpful to all people with TS, nor does any medication completely eliminate symptoms. In addition, all medications have side effects. Most neuroleptic side effects can be managed by initiating treatment slowly and reducing the dose when side effects occur. The most common side effects of neuroleptics include sedation, weight gain, and cognitive dulling. Neurological side effects such as tremor, dystonic reactions (twisting movements or postures), parkinsonian-like symptoms, and other dyskinetic (involuntary) movements are less common and are readily managed with dose reduction. Discontinuing neuroleptics after long-term use must be done slowly to avoid rebound increases in tics and withdrawal dyskinesias. One form of withdrawal dyskinesia called tardive dyskinesia is a movement disorder distinct from TS that may result from the chronic use of neuroleptics. The risk of this side effect can be reduced by using lower doses of neuroleptics for shorter periods of time.
Other medications may also be useful for reducing tic severity, but most have not been as extensively studied or shown to be as consistently useful as neuroleptics. Additional medications with demonstrated efficacy include alpha-adrenergic agonists such as clonidine and guanfacine. These medications are used primarily for hypertension but are also used in the treatment of tics. The most common side effect from these medications that precludes their use is sedation.
Effective medications are also available to treat some of the associated neurobehavioral disorders that can occur in patients with TS. Recent research shows that stimulant medications such as methylphenidate and dextroamphetamine can lessen ADHD symptoms in people with TS without causing tics to become more severe. However, the product labeling for stimulants currently contraindicates the use of these drugs in children with tics/TS and those with a family history of tics. Scientists hope that future studies will include a thorough discussion of the risks and benefits of stimulants in those with TS or a family history of TS and will clarify this issue. For obsessive-compulsive symptoms that significantly disrupt daily functioning, the serotonin reuptake inhibitors (clomipramine, fluoxetine, fluvoxamine, paroxetine, and sertraline) have been proven effective in some patients.
Psychotherapy may also be helpful. Although psychological problems do not cause TS, such problems may result from TS. Psychotherapy can help the person with TS better cope with the disorder and deal with the secondary social and emotional problems that sometimes occur. More recently, specific behavioral treatments that include awareness training and competing response training, such as voluntarily moving in response to a premonitory urge, have shown effectiveness in small controlled trials. Larger and more definitive NIH-funded studies are underway.
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Is TS inherited?
Evidence from twin and family studies suggests that TS is an inherited disorder. Although early family studies suggested an autosomal dominant mode of inheritance (an autosomal dominant disorder is one in which only one copy of the defective gene, inherited from one parent, is necessary to produce the disorder), more recent studies suggest that the pattern of inheritance is much more complex. Although there may be a few genes with substantial effects, it is also possible that many genes with smaller effects and environmental factors may play a role in the development of TS. Genetic studies also suggest that some forms of ADHD and OCD are genetically related to TS, but there is less evidence for a genetic relationship between TS and other neurobehavioral problems that commonly co-occur with TS. It is important for families to understand that genetic predisposition may not necessarily result in full-blown TS; instead, it may express itself as a milder tic disorder or as obsessive-compulsive behaviors. It is also possible that the gene-carrying offspring will not develop any TS symptoms.
The sex of the person also plays an important role in TS gene expression. At-risk males are more likely to have tics and at-risk females are more likely to have obsessive-compulsive symptoms.
People with TS may have genetic risks for other neurobehavioral disorders such as depression or substance abuse. Genetic counseling of individuals with TS should include a full review of all potentially hereditary conditions in the family.
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What is the prognosis?
Although there is no cure for TS, the condition in many individuals improves in the late teens and early 20s. As a result, some may actually become symptom-free or no longer need medication for tic suppression. Although the disorder is generally lifelong and chronic, it is not a degenerative condition. Individuals with TS have a normal life expectancy. TS does not impair intelligence. Although tic symptoms tend to decrease with age, it is possible that neurobehavioral disorders such as depression, panic attacks, mood swings, and antisocial behaviors can persist and cause impairment in adult life.
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What is the best educational setting for children with TS?
Although students with TS often function well in the regular classroom, ADHD, learning disabilities, obsessive-compulsive symptoms, and frequent tics can greatly interfere with academic performance or social adjustment. After a comprehensive assessment, students should be placed in an educational setting that meets their individual needs. Students may require tutoring, smaller or special classes, and in some cases special schools.
All students with TS need a tolerant and compassionate setting that both encourages them to work to their full potential and is flexible enough to accommodate their special needs. This setting may include a private study area, exams outside the regular classroom, or even oral exams when the child's symptoms interfere with his or her ability to write. Untimed testing reduces stress for students with TS.
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What research is being done?
Within the Federal government, the leading supporter of research on TS and other neurological disorders is the National Institute of Neurological Disorders and Stroke (NINDS). The NINDS, a part of the National Institutes of Health (NIH), is responsible for supporting and conducting research on the brain and central nervous system.
NINDS sponsors research on TS both in its laboratories at the NIH and through grants to major medical institutions across the country. The National Institute of Mental Health, the National Center for Research Resources, the National Institute of Child Health and Human Development, the National Institute on Drug Abuse, and the National Institute on Deafness and Other Communication Disorders also support research of relevance to TS. And another component of the Department of Health and Human Services, the Centers for Disease Control and Prevention, funds professional education programs as well as TS research.
Knowledge about TS comes from studies across a number of medical and scientific disciplines, including genetics, neuroimaging, neuropathology, clinical trials (medication and non-medication), epidemiology, neurophysiology, neuroimmunology, and descriptive/diagnostic clinical science.
Genetic studies. Currently, NIH-funded investigators are conducting a variety of large-scale genetic studies. Rapid advances in the technology of gene finding will allow for genome-wide screening approaches in TS, and finding a gene or genes for TS would be a major step toward understanding genetic risk factors. In addition, understanding the genetics of TS genes will strengthen clinical diagnosis, improve genetic counseling, lead to the clarification of pathophysiology, and provide clues for more effective therapies.
Neuroimaging studies. Within the past 5 years, advances in imaging technology and an increase in trained investigators have led to an increasing use of novel and powerful techniques to identify brain regions, circuitry, and neurochemical factors important in TS and related conditions.
Neuropathology. Within the past 5 years, there has been an increase in the number and quality of donated postmortem brains from TS patients available for research purposes. This increase, coupled with advances in neuropathological techniques, has led to initial findings with implications for neuroimaging studies and animal models of TS.
Clinical trials. A number of clinical trials in TS have recently been completed or are currently underway. These include studies of stimulant treatment of ADHD in TS and behavioral treatments for reducing tic severity in children and adults. Smaller trials of novel approaches to treatment such as dopamine agonist and GABAergic medications also show promise.
Epidemiology and clinical science. Careful epidemiological studies now estimate the prevalence of TS to be substantially higher than previously thought with a wider range of clinical severity. Furthermore, clinical studies are providing new findings regarding TS and co-existing conditions. These include subtyping studies of TS and OCD, an examination of the link between ADHD and learning problems in children with TS, a new appreciation of sensory tics, and the role of co-existing disorders in rage attacks. One of the most important and controversial areas of TS science involves the relationship between TS and autoimmune brain injury associated with group A beta-hemolytic streptococcal infections or other infectious processes. There are a number of epidemiological and clinical investigations currently underway in this intriguing area.
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Where can I get more information?
For more information on neurological disorders or research programs funded by the National Institute of Neurological Disorders and Stroke, contact the Institute's Brain Resources and Information Network (BRAIN) at:
Information also is available from the following organizations:
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