Monday, 10 April 2017

Science of Ageing

In the words of  Aldous Huxley, "The knowledge that every ambition is doomed to frustration at the hands of a skeleton have never prevented the majority of human beings from behaving as though death were no more than an unfounded rumour."
While many search for the proverbial mountain of youth, the mass quest has been hovering around the question why do we age at all ? What is it in our bodies in the shape of continual chemical processes or biological protocols that causes us to grow old. There are a plethora of internal and external factors such as diet, exercise or environmental stress and they all contribute to cell damage and affect the rate of ageing, but the truth is that we have a biological clock buried deep within our genetic make up. This clock can only run for so long, in other words we are programmed to die.
Our bodies are made up of trillions of cells, countless perhaps, which are constantly dividing and each time it happens the cells make a copy of their DNA as well or replicate themselves. This DNA is tightly packed into structures called chromosomes. Characteristics and genetics passed on down the generations or racks of sets of chromosomes is dependent on these structures. Humans have 23 pairs of chromosomes. While the DNA replication isn’t quite perfect it skips over the end of each chromosome or at ends is a kind of incomplete process. To protect against important DNA information from being cut out due to this incompletion or imperfection of the process of replication, chromosomes are equipped with “telomeres” on their ends which are essentially meaningless repeat of DNA, something similar to temp files being created while working on a system which  we can afford to loose.  However, each time these cells divide and replicate, these “telomeres" become shorter and shorter until eventually they are entirely stripped away at which point the cell ceases to divide further and eventually dies. In the absence of this shortening of telomeres life could have been eternal and never ending.
Some organisms such as flatworms have the capability of regenerating unlimited telomeres hinting capability to be actually immortal, however disease, infection and environment equals them out with the rest of us. This suggests that aging is related to biological and environment factors. Why don’t our cells replicate telomeres. Ultimately this replication limit actually helps to prevent diseases such as cancer, which is the uncontrollable growth of cells and evasion of cell death.
The point at which a cell stops replicating is known as cellular “senescence.” The causes of senescence and possibilities of delaying or avoiding altogether is the basic tenets of all researches world over.
Human cells can replicate approx 50 times in their lifespan and once it is reached the cell gradually begins to loose it’s function and die, displaying age related characteristics. This also helps to explain why life expectancy is a trait which is inherited down generations through genes, since parents and generations further gave us the length of our telomere and the traits of a timeframe as well in which the entire cycle of a chromosome or cell or telomeres would be run.


Gerontology emerged as a science in late 19th century and seeks towards attaining answers and extensions. Technological innovations have increased life expectancy as better sanitation, clean water, effective prescriptive drugs availability and better medical and health services have all contributed to increasing life expectancy worldwide. However still we are able to see a global inequality in terms of infant or at birth mortality rate which is a cause of worry still, both in developing and done with nations.
Ageing has been studied and gazed upon by all cultures and civilizations. Immortality has been longed for by all generations and compared to salvation or moksha. Ranging from Indian mythology to Chinese folklore, mentions of immortality are rampant across times prestine, There are abundant  chinese medicine which stake high claim on ageing slowing medications and potions for enhancing longevity. In the West ageing has been approached through evaluations done scientifically as exhibited in the studies and works of eminent authors and researchers. One such study by Christopher Hufeland, a German physicist, refers to “protocol for life style and diet to increase life expectancy.”
As the population of the modern world entered old age and experienced degenerative old age related diseases, demand for anti-ageing options increased and the anti ageing industry grew in leaps and bounds with it’s cart of offerings. The growth happened similar to alternate medicine, where the segment has thrived on using scientific principles and fundamental theories symbolically and in an ambiguous, opportunistic way, to present their case and at the same time lay no claims on proven experiments which authenticate their claim. In the garb of rationale reasoning that science offers and yet maintaining distance from clarity, these products continue to grow  and the segment world wide has contributed each year to the GDP. Whatever may be the case the population needs a remedy.
Government released articles make profound mention of anti ageing products and the industry and state the anti-ageing consumer industry to be a sizeable one, full of all types of products at all price levels catering to all segments, such as yoghurt based potions, enema regimens, cell injections, magnetic devices, skin creams, herbal elixirs, glandular extracts, hormonal therapies, vitamin supplements, fad diets and exercise programmes. These products offer anti-oxidants to neutralize oxygen-free radicals; chelators to bind heavy metal ions such as copper and iron; dehydroepiandrosterone to rejuvenate the immune system, improve brain function and relieve stress; growth hormone to increase muscle mass and function; retinoic acid to decrease skin wrinkling, and many more. The grandeur of promises being made have been strongly objected of late by the scientific community due to the lack of experimental and clinical data to support effectiveness of the drugs and especially their high side effects.
Karin Knorr Cetina (page S76 )  cite the issue of consumer exploitation on anti ageing as a segment shrouded with an aura of science. “The use of human frailty for commercial exploitation is also singled out as a deplorable characteristic of the present-day anti-ageing medicines and market” as quoted from works tabled by McConnel & Turner. 
1881 onwards Gerontology found itself being investigated concertedly by nations. (Juengst et al 2003) categorise mainly three parts or directions being followed by  research work on ageing, mainly “compressed morbidity”, decelerated ageing” and “arrested ageing”.
Compressed Morbidity aims at preventing old age related disease, a paradigm relating to intervention in ageing processes at the molecular level to slow the process down. This desire or thought relates thus to life span increase. It is also the most fundamental or conventional one.
Decelerated ageing aims to slow down all fundamental cellular processes of the human body so as to raise the average life span and life expectancy levels overall.
Arrested ageing the most ambitious of all seeks to cure ageing by separating and doing away with all the remnants of damage caused by metabolic processes so as to be able to constantly maintain the vitality and bodily functions.
While the US and France have planned studies on ageing and further research on compressed morbidity approach, basic science has already established that life is a form of metabolism and has its own set of causes and effects, waste effects, lay byes.
These waste products accumulate to degenerate the form physiologically and biologically, slowly weaken and then die. These changes are the main course of research by modern life scientists with focus on how to control the damage caused by these side effects of life that cause ageing.
Mauron, Bruce, McConnel & Turner, in their study on anti aging make an observation on the intended life extension seeking projects that their consequence would result in “ life of the poor remaining 'short and brutish', while the rich could look forward to an extended enjoyment of their privileges.”
Authors such as Halldor Stefansson have argued that, contrary to the wear and tear of inanimate objects, aging in higher organisms is not primarily the result of damage to irreplaceable body parts. Certainly, molecules and cells can suffer from damage akin to wear and tear. Complex biological systems are dynamic and have the ability to repair and regenerate their damaged components. Even for components that cannot be replaced, like mammalian teeth, their degeneration can be seen not just as mechanical senescence but as limitations of the genetic program. There are differences in interpretation of aging changes which influence the way different researchers interpret the essence of aging; as discussed elsewhere, some authors see aging as genetic in nature while others see it as a build-up of damage counteracted by genetically-regulated mechanisms. Nonetheless, it is clear now that aging has a strong genetic component and it is not merely wear and tear.
At present, it appears that the only way of significantly extending human lifespan is with
Caloric restriction. However, there are a number of factors, which seemingly can improve
lifespan. Since ancient times, humans have been concerned with developing and preserving youthful
vigor, stopping the running age clock, and extending lifespan. Today there is a great progress in
understanding the aging process in attempt to delay it. Harmone replacement therapy (HRT) has emerged as the new science and therapy for many disease preventions including ageing. The therapy entails using
popular and easily obtainable hormones: estradiol, testosterone, DHEA, thyroid hormone,
melatonin, growth hormone, and progesterone to control or regulate harmone levels in the body which further impact the risk of diseases such as cardiac,cancer,process of ageing etc. Many of the benefits of using these hormones are equivocal thus far, but we are seeing an increasing number of studies which, at least, recommend these hormones as viable therapies to slow down the aging process, to stop the development of agerelated diseases, and to stay vital and fit in the second half of life.

