Saturday, 3 August 2013

Fats that Harm, Fats that Heal…… well almost

Many people have asked me about how to loose weight or what foods to avoid and I have never had a complete answer for them. From intuition , I would say, “just do everything in moderation!” and the people would go like “Huh!, what does that mean?” Well, I don’t know what it means but I do know now that I was partly right and partly wrong. “Together with smoking and physical activity, dietary habits form the foundation for the causation, prevention, and treatment of most cardiovascular and metabolic diseases, including coronary heart disease (CHD), stroke, and type 2 diabetes mellitus (DM), as well as sudden cardiac death, atrial fibrillation, heart failure, and cognitive decline.( Braunwald’s text book of Cardiology).”

Did you get that, dietary habits form the….. FOUNDATION FOR THE CAUSATION….. as in, you really are what you eat.

In developing countries, the burgeoning epidemics of obesity, Diabetes, and Cardiovascular disease (CVD) result directly from rapid social and environmental changes transmitted primarily through changes in diet and other lifestyle behaviors.[2] Familiarity with the beneficial and harmful effects of various nutritional factors is essential to mitigate and eventually reverse the substantial disease burdens caused by suboptimal dietary habits in individuals and in populations.(Braunwald’s text book of Cardiology)

Translation….. “My people perish for lack of knowledge” which could be viewed in two ways, either people do not know or they act as if they do not know.
So, in view of the above, I will attempt to give a breakdown of what is considered a healthy diet. Most of it is common knowledge to most people but some may be new.
Foods are usually divided into carbohydrates, fats, proteins and fibres. In primary school, I was taught that carbohydrates are the energy giving foods. I still remember the teacher saying it and us, the pupils chorusing it back. I also had the distinct impression that carbohydrates are white in colour while proteins are brown foods. This skewed my thinking so much that I did not consider sugar sweetened beverages to be a form of carbohydrate until  recently, neither do most people. Did you know that 600mls of coke has the same number of calories as 2 chapatis or a good serving of ugali. So, after lunch, when you take a sugar sweetened beverage, it is like you are taking lunch all over again. By the way, alcohol is also quite high in calories and 2 bottles of beer can be equated to a meal of ugali. So, next time you are out on the rave and you want to maintain your weight, just take the beer, a few pieces of meat and an apple and that will be your supper right there, complete in all ways. By the way, when it comes to weight gain, it is not what you eat that matters, it is how much you eat. It is not where the calories are coming from, it I s how much of the calories you are taking in. Think of it this way, if you were a mule and were asked to carry a load from point A to point B, it is not what is in the load that would matter, it is how much the load weighs.
However, when it comes to cardiovascular health, it is the quality of what you eat that is most important. I wonder if there is such a thing as a “healthy fat guy?” What would happen if I eat too much of all the healthy stuff? Hmmh… food for thought!
When it comes to carbs, one should target those that have a low Glycemic index and low glycemic load. These will usually turn out to be foods that have complex carbs, not refined and contain lots of fibre (we all know that, don’t we?)
Whole grain contains bran, endosperm and germ from the natural cereal, while the refined grains have the bran and germ removed. Which reminds me, those who have been on a farm will attest to this, farmers regurlary buy “maize germ” and “maize bran” to add to the cow and pig feed. They buy this from the same millers who make our maize flour and wheat flour……………. Talk about throwing pearls to the pigs.

Bran contains fiber, B vitamins, minerals, flavonoids, and tocopherols; germ contains numerous antioxidants and phytochemicals. Intake of whole grains associates consistently with lower risk of CHD, DM, and possibly stroke. Whole-grain intake has been found to improve glucose-insulin homeostasis, endothelial function, and possibly weight loss and inflammation. Whole-grain oats reduce LDL-C.[77] As with fruits and vegetables, it is not clear that any single micronutrient accounts for these benefits; the benefits may result from the synergistic effects of multiple constituents. (Braunwalds)

