Sweet disease
Your Health
DR GITA MATHAI
A waist-hip ratio (the narrowest part of your waist divided by the widest part of your hips) greater than 1 in men and 0.8 in women is risky
Vellore recently hosted an endocrinology conference that was attended by almost 1,000 physicians. The experts discussed health issues linked to various hormones, but more than half the conference was devoted to diabetes. This was not surprising. After all, we are in the midst of a global epidemic. The physicians talked about new issues, the latest advances, pancreatic islet cell transplant surgery and hopes of an eventual cure. Exciting new developments were discussed. An eminent professor has actually managed to modify insulin so that it can be injected just once a month for good sugar control. Of course, only mice have benefitted thus far, but everyone is hopeful of successful human trials in the near future.
Diabetes has affected 11 per cent of India’s urban population and 3 per cent of the rural population above the age of 15. This may be an underestimation as 30 to 40 per cent of diabetics in India go undiagnosed until complications set in.
But why do we have this predisposition to diabetes? One theory is that India survived several famines, and in the process we evolved genetically and developed a “thrifty” gene. This conserves calories and converts food into fat which is then deposited in various parts of the body. That is why Indians, even thin individuals, tend to have a “tummy”. The first place we put on weight is around the middle.
Metabolic syndrome usually occurs in people who have a close relative like a parent or sibling with diabetes. Women at risk may have polycystic ovarian syndrome (PCOS) or develop diabetes during pregnancy (gestational diabetes).
It is possible to determine if a person is at risk for developing diabetes by recording certain biometric criteria. Such an individual has elevated fasting blood sugar levels of more than 125mg/dL or a random sugar value of more than 200mg/dL. The glucose tolerance test may be impaired. The lipid profile is deranged with triglycerides greater than 150 mg/dL, and HDL cholesterol less than 40mgdL in men and 50 mg/dL in women. The blood pressure is also higher than 135/85. Those who exhibit these abnormalities are said to suffer from “metabolic syndrome” or “syndrome X”.
It is also possible to evaluate yourself using a weighing scale and measuring tape. Risk factors are a BMI (body mass index) more than 30 (BMI = weight in kilogram divided by height in metre squared), a waist to hip ratio greater than 1 in men and 0.8 in women (this is the narrowest part of your waist divided by the widest part of your hips), and a waist measurement greater than 102cm in men and 88 cm in women. These anthropometric measurements do not require medical expertise.
If three or more of the above criteria are present, the person suffers from metabolic syndrome. When checking a cross section of the population, a staggering 40 per cent of those above the age of 15 were found to be affected.
Does this mean the majority of us are doomed to become diabetic?
To prevent syndrome X, and later its progression to diabetes, first the biochemical abnormalities have to be corrected. The abnormalities occur because of insulin resistance. Normally, the food we eat is converted into glucose which enters the cells of the body to provide them with energy. In people with syndrome X, the cells are resistant to insulin. Higher amounts of insulin have to be secreted to force the glucose to enter the cells. Eventually, the body is unable to produce enough insulin to do this and diabetes sets in.
Tackling the insulin resistance attacks the beginning of syndrome X. The most effective way to do this is to achieve and maintain the ideal body weight or a BMI of 23.
Aerobic activities like walking as little as 30 minutes every day will reduce insulin resistance. This has to be at a brisk pace, fast enough to prevent conversation except in short bursts. Ideally a pace of 4km/hr should be maintained. Although this is just about sufficient for fitness, an hour of walking, combined with caloric restriction (1,500 calories), is ideal. Cycling or swimming can be done instead.
If time is a constraint, climb stairs for 20 minutes. Weight lifting and other gym exercises increase strength and flexibility but do not help control syndrome X unless they are combined with aerobic activity. Also, exercises for spot reduction of abdominal fat alone, attempting to correct an abnormal waist-hip ratio, without overall weight loss do not work.
Caloric restriction can be achieved by reducing the amount eaten during each meal by 25 per cent. Reading, watching television and other mind diverting activities during meal times increases caloric intake. Also, fill up on fruits and vegetables and avoid snacking. Oils add hidden calories to food. Consumption should be restricted to 500 ml per person a month.
Healthy eating and the habit of regular exercise should be ingrained in children by parents.
Dr Gita Mathai is a paediatrician with a family practice at Vellore. Questions on health issues may be emailed to her at yourhealthgm@yahoo.co.in
Tuesday, December 28, 2010
Monday, December 13, 2010
coughs and colds
eason of coughs and colds
YOUR HEALTH
DR GITA MATHAI
Self medication can be harmful, consult a doctor when your child is sick
In India, we enjoy four seasons — winter (January and February), summer (March to May), monsoon (June to September) and a post-monsoon period (October to December) with unseasonal rains causing an overlap amongst them. Each season has its own set of illnesses.
During winter and the rains, we often suffer from colds and coughs. People blame it on the weather — getting caught in an unexpected shower or going about on a grey, chilly day. These are unproven theories and fall in the category of urban legends.
Colds are infections caused by 200 types of viruses. With so many subtypes around, immunity is poor and infections are common.
Infection occurs when the cold virus reaches the nose. It is transported to the back of the throat in 10-15 minutes. The nasal mucous membrane attempts to wash out the virus by swelling up and increasing its secretions. This causes sneezing and a characteristic drippy nose.
Sneezing and coughing expel the viruses into the environment to infect others. The viruses can temporarily survive on furniture, walls and clothing. Hands placed on contaminated walls or furniture and then on the nose can cause infection.
During the monsoon and winter, people tend to keep windows and doors shut. As they sit close together with inadequate ventilation, colds spread rapidly.
Children under the age of one year are most susceptible. They have a little immunity passed on by their mothers while in the uterus and also through breast milk. This wanes in about six months. Later, as they come in contact with many others, especially in a closed environment like a poorly ventilated classroom, the number of initial infections proportionately increases. This causes a dramatic increase in the number of fevers, colds and “lost school days”.
Children may develop eight to 10 infections a year. Each cold lasts seven to 10 days. This means around 60 days of ill health due to colds alone, leading parents to feel the child is always sick. They begin to fear the child is suffering not from recurrent illnesses due to different viruses but something more sinister like primary complex or tuberculosis. (These illnesses do not have a symptom free interval — the child is continuously sick.)
The classic symptoms of a cold are mild fever, watery or slightly yellow nasal discharge, a scratchy feeling in the throat, cough and body ache. It is best tackled with rest. If the temperature rises above 100.5° F, or if the body ache is severe, paracetamol may be taken. Adults do not require more than 500mg and children 10-15mg/kg body weight per dose. The medicine can be repeated every four to six hours. Sore throat can be tackled with salt water gargles. Saline nose drops can be administered in each nostril every three hours. It is better to avoid decongestant chemical nose drops as they can cause rebound nasal congestion, habituation and, if used frequently for prolonged periods, atrophy of the nasal mucosa.
Anti histamines can cause drowsiness. Both anti histamines and cough suppressants can cause side effects. The prescribed dose should not be exceeded. Nor should they be used without medical supervision.
Traditional remedies like ginger tea, rasam, rice gruel and chicken soup help soothe the throat, relieve congestion and maintain hydration and nutrition.
Consult a doctor if:
■ The fever lasts more than five days
■ There are chills
■ The headache is continuous
■ There is abdominal pain or vomiting
■ There is earache
■ Breathing becomes difficult
■ There is a persistent cough
■ There is drowsiness.
In children, continuous crying or grunting must be taken seriously. Antibiotics will not shorten the course of a cold or prevent one from appearing. They need to be used if there are complications like an ear infection, sinusitis, bronchitis or pneumonia. They need to be taken in the prescribed dose. The medication should not repeated every time there is a cold without a medical opinion.
The ability to cope with a cold is better in people who keep themselves fit with regular physical aerobic exercise and breathing asanas.
Not all colds are infective. Some may be allergic rhinitis, a watery discharge from the nasal mucosa as a response to allergens like pollen, crackers, mosquito repellents, room fresheners, incense and chalk dust. Allergies are difficult to treat if the cause is not determined. The newer anti allergic nasal sprays if used regularly as directed cause the hypertrophied mucosa to shrink and the allergy to subside.
Dr Gita Mathai is a paediatrician with a family practice at Vellore. Questions on health issues may be emailed to her at yourhealthgm@yahoo.co.in
YOUR HEALTH
DR GITA MATHAI
Self medication can be harmful, consult a doctor when your child is sick
In India, we enjoy four seasons — winter (January and February), summer (March to May), monsoon (June to September) and a post-monsoon period (October to December) with unseasonal rains causing an overlap amongst them. Each season has its own set of illnesses.
During winter and the rains, we often suffer from colds and coughs. People blame it on the weather — getting caught in an unexpected shower or going about on a grey, chilly day. These are unproven theories and fall in the category of urban legends.
Colds are infections caused by 200 types of viruses. With so many subtypes around, immunity is poor and infections are common.
Infection occurs when the cold virus reaches the nose. It is transported to the back of the throat in 10-15 minutes. The nasal mucous membrane attempts to wash out the virus by swelling up and increasing its secretions. This causes sneezing and a characteristic drippy nose.
Sneezing and coughing expel the viruses into the environment to infect others. The viruses can temporarily survive on furniture, walls and clothing. Hands placed on contaminated walls or furniture and then on the nose can cause infection.
During the monsoon and winter, people tend to keep windows and doors shut. As they sit close together with inadequate ventilation, colds spread rapidly.
Children under the age of one year are most susceptible. They have a little immunity passed on by their mothers while in the uterus and also through breast milk. This wanes in about six months. Later, as they come in contact with many others, especially in a closed environment like a poorly ventilated classroom, the number of initial infections proportionately increases. This causes a dramatic increase in the number of fevers, colds and “lost school days”.
Children may develop eight to 10 infections a year. Each cold lasts seven to 10 days. This means around 60 days of ill health due to colds alone, leading parents to feel the child is always sick. They begin to fear the child is suffering not from recurrent illnesses due to different viruses but something more sinister like primary complex or tuberculosis. (These illnesses do not have a symptom free interval — the child is continuously sick.)
The classic symptoms of a cold are mild fever, watery or slightly yellow nasal discharge, a scratchy feeling in the throat, cough and body ache. It is best tackled with rest. If the temperature rises above 100.5° F, or if the body ache is severe, paracetamol may be taken. Adults do not require more than 500mg and children 10-15mg/kg body weight per dose. The medicine can be repeated every four to six hours. Sore throat can be tackled with salt water gargles. Saline nose drops can be administered in each nostril every three hours. It is better to avoid decongestant chemical nose drops as they can cause rebound nasal congestion, habituation and, if used frequently for prolonged periods, atrophy of the nasal mucosa.
Anti histamines can cause drowsiness. Both anti histamines and cough suppressants can cause side effects. The prescribed dose should not be exceeded. Nor should they be used without medical supervision.
Traditional remedies like ginger tea, rasam, rice gruel and chicken soup help soothe the throat, relieve congestion and maintain hydration and nutrition.
Consult a doctor if:
■ The fever lasts more than five days
■ There are chills
■ The headache is continuous
■ There is abdominal pain or vomiting
■ There is earache
■ Breathing becomes difficult
■ There is a persistent cough
■ There is drowsiness.
In children, continuous crying or grunting must be taken seriously. Antibiotics will not shorten the course of a cold or prevent one from appearing. They need to be used if there are complications like an ear infection, sinusitis, bronchitis or pneumonia. They need to be taken in the prescribed dose. The medication should not repeated every time there is a cold without a medical opinion.
The ability to cope with a cold is better in people who keep themselves fit with regular physical aerobic exercise and breathing asanas.
Not all colds are infective. Some may be allergic rhinitis, a watery discharge from the nasal mucosa as a response to allergens like pollen, crackers, mosquito repellents, room fresheners, incense and chalk dust. Allergies are difficult to treat if the cause is not determined. The newer anti allergic nasal sprays if used regularly as directed cause the hypertrophied mucosa to shrink and the allergy to subside.
Dr Gita Mathai is a paediatrician with a family practice at Vellore. Questions on health issues may be emailed to her at yourhealthgm@yahoo.co.in
Saturday, December 11, 2010
don't get pregnant
Don’t get pregnant
Your Health
DR GITA MATHAI
I have done something wrong,” said the young woman. No, it was not theft or murder she was confessing to but unprotected sex. An unguarded passionate moment with her boyfriend had made her pregnant. She was terrified of the stigma — the boyfriend was still a student, there was no way they could get married right away.
This is quite a common scenario in urban as well as rural India. Women increasingly face the problems of unplanned and unwanted pregnancies. It’s most important that they know how to take care of themselves, married or single.
First, women need to be in control of their bodies, especially when it comes to sexual intercourse, pregnancy and childbirth. Many safe women-oriented contraceptive methods are available.
Women become pregnant only on certain days of the month. The ovum or egg of a fertile woman is released 14 days before her next period. The egg survives 12 to 24 hours after release and the sperm for up to 72 hours. Couples may refrain from intercourse on these days if they wish to avoid pregnancy. This method, however, is not reliable as many women do not menstruate with clockwork precision.
Women may use contraceptive creams containing nonoxynol-9 in the vagina. These substances increase the effectiveness of the safe period. They are effective for about an hour. But they do not suit everyone and may cause vaginal irritation or allergic reactions. They are available in pharmacies without a prescription.
Diaphragms can be inserted prior to intercourse. These come in various sizes and need to be combined with a spermicide. An initial medical examination is needed to confirm the size. The device has to be left in the vagina for eight to 12 hours after intercourse but should be removed within 24 hours.
Women can also opt for an intrauterine contraceptive device (IUCD), popularly known as a “copper T”. These need to be inserted by a medical professional. They can work for three, five or 10 years, depending on the type and manufacturer’s recommendations. Imported devices can be purchased from the pharmacy. Also, free IUCDs are distributed by the government.
“Depo” injections of long-acting progesterone are available. A woman needs to have an injection every 12 weeks. They can cause weight gain, irregular cycles, breakthrough bleeding or spotting. The irregular periods can raise the spectre of an unwanted pregnancy.
Oral contraceptive pills (OCP) prevent pregnancy if taken regularly. There are combination pills containing estrogen and progesterone with different trade names. They are also provided free by the government (Mala D). The active ingredient is given for 21 days. Then there is a pill-free interval of seven days after which the next lot needs to be started. Sometimes placebo pills are administered during the pill-free period. They prevent pregnancy as well as regularise the cycle. They do not increase the risk of cancer.
Breast feeding women can opt for “progesterone only” pills. These are taken without a pill-free interval.
There’s a new contraceptive in the market — a plastic ring impregnated with estrogen and progesterone. The ring needs to be inserted in the vagina and left there for three weeks followed by a one week ring-free interval. A woman can purchase and insert the ring herself. An advantage of this over the pill is that the question of forgetting the latter does not arise.
Condoms can be used by the male partner. These have to be used from the beginning to the end of intercourse, and can be combined with a spermicidal cream.
Casual sex and multiple partners can result in sexually transmitted diseases. Some like Hepatitis B and HIV can eventually be fatal. Only condoms can prevent these diseases.
Even if you have had unplanned and unprotected sex, you can use emergency contraception (morning after) pills. Although theoretically these pills should be dispensed only by prescription, in many places they are available over the counter (OTC). The tablet should be taken after intercourse as soon as possible. It is 80 per cent effective if taken within 72 hours.
The morning after pill contains either progesterone or a combination of estrogen and progesterone in higher doses than in the 21 or 28-day packs of OCPs. An alternative is to take four low-dose or two “standard-dose” OCPs, and then take an equal dose 12 hours later.
If an unwanted pregnancy occurs, do not buy medicine OTC or rush to an unqualified quack out of shame or fear. Medical abortion pills are available and effective. They work up to the 49th day after the last period.
The last two are stopgap emergency measures. They are not to be considered regular methods of contraception. They are detrimental to health if repeatedly used.
Dr Gita Mathai is a paediatrician with a family practice at Vellore. Questions on health issues may be emailed to her at yourhealthgm@yahoo.co.in
Your Health
DR GITA MATHAI
I have done something wrong,” said the young woman. No, it was not theft or murder she was confessing to but unprotected sex. An unguarded passionate moment with her boyfriend had made her pregnant. She was terrified of the stigma — the boyfriend was still a student, there was no way they could get married right away.
This is quite a common scenario in urban as well as rural India. Women increasingly face the problems of unplanned and unwanted pregnancies. It’s most important that they know how to take care of themselves, married or single.
First, women need to be in control of their bodies, especially when it comes to sexual intercourse, pregnancy and childbirth. Many safe women-oriented contraceptive methods are available.
Women become pregnant only on certain days of the month. The ovum or egg of a fertile woman is released 14 days before her next period. The egg survives 12 to 24 hours after release and the sperm for up to 72 hours. Couples may refrain from intercourse on these days if they wish to avoid pregnancy. This method, however, is not reliable as many women do not menstruate with clockwork precision.
Women may use contraceptive creams containing nonoxynol-9 in the vagina. These substances increase the effectiveness of the safe period. They are effective for about an hour. But they do not suit everyone and may cause vaginal irritation or allergic reactions. They are available in pharmacies without a prescription.
Diaphragms can be inserted prior to intercourse. These come in various sizes and need to be combined with a spermicide. An initial medical examination is needed to confirm the size. The device has to be left in the vagina for eight to 12 hours after intercourse but should be removed within 24 hours.
Women can also opt for an intrauterine contraceptive device (IUCD), popularly known as a “copper T”. These need to be inserted by a medical professional. They can work for three, five or 10 years, depending on the type and manufacturer’s recommendations. Imported devices can be purchased from the pharmacy. Also, free IUCDs are distributed by the government.
“Depo” injections of long-acting progesterone are available. A woman needs to have an injection every 12 weeks. They can cause weight gain, irregular cycles, breakthrough bleeding or spotting. The irregular periods can raise the spectre of an unwanted pregnancy.
Oral contraceptive pills (OCP) prevent pregnancy if taken regularly. There are combination pills containing estrogen and progesterone with different trade names. They are also provided free by the government (Mala D). The active ingredient is given for 21 days. Then there is a pill-free interval of seven days after which the next lot needs to be started. Sometimes placebo pills are administered during the pill-free period. They prevent pregnancy as well as regularise the cycle. They do not increase the risk of cancer.
Breast feeding women can opt for “progesterone only” pills. These are taken without a pill-free interval.
There’s a new contraceptive in the market — a plastic ring impregnated with estrogen and progesterone. The ring needs to be inserted in the vagina and left there for three weeks followed by a one week ring-free interval. A woman can purchase and insert the ring herself. An advantage of this over the pill is that the question of forgetting the latter does not arise.
Condoms can be used by the male partner. These have to be used from the beginning to the end of intercourse, and can be combined with a spermicidal cream.
Casual sex and multiple partners can result in sexually transmitted diseases. Some like Hepatitis B and HIV can eventually be fatal. Only condoms can prevent these diseases.
Even if you have had unplanned and unprotected sex, you can use emergency contraception (morning after) pills. Although theoretically these pills should be dispensed only by prescription, in many places they are available over the counter (OTC). The tablet should be taken after intercourse as soon as possible. It is 80 per cent effective if taken within 72 hours.
The morning after pill contains either progesterone or a combination of estrogen and progesterone in higher doses than in the 21 or 28-day packs of OCPs. An alternative is to take four low-dose or two “standard-dose” OCPs, and then take an equal dose 12 hours later.
