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Breast Feeding

Its been long got held up with different activities. A new mother was speaking about her concerns regarding feeding her new born and that made me pen down this topic.

Generations back, it was completely normal to nurse babies till two years which in modern days is seen to lose its significance. It’s a real boon to both mother and baby. Then why is it losing its place? Is it the modern system of easy formula feed? Is it easier way to have free hand life because a breast fed child is always dependent on mother? Is it the career that’s preventing? Or is it the taboo and too many suggestions that come from family and relatives leave the mother confused and hamper to choose the right one? Here again comes the role of a health care staff who actually is supposed to counsel and educate the mother with right choice for both baby and mother. Learn about Breast Feeding before the kid arrives because it is the key for unlocking healthy development of baby.

The UNICEF and WHO have urged the government to encourage and invest in breastfeeding because it is not only the cornerstone of a child’s healthy development but also the foundation of a country’s development.

Breast feeding should be established soon after the birth within an hour for the baby by normal delivery and about 2-3 hours later in caesarean section. Breast feeding Promotion Network of India (BPNI) has shown that only 44% women are able to breast feed in 1st hour of delivery. The initial milk of the mother is called as colostrum secreted for first three days. Its a myth that this colostrum shouldn’t be given to the baby and discarded. In fact, its this colostrum which is abundant in antibodies and vitamins and is a must for the baby. Let me list out some most important benefits specifically to colostrum.

  • Colostrum has a laxative effect on your baby, helping him pass meconium which aids in the first bowel movements and helps prevent jaundice.
  • It’s the most important source for baby to defend against infections and illnesses and is considered first immunization because it contains large quantities of an antibody (IgA).
  • Although the amount of colostrum is low, it is high in concentrated nutrition and is extremely easy to digest. Thus making it a perfect first food for your newborn baby.

As breastmilk changes from colostrum to mature milk the volume of breastmilk greatly increases. It provides unique nutritional and immunological benefits as needed for the baby. Without elaborating much, here are some beneficial effects of breast feeding.

Benefits:

  • Mother’s milk is easily digestible and even reduces the frequency of colic.
  • It contains all the nutrients like proteins, fats, minerals and vitamins in such an appropriate amount that which is necessary to the baby till 6 months.
  • Children who are exclusively breastfed have higher IQ levels and less chances of obesity, diabetes or hypertension in their adulthood.
  • Milestones achieved are better and kids grow stronger.
  • It provides a close physical bond between a mother and the baby.

Super Babies rap the benefits of breastfeeding main

Mother benefits:

  • Breast feeding burns calories and helps shrink the uterus so nursing mothers may be able to return to their pre-pregnancy shape and weight quicker.
  • It helps lower the risk of breast cancer, high blood pressure, diabetes, cardiovascular disease and also may help decrease the risk of uterine and ovarian cancer.

Quantity of milk:

The first question that comes to mind of every new mother is, “will the very little amount secreted initially be sufficient to satisfy the baby hunger? I am not able to get enough milk to satisfy my baby.” A mother for first time is always full of questions, anxiety, apprehensive and confused regarding her kid. With so many advices that come from family and friends she stays totally confused and worried. Lady, you have become the mother of a new born!! Enjoy it! Don’t worry about your milk production. Your system will take care of it. You just have to be happy and this in turn will help in better production of your milk. Prolactin and oxytocin are the two main hormones responsible of milk production and ejection respectively. Oxytocin is also called one of the happy hormone or love hormone as its stimulated by cuddling and thinking of baby and the nipple stimulation by suckling. The below picture will explain better.

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Initially on the first day the stomach capacity of the new born is hardly 7-10 ml. this capacity slowly increases and reaches to around 30-60 ml by end of a week. Continuous feeding from day one will ensure production as per the baby needs. On day 1-2, colostrum quantity might be less and one may wonder if that really be sufficient for kid! Actually it is the only food a full term baby needs. Its new to baby also, so the baby too will take time to learn it. Feed frequently even if you are not getting enough. The baby sucking reflex will further stimulate the production and ejection.

