What is the Role of Carbohydrates?

Obesity is a global epidemic with majority of the world’s population in developed countries being over weight or obese!

According to the World Health Organization (WHO), obesity is rising globally with over 1 billion overweight adults out of which 300 million people are clinically obese. Obesity in itself is a disease that is responsible for many conditions ranging from hypertension and stroke to type 2 diabetes and cancer. It not only causes serious chronic illnesses, that reduce the quality of life, but also increases the risk of premature deaths. Diet and nutrition are the most significant factors responsible for an increased incidence in the number of overweight or obese people. 

Although genetic, metabolic, social, cultural as well as environmental factors are associated with obesity, the major cause of obesity and increased weight is the consumption of energy dense and high calorie foods such as fats and sugars, in addition to decreased physical activity. This causes an energy imbalance or an excess of energy, which is stored in the body as fat. 


Studies show that the quality of carbohydrates, rather than the quantity, determines whether a person gains weight and becomes obese. So, if you have a tendency to gain weight, you should refrain from eating white bread, pasta, chips, processed foods, cakes and cookies. This is because the high glycemic index in those foods causes a sudden increase in blood sugar. This increased blood sugar, if not utilized by the body, builds up as fat.

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Similarly, processed carbohydrates or high calorie sugars predispose to the development of diabetes and cardiac diseases, besides causing obesity. David Ludwig, Director of the obesity program at Children’s Hospital Boston says that the “yo-yo effect” that the high glycemic index carbohydrates have on the blood sugar stimulates fat production and inflammation, increases overall caloric intake and lowers insulin sensitivity.

A fiber-rich diet is important in the control and management of obesity. Fiber is a mixture of cellulose, lignin and polysaccharides called pentoses. It is the part of plant food which is indigestible and does not provide any calories. Fiber helps in the management of obesity as it provides bulk to food which makes you feel fuller while reducing the calories consumed. High fiber not only helps you to lose weight but prevents heart diseases as it reduces the absorption of lipids, proteins and simple carbohydrates which are recognized as risk factors. Certain pentoses present in fiber bind with cholesterol, thus reducing its absorption from the intestine. Daily intake of 10-12 grams of fiber is recommended. Fiber rich foods include wheat bran, whole wheat four, peas, carrots and most of the leafy green vegetables.

Malnutrition to Obesity - The Big Leap

Obesity and Its Links with Diabetes and CVD

India has always given been depicted by the westerners as an under-nourished poverty stricken country But the major health concern for us Indians today and especially the growing middle-classes is obesity and its associated health problems like diabetes mellitus, heart disease, hypertension, stroke, high cholesterol, arthritis and gall bladder disease. 


India unfortunately has the distinction of being called the diabetic capital of the world with more than 50 million of its people suffering from diabetes and another 60 million in pre-diabetes state..

Diabetes mellitus and other lifestyle related diseases like metabolic syndrome are becoming pandemic also in populous countries like China. The twenty first century is witnessing a sharp escalation in the prevalence of these diseases, particularly in developing countries. Although, China is reported to have overtaken India recently in terms of this disease, the high rate of diabetics in India is still a major health issue. According to Dr. Vivian Fonseca, a diabetes expert at Tulane, '' Diabetes has soared in many countries around the world – including China and India – mainly because of the larger calorie intake and reduction in physical activity that come with better economies’.

Quiz on Obesity

Tips to Control Obesity in Children - Slideshow

Then again, the World Health Organization data reveals that ‘cardiovascular disease (CVD) is now more prevalent in India and China than in all economically developed countries in the world combined’. 

A closer look will reveal that obesity is an indicator of lifestyle diseases like diabetes, heart disease, stroke, arthritis, and gall bladder disease. There is also the fear that this maybe also be linked to a genetic propensity for Indians to develop obesity? So it is time for the health policymakers to be asking if they should consider obesity to be of national concern and how should they tackle this epidemic?

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Hair Analysis: Your hair tells the truth about you… but not all of it

Hair specialist (examining person's head). "Well, I am sorry, Mr. Rao, but your baldness has gone too far. I am afraid the only cure is a transplant. "Don't be daft man, I'd look bloody stupid with a kidney on my head."

