lipid profiles

a part. If there is no such family history, lipids should be evaluated for the first time at the age of 20. If the results are “desirable”, the next reading can be taken after five years. In an older person (over 45 in men and 55 in women) the values need to be checked every year. The blood should be taken after a nine-hour fast (water can be consumed). There should be no fever, infection, inflammation or pregnancy as these can alter the values. Everyone has fat deposits under the skin, where it serves as insulation against heat and cold. Cholesterol is a fat that is produced by the liver and is essential for normal metabolism. It is not soluble in blood, it is transported through the body by LDL (low density lipoproteins), HDL (high density lipoproteins) and VLDL (very low density lipoproteins). Of these HDL is a “good” lipid as it transports excess cholesterol to the liver for excretion. VLDL and LDL transport cholesterol from the liver back into the blood. As long as blood cholesterol remains in the normal range, the blood circulates freely. When levels are elevated, it precipitates in the blood vessels, forming obstructive deposits called plaques. This eventually leads to high blood pressure, heart attacks and strokes. TGL or triglycerides are different from cholesterol. They are derived from food when the calorie intake is greater than the requirement. It combines with cholesterol and gets deposited in the blood vessels. A person with elevated lipids may develop a yellow deposit of cholesterol under the skin, usually around the eyelids. They may also have a crease on the earlobes. A fat deposit (lipoma) can appear as a painless mobile lump just under the skin anywhere in the body. When multiple, it is a hereditary condition called multiple lipomatosis. These are not markers for elevated lipids. The lumps are not cancerous but may be cosmetically unacceptable. They do not respond to the lipid lowering medications and need to be surgically removed. An elevated lipid profile can often be reversed by changes in lifestyle. Quit smoking immediately and drink in moderation only — two drinks a day for men and one for women. The much publicised cardio protective actions of alcohol are outweighed by the other problems of regular drinking. Try to achieve ideal body weight and bring down the BMI (body mass index, which is found by dividing the weight by the height in metre squared) to 23. This can only be achieved with a combination of diet and exercise. Try to stop snacking, especially on fried items and “ready to eat” snacks. Increase the consumption of fruits and vegetables to 4-6 helpings a day. Walnuts, almonds and fish are rich in protective omega -3 fatty acids and Pufa (poly unsaturated fatty acids). Oats contains dietary fibre. Lower oil consumption to 300ml per month per family member. Try to use olive oil. If that is not practical or feasible, use a mixture of equal quantities of rice bran oil, sesame oil, mustard oil and groundnut oil. Exercise aerobically (walking, running, jogging or swimming) for 60 minutes a day. This need not be done at one stretch but can be split into as many as six 10-minute sessions. If lipids are still elevated after 3-6 months despite these interventions, speak to your physician about regular medication. The “statin” group of drugs are very effective. They lower cholesterol, prevent its deposition and stabilise the plaques in the blood vessels. They can be combined with other drugs like ezetimibe (which limit the absorption of cholesterol), or bile acid binding resins, or niacin or fibrates. Natural supplements of fish oil or pure omega-3 fatty acid capsules also help. Lipid lowering medications are usually well tolerated and very effective. 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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prediabetes

