Goiter

 

Iodine deficiency is well-known to cause enlargement of the thyroid, known as a goiter. It is commonly seen in places far from the sea, where little iodine-rich food (such as fish and seafood) is consumed.

Goiters can be any one of several types of growths in the thyroid gland, located at the base of the front side of the neck just below the Adam’s apple. Basically, it is any enlargement of the thyroid gland.

Types

In the case of Graves’ disease, the entire thyroid gland becomes enlarged.

Another type, called toxic nodular goiter, results when one or more nodules develop in the thyroid and trigger excess production of thyroid hormone resulting in an enlarged thyroid gland.

A simple goiter may be a temporary problem that will remedy itself over time without medical intervention, or a symptom of another, possibly severe, thyroid condition that requires medical attention.

This above picture depicts the typical appearance of a goiter with an entire neck swollen because of the large thyroid. The mass compresses the trachea (windpipe) and esophagus (swallowing tube) leading to symptoms, such as coughing, waking up from sleep feeling breathless, and the sensation that food is getting stuck in the upper throat. Once a goiter gets this big, surgical removal is inevitable to relieve the symptoms.

Causes


It seems that the first side effects of the "imbalances" in the hormones are menopause, weight gain and thyroid problems appearing simultaneously. By itself, the thyroid can be affected by poor diet, fluoride in the water, excessive consumption of unsaturated fats, endurance exercise, pesticide residues in fruits and vegetables, x-ray radiation, alcohol and drugs. Auto-immune response due to the body becoming allergic to thyroid hormones and produces antibodies against the thyroid tissue, resulting in swelling of the thyroid gland is possible too.


Iodine is a critical nutrient for the proper functioning of the thyroid and production of thyroid hormones, failing which goiter develops. The most plentiful thyroid hormone is thyroxine (also known as T4) which stimulates the metabolism. Some thyroxine is converted into a related hormone known as triiodothyronine (T3), which is more metabolically active.

+ Goiters can occur when the thyroid gland produces high levels of thyroid hormone (hyperthyroidism) and may become toxic in some instances. Hence T4 tends to be above average.

+ However, for most sufferers is due to deficiency of thyroid hormone (hypothyroidism). For such cases, the master gland naturally compensates with an increase in thyroid stimulating hormone (TSH) in response to a defect in normal hormone synthesis within the thyroid gland that causes the thyroid to enlarge. This enlargement usually takes many years to become apparent. The reading should indicate low T4 and high TSH (Thyroid Stimulating Hormone).

+ Problem may arise when the pituitary gland fails to boost production of the hormone. This is indicated by a low T4 reading and a low TSH.


The following table summarizes some examples of typical test results and their potential meaning:

TSH	Free T4	Free or total T3	Probable Interpretation
High	Normal	Normal	Mild (subclinical) hypothyroidism
High	Low	Low or normal	Hypothyroidism
Low	Normal	Normal	Mild (subclinical) hyperthyroidism
Low	High or normal	High or normal	Hyperthyroidism
Low	Low or normal	Low or normal	Non-thyroidal illness; pituitary (secondary) hypothyroidism
Normal	High	High	Thyroid hormone resistance syndrome (a mutation in the thyroid hormone receptor decreases thyroid hormone function)

+ Enlargement could also occur with normal production of thyroid hormone, such as a nontoxic multi-nodular gland.

+ A sporadic goiter can form if you eat too many goiter-promoting foods, such as soybeans, rutabagas, cabbage, peaches, peanuts and spinach. These foods can suppress the manufacture of thyroid hormone by interfering with your thyroid’s ability to process iodide. It may also occur in people who live in areas with iodine-poor soil not getting enough iodine in their diet. This problem can be resolved by taking in iodine containing foods.

+ The BBC report makes the point that iodine deficiency can impair brain development in the foetus too. Ensuring adequate iodine intake does appear to be a matter of considerable importance, particularly for women of childbearing age.

+ It should be borne in mind that vegetarians and vegans are at a significantly increased risk of eating a diet deficient in iodine.

+ Certain medications such as lithium or aminoglutethimide can cause a simple goiter.

Likely sufferers

• Anyone over age 40
• People with a family history of goiter
• Mostly females

Symptoms


The main symptom is a swollen thyroid gland. The size may range from a single small nodule to a large neck lump.


Some people with a simple goiter may have symptoms of an underactive thyroid gland. In rare cases, the swollen thyroid can put pressure on the windpipe and esophagus, leading to:

• Breathing difficulties (may rarely occur with very large goiters)
• Cough
• Hoarseness
• Swallowing difficulties 

Other manifesting symptoms are:

• Dry skin, dry hair and hair loss
• Fatigue and weakness
• Weight gain and difficulty losing weight
• Intolerance to cold temperatures
• Muscle cramps and frequent muscle aches
• Depression and irritability
• Irregular menstrual cycles
• Memory loss, migraine
• Low blood pressure
• Impaired hearing
• Decreased libido
• Constipation
• Visible physical signs like yellow-orange coloration in the skin (eg. palms and bumps on the eyelids), hair loss, swollen eyes

In extreme situations of low thyroid hormone, the patient's metabolic rate can drop drastically to a critical level which may develop into a potentially fatal coma state. 


Exams and Tests


The doctor will require you to swallow and check the neck for any swell.


With very large goiters, there may be swelling in the neck vein, and you may feel dizzy when you raise your arms above your head.

