Monthly Archives: March 2016

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Protect your spine

By |March 9th, 2016|General|

The spine is an anatomical design marvel. It is a string of 33 vertebrae, or bony blocks held together by ligaments and tendons and supported by large muscles. The spine encases and protects the spinal cord and the nerve roots to safely relay messages to and from the brain to various parts of the body. The spine’s design allows for flexibility, strength and mobility across planes, and lets us go through our everyday lives without giving much thought to it. Till our spinal health takes a blow.

The spine most often makes its presence felt when the large nerve roots that go to the legs and arms get irritated (this condition is called sciatica). Or when the smaller nerves that innervate, or connect to, the spine get irritated. Or when the back muscles get strained, or the bones, ligaments or joints are injured. Finally, the discs, or the gel-filled cushions between the 33 bony blocks, can slip out of alignment, pressing against the nerve, causing pain—this is called a slipped or herniated disc.

Spinal health problems are on the rise in India’s metropolises. Rajeev K. Sharma, senior consultant (orthopaedics) and joint replacement surgeon at the Apollo Hospital in Delhi, says over the phone: “Over the last decade, the number of people coming in with spinal health problems has gone up three-fourfold. What is particularly disheartening is to see young people in their 20s and 30s with spinal injuries. I first blame work-related stress and the complete lack of exercise. The condition of the roads in cities makes spinal injury inevitable.”

Stress and lack of exercise make the spine vulnerable. And travelling on poor, potholed roads leads to injury. Satish Chandra, chief scientist and head of the National Aeronautical Laboratory’s structural technologies division in Bengaluru, conducted a study last year that showed as much. He runs a lab filled with aerospace engineers who work on aircraft crash safety. His scientists do crash-and-impact tests on aircraft using computer simulation and other equipment. “We realized that we had all this equipment we could use for other purposes. And a basic question that interested us was how damaging to our spines are the roads in Bengaluru?” he says over the phone.

For the study, a seat-pad accelerometer and a 65kg dummy was placed over a sensor that measured the forces acting on the back. An autorickshaw and a car were driven at 25km per hour, which is the speed at which a motorist would drive after spotting a speed breaker or a pothole. Chandra says the study results, which are yet to be published, showed that it took 40 speed breakers or 200 potholes in a car for the spine to be stressed, or become vulnerable. In an autorickshaw, six speed breakers or potholes were sufficient to cause the same amount of distress. “If you are driving over 20 potholes a day in a car, after a while you are likely to have spinal injury. What can help prevent some spinal injuries is wearing a seat belt. We have designed a seat belt that can be retrofitted on an autorickshaw,” says Chandra.

You can also take steps to strengthen your back. One, regular exercise is important. “Just start walking every day, if nothing else. You can follow that up with back-strengthening exercises in the gym or yogic poses,” says Dr Sharma.

Two, stress management is key—a lot of the physical pain people experience is precipitated by stress. Yogic breathing exercises can calm the mind. “The traditional Surya Namaskar is a no-no for people with back problems. (But) there are several yoga poses that are extremely beneficial for the spine,” says Namrata Sudhindra, a yoga instructor in Bengaluru. “It is best to learn the right ones from a trained yoga teacher,” she adds. Meditation too is useful as it has been scientifically proven to reduce blood pressure and heart rate and make the brain waves more coherent—all indications that stress is being kept in check.

Three, a study by Anoop Mattam and George Sunny from Bengaluru’s St John’s Medical College, published in theAsian Spine Journal in February, found a correlation between vitamin D deficiency and lower back pain. Research has found that 60-80% of Indian adults are vitamin D deficient.

While correlation doesn’t imply causation, other studies have reported a similar correlation too. So if you have lower back pain, it may be worthwhile to get your vitamin D levels checked.

Sujata Kelkar Shetty, PhD, is a wellness expert and a certified life coach. She has formerly worked as a clinical scientist at the National Institutes of Health in Bethesda, US.

