Catch them early
Your Health
--------------------------------------------------------------------------------
DR GITA MATHAI
When I was a medical student (so long back that it was actually in the last century), two of the cases placed before us as “spotters” (look and diagnose, don’t touch or question) in an examination were children with kwashiorkor (lethargic and disproportionately swollen with fluid) and marasmus (wizened, wasted and looking like a wise elder). Both were common conditions, the result of malnutrition.
Such diseases are rare today. In fact, now doctors have to spot diagnose children at the opposite end of the spectrum. About 20 per cent of children (some less than a year old) and teenagers in India can be defined as overweight, obese or morbidly obese. Their weights exceed that expected for their heights by 20 per cent, 50 per cent, and even 80-100 per cent. The BMI (body mass index, calculated as weight divided by height in meter squared) which should be 23 is often well above 30. Many of these children maintain their obese status into adult life.
In addition to having a paunch, big hips, knock knees and a double chin, such children have a peculiar velvety black discolouration of the skin — called acanthosis nigricans — on the nape of the neck. No amount of scrubbing will remove it, nor talcum powder conceal it. It is a marker for obesity that is likely to progress in diabetes.
This unhealthy state of over nutrition starts in infancy. Babies are breast fed for less than a year and weaned early. They are often force fed high energy, ready-to-eat carbohydrate substitutes instead of healthy, home cooked weaning foods. Older children gorge on unhealthy packaged snacks that often serve as a substitute for meals.
The children also have limited outdoor activity. Schools do not encourage physical training or games, as academics takes precedence over sports. In the evenings, tuition, homework and television usurp their time. Many parents do not have the time, inclination or space to take the children out.
Energy intake soon overtakes energy expenditure. In children, the waistline expands and fat is deposited in the abdominal regions. A paunch develops and pushes up the stomach and other abdominal contents against the diaphragm (a muscle that separates the abdomen from the chest). The chest is unable to expand fully and breathing becomes shallow, noisy and inefficient. Infections are frequent.
The excess fat is also deposited in muscles and liver tissue. The fat makes the body resistant to the actions of its own insulin. Even young children develop relative “insulin resistance”. Glucose intolerance and hypertriglyceridemia begin to develop in them. Fat gets deposited in the blood vessels. And this can cause the blood pressure to rise and result in premature coronary artery disease.
Adolescent obesity causes hormonal imbalances. In obese girls, androgens are present in excess. They develop unsightly facial hair and menstrual irregularities. This may result in PCOS (polycystic ovarian syndrome). In men, estrogen levels rise and gynacomastia develops. Eventually, these obese adolescents become subfertile adults. Pregnancy occurs only after expensive and frustrating treatment.
Obese children are also prone to numerous orthopedic problems. They may develop bowlegs. The ends of the growing bones may slip causing deformities. All this results in the early onset of arthritis.
Moreover, children are psychologically affected by their obesity. They are often the brunt of jokes. They are often excluded from sports and cultural events.
Quite often, the overweight children appear to have a familial obesity. This correlation is likely to be due to the environment with excessive food intake, limited exercise and almost compulsive television viewing. In these children, the obesity is not genetic but a result of the upbringing.
Boys (not girls) who are obese in childhood and adolescence are at risk for sudden death from coronary artery disease (CAD) as adults. They are also at increased risk for gout and colorectal cancer. This risk remains constant even if they manage to lose weight as adults. Girls who are obese become women at high risk for arthritis.
Television viewing should be restricted to a minimum. If the parents watch television for many hours every day, children too get hooked on to it. It is better to enroll them in coaching classes for activities like cricket, swimming, tennis, football or basketball. The Sports Authority of India conducts camps during summer vacations. Children who attend these camps should be encouraged to maintain the momentum even after school re-opens. Daily running or jogging for 20-40 minutes will help them keep up their stamina and maintain weight till the next round of coaching starts.
As parents and elders, we have to keep our children fit and not fat.
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
Tuesday, July 13, 2010
Wednesday, June 30, 2010
probiotic prebiotic antibiotic
Cup of magic
YOUR HEALTH
DR GITA MATHAI
Curd reduces infections as well as the duration of illnesses
Probiotics, prebiotics, antibiotics. The words often cause confusion because they sound similar. But, of course, they mean very different things, although all three are derived from the Greek word “bios”, meaning “life”.
Most people would love a magic pill that would put an end to all their health problems. Preferably one that contains prebiotics (meaning “before life”) and probiotics (“helping life”), along with a few trace elements, minerals, antioxidants and vitamins.
Probiotics are defined by the World Health Organization as microorganisms, which when administered alive in adequate amounts, confer a health benefit to the host. They are advertised by the pharma industry as protective, anti-infection agents that give the body’s natural reserves a boost against disease. They are sold as capsules and powders containing organisms like Lactobacillus bulgaricus and Streptococcus thermophilus. The products are much hyped, and have fancy names and expensive packaging.
However, what advertisements do not mention is that to be effective, there should be at least 75 million live organisms in each capsule. Food and chlorine in water kill these organisms. They therefore have to be swallowed with non-chlorinated water on an empty stomach. The intestines need to be populated with these organisms. So initially, the capsules have to be swallowed four to six times a day. The minuscule numbers contained in commercially available capsules are insufficient and do not confer any real health benefit.
Probiotics are not new products; they have been around for centuries. Fermented dough and curd (yogurt) contain natural, healthy probiotics. Commercially available yogurt may not contain live lactobacillus (probiotics) unless specifically mentioned on the package.
Natural probiotics like curd have many medicinal properties that are being rediscovered now. Curd starts to act in the mouth itself. It reduces the number of plaque forming bacteria, and prevents bad breath, tooth decay and mouth ulcers.
In the stomach, curd helps neutralise gastric acidity, reducing belching, burning and dyspepsia. It prevents infections, particularly the growth and multiplication of H. pylori, which is implicated in gastric ulcers and stomach cancer.
In the intestine, probiotics live with other protective intestinal flora, reducing gas formation and diarrhoea. The immunological effects reduce the incidence and symptoms of Crohn’s disease (inflammatory condition of the intestines that may affect any part from the mouth to the anus) and ulcerative colitis. Bowel habits become regular and the incidence of colon cancer reduces in those who eat curd regularly.
The action of the probiotics on digested food results in the synthesis of B-complex vitamins. This reduces vitamin deficiencies. Children who are given curd in addition to milk have less diarrhoea than those given milk alone.
