Over Weight is now a main issue of great concern in our day to day life,whether child or adult or a retired person or old every body now is concerned for this.It is a known fact that Overweight is related to bad physique,uglylooking,inferiority complex,a psychological complex leading neropsychiatric disease mixed with anxiety,depression, sleepnessness,bad performance in day to day activities,less concern for education,sports ,l azyness and no interst in personal and physical meeting leading to overeating and viceversa gaining more weight.Beside this aspect of Weight concerns in our middle aged and youngesters,it is of our concern in aged person as it is directly related to Diabetes,Hypertension(High BP)leading cause of more hear attack,Chest pain,Storke and paralysis, Kidney Failure,clogging and blockage of Arteries, changes in vision,sedantry habits,addictions, psychosomatic and sexual diseases beside arthritis,pain over heels and knee joinst and over accidents and skin diseases.

I know each and everyone of us (including me) at some point in our lives are fighting the “battle of the bulge”, hence it is a worth writing on this topic.
Another reason for this writing is the fact that notwithstanding the “magical guaranteed weight loss” as advertised as we regularly see in print or electronic media,internet or socalled practitioners of different types like yoga,acupressure,reki,physical educator,gyms and physical training centres, Exercise centres and instrument sellers and companies of different type of weight reducing machines and devices and beauty ayurvedic,homeo and ingenious and allopathic centres are claiming and attracting every set of people and now senior Doctors are running a camp of Obesity reducing surgeries through laproscopes (Mini Hole surgeries )with a surest gurantee of melting down few KGS in few days.But is it so easy! or so safe without any side effects ? Let me be a party pooper here by saying emphatically…there are no and I mean NO SHORT CUTS.EVERY TIME WE RESORT TO THESE DEVICES EITHER MOST OF THE ARE SHORT LASTING OR WE HAVE TO BEAR SOME SIDE EFEFECTS IF WE ARE NOT VERY MUCH DEDICATED FOR OUR EFFORTS TO REDUCE OVERWEIGHT SERIOUSLY,SO WE GAIN WHAT WE LOOSE IN EARLY DEDICATION.

So let us see why this is such a big problem and what are some of the factors that play a role in weight gain. I would call it weight gain rather than obesity because the term obesity does not include overweight people by definition.

This brings us the fundamental question, when would one be called normal / overweight/ obese or morbidly obese? This classification is based on BMI or Body Mass Index, which is basically a product of a person’s bodyweight divided by a person’s height. A BMI of 18-25 is normal, 25-28 over weight, 28-35 obese and above 35 morbidly obese.

You can calculate your BMI using this online link on any health portal website.


Why does one gain weight? This is a question the answer to which each and everyone wants to know, because if we know the answer to this, very easily we can avoid the causes thereby avoiding weight gain.

Sounds pretty simple, doesn’t it?? Sadly it isn’t that simple.

But to take a common analogy that I give to my patients’ weight gain is like a bank balance, there are only to ways to increase your bank balance (weight) either you earn more (increased intake) or spend less (decreased output).

But sadly I’m sure all of us agree it’s easier to gain weight (except for the lucky few who have genetics on their side), than increase your bank balance. Now once we have the grass root level basic fundamental cause of weight gain let us examine a few reasons as to why and how it actually happens.

INCREASED INTAKE / WRONG INTAKE / IMPROPER INTAKE

As you can see from the heading, it is not only increased intake but also the intake of wrong kinds of food and improper intake, which also contributes to weight gain.

1.Over eating: Though most of us tend not to agree to it, it is often the most common cause for weight gain. Every time you have that extra spoonful, it adds up in the long run. It is said that after a meal one should feel that he can have a little more…. that, is the time one should stop. But more often than not, we stop when we feel full and that is already too much.

2. Fast food: Fast food is fast to make and convenient to eat can be eaten on the move but more often than not is full of fats/cheese & salt.
Anyone who has read science in school knows that fat has more calories (9Kcals/gm) as compared to protein (4Kcals/gm) or carbohydrates (4Kcals/gm). So, the more fats you eat the more calories you are putting in. Carbohydrates are easy to absorb and after your basic energy requirements are met, are converted to fat for storage.

Chips – a favorite amongst most is another common cause. An old saying for them, which holds very true, is “ A minute on your lips & a lifetime on your hips”, hence avoid them.
Increased salt intake causes more water retention in the body and hence is also an important factor for weight gain.

3.Improper timing: The time of a meal also is an important factor. Food should be eaten at least 2 hours before one goes to bed to allow digestion to occur properly. So, siesta’s after a heavy lunch or eating just before going to bed are not such good ideas after all.
There is research also to suggest that, the later in the night one eats, the more chances are that all that food is being converted to fat. So, having “ a midnight snack or munchies” is again not such a great idea.

4.Alcohol: Alcohol has often been blamed for gaining weight but the gain in weight is more related to the increased snacking, which goes along with consumption of alcohol.

5.Fizzy Drinks: These are aerated drinks with empty calories, which are of no use and add up to the over all “Bank Balance of Calories”. Instead, substitute it with fresh fruits or fresh lime, which is much healthier but of course try and avoid excess salt or sugar in them.

DECREASED OUTPUT:

This is now turning out to be an important part of the whole weight gain process, especially so in youngsters and children.

1.Sedentary lifestyles: Now with the comfort levels increasing, activity has reduced. We use the lifts instead of stairs, vacuum cleaners instead of brooms, cars instead of walking, etc. The amount of calories burnt per day is decreasing with more mental activity than physical.
Some amount of physical activity is needed daily to keep the Basal metabolic rate higher so that you can burn more calories. Of course though ideal, considering family and work pressures, it is understandable that a regular gymming schedule is not always possible.
But, one can incorporate small things into the daily schedule to increase the output like taking the stairs instead of the lift, walking to the nearby store instead of driving, morning or evening walks, etc which do not take up too much of your time but help in spending those calories.

