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Editor speak Volume-2
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July-Aug 2011
Editor Dr. M.a Kamal Chief Editorial Adviser Dr. Pradeep Bhardwaj National Head Afzal Kamal Sr. Manager I.A Khurshid Cheif Correspondent SA Rizvi l Dr HN Sharma Design and Layout Vikas Sales and Marketing Amjad Kamal Rahul Ranjan Neetu Sinha S.Y Ahmed Khan Subscribtion & Cirrculation Pallavi Gupta All right Reserved by all everts are made to insure that the information published is correct, Medgate today holds no responsibility any unlikely errors that might occur.
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Spicy food and stress cause stomach ulcers Researchers have only recently begun to understand the many, often complex, diseases that affect the digestive system. Accordingly, people are gradually replacing folklore, old wives’ tales, and rumors about the causes and treatments of digestive diseases with accurate, up-to-date information. But misunderstandings still exist, and, while some folklore is harmless, some can be dangerous if it keeps a person from correctly preventing or treating an illness The truth is, the majority of stomach ulcers are caused either by infection with a bacterium called Helicobacter pylori (H. pylori) or by use of pain medications such as aspirin, ibuprofen, or naproxen, the so-called nonsteroidal antiinflammatory drugs (NSAIDs). Most H. pylori-related ulcers can be cured with antibiotics. NSAID-induced ulcers can be cured with time, stomach-protective medications, antacids, and avoidance of NSAIDs. Now that it is appreciated that H. pylori and NSAIDs are the cause of most ulcers and patients are being managed appropriately, the ulcers that are coming to medical attention are increasingly likely to be unrelated to H. pylori or NSAIDs. Spicy food and stress (except when associated with extreme medical conditions) may aggravate ulcer symptoms in some people, but they do not cause ulcers. Ulcers can also be caused by cancer. Constipation: Habitual use of enemas to treat constipation is harmless. It is not clear whether or not habitual use of enemas is harmless since there has been very little study of the effects of enemas or laxatives over the long term. Early studies showed that laxatives might injure the colon if taken chronically by impairing contraction of the colonic muscles, and this finding was extrapolated to include enemas. The data from the studies is not strong, however. In fact, some physicians feel that enemas are preferred over laxatives since they are a more “natural” means of stimulating a bowel movement. (Enemas mimic a large amount of stool in the rectum, the usual stimulus for a bowel movement.) An ongoing need for enemas is not normal; you should see a doctor if you find yourself relying on them or any other medication to have a bowel movement.
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Content
News Update 6 Risk of Hypomagnesaemia with PPIs 8 USFDA Gives Green Signal to Levofloxacin 9 Natural Infection May Also Cause Bowel Disorder
Thyroid gland Implications in women
Heartburn
26 16 Meniscus injury
16
14 S C ruling saying hospital need not wait for legal formalities - Dr. Pradeep Bhardwaj
32 Geriatric Dentistry: Beautiful Teeth at any Age
Product Line
High Cholesterol
50
NEWS UPDATE
Risk of Hypomagnesaemia with PPIs
A
recent international safety advisory has warned of a potential association between prolonged use of proton pump inhibitors (PPIs) and serious hypomagnesaemia-related adverse events such as tetany, seizures, delirium and cardiac arrhythmias. While this occurs rarely, prescribers should be vigilant to PPI-associated hypomagnesaemia. Patients presenting with hypomagnesaemia may require PPI discontinuation. Suspected PPI-induced hypomagnesaemic hypoparathyroidism was first reported in the literature in 2006, based on two cases identified in Australia. To March 2011, the TGA had received 2545 reports of suspected adverse reactions to PPIs, six (0.2%) of which were reports of hypomagnesaemia. In five cases, the PPI was the only suspected medication and serum magnesium levels returned to normal after the PPI was discontinued. In two of these cases a subsequent fall in serum magnesium levels was reported after an alternative PPI was prescribed. The underlying mechanism is unclear; however, extrarenal magnesium wasting by impaired intestinal magnesium transport or intestinal loss has been proposed. The presentation of patients with mild-to-moderate hypomagnesaemia may be asymptomatic or non-specific. Patients with severe hypomagnesaemia often have coexistent hypokalaemia and hypocalcaemia, which can contribute to potentially life-threatening sequelae such as tetany, seizures and cardiac arrhythmias, and may not be easily corrected without magnesium supplementation. For several of the cases reported in the literature, magnesium supplementation was only partially effective at correcting the hypomagnesaemia while PPIs were n a breakthrough on treatment of heart continued.For further information disease, scientists at the University College on magnesium homeostasis and London have discovered a new stem-cell abnormalities, see the overview in treatment that could allow the heart to heal Australian Prescriber. itself after an attack. Paul Riley and colleagues While most of the TGA reports and have identified a rich source of dormant stem those analysed recently by the US Food cells in the epicardium, the innermost layer of and Drug Administration occurred in the sac, which surrounds the heart, reports New patients who had been taking a PPI Scientist They also found that thymosin beta-4, for longer than one year,5 there is no a peptide naturally produced by the body, could way to reliably predict those who may reawaken and mobilise these stem cells to repair be at higher risk. Other medications heart damage. They showed that mice in the (e.g. loop and thiazide diuretics) may lab were more likely to survive a heart attack if cause or worsen hypomagnesaemia. they had received daily injections of thymosin Prescribers should be vigilant to the beta-4 a week beforehand. Their stem cells were potential risk of hypomagnesaemia active within 24 hours of the attack instead of in patients requiring long-term PPI a week, and they produced larger numbers. The treatment. Patients developing treated mice regrew more heart muscle than the hypomagnesaemia may require untreated mice and their hearts pumped better. PPI discontinuation.
New stem-cell treatment allows
broken heart to repair itself
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6
July - Aug 2011
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NEWS UPDATE
USFDA Gives Green Signal to
Levofloxacin
U
S Foods and Drug Administration (USFDA) has given approval to the launch of its Levofloxacin injections. These injections are synthetic fluoroquinolone antibiotic and are available in the American market. Levofloxacin injections can be used to treat bacterial infections including respiratory tract infections, cellulitis, urinary tract infections, prostatitis, anthrax, endocarditis, meningitis, pelvic inflammatory disease and traveller’s diarrhea. A vaccine that prevents the most common cause of severe diarrhea and dehydration in babies was associated with a potentially life-threatening bowel disorder in a large study from Mexico and Brazil, but the risk was small. Investigators with the CDC and health agencies in Latin America concluded that between 1 in 51,000 and 1 in 68,000 vaccinated babies given the rotavirus vaccine Rotarix, manufactured by GlaxoSmithKline, could be expected to develop intussusception, a condition in which part of the intestine slides into another part of the intestine, like parts of a telescope. Another rotavirus vaccine, Wyeth Lab’s RotaShield, was withdrawn from the market in the U.S. in 1999 less than a year after its introduction. At the time, the FDA determined that the vaccine caused intussusception in 1 in 10,000 babies who got it.
