U The Caribbean Health Digest - Issue 32

The Bittersweet Truth About Shisha All I was doing was inhaling and exhaling fruit-flavoured vapour, right? Wrong!

Worried about Your Child’s Weight?

As a parent, you have the best opportunity to influence your child’s current and future diet.

A fig is not a fig Do you think what Trinbagonians call a fig is really a fig?

Founders

Sherine Mungal Stuart Fraser

Publisher

Eidetic Publishing

Editorial Director

Sherine Mungal

Managing Editor

Roslyn Carrington

Writers

Our Intention candles are hand-poured purposefully crafted to inspire your senses.

We use blends of only one hundred percent pure therapeutic essential oils in combinations that have been researched and proven to soothe, calm and relax.

Assembled using all natural soy wax which are free for all toxins and wicks constructed from natural, cotton threads and contains no lead, zinc or other metals.

Healing Blend Lavender • Eucalyptus • Sage Purify your mind and body with the healing candle. The essential oils of lavender and refreshing eucalyptus soothe the body while reducing physical and mental fatigue. Combined with sage, the “sacred herb,” anxiety can be relieved and euphoria can ensue.

Detoxify, energize and release what doesn’t serve you any longer.

Prosperity Blend Cinnamon • Bergamot • Petitgrain The prosperity candle will release negativity to create and receive abundance with the aromatic blend of cinnamon, bergamot and petitgrain essential oils. This spicy blend is grounding and powerful to welcome success and a sense of stability.

Inspiration Blend Lavender • Spearmint • White Spruce Restore yourself to a place of restoration and calmness with the cooling floral blend found in the inspiration candle.

Combined with the essential oil of spearmint, this candle will revatilize your mind and body while increasing your energy and mental clarity. Let your creativity flow and be inspired.

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Gratitude Blend White Spruce • Rosewood A comforting blend of white spruce and rosewood essentials oils. The gratitude candle is a great gesture of giving thanks to someone special or to light when one wants to honor their blessings in their own life. Take a few moments every day to feel what you are most grateful for and it will shift your energy immediately to a place of peace and joy.

Creative Director Design Project Coordinator Traffic Photography

Medical Advisory

Michelle Ash Maia Hibben Fazal Mohammed Nasser Khan Carol Quash Tian Watson Dr. Claudette Mitchell Dr. Shivanand Ramdeen Karin Pierre Dixie-Ann Dickson David Fenton Stuart Fraser Eidetic Cindy Singh Lorraine Biran Shutterstock iStockPhoto Dr. Neil Singh

MBBS PG MSc

Healthy Blend Eucalyptus • Basil • Lemongrass These inviting smells of basil and refreshing orange will delight your sense of health and well-being. Feel confident in your healthy decisions in life to stay energized and focused with this invigorating blend of neroli, basil and lemongrass essential oils.

Clarity Blend Litsea Cubeba • Peppermint The cleansing fragrance of this clarity candle will clear your mind while stimulating and energizing your mood.

The essential oil of litsea cubeba, combined with refreshing peppermint oil will increase your concentration and help uncover solutions in times of fatigue or stress.

e: info@tortugahills.com

w: tortugahills.com

This information is of a general nature only and is not intended as a substitute for professional health advice and no person should act in reliance on any statement contained in the information provided and at all times should obtain s p e c i f i c a d v i c e f ro m a h e a l t h professional. Eidetic Publishing has made reasonable efforts to ensure that the health information contained herein is accurate and up to date. To the extent permitted by law, Eidetic Publishing, their employees, agents and advertisers accept no liability

(even if negligent) for any injury, loss or damage caused by reliance on any part of this information. U also contains information supplied by third parties.

This information is identified with the name of the source and has been chosen for publication because we believe it to be reliable. To the extent permitted by law, Eidetic Publishing, their employees, agents and advertisers accept no liability (even if negligent) for any injury, loss or damage caused by reliance on any part of this information.

U The Caribbean Health Digest is published 4 times a year by Eidetic Publishing, Gaston Court, Gaston Street, Lange Park, Chaguanas, Trinidad & Tobago. Distribution is handled by Eidetic Limited.

Entire contents are copyright.

Reproduction in part or whole is prohibited. Eidetic Publishing is in no way affiliated with companies or products covered in U. Produced and printed in Trinidad & Tobago.

16 Kidney Disease Understanding these incredible organs and how they work, we explore the kidneys in this, the first of a series of articles dedicated to kidney health and disease prevention, Maia Hibben chats with nephrologist Dr. Emile Mohammed and reveals more.

30 Scuba Diving – A Form of Therapy Johns Hopkins doctors have been researching scuba diving as a form of physical therapy for years. U writer and SCUBA instructor Tian Watson explores this, and reveals more in this article.

32 Making Changes To Your Meal Plans 22 The Best of All Facts and tips we all need to remember to approach each day with health and wellness in mind, shared with us by our friends from the Caribbean Cardiac Rehabilitation and Wellness Centre.

24 Pigeon Peas Here’s another Caribbean staple that finds its way in almost every kitchen, especially around the holiday season: pigeon peas. Packed with more protein than you would imagine, and high in fibre, you’ll surely want to make this a part of your diet.

26 Shisha Ever wonder why so many people are drawn to Shisha or Hookah? Well, apart from the fact that it’s the hottest craze right now, Shisha lounges and bars are popping up everywhere. Carol Quash explores some of the reasons behind its growing popularity, and, more importantly, the health risks associated with this habit.

Dr. Claudette Mitchell dissects what’s in a typical Caribbean kitchen and on our plates, and makes recommendations on how we can improve our dietary habits to lower our risk for disease while still enjoying the things we like.

38 A Fig Is Not A Fig For most Caribbean people, a banana is a fig, no matter the size, shape or colour. Even long after this article is published, and we clarify that a fig is really a completely different fruit and not even related any banana, we will still call it a fig, because it’s part of who we are. So this one is for simply for your reading pleasure. Enjoy!

43 E.Coli There are many strains of E.coli, and the ones that come to mind are the ones associated with food poisoning or diarrhoea. In this article, David Fenton highlights one of the rarer strains of E.coli, which results in serious outcomes like kidney damage for young children in a particular part of England.

Welcome to 2016 and to Issue 32.

Best wishes to you, our dear readers, for a year filled with prosperity and abundance throughout every level of your lives.

Despite our current economic climate here in Trinidad and Tobago, one thing for sure remains at the top of our list of priorities: our health and wellness. After all, we need our healthy bodies and minds to be at their optimum in order to power through this temporary interruption to what we consider the norm.

We remain positive and optimistic about the year ahead and reaffirm our commitment to bringing you enlightening news on the many ways you can combat and beat illnesses, disease and sickness and restore yourselves to the incredible human beings you were born to be.

Our remarkable team outdo themselves issue after issue, and here is another shinning example of their efforts. In this issue we feature the first of a series of articles on kidney disease, too extensive a subject to cover in only one piece, so you can look out for more discussions in the next three issues of U. Obesity in children, the dangers of E.coli, glaucoma and pigeon peas have all found a place in the first issue of 2016. And if those don’t spark your interest, the piece on the shisha craze will; many are astonished at the hidden dangers and risks behind the smoke screen.

This year, we are encouraging our readers to interact with us a little more, and ask more questions. Let us know what you would like to learn more about, and share your story about a health-related issue, or how you overcame an illness.

Who knows; maybe we can share them with our readers.

Keep reading, stay safe and be healthy.

SHERINE & STUART

FOUNDING EDITORS

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KIDS HEALTH

| A PRACTICAL GUIDE FOR PARENTS

A PRACTICAL GUIDE FOR PARENTS

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KIDS HEALTH

Worried about Your Child’s Weight?

{

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a practical guide for

parents WRITTEN BY

MICHELLE ASH, MPH, RD, PG Cert

Registered Dietitian

GLOBAL EATING HABITS HAVE DRAMATICALLY CHANGED, WITH A SHARP SHIFT AWAY FROM TRADITIONAL DIETS TO MORE WESTERNISED PATTERNS COMPRISING FOODS HIGH IN FAT, SALT AND ADDED SUGAR. MANY CHILDREN ARE HEAVIER THAN EVER BEFORE AND ARE FACING SERIOUS HEALTH RISKS THAT COULD LAST THEIR ENTIRE LIFE. AS A PARENT, YOU HAVE THE BEST OPPORTUNITY TO INFLUENCE YOUR CHILD’S CURRENT AND FUTURE DIET AND EXERCISE HABITS, FOR THE REST OF THEIR LIFETIME.

