Does the baby's sex influence the mother's immune system? A new study investigates the link between fetal sex and the mother's immune response to illness. 

 

 

 A team of researchers from Ohio State University Wexner Medical Center set out to examine whether or not there is a connection between the sex of the baby and the mother's immunity.

The team was led by Amanda Mitchell, a postdoctoral researcher in the Institute for Behavioral Medicine Research at Wexner.

The research was triggered by both anecdotal evidence and scientific studies (referenced by the authors) that suggest that the sex of the fetus influences several physiological responses in the mother. Glycemic control, blood pressure, and cortisol levels have all been shown to differ according to the sex of the fetus.

In the new study, Mitchell and team examined 80 women in the early, middle, and late stages of their pregnancies. Of these future mothers, 46 were pregnant with males and 34 with females. Researchers exposed their immune cells to bacteria to see whether they responded differently depending on the sex of the fetus.

The new findings were published in the journal Brain, Behavior, and Immunity.  

 Female fetus raises pro-inflammatory cytokine levels

More specifically, Mitchell and her colleagues examined the levels of cytokines in pregnant women. Cytokines are signaling molecules that regulate immunity and inflammation.

They are sometimes called emergency molecules because they are released by the body to fight off sickness, as they help cells to communicate with each other when there is inflammation in the body. Cytokines are part of the body's natural immune response, but they can cause disease when released persistently. This is similar to how inflammation is a crucial component of the immune response, but too much of it can cause achiness and fatigue.

The study analyzed cytokine levels both in the blood and in the bacteria-exposed laboratory sample.

The findings suggest that women pregnant with girls may experience more severe symptoms of certain illnesses.

"While women did not exhibit differences in blood cytokine levels based on fetal sex, we did find that the immune cells of women carrying female fetuses produced more pro-inflammatory cytokines when exposed to bacteria. This means that women carrying female fetuses exhibited a heightened inflammatory response when their immune system was challenged, compared to women carrying male fetuses."

The increased inflammation noticed in this study could explain why women pregnant with female fetuses tend to have more severe symptoms of pre-existing medical conditions. Examples given by the researchers include asthma and allergies, which are both conditions appearing to be exacerbated when carrying a female fetus compared with a male one.

 More research is needed to understand exactly how pregnancy affects inflammation. Mitchell speculates that sex hormones, or other hormones found in the placenta, may affect inflammation levels.

"It is important to think about supporting healthy immune function, which does not necessarily mean boosting it - it is problematic to have too little or too great of an immune response," Mitchell adds. "That being said, research has shown that exercise supports healthy immune functioning, as does eating some foods, like leafy greens, and relaxing with activities like meditation. Of course, it is always important to check with your healthcare provider before making any changes to your routine or diet," she notes.

Furthermore, the authors point out that more information is required on the relation between fetal sex and other pre-existing medical conditions in the mother (such as preeclampsia), as well as negative pregnancy outcomes (such as preterm birth).

Allergenic foods are basically foods that are known to cause allergies in certain individuals.

If you suspect that your child has a food allergy, you should keep a food diary. Be sure to list everything that you feed her, and keep the labels of any commercial products as well to show the doctor. Photos: Positive Parenting

A food allergy is a result of an immune system response to the presence of specific food types. It is different from food intolerance, which is a digestive system response (e.g. what happens when your child’s body has difficulty digesting food).

There are eight major types of allergenic foods, namely milk, eggs, fish, crustacean shellfish, tree nuts, peanuts, wheat and soybean.

Recognising food allergy

In general, the symptoms associated with food allergies can be difficult to connect to specific foods. Typical allergy symptoms include hives; flushed skin or rash; mouth feels tingly or itchy; face, tongue or lip swelling; vomiting and/or diarrhoea; abdominal cramps; coughing or wheezing; dizziness and/or light-headedness; swelling of the throat and vocal cords; difficulty breathing; and loss of consciousness.

Since young children may not know how to adequately describe the symptoms, they may say things like “My mouth feels tingly” or “My tongue feels heavy/numb”. The key is to stay alert for any signs of distress which could indicate an allergic reaction.

Food allergies often cause symptoms within two hours of ingestion, with some reactions happening within minutes. However, there are very rare cases where the reaction is delayed by up to six hours or more.

There is another type of food allergy with delayed reaction known as Food Protein-Induced Enterocolitis Syndrome (FPIES). This is a severe gastrointestinal reaction which usually occurs two to six hours after consuming milk, soy, certain grains or certain solid foods.

It typically occurs in young infants exposed to these foods for the first time. FPIES can lead to episodes of repetitive vomiting, which in turn can lead to dehydration. Some babies will even develop bloody diarrhoea.

While food allergies can be serious, there are steps you can take to manage this condition. Once food allergy is suspected, a diagnostic test should be done to complement the clinical history. This is done via a skin prick test or a blood test.

Handling food allergy

These are the typical symptoms of a food allergy.

 Once you have ascertained that your child has a food allergy, the best thing that can be done is to avoid the food in question, especially if she exhibits a severe reaction. Do note that if she has an allergy to a specific food, she may also be allergic to other related foods, e.g. one who is allergic to shrimp may also be allergic to crab.

Pay more attention to the ingredients list when you go grocery shopping.

Major allergenic foods may be listed clearly, e.g. “lecithin” (soy), “flour” (wheat), and “whey” (milk).

Some manufacturers may use a statement on the packaging stating that their product contains certain ingredients, e.g. “contains wheat, milk, and soy”.

There are also some manufac­turers who list allergenic foods as “binder” or “emulsifiers”, which could signal the presence of eggs or soy respectively.

If you suspect that your child has a food allergy, you should keep a food diary. Be sure to list everything that you feed her, and keep the labels of any commercial products as well.

This will be a great help in assisting your paediatrician/allergist in determining if she is indeed allergic to any foods. Your child’s paediatrician/allergist will take any family and medical history necessary and carry out any relevant tests to determine if a food allergy exists.

If you do discover that your child has a severe reaction to certain foods, be sure to inform her school and caregivers about her condition. It may be helpful to provide them with an emergency card detailing how to prevent, recognise and manage her food allergies.

Sometimes all it takes is something small: exposure to a cold draught, sleeping on the wrong pillow or sitting tensely at a computer for a long time.

Poor posture puts undue strain on muscles. Taking a few simple precautionary measures, however, generally proves effective. Photo: dpa

You wake up the next morning with a neck so stiff that you can hardly turn your head. It’s a problem almost everyone has had.

“Extended sitting, poor posture at an office, unaccustomed or uneven strain on the body, and also, stress can cause neck tension,” says physiotherapist Ute Merz.

Poor posture puts undue strain on muscles. Taking a few simple precautionary measures, however, generally proves effective.

“If you sit in an office all day, you should make sure that your workplace is ergonomically friendly – for example, that the computer-monitor viewing angle, chair height and lighting are right,” Merz says.

It’s also important to change your seating position as often as possible. She advises standing up more frequently, making telephone calls while standing every once in a while, and consciously sitting down with your neck and back straight.

Although neck pain normally goes away by itself after a few days, the first signs of tension shouldn’t be ignored, she says.

If exercises to counteract it aren’t begun immediately, she warns, there’s a risk of recurrent headaches.

“Tension in certain neck muscles is closely linked to migraine attacks,” notes Dr Florian Heinen, a neuropaediatrician.

