Nuts and dry fruits are probably the oldest and traditional superfoods which our mothers have diligently offered us for our good health. Packed with proteins, iron, magnesium, healthy fats, vitamin B and fiber, these nutritional powerhouses are a must in our diet, but only in a limited quantity. Yes, taking almonds, dates, cashews, pistachios, and walnuts in excess amount can lead to excessive body heat, giving rise to nasty pimples and rashes. Not more than 2 tablespoons of dry fruits are recommended in a day because of their sugar content, they can easily help to put on weight by adding excess calories.

But, how true is the claim or is it a myth? Let's find out.

Here is a brief overview of how overconsumption of dry fruit is detrimental to health:

Weight gain: Studies conducted by researchers over the years has revealed that it takes over 3500 calories to gain 1 pound of weight. However, consuming just 250 calories from dry fruits can result in over 2 pounds of weight in a single month. A sudden increase in weight can bring in other complications such as obesity, menstrual problems in women, high blood pressure, etc. It is therefore imperative to avoid excess intake of dry fruits. To ensure minimum intake of calories, we could focus on dates, apricot, cranberries, blueberries, etc.
Asthma: Sulphur dioxide is often used to process dry fruits. Studies revealed that this foul-smelling gas isn t very harmful when consumed in limited quantities. But, as per food safety experts, the permissible limit of Sulphur dioxide in humans should not be more than 20 mg per day as it can cause asthma, allergic reaction and skin rashes in an individual.
Gastrointestinal problems: Food items with high fiber content help in regular bowel movement and smooth blood flow. However, consuming too much fiber can lead to bloating, diarrhea, flatulence, cramps and constipation. This is exactly the case with dry fruits as well. They contain fiber and have the capacity to wreak havoc in the intestinal lining on overconsumption. Gradual and steady consumption of dry fruits over a period of time can mitigate this risk. 
Tooth decay: Dry fruits that are available in the market come with a thick coat of sugar so that they do not infuse moisture and stick to each other. This sugar significantly contributes to tooth decay. This is the reason why overconsumption of dry foot should be avoided.
Sugar crash: Most dry fruits have a high glycaemic index which can quickly surge blood sugar levels and spike energy levels. Therefore, patients suffering from high pressure should strictly refrain from dry fruits.
While the cons appear frightening, do not cross the nuts off the grocery list completely. Dry fruits when consumed under control, can be really helpful. So remember that moderation is the key. And in case you have a concern or query you can always consult an expert & get answers to all your questions!

Dry Fruits - 5 Reasons Why You Must Not Eat Too Many!

Tummy tuck also known as an abdominoplasty, a tummy tuck surgery is a form of cosmetic surgery, which is used to remove excess fat and skin from the abdomen as well as tighten the muscles in your abdominal regions. Similar to 'mommy makeovers' (a procedure applicable after pregnancy, which helps women restore their figure). 


Tummy tuck surgery is used to help patients treat that loose and sagging skin who have experienced excessive weight loss within a relatively short period of time. Although, it is usually done for cosmetic reasons, it does provide a large number of medical benefits, such as:


1. Reduction in stress urinary incontinence: Stress Urinary Incontinence is a bladder control problem that is characterized by involuntary urination because of exercises or normal bodily functions such as sneezing or coughing which might put pressure on the bladder. In some women, (SUI) can develop after a vaginal birth. The condition does not generally require a surgery. However, research has shown that in severe cases, abdominoplasty is helpful in patients who do not have a caesarean section. A slight bladder obstruction is made during the procedure using soft tissue which reduces the incontinence.


2. Better posture and improved abdominal tone: Strong muscles tend to become weak after multiple pregnancies and extreme weight loss. In these cases, diet and exercise are not enough. Abdominoplasty surgically removes excess fat and skin thereby, tightening weak muscles and flattening the abdomen. It is noticed that after the surgery, the patients develop an improved posture due to the tightened muscles supporting the spine. This helps in relieving a variety of back pains.


3. Correction of ventral hernia: Ventral Hernia is the bulging out of tissues through a defect, opening or past incisions within the wall muscles of the abdomen. In such a case, the surgeon may opt for Abdominoplasty to support the abdominal wall and prevent recurrences.