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KIDS HEALTH

| A PRACTICAL GUIDE FOR PARENTS

{ IS MY CHILD OVERWEIGHT? { Most parents are unable to tell if their child is overweight.

In the Caribbean, having a bit of “baby fat” is seen as normal and healthy for young children, but the health effects of being overweight are overlooked.

The weight status of your child can be assessed by a doctor, dietitian or nurse. Overweight refers to an individual that weighs more than the healthy range for his or her age, gender, and height. Obesity is characterised by an excessive accumulation of body fat; much more than the healthy range.

The National Obesity Observatory of Public Health England described some of the most common effects of childhood overweight and obesity: Obese children have a higher tendency to be sick and absent from school.

They are more likely to become obese adults, and have a higher risk of acquiring chronic diseases at an earlier age than compared to their parents. Some of these chronic conditions include Type 2 diabetes, sleep apnoea, asthma, and cardiovascular disease risk factors such as high cholesterol levels and high blood pressure.

They can often suffer from lower joint pain such as in the knees and ankles. Climbing stairs, and sometimes even walking, can leave an obese child breathless since increased weight creates a challenge for a little body to carry.

Teasing or bullying at school may lead to a child becoming isolated and lonely. They may withdraw from group activities at play time and other sports. This can commence a vicious cycle, leading to a decreased participation in physical activity and further negative impacts on weight status.

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While some consider being teased at school as a rite of passage, an overweight child can experience poor self-image and body dissatisfaction. This may cause sadness or depression and these effects can become particularly significant as the child reaches adolescence.

Poor self-image related to being overweight or obese can then lead to developing unhealthy food attitudes and practices, which in turn puts a child at high risk for developing eating disorders.

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IS DIETING TO LOSE WEIGHT RECOMMENDED FOR CHILDREN?

No. Most overweight children can benefit from being more active and eating a variety of wholesome and nutritious foods from all of the 6 Caribbean food groups every day. Many children do not need to reduce the number of calories. Kids need energy from a variety of healthy foods to keep their bodies growing properly. If the child is very overweight or obese, a medical team may need to advise the parent on how to reduce calories safely while still getting all the nutrients necessary for growth.

{PORTION CONTROL { Extra portions of food can lead to weight gain. Therefore, understanding portion sizes can be a good place to start.

Simply putting out as much food on your child's plate as he/she will eat is usually not a good idea.

If your child doesn't fill up using these portion sizes, you could always give more, but offer extra salad or lighter side dishes instead — especially if your child is overweight.

{MORE PORTION CONTROL TIPS { Plan ahead for home-cooked meals. Eating out should be only occasional, and in those instances choose child portions, small orders, or half orders. Never choose the “up-size” or “super-size”.

Buy only single-serving or bite-sized snacks.

Avoid letting your kids eat straight from a large bag of snacks or carton of ice cream, since they will likely eat much more than one serving. Repackage foods into single serving sizes.

A PRACTICAL GUIDE FOR PARENTS

Fried chicken & fries

If your child is two or older, and overweight, it is okay for them to drink low fat milk instead of full cream or full fat milk.

For healthy teeth and bone development, 2 to 8-year-olds are recommended to drink at least 2 cups of milk per day; those up to 13 years old, 3 cups of milk per day.

{READ THAT FOOD LABEL! { Learn to think in terms of standard serving sizes (the size stated at the back of a food package) and try to limit your child to single servings of foods.

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KIDS HEALTH

Oven baked Irish & sweet potato wedges, oven-fried fish, salad

{

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HELP YOUR CHILD DEVELOP HEALTHY ATTITUDES TOWARDS FOOD AND THEMSELVES

If you think that your child might be overweight or obese, do not mention it to them. Some children are very vulnerable and impressionable, and from a parent, such a conversation

FOR EXAMPLE: Many soft drinks or sodas are sold in 16 oz. bottles, but a single serving is just 8 oz. If your child drinks the whole bottle, he will get 250 calories; not the 125 calories in a single serving. This means that your child can gain 1 extra pound if he/she drinks one whole bottle of soda every day for two weeks!

NOTE:

There can be two, three, or even five servings in one pack, bottle or container!

can come across as shaming or even abusive. Seek advice from a professional.

Children mirror what they see. If they see you eating right and with a positive and accepting attitude towards their bodies and others — regardless of size — it will be easier for them to adopt these behaviours.

Do not put your child on restrictive “fad” diets. This is dangerous and can set a child up for an eating disorder.

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FOLLOW THE RED LIGHT, GREEN LIGHT PRINCIPLE

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This is about giving your child plenty of healthy alternatives rather than teaching what cannot be eaten. Teach your child how to make healthy food swaps in place of junk food.

EXAMPLE:

Compliment your child on his/her other attributes; such as their disposition; are they kind, thoughtful, et cetera. Are they good at backstroke swimming or have great problem-solving skills? Children should be taught that people are to be valued, regardless of their body size.

Make time for play every day. At least one hour of daily

INSTEAD OF THIS (STOP, RED LIGHT!)

TRY THIS (GO, GREEN LIGHT)

exercise is recommended for children.

Soft drinks and cola

Water, unsweetened 100% fruit juices, coconut water

engages in planned and fun physical activities that they

Lollipops and candy

Fresh fruit slices

Fried pies and pastries

Whole grain sandwiches with veggie/meat fillings

Encourage your child to join a group, club, or team that might like.

Many family activities don’t cost a lot. Take the time to schedule it into your everyday lives, for example, as family fun nights. Teach your kids to play games like hopscotch, that you learnt growing up. Do a “dance-off”. Go for an

Potato chips/crisps

Old fashioned popcorn, roasted nuts or fruit chows

after-dinner family stroll. Go outdoors to pull some weeds and do some gardening. Just keep moving!

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FEATURE

| KIDNEY DISEASE: WHY ARE THE KIDNEYS IMPORTANT, AND WHAT IS KIDNEY DISEASE?

KIDNEY DISEASE: WHY ARE THE KIDNEYS IMPORTANT, AND WHAT IS KIDNEY DISEASE?

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FEATURE

WHY ARE THE KIDNEYS IMPORTANT, AND WHAT IS KIDNEY DISEASE? WRITTEN BY

MAIA HIBBEN

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FEATURE

| KIDNEY DISEASE: WHY ARE THE KIDNEYS IMPORTANT, AND WHAT IS KIDNEY DISEASE?

The normal kidneys Your kidneys are two bean-shaped organs the size of your fist, which sit at the very bottom of your ribcage, on either side of your body. The kidneys are the body’s filtering system. Inside each kidney are a million filtering units called nephrons. These nephrons separate waste products and water from the blood, which is then concentrated into urine.

The urine is collected via a plumbing system that flows to the bladder, which stores the urine until you urinate. The kidneys normally make one to two litres per day, depending on how much you drink and how much excess fluids you lose, for example through sweating. The kidneys are essential and also help to: • Regulate water: For your body to work properly, it must contain the right amount of water, which is tightly controlled by the kidneys.

• Remove wastes: Many of the substances in the blood and body must be kept at the correct level for the body to function well. There are wastes such as urea, which is generated when the body breaks down and utilizes protein and creatinine, a waste product of the muscles, which must be removed, and this is done by the kidneys.

If these waste products are not removed sufficiently, they become toxic to the body.

• Regulate salts: When the kidneys ware working properly, excess salts and minerals such as sodium, potassium, calcium and phosphate are excreted from the body in the urine to keep the levels within the normal ranges for the body.

• Release hormones that regulate blood pressure: Normal kidneys make important chemical messengers called hormones which circulate in the bloodstream and regulate functions such as blood pressure. Any malfunction of these hormones can lead to high blood pressure.

• Control the production of red blood cells: The kidneys produce a hormone called erythropoietin, which stimulates the bone marrow to make blood. Any damage to the kidneys can lead to reduced production of these hormones and therefore a low blood count or anaemia.

• Produce an active form of vitamin D, which helps maintain strong, healthy bones.

What is kidney disease?

