Happiness holds the key to Wellness

In their pursuit to understand why some people live healthier and longer lives, and after chasing several measurable parameters such as blood pressure, blood sugar, cholesterol, uric acid and smoking for over half a century, medical scientists are now tumbling upon an esoteric factor that has been conspicuously missing from medical books, called ‘happiness’ that could hold the key to our wellness.

Happiness is quite like the hippo in the zoo. When you see it you can easily recognize it, but when someone asks you to describe it, it is not easy. It does not have the distinctive features like an elephant’s trunk or a leopards spots. And yet when you try counting people in office who are happy, or occasions when you have been happy, you know exactly who or what they are!

Funny as it might sound, the arrival of “happiness” as a medical factor affecting our lives probably started when a group of German pragmatists tried to beat the Americans at their habit of measuring every aspect of life with dollar as the common denominator, in their own backyard by whipping out stats that many with piles of money were not necessarily living great lives. Despite their limousines, liquors and lavish means, the frequency of drugs, divorce, and deaths due to suicides and murders were often disproportionately high. Why else would youngsters go berserk every few weeks and go on shooting sprees killing innocent kids in schools and campuses?

If you have started chuckling tauntingly at the Americans for their dollar-obsession, just hold on.  Let us see how we Indians, with our multitude of faiths, philosophies, festivals, and even our recent Santa-Banta fare against them and others in the world. The World Values Surveys samples populations from 97 nations to see how happy and satisfied they feel, and rank them from the most to the least happy, based on scores from +4.24 to -1.92. Sadly, despite our rich philosophical heritage India ranked 67 with a measly score 0.85!

The irony gets worse as India is the place where Hasya yoga or laughter yoga is thought to have originated. Also, it was an Indian doctor from Mumbai, Madan Kataria, who started a laughter movement in 1995 that has become global, spanning 70 countries with 7000 laughter clubs, which I discovered in faraway Melbourne, Australia during a visit there!

In recent times, “Wellness”has become the new watch word in Indian media hogging up space next only to scams, disasters, crime and sports.The pursuit of “Wellness” needs a top-down approach, beginning with Happiness at its fountain head, and  steering our attitudes and feelings to positive zones, before we turn our attention to the heart, muscles, skin, and bowels.

A daily dose of happiness could be far more effective than the proverbial apple in keeping the doctor away. Try it.

As published in HT City ( Hindustan Times) dated 30th March, 2014.

Fifteen Tips on Exercise that you can use

Let us recapitulate a few essential points about the role, aims, targets and methods of exercise that should keep you fit and well. In case you have missed the previous columns, here are the key points:

1. Exercise comes next only to food as an essential component for ensuring good health and longevity.
2. It tones up the heart, lungs, muscles and joints. People who exercise regularly have healthier hearts and tend to live longer.
3. People with diabetes, obesity and fatty liver can do very well with exercise. Aerobic exercise improves insulin sensitivity, brings down blood sugar levels, help burn extra fat and prevents clogging of arteries of the heart with cholesterol
4. The type of exercise that is good for the heart is called cardio-vascular or aerobic exercise. It involves movement such as brisk walks, jogging, cycling, swimming, treadmill or playing outdoor games.
5. A good point is to calculate your Body Mass Index (BMI). It should be between 20 -23 for Indians. If it is more than 23 you are overweight and need to shed weight.
6. The amount of exercise should be adequate to obtain good results: at least 30-40 minutes a day, most days of the week and should achieve a heart rate of 70% of the Maximal heart rate for that age.
7. Muscle building exercise like weight lifting or bull-worker is called isometric exercise. People above 40 years should avoid this form.
8. Choosing the right exercise should take into account your body needs, your personality type as well as the opportunities and circumstances where you live
9. While brisk walking is a good exercise, you should assess the safety of this form from traffic and crime in your locality.
10. If you are not a very determined person, an exercise regime which has to be undertaken by you alone, often does not sustain. A group activity may be more sustainable.
11. Games have the additional advantage over walking and running, in that it provides entertainment and challenge too.
12. You must take into account your special problems and limitations when choosing the right exercise. People with knee pain, for example, should avoid weight bearing exercise.
13. Joining a gymnasium or fitness centre works well for many. It shelters you from the extremes of weather, provides a variety of methods and instruments to work on, and is safer than walking on city roads in dark hours.
14. Aerobic exercise improves your basal metabolic rate, making your mind sharper and more alert. Students preparing for examinations will find their learning abilities to be enhanced if they leave their books and work-out for half an hour,
15. Keep changing the type of exercise from time to time. Variety adds that extra bit of interest to help you sustain it for all your life.

