National Medical Commission Bill 2017

The proposed legislation is full of anomalies (Hindustan Times: 20180108)

http://paper.hindustantimes.com/epaper/viewer.aspx

The Parliament’s decision to send the draft National Medical Commission Bill 2017 to the

standing committee of health has raised hopes for a constructive debate among all political

parties to remove the draconian clauses in the proposed bill. If not modified, the bill will

replace the Medical Council of India (MCI) by a near-total central government department

called the National Medical Commission (NMC). Devoid of federal character, this non-

representative body will be a poor substitute for the MCI.

The proposed NMC will not represent the medical profession of India in any significant

manner. The MCI had one representative each from state and practising doctors. With this

being taken away, it remains to be seen how the ethics of practising doctors providing care to

80% of the population can be managed without having representatives from their own tribe!

The Indian Medical Association (IMA) is the collective consciousness of more than three

lakh doctors from modern medicine, yet it was not consulted when the Union cabinet took

this momentous decision to replace the MCI with the NMC.

The Bill is not ‘national’ as it does not represent all state governments. Although, each state

government does have the presence of a vice chancellor, he or she will be appointed by the

governor through the central government. It isn’t ‘medical’ either as it allows the mixing of

‘Ayush’ with ‘modern medicine. Mixing of Ayush with modern medicine is not evidence-

based medicine. Combining the two in the same treatment by the same doctor will constitute

a new treatment and hence necessitate a trial which requires the approval of the ethics

committee. The same is true for a fixed-dose combination (FCD) of two approved drugs that

requires another approval under a new drug category.

DAILY NEWS BULLETINLEADING HEALTH, POPULATION AND FAMILY WELFARE STORIES OF THE DayMonday 20180108

The NMC is not a ‘commission’ as any commission requires the provision for a

developmental grant in the five-year plan. It’s also not ‘representative’ as there is no

representation of doctors from every state but only five elected zonal members in the

commission with only an appellant authority. The so-called four ‘autonomous’ boards, with

full powers, will have 12 nominated salaried full-time members with no representation from

elected members. The Bill is not ‘community-friendly’ as it will lead to medical education

becoming expensive. The percentage of fee for private colleges could increase from 15% to

more than 60% of seats.

One of the main contentions for replacing the bill was to get a new corruption-free

mechanism but the NMC has the potential to breed corruption in the future. Whole powers

are given only to three full-time nominated members in the board appointed on salary by the

government. The commission has only appellant powers; more than 60% medical seats in

private colleges will have no fee restriction and the penalty for violating norms will vary

from 1/2 to 10 times (for example, from 5 crore to 100 crore). Also, the central government

vests total control on waiving off penalty, giving permissions, and allowing doctors to

practice without fulfilling all norms.

The bill is also not ‘students friendly’. Those medical students who pass MBBS by grace but

fail in the licentiate exam will not be allowed to practice. It’s akin to being ousted from

cricket for successfully playing a five-day Test series but failing one T20 match. The ‘so-

called’ autonomous boards are not really autonomous as all boards are under direct control of

the government and the commission. And, the commission has regulatory as well as

directional powers. The secretary of the commission can be a non-doctor appointed by the

government.

The bill is not IMA-friendly, which was not made a part of discussions despite being the

largest stakeholder comprising of government and private doctors, students, teachers, and

hospitals. It is not ‘state medical council-friendly’ either as it takes away their autonomy to

function. Not only this, the NMC will even have directional power over state governments.

I hope the standing committee on health will rectify these anomalies and either amend the

present NMC act or bring a new act filling in all the deficiencies.

KK Aggarwal is former national president, IMA

Food poisoning

Food poisoning, a common outbreak in 2017 (The Hindu: 20180108)

http://www.thehindu.com/news/national/food-poisoning-a-common-outbreak-in-

2017/article22392234.ece

Incidence high in areas where food is cooked in bulk

Recent data put out by the Union Health Ministry’s Integrated Disease Surveillance

Programme (IDSP) has indicated that food poisoning is one of the commonest outbreaks

reported in 2017. This is apart from acute diarrhoeal disease (ADD).

According to the data, 312 of the 1,649 outbreaks reported till the third week of December

2017 were due to ADD and 242 were due to food poisoning.

The IDSP has interpreted that the incidence of ADD and food poisoning is high in places

where food is cooked in bulk, such as canteens, hostels and wedding venues.

Same trend

A.C. Dhariwal, Director of the National Centre for Disease Control (NCDC), the nodal

agency under the Union Health Ministry that documents outbreaks and brings out data under

its disease surveillance programme, told The Hindu that the trend had been the same over

many years.

“It is not just this year. Acute diarrhoeal disease and food poisoning have been common

outbreaks since 2008. This is followed by chickenpox and measles,” Dr. Dhariwal said.

Food poisoning, also called food-borne illness, is caused by eating contaminated food.

Infectious organisms including bacteria, viruses and parasites or their toxins are the most

common causes.

Dr. Dhariwal said it was important to follow safety measures and maintain hygiene while

handling food. “It is a matter of concern for all as food poisoning outbreaks have increased

from 50 in 2008 to 242 in 2017. Similarly, ADD cases have increased from 228 in 2008 to

312 in 2017,” he said, quoting the IDSP data.

