prenatal vitamins

Healthy living for moms-to-be

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

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

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

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

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

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

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

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

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

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

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

HIIT and other new health mantras

The new health mantras

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Your Health - Dr. Gita Mathai

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

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

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

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

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

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

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

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

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

dieting or fasting

Dieting of Fasting?

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

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

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

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

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

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

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

Once you have decided to go on a fast:

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

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

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

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

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

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

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

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

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

Dr. Gita Mathai

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

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breathe easy

Breathe easy

http://www.telegraphindia.com/1160321/jsp/knowhow/story_75553.jsp

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Your Health - Dr. Gita Mathai

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Breathing is an involuntary action, coordinated by respiratory centres deep in the brain. It is not really possible to die by voluntarily holding your breath, as without practice and training, apnoea (not breathing) cannot be sustained for more than 1-2 minutes. This is because "breath holding" results in accumulation of carbon dioxide in the blood and a drop in the blood pH. The respiratory centre in the brain is automatically stimulated. Breathing sets in.

Sleep apnoea (cessation of breathing during sleep) can occur in adults, usually middle-aged overweight males with a thick neck. It can occur in all ages and both sexes, especially if the tonsils or adenoids are enlarged, there is a deviated nasal septum or GERD (gastro esophageal reflux disease). Sleep apnoea can cause high blood pressure, stroke, heart disease, and daytime drowsiness. Academic performance and decision making at work can suffer. There may be daytime lapses in concentration, which can cause accidents.

Mild cases of sleep apnoea respond to weight loss and exercise. Severe cases may require CPAP (Continuous Positive Airways Pressure), or surgery.

Reactive Airways Disease (old name bronchial asthma) is a condition where the smaller airways in the lungs constrict when exposed to many triggers. These may be a viral or bacterial infection, pollen, food, or odours in the air. As the breathing pipes become smaller, the outflow of air is obstructed and there is whistling sound with each breath. The person may start coughing vigorously or panic as they feel the air supply is being cut off.

This can be tackled with nebulisers, inhalers and rotahalers. These devices deliver dilating medication directly to the breathing pipes. The effect is almost instantaneous and there are practically no side effects.

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Our airways are designed to filter out dust and other harmful particles. Unfortunately our inbuilt air purification system can only filter out particles of 2·5 µm (PM2 ) in diameter. The smaller - found around us both indoors and out - can enter the lungs. Indoor pollution comes from the use of solid fuels, such as coal, wood, or charcoal (even when it is only used to heat water), burning rubbish and waste, particularly plastic. Cigarette smoke harms the smoker and the polluting particles secondarily affect others in the environment. Agarbattis release many polluting chemicals as do mosquito repelling coils, mats and liquids.

Industrialisation and urbanisation have? resulted in fossil fuels being used in factories and for transport. Smoke from factories is sent high into the sky through industrial chimneys, but that just means that the particles spread over a wider area. The petrol and diesel vehicles on the road also emit particulate material and harmful gases. Seven million deaths occur annually because of air pollution alone. Pregnant women and children are particularly vulnerable. Constant exposure to a polluted environment affects long-term growth and cognitive ability in children. If we keep polluting the environment like this, our IQ levels will be affected.

Eventually, constant exposure to pollutants over many years can also result in COPD (chronic obstructive pulmonary disease) with breathlessness with the slightest activity. This too is treated with nebulisers and inhalers.

• We all breathe but this does not mean we breathe correctly. Lungs need regular breathing exercises and correction of faulty breathing techniques. Yoga corrects the technique.

• Exercise early in morning when pollution is less or indoors in a gym.

• Keep indoor plants in your home. They reduce particulate matter and pollutants.

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

Zika virus

http://www.telegraphindia.com/1160314/jsp/knowhow/story_74296.jsp

A strange disease

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Your Health - Dr. Gita Mathai

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The Aedes Egypti mosquito has long been spreading diseases such as chikungunya and dengue in India. It has now added another illness to its spectrum -- the Zika virus.

