aloe vera

A magic pill? http://www.telegraphindia.com/1160613/jsp/knowhow/story_90821.jsp

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Your Health - Dr. Gita Mathai

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People are always searching for a magic pill that will miraculously cure all their diseases. Aloe vera is the latest candidate. The aloe vera plant has been around for centuries but it is only now that it is being touted as a panacea for all diseases, with anti-aging and rejuvenating properties. Ointments, cosmetics, drinks, tablets and extracts of aloe vera are all available OTC (over the counter).

Aloe vera is the name of a family of cactus-like plants with fleshy green leaves lined with spikes. Both the milk (latex), extracted from under the skin of the leaf, and its juice, obtained by splitting the fleshy leaf, contains a variety of anti-bacterial and anti-viral chemicals. It has long been used in traditional medicine but now it is being used in allopathic medicines as well.

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Applying 30 per cent aloe gel twice daily to the skin alleviates diaper rash, sunburn, dry skin, the allergic rashes, scabies and superficial burns. For haemorrhoids and anal fissures, try 0.5 per cent spray dried and powdered aloe juice ointment. To be effective, the application has to be combined with sitz baths three times daily, a diet with sufficient fibre and supplements of ispaghula husk, for three weeks. The severity of dandruff and seborrhoeic dermatitis can be reduced by using shampoos with 80-85 per cent aloe vera daily, for at least six months. Aloe vera toothpaste reduces the build up of dental plaque if used three times a day for a month. Gels reduce the pain, severity and duration of mouth ulcers.

While application of aloe vera is quite effective, eating it is more problematic. For one, effects of the consumption of aloe vera extracts have not been extensively studied. The scientific evidence is confusing. Much of the evidence is anecdotal. Children below the age of 12 as well as pregnant and lactating mothers should not consume aloe vera.

Aloe vera juice, if taken in doses of 5-15ml twice a day, lowers blood sugar. To lower lipids, take 10-20ml of aloe daily. This also decreases your hunger so you eat less. The problem is that aloe vera increases the effectiveness of diabetes medication, so blood sugar levels may dip dangerously.

Chemicals called anthraquinone glycosides, present in aloe vera, act as a laxative. The recommended dose is 0.04-0.17 grams of dried juice. If consumed in higher than recommended doses, or in the non-decolourised form, there can be abdominal pain, cramps and diarrhoea. The liver can get damaged. Consumption of the whole leaf extract is can cause cancer in animals.

For heart disease, take a 120 ml dose of a solution containing 1,200 mg of aloe vera. It increases the effectiveness of any cardiac drug, so it can result in arrhythmias.

So think deeply and work out all ramifications before you decide to take aloe vera as a herbal supplement.

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

cystitis

Your Health - Dr. Gita Mathai

http://www.telegraphindia.com/1160606/jsp/knowhow/story_89487.jsp

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Sometimes, without warning, people (mainly women) develop a burning sensation while urinating and a heaviness in the lower abdomen. They have to run to the toilet frequently but pass small quantities of high coloured or blood stained urine. They may or may not have fever. The agony is apparently indescribable! In children, the symptoms may be subtle - with vomiting or sudden loss of bladder control.

These are the classical symptoms of cystitis, the medical term for inflammation of the urinary bladder. Cystitis is usually due to a bacterial infection. It is annoying and debilitating, and can become a serious problem if the infection ascends from the bladder to the kidneys.

All cystitis is not due to infection. It may be a complication of another illness, such as catheterisation or radiation treatment for cancer. It may be due to allergy to feminine hygiene sprays, harsh soap or some other chemicals used on the private parts.

Women are more prone to UTIs than men. Around 85 per cent of medical consultations by women are for UTI or related symptoms. By the age of 30, 30 per cent of women and in a lifetime, 50 per cent will experience at least one episode of UTI. Young men are 30 times less prone to infection than women. The disparity is due to the shorter length of the female urethra, its proximity to the anus, and hormonal changes that occur with pregnancy and menopause.