Medical Benefits of Tummy Tuck Surgery 

The liver is the engine of the human body. It is basically composed of 2 types of cells (a cell is the basic building block of the human body)   hepatocytes (liver cells) and cholangiocytes (bile duct cells). It also has other supporting tissue and their respective cells. The hepatocytes are by far the most numerous cell type, not surprisingly tumours (otherwise called mass or lump.  Tumor  means lump in Latin), of this cell form the majority of abnormal growths in the liver. Abnormal growths can be benign (that is, they do not grow rapidly, spread to other parts of the organ or to other parts of the body) or malignant (grow rapidly, spread to other parts of the organ and to other parts of the body, i.e. cancer). These abnormal growths from liver cells are Focal nodular hyperplasia (FNH), Adenomas (the benign variety) and hepatocellular cancer (otherwise called Hepatoma/HCC, the cancerous type). What we need to recognize is that certain adenomas can turn into HCC, over a period of time. The other type of growths in the liver are those that have originated elsewhere in the body and spread to the liver, for example a growth of the breast spreading to the liver. These are in fact the commonest tumours of the liver. I will discuss these at a later date.

Benign growths of the liver

Common benign growths are Haemangiomas, FNH and Adenoma. Most of these are identified when a scan is performed as investigation for some other problem. Accurate diagnosis of the nature of these lumps is important to determine the type of treatment needed. This can be ascertained by a carefully selected scan like an Ultrasound, CT scan or an MRI. The technology of these scans is continuing to evolve and get better year on year. There are different types of Ultrasound, CT and MRI scans with different applications, based on whether contrast is used or not, the different phases of scanning, the type of MRI scanning sequence etc. Therefore, these scans although commonly available and used very frequently, need to be performed under the supervision of a team involving Liver doctors and radiologist who is well versed in the diagnosis of liver lumps, for accurate diagnosis without the need for unnecessary tests (Box 1).

Haemangiomas are by far the commonest. It is estimated that 5% of the adult population harbor this lump in their livers! They occur in both sexes and at all ages but are commonest between 30 to 50 years in women. Most of them are small, less than 4-5 cms in diameter and are are identified on Ultrasound. MRI and its various applications is the scan of choice for accurate diagnosis. This is crucial as most of them do not need treatment.

Focal Nodular Hyperplasia (FNH) are the second most common liver lumps. They are usually single and small (less than 4 cms) and occur in women between 35   50 years of age. About 2.5-3% of population harbor this lump in their livers. Special MRI techniques using special contrast agents is diagnostic and the findings are quite distinct from haemangiomas. Again treatment is not recommended apart from selected circumstances. Assessment in a dedicated Liver team is recommended for accurate diagnosis and a proper management plan to be formulated.

Hepatic adenomas (Hepatocellular adenoma, HCA) are rare lumps and occur in 0.2 to 0.3% of the population, again occurring mostly in young women during their reproductive period. They are again solitary and most usually 3-4 ms in diameter.

There are a couple characteristics which make this lump different from the previous 2, there is a strong relation between hormones the development of HCA and some of these HCA can turn into the malignant Hepatocellular carcinoma (HCC). Therefore, accurate characterization and diagnosis of these HCA is essential. Sometimes biopsy of the lump, molecular and genetic tests maybe necessary to determine if the HCA has a high chance of progressing to HCC. Imaging tests are generally adequate, contrast MRI Liver and its different techniques is accurate in diagnosing HCA and sub-typing it, however CT and contrast-enhanced Ultrasound is sometimes necessary along with MRI.

Generally, a HCA in a male is recommended for surgical resection. While in women, discontinuation of the OCP pill/ any other such hormone is recommended for a period of 6 months, if the HCA does not have any worrying features and size is less than 5 cms. IF HCA is larger than 5 cms and has features suggestive of a high risk for change to HCC, surgery is advised. Again these decisions have to be made as a part of a Multi-disciplinary team (Box 1)

Malignant growths beginning within the Liver

As mentioned earlier, usually malignant growths which are seen in the liver spread to it from elsewhere in the body. Hepatocellular cancer/Hepatoma (HCC) is the commonest malignant tumour beginning within the liver, as apposed to those that spread to the liver from elsewhere. It occurs between 40-70 years of age and occurs commonly in men. It is estimated that 17000 new patients develop this tumour every year in India. The vast majority (> 80%) of these develop in patients who have chronic liver disease (cirrhosis). Importantly the number of HCC cases is increasing year on year as cirrhosis due to fatty liver disease, Hepatitis B (3% of Indian population carry this virus, ie nearly 40 million individuals) and alcohol are continuing to increase in India. Nearly overall it is the 4th or 5th most common cause of cancer and the second most common cause of cancer-related death. This is continuing to increase too. We do not have a national policy in India to screen and diagnose these lumps in the liver at an early stage. Most patients present at a late stage when effective treatment is not possible.

