Thursday, July 02, 2015

The Secrets to losing weight…

Many want to lose weight and many need to. Many try but few succeed. What is the secret of their success? Is there one secret or are there many? Do doctors know all the answers? Maybe, but aren't there lots of obese doctors around? 


In my practice I have had the opportunity to speak to both types of people; the ones who have lost weight and the ones who have failed. I myself have struggled for many years to lose weight only to find success recently. So what are these secrets? 


Secret 1: Sincerity. People who successfully lose weight have a deep commitment and sincerity in their effort. It is akin to a project that they have taken up and need to see it to completion. They work hard to lose weight, they have pride in their effort and they celebrate their achievements. Quite often the commitment comes due to a life altering mishap that they have suffered like a heart attack or a complication from diabetes. It is only after a major near death experience do they realise how fragile life is and how much they have taken for granted. I urge readers to take weight loss seriously and not wait for their wake up call!


Secret 2: Exercise or Diet? Is dieting enough to lose weight? or is exercising enough? or do we need both? the reality is that diet is far more crucial to reduce weight than exercise. Exercise helps but diet is the key. Those who exercise but continue their usual eating habits almost never lose weight. Of the weight one loses, 75% will be due to changes in diet and 25% will be due to exercise. 


Secret 3: Quality of food. Is it acceptable to buy petrol mixed with water? We are so particular about quality of the things we buy, however we stop thinking of quality when it comes to food. We are ruled by taste. What tastes good is good. Its time to stop and think about what we consume. We ought to eat only quality food. We should avoid deep fried foodstuff. We should also avoid artificial sugar. Avoiding sugar doesn't stop at adding Splenda to tea. One cannot imagine the extent to which artificial sugar has infiltrated our eating habits! Biscuits, chips, packaged snacks, cakes, chocolates, sweets, mithai, cold drinks, ice creams etc etc are all loaded withartificial sugar. This modern sugar stresses the body's mechanisms to control blood sugar. The body converts all this excess sugar to fat and stores it, resulting in a pot belly. The hotel industry, the biscuit manufacturer, the bakery, the chocolate industry, the Paani-Puri Wala or the Wada-Pav Center are not interested in your health. They thrive on our weakness for taste. So when I say avoid fried foods and artificial sugar, I really mean one must avoid eating packaged food (what is typically stocked at a Kiraana store) and one must avoid eating outdoors. Home cooked meals will always have the quality you are looking for! In addition to this we must reduce our consumption of the GREAT FOUR! They arerice, potatoes, pasta (and other maida products) and bread (bakery products). These products are similar to sugar and have high carbohydrate content which will be converted to fat. Once one learns to avoid these poor quality foods, what remains is all healthy. Wheat (or jowar, bajra) chapatis, dals, vegetables, meat (in limited quantity)  and nuts are healthy to eat. To this we can add cereals(without sugar), muesli, oats, milk and eggs. Milk products without sugar like dahi and chaas are good. The sugar in fruit is natural and far far superior to artificial sugar. One can safely consume all types of fruits unless diabetic. Raw vegetable salads (without unhealthy mayonnaise dressings) are a complete winner. Now with this knowledge lets assess the quality of some of our foodstuffs - first the seemingly harmless 'wada-pav'. It has got potato, maida and bread. Plus it is deep fried. Its a total disaster, isn't it? Lets see another scenario: a visit to MacDonald's. What do we end up eating? A fried patty in bread? Still not so bad one may feel. But lets see the accompaniments. A sugar filled cold drink and fried potato chips! Another disaster. What about the people who drink many cups of tea in the day? Not much harm done? Actually lots of harm done if the tea has sugar! All the sugar just ends up in one's belly. 


