YOUR BODY NEEDS FATS

With the current preoccupation with obesity and overweight, fats are being considered as something to avoid. However, don’t completely cut out fats from your diet. They play an important role in keeping the body healthy. 

Why fats are important…

FATS…

• provide energy for all body functions, and are a reserve of energy when stored in the body.

• support health  

                    - transport some fat soluble vitamins 

                    - regulate body cholesterol metabolism. 

                    - insulate against extreme temperatures 

                    - protect organs from injury. 

                    - help the body to use proteins and carbohydrates more efficiently.

• make food very tasty

Fats are required to keep the body healthy but the type and amount of fat in the diet depends on tradition, culture, and economic factors .For example, the traditional Japanese diet is low in fat, whereas Italian food uses a lot of olive oil. Coconut oil is used in Kerala while mustard oil is used in Bengal and some northern states.

The body breaks down fats and oils in the diet into fatty acids.

UNDERSTANDING   FATTY ACIDS…

Fatty acids can be saturated, monounsaturated or polyunsaturated.

Fats with a high content of saturated fatty acids are solid at room temperature and are usually obtained from animal sources, for example, lard, suet and butter.

Trans fats which are also solid at room temperature enhance the flavour, texture, and shelf life of many processed foods but they are a health risk.Small amounts of trans fats occur naturally in beef, lamb, and full-fat dairy products but most are commercially produced by processing liquid vegetable oil into a solid fat –  for example Vanaspathi/ Dalda/margarine. Major sources of trans fatty acids are  pizzas, cakes, cookies , doughnuts,  crackers, meat and dairy products, snack chips, peanut butter and shortening in fried foods.

Like saturated fats, trans fats raise LDL "bad" cholesterol and increase the risk of heart disease. But unlike saturated fats, trans fats lower HDL "good" cholesterol and may do more damage. So the intake of these foods should be very controlled.

Most plant oils,except for palm oil and coconut oil, are high in either polyunsaturated (PUFA) or monounsaturated fats (MUFA). Monounsaturated fats should be used as much as possible along with polyunsaturated fats instead of the bad saturated fats and trans fats.

Good sources of monounsaturated fats are olive oil, peanut oil, gingelly oil, canola oil, avocado, and most nuts.

While saturated fats and monounsaturated fats can be made in the human body, the body cannot maketwo polyunsaturated fats - linoleic acid (LA)and alpha-linolenic acid(ALA). They are necessary for human health and since the body cannot make them, they have to be obtained through the diet. So, they are called essential fatty acids (EFA).Both linoleic acid (LA) and alpha- linolenic acid (ALA) can be converted in the body into other polyunsaturated fatty acids (PUFAs).

A diet low in both fat and saturated fat combined with regular fish consumption produces the best results.

ESSENTIAL FATTY ACIDS (EFAS)…

There are basically two types of EFA’s –Omega- 6 essential fatty acids and Omega -3 essential fatty acids.

Omega-3 fatty acids and Omega-6 fatty acids play a very important role in brain function as well as normal growth and development. They help stimulate skin and hair growth, maintain bone health, regulate metabolism, and maintain the reproductive system.

Most Omega-6 fatty acids in the diet come in the form of linoleic acid (LA)from vegetable oils and also from leafy vegetables, seeds, nuts,  grains and plant oils such as corn oil, unhydrogenated  soybean oil, and sunflower oil, safflower oil , olive oil as well as meat and poultry.

A well- balanced diet provides enough of it but the effectiveness is spoiled by the sugar and trans fats in the diet.

Omega-3 essential fatty acids come primarily from fatty fish such as salmon, herring, anchovies, sardines , mackerel, and tuna, as well as from nuts and seeds, soyabean, walnuts, almond, sesame seed  and flaxseed in lesser amounts. Alpha-Linolenic  acid  (ALA )is the primary member of the Omega- 3 family.

Most fats are a combination of saturated, monounsaturated and polyunsaturated fatty acids. The body’s requirement depends on an optimal ratio and a ratio of 1:5 or 1:10 of Omega-3 fatty acids to Omega-6 fatty acids has been suggested. A balanced diet that includes grains, seeds, nuts,  leafy vegetable , vegetable oils and fish supplies  a good balance of all the Omega- 3 and Omega- 6 fatty acids.

For the right balance eat more fish than meat. Even one fish meal a week can make the difference. Fish provides many minerals and vitamins. 