Hepatitis B is a vaccine-preventable disease, there are good drugs to treat it and decrease the risk of cirrhosis and HCC in HBV patients, therefore it is important to test for this virus infection. The fatty liver disease can cause chronic liver damage and HCC, regular exercise and consuming a balanced diet can reduce the risk of fatty liver disease.

The usual mode of detection of these growths is when a scan is done for some other reason. Occasionally patients can develop pain in the abdomen or jaundice which leads to an investigation. The treatment of HCC depends on the extent of tumour, the extent of the chronic liver disease (the stage of cirrhosis) and the overall condition of the patient. These patients are best seen, assessed and treated in a team (Box 1) which specializes in the treatment of Liver disease.

The best treatment for HCC is surgery. However, this is suitable only for certain carefully selected patients. This can take the form of liver resection (where a portion of the liver with tumour is removed) or liver transplantation (where the whole liver is removed and a donated liver (full or partial) is replaced into the patient. Indeed surgical has excellent survival rates; more than 75% of patients survive for more than 5 years after resection or transplantation making treatment for these cancers one of the most satisfactory.

Other treatments which can be combined with surgery in selected patients or can be combined with patients not suitable for surgery are different types of Interventional radiological therapy   chemotherapy or radiotherapy delivered through fine catheters introduced into the blood vessels of the liver (TACE: Transarterial chemotherapy, TARE: Transarterial radiotherapy) and or heat energy delivered to the tumour area by means of carefully placed needles/probes (RFA: radiofrequency ablation, MWA: microwave ablation).

HCC is unique cancer as its treatment should be tailored to the patient, the treatments are varied and range from catheter-based non-invasive treatment to major surgery and transplantation. This necessitates that HCC patients are best managed in a multidisciplinary team which is highly skilled in and specializes in the management of liver diseases.

Box 1: A liver tumour multidisciplinary team   Integrated Liver Care team

The team should be one with expertise in the management of benign liver lesions and should include a Hepatologist, a Hepatobiliary & Transplant surgeon, Diagnostic and Interventional radiologists, Medical oncologist and a Pathologist.

Each member of the team must hold specific and relevant training, expertise and experience relevant to the management of benign liver lesions.

The team should be one with the skills required not only to appropriately manage these patients but also to manage the rare but known complications of diagnostic or therapeutic interventions.

The Increasing Problem Of Liver Tumours In India!

Potassium is an essential mineral which is known as an electrolyte. Electrolytes are responsible for maintaining the ionic balance of your body. Other electrolytes are sodium, calcium, magnesium, phosphate, chloride. These electrolytes bear an electric charge which manages the electrical activity of your health system. Potassium also helps the muscles of the body to function properly. In fact, it has its contribution in regulating blood pressure; a crucial role for a healthy heart.

Potassium deficiency is a kind of medical condition which is known as hypokalemia. The normal level of potassium in the human body should be in between 3.5-5.0 mmol/L. But the deficiency in potassium can cause severe problems including muscle weakness, nerve disorders, heart problems, etc. Kidney is the organ which is known to manage the potassium balance by removing the extra potassium through urine.

Causes of potassium deficiency:

Lack of potassium in diet
Dehydration
Diarrhoea
Too much sweating
Several medicines also cause potassium deficiency

Signs of potassium deficiency:

You are getting wiped out too often: Like it is discussed before that potassium is responsible for your muscles to work actively. Each and every cell needs the required amount of potassium to work effectively. So, a little deficiency of potassium can leave you exhausted throughout the day. If your normal working routine leaves you exhausted and if you are sweating too often, then there is a chance that you are suffering from hypokalemia.
High blood pressure: Potassium plays an important role in maintaining the blood pressure by helping in relaxing the blood vessels. Low potassium can cause the blood vessels to get constricted, due to which your blood pressure increases.
Muscle weakness: Potassium plays a significant role in building the strength of your muscles. Lack of potassium can easily cause muscle weakness, aches and spasms.
Irregular heartbeat: Anything regarding your heart problem can scare you badly; especially when you experience sudden skipped heart rate or when your heart rate doubles. Low potassium can cause such palpitations and skipped heartbeat.
Feeling dizzy: Lack of potassium in your body can slow down your heart rate and make you feel dizzy or you may feel that you are going to faint. Though many other medical conditions can be responsible for such symptoms but hypokalemia is one of them.
Constipation: Potassium deficiency can affect your overall health. You might encounter symptoms like bloating, abdominal cramping etc.
Numbness and tingling: Potassium is significant in keeping your nerves healthy. Potassium deficiency can make you experience numbness, needle sensations on your feet, wrist, etc.
These are the signs that people encounter when they suffer from hypokalemia. Hypokalemia can make you feel extremely sick and it causes several diseases which are discussed above. It is always advisable to visit a doctor when you encounter any of these above mentioned symptoms.