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Kidney disease describes a variety of diseases and disorders that affect the kidneys. Most of these diseases attack the filtering units of the kidneys, the nephrons. Damage to these units affect their ability to eliminate wastes and excess fluids. Damage to the kidneys can be acute, when the kidney fails rapidly over a short period of time, or chronic, where there is the gradual loss of kidney function. Chronic Kidney Disease (CKD) is defined as persistent damage for a period

of three months or more. It is almost always irreversible and progresses with time. If this happens, the body cannot expel the waste products it produces, and toxins and electrolytes build up in the body. However, our kidneys are silent workers and problems are often detected by accident during routine screenings — meaning that we may not feel seriously ill until the kidneys are significantly impaired. In other words, most people with kidney disease are not aware that their kidneys are damaged!

A misunderstood aspect of Chronic Kidney Disease (CKD) is that it has 5 stages, the last of which is stage 5, end-stage kidney disease or kidney failure, which requires dialysis and can be fatal. Most people equate kidney disease with kidney failure resulting in the need for dialysis, or even death. However, the majority of people with kidney damage have earlier stages of chronic kidney disease. If kidney disease is detected early, there are a number of preventative measures that can be taken to stablise kidney function, slow down its deterioration, and lower risk of more serious problems developing.

Who is at risk?

According to Dr Emile Mohammed, Consultant Nephrologist at Port of Spain General Hospital and Medical Director of the Caribbean Kidney and Dialysis Institute based at Westshore Medical, kidney disease is rapidly increasing globally, to epidemic proportions, and Trinidad and Tobago is no exception. In fact, regionally we suffer from greater levels of kidney disease than our neighbours and have significantly higher rates of kidney disease compared to developed countries. But why is this?

Dr Mohammed explained that there is now a wealth of evidence that points to strong links between cardiovascular disease (CVD) (i.e. heart disease, heart attack and strokes) and chronic kidney disease (CKD). Throughout the 20th Century it was observed that there was increasing mortality (deaths) due to cardiovascular disease in developed countries, and a landmark study known as the Framingham study (a longitudinal study which has been running since 1948) identified risk factors for cardiovascular disease, which include: • • • • • • •

Age (over 65) Diabetes Smoking Hypertension High cholesterol Obesity Certain ethnicities, such as Asians

But why is this of particular relevance for Trinidad and Tobago? Because, there are extremely high levels of hypertension, obesity and diabetes in T&T, as well as a diverse

KIDNEY DISEASE: WHY ARE THE KIDNEYS IMPORTANT, AND WHAT IS KIDNEY DISEASE?

genetic pool as a result of the varied ethnicities that make the people of T&T more susceptible to cardiovascular disease.

• 25% of the adult population is diabetic • 25% of the adult population is hypertensive • 50% of the adult population is overweight/obese (Estimates suggested by local data and Dr Mohammed) This data suggests that Trinbagonians are at increased risk for cardiovascular disease. What is not as well known is that these chronic non-communicable diseases also put you at high risk for chronic kidney disease, and further, that if you have chronic kidney disease you are at greater risk for cardiovascular disease.

So it would seem that having one puts you at risk for developing the other. Dr Mohammed highlights some worrying statistics: • Of the diabetic population in T&T, about 40% will have some stage of Chronic Kidney Disease (CKD).

• Of those with hypertension, about 25% will have CKD. • Of the obese population, about 25% will have CKD.

But why have Trinbagonians become such a risky population?

Over the last two generations there have been significant changes in lifestyle, such as less physically demanding jobs and more sedentary lifestyles — resulting in decreased fitness and increased weight; and changes in diet — with diets becoming less healthy and more processed, leading to greater levels of obesity, hypertension and diabetes. These environmental and lifestyle changes over a relatively short period of time have unmasked a genetic susceptibility to developing Chronic Kidney Disease, resulting in Trinbagonians having higher rates of CVS disease and CKD than their neighbours and the rest of the world.

So what are the specific risk factors for Chronic Kidney Disease?

• • • • • • • • • • •

Diabetes Hypertension (high blood pressure) Autoimmune diseases Urinary tract infections Urinary stones Family history of CKD Low birth weight Ethnicity Older age Smoking Obesity

Also unique to Trinidad (and the Caribbean) are higher rates and more severe presentations of other causes of kidney disease, such as lupus, prostate disease and urinary stone

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FEATURE

disease. Dr Mohammed’s observations and clinical work suggest that 20% of the population in T&T will have some form of kidney disease. That’s 1 in 5 – which is alarmingly high. So where are we at now in Trinidad and Tobago, and how do we start to address this epidemic of CKD? In Trinidad and Tobago the number of people on dialysis has risen from 287 in 2005 to 750 in 2015, yet this only represents less than half the number of people who should be on dialysis, given the large number of new patients that present each year for the first time needing renal replacement therapy. This number is about 450–500 patients each year in T&T. There are a number of contributing factors to this discrepancy, one important reason being insufficient medical infrastructure and volume of resources necessary to deal with the number of patients.

Dialysis has significant socioeconomic implications, regardless of whether you are a developed or developing country. In the developed countries, the average cost of dialysis is USD$57,000 per patient per year, in T&T the government allocates $144,000TT per patient per year (USD$22,800). With such a high-risk population, is enough being done to provide dialysis services, and indeed prevent kidney disease altogether?

Perhaps these worrying statistics have been the motivation behind the government’s commission of two new dialysis centres which are set to come on stream in the near future. In the meantime, kidney specialists like Dr Mohammed continue to serve kidney patients and raise public awareness about the lifestyle choices that can increase your risk of kidney disease.

As emphasised by Dr Mohammed, the real long-term solution lies in prevention, thereby reducing the number of people arriving at stage 5 or end-stage kidney disease, hence reducing the number of new patients needing dialysis each year. In the next issue, with Dr Mohammed’s expertise, we will continue to look at the treatment and prevention of kidney disease.

FOR FURTHER INFORMATION, CONTACT:

Dr. Emile Mohammed, Medical Director MB ChB (Aberdeen), FRCP (UK), CCST Nephrology and General Internal Medicine (UK) Caribbean Kidney and Dialysis Institute West Shore Medical Private Hospital 239 Western Main Road, Cocorite, Trinidad and Tobago, W.I. TEL: 1 (868) 622-2025 / 6528

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HEALTH

| THE BEST OF ALL

THE

BESTOF ALL WRITTEN BY FAZAL

Caribbean Cardiac Rehabilitation and Wellness Centre

HEALTHY BODY THROUGH EXERCISE If you’re slim, you can sometimes be fooled into thinking that you’re free from major diseases such as heart disease, diabetes, or stroke. Unfortunately, you can still be at risk. Your body is designed to remain healthy, regardless of size, shape or age.

While keeping slim would reduce your risk, there’s a difference between staying slim with and without exercise.

cosmetic problem; it's very much a health problem as well. You may be reading this because you’re obese, or have concerns about your physical appearance.

However, losing weight isn't just about looking good. It’s about feeling good, being healthy and living a meaningful, productive and comfortable life. Above all, it is about avoiding the terrible health consequences of carrying around excessive weight.

Overweight people are more likely to have high blood pressure, a major risk factor for heart disease and stroke. High levels of cholesterol and triglycerides (blood fats) can lead to heart disease, and are often linked to obesity. Being overweight also contributes to angina (chest pain caused by decreased oxygen to the heart) and sudden death from heart disease or stroke without any signs or symptoms.

First comes proper nutrition. You feed the body what it needs to grow, and then maintain it as it ages. Next comes exercise, the lowest cost for potent and natural “medicine”. Given the hustle and bustle of the world, we need to add a structured form of relaxation/meditation.

With all three components in the order presented, you will be on the road to good life and longevity.

HEALTH PROBLEMS ASSOCIATED WITH OBESITY If you’re overweight you are more likely to develop health problems such as heart disease, stroke, diabetes, certain types of cancer, gout (joint pain caused by excess uric acid), and gallbladder disease. Overweight can also cause problems such as sleep apnea (interrupted breathing during sleep) and osteoarthritis (wearing away of the joints).

HOW CAN YOU REDUCE THE RISK OF HEART DISEASE? The good news is that reducing your weight by 10% can decrease your risk of developing heart disease by improving how your heart works, reducing your blood pressure, and reducing the levels of blood cholesterol and triglycerides.

WATCHING YOUR WEIGHT – OBESITY Now that we understand the importance of exercise, let’s focus on obesity. An obese body places you at higher risk of ill health. Obesity isn't just a

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MOHAMMED

BEING OVERWEIGHT IS A RISK TO YOUR HEART Heart disease and stroke are the leading causes of death and disability for both men and women in the western world.

