U The Caribbean Health Digest - Issue 33

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APR JUN 2016


TT$35.00 US$5.99



Protecting your business from the

Where you stand and how to protect your employees.

Getting the Juice on Juicing Juicing is healthy but is it more beneficial health-wise than eating fruits and vegetables? Keeping Motivated During Your Fitness Drive Easy steps on your journey towards healthy living. Dasheen and Eddoes These crops are nutritious, relatively inexpensive and available all year round.



Be the


Know with


Sherine Mungal Stuart Fraser


Eidetic Publishing

Editorial Director

Sherine Mungal

Managing Editor

Roslyn Carrington


Leah Lewis Roslyn Carrington Carol Quash Maia Hibben Nasser Khan Vernon Khelawan Tian Watson Candida Khan

Creative Director Design

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Project Coordinator Traffic Photography

Medical Advisory

Stuart Fraser Eidetic Cindy Singh Lorraine Biran Shutterstock iStockPhoto Bigstock AdobeStock Dr. Neil Singh


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.

INNOVATION FOR TOMORROW Miami Cardiac & Vascular Institute at Baptist Health South Florida has advanced care in the region for nearly 30 years – keeping innovation and the highest quality at the heart of everything we do. The Institute is composed of a multidisciplinary team of physicians who have achieved international acclaim for their breakthrough research and impact on cardiovascular care. Experience the advantage of our commitment to helping patients lead healthy lives. Call Baptist Health International at 786-596-2373 today to see one of our experts or learn more by visiting Heart.Miami

12 ZIKA – How to Protect Your Business As business owners, one way to ensure a stronger and healthier business is to encourage and support staff with initiatives that inform and educate. In this article, our writer looks at ways that businesses can protect themselves and employees against Zika.

16 Environmental Wellness When we think of wellness we think of ourselves, but that’s just not good enough. We must remember we don’t just live ON this planet, we are a PART of it, so when our environment is well, we are too.

22 Let’s Talk Juicing There are very few foods that can’t be juiced. In fact it’s quite amazing what juicing can do for your health, so if you’re one of the many people with a juicer in the cupboard, but not motivated to actually do well, here’s our attempt to get you juicing!

24 Kidney Health Part II Simply too much of an intense and important subject to cover in just one article. Here’s our second article on kidney health: in this instalment, we focus on early detection, management and prevention of kidney disease.

28 Dasheen and Eddoes If you’re not West Indian, dasheen and eddoes may sound like exotic names that Caribbean people give to their kids, but if you don’t know what they are, you’d be missing out on the taste of these very versatile root vegetables. Writer Nasser Khan gets to the root of these must-have staples.

30 Annual Check-ups To many, medical check-ups may seem like nothing but a nuisance, but the reality is that they are often a useful method for early detection for many health conditions. But, as Vern Khelawan asks, do we really need to do them annually, or is less frequently good enough?

36 Keep Motivated During Fitness How many times have you set a goal for yourself where your fitness was concerned, but never made it past the first month? Well, Tian Watson is sharing ways that you can take control and motivate yourself to stick with your fitness regime and achieve your ultimate goal of wellbeing.

42 Are You Drinking Enough Water? It’s one of the simplest things that any human being can do, yet so many of us find it difficult to consume the right amount of water. Not drinking enough water can have serious effects on your health. Candida Khan looks at ways to up your water consumption.

Welcome to Issue 33. From time to time, we find ourselves having to make certain judgment calls on the content of our publication, especially regarding how our cover stories are chosen. There are many factors that drive these decisions, and this issue, #33, is a perfect example. While we intended to focus on Improving Environmental Wellness as our cover feature, the current situation and threats associated with Zika, both globally and locally, just couldn’t be ignored. In this feature the writer not only addresses how businesses and corporations can manage the spread of Zika in the workplace, but highlights ways that employers can play a greater role in educating their staff about the many aspects of the virus. We are eternal advocates for encouraging people to take responsibility for their own health and wellbeing. In this issue, we take a more in-depth look at the importance of regular check-ups, and the benefits of early detection of many health conditions. Root vegetables are a part of every West Indian’s diet, and dasheen and eddoes star at the top of the ground provision list. We look at their nutritional value and history in this issue. The second instalment of the series on kidney health, the benefits of juicing, and the importance of drinking more water are all featured here. Remember, dear readers, the way to ensure a healthier tomorrow is to take control of your health today. Happy reading, and God bless.





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How to Protect Your Business from Zika


LEAH LEWIS, MPH, CEO/Principal Consultant

To’ren Healthcare Consultancy


Just when we seem to have gotten over that troublesome Chikungunya virus, here comes the latest in mosquito-borne infections – the Zika virus (ZIKV). This time around, you don’t want droves of employees suddenly falling ill. You want to be ready. You want to protect your employees and your company’s productivity. What you need is information on how to do just that.

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and workforce productivity, healthcare costs, and not to

ZIKV is a viral illness that is transmitted to humans by

mention your company’s reputation, can be tremendous.

infected Aedes aegypti mosquitoes — the same

Yet the risks of the disease to a company’s workforce are

mosquitoes responsible for transmitting dengue and

often misunderstood and underestimated by nearly all levels


of management. There’s also the threat of employees who have travelled to high-risk countries returning with, and

Symptoms appear between 3 and 7 days after being

hence spreading, the disease. An outbreak can potentially

bitten by an infected mosquito.

render a high percentage of employees unfit to work within a matter of weeks.

According to PAHO, only 1 in 4 persons bitten by infected mosquitoes develop the following symptoms

But what can you do for your own business? While the

• Mild fever

threat is very real, the spread of ZIKV can be prevented. For

• Rash

the workplace, the most feasible solution at this time can

• Conjunctivitis (red eye)

only be through a targeted Zika virus control program,

• Headaches

allowing employers to protect their workers, their community

• Joint pain

and their reputation, thus reducing overall costs while

The symptoms are similar to those of dengue fever, so a

maintaining productivity. They may also be able to create

proper diagnosis is essential.

substitution plans in the event that the workforce is depleted.

Symptoms are not as debilitating as ChikV; neither are

I would suggest that a control program be:

they as long lasting.

• Focussed on employee education and support; or • A full workplace and community health program designed

There is no vaccine to prevent it or medicine to treat it.

to prevent and control ZIKV within chosen populations.

