Health - Livemint.com

What it takes to be star-shaped

Blessy Augustine — Mon, 16 Nov 2009 16:17:00 GMT

If you thought being a movie star was all about diamonds and pearls, champagne soirées every week, and dodging the unrelenting paparazzi, you have another think coming. Actresses work hard for their fame and fortune, and not just in front of the camera. Behind the screens, it takes hours of training at the gym and dedication to diets to fit every role—and the regimens must change to suit the role!

Here’s a round-up of what four female leads with very different requirements needed to do for that shapely figure (just don’t try this at home without supervision).

Vidya Balan’s curvy look

The brief: Vidya Balan, who had been facing criticism for her flab, wanted to tone her body while retaining her curves.

The plan: Since the motto was not to attain a size-zero figure, the exercise routine did not involve going to a gym or using equipment, says Vilayat Hussain, a personal trainer who has worked with Balan for the last six months. Instead, he recommended calisthenics, a form of exercise consisting of a variety of simple movements that are intended to increase body strength and flexibility using one’s body weight for resistance.

(left to right) Calisthenic curves: For Vidya Balan’s curvaceous but toned look, her trainer recommended exercises that use body weight for resistance. Athletics-inspired: Rani Mukherjee’s sporting role called for eating every 2 hours, plus extra cardio and weights. Confined shape-up: Floor-based exercises were prescribed to help Shamita Shetty stay fit during the Bigg Boss season. Beach body: Interval cardio training ensured Lara Dutta’s bikini-friendly belly.

The aim was an all-round shape-up, so the focus was on all three divisions of the body—sagittal (left and right), coronal (front and back) and transverse (waist-up and waist-down). Hussain explains that most gym exercises concentrate on toning the arms and thighs. However, most human movements involve using the torso, so focusing on the arms and legs is a waste of time. For Balan, he focused on two torso-training exercises: diagonal chops (using medicine balls) and an anti-rotator exercise. Crunches were avoided since Hussain felt they were bad for the lower back. He also avoided cardio exercises because “cardio exercises...end up giving you a Westernized slimmer physique which is more angular, but that is not the look Vidya wanted”, he says. Hussain also did not place any dietary restrictions on Balan, who loves home-cooked food, and stuck to it. “Everyone knows what to eat and what not to...so I don’t see any point on instructing people on their diet,” says Hussain. Balan exercised for 45-60 minutes a day, every alternate day.

Stay-fit tips: Make exercise an enjoyable part of your daily life. An average person can do 30 minutes a day. But the first step in the right direction would be to get a trainer. For those who don’t want to hire a personal trainer, at least consult one, have a programme charted out and then follow it up on a regular basis with the trainer.

Don’t confuse an instructor with a trainer. “The guy who shows you how to use a machine in a gym is not a qualified trainer,” he adds. And don’t forget to ask for the trainer’s credentials.

Rani Mukherjee’s slimmer specs

The brief: Improving Rani Mukherjee’s thighs, abdomen and arms to get her in great shape for Dil Bole Hadippa!

The plan: Satyajit Chaurasia, a personal trainer who had earlier worked with Aamir Khan for Ghajini and has worked with Mukherjee for the last five years, made her follow the usual cardio and weight training (the treadmill, dumb-bells, lunges, crunches and squats), but this time for a longer period. The regime involved exercising an hour and a half to 2 hours, five days a week. The routine was divided into 15 minutes of cardio exercises, such as working out on a treadmill or cycling, and 15 minutes of weight training. The best way to deal with a flabby stomach in Mukherjee’s case, according to Chaurasia, was to alternate between crunches and leg raises (front and side), doing each 25 times.

Chaurasia laid stress on eating right, instructing Mukherjee to eat every 2 hours. “This,” he says, “is better for your metabolism and keeps your energy levels constant.” Mukherjee’s diet involved eating lots of fruits, salads and egg whites. She was asked to avoid red meat and deep-fried foods. “However, I allow her to indulge herself twice a week. A diet isn’t a punishment. You need to be able to eat food you like,” says Chaurasia.

Stay-fit tip: Exercise every day for at least 30 minutes—whatever simple exercises one can manage at home or in a park.

Lara Dutta’s bootylicious belly

The brief: Since Lara Dutta had to flaunt a bikini in many scenes for her latest movie Blue, the goal was to get a flat abdomen.

The plan: Zarine Watson, who runs the Watson’s Fitness Centre in Khar, Mumbai, has been training Dutta for three years, but for Blue she focused on interval cardio training, which means alternating high-intensity workouts with low-intensity recovery periods. The best exercise for a well-sculpted abdomen is the core-strengthening exercise of crunches, says Watson, who has trained Hrithik Roshan, John Abraham and Bipasha Basu. Squats (to train the muscles of the thighs, hips and butt), lunges (for leg muscles) and adductions (moving your outstretched limbs back to your body, close to the midline) helped in forming a compound workout regimen.

Stay-fit tip: Simple dietary changes should be incorporated. No simple starches such as rice and potatoes, aerated drinks, deep-fried foods and fatty foods (butter, cream and the like) while you are trying to get into shape. A strict rule: Do not starve yourself.

Shamita Shetty’s maintenance mantra

The brief: Since Shamita Shetty was going to spend time in the Bigg Boss house (she has just exited the reality show), she needed a maintenance plan that would help her stay fit .

The plan: Floor exercises such as crunches, lunges and reverse lunges formed part of the routine. “When you are in a situation where you can’t access a gym or for some reason can’t follow your normal exercise routine, it helps to do some basic floor exercises, like a few sets of crunches and lunges. This can hold you good for about 25 days,” says her personal trainer Sherin Poojari, who also trains sister Shilpa, industrialist Raj Kundra and actor Celina Jaitley. “But after that if you are serious about your body you need to get back to your routine.”

According to Poojari, Shetty is genetically blessed and has a good metabolism rate that prevents her from accumulating fat. Yet he admits that like most women her problem areas are her waistline, biceps and thighs. Though Poojari follows the usual routine of crunches, bicep curls and leg curls to tackle these areas, he says that one key factor plays an important role for women’s fitness—antioxidants. Antioxidants are nutrients that clean up the harmful byproducts oxidation creates in the body. When you exercise, oxidation levels increase, requiring you to increase your capability to clean up its byproducts as well. Carrots, tomatoes, oranges, nuts, etc., are good sources of antioxidants.

Stay-fit tip:“Most trainers,” says Poojari, “pay attention to their clients’ protein and carb intakes, but these are macronutrients. With women it’s important to pay attention to the micronutrients such as vitamins, minerals and fibre first. Only after this can you move to cutting down on carbs.”

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Dietary guidelines

The last time Indians got government-backed dietary guidelines was in 1998, when they were drawn up by the National Institute of Nutrition, Hyderabad. However, new guidelines, drafted this April at a summit on nutrition organized by the department of science and technology, were announced on 13 November. Key changes include a way to calculate calorific needs, sample healthy regional diets, recommendations on lower carbohydrate and salt intake (more water, different kinds of fat and sweeteners), guidelines on eating out, portion sizes and meal times, and one that does not “discourage” small quantities of alcohol. The full document will be published early next year. Staff writer

Pain and health policies

In October, independent rights organization Human Rights Watch published ‘Unbearable Pain: India’s Obligation to Ensure Palliative Care’. In it, senior researcher Diederik Lohman reports on the pain of millions of Indians suffering from cancer, HIV/AIDS, chronic renal problems and other life-threatening disorders. The World Health Organisation regards palliative care as vital in such cases, but the report finds there is hardly any government-aided palliative care in most states, nor is pain treatment medication readily available (only 13 states follow the model rule on use of morphine by recognized medical institutions). The report advises the government to focus more on palliative care, training health workers for it and incorporating it into health policies. Permitting citizens to suffer this pain, it points out, violates the right to health. Benita Sen

Run in the sun

A run in the sun may support your diet better than a workout in a climate-controlled gym, according to an Australian study published in the ‘American Journal of Clinical Nutrition’. Researchers found that participants ate less immediately after working out in hot conditions—about 36 degrees Celsius—than in a more moderate (25 degrees Celsius) environment. On average, men ate around 300 calories more when they worked out in moderate temperatures. Researcher Kym Guelfi of the University of Western Australia’s School of Sports Science adds that future studies should look at whether warm-weather exercisers just make up for the smaller meals with larger ones later in the day. Reuters

Food-borne diseases

Some food-borne illnesses can leave you with more than just stomach flu. They can have long-term consequences, especially for young people, says a report released on Thursday. Researchers at the Center for Foodborne Illness Research and Prevention in Pennsylvania studied the five most common food-borne diseases in the US and the health consequences of pathogens such as campylobacter infection, E. coli O157:H7, ‘Listeria monocytogenes’, salmonella and ‘toxoplasma gondii’. They found these can cause life-long complications, including kidney failure, paralysis, seizures, hearing or visual impairment and mental retardation. Diarrhoea and vomiting are the most common symptoms of food-borne illness, but they can cause serious health problems in 2-3% of cases, says the US Food and Drug Administration. For example, salmonella can cause reactive arthritis. Reuters

River of disease

Chitra Narayanan — Mon, 16 Nov 2009 16:14:00 GMT

Mumbaikars may die younger than other Indians, according to the Human Development Report 2009 by the National Resource Centre for Urban Poverty and the All India Institute of Local Self Government, Mumbai (published in the first week of November), but the Capital is none too healthy a place to live in either. Delhi residents dependent for their water needs on a dying river are getting sicker and sicker by the day, finds a soon-to-be-released report.

The Delhi-based PEACE Institute Charitable Trust, which initiated the study to discover the correlation between the health of the Yamuna and the health of the community dependent on it over the last 25 years, unequivocally blames the Capital’s increasing ill-health on the river’s condition. It has based its findings on data collected largely from different state agencies.

The cost

The study, supported by Ford Foundation, says Delhi’s per capita spending on healthcare is more than three times the national per capita: a figure that shows how high its disease burden is. The figures are telling: From just 9,750 cases of typhoid in 2000 in Delhi, the figure rose to 20,864 in 2008. There were 2,850 cases of Hepatitis A virus in 2006, going up to 5,425 in 2008. As for diarrhoea, from 0.13 million in 2002, the figures zoomed to 0.24 million in 2007.

In its 2008 shortlist of 13 killer communicable diseases (those that caused 100 or more deaths that year), India’s Central Bureau of Health Intelligence puts acute diarrhoeal disease and typhoid at fourth and eighth positions, respectively. And this is probably the tip of the iceberg. The report suggests the figures are likely to be far higher since “complete data from private health practitioners and institutions does not reach the government recording system”. Indeed, estimates suggest that 71% of Delhi is dependent on private practitioners for health needs.

Messy waters: A stretch of the Yamuna near Kalindi Kunj. Harikrishna Katragadda/Mint

Study author Pushp Jain directly and indirectly links the rising morbidity to the river that feeds Delhi. The Yamuna contributes 724 mcm (million cubic metre), practically almost all the surface water Delhi has. The presence of bacteria, viruses and protozoa that cause diseases is indisputable. Drinking water contaminated with coliform bacteria can pose risks of ear infections, dysentery, typhoid, viral and bacterial gastroenteritis and Hepatitis A. A 2007 report by the Central Pollution Control Board on the status of water quality in India found that the total number of coliform bacteria and faecal coliform numbers was the highest in the Yamuna, with a count of 3.2 billion MPN/100ml and 2.3 billion MPN/100ml respectively (MPN is the most probable number). For acceptable levels for bathing purposes, total coliform organism count should be 500 or less per 100ml, and for drinking, it should be 50 or less. In Delhi, it is in billions.

Water that you eat

While there is a direct link between contaminated water and waterborne diseases, the Yamuna also probably has a hand to play in the rising cases of cancer in the city. The report points to the high level of contamination in vegetables irrigated by the water of the river. Not only do common vegetables (such as spinach, radish, brinjal, cauliflower, tomato and cabbage) contain all kinds of pathogens, including Salmonella typhi and typhoid bacteria, they also carry high traces of heavy metals and pesticides, harmful to human health.

Most Delhiites spend a lot on filtering and boiling water, but ignore the perils of eating vegetables, which have been grown locally, raw. Contrary to conventional dietary wisdom, it’s best if Delhiites do not eat raw vegetables or salads. All vegetables should be either steamed or boiled.

No safety in going to ground

While poorer households are more prone to morbidity from waterborne diseases, the study finds that the exposure to contaminated water is high across all economic groups. Most higher income households (houses built on private plots, commercial plots, multi-storey buildings, cooperative group housing societies) do not depend solely on the Delhi Jal Board as they have groundwater abstraction facilities. But with the groundwater table sinking to new lows, there is increased chemical concentration in that water too.

“Much of the groundwater in Delhi, besides disappearing fast, is unhealthy, with virtually all kind of contaminants—nitrate, arsenic, fluoride and coliforms. There are areas with cadmium, mercury and other heavy metal contamination also,” notes the study. Alarmingly, these are above permissible levels, posing serious health hazards.

Quite clearly, Delhiites need to do more to save the river.

Write to us at businessoflife@livemint.com

10 surprisingly palatable prescriptions

Kavita Devgan — Mon, 09 Nov 2009 19:45:00 GMT

Flossing can save you from heart disease—but your dentist may not have time to tell you. A daily dose of walnuts could keep cancer away, and cocoa may be the way to keep your heart strong—did you ever think about asking your doctor about the small things that can help you keep diseases at bay?

These and other bits of research often don’t make it to your doctor’s list of dos and don’ts—mostly because he or she is focusing on medication. But when it comes to your well-being, every little detail can be put to good use.

Here is a list of 10 things that can help you find health and happiness.

A cup of cocoa…to care for your heart

In a study published in the November issue of the ‘American Journal of Clinical Nutrition’, Spanish researchers divided study subjects (both men and women) into two groups: One group was given a daily drink of 40g unsweetened cocoa powder mixed with skimmed milk and the other group drank plain skimmed milk. After one month, those who had the cocoa drink had lower levels of the inflammatory markers associated with heart disease.

Other studies have also shown that hot cocoa has more protective antioxidants than the better-known options of tea or red wine.

An earlier study published in the 3 June 2008 issue of the ‘Journal of the American College of Cardiology’ found that after diabetic patients drank a specially formulated cocoa—high in the antioxidant flavanol—for one month, blood vessel function went from severely impaired to normal.

Ditch the fruit drink...to steer clear of diabetes

Apparently fruit juice is worse than sugary soda if you’re worried about developing Type 2 diabetes, according to a study that appeared in the 28 July 2008 issue of the ‘Archives of Internal Medicine’. Researchers from Boston University’s Slone Epidemiology Center found that two or more soft drinks per day increased diabetes risk by 24%—and orange juice had the same effect. But two or more fruit drinks per day meant a 31% increased risk.

“We need to be aware that juice drinks are not a healthy alternative to soft drinks with regard to risk of Type 2 diabetes. Canned juices tend to have a lot of sugar added. And they immediately increase the blood sugar level,” says Dr Ashok Jhingan, chairman and consultant physician and diabetologist, Delhi Diabetes Research Centre, New Delhi.

A glass of wine...for a slimmer waistline

Surprised? An antioxidant found in red wine and grapes, known as resveratrol, not only helps to ward off cancer but may also turn out to be a fat fighter, according to research presented by Martin Wabitsch, a researcher from the University of Ulm in Ulm, Germany, at ENDO 08, the US-based Endocrine Society’s 90th annual meeting in San Francisco last year. Sounds like the hormonal effect of resveratrol can make grapes, grape juice and wine a chic addition to your diet plan.

Take your green tea with lemon…for extra antioxidants

A study published in the ‘Molecular Nutrition and Food Research Journal’ in November 2007 showed that citrus juices (including lemon, lime, orange and

grapefruit) boosted the benefits of green tea. Normally, some of the natural antioxidants in green tea, called catechins, are broken down during digestion and therefore can’t be useful to you. But citrus juices apparently stabilize the catechins, making more of them available for absorption.

In the study, researchers at Purdue University combined green tea with either one of the citrus juices or with vitamin C, and found more catechins became available for absorption in each case. The juice that worked best was lemon juice, which helped to retain 80% of the catechins. The others, in diminishing order of effectiveness, were orange, lime and grapefruit. “This is actually a great idea, especially for people who don’t like the taste of green tea and like to mask it with something,” says Jyoti Arora, team leader, nutrition and dietetics, Artemis Health Institute, Gurgaon.

Walnuts each day… to keep cancer at bay

Walnuts contain an antioxidant compound called ellagic acid that supports the immune system and has anticarcinogenic properties. “(Walnuts) also contain multiple ingredients such as omega-3 fatty acids, antioxidants and phytosterols that, individually, have been shown to slow cancer growth,” says Arora of Artemis Health Institute, Gurgaon.

Half a metre of floss…to keep clear of cancer, diabetes and heart disease

“Besides protecting against gingivitis (gum disease) by removing plaque and food particles, flossing has been shown to protect the heart, keep diabetes away and also, some researchers believe, prevent cancer too as periodontal disease seems to have a direct co-relation with all three,” says Neeraj Verma, senior consultant, dental surgery, Indraprastha Apollo Hospital, New Delhi.

Flossing is crucial for basic dental hygiene too; simply brushing isn’t enough. “Flossing cleans between teeth where a toothbrush can’t reach those hard-to-reach areas under the gum line and also helps control bad breath,” says Dr Verma.

