Madeeha Syed

Just because you’re pregnant doesn’t mean you can go crazy with food. You’re supposed to increase your diet by just 300 calories, the equivalent of a small apple or a slice of bread!

Are You Really Eating for Two When You’re Pregnant?

This article or video has been vetted and verified by Meri Sehat’s specialists. It contains citations and research from validated sources.

Nutritionists suggest that you do not have to eat double for a healthy pregnancy. Know your pregnancy diet, including what fruits to eat during pregnancy and what vegetables to avoid during pregnancy.

Are You Really Eating For Two When You’re Pregnant?

What Is Cupping And Do You Need It?

Overview

Have you noticed those small, circular marks that celebrities flaunt these days? In malls, on red carpets, they&rsquo;re everywhere. What is it? Is it a cause for concern?&nbsp;

Well, they are a result of cupping therapy.&nbsp;

Cupping is a form of complementary therapy. It is believed that the suction it creates would enhance your body&#39;s energy flow and promote healing. 
&nbsp;

Cupping Treatment

Historical text referring to cupping therapy dates back to 1550 B.C. It has been a part of many ancient healing systems &ndash; Chinese, Tibetan, Korean, and Unani. Even the &ldquo;father of medicine&rdquo;, Hippocrates, wrote and compiled extensively on cupping procedures.&nbsp;

Nowadays, traditional Chinese medicine practitioners are known for using cupping therapy as a form of treatment. 
&nbsp;

The Chinese word for life force is Qi. Proponents of cupping believe the therapy is helpful in regulating the flow of Qi in the body. A lot of people also believe it balances out the negative and positive energy flow within the body. This balance is necessary to fight pathogens (illness causing microorganisms), increase blood flow, and <a href="https://merisehat.pk/article/natural-remedies-for-pain">reduce the level of pain</a>. 
&nbsp;

The process of cupping improves blood flow to the area where the cups are applied. This eases muscular tension, which, in turn, promotes cell repair and enhances general blood flow.&nbsp;

Additionally, cupping might support the development of new blood vessels and connective tissues.

Cups are frequently placed on the back, chest, abdomen, or legs. The most common site is back, though. For facial cupping, as the name suggests, the cups are placed on the face. 
&nbsp;

People use cupping as a supplementary type of treatment for a variety of symptoms and ailments:

<ul>
	<li>Neck and back pain</li>
	<li>Lowering cholesterol levels</li>
	<li>Knee and joint pains</li>
	<li>Improving immune system performance</li>
	<li>Chronic headaches 
	&nbsp;</li>
</ul>

The question here is how exactly cupping helps in treating these conditions? It is still unclear how sucking and drawing of blood under the skin could be this beneficial.&nbsp;

One study describes cupping as a complementary treatment and draws attention to how it deals with any disease-causing factors by simply restoring the body&rsquo;s energy flow and eventually improving blood circulation.

Actually, the cup is first heated with the herbs, alcohol, and paper placed within it. The heated cup is then placed on the skin upside down. The air inside the heated cup cools down. This creates a vacuum that pulls the skin and muscles up into the cup. As a result, changes in blood pressure causes the skin to turn red. 
&nbsp;

Unfortunately, despite the fact so much research has been carried out on cupping, no one seems to have come up with solid evidence to prove whether it actually works.&nbsp;

Back in 2015, an evaluation of the evidence discovered that cupping might help relieve chronic neck or back discomfort to some extent. Unfortunately, the quality of the research was insufficient to make definite conclusions.&nbsp;

In 2017, according to a study, cupping could increase the blood flow and stretch the underlying tissue.

Despite many competing theories, however, the effectiveness of cupping remains dubious. 
&nbsp;

Bottom Line

Cupping might be a useful supplemental treatment for a number of symptoms and illnesses, according to a growing body of research. However, more credible research is required to confirm the benefits of cupping.

Namwer Rao

Beat The Heat: What Happens When Heat, Sweat And Skin Collide

The summer months can be a fun time for outdoor activities and spending time with friends. But if you&rsquo;re prone to chafing or rashes, they may not be so enjoyable.&nbsp; 
&nbsp;

effect of heat on skin

Chafing and rashes are a common problem, especially during the summer months. The main cause of these annoying conditions is sweat. When your skin gets wet and rubs against itself or another surface, it can become inflamed and tender to the touch.

When you put on clothes that are too tight or made with synthetic materials like lycra, they can act like a glue trap for sweat, which contributes to chafing and rashes by trapping moisture between your skin and clothing. Sweat can also irritate sensitive skin as it evaporates off of your body &mdash; this is why you should always wear breathable fabrics such as cotton when exercising outdoors or in an air-conditioned room on hot days. 
&nbsp;

Sweat is the main cause of chafing, but it&rsquo;s not the only one. Friction is also a major factor in causing irritation and soreness that can make you unable to enjoy your day-to-day activities. 
&nbsp;

There&rsquo;s a rash for every occasion:

<ul>
	<li>Boob Rash: It&rsquo;s the bane of many a lady&rsquo;s existence, especially during sweaty summers and strenuous workouts. The friction of your bra rubbing against your skin causes irritation, which leads to red bumps and rashes.</li>
	<li>Thigh Chafing: Similar to boob rash but on your legs instead of chest, thigh chafing is caused by the constant rubbing of clothing against bare skin as you walk or run around all day long &mdash; especially if you&rsquo;re wearing shorts or skirts!</li>
	<li>Nipple Chafing: This is one particular type of nipple rash that can happen during pregnancy or breastfeeding when there&rsquo;s excess fluid flowing through those delicate glands in addition to sweat from exercise! 
	&nbsp;</li>
</ul>

Sweat itself doesn&rsquo;t cause chafing, but it can make things worse. If your skin is already sensitive to friction or susceptible to rashes and blisters, then sweat will make it even more sensitive.

&nbsp;

When you&rsquo;re trying to keep cool in the summer heat, it&rsquo;s easy to over-hydrate and end up with a gush of liquid dripping down your back as you walk around. When that happens, you might start thinking that all this sweat must be causing me some discomfort &mdash; but in reality, we just need a little bit more salt!

&nbsp;

These rashes could cause serious health problems if left untreated

Cuts and scrapes can lead to infections. Chafing can lead to blisters, and, in turn, those blisters can become infected.

Infections in the skin can cause damage that leaves you vulnerable to infection by other germs and even viruses like <a href="https://merisehat.pk/disease/hepatitis-b-113">Hepatitis B</a> and C or <a href="https://merisehat.pk/disease/hiv-61">HIV</a>, which can be fatal if left untreated.

To avoid these rashes in the first place, you need to keep the skin dry, reduce friction and stop rubbing your skin raw.

A rash is an uncomfortable, and sometimes painful, skin condition that can occur due to a variety of reasons. The most common cause of rashes is sweat and friction. To avoid these rashes in the first place, you need to keep the skin dry, reduce friction and stop rubbing your skin raw. 
&nbsp;

Avoiding Sweat And Friction: Using a lubricant between two surfaces that rub together without causing much wear (skin against fabric) will help prevent chafing and blisters caused by sweating under heavy loads or tight-fitting clothing like cycling jerseys or hiking shorts. Silicone-based lubricants work well because they stay slick longer than water-based lubricants; however, they&rsquo;re not as safe for use around water because silicone doesn&rsquo;t absorb into fabrics so it can be slippery when wet!

Keeping Skin Dry: You should apply sunscreen before you go outside since sun exposure makes you more susceptible to getting burned &mdash; especially if there isn&rsquo;t any breeze to cool down your body temperature during long runs outdoors (or even short ones). 
A good rule of thumb is that if it&rsquo;s hot outside but feels less humid than usual then put on sunscreen anyway just in case because humid conditions make it harder for sweat from evaporating off our bodies which means we need more frequent hydration breaks during long workouts outside in summer heat waves! 
Don&rsquo;t forget about protecting yourself against UV rays too because even though clouds may block direct sunlight from reaching us directly down here on earth&rsquo;s surface &mdash; they don&rsquo;t block UV rays which come through holes in them called &ldquo;glare points.&rdquo; These glares points are responsible for generating many different kinds of reflections including glare reflection off surfaces such as pavements when walking along city streets. 
&nbsp;

The first rule of treating any skin condition is not to try to rub it off. The rubbing can make it worse, and you may introduce bacteria into the area, which could cause inflammation and infection. The best thing to do is keep the area dry by using talcum powder or a non-oily moisturizer with a high water-content like Vaseline or Petroleum Jelly. 
&nbsp;

<h4>&quot;Most rashes will clear up within a few days after you adopt prevention techniques that keep your skin dry and limit friction&quot; 
&nbsp;</h4>

If you&rsquo;re at risk of developing a rash, it&rsquo;s best to take the following precautions:

<ul>
	<li>Use a towel to dry off immediately after swimming or sweating.</li>
	<li>Apply a moisturizer with an SPF of at least 30 every morning and reapply in the afternoon if you plan on being outside for longer than an hour.</li>
	<li>If you are wearing clothes that rub against your skin, use an anti-chafing product such as zinc oxide paste until your rash clears up and then switch to a heavier formula like dimethicone which will protect against future rashes. You may also want to try tea tree oil or aloe vera gel if those options appeal more strongly than using medication prescribed by a healthcare professional. 
	&nbsp;</li>
</ul>

The best way to prevent chafing while running is to take steps before your run. You can start with a good exfoliating shower and apply some body lotion or cream to dry areas. Then, wear the right clothes. Make sure they fit you well and aren&rsquo;t too tight or too loose where it counts &mdash; the thighs and crotch area are particularly susceptible to chafing.

