Dietary guidelines for kidney stone formers

The chances of a person developing a kidney stone during the course of their lifetime are 1 out of 10. So if you have developed kidney stones, do not be alarmed. The condition is manageable and stones can be passed out of your body with medication and the right diet. Further, your doctor will run blood and urine tests to determine any risk factors and then prescribe you medical treatment and a specific diet plan to prevent the recurrence of stone formation.

What is a kidney stone?

A kidney stone is formed by the concentration of crystals in your urine. Usually, the natural chemicals in the urine prevent stone formation, but chemical imbalance and other factors can lead to substances getting concentrated into kidney stones.

What kinds of kidney stones are there?

The most common kind of kidney stones is calcium oxalate stones. Calcium in the urine can combine with chemicals like oxalate or phosphorus and solidify into crystals. With increasing concentration of these crystal substances over time, calcium oxalate kidney stones can be formed.

Another common kind of stones is uric acid stones, formed by the buildup of uric acid. This buildup is caused by the metabolism of proteins. Organ meats, red meat, and fish have large amounts of a natural compound called purines. A high intake of purine leads to high uric acid production, which in turn creates a higher acid load to be excreted by the kidneys. This high acid concentration in the urine makes the kidneys susceptible to uric acid stone formation.

What is the most important aspect of managing kidney stones?

The most thoroughly proven intervention to prevent stone formation from recurring is good hydration. Drinking enough water to keep calcium crystals in solution or keep uric acid concentrations low in the urine is one of the most reliable methods to prevent kidney stones.

How much is enough water for low urine concentration? A water intake that produces a volume of 2.5 litres per day of urine is recommended. Fluid intake from non-sugary and non-alcoholic beverages such as lemonade, freshly-pressed juices, and water with the exception of grapefruit juice is proven to have a beneficial effect.

It is also important to be mindful of the other ways in which your body loses water. If you sweat a lot due to exercise or because of your environment, you must increase your water intake. Loss of water due to excessive sweating can reduce urine production and cause stone-causing crystals to deposit in your kidneys, increasing the chances of stone formation.

Dietary recommendations to manage kidney stones

For calcium-oxalate stones:

1.Increase citrus intake: Citrate reduces the formation of calcium stones by binding with urinary calcium to reduce saturation and by binding with calcium oxalate crystals to reduce crystal growth. Citrus fruits such as oranges, grapes, lemons, and their juices are a rich source of naturally occurring citrates.

2.Limit foods with high oxalate and phosphate content: Oxalate is found naturally in many kinds of food including vegetables, fruits, legumes, nuts and seeds, and grains. A few examples of these oxalate-rich foods are peanuts, spinach, sweet potatoes, beets, chocolate, Swiss chard, and rhubarb. Limiting the intake of these foods can prevent exacerbating current stone formation and also prevent new stones from forming. Avoid colas. Colas contain a high amount of phosphates and increase the risk of stone formation.

3.Include adequate calcium in your diet: Though the name “calcium-oxalate stone” may suggest that calcium leads to stone formation, on the contrary, a lack of dietary calcium actually increases the chances of developing kidney stones. It is advised that calcium and oxalate-rich foods are eaten together in a meal so that they bind in the stomach and intestines before entering the kidneys. The daily recommended intake of dietary calcium to reduce the occurrence of calcium stones is 1000-1200mg per day.

4.Reduce sodium intake/ avoid a high salt diet: High sodium levels in your diet and body can increase calcium buildup. Sodium and calcium share the same transport in the kidneys, so a high sodium intake increases the leakage of calcium into the urine. A high sodium diet thus increases your chances of developing a new kidney stone. Hidden sources of sodium are canned and processed foods, restaurant and fast foods, and even some vegetable juices.

5. Avoid fasting: Fasting, in general, dehydrates the body and concentrates urine. Such conditions are ripe for crystal deposits to concentrate in the urine. Once triggered, this usually leads to stone formation. It has been noted that individuals who keep religious fasts are prone to recurrent stone formation.

For uric acid stones:

1. Reduce animal-based protein in your diet: Animal proteins like red meat, chicken, poultry, fish, organ meats, and gravies containing these foods have high purine content. Reducing purine-rich food in your diet reduces the risk of recurrence of uric acid stones.

2. Eat a plant-based diet: A diet comprising vegetables, fruits, whole grains, and low-fat dairy items is recommended to manage and reduce the recurrence of uric acid stones.

3. Avoid added sugars, sugary and alcoholic drinks: Avoid drinking beverages that dehydrate you, such as alcohol. Alcohol also increases uric acid levels in the blood and urine and the risk of uric acid stones. Sweetened drinks, especially those that contain fructose corn syrup should be avoided. Added sugars increase the risk of kidney stones. Processed foods such as cakes, corn syrup, white sugar, commercially produced desserts are high in added sugars.

Kidney stones can be a painful ailment to live with. However, it is a condition that can be managed effectively with diet and medication. Staying hydrated is a key factor in managing and preventing new kidney stones. Increasing your citrate intake, pairing calcium with oxalates and phosphates, and maintaining regular eating habits can be beneficial as well. Avoiding certain foods such as those containing high sugar and salt, alcohol, and sticking to a plant-based diet are important aspects of an effective diet for stone formers. For more information regarding kidney stones and how to manage them, book an appointment with our urology experts at the Department of Urology and Nephrology at Sagar Hospitals.

