nergy drinks: boon or bane?
Your Health
DR GITA MATHAI
New age gadgets are supposed to make life simpler. A majority of us, however — and this includes children, teenagers, adults and the elderly — always seems to complain about a lack of energy, tiredness and an overwhelming feeling of lethargy. Apparently, these symptoms exist in epidemic proportions. Perhaps the gadgets only aggravate the problem.
A variety of nutritional drinks, like Complan, Boost and Horlicks, are advertised on television. Most provide between 170 and 250cal (equal to two and a half chapatis) when prepared as per the instructions. Milk adds another 60 cal per 100 ml. Such drinks do boost one’s energy level, but it’s temporary. The perceived increase in energy fades rapidly. When the same amount of calories is provided by cooked stuff like chapatis or dosas, the food has to be digested and slowly absorbed by the body. The energy provided is released gradually in a sustained manner.
A “health” drink first thing in the morning produces a rapid rise in energy. The stomach feels bloated and full. This results in a failure to eat a good breakfast (which will carry the child through the day), and eventual hunger and tiredness. If you must give your child such a drink, do so after breakfast.
Ads of energy drinks aimed at teens and adults too abound. They are touted to lift sagging spirits, perk you up, enable you to party all night and work 20 hours a day without fatigue. There are more than a dozen on the market — Red Bull, Cloud 9, XXX, Gatorade, Lucozade and so on. Some are locally made while others are imported. A few “sports drinks” claim to replenish the calories and electrolytes lost after gruelling sporting events.
Before buying such drinks, read the labels on them carefully. India is not as strict as some EU nations vis-a-vis regulating the sale of recreational drinks to under age persons. Most drinks contain only sugar, electrolytes, ginseng, taurine (a naturally occurring amino acid found in the intestine) and glucuronolactone (a component of connective tissue). Studies have not shown these to be either beneficial or harmful.
The energy boost is usually provided by the caffeine in these (80 to 150mg, same as in a cup of coffee). Caffeine as a drink reaches all tissues in five minutes. A peak level is reached in 30 minutes. It does not accumulate in the body but is metabolised and excreted within a few hours. Side effects appear with as little as 75mg. There is an increase in temperature, activity, breathing and urination. The brain gets stimulated, sleep and fatigue are postponed, and performance at intellectual tasks is improved.
Unfortunately, children and teens who consume energy drinks don’t stop with one. The average is two to three drinks a day. These larger doses of caffeine can produce headache, jitteriness, rapid heartbeat and even convulsions and delirium. A dose of 3,200mg is fatal.
With habituation, bigger amounts are needed for the same effect. Ephedrine, dextrorphan, codeine and alcohol are added to these to give a sense of euphoria. These are dangerous and can lead to drug addiction and abuse.
Fizzy cola drinks contain sugar, water, carbon dioxide, flavouring agents and 30 to 50mg of caffeine. Many consume large quantities of colas, increasing their caffeine intake. As little as 30mg of caffeine (a cup of tea) impacts a child’s brain. It causes hyperactivity, an inability to think clearly, lack of energy and irrational anger.
Caffeine is a habit with many adults; they require a cup of coffee or tea to kick-start the day. Up to a maximum of six cups (650mg of caffeine) is usually tolerated without side effects. Some people are more caffeine sensitive than others.
A balanced diet with sufficient calories, antioxidants, vitamins and minerals will provide the energy you need. To increase endurance and develop the ability to work or play through fatigue, you have to build stamina. This can be done naturally with regular aerobic activity. Children need to play in fresh air for at least an hour a day. Teens burdened with vast syllabi and exams must jog 40 minutes or run half an hour regularly.
The Chinese tackle sleepiness and fatigue with self applied acupressure. The claims have recently been verified by studies at the Michigan School of Public Health in the US. A steady downward pressure is applied with a finger, thumb or palm to specific points on the base of the thumb, front of the leg, top of the head, and on both sides of the neck for one to two minutes. This alleviates fatigue and reduces sleepiness.
If fatigue can be tackled naturally without energy boosters, why spend money on them?
Wednesday, January 26, 2011
Sunday, January 16, 2011
overindulgence
ess is more
YOUR HEALTH
DR GITA MATHAI
Overeating and overindulgence in anything is detrimental. No wonder it is classified as one of the deadly sins. It is easy to go overboard, with so many festivals one after the other — Ganesh Chaturthi, Dusshera, Diwali, Ramzan, Bakrid, Christmas and New Year. It has been like a continuous eating and drinking festival for the last four months.
Gaining weight is easy. All you need to do is eat 3,500 calories more than required, and bingo — you are heavier by more than 2 kg. The average calorific requirement for a 5’8’’, 70-kg man is 2,000 calories. This assumes that he has a sedentary job and does not actively exercise. He probably manages to maintain his weight without much effort, till the festive season rolls out.
Calories add on if the activity remains constant and the person decides to eat just “a little extra”, like an omelette (150 calories), a vadai (100 calories), a samosa (200 calories), some halwa (100gm — 322 calories), a paratha (300 calories) or peanuts or cashew nuts (100gm — 600 calories).
The weight creeps up gradually. Also, food transiently elevates the mood. Eventually the person finds he has gained 5-10kg without realising why or how.
This New Year, try to step up your level of physical activity. All it requires is an hour of brisk walking, jogging, swimming or half an hour of continuous stair climbing. This consumes around 300-350 calories, and, all other factors remaining constant, takes care of the “little extra” eating during festival time.
Alcohol is the other bane of celebrations. Although India is traditionally regarded as a temperate and controlled society, alcohol consumption is on the rise. Around 21 per cent of adult males and 5 per cent of women consume alcohol. The consumption is higher in the northeastern part of the country and lowest in the traditionally dry state of Gujarat.
The government and distilleries profit from the manufacture and sale of alcohol. Surrogate advertising promotes it as “the king of good times”. Mild and flavoured beverages are now being promoted to attract women and young first time consumers.
People drink socially to relax, forget their worries and cope with difficulties. At first, it is only with friends, on weekends or during celebrations. This sounds innocuous enough, but 20 per cent develops alcohol dependence of which 20 per cent go on to become problem drinkers.
Alcohol consumption gets out of hand when there is a strong uncontrollable urge to drink earlier and earlier in the day, accompanied by an inability to stop. The numbed conditioned brain does not emit warning signals saying “enough”. Stronger and larger drinks are required to achieve the same “kick”. Failure to consume alcohol results in sleeplessness, anxiety, nervousness, hallucinations, tremors and eventually convulsions. The patient ignores the side effects and thrives on the initial euphoria produced by the alcohol. The brain, heart, liver, pancreas and stomach are all eventually damaged.