People should see a doctor if they’re unable to get rid of their neck pain themselves.

The same goes if the pain radiates into their arms or their hands suddenly go numb.

The problem could be a pinched nerve or spinal damage.

“Sometimes, muscle tension has the protective function of preventing certain motions when there’s a spinal disorder,” says Dr Bernd Kladny, an orthopaedic and casualty surgeon.

A definite cause such as a herniated disk that’s putting pressure on nerves must be treated immediately, but such cases are fairly rare. An examining doctor frequently finds no physical problem.

“Sometimes, the culprit is what’s colloquially called locked-up joints,” Dr Kladny says.

In this case, flexibility must be restored to the cervical vertebrae in the neck by means of a cervical manipulation, also known as a chiropractic adjustment, or stretching therapies.

Treatment is more complicated if neck tension has become chronic, that is, has persisted for three months or more. “When pain is chronic, it becomes an illness itself and a cause is frequently no longer found,” Dr Kladny says.

Psychological factors typically play a key role. Stress leads to muscle tension, and persistent muscle tension can lead to anxiety and depression, causing more stress.

To break this vicious cycle, individual treatment plans must be made that also take the patient’s mental health and social environment into account. – dpa

Calcium is important for optimal bone health throughout your life.

Although diet is the best way to get calcium, calcium supplements may be an option if your diet falls short. Photo: TNS

The mineral is also a component of the plaque that develops in your heart arteries if you have atherosclerosis, or hardening of the arteries.

Does this mean taking calcium increases your risk of heart disease and heart attack?

Authors of a study published in the Journal Of The American Medical Association examine this issue and found that, when taken in supplement form, calcium may increase a woman’s risk.

But the opposite is true when consuming calcium-rich foods. In that case, calcium is good for your heart.

Although diet is the best way to get calcium, calcium supplements may be an option if your diet falls short. Before you consider calcium supplements, be sure you understand how much calcium you need, the pros and cons of calcium supplements, and which type of supplement to choose.

Your body needs calcium to build and maintain strong bones.

Your heart, muscles and nerves also need calcium to function properly.

Some studies suggest that calcium, along with vitamin D, may have benefits beyond bone health: perhaps protecting against cancer, diabetes and high blood pressure. But evidence about such health benefits is not definitive.

Your body doesn’t produce calcium, so you must get it through other sources.

Calcium can be found in a variety of foods, including:

• Dairy products, such as cheese, milk and yoghurt

• Dark green leafy vegetables, such as broccoli and kale

• Fish with edible soft bones, such as sardines and canned salmon

• Calcium-fortified foods and beverages, such as soy products, cereal and fruit juices, and milk substitutes

To absorb calcium, your body also needs vitamin D. A few foods naturally contain small amounts of vitamin D, such as canned salmon with bones and egg yolks.

You can also get vitamin D from fortified foods and sun exposure.

The recommended dietary allowance (RDA) for vitamin D is 600 IU (15 mcg) a day for most adults. – Mayo Clinic News Network/Tribune News Service.

Has your hand ever trembled while performing a really important task? Perhaps it was in a competition setting where time was rapidly running out, or during a delicate task like threading a needle.

Many elderly people believe that tremors are a part of ageing, but tremors can be treated if it interferes too much with their daily activities.

Many of us would have experienced this type of tremor at one time or the other.

England-based consultant functional neurosurgeon Dr Ian Low says: “Tremor is normal. All of us have a tremor – it’s called a physiological tremor.

“It becomes pathological when it becomes very severe; and this is due to a breakdown in the feedback circuits to the tremor itself, but we don’t really know the exact mechanism.”

Dr Low says that tremors are due to a breakdown in the feedback circuits of the brain, but the exact mechanism remains unknown. Photo: The Star/Tan Shiow Chin

The Queen’s Hospital’s surgical lead for functional neurosurgery in London explains that a tremor is defined as a neurological condition characterised by involuntary oscillation of a part of the body – with emphasis on “involuntary”.

It can be caused by many conditions, including Parkinson’s disease, stroke, brain injury and metabolic disorders.

However, the condition that, by far, most commonly causes tremors is called essential tremor.

Dr Low notes that: “Essential tremor is the most common movement disorder in the world.

“In fact, it is much more common than Parkinson’s disease, but Parkinson’s disease gets all the attention and the funding.

“So this is actually a hidden condition, but its impact is very, very great.”

In Malaysia, there are about 15 new cases of Parkinson’s disease diagnosed every year for every 100,000 people in the population.

However, Dr Low says that essential tremor cases are between three to 20 times more frequent than Parkinson’s disease.

One of the reasons he thinks that it is not diagnosed as much as it should be is because many people think that getting a tremor is a part of old age, and thus, do not seek medical attention for it.

Another reason is more insidious; as alcohol tends to suppress essential tremors quite well in the initial stage, many people tend to self-medicate by drinking.

However, the worse the tremors get, the more they drink, and the more likely other people are to attribute their tremors to their alcohol addiction.

“So people then say if you have a tremor, it means you are an alcoholic.

“But actually, it was the tremor that caused the alcoholism, rather than the alcoholism being the cause of the tremor,” he says.

Types of tremors

According to Dr Low, there are three major forms of tremors: tremor at rest, postural tremor, and action or intention tremor.

A tremor at rest is a tremor that occurs even when you are not doing anything, while a postural tremor occurs when you stretch out your hands, he explains.

“And the final one is when you are actually trying to do something with a limb – usually the hand, and less commonly, the leg – that is called an action or intention tremor,” he says.

Dr Low notes that the tremor at rest is typically – although not always – associated with Parkinson’s disease.

A Parkisonian tremor looks like the patient is rolling a pin and only occurs at rest, disappearing as soon as the patient attempts to do something.

Meanwhile, postural or intention tremors are most likely due to essential tremor, he says.

Intention tremors are particularly disabling as the tremor gets worse the closer you get to the target of your action.

For example, if you are reaching out to take a sip of water, the tremor becomes increasingly worse the closer the hand gets to the cup, then subsides after grasping the cup. Then, the closer the cup comes to the mouth, the worse the tremor gets again.

“Action tremors are incredibly disabling as we use our hands to do a lot of things that need purposeful movements; action tremors prevent you from doing purposeful movements – you cannot write, you cannot hold a cup, you cannot do your buttons,” explains Dr Low.

“In very severe cases, they cannot feed themselves, they cannot clean themselves.”

He emphasises that: “The most important thing about the management of tremors is that you have to get the diagnosis correct, because there are many, many conditions that mimic essential tremors, for which the treatment is completely different.”

However, he says that essential tremor is a very difficult diagnosis to make, with neuro-logists likely to misdiagnose it in up to 20% of cases, according to the latest studies.

“Neurology is not actually an exact science, it is nothing but recognising patterns – there’s no black-and-white in neurology.

“And that’s why long-term follow-up is required because the tremor pattern will become more apparent with time – sometimes it may be very clear cut, but other times, it is not.”

When treatment is needed

The necessity for treatment really depends on the patient’s perception of how much their tremors affect their quality of life.

“Once you’ve decided what kind of tremor the patient has, the treatment varies depending on the severity of the condition, and also, the patient’s characteristics,” says Dr Low.

If the tremor is slight and the patient does not find it too disturbing, it can just be monitored.