6 Superfoods to Improve Your Heart Health

Contrary to what the name might suggest, superfoods are neither exotic nor expensive. They are usually common, affordable, and fairly easy to incorporate into your diet for healthy eating.

Superfoods are nutrient-dense foods that include vegetables, fruits, whole grains, and plant-based and animal proteins. They are recommended by nutrition experts as healthy food choices because of their numerous health benefits. Superfoods can be beneficial to prevent a wide variety of conditions including heart disease.

The following are 6 superfoods that can improve your heart health:

1. Leafy green vegetables: Some studies have found a direct link between increasing the intake of green leafy vegetables and a lower risk of heart disease to an extent of 16%. Common dark leafy greens found at the grocery store are kale, broccoli, spinach, mustard, and salad greens.

Green leafy vegetables are rich in minerals, vitamins, and antioxidants. In particular, they are rich in Vitamin K, which promotes proper blood clotting and protects your arteries. They also contain folate—a very important vitamin B that prevents heart disease. These vegetables are also rich in dietary nitrates which are shown to decrease blood pressure, protect blood vessels, and decrease arterial stiffness.

Leafy greens can be sautéed, stir-fried, roasted, and added to salads to make a delicious meal easily.

2. Berries: Researchers recommend eating berries such as strawberries, blueberries, and blackberries three times a week to reduce several risk factors for heart disease. Berries are rich in antioxidants like anthocyanins that protect against inflammation and age-induced oxidative stress and prevent cardiovascular disorders.

An analysis of 22 studies has shown that the consumption of berries is associated with a reduction of bad LDL cholesterol, blood pressure, inflammation, and body mass index. Berries are jam-packed with nutrients that can play a central role in maintaining the health of your heart.

3. Beans: Beans are a rich source of protein and fiber and have almost no saturated fats that increase cholesterol and risk of heart disease. Fiber not only helps in digestion but also prevents heart disease. Beans are a good substitute to animal proteins, which though contain high quantities of protein and iron, tend to contain saturated fat.

Beans contain resistant starch which is shown to improve heart health by reducing levels of cholesterol and triglycerides in the blood. In addition, the inclusion of beans to the diet has shown a reduction in inflammation and blood pressure, both of which are major contributors to heart disease.

4. Whole grains: Whole grains such as oats, whole wheat, brown rice, rye, barley, and quinoa are grains that include all three nutrient-rich parts of the grain—bran, endosperm, and germ. Whole grains like oats contain a fiber called beta-glucan. Fibers are known to reduce bad LDL cholesterol and reduce the risk of heart disease and stroke. Eating whole grains is also shown to reduce systolic blood pressure.

Multiple studies have found a link between including whole grains in your diet and improved heart health. An analysis of 45 studies concluded that eating three more servings of whole grains daily was associated with a 22% reduction in the risk of heart disease.

5. Foods with good fats: fatty fish, seeds, and nuts: Fats like omega-3 fatty acids and mono- and polyunsaturated fats can reduce cholesterol and prevent cardiovascular disorders. Fatty fish such as salmon, mackerel, sardines, and tuna are particularly rich in omega-3 fatty acids. Nutritionists at the American Heart Association recommend eating at least two portions of fatty fish a week. Omega-3 fatty acid is a nutrient that can lower blood pressure, lower total cholesterol and triglycerides, decrease the risk of abnormal heart rhythms or arrythmia, reduce plaque from arteries to prevent coronary artery disease, reduce the probability of a < href="https://sagarhospitals.in/healthlibrary/heart-attack-every-second-counts/" target="_blank">heart attack, and improve arterial function.

Nuts and seeds such as walnuts, chia seeds, and flaxseeds are rich in mono- and polyunsaturated fats. They are also excellent plant-based sources of omega-3 fatty acids such as alpha-linolenic acid.

6. Tomatoes: Tomatoes are rich in lycopene, a natural plant pigment with antioxidant properties. Antioxidants help neutralise harmful free radicals, preventing inflammation and oxidative damage that can cause heart disease. Lycopene has been linked to a reduced risk of heart disease and stroke.

Tomatoes are also rich in nutrients such as folate, vitamin C, potassium, and choline, all of which promote heart health. Scientists have argued that increasing potassium intake while reducing sodium intake is the most important dietary change while trying to prevent cardiac disease.

Healthy eating can not only improve your overall health, but certain foods can significantly improve the health of your heart and help keep heart disorders at bay. However, eating superfoods alone is no guarantee of good heart health. You must eat a balanced diet with the right portions of fiber, vitamins, protein, and fat to main a healthy body weight. For more information regarding your heart health and risks of cardiac disorders, book an appointment with our specialists at the Sagar Heart and Vascular Institute.

Meal Planning with Prediabetes

A precursor to Type 2 diabetes, prediabetes means that a person has blood sugar levels that are already high, but not within the diabetes range yet. If left unchecked, with sustained high sugar levels in the blood, production of insulin (the hormone that regulates sugar in your body) burns out, leading to Type 2 diabetes. According to research, about 70% of patients with prediabetes go on to develop Type 2 diabetes.

