Author: noorali

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How To Loose Weight

How much should Canadians eat?

That’s the question I ask of myself when I look at my girth in the mirror. Or stare at my bathroom scale six feet away from my eyes.

The other day, I took my last dress pants to a seamstress to make room for my ever-increasing girth. She says, “Dr. B, do some exercise!”

I thought I did enough exercise each week. May be I am eating too much! I did not think so. I thought I did both – ate less and did regular exercise. So what am I doing wrong? Why am I not losing weight?

I am not the only one asking this question. Million of Canadians and others in the world are asking the same question. What are we doing wrong?

Dr. C. Laird Birmingham, Professor of Medicine, University of British Columbia and Dr. Peter J. Jones, Professor of Dietetics and Nutrition, McGill University, have published an article in the recent Canadian Medical Association Journal (CMAJ) titled: How much should Canadians eat?

The professors believe that the current methods for assessing energy intake are flawed. These methods underestimate actual energy intake. Does that mean we are eating more than we think? The article also reviews new methods for measuring the energy content of foods and address the problem of energy expenditure in obese people.

Obesity is defined as an excessive accumulation of body fat. The body mass index (BMI) of over 30 is considered to be obese. BMI is measured by dividing the weight in kilograms by the square of the height in meters. Currently, about 20 to 30 percent of North American adults have BMI of 30 or more. These people roughly have 50 to 100 percent higher mortality rate than those with BMI of below about 25.

How do people become obese? When the amount of energy absorbed exceeds expenditure – the net gain of energy ends up as body fat. The authors say that the current wave of obesity epidemic are due to shifting perceptions about what constitutes a “normal” portion size, the increased availability to pre-prepared foods and the more sedentary “couch potato” lifestyles of individuals within developed societies.

The Canada Food Guide provides guidelines for food intake in Canada. Nutritionists follow these guidelines to advice individuals who want to lose weight. “Unfortunately,” says the CMAJ article, “the existing values contained in these guidelines are out of date.” They provide estimates of energy requirement that are erroneously low.

There are also biases in the methods used to measure expenditure of energy. Until these methods (for energy intake and expenditure) have been revised and updated, the energy intake should be individualized based on observation of outcomes based on BMI, blood lipids, and waist measurement, says the CMAJ article.

The most reliable indicator of energy balance or imbalance is individual’s weight. If a person is not losing weight then he is eating more than what he needs and he is not exercising enough – income is more than expenditure!

Whatever methods we use for measuring energy intake and output, one problem will always be there – obese people always underestimate their energy intake.

So, how much should Canadians eat? Is there an ultimate diet plan? Yes, listen to your weighing scale and measure your waist, if it ain’t going down then you are eating too much! And the best exercise you and I can do is to push ourselves away from the table. That is called will power! Your girth and weighing scale will tell you how much you should eat.

Start reading the preview of my book A Doctor's Journey for free on Amazon. Available on Kindle for $2.99!

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Irritable Bowel Syndrome

Are your guts driving you nuts?

Then the problem may be in your head. Not in your guts.

What’s your head got to do with your guts?

Well, we are talking about stress. Stress can play havoc with your body. Stomach and intestine are very sensitive to stress. And the result is – irritable bowel syndrome (IBS).

IBS is not like other conditions. There are no definite abnormalities to find in a patient with IBS and there are no tests to confirm the diagnoses.

How do we know a person has irritable bowel syndrome?

Mainly by symptoms of abdominal pain, bloating and irregular bowel movements. And by ruling out other conditions of the gastrointestinal tract.

IBS is a complex condition that affects a person’s psychology (emotional and behavioural characteristics). A physician treating this condition must have a good understanding of the problem. He should be able to dedicate time and energy to help his IBS patients.

IBS is considered to be a functional disorder of the gastrointestinal tract. But there is high incidence of psychiatric disorders in patients with IBS – panic disorder, major depressive disorders, and phobias.

