Therapies

PREMENSTRUAL SYNDROME
  INTRODUCTION  

Premenstrual syndrome (PMS) is a combination of signs and symptoms that many women may experience about a week or two before their menstruation, which includes mood swings, changes in emotional, physical health and behaviour.1 Three out of every four women experience physical or emotional changes in the days leading up to menstruation.2

  SIGNS AND SYMPTOMS3  

  • Irritability
  • Mood swings
  • Fatigue
  • Acne
  • Sleep disturbances
  • Appetite changes with food cravings
  CAUSES  

  • PMS occurs due to cyclic changes in hormone levels (i.e. oestrogen and progesterone)
  • Women who suffer from mental illnesses like depression or anxiety
  • Pre-existing family history of PMS1
  RISK FACTORS  

Women who are overweight or obese are at higher risk of PMS.4 Other common risk factors are as follows:

  • Smoking4
  • Lack of physical activity1
  • Lack of sleep1
  • High sugar and salt intake1
  • Physical, sexual or emotional trauma4
  • A stressful event in the past year4
  DIAGNOSIS  

There are no specific physical or laboratory tests that can be used to diagnose PMS. 5 Clinicians suggest that women should write down their symptoms and maintain a record of each day on a calendar or with a phone app. This information could be essential in the diagnosis.6

  TREATMENT OPTIONS FOR PMS  

While there is no cure for PMS, there are certain measures people can take to ease the symptoms. 7 Some of these measures are listed below.

  • Measures, such as avoiding stress or performing relaxation exercises prior to menstruation, drinking plenty of fluids, eating a balanced diet, exercising everyday at least half an hour, getting adequate sleep and self-care, can help to manage PMS.1
  • Various nutrition supplements, such as vitamins and minerals that include folic acid, magnesium, vitamin B6 (pyridoxine), vitamin E and calcium with vitamin D, have also proved to be helpful.7
  • Evening primrose oil a natural plant extract that contains gamma-linolenic acid (GLA), an omega-6 fatty acid that has both anti-inflammatory and analgesic (pain-relieving) properties, is also recommended. It is also used for the treatment of acne.
  • Simple painkillers, such as ibuprofen or paracetamol, may help with breast tenderness and the management of pain.7
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  REFERENCES  

  1. Healthline. PMS: Premenstrual Syndrome Symptoms, Treatments, and More. Available at:
    https://www.healthline.com/health/premenstrual-syndrome. Accessed on 4 March 2022.
  2. ACOG. Premenstrual Syndrome (PMS). Available at:
    https://www.acog.org/womens-health/faqs/premenstrual-syndrome. Accessed on 3 March 2022.
  3. Medicine Net. Premenstrual Syndrome (PMS). Available at:
    https://www.medicinenet.com/premenstrual_syndrome/article.htm. Accessed on 3 March 2022.
  4. Health Library. Risk Factors for Premenstrual Syndrome (PMS). Available at:
    https://www.winchesterhospital.org/health-library/article?id=20024#:~:text=Women%20who%20are%20overweight%20or,%2C%20sexual%2C%20or%20emotional%20trauma. Accessed on 4 March 2022.
  5. Mayo Clinic. Premenstrual Syndrome (PMS). Available at:
    https://www.mayoclinic.org/diseases-conditions/premenstrual-syndrome/diagnosis-treatment/drc-20376787. Accessed on 3 March 2022.
  6. Office on Women’s Health. Premenstrual Syndrome (PMS). Available at:
    https://www.womenshealth.gov/menstrual-cycle/premenstrual-syndrome. Accessed on 4 March 2022.
  7. Patient. Premenstrual Syndrome. Available at:
    https://patient.info/womens-health/periods-and-period-problems/premenstrual-syndrome. Accessed on 4 March 2022.
INFERTILITY
  INTRODUCTION  

Infertility is defined as the inability to achieve a pregnancy after 12 months or more of regular unprotected sexual intercourse.1

Infertility is a commonly occurring problem in both genders of the reproductive age group. It is a medical condition that can cause psychological, physical, mental and medical disability in the patient.2

According to the World Health Organization, infertility is a serious health condition affecting approximately 8% to 10% of couples worldwide.1

  SYMPTOMS  

The signs and symptoms of infertility in women are:3

  • Pain during sex
  • Menstrual changes like: heavy, long or painful periods, dark or pale menstrual blood, irregular menstrual cycle, premature menopause, polycystic ovarian syndrome, endometriosis (growth of uterine tissue outside the uterus), etc.
  • Hormonal changes
  • Anxiety

The signs and symptoms of infertility in men are:

  • Hormonal imbalance3
  • Erectile dysfunction3,4
  • Problems with ejaculation3
  • Decreased size of testicles3
  CAUSES  

Female infertility may be caused due to:1

  • Damaged or blocked fallopian tube, which generally occurs due to untreated sexually transmitted infections or complications of unsafe abortion
  • Uterine disorders such as endometriosis
  • Imbalance of reproductive hormones. Pituitary cancers and decreased size of the gland, examples of common disorders affecting the reproductive system.
  • Ovarian disorders like polycystic ovary disease or ovarian cancer.