Only the symptoms are treated. Both options should be specifically designed towards a In the U.S., ZIKV has been reportedly linked to birth

particular population of employees and the community

defects in infected mothers, and in French Polynesia it

within which your business operates, and also be aligned to

has been suspected of being sexually transmitted

your own corporate policies, based on specific risk

between infected partners.


In March 2014, ChikV was identified in Chile, and it has


since been detected throughout Central and South

Looking at my first suggestion, we see that prevention is the

America and in various Caribbean states, including

strongest defence against ZIKV, and it begins with

Trinidad and Tobago.

education. Know that the best way to prevent contracting the disease is to avoid being bitten by a mosquito. That’s it.

No deaths related to ZIKV have been recorded to date.

Sounds easy? Well, it’s not. The Aedes species feeds during the daytime as well as at dusk and at dawn, so protection is


the most crucial at these times.

There’s no doubt that the need for prevention and control of the disease exists. If not effectively managed, the

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impact of the disease on employee health, absenteeism

Here are some prevention tips: • Use tight-fitting window and door screens to keep


mosquitoes outside. Netting around beds is also quite helpful. • Apply insect repellents properly on exposed skin or to clothing, carefully following all label instructions, particularly when used on children. Repellents that contain DEET, picaridin, IR3535, citronella or lemon eucalyptus oil provide long-lasting protection. • Ease up on wearing perfumes, colognes or other scented products before going outside, since strong fragrances may attract mosquitoes. • Mosquitoes thrive in wet environments, and so their breeding places must be eliminated. You can begin by emptying standing water from containers near to your home or workplace, including buckets, trash cans and flowerpots, and replace water in wading pools and bird baths daily; cleaning and covering stored water sources as well. • Minimize skin exposure and attraction by wearing clothing that is long, loose-fitting and light in colour. • Weeds, tall grasses and bushy areas should be cut short, since adult mosquitoes look for these shady places to rest during warmer daylight hours. • Burn mosquito coils or use other insecticide vaporizers, as these can also reduce the risk of indoor biting. My second suggestion of a larger scale intervention should be a step-by-step process, targeting the disease to ensure its decreased prevalence within a given population. Such a program must be designed and implemented by medical and public health professionals, but here’s an idea of what it should entail:

VECTOR CONTROL This may be focused on reducing the density of the mosquitoes (the disease vector). At this stage, there should be: • The provision of regularly scheduled indoor spraying of housing, offices and workstations with a long-lasting residual insecticide • The proper identification and elimination of important breeding sites, wherever possible • The application of suitable methods for larval control, via



the use of environmentally safe and effective larvicides • The implementation of a safe and effective program to control adult mosquitoes by using fogging in outdoor locations, (e.g. thermal fogging or ultra-low volume spray, known also as cold fogs) when necessary; and • The implementation of a proper monitoring and evaluation program to measure program efficacy.

PERSONAL PROTECTION This may be focused on reducing the risk of infection by implementing effective education and control programs to influence individuals to change their perceptions of the situation and hence change their behaviours towards it. In addition to the prevention tips listed earlier, there may also be: • The development of appropriate workplace insect vector policies and standards • Focus placed specifically upon travelling employees who may need pre-travel disease advice and education aimed at preparing them before they leave, in the form of pre-trip awareness training with e-resources readily available and accessible • Awareness efforts on site through information booklets, regular talks on ZIKV transmission and prevention, as well as policy enforcement; and • Prevent biting on site, by supplying workers with repellents.

DIAGNOSIS AND TREATMENT Although there are no therapeutic drugs for the management of ZIKV, this stage should be focused on the correct diagnosis of the disease and follow-up access to treatment. Here is where professional healthcare services take the primary role. Overall, it’s to everyone’s benefit that your workforce remains in good health, and not fall prey to any mosquito-borne viruses. Not only is it essential for maintaining company productivity, reducing worker absenteeism and having a favourable reputation amongst your competitors, but also for meeting corporate social responsibility targets. So don’t just wait for ZIKV to happen. There’s always something that you can do to protect yourself, your employees and your community.

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Stop looking inward for wellness and begin looking around you.

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In embracing environmental wellness, we must turn away from the ME and begin to consider the WE.






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When we think of wellness, we think about ourselves. We look inward: How am I feeling? Am I eating well? Sleeping well? What about exercise; am I embracing the right modalities for my needs, and am I doing it frequently enough? We consider our mental, emotional and spiritual balance. An assessment of all these elements helps us determine whether we are “well”.

average American consumes 159 gallons of potable water per day, more than half the world's population lives on 25 gallons. A new class has risen, known as the “consumer class”, of people who exist to consume rather than produce. They buy, they eat, they play, with little thought as to where their goods come from, what resources are depleted in their construction, and how, if at all, these resources can be replaced. The Worldwatch Institute claims that the consumer class comprises about 1.7 billion people,

But we do not exist in a vacuum. We cannot ignore our surroundings. In order for us to live in harmony with ourselves and each other, we must learn to live in harmony with our environment. This is environmental wellness. The first step to environmental wellness is to recognise that many of our available resources are finite. After all, we have just one planet that’s fit for habitation — at least for now. As the dominant species, we have been entrusted with its care. In harming it, we harm ourselves. Conversely, the Earth’s salvation is our own.

mainly from developed countries in North America and Europe, and in Japan. People are spending four times the amount they did on goods and services fifty years ago. Status symbols are trending towards possession of electronic items, such as televisions, phones, and Internet connections. Apart from the inherent unfairness, even selfishness, manifested by these consumption patterns, there is also the very real threat of irreparable damage to the planet. We, in turn, will inevitably suffer. When the host is ill, the organisms that rely upon the host fall ill as well.