2. Children especially should have some regular physical activity in their daily schedule or we are going to be waking up to a generation of overweight youngsters. It is already happening in the west and is a major health hazard. We can see it happening around us in India too.

Real games instead of Video Games, fruits instead of chips or pizza & fruit juices instead of a fizzy drink should be the mantra for the kids.

MEDICAL CONDITIONS FOR WEIGHT GAIN:

There are a few medical conditions that can be a cause for weight gain. These are usually hormonal imbalances. The most common being:

1.Hypothyroidism: Here there is a decreased secretion of “Thyroid Hormone” which is responsible to maintain the Basal Metabolic Rate and hence there is a tendency towards weight gain. This is a treatable condition and after proper tests to find out the hormonal levels, replacement of the hormones causes a reduction in weight.

2. PCOD: Poly Cystic Ovarian Disease or PCOD is another condition associated with weight gain. Here again the hormonal imbalances cause weight gain and the weight gain in turn worsens the PCOD. Medical & surgical options are available for treatment of this condition. A curious thing seen here is that weight reduction helps with the gyneacological condition with normalization of hormones.

3. Adrenal Hormonal Imbalance: This also can cause weight gain because of water retention.

WEIGHT GAIN & DIETING

A lot has been written n said about dieting and weight loss. Every other person is an expert in some sort of a diet. But a recent study has brought the proper perspective, as I have been saying for quite some time now, its not what kind of a diet you follow but the total intake versus the total output.

So whether it’s a low carb diet, a low fat diet or an only protein diet, it doesn’t really matter. What matters is,the total amount of calories going in.

Crash Dieting is a not a way to loose weight at all. You might loose weight initially but you are loosing muscle bulk and replacing it with fat. And most of the food that one eats gets converted to fat directly because of the body’s survival mechanisms. Secondly, with crash dieting there is a tendency to alternate binging with crash dieting and this doesn’t help.

So, what one needs is a proper balanced diet according to the work he or she does, which has all the necessary nutrients.

TREATMENT OPTIONS

I’m sure all of us have heard or read quite a bit on the treatment options. I’m not going to discuss exercise, lifestyle modification and diet control which are essential to all treatments as an adjunct.
For the ease of understanding, I will divide the treatment options according to the BMI.

BMI of 25-28(30) – Overweight Category:

This is the category for which we have the most number of options.

1. Isometric Exercise/ Non Surgical Body Contouring – This is an option where in, with the help of targeted muscle stimulation & Infra red waves, isolated areas of the body are treated to achieve targeted contouring and inch loss. Here the patient comes in twice or thrice a week to the center, where the machine does the work for them and helps to achieve targeted contouring.

Very good for people in whom muscle laxity is a cause for bad body contour especially in the tummy area. Also very good immediately post pregnancy to help reduce the flab and tighten the muscles which have become loose post pregnancy and child birth

2. Ultrasonic Lipolysis: This involves breaking down the fat cells directly with the use of a non-invasive ultrasonic wave. The patient comes in once a month for the treatment, which lasts 45 mins to an hour. The released fat has to be reabsorbed and excreted by the body. It works well for small isolated areas like the saddlebags, lower tummy. This doesn’t work for large areas.

3. Injection Lipolysis or MESOTHERAPY: This involves giving multiple injections in the target areas to help dissolve fat in that area. The injection is usually of a derivative of Soya protein, which helps the cell membranes of the fat cells to break down and release the fat into the body. This is absorbed by the body and excreted.

It requires injections maybe once a month for 4 or 5 times. It works well if given properly and for small areas like the double chin or the saddlebags. Contrary to what people might claim it is not for large areas. Complications in the form or small injections abscess or collections of liquefied fat, which may require drainage, are occasionally seen.

4. LASER Lipolysis: This is a minimally invasive procedure which involves insertion of a small LASER probe in the affected area help break down the fat cells in the track of the probe thereby releasing fat into the body which is reabsorbed and excreted. This is also an office procedure and requires multiple sittings maybe a month apart.

Works well again for isolated areas like double chin, cheek fat, saddlebags, arms, etc. Large volume Lipolysis again is technically possible to a certain extent but not practical. The patient does need to use pressure garments, should have the patience to wait for the results for a few months and of course undergo multiple sittings.

5. Liposuction: This is a surgical procedure where a cannula is inserted under the skin by small 1-1.5 cm incisions in hidden areas to suck out the fat. This again is a procedure for body contouring. Though one does loose weight, he will loose more in inches

There are various techniques like the mechanical, ultrasonic, VASER, power assisted. All these are different methods of suction depending on the type of probe used to breakdown the fat cells.

As regards to the technique there is also the tumescent technique which is the preferred technique nowadays and basically involves infiltrating large volumes of saline along with some drugs to help minimize bleeding and trauma to other structures in the vicinity.

Liposuction can also be classified according to the volumes to be removed. Small, moderate or mega liposuctions. Small volume suction can be done under local anaesthesia. Moderate volumes can be done under local anaesthesia with sedation or general anaesthesia depending on the patient’s comfort level. Mega liposuctions require anaesthesia, hospitalizations and in some rare instances blood transfusions.

Internationally, the accepted volumes of fat that can be safely sucked out at one sitting is @ 8% of body weight in men and @ 9-10% of body weight in women. This is because of the fact that men tend to have an equal amount of fat inside the abdomen, whereas in women most of the fat is extra abdominal and also the fat that men have more fibrous fatty deposits. Hence, women are good candidates for liposuction.

Problems after liposuction are because of the swelling. Here as the fat is physically being sucked out, the effects are noticed immediately, but in a few days swelling sets in and takes around a month before significant changes can be felt. This also depends on the areas targeted and the amount removed. Full healing takes around 3-4 months and during this period the patient needs to wear a pressure garment to help the skin shrink. Some amount of unevenness maybe present which gradually settles with time and massages.

