Cholesterol today is a household word. It has been deemed the root cause for just about every case of heart disease in the last 2 decades. As such almost everyone today is cholesterol-fearing. Nearly everyone I know parrots about it demonizing it, completely ignorant to the fact that without it, they would just not be! Worse still, the half-baked knowledge about Cholesterol has been instrumental in demonizing a variety of foods. “Eggs and saturated fat anyone?”

“Gosh no! I don’t want to bleed cholesterol.”

That’s the problem right there! The belief today is to keep it as low as possible or suffer the consequences. But what if cholesterol wasn’t in fact the cause of all evil? What if in fact it was essential to one’s health? 

the What ? 

The word Cholesterol has Greek roots, not unlike many others. Cholesterol is an organic molecule synthesized by all animal cells. It is a soft, white, waxy substance that is found in every single cell of your body i.e. vital! It’s made up of lipids, which are molecules of fat. Typically the body produces about 1 gram of cholesterol daily and the body’s content of cholesterol at any given time is approximately 35g.

A vast majority of the body’s cholesterol requirement is accounted for by self-production. The body titrates the production against that ingested in food. So if foods high in cholesterol are ingested, the body’s own production falls to accommodate this. In addition to producing cholesterol the body recycles it as well. This means that cholesterol excreted from the liver into the digestive tract is re-absorbed in the small bowel back into the blood stream for reuse. This is

the case with approximately 50% of the body’s cholesterol. The remainder is excreted in faeces.

The cholesterol made by plants is different to that made by animals. These are called Phytosterols and when ingested, compete in the small bowel with animal cholesterol for absorption thereby potentially lowering the recycling efficiency. However when the small bowel absorbs Phytosterols, they are then re-excreted back into the GI tract.

the Why ? 

Cholesterol serves several functions within the body.

• In the cell it forms an integral component of the cell membrane structure and protects viability. It further allows animals cells to be fluid and change shape unlike plant and bacterial cells.
• Cholesterol is an essential precursor in the synthesis of steroid hormones like testosterone, estrogen, cortisol, aldosterone, Bile acids (necessary for fat digestion) and vitamin D.
• Cholesterol plays a role in nerve conduction and helps conduct the impulses more efficiently. It also plays a role in the functioning of memory.
• There is much evidence to suggest that cholesterol further plays an important role in psyche and one large Dutch research study found that men with low cholesterol levels had greater incidence of depression. Cholesterol affects serotonin metabolism and a Canadian study provides evidence for the fact that the lower one’s cholesterol levels, the more like he/she is to commit suicide when in depression. Other studies too indicate and support a relation between low or lowered cholesterol levels and violent, aggressive behavior.

Bottom line – Cholesterol IS essential and NOT evil !

the problem ? Is there one ? 

As it is with any other commodity, so it is with cholesterol; moderation is key! Excessive cholesterol is bad, just like excess sugar is bad Sweet Sorrow [Part 1].

Conventional medicine will tell you that there are good fats and bad fats. The good fats are commonly referred to as HDLs or High Density Lipids and the bad fats are LDLs or Low Density Lipids. Physicians and nutritionists have engrained it into our psyche that LDLs cause strokes, heart attacks and obesity. They deposit on the insides of our blood vessels causing narrowing (this is medically termed ‘atherosclerosis’) and et voila – blockage which if in the heart equals ATTACK!

What are HDLs and LDLs ? They are fats that combine with proteins so that they can be transported in the bloodstream; fat and water doesn’t mix and so fats on their own can’t travel in the blood. LDL and HDL are forms of proteins and are far from being just cholesterol. LDL particles come in many sizes and large LDL particles are not a problem. Only the so-called small dense LDL particles can potentially be a problem, because they can squeeze through the lining of the arteries and if they oxidize, otherwise known as turning rancid, they can cause damage and inflammation.

To obtain levels for the various fats and cholesterol, a lipid profile test is done and typically if LDLs and Cholesterol is high, medication and treatment is ensured to prevent heart disease. However there is increasing evidence to suggest that these numbers don’t accurately predict heart disease incidence and occurrence and increasingly the HDL percentage and Triglycerides to HDL ratio is being taken into account.

If your arteries are damaged, a very similar process occurs inside of your body, except that a "scar" in your artery is known as plaque. This plaque, along with the thickening of your blood and constricting of your blood vessels that normally occur during the inflammatory process, can indeed increase your risk of high blood pressure and heart attacks. Notice that cholesterol has yet to even enter the picture. Cholesterol comes in because, in order to replace your damaged cells, it is necessary.

Because high levels of Cholesterol were found in sites of arterial inflammation it came to be factual that high cholesterol was the cause of heart disease. As a result, the Western developed world made radical changes to their diets by cutting out butter, red meats, animal fats, eggs and replacing them with more processed grains, more vegetable oils, and more high-fructose corn syrup, all of which are nutritional disasters. This “low fat diet” became the cause for the epidemic of Obesity and Diabetes in the modern world both of which lead to increased inflammation in the blood vessels and therefore cholesterol increase in the body.

There are other factors too which result in the inflammation being discussed here. These include:
 

• Excessive consumption of trans fats
• Sedentary lifestyle with minimal or no physical activity
• Smoking and alcohol excess
• Stress
• Excessive consumption of sugar and grains
• Oxidized cholesterol which is what occurs when cholesterol has gone rancid in food i.e. overcooked
• Age and gender – sadly men are more likely to have high levels of cholesterol with increasing age than their female counterparts
• Genetics – some people are more prone to having high cholesterol levels simply because of the genes they’ve inherited. 

the What to do 

Now just because cholesterol seems suddenly less ‘evil’ doesn’t mean one can gorge on saturated fatty foods without a care in the world. If your calorie intake exceeds that which you burn then fat and weight gain is inevitable and obesity in turn is the root cause of infinite health disorders and diseases.

