Tobacco smoking and diabetes
Dr Arup Ratan Choudhury The harmful effects of smoking. Studies show that smokers are five times more likely than that of the nonsmokers to have gum disease. For smokers with diabetes, the risk is even greater. If you are a smoker, diabetic and age 45 or order, you are 20 times more likely than a person without these risk factors to get severe gum disease.
Smoking increases your risk of getting type 2 diabetes
Some recent research shows there is a significant relationship between diabetes and smoking. The more you smoke, the more chance you have of getting diabetes. If you smoke 16 to 25 cigarettes a day, your risk for type 2 diabetes is 3 times greater than a non-smoker. When you quite smoking, your risk decreases during the years that follow.
Smoking affects the way insulin works in your body
In type 2 diabetes, the body does not respond to insulin made by the pancreas. Insulin helps blood glucose enter into the cells for fuel. When you smoke, your body is less able to respond to insulin. When your body resists insulin, your glucose level increase in the blood. Resistance does not start to reverse until you do not smoke for 10 to 12 hours.
Smoking makes it harder to control your diabetes
Studies show that smokers have poorer glucose control than non-smokers do. Smokers who quit have the same blood glucose control as non-smokers. When you have type 1 or type 2 diabetes, glucose control is very important. The HbA1c test checks how well you control your glucose level over 3 months. The goal is to keep your A1c at 7 percent or less. When you have diabetes and you smoke, your A1c level increases. If you quit smoking, your A1c level may decrease to the same level as a non-smokers.
Smoking increases your risk for getting other problems from diabetes
When you have diabetes and smoking habit, your chances are greater for getting other health problems form diabetes — complications. You can get serious eye problems, kidney problems, nerve problems, heart and blood vessel disease and so on.
Even for people who do not have diabetes but smoke, the risk of getting other health problems is greater. The more and the longer you smoke, the more your risk increases. Smoking and diabetes together greatly increase the danger of getting complications. To lower your risk, you must control your glucose levels and quit smoking. Diabetic people will be benefitted in many ways when they quit smoking.
Experts' views
All smokers need stop smoking in a clear, strong and personalised manner. Ask every tobacco user if s/he is willing to make and attempt to stop smoking at this time (within the next 30 days for example).
Assist all people with smoking cessation. For those unwilling to attempt cessation at this time, stress the 5 R's.
Relevance: provide individualised information on the hazards of smoking.
Risks: Emphasise the increased risks of heart disease and diabetes complications arising from the combination of smoking and diabetes.
Rewards: Review benefits of smoking cessation.
Roadblocks: Assure people of your willingness to assist in their efforts to stop smoking.
Repetition: Review people's thoughts about cessation during their following visit.
Key messages
* Review major steps of smoking cessation
* Set a date to stop smoking
* Identify likely relapse triggers and make specific plans for coping with them before stopping smoking
* Assess for nicotine replacement therapy
* Discuss any concerns about weight gain and other concerns related to diabetes
* Make referral for additional smoking cessation support, prescribe nicotine replacement, provide self-help materials, or otherwise assist in a specific plan
* Arrange for ongoing contact
* Schedule follow-up contact either in person or via telephone
* Follow-up contact should occur soon after the date set to stop smoking, preferably within the first week
The writer is Professor and Head of the Department of Dentistry, BIRDEM, Dhaka. E-mail: aratan@dab-bd.org
Vegetarian diet: How to get the best nutrition
Dr Md Rajib Hossain Adopting a healthy vegetarian diet is not as simple as scraping meat off your plate and eating what is left. You need to take extra steps to ensure you are meeting your daily nutritional needs. Find out what you need to know about a plant-based diet.
Vegetarian diet planning
A healthy vegetarian diet consists primarily of plant-based foods, such as fruits, vegetables, whole grains, legumes, nuts and seeds. Because the emphasis is on nonmeat food sources, a vegetarian diet generally contains less fat and cholesterol, and typically includes more fiber.
