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How to eat right for a healthy brain

A balanced diet high in micronutrients and healthy fats and low in processed sugar can keep our brains healthy in the long run, suggest top doctors.

Shalini Bhardwaj

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The food we eat directly affects our physical and mental health, especially by improving or worsening the functioning of our brains. Top experts Dr Manjari Tripathi, senior neurologist at AIIMS, Dr Vipul Rastogi, senior psychiatrist at Medanta, and Dr Megha Jain, senior dietician at BLK Hospital, share more information on how a balanced diet is essential for a healthy brain and state of mind.

Q: What role does food play during pregnancy?

Dr Jain: Nutrition is important in every stage of life. In pregnancy, it is responsible for the development of the foetus, expansion of the mammary glands, and the mineralisation of the skeleton. As nutrition plays a very important role, the mother should take a diet high in calcium, iron, vitamins and minerals. These days, many people follow a special diet for weight loss, which should be taken care of as there should not be a lack in nutrition.

Q: How does omega-3 affect the development of the brain in a foetus?

Dr Jain: Omega-3 and 6 are familiar terms, which are essential fatty acids required for the development of the cell membrane and overall good health. Both these nutrients work together for better health, but an equal proportion of nutrients is very important. It comes from nuts, seeds, fish oils and ghee. All these things should be included in one’s daily diet as they are very important for the development of the child and for brain health too.

Q: What is the connection between food and neurological disorders?

Dr Tripathi: There is a lot of interdependence. Food plays an important role in modifying the course of any disease. For instance, we know that ADHD, which can be seen in children who have been given a high-sugar diet or a typical American diet, increases hyperactivity. The growing brain, particularly in children, needs a balanced diet, but now the concept of a balanced diet is fading. Normally, people prefer a high-protein and low-carb diet, but it should also have complex carbohydrates, fibre, vitamins and healthy fats. Mustard oil, olive oil and cold pressed oils are very important but we should avoid dalda. Eating ghee, nuts and seeds are also important as they are good for the brain. Millets, legumes and freshwater fish are important too. Mediterranean diets are good too.

There are some limitations. Red meat should be avoided, but white meat is okay, although where it is coming from needs to be kept in mind. Similarly, milk is good but people should check its sources as people these days add many toxic things for business purposes. As we grow, salt intake should also be reduced as it increases blood pressure. Particularly for the brain, raw vegetables, which we usually eat in fast food outside, can be harmful as tapeworms attached to the leaves can go to the brain via blood vessels. They can cause a disease called neurocysticercosis, which can lead to dementia.

Health can be maintained by a simple diet. The Poshan Abhiyan started by the government shows easy recipes which are tasty and good for health. A few days back Smriti Irani shared a video of a Manipuri girl who was making a dish with jimikand, mustard leaf and tomatoes, which is filled with omega-3 and makes a very balanced diet. We should consume good food mostly but as we are human, we can ‘cheat’ once or twice a month with whatever we like. This is what I advise my patients.

Q: There are a lot of studies which say that junk food can make a child aggressive. How does it impact a child if the mother eats junk food during her pregnancy?

Dr Tripathi: Food plays an important role in deciding behaviour and there is a direct connection when it comes to fast food. Indian fast food is still better than Western foods as we completely cook the food. Junk food has sugar and zero fibre which decreases physical activities and eventually affects the proper functioning of the brain. Conditions like ADHD increase as there are no nutrients present in those foods. Thus healthy foods should be taken along with a plant-based diet.

Q: How is food connected to mental health?

Dr Rastogi: Food definitely affects us in multiple ways. As we all know, a fulfilling meal can make us feel happy. If we come back from work and the food is not appealing, it irritates us. We also tell people not to have coffee late in the evening because it can disturb our sleep. Also children should not be given sweets at night as they become hyperactive. Foods have both short-term as well as long-term effects. When we talk of long-term effects, diets high in calories, fat and sugar will affect our arteries, which will affect the heart eventually. Since the blood vessels are the same, a bad diet will also affect the brain. The lack of nutrition affects the body and mind in many ways. The lack of iodine will lead to thyroid, which will lead to weight gain, and if thyroxine is not being made then the person will feel depressed. So, micronutrients also decide what we become and how we behave.

Q: What patterns have you noticed in people who come to you with depression and anxiety?

