https://www.telegraphindia.com/1170130/jsp/knowhow/story_132934.jsp to eat or not

o eat or not to eat

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Your Health - Dr. Gita Mathai

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We need nourishment to survive. Our body signals to us when we need food, our stomachs rumble when we feel hungry and, if the deprivation has been prolonged, we may even feel "faint" - signalling that blood sugar levels are falling.

An empty stomach secretes a chemical called ghrelin. This stimulates the appetite centre in the hypothalamus (a part of the brain). Unfortunately, even when you do not really require food, seeing the photo of a delicious-looking dish or actual food (say, in a shop window) or the tantalising smell of cooking can trigger the release of the hunger hormone, ghrelin. That why the fast food and aerated beverage advertisements on TV are so successful.

The message conveyed by ghrelin is often irresistible. People eat even when they are not really hungry. This is because ghrelin also works on "reward centres" in our brain, the same sites that are stimulated by alcohol, tobacco and addictive drugs like cocaine. So whenever we eat, we feel good and mood is elevated. That means the next time someone says they are addicted to chocolate, you'd better believe them.

The biochemical signals for appetite and satiety are complex. As hunger causes the blood sugar levels to drop, the pancreas releases glucagon, and the brain releases neuropeptide Y. As soon as we eat, and the blood sugar levels go up, our fat cells produce leptin and our brain proopiomelanocortin (POMC) - both appetite inhibitors. Some of these signals reach the brain via the nervous system and the blood carries others there. If we listen to our bodies, at this point we should theoretically stop eating.

Unfortunately there is a time lag in the signals and our response to them. By the time we realise and respond, it may already be too late and we have overeaten. This is particularly true of sugary snacks made from refined flour as they are digested rapidly. Plants and fruits take longer to digest. The chances of overeating are therefore reduced.

Children have well formed appetite centres practically from birth. If overfed (very easy to do with artificial feeds), the infant may refuse to feed or regurgitate. As the child becomes older, there may be a mismatch between how much the parent feels the child should eat and the amount actually consumed. If we make a fist with our hand (at any age), that is roughly the size of the stomach. Based on that, it is possible to calculate how much a child can be expected to eat.

Out of love and affection, we can force-feed children. Then their appetite centres get reset (sometimes permanently) at higher levels. Also, by giving fast food, there is a mismatch between amount consumed, caloric intake and requirement. This is clearly seen in our present day epidemic of childhood obesity.

Some children are picky eaters and will not eat the healthy food placed in front of them. Mealtimes become contentious and stress-filled. To avoid this

♦ Do not substitute milk or snacks for meals

♦ Do not begin or end the day with milk

♦ Do not put the child to bed with a feeding bottle

♦ A child over the age of 1 needs only 400ml of undiluted milk per day.

In the case of adults, loss of appetite may occur normally because of smoking, increasing age, pregnancy or thyroid disorders. If there is no obvious reason for loss of appetite, investigations need to be done.

There is really no safe drug that can be used long term for appetite suppression and weight loss. Eating food slowly, savouring it, increasing consumption of fruit and vegetables, cutting off snacks and exercising regularly is the only proven path to follow.

Dr Gita Mathai is a paediatrician and author of Staying Healthy in Modern India. Mail your questions to yourhealthgm@ yahoo.co.in

IBS

Oh shit!

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https://www.telegraphindia.com/1170116/jsp/knowhow/story_130445.jsp

Your Health - Dr. Gita Mathai

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IBS (irritable bowel syndrome) is an irritating and sometimes incapacitating disease. It produces painful abdominal cramps, bloating, explosive watery diarrhoea, or, conversely, constipation with pellet-like stools. These symptoms can occur at any time during the day. This makes people fearful about leaving the house. As they near the door, a feeling of incomplete evacuation of stool, or an overwhelming desire to return to the toilet delays departure. This can be a life-changing delay when examinations, interviews or timed departures (planes, trains) are scheduled.

Fifty per cent of India is between 20 and 50 years of age. A conservative estimate is that around 10 million of these people suffer from IBS. More women than men are affected. All of them are not symptomatic all of the time. The illness has spontaneous exacerbations and remissions. The uncertainty of if and when IBS will occur interferes with a tension-free lifestyle in young adults during their most productive years.

