Friday, August 30, 2013

Curd, Yoghurt and Probiotics

Curd, Yoghurt and Probiotics

So stop feeding it mindlessly...
I have often written on this blog (here and here) about the useful role antibiotics play in combating life threatening infections.  But I have also been repeatedly asked by the readers about the side effects of giving antibiotics and so I reasoned that instead of answering individually to every commenter who raises the same question again and again let me write out a detailed blogpost on it to which I can refer them to next time i get asked. So bear with me as I take you on a slightly detailed tour of the side effects of antibiotics and what we can do to minimize them.

For those who came late to class or are just reading this blog for the first time- the short version is - antibiotics are germ killers, drugs which destroy bacteria in our bodies. now if you pay careful attention you can see that that I said "bacteria" and not "harmful bacteria" for antibiotics not only kill off the disease giving bacteria (called pathogens) but also their harmless cousins living inside our body (called commensals) which actually have some good effects on us- an example would be like spraying a weed killer and killing the grass too.

Now if you think that this killing off of a few harmless bacteria is of no consequence let me assure you that it does have some direct effects on our health. The current theory of human health called the human microbiome theory - says that human bodies are a mass of human cells and bacterial cells with the bacterial cells outnumbering the human ones - which means we are more bacteria than human. Kind of a difficult concept to get around our head isn’t it? 

So the theory goes on to say that as long as these healthy and harmless bacteria dominate our bodies they do two things for us. Their first help to us is - the good bacteria prevent the harmful, disease causing bacteria (like Clostridium Difficile - the dysentery causing bacteria) from multiplying limitlessly and dominating our stomach (imagine getting daily dysentery or rather don’t) and the second benefit of the good bacteria is that they produce good things for us like absorbing vitamins - the intestinal bacteria or our gut bacteria is mainly responsible for absorbing Vit.B-12 from our guts - from the food which we eat. In the absence of these bacteria the vitamin is not absorbed and passes straight out through our body- from the other end- uselessly. 

Our Gut has a 100 trillion Bacteria inside it
So that makes it a no-brainer doesn’t it? we need these bacteria for better absorption and digestion of our food and in the absence of these bacteria we are not only losing all the important bits of the food we eat -getting nutritional deficiencies in the process but even if we take tablets full of supplements even that is not going to be absorbed but only lost from our bodies. Hence we need these bacteria to survive and they need us to thrive- a simple give and take relationship- till death do us part.

Now all this is disturbed - temporarily- when we take antibiotics. Our digestive system is put out of sync with our body and we get loose stools called AAD- Antibiotics Associated Diarrhea, which is by far the biggest side effect of taking antibiotics. And that’s where some scientists thought up the idea of Probiotics- which is the very opposite of Antibiotics. If "Anti"-biotics kill bacteria then "Pro"-biotics help bacteria grow, right? And the way to do it is by adding live bacteria to the diet through various supplements and food products like yoghurt and curd.

Fortified Yoghurts come in many sizes

Some of the commonest probiotics contain organisms like Lactobacillus and yeasts which are freeze-dried to preserve them in tablet form. Once inside our stomachs they can gain their original forms, multiply and restore the good vs bad bacterial balance. The same purpose is solved by eating yoghurts and curds and fermented products which contain natural probiotic yeasts and bacteria. Yoghurts are thought to contain single varieties of bacteria only while natural homemade curds have been found to contain both yeasts and bacteria in abundant numbers - the more the merrier (better) .

So this has made it simple right? When you take antibiotics you better take some probiotics too - to prevent the side effects. But unfortunately it’s not so simple - hard scientific evidence of the benefit of taking probiotics is still not available and there are still questions about which are the actual beneficial bacteria and how much to take and whether the yeasts (which are fungi) can take advantage of an already sick body with a weakened immune system. Till now, despite numerous studies going on all over the world, we don’t have clear answers for the doubts whether probiotics really work as they are claimed to do. The only hard evidence is from a Cochrane Review (Johnston,2011)- Cochrane reviews can usually be trusted as good science- after studying 3400 patients decided that probiotics work and are beneficial to a certain extent.

So we can conclude off by deciding that taking Probiotics  helps in preventing the stomach upsets after taking antibiotics even if we don’t know which antibiotics is taken or for how long it is taken. And natural probiotics like curds and yoghurts certainly are better than the tablet supplements which have been stored for months together as dried forms. After all the very definition of a probiotic is a LIVE bacteria which benefits the host by improving the intestinal microbial balance and so what good is a tablet which has stayed in a pharmacy fridge for months together and the bacteria are all dead. If fermented milk contains the best bacteria which is made into the tablets- then its better to eat some live yoghurts or curds in that case, right? 