Many Indians are relatively lactose intolerant and develop bloating, abdominal pain and diarrhoea when given to drink milk. They thus tend to curtail their milk intake and in the absence of calcium supplementation become susceptible to osteoporosis. In curd, however, the milk is already partially digested, and this reduces the symptoms of intolerance. As little as one cup of curd a day is beneficial in the prevention of osteoporosis.
Studies have also shown that eating curd regularly prevents the development of candidiasis, a common vaginal fungal infection. Other studies have shown conflicting results with no real benefit. But this has not prevented pharmaceutical companies from advocating lactobacillus capsules and vaginal pessaries for candidial infection. Curd also boosts the immune system. Regular eaters swear by it, saying it reduces infections as well as the duration of illnesses.
Prebiotics, on the other hand, are soluble fibres and non-digestible food ingredients that remain in the colon. They selectively stimulate the growth and activity of beneficial microorganisms already present in the large intestine. Prebiotics are found in oats, wheat, onions and garlic. When probiotics and prebiotics are combined, they form “synbiotics”. This probably confers the best health benefits with probiotics acting in the small intestine and prebiotics in the large.
Antibiotics are used to kill harmful microorganisms in the intestine, bloodstream and the various organs. They should be used appropriately in the correct dosage and duration. Unlike probiotics and prebiotics, antibiotics are specific for a particular infection. They are not health supplements.
Antioxidants are found in coloured fruits and vegetables. Oxidation is essential for cell metabolism. During this process a few cells die releasing harmful free radicals. This is prevented by antioxidants.
All said and done, health does not come packaged as an expensive magic capsule containing probiotics and antioxidants to be drunk with a glass of artificial fibre. For good health,
Eat four to five helpings of fresh fruits and vegetables daily. The green, yellow, orange and red ones contain antioxidants
Eat one tablespoon of homemade curd first thing in the morning on an empty stomach
Eat chappatis four or five times a week
Give these health ingredients an extra boost by exercising one hour everyday.
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
YOUR HEALTH
DR GITA MATHAI
Curd reduces infections as well as the duration of illnesses
Probiotics, prebiotics, antibiotics. The words often cause confusion because they sound similar. But, of course, they mean very different things, although all three are derived from the Greek word “bios”, meaning “life”.
Most people would love a magic pill that would put an end to all their health problems. Preferably one that contains prebiotics (meaning “before life”) and probiotics (“helping life”), along with a few trace elements, minerals, antioxidants and vitamins.
Probiotics are defined by the World Health Organization as microorganisms, which when administered alive in adequate amounts, confer a health benefit to the host. They are advertised by the pharma industry as protective, anti-infection agents that give the body’s natural reserves a boost against disease. They are sold as capsules and powders containing organisms like Lactobacillus bulgaricus and Streptococcus thermophilus. The products are much hyped, and have fancy names and expensive packaging.
However, what advertisements do not mention is that to be effective, there should be at least 75 million live organisms in each capsule. Food and chlorine in water kill these organisms. They therefore have to be swallowed with non-chlorinated water on an empty stomach. The intestines need to be populated with these organisms. So initially, the capsules have to be swallowed four to six times a day. The minuscule numbers contained in commercially available capsules are insufficient and do not confer any real health benefit.
Probiotics are not new products; they have been around for centuries. Fermented dough and curd (yogurt) contain natural, healthy probiotics. Commercially available yogurt may not contain live lactobacillus (probiotics) unless specifically mentioned on the package.
Natural probiotics like curd have many medicinal properties that are being rediscovered now. Curd starts to act in the mouth itself. It reduces the number of plaque forming bacteria, and prevents bad breath, tooth decay and mouth ulcers.
In the stomach, curd helps neutralise gastric acidity, reducing belching, burning and dyspepsia. It prevents infections, particularly the growth and multiplication of H. pylori, which is implicated in gastric ulcers and stomach cancer.
In the intestine, probiotics live with other protective intestinal flora, reducing gas formation and diarrhoea. The immunological effects reduce the incidence and symptoms of Crohn’s disease (inflammatory condition of the intestines that may affect any part from the mouth to the anus) and ulcerative colitis. Bowel habits become regular and the incidence of colon cancer reduces in those who eat curd regularly.
The action of the probiotics on digested food results in the synthesis of B-complex vitamins. This reduces vitamin deficiencies. Children who are given curd in addition to milk have less diarrhoea than those given milk alone.
Many Indians are relatively lactose intolerant and develop bloating, abdominal pain and diarrhoea when given to drink milk. They thus tend to curtail their milk intake and in the absence of calcium supplementation become susceptible to osteoporosis. In curd, however, the milk is already partially digested, and this reduces the symptoms of intolerance. As little as one cup of curd a day is beneficial in the prevention of osteoporosis.
Studies have also shown that eating curd regularly prevents the development of candidiasis, a common vaginal fungal infection. Other studies have shown conflicting results with no real benefit. But this has not prevented pharmaceutical companies from advocating lactobacillus capsules and vaginal pessaries for candidial infection. Curd also boosts the immune system. Regular eaters swear by it, saying it reduces infections as well as the duration of illnesses.
Prebiotics, on the other hand, are soluble fibres and non-digestible food ingredients that remain in the colon. They selectively stimulate the growth and activity of beneficial microorganisms already present in the large intestine. Prebiotics are found in oats, wheat, onions and garlic. When probiotics and prebiotics are combined, they form “synbiotics”. This probably confers the best health benefits with probiotics acting in the small intestine and prebiotics in the large.
Antibiotics are used to kill harmful microorganisms in the intestine, bloodstream and the various organs. They should be used appropriately in the correct dosage and duration. Unlike probiotics and prebiotics, antibiotics are specific for a particular infection. They are not health supplements.
Antioxidants are found in coloured fruits and vegetables. Oxidation is essential for cell metabolism. During this process a few cells die releasing harmful free radicals. This is prevented by antioxidants.
All said and done, health does not come packaged as an expensive magic capsule containing probiotics and antioxidants to be drunk with a glass of artificial fibre. For good health,
Eat four to five helpings of fresh fruits and vegetables daily. The green, yellow, orange and red ones contain antioxidants
Eat one tablespoon of homemade curd first thing in the morning on an empty stomach
Eat chappatis four or five times a week
Give these health ingredients an extra boost by exercising one hour everyday.
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
Monday, June 7, 2010
lousy life
Lousy problem
YOUR HEALTH
DR GITA MATHAI
A young girl gets lice removed mechanically
Itchy scalp? Scratching in public? And people looking askance at you? The problem could be dandruff or seborrhic dermatitis. Or worse, it could be lice.
