Tag: featured

“Cancer? Yes, obesity causes cancer!”

“Being overweight is not good for you, you can get diabetes or have heart disease”. This is something we all hear frequently and know for a fact. What we don’t hear and many of us don’t know is that being overweight and obese also causes cancer! Yes, that disease that we all fear CANCER. In fact, it can cause up to thirteen different types of cancer. This includes cancers with some of the worst outcomes like oesophageal and pancreatic and those linked to reproductive organs like womb and ovarian.  This is in addition to the risk from diabetes and heart disease that we are all familiar with. With obesity levels rising globally it is currently the second biggest cause of preventable cancers after tobacco use and we must do more to reduce rates. 

The way that obesity and extra weight can cause cancer can be considered complex but as the diagram shows very simply, the extra fat cells are active and lead to an excess production of hormones and growth factors.  These in turn stimulate key cells to divide increasing the risk of mutation and cancer cells being produced.  It is the mutation through cell division that leads to a cancer cell in the body that rapidly divides to form a tumor.

There are many factors that contribute to obesity but we know that the best way to reduce your weight to a healthy body mass index (Height cm/Weight kg; 18.5-24.9) is to eat healthily and reduce the amount of foods that are high in fats sugars and salt (HFSS).

Currently the evidence shows the link between obesity and cancer in adults BUT we do know that if a child is overweight and obese, they are 5 times more than likely to become an overweight adult with an increased cancer risk, in addition to the risk of diabetes and heart disease.  All have high associated health costs. Knowing this it is vital that we do more to support children to eat healthy.

There are many things around us that constantly tempt and encourage us all but especially children, to see, want and buy these HFSS foods – from marketing to price promotions.  Research from Cancer Research UK has shown that for every extra broadcast advert a child watches a week they are likely to consume an extra 350 calories/week!!

Obesity rates are rising globally and if we don’t do anything it will overtake smoking as the leading cause of cancer.  It has a large health risk associated with it financially, physically and mentally and we must do more to prevent it.  Raising our awareness of the health risk posed from obesity is a start and combined with doing more to reduce the increasingly “obesogenic” (obesity friendly) environment we are living in, we can start to hopefully turn this epidemic around.

References:

Brown KF, Rumgay H, Dunlop C, et al. Thefraction of cancer attributable to modifiable risk factors in England, Wales,Scotland, Northern Ireland, and the United Kingdom in 2015. British Journal ofCancer 2018; 118(8): 1130-41.

https://www.cancerresearchuk.org/about-cancer/causes-of-cancer/obesity-weight-and-cancer/does-obesity-cause-cancer#Obesity0

“Under Pressure: New evidence on youngpeople’s broadcast marketing exposure in the UK”. 2018. Christopher Thomas,Lucie Hooper, Gillian Rosenberg, Fiona Thomas, Jyotsna Vohra. https://www.cancerresearchuk.org/sites/default/files/under_pressure.pdf

by Jyotsna Vohra PhD

Children and Media- Young Children

From interactions with my patients and their families, I am increasingly concerned about the impact of digital media on our children who are growing up in environments saturated with technology. I had the mother of a two-year-old patient insist he was getting his “own” tablet as a present, and she became very upset when I cautioned her about the impact of unsupervised use of media. She insisted that she only used educational programs and that her child would be “left behind” if she did not buy him a device. The American Academy of Pediatrics (AAP), the American Psychological Association, (APA), Common Sense Media and many other experts and organizations have expressed concern about this issue as well. This is true in the United States and also in developing countries, like India. Child psychologist Dr. Malavika Kapur states: “Based on field and clinical experience, psychodynamic and behavioral theories and most of all from a developmental perspective,…indiscriminate viewing of visual media, especially with violent content, interferes with normal development.” The people who sell us this technology are themselves concerned and are limiting or banning their own children from using these devices. Concerned parents in Silicon Valley even have their nannies sign contracts so their children are not exposed to “screens.”