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From the birth day till 6 months, baby needs only breast milk.  If needed, doctor will add vitamin supplement but generally not necessary. 6 months to 12 months along with milk baby needs to be introduced to different foods. From 1 year its mainly solids and thus liquid food (milk and juices) should be restricted to not more than 400ml

Positions:

There are various positions where both the baby and mother can adopt a position comfortable as per to them. The below pictures explains the positions. Two most important points to put in mind is Latching of baby and that the baby nose should have the gap to breath.

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  1. Cradle position: Most common and is more suitable for term babies. This position work well after breastfeeding is well established.
  2. Cross cradle: Here hand supports the head and forearm back of the baby. It gives good support to the baby and is good for preterm and new mothers
  3. Side lying: This is the comfortable position for the caesarean mothers and mid night feeds. Care should be taken that the nose doesn’t get pressed blocking the airway
  4. Football: This is also known as clutch position. It is the easy position and very useful in caesarean and twins. This position avoids baby weight to fall on abdomen and thus is easier for caesarean mothers.

Never hesitate to ask for help for it takes time to get adopted to positions and proper latching of the baby and effective feeding.

Work and feed:

Working ladies may have to resume work as per to their company norms. You can provide breast milk for your baby even when you are apart. Talk to your supervisor ahead of time about the conveniences at work place. Most employers by law are now required to give you time and a place to pump milk for your baby. Eextreme care should be taken about its cleaning and sterilization. Don’t hesitate to take any necessary help from co-workers.

Feeding in public:

Breastfeeding your child in public places is not a shameful act. Initially as you may have to feed the baby frequently, you may need to feed while travelling, shopping or any picnic places you visit. Feed your child with dignity because its something God has given as a part of motherhood. If you don’t find a special rooms for feeding, move to a calmer area, with minimal people or can just use a thin breathable cloth to cover during feeding. Care should be taken to check the baby in between for any inconvenience or suffocation.

Mother can breastfeed her baby even if she has some health problem exceptional being some cases where the medication of mother might be passing on through the milk to the baby, or  when the mother is going through some terminal illness. In such cases the doctor will advise as needed. Always have a glass of water, milk, or juice handy to drink while you breastfeed as this will keep you hydrated which helps you produce milk.

Conclusion:

Breastfeeding is an ocean to speak about. Tried to put it short with important points. Drop me a mail in case you need any further details.

  • Exclusive breastfeeding for first 6 months will keep your child healthier. One can continue breastfeed till 2 years along with other food supplements.
  • Let colostrum be the first food to your baby. Though little in quantity, highly nutritive and frequent feeding will prevent breast engorgement.
  • Be relaxed and happy, have all healthy food and fruits and plenty of water. This will improve your milk production.
  • Among various breastfeeding positions adopt one which is comfortable to both of you.
  • Feed on demand should be followed during initial months and take the help of your health care provider for any help.
  • Breastfeeding decreases the prevalence of the most aggressive breast cancer
  • For this 21st century society its more important trying to avoid bottles to boost immunity to prevent recurrent illness and protect the child against certain chronic conditions.

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Mosquito repellent – better way

All Go Out …. Mosquitoes

With the rise in mosquito borne diseases affecting huge population, its very important to take proper measures to prevent from bites.

Have you ever wondered why the mosquitoes are more fond of some people specifically? At this point, lets see some scientific reasons behind. Mosquitoes are mostly attracted to the blood and sweat type which emits particular odor. Bacteria, lactic acid, ammonia, carbon dioxide etc are present in sweat and breath. The more you emit, the more mosquitoes are attracted. it’s specially the old sweat not fresh one. Thus its advisable to have a bath after returning from work.

There are many chemical mosquito repellents available in market but then you may not like to cover yourself or inhale those harsh chemicals to repel them because most of them are in simple words ‘pesticides’. Though these repellents try putting the mosquitoes away, somewhere we are concerned even about the health hazards due to the contents like DEET, permethrin specially when you have kids and very elderly ones at home.  So lets make a trip trying to find some solutions naturally which are mild and good for us and bad to the mosquitoes.

Camphor:

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camphor

Camphor strikes first when we think of a natural repellent and it  really worked good to me. Its been in indian tradition since ages to use camphor for prayers in a way puts away the insects and mosquitoes. Apart from giving good aroma, its even a bronchodilator which helps in easy breathing. The same camphor is some how intolerable to mosquitoes. Place 4  pieces of camphor on different corners of the room where mosquitoes seem to love to stay. Leave them there and they will evaporate in a day or so. You can also put them in a small bowl of water by slightly crushing it. Place the bowl in a corner of the room.