Lice (singular: louse) are ectoparasites — that is, they live on the outside. Each insect is about the size of a sesame seed, with six legs and no wings. Human lice cannot survive on other animals such as cats, dogs and birds. They are also specific to the area they infest. They may live on the head (head lice). A slightly different variety lives in the genital area (pubic lice). A third type (body lice) lives only on the body.
School-going children are particularly likely to pick up head lice. In India, 60 per cent of girls in the age group of five to 11 are infested. This is, however, wrongly attributed to poor hygiene and low socioeconomic status. The social stigma attached to lice infestation and accusing letters from school authorities add to the psychological trauma of the child and her parents.
Lice feed on human blood and live for 30 days. If they fall off the body, they can survive on clothes, combs, crash helmets, bed sheets or pillows for two days. Each pair of lice lays about 100 eggs. These characteristics make them a tough species. They have managed to survive unchanged for more than 2,000 years. Archaeologists have found evidence of lice on Egyptian mummies, which are identical to the ones seen today.
The spread of lice occurs only if there is close contact with infested persons or their personal belongings. A louse cannot jump or fly. It has to crawl to its next victim. Once the insect has settled, it immediately starts to bite and feed. Lice release chemicals from their saliva which can cause intense scratching. This introduces bacteria to the skin which may cause secondary infection. The lymph nodes may become enlarged and appear as painful lumps in the neck.
There are many home remedies for lice. Mixtures of oils or ghee are sometimes applied in the hope that it will smother the lice. Others may shampoo frequently, thinking it will drown or wash away the insects. These, however, do not work.
The “lice comb” is a traditional and effective method. The comb may be made of metal, plastic or wood. Combing has to be done every day for two to three months. When the adult lice fall off, they have to be killed. Removing nits with a comb is difficult, tedious, time consuming and somewhat painful. Moreover, the child may not cooperate.
There is another effective method. Often in traditional families, all the members get their heads tonsured under some religious pretext. No hair, no lice.
Many chemicals are known to eradicate lice. Kerosene, for example, is effective when applied to the whole head and left for two or three hours. The head should be tied up securely in a cloth. But the method is dangerous as kerosene is highly inflammable.
Medicated “lice treatment” shampoos and lotions contain malathion, lindane and permethrin and can be applied to the hair. These chemicals paralyse the lice. The motionless insects must then be removed by washing or combing as they can recover movement in two or three hours.
The medications, however, do not remove all the lice. Only about 20 per cent are susceptible to the commonly used chemicals. The tough survivors mutate, thrive and multiply even in the presence of these chemicals. Higher concentrations offer no greater benefit. Instead, they seep through the skin and may build up to toxic levels. Also, the chemicals cannot be used in pregnant women and children under one. Treatment has to be repeated after 10 days to kill any newly hatched lice before they start to reproduce. Body and pubic lice respond poorly to lotions and shampoos.
In all the three types of lice infestation, relapse, recurrence and re-infection are common. This makes dealing with the parasite both embarrassing and frustrating.
Commercially advertised “herbal” products appear safer than chemicals and gullible sufferers opt for them. A few harmless ingredients like neem and tulasi are mentioned on the package. The rest are not. Their sale and production are not regulated. Their safety is questionable and side effects undocumented.
Lice can be effectively eradicated using an oral dose of 200 µgm/kg body weight of the tablet Ivermectin. It cannot be given to pregnant women or children whose weight is less than 15kg. The medicine acts only on live lice. A repeat dose is required on the eighth day when the eggs hatch.
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
YOUR HEALTH
DR GITA MATHAI
A young girl gets lice removed mechanically
Itchy scalp? Scratching in public? And people looking askance at you? The problem could be dandruff or seborrhic dermatitis. Or worse, it could be lice.
Lice (singular: louse) are ectoparasites — that is, they live on the outside. Each insect is about the size of a sesame seed, with six legs and no wings. Human lice cannot survive on other animals such as cats, dogs and birds. They are also specific to the area they infest. They may live on the head (head lice). A slightly different variety lives in the genital area (pubic lice). A third type (body lice) lives only on the body.
School-going children are particularly likely to pick up head lice. In India, 60 per cent of girls in the age group of five to 11 are infested. This is, however, wrongly attributed to poor hygiene and low socioeconomic status. The social stigma attached to lice infestation and accusing letters from school authorities add to the psychological trauma of the child and her parents.
Lice feed on human blood and live for 30 days. If they fall off the body, they can survive on clothes, combs, crash helmets, bed sheets or pillows for two days. Each pair of lice lays about 100 eggs. These characteristics make them a tough species. They have managed to survive unchanged for more than 2,000 years. Archaeologists have found evidence of lice on Egyptian mummies, which are identical to the ones seen today.
The spread of lice occurs only if there is close contact with infested persons or their personal belongings. A louse cannot jump or fly. It has to crawl to its next victim. Once the insect has settled, it immediately starts to bite and feed. Lice release chemicals from their saliva which can cause intense scratching. This introduces bacteria to the skin which may cause secondary infection. The lymph nodes may become enlarged and appear as painful lumps in the neck.
There are many home remedies for lice. Mixtures of oils or ghee are sometimes applied in the hope that it will smother the lice. Others may shampoo frequently, thinking it will drown or wash away the insects. These, however, do not work.
The “lice comb” is a traditional and effective method. The comb may be made of metal, plastic or wood. Combing has to be done every day for two to three months. When the adult lice fall off, they have to be killed. Removing nits with a comb is difficult, tedious, time consuming and somewhat painful. Moreover, the child may not cooperate.
There is another effective method. Often in traditional families, all the members get their heads tonsured under some religious pretext. No hair, no lice.
Many chemicals are known to eradicate lice. Kerosene, for example, is effective when applied to the whole head and left for two or three hours. The head should be tied up securely in a cloth. But the method is dangerous as kerosene is highly inflammable.
Medicated “lice treatment” shampoos and lotions contain malathion, lindane and permethrin and can be applied to the hair. These chemicals paralyse the lice. The motionless insects must then be removed by washing or combing as they can recover movement in two or three hours.
The medications, however, do not remove all the lice. Only about 20 per cent are susceptible to the commonly used chemicals. The tough survivors mutate, thrive and multiply even in the presence of these chemicals. Higher concentrations offer no greater benefit. Instead, they seep through the skin and may build up to toxic levels. Also, the chemicals cannot be used in pregnant women and children under one. Treatment has to be repeated after 10 days to kill any newly hatched lice before they start to reproduce. Body and pubic lice respond poorly to lotions and shampoos.
In all the three types of lice infestation, relapse, recurrence and re-infection are common. This makes dealing with the parasite both embarrassing and frustrating.
