TREATMENT AND MANAGEMENT OPTIONS FOR RHEUMATOID ARTHRITIS

What is Rheumatoid Arthritis?

It is a disorder of the body system involving inflammation and degenerative changes principally in the small and large synovial joints. This is often associated with a lot of systemic disturbance and extra-articular disease. It usually pursues a chronic course that is life-long, with intermittent exacerbations and remissions with highly variable severity of symptoms and signs.

What is the cause?

The cause of the disease is unknown but autoimmunity plays a major role in its chronicity and manifestations and it is often considered to be a systemic autoimmune disease.

What are the signs and symptoms for diagnosis?

Most patients experience at least four or more of the following symptoms and signs of the disease by the time they present themselves for treatment at the clinic:-

•  Morning stiffness (> 1 hour)
•  Arthritis of hand joints
•  Symmetrical Arthritis
•  Arthritis of three or more joint areas
•  Rheumatoid nodules
•  Rheumatoid factor
•  Radiological changes seen on X-ray of joints
•  Problem has been on for more than 6 weeks

Most commonly patients present with a gradual onset of arthralgia (often symmetrical) and synovitis of the small joints of the hands, wrist and feet. In some, onset may be paindromic, with recurrent acute episodes of joint pain and swelling which may last from a few hours to days. Whatever pattern of presentation, most sufferers have evidence of morning and inactivity stiffness and stress pain.

It is to be noted that RA is a systemic disease and other extra-articular areas of the body may be affected. These include:-

• The Muscles and Tendons
• The blood vessels and Lymphatic’s including Lymph nodes
• The Lungs
• The heart
• The Nerves and nervous system
• Amyloidosis

Treatment Options and Management:

In the U.S.A. about 1.3 million people are affected by the disease, being three times more prevalent in women especially during the post-partum and breastfeeding periods. Age of onset is usually between 40 to 50 years but it can occur in any age group.

For the majority of patients, the aims of management are:-

1. To educate the patient
2. Control pain
3. Optimize bodily functions, especially that of the joints
4. Modify the disease process in such a way that will most benefit the patient

Since there is a wide variety of treatment modules, the expertise of a number of health professionals working synergistically together may be required for most patients. The patients’ symptoms and signs change with time and will usually require adjustments of the treatment modules. There is no cure for RA. Medications help to reduce joint inflammation, pain, and slow down joint damage, while occupational and physical therapy teach on how to protect the joints and how to make use of adaptive utensils where there is joint deformity causing limitations of movement. Severely damaged joints by RA may require surgery to regain some appreciable functionality back.

Type of Medications in Use:

The following are the various drugs used to treat RA. Most patients require a combination of drugs to get the most beneficial effect:-

•  Steroids:- These help reduce the inflammatory process and slow down the damage to joints. It cannot be used for long term treatment because of its undesirable side effects. Most of the time it is prescribed to relieve the acute symptoms of the disease. Those usually prescribed include Prednisone and methylprednisolone (Medrol).
•  Disease Modifying Antirheumatic Drugs (DMARDs):-These are drugs that act to slow down the auto-immune destructive processes of RA, thus saving the joints and other tissues from permanent damage. Among the common one’s often prescribed are: Minocycline (Minocin), Methotrexate (Trexall), Hydroxychloroquine (Plaquenil)
•  TNF-alpha Inhibitors:-These inhibit a destructive substance, Tumor necrosis factor alpha, produced in the body causing severe inflammatory activity in various body tissues. Use of these drugs help to reduce morning stiffness, and painful swelling of the joints. They include; Infliximab (Remicade) and Adalimumab (Humira).
•  NSAIDs:-These are Non Steroidal Anti Inflammatory Drugs and are used to relieve pain and reduce inflammation. They include Ibuprofen (Advil), and Naproxen sodium (Aleve), which are off the counter drugs (OTC). Stronger ones in this group are prescription only drugs
• Immunosuppressants:- These are drugs that try to correct the abnormal behavior of the immune body system in RA. Examples include Cyclophosphamide (Cytoxan), Azathioprine (Imuran) and Cyclosporine (Neoral)

Other Medications:-

There are some other inflammatory substances produced by the body in RA. These act as targets for some other drugs used in the treatment of RA. They include Abatacept (Orencia), Rituximab (Rituxan) and Anakinra (Kineret).

