We know that obesity is a risk factor for several non communicable diseases, it can lead to diabetes and other metabolic conditions, but there is less awareness that obesity can lead to serious liver disease.It is estimated up to 1 in every 3 people in the UK has early stages of NAFLD, where there are small amounts of fat in their liver.

Non-alcoholic fatty liver disease is the accumulation of triglycerides in the liver cell and this buildup is independent of alcohol consumption. It is a spectrum of disorder ranging from less severe steatosis (fatty liver) to more severe non-alcoholic steatohepatitis (NASH), where the liver has become inflamed; this is estimated to affect up to 5% of the UK population. Fibrosis and cirrhosis develop at later stages and lead to liver failure and sometimes liver carcinoma.

what causes NAFLD

• The exact cause of NAFLD remains unclear, however, it is linked with genetic and environmental factors like
• 1.Obesity
• 2.Diabetes
• 3.Hyperlipidemia
• 4.Women with PCOS5.
• 5.Sedentary lifestyle

Treatment and prevention

There is no specific pharmacological treatment for NFALD. However, various medicines can be useful in managing the problems associated with the condition like;medications for high cholesterol, high blood pressure and Insulin sanitizers.

Life style modifications;

There is a strong consensus that lifestyle interventions such as diet, physical activity and weight reduction can help in preventing and reduces the progression of the disease. A metanalysis of 23 trials shows that lifestyle modification including weight loss and physically activity consistently reduced liver fat and improved histopathology.

WELL BALANCED DIET; Diet consists of vegetables and fruits with less processed carbohydrates. Low Glycemic index carbohydrates with more fibre content also reduce insulin resistance which is directly linked with NAFLD. Low caloric diet intake ( 3-6 months) either low carbohydrates or low fat diet results in weight loss and improved lipid profile.

Intake of polyunsaturated fats especially omega 3 fatty acids reduces the risk of NAFLD. Mediterianean diet is a best source of mono unsaturated fatty acids( MUFA) like n– oleic acid (olives, nuts, avocado), which play an important role in the metabolic profile of human metabolism. MUFA has been demonstrated a beneficial effect on lipid profile bt decreasing  plasma triacylglycerol and very low density lipoprotein (VLDL) cholesterol concentrations and modestly increasing high density lipoprotein (HDL) cholesterol without adversely affecting low density lipoprotein (LDL) cholesterol concentrations. 

Soft drinks are leading cause of added sugars in the world and different observational studies report a positive association between soft drink consumption and NAFLD. Soft drinks like cola drinks contain caramel coloring, which is rich in advanced glycation end products (AGEs) that may increase insulin resistance and inflammation.

Observational studies have demonstrated a favourable impact of coffee intake on health and in particular a protective effect from the metabolic syndrome. Coffee contain polyphenols chlorogenic acid which acts as antoxidants, anti inflammatory and reduces the risks of developing NAFLD and cardiovascular diseases.

Regular physical activity: There is a dose-response relationship between NAFLD and physical activity (both prevalence and disease severity,  therefore, the more physical activity performed throughout the day, the better! Aim to do at least 150 minutes/week of physical activity like walking or cycling. Increasing daily walking has also been shown to improve fat oxidation and is a way of increasing physical activity levels at no cost and without additional equipment. Aerobic and resistance exercises both improves NAFLD. A systematic review (24 exercise-only studies) revealed that exercise produced a 20–30% relative reduction in hepatic steatosis, independent of weight loss in NAFLD patients.

weight reduction: Based on available data, patients should optimally achieve a 5%-10% weight reduction. A prospective study with 7 years of follow up emphasized that even a modest weight change of 3–5 kg is an independent predictor for the development and remission of NAFLD, regardless of baseline body mass index (BMI).

TAKE-HOME MESSAGE

Lifestyle interventions can be highly effective in treating NAFLD across the disease spectrum and offer a holistic way of managing not only liver health, but also cardiovascular and metabolic health. Patients often feel difficult to achieve and implement these modifications, however with proper and individualized support suffient long term changes can be possible.

always set Smart, Meaurable, Achievable, Relevant, Timely goals

Irritable bowel syndrome (IBS) is not as simple as just having an unhappy gut, its not all in our head either. IBS not only manifest as painful gut but it also affects patients confidence, body image and mental health.

Irritable bowel syndrome (IBS) is the most common chronic functional disease of the digestive system. Around 20% of the world population is affected by this order. Women are around 2 to 3 times more likely to be diagnosed with IBS and 4 to 5 times more likely to seek specialty care for it than men.