Lastly, you should use products like Vaseline on dry spots before you hit the road. These products will help protect against rubbing and chafing during exercise so that when it&rsquo;s time for your next long run, all of those miles won&#39;t be spent dealing with embarrassing rashes instead of crossing finish lines! However, this is not just limited to the girlies who are active. Even when you are going on with your daily life, you can always incorporate these hacks to make summers more comfortable for you. 
&nbsp;

We know that dealing with these rashes can be frustrating. We want you to know that there is hope, though! They are all preventable, and it&rsquo;s not just about following the rules of hygiene either. You need to keep your skin dry and limit friction by wearing loose clothing and changing out of sweaty clothes as soon as possible after an activity ends. If you find yourself with a rash or chafing, don&rsquo;t try rubbing it off&mdash;that will only make things worse! Instead let your body heal naturally by keeping the affected area clean and dry until the symptoms subside on their own.

Umna Salah

Medilink Consultant clinic

Online Consultation

ZAKA CLINIC GULBERG LAHORE

Saad Ullah Siddiqui

This article or video has been viewed by many visitors, and is popular.

Time For Men To Share The Burden Of Pregnancy

Introduction

A fast-growing population is one of the greatest challenges currently faced by Pakistan. Increasing poverty, food shortage, health challenges, depletion of natural resources, and overcrowding are just some of the problems associated with overpopulation. According to the 2017 Census of Pakistan, with a population of more than 207 million, the country is the fifth most populated country in the world<a href="#accordion">[1]</a>. Therefore, effective birth control methods are a need of the hour to prevent the risks associated with overpopulation.

However, the use of contraception is largely stigmatized in Pakistan due to various reasons. As per the Pakistan Demographic and Health Survey (PDHS), the current contraceptive prevalence rate (CPR) is only 34%<a href="#accordion">[2]</a>. Moreover, the use of contraceptive methods among men is extremely low. Thus, resulting in the burden of pregnancy and contraception lying largely with women. This could probably be due to a lack of awareness among men regarding various contraceptive methods that are readily available. Raising awareness about these methods is the first step in ensuring that the financial and emotional burden of <a href="https://merisehat.pk/article/how-to-practice-safe-sex">safe sex</a> is shared among both partners in a couple.&nbsp;

Almost 200 years ago, humans invented the world&#39;s first condom, and for a long time that was the greatest discovery in the world of contraception. However, scientists soon discovered methods specifically designed for women that could aid further in population control. Several female contraceptive options ranging from hormonal pills to invasive tubal ligation were introduced. However, each of the proposed methods comes with its side effects. Contraception methods have been widely politicized and various speculations exist regarding the reasons behind the disparity among male and female contraceptives. However, it is important to mention that male contraceptive methods are generally safer than their female counterparts, which is why in recent years significant work has been done to search for effective male contraceptive options. This shift in tide is also perpetuated in part by the increasing awareness among men and their willingness to use contraceptives.&nbsp;&nbsp;

&nbsp;

Understanding Male Contraceptives

Currently, two widely acceptable male contraceptive methods exist: condoms and the invasive vasectomy.

&nbsp;

<h5 dir="ltr">Condoms</h5>

These are a form of barrier method and stop the sperm from entering and fertilizing the egg. Along with being an effective and inexpensive birth control, condoms also prevent sexually transmitted infections (STIs). However, incorrect use is associated with a high failure rate, and they can easily break or get damaged. In Pakistan, condoms are the most used form of contraceptive method, with a frequency of 65.5%<a href="#accordion">[3]</a>.&nbsp;

In recent years, the Pakistani government has stepped up its social media campaigns in a bid to educate the public regarding the use of condoms and other effective family planning methods. This is aimed at controlling the growing population by promoting birth spacing and awareness of women&#39;s fertility. Doorstep availability and affordable prices have significantly increased the use of condoms among the general population.&nbsp;

Unfortunately, misconceptions about condoms and other family planning methods still need to be overcome.&nbsp;

&nbsp;

<h5 dir="ltr">Vasectomy</h5>

Also called male sterilization, the surgical procedure has been in use since the 1970s. The procedure involves cutting or blocking the vas deferens that carry sperm to the urethra. As a result, the semen is devoid of sperm and the egg cannot be fertilized. It is not easily reversed; therefore, it is mostly advised to men who are sure of not wanting children or who believe their family is complete.&nbsp;

With a success rate of 99.85%, it is the most reliable contraceptive option. Moreover, compared to tubal ligation in women, it is less invasive, has fewer risks, and has a quicker recovery time. However, only 2.4% of men around the world have undergone the procedure<a href="#accordion">[4]</a>. In Pakistan, the prevalence is only 0.4%<a href="#accordion">[3]</a>.&nbsp;

The lack of knowledge regarding vasectomy plays a major role in its low acceptance. Moreover, a majority of men hold the view that it leads to impotency or reduces sex drive. However, a recent study has found that men in Pakistan are becoming more accepting of vasectomy and recognizing their role in sharing the responsibility of family planning<a href="#accordion">[5]</a>.&nbsp;

&nbsp;

While female birth control pills have been around for more than 50 years, researchers have only recently started looking into pills for men.&nbsp;

In 2019, a team of scientists conducted a clinical trial for a male birth control pill among 82 healthy men<a href="#accordion">[6]</a>.&nbsp;They administered dimethandrolone undecanoate (DMAU) in varying doses over a period of 28 days. The two active hormones, progestin, and modified testosterone, helped suppress levels of follicle-stimulating hormone (FSH) and luteinizing hormone (LH) in the study participants. Thus, suppressing sperm production without causing symptoms of low testosterone levels.&nbsp;

Although the study did not measure sperm count, the pill was found to be safe, even in high dosages. The team is currently conducting a longer trial to assess the drug&#39;s effect on sperm production and any long-term effects on the body.&nbsp;

However, men are often hesitant to use hormonal options due to the presence of adverse effects. Therefore, a team at the University of Minnesota have developed a non-hormonal male contraceptive pill. According to early results from a trial in mice, the contraceptive was 99% effective at preventing pregnancy<a href="#accordion">[7]</a>. Moreover, it had no obvious side effects in the mice.

Called YCT529, the non-hormonal pill works by targeting a protein called the retinoic acid receptor alpha (RAR-&alpha;). Through inhibition of this receptor, the retinoic acid in the body is unable to cause cell growth and differentiation, both of which contribute to sperm formation. As a result, the contraceptive helped cause reversible sterility in male mice.&nbsp;

Researchers now plan to conduct human trials for the compound. However, it is too early to tell whether the results in mice will also translate to humans.&nbsp;

&nbsp;

Conclusion

Pakistan faces several challenges to the acceptability of various family planning methods. These range from religious and cultural beliefs, low literacy levels, misconceptions about side effects, lack of knowledge regarding various options for men and women, and reluctance to adopt a method. According to a study from Karachi, fear of side effects was the most common reason for low prevalence among users<a href="#accordion">[8]</a>.&nbsp;

Several trials are currently underway to look for safe and effective male contraceptive pills. However, it can take years till a pill is available in store. Even then, its availability will not matter until there is a change in beliefs regarding family planning.

Despite the safety and availability of male contraception, men are reluctant to use the contraception methods due to various reasons ranging from misconceptions about side effects to a lack of knowledge about safe sexual practices.&nbsp;

Therefore, there is a need for campaigns aimed at educating men about the importance of adopting contraception methods.&nbsp;

&nbsp;

Key Points

<ul>
</ul>

<ul>
	<li>A growing population poses several challenges to a country&#39;s health and economic stability.</li>
	<li>Effective implementation of family planning measures can help control overpopulation.</li>
	<li>In Pakistan, use of contraceptives is highly stigmatized due to various reasons.</li>
	<li>While several advances have been made in the search for female contraception, men have only been presented with two options: condoms and vasectomy.</li>
	<li>Condoms are the most commonly used form of contraception; however, there is a need to raise awareness on its correct usage.</li>
	<li>Vasectomy is the most effective male contraceptive method, but the lack of education and widespread myths regarding its side effects has resulted in a low frequency (0.4%) of the procedure in Pakistan.</li>
	<li>Recently, scientists have begun testing various hormonal and non-hormonal compounds as male contraceptive pills.&nbsp;</li>
	<li>In 2019, a team of scientists tested varying doses of dimethandrolone undecanoate (DMAU) among healthy males and found it was well-tolerated. They are now planning long-term clinical trials to test the compound&#39;s effect on sperm production.</li>
	<li>Recently, a team at the University of Minnesota developed a non-hormonal contraceptive pill. They tested the compound in mice and found it to be 99% effective, with no observable side effects. The team now plans to conduct human trials of the compound.</li>
	<li>The development of male contraceptive pills can help men share some of the burden of contraception and pregnancy.</li>
</ul>

&nbsp;

[1] Statistics, P. B. o., 2021. Brief on Census - 2017. [Online].