Hair loss is one of the common problems among all of us. All hairs are shed at the end of their growth cycle, so some degree of hair loss is normal. If you have excessive hair loss, it makes sense to first understand the possible causes. There are many possible causes of hair loss, however most hair loss is normal, and part of each person's genetic program.

The most common type of hair loss is related to both genetic and hormonal make up, and is called androgen-dependent hair loss. About 50% of children with a balding parent of either sex will themselves become bald over a period of time.

Commonly used name for this type of hair loss is male or female pattern baldness:-

Male pattern baldness: Is characterized by a receding hairline, and moderate to extensive loss of hair, especially on the crown area.

Female pattern baldness: causes an overall thinning of hair on the head, and a moderate loss of hair on the crown or at the hairline.

Hair Loss-Couses

One of the primary cause of hair loss is a high amount of the male hormone, dihydrotestosterone (DHT) within the hair follicle. DHT is produced from testosterone in the prostate, various adrenal glands, and the scalp. After a period of time, an over abundance of DHT causes the hair follicle to degrade and shortens the active phase of the hair.

Another factor that has been linked to hair loss is the amount of sebum in the scalp. Sebum contains a high amount of DHT, and clogs pores in the scalp, both of which cause the malnutrition of the hair root. The amount of sebum in balding hair is related to the amount of oil in the hair. Meanwhile most doctors agree that frequent shampooing is advised in hair loss cases with oily scalps.

The most important cause of hair loss is inadequate nutrition. Even a partial lack of almost any nutrient may cause hair to fall. But hair grows normally after a liberal intake of these vitamins. A high protein and and an iron rich diet is recommended for hair loss. An adequate intake of raw vegetables, fresh fruits, salads, green leafy vegetables should be included in the diet on a regular basis.

Another important cause of falling hair is stress, such as worry, anxiety and sudden shock. Stress leads to a severe tension in the skin of the scalp. This adversely affects the supply of essential nutrition required for the healthy growth of hair.

General debility, caused by severe or long standing illnesses like typhoid, syphilis, chronic cold, influenza and anaemia, also gives rise to hair disorders. It makes the roots of the hair weak, resulting in falling of hair. An unclean condition of the scalp can also cause loss of hair. This weakens the hair roots by blocking the pores with the collected dirt. Heredity is another predisposing factor which may cause hair to fall.

How can Hair Loss be Treated

The healthy condition of the hair depends, to a very large extent, on the intake of sufficient amounts of essential nutrients in the daily diet. Hair is made of keratin, a protein, which also makes up the nails and the outer layer of our skin.

A WELL BALANCED DIET:

Women require 60 grams, men 80 to 90 grams, adolescent boys and girls 80 to 100 grams of protein. It is supplied by milk, buttermilk, yogurt, soyabean, eggs, cheese, meat and fish. A deficiency of some of the B vitamins, of iron, copper and iodine may cause hair disorders like falling of hair and premature greying of hair.

Persons with a tendency to lose their hair should thus take a well balanced diet . An adequate quantity of vegetables seeds, nuts green leafy vegetables, fresh fruits, egg and milk should be included in their diet regularly.

       HAIR CARE GUIDE

SURGICAL HAIR RESTORATION:

There are many surgical procedures which will help to restore the hair from falling. Surgical restoration is the only permanent solution to baldness. It involves a series of operations that extract plugs of scalp from the sides and back of your head, where hair grows densely, and implant them on top and in front, where you are going bald.

SCALP REDUCTION:

Scalp reduction is performed on patients with well-defined bald spots in the crown area of the scalp. It is sometimes done in conjunction with hair transplantaion to reduce the size of the bald scalp, especially in patients who do not have enough donor hair to cover the bald areas.

TISSUE EXPANSION:

Silicon bags are inserted beneath an area of hairy scalp and gradually inflated with saline water over a six-week period. This causes the hair-bearing skin to stretch, thus increasing the amount of hair-bearing scalp. After removing the bags, expanded hair bearing skin is lifted and moved to an adjacent bald area where a similar sized patch of scalp has been excised.

Lern more about Hair Loss

HOME REMEDIES

Several home remedies have been found useful in the prevention and treatment of hair loss.