Patients have to realise that they may need psychological treatment for a physical condition. And having irritable bowel does not mean a person is mentally ill. Antidepressants and medications that inhibit anxiety have been shown to be effective in IBS. But these drugs have to be used with care.

Stress-induced anxiety can make symptoms of IBS worse. The source of stress can be internal (from within your own body) or external (from your environment). IBS patients experience higher levels of anxiety and fatigue than do healthy people.

In more severe, treatment-resistant IBS, psychotherapy has been proven to be useful. But there is no evidence to suggest that psychotherapy is beneficial in patients with mild IBS. Before psychotherapy is instituted, a physician should rule out some of the common conditions of the gastrointestinal tract – ulcers, inflammation (inflammatory bowel disease), and cancer.

Management of IBS poses a big challenge to a physician. Many drugs are available in the market for use in IBS. But none of them have proven benefits. Some of them may act as placebo. Smooth muscle relaxants tend to help relieve abdominal pain with or without relief of other symptoms of IBS. Loperamide (Imodium) is beneficial in patients who have diarrhoea as a predominant symptom.

Current treatment of IBS includes advice on high fibre low fat diet, smooth muscle relaxant, agents to stop diarrhoea or bloating and psychotherapy or psychoactive drugs to take care of depression or anxiety.

If your mind is playing games with your guts then stop and ask, “Who is playing games with my mind?” If it is your own thought process then take control of it – try exercise, laughter and meditation. If it is your environment, then get out of that environment. Create your own environment of happiness and relaxation. It can be done, if you have the desire and willingness to accept change.

Remember, if you take care of ELMOS (exercise, laughter, meditation, organic healthy food, stress management) then ELMOS will take care of you and your IBS!

Start reading the preview of my book A Doctor's Journey for free on Amazon. Available on Kindle for $2.99!

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Skiing and Stress Relief

Let’s talk about skiing and stress relief.

In last Friday’s Talk of the Town column, Angus Henderson wrote about Hidden Valley Ski Resort. I am glad he did that. I am very fond of that place.

I like to commend Kevin Fischer and his staff. They do a wonderful job of running the place. Kevin is a very approachable fellow. Always has a smile on his face. His staff is always very cheerful, friendly and helpful.

Kevin’s presence is always visible and his hands-on leadership is very evident.

My family and I love Hidden Valley. I started taking ski lessons eight years ago when my son joined the Nancy Green program. He has been a fast learner. He now snowboards.

My daughter also likes to ski but my wife felt that she would be a good family cheerleader than a skier! And supply us with hot chocolate, lunch and snack during breaks! Not a bad deal!

For me the progress has been slow. I have fear of heights and speed. And as a surgeon, I did not want to break my wrist and be out of commission for several months. But I was determined to learn and be with my family.

I was born and brought up in Tanzania. I had never seen snow in Africa except in pictures. Mount Kilimanjaro in Tanzania is famous for snow-capped peak. But I never got a chance to get there. In any case, there is no skiing on Mount Kilimanjaro.

Over the last eight years, I have made slow but sure progress. Many young instructors and friends at Hidden Valley, Sunshine and Canada Olympic Park helped me get through my fears. Now I can ski all the hills at Hidden Valley except Suicide and Showoff. This year my target was to be comfortable on the Hidden Valley run. I successfully did it several times. Next year, the plan is to get over the fear of Suicide run! Showoff, probably never!

Each year, by October, I am looking forward to winter, snow and skiing. I find skiing very relaxing and good for stress relief. A good example is what happened last week. It was a busy week and in some respects a very traumatic week at work. It culminated in a very exhausting and draining Friday meetings.

I am glad I had a weekend off to recover. For two days, my son and I went skiing at Hidden Valley. The weather was great. Snow was excellent. The weekend of skiing completely refreshed me.

At Hidden Valley, you are amongst happy people. Unlike golfers, skiers are always smiling and are ecstatic when they come flying down the hills. Skiers don’t shout “fore” and you don’t hear anybody swear!

