Healthy Times Winter 2017 Edition

WINTER 2017

HEALTHY HOME

WELLNESS AT WORK

STEPS TO HEALTHY MEETINGS

FOOD STORAGE

STOP FOR A TEA’S

CUPPA

HEALTH BENEFITS

Getting grips w to genericith s

SOUND ADVICE ABOUT HEARING LOSS

ROMEO REDEFINING FATHERHOOD

NEW EXERCISE REGIMES

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of the most popular options

SILENT KILLER

HAVE YOU HAD YOUR BP CHECKED?

101

KUMALO How he builds a healthy emotional relationship with his three children

contents

WINTER 2017

19 30 HEALTHY HEART What you need to know about high blood pressure

30

35 EXERCISE Alternative exercise: three popular options 38 HEALTHY FEET The podiatrist’s guide to buying shoes

15

41 HEALTHY JOINTS Facing up to the burden of osteoarthritis 43 HEALTHY BONES About osteoporosis 47 HEARING Advice on hearing loss

35 4

FROM THE EDITOR

8

COVER STORY How Romeo Kumalo builds a healthy emotional relationship with his three children

11 COLDS AND FLU Should you take antibiotics for colds and flu?

12 VITAMINS AND SUPPLEMENTS What can we do to fortify our immune system?

51 HEALTHY MIND Anxiety and panic disorder 53 AGEING About memory loss 15 NUTRITION The health benefits of tea 19 MEDICATION KNOW-HOW Getting to grips with generics HEALTHY HOME 21 Guide to how long you can safely store food 22 Pay attention to your mattress and bedding 25 WELLNESS AT WORK Ten steps to healthy meetings

57 HEALTHY SLEEP The symptoms and treatment of obstructive sleep apnoea 60 HEALTHY BABY Tips for your first year as a new mom

60

FS R T ROAMP LT IHNEE EHDEI R TO ER

EDITORIAL Editor: Mandy Collins

i

winter

am writing this note on a chilly Monday, after a weekend of icy, gusty wind that took us squarely into winter. I’ve been loving the mild autumn days, but I’m going to have to face the fact that winter is finally here.

That said, it’s the perfect time to curl up on the couch with a magazine – and ours is packed with advice and information for keeping you at your healthiest. Grab a blanket and a hot cup of tea – and turn to page 15 to see why you should be tea-totalling this season.

Our cover star is Romeo Kumalo, who has been a household name and face in South Africa for more years than he would probably like me to reveal. Romeo has gone from being a continuity announcer to a great career in radio, then telecommunications, and now he’s an entrepreneur. He talks to us about fatherhood and the emotional investment he’s making in his children, on page 8.

We also have a wealth of advice for keeping you healthy wherever you may be – at home, at work, and in contact with the viruses that see so many of us succumb to colds and flu. Our feature on page 12 will tell you how to keep your immune system at its strongest, by eating well and supplementing wisely, and on page 11 we explain why you shouldn’t be asking your doctor for an antibiotic every time you get the sniffles.

“It’s the perfect time to curl up on the couch with a magazine – and ours is packed with advice and information for keeping you at your healthiest.

And don’t forget that, even though it’s tempting to spend winter eating chocolate and watching series, you still need to follow the same guidelines for a healthy lifestyle: eat plenty of fresh fruit and vegetables, exercise regularly for health and warmth, get enough sleep, quit smoking, drink moderately, manage your stress – and, of course, ensure that you read Healthy Times.

Mandy Collins Editor

4 l HEALTHY TIMES

Copy Editor: Joy Capon

Contributors: Louise Ferreira, Caryn Gootkin, Georgina Guedes, Penny Haw, Nia Magoulianiti-McGregor, Zaza Motha, Prevashni Naidu, Tamara Oberholster, Candice Tehini Cover image: Franz Rabe ADVERTISING Project Manager: Roman Ross

romanr@picasso.co.za Tel: 021 469 2498

Sales Consultants: Jay Deary, Sandile Patrick Koni, Marc Plastow, Lyzzette September Advertising Co-ordinator: Ameer Allie

Advertisement Design: Nichole Liedeman

Copy Editor Advertisements: Lynn Berggren-Goodwin PRODUCTION Production Editor: Shamiela Brenner

Distribution: Shihaam Adams subscriptions@picasso.co.za Tel: 021 469 2523 Printing: Paarl Media Gauteng MANAGEMENT Senior Bookkeeper: Deidre Musha

Business Manager: Lodewyk van der Walt

General Manager, Magazines: Jocelyne Bayer Published by

Times Media Building Central Park, Black River Park Fir Street, Observatory, 7925 Tel: 021 469 2400 Fax: 086 682 2926

Disclaimer While every effort has been made to ensure that the information in this publication is sound, it is expressly not designed to diagnose or treat a medical condition or health problem. The information does not constitute medical advice. It is also subject to personal interpretation and may become dated or obsolete. The publisher, editor, authors and their employees or agents, therefore, cannot accept responsibility for the information in this publication or for any errors, omissions or inaccuracies contained therein, whether arising from negligence or otherwise. They are therefore not liable for any direct or indirect effects of the information. Please consult a qualified healthcare practitioner regarding any medical or health issues.

Copyright: Picasso Headline. No portion of this magazine may be reproduced in any form without written consent of the publishers.

The publishers are not responsible for unsolicited material.

Healthy Times is published by Picasso Headline Reg: 59/01754/07.

The opinions expressed are not necessarily those of Picasso Headline.

All advertisements/advertorials and promotions have been paid for and therefore do not carry any endorsement by the publishers.

Image: Cobus Bodenstein

WINNING IN

Art Director: Janine Wait

primary healthcare advertorial

r

ecent pandemic and epidemic outbreaks have cast a harsh light on the standard of primary healthcare in emerging markets.

According to government statistics, in the last three years, more than 11 000 of the nearly 29 000 people infected by Ebola have died, and thousands of infants have been born with birth defects and neurological problems as a result of the Zika virus.

Medical scientists predict a possible outbreak of Ebola this year, and economists believe that a major flu pandemic could cripple the economies of affected countries. The harsh reality is that we are not doing enough to prepare for future infectious outbreaks, despite knowing quite clearly what causes them.

The main causes of poor health in Africa are unhealthy living conditions, poverty and lack of access to primary healthcare.

According to a report by the United Nations International Labor Organization, almost half of the world’s population does not have access to healthcare. The report shows that 56% of people living in rural areas worldwide cannot access healthcare. In Africa the number of rural people who don’t have access to healthcare spikes to 83%.

Our research shows that a high percentage of the existing primary healthcare centres in sub-Saharan Africa currently lack access to clean water, electricity, medical equipment, health, IT and trained staff. Many do not even have a bank account.

If we want to successfully prevent or manage future outbreaks, we must invest in primary healthcare. I firmly believe investment must be concentrated in three key areas: • The expansion of public-private partnerships (PPPs); • The adoption of new technologies; and • The training of healthcare workers.

6l h H eE a A lL tT h H yY tT iI m M eE sS

a three-pronged approach to equitable, quality primary healthcare

In order to fight infectious diseases effectively, we must collaborate and leverage synergies. Health Ministries must take advantage of the innovation and disruption which have become the purview of the private sector, and in turn educate business about the effects of pandemics on their bottom line.

We only need to look at how PPPs have driven innovation in financial services to see the impact it can have. Healthcare in Africa must embrace mobile technology in the way that financial services have.

By connecting patients and care providers with public health workers via mobile telecommunications, we can effectively detect and act against infection outbreaks, and develop valuable health data insights for long-term preparedness for future outbreaks. It’s called disease surveillance, and it involves the collection, analysis and interpretation of large volumes of data originating from a variety of sources.

To effectively implement surveillance through technology, we must empower primary healthcare The main causes of poor workers by turning them into data gatherers. This will take a major health in Africa are unhealthy investment in skills development. living conditions, poverty and By training staff to recognise symptoms and to collect data for lack of access to primary epidemiological reasons, we will be healthcare. – Jasper Westerink, building an extra layer of defence in CEO of Philips Africa pandemic preparedness.

how what we have learnt can help to fight future outbreaks the lessons we have learnt in rolling out this model across sub-saharan africa can be used to build equitable, quality primary healthcare – which will result in better preparedness for outbreaks.

We have learnt that strengthening healthcare must start with primary healthcare for people in individual communities.

We have also learnt that a lack of infrastructure can be overcome by using technology – mobile devices, in particular – linked to a regional hospital or call centres, to bridge human resource gaps. sustainable, cost-effective technology has a key role to play in fighting pandemics. so do well-trained and equipped medical staff. most importantly, we have learnt that establishing new ways of delivering care will build stronger and more resilient communities, and make healthcare much more accessible and affordable. a strong primary healthcare structure will not always prevent pandemics or epidemics from occurring, but it will help to manage them in a faster and more impactful way, limiting their socio-economic toll.

Image: Supplied

Pandemic outbreaks in emerging markets have a severe socio-economic toll. To date the responses to these outbreaks from the global health industry has been reactionary. In light of the fact that we are acutely aware of the reasons why these outbreaks occur in Sub-Saharan Africa and socio-economically similar regions, it is time to have an important conversation about how improved primary healthcare can help limit the impact of outbreaks.

As the CEO of Philips Africa, Jasper Westerink is able to provide insight into the three areas he believes the health industry should be concentrating on. They are Public Private Partnerships, technology and data, and skills development.

All these form part of a three-pronged approach to building a primary healthcare system that will help combat pandemic, epidemic and infectious outbreaks in Sub-Saharan Africa.

You may think you are healthy,

BUT YOUR DOCTOR DISAGREES

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Images: ©iStock.com/michaeljung/SKapl/skiny25

According to the Future Health Index , only 33% of healthcare professionals believe the overall health of South Africans is positive

oyal Philips, a global leader in health technology, recently released the South African results of the second annual Future Health Index (FHI). The study builds on data from over 33 000 participants in 19 countries, and advisory input from leading academic and global non-profit organisations.

Local findings signal that South Africans generally evaluate their health positively, with the majority (80%) of the population rating their current health as good, very good or excellent, while healthcare professionals are less optimistic. Just one third (33%) of healthcare professionals agree that the overall health of the population in South Africa is positive.

However, despite the discrepancy between the South African general population’s and healthcare professionals’ perception of health, the results suggest that both groups perceive they have more access to healthcare than the system is set up for in reality, which signals that there is an opportunity to improve access to care further.

Where there are distinct gaps between reality and perception, it is harder to design a clear plan for future development.

There is a call for greater integration globally, as the study reveals clearly that the largest perception/reality gap globally is centred on health systems integration, which also aligns to local findings. “The general population often have a perception that healthcare is integrated, and people only find that the integration is not there once they are a patient in the system,” says Jasper Westerink, CEO of Philips Africa.

The general South African population and healthcare professionals believe that connected care technology would make healthcare more expensive in the long-term. In order to increase the likelihood of connected care technology being used, training opportunities, informational resources such as databases of available technologies, and government subsidies to manage cost concerns may be needed.

“Despite these barriers, the potential for global health systems to benefit from better integration remains a positive possibility, while the large local gaps indicate ample room for growth,” says Westerink.

The 2017 FHI highlights that it is important not only to adapt healthcare delivery across different healthcare systems, but in the meantime to address the differences between the perceptions of users of the health system and the reality of how well the system is set up for the future in South Africa.

“The general population often have a perception that healthcare is integrated, and people only find that the integration is not there once they are a patient in the system.”

• The Future Health Index, commissioned by Philips, reveals that South Africans’ perceptions of the health system do not align with the realities.

• South Africans perceive that they have more access and greater integration of the healthcare system and better adoption of connected care technology, than they have in reality. The large gap between the perception of the healthcare system and its realities, indicate ample room for growth.

For additional information, visit www.futurehealthindex.com.

Join in the conversation on social media by using the hashtag #futurehealth in your posts.

We’d love to hear your views on the above.

HEALTHY TIMES l 7

COVER STORY

HEALTHY HOME, HEALTHY KIDS

8 l HEALTHY TIMES

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omeo Kumalo once flew 32 hours – from Boston to New York to Johannesburg and back that same night – to see his second son, Kgositsile uShaka Emmanuel, now five, come into the world. During business studies at Harvard Business School, he surprised wife Basetsana by arriving just in time for the birth.

“My wife was completely perplexed. She kept asking, ‘How did you get here?’ – because she usually makes all the travel arrangements – but I was there for the birth of our first son, Nkosinathi Gabriel, now 12, and nothing was going to make me miss the birth of our second son.”

Romeo was also in theatre for the birth of daughter Bontle ba Morena Jasmine, three – and he has the photos to prove it.

“I love recording them at different times of their lives. I’m obsessed with it. I want to catch every moment.”