Exercise and Occupational Therapy:-

Occupational therapists play a very important role in the treatment and management of RA patients. They teach them basic exercise movements that will help affected joints not to become stiff. They also help them to find different methods to approach everyday tasks in ways that take stress off painful joints and also teach and encourage the use of assistive devices to make their work easier.

Surgery:-

This should be a last resort when all else has failed and there is evidence of damage to joints.

The different types of Surgery performed for RA are as follows:-

• Total joint replacement (Arthroplasty)
• Tendon repair 
• Removal of the joint lining (Synovectomy)
•  Joint fusion (Arthrodesis)

Author: Ola Suyee

                                                                                                                                                                                                                                                                                                 

CORE TRAINING ANATOMY AND EXERCISE

What is core anatomy?

Core anatomy refers to the body minus the legs and arms. The major muscles involved in these core areas include the muscles of the belly, mid and lower back (external and internal obliques, tranversus abdominus, rectus abdominis, multifidus, erector spinae (sacrospinalis), longissimus thoracis, and the diaphragm. The minor muscles are distributed peripherally and include latissimus dorsi, gluteus maximus, medius and minimus and trapezius.

What are the functions of the core?

The core has the function of stabilizing the thoracic cage and the pelvis during dynamic movements. An efficient core helps to maintain a normal length-tension relationship between the muscles of the core, maintains normal muscle force coupling and optimizes arthrokinematics. It also ensures optimal efficiency of the entire kinetic chain during movements, giving dynamic stabilization to acceleration and deceleration and proximal stability to movements of the extremities as well.

It is also involved in providing internal pressure in the expulsion of substances from the abdominal cavity (passage of feces, air, and vomiting). Women employ the core muscles for labor and delivery (especially the tranversus abdominus). A weak core musculature of the pelvic region can result in either urinary or fecal incontinence or both. In summary, the core muscles are needed for:-

•  Pushing
•  Lifting 
•   Excretion
•  Birthing

The core is involved in most full-body functional movements, especially in sporting activities and it determines to a large extent, a person’s posture. The core muscles align the pelvis, spine and ribs of an individual to resist a specific force, static or dynamic.

What are the aims of core muscle training exercise?

The aims of core muscle training should include:-

• Spinal stabilization to ensure proper coordination and control of the spine and effectively utilize or restore strength, power, neuromuscular control and endurance of the major core muscles to control and protect the spine from injury.
• Facilitate and balance muscular functioning of the entire kinetic chain.
•  Enhance neuromuscular control and increase neuromuscular efficiency throughout the entire body and provide a more efficient body positioning during sporting activities and at rest.

Guidelines for Exercise Selection

The exercises should be such that will be safe, challenging, proprioceptively rich, ensure stress in multiple planes, be activity specific, incorporate multi-sensory environment and be progressively functional and continuous (i.e. slow to fast, simple to complex, low force to high force, static to dynamic, known to unknown etc)

Exercises:-

There are various types of exercises designed to train the core muscles and guidelines for selecting some of them has been given above. These exercises may include:-

1.  The McGill stability exercises
2.  Pilates exercises
3.  Swiss ball program
4.  Balance board
5.  Shoe training program

and many more. For the abdominal muscles like rectus abdominis, internal and external obliques, they can be trained using the abdominal hollowing technique. This involves the athlete lying on his or her back in the neutral position, he/she is instructed to relax the muscles of the abdomen, bend the knees and while slowly exhaling, pull the lower abdomen inwards as if trying to push the belly button (umbilicus) towards the floor. This is a common exercise known as zipping-up maneuver. This technique can be combined with other exercises involving the lower extremities like straight leg lifts and knee to chest exercises. The athlete must always remember to begin with the abdominal hollowing technique before adding limb movements exercises.