Commercially advertised “herbal” products appear safer than chemicals and gullible sufferers opt for them. A few harmless ingredients like neem and tulasi are mentioned on the package. The rest are not. Their sale and production are not regulated. Their safety is questionable and side effects undocumented.
Lice can be effectively eradicated using an oral dose of 200 µgm/kg body weight of the tablet Ivermectin. It cannot be given to pregnant women or children whose weight is less than 15kg. The medicine acts only on live lice. A repeat dose is required on the eighth day when the eggs hatch.
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
Monday, May 31, 2010
my feet are swollen
Overcoming oedema
YOUR HEALTH
DR GITA MATHAI
Swollen feet — medically called oedema — can make life miserable. Shoes and slippers don’t fit — they are tight and uncomfortable and sometimes impossible to put on. The feet feel like dead weights, and walking becomes a Herculean task. It is much easier to simply sit. But inactivity makes the swelling worse, and the sufferer is caught in a vicious cycle of swelling-inactivity-more swelling.
The fluid that accumulates and causes oedema leaks from tiny blood vessels called capillaries. This can occur as a result of increased pressure, damage to the vessels or a fall in the protein concentration of the blood. As soon as the body senses that the capillaries are leaking, compensatory mechanisms come into play and fluid is retained in the body by the kidney. The amount of fluid circulating in the body therefore increases. This, in turn, causes the capillaries to leak more. This fluid from the capillaries leaks into the surrounding tissue, causing the swelling. At least five litres of fluid need to be retained before actual swelling appears.
Feet swell before any other part of the body. This is because the hydrostatic pressure on the blood vessels of the lower limbs are, by virtue of gravity, one metre more than the pressure on the face. Also, when we sit and stand, our feet are at a lower level than the heart and this aggravates the problem.
To demonstrate oedema, press firmly with your forefinger and maintain the pressure for 10 seconds. A persistent dimple like depression indicates the presence of oedema.
However, swollen feet do not always indicate disease. Overweight individuals may develop some amount of swelling at the end of a stationery day. (Fat is fluid at body temperature). This can be normal. The swelling can extend up to the knees.
Salt also causes fluid retention. If you consume a lot of salty snacks and pickles, the kidney is not able to handle the sodium overload and fluid is retained.
Women are more prone to develop oedema than men. The female hormones oestrogen and progesterone cause fluid retention. Women tend to “swell up” during the pre-menstrual period, pregnancy and if they are on hormones, either as oral contraceptive pills or as part of hormone replacement therapy (HRT). This can extend to the hands, making finger rings tight. The face may also appear puffy. This type of oedema disappears spontaneously in a few days once menstruation occurs, the baby is born or the hormones discontinued.
Oedema can be a side effect of prescribed medication like nifedepine, amlodepin and other anti-hypertensives. Medicines for pain belonging to the non-steroidal anti-inflammatory drugs (NSAIDs) group can also cause fluid retention. Some like diclofenac may damage the kidneys. If you develop swelling while on medication, consult your doctor.
At times, oedema can be the first sign of a serious underlying medical condition. If the heart is unable to pump blood efficiently, blood can accumulate in the capillaries of the legs, ankles and feet, causing oedema.
The liver regulates the protein content of the blood. It is also responsible for adjusting the hormones and chemicals that regulate the fluid content of the body. The organ can become damaged as a result of alcoholism, hepatitis B infection or other diseases. This injury results in scar formation and is called cirrhosis. Fluid can then accumulate in the legs and abdomen. But two of the causal factors can be prevented — don’t drink excessively and take your hepatitis B immunisations.
Damaged kidneys cannot excrete excess fluid. The oedema then occurs typically around the legs and eyes. Kidney damage can occur for a variety of reasons. Preventable causes are uncontrolled, neglected diabetes and hypertension.
The veins in the leg may be damaged or weak. Sometimes the valves in these veins — which prevent back flow of blood — may be inefficient. Chronic venous insufficiency and varicose veins can result in swelling.
Excess fluid from tissues is cleared by the lymphatic system. These drain into lymph nodes and eventually into the large veins. Infections like filaria can damage the lymphatic system. The nodes can be infiltrated by cancerous deposits. The nodes may have been removed or damaged during surgery. All this can result in swelling. Usually this is present in any one limb and not symmetrically on both sides of the body.
Remember
• Oedema can be treated if the causal factor is removed
• Reduce weight if the BMI (body mass index or weight divided by height in metre squared ) is more than 23
• Walk, jog or swim for 40 minutes a day
• Try to move the legs every half hour during the day
• Do not add extra salt to food and avoid salty snacks
• Keep the feet elevated
• Use elastocrepe bandages or compression stockings on affected limbs
• Do not consume NSAIDs unnecessarily
• Seek medical advice immediately for filaria
• Use diurectics to get rid of fluid only if prescribed by a doctor
• Control diabetes and hypertension.
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
YOUR HEALTH
DR GITA MATHAI
Swollen feet — medically called oedema — can make life miserable. Shoes and slippers don’t fit — they are tight and uncomfortable and sometimes impossible to put on. The feet feel like dead weights, and walking becomes a Herculean task. It is much easier to simply sit. But inactivity makes the swelling worse, and the sufferer is caught in a vicious cycle of swelling-inactivity-more swelling.
The fluid that accumulates and causes oedema leaks from tiny blood vessels called capillaries. This can occur as a result of increased pressure, damage to the vessels or a fall in the protein concentration of the blood. As soon as the body senses that the capillaries are leaking, compensatory mechanisms come into play and fluid is retained in the body by the kidney. The amount of fluid circulating in the body therefore increases. This, in turn, causes the capillaries to leak more. This fluid from the capillaries leaks into the surrounding tissue, causing the swelling. At least five litres of fluid need to be retained before actual swelling appears.
Feet swell before any other part of the body. This is because the hydrostatic pressure on the blood vessels of the lower limbs are, by virtue of gravity, one metre more than the pressure on the face. Also, when we sit and stand, our feet are at a lower level than the heart and this aggravates the problem.
To demonstrate oedema, press firmly with your forefinger and maintain the pressure for 10 seconds. A persistent dimple like depression indicates the presence of oedema.
However, swollen feet do not always indicate disease. Overweight individuals may develop some amount of swelling at the end of a stationery day. (Fat is fluid at body temperature). This can be normal. The swelling can extend up to the knees.
Salt also causes fluid retention. If you consume a lot of salty snacks and pickles, the kidney is not able to handle the sodium overload and fluid is retained.