What it simply means is that one needs to be aware of what are the risk factors and take measures accordingly.

1. The first and foremost would be to get a lipid profile blood test done to assess and evaluate whether you have an imbalance in one or more parameters.
2. Once cholesterol levels are determined, dietary modifications need to be made. It’s best to consumer healthy fatty foods like olive oil, coconuts and coconut oil, organic raw dairy products with low fat percentages like butter, cream, sour cream, cheese, avocados, raw unsalted nuts, seeds and eggs cooked correctly.
3. Instead of red meats like beef and pork opt for leaner meats like chicken, fish and turkey
4. Increase the amount and variety of fresh fruit, vegetables and wholegrain foods you have each day. Good sources of soluble fiber include oats, certain fruits (such as oranges and pears) and vegetables (such as brussels sprouts and carrots), and dried peas and beans. Eating oats and legumes can lower LDL cholesterol by five per cent. Food components like saponins (found in chickpeas, alfalfa sprouts and other foods) and sulphur compounds (like allicin – found in garlic and onions) may also have a positive effect in lowering cholesterol levels.
5. Engage in aerobic and anaerobic exercise. Honestly if more people would jump onto the fitness bandwagon, more than half the diseases and disorders of modern day living could be kept at bay. Nothing will moderate and regulate cholesterol metabolism in the body like exercise. Indulge in HIIT Cardio at least 3-5 times a week and throw in 2-4 sessions of strength and weight training. Check out the Haute Body videos for quick, simple and easy workouts that can be done sitting at home. It is important to keep your body weight and body fat percentage within normal ranges because obesity is what directly leads to heart disease.
6. Ensure you’re blood sugar levels are normal. A simple blood test and consultation with your physician should establish this. Elevated blood sugar levels are directly linked to plaque formation in blood vessels. If blood sugar levels are high then eliminate all processed sugars in your diet completely deriving only a very tiny proportion from fruit.

the What nots 

If you are determined to have high levels of cholesterol do NOT :

1. Overindulge in fatty meats like beef, pork, shrimp and especially eliminate processed meats from your diet.
2. Eat processed foods like chips, takeout food, cakes, biscuits, pastries, deep-fried foods – basically anything that comes in a packet! Buy whole ingredients and cook your food yourself. The RYE Kitchen is a great place for super healthy, speedy and nutritious recipes
3. Smoke! Just don’t.
4. Consume excessive amounts of alcohol. Check with your physician with regards to where you stand but keep this to a bare minimum. Binge drinking is a complete NO!
5. Ignore or avoid emotional stresses and challenges. Believe it or not, the more stressed you are, the more your Cholesterol levels shoot up. Remember, cholesterol increases because of inflammation and inflammation happens when any part of the body is ‘irritated’ by a stimulant. Mental stress causes inflammation of the nervous system. Engage in therapeutic practices like yoga, meditation, exercise etc. Take time off from work and spend time on your hobbies – RYE

Last week was all about ringing that alarm bell and alerting you to what kind of damage sugar can do to you. ‘Vast’ and ‘horrific’ are adjectives I’d definitely reiterate. If you haven’t yet then do check out Sweet Sorrow [Part 1]. This week it’s back to the traditional way of Medically Fit.

Sugar is sweet but it’s sneaky as well. It exists in the most unexpected of foods. Did you know that your average frozen single-person lasagna could load your body with up to 40g of sugar? No, I’m not kidding!

The American Heart Association and WHO together state that the average person in the developed world ingests 4 times the recommended daily sugar intake. It really is vital that we become more aware and learn how to cut back on our intake.

the What – What is sugar? 

The most basic sugar forms exist in 3 kinds – Glucose, Fructose and Galactose.

These are monosaccharides (one molecule only).

Disaccharides consist of two molecules. So for instance Sucrose is when one Glucose combines with one Fructose, Maltose is when 2 Glucose molecules combine and Lactose is formed when one Glucose combines with one Galactose molecule.

Chains of disaccharides make a polysaccharide chain, many molecules long. When several polysaccharide chains come together and twist and knot into a 3 dimensional structure, a complex carbohydrate is formed. An example of this is starch which is found in potatoes and other vegetables. The human body stores energy in the form of the complex carbohydrate – Glycogen. When needed, the liver breaks it down into monosaccharide glucose molecules.

Glucose is found in varying quantities in nearly every food item from meats to vegetables to dairy products to even fruit. However, the dominant sugar in fruits in particular is Fructose. Galactose is found in dairy products mostly.

The body digests carbohydrates into first polysaccharides, then disaccharides and eventually into monosaccharides.

the Why – Why we need sugar? 

Carbohydrate digestion is the main provider of the body’s fuel. Fat though it provides more fuel per gram (9 calories per gram to be specific) is a stored form of energy. The body calls upon fat in times of dire need i.e. starvation. In contrast, Carbohydrates only provide 4 calories of energy per gram.

Glucose colloquially speaking is the body’s fuel favorite! All carbohydrates eaten are digested by the body into the monosaccharide molecules – Glucose, Fructose and Galactose. Because the body “likes” Glucose the best, the liver converts the Fructose and Galactose to Glucose and then slowly releases the Glucose into the blood stream. Basically, all sugar is eventually converted into Glucose.