The following blood tests can measure thyroid function: 

Free thyroxine (T4) and T3

Thyroid stimulating hormone (TSH)

If all 3 fall below the clinical range, it is confirmed the hormone level is abnormally low for proper functioning. At personal level, take 5 consecutive readings of the auxillary temperature (underarm) 10 minutes after waking up and if the average falls below 97.8, thyroid hypo-function is suspected. Other possibilities of lower temperature include adrenal stress, thiamine deficiency, diets low in essential fatty acids and protein malnutrition.

If your test results come back ‘normal’ but you have many of the symptoms or risk factors for thyroid disease, consider tests to look for abnormal, and possibly cancerous areas in the thyroid gland include:

• Thyroid scan and uptake
• Ultrasound of the thyroid

If nodules are found on an ultrasound, a biopsy should be done to check for thyroid cancer.

Treatment

A goiter only needs to be treated if it is causing symptoms. Treatments for an enlarged thyroid include:

• Thyroxine medication, if the goiter is due to an underactive thyroid. Mixing with calcium and iron can impair its bioavailability.
• Small doses of Lugol’s iodine or potassium iodine solution if the goiter is due to a lack of iodine.
• Radioactive iodine to shrink the gland, especially if the thyroid is producing too much thyroid hormone.
• Surgery to remove all or part of the gland. (for the vast majority of patients, surgical removal of a goiter for fear of cancer is not warranted).

Other comments

+  Iodine deficiency has been linked to breast cancer and other disorders like extreme fatigue, hypothyroidism and weight gain. You can derive iodine from sea salt and sea foods. However, excessive iodine intake may inhibit the secretion of thyroid hormone and can produce a metallic taste and sores in the mouth, swollen salivary glands, diarrhea and vomiting. Selenium intake is not recommended for goiter patients.


+  In patients with mild to moderate Graves’ disease, selenium supplementation seems to work well as it contributes to the antioxidant defense in the thyroid, by removing oxygen free radicals generated during the production of T4 and conversion to T3.

VIVA corner

Vivashield with 4 antioxidants - Vitamin A, C, E and selenium combined combat free radical damage.
Viva CalMag and D should be added as calcium production may be impeded with the malfunctioning of the thyroid gland.

VIVA Vivaguard offers protection to surrounding tissue from destruction by free radicals and speeds up recovery. VIVA Chloroguard derived from seaweed offers good protection with the ability to compensate for the need for iodine. The idea is that if we were to saturate the thyroid with iodine, then it would not absorb any radioactive iodine that might be present in the atmosphere. Children appear to be at highest risk for this matter.

The SWEET killer - Diabetes

Diabetes Mellitus is a Greek word that means 'discharge of "honey sweet" water'. It is one of the most commonly encountered diseases by healthcare professionals worldwide. In Singapore, the current incidence rate is an alarming 1:10 as compared to 1:50 way back in 1975. With such an exponential rise in numbers, is there an effective cure for this disease?

Causes

Diabetes Mellitus is a syndrome characterised by metabolism disorder (body is unable to use carbohydrates, protein and fat in a normal way) and high blood sugar resulting from either low levels of the hormone insulin or a failure of the body cells to respond to insulin.

Normally, food carbohydrates are converted into the form of sugar called glucose to supply heat or energy, or store as glycogen in the muscle and liver cells for future use. This important task of regulating the uptake of glucose from the blood into the cells is carried out by insulin, the principal hormone secreted by the beta cells of the islets found in the pancreas.

 

Under normal condition, our urine does not contain any sugar. In uncontrolled diabetic condition, glucose accumulates in the blood. Eventually, it has to be expelled from the body by way of the urine with sugar loaded.

Two classifications of diabetes are:

Type 1 - Usually called juvenile diabetes, it affects 5-10% of diabetic patients who need to undergo daily injection of insulin. It is an auto-immune disease in which the body’s immune system attacks and destroys the insulin-producing cells in the pancreas, resulting in insufficient insulin for optimal use. The onset is usually intense and takes only few days to develop, often arising from an infection. Some babies fed on cow milk are found to end up having this condition.

Type 2 - Usually called adult onset diabetes or non-insulin dependent diabetes, insulin resistance occurs in 95% of diabetic patients, a condition in which cells fail to use insulin properly or insulin produced in small quantities not sufficient to fuel the cells.

Other causes -

+ Pancreatitis where the pancreas is inflamed or diseased, and may be surgically removed. Also possible is viruses produce antibodies that destroy the islet cells resulting in diabetes.

+ An increase in the rate at which insulin is used up or destroyed in the body may lead to diabetes. The efficacy of insulin is compromised due to liver disease or prolonged used of drugs (eg. steroids) that impede insulin activity.

+ In the case of pregnancy, a rare type Gestational Diabetes can develop during the late stages of pregnancy. Normally it goes away after birth delivery or slips into Type 2 Diabetes later in life (high chance if baby weighed more than 9 lbs). Hormonal changes are responsible for the shortage of insulin. It does not cause birth defects sometimes seen in babies whose mothers had diabetes before pregnancy.

Irrespective of the type, diabetes leads to a rise in the blood sugar level, which can ultimately affect the various organs of the body and their functions, leading to severe complications. (see below)

What is the safe level?