A spoonful of spice…to clear your sinuses

Spicy food can give you a runny nose. For the same reason, spices help to clear the sinuses. This is one case where a pinch of a slightly bad thing becomes good! “(Pungent spices) produce more nasal secretions because (they) irritate the inner lining of the nose, which helps clear up things, definitely,” explains Ashok Vaid, consultant, ENT, at Max Hospital, Pitampura, New Delhi. If you’re all plugged up, “add hot peppers (such as cayenne powder, curry powder and chillies) and other spices to your diet to help clear things up,” says Arora of Artemis Health Institute, Gurgaon. “Adding ‘kali mirch’ (black pepper) to tea is a good idea, specially as winter is upon us already,” adds Arora. However, too much can obviously lead to excessive irritation, so practise moderation: A pinch more than your usual intake is enough.

Walk away from your workstation...and from dangerous blood clots

So you thought deep-vein thrombosis (DVT)—a blood clot in the long leg veins that can prove deadly if part of the clot breaks off and blocks a smaller blood vessel

happens only to frequent flyers? In a study led by Prof. Richard Beasley of New Zealand’s Medical Research Institute, published in April 2007 in the ‘New Zealand Medical Journal’researchers found that office workers who stay glued to their computer screens are at greater risk of blood clots forming in their legs than long-distance air travellers. The study reported findings that only 21% of patients admitted to hospital with dangerous blood clots had recently been on lengthy aeroplane flights—but 34% had spent more than 8 hours a day at their desks the previous month, not getting up at all for at least 3 hours or more. To avoid problems, stand up and stretch your legs every 30-60 minutes as this is important for good circulation,” says Vaishya, senior consultant, orthopaedic and joint replacement surgeon, Indraprastha Apollo Hospital, New Delhi.

Also Read DVT: It could happen to you

5 minutes of Scrabble and crosswords, twice a day…to boost your immunity

“Studies indicate that people who do crossword puzzles, math calculations and brain-teasers under time constraints keep their minds activated, besides boosting their immune responses,” says P.N. Renjen, senior consultant, neurology, Indraprastha Apollo Hospital, New Delhi.

Listen to music… to improve your immunity

Winter’s worth of flus and sniffles are here already. Scientists from Sussex University and the Max Planck Institute, Leipzig, Germany have found in a 2008 study that listening to just 50 minutes of uplifting dance music increases levels of antibodies (particularly immunoglobin A, the immune system’s first line of defence), as well as decreasing stress levels (which, when high, can weaken the immune system). The researchers said music led to physiological changes that eventually induced both stress reduction and direct immune enhancement.

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Floss

Neeraj Verma, senior consultant, dental surgery, Indraprastha Apollo Hospital, talks about the right way to floss:

• Cut an 18-inch piece of floss. Wind most of it on the middle finger of one hand. Wind the rest around the other middle finger, leaving an inch to hold between index fingers and thumbs.

• Wrap the floss around the back of the last tooth in your jaw. Gently slide into the space between tooth and gum until you feel resistance, then bend it into a C-shape around the tooth. Use a gentle sawing motion to clean.

• Unroll clean floss from one hand and wind up on the other. Curve the fresh length of floss around the next tooth and repeat.

--Kavita Devgan

World Diabetes Day: get yourself tested

14 November is World Diabetes Day. In an ongoing study, Ashutosh Shukla, head, internal medicine, Artemis Health Institute, Gurgaon, found simple lifestyle adjustments can prevent people with pre-diabetic symptoms from developing full-blown diabetes. Of 300 people who got an executive health check-up at the hospital in 2008, the study found 45 were pre-diabetic. These individuals were advised lifestyle and diet changes. Two years later, all of them were controlling their condition well. The study will continue to track them (earlier studies show a majority of pre-diabetics get Type 2 diabetes in 10 years). But based on the study, Dr Shukla recommends more stringent screening for pre-diabetes: “Screening should start at 30 years and be repeated every two years. If either of your parents are diabetic, get tested once a year.”

--Kavita Devgan

Injustice at work can be detrimental to health

The Whitehall studies have been investigating social determinants of health since 1967. As part of the Whitehall II study (begun in 1985), David Gimeno of the department of epidemiology and public health, University College London, and colleagues found that injustice at work is detrimental to health—if you are a man! Women don’t seem to be affected. In the article published online in the ‘BMJ’ journal in October, a perception of a high organizational justice was associated with a low risk of metabolic syndrome (a cluster of characteristics making cardiovascular disease and diabetes more likely)—a condition Indians are prone to.

--Staff Writer

The claims, the facts and the bottom line

Anahad O’Conner / NYT — Mon, 09 Nov 2009 15:01:00 GMT

The Claim

Men and women differ in their tolerance to cold

The Facts

Over the years, scientists have sought to determine whether tolerance to cold is at all influenced by gender. Some researchers speculate that men, generally speaking, should have a higher tolerance, resulting from a greater ratio of body mass to surface area, more heat-generating muscle and a higher metabolism. But the science is not so clear-cut.

One study in The Lancet looked at 219 people of all ages and found that the female subjects averaged higher core temperatures (97.8 degrees Fahrenheit versus 97.4 degrees Fahrenheit) but colder hand temperatures (87.2 degrees Fahrenheit versus 90 degrees Fahrenheit). That could indicate a better ability to conserve body heat and protect vital organs. But less blood flow to the extremities would also mean a greater feeling of cold.

Then again, studies in which men and women are immersed in cold water have found that the body’s reaction depends primarily on size and body fat. In other words, a man and a woman of equal size and body fat would show no difference in their response. Some studies also indicate that women’s perceptions of cold vary during the menstrual cycle, with body temperatures rising and falling. But that too is widely debated.

So many other variables also play a role in core and peripheral temperatures—diet, activity levels, hot flashes in menopause, smoking and sleep—that there’s no clear answer.

The Bottom Line

The research is unclear on whether gender influences cold tolerance and perception.

The Claim

Never blow your nose when you have a cold

The Facts

Blowing your nose to alleviate stuffiness may be second nature, but some people argue it does no good, reversing the flow of mucus into the sinuses and slowing the drainage.

Nasal etiquette: While sneezing, blow one nostril at a time and take decongestants.

Counterintuitive, perhaps, but research shows it to be true. To test the notion(in 2000), J. Owen Hendley and other paediatric infectious disease researchers at the University of Virginia conducted CT scans and other measurements as subjects coughed, sneezed and blew their noses. In some cases, the subjects had an opaque dye dripped into their rear nasal cavities. Coughing and sneezing generated little, if any, pressure in the nasal cavities. But nose blowing generated enormous pressure—“equivalent to a person’s diastolic blood pressure reading,” Dr Hendley said— and propelled mucus into the sinuses every time. Dr Hendley said it was unclear whether this was harmful, but added that during sickness it could shoot viruses or bacteria into the sinuses, and possibly cause further infection. The proper method is to blow one nostril at a time and to take decongestants, says Anil Kumar Lalwani, chairman of the department of otolaryngology at the New York University Langone Medical Center. This prevents a build-up of excess pressure.

The Bottom Line

Blowing your nose can create a build-up of excess pressure in sinus cavities.

The Claim

Nasal irrigation can ease allergy symptoms

The Facts

As pollen counts rise and smog thickens, allergy sufferers may be struggling to find relief.

For some, the neti pot, a nasal irrigator that resembles a small teapot, has become an alternative remedy. While it is not nearly as convenient as popping a pill or using a spray, several recent studies have found that nasal irrigation can reduce symptoms of allergies and other nasal problems.

One benefit is that irrigation can clear nasal passages without dryness or “rebound” congestion, which occurs when overuse of decongestants leads to dependence and irritated tissue. In one independent study in 2008, researchers (from the department of otolaryngology, First Affiliated Hospital of China’s Nanjing Medical University) examined a group of children with severe allergies. They found that regular nasal irrigation with a mild saline solution significantly eased symptoms and helped reduce the need for steroid nasal sprays.

A 2007 study at the University of Michigan looked at 121 adults with chronic nasal and sinus problems. Over two months, the scientists found that those treated with nasal irrigation reported greater improvements than those treated with a spray. Other research, including an analysis of studies in the Cochrane database in 2007, found that it can be an inexpensive adjunct to medication.

The Bottom Line

Studies suggest that nasal irrigation can reduce sinus and allergy symptoms.

Stretching the limits of fitness

Treadmill | Rajat Chauhan — Mon, 02 Nov 2009 17:01:00 GMT

Among those who exercise, there are several misconceptions about stretching in general, and more so about its usefulness prior to playing any sport. Recent studies suggest that stretching before or after exercise does not prevent muscle soreness or muscle injury. It seems to have limited use at best. In fact, improper stretching can, at times, cause injuries.

What is stretching?

The traditional stretches commonly done are called “static stretching”. They involve holding a stretch for a fixed amount of time, ranging from a few seconds to a few minutes. The other type of stretching, called “dynamic stretching”, involves stretching muscles while moving.

The theory is that ‘cold’ tendons are less elastic, and this is why you stretch—to loosen them up. For this, I would recommend a warm-up, which may include stretching in the case of certain sports but is not the same thing (a warm-up is meant to increase blood flow to the muscle, literally warm it up). A warm-up should be repeated movements similar to those one would use in the sport. Or you could simply jog for 5 minutes so that your body gradually gets used to movement.

Also Read Previous Treadmill columns

Whether the warm-up involves stretches will depend on the kind of sport you intend to play. In gymnastics, for instance, your warm-up would obviously involve a lot more stretching than, say, cricket or hockey. But do it slowly.

When to stretch?

Danger spot: The typical hamstring stretch can lead to sciatica

Pre-exercise stretching is, in most cases, a waste of time. Indeed, it can injure you. In a systematic review of controlled trials, published in British Medical Journal in August 2002, Rob D. Herbert and Michael Gabriel, from the University of Sydney in New South Wales, Australia, concluded: “Stretching before or after exercising does not confer protection from muscle soreness. Stretching before exercising does not seem to confer a practically useful reduction in the risk of injury”. They quoted two studies on army recruits in military training, which showed that stretching before exercise insignificantly reduced injury risk by around 1%. The authors, therefore, concluded that the average subject would need to stretch for 23 years to prevent one injury.

However, in an accompanying editorial, Domhnall MacAuley, from The Queen’s University of Belfast, and Thomas M. Best, from the University of Wisconsin Medical School in Madison, point out that a great deal in sport and exercise medicine is not supported by research evidence. “Stretching is long established as one of the fundamental principles in athletic care... Sport is rife with pseudoscience, and it is difficult to disentangle the evangelical enthusiasm of the locker room from research evidence,” they write.

So, when can stretching be useful? It can be useful for stiffness and treatment of certain injuries (gently, and under supervision), and is sometimes beneficial after sports to combat soreness (it may seem to make it better, but there hasn’t been any evidence that stretching or not actually makes a difference to soreness or pain.)

Which way to stretch?

Static stretching is practised by the majority of people with the objective of priming muscles. This does not help; in fact, it weakens the muscles. Studies have shown that athletes generated less force from their leg muscles after static stretching than they did after not stretching at all. The straining muscle becomes less responsive and stays weakened for up to 30 minutes after stretching, which is not how an athlete wants to begin a workout.

Dynamic stretching works better, if at all a sportsperson wants to do stretches beforehand. In games such as gymnastics and golf, where the motions of the game itself involve stretching, it can increase power, flexibility and range of motion—but only if done gently and correctly.

The author is a practitioner of musculoskeletal medicine and sports and exercise medicine. He is also CEO and medical director of Back 2 Fitness.

Write to him at treadmill@livemint.com

Burnout at work and play

Chitra Narayanan — Mon, 02 Nov 2009 17:00:00 GMT

When 42-year-old Ranjan Das, SAP India’s high-achieving managing director, who was known for his fitness and healthy eating habits, collapsed suddenly on 21 October, reportedly after a workout on a treadmill, there was much shock and conjecture. Was he yet another victim of a burnout, over-exercise or of sleeping too little?

SAP spokespersons are unwilling to go into the cause of Das’ death, which was reported in different publications as “heart attack”, “stroke” and “massive cardiac arrest” (all three have different medical implications). If it was indeed a cardiac arrest, then cardiologists are unwilling to link what they term “a one in a lakh” phenomenon to work stress.

Also Read Keep pace with your heart

10 tips for safer workouts

Yet, across executive ranks, people are now asking themselves if being conscious of diet and regular exercise is really enough of a buffer against the inevitable stress of a high-pressure job. While there are no definitive answers, the way ahead is definitely linked to understanding what works for your body and what does not.

Treadmill or ‘tread kill’?

Photo: Raajan / Mint

One-third of all sudden cardiac deaths (SCD) outside homes and hospitals occur in fitness clubs or sports facilities, says Balbir Singh, consultant, interventional cardiology and electrophysiology, Indraprastha Apollo Hospitals, New Delhi. Although most researchers downplay the risks of SCD during exercise—the American Heart Association pegs it at one in 100,000-200,000 cases—three deaths during the 18 October Boston marathon this year, the death of popular American basketball hero Randy Smith in Connecticut this June and, closer home, Das’ demise have highlighted the issue again.

Men are at higher risk of collapse during exertion than women, says Dr Balbir Singh. An October 2007 article published by the Canadian Society for Exercise Physiology in its newsletter pegs the risk for men at 1 SCD per 19 million hours of exertion.

Despite apparently low levels of risk, people such as Vishal Bali, CEO, Wockhardt Hospitals—who describes a CEO’s life in India as a “run-chase”—do guard against excessive exercise. “I do hit the treadmill and it helps me cope with stress. But obviously exercise also takes its toll on the body, so one has to do it in the right balance,” says the 41-year-old, adding, “When you do it under supervision, with a trainer, your protocol is set out for you. The regime varies according to your current health condition and current body parameters.”

Bali has hit the nail on the head. Body parameters do keep changing—a flu attack can weaken the heart muscles, making you a candidate for SCD. Which is why regular check-ups are a must.

Exercise without knowing your limits, without proper supervision, and without following safety protocols, such as getting medical clearance first, can have life-threatening consequences. “You must treat exercise as a super-speciality and while getting into it, you should know what you are getting into,” says Gaurav Sharma, a fitness and sports medicine specialist heading the Optima Wellness Centre, Gurgaon.

Unfortunately, most people don’t bother. Nor is supervision or knowledge of safety protocols in gyms adequate. Dr Balbir Singh says: “My own instructor often urges me to increase speed—he wants me to burn 300 calories in 6 minutes, which is dangerous.”

He believes every gym should have written protocols on how to use a treadmill and a process of graded increase should be followed. But first, he adds, “Anybody who goes to (a) gym should have a basic cardiac check-up”.

Take it easy

Amitav Mukherji, a 37-year-old, Bangalore-based senior human resources executive in an Indian multi-business conglomerate, is a case study of somebody who over-exercised, without supervision and paid for it. About a year ago, in his enthusiasm to train for a marathon, Mukherji suddenly upped the time he spent on the treadmill. Going from 20 minutes of running to 40 minutes and then to 1 hour, he suddenly found his knee caving in.

It took two months of physiotherapy and a period of rest before Mukherji could start exercising again. This time he sought advice from a professional trainer and now exercises only five times a week, and never more than an hour a day. “One month with a trainer who can set the right regimen is sufficient for a self-motivated person,” he says.

Friends and colleagues describe Das as a fitness freak who was so compulsive about his exercise regime that even when travelling, he sought out gyms for his daily workout. “It seems like Mr Das was a Type A personality. Such people have such high motivation levels that they tend to overachieve at everything. Chances are they will take even exercising to extreme levels,” says Rachna Singh, lifestyle management expert, Artemis Health Institute, Gurgaon. (In the 1950s, cardiologists Meyer Friedman and R.H. Rosenman propogated a personality type theory categorizing people according to their coronary artery disease (CAD) risk. Contemporary psychologists reject this theory totally but according to it, Type A personalities, described as “stress junkies”, are high-achieving workaholics who multitask, drive themselves with deadlines, and are unhappy about delays. They are supposed to have double the risk of CAD than others. Type B individuals are patient, relaxed, and easy-going. Type AB is a combination of both.)

Overachievers often forget that in its own way, exercise is physical stress, too. In fact, just as a six-pack is no benchmark of good health, a great deal of time spent on the track or treadmill is no guarantor that it will lead to maximum fitness.

Raghav Pande, a health and fitness coach for Mynutrition.in (a portal that provides personalized diet and fitness packages), says all individuals must take into account their current fitness levels before embarking on a fitness plan. “Overweight individuals should not get on to a treadmill and individuals suffering from hypertension should not pursue a regime which uses 60% (or more) of (their) maximum heart rate.” To avoid injury (the possibilities are wide-ranging), don’t push yourself through discomfort, pain or weariness.

Holistic approach

“Ranjan and I recently exchanged notes on how little we were sleeping. He observed that all the ‘great guys like Einstein did 4 hours a day’,” says Prasanto K. Roy, president and chief editor, CyberMedia. It has been widely reported that Das slept for only 4 hours.

“Most high achievers in their productive years give far more than they should, thinking that nothing will happen to them when they are young. So they work at the cost of sleep,” says Samir Parikh, well-known psychiatrist and head of mental health and behavioural sciences department, Max Healthcare, New Delhi.

“Sleep is the most important rejuvenation tool,” says Rachna Singh. But deadline pressures can leave sleep and rest as the biggest casualties. You cannot postpone rest, nor can you fruitfully “catch up” on it later.

