Food Fads in Liver Disorders

In an attempt at trying to do well to those they love, spouses and parents often enforce diets on patients of liver diseases that often turn out to be detrimental.

The commonest food fad is pale insipid boiled cabbage being doled out to nauseous patients suffering from hepatitis that makes them puke even more. 

The liver, in a way, is a buzzing manufacturing unit that requires lots of energy to keep its multiple functions going. And it derives all this from the food we eat.

During disease, such as during an attack of jaundice, when many of the liver cells get killed, the liver attempts damage control by trying to regenerate quickly. For its cells to multiply however, it requires a generous supply of energy that comes from carbohydrates, and protein, the building block for its cells and tissues.

Boiled green vegetables unfortunately have neither of these. Hence the situation often progresses to that of a starved liver unable to recuperate due to cut-off food supply.

Recent studies are beginning to show how adequate supply of energy and protein food during this critical phase revives damaged livers. Carbohydrates (starch and sugar), the most important sources of energy are sourced from rice, sugar, idlis, idiappams, sooji, noodles, as are fruit juices, sweets and rasgullas that need to be given liberally.

Interestingly, fat, thought to be toxic to livers, is good too, in moderation. Each gram of fat provides 9 Kilo calories, compared with only 4 of carbs. That patients do not enjoy fried food at this stage of their illness is of course another matter.

Adequate importance has not been given to protein, the other important ingredient our livers need most. International guidelines recommend a diet of 1 to 1.5 g per Kg body weight per day to meet the liver’s increased requirement.  Here again the spotlight has shifted from the conventional animal sources (meat, chicken fish, eggs, milk, curd and cheese) to those derived from veg ones such as daals, rajma and soya.

Soya is perhaps the most useful and yet the most neglected item. It is not only rich in protein (40%) but contains large proportion of branched chain amino acids (BCAA) that have been found to be specifically beneficial in liver disease.  Eating soya chunks at least once with lunch or dinner can do the liver much good.

Last, but not the least, is withholding “haldi” or turmeric from cooking. This fad stems from associating its yellow colour with that of bilirubin, the compound that gives the yellow hue in jaundice. The link is as stupid as feeding tomatoes which derive its red colour from a pigment called anthrocyanin, to anemic patients with low haemoglobin levels. We need to look beyond colour!

We often look to doctors to merely write medicines, and take it upon us to decide what food we should provide to our ailing relatives. No harm. As long as we update ourselves, and rid our minds of senseless fads!

As published in HT City ( Hindustan Times) dated 17th February, 2013.

Sunshine Vitamin - the New- age Immune Booster

Vitamin D, also called the sunshine vitamin, and considered for decades to be needed only for the health of our bones, is emerging as an essential enhancer of our body’s immune system. Recent research findings are increasingly ascribing a key immune- boosting role for this vitamin.

Scientists were surprised to find that patients of tuberculosis undergoing treatment with anti-tubercular medicines cleared their infection faster, and recovered earlier when given Vitamin D in addition.

The research, conducted in England, showed that recovery was almost two weeks faster when vitamin D was added with the infection clearing in 23 days on average, compared with 36 days if they were given antibiotics alone.

Dr Adrian Martineau, from Queen Mary University of London, said "This isn't going to replace antibiotics, but it may be a useful extra weapon, andthere could be an even greater role in preventing the disease.

One in three people have low levels of tuberculosis bacteria in their lungs and have no symptoms, known as latent tuberculosis. However, this turns to full blown TB in about 10% of people. Prof Davies's idea is that giving vitamin D supplements, for example in milk, could prevent latent TB developing.

The idea of using vitamin D to treat tuberculosis (TB) harks back to early times. Before antibiotics were discovered, TB patients were prescribed "forced sunbathing", known as heliotherapy which increased vitamin D production. Many returned cured after a few months of sun bathing in the hills. However, the treatment disappeared when antibiotics proved successful at treating the disease.

Vitamin D is a fat-soluble vitamin which can provide for the body's needs in one of two ways...through the action of sunlight on the skin, or through the major food sources of cod liver oil, cold-water fish, butter, and egg yolks.  When the sun shines on the skin, the ultraviolet rays activate a form of cholesterol which is present in the skin, converting it to Vitamin D.  Because the body can provide sufficient Vitamin D to meet its needs simply through exposure to sunlight, it is called the “Sunshine Vitamin”

Vitamin D is needed to stimulate the absorption of calcium.  A Vitamin D deficiency causes rickets in children, and osteomalacia in adults.

It is now known that Vitamin D plays a huge part in boosting the immune system.  One of the best ways to prevent colds, flu, cancer, or any chronic disease is with Vitamin D.  In order to correct the deficiency condition which most people have but don't know they have, 5,000 IU's a day are necessary.   After taking this much for about a month, you will have filled your need for Vitamin D for normal daily processes, and then some of the deeper needs can be filled. 

It is a pity that we do not use the abundant sunshine adequately and keep ourselves toned, fit and boosted!

