Diet - Drug interactions in upper Gastrointestinal tract disorders

Antacids: Neutralise gastric acid, aluminium containing antacids contribute aluminium to the diet and may cause constipation or lead to phosphorous deficiency. Longterm or inappropriate use can lead to Aluminium toxicity. Calcium containing antacids contribute calcium to diet and may cause constipation . Magnesium containing antacids contribute magnesium to diet and may cause diarrhoea. Longterm use may lead to magnesium toxicity.

Antiboitics: When amoxylin is given without regard to food nausea and diarrhoea are common side effects.It is better to take medicine with food to reduce nausea.

Clarithromycin: when taken it may cause taste alteration nausea and diarrhoea.

Metronidezol: May cause taste alterations and no alcohol should be used during treatment  if  alcohol is given and for 24 hrs afterwards alcohol can react with metronidezole and result in nausea , vomiting, headache, cramps .

Antisecretary agents:  Inhibit gastrophasis secretion . Citnitidine may increase formation of toxic metabollites. Nizartidine when taken with tomato based juices its potency is reduced.

Omeprazole and rebeprazole:  They inhibit secretion of acids may interfere with iron absorption. When iron supplements are necessary they should be given 2 hours before or after taking protonpump inhibitors.

Root Canal Treatment (RCT)

Root canal treatment is a method to clean roots by gaining access from the tooth with the help of Dental instruments and specific equipments. When the carious lesion reaches pulp (where all blood vessels are present), then the only option left is RCT. Sometimes carious lesion even extend from root to apex (where root ends), then extraction is advisable as RCT will have poor prognosis in this case.
Time taken or sittings involved during RCT depends upon the extent of infection in tooth.
Steps involved in RCT are as follows:
Gaining Access to Root canals: Access from the surface of the tooth(crown) is gained with the help of Drilling instrument . Normally there are 3 canals in molars, 2 canals in premolars and 1 canal in Incisors and canine. Number of root canals can vary in tooth from person to person, it is never fixed.
Cleaning and Shaping of Root canals: Once the access is gained, then with the help of instrument known as files as shown in figure, Canals are cleaned. To avoid friction and proper cleaning disinfectant solution known as sodium hypochlorite is used. It removes all the debris and infection from the canals and makes them sterile. It usually takes 2 sittings, but if infection is less than it can be completed in 1 sitting also. After the thorough cleaning, temporary filling is placed in tooth and patient is asked to come after 2 days.

Filling of Root canals: Once the canals are cleaned, and then canals are properly dried with the help of paper points and filled. Canals are filled tightly with Gutta percha points (GP points). After filling of root canals, Permanent filling is placed in tooth; normally permanent filling does not last long. Always Crown is mandatory after RCT as tooth becomes weak from inside. To avoid further fracture of tooth, crown is mandatory.
Some frequently asked questions regarding RCT:

Is RCT Painful ?
No, RCT  is not painful. Before starting the procedure dentist always anaesthetize the tooth to make it convenient for patient and as well as for Doctor.

Is RCT Safe ?
Yes, RCT is safe. When carious lesion reaches deep inside the tooth then RCT is only option to save the toth.

How many sittings are normally involved in RCT ?
If tooth is not infected then RCT can even be completed in single sitting. But, if infection is more then it normally takes 3 sittings and even more depends on the extent of infection.

Can Pregnant Women Undergo RCT ?
No, It is not at all recommended. RCT should be postponed until the birth of baby.

Is Crown Mandatory after RCT ?
Yes, Crown is mandatory after RCT to make tooth stronger and last longer. Without crown tooth can fracture anytime and after fracture, Extraction is the only option.

Does Pain Exists After RCT ?
If through cleaning and infection is removed during procedure then pain vanishes. But, if cleaning and filling of root canal is not done properly by the Dentist then surely patient will complain of pain again and again.

How Many X-Rays Are Involved In RCT ?
Normally one X-Ray before starting the procedure and one at the end of the procedure. It depends upon the Dentist, as he is a better judge of the condition involved during the procedure.

Do All Carious Tooth Need RCT ?
No, only the tooth in which carious lesion extends deep inside the pulp need RCT. Otherwise, fillings can be done to save the tooth.

Why Root Canal Treated Tooth Is Known As Dead Tooth ?
In Root canal procedure, Pulp(where blood supply of tooth is present) is removed and canals are cleaned properly. Main indication of RCT is when carious lesion reaches pulp and infects that area, then to relieve patient from pain it is removed. Tooth will no doubt remain in its position only the difference comes is it becomes non - sensitive, for this reason it is known as dead tooth.