Overall mortality

Pointing out that the increase in the number of cases was due to better and increased reporting

of cases, he said the good thing was that the overall mortality was not alarming.

K.K. Aggarwal, who recently stepped down as the national president of the Indian Medical

Association, said infectious organisms or their toxins could contaminate food at any point of

processing or production.

“Contamination can also occur at home if food is incorrectly handled or cooked,” he said.

“While it is known that raw meat, poultry and eggs can also harbour diseases, in recent years

most outbreaks of food-borne illnesses have been due to contaminated fresh fruits and

vegetables,” he said.

PTI reports:

4 of family found dead

Jharkhand: Four members of a family, including three minors, died, while three others were

hospitalised in a suspected case of food poisoning at Sitpahari village in Dumka district of

Jharkhand on Sunday.

The police said the family had its meal on Saturday night and went to sleep. After they failed

to wake up late on Sunday morning, nearby villagers informed the police.

A three-member board of doctors will conduct a postmortem.

Food and Nutrition

Changing your meal schedule can help lose weight (The Tribune:

20180108)

http://www.tribuneindia.com/news/health/changing-your-meal-schedule-can-help-lose-

weight/524943.html

Trying to lose weight? Changing your eating schedule — such as having an early dinner or

even skipping it — can help reduce hunger pangs and boost fat burning.

“Eating only during a much smaller window of time than people are typically used to may

help with weight loss,” said Courtney Peterson, an associate professor at University of

Alabama at Birmingham in the US.

“We found that eating between 8 am and 2 pm followed by an 18-hour daily fast kept

appetite levels more even throughout the day, in comparison to eating between 8 am and 8

pm, which is what the average American does,” said Peterson.

The study is the first human test of early time-restricted feeding (eTRF). This meal-timing

strategy reduced swings in hunger and altered fat and carbohydrate burning patterns, which

may help with losing weight.

With eTRF, people eat their last meal by the mid- afternoon and do not eat again until

breakfast the next morning.

The research suggests that eating a very early dinner, or even skipping dinner, may have

some benefits for losing weight, although further studies need to take place to confirm that

theory.

Previous animal studies showed that eTRF helped rodents burn more fat.

The human body has an internal clock, and many aspects of metabolism are at their optimal

functioning in the morning.

Therefore, eating in alignment with the body’s circadian clock by eating earlier in the day

may positively influence health.

This first test of eTRF in humans follows rodent studies of this approach to weight loss,

which previously found that eTRF reduced body fat and decreased the risk of chronic

diseases in rodents.

During the human study, researchers followed 11 men and women with excess weight over

four days of eating between 8 am and 2 pm, and four days of eating between 8 am and 8 pm.

Researchers then tested the impact of eTRF on calories burned, fat burned and appetite.

Participants tried both eating schedules, ate the same number of calories both times and

completed all testing under supervision.

Researchers found that, although eTRF did not affect how many total calories participants

burned, it reduced daily hunger swings and increased fat burning during several hours at

night.

It also improved metabolic flexibility, which is the body’s ability to switch between burning

carbs and burning fats.

Whether eTRF helps with long-term weight loss or improves other aspects of health is still

unknown. A larger, more comprehensive study will need to take place to find out, Peterson

said. — PTI

Dental health

Poor dental health ups frailty risk in older men: study (The Tribune:

20180108)

http://www.tribuneindia.com/news/health/poor-dental-health-ups-frailty-risk-in-older-men-

study/523920.html

Older men with oral health issues like tooth loss and gum disease are at an increased risk of

frailty, a study has found.

Frailty is the medical term for becoming more vulnerable to declining health or the inability

to perform the activities of daily living. It increases the risk for falls, disability, and even

death.

Over a three-year period, researchers, including one of Indian origin, examined the

relationship between poor oral health and older adults' risks for becoming frail.

The study, published in the Journal of the American Geriatrics Society, included 7,735

British men. They were first examined in 1978 to 1980 when they were 40 to 59 years-old.

In 2010 to 2012, the researchers invited 1,722 surviving participants to be re-examined.

During that time period, the participants were 71 to 92 years-old.

The participants were given physical exams, which included height, weight, and waist

measurements.

They also answered a questionnaire asking about medical, social, and health-related

information.

The exam included a dental test. Dental health professionals counted the participants' natural

teeth and measured the health of their gums.

They answered questions about their dental health, including if they had dry mouth.

The researchers also noted the participants' frailty status. They were considered frail if they

had at least three of these issues: exhaustion, weak grip strength, slow walking speed, weight

loss, or low levels of physical activity.

They found that 20 per cent participants had no teeth, 64 per cent had fewer than 21 teeth, 54

per cent had gum disease, 29 per cent had at least two symptoms of dry mouth, 34 per cent

rated their oral health as "fair to poor" and 11 per cent said they had trouble eating.

According to the researchers, men with dental issues were more likely to be frail than men

without those issues.

These dental issues included having no teeth, having trouble eating, having dry mouth

symptoms, or rating oral health as "fair to poor."

The experts also noted that complete tooth loss, dry mouth, and additional oral health

concerns were especially linked to developing frailty. — PTI.

