Bodylanguage issue 06 winter 2014

A better health care experience altogether

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Issue 06

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2014

Is your home safe?

Prevent household accidents for big and small

Breast cancer

Know the risk factors

Contact lenses

t h g i r g n i n trai

All you need to know

Low-fat or low-carb diets Which one is right?

Swak mondhigiĂŤne

Achieve your ultimate health and well-being

se gesondheidsgevare

10 Tips for creating happy families FREE

Y

COP

Issue 06 | 2014

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contents up close and personal 02 Boodskap van die Uitvoerende Hoof

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08 Health bites – Short bits of info to digest while on the go

interact 03 Contributors

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05 Must haves

16 Diagnosis – Breast Cancer Know the risk factors

Great products and giveaways we

24 Product IQ – Contact lenses

want you to know about

All you need to know

06 A day in the life of ...

14 things to know about

your health

Dr Liezl Botha

12 How to – Moving 101

07 Intercare events

Tips on lasting results

What happenend over the last few months

20 Orientation – Happy family Building lasting relationships

your body

28 Health strategy

23 Feature – Swak mondhigiëne Die gesondheidsgevare

Low-fat or low-carb diets

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Which one is right?

26 Feature – Fetal Alcohol Syndrome

31 First-aid – Home sweet home

Drinking during pregnancy

32 Recipe – Breakfast bites

from the experts 10 Women’s health Servikale kanker en die Menslike Papiloomvirus (MPV)

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Making your own recovery the first priority in your life!

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BOODSKAP VAN DIE UITVOERENDE HOOF T

andversorging speel ‘n belangrike rol in die handhawing van algemene gesondheid.

Tog is ‘n besoek aan die tandarts dikwels laaste op ‘n persoon se gesondheidlysie. Tandheelkundige ondersoeke is egter nie ‘n luukse nie, maar ‘n noodsaaklikheid aangesien sekere tandheelkundige probleme tot lewensgevaarlike mediese toestande soos hartversaking kan lei. Dit kan egter voorkom word indien die probleem vroegtydig gediagnoseer en behandel word.

Intercare se tandheelkundige

Editorial Publishing editors Christa Grobler christa@health-bytes.co.za Marilize Eygenberger marilize@health-bytes.co.za

praktyke word deur hoogs gekwalifiseerde tandartse, spesialiste en mondhigiëniste beman wat die beste moontlike tandheelkundige diens bied. Vir die gerief van die besige sakepersoon of familie bied die praktyke verlengde diensure gedurende die week en is ook oor naweke en publieke vakansiedae oop.

Ons nooi u uit om ons nuwe webtuiste by www.intercare.co.za te besoek, nie net vir meer inligting oor ons tandheelkundigepraktyke en dienste nie, maar ook vir ‘n oorsig oor al die fasiliteite en dienste wat deur

Editorial enquiries Unit 11, Bellfour Office Park, Corner of Rodger & Edmar Street, Bellville, Cape Town, 7530 Tel: 021 917 8804 Fax: 021 917 8801 info@health-bytes.co.za

die Intercare Groep gebied word.

U is ook welkom om ons te skakel by info@intercare.co.za of om u Intercare ervaring met ons te deel by myexperience@intercare.co.za.

Wees verseker van Intercare se volgehoue strewe om aan u en u familie 'n beter gesondheidservaring te bied.

Dr Hendrik Hanekom Uitvoerende Hoof Intercare Groep

Design Blinc Design, Bronwen Moys Content editor Itha Kieser Proofing Albert Buhr Business managers & publishers Christa Grobler & Marilize Eygenberger Printing CTP Print

Indemnity: The information contained in Body Language is intended for general informational and educational purposes only, and not to replace professional medical advice. Persons requiring any medical advice or treatment should consult their relevant qualified health-care professional. The publisher cannot accept any responsibility for any act, omission, loss, damage, or the consequences thereof caused

Advertising: Body Language is published quarterly. FREE copies are distributed at Intercare Medical and Dental Centres. To advertise, please contact our advertising department at: Tel: 021 917 8804 Fax: 021 917 8801 info@health-bytes.co.za

by reliance by any person upon the information contained in the publication. The information included in Body Language is subject to copyright and all rights are reserved. The information may not be sold, resold, transmitted or otherwise made available or disseminated in any manner via any media to third parties unless the prior written consent of the publisher has been obtained.

Issue 06 | 2014

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contributors

Dr Willie Booyens praktiseer sedert 1975 as tandarts en is die afgelope agt jaar deel van die tandheelkundige span

by Intercare Silver Lakes.

Dr Marcel C Niemandt is an ophthalmologist (medical doctor that specialises in diseases and other conditions of the eye) and has his own practice in Hazeldean, Silver Lakes. His practice aims to provide a general ophthalmological service, with a special interest in cataract surgery as well as corneal and refractive surgeries.

Professor Justus Apffelstaedt (Head of the Breast Clinic, Tygerberg Hospital, Associate Professor University of Stellenbosch and Chairman of the Breast Interest Group of South Africa) has been responsible for the treatment of thousands of women with breast cancer and introduced many new treatments. He has published widely on breast health matters and is an invited expert at many international conferences. He advises governmental and non-governmental organisations at provincial, national and global level.

We want to hear from you...

We would like to invite all patients and customers to air their views and provide us with input regarding this magazine. In doing so, we can remain relevant and will then be able to make a difference and “create the better health care experience altogether” on a daily basis.

Please email us at info@intercare.co.za with any suggestions, ideas and topics you would like to read about.

Dr Elna Rudolph is Kliniese Hoof van My Sexual Health – ‘n multi-dissiplinêre seksuele gesondheidspraktyk by Intercare Silver Lakes. Soortgelyke praktyke sal binnekort ook by Intercare Tygervallei in Kaapstad en Intercare Glen Marais in Kemptonpark wees.

Health Bytes Publishers, Christa Grobler (MSc Biochemistry, MBA) and Marilize Eygenberger (BPharm, MBA), have extensive experience in the pharmaceutical industry with regard to patient education, sales, marketing research, scientific knowledge (disease and products) and pharmacy management.

9th AUG: WOMEN's DAY!

NET#WORK BBDO 8015661/E

Every year, approximately 5 000 South Africans require a kidney transplant.

Of these, not even 10% get the kidneys they need. Become a kidney donor while you’re still alive or after death and save a life. After all, you only need one kidney to live a perfectly normal life, as does someone else.

Contact us at n k f s a @ m w e b . c o . z a o r ( 0 11 ) 4 4 7 2 5 3 1 .

Issue 06 | 2014

To see your products on these pages please email us at info@health-bytes.co.za

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Products we love & want you to know about!

Must haves To stand a chance to qualify, email the product code with your name and surname to competitions@health-bytes.co.za. Please use Body Language 06 in the subject line.

Lorna Jane’s book More of the Fit Woman's Secrets

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All day comfort 24/7 motivation

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fter the success of her first book, Move, Nourish, Believe: The Fit Woman’s Secret Revealed, Lorna Jane Clarkson was inundated with people wanting to know how she manages, achieves and squeezes in everything in her life, and on top of it, staying fit and healthy.

Her answer is active living.

In her second book, Lorna shares her life – her stories, inspirations and personal experiences, the food she loves, the things she does every day, the things she never does, with the hope to inspire you to live your best active life.

Her promise is to be authentic and to speak from the heart, as well as give you insights into her daily rituals, how she runs her multi-million dollar active-wear fashion business, and how she motivates herself to eat well and exercise every single day of her life.

eeping fit is easy and stylish with the Oregon Scientific Ssmart Dynamo activity tracker. It is so comfortable you can even wear it as you sleep!

It monitors your activity levels every day around the clock with both a quickglance LED light display and a Smartphone synchronised app. Track your sleep time, steps taken, distance travelled, calories burned and more. It even has an adjustable band for a perfect fit.

The Ssmart Dynamo synchronises with your Smartphone* app to share your activity levels with friends. Smart core collects your activity volume for analysis and displays the real-time data in the application. Different colours of the indicator on the activity tracker represent different activity achievements, so that you can see at a glance if you’ve got your recommended half-hour of activity each day.

Visit www.active-wear.co.za for more information.

Visit www.oregonscientific.co.za for more information or call 011 805 1996 to locate a retailer near you.

Lorna Jane is giving away a hamper worth R1 000. Product code for give-away is LJ.

*Compatible with Android 4.3 & iOS5 or higher, Bluetooth 4.0 enabled SMART Phones

Competition closes 10 October 2014.

Wellness Warehouse

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ant to beat the queues when shopping for health products? Do just that with a simple click. You will find Wellness Warehouse's online shop incredibly easy to navigate. They are known for speedy delivery and personal service and their payment system is entirely safe. Find everything you need by browsing the related categories – health, foodmarket, lifestyle, beauty, mom and child and well-being. You can even order a gift voucher and have it delivered to a friend.

