Vegan Diet-2022 Blog 1

 

These days many different types of diets are available, mainly vegetarian

Low carb, Mediterranean, no sugar, fertility diet and so on. One such Diet which is very common among the younger generation is called vegan diet. This means that you do not eat any animal products, including dairy products, and eggs.  This even excludes honey.

The vegan diet mainly consists of fruits, vegetables, plant based milk alternatives, legumes, beans, lentils and peas. Again their nutrition is improved by soaking, cooking and then fermenting.  Nuts in vegan diet provides zinc magnesium selenium vitamin E, some iron and protein. 28 gms of nuts contain 5-12 gms of protein .Hemp, chia seeds and flax seeds are a rich source of omega 3. Chia seed is a great substitute for egg in baking .Hemp has been removed from controlled drugs act. Most vegans use fortified products such as vegetable milk, breakfast cereals, and fortified nutritional yeast. Nutritional yeast is a good source of nutrients, it is cheese supplement for vegans/ however it can cause a few side effects such as gastrointestinal upset, flushing of the face, and can precipitate migraine head ache.

Vegan diets are good diets but if not followed intelligently considering your personal reasons, one can suffer from severe deficiency problems due to lack protein, of calcium, vitaminB12, vitamin D, Iron and essential fatty acid. Special care is needed for, pregnant mothers, new mothers, their babies and children. Proteins are required for sports people, growing children, pregnant or nursing mothers, people recovering from an illness. Soya products are a very rich source of proteins such as tofu, soya drinks. Tempeh is made from fermented soya beans this increases its nutritional value and this contains a very small amount of B12 as well. Nutritional yeast especially if fortified is a rich source of protein and B12. For calcium green leafy vegetables, cabbage, broccoli okra are good. Calcium set tofu is also made. Sesame seeds Tahini pulses are good sources. Soya drinks fortified with calcium and vitamin D are good supplements. Fortified cereals are good supplements for many nutritional needs for iron one needs pulses, green leafy vegetables dried fruits. For B12again fortified cereal, soya drinks yeast extract or even a medical supplement. Essential fatty acids are required for many functions in the body. They come from grain, green leafy vegetables and nut, walnuts and pistachio nuts, seaweeds are rich in essential fatty acids antioxidants and iodine. Vitamin D is also available in many fortified food. One can easily get it from sunshine.

Vegan diet is excellent for animal protection, personal satiety as there is bulk in food , good to lose weight, lower cholesterol and above all saves from heart disease which in the major killer of human society. If care is taken to protect one from deficiency problems it can be excellent. When one wants to start any diet see what is your need for example if you have a family history of heart attacks it will be very good for you, but if your family has suffered from osteoporosis it is no good for you. Also you do not have to follow it the whole, one can modify according to once needs.

Asha Pahuja

PREGNANCY AFTER WEIGHT LOSS (BARIATIC) SURGERY

 

IN the modern world obesity is one of the biggest problems. However the medical world has found a solution to it. They perform special types of surgical procedures to overcome this. These are called Bariatric surgery. There are 3 such operations, gastric banding, Ry gastric bypass, and Gastric sleeve by pass. After these women can lose up to 38 kgms. Eating decreases extra care is required to keep the nutrition good. Fertility, PCOS blood pressure, and diabetes improves .Women should wait for12 to18 months after bariatric surgery before getting pregnant. This time is necessary for them to establish their weight loss and nutrition.

During pregnancy the risk for preeclampsia, gestational diabetes, decrease. However risk of hyperemesis, intestinal obstruction, internal hernias, and cholelithiasis increases. Often an adjustment to gastric banding is required. There is risk of premature labor, lower risk of forceps delivery, caesarian section, epidural anesthesia labor dystocia, fetal distress, peripartum[Ma1]   sphincter injury , large babies ,and post-partum bleeding on the fetal side there is no  increase in fetal malformation , neonatal intensive care admissions neonatal  deaths and stillbirths increased.  

