obesity

Keep fat away Your Health DR GITA MATHAI Forty odd years ago, when I started practicing medicine, we seldom checked if people under 45 years of age had elevated blood sugars or an abnormal lipid profile. We made cursory enquiries about “family history of diabetes” and that was it. This was before the era of health insurance and master health check ups. So most people were not even aware whether their family members actually did have diabetes. The processed food industry was also in its infancy, and packaged foods with unhealthily high levels of trans fats, salt, chemicals, fructose and sugar were either not available or prohibitively expensive. Times have changed. We are now a prosperous nation, and most of us consume calories in excess of our physical requirement. We also have a sedentary lifestyle. The emphasis is on long hours of study or work with physical activity an unwelcome intruder. Mechanised transport has replaced walking, and even the bicycle is not as popular as it used to be. Now, many people over 25 are obese. They have a BMI higher than 30 (obese), and definitely above 23 (overweight). Many have deranged lipid profiles. Some have blood sugar values which are in the “higher normal” range. Women are more affected than men by these changes in lifestyle; 60-70 per cent have menstrual irregularities. When they try (often unsuccessfully) to conceive, they are told that they have PCOS (polycystic ovarian syndrome.) All these patients have the cardio-metabolic syndrome, a disorder of energy utilisation and storage. It is diagnosed if at least three out of the following five conditions are present. • Central abdominal obesity is present if the waist:hip ratio > 0.90 (male) or > 0.85 (female). The waist circumference alone can be used and should be less than 94cm or 37in (male), or 80cm or 32in (female). • The blood pressure is 130/90 or more on three or more occasions. • High blood sugar levels, with a fasting blood glucose test result of 100 milligrams per deciliter (mg/dL), or 5.6 millimoles per litre (mmol/L), or more. • High cholesterol, with a level of the blood fat called triglycerides of 150 mg/dL (1.7 mmol/L) or more and the level of high-density lipoprotein (HDL) cholesterol — the "good" cholesterol —less than 40 mg/dL (1.04 mmol/L) for men or less than 50 mg/dL (1.3 mmol/L) for women. • A BMI of 30 or more. • Additional findings which should raise suspicions of metabolic syndrome are fatty liver, gall stones and high CRP (C Reactive Protein). As we age, we are more prone to develop the cardio-metabolic syndrome. Normally, the food we eat is broken down into simple sugars, which are absorbed, utilised for energy or stored in tissues. In order for the glucose to be broken down, adequate amounts of insulin need to be produced by the pancreas. Metabolic syndrome is due to a type of insulin resistance where more and more insulin needs to be produced to keep the sugars under control. This insulin resistance leads to abdominal obesity, high uric acid levels, abnormal lipid profile and eventually (when supply fails to keep pace with demand) frank diabetes. In women it is one of the causes of PCOS. Metabolic syndrome X results in a 20 per cent higher risk for stroke and heart attacks. The risk factors for developing metabolic syndrome should be tackled in childhood. Despite heavy academic schedules, 30 minutes of non-stop active exercise is essential from the age of five. This should be maintained all through life. Keep a watch on the waist circumference, weight and BMI. Losing as little as 15 per cent of the additional body weight can reverse many of the changes responsible for the metabolic syndrome. Eat a sensible high fibre diet, low in fat and processed food with at least 4-6 helpings of fruits and vegetables. Try to use only half litre of oil a month per family member. Avoid ghee, vanaspathi and palm oil. Smoking or being around smokers increases the risk of insulin resistance. After 3-6 months of dieting, walking and other lifestyle changes, if the abnormal biochemical values do not return to normal, your doctor can help you with medications to help your body fight the insulin resistance. Metformin helps the body to efficiently utilise glucose and reverses some of the insulin resistance. The statin group of drugs corrects the lipid profile. Blood pressure can usually be brought to normal with medication. Since no particular group of drugs has been proved to be superior to another, your physician will be able to prescribe what is best for you. Prevention of heart attacks and strokes may require a nightly dose of (75mg) aspirin. 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