Which shows how, in just a generation, society has evolved. Says Romeo: “Dads are now much more emotionally connected to their children than ever before. Culture, including black culture, has evolved.

“I come from a patriarchal society where everyone knew their place – my father went out to make money to support his family, while my mom’s

place was expected to be in the kitchen. Although, actually, it’s the women who worked harder. Dads were the ones who usually missed out on play.

“Now we are emotionally invested and involved in our children’s lives. We want a healthy connection. Before I even became a father, I made a conscious decision that I was going to take an active part in helping to shape my children’s lives.

“I always knew I wanted to be a different kind of dad.

Shaping their values means raising boys to live in a society that respects women.”

“They tell you that if you don’t catch them before the age of seven, you’ve lost the opportunity to guide them and instil your family’s values.”

Dads bring something different to the family table, he believes. “Generally, as toddlers, the kids were closer to their mom, but at around three years old, I noticed they kind of ‘switched’ and it was, ‘Let’s go and do boys’ stuff !’.”

So, off they’d go to the golf range and hit

Images: Franz Rabe

BUSINESSMAN, MEDIA PERSONALITY AND DEVOTED DAD, ROMEO KUMALO INVESTS TIME, THOUGHT AND ENERGY INTO BUILDING A HEALTHY EMOTIONAL RELATIONSHIP WITH HIS THREE CHILDREN. NIA MAGOULIANITIMCGREGOR SPEAKS TO HIM JUST BEFORE FATHER’S DAY

a few balls, or the bike park, or even have boys’ lunches.

But don’t imagine Romeo runs a sexist household. “Before, Bontle was too young to come with us. Now she’s three, she’s part of it all. There’s a different dynamic, but she’s no princess. We don’t raise her any differently. She’s growing up in a house where she’s equal to the boys, and she’s affirmed and nurtured in the same way. My girl makes my heart melt, but I don’t want her to be seen as weak or needing protection.

I think, as a result, she’s very feisty and more than equipped to take the boys on.

“I always knew I wanted to be a different kind of dad. Shaping their values means raising boys to live in a society that respects women. So, in our home, we are all equal, because kids don’t do what you tell them; they do what you show them. There is no patriarchal nonsense here.

“My mother, Jennifer, was a loving, kissing mom who told me I was loved every day, but she also made sure I never saw women as weak. My wife, Bassie, is also a tough cookie – she’s a working mom, a successful businesswoman.”

Talking about sport or generally just “chilling together” helps to instil a conversational environment in the house.

“Nkosinathi is a pre-teen and very into soccer, water polo and rugby, so we often spar about whose soccer team is better – he supports Real Madrid, I’m Barcelona. It keeps alive an emotional connectivity, a trust, so that, if necessary, he can ask for advice or tell me about anything he’s going through.”

Still, Romeo struggles with the challenge of bringing up kids in the digital age. “You have to get involved in their digital world. You can’t leave it to the teachers and peers. There are so many influences from all sorts of places that may not be good for them. As and when I want to, I check Nkosinathi’s phone. As I see it, it’s not their phone; it’s my phone.”

Romeo and Basetsana are also both “very strict” about TV watching. “There is no TV in the week, only on Fridays and Saturdays – and no TV on Sundays.” That makes space for quality time.

“I want to know everything that’s happening in their lives. The only thing I can give them really is a healthy value system, for them to be in a position to resist peer pressure. You can try to police kids as much as you can, but as soon as they leave

‘‘

YOU CAN TRY TO POLICE KIDS AS MUCH AS YOU CAN, BUT AS SOON AS THEY LEAVE THE HOUSE, ALL THEY HAVE ARE THE TOOLS YOU’VE GIVEN THEM SO THEY CAN THINK TWICE ABOUT THE DECISIONS THEY MAKE.”

the house, all they have are the tools you’ve given them so they can think twice about the decisions they make.”

Just like working moms, working dads these days also try to find a work/life balance. “We can get so busy with business commitments, it’s necessary to create together moments so you don’t let others raise your children. It’s not about quantity, but quality time. I try to avoid any work on weekends if I can, but if I have to work, I try to keep at least Sunday a no-work day – we keep to a family ritual of Sunday church and lunch together – and I always try to take some time off during school holidays.”

Romeo is a demonstrative, emotional dad.

“I hug, I kiss. And I tell them I love them every day, and, in turn, they never leave the house without saying, ‘I love you, Papa’. I’ve also taught them it’s healthy to cry, and that it’s not a weakness, but a strength.

“I also believe it’s good for kids to witness that I have a good relationship with ‘mommy’,

so we’re a very affectionate family.”

If he had to give a young dad advice, Romeo would say: “Get involved. Men can do just about everything. Make quality time.

Switch off the phone. Know their friends. Get your rituals going. You’ll be so richly rewarded.

“There’s nothing like coming home and seeing their eyes light up, before they start screaming, ‘Dad, dad, can I get a flip?’ – that’s being swung around! There’s nothing like seeing the unconditional love.”

All Romeo wants for Father’s Day is a personal card from each child. “Over the years, I’ve kept all of them in a box.” Some of them are just a hand-print from when they were little. “When they’re big, I’ll show them what they used to do for me,” he smiles.

The other gift is seeing they are “happy, secure and confident”.

“It’s a conscious decision to parent children lovingly. It’s a journey, for the kids as well as me. And a journey for us as a family.

I’m not perfect, but I’m learning as I go.”

“We can get so busy with business commitments, it’s necessary to create together moments so you don’t let others raise your children. It’s not about quantity, but quality time.”

HEALTHY TIMES l 9

COLDS AND FLU

ANTIBIOTICS FOR

n

colds and flu?

Absolutely not, says Penny Haw

ext time you consider badgering your doctor for antibiotics to get rid of a cold, remember this: “The only way to treat the common cold is with contempt.” These are the words of Canadian physician Sir William Osler, who, in the late 1800s, was a founding professor of the acclaimed Johns Hopkins academic hospital. He also said: “One of the first duties of the physician is to educate the masses not to take medicine.”

Centuries have passed, medicine has advanced and Osler’s advice prevails, but that doesn’t stop people from pestering doctors for antibiotics to treat colds and flu. This, despite unequivocal knowledge that antibiotics cannot kill viruses responsible for colds and flu – or even change their course – and that prescribing them when they’re not needed is harmful.

“Antibiotics receive a lot of undue credit,” says general practitioner Dr Yolande Louw, who is also a member of the South African Society of Travel Medicine and the Federation of Infectious Diseases. “Many people believe if you feel sick, antibiotics will kill the culprits. Antibiotics only kill bacteria, not viruses. Colds and flu are caused by viruses, so it’s a disappointing medical fact that antibiotics will not cure them.”

The more frequently you take antibiotics, the more resistant bacteria become to them.

Images: ©iStock.com/LeoPatrizi/tanatat/Xacto

IF YOU REMAIN UNCONVINCED THAT ANTIBIOTICS DO NOT CURE COLDS AND FLU, HERE ARE THE FACTS: • Antibiotics are crucial tools in the fight against life-threatening bacterial infections. They are ineffective against viruses because the structures of viruses and bacteria are different. Viruses are infectious agents that live within the cells of other living things. They need hosts. Bacteria are singlecell organisms that can live both inside and outside other cells. They can survive without hosts.

• Inappropriate and/or overuse of antibiotics leads to increased resistance to antibiotics by bacterial infections. Antibiotic resistance is a major concern in modern medicine.

• Simply put, the more frequently you take antibiotics, the more resistant bacteria become to them.

If you take an antibiotic when you have a viral infection such as a cold or flu, the antibiotic still attacks bacteria in your body. These bacteria – some beneficial and some at least not causing disease – become resistant to antibiotics and, though they’re harmless, can transfer what they learn about resisting antibiotics to other bacteria, which may not be as harmless.

• The danger is, should you need antibiotics to treat bacteria and you’ve helped them to build resistance, treatment won’t be effective. Antibiotic-resistant bacteria can create life-threatening infections that do not respond to antibiotics.

• By taking antibiotics for colds and flu – created by viruses that are immune to antibiotics anyway – you’re fortifying potentially dangerous bacteria.

While antibiotics cannot cure colds and flu, viral infections are occasionally complicated by secondary bacterial infections. This can happen when congestion is longlasting. Don’t, however, fall for another misconception, says Dr Louw, which is that, when nasal discharge turns green or yellow, you have a bacterial infection – this is also seen in viral infections.

Tell-tale signs of a bacterial infection are when illness worsens and persists for longer than the anticipated 10 to 14 days a virus usually lasts, fever increases days into the illness, and your temperature is higher than is normal from a virus.

When your doctor believes you have a secondary bacterial infection following flu or a cold, antibiotics might be prescribed. But, says Dr Louw: “Taking an antibiotic even when you start with acute fever and body-aches (associated with colds and flu) will not prevent a possible secondary infection.”

It’s time to accept it once and for all: antibiotics do not cure colds or flu. The best way to deal with them? Ample bed rest, plenty of fluids and a healthy dose of contempt.

H E A L T H Y T I M E S l 11

VITAMINS AND SUPPLEMENTS

’TIS THE SEASON FOR olds and flu are synonymous with winter – they occur more during the colder months because we tend to stay indoors.

With windows and doors often closed, the organisms that cause colds and flu can spread more easily.

Keeping your body healthy from within

can help you fight off cold and flu viruses.

Registered dietician and co-founder of the Resilient Energy Center and FAB Quotient™, Celynn Morin (Erasmus), says food really can be your best medicine. “Use natural immuneboosting herbs or spices to give you a kickstart and fight flu symptoms before they even begin,” she advises.

TOP IMMUNE-BOOSTING FOODS Morin says these superfoods can help to keep your immune system strong: Chilli: It packs on some vitamin C, and adds zing and warmth to your meals. Chop fresh garlic, chilli and onions together, and keep a large container in the fridge for quick and easy use when preparing meals.

Garlic: It is a powerful natural antibiotic. Use garlic in salad dressings or add to cooked vegetables.

Ginger: It improves digestion and energises. It is great for common colds, flu and nausea. Slice and include it in stirfries, and use it for ginger tea.

Spices: Use a lot of turmeric, cayenne pepper, garlic and ginger. These are powerful antioxidants, digestive aids and immune-boosters.

Vitamin C: Eat a variety of fruit and start your day with a glass of warm water with a generous amount of sliced lemon. Take a supplement with 1 000mg vitamin C daily.

Zinc: Add a handful of pumpkin seeds to your daily snack quota.

“Natural vitamins obtained through foods are crucial in stabilising cell membranes, which is the body’s first level of defence,” says Morin. But we don’t always eat as well as we should, so Morin offers the following immune-boosting regime to be taken daily during the cold months if you struggle to eat well: • A general multivitamin and mineral containing 30mg of zinc.

• Omega 3 providing at least 500mg EPA and DHA. • Buffered vitamin C: 1 000-2 000mg.

• Olive leaf extract: 20-40 drops in a little water.

• Other useful immune-boosters, such as echinacea capsules, colostrum, propolis extract, curcumin capsules.

“You must also remember to drink enough water, get enough sleep and rest, and wash your hands regularly,” she concludes.

12 l H E A L T H Y T I M E S

PREVENTION TIPS

There is an obvious way to minimise your risk and boost your immunity: avoid coming into close contact with those with active symptoms, such as a runny nose or cough. “However, because the viruses are transmitted in the air, it may be a challenge. Practising hand hygiene and avoiding contact of the eyes, nose or mouth with unclean hands would also help,” says Dr Lerato Sikhosana, a South African Field Epidemiology Training Programme (SAFETP) resident.

She adds that those who have a cold should practise coughing and sneezing etiquette, and preferably stay home to recover and prevent passing it on to others. “Getting the flu vaccine, preferably two weeks before the start of the flu season, will help to minimise the chances of getting flu.

It should be noted, though, that being vaccinated will not protect you 100%, as there may be some strains of the flu not covered by the vaccine.”

Practise hand hygiene and avoid contact of the eyes, nose or mouth with unclean hands.

Images: ©iStock.com/alptraum/kgfoto/nicolas_/pidjoe/Tatami_Skanks/Torresigner

colds c

Cold and flu season is inevitable, says Zaza Motha , but what can we do to fortify our immune system?

NUTRITION

GET A BOOST WITH YOUR

cuppa

There’s no question about the mental benefits of relaxing with a cup of hot tea, but there are lots of physical benefits too – depending on the type of tea, writes Georgina Guedes

Images: ©iStock.com/Diane Labombarbe/-lvinst-/YelenaYemchuk

t

here’s nothing like a steaming cup of tea when you need to relax. And there are teas to match just about every flavour preference or, purportedly, health requirement. But it’s that last point that presents a bit of a stumbling block – are teas, in all forms and guises, really that good for you?