Women are more prone to develop oedema than men. The female hormones oestrogen and progesterone cause fluid retention. Women tend to “swell up” during the pre-menstrual period, pregnancy and if they are on hormones, either as oral contraceptive pills or as part of hormone replacement therapy (HRT). This can extend to the hands, making finger rings tight. The face may also appear puffy. This type of oedema disappears spontaneously in a few days once menstruation occurs, the baby is born or the hormones discontinued.
Oedema can be a side effect of prescribed medication like nifedepine, amlodepin and other anti-hypertensives. Medicines for pain belonging to the non-steroidal anti-inflammatory drugs (NSAIDs) group can also cause fluid retention. Some like diclofenac may damage the kidneys. If you develop swelling while on medication, consult your doctor.
At times, oedema can be the first sign of a serious underlying medical condition. If the heart is unable to pump blood efficiently, blood can accumulate in the capillaries of the legs, ankles and feet, causing oedema.
The liver regulates the protein content of the blood. It is also responsible for adjusting the hormones and chemicals that regulate the fluid content of the body. The organ can become damaged as a result of alcoholism, hepatitis B infection or other diseases. This injury results in scar formation and is called cirrhosis. Fluid can then accumulate in the legs and abdomen. But two of the causal factors can be prevented — don’t drink excessively and take your hepatitis B immunisations.
Damaged kidneys cannot excrete excess fluid. The oedema then occurs typically around the legs and eyes. Kidney damage can occur for a variety of reasons. Preventable causes are uncontrolled, neglected diabetes and hypertension.
The veins in the leg may be damaged or weak. Sometimes the valves in these veins — which prevent back flow of blood — may be inefficient. Chronic venous insufficiency and varicose veins can result in swelling.
Excess fluid from tissues is cleared by the lymphatic system. These drain into lymph nodes and eventually into the large veins. Infections like filaria can damage the lymphatic system. The nodes can be infiltrated by cancerous deposits. The nodes may have been removed or damaged during surgery. All this can result in swelling. Usually this is present in any one limb and not symmetrically on both sides of the body.
Remember
• Oedema can be treated if the causal factor is removed
• Reduce weight if the BMI (body mass index or weight divided by height in metre squared ) is more than 23
• Walk, jog or swim for 40 minutes a day
• Try to move the legs every half hour during the day
• Do not add extra salt to food and avoid salty snacks
• Keep the feet elevated
• Use elastocrepe bandages or compression stockings on affected limbs
• Do not consume NSAIDs unnecessarily
• Seek medical advice immediately for filaria
• Use diurectics to get rid of fluid only if prescribed by a doctor
• Control diabetes and hypertension.
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
Wednesday, May 19, 2010
colour of the skin
The colour of your skin
Your Health
DR GITA MATHAI
Indians are very conscious of their skin colour. There is great alarm and anxiety if the skin suddenly develops white patches. About 1 per cent of the population is affected by this condition — called leukoderma (white skin) or vitiligo (“streaked calf” in Greek). The patches usually appear between the ages of 12 and 40. The disease affects people in all socio-economic strata. Michael Jackson was affected by it. Other rich and famous sufferers are Amitabh Bachchan and Gautam Singhania, the chairman and managing director of Raymonds.
The sudden loss of pigmentation causes 25 per cent of these people to become obsessed with their skin colour, depressed or even suicidal. Money does not make the disease disappear; it only makes it possible to consult the world’s best dermatologists.
The de-pigmentation often starts on the hands and feet. In the case of Jackson, it first appeared on his hands. This was the reason behind his signature white glove. In others it may start around orifices like the nose, mouth, eyes, umbilicus, genital areas and rectum. The patches may remain stationary, increase in size or spread over the whole body. They are symmetrical on both sides of the body. Some areas may suddenly re-pigment while the white patches continue to spread.
The loss of colour is due to the mutation of one of the genes on chromosome 17. This is usually inherited. The mutations may remain unexpressed and the person may be normal all through life. However, if a family member is affected, the risk of vitiligo developing eventually in another member is increased five-fold. The same gene is responsible for premature greying. Some members may have patches, others may develop grey hair in their twenties while still others may appear perfectly normal. The gene may start to express itself and cause de-pigmentation as a result of a trigger like a stressful event. It may also be precipitated by an injury or constant friction in shoes or clothing.
The mutated gene triggers an autoimmune disorder and the body forms antibodies against melanocytes (pigment producing cells). The latter are thus destroyed. Vitiligo may be associated with other autoimmune disorders which affect organs such as the thyroid, stomach and adrenal glands. It may form part of the spectrum of systemic lupus (an autoimmune disease that affects all the organs in the body, and is thus difficult to diagnose).
Sometimes a white baby is born to a “normal” family. The entire skin, hair and even the eyes lack pigment. This condition is called albinism and the person is referred to as an albino. It occurs because the melanocytes are unable to produce melanin, the colouring pigment. This is also an inherited condition but since the gene is recessive it does not express itself and manifest itself as a “white baby” unless it is inherited from both parents. A person who carries the gene may look normal and not be aware of it. If he or she incidentally marries another carrier, the child can be albino.
The pigment producing melanocytes may be absent from birth in certain areas. This hereditary condition is called piebaldism. It can occur anywhere, and can result in just a white forelock — like in the case of Indira Gandhi.
Owing to the similarity in symptoms, vitiligo is sometimes confused with piebaldism, albinsim or even leprosy. White scars may give rise to a similar appearance. A diagnosis can be reached by a skin biopsy.
It is better to avoid sunlight when vitiligo first appears. As the skin tans, the areas without melanin become obvious. Use an umbrella or apply SF (sunfilter) 30 sunscreen on the exposed areas.
Small patches can be camouflaged with cosmetics. They can also be treated under supervision by applying steroid creams. Constant use of these creams, however, can damage the skin texture.
Physicians in India and Egypt documented vitiligo as early as 1,500 BC. They treated it by applying and administering extracts of the fruit, seeds and leaves of two plants — Psoralea coryifolia Linnaues and Ammi majus Linnaeus. Even today, isolates of these plants are successfully used topically and orally. Synthetic compounds are also available. They act by increasing sensitivity to light and augmenting pigmentation in the affected areas (photochemotherapy) . Treatment usually involves exposure to a measured amount of natural sunlight (PUVASOL) or artificial UV radiation (PUVA) to induce re-pigmentation. Phototherapy (without light-sensitising chemicals) can also be used. Sunburn is a common complication.
Surgical treatment can be tried by using skin grafts from pigmented areas. The success rate varies between 65 and 90 per cent. If the de-pigmented areas are extensive, some patients bleach the remaining dark portions of the skin to achieve a universal white colour.