However, taking preventive action, such as dietary change, can reduce this risk by 40%-75%. As per the same research, with adequate changes in diet, 5%-10% of prediabetes patients go back to leading normal lives. A diet to prevent the development of diabetes is focussed on reducing body weight (1kg of weight loss per year equates to a 16% reduction in diabetic risk) and sugar intake in food.

If you have been diagnosed with prediabetes, the following diet modifications are going to help you manage your condition and bring it under control:

1. Stop drinking sugary drinks and cocktails: In the short-term, the consumption of sugary beverages, which includes certain cocktails, creates a spike in blood sugar levels in the body. These drinks can overwhelm the body with glucose and fructose. The real risk, however, lies in the long-term intake of these high-sugar drinks. With time, your body develops insulin resistance, and the way your pancreas releases insulin can be affected permanently, leading to Type 2 diabetes.

A 2016 study published in The Journal of Nutrition found that people who drink carbonated soft drinks more than three times a week were 46% more likely to develop prediabetes than those who did not. Even more, 34% of people who continued to drink sugary drinks like soda, energy drinks, and juices for a year after being diagnosed with prediabetes developed Type 2 diabetes. On the other hand, only 8% of prediabetic patients who gave up sugary beverages for the year developed diabetes.

To improve or reverse prediabetes, it is important to stop the consumption of sugary carbonated drinks, juices, energy drinks, and cocktails.

2. Re-evaluate your carbohydrate intake: Processed and refined carbohydrates can cause spikes in blood sugar levels. Being aware and mindful of the kind of carbohydrates you are consuming in your diet will help minimise that impact. Limit your consumption of carbohydrates that have been stripped of fiber and nutrients. Instead, include more complex carbohydrates in your diet.

Glycemic index or GI is a useful tool that ranks food according to the rate at which they affect blood sugar levels. Food that ranks high on the GI digests in your stomach quickly and raises your blood sugar levels faster. Refined carbohydrates rank high on the glycemic index and should be avoided by people with prediabetes. Carbohydrates in the form of whole grains digest slower and rank low on the GI as well.

Substituting the following refined carbohydrates with healthier options will help minimise blood sugar spikes:

• Whole grain bread instead of white bread
• Sweet potatoes and cauliflower instead of white potatoes
• Air-popped popcorn instead of potato chips
• Brown rice, parboiled rice, and red rice instead of white rice
• Steel-cut or whole oats instead of instant oatmeal
• Whole wheat pasta instead of pasta made from all-purpose flour

3. Eat more fiber-rich food: Foods with high fiber content not only are low on the glycemic index but keep you fuller and make you less prone to overeating. A high-fiber diet plan is highly beneficial for prediabetic people and has long-term benefits in reducing blood sugar levels.

A 2009 study found that eating non-starchy vegetables, whole grains, fruits, beans, and plant-based oils in meals could minimise blood-sugar spikes post-meal, compared to eating meals with a high proportion of meat and other high GI foods.

Examples of high-fiber foods include:

• Green and non-starchy vegetables
• Beans, lentils, split peas, and other legumes instead of meat
• Whole grains, such as wheat, barley, and quinoa
• Whole fruits instead of fruit juices and fruit-based desserts such as fruit roll-ups

4. Look for added sugar: Added sugar has rightly been described as the worst ingredient in the modern diet; it has no nutritional value, causes weight gain, and can lead to insulin resistance. It is difficult to root out added sugar from our diet because it is present in much of what we eat: baked goods, breakfast cereals, juices, ketchup, flavoured coffees and milk, and other processed foods. Even more, it is present in “low-fat” and “diet” foods such as low-fat yogurts, diet soft drinks, and cereal bars. When you read nutritional labels, look for added sugar in the form of fructose, sucrose, corn syrup, molasses, maltose, and dextrose. Their presence in the ingredient list is usually a marker of added sugar.

The right diet and judicious meal planning play a major role in controlling and reversing prediabetes. However, there is no one-size-fits-all diet for prediabetes. Anyone who is diagnosed with prediabetes should ask their doctor for advice. For more information book an appointment with our medical experts at the Department of Diabetology and Endocrinology at Sagar Hospitals.

The Truth About Menopause: What to Expect

In short, menopause is the end of a woman’s menstrual cycles and her natural reproductive years. Menopause is the result of a normal and gradual change in women’s bodies induced by changes in hormones, ultimately leading to a complete stop of ovulation.

Menopause is a natural process and a stage that all women reach. With its onset, the two hormones which are most significantly affected are estrogen and progesterone. These hormones control your menstruation (periods) and ovulation (release of eggs). Menopause is said to occur when the ovaries stop releasing an egg every month and menstruation stops permanently. Most women stop having periods around the ages of 45-55, with menopause beginning at an average age of 51.

How does menopause progress with time?

Menopause is considered to occur over 3 stages. They are:

1.Perimenopause: This refers to the phase that begins several years (around 8-10 years) before menopause and eventually leads to it. It is characterised by a reduction in the production of estrogen by the ovaries. In the last few years of this stage, estrogen production falls even more and women often experience menopausal symptoms at this time. Perimenopause ends when your body finally stops releasing eggs.

