Food sources of vitamin C

All fresh fruit and vegetables  contain Vitamin C. Unfortunately, vitamin c is easily leached out of vegetables if they are placed in water and is also easily destroyed  during cooking or exposure to copper or alkali. So fresh fruit and juices and salads are encouraged. Also advised to cook vegetables lightly and quickly. Vitamin  is lost during storage. About  40% of the U.S. population consumes vitamin C as a dietary supplement in which “natural forms” are no more bio available than synthetic forms.

The recommended  nutrient intake for adults

90 mg/day for males  in the United States - for healthy people.

75 mg/d for females

Following  are the rich sources of vitamin C.

1. Blackcurrants, guavas.

2. Rosehip syrup, green peppers.

3. Oranges, other citrus fruit, strawberries.

4. Cauliflower, broccoli.

5. Sprouts, cabbage, watercress.

6. Potatoes.

7. Liver and milk.

Absorption  of vitamin C

If the dose of vitamin C administered in a single dose is < 100 mg,  complete absorption occurs. At doses more than  1 g less than 50% is absorbed, this is because of increased degradation and fecal and urinary excretion of vitamin C at higher doses. As already mentioned above good dietary sources of vitamin C include citrus fruits, green vegetables (especially broccoli), tomatoes, and potatoes. People get recommended daily allowance by consuming five servings of fruits and vegetables a day. There are several drugs that interfere and cause vitamin C deficiency such as  corticosteroids, aspirin, indomethacin, phenylbutazone, and tetracycline. As the requirement of vitamin C increase during major surgery it is advisable to supplement vitamin C upto 250 mg  a day to cover major surgery. Bottlefed infants are advised to give orange juice. In the elderly scurvy can be avoided by consuming adequate  fruits and vegetables. Careful observation is required  in the elderly people who live alone. Rarely vitamin C supplementation is required.

Vitamin C requirements increase in the following situations.

1. Smoking,

2. Hemodialysis,

3. Pregnancy,

4. Stress

5. Infection

6. Trauma

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Diet for Heart disease - A must read for every one

Coronary artery disease (Heart attack) is  a multi factorial disease. Here the strongest environmental factor is diet. Basic abnormality that lead to coronary artery disease is  is atherosclerosis. Major constituent of atherosclerosis is cholesterol esters,which  are carried by LDL (Law Density Lipoproteins ) in the blood. LDL cholesterol is affected by the type of  dietary fat.
Saturated fatty acid raise the blood cholesterol,while polyunsaturated fatty acid decreases the cholesterol. Cholesterol is found only in  animal food.

Following are the dietary recommendation in patients with coronary artery disease.

• Balanced diet is recommended.
• High fiber content (Complex carbohydrates) - Effect is determined by the type of dietary fiber. Soluble fibers such as pectin, guar and oat fibers can produce moderate reduction of cholesterol. Wheat fibers (wholemeal breads or bran) wont reduce the plasma cholesterol, but those who consume more wheat fibers and whole grain food the incidence of CAD  is decreased.
• Weight reduction to achieve optimal BMI (Body Mass Index) - Overweight, especially abdominal obesity is an independent risk factor for CAD. Weight reduction will reduce the cholesterol.
• More vegetables and fruits - Soya protein if included in the diet help to reduce the total and LDL cholesterol. Vegetables and fruits are law in fat and contain pectin other dietary fibers ,flavanoids and antioxidants. Five servings of different vegetables and fruit per day (400 g/day average weight)  is recommended.
• Avoid excessive caffeine intake - Coffee contains small amounts of diterpenes (lipids), cafestol and kahweol - not caffeine - it raise plasma total and LDL cholesterol. Since the diterpenes are removed  filtered or instant coffee does not raise the cholesterol.
• Avoid junk food.
• Avoid  foods with high fat content especially MUFA, excess salt ,cholesterol.
• Fish oil (omega 3 PUFA), garlic, plant sterols, antioxidants all help in reducing the cholesterol.
• Salt (NaCl)   should be restricted to 6 gram/day for the general population this is more important for CAD  patients.
• Fish  at least twice a week preferably fatty fish is recommended, it should not be fried in saturated fat. EPA (eicosapentanoic acid) help in reducing  CAD.
• Alcohol one or two drinks per day may be beneficial in middle aged people at risk for CAD, because of complications of over intake not recommended in general population.
• The following dietary components reduce the risk of coronary heart disease. Fruits and vegetables, cereal fiber,  PUFA, linolenic  acid, alcohol and fish, nuts, vitamin E, folate.