A variety of gastrointestinal and extraintestinal factors are likely to influence the manifestation of IBS. Dysregulation of the brain-gut axis, gastrointestinal infection, low-grade infiltration and activation of mast cells in the intestinal mucosa with consequent release of bioactive substances, and altered serotonin metabolism are the emerging factors of IBS pathogenesis.

sex hormones like estrogen and progesterone affect motor and sensory function of GIT and triggfer IBS symptoms in women before or during mensturation.

SYMPTOMS OF IBS

The most common symptoms of IBS are abdominal pain, bloating, altered bowel movements diarrhea or constipation. Some people may experience both constipationa and diarrhea at different time. IBS is also associated with psychological disorders like anxiety and depression, gastroesophageal reflux and genitourinary infections. women with IBS may be at risk of developing endometriosis or having a hystercetomy.

TREATMENT

Only symptomatic treatment is available for IBS, the choice of drug treatment depends on the nature and severity of the symptoms. Many drug treatment options for IBS are available over-the-counter. According to NICE guidelines, Antispasmodic drugs (such as alverine citrate, mebeverine hydrochloride and peppermint oil) can be taken in addition to dietary and lifestyle changes. A laxative (excluding lactulose as it may cause bloating) can be used to treat constipation.

Antidepressants like amitriptyline and citalopram can be used as a second line of treatment  in patients who have not responded to antispasmodics, anti-motility drugs, or laxatives. A selective serotonin reuptake inhibitor may be considered in those who do not respond to a tricyclic antidepressant [unlicensed indication]

LIFESTYLE INTERVENTIONS

DIET

Diet plays an important role in IBS management as it controls symptoms, but it does not necessarily target the underlying cause. so if you eliminate the foods that trigger your symptoms it improves your IBS symptoms but, when trigger foods are reintroduced, often symptoms also return. In IBS management, the way you eat and what you eat both have an important impact on gut symptoms.

• Reduce caffiene intake;limit tea and coffee to not more than three cups a day.
• limit alcohol and fizzy drinks
• Reduce intake of resistant starch, fatty foods
• Drink plenty of water
• Try Probiotics;Yoghurt and some drinkss and supplemets such as tablets, capsules or sachets.

Fibre in IBS; Fibre is double edge sword in IBS as for some it is a blessing and for other IBS patients, it can worsen their symptoms. When considering fibre, it is important to look at both the quantity and the type of fibre (insoluble or soluble), as too little or too much fibre can trigger IBS symptoms.

Quality of fibre also matters. soluble fibre and insoluble fibre behave very differently when they reach the digestive system. If an increase in dietary fibre is required always to prefer soluble fibre as they dissolve in water and remove excess fluid and that how they are good in IBS with diarrhea.

 Intake of insoluble fibre (e.g. bran) and ‘resistant starch’ should be reduced or discouraged as they may exacerbate symptoms.

• Psyllium; It is a unique soluble fibre that has a dual function, it softens the hard stools and also helps in IBS with diarrhea by thickening up loose stool.it may also improve bloating and incomplete evacuation.

• Flaxseed; Flaxseed is good for IBS with constipation. aways start with low quantity like half tablespoon (6g) per day and then gradually increase up to 2 tablespoons. The seeds are either swallowed whole with water or soft food such as yogurt, or they are ground up and sprinkled on food

• Peppermint oil /tea; There is a growing body of evidence that supports the efficacy of peppermint oil in IBS. It is a natural solution for IBS with minimal side effects. Peppermint oil is antispasmodic and relax intense intestine and reduce abdominal pain.

FODMAP

There is a group of carbohydrates found in different foods which causes IBS symptoms as they are poorly absorbed in the small intestine. FODMAP is a term used for these foods. f=fermented,o=oligosaccharide,d= disaccharides, m=monosacchrides,p= polyols. these are present in the stonefruits, legumes, lactose-containing foods, and artificial sweeteners might exacerbate symptoms in a subgroup of patients due to their fermentation and osmotic
effects.

• BACTERIAL FERMENTATION; Gut bacteria in the large intestine ferment this indigestible fodmap and gives off-gas. This gas distends the stomach, causing bloating, wind, constipation and explosive stool.
• OSMOTIC OVERLOAD; FODMAP can draw water in from the body into the small bowel and increasing the pressure over the intestinal wall causing diarrhea or some experience hard stool followed by watery stools.

Low FODMAP diet ; Low fodmap diet is a sceond line approach for IBS patients. It improves IBS symptoms in around 70% of patients however, this diet is not for a lifetime and should be introduced under the supervision of qualified professionals. For more about low fodmap diet, which food are included, phases of this diet, visit this website. https://www.monashfodmap.com/

NON DIET APRROACH

Move YOUR BODY;

Physical activities boost mood and also good for the gut muscles. Low-intensity exercises like walking, swimming, cycling, light jogging can help reduce stress and control IBS symptoms.