If, however, the tremor is severe enough to significantly disturb the patient’s daily activities, then treatment according to the condition causing the tremor is indicated.

For Parkinsonian tremors, the treatment targets the Parkinson’s disease itself. Options include a number of drugs, including levadopa, which is the gold standard treatment, according to Dr Low.

He adds, however: “It has to be emphasised that the tremor of Parkinson’s disease is very difficult to control with medications, for reasons we don’t understand.

“So, if you have Parkinson’s where the main problem is tremor, medication is mainly effective in only about 30%-40% of cases.”

Drugs are also one option in the treatment of essential tremors.

According to Dr Low, these include beta-blockers like propanolol, which are effective in 50%-60% of cases, but cannot be taken by those with low blood pressure, heart problems, breathing difficulties and diabetes; primidone, which is very effective in controlling tremors, but tends to make patients feel disorientated, unsteady and unable to think properly; and other less effective drugs like topiramate, gabapentin and benzodiazepine, which only work in about 30% of cases and cause drowsiness.

If the tremor is localised to the head or vocal cords, Botox injections are an option.

Dr Low explains that these injections are impractical in other parts of the body, like the hands, as they would paralyse the muscles.

Other non-medical methods to help mitigate the effects of tremors include calming techniques, like meditation, as anxiety increases the severity of the tremors, and using assistive devices like weighted utensils to help counter the effect of the tremors.

Treating surgically

The next option, once the tremors become too disruptive to the patient’s life, is surgery.

“There are two surgical methods for tremor: one is radiofrequency lesioning and the other is deep brain stimulation,” says Dr Low.

“Radiofrequency lesioning involves destroying the small part of your brain that controls the tremor.

“And this can be done by putting a wire into your brain and heating the end of the wire such that it burns a hole in the brain.”

The advantages of this procedure is that it is relatively cheap, quick, has been proven safe over the long term, and very effective, with relatively few side effects for a single-sided lesioning.

Dr Low notes that lesioning is not done on both sides of the brain as there is a very high chance of decrease in thinking function in such cases.

The procedure requires a very skilled neurosurgeon as “once you destroy that part of the brain, it is gone – there are no second chances”.

Also, both essential tremor and Parkinson’s disease progress with time; this means that after a few years, the tremor is likely to return, and another procedure would be necessary.

According to Dr Low, there are two other methods of lesioning that do not require opening up the brain, i.e. radiosurgery and magnetic resonance-guided focused ultrasound.

However, neither of these techniques are very effective.

The other surgical option is Dr Low’s particular area of expertise: deep brain stimulation.

“Deep brain stimulation is the most commonly accepted surgical technique for |tremor control in developed countries,” he says, noting that many developing countries that cannot afford this technique still use radiofrequency lesioning.

In deep brain stimulation, microelectrodes are passed through a five sen-sized hole in the brain to the area that controls the tremor.

Once it is in the right position, the neurosurgeon adjusts the electric current to stop the tremor, as well as to test for any side effects like double vision and one-sided muscular contractures.

“The ideal spot is the one that will stop the tremor and has no side effects.

“And that’s why the patient needs to be awake for this part,” he says, explaining that the patient needs to give feedback as to the side effects they may experience. The patient is under local anaesthetic at this point in the procedure.

Once the ideal spot is located, the neurosurgeon will then put in the permanent electrode, sending the patient for magnetic resonance imaging (MRI) to ensure that it is in the right place and that there is no bleeding in the brain.

Then the patient is given general anaesthesia so that the neurosurgeon can run the extension wire from the electrode under the skin to a neurostimulator, also called a brain pacemaker, placed just under the collarbone.

Dr Low says that the entire procedure usually takes approximately eight hours and the patient can return home the next day.

“Then we bring them back to the hospital in about two to four weeks’ time to check the wound, programme their neurostimulator and teach them how to use their own personal programmer,” he said.

He adds that the patient might need more than one programming session, but once they find the right programme – that is, the right pulse width, amplitude and frequency of the current – it usually stays unchanged for years.

On average, a patient undergoing deep brain stimulation will see a 74% reduction in their tremors, and research has shown that this will remain stable for at least 10 years.

“It is the most effective form of treatment for tremor-dominant Parkinson’s disease,” Dr Low adds.

In addition, it can be done on both sides of the brain, unlike radiofrequency lesioning, and any side effects can be managed instantly by adjusting the neurostimulator.

“But it is expensive and it needs follow-up,” says Dr Low, adding that in Britain, deep brain stimulation costs about £30,000 (RM166,314), while radiofrequency lesioning costs half of that.

Some of the other disadvantages of the procedure include having a foreign body (the electrode, wire and neurostimulator) in the body and needing to change the neurostimulator’s battery on average once every four years for Parkinson’s patients and six years for essential tremor patients,

These patients will also face limitations when it comes to undergoing an MRI and certain types of surgery, as well as if they require a cardiac pacemaker for heart problems.

According to the World Health Organization (WHO), physical inactivity is the fourth leading cause of disease and disability worldwide.

Kids going through cycling exercise drill at Zac & Zibbo.

In spite of this scary fact, the National Health and Morbidity Survey (NHMS) 2015 showed that about one-third of adult Malaysians are physically inactive.

Many studies show that regular exercise can reduce the risk of non-communicable diseases such as heart disease, type 2 diabetes, stroke and cancer.

Let us discuss in greater detail why it is important not to lead a sedentary lifestyle and see how we can all get up and move.

Malaysians are inactive

The NHMS 2015 indicated that over 60% of adults were physically active. However, if we examine the findings in greater detail, it shows that the majority of these adults are only minimally active.

The reasons given by some for not taking up physical activities were: too difficult, not rewarding, uncomfortable, dangerous, or just generally uninteresting.

The NHMS report also indicated that adults with primary, secondary and tertiary education were more physically active than those with no formal education.

Even our younger generation is starting to give in to this culture of physical inactivity. In one study, Malaysian children recorded low physical activity levels and high sedentary behaviour, spending an average of almost seven hours daily in sedentary activities.

In contrast, the Malaysian Dietary Guidelines recommends to limit sedentary activities such as watching television, sitting or lying down to only two hours or less in a day

Participants of the World Heart Day Mini Olympic doing an aerobic dance before the competition started

 A sedentary lifestyle can increase all causes of mortality, double the risk of cardiovascular diseases, diabetes and obesity, and increase the risks of colon cancer, high blood pressure, osteoporosis, lipid disorders, depression and anxiety.

This growing problem, left unresolved, would lead to an overall depreciation of quality of life that would not only affect individuals, but also families, and certainly, the nation at large.

Being more physically active

The importance of physical activity to health is well recognised. Being physically active everyday, which should begin from a young age, can help to:

• Prevent chronic diseases (e.g. heart disease, diabetes, cancer).

• Maintain a healthy weight, thus preventing overweight and obesity, which are underlying risk factors for other major non-communicable diseases.

• Increase strength and performance of bones, muscle and joints.

• Improve mental and neurological health (e.g. improves mood, reduces symptoms of depression and anxiety).

• Improve overall health and wellbeing.

You should try to be more physically active every day in as many ways as possible any time you get a chance to. Whether it’s in the house, at the office or while doing routine everyday tasks, physical activity should be practised and encouraged.