During pregnancy special care is required both for mother’s nutrition and growth of the baby. The pregnancy complications are minimized however they are not completely eliminated. Normal pregnancy tests are all performed, glucose tolerance test is modified. In women after bariatric surgery threshold for diagnosis of GDM is a fasting more than5.3mmol/L, one hour after a meal7.8mmols/L 2hours more than 6.7 mmol/L is considered as GDM.

 This subject needs to be studied a bit more by all concerned surgeons for new techniques ,nutrionalists[Ma2]  and above all obstetrician who need to manage these women .

 

---

 [Ma1]

 [Ma2]

DYSMENORRHEA

 

Dysmenorrhea means painful period. Almost every woman must have experienced this to some degree in her life time. If you have never felt it, you are extremely lucky. DYSMENORRHEA (DYSM) Starts 6-12 months after menarche, it can even happen after 2 years. This is due to the fact that it happens when ovarian function matures, that is when ovaries start to make an egg. It is a very painful spasm in the lower abdomen, backache, and pain in the legs. In severe cases it even causes nausea, vomiting, diarrhea, headache, and dizziness. It can make adolescent or a woman totally incapacitated to attend school or work. It often starts one or two days before bleeding starts and can last up to 12 or 72 hours. Proves very harmful for studies or work situations. Many women can manage it easily just by paracetamol or Ibuprofen or drugs available over the counter. Why does this happen? It is due to tissue damage, resulting in the production of hormone like chemicals produced locally from fatty acids called prostaglandin, these help with inflammation and healing. Unfortunately they also cause severe uterine spasm and blood clots. There are two types of DYSM primary meaning there is no other pelvic pathology and secondary meaning there are other pelvic diseases such as, Endometriosis, pelvic infections, adenomyosis and fibroids. The last two most often happen in older age group and often associated with heavy bleeding. Endometriosis is the most common cause of very painful periods in all age groups, if a woman is sexually active sex is painful, even bowel action can be painful. Very often women need to take medical advice, about painful periods.  When you attend a clinician he will take a history, do a pelvic examination and see if there is pain or any pathology. You may require Smear test, blood tests, tests for sexually transmitted infections and an ultrasound. These are only done depending on the pathology. If Endometriosis is suspected often an operative procedure called LAPASCOPY is performed. Here the surgeon looks inside the abdomen with a telescope under anesthesia and often Endometriosis is treated at the same time with ablation by laser or electric current. For simple cases life style factors such as regular exercise, good nutrition rich in calcium, Zn, magnesium, vitamin D. Avoid constipation. Hot bathes, hot water bottle will provide heat to the abdomen. Heat packs also are a good source of portable heat to the area. Acupressure and acupuncture helps. Often the treatment to stop periods is offered such as progesterone implants injections even intra uterine hormone devices.  As it was mentioned at the start that it is the ovulatory cycles which are painful oral contraceptive pill is an excellent option if there are no contra indication to use it or having children is not an issue. In older women, when child bearing is completed with adenomyosis and fibroids often operative treatment is offered.

DHEA: DIHYDROEPIANDROSTERONE

 

What is DHEA; a hormone easily available in many countries over the counter and in many countries in the nutritional section of tablets? In many countries women use it freely as a heath product often without proper advice. They think it helps their wellbeing, muscle strength, lose weight, cognition, boost immunity and sexual function. Some also feel benefitted from hot flushes and depression. It    is available as tablets, topical cream, powder, capsules, and gel. The studies on this subject are confusing. Only one study has suggested in a small number of women that helped with hot flushes, sexual dysfunction. Off course it helps with bone density. It has a few side effects such as, headaches, fatigue, insomnia, abnormal bleeding, acne, may be loss of hair and hairiness (Hirsutism).They can also interact with some important drugs such as blood thinners, anticonvulsants and drugs used for heart or liver disease. One situation it is useful in, is vaginal atrophy due to menopause. It has no systemic effect hence can be useful in women after treatment for breast cancer. It is helpful in sexual function due to prevention of pain, it is not believed that it helps in improving libido in any other way. Using DHEA women, also risk getting problems with, Thyroid, HDL, PCOD, and Clotting problems. I have come across many menopausal women taking DHEAS to prevent aging effects, wellbeing and feel better sexually; my suggestion to them is not to take this without proper advice, it does nothing for aging, may be a bit for menopausal symptoms and surely helps with vaginal atrophy and bone density.