Alcohol must be stopped abruptly. It cannot be reduced one drink at a time. Gradual reduction results in relapse and failure.
Help and support are available in specialised psychiatric detoxification centres. Also, there are Alcoholics Anonymous (AA) cells in major cities in India.
No one realises that drug overuse is actually rampant in India. There are one million (0.1 per cent of the population) heroin addicts officially registered but the number may actually be 5 million (0.5 per cent). The exact usage of “soft” drugs like marijuana (bhang) is not known as it is used traditionally by labourers.
Today the lines between different addictions are blurred. Hard and soft drug usage has permeated all strata of society. It often starts as casual recreational use just once or twice. Drugs are very addictive and the habit soon escalates. Oral or inhaled use eventually leads to intravenous use. Academic and professional performance drops. It can lead to infectious diseases like hepatitis B, C and AIDS and death from accidental overdose. It is a myth to think that you control your drug usage.
A large and unknown percentage of the population uses “medicines” to relieve sleeplessness, pain and to “feel good”. Cough mixtures available over the counter containing diphenhydramine (like Benedryl) or codeine are drunk in large quantities. Painkillers like dextropropoxyphene (Proxyvon) are either swallowed or injected. Sometimes these medications are mixed with caffeine-containing cola drinks. Others take sleeping tablets, like alpraxolam or diazepam (valium) regularly. Dependence and habituation set in, requiring higher doses to sleep. These medicines cause sleep disturbances, an inability to think clearly, poor decision making, tiredness and depression. An inability to obtain the medication may result in agitation.
Control in every aspect — food, medication and partying — is necessary for a long, healthy and disease free life. Endorphins that elevate the mood are released with exercise. To achieve a “high”, good mental acuity and concentration, exercise by running, jogging or swimming for an hour a day. Why resort to drugs and alcohol?
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
Overeating and overindulgence in anything is detrimental. No wonder it is classified as one of the deadly sins. It is easy to go overboard, with so many festivals one after the other — Ganesh Chaturthi, Dusshera, Diwali, Ramzan, Bakrid, Christmas and New Year. It has been like a continuous eating and drinking festival for the last four months.
Gaining weight is easy. All you need to do is eat 3,500 calories more than required, and bingo — you are heavier by more than 2 kg. The average calorific requirement for a 5’8’’, 70-kg man is 2,000 calories. This assumes that he has a sedentary job and does not actively exercise. He probably manages to maintain his weight without much effort, till the festive season rolls out.
Calories add on if the activity remains constant and the person decides to eat just “a little extra”, like an omelette (150 calories), a vadai (100 calories), a samosa (200 calories), some halwa (100gm — 322 calories), a paratha (300 calories) or peanuts or cashew nuts (100gm — 600 calories).
The weight creeps up gradually. Also, food transiently elevates the mood. Eventually the person finds he has gained 5-10kg without realising why or how.
This New Year, try to step up your level of physical activity. All it requires is an hour of brisk walking, jogging, swimming or half an hour of continuous stair climbing. This consumes around 300-350 calories, and, all other factors remaining constant, takes care of the “little extra” eating during festival time.
Alcohol is the other bane of celebrations. Although India is traditionally regarded as a temperate and controlled society, alcohol consumption is on the rise. Around 21 per cent of adult males and 5 per cent of women consume alcohol. The consumption is higher in the northeastern part of the country and lowest in the traditionally dry state of Gujarat.
The government and distilleries profit from the manufacture and sale of alcohol. Surrogate advertising promotes it as “the king of good times”. Mild and flavoured beverages are now being promoted to attract women and young first time consumers.
People drink socially to relax, forget their worries and cope with difficulties. At first, it is only with friends, on weekends or during celebrations. This sounds innocuous enough, but 20 per cent develops alcohol dependence of which 20 per cent go on to become problem drinkers.
Alcohol consumption gets out of hand when there is a strong uncontrollable urge to drink earlier and earlier in the day, accompanied by an inability to stop. The numbed conditioned brain does not emit warning signals saying “enough”. Stronger and larger drinks are required to achieve the same “kick”. Failure to consume alcohol results in sleeplessness, anxiety, nervousness, hallucinations, tremors and eventually convulsions. The patient ignores the side effects and thrives on the initial euphoria produced by the alcohol. The brain, heart, liver, pancreas and stomach are all eventually damaged.
Alcohol must be stopped abruptly. It cannot be reduced one drink at a time. Gradual reduction results in relapse and failure.
Help and support are available in specialised psychiatric detoxification centres. Also, there are Alcoholics Anonymous (AA) cells in major cities in India.
No one realises that drug overuse is actually rampant in India. There are one million (0.1 per cent of the population) heroin addicts officially registered but the number may actually be 5 million (0.5 per cent). The exact usage of “soft” drugs like marijuana (bhang) is not known as it is used traditionally by labourers.
Today the lines between different addictions are blurred. Hard and soft drug usage has permeated all strata of society. It often starts as casual recreational use just once or twice. Drugs are very addictive and the habit soon escalates. Oral or inhaled use eventually leads to intravenous use. Academic and professional performance drops. It can lead to infectious diseases like hepatitis B, C and AIDS and death from accidental overdose. It is a myth to think that you control your drug usage.
A large and unknown percentage of the population uses “medicines” to relieve sleeplessness, pain and to “feel good”. Cough mixtures available over the counter containing diphenhydramine (like Benedryl) or codeine are drunk in large quantities. Painkillers like dextropropoxyphene (Proxyvon) are either swallowed or injected. Sometimes these medications are mixed with caffeine-containing cola drinks. Others take sleeping tablets, like alpraxolam or diazepam (valium) regularly. Dependence and habituation set in, requiring higher doses to sleep. These medicines cause sleep disturbances, an inability to think clearly, poor decision making, tiredness and depression. An inability to obtain the medication may result in agitation.
Control in every aspect — food, medication and partying — is necessary for a long, healthy and disease free life. Endorphins that elevate the mood are released with exercise. To achieve a “high”, good mental acuity and concentration, exercise by running, jogging or swimming for an hour a day. Why resort to drugs and alcohol?
