Madeeha Syed

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The Intricate Relationship Between Weight Gain/Loss And Depression

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The Intricate Relationship Between Weight Gain/ Loss And Depression

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Saad Ullah Siddiqui

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Do Supplements And Herbs Cure Depression?

Introduction

As predicted earlier by the World Health Organization (WHO), major depressive disorders now account for a major illness in the world<a href="#accordion">[1]</a>, especially since the emergence of <a href="https://www.merisehat.pk/disease/covid-19">COVID-19</a>. As the pandemic rapidly swept across the globe, it induced a considerable degree of fear, worry and concern in populations at large. Additionally, social isolation and loneliness worsened mental health worldwide.&nbsp; 
&nbsp;

Major depressive disorder is a major contributor to the incidences of suicide and ischemic heart disease. Moreover, it is the second leading cause of years lived with disability (YLDs) worldwide<a href="#accordion">[2]</a>. <a href="https://www.merisehat.pk/disease/depression">Depression</a> not only affects day-to-day activities but also decreases the quality of life and well-being of people. The mood disorder can present with mild to potentially debilitating and life-threatening symptoms.&nbsp;

&nbsp;

Over the years, the increase in the prevalence of psychiatric disorders, depression, anxiety, and insomnia has led to a search for more effective treatments. For this reason, people look to manage depression with more natural remedies. Hence, treatment (often self-treatment) with supplements and herbs continues to gain popularity. But natural does not always mean safe or effective.&nbsp; 
&nbsp;

Herbal formulas are commonly prescribed for the treatment of mental illnesses. More people are now turning to herbal medications because of the various side effects, high prices, and increased relapse rates associated with prescription medications. Over the past decade, several studies have been conducted on the mechanism of action of supplements and herbal medications for treating depression, anxiety, and insomnia.&nbsp;

&nbsp;

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Understanding the role of natural remedies  in treating depression

Below are some supplements and herbs that are most widely used for the treatment of depression:&nbsp; 
&nbsp;

<ul>
	<li>
	<h5>Omega-3 fatty acids&nbsp;</h5>
	</li>
</ul>

Omega-3 fatty acids are essential fats that help with treating depression. A randomized control trial conducted on pregnant women in 2020 concluded that omega-3 fatty acids significantly improve symptoms of depression and postpartum depression<a href="#accordion">[3]</a>. Supplements containing the two omega-3 fatty acids eicosatetraenoic acid (ECA) and docosahexaenoic acid (DHA) are most effective. Omega-3 supplements containing 60% or more eicosapentaenoic acid (EPA) show an overall positive effect on treating depressing symptoms<a href="#accordion">[4]</a>. While there is a lack of research to support the argument, the supplement is a well-tolerated and considered healthy addition to your diet that may help treat the mood disorder.&nbsp; 
&nbsp;

<ul>
	<li>
	<h5>NAC (N-acetylcysteine)&nbsp;</h5>
	</li>
</ul>

NAC is a precursor of glutathione, an important antioxidant in your body. It is essential for protecting cells against oxidative damage and regulating inflammation<a href="#accordion">[5]</a>. Studies have shown that people with depression are more likely to have higher levels of inflammatory markers. Thus, taking NAC may reduce inflammation and relieve the symptoms of depression. Doses of 2 to 2.4 grams in a day are thought to help treat mental health conditions. 
&nbsp;

<ul>
	<li>
	<h5>Vitamin D&nbsp;</h5>
	</li>
</ul>

Vitamin D is an essential nutrient for the body. However, many people, especially in Pakistan don&rsquo;t have sufficient vitamin D. Studies have further shown that people with depression are deficient in vitamin D. Similarly, people with vitamin D deficiency have more severe depressive symptoms<a href="#accordion">[6]</a>. Vitamin D helps curb depression by reducing inflammation and regulating mood. A randomized control study highlighted that vitamin D supplements are beneficial for people with clinical depression<a href="#accordion">[7]</a>. Another study found that 300,000 IU of adjunctive vitamin D significantly improved the severity of illness and overall quality of life in people with clinical depression<a href="#accordion">[8]</a>. 
&nbsp;

<ul>
	<li>
	<h5>B vitamins&nbsp;</h5>
	</li>
</ul>

B vitamins play an essential role in the regulation of mood. These vitamins include folate, B12 and B6, and are needed to produce serotonin or the &ldquo;happy hormone&rdquo;. Studies have shown that a deficiency in vitamin B12 and folate increases the risk of depression. Whereas, supplementing vitamin B12 may help reduce depressive symptoms. According to a study published in 2020, low vitamin B12 levels are associated with a high risk of developing depression<a href="#accordion">[9]</a>.&nbsp; 
&nbsp;

<ul>
	<li>
	<h5>Zinc&nbsp;</h5>
	</li>
</ul>

Zinc is an essential mineral for brain health and a deficiency in the mineral may increase the risk of depression and the severity of symptoms. Studies have further shown that zinc when used alongside antidepressant medications may reduce depressive symptoms.&nbsp; 
&nbsp;

<ul>
	<li>
	<h5>Magnesium&nbsp;</h5>
	</li>
</ul>

Magnesium is an important mineral that may help with the symptoms of depression. A randomised study concluded that 248 mg of magnesium per day for 6 weeks can significantly reduce the symptoms of depression<a href="#accordion">[10]</a>.&nbsp; 
&nbsp;

<ul>
	<li>
	<h5>Creatine&nbsp;</h5>
	</li>
</ul>

Creatine is an organic compound that is essential for maintaining brain energy, which has shown to be involved in the development of depression. Some studies have shown that supplementing creatine can help with the symptoms of clinical depression.&nbsp; 
&nbsp;

<ul>
	<li>Rhodiola Rosea&nbsp;</li>
</ul>

Rhodiola Rosea is a popular herb that has several health benefits when taken in the form of a supplement. In addition to helping the body cope with stressful situations, the herb is known to reduce symptoms of depression. The herb when used in combination with saffron can significantly reduce depression and anxiety symptoms of mild to moderate depression<a href="#accordion">[11].</a>&nbsp; 
&nbsp;

<ul>
	<li>
	<h5>Saffron&nbsp;</h5>
	</li>
</ul>

Saffron is a spice that is commonly used in Asian foods. The spice is packed with antioxidants that have been shown to improve the symptoms of depression. While the exact mechanism behind it is unknown, studies have shown that saffron increases levels of the &ldquo;happy hormone&rdquo; in the brain 
.