Wellness Warehouse deliver almost anywhere in South Africa using a courier company. Delivery is straight to your door and is trackable, safe and efficient. Delivery prices vary according to area, for instance very remote areas may be slightly more expensive than urban areas. You can expect your order in two to three working days from day of despatch.

Visit www.wellnesswarehouse.com for more information.

Oregon is giving away a Ssmart Dynamo (PE128) + Accessory band Pack (AD268) worth R999. Product code for give-away is SD.

GIVEAWAY

CONGRATULATIONS!

GIVEAWAY

Congratulations to the following winners from our previous Body Language issue 05: USN protein slabs: 1. Veronica Kapp, 2. Catherine Hobson, 3. Savannah Mihaleto. Lorna Jane hamper: Celine Macquet.

Give-away terms and conditions: The winners will be the first correct entries drawn after the closing date. In the event of the judges not being able to get hold of winners on details supplied, alternative winners will be selected. The judges’ decision is final and no correspondence will be entered into. Winners must be prepared to be photographed for publicity purposes. The prize is not transferable and may not be converted into cash. Please note: Give-away prizes/hampers may differ from the images depicted here and they are at the discretion of the sponsor/suppliers who are responsible for delivering the prizes and not Health Bytes Publishers or Intercare.

A day in the life of ...

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14 THINGS

TO KNOW ABOUT ...

Dr Liezl Botha, one of our dedicated colleagues, who is a general practitioner at Intercare Parow.

1.

2.

3.

Where did you grow up?

I grew up on a farm in the Oudtshoorn district and spent most of my childhood on horseback and climbing the old blue gum tree in front of our house.

4.

How would you describe the word success?

Success is achieving your personal goals in life.

5.

Who are your mentors?

Both my parents have played an important role in my life. They

otto... ery m e f i L ve ev o l d n a Live here is t f i s a y da rrow. o m o t o n

You wish you … could fly!

taught me to respect others and live life to the fullest. My father passed away 20 years ago, but the example he set will always have an influence on my life.

Describe yourself in three words ...

Extrovert, compassionate, humorous.

6.

Who shares your home?

My husband Wilhelm, daughter Beulah and our daschund Tinkerbell.

12. Dislikes  Poor service delivery  Unfriendliness  Alarm clocks

7.

What music do you listen to?

Anything from U2 to classical composers such as Beethoven.

8.

Perfect happiness is ... a good book and Lindt dark chocolate.

9.

My ideal date will be … wine tasting on horseback in the Franschhoek valley… but my husband will definitely object!

10.

What would you still like to do?

I would like to see my daughter grow up and blossom. I definitely have a few travel plans up my sleeve.

11.

What makes you happy?

Hearing my daughter’s infectious laughter.

Are you a cat or dog person?

I am a dog person.

Your dream vacation is … at the French Alpes – Courchevel 1850 ski resort. My first ski holiday was at this resort in 1997 and I would like to go back and share the experience with my family.

fun facts

13. Hobbies  Long walks with our dog  Reading 14. Favourite food  Sushi  Nothing beats a braai

Issue 06 | 2014

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Intercare branch news: events over the last few months

Tekkie Tax Day

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ntercare recently supported Tekkie Tax Day on 30 May 2014. Staff members opened their hearts and generously contributed to various charities. More than R5 000 was handed over to the organisers of this fund raiser. Intercare Parow went the extra mile and visited the Alta du Toit Aftercare Centre for adults with intellectual disabilities.

They each received a cupcake and were eager to show off the projects that they are working on.

Below: Lizl Rodrigues, practice manager in Parow, and members at the aftercare centre

Hockey Tournament

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ntercare Tyger Valley recently sponsored a mini hockey tournament at Kenridge Primary School. Players from 10 primary schools participated in the tournament.

Intercare Conference

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ntercare hosted a conference at the Arabella Hotel & Spa from 7–9 March 2014. The aim of the conference was inter alia to discuss the strategic direction of the Intercare Group in relation to global trends and to find ways to further improve access to quality cost-effective health-care.

Dr Jonathan Broomberg (CEO, Discovery Health) and Mr Jelco van der Avoort (manager, advisory health-care at KPMG) also shared their views on the future of health-care in South Africa with the group.

During the gala dinner, sponsored by Cipla Medpro, the Intercare Employee of the Year Award for 2013 was presented to the group procurement officer, Tyrone Waugh.

Below: Dr Hendrik Hanekom (CEO, Intercare Group), Tyrone Waugh and Dr George Veliotes (chairman, Intercare Group).

Below: Staff members of the corporate office with their Tekkie Tax laces

Health bites

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healthbites Short snippets of info to read and digest while on the go.

Hallo – Ek is verslaaf aan SUIKER

Keep calm and snap The idea that your smartphone could help you find inner peace and stillness might seem awkward, as for many of us our phones are the ultimate form of distraction.

Ironically your phone may provide a way to cut through the chaos in your life. With cameras built into most phones, the practice of photography is now accessible to most of us while "on the go", and it's a great way to still a busy mind.

A camera in your hands is a reminder to consciously slow everything down from your breath, to your walk and your thoughts. To take photographs, we have to stop, look around, focus and capture.

It brings our awareness to what's going on around us.

You don't need to be an expert in the art of photography or have a fancy camera. It doesn't matter what the photograph is, the important thing is the process and slowing down.

Garlic might be natural but it can interact with bloodthinning medications and some cancer drugs. You should limit high doses a week or so before any surgery.

Train your brain You can train your brain, boost your mental performance and even reduce your risk of dementia by changing your lifestyle. Here is how:  Stay mentally active Do things that make you think and learn, like taking up a second language, study, read widely, learn a musical instrument or build a puzzle.  Stay socially active Maintain a network of friends and play that game of bridge.  Stay physically active Physical activity helps with growing new brain cells and new connections between brain cells.  Eat well A balanced diet keeps your brain healthy.  Manage your cardiovascular risk factors Keep your blood pressure, cholesterol and blood sugar levels in the healthy range.

Voel jy ‘n bietjie moeg, lomerig of onrustig? Dalk is die oorsaak suikerverslawing – ‘n baie algemene siekte. Suiker is deesdae oral en in alles te vinde – veral in verpakte en geprosesseerde kosse. Dis ‘n bedrieglike bestanddeel wat hemels kan proe, maar ook ‘n mens se gestel kan aftakel en tot hewige gewigsverlies of selfs dood kan lei.

Indien jy vermoed jy is verslaaf aan suiker, maar nie seker is nie, kan die volgende sleutelvrae help:  Het jy al ooit probeer om jou suikerinname te beperk of te beheer?  Is dit vir jou onmoontlik om “nee” te se vir soetgoed?  Eet jy meer soetgoed as ooit tevore?  Het jy al ooit uit jou pad uit gegaan om soetgoed in die hande te kry?

Indien jy JA gese het op enige van hierdie vrae, is jy moontlik verslaaf aan suiker.

9 Fewer SA men having sex than ever South African men are having far less sex than their global counterparts, according to a recent survey done by a leading generics pharmaceutical, specialising in men’s sexual health.

While the average number of times a year SA men enjoy sex is 52, it pales in comparison to the global average of 104 times annually. Pharma Dynamics also found that a startling 22% of SA men are making love less often than three times a month and a further 16% are considered to be in a sexless relationship. 23% of men suffer from erectile dysfunction (a quarter of them are younger than 40), which also causes a low desire.

Over 500 men involved in committed relationships, between the ages of 18 and 55, participated in the survey, which revealed a treasure trove of intimate data about men’s bedroom behaviour.

“Contrary to popular belief, when men are worried about their jobs and money, they are generally not in the mood for sex. It’s a fallacy that men are always up to the task.

Stress and anxiety activates the survival system of the body and inhibits libido. When you’re very depressed you lose your appetite for a lot of things in life, including sex,” says Mariska van Aswegen, spokesperson for Pharma Dynamics.

Cuppa for a cause CANSA encourages all to take part in its annual national Cuppa For CANSA Campaign. Host a Cuppa event by inviting loved ones, friends and work colleagues. The theme this year is Holistic Care and Support, with the focus on the Tough Living With Cancer programme – focussing on childhood cancers and early detection.

Freshpak is welcomed back as an official tea supplier, donating 100 000 Rooibos tea bags. www.cansa.org.za

Issued by Lange 360 on behalf of Pharma Dynamics.

Gesondheidsfeit

Op soek na 'n ontspannende manier om stres te verlig? Luister na strelende musiek - dit kan jou bloeddruk verlaag en jou kalmeer.

Stand up and meet!

A new study shows standing up during meetings indirectly benefits work performance in organisations where knowledge working is key to productivity. It found that compared with sitting, groups who held meetings standing up were more excited and less territorial about ideas, both of which lead to better elaboration of information, indirectly benefitting group performance.

