The Relationship between Nails and Health.

Health, Lifestyle

fingernails main

Human nails are present on the dorsal aspect of all the fingers and toes. A nail is formed by the living cells presents that are present in the ends of the fingers and toes. It’s structure is shown in Figure 1.

Nail structure

Fig 1: Structure of a nail

  • The nail body or plate: Visible part of the nail that remains attached to the nail bed which represents the skin below the nail. 
  • The cuticle (Eponychium): It is the tissue that forms the rim of the base of the nail and overlaps the nail body. 
  • The nail walls or folds: These are the skin folds that supports the nail from three sides.
  • The lunula: This forms the whitish half-moon part at the base of the nail.
  • The nail root: The nail root forms the matrix which is the underlying structure of the nail found under the cuticle.

Growth rate of the nails

The nails grow from its roots and is made of keratin protein that is also seen in skin and hair. The growing of nails occurs when new cells of the nail matrix are formed pushing the older part of the nail to grow outside the edge of the nail body.  

Due to its biological design, the growth rate of a nail is dependent on the age, gender and environmental conditions. The average growth rate of the nails is approximately 0.1 mm per day that is 1 centimeter in 100 days. 

Why look at the nails?

The main function of the nails is to protect the ends of the fingers and toes from injury. 

Shape, colour and texture can often change with an underlying skin disease or an infection (most often fungal). Although, changes in the nails may not be the first sign of a problem, it can often be accompanied with an underlying health condition which is known or unknown to an individual. Hence, a simple examination of the nails can provide a lot of information about the health and the underlying risk of many conditions.

What should be examined about the nails?

  • Changes in the shape of the nails by comparing with the other hand.
  • Discoloration 
  • Changes around the nail
  • Monitor nail growth

Health problems that are reflected in nails

Abnormal shape and structure of the nail:

Clubbing: This is caused by thickening of the nail plate at the base of the nail due to softening of the nail bed that causes the nail to curve inwards.

It can be found doing a test by keeping the index fingers of both the hands together as shown in Fig 2.

CLUBBING

Fig 2: Test for clubbing

Normally, there should be an angle between the upper skin flesh of the nail and the nail plate forming a diamond shape window. If this window is absent and the angle is lost, it creates the “Schamroth sign” that indicates clubbing.

Clubbing can occur in conditions like:

  • Inflammatory bowel disease – inflammatory conditions of the small intestine and the colon involving ulcers that are formed in the intestine.
  • Lung diseases: Lung cancer, chronic bronchitis, Chronic obstructive lung diseases – asthama.
  • Heart Diseases: Congenital heart disease, heart defects and abnormalities

Koilonychia: This explains wasting of tissue under the nail plate causing the nails to become spoon-shaped as shown in Fig 3.

koilonychia spoon shaped

Fig 3: Spoon shaped nail

 This shape is seen in conditions like:

  • Iron deficiency anaemia – low red blood cells or haemoglobin
  • Diabetes
  • Raynaud’s disease- constriction of blood vessels of fingers and toes due to cold or stress.
  • nail-patella syndrome – genetic disorder affecting the nails and the knee caps.

Ripples on nails: This involves pitting of the nails as shown in Fig 4.

nail pits

Fig 4: Rippled Nail

This can occur as an early sign of,

  • Psoriasis (skin infection with scaly patchy skin problems)
  • Arthritis (painful inflammation of the joints).

Beau’s line: Presence of transverse lines or a line on the nail plate as shown in Fig 5,

Beau's lines

Fig 5: Beau’s Line

It can indicate,

  • Severe infection
  • Heart problem
  • Hypotension (Low blood pressure)
  • shock
  • Hypocalcemia (low calcium in the blood)

Cracked thin and brittle nails: This type of nail is shown in Fig 6.

split nail

Fig 6: Cracked nail

Cracked nails:

  • Thyroid problems
  • Metabolic bone disease like osteopenia (loss of bone mass invovingminerals and bone tissue)
  • Malnutrition

Bitten nails or Gnawed nails: Habitual biting of nails or picking causes damage to the nail plate, nail walls and the skin around the nail. 

Gnawed nails

Fig 7: Gnawed nails

Bitten nails:

  • Chronic anxiety problems
  • Obsessive-compulsive disorder

Nail abnormalities related to Colour

Dark lined nail: Blackish dark discolouration seen beneath the nail as shown in Fig 8.

discoloured nail

Fig 8: Nail with dark lines

 This type of discoloration can be seen among,

  • Dark skinned people with pigmentation problems
  • Melanoma (skin cancer)

Blue coloured nails:

Bluish discoloration of the nails also called as cyanosis is shown in Fig 9, can indicate a problem with the oxygen-carrying capacity in the blood relating to respiratory problems.

Cyanosis

Fig 9: Bluish nails

Conditions related to bluish nails:

  • Lung problems- emphysema (a lung condition that damages the air sacs in the lungs causing breathing difficulty)
  • Heart problems

Yellow coloured nails: Yellowish nails (refer fig 10) can also appear thin and cracked in severe cases.

yellow nails

Fig 10: Yellow discolored nail

Yellowish nails:

  • Fungal infections
  • Severe thyroid disease
  • Lung disease
  • Diabetes 
  • Psoriasis

Whitish nails: White nails with a discolored dark rim as shown in fig 11.

white nails

Fig 11: White nails

  • Liver diseases
  • Hepatitis

Nail Beading: Beads formed on the nails look as if it is like melted wax dripping down a candle ( Refer Figure 11). 

nail beading

Fig 12: Nail Beading

Conditions related to beaded nails:

  • Diabetes mellitus
  • Thyroid disorders
  • Vitamin B deficiency

What can you do if you find changes in your nails?

  • If you see any differences in your nail shape, colour or develop changes in your nails, it could be simply because of any deficiency and not necessarily related to an underlying health condition.
  • It is best to consult with a professional in order to get your finger and toe nails examined. You may be asked to undergo a blood test and/or other tests to correctly determine the cause of your health problem.
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Benefits of Human Milk

Health, Lifestyle, Pregnancy

Baby Milk

Human milk provides optimal nutrition for infants and children for improving their health, growth, and development. It contains many unique properties such as nutrients, growth factors, hormones, enzymes, and anti-microbial factors that provide immunity to many acute and chronic diseases.

Macronutrients of Human milk: These include vitamins A, B1, B2, B6, B12, D, and iodine.

Bioactive components: These are elements that can affect biological processes and play an important a role in healthy body function. 

Bio-active Components What are their functions?
Macrophages and stem cells These cells protect against infection and healing.
Immunoglobulins (IgA/sIgA, IgMIgG) Anti-microbial and anti-inflammatory response to microbes and allergens
Cytokines IL-6, IL-7, IL-8, IL-10, IFNγ,   TGFβ,  TNFα Antibody production, Anti-inflammatory, Stimulates inflammatory immune activation
Chemokines (G-CSF,  MIF) Help the gut against infections, help anti-pathogen activity of macrophages
Cytokine Inhibitors TNFRI and II Anti-inflammatory effect
Growth Factors (EGF,  HB-EGF,  VEGF,  NGF, IGF) Protective against damage from low oxygen. Promotion of healing, nerve growth, Stimulation of growth and development, increased red blood cells and hemoglobin
Hormones (Calcitonin, Somatostatin) Regulation of healthy gut (intestines)
Metabolic hormones (Adiponectin, Leptin,Ghrelin) Reduction of infant BMI and weight, anti-inflammatory, regulation of energy conversion and infant BMI, appetite regulation, Regulation of energy conversion and infant BMI
Oligosaccharides & glycans, HMOS, Gangliosides, Glycosaminoglycans Brain development; anti-infectious
Mucins (MUC1, MUC4) Block infections by viruses and bacteria.