Bowel Risk Not Limited to
T
Rota Shield
he new study confirms that the bowel obstruction risk was not limited to the withdrawn vaccine, but it also makes it clear that the benefits of vaccination far exceed the risks, epidemiologist Umesh D. Parashar, MD, of the CDC’s National Center for Immunization and Respiratory Diseases. According to health surveillance data from Mexico and Brazil, about 80,000 hospitalizations and 1,300 deaths are prevented in the two countries every year by vaccinating babies against rotavirus. If the rotavirus vaccine-associated risk in the United States is the same as in Latin America, Parashar says vaccination is probably responsible for 50 to 60 cases of intussusception each year nationwide, while preventing 40,000 to 50,000 rotavirus-related hospitalizations. “The risk with the vaccines we have now appears to be five to 10 times lower than that seen with RotaShield,” he says. “And the benefits far outweigh the risks both in the United States and elsewhere.” Rotavirus is responsible for more than 500,000 deaths each year, primarily in underdeveloped countries, but it is also a significant cause of childhood illness in more affluent nations. Before the introduction of the rotavirus vaccine, as many as 70,000 rotavirus hospitalizations and about 60 deaths were reported in the U.S. each year. 8
July - Aug 2011
NEWS UPDATE
Natural Infection May Also Cause
Bowel Disorder
R
otarix is one of two rotavirus vaccines licensed for use in the United States. The other, Merck’s RotaTeq, was not used in the Latin American populations included in the newly reported study, but researchers in Australia have reported a small intussusception risk with that vaccine, Stanford University professor of microbiology and immunology Harry Greenberg, MD, notes in an editorial published with the study. “We can infer from these studies that any orally administered live rotavirus vaccines will probably carry some detectable risk of intussusceptions ... and that the risk seems to be small,” he writes. In a news release, Williams notes that vaccination may not actually increase intussusception risk, because it now appears that natural rotavirus infection can also cause the bowel obstruction. Children’s Hospital of Philadelphia rotavirus vaccine researcher Paul A. Offit, MD, agrees. Offit, who is a co-developer of the RotaTeq vaccine, tells WebMD that vaccination may prove to be associated with a lower risk for intussusception than natural rotavirus infection.
T
HERCEPTIN APPROVED FOR GASTRIC CANCER
he TGA has approved trastuzumab (Herceptin®) for the treatment of advanced gastric cancer. The approval follows results from the phase III trastuzumab in gastric cancer (ToGA) clinical study that showed trastuzumab in combination with standard chemotherapy prolongs the lives of patients with HER2positive advanced gastric cancer compared to chemotherapy alone (13.8 months vs.11.1 months). 10
BARIATRIC SURGERY EASES
MIGRAI N E
W
eight-loss surgery can alleviate migraine in severely obese individuals, a small observational study finds. After undergoing bariatric surgery obese migraine sufferers experienced significant improvements in frequency and severity of their headaches, the study of 24 obese people with migraine found. The average number of headache days decreased from 11.1 to 6.7, after losing an average of 49.4% excess weight. Patients who had greater weight loss were more likely to experience a 50% or greater reduction in headache frequency July- Aug 2011
NEWS UPDATE
Death toll mounts from
encephalitis in Bihar
H
ealth experts have finally identified the “killer disease” which has killed close to 40 children, aged between two and eight years, in the past week, creating panic among the families. The experts came to this conclusion after two days of extensive examination of victims in city hospitals and a study of symptoms noticed in them. All the victims had displayed high fever and bouts of unconsciousness as well as convulsions. “Right now we can say the reason for the deaths of children is encephalitis but at this stage it’s difficult to say what kind of encephalitis it is — whether Japanese or viral one. This can only be ascertained after a detailed clinical test,” Dr I.P. Chaudhary, a member of three-member central team from Federal Health Ministry, told the media. The team was rushed to affected areas of Bihar on Tuesday on the directive of the Federal Health Minister Ghulam Nabi Azad on Chief Minister Nitish Kumar’s request. During the course of the study, the experts also came to know that the disease spread fast owing to lack of awareness among the villagers about hygiene and nutrition. The team also found the majority of the victims were from slums and were malnourished. Majority of the deaths have been reported from Muzaffarpur, a north Bihar district located close to Patna.
12
FORTIS CLOSES FISCAL YEAR WITH NET PROFIT OF RS 124 CR
F
ortis Healthcare (India) Ltd., Asia’s largest private healthcare provider with a network of 56 hospitals (Including eight projects in the pipeline),
today announced the audited consolidated results for the three months and twelve months ended March 31, 2011. The year witnessed a significant addition in operating bed capacity through the commissioning of three Greenfield hospitals and six Brownfield hospitals in various parts of the country. Furthermore, the company added new verticals focused on diabetes and dialysis, which will enhance accessibility to quality healthcare services. During the year, various strategic initiatives were undertaken to improve the offerings, elevate the medical programmes and improve employee skills to enhance the patient experience and bring about better clinical outcomes. JulyAug 2011 May - June
NEWS UPDATE
S C ruling saying hospital need not wait for legal formalities to be done will I quicken delivery of critical treatment-
T
he supreme court says hospital should not wait for police or legal formalities “whether medico Legal or not to treat an accident victim. Research conducted recently by the six sigma health care shows that in India 80%percent of people only watch when a mishap happens only 20 percent try to help and five percent succeed . Dr. Pradeep Bhardwaj , CEO, Six sigma says he has encountered many strangers bringing in accident Victims, who are willing to wait till necessary formalities are over,. Sometimes they even leave their ids in case they are needed in future .But he is not so thrilled by the judgment. What people don’t Realize is doctors will land in trouble by the taking the decision to operate on their own This verdict will save accident victims life .