It is to be noted that abdominal exercises are an important part of any core training program, for example, it forms a major part of coordination and control exercises that are designed to help the body proprioceptive systems coordinate muscle control to prevent injury during movements or when colliding into external forces as is the case in some sports (e.g.rughy).

Author: Ola Suyee

LASER (LED)THERAPY – ITS MEDICAL USES

WHAT IS LASER?
The term laser is an acronym for “LIGHT AMPLIFICATION BY STIMULATED EMISSION OF RADIATION”.
Ordinary light, such as that from a light bulb, has many wavelengths and spreads in all directions. Laser light, on the other hand, has a specific wavelength. It is focused in a narrow beam and creates a very high-intensity light. Because lasers can focus very accurately on tiny areas, they can be used for very precise surgical work or for cutting through tissue (in place of a scalpel).

Laser Therapy is therefore any treatment that uses intense beams of light to precisely treat tissue pathology in the body of humans or animals. The laser light beam is generated from radiation sources so small and safe, that it poses no health risks to the patient or medical team.

The laser is used for many medical purposes and because the laser beam is so small and precise, it enables doctors to safely treat tissues without injuring the surrounding area.

Lasers may be used to remove growth or cauterize blood vessels. They may also be used for eye surgery. In essence, laser surgery is a medical procedure that uses laser light to remove diseased tissues or treat bleeding blood vessels. It may also be used for cosmetic purposes, such as removing wrinkles, tattoos, or birthmarks.

Low-level laser therapy (LLLT) is a medical and veterinary treatment that uses low-level lasers or light emitting diodes (LED) to alter cellular function.

Medicine and especially Dentistry have found many new applications for diode lasers. The shrinking size of the units and their increasing user friendliness makes them very attractive to doctors for minor soft tissue procedures. The 800 nm – 980 nm units have a high absorption rate for hemoglobin and thus make them ideal for soft tissue applications, where good hemostasis is necessary.

Medical areas that employ lasers include:

• Angioplasty
• Cancer diagnosis and treatment
• Cosmetic applications such as laser hair removal and tattoo removal.
• Dermatology
• Lithotripsy
• Mammography
• Medical Imaging
• Microscopy
• Ophthalmology (includes Lasik and Laser Photo-coagulation)
• Optical Coherence Tomography
• Prostatectomy
• Surgery

In recent times, there has been a lot of research into the healing effects of light on our bodies. Therapeutic light has many beneficial effects on the human body, amongst which are:-
 

• Promotion of better mental clarity.
• Improvement of mood and reduction of depression.
• Improvement of energy levels.
• Improvement of learning ability in children, reduction of attention-deficit and hyperactivity disorders.
• Anti-aging and facial lifting effects.
• Lowering of blood pressure.
• Strengthening of the immune system.
• Improvement and protection of vision.
• Prevention and cure for a host of diseases.

Various forms of light therapies have been around since ancient times. Modern light medicine received its greatest boost in the USA from the pioneering work of an Indian physician named Dinshah Ghadiali. He got his start in light medicine in India after a young woman with severe diarrhea caused by colitis was rapidly cured after light from a kerosene lantern, passed through an indigo-colored glass bottle, was shone onto her. The woman was also helped by drinking milk that had been in an indigo bottle left out in the sun, with the milk apparently taking on the healing vibrations of that color of light. 

Dinshah did a great deal of research and clinical trials into the use of color light for healing after moving to New York in 1911, and he trained over 800 professionals between 1920 and 1924. Over the next 20 years, his group amassed many thousands of successful case studies showing the remarkable power of light healing for a very wide range of human diseases.
 