Male infertility may be caused due to:1

  • Reduced sperm production or sperm motility.
  • Obstruction of the reproductive tract causing dysfunctionalities in the ejection of semen.
  • Hormonal disorders leading to abnormalities in hormones produced by the pituitary gland and testicles.
  • History of genital surgery, sexually transmitted infections, chemotherapy and radiotherapy. 3
  • In a few advanced varicocele (an enlargement of veins in the scrotum).5
  RISK FACTORS  

In both male and female reproductive systems, there are many risk factors for infertility, including: 6

  • Age: Women's fertility gradually declines with age, especially in the age of 30–39 years compared to women who are younger than 30 years. Men over the age of 40 years may be less fertile.
  • Smoking
  • Excessive alcohol use.
  • People with obesity or underweight.
  • Excessive physical or emotional stress that results in amenorrhoea (absence of menstruation).
  DIAGNOSTIC EVALUATION  

There are five diagnostic evaluation categories for infertility:2

  • Semen analysis
  • Assessment of ovarian function and reserve
  • Hormonal testing
  • Radiological evaluation of the uterus
  • Fallopian tubes by hysterosalpingogram7

According to the gold standard, laparoscopy is indicated as a first-line diagnostic test for suspected pelvic adhesions, endometriosis or other pelvic pathologies, and hysteroscopy is used with saline infusion sonogram to access the uterine cavity abnormalities.

  TREATMENT  

Treatment options are as follows:8

  • Medical treatment for lack of regular ovulation
  • Surgical procedures such as treatment for endometriosis, repair of the fallopian tubes or removal of scarring (adhesions) within the womb or abdominal cavity
  • Assisted conception such as intrauterine insemination or in vitro fertilisation

These treatment options aim to eliminate the causes of infertility.

Role of nutritional supplementation in the treatment of infertility9

  • Folate (vitamin B9) is an important nutrient that is involved in oocyte (immature egg) quality and maturation, implantation (a stage at which the embryo adheres to the uterine wall), fetal growth and organ development.
  • Effects of zinc:
    • In males:
      • It accelerates the onset of sexual function
      • Improves sperm count
      • Improves sperm motility and morphology
      • Improves testosterone concentration
      • Improves sexual potency
    • In females:
      • It helps in sexual development, ovulation and the menstrual cycle
  • Antioxidants such as vitamin B, C and A are responsible for improving cellular damage in semen and improving egg quality.
  • Natural astaxanthin increases sperm concentration and linear velocity, thus exerting a positive effect on male infertility.
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  REFERENCES  

  1. Infertility. World Health Organization. 2020. Available at: https://www.who.int/news-room/fact-sheets/detail/infertility#:~:text=Infertility%20is%20a%20disease%20of,on%20their%20families%20and%20communities. Accessed 08 March 2022.
  2. Walker MH, Tobler KJ. Female Infertility. [Updated 2021 Dec 28]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan. Available at: https://www.ncbi.nlm.nih.gov/books/NBK556033/. Accessed 08 March 2022
  3. Kamel RM. Management of the infertile couple: an evidence-based protocol. Reprod Biol Endocrinol. 2010;8:21. doi:10.1186/1477-7827-8-21
  4. Katib A. Mechanisms linking obesity to male infertility. Cent European J Urol. 2015;68(1):79–85.
  5. Gonda RL, et.al. Diagnosis of subclinical varicocele in infertility. Am J Roentgenol. 1987;148: 71–5.
  6. Infertility FAQs. Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion. 1 March 2022. Available at: https://www.cdc.gov/reproductivehealth/productspubs/index.htm. Accessed 08 March 2022.
  7. Samuel Smith et al. Diagnosis and management of infertility. JAMA. 2013;290(13):1767–70.
  8. National Health Service [Internet]. UK. NHS conditions. Available at: https://www.nhs.uk/conditions/infertility/. Accessed 08 March 2022
  9. Ebisch IM, et al. The importance of folate, zinc and antioxidants in the pathogenesis and prevention of subfertility. Hum Reprod Update. 2007;13(2):163–74.
OSTEOARTHRITIS
  Table of contents  

