Sunday Observer Online


Sunday, 17 October 2010





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Government Gazette

n World Osteoporosis Day is on October 20:

Nutrition education should be compulsory

- Dr. Renuka Jayatissa

Despite various awareness programs around the country, osteoporosis still affects 40 percent of Sri Lankan women over the age of 50 years.

Osteoporosis, often called ‘porous bones’, is a disease of bones that contributes to a high risk of fracture. “During menopause, women are at a risk of having osteoporosis called postmenopausal osteoporosis because the bones tend to be weaker with age.

If they get injured or accidentally have a fall, it makes the condition worse,” said consultant nutritionist at the Medical Research Institute (MRI), Dr. Renuka Jayatissa. She said that there are many medical referral cases every day but it is the simple lack of nutritional education that makes these women become prone to osteoporosis.

Dr. Jayatissa said, “It is important that the family physicians and the GPs themselves educate patients on nutrition without only focusing on the treatment part alone.” Moreover, she said that about one-fifth of Sri Lankan women are undernourished but it’s not the lack of food or the cost of living.

Dr. Jayatissa said, “In a survey we did, even though the cost of basic essentials is high, only 2 percent of the population actually live without three meals a day.” According to the doctor, those with low income managed to live comfortably by eating something but it was the food decisions that really made the difference.

“Nutrition is a vital factor in preventing not only ailments like osteoporosis but anything for that matter,” said the doctor. Working for about ten years in the nutrition sector of the Ministry of Health, Dr. Jayatissa is the only nutritionist attached to the Government’s health sector.

“In the MRI survey, it was also revealed that a traditional household would rather spend on their children’s education than a healthy balanced diet.

They don’t understand that if they don’t give proper nutrition for the child, what use would it be if they can’t attend school or university?” said Dr.Jayatissa. It was obvious that women who head households and make food decisions such as this forget about their nutritional condition due to the best interests of their family.

The doctor said that 20 percent of the total population of women in Sri Lanka are overweight and 20 percent are underweight. “Underweight women are more at a risk because they don’t obtain sufficient nutrition to compensate for the calcium levels in their body.

Hence, bone thinning causes the bones to be fragile and if they have a fall or injury, the condition would be aggravated,” she said. However, if a woman is overweight, she is capable of getting ostereo-arthritis which means that her bones are not strong enough to hold her weight.

The doctor advised that exercising would not only keep weight at a minimum but strengthen bones to make them resistant to osteoporosis.

Dr. Jayatissa said, “Osteoporosis can be easily prevented if patients take the doctor’s advice but they shouldn’t overdo it. For example, calcium supplements can be obtained through a prescription but if anyone takes more than the recommended dosage, severe adverse effects are likely to occur.”

Speaking about the link between osteoporosis with pregnant and lactating mothers, the doctor said that usually a prescription of calcium tablets are given to them. She said, “A continuous six-month course is given for women who are breastfeeding and pregnant women and this is compulsory with the health policies in place by the government.”

The doctor said that the common risk factors of age and family hereditary brings about ostereoporosis in addition to nutritional aspects. Furthermore, she said that Vitamin D is very much another requirement in bone formation.

“In Sri Lanka, we have taken the sunshine for granted but due to a hectic lifestyle most people don’t even go outside.

It is recommended that we are exposed to at least 10 minutes of sunlight everyday to produce vitamin D or we will have tragic complications,”she said. Dr. Jayatissa said that the best times for going out in the sun is before 10 am and after 2 pm.

Osteoporosis is easily treatable but prevention is better than cure. Dr. Jayatissa said that there are drugs available to treat the different stages of osteoporosis.

“However, my advice is to ensure that you have a balanced diet with plenty of exercise. Also, women should give priority to their health in order to support the health needs of their families,” she said.

The doctor said that there are some adolescent cases of obesity, anorexia and bullimia which also can trigger osteoporosis one day so she advises young adults to take care of their health.

