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Dr K K Aggarwal

How to make bones strong

By Dr K K Aggarwal
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Everyone builds bone up to the age of 30, and then, the process of bone resorption begins. It is, therefore, important for children to build strong bones so that they are not susceptible to fractures when they grow old. Here are some tips:

• For maximizing big bone mass during the bone forming years, one should live a healthy lifestyle, which includes adequate calcium intake, adequate vitamin D intake, optimal physical activity and avoidance of smoking and alcohol.

• To prevent subsequent bone loss in adults, one should adopt a similar approach, which includes regular weight-bearing exercise, avoidance of oversmoking and limitation of alcohol to an average of not more than 2 drinks per day.

• Cigarette smoking is associated with reduced bone mass and increased risk of fractures.

• Calcium supplements are recommended. The recommended daily intake of calcium for post menopausal females is 1200 mg daily (double diet + supplements).

• Vitamin D supplementation is recommended if dietary intake is inadequate. In India, the recommendation is 2000 units per day.

• It is recommended that 40% of the body should be exposed to sunlight uninterrupted for 40 minutes for 40 days in a year so that the body can form adequate vitamin D.

• Regarding weight-bearing exercises, the general recommendation is a minimum of 30 minutes of physical activity such brisk walking on most, if not all, days of the week.

• Heavy alcohol intake predisposes to hip fractures due to osteoporosis.

• Heavy drinking means more than 14 drinks in a week. One drink is equivalent to 30 ml of whiskey.

• Many drugs including steroids and antiepileptic drugs can cause bone thinning over a period of time.

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All success stories are stories of great failures. The only difference is that every time they failed, they bounced back. This is called failing forward, rather than backward. You learn and move forward. Learn from your failure and keep moving. The third avtara of Vishnu, the boar, signifies the same. The answer is persistence in your objectives.

Here are few quotes and success stories

1. “So never mind these failures, these little backslidings; hold the ideal a thousand times, and if you fail a thousand times, make the attempt once more. The ideal of man is to see God in everything”. II.152 (Complete Works of Swami Vivekananda)

2. “It is in the nature of things that many should fall, that troubles should come, that tremendous difficulties should arise, that selfishness and all other devils in the human heart should struggle hard, when they are about to be driven out by the fire of spirituality. The road to good is the roughest and the steepest in the universe. It is a wonder that so many succeed; no wonder that so many fall. Character has to be established through a thousand stumbles”. VIII.383 (C W of SV)

3. “Therefore, stand up, be bold, be strong. Take the whole responsibility on your own shoulders, and know that you are the creator of your own destiny”. II.225 (CW of SV).

4. “Successful people don’t do great things, they only do small things in a great way”

5. “One day a partially deaf four year old kid came home with a note in his pocket from his teacher, “Your Tommy is too stupid to learn, get him out of the school.” His mother read the note and answered, “My Tommy is not stupid to learn, I will teach him myself.” And that Tommy grew up to be the great Thomas Edison. Thomas Edison had only three months of formal schooling and he was partially deaf”.

6. “Henry Ford forgot to put the reverse gear in the first car he made”.

7. “Thomas Edison failed approximately 10,000 times while he was working on the light bulb”

8. “Henry Ford was broke at the age of 40”.

9. “Lee Iacocca was fired by Henry Ford II at the age of 54”.

10. “Young Beethoven was told that he had no talent for music, but he gave some of the best music to the world”

 

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Low–temperature cooking reduces insulin resistance among overweight women as per a 4–week study published in the journal Diabetes Care by Alicja B. Mark, PhD, from the department of nutrition, exercise and sports, faculty of science, University of Copenhagen, Denmark, and colleagues.

Cooking at high temperature such as with baking, roasting and frying — induces formation of advanced glycation end products (AGEs), which are associated with inflammation and believed to impair glucose metabolism in patients with type 2 diabetes. Common high–AGE foods include bakery products, cooked meat and roasted coffee.

In the study patients randomized to a high–AGE diet were instructed to fry, bake, roast, or grill their food, eat bread with the crust and choose other high–AGE foods from a list. The low–AGE group was told to boil or steam their food, eat bread without the crust, and choose lower–AGE foods from a list. They were also randomized to supplements of either fructose or glucose.