  • Overview
  • Risk factors for osteoarthritis
  • Clinical features: Signs and symptoms
  • Diagnosis
  • Treatment
  Overview  

  • Osteoarthritis is one of the most common types of arthritis, which causes inflammation and injury to the joints leading to bony changes, deterioration of tendons and ligaments and a breakdown of cartilage
  • It is more likely to develop in older age individuals
  • Approximately 80% of older persons, aged more than 55 years, have evidence of osteoarthritis on X-ray
  • After menopause, women are at an increased risk of knee osteoarthritis
  • Osteoarthritis most commonly affects the joints of the knee, hip, lower back, neck, hands and feet
  Risk factors for osteoarthritis1  

  • Obesity
  • Older age
  • Women are at increased risk of osteoarthritis
  • Diabetes and hyperlipidemia (elevated levels of lipids or cholesterol)
  • Low oestrogen levels as experienced by post-menopausal women
  • Heredity
  Clinical features: Signs and symptoms1  

  • Joints affected by pain might hurt during or after movement
  • Joint stiffness may be most noticeable upon awakening in the morning or after being inactive
  • Swelling may be triggered by soft tissue inflammation around the joints
  • Tenderness: Feeling of pain while applying mild pressure
  • Loss of flexibility: Reduced ability to move the joints through its full range of motion
  • Grating sensation: Feeling of a grating sensation whenever there is a movement in the joints, and there may be a cracking sensation in the joints
  Diagnosis  

  • X-ray of the joints reveals cartilage loss with narrowing of the space between the bones in the joint
  • X-ray also shows bone spurs around the joint
  • Magnetic resonance imaging (MRI) can help provide more information in complex cases
  Treatment  

  1. Non-steroidal anti-inflammatory drugs (NSAIDs) such as paracetamol and ibuprofen can be used
  2. Physiotherapy: Exercises to strengthen the muscles around the joint can help increase flexibility and reduce pain
  3. Transcutaneous electrical nerve stimulation: This uses a low-voltage electrical current to relieve pain
  4. Cortisone injections
  5. Lubrication injections: Hyaluronic acid injections
  6. Joint replacement
  Alternative medicine  

Complementary and alternative medicine treatments, which have shown promising results in the management of osteoarthritis, include the following:

  • Acupuncture
  • Glucosamine and chondroitin as nutritional supplements
  • Omega-3 fatty acids
  • Bioactive collagen peptides (BCPs)
    • Recent studies have shown that collagen peptide was absorbed and distributed to joint tissues, thus reducing pain and inflammation
    • In several clinical trials, BCP supplementation has demonstrated a positive effect on pain and mobility in patients with osteoarthritis
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  REFERENCES  

  1. Mayo Clinic. Osteoarthritis. Available at: https://www.mayoclinic.org/diseases-conditions/osteoarthritis/diagnosis-treatment/drc-20351930. Accessed on 22 February 2022
  2. Kumar S, et al. J Sci Food Agric. 2015;95(4):702–7.
  3. Oesser S, et al. Osteoarthr Cartil. 2016;24:S63–S534.
NUTRITION
  INTRODUCTION  

Nutrition is an important component for overall wellness and health.1

Nutrition is a process by which substances in the food are transformed into body tissues and provide energy for the physical and mental activities that make up human life.2

The food that we eat undergoes many processes such as, digestion, absorption into blood and transportation to various parts of the body, and utilises the materials necessary for growth, renewal and maintenance of the body components. The waste products and undigested food are excreted from the body.2

  Types of nutrients  

Based on an individual’s needs, nutrients are divided into two types:

1. Macronutrients, which are needed in large amounts by the body. They essentially provide energy (or calories) to fuel up the bodily functions.3

Macronutrients are proteins, fats and carbohydrates.

These macronutrients contribute to the total energy intake as follows:4

1 gram fat = 9 kcal/g (Cal/g)

1 gram carbohydrate = 4 kcal/g (Cal/g)

1 gram protein = 4 kcal/g (Cal/g)

2. Micronutrients, are needed in small amounts by the body mostly responsible for building immunity and overall growth and development of the body. Micronutrients are vitamins and minerals.

  Factors affecting the nutritional requirements5  

Biological factors

  • Age
  • Height/weight
  • Gender
  • A host disease
  • Genetic factors

Non-biological factors

  • Poverty
  • Low socio-economic status
  Malnutrition6  

Malnutrition occurs due to deficiencies, excesses or imbalances in a person’s intake of energy and/or nutrients.