Exclusive Breast Feeding

Global guidelines recommend exclusive breastfeeding for an infant for a minimum period of the first 6 months. Exclusive breastfeeding is an infant’s consumption of mother’s milk without the use of milk powder supplements. 

Mother’s health Benefits from breastfeeding 

  • Healthy Breast Cells: Breastfeeding also increases differentiation, or maturation, of the ductal cells in the breast that is believed to increase resistance to cancer growth.
  • Cancer prevention: It is reported that it can reduce the number of menstrual cycles lowering the hormonal exposure that can help prevent cancers grow.
  • Prevents stress and depression post-delivery: During feeding, a hormone called oxytocin is released that is found to promote nurturing and feeling of relaxation to the mother thus improving the mother’s mental health.

Milk Banks 

The world health organization (WHO) supports the use of donor human milk in situations where a mother is unable to produce enough or if the mother’s own breast milk is unavailable.  The milk banks are the non-profitable market in human milk that provide services to the community for babies in need. The main priority of milk banks is to provide milk for fragile and sick babies in Neonatal Intensive Care Units of the hospitals for therapeutic purpose for nutrition. 

Human Milk trade 

The informal market in human milk is rising with great demands of human milk even outside hospital community. Now, human milk can be made available by sharing largely through social media and the Internet-based marketing. It is often called “informed sharing” where Mothers feel safe buying human milk from donors that share their health information online.

Personal Consumption of Human Milk

Many human milk traders are increasingly profiting by selling human milk for personal consumption on the internet. Similarly, it has also been reported that a dessert called “Baby Gaga” an ice-cream recipe that used human milk was being served in one of the restaurants in UK for monetary profits. 

Threat of spread of diseases

  • While the milk itself is sterile via breastfeeding, human milk is usually not collected in a controlled or sterile environment. This can cause contamination of the milk. It has been reported that 93% of breast milk sold online are contaminated.
  • Many serious diseases spread through body fluids. Therefore if human milk is infected with viruses, it can spread life-threatening diseases like hepatitis B and C, Human immunodeficiency virus (HIV-aids) and syphilis.
  • Even if the milk is collected by a sterile technique, if it is not stored in proper conditions, there can be a risk of bacterial growth such as staphylococcus, streptococcus and salmonella microbes leading to an infectious spread.

Community Benefit

It is the responsibility of all the parents and consumers to understand the importance of human milk and to support its use for the purpose of nutrition children in need. It is also important to raise awareness on the trade of human milk and the potential health risks involved to maintain a safe and healthy community.

Why do we sleep?

Exercise, Health, Lifestyle

sleeping problems

What is sleep?

Sleep is a state of altered consciousness of the mind and body which typically lasts for several hours every night. It involves the inactivity of the nervous system, relaxation of all the muscle of the body and is considered important for optimal health.

Sleep pattern

The normal sleep pattern involves the alternating REM (rapid eye movement) and NREM (non-rapid eye movement) sleep that occurs in a 90-minute interval cycle in a typical night’s sleep.

There are four phases:

Stage 1: Light sleep – between being awake and sleeping

Stage 2: Initiating sleep, drop in the body temperature, regular heart rate and breathing.

Stage 3 and 4: The deepest form of sleep when the breathing slows down and the blood supply to all the organs increases, the repair process begin, muscles are relaxed, the blood pressure goes down, various hormones like growth hormone are released.

What is the importance of REM and NREM?

REM makes up about 25% of the night’s sleep: It first begins about 90 minutes after falling asleep. Lasts for some time and recurs about every 90 minutes. In the REM stage, the brain is more active, heart rate is raised and intense dreams can occur. At this stage, brain development occurs as the area of learning in the brain is stimulated.

Like deep NREM sleep, REM sleep also helps protein binding for growth.

During the NREM sleep, the body restores its functions of the brain, repairs and regrows tissues, promotes growth, and improves the immune system.

Benefits of sleep 

Normal Brain function and development: Sleep is essential for maintaining the normal levels of cognitive skills. ( This include speech, memory, innovative and focused thinking.)

Emotional well-being: Sleep can give you a feeling a sense of freshness, motivation and relaxation.

Physical health:

  • Sleep will help maintain hormonal balance in the body. For example, the hormones that regulate hunger and insulin regulation for blood sugar levels.
  • It is involved in the healing process of your heart and blood vessels.
  • It can support growth and development in children and teens by releasing hormones that builds muscle mass and helps the body repair.
  • It plays a role in puberty and fertility. 
  • It can improve immunity and help fight infections better.

Good physical performance levels:

  • Sleep can improve concentration, focus, awareness and general activeness of your body. 
  • It improves your ability to perform skillful activities.

How much sleep is recommended?

Age Recommended Amount of Sleep
Newborn babies about 17 to 18 hours per day
Preschool children about 11 to 12 hours per day
School children Minimum 10 hours per day
Teenagers about 9 to 10 hours a day
Adults (including the elders) about 7 to 8 hours a day

Sleep deficit 

Sleep deficiency can increase the risk for some chronic health problems.

  • Heart disease: Lack of sleep will keep the heart rate elevated leading to increased calcification (calcium deposits) in the blood vessels of the heart. There is also an increase in CRP (C-reactive protein), which is released with stress and inflammation that can lead to heart problems.
  • Obesity: Lack of sleep can interfere with appetite regulation due to imbalances in the hormones that regulate hunger. This can lead to eating at night when your body’s metabolism is low causing excessive fat storage leading to obesity.
  • Diabetes: Due to the increase in food intake and lack of rest, hormonal imbalances can affect the insulin response in the body. The metabolism of glucose is affected due to insulin resistant that can lead to type 2 Diabetes.
  • High blood pressure: With insufficient rest, the heart rate remains elevated. This raises the blood pressure which may cause hypertension.
  • Stroke or transient ischemic attack (mini-stroke):  It is related to elevated heart rate and hypertension that can lead to a reduction of blood supply to the brain leading to a stroke or mini-stroke.
  • Depression and attention-deficit hyperactivity disorder (ADHD): Due to lack of rest and interference in the brain function, lack of sleep can cause problems with thinking, mood swings, depression and hormonal imbalances that may lead to ADHD and depression.

Sleep Disorders – There can be about 81 disorders.

