KNOW YOUR WEIGHT

Obesity is now considered as a "killer" lifestyle disease and has become the second leading cause of preventable deaths. It has become a disease that needs as much medical attention as any other health condition.

Obesity has become a widespread health problem across the globe. Severe obesity threatens one’s health and affects lifespan too. It also leads to development of life-threatening complications such as high blood pressure and Type 2 Diabetes.

In the Indian scene, even with the growing awareness about health and fitness, more than two per cent of the population is obese. Each year, this number is growing especially in urban areas due to changing lifestyles.
Causative factors

Environmental factors play an important role in the prevalence of this condition. Our increasing dependence on elevators and escalators, long hours at the computer, watching television, consumption of high calorie food sets the ground for the development of obesity.

Obese people develop complex and multi faceted problems such as discrimination at workplace, school and home;

Finding clothing, furniture incapacity in public places, bus, plane and personal hygiene. Depression rates are among the highest in the obese. Health risks like high blood pressure, diabetes mellitus, elevated cholesterol, arthritis, sleep apnea, gall stones, stroke, heart attack, are closely associated with obesity and lead to further complications.
Treatment

A simple calculation called Body Mass Index or BMI is used to classify the people as underweight, normal, overweight, obese and morbidly obese. BMI is calculated by dividing weight in kg by height in metres squared.

There are two accepted methods to treat obesity: Medical or Surgical. The first involves a diet low in calories, fat and carbohydrates; exercise of 40 minutes five times per week; behaviour modification, which involves eating three sensible meals a day and avoiding snacking. Additionally drugs like stimulants, appetite suppressants, antidepressants and medication to reduce fat absorption are prescribed. The disadvantages of this method is that most patients regain much of the lost weight and the average amount of weight loss is relatively small. Drug therapy may also be associated with side-effects and it is very difficult for most to maintain the programmes in the long term.
Surgery

According to National Institutes of Health (NIH), since many obese people can’t shed weight with diet and exercise alone, Bariatric Surgery has proven to be the most effective method to treat obesity. This can improve the person’s quality of life in many ways since significant amounts of weight is lost making the person more active. It also reduces the life threatening risk factors associated with obesity. Improving self-esteem gradually opens the doors for better work opportunities, friendships and relationships.

Patients with a BMI of 40 or greater who also suffer from severe medical conditions related to obesity (sleep apnea, diabetes, heart failure, high blood pressure) are the ones who can opt for bariatric surgery. Such patients must be willing to commit to the lifestyle changes that have to follow the surgery.

Patients with a history of substance abuse, eating disorder, or psychiatric problems; those who are too ill or women who may become pregnant within two years are not eligible for surgery.

CHRONIC OBSTRUCTIVE PULMONARY DISEASES

Almost every one knows that outdoor air pollution can damage one’s health and lungs in particular. But not many people are aware about indoor air pollution.

Your house, your office, school or college and your work environment, shops and restaurants all contribute in their own small way.

In other words about 80 per cent of our time is spent indoors without knowing that we are damaging our health.

Poor indoor air quality has been linked to lung diseases like allergic rhinitis, sinusitis, asthma, Chronic Obstructive Pulmonary diseases (COPD) and lung cancer. People who already have asthma and smoking-induced bronchitis suffer the most. Old people who are constantly indoors can also get pollution-related lung diseases. The following FAQs will throw some light on the indoor air pollution.

What is ventilation?

Entry of air into the house is ventilation. Air can enter the house in many ways: natural ventilation when we open the doors or windows or by infiltration through the cracks in the walls, floors or ceilings or through exhaust fans or air conditioners.

What do they cause?

These pollutants cause dry throat and cough in a very slow manner. One may forget that indoor air pollution may be the cause. Most of the unexplained cough or cough variant asthma result from these causes.

Whom does it affect the most?

Children seem to be more sensitive than adults. They are more sensitive to tobacco smoke while women suffer silently. Patients who are allergic to mites or moulds suffer most when they enter a room that has carpets, curtains and air conditioners. The effect can start in the womb if the mother or father smokes.

Is it possible to control indoor air quality?

Levels of outdoor pollution are measured although little action is taken from any one. Some countries have set guidelines for indoor air quality but setting them in India will be difficult. For example in a multi-storeyed residential complex one does not worry about petrol pollution, but the vehicle exhaust enters homes thanks to basement car parks!