The blood carries Glucose to all the body’s cells where metabolism burns it as fuel and converts into energy. This is a constant, continuous process as the body requires glucose 24/7 to power all it’s various functions i.e. breathing, sleeping, thinking, moving etc

Excess Glucose is stored in two ways – the first is as Glycogen which is the first line of energy provision in case of emergencies and the second is as fat! The excess Glucose is converted into fat molecules by the liver and tucked away under the skin and around muscles.

Evidently we require sugar so WHY the problem? The problem is that whilst sugar is necessary, we’re consuming far greater quantities than we require. The problem is further enhanced by how unbelievably sedentary our lifestyles have become. The obvious result – fat storage!

The excess sugar we consume is pointless and the foods we eat are “foodless”. There is literally no need for this physiologically. Also, if there came a point to when the body required Glucose but was deprived of a steady stream, then the clever liver breaks down proteins and fats and converts them into Glucose.

the How – HOW to battle excess sugar? 

Forewarned is forearmed! Sometimes I wish foods too had warnings printed on them like cigarettes do because if truth be told, sugar is the 21^st century’s tobacco equivalent. Toxic and highly addictive it is now the root cause of the worst diseases and disorders.

Here are some foods that should have warnings:

• Aerated soft drinks –– they rack up 9 teaspoons of sugar already a third more than the recommended daily intake
• Sauces, Condiments and Salad dressings –– these can have anywhere between 6-12 grams of sugar for just ½ a cup

• Flavored oatmeal and Granola bars –– you’re looking at 10-15 grams of sugar per serving right there
• Sports and Energy drinks ––  these pack close to 30grams of sugar. Basically you could just eat 8 teaspoons of sugar instead
• Alcohol — Empty calories and the calories are purely from sugar

To battle hidden sugar – FLIP & READ THE LABEL of food products. It really is as simple as that. Zoom into the “Carbohydrates” listed on the label and read the quantity of “sugar” underneath. Further, read the ingredients list and lookout for sugar alternatives, which are all still sugar.  (refer to Sweet Sorrow [Part 1] for sugar substitutes)

Note on the label where sugar is listed in the ingredients’ list. By law, manufacturers have to list ingredients in decreasing order of the quantity used in the product. If the packaged food contains ‘sugar’ in the first three ingredients, avoid it. Similarly, if the food item has more than 3 kinds of sugars, put it back on the shelf.

Your aim should be to consume no more than 25-30grams of sugar a day inclusive of all the different kinds of sugar i.e, that found in fruits, grains, vegetables, dairy and in meat.

the What to do 

Now that you’re getting the idea of how to read the label it’s important to weed out foods that have high sugar content and instead substitute your diet with healthier and more wholesome alternatives.

1)If you’re looking for a carb fix opt for whole grains like brown bread and brown rice instead of the white kind. While these do end up as Glucose eventually, their complex structure ensures slow digestion and as such Glucose is released very slowly and over a longer period of time into the blood. Sudden spikes in blood Glucose ‘alarms’ the liver and it converts it into fat

2)Fruits are a fabulous way to get a sweet fix. They’re just peachy 😉 The fibre of fruit too aids slow digestion and slow release of Glucose. Plus fruits nourish your body with vitamins, minerals and antioxidants

3)Eat good fatty foods like nuts and avocado when the sweet tooth strikes. They’ll keep you satiated and energized for longer periods and will prevent that blood sugar spike.

4)Lean protein foods have the same effect as fatty foods so include plenty of eggs, turkey, chicken and legumes in your lunches & dinners

5)DON’T drink sodas or bottled juices. If you fancy a fruit juice, grabs some fruit and throw it into a blender ensuring that the fibre is all there. Learn to recognize thirst and up your water intake (check out RYE Kitchen for Smoothie recipes). Similarly DON’T consume fruit yoghurts and cereal bars. Instead buy good quality Greek Yoghurt and throw some berries, nuts and oats into it.

6)Avoid salad dressings and sauces. Get creative and make your own vinaigrette type of dressings with olive oil, tomatoes, basil etc

7)Recipes that call for sugar can be substituted in parts with Cinammon, Vanilla, Sweet spices & Herbs, Citrus zest, Nutmeg, Almond extract and Ginger. Not only will they help reduce your sugar intake and satisfy your sweet craving but they also boost metabolism

The bottom line is be aware of what you put into your mouth. If you’re not – GOOGLE and then find alternatives 😉

the What nots 

Sounds pretty easy to exorcise the excess sugar doesn’t it? If only …

Sugar is dangerously addictive and lights up the same centres in our brain like cocaine and heroin. The withdrawal if stopped suddenly is unbelievably and in extreme cases can have you crashing from hypocglycemia (very low blood sugar levels). As such it’s important to NOT go cold turkey when it comes to sugar cut backs. Do it gradually! For instance if you’re used to having a bar of chocolate everyday, begin by reducing it to every other day, then slowly to twice a week then to only special occasions or cheat days. Even then, limit your quantity to just 1-2 pieces of chocolate. After all, you are only trying to satisfy the tongue – those 2 pieces will do that perfectly. Anything more is unnecessary and excess.

It is also important to note, don’t overdo the artificial sweetener bit. While they are lower in calories and not really sugar they have a twisted effect on our brain. Because artificial sweeteners are infinitely sweeter than sugar, when ingested the brain gets a message it’s received sugar and insulin is produced by the pancreas for digestion. However, there is no sugar received by the gut and this confuses the brain further; the tongue indicated “sweet”. The insulin spike produced sends you crashing not long after and as a result you develop enhanced and more intense sugar cravings. Wonder why you feel like a donut post an Americano coffee with sweetener?