  • Insomnias (Sleeplessness): There can be difficulty at the beginning of sleep, maintaining sleep, abrupt waking from sleep, waking too early or poor quality sleep. This sleep difficulty can occur despite all attempts of trying hard to sleep.  This can be related to mental disorder, restless leg syndrome, sleep apnea or due to drug side-effects.
  • Sleep-related breathing disorders: Cheyne-Stokes breathing pattern is characterized by a gradual increase in the breathing followed by a gradual decrease and holding of breath for 5 to 50 seconds. This type of respiratory problem is also typically seen with other medical problems of the heart and kidney.
  • Sleep apnea: Irregular breathing pattern with disruption or episodes of breathlessness. It can be due to lack of sleep causing arterial oxygen desaturation (reduction in oxygen in the blood).
  • Hypersomnias (Narcolepsy): This involves daytime sleepiness and may be related to dysfunction in the brain due to increased lack of sleep at night or misaligned circadian rhythms (body clock).
  • Circadian rhythm sleep disorder: The “body clock” or the circadian rhythm is the 24-hour cycle that tells your body when to sleep and helps to regulate many other physiological processes. Disturbances can occur between the person’s sleep pattern and the pattern that is desired. For example, one cannot sleep when sleep is desired.
  • Parasomnias: The parasomnias consist of abnormal sleep-related movements, behaviors, emotions, perceptions or dreaming. It occurs while falling asleep, sleeping, between sleep stages, or during arousal from sleep. They are disorders that cause sudden waking up or a state of disturbed sleep.
  • Sleep-related movement disorders: Restless legs syndrome, sleep-related rhythmic movement disorder, large movements of the body or legs while sleeping can affect normal sleep pattern.

Other problems: 

Snoring is a sound produced by breathing. Snoring can also lead to impaired health as it can disturb the sleep of the individual and their sleeping partner. 

Sleep talking and sleep walking can be associated with REM sleep behavior disorder or sleep-related eating disorder. Usually, the person can get a sensation of falling, a sensory flash of walking to a place or a sleep-onset dream that can cause talking or walking. 

Who can be at risk of sleep disorders?

  • Working on odd timings/shifts:  Job timings that are against the internal body clock and working long hours.
  • Lifestyle problems: People who take medications to stay awake to complete tasks and studies. Other problems like alcohol or substance abuse.
  • Known or unknown medical condition: People who take medications that have side-effects that interfere with sleep. People with underlying unknown problems like stress and anxiety.

How is sleep problems diagnosed?

  • Blood Tests can be done to help find other underlying medical problems that can cause sleep problems.
  • Sleep studies (polysomnography): The electric activity in the brain (Electroencephalogram studies), behavior and other changes are observed while the person is asleep to study the problems associated.

How to get a good amount of sleep?

  • Sleep schedule should be kept the same every night. Avoid differences that may disturb your body clock.
  • Avoid strenuous exercise or doing work before bed as that will keep your brain active and delay sleep.
  • Avoid cigarettes (nicotine) and caffeine. Nicotine and caffeine are brain stimulants so both substances can interfere with sleep.
  • Getting enough fresh air and sun during the day can also help a good night’s sleep.
  • Learning relaxation techniques like breathing exercises can help.
  • Taking a warm shower before sleep can also relax the body. Keeping the bedroom cool and dark will also help prevent any disturbances.

If you have any type of sleep issues due to a shift-work schedule, it’s best to speak to your employer or consider visiting the experts to better understand your issues and eliminate the worry of any underlying medical condition.

The 5 Types of Hepatitis

Common conditions, Health, Lifestyle

Hepatitis liver

The liver is a vital organ located in the upper right part of your belly under the ribs.

Functions of the liver:

  • Making bile, a yellowish-green liquid that helps with digestion
  • Producing proteins and blood-clotting factors that the body needs
  • Regulating glucose (sugar) in the blood and stores extra sugar
  • Working with the stomach and intestines to digest food
  • Storing vitamins and minerals
  • Removing toxic (poisonous) substances from the blood

“Hepatitis” means inflammation of the liver. Hepatitis is also the name of a family of viral infections that affect the liver.

There are 5 types:

  • Hepatitis A
  • Hepatitis B
  • Hepatitis C
  • Hepatitis D
  • Hepatitis E

The most common types of hepatitis disease are Hepatitis A, B and C. 

Causes of infection and types –

Hepatitis A: This is caused by consuming food or drinking water that is contaminated with faecal matter (human waste). As compared to other infections of hepatitis, hepatitis A usually improves without treatment.

Hepatitis B: It can be transmitted through sexual contact with an infected partner, through infected blood transfusions and dirty needles. Hepatitis B may scar the liver (cirrhosis) and lead to liver cancer.

Hepatitis C: This is the most common form of viral hepatitis. The exact cause is unknown, but it can happen through blood transfusion of infected blood and blood products, contaminated injections and through injection drug use.

Hepatitis D: Hepatitis D occurs in people with hepatitis B, increasing the severity of symptoms associated with hepatitis B.

Hepatitis E: Similar to hepatitis A, hepatitis E happens among people in countries with unhygienic living conditions where contaminated water and food consumption often leads to a spread of infection.

Which hepatitis is dangerous?

  • Types B and C have been reported more among people leading to a chronic (long-term) illness of liver disease. It is the most common cause of liver cirrhosis (liver tissue scarring) and cancer.
  • In addition, there are vaccines to prevent Hepatitis A and B. However, there is no known vaccine for Hepatitis C.

Period of illness with different types of hepatitis

Acute Hepatitis viral infection: This is a short-term illness that occurs within the first 6 months after someone is exposed to the hepatitis virus. Hepatitis A and E may not cause chronic hepatitis but for some with compromised immunity and delayed treatment, it may lead to chronic infection.

Chronic Hepatitis virus infection: Hepatitis viruses B and C can progress from acute to chronic episodes of illness after about 6months. It is long-term as the virus remains in a person’s body and continues to affect liver cells for years to an extent that there can be a complete liver failure.  

Pathophysiology of Hepatitis infection

Acute infection: The course of the virus is not completely understood but once it enters into the body, it multiplies and the infection persists due to weak immune responses which fails to control the viral spread of infection. Symptoms will appear and continue.

Chronic infection is established with the progression of infection. Liver lesions appear due to the immune responses and inflammation of the liver cells. It also triggers fibrogenesis in which the cells of the liver become hard, thickened and fibrous. This leads to scarring of the liver tissue known as cirrhosis. People with cirrhosis are then at high risk of developing end stage liver disease (ESLD) with hepatocellular carcinoma (cancer of the liver cells). 

Chronic hepatitis

Fig 1: Stages of liver infection with Hepatitis C virus(HCV)

Signs and Symptoms with all types of hepatitis

  • Fever due to infection.
  • Fatigue due to loss of appetite, nausea, and vomiting. Also, lead to long-term weight loss.
  • Abdominal pain due to build-up of fluid in the stomach due to inflammation. This occurs when the damaged liver doesn’t produce enough albumin, a substance that regulates the amount of fluid in cells. This may also lead to Pale colored stools, darker urine.
  • Joint pain: Pain and stiffness are early signs of inflammation caused by the body’s autoimmune response to the hepatitis virus.
  • Jaundice: Bilirubin present in the hemoglobin of the red blood cells can build up and cause your skin and the whites of your eyes to turn yellow. 
  • Brain problems: A build-up of toxins in the brain can cause personality changes. Advanced symptoms include abnormal shaking, agitation, disorientation, and slurred speech.
  • Diabetes: Liver is unable to store excess glucose and too much sugar is present in the bloodstream which may lead to insulin resistance or type 2 diabetes.

