What is Driving us to Eat More and Fall Sick?

Eating, long held to be an essential act of replenishment energy we spend at work, is now emerging as the major killer of urban India fueling the epidemics of obesity, diabetes and heart disease and fatty liver.

Sounds paradoxical, but true: it is no longer lack of food or starvation, but consumption of amounts in excess of what we need that is killing us.

Scientists have identified patterns of eating behavior that could explain the present phenomenon.

“Homeostatic” eating is when we consume food to fulfill the calorie and protein requirements of the body. After a hard day’s labor, we eat to satisfy our hunger, consuming cereals, pulses, regional seasonal veggies or what-ever come our way. We are not fussy about the taste of food, but eat to regenerate energy and prepare ourselves for another day’s work. Most such eaters do not suffer from obesity, diabetes, hypertension, coronary artery disease or fatty liver.

It is ”Hedonic or “pleasure” eating is what is in vogue now. As many of us prospered, we started relishing “good” food; preparations that would attract us and satisfy our taste buds. There came “fast foods” and pastries that were carefully crafted and prepared to tickle not just one type of taste buds ( sweet or salt) at a time , but several types (salt, sweet, hot, sour) at one go. No wonder once we put a tasty “masala” potato wafer, “khatta meetha” namkeen or chocolates (sweet, salt, bitter) in our mouths, we cannot stop ourselves from reaching out for more!

Hedonic eating has become so pervasive that we fail to realize how difficult it has become to say “NO” when offered an attractive pastry or cookie or salted nuts. And though we leave home after a heavy breakfast, we are unable to restrain when the bowl of salted cashews is passed around the office table!

The easy access, availability in abundance of “Pleasure foods”, even in small towns, coupled with sedentary life style have joined hands and fueling the present surge in metabolic syndrome (overweight, diabetes, hypertension, increased cholesterol in blood, propensity for heart disease) and fatty liver disease. 

And the food industry is discovering more innovative ways to lure us on!

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Skeletal Muscle latest member to join the Endocrine Club

Hormones, or chemical proteins that circulate in the blood and regulate body function, have long been known to be produced by just a handful of endocrine glands such as the pituitary, thyroid, parathyroid, adrenals, pancreas and the gonads. Three latest ones to join this exclusive club are intestines, bone and skeletal muscles!

It may sound funny but medical scientists are beginning to discover how some of these large tissues also produce “hormones’ and regulate metabolism.

Skeletal muscles, for instance, produce a wide variety of “hormones”, largely referred to as “MYOKINES”. Their subtle actions range from maintaining blood sugar control (apart from Insulin), keep us in good mood (stretching skeletal muscles has stress busting effects on the brain), improves fat metabolism (converts white fat to brown fat, and reduces its quantity), improves liver functions, regulates bowel movements, and removes cholesterol plaques from blood vessels. 

What goes on between myokines and other organ systems is referred to in scientific circles, as CROSS TALK. The myokines released from muscle fibers during exercise or stretching, interact with other systems and hormones. Some of the important functions recently ascribed to myokines are improved cognition (alertness, learning), ant-depressive actions, reduced stress hormone levels and cardio-protection.

To make it simple, research is showing that those who have been actively exercising are less prone to fatty liver disease and developing diabetes. Indeed they tend to develop Alzheimer’s disease less often and demonstrate less risk for developing cancers.

The discovery came in 2000 when it was realized that exercise caused release of a hormone-like substance called IL-6 (interleukin 6) from muscles into the circulation. It turns out that this IL-6 has anti-inflammatory and health promoting properties from the brain to the liver. 

The only way to get your share of IL-6 release into the circulation, unfortunately, is by stretching and doing some exercise, squeezing your muscles to release it. This set of observations now explains why “healthy” living requires a daily dose of myokines or IL-6, and no pill can help provide that as of now!

Lessons from the Turkey Earthquake. Can we be better prepared for such an eventuality?

The recent earthquake in Turkey and Syria when the earth shook violently inflicting unimaginable trauma, claiming 50k lives and shaking up the thousands of those who survived death with wounds that might change their lives for as long as they live.

“Natural disasters’ are of 2 types: some that can be predicted, such as cyclones, where major advances in satellite technology and evacuation drives have reduced deaths significantly, while some such as earthquakes that are difficult to forecast.

1. Needless to say, modern buildings need to be “earthquake resistant”. Japan, a very earthquake-prone place, has significantly reduced impact of earthquakes on their buildings and peoples’ lives. Earthquakes still happen there, buildings do shake violently at times, but they rarely collapse like a pack of cards and kill its inhabitants.

2. The prime reaction evoked by shaking of the earth is FEAR; It generates either a FLIGHT or FIGHT response. Most who could, would have run to open spaces and escaped buildings and debris falling on their heads.