Self-discipline, individual choice and control over what we use in our homes and how we ventilate them is the only way out. It is hard to control, check, establish and maintain good levels of air quality in schools, offices, shops and restaurants. However we can be aware of the risks and make an effort to reduce them. Only individual effort, not law, can make the earth pollution free.

WHEN YOUR WORLD SPINS

Vertigo, or dizziness, is a symptom, not a disease. The term vertigo refers to the sensation of spinning or whirling that occurs when balance (equilibrium) is disturbed. It also may be used to describe feelings of dizziness, light-headedness, faintne ss, and unsteadiness. The sensation of movement is called subjective vertigo and the perception of movement in surrounding objects is called objective vertigo.

Severe vertigo can be disabling and may result in complications such as irritability, loss of self-esteem, depression, and injuries from falls. Falls are the leading cause of serious injury in people over the age of 65.
Causes

Benign paroxysmal positional vertigo occurs when debris made up of calcium carbonate and protein (called otoliths or ear crystals) builds up in and damages the inner ear. Inner ear degeneration (usually occurs in elderly patients), head trauma, and inner ear infection (e.g., otitis media, labyrinthitis) can cause BPPV.

Some medications and environmental chemicals (lead, mercury, tin) can cause ototoxicity (ear poisoning), which may result in damage to the inner ear or the eighth cranial nerve (acoustic nerve) and cause vertigo. The damage can be permanent or temporary. Long-term use or high doses of certain antibiotics and antineoplastics can cause permanent ototoxicity.

Central vestibular disorders that may cause vertigo include the following: Cardiovascular disorders (bradycardia or slowed heart rate, tachycardia or rapid heart rate); Central nervous system (CNS) disorders like stroke or brain haemorrhage); Head trauma; Migraine; Multiple sclerosis (MS may occur when demyelination affects the brainstem or cerebellum).

It is important to diagnose the cause of vertigo, or dizziness quickly to rule out serious conditions such as cardiovascular disease, stroke, haemorrhage, or tumour. Diagnosis includes clinical history, physical and neurological examination, blood tests, and imaging tests (e.g., CT scan, MRI scan). The physician also needs to consider what triggers the vertigo; other symptoms; duration of dizziness and what improves or worsens symptoms.
Diagnosis

There are five cardinal steps in the approach to a patient with vertigo. The first is to identify whether it is true or false vertigo. True vertigo is the spinning sensation or sense of rotation that persists even when the patient lies down. On the contrary false vertigo remits on lying posture. The next step is to find out whether the reason for vertigo lies in the eye, ears, or neck. The third is to identify whether the vertigo is central or peripheral. The next step is to find the aetiology of vertigo. The last is to investigate the patient for causes. The main things to look for are raised blood sugar, raised blood pressure, elevated triglycerides and cholesterol and hypothyroidism. One should also look for upper and lower respiratory infections, gastrointestinal infections, diet, and drugs.

Treatment depends on identifying and eliminating the underlying cause. If a particular medication is responsible for the condition, lowering the dosage or discontinuing the drug may eliminate vertigo.

Vestibular Rehabilitation Therapy (VRT) aims to minimise dizziness, improve balance, and prevent falls by restoring the normal function of the vestibular system. The patient performs exercises designed to allow the brain to adapt to and compensate for whatever is causing the vertigo. The success depends on several factors including patient’s age and overall health; cognitive function; coordination and motor skills; physical strength. As the patient progresses, difficulty of the exercises increases until the highest level of balance is attained.

Ear infections caused by bacteria may be treated using antibiotics. Myringotomy is a surgical procedure that may be used to treat chronic ear infections. In this procedure, which is performed under anesthesia, an incision is made in the eardrum and a small tube is placed in the opening to prevent fluid and bacteria from building up inside the ear.

Benign paroxysmal positional vertigo may be treated with meclizine, an oral anti-emetic that can be taken up to thrice a day, or as needed. But it may cause drowsiness, dry mouth, and blurred vision. If this is ineffective, benzodiazepines or antihistamines may be prescribed. But these have side effects like drowsiness, lack of coordination, fatigue, and tremors.

Ménière’s disease may be treated by reducing salt intake and with diuretics. A short, tapered course of corticosteroids may be prescribed in the early stages to reduce inflammation and stabilise hearing. Antibiotics may be administered into the middle ear to treat severe vertigo caused by this disease.