If an unwanted pregnancy occurs, do not buy medicine OTC or rush to an unqualified quack out of shame or fear. Medical abortion pills are available and effective. They work up to the 49th day after the last period.
The last two are stopgap emergency measures. They are not to be considered regular methods of contraception. They are detrimental to health if repeatedly used.
Dr Gita Mathai is a paediatrician with a family practice at Vellore. Questions on health issues may be emailed to her at yourhealthgm@yahoo.co.in
Saturday, November 20, 2010
red eye
Watch your eye
Your Health
DR GITA MATHAI
What do people fear most? When do they rush to a doctor? Apparently the greatest fear is death, followed by loss of vision and cancer, probably in that order. This is the reason why people rush to a doctor when anything goes wrong with their eyes.
The current epidemic of conjunctivitis (also called Madras / Delhi eye, pink / red eye, or joybangla) has people really worried. Not only is the infection uncomfortable — the eyes are red, itchy and swollen — but also it spreads like wildfire.
Conjunctivitis occurs when the transparent membrane that lines the eyelids and part of the eyeball becomes inflamed and red. This may be due to an allergy, infection, a foreign body or blocked tear duct. The redness appears because the small blood vessels in the conjunctiva react to it. If the infection is severe the conjunctiva may be swollen. The eye may then feel gritty and itchy, shed tears and have a yellow or white discharge.
Infection is often due to a seasonal bug — an adeno or influenza virus. It may be associated with a cold or sore throat. These infections are self-limiting. Cold or warm compresses applied to the eyes can be soothing. It does not really require any treatment with eye drops and clears up spontaneously in three or four days.
The discharge in bacterial conjunctivitis can be yellow and purulent (containing pus). This requires antibiotic eye drops. These are effective when applied every two or three hours. An eye ointment may be applied at night.
Infectious conjunctivitis (viral or bacterial) can spread rapidly within a classroom, home or community. Contrary to popular belief, just looking at an affected person does not cause the infection to spread. The virus or bacteria gets transferred from the infected person’s eyes on to table tops, books and other frequently used items. If an uninfected person touches a contaminated surface, and then his or her eyes, the infection is transferred. Wearing dark glasses reduces photophobia due to the infection and prevents people from touching and rubbing their own eyes.
If you develop conjunctivitis:
• Don’t touch your eyes. Don’t itch or scratch
• Wash your hands often
• Use a clean towel which must be changed daily. Don’t share towels
• Change your pillow cases everyday
• Don’t share eye cosmetics or personal eye-care items (like mascara and kajal)
• Apply a compress to your eyes by soaking a clean cloth in water and applying it gently to your closed eyelids. Don’t touch both eyes with the same cloth. This reduces the risk of spreading red eye from one eye to the other
• Clean the crusts from the eyelids with a solution of 1 part of baby shampoo to 10 parts of warm water
• Stop wearing contact lenses until the infection completely clears up.
Children with viral conjunctivitis rapidly transmit the infection to their classmates. They should stay at home if infected and return to school only when the eyes no longer have a discharge. This may take around a week.
During the process of birth, a baby’s eyes can become contaminated by organisms present in the birth canal. An antibiotic ointment or drops are usually applied soon after birth to the infant’s eyes to prevent infection. In ancient civilisations, these infections were recognised and treated by applying a few drops of expressed breast milk to the baby’s eyes. Breast milk contains high concentrations of immunoglobulin which can protect against infection.
Sometimes, the tear ducts in babies are blocked. This occurs because either they are not yet fully developed or have been partially blocked by debris during the process of birth. This causes constant tearing of the affected eye and can result in a secondary infection. It usually clears up spontaneously by the age of one year.
All cases of conjunctivitis are not caused by infection. Allergy to substances like pollen, dust or chemicals can also cause the mucous lining of the eyes and airways to respond by releasing chemicals like histamine. This can result in itchy, red and watery eyes, a running nose and sneezing.
Non-steroidal anti allergy eye drops containing sodium chromoglycate are usually all that is needed to clear this. The eyes may respond faster to over-the-counter steroid eye drops but if the diagnosis is wrong, they can cause a flare up of the infection.
Chemicals like chlorine in swimming pools or detergents in soap and shampoo can cause a conjunctivitis-like response. Flushing the eye with clean water usually cures the problem within a day.
Dust particles, saw dust and other foreign bodies can be accidentally imbedded in the eye. An eyelash may also grow inwards. Both these cause constant irritation, redness and watering. If this occurs, you need to consult an ophthalmologist.
Dr Gita Mathai is a paediatrician with a family practice at Vellore. Questions on health issues may be emailed to her at yourhealthgm@yahoo.co.in
Your Health
DR GITA MATHAI
What do people fear most? When do they rush to a doctor? Apparently the greatest fear is death, followed by loss of vision and cancer, probably in that order. This is the reason why people rush to a doctor when anything goes wrong with their eyes.
The current epidemic of conjunctivitis (also called Madras / Delhi eye, pink / red eye, or joybangla) has people really worried. Not only is the infection uncomfortable — the eyes are red, itchy and swollen — but also it spreads like wildfire.
Conjunctivitis occurs when the transparent membrane that lines the eyelids and part of the eyeball becomes inflamed and red. This may be due to an allergy, infection, a foreign body or blocked tear duct. The redness appears because the small blood vessels in the conjunctiva react to it. If the infection is severe the conjunctiva may be swollen. The eye may then feel gritty and itchy, shed tears and have a yellow or white discharge.
Infection is often due to a seasonal bug — an adeno or influenza virus. It may be associated with a cold or sore throat. These infections are self-limiting. Cold or warm compresses applied to the eyes can be soothing. It does not really require any treatment with eye drops and clears up spontaneously in three or four days.
The discharge in bacterial conjunctivitis can be yellow and purulent (containing pus). This requires antibiotic eye drops. These are effective when applied every two or three hours. An eye ointment may be applied at night.
Infectious conjunctivitis (viral or bacterial) can spread rapidly within a classroom, home or community. Contrary to popular belief, just looking at an affected person does not cause the infection to spread. The virus or bacteria gets transferred from the infected person’s eyes on to table tops, books and other frequently used items. If an uninfected person touches a contaminated surface, and then his or her eyes, the infection is transferred. Wearing dark glasses reduces photophobia due to the infection and prevents people from touching and rubbing their own eyes.
If you develop conjunctivitis:
• Don’t touch your eyes. Don’t itch or scratch
• Wash your hands often
• Use a clean towel which must be changed daily. Don’t share towels
• Change your pillow cases everyday
• Don’t share eye cosmetics or personal eye-care items (like mascara and kajal)
• Apply a compress to your eyes by soaking a clean cloth in water and applying it gently to your closed eyelids. Don’t touch both eyes with the same cloth. This reduces the risk of spreading red eye from one eye to the other
• Clean the crusts from the eyelids with a solution of 1 part of baby shampoo to 10 parts of warm water
• Stop wearing contact lenses until the infection completely clears up.
Children with viral conjunctivitis rapidly transmit the infection to their classmates. They should stay at home if infected and return to school only when the eyes no longer have a discharge. This may take around a week.
During the process of birth, a baby’s eyes can become contaminated by organisms present in the birth canal. An antibiotic ointment or drops are usually applied soon after birth to the infant’s eyes to prevent infection. In ancient civilisations, these infections were recognised and treated by applying a few drops of expressed breast milk to the baby’s eyes. Breast milk contains high concentrations of immunoglobulin which can protect against infection.
Sometimes, the tear ducts in babies are blocked. This occurs because either they are not yet fully developed or have been partially blocked by debris during the process of birth. This causes constant tearing of the affected eye and can result in a secondary infection. It usually clears up spontaneously by the age of one year.
All cases of conjunctivitis are not caused by infection. Allergy to substances like pollen, dust or chemicals can also cause the mucous lining of the eyes and airways to respond by releasing chemicals like histamine. This can result in itchy, red and watery eyes, a running nose and sneezing.
Non-steroidal anti allergy eye drops containing sodium chromoglycate are usually all that is needed to clear this. The eyes may respond faster to over-the-counter steroid eye drops but if the diagnosis is wrong, they can cause a flare up of the infection.
Chemicals like chlorine in swimming pools or detergents in soap and shampoo can cause a conjunctivitis-like response. Flushing the eye with clean water usually cures the problem within a day.
Dust particles, saw dust and other foreign bodies can be accidentally imbedded in the eye. An eyelash may also grow inwards. Both these cause constant irritation, redness and watering. If this occurs, you need to consult an ophthalmologist.
Dr Gita Mathai is a paediatrician with a family practice at Vellore. Questions on health issues may be emailed to her at yourhealthgm@yahoo.co.in
Monday, October 25, 2010
10 steps for health
10 steps to a long life
YOUR HEALTH
--------------------------------------------------------------------------------
DR GITA MATHAI
As we grow older and mature, the habit of reading the newspaper too grows. Everyday we find a wealth of information on health in newspapers, books and magazines, and wonder: what do we really need to do to stay fit?
1 Body weight
Body weight is a dynamic equation between the calories consumed and the level of activity. At all ages, we need to maintain our BMI (body mass index) — which is calculated by dividing the weight in kilograms by the height in metre squared — at 23.
Obesity (BMI over 30) is associated with a host of diseases like arthritis, diabetes, hypertension and cancer. It can be tackled by reducing the food intake and increasing the amount of exercise.
Being “size zero” with a BMI of 20 or less (underweight) may be fashionable if you are a model, but actually it’s a sign of ill health. It is associated with menstrual irregularities, poor pregnancy outcome and weak bones. Such a condition is often due to inadequate food intake. Correction of the diet will cause a weight gain. It may also be due to caries in the teeth, diabetes, thyroid problems, malabsorption, cancer and other chronic illnesses.
The number of calories needed a day varies from person to person. For weight loss it is 20 calories / kg, maintenance requires 30 calories / kg and for weight gain it is 40 calories / kg. These are approximate values and need to be adjusted according to activity levels.
2. Heart disease
Heart disease now affects men even in their thirties. Women are protected by their hormones till menopause. After that there is no difference between the sexes. You can take charge of your heart by not smoking as well as preventing exposure to second hand smoke. Include at least an hour of walking, jogging or running every day. Reduce stress with yoga or meditation.
3. Diet
The diet should be rich in vegetables, fruits, whole grains, fibre and fish (in the case of non-vegetarians). Snacking on readymade foods high in saturated fat and sodium is unhealthy.
4. Exercise
The current recommendations are an hour of aerobic activity like jogging, walking or swimming and 20 minutes of stretching or yoga every day.
5. The big C
Prevention and early detection of cancer can increase the lifespan considerably. Correct weight, regular exercise, a healthy diet, not smoking, and drinking in moderation contributes to the prevention of cancer. Hepatitis B immunisation protects against liver cancer, and HPV (human papillovirus virus) vaccine against cervical cancer. Regular “pap smear” tests, breast self examination and mammography detect cancers early in women. For men over 50, colonoscopy (in high-risk individuals) and PSA (prostate specific antigen) test should be regularly done.
6. Injuries
In India, over 80,000 persons die in road accidents annually, over 1.2 million get injured seriously and about 3,00,000 disabled permanently. Many motorbike accidents can be prevented if both the rider and pillion rider use crash helmets. While travelling in a car, everyone should use seat belts, not just on the highway but even for short distances within the city.
In the house, falls can occur on staircases and in bathrooms. These areas should be well lit. In addition, bars should be fixed in the toilet so that older people can grasp it firmly for support.
7. Master health checkups
A physical examination should be done every year, recording the height, weight, blood pressure, general condition of the heart, lungs and abdomen. The eyes and teeth should also be evaluated annually. Routine master health checkups offered by laboratories often have tests that are not required for a particular person. Some of the “package deals” may be unnecessarily expensive. It is best to go to your physician and do the tests you require. Some tests like haemoglobin, blood sugars and a lipid profile have to be repeated every year.
8. Chronic disease
If you have diabetes, kidney disease or some other chronic ailment, adhere to your diet and take your pills regularly. Keep all your follow-up appointments and do the blood tests on schedule. Complications of disease set in when patients are non-compliant.
9. Immunisations
Older people need influenza injections in September-October. The vaccine protects against the strain causing “flu” that year. When there is a pandemic (as there is this year of swine flu), that particular vaccine should also be taken. For those over 65, pneumococcal vaccine needs to be taken as a single dose.
10. Health supplements
Bone loss occurs in older people, in both men and women. Calcium supplements (around 1,200 mg a day) are needed to prevent this.
Tonics and protein supplements are not needed.
Dr Gita Mathai is a paediatrician with a family practice at Vellore. Questions on health issues may be emailed to her at yourhealthgm@yahoo.co.in
YOUR HEALTH
--------------------------------------------------------------------------------
DR GITA MATHAI
As we grow older and mature, the habit of reading the newspaper too grows. Everyday we find a wealth of information on health in newspapers, books and magazines, and wonder: what do we really need to do to stay fit?
1 Body weight
Body weight is a dynamic equation between the calories consumed and the level of activity. At all ages, we need to maintain our BMI (body mass index) — which is calculated by dividing the weight in kilograms by the height in metre squared — at 23.
Obesity (BMI over 30) is associated with a host of diseases like arthritis, diabetes, hypertension and cancer. It can be tackled by reducing the food intake and increasing the amount of exercise.
Being “size zero” with a BMI of 20 or less (underweight) may be fashionable if you are a model, but actually it’s a sign of ill health. It is associated with menstrual irregularities, poor pregnancy outcome and weak bones. Such a condition is often due to inadequate food intake. Correction of the diet will cause a weight gain. It may also be due to caries in the teeth, diabetes, thyroid problems, malabsorption, cancer and other chronic illnesses.
The number of calories needed a day varies from person to person. For weight loss it is 20 calories / kg, maintenance requires 30 calories / kg and for weight gain it is 40 calories / kg. These are approximate values and need to be adjusted according to activity levels.
2. Heart disease
Heart disease now affects men even in their thirties. Women are protected by their hormones till menopause. After that there is no difference between the sexes. You can take charge of your heart by not smoking as well as preventing exposure to second hand smoke. Include at least an hour of walking, jogging or running every day. Reduce stress with yoga or meditation.
3. Diet
The diet should be rich in vegetables, fruits, whole grains, fibre and fish (in the case of non-vegetarians). Snacking on readymade foods high in saturated fat and sodium is unhealthy.
4. Exercise
The current recommendations are an hour of aerobic activity like jogging, walking or swimming and 20 minutes of stretching or yoga every day.
5. The big C
Prevention and early detection of cancer can increase the lifespan considerably. Correct weight, regular exercise, a healthy diet, not smoking, and drinking in moderation contributes to the prevention of cancer. Hepatitis B immunisation protects against liver cancer, and HPV (human papillovirus virus) vaccine against cervical cancer. Regular “pap smear” tests, breast self examination and mammography detect cancers early in women. For men over 50, colonoscopy (in high-risk individuals) and PSA (prostate specific antigen) test should be regularly done.
6. Injuries
In India, over 80,000 persons die in road accidents annually, over 1.2 million get injured seriously and about 3,00,000 disabled permanently. Many motorbike accidents can be prevented if both the rider and pillion rider use crash helmets. While travelling in a car, everyone should use seat belts, not just on the highway but even for short distances within the city.
In the house, falls can occur on staircases and in bathrooms. These areas should be well lit. In addition, bars should be fixed in the toilet so that older people can grasp it firmly for support.
7. Master health checkups
A physical examination should be done every year, recording the height, weight, blood pressure, general condition of the heart, lungs and abdomen. The eyes and teeth should also be evaluated annually. Routine master health checkups offered by laboratories often have tests that are not required for a particular person. Some of the “package deals” may be unnecessarily expensive. It is best to go to your physician and do the tests you require. Some tests like haemoglobin, blood sugars and a lipid profile have to be repeated every year.
8. Chronic disease
If you have diabetes, kidney disease or some other chronic ailment, adhere to your diet and take your pills regularly. Keep all your follow-up appointments and do the blood tests on schedule. Complications of disease set in when patients are non-compliant.
9. Immunisations
Older people need influenza injections in September-October. The vaccine protects against the strain causing “flu” that year. When there is a pandemic (as there is this year of swine flu), that particular vaccine should also be taken. For those over 65, pneumococcal vaccine needs to be taken as a single dose.
10. Health supplements
Bone loss occurs in older people, in both men and women. Calcium supplements (around 1,200 mg a day) are needed to prevent this.
Tonics and protein supplements are not needed.
Dr Gita Mathai is a paediatrician with a family practice at Vellore. Questions on health issues may be emailed to her at yourhealthgm@yahoo.co.in
Saturday, October 9, 2010
stop dengue
Stop dengue in its tracks
Your Health
--------------------------------------------------------------------------------
DR GITA MATHAI
India has had a good monsoon this year. Rivers are flooded and stagnant water can be seen everywhere. Urbanisation has resulted in a proliferation of improperly planned cities — with slums, and poor sanitation and sewage. This has provided mosquitoes with excellent breeding grounds. The population explosion in the insects has resulted in epidemics such as dengue.
Dengue fever is caused by the Aedes egypti mosquito. Culex and Anopheles mosquitoes (which cause diseases like malaria and filaria) are nocturnal — that is, they emerge and bite at night. They can be effectively kept at bay by using mosquito nets while sleeping at night. Aedes egypti, however, is a daytime urban insect. It cannot live above 1,220m or fly more than a hundred metres. It is easily identifiable — its body is striped like that of a tiger. It lives in houses and breeds in stagnant water. This could be in flower vases, old tyres, upturned bottle caps, and even water that collects on leaves and plants.
Eradication of their breeding grounds is, therefore, a Herculean task, which cannot be achieved by the government alone. Citizens need to do their bit, awaken their civic sense and keep their neighbourhood garbage free. At home, flower vases, water cooler trays, and all sorts of open containers — including broken mugs and bottle caps — should be emptied.
The government often uses “fogs” or sprays of insecticides to reduce the population of Aedes egypti in populated areas. The sprays need to be used every eight to 10 days to interrupt the cycle of virus transmission. Also, people must leave their doors and windows open so that the insecticide can penetrate indoors, into the nooks and crannies where the mosquitoes rest. We often close all openings to prevent the “harmful chemicals” from entering inside. This negates the effects of spraying.
Once an infected mosquito bites, there is an asymptomatic incubation period of five to six days. After this, dengue sets in abruptly with headache and high fever. There is pain behind the eyes and on moving the eyes. Severe body ache makes it difficult for the person to move, giving dengue the nickname “back breaking” fever. There may be rashes on the skin and inside the mouth. There may also be bleeding into the conjunctiva of the eyes, making them appear blood shot.
After three or four days, the temperature returns to normal. But this is only a temporary respite; the fever returns a few days later with all the previous symptoms but in a milder form. Dengue is, therefore, also called “saddle back” fever.
Unfortunately, there is no specific treatment for dengue. There is no vaccination (as yet) to prevent infection or specific antiviral medication to combat the condition. Affected persons have to ride out the disease with supportive treatment, hoping for the best. Treatment is symptomatic with paracetamol for lowering the fever and fluids for hydration. Aspirin and non-steroidal anti-inflammatory agents like brufen must be avoided. Blood transfusions may have to be given if there is bleeding and shock.
The first attack of dengue usually takes a few weeks to completely recover from. Overall, the disease has a five per cent mortality. It is especially dangerous in children. The dangerous form, called dengue haemorrhagic fever, which is accompanied by shock and bleeding, occurs with subsequent infections with the virus, especially if they are of a different “serotype”.