Fish oil supplements should be taken under the supervision of your physician.

A diet that is high in meat tends to contain 14 - 25 times more Omega-6 fatty acids than Omega-3 fatty acids. 

The Mediterranean diet has a healthier balance between omega-3 and omega-6 fatty acids as it emphasizes foods rich in omega-3 fatty acids, including whole grains, fresh fruits and vegetables, fish, olive oil, garlic, as well as moderate wine consumption.

DEFICIENCY OR IMBALANCE IN OMEGA 6 FATTY ACIDS AND OMEGA 3 FATTY ACIDS CAN AFFECT HEALTH.

Omega-3 deficiencies are linked to decreased memory and mental abilities, tingling sensation of the nerves, poor vision, increased tendency to form blood clots, weakened immune function, increased triglycerides and "bad" cholesterol (LDL) levels, impaired membrane function, hypertension, irregular heartbeat, learning disorders, menopausal discomfort, itchiness on the front of the lower leg(s), and growth retardation in infants, children, and pregnant women.

On the other hand, high doses of Omega- 3 fatty acids can cause gastro- intestinal disturbances such as abdominal discomfort, diarrhoea, nausea and belching.

Some Omega-6s improve diabetic neuropathy, rheumatoid arthritis, skin disorders (e.g. psoriasis and eczema), and aid in cancer treatment.

ARE PHYTOSTEROLS GOOD FOR PEOPLE WITH DIABETES? 

Phytosterols are cholesterol- like molecules found in all plant foods with highest concentration in vegetable oils. These are absorbed only in trace amounts but inhibit absorption of intestinal cholesterol and help lower LDL cholesterol in patients with diabetes.

TIPS TO GET THE MOST OUT OF FATS…

• High heat, light, and oxygen destroy essential fatty acids, so while consuming foods for their essential fatty acid content, try to avoid cooked or heated forms. For example, raw nuts are a better source than roasted nuts. Never re-use any type of oil.
• Heating fish? - Omega-3 fatty acids are very easily damaged by heat, light and oxygen. They become rancid and the flavour and taste change and nutritional value is lowered.  Baking or steaming fish containing Omega-3 fatty acids are better cooking methods than frying.

• Heating olive oil? –  If cooking at high temperatures, use refined olive oil and not virgin oil. The unrefined particles in virgin olive oil are burnt when heated and this spoils the flavour. Use virgin olive oil without heating in salads instead of salad oil for another healthy change.

• Replace hydrogenated fats (like margarine),cholesterol-based fats (butter/dairy products) with healthy essential fatty acid-based fats whenever possible. For example, instead of margarine or butter on your warm vegetables, use extra virgin olive oil with salt. 

• Sprinkling flaxseed powder on vegetables adds a slightly nutty taste. Whole flaxseeds are usually passed through the intestine, absorbing water only and not yielding much oil.  However, it's best not to use large amounts of flaxseed in its ground seed form, as it contains phytoestrogens. 
• Replace oily snack foods, like potato chips and corn chips, with healthy nuts and seeds.
• Vegetarians can achieve a better balance of PUFAs in their body tissues by using less sunflower, safflower and corn oils and more oils containing alphalinolenic acid such as rapeseed (canola) oil, mustard oil, peanutoil, gingelly oil, or soya bean oil. This would encourage their tissues to make more DHA.
• Although most diets supply sufficient linoleic acid, it is often not converted because of metabolic problems caused by diets rich in sugar, alcohol, or trans fats from processed foods, as well as smoking, pollution, stress, ageing, viral infections, and other illnesses such as diabetes. 

Depending only on one type of cooking oil does not guarantee that a person is getting the best combination of various fatty acids. So, use a combination of oils in rotation to get allthe benefits. While selecting cooking oils consider the omega -6 to omega -3 ratio, MUFA content, PUFA content and saturated fatty acid content. Be aware of the trans- fatty acid content and the smoking point and heat stability of cooking oils as Indian cooking involves high temperatures for long hours.The ideal oil combination for Indian population for best intake of various fatty acids is groundnut oil or gingelly oil or mustard oil used alternately with soya bean oil,sunflower oil, Saffola or canola oil.

Ref: Understand Nutrition- Eleanor Noss Whitney, Sharon Rolfes.