Dr. Pradeep Bhardwaj CEO, Six Sigma Health Care
Gord Srongly Linked to Non-Cardiac
Chest Pain
G
astro-oesophageal reflux disease (GORD) is a major factor in non-cardiac chest pain in both women and men according to a combined UK and Australian review. The review reported an almost five-fold increase in the odds of non-cardiac chest pain in people who also had symptoms of GORD and this increased according to the frequency of GORD symptoms. The prevalence of non-cardiac chest pain was higher (16%) in Australian studies compared to an average prevalence across global geographical regions of 13%. 14
July- Aug 2011
EXPERT VIEWS
Meniscus injury Part-I
M Dr. Ashwani Maichand M.S. (Ortho) M.Ch (Ortho) Fellowship Joint Replacement Senior Consultant & Head Joint Replacement Unit
Dr. B L Kapur Memorial Hospital 16
eniscal injury is a major cause of functional impairment of the knee. For many years the meniscus was treated with disrespect as an unnecessary appendage that could be sacrificed with the first hint of malfunction. As long term results after major meniscectomy were disappointing, a conservative clinical approach to the management of meniscal tears has developed over the past two decades. Meniscal preservation is emphasised, as the menisci play important roles in weight July- Aug 2011
EXPERT VIEWS
Meniscal tears are common in sports and non-sports related injuries. The long term protective effect of the menisci on the joint surfaces has been well documented. Meniscal preservation should be the goal of treatment. When surgery is indicated, minimally invasive arthroscopic techniques can adequately achieve this goal.
bearing, stabilisation, and energy absorption. In recent decades, a shift towards meniscal preservation has led to the development of new surgical techniques. This article will review the basic science of the semilunar cartilage and current approaches to diagnosis and treatment of meniscal injuries. ANATOMY AND MENISCUS The semilunar cartilage gained its name from
July - Aug 2011
the C shape appearance reminiscent of the moon as the month begins. Arising from the tibia, the menisci serve to deepen the surface of the tibial plateau. The menisci are crescents roughly triangular in cross section, covering one half to two thirds of the articular surface of the corresponding tibial plateau. The outer rims of the menisci are convex and attached to the knee joint apsule. The inner edges are concave, thin, and free. 17
EXPERT VIEWS
The medial meniscus is C shaped and occupies 50% of the articular contact area of the medial compartment. Its posterior horn is wider than the anterior horn. The anterior horn is attached firmly to the tibia anterior to the anterior cruciate ligament (ACL). The posterior horn is attached immediately in front of the attachment of the posterior cruciate ligament (PCL). The outer border of the medial meniscus merges with the knee joint capsule. The coronary ligament attaches the meniscus to the upper tibia. The lateral meniscus is more uniform in width and circular. It covers 70% of the lateral tibial plateau. The anterior horns of the lateral and medial menisci are attached to each other through the transverse (intermeniscal) ligament.
Type of Meniscus Injury A Meniscus tear can be classified in various ways – by anatomic location, by proximity to blood supply, etc. Various tear patterns and configurations have been described. These include: • Radial tears • Flap or Parrot-beak tears • Peripheral, longitudinal tears
• Bucket-handle tears • Horizontal cleavage tears • Complex, degenerative tears
Symptoms of a meniscal tear
can include “popping,” catching, locking and buckling of the knee, mild synovitis and joint line pain. Physical assessment for meniscal damage often includes the McMurray test. On its own, the McMurray test has limited sensitivity and specificity and is subject to a fair degree of interrater variability. MRI is often used in the diagnosis of meniscal tears, but it is an imperfect diagnostic tool. In one series of asymptomatic adults, MRI findings consistent with meniscal tears were found in 12 of 74 (16%) people. To be continued in next issue.....
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July - Aug 2011
DOCTOR SPEAK
Thyroid gland Implications in women
Thyroid disorders are commoner in women than in men, by about 2 to 5 times, according to various studies. Women more often have anti-thyroid antibodies in their blood, as compared to men.
Write up is shared by
Dr. Suman Bijlani Director at Gyneguide
20
T
he thyroid gland has profound effects on the woman’s menstrual cycles and fertility. Thyroid disorders can affect pregnancy adversely too. The incidence of thyroid disorders is about 4 to 5% in the general population. Thyroid disorders are commoner in women than in men, by about 2 to 5 times, according to various studies. Women more often have anti-thyroid antibodies in their blood, as compared to men.
ensue. • Hypothyroidism can increase the hormone prolactin in the blood, the excess of which may prevent ovulation and cause delayed or absent periods. • The incidence of miscarriage in women with anti-thyroid antibodies may be twice as high, compared to those who don’t. • Anti-thyroid antibodies may affect her chances of conception too, whether by natural means, or through assisted reproduction.
Thyroid and PMS A large number of sufferers of PMS are found to be suffering from ‘subclinical hypothyroidism’, though the exact link between thyroid and PMS does is not known. Undiagnosed or uncontrolled hyporthyroidism is also linked to depression, which may contribute to PMS.
Pre-pregnancy planning All women planning a pregnancy should consider testing for thyroid disease.