Based on conditions, malnutrition can be:

  • Undernutrition: Wasted growth (low weight-for-height), stunted growth (low height for age and underweight (low weight-for-age).
  • Micronutrient-related malnutrition. This occurs due to the lack of important vitamin and minerals or micronutrient excess.
  • Overweight, obesity and diet-related noncommunicable diseases (such as heart disease, stroke, diabetes and some cancers).
  Role of nutrition in maintaining health3  

Nutrition is a basic element of health. Adequate nutrition plays a major role in maintaining health and wellness and many disease states.

Growth and development:

  • Infant life and child: good nutrition helps in the growth and development during fetal life and childhood. Physical growth, intellectual development, learning and behaviour are essential while growing.
  • Adult life: elderly people need special nutrition due to their physiological and chronological changes.
  • Women: and lactating mothers require more proteins and nutrients to prevent abortion, growth retardation and low birth weight in infants and provide adequate breast-feeding for their babies. Good nutrition prevents miscarriage and helps in healthy breast-feeding habits for babies.

Specific deficiency disease: A good nutrition is essential to prevent nutritional deficiency diseases such as protein energy malnutrition, blindness, goitre (enlargement of thyroid gland), low haemoglobin, beriberi (vitamin B1/thiamine deficiency), rickets (vitamin D deficiency), etc. are common in India. It also helps to prevent increased incidence of abortion, prematurity, stillbirth and low birth weight babies in malnourished mothers and helps in the treatment of deficiency diseases.

Resistance to infection: Balanced nutrition helps prevent infections like tuberculosis, enhances wound healing and improves the resistance to an individual's infection.

Mortality and morbidity: Malnutrition increases the risk of death, neonatal mortality, stillbirths, and early births. The leading cause of death is prematurity, and poor nutrition leads to obesity, diabetes, hypertension, cardiovascular and renal disorders and causes death.

Functions of each nutrient in development of the bodily functions7

Name of the nutrient Function
1. Fats (saturated fats, trans fats, monounsaturated fats and polyunsaturated fats)
  • Omega 3 fatty acid (a type of polyunsaturated fatty acid) has three types: Alpha-linolenic acid, eicosapentaenoic acid, and docosahexaenoic acid.
Acts as an energy source for the body functions and structural components of cells. It provides insulation to vital organs and helps in maintaining body temperature.
These are the components of cell membranes that affect cell function.8
Additionally, they aid in preventing heart disease, maintain vision, brain function, control eczema, lupus, rheumatoid arthritis and cancer.
2. Proteins Are building blocks of the body. It provides support in tissue and organ formation, cellular repair, hormone and enzyme production.
3. Minerals Maintain fluid balance, build bone tissue, synthesize hormones and transmit nerve impulses.
4. Vitamins
  • Water soluble (vitamin B1, B2, B3, B5, B6, B7, B12, C)
  • Fat soluble (vitamin A)
  • Vitamin D
  • Vitamin E
  • Vitamin K

Assist in energy metabolism
Improves vision
Maintains bone and teeth health
Acts as an antioxidant, provides cell membrane function
Helps in blood clotting
5. Water Acts as a transport medium for all the nutrients within the body
  OUR BRANDS  

  REFERENCES  

  1. World Health Organization. Nutrition. Available at: https://www.who.int/health-topics/nutrition. Accessed 11 March 2022.
  2. Carpenter K, et al. Human nutrition. Encyclopedia Britannica. 2021. Available at: https://www.britannica.com/science/human-nutrition. Accessed 11 March 2022
  3. Alex M. Role of nutrition in maintaining health. IJPESH. 2020;7(4):279–80.
  4. Yoshita K, et al. Total energy intake and intake of three major nutrients by body mass index in Japan: NIPPON DATA80 and NIPPON DATA90. J Epidemiol. 2010;20 (Suppl 3):S515–S523.
  5. Jackson RT. Some factors influencing variation in nutritional needs and requirements of children. J Child Health. 2003;1(2):173–80.
  6. World Health Organization. Malnutrition. 9 June 2021. Available at: https://www.who.int/news-room/fact-sheets/detail/malnutrition. Accessed 11 March 2022.
  7. Introduction to Nutrition. (28 April 2019). University of Hawai’i at Mānoa. Available at: https://med.libretexts.org/@go/page/8675. Accessed 11 March 2022.
  8. National institute of health. Available at: https://ods.od.nih.gov/pdf/factsheets/Omega3FattyAcids-Consumer.pdf. Accessed 14 March 2022.

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