Coronary Artery Disease- Can It Be Prevented?

These are called the communicable diseases the incidence of which was very high about 2 decades ago. But gradually the incidence of these has considerably decreased, thanks to the boon of improved technology and better living standards. However, another set of diseases, called the non communicable diseases (NCD) have slowly crept in and now has laid its trap on mankind in this industrialized society. These are the ones which occur not due to contact but due to certain modifiable and non modifiable factors. In this class is one of the most wide spread disorders, the coronary artery disease (CAD).

The non modifiable factors are age, gender, race and family history. Family history could include incidence of diabetes, blood pressure, obesity or cardio vascular disease. The risk of developing CAD increases with age greater than 45 years in men and 55 years in women. A family history of early heart disease would mean heart disease in the father or brother diagnosed before age 55 years and in the mother or sister below 65 years. So what about the modifiable risk factors? Can we by some modifications in our lifestyle help avert the dreadful disease? Yes certainly. These are our lifestyle factors –dietary habits, our environment, our social life and habits like alcohol, smoking, physical activity and sleep pattern.

Our dietary pattern and eating culture have taken a big leap from that of high fiber based cereals, pulses, vegetables and fresh fruits to refined, processed foods, high in fats and also in sodium content. Added to these, is the decreasing physical activity from that of a once more active lifestyle. These are the main causes of high blood pressure, diabetes and obesity. Consumption of alcohol, smoking and erratic sleeping hours coupled with a highly demanding stressful life have further added to the miseries.

In this context, therefore health workers have shifted focus on prevention of such diseases and thereby increasing our lifespan rather than just treat or cure them. The answer to these problems hence lies in to reverting back to the age old lifestyle of healthy diets, more physical activity and avoidance of alcohol and smoking. For this one can get involved in some relaxation activities like yoga, meditation or going out for long walks or perhaps a break from the demanding schedule once in a while.

In non modifiable conditions, where there is a family history of any one of the above mentioned problems, even there we can play some role in averting or perhaps delaying it or at least minimizing the severity of the disease. Timely action can always go a long way in developing more complications in the long run. It is advisable to maintain a routine check of those either annually or 6 monthly in case of high risk groups. For instance, one could get his/her blood pressure check done and monitoring it at the ideal or near ideal value of 120/80 mm of Hg.  A fasting blood sugar value of < 100 mgs/dl, a total cholesterol value of <200 mg, triglycerides <150 mgs, LDL (bad cholesterol) <130mg and a HDL (good cholesterol) of 45 -75 mg/dl should be the ideal target to be maintained.

So to avoid falling prey to the coronary artery diseases, the major focus in our lifestyle should be on healthy eating pattern, a healthy body weight, a desirable lipid and blood sugar profile and an acceptable blood pressure range.

A little care and effort in our day to day life can certainly help us remain healthy and disease free for a longer span in the times to come.

Is Your Child Having Enough Iron

You would wonder, the child is otherwise active and appears normal with no apparent problem, but when it comes to eating, he just refuses to. He might gorge on other products like milk, biscuits or chocolates or kurkure etc, but no food. Well, do you know the mystery behind this behavior could be nothing else, but just lack of iron in your child’s body? Yes, anemia, as it is commonly known, is a manifestation of iron deficiency. This phenomenon was earlier observed generally in the less privileged class of society due to lack of food availability or poverty etc. But now this problem is not restricted to a class of people, but widely prevalent across all sections of classes thanks to the western influence on our eating culture, to the extent that iron deficiency anemia is regarded as one of the National nutrition problems in our country.

There would be other subtle signs and symptoms which parents may generally fail to recognize, like growing very irritable, easy fatigueability, a pale look and pica, which is quite a common sign of iron deficiency, i.e. craving to eat mud, clay or wall scrapings and failure to grow. Pica and loss of appetite are one of the earliest signs in a child which should alert the parents that all is not well and their child could be suffering from anemia. According to studies, almost 53%-54% of children in a survey were found to be anemic, with greater prevalence of girls compared to boys.