As published in HT City ( Hindustan Times) dated 16th March, 2014.

Way to Wellness through Yoga

Our series on exercise and wellness would be incomplete without a column on Yoga. At the outset I must confess that I am not an expert on yoga and will offer my sceptic observations as a medical scientist.

Of the numerous reports in the literature on the effects of Yoga on various aspects of health such as insulin resistance, heart and fatty liver, very few stand up to scientific scrutiny as the trials have not been designed in line with modern medical requirements.

 

When asked to review this topic for an international conference a few years back, I could find only 25 eligible studies of which just 4 were randomized controlled ones (considered to be scientifically well designed), 6 were non-randomized controlled trials (these studies are subject to bias in evaluating outcome), and 15 were uncontrolled studies (likely to be biased by the person conducting it as there are no controls).

Having explained the limitations and lacunae let me turn to the positive side: what did the studies show? Nineteen of the 20 studies that looked at the effect of Yoga on insulin resistance (the key underlying factor responsible for coronary heart disease, type 2 diabetes and fatty liver) showed significant improvement.  Regular yoga brought about a 6-34% reduction in fasting glucose levels and significantly improved HbA1C levels in diabetics!

The improvement in health parameters with Yoga in fact went beyond to significant improvement in lipid profile (reduction in bad cholesterol and increase in good cholesterol levels), decrease in weight and enhancement in cardiac function.

Further, yoga has several additional benefits. It tones up all the muscles, joints and nerves of the body, and provides a great sense of fitness and energy. The real advantage of yoga over other forms of exercise, that often gets overlooked, is that it focuses on breathing, making it coordinated, rhythmic and invigorating, exerting a positive effect on the mind in turn.

Despite the growing popularity of Yoga in several parts of the world, Yoga, unlike modern medicine, still unfortunately remains scattered, fanciful and whimsical largely due to lack of uniformity and standardization. Every yoga teacher seems to have an individualistic approach, lays claim to his being not just the best but often the only right way of doing it, and spares little effort in denigrating other teachers and methods, causing considerable confusion in the minds of aspirants.

It is time that Yoga gurus held a conference and thrashed out their claims and differences, and presented a unified realistic balanced picture of this precious Indian therapy to the world. I have seen several faithful followers suddenly stopping their blood pressure and diabetes medications on the exalted claims of their Yoga gurus that they can cure everything, and land up in the emergency in crisis.

To get the maximum benefit from Yoga, choose the right asanas that you need and pay due heed to its emphasis on breathing and focussing of the mind.It could be transformational experience!

As published in HT City ( Hindustan Times) dated 9th March, 2014.

Make the right choice of exercise

Having been convinced that exercise is necessary for well-being and that an appropriate amount of daily dose of aerobics is the requirement, we need to move to the very important issue of choosing the right one that suits your requirements and constraints. Here are a few tips:

• Brisk walks: This is the form most frequently prescribed by doctors. What you need to assess is where can you take your walk, and how safe is it for you? If you are in a gated campus or near a park or the botanical garden, you are lucky. If you wander on the streets especially in the early pre-dawn hours. You could be in for trouble. Enthusiastic walkers being knocked down by rogue drivers or attacked by criminals is increasingly becoming common. Hence safety should be a pre-condition. Also, the vagaries of weather, during monsoons, foggy winters and desiccating summers should not cause long interruptions.
• Going to the Gym. I think it is a good method for 3 reasons: the weather cannot play spoil-sport; you have several options to add variety to your exercise, and last but not least, provides a sense of compulsion once you have paid up. Further, when you see others struggling too, you realize you are not alone in your endeavour.
• Cycling: Excellent exercise, especially for those with creaky knees as it is non-weight-bearing. The safety concerns mentioned under walking, however apply here too.
• Games: Games such as shuttle, tennis, squash or golf are excellent because they add the extra value of entertainment that the previous three do not. When you play a game, you cannot help but challenge your opponent, and in doing so, your own body as well. Further, group activities are more motivating. Our tennis session in the morning was the best way to start the day for many years. Golf is unique in the sense that you do not need a partner or an opponent, as you challenge your own self. It is however time consuming and expensive and the family may resent the long hours you spend away from home on weekends.
• For out-door games, weather does become an interrupting factor. Our paunches used to become prominent during monsoons and the foggy winter weeks. Switching to an alternative (shuttle for instance) that could be played indoors, was an effective strategy.
• Gadgets at home: This can be very effective and practical, provided, and let me state it in capitals, PROVIDED, you are the disciplined type with loads of will power. I have seen several people clutter their homes with treadmills and cross-trainers that they do not put to use.

