HYPERTHYROIDISM

HYPERTHYROIDISM

Hyperthyroidism / thyrotoxicosis is a clinical condition, resulting from excess of circulating thyroid hormones T4 (normal range 5.5-12.5 µgm/dL) and / or T3 (normal range 80-200 mg/dL).

CAUSES: 

• More common between the age of 20 and 40.
• It often starts after times of extreme stress or during pregnancy.
• Diffuse Toxic Goiter (enlargement of the thyroid gland)- Grave’s disease.
• Nodular goiter
• Hashimoto’s thyroiditis.
• Iodine induced thyrotoxicosis.
• Cancer of thyroid (secondary).
• Ovarian struma.
• Hydatidiform mole.
• Thyroid stimulating Hormone (TSH) pituitary tumor.
• Ingestion of excess quantities of thyroid hormone, termed thyrotoxicosis factitia.
• High-dose radiation therapy.

SIGN AND SYMPTOMS: 

• Trembling hands.
• Increased appetite.
• Weight loss in spite of eating well.
• Sometimes may have weight gain due to increased appetite.
• Heat intolerance.
• Nervousness.
• Insomnia.
• Breathlessness.
• Palpitations.
• Chest pain.
• High blood pressure.
• Increased bowel movements.
• Light or absent menstrual periods.
• Muscle weakness.
• Fatigue
• Warm moist skin.
• Hair loss.
• Irritability.
• Mood swings.
• Restlessness
• Hyperactivity.
• Profuse sweating.
• Non- infective diarrhea.
• Occasionally double vision, undue prominence of eyes, irritation, photophobia, excessive lachrymation.
• Staring gaze, lid lag, lid retraction, and mild degrees of conjunctival injection.
• Visible swelling in the middle of neck goiter.
• Vitiligo (white discoloration of skin).
• Infiltrative ophthalmopathy (common) and dermopathy (uncommon), which are autoimmune manifestations of Graves’ disease and are not seen in other cause.
• Occasionally, raised, thickened skin over the shins, back of feet, back, hands, or even face.
• In crisis: fever, very rapid pulse, agitation, and possibly delirium.

DIETARY MANAGEMENT: 

Avoid:

• Avoid smoking, alcohol.
• Avoid tea, cola and chocolates.
• Avoid coffee and caffeinated drinks.
• Avoid refined foods, dairy products and wheat.

CONSUME:

• Consume vitamins and minerals, high protein and high calorie diet.
• Vitamin C increases the levels of antioxidants and helps to regulate the thyroid gland. B complex vitamins are another example of vitamins that can help hyperthyroid patients. They help to build the immune system and stabilize the digestive process, which goes off track due to increased metabolism in hyperthyroid patients.
• Consume food that depresses the thyroid – broccoli, cabbage, Brussels sprouts, cauliflower, kale, spinach, turnips, soy, beans, and mustard greens.
• Increase consumption of Omega-3 fatty acids, Vitamin D, Calcium, Vitamin E, magnesium and Phosphorous.
• Omega-3 fatty acids are anti-inflammatory and help immune system function properly.
• Sources of Omega-3 fatty acids: Fish and fish oils provide excellent forms of omega-3s. Flax / linseed oil is the richest source of PUFA’s. Other oils that contain PUFA’s are safflower oil, soybean oil, cottonseed oil, maize oil, sesame oil, rich bran oil, ground nut oil, mustard oil and olive oil.
• Add little Turmeric to food as it has an anti-inflammatory property.

IRRITABLE BOWEL SYNDROME [IBS]

Irritable bowel syndrome (IBS) is a common disorder that affects the stomach and intestines, also called the gastrointestinal tract. Symptoms include cramping, abdominal pain, bloating, gas, and diarrhea or constipation, or both. IBS is a chronic condition that you’ll need to manage long term. Irritable bowel syndrome is more common in the age of 20-45 years.

CAUSES: 

• Psychological factors – stress, anxiety.
• Specific food intolerance – wheat (gluten), lactose etc.
• Abuse of laxatives.
• Post gastroenteritis.