Hazards and toxins With scientific and technological advancements come a slew of hazards that previous generations never had to

Unfair consumption of resources

face: rising levels of exposure to toxic materials, effluent, smog, and more. Here in Trinidad and Tobago we have a

Let’s look at natural resources. It’s bad enough that they


are being depleted at a rate never seen before, but they

producing commodities such as oil, iron and steel,

are also being consumed in unfair proportions by the

ammonia, urea, soaps and detergents, foodstuff and

developed world. North America and Western Europe,

consumer goods. The problem of disposal is weighty,

which makes up 12 percent of the world’s population,

and every now and then a story surfaces of improper

accounts for 60 percent of the world’s private

waste disposal or dumping. Frighteningly, much of this

consumption spending, compared to the 33 percent of people living in South Asia and sub-Saharan Africa, who

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account for just 3.2 percent. The United States,





waste is likely to find its way back into our water table. Food production is also a matter for concern. With the price of imported foods escalating due to foreign

comprising just 5 percent of the world’s population,

exchange and trade woes, we are focusing more and

consumes a quarter of the world’s energy. And while the

more on local production. An excellent idea, but




unfortunately mass food production usually walks hand

• Yep, you guessed it: Reduce, Reuse: Recycle. You

in hand with industrial pest management practices: in

hear the same mantra over and over again. You

other words, many local crops are exposed to pesticides

KNOW what to do. There are several local resources,

and even fertilisers that are harmful or toxic.

such as the T&T Solid Waste Management Company, (SWMCOL), that are brimming with ideas about how

Take a deep breath. Did you start coughing? The EMA

you can help. They’re only a click away.

ascribes about 7 million deaths in one year, around the world, to poor air quality. Much of this is due to tiny

• Minimise your exposure to toxins in your food by

particles (such as those found in smoke and smog),

patronising small local farmers rather than mass

which lead to cancers and cardiovascular and respiratory

producers. Enjoy the many farmers’ markets that are

disease. Common causes are industrial and vehicular

cropping up all over, such as So Oro in San

pollution. In the dry season we also have to contend with

Fernando, the Green Market in Santa Cruz, and,

a seemingly never-ending spate of bush fires.

most recently, the NEDCO market at the Queen’s Park Savannah. You’ll find not only fresh produce,

We think of pollutants as being tangible, but noise is also

but home-cooked food and artisan goodies.

a pollutant. It can damage hearing, and even send our stress levels soaring… and we all know that stress can have a negative impact on our well-being.

• Wear a wide-brimmed hat when gardening. Enjoy the beach, but use a good, high-SPF sun block, especially on children. Find shade when you can.

There’s an old saying that “only mad dogs and Englishmen go

There’s no shame in walking with an umbrella!

out in the noon-day sun”. Yes, we are a West Indian people, and we do love our sunshine, but even the most natural and benign resource of all — the sun — can be a hazard.

• Cut down on noise exposure. Do you really need to listen to music that loudly?

Let’s not be fooled; just because the majority of us have dark skin doesn’t mean we cannot be harmed by the sun.

• Try to plan your movements around peak traffic

While melanin does offer some protection from harmful

hours. It will do wonders for your stress levels.

UV rays, we are NOT immune. As a matter of fact,

Car-pooling can help with this, while also reducing

darker-skinned people are more susceptible to acral

everyone’s gas bill.

lentiginous melanoma (ALM), an especially virulent form of melanoma, which usually appears on the palms of the hands and soles of the feet.

• Keep your exposure to toxic air low by avoiding exercising in high traffic areas. Don’t burn your garbage: recycle as much as you can and safely

There are many more elements of environmental wellness,

dispose of the rest. And remember, smoking emits

too many to list here, but we urge you to read more and

airborne toxins too!

expand your knowledge. Friends, this is our planet. We don’t just live ON it; we rose from it. We are a part of it. A sick environment

How to ensure environmental wellness

breeds sick families, and an unwell nation. In embracing environmental wellness, we must turn away from the ME

There is much you can do to help, not just for yourself,

and begin to consider the WE.

but for everyone: your fellow man, the living things who also call this blue dot their home, and our precious

Because none of us is truly well if there are those among

planet itself.

us who are ill.

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• Zika virus is a mosquito-borne illness that is spread by the Aedes species of mosquito, the mosquito is also responsible for the transmission of the dengue and chikungunya viruses. • People usually don’t get sick enough to go to the hospital, and they very rarely die of Zika. For this reason, many people might not realize they have been infected. • The most common symptoms of Zika are fever, rash, joint pain, and conjunctivitis (red eyes). Other common symptoms include muscle pain and headache. • The Zika virus can also be sexually transmitted, and unborn babies are at most risk from Zika virus complications. • Currently, there is no vaccine against Zika virus infections. • Treatment is related to symptom control, and over-the-counter

medication is used to treat most infected people. • The best form of prevention is protection against mosquito bites. • Use mosquito repellents in accordance with the instructions indicated on the product label. Repellents should contain DEET, IR3535 or icaridin. • Cutting down on mosquito breeding is one way to prevent spread of this and other mosquito-borne viruses. Remove all open containers with stagnant water in and surrounding your house on a regular basis (flower plates and pots, used tyres, tree-holes and rock pools), or, if that is not possible, treat with larvicides. • People sick with the Zika virus should get plenty of rest, drink enough fluids, and treat pain and fever with common medicines. If symptoms worsen, please seek medical care and advice.







uicing fruits and vegetables has become a cultural phenomenon. Juice fasts, juice cleanses, juice diets, fruit smoothies and the likes have all become a way of life in today's health-conscious world. Juicing is healthy for a number of reasons, but is it more beneficial health-wise than actually eating the whole fruit or vegetable?

“Juicing probably is not any healthier than eating whole fruits and vegetables. Juicing extracts the juice from fresh fruits or vegetables. The resulting liquid contains most of the vitamins, minerals and plant chemicals (phytonutrients) found in the whole fruit,” explains Jennifer K. Nelson, R.D., L.D., in an article in mayoclinic.com.

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“However, whole fruits and vegetables also have healthy fibre, which is lost during most juicing.” But some advocates of juicing argue that it is better to juice the fruits and veggies as opposed to eating them whole because they are more easily absorbed into the body with the absence of all the fibre. “They say that juicing can reduce your risk of cancer, boost your immune system, help remove toxins from your body, aid digestion, and help you lose weight. However, there's no sound scientific evidence that extracted juices are healthier than the juice you get by eating the fruit or vegetable itself,” Nelson adds.


Not everyone finds the taste of certain fruits and vegetables appealing. Some people may eat pineapples with a smile, while other may pass on a helping because they don't fancy the taste. Juicing is an excellent way for people to get the nutrition they need from certain fruits and vegetables that they do not find palatable. Here are some of the most common juicing selections and the nutritional benefits that can be derived from them.


Citrus fruits are among the best, if not the best to juice. Oranges, grapefruits, portugals and their relatives are delicious and are rich in carotenoids, bioflavonoids and the ever-popular Vitamin C — all of which help in the fight against cancer and do their part in reducing blood pressure and plaque in the arteries.