Oral Cancer

What is oral cancer?
Excessive cell growth results in enlarged mass known as tumor. There are no strict boundaries of tumor, it slowly and slowly extends to surrounding healthy tissues and make them infected. Oral cancer generally invades throat, head and neck. Generally all oral cancers begin in squamous cells, therefore known as squamous cell carcinomas.
What are the causes of Oral Cancer?
Excessive smoking: Cigarettes contains tar which is harmful for the system of human being. If you practically smoke cigarette on white clean surface it will turn that surface yellow. Slowly and slowly tar keeps on depositing in our lungs and makes them even difficult to work. Excessive smoking results in limited mouth opening because of bands formation in cheek area. Eventually this condition turns into carcinoma formation.
Tobacco chewing: Tobacco chewers are in habit of keeping tobacco in between the cheeks or below tongue which makes that area infected. Heavy deposition of tobacco and prolonged habit is the main cause of oral cancer.
Excessive exposure to sunlight: Excessive exposure to sunlight causes cancers of oral cavity. Normally lower lip gets infected. Before going in sunlight always carry umbrella or apply sunscreen.
Exposure to X-Rays: High duration and prolonged exposure to x - rays can cause oral cancer.
Hereditary: Hereditary is one of the major factor in causing oral cancer. Inherited genes makes cells more sensitive to exposure to sunlight, x - rays and eventually result in cancer.
Sharp Tooth: Sharp tooth which keeps on irritating the tongue, if left neglected can turn into cancer in a period of time.
What are the prevention measures of oral cancer?

• Limit the frequency of smoking and slowly and slowly stop completely. It is not at all healthy habit for oral cavity and body system as well.
• If you are sensitive to exposure of x - rays, its patient duty to priory inform the dentist so that Dentist will treat accordingly.
• If you are going in scorching heat then always carry sunscreen, apply lipstick or lip balm which has SPF in it.
• Regular follow up checkups are recommended to treat condition in early stages.

What are the methods of treatment?

• Chemotherapy
• Radiation therapy
• Surgery

Dentures

What are Dentures?
Dentures are the artificial prosthesis which is the substitute of missing teeth.  Dentures take support of surrounding soft tissues and teeth to stabilize in oral cavity.
How many types of dentures are there?
There are two types of dentures:
• Partial dentures
• Complete dentures

What are partial Dentures?
When some teeth are present and few are missing then Partial denture is fabricated.

How many types of partial dentures are present?
Partial dentures are of two types:

• Removable partial denture(RPD)
• Fixed Partial Denture(FPD)

What are the advantages of Removable partial denture?

1. Removable partial denture can be easily removed by patient and can easily be cleaned.
2. It is less expensive
3. Removable partial dentures are fully tooth supported and helps in normal chewing.
What are the disadvantages of Removable partial denture?
1. Since removable partial denture are fully tooth supported, sometimes cause injury to tooth supported gums.
2. If patient does not maintain proper oral hygiene, RPD can be harmful for other remaining natural teeth.
3. Due to removing RPD again and again it sometimes becomes loose.

What are the advantages of fixed partial denture?
1. These dentures are attached to natural teeth, roots or implants and cannot be removed by patient.
2. FPD has high retention as compared to removable partial denture.
3. Patient feels FPD like his natural teeth. Hence less compliance factor.
What are the disadvantages of FPD?
1. It is expensive procedure.
2. More time consuming and regular checkups are advisable.
3. If patient’s supportive teeth are not strong enough to bear forces offered by FPD, then it has poor prognosis.
4. If RCT of supportive teeth fails and patient come back with pain in supporting tooth then whole FPD has to be removed and placed again.
5. If FPD is not fixed properly or some space is left while fitting then food lodgment continues and results in bad smell from mouth.

What are the steps to be taken care of after placing partial denture in mouth?
• Patient should maintain proper oral hygiene.
• Regular flossing is advisable.
• Patient should not bite hard from artificial teeth.
• Regular follow up checkups are recommended.
• Always put RPD in water after removing from mouth.
• Do not wash RPD with bleaching agent or detergent. Special cleansing agents are available to wash RPD.

What is complete denture?
When all the teeth are missing (edentulous) then complete denture is fabricated. Below are images of maxillary complete denture and mandibular complete denture. They vary in shape according to the shape of oral cavity.
How many teeth are present in complete denture?
Normally 28 teeth are present in Complete Denture, but sometimes we have to miss second premolar in case of small jaw size.
How much time is required to fabricate complete denture?
At least 1 week time is optimum for complete denture
Why dentist ask to carry old photo while adjusting teeth in Denture?
After having a look of old photograph Dentist gets an idea of the shape and setting of teeth. To minimize the patient compliance and to have a natural look old photograph is mandatory.
Can patient start immediately eating with complete denture?
First patient should start with liquids and then with soft food and then finally with normal daily routine food items. Surrounding soft tissues and tongue takes time to adjust with new thing in mouth. May be for few days patient find some speech problem as well. Once you oral cavity get use to denture then everything gets fine.
Can patient brush complete denture?
Yes, patient should daily brush the teeth of denture in a same way like his natural teeth. After every meal cleaning is mandatory. Special cleaning tablets are available which are used to remove satins from the denture.

