The human body s ability to manage the fats consumed and the way the liver functions to handle this in the overall metabolism setting are dependent on choline. Choline, which is present mostly in the form of Vitamin B12, is available in plenty in most of the foods consumed by people regularly. The issue arises when the body system fails to absorb choline nutrient from the food consumed. There are also cases where the dietary intake does not possess adequate choline in it.

Natural Difficulty in Absorbing Choline
There are certain conditions in which the system finds it difficult to absorb choline though the diet may contain the nutrient. People who have just undergone a by-pass surgery or those who have had a kidney transplant done or if there is already a liver problem like cirrhosis face this issue. There are other reasons also which can lead to choline deficiency, such as the prolonged intake of anti-convulsant drugs and so on.

How to Detect or What are the Symptoms?
Some apparent symptoms can lead the GP to ask for more tests to establish that the person does have choline deficiency. In normal person, even high blood pressure could be caused due to choline deficiency. Then in many cases, a blood test for any other condition might reveal very low levels of VLDL (Very Low-Density Lipoprotein). This substance in the blood is used by the liver to transport fats and naturally, if VLDL is below a certain threshold the person is bound to be suffering from choline deficiency. High level of cholesterol is another symptom. It has to be understood that choline is also essential for the human brain to be functioning at its active best. Deficiency of choline can lead to an early setting in of dementia. Of course, any patient with liver and kidney related condition reaching the doctor will be checked for choline deficiency since these are closely related.

Where to Get Choline from?
The next obvious question is which foods can get you choline easily and you won t suffer from a deficiency. As mentioned there are plenty of food items of daily consumption which have choline in them. The most frequently recommended are the yolk of the egg. Pastured eggs are recommended and though even one egg can give some 115mgms of choline, you can make a couple of eggs a part of your daily breakfast menu. The other suggestion is raw liver as in beef liver which is quite rich in choline. Those who consume only vegetarian foods can always eat a lot of green vegetables like cauliflower, cabbage and also nuts and legumes (soaked) and milk and yoghurt are all good for choline intake.

Choline is an essential nutrient in the human body and is critical to the growth and development of cognitive functions and its deficiency can lead to many serious conditions, including liver impairment and brain disorders. There are plenty of foods rich in choline and should be consumed regularly.


Choline Deficiency - Signs You Are Suffering From It + Sources Of Choline!! 

The only thing that can ruin a great meal is the feel of a bloated tummy afterwards! Usually any abnormal swelling or increase in diameter of the abdominal area is termed as bloating. The condition has become very common and is experienced by people around the world. Poor diet, sedentary lifestyle, high level of stress and need for daily medications seem to be making people more prone to this epidemic. It can sometimes also be a result of an underlying health issue that you might be unaware of. The good thing is that there are signs of it which can be watched out for.

What to Keep an Eye Out For: To start off, there is the sign which is considered to be rather obvious by many flatulence. If a person wants to get rid of flatulence for an extended period, he or she should consider this to be a warning.

Bloating itself can be a sign for other problems which are deeper. The prime example of this happens to be coeliac disease. A bloating of the stomach which is accompanied by pain and a puzzling loss of weight could be signs of this disease.

If a fever seems to keep recurring without a cause which is explainable, it could be a sign of bloating. As a matter of fact, this sign along with bloating also does signal some infection, which should be looked at immediately by a medical professional. Also, too much stress on a person could be a sign of impending bloating issues.

Getting Rid of Bloating: In order to cure bloating which is caused by flatulence, an easy and elementary solution is to eat your food slowly and to chew properly. In serious case, seeking adequate medical help is important.

When a person finds that he or she seems to be suffering from bloating very often, it is a good idea to maintain a food diary. This will help find whether there are certain trigger foods which cause bloating. The pattern can be discussed with your doctor and concrete steps can be taken towards a complete solution.

Simple lifestyle changes beyond the diet can also make a difference. These include correction of sleeping and eating habits of a person. You are also required to be very regular with this.

Bloating always has some signs which are associated with its causes so it makes good sense to be aware of the same as the saying goes, 'a stitch in time saves nine'!

Warning Signs of Bloating? How to Treat It?

An infant is usually called a bundle of joy and with good reason. There are simple and carefree, and bring a smile to your face with their antics. However, the mood and health of an infant can be tarnished due to an issue which is known as galactosemia.

What is Galactosemia?
When a baby has galactosemia, he or she will have a problem when it comes to digesting galactose, which is something that is present not only in milk but in all milk products. Galactose is a sort of sugar, just like fructose and glucose is. As a matter of fact, lactose, which is what milk has, is, in fact, a combination of glucose and galactose. Also, when lactose is processed, it is broken down by the human body into its constituents.

The condition is something that is passed down through the genes of the parents of the baby. The condition would occur if the gene which causes a tendency for a baby to have galactosemia is present not only in one parent but both of them. A baby who has the condition will be lacking an enzyme which is known as the GALT enzyme. The enzyme could also not be functioning as it should be under normal circumstances.

When it comes to the problem, it is very important, to say the least, to detect it sooner rather than later as if there is a build-up of unprocessed galactose which is allowed to occur, it can affect the baby adversely and in some cases, it can also be threatening to the life of the baby!

How does it affect a baby?
The problems which can erupt due to galactosemia include issues which affect organs such as the brain, eyes, liver and kidneys. It is interesting to take note of the fact that these are all organs which either have something to do either processing the blood or are heavily dependent on it. While a baby is not in the position in which he or she can communicate the issues that are being faced, when keeping an eye out for galactosemia, the signs which are displayed include an irritability of the baby as well as lacking consumption of the milk of the mother.