It is a rich source of the enzyme papain, which does a great job at breaking down protein. It is also an excellent source of Vitamin C and is reputed to prevent cancer. Because of its consistency, it is not juicer-recommended, but it does make a delicious smoothie.

Because of their anti-viral and anti-bacterial components, citrus fruits help to ease the workload of the immune system. Juiced citrus is very refreshing, especially around this time of year.

Apples store antioxidants, help with the reduction of cholesterol, are natural digestive system cleansers, and give the immune system an overall pick-me-up. They juice well and can be combined with almost any fruit or vegetable.

Pineapples are well known for their anti-inflammatory, anti-viral and anti-bacterial components. They are reputed to help in the dissolution of blood clots and with the body's digestion of protein. When juiced, the tropical flavour of pineapples becomes more distinct, and is quite refreshing. Watermelons have often been referred to as superfruits because of their various nutrition and health benefits. They contain high levels of water and are therefore natural diuretics. They cleanse, re-hydrate, and detoxify. They also contain anti-viral and anti-bacterial components. Juiced watermelons are refreshing, especially on super-hot days. Paw paw or papaya is one of those fruits that a number of people can't eat because of its pungent scent. But it is also one of those fruits that is kindest to the digestive system.

Cranberry juice is so much more than a complement for vodka. This tiny fruit is a rich source of mannose, a natural anti-infection for the urinary tract. It protects against the formation of bacteria in the bladder, kidneys and prostate. However, because of its tart taste, it is recommended that juiced cranberries be mixed with water or other sweet juices. The debate on whether tomatoes are fruits or vegetables continues, but one thing is certain – they are packed with nutritional and health benefits. Their high lycopene content make them heart smart, and they are known to reduce the risk of cancer. They are also team players, as they form a healthy, tasty alliance with a number of other fruits and veggies. Cooked tomatoes tend to be acidic, but when juiced, tomatoes maintain their pleasant taste. Eating celery sticks appeals to some people; to others, not so much. But you don't want to miss out on the many benefits derived from consuming celery. This simple herb cleanses the digestive



system, helps lower blood pressure, and acts as a diuretic. Juiced celery – both the stalk and the leaves – is recommended for detoxifying the body. Broccoli is a rich source of antioxidants and contains a fair share of vitamin C. In its raw form it is reputed to protect against certain types of cancer – namely lung, colon and breast cancer. The chlorophyll contained in broccoli assists with the regulation of insulin and blood sugar. When juiced it may not be the best tasting drink, but can be mixed with other juices to mask the taste. Juiced carrots have been around forever. The sweet juice is packed with beta carotene, giving your skin, brain, and immune system an extra boost. It also helps in the fight against cancer and infection, and protects the arteries. Like tomatoes, carrots mix well with other fruits and vegetables when juiced, making the combination a powerhouse of nutrition. Wheatgrass has been making the rounds on the “nutritious and healthy” lists. A rich source of indoles, a cancer-preventing component, wheatgrass also contains provitamin A, chlorophyll, potassium, magnesium, and a variety of enzymes. Kale, like wheatgrass, is also topping the list when it comes to eating or drinking healthy. It is rich in protein, calcium and minerals — all of which the body needs to be at its best. It helps with bone development, helps in the fight against cancer, and provides cardiovascular support. Juiced kale, much like other greens, may be a bit difficult for some people to drink. Mixing with other juices will make it easier to swallow. Juicing may or may not be around for the long haul, as things, including health-related thoughts and theories, are always changing. At the end of the day, to juice or not to juice remains a matter of choice. But for those die-hard juicers among us, the types of juicers available on the market — from high-end to reasonably-priced — are almost as long as the things that can be juiced. Happy juicing!

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Early Detection, Management and Prevention WRITTEN BY



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Let’s recap... Kidney disease refers to a variety of disorders that attack

Screening is usually carried out by a GP through blood and

the filtering units of the kidneys, rendering them unable to

urine samples. The blood test is used to calculate your

effectively expel the waste products our bodies produce.

Glomerular Filtration Rate (GFR). This is a measurement of

Kidney disease is very closely linked with cardiovascular

how many millilitres of waste product your kidneys can

disease. The risk factors for cardiovascular disease include

process in a minute (ml/min). Healthy kidneys should be

hypertension, diabetes, obesity and high cholesterol — all

processing above 90 ml/min. It is tricky to accurately measure

of which are extremely common in Trinidad and Tobago.

the GFR so a special formula is used to help, and it is called estimated Glomerular Filtration Rate or eGFR. This is then

Because Trinbagonians are at such high risk for cardiovascular

used in conjunction with a urine test, which measures albumin

disease, it also means that they are at increased risk for

and creatinine levels, to provide doctors with a more accurate

chronic kidney disease, with research suggesting that 20%

picture of how the kidneys are functioning.

of the population will develop some form of kidney disease. This obviously creates an immense strain on the healthcare system, which is already underequipped to deal with the increasing number of kidney patients. A key way to help alleviate this strain is through screening and early detection,

If your blood and urine are screened and your GP finds that the samples indicate that your kidneys are not functioning efficiently and that you may have chronic kidney disease, they will determine what stage your kidney disease has reached.

as well as through public education — helping the population recognise the signs and reduce their risk of developing kidney disease in the first place.

Treatment STAGE 1 – 2 If you are diagnosed with stage 1 – 2 chronic kidney disease,

Screening — How do you screen for kidney disease? If you fall within a ‘high-risk’ group, you should be screened for chronic kidney disease. This includes:

changes can be made. This may take the form of • giving up smoking

• People with diabetes

• decreasing alcohol consumption

• People with hypertension (high blood pressure)

• eating a low-fat, balanced diet

• People with cardiovascular disease (heart failure,

• significantly reducing salt consumption

coronary heart disease) • People with a family history of kidney disease • People with diseases that can affect the kidneys, e.g. lupus

• spending time losing weight and exercising, preferably 30 minutes a day 5 days a week • Depending on other areas of risk that you present with, you

• People with prostate or kidney stone disease

may also be treated for hypertension (high blood pressure)

• People who have had previous acute kidney injury

with specific drugs, or for high cholesterol, with

• People with protein or blood in the urine, which has no

lipid-lowering drugs. This approach can slow down the

other known cause

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the first step your GP will make is to assess what lifestyle

progress of CKD and sometimes stop or reverse it.





