|HEALTH TRIBUNE||Wednesday, April 24, 2002, Chandigarh, India|
cholesterol — good and bad
AYURVEDA & TOTAL
and mental health
THE use of force and violence seems to be increasing in our society. There is a big change in the attitude of the public that now seems to accept violence as a legitimate way for achieving one’s goals. In our anger, hurting innocent victims no longer seems to disturb us. Every day we read in newspapers reports of terrible sufferings of innocent people, may it be in Jammu and Kashmir, Gujarat or other parts of India.
As a psychiatrist, I feel very upset because I have seen from close quarters the effects of violence on the physical and mental health of the individual. I have also seen the social impact of violence on families and society in general.
Types of violence: Violence is a form of behaviour in which there in intention to hurt or kill somebody. It can be physical as well as psychological. The effects of psychological violence by humiliating or harassing an individual can be as devastating as physical violence.
Violence comes in many forms. Perhaps the least noticed and talked about form is the violence in the home setting. Beating of women is very common in many communities. In a recent issue of The Tribune (Her World, Sunday April 14, 2002) Leena Prasad has reported that almost every six hours, somewhere in India, a young married woman is burnt alive, beaten to death or forced to commit suicide. Lesser forms of beating and humiliation are suffered in silence and hardly reported.
Violence in our streets is rapidly increasing. Every day one reads about cases of robbery, dacoity, chain-snatching, kidnapping, and shooting in gang wars of the underworld. The effects of violence are much worse in areas where militancy is rampant — like Jammu and Kashmir, parts of the North-East, Andhra Pradesh or Orissa. Equally damaging are caste wars in Bihar and other parts of the country.
In Punjab we witnessed a terrible phase of violence during a decade of militancy in the 1980s.
Perhaps much worse than all this is the sudden violence which is unleashed during communal riots, may it be in Delhi (1984) or Bombay (1992) or Gujarat this year, resulting in a huge loss of life and property and doing incalculable harm to the emotional life of large sections of the population. One should also not forget the kind of violence which results from the State’s suppression of various riots and militancy movements. The most extreme form of State-sponsored violence is, of course, WAR in which these days the targets are not only the armies but also the civil population. Lastly, one special type of violence used against the individual by the authorities in power is the deliberate physical and mental torture to obtain information or to force a person to change his or her views.
The size of the problem: Violence does enormous harm to health. The WHO World Health Report 2001 has mentioned that over 520,000 people died of violence (intentional injury) in the world in the year 2000. In addition, 310,000 died in various wars. About 815,000 people committed suicide.
Violence constitutes the sixth leading cause of disability in males between the ages of 15 and 44 years. The WHO has estimated that there are over 50 million refugees in the world. The physical and mental health of the refugees is a major health problem of our times.
Common impression: In the public mind there is a common impression that mentally ill persons are violent. In fact, very little of the total violence in the world is done by the mentally ill. Most of the violence in the world is done by people who are considered "sane’ rather than by those who are called mentally ill or "insane". The violence done by the mentally ill is of limited nature. On the other hand, society is often much more violent to the mentally ill — physically and mentally maltreating them, taking away their human rights and depriving them of ordinary facilities of life. Last year, in Erwadi, Tamil Nadu, we saw the grim tragedy in which 25 mentally ill persons were burnt alive while lying with iron chains in their legs.
The effect of violence on mental health: As a psychiatrist, I regularly see the effect of violence on the health of the individual. It may be domestic violence or social violence or torture. I see many cases in which violence has led to states of anxiety, depression, unexplained fear and panic, physical symptoms of various kinds not responding to treatment, sleeplessness, agitation and so on. Sometimes, the depression is so severe that it leads to an attempt at suicide. In such circumstances many patients resort to drugs and alcohol.
One special type of syndrome seen in these cases is what is called Post Traumatic Stress Disorder (PTSD). In this condition, after some exceptionally painful experience of violence, torture, war, riots etc, a person goes into a morbid psychological state in which there are repeated flashbacks of painful experience. For example, to a victim of torture even a picture of torture in a newspaper is enough to start panic reaction.
Entire life is changed. A person is unable to relax and enjoy life as he used to do before. There are repeated bouts of anxiety, panic and depression with inability to work or sleep properly.