The main causes of this high prevalence are nothing but faulty feeding habits right from infancy. Children who have not been exclusively breast fed till 6 months of age, children having diary milk which could be diluted too, excess of milk intake (as high as 1 lt/d), inadequate cereals, pulses and veggies in their diet, munching of biscuits, chocolates or other processed foods and most important those who are addicted to tea, all fall prey to iron deficiency anemia. Breast milk has a higher bioavailability of iron compared to other milk and a child deprived of this milk in early infancy can begin with a setback of deficient stores which are not easily repleted, as the child’s demands increase with age. On the other hand, prolonged exclusive breast feeding or any other dairy milk beyond 6 months, without adequate supplementation of cereals and pulses also can result in iron requirement not being met, because milk is almost devoid of iron. Once the iron stores are depleted in the body, the child will just refuse to eat, even though he may accept milk, tea or other non nutrient foods. Once this deficiency sets in, depending upon the severity, the symptoms too may get more serious like palpitation, shortness of breath, abnormally shaped nails, lowered IQ level and gastro intestinal problems. At this stage, just diet will not help alone and iron supplements in the form of capsules or syrup need to be given too.

Therefore, as we know prevention is better than cure, it would be wise on the part of the parents and care givers to ensure the child is breast fed exclusively for first 6 months followed by adequate cereal supplementation by way of healthy home based foods rather than encourage foods like bakery products, sweets, coals, or even excessive milk and milk products. Some good iron rich sources of foods are whole cereals and pulses, gram, ragi, jaggery, green leafy vegetables, dry fruits like almonds, raisins, dates and egg yolk.

The Salt Factor in Our Diet

As a routine, we may not be even aware of how much salt we are actually consuming. This is because it is not just the visible salt that we add in our diets, but there are a number of ‘hidden sources’, which may actually make one consume far in excess than actually our body requires, which is no more than 3-5 grams per day. Ideally it is the sodium component of the salt (sodium chloride), which matters. This is present in a number of foods around us including medicines.

Our body does require some sodium since it helps to maintain the right balance of fluids, helps transmit nerve impulses and influences the contraction and relaxation of our muscles. But what is required is the right balance of sodium in our diet. This is maintained by the kidneys by holding on to it when our body stores are low, or excreting it out when there is excess of it. But with a prolonged period of excess intake of sodium the kidneys may one day fail to maintain this balance, resulting in increased blood volume by holding on to fluids. This can lead to heart problems, renal and liver disorders and hypertension etc.

The sodium requirement also varies with age. With increasing age it is advisable to reduce the sodium content by reducing the total salt intake per day. This does not imply table or cooking salt alone, but a number of foods which may be having ‘hidden sodium’, in them which actually may add up to much more than just salt consumed as such.

Some of the main sources of sodium, commonly consumed on day to day basis are:

Processed or Ready to Cook Foods: bread, biscuits and all other bakery items (which require soda bicarbonate or baking soda), pasta, noodles, pizzas, burgers, cheese etc.

Preserved Foods:  Pickles, jams, marmalade, chutneys, spreads, ketchup, sauces, chutney, papad, vadi, all tinned foods, breakfast cereals like cornflakes etc.

Natural Sources: Dairy products, meat, chicken, eggs, fish, legumes.

Medicines; Certain medicines may be sodium based (read label or check with your physician)

Some tips for cutting down sodium in your daily dietary intake are:

  • Eat more of fresh fruits and vegetables
  • Limit use of sauces, dips, salad dressings, pickles and chutneys etc.
  • Use dried herbs and spices for flavoring
  • Black or rock salt as is commonly referred to, has the same amount of sodium as the normal salt.
  • Read labels carefully on all medicines and foods while shopping for groceries. Look for ingredients like baking soda, baking powder, disodium phosphate, sodium alginate, sodium citrate, sodium nitrite.
  • Avoid table salt or salt dispensers.

Finally, your taste for salt can be acquired with sustained elimination of excess salt from one’s diet, since the taste buds get adjusted to enable you to enjoy your low sodium diet.

The Importance of a Good Breakfast

As the name suggests, breakfast implies ‘breaking the fast’, and that is the overnight fast, the last meal being the dinner of the previous night. In effect, it actually means the first eating occasion of the day within 2-3 hours of waking. i.e by about 9.00 -10.00 a.m.