In the Indian context life extensions have been claimed by many gurus and yogis who underwent rigourous penance and meditation and attained a higher form of existence with slowed metabolism and control over aging. These ascetics were known to eat or drink almost neglible and even control their breathing to slow down the demands of the body and impact longevity. The concept although stemming out of spiritual realms has it’s roots embedded in the very scientific principle of slowing down the metabolic rate of the body thereby preserving the telomeres from getting stripped faster.
By adopting a more practical and do able approach to extension of life spans, meditational practices, organic eating without a coat of insecticide sprays, abstinence from life shortening vices such as smoking and drinking and leading a simple stress free existence, we have a better chance of surviving longer and see the sun shine on our eightees and ninetees and on our progeny too.

The quest for immortality however shall continue within our curious minds as we remain unquenched. As King Crimson says it “ confusion will be my epitaph, as I crawl, cracked and broken.”
As the great rock kings The Rolling Stones sum it all up aptly in their song “ Time waits for no one and it won’t wait for me.”
#Extracts #HeartDisease #Atherosclerosis #alternateMedicine #herbs #cholesterol #BlockedArteries #ginger #garlic #appleciderBenefits #angioplasty #bloodpressure #Lemon #Antioxidants

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Friday, 20 May 2016

Whey Proteins- The way to go

Whey is a protein, a mixture of globular proteins isolated from whey, the liquid material created as a by-product of cheese production. Milk contains two primary sources of protein, the caseins and whey. After processing occurs, the caseins are the proteins responsible for making curds, while whey remains in the shape of a liquid.
Whey protein exists in 4 types - concentrate (WPC), isolate (WPI), hydrolysate (WPH) and Native Whey. Concentrates are little low on fat content  and cholesterol  and higher levels of bioactive compounds and carbohydrates. Isolates are usually lower in bio activated compounds as well — they are 90%+ protein by weight. Like whey protein concentrates, whey protein isolates are mild to slightly milky in taste. Hydrolysates are whey proteins that are predigested and partially hydrolyzed for the purpose of easier metabolizing, but their cost is generally higher. Native whey protein is the purest form of whey protein, extracted from skim milk and not as a by product of cheese production.

Whey, essentially a protein complex, is a modern day nutrient and food, with lots of health giving and curing properties. Whey’s ingredients include lactoferrin, betalactoglobulin,alpha-lactalbumin, glycomacropeptide, and immunoglobulins. These exhibit a plethora of immune-enhancing properties. Also whey is capable to act as an antioxidant, antihypertensive,antitumor, hypolipidemic, antiviral,antibacterial, and chelating agent. The property of whey to be able to intracellularly convert amino acid cysteine to glutathione, a potent intracellular antioxidant gives it the name of a healer.
Numerous clinical trials vouch for the healing or curing properties of Whey for multiple diseases such as cancer, HIV, hepatitis B, cardiovascular disease, osteoporosis, and as an antimicrobial agent and an infant colic and immune builder. Whey protein is also useful as a performance enhancer in exercise.
Milk constituents have become functional foods having a noticeable impact on health. Whey, a by-product of cheese and curd manufacturing, is a popular dietary protein supplement purported to provide antimicrobial activity, immune modulation, improved muscle  strength and body composition, and to prevent cardiovascular disease and osteoporosis.
Processes such as microfiltration, reverse osmosis, and ion-exchange,have resulted in development of several different finished whey products.
Each whey product varies in the amount of protein, carbohydrates, immunoglobulins, lactose, minerals, and fat in the finished product which determine its category according to the application desired out of it.
Whey needs to be evaluated here to understand briefly what Whey is made up of.  First of all it has sufficient amounts of Amino Acids and in higher concentrations than vegetables or soy or corn which are the other sources of proteins, specifically leucine, important for tissue growth and repair. Leucine has been identified as a key amino acid in protein metabolism.
Whey proteins are rich in sulfur containing amino acids cysteine and methionine. With a high concentration of these amino acids, immune function is enhanced through intracellular conversion to glutathione.
Lactoferrin, an iron-binding glycoprotein, is a non-enzymatic antioxidant found in whey. However, the concentration in most commercial whey protein powders is only 0.35-2.0 percent of total proteins.
An immunoglobulin (Ig) is an antibody or gamma-globulin. There are five classes of antibodies – IgA, IgD, IgE, IgG, and IgM. IgG constitutes approximately 75 percent of the antibodies in an adult.
Beta-Lactoglobulin represents approximately half of the total protein in bovine whey, which has the potential to modulate lymphatic responses.
Alpha-Lactalbumin alpha-Lactalbumin is one of the main proteins found in human and bovine milk. It comprises approximately 20-25 percent of whey proteins and contains a wide variety of amino acids, including a readily available supply of essential and branched chain amino acids.  Lactoperoxidase Whey contains many types of enzymes, including hydrolases, transferases, lyases, proteases,and lipases. Capable of destrying many bacteria.
Glycomacropeptide (GMP) is also referred to as casein macropeptide. GMP is a protein
present in whey at 10-15 percent
 and is a source of essential amino acids .
Whey protein has been clinically studied of late although with limited trials to date on it’s various effects on a host of health conditions, from cancer to cardiovascular disease and osteoporosis.It has been found useful in the treatment and regulation of many critical diseases and syndromes, some of which are briefly touched upon here.
Cancer- In a study published by Keri Marshall, ND MS, clinical trials on tumour subjects on various stages of malignancies have indicated that Whey protein concentrates are effective in the prevention and treatment  of cancer. Glutathione stimulation is thought to be the primary immune-modulating mechanism. The amino acid precursors to glutathione available in whey are thought to increase  glutathione concentration in relevant tissues and stimulate immunity.
Some researchers also believe the iron-binding capacity of whey may also contribute to anticancer potential, as iron may act as a mutagenic agent causing oxidative damage to tissues.  
In a recent clinical trial, 20 patients with stage IV malignancies (one bladder, five breast, two prostate, one neuroblastoma, one ovarian, one gastric, three colon, one mesothelioma, two lymphoma,two non-small cell lung, and one osteosarcoma) received a combination of 40 g/day nondenatured whey protein concentrate. After six months there were 16 survivors, all of whom had significantly higher NK function and higher mean haemoglobin and hematocrit levels. All patients noted having an improved quality of life during the course of the study.
Hepatitis Whey proteins affect patients with Hepatitis B or C. It hs been clinically seen through open and closed clinical studies that whey subjects responded better to controlling the disease.

