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| HEALTH & FITNESS |
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Can you be fit and obese?
A medical emergency called hypoglycemia
How to avoid heel pain
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Kick boxing twice a week, walking the dog two miles every day — Clint Witchalls thought he was healthy. Then a visit to the doctor revealed he was dangerously overweight... I keep seeing headlines about the obesity crisis, usually accompanied by a picture of a gargantuan man or woman. When I read on, however, I discover that most of the article is in fact about overweight people - people like me - who don't look a bit like the person in the picture. Who gets to decide who is obese or overweight anyway? A quick Google search reveals that a 19th-century Belgian astronomer and mathematician, Adolphe Quetelet, gets to decide. He's the man who invented the body mass index (BMI). BMI is your weight divided by the square of your height. The resulting number, usually ranging from 12 to 42, tells you whether you're underweight, healthy, overweight, obese or extremely obese. In my case, 95.9kg divided by my height, 1.86m, gives me a BMI of 27.7. This number puts me at the top end of the overweight category - knocking on obesity's door. BMI is widely used, yet despite its popularity not everyone is convinced it's a useful tool. One criticism is that it doesn't look at body composition. BMI can't tell what proportion of your weight is muscle, bone, water or fat. It just works on total weight. Under BMI, rugby players and bodybuilders would be classed as overweight or obese because of their muscle mass. BMI also starts to unravel for very tall people and pregnant women. "In modern society, the obsession is with weight," says Professor Jimmy Bell of the Medical Research Council's Clinical Sciences Centre at Hammersmith Hospital. "Weight is meaningless. You can be thin. You can have a [healthy] BMI of 20 but still have lots of fat in your liver and be pre- diabetic. That is the problem with BMI." Things have moved on since Quetelet's era. Today, there are a number of systems for determining body composition. Some of them are expensive, such as a magnetic resonance imaging (MRI) scan - which is Professor Bell's specialism . Others are cheaper, such as bioelectric impedance analysis (BIA). I don't think I can convince my GP I need an MRI scan, so I opt for the BIA. A BIA device looks like bathroom scales. When you stand on it a low-level electrical signal is sent through the footplates and the resistance to the current, as it flows through your body, gives a reading of your body composition. Unlike muscle, there is not much water in fat, so the current is impeded when it passes through fat. The BIA monitor I used, a Tanita InnerScan50, measures total body water percentage, bone mass, muscle mass and total fat percentage. The machine tells me that I'm 25 per cent fat - which is not good. Men shouldn't be more than 20 per cent fat and women shouldn't be more than 30 per cent fat. It rated my physique a "2". The manual that comes with the machine tells me this means: "Obese: This person has a high body-fat percentage with a moderate muscle mass level." So now I've been upgraded from pre-obese to obese. I am Mr Creosote - only I still don't feel it. But maybe I shouldn't worry about what my BMI or some jumped-up bathroom scale says. A recent study suggests that being overweight when you're 40 years or older (I'm 44) might provide some benefit. Researchers at Tohoku University followed 44,000 people aged between 40 and 79 over a 10-year period, and found overweight people had the longest life expectancy. At age 40, overweight men could expect to live 40.5 more years and women 47 more years. This compared with 38.7 years for normal-sized men and 46.3 for normal-sized women. Slim people did a lot worse. Underweight men only get 33.8 more years and women 41.1 years. Then there was the National Health and Nutrition Examination Survey of 5,440 people, which found that more than half of overweight people and nearly one third of obese adults are metabolically healthy; that is, they don't have high blood pressure, high blood lipids (fats), insulin resistance or other signs that they are en route to a heart attack or diabetes. "There are no short cuts," Professor Bell says. "If you want to know how healthy you are, you have to have an [MRI] image, or you have to be fit. You don't need to have an image if you jog every day and have a healthy lifestyle." And that's the thing. I could keep on digging, trying to discover just how unhealthy I am, or I could just get on with doing something about it. Time to get my running shoes on. — The Independent