The social impact of violence: In any large-scale strife, war or militant movement, or in riots, hundreds of people die. Children are orphaned; women are raped and humiliated. It has a terrible social impact. The children who have lost their parents easily fall prey to a life of crime, violence and drug addiction. In a way violence breeds more violence.
One of the worst sufferers in any conflict are young children. A recent UNICEF report, "Psychosocial Assessment of Children Exposed to War-related Violence in Kabul — Afghanistan", by Dr L. Gupta (1997) graphically describes how children had been emotionally traumatised by war events. About 41 per cent had lost one or more parents. Over 90 per cent children expressed the fear of dying in conflicts. Over 80 per cent felt that they could not cope with the events and thought that life was not worth living. Many complained of different kinds of bodily and psychological symptoms.
Personal experience of war and strife: I have served in the World Health Organisation for eight years — from 1984 to 92. I was mental health adviser in the Eastern Mediterranean Region covering 22 countries — from Pakistan to Morrocco, i.e. the whole of West Asia and North Africa. Unfortunately, in my time, many countries in this region were having armed conflicts. I have travelled in warlike situations in Iran, Iraq, Afghanistan, Kuwait, Palestinian refugee camps in Jordan, etc. I have seen terrible effects of such conflicts on the mental health of people.
My most powerful and distressing experience was in Yogoslavia where I went as a special WHO consultant for three months in 1993 to report on the effect of war on mental health services. I visited almost all the successor states — Slovenia, Croatia, Serbia, Bosnia-Herzegovina, etc. I was probably the first foreign psychiatrist to reach Sarajevo in Bosnia in 1993. It was a war zone. I had to go there wearing a helmet and a bullet proof jacket. I met many victims of violence and torture in hospitals. One case particularly stands out in my memory.
A young woman was sitting in a corner with a strange sad, half smile on her face. To start a conversation, I asked her what her problem was. She replied, through an interpreter: "You ask me what is my problem. You should ask me what is not my problem. I have lost my father, I have lost my family, I have lost my house, I have lost my job. There is nobody to live for and you ask me what is my problem". I apologised and requested her to tell me her story. In broken sentences, she told me the following story:
In the village where she lived, the police (of the opposite community) arrested her old father. In the evening a message came informing her that if she wanted to save her father, she must go and talk to the police chief. She knew the police chief who was in school with her but the times had changed. She went to the police station. The police officer made enquiries about her father and then took her to an inside room. There were other men in that room. They tied her to a cot, put a blanket on her face and nine men, one after the other, raped her the whole night. She came home next morning. For the next two days she was like a statue — did not speak, did not eat, did not sleep. On the third day she went into a state of frenzy, broke everything in sight in the house — TV, radio, glasswares, lights etc. In this state of excitement she was admitted to the hospital where I met her. It was a stark example of how torture and violence damaged one’s personality.
When I visited a large mental hospital in Zagreb I saw mental patients. Croatians, Serbians and Bosnians were all living together in peace in the wards of the hospital while outside their countrymen were killing, raping and torturing one another. I wondered who should be called sane and who should be called insane!
What is the solution?: I am conscious that there is no easy solution to the problem of violence in society. It has existed since the beginning of history. It cannot be abolished but conscious efforts must be made to reduce it. This thought always puzzles me: Why do human beings derive so much satisfaction, and a feeling of superiority, after hurting and humiliating another human being.? The hatred among groups is perhaps the root of violence. Even if we cannot love our neighbours, we must develop a degree of tolerance for them.
Dr Wig is Professor Emeritus at the
PGI, Chandigarh. This article is based on a lecture delivered by him
at the annual conference of Indian Doctors for Peace and Development
at Ludhiana earlier this month.
MOTOR vehicle travel is the primary means of transportation providing an unprecedented degree of mobility. Unintentional injury from motor vehicle crashes is viewed as an act of God or an unpreventable accident. This is clearly not true. Speeding — exceeding the permitted speed limit or driving too fast for the prevailing conditions — is one of the most prevalent factors. Speeding reduces a driver’s ability to steer safely around curves or objects in the roadway, extends the distance necessary to stop a vehicle and increases the distance a vehicle travels while the driver reacts to a dangerous situation. Alcohol and speeding are a deadly combination.