Glossary

1. BMI - Body mass index
2. CAD - Coronary artery disease
3. LDL - Law density lipoproteins
4. MUFA - Monounsaturated fatty acids, plant-based fats found in avocado, nuts and seeds, oils, olives, and dark chocolate
5. PUFA - Cutting off all vegetable oils except coconut oil, olive oil and palm oil. 

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Drugs used for treatment of heart attack patients.

Heart attack occurs when there is reduced blood supply to heart. It is an emergency situation and immediate medical care is required. Here in this article we will tell you some of the drugs and their aims. It is always good to have these in your mind

Following are the aims of treatment.

1.Immediate stabilization of patient.

2.longterm symptom control.

3.Cure of the condition if possible.

Drugs used for the treatment are given below.

1. Antiplatelet drugs –Aspirin and Clopidogrel, it is a group of powerful drugs that will prevent the blood clotting.

2. Nitrates will help to reduce the pain

3. Betablockers decrease the heart rate, blood pressure and improve the oxygen supply to heart.

4. Statin will reduce the blood cholesterol. Stabilize the plaque so prevent further attack.

5. ACE Inhibitors- role is to reduce the blood pressure, dilate the blood vessels and increases the blood supply.

6. Angiotensin II Receptor Blockers will increase the blood supply to heart.

7. Clot lysis with streptokinase give immediate improvement.

8. Diuretics remove excess salt and water from the body so help the heart to work properly.

9. Digoxin improve the function of heart.

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Statin a cholesterol lowering agent - Reduce cholesterol in 4 weeks

The problem of high cholesterol is increasing in the society. This will lead to atherosclerosis and increased risk for heart attack and stroke. Statin's will help to reduce the cholesterol level and thus will help to reduce heart attack and stroke in the community. Statin's are the most efficacious and best tolerated lipid lowering drug. They will reduce both primary and secondary hypercholesterolemia. Statin's can reduce the total cholesterol in 4 to 6 weeks. All the statin's are given at bedtime to get maximum effect.

Statins include the following

1. Atorvastatin­ dose 10 to 80 mg/day.

2. Lovastatin­ 10 to 40 mg/day,this is the first used statin.

3. Simvastatin ­5 to 20 mg/day.

4. Fluvastatin.

5. Pravastatin.

Adverse effects of statins

1. Headache.

2. Nausea and bowel upset.

3. Rash.

4. Sleep disturbance.

5. Muscle pain and rise in CPK level.

6. Increase in serum transaminase,but liver damage is not seen.

Uses of Statins

1.Reduce  cholesterol level.

2.Decrease heart attack rate

3.Decrease  stroke rate.

4.Help in plaque stabilization in atherosclerosis.

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Prevention of recurrent heart attack

Prevention of heart attack is very important because the chance of second attack is high in known heart patient. Repeated attacks are dangerous because it will increase the  risk of death in a given patient. The interesting factor is that the recurrent attack can be prevented with control of risk factors along with certain drugs. This will improve the long term survival.

Following are the measures to prevent recurrent heart attack

1.Drugs

2.Control blood pressure

3.Control blood glucose

4.Regular exercise

5.Balanced diet

6.Control blood cholesterol

7.Stop smoking

8.Avoid excessive alcohol intake

9.Reduce mental and physical stress.

Drugs that will reduce recurrent heart attack

Antiplatelets such as Aspirin and Clopidogrel will produce a 25%reduction in recurrent attack and increase the survival.

ACE inhibitors and ARBS (Angiotensin II receptor antagonists) are also useful in prevention.

Beta blockers will reduce the heart rate and help to  improve the long term survival.

Regular exercise will help to reduce weight ,cholesterol ,control of hypertension and diabetes.

Diet should be low in fat and rich in calories.

Quitting of smoking is very important as it will help to increase the Oxygen supply to heart and decrease the atherosclerosis.

Note : In diabetic patients apart from control of blood glucose control of blood pressure to 120/80 mm of mercury and LDL cholesterol to less than 70mg /dl is advised. 

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How will you detect obesity?

Obesity is a risk factor for many disease. Simply it means overweight. But there are special method to detect obesity. These measurements will give you an accurate level of overweight and risk of developing disease. It is a good practice to record the weight periodically. Comparison of the previous weight help to detect early weight gain.