Thyroid and fertility The thyroid gland may impair a woman’s ability to get pregnant, due to the following reasons: • Abnormal thyroid function may lead to anovulation (inability to produce an egg monthly) and menstrual irregularities. • In some cases, thyroid dysfunction may lead to a “short luteal phase”. The luteal phase is the period between ovulation (egg production) and the next menses. During this phase, the uterus prepares itself to nurture the fertilized egg. If this phase is short, it may be unable to sustain the fertilized egg and early pregnancy loss (miscarriage) can
Thyroid and menses The thyroid gland as well as a woman’s menstrual cycles, are both controlled by the endocrine system. Since the two are closely related, menstrual problems are often associated with an abnormal thyroid function. Hyperthyroidism often causes lighter periods, while heavy periods with prolonged bleeding can often be seen in women with hypothyroidism. The frequency of menstruation is also related to thyroid disease. Hyperthyroidism may cause infrequent periods and sometimes stop menstruation completely. Hypothyroidism can lead to more frequent periods. Thyroid and pregnancy Thyroid hormone is critical to normal development of the baby’s brain and nervous system. During the July - Aug 2011
DOCTOR SPEAK
first three months, the fetus depends on the mother’s supply of thyroid hormone, which it gets through the placenta. At 10 to 12 weeks, the baby’s thyroid begins to function on its own. The baby gets its supply of iodine through the mother’s diet, and utilises it to produce its own thyroid hormone. Pregnant women need more iodine in their diet, which can be ensured by consuming iodised salt. Cretinism or congenital hypothyroidism most commonly results from iodine deficiency in the mother’s diet. The diagnostic dilemma The thyroid gland enlarges slightly in healthy women during pregnancy, but not enough to be detected by a physical exam. A noticeably enlarged gland can be a sign of thyroid disease and should be evaluated. Some symptoms of hyperthyroidism are common features in normal pregnancies, including increased heart rate, heat intolerance, and fatigue. Similarly, some features of hypothyroidism are common to pregnancy too, like constipation, lethargy, swelling and muscle cramps. That makes the diagnosis of thyroid disorders relatively difficult. The levels of thyroid hormones as well as of TSH (thyroid stimulating hormone) may vary widely in pregnancy. Hence, results of thyroid tests should be interpreted with caution. All pregnant ladies should undergo testing to rule out thyroid disorders. Hypothyroidism in pregnancy This is a very common disorder of the child bearing age group. The thyroid hormone is crucial to fetal brain development, hence, undiagnosed or inadequately controlled hypothyroidism in the first three months can lead to learning and developmental disability in the baby. The more significant the hypothyroidism, the greater July - Aug 2011
the likelihood of developmental problems. The treatment is simple i.e. replacement therapy. The hormone thyroxine is given in the tablet form Uncontrolled hypothyroidism during pregnancy can also lead to
• miscarriage • low birthweight • stillbirth • anemia—a disorder in which the blood does not carry enough oxygen to the body’s tissues • congestive heart failure • preeclampsia (increase in blood pressure)
daily. It is safe for the fetus as well. Since the needs for this hormone may fluctuate throughout pregnancy, the thyroid hormonal evels should be tested every two months and dosing be changed as and when needed. Hyperthyroidism in pregnancy Hyperthyroidism occurs in 1:500 pregnancies. Often it is caused by autoantibodies, hence women may show an improvement in the condition towards the second half of pregnancy because of immune suppression
Uncontrolled hypothyroidism during pregnancy can also lead to
• miscarriage • premature birth • low birthweight • preeclampsia—a dangerous rise in blood pressure in late pregnancy In severe uncontrolled cases or undiagnosed ones, the following conditions may result
• congestive heart failure • thyroid storm—a sudden, severe worsening of symptoms
which occurs normally in pregnancy. Women with hyperthyroidism may benefit from selenium supplementation before and during pregnancy. These auto-antibodies can stimulate the fetal thyroid gland and cause hyperthyroidism in the newborn, which can result in rapid heart rate that can progress to heart failure, poor weight gain, irritability, and sometimes an enlarged thyroid that can press against the windpipe and interfere with breathing. Women with Graves’ disease and their newborns need close monitoring by their health care team. 21
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DOCTOR SPEAK
Cow’s milk
Protein Allergy More Frequent question should and when one start cow’s milk.
M Dr. Rajiva Kumar Child Specialist
24
ilk is the first food to be introduced in human. Exclusive breast feeding is recommended for first six months unless contraindicated. It is best possible food for 1st six months of life, however, Cow’s milk has ben promoted as a perfect food for children, high in protein, calcium and healthy calories, But there are fact Cow milk protein is associated with allergy cow milk protein allergy (CMPA) Prevalance various from 2-7.5 % Cow milk may cause, anaemia, autism diabtes, Heiuer’s syndrom (milk in duced chronic pulmonary desease) and even cancer. Anaphylaxis and cutaneous, respiratory and gastro intestinal reaction may occur. Most important allergen of cow’s milk alpha-lactalbumin, Beta Lactoglobulin and casein allergi 5% pateint attain tolerance within 2 years after diagnosis of CMPA, 80 % attain tolerance -3-4. years. Now a question arise when one should give cow’s milk or not to give at all. In my veiw one
July - Aug 2011
DOCTOR SPEAK
should introduce yogurt first because its enzyme and bacteria result in amoredigislitle product, if no obvious symptum occur then try milk. I don’t recommend cow’s milk when Children are at least 18-24 month. Second thing one should avoid milk that contains basic growth harmone, antibiotics and pecticide that means one should drink only organic milk. These chemical may be responsable for some of the health problem associated with milk. Use organic dairy product (ice cream, Chees Chocolate) where ever possiable.
July - Aug 2011
25
COVER STORY
D
espite its name, heartburn has nothing to do with the heart (although some of the symptoms are similar to a heart attack). Heartburn is an irritation of the esophagus caused by acid that refluxes (comes up) from the stomach. Heartburn is also a symptom of more serious gastro esophageal reflux disease, or GERD. When swallowing, food passes down the throat and through the esophagus to the stomach. Normally, a muscular valve called the lower esophageal sphincter (LES) opens to allow food into the stomach (or to permit belching); then it
Heartburn Heartburn (a symptom of gastro-esophageal reflux disease or GERD) occurs in one-quarter to one-half of all pregnant women. It usually begins in the first or second trimester of pregnancy and continues throughout the remainder of the pregnancy. closes again. Then the stomach releases strong acids to help break down the food. But if the lower esophageal sphincter opens too often or does not close tight enough, stomach acid can reflux or seep back into the esophagus, damaging 26 26
it and causing the burning sensation we know as heartburn. Not only can stomach acid in the esophagus cause heartburn, but it can also cause ulcers, strictures (narrowing) of the esophagus, and cancer of the esophagus. Most people have felt
heartburn at one time or another. In fact, the American Gastroenterological Association reports that more than 60 million Americans experience heartburn/GERD symptoms at least once each month. Though uncomfortable, July - Aug 2011
COVER STORY
heartburn does not usually pose a serious health problem for most people. However, if heartburn symptoms occur frequently and persistently, it may be a sign of a more serious problem, such as gastroesophageal reflux disease (GERD). GERD is a chronic reflux of acid into the esophagus. Left untreated, GERD can cause a host of complications, including esophagitis, esophageal ulcers, hoarseness, chronic pulmonary disease, and Barrett’s esophagus (a
change in the lining of the esophagus that increases the risk of developing cancer of the esophagus). July - Aug 2011
Precaution to avoid heartburn • Avoid eating quickly. • Eat several small meals every day. • Do not eat fried foods. • Avoid spicy foods. • Avoid tomato products. • Limit or avoid chocolate. • Don`t eat mustard or vinegar. • Sit up straight instead of slouching. • Stay awake after you eat rather than lying down. • Use pillows to elevate your head and chest while sleeping. • Drink milk. • TUMS are safe during pregnancy. • Avoid caffeine, carbonated drinks and alcohol. • Avoid acidic foods and juices. • Do not gain an unnecessary amount of weight.