Road rage is uncontrolled anger that results in violence or threatened violence on the road. It is defined as an incident in which an angry or impatient motorist intentionally injures or kills another motorist, passenger, or pedestrian, or attempts or threatens to injure or kill another motorist, passenger or pedestrian. There is a higher incidence of road rage under congested conditions and peak travel times. Road rage is distinct from aggressive driving and involves verbal or physical abuse.
Specific driver behaviours contributing to aggressive driving include speed violations, following too closely, improper lane changes, traffic signal or sign violation, failure to yield the right of way, improper passing, and disregard of school bus safety laws. Red light running is one of the most dangerous forms of aggressive driving. A majority of fatal crashes occur at intersections or intersection-related sites. A large number of drivers have identified unsafe driving by others as a major threat. The combination of speed and red light or stop-sign violation carries a specially high risk.
Public information efforts are not sufficient to induce behavioural change. The driver’s perception of the likelihood of being caught violating the law may be a deterrent. Efforts need to be directed towards creating a social climate in which aggressive driving is considered unacceptable to the community. Violators must be penalised. Automated systems with a high likelihood of identifying violators and dispensing penalties may be preferred solutions for deterrence and enforcement, along with psychological interventions for selected drivers.
Driving is a complex psychomotor skill best acquired with considerable practice in low-risk situations as essential experience is gained. Graduated driving licensing programmes have been adopted by several countries by requiring teen-aged drivers to gain experience and maturity under conditions of relatively low-crash risk before gaining full driving privileges. The immaturity of teen-aged drivers manifests itself in risky driving practices such as speeding and tailgaiting. It also makes it difficult for them to recognise and respond to hazards.
The efforts needed to combat aggressive driving include enhanced enforcement and awareness created by the media. We need to launch education campaigns to teach drivers facts about their own behaviour and how to deal with the aggressive behaviour of other drives. We need to help drivers increase their awareness and reduce personal stress levels. Various sources to avoid aggressive driving include books, seminars and classes in anger management. Psychologist support helps drivers curb road rage. Provisions need to be made to give motorists adequate advice on how to avoid stressful situations and what to do when they are specifically focused to include segments on aggressive driving.
Road rage is a threat and should not
be tolerated or condoned. Enhanced enforcement, public education and
awareness are the most effective techniques to curb road rage.
Graduated driving licensing may prove to be another means of
prevention of violent or aggressive driving. Driver education courses,
including those mandated for the re-education of less motivated
offenders may be a worthwhile avenue for preventing road rage.
about cholesterol — good and bad
CHOLESTEROL is a soft, waxy and fat-like substance in the body which is essential.
Our body needs cholesterol to manufacture sex hormones, digestive juices, Vitamin D, nerve endings and brain cells in children. All animals, including human beings, need cholesterol to survive.
Animal fats are the only sources of cholesterol. Vegetables do not have any cholesterol. Milk and milk products, poultry, egg, fish, mutton and other sources of animal meats provide cholesterol.
Liver is the biggest source of cholesterol in the human body. It manufactures about 2000 mgm of cholesterol daily. This amount is enough for us.
A vegetarian eats about 200-400 mg cholesterol daily through milk and milk products like cheese and ghee while a non-vegetarian consumes 400-600 mg daily. The lesser one eats such things the better it is for the body.
As per the latest guidelines of the Expert Panel on Detection, Evaluation and Treatment of High Cholesterol in Adults (ATP III) constituting the National Cholesterol Education Programme, the normal values are:
The amount of cholesterol that is not burnt by the body starts getting deposited in the cells and causes fat deposition in various parts, mostly the abdominal area. Cholesterol deposition in blood vessels can cause narrowing of blood vessels and their blockage. This can result in a heart attack, brain stroke and paralysis.
Cholesterol does not mix with blood as oil and water do not mix; so it is transported through the blood attached to a special type of protein, the lipoprotein, which is done in liver. There are two types of cholesterol:Low-density lipoprotein (LDL), and high-density lipoprotein (HDL). LDL carries and deposits cholesterol in the blood vessels that can lead to the clogging of the vessels (to heart and brain) and so it is called "bad cholesterol".