“We are going to see a lot more fatal incidents happening at fitness centres as people start pushing their limits, without paying attention to the rebuilding tools,” says Sharma, adding, “After a bout of intensive exercise, you need to constantly keep rebuilding your overworked body parts with more proteins, nutrients, proper sleep.”

In short, you need a holistic approach. The complete wellness prescription entails not just the physical aspects, such as good diet, adequate exercise and sound sleep, but also the emotional and spiritual aspects. And there lies the rub. “You can’t be smoking like a chimney or eating rotten food or sleeping less and then trying to compensate this lifestyle by exercise. The approach to well-being has to be holistic,” says Neeraj Bhalla, consultant cardiologist, Max Healthcare, New Delhi.

Behaviour specialists say there are several warning signs of a life out of balance that families, friends and colleagues can catch. Parikh says: “The kind of time I have for my family and friends is the biggest warning signal. If I cannot find time to do something I am fond of, surely that means something is wrong.” And it is these small things the “work hard, play hard’” mentality can overlook.

Rachna Singh says HR departments can be a bit more proactive and address work-life balance on a priority. “Management of stress and burnout is always termed a ‘soft skill’ by the corporate sector,” Parikh says ruefully. “This itself undermines the importance that (companies) pay to this issue. These are not “soft” areas but are “hard facts” and life and death issues.”

Archana Rai contributed to this story.

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Macrobiotic diet

Actor Gwyneth Paltrow and singer Madonna supposedly owe their figures to a macrobiotic diet. Actors Esha Deol, Tabu and Katrina Kaif are also said to follow it. The pursuit of wellness doesn’t come cheap, however; the macrobiotic lifestyle advocates an organic, whole grain, no-dairy, pesco-vegetarian diet. French-born chef Patrick Verré is conducting a five-day course (13-17 November) at Aristo Spa, Bangalore (080-45121212), costing Rs29,999. In Mumbai, Shonaalii Sabherwal (9819035604), director of Enhance, Healthier Lifestyles Options Pvt. Ltd, offers macrobiotic diet consultations at Rs2,000 a session. Chitra Narayanan

Vaccine for Pneumonia

Most flu deaths are caused by pneumonia. So, a more protective form of Pfizer’s older vaccine for pneumococcal disease could prevent deaths from pandemic influenza, independent researchers and the firm reported over the weekend. In a severe outbreak (such as the 1918 Spanish influenza), the new Prevnar 13 vaccine could result in savings of $18 billion (Rs84,600 crore) in medical costs in countries that have not offered any immunization against pneumococcal disease, the team reported at a meeting of the Infectious Diseases Society of America in Philadelphia over the weekend. The Prevnar 13 vaccine protects children against 13 strains of bacteria that cause pneumococcal diseases, ranging from ear infections to pneumonia and meningitis. Pneumococcal disease kills around 1.6 million people worldwide each year, including 800,000 children. Reuters

Cancer and caffeine

Women dread a diagnosis of endometrial cancer, but those who drink at least two cups of caffeinated coffee a day may have a lower risk of this cancer, according to a recent study. Coffee drinking seemed to particularly protect overweight and obese women, study co-author Emilie Friberg, at the Karolinska Institutet in Stockholm, Sweden, told ‘Reuters Health’ by email. Reuters

Write to us at businessoflife@livemint.com

Countdown: 12 hours to the race

Rajat Chauhan — Mon, 26 Oct 2009 15:25:00 GMT

If you have been training for any of the running events—marathon or half marathon—coming up in Delhi, Mumbai and Bangalore, you should be ready to sprint now. If you haven’t been training, it is too late to start now, so wait until next year (and make sure you start on time).

Prepare for the early start on the day of the marathon by organizing on the day-before-the-run evening.

Cut out this list of dos and don’ts and keep it handy.

The timings are based on the first of the races coming up, the Delhi half marathon; but you can always count back 12 hours from the race start time in your city (see Running Times) and adapt this checklist accordingly.

Also Read How to train for a half marathon

Treadmill: Life’s a marathon

The day before the race

Don’t go running. Take it easy—if you’ve been training, you’ve done enough. If you really must, go for a 1-2km run in the morning. Don’t make plans to train in the evening.

7.30pm

Pack your bags

• You’ll need three small bags to fit into one lightweight and waterproof bag. One bag for the stuff you’ll need in the morning, and two others to hold the things you will need during the race and after you cross the finish line

• Do not pack anything new (especially T-shirt or shoes) for the day of the race. Everything you pack should have been tried and tested during your training runs — not just once, but several times

Morning/pre-race bag

• Full sleeve T-shirt or tracksuit top

• Track pants

• Mobile phone

• Change of Rs50 (the parking lot is not always close to the start point)

• Water bottle

• Large bin liner (if it’s cold, bin liners work very well to keep you warm while you wait for the run to begin, and you won’t mind discarding them as you set off).

Running bag

• Running shoes

• Socks

• Dry-weave T-shirt (not cotton)

• Bib with your participant number (attach four safety pins to the corners; on the back, write your name and the phone number of a person to contact in an emergency)

• Shorts

• Sunglasses (it’ll get quite bright after 7am or so, but bring this only if you’re used to wearing one while you run)

• Cap (if you are used to wearing one while you run)

• Belt pouch for on-the-run snacks

After-race bag

• Change of Rs50 (the finish point may not be very close to the parking lot)

• Water bottle

• Dry snack foods, fruit (cereal bars, bananas, etc.)

• A complete change of clothes, including a fresh set of underclothes and a pair of comfortable slippers or floaters

• Set of adhesive bandages for blisters and minor cuts

• For men: Thick cream (such as Nivea), petroleum jelly (such as Vaseline), or micropore tape to protect your nipples (bleeding from friction is not unusual, and is not just embarrassing but painful)

8pm

• Eat a carbohydrate-rich dinner. The “traditional” marathoners’ choice would be pasta or pizza. Rice is great as well.

8.30pm

• Call the people you intend to carpool with and confirm arrangements (who, where, when). Also ask a friend or a co-runner or participant to call you at 5am, as a back-up plan in case your alarm clock experiences sudden death or you to hit the snooze button.

9pm

• Set an alarm for 5am; go to bed early

The day of the race

5am

• Rise and shine, take your own sweet time in the loo

• Also take stock: Are you feeling good? Most medical emergencies during races occur because people were unwell but did not wish to miss the event. If you check off any of the following, please don’t run

• Feeling feverish

• Having flu-like symptoms

• Feeling nauseous

• Having diarrhoea

• Feeling chest pain

• Even if you are raising money for charity, or running to prove a point to yourself or to your friends, it is unfair to your sponsoring charity and the race support staff if you become a medical emergency on the track. There are many other races that you will be able to compete in.

5.30am

Final pack and check

• Double-check your packing list and the contents of your bags

• Pack your belt pouch with your choice of mid-marathon nutrition:

• A sports drink

• 2 cereal bars

• A handful of non-sticky semi-soft candy, such as jelly beans, wine gums or jelly babies

• 1 jam/butter/cheese sandwich

• A couple of fruits, such as bananas (a runners’ favourite), apples or oranges

• 2 handfuls of dried fruit

5.40am

Eat your breakfast...or not

• This is a personal choice. Some people like to eat a bit before the run, others (like me, I confess) don’t. It is actually important to “practise” your pre-race snack too during training, to find out what works best for you.

• If you do eat breakfast or would like to bring something along to eat in the car, it is advisable to choose a light snack. Ideally you want about 250-300g carbohydrates, but very little fibre to avoid causing a stomach upset. No need to fix anything special—just have something high-carb for energizing, similar to the items you’d carry on your run, or maybe a low-fat fruit yogurt

• Some people would like to eat, but find it difficult because of nerves. In this case, try a liquid meal such as a fruit smoothie or fruit yogurt drink

6am

Leave home

• To get to the venue in good time, you need to take into account various road blockages due to the race route, and then give yourself time to find the parking lot, get a space...and not race to the start line

6.30-7am

On your mark…and drink up

• Check in your baggage and get to the start point early. These races do start on time

• Use your waiting time to stay well hydrated. Drink 250ml of water or a sports drink in sips over the next half-hour—but don’t gulp your drink down right before the race

During the race

7.30am

Start running…

• Start… slower than what you know you are capable of. You have enough distance and time to catch up

• First aid… will probably not be needed if you have followed a training programme faithfully. If you do find you need medical attention, go to one of the race’s First Aid posts, located at various points along the route

• Drink… some water. There are water stations positioned every 2km. Take a few sips at every station, but don’t drink it all or you’ll overdo it (although this is only a half marathon, over-hydration is a very big problem among novice runners. This can cause a rare but fatal condition called hyponatremic encephalopathy, when there is too much water to balance the sodium salts in your body and this leads to water retention in the brain. Just be guided by your thirst, not your apprehension)

• The stations are long, so don’t stop at the start, where it’s crowded. Go on ahead, and you will find a spot that is free

• When you are going to stop, look behind and move to the side, out of the way of other runners so they needn’t collide or swerve to avoid you

• Don’t take more than one bottle if you can help it. Consider the others behind you (you can always get a refill at the next station)

• Don’t glug it all down. Take the bottle with you to sip as and when you need to

• When you discard your bottle, do so carefully. It’s easy for runners to trip over a bottle in their path or bump into another runner who suddenly swerves into their path

• Say thanks...to those manning the stations! They are all volunteers and are out there to make it an enjoyable day for you

• Eat… if you take any longer than 2 hours for 21km, please eat! Forgoing food is not heroic, merely dangerous to you and potentially a nuisance for others (who may have to tend to you when you faint). Options: sports drinks, cereal bars, jam sandwiches, pieces of fruit, handfuls of dried fruits (remember the belt pouch?). Have your first snack around 30 minutes into the race, aiming for 30-60g of carbohydrate per hour, and continue at regular intervals

At the finish line

• Finish… and keep walking. Don’t just stop short as soon as you cross the line. You need to cool down, and this way other runners coming in are less likely to barrel into you too

• Change… into warm, dry clothes. Get to the baggage area as soon as you can—where you should get your kit—and then head for the reunion area

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Related articles

Dr Rajat Chauhan is also blogging about his own experiment with minimalist running footwear over the next few months. Read about it on blog.livemint.com/life

If going barefoot is too radical for you and you’re not quite ready for minimal footwear either, here’s help on selecting running shoes. Also ReadFor the shoe to fit

Racing with the brand

Here’s a rundown on new running shoe models from some leading sports footwear brands

Nike LunaRacer: This shoe uses the Flywire technology (engineered support for the foot) and LunarLite (cushioning system). A pair weighs approximately 312g. Priced at Rs8,500, available at Nike stores countrywide.

Reebok SelectRide: This is a multifunctional shoe that transforms flat trainers into running shoes with adjustable cushioning. Price starts at Rs16,000, available at select Reebok stores countrywide.

Adidas adiSTAR Ride II: This shoe has a combination of ForMotion and adiPRENE technologies in the midsole for smooth touchdown despite high-impact forces. A pair of shoes weigh 344g. Priced at Rs8,499, available at Adidas stores countrywide.

PUMA LIFT Racer: A pair of LIFT (light injected foam technology) Racer shoes weigh 346g. It has a breathable mesh. There is a separate version for women. Prices start at Rs2,999, available at Puma outlets countrywide. Varuni Khosla

After the race

Celebrate… what you’ve achieved. However, while spirits are high, it is easy to forget about recovery. Don’t.

Drink… water or fruit juice in moderation, NOT large amounts. You should rehydrate gradually over the next 24-48 hours. Eat salty food and space out your drinks to regulate your isotonic balance. If juices taste too acidic, dilute with water. Remember: Water will replace fluids as well as any commercial drink.

Eat… within 4 hours, ideally sooner. Within the first hour, it’s most important to have proteins to help your muscles recover. After that you need carbohydrates to top up your depleted glycogen reserves.

Recover… over the next two days. Yes, it takes that long for your muscles to recuperate, with lots of carbohydrate foods and rest. Of course, this means you have plenty of time and needn’t run to recover. Rajat Chauhan

Running times

• The Airtel Delhi Half Marathon (21.097km) is on 1 November. The senior citizens’ run (4.3km) starts at 7.10am, the main event at 7.30am, the wheelchair event (3.5km) at 7.45am and the Great Delhi Run (7km) at 9.30am. For details, log on to http://adhm.indiatimes.com

• The Bangalore Ultra Marathon is on 15 November. An ultra marathon is a run of more than 42km. This race, however, has 12.5km, 25km, 50km, 75km and 100km events. Timings are yet to be announced. For details, log on to www.bangaloreultra.com

• The Standard Chartered Mumbai Marathon (42.195km) is on 17 January. It includes a half marathon (21.097km), a dream run (6km), a senior citizens’ run (4.3km) and a wheelchair event (2.5km). Timings are yet to be announced. For details, log on to http://mumbaimarathon.indiatimes.com

Dr Rajat Chauhan is a practitioner of sports and exercise medicine and musculoskeletal medicine, and CEO of the Back 2 Fitness chain of clinics specializing in injury rehabilitation, rehabilitation and performance enhancement.

Write to us at businessoflife@livemint.com

4pm snack attack!

Kavita Devgan — Tue, 20 Oct 2009 04:15:00 GMT

It’s 4pm and you are fidgeting in your seat, trying to ignore your growling tummy. A colleague passes over a couple of burfis, adding 280kcal to your day. Resistance is evidently futile. So you think you might as well take a tea break.

“There are three main reasons (why) people feel hungry in the afternoon. They missed lunch or it was not satisfying; they are bored and want to munch mindlessly; or someone else is snacking,” says Ishi Khosla, consultant nutritionist and proprietor, Whole Foods, New Delhi.

“Snacking per se isn’t bad,” she adds, “it won’t make you fat. In fact, snacking can increase your metabolic rate and stimulate your body to burn more fat.” As long as you are smart about it, you can avoid gaining weight. “Snacking does not have to mean high-fat, high-calorie food,” says Jyothi Prasad, chief dietician, Manipal Hospital, Bangalore.

What you want is 100-150kcal with a good balance of nutrients. “Print a list of healthy snack options and keep it handy. So that when the craving strikes, you know what to order,” she says.

Another choice is portion size. “Just having one vada, instead of two, can help keep things under control,” says Jyoti Arora, team leader, nutrition and dietetics, Artemis Health Institute, Gurgaon. “Remember: Snack to satisfy hunger, not boredom.”

The bad bets

Samosa

Calories: 240kcal (one big or two small ones)

Samosa is a popular snack as it is widely available, filling and tasty. The crust is made from maida, or refined flour, and the filling is usually boiled or fried potatoes

Why it is bad for you: It is high in calories, which mostly come from carbohydrates and fat. It is deep-fried, so is full of the worst kind of fats—trans fats—as the oil is reused over and over again. Experts say trans-fats are worse than even saturated fats for the heart (see ‘Beware’). Plus, you can’t really be sure of the type and purity of the oil used.

Vada Pao

Calories: 370kcal (1 vada = 160kcal, bread = 100-120kcal, butter/oil = 90kcal)

This is really a variation of bread pakoda (see below). Though bigger in size, the ingredients are the same: One white pao bun, a mashed potato fritter and a little chutney.

Why it is bad for you: The refined flour bun and deep-fried fritter of besan-coated potato mash mean high carbohydrates with a full meal’s worth of calories. Also, there are those dangerous trans fats from the deep frying. The meagre helping of chutney adds little to the health quotient.

Potato Chips

Calories: Approx. 540kcal for a 100g pack; 164kcal for a small (30g) bag

Potato chip are not usually even real slices of potato, just reconstituted potato mush with lots of salt.

Why it is bad for you: There are a lot of preservatives (acidity regulators, anti-caking agents, flavour enhancers, essence—added to improve taste, preserve crunchiness and increase shelf life) and loads of salt. Also, be careful of labelling that says “no trans fats” as these are generated when oil is heated to a very high temperature. So oil changes to trans fat while processing. The labelling is factual—but is a half-truth. And, there is no way to know how much trans fat there is in a packet.

Pastry

Calories: 220-310kcal

A 3x5-inch rectangle of sponge cake, sandwiched and topped with butter cream icing (and perhaps chocolate ganache).

Why it is bad for you: Refined flour offers scant satiety or nutrition. Most “butter cream” is really vanaspati (hydrogenated vegetable oil, hence trans fat) and sugar, which are not only calorie dense, but also damaging for the heart and arteries. Plus, unless you buy it from a reputed bakery, the colouring and flavouring agents can be of suspect quality.

Vada Chutney

Calories: 270kcal per serving (1 vada = 190kcal; 1 tbsp chutney = 80kcal

Deep-fried savoury lentil fritters with coconut and lentil chutney.

Why it is bad for you: The vadas are high in calories. Since you do get some proteins from the lentils, vadas are a tad better than samosas. However, they are full of trans-fats and carcinogens from deep frying. Each vada absorbs about a tablespoon (15g) of fat—approximately 120kcal. Coconut chutney is extremely high in calories (an apple is also 80kcal, while a spoonful of mint chutney is only 5kcal).

Instant Noodles

Calories: 330-350kcal per 75g packet

“Instant” noodles are made of refined flour and typically come with a packet of flavouring.

Why it is bad for you: In substance and calorific value, this is closer to a meal substitute, which we often seek for instant gratification. It is usually at least 60–70% refined carbohydrate. Most of the remaining calories are from fat. It is loaded with preservatives, especially the flavouring. A packet of flavouring contains about 900mg salt, which is at least 40% of your daily salt allowance. Also, check for the presence of the controversial monosodium glutamate.