Sweet news for pre-diabetics Your Health Dr Gita Mathai A healthy life is a universal goal. Disease is inconvenient, it affects the quality of life and shortens your life span. Illness does not mean just infections or accidents. It includes chronic lifestyle diseases such as obesity, diabetes and hypertension. These diseases form a group, with one (usually obesity) appearing first and then rapidly progressing to the other two. Combined, they are responsible for more morbidity and mortality than infections. Twenty per cent of our children and 15-40 per cent of adults are obese. They have a body mass index (BMI) of over 30. The highest levels are in the urban areas. In addition, 10-15 per cent of the population over the age of 30 is either frankly diabetic or in the pre-diabetic stage. There are no obvious signs of pre-diabetes. It is suspected in:  A person with a family history of diabetes  Women who developed diabetes during pregnancy or delivered a big baby (more than 4kg) or who have been diagnosed with polycystic ovarian syndrome (PCOS), which is manifested by a obesity, acne, hirsuitism and irregular periods  A person who is relatively inactive. This means less than one and a half to two hours a week of leisure time (not work) activity such as walking, jogging, running, swimming or cycling  A person whose sleep rhythm is disturbed. It is either excessive (more than nine hours a night) or insufficient (less than six hours). These are only average values as healthy sleep habits vary widely  A person whose skin at the neck, elbows, knees, armpits and knuckles become dark and velvety, a condition called acanthosis nigricans. It looks like dirt but it is a change in the skin itself. No amount of scrubbing removes the colour, nor does talcum powder mask it  A person with a BMI of more than 30  A person whose blood pressure has been found to be high (more than 135/90) on three occasions  A person with abdominal obesity who has a waist-hip ratio above 0.90 if male and above 0.85 if female. The waist can be measured at its narrowest point, and the hip at its widest Pre-diabetes is confirmed when the glycated haemoglobin test (A1C) in the blood shows a value between 6-6.5 per cent, fasting blood sugar is between 100-120mg, the two-hour post prandial value is between 140-190mg. Additional abnormalities are high-density lipoprotein (HDL) cholesterol below 35 milligrams per decilitre (mg/dL) and triglyceride level above 250 mg/dL. As soon as the biochemical abnormalities occur, damage to the blood vessels and internal organs like the eyes, heart and the kidney are set in motion. The early diagnosis is a warning, a wake up call. There is a 10-year window period to reverse the trend. The good news — a “pre-diabetic” has a good chance of turning back the clock, reversing the metabolic changes that have occurred and becoming biochemically normal. The first step is to control the weight, by eating a sensible 1,500-2,000 calorie diet with less refined carbohydrates and at least 4-6 helpings of fruits and vegetables. Reduce the salt intake to 5gm (1 level teaspoon) a day. Avoid salted snacks and deep-fried items. Oil consumption should be reduced to 500ml per person a month. If the lipid profile does not return to normal ask your physician about low dose medication (usually the statin group) to control it. Physical activity plays a very important role. The minimum requirement is one and a half hours a week. This will not give you a six pack or help you run a marathon, but it will slow your progression to diabetes. The ideal amount of exercise is an hour a day, seven days a week. If you can only spare the minimum amount of time, the intensity of the exercise (pace) needs to be increased. Aim to reach your target heart rate, which is 80 per cent of 220-age. There are various schedules for this high intensity interval training (HIIT). The simplest (requiring no equipment at all) is continuous stair climbing for 10 minutes at a time. Exercise can also be split into 10-15 minute segments spread out during the day. There will be days when the weather is not conducive to going out doors, you just don’t feel up to it, or social commitments preclude activity. Exercise is more likely to be adequate and consistent if “rest days” are unplanned inevitable events. These simple lifestyle changes can drastically bring down the risk of progression to diabetes and the risk of strokes, heart attacks and other complications by more than 50 per cent. 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

marriage in india

Take a shot at marriage Your Health DR GITA MATHAI Almost everyone in India gets married (95 per cent men of and women by the age of 35). Either they find someone or their friends, relatives, neighbours, marriage brokers and media advertisements pitch in. Society does not condone remaining single. Having children is the next step, and anyone who does not procreate within a year or two of marriage is viewed with consternation and pity. The ideal age for marriage is debatable. Much anthropological data have been collected but there is no clear consensus. The age of maximum and healthy fertility in women is between 18-32 years; men remain fertile longer. The legal age of marriage for a girl is 18 years. By that time, her body is mature enough to cope with the rigours of pregnancy, childbirth and child rearing. But she would barely have finished high school at that age; it is probably better to wait for her to have acquired a college degree or vocational training. This helps the bride to be more mature, physically and mentally. She will also be able to bring up her children better as she will be able to read about advances in childcare, do home tutoring and follow the complicated immunisation schedule. A great deal of money is spent arranging a wedding. It would probably be better if some of it is invested in ensuring that the girl’s health status is satisfactory and her immunisations complete. The MMR (measles mumps rubella) vaccine prevents the mother from acquiring these infections inadvertently during pregnancy. The rubella virus can infect the foetus at any stage of pregnancy but during early pregnancy (before the sixteenth week) it results in malformations in the baby. Common abnormalities seen soon after birth are hearing loss, mental retardation, heart and eye defects. As the child grows, (if it survives) diabetes, thyroid problems and glaucoma may appear. The mother-to-be can be protected if she takes two doses of the vaccine, one at around 15 months and the second along with the DPT booster at five years. It can also be given later as two doses eight weeks apart. Almost all adults in India (99 per cent) have had chicken pox. Usually, it is a mild attack with no after effects but it can be dangerous during pregnancy. If the mother is infected in the first 20 weeks, the child can develop skin and bone defects, abnormal limbs, eye defects and mental retardation. If it occurs close to the date of delivery, the baby can develop a life threatening infection. Again, chicken pox is totally preventable with two doses of the varicella vaccine. Hepatitis B is be life-threatening and can pass directly from mother to baby. It can result in chronic liver disease and the eventual death of the baby. It is easily preventable with three doses of hepatitis B vaccine. The government has now started to give this vaccine free to newborns. It is combined with the DPT or triple antigen. Older children and teenagers have been missed in the free government schedule. They need to get immunised before marriage. Even if these immunisations have been missed, “catch up” immunisation can be given to complete the schedule before marriage. Folic acid (a vitamin) is essential to prevent defects of the brain and spine in babies. Unfortunately our diet is woefully deficient in it. Supplements (5mg per day) need to be started as soon as the engagement occurs and continued for the first five months of pregnancy. It is also important to achieve and maintain the ideal basal metabolic rate of 23. It should be done with a judicious combination of diet and exercise. A balanced diet combined with aerobic activity (running, jogging, walking, cycling, swimming) for an hour a day most days of the week along with yoga, flexion and strengthening exercises for 20 minutes is ideal. Marriage is a partnership. Unimmunised men can bring infections home. An unhealthy lifestyle with obesity, tobacco abuse and excessive drinking reduce sperm count and quality. It can contribute to infertility. Regular exercise is essential to prevent development of lifestyle diseases such as diabetes and hypertension. This will go a long way towards a long, secure and happy married life. 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 Share on emailShare on printShare on facebookShare on twitterMore Sharing Services