Human Immunodeficiency Virus (HIV) Patients with HIV have Glutathione deficiency . Therefore to increase cysteine, and ultimately glutathione, several studies have been conducted on the use of whey proteins in HIV-positive individuals. Both studies note an improvement in quality of life with increased exercise and whey protein intake.
Antimicrobial Lactoferrin in the whey helps redue infection against many viruses including E coli and increase the immunity to fight off invasions.

Cardiovascular Disease CVD It has been established beyond doubt in science that high fat intake increases the risk of CVD, which is also is linked to a number of other factors, such as age, genetics, obesity, sedentary lifestyle, and alcohol intake, quality of dietary fat must be taken into consideration.
Several studies have found milk intake and milk products lower blood pressure and reduce the risk of hypertension, significantly impacting HDLs to increase and triglycerides to decrease thereby creating an ideal environment in prevention of CVD.
Exercise Whey protein supplements, including purified alpha-lactalbumin liquids, having high protein and BCAAs content help enhance performance and tolerance levels.
Obesity a serious problem the world over is being tackled with whey, thought to be an attractive source of dietary protein. Whey protein isolates can be as high as 95-percent protein, after the removal of fat and lactose, and contain valuable minerals and vitamins. Whey has made a significant commercial impact in the weight-loss industry for its protein content alone. The essential and non-essential amino acids in whey act as substrates for protein synthesis and may improve body mass index in individuals participating in exercise programs.
Osteoporosis- Milk has been proposed as a nutritional food that aids in the prevention of osteoporosis due to its bio available calcium content. Milk basic protein (MBP), a component of whey, has the ability to stimulate proliferation and differentiation of osteoblastic cells as well as suppress bone resorption. Similarly whey helps in repair of Gastrointestinal lesions and controlling disorders.
Building Muscle Tissue- Protein powder is a favourite supplement of muscle building regimens with high-quality protein. Shakes are consumed by athletes and sports drinks are galore. The modern day concepts rely heavily on this trait of protein supplementation on which the gym and body building industry thrives. However, is is advised to consume the supplement according to need and in moderation and under medical advise and supervision.
Basic Knowledge on whey- There are various types of protein powders and ideal choice has to be arrived at by each user. Choice should not be based on “promises” made in an advertisement or packaging, product or label. All Products advertise on their benefits on labels and packaging such as undenatured whey protein which for example is next to impossible as manufacturing laws require it to be pasteurized. This may rob the product of it’s effective ingredient however we need to have basic knowledge of whey protein so that we can differentiate.
Similarly cold filtered protein powder on labels could be mythical as the actual filtering process that concentrates the whey into the final percentage of protein (typically +80%) has nothing to do with the fact that most manufacturers who “cold filter” their whey are still flash pasteurizing it at the highest possible temperature beforehand. Why? Because it only takes fifteen seconds to flash pasteurize whey and it takes fifteen minutes to pasteurize it at the lowest heat levels. So you can produce more whey if you only take 1/60th of the time at this stage of processing.
Products may exhibit that they are 100% hydrolyzed where as if that is the case powder would be inedible as broken down (hydrolyzed) protein will not be bound together. The immunoglobulin is bound to the fat globule and as such fat stripped protein may be deficient in it’s properties.

Protein bars sometimes may be under-dosing the protein and overstate the amount on the label. Although powders are better, they're still under-dosed in a lot of cases. They may contain carbohydrates far in excess of what the label states.
Most protein powder comes from a very few manufacturers who source it from the same regions and with same raring techniques which are obviously commercially driven processes. Products may be in thousands boasting a plethora of unique properties but sourcing is almost uniformly same for all commercial brands.
A US Consumer Report July 2010 Article indicated the most popular brands of whey protein in the US had high concentrations of heavy metals including lead, arsenic, and cadmium which can cause permanent damage to the nervous system, kidney, and promote cancer when accumulated in high concentrations.

Consuming the required amount only and not excessively is important and a doctor is the best one to establish that. Excessive amounts can lead to weight gain, kidney problems and increased cholesterol, according to the US Center for Disease Control and Prevention. The University of California Los Angeles reports that the human body can absorb and utilize a maximum of 0.91 g of protein per pound of body weight per day. Similarly McKinley Health Center in the US recommends 20 g to 25 g of protein powder per day for the average active adult.


Side Effects of Whey Protein- Those building muscle could gain weight with using whey as a supplement as it has added sugars and carbohydrates or some may even have fat. Since all this comes in liquid form intake it may not satisfy the solid meal deficiency resulting in eating more than required which could increase body weight. Especially builder protein or gainer protein for lean bodies is to be avoided for normal physiques and hence it is important that labels are read carefully before usage to understand the body type for which product is designed.
Whey protein can worsen a kidney stone health condition and even cause them although this is not conclusively proven. Whey protein eaters are advised to add a sufficient fibre cntent to their diet.
It is therefore very important that a normal balanced whey consumption regimen is adopted which contains fat and carbohydrates as well, consumed alongwith a normal meal diet. Having too much of protein shakes or a heavy protein imbalance can cause upset bowels and irritable digestive tract.
Weak protein digesting people can switch to other proteins asuch as rice, soy and hemp which do not contain lactose and are easily digestible.
In some cases people with genetic history of gout have been associated with increased symptoms of the disease with whey protein intake. In case amino acids are not digested or used up, the body organs which filter them out such as the liver and kidneys could be put under tremendous pressure resulting in organ damage. It is therefore advisable not to exceed daily prescribed intake of protein both in powder or shake form. Protein shakes can be high in calories, so if you're not exercising, they can contribute to weight gain. Whey is a natural by-product of cow’s milk, and, in powdered form, one of the most popular fitness supplements available. There’s nothing inherently risky about whey protein by itself, but following a diet that’s very high in protein for an extended period of time entails risks, especially if you’re not trying to build muscle. Before you make whey a regular part of your eating plan, get the go-ahead from your doctor.
As a sports drink protein supplements should be had in the range 0.5-0.7.5 grams of protein per pound body weight daily for casual exercise cases and 0.6-0.9 grams per pound of body weight in case of professional athletes.
The active precursor in amino acids glutathione can also be increased by following a regular exercise regimen and eating fresh fruits and vegetables although green vegetables when cooked almost entirely loose the precursor property.
Chemicals, toxins and sugar also decrease glutathione levels rapidly.
Milk thistle herb is a rich source of silymarin which may prevent glutathione depletion in the liver.
Curcumin a concentrated form or extract of turmeric is also known to increase glutathione levels.
All in all our own sagacity is more important as to what we require and desire as sometimes some compelling desires can be time and health wasters.
Disclaimer: Information contained in this write up is for education and awareness purposes only and for non commercial use. It is not to be used as a medical advice or prescription. Readers desiring consumption of whey must consult their medical practitioner before consumption.