Cake slices/Muffins

Calories: 274kcal for a 75g pack

Typically about 10-12 slices of cake (or 3-4 muffins) in a packet and we rarely leave a few for next time.

Why it is bad for you: Like chips, these are a popular snack as they are easily stored in desk drawers or bags and stocked in canteens without much worry about spoilage or shelf life. Just as we reach for crisps when we want a savoury snack, we often choose these for a sweet. It helps that they are dry and crumbs are easy to dust off without leaving much evidence. However, they really no better than a pastry—high in fat, sugar (approximately 75kcal from sugar alone) and refined flour. Again, the fat used is typically partially hydrogenated oil, hence trans fats. Satiety, too, is very low without fibre or protein. Also, don’t be fooled by promises of fruit and nut—it’s a negligible quantity of candied fruit and colouring, flavouring and preservatives.

Bread Pakoda

Calories: 330kcal (376kcal if stuffed with potato)

Two half slices (triangles) of white bread coated with besan and deep-fried.

Why it is bad for you: High calories, mostly from being deep-fried, which also means they are loaded with trans fat from oil reused for frying (they are also frequently re-fried for reheating). The presence of besan adds some protein, which only means it is better than plain fried white bread. The accompanying chutney doesn’t really help much despite looking like a ‘green vegetable’—there simply isn’t much nutritional value to talk about. Plus, since they are typically sold alongside uncooked or raw foods (chaats, burgers and sandwiches with raw veggies), there may be a high contamination hazard.

Kathi Roll

Calories: 400-450kcal

A paratha wrap about 8 inches long with an egg coating and a filling of mutton, chicken or paneer in a curry-like gravy or as a grilled kebab.

Why it is bad for you: First of all, this is pretty much a whole meal, not a snack. So unless you’ve actually missed lunch (which causes its own problems and you can’t just make up for it with a late meal), this is your fourth meal of the day! Almost deep-fried, the paratha is made of refined flour to keep it crisp, fried egg adds even more fat and cholesterol (so does paneer or mutton), and red meat makes it worse for the heart. There are scant vitamins and minerals to balance it out. There is also often a danger of contamination from uncooked meat juices on raw onions, due to some serious issues of preparation hygiene (you rarely see the cook washing up between handling raw kebab, cooked kebab, onions and lime, and the paratha). Add to this the carcinogenic substances produced from charcoal grilling.

Grilled Cheese Sandwich

Calories: 330-375kcal

Two slices of white pre-sliced sandwich bread, 60g grated processed cheese, 2 tbsp butter (on both sides), salt and pepper and 2 tbsp mint chutney.

Why it is bad for you: White bread means low-nutrient carbohydrate calories (from refined flour). Processed cheese is 50%, or more, fat to which butter adds saturated fat. The minimal amount of fibre and vitamins from the chutney do you hardly any good. You will not feel satiated. Also, the effect on blood sugar is strong, leaving you hungry just a couple of hours later. The grilling process also produces potential carcinogens.

The Good Eats

Steamed Corn

Calories: 150kcal (for 1 cup)

Either cooked whole, on the cob or steamed as separated kernels, the substance is the same. The former can, however, be more satisfying because you can’t wolf it down as fast, giving your brain’s appetite centre time to register fullness before you overeat. Don’t add any butter if you can help it.

Why it is good for you: Get the goodness of healthy carbohydrates with fibre and a good bit of protein, too, in a snack sans any added fat or sugar that is naturally filling and savoury-sweet. Quite a few vitamins and minerals, plus it contains a little fat (not saturated) naturally, a good addition for satiety (and no, roasted ears of corn are not as healthy—the grilling itself produces carcinogens).

Fruit Chaat

Calories: 50–100kcal for one small (side) plate

Mixed, cut fruits, preferably without salt sprinkled on them

Why it is good for you: It is an energizing high-carbohydrate snack, but these are good carbs, with soluble and insoluble fibre that provide high satiety and heart protection, vitamins and minerals and protective antioxidants. Make sure the fruit is freshly cut after washing with clean water. The more variety you have with a wide assortment of colours and textures, the better it is for your health.

Yogurt

Calories: 140kcal for 150ml

Plain unsweetened yogurt

Why it is good for you: A filling snack with a satisfying quantity of protein. Some types may have probiotic benefits. All types provide a good source of bone-building calcium. Choose a plain yogurt with a neutral flavour (acidity and texture differ across brands) and avoid the sweetened and flavoured ones—that’s more important than choosing between full-fat and Iow-fat. If you must, add fruits or nuts on your own for flavouring.

Roasted Grains or Lentils

Calories: 90-115kcal (for 30g pack of roasted grains); 175kcal (for 50g pack of roasted gram)

Oats, bajra, soya, amaranth, Bengal gram, even mixed grains—the choice is wide now. Try to avoid masala, though a squeeze of lime can’t hurt.

Why it is good for you: A good option for those who eat out of boredom or need something to munch on. Negligible fat, high fibre and a large helping of protein make these a good option to munch on as an alternative savoury snack: Consider that a single small mathri (salty, fried snack made from refined flour) is about 45-50kcal, while half a cup of roasted grains will match that calorie count with much more satisfaction. Since it’s whole grain, there’s a feeling of being full longer, with the added benefit of getting fibre, minus trans fats. Roasted Bengal gram is much healthier than roasted peanuts since lower in fat and hence in overall calories too. It is also loaded with protein and iron—indeed an excellent source of both for vegetarians particularly—besides providing high satiety.

Vegetable Sandwich on Oat Bread

Calories: 190kcal

Two triangles of oat bread (or choose another wholegrain bread, though oat is particularly good for your heart) plus raw or boiled veggies (plus chicken, if you prefer). No mayo or other fatty spread; maybe hung curd for moisture if you need it.

Why it is good for you: A dose of very heart-friendly fibre from the bread, as well as the vegetables, which will keep you feeling satisfied for a much longer time than white bread and cheese. Plus, you should get a few antioxidants from the yoghurt and veggies.

Dhokla

Calories: 65kcal (per piece)

Steamed cakes of fermented lentil batter, typically cut into pieces 2-3 inches across. No added chutney or toppings.

Why it is good for you: Lentils provide a natural balance of carbohydrates and protein. Besides, as a fermented food, this is especially easy to digest. It is low in calories and hardly any fat too. It is also very widely available and not too messy, all good reasons to substitute it for chips and cakes and the like.

Steamed Momos

Calories: 60kcal for two vegetable momos

Steamed dumplings made of a thin flour wrapper filled with boiled vegetables such as carrots and cabbage.

Why it is good for you: Steamed momos are a fat-free snack if ever there was one. They are filling, thanks to the fibrous vegetables, and the refined flour wrapper is too thin to be too bad for you. A chicken version is fine too, but try to make sure you get a few veggies as well to balance them out.

Low-cal Bhelpuri (or Jhalmuri)

Calories: 100-120kcal for 30g (a small katori)

A mix of puffed rice and roasted lentils with salt and other dry spices.

Why it is good for you: When the craving for something savoury, salty and spicy strikes, this is an easily stored and easy to make option that is much better for you than chips, for instance, being somewhat lower in calories and much lower in fat. The puffed rice dilutes the calories and fat content considerably. Avoid the packaged kind where the calories can be deceptively high and the salt levels out of control. Making on your own is easy, with plain puffed rice and roasted lentils, and more hygienic than roadside concoctions. Avoid adding salt (the puffed rice usually has salt in it already). And if you can add in some chopped fresh vegetables (such as cucumber, tomato, green chillies), a squeeze of lime, and some sprouts, so much the better for protein and micronutrients, as well as satiety. Avoid adding chutneys, sauces, oil or peanuts.

Roasted Gram

Calories: 90-115kcal (for 30g)

Roasted dried Bengal gram, with no added oil, with a squeeze of lime and a smidgen of chaat masala

Why it is good for you: Easily bought in a packaged form, this readily stored, non-messy snack is loaded with protein and iron—indeed an excellent source of both for vegetarians particularly—besides providing high satiety. Much healthier than roasted peanuts since lower in fat and hence in overall calories too. If you can develop a taste for munching them without salt or masala, so much the better for you.

Idli-Sambar

Calories: 130-140kcals for two idlis, about 120kcal for a small katori of sambar

Steamed cakes of fermented rice and lentil (urad) batter, with a spicy dal often containing an assortment of veggies.

Why it is good for you: A balanced mix of protein and carbohydrates, plus veggies too if you’re lucky—more a light meal than a snack, really, so make sure you had a light lunch or plan a light dinner. The fermented batter is easy on the digestion, and makes more nutrients available. Very satisfying, yet quite low in calories for that satiety value. Typically served with one or more chutneys as well, but give those a miss—the coconut base is high in saturated fats and calories.

Sprouts

Calories: 60kcal for 200g

You can sprout your own grains and lentils at home or buy them readymade (they are available in small one-serving packets in many supermarkets, even Safal and Mother Dairy outlets in some cities). You can even try a different lentil each day, or a different mix. Serve with salt, pepper and lemon juice.

Why it is good for you: Sprouted lentils and grains are a filling snack, easy to munch on, and an easy way to increase your intake of vitamins and minerals. Germinating seeds and grains increase their nutritional value. The vitamin C content of wheat, for example, increases 60% during sprouting.

Teatime Beverages

The good…

Doodh-chai or masala chai (small cup, 1tsp sugar), 40-50kcals

Soy milk or low-fat milk (1 cup or 250ml), 75kcals

Coconut water (1 glass), 36kcals

fresh orange or sweet lime juice (1 glass from about 2½ oranges), 100kcals

Fresh nimbu-paani (limeade, 1 glass), 20kcals

Green tea (no sugar), 0 calories

Buttermilk, lightly salted (1 glass), 60kcals

Buttermilk, sweet (1 glass), 100kcals

Tomato rasam (1 cup), 72kcals

Instant coffee (1 cup, with sugar, small splash of milk), 55kcals

The not-so-good…

Iced tea (1 glass), 60-150kcals (depends on recipe)

Cappuccino (1 cafe cup), 90-250kcals (depends on cup size and barista’s recipe) Carbonated beverages (300ml bottle), 110kcals

CONNECT

Beware of Trans-fats

Trans-fats increase “bad” cholesterol and triglycerides, reducing “good” cholesterol and raising the risk of cardiac diseases. “These are much worse than even the saturated fats found in butter and beef. (They) trigger cancer, diabetes, immune dysfunction, obesity and reproductive problems. They are almost everywhere,” says Rakesh Sapra, consultant, cardiology, Artemis Health Institute, Gurgaon. In 2007, the Centre for Science and Environment (CSE), New Delhi, tested a variety of Indian cooking fats and found trans-fat levels 5-12 times higher than international recommendations in all seven ‘vanaspati’ (fully or partially hydrogenated vegetable oils) brands tested. “(Trans-fats) are also in cookies, crackers, icing, potato chips, doughnuts, baked goods and other processed (check label for ‘partially hydrogenated oils’) or fried foods (‘samosas’, ‘pakoras’, ‘kachoris’, among others),” says Dr Sapra.

--Kavita Devgan

Easy snacks

Some options which can be rustled up easily and aren’t too messy to eat over a keyboard:

•Sprouted pulses: Calories: 25-30kcal for 100g. Sprinkle salt, pepper and a little ‘chivda’ (beaten rice) or ‘sev’ (lentil vermicelli) over sprouted ‘moong’ (green gram), ‘masoor’ (lentil) or any another pulses.

•Cup of corn : Calories: 120kcal for 100g. Microwave frozen corn; add salt and pepper to taste.

•‘Chana chaat’: Calories: 100kcal for 30g (dry weight). Microwave soaked Bengal gram, and sprinkle lime juice, ‘chaat masala’ and a little chopped onion.

--Kavita Devgan

World Osteoporosis Day

Today is World Osteoporosis Day. “One in five Indians has osteoporosis, but most have no idea of the disease and remain untreated for this potentially life-threatening condition. And, one-quarter of these are men,” says Surya Bhan, director of orthopaedics at Primus Super Speciality, New Delhi. Although osteoporosis is perceived primarily as a woman’s disease, one in three men over the age of 60 (and every second woman in that age group) is likely to suffer a fracture due to osteoporosis. Men are also more likely than women to incur a second fracture—the risk is four times greater after their first fracture (in women it is twofold). The problem with osteoporosis is that it often has no symptoms, other than height loss. “The only way to confirm the condition is through a non-invasive bone density test, similar to an X-ray,” says Dr Bhan.

--Kavita Devgan

Note: All nutritional values and portion sizes are approximations.

Nutritional information courtesy: Ritika Samaddar, senior dietician, Max Devki Devi Heart and Vascular Institute, New Delhi.Write to us at businessoflife@livemint.com

The claims, the facts, the bottom line

Anahad O’connor / NYT — Mon, 19 Oct 2009 14:53:00 GMT

The Claim

With a runny nose, green calls for an antibiotic

The Facts

Old prescription habits apparently die hard.

Studies have suggested that most doctors say they would prescribe an antibiotic if a child with sinus symptoms also had green nasal discharge. The habit stems from the notion that green is indicative of a bacterial infection.

But other studies show that green is no more common in a bacterial infection than a viral one, for which antibiotics are ineffective. In a definitive study from 1984, scientists put 142 children with green nasal discharge into groups, including one that was treated with antibiotics and another that received a placebo. They found that the drugs had no effect on “potentially pathogenic organisms” or on symptoms. About 35% of subjects treated with antibiotics showed improvement, compared with 31% in the placebo group. More recent studies have bolstered that conclusion.

According to the US Centers for Disease Control and Prevention, when cold viruses infect the respiratory tract, the body makes clear mucus that helps wash away germs from the nose and sinuses. After about three days, the body’s immune cells fight back, changing the discharge to a white or yellow colour. “As the bacteria that live in the nose grow back, they may also be found in the mucus, which changes to a greenish colour,” says the agency. “This is normal.”

The only time antibiotics are needed for a runny nose, say experts, is when the diagnosis is bacterial sinusitis.

The Bottom Line

Colour of nasal discharge should not dictate medicine.

The Claim

Chamomile can soothe a colicky baby

The Facts

Colic—uncontrolled screaming and crying in an otherwise healthy infant—can be one of the most stressful parts of raising a newborn.

While its cause is uncertain, there is evidence that it stems in part from gastrointestinal discomfort. That may explain why chamomile tea, which according to research can ease intestinal spasms, has long been a home remedy. Various studies have found it simple, inexpensive and fairly effective.

One report by the American Academy of Pediatrics in 2007 reviewed two of those studies, including a randomized clinical trial that involved 68 colicky infants aged 2-8 weeks. One group received either herbal tea (warm or cool) made primarily with German chamomile, and the other a placebo. Each infant was offered either the tea or placebo with every bout of colic—up to 150ml (a little more than half a cup) no more than three times a day. After a week, “parents reported that the tea eliminated the colic in 57% of the infants,” the researchers reported, “whereas placebo was helpful in only 26%. No adverse effects were noted in either group.”

Other studies had similar results. Experts say allergies to chamomile are rare, but one way to check is to swab a bit on skin. If no redness develops, it should be safe.

The Bottom Line

Research suggests chamomile may ease colic.

The Claim

Loss of sight heightens other senses

The Facts

Studies suggest this familiar claim is more fact than fantasy.

In one series of studies, neuroscientists at McGill University, Canada, tested blind and sighted subjects for pitch perception and their ability to locate sounds. Blind subjects generally scored higher, which came as little surprise—until the scientists discovered that the time the subjects had become blind affected their performance.

Those who were born blind did best, those who became blind as small children were slightly behind and those who lost their vision after the age of 10 did no better than the sighted subjects. The implication was that a young brain could be rewired, so that visual processing areas were used for other purposes.

Perhaps the strongest evidence was shown in brain imaging studies in which scientists found that blind subjects who were best able to locate sound were engaging both the auditory and visual areas of the cortex. Blind subjects who scored low, as well as sighted subjects, had little or no activity in the visual lobe.

Other studies have had similar results with odour discrimination and tactile sensation.

The Bottom Line

Research suggests that at least in some circumstances, blindness can heighten other senses.

Anahad O’connor

Write to us at businessoflife@livemint.com

Have a green diwali, please

Planter’s Club | Benita Sen — Wed, 14 Oct 2009 16:08:00 GMT

As you keep the lights ready this Diwali, perhaps it’s time to pause and reconsider your plans. For years, we’ve known that Diwali, as celebrated today, is not the easiest time for people with or without specific health challenges. However, we often overlook the suffering we inflict on other life forms.

Let there be less light

Govind Singh, director, Delhi Greens, an NGO, and PhD scholar, environmental department, University of Delhi, says, “Light pollution is an aspect of Deepawali that often goes unnoticed.” For centuries, diyas (oil lamps) were the only lights set up on Diwali. These were also kinder to other living things. Now, these range from candles to electric garlands of fairy lights (“tuni” lamps), strings of electric bulbs and even harsh spotlights. Many of these are strung on, or near, trees and plants.

Also Read Earlier columns by Planter’s Club

Says Mumbai-based Deepa Katyal Engineer, veterinarian and trustee, People for Animals, an animal welfare non-profit, “Can you imagine how hot it must be getting for the tree and for the creatures living in it?” Harsh lights also disorient nocturnal creatures such as bats and owls. Daylight-loving birds, too, can’t sleep. The diurnal cycle of plants is disturbed too.