But in the present day the concept of breakfast has transformed considerably.   A decade or two ago, a typical breakfast comprised a serving or two of any cereal, milk or milk product, egg or cheese and perhaps a fruit which was calorie and protein dense. Today the trend has shifted to a calorie and carbohydrate dense breakfast with not so high proteins. This too has been accompanied by a reduction in the actual number of, who do have breakfast.  Children and adolescents are particularly vulnerable to the consequences of losing out on the benefits of a healthy breakfast. According to a recent study in the U.S., approximately 32% of adolescents skip breakfast on a daily basis and up to 60% skip almost 3 times a week. Similar observations have been made in our country too, thanks to the pressure of a power packed schedule which puts diet in the background. The commonly attributed factors for this trend are lack of time by 50% of the respondents and lack of appetite by almost 60% of them. Other causes sited were, inconvenience, forgetting to eat and not of the desired taste.

It cannot be over emphasized that a good breakfast is the key to a healthy day’s start.  A number of studies have shown that children who have had a healthy breakfast do significantly better in their scholastic performance  and have a higher retention capacity as compared to those who have not had breakfast. Recent evidence also suggests those people having a healthy breakfast (protein rich) rather than carbohydrate dense, are able to maintain normal body weight, since it leads to improvement in appetite control and satiety and reduced food intake over the subsequent meals. The rapid progression of incidence of Type 2 diabetes and obesity in the younger age groups can be considered as consequences of an unhealthy or no breakfast, as has been evident by a series of studies in this aspect. Therefore, it is highly recommended that children and adolescents and also adults should begin the day with a good, healthy breakfast, since besides giving an energetic kick start for the day, it is now also considered to be the key factor in preventing obesity and diabetes especially in the younger age group

Lactation Failure In Mums

No other food is as complete, as pure and as natural as mother’s milk for her new born. But unfortunately in our country, over the years, we can see this spontaneous practice is gradually being eroded, resulting in problems for both mother and the infant. After all why are these problems being encountered more and more in the urban and now many semi urban and even rural populations? The answer is simple. The impact of industrialization, competition, pressure at home or work place, the breaking of the joint family system and the onslaught of a barrage of commercial products accessible easily cross the nation are all in a way responsible for this changing trend.

The importance of exclusive breast feeding for the first 6 months has been amply stressed upon by all medical experts and is talked about in forum after forum. But still the problem exists. Some of the common problems and complaints from mothers who are unable to lactate successfully for the first 6 months are: ‘not adequate milk secreted’, ‘baby not accepting feeds’, ‘my milk not suitable or not enough for the baby’,  ‘lack of time to feed the baby’ or’ mother is on some medical treatment taking medicines’. Genuine as these may seem to the mother, there is a need to focus on the related issues and address them as follows:

  • Initiation of breast feeding: Most often breast feeding is not initiated within 1-2 weeks of delivery, as it should be thereby denying the first contact of the baby with the mother. It should be appreciated that only when the baby is put to the breast soon after birth, and the suckling process is initiated, will the mother’s brain receive the signal to produce milk, thereby inducing the milk secretion. The more this time lapses, greater is the effort required by the mother to coax the baby to accept feeds.
  • Family support: The role of the elderly females in the house is very crucial to reassure the mother in her ability to feed and encourage her to nurse the baby as early s possible after delivery. Adverse or negative remarks can result in the mother’s losing the confidence to feed, thereby leading the mother to resort to formula feeding. The more she relies on formula feed or the feeding bottle, the lesser will her milk production become.
  • Lack of Privacy: Too many distractions by constant visitors or family members surrounding the mother also can result in the mother’s attention being distracted from feeding the baby adequately. Privacy and space with the baby, called ‘rooming in’ is very important for the mother to nurse successfully.
  • Mother’s employment: Lack of time due to the mother’s employment and not getting the required maternity leave for 6 months usually forces the mother to acclimatize the baby with the formula or dairy milk using the bottle. This will gradually lead to complete premature lactation failure.
  • Problems of the breast: Problems like mastitis or engorgement of the breast usually occur due to incorrect positioning of the baby to the breast or incorrect ‘latching on’ by the baby. These problems can be avoided by proper advice by health care workers or any experienced female member in the family.