2.Menopause: This stage refers to the phase when your menstrual periods have stopped for at least 12 months. Most of the estrogen production ends by then and no eggs are released by your ovaries.

3.Postmenopause: This is the stage that refers to the years after menopause. This is when risks related to low estrogen in your body increase.

What are the symptoms of menopause?

With dropping estrogen and progesterone levels in your body, bodily functions like metabolism, collagen production, and menstruation are affected leading to side-effects or symptoms such as:

1.Hot flashes or night sweats: Most women nearing menopause experience hot flashes, a sudden feeling of heat that spreads over the upper body that can be accompanied by sweating, blushing, heart palpitations, and dizziness.

2.Mood swings and depression: Declining levels of estrogen can cause emotional changes in women. These emotional symptoms of menopause are generally irritability and feelings of sadness.

3.Sleeplessness and fatigue: Many women undergoing menopause suffer from an inability to fall asleep or to enjoy continued sleep at night. A lack of good quality sleep can lead to tiredness during working hours.

4.Change in libido: Loss of estrogen and testosterone with menopause can lead to changes in a woman’s sex drive. Women may find that they are not as easily aroused and are less sensitive to touch.

5.Vaginal dryness: Low levels of estrogen can cause a drop in the blood flow to the vagina and affect vaginal lubrication.

6.Urinary incontinence: Changes in estrogen level can cause weakening of the pelvic floor, the muscle group that supports the urethra and the bladder, resulting in bladder-control issues in women.

How to manage menopausal symptoms?

Menopause is a natural process and many symptoms associated with menopause cease with time. However, some treatments can help with the symptoms. They are:

1.Hormone replacement therapy (HRT): Medication that replaces the hormones that are no longer being naturally produced in your body can ease symptoms such as hot flashes, bone loss, and vaginal symptoms. However, hormone therapy carries implicit risk and increases your chances of developing heart conditions and breast cancer.

• Non-hormone medications to treat and ease hot flashes, blood pressure, and vaginal dryness.
• Room temperature reductions and dressing in light clothing and in layers to deal with hot flashes.
• Strengthening the pelvic floor muscles with Kegel exercises to prevent bladder incontinence.
• Exercising regularly to maintain proper sleep and body tone to avoid heart conditions and osteoporosis.
• Limiting alcohol intake and stopping smoking. Smoking can increase hot flashes and cause early menopause.
• Topical hormone creams or over-the-counter vaginal lubricants for dryness.

Can there be health complications after menopause (postmenopause)?

In postmenopause, your estrogen levels will remain at low levels. The risk of the following conditions increases after menopause:

1.Osteoporosis: The loss of estrogen in your body exacerbates the loss of bone density. This change is particularly seen in the years immediately after the last menstrual cycle. This loss of bone mass can make your bones thin and brittle, causing a condition called osteoporosis. Osteoporosis makes you more susceptible to spine, hip, and other bone fractures.

According the National Osteoporosis Foundation, osteoporosis is so prevalent in postmenopausal women that 80% of all osteoporosis patients in the US are women. To mitigate the effects of estrogen loss, your doctor may prescribe you calcium and Vitamin D supplements and advise you to exercise regularly and weight train to strengthen your muscles.

2.Cardiovascular disease: While menopause may not cause heart conditions directly, it can increase their risk. The hormonal imbalance following menopause can affect blood pressure, the ability to maintain flexible arteries, and “bad” cholesterol levels that can lead to cardiovascular conditions. In addition, there is an increased risk of heart attacks for women around 10 years after menopause.

Maintaining a healthy weight and a balanced diet (avoid added sugars and salt in particular), exercising regularly, and not smoking or drinking can reduce your chances of cardiovascular diseases.

Menopause is a normal stage in a woman’s life marking the end of her menstrual cycles. Hormone levels drop, especially estrogen and progesterone, and this leads to an increased risk for osteoporosis and heart disease in the postmenopausal. The associated symptoms of menopause can be managed with healthy lifestyle habits and adaptations and medication if necessary. If you are concerned about menopause or are experiencing symptoms that are affecting your ability to function normally, contact us to book an appointment with our specialists at the Department of Obstetrics and Gynaecology at Sagar Hospitals.

Weight Training, Knee Injuries, and How to Avoid Them

Weight training is an effective way to strengthen your body to avoid injuries and pains arising from a sedentary lifestyle. However, weight training exercises put a lot of extra pressure on your knees, putting you at risk of knee injuries. While lifting weights, your knees support not just your body weight, but the weighted equipment that you are lifting as well. As a result, you may end up doing things during your workout that exacerbate the risk of knee injuries instead of preventing them.

Common knee injuries caused by weight training

Knee ligaments, the strong bands of flexible tissue that connect the femur (thigh bone) and the tibia (shin bone), are usually affected in knee injuries related to weight training. These tears can be partial or full tears.

Some of the common knee ligament injuries caused by weight training are:

1. Torn ACL: The anterior cruciate ligament (ACL) is located directly behind the kneecap and prevents the over-rotation of the knee. An ACL tear can occur during weight training due to improper position or posture that overstress the knee joint while added weights are being used. A sudden twisting of the knee joint can push the knee out of its normal range of motion causing the tear.