• Increased resources dedicated to kidney patients, including

Stage 3 usually means there are significant changes in the

more financial investment; improved standards of dialysis

body’s normal functions, leading to problems such as anaemia,

units, with better regulation and an increased number of

and therefore a shortage of red blood cells, often in

properly trained nurses and medical personnel to man them

conjunction with early bone disease. This stage requires the attention of a kidney specialist (a nephrologist). Anaemia can

• Sustained and increased support for the further development of the kidney transplant programme

be treated through iron supplements and, often at this stage of

• A more aggressive and integrated Public Health approach to

CKD, through injections of erythropoietin, which is a hormone

decrease the rates of chronic non-communicable diseases

that helps the body produce red blood cells. A nephrologist will

such as diabetes, hypertension and obesity

tailor the treatment according to the other issues the patient may have, such as high blood pressure or diabetes. But all patients will need to make significant changes to lifestyle habits such as diet, smoking, and exercise to help improve their kidney function.

• Better early detection of kidney disease — improved screening procedures for at-risk patients • Greater public awareness of CKD through thorough education programs — community, work and school-based intervention programs • Improved environment to encourage physical exercise

STAGE 4 – 5 If your kidney disease is advanced, falling within stage 4 – 5, then it is time to start preparing for dialysis and exploring the possibility of a kidney transplant.

• Tax and price interventions • Laws and regulations • Advocacy, communication and information • Continued education programmes for primary care doctors such as family care physicians and health centre doctors, to ensure that all the up-to-date measures are implemented to

Prevention How can we prevent this ever-increasing rise in chronic kidney disease in T&T? We as individuals can be more proactive about our health and try to eat a healthier, balanced diet, limit alcohol

achieve clinical prevention, with a focus on overall risk • Improved disease management such as the treatment of lupus or glomerulonephritis (inflammation of the kidneys) • Earlier referral to a kidney specialist if a patient is at CKD stage 3, or if significant protein in the urine is detected

consumption, reduce or stop smoking, and get more exercise. It is also important if you suffer from a health problem or

With chronic kidney disease rates and mortality rates from

disease that is a risk factor for CKD, such as diabetes, high

CKD at current levels, it seems critical that Trinbagonians start

blood pressure or cardiovascular disease, that you look after

to understand the risks and take responsibility for their bodies

and manage that problem as effectively as possible.

and their health, improving their lifestyles and learning to recognise the signs that something may wrong... before it is too

Dr Mohammed also highlights several ways of improving

late! In our next article, we will be looking at dialysis — what it

T&T’s outlook on a more macro scale:

is and how it works.

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Dasheen and Eddoes WRITTEN BY NASSER


DASHEEN and EDDOES are both variations of the specie Colocasia esculenta, with dasheen being the larger of the two. Thought to be native to Southern India and Southeast Asia, they have been widely distributed throughout the tropics. These are perennial, tropical plants primarily grown as root vegetables for their edible starchy corm, used as staple carbohydrate sources.

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Local ground provisions — or “blue food” as we call them — include (dasheen, eddoes, cassava yam, tannia, and sweet potato. These crops are nutritious, relatively inexpensive and available all year round.





uch is the popularity of the dasheen that the island of Tobago holds an annual “Blue Food Festival” in October. Now in its 18th year, the festival attracts thousands of tourists from Europe, the United States, Canada and the Caribbean. Held at Bloody Bay Recreational Ground, it showcases entrees, appetizers, desserts and liqueurs on sale, most with dasheen as their main ingredient. Some of the offerings include dasheen black cake, dasheen sponge cake, dasheen wine, dasheen kurma and amchar, dasheen fudge, dasheen quiche, and cookies made with dasheen flour. Did someone say, “Provisions and salt fish”? Top Caribbean athletes like Usain Bolt also swear by their “grounding” in ground provisions such as dasheen and eddoes.

Dasheen leaves are used to make callaloo, a popular Sunday meal accompanied by stewed chicken (or any other meat), boiled plantain, macaroni pie, rice and red beans. Leaves and stems are cooked with coconut milk, pumpkin and okra and pureed into a thick liquid. It is sometimes prepared with crab. It is also prepared as a vegetable, cooked down to a dark green paste-like consistency — called dasheen-leaf bhagi — and eaten with dhal and rice or sada roti.

Dasheen leaves (the only part of the plant above ground) are rather large and heart-shaped, with frilly edges, at the end of long, stout petioles. They resemble an elephant’s ear. The leaf usually has a red-purple centre.

Dasheen corms have more calories than potatoes; 100 grams of produce provides 112 calories. Their calorific value chiefly comes from complex carbohydrates, amylose and amylopectin. Nonetheless, dasheen is very low in fats and protein compared to cereals and pulses. The corms, however, are free from gluten protein. They have a high-quality phyto-nutrition profile, comprised of dietary fibre and antioxidants, in addition to moderate proportions of minerals and vitamins. It is interesting to note that eddoes were used as a substitute for white potato during World War II.

Dasheen and eddoes can be grown in fields where water is abundant, or upland, where water is supplied by rainfall or supplemental irrigation. It is one of the few crops (along with rice) that can be grown under flooded conditions. Depth of planting can influence the size and shape of the harvested crop: shallow planting gives rise to smaller, rounded corms, while deep planting results in elongated corms. In Trinidad, land preparation and planting start in mid-April to June. In drier areas, harvesting can begin 6 – 7 months after planting, while in the wetter areas, harvesting can begin after 9 – 10 months. Over 70 cultivars of dasheen have been documented by CARDI in Dominica. There are also distinct colours of the leaf petioles: white (pale green) and red, and the sought-after purple-stemmed variety.

Food and Description

Calcium (mg)

Iron (mg)

Dasheen and eddoes are generally eaten boiled. The texture of boiled dasheen is unlike any other root vegetable. Steamed or boiled, dasheen is soft and almost custard-like, yet still firm and dry at the same time.

Dasheen is one of the finest sources dietary fibres. Young, tender leaves have significant levels of phenolic flavonoid pigment antioxidants such as beta-carotenes and cryptoxanthin, along with vitamin A. It also contains good levels of some of the valuable B-complex group of vitamins such as pyridoxine (vitamin B-6), folates, riboflavin, pantothenic acid, and thiamine. Further, they provide healthy amounts of important minerals like zinc, magnesium, copper, iron, and manganese. In addition, the root provides very good levels of potassium.