Demystifying the pause

By |March 9th, 2016|General|

In 2000, when Radhika* turned 42, she found herself feeling uneasy and more fatigued than usual. There were sudden spells when she would feel so hot that regardless of the temperature outside, she would be drenched in her own sweat. Apart from the physical symptoms, she found that she was also feeling less positive than usual.


Therapeutic:
Try yoga and breathing exercises

She was able to recognize that she was going through menopause because there’s a lot of information available on it in the public domain in Singapore, where she lived and worked. She consulted a doctor, started regular exercise and found that yoga and breathing exercises were helpful in the transition.
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Sujata Kelkar Shetty, PhD, writes on public health issues
and is a research scientist trained at the National Institutes of
Health in Bethesda, US.

Rise, gentlemen

By |March 9th, 2016|General|

Ram Sadhwani* is a banker in his late 40s who spends at least two-three days a week travelling. His long hours at work and travel have had a negative impact on his marital life. A few months ago, while on a short vacation with his wife, Sadhwani found he couldn’t keep an erection firm enough for making love. His wife assured him the situation would resolve itself—after all it had been a while since they had had sex. But when the problem persisted, she suggested they visit a doctor.

The couple’s family doctor suggested he consult an endocrinologist for tests. The endocrinologist asked him to fill out a short questionnaire recommended by the International Index of Erectile Function (IIEF). Sadhwani’s blood was tested for sex hormones, sugar, HDL (high-density lipoprotein), LDL (low-density lipoprotein) and triglyceride levels.

The doctor found his lipid profile to be on the higher side. Higher lipid profiles can lead to heart disease so, as a preventive measure, Sadhwani was prescribed 45-60 minutes of daily exercise and a diet low in fat and rich in fresh fruits and vegetables. He was also prescribed medication to help sustain an erection. In nine months, Sadhwani’s lipid profile was back in a heart-healthy zone and he no longer needed to take the medication.

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Sujata Kelkar Shetty, PhD, writes on public health issues
and is a research scientist trained at the National Institutes of
Health in Bethesda, US

When a cough can turn dangerous

By |March 9th, 2016|General|

Rajinder Singh has been Delhi-based entrepreneur Vinay Gupta’s driver for 20-odd years. He drives him to the office every day, takes care of his dry-cleaning and even replaces the cook on Sundays when Gupta takes his wife and children to their farmhouse in Gurgaon. A little over a year ago, Singh asked for sick leave—he had been suffering from a cough, fever and night sweats that left him drenched for a few days. When his symptoms persisted for two weeks, Gupta’s wife took him to their family doctor. An X-ray and saliva sample showed Singh had tuberculosis (TB). He was immediately put on a six-month course of antibiotics.

Gupta’s doctor advised him to get his daughters, both less than six years old, tested for TB. Adults are not tested unless they show symptoms.

The girls were not infected. Gupta and his wife were advised to watch for the symptoms, though the doctor didn’t expect the children to get the disease since they were both in excellent health.

Vivek Nangia, head of department of pulmonology at Fortis Healthcare, Vasant Kunj, New Delhi, says: “I have seen similar cases and the best thing is to get medical-check ups of the domestic staff done regularly. In case of a persistent cough accompanied with fever and night sweats, it’s best to consult a physician immediately.”
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Sujata Kelkar Shetty, PhD, writes on public health issues
and is a research scientist trained at the National Institutes of
Health in Bethesda, US.

The metabolic monster

By |March 9th, 2016|General|

Arjun Sharma is an IT professional in his mid-40s, working in Bangalore. He used to play squash and tennis but in the last few years the long hours at work have made it difficult for him to play a sport regularly. In the last five years he had put on 20kg, and his wife insisted he get a full medical check-up in December.

