Madeeha Syed

To maintain optimum body weight, we should actually provide correct nutrition to our bodies rather than deny it.

Five Myths About Weight Loss

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What Is The Ketogenic Diet?

Overview

We know that there are three macronutrients in our diet that provide all the energy and nutrition we need to sustain our body&rsquo;s normal structures and functions. In a perfect world where everyone opted for a balanced diet, we would consume adequate quantities of these macronutrients. However, in reality a standard diet consists mostly of carbs (50 percent) with some fats (35 percent) and proteins (15 percent) thrown in.&nbsp; 
&nbsp;

Ketogenic diet

Keto is a low-carb, gluten-free and a low-to-moderate protein diet. It is very similar to the Paleo diet and Atkins diet.&nbsp;

In order to understand how a ketogenic diet works, we first need to establish how our body normally produces energy. Glucose is the main source of energy and is obtained mainly from carbs. Normally, a ketogenic diet comprises 75 percent fat, 20 percent of protein and only five percent of carbohydrates. But there are several renditions so you are allowed to switch these percentages around based on your daily needs.&nbsp;

Now where does your body generate the energy it needs if you eliminate carbs to such an extreme extent? It turns out that the body switches to metabolising fat for this purpose and conducts this via a process called &lsquo;Ketosis&rsquo;.&nbsp; 
&nbsp;

Fats are broken down into ketones and these ketones provide all the energy you need. This is where the name &lsquo;ketogenic&rsquo; is derived from &mdash; Keto for &lsquo;ketones&rsquo; and genic for &lsquo;producing&rsquo;. This primes your body to burn fat as a primary source of energy, which is why it&rsquo;s so well-known and widely used for <a href="https://merisehat.pk/article/five-myths-about-weight-loss">losing weight</a>.&nbsp;&nbsp;

It&rsquo;s important to note that our body is a living organism and there&rsquo;s no switch that can make it perform a different activity within a matter of minutes or even days. It will take your body a few days to adjust to employing fats as your primary energy resource and during that time you will feel all the negative impacts of having low glucose stores, including decreased focus, brain fog, nausea, vomiting, and irritability. This phase is commonly known as the &lsquo;keto flu&rsquo;.&nbsp; 
&nbsp;

Let&rsquo;s see some of the claims the proponents of the ketogenic diet make and how much weight they actually hold:&nbsp;

For Weight Loss: This is the main application of the keto diet and is a huge part of the current trend. Once your body gets used to burning fat for your daily needs it will also go ahead and burn your local fat stores. This helps shave off those few extra inches in a very short amount of time.&nbsp;

Another reason why this works for weight loss is the high fat content of your diet leads to satiety. Basically, this means you don&rsquo;t feel any cravings and also feel fuller for longer periods.&nbsp;

However, it is not good for long-term weight loss, and once you go back to your usual eating habits, you will quickly gain those extra pounds back. Putting your body through this kind of metabolic stress is also not advisable because it&rsquo;s very hard to sustain over a long period of time for many people.&nbsp; 
&nbsp;

For The Brain: Anecdotal evidence shows people feel sharper and more focused. Then again, some of them have also reported experiencing brain fog while observing a ketogenic diet.&nbsp; There is no clinical evidence for either of these claims. 
&nbsp;

This is actually well researched.&nbsp;

<ul>
	<li>Ketogenic diet works well for people who are either prediabetic or have Type 2 diabetes. This makes sense because people whose insulin doesn&rsquo;t work are constantly at risk of having high blood sugar levels. And a lifestyle of eating processed food doesn&rsquo;t help either. These are therefore classified as foods with a high glycaemic index &ndash; which essentially means that they raise your blood sugar very fast.&nbsp;</li>
	<li>People on keto achieve better insulin sensitivity over time. Simply because the diet gives the body less glucose to work with, enabling it to function optimally.&nbsp;</li>
	<li>It&rsquo;s also been found effective for heart disease, Alzheimer&rsquo;s, Parkinson&rsquo;s, certain sleep disorders, polycystic ovarian syndrome (PCOS), and metabolic syndrome.&nbsp;</li>
	<li>Cutting out carbs also helps control acne breakouts.&nbsp; 
	&nbsp;</li>
</ul>

For Childhood Epilepsy: This is what the ketogenic diet originally gained popularity for back in the 1920s and 1930s. Before new anticonvulsant medications and therapies were developed, children with epilepsy would fast in order to control their seizures. Keto replaced this successfully. One in seven kids benefit from a ketogenic diet.&nbsp;

Evidence-based science has established that children with refractory epileptic seizures experience seizures less frequently if they opt for keto.&nbsp; 
&nbsp;

For Cancers: Ketogenic diet has shown some promise when it comes to treating certain types of cancers, but the research is so far inconclusive.&nbsp; 
&nbsp;

There are some disadvantages to keto, including:

<ul>
	<li>Nutritional deficiencies&nbsp;</li>
	<li>Formation of kidney stones</li>
	<li>Frequent urination</li>
	<li>Increased thirst</li>
	<li>High levels of LDL (bad cholesterol)</li>
	<li>Increased incidence of certain cancers</li>
	<li>Constipation</li>
	<li>Indigestion</li>
	<li>Inconvenient and unsustainable over a long period of time</li>
	<li>Low blood sugar (hence the mental fog during the initial days)</li>
	<li>Tougher workouts (since you don&rsquo;t have glucose readily available for energy anymore)&nbsp;</li>
	<li>Keto flu: weakness, irritability, headaches, bad breath, and fatigue</li>
	<li>Dry mouth&nbsp; 
	&nbsp;</li>
</ul>

Bottom Line

The ketogenic diet is great for short-term weight loss if you are otherwise healthy. But, it&rsquo;s very tough to successfully carry out since it requires a drastic switch from a normal diet. Lack of conclusive research and knowledge means we don&rsquo;t know everything that might go wrong (or right!) on this diet. Safe to say, anyone planning to go on this diet needs to exercise a certain level of personal discretion.&nbsp;

Dr. Safia Mehmood

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>

&nbsp;

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;

Umna Salah

Online Consultation

Ismail Munir

Common Menstrual Myths In The Society

Introduction

If you belong to the latter group, then chances are that once you got over the dying part and gathered the courage to speak to a family member, they informed you of your body&#39;s natural function and likely a few additional pieces of information regarding menses. As per results from a recent study, only 28% of women in Karachi, Pakistan had adequate menstrual health knowledge prior to their first <a href="https://www.merisehat.pk/article/natural-remedies-to-help-regulate-your-periods">period</a>.<a href="#accordion">[1]</a> 
&nbsp;

Understanding Myths Associated With Menstruation

Almost 50% of Pakistan&#39;s population is composed of females.<a href="#accordion">[2]</a>&nbsp;Despite the high prevalence of females, awareness of women&#39;s health issues is limited. There is an unfortunate stigmatization of menstruation in low-income countries, for e.g., sanitary napkins are often sold in brown paper bags and menstrual concerns are not a widely discussed topic. This stigmatization of menstruation and lack of awareness leads to the spread of incorrect practices and knowledge among women. This could be a source of concern as these practices can later have harmful implications on the lives of women and girls.&nbsp;

Every woman has been likely exposed to several myths and superstitions pertaining to periods. The following article will help to shed light on some of these myths.&nbsp; 
&nbsp;

<ul dir="ltr">
	<li>
	<h5>No Baths Allowed</h5>
	</li>
</ul>

A multi-center study conducted on menstrual hygiene practices among Pakistani girls reported that 39% of girls avoid bathing during menstruation.<a href="#accordion">[3]</a>The most common reason for avoiding taking a bath is that it can cause an irregular flow.<a href="#accordion">[1]</a>&nbsp;However, such practices can affect one&#39;s hygiene and predispose girls to reproductive tract infections. Moreover, research has pointed out that there is no link between irregular flow and bathing during menstruation. Instead, warm baths are often encouraged to help relieve painful menstrual cramps in women.<a href="#accordion">[4]</a>&nbsp; 
&nbsp;

<ul dir="ltr">
	<li>
	<h5>Don&#39;t Eat The Pickle</h5>
	</li>
</ul>

Cold water, pickles, eggs, and milk are just some of the food items various cultures advise against consuming during menstruation. Approximately 50% of Pakistani girls report avoiding &#39;cold foods&#39;(e.g., yogurt, ice cream) as they fear that it will stop their periods and increase the chances of blood clots.<a href="#accordion">[3]</a>&nbsp;Similarly, &#39; hot foods&#39; (e.g., liver, eggs, dry fruits) are also avoided for fear of menstrual irregularities. However, there is a lack of scientific evidence linking cold or hot food to menstrual cycle abnormalities.&nbsp; 
&nbsp;