HDL carries cholesterol away from the blood vessels to the liver for its breakdown, destruction and excretion, thus removing it away from the blood stream and so is known as "good cholesterol" as it cleanses the body. We want the bad cholesterol levels to be low while wanting the good cholesterol levels to be high.
Triglycerides are fats devoid of any cholesterol. The stored fats of both plants in oil seeds and nuts and animals in depot fats are triglycerides. Triglycerides and cholesterol together constitute the total lipids.
Ways to reduce triglycerides: reduce total fat intake; take less white sugar, sweets, soft drinks; reduce alcohol intake; exercise regularly to burn triglycerides; increase the consumption of foods containing Omega-3 fatty acids which are found in fish, wheat, bajra, soyabeans, pulses and legumes, fenugreek (methi) green leafy vegetables and mustard oil.
And do all this: reduce the intake of saturated fats like butter, ghee, coconut oil, reduce foods having high cholesterol like eggs, meat; reduce whole milk and milk products; decrease the intake of nuts like cashew; nuts, pistachio (pista); avoid sweets, white sugar, chocolates, pastries, sweet soft drinks, tea and coffee; and reduce intake of tobacco; eat plenty of fibre-rich foods. Fruits and vegetables like apples, onion, garlic, soyabeans, amla and banana are known to reduce LDL cholesterol levels; avoid sedentary life and do regular exercises to burn the excess cholesterol in the body; keep blood pressure and blood sugar under check; regular exercises raise the level of good cholesterol; reduce total fat intake. People with high triglyceride levels have lower HDL; reduce the intake of trans-fatty acids like vanaspati "ghee" and margarine as they reduce HDL; reduce the intake of polyunsaturated fatty acid-containing oils like coconut, palm oils, ghee etc; certain foods like onions, apples, bananas, garlic, soluble fibre, isabgol and red wine raise HDL levels.
Useful tips: Watch your weight-the more overweight you are, the more cholesterol your body produces; bring your weight down; cut down on fats, especially saturated fats like ghee, butter and cheese; olive oil is good and certain foods like almonds and peanut oil are high in monosaturated oils which may lower blood cholesterol; consume fewer eggs; egg yolk is rich in cholesterol(4 eggs per week are the maximum allowed by doctors to keep cholesterol in control); eat more beans and legumes as they contain a water soluble fiber, pectin, that throws out cholesterol from the body; eat more fruit; fruits also contain pectin in plenty and grapefruit especially is beneficial in this regard; tea is good for lowering cholesterol; spirulina, brass, barley, rice bran and activated charcoal also combat high cholesterol; corn bran and garlic are very helpful in lowering cholesterol; nutritional supplements like vitamin C, vitamin E, calcium and niacin in B group of vitamins lower cholesterol; carrots can lower cholesterol due to pectin in them; fish that contain Omega-3 amino acids lower cholesterol and increase good cholesterol. Try two six-ounce servings of fish a week; chocolate, apple and red wine raise good cholesterol; onion and garlic are good for lowering bad cholesterol and increasing good cholesterol.
Nuts like almonds (badam) lower LDL
(bad) cholesterol; skimmed milk should be drunk in plenty; exercise
can decrease the buildup of blockage of cholesterol inside the
arteries and raise the level of HDL, the good cholesterol; don't
smoke; relax and exercise.
& TOTAL HEALTH
BRAHMI has been used since time immemorial as a tonic for improving memory. In the gurukuls of ancient India there was the practice to regularly administer Brahmi to young students to help them learn sacred hymns.
The small creeping herb grows wildly in marshy places throughout the hotter parts of India. Scientifically known as Bacopa monnieri and jalneem in Hindi, the whole of the Brahmi plant is endowed with medicinal properties.
Bitter and astringent in taste and light and slightly hot in effect, Brahmi is a pacifier of all the three doshas — mainly kapha and vata. Although people in India, especially ayurvedic physicians, knew about Brahmi’s benefits thousands of years ago, modern research on it was conducted recently by the central Drug Research Institute, Lucknow. The trails have resulted in establishing that this long treasured herb, besides possessing antioxidant properties, also has the amazing ability to facilitate learning and enhance memory and concentration.