His medical reports showed his blood sugar levels were too high, the HDL (high-density lipoprotein or good cholesterol) levels were too low and the triglycerides were too high. The doctor diagnosed him with Metabolic Syndrome and said he was in danger of developing diabetes and/or cardiovascular heart disease if he didn’t lose at least 20kg. Sharma, who weighed 85kg, immediately joined a gym and started working out regularly for an hour every day. He also started eating home-cooked food so he could have a healthy diet low in fat and rich in fresh vegetables. In a year he lost over 15kg and his blood report after the weight loss showed blood sugar, HDL and triglyceride levels were normal. The doctor told him he should get his blood test done every year, but as long as he stayed on course with his exercise and diet, and didn’t regain the weight, there should be no cause for concern.
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Sujata Kelkar Shetty, PhD, writes on public health issues
and is a research scientist trained at the National Institutes of
Health in Bethesda, US.

A micronutrient deficit

By |March 9th, 2016|General|

In her address to Parliament in June, President Pratibha Patil spoke of the enactment of a new law, the National Food Security Act. She said: “Every family below the poverty line in rural as well as urban areas will be entitled, by law, to 25kg of rice or wheat per month at Rs3 per kg.” Given that at least 440 million people in India still live on less than $1 a day, food security is a very important concern. Even more pressing, though, is nutritional security since that impacts our future, our children.
India has the unusual advantage of being one of the youngest countries in the world. In 2000, one-third of our population was under the age of 15 years and by 2020, the average Indian will be only 29 years old. This unique age structure provides us with a demographic dividend that distinguished scholars David Bloom and David Canning argue is conducive to economic growth. However, it will serve us well to remember Bloom and Canning’s caution that “both empirically and theoretically there is nothing automatic about the link from demographic change to economic growth. Age distribution changes merely create the potential for economic growth. Whether or not this potential is captured depends on the policy environment”.
Unfortunately, our policy environment in the area of child health is seriously lacking the initiative necessary to ensure that our children grow in a nutritionally sufficient environment. In children, maximal development of cognitive, social, emotional, physical/motor skills takes place during the years 0-6, and a lack of sufficient nutrition during these years can seriously impact basic skills. Impaired skills in childhood can stunt physical and mental development permanently, making for a young person who is unable to study and work at his or her best capacity. Insufficient nutrition is a combination of a macronutrient and a micronutrient deficit in the diet. Conceptually, the first refers to the total calories or more specifically the carbohydrates, fats and protein in the diet, while the second refers to the essential vitamins and minerals such as vitamin A, zinc and iron. Deficiencies in both can permanently stunt the height, brain development and immune functioning.
We have seen success stories in our battle against malnutrition when the government has shown a commitment to change. One such case is the Marathwada Initiative, launched in March 2002, in eight districts of Aurangabad division. The programme was implemented after 14 children under the age of 6 died from malnutrition in 2000-01 in the village of Bhadhali of Aurangabad district. The anti-malnourishment campaign relied on the infrastructure of the existing Integrated Child Development Services (ICDS) scheme and worked on training and motivating the staff on a regular basis. In just two years, the initiative resulted in the number of children with severe malnutrition going down by 62%. This showed that with no additional budgetary support or no additional staff recruitment by the government, significant change was possible. So the existing government framework can make a difference when local workable solutions are employed and the staff is trained and motivated.
The Copenhagen Consensus 2008, a list of solutions for global challenges created by a panel of leading international economists including five Nobel laureates, identified alleviating micronutrient malnutrition in developing countries as the best development investment. And according to the India Micronutrient National Investment Plan (IMNIP) for 2007-11, an additional investment of just Rs5.40 per capita per year can make the difference. Meanwhile, if we sit back and do nothing, the cost to our gross domestic product from micronutrient deficiencies will be Rs284 per capita, or 50 times more. So a combination of judicious government spending on micronutrient malnutrition while using the existing government framework as a platform could be the answer to removing malnutrition, a public health issue, and a serious threat to our nation’s future.
Sujata Kelkar Shetty was a postdoctoral fellow at the National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), USA. Comment at otherviews@livemint.com

Loving The Wheat Free Life

By |March 9th, 2016|General|

In January, I decided to try a new diet. My energy levels had been on the lower side for some time, and my mind felt sluggish. I needed to do something, but my annual health check-up had found no underlying illness, thyroid fluctuation, or vitamin D deficiency.

