Medical

The myth of healthy drinking

The so-called "healthy" limit for men is between three and four units a day, about one and a half to two pints of normal strength beer. Any more than this, and the health risks begin to rise. And it is no safer saving up these weekly "units" for one big binge at the weekend - this may be just as harmful.

Most people are aware of the immediate effects of consuming large quantities of alcohol - although, as the body builds a tolerance to these, the effects often become less obvious. Too much alcohol can irritate the stomach, leading to sickness and nausea, and can lead to temporary impotence in men.

Alcohol also has a dehydrating effect, and the traditional hangover arrives partly as a result. However, it is the longer term effects which worry doctors. Too much alcohol over a prolonged period can affect nearly every organ in your body. 

Alcohol is essentially a poison, and the cumulative effects can be tremendous. Long term drinkers can suffer liver damage, as the liver is the organ that processes the alcohol and removes it from the body.

There are three types of damage - fatty liver, in which fat is deposited in the liver, impairing its function, alcoholic hepatitis, an inflammation of the liver which can cause severe symptoms and lead in some cases to alcoholic cirrhosis, which can eventually cause liver failure if the drinker does not stop. The first two stages are usually reversible, whereas cirrhosis has no cure.

Heavy drinkers can suffer from chronic gastritis - essentially a daily recurrence of hangover style nausea and sickness. They can also suffer damage to the oesophagus. Pancreatitis is also a common problem in heavy drinkers - this is an extremely painful condition which is hard to treat, and sometimes fatal. Brain damage, too, is possible in some cases - alcoholic dementia is often found in very long- term drinkers. However, it is damage to the heart and circulatory system that places many drinkers at risk. Drinking over the recommended limits is one of the most common causes of high blood pressure, which can, in turn, contribute to heart disease.

It can also contribute to osteoporosis, lead to muscle weakness and make skin conditions such as psoriasis and eczema worse. Many cancers are also alcohol-related, particularly those of the mouth, oesophagus, liver, stomach, colon, rectum, and perhaps breast cancer in women. If these then are the risks, why is alcohol being touted as being protective and healthy in small quantities? Many studies have found suggestions that moderate alcohol drinking, for example one or two units a day, can have a protective effect against, in particular, heart disease.

Firstly, this has yet to be conclusively proven, as it is not clear whether it is the alcohol, or some other ingredient in the drink, which is having the effect. Secondly, it must be remembered that no one began abusing alcohol: all heavy abusers were "healthy" drinkers at first; only they found it difficult to maintain that "healthy" limit. So, the bottom line must be, better none than a little; that way, the chances of remaining healthy are much greater than with a "healthy" amount of alcohol!

Pain-free labour?

Health experts advise women to look carefully at all the options, decide which they would prefer, but keep an open mind as they may change their mind once labour has begun. Signs of labour include the release of a sticky pink mucus plug from the vagina, regular contractions, backache and the release of the sac of water in which the baby has been floating. 

Once in hospital, women may be given a mixture of oxygen and nitrous oxide (entonox) through a mask or mouthpiece, allowing them to control the amount they take in. Entonox does not relieve all the pain of labour, but it can take the edge off. No effects are passed on to the baby, but some women find that, after a while, it makes them feel light-headed and unable to concentrate on labour. 

Diamorphine and pethidine are another option. These are strong pain-relieving drugs which are injected into the woman and take about 20 minutes to work. 

The effects usually last for about two to four hours. Some women find that they relieve the pain well and allow them time to rest, but others find they make them feel nauseous and dizzy. The effects of the drugs, such as drowsiness, can be passed on to the baby, but an antidote can be administered to the baby as soon as it is born. 

Epidural anaesthesia is a type of local anaesthesia which numbs the area around the pelvis and can provide complete pain relief. It is administered by an anaesthetist via an injection into the the space between the woman's vertebrae. It takes about 40 minutes to be set up and for the effects to begin to work and can either be administered continuously or topped up at regular intervals. 

However, it is generally not administered or topped up towards the end of labour when the womb has opened fully and the time has come for the mother to push the baby out. This is because the mother needs to be able to have feeling in the pelvic area in order to know when to push. 

Disadvantages include a heaviness in the limbs which may need to be supported to avoid later backache, the need to have a catheter fitted, the need for a drip because the procedure causes the blood pressure to drop, inability to move from the bed and the need to be hooked up to a foetal heart monitor. 

However, the best option must only be decided in consultation with the doctor who can advise which method is best suited for a particular mother. 