All natural, home-made Curds are the best

 So next time you hesitate to take an antibiotic because antibiotic tablets always gives you a tummy ache and loose stools - go eat some good, home-made curds and thank the good bacteria for helping to restore balance inside your body. 

P.S. there is one yucky way of sending in the probiotic bacteria immediately (and directly) to your stomach - only used in desperate cases - called Fecal Transplant- but let’s not even go there - I don’t want to talk about it and chase you off my blog forever. So, just eat curd/yoghurt through your mouth ok?

Tuesday, August 27, 2013

Biriyani Vs The Babe

For the Love of a Good Biriyani

An enticing plate of Chicken Biriyani
There is this girl I have been seeing recently and I had assumed (optimistically, as usual) that I was onto a good thing. Till a sudden revelation, something like a bombshell falling squarely on my head, came when I least expected it and showed me a different side to her beyond the obvious prettiness which had attracted me. There we were, having a cup of coffee on Sunday talking about innocuous/safe subjects (or so I thought) like two people prefer to chat on in the initial stages of courting, when the talk veered around to her travels in Europe- she being a frequent traveler to those parts in the course of her busy work life. And that’s when she went on to say (with a shudder) that she hated all europeans as they all stank so bad all the time because, you know, they eat non-veg food (for the un-initiated a non vegetarian eater is someone who eats meat/fish/egg or basically anything which is not a plant, which is all that pure vegetarians or plant eaters eat) and what else can you expect from "such" people, she asked me. 

Alarmed at her blanket condemnation of non vegetarians as stinkers, I stopped to sniff my arm pits (twice) just to make sure she didn’t mean present company and once satisfied that the deodorant I had sprayed on earlier was still masking my  natural scent I leaned back away from her (why risk it?) and in a aww shucks you must be kidding me tone of voice, I asked her to explain in fuller detail her theory of non-vegetarian stinkiness, which of course she was happy to do, for which girl can resist talking non-stop on her pet hates? In a rambling speech full of disdain for people other than the "superior caste" to which she belonged, she expounded her pet theory of how  meat eaters were responsible for the downfall of our once great society and for which sins they would all be punished severely after death by lord Yama (the Indian Hades).

And as she dug more and more the grave of our friendship, I couldn’t help but reflect how even an expensive education and a good job traveling around the globe couldn’t erase the prejudice against the “other” instilled in her from her early "orthodox" upbringing. Her modernity had just been a veneer to cover up the shallowness and prejudices underneath. Here was a perfect example of obscurantism masquerading as traditionalism and if parents brought up their kids instilling such thoughts we would soon see an Indian version of the taliban. Of course the blame should be equally divided between her parents who had failed to teach her that all human beings are born equal and her education which had failed to bring her to the same realization independently. She took my silence as agreement with her views and went on and on about the ugly habits (and lifestyles) of non-vegetarians in general and how infinitely superior vegetarianism was as deriving its authority from the ancient vedas and how they alone were the ones dedicated to the maintenance of the purity of our great Indian culture and vedic way of life (vegetarianism) - at which point I felt that I should maybe introduce her to my best buddy in college –arun raghavan. 

Arun and Me - 1ong, long ago - singing Yeh Dosti
 My friend Arun's from the same caste/sect as this girl was- a Tambrahm- but I have never seen anyone else who could polish off a plate of chicken 65 faster than him- so much so that whenever we ate out (on our meager pocket moneys) to celebrate our minor achievements in college - it was a case of the fastest eater gets the most pieces when it comes to side dishes like chicken 65 or butter chicken. I am sure every one of you has known a friend or two like that in your life, who you miss every time you leave a dish half-finished. Anyhow, my point is all kinds of people enjoy eating meat in our modern society and there is no relation between what you eat and what your status in society is. And even if most tambrahms are vegetarians from birth - as specified by their tradition- I haven’t found them to be haters of non-vegetarians like the person who was sitting opposite me prattling away her pet theories of hate for others.

A delectable Chicken 65

 As I sat there listening to all the caste BS she was spouting, I could feel all the mystique of her attraction evaporate like mist and my respect for her growing less and less with every minute. I couldn’t help but think on what a long term relationship with her would mean- no more chicken 65, no more butter chicken, no more mutton roghan gosht, no more mutton biriyani, no more sampling the fine things of life, which alone make life bearable. Was any girl worth this hassle? Of turning into a lifelong vegetarian? What was it to be- a hot biriyani or a hot babe? 