tackling the flu

How to fight the flu Your Health DR GITA MATHAI October to March is flu season, the time when many fall victim to the sniffles. Flu is actually an infection that affects the nose, throat and lungs. It is usually due to a locally active virus that belongs to Influenza group A or B. Since the groups contain a large number of viruses, different strains cause infections every year. Rarely, the flu is due to an internationally virulent strain that rapidly spreads across the globe, such as swine flu or avian flu. Young children, the elderly, pregnant women and those who are suffering from chronic illnesses that have compromised their immune system are particularly vulnerable. This leaves out only teenagers and young adults who are in robust health! The infection follows anywhere between two and 10 days after exposure to the virus. Initially, it may be confused with a common cold. Colds affect people several times a year whereas flu occurs once in several years. Also with flu, several people are affected within a short space of time, either in school, college or the workplace. Flu usually starts abruptly, with a runny nose, cough, fever (over 100°F), chills, dizziness, flushed face, headache, backache, leg and muscle pains. There may be nausea, vomiting and lack of energy. The symptoms are similar to that of a common cold and it may be difficult to distinguish between the two. In the case of flu the symptoms appear with no warning and are severe from the beginning. The first symptom is often fever. In adults the temperature is usually lower than in a child. Colds start slowly and gradually. The fever as well as aches and pains begin to fade on days 2-4, but this is followed by the appearance of new symptoms such as a dry cough, rapid breathing, sneezing and sore throat. These symptoms also usually last 4-7 days. The flu can make asthma, breathing problems, and other long-term illnesses worse. Recovery from the flu may not be complete for weeks. The fever and other symptoms may disappear only to be followed by tiredness, depression, inability to cope with work and lethargy. Secondary lung infection can cause the fever to return. The appetite may remain poor. The flu virus lives in the respiratory tract. Coughing, sneezing or even talking expels the viral particles in the air. They remain suspended as they are very light and can be breathed in by others. They also tend to settle on surfaces such as tables, walls, telephones and computer keyboards. Others touching the surfaces transfer the particles to their respiratory system and acquire the infection. In closed spaces such as metros, aircraft, shopping malls and classrooms, the infection spreads like wild fire. A large number of people are affected in a very short space of time. The flu becomes an epidemic. The virus that causes flu mutates rapidly, changing all the time. Recovery from one episode does not provide protection against a second attack from a different strain. The second attack may be milder if there is some genetic material that is common between the strains. Young healthy adults recover from flu with no long-term after effects. Children and the elderly can develop complications such as pneumonia, bronchitis, sinusitis or ear infections. These are virulent bacterial infections that gain a foothold because the respiratory system is weakened by the viral attack. Recovery from the flu takes time. Bed rest, plenty of fluids and paracetemol for the pain is usually all that is required. Aspirin should not be used in flu. In children and teenagers it can cause a rare fatal reaction known as Reye’s syndrome. Some anti viral medications such as oseltamivir (Tamiflu) or zanamivir (Relenza) can be taken. They have to be started early on in the illness in adequate dosages. They can shorten the duration of illness and reduce the complications. Tamiflu is taken orally and Relenza is inhaled. These medications have side effects. They can induce nausea and vomiting. They are contraindicated in asthmatics. Rarely, they can cause delirium. Inadequate dosing can do more harm than good. The virus can become resistant to the medication. Every year the pharmaceutical companies release “flu vaccine.” A new vaccine is released every year with the three most common strains likely to cause an epidemic that year. It can be an injectable vaccine or a nasal spray. Protection is more than 90 per cent. Washing hands frequently with soap or an alcohol-based hand sanitiser prevents the virus from being carried on the hands. The nose and mouth should be covered while coughing or sneezing. A tissue, which can be discarded, is more hygienic than a cloth handkerchief. If neither is available then sneeze into the crook of the elbow. Crowded places increase the risk of transmission, so it is best to avoid them if possible during the flu season. 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