This list is neither complete nor exhaustive, but should help you decide how to approach the issue of choosing the right exercise. Also it is good to change the form every few months so that it does not become repetitive and boring.

Pant your way to healthy excitement!

As published in HT City ( Hindustan Times) dated 2nd March, 2014.

Exercise: Aerobic or Isometric?

The human body requires at least 1 hour each day being devoted to its care to keep it fit and strong. Of these 60 minutes, a good 40 should be spent on exercise of the body and 20 on exercise of the mind. Remember, a weak restless mind in a strong body does not make for happy living!

There are broadly 2 types of exercise: aerobic or isotonic, and isometric

Aerobic exercise:  This form is characterized by movement and includes walking, running, cycling, swimming or working out on the treadmill or games that involve movement. The heart rate and breathing goes up but no single group of muscles is put to too much strain (compare with isometric). It is also known as cardio-vascular exercise as it keeps the heart charged and fit.

Aerobic exercise is a must for people across all ages, and should be the only form for people above 50. Apart from keeping the heart toned by improving the blood circulation in the coronary arteries, it helps burn fat and increases the basal metabolic rate. Those who exercise are therefore not just physically more fit, but appear more alert and sharp. Those who are overweight or have fatty liver, need to concentrate on this form of exercise to burn their extra body fat.

The main challenge is that most conventional forms of aerobic exercise depend on the use of our legs, a feature that makes people with painful knees or hips to avoid it. This is where a good physical instructor or a gym could make all the difference. There are several gadgets and machines now available that could make you have a good work out without having to put your weight on your creaking lower limbs.

Isometric exercise:  In this form, primarily used for muscle building, certain muscle groups are put to strenuous stretches to make them stronger and bulkier. Body builders develop their shoulder muscles by lifting weights or chest muscles by using the “bull-worker” for instance. Young people keen to build their bodies can try this form. They should however take care not to overdo it and also to ensure that the development is proportionate. We have all seen some body-building fanatics with hugely bulging biceps but weak legs, making them look silly!

Isometric exercise puts a lot of pressure on the heart, and can make the blood pressure shoot up; hence it is best avoided by people with high BP, people above 50 and those with heart disease.

Opinions differ about whether a small judicious component of isometric exercise (lifting light weights) should be included in a weight reducing program. It probably helps by redistributing body mass – by melting the fat pads in our bellies and buttocks and making the muscles in the upper torso become stronger, and may fast track “inch loss” regimes.

Start with the 40 minutes of exercise each day for your body. I will tell you how to use the remaining 20 to charge your minds, next week. 

As published in HT City ( Hindustan Times) dated 23rd February, 2014.

Which Exercise is Best for you?

Exercise and diet are the two most important pillars of good health, and both have as many options and controversies as there are people to give advice on them.  Choosing an exercise regime that fits your specific requirement could be a good starting point for a long term investment in well-being.

You first need to take stock of your current status and then your requirements.

How do you assess your present physical state? Start with the following:

1. How old are you?
2. Do you have any medical problems (heart, knees, anaemia etc)?
3. Are you a strong willed person who can go it alone or do you need company and entertainment?
4. What are your constraints (no playground, unsafe roads, no gym nearby etc) 

The role of Age:

In general, the younger the age, more vigorous should be the exercise. A 16 year old, for instance, should play a vigorous out-door game, sprint and run, undertake long distance cycling and so on, but a 60 year old would have to choose from other milder options.

A quick reckoner for cardio-vascular exercise that takes age into account is to target a heart rate of 60% of the maximal heart rate (MHR).

Apply this formula to decide how vigorous your exercise should be: Subtract your age from 220. That gives you the MHR for your age. Now target a heart rate that is 60% of that, and keep on for 30 minutes.

For example, for a 20 year old youth, the MHR is 200. He should undertake vigorous exercise such as running, so that his heart rate reaches 120 (60% of 200). For a 50 year old man, the MHR would be 170, and the heart rate should reach around 100 per minute.