In order to diagnose IBS, abdominal discomfort should last at least three days a month for three months. Passing stool should relieve the pain. The frequency and consistency of the stool should be altered. There may be a feeling that bowel movements are incomplete. Mucous may be present in the stool. This confuses the picture and often leads to an erroneous diagnosis of amoebic dysentery.

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Most of the time the diagnosis of IBS is made clinically. A few simple tests to rule out amoebae, giardia and other parasites in the stool may be done and are usually enough. Other tests such as endoscopy, barium studies, X-rays, CT scans, lactose tolerance tests and breath analysis may be done if there are other findings, like onset after the age of 50, weight loss, bleeding from the rectum, nausea, vomiting, abdominal pain or diarrhoea at night or anaemia. This may show that the symptoms are due to more serious illnesses such as ulcerative colitis, Crohn's disease or cancer.

The exact reason for IBS is not known. It tends to run in families, though that may be a combination of genes and environment. For some reason, the nerves supplying the colon become hypersensitive and respond inappropriately to even mild stimulation. Instead of slow, steady, progressive contractions and relaxations, the movements become uncoordinated. This produces spasms and pain. The movement may slow down, causing bloating and constipation. There may be intestinal hurry with diarrhoea. There may be overgrowth of bacteria in the intestines with release of toxins, causing the bloating. Since it is commoner in women, it may be due to female hormones. There is an intestine-brain nexus under the control of chemicals such as serotonin and gastrin. The chemicals may be out of sync. All of these are merely theories - none have been proved.

The symptoms improve:

• If you eat on time, with short gaps between each meal

• If you drink at least eight cups of water a day

• If you restrict caffeinated and aerated drinks

• If you avoid processed foods with additives, colours and preservatives

• If you do not eat the seeds or skin of fruits

• If you give up some syrups and artificial sweeteners that contain sorbitol, which aggravates the symptoms.

Certain foods may be a trigger for the disease and are best avoided (this is a very individual phenomenon). Stress too can worsen symptoms. Aerobic exercise for 20-30 minutes a day, vigorous enough to build up a light sweat, combined with relaxation (yoga) and meditation also help.
 

Dr Gita Mathai is a paediatrician and author of Staying Healthy in Modern India. Mail your questions to yourhealthgm@yahoo.co.in

gut feeling

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Gut feeling

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Your Health - Dr. Gita Mathai

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January 1 is the time people make resolutions - to be a better person, to work harder, diet better, exercise regularly, stop drinking or smoking, and to remain in touch with friends. All these are worthy ambitions, decisions that will help you to live a longer, healthier and happier life.

Unfortunately, no matter how enthusiastically you take your resolutions, 80 per cent of them fall by the wayside within four months. Usually, because the resolutions were too unrealistic or you decided to change too many things at once. The other thing is that while resolutions usually focus on our mind and body, we tend to forget the largest organ we have - our intestinal tract and the "brain-gut axis" that influences almost all other behaviour. We are more likely to succeed in all our resolutions if we start by resolving to have a "gut makeover". That will also be a long term investment as a healthy gut results in a healthy body.

The small and large intestines together are about nine metres long. They lie coiled up in our abdomen and are lined with micro-organisms. These bacteria live symbiotically with the cells lining the intestine. Unless there is a breach in the cell wall of the intestine, they do not enter the body or cause disease. They secrete chemicals, which get absorbed into the blood stream and influence our bodily functions such as digestion, absorption, immunity, illness, mood and disease.

The particular mix of bacteria living in our intestines is unique. It is established during the birth process (that is why the bacteria are different in babies born by Caesarian section), and later by our genes, whether we are bottle or breast fed, and even later by diet and environment. The microbes are as unique to each individual as a fingerprint.

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After analysing the gut bacteria of healthy people and those with diseases, researchers found that significant differences existed. It was not just in the case of gastro-intestinal diseases such as peptic ulcer, irritable bowel syndrome (IBS), ulcerative colitis, colon cancer but also diseases like obesity, diabetes, depression as well as autoimmune diseases like rheumatoid arthritis. This can be explained by the fact that ultimately it is inflammation that causes most of these diseases. Gut bacteria release many inflammatory agents. They also release chemicals such as serotonin that tackle depression. It is not the presence or absence of a single organism that increases the risk of developing a disease, but the proportion of the various bacteria.

