Archives for October 2016

October 10, 2016 By Dr Ashwin Nanda 1 Comment

SHEDDING LIGHT ON DEPRESSION

Last year, when the famous Bollywood actress Deepika Padukone opened the lid on her struggle with anxiety and depression and admitted to the world that she was on medication for the same, it became the talk of the town. Everyone started discussing mental health, there were articles in Newspapers, TV channels interviewing the actress and asking her to tell her story. Padukone became an example for many to come out and discuss their issue without fear. Why so? Because depression and mental illness isn’t usually talked about. There is shame and stigma attached to talking about depression. Today, on world health day, I would like to share some insights into depression and what needs to be done when in that situation.

My first experience in dealing with depression was when I was still in Medical school. My very close friend from medical school went through depression. It was then I realized that one needs a lot of empathy and patience to understand what someone is going through in depression. The extreme low mood during depression is such a bad feeling that no one chooses to be depressed by choice …it’s either circumstances or medical conditions that push an individual into depression.

My friend had slipped into depression due to a heart break. The impact was so huge that he withdrew himself from studies, friends and family. He slept longer than usual 8 hours, ate less and experienced terrible mood swings. He refused to talk to anyone and eventually turned suicidal. It is at this point that we had to rush him to the psychiatry department of our college hospital.

The psychiatrist talked to my friend privately for 15 minutes and then to his parents and me privately for another 10 minutes. Then, called us all in and sat us down and explained to us that my friend was suffering from an episode of major depression and medication was a must.

None of us were comfortable that he needed medication to recover from depression but, as counseled by the doctor, avoiding medicines wasn’t an option as he was feeling suicidal. Fifteen days later he started feeling better by 10% and the counselor started weekly sessions with him on the recommendation of the Psychiatrist to expedite recovery. Thankfully my friend recovered completely to his normal self in 6 months’ time and medicines and counseling were discontinued.

It is said that one in every four people suffer from anxiety and depression. According to WHO (World Health Organization) 350 million people worldwide suffer from depression in a year. By the year 2020, it will be the second most common disorder after heart disease. The chemical changes occurring in the brain during depression is a reduction in the level of Serotonin, dopamine and nor adrenaline – these are neurotransmitters (Chemicals which are produced by brain cells).

SOME COMMON SYMPTOMS OF DEPRESSION:

Loss of interest / pleasure in activities which were previously enjoyable.
Decreased energy.
Feelings of guilt and low self – worth.
Disturbed sleep and appetite.
Poor concentration.
Substantial impairment in the person’s ability to handle his/her daily responsibilities.
At its worst it can make the person suicidal.

All symptoms are mild in the beginning and gradually increase in intensity over time.

RISK FACTORS:

Genetics – If you have an immediate family member who has experienced major depression, there is a likelihood that you will also have an episode in your lifetime.
Financial hardships and low education levels.
Female Gender – depression is two to three times more likely in women as compared to men. Depression setting in after delivery of child occurs in some cases.
Chronic illnesses like diabetes, tuberculosis, arthritis.
Exposure to violence / Abuse especially in childhood.
Being separated / divorced especially for men.

MANAGING DEPRESSION:

It is important to recognize depression and take it seriously. Going to a psychiatrist is a must

Mild cases can improve with counseling and psychological therapy (depending on the cause of depression, the person is taught coping mechanisms). Severe cases need anti-depressants along with psychological therapy. Self help is equally essential.

Some self help tips:

Create a daily routine and try to stick to it.
Exercise releases endorphins in the brain which give a feeling of happiness, hence daily exercise is a must to recover and prevent depression.
Try to eat a healthy and balanced diet daily.
Openly communicate with family members and loved ones about what you are experiencing to foster relationships and get support.
Avoid alcohol and recreational drugs as they worsen depression.
Be patient with yourself. For someone with depression even the smallest tasks can seem impossible.

Depression is treatable and plenty of help is available to assist a person cope with it and get back to leading a normal and enjoyable life.