Humans are infective during the first three days when the virus is multiplying in the blood. During this period, it’s important they lie inside a mosquito net all day and night. This is to prevent them from infecting other members of the household.
The diagnosis is made by excluding other causes of fever. Blood tests may show a low white cell count and platelets. There are, however, some confirmatory tests, like complement fixation, Elisa and an increasing number of antibodies.
Dengue is a self-limited disease. The severity of the symptoms depends on the serotype of the virus, immunological status of the host and, to some extent, genetics.
Herbal products — such as fresh leaves and extracts of neem and tulasi — are being investigated for their anti viral and immune boosting properties. The results are not conclusive. Claims and counterclaims about the efficacy of herbal products are difficult to evaluate. Double blind control studies have not yet been done to prove or disprove their efficacy.
One can prevent mosquito bites to a certain extent by wearing long-sleeved clothing, sleeping inside a mosquito net, and using mosquito meshes for windows and doors. Water should not be allowed to stagnate in containers in and around residential areas. Adding a handful of rock salt or pouring kerosene into stagnant water prevents mosquitoes from breeding.
Remember, no vaccine or specific treatment exists — the only way to escape dengue is to prevent being stung by these pesky insects.
Dr Gita Mathai is a paediatrician with a family practice at Vellore. Questions on health issues may be emailed to her at yourhealthgm@yahoo.co.in
Your Health
--------------------------------------------------------------------------------
DR GITA MATHAI
India has had a good monsoon this year. Rivers are flooded and stagnant water can be seen everywhere. Urbanisation has resulted in a proliferation of improperly planned cities — with slums, and poor sanitation and sewage. This has provided mosquitoes with excellent breeding grounds. The population explosion in the insects has resulted in epidemics such as dengue.
Dengue fever is caused by the Aedes egypti mosquito. Culex and Anopheles mosquitoes (which cause diseases like malaria and filaria) are nocturnal — that is, they emerge and bite at night. They can be effectively kept at bay by using mosquito nets while sleeping at night. Aedes egypti, however, is a daytime urban insect. It cannot live above 1,220m or fly more than a hundred metres. It is easily identifiable — its body is striped like that of a tiger. It lives in houses and breeds in stagnant water. This could be in flower vases, old tyres, upturned bottle caps, and even water that collects on leaves and plants.
Eradication of their breeding grounds is, therefore, a Herculean task, which cannot be achieved by the government alone. Citizens need to do their bit, awaken their civic sense and keep their neighbourhood garbage free. At home, flower vases, water cooler trays, and all sorts of open containers — including broken mugs and bottle caps — should be emptied.
The government often uses “fogs” or sprays of insecticides to reduce the population of Aedes egypti in populated areas. The sprays need to be used every eight to 10 days to interrupt the cycle of virus transmission. Also, people must leave their doors and windows open so that the insecticide can penetrate indoors, into the nooks and crannies where the mosquitoes rest. We often close all openings to prevent the “harmful chemicals” from entering inside. This negates the effects of spraying.
Once an infected mosquito bites, there is an asymptomatic incubation period of five to six days. After this, dengue sets in abruptly with headache and high fever. There is pain behind the eyes and on moving the eyes. Severe body ache makes it difficult for the person to move, giving dengue the nickname “back breaking” fever. There may be rashes on the skin and inside the mouth. There may also be bleeding into the conjunctiva of the eyes, making them appear blood shot.
After three or four days, the temperature returns to normal. But this is only a temporary respite; the fever returns a few days later with all the previous symptoms but in a milder form. Dengue is, therefore, also called “saddle back” fever.
Unfortunately, there is no specific treatment for dengue. There is no vaccination (as yet) to prevent infection or specific antiviral medication to combat the condition. Affected persons have to ride out the disease with supportive treatment, hoping for the best. Treatment is symptomatic with paracetamol for lowering the fever and fluids for hydration. Aspirin and non-steroidal anti-inflammatory agents like brufen must be avoided. Blood transfusions may have to be given if there is bleeding and shock.
The first attack of dengue usually takes a few weeks to completely recover from. Overall, the disease has a five per cent mortality. It is especially dangerous in children. The dangerous form, called dengue haemorrhagic fever, which is accompanied by shock and bleeding, occurs with subsequent infections with the virus, especially if they are of a different “serotype”.
Humans are infective during the first three days when the virus is multiplying in the blood. During this period, it’s important they lie inside a mosquito net all day and night. This is to prevent them from infecting other members of the household.
The diagnosis is made by excluding other causes of fever. Blood tests may show a low white cell count and platelets. There are, however, some confirmatory tests, like complement fixation, Elisa and an increasing number of antibodies.
Dengue is a self-limited disease. The severity of the symptoms depends on the serotype of the virus, immunological status of the host and, to some extent, genetics.
Herbal products — such as fresh leaves and extracts of neem and tulasi — are being investigated for their anti viral and immune boosting properties. The results are not conclusive. Claims and counterclaims about the efficacy of herbal products are difficult to evaluate. Double blind control studies have not yet been done to prove or disprove their efficacy.
One can prevent mosquito bites to a certain extent by wearing long-sleeved clothing, sleeping inside a mosquito net, and using mosquito meshes for windows and doors. Water should not be allowed to stagnate in containers in and around residential areas. Adding a handful of rock salt or pouring kerosene into stagnant water prevents mosquitoes from breeding.
Remember, no vaccine or specific treatment exists — the only way to escape dengue is to prevent being stung by these pesky insects.
Dr Gita Mathai is a paediatrician with a family practice at Vellore. Questions on health issues may be emailed to her at yourhealthgm@yahoo.co.in
Tuesday, September 28, 2010
hypertension
Don’t worry, get moving
YOUR HEALTH
DR GITA MATHAI
Hypertension or high blood pressure (BP) is like a thief who creeps in without warning in the dead of the night. That’s because the disease produces practically no symptoms.
People rarely develop giddiness, headaches or nose bleeds until the hypertension is very high. The first sign that there is something wrong may be a complication like a heart attack, stroke or ruptured aneurysm.
Blood pressure is optimal when it is 120/80 mmHg (millimetres of mercury) or less. It is considered normal even if it is 130/90 and high when it is 140/90 or more. Values of 130-140/85-99 are considered in the prehypertension category. Blood pressure needs to be monitored every two years after the age of 20 and yearly after 40.
Some kidney and adrenal gland diseases and diabetes can cause a rise in BP. It can also occur with certain medications like the oral contraceptive pill, some pain relieving medications and even decongestant cough syrups. Pregnancy may cause a peculiar type of hypertension called pre-eclampsia. In these patients, hypertension can revert to normal if the aggravating condition is tackled.
Doctors, too, can precipitate hypertension in normal people. The mere thought of a medical check-up and sight of the blood pressure apparatus can set the heart racing and blood pressure soaring. This is called “white coat hypertension”. If these people are monitored for 24 hours as they go about their daily activities, their BP is found to be normal. They do not require treatment.
Hypertension usually sets in during middle age. The exact reason is not known. Genes, the environment and upbringing count. Though it is not due to a single inherited gene, it’s more likely to occur if one or both parents are hypertensive.
Ideally, those with hypertension should monitor their BP at home to make sure it is under control. This way, they can immediately consult a doctor if it seems to be fluctuating or elevated. Wrist and cuff apparatuses are available that show automatic readings. The arm should be straight and on level with the heart while doing this.
Though a reading of 120/80 is ideal, doctors may set a target that is slightly higher in older people.
High BP should not be ignored. It must be treated and kept under control. Untreated, it makes the blood vessels thicken and less pliable. The blood supply to the brain is then affected. This can lead to loss of memory, balance, reasoning and other changes of dementia. It can cause a stroke with paralysis of parts of the body. The heart, unable to pump against high resistance, may fail or there may be a heart attack.
There are several groups of medicines to control hypertension. They should be taken exactly as advised. Timing is important – they pills should be swallowed as per schedule, even on fasts. They should not be taken in the morning one day and in the evening the next.
To prevent hypertension, and help lower the pressure once it has set in, the diet should have no high calorie snacks or junk food, be low in fat and dairy products, and rich in fruits and vegetables.
Fruits and nuts contain potassium and magnesium. The minerals balance the effect of sodium or salt in the diet. Salt causes the body to retain water and this elevates the BP. Salt consumption should be 2.5gm (1/2 tsp) per person a day. The “hidden salt” in aerated drinks, health supplements and preserved food should be taken into account. The taste for salt is developed at a very young age and depends on one’s cooking and eating habits.
A sedentary lifestyle results in a tendency to gain weight. The BMI (or body mass index — weight divided by height in metre squared) should be 23. Obesity (BMI greater than 30) increases the work of the heart and blood vessels. At least 40 to 60 minutes of active exercise should be incorporated into the every day schedule.
Tobacco in any form (gutkha, chewing tobacco, snuff, beedis and cigarettes) aggravates hypertension. When it comes to tobacco, there can be no halfway measures. Use has to be completely stopped. Alcohol, too, raises the BP. If you must drink, consumption should be limited to 60ml a day for men (two drinks) and 30ml a day for women.
Sustained stress, at home or in the workplace, also elevates the BP. Worry has never provided a solution to a problem. It just produces further problems. Exercise, deep breathing, yoga and meditation are good stress busters. Try them.
And for those who are not affected and want to remain that way, get up and get moving. Now.
Dr Gita Mathai is a paediatrician with a family practice at Vellore. Questions on health issues may be emailed to her at yourhealthgm@yahoo.co.in
YOUR HEALTH
DR GITA MATHAI
Hypertension or high blood pressure (BP) is like a thief who creeps in without warning in the dead of the night. That’s because the disease produces practically no symptoms.
People rarely develop giddiness, headaches or nose bleeds until the hypertension is very high. The first sign that there is something wrong may be a complication like a heart attack, stroke or ruptured aneurysm.
Blood pressure is optimal when it is 120/80 mmHg (millimetres of mercury) or less. It is considered normal even if it is 130/90 and high when it is 140/90 or more. Values of 130-140/85-99 are considered in the prehypertension category. Blood pressure needs to be monitored every two years after the age of 20 and yearly after 40.
Some kidney and adrenal gland diseases and diabetes can cause a rise in BP. It can also occur with certain medications like the oral contraceptive pill, some pain relieving medications and even decongestant cough syrups. Pregnancy may cause a peculiar type of hypertension called pre-eclampsia. In these patients, hypertension can revert to normal if the aggravating condition is tackled.
Doctors, too, can precipitate hypertension in normal people. The mere thought of a medical check-up and sight of the blood pressure apparatus can set the heart racing and blood pressure soaring. This is called “white coat hypertension”. If these people are monitored for 24 hours as they go about their daily activities, their BP is found to be normal. They do not require treatment.
Hypertension usually sets in during middle age. The exact reason is not known. Genes, the environment and upbringing count. Though it is not due to a single inherited gene, it’s more likely to occur if one or both parents are hypertensive.
Ideally, those with hypertension should monitor their BP at home to make sure it is under control. This way, they can immediately consult a doctor if it seems to be fluctuating or elevated. Wrist and cuff apparatuses are available that show automatic readings. The arm should be straight and on level with the heart while doing this.
Though a reading of 120/80 is ideal, doctors may set a target that is slightly higher in older people.
High BP should not be ignored. It must be treated and kept under control. Untreated, it makes the blood vessels thicken and less pliable. The blood supply to the brain is then affected. This can lead to loss of memory, balance, reasoning and other changes of dementia. It can cause a stroke with paralysis of parts of the body. The heart, unable to pump against high resistance, may fail or there may be a heart attack.
There are several groups of medicines to control hypertension. They should be taken exactly as advised. Timing is important – they pills should be swallowed as per schedule, even on fasts. They should not be taken in the morning one day and in the evening the next.
To prevent hypertension, and help lower the pressure once it has set in, the diet should have no high calorie snacks or junk food, be low in fat and dairy products, and rich in fruits and vegetables.
Fruits and nuts contain potassium and magnesium. The minerals balance the effect of sodium or salt in the diet. Salt causes the body to retain water and this elevates the BP. Salt consumption should be 2.5gm (1/2 tsp) per person a day. The “hidden salt” in aerated drinks, health supplements and preserved food should be taken into account. The taste for salt is developed at a very young age and depends on one’s cooking and eating habits.
A sedentary lifestyle results in a tendency to gain weight. The BMI (or body mass index — weight divided by height in metre squared) should be 23. Obesity (BMI greater than 30) increases the work of the heart and blood vessels. At least 40 to 60 minutes of active exercise should be incorporated into the every day schedule.
Tobacco in any form (gutkha, chewing tobacco, snuff, beedis and cigarettes) aggravates hypertension. When it comes to tobacco, there can be no halfway measures. Use has to be completely stopped. Alcohol, too, raises the BP. If you must drink, consumption should be limited to 60ml a day for men (two drinks) and 30ml a day for women.
Sustained stress, at home or in the workplace, also elevates the BP. Worry has never provided a solution to a problem. It just produces further problems. Exercise, deep breathing, yoga and meditation are good stress busters. Try them.
And for those who are not affected and want to remain that way, get up and get moving. Now.
Dr Gita Mathai is a paediatrician with a family practice at Vellore. Questions on health issues may be emailed to her at yourhealthgm@yahoo.co.in
Tuesday, September 14, 2010
fit treatment
Fit treatment
YOUR HEALTH
--------------------------------------------------------------------------------
DR GITA MATHAI
The child stared into space grimacing at bystanders. “Stop it,” said the mother, embarrassed by the responses her actions evoked. But the child ignored her, then blinked and followed her obediently. Nobody realised that the little girl had just suffered a fit of atypical epileptic seizure.
In classical epilepsy, typically, there is a cry followed by rolling up of the eyes and uncontrolled repetitive thrashing of the arms and legs. It usually lasts a few minutes after which the person falls to the ground. There may be no recollection of the event later.
To the untutored bystander, it may appear that the person has lost control of his or her body and been possessed by some “demonic force”. This is why the illness is called epilepsy, from the Greek word “seized”. But epilepsy actually occurs because of sudden unregulated rapid electrical discharges in the brain. It has nothing to do with demons, and exorcism will not help.
All seizures are not the same. Only one half the body, or even just a part — like the arms or face — may be affected. The rapid movements may resemble an uncontrolled tic or twitch. A sudden temporary interruption in the electrical pathways may affect consciousness, awareness, movements or bodily posture. This can result in unfocused staring (absence attacks), or “feelings” of jamais vu (unreality) or déjà vu (familiarity), or disturbances in vision, hearing and balance. In children, the seizures may be even more atypical. The child may just stare inattentively and blankly for a few minutes, suddenly fall forward, or start nodding.
About 2 per cent of adults have a seizure at some time in their life. Often, it is a one-off occurrence. Children are more prone to seizures, particularly when the temperature rises. Such “febrile seizures” occur during an episode of fever, in 3 to 4 per cent of otherwise normal children from the age of nine months to five years. This may recur three or four times during subsequent episodes of fever.
A person is labelled as suffering from a seizure disorder or is an “epileptic” if there have been two or more episodes in the preceding six months, without an obvious precipitating cause. Seizures can occur if:
There is a genetic predisposition (around 30 per cent of epileptics have a close relative with seizures)
The brain structure is abnormal, producing alterations in the electrical pathway. These may be developmental or acquired as a result of trauma or surgery
The person has infections of the brain like encephalitis, meningitis or abscess
There are brain tumours
There is excessive alcohol consumption or sudden withdrawal
The person uses illegal recreational drugs
There are biochemical abnormalities like low blood sugars and other metabolic or electrolyte imbalances
There are disturbances in the blood supply to the brain.
The condition may also be precipitated by physical factors such as flickering lights, sleep deprivation or music.
Seizures are investigated with blood tests, electroencephalogram (EEG), computed tomography (CT) scan and / or magnetic resonance imaging (MRI).
Seizure disorders require regular treatment with medications. These have negligible side effects and most can be taken safely during pregnancy as well. With the patient’s compliance, and correct and adequate medication, seizures are well controlled in 75 per cent of sufferers.
After regular treatment for three to five years, the medications are usually tapered off under supervision. Medication should never be abruptly discontinued or doses missed.
People with seizures can lead normal lives. Their academic performance need not suffer if the disease is managed well. However, driving, operating heavy machinery or working in areas with loud music or flickering lights should be avoided.
In women with epilepsy, fluctuating levels of natural hormones during the course of a normal menstrual cycle can cause an increase in the incidence and frequency of epileptic attacks premenstrually. Fertility is not affected by seizures.
Seizure medications (with the exception of sodium valporate) reduce the efficacy of oral contraceptives. Women with epilepsy who wish to practise contraception need a combination pill containing at least 50 mg of oestrogen. But instead of these higher dose pills, barrier contraception — such as condoms and diaphragms, or an IUCD (intra uterine contraceptive device like copper T) — may be a better option.
During pregnancy, good seizure control should be achieved for the safety of both the baby and mother. The overall risk of birth defects in epileptic women is around 7 per cent as against 3 per cent in the general population. If a woman is planning to become pregnant, she should immediately start folic acid supplements (5mg a day). Folic acid has a protective effect on the baby’s brain and spinal cord development in the first 40 days after conception.
Epilepsy is not a contraindication to breast-feeding, although small amounts of medication do cross over to breast milk. Epileptics can lead normal and productive lives if the condition is adequately controlled with proper medication.
Dr Gita Mathai is a paediatrician with a family practice at Vellore. Questions on health issues may be emailed to her at yourhealthgm@yahoo.co.in
YOUR HEALTH
--------------------------------------------------------------------------------
DR GITA MATHAI
The child stared into space grimacing at bystanders. “Stop it,” said the mother, embarrassed by the responses her actions evoked. But the child ignored her, then blinked and followed her obediently. Nobody realised that the little girl had just suffered a fit of atypical epileptic seizure.
In classical epilepsy, typically, there is a cry followed by rolling up of the eyes and uncontrolled repetitive thrashing of the arms and legs. It usually lasts a few minutes after which the person falls to the ground. There may be no recollection of the event later.
To the untutored bystander, it may appear that the person has lost control of his or her body and been possessed by some “demonic force”. This is why the illness is called epilepsy, from the Greek word “seized”. But epilepsy actually occurs because of sudden unregulated rapid electrical discharges in the brain. It has nothing to do with demons, and exorcism will not help.
All seizures are not the same. Only one half the body, or even just a part — like the arms or face — may be affected. The rapid movements may resemble an uncontrolled tic or twitch. A sudden temporary interruption in the electrical pathways may affect consciousness, awareness, movements or bodily posture. This can result in unfocused staring (absence attacks), or “feelings” of jamais vu (unreality) or déjà vu (familiarity), or disturbances in vision, hearing and balance. In children, the seizures may be even more atypical. The child may just stare inattentively and blankly for a few minutes, suddenly fall forward, or start nodding.
About 2 per cent of adults have a seizure at some time in their life. Often, it is a one-off occurrence. Children are more prone to seizures, particularly when the temperature rises. Such “febrile seizures” occur during an episode of fever, in 3 to 4 per cent of otherwise normal children from the age of nine months to five years. This may recur three or four times during subsequent episodes of fever.
