Author - Dr. Nitin Gupte

Your knees are precious, save them!

Knee pain is a constant companion of overweight people.

The most frequent pain overweight people came to me with, in the first half of my practice, were low backache and pain in the neck. Knee pain had relatively insignificant presence in the list of complaints. Over the last decade knee pain has progressively become the most common complaint, relegating the other two to distant second and third positions!

Today more and more people are developing knee problems and at a much younger age. Osteoarthritis is a common ailment, especially in obese people. Ligament and cartilage injuries are also frequently seen.

To top this, more and more people are reporting accidental knee injuries. The commonest causes of such injuries are two wheeler accidents and sports injuries, especially common amongst football players.

These are the reasons why knee surgeries have become very common. Knee replacement surgeries, almost unheard of a decade ago, are commonplace today.

Many of the knee problems can be prevented by taking simple precautions.

Keeping your weight down is obviously the basic requirement of maintaining your knee health.

Every 4 kg extra weight puts nearly 20 kg of extra load on your lower body joints and wears them down that much faster, causing arthritis.

Extra fat also triggers release of some harmful chemicals in the body, those damage various body tissues including joints, causing arthritis.

Losing those 4 kg can ease that much load on those joints and slows down the progression of arthritis. Keeping them off may even prevent it long term.

Additionally, you must prevent activities that cause undue wear and tear of knee joints. Activities like mindlessly excessive walking, jogging, running, hill climbing and sports like badminton may lead to such wear and tear.

These are all excellent cardiovascular activities and everyone must take up such activities to keep themselves heart healthy. What must be avoided is, overdoing them.

Take up such activities moderately and also ensure that you strengthen your knees with proper knee exercises while you take up the above activities as workout options.

You will have to learn knee exercises, which are easy enough to perform within a few minutes at home, without any special equipment. Start with these exercises when you are young and have healthy knees, don’t wait to develop knee trouble to start them. Water-walking (in chest high water) is also an excellent knee exercise, even for those with arthritis of the knees.

You can consult your own doctor or visit us to learn these exercises.

Your knees are precious, save them for the old age!

Also read the article ‘Losing Four Kg Extra weight Improves Health Immeasurably!‘ on this website.

Getting Slim, Healthy, Happy And Positive To Overcome Infertility!

It is a well known fact that obesity is closely associated with or is one of the major causes of PCOD, miscarriages and primary and secondary infertility.

Obesity is known to cause menstrual irregularities, poor or complete absence of ovulation, lowered chances of conception, increased chances of miscarriages, increased risk of complications during pregnancy and child birth.

Research has proved that even five per cent drop in body weight of obese young women has helped them drop an average of eleven per cent of their abdominal fat, reduced their waist circumference measurements by four cm, increased their insulin sensitivity by an amazing seventy one per cent, improved the hormonal environment in their bodies, restored their regular menstruation and ovulation and improved their pregnancy rates.

In short, it means that many a young women are deprived of natural motherhood only because they are overweight or obese. Losing a small amount of weight, as little as five per cent, will help their periods become regular, ovulation to improve, dramatically improve their chances of conceiving naturally, having a safe pregnancy without miscarriages and a safe delivery and having a healthy child.

In spite of this, these ladies are first put through complex and expensive fertility therapies rather than asking them to lose weight. Only after all the fertility treatments are exhausted, they are advised to lose weight, which should have been done before fertility treatments were unleashed on them.

That is why, in actual practice, when such a young woman begins to start eating healthy and exercise, she conceives quickly even as she loses five to seven kg weight, even when she needs to lose twenty or thirty kg to slim down completely.

So if you are suffering from obesity, PCOD, miscarriages and primary or secondary infertility, lose weight by eating healthy, taking up exercise even as simple as walking and becoming happy and positive. The chances are very high that you will conceive naturally, stop having  miscarriages, have a safe pregnancy and a healthy baby. Without needing any fertility treatments!

Getting slim, healthy, happy and positive is a much surer, healthier and safer way of overcoming obesity related infertility than taking fertility treatments. Doing so will also protect the expectant mother from developing hypertension, toxaemia of pregnancy and diabetes during pregnancy.

In fact, every young woman planning pregnancy should get slim, healthy, happy and positive before she gets pregnant. This will ensure a safe pregnancy and a happy and healthy duo of a mother and a child!

Also read the articles ‘Health Problems Of The Young: PCOD‘ and ‘Slim Women Are Healthy Women‘ on this website.

Vital Information About Cholesterol!

Cholesterol is a waxy, sticky, fat like substance produced in the liver and is also present in our food.

Most people only know that it causes heart disease, few know that it is an essential constituent of our body and has a vital role to play in our health.