Guideline for blood sugar levels (mg) after fasting 12 hours -

* 70 to 110 - normal

* 110-126 – impaired glucose tolerance/borderline

* 126 and over for a 2-3 days period – diabetes

* Below 50 and above 250 – red flag rang

A more accurate reading is HbAIc test where the amount reflects blood sugar control for the past 120 days, which is the usual lifespan of a red blood cell. Well-controlled range should be in the region of 6.5 to 7.


You should also test your urine or blood for ketones when any of the following occurs:

• blood sugar is higher than 240 mg/dL
• symptoms of diabetic ketoacidosis (ketones buildup especially for type 1)
• feel sick or nauseated, regardless of blood sugar reading

Running low on glucose, or due to diabetes, the body does not have enough insulin to help the cells to absorb the glucose, and starts breaking down fats for energy. Ketones are byproducts of the breakdown of fatty acids. Results for ketone testing are labeled in the following way:

• normal/negative: less than 0.6 millimoles per liter (mmol/L)
• low to moderate: between 0.6 to 1.5 mmol/L
• high: 1.6 to 3.0 mmol/L
• very high: greater than 3.0 mmol/L

At dangerous high levels, the kidneys can be at risk of being severely damaged by such large molecules. Other serious effects include: 

• swelling in the brain
• a loss of consciousness
• diabetic coma
• death

Symptoms

Diabetes often goes undiagnosed because many of its symptoms seem so harmless. Studies indicate that early detection of diabetes symptoms and treatment can decrease the chance of developing the complications of diabetes.

In diabetic patients, glucose build-up in the mainstream instead of being taken into the cells to be used as energy, leading to hyperglycemia (abnormally high levels of glucose in the blood). A quarter of diabetic patients are not able to perceive sweet tastes and tend to over-consume unknowingly. Other symptoms include:

1. Frequent urination

2. Excessive thirst

3. Extreme hunger

4. Increased fatigue

Above symptoms are usually ignored especially in hot humid weather where drinking and visiting the toilet is a routine.

5. Unusual weight loss

6. Constant infection

7. Blurred vision (cataract)

8. Cut or wound difficult to heal

9. Numbness of the limbs and lost of sensation

10. Recurrent skin, gum and bladder infection.

The reversal frequently occurs is symptoms of hypoglycemia (less than normal amount of glucose in the blood) which strikes suddenly with a missed meal, too much exercise or a reaction to excess insulin. In functional hypoglycemia, the liver releases stored sugar to compensate for low sugar level and thus takes care of all the symptoms naturally.

 Initial signs are -

1. Hunger

2. Dizziness

3. Sweating

4. Confusion

5. Palpitations

6. Numbness or tingling of the lips

If not treated, can experience double vision, trembling, disorientation or may lapse into a coma. The quickest way to fix up this problem is to take some sweets, fruit juice or soda pop. Repeat 20 mins later if it does not work in the first instance. If second treatment still fails, or still cannot ingest food, seek immediate medical attention and/or administer a glucagon injection.

Complications

In the long run, high level of blood sugar can lead to damaged vessels, which in turn can cause eye disease, heart disease and kidney disease.

+ When the tiny blood vessels of the kidney are damaged, they fail to filter waste materials from the blood, a condition termed diabetic nephropathy. The persistent presence in urine of protein is usually the first sign. Eventually, the accumulated fluids and waste products cause kidney failure, where dialysis or kidney transplantation is required.

+ In diabetic retinopathy, high inflow of blood sugar can cause expansion of the blood vessels of the eye to the extent of collapsing. New blood vessels usually develop but most are defective and unable to contain the blood. As a result, the blood vessels burst causing blurred vision, glaucoma, cataracts or blindness when a large hemorrhage formed.

+ Diabetic patients can experience narrowing or hardening of the arteries, heart attack, stroke and high blood pressure, giving rise to increasing risk for coronary artery disease, heart disease and cardiovascular disease.

+ Presence of excess sugar in the blood can damage the wall of the blood vessels, and the covering of the nerves, especially around the legs and feet, termed diabetic neuropathy. This can manifest in symptoms like tingling and numbness of legs, hands and feet, nausea, vomiting, diarrhea, urinary problems and constipation. For some, is a loss of sensation in the feet. For others, it can be minor injuries to the feet like blisters, sores and highly infectious cuts as there is a lack of oxygen and blood to heal promptly. In advanced stage, it is often accompanied by excruciating leg pains. A severe infection or gangrene when developed, may necessitate foot or leg amputation to prevent further spread to other part of the body. By then, the foul smell emitting can be unbearable.
+ Impotence occurs frequently amongst men with diabetes because of interference with the nerves or blood supply to the male organ. Difficulties with erections may be a man's first sign of diabetes.

+ People with diabetes are more likely to suffer from skin conditions such as fungal and bacterial infections along with bone and joint problems (eg. osteoporosis).

+ Diabetic acidosis is the condition where ketones accumulate in the body. This happens when cells fail to absorb and utilise glucose, thereby turning to fats to derive energy. Breakdown of fats generates ketones as byproducts, which if accumulate in a large amount can increase acidity of blood and the tissues, leading to serious complications, if not treated promptly. One grave consequence is permanent kidney damage or failure.

+ Pregnancy puts a diabetic woman at special risk due to hormonal changes and the demands of the foetus can lead to wild fluctuation in blood sugar. There is a high chance of retaining excessive amount of water, develop high blood pressure and miscarriage. Conceiving mums with poorly controlled diabetic condition is likely to give birth to infants with birth defects eg. heart and nerve disorders, cleft lip and palate.