1. B.M.I.(Body mass index) / Quetelet’s index.
Most commonly used method is BMI which is expressed as weight/height 2 (in kg/m2 ),weight measured in kilograms and height measured in meter (without shoes). This gives an objective method of patients weight and help the patient realize the need for weight reduction.It is independent of height.
2.Anthropometry (skinfold thickness),
3. Densitometry (underwater weighing),
4. CT or MRI,
5. Electrical impedance.

Classification of Weight Status and Risk of Disease

Obesity is defined as  BMI of 30kg/m2, that is  is 20% above the upper end of the acceptable range of weights for height. overweight”, indicate BMI range 25-29.9.

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Causes of gout and hyperuricemia

Causes of  gout and hyperuricemia

Gout is a metabolic disease where there is an increased body pool of uric acid. This will lead to deposition of mono sodium urate crystal in the joints. It causes pain in joints due to arthritis .It is a disease of middle aged to elderly men and post menopausal women.Gout  is more common in men than women with a sex ratio 5:1. Incidence  increases  with advance in age.Recently it has become more common  due to raise in metabolic syndrome, where hyperuricemia is an important component.
Definition of  Hyperuricaemia is - serum uric acid level more  than two standard deviations from the mean (420 umol/L in males, 360 umol/L in females).Increased uric acid level is  a risk factor for hypertension, renal and cardiovascular disease.

Why people develop hyperuricemia?

One third of body uric acid pool is derived from diet and two –third is produced within the body from metabolism.Uric acid is eliminated from the body through kidney(two-thirds)  and gut (one-third).Body uric acid pool  is determined by  the balance between ,synthesis within the body and elimination.Network of enzymes are involved in the synthesis of uric acid most important one is Xanthine oxidase.Though there is  a variety of causes for hyperuricemia in 90% of cases it is due to decreased elimination by kidney.Genetic factors also play important role in gout.

Causes of hyperuricemia.

• Decreased  excretion by kidney
• kidney failure
• Lead toxicity (saturnine  gout)
• Lactic acidosis from alcohol ,exercise ,starvation.It interfere with renal excretion
• Alcohol (especially beer,that contains guanosine)
• Drugs
• Thiazide and loop diuretics
• Low-dose aspirin
• Ciclosporin
• Pyrazinamide
• Hypothyroidism

Increased intake

• Red meat
• Seafood
• Offal

Increased uric acid production

• Myeloproliferative and lymphoproliferative disease example  polycythemia ,leukemia
• Psoriasis
• High fructose intake
• Glycogen storage disease
• Inherited disorders  Lesch–Nyhan syndrome(HPRT mutations)
• (mental retardation, self-mutilation and choreoathetosis)

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Lemon juice to get fair skin

Lemon juice is a natural skin lightening and exfoliating agent because of the following.
1.Citric acid in lemon has bleaching effect that will help to lighten the skin.
2.Alpha-hydroxy acid in lemon juice is an exfoliating agent that remove dead cells and help to get a  fairer skin.

How it is applied?
1. Lemon juice rinse.
Take juice from half the lemon then add equal amount of water for dilution to avoid irritation to skin.
Apply it to the face ,neck and other desired bodyparts.
Keep it for 20 minutes after that wash with warm water.

2. Lemon honey mask.
Make a mask mixing lemon juice, honey and 1 teaspoon of ground oatmeal,apply it on the face, keep it after 20 minutes .
As you wash it off, with tips of your finger make circular movements.
Oatmeal act as a scrub that remove the dead cells.
Lemon juice has bleaching effect.
Honey offsets drying effect of lemon juice.


How long it is used?
For better results repeat 3 times a week for 4 to 6 weeks.

Precautions.
Apply moisturizer after the treatment with lemon juice.
Do not go in sunlight with lemon juice applied on the face.