 

Essential Oil Spray:

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Essential oils are one of the most effective ways to get rid of mosquitoes is by making your own bug spray with essential oils. Essential oils have lovely aromas which are adversely hated by mosquitoes. These can be made by mixing around 10 – 15 drops of any of these essential oils with distilled water say 200 ml in a spray bottle. These can even be directly applied to skin while going out by mixing it with some oil base in 1:3 proportion. You can adjust it as per your tolerance. Though it can be used on skin to kids above 2 years, it is always advisable to check for any allergic tendency by patch test.

  • Lemon Eucalyptus
  • Cinnamon
  • Lavender
  • Neem
  • Citronella
  • clove

you can even mix two of the essential oils say neem and citronella or you can even mix it with camphor. My favorite mix is neem and camphor powder. Neem is very good anti infective too. If you are someone with hectic schedule and don’t find time for these interesting preparation, you can head with readily available natural repellents in market. Just make sure of the composition though.

Mosquito racket:

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One of the good way to put them off completely! It would be a good exercise to you too. Do it with your kid and trust me it will be fun. These electric racket kills the mosquitoes instantly just you need to play hide and seek with them a bit.

Mosquito nets:

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No doubt these are the best way to keep mosquitoes away at night and have a safe and peaceful sleep. Make it mandatory to use them especially for pregnant and infants.

 

Mosquito Repellent Plants

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There are many plants which repel mosquitoes. In india easily available are holy Tulsi, lemongrass, mint and marigold. Thyme and rosemary are also effective and they can be used by burning little inside home to spread fumes within. Thenyou maynot like to have a fumy home! Best is grow these plants in garden or in your veranda. Mosquitoes will think twice before it enters. Go green…. Just enjoy cooking and same time put mosquitoes at distance.

 

The most important way to keep mosquitoes out is to keep them OUT!  Wear long sleeved clothes and full pants to keep arms and legs safe. have a bath as you return from work or workout. Close windows and doors in the early evening which is when mosquitoes tend to enter in. Use a mosquito net at night, especially over babies’ cots and kids’ beds. Always have at least two options to deal with them. In heavy and endemic areas you just cant rely on one method. Along with usage of essential oil, mosquito net or racket becomes mandatory.

 

Freedom from Pre-Menstrual Dystrophic Disorder

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 By definition premenstrual dysphoric disorder (PMDD) is a severe form of PMS (Premenstrual syndrome). Premenstrual syndrome (PMS) is characterized by significant mood, behavioural and physical changes that occur 1 to 2 weeks before menses and abate during the menstrual flow. The symptoms of PMDD are similar to those of PMS, but are severe enough to interfere with work, day to day activities and relationships.

Most of the women especially of child bearing age group experience some degree of emotional or physical discomfort a few days before their menstrual period begins each month. About 40% go through PMS which they hardly discuss with their doctors. Around 5% of menstruating women suffer from PMDD and approach health care mainly with the feeling of unwell with vague symptoms.

What can be the possible cause?

The pathophysiology is still uncertain that why exactly the normal physiological hormones cause these problems in some while others are not much affected. Oestrogen and progesterone are the two main hormones playing major role in menstrual cycle. To understand it better let’s have a look at below picture.

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During ovulation there is peaking of the hormones with sudden dip whereas progesterone starts raising including oestrogen in luteal phase. Scientists believe that these hormonal changes and these hormonal imbalance also trigger the neurotransmitter called serotonin which is the main cause for mood fluctuations and certain physical symptoms. Serotonin is considered as a feel good hormone and decrease in its level causes depressive feeling.