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
Thursday, January 6, 2011
sunshine effect
The sunshine effect
Your Health
--------------------------------------------------------------------------------
DR GITA MATHAI
The sun shines almost all the year round in India. Doctors were thus surprised when studies showed that 30 per cent of urban males, 50 per cent of rural and almost 90 per cent of urban women were vitamin D deficient. This vitamin is produced naturally by the action of sunlight on skin. Only 10 minutes of exposure, particularly to ultraviolet rays that appear at sunrise, is sufficient for the daily requirement.
Vitamin D can also be obtained from cereals, almonds, spinach, soya products, eggs, meat and fish. About 5 micrograms (200 International Units) are needed daily for all individuals (men and women, including those pregnant or lactating) under the age of 50 years. Those between 50 and 70 years need 10 micrograms (400IU), while those above 70 require 15 micrograms (600IU). Excessive intake — more than 2000IU or 50 micrograms — may result in side effects and toxicity.
Vitamin D is essential for proper calcium metabolism and bone mineralisation. Deficiency occurs because of changing lifestyles. In children, inadequate intake results in rickets characterised by soft, defective bones. The rib cage may become permanently misshapen, leading to breathing difficulties, and the long bones of the legs may be bowed. Similar softening of the bones in adults is called osteomalacia. In older people, the bone structure may become damaged, resulting in osteoporosis.
Vitamin D also affects enzymes and cell division. Its deficiency may cause excessive fatigue, muscle cramps, depression, insomnia and low immunity levels. Adequate levels have a protective effect against high blood pressure, auto immune diseases and the development of certain types of cancer.
Adequate amounts of calcium are needed for the vitamin to function efficiently. Children up to one year need 200mg daily, those between one and three need 500mg, four to 10-year-olds need 800mg, 10 to 18-year-olds need 1,300mg and adults 1,000mg. Adolescents require big amounts because that’s when a “calcium bank” is being built.
Women require more calcium than men, because of the loss during pregnancy and lactation. The female hormone estrogen makes calcium metabolism efficient. However, their bones may deteriorate rapidly after menopause. The vertebrae are primarily affected, resulting in a “dowager’s hump”, and the slightest fall can result in fractures, particularly of the hip and wrist.
Men, too, may develop osteoporosis and need sunlight exposure and calcium supplementation.
Some of the predisposing factors for weak bones cannot be changed. The risk increases if you are a woman, of Asian descent, have a family history of osteoporosis and as age advances. In both the sexes, a small frame with a body mass index or BMI (weight in kilogram divided by height in metre squared) of 19 or less adds to the risk as such persons have very little bone reserve. Thyroid diseases, diabetes and malfunctions of the adrenal glands contribute to weak bones. Digestive disorders with malabsorption adversely affect calcium and vitamin D uptake as both are absorbed from the intestines.
A low calcium intake can be tackled by consuming more dairy products or taking calcium and vitamin D supplements. Weight-bearing exercises like walking, running, jumping, dancing and weightlifting are helpful for developing healthy bones.
Tobacco contains nicotine, which contributes to weak bones. Alcohol interferes with calcium and vitamin D absorption and increases the risk of osteoporosis if more than two pegs (60ml) a day are drunk .
Osteoporosis is treated with calcium supplementation. To help the mineral enter the bones, selective estrogen receptor modulators like raloxifene and other drugs like calcitonin, bisphosphonates and parathyroid hormone may be used. In women, hormone replacement therapy after menopause was initially popular, as it appeared to reverse many of the adverse health effects of menopause. However, it has side effects, and is now used only in selected women under medical supervision.
Natural supplements from evening primrose oil, ginseng, natural soy products and tropical wild yam are popular. The advantages are anecdotal and scientifically unproven.
Osteoporosis, osteomalacia and rickets are totally preventable.
• Maintain an ideal body weight (BMI 23)
• Exercise seven days a week, one hour a day
• Expose the body to the early morning sun for 10 minutes
• Take calcium supplements.
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
The sun shines almost all the year round in India. Doctors were thus surprised when studies showed that 30 per cent of urban males, 50 per cent of rural and almost 90 per cent of urban women were vitamin D deficient. This vitamin is produced naturally by the action of sunlight on skin. Only 10 minutes of exposure, particularly to ultraviolet rays that appear at sunrise, is sufficient for the daily requirement.
Vitamin D can also be obtained from cereals, almonds, spinach, soya products, eggs, meat and fish. About 5 micrograms (200 International Units) are needed daily for all individuals (men and women, including those pregnant or lactating) under the age of 50 years. Those between 50 and 70 years need 10 micrograms (400IU), while those above 70 require 15 micrograms (600IU). Excessive intake — more than 2000IU or 50 micrograms — may result in side effects and toxicity.
Vitamin D is essential for proper calcium metabolism and bone mineralisation. Deficiency occurs because of changing lifestyles. In children, inadequate intake results in rickets characterised by soft, defective bones. The rib cage may become permanently misshapen, leading to breathing difficulties, and the long bones of the legs may be bowed. Similar softening of the bones in adults is called osteomalacia. In older people, the bone structure may become damaged, resulting in osteoporosis.
Vitamin D also affects enzymes and cell division. Its deficiency may cause excessive fatigue, muscle cramps, depression, insomnia and low immunity levels. Adequate levels have a protective effect against high blood pressure, auto immune diseases and the development of certain types of cancer.
Adequate amounts of calcium are needed for the vitamin to function efficiently. Children up to one year need 200mg daily, those between one and three need 500mg, four to 10-year-olds need 800mg, 10 to 18-year-olds need 1,300mg and adults 1,000mg. Adolescents require big amounts because that’s when a “calcium bank” is being built.
Women require more calcium than men, because of the loss during pregnancy and lactation. The female hormone estrogen makes calcium metabolism efficient. However, their bones may deteriorate rapidly after menopause. The vertebrae are primarily affected, resulting in a “dowager’s hump”, and the slightest fall can result in fractures, particularly of the hip and wrist.
Men, too, may develop osteoporosis and need sunlight exposure and calcium supplementation.
Some of the predisposing factors for weak bones cannot be changed. The risk increases if you are a woman, of Asian descent, have a family history of osteoporosis and as age advances. In both the sexes, a small frame with a body mass index or BMI (weight in kilogram divided by height in metre squared) of 19 or less adds to the risk as such persons have very little bone reserve. Thyroid diseases, diabetes and malfunctions of the adrenal glands contribute to weak bones. Digestive disorders with malabsorption adversely affect calcium and vitamin D uptake as both are absorbed from the intestines.