The first thing to understand is that “tea” can mean many different things. Tea made from the leaves of the tea bush, or Camellia sinensis, is considered by purists to be the only true tea. Green tea, black tea, white tea and oolong tea are all made from the tea bush, with the only difference being when they are picked and how they are processed.

Herbal teas, in fact, are tisanes – infusions made from herbs, fruits, spices and oils.

According to Philip Tobiansky, tea buyer for the Tea Merchant, a tea shop with branches nationwide, herbal teas are naturally sugar and dairy-free, which immediately makes them healthier than other hot beverages with milk and sugar added (of course, you can add milk and sugar, but that’s up to you).

“They also offer the calming and soothing effect of drinking a hot liquid that is not a stimulant,” he adds.

HERE ARE SOME TEAS THAT OFFER SPECIFIC HEALTH BENEFITS: • Matcha, a stone-ground Japanese green tea, has seven times the antioxidants of regular tea. This means it helps to clean up the free radicals in your body – cellular byproducts that can cause illness. However, it does come with the same caffeine volumes as a cup of coffee.

• Moringa leaf tea has twice the antioxidants of matcha, and also contains calcium, potassium, beta-carotene, vitamin C and iron. In fact, some moringa leaf tea suppliers say you should split open your teabag after brewing, and use the contents in a smoothie or shake for a double boost of nutrients. And all of this with no caffeine.

• South Africa’s finest, rooibos tea is another naturally caffeine-free tea with added health benefits. It replaces essential minerals, iron, potassium, zinc and sodium, and has a calming effect. Tobiansky says it is one of the finest teas with which to blend other flavours, which makes it extremely popular for the export market.

(Sadly, rooibos growers have suffered severely under the recent drought and the crops could take up to three years to recover.)

• Liquorice tea helps to raise blood pressure.

• Stinging nettle tea helps with fertility and breastfeeding.

• Mate, a South American herb, is used to alleviate the headaches associated with detoxing, but contains three times the caffeine of a cup of coffee.

THE GREAT DEBATE: MILK FIRST OR LAST?

The thorny issue of when to add milk to tea has divided tea drinkers for some time. According to upmarket British department store Fortnum & Mason, traditionally, adding the milk first was considered the correct thing to do in refined social circles. This was because, in better-quality china, the hot tea was less likely to crack the cup.

However, it believes there’s a good reason for adding the milk last, which is that if you are drinking an unfamiliar tea, it is easier to judge the correct amount of milk for the strength in your cup.

“So, now that the days when one’s social position was judged by this sort of thing are long gone, you may pour your tea however you choose,” Fortnum & Mason says.

H E A L T H Y T I M E S l 15

ADVERTORIAL

Happier, Slimmer, Sexier – SAFFRON

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affron is a reddish-golden spice derived from the styles and stigmas of the saffron crocus (Crocus Crocus sativus) flower, native to the Mediterranean and western Asia. Saffron has numerous health benefits that today have been validated by science and research, making it one of nature’s most powerful herbs and a popular choice for millions of people around the world.

This exotic spice has been used to treat more than 90 illnesses over 4 000 years. Here are just a few healthy reasons for using more saffron.

In traditional Persian medicine, saffron was used as an antidepressant. The active constituents in saffron – crocetin and crocin – were identified to exhibit protection from neuro-degenerative disorders such as memory loss and depression. Several clinical studies have been conducted on Saffron to investigate its anti-depressant qualities.

In separate studies it was compared to popular antidepressant drugs, currently prescribed anti-depressants (SSRI’s and tricyclic types) as well as a placebo, and then as a complementary adjunct to traditional antidepressant therapies. In these studies, saffron was found to be as effective as the drugs, it outperformed the placebo group, had no sideeffects and even reduced some of the negative side-effects people experienced while on traditional SSRI medication. Participants used 30mg per day, every day for four to six weeks.

2. SEXUAL DYSFUNCTION

Studies show that saffron is effective in treating erectile dysfunction (ED). In one study, 20 patients with ED took a 200mg capsule of saffron every morning. After just 10 days, scores of rigidity and tumescence were significantly higher, and erections increased in frequency and duration. Saffron improves sexual problems induced by Prozac in women, too. In a randomized double-blind placebo-controlled study, 38 women on Prozac who complained of sexual dysfunction were treated with either a placebo or 30mg of saffron per day. After four weeks, the saffron group scored significantly higher in sexual functions including arousal, lubrication and pain.

Saffron has numerous health benefits that today have been validated by science and research.

3. WEIGHT LOSS

In a French study, researchers tested an extract of saffron in 60 mildly overweight women.

The women received either a placebo or

176.5mg of the saffron extract twice a day.

Over an eight-week period, caloric intake was left unrestricted. At the end of the study, the saffron group had a significantly greater bodyweight reduction than the placebo group. The researchers concluded that this herb can help to treat obesity by curbing the appetite.

4. SUPPORTS MEMORY, HELPS ALZHEIMER’S

The crocetin and crocin in saffron may improve memory and cognitive processing.

These properties may be a useful for treating degenerative brain disorders such as Alzheimer’s disease, according to a study published in the Journal of Clinical Pharmacy and Therapeutics in 2010.

4. MACULAR DEGENERATION

A study by Australian and Italian researchers shows saffron helps to slow the progression of age-related macular degeneration (AMD) and improve vision. The study was conducted

by Prof Silvia Bisti at the ARC Centre of Excellence in Vision Science and University of L’Aquila.

USING SAFFRON No spice is more special than saffron. It straddles sweet and savoury effortlessly, and gives dishes a striking golden hue. A few strands of saffron will transform a long list of dishes, adding an x-factor to everything from risottos and milk puddings to rich curries and fish stews. For those wanting to receive the health benefits of Saffron, the most convenient and cost-effective way is to use a high-quality supplement. These can be found in most good health stores and pharmacies. It is recommended to use 30mg per day, every day for six to eight weeks to receive the full benefit.

Saffron is generally regarded as safe, but it is not recommended during pregnancy and while nursing.

16 l H E A L T H Y T I M E S

Images: Shutterstock and ©iStock.com/rez-art

1. MOOD

MEDICATION KNOW-HOW

GETTING TO GRIPS WITH

generics

Tamara Oberholster looks at

what generic medicines are, why they are less expensive than brand-name products, and whether they are as effective

ARE GENERICS AS EFFECTIVE?

r

egistered pharmacist Susan Burchell explains that a generic drug is “bio-equivalent to a brand-name drug”.

This means it is a copy of the original drug, and has the same intended use, strength, dosage, route of administration, performance, side-effects and risks.

“The most significant difference between generics and brand-name drugs is their lower cost,” Burchell says. “They may also appear different in shape, size, colour, smell and taste; however, the active ingredient will be identical.”

Images: ©iStock.com/ayo888/studiocasper/WanjaJacob

WHY ARE GENERIC MEDICINES CHEAPER?

Pharmaceutical companies charge high prices for brand-name medicines to cover the costs of the process of developing new medicines – it takes years to develop a new medicine, to ensure it works, to check it’s safe for human use, and to complete the legal processes.

“Once a product’s patent has expired, other companies can start producing that same product, and are able to do so at a much lower cost,” Burchell says.

According to the Southern African Generic Medicines Association (SAGMA), a patent on an original brand-name pharmaceutical lasts for 20 years. The challenge, however, is that one original pharmaceutical product may be protected by up to 40 patents. Pharmaceutical companies can also make minor changes to the original product under a new patent, to delay competition from generic medicines.

“In order to become a registered medicine, a generic product has to be able to prove its bio-equivalency to its original counterpart,” Burchell notes.

Generics manufacturing company Mylon explains that bio-equivalence means generic and brand-name medicines are the same in their active ingredient, the maximum amount of medicine in the blood at any given time, the total amount of medicine in the blood from the time it’s taken until the body eliminates it, the strength and dosage, the route of administration (eg they are both tablets or syrups), and the expected safety and efficacy.

“Generic medicines must also comply with exactly the same standards of quality, safety and efficacy as all medicinal products,” Burchell adds. “They are produced in inspected plants under what is known as GMP, or Good Manufacturing Practice.

Just like originator products, once a generic medicine is sold on the market, it must be monitored by the manufacturer in case any adverse reactions are reported.”

“The most significant difference between generics and brandname drugs is their lower cost.”

– Susan Burchell, registered pharmacist PROS AND CONS

“Whether one is a cash-paying patient or on medical aid, there are significant cost savings when one consents to use generics,” she says.

Cash-paying patients experience an immediate cash saving, while most medical aids will only pay up to a set price per item, so selecting an original product may result in a co-payment. Patients are also likely to exhaust their medical aid saving funds more quickly when opting for brand-name products.

One potential downside to generics, particularly in paediatric oral formulations, may be a difference in flavour/colour/smell, Burchell says. However, this is usually a matter of preference.

“Brand loyalty is a high motivator for branded product purchases, and a lack of information on generics often leads to scepticism around them,” she adds. “Through familiarity and good marketing, doctors commonly prescribe brand-name products, and unless it’s stated on the script that it may not be substituted, a pharmacist must offer the cheaper alternative to the patient.”

H E A L T H Y T I M E S l 19

101

FOOD STORAGE

d

HEALTHY HOME

With prices ever on the increase, no one wants to throw away food unnecessarily. Prevashni Naidu offers a guide to how long you can safely store food

ue to limited guidelines in South Africa detailing freezing instructions per product, Mutsa Rwasoka, a food labelling consultant at Mérieux NutriSciences SA, says there are a few basics every consumer should keep in mind when purchasing food to last in cold storage. With her help, we’ve put together a useful guide to safeguarding your family’s health, and stretching your budget, by making your food go the distance.

UNDERSTANDING ESSENTIAL DATES Although we use them interchangeably, the following labels have different and specific meanings:

Images: ©iStock.com/lisegagne/lumpynoodles/macrovector/Mikalai_Manyshau/Sudowoodo

BEST BEFORE The most commonly observed date marking is Best Before

A FEW COLD-STORAGE GUIDELINES Because freezing at -18°C keeps food safe indefinitely, the following recommended storage times are for quality only.

(BB); this is the date that signifies the end of the period in which the flavour and quality of a product are at their optimum. Essentially, this is the last date by which the product is fully marketable and true to the qualities for which claims have been made, such as “smooth”, “creamy” or “source of vitamin C”. The food may still be acceptable/safe after the Best Before date has passed, but consumers would have to use their discretion on whether to consume the food.

PRODUCT

USE BY The Use By date shows the date after which, under stated storage

LUNCH MEATS

conditions, the product will not retain quality attributes expected by the consumer – it is the last recommended date of consumption. After this date, products should be considered unsafe.

Opened Unopened Soups and stews

SELL BY The Sell By date is the last date on which the product may be offered

SAUSAGE

for sale; there should still be a reasonable storage period in the home.

DEFROSTING

THERE ARE SOME BASIC GUIDELINES CONSUMERS SHOULD ADHERE TO:

• Always allow bulk food items to defrost completely before cooking. While micro-organisms cannot multiply in frozen temperatures, they can survive.

• Defrost food products on a deep enough tray to collect any liquid which may drip from the product.

• Don’t pack too much food into one dish for defrosting – this prolongs defrosting time and could cause the outer contents to defrost faster than the rest.

• If defrosting naturally (ie not in a microwave/oven), do so at cool temperatures to ensure safe, consistent thawing of the product.

• Always adhere to the defrosting instructions set on a product.

• If using a microwave, do not defrost items on high, as it could cause the item to cook on the outside before the inside has completely defrosted.

• Defrost only the amount of product required, as defrosting and returning to the freezer may allow for spoilage of the product.

EGGS

Fresh, in shell Raw yolk/whites Cooked Frozen TV dinners/casseroles Vacuum-packed deli goods

Raw Smoked Fresh red meat Roasts MEAT LEFTOVERS

Cooked meat Gravy and broth FRESH POULTRY

Whole Parts Giblets Cooked poultry FISH AND SHELLFISH

Cooked fish Smoked fish Shrimp, scallops, squid Canned seafood (after opening)

FRIDGE

FREEZER

4-5 weeks 2-4 days 1 week 3-5 days

Don’t freeze 1 year Won’t freeze well 3-4 months Don’t freeze well

3-5 days 2 weeks 3-4 days

1-2 months 1-2 months 2-3 months

1-2 days 7 days 3-5 days 3-5 days

1-2 months 1-2 months 4-6 months 4-12 months

3-4 days 1-2 days

2-3 months 2-3 months

1-2 days 1-2 days 1-2 days 3-4 days

1 year 9 months 3-4 months 4 months

3-4 days 2 weeks 1-2 days 3-4 days

4-6 months 2 months 3-6 months 2 months

Source: USFDA

H E A L T H Y T I M E S l 21

HEALTHY HOME

GET UP ON THE RIGHT SIDE

of your bed When it comes to healthy living, it’s easy to focus on fitness and diet. Yet, if you stop to think about it, you actually spend far more time in your bed than you do at the gym or dinner table, suggests Tamara Oberholster. By paying attention to your bed, you can improve your overall health… while you sleep

w

e’ve all heard that we should aim for eight hours of sleep a night, but the quality of sleep is important too, and can be affected by an uncomfortable bed. “Don’t underestimate how a good pillow and mattress can influence your back and neck pain, as well as your night’s sleep,” advises Candice Webb, a registered physiotherapist.