At 4 weeks, no effect was seen from the fructose or glucose on insulin resistance, as assessed by the homeostasis model assessment of insulin resistance (HOMA–IR) and the calculated insulin sensitivity index (ISI) or on any secondary measures. But the AGE content of the diet did make a difference. Weight, BMI, and waist circumference all decreased in both the high– and low–AGE groups, but to a greater degree among those in the low–AGE group compared with the high–AGE group. Overall, the low–AGE group consumed about 15% more protein, 10% more carbohydrates, and 22% less fat than did the high–AGE group

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Smile is a sign of joy while hug is a sign of love. Laughter on the other hand is a sign of inner happiness.

Neither of them are at the level of mind or intellect. All come from within the heart. They are only the gradations of your expressions of your happiness.

It is said you are incomplete in your dress if you are not wearing a smile on your face.

Hug comes next… and laughter the last. Laughter is like an internal jogging and has benefits similar to meditation.

But be careful we must know when not to laugh. The most difficult is to laugh on oneself.

 


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Kidney patients can become pregnant

By Dr K K Aggarwal
Filed Under Wellness | Tagged With: , | | Comments Off

Pregnancy is not contraindicated in most women with diabetic nephropathy (kidney disease).

Maternal and peri-birth outcomes are generally good with tight control of sugar and blood pressure. Although mortality is low, maternal and neonatal morbidity are increased compared to non-diabetics and diabetic women without nephropathy. The major obstetrical complications are preeclampsia, fetal growth restriction and preterm birth.

Pre-conceptional treatment with drugs like angiotensin-converting enzyme inhibitors and angiotensin II receptor antagonists in women with microalbuminuria may have benefits that extend through the pregnancy. These agents should not be used during pregnancy as they are teratogenic.

Pregnancy does not appear to accelerate the progression of diabetic nephropathy in women with a mild to moderate decline in renal function.

Women with moderate to severe renal impairment (serum creatinine level >1.5 mg/dL, proteinuria >3g in 24 hours) may benefit from renal transplantation or dialysis therapy before initiating pregnancy.

 

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Doctors are regarded as God because their primary job is to save the life of a patient. In fact, they are the messengers of God to look after the health of the sick person. But, Doctors are God later and human beings first.

To err is human and every doctor is likely to make mistakes. The very fact that a doctor is getting himself insured under Indemnity insurance means that medical errors are recognized as a part and parcel of Government policies.

For any error, the Court has decided a financial compensation to the patient and that compensation is paid by the insurance company as the doctor is covered under the Indemnity insurance. Medical negligence on the other hand, if proved, is not covered under the insurance. Therefore, medical negligence has to be differentiated from medical errors.

The error of judgment and difference of opinion are accepted in the law as not negligence and there are ample Supreme Court judgments to support that. Medical accidents are also exempted from being termed negligence by various Supreme Court clarifications/judgments. For a doctor to be punished under medical negligence, there has to be a proof that he willfully did some omission or commission, which led to the death or caused harm to a person.

A doctor is also not required to possess the maximum degree of skill and knowledge but is required to possess only an average degree of skill and knowledge. Therefore, when an expert is called for an opinion, he should never give an opinion from his level of perception and knowledge but should take into consideration the knowledge of an average doctor of that specialty.

Recently, a friend forwarded a report to me, which showed that in US when the doctors went on a strike, the number of deaths in the city during the strike period reduced. I totally agree with this observation and I am of the firm opinion that if allopathic medical profession ceases to exit, the number of deaths per day will be reduced. But at what cost? It will invariably be at the cost of increased morbidity, impaired quality of life and more sufferings. In that scenario people with sexual dysfunction will live without enjoying sexual life; people with heart failure will live on the bed all the time, patients with TB will be back in sanatoriums, patients with fractures will be bedridden for months together and patients requiring orthopedic surgeries will remain with life–long deformities. To have a better quality of life, one has to pay the price as any intervention or surgery done to improve the quality of life invariably will carry some risk and mortality. Even a simple bypass surgery of the heart carries a mortality of up to 0.5–1%. But for the family whose patient dies that 1% mortality is 100%.