Sleeping

Sleeping less than 8 hours a night can lead to depression (The Tribune:

20180108)

http://www.tribuneindia.com/news/health/sleeping-less-than-8-hours-a-night-can-lead-to-

depression/523921.html

Are you in the habit sleeping less than eight hours a night? Beware, you may be at risk of

suffering from depression and anxiety, according to a study.

Regular sleep disruptions can increase the difficulty in shifting attention away from negative

thoughts.

While other people may be able to move on from their negative thoughts, people low on sleep

can have trouble ignoring it.

This means that inadequate sleep is part of what makes negative intrusive thoughts stick

around and interfere with people's lives, the researchers said.

"We found that people have some tendencies to have thoughts get stuck in their heads, and

their elevated negative thinking makes it difficult for them to disengage with the negative

stimuli that we exposed them to," said Meredith Coles, Professor at the Binghamton

University.

"These negative thoughts are believed to leave people vulnerable to different types of

psychological disorders, such as anxiety or depression," Coles added.

For the study, published in the journal ScienceDirect, the team assessed the timing and

duration of sleep in individuals with moderate to high levels of repetitive negative thoughts

(e.g., worry and rumination).

The participants were exposed to different pictures intended to trigger an emotional response,

and researchers tracked their attention through their eye movements.

The timing and duration of sleep may also contribute to the development or maintenance of

psychological disorders, a finding that could potentially allow psychologists to treat anxiety

and depression by shifting patients' sleep cycles to a healthier time or making it more likely a

patient will sleep when they get in bed, the researchers said. — IANS.

Fat

When being fat is beneficial (The Tribune: 20180108)

http://www.tribuneindia.com/news/health/when-being-fat-is-beneficial/523917.html

Did you pile on the kilos this festive season? You can take a sigh of relief because being fat

may not be as unhealthy as believed.

According to a recent study, a team of scientists has discovered that the cells found in fat may

be crucial for helping your body fight infection, reports the Independent.

The researchers discovered that when fat was transferred from an animal that had been

exposed to particular bacteria to one that had not, the unexposed animal was able to fight off

infection as well as the one that had already encountered the bacteria.

The team also found that monkeys also have plenty of memory T-cells in their body fat and

that these cells worked better than those from other organs.

Speaking of the study, lead author Yasmine Belkaid said, “Once exposed to a pathogen, they

mount a stronger response the next time they encounter it.” This means that the memory cells

stored in our fat may have a more important function than previously realised. “It means that

fat tissue is not only a reservoir for memory cells, but those memory cells have enhanced

function,” noted Belkaid.

Belkaid thinks these memory T-cells are particularly powerful because they may be feeding

on the energy-rich fat tissue they are stored in.

Not all fat is good. When people become obese, the relationship between fat tissue and

immune cells seems to change, leading to harmful inflammation. However, having some fat

is very healthy, explained Belkaid.

The team is now looking for immune cells in biopsies of human fat tissue. If they find them,

the researchers will try to discover what exactly the fat cells do to boost the power of these

cells.

They hope this could lead to new ways to boost our body's immune response to infections,

cancer and vaccinations. — ANI.

Pollution

After November smog, family puts up pollution monitor at home (The

Tribune: 20180108)

http://paper.hindustantimes.com/epaper/viewer.aspx

Right next to a small park in C Block of New Friends Colony, a black panel with red digital

lights shows PM2.5 readings round-the-clock.

n Residents look at a pollution monitor in New Friends Colony.

It helps the morning walkers decide if they should go out.

Installed in November, this air monitoring device attached to a panel atop the boundary wall

of house C-770, has come as a boon for many.

“I take a peek in the morning from my balcony. If it says that particulate matter 2.5 is above

200 micrograms per cubic metre, I call it a day. If it is less than 200, I venture out for my

walks. It lets us know if the air outside is conducive for brisk walk and light exercising,” said

S Sharma, a local.

But what made this New Friends Colony household put up a PM2.5 panel?

The owner, Anjali Gupta, who has been living here since 2006, says her family runs a

company which makes such monitoring devices and panels.

“We took the decision to install this right after the November smog episode. We already had

one inside home. Some friends, who had come over, said you should also put one outside for

others in the neighbourhood. So we did,” Gupta said.

As per Gupta’s real-time monitoring, in this corner of the Capital PM2.5 levels hover around

200 micrograms per cubic metre at around 6am to 7am. It goes down to nearly 100 during the

day and on windy days, even touches 70 micrograms per cubic metre.

Gupta says said has air purifiers in all rooms. “When we see pollution is high, the purifiers

are put on full blow. When air quality is better, we turn them down,” she said. While the

monitor at her home seems to be helping her, many of her neighbours are perplexed with the

one outside.

“One of them came up and asked me, how come yours is showing 200 micrograms per cubic

metre when the government website says 400 micrograms per cubic metre? I explained it to

him that this is the air quality of our lane while the one you see on the website is of the traffic

signal,” Gupta said.

Environmental Health

Toothless ‘environment marshals’ face the heat (The Tribune: 20180108)

http://paper.hindustantimes.com/epaper/viewer.aspx

Deployed without any identity card to prove their new role, sans any powers to book

violators, and with just a few hours of training on pollution, Delhi’s ‘environment marshals’

are facing a tough time on the ground.