A person is labelled as suffering from a seizure disorder or is an “epileptic” if there have been two or more episodes in the preceding six months, without an obvious precipitating cause. Seizures can occur if:
There is a genetic predisposition (around 30 per cent of epileptics have a close relative with seizures)
The brain structure is abnormal, producing alterations in the electrical pathway. These may be developmental or acquired as a result of trauma or surgery
The person has infections of the brain like encephalitis, meningitis or abscess
There are brain tumours
There is excessive alcohol consumption or sudden withdrawal
The person uses illegal recreational drugs
There are biochemical abnormalities like low blood sugars and other metabolic or electrolyte imbalances
There are disturbances in the blood supply to the brain.
The condition may also be precipitated by physical factors such as flickering lights, sleep deprivation or music.
Seizures are investigated with blood tests, electroencephalogram (EEG), computed tomography (CT) scan and / or magnetic resonance imaging (MRI).
Seizure disorders require regular treatment with medications. These have negligible side effects and most can be taken safely during pregnancy as well. With the patient’s compliance, and correct and adequate medication, seizures are well controlled in 75 per cent of sufferers.
After regular treatment for three to five years, the medications are usually tapered off under supervision. Medication should never be abruptly discontinued or doses missed.
People with seizures can lead normal lives. Their academic performance need not suffer if the disease is managed well. However, driving, operating heavy machinery or working in areas with loud music or flickering lights should be avoided.
In women with epilepsy, fluctuating levels of natural hormones during the course of a normal menstrual cycle can cause an increase in the incidence and frequency of epileptic attacks premenstrually. Fertility is not affected by seizures.
Seizure medications (with the exception of sodium valporate) reduce the efficacy of oral contraceptives. Women with epilepsy who wish to practise contraception need a combination pill containing at least 50 mg of oestrogen. But instead of these higher dose pills, barrier contraception — such as condoms and diaphragms, or an IUCD (intra uterine contraceptive device like copper T) — may be a better option.
During pregnancy, good seizure control should be achieved for the safety of both the baby and mother. The overall risk of birth defects in epileptic women is around 7 per cent as against 3 per cent in the general population. If a woman is planning to become pregnant, she should immediately start folic acid supplements (5mg a day). Folic acid has a protective effect on the baby’s brain and spinal cord development in the first 40 days after conception.
Epilepsy is not a contraindication to breast-feeding, although small amounts of medication do cross over to breast milk. Epileptics can lead normal and productive lives if the condition is adequately controlled with proper medication.
Dr Gita Mathai is a paediatrician with a family practice at Vellore. Questions on health issues may be emailed to her at yourhealthgm@yahoo.co.in
Tuesday, September 7, 2010
running for life
Run for your life
YOUR HEALTH
--------------------------------------------------------------------------------
DR GITA MATHAI
Fauja Singh (in foreground) shows no signs of slowing down even at 99
Last Sunday, when most of you had probably just woken up, I was running the Chennai half marathon with around 8,000 others. For me, a 58-year-old grandmother, age is certainly no bar. The only constraints are the few male louts on the road who stare, pass comments or snigger.
Children run simply for the joy of it, but in older individuals regular running confers specific health benefits. And all you need is a pair of shoes and socks.
Running (not walking) is one of the easiest ways to lose weight. An hour of this activity uses up around 500 calories. A negative balance of 3,500 calories results in loss of half a kilogram. The body metabolism also perks up, becoming more efficient. What’s more, the calories burnt while resting also increase. If running is combined with a sensible diet, appreciable changes can be seen in the weight and shape of your body in a month.
While running, the blood vessels expand and contract at three times their normal rate. This improves circulation, lowers blood pressure and reduces the risk of a stroke and heart attacks.
No one wants to look old. When you run, the muscles and bones are activated. This strengthens them, reducing the risk of weakness and osteoporosis. Running makes you fit and look young without the side effects of plastic surgery and botox.
Everyone would like to be happy all the time. Since mood-elevating drugs are illegal, and alcohol is not advisable, the easiest way to achieve this is to get a “runner’s high”. Mood elevating endorphins are released while running. Around 40-45 minutes of running elevates the mood and prevents depression for the whole day.
While running, the individual has to focus on the road, forgetting the problems of home and work. This relieves stress.
In students, running increases concentration and gives a feeling of accomplishment. Running does not reduce the time available for studies. On the contrary, it freshens the mind and builds stamina. An athletic student can study more effectively than a sedentary one.
While running we often find that roads are uneven with rocks, potholes and other hazards. Concentration, co-ordination and balance improve as a runner negotiates these obstacles. The person develops excellent control over his or her body.
The improved blood supply to the heart and lungs makes runners less prone to infections and illnesses. Even when illness strikes, recovery is quick.
People often fear that runners suffer more knee and hip injuries than others. This, however, is a myth. To get the maximum benefit from running with minimum injury, the muscles should be warmed up with a few stretches and five minutes of slow walking. Also, attention should be paid to increasing the body’s core strength. This can be achieved by doing push ups and holding the “plank” pose.
For those who have not run for many years, there are several techniques to get started. The “10 steps walk 10 steps run” routine is simple. After a week, you can increase to 20 steps run and 10 steps walk. Eventually, over a period of time, you can run the entire hour.
Couples can sometimes be seen walking in the mornings. The man is properly attired in track pants or shorts with shoes. But the woman is often seen struggling, thanks to her voluminous sari and chappals. It is better to wear a salwar kameez or track pants. You need not worry about derogatory comments from neighbours and passers by. As your health improves by leaps and bounds, diabetes and hypertension get controlled, and depression lifts, you will cease to care about popular opinion.
Shoes are important. The soles should be supportive and fitted properly. Repeated impact on the hard ground can cause heel pain, especially in an overweight individual. Slippers are dangerous as the feet can slip out while walking fast. The slipper keeps hitting the back of the heel. This isn’t very comfortable and can result in injury.
Age is considered a deterrent to running, again a fact proven wrong by the oldest marathon runner (distance: 42km) Fauja Singh (born 1911). He started running at the age of 63 and shows no signs of slowing down even at 99. The oldest female marathoner is Ida Mintz who ran till she died at the age of 85. She started running at the age of 73.
So forget all ifs and buts and start moving. Run towards health and happiness.
Dr Gita Mathai is a paediatrician with a family practice at Vellore. Questions on health issues may be emailed to her at yourhealthgm@yahoo.co.in
YOUR HEALTH
--------------------------------------------------------------------------------
DR GITA MATHAI
Fauja Singh (in foreground) shows no signs of slowing down even at 99
Last Sunday, when most of you had probably just woken up, I was running the Chennai half marathon with around 8,000 others. For me, a 58-year-old grandmother, age is certainly no bar. The only constraints are the few male louts on the road who stare, pass comments or snigger.
Children run simply for the joy of it, but in older individuals regular running confers specific health benefits. And all you need is a pair of shoes and socks.
Running (not walking) is one of the easiest ways to lose weight. An hour of this activity uses up around 500 calories. A negative balance of 3,500 calories results in loss of half a kilogram. The body metabolism also perks up, becoming more efficient. What’s more, the calories burnt while resting also increase. If running is combined with a sensible diet, appreciable changes can be seen in the weight and shape of your body in a month.
While running, the blood vessels expand and contract at three times their normal rate. This improves circulation, lowers blood pressure and reduces the risk of a stroke and heart attacks.
No one wants to look old. When you run, the muscles and bones are activated. This strengthens them, reducing the risk of weakness and osteoporosis. Running makes you fit and look young without the side effects of plastic surgery and botox.
Everyone would like to be happy all the time. Since mood-elevating drugs are illegal, and alcohol is not advisable, the easiest way to achieve this is to get a “runner’s high”. Mood elevating endorphins are released while running. Around 40-45 minutes of running elevates the mood and prevents depression for the whole day.
While running, the individual has to focus on the road, forgetting the problems of home and work. This relieves stress.
In students, running increases concentration and gives a feeling of accomplishment. Running does not reduce the time available for studies. On the contrary, it freshens the mind and builds stamina. An athletic student can study more effectively than a sedentary one.
While running we often find that roads are uneven with rocks, potholes and other hazards. Concentration, co-ordination and balance improve as a runner negotiates these obstacles. The person develops excellent control over his or her body.
The improved blood supply to the heart and lungs makes runners less prone to infections and illnesses. Even when illness strikes, recovery is quick.
People often fear that runners suffer more knee and hip injuries than others. This, however, is a myth. To get the maximum benefit from running with minimum injury, the muscles should be warmed up with a few stretches and five minutes of slow walking. Also, attention should be paid to increasing the body’s core strength. This can be achieved by doing push ups and holding the “plank” pose.
For those who have not run for many years, there are several techniques to get started. The “10 steps walk 10 steps run” routine is simple. After a week, you can increase to 20 steps run and 10 steps walk. Eventually, over a period of time, you can run the entire hour.
Couples can sometimes be seen walking in the mornings. The man is properly attired in track pants or shorts with shoes. But the woman is often seen struggling, thanks to her voluminous sari and chappals. It is better to wear a salwar kameez or track pants. You need not worry about derogatory comments from neighbours and passers by. As your health improves by leaps and bounds, diabetes and hypertension get controlled, and depression lifts, you will cease to care about popular opinion.
Shoes are important. The soles should be supportive and fitted properly. Repeated impact on the hard ground can cause heel pain, especially in an overweight individual. Slippers are dangerous as the feet can slip out while walking fast. The slipper keeps hitting the back of the heel. This isn’t very comfortable and can result in injury.
Age is considered a deterrent to running, again a fact proven wrong by the oldest marathon runner (distance: 42km) Fauja Singh (born 1911). He started running at the age of 63 and shows no signs of slowing down even at 99. The oldest female marathoner is Ida Mintz who ran till she died at the age of 85. She started running at the age of 73.
So forget all ifs and buts and start moving. Run towards health and happiness.
Dr Gita Mathai is a paediatrician with a family practice at Vellore. Questions on health issues may be emailed to her at yourhealthgm@yahoo.co.in
Friday, August 27, 2010
superbug made in india
he media have been full of stories about the “super bug from India”. The bug is actually a single-celled bacteria belonging to the Eschericia coli (E. coli) family. The species carries an enzyme called New Delhi metallo-beta—lactamase (NDM-1), which allows it to neutralise all known antibiotics and survive in their presence.
The enzyme was first isolated from a patient who had come to India for elective surgery. When he left, he took the “super bug” with him. No one knows how prevalent the organism is in India, as we do not have a centralised surveillance and reporting system that tracks hospital acquired infections and bacterial antibiotic resistance patterns.
Resistance is not a new phenomenon. Sulpha drugs and penicillin — the first antibiotics — were once hailed as “miracle” drugs. Today, they are hardly used. Overuse and misuse resulted in almost all bacteria becoming resistant to them.
If appropriate antibiotics are administered during a disease process caused by bacteria, the germs die. The host develops antibodies that help the body eliminate the weakened organisms.
E. coli has been around for thousands of years. That’s because the microorganisms developed “plasmids”, stable genetic elements composed of DNA or RNA. These help the bacteria grow resistance to chemicals and antibiotics. Once they have acquired this ability, they pass on the gene to other bacteria, even belonging to different species. Staphylococcus aureus and Klebsiella too have developed multiple drug resistance.
The outbreak of plague in Gujarat in 1994 killed hundreds. The state government realised the disease could be controlled by preventing rats from infesting human habitation and with appropriate antibiotic treatment. The situation was thus brought under control.
The spread of antibiotic resistance too can be controlled with combined concentrated effort. People are often “too busy” to consult a doctor when they are ill. The neighbourhood pharmacy then seems an attractive alternative. The man at the counter (often not a qualified pharmacist) dispenses antibiotics for coughs, colds, fever and diarrhoea. But there is often no rational or appropriate use of antibiotics.
Also, people sometimes do not complete the full course of a drug. They keep a few tablets, popping them for similar symptoms later or dispensing them to friends and relatives. A single dose may temporarily suppress the symptom. In a previously healthy person, the body’s natural defences then take over and eliminate the bacteria. The elderly or those with poor immunity become sicker, requiring the services of a qualified doctor. The bacteria, meanwhile, thrives in the presence of the antibiotic, because either they were not susceptible or the dosage was too small to be effective. Antibiotic resistance develops.
Practitioners of alternative systems of medicine prescribe and dispense antibiotics (which they are not licensed to use) inappropriately, perpetuating the problem.
At times, qualified physicians and surgeons use antibiotics prophylactically, especially after surgical procedures, to “prevent infection”. These antibiotics are eventually excreted by the body. They reach the sewage systems and seep through the earth. Bacteria are naturally present in sewage. They spread and multiply in the presence of the antibiotic.
Cattle and poultry feed are laced with antibiotics to “prevent” infection. Antibiotic resistant bacteria thrive on farms.
Everyone must play his or her part well to prevent another plague with super bugs which places the entire world population at risk.
• Take treatment only from qualified physicians
• Always buy antibiotics with a prescription, not OTC
• Complete the course in the dosage prescribed
Hygiene has to be maintained not just in the hospitals but also at home. Regularly washing hands, an elementary procedure, reduces infection and its spread.
Governments, nationally and internationally, need to maintain surveillance to monitor emerging infections and drug resistance patterns. If everyone — patients, doctors and the public — does not co-operate on a war footing, we may revert to the dark ages of the pre penicillin era. No antibiotic will work against infections and developing an infectious disease will turn out to be a death sentence.
Dr Gita Mathai is a paediatrician with a family practice at Vellore. Questions on health issues may be emailed to her at yourhealthgm@yahoo.co.in
The enzyme was first isolated from a patient who had come to India for elective surgery. When he left, he took the “super bug” with him. No one knows how prevalent the organism is in India, as we do not have a centralised surveillance and reporting system that tracks hospital acquired infections and bacterial antibiotic resistance patterns.
Resistance is not a new phenomenon. Sulpha drugs and penicillin — the first antibiotics — were once hailed as “miracle” drugs. Today, they are hardly used. Overuse and misuse resulted in almost all bacteria becoming resistant to them.
If appropriate antibiotics are administered during a disease process caused by bacteria, the germs die. The host develops antibodies that help the body eliminate the weakened organisms.
E. coli has been around for thousands of years. That’s because the microorganisms developed “plasmids”, stable genetic elements composed of DNA or RNA. These help the bacteria grow resistance to chemicals and antibiotics. Once they have acquired this ability, they pass on the gene to other bacteria, even belonging to different species. Staphylococcus aureus and Klebsiella too have developed multiple drug resistance.
The outbreak of plague in Gujarat in 1994 killed hundreds. The state government realised the disease could be controlled by preventing rats from infesting human habitation and with appropriate antibiotic treatment. The situation was thus brought under control.
The spread of antibiotic resistance too can be controlled with combined concentrated effort. People are often “too busy” to consult a doctor when they are ill. The neighbourhood pharmacy then seems an attractive alternative. The man at the counter (often not a qualified pharmacist) dispenses antibiotics for coughs, colds, fever and diarrhoea. But there is often no rational or appropriate use of antibiotics.
Also, people sometimes do not complete the full course of a drug. They keep a few tablets, popping them for similar symptoms later or dispensing them to friends and relatives. A single dose may temporarily suppress the symptom. In a previously healthy person, the body’s natural defences then take over and eliminate the bacteria. The elderly or those with poor immunity become sicker, requiring the services of a qualified doctor. The bacteria, meanwhile, thrives in the presence of the antibiotic, because either they were not susceptible or the dosage was too small to be effective. Antibiotic resistance develops.
Practitioners of alternative systems of medicine prescribe and dispense antibiotics (which they are not licensed to use) inappropriately, perpetuating the problem.
At times, qualified physicians and surgeons use antibiotics prophylactically, especially after surgical procedures, to “prevent infection”. These antibiotics are eventually excreted by the body. They reach the sewage systems and seep through the earth. Bacteria are naturally present in sewage. They spread and multiply in the presence of the antibiotic.
Cattle and poultry feed are laced with antibiotics to “prevent” infection. Antibiotic resistant bacteria thrive on farms.
Everyone must play his or her part well to prevent another plague with super bugs which places the entire world population at risk.
• Take treatment only from qualified physicians
• Always buy antibiotics with a prescription, not OTC
• Complete the course in the dosage prescribed
Hygiene has to be maintained not just in the hospitals but also at home. Regularly washing hands, an elementary procedure, reduces infection and its spread.
Governments, nationally and internationally, need to maintain surveillance to monitor emerging infections and drug resistance patterns. If everyone — patients, doctors and the public — does not co-operate on a war footing, we may revert to the dark ages of the pre penicillin era. No antibiotic will work against infections and developing an infectious disease will turn out to be a death sentence.
Dr Gita Mathai is a paediatrician with a family practice at Vellore. Questions on health issues may be emailed to her at yourhealthgm@yahoo.co.in
Wednesday, August 11, 2010
work out for well being
Work out your well-being
Your Health
--------------------------------------------------------------------------------
DR GITA MATHAI
Recently, there was some media hype about the so-called negative effects of exercise and suggestions that it could actually be detrimental to health. Many couch potatoes jumped on the bandwagon, proclaiming they had been right all along — that their kind of sedentary lifestyle was preferable and healthier than an active one.
But what the article in question actually said was that a totally sedentary, overweight individual over the age of 50 should not suddenly embark on any intense aerobic activity like running and at the same time start severe dieting. The heart cannot cope with this sudden stress and starvation, increasing the likelihood of a heart attack. This does not mean they cannot do intense exercise; it means they should work up to it gradually under medical supervision.
Few people understand the importance of regular physical activity. They think their daily routine of shopping, housework and workplace activity is sufficient. As a result, 6 per cent of adults in India and 25 per cent of urban adults are clinically obese. The body mass index (BMI) or weight divided by height in metre squared is 30 or more, well above the acceptable norm of 23.
Statistics explain the reason for India being the diabetic capital of the world. Many are not yet diabetic but have “Metabolic Syndrome X”, which places them at high risk for heart attacks. Metabolic Syndrome X is diagnosed if you have:
• Raised blood pressure (systolic BP > 130 or diastolic BP > 85 mm Hg)
• Raised triglycerides ( > 150 mg/dL or 1.7 mmol/L)
• Reduced HDL cholesterol ( < 40 mg/dL or 1.03 mmol/L in men; < 50 mg/dL or 1.29 mmol/L in women)
• Raised fasting plasma glucose (FPG > 100 mg/dL or 5.6 mmol/L)
All these parameters can return to normal with a dedicated approach to diet and exercise.
After an emotionally exhausting and stressful day at work, 30 minutes of brisk walking or a workout in the gym can reduce stress, elevate the mood and rejuvenate the body. This is because exercise releases chemicals from the calf muscles that increase the levels of mood elevating serotonin in the brain. Regular exercise combats depression and increases feelings of self worth.
With exercise the lipid profile becomes normal and this prevents any build-up of harmful plaques in the blood vessels. This, in turn, prevents strokes and heart attacks.
Many often complain they are “too tired to exercise”. But actually, regular physical activity boosts energy levels. A good night’s sleep is the key to a productive day. Exercise does promote good sleep, but it needs to be completed at least an hour before bedtime. Or else the racy pumped-up feeling may not let you fall asleep. Students who want to study late can benefit from a short burst of high intensity exercise like a run around the house. It is healthier and probably more effective than coffee or other caffeine laced beverages.
Some of the chemicals released during exercise like the HSP (heat shock protein) help cells develop immunity and fight cancer and other diseases.
Exercise must be started young. The epidemic of childhood obesity is on the rise the world over. A child growing up in a family where no one exercises is unlikely to be motivated to do anything with spare time other than watch TV, play on the computer or eat snacks. Such children grow into obese adults with Syndrome X.