In a follow up program on Aaj Tak, the film actor, Aamir Khan had said that every household in India has a negative story to tell about medical doctors. Aamir probably misunderstood or could not differentiate medical errors, medical accidents from medical negligence. People equate money with medical success. Most of the medical disputes occur in private sector when the patient’s relatives have to pay money for an unsuccessful surgery or treatment. Attempts have been made to compare the results of medical treatment in India from that of abroad. They are totally incomparable as the amount of fee charged by doctors in India is practically a fraction of the fee that is charged in the west. The patient load in India per doctor is also responsible for potential medical errors.

One should also remember that the Drug Controller Government of India (DCGI) does not inform doctors about banned drugs, introduction of new drugs or introduction of new equipment. Most doctors depend on technology to be learnt through the manufacturers of respective machines. The manufacturers either bring the training persons from abroad or support the training of Indian doctors abroad. Their interest is ultimately covered as the doctors once trained ultimately end up in purchasing their technology.

When a new drug is launched, as there is no information from DCGI to individual doctors, they are forced to attend symposia by drug companies, which now come under the purview of an unethical doctor–pharma relationship.

Most doctors will write pharmaceutical drugs of a company, which people think is in lieu of a commission they are getting. The reality is that a doctor will invariably write a drug of a company who is constantly spending in efforts in educating doctors about new technologies and innovations as both Medical Council of India and the Government of India Health Ministry have no such provisions for the doctors. On the other hand, not attending medical educational programs is considered a professional misconduct

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5 foods that fight high cholesterol

By Dr K K Aggarwal
Filed Under Wellness | Tagged With: , , | | Comments Off

Oats give you soluble fiber. Add a banana or some strawberries to get more soluble fibers. Beans are especially rich in soluble fiber. They also take a while for the body to digest, meaning you feel full for longer after a meal.

Nuts: Eating almonds, walnuts, peanuts and other nuts is good for the heart. Eating 2 ounces of nuts a day can slightly lower LDL by about 5%. Nuts have additional nutrients that protect the heart in other ways.

Foods fortified with sterols and stanols. Companies are adding them to foods ranging from margarine and granola bars to orange juice and chocolate. They’re also available as supplements. Getting 2 grams of plant sterols or stanols a day can lower LDL cholesterol by about 10%.

Fatty fish. Eating fish 2 to 3 times a week can lower LDL in two ways: by replacing meat, which has LDL–boosting saturated fats and by delivering LDL–lowering omega–3 fats

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You cannot be stressed unless you know the person, place or the situation. The same situation may or may not cause stress unless it is interpreted in such a way that it is uncomfortable to the person, and then it ends up causing stress.

Management of stress, therefore, involves either removing the known situation or changing one’s interpretation or preparing the body in such a way that the stress does not affect mind and the body. But, removing the known situation may not be possible all the time. For example, if you are stressful in a job, resigning may not be feasible. The modality, therefore, is to change your interpretation towards the stressful situation i.e. start thinking positively and different and choose the resultant options within, which do not hurt the heart.

Changing of the interpretation is what in allopathy is described as cognitive behavior therapy, the origin of which comes from Ayurveda and in Bhagwad Gita where Lord Krishna counsels Arjuna following principles of Cognitive Behavioral Therapy.

In the first chapter, Lord Krishna only listens to Arjuna indicating the importance of listening, listening and listening. The second counseling session or the second chapter is the longest conversation between Arjuna and Krishna and shows the importance of first effective counseling session. From 3rd to 17th chapters, Krishna explains what he has conveyed in chapter 2 and this tells us the importance of reasoning out every doubt that a person under stress has. During this session, Krishna creates both fear as well as consoles Arjuna again indicating the importance of these two factors in counseling. In the last chapter, Krishna revises what he has taught, which is consistent with the last rule of counseling to make sure that the patient has learnt what has been taught to him.

Apart from counseling, one can also prepare the body in such a way that stress does not bother him. This can be done by learning the art of pranayam, relaxation, meditation, regular exercise, Dosh-specific diet and using certain Ayurvedic Rasayans, which sterilize the brain functions. Brahmi, an Ayurvedic herb, is one such Rasayan, which boosts the brain. Avoid taking allopathic anti–anxiety drugs, unless necessary which, of course, may be required in an acute panic state.

 

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