“Most mattresses have a lifespan of 10 to 15 years. Obviously, this depends on the quality of the mattress. The springs inside the mattress, as well as the foam materials, eventually wear out and need replacing.

When your mattress starts to creak, or if you end up rolling into the middle of the bed, you need to consider buying a new one.”

Another clue that signals it’s time for a new mattress is regularly waking up with back pain, which disappears within about half an hour of getting up.

When choosing a mattress, Webb says, look for one that provides optimum support so that your spine and hips are held in a neutral position.

“The mattress should maintain the natural curves of your spine. It should not be too hard or too soft. The amount of firmness, thickness and shape of the mattress will depend on the individual’s weight, body shape and personal preference,” she explains. “High-quality foam will last longer and give better cushioning for the pressure areas in different sleeping positions.”

For pillows, personal preference will dictate what’s best for you, but Webb believes you should be guided by the same principles as when

choosing a mattress: optimum support and cushioning. “You should always ask to test the pillow in the shop,” she says.

A 2005 study on fungal contamination of bedding, published in the journal Allergy, found that a “typical used pillow contains a substantial load of many species of fungi, particularly A. fumigatus” (which, the researchers note, is a well-recognised allergenic fungus).

The study found that, given the time we spend sleeping and the proximity of the pillow to our airways, pillows could be the primary source of fungi and fungal products, which could affect people with respiratory diseases, especially asthma and sinusitis.

This is why it’s important to wash pillows regularly. Martha Stewart suggests doing this at least twice a year. Check the instructions on the pillow’s care label, as down and feather pillows require different washing and drying methods from synthetic materials.

You can also help to protect your pillow from allergens by using a pillow protector, which you put on the pillow before slipping it into the pillowcase. There are also hypoallergenic options available for those who suffer from allergies.

Consider buying a mattress protector too, which will help to protect your mattress from sweat, body oils and dead skin.

Wash your bedding regularly, especially if you sweat profusely, sleep naked or go to bed without washing after you’ve exercised.

Launder bedding more frequently if someone in your family is sick.

Bear in mind that fungal skin infections such as ringworm (tinea) can be transferred through bedding.

22 l H E A L T H Y T I M E S

Image: Shutterstock

Pillows could be the primary source of fungi and fungal products, which could affect people with respiratory diseases.

SLEEPING HEALTHY with Dynamic Bedding.

Advances in coil technology have allowed for the development of lighter yet sturdier mattresses, while new raw materials such as Gel Memory Foam® and Latex® provide exceptional comfort and support by dynamically molding to your unique body type while managing your thermal environment throughout the night. Proper posture support can eradicate tossing and turning at night, relieve pressure points, and reduce morning aches and pains.

Foam mattresses offer good posture support, while Pocket Coil systems can prevent movement transfer.

Modern textiles such as Bamboo® fiber, Aloe Vera® microfiber and Purotex® treatments found in Dynamic mattresses utilize the power of nature to fight bacteria and allergens within the mattresses to provide long lasting hypoallergenic, anti-bacterial and non-toxic sleeping surface.

® Hybrid

Ultra Deluxe

your bed “ Ultimately should deliver a level

of comfort that allows you to have a peaceful night’s sleep

Quality of life is determined by many factors, a person’s ability to sleep well being of the most important. With ever increasing stress levels the need for rest is vital for a healthy lifestyle and one’s choice of bed is key towards achieving this.

”

The way in which we live our lives and the demands on our bodies have changed over the years and so there should be an expectation that the bed we depend on to get a great night’s sleep has to follow suit. Ultimately your bed should deliver a level of comfort that allows you to have a peaceful night’s sleep, comfort however is different for everyone.

Authentic, South-African made mattresses offer benefits that imported brands don’t. Besides economic aspects such as lower prices, readily available beds, better quality materials and building the South African economy; locally made beds are custom made to suit the South Africans market with its specific preferences, needs and climate.

Innovation in mattress design has recently become vital to achieving specific comfort to aid general health and wellbeing. Matching the latest technology and innovations with the evolution of modern man’s lifestyle is the principal motivator behind mattresses designed and manufactured

by Dynamic Bedding (Pty) Ltd.

In short, to experience the health benefits of a great night’s sleep, make sure that the mattress matches your Custom Comfort level and supports your evolving lifestyle.

“Dynamic Bedding, established in 1994, manufactures and distributes a wide range of bed bases and mattresses through its national network of 120 retail stores operating under the brands The Bed Shop and Bed City, in South Africa, Namibia, Botswana and Zambia. Dynamic Bedding’s manufacturing facilities located in Krugersdorp just outside of Johannesburg.”

120

STORES

DELIVERY

ANYWHERE IN SA

www.thebedshopsaonline.co.za

WELLNESS AT WORK

ESCAPING THE MADNESS OF

meetings Meetings are not the healthiest way – mentally or physically – you could be spending your time, suggests Georgina Guedes.

Here’s how to bring out the best in meetings – and yourself

Images: Shutterstock and ©iStock.com/UltraONEs

s

teve Jobs made a habit of conducting his meetings while walking – especially if he was meeting someone for the first time. Other followers of this habit include business and political leaders such as Mark Zuckerberg, Barack Obama and Richard Branson.

While “walking meetings” are just one way of making meetings healthier, their sudden surge in popularity does highlight that the current culture of meetings does little to power the world’s greatest minds.

You know the feeling: you’re sitting in a meeting while someone drones on and on about a topic that only vaguely relates to your job. The fluorescent light is flickering and the air conditioning is buzzing. You’re desperate to get up and respond to the mails you know are piling up in your inbox, and get some actual work done, but you can’t just get up and walk out.

Stephanie Martinis, an ICF-accredited executive coach, says meetings have become habitual within organisations, with people very busy having meetings, but not actually being productive.

She says meetings are, in fact, making people “dumber”. “If you are sitting in a meeting, not paying attention because you’d rather be doing something else, half-listening but also checking email or Facebook, you are diluting your brain’s ability to form memories and learn from the meeting. And of course, learning should be the purpose of the meeting – to gain insight and move forward in some way.”

While there are many ways to make the time spent in a meeting healthier, the most important step is to hold fewer meetings overall, and when you do call people together, ensure that each person has a purpose for being there.

10 STEPS TO HEALTHY MEETINGS Kaiser Permanente, an integrated managed care consortium, has put together a “Healthy Meeting 10” to assist teams in meeting healthily and productively: 1. Plan ahead for efficient meetings with pre-work and clear outcome-focused agendas.

2. Approach meetings with openness, a collaborative spirit and sense of fun.

3. Start meetings on time and with a healthy tip.

4. Include a stretch or active break for meetings lasting longer than one hour.

5. Meet on your feet, with walking or standing meetings whenever possible.

6. If you serve food, offer fresh, healthy choices.

7. Remember, not all meetings require food.

8. Go green – reduce paper use, offer local sustainable food and recycle.

9. Avoid plastic water bottles; offer water pitchers and reusable glasses.

10. Schedule 45 minute meetings rather than an hour.

Meetings have become habitual within organisations, with people very busy having meetings, but not actually being productive.

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H E A L T H Y T I M E S l 25

wellness at work

stop wasting your tiMe In the US, a 3M Meeting Network survey showed that executives believed 25% to 50% of the time they spend in meetings is wasted. And a study by Microsoft, America Online and Salary.com concluded that the average worker worked only about 1.5 hours a day – the rest of their time was “wasted”, with unproductive meetings being at the top of the list of time-wasters.

“There is legitimately no time available for anyone anymore, no matter what level they work at,” says Sandy Tasman, group talent manager at the Kalleo People Group. “Consider the hourly cost of the people that you have in a meeting – they could almost always be in three other places using their time more effectively.”

Because of this, the second most important thing you can do to improve the wellness of your meetings (after not having them at all) is to keep them short.

Tasman recommends: “Don’t automatically block off a ‘meeting hour’. If you do, you’ll lose the sense of urgency in that meeting and end up using the full hour. There’s no reason why you can’t call a meeting for half an hour or even 20 minutes. And people are much more likely to be able to come if you only want half an hour of their time.”

Jean Birkett, an associate director in the Accenture technology division, agrees. “I set half-hour meetings, because if it can’t be done in half an hour… we didn’t need a meeting; we needed a workshop.”

They agree that the easiest way to get things done efficiently is to have an agenda. “No meeting is valuable without an agenda,” says Birkett. “I don’t accept them without.”

Tasman recommends kicking off by stating what you want to get out of the meeting by the time you’re done, and then facilitating the meeting towards that outcome. “Anything that doesn’t contribute to that outcome should be taken offline or scheduled for another session. And at the end of the meeting, ensure that you have agreement on who is responsible for what, and by when.”

She says it’s vital to capture notes to document this, then to send a follow-up email with the key action points, while it’s still fresh in people’s minds and they are more likely to act.

26 l h e a l t h y t i m e s

Meeting in wellness

One of the greatest health drawbacks of meetings is the food and drink that attendees generally consume while they’re there. “if you’re holding a meeting that’s going to go on for two hours, it’s nice to be able to haul out some snacks. People can’t focus if they haven’t eaten. But remember that many people are trying to avoid sugar or carbs, so it’s better to stick to the savouries that aren’t starch – also because those foods tend to make people tired,” says tasman.

Vegetable and lean meat platters are the best way to go. and while you’ll probably get into trouble if you don’t provide caffeinated and sugary beverages, make sure that water is readily available too. another way to make longer meetings healthier is to ensure that your attendees get breaks at least every hour. “after about 50 minutes, people’s eyes start to glaze over. let them have a break to get some fresh air, walk or stretch.” she also recommends keeping people active within the meeting by encouraging participation in drawing on whiteboards or flipcharts. “standing up gets the creative juices – and blood – flowing, and helps people to be more engaged. and finally, she says, be considerate of everyone who is in the meeting. “Be mindful of where people are coming from and going to if you have very early or late meetings.

Remember that working mothers – and fathers – need to go home to their children.

Be accommodating of those kinds of things if you can.”

A way to make longer meetings healthier is to ensure that your attendees get breaks at least every hour.

Images: Shutterstock

“There’s no reason why you can’T call a meeTing for half an hour or even 20 minuTes. and people are much more likely To be able To come if you only wanT half an hour of Their Time.” – sandy Tasman

HEALTHY HEART

UNDER

pressure High blood pressure is the biggest risk factor for heart disease, but as it has no symptoms, it goes largely undiagnosed, writes Mandy Collins. Here’s what you need to know about high blood pressure

Medication will have to be taken seven days a week – it’s not a cure.

30 30 ll H H EE AA LL TT H H YY TT II M M EE SS

LIFESTYLE MEASURES

Jennifer McKenzie of the HSFSA says lifestyle measures for managing hypertension include: • Reducing salt intake and caffeine; • Taking in only moderate amounts of alcohol; • Becoming more active; • Managing stress effectively; • Avoiding smoking; and • Taking medication as prescribed by a qualified health professional.

the pressure rises to a peak level, called the systolic blood pressure, which is the top reading on the blood pressure measurements, and as the heart relaxes (‘diastole’), the pressure is lowered again to a level from which it starts rising again as the heart contracts (diastolic blood pressure or the lower value) – for example, 130/80. Blood pressure is measured in millimetres of mercury, and blood pressure levels should be below 140/90, but preferably close to 120/80mmHg. Hitzeroth says both numbers in the measurement are of equal concern. “It doesn’t matter whether both values are high, or if it’s just the lower one (diastolic) or the upper one (systolic). If any of the values

Images: Shutterstock and ©iStock.com/hudiemm/Sezeryadigar

i

magine a wall at the bottom of a sloping garden. It’s the rainy season and every day the water pounds against that wall, weakening it, until one day the water breaks right through it. Many of us are unwittingly walking around with a similar scenario inside us – hypertension, a condition in which the force of the blood against your artery walls is too high.

The difference between the flooded garden and your body is that you can see the floodwaters pounding at that wall, and do something about it before it’s a disaster. In the human body, however, hypertension – or high blood pressure – has no warning signs, which is why it has been dubbed a “silent killer”. Many sufferers find out that their blood pressure is dangerously high only after they’ve suffered a stroke or heart attack – assuming they survive.