So what do we do? The following is a summary of the expert recommendations with my own comments and opinions as a pediatrician who has worked in general practice and in the academic world and as a parent. I use the word “media” to include all kinds including digital (computers, tablets, smartphones, educational computer toys), as well as TV and videos.

Young children are particularly vulnerable to exposure to media and devices as this is a crucial period of brain development. I had a parent proudly tell me that their child’s first word was “Alexa”, but I’d really prefer Mama or Dada to be that first word. Children two and younger need to explore with their hands and interact with trusted adults (parents, babysitters, daycare providers) to develop language, physical, social, emotional and other skills. Any use of media should be with parents who watch with them, reteach and reinforce its messages with them. They simply do not have the ability to learn from digital media as opposed to human interactions. An exception might be made for using video chat (Skype, Facetime, WhatsApp) to talk to family in other states and countries.  These programs are wonderful for grandparents and so long as parents are there to help interpret what’s going on, this is okay although it’s not a substitute for a real-life grandparent.

For children who are between the ages of 3-5 years, it’s tempting to use media to get a break from all that energy and maybe get some laundry done. When my children were little, they watched Sesame Street, Mr. Rogers, and Thomas the Tank Engine. They later moved on to dinosaurs and nature-related shows and documentaries. I think it’s important to recognize that while this is “down time” for both the kids and parents, try to be “present” during this time so you can chat about the content. Parents often try to pick educational programs, and some programs like Sesame Street are known to have some beneficial outcomes. I think it’s important to recognize that as parents, we are allowed to take breaks; however, many apps and shows that are supposed to be “educational” are really focused on rote academic skills. At these ages, parent-child interaction and unstructured social play are still critical to developing important thinking and social skills which toddlers lack, including impulse control, emotional regulation, creativity, and task persistence. Excessive TV watching at this age has been associated with cognitive, social, emotional and language delays. Additionally, excessive media use during preschool years is associated with increased risk for obesity possibly related to food-related ads, decreased physical activity and watching TV while eating/ snacking, which, as we all know, makes for “mindless overeating.” Excessive media use has been associated with decreased sleep even in infants, maybe from the screens’ “blue light” and the content watched.

Content is so important. I have had patients who were “expelled” from daycare for hitting and hurting other children. While some children are more “physical” than others, I often find that many of these children have been watching inappropriate or violent content. A patient of mine would sit on her parent’s lap while the parent played “Call of Duty”. She regularly hit children and was asked not to return to daycare. I think it’s preferable to watch media with your child but unquestionably something gentler.

There are times when parents use media to soothe a child, for example, during a plane flight or a doctor’s office visit. That’s not unreasonable and is sometimes necessary, but it is also important for children to learn how to regulate their emotions and soothe themselves. Boredom is not a bad thing and is known to stimulate creativity.

It’s not just the kids. Parent media use also decreases parent-child interactions. And parents who use devices heavily have kids who do.

The AAP recommends “…time limitations on digital media use for children 2 to 5 years to no more than 1 hour per day to allow children ample time to engage in other activities important to their health and development and to establish media viewing habits associated with lower risk of obesity later in life. In addition, encouraging parents to change to educational and prosocial content and engage with their children around technology will allow children to reap the most benefit from what they view.”

In summary (Adapted from AAP)

