|HEALTH TRIBUNE||Wednesday, September 6, 2000, Chandigarh, India|
Diet — Veg, clean and healthy
How to fight depression
Visualise the lungs from inside
one of the most remarkable examples of progress made in the 20th century is related to the direct visualisation of several organ systems with the help of flexible instruments (endoscopes). The inspection of an organ from inside was always a challenge to a clinician. Chest physicians had relied on indirect tools, such as a stethoscope, to assess the happenings in the lungs.
It was the bronchoendoscope which had revolutionised the practice of chest medicine. Although the rigid bronchoscope had been available for several decades earlier, it was the introduction of fibreoptic instruments which had made the job a lot easier. It was because of their flexible character that the hitherto inaccessible areas could be reached and seen with ease. This was invented in Japan in the late sixties.
The flexible shaft essentially consists of a bundle of thousands of glass-fibres used to transmit light from an external source to the tip of the shaft. The inside view is transmitted and undistorted images are seen.
We had an excellent cause of celebration on August 30, 2000, when the ten-thousandth fibreoptic bronchoscopy was performed at the centre at the PGI — the first one was done on September 17, 1979. In itself, the number may not be important. But the pattern of problems which has been identified with its help, is of tremendous significance. It is an achievement which brings cheer to the PGI because it is unlikely that the figure would be matched by any other centre in the country in the very near future.
Bronchoscopy helps us to identify the abnormalities within the bronchial tree, i.e, the air-tubes. It is primarily useful to look for tumours, ulcers and other lesions of the bronchi. Suspected lung cancer, therefore, continues to remain the most important indication for this procedure. But the list of diseases for which the test is performed is long and continues to grow with time.
Bronchoscopy allows the pulmonologists not only to see the abnormality and locate the site of the lesion but also to take biopsies from that area and around. Endoscopic procedures are, therefore, also employed to obtain lung tissues from beyond the bronchi.
Lung biopsies obtained in patients with diffuse lung diseases have solved many a diagnostic dilemma. Many diseases which were either missed or misdiagnosed in the past, can now be recognised more commonly and confidently.
Bronchoscopy can also be used for other guided procedures such as needle aspiration to obtain cytological material. An area of the lung can be lavaged with saline and the lavaged fluid aspirated back for different investigations. This type of "broncho alveolar lavage" has been occasionally referred to as the "liquid biopsy" of the lung. The information on lung pathology obtained in this fashion is largely indirect and is no substitute for the actual lung-tissue biopsy.
The microbiological examination of the bronchial secretion is of great help in the diagnosis of infections, such as tuberculosis. Bronchoscopy improves the diagnostic yield in several such patients in whom sputum is either not available or is tested negative.
There are several therapeutic applications of bronchoscopy. It can be used in selected cases to remove foreign bodies aspirated accidentally in the bronchial tree.
We have removed aspirated plastic whistles, pins, buttons and vegetable material. One of the most interesting examples was that of an adult male who was treated at several places as a severe asthmatic patient with symptoms of cough, breathlessness and wheezing. He was found to have a garlic pod in one of the bronchus and got well on its removal.
Some of the other treatment indications include the application of cryo or laser beams for some obstructive or bleeding lesions; local placement of the radiotherapy source for cancer (lung) and of bronchial stents, etc. Factually speaking, bronchoendoscopy is only an extension of the external examination. Whatever can be done externally on the body surface with hands can be done internally with the help of an endoscope.
A bronchoscopic examination is generally safe with minimal discomfort and risk. Minor bleeding and airleaks can occur.
There are limitations and pitfalls in bronchoscopy as in any other endoscopic examination. Individuals do differ in their observations and interpretations. Moreover, the dictum is: "Your eyes do not see what your mind does not know".
Dr Jindal is the Professor and Head of the Department of Pulmonary Medicine, PGI, Chandigarh.
Diet — Veg, clean and healthy
Those interested in keeping fit and body-building are always searching for the optimum diet. Unfortunately, some diets overdo it with protein, weakening the bones, and straining the kidneys.
Others provide a healthier amount of protein, but enough fat to build a spare tire. Many are low in vitamins and nearly devoid of fibre. How do we find the best diet?