Not for a moment am I saying, NEVER touch another sugary delight EVER again. But be wise in when you do – the sorrows of this sweet stuff just aren’t worth the 2 minute taste sensation. 

Last week was a tad unsavory and this week it’s bitterly sweet. It felt only natural to follow up last week’s Salt with its sweetheart cousin – sugar! But when I began researching it soon became evident this wasn’t going to be an easy topic to put pen to paper to; the sheer volume of literature and the infinite opinions and debates have made it difficult for me to do justice to the topic in just one article.

Thus I’ve decided to write about Sugar in a slightly different manner. The more I researched, the more frightened I became of the little white granules and the sheer horror it inflicts within our skins. Such that I began having nightmares (I lie not!). I will illustrate in the traditional Medically Fit format next week but for now I want to detail the evils of sugar and why it is something we need to beware. I call it the ‘Sweet Sorrows’ …

the Sweet Sorrows

1)  Waist line expansion – It is common belief that because today “playing with a ball” equates to sitting in front of a screen with a remote game console, waistlines are expanding. But the truth is that this is only partially true. Yes for the large part, life today is extremely sedentary and the physical inactivity does us no good but the bigger culprit of piling on of gross poundage is excessive sugar. Sugar is the single leading cause today of the obesity epidemic.

2)  Type 2 Diabetes and Heart disease – Where there’s obesity, there are high levels of insulin in the blood and that sets into motion the wheel of disease. Excessive sugar in the blood makes the body resistant or ‘blind’ to the hormone insulin. Insulin resistance in turn causes several metabolic disorders like Polycystic Ovarian Syndrome (PCOS) and Type 2 Diabetes. The Diabetes in turn paves the way for diseases of the eye, heart and a whole host of other bodily dysfunctions. A very interesting yet deadly effect of insulin resistance is that in the brain, cognition and memory are impaired.

3)  Brain and psychological damage – The addictive buzz that is characteristic of sugar is due to the surge of Serotonin (a neurotransmitter) release from the brain. Serotonin is what makes you happy! But the effects of this are short-lived. This ‘sugar high’ peaks quickly and then falls just as fast. The ‘crash’ of sugar levels leaves one feeling fatigued, lethargic, irritable and unable to focus.  I call this ‘psychoglycemia’. What is most horrifying is that there is now evidence to prove that sugar affects receptors in the brain the same way as illegal and illicit drugs like cocaine and heroin do. Because of this, one becomes dependent and tolerant to sugar. This explains why gradually, you need more of the ‘white stuff’ to get the same ‘high’. Excess sugar over-activates the Serotonin pathways and depletes the supplies of it. This has now led to the suggestion that over-consumption of sugar can be linked to depression. Makes you think about that tub of ice-cream you’ve been digging into to add some cheer into your day/life, doesn’t it?! And if that weren’t enough, there is now growing evidence of a link between excess sugar consumption and an increased risk of Alzheimer’s disease.

4)  Sleep Deprivation – Ever feel jittery and fidgety in bed. Think back to what you ate in the last 5-6 hours before bedtime and chances are the sugar in your food is what’s keeping you up!

5)  Liver – Sugar causes cirrhosis! Now you’re probably thinking I’ve got my facts wrong and it’s alcohol that causes cirrhosis but nope, you heard me correctly. Sugar excess is now the single leading cause of non-alcoholic fatty liver disease especially in children. In particular the perpetrator is Fructose sugar, which in large quantities is metabolized in the liver to form fat globules.

6)  Bowel disease – Disease causing microorganisms (bacteria & fungi) thrive on sugar and in your gut they result in flatulence, irritable bowel syndrome, bad breath, indigestion and decreased absorption of essential nutrients. Basically, eat less sugar so you can properly feed your body. Disturbances of the bowel ultimately result in decreased immunity and this makes one vulnerable to bowel cancers.

7)  Hunger – Sugar is a foodless food. What I mean by this is that whilst fats, proteins and complex carbs give you energy through calories and vital nutrients and keep you feeling ‘full’, sugar doesn’t. Sugar is empty calories! Because it peaks very quickly in the bloodstream, the liver removes it and stores as fat to protect the body. Sugar also wreaks havoc in the feedback mechanism of our ‘hunger hormones’ – Ghrelin and Leptin. Ghrelin makes us hungry and Leptin switches off hunger pangs. Sugar negates the effect of Leptin. Cue cravings!

8)  Tooth decay – No surprises on this one! If I remember correctly, everyone from my parents to my teachers to my dentist threatened me about the dangers of gorging on candies. Sadly, sugar is not limited to just being in candies. Be aware of the sugar quantities you’re consuming and don’t forget to brush after every meal (if not brush then at least rinse your mouth thoroughly after eating).

9)  Sexual health – Sugar is sticky and high quantities of this in your blood vessels makes sticky plaques, which directly interfere with blood circulation (imagine a stone in your house’s plumbing). First effects are seen in body parts that have small, narrow blood vessels. Sugar is now a major cause of erectile dysfunction in men. Further, a 2007 American study found that high levels of glucose and fructose in the diet interferes directly with sex hormones like testosterone and estrogen and resulted in decreased libido.

10)  Kidney disease – Our kidneys are extremely clever in the way they manage to filter out waste. They try their best to siphon off the excess sugar we consume but like everything else, too much causes wear & tear and in this case kidney disease. This is extremely dangerous because the kidneys then also fail to excrete other waste products, which may leak back into our bodies and further harm our health.

