fat or fit?

Fat or fit?

Your Health DR GITA MATHAI

Women often ask, “Do I look fat?” If you feel the need to ask that question you probably have a problem! This question seldom worries overweight men, until their physicians point it out or diagnose lifestyle diseases. All of us want to look good but in reality beauty does not lie in the eye of the beholder; the ideal size and shape is a debatable question and can be calculated with numerical formulae. Various parameters are used by insurance companies to assess health and predict longevity, or, in other words, how fit a person is. The most widely used is the body mass index or BMI (weight in kilograms divided by height in metre squared). Based on this simple formula people were classified into: low (18.5 and below), normal (18.5 to 25.0; Asian value is 23), obese level 1 (25.0 to 30.0), obese level 2 (from 30.0 to 35.0), obese level 3 (from 35.0 to 40.0) and obese level 4 (40.0 and above). But the formula has been found to have many defects. It is accurate for men of medium height, but flawed for women. Athletes have increased muscle mass and this increases their BMI. Very tall or short individuals fall outside the normal range even when they are healthy. Medical professionals sometimes measure the waist alone. If it is more than 35in (89cm) for women and more than 40in (102cm) for men, there is an increased risk of lifestyle diseases. The waist:hip ratio (WHR) can also be used. Ideally, it should be 0.7 for women and 0.9 for men. Women in the ideal range have optimal levels of the female hormone estrogen; this makes them less likely to have menstrual irregularities and more likely to be fertile. The likelihood of developing cancers of the uterus and ovary is also reduced. In men too, normal values indicate better fertility and less likelihood of cancer of the testes or prostrate. An ideal WHR makes both sexes less likely to develop lifestyle diseases. Measurements, statistics and appearance are useful as rough guidelines but health actually means being “fit”, that is, having a flexible body, with efficient heart, lungs, bones, muscles and nervous system. A person in the “overweight” or “obese” range according to the formulae above can actually be fit while a “thin” person may be unhealthy. Fitness means: The person should not use tobacco in any form or drink excessively. Blood pressure, lipid profile and sugars should be normal. The person should be able to move all their joints through their entire range of motion painlessly, both actively and passively. Simple tests to measure fitness at age 30 and above: Seated comfortably in a chair, with arms crossed, they should be able to stand up and sit down approximately 12 times in 30 seconds. Should be able to sprint 100 metres in 20 seconds or less Seated cross legged on the floor, should be able to stand up without using any other part of the body for balance, assistance and support. The primary goal should not be “looking good” but “feeling great”. Weight loss is often difficult, especially after the teenage years. It cannot really be simplified into the formula calories eaten minus calories used. People utilise calories at different rates for the same activities. The BMR (basal metabolic rate) at which their bodies perform basic functions necessary to stay alive varies. This is where genetics comes into play. Some people are inherently more efficient at conserving calories and perform the same functions utilising less energy. Physical activity helps the body maintain healthy levels of insulin and blood sugar. This prevents damage to blood vessels and internal organs such as the heart and kidney. Regular exercise blunts obesity’s ill effects even with little or no weight loss. As fitness is achieved, some amount of weight loss is bound to eventually occur. Together, this increases lifespan and reduces the risk of cancers and other serious illnesses by 20-30 per cent. Achieving fitness should be a lifelong goal. It requires aerobic activity (running, jogging, brisk walking, cycling or swimming) for 30-60 minutes a day, core and muscle strengthening exercises, light weights and yoga or other flexibility exercises for 20 minutes a day. No time for exercise? That just means you will have a lot of time for illness later! 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

problems with gas

ull of air

Your Health DR GITA MATHAI

If you have dyspepsia: • Eat meals on time, chewing the food well. • Drink around three litres of water a day. Water dissolves gas. • Do not sleep for at least an hour after eating. • Avoid consuming more than 400ml of milk a day. • If you have a sedentary job, stand up and move at least around your desk every hour. • Walk, run or jog for 40 minutes to an hour a day. The movements will tighten your abdominal muscles preventing distension. The chemicals released by the muscles during exercise help to regulate the nervous system • Do yoga. There are specific exercises for dyspepsia. The meditation will relieve stress and calm your mind. Burping, belching, a painful distended abdomen, a feeling of fullness after eating “just a little” — these uncomfortable symptoms of dyspepsia affect 20 per cent of the population at some point in their lives. Many blame dietary indiscretions — a temporary overindulgence in rich food. Since there is no consistent pattern, the patient ends up avoiding more and more food items with less and less satisfactory results. Dyspepsia is predominantly a clinical diagnosis, made when the symptoms mentioned above have been present for three months or more. Thorough investigations are necessary if these symptoms suddenly appear in a person over 55 years old, there is bloodstained vomiting, intractable pain, difficulty in swallowing or significant weight loss. The symptoms of dyspepsia can also be a side effect of certain pain relieving medicines or steroids. They can even be caused by diabetes, lipid abnormalities, thyroid problems or kidney disease. In women, symptoms may be aggravated pre-menstrually or during pregnancy, precipitated by hormonal changes. Angina (forerunner of a heart attack) can also lead to pain in the upper abdomen pain but it is usually accompanied by sweating and can be picked up on an ECG. If investigations rule out all of the above, get an X-ray, ultrasound and CT scan done. This can be followed by endoscopy, if necessary. Endoscopy allows the doctor to see the lining of the stomach clearly; if there are ulcers, they can be sent for biopsy. Eighty per cent of stomach and duodenal ulcers are caused by bacteria calledHelicobacter pylori. The “azole” group of drugs can treat ulcers. Gallstones may be blamed for the symptoms but they are rarely the cause. About half of the population has gallstones but no symptoms. Removal of the gall bladder usually does not cure the symptoms. The good news is that medical tests for most people with dyspepsia return normal results. The bad news is that they still have a disease, a chronic condition that improves and relapses. So if their condition improves after they have eliminated a certain food from their diet, it makes patients erroneously believe that is what has led to an improvement. Self-imposed dietary restrictions may then result in other health problems. Dyspepsia is caused by a malfunctioning gastrointestinal smooth muscle. The nerves that supply the muscle do not work properly, probably because signals from the brain and chemicals released for their action are faulty. This can be confirmed with motility studies. This investigation is expensive, time consuming and done only in specialised centres. The emptying time of the stomach and forward propulsion of food are aggravated by eating too fast, drinking carbonated beverages and overeating. The discomfort results in pain and belching. As the air is expelled there is some relief. In some people belching is a response to any kind of abdominal discomfort, even when there is no excess air. Not much research has been done on dyspepsia since it is not fatal. Response to treatment is difficult to evaluate. A variety of medications have been tried — the “azole” group of drugs, prokinetics such as domperone and periactin. The response is variable, with some patients responding well and others poorly. Better results are sometimes obtained if they are also put on anti-depressants. The medicines work on the transmitter nerves and have a pain relieving effect as well. 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