<ul>
	<li>
	<h5>Ginseng&nbsp;</h5>
	</li>
</ul>

The ginseng plant has been used by the Chinese for thousands of years to help reduce the effects of stress, and improve mental clarity and energy. Derived from the plant, ginseng supplements have properties that help with low energy and motivation levels in people with depression. However, currently, there are not many studies to support the benefits of ginseng for depression&nbsp;&nbsp; 
&nbsp;

<ul>
	<li>
	<h5>Chamomile&nbsp;</h5>
	</li>
</ul>

Studies have shown that chamomile is useful in the management of depression and anxiety. The herb provides significant relief from depressive symptoms. However, there is a need for further studies to support the benefits of chamomile to treat depressive symptoms.&nbsp;

&nbsp;

Key Points

<ul>
	<li>While herbal and natural supplements may work for some people, they are not a substitute for conventional treatments. Especially, for people who also struggle with thoughts of self-harm or suicide.&nbsp;</li>
	<li>Depression is a treatable illness, and you may try different herbs and supplements, but they may have potential side effects.&nbsp;</li>
	<li>These herbs and supplements can also interact with other drugs, reducing their potency.&nbsp;</li>
	<li>If you struggle with depression or have thoughts of suicide or self-harm, seek professional help immediately.&nbsp;</li>
</ul>

&nbsp;

[1].Depressive disorder (depression). World Health Organization. Accessed May 18, 2023

[2].Ferrari, A.J., Charlson, F.J., Norman, R.E., Patten, S.B., Freedman, G., Murray, C.J., Vos, T. and Whiteford, H.A., 2013. Burden of depressive disorders by country, sex, age, and year: findings from the global burden of disease study 2010. PLoS medicine, 10(11), p.e1001547.

[3].Zhang, M.M., Zou, Y., Li, S.M., Wang, L., Sun, Y.H., Shi, L., Lu, L., Bao, Y.P. and Li, S.X., 2020. The efficacy and safety of omega-3 fatty acids on depressive symptoms in perinatal women: a meta-analysis of randomized placebo-controlled trials. Translational psychiatry, 10(1), pp.1-9.

[4].Liao, Y., Xie, B., Zhang, H., He, Q., Guo, L., Subramanieapillai, M., Fan, B., Lu, C. and McIntyre, R.S., 2019. Efficacy of omega-3 PUFAs in depression: a meta-analysis. Translational psychiatry, 9(1), pp.1-9.

[5].Šalamon, Š., Kramar, B., Marolt, T.P., Poljšak, B. and Milisav, I., 2019. Medical and dietary uses of N-acetylcysteine. Antioxidants, 8(5), p.111.

[6].Menon, V., Kar, S.K., Suthar, N. and Nebhinani, N., 2020. Vitamin D and depression: a critical appraisal of the evidence and future directions. Indian journal of psychological medicine, 42(1), pp.11-21.

[7].Vellekkatt, F. and Menon, V., 2019. Efficacy of vitamin D supplementation in major depression: A meta-analysis of randomized controlled trials. Journal of postgraduate medicine, 65(2), p.74.

[8].Vellekkatt, F., Menon, V., Rajappa, M. and Sahoo, J., 2020. Effect of adjunctive single dose parenteral vitamin D supplementation in major depressive disorder with concurrent vitamin D deficiency: a double-blind randomized placebo-controlled trial. Journal of Psychiatric Research, 129, pp.250-256.

[9].Sangle, P., Sandhu, O., Aftab, Z., Anthony, A.T. and Khan, S., 2020. Vitamin B12 supplementation: preventing onset and improving prognosis of depression. Cureus, 12(10).

[10].Tarleton, E.K., Littenberg, B., MacLean, C.D., Kennedy, A.G. and Daley, C., 2017. Role of magnesium supplementation in the treatment of depression: A randomized clinical trial. PloS one, 12(6), p.e0180067.

[11].Bangratz, M., Abdellah, S.A., Berlin, A., Blondeau, C., Guilbot, A., Dubourdeaux, M. and Lemoine, P., 2018. A preliminary assessment of a combination of rhodiola and saffron in the management of mild–moderate depression. Neuropsychiatric disease and treatment, 14, p.1821.

Staff Writer

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

Humza Khizer

Baby Blues (Postpartum Depression): Is There A New Treatment?

The entire process of pregnancy is very rewarding, but what happens after you have delivered the baby? Your body that has gone through so many constant changes over the 9 months, reverses them all to get you back to normal. This process often leads to postpartum <a href="https://www.merisehat.pk/disease/depression">depression</a>.

About 11% of women in the United States suffer from postpartum depression (PPD).<a href="#accordion">[4]</a>&nbsp;PPD affects not just the life of the mother but also the infant. If left untreated, it can get worse and affect your spouse or other people close to you. So far, the treatment used for PPD has been very generic; similar to that of major depressive episode (MDE) consisting of conventional antidepressants like SSRIs, benzodiazepines, and tricyclic antidepressants. FDA has recently approved the first-ever drug targeted toward treating postpartum depression. 
&nbsp;

Understanding The Latest Treatment For Postpartum Depression

Postpartum depression is best explained as a worsened form of postpartum blues or baby blues. Baby blues are experienced a few days after delivery. Some new moms, however, experience a much more severe case of baby blues that can be classified as postpartum depression and it can go on for over a year.<a href="#accordion">[8]</a>&nbsp;PPD is characterized by:

<ul>
	<li>Feeling depressed and low</li>
	<li>Sleeping too little or too much</li>
	<li>Feeling tired all the time</li>
	<li>Doubting yourself as a mother</li>
	<li>Thinking that you do not want the baby</li>
	<li>Excessive crying</li>
	<li>Loss of appetite</li>
	<li>Anxiety and panic attacks&nbsp;</li>
	<li>Thoughts of harming yourself or the baby</li>
	<li>Unable to think clearly or make the right decisions</li>
	<li>Increased anger and irritability</li>
	<li>Overall reduced interest in everything</li>
</ul>

If you or anyone that you know are facing any of these symptoms, immediately contact your physician and get yourself screened through the Edinburg Postnatal Depression Scale (EPDS). It is one of the most common and quickest screening tools with high accuracy and allows your physician to assess the situation better through the score.&nbsp; 
&nbsp;

A lot of factors contribute to postpartum depression.The biggest factor that is not only responsible for PPD but also for the baby blues is the drastic change in hormones. During pregnancy, your estrogen and progesterone levels are very high. As soon as the baby is delivered, these levels are dropped drastically.