3. If one found oneself alive and conscious, the fear of missing loved ones can be overwhelming, a mother standing up to see her home reduced to debris with fear that her family could be trapped there.

4. For those who lost so much so suddenly, went through (still undergoing) !various stages of the GRIEF response: initial denial (this can’t be happening to me! Am I having a nightmare?), anger (why did the rescuers take so long? Why did the government allow this to happen?), bargaining (why did I not die instead of my son?), sadness and then finally acceptance (God’s will or Destiny!).

5. India’s disaster response has undoubtedly improved and matured as survival data from cyclones in recent years have shown. Induction of canine squad (4 dogs were taken by the mission to trace human bodies or survivors) was a great step!

6. Most mature international disaster response teams include a squad of psychologists and counsellors, who help people in their darkest bewildering hours. We need to build our strength there too!

Can you do Cardiac Resuscitation?

If you were to see a person “drop dead” all of a sudden, are you capable of doing the hands only Cardiac resuscitation?

Here are some facts for you: 

1. Around 700, 000 (7 lac) people have Sudden Cardiac Arrest (SCA) where the heart suddenly stops beating and pumping blood to organs, leading to sudden death every year in India.
2. Around a third are in persons under 50.
3. What makes the difference between dying and coming back to life for of a person who develops SCA is timely revival with CPR (cardio-pulmonary resuscitation).
4. Calling the ambulance or a doctor is what we all do, but by the time they arrive (over 15 minutes or more, even in many countries) is the time when the organs of the body have undergone irreversible damage. Hence many are declared “brought dead” by the time they reach the hospital. Timely CPR while waiting for help is ESSENTIAL.
5. Most cardiac arrests occur at home; some in place of work or in public places. It could happen to someone close to you too.

Sudden cardiac arrest (SCA) made a dramatic re-entry in the public minds recently when Damar Hamlin, a 34 year-old celebrated American football player, suddenly collapsed on the ground during a match, to the horror of spectators. It took just a couple of minutes to realize that he had sustained a sudden cardiac arrest (SCA). His heart had stopped beating, and he was almost dead.

Para-medics then rushed on to the field and started thumping Hamlin’s chest, giving him external cardiac massage. He was resuscitated within nine minutes, restarting the stopped heart, just in time to save his brain from damage! He was then shifted to hospital where he was treated further, and is now back home. 

The American Cardiac Association acknowledges and stress how TIMELY action (mind you, not BEST, by a famous cardiologist) can save more lives, and reinforced the need for banking on paramedics and “common” people to provide it. 

Several movements are already on to provide training and make every person “CPR literate” as one never knows when the situation could arise. 

Institutions such as schools, colleges, work offices and transport crews are particularly encouraged to learn first aid and CPR. 

Remember it could happen in your home too; many of us live years cursing doctors and hospitals for someone we lost but shrink away from the uncomfortable question “could you have done things differently?” 

Learn about CPR by reading up about Damar Hamlin’s story and join in on a CPR training course. 

New Year Resolutions: fate and implications

New year is a time when one in every two persons get motivated and incited to make a resolution. The reasons and issues behind these resolutions, their fate and implications are interesting.

A recent survey found that the top four of them are around HEALTH issues, and include:

1. Getting into better shape by losing weight
2. Eating healthy, or cutting down on diet, or starting a new diet regime
3. Being regular with exercise such as going to the gym, starting regular walks or a game
4. Stopping or reducing smoking or alcohol

The next few spots are occupied by issues related to work such as “I will work less hours”, or “return home early” or “spend more time with children”. Fairly lower down is the resolution of making more money!

It is equally interesting to note the fate of these resolutions. Around 80% are dropped or forgotten within a month by the time February comes in. Only 5% survive a year!

Despite the very short lives, and the promptness with which they find themselves dropped over the days and weeks, their apparent pointlessness however underscores an important point. We are indeed aware that we have been ignoring our health, quite cognizant of what we ought to have been doing all these days of the last year. There is also a desire to make amends and switch to a new healthy mode.

Psychologists studying the phenomenon of resolutions point out that they are usually “fragile” and made somewhat impulsively. Once broken, even by force of unavoidable circumstances, they are difficult to repair or restore, till perhaps the next new year!

Strategy, on the other hand, is less dramatic, and have a longer range. They are contemplated and set short and long-term results, such as losing 2 kilos of weight every month for 6 months. They involve goal-setting and not just focused on a particular behavior.

If you were one of those who had made a resolution 10 days ago, and feel it is cracking up, do not lose heart. Your goals remain important. Just spend a bit of time going cerebral and strategizing how to get there!

What makes Pele feature Health Adda?

The Brazilian soccer legend, Edson Arantes do Nascimento, more popularly known across the world by his nick name Pele, died at the age of 82 of complications arising from colon cancer.