It would help to first get yourself into the right mind set. Think of physical activity and movement as an opportunity to exercise and stay healthy, instead of an inconvenience. Making exercise a habit requires the right mindset and a smart approach. Once you incorporate physical activity as part of your daily routine, it will eventually become a habit. You will even learn to enjoy it.

You can refer to the Malaysian Physical Activity Pyramid, which can guide you on how to be physically active every day.

The base of the pyramid illustrates the kind of activities you should do most often on a daily basis. Meanwhile, the top of the pyramid indicates the type of sedentary activities or habits you should limit or spend less time doing.

Get your children to move

Physical activity should also start from young so that this habit will continue in later life. For families with children, physical activity also presents an opportunity to spend quality time together. Weekends can be spent hiking or trail-walking in a nearby forest park, cycling around the neighbourhood, jogging around the park, row boating, competing in family walkathons or other activities that require a lot of movement, but are also fun for the whole family.

The Malaysian Dietary Guide-lines for Children 2013 recommends that children accumulate at least 60 minutes of moderate-intensity physical activity daily. Examples of moderate-intensity activities include running and chasing, cycling, swimming, football and badminton.

In addition to getting children to move more, it is also important to reduce the amount of time children remain sedentary. Set rules at home as to how much time can be spent watching TV or at what time of the day it is allowed.

The same goes to other electronic gadgets (e.g. smart phones, tablets, PC’s, gaming consoles).

Motivation to move forward

Another strategy to help you stick to the habit of being more physically active is to exercise with colleagues from office, or get a friend or your partner to commit to exercising with you.

That way, you have someone who can accompany you and keep you motivated to continue the habit – everyone involved benefits!

Setting achievable milestones and personal goals that you can pursue is also another great way to stay motivated (i.e. join marathons or participate in tournaments).

You could also motivate yourself by emulating certain role models whose philosophy and actions in life represent health, vigour, physical strength and other positive values.

Similarly, you should be a good role model for your children as well.

Aim to achieve 10,000 steps a day, which is roughly equivalent to an hour of brisk walking. You can even opt to break this up into two, 30-minute sessions.

You can also monitor your daily steps through various apps available on your phone, using a pedometer or a smart watch/wrist band.

It not only helps to track your pace, distance and the number of calories burned, it also enables you to share your walking adventure with friends.

A journey of a thousand miles starts with a single step. It is not too late for you to start being physically active if you really put your heart and mind to it.

Teach your children to be physically active early on.

Besides being physically active, you should also adhere to a balanced and nutritious diet that includes various foods from the different food groups.

Mention ER and you’re likely to associate it with the popular hit series starring George Clooney that lasted 15 years and scored a whopping 124 Emmy nominations.

Primarily associated with obstetrics and gynaecology at one point in time, the ultrasound has become a useful tool in the area of emergency medicine and critical care.

 Or it might remind you of the eccentric Dr House engaging the audience with solutions to baffling medical cases in House.

Or the ensemble cast of Grey’s Anatomy, Night Shift or Code Black.

Drama series and interesting characters aside, have you ever wondered what happens in the emergency room in real life?

A night like any other

It was drizzling lightly at midnight when 28-year-old James cruised down the Federal Highway in Kuala Lumpur. He stepped on the accelerator, eager to reach his destination to meet a good friend.

All of a sudden, he hit a puddle on the road, losing control as his car spun into the side railings. He hit his chest against the steering wheel, knocking the breath out of him for a moment, and blacked out.

The next moment he woke up groggy, gasping, in the Emergency Room, barely aware of being examined.

“Low BP, mild tachycardia and peripheral pulses at low volume. PR at 102/min, BP 92/54mmHg. ECG stat done,” said the medical officer on duty as he updated the physician in attendance – usually referred to as Doc by his colleagues – handing him some data from the ECG.

Seeing the low voltage recordings on the ECG, Doc zeroed in on the observations he thought were the most significant.

“Distended neck veins. Muffled heart sounds. Low Blood pressure. Seems like a classical Beck’s triad.”

To confirm his suspicions, Doc performed an echocardiogram, using ultrasound to visually display what was happening in the patient’s heart.

It was immediately evident that the problem was a pericardial effusion, possibly from internal bleeding into the pericardial space around the heart.

He immediately called the nurses to assist, preparing to extract the blood to relieve the pressure with a pericardiocentesis procedure guided by the ultrasound display.

James’ vital signs improved immediately as 30cc of blood was drained from his chest, allowing the doctor to do a CT scan of the region and another surgical incision to arrest the bleeding.

Just when Doc thought it was over for the night, a nurse called him for another case.

Forty-eight-year-old Kamala was rushed into the Emergency Department with complaints of experiencing shortness of breath and restlessness.

Nurses already noted that her oxygen saturation was critically low at 80%.

At this level, brain and heart functions would be affected, with the possibility of respiratory or cardiac arrest.

Even with additional high flow oxygen, the medical team could not achieve 90% oxygen saturation.

Observing the patient and the data charts, Doc saw that she was morbidly obese, diabetic and hypertensive, with high sugar levels and an arterial blood gas pH of 7.14, bicarbonate 8 and potassium at 7.2.

Speaking to the critical care physician (intensivist) on duty, Doc shared his working diagnosis: diabetic ketoacidosis with impending collapse.

“She’s diabetic and not getting enough insulin. It’s going to be very difficult, but we need to intubate her and maybe induce a coma.

“Get me an ultrasound on her, she might need an emergency surgical airway. Let’s try an awake intubation first.”

The intensivist gave Kamala a mild sedative to calm her down, and quickly attempted to insert a breathing tube down her throat, but to no avail.

“Doc, I can’t get a clear visual of the vocal cords. We need that surgical airway.”

Luckily, the cricothyroid membrane was identified earlier with the help of the ultrasound. Doc proceeded to create a small incision to insert an airway branula and connected it to a jet insufflator, an apparatus to help her breathe.

Averting a life-threatening situation, they transferred her to the ICU for further care and observation.

Doc stretched his shoulders and took a short break, relieved that clinical acumen, timely intervention and the right instruments at hand saved these patients tonight.

Emergency medicine today

Emergency medicine has come a long way and is now a highly sophisticated, evidence-based practice.

Primarily associated with obstetrics and gynaecology at one point in time, ultrasound has become a useful tool in the area of emergency medicine and critical care.

Focused Assessment of Sonography in Trauma (FAST) uses ultrasound to effectively assess trauma patients for major bleeds and other conditions that could be life-threatening if not addressed at the earliest opportunity.

In recent years, most emergency rooms have been equipped with an ultrasound machine, proving again and again to be a game changer in saving lives.

In its infancy, ultrasound was used to detect intra abdominal fluid collection, which in the context of trauma, is blood until proven otherwise.

It later evolved to include the lungs and heart as part of Extended FAST (EFAST).

Major life-threatening conditions can now be diagnosed within the first few minutes of patients arriving at the Emergency Department.

With the array of medical equipment available, medical officers, or in certain specialised hospitals, an emergency physician on duty, can channel their knowledge and expertise to instantly arrive at a conclusive diagnosis to save lives, just like in reel life

Dr Paranthaman Kaneson is a consultant emergency physician. For further information, e-mail starhealth@thestar.com.my. The information provided is for educational and communication purposes only and it should not be construed as personal medical advice. Information published in this article is not intended to replace, supplant or augment a consultation with a health professional regarding the reader’s own medical care. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.