As published in HT City ( Hindustan Times) dated 10th February, 2013.

Enigmatic Vitamin B12

If you are feeling fatigued, dull and low, you could well be suffering from low levels of Vitamin B12. These symptoms, often passed off as “psychological”, are increasingly finding a true organic basis in Vitamin B12 deficiency. Physicians are progressively becoming cautious not to overlook this modern-age deficit that can now be diagnosed quickly and easily by a simple blood test.

Several problems of nerves and spine, such as tingling of feet , loss of balance, alteration in gait, forgetfulness, drowsiness and dementia, especially in the elderly, are now being put down to Vitamin B12 deficiency, as are fluctuations in mood and even depression. Studies are showing that It may underlying frequent falls and fractures sustained by senior citizen.

Vitamin B12 is a water soluble vitamin that plays a crucial role in the normal functioning of the brain and nerves. Also called cobalamin, as it contains the rare element Cobalt, this water soluble vitamin is one of the 8 “B” vitamins essential for most cell functions. Due to its crucial role in formation of blood, its deficiency sets back division of red blood cells resulting in a type of anaemia characterized by larger but much fewer and less efficient red blood cells, aptly described as “megaloblastic”.

Interestingly, this vitamin is not produced by the human body butsolely by bacteria.Equally interestingly, unlike most other vitamins of the B and C groups that are present in abundance in fresh fruits and green vegetables, this vitamin is present only in animal proteins like meat, fish, milk and cheese. It is for this reason that vegans, a sect of vegetarians who do not consume animal products in any form, are often found to be B12 deficient despite the body’s low requirement of only 2-3 mcg per day.

Symptoms of Vitamin B12 deficiency are usually vague and non-specific, often overlapping with other disorders such as hypothyroidism, diabetes and Alzheimer’s disease, making it impossible for doctors to make the diagnosis on clinical grounds alone. Hence major hospitals and physicians have started testing for serum Vitamin B12 levels in patients with a wide range of symptoms and even in normal individuals coming for a health check. 

Some drugs can interfere with Vitamin B12 absorption. One common culprit is the anti-diabetic medication, metformin while another is the group of acid suppressant medications such as omeprazole and its other -zole sibs. Patients on long term therapy with these drugs should get their Vitamin B12 levels checked periodically.

Once the diagnosis is established, treatment is easy. The vitamin is best replenished by injection of 100 to 1000 mcg every 6 to 12 months. Weak and confused patients promptly brighten and spring back to life like freshly watered lilies.

And as I drag myself to work these days, grope for words when I write this column and scratch my head for the once familiar names, I know it is time for me to take the B12 test.

As published in HT City ( Hindustan Times) dated 3rd February, 2013.

What Makes Modern Medicine Modern

The government’s and court’s recent knee jerk decision to clamp down on clinical research in the country is likely to prove regressive in the long run, for if there is one single factor that keeps modern medicine ahead of other systems, it is new discoveries and innovations fuelled by the indomitable spirit of research.

Heart diseases for instance can now be prevented by new drugs that lower cholesterol or prevent stickiness of clot-forming platelets, which are getting better by the day, thanks to research. Narrowed or blocked arteries of the heart can now be opened up by balloons or stents inserted through the hand, thanks again to bold research. Further, the occluded arteries can also be “bypassed” surgically using grafts or conduits, as our present prime minister’s health bears testimony to, as a consequence of daring experimentation by bold heart surgeons 30 years ago.

What has made these “advances”possible however has been years of painstaking research, initially in laboratories, then in animal labs and finally in human subjects. And if the terms “research” and “clinical trial” evokes creepy feelings of cold inhuman experimentation, remember that the benefits we enjoy today would not have come otherwise.There must have been a “first few’ who went under these therapies that were once “experimental”.

As a corollary, the lack of research has made several systems that once had their day in the sun, become obsolete. In the second century, lived a great Roman physician called Claude Galen, whose observations and teachings reached historical heights and his potions made from herbs became the treatment of that day. The next hundred years witnessed the blind practice of what Galen had written with no new research or additions. Progress soon came to a stand-still and history now looks back at this period as the Dark Age of western medicine.  Our Indian systems of medicine, once rich and flourishing, have also been plagued by lack of new research.

Hepatitis B infection, a leading cause of liver failure and liver cancer, that had no remedy till the mid-eighties, now has 6 good medicines and an effective vaccine for prevention, thanks to medical research. Hepatitis C infection which has only the expensive and toxic injections of interferon by way of therapy today, is all set to see the launch of several effective “oral” drugs that could transform its treatment in a couple of years,. But how will they come into our arsenal unless tested on patients and found to be effective?

Needless to say, medical research needs to meet high standards of ethics, care and safety, and be transparent and accountable.But research needs encouragement and promotion if medicine has to continue its advancement. Banning it would halt its progress and take us back to the Dark Ages!

As published in HT City ( Hindustan Times) dated 13th January, 2013.