2. Torn PCL: The posterior cruciate ligament (PCL) is located behind the ACL and crosses it in an “X” shape. A common cause of PCL injuries is falling hard on the kneecaps due to a loss of balance. To avoid this, it is important that you move slowly to lifting heavier weights and allowing your body to strengthen enough to avoid losing balance while weight training.

3. Torn MCL: The medial collateral ligament (MCL) runs along the inner part of the knee and prevents the knees from bending in the wrong direction. MCL injuries occur when the bodyweight is shifted awkwardly during weight training.

4. Torn LCL: The lateral collateral ligament (LCL) runs along the outer part of the knee and prevents excessive outward movement of the knee. LCL tears can develop due to falling on one’s knees during a weight training exercise.

How to avoid knee injuries during weight training?

The following tips can be followed to avoid injuries arising from your weight training routine:

1. Use correct alignment during exercises: When you start training with weights by in a group, it becomes difficult for the class trainer to supervise your posture and basic form during exercise motions. This problem is equally prevalent when you are exercising by yourself. Without a personal trainer to correct you, you may be doing the fundamentals wrong for a long time. Repeatedly doing simple moves like lunges and squats with incorrect alignment can create muscle imbalance and increase the risk of a knee injury.

A trainer can spot incorrect positions and form and guide you to avoid injuries. You can also use a mirror while mastering basic moves before moving on to advanced positions and heavier weights to prevent accidental pain and injuries.

2. Strengthen all major muscle groups in the lower body: The knee is susceptible to overuse injuries due to imbalances in lower body muscle groups such as glutes, quadriceps, hamstrings, and calves. Most people who sit at work for long durations have weak gluteal muscles. Weakness in the hamstring muscles, a common occurrence, leads to increased strain on the anterior cruciate ligament (ACL).

Instead of loading on the weights during squats and lunges, it is important to work on strength training your gluteal and hamstring muscles to avoid straining the connective ligaments in your knees. Strong hamstrings and quadriceps help hold the kneecaps in place to avoid injury. Incorporate these strengthening exercises into your workout plan before doing any heavy lifting on a regular basis.

3. Work on mobility and stability: If you have started weight training recently then it is important to dedicate time to improve your mobility and stability as well. Exercises that employ resistance to increase body strength can put an extra strain on knees if body balance is not improved.

Everyone has their dominant sides, and as a result the left or the right side of the body has better balance. Improve your balance with single-leg exercises to dynamically perform high impact exercises without causing injuries. Working on gluteal activation to increase mobility in your hips and strengthen them will increase agility and power in your lower body.

4. Focus on your core: If your abdominal muscles are weak, your back muscles can shorten and tighten up. This puts your pelvis on an exaggerated tilt, tightening your hip muscles, and putting an excessive strain on your knees. A stable core is necessary in order to perform weight training exercises without injuring your knees.

5. Stretch your muscles: In order to work the muscle groups in your lower body, you must ensure that they are not so tight and stiff that you cannot activate them. Performing stretching exercises after or before your workout is an effective way to activate your glutes, calves, hamstrings, and quadriceps. Active and strong lower body muscles go a long way in preventing knee pain from weight training.

Your knees play a major role in supporting your body and maintaining balance during any of your weight training exercises. With a weak muscle group to support them, they are easily susceptible to injuries. If you have injured yourself during your weight training program, our experts at the Sagar Bone & Joint Insitute can help restore your knee function with advanced pain management and customized rehabilitation techniques. Contact us directly or book an appointment to speak to our specialists.

Keeping Joints Healthy as You Age

Joints are the connectors between bones that prevent them from rubbing together and allow you the range of movement to twist and bend. With age joints get worn down and there is a change in this mobility offered by them. As per a 2012 study conducted by the National Health Interview Survey (NHIS), nearly 55% of adults face bone and joint issues such as arthritis and back pain. Since joint function and movement have a direct effect on mobility and posture, joint conditions can severely impact your quality of life.

How do joints change with age?

Cartilage and connective tissue act as cushioning between joints and helps them move effectively. In addition, the synovium membrane produces a fluid that supports cartilage health. Over time, this cushioning cartilage and connective tissue can become thin with wear and tear and degeneration associated with age. The lesser cartilage there is, the more bones grind with each other, leading to inflammation and pain in the surrounding tissue. Bone spurs may also grow due to bones scraping together. There may be inflammation and thickening of the synovium membrane with the wearing down of cartilage; with more deterioration, there may not be enough synovial fluid or cushioning to support the joints properly.

Most men and women start exhibiting signs of joint pain around the ages of 45 and 50 respectively. It is wise to take preventive measures and develop healthy a lifestyle early to avoid joint pain later in life.

The following are 5 ways to protect your joints and keep them healthy:

1. Exercise: With age, we start losing muscle mass. So, instead of the muscles supporting and absorbing the impact of daily activities, joints end up bearing the brunt leading to cartilage erosion and joint damage. It is important to strengthen supporting muscles with exercises that do not strain joints much. Exercises such as lifting builds up these muscles and provide stability to your joints.

Physical inactivity also makes joints stiff making even everyday activities painful. Regular activity keeps joints agile and moving. Low-impact exercises, such as walking, swimming, cycling, and yoga help keep joints lubricated and limit joint deterioration.