A high-fibre diet, with at least six helpings of fruits and vegetables, results in genetically diverse healthy bacteria living symbiotically in the gut. The gut is also likely to have "good bacteria" if whole grain products are substituted for refined wheat or polished rice. Disease causing bacteria are more likely to thrive if the food is highly processed, contains chemicals (preservatives and artificial colours), is deep-fried or charred and highly salted or sweetened.

Overeating overloads the digestive tract. Food is not digested well, there is bloating, neither the gut bacteria nor the digestive enzymes are able to keep pace, and cell damaging chemicals and fat globules are formed. Calories should be restricted to 2000-2500 per day for the adult male and 1800-2000 calories per day for the adult female if they are moderately active. (Moderate activity is roughly the equivalent of walking 4-5 km per hour per day). Calories need to be adjusted upward or downwards depending on level of activity.

Moderate activity from childhood (playing actively outside for an hour a day) helped growth of healthy gut bacteria and this continues into adult life.

To promote healthy gut bacteria

• Detox your body by fasting at least once a month

• Eat healthy bacteria in freshly made curd once a day

• Avoid antibiotics (unless specifically prescribed for an illness) as they kill the good gut bacteria.
 

Dr Gita Mathai is a paediatrician and author of Staying Healthy in Modern India. Mail your questions to yourhealthgm@yahoo.co.in

prediabetes http://www.telegraphindia.com/1161114/jsp/knowhow/story_118991.jsp

There has been an increase in the number of diabetic patients in India from 11.9 million in 1980 to 64.5 million. In fact, in the last 15 years, diabetes patients have increased by a 100 per cent. Also, 77.2 million people in India have pre-diabetes. They are not yet diabetic, but with fasting glucose levels in the 100 and 125mg/dL range, they have "impaired glucose tolerance" and are in real danger of eventually developing diabetes.

The pre-diabetic state was originally tested in people 35 and older, but now even preteens are developing impaired glucose tolerance. The explosion in the percentage of people with this condition has coincided with the popularity of cheap, calorie-dense, fast food; aerated, sugary, bottled drinks and home-based entertainment - from television, cell phones and computers - leading to sedentary or "couch potato" lifestyles.

Pre-diabetes is likely to be present at any age if:

♦ The BMI (weight divided by height in meter squared) is more than 25;

♦ The fat is concentrated around the abdomen;

♦ The lipid profile is abnormal;

♦ The blood pressure is above 140/90;

♦ There is a family history of diabetes;

♦ The skin on the folds of the neck and elbows is black and velvety in appearance, a condition known as "acanthosis nigricans";

♦ There are symptoms of increased fatigue, hunger, thirst and urination;

♦ If a woman have polycystic ovarian syndrome (PCOS) or diabetes during pregnancy or delivered a baby heavier than 4kg.

Anyone who exercises less than three days a week, and repeatedly has two consecutive days without physical activity may also become pre-diabetic.

After the age of 45, it is better to test for diabetes even if you are asymptomatic. If the sugar values are normal and there are no risk factors, the test should be repeated every three years. Children aged 10 and older should be tested for diabetes if they are overweight and have at least two risk factors.

To prevent pre-diabetes from becoming full-blown diabetes, maintain ideal body weight. This should be combined with regular exercise.

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CALCULATE YOUR SUGAR SCORE

• Age: If you are younger than 35, add 0 to your score
If you are between 35-49, add 20
If you are 50 or older, add 30

• Abdominal obesity: If waist size is less than 80cm (in women) or 90 (in men) add 0
If waist size is between 80-89 cm (in women) or 90-99 cm (in men), add 10 to your score
If waist size is more than 90 cm (women) or 100 cm (men), add 20 to your score

• Physical activity: If you exercise regularly and do strenuous work, add 0 to your score
If you either exercise regularly or do strenuous work, add 20
If you do not exercise and do sedentary work, add 30

• Family history: If there is no family history of diabetes, add 0
If one  parent is diabetic, add10
If both parents are diabetic, add 20

If your score is:
• >60: There is a very high risk of having diabetes
• 30-50: The risk of having diabetes is moderate. It is recommended you get blood tests done
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Source: Madras Diabetes Research Foundation, Chennai