Mechanism of Action – How does low-level laser therapy (LLLT - LED) work?  

The effects of low-level laser therapy (LLLT) are photo-chemical, like photosynthesis in plants. Red or near infrared light can effect cell membrane permeability and aid the production of ATP (Adenosine Triphosphate) thereby providing the cell with more energy which in turn means the cell is in optimum condition to play its part in a natural healing process. Stimulation of the mitochondrion in the cells leads to increase production of ATP resulting in an increase in reactive oxygen species, which influences redox signalling, affecting intracellular homeostasis, or the proliferation of cells, leading to healing of previously damaged tissues. The final enzyme in the production of ATP by the mitochondria, cytochrome c oxidase, accepts energy from laser-level lights leading to the cell multiplication effect.

The typical wavelength of the most common low-level laser therapy (LLLT - LED) lasers is in the range 600 – 1000 nm (red to near infrared)

Because of the low power energy of LLLT, the effects are not thermal and do not cause heating, and therefore cannot cause damage to living tissue.

Laser therapy devises were developed to treat all forms of sports injuries, and musculoskeletal conditions, release and control pain, provide improved wound healing and for laser acupressure without the use of needles. Laser therapy is a highly effective and non-invasive form of treatment. The patient feels no pain. Low-level laser therapy (LLLT) has proven to be very effective for many conditions that have not responded well to other forms of treatment.

Today light therapy has come of age and is coming into mainstream medicine, bringing to fore Dinshah’s vision.

Here are a few examples of recent research findings and treatments for some human ailments:
 

Light Therapy for Treating Cancer:
Small tumors in the lungs, esophagus and some body cavities can be destroyed without the negative effects of chemotherapy by using FDA-approved light therapy. It works in the following way – First, a chemical that sensitizes cancer cells to light is injected into the body. After waiting for between 24 to 36 hours, a selected wavelength of light is applied to the tumor, which then dies leaving healthy surrounding cells unharmed. There is also some evidence that this treatment stimulates the immune system to kill other cancer cells.

Similar to this, is Laser Surgery, which is a form of precise surgery that uses light of high intensity and narrow beam to remove cancer or precancerous growths or to relieve symptoms of cancer. It is used most often to treat cancers on the surface of the body or the lining of internal organs. This form of laser therapy is often given through a thin tube called an endoscope. An endoscope can be inserted in openings in the body to treat cancer or precancerous growths inside the trachea (windpipe), esophagus, stomach, or colon. Laser therapy causes less bleeding and damage to normal tissue than standard surgical tools, and there is a lower risk of infection. However, laser therapy is extremely expensive and the effects of the surgery may not be permanent, so the surgery may have to be repeated.

In most cases laser surgery for cancer is usually combined with other treatments such as conventional surgery, chemotherapy, or radiation therapy.
 

Light therapy for helping bone marrow transplants – A NASA initiative:
“A device using specialized light emitting diodes (LED), based on NASA technology for plant growth in space, is continuing to show promise as a treatment to aid healing of bone marrow transplant patients ... Biologists have found that cells exposed to near-infrared light – that is, energy just outside the visible range – from LEDs grow 150 to 200 % faster than those cells not stimulated by such light. The light arrays increase energy inside cells that speed up the healing process.”
 

Light used for treating depression:

“A study commissioned by the American Psychiatric Association and led by a psychiatrist at the University of North Carolina at Chapel Hill School of Medicine has found that light therapy effectively treats mood disorders, including seasonal affective disorder (SAD) and other depressive disorders. A report of the study, which appeared April 1 in the American Journal of Psychiatry, also finds that the effects of light therapy, also known as phototherapy, are comparable to those found in many clinical studies of antidepressant drug therapy for these disorders.
 