The Zika virus infection in itself is a mild disease. The bite of the infected mosquito is followed by a 3-7 day asymptomatic incubation period. After this, there is mild fever, red eyes, rash and joint pains. Most people recover spontaneously in a few weeks.

The problem with the infection is that, unlike dengue and chikungunya, the Zika virus can cause the Guillain-Barré syndrome. This is a rapidly occurring paralysis that can actually follow any viral infection, not necessarily Zika alone. It can also be precipitated by respiratory or gastrointestinal infections and even vaccination or surgery. The syndrome starts with a tingling and numbness in both feet and then spreads upwards. There may be pain and weakness. A person who was fine is suddenly bed ridden and paralysed within two weeks. Respiratory muscles can be affected making it difficult to breathe. Control of the bowel and bladder is lost. The heart rate may become irregular and the blood pressure may drop. The breathing problems and the heart irregularities can make the disease fatal.

It occurs because as the body tries to fight the virus causing the infection, it makes a mistake and attacks the protective myelin covering of the nerves instead. The nerves are damaged. They are no longer able to transmit signals to the brain or receive reciprocal messages. The tingling sensation signals the initial attack. This is soon followed by paralysis.

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Doctors in the emergency departments are suddenly confronted with a paralysed person who the relatives claim was previously healthy. The precipitating illness (even Zika) may have been so mild as to pass unnoticed. This means that a number of diagnoses have to be considered. It may be due to a stroke affecting both sides (very rare), a injury to the spinal cord, metabolic conditions, heavy metal poisoning, alcohol intoxication, drug overdose or vitamin deficiencies, especially B12 and folic acid.

The diagnosis is difficult. It is arrived at after blood tests, spinal fluid analysis, electromyography, nerve conduction studies and scans. It is a diagnosis of exclusion, when none of the tests yield a positive result

Guillain-Barré tends to worsen for two weeks then plateau for about a month. After that, there is slow recovery, which may take as long as three years. Eighty per cent of those affected (particularly children) recover completely. Some residual symptoms of weakness and pain may remain in the rest of the patients. About five per cent may suffer a relapse or recurrence.

The treatment is mainly supportive, with physiotherapy and strengthening exercises, mobility, pain relief and prevention of blood clots. Recovery can be speeded up with procedures like plasmapheresis and immunoglobulin therapy.

Mosquitoes spread many diseases such as the Zika virus, dengue, chikungunya, malaria, filaria and brain fever. To prevent that we need to:

• Stop stagnant water from accumulating and clear garbage to prevent mosquitoes breeding.

• Sleep in mosquito nets

• Mosquito-proof homes with nylon or metal mesh.

• Use electric "mosquito bats" to rid the house of any mosquitoes that may have entered.

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

http://www.telegraphindia.com/1160229/jsp/knowhow/story_71810.jsp

Exercise to stay alert

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Your Health - Dr. Gita Mathai

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All our physical and mental functions and activities are controlled by a supercomputer called the brain, housed safely in the skull.

As we age, the telomeres (DNA strands) in our cells shorten. This starts in middle age and accelerates after 60. The connections between the brain cells decrease and become less efficient. The cells also begin to shrink in size, especially in the hippocampus and the prefrontal cortex.

These changes make us "slow down". We no longer talk, walk or react as fast as we used to. Learning a new skill becomes difficult. Sometimes the world around appears confusing. The personality changes and people may become unreasonable or aggressive.

These normal changes are exaggerated and accelerated in people who have dementia, Alzheimer's and Parkinson's disease or other neurodegenerative disorders. Lifestyle diseases such as diabetes, hypertension and high or deranged lipid levels can also hasten brain degeneration. Alcohol taken in excess has a permanent degenerative affect on the brain. Women should not have more than one drink a day, and men two to prevent brain changes.

As we grow older, (especially after retirement), we tend to use less of our brain. The areas responsible for swift decision-making and mathematical calculation begin to degenerate as they are not actively used.