Don’t fan the flames

Both lighting and fireworks can damage plants. Ajay Mahajan, founder member of the Pune-based environmental organization Kalpavriksh, has seen many plants getting scorched during Diwali. “Plants register the presence or proximity to fire and they actually try to move away from the source of fire,” he says.

Since Diwali comes at the end of the peak growing season for most plants, leaf burn can set the plant back by months. Plus, if you peg fireworks to a tree, it injures the inner bark, a living part of the tree. “That’s where the nutrients and water move,” says Mahajan. “Stop treating trees like lamp posts or an inanimate trellis.” Fireworks performing aerial pyrotechnics can also singe insects, birds and arboreal animals such as squirrels.

Don’t raise a stink

Then there’s the more palpable air pollution. During Diwali, most of us are thankful for the plants, those great carbon sinks. They take in a lot of air pollution at a terrible price. Few new leaves sprout and existing leaves get caked with pollution. “I have noticed a black liquid drip from leaves around this time from pollution,” says Mahajan. “Unlike dust that just sits on the leaf, this sticks to it. It is also tougher to wash off.”

Fire crackers are made of potassium nitrate, sulphur and charcoal. When burnt, noxious fumes are released, including sulphur dioxide, carbon monoxide and carbon dioxide. These gases irritate the air passage of humans and animals. “If higher species like humans and dogs get respiratory allergies due to the pollution caused by crackers, do insects and birds stand a chance?” asks Dr Katyal Engineer.

In plants, these harmful chemicals are absorbed through the stomata (pores) and choke them. Vidya Subramanian, project manager, Delhi Greens, says, “Particulate matter like cement dust, magnesium dust and carbon soot on trees can inhibit the normal respiration and photosynthesis mechanisms within the leaf.” With the stomata choked, plants can’t breathe or feed. This can also lead to the death of the leaf tissue.

What doesn’t coat or choke the leaves falls on the soil or floats in the air. If there is rainfall soon after Diwali, this pollution may come down as acid rain, corroding plants, altering soil composition and upsetting water ecosystems. Says Mahajan, “We don’t much look at soil contamination, although it is much more difficult to rectify than air or water pollution.” If animals ingest the chemicals in fire crackers, these poison them.

Too big a bang

Animals, especially birds, are affected more than humans by the noise pollution. Says Dr Katyal Engineer: “The average animal has better hearing than humans. Dogs can hear seven times louder than humans. So if the fire cracker burst during Diwali deafens you, you can imagine its effect on them.” Often, they flee, which is why it’s common for pets to get lost during Diwali.

All in all, your Diwali celebration makes for a less than bright outlook for the neighbourhood’s flora and fauna.

The author is a journalist and writer of children’s books, with a passion for gardening.

Write to us at plantersclub@livemint.com

Vertigo: The dizzying disorder

Archana Rai — Mon, 12 Oct 2009 18:33:00 GMT

Ever felt the world spin out of control? It happened with 30-year-old, Bangalore-based housewife Nalini Patil while she was driving. Patil swerved to hit the road divider as she fought off waves of nausea and dizziness. “It was the first time I had experienced such an attack,” she says.

She sought medical advice and after a series of tests, vertigo, brought on by anxiety and depression (Patil had suffered a loss in the family) plus a sinus infection, was diagnosed. Six months and a course of medication later, she hasn’t had a recurrence.

Anurag Shankar, a 62-year-old retired teacher in Noida, suffered her first attack of acute dizziness four years ago. “I couldn’t even move my head while lying down in bed,” she says. The episodes abated after three-four days. The cause: Vertigo due to a compression of nerves by an extra rib (which Shankar was born with). The permanent solution would be surgery, but she is wary of going under the knife and prefers to live with the infrequent attacks, keeping her prescribed medication (Vertin) handy for the dizzy spells.

Illustration: Jayachandran / Mint

Vertigo is among the most common complaints doctors encounter. It’s typically a sensation of spinning or losing balance—simply put, dizziness. And no, contrary to popular belief, it is not always associated with a fear of heights. “Around 60-70% people suffer vertigo at least once in their lifetime,” says Rakesh Agarwal, senior consultant, neurology, Indraprastha Apollo Hospital, New Delhi.

Only a symptom

Like fever, vertigo is a symptom, not a disease. Most of the underlying problems leading to it, such as high blood pressure, can be treated. But Dr Agarwal adds a note of caution, “While all cases are not serious, some are, so it’s important to get checked out.” He advises a four-step preliminary examination: MRI (magnetic resonance imaging) of the brain, X-ray of the neck, ENT (ear, nose and throat) check-up and a routine blood test.

“Typically, it (vertigo) is caused by problems in the neck, eye, ear or the central system or the brain,” says Ish Anand, vice-chairman and senior consultant, neurology, Sir Ganga Ram Hospital, New Delhi. These can range from astigmatism (cylindrical vision), high or low blood pressure and poor posture to an injury to the inner ear or brain, which disrupts the body’s balance mechanisms. More serious possibilities include a cerebral stroke or a viral infection that affects the ear.

However, once infection, injury or other underlying causes are ruled out, doctors typically zero in on a diagnosis of either Ménière’s disease or Benign Paroxysmal Positional Vertigo (BPPV). These two otherwise benign conditions are the leading causes of vertigo, with a fifth of all cases attributed to BPPV.

Both Ménière’s and BPPV result from disorders of the inner ear, which contains the body’s balance mechanism. Their causes are not known (they are not caused by injury or infection), but the disturbances affect the sense of equilibrium (which usually helps make out whether you are upright, lying down or tilted and lets you recover balance when you move). The result: You feel off-balance and get dizzy. “Ménière’s disease can also be accompanied by hearing impairment, (a) buzz in the ear,” adds Chandran Gnanamuthu, neurologist, Wockhardt Hospitals, Bangalore.

Will it go away?

“In 95% of cases (of vertigo), the dizziness can go away,” says Dr Gnanamuthu. The loss of balance rarely persists, if correctly treated. Not all cases call for pills or surgery. So delaying a visit to the doctor because it is “tolerable” can mean needless suffering.

For astigmatism, for instance, special glasses are advised; for an infection, medication may be prescribed; for cervical spondylosis, proper posture and isometric exercises are advised. Alternative therapies are also available. Raman Kapur, who runs an acupuncture clinic at Sir Ganga Ram Hospital, says, “Almost 90% of patients with cervical spondylosis-related vertigo have been successfully treated through acupuncture.”

In Bangalore, the Jindal Nature Cure Hospital has a 10-15-day detoxification and relaxation regimen for cervical spondylosis. Babina Nandkumar, joint chief medical officer, says, “Then patients are also taught asanas (vrikshasana, trikonasana) and pranayama (sheetali, nadishodhana) to control the vertigo and to train muscles in the affected part to relax.”

There are drugs for Ménière’s disease too, says Dr Gnanamuthu. In the case of BPPV, “Certain head and neck manipulations, (such as those called) Semont manoeuvre or Epley manoeuvre, done by a doctor, can alleviate this problem,” says Joy Dev Mukherji, head, neurology, Max Super Speciality Hospital, New Delhi.

Patients are also taught exercises, such as the Brandt-Daroff exercise (see below), to practise at home. Brandt-Daroff exercises are used as follow-up treatment at home, commonly prescribed to vertigo patients.

But if there is no serious underlying problem, what sufferers need most is reassurance, says Dr Gnanamuthu. This is where counselling comes in. Not just for psychological problems (such as anxiety in Patil’s case), but because losing one’s sense of balance is scary. “Typically, after an attack of vertigo, patients tend to be anxious,” says Dr Gnanamuthu. “It is important to ease the anxiety, which is why some amount of psychotherapy and relaxation techniques are needed.”

Taking precautions

Vertigo can be aggravated by awkward neck postures or jerking motions experienced when, for example, travelling or scrambling out of bed quickly. “Travelling can affect this condition,” says Dr Anand, who advises bed rest and decreased neck movements, besides medication, for intense symptoms.

For milder symptoms, simple precautions suffice. Dr Mukherji suggests people with a history of vertigo should ask their doctor for prescription medicine prior to air travel or long-distance journeys. “But such people should not drive on winding roads,” he says.

The important thing, doctors say, is not to be too anxious about vertigo or let fear of a dizzy spell restrict you from normal everyday life and the activities you enjoy. “Almost everyone has a little bit of vertigo,” says Dr Mukherji. “So it is a question of managing it.”

**********

Brandt-Daroff exercise

Sit on the edge of a bed or a sofa. Lean quickly to the side that causes the worst vertigo. End up lying on your side with your ear down. Remain in this position until either the vertigo goes away or 30 seconds have passed. Then sit up. If this causes vertigo, wait for it to stop before repeating the exercise on the other side. People prescribed this exercise are usually instructed to do sets of 20 repeats at least twice a day.

Expert: Ish Anand, vice-chairman and senior consultant, neurology, Sir Ganga Ram Hospital, New Delhi.

*********

Vaccinate | Shingles and stroke

Sounds like another good reason to get the chicken pox vaccine. Researchers reported last week in the journal ‘Stroke’ that adults who get shingles have a 30% greater risk of a stroke than those who don’t. Shingles, or herpes zoster, is a painful rash caused by the chicken pox virus which can lurk in the body for a lifetime. Jiunn-Horng Kang of Taipei Medical University Hospital, the author of the study, urged doctors treating shingles to be watchful for signs of strokes. The risk was even higher when the rash was clustered around the eyes — 4.28 times more than for people who don’t get shingles. REUTERS

Read | Odd health facts

‘Always Follow the Elephants: More Surprising Facts and Misleading Myths About Our Health and the World We Live In’ (Times Books) is authored by New York Times’ Anahad O’Connor. As with her newspaper column, O’Connor’s paperback takes a look at odd health facts (yes, you’ll get drunker using diet soda as a mixer) and fiction (no, most people don’t dream in black and white). Some might consider it too much information, but others may likely find it fascinating. O’Connor’s earlier title in the same vein, ‘Never Shower in a Thunderstorm: Surprising Facts and Misleading Myths About Our Health and the World We Live In’, was published in 2007.

Treat | Osteoarthritis

One of the most dreaded forms of arthritis is osteoarthritis of the knee. It is more common in women and can restrict movement to the point that the sufferer can no longer walk. One option to delay knee replacement surgery is viscosupplementation in the early stages of the disease. “(It) involves the removal of diseased joint fluid and replacement with a substance that has cushioning and lubricating properties similar to those of normal, healthy fluid,” says Surya Bhan, director, orthopaedics, Primus Super Speciality Hospital, Delhi. A single treatment provides relief from pain for six months to a year and costs Rs15,000 per shot. Once surgery becomes unavoidable, there are new gender-sensitive knees to suit a woman’s smaller bones, costing Rs20,000. “Launched two years back in the US, they appear promising, though their long-term results are awaited,” says Dr Bhan. Kavita Devgan

Don’t | Wear bad shoes

A new study on the link between shoes and foot pain found that women who mainly wore supportive footwear such as sneakers or athletic shoes in the early years cut their risk by at least half (compared with shoes that gave average support, such as hard- or rubber-soled ones). The 60% women who generally wore high heels, pumps, sandals and slippers were most at risk of hind foot, ankle and Achilles tendon pain. The study, published in the October issue of the journal ‘Arthritis Care & Research’, found men make better choices: Less than 2% wore bad shoes. ©2009/The New York Times

Chitra Narayanan also contributed to this story.

Write to us at businessoflife@livemint.com

Dial up if depressed

Breaking Through | Seema Singh — Mon, 12 Oct 2009 17:08:00 GMT

Perhaps we’ll never run out of ideas to use a telephone, the 1876 invention of Alexander Graham Bell. From communication to gaming, entertainment to financial transaction, medical imaging to global positioning, and now structured healthcare delivery.

Last week, researchers reported in the October issue of Archives of General Psychiatry that in a four-year randomized study, patients of depression were shown to have benefited significantly from a structured telephone programme to manage the condition, with only a moderate increase in healthcare costs compared with those who received the usual care.

Cheerful cost benefits

“Depression has large economic effects outside the healthcare system, including disability, lost work productivity, reduced educational attainment and relationship disruption. Ideally, decisions about the value of depression care programmes should consider these broader economic effects,” write the authors. Since organized treatment programmes for depression have proven to be effective, it is important to balance the benefits and costs for large-scale implementation.

Also Read Earlier columns by Breaking Through

The economic costs of this ailment, which the World Health Organization (WHO) predicts will be the second leading cause of health impairment worldwide by 2020, seem unmeasurable in India, largely because of an anaemic attitude to collecting epidemiological data. This prevents us from getting a grip on the prevalence of the disorder. It is further compounded by our cultural hesitation on psychiatric conditions: Reporting on depression is taboo; seeing a medical doctor slaps a social stigma on the individual.

Why India should call

On 28 September, the open-source international journal PLoS One published the largest ever population-based study from India on the prevalence of depression. It found that among urban south Indians, 15.1% suffered from the disorder. So that calls for considering a telephone programme for psychotherapy in a country which is not only witnessing an explosion in mobile telephony, but also a rise in psychiatric disorders as it grapples with demographic transition.

The lead author of the telephone study, Gregory Simon of the Group Health Research Institute, Seattle, believes there are three reasons why a telephone programme would have higher participation than traditional in-person psychotherapy. “First, therapy by phone is simply more convenient. Second, avoiding in-person visits to a therapist’s office would help to circumvent stigma. Third, our programme included fairly aggressive outreach (therapists calling clients to encourage participation) and that’s certainly not the norm for in-person psychotherapy,” he writes in an email.

Though Simon’s study did not directly compare the phone programme with in-person psychotherapy, he says the participation rates in their programme were much higher than usually seen with in-person therapy.

Programming to pay

All this doesn’t mean the public healthcare system, already creaking, needs to take on any additional burden. The problem, the solution and the environment lend themselves to a variety of business models, which some are already exploring, though telehealthcare is in its infancy in India. One example is the start-up, mDhil Llc, founded by former Goldman Sachs financial analyst Nandu Madhava, which provides basic healthcare advice (diabetes management, maternal and sexual health, post-surgery care) on mobile phones. Certain non-profit organizations already offer telephonic counselling. Other entities are trying to work out viable revenue models. One Delhi-based entrepreneur I spoke to, also looking to enter healthcare, noted this logistical issue for telehealthcare: How do you prescribe medicines on the phone and charge the customer?

Arguably, not all therapies are amenable to such telephonic delivery. However, mental healthcare seems a case with fewer such logistical barriers—and Simon’s study has proven its benefits compared with traditional treatment.

The writer is Mint’s deputy bureau chief in Bangalore.

Write to us at breakingthrough@livemint.com

Fighting the flu: boost your immunity

Kavita Devgan — Mon, 05 Oct 2009 17:10:00 GMT

Autumn brings pleasant weather, weddings and a slew of festivals—reasons enough to meet and greet friends and family. It is also the time for the seasonal flu to do the rounds. You could suffer the sniffles and visit doctors, or starting this year, work on building your immunity.

Starting health

“It is the strength of our immune system which decides who gets sick and who doesn’t,” says Nalin Nag, consultant, internal medicine, Apollo Indraprastha Hospital, New Delhi.

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3 Indian firms scramble to make vaccine against H1N1 virus

However, many factors challenge immunity. “We are living longer than ever before, and with age, the defence mechanism of the body becomes less effective,” says Randeep Guleria, professor, department of medicine, All India Institute of Medical Sciences (AIIMS), New Delhi. “Overcrowding in urban areas, low hygiene and faster intercontinental travel all lead to the incidence and rapid spread of pandemic flus.” Some drugs, such as steroids, also suppress immunity.

Stress plays a key role in underminning immunity too. “Even routine daily stresses—deadlines and traffic jams—can downplay immunity,” says Ashima Puri, consultant psychologist, Aashlok Hospital, New Delhi. Other factors include lack of exercise, improper food and working in closed environments, according to S. Chatterjee, senior consultant, internal medicine, Apollo Hospital, New Delhi.

Should you get a shot?

Getting vaccinated to prevent the flu seems like a good short cut since vaccines add acquired immunity to your natural shield. However, many doctors remain concerned about a swine flu vaccine developed on the fast track. S.P. Byotra, senior consultant and co-chairman, department of medicine, Sir Ganga Ram Hospital, New Delhi, is one of the sceptics, and finds it “unbelievable” that companies are claiming a safe vaccine for a disease that is just a few months old. Should this concern extend to regular flu shots?

Doctors point out that the country’s immunization schedule contains only shots deemed both safe and essential by the Indian Academy of Pediatrics. Though recommended by the World Health Organization (WHO), flu shots are not on that list. Whether you or your child should take a flu shot at the onset of the flu season is something Indian doctors are still debating.

Nitin Verma, senior consultant, Max Super Speciality Hospital, Saket, New Delhi, says, “Every year, end of August or beginning of September, a new vaccine—depending on WHO recommendations about the flus to be covered—is released.” He recommends that all children aged 6 months or above get the shot at the beginning of the flu season, only around September.

Dr Byotra, however, feels that adults should take only very essential vaccines. “For example, if you are travelling to a particular country that has an endemic disease pocket”. For children, he believes the childhood immunization schedule should suffice.