WEIGHT LOSS MADE VERY SIMPLE: EAT LESS, EXERCISE MORE In order to lose weight, you need to eat fewer calories per day than your body needs. To lose one pound a week, you need a negative calorie balance of approximately 500 calories per day. If you’re overweight and don’t exercise, you’re at an

THE BEST OF ALL

increased risk of having a heart attack or stroke. Think about it: if you continue eating the same foods, including snacks, etc., and do nothing more than your present daily activities, don’t expect to lose weight. In fact, you would most certainly continue to gain weight.

However, by simply cutting back on your calories, with some exercise, you could make great changes that could only signal a healthier body.

EXERCISE CAN BE FUN Physical activity gives you a chance to unwind, enjoy the outdoors, or simply engage in activities that make you happy. It can help you connect with family or friends in a fun social setting.

So, take a dance class, hit the hiking trails or join a soccer team. Find what you enjoy, and just do it. If you get bored, try something new. Some may find exercise boring, but which is better? Enjoying the nice foods without exercise and end up “popping pills” for the rest of your life, and running a higher risk of ending up in the

emergency room, or eating moderately with exercise, and enjoy a higher quality of life?

EXERCISE, EXERCISE, AND MORE EXERCISE...

Sustained, high-intensity exercise makes you burn more calories for several hours afterwards.

Examples are thirty-minute sessions of heart-rate-raising exercise, such as vigorous walking, step aerobics, jogging or swimming, 3-4 times a week.

BEFORE YOU BEGIN… Get clearance from your doctor before starting an exercise program; better yet, go to your wellness, cardiac pre-habilitation or cardiac rehabilitation facility for a proper assessment. Do some homework: Search online for these terms. See if this can be of some value to you, family members and friends.

EXERCISE TIPS Stretch before you begin any exercise. Stretching all mayor muscle groups should take from five to ten minutes. The type of

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HEALTH

stretch should be “static stretch” (gradually lengthening the muscle) for major muscles. Do a slow count from 1 to 10 while always maintaining a good breathing pattern. Never hold your breath during any sort of physical activities.

UNDERSTANDING BASIC REPS AND SETS TERMINOLOGY “Reps” is short for repetitions – the number of times you perform a specific range of motion or exercise. For example, “eight sit-ups” means, do eight reps of sit-ups and then rest.

“Sets” – the number of times you repeat that exercise for the set number of reps. Eight reps of sit-ups and rest is called one set.

WALKING Start walking slowly, and gradually move to brisk walking with normal arm swings for the first week, 10 to 20 minutes per session, aiming for 45 to 60 minutes per session. You should have a minimum of one session per day, three to five days per week.

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LEGUMES

| PIGEON PEAS

WRITTEN BY NASSER

KHAN

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THE PHRASE “…LIKE PEAS” NO DOUBT COMES FROM THIS SEASON OF ABUNDANCE, WHEN TRAYS OF VANS ALONG THE HIGHWAYS AND MARKET VENDORS’ STALLS OVERFLOW WITH THIS EASY-TO-GROW LEGUME (SEED IN A POD). THE POPULAR PIGEON PEAS: AN ESSENTIAL INGREDIENT IN A DELICIOUS PELAU AND A MUST IN ANY GOOD CARIBBEAN LIME.

PIGEON PEAS

P

igeon peas are easy to grow. They tolerate most soils and can survive with limited water. The mature tree can take up a good bit of space and should be spaced about four feet from any property line or fence to permit easy picking from all sides. With proper care (well-drained soil and a monthly fertilization regime with red (12-24-12) salt, you can get two pickings from each tree. This is a slow-bearing crop; commonly used varieties require farmers to plant in the June/July months. These take 6–9 months to bear. The plant usually lasts about five years and reaches a height of 1–2 metres. It possesses a very deep and fast-growing tap root system that facilitates the characteristic drought-tolerant features of this crop. Pigeon peas are short-day crops; they need a shorter period of light exposure (12 hrs) and longer dark hours to promote the initiation of flowering … they are photoperiodic plants.

They are thus confined to flowering and production during the three-month span at the end of the calendar year. This explains the tradition of having fresh pigeon peas available in the market around Christmas time through to March.

For the backyard garden, planting the crop is simple, but harvesting, although considered time-consuming by some, can actually be an enjoyable family activity.

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LEGUMES

Traditionally, children would sit and watch TV while shelling peas, leaving fingers stained with the tannins from the pods. Finding ‘two-coloured’ peas was often a competition during this common pastime in many Trinbagonian households. After shelling, the peas are sometimes soaked in water for a couple hours, a process that contributes to shorter cooking time for the peas. The whole pea, the split pea and the naked split pea (seed coat removed) are used in a variety of dishes, including pelau, curried pigeon peas and potato, soup, cupcakes, roti, cakes, sweetbread, pastries, bread, muffins, pizza, pies, patties, cookies, ice cream(!), lasagne, accra, pholourie, punch, and even wine.

UWI has a long history with pigeon pea research, from its early days as the Imperial College for Tropical Agriculture (ICTA) in Trinidad. This breeding work, initiated over 80 years ago, sought to address some of the issues plaguing successful, large-scale production of the crop. In the past 5 years, researchers have identified a few locally generated varieties that can be planted throughout the year, with many favourable characteristics for both the farmer and the consumer, all with expected yields in 3–4 months. CARDI also undertook research into varieties that could be used for dhal. These varieties yielded a sweeter tasting dhal by de-husking and splitting the dried seeds.

The peas are an important source of macronutrients and minerals:

Values per 100 grams Calcium Iron Potassium Sodium

Zinc

Thiamine

Pigeon Pea – Whole seeds, dry

130

5.2

1392

17

2.8

3

0.64

0.19

3

0

– Fresh, green

42

1.6

552

5

14

0.4

0.17

2.2

39

Pigeon peas is a pulse food, and, as such, is high in fibre, containing almost twice the amount of protein found in cereal grains. Pulses are generally low in fat and have a low glycaemic index, properties that make them an essential food group to persons dealing with diabetes.

For home storage, it is recommended that fresh shelled peas be first blanched (this stops all enzyme activity) before freezing. This also retains flavour and vitamins/ nutrients, as opposed to just freezing.

Riboflavin Niacin

Folacin Vit C

Since pigeon peas are quick to cook and require very little preparation, many chefs favour it as one of the main vegetables of any dish they create. A popular Old Year’s Day traditional dish is pelau, with many choosing pigeon peas instead of black-eyed peas. Whichever peas are used, pelau is a complete meal in one pot which is satisfying and nourishing.

Other than their many culinary uses, the pigeon pea is used in some traditional Indian and Asian medicine practices to treat stomach problems or even cancer, and can quell swelling of the internal organs.

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HEALTH

| THE BITTERSWEET TRUTH ABOUT SHISHA

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WRITTEN BY CAROL

QUASH

THE BITTERSWEET TRUTH ABOUT SHISHA

O

nce, when I was a teenager, I lit a cigarette for my uncle, and coughed for hours afterward.

Although I grew up in a family where cigarette smoking was the norm for many members, it was not a habit I ever chose to embrace. As far as I am concerned, it poses too many health risks, is a way too expensive a habit to indulge, and frankly it stinks — literally! No offence to my smoking family members and friends.

Last year, just out of curiosity, and with the encouragement of my sister, I tried shisha. I was hesitant at first, but eventually I placed my mouth on the mouthpiece and slowly began inhaling the sweet taste of the shisha tobacco. It was no glass of wine, but I enjoyed it. That apple cinnamon vapour sure did hit a spot and I felt as exhilarated and sophisticated as the flamboyant Samantha (Kim Cattrall) on the Sex and the City 2 movie, when she had her shisha smoking experience on a beach in Abu Dhabi. Besides, it posed no health risk, not like cigarettes, or so I was told. How could it? All I was doing was inhaling and exhaling fruit-flavoured vapour, right? Wrong!

My research, some time after the fact, revealed that shisha is the traditional name for tobacco that has been soaked in honey or molasses, and mixed with fruit pulp or dried fruit. It comes in a variety of flavours and is smoked in a hookah – a type of water pipe that propels charcoal-heated air through a tobacco mixture, then through a water-filled chamber, and subsequently through a pipe that allows shisha smokers to inhale the flavoured vapour. The practice is sometimes referred as smoking shisha or hookah smoking.