Some of the information or content herein including are extracted from articles of various authors and researchers, including University of Maryland Health Centre and studies published by Keri Marshall, ND MS. 

Wednesday, 13 April 2016

Eye to Eye – No cosmetic approach shall repair them!



Eyes are the most important constituents of the face. Not only do they define overall beauty and personality of the being but also express emotions and moods. They enable us to see the world and everything around us. Unfortunately they don’t come as spares in our tool kits.
Accentuating the eyes with mascara, eye shadow, Kajal or Kohl and liner to make them look bigger is a trait every woman has. However not so many are meticulous when it comes to wiping these accentuators off in the evening, carefully following the instructions for removal and following them by the book. This is essential because overnight applications of liners,kajal and mascara can result into blocking the tear ducts causing dry eyes or in some cases even damage the cornea by penetrating into the eyes from the corners. In general longer applications of foreign material on delicate areas such as the eyes can cause irritation, infection and allergies or cause blepharitis. In general various adverse effects may occur in the form of acute toxicity, percutaneous absorption, skin irritation, eye irritation, skin sensitization and photosensitization, subchronic toxicity, mutagenicity/ genotoxicity, and phototoxicity/photoirritation.

Generally eye cosmetics are friendly and safe to use. The products list out the ingredients on the packaging and label although more diligently in the US and developed countries and not so much in India due to lax laws and implementations. Cosmetic products generally come in small packs making reading even more difficult. Careful buying of cosmetics needs to be done, avoiding products which have mercury, lead and parabens which are extremely harmful and hazardous. Safe buying is to be adopted which includes branded products and in case of any problems during application you need to discard the product. Using products beyond their validity and keeping them for longer durations since all are expensive products can result into serious eye problems. In such cases bacteria and fungi grow within the gels and liquids which when applied shift their home into our eyes causing havoc. Similarly cosmetics application and removal methods are also as important, for example application on the inner lining of the lid shall ensure inner seepage causing damage to the eyes.
Another option to circumvent the problem of chemicals in eye products is to try out natural herb based products which are authentic although no product whether herbal or otherwise should be used beyond expiry.
Dr. Louise A.Sclafani, OD, FAAO has some candid observations listed on www.healio.com. According to him, “As eye care professionals we should not avoid the topic of cosmetics and lid hygiene because we are afraid of insulting our patients because if we don’t comment on what we see when they are being tested, they assume that all is well.” He further suggests introducing eye make up one by one into routine so that effects and reactions of each can be clearly noticed. He strongly suggests that eye cosmetic make up should never be shared with anyone no matter how intimate as this results in communication of eye infections. He further says,” do not top off mascara with water or be too aggressive on eye lashes with curlers which can cause damage to delicate follicles and respect the eye mucosal line as the meibomian gland can get blocked, resulting in dry eyes.”
Dr. Louise A.Sclafani recommends removal of make up daily before sleeping usually with soap and water, which she says may not be always effective. She recommends using branded soft lid and eye scrubs for removal and even baby oil which is an amazing application for the job in hand.
“For soft contact lens wearers, patients should put on makeup after putting in their soft contact lenses. For gas-permeable lens wears, the opposite is true,” Dr. Sclafani said.
Make up residue or particles tend to enter the eye and disrupt the tear film, causing discomfort and irritation. This is since cosmetics are applied very near to the ocular surface or on the lid margins, giving them ample opportunity to enter the eyes due to rubbing or other reasons. These residual foreign bodies tend to stick on the tear film or even on the surface of contact lenses or cornea, disrupting the tear film stability and function.
Meibomian gland ducts thicken and get keratinized due to prolonged exposure to retinoid which is an ingredient of anti aging and acne products. It causes degeneration and necrosis of meibomian gland acinar cells, peri-acinar fibrosis and decreased lipid content of meibomian tissue.  Similarly US FDA approved Latisse (Allergan) applied on the eyelashes for hypotrichosis a condition of abnormal hair patterns - predominantly loss or reduction was found to be responsible for increased frequency of conjunctival eyelid hyperaemia which is excessive supply of blood to the eye lids also called engorgement. 
The most feared adverse effect of mascaras is that of infection, particularly Pseudomonas aeruginosa corneal infections, which can permanently destroy visual acuity, due to multiple reuses of applicator and reinsertions into the tube between uses.
Some south Asian, middle eastern countries and parts of Africa are still using old and outdated formulations which include ingredients in cosmetic products suchas  lead-compounds and preservatives such as benzalkonium chloride, thimerosol and chlorhexidine. All products containing such heavy metal or compounds are extremely harmful and need to be avoided at all costs.
Products linked with cosmetics have been put to scrutiny and analysis for rate of formation of bacteria and contamination causing organisms and a related study found 30% products affected after 90 days. Once the product has been opened and if being used by more than one user, it is a potential bacteria rearing place. Although preservatives slow bacteria formation they are short spanned and their effectivity diminishes over a period of time.
Contact lens users need to take precautions of cosmetic application in such a way that the lens surface remains free of residual accumulation which not only will bllurr vision but also cause irritation and infection. For users wearing lens regularly, daily disposable lens are recommended as they are more hygienic and do not have to undergo daily cleaning with solutions which is not foolproof if not done properly.
Therefore it is important that knowhow on the use of cosmetics is spread by opticians, cosmetic retailers and manufacturers on the product itself. Patients coming for medical treatment need to be educated on the cause of their disease without any prejudices.Users must be properly told as to where all cosmetics are not to be applied in the eye areas.
The US government on it’s official FDA website warns users of the dangers of using substandard or persistetnt use of Kohl or Kajal as it may contain lead and cause lead poisoning. This is since kohl is made up of lead ( lead sulphide) and some brands may contain excessive percentage of lead apart from other ingredients used in it’s commercial manufacture such as aluminum, antimony, carbon, iron, and zinc compounds, as well as camphor and menthol.
Lead poisoning or exposure to excessive amounts of lead in the environment is particularly harmful for children as they can absorb lead from their surroundings. It can cause a host of diseases such as anemia (iron deficiency), kidney related diseases and neurological disorders. Prolonged exposure to lead can impair learning capability and behavioural patterns.
India which is a major producer of kohl needs to be particularly careful as culturally kohl is used to accentuate children’s eyes and kohl is widely used by all communities both in rural and urban India. It needs to be mentioned here that US FDA had banned kohl or it’s use as a commercially available cosmetic or it’s manufacture.
From a dermatologist’s point of view, cosmetics may be grouped as: (a) skin-care cosmetics (cleansing agents, moisturizing agents, etc.), (b) hair-care cosmetics (shampoos, hair colorants, styling agents, etc.), (c) face-care cosmetics (facial foundations, powders, eye shadows, mascara, lipsticks, etc.), (d) nail-care cosmetics (nail varnishes, paint removers, etc.), (e) fragrance products (deodorants, aftershaves, perfumes, etc.), and (f) ultraviolet (UV) light screening preparations. Skin cleansing agents remain on the body for a very short period of time and rarely cause significant adverse reactions, however, perfume and others constituents may cause skin irritation and allergic reactions. Moisturizers increase the hygroscopic properties of the skin; however, high concentration of these substances may cause irritation and exfoliation.
Dr. P. K. Nigam, Professor and Head, Department of Dermatology and STD, Pt. J. N. M. Medical College, Raipur in a study on effects of cosmetics on skin and body parts and organs states- Ochronosis is a common adverse effect of HQ (skin lightening/depigmenting agents, hydroquinone) characterized by progressive darkening of the area to which the cream containing high concentrations of HQ is applied for many years. Ć«Black hennaĆ­ tattoo is a chemical stain due to p-phenylenediamine (PPD), in the form of commercial hair dye mixed into the henna paste. Addition of this artificial dye stains the skin in much shorter duration, an hour or less. Adverse reactions to PPD can include stinging sensations, with an erythematous rash, swelling, blisters, and surface oozing. There have been several reports in the literature of immediate allergic (and also anaphylactic) reactions on using henna dyes. Most cases have sneezing, runny nose, cough, and shortness of breath instead of skin reactions. Adverse effects to sun-screening agents may result in irritant, allergic, phototoxic, or photoallergic reactions, and caused not only by the active constituents but also by the additives such as fragrances and stabilizers. Benzophenones are probably the most common sensitizers, while dibenzoylmethanes, para-aminobenzoic acid (PABA), and cinnamates may cause photoallergic dermatitis.[8] The allergic reactions associated with deodorants/antiperspirants and fragrances are usually caused by fragrance or other ingredients. Fragrance can enter the body through lungs, airways, skin, ingestion, and via pathways from the nose directly to the brain and can cause headaches, irritation to eyes, nose, and throat, dizziness, fatigue, forgetfulness, and other symptoms. Fragrance is the number one cause of skin allergic reactions to cosmetics. As much as 15% of the general population may find fragrance a lower airway irritant and as much as 10% of the general population may have skin allergy to fragrance. Fragrance in the air can cause airborne contact dermatitis. Coumarin, methyl eugenol, and others are suspected carcinogens. Some phthalates are suspected hormone disrupters.
 Shampoos and conditioners have only a brief contact with the skin and are not a common cause of cutaneous irritant or allergic contact dermatitis. However, eye irritation can be a problem. Possible sensitizers in shampoos include formalin, parabens, hexachlorophene, triclosan, and fragrances. Matting of scalp hair is most commonly a sudden, usually irreversible, tangling of scalp hair resulting from shampooing.
 Hair straightening (relaxing) with pressing oils and heated metal combs or round tongs may be associated with hair-shaft breakage and scarring alopecia. Hair removal techniques may partially account for allergic and photoallergic reactions. The adverse effects of shaving include skin irritation, cuts in the skin, ingrown hair (pseudofolliculitis), etc. The active ingredients in hair bleaches are hydrogen peroxide solutions that oxidize melanin to a lighter colour.
The adverse reactions may occur to one of the primary constituents of the cosmetic formulation or contamination or procedural misconduct.