Pancreatitis

Pancreatitis is inflammation of the pancreas. The pancreas is a large gland behind the stomach and close to the duodenum—the first part of the small intestine. This gland secretes digestive juices, or enzymes, into the duodenum through a tube called the pancreatic duct.

There are two types of Pancreatitis:

1. Acute Pancreatitis
2. Chronic Pancreatitis

1. Acute Pancreatitis:

Acute Pancreatitis is inflammation of the pancreas that occurs suddenly and the condition will be normal with in  few days after treatment. The causes of acute Pancreatitis are abdominal trauma, certain medications, bacterial infections, tumors and genetic problems.

Symptoms:

Acute Pancreatitis usually begins with slight upper abdomen pain that some times extends through the back. The pain is more after eating. People with acute Pancreatitis usually look and feel very ill and needs immediate medical attention. Other symptoms may include:

• A swollen and tender abdomen
• Vomiting and Nausea
• Fever
• Rapid and irregular pulse

Diagnosis:

Depending upon the condition of the patient the doctor will order a blood test to assist the diagnosis. During Acute Pancreatitis, the blood contains at least three times the normal amount of amylase and lipase, digestive enzymes formed in the pancreas. Once the patient condition is normal the levels come to normal. The doctor will order some more tests depending upon the condition of the patient like Abdominal ultra sound, CT Scan, Endoscope ultrasound, MRCP.

Treatment:

Treatment for acute Pancreatitis requires a few days stay in the hospital for intravenous (IV) fluids, antibiotics, and medication to relieve pain. After the patient got recovered with Acute Pancreatitis the doctor advised not to smoke, drink alcoholic beverages, or don’t eat fatty meals.

2. Chronic Pancreatitis:

Chronic Pancreatitis is inflammation of the pancreas that leads to permanent damage. Chronic Pancreatitis is severe when compared to acute Pancreatitis. The main cause of chronic Pancreatitis is the use of heavy alcohols. Other causes of chronic Pancreatitis are:

• Medications
• Hypercalcemia - high levels of calcium in the blood.
• Certain Autoimmune conditions
• Cystic fibrosis
• Hereditary disorders of pancreas

Symptoms:

The symptoms are same as like the Acute Pancreatitis. Other symptoms include

• Nausea
• Vomiting
• Weight loss
• Diarrhea
• Oily stools

Diagnosis:

Chronic Pancreatitis is often confused with acute Pancreatitis because the symptoms are similar. In advanced stage of Pancreatitis malabsorption and diabetes can occur. The common diagnosis tests are

• Abdominal ultra sound
• CT Scan
• Endoscope ultrasound
• MRCP

Treatment:

People with chronic Pancreatitis treated with pain medications, fluids given trough a vein (IV). Diet plays an important role for people with chronic Pancreatitis.

• Drinking plenty of liquids
• Eating a low fat diet
• Limiting caffeine
• Taking vitamin rich supplement diet.

Nutrition and Gastrointestinal disorders

The majority of the diseases of the Gastrointestinal tract are not fatal but are significant causes of poor health, responsible for significant proportions of patients attending hospitals and local medical services.
Some Gastrointestinal disorders, common symptoms and nutritional consequences:

Dyspepsia:   Some of the common symptoms include upper abdominal discomfort, bloating especially after meals. Increased concerns about diet, possible decreased intake of food in general or selected foods are some of the nutritional consequences.

Duodenal cancer: several hours after meals pain occurs, may be relieved by eating.Food intolerances may occur.

Gastric ulcer: Vague epigastric discomfort associated with eating. Decreased intake in general or selected foods.

Dumping syndrome: Bloating , nausea, satiety later symptoms such as reactive hypoglycemia and possibly cramping , diarrhea may occur. Decreased intake , malabsorption of nutrients , weightloss, micronutrient deficiencies.

GERD: Acid taste, increased belching, dry cough, burning sensation in upper middle of chest, sometimes spasm, difficulty swallowing , bloating may occur. Possible nutritional consequences include altered food choices, not eating evening meals, avoidance od acid foods, reduced quality and quantity of dietary intake.

