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

Food is essential for survival. Most of us love to relish the food that we eat and choose to eat a variety of cuisines. The world around is always bothered about the health problems that crop up due to excess food consumption in terms of obesity and weight gain but not much attention is given to the problems that arise due to lack of consumption of proper quality food. Frailty syndrome exists as a growing concern in the elderly population developing as a result of the food that we eat or rather, the type of food that we don’t eat! Weakness is a part of ageing and every adult over the age of 60 starts experiencing weakness all over the body. But frailty is not a regular part of the ageing process and we need to learn to differentiate between normal ageing and frailty. Normally, a person is diagnosed with frailty syndrome if he/she is diagnosed with three or more of the following criteria that includes weight loss of more than 5% of body weight in the past 1 year, exhaustion, weakness (poor hand grip or extreme pain in joints), slowness and inactivity.

Frailty syndrome is usually present in adults over the age of 65 and these individuals need assistance to perform the daily activities such as brushing teeth or even going for a bath! Researchers don’t yet have a clarity over the development process of frailty but they do come up with certain factors such as sarcopenia and muscle mass loss as a contributing factor. Read more about sarcopenia and how proteins can contribute towards preventing muscle mass loss by visiting www.firsteatright.com. There are studies that show a clear link between frailty development and nutrition intake but certain factors such as protein, calorie, vitamin D and calcium intake too have a greater influence over frailty development. Several trials insist on the relationship between low protein intake and frailty development-a study of over 24,000 participants showed that those with the highest protein intake were at a least risk of frailty development. Studies also show that insufficient intake of vitamin D, vitamin E, vitamin C and vitamin B9 was a significant risk factor for frailty development. There are various studies that show vitamin D as an independent factor for frailty. While we can see from these studies that lack of certain nutrients increase the risk of frailty a latest study has shown that older people who eat a poor-quality diet are increasing their risk of frailty.

A Well-balanced Diet is the Key to Abolish Frailty
The US study on frailty employed 2,154 participants who were all aged between 70 and 81 for a four-year study period. All of these participants were either termed as ‘robust’ as they were devoid of any cognitive or physical frailty problems or termed as ‘pre-frail’ as they had only one or two symptoms of frailty. Totally 277 participants became frail. Of the 1,020 participants who started out as robust candidates 629 of them became frail or developed pre-frailty. The researchers clearly confirmed from the research that those individuals with a poor-quality diet were twice at an increased risk of succumbing to frailty while those with a medium-quality diet were associated with a 40% increased risk of frailty. It was also visible that proteins played a crucial role in frailty development as this nutrient is linked to loss of muscle mass and strength, two conditions that evidently happens with ageing. While total protein intake, animal protein intake and total calorie intake did not affect frailty risk lower vegetable protein intake was linked to a higher risk of robust people developing pre-frailty but the researchers could not conclude whether this could proceed into full frailty as time goes. Diet quality of participants were measured using a food frequency questionnaire. Hence, what you eat is extremely important to decide your course of life. Eat a diet that’s well-balanced, rich in nutrients such as fruits, vegetables and nuts, do regular physical activity and stay active to safeguard yourself from frailty.

Women have outgrown their obsession for a super-thin body and men have outgrown their obsession for a six-pack and highly-muscular physique. This doesn’t mean that they have lost their desire to stay slim and trim or muscular. The ultimate point here is that people are currently focusing on reducing fat mass and staying healthy. While weight loss was a different ball game for both men and women back then, the approach has become more unified in recent times. You and I talk about how differently men and women communicate, act, behave or emote but are their approach to weight loss too poles apart? I don’t think so but it is always necessary to accept that certain variations do exist.

Muscle Hustle
I remember a small incident from my younger years which I considered it to partial back then but now accept it partially. All of us were ready for dinner and my grandma approached all of my male cousins with an extra serving of roti whereas we girls were denied of it. When I questioned her on this, she simply replied that boys needed to eat more. I was appalled by her comment but after a few years I got to realize that genetically men are designed with more muscle mass and less fat mass compared to women due to greater presence of testosterone hormone and this brings about the need to consume more calories than women to help them maintain their weight. My poor grandma couldn’t scientifically explain the reason behind all her extra pampering and care back then 😊

Any two individuals might weigh the same but the one with the extra muscles needs more calories to maintain weight (as he is going to burn more calories). Its muscles that burn more calories at rest compared to fat and now I hope that every woman understands the need to build muscles. Muscles are not monopolized by men and weight loss is not only fat loss but includes muscle loss as well. So, its crucial that you eat the right foods and exercise right by including strength training in your routine to minimize muscle loss greatly. Muscle loss starts once a man or a woman crosses 30. That’s one of the reasons why dietitians and nutritionists insist individuals to reach normal body weight by the age of 30 after which the only concern would be to maintain it. After 30, weight loss becomes more strenuous due to muscle loss which also has a strong impact on immune system and our mobility.