Dr Rastogi: There are a lot of people who do ‘comfort eating’, which means they eat to comfort themselves, to feel happier or feel satisfied. But this makes them duller because it makes them gain weight, slows down metabolism and disturbs their sleep. So, on one hand people are trying to modulate their moods by eating unhealthy. We call it a bad coping mechanism. Good coping mechanisms include going for walks or exercising. Generally, people with depression do not have the motivation to change or do things for themselves, so we can’t really blame them for an unhealthy lifestyle because it is the nature of that disease. But, apart from the medical help we give them, we advise people to follow a healthy routine, use the right proportion of nutrients and quit smoking. That is how they get their sleep cycle back and show improvements.

Q: How are dietary habits linked to dementia or memory loss?

Dr Rastogi: Memory is largely based on concentration, so if one is taking a high-sugar diet and their concentration is not good, they are not going to make good memories. But that’s not dementia. Secondly, if people eat a sugary diet, compounded with fats and cholesterol, it can cause strokes, which affect the brain, especially memory, in the long run. Something called vascular dementia can happen. So, if our children have good habits and we tell them what is good or bad for them, it is going to persist in their memory and reduce chances of developing illnesses like dementia in the future.

Q: There are studies which show that high-sugar diets can also weaken the immune system. What would you say about it?

Dr Tripathi: Sugar is not a food, it is a toxin. It is a highly purified chemical. If you go to a sugar factory, you would not be able to stand the smell of it. There is a high content of sulphur. The sugar is extracted from sugarcane in a long process, which involves bleaching too. Such chemicals are not good for the body. It has been proven that high-sugar diets are not good for cancer patients and children with hyperactivity. Sugar is an acquired taste and if you replace it with jaggery or palm jaggery, which have a lot of nutrients, it will be very healthy for children.

Q: How can we replace sugary treats like chocolate, especially for children?

Dr Jain: Home-made desserts are always better as compared to the stuff available in the market because those are full of preservatives to increase their shelf life. You may have seen the white substance accumulating on chocolate, which are stabilizers and preservatives that are unhealthy for our bodies, especially the heart and brain. To replace those sugars, we can use fruits and make sorbets by crushing them and keeping them in the fridge. We used to make kheer and laddoos rich in ghee, nuts, omega fats and healthy flours at home during festivals. We are now coming back to those traditions and using rava, millets, coconut milk and putting in chopped fruits in sweets.

Q: Any last words of advice on food and brain health?

Dr Tripathi: What goes into our mouths is what we are. We are what we eat. If you want to be fit and free of diseases till old age, it is essential that you eat healthy food and avoid white things like maida, salt and even white rice. Try to have unpolished rice and things which are made at home. Avoid things which are too good to look at. Unfortunately, kids go by the appearance of food and junk food or fast food are decorated in very pleasing ways. Indian foods should also be made more presentable and pleasing.

Dr Rastogi: It is an old saying: the way to a man’s heart is through his stomach. I would say that the way to a good brain is also through the stomach. So, eat healthy, look after yourself, have a good diet and do routine exercise. They will help you have good concentration and good memory.

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Medically Speaking

AGE DISTRIBUTION SAME IN SECOND WAVE, OXYGEN DEMAND HIGH, SAYS ICMR DIRECTOR GENERAL

Shalini Bhardwaj

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In a virtual press conference, three senior members of the national Covid-19 task force, Niti Aayog member V.K. Paul, ICMR Director General Balram Bhargava and AIIMS Delhi director Randeep Guleria, presented data pertinent to the ongoing Covid wave.

Dr Bhargava said there is no difference between the first wave and the second wave and the data showed that over 70% of patients in hospitals in both waves of the infection are above 40 years of age, indicating that seniors are still at higher risk. “Older population continues to be more vulnerable to be admitted in the hospital in the current wave,” Bhargava said while sharing the data.

There is no difference in the percentage of deaths between the first wave and second wave from the data we have,” the ICMR DG added, as per ANI reports.

The statistics presented also outlined that there is a higher need for supplemental oxygen — over 54% in hospitalised patients during the second wave. However, it also showed a decrease in the demand for ventilators, which has come down during the second wave, with only 27.8% of those admitted in hospitals needing it, as compared to over 37% who required it during the first wave.

He also said that more cases of breathlessness are being reported during this wave, while in the last wave, symptoms like dry cough, joint pain, headaches were more prevalent.

