Sunday, July 14, 2019

that potbelly

People are conscious of their appearance and many are irritated with their potbelly, that unappealing unmistakable sign of age and prosperity. A potbelly appears when there is a mismatch between calories consumed and expended both during daily activities and with exercise. Extra calories are stored as fat.

Subcutaneous fat is deposited all over the body under the skin. It forms "love handles", "thunder thighs,"  big hips or arms that look like rolling pins. It can be pinched up and held between the fingers. Although it contributes to overall obesity, it is not as dangerous as the "visceral fat" deposited around the internal organs of the abdomen and around the heart. This fat cannot be pinched up but it contributes to an expanding waistline and a potbelly. Research has shown that the "cut off" value is a 35 in the waistline in women and 40 ins in men. if your waist measures more than this there is a significant amount of visceral fat present.

Visceral fat acts as an extra endocrine organ that is responsible for the synthesis and secretion of several hormones. These extra hormones control appetite, reduce sensitivity to insulin and contribute to inflammatory process mediators. In short,  excess fat around the internal organs increases the risk of insulin resistance, type 2 diabetes, high blood pressure sleep apnea, colorectal and breast cancer an premature death from several causes.

Weight tends to creep up as we get older. Women have less visceral fat than men until menopause, after which there is a reversal. Their waistlines tend to expand and weight increases. Muscles efficiently utilize calories. Muscle mass also gradually decreases with age, unless weight and strength training are actively incorporated into a regular exercise routine. People need 200-300 calories less in their fifties than they needed in their thirties. Although genetically there can be a predisposition to gain weight and have visceral fat, this too can be tackled with caloric restriction and a healthy lifestyle.

The intake of food should be reduced after the age of 55 years to between 1600-2000 unless you are extremely active physically. This should preferably be unprocessed food without added fats, chemicals or sugar.  Have balanced meals with proteins (12-15%), carbohydrates (50-60%)  and fats (30%). Eat 4-6 helpings of fruits and vegetables a day.  Eat till the edge of the hunger goes away and not until you are full.

Stress in the workplace or at home heightens the body's "flight or fight" response releasing indigenous cortisol. This contributes to the expansion and efficiency of the adipose tissue with increased deposits around the abdominal organs. Stress can be reduced with three or four sessions a week of yoga. If this is not possible Deep breathing is one of the best ways to lower stress in the body. Close your mouth and inhale quietly through your nose to a mental count of four. Hold your breath for a count of seven. Exhale completely through your mouth, making a whoosh sound to a count of eight. ... Breathing exercises are a good way to relax, reduce tension, and relieve stress.

Getting  rid of that obvious pot belly is not an easy thing.  Dieting alone will reduce the weight but will also make you lose muscle mass and the body becomes less efficient at burning calories. , the weight creeps up again.  Aerobic exercise alone will not get rid of that pot belly. Sit-ups will improve posture and core strength so that the belly is less obvious. It will help with the control of blood pressure and diabetes.

Advertisements on the media periodically advertise magical solutions for belly fat. To date,  no pills or supplements reduce visceral fat. Fad diets, supplements or medication do not work in the long term. The way to succeed is the time trusted. It is a strategic efficient combination of caloric restriction, aerobic exercise, stress reduction and adequate sleep (7-8 hours a night). 





Thursday, April 18, 2019

restless legs

Sometimes, legs ache, tingle and develop shooting pins and needles in the night. These uncomfortable sensations cause a person to wake up. If he or she gets up and moves around, or massages the leg, the sensations disappears. Only to reappear when the leg is at rest again.
Sleep is very important. Lack of or disturbed, non-refreshing sleep can occur due to these feelings in one or both legs. The person is then unable to get up in the morning or cope with the day. It also results in fatigue, forgetfulness, depression and irritability. Work, efficiency and academic performance suffer.
This “restless leg syndrome” (RLS), also called Willis-Ekbom Disease, affects almost eight per cent of the population. It is commoner in children and middle-aged adults. More women than men are affected.
It is more common in people with diabetes, peripheral neuritis from any cause, kidney disease and anaemia. It tends to run in families. Some specific gene variants have been associated with RLS. One theory is that the basal ganglia in the brain — responsible for the production of a chemical called dopamine that controls smooth, purposeful muscle activity — do not function efficiently. Low levels of iron in the blood have an adverse effect on the production of dopamine.
RLS can be pecipitated in some people by certain medications, such as antipsychotics, antidepressants, antihistamines and those used to combat nausea and vomiting. In these cases, the RLS is temporary. Stopping the medication relieves the symptoms. RLS sometimes appears during pregnancy and spontaneously disappears around a month after childbirth. Use of alcohol, tobacco in any form (cigarettes, beedis, snuff and chewing tobacco) and caffeine (coffee, tea and cola) aggravate RLS.
Simple measures such as controlling diabetes, correcting electrolyte and mineral imbalances, treating kidney disease and taking iron supplements help. Megavitamin supplements, however, are not beneficial.
Sleeping for seven to nine hours a night as well as waking up and going to bed at fixed times is often beneficial. Symptoms are usually less in the early morning, so getting up later may help with sleep. Taking a bath in hot water at bedtime helps relax the muscles as does gentle stretching exercises. Exercise also releases chemicals from calf muscles which reduce the symptoms. Remember, however, to keep a gap of at least an hour between working out and going to bed so that the body has time to cool down.
RLS can also occur during long flights or if you just sit still for a long time, say binge watching television. If you sit reading on the other hand, symptoms can decrease even if there is no active movement of the legs. A hot water bottle or heating pad helps relieve the pain in some people while ice packs help in others. Sleeping with the legs elevated also relieves symptoms.
If these simple measures do not help, medication may be required. Iron supplements can cause gastric irritation and constipation so take them on a full stomach. Combining iron pills with citrus juices (rich in Vitamin C) increases the absorption. Pain relieving medication is helpful but can be habituating (codine) or addiction (benzodiazepines). Some anti-seizure medications such as gabapentin and pregabalin also work. Treatment has to be individualised.
The good news is that in some people RLS spontaneously disappears, especially if they have implemented beneficial lifestyle changes. The bad news is we still don’t know why RLS occurs.
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 toyourhealthgm@yahoo.co.in