Rahul Kumar, one of the environment marshals who has not been given an ID for his new

role.

The state environment department claimed to have deployed 14 home guards as marshals in

seven municipal wards of three civic bodies. Plans are afoot to deploy 70 more.

A reality check by Hindustan Times, however, revealed that not all have reported on duty.

These marshals are seen as the replica of ‘smog police’ that was deployed in Beijing in

January 2017 to tackle pollution. While the environment police squad of Beijing was

empowered to detain suspect sin serious environment related cases, Delhi’ s marshals can

only take pictures and inform their bo

“We have been ordered to just observe and take pictures of open-garbage burning and

uncovered building material and inform our supervisors in the civic body and Delhi Pollution

Control Committee (DPCC) along with details of the location, time and violator. We cannot

issue a challan,” said Rahul Kumar, an environment marshal deployed in IP Extension.

LACK OF ID CARD

HT witnessed one incident when the environment marshal deployed in IP Extension spotted a

heap of uncovered sand near the gate of a society and then tried to enter it to investigate. But,

he was asked a volley of questions by the housing’s secretary: “Who are you? What is an

environment marshal? Why do you want me to know my name? Show me your ID card or

any document that you are a marshal. Do whatever you feel like, issue a challan, but not in

my name.”

The marshal could neither produce any identity card nor any document to prove that he was

an environment marshal. He could only produce the identity card of a home guard.

“This is one of the main problems we are facing on the field. Since most people are unaware

of what an environment marshal is, we have not been provided any identity card. We have a

home guard identity card and a letter from DPCC saying that home guards are being

deployed as environment marshals without naming any of the home guards. This does not

suffice,” said a marshal.

HT contacted some of the state environment department officials but they refused to divulge

any details. While the special secretary SM Ali refused to comment, the environment

secretary Anil Kumar Singh did not respond to any calls or messages.

“It is a welcome move but it should be done in a proper manner... Uniforms can also help. It

would also help the citizens to find them if they want to lodge any complaint,” said Ravi

Agarwal, director of NGO Toxics Link.

LIMITED KNOWLEDGE

As part of training, the Delhi marshals received a briefing for around three hours, in which

they were told what to look for and what action to take. “We were not told anything on

various sources of pollution, how each source and pollutant is different from the other and

how do they affect us. Sometimes when we try to stop violators, they confront us with

questions which we cannot answer. I am a commerce graduate and read about pollution only

in newspapers,” said one marshal.

MISSING MARSHALS

Their woes do not end here. These home guards were earlier deployed in local police stations.

But they claim that the local police stations were not informed about their new role.

“The SHO of the police station where I was deployed has no idea about my deployment.

Hence every day I have to go to the police station – once in the morning and once in the

afternoon – to register my attendance”

When HT spoke to a senior officer of the Mansarovar Park police station, where one of the

home guards was deployed before being roped in as an environment marshal, the officer said

that he is not aware of any such role. Sources said that because of this confusion, not all home

guards, who were deployed as marshals have joined duty. “Only one environment marshal

has joined in our ward. The other one never turned up,” said Devender Sharma, assistant

sanitary inspector of a ward in IP Extension. “... when I see poor street dwellers burning

leaves and twigs to keep them warm and have to douse the fire because of the orders we

really feel bad. But we are duty-bound,” said Pitam Singh a marshal deployed in Anand

Vihar area.

Best diets

What are the best diets for 2018 (Medical News Today: 20180108)

https://www.medicalnewstoday.com/articles/320543.php

When it comes to New Year's resolutions, eating better is at the top of our list. But which diet

plan is the best? A panel of health experts — on behalf of U.S. News & World Report —

reveal the top-rated diets for 2018.

Apples with 2018 engraved

U.S. News & World Report reveal the best diets for 2018.

It is estimated that around 45 million people in the United States go on a diet each year, with

weight loss being the primary goal.

However, whether you're dieting to lose weight or simply to improve overall health, sticking

to a specific eating plan can be challenging. With so many diets to choose from, how can you

tell which one will work for you?

U.S. News & World Report put together a panel of health experts every year to evaluate the

most popular diets in the U.S.

This year, the experts assessed 40 diets, ranking them from lowest to highest in seven

categories, including the best diets for weight loss, diabetes, and heart health. So, we take a

look at some of the key results.

The best diets for weight loss

For the majority of dieters, weight loss is the ultimate goal, but losing weight and keeping it

off is far from easy.

Research suggests that approximately 30–35 percent of weight lost from dieting is regained

within 1 year. But it is possible to maintain weight loss. It's just a matter of finding the right

eating plan.

The U.S. News & World Report panel of experts evaluated 40 popular diets for their effects

on both short- and long-term weight loss, noting that some people want to lose weight

quickly, while others want to maintain their weight loss for years to come.

The health experts rated Weight Watchers as the best diet on both accounts, scoring 4 out of 5

for short-term weight loss, and 3.5 out of 5 for long-term weight loss.

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One of the longest-running, well-known commercial diets, Weight Watchers incorporates a

points system, wherein foods and beverages are assigned points based on their nutritional

values, and dieters are assigned a daily points allowance.