Functions of Cholesterol:

Cholesterol provides structural support to every cell of our body as it is an essential constituent of the cell membrane and plays a significant role in deciding what goes in or out of the cell membrane.

It also helps form the protective myelin sheath of our nerve cells.

It is essential for the synthesis of steroid and sex hormones and for the formation of Vitamin D under the skin when exposed to sunlight.

It is also essential for the formation of bile which is, in turn, essential for digestion of fats.

LDL and HDL Cholesterol:

Cholesterol is insoluble in water. So it has to be transported in blood in complex fat and protein molecules called lipoproteins. Cholesterol moves through our body inside these lipoproteins.

LDL or low density lipoproteins transport most of the cholesterol in the plasma, from the liver to the peripheral tissues where it is used for building the cell membranes of every cell of the body and to the adrenal glands and gonads where it is used for synthesising steroids and sex hormones.

Excess build up of low density lipid cholesterol in the blood can enter the arterial walls causing plaque formation and atherosclerosis, leading to narrowing of the arterial walls causing ischaemia or reduced blood supply to the heart or any tissue of the body and could lead to myocardial infarction or heart attack and strokes.

And if a plaque breaks away, it could block the arteries of the heart or the brain causing heart attacks or stokes.

HDL lipoproteins transport cholesterol from the tissues and the arteries to the liver which excretes it from the body, protecting it from heart disease and strokes.

This is called the reverse cholesterol transport system.

This is why the HDL cholesterol is considered the good and the LDL cholesterol the bad cholesterol.

Our liver is capable of providing us all the cholesterol we need. We don’t need to consume it in food.

Only animal sources of foods such as flesh, eggs, shell fish, whole milk, cream, ghee, butter, cheese and margarine have cholesterol. No food of vegetable source has cholesterol.

Cholesterol And Heart Health

Excess cholesterol in the blood is bad for the heart.

The HDL cholesterol is the healthy cholesterol, while the LDL and the VLDL cholesterol are bad for the health of the heart.

HDL cleanses our arteries by transporting cholesterol from the arteries to liver and cleansing the arteries, thus protecting us from coronary heart disease.

The latter two transport cholesterol from liver to the arteries, where it sticks the walls of the arteries, which become hardened and lose their elasticity, causing atherosclerosis and clogging of the arteries leading to coronary heart disease.

Saturated fats in our food are actually more responsible for raised levels of cholesterol in our body than dietary cholesterol. Animal products including whole milk, eggs and flesh and vegetable fats which are solid at room temperature (e.g. palm oil, coconut oil) are examples of saturated fats.

This means vegetarian people too are going to suffer from raised levels of cholesterol, if they eat fatty and sweet foods in excess.

Genetically too some people are more prone to have high levels of cholesterol as their livers manufacture excess cholesterol.

Trans-fatty acids also are equally to blame for raised levels of cholesterol. In fact they are rated as worse than cholesterol for the health of the heart. Hydrogenated vegetable oils and oils in which food stuffs are fried over and over, again and again, develop trans-fatty acids. Many bakery products and ready to eat snacks are made using hydrogenated vegetable oils as it gives them longer shelf life. Most people who never use hydrogenated oils at home, eat these products without realising that they are consuming hydrogenated oils.

White Meat And Red Meat

The thinking till recently has been that it was red meat that was mainly responsible for raising your blood cholesterol levels and was dangerous to the health of our heart and that it was safe to eat white meats.

But according to study published in the ‘American Journal Of Clinical Nutrition’ the researchers of the ‘University Of California’ have found that white meat can also raise your blood cholesterol and is as bad as red meat for the health of our heart.

So stop eating white meat blissfully imagining that it is heart healthy!

Dietary Fibre and cholesterol:

Soluble fibre dissolves in water, forming a gel like substance that absorbs cholesterol and sugars and clears them out of our bowels, reducing their absorption in our blood stream, thus helping lower blood cholesterol, especially LDL, the bad cholesterol, triglycerides and sugar. Thus it helps lower the risk of diabetes, heart disease and strokes.

Soluble fibre sources are oats, pulses and legumes, apples, citrus fruits, carrots, barley and psyllium (isabgol).

Abdominal obesity and cholesterol:

Abdominal obesity leads to raised levels of blood pressure, blood sugar, total cholesterol, LDL cholesterol and triglycerides and lowers the levels of HDL cholesterol.

This is called the Metabolic Syndrome.

It leads to heart disease and strokes.

Effect Of Smoking On Cholesterol:

Tobacco smoke damages the endothelial lining of the arteries and causes inflammation, making it easier for the white cells and platelets to clump together and stick to the damaged endothelium and cause clot formation.

Burning of tobacco releases fumes which include many toxic substances including acrolein. Acrolein renders the bad cholesterol, the LDL cholesterol more sticky and it sticks more easily to the endothelium of the arteries and white blood cells and other substances stick to it and plaques are formed in the arteries narrowing them. It also interferes with the ability of HDL cholesterol to remove the plaque build up and keep the arteries blockage free.