Walking for an hour and covering a distance of 4km in that time seven days a week is ideal. If you are between 20 and 50 years and have no health problems, jogging the same distance would be more beneficial. Children less than 10 years need to run for 20 minutes to half an hour every day. At least 20 minutes should be also spent on warming up, cooling down and stretching, preferably 10 minutes before and 10 minutes after exercise. Core strength is also essential for fitness and can be improved with sit-ups, push-ups and squats. Ten to 20 repetitions of each are all that are required.
Remember, exercise moderation is the key to success. Build up to your dream fitness level gradually to avoid strain to the heart, muscles, bones and joints.
Dr Gita Mathai is a paediatrician with a family practice at Vellore. Questions on health issues may be emailed to her at yourhealthgm@yahoo.co.in
Your Health
--------------------------------------------------------------------------------
DR GITA MATHAI
Recently, there was some media hype about the so-called negative effects of exercise and suggestions that it could actually be detrimental to health. Many couch potatoes jumped on the bandwagon, proclaiming they had been right all along — that their kind of sedentary lifestyle was preferable and healthier than an active one.
But what the article in question actually said was that a totally sedentary, overweight individual over the age of 50 should not suddenly embark on any intense aerobic activity like running and at the same time start severe dieting. The heart cannot cope with this sudden stress and starvation, increasing the likelihood of a heart attack. This does not mean they cannot do intense exercise; it means they should work up to it gradually under medical supervision.
Few people understand the importance of regular physical activity. They think their daily routine of shopping, housework and workplace activity is sufficient. As a result, 6 per cent of adults in India and 25 per cent of urban adults are clinically obese. The body mass index (BMI) or weight divided by height in metre squared is 30 or more, well above the acceptable norm of 23.
Statistics explain the reason for India being the diabetic capital of the world. Many are not yet diabetic but have “Metabolic Syndrome X”, which places them at high risk for heart attacks. Metabolic Syndrome X is diagnosed if you have:
• Raised blood pressure (systolic BP > 130 or diastolic BP > 85 mm Hg)
• Raised triglycerides ( > 150 mg/dL or 1.7 mmol/L)
• Reduced HDL cholesterol ( < 40 mg/dL or 1.03 mmol/L in men; < 50 mg/dL or 1.29 mmol/L in women)
• Raised fasting plasma glucose (FPG > 100 mg/dL or 5.6 mmol/L)
All these parameters can return to normal with a dedicated approach to diet and exercise.
After an emotionally exhausting and stressful day at work, 30 minutes of brisk walking or a workout in the gym can reduce stress, elevate the mood and rejuvenate the body. This is because exercise releases chemicals from the calf muscles that increase the levels of mood elevating serotonin in the brain. Regular exercise combats depression and increases feelings of self worth.
With exercise the lipid profile becomes normal and this prevents any build-up of harmful plaques in the blood vessels. This, in turn, prevents strokes and heart attacks.
Many often complain they are “too tired to exercise”. But actually, regular physical activity boosts energy levels. A good night’s sleep is the key to a productive day. Exercise does promote good sleep, but it needs to be completed at least an hour before bedtime. Or else the racy pumped-up feeling may not let you fall asleep. Students who want to study late can benefit from a short burst of high intensity exercise like a run around the house. It is healthier and probably more effective than coffee or other caffeine laced beverages.
Some of the chemicals released during exercise like the HSP (heat shock protein) help cells develop immunity and fight cancer and other diseases.
Exercise must be started young. The epidemic of childhood obesity is on the rise the world over. A child growing up in a family where no one exercises is unlikely to be motivated to do anything with spare time other than watch TV, play on the computer or eat snacks. Such children grow into obese adults with Syndrome X.
Walking for an hour and covering a distance of 4km in that time seven days a week is ideal. If you are between 20 and 50 years and have no health problems, jogging the same distance would be more beneficial. Children less than 10 years need to run for 20 minutes to half an hour every day. At least 20 minutes should be also spent on warming up, cooling down and stretching, preferably 10 minutes before and 10 minutes after exercise. Core strength is also essential for fitness and can be improved with sit-ups, push-ups and squats. Ten to 20 repetitions of each are all that are required.
Remember, exercise moderation is the key to success. Build up to your dream fitness level gradually to avoid strain to the heart, muscles, bones and joints.
Dr Gita Mathai is a paediatrician with a family practice at Vellore. Questions on health issues may be emailed to her at yourhealthgm@yahoo.co.in
Monday, August 2, 2010
colds and flu
Season of colds and coughs
YOUR HEALTH
DR GITA MATHAI
The monsoon has set in, bringing much relief from the scorching sun and prickly heat. The cool showers and damp surroundings have also ushered in an epidemic of sniffles and sneezes. This effects the young and old alike. There is a constant fear — is this just a cold, or something more sinister? Could it be avian or swine flu?
Both cold and flu start with similar symptoms of headache, body ache, fever, runny nose and cough. Only the severity varies. In flu, the person is unable to move out of bed, whereas one suffering from a cold is not completely incapacitated.
Colds are caused by around 200 types of viruses, the commonest of which are the rhinoviruses (rhino means nose). They spread through droplets sneezed or coughed into the air by an infected person. The virus can also survive on clothing and articles like tables and books. The infection sets in around three days after exposure.
Children have not yet developed immunity against the cold viruses. Also, they are more likely to come in contact with infected children in schools and parks. Many parents, unfortunately, do not let ill children stay at home. In many schools, children with coughs and colds are advised to “take the test and then go home”. By this time they may have infected the entire class.
Children may develop eight to 10 colds a year. Each can last up to two weeks. This makes parents feel the child is always ill. They do not document the number of illness-free days in between one infection and the next. Many of these children are erroneously diagnosed as “primary complex” and started on rifampicin, isoniazide and other anti-tuberculosis medication. As children grow, their immunity builds up. The number of infections decreases to two to three a year.
A perpetually runny nose and cough without fever may not be due to a bacterial or viral infection. It may be due to an allergy to pollen, paint, incense or mosquito mats, coils and repellents. Smoking predispose one to colds. In children, toxic allergenic smoke may be inhaled passively from a smoking adult.
The classic symptoms of a cold are mild fever (it is best to buy a digital thermometer and check the temperature instead of relying on touch), less than 102° F, watery or slightly yellow nasal discharge, a scratchy irritated feeling in the throat, cough and body ache.
The condition is best tackled with rest. If the temperature goes above 100.5° F, or if the body ache is severe, paracetemol can be taken. Adults do not require more than 500mg. In children the dose is 10-15mg per kg of body weight. It can be repeated after four to six hours. Aspirin is contraindicated in children. A sore throat can be tackled with frequent salt water gargles. Saline nose drops can be administered in each nostril every three hours. It is better to avoid decongestant chemical nose drops as they can cause rebound nasal congestion, habituation and, if used for prolonged periods, atrophy of the nasal mucosa.
Anti-histamines can cause drowsiness. Both anti histamines and cough suppressants can cause side effects. They shouldn’t be taken without medical supervision. Traditional remedies like ginger tea, rasam, rice gruel and chicken soup help soothe the throat, relieve congestion and maintain hydration and nutrition.
A doctor should be consulted if —
• The fever has lasted more than three days
• There are chills
• The headache is continuous
• There is abdominal pain or vomiting
• There is ear ache
• Breathing becomes difficult
• A cough persists
• There is drowsiness.
In children, continuous crying or grunting needs to be taken seriously.
Antibiotics will not shorten the course of a cold or prevent one from appearing. But they need to be taken in case of complications like ear infection, sinusitis, bronchitis or pneumonia. The medication needs to be taken in the prescribed dose for the correct duration under medical supervision.
The likelihood of catching a cold can be reduced by washing hands regularly, cleaning toys and table surfaces, using disposable tissues to blow the nose, covering the nose and mouth while coughing and sneezing, and not attending school or work while infected.
Influenza vaccine is available and can be given to reduce the likelihood of catching seasonal flu but not the common cold. Immunisation is advisable for children under two, those over 65, asthmatics and those with compromised immunity.
Supplements of vitamin C, zinc, iron, B complex and some herbs like Echinacea are anecdotally said to reduce the number of colds. These claims have not been substantiated by double blind controlled studies.
The number of colds can be reduced by maintaining a hygienic and healthy lifestyle with at least 40 minutes of aerobic activity a day.
Dr Gita Mathai is a paediatrician with a family practice at Vellore. Questions on health issues may be emailed to her at yourhealthgm@yahoo.co.in
YOUR HEALTH
DR GITA MATHAI
The monsoon has set in, bringing much relief from the scorching sun and prickly heat. The cool showers and damp surroundings have also ushered in an epidemic of sniffles and sneezes. This effects the young and old alike. There is a constant fear — is this just a cold, or something more sinister? Could it be avian or swine flu?
Both cold and flu start with similar symptoms of headache, body ache, fever, runny nose and cough. Only the severity varies. In flu, the person is unable to move out of bed, whereas one suffering from a cold is not completely incapacitated.
Colds are caused by around 200 types of viruses, the commonest of which are the rhinoviruses (rhino means nose). They spread through droplets sneezed or coughed into the air by an infected person. The virus can also survive on clothing and articles like tables and books. The infection sets in around three days after exposure.
Children have not yet developed immunity against the cold viruses. Also, they are more likely to come in contact with infected children in schools and parks. Many parents, unfortunately, do not let ill children stay at home. In many schools, children with coughs and colds are advised to “take the test and then go home”. By this time they may have infected the entire class.
Children may develop eight to 10 colds a year. Each can last up to two weeks. This makes parents feel the child is always ill. They do not document the number of illness-free days in between one infection and the next. Many of these children are erroneously diagnosed as “primary complex” and started on rifampicin, isoniazide and other anti-tuberculosis medication. As children grow, their immunity builds up. The number of infections decreases to two to three a year.
A perpetually runny nose and cough without fever may not be due to a bacterial or viral infection. It may be due to an allergy to pollen, paint, incense or mosquito mats, coils and repellents. Smoking predispose one to colds. In children, toxic allergenic smoke may be inhaled passively from a smoking adult.
The classic symptoms of a cold are mild fever (it is best to buy a digital thermometer and check the temperature instead of relying on touch), less than 102° F, watery or slightly yellow nasal discharge, a scratchy irritated feeling in the throat, cough and body ache.
The condition is best tackled with rest. If the temperature goes above 100.5° F, or if the body ache is severe, paracetemol can be taken. Adults do not require more than 500mg. In children the dose is 10-15mg per kg of body weight. It can be repeated after four to six hours. Aspirin is contraindicated in children. A sore throat can be tackled with frequent salt water gargles. Saline nose drops can be administered in each nostril every three hours. It is better to avoid decongestant chemical nose drops as they can cause rebound nasal congestion, habituation and, if used for prolonged periods, atrophy of the nasal mucosa.
Anti-histamines can cause drowsiness. Both anti histamines and cough suppressants can cause side effects. They shouldn’t be taken without medical supervision. Traditional remedies like ginger tea, rasam, rice gruel and chicken soup help soothe the throat, relieve congestion and maintain hydration and nutrition.
A doctor should be consulted if —
• The fever has lasted more than three days
• There are chills
• The headache is continuous
• There is abdominal pain or vomiting
• There is ear ache
• Breathing becomes difficult
• A cough persists
• There is drowsiness.
In children, continuous crying or grunting needs to be taken seriously.
Antibiotics will not shorten the course of a cold or prevent one from appearing. But they need to be taken in case of complications like ear infection, sinusitis, bronchitis or pneumonia. The medication needs to be taken in the prescribed dose for the correct duration under medical supervision.
The likelihood of catching a cold can be reduced by washing hands regularly, cleaning toys and table surfaces, using disposable tissues to blow the nose, covering the nose and mouth while coughing and sneezing, and not attending school or work while infected.
Influenza vaccine is available and can be given to reduce the likelihood of catching seasonal flu but not the common cold. Immunisation is advisable for children under two, those over 65, asthmatics and those with compromised immunity.
Supplements of vitamin C, zinc, iron, B complex and some herbs like Echinacea are anecdotally said to reduce the number of colds. These claims have not been substantiated by double blind controlled studies.
The number of colds can be reduced by maintaining a hygienic and healthy lifestyle with at least 40 minutes of aerobic activity a day.
Dr Gita Mathai is a paediatrician with a family practice at Vellore. Questions on health issues may be emailed to her at yourhealthgm@yahoo.co.in
Wednesday, July 21, 2010
hope for the hopeless
Banking on stem cells
YOUR HEALTH
--------------------------------------------------------------------------------
DR GITA MATHAI
Actress Lisa Ray underwent stem cell therapy for multiple myeloma, a cancer of the white blood cells
Advertisements in the media advise parents to “plan and protect your children’s future and their health status”. These are not commercials for insurance plans, but private stem cell banking facilities, where, for a steep price, your baby’s umbilical cord stem cells can be preserved for future use.
Stem cells are in the news. Independent national and international laboratories are making claims and counterclaims about the “miracles” they have achieved with them. Paralysed people have been able to walk, rare degenerative nervous and muscular system diseases been reversed, and some cancers of the blood cells cured. People with terminal illnesses have also been offered hope.
Stem cells may be embryonic, adult or derived from umbilical cords. Embryonic stem cells are obtained from the extra fertilised eggs at in vitro fertilisation (IVF) centres. The use of these cells is controversial, as, theoretically, they have the potential to become human beings. They are the “spare babies” belonging to a particular IVF couple. When supplied to a stem cell research facility, they are grown in a nutrient broth in a culture dish and used for research or treatment.
Adult stem cells are found in bone marrow. These are harvested from the bone marrow of living donors. It’s a surgical procedure done under anaesthesia with some post-operative discomfort. The cells are capable of eventually forming either various types of blood cells or stromal cells from which cartilage and fat tissues arise.
Haematologists treat a variety of hereditary blood disorders and some of the blood cancers with either autologous (the person’s own) stem cells or compatible donor cells from bone marrow transplants. This technology has been used for the last 30 years. Bone marrow transplants are life saving for people with certain blood cancers. They can also be used for serious blood disorders such as aplastic anaemia. They can also help boost the immune system if it is impaired because of an inherited genetic defect or destroyed by cancer.
Umbilical cords are a rich and non-controversial source of stem cells. Cord blood has a greater ability to generate new blood cells than does bone marrow. Also, smaller quantities of cord blood cells are needed for successful transplantation. These cords are normally discarded along with the placenta from labour wards all over the world.
At present, in India, patients who require stem cell treatment or a bone marrow transplant have to search for a relative who is an appropriate tissue match. Sometimes even close first-degree relatives like a parent or sibling are not compatible. India does not as yet have a centralised national bone marrow registry to match recipients and donors.
Some foresighted countries with efficient national health schemes like the United Kingdom and Brazil do have public cord blood banks. Blood is screened for infective agents, documented in a registry and stored. The chances of finding compatible stem cells are high because of the large volumes stored.
India has private cord blood banks which store blood only for the use of that particular child for a period of 21 years. It may be a cost effective option for parents who have a family history of certain genetic diseases, such as severe hereditary anaemias, immune disorders or certain cancers. Even then, the chance that the blood can be used for that particular child is only 1 in 2,000. In families with no such risk factors, there is only about a 1-in-20,000 chance of the child ever needing a stem cell transplantation. Also, even if the child does require a stem cell transplant, it is unlikely that his or her own cord blood would be the desired source of stem cells. The same chromosomal or genetic defect causing the leukaemia, any other cancer or metabolic disorder, is likely to be present in the child’s stem cell line. There is no proof that a transplant using the child’s own stem cells is effective or even safe, especially in cases of childhood cancers.
Indians have a very diverse genetic make-up. The large-scale collection and storage of cord blood in public banks will be very useful. It can be used for matched unrelated recipients who urgently need blood cell transplants.
Stem cells are probably the future of medicine and the human race. They are multifaceted and have the potential to develop into different cell types. They can theoretically keep dividing as long as the person is alive. When a stem cell divides, each new cell has the potential to either remain a stem cell or become another specialised cell like a muscle cell, red blood cell, or brain cell. This means stem cells can be infused as a sort of emergency repair mechanism to replenish damaged tissues.
Perhaps disease, aging, cancer and even death can be controlled and conquered. And living healthily forever may become a reality.
Dr Gita Mathai is a paediatrician with a family practice at Vellore. Questions on health issues may be emailed to her at yourhealthgm@yahoo.co.in
YOUR HEALTH
--------------------------------------------------------------------------------
DR GITA MATHAI
Actress Lisa Ray underwent stem cell therapy for multiple myeloma, a cancer of the white blood cells
Advertisements in the media advise parents to “plan and protect your children’s future and their health status”. These are not commercials for insurance plans, but private stem cell banking facilities, where, for a steep price, your baby’s umbilical cord stem cells can be preserved for future use.
Stem cells are in the news. Independent national and international laboratories are making claims and counterclaims about the “miracles” they have achieved with them. Paralysed people have been able to walk, rare degenerative nervous and muscular system diseases been reversed, and some cancers of the blood cells cured. People with terminal illnesses have also been offered hope.
Stem cells may be embryonic, adult or derived from umbilical cords. Embryonic stem cells are obtained from the extra fertilised eggs at in vitro fertilisation (IVF) centres. The use of these cells is controversial, as, theoretically, they have the potential to become human beings. They are the “spare babies” belonging to a particular IVF couple. When supplied to a stem cell research facility, they are grown in a nutrient broth in a culture dish and used for research or treatment.
Adult stem cells are found in bone marrow. These are harvested from the bone marrow of living donors. It’s a surgical procedure done under anaesthesia with some post-operative discomfort. The cells are capable of eventually forming either various types of blood cells or stromal cells from which cartilage and fat tissues arise.
Haematologists treat a variety of hereditary blood disorders and some of the blood cancers with either autologous (the person’s own) stem cells or compatible donor cells from bone marrow transplants. This technology has been used for the last 30 years. Bone marrow transplants are life saving for people with certain blood cancers. They can also be used for serious blood disorders such as aplastic anaemia. They can also help boost the immune system if it is impaired because of an inherited genetic defect or destroyed by cancer.
Umbilical cords are a rich and non-controversial source of stem cells. Cord blood has a greater ability to generate new blood cells than does bone marrow. Also, smaller quantities of cord blood cells are needed for successful transplantation. These cords are normally discarded along with the placenta from labour wards all over the world.
At present, in India, patients who require stem cell treatment or a bone marrow transplant have to search for a relative who is an appropriate tissue match. Sometimes even close first-degree relatives like a parent or sibling are not compatible. India does not as yet have a centralised national bone marrow registry to match recipients and donors.
Some foresighted countries with efficient national health schemes like the United Kingdom and Brazil do have public cord blood banks. Blood is screened for infective agents, documented in a registry and stored. The chances of finding compatible stem cells are high because of the large volumes stored.
India has private cord blood banks which store blood only for the use of that particular child for a period of 21 years. It may be a cost effective option for parents who have a family history of certain genetic diseases, such as severe hereditary anaemias, immune disorders or certain cancers. Even then, the chance that the blood can be used for that particular child is only 1 in 2,000. In families with no such risk factors, there is only about a 1-in-20,000 chance of the child ever needing a stem cell transplantation. Also, even if the child does require a stem cell transplant, it is unlikely that his or her own cord blood would be the desired source of stem cells. The same chromosomal or genetic defect causing the leukaemia, any other cancer or metabolic disorder, is likely to be present in the child’s stem cell line. There is no proof that a transplant using the child’s own stem cells is effective or even safe, especially in cases of childhood cancers.