The ICMR DG also listed three main reasons for the higher transmissibility of Covid-19: laxity, Covid-inappropriate behaviour and various unidentified mutations. “We have had a tremendous amount of laxity, Covid-19-inappropriate behaviour and various unidentified mutations. Of them, some are of concern — the UK, Brazilian and South African variants, which have been demonstrated to have higher transmissibility,” he said. He also added that a double mutant has been found in India but its higher transmissibility has not been established.

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A COCKTAIL OF DRUGS CAN BE MORE HARMFUL FOR COVID: AIIMS DIRECTOR

Shalini Bhardwaj

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In an interview on Monday, AIIMS Director Dr Randeep Guleria briefed the public on the importance of drug management during the ongoing pandemic, which has sparked concerns about shortages of medicines like Remdesivir.

“As far as drug management is concerned, there are two aspects – one is drugs and the other is the timing of drugs,” he said, warning that, “Giving a cocktail of drugs can also be more harmful.”

He also spoke about treating Covid-19 through drugs, steroids and CT scans. However, he advised against the use of Remdesivir for people recovering at home. “Studies have shown that Remdesivir is not a magic bullet and it is not reducing mortality. We may use it as we don’t have an antiviral drug. It’s of no use if given early to asymptomatic individuals/ones with mild symptoms. Also of no use, if given late,” he said.

“The majority of patients will improve with just symptomatic treatment. It’s only when you have moderate patients who are admitted that we need to look at steroids and other antiviral drugs (like Remedesivir) by following protocols and rationally give treatment,” he added.

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Variants, inappropriate behaviour, Covid fatigue have led to a surge: Top doctors

The ongoing coronavirus surge is not really a sudden, one-off incident. About 100 years ago, there was a similar pandemic, healthcare experts tell The Sunday Guardian in an exclusive interview.

Shalini Bhardwaj

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Top doctors and healthcare experts Dr Rakesh Mishra, director of CSIR-CCMB, Dr Padma Srivastava, senior neurologist from All Indian Institute of Medical Sciences, and Dr S.K. Sarin, director of ILBS, told this paper why they think India is witnessing a massive surge in Covid-19 cases now and how this surge can be controlled. Excerpts:

Q. What explains the sudden surge in Covid-19?

Dr Rakesh Mishra: The most logical reason for the surge in Covid cases is that 2-3 months ago, things were in control, but gradually we started to become careless and common people thought that coronavirus is now gone and normal life can be resumed. We are seeing the consequence of that carelessness. When the number of cases rise, it picks up like a chain reaction. Political activities, farmers’ protests, marriage parties, local trains, schools reopening, restaurant opening, bars opening, malls opening and all such things mean lots of exposure to people in public and these things led to the sudden increase in cases. Also, over a period of time, more variants have emerged and this has affected a large number of people.

Q: In Punjab, we are seeing a lot of people been infected by the UK variant?

Dr Rakesh Mishra: You can actually link that very nicely if you see the data of the UK variant. It means that these are the travellers who initially came from the UK and then participated in some activity where a large number of people came together and then they went to smaller cities and villages and started to spread the virus. But the reason for spreading is only one which is when people are not careful. When people are in close proximity without protection to an infected person, who is also not protected, this is bound to happen. It doesn’t matter which variant it is.

Q. What would you like to say about the sudden surge?

Dr Padma Srivastava: Again, as Dr Mishra said, it is not really sudden. About 100 years ago, there was a very similar pandemic. There was also a second wave which was steeper and worse and then a third wave and then probably, it just vanished. So, what we are seeing today is not an unexpected development. What has happened now, as professor Mishra said, is the presence of variants. To add to it is Covid-inappropriate behavior, which may be due to Covid fatigue as well as overconfidence following the arrival of Covid vaccines. So, people threw caution to the wind at a time when mutants were present and active. Historically, we are going to hit waves and waves again. And for safety, vaccination and Covid-appropriate behaviour are the best bet.

Q: The situation in India is worsening, what are the steps we should all take now?

Dr S.K. Sarin: First, we have to accept that we have a difficult situation and we are actually having more infections now than we anticipated. This is likely to probably overshoot last year’s numbers; so first, we have to accept that we are down in the dumps, we are in trouble and, therefore, if we accept that, then certainly, we have to manage at least this wave of severe and rapidly spreading infection and then, the second step would be to think about how we can prevent a subsequent wave and not let these waves keep on coming and disturbing our economy and lives.