<ul dir="ltr">
	<li>
	<h5>Avoid Exercising</h5>
	</li>
</ul>

Among the general population in Karachi, approximately 53% of women restrict physical activity during menstruation to avoid heavy periods.<a href="#accordion">[1]</a>&nbsp;Walking, sitting, and lifting weights are some of the commonly avoided physical activities among girls and women. However, research shows that aerobic exercise can be beneficial for painful menstrual cramps.<a href="#accordion">[5]</a> 
&nbsp;

Conclusion

In many low- and middle-income countries, periods are considered impure and a process of dirty or impure blood leaving the body. This is likely due to a lack of education regarding reproductive health. Young adolescent girls are often too shy or scared to discuss menstrual issues with their mothers. Moreover, a majority of adult women are also not aware of the physiology of menstruation or good hygiene practices. As a result, there is a high prevalence of misinformation among girls and women. Almost 70% of Pakistani university-going girls believe the source of bleeding in menstruation to be the vagina instead of the uterus.<a href="#accordion">[3]</a>

Therefore, there is a need for the introduction of regular menstrual education awareness programs in schools and universities. Furthermore, primary care physicians should be aware of the common myths and misconceptions regarding menstrual health in a population. Health education campaigns on a community level can ultimately help destigmatize reproductive health issues.&nbsp; 
&nbsp;

Key Points

<ul>
</ul>

<ul>
	<li>Menstruation is a natural phenomenon in a woman&#39;s life that is often stigmatized in various cultures.</li>
	<li>A lack of awareness has led to the development of various myths and practices regarding menstruation. The most common of which is avoidance of taking a bath during periods, not eating certain foods, and avoiding exercise.</li>
	<li>Community-based health education programs can help destigmatize menstruation and propagate correct information and practices among girls and women.</li>
</ul>

[1] Ali, S. A. et al., 2020. Perceptions, Practices, and Challenges Regarding Menstrual Hygiene Among Women in Karachi, Pakistan: A Comparison Between General Population and Healthcare Workers. Cureus, 12(8).

[2] Pakistan Bureau of Statistics, n.d. Census 2017. [Online].

[3] Mansoor, H. et al., 2020. Menstrual knowledge and practices of Pakistani girls: A multicenter, cross-sectional study. Heliyon, 6(1).

[4] Jo, J. & Lee, S. H., 2018. Heat therapy for primary dysmenorrhea: A systematic review and meta-analysis of its effects on pain relief and quality of life. Scientific Reports, Volume 8.

[5] Dehnavi, Z. M., Jafarnejad, F. & Kamali, Z., 2018. The Effect of aerobic exercise on primary dysmenorrhea: A clinical trial study. Journal of Education and Health Promotion, 7(3).

Nimrah H. Sattar

The Dos And Don’ts Of Keto

Keto or <a href="https://merisehat.pk/article/what-is-the-ketogenic-diet">ketogenic diet</a> has myriads of benefits. It is notorious as a shortcut to quick weight loss. Almost everyone has tried it at some point and they have also reaped its benefits. On the other hand, some people found that it was not their cup of tea; the experience left a bad taste in their mouth.&nbsp;

Even though it&rsquo;s not a new trend, there is plenty of misinformation around, which makes it harder to assess what you should actually do. The following tips would help you adapt a keto lifestyle while minimising its adverse effects.&nbsp; 
&nbsp;

Dos and Don’ts of Keto

Keto eliminates the need to count calories. As your body adjusts to using fat as the primary fuel, make sure to follow these rules:

<ul>
	<li>Fewer Carbs: You are allowed to consume only 5-10 percent of carbs. This is required for your body to switch to ketosis instead of using glucose as a primary source of energy.&nbsp;</li>
	<li>Just Enough Protein: When you consume an ample amount of protein, it&rsquo;s a signal for your body to convert it into glucose as well. This is exactly what we want to avoid while trying to elicit the keto state. Therefore, limit your protein intake to only 10-20 percent of your entire diet.&nbsp;</li>
	<li>Lots Of Fats: Your diet should primarily consist of fats (70-80 percent) to make the whole thing work.&nbsp;</li>
</ul>

There are free keto calculators available online that can help you measure exactly how much of these nutrients you consume daily.&nbsp; 
&nbsp;

To make it easier for you, you can eat:

<ul>
	<li>Meat: Devour red meat, sausages, chicken, and turkey. In other words, grass-fed meat.</li>
	<li>Seafood: This includes fatty fish like salmon, mackerel, trout, and oysters besides tuna, sardines, shrimps, and crab. See, keto&rsquo;s not about starving yourself.</li>
	<li>Non-Starchy Vegetables: Feed your belly asparagus, tomatoes, basil, spinach, broccoli, bell peppers, onions, celery, zucchini, lettuce, cauliflower, kale, broccoli, cabbage, jalapenos, cucumbers, eggplant, and Brussels sprouts.&nbsp;</li>
	<li>Cheese: Some good ol&rsquo; cheddar, goat cream, feta, parmesan, mozzarella, blue, brie provolone, and string cheese for flavour.</li>
	<li>Herbs: Don&rsquo;t forget to throw in thyme, rosemary, sage, mint, oregano, dill, parsley, cilantro, and basil.</li>
	<li>Seeds: Munch on flaxseed, chia seeds, and pumpkin seeds.</li>
	<li>Eggs, butter, peanut butter, and cream&nbsp;</li>
	<li>Plain Greek Yogurt, full fat yogurt&nbsp;</li>
	<li>Alternate Between Butter, Ghee, And Oil (extra virgin olive oil or avocado oil) for cooking or making creamy sauces.</li>
	<li>Nuts: Most of them are okay to eat. For example, almonds, pine nuts and walnuts. Avoid pistachios since they have a higher carb content.&nbsp;</li>
	<li>Plenty Of Liquid: Water, coffee or tea to go with your meals or otherwise. Use full fat cream or milk in your tea and coffee. Plant based milk such as soy, coconut, and almond milk are also keto-friendly.&nbsp; 
	&nbsp;</li>
</ul>

&nbsp;Consider the following as strictly off limits

<ul>
	<li>Starchy Foods like bread, rice, pasta, and tortillas. Even healthy whole grains are too high in carbs.&nbsp;</li>
	<li>Sugary Foods, like candy, cakes, brownies, cookies, donuts, ice cream, sweetened yogurt, and breakfast cereals. Natural sugars present in fruits are off limit as well, except for some berries (strawberries, blackberries, and raspberries) in small amounts.&nbsp;&nbsp;</li>
	<li>Starchy Vegetables, such as potatoes, sweet potatoes, parsnips, carrots, corn, and beets.&nbsp;</li>
	<li>Fruit Juices, soda, smoothies, ice creams, and sweet alcoholic drinks.&nbsp;</li>
	<li>Peas, kidney beans, lentils, and chickpeas.&nbsp;</li>
	<li>Sauces like BBQ sauce, honey mustard, teriyaki, and ketchup.</li>
	<li>Processed Vegetable Oils and mayonnaise.&nbsp;</li>
	<li>Sugar, sweeteners, and syrups in your beverages, tea, or coffee.&nbsp;</li>
</ul>

Note: Don&rsquo;t go overboard with adding too much fat as that means your body perpetually burns the fat you consume instead of the fat you had stored previously. 
&nbsp;

While observing a keto diet, the best snack is no snack. But it&rsquo;s understandable how those cravings are hard to resist sometimes. Some of the easiest Keto friendly snack options could be:&nbsp;&nbsp;

<ul>
	<li>Hard boiled eggs</li>
	<li>Slice of cheese</li>
	<li>Cold cuts (salami, prosciutto etc.)&nbsp;</li>
	<li>Avocados</li>
	<li>Olives</li>
	<li>A handful of nuts</li>
	<li>Fresh vegetables with creamy dressings such as ranch&nbsp;</li>
	<li>Berries with whipped cream</li>
	<li>Dark chocolate (the higher the cocoa percentage, the less sugar the chocolate contains)</li>
	<li>Keto friendly snack bars from the market&nbsp; 
	&nbsp;</li>
</ul>

Fatigue, brain fog, irritability, nausea, and headaches are just some of the symptoms you might feel while switching to keto. This is dubbed as the &lsquo;keto flu&rsquo;. 
&nbsp;

In order to combat the keto flu, you could:&nbsp;

<ul>
	<li>Increase your water intake and make sure you are adequately hydrated throughout the day. Also, prefer vegetables with a high water content such as cucumbers, celery, tomatoes, zucchini, etc.&nbsp;</li>
	<li>Increase your sodium, potassium and magnesium intake by adding extra salt to meals. And make sure to take mineral supplements. It would help deal with other micronutrient deficiencies you might suffer in a keto diet.&nbsp; 
	&nbsp;</li>
</ul>