Potassium (mg)

Sodium (mg)

Zinc (mg)

Vit. A

Thiamine Riboflavin (mg) (mg)

Niacin Total Cyano Vit. C (mg) Folacin Cobalamin (µg) (µg)

Dasheen Bush – Raw


























Eddoes – Fresh tuber, raw













Tuber, cooked













Dasheen – Fresh tuber, raw













Fresh tuber, cooked













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Annual Medicals WRITTEN BY CAROL



“It’s time for your annual medical check-up,” said the young man to his aging father.

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“Aw, that’s a waste of time — and money, too’’, said the father. “And further, I am well; I don’t feel a thing. There’s nothing wrong with me.” And the conversation went on. The final result? He did not go for the examination.

you will need your doctor to level with you. The tests he will ask you to get done will probably include an electrocardiogram, urine test and the famous blood test. You may be surprised, but some of these tests are even ordered for people who have no risk factors, especially since most people younger than 40 are generally free of diseases that can be diagnosed purely from a physical exam.

So many of us are like that father. We either are afraid to take the examination or tests, or we believe that in the normal scheme of things, all is well — No pains, no stress; I think I’ll take an annual next year, if for nothing else but to please my children. And that is the story of the annual medical check-up.

On the flip side, there have been many studies conducted on the pros and cons of the annual medical check-up, because many doctors believe they do not help you stay well or live longer. Some believe that they also do not avert hospital stays or keep you from dying from cancer or heart disease, or some of the more esoteric diseases.

But an annual physical becomes more necessary as you age, and at that time your medical practitioner has to become your best friend, simply because

But most general practitioners believe in annual medical check-ups for adults as they grow older. Many times, these practitioners have a medical




Are they necessary? history to work with, and an annual check-up is just a part of that history. It does not mean that you are sick.

The real purpose of this periodic health examination is many-fold, as the following reveals; • It is done as primary prevention • It identifies any risk factors for chronic common conditions (such as diabetes, heart or lung diseases) • It detects diseases that have no apparent symptoms (secondary prevention) • It is a way for a doctor to counsel people and to promote healthy behaviour • It enhances the relationship between you and your doctor; and • It helps to update clinical data since your last check-up. Such check-ups involve tests, and these depend on several factors, like age, gender, health, and, of course, your risk factors. These may include family history, such as having a close relative with cancer, and lifestyle issues, such as smoking. Cholesterol screening, for example, is recommended for people

who have a family history of early coronary artery disease. One local doctor said that we have to realise the annual medical is nothing to fear, but if one sticks to what the AMA says, it is all right for many above the age of 40 to have a one-to-three-year span between exams. For those between 18 and 40, every five years is fine. Whereas we used to think an annual medical examination was compulsory, American doctors are now advocating this new trend. Also, on a corporate level, many medical groups, health insurance companies, and some employers, previously demanded annual physicals, for various reasons. But more recently, taking the lead from the AMA and similar groups, some have quietly moved away from the yearly tests. Today in the US many insurance companies now choose to do a Periodic Health Assessment or Examination, which may be performed every five years for adults over 18, and every one to three years after age 40. More frequent evaluations are recommended for people taking prescribed drugs or medicines.

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Health and Wellness Assessment Packages. Gulf View Medical Centre Limited is proud to offer our range of diagnostic services geared towards maintaining the health and wellness of your workforce. Throughout every step of our medicals, our clients rest assured that each member of our professional team is highly qualified and trained in their area of expertise. Clients may choose from our extensive offering of executive medical packages including Pre-employment, UKOOA Certified, Basic, Occupational, Annual and Executive Medicals all conducted based on the highest standards and quality by our specialists, ensuring that your organisation is provided with accurate, cost effective and comprehensive representation of your workers' health. If required, Dental Cleaning and Sleep Apnoea Screening can also be added to any assessment. Your organisation will be eligible for a group discount if 10 or more employees are scheduled.

Call us today to schedule your Health Assessment and get on the road to good Health.

715-716 McConnie Street, Gulf View, La Romain, Trinidad T 868 285 GVMC (4862) F 868 652 0053 E info@gvmctt.net









“Obstacles don’t have to stop you. If you run into a wall, don’t turn around and give up. Figure out how to climb it, go through it, or work around it.”

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Michael Jordan... basketball icon

When embarking on a fitness drive, we consider what equipment/gear to acquire; what weight-loss supplements to consume; and, oh yes... should I sign up with a personal trainer? These acquisitions are the easy (and costly) steps on your journey toward healthy living. The more challenging part is finding the physical and mental commitment needed to achieve your desired results. Often, people embark on this journey but cannot successfully complete it; they cannot sustain the commitment, and quickly lose the mental and physical stimulation needed to keep up. Finding and maintaining this motivation is key to overcoming obstacles and achieving long-term success. Firstly, let us look at adding variety to your workout programme. Variety can be introduced in a number of ways.




Exercise videos Exercise videos often remain on your shelf. Perhaps one day a week you and your partner can choose a video and introduce it to your programme. Again, you don’t have to commit to the usual six-to-eight week schedule that some of these videos offer, but rather just introduce an exercise video day, your dose of variety.

Reduce your workout time As counterproductive as this may sound, there is a school of thought which suggests that maximum benefits from a workout is achieved within the first 25 – 30 minutes. Do the same gym routines, but increase the intensity. Challenge yourself to cover the same treadmill distance in less time, or take less rest time between sets or muscle groups.

Commit to a workout partner

Having a workout partner can greatly increase adherence to a workout schedule. Find someone with a similar fitness level and similar objectives. Consider similar life commitments as well as daily routines. With the right choice, this person will push you to do more than you would do on your own, and keep you in check.

Look for different gyms or classes Just as you may check out different restaurants, bars or clubs, you can apply the same concept by trying different classes at different gyms. Keep in mind you are simply trying to get the fitness ball rolling, or maintain your motivation. It does not have to come with a long-term commitment. The purpose is to add variety and freshness to your programme. Include groups doing outdoor routines, perhaps in a park. These ‘boot camp’ style workouts have been steadily growing in popularity.

If bulking up is not one of your objectives, intensity can also be increased by reducing the weights, holding form, and doing your reps at a faster rate, with less rest time between sets. These changes can keep your body and mind more engaged, and hence more motivated.