Who may be at risk of getting Hepatitis?

  • Infants born to infected mothers can get hepatitis B
  • Travelers to regions with high risk of Hepatitis infection most commonly reported in Asia, Africa, South America and the Caribbean.
  • Sexual contact with infected persons that cause viral transmission through body fluids.   
  • Household members, healthcare professionals and caregivers of infected persons through an accidental transmission.
  • Recipients of blood transfusions who may have accidentally received an infected blood.
  • Long-term hemodialysis patients through an accidental infected needle use or blood transmission.

Diagnosis of hepatitis

Blood tests for the antibodies can be helpful in diagnosing both acute and chronic hepatitis. Physical examination of the symptoms along with diagnostic studies such as ultrasound scan of the liver or a liver biopsy is also done to determine the severity of liver damage.

Prevention and Treatment of Hepatitis

Immunization :

  • Hepatitis A immunization of children (1-18 years of age) consists of 2-3 doses of the vaccine. Adults need a booster dose every 6-12 months following the initial dose of vaccine. The vaccine is thought to be effective for 15–20 years or more.
  • Hepatitis B vaccines provide protection against hepatitis B for 15 years and possibly much longer. All newborns and individuals up to 18 years of age and adult should be vaccinated. Three injections over a 6 to 12-month period are provided for full protection.

Safety Measures to Prevent Hepatitis

  • Hygiene: Wash your hands after going to the bathroom and before cooking or eating.
  • Protective sex: This may lower the risk of transmission. It’s always wise to know the history of your sexual partners, especially if they have an infection, you may run the risk of contracting the disease.
  • Drinking clean water: Avoid tap water when traveling to certain countries or regions.
  • Careful handling of drug needles and use of disposable drug needles only.
  • Avoid sharing personal items such as toothbrushes, razors and nail clippers.

Once diagnosed with hepatitis, the treatment will depend on the type and stage of infection. Most adults recover completely from acute hepatitis A and B within six months period. Mild relapses may occur over time during the recovery of the disease. 

Early detection and treatment show excellent recovery from both hepatitis B and C. Further research development continues to provide a vaccine for hepatitis C.

 

Obesity – Adult vs Children

Common conditions, Food, Health, Lifestyle

Obesity

Obesity is the presence of excessive adipose tissue (fat) mass affecting the health status of any individual to an extent that it may lead to the risk of other serious health conditions. It is one of the most common global health problem replacing the more traditional public health issues.

Obesity in adults vs children

In order to classify an adult as obese, the body mass index (BMI) can be calculated that best classifies an individual according to his height and weight. 

BMI: It is the weight of the individuals body divided by the square of the body height ( expressed as kg/m2). The standard classification of an individual is given in table 1.

BMI good one

Note-BMI is not the best indicator for health as your excessive weight can also be due to healthy bulging muscles rather than fat storage. It does not give information on the fat storage distribution in the body especially in the waist region and cannot be used as a predictor for lifestyle changes and benefits.

Obesity in children  

In infants and children within 5 years of age, the obesity is determined according to the World Health Organization (WHO) “Child growth standards” and the WHO reference values for 5-19 years (body mass index-for-age).

WHO classification (birth to age 5)

  • Obese: Body mass index (BMI) > 3 standard deviations* above the WHO growth standard median*. 
  • Overweight: BMI > 2 standard deviations* above the WHO growth standard median*.

WHO classification (ages 5 to 19)

  • Obese: Body mass index (BMI) > 2 standard deviations* above the WHO growth standard median* (equivalent to BMI 30 kg/m2 at 19 years).
  • Overweight: BMI > 1 standard deviation* above the WHO growth standard median* (equivalent to BMI 25 kg/m2 at 19 years). 
*Growth Standard median: This is the standard of weight given for boys and girls by WHO according to the weight-for-length and weight-for-height of the children at a particular age.
*Standard Deviation: The weight difference of a child when compared to the mean (average) weight of the children belonging in the same age group.

Other classification for childhood obesity

  • Child is overweight: if BMI at or above the 85th percentile* and lower than the 95th percentile for children of the same age and sex.
  • Child is Obese: if BMI is at or above the 95th percentile* for children of the same age and sex.
*Percentile: It is a term used in statistics to give a value of a percentage of a child’s weight compared to the weights of the children of the same age group. For example, a test score that is greater than or equal to 75% of the scores of people who took the test is said to be at the 75th percentile rank.

Measuring Body fat in Adults

Waist Circumference: This method measures excessive fat around the waist and can be used as an additional measure in people who are obese or pre-obese according to the BMI.

For men, a waist circumference no more than 94cm and for women no more than 80cm is considered a safe range. Beyond which, one can develop obesity-related health problems.

Factors that lead to obesity

Genetic factors: The risk of obesity can be more if one or both parents are obese. This relationship of genes and obesity due to the environment and eating habits.

Age: With age, there can be a decrease in the metabolism of the body and loss of muscle mass. If physical inactivity ensues, coupled with bad eating habits, this can easily increase their ability to store fat in the body. Sometimes hormonal changescan also play a role leading to obesity. 

Gender differences: Women tend to gain weight during pregnancy due to hormonal changes.  Hormonal changes including estrogen, progesterone hormones can lead to weight gain. Imbalances in these hormones can also trigger insulin resistance, which in turn, leads to fat storage. In Men, imbalances in testosterone hormone can lead to weight gain. In general, it is observed that women are more at risk of weight gain compared to men also due to lifestyle differences.

Lifestyle:

  • Physical activity: With improvements in modern technology and conveniences, there is an increasing lack of physical activity. 
  • Food habits: Consuming foods with excessive fat, sugar and calorific foods. Increased snacking and overeating can lead to excessive fat storage.
  • Stress and lack of sleep: Both stress and lack of sleep can slow the body’s metabolism. Eating late at night can cause indigestion and leads to fat storage. 
  • Socio-Economic Status: Lack of resources, lack of access to healthy foods, unable to afford healthy foods or improper cooking habits, eating out too often can all lead to obesity.  
  • Side effects of medications: Certain pain medication, corticosteroids, antidepressants, thyroid medications taken by people with thyroid problems and other medicines can slow down metabolism and lead to fat storage. 
  • Known Medical Problem: Arthritis in the lower limb causing pain on weight bearing can reduce physical activity that leads to increasing fat storage.

Diseases such as stroke, kidney disease, Prader-Willi syndrome, Cushing’s syndrome and many others can prevent the person from engaging into physical activities due to pain or muscle/joint problems etc.  

Consequences of Obesity

obesity problems

Metabolic problems: 

The major metabolic risk factors resulting from obesity are

  • An increase in the total cholesterol concentrations especially triacylglycerol concentrations, and high-density lipoprotein (HDL) concentrations.
  • High blood pressure
  • Diabetes: Insulin resistance and glucose intolerance.

All this may lead to Metabolic syndrome that describes a group of risk factors that can increase the risk of developing a heart condition. 

Diabetes: Obesity can lead to deficiencies in sex-specific steroid hormones (estrogen, progestin etc) that causes insulin resistance and a decrease in glucose metabolism. 