11)  Muscle metabolism – Sugar interferes with muscle repair. Quite the opposite of what most athletes are trying to achieve i.e. ditch those energy sports drinks! There is also strong evidence to suggest that excessive sugar intake causes inflammation in muscles and this results in muscle ache. Further, if you like almost everyone else are trying to lose weight and are working out intensively, excess sugar in your diet will prevent you from building up muscle and you will not see results that you’re sweating and bruising for.

12)  Joint damage and Aesthetic ageing – Just like the inflammation it causes in muscle, excess sugar in bone joints too causes inflammation and this in turn results pain. The same inflammation also results in degradation of collagen and elastin in our skin, which is why people that consume high sugar diets have accelerated ageing. They typically have saggy skin and increased wrinkling. Women with PCOS also see other emotionally upsetting skin changes like darkening patches, increased facial hair and male-pattern balding.

It's still sugar!

When you read the above, it’s almost empowering in the sense that you’re sure to be confident as you vow that you will indeed be cutting down dramatically on the little white crystals in your diet. If only it were that easy …

Food manufacturers hide and disguise sugar in nearly every product they’ve ever produced. Few examples of such ‘sneaky-cheeky’ food items include ketchup, pasta sauces, fruit yoghurts, bottled fruit juices and teas, pizza crusts and other savoury baked goods, salad dressings, instant oatmeal, granola bars, energy sports drinks, coleslaw, frozen packaged meals, alcohol, canned foods …. It is EVERYWHERE ! Even if the ingredients’ list doesn’t state the deadly 5-letter word it exists cunningly disguised as:

• Maple syrup
• Honey
• Molasses
• Brown sugar
• Agave syrup
• High fructose corn syrup
• Barley malt
• Cane sugar
• Dextran
• Sucrose
• Maltose
• Maltodextrin
• Ethyl Maltol
• Lactose
• Dehydrated cane juice
• Fructose
• Raw sugar
• Hydrolysed starch
• Invert sugar
• Corn sweetener
• Coconut sugar ……. (To name a few!)

Did you know that there are infact 56 ways to hide and disguise sugar in the Food & Beverage industry? Daunting isn’t it! How do we get around this and protect ourselves?

For that we need to be fully forewarned so that we can be forearmed.

To be contd. in the next Medically Fit … 

I thought I’d begin Medically Fit with a bang and delve straight into something “deliciously icky” (forgive me but physicians are known to be allured by the ‘gross’ and bear psychopathic tendencies). Add to that, here is a topic, which despite being extremely common in prevalence, lags far behind, in awareness and conversation i.e. optimal fodder for me. 

Statistics currently depict that Bacterial Vaginosis or BV as it’s known, is actually the most frequently seen disease in women of childbearing age. At a given point it wouldn’t be a stretch to state that 30% of people in a given population have BV. That translates into nearly 1 in 3! And almost all women will experience it once in their lifetimes. 

the What

‘Flora’ literally means the micro-organisms that live in a particular region of your body. Vaginal flora is 95% lactobacillus bacteria (don’t get excited because it isn’t the same stuff that’s in your yoghurt). This lactobacillus helps keep the vagina’s pH level within the normal range of 3.8 – 4.5 and ensures the disease-causing bacteria (pathogenic bacteria) is kept in check. BV occurs when the pH of the vagina rises to above 4.5. This happens when anaerobic bacteria (those which thrive in lower Oxygen environments) increase in numbers making the vagina alkaline.

BV usually resolves on its own and causes the affected only mild discomfort. That being said, when symptoms persist, they often cause more than discomfort and are often the sources of embarrassment.

Characteristic signs of BV include a greyish-white, watery vaginal discharge. Some women have reported this to be yellow in colour. The discharge is bothersome particularly because it smells fishy (pun not indended). This discharge often worsens post sexual intercourse and can even cause pain and irritation to the area. It is noteworthy here that BV’s symptoms aren’t unique and often mimic other infections and sexually transmitted diseases (STDs). A correct diagnosis is vital for effective treatment. 

the Why

The first myth I’d like to dispense with is that BV is indeed NOT caused by poor hygiene but on the contrary by excessive washing (read below ‘the what nots’). Another myth I’d like to dispel with is that BV cannot be contracted from using public spaces like toilets, hot-tubs, swimming pools and touching contaminated objects. Similarly it is NOT transmitted from a man to a woman during intercourse. However, female-female transmission is possible during intercourse. 

As mentioned above, BV occurs due to an imbalance of vaginal bacteria. While there is no clear aetiology (cause) for BV, several factors are thought to be linked to its occurrence and these include: 

• Having multiple sexual partners, 
• Not using condoms, 
• Douching, 
• Intrauterine birth control devices (IUDs)
• Smoking

the When

BV is common in women between the ages for 16 to 44 years but can occur in extremes of age too. It tends to develop most commonly after unprotected sexual intercourse. 

A risk factor for developing BV is if you’ve had it before, then chances are you will have it again. Evidence shows that more than half the women that are treated for BV experience recurrence within a year. 

the How (to diagnose?)

If the BV doesn’t resolve on its own then pay your Gynaecologist a visit. He/she will obtain a thorough history, conduct a pelvic examination and take a swab sample, which is then sent to the labs for testing. In the lab and under a microscope, tell-tale signs of BV are something called “clue cells”. 

Another common test that is performed is the Whiff test. Advances in medical science do allow for DNA testing of the BV bacteria but this is not routinely done. 

the What to do

‘Take your meds! Properly! Ask your physician when to take them – morning? Evening? Afternoon? Before or after food? Before going to bed? The treatment for BV is a course of antibiotics of which Metronidazole is the most commonly prescribed drug. Metronidazole is known to have side-effects and when they’re too severe, Tinidazole is another drug which is prescribed. 