Indians have a very diverse genetic make-up. The large-scale collection and storage of cord blood in public banks will be very useful. It can be used for matched unrelated recipients who urgently need blood cell transplants.
Stem cells are probably the future of medicine and the human race. They are multifaceted and have the potential to develop into different cell types. They can theoretically keep dividing as long as the person is alive. When a stem cell divides, each new cell has the potential to either remain a stem cell or become another specialised cell like a muscle cell, red blood cell, or brain cell. This means stem cells can be infused as a sort of emergency repair mechanism to replenish damaged tissues.
Perhaps disease, aging, cancer and even death can be controlled and conquered. And living healthily forever may become a reality.
Dr Gita Mathai is a paediatrician with a family practice at Vellore. Questions on health issues may be emailed to her at yourhealthgm@yahoo.co.in
Tuesday, July 13, 2010
fat children
Catch them early
Your Health
--------------------------------------------------------------------------------
DR GITA MATHAI
When I was a medical student (so long back that it was actually in the last century), two of the cases placed before us as “spotters” (look and diagnose, don’t touch or question) in an examination were children with kwashiorkor (lethargic and disproportionately swollen with fluid) and marasmus (wizened, wasted and looking like a wise elder). Both were common conditions, the result of malnutrition.
Such diseases are rare today. In fact, now doctors have to spot diagnose children at the opposite end of the spectrum. About 20 per cent of children (some less than a year old) and teenagers in India can be defined as overweight, obese or morbidly obese. Their weights exceed that expected for their heights by 20 per cent, 50 per cent, and even 80-100 per cent. The BMI (body mass index, calculated as weight divided by height in meter squared) which should be 23 is often well above 30. Many of these children maintain their obese status into adult life.
In addition to having a paunch, big hips, knock knees and a double chin, such children have a peculiar velvety black discolouration of the skin — called acanthosis nigricans — on the nape of the neck. No amount of scrubbing will remove it, nor talcum powder conceal it. It is a marker for obesity that is likely to progress in diabetes.
This unhealthy state of over nutrition starts in infancy. Babies are breast fed for less than a year and weaned early. They are often force fed high energy, ready-to-eat carbohydrate substitutes instead of healthy, home cooked weaning foods. Older children gorge on unhealthy packaged snacks that often serve as a substitute for meals.
The children also have limited outdoor activity. Schools do not encourage physical training or games, as academics takes precedence over sports. In the evenings, tuition, homework and television usurp their time. Many parents do not have the time, inclination or space to take the children out.
Energy intake soon overtakes energy expenditure. In children, the waistline expands and fat is deposited in the abdominal regions. A paunch develops and pushes up the stomach and other abdominal contents against the diaphragm (a muscle that separates the abdomen from the chest). The chest is unable to expand fully and breathing becomes shallow, noisy and inefficient. Infections are frequent.
The excess fat is also deposited in muscles and liver tissue. The fat makes the body resistant to the actions of its own insulin. Even young children develop relative “insulin resistance”. Glucose intolerance and hypertriglyceridemia begin to develop in them. Fat gets deposited in the blood vessels. And this can cause the blood pressure to rise and result in premature coronary artery disease.
Adolescent obesity causes hormonal imbalances. In obese girls, androgens are present in excess. They develop unsightly facial hair and menstrual irregularities. This may result in PCOS (polycystic ovarian syndrome). In men, estrogen levels rise and gynacomastia develops. Eventually, these obese adolescents become subfertile adults. Pregnancy occurs only after expensive and frustrating treatment.
Obese children are also prone to numerous orthopedic problems. They may develop bowlegs. The ends of the growing bones may slip causing deformities. All this results in the early onset of arthritis.
Moreover, children are psychologically affected by their obesity. They are often the brunt of jokes. They are often excluded from sports and cultural events.
Quite often, the overweight children appear to have a familial obesity. This correlation is likely to be due to the environment with excessive food intake, limited exercise and almost compulsive television viewing. In these children, the obesity is not genetic but a result of the upbringing.
Boys (not girls) who are obese in childhood and adolescence are at risk for sudden death from coronary artery disease (CAD) as adults. They are also at increased risk for gout and colorectal cancer. This risk remains constant even if they manage to lose weight as adults. Girls who are obese become women at high risk for arthritis.
Television viewing should be restricted to a minimum. If the parents watch television for many hours every day, children too get hooked on to it. It is better to enroll them in coaching classes for activities like cricket, swimming, tennis, football or basketball. The Sports Authority of India conducts camps during summer vacations. Children who attend these camps should be encouraged to maintain the momentum even after school re-opens. Daily running or jogging for 20-40 minutes will help them keep up their stamina and maintain weight till the next round of coaching starts.
As parents and elders, we have to keep our children fit and not fat.
Dr Gita Mathai is a paediatrician with a family practice at Vellore. Questions on health issues may be emailed to her at yourhealthgm@yahoo.co.in
Your Health
--------------------------------------------------------------------------------
DR GITA MATHAI
When I was a medical student (so long back that it was actually in the last century), two of the cases placed before us as “spotters” (look and diagnose, don’t touch or question) in an examination were children with kwashiorkor (lethargic and disproportionately swollen with fluid) and marasmus (wizened, wasted and looking like a wise elder). Both were common conditions, the result of malnutrition.
Such diseases are rare today. In fact, now doctors have to spot diagnose children at the opposite end of the spectrum. About 20 per cent of children (some less than a year old) and teenagers in India can be defined as overweight, obese or morbidly obese. Their weights exceed that expected for their heights by 20 per cent, 50 per cent, and even 80-100 per cent. The BMI (body mass index, calculated as weight divided by height in meter squared) which should be 23 is often well above 30. Many of these children maintain their obese status into adult life.
In addition to having a paunch, big hips, knock knees and a double chin, such children have a peculiar velvety black discolouration of the skin — called acanthosis nigricans — on the nape of the neck. No amount of scrubbing will remove it, nor talcum powder conceal it. It is a marker for obesity that is likely to progress in diabetes.
This unhealthy state of over nutrition starts in infancy. Babies are breast fed for less than a year and weaned early. They are often force fed high energy, ready-to-eat carbohydrate substitutes instead of healthy, home cooked weaning foods. Older children gorge on unhealthy packaged snacks that often serve as a substitute for meals.
The children also have limited outdoor activity. Schools do not encourage physical training or games, as academics takes precedence over sports. In the evenings, tuition, homework and television usurp their time. Many parents do not have the time, inclination or space to take the children out.
Energy intake soon overtakes energy expenditure. In children, the waistline expands and fat is deposited in the abdominal regions. A paunch develops and pushes up the stomach and other abdominal contents against the diaphragm (a muscle that separates the abdomen from the chest). The chest is unable to expand fully and breathing becomes shallow, noisy and inefficient. Infections are frequent.
The excess fat is also deposited in muscles and liver tissue. The fat makes the body resistant to the actions of its own insulin. Even young children develop relative “insulin resistance”. Glucose intolerance and hypertriglyceridemia begin to develop in them. Fat gets deposited in the blood vessels. And this can cause the blood pressure to rise and result in premature coronary artery disease.
Adolescent obesity causes hormonal imbalances. In obese girls, androgens are present in excess. They develop unsightly facial hair and menstrual irregularities. This may result in PCOS (polycystic ovarian syndrome). In men, estrogen levels rise and gynacomastia develops. Eventually, these obese adolescents become subfertile adults. Pregnancy occurs only after expensive and frustrating treatment.
Obese children are also prone to numerous orthopedic problems. They may develop bowlegs. The ends of the growing bones may slip causing deformities. All this results in the early onset of arthritis.
Moreover, children are psychologically affected by their obesity. They are often the brunt of jokes. They are often excluded from sports and cultural events.
Quite often, the overweight children appear to have a familial obesity. This correlation is likely to be due to the environment with excessive food intake, limited exercise and almost compulsive television viewing. In these children, the obesity is not genetic but a result of the upbringing.
Boys (not girls) who are obese in childhood and adolescence are at risk for sudden death from coronary artery disease (CAD) as adults. They are also at increased risk for gout and colorectal cancer. This risk remains constant even if they manage to lose weight as adults. Girls who are obese become women at high risk for arthritis.
Television viewing should be restricted to a minimum. If the parents watch television for many hours every day, children too get hooked on to it. It is better to enroll them in coaching classes for activities like cricket, swimming, tennis, football or basketball. The Sports Authority of India conducts camps during summer vacations. Children who attend these camps should be encouraged to maintain the momentum even after school re-opens. Daily running or jogging for 20-40 minutes will help them keep up their stamina and maintain weight till the next round of coaching starts.
As parents and elders, we have to keep our children fit and not fat.
Dr Gita Mathai is a paediatrician with a family practice at Vellore. Questions on health issues may be emailed to her at yourhealthgm@yahoo.co.in
Wednesday, June 30, 2010
probiotic prebiotic antibiotic
Cup of magic
YOUR HEALTH
DR GITA MATHAI
Curd reduces infections as well as the duration of illnesses
Probiotics, prebiotics, antibiotics. The words often cause confusion because they sound similar. But, of course, they mean very different things, although all three are derived from the Greek word “bios”, meaning “life”.
Most people would love a magic pill that would put an end to all their health problems. Preferably one that contains prebiotics (meaning “before life”) and probiotics (“helping life”), along with a few trace elements, minerals, antioxidants and vitamins.
Probiotics are defined by the World Health Organization as microorganisms, which when administered alive in adequate amounts, confer a health benefit to the host. They are advertised by the pharma industry as protective, anti-infection agents that give the body’s natural reserves a boost against disease. They are sold as capsules and powders containing organisms like Lactobacillus bulgaricus and Streptococcus thermophilus. The products are much hyped, and have fancy names and expensive packaging.
However, what advertisements do not mention is that to be effective, there should be at least 75 million live organisms in each capsule. Food and chlorine in water kill these organisms. They therefore have to be swallowed with non-chlorinated water on an empty stomach. The intestines need to be populated with these organisms. So initially, the capsules have to be swallowed four to six times a day. The minuscule numbers contained in commercially available capsules are insufficient and do not confer any real health benefit.
Probiotics are not new products; they have been around for centuries. Fermented dough and curd (yogurt) contain natural, healthy probiotics. Commercially available yogurt may not contain live lactobacillus (probiotics) unless specifically mentioned on the package.
Natural probiotics like curd have many medicinal properties that are being rediscovered now. Curd starts to act in the mouth itself. It reduces the number of plaque forming bacteria, and prevents bad breath, tooth decay and mouth ulcers.
In the stomach, curd helps neutralise gastric acidity, reducing belching, burning and dyspepsia. It prevents infections, particularly the growth and multiplication of H. pylori, which is implicated in gastric ulcers and stomach cancer.
In the intestine, probiotics live with other protective intestinal flora, reducing gas formation and diarrhoea. The immunological effects reduce the incidence and symptoms of Crohn’s disease (inflammatory condition of the intestines that may affect any part from the mouth to the anus) and ulcerative colitis. Bowel habits become regular and the incidence of colon cancer reduces in those who eat curd regularly.
The action of the probiotics on digested food results in the synthesis of B-complex vitamins. This reduces vitamin deficiencies. Children who are given curd in addition to milk have less diarrhoea than those given milk alone.
Many Indians are relatively lactose intolerant and develop bloating, abdominal pain and diarrhoea when given to drink milk. They thus tend to curtail their milk intake and in the absence of calcium supplementation become susceptible to osteoporosis. In curd, however, the milk is already partially digested, and this reduces the symptoms of intolerance. As little as one cup of curd a day is beneficial in the prevention of osteoporosis.
Studies have also shown that eating curd regularly prevents the development of candidiasis, a common vaginal fungal infection. Other studies have shown conflicting results with no real benefit. But this has not prevented pharmaceutical companies from advocating lactobacillus capsules and vaginal pessaries for candidial infection. Curd also boosts the immune system. Regular eaters swear by it, saying it reduces infections as well as the duration of illnesses.
Prebiotics, on the other hand, are soluble fibres and non-digestible food ingredients that remain in the colon. They selectively stimulate the growth and activity of beneficial microorganisms already present in the large intestine. Prebiotics are found in oats, wheat, onions and garlic. When probiotics and prebiotics are combined, they form “synbiotics”. This probably confers the best health benefits with probiotics acting in the small intestine and prebiotics in the large.
Antibiotics are used to kill harmful microorganisms in the intestine, bloodstream and the various organs. They should be used appropriately in the correct dosage and duration. Unlike probiotics and prebiotics, antibiotics are specific for a particular infection. They are not health supplements.
Antioxidants are found in coloured fruits and vegetables. Oxidation is essential for cell metabolism. During this process a few cells die releasing harmful free radicals. This is prevented by antioxidants.
All said and done, health does not come packaged as an expensive magic capsule containing probiotics and antioxidants to be drunk with a glass of artificial fibre. For good health,
Eat four to five helpings of fresh fruits and vegetables daily. The green, yellow, orange and red ones contain antioxidants
Eat one tablespoon of homemade curd first thing in the morning on an empty stomach
Eat chappatis four or five times a week
Give these health ingredients an extra boost by exercising one hour everyday.
Dr Gita Mathai is a paediatrician with a family practice at Vellore. Questions on health issues may be emailed to her at yourhealthgm@yahoo.co.in
YOUR HEALTH
DR GITA MATHAI
Curd reduces infections as well as the duration of illnesses
Probiotics, prebiotics, antibiotics. The words often cause confusion because they sound similar. But, of course, they mean very different things, although all three are derived from the Greek word “bios”, meaning “life”.
Most people would love a magic pill that would put an end to all their health problems. Preferably one that contains prebiotics (meaning “before life”) and probiotics (“helping life”), along with a few trace elements, minerals, antioxidants and vitamins.
Probiotics are defined by the World Health Organization as microorganisms, which when administered alive in adequate amounts, confer a health benefit to the host. They are advertised by the pharma industry as protective, anti-infection agents that give the body’s natural reserves a boost against disease. They are sold as capsules and powders containing organisms like Lactobacillus bulgaricus and Streptococcus thermophilus. The products are much hyped, and have fancy names and expensive packaging.
However, what advertisements do not mention is that to be effective, there should be at least 75 million live organisms in each capsule. Food and chlorine in water kill these organisms. They therefore have to be swallowed with non-chlorinated water on an empty stomach. The intestines need to be populated with these organisms. So initially, the capsules have to be swallowed four to six times a day. The minuscule numbers contained in commercially available capsules are insufficient and do not confer any real health benefit.
Probiotics are not new products; they have been around for centuries. Fermented dough and curd (yogurt) contain natural, healthy probiotics. Commercially available yogurt may not contain live lactobacillus (probiotics) unless specifically mentioned on the package.
Natural probiotics like curd have many medicinal properties that are being rediscovered now. Curd starts to act in the mouth itself. It reduces the number of plaque forming bacteria, and prevents bad breath, tooth decay and mouth ulcers.
In the stomach, curd helps neutralise gastric acidity, reducing belching, burning and dyspepsia. It prevents infections, particularly the growth and multiplication of H. pylori, which is implicated in gastric ulcers and stomach cancer.
In the intestine, probiotics live with other protective intestinal flora, reducing gas formation and diarrhoea. The immunological effects reduce the incidence and symptoms of Crohn’s disease (inflammatory condition of the intestines that may affect any part from the mouth to the anus) and ulcerative colitis. Bowel habits become regular and the incidence of colon cancer reduces in those who eat curd regularly.
The action of the probiotics on digested food results in the synthesis of B-complex vitamins. This reduces vitamin deficiencies. Children who are given curd in addition to milk have less diarrhoea than those given milk alone.
Many Indians are relatively lactose intolerant and develop bloating, abdominal pain and diarrhoea when given to drink milk. They thus tend to curtail their milk intake and in the absence of calcium supplementation become susceptible to osteoporosis. In curd, however, the milk is already partially digested, and this reduces the symptoms of intolerance. As little as one cup of curd a day is beneficial in the prevention of osteoporosis.
Studies have also shown that eating curd regularly prevents the development of candidiasis, a common vaginal fungal infection. Other studies have shown conflicting results with no real benefit. But this has not prevented pharmaceutical companies from advocating lactobacillus capsules and vaginal pessaries for candidial infection. Curd also boosts the immune system. Regular eaters swear by it, saying it reduces infections as well as the duration of illnesses.
Prebiotics, on the other hand, are soluble fibres and non-digestible food ingredients that remain in the colon. They selectively stimulate the growth and activity of beneficial microorganisms already present in the large intestine. Prebiotics are found in oats, wheat, onions and garlic. When probiotics and prebiotics are combined, they form “synbiotics”. This probably confers the best health benefits with probiotics acting in the small intestine and prebiotics in the large.
Antibiotics are used to kill harmful microorganisms in the intestine, bloodstream and the various organs. They should be used appropriately in the correct dosage and duration. Unlike probiotics and prebiotics, antibiotics are specific for a particular infection. They are not health supplements.
Antioxidants are found in coloured fruits and vegetables. Oxidation is essential for cell metabolism. During this process a few cells die releasing harmful free radicals. This is prevented by antioxidants.
All said and done, health does not come packaged as an expensive magic capsule containing probiotics and antioxidants to be drunk with a glass of artificial fibre. For good health,
Eat four to five helpings of fresh fruits and vegetables daily. The green, yellow, orange and red ones contain antioxidants
Eat one tablespoon of homemade curd first thing in the morning on an empty stomach
Eat chappatis four or five times a week
Give these health ingredients an extra boost by exercising one hour everyday.
Dr Gita Mathai is a paediatrician with a family practice at Vellore. Questions on health issues may be emailed to her at yourhealthgm@yahoo.co.in
Monday, June 7, 2010
lousy life
Lousy problem
YOUR HEALTH
DR GITA MATHAI
A young girl gets lice removed mechanically
Itchy scalp? Scratching in public? And people looking askance at you? The problem could be dandruff or seborrhic dermatitis. Or worse, it could be lice.
Lice (singular: louse) are ectoparasites — that is, they live on the outside. Each insect is about the size of a sesame seed, with six legs and no wings. Human lice cannot survive on other animals such as cats, dogs and birds. They are also specific to the area they infest. They may live on the head (head lice). A slightly different variety lives in the genital area (pubic lice). A third type (body lice) lives only on the body.
School-going children are particularly likely to pick up head lice. In India, 60 per cent of girls in the age group of five to 11 are infested. This is, however, wrongly attributed to poor hygiene and low socioeconomic status. The social stigma attached to lice infestation and accusing letters from school authorities add to the psychological trauma of the child and her parents.
Lice feed on human blood and live for 30 days. If they fall off the body, they can survive on clothes, combs, crash helmets, bed sheets or pillows for two days. Each pair of lice lays about 100 eggs. These characteristics make them a tough species. They have managed to survive unchanged for more than 2,000 years. Archaeologists have found evidence of lice on Egyptian mummies, which are identical to the ones seen today.
The spread of lice occurs only if there is close contact with infested persons or their personal belongings. A louse cannot jump or fly. It has to crawl to its next victim. Once the insect has settled, it immediately starts to bite and feed. Lice release chemicals from their saliva which can cause intense scratching. This introduces bacteria to the skin which may cause secondary infection. The lymph nodes may become enlarged and appear as painful lumps in the neck.