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Tips to keep your heart young and healthy

Here are few tips that will help to keep your heart healthy and young

1. Avoid fried foods.
2. Avoid fatty foods such as beef, pork and mutton.
3. Eat small fish such as sardine that is good for your heart.
4. Take un cooked vegetables daily such as cucumber ,carrot, tomato and onion.
5. Reduce salt intake.
6. Take high fiber diet including green leafy vegetables and legumes such as . Soybeans, fava beans, peas ....
7. Avoid egg yolk which has high cholesterol content.
8. Avoid eating fried foods and salty foods such as chips and corn while reading and watching television.
9. Better avoid milk and dairy products.
10. Avoid hotel foods and if inevitable take only vegetarian food.
11. It is better to prevent diabetes and if already present strict control is necessary.
12. Strict control of blood pressure is advised.
13. If possible avoid using lift and climb the staircase.
14. Better to walk small distances rather than using a vehicle.
15. If your work demands sitting for long hours better to take rest and walk in between.
16. Walk for 40 minutes daily.
17. Avoid smoking and alcohol consumption.
18. Maintain body weight , weight should be in proportion to your height.
19. Better to go to bed early and wake up early in the morning.
21. Even if you have to do heavy work do it systematically and ensure adequate rest and enjoyment in between.
22. It is better to practice yoga and meditation.
23. For a happy family environment healthy sexual life is inevitable, avoid extramarital relationships which is a frequent source of mental stress and risk factor for heart disease.

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How to make your lips most beautiful.

One of the most important factor that determine the beauty of your face is beauty of lips. Application of lipstick alone won't make your lips beautiful. Lip makeup should be done with special care and special attention should be given for lip care otherwise you will loss the beauty of lips due to darkness and dryness. Following tips will help you to get beautiful lips.

For lip makeup you need the following .

Lip balm (Petroleum jelly).
Lipliner.
Lipstick.
Lipgloss.
Brush.

Liquid lipstick with good glowing effect and moisturizing effect is now available so you need not buy lipstick and lip-gloss separate.

Casual makeup.

• After washing your face make it dry, before starting facial makeup apply lip balm, so it will get absorbed.
• Take a lip liner and start outlining from the central part of upper lip and extend to both side and then line the lower lip.
• Those with thin lip should give outlining and for thick lips give inner lining. This will give perfect shape to your lip.
• Shade of lip liner should be a shade darker than lipstick.
• For people with fair complexion
  Peach,coral and pink colors are suitable.
• For medium complexion
  Light brown,strawberry color,brickred are better.
• For dark complexion
  Copper color,bronze color,ruby red color are preferred.

For party makeup

• Do all above then take a brush and fill the lips inside the lining.
• Finally apply lip gloss.
• Shiny metallic lipgloss applied in the middle part of the lips give you a glamorous look this is used for bridal makeup and heavy party makeup.

Special precautions.

1. Choose only branded products.
2. Apply lipstick only after using lip balm.
3. Before applying lipstick test for allergy.
4. Lipgloss contains petroleum jelly so it wont make your lips dry.

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Medical disorders associated with Depression

Depressive disorders occurs in 3.7% to 6.7% of general population. In general medical inpatients, the proportion increases to 10% to 14% and 9% to 16% in general medical outpatients. Major depression is an independent risk factor for mortality in patients hospitalized for heart attack at 6 month follow up. About 47% of depressed patients with acute life threatening medical illnesses, either died or had complications compared to 10% of non depressed patients.

Various forms of distress are common in medically ill people. Unless these are recognized and managed appropriately, medical management alone will be less effective. Depression is not the most common distress state, but the most visible one. It is often not diagnosed and insufficiently treated. It will cause the person for decreased survival, marked disability and increased healthcare cost.

In  physically  ill people  depression

• Can  be a coincidental association.
• Can  be a complication of physical illness.
• Cause or make worse somatic symptoms (such as fatigue, malaise, or pain).

Depressed patients with physical illness 

• Consider  themselves as more sick and visit their doctors more frequently than non-depressed physically ill person.
• Have longer hospital stay.
• Poor compliance with medication and  medical advice.
• They  undergo more medical and surgical procedures.
• Depressive illness may be associated with increased mortality (excluding suicide) in patients with physical illness, such as heart attack.

Specific medical conditions with likelihood of developing depression

• Heart attack.
• End stage kidney disease.
• Cancer.
• Chronic pain.
• Neurological disorders such a stroke, Parkinson’s disease,multiple sclerosis.
• Hormonal disorders.
• HIV.

Features to suggest a medical origin of the psychiatric symptoms are the following

• Late onset of initial presentation of symptoms.
• Known underlying medical condition.
• A typical presentation of a specific psychiatric illness.
• Absence of personal or family history.
• Illicit (forbidden by law)  substance use.
• Medication use.
• Treatment resistance or unusual response.
• Sudden onset of mental symptom.
• Abnormal vital signs.
• Waxing and waning mental status.
• Sphincter disturbances in the form of bowel and bladder dysfunction

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