Women’s health: Dr Elna Rudolph, kliniese hoof van My Sexual Health praktyk, Intercare Silver Lakes

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R E K N A K E L A IK SERV

EN DIE MENSLIKE PAPILOOMVIRUS (MPV) Servikale kanker is die grootste oorsaak van sterftes onder vroue in Afrika en die mees algemeenste kanker onder vroue in Suid-Afrika. Die omvang wat hierdie gesondheidsrisiko inhou het die Suid-Afrikaanse regering genoodsaak om 500 000 jong meisies uit arm gemeenskappe gratis teen die virus wat servikale kanker veroorsaak, te laat inent.

Wat is MPV? MPV is hoogs aansteeklike familie virusse waarvan sommige die menslike genitalieë, anale kanaal, mond en keel infekteer.

Sommige van hierdie virusse veroorsaak genitale vratte terwyl ander die selle van die geinfekteerde area so affekteer dat kanker begin ontwikkel. Die rede waarom vroue jaarliks ‘n papsmeer behoort te doen is om te kyk of daar veranderinge van die selle in die serviks is. Dit neem jare vir die veranderinge om in kanker oor te gaan, so indien dit vroeg genoeg waargeneem word, kan die abnormale selle vroegtydig verwyder word. Deesdae kan daar spesifiek vir die MPV virus getoets word, maar jy moet die dokter vra om dit addisioneel as deel van jou papsmeer te laat doen.

Hoe kry ‘n mens MPV? MPV word meestal deur onbeskermde penetrerende seksuele kontak versprei.

Dit is ‘n geharde virus wat basies op enige plek kan oorleef. Ander vorme van genitale kontak soos kontak met toiletsitplekke, klere en ander oppervlaktes wat aan die virus blootgestel word, kan ook tot infeksie lei.

Wie moet wanneer die inenting kry?

Die aanbeveling is om seuns en dogters vanaf nege-jarge ouderdom in te ent. Jy kan vir jouself en namens jou kind besluit of dit in sy/haar beste belang sal wees.

Keel, anus en penis kanker is baie skaars en word nie net deur MPV veroorsaak nie, maar dis nogtans goeie nuus dat jou kind wel daarteen beskerm kan word.

Daar is twee inentings beskikbaar:  Cervarix bied slegs beskerming teen die twee virusse wat meeste van die servikale kankers veroorsaak, maar daar is ook bewyse dat dit beskerming bied teen ander virusse wat ook kanker veroorsaak.

 Gardasil bied beskerming teen die-

selfde twee kankervirusse maar ook teen die twee mees algemene virusse wat genitale vratte veroorsaak.

Vir albei bogenoemde inspuitings is drie doserings oor ‘n tydperk van ses maande nodig. Navorsing is nog vaag, maar inenting sal waarskynlik na 10 jaar herhaal moet word. Dit verseker nie dat ‘n persoon nooit servikale kanker of vratte sal kry nie maar dit verminder die kanse daarvoor.

Is inenting veilig?

Inenting is baie veilig. Dit is effens seer, duiseligheid kan soms voorkom en infeksie bly altyd ‘n risiko met inspuitings, maar niks ernstiger as dit word met die inenting geassosieer nie. Soos met alle medikasie moet die risiko’s teen die voordele opgeweeg word.

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Dit is ‘n us geharde visrop wat basiek kan enige ple f. oorlee

Waar kan jy die inentings

kry?

Enige dokter kan ‘n voorskrif vir inentings verskaf en alle Intercare praktyke verskaf so ‘n diens. Dit is nie nodig om vir elke dosering ‘n dokter te sien nie – as jy ‘n voorskrif het, kan ‘n suster die laaste twee doserings toedien.

How to: Source: www.lornajane.co.za

101

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Moving

There is more purpose behind exercise other than trying to reach your ideal weight. It’s a state of balance in your mind, body and spirit that is needed in order to achieve your ultimate health and well-being.

L

et’s go back to basics and ensure we can obtain the vital ingredients needed for a solidified foundation on the importance of moving.

1

Positivity and setting goals No matter what your fitness level, the importance of positivity and setting goals is undeniable. Goal setting is the perfect tool to keep you on track. It also keeps you focussed, motivated and adds purpose to your workouts. Write down what your goals are and why they are important to you, then place them somewhere visible – that way you are reminded Would and motivated every day. n’t it be g You can’t lead a positive clean reat to ea t to rea life, with a negative mind, ch yo goal ur we exerc ight and nor can you approach the ise enjoy ment just for exercise with a negative bene fits? T and healt attitude. The ‘I can do it’ hat w h ou a libe mentality is what pushes rating ld be feelin you harder and gets you g. over the finish line. If you want to stay on track with your goals, be positive, work hard and believe that you can do it. That’s how we start to tick off that goal list.

2 Moving your body to love yourself If you are feeling a bit apprehensive about exercise, or have simply lost some moti-

vation to work out, try to change your mindset. Think of exercise as a gift and not a chore. The ability to move your body every day is a valuable thing, and you can reap so many rewards, not just physically, but mentally too. You know that feeling you seek when you conquer all confidence that follows a good workout? Well, that is because those endorphins can boost a whole lot of self-confidence. Most people undertake fitness regimes with the goal of losing weight and improving muscle tone.

With these improvements and results come a healthy boost of self-confidence and an improved sense of self – including body image and control over other aspects of life, such as work and relationships. So move your body, start looking at your glass as half-full!

3

Pay attention to your body While it is important to achieve your fitness and health goals, it is equally important to seek balance in your life. This means being aware of not pushing your body beyond breaking point. Stifness pain is a great sign telling you how hard you have worked, but it’s also a great communicator in telling you that something might be wrong e.g. an aching/injured muscle. If this is the case, trust your instincts and act on it straight away. You must never dismiss the signals

Issue 06 | 2014

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Remember, what works for one person may not work for another. If you’re doing all the right things but are failing to see results, seek out a health professional for a consultation – dieticians, trainers and doctors always give good advice – they are the ones with scientific and physiological knowledge and may just get you back on track with the right advice for your specific body.

your body is sending you. Remember, you have not failed by dialling back the intensity of your exercise regime – if you are considering the well-being of your body this should be the ultimate priority. And especially if you are doing extreme sport or events, make sure you put back in your body what you took out – neglecting this aspect can lower your immune system which often results in sickness and diseases.

Do not be discouraged Experts agree that the best form of exercise is one that you enjoy enough to stick with. If you hate running, chances are you just won’t do it. Try walking instead, or sign up for yoga or a dance class. The options are endless, the idea is to pick an activity that you’re suited for and that appeals to you. A cool way to look at it is as if your state of mind and well-being is a bridge that requires the support of all its beams. If you only focus on your physical health and neglect your emotional needs, the bridge will collapse. Likewise, if you focus on only relieving personal stress without strengthening your connection to self, you won’t be able to achieve the sense of balance you are striving for. Don’t be discouraged, sport is not just for kids – there is an enjoyable avenue for all to enjoy, so pick an active move and have fun with it.

4

5 Stretch, stretch, stretch A well-rounded exercise regime would typically cover a healthy mix of cardio and strength training – which is great. However, many tend to neglect a component that is equally important – stretching.

It is so important to stretch all your muscle groups on a daily basis in order for them to be well circulated and healthy. We spend most of our day in the same posture. By not stretching, we continue to overuse and fatigue our muscles, making them short and tight, and bringing in all kinds of health woes (back pain

anyone?). So, don’t forget the need to stretch out your body every day, whether it is when you wake up in the morning or post-workout.

Whether you are an exercise veteran, or are just gearing up to your new active life, the most important thing is to remember the fundamentals. Setting goals and harnessing a positive mind allows you to be motivated and driven. Listen to your body, and move it every day in new and exciting ways – it will make you feel alive and invigorated. Finally, honour your body, and treat it with the utmost respect.

These are the foundations to kick- starting your best, active life!

How to ...

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Lorna Jane's 10 tips for lasting results 1 Preparation Fail to prepare, prepare to fail. I am always prepared. Every night I make my overnight oats for the next morning as I know how busy mornings are. (My oats recipe is ½ cup of oats, 1tbsp. linseeds, sunflower seeds and almonds, 1tbsp. black chia seeds, a sprinkling of cinnamon and nutmeg and ¾ cup of berries soaked over-night in ½ cup of almond milk and some water). Also, every Sunday I do a big cook up with all my lunches for the week. I usually have some meat, veggies and good carbohydrates (brown rice, corn or sweet potato) and freeze them.

Every morning I can just quickly grab my lunch.

2 Track your progress It can be hard to see improvement/results (especially as we can be a bit hard on ourselves). I don’t weigh myself as I find that number irrelevant. Ten women could all weigh the same amount, but look very different and have very different health stories.

Instead, take photos, look at your dress size, take measurements and then consistently monitor your own progress.

3 Do it for YOU and don’t seek approval In the beginning of my journey I would constantly seek approval or compliments on my healthy decisions. Soon enough I learned that no one else’s opinion really mattered. Live a healthy and active life because you want to do it for yourself.

4 If you slip up, don’t worry …

Just keep going. Get back on the wagon!

5 Have a workout buddy Whether that’s a friend, a dog or a personal trainer (I can help you there!), having someone by your side can really motivate you.