Secret 4: Portion control. Now we come to the most difficult part of weight reduction. We may be very motivated to lose weight and we may be willing to let go of our tasty snacks, but are we ready for portion control? What does one mean by portion control? It means that one has to control the quantity of food consumed at a particular time.  This is very critical for the major meals which are lunch and dinner. I have devised the 1 to 2 rule. For lunch or dinner one should not consume more than 2 chapati's or 1 chapati and 1 small helping of rice. Obviously this is hugely difficult as we will feel hungry. There are 2 secrets here to succeed. First is to reduce the speed of eating. It takes time for the stomach to send a signal to the brain that it is full. If we eat too fast, we have already over eaten by the time the signal reaches the brain. Vice versa if we eat very very slowly, we will feel full even with seemingly small quantities of food. One should chew slowly and swallow only after chewing the food completely. One should not put another morsel in the mouth till one has swallowed the previous morsel. The second secret is to eat healthy snacks in between meals. So one can have a fruit or a salad or some nuts at 11:00 am and in the evenings at 4pm and if required even at 7pm. If one feels hungry after dinner, one can have a healthy snack at 10pm. This way we can counter the hunger we will feel because of portion control. I must emphasise here that the snack must be healthy! People have a habit of skipping meals and then binge eating at dinner time. They feel proud of skipping a meal and think it will help reduce weight. Then they feel the need for a reward and feel justified in eating a heavy meal. Little do they realise that all the benefit from skipping a meal is not only lost in the binge eating, in fact more harm is done than good. Binge eating can never result in weight loss! The tough truth is that we can never have a heavy meal ever, if we are serious about weight loss! 


This is a sure shot way of losing weight! Many of us feel that we don't eat much food, we eat healthy and still we don't lose weight! But I request you all to introspect sincerely! You must take into account exact quantity of food consumed rather than your best estimate. You must look at the quality of food as well. Learn to pay attention while eating and actually count the chapatis and helpings of rice. Also every small unhealthy snack eaten in between, like a chocolate, a biscuit, a piece of cake or a few chips, matters! 


Armed with these secrets, I am confident that all of us can start losing weight and move towards a more healthy and happy life! 


Wednesday, January 28, 2015

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Friday, January 16, 2015


Many patients with knee pain feel helpless when their surgeon advises a knee replacement. There must be some other option! Won't medicines help or exercises or braces? How about alternative medicine like Homeopathy or Ayurveda? Maybe magnetic therapy, laser or acupuncture can reduce the pain. Then starts the long and fruitless journey from one doctor to another and from one treatment to another. Patients end up spending lots of money and wasting lots of time only to realise that nothing works. I see patients going through this cycle again and again. Patients need to understand why knee replacement is the only ultimate solution. If the knees are in a early stage of arthritis then obviously don't go for surgery. But if the knees are badly damaged and the legs have become crooked, don't waste more time. Go for surgery! 

So why does knee replacement work when everything else is failing? The ends of the bone which form the joint are covered by a smooth lining called cartilage. This allows for friction free, painless motion. In arthritis, the cartilage gets damaged, eroded and eventually completely destroyed. Cartilage tissue has poor ability for repair and regeneration. No available medicine (Allopathic, Ayurvedic or Homeopathic) can induce cartilage growth and repair. Similarly no treatment method like traction, braces, acupuncture, laser or magnets have any effect on cartilage. These modalities act as mere pain killers. That is why they fail. The second problem in arthritis is the crooked bones or bow leg deformity. Once the legs become crooked at the knees, a vicious cycle ensues. The deformity progresses irrevocably till walking becomes impossible. Again no medicine or treatment method can straighten the knees. Till the legs become straight the problem of pain will not go away. 

Knee replacement solves both these core issues beautifully. Knee replacement replaces the damaged cartilage with a new artificial joint surface. This surface is made of polished alloy which is nearly as smooth as cartilage. Knee replacement also corrects deformity completely. Crooked legs become straight after surgery. This is the basis of success of this procedure. Replacement of cartilage and correction of deformity. No other treatment has even come close to solving these 2 problems. With modern technological advances, knee replacements last for 15 to 20 years providing a truly effective and lasting solution. 

I see patients procrastinating and delaying their decision for surgery because of fear. It's unfortunate because time is wasted in suffering. They become slaves to pain and cannot lead productive lives. Knee arthritis today is a treatable disability. No one needs to suffer. Choose the surgeon and hospital wisely and go ahead. After surgery patients forget that they ever had knee pain! 