Diabetes Medications

Most diabetic patients chose to use medications to control their glucose levels without even realising the side effects of the medication. One popular drug Avandia is found to increase heart attack rate by 43%, and thus prohibited for use by patients with heart problems such as acute coronary syndrome, ischaemic heart disease and heart failure.

Other side effects include hypoglycemia, diarrhoea or abdominal discomfort. Long-term consumption might even cause weight gain, kidney and liver damage. That is why the medication dosage must be under the surveillance of a personal physician who can constantly monitor the body condition.

What can a diabetic patient do?

Diet and exercise alone, without insulin, can control some 30-40% of cases, especially overweight people and those with mild condition. The strong link between type 2 diabetes and obesity shows reducing caloric intake does help.

Hence, no special diet, as long as is nutritionally sound, taken in moderation, suits the patient’s lifestyle and incorporates dietary recommendations to prevent other common diseases like heart disease.

(1) Dieting - well-balanced, high in fibre and lower in fat

For diabetic patients, is important to watch out for the glycemic index (measures how fast food is being absorbed into the blood) of the food. Food which has a high GI (insulin is unable to pick up on fast-moving glucose on time) causes a sharp rise in blood glucose, whilst food with a low GI induces a smaller but more prolonged increase, which is ideal for diabetics. This index also changes depending on how a food is cooked, processed and, in the case of fruit, how ripe it is. Skipping meals can also cause a spike in blood glucose.

Also to follow the Healthy Guidelines - the carbohydrate intake should limit to half of total calories (most have poor carbohydrate utilisation), protein 20% (lesser for renal failure) and 30% good fats, distributed evenly throughout the day.

+ Carbohydrate foods like rice, noodle, vermicelli, bread and salt, white flour product increase the sugar level and should not be eaten excessively, preferably break up into small servings. Note rice turns into porridge yields a higher GI value and when cooked with fat reduces GI index but is unhealthy.

+ It has been observed that most diabetic patients do not consume much sugary foods and yet are obese. So what is the culprit? Genetics as some claimed. Our forefathers were mostly agriculturists and lived on their harvests like rice, wheat flour and corn. These traditional staple diets are high in carbohydrates and contribute to weight gain if is not burnt off and left to linger in the bloodstream or stored as fat.

+ Fruits should be taken in whole and not fruit juice as the sugar element (call fructose) can contribute to a sharp rise in blood sugar level. To avoid sweet fruits eg. grapes, mangoes, bananas, melons. Guava is a great fruit that provides lots of fiber, low GI and enzymes that can reduce glucose effectively.

+ Fresh vegetable juices help to reduce the need for insulin and lower fats level in the blood. To avoid starchy vegetables eg. carrots, potatoes, beets.

+ Iron loading from foods like meat can worsen diabetic condition. Avoid iron cast cooking pan.

+ Slowly digested foods like brown rice, whole grain bread, oats, apple, spirulina, egg yolks, fish, garlic and vegetables help to moderate the rate of transfer of glucose to the blood. This can further improve by chewing as much as possible.

+ A recent study showed that certain cinnamon compounds may help obese people in the fight against fat, inflammation and oxidative stress. In the study, obese people with pre-diabetes took a cinnamon extract called cinnulin twice daily. At the end of the 12-week study, participants' bodies were experiencing less oxidative stress and their antioxidant defenses against inflammation were heightened. They even lost some fat mass while gaining a bit of lean muscle. Researchers think that cinnulin helps cells take in sugar and use insulin better -- otherwise difficult for people who are obese and have pre-diabetes.

+ Stevia leaf has been used for centuries in South America and Japan to substitute for sugar and treat diabetes mellitus type 2. Some studies showed it has a possible trophic effect on β-cells of pancreas, improving insulin sensitivity in rats, and possibly even to promote additional insulin production, helping to reverse diabetes and metabolic syndrome.

+ For vegetarians, to include beans, tofu, seeds and nuts in every meal. Thiamine (Vitamin B) deficiency has been linked to increase in glucose levels. Hence, increased intake helps to speed up metabolism and flush out excess glucose in the bloodstream.

+ Researchers think that cinnulin had such a favorable effect in the study because compounds in the extract may somehow help cells take in sugar and use insulin better. Substitute for sugar to your favorite hot drinks.

(2) Sleep duration can also affect risk factor. A recent study found that those who were not getting enough sleep or getting too much had an increased risk of developing Type 2. A joint effort between researchers from the New England Research Institutes and the Yale School of Medicine over 15 years gained some stunning findings:

* those who slept 6-8 hrs per nite are the healthiest

* those who slept 5-6 hrs per nite have twice the risk of developing type 2 diabetes

* those who slept more than 8 hrs per nite have triple the risk

(3) Regular exercise can regulate insulin sensitivity by achieving better glucose control and improving glucose tolerance to reduce insulin resistance and assist in decreasing risk associated factors like hypertension, obesity and atherosclerosis.

Physical activity helps the body's cells absorb and utilise more glucose for energy, thus effectively reducing elevated glucose cells in the bloodstream. Though all exercises promote healthy blood glucose levels, aerobic exercise is a good choice for most people in its utilisation. The intensity of resistance exercise in utilising more glucose to build more muscle means the body has to increase the storage capacity of glucose.