Thus smoking causes damage and inflammation to the endothelium of the arteries leading to atherosclerosis and also damages the LDL and HDL cholesterols preventing them from functioning properly and leads to heart disease and strokes.

Effect Of Alcohol On Cholesterol:

Drinking alcohol raises the levels of the triglycerides in your blood and build up of triglycerides in liver leads to fat build up in the liver and leads to fatty liver disease. Damaged liver cannot remove the cholesterol from your blood efficiently and this leads to raised blood levels of cholesterol and eventually to heart disease and strokes.

Normal Levels Of Cholesterol

Ideal levels of cholesterol and it’s components are:

Cholesterol below 200 mg/dL

HDL cholesterol above 60 mg/dL

LDL Cholesterol below 100mg/dL. Some physicians want it below 70mg/dL

VLDL Cholesterol below 30 mg/ dL

Triglycerides below 150 mg/dL

Normal range is always provided by every laboratory in its report.

Dietary Cholesterol Guidelines

Until 2013 it was generally accepted that dietary consumption of cholesterol should not exceed 300 mg daily for people who are not at a risk of developing coronary heart disease and 200 mg daily for people who are at a risk of developing coronary heart disease.

But research across the world could not establish a direct link between dietary cholesterol and raised blood cholesterol and LDL cholesterol and cardiovascular disease risk and hence the contemporary guidelines for coronary heart disease risk reduction from the American Heart Association (AHA) and American College of Cardiology (ACC) and the 2015–2020 Dietary Guidelines for Americans (DGA) have not issued explicit guidelines for consumption of dietary cholesterol.

But most of the high cholesterol foods, viz. full cream milk and animal flesh are also high in saturated fats.

So eating these high cholesterol foods also adds excess saturated fats to your diet.

Also the two diets highly recommended for prevention of heart disease, the Mediterranean Diet and the DASH Diet are both low cholesterol diets.

So even if there is insufficient evidence that dietary cholesterol raises blood cholesterol significantly, it is prudent to keep your dietary cholesterol consumption low.

A whole egg provides 210 mg cholesterol, goat meat provides 75 mg per 100 gm, chicken 85 mg, lamb, pork and beef between 85 to 105 mg, sea food provides between 50 to 100 mg cholesterol per 100 gm. Liver of the above animals provides the highest levels, between 350 to 650 mg per 100gm!

Prawns and other shell fish may contain upto 190 mg cholesterol per 100 gm, but it helps lower LDL cholesterol and increase HDL cholesterol and thus is heart healthy according to American Journal Of Clinical Nutrition.

Sea fish including shell fish are low in saturated fatty acids and high in sea source omega 3 polyunsaturated fatty acids. Prawns are low calorie and high in the potent antioxidant astaxanthin, a carotenoid. Hence eating fish and prawns in moderation is healthy.

Keeping Your Cholesterol Levels Healthy:

Lead a healthy lifestyle.

Eat healthy, focussing on skimmed milk and dairy products, whole grain cereals and pulses, ample vegetables and fresh fruits on daily basis and have fatty fish rich in omega-3 fatty acids twice a week.

Most Indians have no problems consuming whole grain cereals, pulses and vegetables as that is what our food basically consists of. What we most often may not consume adequately are skim milk and fruits. Ideally we should have three helpings of both!

Keep consumption of saturated fats to the minimum and trans-fats out of your food. Eat only lean meat, that too in moderate amounts and frequency. Have a whole egg no more than four days week, even if your cholesterol is fully normal.

Make sure to include oats, pulses and legumes, apples, citrus fruits, carrots in your regular diet to consume adequate soluble fibre.

Exercise regularly and be physically active. Even a half hour brisk walk, spread over the whole day, will be invaluable, half an hour twice a day will be wonderful even for losing weight!

Lose weight and get rid of your paunch.

Stop smoking.

Drink alcohol minimally or better quit drinking.

Be mentally happy and peaceful.

In short to keep your cholesterol levels healthy, you do exactly what is needed to be done to be slim and heart healthy!

Read the article ‘Basics Of Nutrition’ on this website for more information.

Boosting Your HDL Cholesterol

Many people have normal total cholesterol but low HDL cholesterol, the cholesterol that cleanses your arteries by removing cholesterol build up within them and prevents coronary artery disease.

The following six steps will help boost your HDL cholesterol levels.

1. Get regular exercise. Regular walks, even half an hour every day, can give you much better heart health than being couch potato!

2. Lose weight. Even four kg loss can dramatically lower your bad cholesterol (total cholesterol and LDL cholesterol) and boost your HDL cholesterol.