Friday, October 17, 2014


Neck pain is common and most of us have experienced it at some point. It brings with it the anxiety of a serious illness like spondylitis!  Fortunately most cases of neck pain are not due to spondylitis. One of the commoner and less understood causes is trapezitis!
The Trapezius Muscle
The trapezius is a large muscle that forms the nape of the neck. It extends from the neck to upper back and fans out to the shoulder. The muscle has many functions but the most relevant one is to lift the head to look upwards. Any work that requires the head to be stable like working on a computer, reading a book, working on a kitchen table, driving for long or watching television etc. brings the trapezius into action. With our modern lifestyle, one can imagine the extent of overuse and often abuse this muscle faces!
Fatigue and inflammation of this muscle leads to trapezitis. The symptoms are typical. It starts with mild pain or discomfort in the nape of the neck at the end of the day. Initially a good night’s rest solves the problem. In the early stages, massaging the muscle or a hot water bag brings relief. As time passes, the attacks become more frequent and painful. The muscle goes into spasm and feels hard to touch. The pain becomes constant and is not relieved easily. Eventually the pain and spasm can become unbearable. At this point, the patient seeks medical intervention and needs muscle relaxant tablets to decrease the spasm. Understandably this disorder is confused with spondylitis. However it is a different illness with a different approach to treatment.
An acute episode of trapezitis is treated with anti – inflammatory, muscle relaxant tablets. In addition, patients require physiotherapy modalities, a soft cervical collar and rest. A physiotherapist will use interferential therapy (IFT) and short wave diathermy (SWD) to reduce the spasm. The severe pain settles in 7 to 10 days.
We cannot avoid our daily routine and daily work! So how do we protect our trapezius from fatigue and bouts of inflammation? Firstly one must strengthen the muscle so that it can take the rigours of our routine. One needs to do neck and shoulder exercises regularly. Here I will emphasise the importance of doing exercises that involve the hands going above the head (overhead exercises). Swimming is an ideal exercise for trapezitis and regular swimmers seldom get such pain. The second philosophy of treatment concentrates on the ergonomics of work! Poor postures are ripe environment for trapezitis. Working with a laptop on bed or watching televisions lying down are a strict NO. Chairs at work should have a lumbar support. One should sit erect. Avoid slouching. The computer screen should be at eye level. A break is necessary every 20 minutes during long hauls in front of the computer or long drives. One should get up, move around and stretch the neck, shoulders and back.   

Trapezitis is a modern day epidemic brought on by our lifestyle. Awareness of the issue and a logical approach to the problem will help most people avoid it all together!  

Wednesday, August 20, 2014

The Sunshine Vitamin

As research continues to shed new light, scientists are realizing that vitamin D has many critical functions in the body. It works more like a hormone rather than a vitamin and affects the performance of almost every cell of the body. 

1.      We all know that vitamin D is critical in maintaining adequate amounts of calcium and phosphorus in bones and teeth. In simple words it helps keep bones and teeth strong and protects against osteoporosis and dental caries. However we need vitamin D for many other roles. 
2.      It is important in the regulation of the immune system. It produces anti - bacterial and anti- viral substances and helps fight infections like common cold and influenza. 
3.      It helps to keep the brain functioning normally in later life and prevents mental illnesses like dementia, Alzheimer's disease, schizophrenia and depression
4.      Vitamin D helps maintain ideal body weight. Those with vitamin D deficiency are likely to be obese and fail at attempts to reduce body weight via diet and exercise. 
5.      It plays a role in preventing inflammatory disorders like Rheumatoid Arthritis (multiple joint pains), inflammatory bowel disease, psoriasis and eczema
6.      It reduces the frequency and severity of asthma and allows for speedy recovery from tuberculosis
7.      It reduces the risk of heart attacks and protects against high blood pressure and diabetes. 
8.      Vitamin D has recently been shown to be critical for a normal pregnancy. It prevents pregnancy related illnesses, reduces risk for premature deliveries and reduces infertility
9.      It reduces risk of all types of cancer. 

What are the daily requirements of this valuable vitamin? Most authorities recommend around 600 IU of vitamin D daily. Infants less than one year old need 400 IU and adults above 70 years of age need 800 IU.