Potassium Deficiency - 7 Signs You Are Suffering From It!

Ulcerative colitis is a disorder that causes inflammations and ulcers inside your colon, affecting the entire digestive system. The disease grows over time and symptoms start to worsen over a prolonged period, rather than the problem showing up suddenly. Severe cases of ulcerative colitis may even be fatal if treatment does not resolve some of the complications arising from the condition.

Causes of Ulcerative Colitis-
The exact cause for the inflammatory bowel disease is unknown. Improper diet and lifestyle can aggravate the symptoms, but do not cause the condition. Some possible causes for the disease include-

Improper functioning of the body s immune system causes it to recognize the colon as a foreign body.
Genetic factors and hereditary may also be held accountable in some instances.
Risk factors for the condition include old age and family history of the condition.

Symptoms of Ulcerative Colitis-
Here are some common symptoms associated with the condition-

Bloody diarrhoea
Rectal pain
Weight loss
Pain in the abdominal region along with cramping
Fever
Urgency to defecate
Inadequate bowel movement despite the feeling of urgency
How can you prevent ulcerative colitis?
Ulcerative colitis cannot be prevented as the exact cause for the condition is unknown. However, there are simple steps that will help manage the symptoms.

Diet change- You need to stop eating certain foods, such as, dairy products, beans, broccoli, cabbage and anything spicy. Instead, fibre intake must be increased drastically.
Exercise- Mild exercise or activities have a profound impact on managing the condition.
Avoiding stress
Drinking plenty of fluids
Role of Homeopathy in Managing Ulcerative Colitis-
Homeopathy follows a natural and holistic approach to deal with the condition. It does not merely treat the symptoms, but looks to cure the underlying cause for those symptoms. Homeopathic remedies will greatly bolster the overall condition of the body s immune system. Furthermore, the bloody diarrhoea accompanying the disease will also stop with proper homeopathic treatment.

Ulcerative Colitis - Does Homeopathic Treatments Work?

Cirrhosis of liver is slow and gradual replacement of normal healthy liver tissue with scar tissue which results in poor liver function and blockage of flow of blood through liver which comes from intestines. As more scar tissue replaces normal healthy liver, liver begins to fail.

What causes cirrhosis?

Alcohol: Amount of alcohol which can cause liver damage varies from person to person, however those who consume alcohol for long in significant amount are more prone to develop liver damage.
Hepatitis B or hepatitis C: Caused by hepatitis B and C viruses, respectively, which are acquired by contact with contaminated blood (like needlestick injury, blood transfusion, injection drug abuser), sexual contact with infected person and from mother to child during childbirth.
Non-alcoholic fatty liver disease (NAFLD): Caused by presence of extra fat in liver (after excluding significant alcohol intake) which causes inflammation and scarring leading to cirrhosis. Usually seen in patients who are overweight or obese, having diabetes, high fat in blood, high blood pressure or metabolic syndrome.
Drugs causing liver injury.
Others: Autoimmune hepatitis (body`s own immunity acting against liver), Wilson disease (build up of copper in body), hemochromatosis (excess of iron in body), certain bile duct disorders, etc.
What are the symptoms of cirrhosis?

Early disease can present with nonspecific symptoms like weakness, fatigue (loss of energy), decrease wish to take food, vomiting or nausea, weight loss, etc.
Advanced disease can present with fluid accumulation in legs (edema) or abdomen (ascites), facial puffiness, yellowish discoloration of eyes or urine (jaundice), redness of palm (palmer erythema), decrease urine output, small red lesions on skin, easy bleeding following trauma, blood coming out of mouth/anus/other body site, black colored feaces, mental confusion, flapping tremors of hand, etc. In men it can cause impotence, breast enlargement and shrinking of testis.
What are the complication of cirrhosis?