There was nothing there to explain my consistent state of brain fog and tiredness. I joked with my friends that I had premature Alzheimer’s disease. I am a hands-on mother of two boys and a health columnist and consultant with a decent (though hardly hectic) social life. Was this fatigue just a result of the normal demands of my life? But I eat mostly healthy food, drink enough water, take multi-vitamins, barely drink alcohol, work out five times a week, do yoga twice a week, and get about 7 hours of sleep on most nights.

I felt I deserved a more energetic body, and a livelier brain for all that effort. I searched the Internet, and that’s where I first came across the wheat-elimination diet. As the phrase suggests, this is a diet free of all wheat-containing foods—no biscuits, cakes, breads, pastas, rotis or puris. Wheat is also found in a range of processed foods and sauces like ice creams, cake mixes, soy sauce and batter-fried foods and stabilizers that are often found in store-bought masalas.

The diet sounded really hard. But the literature was intriguing. David Perlmutter’s book, Grain Brain: The Surprising Truth About Wheat, Carbs And Sugar—Your Brain’s Silent Killers, had been published recently and I devoured it. In a nutshell, Dr Perlmutter, a neurologist and president of the Perlmutter Health Center in Florida, US, writes that the brain is exquisitely sensitive to the foods we eat and there is nothing worse than too many grains and too little fats in your diet when it comes to brain health. While there is a lot more to his book, he is particularly emphatic on the downside of eating wheat and how damaging it can be for the brain.Read More

Sujata Kelkar Shetty, PhD, writes on public health issues and is a research scientist trained at the National Institutes of Health in Bethesda, US.

Meditate and live better

By |March 9th, 2016|General|

Out of pure curiosity, I tried it—and loved it because when you meditate, you very quickly discover this sense of marked inner calm. And when you are not meditating—the other 23 hours and 20 minutes—you feel more alert and less bothered by the small insignificant irritations of life,” writes Richard A. Friedman, director of the Psychopharmacology Clinic at the US’ Weill Cornell Medical College, in an email interview.

Meditation as a spiritual practice has been around for thousands of years, and over the past two decades there has been a growing interest in using it to improve mental performance, emotional balance and physical well-being. The word for meditation in Tibetan is gom and the meaning is best conveyed as “cultivating intimacy with the full spectrum repertoire of what it means to be human”. Medical research is beginning to show us that this ancient practice can improve both mental and physical health parameters.

“There is good empirical data that meditation lowers the heart rate, blood pressure, and promotes more coherence in electrical activity in the brain. This is to say that just by entering into a meditative state, one can induce measurable physical effects (that are beneficial),” says Dr Friedman.

Researchers are beginning to get an inkling of how meditation produces these profound effects. At Israel’s Weizmann Institute of Science, researchers discovered that meditation reduces the brain’s electrical activity, literally “quietening it”. This reduction correlates with a reduction in the number of thoughts experienced and the researchers argue that this is what produces the calming effect that meditators experience and relish.

Psychosocial stress is a known risk factor for all lifestyle diseases, including heart disease, depression, diabetes, hypertension and various cancers, and practising meditation can limit their progression. A US study, published in November 2012 in the journal Circulation: Cardiovascular Quality And Outcomes, found that meditation helped reduce the risk of all heart disease-related events, including heart attacks, strokes and death, by 48%.

George Chrousos, professor and chairman of the First Department of Pediatrics at the University of Athens School of Medicine in Greece, agrees with the findings. He says on email, “Chronic stress plays two very major damaging roles in the body.” First, through classic hormones such as catecholamine and cortisol, it elevates arterial blood pressure, causing fat accumulation and glucose intolerance while it changes the body composition, decreasing muscle and bone mass and increasing fat deposits, especially in the abdomen. Second, stress increases inflammatory cytokine secretion (cytokines are hormones of the immune system) by stimulating the immune cells and increasing body fat, which itself produces pro-inflammatory molecules.

