Diet Advices - Best Private Hospital in Dubai Al Mankhool | IMH Dubai

Gestational Diabetes

Gestational diabetes is a condition in which your blood sugar level becomes high during pregnancy, affecting up to 10% of pregnant women, diagnosed by a blood test done at 24 to 28 weeks of pregnancy. Women with gestational diabetes don’t have diabetes before their pregnancy – and it usually goes away after giving birth.

What causes gestational diabetes?

Hormones produced by the placenta cause a build-up of glucose in the blood. Usually, enough insulin is produced to control blood sugar levels. However, if the body is unable to produce insulin or stops using it, then the blood sugar levels rise, causing gestational diabetes.

Who’s at risk of gestational diabetes?

At your first antenatal appointment, a healthcare professional should check if you’re at risk of gestational diabetes.
The likelihood of getting gestational diabetes increases if you:
• were overweight before you got pregnant.
• have had gestational diabetes in the previous pregnancy.
• have had a large baby in earlier pregnancy (4.5kg/10lb or more)
• have a family history of diabetes – parent or sibling.
• come from a South Asian, Black or African Caribbean or Middle Eastern background.
• have high blood pressure .
• have given birth to a stillborn baby.
• are older than 30 years.
Having gestational diabetes increases your risk of developing it again in future pregnancies. It also increases your risk of developing Type 2 diabetes later in life. You can reduce the risk of developing gestational diabetes by managing your weight, eating healthily and keeping active before pregnancy.

Gestational diabetes symptoms.

Women with gestational diabetes don’t usually have symptoms. Most find out that have it during a routine screening.
You may notice that:
• You’re thirstier than usual
• You’re hungrier and eat more than usual
• You urinate more than usual

Gestational diabetes tests and diagnosis.

Gestational diabetes is diagnosed by routine screening, called Oral Glucose Tolerance Test, also known as an OGTT. The OGTT is done when you’re between 24-28 weeks pregnant. If you’ve had gestational diabetes before, you’ll be offered an OGTT as soon as possible, and another OGTT between 28-32 weeks if the first test result is normal.

How do you manage gestational diabetes?

The goal is to reduce blood glucose to the normal levels exhibited by a woman without gestational diabetes.

This involves:
• Measuring your blood sugar level four times a day
• Eating a healthy and balanced diet
• Performing moderate physical activity for about 150 minutes per week (Running, walking and swimming are good options)
• Reducing stress as much as possible.

These measures must be taken while continuing regular checkup with your doctor and adjusting them as needed. Changes in habits will sometimes not be enough; in such cases, metformin or insulin injections should be used during the pregnancy.

Target blood sugar levels in pregnancy:
• Before a meal: 95mg/dl or less
• An hour after a meal: 140mg/dl or less
• Two hours after a meal: 120mg/dl or less

Tips for eating well with gestational diabetes:
• Eat regular meals.
• There’s no need to ‘eat for two’. Portion size will have the most significant effect on your blood glucose level.
• Include carbohydrates but look for low GI (glycemic index) options and keep the consumption to the optimum level
• Get your five vegetables a day for vitamins, minerals and fibre.
• Cut back on salt, too much salt is associated with high blood pressure, which increases the risk of diabetes complications.
• Stick to water or sugar-free drinks.

What are the potential complications?

In the child:
• Macrosomia (above-average weight)
• Risk of being born with low blood sugar levels and respiratory problems
• Risk of obesity and type 2 diabetes later in life

In the mother:
• Risk of a difficult delivery, possibly by C-section, depending on the baby’s weight
• Surplus of amniotic fluid, which could trigger premature delivery
• Gestational hypertension & Preeclampsia
• Risk of developing type 2 diabetes later
• Risk of suffering from gestational diabetes again in a future pregnancy

Most of the complications can be prevented with appropriate treatment.
In conclusion, in the vast majority of cases, gestational diabetes is easy to control, with your blood sugar levels likely to normal in about six weeks after childbirth. However, the risk of developing gestational diabetes in the next pregnancy increases, with the women also likely to develop type 2 diabetes in the future. It would help if you got follow-up tests every year. Many problems can be avoided through healthy lifestyle habits. Don’t panic and talk to your doctor to see how you can put the odds in your favour.

