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The Secret to Losing Weight – Eat Right and Eat Less

Sunset at Shirley Heights Lookout in English Harbour, Antigua. (Dr. Noorali Bharwani)
Sunset at Shirley Heights Lookout in English Harbour, Antigua. (Dr. Noorali Bharwani)

If you want to lose weight then 75 per cent of your effort should be spent on eating less and eating right. Twenty five per cent of your effort should be spent on physical exercise. If you made a New Year’s resolution on losing weight then this is a good time to take stock of your achievement. We are into April. Have you lost at least four pounds?

If yes, then keep it up. Slow and steady wins the race. If you haven’t then you should know that there are 37,000 books in the market on how to eat right and lose weight. According to the Canadian Medical Association Journal (CMAJ March 17, 2015), dieting programs and books are a $66-billion industry. Now you know where all your money goes.

We all have different ideas on what is right and what is wrong. When it comes to eating, it will be hard to find two people following the same dietary regimen to lose weight. If you want to be a permanent loser (I mean losing weight) then eat less.

Obesity has been officially recognized as a disease by the American Medical Association. Obesity gives you grief with multiple medical problems. In Western countries, people are considered obese when their body mass index (BMI) exceeds 30 kg/m2. They are considered overweight if the BMI is 25-30 kg/m2. In simple terms you are either of normal weight, overweight (25-30 kg/m2) or obese (over 30 kg/m2).

It is no secret that most methods of treating obesity have failed. Some are good for a short duration but most people revert to their old habits. Habits are hard to get rid off.

There are many nutritional guidelines, official and unofficial, and yet, despite all of this evidence, we have failed to make a real impact on the problem at the population level. There is no simple solution. It is determination and hard work.

So the secret is out – to lose weight you have to eat smart and eat less for life.

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Quinine Not a Safe Drug for Treating Nocturnal Leg Cramps

A young tourist in Los Angeles, 2007. (Dr. Noorali Bharwani)
A young tourist in Los Angeles, 2007. (Dr. Noorali Bharwani)

Nocturnal leg cramps, that are cramps occurring at night, also known as rest cramps, are a painful involuntary muscle contraction that typically occur in the legs or feet during prolonged periods of rest and often interrupt sleep, says an article in the Canadian Medical Association Journal (CMAJ March 3, 2015).

Leg cramps are seasonal and roughly double between the winter lows and summer highs. It is not clear why there is such a seasonal occurrence. There is a midsummer peak and a midwinter dip.

Quinine sulfate at a dose of 200-300 mg at night has been used for many years to treat nocturnal leg cramps, says the article. Quinine is modestly effective. Other drugs were found to be either possibly effective (vitamin B complex, naftidrofuryl, calcium-channel blockers) or likely not effective (gabapentin, magnesium).

There is a long list of possible side effects that can occur with the usual dose of quinine. Some of the side effects are tinnitus (ringing in the ears), high-tone hearing loss, photophobia (visual intolerance to light) and other visual disturbances, just to mention a few.

Rarely, it can cause serous blood disorders (immune thrombocytopenic purpura and drug-mediated thrombotic microangiopathy). Overdose of quinine sulphate can cause serious and even fatal arrhythmias (irregular heart rhythm).

As of September 30, 2010, Health Canada had received 71 reports of serious adverse reactions suspected of being associated with quinine use (41 were either life threatening or required hospital admission), says the article. In 2009, the US Food and Drug Administration (FDA) explicitly noted an unfavourable risk-benefit ratio for quinine when used for leg cramps.

Although quinine is modestly effective, concerns regarding potential adverse effects have tempered enthusiasm about its use for nocturnal leg cramps, says the article. In fact practice guidelines for American neurologists on the symptomatic management of muscle cramps concluded that, although likely effective, quinine should be avoided for routine use because of the potential for toxic effects.

The author of the article says that quinine does not have Health Canada approval for the treatment of nocturnal leg cramps, yet it is widely used for this indication.

What else can be done for nocturnal leg cramps? Nightly calf and leg muscle stretching showed significant decrease in both the frequency and severity of leg cramps. The author does not suggest that quinine should be completely banned. It can be tried for short period. During the trial, patients should be closely monitored and the quinine stopped after four weeks if there is no benefit, says the article.

Patients continuing to take quinine after four weeks should be followed and advised periodically to try stopping it, says the author of the article.

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Important Things to Know About Indigestion and Heartburn

Roman Bridge of Cordoba (Dr. Noorali Bharwani)
Roman Bridge of Cordoba (Dr. Noorali Bharwani)

Let us start with the word “dyspepsia.” Dyspepsia is a Greek word that means bad or difficult digestion. Some people use the word dyspepsia to mean heartburn.

When a patient says to me, “Doctor, I have dyspepsia or indigestion” then I have to ask more questions. I need to know exactly what the symptoms are. There may be chronic or recurrent pain in the upper abdomen. There may be upper abdominal fullness and feeling full earlier than expected when eating. There may be bloating, belching, nausea, or heartburn.