Your Contribution to Weight Distribution
Looks say it all! Men carry most of their weight around their abdomen while women carry it in their hips and thighs. Postmenopausal women carry it around their abdomen due to hormone imbalance. Its this fat around the stomach and underneath internal organs (visceral fat) that’s dangerous enough to cause serious problems such as diabetes, cardiovascular disease and fatty liver disease. But understand, any fat is bad-be it around your arms, hips, thigs or belly. Each of us should take every step to reduce this fat and reach normal body weight.

Who Loses Weight Faster?
Its true that men tend to lose weight quickly but we do have studies showing that both men and women end up losing the same amount of weight finally at the end of the weight loss program. It just takes women a little more time to ‘up’ her pace. While a woman might lose between .25-.75 kilograms a week, a man might lose between 0.5-1.0 kilograms a week. On of the main reasons quoted for higher body fat and slower reduction rates in women is owing to reproductive reasons. The set point (the body defends a particular range of body weight and takes all steps possible to maintain it) for a woman is different, her hormones are different and above all, females are healthy at a higher body fat percentage which makes weight loss a longer process for the female gender.

What’s your Food Choice
Its funny that we see most men feasting on meats as they find it to be masculine. How do they relate meat to masculinity? Get your answers at www.firsteatright.com. But a woman loves to munch on fruits and veggies. A woman is more experienced with dieting, gets herself cleared of her doubts with a counsellor or even educates herself by reading more. This might also be one of the reasons why she chooses veggies and fruits over meat. But recent times has seen both men and women realize the need to include more of lean proteins, vegetables and fruits, less of processed foods and baked goods and eat moderate amounts of dairy. While men used to be fans of the Paleo or the Atkins (meat-rich diet) now both, men and women prefer the Mediterranean diet that’s more inclined towards including natural foods such as whole grains, fruits, veggies, nuts and legumes.

This is one area where men and women can help each other. Men can recommend the best foods rich in proteins that help build muscles and women can suggest those that are high in nutrients and low in fats.
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Social Acceptance
Its general to hear a woman go on a diet but the society puts on a funny face to a man who comments that he is on a diet. Many disagree when men sit with a salad bowl but appreciate the same gesture in a woman! But rise in obesity rates has put an end to all these gender-based ideas and has forced both genders to follow some degree of healthy eating, dieting and exercising. A registered dietitian nutritionist approaches both genders with the only goal in mind when it comes to weight loss-providing personalized diet plans suiting individual needs depending on their lifestyle, eating habits and work schedules.

It was the first day of my college hostel life and I was the roommate of a girl who suffered from migraines almost 10 days in a month. Initially I cared less, took it to be a simple headache and did not even bother to ask her if she needed something despite the fact that she used to stay inside the room for hours together lying down, missing classes and suffering in pain. Isn’t it common that all of us get headaches and me, I suffer from sinus and spring back from a groggy head many times which makes me no different from her right? One day I suddenly bounced upon an article in a magazine that spoke about taking care of people with migraine and I was shocked to find that migraine headaches are one of the top 10 disabling conditions (WHO report). Slowly I started showing much concern towards her condition though sometimes I got it all wrong-comforting her with cranky sentences such as ‘It is just a headache. Don’t worry, it will disappear’ or ‘Forget about it, attend classes and divert your attention. Maybe you would become normal’ which aggravated her cortisol levels and put her off mood even more. But in a while I became adept in handling her, sometimes that she comes straight to me for motivation and care when she suffers from one of those migraine days.

Way Too Much than a Headache
Migraine is a neurological disorder involving nerve pathways and brain chemicals that can make the patient suffer from loneliness and isolation. It’s unlike any ordinary headache causing intense pain (mostly on one side of the head), heightened sense of smell, sensitivity and vision changes. The recovery period might take anywhere between few hours and days. Being near a loved one with migraine is taxing on the person staying with the patient too, as he/she is unaware of what exactly happens inside the patient’s body and also doesn’t know how to react to the situation. I hope you get an easy hold on handling your migraine-affected friend with more care and compassion after reading this article.
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1. Please don’t take migraines as normal headaches which is nothing more than pressure sensation felt in the forehead and neck.
2. Your beloved one is over-sensitive to even the slightest music coming off your television or hates the chandelier lights in your living room. Even laughing or your perfume can irritate them
3. Migraines trigger a plethora of emotions, mood swings and changes in your reactions to people/instances in life. The last thing that such a person would like to hear is a comment on their attitude. Even if you cannot be supportive of their emotions or free their schedule for the day, at least don’t spoil their mood even more by commenting inappropriately.
4. Though getting up and moving around is an immense chore by itself some of them with migraine do so as they have learnt to complete their chores with the pain and its mostly those with chronic migraine-migraine that lasts for at least 15 days in a month. Of course. you cannot afford to skip work for such a long duration or even stay away from children fearing their giggles or tantrums in the house.
5. When your family member is down with migraine it is better to take up their chores and free their time. Maybe cook a simple meal, make the dishes, ready kids to school, get the groceries and give a head massage too to relieve pain sometimes. Please don’t suggest taking your normal headache pills as this irritates the person even more (your headache is in no way even a bit closer to the migraine pain he/she is experiencing). In short, don’t underestimate their pain and symptoms
6. ‘I understand’-this is a phrase that irritates anyone greatly. How can you understand someone’s pain until you have experienced it yourself? If you too suffer from migraine then its ok. Otherwise simply refrain from using this phrase as you really don’t know what’s happening in their mind and body. All that you can do is to give support, ask them what they would like from you and tell them that It would be back to normal sooner
7. Home remedies are not a problem but if you realize that your loved ones need the help of a neurologist to diminish the pain suggest it to them gently only after they have recovered from the migraine. Ensure that they don’t resort to self-medication every time they suffer from debilitating pain.
8. If you stay with the patient or be around him/her often at house/office it’s better to learn the triggers (https://time.com/5616125/migraines-how-to-help/) that cause maximum inconvenience to the one suffering from migraine attack. If bright lights disrupt their mood, try switching off the unnecessary lights in the house , if sound is a hindrance please avoid loud music or clumsy handling of vessels and if the patient can’t stand the noise of giggles or tantrums by his/her child it would be greatly helpful if you extend your help in babysitting the child for the day.
9. Also, please don’t say sentences like ‘Don’t eat chocolates, it will trigger pain’, ‘Involve in some engaging activity and you will forget the pain’, ‘You seem brighter in fact’, ‘Maybe you are stressed, try doing meditation’, or such ones. These might sound comforting and helpful to you but these put the patient in maximum distress leaving him/her with a feeling that its better off without you hanging around.
   