Cape Town cardiologist Dr Jens Hitzeroth says hypertension is “the most common cause of heart failure in Africa. Most patients are not diagnosed, and of those who are diagnosed, the blood pressure is often not treated adequately.”

And there’s only one accurate way to know for sure whether your blood pressure is at a healthy level, he says: by having it measured.

“Even younger people should have their blood pressure checked regularly, so that one can intervene early to prevent future damage.”

When blood pressure is measured, it is expressed in systolic blood pressure over diastolic blood pressure. Hitzeroth explains: “Blood pressure measures the pressure the heart generates in the arterial system. The heart contractions result in pulsatile flow – in other words, the pressure is generated rhythmically with each heartbeat, and is not a continuous flow pump, like a water pump, for example.

“So, as the heart contracts (what is technically termed ‘systole’),

Images: Shutterstock and ©iStock.com/rilueda

are elevated, that has a long-term impact on a patient’s health. It does, however, look like an elevated systolic BP is more dangerous than an isolated elevated diastolic blood pressure.”

In adults, a normal blood pressure doesn’t change with age. “In older individuals, the BP should still be below 140/90mmHg. In the very old patient, ie older than 75 to 80, one can be a bit more lenient with a blood pressure of up to 160/90mmHg.” Lifestyle is a vital part of blood pressure management, says Hitzeroth, but in many patients this will not be enough, and they require antihypertensive (blood-pressure-lowering) medication. “Especially at levels over 155 to 160mmHg (systolic blood pressure), the chances of lowering the blood pressure adequately with lifestyle alone are very slim.”

It’s important to note that this is chronic medication that will have to be taken seven days a week – it’s not a cure. If your blood pressure goes down to acceptable levels, it’s because you’re taking the medication consistently. If you stop, it will go back up again.

This is a very important message for hypertension sufferers, as is the reminder that you’re probably not going to feel “better” or any different while taking your antihypertensives – remember, it’s a disease without symptoms.

Jennifer McKenzie, a health promotions officer at the Heart and Stroke Foundation South Africa (HSFSA), says: “For those who are aware of their high blood pressure, feeling fine is not an indication to stop your chronic medication, as it can damage your eyes, kidneys, blood vessels, and so on, before any symptoms appear or any organs fail, at which point it can be too late to reverse the damage.”

There are also many misconceptions about the condition (see “Myths and misconceptions”). “There is an old thumb-suck calculation that an acceptable blood pressure is 120 plus your age,” says Hitzeroth. “This is not correct – age makes no difference.

“Patients also often report various symptoms from hypertension, such as dizziness or headache, but this is probably unrelated. In general, one can’t ‘feel’ one’s blood pressure. One also does not ‘just have hypertension’ – it is one of the most important causes of heart disease, and for the vast majority of patients, it is entirely treatable by medication that, in general, is well tolerated.

“The most important thing is that it is diagnosed early and treated appropriately. In other words, patients should have their blood pressure checked regularly, and if it is high, this needs to be addressed.”

“Even younger people should have their blood pressure checked regularly, so that one can intervene early to prevent future damage.” – Dr Jens Hitzeroth MYTHS AND MISCONCEPTIONS McKenzie outlines three common misconceptions people hold about hypertension: MYTH: Sea salt, Himalayan salt and rock salt are healthier than table salt.

THE TRUTH: Table salt, rock salt and Himalayan salt are all equally high in salt.

MYTH: Never add salt to food.

THE TRUTH: Add salt only after tasting food to determine if it requires salt. If you use salty ingredients while cooking, do not add salt as well.

MYTH: You cannot exercise when you suffer from hypertension.

THE TRUTH: There are many safe exercises for hypertension sufferers, such as moderately paced walking for 30 minutes three to five times per week, yoga, pilates or moderately paced cycling.

Alternatively, she says, ask your doctor for advice.

H E A L T H Y T I M E S l 31

EXERCISE

Fit for PURPOSE

You want to exercise, but you hate the gym, and school sports were never really your bag. Or perhaps you’ve always loved being active and played first-team everything, but you want to try something new. Enter the world of alternative exercise. Louise Ferreira looks at three of the most popular options

Images: Shutterstock and ©iStock.com/SrdjanPav

CROSSFIT

To the layperson, CrossFit can sound intimidating – it’s a highintensity workout, complete with weightlifting. But the bulk of their clients haven’t done any sport in years, says Imtiaz Dezai, co-owner and training director at CrossFit Jozi in Edenvale.

“The adherence is really good. It’s popular partly because you see results quickly, and because it’s constantly varied movement,” he says.

Dezai spent 11 years in New Zealand, and it was there that he was introduced to CrossFit. He opened CrossFit Jozi at the end of 2010 – the fifth CrossFit gym in the country.

When joining his gym, the first step is a consultation and a physical assessment with a physiotherapist. The approach to injury is preventive. “We do what we call scaling, where we scale and modify the exercises according to ability and fitness.”

While they offer one-on-one sessions with clients who prefer individual workouts, CrossFit’s mainstay is group training, with its camaraderie and community support. “[CROSSFIT IS] Tia McDougall, who takes the A COMPLEXITYchildren’s classes, explains that there is no TYPE TRAINING weightlifting for toddlers. The preschool WITH SPECIFIC classes consist mainly of obstacle courses, MOVEMENTS, AND IT’S for example; the intermediate level is for EASY TO DO IT early to mid-primary school, and the third INCORRECTLY.” level goes up to the early teens.

– DAVID LEICHER “They’re learning how to move their body in space, which most kids don’t know

how to do [anymore],” says McDougall. “Their cores are really weak.

If they strengthen those muscles, they will be able to concentrate better in school because they’re not always slumped over, or using a lot of energy to sit up.”

Injury is a risk in any sport. Sports physiotherapist David Leicher explains that the causes of injury, across sporting disciplines, can be boiled down to incorrect technique and overtraining. A good trainer will pick up on bad form.

“We do see CrossFit injuries in our practice,” he says. “You’re doing a complexity-type training with specific movements, and it’s easy to do it incorrectly.”

He says having a physiotherapist on staff and doing a physical assessment will go a long way towards preventing injury, and thinks the kids’ classes are a “brilliant” idea.

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H E A L T H Y T I M E S l 35

exercise

Boxercise

Launched nearly 12 years ago with 30 participants at one location, Adventure Boot Camp now has over 100 locations in cities and municipalities around the country. Johan Bosman, the current owner and managing director, attributes Boot Camp’s popularity to three critical components: it’s women-only, outdoors and group-oriented.

“It’s like personal training in a group context,” he explains. The women get to know and befriend each other, meaning that the camps come with a built-in support system.

Personal safety is a priority, says Bosman, with training always taking place at locations where there are security guards – usually sports facilities at schools and universities.

Overall, they receive excellent feedback, he says, and the numbers don’t lie: their retention rate is 92%.

Personal trainer Louise Gierschick has been teaching Boot Camp classes for seven years, and she has her loyal customers – one woman is now on her 71st camp. The supportive community environment plays a big role.

“The ladies will notice changes and be encouraging,” she says.

As with CrossFit, Boot Camp includes a combination of exercises. The one-hour sessions vary depending on the stage of the course, but generally involve stretching, core strengthening, toning legs and upper body, and running. Participants bring their own exercise mats and hand weights.

Gierschick is always very aware of injuries. “Trainers are given a list of injuries beforehand, and the women usually come up to us before the session as well. We always give alternative exercises.”

According to Leicher, the combination of being outdoors and the different types of exercise make Boot Camp a great option. But the same caveats apply.

“I’ve seen a lot of women come in with knee injuries because of incorrect technique and overtraining. They can also get shin splints because they’re running more than they’re used to – it’s something that should be built up slowly.”

Around the third week of training, you’re at your most vulnerable to injury, because your bone density decreases before it builds up again. You shouldn’t increase weight loads at that point, until your body has adjusted, he cautions.

Women are also more vulnerable to knee injuries, Leicher points out, because the pelvis is wider and the hip joints are weaker.

36 l h e a l t h y t i m e s

the correct technique “Professional is very important, he says. boxing is a very “you need to have ex-boxers tough sPort, and teach the class, not spinning boxercise clients instructors or weightlifting range from coaches. they have no housewives to experience in how to wrap businessPeoPle.” the hands or hold the pads.” leicher agrees. “What we – mick castellan see, especially with women, who love these classes, is that their wrists are not strong enough. so, even if you’re well wrapped up, if you punch the bag slightly off, you can injure the wrist. With shadow-boxing you have to use your muscles to stop the punch, and we often see tennis-elbowtype injuries.”

Finding a form of exercise you enjoy goes a long way to keeping you fit. But you need to keep yourself safe. “everyone has a niggle or two. that’s fine; you can work around that.

But if you have recurring injuries, you should go to a medical professional for an assessment. you need to rehabilitate the injury,” leicher concludes.

Images: ©iStock.com/stevecoleimages/Weekend Images Inc.

adventUre BOOt CamP FOr WOmen

at the team Castellan boxing gym in Waverley, owner mick Castellan, once ranked number 10 in the sa middleweight division, offers a range of boxing-related exercise, along with training professional boxers. he introduced boxercise, already popular in the Us and europe, to south africa in the 1990s after seeing an advert in a boxing magazine. it quickly proved popular here too. “People keep coming back. Over the years i’ve been told that it’s far more stress-relieving than lifting weights,” Castellan says.

Classes are 45 minutes and are taught in groups of seven to 15. it’s a full-body conditioning workout with aerobic and anaerobic training, using all of the components of boxing itself: punching the bag, shadow-boxing, jumping rope.

Workouts are intense; you’re using your legs and your body, and the variations are quite complicated. For a trainer it’s an entirely different experience, Castellan says. “Professional boxing is a very tough sport, and boxercise clients range from housewives to businesspeople.”

HEALTHY FEET

THE PODIATRIST’S GUIDE TO Prevashni Naidu gets advice from a foot expert on choosing the right shoes

s

outh Africans have distinctive feet, apparently; our feet are much straighter than those of other populations, because walking barefoot has helped them to develop naturally.

So says podiatrist Anette Thompson, who is the study author of a published research article on foot types. But there’s a downside, she says: “Shoe manufacturers are using old foot shapes that have their history in European-based shapes (South African shoe sizes are UK-based). We, therefore, need to look for shoes that are straighter, to match our feet – only 2.9 degrees of in-flare.

“If you turn over some of the imported pumps, you will see they have a very curved sole – almost banana-shaped. This shape is too curved to suit our general population and is why so many women, especially, complain of corns and irritation over their fourth and fifth toes. Their feet are trying to be straight, but the shoe is curved and squashing their little toes.”

KNOW YOUR FOOT TYPE

Thompson suggests this easy tip when shoe-shopping: “Draw the outline of your feet on a piece of thin cardboard. Then cut out the cardboard so that you have your foot shape. When out shopping, put that cut-out into shoes to see whether the shoe has the correct alignment for your feet and whether it is wide enough.

“We can’t trust our feet to advise us, because they can be happily squashed for a few minutes. We then assume a shoe is comfortable enough and make a purchase. It’s only a half-hour to an hour later that it starts to burn or pinch us, and then it is too late, as you can’t take a used shoe back to the shop.”

Sources: Podiatrists Anette Thompson and Erin Dayaram, and the American Orthopaedic Foot & Ankle Society 38 l H E A L T H Y T I M E S

• Shoes should support the activity for which you require them: active wear, casual, formal.

• If you have one foot bigger than other, always fit a new shoe for the larger foot.

• Shoes are not meant to be “broken in”; they should fit comfortably from the minute of purchase and should not hurt you when wearing them.

• Shop for shoes later in the day. Most people’s feet swell up by the end of the day.

• The ball of your foot should fit comfortably in the widest part of the shoe.

• The shoe should also have enough depth to fit your toes.

• Stand up and make sure there is 15mm (about the width of your finger) between your longest toe and the end of the shoe.

LOOK FOR QUALITY SHOE CONSTRUCTION According to Thompson, who is a consultant to various health shoe brands, basic principles of a good shoe include a cushioned heel, a firm sole that doesn’t easily twist or bend, and flexibility at the proper area, depending on the type of shoe.

“A soft, breathable material for the upper of the shoe makes it more comfortable to wear for longer periods of time, and less likely to cause rubbing or skin irritation.

The upper of the shoe should allow adjustment (laces, straps, etc) to hold the foot in place comfortably with activity. There should be some arch support in the shoe or the insert inside the shoe.

“Many shoes can be made to fit better simply by removing the factory insert and replacing it with a high-quality pre-moulded orthotic. Custom orthotics are prescribed by podiatrists for specific foot disorders or activities.”