The baby if not fed exclusively for the first 6 months are more prone to face health problems  in the growing years, like allergies, especially asthma, Type 1 diabetes, obesity and decreased immune response leading to frequent infections. Therefore it is very important that  the above mentioned factors be considered so that the mother is able to offer the full benefits of breast milk to her baby not only for the first 6 months but also continue for up to 2 years along with other complementaAAry foods.

The Soda Culture – Impact On The Youth

This includes increased industrialization, increased access to a lot of amenities in our day to day life, be it education, science, computerization or the food industry. With access to a variety of foods in the commercial world (which includes beverages also), our youth is the first category of our population to be influenced by the trend of eating or drinking behavior. One of the most popular items among them is soda consumption. The most benefited by this trend is of course the soda industry. But what about the impact, the plethora of such beverages is causing on the future health of our youth? It is no doubt playing havoc with their lives in terms of the so called lifestyle or the non communicable diseases such as hypertension, diabetes mellitus, cardiac disorders etc. According to a recent survey from the world of medicine, consumption of even one soda (soft drink) per day may be associated with an increase in a negative behavior in young children. The higher the dose of these, greater is the risk of altered behavioral scores ranging from withdrawal behavior to attention deficit disorders. (J Pediatrics, online, Aug, 2013). Studies have demonstrated that even one soda a day is too many for young children, and hence for the very young any soda is not a healthy option.

Not only all of them are contributing to higher than required sugars in the simple form (harmful types), but also suppress normal healthy eating patterns, besides depriving the youngsters of the much needed micro nutrients. Little wonder that an increasing percentage of the youth are being detected with problems of obesity, type 2 diabetes and among adolescent girls the new menace of PCOD (polycystic ovary disease).

Will it be too much to expect some health related regulations vis a vis the food industry to be put in place so that the eating culture of our society is suitably modified, thereby contributing to a healthier adult citizen and also decrease the burden of health care expenditure? I think it would be one small step in the big change.

Fodmap Diet – What, Why And How

In recent times we can hear and read a lot of talk being centered around FODMAP diets. Often times I get calls from people asking me to guide them on FODMAP diets. Are these diets also one of those ‘fad diets’ which come with a wave just to wane of after making some noise? Well, one thing is for sure; these diets are not any kind of a fad, but yes, many people may be just unaware of who and why and how these diets are to be followed. Yes, these diets are generally recommended by experts in Gastroenterology and Nutritionists or Registered Dieticians for their patients with gut issues having discomfort in their digestive tract. There could be signs of bloating, constipation or and diarrhoea or both at various times and all of these might be effecting their quality of life in the end.

However, one thing needs to be kept in mind is that, not all issues relating to the gut may require diets low in FODMAPs. No one size fits all, and hence it is essential that anyone having similar problems should first consult their health care providers, preferably gastroenterologists followed by the dietician dealing with managing them with low FODMAP diets. It could well be possible that, those similar looking symptoms may be related to some other over lapping problem with different root causes and hence may require a different approach. So the red flags of the problem should be excluded first.

What are FODMAPs ?

Most of the plant foods that we consume in the form of grains, legumes, fruits, vegetables and some animal sources like dairy have a group of starches or carbohydrates. These could be of various types generally having some fibre which could be soluble or insoluble. Now, this group of starches are of different types and are termed as – ‘Fermentable, Oligosaccharides, Disaccharides, Monosaccharides, and Polyols’. These are actually supposed to be quite beneficial for the human gut as they promote the growth of the friendly or the good bacteria. However, the problem lies when all or some of these starches are not digested by some people and produce symptoms like bloating, distension, constipation or and diarrhoea causing the gut or the bowel to be irritable and mal functional. This condition is what is termed as Irritable Bowel Syndrome (IBS). These starches tend to pull more water in the intestine causing stretching of the abdomen (bloating and distension), pain and further as they pass into the large intestine, cause fermentation and gas. This may eventually cause constipation or diarrhoea or both alternatively. Some may be constipated dominant (IBS- C), while others may have loose stools pre dominantly (IBS – D), while still others may have a mixed pattern (IBS –M).