Dr Gita Mathai is a paediatrician and author of StayingHealthy in Modern India. Mail your questions to yourhealthgm@yahoo.co.in

eczema

Don’t scratch that itch

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Your Health - Dr. Gita Mathai

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  Skin deep
  Keep eczema away
  
  Use a non-perfumed, moisturising soap. Apply lotion or oil after a bath. Add a tablespoon of coconut oil to the bathwater
  
  Apply mild steroid creams (only with a prescription) for relief. Avoid oral steroid medication
  
  For relief from scratching, take anti-allergy pills that do not make you sleepy
  
  Reduce stress with exercise, yoga and meditation

Eczema is a common skin condition, affecting 10-30 per cent of the population. The word is derived from Greek ekzein, which means ‘boil over, break out’. It is diagnosed when the skin is chronically inflamed in certain areas, with redness, itching and rash. The constant itching makes people scratch. Children are sometimes unable to reach the area, whereupon they rub it against clothing and available hard surfaces. The affected area may then begin to bleed or become secondarily infected. The skin can eventually become thickened and leathery.

The most common type of eczema is called “atopic dermatitis”. It starts in childhood. Affected children have close relatives with atopic dermatitis or other allergies such as constant sneezing. The attacks may be triggered by exposure to allergens in food such as cow’s milk, peanuts or food colouring. Contact with wool or synthetic fibres may aggravate the itching. Perfumes, soaps and detergents may also be precipitating factors.

Atopic dermatitis appears on the front or back of the knees, around the elbow, at the neck, on the scalp, hands or cheeks. It can appear as itchy dry red areas, which can eventually become discoloured. The itching can be severe enough to interfere with schoolwork, daily activities and disrupt sleep.

Infants fed on cow’s milk or formula can develop eczema because of cow’s milk protein. Sometimes rashes make their first appearance during weaning, when solid food like egg is introduced.

Most children grow out of their eczema. They start getting better around the age of one and are completely “cured” by the age of four.

Eczema may also be “contact eczema” where the reaction occurs only in areas in contact with the allergen. This is particularly common with nickel-plated artificial earrings or necklaces. Changing your brand of soap or shampoo can also precipitate a reaction. This type of eczema is easy to treat. Just removing the precipitating factor will make it clear up rapidly.

Sometimes the palms and soles of the feet are affected. Blisters form, the skin becomes rough and it may flake off. This is called dyshidrotic eczema.

Nummular or discoid dermatitis occurs in adults as oval-shaped patches, or blister-like sores. They occur on the arms, hands, feet and chest. They exude fluid, become scaly and can get secondarily infected.

Seborrhoeic dermatitis appears on the scalp (dandruff, cradle cap in infants), nose, around the umbilicus, sides of the nose, eye and skin folds under the breast. On the scalp, applying mineral oil, brushing away the flakes and then using an antidandruff shampoo usually clears the flakes.

Dr Gita Mathai is a paediatrician with a family practice at Vellore and author of Staying Healthy in Modern India.

all work and no play

Play to the top, please

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Your Health - Dr. Gita Mathai

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My parents used to walk to school, a couple of kilometres both ways, in a chatty gaggle that built up a lifetime of friendships. Today's children take automated transport and barely have the time to talk for they are usually cramming - for unit tests, weekly exams or quarterly evaluations. They live and study in a pressure-cooker, their stress levels build up in junior school itself, and by the time they reach the public exams, many are not only physically unfit but may have reached breaking point. Many do not know how to study, or why they cannot recall what they have studied!

Schools contribute to this environment. The 11 o'clock and lunch breaks are reduced from the mandatory half and one hour. This means that children barely have time to gobble their lunch and go to the toilet (no time to play). The games period is usurped for extra classes. Weaker students are coached after school hours or sent to a tuition circuit. There is no time for hobbies, extracurricular activities or sports.

All this is counterproductive. Being a "topper" does not ensure admission to college and the ability to shine in your chosen career. For college, you only need to make the "cut off" grade and good grades do not ensure success in your career After five years, your school marks cease to be relevant. A child who has hobbies and plays a sport is more likely to be a well-rounded individual and be equipped with the character requirements for success.