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
Your Health
DR GITA MATHAI
Indians are very conscious of their skin colour. There is great alarm and anxiety if the skin suddenly develops white patches. About 1 per cent of the population is affected by this condition — called leukoderma (white skin) or vitiligo (“streaked calf” in Greek). The patches usually appear between the ages of 12 and 40. The disease affects people in all socio-economic strata. Michael Jackson was affected by it. Other rich and famous sufferers are Amitabh Bachchan and Gautam Singhania, the chairman and managing director of Raymonds.
The sudden loss of pigmentation causes 25 per cent of these people to become obsessed with their skin colour, depressed or even suicidal. Money does not make the disease disappear; it only makes it possible to consult the world’s best dermatologists.
The de-pigmentation often starts on the hands and feet. In the case of Jackson, it first appeared on his hands. This was the reason behind his signature white glove. In others it may start around orifices like the nose, mouth, eyes, umbilicus, genital areas and rectum. The patches may remain stationary, increase in size or spread over the whole body. They are symmetrical on both sides of the body. Some areas may suddenly re-pigment while the white patches continue to spread.
The loss of colour is due to the mutation of one of the genes on chromosome 17. This is usually inherited. The mutations may remain unexpressed and the person may be normal all through life. However, if a family member is affected, the risk of vitiligo developing eventually in another member is increased five-fold. The same gene is responsible for premature greying. Some members may have patches, others may develop grey hair in their twenties while still others may appear perfectly normal. The gene may start to express itself and cause de-pigmentation as a result of a trigger like a stressful event. It may also be precipitated by an injury or constant friction in shoes or clothing.
The mutated gene triggers an autoimmune disorder and the body forms antibodies against melanocytes (pigment producing cells). The latter are thus destroyed. Vitiligo may be associated with other autoimmune disorders which affect organs such as the thyroid, stomach and adrenal glands. It may form part of the spectrum of systemic lupus (an autoimmune disease that affects all the organs in the body, and is thus difficult to diagnose).
Sometimes a white baby is born to a “normal” family. The entire skin, hair and even the eyes lack pigment. This condition is called albinism and the person is referred to as an albino. It occurs because the melanocytes are unable to produce melanin, the colouring pigment. This is also an inherited condition but since the gene is recessive it does not express itself and manifest itself as a “white baby” unless it is inherited from both parents. A person who carries the gene may look normal and not be aware of it. If he or she incidentally marries another carrier, the child can be albino.
The pigment producing melanocytes may be absent from birth in certain areas. This hereditary condition is called piebaldism. It can occur anywhere, and can result in just a white forelock — like in the case of Indira Gandhi.
Owing to the similarity in symptoms, vitiligo is sometimes confused with piebaldism, albinsim or even leprosy. White scars may give rise to a similar appearance. A diagnosis can be reached by a skin biopsy.
It is better to avoid sunlight when vitiligo first appears. As the skin tans, the areas without melanin become obvious. Use an umbrella or apply SF (sunfilter) 30 sunscreen on the exposed areas.
Small patches can be camouflaged with cosmetics. They can also be treated under supervision by applying steroid creams. Constant use of these creams, however, can damage the skin texture.
Physicians in India and Egypt documented vitiligo as early as 1,500 BC. They treated it by applying and administering extracts of the fruit, seeds and leaves of two plants — Psoralea coryifolia Linnaues and Ammi majus Linnaeus. Even today, isolates of these plants are successfully used topically and orally. Synthetic compounds are also available. They act by increasing sensitivity to light and augmenting pigmentation in the affected areas (photochemotherapy) . Treatment usually involves exposure to a measured amount of natural sunlight (PUVASOL) or artificial UV radiation (PUVA) to induce re-pigmentation. Phototherapy (without light-sensitising chemicals) can also be used. Sunburn is a common complication.
Surgical treatment can be tried by using skin grafts from pigmented areas. The success rate varies between 65 and 90 per cent. If the de-pigmented areas are extensive, some patients bleach the remaining dark portions of the skin to achieve a universal white colour.
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
Monday, May 10, 2010
marked for life
Moles birthmarks and angel kisses
Your Health
--------------------------------------------------------------------------------
DR GITA MATHAI
Mikhail Gorbachev is easily identified in photographs by a distinctive large red mark on his head. The patch is actually a birthmark — a capillary naevus — which is present from birth. One in 10 children has birthmarks on his or her body.
These marks have fascinated people down the ages. In the 16th and 17th centuries, there developed a branch of astrology called moleoscopy. Specialists interpreted the “occult significance” of birthmarks and their “effect” on one’s character and destiny. The positions of the moles were linked with astrological signs. Hippocrates, the father of medicine, wrote a treatise on the link between birthmarks and health. He had the right idea. Health is a strong determinant of the future. We now know that the birthmarks are a coincidence.
Birthmarks that are red in colour are called strawberry marks, angel kisses or stork bites. They are usually present on the eyelids, forehead or nape of the neck. They may be flat or appear slightly raised or bumpy. They are caused by an overgrowth of the small blood vessels (capillaries). They are not hereditary or cancerous and usually disappear without treatment by the age of two.
Gorbachev’s large red naevus is called a port wine stain. Such marks too are present at birth, but are much larger, do not cross the midline and unlike strawberry marks do not fade with age. Sometimes they may be associated with seizures and glaucoma in later life.
Dark slate grey or bluish marks can be present over the areas of the buttocks or back in 80 per cent of Indian babies. These are called “mongoloid spots” and to the untrained eye can be mistaken for bruises. They occur because melanocytes (pigment producing cells in the skin) get caught in the deeper layers of the skin during the development process. The marks may last till adolescence.
Café au lait spots are so called because they are a shade of brown that looks like milky coffee. They may be present at birth or appear in early childhood. If they are very large, or four or more are present, the child may be carrying the gene for neurofibromatosis. This is a condition where multiple painless bumps appear all over the face and body in adult life.
Birthmarks that are large (the size of a fist), black and sometimes hairy are called congenital naevi. They have to be watched carefully as 10 per cent can turn cancerous.
Older children may develop pigmented areas on the skin called moles. These are also called beauty marks. Marilyn Monroe and Madhubala had attractive facial moles. In the last century, moles were a fashion statement for both men and women.
A real mole is an area of skin where there is an increase in the number of melanocytes which then form a cluster. They can be flat or raised. Some may have hair growing in it. The number present increases with age and most adults have 20-40 moles. They also increase during times of hormonal change like adolescence and pregnancy. They can darken when exposed to sunlight. Some fade away with age.