The most effective among these remedies is a vigorous rubbing of the scalp with the fingers, after washing the hair with cold water. The scalp should be rubbed vigorously till it starts to tingle with heat. This will activate the sebaceous glands and energise the circulation of blood in the affected area, making hair growth healthy.

Mustard oil, boiled with henna leaves, is useful in promoting healthy growth of hair. About 250 grams of mustard oil should be boiled in a tin basin. A little quantity of henna leaves should be gradually put in this oil till about 60 grams of these leaves are thus burnt in the oil. The oil should then be filtered through a cloth and stored in a bottle. Regular massage of the head with this oil will produce abundant hair.

Daily application of refined coconut oil mixed with lime water and lime juice on the hair, prevents loss of hair and lengthens it. Application of the juice of green coriander leaves on the head is also considered beneficial.

Another effective home remedy for loss of hair is the application of coconut milk all over the scalp and massaging it into the hair roots. It will nourish the hair and promote hair growth. Coconut milk is prepared by grinding the coconut shavings and squeezing them well.

Amla oil, prepared by boiling dry amla pieces in coconut oil, is considered a valuable hair tonic for enriching hair growth. A mixture of equal quantities of fresh amla juice and lime juice used as a shampoo stimulates hair growth and prevents hair loss.

Regular use of castor oil as a hair oil helps the luxuriant growth of the hair.

Washing the hair with a paste of cooked black gram dhal, (urad dhal) and fenugreek (methi) lengthens the hair. A fine paste made from pigeon pea or red gram (arhar dhal) can also be applied regularly on bald patches, with beneficial results.

Certain home remedies have also been found useful in case of patchy loss of hair. The seeds of lime and black pepper seeds, ground to a fine paste, is one of the valuable remedies. This paste applied on the patches, has a mildly irritant action. This increases blood circulation to the affected area and stimulates hair growth. The paste should be applied twice a day for a few weeks.

These home remedies will be definitely effective and useful for preventing hair loss.

What Causes Hair Loss

The cause of hair loss may vary from a local condition affecting the scalp to an ailment affecting the whole body.

The common causes of hair loss are listed below:

Androgenetic Alopecia: Androgenetic alopecia is the male-pattern baldness that runs in families. The hair is lost in an M-shaped pattern, with loss at the crown and temples and sparing of the sides and back of the head. Such alopecia may also be seen in women with loss of hair in the front and central part of the head. Women with this type of baldness may show excess androgen levels and should be evaluated for other conditions like hirsutism, polycystic ovarian syndrome, acne and infertility.

Telogen Effluvium: Telogen effluvium is a condition where the normal balance between the resting and growth phases of hair is disrupted, resulting in a predominant telogen phase. Thus, it leads to excessive shedding of hair and a decrease in the total number of hair. Some of the conditions that can result in telogen effluvium are:

 Physiological stress like surgery, severe illness, emotional crisis or pregnancy.

 Medical condition: Medical conditions that can cause hair loss include:

 Hypothyroidism and hyperthyroidism

 Systemic amyloidosis

 Liver or kidney failure

 Inflammatory bowel disease

 Lymphoproliferative disorders

 Autoimmune diseases like systemic lupus erythematosus and dermatomyositis

 Chronic infections like HIV and secondary syphilis

 Inflammatory disorders like psoriasis, seborrheic dermatitis and allergic contact dermatitis

 Nutritional factors: Nutritional factors that can cause hair loss include:

 Zinc deficiency

 Iron deficiency

 Severe decrease in protein, fatty acid and calorie intake due to starvation or dieting

 Malabsorption syndromes and pancreatic disease

 Vitamin D deficiency

 Medications: Medications that can cause telogen effluvium are oral contraceptives, androgens, retinoids, beta-blockers, angiotensin-converting enzyme inhibitors, anticonvulsants, antidepressants, and anticoagulants.

The event may have occurred up to 3 months before the hair loss incident. Treatment of the underlying condition usually results in resolution of the hair loss. Thus, telogen effluvium is a sign of an underlying condition and not a disease by itself.

