First Eat Right - Dietitian Nutritionist Dr. Nafeesa's Diet & Nutrition Clinic

Kerala is on fire over Nipah virus ever since May 19th, 2018 when the Nipah virus disease (NiV) was first reported in the Kozhikode district of the state. Till now, there are 15 cases of confirmed deaths in the two affected districts, Kozhikode and Mallapuram in Kerala.
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Tracing the Origin of the Virus
First outbreak of this virus was in the year 1998 in the Malaysian village Sungai Nipah (hence the name Nipah virus!) among pig farmers but there were no cases reported after that. Here, the virus transmission was traced to human exposure to pig secretions or contact with the tissue of a sick animal. Yet another outbreak occurred in Bangladesh in 2001 and the country has witnessed at least a few cases almost every year since then. Eastern India also witnessed rare outbreaks of the disease since 2001 (Siliguri in West Bengal was the first affected city in India). The disease outbreak in 2004 in Bangladesh and India were linked to the consumption of date palm sap contaminated by infected fruit bats (urine or saliva). 

Later outbreaks in Bangladesh and India were mostly due to human-to-human exposure through people’s saliva or excretions. Almost 75% cases reported in the Siliguri city of West Bengal (2001) was within a health-care setting amongst hospital staff or visitors. According to WHO, the Nipah virus has claimed over 300 lives across Malaysia, Singapore, Bangladesh and India between the years 1998 and 2008. Researchers have confirmed that the Bangladesh strain of the Nipah virus is the reason for this latest outbreak in Kerala (2018).
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Nipah Virus: Zoonotic Disease
Nipah virus (NiV) is a zoonic disease (transmitted from animals to humans) that spreads via food or humans. NiV can also affect animals such as pigs severely and incur unwanted expenditure and losses for farmers. While the occurrence rate and numbers are low, the death percentage and severity are high making NiV a public health concern.

Signs & Symptoms
What makes this disease a deadly one is the incubation period which ranges anywhere from 4-14 days generally and even 45 days sometimes. Initial symptoms include fever, headache, muscle pain, vomiting and sore throat which is followed by dizziness, drowsiness, altered consciousness and neurological symptoms that indicate acute encephalitis (inflammation of the brain). Rarely, people do experience atypical pneumonia, severe respiratory problem and fatal encephalitis.

Fatality rates exist anywhere between 40 and 75%. Mostly people with acute encephalitis recover fully but among them, almost 20% people are left with long-term neurologic conditions such as seizure disorder and personality changes. But if proper care is not taken within 24-48 hours after symptoms of delirium, drowsiness and confusion, it can turn into coma. Read more on encephalitis at www.firsteatright.com. 

Diagnosis
Symptoms include influenza-like ones, don’t present themselves immediately and are non-specific which can prevent appropriate intervention, delay detection and take proper control measures. Also, the virus strain is evident only during the acute and convalescent phase of the disease. ELISA, PCR, virus isolation by cell culture and RT-PCR are the various test methods used for detection.

​Weight fluctuations (rise and fall of weight measurements) over a person’s lifetime are common due to diet changes, exercise routines, metabolism changes as we age and lifestyle practices. Weight loss for no valid reason, especially when the loss is too high, can be attributed to different physical or psychological causes. Such dramatic weight loss is a warning sign to the individual to meet his/her physician immediately.

Obesity is a well-known risk factor for cancer and intentionally losing weight reduces levels of certain hormones such as insulin, estrogen and androgens that are related to cancer risk. Right from breast, kidney, pancreas and esophagus to liver, cervix, ovary and gallbladder cancer, overweight/obesity increases the chances of these cancers by multifold. At the same time, unintentional weight loss too is a great risk factor of this deadly disease. Obese individuals who wish to lose weight can get in touch with a registered dietitian nutritionist at www.firsteatright.com. 

Individuals affected by cancer lose weight at some point. When an individual loses weight for no reason it is termed as ‘unintentional weight loss’. By ‘no reason’ it means that the individual is not under any diet program for weight loss, does not do daily physical activity or stay active but still keeps losing weight steadily. Such individuals keep losing around 4-5 kilograms of body weight which is the first sign of cancer. By the books, unintentional weight loss is defined as weight loss of at least 5% of the patient’s body weight that occurs within a period of 6 to 12 months and is not the consequences of treatment of a known illness. A new study has proved that when a patient experiences unintentional weight loss, it is the second highest predictor for some forms of cancer, such as the cancers of the esophagus, pancreas, stomach or lung.