6 Eat clean, whole, fresh foods Nourish your body and drink lots of water.

7 Get plenty of rest Do not discount the benefits of sleep. It helps restore the body, and speed up the metabolism – you can even burn fat while you are sleeping.

8 Reward yourself But not with food – you’re not a dog! I like to reward myself with a new piece from the Lorna Jane Active Sportswear range when I achieve a goal.

9 Surround yourself with positive people A fabulous quote from Oprah: “Surround yourself only with people who are going to take you higher.”

My friends, family and husband do this for me.

10 Talk to yourself like you would talk to a friend I love this advice! I would never tell a friend that they are fat, slow, etc. Use beautiful and positive words to encourage yourself along your journey.

You know that feeling you seek when you conquer all confidence that follows a good workout?

Does your arthritis treatment 2: •

Reduce your symptoms?

•

Allow you to stay active?

Ask your doctor for the new medication from AstraZeneca for the symptomatic relief of osteoarthritis, rheumatoid arthritis and ankylosing spondylitis.

References: 1. Woolf AD, Pleger B. Burden of major musculoskeletal conditions. Bull WHO 2003;81(9):646-656. 2. Kalunian KC. Patient information: Osteoarthritis treatment (Beyond the Basics). Available from Uptodate.com. Last accessed 2013/02/28.

AstraZeneca Pharmaceuticals (Pty) Ltd. Reg. No. 1992/005854/07. Building 2, Northdowns Office Park, 17 Georgian Crescent West, Bryanston, 2191. Private Bag X23, Bryanston, 2021. Tel: (011) 797-6000. Fax: (011) 797-6001. www.astrazeneca.co.za. Expiry Date: October 2014. Activity ID: 76329

KEEP MOOOVING

Living with arthritis can be frustrating. Too often, arthritis pain restricts your activity, productivity and quality of life.1 By managing your arthritis pain better, you’ll be able to take back control and do the things you enjoy, with fewer compromises and limitations.

Diagnosis: Prof Justus Apffelstaedt, Associate Professor, University of Stellenbosch and Head of Breast Clinic, Tygerberg Hospital

16

BREAST CANCER

RISK, DIET AND AGE As we know, some risk factors for breast cancer cannot be modified, such as age and gender.

However, other factors, such as diet, physical activity and smoking, can be.

Lifestyle dos and don’ts DON’T eat too many saturated fats. Avoid anything fried, including junk food.

DO go green. Stock up on fresh fruit and vegetables.

DO watch your weight. Increased body fat is linked to a rise in estrogen levels.

DON’T drink more than two alcoholic drinks per day.

DO exercise more to decrease your breast cancer risk by 30%.

D

iet is thought to be partly responsible for about 30%– 40% of all cancers. But diet alone is unlikely to be the “cause" or “cure" of cancer. Findings in the past have suggested that physical activity, a healthy diet (particularly one low in fat and high in vegetables and fibre), and a healthy weight can help reduce the risk of breast cancer or the cancer coming back.

Vegetables Researchers have investigated possible associations between intake of cruciferous vegetables such as cabbage, turnips, broccoli, Brussel sprouts, watercress and cauliflower, and the risk of cancer. The evidence has been reviewed by various experts. One case-control study found that women who ate greater amounts of cruciferous vegetables had a lower risk of breast cancer. A meta-analysis (a process that analyses data from different studies) made about the same subject of studies conducted in the United States, Canada, Sweden, and the Netherlands found no association between cruciferous vegetable intake and breast cancer risk.

An additional cohort study of women in the United States similarly showed only a weak association with breast cancer risk.

In the studies mentioned in Diet and breast cancer by Isabelle Romieu, MD, MPH, ScD, it is suggested that vegetables have a protective effect against breast cancer. Vitamin E is also suggested to have a positive effect and a high intake of

Issue 06 | 2014

17

phytoestrogen (estrogen-like chemicals found in plant foods such as beans, seeds, grains and soy) in adolescence in Asian populations is related to lower risk of breast cancer. Data from Mexico also suggests that high intake of folate and phytoestrogens are related to lower risk.

When it comes to women who have been through menopause, data from Singapore suggests that a diet rich in vegetable, fruit and tofu items have a protective effect on breast cancer and data from a large study conducted in French women supports the protective effect of a healthy/Mediterranean pattern (essentially vegetables, fruits, seafood, olive oil and sunflower oil).

Nuts Consuming walnuts slowed the development and growth of breast cancer tumours in mice, according to a study published in 2011 in Nutrition and Cancer. Study author Elaine Hardman, a professor at Marshall University's Joan C. Edwards School of Medicine, looked at the effect of a diet containing the human equivalent of 56g of walnuts a day (25 –30 walnut halves). After 34 days, mice that ate walnuts had less than half the rate of breast cancer as a control group on the

t

the young patien Dr Karin Baatjes, Specialist Surgeon and Professor Apffelstaedt, Associate Professor, University of Stellenbosch and Head: Breast Clinic, Tygerberg Hospital

On diagnosis of breast cancer in a younger woman, the impact of treatment on body image, sexuality, fertility, premature menopause, as well as pregnancy and long-term side effects of treatment such as the impact on mental functioning and osteoporosis, all have to be taken into consideration.

B

reast cancer in the young patient is defined as women younger than 35 or 40 years of age. In Western societies 6% of all breast cancers occur in women under 40 years of age. In our practice one in six women with breast cancer is younger than 40 years of age. This may be due to the younger age structure of the population in a developing country, but there is also evidence that breast cancer in non-white populations occurs at an earlier age.

While obesity, a sedentary lifestyle, drinking and environmental factors, as well as commencing menstruation early, before age nine, and falling pregnant for the first time after 30, are associated, it is current thinking that, for younger women with a genetic component is more important and many of the young patients are found to have a mutation in the breast cancer genes.

In younger women, the breasts are generally denser and combined with cyclical hormonal

Diagnosis

18

Fibre could play a role in the risk of breast cancer by decreasing the intestinal re-absorption of estrogen. same diet minus the walnuts. The number and size of tumours also were significantly smaller for the walnut group. The study authors speculate that walnuts' antiinflammatory properties are the reason. It is not recommended that this quantity of walnuts be eaten daily as they have a very high fat content. It’s rather recommended that foods with anti-inflammatory properties be included in the diet. Other foods in this category are kelp, papaya, turmeric, blueberries, broccoli and shiitake mushrooms.

Antioxidants When considering antioxidant intake, there is no consistent association between any antioxidant and breast cancer incidence. However, three studies have suggested a protective effect of vitamin E. In a Danish study, vitamin E intake has been related to a lower risk of breast cancer among postmenopausal women and two reports suggest a protective effect of high serum vitamin E on breast cancer risk.

t

the young patien changes in the breast tissue, the clinical examination is more difficult.

The accuracy of mammography is lower in younger than in older women due to the increased density in the young group. Screening mammography is not recommended for young women except for those with a significant family history of breast cancer. Therefore, they present more often with palpable disease, rather than with a mammographically detected abnormality.

It is paramount that a woman of young age should have any lump fully investigated. Clinical examination along with imaging of the lesion is compulsory. As mentioned, mammography can be more difficult to interpret in younger women as their breasts are more dense, which can obscure small lesions. Full field digital mammography can aid in this regard. The addition of good ultrasound of the breast in conjunction with fine needle aspiration or core needle biopsy of the lump assures a complete examination. A cytological and/or histological diagnosis has to be established before accepting a lump as benign.

Apart from the immediate management of the breast cancer which includes a combination of surgery, radiotherapy, chemotherapy, hormonal therapy and biological treatment, the following issues also come into play:

After that, the proportion rises rapidly to 95%+.

Fertility Current breast cancer drugs (e.g. chemotherapy) can make some women infertile. This may not be an issue for women who are beyond childbearing age or who already have children. It’s a great problem for younger women, who plan future pregnancies. The impact of the treatment should therefore be discussed with the patient before it is commenced, as the response of each patient is different and so is the effect of the drugs on fertility. Current guidelines for the treatment of breast cancer in the young recommend the use of chemotherapy for all but the earliest cancers and the vast majority of young breast cancer sufferers will have chemotherapy as part of their treatment. This is an important factor for women, as the chance of suffering premature ovarian failure is as high as around 50% of women who have chemotherapy before the age of 40.

Age 20-39:

Lack of age appropriate treatments Breast cancer in younger women can be more aggressive than in older women, and treatments are not designed for the younger population.

Since young women have more aggressive tumours most guidelines recommend in addition to surgery, they also need chemotherapy.

Hormonal therapy regimens also differ as ovarian function has to be taken into consideration. Researchers' focus on fine-tuning methods of fertility preservation fuel optimism about its increasing viability, but ovarian failure needs to be taken into account, along with the increased risk of miscarriage.

Work and career paths Prolonged treatment regimes can impinge on the work and/or daily functioning of a young woman who is still active in the mainstream marketplace. Special consideration needs to be given to the patient regarding prolonged sick leave, etc.