Warming up.Give yourself 5-10 minutes of gradual warming up before you push your heart rate up. This is especially important for people who are above 40 years and who are getting started on an exercise regime.

How to calculate your heart rate while exercising? Most treadmills have a meter that tells you. There are special gadgets that you can wear on your wrist for detecting heart rate. Another simple way is to sense “palpitations” and pant while taking your brisk walk for example.

Cooling down is just as important as warming up. After your 30 minutes of gentle panting and palpitations are over, reduce your speed and taper off the speed gradually, allowing your body to cool off over 10 minutes.

Medical Problems

Exercise is not forbidden for those who have medical problems, but have to be specially tailored to their needs and constraints. An elderly patient with chronic heart failure may, for instance, be able to take just a slow walk for 10 minutes as advised by his cardiologist. Those with creaky knees find it difficult to run on the treadmill as the brunt of their excess weight makes their lower joints cry more. They might do well with “rowing” exercises that spares the knees. Your doctor and a good gym instructor can help you choose the right form for you.

If you have now decided to start with exercise and set your goals, watch this space next week for helping you choose your exercise regime.

As published in HT City ( Hindustan Times) dated 16th February, 2014.

Wheat Woes and Worries

Wheat, the staple diet of over half the world’s population, could paradoxically be the cause of several of our vexing health problems. A recent study in the journal ‘Nutrients’ points out that proteins in this cereal could be triggering a wide a range of disorders from autistic behaviour in children to liver cirrhosis in adults.

Wheat does not seem to go down well in 5% of its consumers. In its most well recognized form called Celiac Disease, one of its proteins called gluten evokes an immune reaction from the small intestines, typically causing diarrhoea, malabsorption and growth failure in children. Funnily, despite having literally grown up on chappatis all through childhood, Celiac Disease often appears suddenly in adulthood with loose motions, weight loss, weakness, anaemia and fatigue.

Celiac Disease can also masquerade and present in atypical forms such as delayed puberty, weak bones, deficient dental enamel, neuritis, diabetes, itchy skin rash or an abnormal body movement called ataxia. A simple blood test called IgA TTG often leads to the correct diagnosis.

Wheat Allergy (WA) is another form. Many people who complain of gas, bloating, abdominal cramps, urticarial and itching often overlook the all-too-familiar wheat as being the culprit. In fact, food allergy testing, which has come into vogue these days, throws up wheat as one of the commonest allergens.  The IgA TTG is negative in this condition.

A third form of wheat sensitivity that has recently arrived on stage is called Non Celiac Gluten Sensitivity or NCGS, and seems in fact to be the commonest form. The symptoms are usually those of flatulence, abnormal bowel movement and gas and characteristically respond when one goes on a gluten free diet (GFD). In fact 30 % of patients with Irritable Bowel Syndrome, who have often been told that “it is all in the mind”, seem to get an impressive relief of symptoms by shunning wheat.

The effect of wheaton the mind is emerging as a hot topic for research. Few recent studies have linked NCGS with autistic behaviour in children. Autism Spectrum Disorders (ASD) are one of the fastest growing developmental disabilities in which children below 3 years of age demonstrate a range of stereotyped repetitive behaviour, hyperactivity, aggression, anxiety and depression, and often show impaired language and social skills.

What has come up as a surprise is that many of these children improve remarkably as soon as they are taken off wheat! While scientists are still grappling to elucidate the reason, it appears that wheat proteins make the intestines ‘leaky’, allowing large quantities of natural peptides to enter the circulation and then find their way to the brain. In an extended observation on the effect of wheat and our brain, some patients of schizophrenia got better when the cereal was eliminated from their diets.

These fascinating studies are pushing us to re-explore the pivotal role that our diets may be playing in not just shaping our bodies but in nurturing our brains and emotions as well. 

As published in HT City ( Hindustan Times) dated 26th January, 2014.

Winter Blues

Winter is a season when many find themselves not quite at their best: low on energy and gloomy in mood, resonating with the chill and fog outside the window.

Seasonal depression, or seasonal affective disorder (SAD) as it is now called by mind-scientists, is indeed rather common affecting one of ten people. It often gets passed off as laziness or excess sensitivity to cold, but can also manifest as social withdrawal, oversleeping, appetite changes and weight gain. Many get unduly sluggish during these times. It affects women more often, plunging many into depression.