Moles rarely can become cancerous. The danger signals are —
* If the mole suddenly appears after the age of 20 and seems to be increasing in size
* If the diameter is larger than the end of a pencil
* If it suddenly changes in colour
* If it itches, oozes or bleeds.
A dermatologist can remove a mole which shows any of these signs and send it for testing. Removal of a cancerous mole in the early stages is curative.
Not all pigmentations on the skin are moles. They may be “lentigenes” or brown spots that appear on the face and hands in older people, especially after exposure to sunlight. They resemble freckles. They are harmless and can be prevented by avoiding the sun.
Black spots may appear on the chest and back as people get older. They look like blobs of dirt stuck on the skin, but cannot be picked off. These are barnacles or seborrheic keratosis. The condition may run in families. They occur because keratin, a strong natural protein normally formed in the skin, increases and forms circular whorls. They are harmless and can be left alone. Some may be cosmetically disfiguring. Others may get caught in clothing and become irritated, red and start bleeding. These can be removed by a dermatologist.
The skin, especially in older overweight women, can form tags — small flaps of tissue that hang off the skin. These are not painful or dangerous. If they get snagged frequently on jewellery or clothing, they can be easily removed.
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
Your Health
--------------------------------------------------------------------------------
DR GITA MATHAI
Mikhail Gorbachev is easily identified in photographs by a distinctive large red mark on his head. The patch is actually a birthmark — a capillary naevus — which is present from birth. One in 10 children has birthmarks on his or her body.
These marks have fascinated people down the ages. In the 16th and 17th centuries, there developed a branch of astrology called moleoscopy. Specialists interpreted the “occult significance” of birthmarks and their “effect” on one’s character and destiny. The positions of the moles were linked with astrological signs. Hippocrates, the father of medicine, wrote a treatise on the link between birthmarks and health. He had the right idea. Health is a strong determinant of the future. We now know that the birthmarks are a coincidence.
Birthmarks that are red in colour are called strawberry marks, angel kisses or stork bites. They are usually present on the eyelids, forehead or nape of the neck. They may be flat or appear slightly raised or bumpy. They are caused by an overgrowth of the small blood vessels (capillaries). They are not hereditary or cancerous and usually disappear without treatment by the age of two.
Gorbachev’s large red naevus is called a port wine stain. Such marks too are present at birth, but are much larger, do not cross the midline and unlike strawberry marks do not fade with age. Sometimes they may be associated with seizures and glaucoma in later life.
Dark slate grey or bluish marks can be present over the areas of the buttocks or back in 80 per cent of Indian babies. These are called “mongoloid spots” and to the untrained eye can be mistaken for bruises. They occur because melanocytes (pigment producing cells in the skin) get caught in the deeper layers of the skin during the development process. The marks may last till adolescence.
Café au lait spots are so called because they are a shade of brown that looks like milky coffee. They may be present at birth or appear in early childhood. If they are very large, or four or more are present, the child may be carrying the gene for neurofibromatosis. This is a condition where multiple painless bumps appear all over the face and body in adult life.
Birthmarks that are large (the size of a fist), black and sometimes hairy are called congenital naevi. They have to be watched carefully as 10 per cent can turn cancerous.
Older children may develop pigmented areas on the skin called moles. These are also called beauty marks. Marilyn Monroe and Madhubala had attractive facial moles. In the last century, moles were a fashion statement for both men and women.
A real mole is an area of skin where there is an increase in the number of melanocytes which then form a cluster. They can be flat or raised. Some may have hair growing in it. The number present increases with age and most adults have 20-40 moles. They also increase during times of hormonal change like adolescence and pregnancy. They can darken when exposed to sunlight. Some fade away with age.
Moles rarely can become cancerous. The danger signals are —
* If the mole suddenly appears after the age of 20 and seems to be increasing in size
* If the diameter is larger than the end of a pencil
* If it suddenly changes in colour
* If it itches, oozes or bleeds.
A dermatologist can remove a mole which shows any of these signs and send it for testing. Removal of a cancerous mole in the early stages is curative.
Not all pigmentations on the skin are moles. They may be “lentigenes” or brown spots that appear on the face and hands in older people, especially after exposure to sunlight. They resemble freckles. They are harmless and can be prevented by avoiding the sun.
Black spots may appear on the chest and back as people get older. They look like blobs of dirt stuck on the skin, but cannot be picked off. These are barnacles or seborrheic keratosis. The condition may run in families. They occur because keratin, a strong natural protein normally formed in the skin, increases and forms circular whorls. They are harmless and can be left alone. Some may be cosmetically disfiguring. Others may get caught in clothing and become irritated, red and start bleeding. These can be removed by a dermatologist.
The skin, especially in older overweight women, can form tags — small flaps of tissue that hang off the skin. These are not painful or dangerous. If they get snagged frequently on jewellery or clothing, they can be easily removed.
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
Monday, April 12, 2010
sweet dangers
Sweet danger
YOUR HEALTH
DR GITA MATHAI
“I cannot have diabetes,” exclaimed the middle-aged gentleman. “The laboratory results are wrong. My parents did not have diabetes, I am a vegetarian, and I do not even eat sweets.”
Well, this man is living in a soap bubble that is about to burst. None of the reasons cited protects from the onset of diabetes. As far as family history is concerned, awareness and routine laboratory tests for metabolic diseases are a relatively new phenomenon. His parents may have had diabetes and may have died quietly of an undiagnosed complication like a heart attack.
India has 30 million known diabetics, the largest number in the world. The figure is mounting daily and is slated to escalate by 200 per cent. Most of the affected will be in the economically productive age group of 30-60. We have to find out ways to combat this epidemic, halt it and prevent our children from falling prey to it.
Studies have shown that the possibility of developing diabetes depends on one’s genes, which are inherited from both parents, and the nurturing environment provided first in the womb and later by the mother.
To begin with, women should have the correct BMI (body mass index — weight divided by height in metre squared) of 23 before they become pregnant. Some women are undernourished and eat poorly. Their calorie intake is only 70 per cent of the required amount (2,000-2,200 calories for an active adult female). The protein content may be less than the recommended 075-1gm/kg. Both these situations result in poor foetal growth and an SFD (small for dates) baby.
Compensatory mechanisms come into play in SFD babies and they develop relative insulin resistance so as to maintain normal blood glucose concentrations. Vital organs like the brain and heart receive sufficient nutrition, but it is diverted away from the muscles.
These small babies exhibit a phenomenon called “catch up growth”. If fed adequately after birth, they attain normal weight for age and height within three years. In the process, they can develop impaired glucose tolerance as early as seven years of age.