STRESS MANAGEMENT

IBS is considered a disorder of gut and brain and any kind of stress, physical or psychological have a direct effect on the symptoms of IBS as evident by data. Relaxation and other stress-reduction techniques could bring a sense of wellbeing and have an impact on the severity of IBS symptoms.

COGNITIVE BEHAVIOURAL THERAPY (CBT); There is increasing evidence for the efficacy of CBT in alleviating the physical and psychological symptoms of IBS.

SLEEP HYGIENE;

Sleep disturbance is very common among IBS patients. studies show positive association between sleep deprivation and worse gut symptoms. Poor bad night sleep results in bad IBS day symptoms. Sleep quality and duration equally important, but one in three adult do not get quality sleep.

take home message;

IBS is a chronic disorder ofthe digestive system but for the majority of patient, it is frustrating and its effect on the quality of life make it a disease with high cost. Current medical tratment for IBS, only targets the symptoms of this disorder. IBS can be managed by identifying what triggers the symptoms, which food is good for IBS. Non diet approach like physical activity, relaxing tecniques all show promising results in alleviating IBS sypmtoms.IBS symptoms varies from person to person so personalized interventions are important.

The shoe that fits one person pinches another; there is no recepie for living that suits all

Migraine is common all over the world, it has been estimated that it affects around 1 in every 5 women and around 1 in every 15 men.Migraine is not a just common headache, it is a chronic condition affecting all aspect of life. 90% of people who suffer from migraines are unable to function or work properly during their migraines. According to a report published by Work Foundation UK “Migraine costs the UK economy £8.8 billion per year in lost productivity.

SYMPTOMS;

Migraine symptoms vary from person to person, however the majority of patients presented with three main symptoms;

• Headache which is usually onesided.people with migraine describe it as throbbing, crushing or pounding.
• Sensitivity to light and sound
• Nausea and vomiting

There are different phases of migraine like; prodrome phase, aura phase and resolution phase.

Many migraineurs experience vague vegetative or affective symptoms
as much as 24 hours prior to the onset of a migraine attack. This phase is called the prodrome and should not be confused with the aura phase. Aura phase is consist of neurological symptoms like sensitivity to light or sound.

Within an hour of resolution of the aura symptoms, the typical migraine headache usually appears with its unilateral throbbing pain and associated nausea, vomiting, sensitivity to light(photophobia), or sound (phonophobia). This headache may persist for up to 72 hours if untreated and ended with resolution phase which is characterized by deep sleep.

causes;

The exact cause of migraine remains unclear, but there is often family history of migraine, suggestive of genetic predisposition. Additionally, research suggests that variations within the dopamine D2 receptor gene also may have some effect on susceptibility to migraine. Thus, genetic studies are providing important information about the molecular basis
of migraine. Migraine is also considered as a neurovascular disease because of throbbing nature of headache. According to Dr. John Detre, a professor of neurology and radiology:

Abnormalities in both the circle of Willis and blood flow were most prominent in the back of the brain, where the visual cortex is located. This may help explain why the most common migraine auras consist of visual symptoms such as seeing distortions, spots or wavy lines.”

Every one has different migrain trigger but there are few common triggers which may initiate the attack of migraine like;

• Hormonal changes; The great female preponderance and the tendency for some women to have migraine attack at certain points in their menstrual cycle hint at hormonal influence.
• Emotional stress; According to the American Headache Society, about 4 to 5 people with migraine report stress as a trigger.
• DIET; certain food like alcohol, chocolates, curried meat, smoked fish, yeast extract, food preservatives that contain nitrities and nitrates, artificial sweetener and monosodium glutamate(MSG) may trigger a migraine.
• Sleep; poor sleep reduces the levels of dopamine and serotonin, neurotransmitters, essential for and trigger migraine headache. one study shows that good sleep reduces both the number and frequency of mgraine in the participants.

Treatment and management

There is no specific treatment for migraine but certiain medicine can be effective for acute attack like

• Painkillers like paracetamole, Aspirin with an antiemetic for vomitting like Metoclopramide
• Antinflammatory like ibubrophin
• Triptans like sumatriptan

if attacks are frequents, prevention of migraine can be treated by propranolol or tricyclic such as amitriptilyin

If you suspect a specific trigger is causing your migraines, such as stress or a certain type of food, avoiding this trigger may help reduce your risk of experiencing migraines.

It may also help to maintain a generally healthy lifestyle, including regular exercise, sleep and meals, as well as ensuring you stay well hydrated and limiting your intake of caffeine and alcohol.

Keeping track of your migraine headach bu using migraine journal can help you identify the triggers and potentially reduces the frequency of your attack

If your migraines are severe or you have tried avoiding possible triggers and are still experiencing symptoms, a GP may prescribe medicines to help prevent further attacks.

Do not allow your life to be controlled by migraine.