Wounds heal faster with light:

Infra-red light is most of what comes to us from the sun. It is deeply heating and is what is used to keep the French fries hot at McDonalds. In a recent 2008 study, wounded rats healed significantly faster than controls without light therapy, when polarized (uni-directional) infra-red light was applied to their wounds. Other studies show just what kinds of light speed healing. It seems that red-orange visible light and invisible infra-red light between 820 nm and 980nm work best. This is the range of what is often called in medicine as cold laser which refers to the use of low-intensity or low levels of laser light (LLLT – Low-level laser therapy). Cold laser therapy can reduce pain and inflammation. Cold laser treatment (LLLT) is thought to help some types of pain, inflammation, and wound healing. These lasers are used directly on or over the affected area.
 

Laser treatment in Dermatology:
Laser therapy – for both the management of birth marks, skin disorders (like vitiligo), tattoo removal, hair removal and cosmetic resurfacing and rejuvenation and also for the treatment of skin cancer and precancerous growths, is usually performed by specialists in dermatology.

DNA is highly light sensitive:
Many studies have documented that DNA, the double-helix molecule that holds all our genetic information and guides all growth and healing in the body, is highly responsive to light. In a paper from Kiel University in Germany, N. Schwalb described how light applied to DNA molecules makes them light up, or fluoresce, in distinctive ways. She concludes that laser light could be used to directly recognize and possibly repair many genetic diseases.

CONCLUSION:

Specific tests and protocols for LLLT show that it is effective in relieving short-term pain for rheumatoid arthritis, osteoarthritis, acute and chronic neck pain, tendinopathy and possibly chronic joint disorders. There is also a lot of evidence supporting the fact that LLLT is useful in the treatment of low back pain, dentistry and wound healing.

Author: Ola Suyee

ACTIVATED CHARCOAL – A LIFE SAVER

Activated Charcoal or active carbon is a form of carbon which has been processed from source materials like peat, petroleum pitch, wood, coal, coir, lignite, and nutshells. Processing involves either physical reactivation or chemical activation which gives the charcoal a form that is extremely porous, thus making it to have a very large surface area available for adsorption or chemical reactions.

The charcoal becomes “activated” when acid plus steam at a very high temperature is added to one of the source materials listed above. This oxidative process further erodes the charcoal’s internal surfaces, thus increasing its adsorption capacity by creating an internal network of even smaller pores rendering it two to three times as effective as regular charcoal. Putting this in perspective, one standard 50-gram dose of activated charcoal has the surface area of 10 football fields.

One of the major areas of use of activated charcoal in medicine is in treating poisoning or overdose following oral ingestion. While it is useful in acute poisoning, it is not effective in long term accumulation of toxins such as toxic herbicides. In effect, activated charcoal is used as an emergency decontaminant in the gastrointestinal (GI) tract, which includes the stomach and intestines, and is considered to be the most effective single agent available for eliminating ingested poisons. It is used after a person swallows or absorbs almost any toxic drug or chemical and most times eliminates the need of a stomach washout (gastric lavage), although the two can be combined where the patient gets to the hospital within 30 minutes after ingestion of the drug or chemical. Gastric lavage is not very useful if the time lapse between ingestion and getting to hospital exceeds 30 to 45 minutes. Use of activated charcoal alone is to be preferred in such cases and it is estimated to reduce absorption of poisonous substances by up to 60%. It is to be noted that gastric lavage does not have effects that reach beyond the stomach, unlike activated charcoal which works through the entire length of the stomach, small, and large intestines (GI tract). It is given orally with water.

Activated charcoal exerts its effects by adsorption, which is a process whereby atoms and molecules move from a bulk phase (such as solid, liquid or gas) onto a solid or liquid surface. The toxic substances attaches to the charcoal surface and since no digestion takes place; nor is it absorbed into the bloodstream, it stays in the G.I. tract and the toxins are eliminated when the person passes feces. Because of this, often times, it is combined with sorbitol (a substance that stimulates the bowels to move, like a laxative) in order to shorten the amount of time it uses to move through the GI tract and reduce the possibility of constipation. However, to avoid complications, sorbitol is not given with every dose of activated charcoal.