[2] Meherali, S., Ali, A., Khaliq, A. & Lassi, Z. S., 2021. Prevalence and determinants of contraception use in Pakistan: trend analysis from the Pakistan Demographic and Health Surveys (PDHS) dataset from 1990 to 2018. F1000 Research, Volume 10.

[3] Shattuck, D., Perry, B., Packer, C. & Quee, D. C., 2016. A Review of 10 Years of Vasectomy Programming and Research in Low-Resource Settings. Global Health, Science and Practice, 4(4), pp. 647-660.

[4] Siddiqui, M. et al., 2020. Prevalence and Predictors of Contraception Usage in Karachi, Pakistan. Cureus, 12(10).

[5] Hatesh, H., Maheshwari, B. K., Shah, S. Q. & Kumar, D., 2020. Males’ perception and motivation for Vasectomy. Pakistan Journal of Public Health, 10(4).

[6] Thirumalai, A. et al., 2019. Effects of 28 Days of Oral Dimethandrolone Undecanoate in Healthy Men: A Prototype Male Pill. The Journal of Clinical Endocrinology & Metabolism, 104(2).

[7] Society, A. C., 2022. A non-hormonal pill could soon expand men’s birth control options. [Online].

[8] Bibi, S., Memon, A., Memon, Z. & Bibi, M., 2008. Contraceptive knowledge and practices in two districts of Sindh, Pakistan: A hospital based study. Journal of the Pakistan Medical Associatio, 58(5).

Nimrah H. Sattar

This article or video has been recorded by a subject / domain specialists with a proven track record of excellence in their area. 

How To Heal From Grief?

Grief is a natural reaction to any kind of loss. It&rsquo;s something we all experience, but the way it manifests itself varies from person to person. Some people are able to move on quickly, while others find it harder to heal. In this article I&rsquo;ll explain how the stages of grief work and give some tips on how you can help yourself or a loved one through their grieving process. 
&nbsp;

Tips to Heal From Grief

Denial is a defense mechanism. It&rsquo;s a way to protect yourself from the pain of loss, or at least postpone facing it. You may have heard of denial as something that happens during the grieving process, but this isn&rsquo;t quite accurate. Denial doesn&rsquo;t necessarily kick in once someone has died; it can also be an immediate coping mechanism for people who aren&rsquo;t yet ready to admit their loved one is gone.

Denial helps shield you from the <a href="https://merisehat.pk/article/natural-remedies-for-pain">pain</a> of grief by avoiding reality and hiding from feelings you&rsquo;d rather not experience (such as anger and sadness). 
&nbsp;

Anger is a natural and healthy reaction to loss. Anger can help you express your feelings, release negative emotions and show others that you are upset or hurt by what happened.

However, while it is normal to feel angry after the loss of someone or something close to you, there are some things that should be avoided when expressing anger:

Don&rsquo;t direct your anger at anyone else. You may have some pent-up frustrations with people associated with the loss (e.g., family members or friends), but directing your rage toward them will only make things worse for everyone involved.&nbsp;

Directing your anger inward instead by staying home from work or school can also be harmful because it could prevent you from accomplishing goals (such as getting back into college).&nbsp;

It&rsquo;s best not to let anger boil over into lashing out at others unnecessarily; instead, find other outlets for releasing negative emotion such as yoga classes or therapy sessions with a counsellor who specialises in grief counselling. 
&nbsp;

When you are bargaining, you are essentially trying to make the best of an intolerable situation. You may start thinking that there is something you could have done differently or something that will help save your loved one&rsquo;s life. You might even try to bargain with God or a higher power in order to get them back again.

For example, you might think, &ldquo;If only I had spent more time with my husband before he died!&rdquo;, &ldquo;If only I hadn&rsquo;t taken so long buying groceries!&rdquo; or &ldquo;If only I had remembered to call him earlier!&rdquo;&nbsp;

While these thoughts and feelings aren&rsquo;t necessarily accurate (the reality is that death or breakups happens when they happen), they can still be helpful if they allow you some peace of mind and perspective during this difficult time of grieving. 
&nbsp;

Bargaining can also manifest itself as guilt &mdash; for instance, if someone close dies from an illness but another person survives the same illness, there may be some sense that it should&rsquo;ve been the other way around, even though there&rsquo;s no real reason for this feeling beyond just being human (and overthinking things).&nbsp;

If this sounds like how you&rsquo;re feeling right now &mdash; like maybe there was something else r someone else who could&rsquo;ve helped prevent their death (for example) &mdash; it might be helpful for friends and family members who care about your well-being (or just want their own questions answered) not dismiss these thoughts or feelings outright by saying things like, &ldquo;It wasn&rsquo;t your fault&rdquo; or &ldquo;Of course everything would have been different if only...&rdquo;&nbsp;

Instead, they could take those questions seriously while acknowledging how hard they must be on whoever lost their loved ones without belittling them at all &mdash; because sometimes just recognising how painful it must feel helps us move forward without letting ourselves stay stuck in grief forever.&rdquo; 
&nbsp;

The final stage of grief is sadness and acceptance. The loss of someone leaves you feeling helpless. There will be times when you are too distracted by the world and work to think about it but at times, it is common to have a depressive episode and completely lose your pace or focus.&nbsp;

People who are unable to cope and accept tend to go into depression at this stage and numb themselves towards the outside world. The only way to avoid suffering from this illness is to deal with your loss and come to terms with it mentally. This requires your maximum input as your experience life without the person, the need for acceptance and doing things differently now. The only way is the way forward.&nbsp; 
&nbsp;

The stages of grief are not a checklist, nor are they rules to follow. They aren&rsquo;t even in the same order for everyone.

The five stages &mdash; denial, anger, bargaining, sadness and acceptance &mdash; are merely a general guide to help you understand what your loved one might be experiencing during their time of grieving. However, everyone grieves differently and no two people will go through all five stages at the same time or in the same way. It&rsquo;s important to remember that every person needs different kinds of support during times like these: some may need lots of love and affection as they work through their feelings; others will want space from others so they can take care of themselves first before reaching out for support later on. 
&nbsp;

The most important thing that needs to be acknowledged is that there is no shortcut to coping with grief. You cannot skip the stages. However, you can make it easy for yourself to handle your grief and speed up the process. Following are the steps that are age-old practices employed by people to help them cope:

<ul>
	<li>There are people around you who care about you, lean on them. Share your feelings with your friends and family. Hangout with them more to keep yourself distracted.</li>
	<li>Be acceptable for whatever support you are getting. Not many people know what to say or how to act around someone grieving, appreciate their efforts. They are doing it because they care.</li>
	<li>Religion has been a very strong catalyst for people struggling with grief. If you believe in one, resort to your faith. Praying can be very relaxing for the mind.</li>
	<li>A support group or therapy. Both allows you to talk about your experience, how it has affected you without getting a biased answer from the other side.&nbsp; 
	&nbsp;</li>
</ul>

Grief is a normal part of life and it can be hard to deal with. But remember, there are ways to cope with your feelings and move on from them. If you&rsquo;re struggling with grief or have lost someone close to you, remember that you&rsquo;re not alone. Reach out for help if needed, but don&rsquo;t forget that it may take time before things feel better again!

Iqra Mazhar

Is Keto Diet Safe For People With Diabetes?

In recent years, there has been a significant surge of interest in exploring different weight loss regimes, specifically following high-protein diets. One such high-protein diet is the <a href="https://www.merisehat.pk/article/what-is-the-ketogenic-diet">ketogenic diet</a>, or simply the keto diet, which is a diet rich in proteins and fats. Initially, the ketogenic diet was primarily proposed to reduce the frequency of epileptic seizures in children, but it has since gained popularity for weight loss. While there is evidence of short-term results with the keto diet, the verdict on its long-term benefits is still inconclusive. However, unlike other low-carb diets that center around protein, the ketogenic diet focuses mainly on fat.