Alopecia Areata: Alopecia areata is a condition where the patient suffers from a localized hair loss. When the hair loss extends to the whole scalp, the condition is called alopecia totalis. If it is accompanied by hair loss over the entire body, it is called alopecia universalis. The hairs over the affected area resemble exclamation points, that is, the hair is thinned out but the caliber of the hair at the base remains the same. It may be associated with autoimmune conditions. Most patients recover without treatment in 6 to 12 months. Recurrence occurs in 30% cases. Prognosis is worse if the condition lasts for more than a year, if it worsens, begins before puberty, is present in other members of the family or in patients of Down’s syndrome.

Anagen Effluvium: Loss of hair in the anagen phase occurs due to chemotherapy, radiotherapy (radiotherapy can also cause telogen effluvium), heavy metal poisoning and boric acid poisoning. Hair loss usually appears 1 to 2 weeks following the trigger and is noticeable by 1 to 2 months. Alopecia areata also results in loss of hair of the anagen phase.

Trichotillomania: Trichotillomania is a psychiatric condition where the patient plucks out his or her own hair. It may develop between 8 to 12 years of age. The hair loss appears bizarre, with incomplete areas of clearing. In some cases, the patient may also eat up the plucked hair resulting in obstruction in the intestines.

Traction alopecia: Traction alopecia is a condition where the person suffers from hair loss due to tight tying of hair in ponytails or plaits. A change in hair style is necessary to prevent further hair loss in these patients.

Tinea capitis: Tinea capitis is ringworm infection of the scalp. It is a type of fungal infection where there may be a boggy lesion on the scalp over which the hair are increasingly fragile and breaks easily.

Cicatricial alopecia: Cicatricial alopecia is a condition where the hair follicles are permanently destroyed, resulting in permanent hair loss. It could be caused by a number of conditions like inflammation, autoimmune conditions like discoid lupus and infections like cellulitis.

: Types of Bariatric Surgery or Weight Loss Surgery

Bariatric surgery is the most effective weight-loss surgery for the morbidly obese. Lap banding and gastric bypass are the most common types of d weight loss surgeries with good results and minimal complications.

Obesity is one of the most common nutritional disorders in the world. A Body Mass Index (BMI) of 30 kg/m2 and above defines it. BMI is calculated as weight (in kilograms)/height squared (in meters). 

Morbid obesity is regarded as a metabolic disease linked with numerous medical problems. The list of co-morbidities is long. The most prevailing problems are the combination of arthritis and degenerative joint disease, sleep apnea, asthma, hypertension, diabetes, and gastroesophageal disorders. 

Bariatric surgery (Etymology: Greek words "baros," meaning "weight," and "iatrikos," meaning "medicine") is the term for a surgery that helps you lose weight. It originated in the 1950s. The significant risks associated with this surgery prevent it from being used in every individual who is obese. The success of medical therapy for severe obesity is limited.


Due to the current high levels of obesity among people in US of all age groups, and the lack of success with non-surgical weight loss methods:

1. Bariatric surgery is now becoming a very important option for severely obese patients.

2.  It is estimated that approximately 170,000 bariatric operations were performed in the US in the year 2005.

The procedure was developed out of modifications on cancer/ulcer operations that involve the removal of a part of the stomach or small intestine. It was noticed that patients undergoing these operations lost weight afterwards, and the doctors developed the idea of using similar types of surgery to treat morbid obesity.

These surgical procedures are major gastrointestinal operations that work on the principles-

1. To bypass most of the stomach to reduce the amount of food one can eat.

2. To rearrange the small intestine so as to reduce the calories the bodies can absorb.

There are several different types of bariatric weight loss procedures, and they are collectively called as 'bariatric surgery.”

CELECTION OF PATIENTS

Patients must meet the following criteria for consideration for bariatric surgery:

 BMI >40 kg/m2 or BMI >35 kg/m2 with an associated medical co morbidity worsened by obesity

 Generally when a person’s weight is 220kg or over, they are considered for this surgery.

 Dietary therapy has failed to achieve results

 Mentally (psychiatrically) stable without alcohol dependence or illegal drug use

 Fully informed about the operation and its consequences

 Motivated

 No medical problems that would possibly prevent survival from surgery

Certain other factors taken into account include: 
 If a person is obese for at least 5 years

 No previous history of alcohol abuse

 No history of depression or another major psychiatric disorder

Age is a controversial area for selection of patients for the surgery. Food and Drug Administration (FDA) approved LAP-BAND for use in patients 18 years and older. The age of 60s is generally set as a cut off for performing gastric bypass. Increasing experience will be required to decide what type of surgery benefits which age group.