Anorexia

 

What is Anorexia?

Male-AnorexiaAnorexia Nervosa is a psychological and possibly life-threatening eating disorder defined by an extremely low body weight relative to stature (this is called BMI [Body Mass Index] and is a function of an individual’s height and weight), extreme and needless weight loss, illogical fear of weight gain, and distorted perception of self-image and body.

Additionally, women and men who suffer with anorexia nervosa exemplify a fixation with a thin figure and abnormal eating patterns. Anorexia nervosa is interchangeable with the term anorexia, which refers to self-starvation and lack of appetite.

Types of Anorexia

There are two common types of anorexia, which are as follows:

  • Anorexia Nervosa Binge / Purge Type – The individual suffering from anorexia nervosa binge / purge type, will purge when he or she eats. This is typically a result of the overwhelming feelings of guilt a sufferer would experience in relation to eating; they compensate by vomiting, abusing laxatives, or excessively exercising.
  • Restrictive Anorexia Nervosa – In this form of anorexia nervosa, the individual will fiercely limit the quantity of food consumed, characteristically ingesting a minimal amount that is well below their body’s caloric needs, effectively slowly starving him or herself.

Causes 

Anorexia is not a simple disorder. It has many symptoms and effects, and its causes are complex as well

  1. Environmental factors

The effects of the thinnessculture in media, that constantly reinforce thin people as ideal stereotypes

  • Professions and careers that promote being thin and weight loss, such as ballet and modeling
  • Family and childhood traumas: childhood sexual abuse, severe trauma
  • Peer pressure among friends and co-workers to be thin or be sexy.
  1. Biological factors
  • Irregular hormone functions
  • Genetics (the tie between anorexia and one’s genes is still being heavily researched, but we know that genetics is a part of the story).
  • Nutritional deficiencies

Signs and Symptoms 

Living with anorexia means you’re constantly hiding your habits. This makes it hard at first for friends and family to spot the warning signs. When confronted, you might try to explain away your disordered eating and wave away concerns. But as anorexia progresses, people close to you won’t be able to deny their instincts that something is wrong—and neither should you.

food behavior signs and symptoms

  • Dieting despite being thin – Following a severely restricted diet. Eating only certain low-calorie foods. Banning “bad” foods such as carbohydrates and fats.
  • Obsession with calories, fat grams, and nutrition – Reading food labels, measuring and weighing portions, keeping a food diary, reading diet books.
  • Pretending to eat or lying about eating – Hiding, playing with, or throwing away food to avoid eating. Making excuses to get out of
  • Preoccupation with food – Constantly thinking about food. Cooking for others, collecting recipes, reading food magazines, or making meal plans while eating very little.
  • Strange or secretive food rituals – Refusing to eat around others or in public places. Eating in rigid, ritualistic ways.

appearance and body image signs and symptoms

  • Rapid weight loss with no medical cause.
  • Feeling fat, despite being underweight – You may feel overweight in general or just “too fat” in certain places, such as the stomach, hips, or thighs.
  • Fixation on body image – Obsessed with weight, body shape, or clothing size. Frequent weigh-ins and concern over tiny fluctuations in weight.
  • Harshly critical of appearance – Spending a lot of time in front of the mirror checking for flaws. There’s always something to criticize. You’re never thin enough.
  • Denial that you’re too thin – You may deny that your low body weight is a problem, while trying to conceal it (drinking a lot of water before being weighed, wearing baggy or oversized clothes).

purging signs and symptoms

  • Using diet pills, laxatives, or diuretics – Abusing water pills, herbal appetite suppressants, prescription stimulants, ipecac syrup, and other drugs for weight loss.
  • Throwing up after eating – Frequently disappearing after meals or going to the bathroom. May run the water to disguise sounds of vomiting or reappear smelling like mouthwash or mints.
  • Compulsive exercising – Following a punishing exercise regimen aimed at burning calories. Exercising through injuries, illness, and bad weather. Working out extra hard after bingeing or eating something “bad.”