Symptoms:

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  • Depressed mood
  • Tension, Irritability
  • Mood swings from anxiety to depression
  • Decreased interest in usual activities
  • Lack of energy
  • Insomnia or hypersomnia
  • Physical symptoms such as fluid retention, bloating and breast tenderness
  • Difficulty concentrating
  • General symptoms like Head ache, leg cramps, hot flushes, skin allergy
  • Marked change in appetite
  • Feeling overwhelmed

 

Diagnosis:

There are no exact laboratory tests for this. Your consultant may rule out certain medical conditions and then asses for PMDD. One must have at least five or more of the symptoms listed above and at least one or more of these symptoms must be severe depressed mood, tension, mood swings or irritability. These should be present atleast for two consecutive cycles 1. Symptoms are present a week or two before the onset of menses with resolution after the start.

Treatment and precaution:

  • Medications include: SSRI antidepressants, Oral contraceptives, Gonadotropin-releasing hormone analogs, Anti-inflammatory medications(pain killers)
  • Dietary changes
  • Exercise

Most of the time depending on the severity of the symptoms medication is advised mainly for the mood related symptoms. Pain killers like ibuprofen, mefenemic acid relieve symptoms such as headache, backache, cramps, and breast tenderness. Along with medications, dietary modifications and exercise act as a great adjuvants.

Exercise: In some cases the severity of symptoms can be managed by dietary means and exercise itself. Stress is the major factor in todays life specially in anxiety personality and one of the way to get out of it is regular Exercise and self motivation. Women with mood swings, anxiety and depression have shown to improve with exercise and meditation as these are said to release mood elevating and pain relieving endorphins.

Diet : A healthy diet is important for both physical and mental wellness. Try avoiding too much of caffeine and alcohol. Start your break fast with high lean protein and good fat. Include more of calcium rich food, vegetables including complex carbohydrates which helps in elevating serotonin levels, Omega 3 fatty acids, eggs and bananas(best for cramps and sleep). Vitamins specially Magnesium and vitamin B complex are said to be womens best nutrition for PMDD. Try having more small meals which help to stabilise energy levels during luteal phase.

Education : Know that you will feel better once your period starts. While the symptoms of PMDD may vary from month to month, once you understand whats PMDD and your symptoms how they affect your physical health and moods it becomes easy to deal with. Learn to cope up with the day to day life problems to decrease anxiety and irritability prior to your periods.

There is no doubt that PMDD can greatly affect a woman’s quality of life including the lives of her family and friends. The seriousness of this condition is something that most of the people are not aware of. Educate your partner regarding PMDD. He might be total clueless about what you are going through and your actions. Once he knows he might be a great support. Speak out to your mom and friends. Educate them and convey them that the phase passes by and they are not just alone with this. Hang out with friends or do that which makes you happy or elevates your mood. One may take the help of counseling with a psychologist if nothing seems to help.

It’s a beautiful phrase I came across which sits perfect for what all is faced regularly. Every body is unique, understand your body and its physiology and try to handle accordingly. So face the PMDD with appropriate measures, feel good and eat good having a thought that its going to pass and you will be all fine.

 

Reference:

1. American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders. Fourth Edition. Washington, DC  American Psychiatric Association, 1994

 

Plastic and microwave


As a doctor, many people often ask me about the kind of plastic to use and about the ones to microwave. Most of you must have a bundle of queries like Am I doing it right using them? How can I avoid or decrease health risks to my family due to heating of food or drinks in plastic? Should we completely stop using it? Is it possible to completely stop using plastic in microwave or having outdoor food where we often see the take away containers to be plastic?? It’s not possible to completely stop using them but yes we can use it with caution and in minimal. So here I would mention briefly some important things we all need to consider.

 

Health hazards:

You may be concerned that heating food in a microwave using plastic will increase your risk of developing cancer or many other health issues. Many different chemicals are being used in the manufacturing of plastic and some of these may cause cancer. It is possible that these chemicals may leach out of the container and into the food it holds.Substances are often added to plastic to help shape or stabilize it. Two of these plasticizers are bisphenol-A (BPA)- added to make clear, hard plastic and phthalates added to make plastic soft and flexible

Perhaps one of the most dangerous contaminants in microwavable food is BPA. Bisphenol A, often known as BPA is a chemical found in hard plastics and the coatings of food and drinks cans which can behave in a similar way to estrogen and other hormones in the human body. BPA is used to make many products, including water bottles, baby bottles, dental devices, medical devices, household electronic and sports equipment.