2. Maintain a healthy weight: Your joints are meant to carry a certain weight for your body frame, and exceeding that weight puts extra stress on your joints, especially the knees and the lower back. According to experts, for every additional 4-5 kgs of weight that you carry, 9-18 kgs of added force is carried by each knee. This excessive weight borne by your knees can cause them to become swollen.

The less you weigh, lesser is the pressure on your joints to support your body weight. If your weight isn’t where you want it to be, consult a physician or dietician to make and follow a healthy diet plan for you.

3. Maintain proper posture: Poor posture forces your neck and back muscles to overwork and strain your neck, back, and cause joint damage. Bad form such as prolonged slouching while sitting or standing can put undue pressure on your joints. If keeping your spine straight most of the time seems too strenuous, start by keeping your spine straight for a few minutes and then relaxing.

Another way where joints get damaged due to bad posture is while lifting heavy weights. Lifting heavy things with your back instead of squatting and then lifting them with your legs is a common mistake that leads to joint damage. You should stretch out your muscles before doing any heavy lifting and try to do so with safe technique.

4. Quit smoking: Smoking increases inflammation throughout your body and restricts blood flow to your joints. This can not only cause damage to your joints by making them swell but reduce the rate at which your body recovers from an injury.

Smoking can also alter the way your brain processes pain, with smokers feeling less aware of their pain until the effect wears off. This makes smoking doubly harmful if you are already suffering from joint pain from a condition such as osteoarthritis.

Though quitting smoking can be difficult, you can reach out to your primary healthcare provider to seek support in weaning yourself off cigarettes and other nicotine products. Within 8 hours of stopping smoking, oxygen levels in your blood rise and carbon monoxide levels return to normal—this goes a long way in reducing joint pain.

5. Replace sugary drinks and alcohol with water: Cartilage, the cushioning connective tissue that keeps your joints healthy, is 80% made of water. If your body isn’t well hydrated, it pulls water from cartilage and other areas. Lack of enough water in your body can severely dehydrate your joints and increase the chances of injury and pain.

Drinks such as sugary sodas and juices and alcohol dehydrate your body, increasing the stress of a lack of water on your joints. Replace other drinks with water as much as you can to provide your body the hydration it needs to maintain good joint health.

Joint pain isn’t something that you will most likely face until you are well into your forties, but being prepared for it with our tips will help you maintain joint health and perhaps avoid painful conditions as well. If you want more information on how to keep your joints healthy, contact us to book an appointment with our specialists at the Sagar Bone & Joint Institute.

Cortisol – How Stress Affects Your Body

Cortisol is our main stress hormone. It is one of the steroid hormones and is produced in the adrenal glands. Cortisol is deeply connected to our stress response and it works like an in-built alarm system with certain parts of the brain to control fear, mood, and motivation. When our brain thinks that we are in danger or a crisis, our body’s “fight or flight” response is triggered to release cortisol and adrenaline.

Most cells in the body have cortisol receptors and as a result, cortisol affects many different functions in our body. Cortisol can:

• Regulate metabolism
• Control sugar levels
• Help reduce inflammation
• Assist with memory formulation
• Control blood pressure
• Control the salt and water balance

All these functions make cortisol an integral part of maintaining overall health and well being.

Why is our stress problematic?

Unfortunately, we only have only one stress response—“fight or flight,” one that evolved to keep us alive. Our stress response is meant for use during emergencies, but when we have continued stress in our lives, the “alarm button” stays on in our mind and body. In such cases, cortisol levels in our body do not come down. Our heart, blood pressure, and other functions are not able to escape our stress response and there is no time to rest and recover. Extended everyday stress in our lives can derail the normal working of our body.

Constant stress can create a number of health problems such as:

• Anxiety and depression
• Heart disease
• Problems with memory and concentration
• Headaches
• Trouble with sleeping
• Issues with digestion
• Weight gain

Effect of stress on other hormones:

Cortisol is our body’s life-saving hormone. It takes priority over all other hormones. It can create an imbalance in our hormonal system:

Thyroid – prolonged stress can affect our thyroid function. Thyroid hormones ensure that our body cells have enough energy to function properly. With continued stress, we can suffer symptoms of sluggishness such as fatigue, memory loss, constipation, hair loss, low mood, low libido, brain fog, and constipation.

Insulin – increased cortisol levels metabolises sugar quickly for increased energy during the “fight or flight response.” With increased blood sugar levels, more insulin is produced. This can result in insulin resistance and weight gain over time.

Oestrogen/ progesterone – to balance out the effects of oestrogen, a good level of progesterone is needed. Cortisol and progesterone are produced from the same mother hormone—pregnenolone. When the body needs cortisol, the production of progesterone is halted, resulting in a higher concentration of oestrogen in the body. This can result in PMS, increased risk of fibroids and breast or ovarian cancer, endometriosis, painful periods, tenderness in breasts, and bloating.

Effect of stress on other body functions:

Immune system – cortisol can disturb the inflammatory response of the body, which plays a major role in controlling infections.

Digestion – an excess of cortisol can affect the intestinal lining and gut flora, reducing protection against harmful microbes.