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A medical emergency called hypoglycemia If insulin or sulphonylurea(glimepride. gliclazide etc) is taken in excess amounts, more than the required dose, the patient develops hypoglycemia. Other causes of hypoglycemia and its recurrence:
Signs and symptoms of hypoglycemia 1. Sudden giddiness 2. Unbearable appetite 3. Numbness around the lips 4. Sudden sweating all over the body 5. Palpitations in the heart and rise in BP 6. Shivering of hands and legs 7. Diminishing eyesight 8. Paleness all over the body 9. Confusion and gradual loss of consciousness (just like a drunkard) and rarely seizure. Management of hypoglycemic patient 15-20 g of oral glucose is the preferred treatment for the conscious individual with hypoglycemia. If the glucometer reading after 15mins shows continued hypoglycemia then the above treatment should be repeated. And the person should consume a meal to prevent the recurrence of hypoglycemia. A Glucagon injection should be prescribed for all individuals facing a significant risk of severe hypoglycemia. It can be given by family members or the coworkers or a teacher in the school. In the absence of glucagons, 50% 50ml IV glucose should be administered by a trained professional in unconscious patients. Prevention Prevention of hypoglycemia is a critical component of diabetes treatment. Teaching people with diabetes to balance insulin use, carbohydrate intake and exercise is a necessary but not always sufficient strategy. Individuals with hypoglycemia unawareness or one or more episodes of severe hypoglycemia should be advised to raise their glycemic targets to strictly avoid further hypoglycemia for at least several weeks to partially reverse hypoglycemia unawareness and reduce the risk of future episodes. Continuous glucose monitoring (CGM) may be the alternative tool to self-glucose monitoring in patients with hypoglycemic unawareness and/ or frequent hypoglycemic episodes. HbA1c (glycosylated Hb) and urine glucose monitoring has no role in detection and management of hypoglycemic episodes and its recurrence. Hypoglycemia
unawareness The body of some individuals over a period of time loses the ability to recognise the early warning signs of hypoglycemia. They are at increased risk of sudden episodes of severe hypoglycemia. Careful modifications of their diabetes management, especially the pattern of dietary intake and anti-diabetic drugs with more frequent meals and repeated glucose monitoring, may reduce the risk of hypoglycemia. Similar is the case with “brittle” diabetics who have frequent hypoglycemic as well as hyperglycemic excursions. Hypoglycemia and employment A single episode of severe hypoglycemia should not per se disqualify an individual from employment. However, recurrent episodes of severe hypoglycemia may indicate that an individual may, in fact, not be able to safely perform a job, particularly jobs or tasks involving significant risk of harm to employees or the public, especially when these episodes cannot be explained. Dr K P Singh is Senior Consultant, Endocrinology, Fortis Hospital, Mohali, and can be contacted at k.singh@fortishealthcare.com
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How to avoid heel pain HEEL plays an important role of a shock absorber as and when the foot strikes the ground. Heel pain is a common symptom, which is generally ignored until it becomes a serious problem. It mainly occurs due to the inflammation of the plantar fascia. Plantar fascia is a thin layer of tough tissue, which supports the arch of the foot. While walking as the training leg begins to lift above the ground, tension on the fascia is around twice the body weight and this increases if there is associated lack of flexibility of calf muscles. Classic presentation of plantar fascitis is heel pain, which worsen in the morning or after a prolonged rest. There is a myth that heel spur that appears on X-ray is the main cause of heel pain. Spur formation is related to the progression of age whereas heel pain is due to the stress on the plantar fascia, which causes inflammation and leads to heel pain. Therefore, one should be cautious if somebody advises surgery of heel spur. Causes Sudden increase in training, running on hard and irregular surface. Using worn-out shoes. Being overweight, the pressure on the heel increases, which can stress the fascia. People who have high arch or flat feet are more prone to heel pain as they are unable to absorb the stress of walking. Tips