the season to be jolly

’Tis the season to be jolly

Your Health DR GITA MATHAI

Tipsy tips  Eating fried and greasy food coats the lining of the stomach and delays alcohol absorption. Drinking water and fruit juice will help “wash” the alcohol and chemicals out of the system, relieving the headache. Black coffee initially stimulates the nervous system, and may help with drowsiness, but the headache rapidly returns. The holidays have started, and even though each state rings in its new year on a different date, India will join the rest of the world in celebrating the arrival of 2014 on January 1. The New Year is ushered in with parties at clubs, hotels and resorts or in friend’s houses. Alcohol flows freely and there are several dangerous pitfalls for the unwary. The safe limits for drinking are four units of alcohol for men and three units for women. Women have less muscle reserve than men; so that makes them more susceptible to the side effects. The recommended safe limits are based on alcohol units, so it makes little difference whether you drink beer, wine or whisky! One unit is equal to 10ml of pure alcohol. While calculating intake, one unit of alcohol is about equal to half a pint of ordinary strength beer, lager, or cider, a small pub measure (25ml) of spirits and a standard pub measure (50ml) of fortified wine such as sherry or port. The alcohol content of spirits vary depending on the type (whisky, brandy, rum). An accurate calculation can be done by using the formula percentage of alcohol by volume of a drink equals the number of units. Pregnant women, those planning to become pregnant and teenagers (under 21 years) should not drink at all. No one can really “hold their liquor”. Binge drinking (as can occur during parties) is particularly dangerous. Even in the most seasoned drinkers, it reduces reaction time and clouds judgement. This can result in road accidents. Self-control is rapidly lost and may result in fights. Balance is affected and injuries can occur from tripping and falling. Blood pressure can shoot up, resulting in a stroke. The increased calorific intake from alcohol and accompanying snacks can push diabetes out of control. Actions and decisions taken under its influence can appear ludicrous in the hard light of a sober morning. Certain chemicals such as benzodiazepines or gam- mahydroxybutyrate (GHB, the date rape drug) can be slipped surreptitiously into alcohol or even soft drinks. They are tasteless, so the unsuspecting victim may pass out, or be assaulted, with no memory of the occurrence. January 2 is a working day for many, so recovery from a hard night of partying is a priority. The best way to avoid a hangover is not to drink at all. While partying, eating fried and greasy food coats the lining of the stomach and delays alcohol absorption. The headache that follows heavy drinking is due to dehydration and the additives (flavouring and colouring agents) in the alcohol. Drinking water and fruit juice will help “wash” the alcohol and chemicals out of the system, relieving the headache. Black coffee initially stimulates the nervous system, and may help with drowsiness, but it aggravates the dehydration and the headache rapidly returns. If attending a party with a group of friends outside the house, one person should not drink at all and be the designated driver who will take everyone home safely. Also, the sober person can make sure no one drinks too much, passes out, behaves inappropriately or is in any danger. All those cakes, sweets and pastries served at this time will throw diets and diabetes out of control. A piece of cake about one and a half square inches packs in a whopping 340 calories, a ladoo 240 calories and 20 nuts 100 calories. Just an extra sweet a day can push up your weight by a kilo in 10 days! An hour of exercise uses up between 250 and 300 calories, depending on the intensity, type of exercise and your body weight. One or two “extra” sweets a day cannot really be worked off with exercise alone. Also, this is the holiday season so regular exercise schedules tend to fly out of the window. The start of the New Year should be a time for introspection and resolutions to make the year ahead a healthier one. Don’t postpone your annual health evaluation, blood tests or cancer screening. Try to attain your ideal body weight. This means a BMI (weight in kg divided by height in metre squared) of 23. Exercise regularly (an hour a day is ideal) with 40-45 minutes of walking, jogging, running, cycling or swimming, followed by 15 minutes of stretching or yoga. Try to get a 365/365 score. Don’t miss a single day. Try to cross train – that is, try walking one day, swimming another and cycling on the third day. Not only does exercise then lose its monotony, but also becomes more effective and efficient. Beginning the New Year exhausted and in an alcoholic haze is probably not the ideal start for the next 364 days of your 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