&nbsp;

Understanding The Advantages Of Keto Diet In Diabetes

In 2008, researchers conducted a 24-week study to determine the effects of a low-carbohydrate diet on people with diabetes type 2 and obesity. The study concluded that people who followed the ketogenic diet saw a significant improvement in the glycemic index compared to those following a low-glycemic diet<a href="#accordion">[1]</a>. Patients following a ketogenic diet also saw a significant reduction in the use of medication. Another study conducted in 2013 reported that participants on a ketogenic diet showed improvements in their blood sugar levels and were also able to taper off insulin requirements compared to other diets<a href="#accordion">[2]</a>. Similarly, the ketogenic diet outperformed a low-fat diabetes diet, and the participants showed better weight loss and control of HbA1c in another study<a href="#accordion">[3]</a>.&nbsp;

Although it may seem unlikely that a high-fat diet focuses on weight loss, the ketogenic diet is different and can potentially change the way your body stores and uses energy. The ketogenic diet is high in fat and low in carbs. Instead of sugar, your body converts fat into energy in the keto diet. As mentioned earlier, the diet was initially considered for the treatment of epilepsy in the 1920s, but the effects were later also studied for type 2 diabetes<a href="#accordion">[4]</a>. The ketogenic diet improves blood sugar levels and reduces the need for insulin. However, as with any other diet, there are risks associated with the keto diet as well. Thus, it is important to discuss the possibility of starting the keto diet with your doctor before making any drastic changes to your current diet plan.&nbsp;

&nbsp;

Diabetes is of 2 types: diabetes type 1 and diabetes type 2.&nbsp;

<ul>
	<li>In type 1 diabetes, the body is incapable of producing insulin, and the patient has to rely on medication for life. This condition is less common and is typically diagnosed during childhood.&nbsp;</li>
	<li>In diabetes type 2, which has a more common presentation of the two, the body either does not produce enough insulin to meet the body&rsquo;s needs, or the insulin produced does not work effectively in lowering blood glucose levels.&nbsp;</li>
	<li>Pre-diabetic people have higher than normal blood sugar levels&nbsp;and are at a higher risk of developing diabetes type 2 if they do not take precautionary lifestyle and dietary measures.&nbsp;</li>
	<li>Gestational diabetes is described as diabetes that develops when you are pregnant. This type of diabetes generally resolves after giving birth. Though, it places you at a higher risk of developing type 2 diabetes.&nbsp;</li>
</ul>

&nbsp;

<h4>"Good diabetes control can increase your heart rate variability. Head on over to the <a href="https://www.merisehat.pk/page/sehat-scan/" target="_blank">sehat scan</a> and get your reading now!"</h4><h4> </h4>

Unlike other low-carb diets, the keto diet aims to force your body to use a different type of fuel. And instead of relying on sugar that comes from carbohydrates, for example, fruits, vegetables, legumes, and grains, the diet relies on ketone bodies. This is a type of fuel that the liver produces using stored fat. While burning fat sounds like an ideal way to lose weight, getting the liver to make ketone bodies is a tricky process.&nbsp;

<ul>
	<li>The diet requires that you restrict your intake of carbohydrates to 20 to 25 grams per day.&nbsp;</li>
	<li>Typically, reaching the state of ketosis takes a few days.&nbsp;</li>
	<li>If your diet is too high in protein, it can also interfere with ketosis.&nbsp;</li>
</ul>

In many cases, people with type 2 diabetes are overweight and a high-fat diet may seem unhelpful. The goal of a ketogenic diet is to train the body into using fat instead of carbohydrates or glucose. On the ketogenic diet, most of the energy comes from fat and only a small amount comes from carbohydrates. However, there are some ground rules. A diet high in fats doesn&rsquo;t mean that you should load up on saturated fats. It is recommended that your diet is rich in heart-healthy fats to maintain overall health. Some healthy foods that you can eat on a ketogenic diet include:&nbsp;

<ul>
	<li>Eggs&nbsp;</li>
	<li>Fish&nbsp;</li>
	<li>Cottage cheese&nbsp;</li>
	<li>Avocado&nbsp;</li>
	<li>Olives&nbsp;</li>
	<li>Nuts&nbsp;</li>
	<li>Seeds</li>
	<li>Olive oil&nbsp;</li>
	<li>Nut butter&nbsp;</li>
</ul>

&nbsp;

Foods To Be Eaten In Moderation

<ul>
	<li>Berries -&nbsp;1 cup or less</li>
	<li>Plain, Greek yogurt -&nbsp;1 cup or less</li>
	<li>Cottage cheese -&nbsp;1/2 cup or less</li>
	<li>Nuts and peanuts -&nbsp;1&ndash;2 ounces&nbsp;or 30&ndash;60 grams</li>
	<li>Flaxseeds or chia seeds -&nbsp;2 tablespoons</li>
	<li>Dark chocolate (at least 85% cocoa) -&nbsp;30 grams or less</li>
</ul>

&nbsp;

Foods To Avoid

<ul>
	<li>Bread&nbsp;</li>
	<li>Pasta&nbsp;</li>
	<li>Cereal&nbsp;</li>
	<li>Corn and other grains&nbsp;</li>
	<li>Potatoes, sweet potatoes</li>
	<li>Milk&nbsp;</li>
	<li>Fruits excluding berries&nbsp;</li>
	<li>Juices, sodas, and sweetened teas</li>
	<li>Desserts, candies, ice cream, and other baked goods</li>
</ul>

&nbsp;

When you eat carbs, your body&rsquo;s digestive system breaks down the carbohydrates and turns them into sugars that enter your bloodstream. The more sugar there is in your bloodstream, the more insulin your body needs to break down the sugar for energy. Insulin signals the cells to use the sugar for energy and energy storage. Moreover, the pancreas releases glucagon when the cells of your body begin to use the blood sugar. The two hormones, insulin, and glucagon work together to ensure that you have enough energy. If you have diabetes, then this means that your body is not using the insulin properly or cannot make or is not making enough insulin.

Hence, for people with diabetes type 2, it is recommended to control carbohydrate intake because it turns to sugar, and having it in large quantities can cause spikes in blood sugar levels. However, the ketogenic diet has the potential to decrease the levels of blood glucose. Your doctor will determine the number of carbs you should have based on your needs, current BMI, etc. Studies have shown that some people experience reduced blood sugar by switching to a diet high in fat.

Diabetes affects about 10 percent of the American population. Whereas in Pakistan, 17.1% of the population is estimated to be living with diabetes. This makes a total of 19 million adults in Pakistan who are at risk of the life-threatening complications of diabetes making it a pertinent public health issue<a href="#accordion">[5]</a>.&nbsp;

&nbsp;

Other than the standard keto diet, there are 3 other variations of the diet: the cyclical ketogenic diet, the targeted ketogenic diet, and the very low-carb diet.&nbsp;

<ul>
	<li>On the cyclical ketogenic diet, you can eat 100 to 150 grams of clean carbs once or twice a week.</li>
	<li>With the targeted ketogenic diet, you can follow the same rules as a regular keto diet but the time you eat carbs is fixed. It is suggested to consume carbs before or after a workout.&nbsp;</li>
	<li>The very low-carb diet, as the name suggests, allows you to eat very small quantities of carbs, high fat, and moderate protein. However, compared to the standard keto diet that allows only 50 grams of carbs a day, this diet allows you to eat 100 to 150 grams of carbs daily. However, this may not help you reach a state of ketosis.&nbsp;</li>
</ul>

&nbsp;

After reading this article, you may be wondering how a diet that focuses on fat makes it good for you. Especially, considering the fact that many people with diabetes also have obesity. While this question is completely reasonable, the keto diet is about redefining our understanding of fat. For years, people have focused on low-fat foods, milk, and yogurt thinking that fats are the root cause of all our health concerns, including obesity. However, the situation is more complex.&nbsp;

A recent study indicates that focusing on reducing total fats leads to harmful habits such as increased consumption of refined carbohydrates and added sugars. Moreover, it also leads to avoiding nutrient-dense foods, such as nuts, seeds, vegetable oils, and avocados. We all need fat to keep ourselves healthy and only recently researchers have started shifting from anti-fat foods to encouraging high-fat foods. In simpler words, fat is an important source of energy. It helps our bodies absorb essential vitamins and minerals, helps our muscles move, and enables blood to clot. Thus, science shows that a diet high in fat can be healthy, whereas eating low-fat diets can actually be harmful in the long run because of overconsumption of carbs and processed foods.&nbsp;

&nbsp;

<ul>
	<li>It is important that you speak with your doctor before you start a keto diet. Speaking with your doctor is a rule that should be followed before starting any diet.&nbsp;</li>
	<li>A keto diet can be helpful for diabetics who want to lose weight and lessen the need for medications. However, for others, it might even make diabetes worse. The diet isn&rsquo;t a magic weight loss pill, and there is currently limited information on the long-term effects of a keto diet.&nbsp;</li>
	<li>Moreover, be cautious when transitioning from the keto diet to adding carbs back to your diet. Sudden high consumption of carbs can cause your blood sugar levels to spike, and cause you to gain weight.</li>
</ul>

&nbsp;

[1] Westman, E.C., Yancy, W.S., Mavropoulos, J.C., Marquart, M. and McDuffie, J.R., 2008. The effect of a low-carbohydrate, ketogenic diet versus a low-glycemic index diet on glycemic control in type 2 diabetes mellitus. Nutrition & metabolism, 5(1), pp.1-9.

[2] Paoli, A., Rubini, A., Volek, J.S. and Grimaldi, K.A., 2013. Beyond weight loss: a review of the therapeutic uses of very-low-carbohydrate (ketogenic) diets. European journal of clinical nutrition, 67(8), pp.789-796.