In the end I was thankful that a totally innocuous topic of conversation had helped me see a hidden facet of her- the realization that here was a closet bigot who covered up her prejudices under a false modernity. Wearing modern wear does not translate into modern thoughts- there was still the same old caste fanaticism in her talk by the way which she used even the culinary choices of others who didn’t subscribe to her traditional way of life as evidence of their inferiority to her caste. 

I suddenly felt I needed air, fresh air away from all this and I hurriedly mumbled my excuses and made a break for it before my temper got the better of me and I said something to show my utter contempt at her assertions of caste superiority.  I almost never get angry and rarely lose my temper and I most definitely don’t insult girls (at least to their faces) - but in this case I was tempted to make an exception. Only the reminder that she was there as my guest that day and Athithi Devo Bhave (guests are god)- as per our "superior" culture which prevented me from speaking my mind frankly on her superiority bias.

A half hour later - as I was traveling back home in the auto rickshaw I made a sudden life decision- one of the most important ones of my life. I told the auto driver “Bass, don’t cross the Chintamani signal, just drop me off at the Buhari Hotel entrance” and getting down at Buhari restaurant I went in, ordered a mutton biriyani and chicken 65 and ate with the relish of a condemned prisoner who escaped the noose at the last minute. And I sent a silent thank you up there for rescuing me from a fate worse than death- which I might have fallen into eyes wide open, if not for providence and a loose tongue. 

Moral of the story- Bi***s come and go, but a good Biriyani is forever.

P.S. I wish all the bigots could take a trip out to space and from there once they take a look at our earth- a small little planet in the huge cosmos- they will realize how stupid all this artificial divisions of race, religion, caste and colour is.

Thursday, August 22, 2013

Can You Judge Beauty?

Can You Judge Beauty? Oh! Really?

Yesterday I was forwarded a journal article by a colleague of mine to ask for my opinion of it. The article was an interesting study about biases by doctors in judging the esthetics of a patient, in simple words, in judging whether the patients face was beautiful or not. Now there is an old aphorism which says beauty is in the eye of the beholder or in Plato the Greek philosopher’s words- "We behold beauty with the eye of the mind" a beautiful little explanation of why we see what we see. Till recently, with the absence of effective ways to judge beauty our idea of what we would call “beautiful” was more subjective than objective- often involving snap judgments and wolf whistles as a sign of appreciation- but the development of aesthetic analysis software has the made the job of comparing individual beauty to a standardized ideal beauty easier- like comparing your face to some beautiful person you know - say Monica Belluci and getting a result based on the differences (in percentages) between the faces of you two to see how beautiful you are rank wise.

 Of course, as walking, thinking human beings and not mindless calculating machines each of us have different opinions on what constitutes beauty and we don’t follow the standardized ideal of a software program. Which in fact explains all those hopelessly mismatched happy couples we see wandering around the shopping malls holding hands. "What does he see in her? And what does he have that I don’t have?" are the often heard anguished questions for which there is no right answer. It happens, just happens was the explanation we were giving till now. But now this study explains a bit about the reasons for why we make subjective decisions in judging beauty- by blaming it on human errors and biases.

The current study (Photos vs silhouettes for evaluation of profile esthetics by Matheus Melo Pithona; Iane Souza Nery Silvab; Published Online: August 19, 2013- The EH Angle Education and Research Foundation) And a similar study published earlier both try to show the evidence of such bias. The study is simple- it shows a series of photographs of faces of people from the very beautiful to the not-so beautiful to a group of volunteer judges and the same photographs with all the details blanked out except for the silhouettes to the same group and they are asked to analyze which ones are beautiful and which ones are not. This is because the examiners wanted to prove that there are two different ways of judging faces- one set of people believe that a pleasing face with good esthetic's is because of many different factors which can only be judged from complete photographs while the other group believe that using blanked-out silhouettes removes all the distractions from a patients face and allows us to judge only the outline of a face to see whether it looks beautiful or not - a simplified method of decision to avoid examiners own preferences and biases regarding hair, complexion and make-up.

 The examiners achieve a high degree of correct results in the silhouettes with faces blanked out (in the 90 the percentages) but in the case of the full photographs they achieve only results in the 70th percentages which is explained by the authors of the study as subjective bias based on distracting factors in the face. For example- looking at someone with high cheek bones, a perky little nose and a somewhat thin and protruding lips in the full photo- the examiners took an overall view that the lips did not look so out of place when seen in the face because the nose and cheek bones attracted attention and dominated the overall look diverting us from the deficiency of the lip. In other words photographs made us judge beauty of the overall face and to be more forgiving of minor lapses here and there while silhouettes made us stricter and have a higher standard of beauty.