A low calcium intake can be tackled by consuming more dairy products or taking calcium and vitamin D supplements. Weight-bearing exercises like walking, running, jumping, dancing and weightlifting are helpful for developing healthy bones.
Tobacco contains nicotine, which contributes to weak bones. Alcohol interferes with calcium and vitamin D absorption and increases the risk of osteoporosis if more than two pegs (60ml) a day are drunk .
Osteoporosis is treated with calcium supplementation. To help the mineral enter the bones, selective estrogen receptor modulators like raloxifene and other drugs like calcitonin, bisphosphonates and parathyroid hormone may be used. In women, hormone replacement therapy after menopause was initially popular, as it appeared to reverse many of the adverse health effects of menopause. However, it has side effects, and is now used only in selected women under medical supervision.
Natural supplements from evening primrose oil, ginseng, natural soy products and tropical wild yam are popular. The advantages are anecdotal and scientifically unproven.
Osteoporosis, osteomalacia and rickets are totally preventable.
• Maintain an ideal body weight (BMI 23)
• Exercise seven days a week, one hour a day
• Expose the body to the early morning sun for 10 minutes
• Take calcium supplements.
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, January 3, 2011
sunshine effect
The sunshine effect
Your Health
DR GITA MATHAI
The sun shines almost all the year round in India. Doctors were thus surprised when studies showed that 30 per cent of urban males, 50 per cent of rural and almost 90 per cent of urban women were vitamin D deficient. This vitamin is produced naturally by the action of sunlight on skin. Only 10 minutes of exposure, particularly to ultraviolet rays that appear at sunrise, is sufficient for the daily requirement.
Vitamin D can also be obtained from cereals, almonds, spinach, soya products, eggs, meat and fish. About 5 micrograms (200 International Units) are needed daily for all individuals (men and women, including those pregnant or lactating) under the age of 50 years. Those between 50 and 70 years need 10 micrograms (400IU), while those above 70 require 15 micrograms (600IU). Excessive intake — more than 2000IU or 50 micrograms — may result in side effects and toxicity.
Vitamin D is essential for proper calcium metabolism and bone mineralisation. Deficiency occurs because of changing lifestyles. In children, inadequate intake results in rickets characterised by soft, defective bones. The rib cage may become permanently misshapen, leading to breathing difficulties, and the long bones of the legs may be bowed. Similar softening of the bones in adults is called osteomalacia. In older people, the bone structure may become damaged, resulting in osteoporosis.
Vitamin D also affects enzymes and cell division. Its deficiency may cause excessive fatigue, muscle cramps, depression, insomnia and low immunity levels. Adequate levels have a protective effect against high blood pressure, auto immune diseases and the development of certain types of cancer.
Adequate amounts of calcium are needed for the vitamin to function efficiently. Children up to one year need 200mg daily, those between one and three need 500mg, four to 10-year-olds need 800mg, 10 to 18-year-olds need 1,300mg and adults 1,000mg. Adolescents require big amounts because that’s when a “calcium bank” is being built.
Women require more calcium than men, because of the loss during pregnancy and lactation. The female hormone estrogen makes calcium metabolism efficient. However, their bones may deteriorate rapidly after menopause. The vertebrae are primarily affected, resulting in a “dowager’s hump”, and the slightest fall can result in fractures, particularly of the hip and wrist.
Men, too, may develop osteoporosis and need sunlight exposure and calcium supplementation.
Some of the predisposing factors for weak bones cannot be changed. The risk increases if you are a woman, of Asian descent, have a family history of osteoporosis and as age advances. In both the sexes, a small frame with a body mass index or BMI (weight in kilogram divided by height in metre squared) of 19 or less adds to the risk as such persons have very little bone reserve. Thyroid diseases, diabetes and malfunctions of the adrenal glands contribute to weak bones. Digestive disorders with malabsorption adversely affect calcium and vitamin D uptake as both are absorbed from the intestines.
A low calcium intake can be tackled by consuming more dairy products or taking calcium and vitamin D supplements. Weight-bearing exercises like walking, running, jumping, dancing and weightlifting are helpful for developing healthy bones.
Tobacco contains nicotine, which contributes to weak bones. Alcohol interferes with calcium and vitamin D absorption and increases the risk of osteoporosis if more than two pegs (60ml) a day are drunk .
Osteoporosis is treated with calcium supplementation. To help the mineral enter the bones, selective estrogen receptor modulators like raloxifene and other drugs like calcitonin, bisphosphonates and parathyroid hormone may be used. In women, hormone replacement therapy after menopause was initially popular, as it appeared to reverse many of the adverse health effects of menopause. However, it has side effects, and is now used only in selected women under medical supervision.
Natural supplements from evening primrose oil, ginseng, natural soy products and tropical wild yam are popular. The advantages are anecdotal and scientifically unproven.
Osteoporosis, osteomalacia and rickets are totally preventable.
• Maintain an ideal body weight (BMI 23)
• Exercise seven days a week, one hour a day
• Expose the body to the early morning sun for 10 minutes
• Take calcium supplements.
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
The sun shines almost all the year round in India. Doctors were thus surprised when studies showed that 30 per cent of urban males, 50 per cent of rural and almost 90 per cent of urban women were vitamin D deficient. This vitamin is produced naturally by the action of sunlight on skin. Only 10 minutes of exposure, particularly to ultraviolet rays that appear at sunrise, is sufficient for the daily requirement.
Vitamin D can also be obtained from cereals, almonds, spinach, soya products, eggs, meat and fish. About 5 micrograms (200 International Units) are needed daily for all individuals (men and women, including those pregnant or lactating) under the age of 50 years. Those between 50 and 70 years need 10 micrograms (400IU), while those above 70 require 15 micrograms (600IU). Excessive intake — more than 2000IU or 50 micrograms — may result in side effects and toxicity.
Vitamin D is essential for proper calcium metabolism and bone mineralisation. Deficiency occurs because of changing lifestyles. In children, inadequate intake results in rickets characterised by soft, defective bones. The rib cage may become permanently misshapen, leading to breathing difficulties, and the long bones of the legs may be bowed. Similar softening of the bones in adults is called osteomalacia. In older people, the bone structure may become damaged, resulting in osteoporosis.
Vitamin D also affects enzymes and cell division. Its deficiency may cause excessive fatigue, muscle cramps, depression, insomnia and low immunity levels. Adequate levels have a protective effect against high blood pressure, auto immune diseases and the development of certain types of cancer.