Ayurvedic tests describe Brahmi as medhya, a medicine that braces the mind to carry cognitive functions and intellectual pursuits. But ancient authors seem to believe that the healing effects of Brahmi extend far beyond mind and brain. Brahmi is not only a memory-booster and intellect-promoting herb; it is also a tranquilliser, a muscle relaxant, an anti-convulsant, a blood purifier, and an anti-pyretic, carminative and digestive agent.
Though Brahmi is beneficial for maintaining the tridoshic balance, ayurvedic physicians believe it to be the drug of choice for counteracting the vitiated vata dosha — the factor which governs the nervous system,
Brahmi is known for its salutary effect in anxiety, depression, hypertension, sleeplessness, mental retardation, insanity and hysteria. Acharya Chakradutta has written that Brahmi is beneficial in all types of epilepsy. Ancient texts describe the use of Brahmi in a number of other disorders like biliousness, ulcers, splenomegaly, asthma, skin diseases and in general and senile debility.
Brahmi enhances the mind’s ability to learn and concentrate. As it simultaneously calms and invigorates the mind, it is a very good medicine for reducing the effects of stress and nervous anxiety. It also helps maintain the clarity of thought and has proved effective in treating ADD (Attention Deficit Disorder) in hyperactive children, and age-related mental disorders in old persons.
Equal quantities of powders of Brahmi, Shankhapushpi and Jatamansi make an excellent combination which, if taken in the dose of one gram two or three times a day, combats the symptoms of anxiety, depression and nervous exhaustion. Sesame oil, enhanced with Brahmi, Amla and Vacha, forms a useful hair tonic. Its regular massage calms the mind and induces sound sleep. Apart from Brahmi sharbat, which is a popular home recipe of the summer season, Brahmi Ghrita, Saraswata Churna and Smritisagar Rasa are classic ayurvedic medicines which are beneficial not only in minor anxiety and depression but also in unmada and apasmara (insanity and epilepsy).
of the ancient texts, in their references, have created confusion by
calling another plant, Mandukparni (Centella aciatica) as Brahmi.
Invariably sold as Brahmi, Mandukparni is a different herb which will
be taken up in these columns separately. While using "Brahmi’,
make sure that what you are using is Bacopa moneiri.
HOMOEOPATHY is much more of a choice than people often think it to be. One of its philosophy’s greatest breakthroughs is the realisation that the body is not an object but a process with no pre-ordained limits. The scorching, cruel heat of summer was just setting in the first year of the new century when Mr and Mrs Puri (not their real names) approached us with their only child Ravi (not his real name) who was then four. Two years earlier, at the age of two, he was diagnosed as being autistic. We tested him on the ATEC (Autism Testing and Evaluation Checklist) and his rating was in the moderate to high category. His problem was more in speech/communication and sensory/cognitive areas.
Besides the classical symptoms of autism, the symptoms that actually led us to prescribe Carcinocin were the history of an early eruption of teeth and hairiness. A leading characteristic of Carcinocin is the desire for milk. There are many symptoms — a sweaty head, when sleeping, and physical heat in general; difficulty in falling asleep; the desire for things salty and for chocolate-like energetic foods. Than there are internal restlessness and fidgetiness and love for dancing. Strong passion, sexuality and a very strong family history of cancer in the family are also noticed. The remedy was the boy’s similimum if there ever was one! Fitting him like a glove, the treatment has worked. Ravi has suffered no aggravation in the two years he has been on and off this remedy.
The dosage chosen for him was similarly fitting — the LM dose. Positive results were obvious within the first month. Babbling turned into more formative words, hyperactive behaviour became rare and he started obeying simple commands. His self-stimulatory behaviour, too, was nearly gone.
Very soon a big achievement came when Ravi started interacting with children and started playing with them. He is now five and is attending a normal school. There are still vestigial signs of his former autism though these are not really apparent to teachers or anyone else besides us (parents and the physicians). For example, his language is occasionally awkward. In moments of stress (e.g. if he is sick), he retreats into himself and utilises echolalia as a speech strategy. To sum it up, none but the very discerning can make out that Ravi had this serious problem.
(To be continued).