Pele achieved more fame and stature as a sportsman than anyone could possibly have. He started playing football as a child in an impoverished locality kicking socks filled with paper, got recognized for his extraordinary skill and mastery of the game at the age of 16, and went on to play as a professional soccer player for his country bringing Brazil into the world map of soccer.

His mind boggling achievements include scoring a Guinness World record of 1279 goals in 1363 games, becoming the youngest winner of the world cup at 17 and winning the FIFA world cup three times for Brazil. It was not without reason that FIFA conferred on him the title of “Player of the Century”. 

He went on to become a global icon of not just soccer, but sports across the world. He was also known for his philanthropic activities and for working tirelessly to encourage and pull poor children in Latin America out of poverty through the game of soccer.

He played at a time when television had not come into our homes. We tend to therefore forget two things: more recent heroes appear larger in size, and second, television and social media can alter the “size” of icons!

What stands out about Pele was his passion and commitment to what he did. He is famously quoted as saying “I was born to play football, just as Beethoven was born to write music and Michelangelo was born to paint”. I wonder if I found or did justice to a singular life’s purpose!

He was diagnosed to have colon cancer some time ago. At the time it was detected and surgically removed, it had spread to other organs. He was therefore undergoing chemotherapy for widespread cancer. 

He faced his end quite like a true sportsman, gracefully wishing his relatives (his wife, 6 children and other relatives) farewell from his hospital bed a day before he died.

Colon cancer is the third commonest cancer world-wide affecting 2 million people and killing 900,000 annually. The best chance to beat it is to have it detected at an early stage by a “routine” screening colonoscopy at age 45 onwards. 

Seasonal Affective Disorders or Winter Blues

As the days shorten with the coming of winter, many people begin their struggle with their drooping moods. 

If some of you are feeling low, suffering from fatigue and having a disturbed sleep cycle these days, you could be suffering from “Winter Blues”.  In foggy wintery times, when the days are not just cold, but dull and dark, many begin to  feel lethargic, gloomy and down overall. 

Plunging moods during winter that spring back with the coming of spring is a well-recognised entity called Seasonal Affective Disorder or SAD. It is characterized by feelings of sadness, dullness and negative thoughts that affect normal relationships at home or work. Usually seen in women, SAD sets in every year when the sun starts loosing its brightness to fog and clouds, the day begins to shorten and the temperature dipd and remains low.

The primary culprit of both the winter blues and SAD is the lower level of natural sunlight we are exposed to in winter. This leads to:

1. Disruptions in circadian rhythms (your body’s internal clock), which help control sleep-wake cycles
2. Alterations in melatonin, a hormone associated with both mood and sleep, and serotonin.

Some of the common symptoms are

• Feeling less social than usual, depressed, or sad.

• Difficulty taking initiative, low activity levels, struggling to work at home or office
• Loss of interest in hobbies you typically enjoy
• Withdrawing and isolating yourself from friends and family
• Difficulty sleeping

• Struggling to focus and perform at work or home
• Having thoughts of worthlessness

How to Fight Winter Blues?

Sunlight: It is mportant to get outside whenever the sun is out. Some prefer to go to sunny places to spend the winter.

Light therapy that replicates natural light with light boxes by using white fluorescent bulbs to mimic sunlight, has been proven to help . It regulates the release of melatonin.

Exercise: Research consistently shows a strong exercise-mental health connection, particularly for those with depression. It can increase serotonin and endorphins, which both affect mood. Moderate exercise of at least 30 minutes most days of the week may provide the biggest mood boost.

Medication: If more conservative treatments are not providing adequate relief, you may need antidepressants to regulate the chemical imbalances associated with the winter blues and SAD. 

If you spot it early you don’t have to waste the next few months. Act quickly.

Brain Fog

Fogginess of the brain is a frequently reported symptom these days, and can be best described as

1. Cloudy thinking, 
2. inability to concentrate the way that one earlier could 
3. Lapses in memory
4. Losing train of thought such as forgetting in mid-sentence what you were planning to say, or asking the other person “what was I saying?” frequently
5. Getting distracted easily, with the feeling that the mind is refusing to focus
6. Poor motivation 

We all experience these symptoms once in a while, but if they become disturbing enough to be noticed and affect the quality of life and work, you could be suffering from Brain Fog. 

Reporting of Brain Fog has gone up significantly since the COVID pandemic. It is included as one of the features of Long COVID or Post-COVID Syndrome. 

It is now well recognized that the COVID virus may cause inflammation or swelling of several organs and tissues. The main brunt has been on the lungs but involvement of other organs have thrown up their own typical signs in their own ways such as heart (heart attacks), liver (increased liver enzymes), intestines (abdominal pain or diarrhea) and brain (loss of smell). 

It is therefore possible that another milder but less dramatic form of brain inflammation, could produce the symptoms of Brain Fog, that could last long.

Brain Fog may however occur in people who have not had COVID too. 