Today’s teens have a different story. They are becoming obese on a diet of fast food and “time pass” television. Many girls are overweight when they get married. Pregnancy and well meaning advice to “rest and eat for two” do not help matters. Those who are obese (BMI more than 29) or diabetic during pregnancy can produce large babies (LFD or large for dates). These babies are exposed to excess nutrition in the womb. They secrete excess insulin, can develop insulin resistance and eventually diabetes. The problem is compounded if they are growing up in a family with faulty eating habits and little or no regular exercise.
Since we now know that the majority of us carries a gene which predisposes us to develop diabetes, it makes sense to thwart the march to disease.
Check your blood sugars once a year after the age of 25, even if you are asymptomatic, to be sure you don’t fall in the “prediabetic” category. Those who are prediabetic have a fasting blood sugar between 100 and 126mg/dl and a two-hour post prandial or oral glucose tolerance test value between 140 and 200mg/dl. Abnormal values may occur 15 years before the onset of overt diabetes. Without active intervention eventually 35 per cent go on to develop the disease. With effort and a change in lifestyle, 45 per cent can revert to normal.
Medical complications — which cause heart disease, stroke, peripheral vascular diseases, and eye and kidney problems – begin to set in during the prediabetic stage. Early identification and treatment can reduce the damage.
The BMI should be maintained at 23. This can be done by keeping the caloric intake between 1,500-2,000 calories a day. The diet should be low in fat, and contain four to six helpings of fruit and vegetables. But dieting alone will not help, as weight loss through starvation cannot be sustained. Food restriction should be combined with physical activity for 60 minutes every day. A brisk walk (five kilometres), or one hour of swimming or cycling will do the trick.
Blood pressure should be maintained at 130/80 or less. Salt restriction and weight loss alone may be sufficient to achieve this. If not, medication may be needed.
Lipid levels also need to be monitored in prediabetes as dyslpidaemia and altered glucose tolerance go hand in hand. Elevated lipid levels predispose to a stroke and heart attack. LDL should be below 100 mg/dl, HDL above 40mg/dl (above 50 mg/dl for women), and triglycerides below 150mg/dl. Reducing the total oil intake to 500 ml a month, checking labels for hidden fats in processed foods, and eating more soluble fibre (beans and oats) will help. If levels remain high the statin group of medications can be started.
If parents adopt a healthy lifestyle, children will soon follow suit. Perhaps this way we can reduce the impact of this devastating disease in the next generation.
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
YOUR HEALTH
DR GITA MATHAI
“I cannot have diabetes,” exclaimed the middle-aged gentleman. “The laboratory results are wrong. My parents did not have diabetes, I am a vegetarian, and I do not even eat sweets.”
Well, this man is living in a soap bubble that is about to burst. None of the reasons cited protects from the onset of diabetes. As far as family history is concerned, awareness and routine laboratory tests for metabolic diseases are a relatively new phenomenon. His parents may have had diabetes and may have died quietly of an undiagnosed complication like a heart attack.
India has 30 million known diabetics, the largest number in the world. The figure is mounting daily and is slated to escalate by 200 per cent. Most of the affected will be in the economically productive age group of 30-60. We have to find out ways to combat this epidemic, halt it and prevent our children from falling prey to it.
Studies have shown that the possibility of developing diabetes depends on one’s genes, which are inherited from both parents, and the nurturing environment provided first in the womb and later by the mother.
To begin with, women should have the correct BMI (body mass index — weight divided by height in metre squared) of 23 before they become pregnant. Some women are undernourished and eat poorly. Their calorie intake is only 70 per cent of the required amount (2,000-2,200 calories for an active adult female). The protein content may be less than the recommended 075-1gm/kg. Both these situations result in poor foetal growth and an SFD (small for dates) baby.
Compensatory mechanisms come into play in SFD babies and they develop relative insulin resistance so as to maintain normal blood glucose concentrations. Vital organs like the brain and heart receive sufficient nutrition, but it is diverted away from the muscles.
These small babies exhibit a phenomenon called “catch up growth”. If fed adequately after birth, they attain normal weight for age and height within three years. In the process, they can develop impaired glucose tolerance as early as seven years of age.
Today’s teens have a different story. They are becoming obese on a diet of fast food and “time pass” television. Many girls are overweight when they get married. Pregnancy and well meaning advice to “rest and eat for two” do not help matters. Those who are obese (BMI more than 29) or diabetic during pregnancy can produce large babies (LFD or large for dates). These babies are exposed to excess nutrition in the womb. They secrete excess insulin, can develop insulin resistance and eventually diabetes. The problem is compounded if they are growing up in a family with faulty eating habits and little or no regular exercise.
Since we now know that the majority of us carries a gene which predisposes us to develop diabetes, it makes sense to thwart the march to disease.
Check your blood sugars once a year after the age of 25, even if you are asymptomatic, to be sure you don’t fall in the “prediabetic” category. Those who are prediabetic have a fasting blood sugar between 100 and 126mg/dl and a two-hour post prandial or oral glucose tolerance test value between 140 and 200mg/dl. Abnormal values may occur 15 years before the onset of overt diabetes. Without active intervention eventually 35 per cent go on to develop the disease. With effort and a change in lifestyle, 45 per cent can revert to normal.
Medical complications — which cause heart disease, stroke, peripheral vascular diseases, and eye and kidney problems – begin to set in during the prediabetic stage. Early identification and treatment can reduce the damage.
The BMI should be maintained at 23. This can be done by keeping the caloric intake between 1,500-2,000 calories a day. The diet should be low in fat, and contain four to six helpings of fruit and vegetables. But dieting alone will not help, as weight loss through starvation cannot be sustained. Food restriction should be combined with physical activity for 60 minutes every day. A brisk walk (five kilometres), or one hour of swimming or cycling will do the trick.
Blood pressure should be maintained at 130/80 or less. Salt restriction and weight loss alone may be sufficient to achieve this. If not, medication may be needed.
Lipid levels also need to be monitored in prediabetes as dyslpidaemia and altered glucose tolerance go hand in hand. Elevated lipid levels predispose to a stroke and heart attack. LDL should be below 100 mg/dl, HDL above 40mg/dl (above 50 mg/dl for women), and triglycerides below 150mg/dl. Reducing the total oil intake to 500 ml a month, checking labels for hidden fats in processed foods, and eating more soluble fibre (beans and oats) will help. If levels remain high the statin group of medications can be started.
If parents adopt a healthy lifestyle, children will soon follow suit. Perhaps this way we can reduce the impact of this devastating disease in the next generation.
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
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