So the study concludes by saying that human sympathies should be removed when judging beauty and strict standards should be applied by comparing our faces to an ideal beauty standard as done by computer software. Put simply- humans are prone to biases and computers are better- they don’t fall for beauty because they are strict officers. When someone is ugly- a computer will say without mercy that they are ugly- but we humans try to find beauty even in that ugly face - so don’t trust human judgment. This is the actual conclusion of the study- though they have put it in more polite language- but just wordplay you know. 

And so I e-mailed my friend back with the opinion that even though I agree with the overall results of the study that human judges are prone to biases especially when seeing full photographs, I have to disagree with some of the conclusions drawn from the results. As someone who works in the esthetic's field I have occasionally been called on to officiate as a judge in beauty pageants and I remember that most of the winners were judged on a variety of parameters like poise and posture and overall pleasing faces rather than on a strict application of aesthetic rules and measurement of the tip of the nose to the tip of the chin to see if they fall in the same straight line. In fact most winners were selected as they walked down the ramp towards the judges and even before they could approach near enough to clearly scrutinize their faces and make a decision.

So we have to agree that humans have different ideas of beauty and as long as there is an overall sense of pleasantness about the face and facial harmony with no especially obvious defect- surgical intervention is not recommended. Finally, in my view, the true portrayal of what we see and how we interpret beauty is based on instinct rather than on education and expert analysis.  We instinctively feel that someone is either beautiful or not and others judgment - including that of an infallible software program rarely changes our opinion. In the end, beauty is a gut feel and not based on any rating system. And the only true connoisseurs of beauty are the ones found sitting on parapet walls or lounging around street corners - wolf-whistling impartially at every girl who passes by regardless of her facial attractiveness or aesthetic ratings, don’t you agree?


Tuesday, August 20, 2013

For a “Purr-fect” Nude Look…..

For a “Purr-fect” Nude Look…..

"If you were me, would you go with the nude look?" she asked and I replied "oh honey, I go nude every single day".  Now if your overactive imagination is picturing me going about in a, well, in a state of undress, perish the thought. Cease, desist, and don’t think like that for a minute- for the nude we were talking about here refers to the face- a nude look sans any make-up for the face. Now if you are wondering what I have to do with makeup and such things, let me start the story from the beginning.

As part of a team of surgeons who do extreme make-over’s, I happened to treat an interesting patient recently. This particular patient was a 22 year old female and what’s more important, unmarried and looking to get married pretty soon. In quest of which marriage she had tried to look prettier by becoming thinner, even though she wasn’t very heavy looking to start with. But as they say, is there anything like being too thin or too wealthy?

This patient’s chosen method of rapid weight loss involved starvation, as she was hell bent on achieving a zero-size figure in time for her wedding. Unfortunately for her, she failed to realize that being thin does not necessarily translate into beautiful. There are lots of thin, ugly women walking around if you look, which is incredibly sexist and might bring me brickbats from the feminist brigades, but, hey it’s the truth, so sue me.

Anyway to get back to our patient this girl by binge dieting and extreme starvation became as thin as a stick and then having achieved her life's goal assumed that she had become beautiful. Imagine then the shock to her system when she realized that despite the weight loss she was basically what she always was, albeit a thinner version with a constantly hungry look in her eyes. And then when she realized her folly she did what she should have done in the beginning -approached the professionals.

Let me digress here a bit and offer some general advice- losing weight and becoming thin if done the proper way with exercise retains the muscle tone but losing weight with starvation makes you lose all fat beneath the skin- which pads out and fills up the skin and consequently the skins sags and hangs - giving you an aged appearance - unless you get a skin tuck done by a cosmetic surgeon (if you don’t believe me - check out any liposuction patient after all the fat's been sucked out- they look like the pug dog from the Hutch mobile advertisement- with loose rolls of skin hanging down). So, take my advice- walk, run or dance- but don’t starve.

And also, there is a general rule in plastic surgery that says "Soft tissue follows Hard Tissue" which translated from medical jargon means that the flesh follows the shape of the bone. So anything you do to the muscle and skin will not last long if it’s not in conformity with the bone beneath. If your jaw bones are long and protruding, however much you reshape your lip muscles, you will never have a pout till the bone beneath is also re-shaped and then the flesh above the bone will automatically adapt to the bone below and achieve the perfect shape we want.