EMERGENCY CONTRACEPTION

 Contraception is a constant bane in a women’s life, from the moment she becomes mature as a woman, until one or two years after menopause. In the scheme of life, we usually have 2-3 children and in our 40-50 years of reproductive life, we have to keep protecting ourselves from getting pregnant. There are several ways to do so, however every now and then we get mixed up. Involved in different and other stressful situations, we forget about contraception, and the problem starts for emergency contraception (EC). When do women need this, when they have forgotten to take two pills in the first week of the cycle, did not take the progesterone only pill, and did not put the vaginal ring or the skin patch on in time? Some times bigger things are forgotten such as changing IUCD on time, skin implant not renewed. Besides these the condom breaks during sex, sexually assaulted and diarrhea and vomiting disrupted the pill cycle. Sometimes women assume it is ok to have sex, soon after having had a baby, however one can get pregnant again, and 21 days after having had a baby.  So many situations when one needs emergency contraception (EC). I am sure you will be able to think of many other different situations. 

Now what are the methods of EC? These act by preventing ovulation, altering the lining of the uterus, making it unsuitable for an egg to settle down. Ordinary contraceptive pills are packed as four together to be taken as a single dose. There is also a method called YUZPE method in which two hormones are given to be taken 12 hours apart. Both these pill systems can cause vomiting due to high doses of estrogens, if this happens the dose should be repeated after 2 hours. The three best recognized methods are again two hormone tablets prepared for this purpose. They are called the morning after, however they can be taken up to 72 hours and one after 120 hours. Both these hormone tablets can be bought from a pharmacy, a family planning clinic, sexual health clinic, no script is needed. Some GP’s also can give it. 

 

There is another morning after pill which is very effective, however in some countries you need a script for this, so the cost goes up and as such it is expensive .The next method is insertion of a copper intrauterine device, it can be done up to five days. One must make sure about the sexual history of the woman, exclude the likely hood of any pelvic infection. The morning after pill or copper IUCD does not protect women from STI’s, it is important to test for STI’s. The pill can cause side effects in a small number of women, these are nausea, dizziness, headaches, breast tenderness, and lower abdominal pain. There can be spotting and the next period can be late. Please do not use the morning after method as your regular method of contraception. Always keep STI’s in mind and protect yourself from them and always have a test done for them. If an IUCD insertion is used it is good as it can continue as a regular contraception for up to five years if you wish.

To summarize, emergency  contraception  provides good service, if your regular method fails with your regular partner it is safe, do not make it a habit with new partners it cannot be used twice in the same month,  protection from STI’s is essential. In some parts of the world it can be expensive.

TESTOSTERONE THERAPY FOR POST-MENOPAUSAL WOMEN(The latest help for post-menopausal women)

 