It is therefore paramount that these women be treated in a dedicated breast unit, by a multi-disciplinary team that can address the issues in an individualised fashion in this subset of patients afflicted by breast cancer.

Breast health management, according to age.

 Monthly breast examination  Clinical breast examination by a health-care professional every three years Age 40 and over:

 Monthly breast examination  Annual clinical breast examination by a health-care professional

 Annual mammography

Issue 06 | 2014

19 Meat Red meat consumption could affect the risk of breast cancer because of the highly bioavailable iron content, growthpromoting hormones used in animal production, carcinogenetic heterocyclic amines (chemicals formed when muscle meat, including beef, pork, fish, or poultry, is cooked using high-temperature methods, such as pan frying or grilling directly over an open flame) and its specific fatty acid contents.

Pooled analyses of case-control and cohort studies (definition of the cohort: a group of subjects who have shared a particular event together during a particular time span e.g. people born in Europe between 1918 and 1939; survivors of an air crash; truck drivers who smoked between age 30–40) have yielded conflicting results. However, recent reports suggest an association between the consumption of red meat and processed meat and the risk of breast cancer.

Vitamin B12 There is a suggestion that vitamin B12 may be associated with lower risk of breast cancer and that low vitamin B12 intake may reduce the apparent protection in the risk for breast cancer conferred by folate.

Fibre Fibre could play a role in the risk of breast cancer by decreasing the intestinal reabsorption of estrogen and therefore lowering its circulating levels.

Vitamin D Some studies suggest that the risk of developing certain types of cancer is lower for people who have higher levels of vitamin D in their bodies. There are also studies that suggest higher vitamin D levels might be linked to greater risk of other cancers.

More studies are needed to find out whether vitamin D is the reason for the differences in risk, or if there is another reason. If there is a link, researchers would still have to find out whether vitamin D deficiency raises a person’s cancer risk. They would also need to know whether taking in more vitamin D than the recommended daily allowance

changes this risk. The possible role of vitamin D in treating cancer is still being studied.

The level of carcinogenic exposure children and young adults have may be important in predicting later risk of breast cancer. This is because the mammary gland is more susceptible to environmental exposure before the accelerated cell differentiation during puberty and first pregnancy.

Nutrition in early life can affect height and age at menarche (the first menstrual cycle), which are established risk factors for breast cancer. Data from case-control studies suggests decreased risk for cancer with diets high in fat from dairy foods, milk, vitamin D and increased risk with high consumption of meat with visible fat.

Understanding dietary patterns and the impact they have on different populations is vital for hospitals, doctors and dieticians to make recommendations on eating practices to prevent disease.

Among the prospective epidemiological studies conducted on diet and breast cancer to date, there is no clear association with diet except for alcohol consumption in addition to overweight and weight gain.

Most of the studies have been conducted in Western countries with some limitations in variability of dietary exposure. Few studies are available from middle to low income countries where variations in food intake are wider and food supplementation less prevalent.

On the other side of the coin, eating foods with a high glycaemic index during adolescence is associated with an increased risk of breast cancer.

Data from Mexico also suggests that high intake of carbohydrate and high glycaemic load is related to an increase of breast cancer.

Although these results need to be confirmed in other populations, they suggest that baseline nutritional status and genetic susceptibility might interact with food intake in relation with breast cancer.

DO go green.

Stock up on fresh fruit and vegetables.

20

Orientation: By Health Bytes

tips for creating a

happy family With just a little bit of work every day, you can build something great.

Everyone hopes to have a happy family some day, but without daily attention, families can spin out of control quickly.

Here’s what you can do to get the best out of family life.

Source: WebMD

1. Just enjoy We all live stressful lives, but be happy when your husband or wife gets home – same goes for when the kids get back from school or extramurals. Joy can be built up through everyday interaction.

The happier you look to see people, the more wanted they’ll feel, which will make them happy in turn.

2. A sk about their day and listen Turn off the TV. Make a point of having family time at the start of the evening. Ask about everyone’s day, and really listen. Tell about your own day, and focus on the positive. It’s something for everyone to look forward to, and it makes the family an interesting place to be. You need to guard against boredom at all costs, because boredom is what will make kids turn to the Playstation, TV, the mall ... If you don’t pay attention, your kids could become strangers.

3. Marriage comes first Family starts, ideally, with a stable marriage or partnership. Let the kids come between you, and their very security is in trouble.

Put your marriage first, and the kids will have the privilege of seeing true love in action.

4. Eat together They say families that pray together, stay together, but eating together is just as important. Dinners around a table, no TV in sight, are a time to connect and share. Keep dinner times as relaxed as possible.

5. Play Playing is very important to create a happy, relaxed atmosphere. Set aside a little time for this before dinner every evening. (Active play will work toddlers up, so is not ideal for bed time). For older kids, play could mean listening to music while you chat and make dinner, and then having

a board game afterwards.

Reading is also a fun leisure activity that should not be forgotten. This is perfect for bed time.

6. Family comes before friends Keep kids happy at home – it’s their base. If you let them become bored, or run wild, they’ll end up spending too much time with their friends.

Friendship is great, but friends’ houses have different rules (which might be contrary to yours), and some friends can be an undesirable influence.

What’s more, kids grow up so quickly, if they spend their days out of the house, before long you might realise you hardly know your own child anymore.

7. Keep kids‘ schedules simple Choose your kids’ extracurriculars carefully. While it’s important for children to get a wellrounded education, you need to prevent overburdening them.

Keeping your kids too busy can

Issue 06 | 2014

stress them out, and lead to unnecessary performance and anxiety. What’s more, someone in the family will be kept really busy driving up and down, which is also very stressful.

Try selecting one or two extra-curriculars, and for the rest, keep kids busy at home reading, drawing and playing games and informal ball sports.

8. N ot in front of the children You’ve heard it a million times, but it’s true: you just don’t argue in front of your children. While marriage is by its nature challenging, and you and your partner will have things to work out from time

to time, it should happen in private. Kids feel insecure when they see discord between their parents. They might start fearing divorce (many of their friends might have divorced parents, or maybe you’re on your second marriage). And another effect to be avoided at all costs is a child siding with one parent. It’s unhealthy to have camps in a family. Apologise and reassure your kids if they see any kind of fighting.

9. D on’t be a workaholic Don’t put so much into your work that you have no energy left for your family. Children need to know they can rely

on you to be home when they need you – for a chat, to share the day, to help with homework or just connect at the end of the day. It all helps to make kids feel secure and valued.

10. Communicate The value of communication can’t be overstated. Communication should be open – don’t make one person the messenger. Make sure your kids feel they can trust you with whatever they need to communicate. This might mean you need to learn patience, or to withhold anger. Think about it. You need to work on communication every day, so

that in future, if your child gets into trouble, they can come to you for help.

21

Try selecting one or two extra-curriculars, and for the rest, keep kids busy at home reading, drawing and playing games and informal ball sports.

Dinners around a table – no TV in sight – are a time to connect and share.

Does your arthritis treatment 2: •

Reduce your symptoms?

•

Allow you to stay active?

Ask your doctor for the new medication from AstraZeneca for the symptomatic relief of osteoarthritis, rheumatoid arthritis and ankylosing spondylitis.

References: 1. Woolf AD, Pleger B. Burden of major musculoskeletal conditions. Bull WHO 2003;81(9):646-656. 2. Kalunian KC. Patient information: Osteoarthritis treatment (Beyond the Basics). Available from Uptodate.com. Last accessed 2013/02/28.

AstraZeneca Pharmaceuticals (Pty) Ltd. Reg. No. 1992/005854/07. Building 2, Northdowns Office Park, 17 Georgian Crescent West, Bryanston, 2191. Private Bag X23, Bryanston, 2021. Tel: (011) 797-6000. Fax: (011) 797-6001. www.astrazeneca.co.za. Expiry Date: October 2014. Activity ID: 76329

KEEP MOOOVING

Living with arthritis can be frustrating. Too often, arthritis pain restricts your activity, productivity and quality of life.1 By managing your arthritis pain better, you’ll be able to take back control and do the things you enjoy, with fewer compromises and limitations.

Feature: Dr Willie Booyens, Tandarts, Intercare Silver Lakes

23

DIE GESONDHEIDSGEVARE

VAN SWAK

MONDHIGIËNE

Navorsing toon dat talle gesondheidsgevare deur mondinfeksies veroorsaak word – dus, ‘n infeksie-vrye mond is noodsaaklik om algehele gesondheid te verseker.

D

ie algemeenste tandheelkundige probleme wat voorkom, is die opbou van plaak, tandverrotting en peridontale siekte. Tot onlangs toe is nog geglo dat plaak (kiem-kolonies op tande) in die mond, gesond en noodsaaklik is vir die verteringsproses. Die teendeel is egter waar – sekere kieme en bakterieë in jou mond kan jou liggaam groot skade aandoen. Tandverrotting en tandabsesse kan onder andere jou are, slagare en hart aantas. Slagaarprobleme ontstaan wanneer bakterieë tussen die tande opbou wat ’n vermindering in die bloedtoevoer na die brein veroorsaak.