Steps to recovery

  • Admit you have a problem. Up until now, you’ve been invested in the idea that life will be better—that you’ll finally feel good—if you lose more weight. The first step in anorexia recovery is admitting that your relentless pursuit of thinness is out of your control and acknowledging the physical and emotional damage that you’ve suffered because of it.
  • Talk to someone. It can be hard to talk about what you’re going through, especially if you’ve kept your anorexia a secret for a long time. You may be ashamed, ambivalent, or afraid. But it’s important to understand that you’re not alone. Find a good listener—someone who will support you as you try to get better.
  • Stay away from people, places, and activities that trigger your obsession with being thin.You may need to avoid looking at fashion or fitness magazines, spend less time with friends who constantly diet and talk about losing weight, and stay away from weight loss web sites and “pro-ana” sites that promote anorexia.
  • Seek professional help. The advice and support of trained eating disorder professionals can help you regain your health, learn to eat normally again, and develop healthier attitudes about food and your body.

The difference between dieting and anorexia

Healthy Dieting

Anorexia

Healthy dieting is an attempt to control weight. Anorexia is an attempt to control your life and emotions.

Your self-esteem is based on more than just weight and body image.

Your self-esteem is based entirely on how much you weigh and how thin you are.
You view weight loss as a way to improve your health and appearance. You view weight loss as a way to achieve happiness.
Your goal is to lose weight in a healthy way.

Becoming thin is all that matters; health is not a concern.

Learn to tolerate your feelings

Identifying the underlying issues that drive your eating disorder is the first step toward recovery, but insight alone is not enough. Let’s say, for example, that following restrictive food rules makes you feel safe and powerful. When you take that coping mechanism away, you will be confronted with the feelings of fear and helplessness your anorexia helped you avoid.

Challenge damaging mindsets

People with anorexia are often perfectionists and overachievers. They’re the “good” daughters and sons who do what they’re told, try to excel in everything they do, and focus on pleasing others. But while they may appear to have it all together, inside they feel helpless, inadequate, and worthless.

Develop a healthier relationship with food

Even though anorexia isn’t fundamentally about food, over time you’ve developed harmful food habits that can be tough to break. Part of recovery is developing a healthier relationship with food.

Medical treatment

The first priority in anorexia treatment is addressing and stabilizing any serious health issues. Hospitalization may be necessary if you are dangerously malnourished or so distressed that you no longer want to live. You may also need to be hospitalized until you reach a less critical weight.

Chronic Kidney Disease (CKD)

