origins of obesity

Not so cute http://www.telegraphindia.com/1151026/jsp/knowhow/story_49582.jsp

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Your Health - Dr. Gita Mathai

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All over the world, parents love chubby babies with their potbellies and plump dimpled thighs. Unfortunately, these children grow into overweight teenagers and adults. What was considered "cute" in childhood becomes not only a subject of ridicule but also a health risk.

Sometimes, whether a person will be obese or not is decided even before they are born. The mother's weight gain reflects on the baby's birth weight. Infants who are underweight or overweight at birth tend to grow into obese adults. Women who smoke, use tobacco products or inhale second hand smoke tend to have small babies. Pregnant women with gestational diabetes produce large babies. Both groups grow into obese adults.

Exclusive breastfeeding for the first six month of life protects against adult obesity. Many parents feel their breast milk is not enough and they resort to "top up" feeds with cow's milk or formula. This results in formula-fed infants being fatter and apparently growing faster.

Breastfeeding lowers plasma insulin levels and decreases both fat storage and the development of excessive fat cells. Also, breastfeeding is on demand. Parents who use formula often overfeed their children.

Weaning should be delayed till the age of six months. If this is not possible, then at least till four months are completed. As far as possible, weaning foods should be home cooked. Cereals, fruits and vegetables are ideal. Packaged infant foods are calorie dense, and often have too much sugar and sodium. Artificially sweetened fruit juices should also be avoided.

Infants need to sleep at least 12 hours. Lack of adequate sleep in infancy leads to obesity in later life.

The motor milestones of obese children are delayed as they are unable to lift themselves up to sit, crawl, stand and walk. This further aggravates the obesity and prevents proper development of bones and muscles.

Once they reach adolescence, they may develop pre-diabetes, bone and joint problems and sleep apnoea. This leads to daytime drowsiness and poor academic performance. Eventually they are at risk for heart disease, diabetes, hypertension and also many types of cancer, including cancer of the breast, colon, uterus, gall bladder, multiple myeloma and Hodgkin's lymphoma.

Even if genetics, prenatal development and early life are against you, and it is "all your mother's fault", it is never too early or too late to start rectifying mistakes. Everyone (all ages) needs at around seven to eight hours sleep, an hour of exercise and a sensible and healthy diet.

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

diarrhoea dos and donts

Diarrhoea dos and don'ts

http://www.telegraphindia.com/1151019/jsp/knowhow/story_48726.jsp

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Your Health - Dr. Gita Mathai

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Thousands of adults and children in India suffer from diarrhoea every day. The disease - caused by bacteria, viruses or parasites - is food or water borne and the result of contamination.

The symptoms of "food poisoning" may set in within 12-24 hours or can be delayed for 7-10 days. The delay sometimes makes the diagnosis difficult as by then people have forgotten what they ate. The severity of symptoms varies from person to person depending on the number of bacteria consumed and the general health and immune status of a person. Young children, the elderly, pregnant women, and anyone whose immunity is low (on steroid medication, cancer treatment or in an immunocompromised state like infection with HIV) is likely to be severely affected.

Contaminating organisms are killed when food is cooked at high temperatures. If the cooking process is too rapid, organisms can survive in the relatively raw middle portions of the food. They can remain dormant there and then start to multiply.

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Contamination with bacteria belonging to the staphylococcus family can occur before, during or after the cooking process. The bacteria release heat stable toxins into the food. The bacteria may die during the cooking process but the toxins are unaffected. They cause the stomach upsets.

A dangerous form of food poisoning called Botulism is caused by toxins released by a bacteria called C. botulinium. The spores of the bacteria contaminate the food, the organisms multiply and release toxins. Later, cooking may kill the organism but the toxin remains. In infants the infection is caused by direct ingestion of spores of the organism in contaminated food, usually unpasteurised milk or honey. In addition to the vomiting and diarrhoea (which may be relatively mild) the nerves are affected. There may be blurred vision, droopy eyes and lethargy. Muscle weakness and respiratory paralysis can set in. Antitoxin has to be administered. The person also needs supportive treatment and respiratory support. The diagnosis may be missed because the incubation period can be long (days).

The usual culprits in causing diarrhoea are salmonella, shigella and E. coli. These bacteria are present in the stools of patients and healthy asymptomatic carriers. Food may be contaminated by the fecal-oral route if hands are not washed properly. Surfaces in contact with raw or cooked food should be washed and wiped regularly and frequently with soapy water. The local mithaiwala should wear disposable gloves when he weighs your sweets and savouries.

Sewage contamination of the water supply can occur because the water and sewage pipes run close to each other. Water should be boiled before it is drunk, or only bottled water should be used. Fresh cut fruits and vegetables are also potent sources of infection. Sometimes, they are also sprinkled with contaminated water in the summer months to preserve their appetising appearance.