Skiers are not rushing or pushing you to keep moving. They don’t phone the clubhouse because of “slow play”. There is no marshal in a red power cart chasing you around the ski hills. Instead, you see helpful ski patrols and instructors.

At Hidden Valley, beginners and experienced skiers have fun together. Good skiers don’t look down on beginners or show any signs of arrogance. In fact, they are willing to share their experience. It’s like a big happy family.

Do you know what happens to a golfer after he dies? Saint Peter sends him straight to heaven because he has suffered enough on the golf course!

For skiers, heaven is at Hidden Valley and other ski resorts. Skiers don’t have to worry about life after death. It is heavenly all the way!

Now, am I putting my golf club membership in jeopardy? Glen Carr, don’t worry. I will be there when the golf course opens. In summer, golf course cannot be worse than health care politics!

Start reading the preview of my book A Doctor's Journey for free on Amazon. Available on Kindle for $2.99!

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Patients Who Smoke

Dr. Frederick Ross of Winnipeg must have become a household name. He has been extensively interviewed and quoted in the media. And his recent actions have rekindled the debate about individual’s responsibility to his own health and physician’s responsibility to educate his patients on preventive medicine.

What did Dr. Ross do?

Three months ago, he informed all his patients that he would not treat smokers who are unwilling to give up the deadly habit. They were given 90 days to quit. The deadline was last week. That’s when Dr. Ross hit the headlines. Some people complained that Dr. Ross’s action was unethical. Manitoba’s licensing body for Physicians thinks otherwise.

As we know, tobacco use is the leading preventable cause of death in Canada. It is responsible for one in five deaths. Half of regular smokers die prematurely of tobacco-related disease. Many patients continue to smoke although they have known or experienced ill health due to smoking.

What are the obstacles to quitting?

The main obstacle to quitting is the addictive nature of nicotine, says an article in the New England Journal of Medicine (NEJM).

Nicotine causes tolerance and physical dependence. If you quit smoking then expect withdrawal symptoms like irritability, anger, impatience, restlessness, difficulty concentrating, insomnia, increased appetite, anxiety, and depressed mood. These symptoms may vary widely in intensity and duration.

The withdrawal symptoms begin a few hours after the last cigarette, peak two to three days later, and wane over a period of several weeks or months.

The second obstacle to quitting is the psychological factor – tobacco use is a learned behaviour, cigarettes become part of a person’s daily routine, says the NEJM article.

It is associated with events, such as finishing a meal; handling stress and negative emotions such as anger or anxiety. To stop smoking, a smoker must learn new coping skills and break old patterns.

Smokers who have good intention to quit have two problems: staying free of cigarettes for a long period of time and putting on weight.

What is effective in encouraging smokers to quit?

A physician can do what Dr. Ross did. But scientifically, two approaches have been found to be effective: counselling and nicotine replacement therapy. Each is effective by itself, but the two in combination achieve the highest rates of smoking cessation, says the NEJM article.

Studies have shown that a physician’s advice to stop smoking increases the rates of smoking cessation among patients by approximately 30 percent.

One report in the Medical Post says that half the specialists surveyed never counselled patients on smoking cessation. That burden seemed to fall on the family physicians, who were eight times more likely to ask patients about a quit date than other physicians.

Nicotine replacement therapy comes in different forms: gum, skin patch, a nasal spray, and a vapour inhaler. Combination of counselling and drug therapy achieves typical rate of cessation at 40 to 60 percent at the end of drug treatment and 25 to 30 percent at one year.

Changing public behaviours is difficult. “The first reform is to stay healthy,” says Mazankowski report. We know that relatively small changes in our lifestyle can markedly reduce several major diseases. But are we ready to do that?

Through these columns and through CHAT TV’s “Medical Moments” we have tried to send the same message of self-help and improvement in once life-style. The slogans we have used are: help your doctor to keep you healthy and if you take care of ELMOSS then ELMOSS will take care of you!

So, what did you do today to keep yourself healthy?

Start reading the preview of my book A Doctor's Journey for free on Amazon. Available on Kindle for $2.99!