Since estrogen is directly linked to increasing serotonin levels in our brain&nbsp;and progesterone is known for stimulating dopamine release, the decrease in the production of these hormones coupled with some underlying mental issues or previous history of depression or anxiety becomes the most common and the biggest cause of PPD.<a href="#accordion">[2][3][7]</a> 
&nbsp;

While screening of postpartum depression can be done by several tools that are used for Major Depressive Episodes (MDE), the most universally acceptable tool targeted especially for PPD is Edinburgh Postnatal Depression Scale or EDPS. EDPS is a 10-item questionnaire with a response score of 0 to 3. If the total score is over 12, then there is a need for further in-depth assessment of the situation and severity of the condition.&nbsp;

PPD is best diagnosed by your medical practitioner through regular visits. Your doctor asks a series of questions every few days to assess your mental health and well-being. Another way to differentiate PPD from baby blues is to ensure that the patient has at least 3-5 of the symptoms that make up PPD. The generalized diagnostic criteria used for PPD are similar to the one used for Major Depressive Episode (MDE). Immediate attention is recommended to avoid any worsening of the symptoms and from transitioning of PPD to postpartum psychosis. 
&nbsp;

So far, the treatment of postpartum depression is similar to that of conventional major depressive disorder. Special attention is paid to the excretion of the drug and the concentration of the drug removed from the body through breast milk.

The following antidepressants are commonly used to treat postpartum depression due to their low levels of excretion in breast milk, making it safe for use if you are a breastfeeding mother:

<ul>
</ul>

<ul>
	<li>Fluoxetine</li>
	<li>Paroxetine</li>
	<li>Sertraline</li>
	<li>Bupropion</li>
	<li>Amitriptyline</li>
	<li>Doxepin</li>
	<li>Desipramine</li>
	<li>Tranylcypromine</li>
	<li>Trimipramine</li>
	<li>Desipramine</li>
	<li>Paroxetine</li>
	<li>Escitalopram</li>
</ul>

These antidepressants come with some common side effects that include nausea, vomiting, dizziness, sexual issues, diarrhea, blurry vision, weight gain, increased perspiration, etc.<a href="#accordion">[6]</a> 
&nbsp;

Brexanolone (under the brand name of Zulresso) got approved by the FDA as the first drug targeted toward PPD. Brexanolone is approved with a Risk Evaluation and Mitigation Strategy (REMS) which means that it is currently a controlled medicine available through a restricted distribution channel to carefully assess the conditions of the patients throughout the treatment. The program is currently known as Zulresso REMS Program.<a href="#accordion">[5]</a>&nbsp;Currently, to get Brexanolone administered to you for treating your PPD, you are required to enroll in the Zulresso REMS program.&nbsp; 
&nbsp;

<ul dir="ltr">
	<li>
	<h5>Mechanism Of Action</h5>
	</li>
</ul>

Brexanolone is a synthetic form of allopregnanolone. Allopregnanolone is a neurosteroid. Neuroactive steroids are a group of substances that change a receptor&rsquo;s response to a stimulus by binding to them.<a href="#accordion">[4]</a>&nbsp;Allopregnanolone is best understood as a metabolite of progesterone, which is a GABA-A receptor agonist. This means that progesterone is responsible for increasing GABA functions.

The exact mechanism of the drug and of allopregnanolone is still unknown. Their enhancement of the functions of GABA (Gamma-aminobutyric acid) means that it will inhibit neuronal excitability by blocking messages that are sent to our nervous system with the help of certain stimuli. This not only aids in dealing with depressive triggers but also helps with anxiety.<a href="#accordion">[1]</a> 
&nbsp;

<ul dir="ltr">
	<li>
	<h5>Dosage And Administration</h5>
	</li>
</ul>

Zulresso is administered intravenously. The dosage is determined by your doctor based on your weight and other factors. The drug is administered over a period of 2.5 days or 60 hours and requires constant monitoring due to the risk of unconsciousness.<a href="#accordion">[5]</a> 
&nbsp;

<ul dir="ltr">
	<li>
	<h5 dir="ltr">Adverse Effects</h5>
	</li>
</ul>

Since the drug is relatively new, there are a limited number of side effects reported so far. They include:

<ul>
	<li>Dry mouth</li>
	<li>Dizziness</li>
	<li>Flushed skin</li>
	<li>Losing consciousness</li>
</ul>

<h5 dir="ltr">Important!</h5>

FDA has advised to stop the treatment of Zulresso if more serious side effects occur that may include the worsening of PPD and suicidal thoughts especially in women under the age of 25. 
&nbsp;

Current research suggests that brexanolone may interact with other CNS depressants like opioids and benzodiazepines and increase the severity of the adverse effects with regard to sedation. Alcohol consumption is also not advised due to similar reasons.

During the clinical trials, patients who were taking antidepressants also showed a more severe case of sedation as compared to the ones who did not or were a part of the placebo studies. 
&nbsp;

Conclusion

Considering the rapid onset of action with brexanolone especially when compared to the long-term treatments offered by conventional antidepressants, it is believed that brexanolone can take over the go-to therapy for PPD. However, a much more convenient way of administration would be through oral pills instead of I/V. There are still many concerns left that can only be answered through long-term data in a lesser restricted environment as opposed to a clinical trial setting.&nbsp; 
&nbsp;

<ul>
</ul>

<ul>
	<li>Current antidepressant therapies employed for PPD are based on&nbsp;long-term treatment.</li>
	<li>Brexanolone&rsquo;s onset of action is fast and has shown significant improvement in women of all ages suffering from PPD.</li>
	<li>Some women under the age of 25 were observed to experience severe side effects that even led to the worsening of their PPD.</li>
	<li>The drug is still under strict observation with the help of the REMS program.</li>
	<li>Administration coupled with the duration over which it has to be administered can make it difficult to commercialize as compared to drugs that are available in the form of oral pills.&nbsp;</li>
</ul>

[1] Allen B, Vespa PM. Antiseizure medications in critical care: An update. Curr Opin Crit Care. 2019;25(2):117-125

[2] ATP Science, 2021. HOW DOES PROGESTERONE CREATE A DOPAMINERGIC RESPONSE?. [Online] .