Deadly blood cancers

Lymphomas are cancers of the lymphatic system, a network of vessels which form part of the body's immune system, and carry other infection-fighting cells called "lymphocytes", as well as draining dead cells away from the tissues. 

Symptoms of leukaemias include weakness, frequent infections, fevers, chills, or flu-like symptoms, easy bruising or bleeding, night sweats, bone or joint pain, weight loss and swollen and painful lymph nodes.

Doctors try to tailor treatments for both lymphomas and leukaemias to fit the variety of disease found. 

Often, leukaemia and lymphoma patients are given short, intensive courses of chemotherapy. 

However, if the cancer does not appear to have spread far, then radiotherapy may be an option. Both leukaemia and lymphoma patients sometimes need to have bone marrow transplants, particularly if the first chemotherapy treatment fails and more powerful drugs have to be used.

The bone marrow is found at the centre of the body's larger bones, such as in the spine and upper leg, producing blood cells and helping the body fight infection. 

If high-dose chemotherapy is to be used, this may permanently damage the bone marrow, so it has to be replaced afterwards. 

The patient can be given drugs to stimulate the production of cells vital to rebuilding the bone marrow, which cells are then harvested and replaced after the treatment. Or else, a donor may have to be found whose bone marrow is an exact match for the patient.

Despite all this, however the prognosis in these types of cancers remains poor, though of course there is considerable individual variation, depending on the type of the cancer and the duration of the illness.

Fever: some common symptoms and treatment

Some people still see it as a sign that the body is fighting illness- which is true most of the time. Fever, or pyrexia to give it its medical name, is caused by the release of certain chemicals by the immune system, usually as a result of infection or inflammation. In the past, many infections were rapidly fatal and fever was greatly feared, whether due to measles, flu or after childbirth. These days, despite effective treatments for most infections, fever is an important sign that someone is ill, and a cause should always be established. Other causes include any condition where there is inflammation, from arthritis to trauma to inflammatory bowel disease. Sometimes doctors simply can't find the cause of a persistent fever. Then it is called a fever of unknown origin (FUO or PUO for "pyrexia of unknown origin"). Special tests may be needed to pinpoint the cause and detect hidden abscesses or unusual infections. About 25% are not due to infection, and other explanations must be sought - most importantly cancer. 

About 1 in 5 people with chronic persistent fever have a tumour. Lymphoma, lung cancer, pancreatic cancer and primary liver cancer patients often have fever caused by dead cancer cells or bleeding. Normal body temperatures can vary enormously and are influenced by factors such as exercise, eating, sleeping and time of day - being lowest at about 3 a.m. and highest at about 6 p.m. 

Average normal body temperature taken in the mouth is 37oC (or 98.4oF). But anywhere between 36.5 and 37.20C may be normal. Normal armpit temperatures are 0.2 to 0.30C lower than this. A temperature of 380C or above is usually considered to be a significant fever. 

Not every fever needs medical attention, but if it is in a young child, and the temperature continues to rise, and if there are other worrying symptoms a doctor should be consulted.

There are several things that can be done to help bring the temperature down and make a person feel more comfortable: keep the room at a comfortable temperature, but make sure that fresh air is circulated, drink plenty of water to prevent dehydration, take off excessive layers of clothing, sponge skin surfaces with cool water and give medication regularly- paracetamol as tablets for adults or syrup for children or ibuprofen as tablets for adults or syrup for children. (Aspirin is recommended for adults only. Children under 12 may be at risk from a potentially serious condition called Reye's syndrome if treated with aspirin.) 

Soya: giving you beans

By Dr. D.P. Atukorale

Soya meat and soya milk are very familiar to most Sri Lankans. Low in calories and being a plant product, soya does not contain cholesterol. Soya milk is the ideal substitute for dairy milk if you are allergic to lactose or if you are a pure vegetarian who wants to get the benefits of a diet free of animal products. 

I believe that the expansion of the soya industry should be encouraged by the government of Sri Lanka as it makes good economic sense when compared to the very high cost involved in meat production. 

A cup of soya beans (172g) contains 15.43g of fat of which 3.41g is monounsaturated, 8.71g is polyunsaturated. A cup of soya beans contains 28.62g of protein, 3.47 g of fibre, 1.72 RE of Vit A, 2.92mg of Vit C, 0.27mg of thiamine, 0.49mg of riboflavin, 0.69mg of nicotinic acid, 0.69mg of biotin, 0.31mg of pantothenic acid, 0.40mg of thiamine 92.5mcg of folic acid, 177.44mg of calcium, 8.84mg of iron and 1.98mg of zinc. 