Treatment Heel lift by using Silicon heel. Ultrasound therapy helps in reducing inflammation. Shock wave diathermy is an expensive treatment, and can be used in resistant cases of heel pain. Injection corticosteroid should be considered as the last treatment. Massage the bottom of the foot with the help of a golf ball. In severe cases, night splint can be used to reduce the early morning stiffness. Exercises Towel curls — Place a towel on the floor and then curl the toes to pull the towel towards the heel. Calf stretch: Sit with the affected leg stretched out in front. Loop a towel around the ball of foot and pull it towards the body, keeping the knee straight. Hold the position for a count of 10 and then relax. Repeat 10 times. Standing with calf stretch: Standing in front of a wall, put your hands against the wall. Keep the affected leg back and the other leg forward. Lean forward towards the wall until a stretch is felt at the calf. Hold it for a count of 15. Plantar fascia stretch: Stand with the ball of the affected foot on a stair. Lower down the heel until a stretch is felt in the arch of the foot. Repeat it 10 times. Heel pain cannot be cured immediately. A combined therapy consisting of medication, stretching exercises, the change of shoes and the treatment of the cause can cure it. The writer runs a pain management clinic in Chandigarh. E-mail —
chadha_r2003@yahoo.co.in
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Cancer: Moderate exercise boosts survival rates
Washington: Even moderate physical activity can significantly reduce death risk in men suffering from colorectal cancer, say researchers. They found that patients who engaged in moderate physical activity were 53 per cent more likely to be alive and free of the disease than those who were less physically active. “Moderate exercise has now been incorporated in some guidelines for colorectal cancer survivors and this new research should further reinforce to oncologists that they should discuss this in their survivorship plan,” said the study’s lead author, Dr Jeffrey A. Meyerhardt, MPH of the Dana-Farber Cancer Institute. “However, while our work found a significant benefit for patients who exercise, it’s important that exercise still be seen as a supplement to, not a replacement for, standard therapies,” Meyerhardt added.
— ANI
Disinfectants make them resistant to antibiotics
Washington: A new study has shown that increased use of disinfectants could cause hospital superbugs to become resistant to antibiotics as well as the disinfectant itself. Disinfectants are used to kill bacteria on surfaces to prevent their spread. If the bacteria manage to survive and go on to infect patients, antibiotics are used to treat them. A research team from the National University of Ireland in Galway found that by adding increasing amounts of disinfectant to laboratory cultures of pseudomonas aeruginosa, the bacteria could adapt to survive not only the disinfectant but also ciprofloxacin, a commonly-prescribed antibiotic - even without being exposed to it.
— ANI
Immune cells in arteries to prevent heart attacks
London: Scientists from across the world are set to team up to develop a treatment that specifically targets harmful immune cells in the arteries thought to be the cause of many heart attacks. Experts at the Bristol Heart Institute will work in collaboration with researchers from France, Sweden and the Netherlands to test the effectiveness of combining conventional drugs and new treatments to bring down the immune response in the arteries of patients with heart condition. Professor Andrew Newby will lead the 750,000-pound study backed by the British Heart Foundation. “This research could point to new ways to protect fatty deposits from becoming unstable by selectively modifying the harmful immune cells while preserving their helpful activity,” the BBC quoted Newby as saying.
— ANI
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THE normal blood sugar level is 80-120mg/dl of blood. When the blood sugar level goes below the normal range, the patient develops a condition called “Hypoglycemia.” Severe hypoglycemia requiring the assistance of another person is a medical emergency and if not attended promptly in time, there is every possibility of threat to the patient’s life. Hypoglycemia is defined as a blood glucose level <70 mg/dl.
Some research estimates that between 4 and 13 per cent of the deaths of people with type I diabetes is the result of hypoglycemic events. It is the leading limiting factor in the management of type 1 and insulin treated type 2 diabetes.