Dr. Jayatissa’s recommended calcium-rich food to prevent osteoporosis:

1. Green leaves such as gotukola, mukunuwenna and kathurumurunga

2. Salty shrimps called kunissa

3. Milk foods such as milk and yoghurt

4. Sprats

5. Gingelly

6. Woodapple

A blocked nose?

Dr. Girish Rai and Dr. Usha Chennuru

Blocked nose can lead to chronic problems if not treated separately and immediately.

A blocked nose is a common symptom faced by many people who have a cold. It makes breathing difficult and interferes with one’s daily routine. If this happens during sleep, it is far more distressing.

Chronic, untreated blocked nose leads to problems both in children and adults.

Why does your nose get blocked?

When you have a cold, many chemicals are released in the body which lead to the symptoms of cold - sneezing, blocked nose, runny nose, watering of eyes, etc. These chemicals act on the tiny blood vessels in the lining of the nose leading to a feeling of stuffiness and hence the inability to breathe freely. This is how your nose gets blocked when you have a cold.

What happens if a blocked nose is left untreated in adults? The nose performs the important function of filtering the air we breathe. When the nose is blocked, it cannot filter the air efficiently and this leads to entry of germs and other foreign particles, which can further aggravate the cold and lead to infections.

Since the nose, ear, throat and sinuses are all interconnected, an infection in the nose can travel to these areas and lead to further infections. Such infections can lead to sinusitis which is bothersome and needs to be treated with a course of antibiotics.

What happens if a blocked nose is left untreated in children? If a blocked nose is neglected in children, it leads to breathing through the mouth.

A mother will notice that her child is sleeping with her/his mouth open. Since the mouth cannot filter the air, it leads to entry of foreign particles and germs into the respiratory tract. A child’s immune system is not fully developed and hence is prone to infections.

So, a blocked nose can lead to respiratory tract infections which in turn can lead to ear infections. Also, chronic mouth breathing can lead to tonsillitis.

What can you do to avoid these complications? Nasal obstruction as a complaint is on the rise due to increasing nasal allergy.

Treat a blocked nose immediately! Most people believe that a blocked nose need not be treated separately, and that if the cold is treated, the blocked nose will be treated simultaneously. This is because people do not know the complications of a blocked nose.

To prevent the complications of a blocked nose, you must initiate immediate therapy.

While this would take care of your congestion and help you breathe freely again, it would also save you from a lot of other complications which could be very distressing. Nasal sprays are a good way to relieve the discomfort and complications of a blocked nose.

Courtesy: The Hindu

Heart matters

It’s always about the heart! Anything remotely related to it has never been spared of speculation and debates. But there is a thin line that separates the myths from the facts.

Myth 1: Heart disease affects only the old/middle aged.

Keeping fit: Make an early start.

Many people think that heart disease as a problem of middle and older age, because that’s when the manifestations of heart disease, such as angina and heart attack strike.

Although the manifestations of coronary artery disease typically occur during the middle and later years of life, the roots of coronary artery disease lie early in life - in childhood.

Heart attacks can even happen to people in their 20’s and 30’s, from unusually high cholesterol levels that are hereditary. High paced, stressful lifestyles with irregular eating habits and lack of exercise are one of the causes of coronary artery disease striking early.

Adopting a healthy lifestyle early in life works much better than changing one’s lifestyle later in life. Ideally one should have their cholesterol and blood pressure levels checked in their 30’s and 40’s, which, if too high, can be early indicators of a heart disease.

Moreover, Indians are genetically more prone to and suffer heart disease earlier than their western counterparts.

Myth 2: Heart disease doesn’t really affect women.

Heart disease is the leading cause of death in women older than 40, especially after menopause.

Loss of estrogen is a significant cause of heart disease after menopause and therefore the risk for heart disease increases after the age of 50 for women. There are also some unchangeable factors like family history which make one more prone to heart disease.