<ul>
	<li>Get in the habit of reading food labels. Educate yourself on your nutrient intake and what each food contains and which might sneak into your diet. This will also help you recognise if a meal is keto-friendly or not. For example, when you are eating out and the restaurant doesn&rsquo;t mention it on their menu.&nbsp;</li>
	<li>Minimise the adverse effects of starting a keto diet by starting a low-carb diet at first before going full keto.&nbsp;</li>
	<li>When exercising during your diet, take creatine supplements to boost your performance. Caffeine helps, too. You can also take Whey protein supplements for augmenting your protein intake.&nbsp;</li>
	<li>Avoid keto if you are on any antidiabetic medication as this can cause diabetic ketoacidosis, which is a serious complication.&nbsp;</li>
	<li>Proceed slowly and with caution. Monitor your bad cholesterol levels if you are not over the keto flu within the first week consult your doctor.</li>
	<li>Plan ahead to avoid a high-carb meal. Even one high-carb meal can disrupt the body&rsquo;s metabolism switch towards ketosis.&nbsp;</li>
	<li>The biggest complaint is that it&rsquo;s not sustainable. Who has time to meticulously prepare for meals when you have work and family to look after? If you fall in this category, sign up for meal delivery services to deliver keto friendly meals to your doorstep.&nbsp;&nbsp;</li>
	<li>Use sugar free gum to combat halitosis (bad breath) which you will inevitably suffer from.&nbsp;</li>
</ul>

Armed with all of this information, you should be able to follow a ketogenic diet properly.&nbsp;

AL SHIFA CLINIC KARACHI

Syed Intisar Hussain

Debunking Myths About COVID-19 & Anti-Malarial Drugs

A pandemic is often a cause of panic, and rightly so, as things are often difficult to make sense of at the start or even in the middle. The looming threat of a deadly illness can lead to irrational fears among people. As expected, the <a href="https://www.merisehat.pk/disease/covid-19">COVID-19 pandemic</a> also gave birth to some strange fears across the world. These ranged from thinking 5G networks cause <a href="https://www.merisehat.pk/disease/covid-19">COVID-19</a> to drinking disinfectants as a preventive measure. There has also been a lot of misinformation about coronavirus treatments. While some have touted eating garlic to be lifesaving, others have stuck to drinking camel urine.

According to the World Health Organization (WHO), as of 19th May, the world has reported more than 520 million COVID-19 cases and 6 million deaths<a href="#accordion">[1]</a>. Although the first COVID-19 case emerged in November 2019, Pakistan did not report a case until February 2020<a href="#accordion">[2]</a>. However, the fear of an outbreak had already gripped the country way before the detection of the first case. Soon enough, people were sharing various home remedies and myths about the novel coronavirus. Moreover, the pandemic also led to the prescription and use of unauthorized drugs for the treatment of COVID-19. These included antibiotics and antimalarial drugs, among others.&nbsp;

&nbsp;

Understanding The Dangers Of Unsubstantiated COVID Treatments

At the start of the pandemic, scientists conducted multiple studies in hopes to find a cure for the novel coronavirus. They investigated existing drugs such as ivermectin, anti-viral drugs, and antimalarial medications chloroquine and hydroxychloroquine as experimental therapies for COVID-19. Short on time, many doctors also began prescribing these drugs to COVID patients, without any conclusive scientific evidence of their effectiveness.&nbsp;

To make matters worse, the then U.S President, Donald J. Trump admitted to taking the antimalarial hydroxychloroquine as a preventive strategy. Many of Trump&#39;s advisers and doctors supported his decision. The statement was backed by a French trial that had demonstrated a decrease in viral load after just 6 days of treatment with hydroxychloroquine<a href="#accordion">[3]</a>. However, many experts labeled the results from the small-scale study anecdotal and insufficient.&nbsp;

As a result of the drug demonstrating anti-viral effects in experimental models, the U.S. Food and Drug Administration (FDA) further granted both chloroquine and hydroxychloroquine emergency use authorization early in the pandemic. And researchers around the world began conducting large clinical trials to evaluate the drug&#39;s safety and effectiveness against COVID-19. However, many of the trials had to be stopped in the middle due to the drug&#39;s adverse effects on participants. Moreover, many failed to show a significant benefit compared to a placebo group. In a study done among rheumatoid arthritis patients, researchers found a similar incidence of COVID-19 among both groups: 0.89% in hydroxychloroquine users and 0.62% in non-users<a href="#accordion">[4]</a>. Thus, showing that the antimalarial drug does not provide protection against the novel coronavirus.&nbsp;

As a result of the negative results in multiple trials, the FDA later revoked its emergency use authorization for chloroquine and hydroxychloroquine<a href="#accordion">[5]</a>. According to the regulatory body, the benefits no longer outweighed the risks associated with drug use. Thus, resulting in a reversal of the decision.&nbsp;

Despite the evidence, several countries such as Brazil, Pakistan, and India continued administering the antimalarial. Pakistan even banned exports of the drugs to have more available for the treatment of COVID-19. However, the increased prescription and self-medication of the drug resulted in a shortage for those that truly needed them.

&nbsp;

Both chloroquine and hydroxychloroquine are used for the treatment of malaria. Chloroquine works by preventing the malarial parasite from multiplying within the red blood cells. There was a time when it was hailed as a highly effective drug and was widely used to treat malaria. However, over the years, malaria strains have developed resistance to the drug. Therefore, in areas with chloroquine resistance, doctors usually prescribe other antimalarials such as mefloquine or atovaquone.&nbsp;&nbsp;

Hydroxychloroquine is a safer and more soluble metabolite of chloroquine. Both are used for treating or preventing malaria. However, due to their immunosuppressive effects, they are also FDA-approved for treating autoimmune conditions, such as lupus and rheumatoid arthritis.

The most common side effects of using antimalarial drugs are headache, nausea, diarrhea, itchiness, hives, double vision, anxiety, and hair discoloration. Although both are fairly safe, long-term use of these drugs can lead to retinal toxicity, heart toxicity, and even death. Moreover, in COVID-19 patients, antimalarial drugs have been shown to exert severe cardiac side effects. These include disturbances in the heart&#39;s rhythm and, in certain cases, sudden death.&nbsp;

&nbsp;

Chloroquine and hydroxychloroquine are not the only antimalarial drugs that people have used to treat COVID-19. Many have also experimented with the Artemisia plant in the form of herbal teas or supplements to cure the viral disease.&nbsp;

One of the commonly used antimalarial drugs, artemisinin-based combination therapies (ACTs) are produced from extracts of the Artemisia plant. However, no study has found the drug or the plant to exert a positive effect against COVID-19. The WHO has also found no evidence of the plant&#39;s effectiveness against the novel coronavirus.&nbsp;

One antimalarial drug, atovaquone, has shown anti-viral activity in a lab study. Atovaquone is an effective antimalarial drug used in combination with proguanil. Sold under the brand name Malarone, the medication is highly effective in treating chloroquine-resistant malaria. Moreover, atovaquone is also used to treat toxoplasmosis and mild pneumocystis pneumonia infections. Due to the drug&#39;s anti-viral effects against viruses such as Zika and dengue, scientists conducted a laboratory study investigating its effect on infected human lung cells.

The study not only demonstrated the drug&#39;s ability to prevent coronavirus replication in cells but also its effectiveness against various coronavirus variants<a href="#accordion">[6]</a>. Based on these results, researchers are now conducting clinical trials of atovaquone for COVID-19 treatment.

&nbsp;

The start of the COVID-19 pandemic led to scientists scrambling for a cure or breakthrough in the treatment of the novel coronavirus. Since developing new treatments can take a lot of time, researchers turned to drug repurposing. This involves investigating new uses for existing drugs. The strategy is often employed for its time and cost-effectiveness, especially in times like the pandemic.&nbsp;

During the COVID-19 pandemic, researchers repurposed various drugs such as remdesivir, ivermectin, steroids, antidepressants, vitamin C and D, Zinc, and even immunosuppressants. While this led to several safe and effective coronavirus treatments, it also helped establish which drugs don&#39;t work.&nbsp;

Antimalarial drugs, such as chloroquine and hydroxychloroquine, are among the treatment options that did not show a favorable profile against COVID-19. Although, at the start of the pandemic, many countries adopted the drugs without any validated scientific evidence. Antimalarial use was further exacerbated when the then U.S. President Donald J. Trump reported using hydroxychloroquine as a precautionary step. Despite the lack of evidence, people rushed to get their hands on a prescription for the medicine. Moreover, the increased demand led to pharmaceutical companies putting all their resources into increasing drug production. This diverted attention from the production of important pandemic supplies, like face masks, ventilators, and gowns. Experts have criticized people for hoarding these medications and causing shortages for those suffering from malaria, lupus, or rheumatoid arthritis. Moreover, recent trials and studies have proven hydroxychloroquine and chloroquine as ineffective against COVID-19. Many have also related severe side effects to the drug&#39;s use.&nbsp;

Therefore, the WHO urges people to not self-medicate with these or any drugs that have not been backed by any health regulatory body. Moreover, physicians are advised to refrain from administering such treatments to COVID-19 patients.