For many patients, almost 40%, such unplanned weight loss is the first sign of cancer. Depending on the cancer type and the organs affected, patients experience nausea, lack of appetite, chewing difficulties and swallowing problems that decrease food intake levels drastically. Sometimes, cancer cells use body’s energy supply and alter the way food energy is processed by the body which can also result in weight loss. Cachexia and sarcopenia are two syndromes of such unintentional weight loss. Cachexia is characterized by decreased muscle mass due to some underlying disease such as cancer or advanced heart failure. All patients with cachexia witness unintentional weight loss but not all patients with unintentional weight loss have cachexia.

​Studies on Cancer Risk Due to Unintentional Weight Loss
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Researchers analyzed the findings of 25 studies collected from more than 11 million patients between 1994 and 2015. Results showed that:

1. Weight loss was linked with 10 types of cancer-prostate, esophagus, colorectal, lung, pancreatic, non-Hodgkin’s lymphoma, ovarian, myeloma, renal tract and biliary tree.
2. Unintentional weight loss in people aged 60 and above exceeded the 3% risk threshold for immediate intervention. In females, the average risk for all cancer types increased by 6.7% and in males the risk was up by 14.2%.
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From the data collected, the research team felt that non-specialized doctors did not consider weight loss as an important risk factor for cancer and neglected considering cancer as a threat to the patient until further symptoms erupted. Also, people with pancreatic cancer who showed weight loss as their first symptom of cancer had the longest time for diagnosis and poorest survival rates. Physicians and researchers always knew that unintentional weight loss was a potential risk factor for cancer and the above study has proved this beyond doubts but has not shown how many kilograms can be considered as unexplained weight loss.

Low back pain (LBP) is the leading cause of disability worldwide affecting people across age groups, right from an adolescent to an elderly person, leading to decreased quality of life due to restrictions in activity and common absence from work which in turn results in increased economic burden on the individual and his/her family. LBP is the second-most common reason for visiting a physician. All these factors lead to a major shift in treatment techniques for primary care of LBP.

Arresting Bedrest
During the 1980s, one week or more of complete bedrest was often recommended as the treatment for arresting low back pain. Along with this was given pain relievers, non-steroid anti-inflammatory drugs (NSAIDs) and muscle relaxants. But now, research shows this treatment procedure to be no better (or rather worsening) than taking rest for a day or two and then slowly increasing activity along with strengthening and stretching the back. Results force physicians to take upon a completely different approach to treat low back pain effectively.

Stop Medications
While a recent study recommends physicians to stop prescribing NSAID drugs to treat LBP, the latest study goes one step further and advises doctors to stop all medications and drugs prescribed as a treatment procedure for LBP. The American College of Physicians has revealed this treatment option after completely studying and analyzing more than 150 studies on LBP.

Medications can only suppress pain, relief is temporary and the benefits are average. Such average outcomes have constantly kept researchers on their feet trying an alternative solution to pain-relief medications. The specifics however, depend on the type and duration of back pain.

When low pack pain strikes you for the first time and lasts less than 4 months try treatment options such as heat, massage, acupuncture and spinal care (such as chiropractic care). Only when all of this fail to produce the desired result, physicians are advised to prescribe NSAIDs or muscle relaxants. If LBP is chronic lasting for more than 12 weeks, researchers advise opting for physical therapy, acupuncture, mindfulness-based programs such as yoga and meditation and exercises (stretching, balance and strengthening core muscles). Absence of positive outcomes after practicing these techniques might push doctors to suggest NSAIDs, tramadol or duloxetine. But, opioids must be prescribed only after thoroughly evaluating the pros and cons.

Remember, any of these suggestions are relief methods for LBPs that arise as a result of simple causes such as strenuous exercising, lifting heavy load or shoveling manure while gardening. It cannot be applied as a treatment routine for severe cases of back pain resulting from major injury, cancer, infection and fractures.