How to stay healthy

Raising your immunity is like reinforcing your shield. The other half of your defence is avoiding the attackers. Some pointers:

Hand hygiene: New research suggests a flu mask is not that effective against viruses. The effective alternative: washing your hands. “The way (flu) germs are spread is not by inhaling them, but by picking them up on our hands and spreading them to our face, where they can gain entry to our body through the membranes of the eyes, mouth and nose,” says Dr Nag. Seemingly innocent surfaces such as door knobs, light switches, telephones and keyboards are loaded with germs and every time you touch any of these surfaces and then your face, you are transferring the germs into your system. A study published last month in the journal Risk Analysis found that US college students working on their laptops touched their eyes, noses and lips once every 4 minutes.

Wash repeatedly even when at home or at work, not just before eating, but also every time you sneeze or cough. Keep hand sanitizers and tissues with you. Dr Nag suggests washing hands after touching any potentially contaminated surfaces, and immediately after coming in from outside. Touch as few surfaces as you can when using public transport, elevators and in shared spaces (such as at work or restaurants). Avoid touching your face, especially when in public. Dr Shehla Agarwal, consultant dermatologist, Mehak Skin Clinic, New Delhi, adds, “Although antibacterial soaps are popular, regular soaps are good enough.” Dr Agarwal also suggests a moisturizer to prevent dry skin, which can provide an entry point for germs.

Don’t spread your germs. Instead of a handkerchief, use a tissue when coughing or sneezing and discard it immediately. If you don’t have a tissue, cough or sneeze into the crook of your elbow rather than your hands.

As far as possible, avoid direct contact with the ill. Try to stay at least 3ft away from someone who is coughing or sneezing and 6ft from someone known to have influenza. In the festive season, be careful when you meet and greet people. Avoid too many handshakes, kissing and hugging. A namaste is the elegant, hygienic alternative.

Rest and relaxation: “If practised regularly, any of the well-known relaxation techniques—from aerobic exercise and meditation, reading a book, taking a walk, meeting friends (see Friends as protectors) to doing something you enjoy for just 30 minutes a day—help block the release of stress hormones and increase the immune function,” says Dr Puri.

You also need seven-eight hours of sleep. “Sleeping is our body’s way of repairing your defences,” says Dr Chatterjee. You should go to bed and wake up at the same time each day, not relax your schedule on weekends, he says. If you have trouble falling asleep, step up your exercise routine earlier in the day (however, evening exercise can leave you too alert). A warm bath before bed can also help. In bed, learn to consciously relax your muscles from head to toe, while breathing deeply.

Eating immunity: “30-40% of your immune system is in your gastrointestinal system,” says Jyothi Prasad, chief dietician, Manipal Hospital, Bangalore. “Daily probiotics will restore the natural state of health that a diet of excess sugar, meat, processed foods and prescription drugs have destroyed. Have ‘five a day’ of fruits and veggies. Make your plate colourful: The more colourful they are, the more the phytonutrients.” Nuts and oilseeds (flaxseeds, pumpkin, sunflower) are excellent for immunity. Green tea, studies have shown, can also help fight flus and colds.

Alternative advice

“Diet therapy is the most effective way to boost immunity. Take a glass of hot milk with a teaspoon of turmeric powder every morning; chew five-six ‘tulsi’ leaves every day; increase the usage of black pepper in your diet. Increase the consumption of milk and milk products, eggs, spinach, beans, carrot, soybean, banana, almonds and dry dates. Take a glass of juice prepared from bitter gourd (30g), ‘tulsi’ leaves (30g) and Gilo Sabz (Tinospora cordifolia) (30g)—(this) acts as a protective shield against flu; having 10g of ‘tulsi’ plant juice with 5g of black pepper powder is a good preventive measure too. Unani formulations that help to boost the immune system are Khamira Gaozaban Ambari Jawahar Wala, Dawaul Misk Motadil Jawahar Wali and Khamira Marwareed.”

— Mohammad Tariq

Unani physician and in-charge, board of physicians Hamdard Wakf Laboratories, Delhi

“If there are toxins present in the body, immunity will take a beating. (For detoxification), have lots of salads, sprouts, vitamin C-rich fruits like sweet lime, oranges, lemon and gooseberry. Have two cups (sip it through the day) of a decoction made of ginger, pepper and garlic. To make it, crush all three and boil in two glasses of water till it becomes about a glass.”

—Babina Nandkumar

Joint chief medical officer

Jindal Naturecure Institute, Bangalore

“(One) should always have easily digestible food and the temperature of the food should be around 5 degrees below the normal body temperature. This would help in proper digestion. One should have lukewarm water, liquid foods (such as ‘dal’, ‘khichdi’, vegetable soup, among others) and avoid fermented food (such as curd, pickles, sour products, among others). It is essential that one doesn’t allow the body temperature to go below the normal body temperature as viruses grow the most when the temperature is low.”

— S.V. Tripathi

Senior consultant

Moolchand Ayurveda Hospital, New Delhi

“In homeopathy, the process of boosting immunity is usually twofold. To improve general immunity, homeopathy medicines are prescribed by a qualified practitioner after a deep study of the patient. This works best when the person is not afflicted with any disease. For immunity for specific ailments, specialized medicines are suggested. Gelsimium and Influenzinum 200 help treat and prevent all flus, sneezes and sniffles.”

— Akshay Batra

Deputy management director

Dr Batra’s Clinic, Bangalore

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A polio-free pilgrimage

Saudi Arabia has announced that everyone arriving for the annual pilgrimage to Mecca in November would have to swallow a dose of oral polio vaccine in the presence of health officials. Polio has hovered on the brink of eradication for years in the kingdom. Earlier, Saudi authorities asked for proof of vaccination when pilgrims applied for visas and forcibly vaccinated only those arriving from countries where polio was endemic. It is endemic in only four countries: Pakistan, Afghanistan, parts of Nigeria and India. Each year, travellers from endemic countries seed outbreaks in poor countries, where vaccination drives had been dropped when the disease was thought to have been eliminated. © 2009/THE NEW YORK TIMES

Help poor countries fight H1N1 virus

Rich countries should make more vaccine available to poorer nations where the H1N1 virus is starting to hit, UN health officials said on Sunday. They said increased readiness for swine flu was needed in developing countries with weaker medical systems and with large, young populations who are most vulnerable to the disease. Some countries, such as the US, Brazil and France, have agreed to make 10% of their national vaccine stockpile available to developing countries. Manufacturers have also donated about 150 million doses of the vaccine. More is needed, said David Nabarro, UN coordinator for fighting emerging flus. September and October are usually the start of flu season in the northern hemisphere, but there are signs of a second H1N1 wave this year, said Julie Hall, an infections disease expert at the World Health Organization. Reuters

Friends as protectors

You should certainly avoid spreading germs, but do keep your friends close. Studies show that the value of nurturing, social support and camaraderie is phenomenal. So friends can also be good preventive medicine. In a 1997 study published in ‘The Journal of the American Medical Association’, researchers exposed people to a cold virus and then monitored how many contacts they had with friends, family, co-workers or members of community groups. The more social contacts they had and the more diverse the contacts, the less likely they were to catch the cold. Kavita Devgan

Write to us at businessoflife@livemint.com

Health scores on the job

Archana Rai — Mon, 05 Oct 2009 15:10:00 GMT

A new approach to healthcare at the workplace is now taking into account the impact your desk hours have on your health. Some organizations are hiring professional healthcare companies to provide a medical analysis for employees—it’s termed health risk assessment, because it details employees’ risk for illness and allows companies to take remedial action for the staff. “Typically, employees in high-pressure work situations will remember to work late nights to meet a deadline, but will have no time to return for a recheck of high cholesterol levels; that is why it is important to have an official follow-up programme,” says Vasanthi Vaze, medical director, Pulse Healthcare, a multi-speciality clinic and diagnostic centre offering similar services.

For someone such as Bruno Goveas, 33, a product specialist at the Bangalore-based software company Akamai Technologies, these annual check-ups at work are a boon. Last year, latent tuberculosis led him to surgery. However, despite the surgery, he doubts he would have got his tests done this year if not for People Health, a Bangalore-based healthcare management company, and their arrangement with his organization. “Without the incentive of the office-sponsored scheme, one tends to put off these things.”

Treating both the worker and the workplace

The annual health check from companies such as People Health includes clinical tests plus an assessment model that highlights causative factors. Follow-up action includes a health manager regularly alerting individual employees to return for a monitoring of problem areas. Individual reports are given directly to employees and are strictly confidential. Employers are privy only to the company-wide statistical health risk assessment, a report that lets companies tailor their in-house health and wellness programmes.

The People Health plan also tracks genetic influence on health and helps people balance their risk. “For instance, a professional with a clinical cholesterol reading of 300, who works out four times a week and has no family history of cardiac arrests, is at a lower risk level than someone with a 200 cholesterol reading, but with poor lifestyle habits and a family history of cardiac problems,” says Krishnamurthy Ganesan, chief executive officer, People Health.

For VeriSign India, an information security company, which uses a corporate health scorecard from People Health, the benefits are visible: The company is now able to coordinate a wellness calendar for employees. “At the end of every annual health check, an employee gets a composite health score (0-5, based on various weighted factors). Broad trends are used to tailor a company-wide wellness calendar of eye health camps, nutrition and cardiac health campaigns, and most recently, awareness programmes on H1N1,” says Kiran Punja, human resources (HR) manager, VeriSign.

Employees feel better

For employers, it is about taking responsibility for the workplace’s affect on the employee. If we take the information technology industry as an example, workplace issues seem to definitely impact health, with problems ranging from back problems to high blood pressure, and cholesterol readings showing up in employees in their 20s and 30s. “We are aware of the fact that the technology industry that we work in has a very sedentary work pattern. We have a median age of 28, and are keen to ensure that our employees know what they need to do to stay healthy,” says Chetan Kadamba, manager, HR, at Akamai Technologies. With greater cardiac risk associated with professionals in the information technology/information technology-enabled services industry (IT/ITeS), it makes sense for Akamai Technologies to closely monitor its employees and seek solutions.

Certainly, intervention at the workplace can be more effective than individual check-ups. Says Kadamba, “ I have had employees come up to me and tell me that they would never have opted for a preventive healthcare check if not for the fact that it is offered by the company.” Apart from ease of access and cost benefits (see Cost to Company), peer influence can be a great incentive: “When we noticed Chetan (Kadamba) altering his diet after a health check, it got everybody else in Akamai interested,” says Goveas.

H.M. Venkatappa, medical director of healthcare firm Kanva Diagnostics, feels that for effective preventive healthcare, all professionals above 30 should get a health profile, and for those above 40, it should be mandatory. “With aggressive type A personalities and deadline-driven work environments, people in their 30s are showing high morbidity,” says Gururaja Rao, director, Clumax, a diagnostic services company that recommends mandatory basic blood tests, sugar, lipid profiles and liver and kidney function tests for all professionals aged 35 and above.

Cost to company

The costs are borne by the employer. People Health’s packages cost Rs2,000-6,000 each, based on age and range of tests. “For age groups below 30, the cost of testing is lower. It is highest for those in the above-40 bracket,” says Ganesan. The cost also varies with the follow-up services a company chooses (the Rs2,000 plan does not include any). It also depends on organization size, with volumes translating into economy, something readily appreciated by businesses.

Write to us at businessoflife@livemint.com

Basic Instinct: Sex and common sense

Bobby John Varkey — Mon, 28 Sep 2009 19:00:00 GMT

By the time Saturday’s ICC Champions Trophy match between India and Pakistan ended in South Africa, there were enough tongues wagging on the alleged psychobabble of the coaching staff of Team India. The critics were ready with their bouncers. M.S. Dhoni and his boys, they said, failed to “peak” and “climax” at the right time and surrendered to a 54-run defeat because of a controversial four-page coaching manual that encouraged the boys to go in search of casual sex, among other things, to boost their testosterone levels. Team India’s new carnal strategy: Have sex to score more sixes!

The document, allegedly prepared by coach Gary Kirsten and mental conditioning colleague Paddy Upton (Kirsten, though, was ducking for cover soon after the document became public and denied being involved in preparing it), says that “...having sex increases testosterone levels, which cause an increase in strength, energy, aggression and competitiveness”. And if you don’t have a partner, “Go solo”. In other words, when the going gets tough, take things in your hand. And we aren’t talking of the bat or ball here.

Illustration: Jayachandran / Mint

The ridicule and shock at the suggestions aside, contemporary sports medicine and coaching methods have effectively busted the abstinence myth in the athletic world. Perhaps Muhammad Ali, who reportedly abstained from lovemaking for six weeks before a match, need not have bothered. Studies suggest sex is a performance booster, and you don’t need to be an athlete to benefit from satisfying sex. Performance at the workplace is no different from a big-ticket match.

Ready for a match?

Consider this. Psychiatrists say that if you are tense about an important presentation in the morning, you would do well to give sex a sporty chance, rather than having an early night with a good book. Says Rachna Singh, lifestyle management expert at Artemis Health Institute, Gurgaon: “A healthy sexual lifestyle has a very positive impact on your overall well-being. If you are sexually satisfied, your workplace efficiency, too, goes up. It is one of the best forms of relaxation.”

Mumbai-based sexologist Prakash Kothari agrees: “It is a myth that dissipation of semen leads to weakness. The amount of calories you lose in one seminal dissipation is equal to half a glass of lime juice. You will notice vast improvement in your concentration levels after you’ve had satisfying sex.” Dr Kothari also advocates “going solo”.

“Masturbation involves fantasy which you can colour in whatever way you want to. It could be as beneficial to anybody as normal intercourse. Remember, sex lies between the ears, not between the legs,” he says.

Stress on sex

In 2006, Stuart Brody, a psychologist at the University of Paisley, Scotland, claimed that sex has a very effective and positive impact on stress. His fortnight-long study on 24 women and 22 men concluded that having sex before giving a speech in public reduces stammering and nervousness. He also concluded that participants who had penetrative sex were the least stressed, with normal blood pressure, and those who were asked to abstain were greatly stressed and had high blood pressure levels. The reason behind the calming effect is the hormone oxytocin, which is released during sexual activity, the study concluded.

Helen E. Fisher, an anthropology professor and human behaviour researcher at Rutgers University, says increased sexual activity can lead to improved problem-solving skills, confidence and teamwork at the workplace.

Concluding a study in 2005 on around 40,000 Americans, including 56% women, courtesy the website Chemistry.com , Fisher says, “In addition to being a great exercise and a stress reliever, sex triggers the release of a number of valuable brain chemicals. From improved problem-solving as a result of heightened dopamine levels, to enhanced teamwork skills due to a flood of oxytocin, there are a number of positive benefits that can improve performance in the workplace.”

Fisher adds: “The dopamine rush one gets from sex is associated with improved creativity, so it’s likely those who have regular sex are more creative at work. Also, after sex, men and women receive a boost of chemicals that generate feelings of trust, attachment and calm. Those who have regular sex are likely to feel more cooperative and agreeable. It also drives up testosterone, which can give men and women feelings of competence, self-confidence and well-being.”

Sex is good for short-tempered or depressed people, feel some psychiatrists. Some even add that sex and masturbation can help ease joint and muscle pain, promote heart health and lengthen one’s lifespan.

The perfect painkiller

Says Bharat Inder Singh, a Delhi-based sports doctor: “In women, sexual stimulation produces a powerful pain-blocking effect. At least one of the mechanisms is that sex blocks the release of neuropeptide labelled as Substance P, which is a pain transmitter.”

Vasant K. Mundra, consultant psychiatrist at Mumbai’s Hinduja Hospital, however, cautions against attributing workplace success entirely to satisfying sex. “Performance at the workplace depends upon (a) huge number of variables. If sex alone were to help you concentrate better, then sex workers would be the most successful employees to have. Being unhappy about anything interferes with optimal performance—finances, relationship problems, health and also sex.”

Happy sex relaxes the mind, reduces irritation or anger. “It may also reduce aggression. My suggestion to avoid road rage and accidents: Have sex instead of a drink before you set out to drive,” he adds. But let’s not hope for miracles. Dr Mundra firmly believes, “No cricketer is going to pound sixers just because he had sex.”

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For or Against

For long, sportsmen have adhered to the abstinence myth. The theory goes like this: Ejaculation lowers your testosterone levels, which weakens muscles. Sexual frustration makes you aggressive and helps you to perform better. However, a string of studies have disproved these notions. The sporting world, though, is divided over the new carnal strategy. Cricketer-turned-commentator Ajay Jadeja says the team management is “pushing things to the limit”. He asks, “Tell me, can you ever say decidedly that it is good for you as a journalist?” Madan Lal, former cricketer and coach, has a different take. “Good sex in the night charges you up the next morning. But then, too much of everything is bad. You do it regularly, it would leave a negative impact on you.”

Olympic shooter Mansher Singh disagrees with the notion that sex is good for any sportsperson. “You need not be aggressive in every sport. Maybe in football or rugby, it helps to bring out your basic instincts. But in shooting, you need to control your emotions and be composed. All the coaches I have ever trained under have advised abstinence. Sex, they say, distracts you. Instead, they always suggest we watch a good movie,” he says.

Former Asian boxing champion Rajkumar Sangwan says, “I believe you should abstain at least one month before any bout. I don’t know what science says about this, but we have always been told that it leads to weakness. Before any big tournament or bout, I try not to think about it. See, human nature is always attracted to these things and it is up to you how to control your emotions.”

Sushil Pahalwan, Beijing Olympics bronze medal winner in wrestling, agrees. “Wrestling is a sport where you need all the power and stamina you can save for yourself. And we have always been told to abstain from any such activity, or even thoughts.”