The amounts that were detected, scientists have found to cause neurological and developmental damage in laboratory animals. The problems include genital defects, behavioral changes and abnormal development of mammary glands. The changes to the mammary glands were identical to those observed in women at higher risk for breast cancer. So pregnant ladies are advised to abstain themselves from using if not completely at least minimise its use. An analysis of 455 common plastic products, including supposedly BPA-free ones, found that 70% tested positive for estrogenic activity; that number went up to 95% when the plastics were microwaved. These chemicals used in plastic making are also found to be ‘endocrine-disrupting chemicals’ capable of interfering with the way our glands produce hormones that govern virtually everything our bodies do, including the way we reproduce, grow, sleep, heal, develop mentally etc.(1,2)
For microwave approval, the testing agency estimates the ratio of plastic surface area to food, how long the container is likely to be in the microwave, how often a person is likely to eat from the container, and how hot the food can be expected to get during microwaving. After a series of tests only then the approval is given.

What is Plastic grading?

We often see some number mostly at bottom. Its just the grading which indicates its utility. Before you go for shopping this time, just put in mind to make a note of numbering and for what exactly you need them for!

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The health risks of cooking in plastic seem to include all forms of plastic according to literatures. The worst offender is 6, polystyerene. Plastics with numbering 1, 2 and 4 are the safest.

 

Points to remember:

  • Pregnant ladies should minimise their use of microwave and specially food cooked in it using plastic.
  • If you’re concerned about plastic wraps or containers in the microwave, transfer food to glass or ceramic containers labelled for use in microwave ovens.
  • Don’t let plastic wrap touch food during microwaving because it may melt. Wax paper, kitchen parchment paper or a domed container that fits over a plate or bowl are better alternatives.
  • Most takeout containers, water bottles, and plastic cups are not microwave-safe. Choose bottled drinks and processed foods wisely. Avoid plastic containers labeled with the numbers 3, 6, or 7, which is said to contain more of phthalates.
  • Microwavable takeout dinner trays are formulated for one-time use only and will say so on the package.
  • Old, scratched, or cracked containers, or those that have been microwaved many times, may leach out more plasticizers.
  • If you’re using plastic containers for storage, let the food cool before storing, then refrigerate it immediately. Avoid plastics and containers that are visibly damaged, stained or have a bad smell
  • The World Health Organisation (WHO) estimates there are more than 800 of these chemicals in use in such vast quantities that they are everywhere — not just in the products, but also in the environment and the food chain. So do not panic and use them judiciously. 

References:

  1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3223004/
  2. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3222987/

Love your bones

WHO theme for Osteoporosis this year says “love your bones and protect your future”. It emphasised on one of the unattended part of our body upon which the entire human structure is made of. The incidence of osteoporosis is increasing world wide. So every year on 20th October various camps are arranged at different localities to create its awareness among the public. So here is my contribution for this day . Hope it would help you to understand the importance and take appropriate measures right from the start.

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What is Osteoporosis and its leading cause?

As defined by books, Osteoporosis is a progressive disorder of bones characterized by reduced bone mass and deterioration of microarchitecture predisposing it to increased fracture risk. It is most of times referred to as” silent disease” because it progress without any symptoms and is often diagnosed only after an incidence of fracture with some minor trauma. Bone is a dynamic tissue with a continuous remodeling leading to the formation of new bone and resorption of old bone which is carried out by cells osteoblasts and osteoclasts respectively.

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Not going much into hard core medical details, osteoporosis is mainly classified into two types – primary and secondary and treatment is given as per to the type.

Primary Osteoporosis is linked to the normal aging process and mainly presence of two hormones, oestrogen and progesterone, and the rate at which bone is lost. Deficiency of oestrogen among women and testosterone among men are main leading cause. Secondary osteoporosis is more common among men and is found to have an underlying cause like certain disease (like hypogonadism, hypercalciuria), medications (steroid medications, anticonvulsant medications, chemotherapy), excess alcohol consumption, smoking, immobilisation due to some disease condition.

Osteoporosis is most common among women mainly in post-menopausal. Some studies say that in population over the age of 50 years, it’s almost one among every three women are affected whereas incidence among men are one among five.