Coronary Heart Disease (CHD): Metabolic syndrome and diabetes can lead to atherosclerosis and blocking of the major arteries of the heart leading to a heart condition.

Osteoarthritis: Osteoarthritis (OA) is an inflammatory condition that can be caused by obesity. Excessive weight gain can lead to wear-and-tear of the cartilage and bone leading to inflammatory joints. Other reasons underlying the relationship between obesity and osteoarthritis can be metabolic changes associated with increased fat storage. 

Pulmonary disease: Excessive weight gain in the upper body can increases breathlessness that will lead to CO2 retained in the body and a mismatch in the ventilation and blood flow that further worsens the respiratory system.

Hypertension: The exact cause is unknown, however, due to weight gain there is an increase in resistance to blood flow to and from the extremities. Increases in body mass index (BMI) can put an individual at a higher risk of developing hypertension. 

Gallbladder disease: Obesity is associated with increased secretion of cholesterol in the gallbladder that increases the risk of gallstones particularly cholesterol gallstones.

Hormonal disturbances: Increased obesity in women leads to increased male hormone (testosterone) production leading to hormonal imbalances. Upper body obesity is associated with an increase in testosterone that may be a major cause of problems related to menstruation. Obese men can also get hormonal problems that lead to erectile dysfunction. Childhood obesity can cause early puberty and hormonal problems later in adulthood.

Some forms of cancer:  There is an increased risk of growth of cancer cells in various body tissue among obese people. 

Fatty liver: Nonalcoholic fatty liver disease, a condition in which fat storage is excessive in the liver that can cause inflammation of the liver tissue and scarring(Cirrhosis).

Various psychological problems: There has been increased links of obesity with depression and mood problems possibly due to underlying hormonal problems or other conditions.

Prevention and Treatment 

  • Realistic healthy weight loss goal

Comprehensive lifestyle changes: 

  • Dietary changes: Avoid calorific or sugary foods. Developing meal plans to track what you consume. Seeking advice from a specialist to know what nutrients you are lacking or how to go about the changes. 
  • Increasing physical activity
  • Exercise: 3-4 times per week for 30 minutes each. 
  • Group support: Joining a weight loss group can help psychologically and improve motivational level toward achieving your goals.
  • Relaxation and stress management

Adherence to a weight loss program is important to bring about changes and to prevent health problems due to obesity. For further detailed assessment and treatment, it is best to consult an expert for individualized weight loss programs.

Why is Deep Vein Thrombosis Dangerous?

Common conditions, Exercise, Health, Lifestyle

DVT What is thrombosis?

Thrombosis is a process by which there is clotting of the blood in a part of the circulatory system. This causes a partial or total obstruction thus preventing blood from flowing normally through the circulatory system. This clot is known as a thrombus. 

What is Deep Vein Thrombosis(DVT)? 

A blood clot (thrombus) in the deep venous system is known as DVT. These clots are formed in the deep veins which are a part of the circulatory system that helps bring deoxygenated blood back to the heart. These veins have one-way valves that function to transport blood from various parts of the body to the heart as shown in Fig 1.

veins of our body

Fig 1: Deep veins of the body

Which body part can be affected with DVT?

There is a greater risk of developing DVT in your lower limbs than upper body as the deep lower limb veins work harder to carry blood back to the heart with forces from the body weight and gravity acting on them at the same time. In addition, if there are other factors that increases the pressure exerted on the valves in the deep lower limb veins, there are more chances of blood collecting within the veins thus making the lower limbs deep veins more susceptible to DVT.

Why is DVT dangerous?

There is a risk of a partial or complete detachment of this thrombus formed in the deep veins. This allows the thrombus to move with the blood flow and block other blood vessels. This process is called as venous thromboembolism.

pulmonary embolism

Fig 1: Thromboembolism

As shown in Fig 1, the thrombus blocks the blood vessel and cuts off the circulation to a particular body part or organ. This will lead to a lack of oxygen to the tissue (ischemia) and a loss of tissue function. The clot can also reach other blood vessels that supply the vital organs of the body, putting the body at a dangerous risk of stroke, lung, heart problems and post-thrombotic syndrome (PTS).

Post-thrombotic syndrome is a chronic(long-term) problem that occurs with DVT and involves chronic leg pain, swelling, redness, and ulcers (sores).

How does a thrombus form in the deep veins?

Blood clotting is the transformation of liquid blood into a semi-solid gel. The blood has a protein called fibrin. Fibrin is usually in its inactive state but when tissues or blood vessels are damaged, it becomes active. This process is called coagulation. The main reason of thrombus formation can be explained by the Virchow’s triad as shown in fig 2.

cause of thrombus

Fig 2: Main causes of thrombus formation

Conditions of prolonged bed rest or immobility which could be lifestyle-related or due to other reasons may cause stasis of blood within the veins that may lead to clot formation. Also, if there is an imbalance of the coagulation and anti-coagulation factors in the blood which may be caused by an injury or acute/chronic inflammation to the blood vessel walls may cause blood clot formation.

Who is at risk of developing DVT?

  • Anyone with vein trauma due to broken hip or leg fractures during accidents.
  • Long periods of air travel coupled with lack of movement in sitting position can cause excessive swelling in the legs and stagnation of blood flow leading to clot formation.
  • Bed bound individuals post-surgery, muscular paralysis from a spinal cord injury, pregnancy or having recently given birth, especially by C-section, causing swelling and lack of calf muscle strength that impair blood circulation in the legs.
  • People with inherited blood clotting disorder.
  • People who have cancer as tumors shed particles that contain procoagulant activity.
  • Smoking affects blood circulation and stiffens the blood vessel wall making a smoker at higher risk of DVT.
  • Side-effects with the use of hormone therapy, including that used for postmenopausal symptoms among women.
  • Individuals with varicose veins, which are swollen, twisted and painful may develop clots.
  • People with a history of heart attack, stroke or congestive heart failure have high levels of cholesterol in the blood that lead to inflammation and possibly clot formation.

Signs and Symptoms of DVT

  • Pain, swelling and tenderness in one of your legs (usually your calf)
  • Affected area can be very painful and heavy.
  • Warm skin in the area of the clot.
  • Redness of the skin, particularly at the back of your leg below the knee.

How is DVT diagnosed?

A physical examination may not be enough as there may be individuals with no possible signs of DVT. Diagnostic tests will be necessary to confirm the condition.

  • Doppler ultrasound scan:  A clot may be visible in the image. Sometimes a series of ultrasounds are done over several days to determine whether a blood clot is growing or to detect any formation or movement of a clot.
  • Blood test: An elevated level of a clot-dissolving substance called D dimer will be found in the blood.
  • Venography. A dye (contrast agent) is injected into a large vein in your foot or ankle. An X-ray procedure is then undertaken that creates an image of the veins in your legs and feet, to look for clots. 
  • CT or MRI scans. Both computerized tomography (CT) scan and magnetic resonance imaging (MRI) can provide visual images of your veins and may detect any clot formed. 

When to seek medical care?

  • If you get swelling, redness, and pain in your leg, it may indicate a blood clot and immediate medical attention should be given. Sometimes there may not be any signs or symptoms or these symptoms could be due to other inflammatory condition or infection, therefore, it is difficult to make the diagnosis without seeking medical advice.
  • If there is associated pain in the chest or breathlessness further concern exists that you may be at risk of a pulmonary embolus. This could be a potential danger hence if you are at risk its best to discuss with your doctor about taking medications for preventing clot formation.