Images: ©iStock.com/Poike/Tatomm

buying shoes

ESSENTIAL SHOE-SHOPPING TIPS:

H E SAUL TPHP YL EJMOEI N T S

FACING UP TO THE BURDEN

of osteoarthritis

While numbers relating to the disease burden of osteoarthritis remain undetermined in South Africa, says Prevashni Naidu, health experts are warning that this most common form of arthritis is crippling millions countrywide

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nyone who’s experienced a throbbing – and unrelenting – pain, with joint stiffness that has left them struggling with everyday tasks, such as driving or cooking, knows the debilitating effect of osteoarthritis (OA).

Defined by the Arthritis Foundation of South Africa as “a degenerative form of arthritis found mainly in older patients from general wear and tear, and resulting either from overworked or previously damaged joints or hereditary factors”, OA involves the breakdown of cartilage between bones that acts as a shock-absorber in the body. It commonly attacks the hands, hips, knees and spine, and is seen to affect the ageing population more significantly.

Many patients may ultimately be good candidates for hip and knee replacements, and there are also surgical options for shoulder, hand and ankle arthritis. However, sometimes the patient may have too many other health problems, and surgery is considered too “high-risk”.

“The main issue, however, is the cost and limited health resources that restrict access to these surgical options,” explains rheumatologist Dr Anne Stanwix. “So, as numbers of patients with OA are increasing beyond any reasonable capacity to provide surgery to those who may benefit, there is a need to look at the causes for this increase and what measures may help to offset this trend.”

Managing OA for years with painkillers known as non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, experts are now investigating alternative treatment techniques to help their patients. Stanwix notes: “Because of kidney and stomach problems, as well as increased blood pressure and heart disease caused by NSAIDs, there initially was a shift towards prescribing analgesics that combined paracetamol with opioids. Unfortunately, this has led to increased problems of addiction, and side-effects like excessive sedation.”

As a result, Stanwix says, alternative treatment means are being investigated, and there is a growing body of evidence that suggests

Images: Shutterstock and ©iStock.com/michellegibson

Alternative treatment means are being investigated, and there is a growing body of evidence that suggests natural treatments can be effective.

natural treatments can be effective in treating the condition. Topical antiinflammatory gels and localised measures, such as splinting and bracing, and muscle strengthening to support the affected joints, are receiving more attention, as well as mindfulness training, which involves meditation exercises such as yoga breathing, to help patients to cope better with pain.

Stanwix points out that while genes do play a role in your likelihood of having arthritis, there are other factors that have an impact. These include ageing, smoking, diabetes, overweight, sports injuries (especially knees) or repetitive-use trauma, certain occupations such as farming, and hypermobility (people who have lax joints).

“Osteoarthritis was previously considered to be a non-inflammatory condition related to wear-and-tear, as opposed to inflammatory joint problems like rheumatoid arthritis or gout.

Inflammation is now thought to play a role in various stages of OA, and OA has been linked to other inflammatory conditions such as diabetes and heart disease,” Stanwix explains.

She advises, therefore, that preventive strategies that reduce the risk of developing vascular disease could be of benefit in OA prevention and treatment too. “Lose weight, stop smoking and do regular exercise, and if you need help, join a support group that helps patients better adhere to exercise or weight-loss programmes.”

Ultimately, says Stanwix, the best defence against any disease, including OA, is living a healthy lifestyle.

H E A L T H Y T I M E S l 41

HEALTHY BONES

frame

MIND YOUR

Osteoporosis, which literally means “porous bone”, is a disease in which the density and quality of bones are reduced. Prevention is the best cure, writes Penny Haw

Images: ©iStock.com/m-imagephotography/Neustockimages/wildpixel

m

any of us take our bones for granted. We pore over our skin, pump our muscles, fixate on our flesh and mollycoddle our hair. But, until they bother us, we largely ignore our bones. After all, protected by said skin, muscles and fleshy bits, they’re not that noticeable. That, says CEO of the National Osteoporosis Foundation of South Africa (NOFSA), Teréza Hough, is exactly why we should pay them more attention.

“The progressive bone loss that occurs with osteoporosis is often invisible and painless, which is why it’s known as the ‘silent crippler’ and ‘silent disease’,” she says. “But it can result in fractures that cause pain, disability, loss of independence and even premature death.”

Osteoporosis – a disease that decreases the density and quality of bones, leading to weakness of the skeleton and increased risk of fracture, particularly of the spine, wrists, hips, pelvis and upper arms – is often mistaken as a normal ageing process.

Certainly, it’s more prevalent in older people, but it’s not exclusive to the senior population. Bone loss can begin as early as the age of 25.

Importantly, however, says Hough, if we pay attention to our bones by following a healthy lifestyle and nutritious diet, we can avoid it at any age.

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WHAT ARE THE SIGNS OF OSTEOPOROSIS?

In most cases, the first symptom of osteoporosis is a fracture. While this can happen in other bones as well, osteoporotic fractures most frequently occur at the spine, wrist or hip.

Even then, osteoporosis is not always immediately suspected.

Because spinal fractures can be painless, or, if people do experience pain, they don’t necessarily realise it’s caused by a fracture, spinal fractures sometimes go undiagnosed. A more obvious sign of spinal fractures is loss of height with gradual curvature of the back, which is caused by vertebral compression fractures and is called Dowager’s Hump.

“Since there are frequently no outward signs as osteoporosis develops, depending on your age and if you have other risk factors for the disease, doctors often recommend diagnostic testing,” says Hough. “Early detection of bone loss is key to preventing suffering. Bone mineral density (BMD) tests are effective in assessing fracture risk, confirming a diagnosis of osteoporosis and monitoring the effect of treatment.”

THE PROGRESSIVE BONE A number of different types of BMD tests are available. The most LOSS THAT OCCURS WITH commonly used is dual-energy X-ray absorptiometry (DXA scan), which OSTEOPOROSIS IS OFTEN involves minimum radiation and no injections or special preparation, INVISIBLE AND PAINLESS. causes no discomfort, and usually takes only five to 10 minutes.

SUNSCREEN AND VITAMIN D DEFICIENCY

According to a recent report in the Journal of the American Osteopathic Association, as helpful as sunscreen is against skin damage, it could lead to vitamin D deficiency. While some foods contain vitamin D, which helps to absorb calcium and is thus crucial for bone health, exposure to sunlight is one of the best sources of the vitamin. The study suggests individuals avoid using sunscreen when exposed to midday sun for up to 30 minutes twice a week to increase and maintain normal vitamin D levels.

H E A L T H Y T I M E S l 43

HEALTHY BONES

HOW DO I KNOW IF I AM AT RISK?

Women – particularly post-menopausal women – are at greater risk of having osteoporosis than men. The lifetime risk that a woman will suffer an osteoporotic fracture is 30%-40%.

However, recent studies show the prevalence of osteoporosis in men is higher than previously thought, with approximately one in five men affected by the disease.

Fixed risks include: • Age – the majority of hip fractures (90%) occur in people aged 50 and older; • A parental history of osteoporosis, particularly hip fracture; • A previous fracture, which increases the risk of any fracture by 86%; • Ethnicity – osteoporosis is more common in Caucasian and Asian populations; • Menopause and hysterectomy – the risk of osteoporosis is increased because of loss of oestrogen; • Long-term use of corticosteroids (often used to treat inflammatory conditions such as rheumatoid arthritis); • Rheumatoid arthritis and diseases of the endocrine system, which reduce the strength of bones; and • Primary/secondary hypogonadism (that is, a deficiency of androgen) in men.

BONE-FORTIFYING FOODS ● ●

●

Dairy products such as milk, yogurt and cheese.

Fatty fish varieties, including salmon, mackerel, tuna and sardines.

Vegetables such as cabbage, broccoli, potatoes, sweet potatoes, tomatoes, brussels sprouts, red and green peppers, artichokes, spinach and kale. ● Fruit including oranges, bananas, prunes, papaya, pineapples, raisins and grapefruit.

HOW CAN I PREVENT OSTEOPOROSIS? “While genetic factors play a significant role in determining your risk of having osteoporosis, lifestyle factors such as diet and physical activity influence bone development in youth and the rate of bone loss later in life, which means it’s never too early to invest in bone health,” says Hough. “It’s estimated a 10% increase of peak bone mass in children reduces the risk of an osteoporotic fracture during adult life by 50%.”

To prevent osteoporosis – whether they fall in the high-risk category or not – children and adolescents require a nutritious diet with adequate calcium, protein and vitamin D. They should also participate in regular physical activity and avoid second-hand smoke.

Once peak bone mass is reached, it’s maintained by “remodelling”. This is a lifelong process whereby mature bone tissue is removed from the skeleton (through bone resorption) and new bone tissue is formed. During childhood and early adulthood, bone formation is more important than bone resorption.

Later, however, the rate of bone resorption is greater than the rate of bone formation, which results in the thinning of bones.

“Any factor that causes a higher rate of bone remodelling will ultimately lead to a more rapid loss of bone mass and more fragile bones,” says Hough. “As such, the nutritional and lifestyle advice for building strong bones in youth applies to adults too.”

In addition, adults should avoid too much alcohol, not smoke, participate in regular weight-bearing exercise, and watch out for possible undernutrition, which can be caused by severe weight-loss programmes and eating disorders.

For more information, https://osteoporosis.org.za/

44 l H E A L T H Y T I M E S

Images: ©iStock.com/alexkladoff/amphotora/Creativeye99/Floortje/loops7/Spondylolithesis

Modifiable risk factors, which are linked to personal lifestyle choices and can be adapted to reduce the chances of having osteoporosis and related issues, include: • Alcohol – high intake of alcohol adversely affects bone-forming cells; • Smoking – smokers and people who smoked in the past are at risk; • Low body mass index (BMI) – people with a BMI of 20kg/m2 have a two-fold increased risk of fracture compared to those with a BMI of 25kg/m2; • Poor nutrition – in addition to building bones and keeping them healthy, calcium helps blood to clot, nerves to transmit messages and muscles to contract. When there’s insufficient calcium for your body’s needs, bone calcium is sacrificed and bone mass lost; • Vitamin D deficiency – because it facilitates calcium absorption from the intestines into the blood, vitamin D is essential; • Eating disorders such as anorexia nervosa and bulimia – they present a high risk for osteoporosis; • Oestrogen deficiency – it speeds up bone loss; • Insufficient exercise – exercise encourages bone development; and • Frequent falls – visual impairment, dementia, loss of balance, neuromuscular dysfunction and the use of sleeping pills increase the risk of falling and fracture.

HEARING

Sound ADVICE

Images: ©iStock.com/art-sonik/hudiemm/RuslanDashinsky

m

Most of us are good about annual eye and dental checkups, but what about our hearing? Hearing loss is not just a preserve of the elderly, cautions Mandy Collins

ost of us don’t consider hearing loss as a health issue until it happens. It’s something inevitable that comes with old age, we think.

We’ll deal with it then. But that couldn’t be further from the truth. Hearing loss affects people of all ages – and it’s on the increase in the young.

“In children, temporary hearing loss is often caused by middle-ear infections,” says Johannesburg audiologist and speech therapist Bev Ordman. “When the infection is resolved, the hearing returns, but if it’s untreated and chronic, it can cause more permanent damage and long-term hearing loss.”

“There are also many causes of acquired sensorineural hearing loss, such as ototoxic (damaging to the auditory system) drugs, mumps, measles, chicken pox and meningitis,” adds Johannesburg audiologist Jacqui Reeves, “whereas in adults, the most common types of sensorineural hearing loss are age-related and noise-induced.”

Both experts point out that we don’t take enough precautions to prevent noise-induced hearing loss. “The noise doesn’t have to be loud to damage your hearing,” says Ordman. “Even moderate levels of constant noise over a long time can do it.”

“It is important to remember that just because a sound isn’t annoying you, it doesn’t mean it’s not harmful,” adds Reeves. “And recreational loud noise from, among other sources, mp3 players, loud music in nightclubs and at concerts, hunting and motorbikes is becoming increasingly to blame for noise-induced hearing loss.”

The bottom line is that you need to add hearing tests to your regular health checkup for early detection of problems – aim for every 12 to 18 months, says Reeves. Newborns are usually tested before they leave the hospital, and Ordman urges parents not to skip the hearing screening that is done at many primary schools.

“As an adult, consult an audiologist if you believe you have a problem, or if you have regular ear infections, sinus, allergies, a family history, chronic illnesses, diabetes, and even cancer treatment, as chemo and radiation can be ototoxic,” Ordman adds.

“Untreated hearing loss is more noticeable than a hearing

aid,” Reeves concludes. “If you miss a joke’s punchline or respond inappropriately to what is said, people may be concerned about you or you may be embarrassed. Untreated hearing loss not only means giving up some of the pleasant sounds you used to enjoy, but it could also negatively affect your quality of life.”