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Children need to be physically active to cope with studies and the rigours of life. Unlike their inactive counterparts, they have a normal BMI (body mass index), lower body fat, are mentally sharper, and have better cardiovascular health. They tend to concentrate on studies and tasks better and grasp concepts faster. Their performance in reading and mathematics is demonstrably superior to their inactive counterparts.

Studies have shown that school-going children require an hour of physical activity. Since it is difficult to change the academic mindset, it becomes the responsibility of parents to try to ensure that this happens.

The exercise can be split into two or more segments but at the end of the day the minutes should have added up to an hour. It can be cycling, running, skipping, stair climbing, dancing or swimming. It requires parental involvement.

Parents may feel that taking a break for activity cuts into cramming time and is counterproductive. Actually, long study sessions without a break means that brain power is wasted trying to stay focused. The chemicals required for processing information become depleted. Periodic breaks allow chemicals to accumulate. Endorphins released from muscles during exercise boost this process. Adequate sleep is as important for efficient brain functioning. School going children require 8-11 hours of sleep.

Review of study sessions once or twice a few days apart, or even after a bout of physical activity are important to "grease" and establish brain pathways for efficient recall. Repeating the lesson loudly, reinforces the lesson through sight and sound.

Dr Gita Mathai is a paediatrician with a family practice at Vellore. Send questions on health to yourhealthgm@yahoo.co.in

D for Dumb

Dial D for Dumbness

http://www.telegraphindia.com/1160912/jsp/knowhow/story_107601.jsp

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Your Health - Dr. Gita Mathai

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Infants and toddlers who come to my clinic are often cranky. Instead of the old techniques of carrying them around, distracting them with toys, or my aquarium, today, more and more parents tackle these behaviour problems by immediately handing the child their smartphone. The child can barely walk or talk, but their podgy fingers swipe the screens expertly as they stare unblinkingly at the coloured images flashing on the screen. Parents think that this is a reflection of the intelligence of their toddler. This is far from the case. It is a disturbing and dangerous trend.

All electronic devices, cell phones, tabs or laptops emit MWR (micro wave radiation). Long-term exposure to this radiation is carcinogenic. There is still speculation about exactly how much radiation is safe, with conflicting reports and claims.

A child's thin skull bones allow greater penetration of MWR. His or her nervous system and brain tissue absorbs about two times more MWR than that of adults. His or her bone marrow absorbs ten times more radiation.

It is recommended that children under the age of two should not use cellphones at all. In all age groups, it is better to place cell phones a few inches away from the ear. They should be carried in backpacks or purses and not in pockets. In the case of laptops, computers and tablets, the minimum safe distance from the body is 20cm.

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Tablets are even more popular than cellphones as pacifiers for children. They have a larger variety of passive and interactive programs. The screen is larger (more radiation), it is also held closer to the face (brain). Children soon learn to video themselves. They replay their own videos in a narcissist fashion. This negates the need for friendship or social interaction. They become self absorbed, and since they are always in control of the happenings on the tab, they are unable to control their impulses. They do not interact with their peers or adults. Children learn and mature by watching adult social reactions to situations.

They become experts at swiping and tapping movements, usually with the dominant hand. Children constantly on these devices develop no dexterity or motor skills. They remain clumsy. They do not use their imagination to make believe and play. With no story telling or reading, lateral thinking, problem solving and the ability to learn maths and science are affected.

As the child becomes older, television replaces family interaction, play and even study time. Studies have documented that increased television viewing time delays and decreases development of language, vocabulary and social skills. Some imitate the exaggerated facial contortions and staccato speech of cartoon characters.

Children under two years of age should not watch television at all. Those older than 3 years who watched an hour or more a day were found to fare poorly academically. Their educational achievements by the age of 26 are behind those of their peers. This is because with television, everything is readily visible, and requires no analysis, reading or language skills. These areas of the brain lack stimulation and develop poorly.

There are educational programmes on television, specifically designed for children. These are seldom watched. Instead the focus is on mindless serials, and cartoons with unrealistic situations, which can desensitise the child to violence.

Dependence on media for entertainment leads to social isolation and regression of skills essential for survival and success. In addition, after school, homework, tuition and relaxation with television, there is no time physical exercise. This has led to an epidemic of unfit or obese children who develop lifestyle diseases in their twenties.

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