October 7, 2016 By Dr Darshana Salve 2 Comments

Pregnancy – A New Beginning

Seeing two pink lines (positive) on the pregnancy test strip and confirming the pregnancy after the doctor’s visit knew no boundaries to their happiness.

But, with each passing week of the pregnancy came not only new excitement but, also doubts whether the changes taking place inside the body were normal or not.

Here’s an insight intoPregnancy.

The entire pregnancy is about 38 weeks plus minus 7 days. If the baby is born before 37weeks then it is a pre-term delivery whereas if the delivery happens after 42weeks then it is called a post-term delivery.

Pregnancy is divided into 3 trimesters and each trimester is 3 months.

The first trimester is the most crucial to your baby’s development. During this period, your baby’s body structure and organ systems develop. Most miscarriages and birth defects occur during this period. Inculcating a healthy lifestyle during this period is very important as the foetus depends on its mother for nourishment. During this period have a balanced diet, compromised of proteins, carbohydrates, fats, vitamins and minerals. Make sure you include Folic acid tablets which are essential for normal brain development of the baby.

In this period the expectant mother may not put on weight, rather she may lose some due to morning sickness. She needs 300-350 calories more than her normal requirement during this period. Do not stop eating because you feel nauseated but, try and include foods that you like and that are light on your stomach. Proper diet and exercise ensures foetal health and growth.

Physical changes that normally occur during the First Trimester (1-3 months).

-Nausea (morning sickness) with or without vomiting.
-Increased frequency of urination
-Food cravings
-Breast heaviness and darkening of the areola.
-Constipation,gases or heartburn
-Occasional headaches

-Fetal heart sounds can be heard during the sonography by the 5^th week of pregnancy.

Emotional changes

-Happiness,euphoria,fear or irritability
-Frequent mood swings
-Confused mental state if the pregnancy was unplanned

The Second trimester

The Second trimester of pregnancy is often called the “golden period” because many of the unpleasant effects of early pregnancy disappear. During the second trimester, you’re likely to experience decreased nausea, better sleep patterns, and increased energy levels. You need to supplement with Iron and Calcium tablets as prescribed by your Doctor.

Physical changes that normally occur during Second Trimester (3-6months).

-Decreased nausea and vomiting and increased appetite
-Fatigue and giddiness
-Constipation and bloating
-White discharge from the vagina
-Mild swelling of ankles and feet and leg cramps
-Weight gain 4-6 kgs
-Lower abdomen and back discomfort
-Darkening of skin and stretch marks on tummy

Emotional changes

-Joy of looking pregnant due to enlarging tummy
-Excitement about feeling the fetal movements.

It is advisable to get the Anomaly Scan by the 20^th week of pregnancy to check if there are any congenital defects in the baby like Down’s syndrome, cleft lip or palate and heart and spine abnormalities.

Along with the Anomaly scan, if the Mother is less than 30years of age then the Double Marker blood test is recommended and if she is more than 30years of age then the Triple Marker test is recommended which is used for detecting chromosomal abnormalities that might occur after the conception. 1 in 700 births can have chromosomal abnormalities.

You have now reached your final stretch of pregnancy and are probably very excited and anxious at the same time for the birth of your baby. Some of the physical symptoms you may experience during this period include;

-Large, itchy abdomen and breasts with protruding umbilicus (navel)
-Gentle uterine contractions (Braxton Hicks Contractions) (false labor)
-Leaking of breast milk from the nipples
-Shortness of breath
-Difficulty in sleeping
-Increased constipation and occasionally piles
-Increased in foetal activity (kicking)
-Fatigue and breathing difficulty

Emotional changes

– Anxiety about labour and baby care.
-Excitement about shopping for baby and preparing for the baby nursery.
-Irritability and impatience about reaching the due date.
-“Nesting instinct” – Nesting is the act of preparing your home (cleaning, stockpiling and organizing) for your baby’s arrival.