  • For children younger than 18 months, limit media use other than video-chatting.
  • Do not feel pressured to introduce technology early; children will figure them out quickly once they need to.
  • For parents of children 18 to 24 months of age who want to introduce digital media- choose high-quality programming/apps and use them together (co-view) with children, because this is how toddlers learn best. Letting children use media by themselves should be avoided. Use only quality products (eg, Common Sense Media, PBS Kids, Sesame Workshop).
  • In children older than 2 years, limit media to 1 hour or less per day of high-quality programming. Co-view to promote enhanced learning, greater interaction, and limit setting. Help children understand what they are seeing, and help them apply what they learn to the world around them.
  • Avoid fast-paced programs (young children do not understand them as well), apps with lots of distracting content, and any violent content.
  • Turn off televisions and other devices when not in use.
  • Monitor children’s media content and what apps are used or downloaded. Test apps before the child uses them, play together and ask the child what he or she thinks about the app.
  • Keep bedrooms, mealtimes, and parent-child playtimes screen free for children and parents. Parents can set a “do not disturb” option on their own phones during these times.
  • No screens 1 hour before bedtime, and remove devices from bedrooms before bed.
  • Try not to use media as a calming device unless absolutely necessary (we have all been there with a screaming child); work on setting limits, finding alternate activities, and other ways to calm children. See references below for ideas on how to implement these.

Resources and References

  1. AAP Statement- Media and Young Minds- Council on Communications and Media: Http://pediatrics.aappublications.org/content/138/5/e20162591
  2. For parent resources on finding appropriate content, ideas and how parents can limit their own media use: https://tinyurl.com/nrcwvdv
  3. Developing a Family Media Use Plan: https://tinyurl.com/hv3bh48
  4. https://www.commonsensemedia.org
  5. https://www.apa.org/topics/kids-media/
  6. A Dark Consensus About Screens and Kids Begins to Emerge in Silicon Valley https://tinyurl.com/y49jm6zj
  7. Let Children Get Bored Again by Pamela Paul: https://www.google.com/amp/s/www.nytimes.com/2019/02/02/opinion/sunday/children-bored.amp.html
  8. What’s the Hurry? Let Children be Children by Malavika Kapur: https://tinyurl.com/yy76bovh
  9. Silicon Valley Nannies Are Phone Police for Kids https://tinyurl.com/ybure8an
-Svapna Sabnis

Children and Media -Screens in Teens

At first, it was insidious. I would be at a restaurant with my family and I would see another family dining nearby. The children were using some kind of device, maybe a GameBoy to occupy them before their meal arrived. I noticed that the adults were able to have a real conversation. It was tempting to consider getting such devices for my kids as well as we dealt with children who interrupted our talk and demanded our attention- like normal children would. Growing up, I was a voracious reader, and I remember my mom making me put my books away and insisting I join the conversation at dinner. So I persisted with the rule for my children- no books or screens at the dining table.

I never had any absolute rules on computers and video games. Things were negotiable if a reasonable argument could be made. My older son made it easier on me by preferring being outdoors to video games. Luckily for me, he set a precedent and my younger son didn’t realize he could have asked us for a game system.

Now it seems like the devices at dinner time are ubiquitous, and it’s not just the children anymore. Everyone is checking their social media, texting their friends, catching up on the news and seemingly going out of their way to avoid human connection and conversation. I’ve seen kids connect by looking at each other’s social media accounts and comments they receive. That’s the entire conversation! They are often sitting in the same room texting each other instead of talking or playing, or maybe texting someone else because they don’t care to spend time with the person they are with. I find that incredibly rude, and yet  I catch myself fishing my phone out to check something non-urgent when I’m with friends. I avoided social media for a long time, but I recently succumbed to Instagram, mostly to keep up with my talented artist friends. I love seeing what they are up to and sharing my own amateur watercolors. I discovered that my niece who lives in another state is an incredible artist. Although I really signed up to see what others were creating, I suddenly find myself checking on whether people are commenting on my posts.

Don’t get me wrong, I love being able to look things up whenever I need to, read my newspapers, do my crosswords, play words with friends, check my email. I can even put in prescriptions for my patients on my phone.