Other uses of activated charcoal include:-

1. Use in household water carbon filters to purify drinking water and make it potable. In this respect, it is often combined with silver which act as an excellent antibacterial agent preventing bacteria from multiplying in the filter. It also decomposes toxic halo-organic compounds such as pesticides into non-toxic organic products, further purifying the water and making it more potable.
2. As odor eliminator in the home, especially for fridges, fridge-freezers, kitchen cabinets etc.
3. It is used to relieve flatulence, stop diarrhea in cancer patients undergoing treatments with irinotecan and is good in relieving various “stomach troubles” in general.
4. It can be mixed with some facial cream preparations to make a pore rich active carbon exfoliating masque for facial cleansing and general body skin applications.
5. It can be used to relieve the pains of stings, insect bites, bruises, and can be made into a poultice and applied to bruises and swellings on the body.
6. There is some evidence of its effectiveness as a treatment for irritable bowel syndrome (IBS). It is also used for bowel preparation by reducing intestinal gas content before abdominal radiography to visualize bile, pancreatic and renal stones.
7. A type of activated charcoal biscuits is marketed as a pet care product.

In conclusion, activated charcoal is a very handy first-aid medication every family should have in its first-aid box.

Author: Ola Suyee

ESSENTIAL NUTRITION FOR EFFECTIVE HEALING

Good nutrition is very necessary to ensure good healing of damaged body tissues from whatever cause – domestic or industrial injury, car accident or even planned surgery.

For correct and quick healing to take place, the body requires increased amounts of food nutrients: - Carbohydrates, Proteins, Fats, Vitamins, and Minerals.

Let us quickly consider each of these food nutrients in terms of their basic physiologic functions in the body.

Carbohydrates:

These are foods containing both simple (monosaccharide e.g. glucose) and complex sugars (polysaccharides e.g. dextrose).

 Foods containing carbohydrates include: - Fruits – (Apple, Mango, Avocado, Grapes, Water Melon, etc), Tubers – (Potatoes, Yam), Vegetables – (Spinach, Cabbage, etc), Nuts – (Brazil nuts, Walnut nuts, Mac nuts etc), various types of Cheese, various type of Grains, wheat bread, etc.

The principal product of carbohydrate digestion are sugars and the principal circulating sugar in the body (blood stream) is glucose, which is metabolized by the body cells through the aid of the hormone Insulin to generate calories needed for work and maintenance of body heat (temperature) and other physiological processes of the body.

Proteins:

These are a group of complex organic nitrogenous compounds widely distributed in plants and animals, and which form the principal constituents of the cell protoplasm. They are essentially combination's of the alpha amino acids and their derivatives. They form the “building blocks” for body tissues and are very essential for body tissue formation, growth, and repair. Proteins are grouped as Grade I and II. Grade I proteins are animal proteins of meat, fish and eggs and contain amino acids (especially the eight essential amino acids) in approximately the proportions required for protein synthesis and other uses in the body. Most plant proteins are Grade II because they supply different proportions of amino acids, and some lack one or more of the essential amino acids. Protein needs can be met with a mixture of grade II proteins, but the intake must be large because of the amino acid wastage.

Foods rich in proteins include: - Grade I – Meat (lean), Chicken (Breast, skinless), Fish (Mackerel, Tuna, Salmon, etc), Eggs, Cheddar Cheese, Yogurt (low fat), Milk (low fat, Skimmed).

Grade II – mostly plant proteins – Beans (various types), Oatmeal, Whole wheat bread, Popcorn, etc.

Fats:

These are adipose tissue – white or yellowish tissue which forms soft pads between various organs of the body, serve to smooth and round out bodily contours, and furnishes a reserve supply of energy, as it is easily converted by the body to glucose and needed calories during situations of prolonged hunger from whatever cause (Famine, Ecological disasters etc).