There are many home remedies for lice. Mixtures of oils or ghee are sometimes applied in the hope that it will smother the lice. Others may shampoo frequently, thinking it will drown or wash away the insects. These, however, do not work.
The “lice comb” is a traditional and effective method. The comb may be made of metal, plastic or wood. Combing has to be done every day for two to three months. When the adult lice fall off, they have to be killed. Removing nits with a comb is difficult, tedious, time consuming and somewhat painful. Moreover, the child may not cooperate.
There is another effective method. Often in traditional families, all the members get their heads tonsured under some religious pretext. No hair, no lice.
Many chemicals are known to eradicate lice. Kerosene, for example, is effective when applied to the whole head and left for two or three hours. The head should be tied up securely in a cloth. But the method is dangerous as kerosene is highly inflammable.
Medicated “lice treatment” shampoos and lotions contain malathion, lindane and permethrin and can be applied to the hair. These chemicals paralyse the lice. The motionless insects must then be removed by washing or combing as they can recover movement in two or three hours.
The medications, however, do not remove all the lice. Only about 20 per cent are susceptible to the commonly used chemicals. The tough survivors mutate, thrive and multiply even in the presence of these chemicals. Higher concentrations offer no greater benefit. Instead, they seep through the skin and may build up to toxic levels. Also, the chemicals cannot be used in pregnant women and children under one. Treatment has to be repeated after 10 days to kill any newly hatched lice before they start to reproduce. Body and pubic lice respond poorly to lotions and shampoos.
In all the three types of lice infestation, relapse, recurrence and re-infection are common. This makes dealing with the parasite both embarrassing and frustrating.
Commercially advertised “herbal” products appear safer than chemicals and gullible sufferers opt for them. A few harmless ingredients like neem and tulasi are mentioned on the package. The rest are not. Their sale and production are not regulated. Their safety is questionable and side effects undocumented.
Lice can be effectively eradicated using an oral dose of 200 µgm/kg body weight of the tablet Ivermectin. It cannot be given to pregnant women or children whose weight is less than 15kg. The medicine acts only on live lice. A repeat dose is required on the eighth day when the eggs hatch.
Dr Gita Mathai is a paediatrician with a family practice at Vellore. Questions on health issues may be emailed to her at yourhealthgm@yahoo.co.in
YOUR HEALTH
DR GITA MATHAI
A young girl gets lice removed mechanically
Itchy scalp? Scratching in public? And people looking askance at you? The problem could be dandruff or seborrhic dermatitis. Or worse, it could be lice.
Lice (singular: louse) are ectoparasites — that is, they live on the outside. Each insect is about the size of a sesame seed, with six legs and no wings. Human lice cannot survive on other animals such as cats, dogs and birds. They are also specific to the area they infest. They may live on the head (head lice). A slightly different variety lives in the genital area (pubic lice). A third type (body lice) lives only on the body.
School-going children are particularly likely to pick up head lice. In India, 60 per cent of girls in the age group of five to 11 are infested. This is, however, wrongly attributed to poor hygiene and low socioeconomic status. The social stigma attached to lice infestation and accusing letters from school authorities add to the psychological trauma of the child and her parents.
Lice feed on human blood and live for 30 days. If they fall off the body, they can survive on clothes, combs, crash helmets, bed sheets or pillows for two days. Each pair of lice lays about 100 eggs. These characteristics make them a tough species. They have managed to survive unchanged for more than 2,000 years. Archaeologists have found evidence of lice on Egyptian mummies, which are identical to the ones seen today.
The spread of lice occurs only if there is close contact with infested persons or their personal belongings. A louse cannot jump or fly. It has to crawl to its next victim. Once the insect has settled, it immediately starts to bite and feed. Lice release chemicals from their saliva which can cause intense scratching. This introduces bacteria to the skin which may cause secondary infection. The lymph nodes may become enlarged and appear as painful lumps in the neck.
There are many home remedies for lice. Mixtures of oils or ghee are sometimes applied in the hope that it will smother the lice. Others may shampoo frequently, thinking it will drown or wash away the insects. These, however, do not work.
The “lice comb” is a traditional and effective method. The comb may be made of metal, plastic or wood. Combing has to be done every day for two to three months. When the adult lice fall off, they have to be killed. Removing nits with a comb is difficult, tedious, time consuming and somewhat painful. Moreover, the child may not cooperate.
There is another effective method. Often in traditional families, all the members get their heads tonsured under some religious pretext. No hair, no lice.
Many chemicals are known to eradicate lice. Kerosene, for example, is effective when applied to the whole head and left for two or three hours. The head should be tied up securely in a cloth. But the method is dangerous as kerosene is highly inflammable.
Medicated “lice treatment” shampoos and lotions contain malathion, lindane and permethrin and can be applied to the hair. These chemicals paralyse the lice. The motionless insects must then be removed by washing or combing as they can recover movement in two or three hours.
The medications, however, do not remove all the lice. Only about 20 per cent are susceptible to the commonly used chemicals. The tough survivors mutate, thrive and multiply even in the presence of these chemicals. Higher concentrations offer no greater benefit. Instead, they seep through the skin and may build up to toxic levels. Also, the chemicals cannot be used in pregnant women and children under one. Treatment has to be repeated after 10 days to kill any newly hatched lice before they start to reproduce. Body and pubic lice respond poorly to lotions and shampoos.
In all the three types of lice infestation, relapse, recurrence and re-infection are common. This makes dealing with the parasite both embarrassing and frustrating.
Commercially advertised “herbal” products appear safer than chemicals and gullible sufferers opt for them. A few harmless ingredients like neem and tulasi are mentioned on the package. The rest are not. Their sale and production are not regulated. Their safety is questionable and side effects undocumented.
Lice can be effectively eradicated using an oral dose of 200 µgm/kg body weight of the tablet Ivermectin. It cannot be given to pregnant women or children whose weight is less than 15kg. The medicine acts only on live lice. A repeat dose is required on the eighth day when the eggs hatch.
Dr Gita Mathai is a paediatrician with a family practice at Vellore. Questions on health issues may be emailed to her at yourhealthgm@yahoo.co.in
Monday, May 31, 2010
my feet are swollen
Overcoming oedema
YOUR HEALTH
DR GITA MATHAI
Swollen feet — medically called oedema — can make life miserable. Shoes and slippers don’t fit — they are tight and uncomfortable and sometimes impossible to put on. The feet feel like dead weights, and walking becomes a Herculean task. It is much easier to simply sit. But inactivity makes the swelling worse, and the sufferer is caught in a vicious cycle of swelling-inactivity-more swelling.
The fluid that accumulates and causes oedema leaks from tiny blood vessels called capillaries. This can occur as a result of increased pressure, damage to the vessels or a fall in the protein concentration of the blood. As soon as the body senses that the capillaries are leaking, compensatory mechanisms come into play and fluid is retained in the body by the kidney. The amount of fluid circulating in the body therefore increases. This, in turn, causes the capillaries to leak more. This fluid from the capillaries leaks into the surrounding tissue, causing the swelling. At least five litres of fluid need to be retained before actual swelling appears.
Feet swell before any other part of the body. This is because the hydrostatic pressure on the blood vessels of the lower limbs are, by virtue of gravity, one metre more than the pressure on the face. Also, when we sit and stand, our feet are at a lower level than the heart and this aggravates the problem.
To demonstrate oedema, press firmly with your forefinger and maintain the pressure for 10 seconds. A persistent dimple like depression indicates the presence of oedema.
However, swollen feet do not always indicate disease. Overweight individuals may develop some amount of swelling at the end of a stationery day. (Fat is fluid at body temperature). This can be normal. The swelling can extend up to the knees.
Salt also causes fluid retention. If you consume a lot of salty snacks and pickles, the kidney is not able to handle the sodium overload and fluid is retained.
Women are more prone to develop oedema than men. The female hormones oestrogen and progesterone cause fluid retention. Women tend to “swell up” during the pre-menstrual period, pregnancy and if they are on hormones, either as oral contraceptive pills or as part of hormone replacement therapy (HRT). This can extend to the hands, making finger rings tight. The face may also appear puffy. This type of oedema disappears spontaneously in a few days once menstruation occurs, the baby is born or the hormones discontinued.
Oedema can be a side effect of prescribed medication like nifedepine, amlodepin and other anti-hypertensives. Medicines for pain belonging to the non-steroidal anti-inflammatory drugs (NSAIDs) group can also cause fluid retention. Some like diclofenac may damage the kidneys. If you develop swelling while on medication, consult your doctor.
At times, oedema can be the first sign of a serious underlying medical condition. If the heart is unable to pump blood efficiently, blood can accumulate in the capillaries of the legs, ankles and feet, causing oedema.
The liver regulates the protein content of the blood. It is also responsible for adjusting the hormones and chemicals that regulate the fluid content of the body. The organ can become damaged as a result of alcoholism, hepatitis B infection or other diseases. This injury results in scar formation and is called cirrhosis. Fluid can then accumulate in the legs and abdomen. But two of the causal factors can be prevented — don’t drink excessively and take your hepatitis B immunisations.
Damaged kidneys cannot excrete excess fluid. The oedema then occurs typically around the legs and eyes. Kidney damage can occur for a variety of reasons. Preventable causes are uncontrolled, neglected diabetes and hypertension.
The veins in the leg may be damaged or weak. Sometimes the valves in these veins — which prevent back flow of blood — may be inefficient. Chronic venous insufficiency and varicose veins can result in swelling.
Excess fluid from tissues is cleared by the lymphatic system. These drain into lymph nodes and eventually into the large veins. Infections like filaria can damage the lymphatic system. The nodes can be infiltrated by cancerous deposits. The nodes may have been removed or damaged during surgery. All this can result in swelling. Usually this is present in any one limb and not symmetrically on both sides of the body.
Remember
• Oedema can be treated if the causal factor is removed
• Reduce weight if the BMI (body mass index or weight divided by height in metre squared ) is more than 23
• Walk, jog or swim for 40 minutes a day
• Try to move the legs every half hour during the day
• Do not add extra salt to food and avoid salty snacks
• Keep the feet elevated
• Use elastocrepe bandages or compression stockings on affected limbs
• Do not consume NSAIDs unnecessarily
• Seek medical advice immediately for filaria
• Use diurectics to get rid of fluid only if prescribed by a doctor
• Control diabetes and hypertension.
Dr Gita Mathai is a paediatrician with a family practice at Vellore. Questions on health issues may be emailed to her at yourhealthgm@yahoo.co.in
YOUR HEALTH
DR GITA MATHAI
Swollen feet — medically called oedema — can make life miserable. Shoes and slippers don’t fit — they are tight and uncomfortable and sometimes impossible to put on. The feet feel like dead weights, and walking becomes a Herculean task. It is much easier to simply sit. But inactivity makes the swelling worse, and the sufferer is caught in a vicious cycle of swelling-inactivity-more swelling.
The fluid that accumulates and causes oedema leaks from tiny blood vessels called capillaries. This can occur as a result of increased pressure, damage to the vessels or a fall in the protein concentration of the blood. As soon as the body senses that the capillaries are leaking, compensatory mechanisms come into play and fluid is retained in the body by the kidney. The amount of fluid circulating in the body therefore increases. This, in turn, causes the capillaries to leak more. This fluid from the capillaries leaks into the surrounding tissue, causing the swelling. At least five litres of fluid need to be retained before actual swelling appears.
Feet swell before any other part of the body. This is because the hydrostatic pressure on the blood vessels of the lower limbs are, by virtue of gravity, one metre more than the pressure on the face. Also, when we sit and stand, our feet are at a lower level than the heart and this aggravates the problem.
To demonstrate oedema, press firmly with your forefinger and maintain the pressure for 10 seconds. A persistent dimple like depression indicates the presence of oedema.
However, swollen feet do not always indicate disease. Overweight individuals may develop some amount of swelling at the end of a stationery day. (Fat is fluid at body temperature). This can be normal. The swelling can extend up to the knees.
Salt also causes fluid retention. If you consume a lot of salty snacks and pickles, the kidney is not able to handle the sodium overload and fluid is retained.
Women are more prone to develop oedema than men. The female hormones oestrogen and progesterone cause fluid retention. Women tend to “swell up” during the pre-menstrual period, pregnancy and if they are on hormones, either as oral contraceptive pills or as part of hormone replacement therapy (HRT). This can extend to the hands, making finger rings tight. The face may also appear puffy. This type of oedema disappears spontaneously in a few days once menstruation occurs, the baby is born or the hormones discontinued.
Oedema can be a side effect of prescribed medication like nifedepine, amlodepin and other anti-hypertensives. Medicines for pain belonging to the non-steroidal anti-inflammatory drugs (NSAIDs) group can also cause fluid retention. Some like diclofenac may damage the kidneys. If you develop swelling while on medication, consult your doctor.
At times, oedema can be the first sign of a serious underlying medical condition. If the heart is unable to pump blood efficiently, blood can accumulate in the capillaries of the legs, ankles and feet, causing oedema.
The liver regulates the protein content of the blood. It is also responsible for adjusting the hormones and chemicals that regulate the fluid content of the body. The organ can become damaged as a result of alcoholism, hepatitis B infection or other diseases. This injury results in scar formation and is called cirrhosis. Fluid can then accumulate in the legs and abdomen. But two of the causal factors can be prevented — don’t drink excessively and take your hepatitis B immunisations.
Damaged kidneys cannot excrete excess fluid. The oedema then occurs typically around the legs and eyes. Kidney damage can occur for a variety of reasons. Preventable causes are uncontrolled, neglected diabetes and hypertension.
The veins in the leg may be damaged or weak. Sometimes the valves in these veins — which prevent back flow of blood — may be inefficient. Chronic venous insufficiency and varicose veins can result in swelling.
Excess fluid from tissues is cleared by the lymphatic system. These drain into lymph nodes and eventually into the large veins. Infections like filaria can damage the lymphatic system. The nodes can be infiltrated by cancerous deposits. The nodes may have been removed or damaged during surgery. All this can result in swelling. Usually this is present in any one limb and not symmetrically on both sides of the body.
Remember
• Oedema can be treated if the causal factor is removed
• Reduce weight if the BMI (body mass index or weight divided by height in metre squared ) is more than 23
• Walk, jog or swim for 40 minutes a day
• Try to move the legs every half hour during the day
• Do not add extra salt to food and avoid salty snacks
• Keep the feet elevated
• Use elastocrepe bandages or compression stockings on affected limbs
• Do not consume NSAIDs unnecessarily
• Seek medical advice immediately for filaria
• Use diurectics to get rid of fluid only if prescribed by a doctor
• Control diabetes and hypertension.
Dr Gita Mathai is a paediatrician with a family practice at Vellore. Questions on health issues may be emailed to her at yourhealthgm@yahoo.co.in
Wednesday, May 19, 2010
colour of the skin
The colour of your skin
Your Health
DR GITA MATHAI
Indians are very conscious of their skin colour. There is great alarm and anxiety if the skin suddenly develops white patches. About 1 per cent of the population is affected by this condition — called leukoderma (white skin) or vitiligo (“streaked calf” in Greek). The patches usually appear between the ages of 12 and 40. The disease affects people in all socio-economic strata. Michael Jackson was affected by it. Other rich and famous sufferers are Amitabh Bachchan and Gautam Singhania, the chairman and managing director of Raymonds.
The sudden loss of pigmentation causes 25 per cent of these people to become obsessed with their skin colour, depressed or even suicidal. Money does not make the disease disappear; it only makes it possible to consult the world’s best dermatologists.
The de-pigmentation often starts on the hands and feet. In the case of Jackson, it first appeared on his hands. This was the reason behind his signature white glove. In others it may start around orifices like the nose, mouth, eyes, umbilicus, genital areas and rectum. The patches may remain stationary, increase in size or spread over the whole body. They are symmetrical on both sides of the body. Some areas may suddenly re-pigment while the white patches continue to spread.
The loss of colour is due to the mutation of one of the genes on chromosome 17. This is usually inherited. The mutations may remain unexpressed and the person may be normal all through life. However, if a family member is affected, the risk of vitiligo developing eventually in another member is increased five-fold. The same gene is responsible for premature greying. Some members may have patches, others may develop grey hair in their twenties while still others may appear perfectly normal. The gene may start to express itself and cause de-pigmentation as a result of a trigger like a stressful event. It may also be precipitated by an injury or constant friction in shoes or clothing.
The mutated gene triggers an autoimmune disorder and the body forms antibodies against melanocytes (pigment producing cells). The latter are thus destroyed. Vitiligo may be associated with other autoimmune disorders which affect organs such as the thyroid, stomach and adrenal glands. It may form part of the spectrum of systemic lupus (an autoimmune disease that affects all the organs in the body, and is thus difficult to diagnose).
Sometimes a white baby is born to a “normal” family. The entire skin, hair and even the eyes lack pigment. This condition is called albinism and the person is referred to as an albino. It occurs because the melanocytes are unable to produce melanin, the colouring pigment. This is also an inherited condition but since the gene is recessive it does not express itself and manifest itself as a “white baby” unless it is inherited from both parents. A person who carries the gene may look normal and not be aware of it. If he or she incidentally marries another carrier, the child can be albino.
The pigment producing melanocytes may be absent from birth in certain areas. This hereditary condition is called piebaldism. It can occur anywhere, and can result in just a white forelock — like in the case of Indira Gandhi.
Owing to the similarity in symptoms, vitiligo is sometimes confused with piebaldism, albinsim or even leprosy. White scars may give rise to a similar appearance. A diagnosis can be reached by a skin biopsy.
It is better to avoid sunlight when vitiligo first appears. As the skin tans, the areas without melanin become obvious. Use an umbrella or apply SF (sunfilter) 30 sunscreen on the exposed areas.
Small patches can be camouflaged with cosmetics. They can also be treated under supervision by applying steroid creams. Constant use of these creams, however, can damage the skin texture.
Physicians in India and Egypt documented vitiligo as early as 1,500 BC. They treated it by applying and administering extracts of the fruit, seeds and leaves of two plants — Psoralea coryifolia Linnaues and Ammi majus Linnaeus. Even today, isolates of these plants are successfully used topically and orally. Synthetic compounds are also available. They act by increasing sensitivity to light and augmenting pigmentation in the affected areas (photochemotherapy) . Treatment usually involves exposure to a measured amount of natural sunlight (PUVASOL) or artificial UV radiation (PUVA) to induce re-pigmentation. Phototherapy (without light-sensitising chemicals) can also be used. Sunburn is a common complication.
Surgical treatment can be tried by using skin grafts from pigmented areas. The success rate varies between 65 and 90 per cent. If the de-pigmented areas are extensive, some patients bleach the remaining dark portions of the skin to achieve a universal white colour.
Dr Gita Mathai is a paediatrician with a family practice at Vellore. Questions on health issues may be emailed to her at yourhealthgm@ yahoo.co. in
Your Health
DR GITA MATHAI
Indians are very conscious of their skin colour. There is great alarm and anxiety if the skin suddenly develops white patches. About 1 per cent of the population is affected by this condition — called leukoderma (white skin) or vitiligo (“streaked calf” in Greek). The patches usually appear between the ages of 12 and 40. The disease affects people in all socio-economic strata. Michael Jackson was affected by it. Other rich and famous sufferers are Amitabh Bachchan and Gautam Singhania, the chairman and managing director of Raymonds.
