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M. P. Ravindra Nathan
BEWARE OF PERILS OF SMOKING - GETTING RID OF THE SMOKING MONKEY OFF YOUR BACK (PART III)
By M. P. RAVINDRA NATHAN, MD, FRCP (LONDON AND CANADA), FACP, FACC

The best way to quit cigarette smoking is not to have started it all. Many teenagers succumb to the pressure from their smoking buddies; if they could muster enough courage to ‘just say no,’ they can avoid a lot of future problems. And parents can help by setting an example themselves or at least by not leaving cigarettes within reach of their children. When talking to your adolescent children, always remember how sensitive they are about these issues. Hence, avoid being overtly critical but point out the benefits.

For some, the wakeup call comes a little late, when they get a high impact news from their doctors such as “Your chest pains are from a heart attack or I am afraid the spot in your chest X-ray is cancer.” So, you want to quit while you are still ahead.

Here are a few ideas to get off the nicotine habit.

Behavior modification: No matter how you want to do it, some degree of willpower, self- motivation and mental preparation are needed. And you have to be creative about it too. If ‘quitting cold turkey’ is not an option, tapering off by one cigarette a day is within the reach of many. However when you are down to one or two cigarettes a day, you will feel that ‘hit’ from this cigarette and may want more, so don’t fall for that urge. This may not work for everybody but it is certainly worth a try. You can supplant a cigarette with chewing gums or candy to keep your mouth occupied when the urge hits you.

Smoking cessation counseling. Getting counseling would be helpful before your ‘quit date.’ Not only chronic smokers but even recreational smokers will need adequate support and counseling when they are trying to break the habit. Your family doctor may be your best counselor. Most medical insurance companies now reimburse the doctor for these counseling sessions. Also, it is good to find a partner or two with whom to quit smoking – a ‘buddy system,’ if you like. This also will help prevent relapses which do occur often enough.

There are lots of new research and an arsenal of treatment options available now.

Nicotine replacement therapy: Nicotine gums, 24-hour patches, lozenges, inhaler and nasal spray –contain compounds containing slow release nicotine to ease the withdrawal symptoms. These have a certain amount of nicotine in them and hence the pain and discomfort of withdrawal will be tolerable. Usually, you start with a larger patch or heavier dose of gum and taper down every 2-4 weeks. The recommended time period for quitting is three months but you can shorten this if you have enough willpower. And the quit rate is about 17 percent at six months.

Non-nicotine medications: There are many but two are in common use: Bupropion (Zyban) and the recent one Varenicline (Chantix). Bupropion is an antidepressant drug and increases the level of a chemical in the brain called dopamine, improving the nicotine withdrawal symptoms. As with many medications, bupropion has side effects, including sleep disturbance and dry mouth. And don’t use it if you have a history of seizures. The other is Varenicline (Chantix), which acts on the brain's nicotine receptors, decreasing withdrawal symptoms. Potential side effects include headache, nausea, an altered sense of taste and strange dreams and even suicidal ideations. So, check with your doctor.

Non-drug therapies: Exercise therapy, acupuncture, relaxation and stress reduction techniques and even hypnosis can be tried. Although some hypno-therapists claim that urges to smoke will magically disappear, there are no magic bullets that can make your craving disappear instantly.

Prevention: Anti-smoking campaign that started two decades ago has certainly led to a decrease in smoking in USA. But in many other countries, including Third World nations, smoking is steadily on the increase. The government needs to impose even more rules, although smokers are making a lot of fuss. The multibillion dollar ‘master settlement’ agreed by the tobacco companies against the threatened massive lawsuits in the 1990s hasn’t hurt the industry. They continue their lobbying, spending tons of money for marketing. Do you know that Brown and Williamson had to pay $500,000 to use their brand of tobacco products in five Sylvester Stallone films? However, we can take heart that the Environmental Protection Agency is actively pursing the clean indoor air movement.

The United States Healthy People Initiative aims to reduce smoking prevalence to less than 12 percent in adults and less than 16 percent in youth. Currently, in USA, about 21 percent adults and 22 percent of high school students smoke. That is a whopping 43 million! A concerted effort by health professionals and all concerned citizens will be critical in achievement of the Healthy People 2010 objectives.

Finally, always remember it is never too late to quit.

For information, visit http://cdc.gov/tobacco/ or www.annals/intheclinic/clinicaltools. Or call 1-800-QUIT NOW

(This concludes the series on smoking)

Cardiologist Dr. M. P. Ravindra Nathan, director of Hernando Heart Clinic in Brooksville, lives in Brooksville.


FITNESS COLUMN


BODY WEIGHT OR BODY FAT?
By ACHUT MASHRUWALA

How to tell you are fat or not? What is important, body weight or body fat?

The answer to these questions will determine your health. Most of the time, we focus on body weight. Body weight consists of two types of weight. First is composition weight, which is made of your lean tissue such as muscles, bone and organs that are metabolically active, and second type is fat weight, which is made of your adipose (fat) tissue. The standard scale, one in your bathroom, at the supermarket, in gym and a doctor’s office shows you the whole body weight, which includes both the composition weight (let’s call it a healthy weight) and fat weight (the one we want to minimize). Most of the health specialists, fitness trainers, dietitians, nutritionists and some doctor’s offices carry this BMI and body fat analyzer device. It gives precise measurement of body mass according to your height, composition weight and body fat percentage according to your current standard weight.