Rarely in smokers, there maybe areas of skin necrosis. Sometimes especially with large volume liposuctions, there maybe some collection of fluid called seroma’s which might require drainage.

BMI of 30-35 – Obese Category:

This category is the so-called “Grey Zone” of weight loss treatments. As these patients are not yet candidates for a Bariatric procedure and the procedures for the overweight category cannot fully help in treating these patients. But increasingly we are seeing patients in this category.

In these patients it has to be a combination of procedures and sometimes multiple sittings are needed to get the desired changes.

More often than not we do large volume liposuction in such cases, maybe one or two sittings with a gap of 6 months in between combined with a proper diet and exercise schedule. The procedure of Liposuction has already been discussed.

BMI of 35 and more – Morbidly obese Category:

These patients have other metabolic problems along with the fact that they are overweight. These are candidates for Bariatric procedures that are procedures aimed at reducing the intake drastically (Gastric banding or Sleeve gastrectomy) or reducing absorption of food (Gastric & Duodenal bypass procedures).

These are major surgeries and have to be done in specialized centers and involve a multidisciplinary approach with the involvement of plastic surgeon, gastroenterologist, psychiatrist, dietician, physical therapists, anesthetists, etc. This itself is a topic by itself.

The aim of this blog was to try and bring things into perspective for a person looking at weight loss or to just get in shape. Ultimately, “ a Stitch in time does save Nine”! So the earlier we wake up to the fact that weight is becoming a problem to all of us, the better it is. If not to reduce, at least try and modify our lifestyle and being about some changes in how we do things, it might help prevent the problem from becoming worse, where a much more drastic and major procedure might be required.

As you must have seen in the course of the blog that, this is not a simple topic and I have not even scraped the surface of the problem. But, the aim is to try and simplify things so one can understand what are the little things we can do to bring about a bigger change.

Whatever said and done, all the procedures are only an adjunct to lifestyle modification to get the full benefits in the long run. Change in dietary habits, maintaining a negative intake output balance, increasing physical activity will all go a long way in helping one keep fit and stay healthy.Simple formula is enought your ouput or expenditure should be more than your input or intake,a strong mind with dedication brings change drasitically but one fact is common in India after heart attack or Kidney failure or Stroke many Obese becomes thin dur to strong dedication and confrmed rigid power of determination to reduce weighrt ,so be positive result must come.


So let us bring about the change… by being the change!!!!
DR.D.R.NAKIPURIA
SILIGURI

Healthy Greens is the sogan which is heard everywhere because we know this green by absobing noxious carbondioxide excreted by all living animals of world and by giving oxygen to breathe, bringing rains,wood,forest,fetilising our soil, conserving soil,forest and human Eco atmoshphere preserve us and our Earth by keeping intact our Glaciers and ozone layers save us from ultra violet radiation of this Universe leaving no hazard of its decomposition like of man made plastic materials.
In this article,we shall like to discuss the importance of a beverage in the form of "TEA" which is most prevalent in our country as well as almost in every part of world where it is consumed by almost every family twice a day or being offered to every guest coming to home/business centre or any other interaction in our day to day personal or social gathering.
Green Tea which is directly plucked as fresh upcoming triplet Leaf from a Tea Bush or plant (First Flush,i.e.,First sesonable tea in month of April May every year from a Plant after a rest of 03-4 months shrugging off its old leaves completely form Hilly tops of darjeeling or Assam Valleys) are very rich source of Many Anti Oxidants which burns fat of our body reduce bad Cholesterol,Open or dilate our blood vessels ,prevent ,Prostate cancer(Prooved by study in Mice from Dr.Chan in USA)Lung cancer reduce recurrence of Breast,Stomach,Colorectal Cancer prevent Strok,Heart Attack and Diabetes Mellitus.This Green Tea leaves like Black tea leaves are not crushed or withered,steamed and fermented and powdered to form Blak tea or Oolong tea but here leaves are dried and preserved for making tea.
For drinking this tea we have to boil one or two or three cups of Water as per our requirement but small preparation is good and then put some Green leaves inside it (or 3/4 tsf or one tsf Green Tea )as per concentration needed and then allowed to get these leaves shocked into this water for few minutes and then we can add sugar or sugar free tablets and lemon inside it (Not MILK AS IT HAS BEEN PROOVED THAT MILK DILUTES THE BENEFICIARY AFFECT OF THIS GREEN TEA OXIDANTS) and allow it to cool for few minutes and then drink it slowly taking few minutes not very hot and not in just few seconds.the Top variety of Tea Garden,More HILLY terrain where water is less logged and stayed but comes and go under cold temperature with high humidity or tea organic where not fertiliser used to produce it are of best variety but their cost some time is very high thousand rupees per kg .Usually Black Tea should be taken twice a day or two cups a day ,it should be used as food supplement not as Drug .It has been prooved that Caffienated Black Tea is more important as it burns our fat and reduce bad cholesterol LDL markedly.
Tea beside containing "Tanins" which are not very useful contain "CATECHINS" OR EGCG(Epigallo catechins 3 gallate ) compond and Antioxidant which is responsible for dilating Blood Vessels,burning Fat (reducing Atherosclerosis,Reducing Cholesterol thus preventing Hear attack,Strok and Prevent cancers ) like other good Anti oxidant substance like red wine,Grapes,Berries,and Dark Chocolate. But out of all these Tea is more consumed in almost every household of our Human world so this should be more included as our foos supplement.

Green tea was first brewed in China, where it was known as a 'miracle medicine'. In her book, Green Tea: The Natural Secret for a Healthier Life, Nadine Taylor states that green tea has been used as a medicine in China for at least 4,000 years.