A word of caution

Soya and some other beans contain a substance known as trypsin inhibitor. Trypsin is an enzyme secreted by the pancreas and trypsin helps to digest proteins. As heating destroys trypsin inhibitor, all soya products have to be heated before eating. Soya milk, Tofu and TVP are heated during their manufacture. Therefore in actual practice, only soya sprouts should be boiled before consuming. 

Tofu

Tofu is a fermented product like bean curd but in a dried form. Tofu contains 100% soya bean and has a higher percentage of protein than any other natural food in existence and is entirely cholesterol free. Tofu has been the staple food of millions of people in Asia for centuries. In Japan most of the people say "O-TOFU" meaning honourable tofu. Today the soya bean has become the King of the Japanese kitchen. In fact the arrival of tofu, miso and shoyu initiated a revolution in the national cuisine in Japan. When the new crop of soya beans arrives at tofu shops in Japan each autumn, ardent devotees sample the first tofu with discrimination and relish of French vintners (Book of Tofu by William Shurtleff and Akiko Aoyagi 1975). 

Eating tofu reduces the risk of cancer according to several decades of large scale research in Japan. Eating tofu cuts the risk of stomach cancer and tofu has anti-carcinogenic properties (Nutr.Cancer, 1982:3; 257-68pg)

Tempeh

Tempeh probably originated in Indonesia and is a fermented soya bean product made in the traditional manner for centuries throughout Indonesia where it is a basic food for millions of people. It is highly digestible, smells like fresh mushrooms and tastes remarkably similar to chicken. It is a suitable food for young children and older people. 

Does Tempeh contain vitamin B 12? The answer is both "yes" and "no". Recent tempeh samples purchased from various markets in Jakarta reveal that a high amount of vitamin B 12 is present. However commercially prepared western tempeh does not contain any B12. 

Miso

This is a fermented mixture of soya bean, salt and usually a cereal such as rice or barley. It has a romantic flavour and comes in many different colours. It is one of the staples of every Japanese and Chinese kitchen. It is made by inoculating the basic ingredients with mould and leaving to age in cedarwood kegs for at least one year. In Japan it is commonly respected as a food and as a medicine. It is used as an ingredient in soups, sauces, dressings, spreads and other vegetable dishes. Epidemiological studies have shown that consuming miso usually as soup can reduce incidence of stomach cancer. Researchers from Okayama University Medical School have established that miso has antioxidant properties, isoflavones and saponins. 

Soya sauce

This is an ancient and traditional seasoning which has achieved prominence and acceptance the world over. It is a dark rich sauce with a savoury salty taste as well. Very little is required within a dish or serving. 

There are three types of soya sauce: 

(a) Commercial accelerated production type which is widely available. It is made in a very short time by speeding the process of fermentation using chemicals and usually contains colourings and preservatives. 

(b) Shoyu is made by fermenting wheat and soya bean together for at least 3 years. During this time flavour develops making it a delicious addition to most savoury meals. 

(c) Tamari is made by fermenting soya and salt over a long period of time between 2 and 3 years. It is not used so much for cooking as in the case of shoyu, as the flavour is much stronger. 

Soya flour 

This is ground dried soya bean, a dense rich flour. It may be mixed with wheat flour, with a view to increase the protein content of your bread. 

T.V.P. (Texturized Vegetable Protein)

TVP is made from soya bean processed into high protein low fat food. TVP is made to simulate the look and texture of meat products. This can be flavoured to resemble chicken, beef or bacon. TVP is easy to cook, it readily absorbs flavours of herbs, spices, gravies and other meal components at the saute stage of cooking. TVP is the commonest soya product available in our boutiques and supermarkets. 

TVP is a valuable, safe and inexpensive source of proteins and its content of 40% protein is very much more than in fish, meat, poultry and dhal. 

Soya beans as mentioned earlier are rich in minerals such as calcium, iron and zinc and have many of the vitamins such as C, A and B complex. 

Anticarcinogens

Soya bean is rich in anticarcinogens as mentioned earlier. Protease inhibitors in soya prevent the activation of certain genes that cause cancer and also protect against damaging effects of free radicals. Phytosterols in soya bean protect against cancer of the large intestine. Soya beans also contain lecithin which is a fat which prevents ischaemic heart disease. 

Risk of Heart Disease

Soya beans reduce the blood cholesterol level especially the LDL (bad cholesterol) level and also raises HDL(good cholesterol) level and prevents ischaemic heart disease. 

Courtesy Peter Cox's Guide to Vegetarian Living