Although the objective of surgery is to save lives, surgery can also cause harm. Photo: AFP

Surgery is often the only treatment for many common conditions.

It can be arranged electively or as an emergency.

The former is scheduled in advance by the patient and/or the doctor, and the latter is provided in trauma or acute conditions that present as an emergency.

Emergency surgery includes unplanned surgery for patients admitted in an emergency and unplanned surgery for patients awaiting elective surgery.

Although the objective of surgery is to save lives, surgery can also cause harm.

According to the World Health Organization (WHO), the risks of surgery include reported crude mortality rate after major surgery of 0.5%-5%; complications after inpatient operations in up to 25% of patients; and nearly half of all adverse events in hospitalised patients in advanced economies are related to surgical care.

At least half of the cases in which surgery led to harm are considered preventable.

The Health Ministry reported 1.039, 1.033 and 1.052 million surgical operations in its hospitals in 2012, 2013 and 2014 respectively.

There were one, one and five reports of “wrong” surgery in 2013, 2014 and 2015 respectively, of which three were wrong site surgery.

There were 13, 17 and 15 reports of unintended retention of foreign bodies in the Health Ministry, armed forces and private hospitals in 2013, 2014 and 2015 respectively, involving 11 hospitals each year. (Source: http://patientsafety.moh.gov.my/uploads/pscbook/pscbook.html; Accessed March 20)

Whilst hospitals and surgeons do their best to ensure that surgery is as safe as possible, there is much an individual patient can do for himself/herself.

Need for surgery

Discussions on the need for surgery should be carried out with the surgeon performing the procedure, and not a proxy, irrespective of whether it is another doctor or nurse.

Some of the following questions may help guide discussions.

• Why is surgery necessary?

• Are there alternatives to surgery, and if so, what are they?

• What are the risks of not having surgery?

• What does the surgical procedure involve?

• What are the expected benefits and risks?

• Is there a waiting list?

• What should be done if the condition improves or worsens while waiting for surgery?

• What are the anaesthetic risks?

• How can one prepare for surgery?

• What should one expect after surgery?

• What is pain after surgery like and how will it be managed?

• How long does it take to recover and what is the follow-up care needed?

• What should be done if one changes the mind about surgery, if rescheduling is requested, or if the condition improves and one feels that surgery is no longer needed?

The above questions are not exhaustive and individual patients and/or caregivers are advised to ask any and everything that comes to mind about the proposed surgical procedure before agreeing to it.

Knowledge about what to expect before, during and after surgery helps to ease patients’ fears and enables them to play an active role in their recovery.

Such information is available from the surgeon, patient information leaflets and reliable websites.

This means not being shy about asking questions and not agreeing to anything until it is fully understood.

The provision of detailed information about an individual’s medical history will assist the surgeon, as will information about any previous surgery.

It is important to inform the surgeon of all medications that are currently being consumed, including how much, how often and when they were last taken.

This should include all over-the-counter medications and supplements, such vitamins, creams, etc, as well as traditional medicines.

If one is unsure, assistance may be sought from one’s regular doctor or caregiver.

The medications can also be shown to the attending doctors.

Medication errors are not uncommon. As such, it is essential that medication information is communicated accurately and completely from admission to discharge from the hospital.

Surgical check list

It is important that all safety measures are undertaken, irrespective of whether the surgical procedure is minor or major.

The WHO surgical safety checklist, developed as part of its global patient safety programme, has been proven to keep patients safe during surgery.

It is a set of questions and reminders that surgeons and their surgical teams confirm with patients and each other before, during, and after the surgery.

There are three parts in the checklist – the briefing prior to administration of anaesthesia is completed with the patient, surgeon and surgical team; time-out is completed by the surgeon and surgical team before a cut is made in the patient’s body to facilitate the procedure (incision); and debriefing is completed by the surgeon and surgical team before the patient leaves the operating room.

The pre-anaesthesia briefing involves the patient being asked to confirm his/her name, date of birth, any medical conditions, previous surgeries, any allergies and medications, and any other relevant questions; all of which have to be answered fully.

Sometimes, the operative site is marked with a non-irritating skin marker. If the marker is on the wrong side of the body, the nursing and medical staff should be informed.

In short, clarifications should be sought if there is anything unclear or not understood.

The surgeon and surgical team should be asked if the WHO surgical safety checklist is being used.

If not, they should be asked what procedures are in place to ensure safe surgery.

After the surgery

Some patients are discharged on the same day as their surgery while others require hospitalisation.

In all instances, prior to discharge from the hospital, the patient should be breathing normally, able to eat and there is effective pain control.

The instructions on discharge should include which medications are safe to consume and when, including medications taken regularly; the level of activity that is safe; what food to eat; use of special equipment, e.g. crutches, nebulisers, etc; sexual activity; and any other instructions specific to the surgical procedure.

Infection(s) can affect the surgical incision site and other organs such as the lungs, urinary tract, gastrointestinal tract and so on.

The patient should be provided detailed instructions on how to take care of the incision site.

This will vary depending on the type of surgical procedure and the individual’s health situation.

Similar instructions should be given if there are infections in other organs.

A follow-up appointment is usually given.

If there are any questions, concerns or one feels unwell after discharge, there should be no hesitation in contacting the surgeon.

The above measures will assist surgeons and hospitals in ensuring that surgery is as safe as is possible

Dr Milton Lum is a past president of the Federation of Private Medical Practitioners Associations and the Malaysian Medical Association. The views expressed do not represent that of any organisation the writer is associated with. The information provided is for educational and communication purposes only and it should not be construed as personal medical advice. Information published in this article is not intended to replace, supplant or augment a consultation with a health professional regarding the reader’s own medical care. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.

Pain can be debilitating, or annoying, especially if you cannot find the cause.It can also be difficult to describe accurately.

For some people, pain can be temporary and easily fixed with medications, but for others, it could spell a lifetime of “hell”.

The International Association For The Study Of Pain (IASP) defines pain as an unpleasant sensory and emotional experience associated with actual or potential tissue damage.

“It’s a sensation just like cold or heat, but pain also evokes emotion. Each individual’s experience is different,” says Dr Mary Cardosa, consultant anaesthesiologist and pain specialist.

Pain can generally be categorised as nociceptive pain and neuropathic or nerve pain.

While nociceptive pain is related to the nociceptive sensory nerve, which senses and reacts to external factors that may harm or threaten the body, nerve pain is due to an injury or malfunction of the nervous system.

“The type of pain most people have experienced is acute or short term pain, often associated with tissue injury. It has a protective function, and though unpleasant, you need this kind of pain, or else you won’t know when you injure yourself. It is resolved when the injury is treated or healed,” says Dr Cardosa.

The other kind of pain, which is difficult to understand, is chronic pain as it goes on beyond the healing period, usually more than three months.

Examples include peripheral neuropathy cause by diabetes, chronic back pain and fibromyalgia. Scans and tests come out normal, and doctors cannot find the root cause, leading to frustrated patients.

Dr Cardosa explains, “Chronic pain is called a disease of the pain signalling system or nervous system. In chronic pain, there is no tissue damage or the tissue has already healed, and yet, the pain sensation persists.