Cancer of oral cavity, stomach or esophagus: Asymptomatic or difficulty chewing , swallowing, epigastric discomfort, delayed gastric emtying are some of the symptoms. Anorexia, decreased amount or number of foods, weight loss, change in food texture may require surgery, radiation, chemotherapy , enteral feeding.
General Nutritional guidelines of gastrointestinal disorders:
• Alcohol should be avoided.
• Smoking should be avoided.
• Allergic foods should be avoided.
• Very hot or very cold foods should be avoided.
• Foods should be thoroughly chewed.
• Heavy meals should be avoided. small frequent meals are good.
• Daily 8 to 10 glasses of water if good for health.
• Regularity in meal timings is essential.
• Spicy foods should be avoided.
• Consume adequate fiber.
• Avoid or restrict intake of fructose and sorbitol.
• Minimize consumption of caffeine.

Heart and Circulation » Heart Attack

Heart attack occurs when the supply of blood and oxygen to an area on the heart muscle is blocked, usually by a clot in the coronary artery. Heart attack is the leading cause of death for both men and women worldwide. However, if the indications are recognized early and proper medications are given, the person’s life can be saved to a large extent.
The indications for a heart attack include:
• Pain or discomfort in the center of the chest that can last for more than few minutes.
• The chest discomfort may come and go and can have a feeling of uncomfortable pressure, squeezing, fullness or pain.
• Discomfort in the other areas of the upper body which may include one or both arms, the back, neck, jaw or the stomach.
 • Sudden weekness followed with sweating and fainting.
• Shortness of breath
• Cold
• Nausea
• Lightheadness

Hernia

Hernia is often referred to as a 'rupture'. The term hernia is most commonly used to describe to the protrusion of the intestine through a weak area in the abdominal wall. This will cause bulging of the abdominal wall. This bulging increases the pressure in the abdomen.

Types: The types of  Hernia relates to its location on the body. These include:

Inguinal Hernias: This type of hernias are more common in men than women because the canal is bigger. These are the common type of hernia. The canal contains the spermatic cord and blood vessels. When an inguinal hernia occurs part of the intestine protrude down the canal and into the scrotum.

Femoral Hernias: This type of hernia is more common in women, femoral hernias occur when part of the intestine protrudes through the femoral canal and protrudes at the top of the thigh.

Umbilical Hernias: An umbilical hernia occurs when the abdominal wall is weakened at the point of umbilical cord. Umbilical hernias are most common in children.

Obtuator Hernias: The Obtuator hernia occurs when part of the intestine passes through the gap between the bones of the front of the pelvis.

Risk factors of Hernia:

Any person can get hernia from children to old age. Some of the factors which increases the risk of Hernia are:

1. Obesity
2. Previous abdominal surgery or abdominal injury
3. Straining to lift heavy objects
4. Because of constipation straining during bowel movements.
5. A chronic cough, such as smokers cough
6. Male are 12 times more prone to hernia when compared to females

Symptoms: Symptoms of a hernia include pain or discomfort and a localized swelling somewhere on the surface of the abdomen or in the groin area.

Treatment: The best treatment of hernia is by surgical repair. There are no drug treatments for this condition. Surgery gives relief to the pain and swelling. There are no side effects for surgery.

Prevention: Life style modifications can prevent hernias. Regular exercise can prevent hernia. Another important factor is avoid risk factors which is mainly involved in hernia.

Food Additives

A food additive is defined as a substance or a mixture of substances, other than basic food stuff, which is present in food as a result of any aspect of production, processing, storage or packaging. Food additives are added in order to improve texture, flavor, color and appearance. Food additives are classified as antioxidants, Preservatives, Food colors, food Flavors, Emulsifiers and stabilizers, anti caking agents, acids, bases and buffers, sweeteners, enzymes, leavening agents, anti foaming agents.

Antioxidants: A substance when added to food prevents oxidative deterioration . Some of the anti oxidants added in different foods are gallic acid, resin guiace, citric acid, tartaric acid, octyl gallate, dodecyl gallate, propyl gallate, ethyl gallate, butytlated hydroxyanisole and tertiary butyl hydro quinone.
Preservatives: These are substances when added to food inhibit, retard or arrest the activity of microorganisms such as fermentation, acidification and decomposition of foods. Some of the preservatives are common salt, dextrose, honey, spices, sugar, vinegar, edible vegetable oils, glucose syrup, nisin, sodium diacetate, nitrates, nitrites, lactic acid, sorbic acid, acid calcium phosphate.
Food colours: These food colours are used to enhance colors that occur naturally but at levels weaker than usually associated with a given food. There are natural and synthetic food colours. The natural sources are turmeric, saffron, caramel, beta carotene. The artificial colours are Red, yellow, blue and green.
Flavorings agents:  Flavorings agents add flavor to foods. There are natural and artificial flavours.
Emulsifying agents: Substances which are capable of facilitating a uniform dispersion of oils and fats in aqueous media.
Anticaking agents: Substances that pick up moisture without themselves becoming wet. These are added to products such as table salt and dry mixes to a maximum level of 2%.
Anti foaming agents: The anti foaming agents are added to retard decorative changes and foaming height during heating of edible oils and fats.
Buffering agents: These are agents used to counter acidic and alkaline changes during storage or processing of the food, thus improving the flavour and increasing the stability of foods.