Vertigo caused by migraine can often be treated with medication. Strokes, tumours, and multiple sclerosis may require treatment with medication, radiation, or surgery.
Prognosis

Prognosis depends on the cause and how well the underlying condition responds to treatment. Severe vertigo can be permanently disabling, especially in elderly patients. Peripheral vestibular disorders may cause progressive hearing loss. It is intellectually a lazy approach to do MRI or CT in every case as it is not justified in all cases. In clinical neurology, a good history and a thorough neurological examination are the two most important diagnostic tools.



Some patients describe a feeling of being pulled down or toward one side. Moving the head, changing position, and turning while lying down often worsen vertigo.The sudden onset of vertigo usually indicates a peripheral vestibular disorder (e.g., BPPV, Ménière disease, vestibular neuritis).

Peripheral vestibular disorders may also cause blurred vision; fatigue and reduced stamina; headache; palpitations; imbalance; inability to concentrate; increased risk for motion sickness; muscle ache (especially of the neck and back); nausea and vomiting; reduced cognitive function; sensitivity to bright lights and noise; sweating.

Vertigo caused by a central vestibular disorder usually develops gradually. In addition to vertigo, central vestibular disorders may cause symptoms like double vision (diplopia), headache (may be severe), impaired consciousness, inability to speak due to muscle impairment (dysarthria), lack of coordination, nausea and vomiting and weakness.



Vertigo is usually the result of a disorder in the vestibular system (structures of the inner ear, the vestibular nerve, brainstem, and cerebellum).

The vestibular system is responsible for integrating sensory stimuli and movement and for keeping objects in visual focus as the body moves. When the head moves, signals are transmitted to the labyrinth, an apparatus in the inner ear made up of three semicircular canals surrounded by fluid.

The labyrinth transmits movement information to the vestibular nerve, which carries the information to the brainstem and cerebellum (that control balance, posture, and motor coordination).

WHAT ARE PROBIOTICS?

Time for breakfast? Help yourself to a plate of hot steaming idlis, dosas or uttappams and dahi. These are not only nutritious but are safe, highly acceptable and packed with health benefits that are both protect ive and therapeutic against a wide range of disorders. They are all fermented foods i.e. they are subjected to the action of micro-organisms for a few hours causing desirable alterations in food quality. The process also preserves and predigests the food.

The bacteria that cause these changes are called "Probiotic bacteria". They are not destroyed by the acid in the stomach or by the enzymes in the intestinal tract.


Normally bacteria are considered harmful; but probiotic are good ones responsible for a variety of health benefits. Probiotics and probiotic foods have been used both as therapeutic and preventive supplements for many ailments including GI disturbances and cancers.

The two most recognised ones are lactobacillus and bifidobacteria. The probiotic bacteria found in yogurt belong to the streptococcus and the lactobacillus strains.

Those food ingredients that can promote the growth of probiotics are referred to as "prebiotics". These are not digested by the intestinal tract but stimulate the activity and growth of selective beneficial bacteria in the colon. Cereals like wheat, pulses including soya, onion, garlic, leek, banana and even tomatoes are prebiotics.

A food that is both prebiotic and probiotic is called "synbiotic". This combination can have a beneficial effect on the host by increasing the survival of the probiotics in the intestinal tract.

India probably has the most diverse variety of fermented foods — Idli, Dosa, Dhokla, Khaman, Batura, Kulcha and the traditional dahi. The commonest probiotic foods are fermented dairy products such as yogurt and buttermilk. Sauerkraut or pickled cabbage is an example of a fermented food widely consumed in the West.

Our digestive system contains many millions of bacteria. In a normal intestine there are some 500 different species. They are important for many health functions including those concerned with the digestive system and immunity.


These are mainly the good bacteria and there is a balance between the desirable and the pathogenic bacteria. However, use of antibiotics, a poor diet, alcohol, stress and other reasons can reduce the healthy bacteria and upset this balance.

An adequate intake of probiotic foods helps the desirable bacteria colonise the colon. Antibiotics are the biggest culprit, killing both the probiotic and the disease-causing bacteria. This is why a doctor recommends curds or probiotic supplements with antibiotic treatment.