Pregnancy and Heartburn
Heartburn (a symptom of gastro-esophageal reflux disease or GERD) occurs in one-quarter to one-half of all pregnant women. It usually begins in the first or second trimester of pregnancy and continues throughout the remainder of the pregnancy. Fortunately, the heartburn is usually mild and intermittent, but frequently enough, it is troublesome or severe. Complications of GERD (esophageal bleeding, trouble swallowing, loss of weight, etc.) are uncommon. In non-pregnant circumstances, heartburn is easily and successfully treated since there are several types of medication that are highly effective in relieving heartburn. Heartburn is a very common complaint among pregnant women. Usually, heartburn is not dangerous and will go away after the
baby is born. More than half of all pregnant women will experience some form of heartburn during their pregnancy. Heartburn is also known as acid indigestion or acid reflux and occurs when stomach contents come up from the stomach. This causes a burning feeling in the esophagus and chest area and can become quite painful. Sometimes you may even experience a sour, acidic taste in your mouth. Because of changing hormone levels, an enlarged uterus and a relaxed lower esophageal sphincter, pregnant women are prone to develop heartburn. You are more likely to experience heartburn in the second and third trimester, but heartburn can be a problem at any point of the pregnancy. In the later stages of pregnancy, your large uterus will push stomach contents into your esophagus and heartburn may become worse. 27
COVER STORY
What is
upper endoscopy? To accomplish a safe and complete examination, the stomach should be empty. The patient will most likely be asked to have nothing to eat or drink for six hours or more prior to the procedure. 28
U
pper endoscopy is a procedure that enables the examiner (usually a gastroenterologist) to examine the esophagus (swallowing tube), stomach, and duodenum (first portion of small bowel) using a thin, flexible tube through which the lining of the esophagus, stomach, and duodenum can be viewed using a TV monitor.
How do I prepare for endoscopy?
To accomplish a safe and complete examination, the stomach should be empty. The patient will most likely be asked to have nothing to eat or drink for six hours or more prior to the procedure. Prior to scheduling the procedure, the patient should inform his or her physician of any medications they are currently taking,
any allergies, and all of their health problems. This information will remind the doctor whether the patient may need antibiotics prior to the procedure, what potential medications should not be used during the exam because of the patient’s allergies, and will provide the individual scheduling the procedure an opportunity to instruct the patient whether any of the medications they are taking should be held or adjusted prior to the endoscopy. Knowledge whether the patient has any major health problems, such as heart or lung diseases, will alert the examiner of possible need for special attention during the procedure.
Why have you been scheduled for an endoscopy?
Upper endoscopy usually July - Aug 2011
COVER STORY
sprayed with a numbing solution and will probably be given a sedating and pain alleviating medication through the vein. While lying on your left side the flexible endoscope, the thickness of a small finger, is passed through the mouth into the esophagus, stomach, and duodenum. This procedure will NOT interfere with your breathing. Most patients experience only minimal discomfort during the test and many sleep throughout the entire procedure.
is performed to evaluate possible problems with the esophagus, stomach or duodenum, and evaluate symptoms such as upper abdominal pain, nausea or vomiting, difficulty in swallowing, intestinal bleeding anemia, etc.. Upper endoscopy is more accurate than X-ray for detecting inflammation or smaller abnormalities such as ulcers or tumors within the reach of the instrument. Its other major advantage over X-ray is the ability to perform biopsies (obtain small pieces of tissue) or cytology (obtain some cells with a fine brush) for microscopic examination to determine the nature of the abnormality and whether the abnormality is benign or malignant (cancerous). Biopsies are taken for many reasons and may not mean that cancer is suspected. Upper endoscopy also can be used to treat many conditions within July - Aug 2011
its reach. The endoscope’s channels permit passage of accessory instruments enabling the examiner to treat many of the conditions such as stretching areas of narrowing (strictures), removal of benign growths such as polyps, accidentally swallowed objects, or treating upper gastrointestinal bleeding as seen in ulcers tears of the lining. These capabilities have markedly reduced the need for transfusions or surgery.
What can I expect during endoscopy?
It is most likely that before the procedure the doctor will discuss with the patient why the procedure is being done, whether there are alternative procedures or tests, and what possible complications may result from the endoscopy. Practices vary amongst physicians but the patient may have the throat
What happens after the endoscopy?
After the test the patient will be observed and monitored by a qualified individual in the endoscopy or a recovery area until a significant portion of the medication has worn off. Occasionally a patient is left with a mild sore throat, which promptly responds to saline gargles, or a feeling of distention from the insufflated air that was used during the procedure. Both problems are mild and transient. When fully recovered the patient will be instructed when to resume their usual diet (probably within a few hours) and the patient’s driver will be allowed to take you home. (Because of the use of sedation, most facilities mandate that the patient be taken by a driver and not drive, handle machinery, or make important decisions for the remainder of the day.) 29
COVER STORY
Complementary medicine use rising in
Paediatric GI Clinics
C
omplementary medicine use has almost doubled among children with gastrointestinal symptoms over the last decade, with steep rises in the use of probiotics in particular, a Sydney study shows. A third of parents reported giving their child probiotics in the 2008 survey of families at gastroenterology outpatient clinics at Sydney Children’s Hospital, compared with just short of a quarter in 2002. Probiotics and nutritional supplements were the most commonly used complementary medicines (CAM) in the survey, which involved almost 100 parents. Use of herbal medicines, massage, fish oil and relaxation therapy was also reported by several parents. Overall 69% of patients said they used CAM in the latest survey, compared with 36% in 2002. Writing in the Journal of Paediatrics and Child Health, the authors noted that many CAM users said they chose particular therapies due to personal recommendations, newspapers, magazines and books. This was concerning given that “advertising and word of mouth tends to be biased and may not disclose information on drug- CAM interactions and adverse effects”, they said, adding: “This highlights the responsibility of physicians to be informed and to facilitate frank discussion about CAM use”. Most CAM users were also taking prescription medicines, the survey found – supporting the notion that patients use these therapies to complement standard treatments rather than replace them. While most families using CAM reported that they had informed their doctor about this, 22% said they had not. These families were using a range of therapies including herbal medicine, probiotics, osteopathy and homeopathy.