The insidious entry of winter, with temperatures dropping, days getting shorter and the feeble sun peeping occasionally between fog and cloud, makes it difficult for many of us to notice the link between the weather and our mood. If however we think back on what we did at these times over the last few years, a recognizable pattern often begins to emerge. Patients are often able to link their feelings to this particular time of the year, perhaps around their husband’s birthday or Christmas or MakarSankranti.

Researchers believe that the root of SAD may lie in the conflict of our body clock with the altered day-night cycle that artificial light causes. Many animals hibernate in winters passing several months in a deep sleep, and waking up and being active during summers. Perhaps a similar tendency occurs in higher forms of life as well. But our penchant to defy the natural light-darkness cycle that matches our awake-sleep body clock by the use of artificial light that keeps us up at nights might be playing havoc.

Winter depression can sometimes be severe with feelings of hopelessness and negativity impact professional work output, relationships or life quality, necessitating a visit to your doctor.

There are few simple ways that you can adopt to push back your blues and energize yourself.

Going out on a sunny day and getting as much sunshine as possible is a first simple measure.Don't let colder weather chase you inside; it's what jackets and mittens were made for. Go outdoor (not to a mall! the botanical garden or the zoo are more appropriate places) take a walk around the block, eat lunch at the park or simply sit on a bench and relax.

Staying active is the key. Many notice a definite decrease in their energy levels every December when the days start getting shorter. Pulling yourself out from the bed or the sofa, and take a regular brisk walk or play a game of shuttle to invigorate yourself.

Light therapy also seems to help. Throw open the curtains to let the sunshine stream in as soon as you wake up. Radiation heaters could be more helpful than blowers, as they provide light in addition. Use indoor lights if necessary, but remember not to overuse them into late nights and disrupt your circadian rhythm.

Lastly, keep telling yourself ‘ If winter is here, can spring be far away’.

As published in HT City ( Hindustan Times) dated 19th January, 2014.

Alcohol’s Lakshman Rekha

Alcohol, once tabooed in Indian society, has gained wide social acceptance today. Parties are no longer always as ‘dry’ as to keep the conversation hovering for hours around the weather, the boss, children’s school or politics. A couple of drinks make guests mingle better, voice their honest opinions about Katrina’s lips or Shakira’s hips, crack jokes and even sing a soulful gazal! Ladies have also started prefering spirits to Sprite as they join their men in the ‘wet’ soiree with equal gusto.

Exposure to alcohol is not really recent; humans and their forefathers (apes) have tasted alcohol through the ages while munching or sucking over-ripe fruits, most of which have fermented cores. The difference is in the concentration; it is a meagre 1-3% in naturally fermented foods as the yeasts die when the alcohol levels rise. And these low levels can’t make one tipsy!  It is through the process of “distillation”, discovered by man a few centuries ago,  that alcohol can be concentrated and beverages such as beer (4-7%), wines (7-15%), and spirits (brandy, whisky, gin, rum, vodka, 35-45%) produced, depending on the source of the substrate.

The line dividing harmless social drinking and “alcoholism” is often so fuzzy that a fun loving party-goer does not often realize when he is trespassing the Lakshman-rekha. A familiar story is how he could stay off drinks during the Navratri days or the holy month till a few years ago, but can’t any more.The CAGE Questionnaire, with 4 simple questions, could help let you know if your drinking is getting dangerous.

1. Have you ever felt you need to Cut down on your drinking?
2. Have criticisms by family, friends, colleagues or neighbours over your drinking ever Annoyed you?
3.  Have you ever felt a sense of Guilt about your drinking?
4.  Have you ever needed alcohol in the morning as an Eye opener? 

A “yes” to any of them indicates that you are in the trouble zone, and need urgent help from family, well wishers and experts. Other indicators of alcohol dependence are drinking alone, starting to drink in the morning or afternoon, inability to get sleep, trembling of hands or restlessness if a drink is missed or denied.

Kicking the habit is, by no means, easy and often requires both desire and will. A change of place, setting and circle of friends can help break away from the entrapping vicious cycle. It is often helpful to meet an ex-alcoholic and have him share how he conquered the problem. Many cities have groups called Alcoholic Anonymous, a group of ex-drinkers who provide this kind of support to those wanting to quit alcohol. A specialist can make the process smooth and ensure that the withdrawal symptoms are not too painful.

It is pity that an occasional pleasure often turns a trap ruining careers, families, health and life. It is time to wake up and take the call.

As published in HT City ( Hindustan Times) dated 5th January, 2014.