Portal hypertension: It is a common complication of cirrhosis which is due to increased pressure in portal vein. Portal vein is main blood vessel which carries blood to liver from stomach, intestines, spleen, gallbladder and pancreas. Because of scar formation in liver the normal flow of blood from these organs to liver is hampered. As a result of blockage of blood flow to liver there are few complications which can arise like accumulation of fluid in abdomen (ascites) and legs (edema), formation of enlarged veins (varices) in food pipe (esophagus), stomach, etc., enlargement of spleen (splenomegaly), mental confusion/altered behavior/altered sensorium (hepatic encephalopathy), respiratory discomfort (hepatic hydrothorax or hepato-pulmonary syndrome) or decrease urine output/rise in creatinine (hepato-renal syndrome).

Increase risk of infection because of immune system dysfunction.
Development of liver cancer (Hepatocellular carcinoma)
Easy brusibility or bleeding following light trauma.
Gall bladder stone formation
Metabolic bone disease
What are the stages of cirrhosis?

Compensated cirrhosis: Liver damage is damaged but no abdominal swelling (ascites), blood in vomiting or black/red color feaces (variceal bleed), altered behavior/sensorium (hepatic encephalopathy), respiratory discomfort (hepatic hydrothorax or hepato-pulmonary syndrome) or decrease urine output/rise in creatinine (hepato-renal syndrome).
Decompensated cirrhosis: Presence of abdominal swelling (ascites), blood in vomiting or black/red color feaces (variceal bleed), altered behavior/sensorium (hepatic encephalopathy), respiratory discomfort (hepatic hydrothorax or hepato-pulmonary syndrome) or decrease urine output/rise in creatinine (hepato-renal syndrome).
How cirrhosis is diagnosed?

Your doctor will take good history and do proper physical examination. If there is suspicion of cirrhosis then he will subject you to some blood test, ultrasound abdomen, fibroscan/elastography, upper GI endoscopy and if needed CT scan or MRI of abdomen or liver biopsy.

Ultrasound of abdomen in cirrhosis may shows coarse liver echotexture, nodular liver surface, dilated portal vein or collateral, enlarged spleen or abdominal fluid (ascites).

How to prevent cirrhosis?

Best way to avoid development of cirrhosis from predisposing stage of liver illness is to recognize and treat early. Few advices to keep liver healthy are:

Dietary modification: Eat healthy balanced diet. Avoid high calorie food or drinks, saturated fat, sugar and refined carbohydrates. Keep yourself hydrated.
Lifestyle modification: Maintain healthy body weight. Avoid being overweight or obese. Aerobic exercise (like brisk walk 30-45min/day atleast 5days/week) regularly helps to lower liver fat.
Avoid: Avoid use of contaminated needles, sharing of items of personal hygiene (like shaving razors, toothbrush, nail clippers, etc), use of illicit drugs, self medication with over the counter drugs or using drugs beyond doctor`s advice.
Practice safe protected sex
Alcohol
Motivate others: to stop drinking and follow hand hygiene and doctor`s advice.
Hand hygiene: Wash hand with soap and water regularly before eating, after going to toilet and after touching dirty objects.
Vaccination: For hepatitis A or hepatitis B, if you are not vaccinated or not already infected or unsafe antibody titre. Transmission rate of hepatitis B from mother to child at birth can be reduced with vaccination and immunization of newborn starting within 12 hours of birth as well as by using antiviral drugs (if indicated).
Prevent others from getting infected from you if you harbor virus causing liver damage.

How to treat cirrhosis?

Treatment of cirrhosis is based on cause of cirrhosis and complication of cirrhosis. Main aim of treatment in early stage of cirrhosis is to slow the progression of cirrhosis and prevent complications development

Stop alcohol, antiviral drugs for hepatitis b or hepatitis C, proper sugar level if diabetes, steroid or other medications for autoimmune hepatitis, medications to reduce copper from body in patients with Wilson`s disease, etc.
Drugs to lower portal pressure (beta-blocker or nitrates), drugs to remove fluid from body (diuretics), drugs to lower ammonia level for encephalopathy (lactulose and others), drugs to improve kidney function (albumin, terlipressin and others).
Opt for liver ransplant, If cirrhosis is life threatening or treatment of cirrhosis complication is ineffective.
Low salt high protein diet
Stop alcohol intake even if you have other cause of cirrhosis.
Stop smoking
Avoid over the counter drugs (especially pain killers)
Vaccinate if not done already or infected

Cirrhosis Of Liver - A Complete Guide!

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