Organic Foods

Most of the people do not have clear cut idea regarding the organic foods. Organic foods are those foods that are produced, processed and packaged without using chemicals. Organic foods are free of pesticides. They doesn’t have any synthetic additives. They are natural foods have grown with more conscious for health of soil, the plants and people who consume them. They have significantly higher levels of nutrients and supply to the body when we eat . Organic foods retains the nutrients for longer periods of time. The problem with today’s diet they are filled with refined and junk foods which contain more amount of empty calories and harmful chemicals. And so your body nutritional requirements are not met and it ends up with obesity and diseases. The quality of health and quantity of life can be improved by organic foods.
Health Benefits of organic foods:

• Organic foods are more nutritious as they supply high level of nutrients required by the body. They are richer in vitamins, minerals and essential fatty acids.
• Organic foods contain more antioxidants: Fruits and vegetables grown organically show higher levels of cancer-fighting antioxidants. These fresh Fruits and vegetables are more juicy and full- flavored. They also taste better than non - organic foods.
• Organic foods ensures environment safety as these foods doesn’t contain any harmful chemicals in farming , there is minimal soil, air and water pollution.
• Organic foods are free of additives, flavourings and preservatives used in processing.
• Eating organic foods reduces the amount of toxic substances that you are exposing to your body. It reduces your susceptibility to cancer, Parkinson’s ,allergies etc.
• Organic meat, eggs, dairy products are produced from animals that are fed organic feed. Livestock and poultry are given all organic feeds. No antibiotics, feed grown with pesticides and hormones given to animals.
• Organic foods do not contain genetically modified organisms.
• Children are more susceptible to the harmful effects of chemicals, and prone to various diseases as their immune system is not at developed .Eating organic foods provides health benefits to children.

IMPORTANT ORGANIC FOODS TO EAT AND THEIR MAIN NUTRIENTS ARE PRESERVED:
As we know we are what we eat. Eating safe foods, free from pesticides keeps us healthy. Here are some of the foods which we may have to choose organic -

1. Milk: In today’s some of the commercial brands available are loaded with growth hormones and antibiotics. Make sure milk and other dairy products is from organically fed cows.
2. Apples: still pesticides are used are on apples .Eat only organic apples. The main nutrient of apple is vitamin c.
3. Straw berries: The main nutrient vitamin C.
4. Spinach: The main nutrient iron, vitamins A and C.
5. Peaches: The main nutrient A and C.
6. Cherries: The main nutrient Vitamin C.
7. Pears: Main nutrients are Vitamin A, Potassium
8. Green Beans: Carotenoids ,potassium

Above mentioned are only some the examples that we should eat organic foods. As organic foods are free from pesticides the main nutrients like Vitamin A, C, Iron, Potassium, Carotenoids etc. are not destroyed.

Low Fat diet

A diet low in fat is called low fat diet. Some dietary fat is actually necessary. In certain medical conditions the body cannot tolerate much fat. So, a low fat diet may help people with these medical conditions. Some of the medical conditions where low fat diet is prescribed is Gall bladder disease, Delayed stomach emptying, Fatty liver and malbsorption syndrome.

Gall bladder secrets bile which helps to break down and absorb fat. When Gall bladder diseases or Gall stones are present there is not enough bile secreted or no bile produced by the gall bladder and so fat from food cannot be digested properly and this may cause diarrhea. A low fat diet allows your gall bladder adequate rest. Due to excess of cholesterol in the bile Gall stones are formed.
Gastroparesis is also known as delayed stomach emptying. In this disease the stomach empties food into intestine very slowly. When high amount of fats are present in foods we eat then this delays stomach emptying and cause gastroparesis. So low fat diet is good for gastroparesis.
Malabsorption and low fat diet: steatorrhea which is due to malabsorption of fat , where more than 6% of dietary fat is excreted in stool. In pancreas and small intestine diseases, patients have trouble in absorbing nutrients from diet, that include fat. A low fat diet helps may help to control symptoms.
Fat is normally not stored in liver. Due to number of reasons fat may accumulate in the liver and this may damage to liver. A low fat diet may be helpful.
List of low fat foods:
Non stick cooking spray, puddings with skim milk, soy milk, Low fat yogurt, whole wheat pasta, Brown rice, Whole wheat bread, Popcorn, Millets, Muesli, Whole Rye, Whole wheat tortillas, Oat meal, Black beans, Chick peas, Green peas, Lentils, Lima beans, Kidney beans, White beans, soy beans, Navy beans, Egg whites, Lean pork Lean lamb, skinless chicken, Liver, Skinless turkey, Rabbit, sea foods ,fresh vegetables and fresh fruits, Low fat tofu.
Tips To Follow Low Fat Diet:

• Avoid fried foods.
• Avoid carbonated beverages.
• Drink low fat milk or low fat dairy products.
• Drink plenty of water.
• Avoid alcoholic beverages and stop smoking.
• Increase physical activity.
• Include more number of fruits and vegetables in your diet.
• Substitute one egg with two egg whites.
• Eat lean meat.
• Avoid fried chicken.
• Avoid fast foods.
• Use cooking spray instead of oil.

Knee Pain

The knee joint is a largest hinge synovial joint consisting of 4 bones and is also a major weight bearing joint of the body. The 4 bones are femur (thigh bone on the top), the tibia (shin bone below), fibula (outer shin bone), and patella (knee cap in front). Knee injuries are most common during sports.
Causes:
• Knee pain may occur due to Knee injury, Fractures, Inflammation of lateral/medial ligament of knee, Twisting injuries to knee, Bursitis, Ligament sprains, Repetitive strain injury, Overuse syndrome, Osteoarthritis, Rheumatoid arthritis, Patellar fracture, Excessive jumping, Muscle strain, Tendonitis, Meniscus tears.
Symptoms:
• Pain, Swelling, Stiffness, Weakness, Redness and Warmth on the knee.
• Pooping/Crunching sounds in the knee while movement.
• Pain /Inability to straighten the knee or Locking while straightening the knee.
• Painful knee movements and Difficulty while walking. Any deformity/ Unusual symptoms of knee.
Diagnosis:
• X ray, MRI (magnetic resonance imaging), Menisci tear can be diagnosed through arthroscopy, arthrography.
Treatment:
NOTE: The treatment to the fractures, severe pain and post-operative cases should be followed by the advice of the doctor.
• R I C E treatment program is to be followed for pain reduction.
  1. Rest the knee. Using of knee caps while walking gives stability.
  2. Ice application to the painful knee area is to be done for 15-20 min with certain gap.
  3. Elevation of the knee joint helps reduce swelling and induce healing.
• Analgesics , Anti-inflammatory drugs, Cortisone injections given under doctor’s supervision.
• Joint mobilization , Soft tissue massage, Electrotherapy modalities done by the physiotherapist.
• Strengthening exercises
  1. Quadriceps

- Sit in a chair comfortably at its edge. Slowly lift the feet off the floor keeping knee extended and straight along with tightening of thigh muscles. Hold and relax.

- Lie on the back bending one (left) knee to 90 degrees and foot flat on the floor. Keeping another leg (right) straight, slowly lift it up to a certain height. Hold and relax.

- Sit/Lie on the floor/bed. Keep your leg straight and place a rolled towel underneath your thigh. Then slowly raise your foot off the floor pressing the towel with the thigh. Hold and relax.

  2. Hamstrings

- Sit/ Lie on your back. Bend one of your knees to 45 degrees keeping only toes off the floor. Then slowly pull your heel back towards your buttock as if sliding/ digging the heel into the floor. Hold at a point and relax.

       - Lie on your stomach. Slowly lift one foot off the floor tightening the back thigh muscles. Hold and relax.

- Place left foot on the heel of the right foot. Then slowly try to lift your right heel towards your buttocks with the resistance of the left one (press the left foot to the right heel against each other to resist).

       - Backward walking also strengthens hamstrings resulting in giving less strain to your knees.
  3. Hip adductors (inner quadriceps)
  4. Hip abductors
• Stretching exercises
1.    Quadriceps stretch              2. Hamstrings stretch
• Balancing exercises
Stand straight and take support of the chair. Stand with one leg for one minute and switch to other side. Slightly increase your balance removing the chair support.

Nutrition Basics » Cholesterol

Cholesterol is a fat like substance that occurs naturally in the body. Most of the body’s Cholesterol is produced by liver. Since cholesterol is synthesized in the body, it is not a dietary essential. Dietary sources of cholesterol include meat, poultry, fish, ghee, butter, eggs and prawns. Cholesterol produces certain hormones. Body uses cholesterol to protect nerves and make cell tissues. High intakes of cholesterol increase blood cholesterol. These high levels of blood cholesterol can increase risk of heart disease. Cholesterol cannot dissolve in blood. There are two types of cholesterol LDL and HDL .