In conclusion, prevention is the best strategy against COVID-19. Washing hands, maintaining social distancing, and wearing a mask continue to be the best precautionary steps for preventing COVID-19.

&nbsp;

Key points

<ul></ul><ul><li style="line-height: 1.2; margin-top: 0pt; margin-bottom: 0pt;">The COVID-19 pandemic began in November of 2019 and has infected more than 520 million people across the world.&nbsp;</li><li style="line-height: 1.2; margin-top: 0pt; margin-bottom: 0pt;">The pandemic gave rise to several myths and theories about the spread and treatment of COVID-19. From eating garlic to drinking disinfectants, people have done some rather outlandish things to protect themselves.&nbsp;</li><li style="line-height: 1.2; margin-top: 0pt; margin-bottom: 0pt;">One such myth surrounded the use of antimalarial drugs to treat COVID-19. Early in the pandemic, several scientists also supported the theory, citing successful result from small scale in-vitro studies.&nbsp;</li><li style="line-height: 1.2; margin-top: 0pt; margin-bottom: 0pt;">As the use of chloroquine and hydroxychloroquine increased worldwide, it also led to the development of severe side effects among COVID-19 patients.</li><li style="line-height: 1.2; margin-top: 0pt; margin-bottom: 0pt;">Multiple trials also investigated the effects of these drugs on the novel coronavirus. However, none could demonstrate any benefits. Moreover, many clinical trials ended halfway due to the occurrence of severe cardiac side effects among trial patients taking hydroxychloroquine.</li><li style="line-height: 1.2; margin-top: 0pt; margin-bottom: 0pt;">Other than chloroquine and hydroxychloroquine, people have also explored the Artemisia plant for its anti-viral properties. The plant's extracts are used for making artemisinin-based combination therapies (ACTs) for malaria. However, studies have not found the plant to have anti-COVID activity.</li><li style="line-height: 1.2; margin-top: 0pt; margin-bottom: 0pt;">So far, atovaquone is the only antimalarial that has shown anti-viral properties against COVID-infected lung cells. The laboratory study is now being converted into a clinical trial to help scientists better understand the drug's mechanism of action and safety.&nbsp;</li></ul>

[1] WHO, 2022. WHO Coronavirus (COVID-19) Dashboard. [Online].

[2] Habib, M. & Abbas, M., 2021. Facing the Threat of COVID-19 in Pakistan: A Nation’s Dilemma. Value in Health Regional Issues, Volume 24, pp. 90-95.

[3] Gautret, P. et al., 2020. Hydroxychloroquine and azithromycin as a treatment of COVID-19: results of an open-label non-randomized clinical trial. International Journal of Antimicrobial Agents.

[4] Favalli, E. G. et al., 2020. Role of antimalarials in COVID-19: observational data from a cohort of rheumatic patients. Annals of the Rheumatic Disease, 80(5).

[5] FDA, 2020. Coronavirus (COVID-19) Update: FDA Revokes Emergency Use Authorization for Chloroquine and Hydroxychloroquine. [Online].

[6] Carter-Timofte, E. M. et al., 2021. Antiviral Potential of the Antimicrobial Drug Atovaquone against SARS-CoV-2 and Emerging Variants of Concern. ACS Infectious Diseases, 7(11), pp. 3034-3051.

Humza Khizer

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

Move Over BMI, There Are Some New Kids On The Block!

BMI (Body Mass Index) has always been the most popular way to measure the composition of the body, pertaining to health. However, current research indicates that BMI is not the most accurate and may have serious limitations<a href="#accordion">[1]</a>. 
&nbsp;

Understanding Disadvantages Of BMI And Its Alternatives

Although BMI is an affordable, easily accessible, and quick method to screen whether a person is healthy or not. Its accuracy is limited by the fact that the index does not take certain factors into account. These include: 
&nbsp;

<ul>
	<li>
	<h5>Body Fat Percentage</h5>
	</li>
</ul>

BFP (body fat percentage) is the percentage of fat tissue in your body, in comparison to the total body mass. It is measured using skinfold callipers, and bioelectrical impedance. However, for a more accurate measurement, a DEXA Scan is used. 
&nbsp;

BMI does not account for the difference between muscle and fat. Muscle tissue is denser compared to fat, and most weightlifters, despite being physically fit, are considered fat as per the body mass index. Moreover, body fat percentage is a better assessment of health because most diseases have a correlation with body fat and not body weight. 
&nbsp;

<ul>
	<li>
	<h5>Demographics</h5>
	</li>
</ul>

When BMI was originally created the data was taken from Anglo-Saxon bodies (European population). Hence, it is not a very accurate method of health depiction due to the presence of several other races and ethnicities across the world. 
&nbsp;

Despite a low BMI score, Asians have a higher incidence of metabolic diseases<a href="#accordion">[3]</a>. Moreover, a study conducted at Stanford revealed that healthy BMI values in Black women are higher than the standard BMI range; and in Hispanic women, the healthy BMI values are lower than the standard range<a href="#accordion">[3]</a>. Moreover, in black women, a BMI value of 33 is associated with a <a href="https://merisehat.pk/disease/diabetes-type-1-and-2">risk of diabetes</a>, whereas in white women the risk is present with a BMI value of 29<a href="#accordion">[3]</a>.&nbsp; 
&nbsp;

<ul>
	<li>
	<h5>Fat Distribution</h5>
	</li>
</ul>

Fat is also an important factor for determining overall health that the BMI fails to take into account. Moreover, fat in the upper body and visceral fat is correlated to health complications. For example, cardiovascular disease is linked to lower body fat in the gluteal and thigh region.

&nbsp;

<h4>"A high BMI can add to your stress. Head on over to the <a href="https://www.merisehat.pk/page/sehat-scan/" target="_blank">sehat scan </a>and check your stress level today!"</h4>

There are multiple other alternatives to track your health which can either be used individually or together. 
&nbsp;

<ul>
	<li>
	<h5>Waist-To-Height Ratio (WHtR)</h5>
	</li>
</ul>

The waist-to-height ratio measures the ratio of waist circumference to height, instead of the overall weight to height square. Moreover, the accuracy of WHtR is higher because central weight is taken into consideration. 
&nbsp;

<ul>
	<li>
	<h5>Why Is Central Fat Important?&nbsp;</h5>
	</li>
</ul>

It is important because it accumulates around the organs in the mid-section, which has a link with heart diseases. In fact, researchers have also analyzed that WHtR is more accurate for the prediction of diseases, compared to BMI<a href="#accordion">[4]</a>.&nbsp; 
&nbsp;

<ul>
	<li>
	<h5>Measurements</h5>
	</li>
</ul>

Measurements have a relation with WHtR. It is the circumferential measurement of multiple body parts, for example, arm, legs, and waist. Many people use it for the prediction of their weight loss and weight gain.&nbsp; 
&nbsp;

<ul>
	<li>
	<h5>Resting Heart Rate</h5>
	</li>
</ul>

Resting heart rate is defined as the number of heartbeats per minute, in a resting phase. It is a good measurement of one&rsquo;s cardiovascular health. The stronger your cardiovascular health, the lower your risk of heart diseases. However, resting heart rate should not be checked first thing in the morning.&nbsp; 
&nbsp;

<ul>
	<li>
	<h5>Skinfold Callipers</h5>
	</li>
</ul>

Subcutaneous fat or fat that sits under the skin is measured using skinfold callipers. This gives an estimate of the total body fat. However, it is always better to measure five to six parts of the body for accurate results. For example, your stomach and back. Moreover, with skinfold callipers, the key to accuracy is consistency.

&nbsp;

<ul><li>BMI is a quick and easy method of assessing a person’s health outcomes, but it has tremendous limitations.&nbsp;</li><li>BMI does not address demographics, body fat percentage, or fat distribution.&nbsp;</li><li>Therefore, alternates such as waist-to-height ratio, resting heart rate, and subcutaneous fat measurements can be used.&nbsp;</li><li>Waist circumference or even blood pressure can predict the overall risks and health condition.&nbsp;</li><li>Moreover, if anyone has concerns about their BMI or overall weight, they should consult their healthcare provider for a better understating.</li></ul>

[1] Abel, R.C., Somers, V.K., Sierra-Johnson, J., Thomas, R.J., Bailey, K.R., Collazo-Clavell, M.L. and Allison, T.G., 2008. Accuracy of body mass index to diagnose obesity in the US adult population. Int J Obes (Lond), 32(6), pp.959-966.