Carpal Tunnel Syndrome (CTS) in Diabetes

(Median nerve dysfunction; Median nerve entrapment)

Ms. Seena Rajsekar, Ms.S. Bamila

Podiatry Dept. 

Carpal tunnel syndrome is pressure on the median nerve -- the nerve in the wrist that supplies feeling and movement to parts of the hand. It can lead to numbness, tingling, weakness, or muscle damage in the hand and fingers. The condition occurs most often in people 30 to 60 years old, and is more common in women than men. It also has a higher prevalence in people with diabetes and other conditions which directly affect the nervous system

Causes, incidence, and risk factors

The key risk factors in the workplace that causes the Carpal Tunnel Syndrome include:

• Repetition 
• Awkward joint posture 
• High force 
• Vibration 
• Direct pressure 
• Prolonged constrained posture 

A number of medical problems are associated with carpal tunnel syndrome, including:

• Bone fractures and arthritis of the wrist
• Acromegaly
• Diabetes
• Alcoholism
• Hypothyroidism
• Kidney failure and dialysis
• Menopause, premenstrual syndrome (PMS), and pregnancy
• Infections
• Obesity
• Rheumatoid arthritis

Symptoms

• Numbness or tingling in the thumb and next two or three fingers of one or both hands
• Numbness or tingling of the palm of the hand
• Pain extending to the elbow
• Pain in wrist or hand in one or both hands
• Problems with fine finger movements (coordination) in one or both hands
• Wasting away of the muscle under the thumb (in advanced or long-term cases)
• Weak grip or difficulty carrying bags (a common complaint)
• Weakness in one or both hands
• Interruption of Sleep with Hands Numbness and in Pain 
• Poor Circulation of blood in Hands there by Hands falling asleep 
• Cold Hands 
• Dropping Objects especially small objects. 
• Forearms warm and Loss of Grip Strength by Forearms 

Signs and tests

• Numbness in the palm, thumb, index finger, middle finger, and thumb side of the ring finger
• Weak hand grip
• Tapping over the median nerve at the wrist may cause pain to shoot from the wrist to the hand (this is called Tinel's sign)
• Bending the wrist forward all the way for 60 seconds will usually result in numbness, tingling, or weakness (this is called Phalen's test)
• Electromyography
• Nerve conduction velocity
• Wrist x-rays should be done to rule out other problems (such as wrist arthritis)
• MRI scan, ultrasound imaging

Carpal Tunnel Syndrome(CTS) Treatment 

Treatment of carpal tunnel syndrome should initially be conservative and led by your Doctor. The first period of treatment should include complete rest for the wrist.Following a period of immobilisation, stretching and strengthening exercises can be used to help prevent a reoccurrence of symptoms .IF  symptoms persist over a 6 month period, surgery may be required.

EXERCISES FOR CARPEL TUNNEL SYNDROMES (CTS)

 A. Extend and stretch both wrists and fingers acutely as if they are in a hand-stand position. Hold for a count of 5.

B. Straighten both wrists and relax fingers.

C. Make a tight fist with both hands. 

D. Then bend both wrists down while keeping the fist. Hold for a count of 5. 

E. Straighten both wrists and relax fingers, for a count of 5.

The exercise should be repeated 10 times. 

 F. Then let your arms hang loosely at the side and shake them for a few seconds.

• Wrist Curls without Weights: Sit in a chair with your forearm resting on your thigh (or on a table). With your palm up or palm down. Bend your wrist up about 2 to 3 inches and then slowly lower it down. Repeat 20 times.

• Shrugs

Stand with your arms by your side. Lift your shoulders up to your ears and hold for 1 second. Then pull your shoulders back pinching your shoulder blades together. Hold for 1 second. Relax your shoulders and repeat 20 times. 

Other  conservative  methods of treatment are as follows:

• Wrist splint:  

      Typically the splint is worn at night or during sports. The splint is used for several weeks or months, depending on the severity of the problem, and may be combined with hand and finger exercises.

• Ultrasound employs high-frequency sound waves directed toward the inflamed area and helps in reducing pain.
• Ice and Warmth. Ice may provide benefit for acute pain. Some patients have reported that alternating warm and cold soaks have been beneficial.
• Vitamin B6. Vitamin B6 (pyridoxine) is often used for carpal tunnel syndrome
• Acupuncture.
• Limiting Movement. If possible, the patient should avoid activities at work or home that may aggravate the syndrome. The affected hand and wrist should be rested for 2 - 6 weeks. 