Food poisoning produces mild fever, vomiting and profuse watery diarrhoea with mucous or sometimes blood. There may be stomach cramps and tenesmus (a painful desire to unsuccessfully pass motion). As more and more stool is passed, or vomiting makes it impossible to retain fluids, dehydration can set in. The volume of urine becomes scanty or may cease altogether. The temperature may rise.

There is no need to rush to a doctor when diarrhoea sets in. Your gut needs rest to cope with the bacteria and the toxins. Keep yourself hydrated with sips of water or by sucking on ice cubes. Cook kichdi in a pressure cooker with equal quantities of rice and dal. Add salt to taste and then boil again with water till it is a flowing consistency. Take a tablespoon of this mixture every ten minutes and alternate it with water. You can also alternate the kichdi with bites of yellow banana. Once the gut has rested for 24 hours, spontaneous recovery can occur.

Self-medication with single doses of antibiotics, metronidazole or enteroquinone is dangerous and can lead to the emergence of resistant organisms.

Lomotil and loperamide can reduce the frequency of diarrhoea without eliminating the causative organism. Repeated doses should not be taken. It should not be used in children under the age of 10.

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

bursitis

sacs of painhttp://www.telegraphindia.com/1150928/jsp/knowhow/story_44868.jsp

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Your Health - Dr. Gita Mathai

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The human body has around 160 joints, all of which are in motion at some time or another as we sit, stand, walk and work in the office or at home. These joints are surrounded by protective fluid filled sacs called "bursa". The job of the bursa is to prevent friction between the bone, skin, muscles, ligaments and tendons that surround the joints. Constant overuse or infection of the bursa can result in a painful condition called "bursitis".

Painful bursitis can set in if the amount of fluid in the bursa increases. This can be due to constant excessive friction, an infection or trauma. The skin overlying the bursa becomes red, warm and the bursa itself is painful when pressed.

All 160 bursa do not become painful. Only five or six are notorious for causing problems. Bursitis of specific joints is often referred to by common descriptive terms such as "frozen shoulder" or "bricklayer's shoulder", "tennis elbow" or "miner's elbow", "housemaid's or clergyman's knee", "policeman's heel and "tailor's buttocks" (pain at the upper end of the thigh bone). Bursitis of the big toe is referred to as a "bunion".

Bursitis is precipitated in particular joints like the shoulder if it is used for repetitive movement like lifting a weighted object over the head, swimming, playing a bat and ball game like cricket, golf, tennis or badminton, In the elbow, activity with a flexed hand such as playing tennis, wringing clothes or even leaning on the elbow for long periods while sitting at a desk is likely to cause the problem. Prolonged sitting - particularly on a hard, uncushioned surface - causes pain at the point of contact. In short, sitting on a hard wooden surface leaning forward on a table can cause elbow and buttock pain.

The risk of developing bursitis increases with age, aggravating occupations or hobbies which involve repetitive use of the same joints. It is also more likely with other diseases like gout and diabetes.

When bursitis sets in, the joint suddenly feels itchy or stiff, is painful to touch or on movement and looks swollen.

Home treatment is often effective and can be summarised by the word PRICE (protection, rest, ice compression and elevation)

Apply ice. It reduces the swelling and inflammation, reduces muscle spasm and numbs pain. Alternate with moist heat.

Protect the joint from further strain with elastocrepe bandages, a wrist support, a shoulder brace, elbow guard or knee cap. These are available in medical stores.

If the pain is in the heel, wear soft cushioned footwear and do not walk barefoot.

Take mild painkillers like aspirin, or NSAIDs (non-steroidal anti-inflammatory agents) like Ibuprofen or just paracetemol.

You can usually wait for 10 days to two week before consulting a physician, unless the pain is accompanied by fever, there is redness or a rash, the area has a bluish discoloration like a bruise or there is a sharp pain on movement that brings all activity to a stand still.

It is often difficult to make an accurate diagnosis clinically. X-rays are helpful, but usually CT scans and MRIs are needed to be sure. Blood tests need to be done to rule out infection (the white blood cell count will be high), uric acid levels for gout, blood sugars for diabetes, and rheumatoid factor, C Reactive Protein etc for other types of arthritis.

In addition to specific treatment for underlying diseases, physicians usually recommend physiotherapy. If all else fails, injections into the bursa, or surgical decompression or removal of the bursa itself may be done.

To prevent bursitis

• Maintain ideal body weight
• Do flexion, stretching and strengthening exercises regularly, particularly if you play a sport.
• As soon as pain develops, rest the joint for a day or two to give it time to recover.

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