Chronic kidney disease (CKD) is a condition characterized by a gradual loss of kidney function over time. The term chronic is used to refer to a condition which is permanent and irreversible. In addition, it progressively worsens even with treatment. This will eventually, over a period of time lead to need for dialysis or renal transplantation.
This is associated with complications such as high blood pressure, weak bones, low blood dialysis-access-management-the-miller-procedure-for-steal-syndromeDialysis-Treatment    hemoglobin and cardiac and nerve and brain damages.
Causes of Chronic Kidney Disease
The two main causes of chronic kidney disease are Diabetes mellitus and High blood pressure. These two diseases together are responsible for up to two-thirds of the cases.
High blood pressure, if uncontrolled, or poorly controlled, can be a leading cause of heart attacks, strokes and chronic kidney disease. Also, chronic kidney disease can cause high blood pressure.
Several other conditions can cause chronic kidney disease.
• Glomerulonephritis:A group of diseases that cause inflammation and damage to the kidney’s filtering units. These are unique diseases which generally affect the kidneys primarily and as a result of kidney damage can cause damage to other organs of the body. These disorders are the third most common type of kidney disease.
• Polycystic kidney disease An Inherited diseases, which causes large cysts to form in the kidneys and damage the surrounding tissue.
• Malformations and developmental abnormalities that occur during intrauterine development.
• Systemic lupus erythematosos and other diseases that affect the body’s immune system.
• Obstructions to urine flowcaused by problems like kidney stones, tumors or an enlarged prostate gland in men.
• Repeated urinary infections.
Most people may not have any symptoms until their kidney disease is advanced. However, the following symptoms occur as the disease progresses.
Tiredness and feeling less energetic in day to day activities; have trouble concentrating have a poor appetite and have difficulty in sleeping. These are non-specific symptoms and occur very slowly and are difficult to recognize in the beginning.
In addition patient may also have certain specific symptoms like swelling in the feet, and puffiness of the face especially around the eyes more so in the morning. Decrease in urination sometimes associated with the need to urinate more often at night occurs.
In severe cases and advanced renal failure patients have breathing difficulty, headache, convulsions, visual disturbances, and loss of consciousness. This warrants emergency treatment.
Detection of chronic kidney disease: Important tests of kidney function.
The earlier kidney disease is detected, the better the chance of slowing or stopping its progression.
Blood Urea Nitrogen: This is a chemical which accumulates in the body during day to day activities. It is normally excreted by the kidney and it accumulates in the blood in patients in whom the kidney function is reduced.
Serum Creatinine: this is also a waste material which accumulates in the body and if not cleared by the kidneys its blood levels raise. A raised blood urea and creatinine levels generally indicate kidney failure; however the values need to be interpreted taking in to account several other variables. Generally both blood urea and serum creatinine levels are to be considered.
If these tests are abnormal then several other chemicals in the body need to be measured to decide on the severity of the disease and to guide the treatment.
It is important to note that these tests indicate the severity of the disease and cannot confirm whether the disease is reversible or permanent.To decide if the damage is permanent or reversible renal scan is necessary
Ultra sound scan or CT scan of the kidneys will give information regarding the size of the kidneys and presence or absence of obstruction
In patients with Chronic kidney disease the kidney size is usually reduced to less than 9cms which is the normal size. In addition the appearance of the kidneys in the scan also is abnormal.
Kidney Biopsy:
In some patients if the kidney size is normal taking a small bit of kidney tissue though a needle and studying the microscopic structure may be necessary
Additional tests may be necessary to detect the complications or response to treatment measures.
Salient points:
Early detection can help prevent the progression of kidney disease to kidney failure.
Heart disease is the major cause of death for all people with Chronic kidney disease.
Hypertension can causechronic kidney disease and chronic kidney disease can cause hypertension
Persistent proteinuria (protein in the urine) means Chronic kidney disease is present and may in some cases lead to kidney failure.
High risk groups include those with diabetes, hypertension and family history of kidney failure.
Two simple tests can detect Chronic kidney disease: blood pressure, urine albumin and serum creatinine.
Treatment options

These include the following:
Supportive treatment in the early stages:
Renal replacement therapy when the disease is advanced:
Supportive treatment:
This is started when the patient has kidney failure but the degree of failure is not severe and the patient can be managed with medications and diet.
The aim of therapy is to
1. Control the symptoms
2. To delay the progression of kidney failure
3. To prepare the patient for eventual dialysis support.
Control of Symptoms:
These include medication to control blood pressure, blood sugars in patients with diabetes, and some medications to alleviate the problems due to alterations in electrolytes, water content of the body and the bone minerals. With strict control of blood pressure the progression of kidney failure can be significantly slowed down.
Diet:
Salt restriction:to control blood pressure and fluid accumulation in the body.
Fluid restriction: to control swelling and fluid accumulation
Low protein: Protein in the diet acts as an additional burden on the already malfunctioning kidneys. Moderate reduction in dietary protein intake is known to reduce the progression of the kidney failure.
Fruits; generally fruits are very rich in a mineral called potassium. This is normally excreted only through the kidneys. In conditions where kidneys are unable work normally potassium accumulates in the body. High blood potassium levels are harmful to the heart and require urgent treatment.
Dietary advice from an experienced dietician is very helpful.
Renal Replacement therapy:
There are two treatment options for kidney failure:
Dialysis (hemodialysis or peritoneal dialysis) and kidney transplantation
Briefly Dialysis means removing the waste products from the blood periodically with the help of an artificial kidney or the patient’s own abdominal membrane.
Transplantation involves placing a normal kidney surgically from a donor either living or cadaver.