When it comes to fat intake, the science is not so straight forward. We had been made to believe that solid fats (hydrogenated vegetable oils) are bad and that the liquid ones are good. The hydrogenated vegetable oil companies therefore came up with a campaign stating that their products are “0.00% cholesterol free”. I remember seeing a bill board like that and I thought to myself, “ how can it be 0.00% cholesterol free?  What does that even mean?” I am yet to get an English teacher to explain that statement to me. In my mind, it is either “100% cholesterol free” or “contains 0.00% cholesterol”. Anyway, I believe the idea was to make us think that cholesterol is ingested in the diet ….well it is not. Dietary cholesterol is so little and of largely no consequence to your health. What matters is what the liver does with the fats that you feed it. The liver is actually the major source of body cholesterol and it generates this cholesterol from the food we eat.
Fats are divided into saturated fats, unsaturated fats and trans fats. Saturated fats play a leading part in raising blood cholesterol and factors such as Diabetes, Hypertension, Smoking and Physical inactivity act only on coronary vessels rendered susceptible by elevated cholesterol. Main source of saturated fats is animal fats and some dietary oils. Dietary fat (not dietary cholesterol) is the main contributor to blood cholesterol levels.


Oils to avoid
Coconut oil and Palm oil – contain large amounts of saturated fatty acids with least amounts of unsaturated fatty acids.
Hydrogentaed vegetable oils – contain a lot of trans fatty acids. These are the worst in terms of causing cardiovascular disease.

Good oils
Olive oil, Mustard oil , sunflower oil, canola oil, safflower oil – have large amounts of unsaturated fatty acids.

Poly Unsaturated Fatty Acids
Mono Unsaturated Fatty Acids
Saturated Fatty Acids
LDL cholesterol Response (mg/dl)  (bad chlosterol)
Coconut oil
Palm Oil
Olive Oil
Peanut Oil
Soyabean Oil
Sunflower Oil
Safflower Oil

From the table above, good oils are in red and they will help reduce our bad cholesterol.

PUFA – polyunsaturated FA,   MUFA – monounsaturated FA, SAFA – Saturated FA
The greater the level of PUFA and MUFA, the better the oil is for your heart.

Fish oil is also an important part of dietary cardiovascular disease prevention. It has been shown to lower cholesterol as it provides omega 3 polyunsaturated fatty acids in good quantities.

Fruits and vegetables
It is recommended that we take in at least 5 servings of fruits and vegetables per day. Not only do these provide essential vitamins and anti-0xidants, they are also a great way to aid in digestion due to the presence of fibre. Higher fruit and vegetable intake is related with lower CHD incidence.  Fruit intake is also associated with lower stroke risk and dietary fiber from fruits with lower onset of Diabetes. Hey, we all know that fruits and vegetables are vital for good health, so I will not belabor the point.

Bottom line, we need to watch how many calories we take in if we want to affect our weight. We should also ensure that the calories are coming from healthy sources so as to maintain good cardiovascular health.