"Most shisha smokers are unaware of the health risks involved," observes Associate Professor Loo Chian Min, Senior Consultant and Head, Department of Respiratory & Critical Care Medicine, Singapore General Hospital (SGH). "Some youths don't even realise that there's tobacco involved, and so

they don't regard shisha as smoking."

Meanwhile, further research on the subject led me to the World Health Organisation (WHO) website, which revealed that, "The volume of smoke inhaled in an hour-long shisha session is estimated to be the equivalent of smoking between 100 and 200 cigarettes.

The estimated findings go on to show that, on average, a smoker will inhale half a litre of smoke per cigarette, while a shisha smoker can take in anything from just under a sixth of a litre to a litre of smoke per inhale." This, added to the fact that experts at the London-based Department of Health and the Tobacco Control Collaborating Centre reported that "one session of smoking shisha resulted in carbon monoxide levels spiking to at least four times more than the amount produced by one cigarette," alarmed me considerably. My shisha session had lasted approximately three quarters of an hour.

Shisha smoking is a centuries-old tradition, and has its roots in Persia and India. Today, it has become a popular leisure activity, with hookah cafes popping up in many countries around the world, more popularly in Middle Eastern countries and the United Kingdom.

So, how exactly does it work? Shisha smokers take pleasure in slowly and deeply inhaling the fruit-flavoured tobacco smoke through the hookah mouthpiece. The smoke that passes through a water chamber of the hookah pipe emanates from the tobacco, which is wrapped in aluminium foil and roasted with charcoal.

According to the Niche Tobacco Advisory Group (NTAG) chairman in Manchester, United Kingdom, Dr Khalid Anis, many people, like me, are fooled into thinking that the flavour in the tobacco makes it safer than cigarette smoking. "There's a misconception that shisha is not as bad for you as cigarettes, because the tobacco is flavoured and passes through water first. But the carcinogens and nicotine are still there. So a regular shisha smoker can expect to be at risk to the similar health problems that cigarette smokers face, whether that's respiratory, heart disease or

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HEALTH

cancer. As with any other tobacco product, I expect regular shisha smokers will find it addictive, to the point that they may need it every day," Dr Anis tells theguradian.com Additionally, studies have revealed that the toxin benzene is found in the fumes from the water pipes of the hookah. "Benzene has been linked to an increased risk for leukaemia in prior research," a scientific team, headed by Nada Kassem, Associate Director of the Center for Behavioral Epidemiology and Community Health at San Diego State University, reported in an issue of the journal Cancer Epidemiology, Biomarkers & Prevention.

And much like its life-threatening counterpart — the cigarette — shisha smoking can also have negative effects on non-shisha smoking bystanders. "In addition to inhaling toxicants and carcinogens found in the hookah tobacco smoke, hookah smokers and non-smokers who socialize with hookah smokers also inhale large quantities of charcoal combustion-generated toxic and carcinogenic emissions. In contrast to what is believed, hookah tobacco smoking is not a safe alternative to smoking other forms of tobacco," Nada Kassem tells webmd.com.

And even if you can ignore all of the above reasons why smoking shisha is bad for you, just consider that if you are hookah smoking in a group, as is usually the case, you will be sharing mouthpieces without washing them – thereby increasing the risk of spreading or contracting flus, colds, infections, and even more impactful diseases such as tuberculosis and oral herpes.

Of course, there are some researchers who insist that some of the results of these studies on the negative effects of smoking shisha are not entirely true, and that research on the subject is ongoing. For me, though, the fact that they are even partially true speaks for itself.

So will be I be smoking shisha again any time soon? Let's just say that the only fruit flavoured aroma I will ever be inhaling will come from scented candles. My shisha experience, like my cigarette smoking experience, will be just a one-time thing. Well, at least I can say, 'been there done that'.

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GLAUCOMA AND TRABECTOME

|

EDITORIAL

GLAUCOMA AND TRABECTOME MINIMALLY INVASIVE GLAUCOMA SURGERY WRITTEN BY DR.

SHIVANAND RAMDEEN FRCS AND DR. TRISHANA KRISTA RAMLAL MBBS

G

laucoma is an optic nerve disease usually associated with increased intraocular pressure (IOP). If not properly managed, glaucoma may lead to blindness. There is a high incidence of glaucoma in the Caribbean population. It mainly affects persons of Afro-Caribbean descent, and to a lesser extent persons of Indo-Caribbean descent. The Barbados eye study showed a prevalence of 12% at 60 years old or over, with a higher preponderance in males.

Glaucoma must be diagnosed and treated by a qualified ophthalmologist. Several confirmatory tests may be done, including IOP measurements, pachymetry and visual field testing. Glaucoma may be managed with medical therapy, the backbone of which is drop therapy. If there is failure to maintain adequate control with medications, laser or surgery may be undertaken.

Trabectome has a low complication rate, as indicated by both local and international studies.

Additionally, it is appropriate for patients who are poorly compliant with medical management. It provides an economic benefit in the long term due to the associated decrease in drop requirement. Patients experience better control of IOP post procedure. Further, due to the decreased drop requirement, there is decreased drug toxicity to the surface of the eye and decreased interactions with other medications.

Several surgical procedures are available. These range from minimally invasive surgery to complex procedures involving valves, shunts and filtration surgery.

Trabectome surgery can be performed as a single surgery without cataract removal, but it is more often combined with phacoemulsification. Phacoemulsification is a type of cataract extraction in which ultrasound energy is used to liquefy the lens. Combining Trabectome with cataract extraction adds minimal risk to the procedure. A local study showed a decrease in IOP by 27.3% after combined phacoemulsification and Trabectome. The procedure was shown to be successful in 73.2% of patients, and decreased drop requirement by 88%.

Trabectome is a minimally invasive glaucoma surgery.

The Trabectome removes a section of the drainage area of the eye through a very small incision. This promotes a decrease in IOP.

There is easy after-care for patients. Antibiotic drops must be used for a short period after surgery and, in some patients, glaucoma drops may be decreased or discontinued entirely post-surgery.

Trabectome is a fast procedure that can be done under local anaesthetic. It has been shown in several international studies to decrease IOP by 26%.

In conclusion, Trabectome surgery is a safe and effective means of management of glaucoma and has been shown to have multiple benefits.

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THERAPY

| SCUBA DIVING AS A FORM OF THERAPY

SCUBA DIVING AS A FORM OF

THERAPY WRITTEN BY TIAN

WATSON

PADI Open Water Scuba Instructor Coolblue Diving – SCUBA Diving Tours and Instruction

The sea, once it casts its spell, holds one in its net of wonder forever.

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- Jacques Cousteau

Experiencing any form of physical injury or mental trauma can have a multitude of negative impacts on a person’s life. Depending on the nature of the injury, there are a wide range of therapies and rehabilitations being practiced today. Recently, SCUBA diving has been explored to potentially be added to this list. SCUBA, the acronym for Self-Contained Underwater Breathing Apparatus, is an internationally growing recreational sport. This sport is also steadily gaining popularity in our region.

SCUBA DIVING AS A FORM OF THERAPY

THE IDEAL FOUNDATION FOR A STEADY RECOVERY Like any other sport, there is variety in the type, level and intensity in which one may participate in SCUBA diving. This being said, it is an activity which can be tailored to address the needs of an individual experiencing physical and/or mental challenges in life.

First of all, the very nature of the sport, i.e. plunging into the underwater world, offers an inimitable atmosphere which can be deemed very therapeutic. Most unique of all, is the fact that it is almost impossible to simulate on land.

Secondly, most of us may be familiar with aqua therapy, which is based on the principle of being submerged in water and consequently promoting relief from physical pain.

This allows injured persons to engage in physical activity in a more relaxed and controlled manner. This concept can also be directly applied to SCUBA diving.

These attributes of SCUBA diving could quite likely lead to patients being more focused, which in turn could lead them to a greater sense of accomplishment.

