prenatal vitamins

Healthy living for moms-to-be

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Your Health - Dr. Gita Mathaihttp://www.telegraphindia.com/1160425/jsp/knowhow/story_81967.jsp

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For generations, women have been advised by elders and self-styled experts to follow tradition. "Don't take any medication if you are pregnant! It will affect the baby." They are also told not to go to the doctor till the first trimester is over.

Today we know that any genetic damage that may happen to the baby takes place in the first 12 weeks, so avoiding medication at that time makes sound sense. On the other hand, an early consultation will help the doctor start "preconception" care, the key to having a healthy baby.

Most of the advice given is standard. Don't drink or smoke (this includes exposure to second hand smoke), have screening tests to rule out anaemia, diabetes, hypertension and thyroid diseases. Make sure the immunizations are complete. Diseases like measles, mumps, German measles and chicken pox can cause abnormalities in the baby. These diseases can be prevented with immunization. Sometimes, diseases like typhoid or jaundice (hepatitis) complicate pregnancy. Timely immunization prevents these as well.

The body weight plays a vital role. The BMI (Body Mass Index), weight divided by height in meters squared, should be between 18 and 25. Ovulation (egg release) becomes irregular in women both above and below this range and if eggs are not released, pregnancy is not possible.

Exercise always helps. In the underweight, it helps to increase the appetite, making it possible to gain weight by eating high calorie foods and snacks. In the overweight, it helps to utilise the calories consumed. Exercise also helps to strengthen the core muscles of the back. This prevents the backaches associated with pregnancy. It also increases stamina and endurance, which in turn helps to withstand the rigours of normal labour.

A healthy balanced diet with carbohydrates, proteins and fat will provide sufficient calories. Four to six helpings of fruits and vegetables will usually provide essential vitamins and minerals.

Folic acid is a B group vitamin essential for a healthy baby. Deficiency has been associated with brain and spinal cord defects and cleft lip and palate. Folic acid is found in green peas, beans, papaya, cantaloupe and oranges. Synthetic folic acid is much better absorbed than the natural form. Supplements of 5 mg tablets should be started well before the marriage and definitely three months before a planned conception.

Prenatal vitamins are popular supplements. They usually contain iron, folic acid, calcium, and the vitamins D, A. E. Some of them also contain Omega 3 fatty acids (fish oil). The active component in this is docosahexaenoic acid (DHA). The prenatal supplements are different from the multivitamins prescribed for the general population. The proportion of the vitamins is in sync for the pregnancy, with more folic acid and less vitamin A. Some contain zinc and copper as well. Zinc and iron compete for absorption from identical intestinal sites. Ideally, they should not be packed in the same tablet.

Once a woman is pregnant, the large size of the prenatal supplement may induce nausea. In that case plain folic acid tablets should be continued till the nausea and vomiting subside.

The writer is a paediatrician with a family practice at Vellore and author of "Staying Healthy in Modern India". If you have any questions on health issues please write to yourhealthgm@yahoo.co.in

HIIT and other new health mantras

The new health mantras

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Your Health - Dr. Gita Mathai

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These days, it is recommended that we walk at least 10,000 steps every day to keep fit. This translates into walking about 8km a day. Since it doesn't have to be continuous, you can jog or run around 5km a day and then hope that the remaining 3km is covered by daily activities.

To track how much of that 3km your daily activities cover, get one of those new fitness devices that can be worn on the wrist. The pedometers that counts the number of steps you take are usually sufficient and often the cheapest.

Unfortunately, the fitness readings can give many of us an unpleasant surprise. The number of steps taken seldom cross 5,000. And if you keep a close watch on the calories you take in, you will often find that the calories are greater than perceived and the exercise woefully inadequate.

If boredom is one of the reasons for your inadequate exercise, try weight lifting and high intensity interval training. This is especially appropriate for those who are always complaining about the lack of time.

During physical activity, we use two types of voluntary muscles, the red "slow twitch" muscles and the white "fast twitch" ones. Slow twitch muscles are necessary for endurance and fast twitch ones for sudden movements. Moderate activity (when it is possible to have a conversation) for 20-30 minutes uses slow twitch muscle. These use a steady stream of energy from fat. They require insulin to function efficiently. If there is a lack of insulin (either relative or due to insulin resistance) then the blood sugars can remain high even with 40 minutes of walking. Fast twitch muscles contain higher levels of a protein called BAF60c. They deplete glycogen (glucose) stores in muscles. They lower the blood sugar directly (without insulin) and blood sugars come down even with short spurts of activity.

The ratio of white to red muscle is genetically determined. It changes with age and can be modified with training. Doing weights can increase the amount of white muscle. Doing repetitions of the drill you were taught at school with 1-2 kilo weights in each hand bring the blood sugars crashing down if the diet and medication is maintained. Weight training can cause small breaks in the muscle and collagen. As these heal, the muscle and connective tissue become stronger. Posture is improved, bone strength increased and the likelihood of falls decreased.