If your goal is to build muscle, what matters most is not your diet, but your training regimen. When aspiring body builders ask me what is the best way to build muscle, I answer:"Get plenty of iron. Not in your food — in your hands!" All the nutrition in the world will not build muscles without training. Even so, foods are important. Good nutrition means protein, carbohydrate, fat, fibre, vitamins and minerals – not only in the right amounts, but also the right kind. Protein is a concern for many, so let's focus on that.
Protein: More important than the amount of protein is the type. In the early 1900s, many nutritionists favoured animal proteins, like eggs and meat, because they are high in essential amino acids, the "links" that build the protein chain. However,it is now known that the sulfur-containing amino-acids in animal proteins can leach calcium from the bones, encouraging bone-weakening osteoporosis. Animal proteins are also hard on the kidneys. In high amounts, animal proteins gradually wear out the nephrons, the kidneys filter units.
Plant proteins, on the other hand, provide all the essential amino-acids, and are much easier on the bones and kidneys. But weight trainers demand more than a basic diet. They need more protein and more calories. While the exact amount of protein needed is a matter of continuing controversy, you can get whatever amount you want from plant sources. Surprisingly, vegetables contain generous amounts of protein. Typical green vegetables are approximately 40 per cent protein, as a percentage of calories. The hitch, however, is that vegetables are not at all nutrient-dense, so you have to eat generous servings of vegetables to boost your protein intake substantially.
Pulses (beans, peas, and lentils) are more nutrient dense and easily supply a substantial amount of protein. Most varieties have about 25 per cent protein, and yield about 15 grams of protein per cup. Soyabean products push protein higher.
While soyabeans are higher in fat than other beans, defatted soya products, such as soya granules and soya chunks, are high in protein with virtually no fat at all.
But don't think that beans have a patent on protein. Wheat noodles, believe it or not, contain substantial amounts; some varieties have about 10 grams of protein in every two ounces of dry pasta, and that's before you figure in any toppings.
Vegetarian protein supplements are available at health food stores. Most contain about 25 grams of protein per one-ounce serving, with virtually no fat.
Plant foods are loaded with advantages: There is no better way to cut body fat. And you skip all the animal fat and cholesterol that come from animal products. Don't let anyone tell you that you can't build muscle from plant protein. Bulls, stallions, gorillas and elephants build their massive strength, not from meat, eggs, or dairy products, but entirely from plant nutrition.
The new four food groups:
To ensure complete nutrition, the easiest overall guide is called the New Four Food Groups. Devised by the Physicians Committee for Responsible Medicine in 1991, the New Four Food Groups assures an adequate mix of amino-acids, essential fats, complex carbohydrates, vitamins, and minerals by building the menu from grains, vegetables, legumes (beans, peas, and lentils) and fruits. Put these groups together in the following amounts for every 1200 calories in your daily diet:
Whole grains: 3 or more servings (1 serving = ½ cup hot cereal, 1 oz dry cereal, 1 slice bread).
Vegetables: 5 or more servings (1 serving = 1 cup raw or ½ cup cooked).
Fruits: 3 or more servings (1 serving = 1 medium piece of fruit, ½ cup cooked fruit, ½ cup fruit juice).
Pulses: 2-3 servings (1 serving = ½ cup cooked beans, 4 oz tofu or tempeh, 8 oz soya milk). In this simple plan, animal products are no longer considered dietary essentials, and are best eliminated completely. It is also recommended that vegetable oils be kept to a minimum.
Start with the grain. About half your plate should be rice, noodles, corn, etc., or, if you prefer, substitute a starchy vegetable, such as a potato. Grains give you good, clean-burning, complex carbohydrates that increase your body's production of thyroid hormone and noradrenaline to cut body fat. Next, fill about a quarter of your plate with vegetables. I usually suggest two different vegetables, such as carrots and a green vegetable at a single meal. These are vitamin powerhouses.
The final quarter of your plate should be filled with pulses: beans, lentils, peas, etc. Pulses are rich in protein, complex carbohydrate, fibre and omega - 3 fatty acids.
Fruits make great desserts and snacks, but include them whenever it feels right for you. Add a daily multiple vitamin or any other reliable source of vitamin B-12, and you're set with complete nutrition.
How to fight depression
Depression, a curse of modern life, is hitting people very hard. The number of persons hit by depression is rising rapidly. The fast-moving city-life, the breaking up of the joint family system, the rapidly multiplying external pressure of various kinds, global economic changes, rising expectations and piled-up frustrations are adding to the number frighteningly.