According to U.S. News & World Report, the expert panel "appreciated the program's

support system, which helps dieters keep the pounds off."

The Volumetrics Diet came in at second place for best weight loss diet, scoring 3.8 out of 5

for short-term weight loss and 3.3 out of 5 for long-term weight loss.

Designed by Barbara Rolls, who is a professor of nutrition working at Pennsylvania State

University in Centre County, the Volumetrics Diet focuses on putting foods with low-energy

density, such as low-fat milk, grains, and non-starchy fruits and vegetables, at the forefront of

one's diet, as well as limiting foods with high-energy density.

The best diets for heart health

Heart disease is the leading cause of death for men and women in the U.S., killing around

610,000 people in the country every year.

A poor diet can increase the risk of heart disease, because eating food high in fat can lead to

high blood pressure, high cholesterol levels, and obesity, which are major risk factors for the

condition.

But which eating plan is best for a healthy heart? For this category, the health experts

analyzed each of the 40 diets and gave them average heart-health ratings.

The Dietary Approaches to Stop Hypertension (DASH) diet took first place in this category.

Developed by the National Heart, Lung, and Blood Institute — a part of the National

Institutes of Health (NIH) — the DASH diet is high in fruits, vegetables, whole grains, fish,

poultry, and low-fat dairy, but it limits foods high in sugar and saturated and trans fats.

The DASH diet was also ranked the best overall diet.

The Mediterranean diet — which emphasizes consuming fish and seafood at least twice

weekly, alongside regular consumption of fruits, vegetables, legumes, and whole grains —

took joint second place for best heart-healthy diet, alongside the Ornish diet.

With the Ornish diet, fat is limited to 10 percent of daily calories, and foods are divided into

five groups, from the least to most healthful.

The best diets for diabetes

The Mediterranean diet not only ranked highly for one of the best heart-healthy diets, but it

also took the crown for the best diabetes diet, scoring 3.7 out of 5.

It is estimated that around 30.3 million people in the U.S. are living with diabetes, wherein

blood glucose levels become too high due to the body's inability to produce or effectively use

insulin.

Although eating a healthful diet is important for all of us, people with diabetes need to be

extra cautious; skipping meals or eating the wrong foods may lead to problematic highs and

lows in blood glucose levels.

According to the panel, "The Mediterranean diet is a great option for preventing or

controlling diabetes. [...] Some research has shown that diabetics on a Mediterranean diet

may improve their levels of hemoglobin A1C, a measure of blood sugar over time."

The DASH diet makes yet another appearance here, ranking second in the best diabetes diet

category, with the experts noting that "its menu looks a lot like widely accepted nutritional

guidelines for those with the condition."

Whichever eating plan that you decide is best for you, it's important to note that physical

activity is just as important as the foods you eat.

Current guidelines recommend that adults should engage in at least 150 minutes of moderate-

intensity or 75 minutes of vigorous-intensity aerobic activity every week.

Vitamin B-12

Vegetarian and vegan sources of B-12 (Medical News Today: (Medical

News Today: 20180108)

https://www.medicalnewstoday.com/articles/320524.php

Health benefits Vegetarian foods Foods for vegans Symptoms Takeaway

Vitamin B-12 plays an essential role in a person's health. A lack of vitamin B-12 in a person's

diet can adversely affect their physical and mental health.

Vegetarians and vegans must take particular care to consume enough vitamin B-12, as it is

mainly found in meat, eggs, and dairy products. Therefore, it is more likely a vegan or

vegetarian will develop a vitamin B-12 deficiency.

In this article, we look at how much vitamin B-12 is required and list good vegetarian and

vegan sources.

Vitamin B-12 health benefits

Bowl of fortified granola or muesli cereal with strawberries and blueberries, with soya plant

milk being poured on top.

Fortified cereals and non-dairy milks provide a plant-based source of vitamin B-12.

Ensuring a person includes enough vitamin B-12 in their diet is essential for optimum health.

The health benefits of the vitamin include:

the formation and division of red blood cells

protecting the nervous system

synthesizing a person's DNA

providing the body with energy

The recommended daily allowance (RDA) of B-12 depends on a person's age:

Adults and teenagers: 2.4 micrograms (mcg) per day

Children between 9 and 13 years old: 1.8 mcg per day

Children between 4 and 8 years old: 1.2 mcg per day

Toddlers between 1 and 3 years old: 0.9 mcg per day

Infants between 7 and 12 months old require 0.5 mcg of B-12 per day, and babies less than 6

months old only need 0.4 mcg per day.

Pregnant women require 2.6 mcg, while breast-feeding women need 2.8 mcg per day.

List of B-12 foods for vegetarians

For vegetarians looking to increase their vitamin B12 intake, there are a variety of options.

Some good choices for B-12 include:

yogurt

low-fat milk

fortified plant-based milk

cheese

eggs

fortified cereals

nutritional yeast

While seaweed, algae, and certain mushrooms all contain vitamin B-12, they are not reliable

sources because they do not act the same way in the human body. Studies have found that

consuming these foods does not significantly increase a person's vitamin B-12 levels and can

still lead to a deficiency.

