Faith and Healing

Christmas is the perfect occasion to explore the complex relationship between faith and healing. The plummeting attendance of patients to hospitals and clinics at this time every year has several explanations: the faithful ascribe it to rejuvenation of faith, my medical colleagues to winter being the “healthiest” time of the year, and pragmatists to the cold and fog that deter patients.

The reason why malaria, dengue and encephalitis beat a retreat at this time is because the cold deters mosquitoes even more than people. Further, water borne infections drop sharply as foods are preferred hot or fried (aloo tikis, parathas, tea rather than sharbats, paani batashas and salads) in which germs die.   

Clinic attendance alone may not be a good indicator of the role of religious faith in a community’s health seeking behaviour. It is observed that a sharp drop in patients from concerned communities ,occur during Ramadan, around Diwali and Christmas, and may reflect social attitudes of deferring investigations or hospitalization till the festive time gets over, rather than a true decline in illness.

What then is the evidence that faith benefits health?

The faithful and devoted have been shown to live longer lives than their questioning counterparts, and fall ill less frquently. Faith, by providing a constant emotional support and a sense of purpose, helps reduce stress, keep stress hormone levels at lower levels, improves our ability to cope with hurdles in life, and also increases our capacity to accept and tolerate what is inevitable.

How the practice of faith by a community can be used to improve the health and well being of the followers unfortunately often depends upon its human leaders.

A church based approach to life-style change to reduce risk of heart disease was tried in South Carolina, USA. In this program called “Lighten Up”, church goers with rsik of cardio-vascular disease were given health messages and periodic health check-ups along with scripture-sudy. Of the 133 people covered by this program, 70% lost an average of 2 pounds, and showed significant improvement in their BP and triglyceride levels. Participants complied better to the health advice that came from their church, than if it had come from a doctor.

As most of our religious faiths have been in existence for centuries, and our practices are often steeped in tradition reinforced by time, any attempt to amalgamate modern thoughts or goals is unfortunately often met with reasonless resistance. With the levels of education and awareness rising steeply in society, a wise clergy could do well to encourage followers to live healthier lives based on modern scientific knowledge.

In earlier times, duties of a priest and doctor were often performed by a single person. Today the roles have split with priests focussing only on the soul and doctors caring only for the body. Religious bodies can make themselves more effective and relevant by going beyond theology and faith and encouraging health and well being among their followers.

Merry Christmas. 

As published in HT City (Hindustan Times) dated 25 December, 2011.

The LAST Drink

The recent tragedy in West Bengal in which 170 people died after drinking locally made hooch shows once again how vulnerable our poor are, and how poor are our mechanisms to ensure their safety.

Hooch, Moonshine or Jake is the name given to illicitly distilled illegally produced alcoholic drinks that do not conform to safety standards. They are made by fermenting sugary or starchy substances, distilling them to increase the concentration of alcohol, and often adding other substances for more punch. They have been produced for generations in home-made stills or barns, often under the cover of forests and swamps, and catered to poor labourers, farmers, rikshaw-drivers and hawkers.

Outbreaks of poisoning and deaths due to bad hooch have occured in various parts of the world from time to time. Major Indian tragedies have occured in Gujarat, Tamil Nadu, Kerala, Odisha and UP in the last 3 years, and despite the temporary reactions they elicited, the magnitude of tragedies has just got bigger.

Ethanol or ethyl-alcohol is the intoxicating agent in all alcoholic beverages. It is when unscrupulous manufacturers resort  to mixing other substances  such as methanol (methyl-alcohol), lye, rubbing alcohol, wood paint, paint thinner, bleach, formaldehyde, chemical fertilizers, leather and lead to the drink either as cheaper substitutes or to provide more “kick”, that they become poisonous.

Methanol, a cheaper substitute of ethanol or ethyl-alcohol, produces abdominal pain, acidosis, coma, blindness and paralysis. Treatment, if the victim is brought to medical attention in time, requires giving ethyl-alcohol to flush out the toxic methyl one, or dialysis, both of which are usually not available in small rural centres where these tragedies take place. Those who survive methanol poisoning are often crippled with blindness, paralysis and loss of livelihood.

Hooch tragedies tell much about our society; our scant health and safety standards and the deep cleft between the rich and the poor.

Bootleg country liquor comes cheap and is often the only intoxicant that the poor can afford. The hooch kingpins get more and more people, especially the earning members, hooked to expand their market. Thay also provide employment to the poor for making and selling it, develop financial clout, poliical patronage, and often become invincible lords of local rings.

Banning hooch would seem the obvious solution, but would push the poor, who have already been hooked to intoxication as succour to their struggling lives, to more expensive alternatives, thus promoting the sale of branded products. And do we expect the same law enforcers who are vulnerable to bribes and who allowed this to happen, to be different then.

The deeper question is: Why do poor people who eke out their existence, take to intoxicating drinks? Do they too need entertainment , like their well-to-do counterparts? What options do they have? Could society or governments try to provide them with healthy entertaining engagements that would keep them from drinks and drugs? A well enforced ban would only then have a chance to work!

As published in HT City (Hindustan Times) dated 18 December, 2011.

