Shake off your stress
Stress is a common problem that can build up gradually. You may not be aware of just how much stress you are under until it has reached a critical level. Therefore, it is important that you learn to recognise the types of symptoms that may indicate that your level of stress is too high.

Punjab: drinking to distress & disease
By Dr Rajeev Gupta
The consumption of alcoholic beverages is showing a steep rise in Punjab. Decorated liquor shops in urban and rural areas of the state give a look of festivity and are completely in tune with the pleasure prone Punjabi psyche. Liquor shops, strategically located on highways, entice the drivers of buses, trucks and other vehicles as well as the passersby.

A healthy eating plan
By Dr Stephen Carroll and Dr Tony Smith

The key to healthy eating is a varied and balanced diet, which provides the right mixture of carbohydrates, fats, and proteins; and the recommended amount of all the vitamins and minerals. This ideal diet has enough calories to fulfil your energy requirements, but not an excess that would cause you to put on weight. It also supplies the right quantity of fibre, sometimes called roughage, and water to keep your digestive system working efficiently.

A healthy balance
By eating a wide variety of foods, from each of the major food groups, you should satisfy all your nutritional requirements. Simply eat a range of foods every day from the five separate categories — bread, cereals and other grain products; fruit vegetables meat, poultry, fish, eggs, and plant protein sources such as dried beans, peas, nuts, and seeds; and dairy produce.

A week's food intake.
An average person aged between 18 and 54 years would eat the foods shown here in the course of just one week. Different people have different nutritional requirements which vary according to sex, age, size, activity level, and with any special needs such as pregnancy. For instance, a sedentary adult woman needs to consume about 12,000 calories a week, as compared to 25,000 calories for a man doing a physically demanding job.

Carbohydrates should provide about 50 to 55 per cent of your energy needs, proteins about 15 per cent, and fats 30 per cent or less. However, many people in the West consume far too much fat and eat most of their carbohydrate in the form of refined sugar, which lacks vitamins, minerals, and fibre.

Reducing fats
Cutting down on fats reduces the risk of heart disease. Try to choose unsaturated instead of saturated fats wherever possible. Saturated fats are, found in red meat, milk, cheese, coconut oil, palm oil, and butter, and are also added to processed foods. They increase your blood cholesterol level, which in turn increases the risk of fatty deposits furring up your arteries. Unsaturated fats, contained in oily fish, chicken, nuts and most types of vegetable oil do not raise your blood cholesterol, and may even have a protective effect on your heart and circulation.

Increasing fibre
Healthy eating need not always mean eating less. High-fibre foods such as wholemeal bread, brown rice, fresh fruit, and vegetables fill you up without adding empty calories to your diet. They are also a good source of vitamins and minerals. A high intake of dietary fibre prevents constipation and also helps regulate the absorption of glucose and fatty acids from your digestive system.

If possible, carbohydrates should come from low-calorie, high-fibre foods. Cut down on biscuits and sweets since they contain calories without the benefit of other nutrients. They also increase your risk of obesity and tooth decay.

All in a day
Another key to healthy eating is to have three meals a day, rather than a lot of snacks and one big meal. Do not be tempted to skip breakfast since your body's metabolism works more efficiently on a steady supply of foods. People who do not usually eat three regular meals a day are more likely to put on weight.

Planning a healthy diet
Careful shopping and cooking can ensure that you eat a healthier diet. Simply reducing the amount of red meat in your diet will mean you eat less fat, as all red meats are high in saturated fats as well as protein. Try to eat meat only once a day, or to have a completely meat-free day once a week. To cut down on cholesterol eat no more than four eggs a week.

The smart shopper
When shopping, buy fresh rather than processed foods because they have a higher nutritional value and are free of added sugar and salt. Check the labels on tinned foods, selecting those that do not have salt or sugar added. Choose fish that is packed in water rather than oil. Select low-fat dairy products like skimmed milk and low-fat yoghurts, spreads, and cheeses. When buying meat, choose lean cuts. Fish and poultry, which contain less fat than red meat, pork, sausages, and processed meats, are a nutritionally sound choice.