As Dr Mishra and Dr Padma have already said, in my opinion, this was anticipated even in January when things opened up very rapidly. We had the first mutant coming and the UK variant had come or at least was detected at that time and from then on, everyone knew that like in UK, in three months, it would lead to a major proportion of people getting infected. We are not doing as many sequencing as we should for the virus types, but it is anticipated that in a few weeks, this may become a major problem of viral variants infecting Indians. Of course, other variants are there; the virus has a life cycle of about 12-16 weeks until the time it has a major mutation.

So while they are occurring, we should be aware of mutants coming and infecting the population in different cities where it was not there. What is worrying is that we had opened up almost all our transport systems and our offices back in January thinking that the virus has gone away; also, we thought that now that the vaccine has arrived, all of us will be vaccinated soon. These two things have probably help the spread of the virus now. The worry now is the number of deaths piling up in the next 2 to 4 weeks’ time when the infection becomes deeper and more and more people get infected. I think the situation is difficult, but all of us have a collective responsibility.

Q: How can we check such waves?

Dr Rakesh Mishra: Genome sequencing let you explore the aspects of the virus–what kind of changes it is acquiring and if there is any particular area where a particular variant is increasing in number. We have to keep in mind that we are only generating the mutants by allowing the virus groups to spread across a large number of people and mutations are a natural process of any life form. Genome sequencing provides valuable information which gives us some hints about what might be happening, but to control the spread of the virus, we all have to be extremely careful and behave in a Covid-appropriate manner.

Q: Do you think lockdown is one of the useful options?

Dr S.K. Sarin: Once you finish two to four weeks of lockdown, people tend to think that the virus has gone and they start doing multiple times the level of activities they did earlier; so lockdown sometimes is not a very positive way of managing such things.

As Dr Padma said we have to get things like hospitals, ICU beds, drugs, protocols and healthcare workers in order; however, testing and tracing has to be as strict as possible. Lockdown has to be self imposed–you have to see that you actually lock yourself down compared to others to stop the transmission of the virus. The virus is like a villain, it will go away and then show up again and again.

We need to vaccinate our population faster; we have just done 7% vaccination of our population which is much less, especially with respect to areas where the virus is spreading fast like in Maharashtra or maybe Karnataka and Delhi. I think the age bar should be removed and mass vaccination is required as fast as possible. In the history of medicine, there has never been an occasion when the whole world has to be vaccinated and that too fast. So, there are challenges, challenges of making vaccines available, challenges of side effects, challenges of getting people to vaccinate and most importantly, getting people to accept a vaccine. Having said that, through the media, it is very important for us to communicate that there are two types of vaccines available: one is your mask and the second is the available vaccine and we have to employ both of them. Get your shot, do not be hesitant because there are advantages of getting a vaccine. Some people say he got two shots of vaccines, still he got infection, so what is the use of getting vaccination? But it is important to understand that if someone got vaccine shots and even then that person got infected, the infection will be milder. The severity of the disease is reduced as also the severity or possibility of transmitting the virus to others.

The other advantage of vaccines is that you will have antibodies which will at least last for six months to a year; but that should not make you abandon all the Covid-appropriate behavior. Also, once you have a vaccine, you can become and work like a frontline worker. No doctor, nurse, or healthcare worker should work if they have not received both doses of the vaccine. In fact, if there is a possibility, there is a support, we should test the immunization because vaccination is not equal to immunization; immunization means we have a high level of protective antibodies; we have not come to that stage yet. If you are over cautious that a certain vaccine may have side effects, we will lose more lives. Take whichever vaccine is available; they’re safe as millions have taken them.

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COVAXIN PRODUCTION TO INCREASE TO 10 CRORE DOSES PER MONTH BY SEPTEMBER

Shalini Bhardwaj

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New Delhi: The Centre on Friday said that it is taking steps to boost production of indigenous Covid-19 vaccines, and the production capacity of Bharat Biotech’s Covaxin will increase 6-7 times by July. The government is taking steps under Aatmanirbhar Bharat 3.0 Mission Covid Suraksha to accelerate the development and production of indigenous vaccines. The Centre’s Department of Biotechnology is providing financial support as grant to vaccine manufacturing facilities to enhance their production capacities, a release said.