A thorough examination should be done if UTI is suspected. This includes a general check up and a pelvic examination. In men, an enlarged prostate can cause an impediment to the free flow of urine. In women it can be fibroids or some other growth in the uterus and ovaries. In both sexes, stones in the urinary tract (kidney, ureter, bladder) can be responsible for obstruction. People who are catheterised, have diabetes, are on steroids or are immune-compromised are prone to UTI. These conditions need to be treated for the UTI to respond to treatment.

In addition, the urine needs to be examined and cultured so that the choice of antibiotics is appropriate. Pelvic ultrasound scans, X-rays, CT scans and MRIs may be needed. Sometimes the inside of the bladder may need to be visualised using a scope.

Most UTIs are caused by a bacteria called Escherichia coli. It has little protrusions called pili with which it attaches itself firmly to the bladder wall. Initially, E.coli were responsive to treatment. Taking mild antibiotics for only three days was sufficient to cure it. Now stronger antibiotics may need to be used as the organism has become resilient and resistant. The duration of therapy also has to be seven or 14 days. It is important to follow your physician's advice about the choice of antibiotic and the length of treatment. A medicine that worked for one individual may not be suitable for another. Even if UTIs are recurrent, self-treatment with OTC (over the counter) drugs should be avoided.

Drinking cranberry juice regularly has shown some benefit in UTI. This is because it contains active natural chemicals like condensed tannins and proanthocyanidins, which prevent E.coli and other bacteria from attaching themselves to the bladder wall.

To prevent UTI

♦ Drink 2.5 -3 litres of water a day depending on the climate and the level of physical activity. Do not wait for thirst to develop.

♦ Lean backwards (women) while passing urine.

♦ Clean the area after passing motion from front to back. This is very important in children.

♦ Pass urine before and after intercourse.

♦ Gently wash the skin in the genital area with a mild soap. Do not use perfumes and sprays.
 

Dr Gita Mathai is a paediatrician with a family practice at Vellore and author of Staying Healthy in Modern India. If you have any questions on health issues please write toyourhealthgm@yahoo.co.in

skin infections

http://www.telegraphindia.com/1160516/jsp/knowhow/story_85807.jsp

Skin scourge

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Your Health - Dr. Gita Mathai

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Summer means hot, sweaty days, and, with this year's drought and water shortage, baths are almost a luxury. As the sweat stays on the body in areas unexposed to air, such as the folds of the groin, armpits and under the breasts, the warm moist environment can cause fungus to grow and flourish.

Candida (a fungus) thrives in these areas, especially in individuals who are overweight, diabetic, on antibiotics or steroids, have hypothyroidism or deficiencies of iron or zinc. It is aggravated by friction between the clothes and skin, especially if the clothes are tight fitting and synthetic. Infection can produce itching that is uncontrollable and embarrassing. Eventually, the areas can become discoloured and flaky.

Children can develop candida as a diaper rash on the groin and buttocks. It is common when wet underclothes or cloth diapers are not changed frequently. They can also develop it in the mouth, especially if they are bottle-fed or use pacifiers.

Infection with a fungus of the Malassezia family causes Tinea versicolor, which produces light or reddish patches on the skin of the trunk, chest and, sometimes, upper arms This fungus lives symbiotically on almost everyone's skin. When the environment is ideal, or immunity compromised (diabetes, medication, HIV infection), the fungus invades the superficial layers of the skin. It is highly contagious and spreads rapidly if there is close contact and sharing of towels and clothing.

"Ring worm" is another fungus infection common in children and teenagers. The spores can remain inactive in the soil for months on end. Animals can also be affected. The infection can spread from animals to humans. It causes itchy, raised, red, scaly patches. When it affects the head, the hair falls off in circular patches leaving bald areas.

The areas between the toes of the feet and the fingers of the hands can develop a fungal infection called "Athlete's Foot" in people whose hands and feet are immersed in water for long periods of time. Different types of fungi cause these infections.

The nails of the fingers and toes can be affected by fungus, making them brittle, dark and distorted.

A dermatologist can make a diagnosis of fungal infections by scraping off a small, infected area and examining it under a microscope.