Now that we realise the critical benefits of vitamin D, we must find out how to get it! Unfortunately getting vitamin D from diet alone is an uphill task. Few foodstuffs are a good source of vitamin D. Vitamin D rich foods include beef liver, egg yolk, certain types of cheese and certain types of fish. One egg gives approximately 40 IU of vitamin D. Unfortified milk (milk is fortified with vitamin D in America and European countries as a government initiative) is a poor source of vitamin D. 
Sunlight is an additional source of vitamin D. It is important as dietary sources of vitamin D are few. Ideally we should get 90% of our daily vitamin D requirement from sunlight. UV rays in sunlight convert a type of cholesterol found in the skin to vitamin D. Modern lifestyle has limited our exposure to the sun. There are many variables that affect the ability of the skin to produce vitamin D. As a result it is difficult to recommend how much sunlight is enough. Most authorities recommend between 5 to 30 minutes of sun exposure to your unprotected face, arms, legs or back between 11 am and 3 pm two to three times a week.  Early morning or late evening sunlight does not work as UV rays are not able to penetrate the atmosphere. Ability to produce vitamin D also depends on the colour of the skin. Fair skin people need less sunlight than darker ones in whom melanin (skin pigment) restricts entry to UV rays. Exposure to sunlight should be direct as UV rays are restricted by glass (window panes) and sunscreen. Weather conditions, cloud cover, pollution and clothing also affect vitamin D production in the skin. At the same time too much sun exposure is detrimental.

Certain groups of people are at higher risk for vitamin D deficiency. These include pregnant and breast feeding women, children between 6 months and 5 years, persons older than 65 and persons who keep their skin covered or stay indoors (don't get enough exposure to sunlight). At risk individuals need to discuss with their doctor and get vitamin D supplements. In America and some European countries, milk and fruit drinks are fortified with vitamin D.

Few sources of vitamin D in diet coupled with poor exposure to sunlight and lack of fortified foodstuffs (especially in India and Asia) makes huge sections of the population at risk for vitamin D deficiency. Everyone should get their blood levels of vitamin D tested. If deficient, appropriate changes must be made in lifestyle to increase exposure to sunlight. If that is not possible, vitamin D supplements are necessary.

Vitamin D deficiency is a modern and very real epidemic that has silently contributed to increase rates of osteoporotic fractures, heart attacks, influenza, rheumatoid arthritis, cancer and premature births! The general public needs to become aware of this hidden deficiency and take immediate corrective measures! 

Saturday, May 17, 2014

​Life After Knee Replacement​

Lots of patients are advised knee replacement! But do you really need it? How to really know if you require a surgery? Knee Replacement is a major surgery which should not be taken lightly. It's a great success for those who actually need it and can be a disaster for a  patient who doesn't. The doctor is naturally the best person to make the decision. Sadly many doctors are doing unnecessary surgery for monetary gain. The time has come for patients to become smart! It is my wish that patients become aware enough to decide for themselves. Patients should be able to choose a good decision from a bad one. Enlightening patients has always been my sincere endeavour! 


Knee replacement is the final option for a patient with arthritis. It is chosen when all else fails. The patient should have tried all possible treatment methods before considering surgery. Surgery is done for a patient who has constant and severe pain. Pain on getting up from the floor or when going up and down stairs, is common and doesn't usually warrant a knee replacement. However pain during walking is far more serious. Patients who need surgery can barely walk a few hundred feet. Every step is painful. They limp and walk very slowly. Many need a walking stick for support.  Activities of daily living are affected. Such patients tend to remain at home. They will avoid social commitments that require them to leave the house. Getting up at night and going to the bathroom is a huge and painful effort. Painkiller medications are required to get through the day. If you are so disabled and have tried many types of treatments without much benefit, get a knee replacement done.It is a beautifully successful surgery after which you will become normal again. But if you are not so bad, then think again! Knee replacement may not be the best option for you. It may be wiser to wait a while and consider other options. 