In a nutshell, stress makes us fat, increases our blood pressure and predisposes us to diabetes and heart attacks. Dr Chrousos, who has conducted research on stress-related illness at the US’ National Institutes of Health, adds that meditation, by calming the brain and stabilizing emotions, helps combat the effects of chronic stress, allowing the body to stave off disease.

To initiate a meditation practice, it is worth paying heed to the advice of Madhav Nagarkar, a meditation teacher based in Pune. “All we have to do is assign the mind a mantra and ask it to focus on the breath to enjoy the benefits of meditation. Just as a naughty child will jump from seat to seat in a classroom till you assign him a seat and ask him to sit in it, similarly the mind needs the mantra and the breath to focus on. Only once quiet can the mind start its journey towards experiencing pure consciousness.”

Chant a simple “Om” with each inhalation and each exhalation of breath, and choose a fixed space and time of meditation that is free of mental distraction, he says. “Noise is a major impediment to a meditation practice, even music is disruptive.”

“Awareness constitutes the foundation of all and its cultivation supports all. As meditation increases awareness, meditation is the greatest single tool we can use to improve our lives and the lives of others,” says Kevin Selig, a practising Tibetan Buddhist monk based in Bali, on email.

I’m working on making it a daily practice.

Sujata Kelkar Shetty, PhD, writes on public health issues
and is a research scientist trained at the National Institutes of
Health in Bethesda, US.

The sunshine paradox

By |March 9th, 2016|General|

Vitamin D plays a definitive role in the normal growth and upkeep of our body and the quality of our bones. Though classified as a vitamin, it is actually a steroid hormone that is produced by the skin when exposed to sunlight. A vitamin is an organic compound that is essential for the body but is required in very tiny amounts. In that sense vitamin D is a vitamin. However, vitamins are usually not synthesized by the body and for that reason vitamin D is not a vitamin.

Here comes the sun: Vitamin D is a steroid hormone produced by the skin when exposed to sunlight.
Once produced in the skin, vitamin D is still biologically inert, or incapable of biological action till it is sequentially metabolized first in the liver and then the kidneys. After it has been altered by the liver and the kidneys, it binds its receptor, the Vitamin D receptor (VDR), which is found inside cells, and proceeds to make a variety of physiological decisions.

Vitamin D is known best for its role in maintaining the calcium balance in our bones. But over the last four decades, scientists have identified many new biological actions for vitamin D apart from bone growth and upkeep, says Anthony Norman, Distinguished professor of biochemistry and biomedical sciences, Emeritus, University of California, Riverside, US. Anthony Norman discovered the existence of vitamin D in 1967 and VDR in 1969.

In a mini review by Norman and Roger Bouillon titled �Vitamin D Nutritional Policy Needs a Vision for the Future� published in Experimental Biology and Medicine, September 2010, the authors say that VDR has been found in at least 38 different tissues in the body. This means vitamin D has a role to play in those many tissues. The review also says that research has shown that Vitamin D plays a role in muscle function and improving muscle strength. It also stimulates the synthesis of anti-bacterial agents in blood cells, and strengthens our immune cells so that they can fight infection more efficiently. It makes our pancreas secrete insulin, and maintains heart muscle function. It also prevents excessive cell proliferation. In other words it may deter various cancers, including prostate, colon and breast cancer, from gaining a foothold. Read More

Sujata Kelkar Shetty, PhD, writes on public health issues and is a research scientist trained at the National Institutes of Health in Bethesda, US.

Fast for health

By |March 9th, 2016|General|

Those interested in rejuvenating their bodies and minds post Diwali, listen up. The secret to extending your youth while keeping disease at bay seems to lie in, ever so often, not eating at all. Fasting, or not eating for 12 hours or more, triggers a protective response in our bodies at a cellular level. Our bodies seem to become stronger and more able to fight diseases, both chronic and acute, as a result of this short stint of starvation.