[3] Debra Fulghum Bruce, P., 2020. Postpartum Depression. [Online].

[4] Fala, L., 2019. Approved by the FDA Specifically for Postpartum Depression in Adults. [Online]

[5] Federal Drug Administration, 2019. FDA approves first treatment for post-partum depression. [Online]

[6] Fields, L., 2021. Which Antidepressants Treat Postpartum Depression?. [Online]

[7] Matthew Hoffman, M., 2021. Estrogen and Women's Emotions. [Online]

[8] Mayo Clinic, 2022. Postpartum depression. [Online]

Umna Salah

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;

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.

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

Are My Mental Health Symptoms Linked With HIV?

It is normal to feel depressed and sad when you have HIV, and if over time you feel the sadness is becoming worse, talk to your healthcare provider. You might require <a href="https://www.merisehat.pk/disease/depression">treatment for depression</a>.

&nbsp;

Understanding Mental Health Issues In HIV Patients

The symptoms of depression last for more than two weeks and include the following:&nbsp;

<ul>
	<li>Feeling anxious, sad, hopeless, and irritable</li>
	<li>Loss of weight or weight gain</li>
	<li>Insomnia or sleeping more than usual</li>
	<li>Difficulty in sitting still</li>
	<li>Slow-paced movement and walking</li>
	<li>Loss of interest in things you once enjoyed</li>
	<li>Tiredness</li>
	<li>Worthlessness and guilt</li>
	<li>Having a hard time concentrating</li>
	<li>Suicidal thoughts</li>
</ul>

&nbsp;

There are multiple mental health aspects that you deal with when you have HIV. Some of them are the challenges you face that are associated with HIV and its diagnosis. Moreover, suggestions on how to cope with them can also be irritating.

 
You may experience all or some of the following symptoms:

&nbsp;

<h5>1. Denial</h5>

When you are diagnosed with HIV, it can become very hard to admit the diagnosis for some people. They usually end up denying it and believe that the test results are wrong. This is a very natural and normal first reaction, but not dealing with it can be dangerous. You may end up failing at taking precautions for HIV or even starting your medication on time. So it is important to talk to your physician right away and begin the treatment, in addition to the support you need.

&nbsp;

<h5>2. Anger&nbsp;</h5>

Anger is the most common feeling when you are diagnosed with HIV. A lot of people get upset because they don&rsquo;t know how they got infected by the virus. Most of these feelings can lead to feeling overwhelmed and helpless. However, you can deal with the situation in the following ways:

<ul>
	<li>Talk to your healthcare provider about the treatment of depression, for example, therapy or medications.</li>
	<li>You should also start with HIV treatment if you haven&rsquo;t already and that will be a positive step towards treatment. Moreover, it will also help with depression.</li>
	<li>Joining a support group is also a good option because spending time with other people in a similar situation can help your feel at ease. If you don&rsquo;t want to do that, you can talk to your family and friends who are supportive.</li>
	<li>Avoid being in contact with people who make your condition worse.</li>
</ul>

&nbsp;

<h5>3. Sadness And Depression</h5>

It is completely normal to feel sad when you have HIV, and if the depression or sadness does not go away with time, you can talk to your healthcare provider. You might require treatment for depression. 
&nbsp;

<h5>4. Fear And Anxiety</h5>

When you don&rsquo;t know what to expect after being diagnosed with HIV, fear and anxiety may take a toll on your mental health. Furthermore, you may also fear telling people because you are unsure how they will treat you.&nbsp;

The fear of having the disease can make you anxious and disrupt your sleep. Moreover, anxiety can also make you feel agitated and nervous. You may also be afraid of telling people because you may fear how they will treat you after knowing that you have HIV.

You can manage the fear and anxiety in the following ways:

<ul>
	<li>Talk to a psychiatrist about the possible treatment for anxiety if the feelings are chronic and do not lessen with time, or get worse.</li>
	<li>Educate yourself about HIV.</li>
	<li>Start antiretroviral treatment or ART for HIV. When you take the required action to control your HIV, you will also protect yourself and your partners. Moreover, this can also help in lessening your fears about the future.</li>
	<li>Talk to your healthcare provider and family.</li>
	<li>Sign up for a support group.</li>
	<li>Volunteer at services that has people dealing with the same situation. This can help you in empowering yourself and can also lessen your fear.</li>
</ul>

&nbsp;

The medications that are used in the treatment of HIV and AIDS can affect your brain. When HIV infects the brain alone, it can create problems in thinking and movement. The symptoms of HIV-associated neurocognitive disorders are the following:

<ul>
	<li>Confusion</li>
	<li>Forgetfulness</li>
	<li>Sudden change in mood and behavior</li>
	<li>Weakness in the muscles</li>
	<li>Difficulty in paying attention</li>
	<li>Clumsiness</li>
</ul>

&nbsp;

<h5 dir="ltr">Important!</h5>

Tell your healthcare provider if you think you have HAND.

<ul>
	<li>Don&rsquo;t be scared to tell your healthcare provider if you feel something is wrong.</li>
	<li>Whenever you feel the symptoms are unusual, note them down and keep this information to show your doctor the next time you visit them.</li>
	<li>Building maximum support is helpful, which includes your friends, family, and healthcare providers. Although the treatment of HAND is possible, it does take some time for the symptoms to resolve or completely go away.</li>
</ul>

&nbsp;

<ul>
</ul>

<ul>
	<li>Depression and HIV are linked. Always inform your doctor if you have depression, or if you think you do. They will help you in planning the right treatment.&nbsp;</li>
	<li>Don&rsquo;t give up if one treatment does not work.&nbsp;</li>
	<li>Your healthcare provider can help you in formulating a plan which works best for you. For example,&nbsp;talk therapy, cognitive behavioural therapy, support groups, medications (including anti-depressants), and techniques to reduce stress.</li>
	<li>Remember, healing takes time.&nbsp;</li>
</ul>

&nbsp;

[1] Nanni, M.G., Caruso, R., Mitchell, A.J., Meggiolaro, E. and Grassi, L., 2015. Depression in HIV infected patients: a review. Current psychiatry reports, 17(1), pp.1-11.