There is a condition called functional dyspepsia or it used to be called non-ulcer dyspepsia. That means symptoms of dyspepsia are there but there is no pathological finding to account for that. Functional dyspepsia is estimated to affect about 15 per cent of the general population in western countries.

I found an interesting short article in the Canadian Medical Association Journal (CMAJ March 3, 2015) by Sadowski and van Zanten titled “Dyspepsia.”

If the person has alarm symptoms like vomiting, bleeding or anemia, abdominal mass or unintended weight loss, and difficulty swallowing food then he should be referred for an urgent endoscopy of the esophagus, stomach and duodenum.

Endoscopy is the preferred diagnostic modality if alarm symptoms are present. If a person with dyspepsia undergoes endoscopy, the most common endoscopic findings for new cases are reflux esophagitis (40 per cent), and gastric and duodenal ulcers (10 percent). No time should be wasted doing barium studies. Doctors should avoid performing an endoscopy for dyspepsia without alarm symptoms for patients under the age of 55 years.

Patients with alarm symptoms who undergo gastroscopy will have clinically significant peptic ulcer disease in 13 per cent of cases and gastric cancer in four per cent of cases. Because the prevalence of serious abnormalities increases with age, an endoscopy should be considered for those aged 55 years or older with new-onset symptoms.

Upper gastrointestinal barium studies are less accurate than endoscopy and should not be used if alarm symptoms are present.

Patients should not be maintained on long-term PPI (proton pump inhibitors used for treating reflux and peptic ulcers) therapy without an attempt to stop or reduce PPI at least once per year in most patients. Examples of PPI are – Losec, Prevacid and Nexium.

Up to 30 per cent of patients with dyspepsia in a Canadian population were found to be taking non-steroidal anti-inflammatory drugs (NSAIDS) including acetylsalicylic acid (Aspirin). Eliminating the use of NSAIDS or dose reduction is often effective for dyspepsia.

The article suggests that an eight-week trial of once-daily PPI therapy can be considered in patients with reflux-like dyspepsia. Those requiring continuous acid-suppressive therapy for symptom control should use the lowest effective dose and try stopping the treatment at least once per year because of potential adverse effects (e.g. bone fractures and infection with Clostridium difficile) of long-term PPI use. Older adults should use the drugs only for the shortest duration possible.

If your symptoms do not disappear after taking PPI for four to six weeks then PPI should be discontinued and further investigations should be done to rule out serious pathology. Patients with new-onset dyspepsia should be tested for Helicobacter pylori infection. Its prevalence in Canada is about 30 per cent, but declining in younger Canadians.

Finally, take it easy on hurry, worry and curry. That is what one English surgeon advised me many years ago.

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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February Means Heart Month – Have You Been Kind to Your Heart Lately?

Joggers in Seville, Spain. (Dr. Noorali Bharwani)
Joggers in Seville, Spain. (Dr. Noorali Bharwani)

February is Heart Month. The month is almost over but we are still recovering from the chocolates and dinners we had for Christmas, New Year’s parties and Valentine’s Day. Wow… isn’t that something? Who decides on all these occasions where you eat, drink and be merry? That person is a genius.

We got to have fun to stay healthy. As long as our drinking and eating is within reasonable limits. What is reasonable depends on what common sense dictates, what science says and what your heart says.

Your heart has to be healthy to give you good advice. OK, if you have a bad heart then that tells you something as well. Also remember, your heart muscle is the hardest working muscle in the body. It pumps out two fluid ounces – sixty milliliters – of blood at every heartbeat. Every day, the heart pumps at least 2,500 gallons or 9,4500 litres of blood. The heart has the ability to beat over three billion times in a person’s life. That is one more reason to keep the heart healthy and strong.

In spite of all the insults we inflict on our indispensable heart, it continues to take care of us as long as it can. It is relentless in its function. The heart has to be strong for it to pump blood forcefully to all parts of our body – our brain, our fingertips and our toes are miles apart… so to speak. But the blood still gets there most of the time.

Two elements will predict your heath in 2015 and beyond: what you do for yourself and what fate does for you. We have no control over the later but we can do something over things we have control.

You can control what you eat. You can control how much exercise you do. You can control your weight (not so easy, right?). You can control how much alcohol you drink and whether you are going to smoke.

All these subjects are covered in my easy to read book (Dr. B’s Eight Steps to Wellness). Regular physical activity is a very important component in our fight to keep our heart healthy, blood pressure low and prevent stroke. But don’t over do it if you are not in a good shape. About five per cent of the deaths occur after heavy exertion such as shoveling snow, recreational jogging or sexual activity. In U.S. this accounts for 25,000 deaths a year. Similar statistics are reported from Canada and Europe.

I thought death during sexual activity occurs only in the movies… just kidding. If you are not fit then be careful.

There are three main risk factors that are associated with complications during exercise: age, presence of heart disease, and intensity of exercise. If you exercise regularly then you should be pretty safe. But if you are a new starter (after reading this column) then better check with your doctor and start slowly. As they say, “Slow and steady wins the race.”

Eat, drink and be merry… but be heart smart.

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