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Doctors are human beings, they make mistakes. Unlike other professions, doctors’ mistakes and errors in handling patients in hospitals can take a patient’s life, and on the other hand their care and commitment can save him. A number of high-profile studies assert that between 120,000 and 150,000 people die every year in the US owing to ignorance, inefficiency and callousness of doctors and other healthcare professionals in hospitals and clinics and from communication errors between doctors and attending nurses. How do we, the laypersons, guard against such fatal mistakes as enumerated above and help our family members and even others whom we care evade such incidents? The only way to minimize the incidence of fatal mistakes by doctors involving your family is to educate self in health science. How much should I learn and what is the goal? There is no limit to how much one can learn. In fact, researches on many rare diseases were initiated, funded and advanced by life-long quest to find cures by parents or dear ones of victims. Learning health science is not the preserve of doctors only. One can learn the basic facts about human body, particularly anatomy of gastro-intestinal (GI) tract, that of respiratory tract up to lungs and heart, human metabolism, reproduction health, common diseases, their prognosis and treatment. One should know what a medical emergency is and what is to be done in case of a medical emergency. As for example, if a family member is having a severe chest pain, what is to be done? Everybody knows the first action and calls an ambulance service, 911 in the US, and rush the patient to hospital. What would have been the second action that needs some knowledge and insight? Check the pulse rate and blood pressure by a sphygmomanometer. Before ambulance with healthcare professional arrives, give an aspirin 325 mg immediately and a PPI like rabeprazole, pantoprazole or esomeprazole 40mg to stop gastric irritation as aspirin can cause it and even bleeding. This medication may save the patient’s life if it is a heart attack, but it will not worsen patient’s condition even if the condition is not due to heart. Blood pressure and pulse rate will give some indication of the affliction, which you can immediately convey to the attending physician. As regards goal, your knowledge about diseases and medicines help you communicate better with attending physicians, watch over doctors prescribing medicines and nurses following prescriptions and better monitor improvement. If you are sick and know your disease, you can discuss treatment options, better decide treatment plan and prepare yourself much better for any invasive diagnostic procedures and later surgery. Experts in medicine say healthy life-style, enough sleep that make you refreshed after wake-up, healthy eating habit, not just knowledge about nutrition, exercise and active life and the last but not the least proper stress management can not only prolong life but also provide general wellbeing. However, this may make up 50-60% of total health management. Genes that we inherit from our parents and over which
we have little control are responsible for the rest. However, long-held views on genes are changing. Doctors are correcting genetic defects of unborn children inside mothers’ wombs. Genetic therapies are curing many patients of diseases that were hitherto incurable a few years ago. What will be our role in these complex medical procedures? We can make a family tree and find out what diseases our parents, grandparents and siblings are suffering from and who died of what diseases. We may thus know our predisposition to certain diseases and that of our progenies and let doctors know. Here comes preventive medicine to our rescue. Regular screening for a particular disease enables early detection and treatment at the earliest period creating conditions for higher chances of recovery. Some preventive medicines that doctors prescribe in some conditions and supplements may defer indefinitely onset of many diseases. Many supplements are good for health, but various studies on supplements coming up with conflicting results only confuse us. Once Dr. Robert Atkin became famous for his low-carb diet to lose weight, but now it is discredited. Dr. Dean Ornish advocated for very low-fat diet for good health and long life. His diet in most part consists of vegetables and fruits. Now red wine is in repute and so is resveratrol. We are awash with information from various sources claiming health benefits of many supplements. Doctors oftentimes loath to prescribe supplements because these are not prescription drugs. While benefits of some supplements are indisputable, we are unable to filter out mythical products from a few gems of supplements that can really help us stay healthy. Whom do we approach then? I am neither a doctor nor an expert in nutrition. What credentials