“No one knows why chronic pain exists, how it occurs and who are the people in which it occurs. People used to think this group was ‘crazy’ and that the ‘pain is in their head’, but the pain is real! Something has gone wrong.”

When the pain is related to nerves, it is caused by a lesion or disease of the somatosensory nervous system. For example, this could occur after a spinal cord injury, brachial plexus injury or stroke.

“They cannot walk, they cannot feel their legs, but there is pain at the site. This is distressing to the patient.

There is also something called phantom pain where the leg has been amputated but the patient still feels the leg and pain.

“Despite having no limb, the nerves that represent the leg and that part of the leg which is represented in the brain is still there.

“Your brain and spinal cord retains a memory of the leg, and if that memory includes a painful episode before the amputation (i.e. trauma), then the chances of chronic pain are higher.”

According to a 2015 article published in the American Society for Pain Management Nursing, 7.1% of the general Malaysian adult population suffer from chronic pain.

Apart from being a financial burden, prolonged chronic pain can also bring about depression, exhaustion, loss of appetite and mood swings.

More often than not, chronic pain is idiopathic (no known cause), especially when it involves trigeminal neuralgia (pain in the face), says Dr Cardosa, who is also the president of the Malaysian Association For The Study Of Pain and one of the pioneers of the development of clinical services, health workforce education and pain research in Malaysia.

“The shooting electrical sensation is triggered by brushing your teeth or washing your face and it’s a horrible feeling. In some cases, it’s found that the fifth cranial nerve lies very close to an artery that is near that area of the brain.

“It’s thought that the throbbing of the artery disturbs the nerve. Treatment can be surgery where you put a piece of cloth in between the artery and the nerve to try to protect the nerve.”

Sadly, for most cases of neuropathic pain, the damage has already been done and cannot be reversed.

With acute pain, the doctors know where the pain pathway runs, and block it at different points using different drugs, the common one being local anaesthe-tic, nonsteroidal anti-inflammatory drugs and traditional painkillers.

Mayo Clinic researchers found that 1 in 4 patients prescribed an opioid painkiller for the first time progressed to long-term prescriptions. Photo: TNS

“Unfortunately, all these drugs don’t work for neuropathic pain, only for nociceptive pain. Opioids may work, but we usually give anti-neuropathic agents,” says Dr Cardosa.

All of us have the ability to modulate pain signals. In an emergency, we can run into a burning house to rescue a loved one but only feel pain once we get to safety or the fire has been extinguished.

Dr Cardosa explains, “Our brain has the ability to block pain signals. If a person is very anxious, the pain can increase.

“It’s got to do with what I call a chemical balance. Not all drugs work for everybody. It’s a bit of trial and error; we always try to achieve a balance between the side effects and benefits.”

All these drugs may cause drowsiness, so the dosage needs to be adjusted accordingly. The benefits don’t come immediately as it takes a while to change the chemical balance.

Pain is indeed complicated, and when it becomes chronic, environmental, social and emotional factors need to be taken into account.

Dr Cardosa says, “Pain can go on and on and on; patients cannot function, get depressed, lose jobs, families get upset, etc. So, we use a more holistic approach to treat chronic pain. Patients have to understand what is going on and learn self-management. We found that we can improve function without reducing pain.”

It’s only natural for patients, young and old, to start avoiding certain things because pain increases during those activities.

“When you become less active and stop doing certain things, you become less fit and more stiff, and then you get more pain.

“A vicious cycle is set up. By the time we see these patients, we don’t know how far along the path they are. And it’s a downward spiral they go into.

“People tend to think that pain means damage and it’s understandable to react that way. You could have chronic back pain and the doctor tells you it’s due to a degenerative spine or from wear and tear, part of ageing. But, how do you reduce wear and tear? If you don’t move your muscles in chronic pain and keep resting, it’s only going to get worse,” she points out.

Patients need to be convinced they can move again. Because they have been deconditioned, they have to start slow and pace themselves. Exercise is one of the modalities used, along with cognitive behaviour therapy and relaxation.

However, those with chronic pain may tend to overdo things.

“These people have good days and bad days. On bad days, they rest, and on good days, they overdo. Then the pain increases, and they get into cycle, so we tell them to pace their activities and set goals. They cannot run a marathon overnight!

“These methods must be used together, it comes in a package, and it must be constantly practised. If you’re lucky, sometimes drugs alone will work. Central to all this is the patient’s sense of understanding and their control over the situation.”

Unfortunately, a lot of healthcare providers still understand pain using the acute pain model, so they look for a source of the pain.

“If you go to the surgeon enough times, they may eventually offer you surgery, and if you are desperate enough, you will take it. But, chronic pain will not go away. Other doctors may ask you about your pain, so we have to tell our patients how to deal with other doctors.

“Very often patients say pain controls their life. It’s tough. I tell patients their pain is a result of a wrong signal – don’t pay attention to it. It’s like a fire alarm going off and there is no fire.”

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Recently lost a lot of weight? Health's resident mental health pro weighs in on how to deal with intrusive comments and own your body after shedding pounds.

 Q: I recently lost a lot of weight, but I'm getting sick of hearing constant comments about how much better I look. Is that weird?

You mean you want to run to the grocery store without someone stopping you and saying, "Wow, you've lost a lot of weight!"? That makes perfect sense. Many people who have shed pounds find the incessant remarks about their body to be intrusive or even feel like pressure to keep up the results. You want to get on with your life and make the new you the new normal in everybody's eyes.

Just try to remember that the people who care about you are only commenting because they think you'll appreciate it. You can speak up—just be polite about it. Let folks know that while you understand they mean well, you're hoping to take your focus off weight, body, and dieting. Try saying, "Thank you for the compliment. I'm feeling good and ready to put it behind me and move on to my next chapter." It's better to say something now—if you constantly bite your tongue, your resentment may build up, and eventually you'll let someone have it.

Gail Saltz, MD, is a psychiatrist and television commentator in New York City who specializes in health, sex, and relationships.

About 700 years after his death, a working-class man from Cambridge is getting a new face — one that looks like Daniel Craig after a poor night’s sleep. 

The 13th century man, called Context 958, was found with hundreds of other skeletons in one of the largest medieval hospital graveyards in Britain. The mass grave was discovered underneath the Old Divinity School of St John’s College; it was excavated between 2010 and 2012. Now scientists in the UK are studying the remains to get a better understanding of the lives of ordinary poor people in medieval England. That includes using facial reconstruction technology and other forensics techniques to get a sense of how they looked.

“Most historical records are about well-off people and especially their financial and legal transactions — the less money and property you had, the less likely anybody was to ever write down anything about you,” John Robb, a professor at the University of Cambridge’s Division of Archaeology, said in a statement. “So skeletons like this are really our chance to learn about how the ordinary poor lived.”

Context 958 was over the age of 40 when he died, and he was probably an inmate of the Hospital of St John, a charitable institution that provided food and shelter to the poor and sick between 1200 and 1500. His skeleton is pretty robust, “with a lot of wear and tear from a hard-working life,” Robb says. Unlike most poor people, however, Context 958 ate lots of meat or fish — which suggests he might have been in a trade or job that gave him access to that kind of “rich people” food.

In fact, his remains hint at a life of struggles. His tooth enamel stopped growing when he was young, suggesting he suffered from sickness or famine early on. Archaeologists also found evidence of “a blunt-force trauma” on the back of his skull, as well as dental abscesses — painful tooth infections, according to The Guardian.

