MIGRAINES

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.

seasonal affective disorder

if dark and cold weather makes you depressed and tired, learn about Seasonal affective disorder and what are the best ways to treat it.
Seasonal affective disorder or winter blue is a mood disorder in which people may experience depression/anxiety mostly in winters although they have normal mental health. Around 6%of UK population and between 2-8%of people in other high latitude countries such as Denmark, Canada and Sweden these symptoms may interfere with the normal routine of people and they are unable to perform their work or function properly due to the severity of these symptoms. women are 40% more likely than men to experience symptoms of SAD.

SYMPTOMS OF SAD;

  • 👉Sleepiness/oversleeping
  • 👉Lethargy and low energy
  • 👉Depression/ Anxiety
  • 👉Cravings for carbs /overeating.
  • To be clinically diagnosed with seasonal affective disorder, you need to have experienced these cyclical symptoms for two or more consecutive years.

CAUSES AND RISK FACTORS;

👉Circadian rhythms. short day time, less sunlight disrupt our circadian rhythms and lead to symptoms of SAD.
👉Production of melatonin; it is believed by researchers that excessive production of melatonin is one of the causes of this disorder. Increased levels of melatonin make you sleepy and tired.
👉Production of serotonin; Serotonin regulates depression anxiety and mood. several studies suggest that serotonin is modulated by light. in winters less sunlight reduces the levels of serotonin to such extent that it increases the likelihood of depressive symptoms.

SELF HELP FOR SAD;

 
👉Natural light☀️; many studies have shown that people with SAD feel better after exposure to bright sunlight.
👉 Eat the right foods🥦🥑🍓🍇🍉 citrus food, oily fish, nuts, green leafy vegetables. Avoid refined processed food.
👉Regular exercise🚶‍♀️🏊‍♀️🚴‍♀️; Moving around makes everyone happy and if you are suffering from SAD, regular exercise will boost your mood and makes you happy and energetic.
👉Friends and family; tie the season for family gatherings. spending time with family or friends can make you happy and may help in reducing the symptoms of SAD.
👉Stress management;🧘‍♀️🧘‍♀️yoga and meditation are the best way for the stress management.

TREATMENT

The National Institute for Health and Care Excellence (NICE) recommends that SAD should be treated in the same way as other types of depression. This includes cognitive therapy (CBT), medication. light therapy is also a popular treatment but NICE recommendation says there is not enough data to backup this mode of treatment.

Medications; Antidepressants are thought to be most effective if taken at the start of winter before symptoms appear, and continued until spring. Antidepressants are combined with light therapy for people with severe SAD.

Light therapy; Some people with SAD find that Artificial bright light can help improve their mood. it is suggested by researchers that artificial light stimulate the brain neurotransmitters and reduces the production of melatonin.

take home message

if you are struggling with symptoms of SAD, talking to other is very important. There are several charities or people that can help you through your struggle. Remember,consult your healthcare professional if you think you have SAD.

Advanced Glycation End products and their link to chronic diseases.

Advanced glycation end products are pro-inflammatory molecules found in various foods (animal derived proteins and processed food). They also formed inside the body by a chemical reaction called Glycation. AGEs from diet absorbed partially in the intestine (only 30% ) and about two third of absorbed AGEs remain in the body for 3 day resulting in increased oxidative stress and inflammation.

Factors which may increase the formation of AGEs in food.

Urbarri and his colleagues formed a database of 560 different food and their AGEs content based on standard serving size. This database revealed that AGEs content of food depends on several factors like type of food, cooking temperature and cooking time.Food with higher content of proteins and fats are rich sources of exogenous AGEs as compared to carbohydrates.

  • Animal derived proteins have higher levels of AGEs, On the other hand, fresh fruits vegetables, low-fat milk and legumes have the lowest AGEs (Goldberg et al .,2004). The reason must be sought in the higher quantity of water and in a richer presence of vitamins and antioxidant molecules, which may be able to prevent AGE formation.
  • Cooking techniques; Different cooking techniques are linked to the formation of AGES like grilling, frying, roasting. Foods items processed by dry heat like chips cracker contains the highest level of AGEs per gram of food (Uribarri J, 2010) this processing method also increases AGEs content of lean red meat and poultry. As this pyramid shows formation of AGEs by different cooking techniques frying>grilled>boiled>raw.