With antibiotics it’s important to remember that antibiotics reduce the effect of the contraceptive pill so be careful and practice abstinence or use barrier contraception (condoms) during your course to avoid an unwanted pregnancy. On the same note, avoid alcohol during the course and up to 48 hours after you’ve finished your last dose. 

Topical treatments include vaginal gels and creams in which Clindamycin is the antibiotic ingredient. These gels and creams weaken the effect of barrier contraception i.e. condoms or diaphragms and thereby leave you vulnerable to unwanted pregnancies and STDs. 

**Note : Antibiotics can have a side-effect of causing a vaginal yeast infection so go back to your Gynaecologist if you have itching, inflammation or a white, lumpy discharge. 

If you’re pregnant and find the telltale signs of BV then consult your Gynaecologist immediately as BV is known to result in miscarriages, uterine infections and even preterm delivery. If you’re about to have pelvic surgery then BV makes you vulnerable to pelvic infections and it must be treated and cleared prior to surgery. 

Finally, it is important to be aware that while there isn’t evidence to prove it, it is seen that women with unhealthy diets and lifestyles i.e. sedentary/smoking/alcohol excess tend to have greater risk of contracting BV. Eat well, include plenty of greens and fruits in your diet and limit your refined sugar intake.

the What nots

BV can make you susceptible to reproductive tract infections and inflammations so it is important to follow these do nots : 
 

• Smoke – Simply, just do not smoke.

• Douche – Douching is a Western concept that involves flushing out the vagina with a solution after a period. This was done with the intention to clean the vagina. In reality, the vagina has evolved to being able to cleanse itself and remain hygienic. Douching greatly alters the environment of the vagina and makes you very susceptible to BV. Similarly refrain from using vaginal deodorants and washing down ‘there’ more than once a day. If you’re still unconvinced then just think back to Mrs Homo Sapien and how often in the wild she bathed/douched. Never! And guess what – she didn’t have BV as often as we do.

• Use strong detergents to wash undergarments

• Not use scented soaps or antiseptic bubble bath liquids

RELATED READING
Here’s an article on the Woman 2 Woman blog which voices the concerns, opinions and advice of another physician and makes for a riveting read – Whither White Discharge

Whilst researching for this article I came across a quirky quote – 

“Salt is what makes things taste bad when it isn’t in them.” 

Which brings me to a nugget of information for you if you didn’t already know it – even sweet things (like biscuits) have salt added to them! 

Sugar usually takes centre-stage when it comes to diet and nutrition talk. But what of its savory cousin? As a physician, in my experience I often saw my registrars and consultants imposing low Sodium diets on patients with Hypertension (high blood pressure) and heart disease. Is there any substance to this practice? 

Salt is just as sneaky as its sweetheart cousin and more often than not we’re consuming whopping quantities without the know-how. Too much of anything is bad, right? Should we pass the salt or pass, ON the salt ?

the What

Nearly everybody knows the chemical composition of salt but if you don’t then table salt comprises of sodium and chloride chemical elements. Salt substitutes differ in their chemical composition. A single teaspoon of table salt weighs 6grams approx. and packs in 2,330 milligrams (mg) of Sodium, which is the recommended daily intake by most health authorities across the globe. But if figures and stats are to be believed, average consumption hits anywhere between 1.5 to 2 times that value. 

Salt dissolves in water (but you already knew that!). When it dissolves the Sodium and Chloride elements carry a positive and negative charge and attract water molecules. 

the Why

Salt is critical for bodily functions throughout life. Our bodies mainly utilize the Sodium and Chloride from ‘salt’ for :
 

• Nerve impulse transmission 
• Muscular contraction 
• Maintaining fluid balance in the body – the excess salt is excreted in urine by our clever kidneys, assuming they’re healthy of course 

Prolonged exposure to excess salt can be detrimental to our health and bodily functions and there is reason to believe that there is a direct link to increased blood pressure (Hypertension), which in turn is responsible for heart disease and kidney failure. 
 

the When

What is unclear is if salt is indeed a problem? For many decades now the medical community has believed salt intake to be the reason for Hypertension, Heart & Kidney disease. But in fact, some rather large Cochrane reviews of several randomized controlled trial studies have shown that this in fact is not true. These reviews found that salt restriction had no benefit and didn’t cause or effect cardiovascular disease and/or effect mortality at all! 

On the contrary, some evidence points to negative outcomes of low sodium diets such as an increase in “bad fats” i.e. LDLs (low-density lipids), increase in insulin resistance (which in fact is a known cause of diabetes, obesity and metabolic syndrome) and hyponatremia (low Sodium) in athletes, which is rather dangerous. 

Directly contradicting this though, is breast milk which has a low sodium content (about 14mg Sodium per 100g portion) and which provides infants with all the nutrition they require in the first 4-6 months of life and during which growth is the most rapid. 

So, less salt or more salt? The debate continues for both sides of the argument and till then turn to this phrase to guide you – Moderation is the Key !

the How (to diagnose?)

The problem that is today is we’re so accustomed to the taste of salt because it’s everywhere. Salt exists in practically every boxed/packaged/carton of food we buy and we’ve developed tastebuds for it; unprocessed, wholesome food pales in comparison. But the reassuring bit is we can just as easily and gradually decrease our salt intake and become unaccustomed to the taste. 

What is important is to be aware of what we consume. For example, a simple ham and cheese sandwich from your local supermarket provides 1.5x the salt that a 4 year old child requires. Similarly just 15militers or 1 tablespoon of soy sauce has about 1000mg of Sodium. Even healthy options like a cup of low fat milk and your average whole-wheat slice of bread contain 100mg of Sodium!