blunt injuries

Ouch! That hurt Your Health DR GITA MATHAI Injuries occur unexpectedly all the time. You may walk into a door, slip and fall or be thrown against the dashboard as a vehicle brakes suddenly. Any blunt trauma (as differentiated from a sharp injury that may cause bleeding) to the muscles and bones immediately causes an inflammatory reaction. The area becomes red, swollen and painful. The appearance may mimic an acute infection but differentiated from it by the history of trauma and the absence of fever. The injury may be a contusion, the result of trauma to the belly of the muscle, tendon or bony prominence. Blood coagulates in the affected area forming a discoloured bruise. Untreated, this can eventually form scar tissue. Sprains and strains occur in areas where a ligament is attached to the bone, such as the back, knee, ankle or elbow. The injury is mild when there is only over stretching and a few microtears. If there is a partial tear, the joint may become loose and unstable. Emergency first aid must be given for traumatic inflammation even before obtaining a medical opinion. Ignored and delayed, (while awaiting a medical consultation), it can lead to stiffness, pain and loss of normal function. As soon as possible the RICE principle should be followed. R is for rest. The part should immediately be placed at rest. This means minimal weight bearing till the pain subsides. Usually 2-3 days are sufficient. I is for ice. Ice should be placed in a plastic bag and applied to the affected area. It should be left on for 20 minutes at a time every hour for the first hour and then continued three times a day for 3-4 days until total relief is obtained. Faster and greater pain relief may be obtained if the ice is actively massaged on the swollen area. Ice reduces the swelling, numbs the pain, decreases muscle spasm and helps accumulated blood to renter circulation. C is for compression. Swollen areas can be compressed with an elastocrepe bandage. This should initially be applied by trained personnel. Faulty and tight application can cut off blood supply to the affected limb. Once the technique is learnt, bandaging can be done at home. E stands for elevation, a neglected step. Swelling reduces rapidly if the injured part is placed above the level of the heart. Blunt injury causes pain. This can be relieved by medication like paracetmenol, brufen and diclofenac and other Nsaids (non-steroidal anti inflammatory agents). These are commonly available over the counter (OTC) either as single agents or combination tablets. They relieve pain but cause side effects. There may be nausea, vomiting or symptoms of heartburn. A pre-existing ulcer may be aggravated. Long term use and overdosage are dangerous. Some like diclofenac has been associated with kidney damage. If there is no improvement after 2-3 days, see a doctor. If there is no serious injury, after the swelling has subsided reconditioning of the injured area has to be done. This will help to regain flexibility, endurance and power. Joints and muscles can be strengthened with targeted exercise. Flexibility is equally important. A weak or relatively immobile joint is prone to re-injuries with much less trauma. The joint may also become unstable and weak. Physiotherapy is important to tackle all this. Even without an injury, there may be a sudden cramp in the muscle. This occurs when muscles are overused in hot and humid conditions. It can also occur due to calcium deficiency. The muscles contract and the limb gets painfully fixed. The muscle needs to be stretched to relieve the pain. This can be done in the calf by keeping the leg straight and pushing the foot (not the leg) towards the head. In the thigh the knee should be bent with the foot touching the buttocks. Water, lightly salted limejuice, buttermilk or tender coconut water should be given. A fall or accident may also lead to broken bones. If the bones are already weak as a result of osteoporosis or repeated stress, even a slight injury is enough to result in a fracture. There is severe pain, inability to bear weight on the bone and a localised tender area. Fractures are diagnosed using X-rays and should be treated by an orthopaedic surgeon. Either POP (plaster of Paris) casts are applied or surgery needs to be done. Bones do not heal with medication alone. Neither is it advisable to go to unqualified “bone healers” as they immobilise the bone using cloth and a poultice. Since the treatment is not based on X-rays, it may not be wise to pursue this line of treatment. 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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