Going nuts over choosing oil!

With my days of cricket feats and trecking tales slipping into history, and people calling me “uncle” rather than by my first name, I decided to explore ways of keeping at least my heart younger than my rapidly greying hair. I started by exploring whether the cooking medium in our kitchen needed change.

A mind boggling 479 million results emerging in a trite on googling “healthy cooking medium” bowled me into confusion. The search threw up oils and fats I had not heard of, many clamouring for the “best” spot. Seconds later I realized that most of this “information” was “promotion” stuff by manufacturers, marketeers and oil lobbies, as is often the case in the world-wide-web.

My grandpa’s wise saying “When too many opinions fly around, no one knows the truth” seemed to fit well here.  I therefore chatted up with Dr Sudeep, our young cardiologist, to find out what medical science was preaching these days.

 “Desi ghee”, derived from the nutritious milk of holy cows, whose virtues my grandpa had extolled in my pre-teen days, he told me, had become “toxic” to the heart despite my grandpa living actively on till 85 while liberally consuming it, and  without a coronary angioplasty or even a daily dose of asprin.

Saturated fats,it seems , are the worst of them all. They are solid or thick at room temperatures, and include ghee, vanaspati and butter. They get deposited in the arteries of the heart more easily than others.

Lighter oils from vegetable sources are in fashion: groundnut, sunflower, mustard, gingely, safflower, coconut, palmolein, soyabean, ricebran, olive, canola and many more. What seems to determine their ratings are their proportion of un-saturated fats (more the better), and the balance of MUFAs ( Mono-unsaturated ) to PUFAs (poly-unsaturated fatty acids), and Omega-3 to Omega-6 fatty acids?

The reason for this enormous confusion is that no one seems to know what the ideal mix of MUFAs to PUFAs, or Omega 3s to 6s is, allowing each oil-maker to stake a “healthy” claim for his product.

Coconut oil is a too high in saturated fats and is best had only on occasions with “avial”. Mustard oil is healthy with lots of unsaturated fats, but contains a bit of the undesirable erucic acid. Olive oil is good, at least for Italians whose hearts don’t ache despite gorging on cheese-stuffed pizzas. Samosas and kachoris fried in this oil however often taste like hospital-diet.

To my persistent “Which then?” the cardiologist finally confided, “There is no ideal oil; they all have pluses and minuses. Hence use different ones for different dishes or change the brand every month. And keep the family consumption to 2-3 Kg per month”.

We therefore now use mixed refined oil for routine cooking, changing the brand every other month, mustard oil to fry fish, olive oil in salad dressings........

To my “Can I take a spoon of ghee with daal?” Dr Sudeep however did not melt!

As published in HT City (Hindustan Times) dated 11 December, 2011.

Fight anxiety blues!

It's natural to worry during stressful times. Some people however feel tense and anxious day after day, even when there is little to worry about. When this lasts for six months or longer, it may be generalized anxiety disorder or GAD. This illness affects several of us. Unfortunately, many people don't know they have it, and hence miss out on treatments that lead to a better, happier life.

The main symptom of is a constant and exaggerated sense of tension and anxiety. You may not be able to pinpoint a reason why you feel tense. Or you may worry too much about ordinary matters, such as bills, relationships, or your health. All this worrying can interfere with your sleep and your ability to think straight. You may also feel irritable due to poor sleep or the illness itself.

Body problems that accompany excess worry are muscle tension or pain, headaches, acidity, diarrhea, trembling or palpitations.

What sets GAD apart from normal worries is the feeling that you can't stop worrying. You may find it impossible to relax, even when you're doing something you enjoy. In severe cases, GAD can interfere with work, relationships, and daily activities.

What causes GAD has been the subject of research. Genes passed down through a family may make some people prone, but that's not the whole picture. Scientists think that a mix of DNA, environment, and psychological factors are to blame.

There's no lab test for GAD, so the diagnosis is made based on your description of your symptoms.  What do you worry about? How often? Does your anxiety interfere with any activities? You may have GAD if you have been feeling anxious or worrying too much for at least six months.

An extreme form of GAD is Panic disorder, in which one experiences sudden attacks of terror. Symptoms can include a pounding heart, sweating, dizziness, nausea, or chest pain. You may think you're having a heart attack, dying, or losing your mind.

Few simple changes in your habitscan help too. It is best to avoid caffeine and nicotine, and get adequate sleep and rest. Try relaxation techniques, such as yoga or meditation. And be sure to exercise; there's evidence that moderate physical activity can have a calming effect.

One of the effective methods of treatment by psychotherapy is called cognitive behavioral therapy or CBT. A counselor helps you identify your negative thoughts and actions. CBT may include homework, such as writing down the thoughts that lead to excess worry. You will also learn calming strategies.

Medications, called anxiolytics, that relax you help provide a good start. Antidepressant drugs work well to lower anxiety. Usually, a combination of medicatines and CBT work best for most.

If anxiety is spoiling your life, seek help to get it under control, and bring the relaxed smile back on to your face. 

As published in HT City ( Hindustan Times) dated 4 December, 2011.