I cannot stress this point enough – CHECK and READ the label. As a rule of thumb, aim to consume foods with less than 120mg of Sodium per 100g serving and avoid those with greater than 200mg per 100g serving.

Also watch out for Sodium containing compounds like:

• Monosodium Glutamate (MSG)
• Baking Powder
• Sodium citrate
• Sodium Nitire
• Sodium Alginate
• Baking soda
• Disodium Phosphate

the What to do

Natural, whole foods contain salt. Most fresh fruits, vegetables and fresh meat are low in their Sodium content. The only exception to this rule is shellfish! 

The culprits are processed meats like bacon, luncheon meats and cold cuts, tinned vegetable soups, processed pastas and grains. Other hidden sources of high Sodium include salad dressings, sauces, dips, mustard, relishes, ketchup and seasonings. 

Aim to buy whole fresh produce and for whole-grains. Buy eating fresh veggies, meat, fruits and wholegrains you’ll automatically reduce your carb intake from processed foods and a low-carb diet has been shown to lower in insulin levels and help the kidneys better their excess Sodium excretion. 

Snack on whole nuts (unsalted obviously!), flavor your food with olive oil, lemon/orange juice and cook food through methods that preserve flavor like roasting, baking, stir-frying, microwaving or barbequeing.

Last but most certainly NOT the least – exercise! It is the most powerful medicine and diet there is 😉 

the What nots

Don’t obsessively count the Sodium you ingest. Be aware and eat healthily. Also beware salt substitutes as these often contain Potassium Chloride instead of Sodium Chloride and too much Potassium is lethal for the body.

Oh and one more thing – you know those effervescent vitamin supplements and painkillers you buy off the counter in pharmacies? They contain roughly 1g of salt per tablet. That’s why they have fizzing ability. Swap for regular painkillers and vitamin tablets.

When in doubt, consult your physician. 
 

The chart illustrates major contributors of
dietary Sodium for average North Americans

DOMS or Delayed Onset Muscle Soreness for fitness buffs and gym junkies is possibly the most delicious ache ever! Indeed it’s one we wear with great pride, almost like a badge of honor and brag about to our peers. Just last week I sat in my corporate office and was telling my colleague how sneezing and deep breaths were excruciating. The awestruck sympathy you receive is incredible validation – “definitely ‘beasting’ it out in my ab workouts.”

But whilst I was elaborating and detailing the pain of DOMS I suddenly realized that the person in front of me seemed to think I was injured and was plainly horrified that after just a day of rest I was going to hit training hard the next day. For you Mr. A.G and for all the rest who don’t know how to differentiate between DOMS and other gym-related aches and pains … this Medically Fit is for you!

the What

Before I delve into DOMS and the way it presents, let’s first focus in on the fact that this is a SYNDROME. A ‘syndrome’ is a collection of signs and symptoms and differs from a disease in that there is not just one aspect that produces an abnormal result. A syndrome is quite ‘loopy’ in that several things may be going on at the same time. To explain with logic, cause A may produce result B but it may also give rise to situation C that in turn will produce result D. 

In a syndrome, there may be only one sign/symptom or there may be more than one or there may be all the documented signs and symptoms that present. This is seen in DOMS. DOMS, sometimes referred to as muscle fever, has several characteristic features. Pain, muscle stiffness, localized tenderness, swelling and decrease in muscle strength are most commonly experienced. 

The muscle soreness occurs because the eccentric/unfamiliar exercise causes microtrauma to the muscles fibres. Previously, it was thought that DOMS resulted due to a build up of lactic acid during exercise. This theory has now been completely debunked as evidence shows that the lactic acid is clearly within 30-60 minutes after exercise and so cannot be causal of DOMS.  

The minute mechanical damage that occurs to the muscle fibres results in calcium being accumulated in the damaged muscles. This calcium degenerates muscle protein, which in turn causes muscle inflammation and swelling. Whilst the inflammatory response is necessary and useful for muscle repair and recovery, it is what sensitizes the nerves in the muscle and this is why one experiences pain/soreness/stiffness. 

DOMS is actually a protective mechanism for the body. What happens through the trauma to the muscles is that the muscle(s) is forced to recover, repair and adapt rapidly to the kind of stress it experienced. It then evolves into a stronger form of itself to offer protection so that the next time it is placed under the same stress, it is well-equipped and more than able to take on the tension head-on. The phenomenon is termed “repeated-bout effect” and the protection offered can be for several weeks after the exercise.

the Why

DOMS occurs as a result of eccentric or unfamiliar muscular activity. So for instance whilst you may be a spin-demon and regularly pull-off some seriously spectacular pedaling in your indoor cycling class, you will find you experience DOMS following a pole-dancing workout that you’ve never done before. Simply put, different muscles are used for both the workouts and the muscles aren’t used to being contracted and put under tension the way they’re required to for pole-dancing. 

The severity of symptoms however experienced varies from person to person and depends on factors like age and how seasoned an athlete is. The younger you are and the more conditioned your body is to exercise, the less susceptible you are to DOMS. The other side of the coin is that the older you are, the ‘older’ your muscles are and this shifts your hormonal status and decreases your recovery response; ergo greater susceptibility to DOMS. Generally speaking though, DOMS is unbiased and sans prejudice – it affects all. Further, symptoms and signs don’t necessarily present together and can occur at different times post exercise. 

DOMS pain is exacerbated when the muscle in question is stretched, contracted or put under pressure. At rest, pain is usually not experienced. 