“In adults, the most common types of sensorineural hearing loss are age-related and noise-induced.”

IS A HEARING AID FOR ME?

Jacqui Reeves points out that, in the past, many people with hearing loss in one ear, with a high-frequency hearing loss, or with nerve damage were told (often by their doctor) that they could not be helped.

“This may have been the case many years ago, but with advances in modern technology, almost all people with a hearing loss – basically, as long as some degree of hearing remains – can benefit from hearing aids,” she says.

“If there is a hearing loss in both ears, two hearing aids are important for localisation and speech discrimination. In cases of total hearing loss, a cochlear implant (a surgically implanted electronic device) could be considered.”

Bev Ordman adds that recent research has linked untreated hearing loss with dementia and cognitive loss, ie not fitting a hearing aid can accelerate mental degeneration. “What happens is that the neural pathways are not stimulated, and if you don’t use it, you lose it!”

To do a quick home screening, she suggests downloading the free hearZA app, which makes early detection of hearing loss possible in under two minutes. It was developed specifically for South Africa, with normative data across all official languages.

H E A L T H Y T I M E S l 47

ADVERTORIAL

DON’T DELAY

– have your hearing tested today!

Hearing loss is more common than most people realise, says the South African Association of Audiologists (SAAA)

HEALTH ADVISORY

The Health Professions Council of South Africa (HPCSA) has issued a warning against the use of ear-worn hearing devices that are not supplied and fitted by a fully qualified professional registered with the HPCSA.

WHY IS EARLY IDENTIFICATION OF HEARING LOSS IMPORTANT? There are several reasons for identifying your hearing loss as soon as possible. First, there may be an underlying medical cause you are unaware of.

Second, untreated hearing loss is a major health and quality-of-life issue. It can lead to: • • • • • • • •

Irritability, negativism and anger; Fatigue, tension, stress and depression; Avoidance or withdrawal from social situations; Social rejection and loneliness; Reduced alertness and increased risk to personal safety; Impaired memory and ability to learn new tasks; Reduced job performance and earning power; and Diminished psychological and overall health.

It has also been linked to an increased risk of developing dementia and overall cognitive decline, and can lead to auditory deprivation, which is, in essence, the deterioration of the auditory nerves and hearing centres in the brain responsible for interpretation of sound, to the extent where the damage is both irreversible and not responsive to treatment.

48 l H E A L T H Y T I M E S

The first, most important step is to have your hearing evaluated by a qualified audiologist, who will be able to determine the degree and type of hearing loss. If medical intervention is indicated, your audiologist will refer you to the appropriate medical professional. If your hearing loss is of such a nature that you are in need of hearing aids, your audiologist is the person who will assess your lifestyle and needs to determine the best possible solution for you.

The process involved in being fitted with hearing aids and getting accustomed to them is one you will undertake with your audiologist, who will play a key role in ensuring optimum settings, for maximum satisfaction and excellent outcomes.

Hearing-aid technology is developing at an extremely rapid rate, and continuous research is being done to validate the efficiency of these instruments. In this day and age, with the correct team on your side, there is no need to struggle.

CONTACT:

Find the closest audiologist to you on www.audiologysa.co.za/contact, or contact Cornelle Naude on 082 727 5977 or admin@audiologysa.co.za.

Images: Supplied and ©iStock.com/atwstudios

h

earing loss doesn’t happen overnight, and it’s not just a problem of old age. It is often a gradual process of deterioration of the auditory mechanism, which causes a gradual decline in hearing abilities. And this can start as early as the age of 35.

Hearing loss can be caused by a variety of factors, such as noise exposure, ototoxic [poisonous to the ear/hearing] medications, medical conditions such as diabetes and high blood pressure, as well as ageing of the hearing mechanism itself.

Typically, hearing loss affects some sounds (frequencies) more than others. In most cases, high frequencies are affected first, while the individual can still hear most low-frequency sounds. This causes you to feel as if you are hearing at a normal “volume”, but in fact you could be missing out on some details of speech.

It is also generally easy to hear in quiet environments with little to no background noise, and you will rely heavily on non-verbal cues, such as facial expression and mouth movement, to follow a conversation.

IF I SUSPECT A HEARING LOSS, WHAT IS THE NEXT STEP?

HSEUAPLPT LHEYMME INNT DS

THAT uneasy FEELING

We’ve all experienced bouts of anxiety, perhaps before delivering a presentation or writing an exam. But when it’s ongoing or extreme, it will require intervention. Mandy Collins spoke to Johannesburg clinical psychologist Dr Colinda Linde

Q

WHAT IS ANXIETY? A. Anxiety is an emotion, like sadness or anger, and,

like other emotions, it has a function. Typically, it’s an indication of a “threat” of some kind, which must be dealt with. When there is an actual threat, such as a wild animal or fire, anxiety protects us.

When the threat is perceived, for instance if you feel anxious about a presentation, a moderate degree of anxiety is functional, as it makes you prepare. However, when anxiety is ongoing and/or extreme for the situation, it becomes a disorder and must be addressed.

Q. WHAT CAUSES ANXIETY? A. Anxiety is usually the result of a combination of genetic vulnerability

and stressful life events. It can be triggered by a traumatic event – posttraumatic stress disorder (PTSD), for example – or be chronic, such as in the case of generalised anxiety disorder (GAD). It can also be situation-specific, such as social phobia or panic disorder.

Q. WHAT ARE ITS SIGNS AND SYMPTOMS? A. Each type of anxiety has different symptoms, but what they have

in common is the fight-or-flight response. In panic it happens in acute episodes, and in GAD it’s chronic hyperarousal [a state of increased psychological tension] that waxes and wanes.

Images: ©iStock.com/miflippo/PeopleImages

Q. WHEN IS EXPERT INTERVENTION REQUIRED? A. When it is affecting normal functioning (work, home, studies),

it needs treatment. If it’s acute, you need to start with medical/ pharmacological intervention, to allow the person to be accessible for therapy. GPs don’t specialise in this, so a psychiatrist is better, if you have access. Then cognitive behavioural therapy (CBT) with a psychologist, which is proven to work for treating anxiety. CBT is a light, relatively informal process, where you learn actual techniques and coping skills, like emotion regulation, and identifying and changing dysfunctional habits and beliefs.

Q. CAN ANXIETY BE CURED, OR IS IT SIMPLY MANAGED? A. If you are a naturally anxious person, that usually means GAD – it’s

chronic, so taking medication to take the edge off and lower the general feeling of anxiety is best. Research shows that this combination results in the best long-term effect and protects against relapse.

FAST FACTS ABOUT PANIC

Panic disorder is anxiety’s first cousin. The first time people experience a panic attack, which may include palpitations, sweating, shaking, shortness of breath or numbness, it’s extremely frightening – they may actually believe they are dying. If you are having recurrent unexpected panic attacks, it’s called panic disorder.

Here are some need-to-knows:

• Two to four percent of the population will suffer from panic disorder at some point in their lives.

• Panic is twice as common in women as men.

• For women, the average age of onset is during their early 20s; for men it’s in their 40s.

• The average length of a panic attack is four to six minutes.

• Panic affects people of all races and classes.

• Alternative and complementary interventions, such as St John’s Wort and acupuncture, may be of some benefit in treating panic disorder. Be aware, however, that St John’s Wort can interact with other prescribed medications.

• Caffeine, cold and flu medications, Lariam (anti-malarial drug), appetite suppressants and local anaesthetics may trigger panic attacks.

• With the right combinations of therapy, 90% of people recover fully, and the remaining 10% experience significant recovery.

Source: The South African Depression and Anxiety Group

HELPLINE

The South African Depression and Anxiety Group (SADAG) has a 24-hour helpline: 0800 70 80 90, or SMS 31393 and they will call you back.

H E A L T H Y T I M E S l 51

AGEING

MAKING

memory Young or old, we all forget things from time to time. But at what point do we need to worry? Caryn Gootkin looks at where we draw the line between ordinary forgetfulness, memory loss due to the normal ageing of the brain, and dementia

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oday we seem to hear of more people suffering from dementia than ever before, which is probably due to the fact that people are living longer. And while dementia is usually associated with old people, some as young as 60 have been known to be affected.

Images: Supplied and ©iStock.com/RapidEye/shapecharge

MEMORY LOSS

As we age, everything seems to slow down. We feel less flexible, both physically and mentally, and we often need more time to process information.

“Memory changes occur – it’s common to have greater difficulty remembering names of people, places and other things as we age,” advises the Alzheimer’s Association, the leading American voluntary health organisation in Alzheimer’s care, support and research. While these memory lapses can be frustrating, they generally aren’t anything to worry about and are not the same as dementia.

“Most people will notice changes in their intellectual functioning as they age,” says geriatric psychiatrist Dr Surita van Heerden. “The rate of memory decline is highly variable, with some people showing little age-related decline, others quite a substantial drop over time. Typically, older adults have preserved crystallised intelligence (which represents Dr Surita van Heerden the accrual of information over time), but a decline in fluid intelligence (which reflects the ability to acquire or use new information). They also typically retain memory regarding knowledge and facts about the world, but might experience a decline in the ability to remember new information.”

CAN MEMORY LOSS BE PREVENTED?

While memory loss may not be entirely preventable, you can control your risk factors. “While you still function well, or are still relatively young, you must try to limit and manage stress as far as possible,” advises Van Heerden.

“Chronic stress is especially harmful to the brain and may affect the hippocampus specifically. An acute stressful event can sometimes trigger or precipitate memory problems. It is therefore very important to get whatever help you need to control your stress levels, including seeking treatment for depression and anxiety.”

She also cautions on injury to the head. “Trauma may cause memory problems on its own and may also be a risk factor for later development of dementia. But the damage is considered permanent only once dementia develops.”

In midlife, the following are risk factors for memory loss in old age: obesity, smoking, heavy alcohol intake, hypertension, high cholesterol and diabetes. There are also indications that physical activity, which includes exercise and leisure-time physical activity, may delay memory loss.

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“Most people will notice changes in their intellectual functioning as they age.”

– Dr Surita van Heerden

H E A L T H Y T I M E S l 53

AGEING

TIPS AND TRICKS TO AID MEMORY: • Don’t multitask; focus on the task at hand.

• Reduce environmental stressors; actively seek out activities that calm you.

• Avoid getting agitated if you forget something.

• Stick to a fixed and predictable routine.

• Keep your home and office organised.

• Practise mindfulness; live “in the moment”.

• Don’t procrastinate – you’re more likely to forget if you don’t do it now.

• Go over important facts/names in your head.

• Use memory aids such as whiteboards or Post-It notes.

Based on advice by Prof Narinder Kapur, a neuropsychologist at London Memory Clinic

DEMENTIA AND ALZHEIMER’S

Healthy

Normal neuron

54 l H E A L T H Y T I M E S

Alzheimer’s disease

Amyloid plaques

WHAT HAPPENS IN THE BRAIN TO CAUSE MEMORY LOSS? “As we age, our brains change,” explains Van Heerden. “For example, they atrophy (a shrink or decrease in brain volume), and we lose both grey and white matter. In patients with memory loss, we often find that the hippocampus – the part of the brain associated specifically with memory – atrophies, which can sometimes be seen on a brain MRI.” In those who are ageing normally, brain cells often decrease, form fewer connections with other cells and develop specific neuropathological changes associated with ageing. “Two of these are called ’senile plaques’ (SP) and ’neurofibrillary tangles’ (NFT),” adds Van Heerden. “In a disease like Alzheimer’s, we may find increased atrophy of the brain and see considerably more SPs and NFTs than one would expect from normal ageing. In a disease like vascular dementia, one might find evidence of previous strokes (even very small ones in the deep grey matter) in the brain, as well as more than the normal evidence of hypoxia, especially in the white matter of the brain.”

Images: ©iStock.com/simarik/sudok1/ttsz

Authors Melinda Smith, Lawrence Robinson and Robert Segal wrote for helpguide.org: “The primary difference between age-related memory loss and dementia is that the former isn’t disabling. The memory lapses have little impact on your daily performance and ability to do what you want to do. Dementia, on the other hand, is marked by a persistent, disabling decline in two or more intellectual abilities, such as memory, language, judgment and abstract thinking.”

Van Heerden adds: “Dementia (or major neuro-cognitive disorder) is diagnosed when the normal age-related cognitive decline becomes more progressive or severe. The decline will be significant enough to cause concern from either the person themselves or from a family member or someone close to the person. The decline would be to such an extent to affect the person’s ability to function independently. Typically, the person will have difficulty in instrumental activities of daily living, like managing finances, driving, doing housework, preparing meals, taking medication and using a telephone.”