[2] Kurian, A.K. and Cardarelli, K.M., 2007. Racial and ethnic differences in cardiovascular disease risk factors. Ethnicity & disease, 17(1), pp.143-152.

[3] Stanford, F.C., Lee, M. and Hur, C., 2019, February. Race, ethnicity, sex, and obesity: is it time to personalize the scale?. In Mayo Clinic Proceedings (Vol. 94, No. 2, pp. 362-363). Elsevier.

[4] Ashwell, M., Gunn, P. and Gibson, S., 2012. Waist‐to‐height ratio is a better screening tool than waist circumference and BMI for adult cardiometabolic risk factors: systematic review and meta‐analysis. Obesity reviews, 13(3), pp.275-286.

Staff Writer

14 Labor Induction Myths Debunked

There are a wide range of reasons why it might be essential to induce labor. Most frequently, it&rsquo;s because the delivery is overdue or there are some kinds of pregnancy problems. Despite the fact that in 2017, 43.1% of women expecting their first child had their labor induced, the process is still seen as an emergency intervention and hence requires understanding<a href="#accordion">[1]</a>.

&nbsp;

According to NHS Maternity Statistics, the rate of induction of labor in England has climbed from 21% (March 2010) to 34% (March 2021)<a href="#accordion">[2]</a>. Under the guidance of a skilled gynecologist, labor induction is a safe procedure.

&nbsp;

This article will shed light on various myths and pertinent facts about elective or natural labor.&nbsp; 
&nbsp;

Understanding Myths Surrounding Labor Induction

<h5>Myth #1: Acupuncture Helps Induce Labor</h5>

Fact: <a href="https://merisehat.pk/article/is-acupuncture-the-right-choice-for-you">Acupuncture</a> indeed has a noble past, and many individuals speak of its claimed advantages. Generally, acupuncture has no negative effects as long as it is administered by a trained professional who observes standard medical safety procedures. There isn&#39;t much information available, though, about this technique&#39;s efficacy in inducing labor. 
&nbsp;

<h5>Myth #2: Eating Spicy Food Induces Labor</h5>

Fact: Well, spicy food does not directly contribute to induction. It&rsquo;s an old wives&#39; tale &ndash; since spicy food triggers diarrhea or otherwise excites intestines, it might in turn result in uterine contractions.

&nbsp;

A word of caution is needed here: This isn&#39;t an authorized way to induce labor. It&#39;s not a good idea to induce diarrhea because it might lead to dehydration. There&rsquo;s also a possibility of having a severe case of heartburn. 
&nbsp;

<h5>Myth #3: Sex Induces Labor</h5>

Fact: Yes, in some circumstances, it might be helpful. Semen contains a minor quantity of prostaglandins, which are hormones that encourage cervical ripening. This coupled with female orgasms can bring on uterine contractions and the release of oxytocin, (sometimes referred to as the &quot;love hormone&quot;) during sex. However, experiencing a few contractions post sex doesn&#39;t mean it&rsquo;ll lead to regular contractions or a full-fledged labor.

&nbsp;

Moreover, several smaller studies suggest that having intercourse might not necessarily influence how quickly a pregnant woman goes into labor.

&nbsp;

A pregnant person may be hopeful that this strategy will succeed for a variety of reasons. However, it&#39;s vital to remember that not all pregnant women can have safe sex. If the doctor&rsquo;s advised against it and asked to maintain pelvic rest due to a placenta previa or another pregnancy problem, then the pregnant woman should refrain from having intercourse. 
&nbsp;

<h5>Myth #4: Walking or Exercising Induces Labor</h5>

Fact: This is not likely because walking has little effect on prostaglandin release. The idea behind walking is that gravity, balance changes, and movement can assist in lowering the baby into the pelvis and accelerating labor. However, while studies suggest that walking is an excellent form of exercise for expectant mothers, there is no evidence of its role in inducing labor.&nbsp;

&nbsp;

Regular walks help expecting mothers to feel good about themselves, assist them in getting the baby into the proper position for delivery, as well as enable them to develop strength for childbirth throughout their pregnancy (not just at the end!). Walking, or at the very least, staying upright whenever feasible, has been reported to speed up labor after it has begun. 
&nbsp;

<h5>Myth #5: Pineapple Induces Labor</h5>

Fact: NO. Pineapple contains a protein-breaking enzyme called bromelain, which makes it a crucial component of numerous meat tenderizers.

&nbsp;

Bromelain is thought to break down the tissue in the cervix and soften it in order to prepare for delivery. This is the reason why it&rsquo;s used in labor induction. However, there is no solid scientific proof for this hypothesis.

&nbsp;

Although bromelain may be effective on meat, the human body does not respond well to it. Additionally, pineapple may induce heartburn during pregnancy. 
&nbsp;

<h5>Myth #6: It&rsquo;s Better To Wait till 41+ Weeks Than Opt For Elective Induction</h5>

Fact: False. The recent guidelines by&nbsp; NICE (National Institute for Health Care and Excellence) states that there is an increasing body of evidence that pregnancies that reach, or pass, 41 weeks are associated with a small increase in the risk of stillbirth and perinatal death and that induction of labor reduces this risk<a href="#accordion">[3]</a>. 
&nbsp;

<h5>Myth #7: Nipple Stimulation Induces Labor</h5>

Fact: Nipple stimulation releases oxytocin, which might result in contractions, and anything that initiates labor would help, even when it is not directly related to dilatation.

&nbsp;

Before attempting nipple stimulation, always consult a doctor. When carrying a high-risk pregnancy, it should be avoided because prolonged and intense nipple stimulation can cause stress to the fetus.&nbsp;

&nbsp;

There are three options for nipple stimulation: manually, with a breast pump, or with a spouse. Just be careful not to overdo it; only massage one breast at a time for 5 minutes each. 
&nbsp;

<h5>Myth #8: Eating Dates Helps&nbsp;</h5>

Fact: Yes, frequent consumption of dates provides the body with a good amount of nourishment. Dates possess the hormone potuchin, which serves to bind the uterus and its muscles in an effort to lessen postpartum bleeding. And then, there is the hormone oxytocin, which can encourage uterine muscular contractions to speed up labor<a href="#accordion">[4]</a>. However, please exercise moderation when it comes to food consumption. Please consult your doctor to know the safe amount of dates to consume. 
&nbsp;

<h5>Myth #9: Castor Oil Induces Labor</h5>

Fact: No, and it&#39;s not advised. Castor oil can produce diarrhea and cramping in the intestines, which may make the uterus &quot;irritable&quot; . The cervix does not dilate as a result of these cramps, but these cramps can be exceedingly uncomfortable for the patients.

&nbsp;

Additionally, castor oil might induce feces release in an unborn child (meconium). Meconium can be consumed prior to birth when it combines with amniotic fluid. In rare cases, it might lead to pneumonia in the newborn. Please refrain from attempting castor oil! 
&nbsp;

<h5>Myth #10: Herbal Teas And Cohosh Induce Labor</h5>

Fact: It&#39;s untrue! Medical studies to support the safety of these products for mothers have not been conducted. Cohosh is one plant that contains phytoestrogens, which increases the risk of clotting in pregnant women and, therefore, should be avoided.

&nbsp;

Gamma-linolenic acid or GLA, which is a precursor to prostaglandins, is found in evening primrose oil. It is said to aid in &quot;ripening the cervix.&quot; Although there is no medical proof that it is effective, there is also no evidence that it is hazardous. However, it is best to avoid it.&nbsp;&nbsp; 
&nbsp;

<h5>Myth #11: A Second Labor Is Less Painful and Easy</h5>

Fact: It&#39;s true that successive labors tend to be shorter because the previous birth already stretched the cervix, pelvic floor muscles, and birth canal. But even if they last a shorter time, the discomfort is still there. 
&nbsp;

<h5>Myth #12: A C-Section Is Necessary In Case Of Twins</h5>

Fact: A vaginal birth is entirely conceivable if there are no problems; it&rsquo;s true despite the fact that more than half of all twin births in the UK occur via Cesarean. A vaginal birth ought to be achievable if the first twin is lying head-down. 
&nbsp;

<h5>Myth #13: Full Moon Helps Ease Labor Induction</h5>

Fact: According to an urban legend, more women have labor around full moons. There is absolutely no evidence to support the claim.&nbsp; Despite the absence of proof, many midwives still believe they will have a busy shift around the full moon! 
&nbsp;

<h5>Myth #14: Elective Induction Reduces Labor Time&nbsp;</h5>

Fact: The duration of labor varies from woman to woman and from pregnancy to pregnancy, but induced labor, which is started by using artificial hormones to trigger uterine contractions, can last for a few hours to a few days. It can take longer for first-time mothers or those less than 37 weeks pregnant. Before beginning the induction process, it is impossible to predict how the body will react to the medications being utilized. 
&nbsp;

Although it usually takes less time, labor induction can occasionally last 2-3 days. It takes longer if it's the first pregnancy. Eat very little -before visiting the hospital. Keep in mind that the medications used to induce labor may cause stomach discomfort and very severe contractions. Inform the doctor in case the pain is unbearable. Most of the time, a successful labor induction results in vaginal delivery. Don’t rely on myths. Just go along with the doctor's suggestions.