A vegetarian should be sure to consume enough of the following foods on a regular basis. It

is vital to understand how much vitamin B-12 these foods contain:

8 ounces (oz) of yogurt contains about 1.1 mcg of vitamin B-12

1 cup of low-fat milk can provide 1.2 mcg of vitamin B-12

1 oz of Swiss cheese can contain 0.95 mcg of vitamin B-12

1 large egg contains 0.6 mcg of vitamin B-12

Fortified cereals are a good choice as they have high bioavailability. This means that the

vitamin B-12 does not have to break down before the body absorbs it.

Everything you need to know about vitamin B12

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Nutritional yeast is popular with both vegetarians and vegans because it is easy to add to

dishes while cooking and has a rich, cheesy, nutty flavor. Nutritional yeast can be added to

cooked meals or sprinkled on food and snacks.

To use nutritional yeast, a person can:

sprinkle it on popcorn

mix it into cheese sauces

mix it into mashed potatoes

sprinkle over scrambled eggs or tofu

stir into a creamy soup

add to pasta dishes

put it on salads

B-12 foods for vegans

Bowl of nutritional yeast which contains vitamin b12

Nutritional yeast is a flavorful and versatile source of vitamin B-12 that is suitable for both

vegetarians and vegans.

Because vegans avoid all animal-derived products, they may rely on vitamin B-12 fortified

foods, such as certain breakfast cereals and nutritional yeast. Plant foods do not produce

vitamin B-12, so it is vital that vegans find alternative sources of vitamin B12 to remain in

the best health.

Some foods that can be fortified with vitamin B-12 include:

fortified non-dairy milk

meat substitutes

breakfast cereals

nutritional yeast

vegan spreads, such as Marmite

It is essential to read the labels on all of these foods, as some may not be fortified with

vitamin B-12. For those who are already B-12 deficient, supplemental B-12 in the form of

capsules or injections may be required.

B-12 deficiency symptoms

A vitamin B-12 deficiency can have severe consequences for a person's health. Common

problems associated with vitamin B-12 deficiency include anemia, certain neurological

disorders, and reduced growth and healing.

Common symptoms of a vitamin B-12 deficiency include:

Vegetarians and vegans should take steps to ensure they include an adequate amount of

vitamin B-12 in their diet. Health professionals can provide advice on where to find sources

of vitamin B-12 and how much they need to take.

Without maintaining proper levels of vitamin B-12, a person can suffer serious side effects,

including nerve damage and depression.

Since no plant-derived foods contain vitamin B-12, vegans and vegetarians should be aware

of alternative sources, such as fortified products.

Breast cancer

What you should know about breast cancer in teens ((Medical News

Today: 20180108)

https://www.medicalnewstoday.com/articles/320533.php

Rarity Types Symptoms Survival rate Checking yourself When to see a doctor

Breast cancer is extraordinarily rare in teenagers, so much so that most organizations do not

keep statistics for the disease in this age group.

Nevertheless, teens may worry that changes in their breasts during puberty are due to breast

cancer. To alleviate these concerns, they should monitor their breasts for changes and talk to

their doctor if they want reassurance.

They should also know that breast changes are nothing to fear and are unlikely to mean breast

cancer.

Fast facts on breast cancer in teens:

It is virtually unheard for the condition to occur in this age group.

The disease cannot be diagnosed or ruled out on symptoms alone.

Because it is so rare in teens, there are no reliable statistics on survival rates.

How does it occur in young women?

Breast cancer in teens

Younger women face a much lower risk of breast cancer and as such, it is very rare in

teenagers.

The changes that puberty brings can be scary for any young person. Young women develop

breasts for the first time and may be unaccustomed to their look and feel. Some may worry

about breast cancer.

Early breast development often begins as a lump under the nipple, which may compound

worries a young teen may have about breast cancer. These breast buds may also be sensitive,

triggering fears that something is wrong.

Parents and doctors should reassure teenagers about normal breast growth, since developing

breasts will be a new experience and can be unnerving.

Though rare, it is possible for a teenager to develop breast cancer. Breast cancer, as with all

cancers, occurs when normal cells begin growing and dividing out of control. Over time, this

growth can form a tumor that harms healthy tissue and may spread to other areas of the body.

About 12 percent of women will develop breast cancer during their lifetime. However, the

most significant risk factor for breast cancer is being older. Genetic and cellular changes over

time can increase the likelihood of unusual cell growth in the breasts. So, younger women

face a much lower risk.

Young women who develop breast cancer more often have aggressive, fast-growing tumors.

Their cancer may also be negative for hormone receptors that increase the chances of

survival.

In addition, younger women may wait longer before seeking treatment, meaning that the

prognosis for those with breast cancer is often worse than for older women.

Poor diet during teens, early adulthood may raise breast cancer risk

Poor diet during teens, early adulthood may raise breast cancer risk

Though extremely rare in teenagers, breast cancer in early adulthood may be more of a risk

for those with a poor diet. Learn more about the link between poor diet, as a teenager, and

cancer here.

READ NOW

How common is breast cancer in teens?

Even in young adult women, the odds of developing breast cancer are very low. Less than 5

percent of breast cancers occur in women under 40. At age 30, the risk of developing breast

cancer is 0.44 percent. There are less than 25 cases of breast cancer per year in women in

each age group under 30. Among teenagers, the figure is close to zero.