And while the thought of starving once in a while may seem unpleasant, this is how pre-historic man lived. Eating three meals a day, with snacking thrown in for good measure, is not normal from an evolutionary perspective. And recent research suggests that fasting or eating like our hunter-gatherer ancestors has the potential of helping us live longer, disease-free lives.

Isaac Mathai, chairman and managing director of Soukya, a holistic healing centre in Bengaluru , says naturopathic medicine has always recommended fasting for a host of medical conditions, from constipation to arthritis. “It is considered beneficial for healthy adults as an anti-ageing and detoxifying regimen too,” he says. Dr Mathai suggests a water-only or juice-only fast for 24-48 hours every month for healthy adults. “A fast longer than 48 hours or in someone who is taking medicines is best done under medical supervision,” he says.

Fasts are highly beneficial in reducing the risk of chronic diseases, particularly in people who are obese and sedentary, according to a review of the research on fasting published in February 2014 in the journal Cell Metabolism. Authors M.P. Mattson and V.D. Longo said that in animal studies, fasting improved important health indicators like blood pressure, body fat, insulin, brain performance and inflammation. Fasting has also been found to reduce the risk of heart attacks, diabetes, stroke and, sometimes, even prevent cancer. The reason that fasting works this way, they argue, is because at a molecular level it enhances anti-oxidative pathways, protecting cells from DNA damage and suppressing unrestricted cell growth while simultaneously destroying damaged cells.

In humans too, studies on fasting are promising. According to a review published in the journal Proceedings Of The National Academy Of Sciences in November 2014, multiple studies have shown that fasting can reduce the symptoms in patients with rheumatoid arthritis and asthma.

Dominic Benjamin, a consultant geriatrician at the Bangalore Baptist Hospital in Bengaluru, recommends shorter fasts as a weight-loss measure to patients—to accrue the benefits of fasting and manage weight. “I suggest to my non-diabetic obese patients that they aim for a 14- to 16-hour fast over the weekend. They can eat an early dinner on Friday and Saturday and eat a late breakfast or an early lunch at noon the following day. This kind of a fast isn’t too demanding for my patients,” says Dr Benjamin.

Fasting works in many ways. For one, it suppresses inflam-mation, which is a pivotal participant in arthritis, asthma, heart disease and cancer formation. Another way that fasting works is by increasing the “autophagy” or “eating” of defective proteins and membranes within a cell by the cell. In other words, fasting makes the cell “cleanse” itself of damaged biomolecules.

If you want to give fasting a try, there are many ways to do it, writes Dr Mattson, chief of the laboratory of neurosciences at the US’ National Institute on Ageing, in an email interview. He writes that while we don’t know yet which way is the most beneficial fasting method, and some methods may be more beneficial than others, there is no doubt that fasting is a healthful practice. “Fasting one or two days/week or fasting for two consecutive days every week or every other week are all worth trying. I would suggest starting by eating only one moderate-size meal one day each week for one month and then do this for two days each week for the next month,” he says.

You could also try the intermittent fasting diet called the 5:2 diet popularized by Michael Mosley and Mimi Spencer in their book The Fast Diet: The Secret Of Intermittent Fasting—Lose Weight, Stay Healthy, Live Longer. In this, you would eat 500 calories (600, if you are male) two days a week and eat whatever you want (within reason) the remaining five days of the week. Dr Longo, director of the US’ USC Longevity Institute, cautions that the 5:2 diet has several limitations. “It requires that someone eat a low-calorie diet every third day, which is difficult for most people to maintain, and it can also confuse the body the same way that sleeping erratically would; the body’s circadian clock doesn’t like frequent changes. However, it is still better than not fasting at all,” he writes.

It’s important to add, however, that the research done thus far is limited in its scope and till there is more evidence, it’s best to check with your doctor before incorporating regular fasts into your lifestyle. I fast once a week, living on 500 calories of juices and fruit, and find myself more energetic and alert on fast days.

Sujata Kelkar Shetty, PhD, is a wellness consultant and a
clinical scientist trained at the National Institutes of Health in
Bethesda, US

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