Lifestyle plays a crucial role. Smoking and fatal heart diseases go hand-in-hand.

If a woman smokes, she increases her risk for early heart disease.

There are some differences, though, in how heart disease affects men and women.

For instance, women usually get heart disease 10 years later than men, but they have a lower chance of surviving a heart attack than men.

They are also more likely to have a second heart attack as compared to men.

Some interesting and educational facts about heart related problems: Cholesterol deposition in blood vessels begins in the first decade of life. So, good eating habits and regular physical activity should be inculcated from early childhood if coronary heart disease is to be prevented.

One third of patients with coronary heart disease have normal cholesterol levels. Low levels of good cholesterol (HDL cholesterol) increases risk of heart disease even if level of bad (LDL cholesterol) or total cholesterol is normal.

Blood Pressure : Each blood pressure increment of 20/10 mmHg doubles the risk of coronary heart disease across the entire BP range starting from 115/75 mmHg.

High blood pressure originally thought to be a normal occurrence with increasing age is a misconception. Increased blood pressure is harmful irrespective of the person’s age.

Risk of heart attack in diabetics with no prior heart attack is similar to non diabetics with prior heart attack.

Risk of heart disease in “mild” smokers is almost as high as “heavy” smokers. So, for risk reduction smoking should be completely stopped and not merely reduced.

“Physical inactivity” or lack of regular physical exercise is as important and as harmful a risk factor as high blood pressure or diabetes. Regular physical activity is the best preventive effort for coronary heart disease as it prevents all its risk factors.

Clinical benefits of blood pressure, diabetes and cholesterol reduction are similar irrespective of the treatment modality chosen.

The Hindu -

The writer is a Chief Cardiothoracic Surgeon in Gurgaon

Osteoporosis in men

“We used to think that as a result of menopause women were the only ones who were affected but we have many cases of men having osteoporosis in Sri Lanka,” said Dr. Jayatissa of the Medical Research Institute.

One in five men over the age of 50 are at a risk of developing osteoporosis and bad habits like smoking, drinking excessive alcohol and inadequate exercise contributes to this condition.

“When a man gets drunk, they are prone to accidents and if they fall, fractures would take a long time to heal due to osteoporosis,” said the doctor.

Smoking is also very dangerous to bones because the chemicals in cigarettes make the bones weak and fragile. “Smoking can also lead to chronic disease that affects the kidneys, lungs, stomach, and intestines and alters hormone levels,” said Dr.Jayatissa.

When it comes to osteoporosis in men, testosterone increases bone density in men with low levels of this male hormone. According to the doctor, undiagnosed low levels of the sex hormone testosterone leads to osteoporosis.

Also, prolonged exposure to certain medications, such as steroids used to treat asthma or arthritis, anticonvulsants, certain cancer treatments and aluminum containing antacids.

Dr. Jayatissa said, “Osteoporosis is indeed a silent killer so not only should we carefully check women but men too, because if it isn’t detected promptly the consequences would be devastating. The older the man is, the higher the risk of ostereoporosis.”

What men can do to reduce the risk of fracture - Assess your risks and seek advice from your doctor.

* Diet: a balanced diet rich in the essential nutrients for bone health, includes calcium, which strengthens bone, and vitamin D, which helps the body to absorb calcium.

* Between 25 and 65 years of age, men need at least one gram of calcium a day, increasing to 1.5 grams daily for the over 65s. Sunlight is a natural source of vitamin D and exposure to as little as ten minutes a day can be sufficient or vitamin-rich foods can be recommended.

* Physical activity: weight-bearing exercise, such as walking, tennis and jogging may assist in maintaining bone density and muscle strength, coordination and flexibility and reduce the risk of falls. Resistance training and lifting weights may help maintain bone density.

* Diet, exercise, lifestyle and - if osteoporosis is diagnosed, the use of certain medications - are the major ways of maintaining and restoring bone health.

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