Cosmetics and personal-care products may contain ingredients whose safety is unclear or which are known to pose health risks. Adequate testing or research has not been done on chemical combinations which are being used. Notwithstanding the commercial nature of issue, it is advisable to be prudent in choice, application and duration of use of all such products. Necessary precautions and routines need to be adhered to and most of all awareness needs to be spread around amongst whatever community groups one has access to. It is seldom that an occurance least expected happens despite all non possibilities however we should never extend our luck too far!

Monday, 28 December 2015

Health Care Burden in India-Neck breaking

Health Care is a difficult proposition in India. The agony of having to visit a hospital not withstanding, the ridiculous costs which ensue once securely on hospital bed is a bewildering experience.
The structure of health care sector consists of independent, privately-run hospital and health care centers.Private health care centers accounts for the major share. Nearly 63% of the total spend is accounted by the private health care sector.
Foreigners visiting india as medical tourists may be fine because for them it is still cheaper services but for the Indian middle and lower class it is simply not affordable.
Population ageing is increasing rapidly in India which means more and more rush at the hospital gates. India a country with a large population has a large number of people now aged 60 years or more. The 60+ age group has increased three times in the last 50 years and continues to do so.
Census 2001 concluded that older people were 7.7% of the total population, which increased to 8.14% in census 2011. In sheer numbers the population over 60 years in  2021 shall be 133.32 million. The increases in the elderly population are the result of changing fertility and mortality regimes over the last 40-50 years. Not only old age but lifestyle-related chronic diseases resulting from urbanization, sedentary lifestyles, changing diets, rising obesity levels, and widespread availability of tobacco products all are adding upto the rush.

There is a dual burden of disease to tackle. Urban India is witnessing a surge to the top in terms of incidence of Lifestyle related diseases such as cardiovascular diseases, diabetes, cancer, COPD etc and the Urban Poor and Rural India are struggling with Communicable Diseases such as tuberculosis, typhoid, dysentery etc. Rural India is also seeing a higher occurrence of Non-Communicable Life-style related diseases. Lack of Infrastructure and Manpower especially in rural areas adds to the chaos.
The pressure of sheer numbers is showing on the hospitals too. India is just not equipped enough to manage patient influx both in the government and private hospitals. The shortage of qualified medical professionals is another burning issue.
India’s ratio of 0.7 doctors and 1.5 nurses per 1,000 people is significantly lower than the WHO average of 2.5 doctors and 3.5 nurses per 1,000 people. Paramedical staff is also short on supply. Basically trained medical HR base falls far short of the requirement.
In case you want to get your patient admitted in a PGIMER or an AIMS the waiting is huge and you have to be a string puller to get accommodation. It is half the battle won. Even the influential people need to be in queue as their number is also staggering.
Roughly 8% of older Indians are confined to their home or bed. The proportion of such immobile or home bound people rose with age to 27% after the age of 80 years. However, very little effort has been made to develop a model of health and social care to take care of the patients. Lack of vision and responsibility has created a void. 
Institutions such as Helpage India are dots in the ocean trying to provide nursing and medical care by reaching the sick both in urban and rural areas on mobile units which in itself is challenging.
On-site services offer doctor consultation, diagnosis and detection/testing,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         medicines and home visits. Even specialist doctors are available. Team includes doctor, pharmacist, paramedic and patient facilitator, co ordinated by a qualified social worker.