Switch up the routines A variety of exercises can give results for the same muscle groups. Seek different exercises for these muscle groups. Try to deviate from the same routines, week after week after week. If you do your aerobic routine on one machine, try to split it up and use more machines. Try changing your workout times for a while. Switch some evenings for mornings, if you can. Something as simple as seeing different people in the gym can make a difference. These changes are refreshing for your body and, more importantly, your mind.

Bribe yourself Give yourself something to look forward to if you have a successful workout week: a cheat in your diet plan, a deep tissue massage, or a hairdresser’s appointment. 37 | u



Pay, pay, pay

Make a deal with your friend, partner or colleague. Agree to a financial sum to be paid each time you miss your workout. This concept has been explored in Econometrica (Journal of the Econometric Society, vol. 77 issue 3, 2009). Persons who were given financial incentives/disincentives increased their monthly gym attendance. There is scope for financial intervention in the area of health. In fact, there exists an exercise app based on this principle. Here you get a financial reward for adhering to your exercise program. You, however, also authorize the app to charge your credit card if you do not attend your sessions.

Remind yourself of the reasons you are on the journey... even if some may seem trivial

Some persons may be reluctant to admit to a few of their underlying motivating factors for working out. Acknowledgement of these factors is better than quitting. Avoid clichéd reasons such as: regular exercise prevents diseases; gives you more energy; releases stress and, oh yes, make you live longer. Too often, challenges derail us from our mission. Tapping on our emotions can be an effective motivational trigger. These emotions may offset the common excuses such as, “feeling too tired” and “having a stressful week”. Get pen to paper and make a list of the above. Keep it in a place where you can see it. This list can include:

Carnival season

Imagine putting on that expensive Carnival costume, feeling really good about yourself. On the flip side, imagine putting on that costume looking the way you do now!

The people who expect you to quit

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Some of us may have “friends” who give us that discouraging look if we mention we are embarking on a fitness drive. Prove these individuals wrong. Even if

you have to jot down these names on your list.. do it! Think of them before you decide to miss your workout.

Use someone as a benchmark

We all know someone whose physique we would not mind having. Try to match or even surpass that look. You will feel accomplished, especially if the person also acknowledges your hard-earned achievements.

The feel-good factor

When you maintain your workout schedule, you feel better about yourself, even if you have not changed much physically. As vain as it may sound, you may look forward to bumping into old friends, those that have put on a noticeable amount of weight, especially if these are persons you want to impress. They include ex boyfriends/girlfriends, old schoolmates who used to look better than you did back then, etc. This jolt of self-confidence has a spillover effect in other areas of your life, so remind yourself of the feeling.

Having a greater impact

Many people have an automatic negative perception of individuals who are out of shape and overweight. Having a job where you often interact with new people, your physical appearance could make a difference. It may influence landing a promotion, closing a deal, or just earning the respect of your peers. Though this point may seem morally wrong, it probably is a reality.

Being sexually attractive

Whether we openly admit it or not, being sexually attractive is a huge motivator for working out. This also applies to those who are married, engaged or in long-term relationships. Looking and feeling good can greatly contribute toward your partner having a positive attitude about you. It may even encourage him or her to join you on your journey. Whichever method can be applied to your situation, you will know when you are motivated and on the road to success. Now, missing your workout and missing all the resulting benefits will no longer be an option.

Proper Nutrition and Physical Activity =

Full and Healthy Life Wanda Morales Pérez MPH, CMCP, EDPR, CEF

At the end of the day, have you ever felt like if you have literally run a marathon? Our current pace of life causes exhaustion. Between the responsibilities proper of our job, home, family and other activities we have no time or energy left. We feel so exhausted that we cannot even sleep peacefully. But, how can we fight our exhaustion and lack of energy? Each time there is more scientific evidence that supports the fact that a full health and wellbeing are based on having and maintaining adequate practices of food consumption and practicing physical activity. Technological advances have promoted modified nutritional habits and sedentary lives. The lack of physical activity is associated with health conditions such as diabetes, obesity, cancer and cardiovascular diseases. Physical activity refers to any activity that makes the body work more strongly than usual. While exercise is a planned, structured, and repeated physical activity with the purpose of improving the components of physical ability. Proper nutrition, physical activity, and exercise are the most important and powerful tools that we can use to prevent diseases, promote health and total wellbeing. You may not be a high performance athlete, but the truth is that if you are a physically active person, who exercises regularly or that simply faces a hectic day; the amount, schedule, type of food and hydration state are vital to maintain health, delay fatigue, and for improved regained strength. Active people who exercise need a nutritional pattern that emphasizes high value biological protein intake (one that contains the necessary structures for the body to make additional proteins).

Exercise alters amino acid integrity and breakdown pattern. Additionally, exercise intensity and duration as well as carbohydrate storage determine if the protein being taken is used as a source of energy. Due to this, protein requirements are slightly increased in people who exercise for long periods of time or do strength training. Protein consumption should be adequately balanced with the consumption of other nutrients, such as carbohydrates and fats. Such action promotes an adequate use of all nutrients for maintaining the proper energy levels needed for practicing physical activity. Vitamins are of vital importance especially those that make up B complex since they are directly related with the body’s energy production. Minerals, specifically iron, calcium and magnesium play an important role in our ability to conduct activity. Vitamin and mineral deficiencies have a negative effect on physical performance. After exercising, we need to replace the fluids and electrolytes lost when we sweat. Prolonged and high intensity exercise also requires carbohydrate replacement. Likewise, rapid muscle protein repair is promoted when food or nutritional products with high biological value are consumed. No doubt, if you long for a full and healthy life or just maintaining an adequate level of energy to face the challenges of our daily living, a balanced nutrition along with staying active are key. There are options in the market that can help you achieve the nutritional requirements necessary for an active life. You can use these products to supplement your nutrition, snacks or regain your energy after exercising or after a very active day.