Today, research shows us how true that ancient claim was. Green tea, with its medicinal properties, is a boon for the health-conscious and a wonder, even to modern science. The benefits of green tea are many as told earlier above but again summarised below:-------------------------
Inhibits Cancer:----------------
The main ingredient in green tea, Epigallocatechingallate (EGCG) inhibits the growth of cancer. The latest good news about green tea comes from a study done at the Karolinska Institute in Stockholm. A team of researchers headed by Dr Yihai Cao found that green tea can block angiogenesis, the development of new blood vessels that tumors need, in order to grow. In an interview, Dr Caoexplained that the polyphenols in green tea prevent angiogenesis, which also explains why green tea is effective in preventing cancer. According to Dr Hasan Mukhtar, professor and research director of Case Western University, Cleveland, studies have shownthat the risk of stomach cancer goes down as consumption of green tea goes up.
Prevents High Blood Pressure and Heart Disease:----

With the chaos of our daily lives, we can do without the added tension of high blood pressure, which can result in heart problems. Scientific studies show that daily consumption of green tea can prevent high blood pressure. 3 to 4 cups of green tea a day, can substantially reduce an individual's risk of heart disease and stroke.
Restricts Buildup of Cholesterol:---------------

We all know that fat and cholesterol are bad for our health. Bur that doesn't stop us from drooling over a sinfully creamy dessert, does it? Now green tea brings along some great news for food freaks. Experiments demonstrate that green tea restricts the excessive buildup of blood cholesteroJ. It reduces the bad cholesterol (LDL) in the blood and increases the levels of positive cholesterol (HDL), thus reducing the chances of heart disease. For years, researchers were puzzled by what they called the 'French Paradox' … the fact that, despite consuming a diet rich in fat, the French had a very low incidence of heart disease. The answer was found to lie in red wine, which contains resveratrol, a polyphenol that limits the negative effects of smoking and fatty diets. In a 1997 study, researchers from the Universiry of Kansas determined that EGCG, strongly present in green tea, is twice as powerful as resveratrol. Which explains why the rate of heart disease among the Japanese, who are regular drinkers of green tea, is quite low, even though approximately 75 % are smokers.
Lowers the Blood Sugar Level:---------------
Let green tea take care of health worries like blood sugar levels. The extract of green tea has the ability to actually lower blood sugar. It is believed that both the EGCG and polysaccharides in green tea are factors in lowering blood sugar.
Strengthens Immune System:------------------
Today, we live life right in the midst of the madding crowd ... with deadlines and schedules that leave no time for ourselves. With its share of ups and downs, our body needs to be strong enough to fight common diseases like the flu and other infections. Green tea helps to strengthen a weak immune system, guarding us from illnesses and infections that take a long time to heal.
Prevents Ageing:========
Oxygen is very important to us, but it can also be a very harmful agent in the form of active or free radical oxygen. One way to slow the ageing process is to prevent the accumulation of active oxygen in our body. This can be done by antioxidants, which are strongly present in green tea.
Oral Hygiene and Dental Care:------------------
Now you can flash that charming smile without worrying about bacteria and bad breath. Fluoride in green tea protects tooth enamel and EGCG reduces the development of bacteria growing in the plaque. Green tea can also kill other oral bacteria, which cause bad breath. It also stimulates the production of saliva and reduces the harmful acids that form in the mouth.
Boon for Dieters:-----------------
Get yourself in shape with a new slimming potion. Yes, green tea can actually help burn fat. In November 1999, the American Journal of Clinical Nutrition published the results of a study at the University of Geneva, in Switzerland. Researchers found that men who were given a green tea extract burned more calories, since green tea helped to excrete more fat.
So Drink To Your Health:--------------------
People who drink green tea daily, have lower rates of heart disease and cancer and a higher life expectancy. Unlike other antioxidants, those found in green tea cause no toxic side effects. Sounds good enough to put the kettle to boil and give green tea a try?Many more good compounds are found in Green Tea but not seen in same quantity and concentration in Black or White Tea (which is powdered or steamed or fermented tea)are found but their direct contribution on organs and tissue Human health system is yet to be discovered .
Dr.D.R.Nakipuria
Ambika Multi speciality Hospital
29 Agrasen road
P.O.Siliguri-734005
Dist:Darjeeling(W.B.)
09434143550,

AGING
AND
TOTAL
STRESS MANAGEMENT


DR. SHRINIWAS
KASHALIKAR
Even though aging begins right from conception; it usually refers to the changes in us after the age of forty to fifty years.

Thus; aging undoubtedly leads to variable but distinct reduction in physical capacity and performance. The degree of consciously perceived stress in the form of unpleasant feeling of insecurity, anxiety, worry, tension, depression resulting from relative handicap is obviously more during these years.

Before we consider the way of Total Stress Management while aging, let us first consider in brief; the concept of Total Stress Management (Holistic Health)!

Total Stress Management or Holistic health is nothing else but ongoing progress in perceptions, feelings and actions; with increasing accuracy, appropriateness, precision; and pleasure, power, prosperity and profundity. Perception, feelings and actions are also expressed by terms Cognition, Affect and Conation (Productivity and Creativity); respectively.
A] Cognition
In short, cognition means processing [appraisal] of a huge variety of sensations impinging on us. We can appreciate the importance of this faculty if we consider the two important facts viz. 24 hours of the day and twelve months of the year, every one of us gets sensory inputs in the form of physical, instinctual, emotional and intellectual stimuli, which may be painful or pleasurable in the form of a variety of personal, familial, social, national and international events. Cognition involves sensing, interpreting, memorizing, questioning, pattern finding, analyzing, correlating, synthesizing, contemplating, understanding, appreciating and hypothesizing on the basis of this information input.
2] Affect
Affect means the effect of the variety of stimuli which, may impinge on us. The affect is in a way, “sandwiched” between; cognition or perception of stimuli and the conation or response.