So, after doing the very best we could to give her face an all-natural look- a few nips and tucks here and there, some bone grafts and some collagen/fibrin to bring the shape back to her face- we let her go home to heal. And she returned to us after the usual six weeks of healing to check up on her final results. As part of the hospital protocol- especially for extreme makeovers- and to guard against future litigation by disgruntled patients who are unable to bridge the gap between fantasy and the reality of their looks- the hospital has mandatory post- operative photographs for documentation (and as evidence for the legal team).

In any hospital which does cosmetic surgeries, there are specialists appointed for the purpose of getting patient photographs- photographers and make-up specialists. One of the tricks the photographer employs is to undershoot the pre-operative photos to highlight the post surgical effect- which is unnecessary in my opinion. And vice versa they go all out - overboard sometimes- in getting the post surgical photos- with heavy make-up and lighting effects- which is where the creative difference arose as I mentioned in my first para above.

As an end user and as someone from the team responsible for the actual result- I like to be involved in these photo shoots despite murmurings that I am a know-it-all poking my nose everywhere. I discount the murmurs as I feel that it’s only my insatiable curiosity to learn something new which drives me to hang about the patient photo shoots. Anyway, I always feel that the stark look which the photographers shoot for the pre- surgical pictures are way better than the heavily made up faces they shoot for the post-surgical photos. And hence I decided to get hands-on this time.

As I had been the one from the team who had coordinated the entire makeover for this particular patient and she trusted my judgment, I had to put my foot down for the look I wanted for this patient- a nude look. Now a nude look for those who don’t know much about make-up (which is me -before wikipedia) is a minimal make-up look- as far as possible approaching the natural face. Which is the very point of doing a cosmetic surgery- to make someone look beautiful even in the morning when they wake up sleepy faced.

The make-up team had an ingrained habit of applying make-up liberally but I convinced the patient that a nude look would show her the real results achieved and I sat down with the make-up team and was constantly giving them advice to restrict the amount they usually dab- something which almost drove them nuts, I think.

And the conversation during the photo-shoot went something like this:

Please put just a hint of concealer around the shadow areas of the nose and eyes. Now use that foundation sparingly and blend it in please. Yes, use that marble tone- that would suit this skin tone better. No, no blush please, please don’t, not over the cheek bones- we have accentuated it naturally with bone grafts- we don’t want to highlight it further. Ok, just a little hint of powder. Do you really want to make it soo glossy? Or do you think we can pat it down for a matte finish? What does the photographer feels- shall we ask him? Oh, ok, you would adjust the effect with the lights then?

Now for my signature look- add on the lipstick....MAC raspberry? No I prefer the Estee Lauder one- Coralline Red- here, this is the shade I was telling you about- apply it to her lips and see how the peachy shade makes the lips more inviting and perfectly complements the nude look of the face rather than the bright red raspberry you advice. Yeah, it’s not my province, I know, but hey, who better to admire a lipsticks effects than a man? We look at it from the consumer point of view, so trust me go with the coralline red- it will make your lips all peachy and delectable. What, you want me to apply it and show you the effect? Oh, just kidding me, were you? 

OK time to pose- be natural, don’t use all those patented poses like the photographer showed you pictures of-  be free to give us your own poses- we can always delete later on if we don’t like it. So mr.photographer, are we ready with the soft focus lights? And after you finish shooting the regular ones, I want a few grayscales for my own patient records- no I prefer grayscale without any hint of touch up- for my surgical notes. OK. Thank you all. Nice shoot. And I expect to see you again- next month- for your final check up. Bye.

And you walk away with the sense of a job well done having captured the prefect image you wanted, but then you are in for a surprise -for whatever effects you tried to achieve on the floor of the studio- the photographer who does the final post-processing uses his photoshop software to give  the pictures a uniform bland look like all those models with plastic faces you see on magazines- any sign of individuality in your shot composing is all lost by the time the picture is printed out and you grin and bear it and just add it the patient records and close the file.

Disclaimer : I am not recommending the nude look for everyone- every look should be decided by the individual’s skin tone and more importantly- by the occasion. I am also not recommending you go for a matt finish over a glossy finish or you apply highlights over the cheeks. I am also not recommending you try out coralline red lipstick. I am especially not endorsing any of the products named above. To each their own.

P.S. I would have loved to show you the pictures of the patient we shot as examples for what I am talking about -but medical ethics and doctor patient confidentiality forbids me from using them on social media. Only the hospital has the right to use those photos as part of their promotional campaigns and advertisements.