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THERAPY

Dr. Adam Kaplin, MD, PhD, an assistant professor at the Johns Hopkins University School of Medicine and one of the main researchers on the project, presented the results of this pilot study during the Paralyzed Veterans of America 2011 Summit and Expo. He and his co-researcher, Dr. Daniel Becker of Kennedy Krieger Institute, concluded that out of the veterans selected, eight of them experienced improvement in the following areas of observation: • Reduction in muscle spasticity • Increased light touch sensitivity • Increased sensitivity to pinpricks • Decreased symptoms of obsessive-compulsive disorder and • Strikingly decreased symptoms of post-traumatic stress disorder Cody Unser, who himself was paralyzed in 1999, commented on the study as follows: "I am grateful to the doctors who listened to our plea to study the effects of SCUBA, to research the science, and take the time to see it first-hand in the Cayman Islands, some of the best diving waters in the world.

We have known for quite some time that SCUBA benefits people with paralysis through movement in a neutrally buoyant environment, not to mention the empowerment and confidence realized by delving into Cayman’s clear Caribbean waters.”

MORE SOCIAL INTERACTION Persons with physical or mental challenges could have a tendency to become socially detached as they try to cope with life’s new daily challenges. This can undoubtedly affect personal relationships as well as those in the workplace and the wider society. The very nature of SCUBA diving can help patients in this regard. This is so because any SCUBA activity is always done at least with a dive ‘buddy’, and more often than not with larger groups. This will encourage interaction, connections and relationships.

STUDIES CONDUCTED IN THE FIELD In 2011 a six-week study was commissioned by the Cody Unser First Step Foundation (CUFSF) to explore the healing properties of SCUBA diving. This study was done in partnership with Johns Hopkins University School of Medicine, the International Centre for Spinal Cord Injury (Kennedy Krieger Institute) and the Professional Association of Diving Instructors (PADI). The study explored the neurological and psychological effects of SCUBA diving on people with and without disabilities. In short, for the study, ten paralyzed war veterans, Paralympics athletes, along with accomplished spinal cord injury researchers, were given Open Water Diving instruction.

Al Kovach Jr., Paralyzed Veterans of America Senior Vice President, participated in this pilot study. Al Kovach Jr. is a former Navy SEAL and is paralyzed from his chest down and experiences muscle spasticity daily. He spoke very favourably after the study and stated: “My spasticity had dropped almost entirely.”

Mr. Kovach describes the ‘rush’ he experiences during and immediately after a dive as comparable to the sense of accomplishment he experienced during his military career. His muscle spasticity, however, returned to its previous level soon after the study. He however still holds the opinion that “The psychological impact was greater than the physical impact.... I felt a huge sense of accomplishment upon coming to the surface.”

Though the above results and findings are impressive, Kaplin and Becker are quite aware that these results are preliminary and not conclusive. This study nonetheless leaves the door open for continued research in this arena, and perhaps eventually conclusive links will be found between our captivating underwater world and the healing properties it may hold for mankind.

If you or anyone you know has experienced a life-changing injury or trauma, perhaps rehabilitation that incorporates SCUBA diving can be explored by your doctor or therapist.

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HEALTHY EATING

| MAKING CHANGES IN YOUR MEAL PLAN

MAKING CHANGES IN YOUR MEAL PLAN

|

HEALTHY EATING

Meal Plan WRITTEN BY DR.

CLAUDETTE MITCHELL, Ph.D., RD

Assistant Professor, University of the Southern Caribbean, School of Education and Humanities

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HEALTHY EATING

| MAKING CHANGES IN YOUR MEAL PLAN

A

s

Caribbean nationals, we are quite unique and can be defined not only by our cultural heritage, but also dietary habits and lifestyle practices. Typical meals such as breakfast, lunch, and supper are comprised of foods from the Caribbean Food Groups such as staples, legumes, foods from animals, vegetables, fruits, and fats and oils. Though the foods from these various groups are nutritious, the amount consumed at any given time, portion sizes, and how the foods are prepared and served are essential points as it relates to an individual’s dietary intake, which overall may impact nutritional status.

You should also note that some foods in the region are known by different names, e.g. the fruit “pomerac” in Trinidad and Tobago is also referred to as “French cashew, or Malay apple.” Keeping in mind that though the fruit may be referred to differently, the nutritive value is the same. However, the important point here is that having knowledge of food and nutrition may aid in selecting nutritious local produce and planning balanced meals to maintain health. The focus of this article is to take a look at our dietary practices.

WHAT’S ON YOUR PLATE?

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Beginning with breakfast, several food items such as seasonal fruit, porridge (e.g. cornmeal, tannia log, cream of wheat, oatmeal); breadstuff or starchy food (which may include fried bake, coconut bake, crackers, sada roti, bread, and fried ground provision pieces); protein dish (e.g. cheese slices, peanut butter, omelette, saltfish buljol, fish cakes, scrambled egg or tofu pieces); and a hot or cold beverage can be consumed. At lunchtime, it is not unusual to observe on a plate large quantities of starchy dishes (such as macaroni pie, potato salad, fried rice, ground provision and starchy fruits, e.g. green banana, plantain, bluggoe (a type of plantain), and breadfruit); stew meat or chicken, fried

fish with gravy, stew peas and beans; and a rather small amount of vegetables, be they raw or cooked. For supper, some persons may choose to consume leftovers from lunch or perhaps add to the menu vegetable soup, hops bread with cheese slices, stir-fried veggies with sausage, lettuce and tomato salad, yogurt and fruit.

Overall, similar foods are used throughout the Caribbean region, and different islands prepare various favourite local dishes in creative ways. The common methods of cooking mainly used in food preparation include frying, stewing, baking, boiling, and steaming. In addition, desserts such as sweet potato or cassava pone, coconut ice cream, cake, sweet bread or sweet bun, coconut drops, currant rolls, jam tarts, and coconut turnovers, along with sweets such as fudge, guava cheese, tamarind ball, sugar cake, tooloom, and other home-made sweets, usually have a place on the menu. Beverages such as orange drink, lemon or lime cooler, and other sweetened beverages are served.

Following this brief overview, one might conclude from a cultural perspective that a large amount of the calories are provided through the starchy and high fat food choices, a protein dish, and sugary drinks, whereas dietary intakes of vegetables and fruits appear to be somewhat low. Also, a greater consumption of foods rich in carbohydrate, fat and protein, and low in vitamins, minerals, and dietary fibre over a period of time can probably result in weight gain and nutrient deficiencies. Therefore, to make a quick change to your plate, one half should consist of vegetables and fruit, and the other half of a quarter of starchy food, and a quarter of protein dish.

A BRIEF OVERVIEW… Currently in Latin America and the Caribbean, chronic non-communicable diseases (heart disease, cancer, diabetes mellitus, and stroke) are the main cause of premature mortality; meaning that these aforementioned diseases account for approximately half of all deaths of persons under 70 years, and two out of three deaths overall. The

MAKING CHANGES IN YOUR MEAL PLAN

contributing modifiable biological factors are unhealthy diet (high in fat, sugar, and salt), high blood pressure, obesity, elevated blood sugar and cholesterol levels, and physical inactivity. Similarly, in Trinidad and Tobago the chronic non-communicable diseases such as cardiovascular disease, malignant neoplasms, diabetes mellitus, and cerebrovascular disease are leading causes of death, contributing to approximately 60% of all deaths on theisland, with the distribution mortality of 24.6%, 13.7%, 13.6%, and 9.0%, respectively. This, of course, impacts the region negatively, and the human and economic cost of these diseases cannot be sustained, and are more than likely to undermine development in the region (Healthy Caribbean Coalition & Ministry of Health, 2011).

In a study conducted in Barbados, Sharma et al. (2008) documented that the shift in dietary practices in the Caribbean to a much more unhealthy diet, including higher intakes of fat, sugar, and energy-dense foods, and/or more fast foods, might have contributed to disease. Ramdath et al (2011) supported this view; in a similar study, they found that respondents reported lower dietary intakes for fruits and vegetables in comparison to the consumption of sweetened fruit beverages and carbonated drinks. Also, Xureb et al. (2001) stated that as developing countries emerge from poverty, there tend to be increases in obesity.

Perhaps the result observed can be due to changes in standard of living affecting food choices; as affluence increases and poverty declines within the territories, there is a rise in overweight and obesity, particularly as low income groups improve their income and purchase high fat/high carbohydrate energy-dense foods, while decreasing consumption of grains, fruits, and vegetables.

Moreover, from the review of the literature, the dietary practices of persons can probably account for the chronic non-communicable diseases. Therefore, members of households, communities, colleagues, educators, and church

|

HEALTHY EATING

associates should work together to encourage the selection of healthy foods and participation in physical activity to promote health and wellness.