Meat alternatives
Milk: Drink fortified soymilk, rice milk or almond milk in place of cow's milk.
Butter: When sautéing, use olive oil, water, vegetable broth, wine or fat-free cooking spray instead of butter. In baked goods, use canola oil.
Cheese: Use soy cheese or nutritional yeast flakes, which are available in health food stores.
Eggs: In baked goods, try commercial egg replacers a dry product made mostly of potato starch.
Ensuring adequate nutrition
A vegan diet, for example, eliminates food sources of vitamin B-12, as well as milk products, which are a good source of calcium. Other nutrients, such as iron and zinc, are available in a meatless diet, but you need to make an extra effort to ensure they are in yours.
Protein: Your body needs protein to maintain healthy skin, bones, muscles and organs. Vegetarians who eat eggs or dairy products have convenient sources of protein. Other sources of protein include soy products, meat substitutes, legumes, lentils, nuts, seeds and whole grains.
Calcium: This mineral helps build and maintain strong teeth and bones. Low-fat dairy foods and dark green vegetables, such as spinach, turnip and collard greens, kale, and broccoli, are good sources of calcium. Tofu enriched with calcium and fortified soy milk and fruit juices are other options.
Vitamin B-12: Your body needs vitamin B-12 to produce red blood cells and prevent anemia. This vitamin is found almost exclusively in animal products, including milk, eggs and cheese. Vegans can get vitamin B-12 from some enriched cereals, fortified soy products or by taking a supplement that contains this vitamin.
Iron: Like vitamin B-12, iron is a crucial component of red blood cells. Dried beans and peas, lentils, enriched cereals, whole-grain products, dark leafy green vegetables, and dried fruit are good sources of iron. To help your body absorb nonanimal sources of iron, eat foods rich in vitamin C such as strawberries, citrus fruits, tomatoes, cabbage and broccoli at the same time you consume iron-containing foods.
Zinc: This mineral is an essential component of many enzymes and plays a role in cell division and in the formation of proteins. Good sources of zinc include whole grains, soy products, nuts and wheat germ.
Since no single food provides all of the nutrients that your body needs, eating a wide variety helps ensure that you get the necessary nutrients and other substances that promote good health.
Don't Panic,
Manage the Disease
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Professor M Abid Hossain Mollah |
During the hot summer many parents are alarmed when their infants are afflicted with very high fever (103-105 degree F), continuous runny nose and cough for a few days. Anxious parents rush to the clinics and hospitals, when common medicines fail to get the temperature down.
Child specialists urge parents not to be panicked since this is a common flue caused mostly by the viruses such as rhinovirus which takes an epidemic form during this period of the year. They even suggest not to prescribe any antibiotics initially, because usually the temperature becomes normal within three or four days in case of rhinovirus flu.
"A few parents use high dose di-clofenac suppositories, non-steroidal anti-inflammatory drugs (NSAID), since ordinary paracetamols cannot reduce the temperature in case of such flu," says child specialist Professor M Abid Hossain Mollah, "But the use of NSAID is not wise. It may decrease body temperature drastically that may be even more harmful for babies.
"It is better to prescribe limited doses of paracetamols than to suggest any antibiotic initially. Any form of liquid intake should be increased. It may be pure water, juice or even soft drinks. In case of high fever, it's wise to wash the body with warm water. Only when the fever continues for a week, antibiotic can be prescribed after a thorough diagnosis."
And for treatment of cough Professor Mollah suggests to give babies raw tea. "Treatment of cough for babies is difficult, since most of the available medicines are cough suppressive. World Health Organisation (WHO) suggests tea is very effective to cure cough. I've also got good result prescribing tea instead of any medicine. Moreover, mixture of tulsi juice and honey can be used for cough," says Professor Mollah.
He also suggests parents to be aware of the amount of urine the baby is excreting. "In the late 1980s we recognised a good number of babies suffering from renal problems for viral infections. Though in these days it's not frequent, we should always be careful," he advises.