If persistent, one could run through the check list.

1. Check your blood sugar, blood pressure, Hemoglobin, Vitamin B12 and Vitamin D levels
2. Look out for hormonal changes, especially irregularity of periods or thyroid dysfunction
3. Are you over worked, stressed out, or sleep deprived?
4. Are you on medications for sleep or depression? Are you consuming alcohol?

For a start, try

• 7 to 9 hours of sleep daily for a few days
• Caffeine could help: try a cup of coffee or tea to stimulate your brain.
• Exercise: a daily dose of 30 minutes of cardio could improve blood circulation to the brain

If the symptoms persist, other possible underlying conditions could be 

• Air pollution (try a vacation to the hills or get an air purifier especially at night)
• Depression especially if you experience recurrent negative thoughts, irritability, and low moods
• Early onset dementia could be a worry, but fortunately, most people improve with the above measures and gain back their brain’s vitality.

The symptoms are frustrating, but usually resolve. Consult your doctor for help if you do not get well.

Oral Rehydration Therapy and Dr Dilip Mahalanobis

It would be difficult to find an adult today who has not heard of Oral Rehydration Solution (ORS), or does not know that Oral Rehydration Therapy (ORT) is what we should rush to provide to save the life of someone who has started passing watery stools.

It was not so simple prior to the 1970s! Cholera epidemics came as waves and spread across the world, ravaging populations. Survival then hinged on whether one could get quick access to a hospital for intravenous saline drips. 

One of the flash points of the cholera story was when an outbreak occurred in a refugee camp near the India-Bangladesh border during the 1971 war. A young pediatrician called Dr Dilip Mahalanobis, was tasked to treat thousands of children with diarrhea in a make-shift hospital that had just 16 bed, and a very limited supply of intravenous fluid bottles!

Necessity became the mother of invention, when Dr Mahalanobis started feeding dehydrated children with an oral solution made from water, sugar and salt. He noticed that the death rate dropped from a whopping 30% to 3%!

The idea of trying oral rehydration solution in children who were pouring watery stools from the other end had seemed ridiculous then and had defied conventional logic. His   approach had its basis on laboratory experiments that had shown glucose and sodium, if given together, to help each other get absorbed via a glucose-sodium co-transporter at the intestinal cell’s brush border. It could then drag water into the body partly reversing the fatal effects of dehydration.

ORS is now a household name, and is made up of a mixture of glucose, salt (sodium chloride), and Potassium chloride in exact proportions that can be made into a solution with water. It now comes in few new avatars as well: mixed with lycine, rice powder, zinc, selenium, or in a hypo-osmolar (diluted) form.

Scientists unanimously agree that ORS has been the crowning discovery of the medical profession of the last century and has saved more lives than any other. It continues to save a million lives annually. 

Paradoxically, the scientific paper written by Dr Mahalanobis was rejected by a scientific journal when first submitted. And more disturbing is that he died last month at 87 in Kolkata unsung, without getting a Nobel or any national (Padma) award!

Balancing Skill and Health

One of the disheartening sights is the unusually large number of wheelchairs lined up at arrival terminals at airports when a flight from India arrives. 

With our average life expectancy being around just 70, do we get infirm and immobile early, taking to the wheel chair or seeking physical support too easily as we grow old? And if we do show signs of aging early, is it just “genes”, or how we looked after ourselves in the preceding decades leading up to it?

Dr Michael Roizen from the Cleveland Clinic, an expert on longevity and aging, points out that our ability to maintain balance is a good indicator of how long and healthy we are and can expect to live. 

He describes a “one leg test”, that is a senior person’s ability to stand on one leg for 10 seconds; those who can achieve the feat are three times more likely to live longer and healthier lives than their same-aged counterparts who could not!

Holding balance indicates three aspects of a person’s health. For one it gives an idea about the strength of our leg, spine and body muscles. 

Second, the act of balancing requires nerves, muscles, eyes, vestibular system (behind our ears) and brain to fire and function in a balanced and coordinated manner, and provides a quick assessment of the state of neurological decline that accompanies aging. 

And third, patients who suffer from neuropathies, especially diabetics, find it hard to perceive sensations from the legs, and hence their balance.

He noted that those who could hold their balance, were more alert and had better cognition or learning abilities.

How then can we hold on and strengthen our balancing skill? The tree-pose or Vrikshasan asana seems tailored for just that. 

Other methods include toe-heel walks, walking on a straight line or walking up stairs without holding the rails. 

Walking on a wall or a beam, or in its most challenging form, on a rope, is what it is all about. Many elders would reminisce how they used to do it then when they were young and active. Wouldn’t of course advise my senior compatriots to revisit their agile childhoods now!

Giving up too easily and taking to the wheel chair could enhance our motor deterioration. Regular practice could slow our age-related  decline in movement, and of our balancing skills.