Prostetiese operasies soos knie- en

heupvervangings word ook nadelig deur tandheelkundige probleme beïnvloed.

Ortopediese chirurge is baie gesteld daarop dat die bronne van infeksies voorkom moet word aangesien dit hul pasiënte se operasies kan kompliseer met nadele gevolge. Mediese navorsing toon dat tandvleisontsteking ’n verhoging in die afskeiding van chemikalieë veroorsaak wat kan lei tot voortydige geboortes.

Gereelde besoeke aan ‘n mondhigiënis gedurende swangerskap kan egter die risiko aansienlik verlaag.

Ordentlike tuisversorging speel ‘n belangrike rol en dit sluit ook die versorging van kinders se melktande in.

Versorg so jou tande: Die slagspreuk “Voorkoming is beter as genesing” is veral van toepassing op tandversorging.

 Hê ‘n gereelde mondhigiëne-roetine tuis.

 Besoek ‘n tandarts gereeld (ten minste elke 12 maande) om vroegtydig probleme aan te spreek.

 Besoek gereeld 'n mondhigiënis.

Product IQ: By Dr Marcel Neimandt, MBChB (Pret), FCOphth (SA), Ophthalmologist, Silver Lakes

24

P

: s e s n e l t c a t Con

All you need to know

atients who require refractive correction can either be myopic (nearsighted), hyperopic (farsighted) or astigmatic. The meaning of astigmatism is, simply put, that an abnormally shaped cornea (transparent front part of the eye), is not focussing light onto a single spot on the retina (the nerve layer at the back of your eye). This causes the image that is formed to be distorted.

Types of contact lenses

Many people wearing spectacles for refractive correction seek an alternative and often contact lenses provide this alternative.

Hard contact lenses Hard contact lenses are made from a rigid plastic substance that allows the flow of oxygen from the environment to the front surface of the cornea. This though is not a 100% ideal as the front part of the eye surface (cornea) is still deprived of a degree of oxygen. For certain conditions, however, including keratoconus (an abnormally shaped cornea) and other forms of irregular astigmatism, hard contact lenses are the best alternative to correct the refractive error.

Soft contact lenses Soft lenses in comparison to hard lenses are normally more

act lenses Risks of wearing cont Even though the latest innovation in contact lenses offer a good visual outcome and acceptable patient comfort, some risks can still emerge:

ď‚&#x; I nfectious keratitis / corneal ulcer. This is an infection of the cornea and can be very serious if not detected and treated early. It is therefore strongly recommended that any contact

lens wearer who develops pain and/ or redness should seek urgent medical advice from an eye care specialist/ ophthalmologist.

ď‚&#x; Protein deposition.

With extended wear or the use of the wrong

cleaning solution, protein can build-up behind the lens which can also cause pain and redness.

ď‚&#x; A bad fit. Too tight fitting contact lenses can also cause an inflammatory response. It is there-

Issue 06 | 2014

25

TOP TIPS

comfortable to wear and the latest types of soft lenses also allow more oxygen to reach the cornea. Soft lenses also have the advantage of being available in a variety of disposable options ranging from daily, weekly or monthly replacement. On the other hand, soft contact lenses cannot correct irregular forms of astigmatism and is therefore not suited for these conditions.

Refractive surgical procedures An alternative to wearing contact lenses or spectacles is laser or intra-ocular refractive surgical procedures.

Corneal refractive procedures These procedures are the most popular type of surgical refractive correction and there are a number of these procedures available, including PRK, Lasik, Lasek/Epi-Lasik, ReLEx, FLEx and Smile.

This type of technology has evolved quite dramatically over the past 10-15 years and has proved to be very successful. There are also other options available,

fore very important that your optometrist ensure that you have the correct fit.

Silicone hydrogel materials (SiH) Silicone hydrogel has been shown to offer significant benefits in terms of comfort and reduced dryness for many wearers. The sensation of dryness is related to a variety of factors and has been suggested that one factor may be on-eye dehydration of the lens material. Research indicates that SiH materials show lower levels of dehydration compared with traditional hydrogel lenses.

Newer generation silicone hydrogels also provide the benefits of high oxygen permeability, thus escalating the amount of oxygen available to the cornea, benefiting ocular health and even meeting corneal oxygen needs during overnight wear. Dependant on individual patient suitability, continuous (day and night) wear is an option. Surveys have shown that 79% of wearers would like to occasionally wear their lenses overnight.

However, many practitioners are cautious to recommend continuous day and night wear, due to the risk of corneal inflammatory events and microbial keratitis.

All in all this material has proved extremely successful in promoting long-term eye health. Studies have shown that with an overnight or daily wearing schedule, silicone hydrogels reduce limbal hyperaemia (redness of the eye), which is a feature of many soft contact lens wearers.

In the world of contact lenses, silicone hydrogels are the best optometrists can offer their patients right now.

build-up behind the lens or specific reaction to a contact lens solution.

ď‚&#x; I nflammation. Any type of inflammatory condition of the cornea or conjunctiva (thin white part of the eye) due to mucous

It should be noted that wearing contact lenses unsupervised and without the proper contact lens hygiene

including corneal ring segments, intra-stromal corneal rings and other types of laser procedures.

Intra-ocular refractive procedures This mostly involves the implantation of a lens inside the eye to correct the myopia, hypermetropia or astigmatism. This requires the use of specialised intra-ocular lenses (IOLs) that is specifically made to correct these errors.

Patients who wish to undergo such procedures need a comprehensive ophthalmological assessment that involves a series of tests to determine if the patient is a suitable candidate.

and care, can cause very serious problems.

It is therefore NOT recommended that contact lenses are worn purely for cosmetic reasons, e.g. coloured lenses, unless supervised by an eye care specialist.

In the world of contact lenses, silicone hydrogels are the best optometrists can offer their patients right now.

For more information or to find out if you are a suitable candidate, contact 012 809 6027; e-mail: info@ drmcniemandt.co.za or visit www.drmcniemandt.co.za.

Feature: By Health Bytes

26

FETAL ALCOHOL

Syndrome Drinking during pregnancy will seriously damage a child’s hea

lth.

F

etal alcohol syndrome (FAS) causes mental retardation and a host of other problems, but it’s preventable. Unfortunately, it’s a major problem in parts of our country, especially in rural areas of the Western and Northern Cape.

Children with FAS suffer mental retardation, organ defects, growth deficiency and severe behavioural abnormalities, including hyperactivity, poor concentration, loss of language and maths abilities, and poor social skills. In combination with a poor home environment, affected children often end up participating in serious crime.

Signs and symptoms Fetal alcohol syndrome is a cluster of problems rather than a single disease or disability. In general, FAS affects intelligence, growth, facial features, the heart and the skeleton. You may see:  Specific facial features, including small eyes, an exceptionally thin upper lip, a short, upturned nose and an undefined skin surface between the nose and upper lip (although some normal children may also have these features – don’t make assumptions until you’ve heard from a doctor)  Heart defects  Joint and limb deformities  Low birth weight

 Problems with hearing and vision  Small head circumference and

brain size  Mental retardation and delayed

development

drinking may have effects.

Alcohol passes easily through the placental barrier, and stays in the fetus’s system for a long time, as the fetus is not equipped to metabolise alcohol.

 Short attention span, hyperactivity,

poor impulse control, extreme nervousness and anxiety Alcohol – how much is too much?

The effects are different on each woman, and therefore it’s best to stay away from alcohol completely during pregnancy, especially in the early stages, when the brain of the fetus is developing. In most cases, FAS results from chronic alcohol abuse during pregnancy, but even occasional

Risk factors  A ny alcohol taken during pregnancy

 Other substance abuse  Genetic factors: the genetic make-up of the mother and/or fetus might protect them from or make them vulnerable to the effects of alcohol

 The health and nutritional status of the mother

 Poverty  The mother is poorly educated  The mother has a drinking partner

When to see a doctor If you were pregnant without knowing so, and drank during that time, or you’re pregnant and still drinking, speak to your doctor. If you are struggling to give up drinking, he or she can help. Early diagnosis reduces the risk of long-term problems for children with FAS. If you drank during pregnancy, and you’re worried your child might have FAS, look for help immediately.

Treatments and outcome There’s no cure for fetal alcohol syndrome. In general, the physical defects and mental deficiencies persist for a lifetime. In severe cases the outlook is poor, with severe developmental delay and mental retardation. In mild cases, people can lead relatively normal lives provided the correct schooling and therapy is available. This is often not the case as these children tend to be born into very poor circumstances. Heart abnormalities may require surgery.

Parents often benefit from counselling to help the family with a child’s behaviour problems.

Issue 06 | 2014

27 Coping and support

TOP TIPS

FAS brings with it psychological and emotional problems, and affected families and children will need help.