   

People love to help when in pain and look forward to telling comforting words and this attitude is commendable. But learning to say the right sentences and doing the right things is more important when you try to help people with migraine.

References
13 Things Not to Say to Someone with A Migraine: https://www.huffingtonpost.in/2015/08/04/what-not-to-say-to-people-with-migraine_n_4745863.html

You’ve seen your friend remain obese/overweight since high school days and when you meet her after a decade or so, still she is the same! She doesn’t suffer from high blood pressure, cholesterol or heart disease risk nor does she refrain from daily chores and activities citing overweight issues as an excuse. Life goes on happily and you remain unbothered about her weight issues as she ‘seems’ to look hale and healthy.

Healthy Obesity: A Paradox
Obesity brings with along numerous health risks such as type 2 diabetes, hypertension and several types of cancer along with physical changes to your body structure. Body shaming is commonly observed. Recent times have witnessed the use of the term ‘metabolically healthy obesity’ for obese/overweight woman having high body mass index (BMI) but not having any health conditions that occur as a health risk of obesity. There have been quite a number of varying study results supporting and denying the existence of ‘metabolically healthy obesity’. Latest of them is a research that warns such individuals to lose weight as early as possible to avoid any risk of heart disease.
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Its been commonly accepted even medically that some obese people live a healthy life and are devoid of heart disease risks and have not been advised to lose weight or take preventive steps to stay wary of developing a heart disease anytime in the near future. But the entire medical community was doubtful whether this pattern will continue forever or if these individuals might suffer from metabolic syndrome over time.

Metabolic syndrome includes risk factors such as high blood pressure, high blood sugar, unhealthy cholesterol levels and abdominal fat which are leading causes for cardiovascular diseases and have the potential to increase the risk of diabetes by five times. The current study included more than 6,500 participants who did not suffer from cardiovascular disease but had a BMI greater than 30 and two or few risk factors. The main idea of the study was to check whether metabolically healthy obesity (MHO) at baseline remained stable or led to metabolic syndrome thereby increasing risk of heart disease. They were followed up for 12 years with a clinical evaluation done once in two years to check this risk.

Results showed that baseline MHO was not associated with incident cardiovascular disease but almost 50% participants developed metabolic syndrome over the study period and were at an increased risk of cardiovascular disease compared to those with stable MHO and healthy weight ranges.

To confirm this, the research team conducted yet another study that involved close to 1,00,000 women who were free of CVD at baseline. The participants were categorized into different groups based on their BMIs, metabolic health status and change in metabolic health status and followed up for 30 years. Different risk factors such as age, smoking and drinking habits, activity levels and family history of heart attack/diabetes was also adjusted. Results showed that women with MHO who were free of metabolic diseases for decades were at an increased risk of cardiovascular disease. These women were at a 39% increased risk of CVD compared to healthy study participants. Almost 84% women with MHO at baseline and 68% metabolically healthy women with a normal BMI developed some metabolic condition over a 20-year period. But even those who managed to stay free of metabolic disease over a 20-year period had a 57% increased risk of CVD if they were obese compared to women with a healthy body weight.

‘Healthy obesity’, ‘obese but active’ and ‘fit but fat’ are good to hear but practically they offer no perks and are as bad as simply telling that a person is obese and he/she is at a risk of diseases. Its up to each of us to take the right measures and start leading an active lifestyle to maintain our body weight in normal healthy ranges. Get in touch with registered dietitian nutritionists at www.firsteatright.com to get a personalized diet plan suiting your body type.