In general it involves the activity of various parts of nervous, endocrine and metabolic changes. The affect is usually experienced as a] confidence, enthusiasm, excitement, pleasure, happiness, love, attraction, patience, comfort etc. or b] sadness, jealousy, hatred, depression, inhibition, diffidence, loneliness, listlessness, impatience, discomfort etc.
3] Conation or action i.e. response
Conation is the response of an individual. This can be in the form of speaking, writing, singing, painting, dancing, fighting, and other interactions usually referred to as behavior.

In Hindu tradition this response was aimed at fulfillment of life and the precept for the life time activity was called PURUSHARTHA. There were four sequential components; of PURUSHARTHA viz.; DHARMA, ARTHA, KAAMA and MOKSHA.

DHARMA refers to accuracy in perception, affect and conation. This leads to ARTHA i.e. acquisition of material gains, followed by KAAMA i.e. satisfaction of the mundane desires, which are not against the principles of individual and universal blossoming) and MOKASHA i.e. liberation from all sorts of bondages.
In short; Total Stress Management or holistic health; refers to ever increasing and appropriate satisfaction of physical, instinctual, emotional, intellectual needs and fulfillment and happiness arising from it.

Total Stress Management or Holistic Health while Aging:

By the word aging we generally think of; merely an unpleasant process associated with dysfunction and disability. We think of a phenomenon full of dependence and helplessness. It seems to indicate only cumulative wear and tear due to micro insults and time dependent programmed loss of structure and function. It seems to imply physical, psychological, intellectual and social incapacitation. It seems to involve choking of charm, routing of romance, decay of dreams, annihilation of aspirations and end of new beginnings. It seems to be an entity that signals us to wind up every thing and get ready to quit this world - the world; that we so much long to live in.

But is this entirely true?

Let us study the process of aging and find out!

But for that; we have to first distinguish the handicap or dysfunction that results from the diseases; and the changes resulting from the natural process of aging that takes place in the absence of diseases.

We can appreciate that such distinction is quite difficult. Most of us suffer from ailments such as infections, malignancies, diabetes, IHD, as well as environmental onslaughts in the form of ultraviolet radiation, heat, cold, pollution, food additives, allergic substances, physical and chemical injuries etc apart from psychological inflictions!

But still the changes, which take place after forty and fifty; in the absence a history of gross or major diseases or accidents; roughly represents the true aging and is generally attributed to two basic facts

1) Genetic program, which decides the range of the longevity of life for a specific species and determines the time dependent loss in structure and function characterizing senescence and death and 2) Accumulation of injuries or micro insults:

Since very little is understood in this respect; there are many theories based on these two tenets meant to explain aging. Since they focus on a specific change, they are inadequate in isolation; but together they do give us some insight into the process of aging.

THEORIES OF AGING:

A] The Error Catastrophe Theory:
Random increase in errors of protein synthesis i.e. defects in the processes involved in protein synthesis called transcription and translation. But aging processes seem to be posttranslational (i.e. after the proteins are completely synthesized) modifications. Further, in senescent cells accumulation of misspelled proteins is not found and induction of synthesis of erroneous proteins experimentally does not give rise to ageing. Thus there is possibility of that errors are not causes but merely coexisting with aging processes.

B] Somatic mutation theory:
This suggests that there is age associated increase in chromosomal aberration. This is suggested to give rise to progressive increase in inefficient cells leading to organ dysfunction.

C] Free radical theory:
Accumulation of metabolic waste products and radical mediated cell damage e.g. hydroxy peroxide, aldehydes and ketones, superoxide radical, singlet oxygen and hydrogen peroxide. If this were so, we would expect lipid peroxidation at cellular level, which is not demonstrated in aging. Further, the antioxidants which we expect to delay aging are not proved to do so!

D] Ionizing radiations and such other environmental factors may cause cell injury. This could be so; but the cause and effect relationship and the quantitative aspects; are not yet demonstrated to cause aging by themselves!

E] Cellular dysfunction in tissues such as CNS, endocrine and immune system; influences other systems and causes aging! Thus decreased synthesis, increased breakdown, decreased receptor number, decreased Hormone-Receptor (HR) combination, decrease in HR internalization etc may be responsible for aging.

These are merely physiological interactions (associated with aging) amongst tissues; and can not be called mechanisms or causes of aging.

F] Sedentary jobs, late night parties, noise, crowding, stress of highly competitive life, uncertainty of socio-political surroundings, consistent and protracted denial of the recognition and appreciation in life, habits such as excessive smoking, lack of enjoyable job, lack of promotions and incentives in jobs etc. and the plethora of stressors either not thought of or not given due importance and hence not mentioned in the text books; immensely expedite or aggravate (though do not constitute the basic mechanisms or causes as such) the aging process; and are described; in my books viz. “Stress: Understanding and Management” and Conceptual Stress: Understanding and Management”.


CHANGES DURING AGEING PROCESS

Overall changes in the body are loss and graying of hair starting with the temporal hair (side buns), drying and wrinkling of skin, loss of teeth, decrease in reaction time, decrease in the height, increase in the length of nose, increase in the length of ears, decrease in the circumference of neck, decrease in the circumference of thighs, osteoporosis, bending of the vertebral column causing kyphotic deformity, reduction in the periorbital fat causing sinking of the eyes etc. Broadly speaking, maximum capacity, tolerance, peak performance and reserve are reduced.
The details of the changes can be enumerated as follows.

Matrix:
Collagen becomes stable, more rigid, more insoluble due to increase in its degradation. In addition there are changes in proteoglycans and plasma proteins. This is due to damage due cross linking, less formation of collagen and reduction in the elastin. Fascia, tendons, ligaments, bones, joints, and peripheral vascular disease become rigid. Skin becomes dehydrated, devoid of subcutaneous fact and less elastic thus skin becomes wrinkled, dry, pale due to reduction in capillary bed, and becomes more susceptible to injury.

Blood:
Red bone marrow is replaced by yellow bone marrow in the long bones first, flat bones and then vertebrae. Physiological reserve capacity for erythropoiesis and leucopoiesis (Formation of red blood cells and white blood cells); is reduced.