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There are several ways to get the best of the brain. Control diabetes, hypertension and lipids. Stop smoking and control drinking. Writing down things that need to be done in a diary or the phone will help you remember. If names are a problem, repeat a person's name several times in your head when you are introduced to them. Reading a book helps develop concentration. Even watching the news channel or scientific programmes (not serials) on television helps. Try alternating your hands. Do the things that you normally do with your right hand with the left.

Mind games like chess, scrabble and cards help to keep the brain active. Video games and computer games are good for older people as they help to develop strategy and speed up reaction time. (They are not good for children though.)

The diet should be healthy, with less oil, fat, processed flour and sugar. It should contain 4-6 helpings of fruit and vegetables. Rich coloured fruits and vegetables contain protective anti-oxidants, which help prevent cell damage and deterioration.

Scientists have now discovered that physical activity like walking, jogging, running, swimming and cycling is not only good for cardiovascular fitness it also keeps the telomeres long and undamaged. It is best if you exercise for an hour everyday and then sleep for 7-8 hours to recover, but even half an hour twice a week has benefits and is better than nothing at all!

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

Oh my foot!http://www.telegraphindia.com/1160222/jsp/knowhow/story_70544.jsp

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Your Health - Dr. Gita Mathai

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Once we start to walk, (around the age of one) most of us take around 5000 steps a day, even though the recommended number to maintain health is 10,000. This means that each of our two feet, which are comparatively small compared to our body, carries half our body weight around for at least six hours a day. In addition, the feet have to propel us forward, absorb the shocks and jolts of uneven surfaces and help maintain our balance. The force eventually exerted on the feet is actually 50 per cent greater than the body weight.

The foot has 26 small bones and 33 joints - all to each other by 120 muscles, many ligaments and an intertwining web of nerves. There is therefore a great deal of potential for things to go wrong!

Once the feet start to pain, the function of the whole body is affected. But first, it is important to analyse it. Is it a onetime phenomenon due to an acute injury like hitting a door or stepping on a rock, or is it chronic and long lasting? In either case, it is important to localise the area of the pain broadly into toes, forefoot or hind foot.

Footwear can cause and aggravate foot pain if they are ill-fitting and have hard unyielding soles. Feet (specially those of school children) are often squeezed into shoes a size too small, or may flap around in shoes a size too large. Children's feet do grow rapidly and shoes are expensive but buying the correct size will prevent long lasting damage to their feet. Adults may buy shoes that are in fashion. High heels, pointed toes and shoes too narrow for the feet with hard soles can cause corns and callouses. If feet are squeezed into narrow shoes, the front toes can develop arthritis and pain.

Pain in the feet may be due to the wear and tear of age, or part of a medical problem like rheumatoid or osteoarthritis. Obesity may increase the strain on the foot. The weight gain in pregnancy can cause pain in the feet. Diabetes can make the feet numb and cause nerve damage and shooting pains. Spinal problems, weakness and paralysis, cerebral palsy or Parkinson's disease, all of which cause changes in the gait, can alter the alignment of the joints of the foot and result in pain.

If feet pain, soak them in warm salted water for about 10 minutes. Manipulate the feet with your hands to see if the pain is relieved. Practise proper walking posture. Raise and curl the toes several times. Practise picking up a soft object with the foot. Stand up and rock heel to toe.

If the pain persists, an orthopaedic surgeon needs to be consulted. There may be obvious problems in the forefoot, like hammertoes, claw toes, ingrown toe nails, bunions, corns or callouses. It may be due to a metabolic disorder like gout or diabetes. Specific remedial treatment will cure the pain.

Pain in the midfoot is often due to flat foot. This may have been present from childhood or it may appear with increasing age and obesity. Insoles or corrective footwear will help with this.

The heel often hurts because of the Achilles tendon (the large tendon attaching the calf muscle to the heel pulling on it and causing micro fractures. There may be bursitis under the heel bone, or a bony spur may form there.

Any foot pain that does not disappear in a few days with hot soaks and OTC pain relievers requires a medical evaluation.

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