Preparing For Weight Loss Surgery

The success of medical therapy for severe obesity is limited. Despite this limited success, a medically supervised diet program is first tried on every severely obese patient. Consultation with an array of specialists is scheduled before the surgery:

It is necessary for persons to undergo a thorough certain examinations to determine eligibility for gastric bypass surgery such as:

 Medical
 Nutritional
 Psychiatric

These evaluations are done to protect the patient's interests, and to give the surgical team proper information necessary for the procedure.

A detailed work up is done to rule out any of the contra indications. For details refer to the FAQs section of this article.

Pre Operative Period of Bariatric SurgeY

Patient getting admitted for the procedure will have to be prepared for

 Admission one or two days prior to the surgery.

 Routine blood and urine tests will be undertaken on the patients.

 This is the time for the patient to clear all the leftover doubts with the surgeon about the surgery and its results.

 Breathing exercises should be practised to help in the postoperative period.

 Smoking should be given up.

 One should be prepared to stay on for a few days after surgery if there are any complications.

 In the morning of their surgery they are taken to the pre-operative room, where they change into a hospital gown and receive intra-venous (IV) fluids.

 Families can stay with the patient until they are taken to the operating theatre, at which time the family will be taken to the waiting room.

Type of Bariatric Surgey

Lap banding and gastric bypass are the most commonly used Bariatric Surgery or Weight loss surgeries. All surgeries fall into two groups: restrictive and restrictive-malabsorptive.

Several types of weight loss surgeries (Bariatric surgeries) are available. Lap banding and gastric bypass are the most commonly used ones.

 Roux-en-Y gastric bypass

 Laparoscopic adjustable gastric banding (LAGB)

 Biliopancreatic diversion (BPD)

 Duodenal switch (DS)

 Vertical banded gastroplasty (VBG)- abandoned

Weight loss surgeries (Bariatric surgeries) fall into two groups: restrictive and restrictive-malabsorptive. In a restrictive surgery, the amount of food the stomach can hold is limited and the rate of gastric emptying is slowed down.

Laparoscopic adjustable gastric banding (LAGB) is the most commonly performed restrictive operation. An adjustable band (the lap-band) is used around the opening of the stomach. The band is connected to a reservoir that is implanted under the skin. Injection or removal of saline into the reservoir constrains or loosens the band's internal diameter. The size of the gastric opening can thus be altered.

There are three restrictive-malabsorptive bypass procedures: Roux-en-Y gastric bypass (RYGB), Biliopancreatic diversion (BPD), and Biliopancreatic diversion with duodenal switch (BPDDS). They work by combining the elements of gastric restriction and selective malabsorption.

Roux-en-Y gastric bypass (RYGB) is the most commonly performed and accepted bypass procedure. A small pouch is created in the stomach and it is attached to the small intestine. The procedure can be performed as an open surgery (by making an incision on the abdomen) or laparoscopically (via smaller incisions, using smaller instruments). The surgery usually involves a 5-7 day hospital stay in case of open and 2-3 days in case of laparoscopic procedures. Most people may return to their normal activities within 3 to 5 weeks.

Patients who have an extremely high BMI and are high operative risks benefit from a two-stage duodenal switch (DS) procedure. This includes sleeve gastrectomy where the size of the stomach is reduced to a narrow tube. This procedure is however not as commonly done as the previously mentioned ones.

Post Operative Care After Bariatrict Surgery

Bariatric surgery generally takes 2-2 ½ hrs, and the surgeon will normally inform the family after surgery has been completed.

 The patient recovers in the recovery room from the effects of anaesthesia, after 2-3 hr

 Once fully recovered the patient will be wheeled to their bed or room in the hospital.

 Patients may have a nasogastric tube (NG), an IV and a Foley catheter in their bladder.

 The NG is usually removed 1-2 days later, after an x-ray of the new pouch has been taken.

 After 2-3 days the patient can begin drinking water and about 60ml of a dietary supplement such as Boost, Horlicks or other similar food supplements.