   The AGES Pyramid                                                                      

AGEs and their link with chronic diseases;

Advanced glycation end products are believed to play a critical role in the pathogenesis of different diseases like polycystic ovarian syndrome (PCOS), diabetes, liver diseases, heart diseases, arthritis and kidney failure. our body can eliminate AGEs by enzymatic mechanisms and through the kidney. however, when we consume too much AGEs, they begin to accumulate in our body and promote oxidative stress and inflammation.There is also evidence that people with Diabetes and PCOS have higher levels of AGEs in their body as compared to healthy population.

How much do we need;

limited data is available regarding the exact amount of AGEs intake however, according to Uribarri, the average total daily adult consumption of AGEs in our diet is around 16,000 AGE kU/day. Therefore, a high-AGE diet is often referred to as anything significantly above 16,000 kilo units daily and anything well below this is considered as low AGEs diet.

How we generate low AGEs diet;

studies has shown that by restricting the dietary intake of AGEs in patients with diabetes and kidney diseases as well as in healthy people, reduces the markers of oxidative stress and inflammation.one study reported that consumption of low AGEs diet over 4 weeks improve insulin resistance in overweight women .Some studies reported that reduced level of serum AGEs are associated with reduction in body fat mass and adipose tissues in women with PCOS.

Reduced intake of AGEs can be achieved by ;

  • Increasing the consumption of fish, legumes, low-fat milk products, vegetables, fruits, and whole grains.one study reported that phytonutrients like iridoids found in deep red coloured berries can reduces AGEs formation in our body.
  • By reducing the intake of solid fats, fatty meats, full-fat dairy products, and highly processed foods.
  • By switching cooking techniques; boiling, steaming and stewing reduces the production of AGEs in food. For example, the high AGE content of broiled chicken (5,828 kU/100 g) and broiled beef (5,963 kU/100 g) can be significantly reduced (1,124 kU/100 g and 2,230 kU/100 g, respectively) when the same piece of meat is either boiled or stewed.
  • The use of acidic marinades, such as lemon juice and vinegar, before cooking, can also be encouraged to limit dAGE generation.
  • Get active; regular physical activity may reduces the formation of AGEs inside the body.

Finally, more research is needed to fully understand the role of dietary AGEs in chronic diseases and a complete database on AGE content in different foods may helpful for future studies. however, low AGEs diet guidelines are consistent with the existing healthy eating recommendation. As with most dietary issues, the key is moderation: “Just diminish your exposure.


Polycystic ovarian syndrome and lifestyle interventions

Polycystic ovarian syndrome (PCOS) is the most common endocrine disorder among women in their childbearing age around 18 -25% of women all over the world suffering from this syndrome.

PCOS SYMPTOMS

Women with this PCOS can represent different symptoms, most common are following;

  • Irregular periods
  • Excess facial hair growth (HIRSUTISM)
  • Infertility or difficulty getting pregnant ( because of irregular ovulation or failure to ovulate)
  • Obesity
  • Acne and skin problems like Dermatitis.
  • Depression, anxiety, bipolar disorders and eating disorders.
  • Metabolic syndrome; hypertension, diabetes and coronary artery diseases

How to diagnose PCOS??

This condition should invite early diagnosis and intervention because there is considerable evidence that women with PCOS are at increased risk of
infertility, dysfunctional uterine bleeding, metabolic syndrome, type II diabetes, and cardiovascular disease. A Rotterdam criterion is widely used as a diagnostic assessment for PCOS. It requires two of the following three features;

  • Irregular or skipped periods
  • Anovulation
  • Multiple cysts in ovaries on ultrasound
  • Higher levels of Androgens; either manifested by symptoms like Hirsuitism, Acne or balding or biological evidence like raised levels of Testosterone in their blood tests.

Causes and risk factors;

The exact cause of this syndrome remains elusive however excess androgens production and insulin resistance may cause this syndrome. A Genetic factor is also important as several studies reported an increase incidence among first degree relatives. It is reported by studies that around 50-70% of women with PCOS have insulin resistance meaning their cells are not able to use insulin effectively. To keep body glucose normal, the body tries to pump out the high level of insulin. This hyperinsulinemia is associated with weight gain and increase production of androgen hormone testosterone. Insulin resistance makes it harder to lose weight, that’s why women with PCOS experience this issue.

lifestyle interventions for PCOS management;

According to international PCOS guideline 2018, lifestyle interventions like diet, exercise, behaviour or combined are recommended as first line management for PCOS. Several studies reported the higher prevalence of obesity and overweight in women with PCOS as compared to the general population so these prevention opportunities are particularly relevant for the management of PCOS symptoms.