Hemodialysis
Hemodialysis is a treatment that removes wastes and extra fluid from the blood.During hemodialysis, the blood is pumped through soft tubes to a dialysis machine where it goes through a special filter called a dialyzer (also called an artificial kidney). After the blood is filtered, it is returned to the bloodstream.-peritoneal-dialysis-catheter
Dialysis is necessary if the kidneys no longer remove enough wastes and fluid from your blood to keep the body healthy. This usually happens when there is only 10 to 15 percent of kidney function left. The patient usually has severe symptoms such as nausea, vomiting, swelling and fatigue. However, one can still have a high level of wastes in the blood that may be toxic to the body and yet have minimal symptoms. Your doctor is the best person to tell you when you should start dialysis.
Blood is removed from the body using needles placed in the veins or through tubes inserted in to major veins. This is called dialysis access
(Images)
For the peripheral veins to give good amount of blood for cleaning a small surgery to connect the vein to the artery is required. This needs to be done several weeks before dialysis is anticipated.
Dialysis is generally required 3 times a week each time lasting for 4-5 hours. This can be done as an outpatient procedure and the patients usually can get back to work after the session is over. Blood tests are done monthly to assess the adequacy of dialysis.
Peritoneal dialysis:
In this process a small soft rubber tube is placed in the abdomen and once the wound heals sterile fluid can be instilled in to the abdominal cavity through this tube. The fluid is left in place for 3-4 hours and during this time it takes up the waste material from the blood and it can then be removed through the same tube. This is called one exchange. Usually 3-4 exchanges are required daily and the patient is trained to do the same at home. The quality of dialysis is assessed monthly by the Nephrologist.
Renal Transplantation:
This is the most physiological way of replacing the kidney function. It involves placing a new kidney in the patient’s body usually the lower abdomen. The kidney can be donated by a close relative or it can also be from a brain dead person. The donor and recipient pair undergo a series of tests to confirm mutual compatibility and matching. The recipient will require medications life long and close and frequent monitoring.

Diet And Acne – What Your Doctor Isn’t Telling You

Diet And Acne – What Your Doctor Isn’t Telling You

acne-and-diet

Acne is caused by a combination of the skin producing too much sebum and a build-up of dead skin cells which clog the pores and leads to a localized infection or spot. It is thought that excess sebum production is caused by hormonal fluctuations, which explains why around 80% of teenagers experience bouts of acne throughout adolescence. While there is no danger from the spots themselves, severe acne can scar as well as lead to anxiety, low self-esteem and depression.
For ages there’s been an exception to ‘you are what you eat’ saying- ‘Acne’. Doctors scoff at the idea and the web is littered with diet acne myth articles. But is it really so?
A landmark overview of research carried out over the past 50 years has found that eating foods with a high glycaemic load (GL) and dairy products not only aggravated acne, but in some cases triggered it, too.

Current diet-acne scenario

A positive correlation exists between consumption of dairy products and acne. A 2005 analysis titled “High school dietary dairy intake and teenage acne explored the possible associations between dairy-related foods and the incidence of physician-diagnosed acne. In an analysis of more than 47,000 teens, a positive correlation was found between acne and the intake of milk. The study noted that there was no difference seen between full-fat versus low-fat milk intakes in relation to breakouts. In other words, regardless of the type of cow’s milk, acne was still seen prevalently in the participants’ skin.
A similar analysis study conducted in 2006 titled “Milk consumption and acne in ` adolescent girls reviewed the affects of dairy on visible breakouts in young women from 9–15 years of age. Researchers concluded that greater consumption of milk was associated with higher prevalence of acne.”
Both studies also pointed to the hypothesis that the association with milk may be because of the presence of hormones and bioactive molecules, as well as its effect through the insulin like growth factor (IGF-1) pathway. Through these pathways, dairy intake may aggravate acne on a number of levels, including an increase in oil production, inflammation and abnormal hormonal activity.