<ul><li>When the doctor administers medication or punctures the water to initiate labor, this process is referred to as inducing labor (also known as labor induction).</li><li>Only medical needs should justify inducing labor. The best course of action is to wait for labor to begin naturally if the pregnancy has been a healthy one.</li><li>Ask about delaying labor induction until at least 39 weeks if the doctor advises, so the baby has time to grow within the womb.</li><li>Never believe in myths without any medical research evidence.</li></ul>

[1] Can I. Induction of Labour.

[2] Wilkes E, Gamble J, Adam G, Creedy DK. Reforming maternity services in Australia: Outcomes of a private practice midwifery service. Midwifery. 2015;31(10):935–40.

[3] guideline NG207 N. Inducing labour. 2021;

[4] Kuswati K, Handayani R. Effect of Dates Consumption On Bleeding, Duration, And Types of Labor. J Midwifery. 2019;4(1):85–91.

Neelam Asad

Iqra Mazhar

Is Your Asthma Due To Your Mother’s Gestational Weight Gain?

Gestational weight gain and high BMI (body mass index) affects a majority of pregnant women. There are various factors such as social factors, environmental factors, maternal factors, and energy balance that could contribute to weight gain <a href="https://merisehat.pk/disease/lets-talk-about-sex-during-pregnancy">during pregnancy</a>.&nbsp; 
&nbsp;

Although gestational weight gain (GWG) is a natural response to accommodate a growing fetus, GWG that is either too high or too low contributes to long-term or short-term health complications. This specifically applies for women whose BMI is greater than 25 at the time of their pregnancy. 
&nbsp;

The number of women who experience excessive gestational weight gain while they are pregnant is increasing, irrespective of their socio-economic status. Institute of Medicine, USA, has worked on identifying optimal gestational weight, so healthcare providers can advise pregnant women accordingly<a href="#accordion">[1]</a>.

&nbsp;

Understanding The Impact Of Pregnancy Weight Gain On Childhood Asthma

Extreme gestational weight gain has a significant impact on pregnant women and their health. It increases risk of birth complications, and leads to long-term maternal obesity. 
&nbsp;

Additionally, excessive gestational weight gain is harmful for the child, especially because of increased risk of childhood obesity<a href="#accordion">[2]</a>. There is also enough evidence to link maternal obesity with childhood obstructive lung diseases, e.g., asthma<a href="#accordion">[3]</a>. 
&nbsp;

<h5>GWG And Asthma&nbsp;</h5>

Obesity during pregnancy is directly related to adverse outcomes in children, e.g., higher probability of developing asthma&nbsp; 
&nbsp;

The mechanism to identify this connection is fetal programming. It describes the in-utero exposure that influences gene expression and chronic diseases during childhood. The disease originates from metabolic and psychological adaptations, which are made by the fetus in response to in-utero exposures during critically sensitive developmental phases. Moreover, environmental and genetic factors also play a role in the immune modulatory effects. 
&nbsp;

<h5>The Effects Of BMI</h5>

It&rsquo;s difficult to gauge the effects of the mother&rsquo;s and the child&rsquo;s BMI on childhood asthma. Researchers have investigated the mediating effects of BMI by adding childhood body mass index to their variable models with two or more quantities, and further describing what would reduce the risk. 
&nbsp;

Some studies concluded that birth weight of babies and BMI at the age of eight partially affected childhood asthma due to gestational weight gain. However, other studies found minimal effects on childhood BMI<a href="#accordion">[4]</a>. 
&nbsp;

Another research studied the relationship between maternal pre-pregnancy BMI, gestational diabetes, weight gain, and the risk of wheezing in preschool offspring. The focus was on the growth, infection, and atopic mechanism. 
&nbsp;

The age group of the children in the study was 1-4 years and it was observed that mothers who had a history of asthma, atopy, and pre-pregnancy obesity, had kids at risk of pre-school wheezing.&nbsp; 
&nbsp;

Moreover, whenever the standard gestational weight gain deviated, it increased the risk of preschool wheezing. The results were independent of pre-pregnancy BMI and no difference was seen in mothers with history of atopy or asthma<a href="#accordion">[5]</a>. Additionally, child growth or eczema did not change the results either. 
&nbsp;

An overall higher risk of pre-school wheezing was seen in offspring of mothers with obesity before pregnancy, history of atopy, asthma, and gestational weight gain. Neither of these could be explained by infectious or atopic mechanisms. However, further research might be able to identify what the underlying mechanisms are.

&nbsp;

Childhood asthma is one of the most common chronic respiratory diseases. Considering that the death rate of children by asthma is 0-0.7 per 100,000 around the world, it is a cause for global concern. Moreover, the annual prevalence of asthma in children is 9.5%, which is higher compared to the 7.7% seen in adults<a href="#accordion">[6]</a>. Therefore, new tools have been developed to target preventive strategies, and improve health. 
&nbsp;

Studies suggest that asthma in children is associated with maternal weight gain before and during pregnancy. Moreover, pre-pregnancy weight gain is a global issue; it jumped from 13% to 22% within a decade (1993-2003). Overall, it indicates an increase of 69%.&nbsp; 
&nbsp;

Unfortunately, numerous studies have examined the link between GWG and pre-pregnancy obesity with childhood asthma, and the results remain inconclusive.&nbsp;

&nbsp;

A healthy and balanced diet can help the baby get the required nutrients for a healthy growth. However, the question that is commonly asked is how much extra calories are even normal? Extra calories are helpful and required in some cases, but eating for two is not recommended.&nbsp; 
&nbsp;

However it is important to note that the below caloric add-ons are applicable if a woman&rsquo;s weight is within a normal range and is moderately active. In this case, the recommended daily intake before pregnancy would be about 2,000 calories a day.&nbsp;&nbsp; 
&nbsp;

The caloric intake in pregnant women depends on the time of the pregnancy. For example, slight increase is good enough for the first trimester, which then needs to increase to an additional 300 to 350 calories per day during the second trimester. In the third trimester, an additional 450 to 500 calories per day are needed. If you&#39;re carrying multiple pregnancies, you could need an additional 300 calories per day for each baby. 
&nbsp;&nbsp;

Pregnant women need to consult their healthcare providers to know how much weight they can gain. Women who have the ideal weight according to their BMI should be able to gain 25-35 pounds during pregnancy, whereas underweight women have a margin for 28-40 pounds. Overweight women can gain only 15-25 pounds when pregnant<a href="#accordion">[7]</a>. 
&nbsp;

So, the general rule is that women can gain 2-4 pounds in their first trimester and 1 pound per week for the remaining pregnancy. Besides, women who are expecting twins can gain 35-45 pounds, which makes it an average of 1.5 pounds per week after the usual first trimester weight gain. It is very important for women with twin pregnancy to gain the right weight.&nbsp;

&nbsp;

It is advised that prenatal healthcare providers evaluate maternal weight at every visit. They should also monitor weight goals and provide counselling accordingly. More than 50% of women tend to exceed their weight gain goals and become overweight, which is a serious health hazard. It leads to low birth weight, failure to produce breast milk, cesarean deliveries, and postpartum weight retention. Furthermore, the offspring can also be overweight and suffer from macrosomia. 
&nbsp;

Although gestational weight gain is potentially threatening to women and the offspring, it is a modifiable risk factor. Diet and exercise during pregnancy helps in reducing the extra weight. However, these interventions have not improved neonatal outcomes significantly, and the effects on obese women are also limited. Thus, indicating that its best to achieve a healthy BMI prior to conception.

&nbsp;

[1] Rogozińska, E., Zamora, J., Marlin, N., Betrán, A.P., Astrup, A., Bogaerts, A., Cecatti, J.G., Dodd, J.M., Facchinetti, F., Geiker, N.R. and Haakstad, L.A., 2019. Gestational weight gain outside the Institute of Medicine recommendations and adverse pregnancy outcomes: analysis using individual participant data from randomised trials. BMC pregnancy and childbirth, 19(1), pp.1-12.