How the intervention might work

Lifestyle intervention is therefore anticipated to work because a reduction in the Body Mass Index (BMI) will be associated with a reduction in insulin resistance, which will, in turn, lead to an improvement in the reproductive and metabolic features of PCOS. Weight loss of as little as 5-10% has been demonstrated to correct oligo anovulation and improve the ability of women with PCOS to conceive.

PCOS nutrition ;

its is frequently asked by women with PCOS that which diet is best for curing their symptoms but unfortunately there is no such miracle diet. Research shows that diet which reduces insulin resistance like some carbs, proteins and healthy fats may help in improving menstrual irregularities and obesity.

➡️choose your carbs wisely as all carbs are not bad… carbohydrates with high fibre content like whole grains, lentils, legume and beans are helpful in reducing weight and risk of type 2 diabetes in women with PCOS.

➡️ Food with a low glycemic index (a ranking system indicate how rapidly blood sugar level rises after eating carbohydrates) may reduce insulin resistance as reported by several studies.

➡️ Protein may helps in cravings, balance hormones levels and aid in weight reduction, examples are lean meat, egg, seafood and plant based proteins. some evidence has suggested the beneficial effect of a diet with higher ratio of protein to carbohydrates.

➡️ Food that reduces inflammation as; tomato, spinach, olive oil, walnuts, almonds, blueberries and strawberries.

Food to avoid;

  • Food high in refined carbs like white bread, Muffins, white pasta
  • sugary drinks like soda and juices as they increase blood sugar levels, which can lead to weight gain and worsen the symptoms of PCOS.
  • Processed food and red meat.

Review the stress in your life;

stress increases cortisol level and this high level is linked with insulin resistance and weight gain. yoga and meditation can reduce stress as reported by studies.

Make sure you are getting enough sleep:

Several studies observed that short sleep duration is significantly associated with metabolic abnormalities, including higher BMI, raised fasting insulin levels, and increased risk of insulin resistance. Make sure you are getting enough and good quality sleep.

Get active;

Regular physical activity may help in reducing insulin resistance. studies have shown that low intensity exercise like walking or cycling reduces levels of cortisol and helps in reducing insulin resistance.

Consider supplements;

certain supplements like vitamin D, Myo inositol may help manage weight and other symptoms of PCOS though there is very little research is available to recommend these supplements for PCOS.

Take-home message;

PCOS is distressing for most of the women due to its symptoms and it is suggested by clinicians and dietitians that life style modification is the first line treatment for overweight and obese women.However due to diversity of symptoms one size does no fit for all. Make healthy food choices and create workout plan that suits your body and your PCOS….

BEAT THE BLOAT

Bloating is swelling or distention of the abdomen (belly area) after eating.it is very frequent and normal for the majority of people. About 16-30% of people report that they regularly experience bloating after eating. But for some, it is quite painful and makes them sluggish and uncomfortable.

Causes of bloating;

➡️ Some medical conditions like; celiac disease, irritable bowel syndrome, eating disorders, hormone flux and food intolerance.

➡️ Serious causes like; ovarian cancer, pancreatic cancer, stomach cancer liver diseases and kidney diseases but remember, bloating in these conditions is associated with other specific symptoms.

➡️Large meals: eating large potion means our body produces more gas during digestion and that process can lead to our tummy being larger.

➡️Food sensitivity: some food like beans, pulses, lactose, wheat, veggies high in FODMAP may cause bloating in some people.

➡️ fizzy drinks, drinking through a straw and talking during eating may increase the amount of swallowed air.

➡️Stress and anxiety may also cause bloating, poor sleeping habits can have an impact.

➡️Drinking too much caffeine or alcohol

How to reduce bloating;

👉Small meal and proper chewing: proper chewing may reduce the amount of swallowed air and makes you eat slower.

👉Check your fibre: fibre intake should be adequate. too little or too much fibre can make bloating worse.

👉Food records: food diaries may help to identify the patterns of symptoms and food you eat.