What has been the experience of patients who have undergone this surgery? Is it really successful? Does it give long term relief? Is the surgery painful? Before surgery, the patients are screened for infection and assessed for fitness. This involves investigations like blood tests, chest X-ray, etc. A physician checks the patient and certifies him or her fit for surgery. The patient is admitted one day prior to surgery. The surgery is done most often under spinal anaesthesia. A small injection is given with a thin needle in the lower back of the patient which makes the legs numb. The actual surgery lasts for 60 to 90 minutes. When the anaesthesia wares off, the patient experiences postoperative pain. The pain is severe for the first 2 to 4 days. Doctors usually have pain management protocols in place to manage the pain like epidural injections, blocks etc. After that the patient gets pain while exercising the knee (lifting the leg, bending the knee) and during walking.  As time passes the pain reduces and completely disappears by 8 to 10 weeks. The patient starts walking on the second or third day after surgery.  Post surgery the patient's leg becomes weak (due to cutting of muscle during surgery). Initially the patient needs a walker to walk. As time passes the leg becomes stronger and the patient can walk independently. Surgery also leads to swelling of the leg and the knee. This is a normal reaction to surgical trauma. The swelling automatically subsides in 12 to 16 weeks. After this period of recovery is complete, the patient truly experiences the benefits of surgery. The Person stops being a patient and becomes normal. He/she has complete relief from pain. He/she can walk normally (and fast) without a limp or stick. He/she does not need pain killers.


Even though knee replacement is a major surgery and has a long recovery time, it is a truly gratifying surgery which gives a person spectacular and lasting results.         

Wednesday, December 18, 2013

What to ask your surgeon?

It is normal to be afraid of surgery. If given a choice, all of us would stay away from surgery. Our reasons for avoiding surgery are obvious. Surgeries come with a baggage of complications. Rarely a complication is severe enough to offset any potential benefit promised by the surgery. The complication itself becomes a bigger problem than the original illness. A complication can happen with the best surgeon having the purest intentions. Therefore it is wise to be scared of surgery. 

Yet we often find ourselves facing surgery. The truth is many problems cannot be solved effectively unless tackled by surgery. Surgery today is far more successful due to improved knowledge, experience and technology. Many patients have undergone surgery and have benefitted tremendously. So if a patient is offered surgery, how should he/she approach the situation?

The first question to be answered is 'Is my problem bad enough?' This is an obvious question and most patients address it correctly. Doing a major surgery for minor issues is a strict 'NO'. Often the alternative non surgical treatments are equally effective. Even though this is a simple decision to make, sometimes patients get carried away by social and economic pressures. I find patients asking for surgery just because they have seen a friend benefit from it or they have the money to buy it! Surgeries are of 2 types: the 'life saving' surgery and the 'quality of life' surgery. With life saving surgeries, the decision is easy. The problem is with 'quality of life' surgeries. For example: a decision to do angioplasty (heart) surgery is easy as it is life saving but a decision to do knee replacement is difficult as it is done to improve quality of life. 

The second question is 'what is the risk-benefit analysis?' Is the benefit promised by the surgery more than the risk of something going wrong or a complication happening. The best surgeries are the ones that offer good results with little risk. For e.g. Knee Replacement completely solves the patients problem (huge benefits) and has a low complication rate. At the other end of the spectrum are surgeries that are new, experimental and unproven. Beware of these as failure rates are high and complications are more.  In between are the surgeries that have proven good results but with a high complication rate. In this situation, I encourage patients to understand the risks completely by a detailed dialogue with the surgeon. 

The next question is 'How good is the surgeon?' This is a difficult question for the patient to answer. As a general rule a specialist will be better. Patients gauge a surgeons skill by his success. Though patients don't have a better way, this method of finding a good surgeon is flawed. Success or fame is multi factorial and a 'famous' surgeon may not necessarily be the most skilled. One effective way is to speak to patients already operated by the surgeon. They often give lots of insight and improve your confidence. 

The last question is 'Have I done my research?' We do a lot of research when we have to buy a new car or a new house. Similarly I encourage patients to do research when they are facing a surgery. Today is the age of information technology and all is available on the Internet. Details of the illness, the success rate of the surgery, the potential complications, the experience of other patients etc need to be researched by patients looking at a surgical option. The procedure should be discussed in detail with your surgeon. I see patients asking questions like 'Is there any guarantee for this surgery?' The answer is obvious and the surgeons who say 'YES' are lying. While this is not a sensible question to ask, there is a list of questions that every patient must ask his/her surgeon. 'What is the percentage of success of the surgery?', 'What are the complications?', 'What are the chances of something going wrong?', 'If a complication occurs, what is its treatment?', 'What is the recovery time?', 'How long will the surgical pain last?' are some of those questions.  

To conclude, everyone would like to avoid surgery but sometimes we cannot. If facing surgery, we should arm ourselves with knowledge beforehand so that we can take intelligent decisions and avoid facing nasty surprises later.