Once Context 958’s DNA is analyzed, the facial reconstruction will include eye and hair color, Chris Rynn, a lecturer at the Centre for Anatomy and Human Identification at the University of Dundee, who worked on the reconstruction, told The Guardian. That’s unlikely to change the ragged look of a James Bond with severe under-eye bags.

But even in black and white, looking a medieval man straight in the eyes is amazing. And that’s what the scientists analyzing all those graveyard remains are going for. “Humanizing people in the past, getting beyond the scientific facts to see them as individuals with life stories and experiences,” Robb says. “That's why putting all the data together into biographies and giving them faces is so important.”

"Moringa seeds are obtained from the pods of the Moringa plant (Moringa Oleifera) or the drumstick tree, native to Northern India. Fresh and raw moringa seeds are quite tender, but as soon as they get dried, they become hard and start to resemble small beans. They are greyish-white in colour with unique wing-like structures. They can be steamed, boiled or roasted for various purposes," says Dr. Divya Choudhary, Chief Dietitian, Max Super Speciality Hospital.

According to Dr. Manoj K. Ahuja, Fortis Hospital, Vasant Kunj, "Moringa is a nutrient-dense plant that is rich in vitamins, calcium, iron and essential amino acids. It can benefit the body in a number of ways."

Here are 10 health benefits of moringa seeds:

1. Improves Sleep

"Steep moringa leaves in hot water for 15 minutes and drink it before you go to bed for a good night's rest. It helps you slip into slumber at night, and in turn will leave you energised to tackle the day," says Dr. Choudhary, Max Hospital.

 

2. High in Fiber

"Moringa seeds are high in fiber, and help in moving food along your digestive system," says Delhi-based Nutritionist Anshul Jaibharat.
 

3. Regulate Blood Sugar Levels

Dr. Ahuja says, "Moringa seeds are a great source of zinc and can regulate blood sugar levels which can help manage or even prevent diabetes."

4. Great Source of Iron

"Did you know that a single serving of moringa has almost three times the amount of iron as spinach? This is especially important for vegetarians/vegans or those who suffer from low iron issues, as the body needs iron to enrich the blood and carry oxygen to our muscles, organs and tissues," adds Dr. Choudhary.

5. Reduces Joint Pain

Dr. Ashutosh Gautam, Clinical Operations and Coordination Manager at Baidyanath says, "Moringa seeds make for a great supplement of calcium and help those suffering from joint pain. They help in reducing inflammation and severe bone disorders like arthritis."

 6. Lowers Cholesterol

"Some plants have been known to reverse bad cholesterol and according to research, moringa is among them," says Dr. Divya, Max Super Speciality Hospital.

7. Induces Death of Cancer Cells

Dr. Ahuja says, "Moringa seeds are well known for their anti-carcinogenic effects. They can stop the growth and development of cancer cells by accelerating their death count."

8. Promotes Heart Health

"Scientists have proved that moringa seeds can reduce the amount of oxidised lipids in our body and take care of our cardiac health by safeguarding the heart tissues from constructional damages," says Dr. Choudhary.

9. Powerhouse of Antioxidants

"The oil extracted from moringa seeds contains almost 30 antioxidants. It contains vitamins A, B-complex, C and other free radical busters that save our body from severe oxidative damage. In other words, these antioxidant properties of moringa seeds can take care of our overall health", says Dr. Choudhary.

10. Promotes Healthy Skin

"Moringa seeds are packed with antioxidant, anti-inflammatory and antiseptic properties and are thus, very beneficial for skincare. The oil obtained from moringa seeds can be used as a moisturizer or used to treat skin problems like skin rashes and sunburn," says Dr. Ashutosh Gautam, Baidyanath.

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Sharing sweet treats at workplace may be contributing to several health problems such as obesity and poor oral hygiene, experts in the UK have warned.

 
It may be a case of managers wanting to reward staff, colleagues wanting to celebrate or people bringing presents back from their holidays that sees sugary snacks going into the workplace, said Professor Nigel Hunt, dean Faculty of Dental Surgery at the Royal College of Surgeons in the UK.

However, it was detrimental to employees' health and they should make a New Year's resolution to "combat cake culture" in 2017, he said.

"While these sweet treats might be well meaning, they are also contributing to the current obesity epidemic and poor oral health," Hunt said.

"We need a culture change in offices and other workplaces that encourages healthy eating and helps workers avoid caving in to sweet temptations such as cakes, sweets and biscuits," he said.

However, 2016 Great British Bake Off runner-up Jane Beedle said that cake could "bring joy to the office". "I don't think a little bit of homemade cake is going to kill anybody," Beedle told BBC Radio 2.

The Faculty of Dental Surgery has released tips to cut down on sugar consumption in the workplace by considering low-sugar alternatives and reducing portion sizes.

It advises people to avoid snacking and keeping sugar as a lunch-time treat, keeping a "sugar schedule" to limit sugar intake and thinking about where sweet treats are positioned

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An astonishing 5.5 billion people - up to 76 per cent of the world's population - are 'overfat', warn researchers who say the new pandemic has quietly overtaken the planet and argue for a change in global health efforts against chronic and metabolic diseases.

 An astonishing 5.5 billion people - up to 76 per cent of the world's population - are 'overfat', warn researchers who say the new pandemic has quietly overtaken the planet and argue for a change in global health efforts against chronic and metabolic diseases.

The researchers, including those from Auckland University of Technology in New Zealand, put forth a specific notion of overfat, a condition of having sufficient excess body fat to impair health.

Based on a new look into current data, they argue how, in addition to those who are overweight and obese, others falling into the overfat category include normal-weight people.

"The overfat pandemic has not spared those who exercise or even compete in sports," said lead author of the study Philip Maffetone, CEO of MAFF Fitness Pty Ltd in Australia.

"The overfat category includes normal-weight people with increased risk factors for chronic disease, such as high abdominal fat, and those with characteristics of a condition called normal-weight metabolic obesity," said Maffetone.

While the obesity epidemic has grown considerably over the last three to four decades, this work casts light on the much higher numbers of people who may have unhealthy levels of body fat.

"We want to bring awareness of the rise in these risk factors, where the terms 'overfat' and 'underfat' describe new body composition states. We hope the terms will enter into common usage, to help create substantive improvements in world health," said Maffetone.

The work, involving Ivan Rivera-Dominguez, research assistant at MAFF and Paul B Laursen, adjunct professor at the Auckland University of Technology also indicates that 9 to 10 per cent of the world population may be underfat.

"While we think of the condition of underfat as being due to starvation, those worldwide numbers are dropping rapidly.

However, an ageing population, an increase in chronic disease and a rising number of excessive exercisers or those with anorexia athletica, are adding to the number of non-starving underfat individuals," Maffetone said.

This leaves as little as 14 per cent of the world's population with normal body-fat percentage, researchers said.

"This is a global concern because of its strong association with rising chronic disease and climbing healthcare costs, affecting people of all ages and incomes," said Maffetone.

While it is estimated that up to 49 per cent of the world's population, or 3.5 billion people, are obese or overweight, the well-documented obesity epidemic may merely be the tip of the overfat iceberg, researchers said.


The term overfat, as opposed to obesity and overweight, may be more helpful moving forward in addressing this global health problem, they said.