The person, male or female, may fall in high range of BMI (body mass index) and weigh more than normal range and still be healthy by having normal body fat percentage. Most athletes weigh more than normal weight range but their composition weight is higher than their body fat percentage. In the same perspective, a person may weigh normal and their BMI is within normal range. However, their body fat percentage is in high or extremely high range. That person may look thin but is not healthy and is at risk of getting chronic disease such as heart problem, blood pressure, diabetes, etc.

Your goal from today:

Reduce the percentage of your body fat. Live healthy, not just thin.

How to reach your goal:

The combination of exercise and proper diet is vitally important to decrease body fat percentage. Only diet will not give the results you need or just exercise will not lower your body fat percentage. Only diet will help you lose weight in general, which means you will lose part of your composition weight along with fat weight. Losing composition weight means losing strength and active metabolism. That can create health complications. Only exercise will increase your composition weight, yet not reduce the body fat percentage. The best way to reach the goal of reducing the body fat percentage is to decrease daily calories by about 500 and increase the course of exercise.

Aerobic exercise is the way to go. Start with walking 1-2 miles a day, then jog and add some stretching routine to daily activities. Do at least three of the following aerobic and agility exercises: Rope jumping, plain high jumps, steps, squats, zigzag jumps, squat jumps and sprint (fast running). These exercises (at least 3 set of 10) will energize the entire body. They create movement through your entire body.

As you progress with aerobic exercise, add strength by holding weight while you walk or jog. Start with three sets of 10 crunches a day to reduce the belly fat. Do some lunges (3 set of 10) to reduce the lower body fat and gain muscle strength. Add some push ups (3 set of 10) to reduce the upper body fat and gain muscle strength. Always, there is a room to improve the repetitions, a set of exercise and strength. Regularity in exercise and gradual improvement is the key to see the results.

Be sure to reduce your calories intake. A simple way is to eliminate extra side dishes. For example, if you are in habit to eat pickle or papad with you meal, STOP THAT! Do not take the extra carbohydrates to finish your protein. For example, do not take extra scoop of rice to finish the leftover dal. Either eat your left over dal by itself or don’t eat it at all. Reduce a portion of your meal and increase the frequency of the meal. For example, eat in small portion 4-5 times a day instead of three big meals a day.

Achut Mashruwala of Fitness Guru Inc. can be reached at (813) 857-5103 or e-mail andy@fitnessguruone.com




Payal Patel
CHILDHOOD OBESITY PART III: HEALTHY CHOICES
By PAYAL PATEL, M.D.

In this month’s article, I would like to stress the importance of food groups and serving sizes as well as talk about eating a balanced meal. It is important that a child eat the serving size recommended for his/her age as well as choose healthy foods.

A child aged 1-10 years of age should have three servings per day of milk products such as milk, cottage cheese, yogurt, cheese, etc. Children in this age group should have four or more servings of bread and cereal per day such as wholegrain bread, unsweetened cereal, cooked rice, pasta, grains. For Indians, a roti is a better choice than naan, bhakri or puri, which either is made with enriched white flour-with little nutritional value or contains more oil. For South Indian cooking, idli is a better choice than medu vada, dosas, uttapamas, which require more oil.

Adding vegetables such as peas, carrots-grated or blended spinach to idlis also fortifies them. Four or more servings of fruits and vegetables are ideal for kids of this age. Examples of yellow/green group are spinach, squash, carrots, peach, cantaloupe, etc., as well as citrus such as oranges, tomatoes, tangerines and strawberries. You can incorporate these as snacks such as carrot sticks, baby tomatoes or even salad before dinner. Frozen or canned vegetables also can be utilized in cooking.

Fruits such as strawberries, bananas, etc. can be used to create smoothies or be eaten as snacks or as a healthy alternative to dessert.

Since a lot of Indians don’t eat meat, beans such as chickpeas (cholay), kidney beans (rajma), moong (mag), black-eyed peas, etc. are a good source of necessary protein in our diet. For those who are lactoovo-vegetarians, eggs are a good source of protein.

Serving size is important because it determines the amount of calories consumed by a child. Discussing these choices with your child can help them understand nutrition as they grow up. A serving for a 1-3-year-old is half the serving of a 3-10 year old. For example, a half a cup of milk one serving for a 1-3 year old, whereas one cup is a serving for a 3-10 year old. A 1/4th cup of strawberries equal a serving for a 1-3 year old, whereas a ½ a cup of strawberries is a serving for a 3-10 year old.

Choosing nutritional foods such as for iron beans, lentils, cereals, dried fruit and green leafy vegetables as well as using cream of wheat (not instant) as a substitute for rava is important. Vitamin B12 can be obtained from dairy products, eggs and cereal. Folic acid rich foods are beans, berries, etc. Vitamin C can be obtained from fresh or frozen fruits and vegetables and fruit juices. A good source of Vitamin D is dairy products, eggs and cereals. Calcium can be obtained from dairy products and green vegetables.

Some of the ways to maintain healthy eating habits is eating at regular times, discouraging snacks, eating only at the table, eating slowly, grocery shopping together and teaching children about foods that are healthy choices. Other good options are packing lunch for school, instead of buying lunch from school. If your child does buy from school, reviewing the school lunch menu with him/her is a great way to ensure health eating habits.

In my next and final article on obesity, I will talk about a more generalized diet concentrating on particular foods, especially Indian meal choices that will benefit the children as well as the parents change their eating habits to better the lifestyle of the whole family.

Dr. Payal Patel is a board-certified pediatrician at Sunshine Pediatrics, 18928 N. Dale Mabry Highway, Suite 102, Lutz. For information, call (813) 948-2679.



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