👉 Fermented food; eating fermented food like kimchi, tempeh, pickles and kefir may reduce bloating as they are full of probiotics and natural way to boost good bacteria in our gut.

👉 Stay well hydrated: As constipation is one of the main cause of bloating and could be triggered by not drinking enough fluid. Aim to drink 1.5 litres of water a day and cut down on hydration robbers like caffeine, alcohol, fizzy drinks.

👉Avoid chewing gums and carbonated drinks.

👉Regular exercise: A short walk after a meal can alleviate bloating. Aim for 30 minutes mild exercise. gentle exercise and stretching can help diffuse trapped gas like yoga

👉 Check your hormonal cycle; many women experienced bloating and constipation when their period is due, because of higher levels of progesterone. Overcome any hormonal hurdle by staying active, drinking plenty of water and eating a healthy diet.

👉Herbal tea can also helpful; peppermint tea or peppermint oil has been shown to relax our gut muscles and help relieve bloating triggered by trapped gas. several studies suggest that peppermint oil in IBS is helpful as it has an antispasmodic effect which means it relax our gut and reduce tummy pain and bloating associated with IBS.

▶️Take-home Message: it is important to remember that occasional bloating is normal but If bloating is associated with diarrhoea and other medical conditions you should consult with the doctor.

Carbohydrates; friend or foe

Carbohydrates one of the important macronutrient found in food along with fats and protein, but the most misunderstood nutrient. People often say carbs as fattening and linked to various diseases, but this is not a real story. Let’s examine their role and bust this myth surrounding this hotly debated topic.

Types of carbohydrates:

Simple carbohydrates; simple carbohydrates consist of molecule called glucose. They rapidly degraded inside the body and raises blood glucose level. examples are honey, maple syrup, fruits and vegetables. Added sugar in cakes,candies and fruit juices is also simple carbs.

Complex carbohydrates; complex carbohydrates are starch and fibre. These are consist of long chain of glucose molecules. Examples are potatos, corn. Refined carbohydrates like white bread and pastries are also strach. Fibre is a plant derived indigestible carbohydrate.

Why we need carbohydrates:

  • Primary source of energy; The main function of carbohydrates is to provide energy. carbs are quicker to process and provide fuel to our body.our brain consume more than 20% of total energy intake and glucose is the main fuel for brain cells.unused glucose is stored in muscles and liver in the form of glycogen.
  • Important for Gut health; Fibre is helpful in digestion and improves our gut health. Our gut is the host of around 1 trillion microorganisms. several studies show that these microorganisms are crucial for various aspects of our health. Dietary fibers are indigestable and feed our gut microbiota and promote growth of GOOD bacteria.
  • Carbohydrates helps preserve muscles mass; carbohydrates prevent the breakdown of protein for energy and preserve muscles mass.
  • They influence heart diseases and Diabetes; carbohydrates enrich with fibre, reduces the risk of heart diseases, diabetes and some form of cancer. One study shows that people eating cereal based fibre have a decreased risk of colon cancer. Oats and barely contain a special chemical called Beta glucan which may helps to reduce blood cholesterol levels.

How much carb do we need

Daily recommended intake for carbohydrates is 45-65% of total caloric intake and 130gm of glucose is needed for adequate supply of energy to the brain.

Why people think carbs are bad for our health;

Carbohydrates have a bad reputation as people think eating carb means they are eating an unhealthy diet and may gain weight, but all carbohydrates are created not equally. What makes a carb good choice for our health. complex carbohydrates are good for our health as they are

  • lower in calories
  • nutrient dense like minerals vitamins and fibre
  • lower in salt and fats

while simple carbohydrates like sugar, processed food, candies, fizzy drinks fruit juices and pastries.They ae not good for our health as they are

  • lower in nutrients
  • higher in calories
  • higher in salt and fat

These carbohydrates are linked to obesity and other chronic dieaeses as reported by studies. These carbs increase blood glucose levels rapidly and to combat this hyperglycemia, our body releases insulin. insulin promotes glucose storage in muscles and liver and allows the entry of glucose into fat cells by converting glucose into fatty acids. long term intake of a diet high in refined carbs may cause insulin resistance and increase the risk of obesity and type 2 diabetes. Moreover, sugary drinks are a leading cause of tooth decay in children and adults.

what’s the answer to carbohydtrates;Eating the right type of carbs with moderation.