TAKING SMALL STEPS… The steps which you take to improve your dietary habits today might lower your potential risk for disease. You may wish to consider the following points: • Choose nutritious foods from the Caribbean Food Groups for meals and snacks; incorporating ground provision, grains, legumes, lean meats, fish, poultry, fruits, vegetables, and nuts and seeds.

• Plan well-balanced meals.

• Eat fried foods sparingly.

• Limit concentrated sweets and sugary drinks.

• Drink water in plain or flavoured form. The recommendation: 6 to 8 glasses per day.

• Watch your portion sizes.

• Cut down on your salt intake; use fresh seasonings, e.g. chives, onion, garlic, celery, pimentos, thyme, shado beni, etc. Omit onion salt, garlic salt, celery salt, and other seasoning salt in meal preparation. Buy crackers, nuts and seeds and snacks that are unsalted or lightly salted.

• Avoid processed meats.

• Purchase fresh or frozen vegetables and dried peas and beans, instead of canned products; if you buy canned goods, be sure to drain the liquid and rinse the contents thoroughly under running water before cooking.

• When grocery shopping, take time to read the food labels.

• Prepare foods using the methods of cooking e.g. baking, boiling, steaming, grilling, and stewing.

• Manage your weight.

• Participate regularly in physical activity; if you have not exercised before, first talk with your medical doctor and follow their advice.

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THE NURSING COUNCIL OF TRINIDAD AND TOBAGO

|

EDITORIAL

Role and Function WRITTEN BY MS.

KARIN PIERRE, Registered Nurse (R.N), Licensed Midwife (L.M), B.Sc., Diploma Public Administration

M.A Nursing Education

The Nursing Council of Trinidad and Tobago was established in June 1950 by the Nurses and Midwives Registration Ordinance, which has since been repealed and continued under the Nurses and Midwives Registration Act Chapter 29:53. The Act was amended in 1963, 1966, 1970, 2005 and most recently 2014 (Sept).

The Nursing Council of Trinidad and Tobago is the recognized body incorporated by law for the regulation of nursing and midwifery professions and the protection of the public.

The regulation of the nursing and midwifery professions means that standards and rules are in place under specific legislation that governs the professions. The standards are established to govern education training, performance and ethical conduct of the nurse and midwife.

Standards enunciate the principles of minimal good practice required by the nurse and/or midwife, and form the basis by which performance can be evaluated.

Nurses and midwives hold a position of trust and responsibility and are accountable for their actions directly or through delegation to the Council and the law, in accordance with the Nurses and Midwives Registration Act, and contractually to their employers

through respective policy guidelines.

The Mission of the Nursing Council of Trinidad and Tobago (NCTT) is to safeguard the public interest by regulating the professions of nursing and midwifery through its legal obligations for registration, enrolment and disciplining of nursing and midwifery practicing locally; establishing and monitoring standards of nursing and midwifery education, and maintaining the integrity of the profession.

FUNCTIONS OF THE COUNCIL • Open and maintain the registers or rolls required under this Act • Register, enrol, certify or license nursing personnel under this Act • Set standards for education and practice of nursing personnel • Develop a Code of Ethics and Conduct for nursing personnel • Monitor the adherence to standards and the code of ethics and conduct • Determine in collaboration with the Minister the qualifications necessary for registration, enrolment, and certification or licensing of nursing personnel The Nursing Council also has powers in accordance with the Act. Some of these powers are: • Register or enrol nursing personnel • Issue certificates or licenses to

nursing personnel • Set standards for education and practice of nursing and midwifery • Verify the authenticity of certificates and other documents in support of applications under this Act • Collect fees required to be paid under this Act SERVICES OFFERED BY NCTT • Advises on professional standards and regulatory matters related to nursing and midwifery • Governs the training of nurses, midwives, and nursing assistants • Maintains a register of nurses and midwives • Maintains a register of student nurses and pupil midwives • Maintains a roll for nursing assistants and trainees • Processes applications for the registration of nurses and the enrolment of nursing assistants trained locally and abroad • Issues permits to applicants for entry to approved training institutions for nursing • Processes application for students from abroad requesting elective placement locally Ref: Nurses and Midwives Registration Act No. 8 of 2014 e-mail: thesecretary@ttnursingcouncil.org

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FRUIT

| A FIG IS NOT A FIG

a fig is not a fig

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WRITTEN BY DIXIE-ANN

DICKSON

A FIG IS NOT A FIG

What is a fig?

Do you think what Trinbagonians call a fig is really a fig? Well, let’s see. I asked several people what is a fig to determine if I would get the same answer. These were the following responses: Cindy: It’s a banana, a small fat banana like the Sikyé.

Roger: A small mini-type banana. It’s a cousin to the banana.

Denise: The small mini-size bananas, as well as the green ones we cook.

The responses are quite similar. It is clear that everyone shares the same view that more or less a fig is a small banana. This is really not a surprise, because as Trinbagonians we share the same culture, even though sometimes our geographical location may influence us differently.

So I asked another person, Tom, who lives in Trinidad, but is a native of Barbados. Tom said there are different types of fig: silk fig, Sikyé fig and the green fig. Apparently, most Caribbean islands call certain types of bananas fig, just like Trinidad and Tobago.

Tom further stated that there is a scientific name for banana, which is Cavendish. The article, “Benefiting Bananas” by Donstan Bonn, states that the Cavendish is the first of several types of banana to be grown. Notice I said “banana” and not “fig”. The Cavendish accounts for 99 percent of international consumption, with the United Kingdom being the largest consumer.

There are different types of Cavendish, which include some of Trinidad’s popular varieties, namely the Gros Michel, Lacatan, Sikyé, and silk.

According to Puurdue University (https://hort.purdue.edu/newcrop/morto n/banana.html), the Gros Michel was brought to Jamaica from Martinique in 1820, and was then taken to Fiji, Nicaragua, Hawaii and Australia, in that sequence.

The University describes it as a tall plant bearing long bunches of large, yellow fruits, and it was formerly the leading commercial cultivar in Central Africa, Latin America and the Caribbean.

The University also stated that the silk banana, popularly known as the silk fig, is also referred to as 'Manzana' in Spanish.

It’s the most popular dessert banana of the tropics. The plump bananas are 4” to 6” (10–15 cm) long, slightly curved; astringent when unripe, but pleasantly sub-acid when fully ripe; and apple-scented.

So after all, the term fig may not just be a Caribbean “thing”, as it has also been referred to as silk fig outside of the Caribbean.

So what, really, is a fig?

In the United States and in most countries, a fig is known as a soft, pear-shaped fruit with sweet, dark flesh and many small seeds, eaten fresh or dried. Referencing www.bbcgoodfood.com/howto/guide/hea lth-benefits-figs, figs are the fruit of the ficus tree, which is part of the mulberry family (Moraceae). Figs have a unique, sweet taste, a soft and chewy texture, and are littered with slightly crunchy, edible seeds. Fresh figs are delicate and perishable, so are often dried to preserve. This produces a sweet and nutritious dried fruit that can be enjoyed all year round. There are multiple varieties of fig, all of which vary widely in colour and texture. Their unique feature is a little bud-like opening called an ostiole at the top that helps the fruit develop. Their natural sweetness meant that, before the days of refined sugars, they were often used as a sweetener.

One of the world’s oldest trees, the fig tree can be traced back to the earliest historical documents and features prominently in the Bible. Figs are native to the Middle East and Mediterranean and were held in such high regard by the Greeks that laws were once created to prevent their export.

Nutritional value Figs are high in natural sugars, minerals and soluble fibre. Figs are rich in nutrients, including potassium, calcium, magnesium, iron, and copper, and are a good source of antioxidant vitamins A, E and K that contribute to health and wellness. Their high potassium content may counteract the urinary excretion of calcium caused by high salt diets.

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FRUIT

This, in turn, helps to keep calcium in bones and lessens the risk of osteoporosis. They are often recommended to nourish and tone the intestines and act as a natural laxative because of their high fibre content.

The fig, which also contains prebiotics (plant material that goes through the digestive system unchanged), helps support the pre-existing good bacteria in the gut, improving the digestive wellness.

Different types of figs According to the website localfoods.about.com, these are the different types of fig.

• Adriatic figs These pale green to pale yellow figs are sometimes called "white figs" for their light colour. They have bright pink to brilliant red insides and an extra-sweet flavour. They are harvested in June and again in August.