[3] Saslow, L.R., Mason, A.E., Kim, S., Goldman, V., Ploutz-Snyder, R., Bayandorian, H., Daubenmier, J., Hecht, F.M. and Moskowitz, J.T., 2017. An online intervention comparing a very low-carbohydrate ketogenic diet and lifestyle recommendations versus a plate method diet in overweight individuals with type 2 diabetes: a randomized controlled trial. Journal of medical Internet research, 19(2), p.e5806.

[4] Meira, I.A., Romão, T.T., do Prado, H.P., Krüger, L.T., Pires, M.E.P. and da Conceição, P.O., 2019. Ketogenic diet and epilepsy: What we know so far, Front. Neurosci-Switz.(13), 5.

[5] Akhtar, S., Nasir, J.A., Abbas, T. and Sarwar, A., 2019. Diabetes in Pakistan: a systematic review and meta-analysis. Pakistan journal of medical sciences, 35(4), p.1173.Akhtar, S., Nasir, J.A., Abbas, T. and Sarwar, A., 2019. Diabetes in Pakistan: a systematic review and meta-analysis. Pakistan journal of medical sciences, 35(4), p.1173.

Staff Writer

Your Body After Giving Birth

Post-pregnancy or postpartum is a crucial period. It&rsquo;s also known as the fourth trimester. This is when your body is <a href="https://merisehat.pk/disease/chronic-fatigue-syndrome">recovering from the fatigue</a> of pregnancy.

During pregnancy, the body goes through a lot of changes to accommodate your baby. The body eventually goes back to normal, but this can take a while.&nbsp;

Continue reading to find out more about some common changes that take place in your body, after you give birth. 
&nbsp;

Post-pregnancy or postpartum

During pregnancy, hair growth gets better and the texture of hair gets thicker. This is all thanks to the hormones that are active during that phase. However, post-delivery, this phase settles down and enters into a resting phase for about one to five months. Normal hair growth pattern usually returns six to 15 months after delivery. 
&nbsp;

Shoe surprise is pretty common after pregnancy. It is not just the midsection that gets affected. After a baby is born, your shoe size changes permanently. That is because during pregnancy women gain an average of 25-35 pounds which puts extra pressure on the feet. This pressure flattens out the arch in your feet which is the reason for extra inches in your feet. 
&nbsp;

Belly bulge is common after pregnancy. A lot of women expect that the belly will return to its normal size after birth. The upper portion of the uterus is at the level of your navel. Post-pregnancy belly returns to its normal size in about six to eight weeks. A good diet and exercise are the key to toning down your belly. Workouts focused on the core can show quick results. 
&nbsp;

A common expectation of most women is that the breast size will go up after giving birth and breastfeeding. Once you stop breastfeeding, however, the size goes back to what it was. In fact, in some cases, it goes a cup down. The main reason for the size to increase is that fat tissue in the breast is replaced by functional tissue. Once a woman stops breastfeeding, functional tissue depletes as it is no longer needed. 
&nbsp;

The first six months of the post-partum period are the recovery period. No matter how easy or smooth your pregnancy is, your body has gone through a lot of stress and trauma. It needs time to recuperate. Remember that every mom goes through a different experience and symptoms; hence, the recovery rate also changes.

Most of the symptoms, like sore nipples, backache, pain in the thigh area, etc., continue for more than a week. Other symptoms, like leaky breasts, can linger on for months.

In vaginal delivery, recovery timelines vary depending upon the kind of delivery. The soreness and perennial pain go away in three weeks. However, in the case of vaginal tear or episiotomy (incision made on the vagina to ease the delivery process), recovery can take up to six weeks.

If you have been delivered through c-section, it will take around three to four days in the hospital to recover. In about four to six weeks you can recover completely. 
&nbsp;

For the first 24 hours after birth, ice your perineum region. Sit in warm baths for 20 minutes to ease pain and avoid long periods of standing or sitting.

Ease pain and aches by taking hot showers and massages.

Do your Kegel exercises, to strengthen your pelvic muscles.

Keep up with your doctor appointments. It will help you stay on track. Your doctor can also notify you about your emotional well-being and help you with your new journey.

Ask your doctor regarding your workout plan. They can guide you about how and when can you exercise. It is a good idea to start by walking into your house and then gradually into the neighbourhood. Walking helps in recovery by improving blood circulation and toning muscles. 
&nbsp;

Your diet after pregnancy shouldn&rsquo;t be very different from what you eat during pregnancy. Avoid processed foods. Focus on eating whole grains, high fibre foods, Omega-3 fatty acid-rich food, nuts, and fish.&nbsp;

<ul>
	<li>Lean Meat: Milk, cheese, and yogurt are all crucial components of a breastfeeding mother&#39;s diet. Your infant receives calcium from breastmilk for the formation of bones. Consume foods high in calcium to replenish the calcium your body has lost. Include three cups of dairy in your diet each day.</li>
	<li>Pulses: These are a good source of protein and fibre. You can cook them with different seasonings to make them tasty and easy to eat. Pulses also prevent fat from accumulating in the body.</li>
	<li>Vegetables:&nbsp;These are low-calorie healthy food. They are rich in antioxidants and aid in losing weight. Spinach and broccoli are good sources of Vitamin A which is healthy for you and your baby.</li>
</ul>

Once the baby is born, you can resume most of the food you avoided during pregnancy. Include nutrient-rich foods like legumes, proteins, fibre, citrus fruits, and vegetables. Don&rsquo;t forget to keep yourself hydrated. You may consult a dietician and your doctor in designing your diet plan.

Ismail Munir

How Do I Boost My Iron Levels?

Iron is an essential mineral that your body uses to make hemoglobin. Iron is also an essential mineral for growth and development. There are two types of iron in food: animal-derived and plant-derived. While there is enough iron available in our food sources, it can also be taken as a supplement.

Understanding Ways To Treat Iron Deficiency Anemia

Studies have shown that the average amount of iron is 8.7 milligrams per day for men and 14.8 milligrams per day for women. The requirement for iron in vegetarians and vegans is 1.8 times more than in people who eat meat.&nbsp;

&nbsp;

You need iron to function properly. A lack of iron in your diet will lead to iron deficiency. Iron plays an important role in different bodily functions; it is an essential nutrient needed to form hemoglobin and carry oxygen in your blood to organs and tissues. This is important for optimal heart health, immune function, and respiratory functions.

&nbsp;

<a href="https://www.merisehat.pk/disease/anemia">Anemia</a> occurs when the body does not have enough red blood cells to carry oxygen to the body&rsquo;s organs and tissues. There are different types of anemia, but iron-deficiency anemia is the most common type of anemia in developing countries. According to the World Health Organization, 1.62 billion people are estimated to be affected by anemia worldwide.&nbsp;

&nbsp;

Low levels of iron can further lead to iron deficiency anemia. The symptoms of anemia include:&nbsp;

<ul>
	<li>Fatigue&nbsp;</li>
	<li>Weakness&nbsp;</li>
	<li>Pale and yellow skin&nbsp;</li>
	<li>Shortness of breath&nbsp;</li>
	<li>Lightheadedness&nbsp;</li>
	<li>Chest pain&nbsp;</li>
	<li>Cold hands and feet&nbsp;</li>
	<li>Headaches&nbsp;</li>
</ul>

&nbsp;

There are some types of anemia that are inherited and cannot be prevented, for example, sickle cell anemia, hemolytic anemia, and aplastic anemia.&nbsp;

However, anemia caused because of iron deficiency, vitamin B12, and vitamin B9 deficiency, can be prevented by eating well. This includes eating foods that provide enough iron and vitamins, in addition to vitamin C food sources, because it helps with the absorption of iron. Studies have also shown that drinking enough water helps keep hemoglobin levels up.

Moreover, daily iron supplementation may increase hemoglobin levels, and decrease the risk of anemia in infants, school-aged children, and pregnant and non-pregnant women. Foods fortified with iron and improving overall diet also have benefits in reducing the risk of developing iron-deficiency anemia.

There are some types of anemia that are short-term and mild. However, others can affect you throughout your life. There are several ways to manage anemia, including:

<ul>
	<li><a href="https://www.merisehat.pk/article/anemia-best-meals-for-boosting-iron">A healthy, well-balanced diet</a></li>
	<li>Stay hydrated</li>
	<li>Regular exercise</li>
	<li>Avoid&nbsp;exposure to chemicals that trigger anemia</li>
	<li>Visiting the dentist regularly because anemia increases the risk of tooth decay and gum disease</li>
	<li>Keep track of your symptoms and talk to your doctor about any changing symptoms</li>
</ul>

&nbsp;

If you have anemia, it is important to make good food choices. For example, avoid junk foods because it means adding calories to your diet without getting any essential nutrients. In addition, some foods impair the absorption of iron. Therefore, it is important to make the right food choices.