Following the old proverb 'prevention is better than cure', Professor Mollah suggests proper baby care can effectively keep children safe from diseases. He says, " According to the Infant and Young Child Feeding (IYCF), the guideline formed jointly by WHO and Unicef, children below two years of age should never be fed any type of commercial food. Till six months age only breast milk should be given to infants. Not even water or baby cereal should be given, suggests IYCF. After six months, along with breast milk, the child should be given natural food like khichuri, eggs and fruits.
"It's better to give more oil in baby food, because oil provides sufficient energy. Moreover, vitamin A that increases body resistance is fat-soluble. So use of more oil in khichuri or other types of naturally cooked food makes babies healthier", continues Professor Mollah, "At the same time parents must keep the babies clean all the time. They should be given baths regularly."
But, whenever a baby has symptoms like anemia, gradually becoming pale, lack of interest in playing and other things, she should be immediately taken to a child expert to find out the cause of anemia. In Bangladesh the most common cause of anemia in children is iron deficiency anemia. "In addition to the iron deficiency anemia there are possibilities of hemoglobin related disorders and thalassaemia, the name given to a group of inherited blood disorders that affect the body's ability to create red blood cells. So, symptoms like anemia, gradually becoming pale should seriously be considered, since in these days the rate of thalassaemia major afflicted babies has increased.
"An estimated six percent people in Bangladesh are carriers of thalassaemia which is not that much harmful, But when both of the parents are carriers, the baby becomes a thalassaemia major carrier. Each year seven to eight thousands babies are born carrying thalassaemia major in Bangladesh. The most serious types of thalassaemia can cause other complications including organ damage, restricted growth, liver disease, heart failure and even death."
For the preventive measure for life killing thalassaemia major disease Professor Mollah suggests, "In fact, we should initiate awareness generating programmes for preventing thalassaemia immediately, since treatment for such disease is very expensive. An introduction on thelaseamima may be included in academic curriculum. And marriage between blood relations should be discouraged."
Many countries in the world such as Italy, Cyprus, Greece and Iran have significantly decreased the rate of major thalassaemia through awareness generation programme. The carriers of thalassaemia should not marry each other. In many countries of the world people ask report of thalassaemia test before marriage. Such preventive measures have proved effective in those countries.
World No Tobacco Day 2009
Showing the truth: Health warnings on tobacco
Tomorrow is World No Tobacco Day. This year theme for the Day is “Tobacco Health Warnings”. Health warnings on tobacco product packaging are critical to any effective tobacco control strategy. They increase public awareness of the serious health risks of tobacco use and help to ensure that the packaging tells the truth about the deadly product within. Tobacco package health warnings that include images are a particularly powerful and cost-effective vehicle for communicating health risks.
Tobacco is the leading preventable cause of death. More than 1.2 million people die every year in South-East Asia Region due to tobacco use. The wide-spread use of tobacco products in the Region has resulted from unrestricted use of marketing tools by the tobacco industry, the addictive nature of nicotine and the lack of knowledge about the harmful effects of tobacco products among tobacco users and non-users in the form of second-hand tobacco smoke. The lack of regulation of the tools of a product that kills half of its users has exposed the population to the misinformation of the tobacco industry about the suitability of their products.
Yet tobacco product packaging in most countries provides little or no information of warn consumers of the risks. The WHO Framework Convention on Tobacco Control (FCTC) in its Article 11 mandates that countries should enact effective measures to ensure appropriate health warnings on tobacco products packages. It also says that these health warnings should be rotating, large, clear, visible, legible and include pictures or pictograms and occupy at least 50 percent or more and no less than 30 percent of the principal display areas.
Comprehensive health warnings about the dangers of tobacco use play a vital role in changing its image, especially among adolescents and young adults. Text and pictorial health warnings are useful to communicate the health risks of tobacco use, provoke more thought about the health risks of tobacco use and have a greater emotional response and generate increased motivation and intention to quit. They are particularly effective in communicating health effects to comparative low literate populations, children and young people.
US President Barack Obama speaks on securing cyber infrastructure May 29. 