How to prevent DVT?

  • Compression stockings for bed bound individuals.
  • Early ambulation Post-surgery – getting the individual out of bed walking to allow good circulation of blood. If not possible, use a continuous passive motion (CPM).
  • Low dose of anti-coagulants can also be prescribed by the doctor.
  • During long flights, it is recommended to move frequently and/or use compression stockings.
  • Ankle exercises can help pump the blood from the legs upwards to the heart.
  • Lifestyle modifications –  smoking cessation and increased exercise.

If in doubt or experiencing any of the symptoms, always seek medical advice immediately. When detected early, it’s much easier to deal with.

What is Blood Pressure?

Exercise, Health, Lifestyle

Blood pressure main

What is blood pressure (BP)?

Blood pressure is the pressure exerted by the circulating blood on the walls of the blood vessels.

What system is it part of and why?

BP is a part of the blood circulatory system, which is also known as the cardiovascular system(Refer Fig 1)

  • The heart
  • The blood vessels – arteries and veins
CirculatorySystem

Fig 1: The Circulatory System

The heart acts as a pump that is responsible for,

  • pumping oxygenated blood carried by the arteries to our organs
  • pumping deoxygenated blood that it receives through the veins from our organs. 

One of the functions of the circulatory system is to regulate the blood pressure for maintaining good blood flow throughout the body. This is required in order to transport nutrients and oxygen for every body part, for regulating body temperature, pH balance and for normal functioning of the body.

For example, when the heart pumps out oxygenated blood through the arteries, the blood flow exerts a force on the walls of the arteries. This force is measured as arterial blood pressure as shown in Fig 2. Any problems with this arterial BP may lead to a problem with the normal functioning of the body.

blood pressure

Fig 2: Arterial Blood pressure 

How is Arterial BP measured? 

The instrument that can measure the blood pressure is called Sphygmomanometer (Refer Fig 

Sphygmomanometer

Fig 3: Sphygmomanometer

It consists of:

  • a cuff,
  • a pump, and
  • a calibrated mercury scale

Typically two numbers that are being recorded on the scale which is written as a ratio. For example, BP of 120/70 mmHg, where 120 is the top number and 70 is the bottom number.

BP Measurement

Fig 3: Measuring BP

As shown in Fig 3, the BP is measured in four steps,

Step 1: Locate the pulse on an artery of the arm

Step 2: The health professional wraps the cuff around your arm and inflates it to squeeze your arm. This is done to temporarily press on the artery and close the blood flow in your arm. 

Step 3:  After the cuff is inflated, the health professional will slowly let air out. While doing this, he or she will listen to your pulse with a stethoscope and watch the mercury level on the calibrated scale to accurately note the measurements. The first pulse sound is heard and simultaneously measured on the scale.

Step 4: As the successive pulse sounds continue the professional hears it until the last pulse sound is heard which is again measured. 

The scale used is in “millimeters of mercury” (mmHg) to measure the pressure in your blood artery.

Blood pressure numbers- what does it indicate? 

systole and diastole

Fig 4: Systole and Diastole of the heart

The top number- Systolic pressure

The top number, which is also the higher of the two numbers, is the measure of the pressure in the arteries when the heart beats or contracts to pump the oxygenated blood. This is also known as the systole of the heart as shown in fig 4. 

The bottom number- Diastolic pressure

The bottom number is also the lower of the two numbers. It indicates the pressure in the arteries when the heart muscles are relaxing between two heart beats and refilling with blood. This is also known as the diastole of the heart as shown in fig 4.

BP Categories

Fig : BP Categories

Fig 5: BP Categories

Typically more attention is given to the top number (the systolic blood pressure), however, both the systolic and the diastolic pressures are important for indicating if a person is at risk of any heart disease.

What are the risk factors that will lead to high or low BP?

Risk factors

High BP

Low BP

  • Family history of High BP
  • Advanced age
  • Men get High BP more than women
  • Sedentary lifestyle
  • Poor diet, excessive salt intake
  • Drinking too much alcohol
  • Obesity
  • Smoking
  • Stress
  • Sleep apnea- a sleep disorder in which tissues in the throat collapse and block the airway.
  • Prolonged bed rest
  • Pregnancy
  • Trauma- loss of blood from major trauma, dehydration or severe internal bleeding
  • Certain medications
  • Abnormally low heart rate 
  • Endocrine problems- thyroid problems, Diabetes
  • Severe infection
  • Severe allergic reaction
  • Anemia
  • Nutritional deficiency- low blood volume due to Vit B12 and folic acid deficiency
  • Extreme heat- hot sauna and hot bath

When to seek Medical help?

There’s a common misconception that people will experience symptoms such as nervousness, sweating, difficulty sleeping or facial flushing. But the truth is that changes in blood pressure can be a symptomless condition. If you ignore your blood pressure because you think symptoms will alert you to the problem, you are actually taking a risk. It is important to know your blood pressure numbers as everyone should prevent blood pressure problems.

However, there are few signs and symptoms that may possibly occur with low and high BP. 

Signs and symptoms 
High BP Low BP
  • Severe headaches
  • Severe anxiety
  • Shortness of breath
  • Nosebleeds
  • Blood spots in the eyes
  • Facial flushing

 

  • Dizziness or lightheadedness
  • Fainting
  • Dehydration and unusual thirst
  • Lack of concentration
  • Blurred vision
  • Nausea
  • Cold, clammy, pale skin
  • Rapid, shallow breathing
  • Fatigue
  • Depression

 

How to manage BP problems?

Routine Check-up: Most people are unaware of their BP problems and going for a check-up will detect any blood pressure problems. This will prevent any potential health conditions. 

Understand your normal level of BP: There is no healthy level of high blood pressure or low blood pressure.  Your healthcare professional will determine your treatment goals based on your overall lifestyle and your body.

Lifestyle modifications

  • A nutritional diet, which may include reducing salt depending on High or low BP, Vitamin and mineral rich diet.  
  • Physical activity – exercise
  • Maintaining a healthy weight
  • Stress management
  • Smoking cessation support
  • Alcohol limitations
  • Prescribed medication in specific cases

Take precautions while exposed to heat 

When your body gets heated up during hot weather or during a hot tub or sauna bath, your blood pressure could drop and your heart rate may increase to counteract a drop in blood pressure. Normally, these events don’t cause problems. However, if you have an existing low BP you may be at risk of fainting, falls and heart problems.

Some of the precautions can be,

  • Limit your exposure to heat. Most experts say no more than five to 10 minutes is safe.
  • Stay hydrated.
  • Regulate water temperature during hot tub or sauna baths.

Conclusion

Managing blood pressure requires an individual’s adherence to the lifestyle changes and habits. It is advisable to get early assessment and treatment of your blood pressure problems in order to have a healthy circulatory system and to prevent the risk of many health conditions.    

Alcohol Flush Reaction – Why does it happen?