  • Look for carbohydrates which makes you fuller for longer with minium calories like wholegrains, fruits and vegetables.
  • Avoid refined or procesed carbohydters.limit the intake of added sugars.
  • Take note of your body; whats makes you happy and energize and what food makes you lethargic and bloated. Notice pattern of your body, adjuct accordingly and choose your carb wisely.

Do not eat less, eat right ”.

Sleep ;an important pillar of healthy life.

”Sleep is the golden chain that ties health and our bodies together.”

~ Thomas Dekker

Sleep: the important pillar of health is forgotten by many of us…. constantly tired, puffy eyes and hands holding a cup loaded with caffeine is a common picture of this modern era. Sleep form around one- third of human life, so the shut-eye must be doing some restoration work which improves brain and body health.

What is Circadian rhythm;

it is 24 -hrs biological clock which regulate our sleeping pattern along with other vital functions like feeding , hormones production and body temperature. Normally this rhythm rises in morning time causes wakefullness and alertness, with the onset of darkness it dropped down to the lowest level and helps in sleeping.

Impact of sleep deprivation on our health;

Good sleep is as important as eating a healthy diet. Our body needs good sleep for maintaining brain health, mood stabilization and to fight against diseases. The cost of sacrificing sleep is very high, lack of sleep and disturbed sleep pattern are linked with health issues like obesity, depression, increased risk of diabetes and hypertension. Sleep deficiency does have a negative impact on work performance.

  • Sleep deprivation and Physical health; there is a growing body of evidence that sleep deprivation is associated with hypertension, coronary heart diseases (CHD), and diabetes mellitus(DM). Increased sympathetic nervous system activity is considered to serve as common pathophysiology in sleep deprivation’s relationships with these diseases.
  • Poor sleep and Obesity; The majority of studies found positive association between short sleep (<6 hrs/night) and obesity. Sleep deprivation is associated with altered metabolic and endocrine mechanism resulting in increased appetite and late-night cravings. Moreover, insufficient sleep makes you tired and less active, over time reduced physical activity may cause weight gain and obesity.
  • Poor sleep and Depression; Lack of sleep or disturbed sleep pattern has a direct link with psychological issues like depression and anxiety and suicide. Sleep deprivation causes decreased production of serotonin, a mood regulator chemical produced by our brain. Reduced level of serotonin causes depression and anxiety.
  • Poor sleep and work life: Short duration sleep may have a negative impact on a person’s work life. Poor sleep can impair people creative capacities and reduces motivation to learn and generate new ideas.

How much sleep do we really need?

Although there is no perfect sleep number to fit each individual, National sleep foundation published a report updating sleep recommendation for all ages.

How to imrove sleep hygiene ;

  • Food and drink; Avoid eating foods that are spicy and fatty as they are tough for the stomach and may disturb sleep. Timing of meal is also an important factor for having a good sleep. Avoid excessive consumption of alcohol and caffeine before going to bed.
  • Day light exposure; it is reported by some studies that daylight helps keep our circadian rhythm healthy.
  • Regular physical activity; According to National sleep foundation, people who exercise regularly have better sleep than those who do not. Some other studies suggested that exercise increases body temperature and increases production of Adenosine a chemical which causes drowsiness and improves circadian rhythm.
  • Maintaining good sleeping habits; Avoid day time sleep, stop using elecronic gadgets (cell phones, laptops, tv) 30 minutes before going to bed. Smartphone light distrub production of Melatonin a chemical produced by our brain, which plays a vital role in regulating sleep-wake cycles.
  • Make a regular sleep cycle: Regular sleep pattern may also help in improving sleep quality and duration. Waking up and going to the bed at the same times each day improves our wakeup/sleep cycle.
  • Bedroom environment; Minimize noises, external light exposure. Try to make your sleeping environment quiet, relaxing and clean.
  • Clear your mind before going to bed; Several relaxing techniques like meditation, reading a book and relaxing massage may improve sleep quality and duration.

Take-home message ;

Sleep is the third pillar of a healthy life and good sleep is important for our physical and mental health. Everyone has occasional disturbed sleep but if you are struggling with lack of sleep for prolong period, contact your doctor for identifying and treating any underlying cause.

Happiness in simplicity can be achieved with a flexible mindset and nine hours of sleep each night.” – Dalai Lama