[2] Kominiarek, M.A. and Peaceman, A.M., 2017. Gestational weight gain. American journal of obstetrics and gynecology, 217(6), pp.642-651.

[3] Rusconi, F. and Popovic, M., 2017. Maternal obesity and childhood wheezing and asthma. Paediatric respiratory reviews, 22, pp.66-71.

[4] Harskamp-van Ginkel, M.W., London, S.J., Magnus, M.C., Gademan, M.G. and Vrijkotte, T.G., 2015. A study on mediation by offspring BMI in the association between maternal obesity and child respiratory outcomes in the amsterdam born and their development study cohort. PLoS One, 10(10), p.e0140641.

[5] Leermakers, E.T., Sonnenschein-van der Voort, A.M., Gaillard, R., Hofman, A., de Jongste, J.C., Jaddoe, V.W. and Duijts, L., 2013. Maternal weight, gestational weight gain and preschool wheezing: the Generation R Study. European Respiratory Journal, 42(5), pp.1234-1243.

[6] Liu, S., Zhou, B., Wang, Y., Wang, K., Zhang, Z. and Niu, W., 2020. Pre-pregnancy maternal weight and gestational weight gain increase the risk for childhood asthma and wheeze: an updated meta-analysis. Frontiers in pediatrics, 8, p.134.

[7] National Research Council, 2010. Weight gain during pregnancy: reexamining the guidelines.

What Is Hormonal Weight And How To Deal With It?

Have you ever felt like you&rsquo;ve tried everything to lose weight and it just doesn&rsquo;t work? That no amount of dieting or exercise keeps those few extra pounds off.&nbsp;

The solution to your weight loss may not be as simple as <a href="https://merisehat.pk/article/body-weight-exercises-for-strength-training">diet and exercise if the weight gain</a> itself is &lsquo;hormonal&rsquo;.

Hormones are chemicals, responsible for various functions that go on in your body, from digestion, sleep, mood swings, and sexual desires to metabolism. That is why having any kind of a hormonal imbalance can lead to health issues including, weight gain, low mood and that awful bloated feeling.&nbsp;

Hormones can make you gain and lose weight because they control how your body uses and spends the energy that is generated. Therefore, hormonal weight gain occurs when there is an imbalance in hormone production. This in turn can disturb levels of cortisol, thyroid, insulin, estrogen, and testosterone. 
&nbsp;

Signs And Symptoms

A classic sign of hormonal weight gain is the accumulation of fat around the abdominal area.

There are several hormones responsible for wreaking havoc on your body, your weighing machine and, as a result, your overall peace of mind. These include:

<h5>Thyroid</h5>

This hormone is responsible for regulating your metabolism and burning calories. In short, your body needs the right amount of thyroid hormone to burn calories. It also controls the body temperature, heartbeat, and the rate at which the food moves through the digestive tract. 
&nbsp;

<h5>Estrogen</h5>

Estrogen is a hormone responsible for sexual and reproductive health. But it can also trigger weight gain. Imbalances in estrogen levels can affect ovaries and cause PCOS (Polycystic ovary syndrome).

&nbsp;

<h5>Cortisol</h5>

This stress hormone is one of the silent culprits when it comes to weight gain and hormonal imbalances. Increased cortisol levels can lead to major weight gain as they are associated with addiction and cravings for sugary foods. The worst part is that this food makes you jittery and lazy. Hence, there is no motivation to work out to address the weight gain. A cortisol imbalance is like a double-edged sword. 
&nbsp;

<h5 dir="ltr">Insulin</h5>

The hormone responsible for energy. It pushes glucose into the cells. When insulin levels are too high, there is an excess of sugar in the blood. This extra sugar is converted to fat. This eventually leads to increased fatty deposits and cravings for sugary food.

 
In conclusion&nbsp;Shedding weight gain caused by an imbalance of hormones can take longer than expected.

&nbsp;

<h5>Exercise</h5>

Under the supervision of your doctor and certified trainer, you can try workouts like high-intensity interval training (HIIT), yoga, and strength training to release the happy chemicals (serotonin, dopamine, and norepinephrine) into your brain. These chemicals in turn reduce the level of stress hormones which are the major contributor to weight gain.

&nbsp;

<h5>Diet</h5>

Workouts and supplements without a proper diet can only take you so far. A balanced and doctor-supervised diet is crucial for weight loss. A diet that is specifically designed to offset hormonal weight has foods that have a naturally therapeutic and balancing effect on the body.

&nbsp;

Solution

Besides, the common sign of weight gain, other signs of hormonal imbalance might not always be apparent. We might think it is due to aging or genetics are at play for the fat that&rsquo;s being accumulated in our bodies. And this may not be true.&nbsp;

To be sure, the best thing to do is to get yourself tested after a thorough consult with a doctor. This way you can find out which hormones are in excess and which ones are not. You can then plan out your strategic weight loss journey without the pain of constant disappointments.

Hormonal weight loss is reversible. Patience and a plan are all you need.&nbsp;

Namwer Rao

Debunking Myths Of Kidney Stones

<a href="https://www.merisehat.pk/disease/kidney-stones-66">Kidney stones</a> are notorious for being one of the most painful and difficult ailments an individual can be diagnosed with. And they are becoming more prevalent. Today over half of all urology patients in Pakistan have a kidney stone and 3-5% of the population is at risk of developing a kidney stone at some point in their lives[1]. Diet, an abundance of body weight, and certain ailments and medications are among the leading reasons for kidney stones. From the kidneys to the bladder, any segment of the urinary tract can be hindered by renal stones. 
&nbsp;

Although a common occurrence, there are a ton of myths and misinterpretations surrounding kidney stones, their causes, and ways to prevent their formation. 
&nbsp;

Potential causes include drinking too little water, excessively working out, weight reduction surgery, obesity, or eating salty or sugary food. In certain individuals, diseases and family ancestry may also play a role. Moreover, consuming an excess of fructose (present in table sugar and high fructose corn syrup) corresponds to a growing chance of fostering a kidney stone<a href="#accordion">[2]</a>. 
&nbsp;

There are four main kinds of kidney stones: 
&nbsp;

<ul>
	<li>Calcium Stones: Calcium stones are the most common type of kidney stones<a href="#accordion">[3]</a>.&nbsp;Calcium oxalate stones are formed due to calcium mixing with the oxalate present in urine. Consuming oxalate-rich foods such as spinach, peanuts, and chocolates can increase one&rsquo;s risk of these stones. On the other hand, calcium phosphate stones are less prevalent than oxalate ones. They are typically caused by hyperparathyroidism, renal tubular acidosis, and urinary tract diseases<a href="#accordion">[4]</a>. 
	&nbsp;</li>
	<li>Uric Acid Stones: Uric acid stones are often associated with diabetes, body weight fluctuations, and several metabolic disorders. These stones are formed due to excessively acidic urine<a href="#accordion">[3]</a>. 
	&nbsp;</li>
	<li>Struvite Stones: The most well-known reason for struvite stones is urinary tract infections (UTIs) that lead to urine pH imbalances These stones can be significantly large and cause urinary obstruction<a href="#accordion">[3]</a>. 
	&nbsp;</li>
	<li>Cystine Stones: This is the least common type of kidney stone. It occurs in people with cystinuria, a genetic condition that results in increased levels of the amino acid cystine in the urine.&nbsp; 
	&nbsp;</li>
</ul>

&nbsp;

Understanding kidney stones and some common myths

Have you ever received unsolicited medical advice from a neighbour? A friend? Or maybe an aunt with no blood relation to you?&nbsp; Technically, anyone but a medical practitioner? Then you have stumbled upon the right page. If there is anything desis love more than chai it is reliance on pseudo-helpful home remedies and ancestral healing concoctions. And why should kidney stones be any different? Here, we have listed the top 5 myths about kidney stones, believing which would do you more harm than good: 
&nbsp;

<h5>1. Toss Out Dairy</h5>

It has been misconstrued that you need to opt for non-milk options and adapt to a dairy-free life as research suggests otherwise. The calcium in milk is essential for several bodily functions such as blood clotting, assisting muscular contractions, regulating healthy heart contractions and relaxations, nerve functioning, strong bones and teeth, and, most of all, preventing kidney stones<a href="#accordion">[5]</a>. 
&nbsp;

Many individuals dread calcium since calcium consumption has been linked to the formation of kidney stones, yet the reality of the situation could not be further from such a restrictive diet. If there is a possibility that your calcium intake is excessively low, you are in fact in danger of increasingly absorbing oxalate, a typical compound we eat in numerous food sources. Excessive retention of oxalate can prompt additional oxalate in your urine and that can give rise to calcium oxalate stones. 
&nbsp;