[2] Tran, B.X., Ho, R., Ho, C.S., Latkin, C.A., Phan, H.T., Ha, G.H., Vu, G.T., Ying, J. and Zhang, M.W., 2019. Depression among patients with HIV/AIDS: research development and effective interventions (GAPRESEARCH). International journal of environmental research and public health, 16(10), p.1772.

[3] Bhatia, M.S. and Munjal, S., 2014. Prevalence of depression in people living with HIV/AIDS undergoing ART and factors associated with it. Journal of clinical and diagnostic research: JCDR, 8(10), p.WC01.

[4] Gonzalez, J.S., Batchelder, A.W., Psaros, C. and Safren, S.A., 2011. Depression and HIV/AIDS treatment nonadherence: a review and meta-analysis. Journal of acquired immune deficiency syndromes (1999), 58(2).

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.

AL SHIFA CLINIC KARACHI

Syed Intisar Hussain

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

Anorexia Nervosa: Answering Your Questions

At the same time that doctors in the United States and France were reporting incidents of anorexia nervosa among their patients, Sir William Withey Gull, a British physician, came up with the term to describe the disorder in 1874<a href="#accordion">[5]</a>.&nbsp;

&nbsp;

Being diagnosed with anorexia means you weigh at least 15% less than your normal body weight<a href="#accordion">[6]</a>. The disorder becomes dangerous when you lose too much weight, as a result of which health complications arise; in severe cases, even death can occur.

&nbsp;

So, yes, anorexia nervosa is a serious eating and mental health disorder that can easily ruin lives. The silver lining is you can treat it and, more importantly, you can recover from it. Of course, a full recovery is a long process; since it involves a&nbsp; therapy, behavioral modification, and nutritional education all together to not just ensure progress, but to also ensure that there&rsquo;s no relapse.&nbsp;

&nbsp;

However, the fact that the disorder is treatable is doing little to prevent it. While the overall incidence rate has remained remarkably steady over the past few decades<a href="#accordion">[1]</a>, the number of cases of anorexia are steadily - and quite alarmingly - increasing among young people (under the age of 15); whether they&rsquo;re due to early onset or early detection, it is still unclear.&nbsp; &nbsp; 
&nbsp;

<h5>Should you be worried? 
&nbsp;</h5>

Especially when modern anorexia nervosa treatment centers provide residential and outpatient treatment programs, many of which are geared specifically toward teenagers. Well, in a nutshell, yes.&nbsp;

&nbsp;

The primary reason is that most people just cannot see that they are underweight. Especially these days when, triggered by the picture-perfect social-media addicted world, a lot of us suffer from body image disturbance, i.e., we view our own body as unrealistically large and constantly negatively evaluate our physical appearance.

&nbsp;

Did you know, that&rsquo;s a key symptom of anorexia nervosa? Where you or your kid frequently concentrate on body parts, trying to get rid of &lsquo;excess&rsquo; weight in a specific area of the body. &lsquo;Trying to get rid of it&rsquo; because let&rsquo;s face it - your attempts will fail; according to scientific evidence, spot reduction is just not possible. But, as anorexics, you won&rsquo;t think that way and you will keep on analyzing different body parts that you think need to be &lsquo;slimmer&rsquo;. 
&nbsp;

If you can identify this trait in yourself or in your child, contact your doctor or an eating disorder specialist immediately. The earlier you begin treatment, the better your chances are at overcoming anorexia nervosa.&nbsp;

&nbsp;

But, that&rsquo;s not all. Let&#39;s have a look at some commonly asked queries about <a href="https://merisehat.pk/disease/anorexia-nervosa">anorexia nervosa</a>.

<div>&nbsp;</div>

Understanding FAQs about Anorexia Nervosa

<h5 style="margin-left:0px; margin-right:0px">What Happens to your Body in Anorexia?</h5>

&nbsp;

Besides the mental pressure, your body is deprived of the necessary energy due to malnutrition. As a result, your body&#39;s normal functioning will slow down, which will further affect your health in various negative ways.

&nbsp;

One of the complications of anorexia is your body&#39;s organs will stop working, especially in the later stages. For instance, if your blood test shows elevated levels of liver enzymes, then that&rsquo;s an indication of organ failure. Also, the electrolyte imbalance and fluid loss in the body induced by malnutrition can affect the heart, kidneys, GIT, and brain<a href="#accordion">[7]</a>. 
&nbsp;

<h5 style="margin-left:0px; margin-right:0px">Will Anorexia Damage your Brain?</h5>

<h5>&nbsp;</h5>

Anorexia is a mental health condition characterized by compulsive food restriction. Many anorexics reportedly have cognitive problems as a result of their restricted diet. In severe cases, it does lead to brain damage. 
&nbsp;

<h5 style="margin-left:0px; margin-right:0px">Is Anorexia Nervosa an Inherited Disorder?</h5>

<h5>&nbsp;</h5>

Although it&rsquo;s considered a psychological issue, the eating disorder frequently runs in families, implying that it has a genetic component. Researchers have discovered 2 genes that help determine the risk of having the disease<a href="#accordion">[8]</a>. Furthermore, studies have also shown that if your parents, siblings, or even your child is anorexic, then the risk of you having the disorder is also high - at least, 10 times higher than those who have no family connection whatsoever to the eating disorder<a href="#accordion">[9]</a>. 
&nbsp;

<h5 style="margin-left:0px; margin-right:0px">What is the Normal age of Onset?</h5>

<h5>&nbsp;</h5>

Anorexia nervosa has recently been observed in children as young as 6. However, the normal age of onset is 14-21<a href="#accordion">[10]</a>. Most girls are likely to develop anorexia nervosa when they are around the age of 15<a href="#accordion">[1]</a>. These are critical developmental years; therefore, adolescent anorexia nervosa treatment is necessary in this case. If your anorexic kid is an adolescent, it is usually best to look for a treatment tailored to this age group.&nbsp; 
&nbsp;

Anorexia can affect anyone, but it is much more common in females and girls. It usually occurs in teenage or early adulthood. 
&nbsp;