© 2015 Abbott Laboratories APR-140112



RELYING ON THIRST AS AN INDICATOR THAT YOU NEED TO DRINK WATER IS NOT A GOOD IDEA. THE AIM IS TO CONSUME ENOUGH WATER SO THAT THIRST IS OUT OF THE QUESTION. IT IS IMPORTANT TO REMEMBER THAT IF YOU ARE THIRSTY, IT MEANS THAT YOU ARE ALREADY DEHYDRATED. Many persons neglect water intake and forget that it is a very important part of your daily routine. To maintain a healthy balance in the body, water plays a vital role. It is a nutrient that is classified as essential, since it comes from the diet. If there is an alteration in the water content of the body, it can upset the balance of minerals. According to the NHS (National Health Service), water makes up more than two thirds of the healthy human body. It aids in digestion, acts as a lubricant at the sites of joints and eyes, and helps keep the skin healthy.

are you drinking

enough 42 | u


Khan, RD




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IMPORTANCE OF WATER AS PART OF YOUR DAILY INTAKE Water is a vital part of survival. Without enough water, we would not be able to function. Every cell, organ and tissue needs water to work properly. Your body uses water to regulate blood pressure, body temperature, and removal of waste through faeces and urine excretion.

RECOMMENDED INTAKE OF WATER According to the World Health Organization (WHO 2016), a minimum of 7.5 litres per capita per day will meet the requirements of most people under most conditions. An adequate intake for teenagers can range between 1.6 L to 2.6 L (6 cups to 11 cups) and for adults is 2.7 L to 3.7 L (12 cups to 21 cups) recommended by National Institutes of Health (NIH 2016).


WATER (ml)

CONSUMED Milk, 1% (8 oz.)


Orange juice (6 oz.)


Cantaloupe, cubed (1/2 cup)


Coffee, black, unsweetened (12 oz.)



Banana (1 medium)


Water can be lost in many different ways, in reactions in the body including sweating and breathing, and in faeces or urine. Did you know that climate and humidity can affect water loss? The hotter the climate, the more water loss there will be. Vomiting and diarrhoea can also contribute to a large amount of water loss.

Almonds, dry roasted,


Water loss is dependent on many factors. This includes activity level, environmental factors such as weather and humidity, as well as age and body composition. The older the population, the more water intake needed. Alcohol intake can also affect your hydration status. It can act as a diuretic, which means that it increases water loss from the body. A headache after drinking excessive amounts of alcohol can be associated with dehydration. The aim is to replenish this loss by drinking water.

SOURCES OF WATER Water can be found in anything you drink or eat, for example • Fruit juices • Vegetables • Fruits • Fish • Meat • Nuts • Rice Labels include ingredient listings that can specify the amount of water in the product. The name of the ingredient that is first on the list has the highest content in 44 | u

the product. For example, the product will be made of mostly water if the ingredient list says: water, sugar, whole wheat flour.

Unsalted (1/4 cup) Raisins (1/4 cup)


WAYS TO INCREASE WATER INTAKE 1. Drink water with meals instead of carbonated beverages. Water has no calories, and therefore drinking it with meals can assist in weight control. 2. Add fruits to water to enhance taste, for example, orange, watermelon (or any local fruits). This can help to provide favourable drinking conditions. 3. Keep a bottle of water with you when leaving the house. When you keep water on your person, it is more likely that you will drink it. 4. Drink water between main meals or with snacks. 5. Always have water within your vision at home. When you see water, it may increase your desire to drink it. 6. Purchase water when dining out. Normally, when dining at restaurants, water is offered and it can be recommended to drink water when dining.

REGULATING WATER IN THE BODY The kidneys are some of the main organs that impact the regulation of water in the body. The brain sends signals to the kidneys when there are changes in the water concentration in the blood. The kidneys will reabsorb more water when water in the blood is low. If water in the blood is high, the kidneys release water in the form of urine or faeces.




DEHYDRATION Dehydration can be defined as more loss of water from the body than intake. When your body does not have enough water to carry out its normal functions, dehydration can be the cause. If you are ill, the risk of dehydration increases. Possible signs and symptoms of dehydration include • Sunken eyes • Dry skin • Little or no urine • Dry mouth • Loss of saliva • Confusion • Fatigue

RISKS ASSOCIATED WITH DEHYDRATION The NHS (National Health Service) confirms that dehydration can lead to a loss of strength and stamina. It's a main cause of heat exhaustion in athletes and can have a negative impact on performance. The aim is to increase water intake as treatment for dehydration. If dehydration is ongoing, kidney function can be affected, and the risk of kidney stones can be increased. It can also lead to muscle damage and constipation. Signs and symptoms of serious complications include: • feeling unusually tired or confused • dizziness when you stand up, that doesn't go away after a few seconds • not passing urine for eight hours • a weak pulse • a rapid pulse • fits or seizures • a low level of consciousness If severe dehydration is not treated immediately, it can lead to complications. This level of dehydration needs hospital treatment. Most of the time, this can lead to restoring fluid loss with drips.

WHAT TO DO IF YOU ARE DEHYDRATED The aim is to rehydrate the body with water. Drinking lots of fluids, such as water or diluted juices, can be recommended. If you have difficulty, try sipping the fluids over a longer period of time. Excessive drinking to try and rehydrate can lead to problems with mineral balance in the body. Slow and steady is recommended. If your symptoms continue, get assistance from a health care professional. 45 | u

THE NEXT U July to September


Don't let the bed bugs bite! ... how to prevent these pesty little critters. Paleo Diet Is it the healthiest way to eat? Mamey Sapote The history behind this exotic fruit.

Article submission guidelines U strives to provide informative, educational articles emphasizing health and lifestyle in the Caribbean. We select articles that will appeal to our Caribbean audience that are uplifting, informative and pertinent to health and wellness. Policies You must submit only original and unpublished work. By submitting to us, you are giving U permission to publish your work both in a single issue and in any future publications that feature items from U. This may include compilation works, web page summaries of the magazine, etc. Although we are retaining the right to use your work, we do not take complete ownership of it. This means that if we publish your work in U, you retain the right to submit the work to other publications. All articles are accepted on speculation. Publication of any article cannot be guaranteed. U reserves the right to edit all copy.

Specifics All accepted articles will be accompanied by the byline and monetary compensation as set out in our writers’ contract. Letters to the editor We encourage Letters to the Editor commenting on recent articles published in our magazine. They are not peer reviewed as such, but are assessed in-house to make sure they are factual and non-inflammatory, etc. Submit all comments, letters and/or subscription requests to: U The Caribbean Health Digest, Gaston Court, Gaston Street, Lange Park, Chaguanas, Trinidad & Tobago or email us at info@uhealthdigest.com www.uhealthdigest.com Advertising. P: 868-665-6712 + 5994 + 4428 F: 868-672-9228

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