Do's and Don'ts:

Avoid over extending and flexing your wrist. Also, avoid keeping your wrist in an extended or flexed position for long periods of time. That is why your doctor gave you a wrist splint to wear. It is very helpful to wear the wrist splint at night as well. If your pain and numbness does not improve, consult doctors.

Source:

• Carpal Tunnel Syndrome in Patients With Diabetic Polyneuropathy  Bruce A. Perkins, FRCPC,David Olaleye, PHD and Vera Bril, MD, FRCPC 
• Source:  By Dr. Housang Seradge at the University of Oklahoma Orthopaedic & Reconstructive Research Foundation (http://ortho-ok.com/orrf/ORRF_CARPAL_TUNNEL_PREVENTION.htm).
• Carpal Tunnel Syndrome Exercises -En Espanol
• http://www.medicinenet.com/carpal_tunnel_syndrome/article.html
• [Carpal tunnel syndrome in diabetes mellitus].[Article in German]Bahrmann A, Zieschang T, Neumann T, Hein G, Oster P.

EAT RIGHT

Most nutrients don’t work on their own. They interact- sometimes working together and at other times hindering each other. Combining foods can increase their nutritive value which is very good for health. Foods that don’t complement each other when eaten can cause digestive discomfort such as bloating , flatulence and even an upset stomach. 

It is therefore important to plan your meals and eat the right combination of foods.

Common foods such as rice and dal/ rajma and rice are good combinations because rice is deficient in lysine and dal in methionine – both of which are essential amino acids – and when eaten together, provide complete protein.

Green tea has an antioxidant that helps strengthen the immune system, and has weight loss and anti-ageing properties.A little lemon juice reduces the breakdown of the antioxidant in the digestive tract thereby making it more effective. 

Iron and Vit. C: VitC enhances the retention of iron from what we eat.  Iron is essential for healthy red blood cells, helps improve oxygen supply to the brain and the muscles. Poha which contains iron is usually eaten with a squeeze of lime.

Calcium  and Vit D : Calcium makes healthy bones, teeth,muscles and  nerve function. However it is better retained in the intestines and deposited in the bones in the presence of Vit D. Omlette with a glass of milk, a tuna sandwich of wholegrain bread and a bowl of fruityoghurt , grilled salmon and sautéed broccoli .

Sodium and potassium: We usually consume a lot more sodium/ salt than is needed in the body. Excess sodium can result in high blood pressure that increases the chance of heart attack or stroke. Potassium encourages the kidneys to excrete sodium. Many studies have shown the connection between high potassium intake and lower blood pressure. Eating fruits and vegetables increases potassium while eating less of breads,cookies ,salty food, pizzas, burgers and ready to eat meals decreases the sodium in the diet.

Vit B12 and folate:  Vitamin B12 helps the body to retain folate and the two together support cell division and replication which allows the body to replace cells that die. This is important during growth in childhood and in adults. Good source of B12 include meat, eggs, and milk. Folate – leafy green vegs, beans and legumes. Fortified breakfast cereals have both. A deficiency in either or both can cause macrocytic anaemia. Lactation and alcoholism can also reduce the levels of folate.

VitK is important in blood clotting and bone formation. It is a fat soluble vitamin and so needs some fat for its retention . Fat is important for maintaining body temperature, regulating hormones, protecting vital organs and including small amounts of fat – mono and poly unsaturated fats in the diet  will help retain fat soluble vitamins ADEK in the diet.

Spinach, broccoli, lettuce, brussel sproutsare good sources of VitK and can be tossed in olive oil and garnished with walnut and almonds.

The anticancer compounds in cauliflower and cabbage are better retained in the presence of mustard from mustard sauce.

The truth about fats: bad and good

The body needs fat. It’s a major energy source and also helps you absorb certain vitamins and nutrients. Only some fats are bad for you: saturated fats and trans fatty acids, or trans fats. These bad fats raise your chances of developing heart disease by increasing two of its main risk factors: LDL cholesterol and triglycerides.

Unsaturated fats are good for you . There are two types of unsaturated fats: polyunsaturated fats and monounsaturated fats. These good fats can help lower LDL, prevent abnormal heart rhythms, and prevent heart disease.