do I have to advise people who may be more knowledgeable than I am? I dare give advice. The following is just a statement from a person who had suffered unimaginable pain and from diseases for at least 40 years and gained some insights that curious readers may glance through minding that these suggestions are no substitutes for doctors’ advice. My grandfather had passed away at the age of 28, my mother at 53 and father at 63. I was born seven days after my mother had gone into labour. There was no doctor, no nurse not even a midwife. My mother and I survived partly because of luck and partly because she was a strong and healthy girl of only 16 and I was the eldest. Nature usually bestows the eldest child of a healthy normal couple with enormous biological advantages for survival. Among 10 siblings including me, two expired very early-one died of tetanus because the village midwife cut his umbilical chord with an old blade used by my father for shaving and the other boy of cholera. Extra seven long days in mother’s womb when amniotic fluid had exhausted, my vital organs might have been under extreme stress and weakened to a certain extent. For reasons not detected, I had suffered from infantile diarrhea almost continuously from infancy until the age of 5. I was rickety because of malnutrition. My grandmother was alive then; she used to give me concoction of various herbal extracts. At age 12, I had a severe attack with sinusitis and later developed abdominal pain and vomiting in the morning. Thereafter, I suffered one after
another from bouts of malaria, amoebiasis, giardiasis, bacillary dysentery with bloody feces, typhoid, seasonal flu, chicken pox, measles and occasional fever from the age of 13 to 20. Occasionally I wad given emetine injection to stop bloody diarrhea. At a later stage, I was taken to capital city Dhaka. I was admitted to Dhaka Medical College hospital, the best one in town at that time. I was diagnosed duodenal ulcer, sinusitis, dysentery/chronic diarrhea and treated with antibiotics (Terramycin), antacids containing mostly aluminum hydroxide and magnesium trisilicate and anti diarrheal drugs. I was hospitalized thrice for severe drug reactions. When symptoms subsided to some extent, I was under the regular prescription regimen of antacid and anti-cholinergic drugs. Despite medication, I was unable to digest any fatty and spicy food. In fact, I had never been free of abdominal pain and flatulence until I took charge of my own health. After few years, I had also developed debilitating neck and lower back pain and treated with NSAIDs, particularly ibuprofen. During these years of afflictions, I never gave up studies, although at times I had to appear in examinations in sick-bed. In early 1980s I was diagnosed in Singapore with cholelithiasis (gall-stone) and ulcerative colitis. Gall bladder was removed and colitis treated with salazopyrin. Later I underwent another two operations with general anesthesia to correct ano-rectal and prostate problems. Occasionally my blood pressure fluctuated. I passed many nights with insomnia. Sometime in late 90s, endoscopic examination of my stomach and later biopsy of gastric tissue showed moderate gastritis caused by helicobacter pylori. Triple therapy consisting of two antibiotics and a PPI was prescribed. Symptoms improved, but recurred later. I consulted Helico Foundation in America, set up by one of two Nobel laureates- Barry John Marshall (the other being J. Robin Warren), the inventor of H. pylori responsible for ulcers in stomach and duodenum, gastritis and cancer. I had recourse to quadruple therapy- two antibiotics, one PPI, this time esomeprazole (purple pill) and one bismuth compound, all of which I figured out after studying books, journals and various websites and getting a prescription from one of my friend doctors. This time medicines worked and later investigation revealed complete eradication of the organism. I got rid of my sinusitis by saline irrigation. I still live with mild to moderate abdominal discomfort and mild neck and lower back pain. In my earlier days in service, I used to read only three magazines- Time, Newsweek and the Economists- that every learned person reads. But I regularly read books of eminent scientists like Enrico Fermi, John Barrow, Stephen Hawkins, Roger Penrose, Martin Rees, Paul Dirac, Alan Guth, Brian Green, Richard Feynman, Frank Tipler, Lee Smolin, Paul Davies, Lisa Randhel, Carl Sagan, Weinberg, Edward Witten, Leon Lederman and Freeman Dyson and so on. My interest in astrophysics and quantum mechanics developed during academic years, particularly reading Einstein Theory of Relativity. But years of suffering motivated me to learn as much as possible some fundamental elements of human body and medicines. I have been reading from late nineties books on nutrition and medicine and following science and medical journals to learn more about developments in medical science.