LDL cholesterol: LDL is low density lipoprotein.LDL cholesterol is bad cholesterol. When too much of cholesterol circulates in the blood, it builds up slowly in the inner walls of arteries and form a plaque, this can narrow the arteries and known as atherosclerosis.
HDL cholesterol: HDL cholesterol is high density lipo protein. It is known as high density lipoprotein. High levels of HDL cholesterol protect against heart disease and low levels of HDL cholesterol increase the risk of heart disease.
Triglycerides: Triglyceride is a form of fat made in the body. People with high triglyceride levels can have high total cholesterol.

Diet Plans

calorie

1000 Calorie - Diet Plan	1200 Calorie - Diet Plan
1400 Calorie - Diet Plan	1500 Calorie - Diet Plan
1800 Calorie - Diet Plan

Renal - Diet Plan

1200 Renal Kilocalories - Diet Plan

1400 Renal Kilocalories - Diet Plan

Heart Healthy - Diet Plan

1200 Kilocalories Heart Healthy - Diet Plan

1500 Kilocalories Heart Healthy - Diet Plan

Diabetic - Diet Plan

1200 Kilocalories Diabetic- Diet Plan	1500 Kilocalories Diabetic- Diet Plan 1
1500 Kilocalories Diabetic- Diet Plan 2
1800 Kilocalories Diabetic- Diet Plan 1	1800 Kilocalories Diabetic- Diet Plan 2

Nutrition and Celiac disease

Celiac disease: In celiac disease one cannot digest gluten properly. It is an autoimmune disorder of small intestine. Symptoms of celiac disease include diarrhea and fatigue. In celiac disease absorption of all the macronutrients is reduced.

Dietary guidelines:

• Iron deficiency anemia is common with celiac disease. optimize dietary sources with iron.
• The gluten free diet are low in iron, calcium, zinc, magnesium , vitamin b12 and fiber. Hence daily vitamin and mineral supplementation is necessary.
• Eat sprouted nuts and seeds.
• Add omega 3 rich foods in your diet.

Foods to eat:

• Rice
• Rice bran
• Arrowroot
• Flax seeds
• Soy
• Legumes
• Potato
• Corn
• Sago
• Sorghum
• Amaranth
• Tapioca
• Millets
• Malt vinegar

Therapeutic Diets » High Fiber diet

A fiber diet contains foods that have a lot of fiber. High fiber diet has many health benefits. High fiber diet is recommended in the treatment of digestive problems such as diarrhea, constipation, hemorrhoids, diverticulitis and irritable bowel syndrome. Eating high fiber foods helps in proper digestion also helps in absorption of nutrients. When you eat the diet rich in fiber the daily intake of water should be adequate as liquids help your body to digest fiber. Recommendations for adults are between 25 and 40 grams per day. Dietary fiber adds bulk to your diet.

Health benefits of high fiber:

• A diet rich in fiber controls Diabetes by maintaining the blood glucose levels. It actually slows down the digestion and it doesn’t raise the blood sugar levels too fast. It takes more time than it takes time when the food does not contain fiber. As the glucose is not released into blood too fast, pancreas doesn’t secrete insulin too fast and blood sugars are in control.
• High fiber diet protects against colon cancer.
• A diet rich in fiber lowers cholesterol levels. Fiber absorbs the water as it moves through digestive tract. And this increases the stool bulk, which causes the intestine to pass them more quickly. As the stool passes more quickly there is less chance for any harmful substances they contain to harm the cells lining the intestine. Fiber also helps as it traps cancer causing agents in colon.
• It improves bowel regularity.
• It increases satiety and controls appetite.
• It also enhances immune system.
• Prolonged contraction of the colon may result in diverticulitis. This increase in pressure cause small and larger ballooning pockets to form. Usually this doesn’t cause any problems. But sometimes they can become infected or also cause inflammation when the pockets are perforated. As the diet rich in fiber increases bulk in the stool and this reduces the pressure in the colon. And so the formation of pockets is stopped.
• Fiber helps in treatment of irritable bowel syndrome. The increased amounts of fiber in diet produces soft and bulky stools. But IBS patients should be careful in selecting the amount and type of fiber. The reason is that the increased amount of soluble fiber may cause health benefit by growing the good bacteria, if too much of soluble fiber is consumed intestinal gas can occur.
• High fiber diet lowers the risk of heart disease and controls the cholesterol levels and triglycerides.
• High fiber diet is good weight management.

TIPS TO INCREASE FIBER IN YOU DIET:

• Eat Fruits with skin instead of fruit juices.
• Do not sieve whole wheat flour while you prepare rotis.
• Instead of white rice choose brown rice.
• Choose complex carbohydrates than simple sugars like whole grain cereals, whole grain breads.
• Eat the skin on baked or mashed potatoes.
• Eat unrefined foods.