Monday, 27 May 2013

Summer Paradox

We had been warned about the summer but at the back of my mind, I thought, these guys are exaggerating, surely it cannot be that bad. We had been told that temperatures would hit 45 degrees and we thought, “bring it on, that does not sound so bad.” Little did we know. As January turned into February, the heavy blankets of winter were quickly packed away. Suddenly, we all seemed to have lost some kilos as the extra layers of clothes vanished into the deep recesses of the cupboard never to be used again. I began to wonder what the hullabaloo about winter was all about and why I had gone out of my way to buy winter clothes. February turned into March and the overhead fan came on. Our landlord had told us that by April, we would need an air conditioner ( AC) – which he was not providing by the way. As the days grew warmer, I began to sympathize with my very resilient family. I began to marvel at the wonder of childhood. Despite it getting warmer every day, the kids seemed to just get along with it. They did not seem bothered at all. M suddenly developed a liking for sleeping on the floor. When asked why she likes it, she says she just likes it period. My sixth sense tells me it is because the floor is cooler than her bed sheet. And, indeed, upon lying down on the bed sheet, it feels like the bed sheet has just been ironed 2 seconds before your skin touched it, great feeling for the winter, but not so great when you already feel that your skin is on fire. I have officially banned hugs in my house. I have warned all the gals to only give me a hug once a week preferably when it is cool. The kids are yet to catch on to this concept. My one year old has learnt that it is suicidal to go onto the balcony while barefoot. It is quite an interesting sight to see her running frantically through the house in search of her crocs whenever she discovers that we are about to go outside. Experience is the best teacher I tell you. She has experienced the feeling of hot concrete on bare feet. Our kitchen is now a certified steam room  and my wife is glowing every time she emerges from it.  She now has an exercise routine. She wakes up early, at 5 am and either goes for a walk or does the laundry. After the walk , she spends some time in the steam room as she prepares breakfast for the family. If it’s a laundry day, she gets to spend time in the sauna, then dry up in the steam room. Beat that for living in a multifunctional, ecological , energy efficient, space saving neo- environment. The other day, she was annoyed with me, so she went to the bathroom, poured water on the floor and had a 1 hr sauna session contemplating her next move. The cooking pots and utensils are hot all the time. A sufuria hanging on the rack feels like you have just boiled something in it 5 minutes ago. I bet it takes food half the time to cook as it is already hot by the time it hits the equally hot pot/sufuria. Which makes me wonder, why is it that I am baby sitting for longer hours nowadays as she ostensibly cooks… this calls for an investigation. The fridge has declared ‘siwesmake’. It has refused to cool anything below the upper compartment and putting food for 24hrs in it is now a pipe dream.  I can now conserve the towel as it has become the most unnecessary invention to use after taking a bath. Just put on your clothes and you will be dry in no time. Bed time has now become a ritual, put the kids to bed, soak yourself in cold water..clothes and all… until you are dripping wet, walk around the room to allow the water to drip down to the floor, pour some water on the bed or better yet, soak the whole bed sheet in water and wring only lightly, then plop yourself on it before the whole thing dries up then pray that sleep overtakes you before the bed dries up. Thank God for sleep. “Unajua kama umerara, ni kama umekufa nusu!”  When the kids wake up in the morning, the first stop is the kitchen, to drink up copious amounts of luke warm water.  Despite all this, I have to carry a sweater to school.  The AC in the library and other buildings is something else. It is like being in a cool box and even with those low temperatures someone will come and turn on the fan right above my head. I therefore wear a sweater when I go into buildings and remove it on my way out. What a paradox!

Monday, 11 March 2013

Delhiites and their dogs

On arrival in Delhi, one of the things that struck me is the sheer abundance of stray dogs. There is a dog at literally every street corner. Back in kenya, stray dogs exist but unless there is a garbage dump somewhere, these dogs are usually emaciated. Not so in Delhi, the dogs here are fat, very fat and ready to have a heart attack any moment. Some of them cannot even walk, they waddle...... sideways. Ever since I spotted these fat dogs, I became intrigued at how they managed to keep such a hefty physique despite being stray dogs. I also noted that the Delhiites are in love with dogs. Despite living in flats that may be cramped, it is not uncommon to see an old man walking 2 or 3 overweight dogs every morning. There is even a lady I see quite often who walks no less that 4 cute dogs everyday. During winter, all the dogs get to wear winter jackets... even the stray ones. This reminds me of a true story.

One of our friends is in a club that has alot of Delhiites. During winter, when the cold was really biting and almost unbearable, the club raised an appeal for money to be donated to buy winter jackets for the stray dogs that congregated at a point near where the club would meet. The members gave generously such that the canines all got a jacket and there was left over cash. So the question was posed, "what do we do with this extra money?' It was proposed that they should look around for a street family that is in need of blankets and donate some.

The conundrum of how the dogs manage to stay so overnourished was finally answered. It had always intrigued me why sometimes I would find food remains(snacks really like biscuits and chevra)on the porch right outside my landlords house and the gate wide open. One day, we found dog poop on our steps on the 2nd floor and I wondered how the dog got there. Our landlord does not own a pet dog. Another day, I went to the grocery store and I witnessed the shop owner tear open some biscuits and pour them out on a receptacle for the canines around his shop to have dinner. Some will even pour out some milk to quench their thirst after the biscuit feast. That was the eye opener for me. The "aha" moment. Since then, I can't help but notice the receptacles outside many homes that seemingly look like trash but may indeed be performing a role every now and then. There was a day when we witnessed a lady who had stopped her car in the middle of the road at the main market, opened the boot, got out a large plastic plate, put it on the tarmac and proceeded to pour out dog biscuits for the stray mutts........incredible.