30
July - Aug 2011
DENTAL HYGIENE
Geriatric Dentistry: Beautiful Teeth at any Age
G
eriatric dentistry is that branch of medicine which provides oral health care to older adults. Seniors always confront themselves with more oral health related problems than a younger person, so this is why a special branch needs 32
to offer these people all the care that they need. Life expectancy in our days is much greater than it used to be several decades back. One reason for this growth is the advancement of medicine. New diagnosis tools discover the diseases in July - Aug 2011
DENTAL HYGIENE
much earlier stages, ands thus proper treatment can be provided in time. From an oral health point of view, the elderly suffer from age related teeth problems such as: • Periodontal diseases • Root carries • Missing teeth • Dentures that are ill fitting • Oral ulceration • Oral cancer • Tooth decay (caries) Many of these problems are present because the person did not take care of his/her own oral hygiene much earlier. Added to these are the bad eating habits that ruin the teeth and the health of the gums, and not respecting an oral health cleaning regimen (brushing + flossing), and of course the bad habits like smoking and drinking alcohol. A geriatric dentist must be extremely patient, because he must be aware of the fact that an older person might be struggling with a much higher degree of anxiety than a younger patient. Seniors are not used to all this modern day advanced technology tools that can be found in the dentistry offices. Therefore, the dentist might also have to kindly explain what each tool is used for and how it will be operated. This will automatically reduce the stress and anxiety levels in the elderly patients. Then, unfortunately there are old people who struggle with extremely complex diseases such as dementia, Alzheimer’s, or Parkinson’s. July - Aug 2011
New diagnosis tools discover the diseases in much earlier stages, ands thus proper treatment can be provided in time.
Some of these diseases affect their mental abilities, and the dentist must know very well how he can treat such a patient, and how to help him not to perceive a dental treatment like a traumatic experience. A few decades back oral education has been extremely poor, ands people were not giving that much importance to having a healthy set of teeth. This fact might also be yet another underlying factor for the poor state of the oral health in many elderly people. 33
DENTAL HYGIENE
Have you had
Chronic Tooth Pain?
M
aybe your dentist has mentioned that you need a root canal. These are words that can scare any patient immediately. Perhaps a little explanation will diminish the mystery of root canal treatments and put your mind at ease. Root canal treatment, known in the dental industry as endodontics (yes, a big scary word!), basically involves a simple and common dental procedure that effectively removes the diseased part of a tooth. Often this procedure can save a damaged or decaying tooth, thereby preventing you from requiring further treatments or interventions, like dentures or bridge work. Worse yet, untreated infections can lead to problems within the jaw bone which could require extensive medical work. A healthy tooth is filled with pulp, a soft connective tissue filled with nerves and blood vessels. When a tooth becomes decayed or infected, your dentist can often save the tooth by removing the infected or diseased pulp. Your dentist will basically drill a small hole into your tooth, remove the infected tissue, and probably apply an antibiotic treatment to stop any further infection. Once the diseased pulp is drained, a temporary filling will be used until the tooth is healed. Once healed, a crown or permanent filling will be placed on the damaged tooth and it will be as good as new. Endodontic treatments can usually be performed fairly quickly, often in one to three visits. These treatments are perfect to combine with a holiday, as the prices abroad for dental treatment are significantly lower than those you’ll find at home. 34
July - Aug 2011
EXPERT VIEWS
7Steps to a Sustainable Introduction
A
Sustainable Hospital is a buzz word today. Sustainability talks about the potential of long life of any hospital. Green building refers to a structure and using process that is environmentally responsible and resource-efficient throughout a building’s lifecycle: From siting to design, construction, operation, maintenance, renovation, and demolition. Although new technologies are constantly being developed to complement current practices in creating greener structures, the common objective is that green buildings are designed to reduce the overall impact of the built
environment on human health and the natural environment by: • Efficiently using energy, water, and other resources • Protecting occupant health and improving employee productivity • Reducing waste, pollution and environmental degradation But in practical life many hospital are facing the problem of high operational cost than revenues making them very difficult to sustain. When we look into operational cost any hospital there are some direct costs while some are hidden cost which can be reduced with proper planning and management of resources of hospital. Lets discuss 7 easy steps to reduce this cost and make a hospital sustainable.
Architecture
The orientation and elevation are the two key focus areas for a green structure of a hospital. Choosing right material to keep the heat out may turn out to be cost effective in the long run. An
insulated wall may have a higher upfront cost, but significantly brings down airconditioning tonnage. • Use of lime and other stone to create thick walls which ensures cooler rooms. • Also 18 inches walls which act as a natural retainer against temperature variations. It is useful exercise to compare initial cost of the ecostructure with the projected cost of maintenance which is always neglected at the time of construction of hospital. Hospital may pay 20% at the construction stage and 80% on maintenance and outgoings over the next 20 years. A better “building envelope” can help hospitals save on lightings costs and harvest natural lights more efficiently. “Correct shading and window placement can work towards day- lighting”. Drywalls are also catching on as a sustainable construction technique that is also cost effective in the long run.
Energy
Accounting for a good 25% to 30 % of operating costs, 36
July - Aug 2011
EXPERT VIEWS
Hospital energy is both a financial and environmental concern. Hospitals are round the clock working but there is no need for the same supply flow right through.
Automatic damper can be worked out which can automatically start when the Carbon- di – oxide in the room increases. Introduction of big fans in
Laundry Tips • Use of hot – fill washing machine with low water consumption and high spinning speed. • Only use a dehumidifier in rooms with closed windows. • Utilize the waste heat from the mangle and the tumble dryer by recovering the heat from the ambient air. • Pre- heat the water entering the machine using waste heat from the boiler.
Air-Conditioning
About 45% of operating costs on energy is from HVAC. The usual practice for public area air handling units is to have manual damphers, which are opened when the number of people in the public area increases and are closed when there are few people. But concern is that the dampers are left open most of the time as its usually put in a place where it won’t be visible – so it’s also out of reach. In place of this
July - Aug 2011
main area can reduce the temperature by 2 degree allowing you to keep the air- conditioning at two degrees lower. One more way to reduce loads of AC is bringing in fresh air at 44 degree and passing it through rain shower and reduce the
37
EXPERT VIEWS
temperature to 24 degree
3. Lighting
Lighting consumes 20% - 25% of energy cost. There are many ways to reduce the same. • Day lighting is visibly finding takers and LED lights are becoming more of commonality • Dimming all outdoor
5. Waste management
Recycling plants are becoming more and more common nowadays. Use of ozone for treatment of waste water and sewage helps in reducing BOD and COD, discolourising, deodorizing, and disinfection. Ozone is very powerful oxidizing agent, next to only fluorine, residual
Kitchen Equipment Tips • Cook with minimal quantities of water. Warming up and steaming are very energy intensive processes. • Repair uneven pots. • Chromium heat pans radiate less heat than cast iron pans. • Use residual heat in the oven 10 minutes before the dish is ready.
public lights to half by 22:30 hrs and to one third by mid night, Ex – cafeteria, OPD blocks, lobby.