It is important to know that when identified at an early stage, most of the cases can be managed with non-medical treatment. Only a few persons need medical or expert psychiatric consultation. Here are some facts and tips.
Early signs and symptoms:
* Lack of interest in life
* Inability to enjoy life
* Baseless fears
* Constant fatigue
* Vague bodyaches
* Reduced appetite or increased craving for food
* A fall in libido or diminished sexual activity.
* Preoccupation with the mistakes of the past
* A negative attitude towards life
* Unnecessary criticism of others
* Feeling of sadness
* Disturbed sleep
* Feeling of anxiety
* Bad memory
* Distressful worrying
* Loss of grip over life
* Weeping spells
* Hallucinatory experiences
* Paranoid attitudes
* Suicidal ideas
* A tendency to harm oneself physically
* Violent acts
* A tendency to run away from home
* Attempts to commit suicide
How to cope with depression.
One should fight back when one is depressed. I tell my patients:
1. Increase your activity
A depressed person has a tendency to withdraw himself into his shell. He wants to sit alone and stay cut off from the outside world. When he feels low, he should go for a walk, listen to music or watch a good TVprogramme. Reading cheerful books helps. One should not sit idle. Starting doing something creative is a big step.
2. Talk to someone
Depressed people are loaded with negative emotions. They are full of anxieties and fears. Their mind is under the constant grip of apprehensions. If they are able to talk to their friends, colleagues or spouses and express their problems, they feel light and better.
3. Go for a regular walk or do enough exercise.
Physically activity is the best antidote for depression. It has been observed that depression often knocks down those who are physically less active than required and live a sedentary life.
4. Avoid intoxicants and tranquillisers
The regular use of intoxicants, including alcohol, leads to a stage of chronic depression. The same is the case with the abuse of tranquillisers. Alcohol depresses the central nervous system and should be avoided by depressed people. It has been my experience that during the period of depression, many persons start drinking alcohol or increase its quantity. They feel it helps them to calm their nerves. They do not realise that it makes them plunge into deeper depression. It is widely known that drug addicts are always prone to developing moderate to severe depression. It is common for alcoholics to experience depression after stopping alcohol consumption. Such a phase may last from a few weeks to a few months.
5 Visit religious places
Many depressed patients harbour rational or irrational feelings of guilt. Regular visits to a temple, a mosque a church or a gurudwara may help the patient in unloading such feelings. Spiritual strength cures the body and the mind.
6. Pray to God
Prayer has a great healing effect. All kinds of patients with psychological and physical illnesses feel better after praying in an articulate manner. It helps them discover their hidden potential. It also gives one immense support, security and solace. Recent medical studies have revealed that prayers also help improve the body's immunity.
7. Do regular meditation
Meditation brings tranquillity and calmness. A depressed mind is a worried mind. One becomes negative in routine or neutral situations. The mind keeps on responding to a number of negative thoughts and environmental stimuli. It adds to the inner agitation. Meditation has an established role in calming down the restless mind. It releases positive energy and thoughts which help neutralise the effects of depression
8. Do some charitable work
Extend your helping hand to those who are needy and need your services. Alutrism will make you feel good. It creates positive feelings which neutralises the negative ones. Remember Dr (Brig) M.L. Kataria's scriptural prescription: "Sakal rog ko aukhadh naam." (To be concluded)
Breakthrough in malaria research
LONDON, (Reuters): Researchers have discovered just how the malaria parasite feasts on human blood cells in a breakthrough that could lead to new treatments for the world’s most dangerous tropical disease.
Malaria kills more than a millionpeople each year and researchers now have a new understanding about how the parasite survives and grows in its human host.
The scientists found that up to 2,000 pore-like holes on the membranes of infected red blood cells provide the nutrients needed for the hungry mosquito-borne parasite, plasmodium flaciparum.
Scientists at the US National Institutes of Health said the discovery of the so-called feeding channels could lead to a new approach to combat the disease.
“It has been known for some 25 years that the parasites increase uptake of certain nutrients but the mechanism was not known,” Dr Sanjay Desai said in a telephone interview.
“With this information, researches may be better able to develop drugs to cut off the parasite’s nutrient supply”.
In addition to malaria, Dr Desai said the research, a collaboration with scientists from the National Institute of Child Health and Development in Bethesda, Maryland, could also have implications for other parasitic diseases.