I am yet to understand what the dogs have to do with Indian culture. There are also many monkeys around Delhi that are quite a nuisance. We have been warned that the monkeys even know how to help themselves to the contents of your fridge if you grant them access to the kitchen. We have also been warned not to feed the monkeys. I don't understand why I can feed the dog but not the monkey. The Delhites also have a thing for feeding birds. There is a place near the main market that is always littered with seeds that someone routinely scatters for the birds. There are also containers of water, just in case the seed goes down the wrong pipe.

Ooops, after writing the above paragraph, I decided to check out wikipedia. Apparently, in Hinduism, it is believed that dogs guard the doors of heaven and hell .... go figure!

Saturday, 23 February 2013

North India by Train

I am grateful to the Lord that we found a wonderful church in Delhi known as Bible Bhavan Christian Fellowship. Before we stumbled upon Bible Bhavan, we had visited 2 other churches and still did not feel at home. On the first day of visiting Bible Bhavan, we knew that this was it. It was like a family away from home where the word of God is explained sequentially and clearly. We looked no further for a church as we now felt at home. At last, we had a family in Delhi where we could fellowship, visit and we lost no time in making friends. Our prayers for a church had been answered.

Some time ago, we went on a medical mission trip whose main aim was to minister to the needs of our brothers and sisters in Christ serving as church planters, ministers and workers in various Bible Bhavan affiliated centres in North Delhi.  Our journey began with a bus ride to the train station at 5a.m. The train journey to Dehradun took almost  6 hours. The train station was crowded even at 5a.m and I shuddered to think what it looks like during holiday season when everyone is travelling to join their families. The journey itself was not too bad. The train was clean with seats that had seen better days but were still in good condition. It was spacious with ample leg room and hot meals were served. The toilets however were nothing to write home about and we were petrified by what we would do if our daughter decided that she needed to use the bathroom. The camp went well and the journey back was better; we knew what to expect and since it took place at night, we slept for half the time. On the third day, we flew to Lucknow and spent an afternoon and the next morning seeing people with various medical issues. The dental team had set out a full mobile dental clinic that was impressive. They were cleaning teeth, doing extractions and even had a mobile 'denture factory' (for lack of a better word). The optical team were diagnosing problems and issuing reading glasses. Thereafter, we took a train ride to Varanasi. We had been warned that theVaranasi train ride would be a difficult one. My wife had immediately taken upon the spiritual dimension on hearing this and could be heard explaining how the "air will be thick, and choking because of all the evil spirits on the way!". Varanasi is where many Hindu adherents go to bathe in the river Ganges. It is also the bed rock of Budhism where it is reputed that Budha gave his first ever sermon. In my mind, I had thought that 'difficult' had a spiritual connotation but little did I know that it was also meant in a very physical way. The first assault to my senses was when the team leader announced that we should carry our water with us from the dining area at Lucknow. I thought to myself, "that is odd. In the previous 2 train rides, water was provided in abundance. Every person had their own water bottle and you could get more if need be." However, I decided to pack a water bottle though half heartedly. On arrival at the train station, I was still oblivious as to what to expect on this train ride. I started to fantasize on the hot dinner and then I would settle down on the wide seats, stretch my legs and nod off for some 5 hrs or so.  On boarding the car we were supposed to travel in, I almost turned back, thinking I was in the wrong train. My sense of sight was assaulted by images of very old seats, some of which did not recline, were rusted in some areas and the cabin curtains looked like they had not been to a laundry in a hundred years. The seating space was also narrow. As if that was not enough, alarm bells go off in my nose as I sense the acrid smell of urea that was poorly camouflaged by an equally strong smell of disinfectant. On entry, at the cabin door, my subconscious mind registered that there was no activity at the door of loading food items but at the same time, I wondered how I would consume a meal with these competing nauseating aromas in the air. As I sat down at my seat with a sinking feeling, I observed that the fold down table for my seat was spoilt. As I was contemplating how to eat my food without a table on a moving train, with a toddler balanced on my knee, my memory rushed back to to what I had heard before. Like a movie, the comments came rushing back.....'the train ride to Varanasi is very difficult'......... 'please carry your water with you for the train ride'........... the sight of no food being loaded  at the door....... and now.......... no table. It hit me like a thunderbolt......." my goodness, there is no food on this train!!"  We had to think fast. We had no idea how much time we had to go out and buy snacks before the train started to move. Luckily, the snack vendors were just out there on the platform and I figured if the train started to move, I could jump on quickly enough. I dashed out and got some snacks then settled down for the ride. By the 3rd hour of our 5 hour train ride, we were all "snacked out". Hungry but unable to force down another snack. Even the kids could not stand the biscuits and crisps. However, our God is merciful and he delivered sweet sleep that ensured that our last 2hrs were spent in blissfull oblivion to the hardships of the train ride to Varanasi.