Costs - Elderly patients who are unwell consume 13% of the family income annually on health including medicines. 65 years and above consume 21%. Even as India boasts of being the largest manufacturer of generic prescriptive drugs, still the healthcare expenses work out heavy.
The rate of increase of cost of healthcare has been a steady double the pace of growth or inflation in general. Increased house hold out of pocket expenditure on health has become the 2nd major cause of indebtedness in rural population, next to agriculture.

 Total health care spending is projected to rise at an annual rate of over 12 percent, from an estimated $96.3 billion in 2013 to $195.7 billion in 2018.
The average hospitalization cost in India is INR 24500 in urban and 15000 in Rural areas calculated for the year 2014.
Non-communicable diseases (NCDs) amongst old people are the main culprit causing disability and a pocket drain. Cancer treatment, joint replacements, heart surgery, neurosurgical procedures, dental implants, kidney dialyses or transplants are some of the richer man’s game only.
Highest hospitalization expenses incurred are in places such as Delhi INR 34750 with 45% people using public and 55% private hospitals. Assam tops the list with hospitalization expenses at INR 47050 with 51.5% using public and 48.5% private hospitals. States such as UP,Haryana,Madhya Pradeh and Karnataka are just little behind Delhi figures.
The high costs of healthcare also acts as a deterrent for poor people to visit medical centres with alacrity with such delays leading to further complicating the health of people. In urban India even basic
Heart surgeries can cost anywhere between 1.5 lacs to 3.00 lacs and with high medical cost inflation it could double in 5-6 years. India as a topper in heart ailment globally has a huge heart cost to deal with.

However Healthcare still remains low as an expenditure item in India. Expenses are just 4.5% of GDP a figure much lower than USA 15.70% of GDP and UK 8.2% .

The scenario is tailor made for foreign direct investment to flow in which is in fact picking up rapidly. In healthcare FDI is allowed upto 100%. There is a tax holiday for 5 years for hospitals springing up in rural areas. The sector will be bolstered with capital
investments, technology tie-ups, and collaborative ventures across various segments, including diagnostics, medical equipment, hospitals, and education and training.

Healthcare thus is already one the fastest growing service sector in India.

Still India’s public health care system remains bad. The whole map is characteristic of  under funded and overcrowded hospitals, clinics and inadequate rural coverage. Reduced funding by the Indian Government has been attributed to in excusable failures of the Ministry of Health and Family Welfare (MHFW) to exhaust its annual fund allocation despite increasing demand.

In such a situation urban Indians are adopting to health insurance or plans. These options offer cashless facilities against hospitalization and treatment including 30 critical illnesses and 80 surgical procedures, covering a large spectre of private and well equipped medical facilities.

The private sector has evolved a multi-dimensional approach to increase accessibility and penetration. It is tackling the issue of Lifestyle related diseases with the development of high-end tertiary care facilities. Also new delivery models such as Day-care centres, single specialty hospitals, end-of-life care centres, etc. have emerged.
The Public Sector is keen to continue to encourage private investment in the healthcare sector11 and is now developing Public – Private Partnerships.
Both sectors have also undertaken initiatives to improve functional efficiencies in the form of
Accreditations, Clinical research, outsourcing of non-core areas, increased penetration of healthcare
insurance and third party payers.


Silver Lining- Mass media has emerged as a  great medium to educate and spread awareness on health fitness and disease awareness. Current generation is much more aware and health conscious and wants to avoid medical situations at all costs perhaps the only way to save on costs.

People by and large have been affected by the health wave and practices such as Yoga, Alternate medicine such as naturopathy, Ayurvedic medication such as herbs and extracts, nutrition in foods, health supplements and life style changes have suddenly assumed meaning and visibility.

Morning parks are much fuller than previously or is it because of the sheer number game which India enjoys and sulks in at the same time.

There is greater stress on public hygiene and sanitation. The Government is also running a project to this effect and with fervour. Clean the Ganga type of projects also share a common objective apart from ecological ones. All such projects if implemented on ground can bring about radical changes in atleast the communicable disease incidence in rural and semi urban areas, although there is no internationally comparable metro in India as well in terms of cleanliness and infrastructure.

The effect of of all health sector reforms have improved the overall scenario from dismal to hopeful.
Primary Health Care Centres (PHCs) increased from 22,699 in 2006 to 24 448, Sub Centres (SCs) from 146,026 to 151 684 and Community Health Centres (CHCs) from 3910 to 5187 in
2013. Number of government hospitals and beds have not shown much advances in numbers except in 2012.
Average coverage of rural population by Sub Centres is 5,624 against the standard of 3,000-5,000, by PHCs 34,876 against the standard of 20,000-30,000 and by CHCs 173,235 against the standard of 80,000-120,000 indicating that at least there are enough health care centres to serve the population although they are grossly uneven in distribution.

International models and practices need to be adopted to increase throughput of the whole medical machinery, be it at any level. India has a complex structure of government institutions right from planning to implementation stage. The scenario needs to be that of adoption of internationally successful models and protocols rather than create magic out of a box with overnight fixes.

It is baffling as to why nothing affects us until it sticks in our throats like cancer.


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The Kidneys- Our filter houses

Typical Human kidney is crescent shaped with 2 layers, the Renal Cortex and the Renal Medulla. The Vertebrates possess the kidneys on either side on the back portion. Kidneys are internal organs which are vital to ion and water balance and excretion.  The primary role of the kidneys is to flush out wastes from our body that allows optimal cellular function and to remove toxins that are generated by metabolism or ingested with a diet. The careful monitoring of the internal systems,  the adjusting of excretory patterns for perturbations from intake, endogenous production, external losses, or metabolic consumption is called homeostasis. The removal of toxins is called clearance.
Major functions of the kidney
1) Maintenance of body fluid composition
a)  Electrolyte homeostasis
b)  Water homeostasis
2) Excretion of metabolic end products and drugs
3) Regulation of blood pressure: renin production and sodium balance
4) Production of erythropoietin
5) Production of 1,25 dihydroxy-vitamin D

Additional responsibilities of the kidney include maintaining systemic hemodynamics and producing several important endocrine molecules. Homeostasis is the response to changes in intake, losses, and metabolic demands in order to maintain a relatively constant extra-cellular environment. The kidney balances intake and production against losses and consumption. y Blood Flows in the kidneys  generously  receiving 25% of the resting cardiac output. Kidneys also utilize large amounts of energy and oxygen.
Kidneys have 1% of body mass, each kidney having a high rate of blood circulation. Blood enters the kidney from renal artery, which branches into smaller vessels that give rise to the “glomerulus.” It passes total body blood volume every 4-5 minutes, filters 180 litres of blood per day and reabsorbs 178.5 litres of it. The kidney produces 1.5 litres of acidic (pH~6) urine per day. A 5% increase in filtration would generate 9 litres of urine per day although the regulation of kidney ensures that this does not happen. Once urine is formed, it passes into a cavity called the minor calyx, multiple minor calyces drain it into the major calyx which empties into ureters that drain the kidney. From there, the ureters empty into the urinary bladder where urine is stored.