Probiotics are involved in synthesising and enhancing the bioavailability of some nutrients.
Nutritional benefits

Fermenting the foods produces certain nutrients like an increase in the Bcomplex (folic acid and vitamin B12) and vitamin K. Probiotics also produce short-chain fatty acids, an important energy source for the colon. Some amino acids, growth factors, antioxidants and antimicrobial factors are also produced. Fermentation also destroys certain anti-nutrients like phytates and oxalates that interfere with the absorption of minerals like iron and calcium.

People with lactose intolerance are unable to digest lactose, the milk sugar, leading to bloating, flatulence and abdominal pain and diarrhoea. Consumption of fermented dairy products such as dahi and lassi helps in such cases because the bacteria produce the enzymes necessary to break down lactose. Probiotics also reduce intolerance symptoms such as diarrhoea.

Fermented foods, especially dairy foods, contain certain strains of bacteria that promote the health of the gastrointestinal tract. Prebiotics have also been studied for their beneficial gastrointestinal effects. A synbiotic combination is the best.

Probiotic bacteria prevent the proliferation of the pathogenic (disease-causing) micro-organisms in the gastrointestinal tract. When are ingested orally, such as through fermented foods, they produce antibiotic substances in the intestine, which can destroy the pathogens and also deprive pathogens of nutrients necessary for their growth. Probiotics can also enhance the immunity to microbial pathogens and thus exclude pathogens from the gut.

The microbes in most fermented foods are sensitive to heat and are destroyed by pasteurisation or processing. Some may be destroyed when cooked, which means that when you make idli or dosa it may not necessarily contain all the probiotic organisms originally present in the batter. A cup of yogurt will contain more live beneficial microflora than a cooked fermented product. Fermented dairy products are, therefore, a preferred delivery vehicle for probiotics.

Today probiotics are available as dietary supplements and are used to prevent and treat certain illnesses and also support good health. They provide higher levels of the beneficial bacteria than fermented foods.

Routine therapeutic interventions with probiotic strains may well become a reality soon. It is, however, wise to take them only under the guidance of a doctor. In the meantime go ahead with the fermented foods. They are totally safe and you can have them as much as you can. The fresher the product, the higher the count of good bacteria.

Are probiotic supplements safe? In most cases, yes. In some rare cases, a few side effects such as bloating of the stomach have been reported. However they are not recommended for persons with low immune status, premature infants or neonates.
Other benefits

There is enough evidence to show that administration of selected micro-organisms like lactobacillus is beneficial both in the prevention and treatment of certain intestinal and, perhaps vaginal, infections.

Probiotics may help reduce risk of rotavirus-induced diarrhoea and diarrhoea associated with intake of antibiotics and help treat infantile and, to a smaller extent, adult gastroenteritis.

They may be useful in treating constipation; specific strains of Lactobacilli may suppress the growth of and displace Helicobacter Pylori, which is associated with peptic ulcers.

Some studies suggest that prebiotics improve calcium and magnesium absorption from the human intestine. This may be associated with a change in peak bone density and mineral bone mass and a reduction in osteoporosis. Probiotics are useful in treating food allergy and inflammatory bowel diseases such as ulcerative colitis and Crohn’s disease.

Some probiotic bacteria can break the milk protein casein into smaller units and provide relief from allergic manifestations such as intestinal inflammation. They may also prevent and possibly treat allergic conditions like eczema and allergic dermatitis.

Studies on infants have shown probiotic bacteria help increase Immunoglubulin (compounds that confer the ability to fight infections) levels.

Fermentation of milk is reported to produce certain peptides (chains of amino acids) that inhibit an enzyme which tends to increase blood pressure. Studies on humans indicate that fermented milk could help lower blood pressure when used on a daily basis.


Although the evidence is weak, some studies have reported a modest reduction in cholesterol levels after consumption of fermented milk products for two to four weeks.

Animal experiments have shown that probiotic bacteria reduce the risk of colon cancer. Some epidemiological studies suggest that consumption of fermented dairy products may have some protective effect against cancer of the large colon. Regular consumption of thayir sadam may be a simple way to lower the incidence of colon tumours.

Probiotics may be useful in preventing alcohol-induced liver damage, a common condition in many societies. Studies from Johns Hopkins Hospital in the United States suggest that orally administered probiotics could be superior to the conventional therapy in the treatment of hepatic encephalopathy, a common and dreaded complication of liver disease.