Fats are also called lipids and the biologically important lipids include the neutral fats (Triglycerides), the phospholipids and related compounds, and the sterols. The triglycerides are made up of 3 fatty acids bound to glycerol (palmitic acid, oleic acid and stearic acid). The phospholipids are constituents of cells, especially in the nervous system and very important in the healing processes of body tissues. The sterols include the various steroid hormones and cholesterol.

Foods rich in essential fatty acids and phospholipids include:- Fruits(Various types), Vegetables, Egg white, skinless Chicken breast, lean Meat, Fish, Beans, Nuts and Seeds, low fat Diary Products.

Vitamins:

These are organic substances with key roles in certain metabolic pathways. They are required in small amounts in food because they are not synthesized in the body. Vitamins are broadly categorized into those that are water soluble (vitamins of the B complex group and vitamin C), or fat soluble (vitamins A, D, E, and K). The water soluble ones are easily absorbed in the intestines while the fat soluble ones are poorly absorbed in the absence of bile or pancreatic lipase (a digestive enzyme). Some dietary fat intake is necessary for their absorption.

ESSENTIAL DIETARY COMPONENTS FOR GOOD HEALING

What is a Balanced Healthy Diet?

A balanced healthy diet includes in addition to sufficient WATER, adequate calories, protein, fats, minerals and vitamins. It is a diet that is basically derived from the five main food groups, which are:

• Fruits
• Vegetables
• Cereals and Pulses
• Dairy
• Poultry, Fish and Meat products

-      Emphasis should be placed on fruits, vegetables, whole grains and fat free or low fat milk and milk products.

-      Lean meat, poultry, fish, beans, eggs and nuts.

-      Foods low in saturated fats, trans fat, cholesterol, salt (sodium chloride) and added sugars.

Water: A lot of people fail to take enough water during and in between meals. Water is very essential in the body forming about 60% of total body weight in the adult and is necessary both for metabolism and excretion of waste products from the body. At least 2 to 3 liters of water should be taken daily in divided doses over a twenty four hour period. A glass of clean cold water (about 400-500mls) early in the morning on waking up before brushing your teeth has been known to help flush the digestive system, eliminate constipation and clean the urinary tract as well.

Caloric Intake and Distribution:

The caloric value of the dietary intake must equal the energy expended as heat and work (in this case healing), if body weight is to be maintained. When the caloric intake is insufficient, body stores of protein and fat are catabolised (i.e. broken down for energy) and when the intake is excessive, obesity results. In addition to the 2000kcal/day necessary to meet basal needs, 500 – 2,500 or more kcal/day are required to meet the energy demands of daily activities including healing of body tissues. The distribution of the calories among carbohydrates, protein, and fat foodstuffs is determined partly by physiologic factors (e.g. healing requires some extra nutrients) and partly by taste and economic considerations.

A daily protein intake of at least 1g/kg body weight to supply the eight (8) essential amino acids and other amino acids is desirable. This should be a combination of both Grade I and Grade II proteins(see the paragraph on proteins).

Fat is the most compact form of food, since it supplies 9.3kcal/g in terms of energy. However, it is also the most expensive. Indeed there is a reasonable good positive correlation between fat intake and standard of living and in the past, western diets have contained moderately large amounts (100g/day or more). The current interest in preventing obesity has changed this. In Central and South American Indian communities where corn (carbohydrate) is the dietary staple, adults live without ill effects for years on a very small fat intake. Therefore provided the need for essential fatty acids is met, a low fat intake is not harmful, and a diet low in saturated fats is desirable.

Carbohydrate is the cheapest source of calories and provides 50% or more of the calories in most diets. For a balanced, healthy diet, approximately 50% of the calories should come from carbohydrates, 15% from protein, and 35% from fat.