Here are some foods you should avoid:&nbsp;

<ul>
	<li>Coffee, tea, and other tannin-containing products, such as some spices</li>
	<li>Egg whites</li>
	<li>Fiber, but not all of it because some iron supplements may cause constipation</li>
	<li>Soy protein</li>
	<li>You should not be taking calcium with iron supplements because it impairs its absorption</li>
</ul>

&nbsp;

Here are some foods you should eat:

<ul>
	<li>Whether you eat meat or not, you should generally eat iron-rich foods, such as lentils, spinach, and pistachios.&nbsp;</li>
	<li>You can also get protein from different kinds of meat, like lean beef and turkey. There are some iron-fortified foods also available for vegans and vegetarians.&nbsp;</li>
	<li>It is also important to incorporate citrus fruits, berries, and other vitamin C-containing foods such as peppers and tomatoes in your diet to improve iron consumption.</li>
</ul>

&nbsp;

Consult with a healthcare provider to help with your iron intake, and do what works best for you.&nbsp;

&nbsp;

AL SHIFA CLINIC KARACHI

Syed Intisar Hussain

I'm A Heart Patient - Are Oral Contraceptive Pills Safe For Me?

Dialogues concerning sexuality, reproductive health, contraception, and sexually transmitted illnesses (STIs) are limited worldwide. One of the biggest reasons for these decreased dialogues is the fear of spreading indecency among the younger population. Unfortunately, the failure to discuss these topics has had a great impact on public health and led to an increase in the prevalence of abortions and STIs, such as HIV, in the country. The current abortion rate in Pakistan stands at 50 per 1,000 women aged 15-49 years; one of the highest in the world<a href="#accordion">[1]</a>.

The lack of education on such topics also means that both men and women are generally unaware of reproductive health issues. Moreover, the lack of knowledge and awareness of contraception increases the risk of teenage pregnancies, unplanned pregnancies, and unsafe abortions. Thus, resulting in poor health outcomes for both mother and child.&nbsp;

As per estimates, only 35% of married women of reproductive age in Pakistan, use some form of contraception<a href="#accordion">[1]</a>. Condoms are the most common method of contraception, followed by pills and withdrawal methods<a href="#accordion">[2]</a>. Although the use of oral contraceptive pills has increased over the years, there is still poor knowledge of the drug&#39;s effects. This lack of awareness can lead to the misuse of these medications, leading to adverse effects in at-risk individuals for e.g. women with existing cardiovascular disease (CVD) are often at a higher risk of these side effects.&nbsp;

Across Europe and the world, CVD accounts for a majority of deaths in women, while contrastingly in Pakistan, men and women are at an equal risk of coronary artery disease<a href="#accordion">[3]</a>. Due to the high prevalence, it is important that women are aware of the risks associated with using oral contraceptives with pre-existing heart conditions.&nbsp;

&nbsp;

Oral contraceptive pills (OCPs) are often the most popular option among users. They range in effectiveness from 89-99%. They are of two types: combined estrogen-progesterone and the progesterone-only pill. While both are a form of birth control, they can also be used for treating medical conditions such as endometriosis, <a href="https://www.merisehat.pk/disease/polycystic-ovary-syndrome-pcos">polycystic ovary syndrome (PCOS)</a>, and other menstrual disorders.

&nbsp;

1. Combined Oral Contraceptive (COC) - These contain a combination of the hormones, estrogen and progesterone that help prevent ovulation; thus, preventing pregnancy. The pills may contain the same dose of the hormones (monophasic), or varying weekly doses of both or either component (multiphasic). A single packet typically contains 21 pills that are taken over a 28-day period and 7 placebo pills for menstruating days. Although they have a generally safe profile, nausea, vomiting, weight gain, fluid retention, and bloating are common side effects of drug use. However, in some cases, they can also cause other severe side effects, such as:

<ul>
	<li>Increased risk of blood clots</li>
	<li>Hypertension</li>
	<li>Increased risk of stroke and myocardial infarction</li>
</ul>

These drugs are usually contraindicated in smokers and those older than 35 years of age.

&nbsp;

2. Progestin-Only Pill (POP) - Unlike COCs, these only contain a synthetic progestin. The lack of estrogen reduces the risk of adverse side effects such as thromboembolism, stroke, or cardiovascular diseases. However, it can cause breast tenderness, heavy bleeding, mood swings, anxiety, and weight gain among users. POPs are typically prescribed to women who cannot have COCs or estrogen-containing compounds.

3. Emergency Contraception Pill (ECP) - Also called the morning-after pill, it may contain higher doses of the hormone estrogen, progestin, or both. They help delay ovulation or fertilization and are commonly used following unprotected sexual intercourse or a condom breakage. However, they are not meant for regular birth control.

Understanding The Correct OCP For Heart Patients

Doctors usually prescribe contraceptive methods based on a patient&#39;s health and preference. As per current guidelines, doctors must weigh the risks and benefits for each patient prior to selection of contraception.&nbsp;

Women with cardiac disease are not only at a higher risk of maternal death during pregnancy, but also complications such as stillbirth, preterm delivery, or intrauterine growth restriction. Due to the high incidence of unplanned pregnancies, it is important that these women are counselled on effective and safe contraceptive options. Moreover, they are more likely to develop adverse effects to oral contraceptives. Therefore, caution is practiced when prescribing them pills or other contraceptive options.&nbsp;

OCP use among smokers older than 35 years of age is associated with a significantly higher risk of cardiovascular side effects such as deep vein thrombosis. As per estimates, such women have a ten-fold increased risk of myocardial infarction<a href="#accordion">[4]</a>. Therefore, women older than 35 are typically assessed for risk factors such as CVD, hypertension, diabetes, and kidney disease prior to use.&nbsp;

Compared to non-users, combined oral contraceptive users have a much higher risk of myocardial infarction and stroke. Moreover, women with pre-existing hypertension have a 9-16% chance of exacerbation when using OCPs<a href="#accordion">[4]</a>.

&nbsp;

Ideally, contraception is meant to be safe, effective, and protect against sexually transmitted infections. However, no one method can guarantee all three.&nbsp;

&nbsp;

<ul>
	<li>Barrier Methods - These methods are all safe for cardiac patients; however, they have a high failure rate. Therefore, should not be prescribed in cardiac patients to avoid pregnancies.&nbsp;</li>
	<li>Combined Oral Contraceptive Pill - Due to the estrogen component, COCs are associated with multiple risks to women with cardiovascular disease. Therefore, women with CVD risk factors and existing heart disease are not prescribed COCs.</li>
	<li>Progestin-Only Pill - In women with an increased risk of thromboembolism, POPs are usually the preferred option. They are generally considered safe for all CVD patients. However, they can interfere with warfarin metabolism and decrease its therapeutic role. Therefore, careful monitoring of INR is required in such patients.&nbsp;</li>
	<li>Depo-Provera Injection - These injectable contraceptives last 12 weeks and are very effective. However, discontinuation causes a rapid return to fertility. Moreover, it can put patients at risk of ischemic heart disease.</li>
	<li>Mirena Intra-uterine Device (IUD) - Although extremely effective, its insertion can induce a vasovagal reaction in 5% of patients, and lead to a cardiovascular collapse<a href="#accordion">[5]</a>. It is contraindicated in women with pulmonary vascular disease and those at high risk of endocarditis.&nbsp;</li>
	<li>Hormonal Implants - Subcutaneous progestogen implants are highly effective and work as a form of sterilization. Moreover, they have no cardiac contraindications.</li>
</ul>

&nbsp;

According to the Pakistan Demographic and Health Survey (PDHS), the current contraceptive prevalence rate (CPR) is only 34%<a href="#accordion">[6]</a>. There are several barriers to contraceptive use among Pakistani women of reproductive age. These range from religious factors, and lack of access to low socioeconomic status. Although oral contraceptive pills are commonly used as a form of birth control, there are a lot of misconceptions regarding infertility and weight gain that further limits their use.&nbsp;

The lack of dialogue around sexual and reproductive health has left a huge majority of Pakistani women unaware of their health condition and the best health options for their bodies. Moreover, in Pakistan, there is a high prevalence of cardiovascular diseases among women. This puts them at an even higher risk of pregnancy complications; thus, emphasizing the need for better contraceptive methods for these individuals.&nbsp;

Currently, progestin-only pills and hormonal implants are considered the most effective and safe contraceptive options for women with CVD. However, newer formulations of oral contraceptive pills with lower overall risk are being developed. These are expected to help lower blood pressure in users and prevent weight gain.&nbsp;

For now, the best method is to weigh all benefits and risks associated with a particular method before use. Moreover, women should be counseled on the various options available to them and the adverse effects associated with these options.&nbsp;

&nbsp;

<ul>
</ul>

<ul>
	<li>In Pakistan, only 35% of married women of reproductive age practice some form of contraception.</li>
	<li>The stigma surrounding sexual health has placed several barriers for women to access safe contraception methods in the country.</li>
	<li>The lack of awareness of various contraceptive methods has led to an increase in abortions and sexually transmitted infections among the younger population.</li>
	<li>Due to their overall safety profile, easy availability, and high effectiveness oral contraceptive pills are mostly prescribed to women. The two common oral contraceptives include the progestin-only pill and the combined oral pill.</li>
	<li>Despite the overall safety profile, OCPs can increase the risk of several side effects, especially among women with a cardiovascular disorder.</li>
	<li>Women with existing cardiac disease are at a higher risk of maternal death during pregnancy, and complications such as preterm birth, growth restriction, and stillbirth. Therefore, there is a greater need for safe and effective contraceptive methods for these high-risk individuals.&nbsp;</li>
	<li>COCs increase the risk of stroke, thromboembolism, and myocardial infarctions. Therefore, they are contraindicated in smokers above 35 years of age and women with CVD risk factors or existing cardiac disease.</li>
	<li>POPs and hormonal implants are generally considered safe and effective in cardiac patients.</li>
	<li>Newer contraceptive pills are being developed that are expected to have a lower overall risk for cardiac patients.</li>
</ul>

&nbsp;

[1] Siddiqui, M. et al., 2020. Prevalence and Predictors of Contraception Usage in Karachi, Pakistan. Cureus, 12(10).