 The patient will remain on liquids for the first 2 weeks after surgery, drinking the supplement for meals.

 The other liquids patients may have are decaffeinated coffee or tea, skimmed milk, broth (kanji), water, diluted fruit juice (1/3 juice mixed with 2/3 water) and sugar-free ice candies.

 The patient must avoid at all costs sweetened and/or carbonated beverages and adding sugar in their liquids.

 Average hospital stay is from 5 to 7 days depending on the physique of the patient.

 Patients must be able to drink adequate amounts of fluid before they can be discharged home.

Complications and Risks of Bariatric Surgery

Surgical mortality from bariatric surgery is generally less than 1%. Risks involved vary with the procedure, patient’s age and medical conditions, and the expertise of the operating team.

Males have increased risk for morbidity and mortality compared to females undergoing this surgery.. What follows is a list of the possible complications of bariatric surgery:

 Bleeding from the intestines

 Infection of the wound

 Blockage, tear in the bowels

 Food intolerance

 Vomiting or straining after surgery before the incision heals can cause a hernia. Laparoscopy assisted surgery greatly reduces hernia risk.

 Depression

 Nutritional consequences: Deficiency of calcium, vitamin D, vitamin B-12, iron.

 Gastroesophageal reflux

 Hiccups and bloating may occur due to the enlargement of the bypassed stomach

 Ulcer

 Blood clots in the legs or lungs

 Heart attack

 Pneumonia

 Urinary tract infection

Anesthetics problems may occur as in any major operation.

In bariatric surgery a condition called "rapid gastric emptying" or Dumping syndrome can occur. Dumping syndrome occurs when the lower section of the small intestine (jejunum) fills up too quickly with undigested food from the stomach, causing unpleasant digestive effects. Dumping syndrome can also be triggered in gastric surgery patients by consumption of simple carbohydrates (sugar, or some starches) or carbohydrates with a high glycemic index.

There are two variants of rapid gastric emptying: early and late dumping.

Early dumping typically starts during or immediately after a meal with symptoms like:

1. Abdominal cramps

2. Bloating

3. Palpitations

4. Nausea

5. Vomiting

6. Diarrhea

7. Shortness of breath

Late dumping typically occurs 1-3 hours after eating with symptoms like:

1. Weakness

2. Dizziness

3. Fatigue

Diet of Bariatric Surgery

 Patients would be started on to solid food in about 2 weeks after surgery.

 At this time the patient will be instructed to start a soft diet, in 60ml, portions, focusing on eating proteins.

 The diet will be advanced slowly so that the patient may add new foods every 1-2 week for the first 8 weeks.

 At the end of 2 months the patient will be able to try new foods, in small amounts. Around 6 month after surgery, the patient should be able to eat a child-sized meal.

 There are some foods like those high in sugar that could cause "dumping syndrome" and patients should avoid them, these include-
   1. Sweetened sodas
   2. Ice cream
 There may be some foods like bread that patients may not tolerate initially after the surgery but would be able to eat several months later.

 Every patient will need to find what foods they best tolerate during the different phases of their weight loss process.

Result of Bariatric Surgery

Safety & Effectiveness of Weight Loss Surgery (Bariatric Surgery)

Bariatric surgery is the most effective weight-loss therapy for the morbidly obese. The result of the surgery is well acceptable and has made this surgery safe for the morbidly obese. The first follow-up has to occur within a month after surgery.

Studies have shown that bariatric surgery is the most effective weight-loss therapy for the morbidly obese. Morbid obesity is defined as a BMI>40 kg/m2. Most of the weight loss occurs in the first 1 to 2 years after surgery. Loss of weight will bring down medical problems associated with obesity.

An ideal weight need not be attained after bariatric surgery. A 50 to 60% of excess body weight is sufficient to declare the surgery to be a success.

Follow-Up after Surgery 

A long-term follow-up is always required. The first follow-up has to occur within a month after surgery when the doctor evaluates oral intake, tolerance to food, the status of the wounds (progress of healing) and weight loss. With time, the frequency of visits decreases. The advice from your nutritionist is to be tightly adhered to. Vitamin supplements are often required.

A commitment to staying healthy for life is an absolute must.

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