When calculating dietary needs, it is usual to meet the protein requirements first, (this is essential for good healing of the tissues) and then split the remaining calories between fat and carbohydrate, depending on taste, income and other factors (e.g. is the individual suffering from any disease like diabetes, hypertension etc).

For example, a 70kg man, who is moderately active needs about  2,800kcal/day. He should eat at least 65g of protein/day, supplying 267 (65x 4.1) kcal. Some of this should be Grade I protein. Fat intake depends upon taste but a reasonable figure is 60 – 70g. The rest of the caloric requirement can be met by supplying carbohydrate.

It is important to eat natural organic fruits and vegetables because they contain vitamins and antioxidants. The ‘bad’ carbohydrates to avoid or reduce eating are the processed sugars/starches.

Mineral Requirements: A number of minerals must be ingested daily for maintenance of health and good healing processes. Besides those for which recommended daily dietary allowances have been set (Fig.1) different trace elements should be included in the diet. Trace elements are defined as elements found in tissues in minute amounts necessary for metabolism and growth of the tissues. A list of essential trace elements is given in Fig.2.

Fig.1

Calcium……800 – 1200mg/day            Phosphorous…….800 – 1200mg/day

Iodine………100 – 120microg/day        Iron……………………..10 – 18mg/day

Magnesium...300 – 350mg/day           Zinc………………………10 – 15mg/day

Fig.2

Chromium                                         Nickel

Cobalt                                               Selenium

Copper                                           Silicon

Fluorine                                          Tin

Iodine                                             Vanadium

Manganese                                      Zinc

Molybdenum

Cobalt is part of vitamin B12 molecule and its deficiency leads to megaloblastic anemia. Iodine deficiency causes thyroid disorders. Zinc deficiency causes skin ulcers, loss of hair (alopecia) and hypogonadal dwarfism. Copper deficiency causes anemia, neutropenia and CNS abnormalities.

Trace element deficiencies are rare, because any diet that is adequate in other respects easily supplies the needed minerals.

Below is an example of a prescribed diet, follow it as much as possible, (and you can adjust it to sooth your situation) as it will help promote tissue healing and prevent complications.

Recommended Serving Sizes
Food Groups	Serving Size
Breads and grains, using whole grain sources as much as possible	1 slice bread; ¾ cup dry cereal; ½ cup cooked cereal, pasta, noodles, or rice
Vegetables	1 cup cooked or raw vegetables; 1 cup raw leafy vegetables
Fruits	½ cup canned fruit or fruit juice; 1 piece of fruit; ¾ cup fresh fruit
Dairy	1 cup milk or yogurt; 1 ounce cheese
Protein	2 – 3 ounces meat; 1 cup cooked beans or legumes; 1 egg; 2 tablespoons peanut butter
Fats and sweets	Good source of calories but needs caution

Where there is serious injury you may require a high proteinous diet for good rapid healing.  Take at least 2 to 3 servings per day of beef, fish,
poultry, pork, veal, lamb, eggs, cheese, milk, yogurt, dried beans and peas,
nuts and seeds.

Eat five or six small meals a day. Instead of trying to eat three big meals a day, try eating smaller meals and snacks between meals to get enough nutrition.

Foods to avoid:

(1)        Refined sugar – table sugar and candy. Use sweeteners like Saccharin if necessary.

(2)        Red Meat is usually too high in saturated fat, which has been shown to cause degenerative diseases. Red meat also increases inflammation, which causes pain, suffering and numerous health problems.

(3)        Dairy containing saturated fats such as full cream milk – go for skimmed milk or low fat milk and yogurt.

(4)        Excess salt – National Academy of Science recommends 3 – 8g/d. Limit table salt, salted nuts, popcorn and most prepared canned and package foods.

(5)        Eliminate caffeine and alcoholic beverages and reduce all sugary drinks (carbonated drinks, milk shakes etc.) to the barest minimum.

Author: Ola Suyee