Brain function – stress can affect focus, concentration, creativity, and increase memory loss and cause brain fog.

How can you control or lower cortisol?

The following things can be done to moderate cortisol levels:

Reduce stress – you can try identifying your triggers of stress and reducing them by learning to manage them proactively to reduce anxiety or by removing yourself from such situations.

Counteract your fight or flight response – engage your “rest and relax” response or parasympathetic nervous system by switching off or unwinding with meditation, deep breathing, mindfulness, yoga, and being in nature.

Sleep – bad quality of sleep or sleep deprivation can lead to increased cortisol levels. Adhering to your natural sleep cycle and adequate sleep with minimal disruptions can help restore the cortisol balance.

Eat a good diet – a balanced diet with a controlled sugar intake can reduce cortisol levels.

Exercise – exercise can improve your mood and help beat stress. It accustoms your body to a “controlled stress” which helps reduce stress in the long-term.

Laugh and engage in activities you enjoy – cortisol levels are shown to decrease with laughter. Being happy and having a positive outlook also reduce blood pressure and stress.

Take supplements – supplements such as fish oil, vitamin B5 and B6, and herbal adaptogens like ashwagandha have shown the ability to reduce cortisol levels.

Having too much cortisol in the bloodstream can be harmful to your health, especially if cortisol levels remain high over extended periods. Reducing stress and supplementing it with good quality sleep, diet, and exercise are effective ways to reduce cortisol levels.

Blood tests can be done to measure cortisol levels in your blood and treatment plans can be made to restore their balance. If you think you suffer from stress and want more information, book an appointment with our expert doctors at the Department of Diabetology and Endocrinology at Sagar Hospitals. Contact us for a discovery call to see how best we can help you.

How to Find and Choose the Right Cardiologist

The heart is the most vital organ of the circulatory system. There may be various reasons for you to seek consultation from a cardiologist for a non-urgent heart problem. For issues that do not present symptoms yet, to those for which you may have been advised to see a specialist by your family physician, cardiologists deal with the prevention and treatment of all heart diseases.

This decision isn’t one that can be made or taken lightly. There are many factors to be considered in your search for a cardiologist who is right for you.

Take these following 7 points into consideration while choosing a cardiologist:

1. Ask around and get referrals: See if your primary care physician is willing to refer a few cardiologists. A referral from a doctor or other healthcare professionals is one of the safest places to begin your search. You may also know someone, a family member or a friend, who has seen a cardiologist. Inquire about the doctor as well as the health system in which the cardiologist practices.

2. Research the cardiologist's credentials:

Cardiologists receive extensive education and are subspecialists trained in cardiac and vascular care. You need detailed information about the medical credentials of a cardiologist to ensure that the concerned doctor has adequate training, skills, and experience to provide the right care in cardiology. Along with standard medical credentials, cardiologists are also certified in various subspecialties. You can find the cardiologist’s medical school, state registration council, certifications, malpractice and disciplinary history, and other credentials on the Indian Medical Register.

Finally, ensure that the cardiologist is part of the medical team of a hospital that you trust and are comfortable with. You are likely to have tests or procedures done at this hospital. At the doctor’s registry at the Sagar Heart and Vascular Institute website, you can find detailed information about the entire medical staff.

3. Consider the accessibility and convenience of the hospital: Where your cardiologist practices and the hospital where the doctor holds privileges is an important factor to consider. In addition to the infrastructure and services that the hospital provides, it must be located in a convenient location. If you are someone with an active heart condition, numerous trips to the cardiologist for check-ups and tests may be required throughout the year. It cannot be a place where it takes you a long time to reach. The location should encourage, rather than discourage timely care.

4. Consider the cardiologist's experience: The more experience your cardiologist has with a procedure or a condition, the better the results of your treatment are likely to be. A fellowship in one or more subspecialties is also very valuable. You can inquire about the number of patients with your condition the cardiologist has treated. If you require a particular procedure, ask about how many of those the doctor has performed. Also, ask about complication rates—your risk of facing a complication as well as the ones the doctor has faced in his or her experience.

5. Research the quality of the hospital: The quality of care that you will receive from your cardiologist is dependent on the quality of the hospital where he or she practices. In effect, your doctor’s hospital is your hospital. Hospital quality is important because highly rated hospitals have higher survival rates and fewer complications. It is critical that the hospital is capable of performing a wide array of heart procedures and has the ability to provide multi-disciplinary solutions to complications. With two multispecialty hospitals in southern Bangalore, the flagship services of the Sagar Heart and Vascular Institute are accessible without sacrificing exceptional care.

6. Consider the cardiologist’s willingness for innovation: The medical science of preventing and treating heart disease is always evolving. You want your cardiologist to have firsthand knowledge of these technological advances and be someone who is at the forefront of their field. Your doctor must be an expert on existing standard practices, but a willingness to gain expertise in the latest medical innovations can make the difference that gets you the results you need.

7. Evaluate the communication style: Choose a cardiologist you are comfortable talking to and one who is supportive of your information needs. In order to make informed health decisions, you want to make sure that your questions are answered in a way that you understand. When you meet the cardiologist for the first time, ask a question, and observe how he or she responds. Your cardiologist should have an interest in getting to know you, consider your treatment preferences, and create trust so that you can place your heart health in his or her hands.