A more efficient way to exercise in limited time is to opt for HIIT (high intensity interval training). This explosive activity of 30-60 seconds is followed by 30 seconds of rest, repeated for a total of 10 minutes. There are a series of activities that can be modified for this such as cycling, swimming, climbing stairs, walking and jogging, running in place or skipping. A simple way is to alternate sprints with walking or fast cycling with slow. But before you start this exercise regimen, check with your doctor.

HIIT has many advantages. It improves blood circulation by keeping the vessels pliable and responsive. That reduces the risk of clots, heart attacks and strokes. Patients with lung diseases do not get breathless during the short bursts of activity associated with HIIT and develop increased lung capacity. Patients recovering from a stroke and even those with Parkinson's disease can do HIIT on stationary exercise cycles and reap tremendous benefits.

Dr Gita Mathai is a paediatrician with a family practice at Vellore. Questions on health issues may be emailed to her atyourhealthgm@yahoo.co.in

dieting or fasting

Dieting of Fasting?

Fasting is the voluntary abstinence from either all food, or  certain types of food or drink for a period of time.  It is an activity that is present in all cultures and religions. The fast may last for days at a time or for fixed periods of time during the day. It may or may not preclude the intake of water.  

Eating is a voluntary activity, and all fasting is not religious. It may be political, to pressurize leaders into taking or reversing certain decisions. It is possible to “fast to death,”  if there is no outside interference, like the freedom fighter Jatin Das, or go on  for as long as 116 days (world record) by Bhagat Singh. Such prolonged denial of food requires tremendous will power and motivation.

Medically a 8-12 hour fast is required before doing certain tests like estimating the “fasting” blood glucose level or evaluating the lipid profile. This is because the digestive process is over in 3-5 hours. After an overnight fast the body reveals the true biochemical values. Fasting is required before anaesthesia  to prevent aspiration of food during surgery.

Fasting may  be a part of holistic healing, to  naturally “detoxify” the body. Toxins from food and the environment are stored in body fat. Fasting makes the body breakdown the fat for energy theoretically ridding it of these toxins. There is no controlled scientific study to back up this claim. The body is actually efficient at detoxifying itself through its natural cleansing organs the liver, kidney and lymph nodes.

There is a theory that fasting for 3 days destroys the white blood cells (WBC). A whole new generation of is released when the fast is over, boosting the body’s immunity. Again, this is not proven.

The body reacts to the absolute deprivation of food during fasting by going  into a “starvation mode”. It suddenly realizes that food is no longer available. (As humans evolved there were periods of famine. The ones who survived were genetically able to withstand this food deprivation).The metabolism slows down and the body tries to conserve energy and hoard fat. Energy is utilized mainly for vital functions. Fasting does reduce the appetite,  but once the fast is over the body reverts to normal. To make up for lost days, the appetite may rest itself to a higher level.  The lost weight regained and a little extra may be added to withstand the next “famine”.

Fasting should not be undertaken by children, pregnant or lactating women,  those with diabetes or on medication for other diseases.

Once you have decided to go on a fast:

·      Decide the number of days. If it is for the first time, 2-3 days is sufficient. If you have done it several times before, 7-10 days is probably optimal.

·      You may feel weak and have trouble concentrating on work, driving and other activities so pick a time when you do not have to do these things.

·      Drink plenty of water, preferably with a pinch of salt.

·      Do not exercise while fasting as you may feel lightheaded or even worse collapse.

·      Breaking the fast should be done gradually. Liquids  like juice or butter milk should be taken first. Later fruits and vegetables should be added to acclimatize your body to food once again. Starting with a heavy meal may produce abdominal pain and discomfort.

Dieting and fasting are two different things. Dieting is the voluntary reduction of the type and quantity of food eaten. It may be for medical reasons. The diet may have been restricted for diabetes, kidney or liver disease, food intolerance  for certain items (milk, peanuts) or  for certain inborn  errors of metabolism. Most people diet voluntarily, in an attempt to rid themselves of excess weight. 

There are several popular diets. Some restrict one or other items in the food chain completely. Others provide “shakes” as substitutes for meals.  These diets are not sustainable in the long run. The weight gradually returns. Skipping a meal a day and then controlling the amount eaten at the next does result in gradual weight loss.  This method is called the “eat stop eat” diet. It requires tremendous self control. The down side is that people often overeat to compensate for the missed meal. They feel that the “little extra “is justified.

Eating three meals a day and snacking twice a day is also healthy. To avoid overeating, try serving the portions on a quarter plate instead of a regular one. Do not take a second helping even if some food falls off. Appease hunger pangs  with a few nuts or a fruit.

Ideal body weight can be achieved with mild under nutrition without fasting or fad dieting.  Eat till the hunger pangs go away and not until you are full. This combined with exercise will extend your life span and  reduce the incidence of lifestyle diseases and cancer.

Dr. Gita Mathai

The writer is a paediatrician with a family practice at Vellore.
If you have any questions on health issues please write to
yourhealthgm@yahoo.co.in

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