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CONNECT

Anti-phospholipid syndrome

Women under 50, who have a rare flaw in their immune system, are 43 times more at risk of a stroke and five times likelier to have a heart attack than the general population, says a study headed by Rolf Urbanus and Philip de Groot at the University Medical Centre, Utrecht, the Netherlands. The probe focuses on the risks for women from the anti-phospholipid syndrome. It occurs when antibodies adhere to cell membranes, disrupting the blood’s regular clotting mechanisms. The disorder has been in the spotlight in the past for causing bleeding, thrombosis and repeated miscarriage. AFP

Diabetes and Depression

Depression is more common among diabetic women than men, says a study by the Delhi Diabetes Research Centre (DDRC). It also claimed that depression among Indian diabetes patients was at par with those in the West. It showed that depression was more prominent and frequent in the 35-46 age category, and especially among women. “In our two-year study on diabetes patients, we found that depression in Indian patients is as high as it is in the Western world. It is almost 15-20% in diabetes patients,” says Dr A.K. Jhingan, chairman, DDRC. PTI

Write to us at businessoflife@livemint.com

Footwear or Bare?

Treadmill | Rajat Chauhan — Mon, 28 Sep 2009 19:00:00 GMT

British physician Mike Stroud suggested in his book Survival of the Fittest that humans are suited for a hot, not cold, climate. Had some of our ancestors not decided to move to colder climates, we may never have had footwear.

Yet most of us can hardly conceive of athletes running a race without “proper” shoes. Then again, Olympic sensation Zola Budd trained and ran barefoot. In recent years, going barefoot, both for races and regular fitness runs, is finding more adherents in developed countries.

Erik Trinkaus, professor of physical anthropology, Washington University, St Louis, suggested that the first supportive footwear appeared 26,000-30,000 years ago (Journal of Archaeological Science, July 2005). Analysing anatomical evidence from early modern humans and their Upper Paleolithic ancestors, he said, “The bones of the little toes of humans from that timeframe were much less strongly built than those of their ancestors, while their leg bones remained large and strong.” He suggested the most likely cause for this was the introduction of supportive footwear.

If going barefoot is too radical for you and you’re not quite ready for minimal footwear either, you need to know how to make the right choice from the more traditional models of walking and running shoes. To understand the basic parameters of selecting running shoes that suit you, read For the shoe to fit

A quarter of bones in the body are in the feet, 26 on either side. They have 33 joints each, more than 100 muscles, ligaments and tendons. There are 250,000 sweat glands to cool them, which are made redundant when one wears shoes. There are more nerve endings on your soles than any other body part, suggesting that touching and feeling the ground is important. The foot can sustain enormous pressure (several tonnes over the course of a one-mile run) with in-built flexibility and resiliency. The ankle serves as a foundation, shock absorber and propulsion engine. So do we need shoes at all? Or were we designed to run barefoot?

Shod for injury?

It’s commonly assumed that good athletic shoes make a better athlete. Surprisingly, there is no evidence of this. Australian researcher (also a runner and physician) Craig Richards’ team noted in a 2008 British Journal of Sports Medicine article: “Since the 1980s, distance running shoes with thick, heavily cushioned heels and features to control how much the heel rolls in, have been consistently recommended to runners who want to avoid injury. We did not identify a single study that has attempted to measure the effect of this shoe type on either injury rates or performance.”

Dr Richards took note of a Dutch research that found that 37-56% of recreational runners are injured at least once a year, mainly in the leg or foot. The standard shoe recommendation doesn’t seem to work. Indeed, given the lack of research, we can’t make any evidence-based shoe recommendations.

Hence Christopher McDougall’s controversial best-seller, Born to Run. At Harvard University, professor of biological anthropology Daniel Lieberman’s current projects include “How humans run barefoot (and why it may be good for you)”. Dr Lieberman was quoted in the Daily Mail in May as saying, “Until 1972, when the modern athletic shoe was invented, people ran in very thin-soled shoes, had strong feet and had a much lower incidence of knee injuries.”

New no-shoes

Is the shoe industry ignoring the facts? Not really. Research and development departments at leading footwear companies have a new goal: A running shoe that recreates the barefoot environment, a good compromise. Called minimalist shoes, these include the startling Vibram FiveFingers and also mainstream brands such as Nike Free or Teva Proton series. There’s also the traditional Mexican huarache sandal .

Should you shed your shoes for good?

Despite all I have said (see ‘Treadmill’), I would find that extreme. Even if we agree that shoes are making our feet weaker, our feet are simply not accustomed to going bare any more. When a cast is put over a limb for 4-6 months, the muscles atrophy by 40-60%, and here we are talking about 20-40 years of wearing shoes for more than 12 hours a day.

If you are keen, change very gradually: first, just walk barefoot around the house; then walk on your lawn grass a few minutes a day; and so on. Honestly, it doesn’t seem very practical on Indian roads, given hygiene and safety issues. It’s more realistic to wear shoes, however basic, for their original protective purpose.

The author is a practitioner of musculoskeletal medicine and sports and exercise medicine. He is also CEO and medical director of Back 2 Fitness.

Write to us at treadmill@livemint.com

Help your heart with the good cholesterol plan

Chitra Narayanan — Tue, 22 Sep 2009 03:12:00 GMT

Do you know what my HDL (high-density lipoprotein, often called “good cholesterol”) levels are? 64 mg/dL,” says K.K. Jain, a Delhi-based family physician. Most Indians would count themselves lucky if their HDL levels stay above the prescribed minimum of 40mg/dL. Yet experts now hold that the ratio of low-density lipoprotein (LDL) to HDL is a better indicator of health and cardiac risk than total cholesterol. The more the HDL, the better it is.

High HDL = healthy heart

Madhukar Shahi, interventional cardiologist, Artemis Healthcare, Gurgaon, says: “We don’t usually look at total cholesterol. We look at the ratio of HDL/LDL or ratio of total cholesterol/HDL, and also the level of non-LDL bad cholesterols. Third, we look at trigylcerides.” For men, a good total cholesterol/HDL ratio is 4.5 or less; for women, it’s 4 or less.

Your workplace can also be a health aid for your heart. To find out how, also read Taking heart care to work

Decoding your blood test report

Feed the (good) bacteria, please!

The third report of the US National Cholesterol Education Program (NCEP) in 2001 noted: “The ability of HDL to predict the development of coronary atherosclerosis has been estimated to be four times greater than LDL and eight times greater than TC (total cholesterol). Treatment is recommended for those with a HDL level below 40 mg/dL.” Today, young people are increasingly falling prey to high triglycerides, high readings of “bad cholesterol”, too low HDL.

The gender difference

Illustration: Jayachandran/Mint

In 2007, Ravi Kasliwal, senior consultant, cardiology, Global Healthcare, New Delhi, conducted a survey of office executives (mean age 40) and found that 49.8% of the women had low HDL counts, as against 36.4% of men. At least 35% of all surveyed had high triglycerides. A 2006 study of urban Indians (in Delhi) by the Diabetic Foundation of India, found that over 68% of women had low HDL. The foundation’s science adviser, Anoop Misra, also director and head, department of diabetes and metabolic diseases, Fortis Hospitals, New Delhi, led the study.

This gender bender is why women should have HDL levels at least 10 units higher than men, that is, 50mg/dL or above, says nutritionist Ishi Khosla, who heads the Centre for Dietary Counselling, New Delhi.

Medicines, last recourse

“Medicines should be (a) last recourse,” she says. Many of her patients, she adds, have managed to perfect their lipid profile by eating right

Dr Jain attributes his own readings to the handful of almonds, walnuts and watermelon seeds he has every morning, plus a diet high in soluble fibre.

Case studies

Delhi-based clinical and rehabilitation psychologist Divya Parashar, 32, is a case in point. Overweight and suffering from high cholesterol, she was put on statins in December 2005. Weighing 94kg, her cholesterol readings then were: LDL 127 mg/dL; HDL 35.7 mg/dL, triglycerides 199 mg/dL.

Despite regular exercise and a curtailed diet, nothing helped until June 2006, when Dr Parashar met Dr Khosla. A 90-minute cardiovascular exercise regimen, a diet rich in oatmeal, salad, fresh fruit, milk and curd, plus aloe vera, Omega-3 supplements and psyllium husk (isabgol) followed, and by August 2007, she was down to 64kg. Since then, Dr Parashar has maintained her weight, eliminated statins from her life and until June, when checked last, maintained the recommended lipid profile.

Dr Shahi says that if the patient is willing, cholesterol can be altered by diet and lifestyle corrections. “A fair trial of three-six months has to be given. Don’t start medication right away,” he says.

No easy way out

Delhi-based journalist S. Kannan, 45, diagnosed with high cholesterol (240 mg/dL) at 37 and prescribed statins, says: “Medicines are the easy way out. You continue living life the way you are and pop a pill every day.” Kannan took the diet and lifestyle correction route. It’s been a tough journey, he says, filled with experiments, but he got his total cholesterol down to 165 mg/dL. Nuts, fenugreek seeds soaked overnight and mixed with curd, a lot of salads, less alcohol and 8kg off did the trick. Averse to conventional medicine’s long-term medication plan, he also tried alternative medicine (see below Know | Guggul tree for lipid disorder ).

But it takes very little for the slide to set in again, which may be why doctors often prescribe pills right away.

Maintenance a must

Communications and public relations professional Sanjiv Kataria, 54, another long-time sufferer of dyslipidaemia, sought naturopathy in December 2004 at Jindal’s Naturecure Institute in Bangalore. After the 10-day detox, he had a “perfect” lipid profile, also 5kg (though this was not a stated goal or benefit) and lost his sinusitis problem. He continued a vegetarian diet till January 2005. However, as soon as he returned to his old lifestyle in Delhi, he regained weight, and triglycerides and the total cholesterol shot up, and he fell back on the medical management route.

Most dyslipidemia sufferers (people with an unhealthy lipid profile) don’t give lifestyle changes a fair trial, either due to lack of awareness or will.

Shifting the focus

Dr Khosla is familiar with the drill. She feels most people are unable to meet the challenge because the list of “nos” seems long. If you focus on the “haves”, highlighting all the good stuff allowed, and introduce lifestyle changes gradually, the results follow readily, she says.

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1O ways to get your HDL level up

1. Take a walk: Any exercise—walking, jogging or bicycling—that raises your heart rate, done for a minimum of 45 minutes a day, is effective. Duration is more important than intensity.

2. Maintain a healthy weight: Reduce weight if overweight. Especially important is abdominal fat (waist line more than 80cm for women, 90cm for men).

3. Stop smoking: Giving up tobacco improves HDL levels.

4. Find better fats: Cut out trans fatty acids totally. Partially hydrogenated vegetable oils (commercially-produced biscuits and bakery products, peanut butter, fried street foods, processed food products) need to go. Replace with mono-unsaturated fats (found in canola oil, mustard oil, avocado oil, olive oil, nut oil, among others). Use a combination of oils (rotate your household cooking medium), with special focus on cold-pressed oils, which retain their essential fatty acid composition better than refined fats and those heated to high temperatures. Also, feed on fatty fish (just two-three servings of salmon, ‘hilsa’ and other fatty fish each week make a difference because of the Omega-3 fats). Nuts are nice too: Almonds, walnuts, pistachio and several types of seeds (pumpkin, watermelon, fenugreek, flax, sesame) are beneficial for their healthy fat proportions.

5.Add soluble fibre: Oats and oat bran or other whole grains, fruits such as apples, grapes and citrus fruits, most vegetables and legumes, fenugreek seeds and psyllium husk are good sources. For the best results, eat at least two servings a day.

6. Consider soy: Though still a matter of debate requiring further research, some studies have shown that 25g (about three servings) of soy protein a day can help increase HDL levels and lower LDL.

7. Reach for red wine: One glass (30-60ml) per day, drunk with a meal (not on an empty stomach) has protective benefits.

8. Defuse the dairy debate: Doctors usually advise Indians to give up dairy items, says Dr Khosla, “due to the high fat content of whole milk products. But new research shows that conjugated linoleic acids (CLAs) found in the rumen of cows and other ruminants, and present in their milk, is helpful in reducing bad cholesterol and triglycerides.” Skimmed milk and low-fat dairy foods are a good compromise.

9. Think about probiotics: Recent studies have shown that certain probiotic formulas (especially those that include prebiotic fructooligosaccharides) can help lower LDL levels, as well as reduce levels of triglycerides.

10. Don’t stop: If you don’t make these changes a habit, you will soon be back to square one.

Source: Ishi Khosla, nutritionist, New Delhi; Seema Gulati, chief nutritionist, Diabetes Foundation of India, New Delhi.

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Know | Guggul tree for lipid disorder

Gugulipid, an extract from the guggul tree (‘Commiphora wightii’), has long been used in Ayurveda and has received regulatory approval in India for lipid disorder. Yet it isn’t widely endorsed by doctors. Peeyush Jain, head of department, preventive and rehabilitative cardiology, Escorts Heart Institute and Research Centre, New Delhi, says that during controlled trials, guggul was not found effective, and the benefits perceived by patients are probably due to other diet or lifestyle changes. A May 2002 article in ‘Science’ magazine endorsed it, reporting that Texas-based scientists found that gugulipid extract blocks the Farnesoid X Receptor (FXR), which plays a key role in maintaining cholesterol levels. Meanwhile, the guggal tree is highly endangered (it’s on the International Union for the Conservation of Nature and Natural Resources, or IUCN, red list) in India. Chitra Narayanan

Debate | Eggs and cholesterol

Eggs get bad press as cholesterol culprits. In ‘Help your heart with the good cholesterol plan’ (see above), two individuals claimed to have had opposite experiences. Even with high cholesterol levels, Divya Parashar was told it was fine to eat eggs. But Sanjiv Kataria attributed his backslide to whole eggs and has since sworn off the yolk. Delhi-based nutritionist Ishi Khosla says the recommendation for dietary cholesterol is “less than 300mg a day”. A large egg has 200mg, all in the yolk. Eggs are fine for most people, but if in doubt, leave out the yolk. Another hypothesis to chew on: Saturated and trans fats are more harmful for blood cholesterol than dietary cholesterol in foods. Chitra Narayanan

Beware | Alcohol and cholesterol

In moderation, alcohol (especially red wine) can increase high-density lipoprotein (HDL, or “good cholesterol”) and also offers anticoagulant benefits. However, it may also increase blood pressure, raise triglyceride levels and encourage weight gain. Doctors, therefore, advise teetotallers against taking up drinking. Those who do drink should stop at two small ones on alternate days, sipped along with a meal. “When taken with carbohydrates, the effect on trigycerides is minimal,” says Madhukar Shahi, interventional cardiologist, Artemis Healthcare, Gurgaon. Chitra Narayanan

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Taking heart care to work

Kavita Devgan — Mon, 21 Sep 2009 15:28:00 GMT

“In India, in the past five decades, rates of coronary disease among (the) urban population have risen from 4% to around 10%. In 2000, for example, India has lost more than five times as many years of economically productive life to cardiovascular disease than any other country,” says Anil Saxena, associate director, interventional cardiology, Escorts Heart Institute and Research Centre, New Delhi. By next year, estimates the World Health Organization (WHO), 60% of the world’s cardiac patients will be Indian.

The Delhi government’s Economic Survey, released in June, shows heart disease is the single biggest killer in the capital. It found that heart attacks killed approximately 15,442 people in 2007—that’s more than diabetes, tuberculosis and cancer put together. Clearly, the statistics are intimidating enough to warrant emergency action.

Could the answer lie in your office?

Experts believe prevention should begin early in life, with education in the classrooms. The battle itself needs to be taken to offices, say some experts. This is the thinking behind the WHO message for World Heart Day this year: Work With Heart (the WHO observes World Heart Day every year on the last Sunday of September; this year, it’s on 27 September).

Also Read How safe are you at work?

“There is a lot of sense behind this prevention strategy, as today we spend more than half of our waking hours working—in office,” says K.K. Sethi, senior cardiothoracic surgeon and chairman, Delhi Heart and Lung Institute, New Delhi. “Besides, it is well proven that young Indians are more prone to heart disease—genetically and otherwise—and it is this group of Indians that is facing the scourge of heart attacks today,” says Anshul Jain, senior cardiologist, Maharaja Agrasen Hospital, New Delhi.

Why should the office care about your health? Advocates say that a healthy employee is a bigger asset—the investment is akin to that made in equipment and training. Besides, the employer has to take responsibility for on-the-job factors that influence employee health. “(The) physical, mental, economic and social well-being of the employees is directly influenced by the workplace,” says Peeyush Jain, principal consultant, cardiology, and head, department of preventive cardiology, Escorts Heart Institute and Research Centre, New Delhi. “And the workplace in turn thrives on the optimum working (read: health) of its employees. Thankfully, organizations are now recognizing it and taking steps accordingly.”

When the workplace doesn’t work so well

A 2008 study at University College, London, showed a strong link of work-related stress with heart disease. “People who reported stress at work were at a 68% greater risk of coronary heart disease as compared to those with low-stress jobs,” says Dr Jain. “An unhealthy work environment is characterized by stress, depression, chronic back problems, unhealthy eating habits due to lack of time and decreased opportunity for physical activity, which may lead to heart diseases,” says Dr Saxena. And this in turn provides a definition for a healthy workplace: One where these problems are countered consciously to make your office safer for your health.