(4) Close monitoring of blood sugar level and keeping a normal body weight prevent and delay the onset of obesity and diabetes mellitus.

When all precautionary steps are taken and still fail to yield satisfactory result, oral medications or injections of insulin can be added to prevent deterioration.

Conclusion

Having a parent or sibling with the chronic metabolic disease, being overweight with a body mass index above 23.5, and being inactive and older are factors which can increase the risk of developing diabetes.


Maintaining a healthy lifestyle is of prime important. Most people would become diabetic in their old age if this rule is not properly observed.


VIVA corner

VIVA Glucoguard contains chromium yeast that acts as Glucose Tolerance Factor (GTF) which aids in the digestion and absorption of glucose, enhances the effects of insulin and thus improves diabetic condition.

VIVA Green Barley provides fibre that helps to stabilise blood glucose level. It also contains chromium and amylase to promote the metabolism and utilisation of carbohydrate, thus helping to regulate blood sugar levels.


VIVA Vivashield is rich in antioxidant and is able to neutralise free radicals that cause blood lipid oxidation. A good example is flavonoids present here which help to inhibit the accumulation of polyols (elevated glucose levels in the lens of the eyes)

VIVA Floraguard promotes absorption of vitamins and minerals and helps to inhibit bacterial or fungal overgrowth, which is common in diabetes.

VIVA Gingko Biloba improves blood circulation thus beneficial for retinopathy and other diabetic complications.

Sources:

Singapore Med J 2002 Vol 43/3 1`28-134,  Diabetes Lifestyle, NaturalNews, Am J Clinical Nutrition 1995

How to LOSE weight SAFELY

Being beautiful is a common human desire. Given the choice majority of us like to be seen as ‘slim’ or ‘fit’ and not obese. Some people are so blessed to stay slim all their lives and are perfectly healthy that way. For others, losing weight perpetually poses a major challenge even if they are very disciplined.  For most guys, transforming your Buddha belly into a sexy set of six-pack abs sounds impossible, especially those who past their mid-life.  As for most women, putting on the extra pounds is dreadful. The ugly sight of love handles and flabby thighs is a turn-off. Conscious efforts like exercising and strict dieting can bear little or no result for them. This perceived failure to lose weight is a big disappointment and dent their self-esteem. In no time, they may lose total hope and revert back to unhealthy lifestyle.

In recent times obese individuals are increasing rapidly, and estimated to form 1/4 of the global population. Recent statistics showed as much as 64% of the United States’ adult population is considered either overweight or obese, and this figure is still rising over the last four decades. Taking the top slot is her neighbour, Mexico with 73% of the population in the obesity zone.

For aesthetic and health reasons, most of us are working hard to shed that extra pound whenever possible. However, it is crucial to lose weight the right way in order not to jeopardise our health.


OBESITY vs OVERWEIGHT

Before going any further, let us make a distinction between ‘obese’ and ‘overweight‘. An overweight condition refers to an excess of total body weight whilst obese refers to an excess of only body fat. It is possible to be overweight without being obese as in the case of a bodybuilder with large muscle mass (muscles are heavy). It is also possible to be obese without being overweight as in the case of a sedentary worker with an excess of body fat and low muscle mass.

 

The social stigma for an obese and overweight individual is usually negative - associated with laziness, disgust, slovenliness, greed and gluttony. Finding a job, a relationship or physical task can be demanding, not to mention the health challenges to overcome.

 

Unlike the past where poverty was associated with thinness and obesity with wealth, most overweight and obese people today usually occupy the lower rungs of the economic ladder.

Though people with normal weight are not into such stress, they can be unhealthy without their knowledge too. Unhealthy lifestyle, of which poor diet is the main culprit can easily push one into the ‘obese’ category.

Risks of Obesity

 

+ Obesity causes traffic jam in the body, increasing the risk of colon cancer, breast cancer, uterine cancer, pancreatic cancer, gall bladder cancer, liver cancer etc. Overweight women have 2 times more risk for the endometrial cancer than those with normal weight. Obese men face a 50% chance of getting colon cancer over those with normal weight. Also research found those with are obese tend to have poorer immunity.

Statistics showed that 1/3 of all deaths is correlated to obesity.

+  Clinical studies showed that cardiovascular risk is increased by 20% when men put on 10% of their ideal weight and can expect an increase in the risk of high blood pressure, high triglycerides and high blood glucose.

 

+ Another serious problem arising is degenerative arthritis caused by more weight placed on the legs to carry. The knee joints experience a weight load of 3-4 times more than their body weight on walking. Half of the pain can be relieved if the patient cared to lose weight. Every half a kilo you shed, you alleviate the pressure on your knees by 2 kilos. Not only the joint pain is reduced, there should be an improved range of motion and reduction of demand on nearby muscles to provide stability.

 

What should be your waistline?

As a guideline, the waistline for men should be under 90cm and 80cm for women. With every 1cm increase in waistline, the risk will increase 3% for cardiovascular disease, 2-4% for diabetes and 6% for hypertension. Those with high waist-hip ratio have 4-6 times more risk of suffering chronic metabolic disease, especially Type II diabetes.