2. A low-glycemic load diet has a positive correlation in the reduction of acne.

Regular consumption of high-glycemic load foods elevates insulin levels and may, in turn, stimulate sebum production and sebaceous cell prolifer¬ation. It concluded that the improvement in acne and insulin sensitivity after a low-glycemic load diet suggests that nutrition-related lifestyle factors may play a role in the pathogenesis of acne. This includes whole foods, such as fruits, greens, vegetables, brown rice and nuts.

3. Fruits and vegetables may help minimize signs of acne.

Rural cultures with diets high in fruits, nuts and root vegetables have been observed to have a very minimal incidence of acne. Studies point to whole foods, such as fruits and vegetables, as having a positive correlation with clear skin. This makes sense: Plants are, by and large, some of the strongest anti-inflammatory food sources available. By increasing daily intake of fruits, greens and vegetables, clients biologically increase their immunity and could potentially decrease signs of acne.

Choosing low Glycemic load (GL) foods

  • Only carbohydrates have a GL rating.
  • Because the body takes longer time to break lower GL foods hence they help you feel fuller for longer too.
  • High GL foods include sugary fizzy drinks, cakes, pastries, chocolate, white bread, potatoes etc.
  • Low GL foods include fruit and vegetables, wholegrain options such as brown pasta, brown rice, pulses etc.
  • Not overcooking your pasta and vegetables helps lower the GI.

Encourage and educate
Physicians are often first in line to work with clients suffering from acne. With the subject of diet and skin care becoming more mainstream, it is important that those working in the skin care community arm themselves with the information and know-how to advice clients about such matters.

• Keep a binder of studies in the waiting area. Allow clients easy access to such information, perhaps even highlighting important areas of note.
• Inform clients that research shows a positive correlation between high glycemic load diet/ dairy consumption and acne.
• Encourage healthy eating by suggesting an increase of more fruits, greens and vegetables. On average, a person eat less than two servings of fruits and vegetables a day, which is far below the minimum daily recommended serving size of 5–13. Plant-based foods are some of the richest anti-inflammatory resources available. An increase in these foods may decrease visible signs of inflammatory skin disorders, such as acne.

By bringing to light the diet-acne connection, the wheels start turning for clients to consider how their food choices affect their skin. It is important for skin care professionals to be at the forefront of emerging research and understand the nutritional connections to skin health. Providing sound and honest advice about skin care is crucial to enriching your individual practice. The more you are able to share with your clients, the deeper your relationships with them will grow.

Bibliography:
1. CA Adebamowo, et al, High school dietary dairy intake and teenage acne, J Am Acad Dermatol 52 2 207–214 (Feb 2005)

2. CA Adebamowo, et al, Milk consumption and acne in adolescent girls, Dermatol Online J 12 4 1 (May 2006)

3. RN Smith, et al, A low-glycemic-load diet improves symptoms in acne vulgaris patients: a randomized controlled trial, Am J Clin Nutr 86 1 107–115 (Jul 2007)

4. ML Nagpal, et al, Human chorionic gonadotropin up-regulates insulin-like growth factor-I receptor gene expression of Leydig cells, Endocrinology 129 6 2820–2826 (Dec 1991)

5. L Cordain, et al, Acne vulgaris: a disease of Western civilization, Arch Dermatol 138 12 1584–1590 (Dec 2002
6. http://howtostoyno.altervista.org/diet-and-acne/ (Accessed April 30 , 2015)

7. O Schaefer, When the Eskimo Comes to Town, Nutrition Today 6 6 8–16 (Nov/Dec 1971)

 

Dr. Rahul Chaudhary

M.B.B.S, MD(Dermatology)

Specialist Dermatology
 
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