Sunday, March 31, 2019

GERD

Guard from the gut

GERD: symptoms and solution
By Dr Gita Mathai
  • Published 27.03.19, 12:09 PM
  • Updated 27.03.19, 12:09 PM
  • 2 mins read
  •  
Nearly 25% of older Indians suffer from symptoms of gastro-oesophageal reflux disease or GERD.(Shutterstock)
Many older Indians — nearly 25 per cent of them — suffer from symptoms of gastro-oesophageal reflux disease or GERD. They have a plethora of disconcerting symptoms, some of which may seem unrelated to acid or reflux. They may have a persistent dry cough, sore throat, hoarseness of voice, burping, hiccups, bloating, difficulty swallowing with a choking feeling and a sensation of a something sticking in the throat. Sometimes, it can give rise to agonising chest pain, which can be mistaken for a heart attack. Many such patients wind up in casualty or chest pain units. After a medical evaluation, often expensive, many are told, “It is just stomach pain.”
There is a tight sphincter muscle at the junction of the stomach and the oesophagus. This acts like a valve, keeping the contents of the stomach from flowing back into the oesophagus. There is another such muscle at the intersection of the throat and the oesophagus. If and when food is swallowed, these muscles relax sequentially. They then shut tightly, preventing regurgitation of the food and acidic stomach contents into the oesophagus and mouth.
If the stomach contents regurgitate, the lining of the oesophagus is bathed in acid. It becomes damaged, can form ulcers and repeated damage can even cause cancer.
Some people are born with defective valves. They develop acid reflux at a young age. But GERD occurs mostly in middle-aged people because of obesity, especially those with protruding pot bellies and poor core strength.
GERD is often a clinical diagnosis. It can be confirmed, if required, with X-rays, endoscopy, oesophageal manometry and an ambulatory acid probe test.
Symptoms are aggravated by use of tobacco in any form — smoking, chewing or as snuff. Alcohol also loosens the oesophageal sphincters. Some foods such as citrus fruits, tomatoes, caffeinated cola drinks, raw onions, garlic, coffee, tea and chocolate are also blamed. Foods that cause reflux are idiosyncratic to the individual. Some foods aggravate symptoms in certain people but not in others. This can be determined with a detailed food history. Oily foods take a long time to digest and universally exacerbate symptoms. High-fibre foods like carrots, beetroot, radish, green leafy vegetables, apples, bananas, pears, almonds and walnuts, lentils, chickpeas and beans reduce symptoms. As far as possible, non-processed natural food should be eaten. Processed foods contain chemicals, colouring, flavours and preservatives, which increase acidity.
Symptoms can be reduced by eating 5-6 small, healthy meals a day instead of three large ones, and not sleeping or exercising for at least an hour after eating. The head of the bed can also be raised by six inches to prevent regurgitation.
Weight loss, diet restrictions and lifestyle modifications are not popular with many adults. They prefer to “pop a pill” to solve the problem. Ranitidine, omeprazole and its many acid-suppressing proton pump inhibiting derivatives are easily available in pharmacies without a prescription. Many people are on long-term self-medication with these acid suppressants.
These pills should ideally be taken 30 minutes before a meal once or twice a day. They should be stopped after two weeks. They should not be taken “as and when” in anticipation of a heavy meal or drinking binge. It is a myth that these medications are harmless. Long-term and unregulated use leads to side effects, more and more of which are being discovered every day. As they suppress acid formation, they can lead to micronutrient deficiencies, susceptibility to infections and reduction in bone density leading to fractures. If they are also combined with antacids, there is growing evidence that they can precipitate early onset dementia.
Diet and lifestyle changes can heal ulcers, undo damage already done and reduce the symptoms of GERD. That is the only way to treat it.
  • 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 toyourhealthgm@yahoo.co.in