<h5>When should you Worry about Anorexia? 
&nbsp;</h5>

You should be worried if:

<ul>
	<li>You are constantly preoccupied with dieting, food, calories, and weight</li>
	<li>You make a lot of complaints about being &quot;fat&quot;&nbsp;</li>
	<li>You refuse to consume entire food groups, such as carbohydrates 
	&nbsp;</li>
</ul>

<h5>Which Doctor should you see for Anorexia Nervosa? 
&nbsp;</h5>

In addition to an eating disorder therapist, it is necessary to seek the advice of a psychiatrist. 
&nbsp;

<h5>What Effects does Anorexia have on your Personality?</h5>

&nbsp;

Have you felt an increased level of harm avoidance of late? That is a personality trait characterized by worry, negative thinking, doubt, and shyness. And you&rsquo;ll be experiencing it if you suffer from anorexia. 
&nbsp;

<h5>How&rsquo;s Amenorrhea Linked to Anorexia Nervosa?&nbsp; 
&nbsp;</h5>

If you are restricting your caloric intake through excessive diet or excessive exercise, your body won&rsquo;t be able to obtain the nutrition it needs to function; your hormone levels will drop and your periods will stop. This absence of periods is known as amenorrhea and it will affect you once you lose a certain amount of weight. 
&nbsp;

<h5>Can Anorexic Women Recover and Become Pregnant? 
&nbsp;</h5>

A complete recovery from anorexia means you will have a better shot at pregnancy. This is because as an anorexic woman, you&rsquo;ll neither menstruate nor ovulate<a href="#accordion">[11]</a>. As a result, it&rsquo;s more difficult to become pregnant at that stage. 
&nbsp;

<h5>Can Anorexia Harm Your Baby during Pregnancy? 
&nbsp;</h5>

If you do become pregnant while you&rsquo;re still anorexic, both you and your baby will suffer. It&rsquo;s highly probable that you have a premature delivery and your baby has a low birth weight. Moreover, it&rsquo;s a complicated pregnancy because anorexia can lead to a miscarriage or it can require an emergency Caesarean section; as an anorexic mom-to-be, you will also be more vulnerable to postpartum depression<a href="#accordion">[11]</a>. 
&nbsp;

<h5>What Effects will Anorexia have on a Male Body? 
&nbsp;</h5>

Anorexia causes a decrease in the male hormone testosterone and vitamin D. Testosterone contributes to the strength of muscles and bones. Low testosterone is directly linked to loss of bone mineral density and anorexic males experience it more than female anorexic patients<a href="#accordion">[7]</a>. 
&nbsp;

<h5>Does Anorexia Nervosa Trigger Hair Loss? 
&nbsp;</h5>

Hair loss is frequently linked to eating disorders like anorexia nervosa. This is because of the eating-related behaviors practiced by individuals with these conditions, such as starvation, self-induced vomiting, decreased food intake, and over-exercising, that cease nutrient intake and/or cause trauma or shock to trigger hair loss. 
&nbsp;

<h5>Does Anorexia Nervosa cause Seizures?&nbsp; 
&nbsp;</h5>

Seizures do not occur in every case of anorexia, but they are serious side effects that you should not ignore. Even if you do not have epilepsy or another epileptic condition, you may experience seizures due to anorexia.&nbsp; 
&nbsp;

<h5>Is Anorexia a Permanent Disorder? 
&nbsp;</h5>

You can reverse many temporary effects of anorexia if you and your doctor are able to diagnose and start on its treatment early. However, if it&rsquo;s left untreated for an extended period, anorexia can lead to a variety of long-term health issues, some of which are irreversible. 
&nbsp;

<h5>Can you overcome Anorexia Nervosa? 
&nbsp;</h5>

Although anorexia nervosa is a serious illness that can cause various health issues or even death when left untreated, recovery is possible with the assistance of eating disorder treatment specialists. This is why it&rsquo;s critical to educate yourself and begin your recovery process as soon as possible. 
&nbsp;

<h5>Do You need Hospitalization? 
&nbsp;</h5>

As an anorexic, you can experience severe, life-threatening weight loss. If your doctor believes that your life is in danger and they have no other choice, they may forcibly hospitalize you for better treatment. 
&nbsp;

<h5>Is Medication Beneficial for You?&nbsp; 
&nbsp;</h5>

No medications are approved for anorexia because none of them are effective.&nbsp;

&nbsp;

However, antidepressants and other psychiatric medications can help you deal with different mental health disorders, for example, depression or anxiety<a href="#accordion">[12]</a>. 
&nbsp;

<h5>What&rsquo;s the Prognosis of Anorexia Nervosa? 
&nbsp;</h5>

According to research, the standardized mortality ratio (SMR) for females is 15.9 and for males it&rsquo;s 22.4, with older age being a significant predictor of mortality. The mean age at death of an anorexic person is 41.3 years<a href="#accordion">[13]</a>. 
&nbsp;

<h5>How Often does Anorexia Lead to Death? 
&nbsp;</h5>

Anorexia can be dangerous to your health to the extent of causing death. Reports vary greatly, but generally the mortality rate ranges from 5-20%. Recent meta-analyses revealed a rate of 5.9%<a href="#accordion">[3]</a>. 
&nbsp;

<h5>How Long does it Take to Recover from Anorexia Nervosa?&nbsp; 
&nbsp;</h5>

No two people will be affected by anorexia the exact same way. Therefore, no two anorexia treatments will be the same. However, reportedly it takes a young anorexic patient anywhere between 6 months and 2 years to achieve complete healing<a href="#accordion">[14]</a>. 
&nbsp;

<h5>What is a Reasonable Goal for a Patient Suffering from Anorexia Nervosa? 
&nbsp;</h5>

The primary goal of your treatment should be to regain a healthy weight. You will not be able to get better from anorexia unless you return to a healthy weight and learn to consume appropriate nutrition.&nbsp; 
&nbsp;

The Netflix film &quot;To the Bone&quot; (2017) is a semi-autobiographical story about a 20-year-old girl struggling with anorexia nervosa and her recovery. It&rsquo;s a good representation of the various behaviors that may be displayed by someone suffering from an eating disorder.&nbsp;

&nbsp;

If you or someone you know is suffering from anorexia, don&rsquo;t sit there assuming that they&rsquo;re aware of their condition and will know when to ask for help. Anorexics often underestimate the severity of their illness and are hesitant to seek treatment. Early involvement schemes, such as education and screening, are critical to prevent persistent malnutrition, long-term health problems, and death.&nbsp; 
&nbsp;

<ul><li>Low body weight, a fear of gaining weight, and a distorted body image can all be symptoms of the potentially fatal eating illness anorexia.</li><li>Although it can afflict people of many ages, genders, races, and body types, anorexia is most frequently found in young women.</li><li>Anorexia can be treated successfully. Early assistance can aid in rehabilitation.</li></ul>

[1] van Eeden AE, van Hoeken D, Hoek HW. Incidence, prevalence and mortality of anorexia nervosa and bulimia nervosa. Curr Opin Psychiatry. 2021;34(6):515.