The sudden loss of pigmentation causes 25 per cent of these people to become obsessed with their skin colour, depressed or even suicidal. Money does not make the disease disappear; it only makes it possible to consult the world’s best dermatologists.
The de-pigmentation often starts on the hands and feet. In the case of Jackson, it first appeared on his hands. This was the reason behind his signature white glove. In others it may start around orifices like the nose, mouth, eyes, umbilicus, genital areas and rectum. The patches may remain stationary, increase in size or spread over the whole body. They are symmetrical on both sides of the body. Some areas may suddenly re-pigment while the white patches continue to spread.
The loss of colour is due to the mutation of one of the genes on chromosome 17. This is usually inherited. The mutations may remain unexpressed and the person may be normal all through life. However, if a family member is affected, the risk of vitiligo developing eventually in another member is increased five-fold. The same gene is responsible for premature greying. Some members may have patches, others may develop grey hair in their twenties while still others may appear perfectly normal. The gene may start to express itself and cause de-pigmentation as a result of a trigger like a stressful event. It may also be precipitated by an injury or constant friction in shoes or clothing.
The mutated gene triggers an autoimmune disorder and the body forms antibodies against melanocytes (pigment producing cells). The latter are thus destroyed. Vitiligo may be associated with other autoimmune disorders which affect organs such as the thyroid, stomach and adrenal glands. It may form part of the spectrum of systemic lupus (an autoimmune disease that affects all the organs in the body, and is thus difficult to diagnose).
Sometimes a white baby is born to a “normal” family. The entire skin, hair and even the eyes lack pigment. This condition is called albinism and the person is referred to as an albino. It occurs because the melanocytes are unable to produce melanin, the colouring pigment. This is also an inherited condition but since the gene is recessive it does not express itself and manifest itself as a “white baby” unless it is inherited from both parents. A person who carries the gene may look normal and not be aware of it. If he or she incidentally marries another carrier, the child can be albino.
The pigment producing melanocytes may be absent from birth in certain areas. This hereditary condition is called piebaldism. It can occur anywhere, and can result in just a white forelock — like in the case of Indira Gandhi.
Owing to the similarity in symptoms, vitiligo is sometimes confused with piebaldism, albinsim or even leprosy. White scars may give rise to a similar appearance. A diagnosis can be reached by a skin biopsy.
It is better to avoid sunlight when vitiligo first appears. As the skin tans, the areas without melanin become obvious. Use an umbrella or apply SF (sunfilter) 30 sunscreen on the exposed areas.
Small patches can be camouflaged with cosmetics. They can also be treated under supervision by applying steroid creams. Constant use of these creams, however, can damage the skin texture.
Physicians in India and Egypt documented vitiligo as early as 1,500 BC. They treated it by applying and administering extracts of the fruit, seeds and leaves of two plants — Psoralea coryifolia Linnaues and Ammi majus Linnaeus. Even today, isolates of these plants are successfully used topically and orally. Synthetic compounds are also available. They act by increasing sensitivity to light and augmenting pigmentation in the affected areas (photochemotherapy) . Treatment usually involves exposure to a measured amount of natural sunlight (PUVASOL) or artificial UV radiation (PUVA) to induce re-pigmentation. Phototherapy (without light-sensitising chemicals) can also be used. Sunburn is a common complication.
Surgical treatment can be tried by using skin grafts from pigmented areas. The success rate varies between 65 and 90 per cent. If the de-pigmented areas are extensive, some patients bleach the remaining dark portions of the skin to achieve a universal white colour.
Dr Gita Mathai is a paediatrician with a family practice at Vellore. Questions on health issues may be emailed to her at yourhealthgm@ yahoo.co. in
Monday, May 10, 2010
marked for life
Moles birthmarks and angel kisses
Your Health
--------------------------------------------------------------------------------
DR GITA MATHAI
Mikhail Gorbachev is easily identified in photographs by a distinctive large red mark on his head. The patch is actually a birthmark — a capillary naevus — which is present from birth. One in 10 children has birthmarks on his or her body.
These marks have fascinated people down the ages. In the 16th and 17th centuries, there developed a branch of astrology called moleoscopy. Specialists interpreted the “occult significance” of birthmarks and their “effect” on one’s character and destiny. The positions of the moles were linked with astrological signs. Hippocrates, the father of medicine, wrote a treatise on the link between birthmarks and health. He had the right idea. Health is a strong determinant of the future. We now know that the birthmarks are a coincidence.
Birthmarks that are red in colour are called strawberry marks, angel kisses or stork bites. They are usually present on the eyelids, forehead or nape of the neck. They may be flat or appear slightly raised or bumpy. They are caused by an overgrowth of the small blood vessels (capillaries). They are not hereditary or cancerous and usually disappear without treatment by the age of two.
Gorbachev’s large red naevus is called a port wine stain. Such marks too are present at birth, but are much larger, do not cross the midline and unlike strawberry marks do not fade with age. Sometimes they may be associated with seizures and glaucoma in later life.
Dark slate grey or bluish marks can be present over the areas of the buttocks or back in 80 per cent of Indian babies. These are called “mongoloid spots” and to the untrained eye can be mistaken for bruises. They occur because melanocytes (pigment producing cells in the skin) get caught in the deeper layers of the skin during the development process. The marks may last till adolescence.
Café au lait spots are so called because they are a shade of brown that looks like milky coffee. They may be present at birth or appear in early childhood. If they are very large, or four or more are present, the child may be carrying the gene for neurofibromatosis. This is a condition where multiple painless bumps appear all over the face and body in adult life.
Birthmarks that are large (the size of a fist), black and sometimes hairy are called congenital naevi. They have to be watched carefully as 10 per cent can turn cancerous.
Older children may develop pigmented areas on the skin called moles. These are also called beauty marks. Marilyn Monroe and Madhubala had attractive facial moles. In the last century, moles were a fashion statement for both men and women.
A real mole is an area of skin where there is an increase in the number of melanocytes which then form a cluster. They can be flat or raised. Some may have hair growing in it. The number present increases with age and most adults have 20-40 moles. They also increase during times of hormonal change like adolescence and pregnancy. They can darken when exposed to sunlight. Some fade away with age.
Moles rarely can become cancerous. The danger signals are —
* If the mole suddenly appears after the age of 20 and seems to be increasing in size
* If the diameter is larger than the end of a pencil
* If it suddenly changes in colour
* If it itches, oozes or bleeds.
A dermatologist can remove a mole which shows any of these signs and send it for testing. Removal of a cancerous mole in the early stages is curative.
Not all pigmentations on the skin are moles. They may be “lentigenes” or brown spots that appear on the face and hands in older people, especially after exposure to sunlight. They resemble freckles. They are harmless and can be prevented by avoiding the sun.
Black spots may appear on the chest and back as people get older. They look like blobs of dirt stuck on the skin, but cannot be picked off. These are barnacles or seborrheic keratosis. The condition may run in families. They occur because keratin, a strong natural protein normally formed in the skin, increases and forms circular whorls. They are harmless and can be left alone. Some may be cosmetically disfiguring. Others may get caught in clothing and become irritated, red and start bleeding. These can be removed by a dermatologist.
The skin, especially in older overweight women, can form tags — small flaps of tissue that hang off the skin. These are not painful or dangerous. If they get snagged frequently on jewellery or clothing, they can be easily removed.
Dr Gita Mathai is a paediatrician with a family practice at Vellore. Questions on health issues may be emailed to her at yourhealthgm@yahoo.co.in
Your Health
--------------------------------------------------------------------------------
DR GITA MATHAI
Mikhail Gorbachev is easily identified in photographs by a distinctive large red mark on his head. The patch is actually a birthmark — a capillary naevus — which is present from birth. One in 10 children has birthmarks on his or her body.
These marks have fascinated people down the ages. In the 16th and 17th centuries, there developed a branch of astrology called moleoscopy. Specialists interpreted the “occult significance” of birthmarks and their “effect” on one’s character and destiny. The positions of the moles were linked with astrological signs. Hippocrates, the father of medicine, wrote a treatise on the link between birthmarks and health. He had the right idea. Health is a strong determinant of the future. We now know that the birthmarks are a coincidence.
Birthmarks that are red in colour are called strawberry marks, angel kisses or stork bites. They are usually present on the eyelids, forehead or nape of the neck. They may be flat or appear slightly raised or bumpy. They are caused by an overgrowth of the small blood vessels (capillaries). They are not hereditary or cancerous and usually disappear without treatment by the age of two.
Gorbachev’s large red naevus is called a port wine stain. Such marks too are present at birth, but are much larger, do not cross the midline and unlike strawberry marks do not fade with age. Sometimes they may be associated with seizures and glaucoma in later life.
Dark slate grey or bluish marks can be present over the areas of the buttocks or back in 80 per cent of Indian babies. These are called “mongoloid spots” and to the untrained eye can be mistaken for bruises. They occur because melanocytes (pigment producing cells in the skin) get caught in the deeper layers of the skin during the development process. The marks may last till adolescence.
Café au lait spots are so called because they are a shade of brown that looks like milky coffee. They may be present at birth or appear in early childhood. If they are very large, or four or more are present, the child may be carrying the gene for neurofibromatosis. This is a condition where multiple painless bumps appear all over the face and body in adult life.
Birthmarks that are large (the size of a fist), black and sometimes hairy are called congenital naevi. They have to be watched carefully as 10 per cent can turn cancerous.
Older children may develop pigmented areas on the skin called moles. These are also called beauty marks. Marilyn Monroe and Madhubala had attractive facial moles. In the last century, moles were a fashion statement for both men and women.
A real mole is an area of skin where there is an increase in the number of melanocytes which then form a cluster. They can be flat or raised. Some may have hair growing in it. The number present increases with age and most adults have 20-40 moles. They also increase during times of hormonal change like adolescence and pregnancy. They can darken when exposed to sunlight. Some fade away with age.
Moles rarely can become cancerous. The danger signals are —
* If the mole suddenly appears after the age of 20 and seems to be increasing in size
* If the diameter is larger than the end of a pencil
* If it suddenly changes in colour
* If it itches, oozes or bleeds.
A dermatologist can remove a mole which shows any of these signs and send it for testing. Removal of a cancerous mole in the early stages is curative.
Not all pigmentations on the skin are moles. They may be “lentigenes” or brown spots that appear on the face and hands in older people, especially after exposure to sunlight. They resemble freckles. They are harmless and can be prevented by avoiding the sun.
Black spots may appear on the chest and back as people get older. They look like blobs of dirt stuck on the skin, but cannot be picked off. These are barnacles or seborrheic keratosis. The condition may run in families. They occur because keratin, a strong natural protein normally formed in the skin, increases and forms circular whorls. They are harmless and can be left alone. Some may be cosmetically disfiguring. Others may get caught in clothing and become irritated, red and start bleeding. These can be removed by a dermatologist.
The skin, especially in older overweight women, can form tags — small flaps of tissue that hang off the skin. These are not painful or dangerous. If they get snagged frequently on jewellery or clothing, they can be easily removed.
Dr Gita Mathai is a paediatrician with a family practice at Vellore. Questions on health issues may be emailed to her at yourhealthgm@yahoo.co.in
Monday, April 12, 2010
sweet dangers
Sweet danger
YOUR HEALTH
DR GITA MATHAI
“I cannot have diabetes,” exclaimed the middle-aged gentleman. “The laboratory results are wrong. My parents did not have diabetes, I am a vegetarian, and I do not even eat sweets.”
Well, this man is living in a soap bubble that is about to burst. None of the reasons cited protects from the onset of diabetes. As far as family history is concerned, awareness and routine laboratory tests for metabolic diseases are a relatively new phenomenon. His parents may have had diabetes and may have died quietly of an undiagnosed complication like a heart attack.
India has 30 million known diabetics, the largest number in the world. The figure is mounting daily and is slated to escalate by 200 per cent. Most of the affected will be in the economically productive age group of 30-60. We have to find out ways to combat this epidemic, halt it and prevent our children from falling prey to it.
Studies have shown that the possibility of developing diabetes depends on one’s genes, which are inherited from both parents, and the nurturing environment provided first in the womb and later by the mother.
To begin with, women should have the correct BMI (body mass index — weight divided by height in metre squared) of 23 before they become pregnant. Some women are undernourished and eat poorly. Their calorie intake is only 70 per cent of the required amount (2,000-2,200 calories for an active adult female). The protein content may be less than the recommended 075-1gm/kg. Both these situations result in poor foetal growth and an SFD (small for dates) baby.
Compensatory mechanisms come into play in SFD babies and they develop relative insulin resistance so as to maintain normal blood glucose concentrations. Vital organs like the brain and heart receive sufficient nutrition, but it is diverted away from the muscles.
These small babies exhibit a phenomenon called “catch up growth”. If fed adequately after birth, they attain normal weight for age and height within three years. In the process, they can develop impaired glucose tolerance as early as seven years of age.
Today’s teens have a different story. They are becoming obese on a diet of fast food and “time pass” television. Many girls are overweight when they get married. Pregnancy and well meaning advice to “rest and eat for two” do not help matters. Those who are obese (BMI more than 29) or diabetic during pregnancy can produce large babies (LFD or large for dates). These babies are exposed to excess nutrition in the womb. They secrete excess insulin, can develop insulin resistance and eventually diabetes. The problem is compounded if they are growing up in a family with faulty eating habits and little or no regular exercise.
Since we now know that the majority of us carries a gene which predisposes us to develop diabetes, it makes sense to thwart the march to disease.
Check your blood sugars once a year after the age of 25, even if you are asymptomatic, to be sure you don’t fall in the “prediabetic” category. Those who are prediabetic have a fasting blood sugar between 100 and 126mg/dl and a two-hour post prandial or oral glucose tolerance test value between 140 and 200mg/dl. Abnormal values may occur 15 years before the onset of overt diabetes. Without active intervention eventually 35 per cent go on to develop the disease. With effort and a change in lifestyle, 45 per cent can revert to normal.
Medical complications — which cause heart disease, stroke, peripheral vascular diseases, and eye and kidney problems – begin to set in during the prediabetic stage. Early identification and treatment can reduce the damage.
The BMI should be maintained at 23. This can be done by keeping the caloric intake between 1,500-2,000 calories a day. The diet should be low in fat, and contain four to six helpings of fruit and vegetables. But dieting alone will not help, as weight loss through starvation cannot be sustained. Food restriction should be combined with physical activity for 60 minutes every day. A brisk walk (five kilometres), or one hour of swimming or cycling will do the trick.
Blood pressure should be maintained at 130/80 or less. Salt restriction and weight loss alone may be sufficient to achieve this. If not, medication may be needed.
Lipid levels also need to be monitored in prediabetes as dyslpidaemia and altered glucose tolerance go hand in hand. Elevated lipid levels predispose to a stroke and heart attack. LDL should be below 100 mg/dl, HDL above 40mg/dl (above 50 mg/dl for women), and triglycerides below 150mg/dl. Reducing the total oil intake to 500 ml a month, checking labels for hidden fats in processed foods, and eating more soluble fibre (beans and oats) will help. If levels remain high the statin group of medications can be started.
If parents adopt a healthy lifestyle, children will soon follow suit. Perhaps this way we can reduce the impact of this devastating disease in the next generation.
Dr Gita Mathai is a paediatrician with a family practice at Vellore. Questions on health issues may be emailed to her at yourhealthgm@yahoo.co.in
YOUR HEALTH
DR GITA MATHAI
“I cannot have diabetes,” exclaimed the middle-aged gentleman. “The laboratory results are wrong. My parents did not have diabetes, I am a vegetarian, and I do not even eat sweets.”
Well, this man is living in a soap bubble that is about to burst. None of the reasons cited protects from the onset of diabetes. As far as family history is concerned, awareness and routine laboratory tests for metabolic diseases are a relatively new phenomenon. His parents may have had diabetes and may have died quietly of an undiagnosed complication like a heart attack.
India has 30 million known diabetics, the largest number in the world. The figure is mounting daily and is slated to escalate by 200 per cent. Most of the affected will be in the economically productive age group of 30-60. We have to find out ways to combat this epidemic, halt it and prevent our children from falling prey to it.
Studies have shown that the possibility of developing diabetes depends on one’s genes, which are inherited from both parents, and the nurturing environment provided first in the womb and later by the mother.
To begin with, women should have the correct BMI (body mass index — weight divided by height in metre squared) of 23 before they become pregnant. Some women are undernourished and eat poorly. Their calorie intake is only 70 per cent of the required amount (2,000-2,200 calories for an active adult female). The protein content may be less than the recommended 075-1gm/kg. Both these situations result in poor foetal growth and an SFD (small for dates) baby.
Compensatory mechanisms come into play in SFD babies and they develop relative insulin resistance so as to maintain normal blood glucose concentrations. Vital organs like the brain and heart receive sufficient nutrition, but it is diverted away from the muscles.
These small babies exhibit a phenomenon called “catch up growth”. If fed adequately after birth, they attain normal weight for age and height within three years. In the process, they can develop impaired glucose tolerance as early as seven years of age.
Today’s teens have a different story. They are becoming obese on a diet of fast food and “time pass” television. Many girls are overweight when they get married. Pregnancy and well meaning advice to “rest and eat for two” do not help matters. Those who are obese (BMI more than 29) or diabetic during pregnancy can produce large babies (LFD or large for dates). These babies are exposed to excess nutrition in the womb. They secrete excess insulin, can develop insulin resistance and eventually diabetes. The problem is compounded if they are growing up in a family with faulty eating habits and little or no regular exercise.
Since we now know that the majority of us carries a gene which predisposes us to develop diabetes, it makes sense to thwart the march to disease.
Check your blood sugars once a year after the age of 25, even if you are asymptomatic, to be sure you don’t fall in the “prediabetic” category. Those who are prediabetic have a fasting blood sugar between 100 and 126mg/dl and a two-hour post prandial or oral glucose tolerance test value between 140 and 200mg/dl. Abnormal values may occur 15 years before the onset of overt diabetes. Without active intervention eventually 35 per cent go on to develop the disease. With effort and a change in lifestyle, 45 per cent can revert to normal.
Medical complications — which cause heart disease, stroke, peripheral vascular diseases, and eye and kidney problems – begin to set in during the prediabetic stage. Early identification and treatment can reduce the damage.
The BMI should be maintained at 23. This can be done by keeping the caloric intake between 1,500-2,000 calories a day. The diet should be low in fat, and contain four to six helpings of fruit and vegetables. But dieting alone will not help, as weight loss through starvation cannot be sustained. Food restriction should be combined with physical activity for 60 minutes every day. A brisk walk (five kilometres), or one hour of swimming or cycling will do the trick.
Blood pressure should be maintained at 130/80 or less. Salt restriction and weight loss alone may be sufficient to achieve this. If not, medication may be needed.
Lipid levels also need to be monitored in prediabetes as dyslpidaemia and altered glucose tolerance go hand in hand. Elevated lipid levels predispose to a stroke and heart attack. LDL should be below 100 mg/dl, HDL above 40mg/dl (above 50 mg/dl for women), and triglycerides below 150mg/dl. Reducing the total oil intake to 500 ml a month, checking labels for hidden fats in processed foods, and eating more soluble fibre (beans and oats) will help. If levels remain high the statin group of medications can be started.
If parents adopt a healthy lifestyle, children will soon follow suit. Perhaps this way we can reduce the impact of this devastating disease in the next generation.
Dr Gita Mathai is a paediatrician with a family practice at Vellore. Questions on health issues may be emailed to her at yourhealthgm@yahoo.co.in
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