<h5>2. Like A Stomachache</h5>

We trace the origin of this myth to just a lack of knowledge of anatomy, where any region of the abdomen below the chest and above the legs has been coiled under the umbrella term stomach. While you will experience incredible levels of discomfort and sharp pain in your lower abdominal region, it will feel more like a spasm. At the point when you have spasms, your stomach muscles flex with incomparable force and intensity which causes serious pain. As the stone travels through the urinary tract, the pain might differ in levels of intensity. Kidney stones can cause a tightening of muscles, and for certain individuals, the stabbing sensation of pain is like that experienced in menstrual cramps. To rule out the dismissing excuse of a stomachache, keep an eye out for other symptoms of kidney stones, which include nausea, discomfort while urinating, and a pungent smell of urine<a href="#accordion">[5]</a>. 
&nbsp;

<h5>3. Kidney Stone Is Always Painful</h5>

Kidney stones are defined as hard sediments of minerals within the urinary tract that obstructs the path of urine, cause infection, and bring a mammoth of pain. However, they are not always bearers of pain, especially when they are in the initial stages of formation. Other symptoms might indicate the formation of a kidney stone such as blood while urinating, severe nausea, and uncontrollable vomiting. 
&nbsp;

A type of kidney stone termed &lsquo;Silent Stone&rsquo; fails to exhibit characteristic kidney stone symptoms and is diagnosed by an imaging test or a routine checkup. In Pakistan, the results of a study in a urology department found that 3% of all urology patients suffered from silent kidney stones<a href="#reference" target="_blank">1</a>. Therefore, routine visits to a GP are necessary to catch any unprecedented discovery and receive timely treatment before the development of any complications. 
&nbsp;

<h5>4. Cranberry Juice Is The Elixir Of All</h5>

Cranberry juice is a perfectly viable option and beverage for when you have a urinary tract infection or as a preventive measure to forestall one. It thickens and solidifies your urine, which drains the contaminated substances out and wards off the probability of having it again. However, if you have a kidney stone, it exacerbates the issue. Cranberry contains high measures of oxalate, which is a primary mineral found in kidney stones. Therefore, if you want to get rid of kidney stones, skip the cranberry juice. 
&nbsp;

With regards to halting kidney stones, lemon juice is a far better alternative to cranberry juice. Citrus refreshments have been associated with an increment of citrate levels in urine, which can limit and restrict stone development. Nonetheless, research shows the amount you drink has a lot more prominent effect than what you drink. You must hydrate yourself sufficiently with 100 ounces of liquids daily - anything that those liquids might be - to keep the kidneys flushed out and the abundance and prevalence of stone-forming salts lower. 
&nbsp;

<h5>5. Sodas Cause Kidney Stones</h5>

As an organization dedicated to garnering public attention towards medical illnesses, we feel obligated to suggest avoiding sodas and fizzy beverages as their high sugar and preservative concentrations can cause several complications. But, as morally honest fact bearers, we must admit that soft drinks are not the sole contributors to kidney stones. The truth of the matter is phosphoric acid is the main culprit. The ingredient is commonly found in dark-colored soft drinks. The other issue with soda is that it is an infamous diuretic because of the addition of caffeine. This raises the normal concentration of salt in your urine, which advances kidney stones<a href="#accordion">[6]</a>. So, if you choose to consume a soft drink, compensate the ounces with an equivalent measure of water and you will diminish that concentration. Then again, you could stay away from soft drinks through and through and replace them with better options. 
&nbsp;

<h4>"A high Heart rate variability is a an important indicator of good health. Head on over to our <a href="https://www.merisehat.pk/page/sehat-scan/" target="_blank">sehat scan </a>and check your heart rate variability today!" </h4>

The only conclusion that can be drawn from busting several myths is another myth that the internet knows it all. While many verified health blogs and revered medical journals will supply you with an influx of information, it is important to realize that each body is different. For any disease or illness or even kidney stones, always consult a doctor, a urologist, and a certified dietician who can guide you, assist you, and support you with reasonable and sustainable solutions. 
&nbsp;

Tip of the day: Be old school and book that appointment ASAP. 
&nbsp;

This article gathered to debunk some of the most common myths surrounding kidney stones that patients have heard from their acquaintances or on the internet. With the intent to inform rather than offend the key takeaways from this article are:

<ul>
	<li>There are four types of kidney stones: calcium stones, uric acid stones, struvite stones, and cystine stones.</li>
	<li>The body should not be deprived of calcium as its deficiency can lead to kidney stones.</li>
	<li>Kidney stones are not always painful and can be silent.</li>
	<li>Kidney stones cause a more severe pain than a stomachache.</li>
	<li>Kidney stones cannot be cured with cranberry juice; opt for lemon juice instead.</li>
	<li>Stay hydrated!&nbsp; 
	&nbsp;</li>
</ul>

[1].Buchholz, N., Abbas, F., Khan, R., Talati, J., Afzal, M., & Rizvi, I. (2003). The Prevalence of Silent Kidney Stones - an Ultrasonographic Screening Study. Journal of the Pakistan Medical Association, Vol 53, 1-5.

[2].National Kidney Foundation. (2022). Kidney Stones. Retrieved from National Kidney Foundation:

[3].U.S. Department of Health and Human Services. (n.d.). Definition & Facts for Kidney Stones. National Institute of Diabetes and Digestive and Kidney Diseases. Retrieved July 28, 2022,

[4].Loughlin, K. R. (2019, May 17). What causes kidney stones (and what to do). Retrieved from Harvard Medical School:

[5].Urology Specialists of Georgia. (2022). Debunking 3 Common Kidney Stone Myths. Retrieved from Urology Specialists of Georgia:

[6].Uribarri, J., Oh, M. S., & Carroll, H. J. (1989). The First Kidney Stone. Annals of internal medicine, 111(12), 1006–1009.

Zarlish Kazmi

While the acceptance of diversity in bodily sizes is on a steady rise, certain &lsquo;thin body&rsquo; lobbyists will still try to promote unhealthy weight loss methods. This article aims to explore five of the most prevalent weight loss myths and how we can move forward towards a healthier lifestyle.

&nbsp;

Understanding of Weight loss myths

<h5>You Shouldn&rsquo;t Eat Dessert</h5>

While an excess consumption of carbohydrates will catalyse the production of fat, both in terms of storage reserves and insulin spikes, a moderate consumption of sugary foods and bread is actually essential for your health.&nbsp;

Our body requires a diverse range of micro- and macronutrients as well as glucose in order to survive. Since carbohydrates break down immediately into glucose, it temporarily relieves the body of additional effort that is required to create glucose from other foods.&nbsp;

Not only do our bodies need this rest, but it is also highly unsustainable to avoid desserts for the long term and can have catastrophic impacts on impulse control. 
&nbsp;

<h5>Cooking With Olive Oil Is Healthier</h5>

Olive oil is a miracle substance. It contains large amounts of antioxidants, prevents heart disease and stroke, and is a powerful anti-inflammatory. It also promotes healthy weight loss due to large quantities of monounsaturated fatty acids. But it cannot remain stable in heat.&nbsp;

This miracle oil is extremely gentle and exposing it to high degrees of heat actually makes it more absorptive of free radicals in the air. In fact, even in environments where there&rsquo;s not a lot of heat, olive oil should not be directly exposed to the atmosphere. The best way to store olive oil is to cap it up tightly and put it in a cool, dry place like the fridge.&nbsp;

Coconut oil can easily replace olive oil in healthy cooking efforts as it remains stable in heat and contains a lot of the benefits of olive oil as well.&nbsp; 
&nbsp;

<h5>There Is A Miracle Weight-loss Elixir Out There</h5>

To put it simply, they do not exist. They&rsquo;re called laxatives, are extremely bad for digestion, and can in fact contribute to eating disorders.

&nbsp;

<h5>Mangoes Cause Weight Gain</h5>

If you&rsquo;ve been avoiding mangoes this season, now is the time to remedy this mistake. Mangoes are widely believed to promote weight gain due to their meaty, sweet content. In truth, however, mangoes promote satiety and can therefore be used for weight loss when consumed in moderation.&nbsp;

&nbsp;

<h5>You Need To Control Your Hunger</h5>

Not eating when you&rsquo;re hungry is actually the surest way to gain weight faster. This is because it cultivates issues with impulse control and denies our bodily intelligence. Our bodies are incredibly wise and will inform us of whatever we need whenever we need it. For example, craving chocolate is your body&rsquo;s signal for magnesium and craving vegetables is your body&rsquo;s signal for fiber and vitamins. 
&nbsp;

It might be tempting to try out a yo-yo diet or quick fix for weight loss but the best way to optimize health and maintain a good body weight is actually to lean into your body&rsquo;s intuition and give it what it needs with compassion.