“With the current model of work culture we follow (impossible deadlines, killing targets, among others), there is bound to be a lot frustration and negativity in employees,” says H.K. Chopra, senior consultant, medicine and cardiology, Moolchand Heart Hospital, New Delhi, “And this could result in liberation of jittery molecules like epinephrine or non-epinephrine, and can precipitate rupture of vulnerable plaques and massive heart attacks.” Unmanaged stress can also give rise to various emotional, physical and psychological problems that can take an indirect toll on your heart.

Use your office to heal your heart

Dr Saxena lists a few steps to curb stress at the workplace:

Take a break: Stop, take a break and then reassess during stressful tasks or busy days. This will refresh your mind and give you the energy and motivation to take on the next task.

Spread happiness: Begin your day with a smile, compliment at least one person every day and surround yourself with things that make you happy or remind you of happiness...yes, even at your work desk. The cascade of positive chemicals counteracts the chemical response of stress—and that’s sound science.

Make friends: This is an extension of the earlier point, because the happiest people at work are often the ones whose colleagues are their friends. On the other hand, apathy, loneliness, competitive emotions are all sources of stress.

Exercise as if your life depends on it: Because it does. Exercise is non-negotiable, as is learning to relax. Which is why, the more progressive workplaces come equipped with gyms and meditation rooms. “Most of the people who don’t exercise cite the excuse of lack of time. Workplace fitness is the perfect answer to this excuse as employees can exercise before work, during breaks, during lunch or after work,” says Dr Jain. “The convenience factor of doing exercise at (the) workplace is immense, as this way exercise can easily fit into their schedules. Complementary memberships to sports clubs and a 24/7 fitness centre with (the) latest equipment can be a good incentive,” he adds.

Ashutosh Shukla, head of department and senior consultant, internal medicine, Artemis Health Institute, Gurgaon, adds: “A gym in the office premises is a boon and encourages employees to stay physically fit, besides space for a recreation room where yoga or tai chi classes can be organized. Even simple steps like walking around the building during lunch break, taking the steps up instead of the lift go a long way in helping.”

Dr Saxena also suggests “a walking and/or running club (during lunch hour or breaks), a bike rack on premises (so employees can ride to work or during lunch, mind/body classes (yoga, tai chi) initiatives and organizing team sports (volleyball, basketball, softball).”

Management’s health plan

For employers, here’s a ready reckoner to a healthier, and hence more productive, workforce:

1. Having a smoke-free workplace doesn’t help much if the smoke is just fogging up the entry to your lobby. Instead, seek a permanent solution: Conduct tobacco cessation workshops — and ensure adequate follow-up.

2. Advertise a discount on healthy foods (sandwiches, low-fat yoghurt, grilled chicken, fruits, pasta, salads, boiled corn, whole-grain breads and other high-fibre foods) in the office cafeteria. Ban fried food and trans fat rich foods such as bread pakoras, samosas, commercial pizzas, vada, bhaturas, tikki and pastries from the menu. Make fresh fruit, cut up and served hygienically, available within the office premises.

3. Make the staircase accessible. In too many offices, the staircase is synonymous with the fire escape and only the elevator makes any concession to style and comfort. Ensure that the stairwell is not blocked by storage cartons or left dirty and dingy. The idea is for people to find it a pleasure to take the stairs, not consider it a drudgery and punishment.

4. Encourage formation of fitness groups and organize non-competitive sporting activities, preferably involving entire families, for weekends or special days such as running a marathon where the goal, say, is to finish and raise money for charity, not clock in the best time.

5. Organize regular check-ups of all the staff (not just an executive health plan for the upper echelons).

6. Offer support for weight loss and weight management programmes with trainers and nutritionists who can offer one-on-one guidance.

7. Ensure the availability of a counsellor, one who can be seen to be confidential.

8. Educate employees about risk factors such as smoking, blood pressure, cholesterol levels, obesity, lack of exercise and personality types, among others. Encourage a work ethic where competitive spirit does not get out of hand. Periodic interaction with physicians and dieticians in a question-answer session, taking up specific subjects at each meeting (blood pressure, diabetes, cholesterol, genetic interference, among others) also helps remind people of their life beyond work and teaches crucial life skills.

9. Keep noise levels low. If there must be piped music to impress clients, play something soothing (need not be a drone or chant, either).

10. Put appropriate aromatherapy oils in the AC duct to keep the mood of the staff upbeat (cedar wood, basil), soothe stress (lavender) and boost immunity (lemon).

Strategies that have worked

It’s not all theory either. Many have fruitfully put workplace health measures into practice. And help may be as close as your nearest hospital. A physicians’ stress management centre run by Nalin Nag, internal consultant at Apollo Indraprastha Hospital, New Delhi, offers lifestyle and stress management workshops regularly for employees at National Thermal Power Corp. (NTPC), Airtel, Modi Enterprises, Polyplex, Ester industries, Emirates Bank and more.

Gujarat Guardian Ltd has a health guard programme in which it gives points to people who live a healthy lifestyle and give incentives accordingly. Tobacco chewing was common among operators at its glass manufacturing unit in Ankleshwar, so Dr Nag conducted interactive sessions using presentations, films, case studies, among others, for the workers. The result: a zero-tobacco company six months down the line.

The Delhi Heart and Lung Institute has organized public lectures and awareness programmes, including interaction of employees with senior physicians, in many private and public sector undertakings: Mahanagar Telephone Nigam Ltd (MTNL), Delhi Jal Board, Delhi Metro, Oil and Natural Gas Corp. (ONGC), Bharat Sanchar Nigam Ltd (BSNL), Food Corp. of India, State Bank of India and National Textile Corporation, among others.

“At Hero Honda Ltd, our employee health programme has been active since the last 10 years,” says Rakesh Sharma, the company’s chief medical officer (CMO), based at the company’s Daruhera branch. There is a tie-up with the Indraprastha Apollo Hospital, so a team of experts conducts regular health camps, identifies risk groups, examines employees and gives health awareness talks at least seven-eight times a year. Yoga training sessions are held monthly. Bhavna Barmi, a psychologist from Fortis Escorts Heart Institute and Research Centre, Okhla, runs stress management workshops at least four times a year; and Escorts also runs an ongoing substance abuse and smoking cessation programme for employees here. Plus, there’s one-on-one nutritional counselling by a dietician on offer the year round and all the staff up to the level of supervisor are trained in first aid and cardiopulmonary resuscitation (CPR). “Due to our regular blood donation camps, a pool of blood (is) always readily available for all employees,” says Dr Sharma, “and physicians come and do regular and even specific tests (such as doppler for diabetes) regularly in office.”

Moolchand has initiated a preventive heart programme (PHP) for its employees, the first of its kind in the country. Under this programme, psychologists analyse each individual from the personality perspective and their day-to-day capacity to cope with stress, and then advocate some exercises of the mind and relaxation techniques.

At Artemis Health Institute, the human resource (HR) department runs a yoga programme for all employees.

Escorts Heart Institute has several such initiatives for the doctors and other staff, including an in-house gym, table tennis facility, healthy food choices and a tobacco-free environment. They also have tie-ups with several organizations that send executives regularly in batches for physical check-ups, detection of risk factors and stress-reduction counselling.

Vanishing aid

Chitra Narayanan — Mon, 21 Sep 2009 15:13:00 GMT

Are we soon going to see stents that vanish?

Going by the buzz among cardiologists, the eagerly-awaited fourth-generation stents, which are bioabsorbable, are not too far away.

Balbir Singh, interventional cardiologist, Indraprastha Apollo Hospitals, Delhi, is looking forward to preliminary results on biodegradable stents that he says will be presented at the annual TCT (Transcatheter Cardiovascular Therapeutics) meet of cardiologists in October in Washington. Cardiologists in India are hopeful that by 2010, the path-breaking stent would have cleared all trials and gained regulatory approvals.

The excitement is understandable. As Madhukar Shahi, interventional cardiologist at Artemis Healthcare, Gurgaon, puts it, “Stents that can simply dissolve and disappear—that is the holy grail of angioplasty.”

Gone when the work is done

Dr Shahi likens a stent to the scaffolding of a building. Once the construction is done, the scaffolding comes off. Unfortunately, till now, stents (which performed the function of a scaffold inside the artery, holding the arterial vessel open and preventing closure while the procedure was done) had to stay put in the human body. “Whereas, ideally, you want a stent that stays only a finite time in your body,” says Dr Shahi.

Soluble solution: Like this candle, the new generation of stents will simply melt away once their job is done.

Riding on fears of stent thrombosis and other complications (clots, interference with future surgeries, immune reactions), scientists and researchers have been pushing the envelope in developing this fourth-generation technology. As Dr Singh points out, it is not desirable for a foreign body to remain inside our body when its usefulness is over.

The coronary stent: a history

It was way back in 1986 that the first coronary stent was used—these were bare metal stents. Unfortunately, bare metal stents were associated with a high degree of restonosis (artery narrowing again). In 2001, this led to the introduction of drug-eluting stents (DES)—a coronary stent system composed of a drug-eluting polymer layer and an antiproliferative drug, which would prevent restonosis. However, stent thrombosis (blood clot formation), though a rare occurrence, continues to be an issue plaguing angioplasty.

Race for a better stent

As Dr Shahi explains, the ideal stent would be one which would have enough force to prevent the elastic recoil of the vessel during the procedure, contain drugs that can prevent restenosis from happening and disappear six months later when medication is no longer needed.

Today, a lot of companies are in the race for the biodegradable stent, which is in various phases of trials. Abbot, Igaki Tamai and Biotronik have had human trials of their biodegradable stents. Both polymer-based and magnesium-based bioabsorbable stents are in the development pipeline. Opinion, however, is tilted towards the polymer-based bioabsorbable stent.

Still second best in India

In India, manufacturers of medical devices estimate that at least 150,000 stents are placed in blocked arteries during the ballooning angioplasty procedure every year. Unlike the US, where angioplasty is the preferred option over bypass surgeries, in India, more patients opt for surgery. If the technology of stents improves, the ratio could change in India, though there are other reasons for surgery being the preferred route here: economic reasons (a single stent is cheaper than a bypass, but if multiple stents are used, the cost is higher; some insurance policies do not cover stents though they cover bypass surgery) and also because of the diffused pattern of cardiac disease in India (that is, there is often diabetes and other complications as well to contend with). Also, surgery is perceived by patients as a more permanent and long-term solution. But that’s another story.

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Your phone as a personal trainer

Roy Furchgott / NYT — Mon, 14 Sep 2009 15:38:00 GMT

To prepare for his first marathon last year, Michael Nolan trained for six months with the New York Road Runners Club, running up to 20 miles a day, five days a week.

Nevertheless, he finished with an average speed of about 11 minutes a mile, a full 60 seconds a mile off his target pace. This year, he vowed to be faster. “I didn’t want to take that long again,” he says.

So he got a personal trainer. Now, as Nolan prepares for this year’s New York marathon, he is leaner, stronger and “easily” averages eight-and-a-half-minute miles on training runs, he says.

Nolan’s new workouts are not coached by a running guru, but by iPhone applications that show video workout instructions and tabulate every set of burpees and step-ups.

The sports and health industries are just beginning to tap the computing power of smartphones. Applications range from simple calorie counters to heart-rate monitors that use complex metabolic calculations.

These applications can help an athlete achieve a personal best, but some doctors say that more important is their ability to produce no-fail routines for the sedentary and obese which could improve health and drive down medical costs. Here are some of the popular fitness applications out there:

Weight loss

In theory, losing weight is simple: Just burn more calories than you eat. Martin Gramckow, an avid bicyclist based in California, had considered that fact since a cyclist he met on a ride bragged about losing 50 pounds. “I’m huffing and puffing trying to keep (up) with him, while he leisurely pedals along and tells me how he did it,” Gramckow says.

The answer was calorie counting. But Gramckow thought logging every morsel that passed his lips “was always too much work”. Then he saw Calorie Tracker for the iPhone, a free application from LiveStrong.com, an affiliate of the Lance Armstrong Foundation.

As with similar applications, Gramckow can search for foods by name or meals from restaurant chains and the application calculates and stores all the nutritional information.

“Sure enough, I find a couple of things in my meal plan that are out of whack,” says Gramckow, who trimmed 10 pounds in less than a month. “I’m not far away from being the fittest I’ve been in a long time,” he says.

Calorie Tracker, which is also available for the BlackBerry ($2.99), won’t give you a breakdown of proteins, carbohydrates and fats (unless you sync it and view the result on your computer), but a free iPhone application called Lose It! will. The application also allows you to enter the ingredients of your own recipes and store a list of meals you commonly eat.

My Food Diary may have the most complete food database and it can be accessed from any mobile browser, but it has no phone-specific application. Phone access is free with a $9-a-month (Rs436.5) membership to the website. Make sure you point your browser to the site formatted for the phone, Mobile.myfooddiary.com.

Indoor fitness

FitDeck Mobile ($4.99 for iPhone and $14.99 for BlackBerry) is designed by a former Navy Seal instructor, Phil Black, as a simple workout that requires no equipment. Illustrations show exercises such as jumping jacks and push-ups.

Fitsync is a website with a collection of workout routines that can be loaded on to phones using Android, Palm or Windows Mobile software, as well as an iPhone. The company claims a library of 1,600 exercises organized into at least 400 workouts such as “Rock Hard Challenge” and “Bikini Body Cardio”. Scheduled workouts from the website can be sent to your phone on workout days. An annual subscription, normally for $39.95, is being offered at $2.99 for Android phones.

Nolan used applications from PumpOne, which has 20 workout applications for the iPhone, including ones for specific sports such as golf or specific goals such as burning fat. The newest application from the site, FitnessBuilder 2 Plus, has 5,000 images and videos of exercises, and 500 ready-made workout programmes for a $4.99 monthly subscription or a $99.99 one-time fee. Designed by an exercise physiologist, Declan Condron, workouts can be researched by muscle group, effort level or type of equipment or goal (such as speed or strength). It also lets you enter the number of reps and the weight used.

Smheart Link ($124.95) makes a heart monitor that links to an iPhone. Smheart Link works with four applications that allow gym rats to arrange a display screen to show what they want, such as calories burnt, average heart rate or elapsed time. It also links to sensors on indoor and outdoor bikes that measure cadence and estimated speed and distance. Hardcore riders can attach a power meter that measures the watts a cyclist generates, a measure bikers often use in competitive training.

For precise data, you can visit a New Leaf-trained technician, who employs metabolic testing equipment to measure your heart and lung efficiency in a gruelling aerobic test (average cost $175-200). Using that data, New Leaf sends custom exercise programmes to your phone and works like a virtual personal trainer, telling you how high to push your heart rate, when, and for how long.

It also tracks results through the Smheart Link heart monitor. New Leaf’s detailed reports show how many fat and carbohydrate calories you have burnt, and how much time is spent in each of the five heart rate zones.

Outdoor fitness

One of the beauties of a mobile device is that you don’t have to be wired to a machine in a gym. Several applications are designed with hiking, biking and running in mind.

MyTracks, a free application for Android phones, uses GPS signals to track your time, distance, speed and elevation as you hit the trail. The data can be loaded into a spreadsheet on Google Docs to determine whether you are getting faster, or you can put the map and statistics in MyMaps to share with friends. You can also send an email message of your route to running buddies from the application. If you want heart rate data or calories burnt, however, you will need a second device.

The Nike (Plus) iPod Sport Kit is made especially for runners (it can be used in a gym for cardio workouts as well); it tracks time, distance, pace and estimates calories burnt. It uses a $29 sensor compatible with a Nike (Plus) shoe and beams information to an iPod or iPhone. It does take some set-up to calibrate. You will need to run a known course to set it up for highest accuracy.

The cycling application iMapMyRide turns the iPhone into a GPS cyclometer, recording time, distance, speed, altitude and estimated calories burnt. You can see your position on a map as you travel, and it has a button to pause your ride. Your maps and statistics are loaded to the MapMyRide website, where you can measure your progress and, if you like, share your routes with other riders.

MapMyRide has a free application if you don't mind seeing advertisements or an ad-free $4.99 version that also stores a greater number of rides and statistics. There is a separate running application as well. The website requires a separate subscription, but there is a free option, as well as an unlimited-use $99 annual membership.

There is one respect, however, in which these applications don’t go the distance. Powering the screen while also using GPS or a heart monitor (and maybe listening to music as well) will leave your batteries wheezing like a tubby, two-pack-a-day smoker. If you’re really into getting fit, your smartphone may hit the wall before you do.

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Must Read

Meat eaters might happily chew on the findings of this new study from Japan. It suggests that eating meat at least every two days during middle age may help maintain independent daily activities when older. The Japanese elderly often live about seven years with reduced daily activities before death. This was the reason Yasuyuki Nakamura and colleagues at Kyoto Women’s University sought to determine whether food intake influenced the declining abilities of the elderly to independently care for themselves.

A change of heart

• Not needed

For a long time, it was believed that the following two tests were very useful. But cardiologists are now having a change of heart:

1. Positron emission tomography (PET): A nuclear medicine imaging technique, it produces a 3D image or picture of functional processes in the body.

2. Thallium stress test: It shows how blood flows to the heart muscle, an indication of the heart’s health.

• Be careful

Heart disease affects the kidneys or lungs only indirectly. For instance, if the heart is not pumping well, the kidneys and lungs get damaged. When your heart fails, it puts pressure on the brain, leading to blood clots.

• Prevention, the best bet

You can take care of your heart with regular exercise, a healthy lifestyle and by ensuring good sleep.

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