Sunday, 20 January 2013

Lets arrange some Love

Arranged love. An interesting scenario when you come from a background where love is allowed to fester on its own between two people before they can announce their intentions to them that would care to hear. I first came face to face with the concept of arranged marriages on a bus ride to Moshi, Tanzania. There was this young looking Asian of Indian origin ( lets call him Abhinit) who seemed very fascinated with one of our daughters. As is expected on a long bus ride, it did not take long for the parents to get involved in the conversation between this stranger and their daughter. It emerged that this guy had had an arranged marriage and was beaming at the experience. He was working in Australia and when he felt ready for marriage, he asked his parents to look for a nice girl, they did, the guy went to India for 2 weeks, got married and went back to Australia with a wife. (of course I don't remember the exact time lines but it was something close to this). In fact, Abhinit's view of 'love marriages' was that the courtship and all that goes into bagging a bride was a great waste of time, resources, very stressing and led to immoral behaviour. I was intrigued by his views because until then, I had always thought that people were forced into arranged marriages and just had to perservere through it.

Fast forward to Aiims and I meet this guy, Lalit (names have been changed). He is very excited. Next week, he is going to his home area where his parents have arranged for him to meet a prospective wife. The excitement is palpable. He tells me that this is the first time he is going to meet the girl and if he is happy, he will marry her. 2 weeks later, I bump into him and enquire whether he liked the girl. He says he is fifty fifty about her. He says she is young and has lived for a long time in a hostel away from parents while studying and he was not sure. In addition, his family were also not so sure that she would be respectful and perform well as a wife; she may be childish. So, the long and short of it is that he may consider her but first he will look around a bit more.

In church, we meet this couple, Priya and Narang (not their real names). They have been married for 3 years and have 2 children. They seem very happy. Their marriage was arranged. Priya had had a fair bit of "window shopping" courtesy of her parents and had not found anyone suitable. By the time her meeting with Narang was arranged her mother was fed up with facilitating the 'window shopping'. According to Priya, the previous guys did not match up to her ideals. She had a list of questions that she would use to gauge the the appropriateness of her future spouse and if they did not march up, she would continue looking. After 2 weeks of hanging out with Narang, she knew that this guy was okay. Narang also felt she was okay. They let their parents know, were engaged 2 weeks later and married within 2 months of first laying sight on each other. Incredible!

Another couple, Suxenna and Ajit (lets assume these are their names) had an interesting story. Suxenna is light skinned and comes from a Christian family. Her dad is a pastor, I think. Ajit is dark skinned. If you know India, you will know that dark skin puts you at a definite disadvantage when you are dealing with Indians of lighter skin tone most of whom consider themselves to be of high caste. So Suxenna's dad tells her, they have found a nice young christian man for her to marry. Only problem is that he is dark skinned. She agrees to meet him, likes the guy and the rest is history.

Not all arranged marriages end well though. Sometimes, the family really wants to control who joins the family and problems then develop. The family will want to match for level of education, family economic status, beauty, caste, jobs held etc. I read of many suicides comitted because someone has been denied marriage to the person they want. This whole scenario of arranged marriages  has made me realise the wisdom of my form 1 social ethics teacher who once declared " Love is a decision !" I thought she was crazy then and had never been in love. Now I know better!