My 16-year-old uses his phone to keep in contact with his friends, play games, browse some social media but also to do school-related activities. The lines are blurred between work and fun. I bought him a flip phone in sixth grade and a smartphone in eighth grade. With the smartphone came new rules (responsible use, parent access to his phone and any social media). Phones can be used to play games that are fun, entertaining, educational or destructive. I have preteen patients develop sleep problems because they won’t (or cannot) stop using the phone or playing video games. I’ve read that kids have shadow social media accounts that their parents follow, and real accounts that their parents don’t know about.  I’ve read that one can hide porn behind the seemingly innocent Calculator app. Kids have always known how to fool their parents. At some point, you have to throw your hands up and hope that you taught them well. But every child’s maturity level is different. Smartphones can be dangerous in the hands of an immature, impulsive child. It can be used to bully, threaten, intimidate, access porn, post inappropriate selfies or pictures of others, destroy a reputation, or ruin a young life. I had patients (really all girls) who shared nude pictures of themselves with boys which were then forwarded to the boyfriend’s friends. The girls were traumatized, grades plummeted, and they became anxious and depressed.

Smartphones are incredibly convenient and frighteningly addictive. And we put them in the hands of young people who have not yet learned to moderate their impulses. We wouldn’t give them unrestricted access to alcohol, drugs or cigarettes, would we?

Pandora’s box has been opened! We can use our phones for good and for evil. As adults let’s put our own oxygen masks on first, examine our own use of media, and then help our kids have better balance. Let’s get them back in the yard with their friends, balance the screen time with outdoor time. Maybe some star gazing, a hike, have real adventures.

For American Academy of Pediatrics guidelines on Children and Media https://tinyurl.com/y95q9w4c

And if you really want to learn about the importance of play in children’s lives I recommend Malavika Kapur’s book “What’s the Hurry? Let Children be Children”. Disclaimer- she is my mom. https://tinyurl.com/ycx97ke3

http://Other interesting articles https://www.nytimes.com/2018/10/26/style/phones-children-silicon-valley.html https://www.nytimes.com/2018/10/26/style/digital-divide-screens-schools.html https://www.nytimes.com/2018/09/20/business/media/google-youtube-children-data.html

https://www.theatlantic.com/magazine/archive/2018/11/raised-by-youtube/570838/

https://www.theatlantic.com/magazine/archive/2018/07/the-dangers-of-distracted-parenting/561752/

https://www.commonsensemedia.org/research/zero-to-eight-childrens-media-use-in-america-2013

by Svapna Sabnis

food rules

We all love to change the traditional ways of making food but what we don’t expect is that we are introducing new elements in the game of food. Food is chemistry and what we do to it has repercussions to the end product and to our health. However, it is fun to experiment and to explore creative foods and ideas. The problem is that traditional recipes come to us with rules and restrictions and we need to know when and why to make changes to them. Or not. Like cooking spinach with a fat and an acid to make sure the iron is absorbed in the body- something that I did on a regular basis. So this changed when I put spinach in a smoothie with a banana and yogurt. There was no fat or acid added. Spinach, a green micro-nutrient was a total loss to my system and to the process of setting up a new routine.

And consider dal or lentils.

A nutritionist I follow on instagram gave me some details on lentils. She posted about the lentil cheela with lots of vegetables and that got me thinking to how when my father suffered with kidney and liver problems and the doctor suggested eating less toor dal or any dal (lentil). He was a mid-life teetotaler, so alcohol was not the reason. The nutritionist said this about the dal intake- “…Ayurveda has already prescribed ways to prevent the ill effects of lentils. Think about our dal ka tadka with asfoetida, garlic, cumin and chillies or sambar that is made with tamarind and a tadka or the various fermented lentil preparations. The oxalates and purines in lentils are associated with oxalate type stones in kidney but if lentils are cooked according to Ayurveda prescribed ways and one consumes enough water, there is no need to worry.”

Thank you Sangeetha Khanna for this, and I would suggest you follow her blog and posts for more interesting information on food and nutrition guidance.

the inevitable dawning of common sense

The physical body over the mental- which comes first? Is it the chicken or the egg? Or is it easier than that? I practiced the mental well being for far too long and got hit by the lack of the physical care that was needed. Hence the effort to get to the core of it and understand how both are connected.