tuberculosis

The great deceiver Your Health DR GITA MATHAI TB spreads through the air. Only lung TB is infectious. People with extra-pulmonary TB are not infectious to others Children with TB do not spread it to their contacts TB is curable with adequate treatment and patient compliance Tuberculosis can be described as “the great deceiver,” confounding doctors and patients alike. It appears so slowly and insidiously that the patient is often unable to pinpoint the exact time and date the illness started. The symptoms may be non-specific — a vague feeling of being unwell, tiredness, fatigue, aches and pains, a rise in temperature in the evening, sweating in the night and occasional chills. Symptoms may be present for weeks before the patient or the doctor realises that something is wrong. When we think of TB patients, we visualise an emaciated — possibly poor — person who coughs up blood. This image is, however, far from the truth. Although TB most commonly occurs in the lungs, it can also affect other organs such as lymphnodes, covering of the heart, bones, brain and spinal cord, urinary tract, abdomen, reproductive system and even the eye. Only “open” cases of TB transmit the infection, that is, patients who cough or spit out sputum containing TB bacteria. Anyone who inhales the bacteria may get infected. About 40 per cent of the Indian population carries the TB bacteria but not all of them manifest the disease. Once the person’s resistance is compromised, the disease can flare up. Although the initial infection is in the lung, it can spread via the blood to any organ in the body and produce an infection there. Sometimes, particularly in children or immunodeficient individuals, it can produce an explosive illness — a “military spread” that affects all the organs in the body. TB is more likely in children, those aged between 14 and 20, and the elderly. The risk increases if the person also has cancer and is undergoing treatment for it, has silicosis (an occupational disease affecting people who work in quartz, granite or silica mines) or diabetes, liver or kidney failure, is on steroids or has HIV. Overcrowding, lack of ventilation and using a wood fire increases the risk. Overcrowding means a person with open tuberculosis has a greater chance of infecting family and neighbours. Smoking beedis or cigarettes is an independent risk factor. It has been linked to 50 per cent of TB cases in India. Despite treatment, smokers tend to have a higher mortality. The same is true of alcoholics, particularly if liver function is compromised. Most of the initial exposure to TB occurs in childhood. In an attempt to prevent this, the government administers BCG (Bacilli Calmette-Guerin) immunisation to all children soon after birth. The vaccine does not prevent TB, but it does reduce the severity of the disease, and also prevents TB meningitis (in the brain). Once the disease has been diagnosed, treatment has to be adhered to. Medication has to be taken regularly and systematically for periods ranging from six months to a year. Usually, a combination of three to four drugs is used. Of them, rifampicin has to be taken on an empty stomach to have maximum effect. It can cause sunlight sensitivity so patients must use sunscreen. Ethambutol can cause blurred vision, painful red eyes and red-green colour blindness. Pyridoxine (a B complex vitamin) needs to be concurrently taken to prevent INAH (isoniazide)-induced nerve toxicity. The government provides free TB treatment through primary health care settings and non governmental orgnisations. They usually administer DOTS (Directly Observed Tuberculosis treatment Short course). The drugs are administered under supervision to the patient every alternate day. Some schemes give the patient a week or a month’s treatment in hand. The schemes have drawbacks. The distribution site may be inconveniently located, timings of the centre may be inconvenient for working people, strikes and government holidays may interfere with its efficiency. Many people do not know that anti-TB medication can be purchased from private pharmacies with a prescription. A few weeks after treatment is started, the symptoms disappear and the patient feels better. Unfortunately, at this time many discontinue treatment. Strict adherence to treatment usually results in a cure. Failure to do so can result in relapses or recurrences. These can be expensive, difficult to treat or fatal, as the organism may have developed multi drug resistance. 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