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Reason can be low calcium intakes with extensive prevalence of vitamin D deficiency, increasing longevity, early menopause, genetic predisposition, lack of diagnostic facilities, and poor knowledge of bone health have contributed toward the high prevalence of osteoporosis.

Components that make up the bone:

As we all know calcium is the main component of bones but other factors also plays an equally important role in the formation either directly or indirectly by enhancing the absorption of calcium.

Most important being Vitamin D ( for better absorption of calcium) typically produced in skin from sunlight. Others being vitamin C (collagen formation), phosphorus (integrity of bone),zinc (for better functioning of calcium and Vit D), magnesium ( promotes absorption of calcium), manganese (synthesis of connective tissue in cartilage and bone) and protein. Protein, a nutrient that is necessary for building and repairing body tissues including bones. Protein gives bone its strength and flexibility. So its very important to include variety of food containing these elements for good health of bones.

So what is the requirement of Calcium and Vitamin D?

Adults up to age 50 require 1,000 mg of calcium daily which is equivalent to a glass of milk of around 240ml. older adults will need about half a glass more of milk. As for vitamin D: We need 200 International Units (IU) of vitamin D a day until age 50. Beyond this age, the demand always is more.

Diagnosis

The diagnosis of an osteoporotic fracture is by clinical or radiological and or by Bone Mineral Density (BMD).The gold standard method of BMD testing is by dual X-ray absorptiometry (DXA). Its value is expressed in standard deviation (SD) units either as T-score or Z score

Treatment:

Osteoporosis is a costly debilitating disease, hence it is important to inculcate preventive measures, diagnose early and modifications of risk factors associated with osteoporosis.

  • For me, counseling to patients on nutritional factors, smoking, heavy alcohol consumption, and on eating pattern is the first step.
  • I would treat with pharmacologic agents only when the condition is already established. Calcium, vitamin D, and bisphosphonates are the commonest first-line therapies used and your doctor would preferably prescribe one or two among them depending on the condition. The use of other drugs such as hormone replacement therapy, estrogen agonists, calcitonin, parathyroid hormone, and denosumab is decided as per the affordability and availability of treatment options.

 

Do it in natural way:

Do it from start and even include the pattern among your kids. Even if 30 years, can go for a check up and modify your lifestyle and eating pattern accordingly. Below are certain naturally available bone friendly eatables.

  • Diet must provide adequate quantities of protein, vitamins and minerals especially calcium and vitamin D.
  • So your diet must include foods like milk, cheese, buttermilk, yogurt, dark green leafy vegetables, salmon, soybeans and tofu for enhancing the calcium intake and absorption.
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  • One should take Vitamin D fortified milk and cereal products, egg yolk, saltwater fish and liver which contains adequate amounts of vitamin D mainly essential among those who are mostly into indoor work or less exposed to sun. ladies should make a note that sunscreen hampers the absorption of vitamin D.
  • Regular exercise is another important preventive measure because it strengthens the supporting factors for bone and improves the blood circulation. Walking, climbing stairs, weight training, and dancing are some easy ways out.

Avoid:

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  • Smoking and drinking should be restricted as theses increases the demand of calcium. Excessive alcohol (more than 2 ounces a day) interferes with the calcium and vitamin D absorption. Studies have shown that men with alcoholism produce less testosterone, a hormone linked to the production of osteoblasts. In women, chronic alcohol exposure can trigger irregular menstrual cycles, a factor that reduces estrogen levels and increasing its risk for osteoporosis. Drinkers often avoid vegetables, salads and fruit in favor of fast food or a high protein diet. This is also a reason for low levels of calcium as well as other related problems.no-soft-drinks-clipart-1
  • Carbonated drinks are equally bad. Why? Firstly, they contain caffeine which itself is a risk factor.

Secondly the main culprit is phosphoric acid present in it which aids in resorption of bone and excreting out the calcium. This is really bad for your bones and teeth.

Thirdly the sugar! It contains high amount of sugar which has been found to be associated with an increase in urinary excretion of calcium. That’s one of the prime reason people with diabetes are often prone for weak bones.

 

            My last word to you in this regard will be, take precautions, go for early and regular tests, eat healthy, exercise regularly, avoid all risk factors and just postpone the weakness of bones and have a healthy and disabling free life!