Using BMI measurement (take weight in kg divide by the square of height in metres), the healthy range of 18.5 to 24 is hard to maintain with our affluent lifestyle and advancing age. Those in the range of 27-30 have a 2 times higher risk of suffering with diabetes. Those with 30-35 are 5 times more at risk and above 35 have a 10 times greater risk. Clinical studies showed that diabetic patients can improve the condition of blood glucose and pressure by reducing 5% of their body weight.

Beware of fats hidden beneath the muscles not visible and cannot be felt by pinching our belly can pose a major health threat with accompanying diseases like heart failure and diabetes. Unlike subcutaneous fat which shows as flabbiness, visceral fat builds up and wraps itself protectively around the spinal cord and vital organs in the midsection of our anatomy from external shocks.  However, too much can cause respiratory failure and cancer. Whenever this fat is being broken up, fatty acids are being released into the bloodstream and on reaching the liver, it is being metabolised into cholesterol and can form a plaque that block the arteries or develop diabetic condition.

What is weight gain?

Weight gain can result from an increase in body fluid, muscle mass or fat.

- An increase in body fluid can come from medications, fluid and salt retention, intravenous fluid infusion, renal or heart failure.

- An increase in muscle mass occurs with exercising.

Losing weight should not be at the expense of loss of normal body fluid or muscle mass with little change in body fat, especially by dieting only. Gradual muscle loss is unhealthy as it is a catalyst for a host of other age-related biomarkers – drop in metabolism, increased body fat, declining aerobic capacity, reduced blood sugar tolerance and osteoporosis. In other words, when you lose weight due to muscle loss instead of fat loss, expect to see an acceleration of the aging process.

- For majority, an increase in body fat is attributed to poor diet or lack of exercise as the body converts muscle to fat. Note that 3500 calories yields one pound of fat over time. Our discussion is structured around how to lose weight in term of fat.

How is weight gain?

Gaining weight is so easy. Losing weight can also be a simple task. Most of us need to take only 1800 calories for normal bodily functioning. If we can eat fewer calories, the body will retrieve from the store to burn as energy. Sounds easy, but tough right?

Inflammatory chemical messengers known as cytokines are found in fat cells, and can be caused by chronic stress, excess consumption of junk food, inadequate sleep, fungal infection and overloading of toxins. Its presence prevents the body’s cells from responding to insulin. When the insulin receptors of our cells become resistant to insulin, the glucose in our blood cannot be stored in cells for energy use. Instead it is converted into fatty acids and stored as fat. It is worsened with fat cells also generating cytokines, further increasing insulin resistance.

Though inflammation can be linked to uncontrollable factors like certain gene variants, controllable ones like foods that promote inflammation can be avoided. Basically, foods loaded with sugar, saturated fat and most types of processed foods are bad. That is why there is an urgent need to switch to more natural whole foods, such as fresh fruits, vegetables and whole grains.

 

In America, more than U$60 billion are spent every year on soda pop. The late Dr. Robert C. Atkins believed that the heart disease epidemic started after Coca Cola was invented. Many more billions of dollars are spent annually on ‘bankrupt foods’ like ice cream, cookies, candy, gum, doughnuts, pies, pizza, bagels, potato chips, french fries, chocolates and frozen yogurt. These popular junk foods contain more than half of the calories over its original form with the extra substances. The common substance found in these products is carbohydrates, which turn into sugar, and overloading can cause havoc in the body over a prolonged period. Mind you, the calorie count due to sugar added to your apple juice can be more than that of the Coke!

How to reduce weight??

(1) POPPING PILLS?

++ Wrong approach

The slimming industry is a money spinner worth billions of dollars. There is no one full-proof method of bringing down one’s weight forever as our genes determine our body shape and mass.

Medical researchers do not believe there is a miracle drug that can do the job without causing side effect. From mild symptoms of breathlessness to more serious complications like seizures and deaths, is slim chance to slim down effortlessly with drugs without unpleasant consequences.

Watch out those slimming products displayed over the counter such as fat burners, appetite suppressants and energy boosters that claimed almost instant results without the accompanying side effect of drugs. The truth is that some of these medications are not sold as drugs but food supplements instead to put off fear of buying them. Also, most Health Authorities do not regulate or control food supplements. Look at the label and you notice the ingredients are not clearly spelled out, safety and efficacy profiles are missing too.

In Singapore, our Health Authority has discovered some slimming products being adulterated with synthetic drugs, including fenfluramine, thyroxine and ephedrine, to increase their effectiveness. For instance, ephedrine is labeled as ma huang or ephredra, while caffeine is listed as guarana or kola nut. Both are known to cause hyperthyroidism (swelling of the thyroid gland), nervousness, dizziness, altered blood pressure and heart palpitation, and worst cases, heart failure, stroke, seizures and deaths. Fenfluramine is a controlled drug under the Poison Act as it can cause heart valve disorders when taken together with other slimming drugs like phentermine or dexfenfluramine. Be careful with taking such drugs even under doctor’s prescription as over-dosage can cause minor to massive damage to the body.

What happened is that consumers taking over the counter slimming products do see fast results but this can be explained by the sudden loss of body fluids but do not deliver permanent, long-term efficacy. The danger of starving the body leading to inadequate nutrient intake can end up being malnourished. Some slimming tea can drain the body of important nutrients too.

 

 ++ Right approach

The first prerequisite for maintaining an ideal weight is to ensure that our thyroid hormone is keeping our metabolism in an optimal state. To augment the optimal diet with high levels of antioxidant supplements, including vitamins A, D, E and K. Large amounts of vitamin C and brewer’s yeast are for the benefits of the B complex vitamins and minerals necessary to improve metabolic rate.