Gastrointestinal tract (GIT):
*Enamel, dentin and cement of teeth show decline. There is loss of teeth due to caries, periodontal infection and reduced masticatory efficiency.
*Weakness of cricopharyngeus (Muscle of swallowing), reduction in pressure gradient and inability to relax the lower esophageal sphincter cause dysphagia (difficulty in swallowing).
*Age related atrophy of inner lining of stomach called mucosa causing achlorhydria (absence of digestive acid in stomach).
*Pancreatic lipase (fat digesting enzyme secreted by pancreas) is reduced causing streatorrhoea (presence of fat in the stools).
*Motility of GIT is reduced: Hence there is tendency towards constipation. In Ayurveda this is categorized under VAATA VRIDDHI.
*Intestinal lactase activity is reduced and villi are reduced and absorption is reduced.
*Liver cells reduce in number fibrous tissue increases in the liver and size of liver cells increases.
Protein synthesis and microsomal mixed oxidase activity required for metabolism of drugs and steroids; become less. Thus functions are reduced but since the reserve of liver is great; the liver function tests are in normal limit.

The immune system:
There is decrease in the T cell activity, Antibody (AB) production; but increase in the presence of auto anti bodies.
The auto-antibodies are increased due to reaction with the antigens (which were previously recognized as “self” and not reacted with)! This is called reduced tolerance to “self” antigens.

There is susceptibility to infections.

Since immunological - surveillance is believed to eliminate neoplastic cells (cancer cells); there is higher incidence of cancer.

Following stress of bereavement; there is steep decline in cell mediated immunity (T cells) and this is one of the causes of infections leading to the death that follows the death of spouse or any other near and dear one.

Reproductive system:
The hormonal secretion reduces and there is stoppage of ova formation, ovulation in females and there is gradual reduction in the spermatogenesis (formation of sperms) causing reduction in the sperm count in males.

Females show a distinct and identifiable change in the form of menopause; where as such change is not distinct in males.

There is reduction in sexual performance in terms of number masturbations and number of intercourses in a given time and reduction in the functions such erection, ejaculation and the climax. The infatuation about sex may be increased and provoked by pornographic and or sexually romantic atmosphere even as the sexual performance is dwindled.

Central nervous system and special senses:
There is atrophy of the brain and neuronal loss associated with accumulation of lipofuscin and loss of synapses and dendrites. Cholinergic deficit is demonstrated in Alzheimer's disease and Dopamine defect is demonstrated in Parkinson's disease. But, milder form of cholinergic deficit may be responsible for commoner forms of senile dementia and milder form dopaminergic deficit may be responsible for milder form of hypo-kinesia seen in old age.

There is deficit in autonomic responses leading to postural hypo-tension and impairment of temperature regulation.

There is difficulty in getting sleep as well as there is tendency to wake up during night and waking up early.

There is development of Presbyopia (age related difficulty in focusing on the near object), cataract, rise in intraocular pressure; Presbyacusis (age related difficulty in understanding speech and localization of sound) decline in perception of smell and taste.

Endocrine system:
There is decrease in the functioning of sympatho-adrenal axis and there is reduced tolerance to stress. In other words, there is inappropriate production of adrenaline, noradrenalin, cortisol etc.

Cardiovascular system:
Aging is associated with atherosclerosis. But even in those without atherosclerosis; there is still reduction in the elasticity of aorta (indicating overall changes in connective tissue); leading to increase in systolic and pulse pressure; but not in diastolic pressure. In addition; there is also atherosclerosis, atrophy of myocardium, accumulation of lipofuscin, fibrosis, deposits of amyloid, diminish in contractility relaxability, decrease in ventricular compliance, stenosis of aortic and incompetence of mitral valves, reduction in pacemaker cells, responses to sympathetic as well as parasympathetic stimulation also reduce (this causes postural hypotension).
Maximal Heart Rate during exercise is reduced in aged but cardiac output is maintained by increasing stroke output.

Respiratory System:
The alveoli (the air pockets in the lungs) become flatter and narrower and ducts enlarge. Alveolar walls become thin, capillaries decrease in number causing reduction in diffusion, surface area decreases by 4 % every decade after the age of 30 and the pulmonary blood vessels show age related increase in wall thickness.

Functionally there is decrease in total and timed vital capacity, increase in residual volume, due to reduced elastin lung compliance increases (degree of expansibility) but compliance of the total respiratory system decreases due rigidity of chest wall after the age of 60 years. Due to loss of elastic recoil the pressure which has to be built during expiration from the alveoli; so that air from alveoli forces open the airways, is decreased. Due to this there is tendency of the airways to collapse. This tendency to collapse; increases during expiration when expiration must become active. The response to hypoxia and hypocapnia (reduced carbon dioxide) are reduced.

Thus ventilation, diffusion and regulation are all impaired in elderly individuals.

Muscles:
There is atrophy, reduction in contractility, decrease in tone, hernia and rupture of inter-vertebral disc etc.

Excretory system:
As a result of aging; the kidneys reduce in size and their blood flow and rate of formation of urine reduces by 10 % per decade after 30, nephrons (urine forming tubules) and their secretory and absorptive functions; reduce and fibrous tissue increases. Kidney vessels show age related changes irrespective of hypertension (high blood pressure).

It has been hypothesized that due to high protein diet there may high solute load on the renal capillaries leading to chronic dilatation of the capillaries leading to extravasation of macromolecules in renal glomeruli leading to mesangial reaction causing renal damage.