Adequate amounts of calcium are needed for the vitamin to function efficiently. Children up to one year need 200mg daily, those between one and three need 500mg, four to 10-year-olds need 800mg, 10 to 18-year-olds need 1,300mg and adults 1,000mg. Adolescents require big amounts because that’s when a “calcium bank” is being built.
Women require more calcium than men, because of the loss during pregnancy and lactation. The female hormone estrogen makes calcium metabolism efficient. However, their bones may deteriorate rapidly after menopause. The vertebrae are primarily affected, resulting in a “dowager’s hump”, and the slightest fall can result in fractures, particularly of the hip and wrist.
Men, too, may develop osteoporosis and need sunlight exposure and calcium supplementation.
Some of the predisposing factors for weak bones cannot be changed. The risk increases if you are a woman, of Asian descent, have a family history of osteoporosis and as age advances. In both the sexes, a small frame with a body mass index or BMI (weight in kilogram divided by height in metre squared) of 19 or less adds to the risk as such persons have very little bone reserve. Thyroid diseases, diabetes and malfunctions of the adrenal glands contribute to weak bones. Digestive disorders with malabsorption adversely affect calcium and vitamin D uptake as both are absorbed from the intestines.
A low calcium intake can be tackled by consuming more dairy products or taking calcium and vitamin D supplements. Weight-bearing exercises like walking, running, jumping, dancing and weightlifting are helpful for developing healthy bones.
Tobacco contains nicotine, which contributes to weak bones. Alcohol interferes with calcium and vitamin D absorption and increases the risk of osteoporosis if more than two pegs (60ml) a day are drunk .
Osteoporosis is treated with calcium supplementation. To help the mineral enter the bones, selective estrogen receptor modulators like raloxifene and other drugs like calcitonin, bisphosphonates and parathyroid hormone may be used. In women, hormone replacement therapy after menopause was initially popular, as it appeared to reverse many of the adverse health effects of menopause. However, it has side effects, and is now used only in selected women under medical supervision.
Natural supplements from evening primrose oil, ginseng, natural soy products and tropical wild yam are popular. The advantages are anecdotal and scientifically unproven.
Osteoporosis, osteomalacia and rickets are totally preventable.
• Maintain an ideal body weight (BMI 23)
• Exercise seven days a week, one hour a day
• Expose the body to the early morning sun for 10 minutes
• Take calcium supplements.
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, December 28, 2010
metabolic syndrome X
Sweet disease
Your Health
DR GITA MATHAI
A waist-hip ratio (the narrowest part of your waist divided by the widest part of your hips) greater than 1 in men and 0.8 in women is risky
Vellore recently hosted an endocrinology conference that was attended by almost 1,000 physicians. The experts discussed health issues linked to various hormones, but more than half the conference was devoted to diabetes. This was not surprising. After all, we are in the midst of a global epidemic. The physicians talked about new issues, the latest advances, pancreatic islet cell transplant surgery and hopes of an eventual cure. Exciting new developments were discussed. An eminent professor has actually managed to modify insulin so that it can be injected just once a month for good sugar control. Of course, only mice have benefitted thus far, but everyone is hopeful of successful human trials in the near future.
Diabetes has affected 11 per cent of India’s urban population and 3 per cent of the rural population above the age of 15. This may be an underestimation as 30 to 40 per cent of diabetics in India go undiagnosed until complications set in.
But why do we have this predisposition to diabetes? One theory is that India survived several famines, and in the process we evolved genetically and developed a “thrifty” gene. This conserves calories and converts food into fat which is then deposited in various parts of the body. That is why Indians, even thin individuals, tend to have a “tummy”. The first place we put on weight is around the middle.
Metabolic syndrome usually occurs in people who have a close relative like a parent or sibling with diabetes. Women at risk may have polycystic ovarian syndrome (PCOS) or develop diabetes during pregnancy (gestational diabetes).
It is possible to determine if a person is at risk for developing diabetes by recording certain biometric criteria. Such an individual has elevated fasting blood sugar levels of more than 125mg/dL or a random sugar value of more than 200mg/dL. The glucose tolerance test may be impaired. The lipid profile is deranged with triglycerides greater than 150 mg/dL, and HDL cholesterol less than 40mgdL in men and 50 mg/dL in women. The blood pressure is also higher than 135/85. Those who exhibit these abnormalities are said to suffer from “metabolic syndrome” or “syndrome X”.
It is also possible to evaluate yourself using a weighing scale and measuring tape. Risk factors are a BMI (body mass index) more than 30 (BMI = weight in kilogram divided by height in metre squared), a waist to hip ratio greater than 1 in men and 0.8 in women (this is the narrowest part of your waist divided by the widest part of your hips), and a waist measurement greater than 102cm in men and 88 cm in women. These anthropometric measurements do not require medical expertise.
If three or more of the above criteria are present, the person suffers from metabolic syndrome. When checking a cross section of the population, a staggering 40 per cent of those above the age of 15 were found to be affected.
Does this mean the majority of us are doomed to become diabetic?
To prevent syndrome X, and later its progression to diabetes, first the biochemical abnormalities have to be corrected. The abnormalities occur because of insulin resistance. Normally, the food we eat is converted into glucose which enters the cells of the body to provide them with energy. In people with syndrome X, the cells are resistant to insulin. Higher amounts of insulin have to be secreted to force the glucose to enter the cells. Eventually, the body is unable to produce enough insulin to do this and diabetes sets in.
Tackling the insulin resistance attacks the beginning of syndrome X. The most effective way to do this is to achieve and maintain the ideal body weight or a BMI of 23.
Aerobic activities like walking as little as 30 minutes every day will reduce insulin resistance. This has to be at a brisk pace, fast enough to prevent conversation except in short bursts. Ideally a pace of 4km/hr should be maintained. Although this is just about sufficient for fitness, an hour of walking, combined with caloric restriction (1,500 calories), is ideal. Cycling or swimming can be done instead.
If time is a constraint, climb stairs for 20 minutes. Weight lifting and other gym exercises increase strength and flexibility but do not help control syndrome X unless they are combined with aerobic activity. Also, exercises for spot reduction of abdominal fat alone, attempting to correct an abnormal waist-hip ratio, without overall weight loss do not work.
Caloric restriction can be achieved by reducing the amount eaten during each meal by 25 per cent. Reading, watching television and other mind diverting activities during meal times increases caloric intake. Also, fill up on fruits and vegetables and avoid snacking. Oils add hidden calories to food. Consumption should be restricted to 500 ml per person a month.