The inevitable dawning of common sense

For a number of years for me, the refining of the thought process to understand a social problem (as a sociologist) was to me a far critical issue to work towards. It has become my default setting for the longest time I could remember. The idea of “seeking help” was not an option to fix this lack of understanding- if it came about. I always knew that the most nonsensical of the problems has a solution, if only one reads more about it or finds ways to newer understandings and the truth as I seek it would unravel in front of me.

The mind-body connection, or the physical-body problem in the form of high BMI, is a new one that life has dealt in a fashion that now cannot be ignored. This is a warning sign of what’s more to come soon. On the other hand, the lack of a right mind-set that makes you look like a dim-wit in a certain circle, like your class mates in the Sociology class, was a warning sign. I clarified my ideas and concepts by reading more and more, to arrive at an understanding that not only made me “wise” but also got the grades I was looking for.

The physical body however, took a while to give me the warning sign and working to fix that is what this dashboard or a thesis is about. Contact our editor to contribute to the dashboard as a writer.

about cholesterol

Target Numbers for Asian Indians to Prevent Heart Disease
Non HDL Cholesterol less than 130 mg/dl [152]
(Total Cholesterol-HDL= Non HDL Cholesterol)

LDL-Cholesterol less than 100 mg/dl [126]

HDL-Cholesterol greater than 40 mg/dl for males and greater than 50 mg/dl for females [45]

Blood pressure: less than 140/80 mm
Waist Circumference: less than 35″ for men and less than 31″ for women

What is HDL cholesterol
High-density lipoprotein is a part of the total cholesterol measurement. It is often referred to as “good” cholesterol. The recommended level for men with diabetes is greater than 40mg/dl and for women with diabetes is greater than 50 mg/dl.

What is LDL cholesterol
Low-density lipoprotein is a part of the total cholesterol in the blood. It is often referred to as “bad” cholesterol. LDL should be less than 70mg/dl for those with diabetes and/or heart disease.

Dietary Recommendations to reduce LDL (bad) cholesterol level
The National Cholesterol Education Program Adult Treatment Panel III recommends:
1. Adjust caloric intake to achieve and maintain a healthy weight. Weight gain raises LDL (bad) cholesterol and triglyceride levels in the blood.
2. Choose a diet low in saturated fat (less than 7% of caloric intake), trans-fat (less than 1 % of caloric intake) and dietary cholesterol (less than 200 mg/day) by consuming a diet high in fish (especially fatty fish), non-fat dairy products, small amounts of lean meat and/or lean meat alternatives e.g. dry beans e.g. rajma, channa, soybeans (like edamame), lentils (daal) and tofu.
3. Include food sources of plant sterols & stanols. At the recommended dosage of 2 gm per day, plant sterols reduce cholesterol absorption in the intestine by up to 30% and reduce LDL “bad” cholesterol by 10%. Plant sterols have the same chemical structure as animal cholesterol which blocks the absorption of cholesterol eaten in the diet as well as
cholesterol manufactured by the liver.
4. Increase intake of viscous (soluble) fiber to 7-13g daily e.g. oats, fruits such as strawberries, apples, vegetables such as okra, eggplant, brussel sprouts and legumes such as lentils. Soluble fiber can lower LDL cholesterol 3-5%.  It is recommended that adults eat 21 to 38 grams of total fiber daily.

Source: Indian Foods: AAPI’s Guide to Nutrition, Health and Diabetes
Edited by RANJITA MISRA Professor & Research Director, Texas A&M University

remedies

HEART HEALTHY

What is heart healthy and why? Understand what it means to stay healthy! Be proactive about testing for diseases- know your challenges with genes and with your environment. Be equipped to deal with it. Coming soon- engage with your fitness calculators to enable better eating and working out. Know when to exercise more and do it. Find out about fitness classes around you and take on the extra work during the holidays. We all have the time to do it if you get it all together.