I self-medicated many times and tried many supplements, with mixed results. Now I take only one medicine- proton-pump inhibitors (PPI), a 20 mg omeprazole now available in the US over the counter and no more. I learnt from books and journals and sometimes through trial and error what works best for me in particular and what should work for others in general. Carbohydrates, fats and proteins are macronutrients. Water and dietary fiber definitely form part of macro-nutrients. Vitamins, about 80 minerals, some of which are trace and phytochemicals are micronutrients. Do we need extra supplements in addition to what we get from food? I tried multivitamin and mineral supplements and in addition vitamin C and E in 1980s and 90s. I did not benefit much. The scientists are now saying we are getting many vitamins and minerals from fruits and vegetables as well as from fortified cereal and many other sources and taking large doses of vitamins and minerals can have toxic effects. Then what should we do when experts differ and newer studies on nutrition agents invalidate their earlier findings of some having beneficial effects, and in other cases confirm their efficacy? What are those that have proven beneficial effects? I have inflammation in the gut and my C-reactive protein, marker of inflammation is quite high. Inflammatory condition in any part of the body, particularly in arteries can cause hypertension, diabetes, myocardial infarction, stroke and cancer and arthritis in joints. How do I control my abdominal pain, pain in head, neck and joints and sinusitis? I have discovered after 10-15 years of study and probe on me and few others who are my close relatives that isoflavons (flavonoid and isoflavone groups), particularly soy isoflavones and resveratrol do reduce inflammation and improve health condition after long-term use. Many nutrition scientists are reaffirming that vitamins and minerals are absorbed in our system in small quantity from supplements, particularly for those who are healthy. Moreover it would be prudent to get vitamins and minerals from fruits and vegetables; else vitamins and minerals from supplements and various processed food products can raise the level of these micronutrients in our body beyond the recommended limits causing adverse side effects. But vulnerable group like the elderly, pregnant women and children need supplements of selected vitamins and minerals. Zinc supplement may be given to children, which improves immunity against cold and diarrhea. I must emphasize on two vitamins and phytochemicals, which are anti-oxidants and protect our cell from damage and mutation. As these two vitamins and anti-oxidants are beneficial, I wish to elaborate on their genesis and properties. The first vitamin is D, which are of three types- cholecalciferal (D3), calcidiol (D2) and D1. Cholecalciferol, the most beneficial and commonly used vitamin D is the precursor of calcidiol, which in turn is the precursor of calcitriol. Recent studies found enough evidence that D3 not only helps absorb calcium in the body, but it is an immune booster also and is involved in many physiological processes in cells. In cold countries, supplement of D3 10002000 IU is recommended by all nutrition scientists. The other is vitamin C. Linus Pauling, one of the most influential scientists of all times, used to take 3g vitamin C. Despite critics’ contrary views, I have been taking vitamin C 1000mg for quite
sometime and am getting its beneficial effects. Some doctors are using in terminal cases of cancers and full blown AIDS vitamin C intra-venous drip 100 times the normal doses with spectacular results. But this is still under trial stage. But regular intake of 500-1000 mg of vitamin C over a long period of time is sure to benefit us. Another important dietary supplement is probiotics. These are helpful bacteria. Human body consisting of 100 trillion cells is inhabited peacefully by 10 times more microbes. Hundreds of billions of bacteria live in our small and large intestines. Probiotics or beneficial bacteria help us produce a few vitamins, digest food including lactose in milk, breakdown cellulose and keep harmful bacteria like clostridium defficil and fungi under check. In fact intake of antibiotics kills both harmful and helpful bacteria and as such opportunistic infectious agents like yeast and fungus infect gut and many organs including tongue what we call thrash. Combination of probiotics with antibiotics can help check proliferation of these infections. Intake of probiotic supplement any time can reverse the unwanted growth of these bacteria and fungi. Many types of probiotics having beneficial effects have been discovered. Lactic acid bacteria are the most popular and commonly used ones. They are lactobacillus acidophilus, L. casei, L. rhamnosus and more than nine others. Then there are bifidobacterium, enterococcus and streptococcus. Among many types, bifidum, B. longum, S. thermophilus are widely used. Japanese are probably the first to use widely probiotics to treat many diseases, particularly diseases involving GI tract. In fact, Japanese doctors prescribe me probiotics. As usual, I studied about probiotics, its beneficial effects, limitations and side effects, if any. Numerous studies found that many diseases caused due to infections by bacteria, viruses and fungi in early childhood and during teens leave behind a telltale sign of inflammation and lifelong burden on the immune system. As for example, varicella zoster virus (VZV) causes chicken pox. Even if a person is cured of the disease, many of the viruses remain in the body even lifelong, which may be activated in old age to cause shingles, very debilitating conditions. Epstein Barr virus and cytomegalovirus, which cause flu-like symptoms, may remain in the body causing inflammatory conditions and at later years arthritis and even cancer. Various kinds of herpes viruses once enter our body and cause diseases may remain in the body throughout whole life. Human Papilloma virus (HPV) may not cause any symptoms initially, but it causes women cervical cancer and men some other cancers. Good news is that vaccine against HPV is now in the market. Recently, researchers have found evidence that prostate cancer is caused by sexually transmitted diseases (STD). The most common STD chlamydia is caused by chlamydia trachomatis. It may not cause any symptoms initially, but may cause serious complications later, infecting both urinary tract and genital organs of both men and women. Promiscuity is therefore no option for those who want to live longer in good health. Inflammatory conditions in the body, which these infectious diseases cause, is responsible to a great extent to a number of chronic afflictions like atherosclerosis,