How do you know you are in labour?

Blood tinged or brownish vaginal discharge.
Diarrhoea
Fluid gushing or leaking from the vagina means the membranes of the amniotic sac that surrounded and protected the baby have ruptured.
More frequent and intense painful Contractions.

Look out for these signs and know that your baby is on its way. Contact your Doctor and prepare for the delivery. Labour can be absolutely exhausting extending anywhere between 12 to 36 hours but, always remember the end result is the joy of holding your precious baby in your arms and knowing that this is your perfect creation. It’s not the end but the beginning of a beautiful journey.

October 6, 2016 By Dr Darshana Salve Leave a Comment

Pregnancy- Not by Chance!

Whether it is shopping for groceries, clothes, perfumes, appliances etc., we are extremely choosy and want to go for the best. There is no doubt in the fact we would not want to compromise for anything that is not up to the mark. But, sadly, I find that same is not the attitude when it comes to our own body. Whether it is taking care of our body to be fit and healthy or whether it is to take care of it prior to planning a family.

It is very important to realize that one of the pre requisites to conceive a healthy baby is that both the father and the mother must be in the best of health and there are no two ways about it.

Holistic preconception is about nurturing the mind/ emotions, body and spirit to create the most ideal environment for creating and cultivating life. While, much attention is placed on the mother’s health, we know that the health of the sperm is equally important as that of the egg and womb. Precisely why both egg and sperm should be addressed with the intention of increasing fertility and minimizing exposure to toxins.

Prior to starting, both the parents should undergo a complete health check-up (e.g. Medical history, Genetic history, Blood tests- to check for thyroid levels, hemoglobin, Vitamin B12 & Vitamin D, folic acid, Blood sugars). If any medical condition is detected prior, it will only help to correct the situation before conception and reduce the risk of complications in pregnancy like gestational diabetes, gestational hypertension, thyroid disorders and anemia.

Start the regime mentioned below, three months prior to your planned conception and continue it till you conceive.

How to prepare for a healthy conception-

Diet– Diet should include folic acid rich food. Folic acid plays an important role in the production of red blood cells and helps baby’s neural tube develop into a brain and spinal cord.

e.g. Vegetables-Cluster Beans (Gavarfali), Spinach (Palak), Lady Finger, Tomatoes, Broccoli, Beetroot, French beans.

Curds
Cereals/pulses
Dry fruits- Walnuts (2), Almonds(4)

Eat unrefined, fresh and homemade food as much as possible.

Exercises

Exercise is one of the most important aspects of keeping your body healthy. All exercises improve the blood flow to the pelvic organs, including the male and female reproductive organs which is beneficial to conceiving. (http://goqii.com/blog/excercises-pre-pregnancy-a-good-start-is-half-done/).

Remember “A mother’s health has direct correlation with her baby’s health” , so the earlier you start, the better.

Lifestyle

Stop smoking. Avoid alcohol completely. Avoid drugs – both pharmaceutical drugs for chronic conditions and recreational drugs. Avoid caffeine. Avoid exposure to X-rays and Radiations.

Stress

Relaxation techniques – Meditation, massage, or Yoga have been known to help people with stress.

Express your thoughts and worries to your spouse, this will eventually strengthen the bond between the couple & always think positive.

Hydration

Water is the simplest method of detoxifying and 2-3 liters are recommended daily.

Stopping contraception

Stop hormonal pills and remove intrauterine device (IUD) if any, about 3 months before conception is planned. Use a barrier method (like condom) at this time. Allow a minimum of one normal menstrual cycle between stopping contraception and conception.

Dental care

If there are any dental problems (e.g. cavity) get it treated before you conceive. Oral infections are associated with premature labor.

A happy healthy mother is equal to happy healthy baby. Martin Luther once said, “Maternity is a glorious thing, since all mankind has been conceived, born, and nourished of women. All human laws should encourage the multiplication of families”.

May this amazing journey of parenthood begin in a holistic healthy way.