Healthy eating and the habit of regular exercise should be ingrained in children by parents.
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 waist-hip ratio (the narrowest part of your waist divided by the widest part of your hips) greater than 1 in men and 0.8 in women is risky
Vellore recently hosted an endocrinology conference that was attended by almost 1,000 physicians. The experts discussed health issues linked to various hormones, but more than half the conference was devoted to diabetes. This was not surprising. After all, we are in the midst of a global epidemic. The physicians talked about new issues, the latest advances, pancreatic islet cell transplant surgery and hopes of an eventual cure. Exciting new developments were discussed. An eminent professor has actually managed to modify insulin so that it can be injected just once a month for good sugar control. Of course, only mice have benefitted thus far, but everyone is hopeful of successful human trials in the near future.
Diabetes has affected 11 per cent of India’s urban population and 3 per cent of the rural population above the age of 15. This may be an underestimation as 30 to 40 per cent of diabetics in India go undiagnosed until complications set in.
But why do we have this predisposition to diabetes? One theory is that India survived several famines, and in the process we evolved genetically and developed a “thrifty” gene. This conserves calories and converts food into fat which is then deposited in various parts of the body. That is why Indians, even thin individuals, tend to have a “tummy”. The first place we put on weight is around the middle.
Metabolic syndrome usually occurs in people who have a close relative like a parent or sibling with diabetes. Women at risk may have polycystic ovarian syndrome (PCOS) or develop diabetes during pregnancy (gestational diabetes).
It is possible to determine if a person is at risk for developing diabetes by recording certain biometric criteria. Such an individual has elevated fasting blood sugar levels of more than 125mg/dL or a random sugar value of more than 200mg/dL. The glucose tolerance test may be impaired. The lipid profile is deranged with triglycerides greater than 150 mg/dL, and HDL cholesterol less than 40mgdL in men and 50 mg/dL in women. The blood pressure is also higher than 135/85. Those who exhibit these abnormalities are said to suffer from “metabolic syndrome” or “syndrome X”.
It is also possible to evaluate yourself using a weighing scale and measuring tape. Risk factors are a BMI (body mass index) more than 30 (BMI = weight in kilogram divided by height in metre squared), a waist to hip ratio greater than 1 in men and 0.8 in women (this is the narrowest part of your waist divided by the widest part of your hips), and a waist measurement greater than 102cm in men and 88 cm in women. These anthropometric measurements do not require medical expertise.
If three or more of the above criteria are present, the person suffers from metabolic syndrome. When checking a cross section of the population, a staggering 40 per cent of those above the age of 15 were found to be affected.
Does this mean the majority of us are doomed to become diabetic?
To prevent syndrome X, and later its progression to diabetes, first the biochemical abnormalities have to be corrected. The abnormalities occur because of insulin resistance. Normally, the food we eat is converted into glucose which enters the cells of the body to provide them with energy. In people with syndrome X, the cells are resistant to insulin. Higher amounts of insulin have to be secreted to force the glucose to enter the cells. Eventually, the body is unable to produce enough insulin to do this and diabetes sets in.
Tackling the insulin resistance attacks the beginning of syndrome X. The most effective way to do this is to achieve and maintain the ideal body weight or a BMI of 23.
Aerobic activities like walking as little as 30 minutes every day will reduce insulin resistance. This has to be at a brisk pace, fast enough to prevent conversation except in short bursts. Ideally a pace of 4km/hr should be maintained. Although this is just about sufficient for fitness, an hour of walking, combined with caloric restriction (1,500 calories), is ideal. Cycling or swimming can be done instead.
If time is a constraint, climb stairs for 20 minutes. Weight lifting and other gym exercises increase strength and flexibility but do not help control syndrome X unless they are combined with aerobic activity. Also, exercises for spot reduction of abdominal fat alone, attempting to correct an abnormal waist-hip ratio, without overall weight loss do not work.
Caloric restriction can be achieved by reducing the amount eaten during each meal by 25 per cent. Reading, watching television and other mind diverting activities during meal times increases caloric intake. Also, fill up on fruits and vegetables and avoid snacking. Oils add hidden calories to food. Consumption should be restricted to 500 ml per person a month.
Healthy eating and the habit of regular exercise should be ingrained in children by parents.
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, December 13, 2010
coughs and colds
eason of coughs and colds
YOUR HEALTH
DR GITA MATHAI
Self medication can be harmful, consult a doctor when your child is sick
In India, we enjoy four seasons — winter (January and February), summer (March to May), monsoon (June to September) and a post-monsoon period (October to December) with unseasonal rains causing an overlap amongst them. Each season has its own set of illnesses.
During winter and the rains, we often suffer from colds and coughs. People blame it on the weather — getting caught in an unexpected shower or going about on a grey, chilly day. These are unproven theories and fall in the category of urban legends.
Colds are infections caused by 200 types of viruses. With so many subtypes around, immunity is poor and infections are common.
Infection occurs when the cold virus reaches the nose. It is transported to the back of the throat in 10-15 minutes. The nasal mucous membrane attempts to wash out the virus by swelling up and increasing its secretions. This causes sneezing and a characteristic drippy nose.
Sneezing and coughing expel the viruses into the environment to infect others. The viruses can temporarily survive on furniture, walls and clothing. Hands placed on contaminated walls or furniture and then on the nose can cause infection.
During the monsoon and winter, people tend to keep windows and doors shut. As they sit close together with inadequate ventilation, colds spread rapidly.
Children under the age of one year are most susceptible. They have a little immunity passed on by their mothers while in the uterus and also through breast milk. This wanes in about six months. Later, as they come in contact with many others, especially in a closed environment like a poorly ventilated classroom, the number of initial infections proportionately increases. This causes a dramatic increase in the number of fevers, colds and “lost school days”.
Children may develop eight to 10 infections a year. Each cold lasts seven to 10 days. This means around 60 days of ill health due to colds alone, leading parents to feel the child is always sick. They begin to fear the child is suffering not from recurrent illnesses due to different viruses but something more sinister like primary complex or tuberculosis. (These illnesses do not have a symptom free interval — the child is continuously sick.)
The classic symptoms of a cold are mild fever, watery or slightly yellow nasal discharge, a scratchy feeling in the throat, cough and body ache. It is best tackled with rest. If the temperature rises above 100.5° F, or if the body ache is severe, paracetamol may be taken. Adults do not require more than 500mg and children 10-15mg/kg body weight per dose. The medicine can be repeated every four to six hours. Sore throat can be tackled with salt water gargles. Saline nose drops can be administered in each nostril every three hours. It is better to avoid decongestant chemical nose drops as they can cause rebound nasal congestion, habituation and, if used frequently for prolonged periods, atrophy of the nasal mucosa.