 In fact this phenomenon of water being absorbed in the intestine happens in all individuals, but those with IBS symptoms tend to have a sensitive gut and the motility of the intestinal contents (the partially digested food) is impacted – either it can slow down too much (constipation) or may rush out too fast (diarrhoea).

 In healthy normal individuals the food content will pass through the small intestine slowly attracting water and on reaching the large intestine, the gut bacteria use these FODMAPs as a fuel to survive. The bacteria rapidly ferment the FODMAPs producing gas without causing much discomfort. But in others this may cause extreme discomfort and also impact their quality of life.

Which Foods Comprise FODMAPs

Some of the foods under the various categories of High FODMAPs are as follows:

Fruits – Apples, apricots, peaches, pears, plums, prunes, water melon, pomegranates.

Grains – Wheat and all wheat products, barley, cous cous, rye (not the spice rai)

Dairy – Milk and all milk products.

Vegetables –  Beets, cauliflower, onion, garlic, leeks, mushroom, okra, peas, Brussels sprouts,

Legumes  –  Chickpeas, kidney beans, toor dal, balck eyed beans, soyabeans, lentils, lima beans, split peas, Black gram

Sweeteners – Honey, fructose, high fructose corn syrup, mannitol, sormito, molasses, xylitol, isomalt.

Some of the Low FODMAPs foods would be

Fruits – Banana, avocado, blackberry, red grapes, kiwi, lemon, lime, tomatoes, olives, oranges ,pineapple, strawberry, papaya, cantaloupe.

Vegetables – Carrots, bell peppers, common cabbage, egg plant, green beans, lettuce, potatoes, radish, cucumber, sweet potato, zucchini, spinach, kale, fennel

Grains –  Rice, corn, amaranth, quinoa, oats, spelt products gluten free products, millets like sorghum, pearl millet, foxtail millet, finger millet, little millet, barnyard millet

Dairy and Alternatives –  All non dairy milk  – almond milk, soya milk, hemp milk, lactose free milk and its products, cottage cheese, butter, ghee, coconut milk, cheese

Legumes – Small amounts of moong dal, green gram whole, tofu, canned beans, canned peas, small amounts of black gram dal as a ingredient in a recipe (dosa, idli)

Sweeteners – Sugar (sucrose), maple syrup, brown sugar.

Apart from the above, all nuts and seeds including most spices are low in FODMAPs. Care may be taken to include the Indian asafoetida as it contains some added gluten.

Approach to Follow a Low FODMAP Diet

Having known the list of various high and low FODMAP foods, it might seem quite easy for anyone to just avoid and include these foods in their diet and comfort themselves that they are following this regimen. Well, it is not as simple as it may sound. Having excluded the so called offending foods, one may still not experience complete relief from symptoms, or maybe they might manifest some other issues over a period of time. Or simply, they might just get tired of following their restrictive diet and just give up some day, only to see a return of symptoms. It may be borne in mind that a low FODMAP diet is not a one to be done lifelong. As explained earlier, FODMAPs are actually beneficial for our gut, but since some individuals may have a ‘sensitive gut’, the aim should be to fine tune one’s diet with at least some of these foods, over a period of time and zero down to the ones that they may be able to tolerate. In short these diets need to be customised to every individual. This is generally achieved over a period of 8 -10 weeks.

These diets are generally recommended for patients with not only IBS, but may be beneficial for those with issues of inflammatory bowel disease or even endometriosis. Secondly, it may not be possible for each such individual to follow or adhere to the diet, may be due to the nature of their work, home environment or anyone travelling a lot, or even anyone with a lot of underlying stress. It is here that the help and guidance of a registered dietician certified in FODMAP diet management would be of great help to successfully manoeuvre through the journey of this regimen. She or he would walk you down the 3 phases of this regimen – Elimination, Re introduction and Personalisation. This would enable the individual to gradually and carefully include at least some of the foods from each category and in a suitable proportion, over a period of time and finally customise to a diet with some FODMAPs rather than a zero FODMAP diet. Moreover, following this diet blindly over long duration could also lead to malnutrition with many nutrient deficiencies or obesity and other disorders.

After all, FODMAP foods are an important component of our diet for a healthy gut with the friendly bacteria which contribute to our overall well being. The only thing is it should be a customised approach to ensure good, balanced nutrition and health.