You cardiologist plays a primary role in the treatment of your heart condition and these tips can guide you to find the right one. In addition, the hospital from which you choose your cardiologist must also be capable of providing holistic care for all kinds of cardiac and vascular conditions. For more information about the range of conditions, procedures, and treatments provided by the Sagar Heart and Vascular Institute, visit our website. Please call us to book an appointment or seek more information.

Prenatal Care—Why is it Important?

Pregnancy is not just a happy time for you and your family, but one where your body is going through a lot of changes as well. Prenatal care is tailored healthcare that is provided to pregnant women for a healthy pregnancy, labor, and child. The main goal of prenatal care is to provide pregnant women with regular checkups to ensure that both the expectant mother and baby are healthy and that the pregnancy progresses normally. Prenatal care can be critical, especially if the pregnancy occurs after the age of 35.

These checkups are a great opportunity for the expectant mother and her family to ask all their questions to the doctor and develop a relationship with their obstetrician/ gynaecologist (OB/ GYN). This eases apprehensions and makes you more comfortable and confident going into labor.

What should you expect in your prenatal checkups?

Your prenatal care should begin as soon as you suspect that you might be pregnant. Meet your OB/ GYN to confirm and begin your check-up appointments as early as possible.

During your prenatal visits your OB/ GYN will:

• Ask if you have any questions, concerns, pre-existing issues, and other problems that might affect the pregnancy.
• Discuss all the changes that your body is experiencing during your pregnancy.
• Assess and discuss the growth and development of your baby.
• Review any medications that you might be taking.
• Monitor your baby’s heartbeat (once your pregnancy has reached at least 11-12 weeks).
• Discuss the results of any tests that you might have to undergo.
• Ensure that your personalised plan for your pregnancy care is being followed properly.

What are the benefits of prenatal care?

The following are 7 benefits that prenatal care holds for expectant mothers:

1. Maintain good health for yourself and your baby: It is important to maintain good health not just for yourself, but also for your child. Babies whose mothers have not had any prenatal care are at a greater risk of being born with low birth weight. A low birth weight makes a baby more susceptible to an early death. It is also important to reduce stress during pregnancy to prevent the adverse effects of stress on the health of the child.

2. Receive proper nutritional information and advice: Your pregnancy mandates that your diet meets certain requirements for the optimal health of your baby. Your OB/ GYN will be giving you detailed information about the recommended dietary intake of healthy foods for the course of the pregnancy—especially regarding what not to eat. It is important for the overall health of your child that you follow these recommendations carefully. Your doctor’s instructions will clarify many doubts and myths—contrary to a popular belief, being an expectant mother does not mean that you eat for two; you only require an additional 300 calories a day to provide adequately for a single baby.

3. Monitor the baby’s development: Your baby’s growth over time is a key indicator of his or her health. Your OB/ GYN will routinely measure your belly to monitor how well your baby is growing. Ultrasounds will also be scheduled to verify your child’s development and detect any issues early.

4. Reduce the risk of pregnancy complications: Prenatal care can help ensure safe childbirth and avoid pregnancy complications that are hard to detect without medical supervision. Though women’s bodies possess the natural function to give birth, prenatal checkups will help catch potential health concerns early, such as gestational diabetes, pre-eclampsia, cervical insufficiency, foetal growth restriction, and anaemia, that can complicate the pregnancy.

5. Reduce the baby’s risk for complications: Your OB/ GYN will give you detailed instructions about the risks of smoking and alcohol consumption during your pregnancy. Intake of tobacco and alcohol during pregnancy has shown to increase the risk of Sudden Infant Death Syndrome. Alcohol, in addition, increases the risk of foetal disorders such as facial and bone deformities, intellectual disability, poor memory, poor coordination, and issues with the heart and kidneys.

6. Undergo important testing: Your OB/ GYN will schedule prenatal tests for you on the basis of your age, medical and family history, and stage of pregnancy to assess pregnancy-related risks to you and check your baby’s health. Prenatal tests can detect risks such as miscarriage, molar pregnancy, and maternal death for the expectant mother. Testing of the foetus can verify growth-markers such as the maturity of the baby’s lungs and detect foetal malformations such as clenched fists, club foot, and spina bifida. Tests done on the amniotic fluid (amniocentesis) can help detect infections or genetic abnormalities such as Down Syndrome. These tests can be important especially in cases such as Rh sensitisation, where the baby has a different blood type than the mother.

7. Learn about labor and delivery: Prenatal visits to your OB/ GYN will get you important information about labor and help you decide what form of delivery procedure you want to go through. Based on the advice and the discussions you have with your doctor, your delivery plan can be made. This plan includes possible scenarios, procedures, and the benefits and risks of every intervention and treatment that will be available you.

Most pregnancies lead to positive outcomes, both for the mother and child. However, it is difficult to identify and mitigate pregnancy risks by yourself. Prenatal care bridges this uncertainty by providing healthcare specific to your pregnancy.

Pregnancy involves the health of more than one life. For the most compassionate and expert care for your baby and you, book an appointment with our OB/ GYN specialists at the Department of Obstetrics and Gynaecology at Sagar Hospitals.