Anti histamines can cause drowsiness. Both anti histamines and cough suppressants can cause side effects. The prescribed dose should not be exceeded. Nor should they be used without medical supervision.
Traditional remedies like ginger tea, rasam, rice gruel and chicken soup help soothe the throat, relieve congestion and maintain hydration and nutrition.
Consult a doctor if:
■ The fever lasts more than five days
■ There are chills
■ The headache is continuous
■ There is abdominal pain or vomiting
■ There is earache
■ Breathing becomes difficult
■ There is a persistent cough
■ There is drowsiness.
In children, continuous crying or grunting must be taken seriously. Antibiotics will not shorten the course of a cold or prevent one from appearing. They need to be used if there are complications like an ear infection, sinusitis, bronchitis or pneumonia. They need to be taken in the prescribed dose. The medication should not repeated every time there is a cold without a medical opinion.
The ability to cope with a cold is better in people who keep themselves fit with regular physical aerobic exercise and breathing asanas.
Not all colds are infective. Some may be allergic rhinitis, a watery discharge from the nasal mucosa as a response to allergens like pollen, crackers, mosquito repellents, room fresheners, incense and chalk dust. Allergies are difficult to treat if the cause is not determined. The newer anti allergic nasal sprays if used regularly as directed cause the hypertrophied mucosa to shrink and the allergy to subside.
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
Self medication can be harmful, consult a doctor when your child is sick
In India, we enjoy four seasons — winter (January and February), summer (March to May), monsoon (June to September) and a post-monsoon period (October to December) with unseasonal rains causing an overlap amongst them. Each season has its own set of illnesses.
During winter and the rains, we often suffer from colds and coughs. People blame it on the weather — getting caught in an unexpected shower or going about on a grey, chilly day. These are unproven theories and fall in the category of urban legends.
Colds are infections caused by 200 types of viruses. With so many subtypes around, immunity is poor and infections are common.
Infection occurs when the cold virus reaches the nose. It is transported to the back of the throat in 10-15 minutes. The nasal mucous membrane attempts to wash out the virus by swelling up and increasing its secretions. This causes sneezing and a characteristic drippy nose.
Sneezing and coughing expel the viruses into the environment to infect others. The viruses can temporarily survive on furniture, walls and clothing. Hands placed on contaminated walls or furniture and then on the nose can cause infection.
During the monsoon and winter, people tend to keep windows and doors shut. As they sit close together with inadequate ventilation, colds spread rapidly.
Children under the age of one year are most susceptible. They have a little immunity passed on by their mothers while in the uterus and also through breast milk. This wanes in about six months. Later, as they come in contact with many others, especially in a closed environment like a poorly ventilated classroom, the number of initial infections proportionately increases. This causes a dramatic increase in the number of fevers, colds and “lost school days”.
Children may develop eight to 10 infections a year. Each cold lasts seven to 10 days. This means around 60 days of ill health due to colds alone, leading parents to feel the child is always sick. They begin to fear the child is suffering not from recurrent illnesses due to different viruses but something more sinister like primary complex or tuberculosis. (These illnesses do not have a symptom free interval — the child is continuously sick.)
The classic symptoms of a cold are mild fever, watery or slightly yellow nasal discharge, a scratchy feeling in the throat, cough and body ache. It is best tackled with rest. If the temperature rises above 100.5° F, or if the body ache is severe, paracetamol may be taken. Adults do not require more than 500mg and children 10-15mg/kg body weight per dose. The medicine can be repeated every four to six hours. Sore throat can be tackled with salt water gargles. Saline nose drops can be administered in each nostril every three hours. It is better to avoid decongestant chemical nose drops as they can cause rebound nasal congestion, habituation and, if used frequently for prolonged periods, atrophy of the nasal mucosa.
Anti histamines can cause drowsiness. Both anti histamines and cough suppressants can cause side effects. The prescribed dose should not be exceeded. Nor should they be used without medical supervision.
Traditional remedies like ginger tea, rasam, rice gruel and chicken soup help soothe the throat, relieve congestion and maintain hydration and nutrition.
Consult a doctor if:
■ The fever lasts more than five days
■ There are chills
■ The headache is continuous
■ There is abdominal pain or vomiting
■ There is earache
■ Breathing becomes difficult
■ There is a persistent cough
■ There is drowsiness.
In children, continuous crying or grunting must be taken seriously. Antibiotics will not shorten the course of a cold or prevent one from appearing. They need to be used if there are complications like an ear infection, sinusitis, bronchitis or pneumonia. They need to be taken in the prescribed dose. The medication should not repeated every time there is a cold without a medical opinion.
The ability to cope with a cold is better in people who keep themselves fit with regular physical aerobic exercise and breathing asanas.
Not all colds are infective. Some may be allergic rhinitis, a watery discharge from the nasal mucosa as a response to allergens like pollen, crackers, mosquito repellents, room fresheners, incense and chalk dust. Allergies are difficult to treat if the cause is not determined. The newer anti allergic nasal sprays if used regularly as directed cause the hypertrophied mucosa to shrink and the allergy to subside.
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
Saturday, December 11, 2010
don't get pregnant
Don’t get pregnant
Your Health
DR GITA MATHAI
I have done something wrong,” said the young woman. No, it was not theft or murder she was confessing to but unprotected sex. An unguarded passionate moment with her boyfriend had made her pregnant. She was terrified of the stigma — the boyfriend was still a student, there was no way they could get married right away.
This is quite a common scenario in urban as well as rural India. Women increasingly face the problems of unplanned and unwanted pregnancies. It’s most important that they know how to take care of themselves, married or single.
First, women need to be in control of their bodies, especially when it comes to sexual intercourse, pregnancy and childbirth. Many safe women-oriented contraceptive methods are available.
Women become pregnant only on certain days of the month. The ovum or egg of a fertile woman is released 14 days before her next period. The egg survives 12 to 24 hours after release and the sperm for up to 72 hours. Couples may refrain from intercourse on these days if they wish to avoid pregnancy. This method, however, is not reliable as many women do not menstruate with clockwork precision.
Women may use contraceptive creams containing nonoxynol-9 in the vagina. These substances increase the effectiveness of the safe period. They are effective for about an hour. But they do not suit everyone and may cause vaginal irritation or allergic reactions. They are available in pharmacies without a prescription.