October 4, 2016 By Komilla Pareek 1 Comment

High Fructose diet and Vitamin D

We are all aware that lack of sun exposure and spending more time indoors makes us prone to Vitamin D deficiency. But, did you know that Vitamin D deficiency could also occur due to an unhealthy diet –especially one that is loaded with high fructose.

In fact, what led me to write this blog is a recent conversation with a close friend of mine. Anita, as I knew her was always conscious about her diet and what she ate. Her seemingly healthy breakfast included packaged cereals and fruit yogurt. Trying to keep her meals small and frequent, her snacking included salads from fast food joints and her quick fix dinner at home mostly comprised of fruit juices with a veg sandwich.

But, something seem to bother hear off late. When I casually asked her how she was doing and that she looks a bit perturbed, she mentioned about her recently diagnosed Vitamin D deficiency at the age of 35 years.

What triggered the check up? Well she had a fall and fractured her right hand. It intrigued me to find out more. Anita was also keen to find out if there was anything in her diet that had led to the Vitamin D deficiency. She was obviously under the impression that she was eating healthy.

As a nutritionist, let me tell you that the sunshine vitamin-Vitamin D, can have reasons other than insufficient exposure for its deficiency. Fast paced lifestyle and dependence on packaged foods pointed to high fructose in the diet, which could be a major cause. Precisely, what triggered the deficiency in Anita as well? Surviving on packaged foods is not a good idea at all.

Fructose, as we know is a fruit-sugar; unfortunately, it’s not fruits from where we get most of the fructose in our diet. A large part of fructose in our food enters via HFCS – High fructose corn syrup which is an alternative to sugar in most packaged foods.

This low cost sweetener is favorite of food processing industries.Being stable in acidic foods and beverages, HFCS is attractive alternative to sucrose and is found in many unsuspecting packaged foods such as – Packaged fruit juices, carbonated drinks, breakfast cereals, flavored yogurt, salad dressing, ketchups, soups, sauces, nutrition bars etc. Baked products such as biscuits and breads, which is a classic case of ‘HFCS camouflaged with the whole grain marketing’.

When we consume high levels of fructose, an enzyme called 24-hydroxylase (which is responsible for degrading vitamin D₃) becomes more active, while another enzyme, 1α-hydroxylase (which helps synthesize vitamin D) becomes less active. As a result of this high level of fructose consumption, the body tends to start breaking down whatever levels of Vitamin D you have. In other words Fructose reduces blood levels of active Vitamin D.

Vitamin D in the form of calcitriol plays a critical role in maintaining calcium levels in blood. It regulates active calcium transport in the intestine, helping increase its absorption from food. In fact, in Vitamin D deficiency, we absorb only about 10 to 15% of the dietary calcium we eat!

We need calcium for proper functioning of nerves and muscles, including the cardiac muscle –Heart. When calcium levels go too low,in its survival mode body starts pulling calcium from bones. Boom: suddenly we enter a state of bone-tissue breakdown, because of a chain of events initiated by excess fructose. Over time, skeletal health becomes compromised, and the risk of osteopenia, osteoporosis, and fracture may go up.

A study published by PLOS One in April 2014 demonstrated that a chronic intake of high levels of dietary fructose can lead to a decrease in circulating levels of Vitamin D and also creates physiological increases in calcium requirement. They quoted this finding as highly relevant since fructose, a sugar contained in many types of foods that are being consumed at high levels, may contribute to the increasing prevalence of vitamin D insufficiency, especially in sensitive populations with high, processed sugar intakes. (http://journals.plos.org/plosone/article?id=10.1371%2Fjournal.pone.0093611).

Before it’s too late, cut down on your fructose intake. Less than 40 g of fructose from whole foods sources per day is a great target. For reference, that’s what we’d get from 1.3 whole mangoes or 3.5 apples. Yes, 2-5 servings of fruit per day (depending on fruit choice, stick to max 2 if high fructose fruit) is perfectly fine!