Food sources: Excellent sources:

• Horse gram
• Rajmah
• Dry peas
• Drum sticks
• Drum stick leaves
• Curry leaves
• Fenu greek leaves
• Colocasia leaves
• Broccoli
• Turnip greens
• Mustard greens
• Rasberries
• Red gram dal

Very good sources:

• Ragi
• Bengal gram ,whole
• Barley
• Soya bean
• Double beans
• Flax seed
• Green gram, whole
• Straw berries
• Lettuce
• Spinach
• Cranberries
• Celery
• Fennel
• Cow pea
• Cluster beans

Good sources:

• Jowar
• Whole wheat flour
• Maize, dry
• Bitter gourd
• Field beans
• Amaranth
• Tamrind leaves
• Carrot
• Sweet potato
• Mango ginger
• Radish
• Capsicum
• Cucumber
• Apricots
• Oats
• Mushrooms
• Rye
• Grapes

Blood Pressure

Blood pressure is actually the pressure of blood against the walls of the arteries. Blood pressure is measured in mm Hg. Typical values for a healthy adult human are approximately 120/80. But, if the blood pressure reading is equal to or above 140 over 90 mm Hg, then that means the concerned person is suffering from high blood pressure or hypertension. Hypertension has been called the "silent killer" because it usually produces no symptoms. Untreated hypertension increases slowly over the years. Hypertension can cause certain organs (called target organs), including the kidney, eyes, and heart, to deteriorate over time. Malignant hypertension, an emergency condition resulting from untreated primary hypertension, can be lethal. It is important, therefore, for anyone with risk factors to have their blood pressure checked regularly and to make appropriate lifestyle changes.
   Symptoms of high blood pressure include drowsiness, confusion, headache, nausea, loss of vision.  Some basic steps that may be followed to check High Blood Pressure or Hypertension:
  - Be physical active by regular exercise, walking, yoga etc.
  - Maintain a healthy body weight.
  - Follow a healthy eating plan that emphasizes fruits, vegetables and low fat dairy foods.
  - Avoid alcoholic beverages.
  - Quit smoking.
  - Have a low salt intake.

Anemia

»   Beetroot are also rich in iron and various other minerals.so,person who is suffering anemia should include it in his diet to treat anemia.

  »   Leafy vegetables contains high grade iron it helps in formation of hemoglobin and red blood cells.

  »   Apple contain high amount of iron eat one apple every day it is effective remedy for anemia.

  »   Eat organic meat like liver and kidney to treat anemia.

  »   Cold water bath is also helps in curing anemia. A person with anemia must have at least two cold water baths a day.

Importance of calcium rich foods

Calcium is needed for growth and bone development. Deficiency of calcium leads to osteoporosis. Osteoporosis makes the bones thin. It is more common in women. More calcium is required during pregnancy, lactation. Even children and elderly require more amounts of calcium. Milk, curd, nuts, milk products, green leafy vegetables and ragi are some of the sources of calcium. Doing exercise reduces calcium loss from bones.

Antiaging Nutrition

     

Aging is characterized by memory loss, wrinkles , may have increased risk of diseases such as cardiovascular, diabetes, osteoporosis, kidney disorders Having proper nutrition can extend your life and make you feel younger and look younger. Physical activity also plays a significant role. Antioxidants in your diet play an important role.

Nutrition tips:

* Drink adequate water. Water prevents from dehydration.
* Choose high fiber foods. A fiber rich food helps in lowering age related diseases.
* Instead of 3 meals in a day have 6 small frequent meals. Improves metabolism.
* Reduce the intake of fat foods and junk foods.
* Reduce sugar and salt intake.
* Avoid drugs, cigarettes, caffeine and alcohol.
* Avoid processed foods. Processed foods don't have enough nutrients as they lose in processing. They also lack fiber.
* Choose good amount of fruits and vegetables. Fresh fruits and vegetables supply vitamins and minerals. They are also rich in antioxidants.
* Take vitamin supplements. As we age body doesn't produce nutrients efficiently resulting in the need for us to increase nutrients intake. Vitamin B requirement increases. Homocysteine levels should be maintained properly, if homesysteine levels rise in blood then it may lead to heart diseases. Vitamin B6 and B12 keeps the homesysteine levels low in blood.
* Eat calcium rich foods. Especially in women as they age there may be risk for osteoporosis, so the calcium intake should be increased. After menopause if you are on hormone replacement therapy 1200 mg of calcium is recommended. If not on hormone replacement therapy 1500 mg of calcium is recommended.

Foods that cause aging: Processed foods, food additives, sugars, high carbohydrates, artificial sweeteners, alcohol, hydrogenated fats, fried foods, preserved meat, monosodium glutamate, refined flours, cigarettes, margarine.