Since women are living for longer and longer they wish their lives to be happy. The desire to have a happy sex life is one such prerequisite. Many women suffer from what is called HYPOACTIVE SEXUAL DESIRE DISORDER (DYSFUNTION) (HSDD).   This is attributed to be many causes, however one such reason is supposed to be testosterone deficiency. This happens in young as well as older women.  Besides estrogens and progesterone women have small amounts of testosterone in their bodies, much less than men. One of the functions of this is to give us hairiness, muscle mass, help with fertility, menstrual cycle and last but not the least with sexual feelings (Libido).  The testosterone comes from the ovaries and adrenal glands in different chemical forms and converted to testosterone at area of need, within the body and inside the cells. As we age the testosterone levels decline causing difficulty in women’s sexual desire. This is in addition to the anatomical changes that are happening at the same time in post-menopausal women. To some extent the clinicians have improved the anatomical difficulties of genitourinary syndrome of menopause (GUS). However HSDD needed to be solved. There are many reasons for HSDD to happen such as psychosexual problems in the relationship, drugs, diseases such as Diabetes, thyroid disorders, local genital tissues damage. HSDD leads to relationship distress, depression, poor self-image and fatigue. After a fair bit of work it was decided to give testosterone therapy to these women, only for HSDD not for muscular strength, cognitive improvement or any other problems. Special suitable testosterone preparations were prepared for women. After a proper history, investigations, counselling; after it was made sure that the real cause of HSDD is lack of testosterone.  It was then offered as treatment. A testosterone preparation was offered as dose of 0.5 ml of a cream containing 5 mgm of testosterone. The women are advised to use it once a day in a measured amount and it is applied to thigh or torso as a cream. It will take 4 to 6 weeks for it to take effect. If it doesn’t help within six months it should be discontinued. Before starting the testosterone other causes of HSDD, should be excluded. The side effects of testosterone, can be acne, loss of hair, small gain in weight, deepening of the voice and increased hairiness. The women should be observed for any excess of testosterone. Hopefully along with the treatment of genitourinary syndrome of menopause (GUS) and testosterone for HSDD, post-menopausal women can have a happier time with their sex life.

HEART ATTACKS IN WOMEN

 

Heart attack is the commonest cause of death in women after sixty five. As many women die of heart attack as men at this age. 26.8% of women die of heart disease as compared to all cancers, which is 26.7 %. Sudden grief in women often results in heart attack. I have personally seen two examples of this among my friends. Women’s symptoms of a heart attack are slightly different to men.  They are often resting as opposed to men who are active at the time. They can experience unexplained anxiety, pain in the jaw, back ache, chest discomfort, abdominal pain and even mild flu like symptoms. The reason for these include conditions such as; high blood pressure, diabetes , high (bad) cholesterol(LDL), low (good) cholesterol (HDL), smoking, and high BMI. Even more important than the BMI is abdominal girth as this indicates visceral fat that is the fat inside the body organs. The abdominal girth measured at the level of belly button, should be less than 35 inches, or 89 cms. There can be fast and irregular beating of the heart. There is swelling of the feet if there is associated heart failure. Other conditions that can cause a heart attack are HIV, depression, inflammatory diseases, rheumatoid arthritis, Lupus. Cardiac arrest and aneurysm (Dilated Blood Vessel), high blood pressure during pregnancy and gestational diabetes are also risk factors for heart attacks in women. Women often ignore their symptoms if they are; having chest discomfort or pain, pain in the arm or jaw, sweating, suddenly feeling unwell or fainting. Do not ignore these symptoms. Seek urgent medical help. A dose of Aspirin can be lifesaving. Take it only after you have spoken to your medical adviser. Make sure you are not allergic to it.  For urgent diagnosis an ECG (Electronic heart monitoring) is done. Cardiac Markers are also tested in the blood, they give a good indication of what is happening. Cardiac Markers are repeated to assess the progress. An Ultrasound, chest X-ray, Coronary Angiogram or CT Coronary angiogram is performed to assess the blood vessels of the heart.  Other tests  to assess the general condition such as a full blood examination, inflammatory markers, kidney, liver, thyroid functions and blood electrolytes (Sodium, potassium) are all done. The patients are stabilized, cardiac rhythm is controlled. The final treatment depends on the findings. Either an angioplasty is performed by open heart surgery (changing the blocked blood vessels) or stents are put in the blocked blood vessels. This depends on the severity and degree of blood vessels involved. Both the procedures are very safe. Some researchers believe if early in menopausal life a women takes or given HRT, it is protective against heart attacks in later life. However one cannot be given HRT to protect repeat attacks. In summary it is good to know that, there are lots of solutions for heart attacks. Do not ignore the symptoms if they seem cardiac, as many women get heart attacks as men, after menopause. There is some protection by HRT if one has taken it at the right age, early in menopause. Improve your life style factors. Quit smoking, limited alcohol, watch weight and abdominal girth, regular exercises, cut down your stress levels and be happy. Change of life style factors will take you a long way to protect you from heart attacks.