The functional unit of the kidney is called nephron. Nephrons are composed of 2 elements:
Glomerulus- A Twisted ball of capillaries which Delivers fluid to the tubule and Renal tubule which is Composed of a single layer of cells. There are 1 million nephrons in the kidney and they contain Water + urea, NaCL, KCL, phosphates, etc. Function of the nephron is to Filter everything out and take back what is worth keeping through reabsorption of water and salts and secretion of additional unwanted substances.
Each nephron filters blood to generate a “filtrate” composed of water and solutes (glomerular filtration), which then passes through a tubule that progressively modifies the filtrate, mainly by reabsorbing desirable solutes and water.

Being complex organs in structure and function, the kidneys have a deep interwoven relationship with the circulatory system.
Kidney disorders can occur silently 0ver time  developing into a chronic condition. Chronic kidney disease (CKD) is a condition characterized by a gradual loss of kidney function over time .  It refers to damage to the kidneys and a decrease  in their ability to keep  the body healthy by only partially performing their functions. If kidney disease gets worse, wastes can build to high levels in the blood  resulting in a sick feeling. Complications such as high blood pressure, anemia (low blood count), weak bones, poor nutritional health and nerve damage can develop.
Also, kidney disease increases the risk of having heart and blood vessel disease. These problems may happen slowly over a long period of time. Chronic kidney disease may be caused by diabetes, high blood pressure and other disorders. Early detection and treatment can often keep chronic kidney disease from getting worse. When kidney disease progresses, it may eventually lead to kidney failure, which requires dialysis or a kidney transplant to maintain life.
Some important observations on CKD are:
·        Early detection can help prevent the progression of kidney disease to kidney failure.
·        Heart disease is the major cause of death for all people with CKD.
·        Glomerular filtration rate (GFR) is the best estimate of kidney function.
·        Hypertension causes CKD and CKD causes hypertension.
·        Persistent proteinuria (protein in the urine) means CKD is present.
·        High risk groups include those with diabetes, hypertension and family history of kidney failure.
The two main causes of chronic kidney disease are diabetes and high blood pressure, which are responsible for up to two-thirds of the cases.
Other conditions that may affect the kidneys are: Glomerulonephritis, a group of diseases that cause inflammation and damage to the kidney's filtering units. These disorders are the third most common type of kidney disease. Inherited diseases, such as polycystic kidney disease, which causes large cysts to form in the kidneys and damage the surrounding tissue. Malformations  of organs in womb such as a narrowing that prevents normal outflow of urine and causes urine to flow back up to the kidney. This causes infections and may damage the kidneys. Obstructions caused by problems such as kidney stones, tumours or an enlarged prostate gland in men and repeated urinary infections.
Most people may not have any severe symptoms until their kidney disease is advanced. However, some indications are such as feeling more tired and having less energy, have trouble concentrating, have a poor appetite, have trouble sleeping, experiencing muscle cramping at night, swollen feet and ankles, puffiness around your eyes, especially in the morning, have dry, itchy skin and needing to urinate more often, especially at night.
CKD can be detected by calculating the Glomerular Filtration Rate (GFR).  It is the best way to calculate kidney function.  It is calculated from blood creatinine, age, race, gender and other factors. GFR establishes stage of kidney disease and helps the nephrologists plan treatment.
GFR in people with increased risk of CKD due to other conditions such as diabetes, high blood pressure, family history, older age, ethnic group) is more than 90. Those with kidney damage with mild loss of kidney function it is 89-60. Mild to moderate loss of kidney function may give a GFR value of 59-44 and with moderate to severe function loss 44-30.
A severe loss of kidney function denotes GFR value of 29-15 and kidney failure below 15. A GFR below 60 for three months or more or a GFR above 60 with kidney damage (marked by high levels of albumin in your urine) indicates chronic kidney disease.
A simple urine test will also be done to check for blood or albumin (a type of protein) in the urine. When you have albumin in your urine it is called albuminuria.  Blood or protein in the urine can be an early sign of kidney disease.
Also an ultrasound or CT scan  can be performed to get a picture of the kidneys and urinary tract to establish size of kidneys , whether too large or too small, detection of  kidney stone or tumour and whether there are any problems in the structure of kidneys or urinary tract. Sometimes a kidney biopsy may be performed to check for a specific type of kidney disease, see how much kidney damage has occurred and help plan treatment. To do a biopsy, the doctor removes small pieces of kidney tissue and looks at them under a microscope.
Acute Kidney Injury (AKI) is another kidney condition of note which can lead to chronic kidney disease. It is a syndrome that results in a sudden decrease in kidney function or kidney damage within a few hours or few days. Dr. Javier A. Neyra has observed that AKI is common in patients who are in the hospital especially in the elderly and those in intensive care units (ICU). He says,” AKI causes a build-up of waste products in your blood and makes it hard for your kidneys to keep a balance of fluid in your body. This can also affect other organs such as the brain, heart, and lungs. AKI is found through simple blood and urine tests. AKI can lead to chronic kidney disease (CKD), or even kidney failure needing dialysis (end-stage kidney disease). It may also lead to heart disease or death. Even mild AKI or a seemingly complete recovery from AKI may have some short- and long-lasting health problems.”
Major causes of AKI include Decreased blood flow to the kidneys. This can result from Hypotension (low blood pressure) or shock, Blood or fluid loss (e.g., bleeding, severe diarrhoea), Heart attack, heart failure, and other conditions leading to decreased heart function, Organ failure (e.g., heart, liver), Use of NSAIDs (e.g., ibuprofen, naproxen), Severe allergic (anaphylactic) reactions, Burns, Injury and Major surgery
AKI can also be caused by Direct damage to the kidneys due to conditions such as Acute glomerulonephritis (inflammation and damage to the kidney glomerular membrane) or Acute interstitial nephritis (allergic reaction that can be caused by several drugs) or Sepsis (total body response against infection which can cause poor organ function or poor blood flow) or an enlarged prostrate or kidney stones.
Clinically AKI can be detected through a blood test for creatinine to find out how well the kidneys are working by estimating the glomerular filtration rate (eGFR) and also by A urine test to find protein in the urine (proteinuria) which may show kidney damage
other preventive measures include Staying well hydrated – drinking a lot of water and avoid long term use of drugs that are toxic to the kidneys such as NSAIDs (ibuprofen, naproxen) or herbal remedies or supplements.
Kidney failure is a term referred to a condition of 85-90% of impaired kidney function. People with this condition have to undergo Dialysis treatment which removes excess wastes and fluid from the blood. With sufficient treatment, overall health improves and patient will have more energy to cope with life. Inadequate dialysis may result in accumulation of excess wastes and fluids in the blood.
 In addition, studies have shown that receiving adequate dialysis treatment increases lifespan of the patient. Dialysis dose is established by a test called Kt/V.. Another test used is called urea reduction ration (URR). Three major types of treatment are available for patients with kidney failure. They are haemodialysis, peritoneal dialysis and kidney transplantation. Haemodialysis may be done at a dialysis center or at home, and treatments usually take place three times a week. Peritoneal Dialysis may be done at home, at work, at school or wherever a clean, private space is available for bag exchanges. The two types of peritoneal dialysis are automated peritoneal dialysis (APD), which requires the use of a machine, and continuous ambulatory peritoneal dialysis (CAPD), which is machine-free.
Kidney Transplants can come from living donors, who are usually family members, spouses or friends of the patient. Transplants can also come from people who died recently (non-living donors).
It is important to note that treatment does not cure kidney failure and that each type of treatment has its benefits and drawbacks. Each choice has to be carefully weighed.
Kidney failure interferes with the body's natural immunity, increasing chances of some infections such as hepatitis or AIDS through dialysis treatments. Those in line for dialysis are vaccinated before hand for such diseases which may be acquired through blood transfusion.
Almost all patients and their families have fears before starting treatment as to how long one can survive with the disease and it is normal and expected. In such a situation referral to the dialysis unit where treatment will take place by the doctor should be consulted who have already been through it.
Diet with less salt, avoiding high potassium and phosphorus foods and limited intake of fluids can be severely harsh on the patient. Small amounts of restricted foods can be had topped with spices and tangs suitable to one’s palate.
Frequent Mood changes are also common among kidney patients due to Uremia or the build up of waste products in the blood, making them irritable. The stress caused by chronic illness itself may lead to frustration and mood swings. The experience of having an older parent with chronic illness can be difficult. Treating them with dignity and respect while, at the same time, taking more responsibility for their care, requires a delicate balance of patience, sensitivity and frankness especially with the elder caretaker in the family.
Kidney risk groups must avoid alcohol, pain killers such as analgesics, Nonsteroidal anti-inflammatory drugs (NSAIDs) and over the counter medication.
World kidney day is observed on every second Thursday of March. On this occasion it was divulged by Dr. Sanjay K. Agarwal, Professor and Head of Nephrology, AIIMS Delhi that one in every 10 adults in India suffers from chronic kidney disease (CKD), and at any given point, nearly five lakh patients are in need of life-long dialysis or transplant. He further said that “only 6,000 patients received new kidney and another 30,000 could afford or get access to dialysis. For the remaining 4.5 lakh, there was no definitive treatment and their survival was difficult beyond a few weeks.”
Dr. Agarwal noted that “just two simple tests to check the level of protein in urine and a blood test for measuring serum creatinine once a year can help prevent the disease. If the tests are normal, they can be repeated after a year.”
Present in drinking water, it is believed that Sodium bicarbonate can reduce the progress of kidney damage. It results in higher O2 levels through increased alkalinity to the cells. New research by British scientists at the Royal London Hospital shows that sodium bicarbonate can dramatically slow the progress of chronic kidney disease.
The findings have been published in the Journal of the American Society of Nephrology. Dr. SK Hariachar, a nephrologist who oversees the Renal Hypertension Unit in Tampa Florida stated, upon seeing the research on bicarbonate and kidney disease, “I am glad to see confirmation of what we have known for so long.  I have been treating my patients with bicarbonate for many years in attempts to delay the need for dialysis, and now we finally have a legitimate study to back us up. Not only that, we have the added information that some people already on dialysis can reverse their condition with the use of sodium bicarbonate.”