Prescribing Drugs
After years of analyzing and witnessing innumerable cases, we now clearly know that back pain goes away on its own, regardless of treatment options. The hard work here has been to work out on certain techniques and practices that safely ease symptoms while waiting for relief and improvement.

When there is lasting pain despite non-medication approaches and medication-based treatments, physicians might advise taking an MRI or prescribe additional tests. Every person has different response rates, situations differ patient to patient and medications that don’t work well on average might work well for some individual.
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Yes or No
99% of low back pain causes are trivial. But it is our duty to ensure that our causes don’t fall under the 1% clause that might lead to dangerous consequences. Answer ‘yes’ or ‘no’ to the following questions and meet your doctor immediately even if your answer to a single question is undoubtedly a ‘yes’:

1. Have you been diagnosed with cancer any time in your life?
2. Do you use intravenous drugs?
3. Have you met with any accident that had a significant impact on your back?
4. Did you suffer from fever recently?
5. Do you use intravenous drugs?
6. Did/do you suffer from bladder or bowel incontinence?

A positive response to these questions are suggestive of tumors, infections or other threatening causes that need immediate medical intervention.

​The result outcomes suggest treatment options that would have been declared unhelpful or incorrect if these were prescribed a few years back. Now, people are self-aware of lack of effective results from medications for LBP and come forward to try out alternative medicines or choose therapies such as yoga and tai chi to ease pain. Tai chi, also known as meditation in motion (reason behind this naming is available at the website www.firsteatright.com), is an excellent exercise form for those who have been inactive all these years but would like to start practicing physical activity hereon.  In the long run, such non-pharmacological treatments for back pain could become the standard set of prescriptions for treating LBP.

‘Bear hugs’ are warm, cozy and satisfying. A dad hugging his daughter, a squeeze with your loved one or best friends meeting after a long, long time hugging each other are commonly witnessed. Hugs are a sign of love, compassion and friendliness. There is more to hug than these! Research proves hugs to provide health benefits such as lowered blood pressure and decreased stress. Hug more and love hugging!

Hugs Decreases Stress
Being hugged before a big presentation, a long journey, an important interview or examination calms down the individual, according to research. One study asked a group of girls to present an impromptu speech in front of a big crowd suddenly. Those who received a hug or call from their mom experienced lower levels of the stress hormone cortisol.
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Hugs Increase Immunity
Hugging can decrease your risk of common cold! Researchers at a reputed university found that stressed-out people who were likely to fall sick when exposed to the virus responsible for common cold experienced reduced chances of being affected by the infection when they were hugged frequently. Even if they were attacked by cold, they developed less severe symptoms when they received frequent hugs.

Hugs Increase A Sense of Trust
Individuals feel closer and connected to each other when they hug and that’s not it. Hugging triggers the release of oxytocin, a chemical that induces bonding, trust and connection. Physical connection between two people increases emotional and psychological connection between them as well spreading a sense of calm and comfort.

Hugs are an Anti-depressant
Hugs induce release of serotonin, a natural anti-depressant, that triggers emotional well-being. We express affection towards our loved ones by hugging them, kissing them and spending quality time with them. Such behavior promotes emotional well-being and intimacy that are critical for a healthy relationship between two people. Babies love our sense of touch and when they miss out on it, they feel utterly depressed and start becoming cranky, stop eating food and misbehaving. Hug your loved ones at least for 3 minutes a day and kiss them at least once a day to keep your relationship going steady.

Hugs Lower Blood Pressure
Though not proved accurately, a small study of a group of 59 premenopausal women found that frequent hugs between women and their partners increased oxytocin levels and decreased blood pressure levels. Spouses start taking undue advantage of each other after marriage and hugging is a simple way to overcome disagreements and save your marriage from collision.

​Newborns are cuddled and crushed with kisses and hugs by mom, dad, family members, known people and strangers as well. As the newborn grows, he/she is cuddled by mom and dad frequently for all the small or big things he/she accomplishes. Being in a constant state of touch since birth makes us crave for it even as we nurture into adults. Staying connected, hugging loved ones and showing affection towards them make us feel complete and connected to each other. Spread love, cherish being loved and share the joy of affection with people around. ​