The health-conscious cook
In the kitchen, trim all visible fat from meat and remove chicken skin. Bake, boil, grill, stir-fry, or steam food rather than frying it. If you choose to fry, use olive oil or a polyunsaturated vegetable oil rather than butter or lard. Two generous portions of foods that are high in fibre, such as whole grain bread and cereal, fresh fruit, raw or lightly cooked vegetables, wholemeal pasta, brown rice, and dried beans, should be eaten every day. Salads supply vitamins, minerals, and even fibre; they are healthiest when served with lemon juice or a low-fat dressing.

Sugary foods and alcohol are both high in calories and should be consumed in moderation. Although small amounts of alcohol are good for your heart and circulation, you should limit your intake to two measures of wine, beer, or spirits each day.

A healthy diet
The Mediterranean diet is far healthier than the high-fat diet of most other people in the West. This pasta with a seafood sauce is low in fat but high in nutrients.

Keeping trim and healthy
Eat plenty of vegetables and salads, and finish your meals with fruit rather than rich desserts that are high in calories.

Low calorie foods
Because fish and salad are low in fat and therefore calories, you can eat far more of them than of foods like butter or red meat.

The latest edition of the authors’ “The Complete Family Guide to Healthy Living”, from which the information given here has been culled, will be reviewed in these columns next week.

Shake off your stress

Stress is a common problem that can build up gradually. You may not be aware of just how much stress you are under until it has reached a critical level. Therefore, it is important that you learn to recognise the types of symptoms that may indicate that your level of stress is too high.

Find out how vulnerable your personality is to the harmful effects of stress; assess the current level of stress in your life; and learn whether you are suffering from any stress-related symptoms by answering the following questions:

Question: Do you go over and over the events of the day and worry about them?

Answer: No. Sometimes. Yes.

Constantly brooding about the past or worrying about future events increases the amount of stress in your life. Try not to worry so much; it is pointless fretting about events over which you have no control.

Q: Do you lack ambition and always rely on other people to spur you into action?

A: No.

Sometimes.

Yes.

If you just allow events to happen to you and never take control of your life you are increasing your risk of suffering from stress. Be positive: you can beat your apathy, boost your confidence, and eliminate stress.

Q: Are you competitive and aggressive in everything you do?

A: No, I avoid unnecessary confrontation. Yes, I strive to be successful at play as well as at work.

There is nothing wrong with wanting to be successful. It is a good idea, however, to take part in at least one noncompetitive activity in order to reduce tension.

Q: Do you find it hard to express your feelings and anxieties out loud?

A: No.

Yes.

People who constantly bottle up their emotions are more likely to develop a harmful build-up of stress. Being able to cry or shout out loud occasionally is a good way to release pressure.

Q: Do you take on too much or accept unrealistic deadlines?

A: No.

Yes, but this is the nature of my work.

Yes, but I like to push myself hard.

The ability to say "no" to excessive demands is a skill. If you create your own stress by pushing yourself too hard, try to manage your time better, increase the amount of work you delegate, and find time to relax.

Q: Do you find it hard to relate to people?

A: No.

Yes.

If you do suffer from too much stress you are likely to recover more quickly if you have close friends or relatives that you can confide in. Friendly advice or a shoulder to cry on can make all the difference and enable you to cope until the crisis is over.

Q: Are you suffering from any symptom of stress?

A: If you are suffering from more than four of the symptoms listed in the table you are likely to be overstressed. To maintain your health you need to identify the sources of stress in your life and try to alleviate them.

Q: Has your life changed much in the last six months?

A: Some areas of my life have changed but others are exactly the same.

No, everything is the same as it was.

Yes, many aspects of my life have changed.

New activities and events add variety to life, reduce stress, and help to keep you healthy. However, too much or too little change can actually cause stress.

Q: How many interests and activities do you have outside of work?

A: Many.

Only a few.

None.

Working for excessively long hours, without allowing yourself time to wind down, increases your risk of becoming over-stressed. Any activity that you enjoy will help to relieve tension and keep you relaxed.