Superficial fungal skin infections heal if the area is kept dry and anti-fungal creams (single ingredient) applied twice or thrice a day. Anti-histamines will relieve the itching. The response is faster, better and permanent if the precipitating factors are removed.

In children, pacifiers should be avoided. Bottles should not be left in the mouth all night. As far as possible, a cup and spoon should be used for feeding. Diapers should be changed regularly or disposable diapers with "Dri" technology should be used. In adults, precipitating factors such as iron and zinc deficiency, diabetes and obesity should be tackled.

Sometimes for a rapid response, a combination cream with steroids and anti-fungal medication is used. The symptoms return once the cream is stopped. This is because fungal infections thrive in the presence of consumed or applied steroids. Anti-fungal tablets may need to be taken for 1-12 months to cure infections of the nail and hair.

Dr Gita Mathai is a paediatrician with a family practice at Vellore and author of Staying Healthy in Modern India. Questions on health issues may be emailed to her atyourhealthgm@yahoo.co.in

bone health

Bare bones truth

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Your Health - Dr. Gita Mathai

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We take our bones for granted, even though without them we would be masses of protoplasm wobbling along like amoebae. Bones help us to maintain our form, figure, balance and locomotion. If we do not take care then our bones weaken with age. Posture and balance are affected and eventually falls and fractures occur. In India, in the population over the age of 60, 50 per cent have fallen in the last six months and 25 per cent of these falls have resulted in fractures.

In the previous era, fractures were not as frequent. The life expectancy was around 40, so death was more likely than a fracture. Pan chewing was rampant. The lime in the pan provided bone-strengthening calcium. People walked for long distances in the sun, receiving vitamin D and developing strong bones. Many practised yoga.

Yoga actually places pressure on the bone. As it is practised, agonistic and antagonistic muscles pull against each other. This strengthens the bones. As a bonus, posture, balance, coordination, the range of motion, flexibility and gait improve. This reduces the chances of falls and fractures.

The nine yoga poses (English names) found to be most helpful are tree, triangle, warrior II, side-angle, twisted triangle, eagle, locust, bridge, straight-legged twist, and bent-knee twist.

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Calcium is needed for strong bones. The requirements are 800 milligram (mg) a day from ages 4-8 and 1300mg a day after the age of nine. Calcium is absorbed and utilised when sufficient concentrations of the "sunshine vitamin" D is available. Children from one to 18 need 800 International Units (IU) of vitamin D daily. Adults require 1000-1200 IU daily. Very few people expose their skin to sufficient sunshine to get this amount naturally.

Just consuming the recommended amount of calcium and vitamin D is not enough. Stress has to be placed on the bones for the calcium to enter the matrix. Weight bearing and muscle strengthening activities have to be performed regularly. Walking, running, jogging, stair climbing, dancing, or sports such as basketball, tennis and badminton are excellent. Swimming improves overall fitness, but does not improve bone strength.

If you are strapped for time, the most efficient exercise for bones is 40 jumps overall, or 20 hops on each leg. This will also help coordination and balance. Please make sure that you wear supportive footwear.

The maximum bone development occurs in childhood and adolescence. It is important that children and teenagers spend an hour a day doing physical activity to balance time spent in front of the computer or television. If their diet is inadequate in calcium and vitamin D, supplements can be given. Poor bone development at this crucial stage in life will result in diminished bone density, early bone loss and increased risk of fractures in later life.

The risk of osteoporosis is increased:

• In older persons, particularly women

• In both sexes if they are inactive

• If you have a BMI (weight divided by height in metre squared) less than 19

• If there is a history of osteoporosis and fractures in the family

• If you smoke or are exposed to second hand smoke

• If you have more than two pegs of alcohol a day

• If you are on steroid medications

• If you have had gastric or weight loss surgery

• If you suffer from Coeliac disease or Crohn's disease

Many of these factors cannot be avoided, but you can lessen their impact with regular exercise and calcium and vitamin D supplements.

Dr Gita Mathai is a paediatrician with a family practice at Vellore and author of Staying Healthy in Modern India. Questions on health issues may be emailed to her at yourhealthgm@yahoo.co.in

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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