heart disease, stroke, diabetes, hypertension, arthritis and even cancer. Maintaining good hygiene in oral cavity and nostrils in many instances can fight off microbes to gain foothold in the body in the first place. NSAIDs and Statins both reduce inflammation and Statin alone lowers total cholesterol and seems to increase HDL. But these medicines can cause serious side effects. Long term use of NSAIDs can cause ulcer and bleeding. Statins can cause liver problems and in rare cares muscular dystrophy. Long term use of isoflavons and reveratrol, which are naturally occurring chemical substances, can have similar beneficial effects without causing side effects that NSAIDs and Statins can cause. Another group of naturally occurring fats can lower cholesterol, lubricate joints and provides elasticity to arteries, capillaries and nerves and so on. These are essential fatty acids and the most beneficial group is Omega-3s fatty acids- alpha-linolenic acid (ALA), eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA). Raw sea-fish is the best source. Wall nut, flaxseed, avocado and egg (contains saturated fatty acids also) are also good sources. Those who have high cholesterol and family history of death by heart attack should take supplement of Omega-3s. Mainstream doctors are also prescribing or advising patients to take probiotics supplement. We must not forget to consume 5 servings of fruits and vegetables, which provide phytochemicals or plant chemicals labeled as antioxidants. Phytochemicals are numerous and grouped into 6 broad categories: 1) terpenes 2) thiols 3) phenols 4) physterols 5) tocopherols and 6) isopreniods. It is not my intention to discuss in details what oxidants are and how antioxidants like phytochemicals can neutralize oxygen free radicals. Glucose, amino acids and fatty acids transported to cells are oxidized by oxygen molecules existing in all cells through blood circulation and converted to adenosine-5-triphosphate (ATP) through some complex processes. Energy is stored between 3 phosphate bonds and released when ATP phosphorylates and breaks off a phosphate bond. During oxidative process, many oxygen ions are released, which are known as oxygen free radicals. Creation of these ions is a normal process inside cells and there is built-in mechanism to neutralize them. However, when oxygen ions accumulate and further produced due to UV rays and other pollutants like molecules of heavy metals and food additives and insecticides, oxidative stress is built up in cells setting in motion cascade of reactions making unstable molecules and atoms as oxygen ions absorb electrons from stable atoms. Moreover, during burning of fuel many free radicals like nitrogen compounds, CO2, phosphates, sulphates are produced. These compounds together with toxic compounds from atmosphere including food freely move inside cells. All of them cause damage to mitochondria including its DNA, the energy producing part of a cell and cellular membrane. These damages may ultimately change genetic instructions embedded in DNA inside cell-nucleus. The outcome, as known to everybody, is the onset of diseases including cancer. In order to protect our cells from oxidative stress and free radicals, we should eat at least 5 servings of fruits and vegetables of all kinds and drink tea- black tea, green tea and some kinds of herbal teas. Without elaborating on what food items contain
what nutrients, it would be prudent to eat fruits, vegetables, whole grains (contain both macro and micro nutrients), nuts, legumes, seeds, licorice, soy products like soy milk and soy curd and tea. Then you get all micronutrients, fiber, Omega-3s (preferred) and Omega-6s. Now add to food basket macro-nutrients protein and fat to a lesser extent, although some protein and fat are available in the food items mentioned earlier. Knowledge of nutrition science is not the end in itself; it is just the beginning of a process to form habit. Good food habit needs be complemented by smoke-free healthy life style, enough sleep to feel refreshed after wake up, regular work out and active and stress-managed life. I have formed a good eating habit, follow a healthy life style, don’t smoke and drink, take a regular walk, try to sleep well and take regularly one prescription pill and a few supplements, which I feel is keeping my blood sugar and blood pressure within normal range without medication. My heart is functioning well without giving me any trouble. My abdominal pain is under control and so is my arthritis. I regularly take the supplements of soy isoflavons (100-150 mg), resveratrol (320 mg), vitamin D3 (1000 IU) and vitamin C (500-1000 mg). I occasionally take vitamin E, probiotics and once a week supplements of multi vitamins and minerals in case any of the micronutrients falls short of required level in my body without the apprehension that they could reach toxic level. I maintain an ideal BMI. I am 63+ and already outlived the age of my father and feel overall great. I know I inherited genes, some of them being mutated that are acting against my will to live beyond 100 years, but I make great strides to know what weapons science has provided to lengthen our lives and apply them to my system to stay healthy and alive for many years. My philosophy is if I can’t manage my health properly how I can manage other things in life.