Chromium has been extensively used for weight management as it can help to increase muscle mass, decrease body fat and promote weight loss. It is known to suppress appetite and reduce sugar cravings through its ability in regulating blood sugar levels. At the same time, it also helps to metabolise glucose and fatty acids more efficiently within the body, resulting in increases in fat loss and promotes a gain in lean muscle tissue to remove the excess body fat and weight.

 

Having said that, taking the right type of chromium supplement is crucial since organic and organic chromium have different bioavailability. Among the few forms of chromium supplement, most of the scientists proposed chromium yeast as the safest form. Organic form is readily absorbed whilst the inorganic form is toxic and can cause impairment of gastrointestinal, liver and kidney functions.

(2) CRASH DIETS?

Eating merely fruits and vegetables? Eating only fatty foods without carbohydrates? Strictly Atkins diet – only proteins? What comprises a good diet to reduce weight fast?

Most experts claimed that as long as one attempts to reduce calorie intake, weight should be reduce appropriately. So a crash diet program should go well with fast weight reduction. In most instances, this result in loss of water content in the body, and the skin becomes dry and loses elasticity. Repeated crash dieting is detrimental to health especially if quick weight loss tends to come back rapidly. The following weight gain often results in rising cholesterol levels, and can damage the vital organs and develop gallstones (alternating with too little or too much food for the biles to process).

A slow and steady approach yields more lasting result as the body is given time to adapt. In fact, it takes a good 6 weeks for it to adjust and re-learn new metabolic pathways in diet changes. Also, understand how different foods are being processed by the digestive system.

+ Fat digestion is simplest as it tends to be readily stored for vital cellular function. This is suspected to be a survival tactic brought down by our long ancestors to store food for energy as food is not easily available then. Advice is not to take fatty food in the evening when metabolism is running low due to lack of physical activity.

+ Proteins need much more energy to be digested and thus reduce the calories as well. Carbohydrates is in between both. A rough calculation of 1600 calories of chiefly protein will shave off 80 calories even without any exercise done. Protein can increase our metabolic rate by as much as 30% and help to balance the release of insulin by prompting secretion of the pancreatic hormone glucagon. Protein-induced glucagon mobilises fats from the tissues (we have about 30-40 billion fat cells in our body) to which it is stored, thus aiding in weight loss. However, taking high protein can produce a state of ketosis (a process where the body burns fats for fuel) due to the absence of carbohydrates. Vital electrolytes, especially potassium, can be dangerously depleted that can lead to heart attack. Excessive ketones accumulated can cause blood acidity, leading to coma or death.

+ Taking more fibres also helps to prolong travelling time of food down the digestive tract and reduce the hunger pang. Blood sugar level is under better control and can prevent constipation too. Oatmeal is a low glycemic index carbohydrate with a rich source of fibre and thus helps to prevent insulin and other diabetic complications. Also consider adding chilli and hot peppers, known to contain capsaicin, which can raise metabolism by as much as 25%.

The trick is not to cut off carbohydrates or fats, but balance our diet with calorie restriction. A healthy diet program comes with sufficient quantity and variety of macro-nutrients (carbohydrates, proteins and fats) and micro-nutrients (vitamins and minerals) to support lean mass while accelerating fat loss.

Eat a well-balanced diet to include protein: eggs, milk, meat, chicken and fish. Carbohydrates should be in the form of whole grains, vegetables, salad greens, berries and fruits. Needed fats are essential fatty acids and monounsaturated oils, like olive oil and fish oils. Round out the diet with fibres from nuts, seeds and legumes. Get rid of food loaded with trans fats eg. cookies, pastries and cinnamon buns.

Often missed is yogurt that contains abundant healthy bacteria vital to increasing production of intestinal hormones to enhance satiety and decrease hunger. Such bacteria helps to raise the body’s metabolic rate to clear toxins and fats faster.

For better result, you may like to practise eating food in the right order. By taking in a small amount of protein eg. fish, chicken breast, beans and eggs first, it helps to suppress your appetite and stabilise blood sugar as proteins are slower in digestion than carbohydrates. Save the fresh fruit for the end of the meal as a dessert. This is to prevent the blood sugar from spiking that can cause insulin release and leads to fat storage.

 

Also never miss your breakfast. After a night without food, the body craves for some. By depriving this feed, the metabolism is retarded, low blood sugar and pangs of hunger drive the body to take it higher quantity upon the next chance. Likelihood of taking the wrong types of foods is thus high. Having food 5 hours apart is ideal for keeping energy level stable. In addition, calories are burned off easily in the day than night.

Based on illustrated picture, the meal to go along with timing to achieve better slimming results should be:

** breakfast – fats and protein (take longest to burn and sustain appetite)
** lunch – carbohydrates (raises serotonin and boosts energy level)
** dinner - light best with easily digestible foods including soluble fiber

 

(3) EXERCISE!

Mention exercise and most people give the excuse “no time”. Those who bother to do it develop the habit and those who do not, avoid completely or do little. Regular exercisers feel uneasy if merely stopped for few days without doing. To them, is a habit hard to break. If one can carry on an exercise regime for 6 months, there is high probability interest can be sustained for longer period of time. Best advice is to combine fun with exercise. Another preferred choice is to pick a convenient spot to facilitate regular exercise. Do not restrict exercising to only outdoor as weather condition may not permit at times. Riding stationery bike and treadmill running while watching our favorite tv program  is good for those who complain no time.