[2] Mushtaq, K., Ashraf, M. & Thaver, I. H., 2020. Who are the women wishing to opt for contraception?. Journal of the Pakistan Medical Association, 70(12).

[3] Jafar, T. H., Jafary, F. H., Jessani, S. & Chaturvedi, N., 2005. Heart disease epidemic in Pakistan: women and men at equal risk. American Heart Journal.

[4] Cooper, D. B., Patel, P. & Mahdy, H., 2022. Oral Contraceptive Pills. s.l.:StatPearls Publishing.

[5] Kaminski, P., Szpotanska-Sikorska, M. & Wielgos, M., 2013. Cardiovascular risk and the use of oral contraceptives. Neuro Endicrinology Letters.

[6] Hudsmith, L. & Thorne, S., 2007. Contraception in women with cardiac disease. Women's Health, 3(6), pp. 711-717.

[7] Meherali, S., Ali, A., Khaliq, A. & Lassi, Z. S., 2021. Prevalence and determinants of contraception use in Pakistan: trend analysis from the Pakistan Demographic and Health Surveys (PDHS) dataset from 1990 to 2018. F1000 Research, Volume 10.

To Meat Or Not To Meat?

Research over the years has shown that a strict vegetarian diet excluding all animal fats can lead to vitamin B12 deficiency. Thus, increasing the risk of developing anemia. Newer research also suggests that a more lenient diet puts people at risk of developing <a href="https://www.merisehat.pk/disease/anemia">anemia </a>and heart disease.

There are various reasons behind people giving up eating meat and animal products (milk, cheese, and eggs). However, doing so might increase their risk of anemia, which is a potentially serious condition in which the body does not make enough red blood cells. For vegetarians, vitamin B12 deficiency anemia is typically caused because of eliminating meat from their diet. Similarly, for vegans, giving up all animal products including dairy, eggs, and even honey increases the risk of developing anemia.&nbsp; 
&nbsp;

Understanding Ways To Diversify Iron Sources In Vegetarian And Vegan Diets

A lack of vitamin B12 in your diet can cause pernicious anemia. The body needs vitamin B12 from foods such as meat, poultry, fish and eggs to make red blood cells. Pernicious anemia is a rare type of anemia in which the body is unable to absorb vitamin B12. The vitamin is only available in meat and animal products. While vegetarians who eat dairy and eggs are getting enough vitamin B12 through these sources, vegans must find other ways to include it in their diets, for example, through vitamin B12 supplements. 
&nbsp;

Vitamin B12 deficiency can boost the levels of homocysteine in the blood, a common amino acid that is associated with a higher risk of heart disease. Studies also suggest that the level of this amino acid can over time cause blockages in arteries and lead to heart disease or stroke. Vitamin B12, unlike B vitamins, is not found in any plant derived foods and fortified cereals. However, many types of meat and fish are abundant in vitamin B12. Thus, making it difficult for people following a strict vegetarian diet to get the necessary amount of vitamin B12. The answer is to eat a well-balanced diet and get the needed B12 from other sources, such as vitamin B12 supplementation, to prevent anemia.&nbsp; 
&nbsp;

Look for foods fortified with vitamin B12. Read the nutrition label on packaged foods. Some examples of processed foods that contain vitamin B12 are:&nbsp;

<ul>
	<li>Fortified rice&nbsp;</li>
	<li>Soy milk&nbsp;</li>
	<li>Grain products and cereal&nbsp;</li>
	<li>Meat substitutes</li>
	<li>Dietary supplements containing B complex&nbsp;</li>
	<li>Nutritional yeast&nbsp; 
	&nbsp;</li>
</ul>

Whether you are on a vegan or vegetarian diet, you need to create a healthy and balanced diet that includes enough vitamin B12 to prevent anemia. While fortified cereals are a good choice because of their good bioavailability, meaning it doesn&rsquo;t need to break down before the body absorbs them, vegetarians should consume the following foods on a regular basis:&nbsp;

<ul>
	<li>8 ounces (oz) of yogurt contains about 1.1 mcg of vitamin B12</li>
	<li>1 cup of low-fat milk can provide 1.2 mcg of vitamin B12</li>
	<li>1 oz of Swiss cheese can contain 0.95 mcg of vitamin B12</li>
	<li>1 large egg contains 0.6 mcg of vitamin B12</li>
</ul>

Nutritional yeast is also popular among vegetarians because of its rich, cheesy, and nutty flavor. The yeast can either be added to cooked meals or sprinkled on foods and snacks.

<div>
Since vegans avoid all animal-derived products, they may rely on vitamin B12 fortified breakfast cereals and nutritional yeast, as an alternative source of vitamin B12. For example, fortified non-dairy milk, meat substitutes, breakfast cereals, nutritional yeast, and vegan spreads. However, it is essential to read the labels of the foods as some may not be fortified in vitamin B12.&nbsp;

For those who are deficient in vitamin B12, supplemental vitamins in the form of capsules may be required.&nbsp; 
&nbsp;
</div>

<h4>"All that meat is great for your anemia. But can it also be affecting the heart rate? Get your reading with our <a href="https://www.merisehat.pk/page/sehat-scan/" target="_blank">sehat scan</a>!" </h4>

If you decide on taking a dietary supplement, there are some ground rules. A healthy body does not readily absorb all the vitamin B12 in a supplement. Food supplements should never be used as a substitute for a balanced diet and healthy lifestyle. Therefore, it is essential that you talk to your doctor or nutritionist to know the amount of vitamin B12 supplement that is right for you.&nbsp; 
&nbsp;

<ul>
	<li>Vegetarians and vegans need to take steps to make sure that they are including an adequate amount of vitamin B12 in their diet. Not maintaining proper levels of vitamin B12 increases the risk of developing anemia.</li>
	<li>Similarly, since there are no plant-derived foods that contain vitamin B12, it is essential to look into alternative sources, for example, fortified foods and vitamin B12 supplements.</li>
	<li>Speak with a healthcare provider for advice on how much you need to take and where to find sources of vitamin B12.</li>
</ul>

[1] Pawlak, R., Parrott, S.J., Raj, S., Cullum-Dugan, D. and Lucus, D., 2013. How prevalent is vitamin B12 deficiency among vegetarians? Nutrition reviews, 71(2), pp.110-117.

[2] Walsh, S., Appleby, P., Baron, L., Dallas-Chapman, G., Davis, B. and Harris, W., 2001. What every vegan should know about vitamin B12. Birmingham: Vegan Society.

[3] Watanabe, F., Yabuta, Y., Bito, T. and Teng, F., 2014. Vitamin B12-containing plant food sources for vegetarians. Nutrients, 6(5), pp.1861-1873.

What Anti-Vaxxers Get Wrong About the Polio Vaccine

Polio is a thing of the past, right? You don&rsquo;t see it much in the news anymore and it&rsquo;s not something we really have to worry about. Well, anti-vaxxers would like you to think that this is true. But it isn&rsquo;t. Polio still exists today and, if you&rsquo;re not vaccinated against it, you could get polio or spread it to someone else who might die from it. It&rsquo;s important for everyone not just parents with children to know how vaccines work and why they&rsquo;re safe.&nbsp;

<div>&nbsp;</div>

Anti-Vaxxers  About  Polio Vaccine

The anti-vaccine movement is growing increasingly popular, despite the fact that many of its arguments are based on erroneous historical facts. Here are just a few:

<ul>
	<li>Vaccines aren&rsquo;t effective</li>
	<li>They do not cause infertility</li>
	<li>No, your government is not injecting you with nanochips to track you</li>
	<li><a href="https://merisehat.pk/disease/autism" target="_blank">They cause autism</a></li>
	<li>They&rsquo;re not necessary because polio hasn&rsquo;t been around for decades now</li>
</ul>

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It&rsquo;s important to remember that, as we speak, polio is still a problem in many countries. In fact, the World Health Organisation still refers to it as an &ldquo;endemic&rdquo; disease. Since 1988 , when the UN certified that polio had been eradicated in every country on Earth, there have been only 21 cases of wild poliovirus found globally: 16 in Somalia and five in Pakistan (the last case on this list occurred just this past September).