4. Water
Reuse of water is very common step to save water. Using of species of plants which don’t require much quantity of water. Some ways to conserve water are • Rain water harvesting • Push Button taps and low volumetric tabs • Vacuum flush tank
38
toxicity is absent as the half- life of ozone in water is approximately 20 minutes. Ozone also has a micro flocculent property and helps in filtration thus reducing the turbidity further. After ozone treatment, the water can be reused for varied purposes, or discharged into the sewage as it meets the pollution control norms.
6. Training Green Teams
Existing hospitals and new builds most of experts have pointed to training as key to reducing one’s footprint and ensuring the effectiveness of green initiative. Green team concept “sustainability development team”– come July - Aug 2011
EXPERT VIEWS
up with green team with in hospital with well explained guidelines and encourages them for all initiatives
7. Use Government Subsidies
Since the healthcare service comes under the basic needs of population government provides various kind of subsidy for hospital providers. I. Tax holiday for first five year Hospitals are free from the burden of paying tax for first five year.
II. Land
If any hospital comes up in rural area government provides land on lease for the hospital also.
and healthy life (in terms of profit) of hospital. All the energy conservation methods, installations pretends to be very expensive but once they are put in place cost is easily recovered in a year or two and subsequently
reduces the operational cost to 60%. If worked according to all above 7 steps helps the hospital to involve in ecofriendly measures and therefore reducing global warming. Thus the hospitals also fulfill their Corporate
III. Special Incentive for Women
SSI units owned and managed by women entrepreneurs having more than 80% women laborers are provided special incentives like 50% subsidy for building and machinery, rent subsidy, managerial grant, stipendiary training etc, the facilities are available in Tripura and Kerala.
Conclusion
Therefore a hospitals needs to rethink on all these 7 issues for a long July - Aug 2011
39
PRODUCT LINE
Forbo Flooring India
F
orbo Flooring, the four year-old Indian arm of its Swiss parent, is expanding its presence in the domestic commercial Flooring sector. The company has already worked with leading IT firms including Airtel, CICSO and Microsoft, and hospital such as Apollo, Wockhardt and Fortis.Forbo recently got a breakthrough in the education sector with Hiranandani School in Mumbai. Currently the company is promoting its Marmoleum range of flooring “This is linoleum flooring, an ecologically and economically viable material. As it is made of natural and renewable raw material, it becomes the ideal choice for the a diverse range of healthcare and clinical environments. Flooring here has to be highly hygienic, durable, easy-to-maintain and chemical resistant. Forbo Flooring Systems is a global player in high-quality commercial and residential floor coverings. It focuses on environmentally friendly, functional and design-oriented linoleum, project vinyls for specialized applications, entrance matting systems, carpet tiles for the object market and needle felt, as well as cushion vinyls for the home market. In addition to ultrahard-wearing materials with excellent acoustic and nonslip properties, our collections include many specialty products for clean rooms and operating theaters. 40
Unique features l After installation there’s no need to apply a coat of polymer l Lower cost due to less cleaning and maintenance time l Better protection against dirt and scuff marks l Independent testing shows how little dirt is picked up
July - Aug 2011
PRODUCT LINE
UNIQUE FEATURES OF FORBO MARMOLEUM RANGE AND ITS ADVANTAGES l Marmoleum is produced from renewable materials: linseed oil, rosins, wood flour, jute and ecologically responsible pigments. l Marmoleum is extremely durable floor covering that is almost synonymous with the optimal solution for hospitals, schools, offices, government buildings and utilities. l The most complete collection in linoleum and the material of choice for many architects and interior designers to give them opportunity to play with a large range of colours. l Available in sheet and tile form, but also as a laminate product, Marmoleum click. l it has a unique feature of Top Shield or the Wear Layer which enhances the floor´s cleaning and maintenance performance. The functionality of Top shield has been proven by the independent test institute WFK. Of all tested resilient samples Marmoleum with Top shield showed the least dirt pickup. Top shield, Marmoleum and Artoleum’s unrivalled richness in colour and design stays as sharp and striking as the day it was installed.
How Top shield works l Strong primer and top layer ensure an effective shield against dirt l High density primer ensures smoothness and durability l Top layer guarantees scuff and dirt resistance l The top layer can be renovated July - Aug 2011
Every step you take … at home, at work or on the move. Forbo floors are essential to the way people experience quality of life. We work constantly to improve our products and invent new ones. Linoleum, also known as the green flooring, was invented way back in 1860s. This flooring, due to it being green, has become highly popular in the Indian commercial space. It is made of renewable material such as solidified linseed oil (linoxyn), pine rosin, ground cork dust, wood flour, and mineral fillers such as calcium carbonate. It is supplied in rolls, usually 2m in width and 27m-32m in length. Linoleum floors form an ergonomic, economic and ecological point of view. Marmoleum, our brand for linoleum, is the ideal choice for a diverse range of health and clinical environments, as flooring in these areas has to be
highly hygienic,durable,easy to maintain, and chemical resistant.Additionally,we also have a range of decibel linoleum which offers impact sound reduction of 17db.”He advises that to reduce wear and tear of the floor due to heavy traffic, linoleum flooring should be coated with a high performance stain and scratch resistant layer. Today, as the global leader in linoleum floor coverings. Forbo solution are available all around the world, enabling architects and designers to express aesthetical and functional priorities in ways never seen before in projects for healthcare,educationa l,institutional and public environment settings. Forbo’s linoleum is the perfect answer to today’s ecological concerns. As a product made from natural and renewable raw material, linoleum has always been kind to the environment.