Herbal supplements are a big no for kidney patients. People with high risk of kidney disease or those who are already kidney disease patients should not use herbal supplements. Use of herbal supplements is unsafe if you have kidney disease since some herbal products can cause harm to your kidneys and even make your kidney disease worse. Also, your kidneys cannot clear waste products that can build up in your body. Herbal supplements may contain Potassium or Phosphorous, minerals that can put pressure on the kidneys and worsen their condition. Some supplements made in lax conditions may contain heavy metals.

Mechanisms of action have been studied in clinical studies for some herbs. Their effects are mainly related to anti-inflammation, antioxidation, antifibrosis, regulation of immune system, anticoagulation, and improvement of metabolic disturbance. Active ingredients purified from herbs that have been studied in CKD include saikosaponin a and d (SSa and SSd) and triptolide. However, the active compounds in many decoctions or patent medications are still unknown, and clinical trials demonstrating their efficacy for treatment of CKD are limited.
Kidneys are sensitive organs. We need to evaluate and take informed decisions on medications being prescribed by doctors and ensure that no harmful drug is being given. For example doctors may say that PTH hormone level  is high and prescribe Calcium Channel Blocker, such as amlodipine which needs to be avoided and substituted by ACE inhibitor such as Quinapril, and Accupril. The Parathyroid glands control calcium levels in the body. Thyroid gland will release calcium into the blood stream from the bones to maintain calcium balance, after calcium is blocked to the heart by drugs such as amlodipine. More PTH will be released, side effects shall be controlled by another drug and so on until all accumulatively start having a derogatory impact on kidneys.

According to Brig AS Narula one lakh patients with end stage renal disease report at hospitals every year. In a community based study by Agarwal et al , from Delhi in Northern India the prevalence of earlier stages of CKD was reported to be 7852 per million population.
 Brig AS Narula further observes that India has a rising burden of chronic diseases such as hypertension and diabetes. The increase in number of CKD patients can be partially attributed to the epidemic of chronic diseases and the aging population. India has the largest number of diabetics in the world with a prevalence of 3.8% in rural and 11.8% in urban adults.
The prevalence of hypertension has been 12-17% among rural adults. It is estimated that 25-40% of these patients are likely to develop CKD, with a significant percentage requiring renal replacement therapy. The health care system in our country is not designed to provide the required level of care for CKD at the primary or secondary level.
In developing countries various health care programs have been devoted to communicable diseases, nutritional deficiencies and population control and recently to acquired immunodeficiency syndrome. For non communicable diseases such as diabetes, hypertension and CKD the focus has been on developing advanced treatment facilities at the tertiary level.
The staggering costs incurred in developing these centres of excellence needs to be recognized thus making it imperative to shift the approach from provision of renal replacement therapy to early detection and prevention of CKD. This approach may additionally reduce the morbidity and mortality of underlying conditions such as diabetes and hypertension, which is related directly to the presence of albuminuria or degree of renal function impairment.
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