SIGN AND SYMPTOMS: 

• Abdominal pain.
• Spasmodic, explosive watery diarrhea.
• Frequent urge to defecate.
• Worse in morning and after breakfast.
• Incomplete defecation with mucus in stools.
• Feeling of bloatedness.
• Inability to finish meals.
• Slight weight loss.
• Occasionally backache, frequent urination and urgency in males.

DIETARY MANAGEMENT: 

• In acute phase of disease rest and take only liquids- water with salt and sugar, fruit juices- water melon, etc, start dioralyte in case of severe diarrhea.
• Later start with semi solid, light and bland diet – porridge, soups, fruit juices etc.
• Add a pinch of turmeric to food, it has anti inflammatory properties and its action is seen more in the colon.
• Try to consume more of antioxidants (vitamin A, E, C, Selenium etc.)– Most fruits and vegetables contain bioflavanoids, which is a good antioxidant.
• Eating too much insoluble fiber in the form of grains can increase diarrhea. Focus on soluble fiber which is present in vegetables and fruit.
• Avoid intake of milk and milk products.
• Increase intake of iron – boiled eggs, jaggery, beet roots, green leafy vegetables, and nuts – Brazil nuts and almonds, dried fruits, dates etc.
• Avoid eating beans.
• Limit fried, fatty and non – vegetarian food.
• Avoid refined sugars, tea, coffee and aerated drinks.
• Avoid food that you are allergic to.

PILES OR FISSURES OR FISTULA

PILES / FISSURES / FISTULA

Piles are caused by swollen veins inside or outside the anus.

Anal fissure is an elongated ulcer in the long axis of the lower anal canal.

Anal fistula is an abnormal passage formed rectum to the vagina.

CAUSES:

• Straining to evacuate stool in constipation.
• Over purgation – Diarrhea of colitis, dysentery etc.
• Low roughage diet.
• Pregnancy.
• Cancer of rectum.

PILES:

• Straining to urinate – in case of stricture of urethra or enlarged prostate (piles).
• Hereditary tendency.
• Sedentary life.
• Obesity.

SIGN AND SYMPTOMS: 

• Bleeding from anus along with defecation.
• Bleeding of bright red blood.
• Blood and pain while defecating.
• Blood streaked stools (fissures).
• Drops of bright red blood after stools (piles).
• Mucus discharge and itching.
• Prolapse of piles – either it go back themselves or need to be replaced manually.
• Sensation of incomplete evacuation of rectum.
• Stools being evacuated from vagina (in case of anal fistula).

DIETARY MANAGEMENT: 

• Avoid hot spicy and highly seasoned food.
• Consume more apples, pears, watermelons, papaya, grapes, strawberries, pomegranates, rose petals, kiwis, pineapples, and Coconut water.
• Have high fiber diet – whole grains, bran, oat, green leafy vegetables, peas, beans, potatoes, raw vegetables, salads, dried fruits and fresh fruits.
• If possible stick to vegetarian diet.
• Eat bitter gourd, black musale (Kali musli), Kareer (ker) are said to be beneficial.
• Drink sufficient water to avoid constipation.
• If over-weight reduce weight.

KIDNEY STONES OR URINARY CALCULI

The formation of crystals and calculi due to mineral deposits in urine are known as urinary calculi, when formed in kidney are known as kidney stones but can form anywhere in the urinary tract and they are named depending on the site where they are formed.

1. Calcium oxalate: The most common type of kidney stone which is created when calcium combines with oxalate in the urine. Inadequate calcium and fluid intake, as well other conditions, may contribute to their formation.
2. Uric acid: This is another common type of kidney stone. Foods such as organ meats and shellfish have high concentrations of a natural chemical compound known as purines. High purine intake leads to a higher production of monosodium urate, which, under the right conditions, may form stones in the kidneys. The formation of these types of stones tends to run in families.
3. Struvite: These stones are less common and are caused by infections in the upper urinary tract.
4. Cystine: These stones are rare and tend to run in families.