Even though galactosemia may not be the case, a doctor should be consulted as the exacerbated issue can include seizures and jaundice. It is to be kept in mind that galactose is something that can be found not only in the milk of the cow but also human milk as well as the milk of other animals such as goats.

Galactosemia In Infants - Know the Reasons Behind It!

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!

Digestion is an important process that helps in converting food to energy. It begins at the mouth and the stomach is where the detailed process begins. The stomach produces acids to digest the food. But when food is not consumed at the right time or if it is too spicy, it can lead to acid reflux. Acid reflux may result because of individual habits too such as excessive smoking and alcohol consumption. In this condition. the valve that controls the release of acids does not close properly. This causes the acid to move up and cause pain in the upper abdominal region. Acid reflux or hyperacidity initially starts with a burning sensation and gradually manifests itself as severe pain that is intolerable. Ayurveda, the ancient medical science of India, suggests a number of efficient solutions for this condition.

Triphala: This is a combination of three ingredients   the Indian gooseberry, ink nut, and beleric   in equal proportion. These three ingredients ensure a balance of the three doshas   pitta, vatta, and kapha. Ayurveda says that any imbalance in three doshas can cause diseases and disorders in the body. Therefore, consuming triphala in the form of powder or pills every day helps balance the three doshas. You can take half to one teaspoon on to triphala with warm water on an empty stomach in the morning and as you go to bed at night.

Indian gooseberry: This is an Indian fruit that is loaded with antioxidants and anti-inflammatory properties. It helps in reducing pitta, which is fiery in nature as per Ayurveda and is characterized by an excessive heat. Elevated pitta is responsible for acid reflux. Taking gooseberry is easy, as it can be eaten raw or taken in the form of juice. It can also be included in a few recipes.

Other remedies: Lots of other home remedies come handy in alleviating pain related to hyperacidity. One of them is Aloe Vera. Aloe Vera juice soothes the pain and cools down the system. Additionally, buttermilk offers an instant remedy to ensure that the pain and burning sensation are relieved.

Restrictions that Ayurveda suggests: It is not only what you consume to treat the disease that matters. A few foods should be avoided to ensure complete cure. While people know that spicy foods should be kept at bay, tea, coffee, vinegar, tamarind and other sour foods should be avoided as well. Peanuts are very acidic and can trigger acid reflux.

Lifestyle changes recommended by Ayurveda: Quitting smoking and stopping consumption of alcohol is what all streams of medicine recommend. Ayurveda also advises people to follow early to bed and early to rise principle. This ensures that the body performs all its duties within hours of its optimum functioning. Lying down after a meal is not advised. Also, wearing tight clothes should be avoided. Foods that are oily and fatty should be avoided. Eating freshly-prepared food items is considered good as per Ayurveda.

Stay relaxed: Hyper acidity may also result because of stress and tension. The best way to combat stress is to stay cool and calm. Practicing yoga can help relieve hyperacidity and also alleviate pain caused by it. 

Pranayama, peacock pose, and shoulder pose are recommended to combat hyperacidity. As per Ayurveda, sticking to healthy eating habits is the one-stop solution for several ailments and hyperacidity is no different. Sleeping for at least 7 to 8 hours in a silent and soothing environment is also advised by this system of ancient medicine to lead a happy and healthy life. 

Hyperacidity - How Ayurveda Can Help? 

The food you eat plays an important role in your gastrointestinal health. Some foods can be difficult to digest and lead to bloating and heartburn while others increase the healthy bacteria in your gut and make digestion easier. 

Here are ten things you should include in your diet for a healthy digestive system.

1. Bananas: Bananas help regulate bowel movements and help bind food waste together thus helping with irritable bowel syndrome and diarrhea. They also help restore the electrolyte and potassium balance in the stomach.

2. Oats: Oats are rich in fiber and low in calories. It is also a rich source of phosphorus, vitamin E and Zinc. Oats helps with the proper functioning of the digestive system and the extraction of waste.

3. Curd: Curd rice is the most well known home remedy for an upset stomach. Curd is a rich source of probiotics that helps restore the balance of healthy gut bacteria and eases digestion.

4. Coconut oil: Coconut oil is an excellent substitute for normal cooking oil or butter. Coconut oil has antimicrobial properties and fatty acids that ease the digestive system and boost immunity and energy levels.

5. Lentils: Lentils are rich in prebiotics and fiber. These prebiotics promote the growth of healthy gut bacteria and prevent harmful bacteria from causing stomach infections.

6. Ginger: Herbs and spices are very helpful with digestion. Amongst these, ginger is foremost. It can be used to treat a number of stomach infections such as bloating, nausea and diarrhea. Ginger also helps 
speed up the movement of food from the stomach to the intestines.

7. Vegetables: Vegetables are rich in fiber and probiotics. While beetroots help relieve constipation, sweet potatoes help treat ulcers and bowel problems. Other vegetables that aid digestion include cucumbers, tomatoes and carrots.

8. Brown rice: A certain amount of carbohydrates are essential for a well balanced diet. Brown rice has a high calorific value but is less fattening. Brown rice helps food move smoothly through the digestive system and hence promotes regularity.

9. Peppermint: Peppermint helps ease indigestion and symptoms of irritable bowel syndrome. Peppermint can be had on its own as a flavoring agent in salads and on fruits or taken as a supplement.

10. Water: Water is crucial to healthy digestion. It helps smooth the movement of food through the digestive system and out of the bowels. Inadequate water is one of the most common causes of constipation. Ideally, you should have a minimum of 8 to 10 glasses of water a day.

10 Foods That Support Your Digestive Health

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