Common conditions, Food, Lifestyle

drinks

Many people experience a prompt reddening on their face after few drinks of alcohol. It is called “Alcohol flush reaction” and is also known as “Asian flush syndrome” due to its greater prevalence among Asians. The reaction is often considered to be a sign of natural body protection mechanism from excessive drinking. What might seem like an unexpected natural reaction is, in fact, a sign of alcohol intolerance. An associated risk factor to many health conditions.

Alcohol tolerance vs Intolerance

Alcohol tolerance is the ability of the body to metabolize alcohol and reduce its concentration in the blood. When the body and the brain are subjected to alcohol, it activates the liver to produce large amounts of liver enzymes for the breakdown of alcohol to flush out any toxic products of alcohol out of the body.

Alcohol intolerance is the inability of the liver to break down alcohol. It is related to a genetic disorder of aldehyde dehydrogenase gene (ALD­H2) that is responsible for normal functioning of the liver enzymes. Due to its absence, a toxic by-product of alcohol called ac­etalde­hyde builds up in the blood which causes intolerance.

Acetaldehyde in the blood triggers Alcohol flush reaction. It also releases a chemical called histamine in the body that causes inflammation and aids allergic reaction.  

Signs and Symptoms of high levels of blood acetaldehyde

  • Redness and flushing

One of the earliest reaction of Alcohol flush involves a persistently red face (refer Fig 1) due to enlarged blood vessels. This may also be seen on the chest and neck region.

before and after alcohol

Fig 1. Alcohol Flush Reaction

  • Palpitations

Acetaldehyde increases palpitation which is a sensation within the chest that brings awareness of an irregular or racing heartbeats.

  • Increased heart rate

An increase in heart rate is seen with increased levels of acetaldehyde. It causes the blood vessels to dilate, making the heart pump harder and faster for the blood to flow through relaxed blood vessels. 

  • Low blood pressure

Blood pressure is the pressure of blood in the circulatory system. Due to the alcohol reaction, the heart beats faster pumping out less volume of blood and dropping the blood pressure. One may feel light headed and dizzy which can get severe.

  • Extreme drowsiness and headaches

The direct cause is unknown, however, it is believed that due to the expansion of the blood vessels in the brain, histamine release and low blood pressure one may get extreme drowsiness and headaches. 

  • Pruritus (Itching)

This is an unpleasant sensation that provokes the desire to itch or scratch. This happens due to irritated nerve endings on the skin caused by histamine released by the acetaldehyde levels in the blood.

  • Nausea

A feeling of vomiting starts as the acetaldehyde levels in the body irritate the stomach lining, leading to inflammation (gastritis). 

  • Alcohol-induced asthma

Increased levels of acetaldehyde and histamine release in the body can trigger breathlessness due to constriction of the airway. It is often reported to appear after approximately 30 minutes post-alcohol consumption.

Risk Factors associated with people who get Alcohol Flush Reaction 

  • Esophageal Cancer

 Acetaldehyde in the blood is known to interfere with the DNA synthesis and repair mechanism and increases the risk of cancer by producing free radicals that are known to destroy healthy cells.

  • Alzheimer’s disease:

Alzheimer’s disease is a neurological disorder in which the death of brain cells causes memory loss and affects brain function. Research has claimed that genetic disorder related to the aldehyde enzyme also interact with the brain cells which are believed to be a risk factor of Alzheimer’s disease. 

  • Heart disease

 Continual drinking of alcohol among people with Alcohol flush reaction will affect the functioning of the heart and may lead to the risk of heart problems.

  • Liver disease 

Acetaldehyde causes oxygen deficits in the liver (hypoxia), including formation of harmful compounds that damage the cells of the liver leading to a liver disease.

Are you sensitive to alcohol or is it something else? 

If you are only experiencing this reaction with specific alcohol beverages. This may suggest that it is not alcohol intolerance but could be due to other ingredients involved that triggered the reaction. 

What can be done about the Alcohol flush reaction?

There is medication available to help with the flush. However, these drugs can only curb the redness but will not be able to break down the acetaldehyde levels in the body. Thus, individuals who drink often and use drugs to suppress the flushing will still be at risk of developing a health problems.

The best way to prevent alcohol flush reaction and minimise health issues is by not drinking alcohol at all. This may however be an unrealistic solution to many especially during social events.

There are few things one could consider that may help reduce the alcohol flush reaction:

  • Eating before alcohol consumption.
  • Having drinks with lower alcohol content.
  • Alternate alcoholic drinks with water or non-alcoholic drinks.

Like all things, always consume alcohol in moderation. Alcohol is a depressant, but it’s also an indirect stimulant. Never drink and drive. Medication can help mask the reaction but if you feel that it’s more than just a flush, always seek immediate medical attention.

Ankle Injuries – Sprain, Strains and Fractures

Common conditions, Exercise, Injury, Lifestyle, Pain

Ankle sprain main

An ankle injury is the most common type of injury that may involve the bones of the ankle and other soft tissue structures. Three are three types of injuries that are observed at the ankle:

  • Sprains
  • Strains
  • Fractures

Sprains are injuries to the ligaments that connect one bone to another. An ankle sprain may involve an injury to one or more ligaments that stabilize the ankle and the foot. 

Strains are injuries that involve musculotendinous (muscle and tendon) structures. Both sprains and strains can occur due to over-stretching or tearing of the ligaments and tendons due to sudden twisting of the ankle joint or when excessive forces are applied on them.

Fractures are injuries that involve bones of the ankle joint. It ranges from a simple break in one bone to several fractures, which causes your ankle to move out of place and puts you in great pain.

Who could be at a risk of an ankle injury?

Ankle injuries may occur among,

  • Dancers
  • Sports persons- Gymnasts, basketball players, players participating in jumping sports etc.
  • Women wearing unstable high heels
  • Hypermobile people who already have laxed ankle ligaments 

Types of Ankle injuries

  • Lateral ankle injury

This is the most common injury to the ankle. Often, an inversion sprain could be an associated with a fracture and a strain to the peroneal tendons.  

An inversion sprain happens when the ankle in twisted inwards with an inward rolled foot as shown in Fig 1.

inversion injury

Fig 1: Lateral ankle injury

  • The Medial ankle injury

This type of injury occurs at the inner aspect of the ankle. Like a inversion sprain, the eversion sprain may also be associated with fractures of lower ends of the leg bones and strains to the tibialis anterior muscle.  

Eversion sprain happens when the ankle is twisted out with the foot rolled outwards as shown in Fig 2.

eversion injury

Fig 2: Medial ankle injury

High Ankle Injury

This type of injury is very rare. A high ankle sprain happens when the tibia bone rotates injuring the ligaments that hold the lower end of the two leg bones (tibia and fibula) as shown in Fig 3.