• Black Mission figs Black Mission figs are extremely sweet and thus are perfect for serving plain or with yogurt or tangy fresh cheese (such as marscapone, fromage blanc or farmers’ cheese) for dessert. They have blackish-purple skin and dark pink flesh.

• Brown Turkey figs Brown Turkey figs have brownish-dark purple skin, a milder flavour than other figs, and are noticeably less sweet than the similar-looking Black Mission figs. Brown Turkey figs work well in salads or in desserts where a sweetener will be used.

• Calimyrna figs Calimyrna figs are comparatively large, with slightly golden skin and a pinkish flesh that has a distinctive nutty flavour. All figs have that nuttiness (which is why they're so good with nuts), but these have a stronger sense of nut about them with their striking pink insides.

• Kadota figs Kadota figs have light green skin and are less sweet than other figs. They're good raw, but take very well to being heated up with something else, like Honey-Fried Figs.

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TEN

TH INGS ABOUT

FIGS

The green banana is simply the unripe version of the same banana most people know and love. While you can eat the yellow banana immediately after peeling, the green banana is best eaten cooked, either boiled or fried.

Green bananas increase your body’s ability to absorb nutrients, containing compounds called short-chain fatty acids (SCFAs), which nourish the cell tissue lining of the small intestine, dramatically enhancing the body’s capacity to absorb nutrients.

They are full of vitamins: Vitamin B-6, important for metabolism and every enzyme reaction in your body, and Vitamin C, a powerful anti-oxidant that prevents disease and boosts your immune system.

They can be ground and transformed into banana flour, which contains three times more minerals than wheat flour. In addition to this, banana flour is gluten free.

Green bananas contain a high amount of resistant starch, a type of starch that cannot be broken down by enzymes in your digestive system, and therefore acts more like a fibre than starch. Foods high in this starch in your diet may reduce your risk of diabetes by aiding in blood sugar control, and heart disease by helping to lower cholesterol levels.

Green bananas have numerous health benefits that recommend it as a permanent addition to a balanced diet. If you want to lose weight, to treat digestive problems, to prevent colon cancer or just to try a new dessert, you should really consider bananas. Choose green bananas in order to be healthy!

They work well for weight loss because they help you burn more fat and boost your metabolism. They are low in carbs and calories, high in water, and also help your body absorb more calcium.

They contain lots of potassium, which is important for lowering blood pressure, preventing strokes, and also vital for brain, heart and kidney function.

The brown spots that develop on a banana’s skin as it ripens are harmless, and do not diminish its nutritive benefits. Since they are softer, they are ideal for banana-based foods like banana bread, muffins, and pancakes.

Some people suffering from depression report feeling better after eating a banana. This is probably due to the tryptophan they contain. Tryptophan is a type of protein that can be converted within the body into serotonin, a substance proven to enhance your mood and help you relax. Bananas make you happy!

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DISEASE

| E.COLI

E.COLI

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DISEASE

e.coli WRITTEN BY DAVID

FENTON

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DISEASE

| E.COLI

Like finding a needle in a haystack — how scientists are searching for a rare and dangerous new bacteria that is putting children in hospital with kidney damage. David Fenton reports from the UK. Isaac is a busy, active little child. He looks well — but he's not. In 2014 Isaac nearly died from a rare bacterial infection, caused by a type of E.coli which had never before been found in England. Isaac survived, but he has behavioural difficulties, seizures and feeding problems.

His mother Gabrielle said the bacteria that attacked his kidneys has changed his life forever.

'He is not Isaac anymore; he's a different boy from the one who went into hospital, and it's taken a long time for me to come to terms with that. On Christmas Eve he had a full seizure and was diagnosed with epilepsy. His kidneys were damaged and they have not returned to normal. We have been told that sometime in the future he will need a full kidney transplant.'

But Isaac isn't the only child to have fallen ill from this mysterious new bug. Soon after he became poorly, other children began appearing at hospital with similar symptoms. Dr. Shuman Haq is the consultant kidney specialist at Southampton General Hospital who treated the children. He said, 'They all came in a rush; it was quite hard work looking after them all together, and of

Dr. Gauri Godbole, a consultant microbiologist for Public Health England, said, 'The E.coli bacteria are widespread. We have a lot of E.coli in our bodies, but they are harmless and generally don't cause us any problems or infections. But there are also some toxin-causing E.coli — mostly found in reservoirs in cattle and wild animals, and also in soil and water.'

And it's these toxic strains of E.coli that can make us very ill.

E.coli 0157 is the usual suspect and the one most commonly found – but that's not what the Dorset children had.

'When we did the tests I was anticipating seeing 0157 in the lab,' said Dr. Godbole, 'but when I looked at these samples that we were getting, it was a completely new strain of E.coli 055 that we have never seen in England before. The toxin that this bacteria produces likes certain places in the body: kidney cells in particular. It likes to bind with them, causing havoc there and causing kidney damage. It can also cause problems to the brain where it likes to attach to the brain receptors, and can cause fits. This toxin is so hazardous.'

Adults can be infected, but children seem especially susceptible.

geographic patch from our overall catchment area.'

The E.coli can cause Haemolytic Uraemic Syndrome, or HUS. Here the children's red blood cells are literally shredded in their bodies, as the toxin gets to work. Some children needed 24-hour dialysis to keep them alive. The effects of the E.coli 055 were worse than anyone had expected.

In fact, they all came from one small part of Southern England, from Dorset — a county about half the size of

Dr. Shuman Haq said, 'Usually in HUS, people need dialysis for 11 days. The

course they were all coming from a very small

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Trinidad and Tobago. What was causing these infections?

Tests in Southampton drew a blank — so samples were sent to the Public Health England laboratories in London, where they keep every known strain of E.coli — all 160 of them.

E.COLI

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DISEASE

patients who we saw in hospital averaged 20 days — so twice as long.'

tests in fields, rivers and farms, so far scientists have found no trace of the elusive E.coli 055.

But the new bacteria didn't stop there – in Isaac it also caused epilepsy. His mother Gabrielle will never forget the moment he was taken into hospital.

Louise Jones is the one of the Environmental Health officers

'When we went into intensive care the doctor told us that Isaac's brain was being agitated. What was happening was that Isaac was moving his head from side to side. The doctor said to kiss him goodbye and they needed to get on and do what they had to do. So I had to kiss him goodbye, and I honestly thought I would never see my child again.'

With children seriously ill in hospital — and new infections appearing every few months — the pressure was on to find answers. Where was this bug coming from, and why was it only in Dorset? So Gauri's team turned to genetics. Using DNA fingerprinting they managed to map the bacteria's genome — it's genetic code.

It was Dr. Tim Dallman's job to crack the bacteria's genome.

To do this the team had to create an entirely new DNA test, specifically for the 055 strain of E.coli.

'What we did was to decode the 5 million base pairs of DNA that make up the 055 genome,' he said. They were looking for slight mutations in the DNA code, and they found them.

What that meant was the bacteria were evolving and were not coming from just one source — such as a restaurant or a farm — but from multiple sources. The bugs were in the environment.

But trying to find a microbe in hundreds of miles of countryside is not an easy task. And despite thousands of

looking for the bug. 'It's frustrating that we have had children so poorly in hospital and we haven't been able to give the families answers about where it is coming from,' she said. 'We want to find the answer, because we want to make sure there are no other cases. That is what we are here to do.'

For families the lack of answers is frustrating and worrying.

Jess Archer is still suffering from the effects of her infection.

She spent weeks in hospital and very nearly died.

'Physically, I still get really tired,' she said. 'If I go out with friends, the next day I suffer with it; I can't wake up, and my face is swollen. At the time I was in hospital I was so ill I thought that I was going to die and I didn't want to; I'm not ready to die yet.'

Where and how this strange new bacteria came to Dorset is still a mystery — but what happens when it is eventually found?

Noeleen McFarland from Public Health England said, 'If and when we find the source I don't believe we can eradicate it. It would indicate when we need to increase our measures to protect ourselves, with hand hygiene, food hygiene and cleanliness. The bacteria is not going to go away. This is one strain; there could be others. This is how the bacteria works.

People are going to have to learn to live with it and protect themselves from it.'

To date, no source for the bacteria has yet been found, but the scientists are still looking.

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THE NEXT U April to June

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