3. Eat healthy fats viz. omega 3 rich sea fish, cold pressed cooking oils like groundnut oil, sesame oil and olive oil and walnuts and flaxseeds. Reduce unhealthy fats viz. saturated fats coming from milk viz. cream, butter, ghee, cheese, full cream paneer and fatty meats. Stop consuming foods made from hydrogenated oils, they are loaded with trans fatty acids which can cause more damage to your coronary arteries than cholesterol.

4. Stop smoking.

5. Reduce your alcohol consumption.

6. Consult your physician.

Also read the articles ‘Basics Of Nutrition‘ and ‘The Good And The Bad Fats‘ on this website.

Dietary Fibre Protects Us From Diabetes, Heart Disease, Strokes And Colon Cancer!

Dietary Fibre, commonly known as roughage, is an essential component of our food.

It is one of the two main types of complex carbohydrates, the other being the starches.

It includes all the parts of plant foods that we cannot digest or absorb. It passes through our digestive tract and is eliminated from our body more or less unchanged. The word fibre is really a bit of a misnomer in the sense that not all the plant parts that are included in this food group are fibrous.

Most of us know fibre as the element of our food that prevents constipation. But there are other vital health benefits of fibre for us.

Chemically, dietary fibre consists of non-starch polysaccharides such as arabinoxilans, cellulose, and many other plant components such as resistant starch, resistant dextrins, inulin, lignin, waxes, chitins, pectins, beta-glucans, and oligosaccharides.

Fruits, vegetables, whole grain cereals, pulses and legumes, nuts and seeds are the major sources of fibre in our food. Thus our normal Indian food, with major emphasis on vegetarian food, is naturally rich in dietary fibre.

Whole grain cereals have around 10 to 15 grams of fibre per 100 gm, pulses around 7 to 15 gram, fruits like raspberries, blackberries, and strawberries around 5-8 grams, and apples, pears, and bananas around 2-3 grams.

It is the high fat, high protein egg and meat based Western food that is deficient in fibre.

Dietary fibre is broadly classified as soluble and insoluble fibre.

Soluble fibre dissolves in water, forming a gel like substance that absorbs cholesterol and sugars and clears them out of our bowels, reducing their absorption in our blood stream, thus helping lower blood cholesterol, especially LDL, the bad cholesterol and sugar. Thus it helps lower the risk of diabetes, heart disease and strokes.

Soluble fibre sources are oats, pulses and legumes, apples, citrus fruits, carrots, barley and psyllium (isabgol).

Insoluble fibre obviously does not dissolve in water. It absorbs water, adds bulk, softens stools and speeds up it’s transit through the bowels and relieves constipation. It regulates bowel movement, promotes growth of useful bacteria in the bowels, regulates the pH in the bowels, helps eliminate toxins from the bowels and helps prevent colitis, haemorrhoids and colon cancer.

Insoluble fibre sources are all types of fruits and vegetables, especially leafy vegetables, potatoes, beans, nuts, whole grain cereals and bran.

The major sources of fibre in legumes per 100 gm are:

White beans (total 17.7, insoluble 13.4, soluble 4.3 gm), soy (total 15 gm), lentils (total 11.4, insoluble 10.3, soluble 1.1 gm).

The major sources of fibre in cereals per 100 gm are:

Barley (total 17.3 gm), corn (total 13.4 gm) oats (total 10.3, insoluble 6.5, soluble 3.8 gm), wheat (total 12.6, insoluble 10.2, soluble 2.3 gm).

The major sources of fibre in vegetables per 100 gm are:

Bitter gourd (total 16.6, insoluble 13.5, soluble 3.1 gm), beetroot (total 7.8, insoluble 5.4, soluble 2.4 gm), brinjal (total 6.6, insoluble 5.3, soluble 4.3 gm), fenugreek leaves (total 4.9, insoluble 4.2, soluble 0.7 gm), ladyfinger (total 4.4, insoluble 3.0, soluble 1.3 gm).

In fact most plant foods have both kind of fibre in varying amounts, a little more insoluble than soluble fibre.

Most fibre rich foods are also rich in vitamins and minerals and low in fats and calories. Thus a fibre rich diet also helps us get and stay slim and healthy.

Women up to the age of 50 need about 25 gm, those above 50, 21 gm and men need between 31 to 38 gm of fibre daily.

If you eat balanced nutrition, including a combination of whole grain cereals, pulses and legumes and fresh vegetables and fruits, you don’t have to worry about getting adequate fibre. To derive the full benefits of fibre, it is essential to drink ample water.

Too much fibre can cause gas formation and colic in abdomen. It can also cause constipation if you don’t drink enough water. So don’t overdo fibre and make sure you drink ample water.

Read the article ‘Basics Of Nutrition‘ on this site.