Severe injuries may cause fracture to the lower ends of the leg bones.

syndesmosis injury

Fig 3: High ankle injury

Severity of an ankle sprain 

An ankle ligament sprain can be graded according to the severity of the tear in the ligaments as shown in Fig 4.
 
lateral ankle sprain

Fig 4: Grades of ankle sprain

Sign and Symptoms of Ankle Injury
 
    • Swelling: Increased fluid in the tissue due to inflammation and soft tissue damage.
    • Pain:  Depending upon the severity of the injury and the structures involved, pain intensity can vary. 
    • Redness/ Warmth/ Tenderness: Caused by increased blood flow to the area.
    • Unstable ankle: The affected side feels weak and difficult to weight-bear.
    • Deformity: Severe injuries can cause fractured bones to move out of place and make the ankle look deformed.
Causes of Ankle Injury
Trauma
  • Stepping in a hole or a stone
  • Running on uneven ground
  • Fall or slippage on wet floor
  • Contact injury during sports like basketball, when a player is accidentally hit by an opponent causing the foot to roll inwards as shown in Fig 5.
Basketball

Fig 5: Lateral ankle sprain during basketball

Muscle imbalances

Lack of flexibility in muscles can hamper joint movement. For example, if the calf muscles are very tight, it will affect the stability and mobility of the ankle joint. In such a state, if one engages in any physical activity like running there could be a potential risk of twisting an ankle. Sometimes even lack of warm-up and stretching could be the cause of muscle imbalances.

  • Lack of Postural control

Postural control is defined as the act of maintaining, achieving or restoring a state of balance during any posture or activity.

It helps to maintain a good base of support for balance so that the force of gravity can act on the center of mass (COM) of the body. Centre of mass is the point in the body where the entire body weight is concentrated (located in the lower end of the spine) as shown in Fig 6.

Figure_10_03_05

Fig 6: Line of gravity and base of support

During sports, sudden quick body movements or external forces like a push or a contact by an opponent will affect your balance. If you lack postural controlm you may lose balance and risk hurting your ankle. 

Diagnosis of an ankle injury

Most ankle injuries are usually straightforward ligament strains. However, the clinical presentation of subtle fractures can be similar to that of a ankle sprains and these fractures can be easily missed on initial examination. Fractures are usually detected via X-ray scans. If any fracture is left untreated, it may cause excessive pain and disability to an extent that you may not be able to bear weight on the joint. Therefore, an X-ray or an MRI scan is often recommended to understand the severity of the injury.

For example, a lateral ankle sprain showing fractured bones in an X-ray is shown in fig 7. 

ankle sprain with bone fracture

Fig 7: Lateral ankle sprain with fracture of the lower end of fibula bone

Ankle Injury management

Usually, ligament injuries heal in about 6-12 weeks and fractured bones take about 3-6 months to heal. This is however largely dependent on the severity of the injury and lifestyle of the individual so complete healing time frame may vary. 

Even after the healing process, ankle injuries may cause long term instability if not healed correctly. This may also be the cause of recurrent ankle sprains. An expert assessment of ankle mechanics is very important to decide on how long to protect and rehabilitate an ankle after an injury. The treatment plan will aim to restore the normal functions of the ankle and make return-to-play decisions based on the stability of the ankle thus preventing recurrent ankle injuries.

The ‘Wee’ problem about Asparagus

Food, Lifestyle

ASPARAGUS

The asparagus is a tall plant belonging to the lily family and is cultivated for its edible shoots. The tender young shoots of this plant are eaten as a vegetable and is well known for its health benefits.  However, for some, there can be a distinct odor in their urine after consuming this vegetable. 

Brief History of Asparagus cultivation

Asparagus was first known in ancient greek mythology, where the descendants of the greatest greek hero “Theseus” of Athens planted and protected asparagus by law and out of respect for the ancestors. Formal cultivation of asparagus came into being in Roman times (234-149 B.C). It became more popular in Europe, when John Gerard in 1597 called the plant “asparagi ” which he translated to signify “the first spring or sprout of every plant, especially when it be tender”.

Asparagus and Odorous Urine

The phenomenon of asparagus causing odorous urine was first documented in the 18th century. French botanist, Louis Lémery, reported a link in its ingestion causing the production of odorous urine. John Arbuthnot, a Scottish mathematician and physician to Queen Anne, noted in a book on foods first published in 1731, that asparagus affected the urine with the distinct smell (especially if eaten when they are white). French novelist, critic and essayist Marcel Proust described his experience with asparagus to be like a Shakespeare’s fairy-tale story that transforms his chamber-pot into a flask of perfume.

What causes the “Asparagus Wee Phenomenon” 

With the use of soil fertilizers containing sulfur, it is believed that the sulfate components from the soil must have been absorbed by the asparagus plant. It was believed that upon digestion, this produces an odor in the urine. But why is it that other foods like garlic, parsley, cabbage and egg that contain sulfur do not create the same odor in the urine? This is as the asparagus has a unique component of sulfur that even after digestion, stays present in the urine.

Odor producing component in Asparagus

A sulfur derived asparagusic acid (1,2-dithiolane-4-carboxylic acid) is believed to be the main component that produces the odor. This acid is known to be deadly to insects and has a higher concentration in young asparagus. Through digestion, asparagusic acid is converted to methanethiol and other dimethyl components that causes the smell in wee.

Detectors and Non-detectors

The asparagus urine phenomenon does not affect all asparagus-eaters! 

Research tells us that although every asparagus-eater produce smelly components in their urine, there is a variation in:

1. the amount of smelly components one produces.

2. the ability of one’s nose to detect the sense.

There is no known scientific evidence of any clinical problems associated with the production or detection of the asparagus odor.

Despite this, the asparagus has many health benefits that make it one of the most healthy vegetables.

Benefits of Eating Asparagus 

  • Anti-inflammatory action

Asparagus contains a good amount of beacasparanin A, sarsasapogenin, protodioscin, diosgenin and many flavonoids that have been reported to reduce inflammation in the body. It will help in reducing chronic inflammation which is one of the causes for many conditions of heart, liver, joint etc. 

  • Anti-diabetic

The extracts from asparagus have amino acid asparagine and chromium that improves insulin secretion which is responsible for glucose metabolism in the blood. 

  • Anti-oxidant 

Asparagus is rich in glutathione, a detoxifying agent that can help destroy carcinogens. 

  • Rich source of Vitamin B 

Asparagus has a rich content of B vitamins (B1, B2, B3, B5, B6, B7, B9, B12 ) that helps to turn the food we eat into energy, it metabolizes sugars and starches, decrease in fatigue. It is essential for healthy skin, hair, and nails. It helps in cell regeneration that help repair and constant renewal of the skin. Vitamin B12 helps protect against unhealthy cholesterol levels, stroke, high blood pressure and cancer.

  • Aid digestion

Asparagus contains a substance called “inulin” that acts as a prebiotic which is used by good bacteria to improve nutrient absorption. Also, the vegetable has a high fiber content that helps get food through the gut more smoothly. Therefore, can provide relief from digestive discomfort.

  • Improves brain function

The folate in asparagus works with the vitamin B12 to helps cognitive function which mean it improves the mental process of knowing, including aspects such as awareness, perception, reasoning, and judgment.  

  • Diuretic 

The diuretic and alkaline properties of asparagus help flush out the kidneys and eliminate water retention in the body. It contains a substance called asparagine that makes it the remedy of choice for urinary tract problems.

Considering the health benefits of asparagus, it would be wise to ignore the odorous urine and still consume the vegetable. If the smell is an issue, try eating older asparagus instead of young shoots. Though older asparagus have a woodier stem and will need that extra bit of peeling, its sulfate content is much lower yet they have the same amount of nutrients as the younger ones.