[2] Silén Y, Sipilä PN, Raevuori A, Mustelin L, Marttunen M, Kaprio J, et al. DSM-5 eating disorders among adolescents and young adults in Finland: A public health concern. Int J Eat Disord. 2020;53(5):790–801.

[3] Neumärker KJ. Mortality and sudden death in anorexia nervosa. Int J Eat Disord. 1997 Apr;21(3):205–12.

[4] Wu H, Van Dyck-Lippens PJ, Santegoeds R, van Kuyck K, Gabriëls L, Lin G, et al. Deep-brain stimulation for anorexia nervosa. World Neurosurg. 2013;80(3–4):S29--e1.

[5] Till C. The quantification of gender: Anorexia nervosa and femininity. Heal Sociol Rev. 2011;20(4):437–49.

[6] Anorexia nervosa:symptoms, causes, diagnosis, treatment. WebMD.

[7] Mehler PS, Brown C. Anorexia nervosa - medical complications. Journal of eating disorders.

[8] How eating disorders are inherited. Science.

[9] Holland K. Is anorexia genetic? Healthline.

[10] GAfor. A beginner's guide to understanding anorexia nervosa. Resources To Recover.

[11] Anorexia nervosa. Anorexia nervosa | Office on Women's Health.

[12] Anorexia nervosa. Mayo Clinic.

[13] Yager J, Gaudiani JL, Treem J. Eating disorders and palliative care specialists require definitional consensus and clinical guidance regarding terminal anorexia nervosa: Addressing concerns and moving forward. Journal of Eating Disorders. 2022;10(1). doi:10.1186/s40337-022-00659-x

[14] Lauren Muhlheim PD. Why full anorexia recovery is crucial for Brain Health. Verywell Mind.

Neelam Asad

Body Weight Exercises For Strength Training

Body weight exercises mean using your own body weight as resistance to train your muscles. If you’re someone who has never worked out a day in their life, doing bodyweight exercises is the perfect place to start. It’s great for building strength, endurance, balance, coordination and a nice lean muscular body. They are super convenient, can be done anywhere, costs no money and requires no equipment. There are also lower chances of injury that you might get with lifting weights that are too heavy. Another great thing about this mode of exercise is that you can easily mix and match or modify them according to your liking. You don’t have to get perfect at it from the get go and can start any of these bodyweight exercises at the beginner level. Once you perfect your technique, range of motion and your form you can move on to either the normal or tougher variations of these. Some of the easiest and most useful body weight exercises you can do anywhere and anytime are listed below. Most of these can be done in 3 sets with 12 – 15 repetitions.&nbsp;

Planks

&nbsp;This is one of those perfect exercises that challenge multiple muscle groups at once and are super easy to do. They can train muscles in you upper back, shoulders, arms, abs, oblique’s, glutes and quads while helping you work on your stability. They are also great for improving posture and provide your spine that much needed stability by strengthening core muscles, this means no more back pain!&nbsp;The correct way to do a plank is to make sure you are balancing yourself on your toes and elbows, if your are doing arm planks then you are supposed to balance yourself on your palms (start off in a pushup position) while keeping your core tight and your back straight. You can do elbow planks as a beginner or put your knees on the ground to make it easier. If you want to increase difficulty you can do either an active plank which requires you to flex and extend your abdomen or a marching plank where you balance yourself on alternate feet and arms. And no you don’t have to be able to hold a 1 minute plank in your first attempt. You can start off with as little as 20 seconds and build your capacity from there.&nbsp;

Side Planks

This is great for your obliques which usually get ignored amongst all the ab exercises. It also engages your glutes and shoulder muscles and is an overall effective body weight exercise. All the same rules as the plank apply, you can start with a 20 second side plank and you can start at beginner level.&nbsp;The correct way to do this is by putting one elbow on the floor and facing the front of your body entirely to one side while balancing yourself on your feet. You can drop down one knee to make it easier. If you are pro you can do an active side plank by adding a hip dip to make it tougher and challenge more of your muscles.&nbsp;

Mountain Climbers

&nbsp;Another exercise that engages and works multiple parts of the body including your core, abs, obliques, arms, back and shoulders. These can be done in sets of 3 with however many reps you&rsquo;re comfortable with (start with 10/15 and build up to 30). Since this is an active exercise that you can either slow down or speed up, it does give you similar benefit as <a href="https://merisehat.pk/article/why-is-both-cardio-and-strength-training-important-for-a-total-body-workout">doing cardio</a> by getting your <a href="https://merisehat.pk/page/sehat-scan/">heart rate</a> up and making you sweat.&nbsp;

In order to perform mountain climbers you start off in a push up stance, make sure your back is straight and nothing is sticking up, pick your feet and bring your knees to your chest. You can also bring alternate knees to your chest to engage obliques.&nbsp;&nbsp; 
&nbsp;

Squats

&nbsp;The most dreaded yet the most beneficial of exercises perhaps, squats work your lower back, glutes, quadriceps, hamstrings and calves. They also help you burn calories and are great for your joints Although there are a ton of variations of squats but here we are going to discuss the basic squat technique. You start off with your feet a little more than your shoulders’ width apart, you can extend your arms in the front, palms facing the ground and lower down slowly making sure you put all your weight on your heels. Depending upon your flexibility, balance and coordination you can go down as much as possible but note that the deeper your squat the better it works. Now after holding this position for 5 seconds or more, slowly come back up to your original standing stance. You can hold onto something in front of you for example a kitchen counter top in order to make it easier to get back up. Or, to make it tougher, you can stop coming back up entirely to a standing pose before going back into a squat.

