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
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