— SC & TS

Punjab: drinking to distress & disease
By Dr Rajeev Gupta

The consumption of alcoholic beverages is showing a steep rise in Punjab. Decorated liquor shops in urban and rural areas of the state give a look of festivity and are completely in tune with the pleasure prone Punjabi psyche. Liquor shops, strategically located on highways, entice the drivers of buses, trucks and other vehicles as well as the passersby.

Today, no party, get-together or social function is considered a success unless a liberal supply of expensive brands of whisky or scotch is made freely available and obliging guests are virtually drowned in liquor. More and more women from the high and upper middle classes are turning to alcohol to join the new class of "free, modern and advanced Indian Mem Sahibs".

High school girls and boys celebrate their birthdays and Valentine Day with bottles of champagne. It is a common sight to find them drinking from beer cans while enjoying a drive on city roads.

Statistics from the Excise Department indicate that the consumption of alcohol is rising fast in Punjab and the per capita consumption of liquor there has reached the highest point recovered in the country. This upward trend may be gratifying to the officers of the Excise Department and economists, but for those whose wards and husbands have got hooked to alcohol, these figures frustrate. There is indirect evidence to show that after the rise in the prices of liquor, the consumption of potentially country-made liquor has gone very high.

Visit any labour colony in the evening, and you would feel the damage and the injury alcohol has inflicted on the health, wealth and peace of the families of the alcoholics. Talk to a medical specialist or a gastroenterologist and you would be shocked to learn some facts about the fast multiplying number of patients with alcoholic liver disease and alcoholic pancreatitis who are straining the already weakened health care system.

Most of these patients are males in their thirties and forties, sitting on the edge and gradually sliding towards severe morbidity and death. Visit any trauma ward in a hospital. You would see that roadside accidents under the effect of alcohol are making people invalid for lives.

In the absence of adequate monitoring by the traffic police, alcohol is becoming Killer Number I on Punjab roads.

Talk to any psychiatrist. He would say that the regular consumption of alcohol is responsible for the rise in the number of cases of crime, suicide, depression, violence, dementia and epilepsy.

The electronic media is also to blame for spreading the trend of alcohol consumption by glamourising its use by cinestars. TV serials display female characters boozing to escape the tribulations of life or to keep a high profile in society.

The modern Indian woman is competing with her male counterpart in every walk of life. No wonder, therefore, that young children imitate their elders when they take a cold drink that looks like beer, say "cheers" and clink glasses to enter the world of fantasy of their elders. Unfortunately, the breaking up of the joint family system and the weakening of the social norms have forced many urban Indian couples to find easy respite in alcohol from the stresses and strains of our competitive society. The scenario is equally depressing in rural Punjab.

Home-made liquor is available in plenty in rural areas where an army of unemployed and underemployed youth find it fashionable to join the band of fast-growing young alcoholics.

In the West, states have been able to reduce alcohol consumption by educating the public and strictly enforcing the law of the land. Here, many of my own medical colleagues keep on arguing in public that "moderate quantities of alcohol" have no harmful effect; rather, these have a soothening effect on a tense and strained mind.

Liver function tests like SGOT, SGPT and GGT are often deranged in these patients, clearly pointing to the downhill course they are going to take in their near future. They also show clinical and radiological evidence of liver enlargement, indicating progressive alcohol liver disease.

Unfortunately, they tend to ignore the results of these laboratory tests.

This is the group which gradually drifts towards serious stages of alcoholic liver cirrhosis. But since some people do not have pronounced clinical symptoms, they keep on falsely reassuring themselves that there is nothing wrong with them. The number of such groups of alcohol users is enormous and may run into lakhs in Punjab alone.

We cannot afford to close the liquor outlets at every nook and corner. A balanced approach would, however, reduce alcohol consumption.

A simple and effective way is to reduce the number of the outlets and cut their working hours short.

The author is a Ludhiana based psychiatrist. He edits Meditrack and maintains a health site (www.meditrackindia.com) for the poor.