“The current production capacity of indigenously developed Covaxin vaccine will be doubled by May-June 2021 and then increased nearly 6-7 fold by July-August 2021 i.e increasing the production from 1 crore vaccine doses in April 2021 to 6-7 crore vaccine dose/month in July- August. It is expected to reach nearly 10 crore doses per month by September 2021,” it said.

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DR HARSH VARDHAN REVIEWS HEALTH FACILITIES AT AIIMS TRAUMA CENTRE

Shalini Bhardwaj

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Harsh Vardhan

New Delhi: In the wake of a massive spike in Covid-19 cases during the second wave, Union Health Minister Dr Harsh Vardhan visited AIIMS to review the facilities available at its Trauma Centre, including the availability of oxygen for the Covid patients. In the review meeting, AIIMS director Dr Randeep Guleria and other doctors were present.

“The implementation of Covid-appropriate behaviour is the biggest challenge before us. People have become casual during the second wave. We are doing everything to speed up vaccination and bring more vaccines into the country. We have already given ventilators to the states and they are not demanding more because they are not able to use the current ones because of lack of space. In the last week we took many decisions to strengthen the supply of oxygen on the same dynamic pattern as we did last year,” Dr Harsh Vardhan said.

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NINE COVID TIPS TO KEEP IN MIND THIS NAVRATRI

Dr Deepak Gupta

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The ongoing Navratri celebrations in India are nine holy days when the nine incarnations of Goddess Durga are worshipped. In the spirit of the occasion, senior neurosurgeon at AIIMS Dr Deepak Gupta shared nine important tips to remember during the current Covid-19 ‘wave’ so people can be better equipped in the fight against the infection.

DON’T TAKE STEROIDS FOR MILD CASES

Steroids dexamethasone, hydrocortisone and MPA may have some benefit, but they are only useful for patients who are on oxygen therapy or ventilator support. Don’t give the patients steroids early or in the first week of the course of the infection. More importantly, don’t use them for mild cases as they might do more harm. Avoid steroids in case of asymptomatic and just RT-PCR positive cases.

REMDESIVIR CAN BE EFFECTIVE IF GIVEN EARLY

Remdesivir with or without Baricitinib can be effective if administered within the first ten days of the illness for patients on ventilator support, non-invasive ventilation or HFNC. It can speed up the time taken for recovery but has no effect on mortality.

WHEN TO USE ANTICOAGULANTS

Anticoagulants (LMWH) followed by oral anticoagulants (Apixaban for three weeks) are useful if D-dimer is high.

PLASMA THERAPY MIGHT NOT BE AS BENEFICIAL

Plasma therapy has no benefits. If at all, plasma must be given within the first three days of the infection from a donor who has very high antibody titers.

OXYGEN THERAPY IS RECOMMENDED

Oxygen therapy, HFNC or ventilator support is highly recommended, if levels of oxygen saturation fall in a Covid patient.

KNOW WHICH MEDICINES MAY BE USEFUL FOR COVID

Inhaled nebulised interferons may be useful, if available. Favipiravir can also improve time taken for clinical cure and help in the cessation of viral shedding by two or three days in mild to moderate cases. MoAb can be used in mild but high-risk cases as it helps in recovery but it is very expensive.

TAKE NOTE OF WHAT DOES NOT WORK FOR COVID

Antibiotics like azithromycin and doxycycline, antivirals like lopinavir, HCQS (chloroquine), ivermectin, and vitamins are not useful for treating Covid-19. Tocilizumab (IL-6 antagonist) is not effective for preventing death in moderate or severe cases and has a risk of sepsis. If one does use it, take only one dose of 400 mg (but only in select cases).

YOUR IMMUNITY MIGHT BE ENOUGH

A majority of patients are improving on their own and developing body immunity, without any treatment. In India, with over a million cases being reported in the last year and the vaccination drive running at its best, people might be likely to achieve natural herd immunity soon.

OPT FOR THE VACCINES

The vaccines available for Covid-19 in India—Covaxin and Covishield—are recommended for all. Two doses are to be taken with a gap of minimum four weeks between them. The Sputnik V is also in the coming, while the Pfizer and Moderna vaccines are available elsewhere.

The novel coronavirus is going to keep spreading and infect everybody it possibly can, until the vaccines can protect everyone or the population develops natural herd immunity. Until then, it would be wise to practise Covid-appropriate behaviour like wearing masks (preferably the N95 kind) washing hands, distancing from each other, and avoiding any unnecessary travel.

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