Our body stem cells that are developed into bone, muscle or fat cells cannot function properly if they are engulfed in a sea of fats. A workout exercise lasting 30 minutes each day can help to accelerate the burning of fats.

By gaining more muscles, the metabolic rate rises correspondingly. More calories are required to maintain muscle tissues than fat tissues. Obese people tend to have less than normal metabolic rates, making weight losing all the more difficult to accomplish. Hence, doing routine exercise can expect to achieve fat reduction and leaner muscle tone.

(4) OTHER LIFESTYLE CHANGES*

+ Control stress well

Feeling stressed out all the time, whether due to anxiety, grief or anger. Stress causes our body to react by producing certain chemical substances, such as the hormone cortisol. This hormone increases the body’s tendency of storing fat, especially around the abdomen, which is responsible for many serious health problems. Hence, eat when relaxed and not distracted or rushing off so that the food can be properly digested.

+ Sleep well

A lack of sleep can decrease metabolism and cause problems with rise in insulin levels. Research carried on a group of students preparing for exams who were deprived of sleep for a week showed most suffering diabetic condition later.

If you are chronically sleep-deprived, your body’s hormone levels can be imbalanced, causing increased hunger and appetite, while decreasing satiety so that you do not feel full after eating. Keeping late nights and having late supper induce excessive calorie intake.

+ Not paying attention when eating

Distracted eating like snacking while watching television, playing games, reading or chatting tend to consume more calories in a sitting could cause the amount consumed to rise by up to 50%.

+ Reduce alcohol intake

Alcohol intake to keep to a minimum (say a glass a wine per day), as it is converted into sugar in the liver. Consume during happy hours around 5 pm to allow body to relax and prepare for a good rest.

+ Quit smoking

Quitting smoking has a temporary (lasting few weeks) side effect that causes weight gain initially. This is because non-consumption of nicotine will improve the smoker’s appetite as food seems to taste better. Coupled with lower metabolism, the body is not ready for the sudden surge in calorie intake. Counteract this effect by eating a healthier diet, watching your calories and getting more exercise can definitely help.

+ Medications

There is a wide variety of medications that can cause weight gain including:

- diabetes medications (e.g. sulfonylureas),

- antidepressants (e.g. amitriptyline or Elavil, imipramine/Norpramin and trazodone/Desyrel),
- birth control pills,
- corticosteroids taken for conditions like asthma and lupus,
- anti-epileptics taken to control seizures, especially valproic acid (Depakene/Depakote) and carbamazepine (such as Tegretol),
- antipsychotic or schizophrenia medications can cause the appetite to increase, while lowering the metabolic rate eg. chlorpromazine (Thorazine), thioridazine (Mellaril), and olanzapine (Zyprexa),
- beta-blockers, which are prescribed for high blood pressure and heart disease may lower metabolism by about 80 calories a day, contributing to weight gain.

If you are on long-term medication that causes weight gain as one of its side effects, better discuss with your doctor about switching to another type of medication without the same effect.

 

In conclusion

Obesity is now the Number 1 killer in the 21st century. Being overweight can mean having “chronic diseases”. The best way to lose weight is cutting down on high caloried foods, do more exercise and take some healthy supplements not slimming drugs.

 

Note that slimming is not for everybody. There are many ladies out there who are never satisfied with their nice frames and strive to trim any remaining fat that can be found anywhere on their bodies. If they fall within the BMI healthy range, losing weight versus the risks involved may not be a good trade-off. They can end up suffering from eating disorders like anorexia or bulima.

As for those are who serious in losing weight, take it step by step. By embarking on an aggressive weight loss management program, the liver may not be able to cope with the sudden surge in additional fats to be broken down and fatty liver may occur.

Quality of life does not need to be sacrificed if we can effect change in a creative and positive way. Adopt a holistic approach to the whole health paradigm to enjoy the many lean and healthy years to come!

VIVA corner

VIVA GucoGuard contains an advance, natural peptide-bonded chomium yeast to promote healthy metabolic system. It is a unique formulation that combines chromium yeast in organic form with antioxidant vitamins and minerals in a proprietary blended to increase its bioavailability and absorption rate.

VIVA Fibrecleanse contains psyllium husk, soy fibre, apple pectin, psyllium seed etc that helps to absorb water, fills the stomach and provides a sense of fullness. It also delays the emptying of food from the stomach, thus reducing hunger pang. By slowing the release of glucose into the blood steam, and stabilise blood glucose levels, it may control food craving.

VIVA Floraguard is an enhanced formula that provides 10 billion CFU/serving of 5 strains of friendly bacteria to expedite the digestive process. As compared to the most yogurt products, this is definitely more potent and thus beneficial.

VIVA Cleanse Tea, a proprietary blend of buckthorn, peppermint, dandelion, orange, licorice etc cleanse the digestive system thoroughly and removes clogs and impurities including excess fats, toxins and accumulated wastes.
 

VIVA Chloroguard is a combination of 4 types of seaweeds that provide a complete range of vitamins, proteins and minerals. Taken 30 minutes before mealtime can curb appetite. Also, it sustains energy, aids in detoxification and aids in maintaining proper bowel function.