PSYCHOLOGICAL CHANGES
Frustration, depression, fear, anxiety, insecurity, loneliness, vacuum, dejection, self pity, sadness are some of the hallmarks of old age. This is because; 1. With aging there is increasing restriction on the kind of accustomed enjoyments (e.g. sexual); and this can lead to frustration or depression. 2. The realization of the increased chances of death; (due to observation of the deaths of the contemporaries); causes alarm, concern, anxiety and excessive fear of death, diseases and debility. 3. Due to lack of job after retirement or physical inability there is always a sense of insecurity. 4. Lack of the children's company due to their being increasingly independent gives a feeling of unwantedness and loneliness, especially due to children going abroad or away from home for their jobs. 5. Since most of the people of younger age groups; have their own pre-occupations we the elderly are left out. 6. Due to generation gap; the ideas, choice, preferences and other areas of interests differ and hence the elderly are cut off from younger generation. This distance gradually increases with advancing age and leads to vacuum, dejection, self pity and sadness. Thus overall we tend to become increasingly melancholic in old age.

ECONOMIC CHANGES
The aging almost always associated with reduced income and increasing economic dependence on the others. The medical expenses also swell!

SPIRITUAL CHANGES
We begin to visit temples and participate in SATSANG. This is because we want a certain kind of solace which we do not get from day to day life and routine activities. This is also to fill the vacuum created due to retirement, and to get company of those who sail in the same boat!

When we are aging; we become somewhat disinterested and indifferent towards life. But this is not detached attitude described in Geeta. We get detached because; we cannot participate or oppose the activities of young generation! Thus; this is actually reluctant acceptance of defeat!

Sometimes we develop ascetic thoughts due to losing interest in the routine life because we are tired of responsibilities and dynamism required; for a job or a profession. Even as this engenders reduction in income; it is not a spiritually oriented selflessness and sacrifice. It is only fallout of mental apathy.

Sometimes we lose interest in the surroundings due to decreasing sensory perception and decreased mobility. We become shy about our deficiency. So we avoid socialization. Gradually we become increasingly self centered and selfish. We become over-concerned about ourselves and less sensitive to others' problems. We become more rigid, adamant and at times obstinate; in an attempt to assert ourselves; and become unreasonable and erratic.

The courage, alertness, enthusiasm and other physical and mental faculties which are extremely important to undertake spiritual pursuit i.e. growth of consciousness are considerably diminished in old age; unless the spiritual quest has been integral part of us from childhood.

However having said all this; the impression, which we get from the foregoing, is quite inadequate and therefore wrong, dangerously pessimistic and depressing. The aging, as made out to be by merely observing certain physical or psychological changes; without realizing that there is a vast difference between our aging and that of the animals; creates fear about aging. As a result; instead of helping ourselves and others; we expedite the process of aging and its ill effects! We can refer to these conditions; with new terms viz. gerontophobia, and genrontoneurosis.

Let us realize that; while aging, a person accumulates not merely micro insults and injuries but simultaneously accumulates a variety of pleasant experiences (e.g. romance) and fulfillment, satisfaction, and contentment due to achievements in life! Even in the lesser fortunate ones; aging is associated with the happiness of having procreated, reared, pampered, and played with the children and grand children and the satisfaction living and not dying prematurely!

Further it has to be realized that while aging we gradually learn the inevitable nature of aging and death; and hence gradually learns to accept them uncomplainingly and gracefully.

Age is respected in Indian culture. Thus age brings (though this is not a universal truth) extra care, respect, services and comforts in preference to the younger lot.

Philosophically speaking; let us clearly and definitely understand and appreciate without any ambiguity that aging is not merely becoming old, but actually growing and maturing! Aging is actually; the culmination of our passage (through the body) full of wonderful learning and blossoming experiences of merging with our true self through NAMASMARAN!

BUT WHAT IS NAMASMARAN?

(The following explanation is given by Dr. Shriniwas Kashalikar in response to a clarification sought by Dr. Suhas Mhetre; for the benefit all those, who are not conversant with the concept and practice of NAMASMARAN)

Namasmaran means; remembering the name of God, Guru, great souls; such as prophets and holy objects such as planets and stars. It may be remembered silently, loudly, along with music, dance, along with breathing, in group or alone, either with counting by rosary (called SMARANI or JAPAMALA) or without counting. The traditions vary from region to region and from religion to religion.

However the universal principle underlying NAMASMARAN is to reorient your physiological being with your true self. In fact while reorienting with true self you aim to establish and strengthen the bond or connection; between; your physiological being; with your true self. You aim at reunification with yourself!

Since remembering your true self is the pinnacle of or culmination of individual consciousness, and individual consciousness is the culmination of every activity in life, remembering any name of God or Guru (any symbol of your true self) is equivalent to opening the final common pathway for the individual consciousness associated with every possible activity to get funneled into or unified with objective or cosmic consciousness.

Thus NAMASMARAN is in fact the YOGA of YOGA in the sense that it is the culmination of consciousness associated with every possible procedure and technique in the yoga that you are familiar with. It is the YOGA of YOGA because it is the culmination of consciousness associated with all the activities in the universe, which it encompasses as well! It is YOGA of YOGA because everybody in the world irrespective of his/her tradition and the beliefs; would eventually, ultimately and naturally reach it it in the process of liberation. Even so called non believers also would not “miss” the “benefit of remembering the true self through one symbol or another”!

Just as NAMASMARAN is YOGA of YOGA it is meditation of meditation also! It is the natural and ultimate climax of every form of meditation.

These facts however have to be realized with persistent practice of NAMSMARAN and not blindly believed or blindly disbelieved with casual approach!

In short NAMSMARAN is super-bounty of cosmic consciousness for every individual to realize it (cosmic consciousness)! This is truly a super-bounty because a person, who experiences it, rises above mercenary, commercial and even professional and charity planes and manifest super-transactions in his or her life!

These are just few observations to give rough idea about what is NAMASMARAN.

NAMASMARAN is an ocean of bliss. Its true meaning is beyond description in words.