Ask your doctor or public health nurse for local sources of support for families and children with FAS. A stable, nurturing home is the single most important factor in protecting children with FAS from some of the problems they’re at risk of later in life, including drug abuse, dropping out of school and encounters with the juvenile justice system.

If you’ve given birth to a child with FAS, you may benefit from substance abuse counselling and treatment programmes that can help you conquer your misuse of alcohol.

Prevention is key There’s no evidence to show how much alcohol a woman can safely have during pregnancy, however, doctors do know that avoiding alcohol is sure to prevent FAS. Further guidelines for prevention:  Avoid alcohol completely if you’re planning to become pregnant, or as soon as you know you’re pregnant. Your baby’s brain, heart and blood vessels begin to develop in the early weeks of pregnancy.  Continue to avoid alcohol throughout your pregnancy.  Consider giving up alcohol during your childbearing years if you’re sexually active and you’re having unprotected sex.

Many pregnancies are unplanned.  Get help first. If you have a drinking problem, don’t get pregnant until you get help.

Sources: MayoClinic.com, Health24.com, Faithfund.co.za, www.medicinenet.com, University of the Witwatersrand, Fetal Alcohol Research Initiative

Alcohol passes easily through the placental barrier, and stays in the fetus’s system for a long time, as the fetus is not equipped to metabolise alcohol.

Problems associated with FAS tend to intensify as children move into adulthood.

FAS FACIAL ABNORMALITIES

A characteristic pattern of mild facial anomalies associated with FAS includes small eye openings, a thin upper lip, small head circumference, skin folds at the corner of the eyes, low nasal bridge, short nose, indistinct philtrum (groove between nose and upper lip).

Source: Warren, KR, and Foudin, LL : Alcohol-related birth defects – the past, present, and future. Alcohol Research & Health 25(3):153-158, 2001. (Image from NIAAA)

Health strategy: By Health Bytes

28

Low-fat or low-carb diets

you? for t righ is one which

Over time, many different types of diets have been popular, including low-fat and lowcarbohydrate diets.

Some years ago, low-fat was the mantra, but more recently low-carb has been the rage, promising effortless weight loss while eating all the highfat foods you want.

O

ne reads about twin brothers putting the two different diets to the test and neither felt they had the better end of the stick after one month, and this leaves us confused even more.

Low-fat usually means high-carb, but doesn't always mean low-kilojoules if one eats too many carbs, particularly processed carbs that are more concentrated in kilojoules. Conversely, low-carb usually implicates high-fat. Many people who have tried this type of diet know it can be difficult to sustain for a long time because a lot of good-tasting fruits and other carbohydrates are off limits and high-fat goodies do get a little old after a while.

The most important factor related to weight loss is not low-fat or low-carb, but kilojoules. Either type of diet could lead to weight loss if total kilojoule intake is low. There have been a number of studies comparing weight loss with these two types of diets. In general, low-carb diets

may result in a little more weight loss in the first three to six months. However, after one to two years there isn't much difference. What's interesting is that the amount of weight loss varies widely among people following either diet.

Whichever type of diet you choose may matter less than whether you stick to it.

Another important factor is the healthfulness of the diet – both of these types of diets could be healthy or unhealthy, depending on the types of fats and carbohydrates that are consumed. Other factors that may impact the sustainability of a diet are taste, satisfaction, satiety, practicality and affordability.

Recently, the debate on low-carb and high protein and fat diets has cut across South Africa. It is no wonder that people are shouting ‘who do I believe?’. Despite the publicity and best-selling books, there is little evidence to support a radical change in nutritional guidelines. Even the experts caution against this in the face

Sources: www.health.harvard.edu, www.heartfoundation.co.za, www.mayoclinic.com

Issue 06 | 2014

29

of potential risks such diets pose in the long-term. Further to this is the fact that such diets may be appropriate in particular settings, and not for the general public.

There are no quick fixes. Ideal eating plans must be individualised to take into account a person’s health, lifestyle and affordability. It is not that the existing dietary guidelines do not work, it is more the case of an individual’s personal motivation and external influencing factors that collude to determine failure or success. We cannot underestimate the difficulties in changing behaviours that drive poor eating habits. The association between good nutrition and good health is unequivocal. The real challenge, though, is our interpretation of good nutrition.

The current highs and lows Low carbohydrate (or high protein, high fat) diets like the Atkins Diet, Dukan Diet or Paleo Diet have been around for years. In as much as they have been the cause of many debates, there are as many success stories of dramatic weight loss.

The debate has been reopened recently, for good reason in some aspects, but requiring clarification in others. Yes, any diet that restricts overall total kilojoules (energy), whether low in carbs or low in fat, will result in weight loss. However, the questions we have to ask are around long-term safety, sustainability and nutrient adequacy.

While in the short-term, we know that low carbohydrate diets do achieve dramatic weight loss (initially mainly due to large fluid losses), in the long-term there is little evidence that they are safe for our health, promote the maintenance of weight loss achieved in the shortterm, and can meet our nutrient needs to maximise the health and quality of life (including reducing risk of chronic diseases). In fact the converse is true, for example, we know a high protein diet or too little fibre comes with health risks.

Eat to live or live to eat?

Where once the motivation to eat was for survival, now the challenge lies in regulating how much and what we eat. We live in an ‘obesogenic’ environment, surrounded by easily accessible, highly processed, energy-dense foods. The reality is that we have developed taste preferences to make us seek sweet, creamy, fatty and salty tastes. So it comes as no surprise that in the face of our battle with obesity and our desire for the slimness of celebrities and magazines, dietary variations and dietary fads seem to come and go on an almost daily basis. The motivation and scientific basis of many remain questionable. Add to this the profiteering nature of both food manufacturers and the diet industry, which may create addictions or prey on our weaknesses through dubious marketing practices, and we have a recipe for disaster.

The equivical Like all low carbohydrate, high protein diets, this dietary strategy, which has been receiving so much media attention recently, may achieve significant weight loss in some people. However, any diet that restricts a food group, and consequently results in a lower total kilojoule (energy) intake, carbohydrates or be it fats, will result in weight loss. Health benefits in the short term such as potentially improved blood sugar and blood pressure control are noted with these diets, as well as with a balanced eating plan. But the questions remain.

How safe is this in the long term?

There is little evidence to show long-term health benefits and safety. Over the longterm, this type of diet is associated with increased risks of insufficient intake of fibre, important vitamins and minerals. In addition, these diets are high in unhealthy (saturated) fats and cholesterol, hence increasing the risk of cardiovascular disease. Long-term side-effects have been noted with high protein diets. When the body’s energy comes from burning fat rather than carbs, a state of ketosis develops (high levels of ketones are

produced), which increases risk of gout, kidney stones and kidney failure. A high protein intake can also result in increased calcium losses which may increase the risk of osteoporosis and kidney stones, and in some cases cholesterol levels increase due to high saturated fat intake.

High protein intake may also promote kidney damage over the long-term by increasing the pressure on these organs to remove waste products, especially in those who are susceptible to kidney damage or already have reduced kidney function. At this point, what is needed are well-designed long-term trials to gather evidence for health, safety and efficacy of long-term weight loss and risk-factor reduction.

?

Is it sustainable and affordable Taste preferences as well as cultural practices pose a barrier to long-term sustainability. Carbohydrates form the basis of affordable meals for the vast majority of South Africans. Considering South Africa’s context of varying socioeconomic groups, can poorer communities afford meat and salmon daily? Quite simply – NO! These diets are not affordable or sustainable for many people – they are expensive.

And once people revert to eating as they did before, they regain the weight lost and probably even more than that.

Health strategy

30

The most important factor related to weight loss is not low-fat or low-carb, but kilojoules.

What is a sustainable healthy balanced eating plan?

The Heart and Stroke Foundation South Africa (HSF) bases its nutritional strategy on the guidelines of the World Health Organisation, American Heart Association and the South African Food-Based Dietary Guidelines. The HSF recommends following a healthy lifestyle to reduce the risk of developing chronic diseases of lifestyle and their risk factors, such as obesity, diabetes, hypertension, high cholesterol, cardiovascular disease and cancers. A healthy, balanced diet includes a variety of foods.

Limit fat, salt, sugar and alcohol, and opt for healthy foods like unrefined whole grain carbohydrates, legumes, low fat/fat-free dairy and plenty of fruit and vegetables.

Added sugar in foods and sweetened beverages like canned drinks and juices

should be limited as far as possible. Opt for unsaturated fats or oils and use them sparingly. Choose lean or lower-fat options of chicken or red meat and try to include fish at least twice a week. Too much of any food, whether it is carbohydrates, protein or fat, will cause excess weight gain. It is important to control portion size and avoid extra fat. While diet pills and energy shakes may make one lose weight quickly, it is not a safe or sustainable approach to weight loss and is certainly an expensive one!