These statistics mean that issues with the breasts are almost certainly due to other causes and

these are often just normal development.

Other reasons a teenager might develop a lump in her breast include:

Fibroadenoma

A fibroadenoma is a benign breast tumor. Common among women in their 20s and 30s, these

lumps do not turn into cancer. They have clear borders and range in size from very tiny to

several inches. They are associated with a slight increase in the risk of breast cancer.

Cystosarcoma phyllodes

Phyllodes are tumors that grow fast, but they are almost always benign. They are very rare,

but in 10 percent of cases, they can spread to other areas of the body. So women with these

tumors may elect to have them removed.

Breast cysts

Cysts are small growths in the breast tissue, akin to pimples under the skin. Some women

have fibrocystic breasts, which means their breasts contain many cysts and may feel lumpy.

Teens who have fibrocystic breasts should talk to a doctor about their concerns. Knowing

how their breasts normally feel can help women with a lumpy breast distinguish cancer from

a cyst.

Types of breast cancer

Similarly to older women with breast cancer, teens with breast cancer can experience many

different types of the disease. The most common include:

In situ cancers

In situ means that the cancer is only in the breast. These cancers are easier to treat and less

likely to be fatal.

The most common types of in situ cancers are ductal carcinomas and lobular carcinomas. A

ductal carcinoma is a noninvasive cancer sometimes called pre-cancer or stage 0 breast

cancer. Lobular carcinoma grows in the milk ducts and typically does not spread.

Invasive breast cancers

Invasive breast cancers are forms of cancer that can spread, potentially affecting the lungs,

brain, liver, and other vital organs. They are more likely to be fatal, particularly if they are

not promptly caught and treated. There are invasive forms of both lobular carcinoma and

ductal carcinoma.

Less common cancers

Other breast cancers are far less common. They include:

inflammatory breast cancer, which may cause swollen or red breasts

Paget disease of the nipple, which spreads from the breasts to the nipple and areola

angiosarcomas or cancers that begin in blood or lymph vessels and spread to the breasts

phyllode tumors that turn cancerous

Symptoms

doctor checking breast of teenager Breast cancer in teens

Annual breast exams are recommended.

An annual breast exam and a relationship with a trusted doctor are valuable tools for

diagnosing breast-related conditions. Even teens that have several symptoms associated with

breast cancer should know that these are likely due to another cause.

Some 90 percent of breast lumps are not due to cancer. Cancerous lumps tend to be hard,

with irregular borders, not soft or movable.

Common breast cancer symptoms include:

a breast lump or lumps

swollen lymph nodes under the armpits or in the neck

unexplained changes in the size, shape, or symmetry of the breasts

changes in the skin of the breast or nipple

discharge from the nipple not related to menstruation, pregnancy, or breastfeeding

a breast that looks red or swollen

puckering or dimpling of the breast skin

an itchy, scaly rash on the breast

People with multiple breast cancer risk factors may be more vulnerable. Those risk factors

include:

having a mutation on the genes BRCA1 or BRCA2

having several relatives who have had breast or ovarian cancer

not being active or being obese or overweight

exposure to radiation

taking estrogen therapy or hormonal birth control pills

heavy drinking

smoking

Breast cancer vs. normal development

Normal breast development can resemble breast cancer, and it is not possible to tell what is

normal and what is not based on a comparison of symptoms.

Normal breast development, however, usually follows a pattern. It begins with nickel-sized

lumps under each nipple, and the breasts gradually grow from these lumps.

Surviving teen breast cancer

Breast cancer, in general, is survivable with prompt treatment. This is particularly true of

noninvasive breast cancers, and of breast cancers that have not spread to other areas of the

body.

Treatments often include chemotherapy, radiation, medication, surgery, or a combination of

these.

Checking yourself for breast cancer

Breast self-exams to check for lumps and other changes can help women detect the early

signs of cancer.

Even more important than looking for specific changes is knowing how your breasts feel

normally. A change in their shape or texture, a new lump, or other significant change could

signal a problem, including cancer.

Women should also get regular breast exams from their doctor. Those at high risk of breast

cancer may need annual mammograms, although teens almost never fall into this category.

When to see a doctor

Delaying treatment can reduce the chances of survival as it may allow a cancer to spread.

Girls concerned about their breasts should see a doctor immediately, even though teen breast

cancer is rare.

Parkinson's disease

What is early-onset Parkinson's disease? ((Medical News Today: 20180108)

https://www.medicalnewstoday.com/articles/320527.php

Definition Signs Diagnosis Treatment Management Caregiver tips Outlook

Early-onset Parkinson's occurs when a doctor diagnoses the disease in a person 21 to 50 years

old, according to the American Parkinson Disease Association.

While a Parkinson's diagnosis can be devastating at any time of life, being diagnosed with the

disease at an early age can significantly impact a young person's quality of life and that of

their family. Currently, there is no cure for the disease.

Because doctors most often diagnose Parkinson's disease in people around 60 years old, it is

likely that a much younger person with early-onset Parkinson's disease could remain

undiagnosed or misdiagnosed for some time.