"INDIA holds World's Largest Young and Productive Population "

World Society of Antiaging Medicine, Antiaging Medicine and Research, and World Anti-aging Network bring INDOMEDICON 2010, The Antiaging Aesthetic and Regenerative Conference cum Certification Course to India. This event will be held on 19th and 20th June 2010 @ Hotel Imperial palace Royal Palm, Mumbai.

The main goal of this event is to connect like minded Physicians who believe in the concept of health promotion and life span wellness medicine, not just medicine based on relief of symptoms. Integrative medicine is the new approach of Antiaging medicine and Age management medicine where we are fighting with premature aging and age related diseases and disorders to prevent diseases and disorders out of the scope of geriatrics and improve the quality of life even before its starts to decline.

It is very important for the Indian subcontinent as right now India holds the World’s largest and strongest youth population which has to be maintained for next 50 years minimum before baby boomer population hits the nation.

I personally invite you to join hands with us to promote the fastest growing specialty of Anti-aging, Aesthetic, Regenerative and Life Span Medicine movement for the future of our nation.
Let’s work together to keep our nation young, productive and healthy forever
Dr. Anoop Chaturvedi
International Scientific Advisor: World Society of Anti-aging Medicine
President: Antiaging Medicine and Research, India www.indomedicon.com
Founder: World Antiaging Network www.worldantiagingnetwork.com

WORLD
POLITICS

DR. SHRINIWAS
JANARDAN KASHALIKAR

World politics is; or rather ought to be; the expression of cosmic consciousness by people with the perspective of individual and global blossoming. Thus people of such perception and conviction, when identify, appreciate, come together and interact; the pragmatic aspects of actual means and modalities of actions can be crystallized.

At present also this is happening, but in a rather imperfect, immature, inaccurate, insufficient, inadequate and ineffective manner. Primarily, this imperfection is that of perspective, conceptualization, conviction and actual experience or realization.

The millions of different needs, wants, likes, dislikes, virtues, vices, actions, interactions, contradictions, dialogues, hopes and despairs of billions of living beings of different ages with different geographical, political, social, economic, cultural and historical backgrounds have a tendency for individual and global blossoming in common! This is either voluntary or involuntary and conscious or subconscious!

The visible hallmarks of this individual and global blossoming are (though in formative or developing stage, such as millions of people being served food free of cost and millions of cows being cared as by Gondavle Sansthan, ISCKON and many other institutions, tress being planted by ISHA, millions of people being trained in yoga by Swami Ramdev and Patanjali Yogapeeth pariwar, Promotion and cultivation of herbal plants by Ahcarya Balkrishna, millions of people being trained in Sudarshan Kriya by Sri Sri Ravishankar and Art of Living pariwar, millions of people getting holistic medical treatment by practitioners in the world, some attempts towards international institutions for justice in political, legal, economic, agricultural and health care areas, exchange of scientific technology etc), or would be,
 Universal Practice of NAMASMARAN i.e. remembering one’s true self (about whom we are usually oblivious), right from childhood, according to the particular tradition.
 Availability, upholding and promotion of safe drinking water and vegetarian food would be ensured by all governments.
 Redefining the holistic health as “Optimal intellectual, emotional, instinctual and physical actions to promote individual and global blossoming, in one’s field”.
 Practice and promotion of Holistic Medicine; i.e. the art, science and skills of employing everything effective; in regaining and promoting HOLISTIC HEALTH, would be the essential and inseparable core of mainstream Medical Education, Teaching, Practice and Research.
 Holistic Education with emphasis on productive domain in addition to affective, cognitive, psychomotor domains, with prayerful empowerment, practical productive progress and self sufficiency; and research and teaching in different fields conducive to holistic health. Even the specialized institutions would not be exception to “earn and learn”, “produce and progress”, “practice and pass” principles. The written examinations would be replaced by actual assessment of the skills.
* All religious temples and places of worship would voluntarily incorporate educational, industrial, and agricultural and research activities conducive to holistic health; thereby get re-integrated with mainstream life. Conversely, all educational and industrial houses would adopt the activities of religious and spiritual bodies and institutions; in which, the philosophy of holistic health is implicit (though variable in terms of semantics i.e. languages and terms).
* Getting up early, drinking of water in morning, rubbing the teeth, gums and palate in morning and using herbs conducive to dental, oral and general health, would be promoted as essential elements of holistic health.
* By hearting of hymns and prayers of different religions, would be practiced and sung together amongst all religions.
* Laws would be devoid of vindictiveness and conducive to holistic health. The worst possible criminals also would not be treated with vengeance. In general, the laws would be formative, e.g. the persons soiling the public property would me made to clean the same, a corrupt person would be made to work double the duty hours, in say, half the salary and those involved in misleading or deceptive commercials such as (98% stoppage of hair fall, double increase in height) would be made to participate in production, research, training and practice of holistic health and medicine, at no profit. The production of bicycles and vehicles of mass transport being echo-friendly would have minimum or no tax.
* Sanskrit would be researched and taught all over the world if after careful scrutiny of international well meaning intellectuals belonging to different religions; and found beneficial to mankind.
* The unifying elements and enlightenment in the lives of saints, seers and other reformers would be integral part of the curriculums.
* The doctrines of bigotry, fanaticism, Zionism, racism, wars and hatred would occupy minimum or if possible actually NO space in curriculum.
* There would be introspective research and dialogue over; whether the culture of slaughtering the cows and bullocks (and other animals) is an evolved and civilized act beneficial to mankind or it is preferable to love, care, adopt and coexist with animals. There would be extensive and conclusive debate, evolution of globally beneficial policies, laws, rules and their implementation in this regard; world over. This may happen simultaneously with a global convincing operation.
* There would be encouragement to folk sports as for the folk arts and folk music.
* The defense policies would gradually become less barbaric, less cruel, less vicious, less prejudiced, less suspicious, less obstinate and more reconciliatory. This would be coupled with promotion of global perspective with liberal and considerate attitude.

(To be continued and revised if and when necessary)