CAUSES: 

• Family history of kidney stones.
• Hot climate and dehydration.
• Working in hot environment.
• Decreased intake of water.
• Deficiency of vitamin B6 and magnesium.
• Sedentary life style.
• Hereditary disease – renal tubular acidosis develop kidney stones.
• Cystic kidney disease.
• Hormonal disorder.
• Drugs used to treat HIV.
• Uric acid stones: more common in men then in women.
• Low urine output.
• Blockage of the urinary tract.
• Diet high in animal protein, such as red meat.
• High intake of alcohol.
• Results from a problem in metabolizing purines.
• Gout.
• Inflammatory bowel disease.
• Excess intake of vitamin D
• Urinary tract infection.
• Chemotherapy.

SIGN AND SYMPTOMS: 

• When kidney stones are small they are passed unnoticed with the urine.
• Large stones cannot easily pass through urinary tract and are painful.
• Sudden onset of pains.
• Sharp, cramping pains in the back and side in the area of kidney or lower abdomen.
• Pain in the abdomen radiating down to the groin.
• Painful urination. Restlessness
• Hard Abdomen
• Increased pulse
• Nausea & Vomiting.
• Profuse sweating.
• In males – excruciating pains in the testicles as the stones passes out.
• Red urine
• Painful urination
• Pus in urine
• In case of an infection along with the above mentioned symptoms there may be

-Fever with Chills.

-Frequent urge to pass urine.

DIETARY MANAGEMENT: 

Kidney stones have tendency to reoccur, it can be prevented by some dietary changes. Depending upon the type of stones you can make necessary changes in your diet and prevent stone formation.

• Fluid intake:

– Drink lots of water, fruit juice, vegetable juice and other drinks. At least 50% total fluid intake should be water.

– Drink about 3-5 liters of water as water dilutes urine and there by hinders the stone formation.

– Drink enough to ensure the passage of 2000 ml / 70 oz of urine per day.

– Never let yourself to become dehydrated. Drink more water if you are doing strenuous work or are working in hot humid climate.

– You can drink barley water and coconut water daily, it helps in removing stones.

• Drink lots of orange juice or other citrus fruit juices like – grapefruit, cranberry and grape juice. Citrus fruits especially orange juice is rich in potassium and citrate, potassium citrate is commonly used to prevent kidney stones.
• Foods that have been shown to increase the amount of oxalate in urine include

-spinach

-rhubarb

-nuts

-wheat bran

-Avoiding these foods may help reduce the amount of oxalate in the urine.

• Reduce sodium intake. High sodium intake increases the risk of kidney stone by increasing urinary saturation of calcium phosphate and monosodium rate and decreases the inhibitory activity against calcium oxalate crystallization.
• Increase intake of fiber – bran, whole grains, oat, green leafy vegetables, peas, beans, potatoes, raw vegetables, salads, dried fruits and fresh fruits.
• Consume good amount of B-complex vitamin daily, especially pyridoxine (Vitamin B-6) and B-1 (thiamine) as their deficiency is associated with formation of stones.
• Reduce intake of sugar as it is associated with kidney stones.
• If possible stick to vegetarian diet. Studies have shown that plant sources of oxalates and calcium are not the cause for stone formation. Diet high in animal protein affects certain minerals in the urine which aids in the formation of kidney stones.
• Avoid high purine foods. They lead to high production of uric acid.
• Stop eating MEAT, be a vegetarian as meats are major sources of purine.
• The following foods are very high in purine and should be avoided completely:

– Anchovies, herring, mackerel, roe, sardines, scallops, shrimp, mussels, partridge, meat and meat extracts (oxo, bovril), red meat, mincemeat, goose, bouillon / broth / consommé of brains, kidney liver and heart.

– Dried legumes, sweetbreads, yeast (baker’s and brewer’s), yeast extracts (marmite, vegemite).

• If possible avoid alcohol or limit alcohol consumption to 1 drink three times a week. Completely avoid beer.
• Consume moderate amount of protein. Instead of animal proteins consume plant sources of proteins.
• Limit fat intake, foods high in fats are listed above.
• Consume lots of vitamin C; avoid crystallization of uric acid and helps in urinary excretion of uric acid. Consume buffered form of vitamin C, ascorbate.