Losing weight sometimes takes some experimenting – if you give a diet your best shot and it doesn't work for long, maybe it wasn't the right one for you, your metabolism or your situation. Your genes, your family, your environment — even your friends — influence how, why, what, and how much you eat. So don't get too discouraged or beat yourself up because a diet that

ARE ALL FATS GOOD Trans fats in processed foods like in biscuits, pies and crisps are bad and linked with raised cholesterol levels and increased risk for cardiovascular disease. Saturated fats also have a detrimental effect on cholesterol levels and coronary heart disease (CHD) risk.

Replace them with unsaturated (mono- or poly-unsaturated) fats – polyunsaturated fats include omega-6 and omega-3 fats. Reduce fatty red meat, butter, hard margarine, cream, while vegetable fats from palm and coconut oil also contain saturated fats. Replace them with mono-unsaturated fats, like avocado, nuts, olive and canola oil, soft tub margarines, omega-3 and omega-6 polyunsaturated fats like in pilchards, sardines, mackerel and salmon, flaxseed, canola oil, sunflower, grape seed and corn oil as well as soft tub margarines.

1 Fibre fights Refined carbs should be treated with caution. These, together with hidden sugars

“worked for everybody" didn't pay off for you. You can always try another, keeping in mind that almost any diet will help you shed pounds — at least for a short time.

Make your own The best approach to weight loss is to follow a healthy, balanced eating plan coupled with regular exercise. At least 30 minutes of moderate-intensity physical activity on 5 days a week can give significant health benefits. A good diet should include all the necessary food groups, balance, few restrictions and no long and expensive grocery lists of special foods. It should be as good for your heart, bones, brain and colon as it is for your waistline – it should be sustainable for years. Such a diet won't give you a quick fix, but rather offer you a lifetime of savory, healthy choices that will be good for all of you, not just parts of you.

FOR YOU?

and fats, are the traps found in most processed food, e.g. white flour, sugars, white bread, sugary cereals, cakes and biscuits.

Avoid them completely and replace with unrefined or whole grain carbs (brown bread, wholewheat pasta, brown rice, oats, barley, sweet potato or legumes such as lentils, chickpeas and beans – it all contains fibre, which helps to control blood sugar levels, preventing constipation, assists in lowering cholesterol levels and helps fight against certain cancers.

2 Sweet nothings Avoid added sugar (sucrose or any other forms), altogether. Sugar-sweetened beverages are very unhealthy – this way you can lower total energy intake. Other names for sugar used in food labels are maple syrup, honey, molasses, brown rice syrup, cane juice, evaporated cane juice, all fruit juice concentrates (including apple and pear) and words ending in "ose" e.g. dextrose, fructose, glucose, maltose and sucrose.

3 5 a day Most vegetables and fruits are rich in nutrients, high in fibre and low in kilojoules.

Diets rich in vegetables and fruits have been shown to lower blood pressure and lower the risk of developing CVD (particularly stroke). Cruciferous ones (cauliflower, broccoli, cabbage) and green leafy ones are good choices. Deeply coloured vegetables (spinach, carrots, peaches and berries) contain high levels of phytochemicals and micronutrients that provide health benefits. Eat at least one cruciferous, one dark-green, one yellow-orange vegetables and one serving of yellow-orange fruit per day.

4 Shake off the salt Salt is a hidden trap in food. There is a strong link between high salt intake and increased blood pressure and cardiovascular disease risk. The recommended intake is 5g/day (1 teaspoon). Look out for and avoid “sodium” in additives such as sodium chloride, sodium citrate and sodium bicarbonate.

Issue 06 | 2014

FACT FILE

Home sweet HOME

ehold Accidents Childproofing & Preventing Hous

Kids explore their everyday environments, so it's crucial to check things out from their perspective to make sure your home is safe – yes, get on your hands and knees and crawl around your home. Don’t let the neighbours see you …

Accidents that happen at home The common causes of home-injury deaths are fire and burns, suffocation, drowning, choking, falls, poisoning, and firearms. Most home accidents happen where there is:  water: in the bathroom, kitchen, swimming pools, or hot tubs  heat or flames: in the kitchen or at a barbecue grill  toxic substances: under the kitchen sink, in the medicine cabinet, in the

garage or garden shed, or even in a purse or other place where medications are stored  potential for a fall: on stairs, slippery floors, from high windows, or from tipping furniture.

You can take precautions to make these places safer, but the most important thing to remember is to watch young kids at all times. Even if your home is childproofed, it only takes a second for babies and toddlers to fall, run over to a hot stove, or put the wrong thing in their mouths. Your watchfulness is your child's best defence. However, accidents will still happen, so it's important to be prepared. If you're expecting a baby or have kids, consider the following:

Learn cardiopulmonary resuscitation

(CPR) and the age-appropriate Heimlich manoeuvre.

Keep the following near the phone

(for yourself and caregivers):  Poison-control (Cape Town): 021 592 2601 and Poison Centre (Tygerberg): 021 931 6129  doctor's number  parents' work and cell phone numbers  neighbour's or nearby relative's number (if you need supervision for other kids in case of an emergency) Keep a first-aid kit with emergency

instructions inside. Install smoke detectors and carbon monoxide detectors.

8 safety tips 1

eep guns, choking hazards, and toxic, hot, K and sharp items out of reach.

2

Use safety gates.

3

Install outlet covers.

4

Never leave young kids unattended in a bath.

5

Install smoke detectors.

6

Install knob covers on doors to nonchildproofed areas.

7

Don't put soft bedding or toys in cribs.

8

Don't use walkers.

Remember:

Supervision is the best way to prevent injuries at home, but even the most watchful parents can't keep kids completely out of harm's way every second of the day.

Sources: kidshealth.org, realsimple.com

H

ousehold injuries are one of the main reasons kids under the age of three visit the trauma unit, and nearly 70% of children who die from unintentional injuries at home are four years old and under. Young kids have the highest risk of being injured at home because that's where they spend most of their time.

And though we often think of babies and toddlers when we hear the words "babyproofing" or "childproofing", unintentional injury is the leading cause of death in kids 14 years old and under, with more than a third of these injuries happening at home.

Supervision is the best way to prevent injuries at home, but even the most watchful parents can't keep kids completely out of harm's way every second of the day.

Here are some simple ways to help prevent injuries in your home:

31

Recipe: www.lornajane.co.za

32

Breakfast

bites

Ingredients  3 whole eggs  6 egg whites  2 chicken breasts  Ground black pepper  5 broccoli florets  Goat’s milk cheese (optional)

Method 1

Place eggs in a mixing-bowl and

2

Preheat oven to 180˚C.

whisk until smooth.

3 Spray a muffin tray with WeighLess Non-Stick Spray.

4

Add black pepper or your preferred seasoning to the mixture.

5

Grill chicken breasts and once cooked, cut them up into small pieces.

6

Chop broccoli florets.

7

Add chicken and broccoli to the whisked eggs.

8

Pour the mixture into eight muffin tray molds evenly.

9 Place the tray in the oven and bake for 30-35 minutes until the tops are golden.

10 Once cooked, remove tray from

oven and leave the bites to cool.

Make

8

s

bites

Did you know that breakfast is considered the most important meal of the day? It’s up to you to make sure that you start each day right!

Remove from the tray and store in the fridge.

11

In the morning take two bites out the fridge, top with goat’s milk cheese, heat in the microwave for 30 seconds and enjoy!

12

Don’t be scared to experiment with your favourite healthy choices like vegetables, spices, lean proteins or cheeses.

No more excuses allowed! Whip up a batch on a Sunday evening, pop them into the fridge and simply heat them up in the morning for a healthy breakfast to kickstart your day … it’s that easy!

First, the product applies for endorsement.

Next, it is thoroughly tested by an independent, accredited lab.

The laboratory results are then examined by a team of dietitians.

Levels of fats, cholesterol, fibre, sodium and sugar are checked to see if nutritional criteria are met.

Now the product is ready to receive our stamp of approval.

But not before its packaging is assessed for nutritional accuracy according to our strict requirements.

It may seem excessive, but it means that every Heart Mark approved product is nutritionally sound.

Look out for the healthy choice you can trust.

TJDR (CT) 39013/E

THIS IS WHAT IT TAKES TO GET A HEART MARK

Does your arthritis treatment 2: •

Reduce your symptoms?

•

Allow you to stay active?

Ask your doctor for the new medication from AstraZeneca for the symptomatic relief of osteoarthritis, rheumatoid arthritis and ankylosing spondylitis.

References: 1. Woolf AD, Pleger B. Burden of major musculoskeletal conditions. Bull WHO 2003;81(9):646-656. 2. Kalunian KC. Patient information: Osteoarthritis treatment (Beyond the Basics). Available from Uptodate.com. Last accessed 2013/02/28.

AstraZeneca Pharmaceuticals (Pty) Ltd. Reg. No. 1992/005854/07. Building 2, Northdowns Office Park, 17 Georgian Crescent West, Bryanston, 2191. Private Bag X23, Bryanston, 2021. Tel: (011) 797-6000. Fax: (011) 797-6001. www.astrazeneca.co.za. Expiry Date: October 2014. Activity ID: 76329

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