Diaphragms can be inserted prior to intercourse. These come in various sizes and need to be combined with a spermicide. An initial medical examination is needed to confirm the size. The device has to be left in the vagina for eight to 12 hours after intercourse but should be removed within 24 hours.
Women can also opt for an intrauterine contraceptive device (IUCD), popularly known as a “copper T”. These need to be inserted by a medical professional. They can work for three, five or 10 years, depending on the type and manufacturer’s recommendations. Imported devices can be purchased from the pharmacy. Also, free IUCDs are distributed by the government.
“Depo” injections of long-acting progesterone are available. A woman needs to have an injection every 12 weeks. They can cause weight gain, irregular cycles, breakthrough bleeding or spotting. The irregular periods can raise the spectre of an unwanted pregnancy.
Oral contraceptive pills (OCP) prevent pregnancy if taken regularly. There are combination pills containing estrogen and progesterone with different trade names. They are also provided free by the government (Mala D). The active ingredient is given for 21 days. Then there is a pill-free interval of seven days after which the next lot needs to be started. Sometimes placebo pills are administered during the pill-free period. They prevent pregnancy as well as regularise the cycle. They do not increase the risk of cancer.
Breast feeding women can opt for “progesterone only” pills. These are taken without a pill-free interval.
There’s a new contraceptive in the market — a plastic ring impregnated with estrogen and progesterone. The ring needs to be inserted in the vagina and left there for three weeks followed by a one week ring-free interval. A woman can purchase and insert the ring herself. An advantage of this over the pill is that the question of forgetting the latter does not arise.
Condoms can be used by the male partner. These have to be used from the beginning to the end of intercourse, and can be combined with a spermicidal cream.
Casual sex and multiple partners can result in sexually transmitted diseases. Some like Hepatitis B and HIV can eventually be fatal. Only condoms can prevent these diseases.
Even if you have had unplanned and unprotected sex, you can use emergency contraception (morning after) pills. Although theoretically these pills should be dispensed only by prescription, in many places they are available over the counter (OTC). The tablet should be taken after intercourse as soon as possible. It is 80 per cent effective if taken within 72 hours.
The morning after pill contains either progesterone or a combination of estrogen and progesterone in higher doses than in the 21 or 28-day packs of OCPs. An alternative is to take four low-dose or two “standard-dose” OCPs, and then take an equal dose 12 hours later.
If an unwanted pregnancy occurs, do not buy medicine OTC or rush to an unqualified quack out of shame or fear. Medical abortion pills are available and effective. They work up to the 49th day after the last period.
The last two are stopgap emergency measures. They are not to be considered regular methods of contraception. They are detrimental to health if repeatedly used.
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 have done something wrong,” said the young woman. No, it was not theft or murder she was confessing to but unprotected sex. An unguarded passionate moment with her boyfriend had made her pregnant. She was terrified of the stigma — the boyfriend was still a student, there was no way they could get married right away.
This is quite a common scenario in urban as well as rural India. Women increasingly face the problems of unplanned and unwanted pregnancies. It’s most important that they know how to take care of themselves, married or single.
First, women need to be in control of their bodies, especially when it comes to sexual intercourse, pregnancy and childbirth. Many safe women-oriented contraceptive methods are available.
Women become pregnant only on certain days of the month. The ovum or egg of a fertile woman is released 14 days before her next period. The egg survives 12 to 24 hours after release and the sperm for up to 72 hours. Couples may refrain from intercourse on these days if they wish to avoid pregnancy. This method, however, is not reliable as many women do not menstruate with clockwork precision.
Women may use contraceptive creams containing nonoxynol-9 in the vagina. These substances increase the effectiveness of the safe period. They are effective for about an hour. But they do not suit everyone and may cause vaginal irritation or allergic reactions. They are available in pharmacies without a prescription.
Diaphragms can be inserted prior to intercourse. These come in various sizes and need to be combined with a spermicide. An initial medical examination is needed to confirm the size. The device has to be left in the vagina for eight to 12 hours after intercourse but should be removed within 24 hours.
Women can also opt for an intrauterine contraceptive device (IUCD), popularly known as a “copper T”. These need to be inserted by a medical professional. They can work for three, five or 10 years, depending on the type and manufacturer’s recommendations. Imported devices can be purchased from the pharmacy. Also, free IUCDs are distributed by the government.
“Depo” injections of long-acting progesterone are available. A woman needs to have an injection every 12 weeks. They can cause weight gain, irregular cycles, breakthrough bleeding or spotting. The irregular periods can raise the spectre of an unwanted pregnancy.
Oral contraceptive pills (OCP) prevent pregnancy if taken regularly. There are combination pills containing estrogen and progesterone with different trade names. They are also provided free by the government (Mala D). The active ingredient is given for 21 days. Then there is a pill-free interval of seven days after which the next lot needs to be started. Sometimes placebo pills are administered during the pill-free period. They prevent pregnancy as well as regularise the cycle. They do not increase the risk of cancer.
Breast feeding women can opt for “progesterone only” pills. These are taken without a pill-free interval.
There’s a new contraceptive in the market — a plastic ring impregnated with estrogen and progesterone. The ring needs to be inserted in the vagina and left there for three weeks followed by a one week ring-free interval. A woman can purchase and insert the ring herself. An advantage of this over the pill is that the question of forgetting the latter does not arise.
Condoms can be used by the male partner. These have to be used from the beginning to the end of intercourse, and can be combined with a spermicidal cream.
Casual sex and multiple partners can result in sexually transmitted diseases. Some like Hepatitis B and HIV can eventually be fatal. Only condoms can prevent these diseases.
Even if you have had unplanned and unprotected sex, you can use emergency contraception (morning after) pills. Although theoretically these pills should be dispensed only by prescription, in many places they are available over the counter (OTC). The tablet should be taken after intercourse as soon as possible. It is 80 per cent effective if taken within 72 hours.
The morning after pill contains either progesterone or a combination of estrogen and progesterone in higher doses than in the 21 or 28-day packs of OCPs. An alternative is to take four low-dose or two “standard-dose” OCPs, and then take an equal dose 12 hours later.
If an unwanted pregnancy occurs, do not buy medicine OTC or rush to an unqualified quack out of shame or fear. Medical abortion pills are available and effective. They work up to the 49th day after the last period.
The last two are stopgap emergency measures. They are not to be considered regular methods of contraception. They are detrimental to health if repeatedly used.
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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