Lunges

The first noteworthy thing about lunges is that Jennifer Lopez prescribes them to get a body like hers. The second noteworthy thing is that they work your abs, back, quadriceps, glutes, calves and hamstrings while also helping you lose weight and build up more coordination and balance. These can be forward lunges, reverse lunges, side lunges or one of the countless other variations.&nbsp;Let’s see how to do a basic stationary lunge: you stand in the same wide stance with your feet parallel to each other as you do at the beginning of a squat, hold your arms either in front of you or put them on your hips, lift up one leg and put it in front of you as far as you can go, bend your knee at a 90 degree angle and slowly lower yourself while keeping your upper body straight. As a beginner this is the easiest body weight exercise you can start off with. To make it tougher put one leg up onto something behind you before going into a lunge.&nbsp;

Pushups

The classic pushup works your chest muscles (pectorals etc.), shoulders, arms (triceps, deltoids), glutes, quads and abs. It’s also great for your back and joints. It has quite a few variations too and can be simplified for those who are just starting off.&nbsp;&nbsp; In order to do a pushup you first need to get on all fours and position your arms just a little wider than your shoulders, make sure you keep your elbows lax because this is where the movement will be, keep your back straight and core tight and slowly lower your chest to the ground as far as you can go. Your elbows should end up at a 90 degree bend. Beginners can start with wall pushups as it still engages your core and works your glutes, abs and quads or you can drop down to your knees and perform the rest of the pushup as it is. If you have been working out for a while and consider yourself a pro, you can make it harder by doing a lifted pushup which requires you to keep your feet up on an elevated surface. This helps you put more weight on your hands.&nbsp;&nbsp;

The relationship between weight gain/loss and depression is a multifaceted and intricate interplay that has garnered significant attention in recent years. While it is well-known that depression can impact appetite and eating patterns, the connection extends beyond simple cause-and-effect. In this article, we delve into the complex relationship between weight and depression, exploring the factors involved, potential mechanisms, and the importance of addressing both aspects in achieving holistic well-being. 
&nbsp;

&quot;I wish someone told me there was more to life than just eating food,&quot; says 39-year-old Nariman Khan, a mindfulness meditation instructor based out of Islamabad. &quot;I had always been chubby but my weight ballooned in my 20s. I tried all kinds of crazy diets and would always end up with a tub of ice cream at midnight, binge eating until I finally felt full.&quot;&nbsp;

And as a result, Nariman would pack on more pounds, suffer from severe self-esteem issues, and avoided meeting people and going out. &quot;It took me years to realise I needed to love myself in order to really feel full,&quot; she adds. &quot;And once I did, I could do what was good for me, insteading of approaching weight loss as a form of punishment, it became self care. Our mental health is very closely linked to our weight gain or loss. It goes both ways.&quot;&nbsp;

&nbsp;

Bidirectional Impact between Weight and Depression

The Bidirectional Influence: Weight gain/loss and <a href="https://merisehat.pk/disease/depression">depression </a>often interact in a bidirectional manner, with one influencing the other and vice versa. On one hand, individuals experiencing depression may find solace in comfort eating, leading to weight gain. Depression can also cause a lack of motivation or energy, resulting in a sedentary lifestyle and further weight gain. On the other hand, weight gain itself can trigger feelings of low self-esteem, body dissatisfaction, and contribute to the development or exacerbation of depressive symptoms. Similarly, weight loss due to depression may stem from loss of appetite, decreased interest in food, or changes in metabolism. 
&nbsp;

Psychological Factors: Psychological factors play a vital role in the relationship between weight and depression. Negative body image, low self-esteem, and distorted perceptions of one&#39;s physical appearance can contribute to both weight gain and depressive symptoms. Society&#39;s emphasis on thinness as an ideal, coupled with social pressures and stigma, can exacerbate these psychological factors and create a vicious cycle. Additionally, emotional eating as a coping mechanism for managing <a href="https://merisehat.pk/disease/stress">stress</a>, sadness, or other negative emotions is common, further influencing weight gain and emotional well-being. 
&nbsp;

Biological Mechanisms: Biological mechanisms, such as hormonal imbalances and neurotransmitter dysregulation, also contribute to the relationship between weight and depression. Stress-related hormones, such as cortisol, can impact appetite, food cravings, and fat distribution in the body. Furthermore, neurotransmitters like serotonin, which are implicated in mood regulation, appetite control, and satiety, can influence both weight and depressive symptoms. Imbalances in these biological factors can create a complex feedback loop, perpetuating weight gain/loss and depressive states. 
&nbsp;

Treatment Approaches: Addressing the relationship between weight gain/loss and depression requires a comprehensive approach. Effective treatment involves targeting both mental health and physical well-being simultaneously. Integrated treatment strategies may include:

<ol>
	<li style="list-style-type:decimal">Psychotherapy: Cognitive-behavioral therapy (CBT) and other evidence-based approaches can help individuals develop healthier coping mechanisms, manage emotions, and improve body image.</li>
	<li style="list-style-type:decimal">Medication: Antidepressant medications may be prescribed to manage depressive symptoms, with consideration given to potential effects on weight.</li>
	<li style="list-style-type:decimal">Lifestyle Changes: Encouraging regular physical activity, adopting a balanced and nutritious diet, and promoting healthy sleep patterns are crucial in addressing both weight and depression.</li>
	<li style="list-style-type:decimal">Support Networks: Building a strong support system, including friends, family, or support groups, can provide emotional support and practical assistance throughout the recovery process.</li>
	<li style="list-style-type:decimal">Professional Guidance: Collaborating with a multidisciplinary team comprising mental health professionals, nutritionists, and physicians can ensure a holistic approach tailored to the individual&#39;s needs. 
	&nbsp;</li>
</ol>

bottom Line

The relationship between weight gain/loss and depression is a complex interplay involving psychological, biological, and social factors. Recognizing and addressing this intricate connection is vital for comprehensive well-being. By integrating mental health support, lifestyle changes, and a holistic treatment approach, individuals can work towards achieving both physical and emotional wellness. Through increased awareness and a compassionate understanding of this relationship, we can foster a more inclusive and supportive environment that prioritizes the overall health of individuals struggling with weight and depression.