But while anti-vaxxers are right that vaccines can&rsquo;t prevent all disease outbreaks, they&rsquo;re wrong about why we need them at all. Because the truth is this: vaccines aren&rsquo;t just useful for preventing one infectious illness, they&rsquo;re also useful for preventing other diseases from spreading by stopping people from getting sick with them too. That&rsquo;s why some people think of vaccines as a sort of &ldquo;immunity insurance&rdquo; against outbreaks rather than just something you need when you actually start showing symptoms of an illness like measles or mumps (which are both very contagious). 
&nbsp;

Thimerosal is a preservative that prevents the growth of harmful bacteria in vaccines. It has been used since the 1930s, and thimerosal-free vaccines have been available for several years. There is absolutely no scientific evidence that links thimerosal to any health problems. In fact, all credible studies have shown just the opposite. In fact, it&rsquo;s safe to use as a preservative in food items, too!

Although many anti-vaxxers will try to tell you otherwise, thimerosal isn&rsquo;t dangerous or toxic at all. It&rsquo;s just an additive used by doctors and manufacturers alike in order to make sure our vaccinations remain effective while they&#39;re being stored and transported around the world!

<div>&nbsp;</div>

It&rsquo;s important to note that the polio vaccine does not cause cancer. Nor does it cause autism, any other brain defect, autoimmune disease, or death. The idea that vaccines are some kind of hoax like climate change denialism or flat-Earth-ism is a conspiracy theory with no basis in reality. We know this because there is plenty of evidence to prove that vaccines work and are safe for children (and adults). 
&nbsp;

Vaccines Are Safe

Polio Vaccine Is Important, Polio Vaccine Is Safe: You may be thinking that anti-vaxxers are a bunch of crazy people, but there&rsquo;s actually a lot to like about them. They&rsquo;re confident in their beliefs and not afraid to stand up for what they believe in. They&rsquo;re also highly educated, which makes them more likely than others to be able to articulate their beliefs effectively.

What anti-vaxxers get wrong about polio vaccines is that it&rsquo;s not just one type of vaccine; it&#39;s two types: oral polio vaccine (OPV) and inactivated polio vaccine (IPV). The OPV is commonly used in Pakistan due to its ease of administration. The oral polio vaccine also eradicates the need for the presence of a healthcare professional and highly sterile equipment. This has allowed Pakistan to conduct vaccinations on a mass level. Whereas the IPV on the other hand, requires the presence of proper healthcare workers, sterile equipment and multiple doses. IPV is far more effective than OPV but since we are on a mission to completely eradicate polio from the face of earth, whatever vaccine you can get your hands on, works.&nbsp;

Many countries stopped using OPVs long ago because they discovered that although it could prevent children from getting paralysed by wild versions of poliovirus, these viruses would still circulate around the community throughout childhood &mdash; which meant other kids might get infected anyway! The risk/benefit ratio was no longer proportionate. 
&nbsp;

I hope that this has helped to clear up some of the misconceptions about polio vaccines. It is important to note that the polio vaccine is not a one-size-fits-all approach, and there are many factors involved in deciding whether or not you should receive it. However, these arguments do not mean that anti-vaxxers are wrong about everything: they are right in their belief that public health decisions should be made on the basis of science rather than fear mongering.&nbsp;

You&rsquo;re pregnant! Congratulations! And now, naturally, there must be a lot of questions in your mind about what&#39;s going to happen to your body and how it&rsquo;s going to change.&nbsp;

It&rsquo;s an experience unique to each woman. But the statement should not make you throw caution to the wind. From what the doctors say to what&rsquo;s been tried and tested by pregnant women around the world, there&rsquo;s some good, genuine advice to help you. Especially, the general precautions related to your diet <a href="https://merisehat.pk/article/lets-talk-about-sex-during-pregnancy">during pregnancy</a> that you should adhere to religiously.&nbsp;&nbsp;

So, let&rsquo;s dig in! 
&nbsp;

Diet during Pregnency

You probably know how it feels when you&rsquo;re &ldquo;eating for two&rdquo;, instead of one.&nbsp;

To begin with, during your pregnancy, you only need about 300 extra calories per day.

There is a good chance that you have been told that you need to eat for two. Because of this advice, some expectant mothers worry about whether they have to eat twice as much as they normally would.

The truth is that while your body does require 300 extra calories per day during pregnancy, the equivalent of a slice of bread or a small apple, you should still be eating balanced meals like fruits, vegetables and whole grains along with lean protein sources like chicken or fish.&nbsp;

Staying hydrated is also important. A majority of doctors recommend drinking at least eight glasses (64 ounces) of water per day. 
&nbsp;

This is your time to eat for one.

This can be a challenging concept to grasp if you&rsquo;re used to going all out when it comes to food. Especially, if you&rsquo;re pregnant with your second or third child. It&rsquo;s important to remember that while your body is making a lot of changes during this time, it is still adapting to its new role and not yet fully prepared for what&rsquo;s ahead.

The best thing you can do right now is follow these guidelines:

<ul>
	<li>Eat healthy food. Choose fresh fruits and vegetables over processed ones whenever possible.&nbsp;</li>
	<li>If they are not organic, wash them thoroughly with soap and water before eating them raw (or cook them). Some foods are more likely than others to contain harmful bacteria like listeria. These include unpasteurised milk products (raw milk), undercooked chicken and meat products as well as raw shellfish such as oysters and mussels.</li>
	<li>Eat a variety of foods from each food group every day. Healthy eating during pregnancy is about getting the right amount of nutrients in the right balance for you and your baby</li>
	<li>Eat plenty of fruits and vegetables (at least five servings per day)</li>
	<li>Choose whole grains like brown rice, oats and whole wheat bread, instead of refined grains such as white rice and white bread. Whole grains provide fibre which supports colon health and regular bowel movements so say bye-bye to constipation. Some examples include barley, quinoa, bulgur (cracked wheat), oats, and popcorn without butter added.</li>
	<li>If you have any concerns about consuming gluten during pregnancy, contact your healthcare provider first before making changes to the food choices that you normally make at home. They may be able to recommend alternatives that in their opinion would work better with your unique situation.</li>
	<li>Eat lean meat, poultry fish eggs at least two times per week. This means trimming excess fat from meats before cooking them as well as choosing low-fat options like ground turkey breast instead of ground beef. 
	&nbsp;</li>
</ul>

If you&rsquo;re pregnant, you probably know that there&rsquo;s a difference between your first and third trimester cravings. Most women experience nausea in the first trimester (which is why it&rsquo;s called morning sickness), but by the second or third trimesters many cravings come along. These are often specific foods that provide nutrients like iron and protein.&nbsp;

By this point in the pregnancy, some women may have an aversion to certain foods they once loved, especially if they&rsquo;re in their second or third trimester. But others continue to eat pretty much anything they want throughout their pregnancies.

The first trimester is also when doctors generally recommend eating for one. Many women get morning sickness early on during this time and aren&rsquo;t able to keep much food down at all! 
&nbsp;

It&rsquo;s important not to deprive yourself of nutrition during this time because not eating enough could lead to low blood sugar levels that affect your baby as well as risk complications like preterm labour later on in pregnancy

In fact, the physical stress on your body during pregnancy could be as great as or greater than that experienced during any other time in your life. This is because you are making more blood than normal.

Your blood volume increases by 60-80 percent. This means that you need to make more oxygen-carrying red blood cells and platelets (cells in the blood that help with clotting) during pregnancy. Your heart has to work harder to pump this extra volume around your body and through the placenta, which carries oxygen and nutrients from mother to fetus through their bloodstreams an amazing feat of engineering! That&rsquo;s why it&rsquo;s called &ldquo;double trouble&rdquo;. 
&nbsp;

We&rsquo;re not saying that supplements are a panacea, but they could be an important part of a well-rounded pregnancy diet.&nbsp;

<ul>
	<li>Be sure to talk to your doctor about supplements before taking any.</li>
	<li>Supplements are most effective and safest when they&rsquo;re taken in conjunction with a healthy diet and lifestyle.&nbsp;</li>
</ul>

If you follow these guidelines, you&rsquo;ll be on your way toward having the healthiest baby possible.

&nbsp;

Fast food is not healthy, and it&rsquo;s certainly not good for your developing baby. You&rsquo;ll be consuming something that&rsquo;s high in calories and low in nutrition. It tends to be fried, over-processed, or processed with artificial ingredients.&nbsp;

A diet rich in fast food leads to weight gain and increases your risk of heart disease, diabetes, stroke and certain cancers.

To be fair, though, the occasional burger or burrito wouldn&rsquo;t harm you or your baby. However, that won&rsquo;t be the case if all you eat most days is a burger or burrito. So, if you think about it, an eating a salad occasionally, like once a week, won&#39;t hurt either! 
&nbsp;

Eating well is the key to good health and a long life. If you&rsquo;re eating for two, remember that it doesn&rsquo;t mean eating twice as much food. In fact, it means eating only about 300 extra calories each day.&nbsp;