41
PRODUCT LINE
S
cientech Medicare, a Scientech group division has introduced Caddo 17 B - Fetal Monitor which is used for tracking how well the growing fetus is within the contracting uterus and for detecting signs of fetal heart distress. Fetal monitoring is performed by attaching external transducers to the mother’s abdomen with elastic straps. A high sensitive 9 elements transducer uses 1 MHz Doppler ultrasound to detect fetal heart motions and the information is sent to the fetal monitor that calculates and records the fetal heart rate on a continuous strip of paper. Caddo 17 B uses microprocessors and mathematical algorithm to improve the fetal heart rate signal and accuracy of the recording. Caddo 17 B comes with 8.4” LCD screen with 60 degree folding which is also capable of monitoring the twins. Scientech Medicare provides its own branded quality Z-fold thermal graph papers that display FHR waveforms and corresponding TOCO values simultaneously. The upper portion of graph describes fetal heart rate (50 – 210 bpm) and lower portion of graph describes mother’s contractions. Inbuilt high resolution long life thermal printer prints all the parameters and graph readings. Caddo 17 B is easy to use, space saving and light weight. One can also connect it to the central monitoring system which is an optional feature. Scientech Medicare, a Scientech Group Company is a renowned provider of medical equipments. Our world class products provide user a high degree of quality & reliability. Scientech Medicare offer comprehensive range of medical instruments and technical support. Leveraging the heritage and domain expertise of Scientech, the products encompass a board technology spectrum and high customer satisfaction across the globe. Scientech Medicare policy is not just offering customers with products but also in providing them with prompt technical support. Scientech has 16 branch offices in India & their products are exported to over 52 countries.
Scientech Technologies Pvt. Ltd.,
94, Electronic Complex, Pardesipura, Indore – 452010, INDIA Tel : 0731-4211100 Fax : 0731 2555643 Email : info@scientech.bz Website : www.scientech.bz 42
July - Aug 2011
PRE SHOW
MEDICALL 2011 :
Taking Indian Medical Technology to the next level. Welcome’s all the Hospital & Healthcare Professional
I
f one has to pick from a list of successful events which have created a stir within a short span, MEDICALL would turn out to be a winner. Not only is it India’s premier Medical Equipment Expo, but it has emerged as, and earned the
7th Edition, MEDICALL 2011 will be hosted from 12-14 August 2011 at Chennai. envious reputation of being, the first real “supermarket” for hospital equipment and supplies. With India on the fast track to economic growth its healthcare industry is expected to grow from its
Dr. Manivannan CEO, MEDICALL
44
current $36 billion (approx), growing at 15% CAGR, the Indian Healthcare Industry will be a US$ 280 billion by 2022. In this context the role of MEDICALL assumes even greater significance. This is evident from its awesome and comprehensive range of exhibits. - from Hospital Information System, solutions, surgical and examination furniture, rescue and emergency equipment, to diagnostic/ laboratory.O.T.equipment dental / ophthalmology equipment, medical disposables and cleaning equipment. MEDICALL reflects the acute vision and entrepreneurial skills of its organizers, in that; it has grown as a brand. It
continues to draw the highest percentage of hospital owners, doctors, medical directors and purchase heads in addition to being a proven and highly successful platform for attracting affluent producers, dealers and suppliers. The fact that its previous hosting attracted over 400 exhibitors and over 8000 quality visitors mostly from the its core target group, speaks volumes about the credibility of the event. Now in its 7th Edition, MEDICALL 2011 will be hosted from 12-14 August 2011 at Chennai. It will bring together the best in the business of ICU and Operation Theatre equipments, Refurbished equipments, Trolley, wheel chairs, Cots and other furniture, Hospital linen and laundry, Hospital charts and stationary, Office automation equipments, Printers dealing with pamphlet and file designing, Communication equipments, Medical disposables etc. MEDICALL 2011 has a wide range of dental products from Taiwan and other technological healthcare products from Bayern and other countries.
July - Aug 2011
Importer, Exporter of :
Non Glare Surgical Instrument Hard Age Scissors Gynecology, Ortho & Dental Instruments
ATLAS SURGICAL CO. H.NO. 311, Ilnd Floor, H/1 Gali No. 22, Zakir Nagar, Okhla, New Delhi-110025 Tel./Fax: +91-11-26987849 Mob: +91-9899670034/ 9990244638/ 9910692357
POST SHOW
Meditek Clinika 2011 Event huge quality visitors Meditek Clinika:
debut, exhibitors pleas e
T
he 3rd International Trade Fair for Medical equipment and Technology MEDITEC CLINIKA 2011 3 days event concluded successfully at Palace ground ,Bengaluru. Meditek Clinika, the trade exhibition and key platform for expanding the Indian Medical market. The one stop medical technology exhibition with 1st comprehensive symposium & workshop on “MEDICO LEGAL ISSUES IN CLINICAL PRACTICE�. Several innovative medical devices and products were displayed that made the event truly global. Thousands of VISITORS had registered for participation in conference and exhibition. The exhibitors did a very good business and response and they met entire medical fraternity at one place.
48
July - Aug 2011
POST SHOW
ends successfully, Attracts s and sets a new record
:
Makes an Impressive s ed with overall results. Meditec Clinika 2011– India’s dynamic networking platform for Medical and Hospital Equipment & Supplies The 4th International Trade Fair Meditek Clinika 2012 to be held in same venue in September 2012 have already begun and booking of booth and registration for Meditec clinika 2012 has started.
For more detail Contact: Ms.Rohini Parlekar Manager Project Coordination
Cell: +91 9322037957 Tel: +91 22 39504586 Email: info@meditek-clinika.com
July - Aug 2011
49
POST SHOW
High
Cholesterol What are the best foods to fight belly fat? Highly processed, sugary, starchy, energy-dense foods increase the number of calories it takes to feel full. Wholesome foods close to nature, rich in nutrients, and especially those with a high content of water and fiber, such as vegetables and fruits, reduce the calories it takes to feel full. 50
July - Aug 2011
POST SHOW
T
he answer to this question begins with the best foods to fight any fat, and specifically, any excess fat. The truth about this is that it has more to do with quantity, than quality; the recently reported results of the ‘Twinkie diet’ are a good illustration. If you take in fewer calories than you burn, you will mobilize body fat. Belly fat actually tends to go first. So lose weight, and belly fat will go. But there are certainly ways to use the quality of food to accelerate your success. One important consideration has to do with ‘satiety.’ Satiety is the feeling of being full and satisfied, and the number of calories it takes to get there varies with the foods you choose. Highly processed, sugary, starchy, energy-dense foods increase the number of calories it takes to feel full. Wholesome foods close to nature, rich in nutrients, and
those with a high content of water and fiber, such as vegetables and fruits, reduce the calories it takes to feel full. So a diet rich in natural plant foods is part of the formula for losing belly fat, without going hungry. Finally, belly fat is associated with insulin resistance, and high levels of insulin contribute to preserving, and growing belly fat. So
you can speed it on its way by choosing foods that help stabilize and lower blood insulin levels. Such foods have a low glycemic load, and are rich in monounsaturated fats, soluble fiber, or both, and include: nuts, seeds, avocado, olives, oats, berries, beans, and lentils among others.
especially
July - Aug 2011
51
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