This is the first effort to globally quantify those who are overfat versus overweight or obese. The traditional body-mass index (BMI) measures weight and height, but is not a direct measure of body fat, researchers said.

The research was published in the journal Frontiers in Public Health.

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Deficiency in the levels of Vitamin D may increase the risk of chronic headache in middle-aged and older men, according to a new study.

The findings showed that individuals with the lowest vitamin D levels had over a two-fold risk of chronic headache in comparison to the those with the highest levels.

Vitamin D deficiency has also been associated with chronic tension-type headache, perhaps by causing musculoskeletal pain.

Previous studies have found Vitamin D to play a role in various neurovascular diseases.

The study adds to the accumulating body of evidence linking a low intake of vitamin D to an increased risk of chronic diseases, said researchers from the University of Eastern Finland.

For the study, the team analysed the serum vitamin D levels and occurrence of headache in approximately 2,600 men aged between 42 and 60 years.

In 68 per cent of these men, the serum vitamin D level was below 50 nanomoles per litre (nmol/l), which is generally considered the threshold for vitamin D deficiency.

People with low exposure to UVB radiation -- a major source of vitamin D -- should make sure that they get sufficient vitamin D from food or from vitamin D supplements, the researchers suggested.

The findings were published in Scientific Reports.

(This story has not been edited by NDTV staff and is auto-generated from a syndicated feed.)

His heartfelt open letter proves fat-shaming helps no one.

 Sadly, body shamers are everywhere. In the last few weeks alone, trolls called photos of Simone Biles in a swimsuit "ugly" and "gross," Amy Schumer's social feeds were filled with hateful comments after she was cast in an upcoming Barbie movie, and Lena Dunham felt the need to defend her un-Photoshopped Glamour cover.

Now, at least one body-shaming bully is trying to make amends with the people he used to harass. On Tuesday, Reddit user roundrobinator posted to the weight loss subreddit LoseIt an "Open Letter of Apology." "I am the one who was giving you dirty looks in the grocery store. I am the one who rolled their eyes at you in the restaurant. I am the one who shared that insensitive meme," he says at the beginning of his screed. Later, he reveals what caused his change of heart: After a lifetime of being thin, he ruptured his Achilles' tendon and gained 119 pounds, and became the butt of the same types of jokes and insensitive comments he used to dish out. He wrote the apology letter shortly after a random passerby made pig-snorting noises at him.

"[I hoped] that someone like me who's never been big and tended to judge those who are would read this and just go out into the world with somewhat of a different perspective the next day," roundrobinator told Health via Reddit. (He declined to provide his real name.) He also said he wants to be a more body-positive role model for his daughter.

The letter received an outpouring of positive comments—more than the anonymous writer says he ever could have imagined. He says other Reddit users have offered him health advice books they've written, complimentary consulting services, and simply (but arguably most importantly) words of support on his journey to reclaim his own health.

Regardless of the author's motives, he concludes his apology with a message we wish we saw more often: "I know now that you are so much more than your weight."

These simple tweaks can help you lose big. 

 

 

In a recent post on her app, Kendall Jenner explained why she decided to paint her living room a very specific shade of pink. “Baker-Miller Pink is the only color scientifically proven to calm you AND suppress your appetite," she wrote. "I was like, 'I NEED this color in my house!'"

In Jenner's Instagram post below you can see the result. And so far, the model and reality star is very pleased with her choice. "I'm loving it!" she wrote on her app.

RELATED: 16 Ways to Lose Weight Fast

But can the color really help relax you and curb your cravings? Baker-Miller Pink is named for two United States Naval officers who, in 1979, experimented with the effects of the hue in prison cells, and found that it seemed to calm inmates down. A 1985 study that took place at correctional facilities, psychiatric hospitals, and universities confirmed the preliminary findings. But a 2014 study wasn't able to replicate the results.

As for the color's power as an appetite suppressant, it's possible it may have a placebo effect, says Health’s contributing nutrition editor, Cynthia Sass, MPH, RD. "Some may see the color and think about candy, and pink frosted cupcakes, while others might see the color and feel a sense of calm and centeredness that helps them better tune into their hunger and fullness cues.”

The takeaway: It's probably not worth changing the colors of your walls. But there are other, simpler tweaks you can make at home that can help you eat less (and enjoy your food more). Here are six small changes that may make a big difference for your waistline.

RELATED: 49 Ways to Trick Yourself Into Feeling Full

• Pick up new plates in a different hue

Rather than repainting your walls, you may want to grow your dinnerware collection with dishes in a lighter or darker hue. A study from the Food and Brand Lab at Cornell University found that when diners had low contrast between their plate and their food (think fettuccine alfredo on a white plate), they served themselves 30% more food than diners who had high contrast between their food and their plate (picture fettuccine alfredo on a red plate). So when you have fish for dinner, you might try using a darker plate. Black bean soup for lunch? Choose a light-colored bowl. You get the idea. (Try this 16-piece dish set by Fiesta, which includes settings in four colors.)

• Put smaller dishes within reach

It’s hard to estimate proper portion size, and using a large bowl or plate can make it more challenging, even for experts: A study published in the American Journal of Preventative Medicine found that when nutritionists were given a larger bowl, they scooped themselves 31% more ice cream than those who were given a smaller bowl. Using your smaller dishes may be a painless way to better control how much you eat. (Check out these 13 other easy portion control tips.)

• Hang a mirror near the table

The kitchen may not be the most traditional place for a mirror, but it could help you wean yourself off sweets. A 2016 study revealed that people who ate chocolate cake in a room with a mirror found the treat less enjoyable than those who ate it in a room with no mirror. (Being around a mirror did not affect the taste of fruit salad, however.)

"The presence of a mirror can make unhealthy food less tasty by increasing self-awareness," author Ata Jami, PhD, assistant professor of marketing at the University of Central Florida, wrote in the study, which was published in the Journal for the Association of Consumer Research. In other words, catching a glimpse of your reflection as you dig into a sugar-laden snack may remind you it isn't the best choice for your body, and help you choose a more nourishing treat next time.

• Create mood lighting

It turns out ambiance can make a real difference in terms of calorie consumption: When researchers from the University of Illinois at Urbana-Champaign made over a fast food restaurant with dimmer lighting and mellow music, the study participants consumed 175 fewer calories, on average. They also enjoyed their food more. Your can set the right mood in your own kitchen by turning down the lights (here's a cheap and easy lamp dimmer you can buy), and turning on some jazz.

• Move the TV out of the kitchen

And while you're at it, establish a no-phones-at-the-table rule. One British study found that eating while distracted caused participants to eat more food not only during that meal, but later in the day too. When you remove distractions and eat more mindfully, you're better able to tune into your body's hunger cues, which can help you avoid consuming more calories than your body actually needs.

• Use an essential oil diffuser

The right scent may be just want you need to curb your cravings. Researchers from Wheeling Jesuit University in West Virginia found that people who sniffed the scent of peppermint every two hours ate 2,800 fewer calories over the course of a week than those who didn't. "It may induce something called olfactory sensory-specific satiety," Alan Hirsch, MD, neurological director of the Smell and Taste Research Foundation in Chicago explained to Health in a prior interview. "The odor makes you feel full, so you eat less." Add water and a few drops of peppermint oil to an essential oil diffuser to fill a room with a fragrant mist.