Early-onset Parkinson's may also progress differently to the more traditional form of the

disease. Being aware of symptoms and risk factors may help a person get the treatments they

need as early as possible.

Early-onset Parkinson's definition

Early onset parkinsons

People with early-onset Parkinson's may not initially experience some of the symptoms

associated with the disease.

According to the American Parkinson Disease Association, an estimated 10 to 20 percent of

those with Parkinson's disease are diagnosed at an early age. This amounts to anywhere from

6,000 to 12,000 people under 50 years old in the United States.

Many people with early-onset Parkinson's will not experience some of the symptoms

associated with the disease for many years. People diagnosed with Parkinson's at an older age

tend to progress to these symptoms more quickly.

These symptoms include:

confusion

memory loss

problems with balance

However, people with early-onset Parkinson's are more likely to experience problems with

involuntary movements — jerking or other tics that a person has no control over. These

movements may be due to the disease itself or a result of the side effects of a medicine called

levodopa, which is commonly prescribed to treat the disease.

For this reason, some doctors will prescribe different medications to treat early-onset

Parkinson's.

In addition to differences in symptoms and treatments, those diagnosed with early-onset

Parkinson's disease also face different challenges in living with the disease. For example,

they may be parents of young children or just starting out in their careers without insurance or

savings for medical costs.

Parkinson's stages: Signs and symptoms

Parkinson's stages: Signs and symptoms

Learn more about the symptoms at each stage of Parkinson's disease.

READ NOW

Signs and symptoms

According to an article in the journal Translational Neurodegeneration, changes in the brain

begin to occur an estimated 6 years before a person experiences symptoms of Parkinson's.

Parkinson's disease causes a reduction of dopamine in the brain, which may be responsible

for movement-related symptoms. These symptoms are similar in people diagnosed with both

early-onset Parkinson's disease and those diagnosed at a later age.

Examples of movement-related symptoms include:

tremors, or all, shaking movements of the hands, arms, legs, jaw, or face

stiffness or rigidity of the arms, legs, or trunk

slow, stiff movements

affected balance

affected coordination

Parkinson's disease can also cause other symptoms besides impaired movement. These

include:

changes to thinking or memory

depression

problems going to the bathroom, such as constipation or urinary incontinence

sleeping problems

Diagnosis

an mri scanner being used to detect prostate cancer

A brain MRI scan may be used to rule out other conditions.

Currently, no specific test exists to help a doctor diagnose Parkinson's disease. Diagnosis

often involves ruling out other medical conditions that can cause similar effects. Doctors may

also compare a person's symptoms with those of a younger person already diagnosed with

Parkinson's disease.

Sometimes, a doctor may ask a person to keep a diary of their symptoms. Tracking these

symptoms over time may help a doctor to identify a Parkinson's-like pattern of symptoms.

Examples of diagnostic testing to rule out other conditions include:

imaging scans of the brain to test for brain abnormalities, such as tumors

blood testing to identify the presence of bacterial or viral illnesses, or cancers

Sometimes, a doctor might prescribe medications that are typically used to treat Parkinson's

disease to see if a person's symptoms improve. If a person's symptoms do improve, this might

suggest that a person has Parkinson's disease.

Treatment options

Traditionally, the treatment approach to early-onset Parkinson's has been to delay prescribing

medications until a person's symptoms start to affect their daily life significantly.

However, the Parkinson's medication levodopa and its variants, such as Carbidopa-levodopa,

are known to cause increased symptoms in a younger person with Parkinson's disease. As a

result, doctors may prescribe different medications, such as:

MAO-B inhibitors, such as selegiline (Eldepryl)

dopamine agonists, such as ropinirole (Requip)

These drugs are associated with fewer side effects in young people than levodopa.

Another therapy that has been shown to help people with early-onset Parkinson's is deep

brain stimulation.

This treatment involves implanting a small electrical device similar to a pacemaker into an

area of the brain involved in movement. A special programmer will adjust the electrical

stimulation levels to help a person have better motor control related to their Parkinson's

disease.

Living with early-onset Parkinson's

Support group

A support group may be recommended to help a person live better with Parkinson's disease.

Early-onset Parkinson's disease can affect how a person moves and thinks. These effects can

be understandably life-changing.

When a person is first diagnosed with early-onset Parkinson's, they might want to try some of

the following steps to help them live better with Parkinson's disease:

Educating themselves about the disease, its symptoms, and treatments.

Identifying a medical team to help care for them. This could include a primary care

physician, neurologist, psychiatrist, and physical therapist.

Discussing the diagnosis with their boss or colleagues and creating a plan to keep them

working for as long as they desire.

Finding support groups, both in person and online, to support them.

Identifying caregivers and loved ones who can offer encouragement and a helping hand.

While doctors do not know exactly what causes Parkinson's and early-onset Parkinson's, they

do believe that there is a genetic component to the disease. This is especially true for those

with early-onset Parkinson's disease.

As a result, a person living with early onset Parkinson's may wish to see a genetic counselor

if they are thinking of having children.

If recommended, a counselor may test for the presence of genes linked to early-onset

Parkinson's disease, such as SNCA, PARK2, PINK1, and LRRK2.

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