Some evidence does support that DOMS does occur if proper form isn’t maintained during exercise. It is vital to ensure you are wearing the correct sporting gear during your workouts and that your form is accurate and isn’t causing excess, unnecessary strain to your body. For correct form refer to Haute Body Directory.

the When

DOMS does not occur immediately after the eccentric exercise. The muscle soreness takes anywhere from 24 to 72 hours to develop post workout. Pain experienced soon after a workout is NOT DOMS and should be investigated and managed appropriately. 

DOMS subsides and disappears usually within 5-7 days after the workout. Any symptom that persists for longer is safe to say not DOMS and requires attention. 

the How (to diagnose?)

DOMS pain is unique in that further activity of the sore muscles helps alleviate the soreness after some initial pain. DOMS is also unique in that this continued use of the pained muscles does not hamper its recovery nor worsens the muscle damage. 

It is easy to distinguish DOMS from muscle injury, which usually occurs at the very instant that the muscle receives trauma. Any pain or swelling that occurs during the exercise at the instant of contraction is not DOMS and must be viewed with an index of suspicion. Another way to differentiate between DOMS and muscle soreness from injury is that at rest, DOMS doesn’t produce pain whilst an injured muscle will ache/throb even at rest. 

the What to do

DOMS is not a cause for concern and resolves on its own in a matter of days following exercise. It is highly recommended that the day after the eccentric/unfamiliar exercise should be a day of rest and that exercise be resumed the day after at a slightly decreased intensity. Yes folks, I am saying go back to working out after a rest day (or two)! This ensures that muscle memory is preserved and yet that the damaged muscle isn’t overloaded with stress. 

That said, there’s no denying that at times the muscle soreness can be sorely uncomfortable and may hinder your daily activities. (Try sitting on a toilet seat following a day of 300 squats!)

To relieve inflammation and soreness, anti-inflammatories and sports massages have been found to be effective. Non-steroidal anti-inflammatory drugs (NSAIDs) like Ibuproffen and topical Voltaren gel definitely take the edge off and well, a sports massage is just harmony to aching, fatigued muscles. Be careful when taking Ibuproffen though as it is known to cause gastric irritation. Consult a physician. 

Just like the massage increases blood flow to the damaged muscles, a sauna steam or hot bath too offers the same therapy and can be helpful for DOMS pain. 

A good warm-up pre-workout and regular static stretching is thought to offer some protection against DOMS. While the literature on this is controversial stretching is good for muscle elasticity and flexibility and should be incorporated into your routine. Regular stretching is thought to improve muscle function and decrease muscle viscosity thereby allowing for more efficient muscle contractions.

Finally, there is a great deal of research going into different muscle enzyme therapies. For the most part the research is primitive and rather than taking synthetic drugs and enzymes, be sure that your diet is well balanced and that you’re consuming good amounts of protein from lean meats, vegetables and eggs. Also be sure to eat antioxidant rich foods like berries, which will help combat the inflammation and reduce swelling.

the What nots

If repetition of the eccentric exercise after a rest day does not alleviate DOMS then do NOT continue. It is essential that a distinction is made between muscle injury and DOMS (see “the How to diagnose?” section) and if not done accurately can intensify the injury. For the most part continued exercise is NOT possible with muscle injury. 

If you suspect muscle injury, do NOT indulge in sports massages, as it will exacerbate the muscle damage. Consult a physician!

Finally, don’t get obsessed with DOMS (I know I did when I was struck by the fitness fad). I found myself trying to push myself till I was battered, bruised, crippled and crushed (BBCC) after a workout. DON’T! If you are indeed BBCC then you’ve pushed too hard and chances are you’re injured. Ease yourself slow and steady into a new exercise. Going hardcore on day 1 will achieve nothing and do more harm than good.

DOMS is not a measure of how good your workout has been. With time your muscles will adapt and get stronger and repetition of the exercise won’t cause DOMS. This is why it is important to mix-up your workouts and trick your body time and again. Do not let it get used to any one activity. A good workout and a good fitness regime is where you constantly challenge your muscles and your body through different means and where at the end of the hour you are well and truly sweaty. 

As for DOMS, you’ll learn to LOVE THAT BURN 😉

Medically fit has been a pet project of mine for many months now. I’ve often heard from close friends and family in the UAE, horror stories of being misdiagnosed and worse still, being diagnosed and not having a clue as to what their diagnosis meant. Moreover, with the growing commercial nature of the healthcare profession today, lengthy and whopping bills are being drawn and presented to patients which often have patients bearing expenses that are completely unjustified, unnecessary and which have not really contributed to the diagnosis in the first place.Unethical to say the least!

As I see it there are two wrongs – One the physician who fails to communicate accurately and thoroughly and Two, the patient who fails to question the physician when in doubt.

Medically fit is my attempt to equip people with a basic knowledge of various ailments, disorders and diseases and to encourage them to gain a better understanding of their bodies on a whole. I don’t claim to be a specialist in any particular medical field but what I do have is a fair bit of experience in General and Internal medicine, General surgery and Accident & Emergency medicine as well. This is in addition to the knowledge and experience I’ve gained over my 7-year stint in the medical profession definitely allows for me to share with YOU, dear reader, facts.

It’s so that when people turn patients they are not in a state of panic and confusion post a doctors’ visit and are encouraged to voice their opinions and apprehensions. I’m going to try my level best to arm you with information over progressive weeks but should you require further clarification please do write in and ask. I promise you – my bark is far worse than my bite 😉 It’s important because it is YOUR body and you require awareness and education along with your health to be – Medically Fit ☺