Alzheimer’s South Africa, a non-profit organisation and South African representative of Alzheimer’s Disease International, classifies Alzheimer’s as one of the causes of dementia, a group of illnesses that affect the structure and chemistry of the brain. The most common symptoms of dementia include gradual loss of memory, a decline in the ability to think and reason, and problems with communication.

“While the risk of developing dementia increases dramatically with age, most older people do not develop the condition – it is not an inevitable consequence of getting older.

Age is an important risk factor, but not the only one. Dementia affects one person in 20 over the age of 65, and one person in five over the age of 80 across all races, genders and cultures,” says Alzheimer’s SA.

NEW HEALTH CARE CLINIC IN SA voted best alternative medicine clinic in Africa *Independent Survey

•conventional medicine •complEmentary alternative medicine •advanced biotechnology

ALT MED CARE INTERNATIONAL CLINICS Offering conventional medicine, complementary alternative medicine and advanced biomedical technology, The Advanced Life Therapies Medical Care (Alt Med Care) Clinic in Pretoria East, South Africa is the first of its kind on the African continent.

OFFERING ONLY THE BEST IN INTEGRATIVE AND ALTERNATIVE MEDICINE The fully integrated medical centre was founded by Dr. Steven Gunn (MD) and Dr. Bret Phillips (PhD). Together they offer combined experience of more than 30 years and a diverse range of diagnostic and treatment products and technologies.

Alt Med Care International Clinic is an exceptional and pioneering institution in South Africa. They treat patients from all over the world, including Africa. Like many clinics in Germany, the UK, USA, Canada, Mexico and Japan, Alt Med Care offers only the best integrative medicine. AMC International Clinics have a special interest in chronic diseases including cancer, fibromyalgia, autoimmune disease, disease prevention, antiaging medicine, pain, brain- and learning disorders, medical weight loss and sports performance enhancement.

TOP MEDICAL SCHOOLS ADOPT INTEGRATIVE MEDICINE In 2000 Duke University Medical School (USA) built a first of its kind integrative medicine facility; approximately one third of American Medical Schools (including Harvard, Yale, Johns Hopkins and George Town Universities) now offer courses in integrative and alternative medicine. In Europe alone, there are nearly 300 000 practitioners who use integrative or alternative medicine.

HEALTH AND DISEASE ASSESSMENT AND TREATMENT Alt Med Care uses a six-step approach to health and disease assessment and treatment. Steps include conventional, complementary and advanced testing and technologies and therapies include conventional medicine, oxygen, heat, light, sound, frequency, magnetic, nutrition, enzyme, diet, exercise, pain, anti-aging, slimming, counseling therapy and sports performance enhancement.

TREATMENT PROGRAMMES The clinic offers conventional and standard medical treatments such as IV (Intravenous) therapy, nutritional therapy and specialised food supplements in addition to optional treatments and specialist referrals.

Complementary and alternative medicine treatments include: • magnetic therapy • audio-brain frequency and music therapy • pulsed magnetic frequency therapy • variable photonic (light) therapy (plasma therapy not laser therapy) • hyperthermal (heat) ozone therapy • far infrared therapy blanket • far infrared lamps (invisible rays) therapy • hyperbaric oxygen chamber

Tel: +27 12 991 1764/464 | Fax: 086 645 0668 Website: www.altmedcare.co.za | Email: Info@altmedcare.co.za ALT MED CARE CLINICS Satellite Clinic in Fourways, JHB

ALL PATIENTS WELCOME!

HEALTHY SLEEP

DON’T LET

sleeping

DOGS LIE

Images: Shutterstock and ©iStock.com/AlexLMX/Wavebreakmedia

f

Obstructive sleep apnoea is a potentially serious sleep disorder. Caryn Gootkin outlines the symptoms and treatment

orty-six-year-old Sarah* was snoring so badly that her husband couldn’t sleep next to her. “I thought it was just from being overweight. Eventually I saw an ENT, who sent me for a sleep test, and then a CPAP – I’d never heard of it before. I was having an average of 25 events of obstructive sleep apnoea every hour, which means that I stopped breathing almost every two minutes!”

The Oxford Dictionary defines an apnoea as a “temporary cessation of breathing, especially during sleep”. (Apnoea is a Greek word meaning “without breath”.) Obstructive sleep apnoea (OSA), the most common form of sleep apnoea, is a potentially serious sleep disorder in which breathing stops (usually for 10 seconds and more) and starts at intervals throughout the night. Sufferers can experience hundreds of apnoeas each night.

As we fall sleep, our throat muscles relax. In those with OSA, the soft tissue in the back of the throat relaxes to the point of collapse, partially or totally blocking

It appears that lifestyle measures alone cannot effectively treat the underlying problem.

the airways. This causes the sleeper to stop breathing, which then wakes them up (although they’re usually unaware they’ve been woken up), causing the airways to reopen. And so the Mariza van Wyk Dr Irshaad Ebrahim natural sleep cycle is interrupted. (Central sleep apnoea, a rare phenomenon, is caused by a neurological problem.)

“Several factors predispose one to OSA,” says Mariza van Wyk, PhD candidate and research neuropsychologist at UCT Sleep Sciences and Constantia Sleep Centre. “These include being male, overweight, over 40, having an increased collar size and/or a narrowed airway, alcohol consumption, and a history of smoking.”

However, while this describes the typical OSA patent, sleep apnoea affects both males and females of all ages and those of ideal weight, adds Dr Irshaad Ebrahim, specialist neuropsychiatrist in sleep disorders at the Constantia Sleep Centre. “A family history of sleep apnoea is also a prominent risk factor. Central sleep apnoea can be brought on by using certain painkillers and having a pre-existing heart condition.”

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SLEEP APNOEA AND SLEEPING TABLETS: A POTENTIALLY LETHAL COMBINATION

Alcohol, sleeping pills, antidepressants and smoking can increase the frequency and severity of apnoeas. “Sleeping tablets and other sedating substances like alcohol further relax the muscles in the airway, increasing the chances of the airway collapsing. This can be life-threatening for those who suffer from OSA,” says Dr Irshaad Ebrahim.

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HEALTHY SLEEP

Those who suffer from OSA will invariably snore loudly, be excessively sleepy during the day and nod off frequently. Their cognitive function may be impaired, leading to inability to concentrate and a bad memory. Their mood and personality may also change due to the reduction in their quality of life.

“A diagnosis of sleep apnoea is typically based on a thorough clinical history, in conjunction with a diagnostic sleep study, which can detect both the presence and severity of sleep apnoea,” notes Van Wyk. Some, like Sarah, do their sleep tests at home, while others attend a sleep clinic for observation. “We perform a study and thorough observation of your pattern of sleep, breathing, snoring, oxygen levels, heart rate and body movements during an overnight test in a dedicated sleep laboratory,” explains Anton Fourie of Fourie and Associates Clinical Technology Group, which runs three sleep clinics in Cape Town. “On board are a dedicated team of neurophysiologists and clinical technologists who oversee and perform the procedures.”

As certain lifestyle factors predispose you to OSA, it should follow that lifestyle interventions should be able to prevent or, at the very least, manage the condition. However, as important as it is to reduce weight, decrease alcohol consumption and be more active, it appears that lifestyle measures alone cannot effectively treat the underlying problem.

“Depending on the severity of the disorder, as well as daytime symptoms like sleepiness and fatigue, the healthcare professional might recommend bilevel or continuous positive airway pressure therapy,” says Ebrahim. Other interventions include oral appliances (also known as mandibular advancement splints) and surgery.

CPAP – continuous positive airway pressure therapy – is the most common and effective treatment. The CPAP machine is a bedside device that blows a gentle, constant stream of air into your airways, thus preventing your airways from collapsing. “This device is the ‘gold standard’ for treatment of OSA,” says Wayne CPAP machine Banfield of SleepNet, a 58 l H E A L T H Y T I M E S

company that sells equipment used for the treatment of OSA. “We programme each device to blow at a specific pressure throughout the night, according to the results obtained from your sleep study. APAP (Auto-adjusting Positive Airway Pressure) devices, which adjust the air pressure based on changes in the patient’s requirements and the level of relaxation of your airway, are slightly more expensive.”

“Since I’ve been sleeping attached to a CPAP machine, I’ve only had 0.6 events per hour, as opposed to the 25 I was having before,” says Sarah. “My husband sleeps next to me again – he can’t believe how quiet I am! Although I do look like a WWII pilot…”

SnoreMeds is a South African company that manufactures and distributes a mandibular device which works as a splint, by positioning and holding the lower jaw slightly forward during sleep. “By SnoreMeds doing this, the respiratory tract is widened, which enables air to flow unobstructed through the breathing passage, enabling the patient to breathe more freely and stop snoring,” says Michelle Hall-Jones, co-owner of SnoreMeds.

In a small percentage of patients with OSA, surgical and laser interventions have been necessary in cases where the airway is obstructed by an anatomical cause, such as enlarged tonsils or an elongated soft palate. *not her real name

Those who suffer from OSA will invariably snore loudly, be excessively sleepy during the day and nod off frequently.

SEE A DOCTOR If you have several of these symptoms, you should consult a medical practitioner to rule out sleep apnoea: • • • • • • • • • • • • •

Chronic fatigue; Falling asleep at inappropriate times of the day; Choking and gasping during sleep; Snoring; Restless and broken sleep; High blood pressure; Neck size greater than 42cm in men or 40cm in women; Excess weight; Depression; Trouble concentrating; Irritability; Forgetfulness; and Morning headaches.

Images: Supplied and ©iStock.com/vgajic/Wavebreakmedia

A DIAGNOSIS OF SLEEP APNOEA IS TYPICALLY BASED ON A THOROUGH CLINICAL HISTORY, IN CONJUNCTION WITH A DIAGNOSTIC SLEEP STUDY.

mom HEALTHY BABY

FIRST-TIME

Candice Tehini outlines what you need to know in your first year as a new mom

ONCE BABY ARRIVES

During your hospital stay, you will have nurses, experts and hospital staff advising you on how to bath, feed and care for your baby. Ask as many questions as you can, as you won’t have them on call once you’ve left the hospital.

When you are home with your baby, it’s a good idea to find a baby clinic that will help you monitor your baby’s growth and development, and answer any further questions. If you can afford to, you could think about hiring a breastfeeding consultant, who will visit you at home and help with any breastfeeding issues you’re experiencing.

You will visit the clinic once a week for the first six weeks, mostly to make sure your baby is gaining weight. “At these checks we monitor the weight, check the height and head circumference, and heart, hearing and eyesight. We also do milestone developmental checks and reflexes, and make sure the baby is doing what they should for the right ages,” says Liesel Turnbull, a registered nurse and midwife, and the owner of Bedfordview Mother and Baby Centre. “At six weeks we start with the vaccinations,” she says.

60 l H E A L T H Y T I M E S

VACCINES 101

While there’s no law saying you must vaccinate your child, it does help to protect your child and everybody else. There has been a resurgence of serious illnesses such as measles, because there are people choosing not to vaccinate their children.

Dr Simon Strachan, chairperson of the Vaccination Forum, explains that the government’s expanded programme on immunisation (EPI) vaccines are recommended according to the need of the country, and are available for free. These are done at six, 10 and 12 weeks. Vaccinations can also be done privately.

The private sector also recommends vaccinating against hepatitis A, chicken pox and MMR (measles, mumps and rubella). [Ed’s note: the government vaccinates against measles, but doesn’t administer the combination MMR vaccine.]

However, in light of the recent measles outbreak, it is recommended to have the measles vaccine at months six and 12, as opposed to months nine and 18, says Strachan, who also points out that the new measles vaccine cannot be given with any other vaccine.

(For a full vaccine schedule, visit www.paediatrician.co.za.)

Strachan does not recommend giving your child paracetamol before their vaccinations, as this may affect their efficacy. You may give it to them a few hours after their vaccination if they run a low-grade fever or are in pain, which happens in only 30%-40% of cases. He urges parents to contact the clinic if their child reacts badly to the vaccine, which he says may be less than 5% of children.

SOLID FOUNDATION

For the first four to six months, breast milk or formula provides your baby with all of the nourishment they need. From four, and not later than six, months, your baby will start solids.

Your baby clinic will generally advise you on when to start solids, but some cues are good head control, sitting well with a bit of support, and adequate weight gain.

Introduce one food at a time. Good foods to start off with are cereals, sweet potatoes, squash, apples, bananas, peaches and pears. If these foods are tolerated well, you can move on to more allergenic foods, such as eggs, peanut butter, fish, etc. Make sure it’s puréed well and contains no salt, sugar or butter.

For the first few feeds, your baby will need only a teaspoon or two of food after their milk.

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otherhood may be the best time of your life, but it’s also overwhelming – there are so many things you need to do, and also some that are “nice” to do. Here are some tips for keeping your baby healthy in your first year of motherhood.