Bad fat

Saturated fats and trans fats are both solid at room temperature, for example butter, shortening, or the marbleized fat in meat. They are also found in whole milk, cream, palm oil and coconut oil. These fats increase total cholesterol, in particular LDL cholesterol, the destructive type that encourages the formation of blockages in the coronary arteries.

Saturated fats. Not all saturated fats are equally bad for the health. The saturated fat found in butter, whole milk, cheese, and other dairy products increases LDL levels the most, followed by the saturated fat in beef. However, the saturated fat found in pure dark chocolate, is more like unsaturated fat in that it lowers LDL levels. 

Trans fats (partially hydrogenated oils). These fats occur naturally in meat, but their main dietary source is packaged baked products such as cookies, cakes, breads, and crackers, as well as fast foods and some dairy products. Trans fats such as shortening and margarine were artificially created in the laboratory to provide cheap alternatives to butter. Trans fats are even worse than saturated fats. Not only do they increase your LDL cholesterol, but they also reduce the good HDL cholesterol. 

There is no safe level of trans fats.

Good fats:

Good fats come mainly from vegetable and fish products. They are liquid, not solid. There are two main types of beneficial fats: polyunsaturated and monounsaturated.

Polyunsaturated fats. Corn oil is a common example. Polyunsaturated fats are required for normal body functions, but your body can’t manufacture them and so must get them from food. Polyunsaturated fats help build cell membranes, the exterior casing of each cell, and the sheaths surrounding nerves. They’re vital to blood clotting, muscle contraction and relaxation, and inflammation. Some studies suggest these fats may also protect against Type 2 diabetes, Alzheimer’s disease, and age-related brain decline. They reduce LDL more than they lower HDL, thus improving your cholesterol profile. Even better, they also lower triglycerides. 

There are two types of polyunsaturated fats: omega-3  fatty acids and omega-6  fatty acids.The human body needs omega 3 and omega 6 fatty acids in the diet because it can’t produce them. The only source is food. 

Linoleic acid  (LA ) is an Omega-6 fatty acid that is found in plant oils such as corn oil,unhydrogenated soybean oil, and sunflower oil, safflower oil as well as from nuts and seeds. The American Heart Association recommends that at least 5% to 10% of food calories come from omega-6 fatty acids.

Alpha linolenicacid ,(ALA) is an Omega-3 fatty acid that come primarily from fatty fish such as salmon, mackerel, and tuna, as well as from walnuts and flaxseed in lesser amounts.

Research has shown that omega-3 fatty acids help prevent and even treat heart disease and stroke. Evidence also suggests they have similar benefits against autoimmune diseases such as lupus, eczema, and rheumatoid arthritis. 

Monounsaturated fats. These fats should be used as much as possible along with polyunsaturated fats to replace the bad saturated fats and trans fats. Good sources of monounsaturated fats are olive oil, peanut oil, canola oil, avocados, and most nuts.

THE CRUX OF THE MATTER IS THAT “GOOD FATS” ARE AN INTEGRAL PART OF HEART-HEALTHY DIETS, ESPECIALLY WHEN THEY REPLACE SATURATED AND TRANS FATS IN OUR DIETS. 

A few  simple changes in using fats in our diet can provide considerable health benefits.

Replace Butter and Cream with Unsaturated Oils

Saturated fats, which are mostly found in animal sources, raise LDL, the form of cholesterol that clogs arteries. Unsaturated fats from vegetable oils, nuts, and fish can help lower cholesterol levels.  

Sautéing in canola or other vegetable oil instead of butter

Drizzling olive oil over vegetables

Dipping bread in olive oil instead of spreading it with butter

Using non-hydrogenated margarine in place of butter

Making cream sauces with low-fat yogurt

Using oil-based salad dressings instead creamy dressings

Add Nuts to the Menu

Nuts are a rich source of omega-3 and omega-6 fatty acids. Nuts make a satisfying and convenient snack, and are also a great addition to meals.

Stir-fries with cashews or almonds

Salads topped with walnuts

Eat Fish for Health

Fish is rich in two forms of omega-3 fatty acids. Growing evidence shows that these two forms are particularly important for lowering inflammation and protecting against heart disease. 

Use Other Sources of Omega-3 fatty acids

If you don’t eat fish, flaxseed oil, for example, contains about 55% omega-3 fats. Canola oil has about 10%. Soybean oil has about 7% omega-3 fats. Walnuts and leafy green vegetables are also good sources of omega-3 fatty acids.