Colorectal Cancer – Preventable, Treatable, and Beatable

Colorectal Cancer Awareness Month

In March of each year, Colorectal Cancer Awareness Month is observed globally to increase awareness about colorectal cancer. Building awareness plays an important role in early detection and reducing mortality rates. 

Colorectal cancer is a preventable, treatable, and beatable disease, and it is one of the few cancers that can be effectively managed through screening. We should take prevention seriously which is always a cheaper and better option, and ultimately, can help save lives.

What is colorectal cancer? 

Cancer that originates from the colon and rectum is referred to as colorectal cancer. As per the World Health Organization (WHO) cancer mortality statistics, colorectal cancer is the third most common cause of cancer in the world in both men and women. It is estimated that about 4.3% of people will be diagnosed with colon or rectum cancer at some point in their lives. In Bangladesh, colorectal cancer is the third most common cause of all cancer deaths in the country. The main risk factor for colorectal cancer is increasing age. Around 90% of colorectal cancers are diagnosed after the age of 50

Colorectal cancer is not a contagious disease. Factors that increase a person’s risk of colorectal cancer include increasing age, high fat intake, a family history of colorectal cancer and abnormal tissue growth also known as polyps, the presence of polyps in the large intestine, inflammatory bowel diseases, and primarily chronic ulcerative colitis.

Symptoms of colorectal cancer 

Colorectal cancer might not cause any symptoms until it becomes late-stage, but when it does, it may cause one or more of these symptoms:

  • A change in bowel habits, such as diarrhea, constipation, or narrowing of the stool, that lasts for more than a few days
  • Rectal bleeding with bright red blood
  • Blood in the stool, which might make the stool look dark brown or black
  • Cramping or abdominal pain
  • Weakness and fatigue
  • Unintended weight loss

Many of these symptoms can also be caused by conditions other than colorectal cancer, such as an infection, hemorrhoids, or irritable bowel syndrome. Still, if you have any of these symptoms, it’s important to see your family doctor right away so the cause can be found and treated.

Preventing colorectal cancer 

The most effective prevention is early detection and removal of precancerous cells and tissues before they turn cancerous. Even in cases where cancer has already developed, early detection still significantly improves the chances of recovery, as cancer can be surgically removed before spreading to other organs. 

Other preventive measures include:

  • Regular physical activity
  • Hormone replacement therapy lowers the risk in postmenopausal women
  • Diets with reduced fat intake and increased fiber
  • People with a family history may take advantage of genetic counseling, followed possibly by genetic testing
Screening to help early detection of colorectal cancer 

Screening for colorectal cancer can greatly reduce the risk of death associated with the disease. The US Preventive Services Task Force (USPSTF) recommends strongly that screening should begin at age 50 for average-risk adults. 

People at high risk might need to start screening before age 45. This includes people with:

  • Strong family history of colorectal cancer 
  • Personal or family history of certain types of polyps
  • Personal history of inflammatory bowel disease (ulcerative colitis or Crohn’s disease)
  • Family history of a hereditary colorectal cancer syndrome such as familial adenomatous polyposis (FAP)
  • Personal history of radiation to the abdomen or pelvic area to treat a prior cancer

Praava’s molecular cancer diagnostics lab performs numerous tests for colorectal cancer – including screening through blood tests and therapeutics. Praava’s tests include:

  • Septin 9 methylation test – The procedure for screening is through a blood test
  • KRAS mutation test – The test is done through the blood sample
  • NRAS mutation test – The test can be done with both blood and a tissue sample
  • BRAF Mutation test – The test can be done with both blood and a tissue sample

If you are at high risk for colorectal cancer, talk to your healthcare provider to learn more and take measures accordingly.

World Oral Health Day 2021 – Be Proud of Your Mouth

In March of every year, the FDI World Dental Federation celebrates World Oral Health Day to raise awareness about the importance of oral health. The theme, “Be Proud of your Mouth,” is an essential message that should be a part of our daily lives.

How to take care of your mouth

To keep our mouths clean and healthy we must brush our teeth, rinse with water, and floss regularly. It is also important to avoid alcohol, tobacco, and all types of tobacco-related habits, such as chewing betel leaves, which cause oral cancer – one of the most common cancers in Bangladesh. 

Tips for a healthy mouth

Starting from childhood, a person should maintain proper teeth brushing. For babies, their gums should be cleaned every night before going to bed with a soft clean wet cloth. Both children and adults should brush their teeth once after breakfast and once before going to bed. 

Proper brushing techniques include:

  • Up and down motion
  • 45-degree angle rotatory movement
  • Using a medium-short bristled brush

In between brushing time:

  • Rinse your mouth with water or mouthwash after each meal
  • Use dental floss

One should also intake vitamins and proper protein-rich food to build up strong teeth structure and body immunity, and avoid eating too many sugary foods such as candy, soft drinks, and fast food, which can cause cavities and other problems.

Visits to the dentist

Children and adults should visit the dentist every six months to avoid dental problems and oral diseases, which are common in Bangladesh. Every dental visit can make you more protected against long-term problems.

During the pandemic

During the pandemic, it is recommended for older people and people with chronic diseases to make fewer in clinic visits to the dentist, and only go if it is necessary or if you are advised by a doctor. If anyone in your household is suffering from a cold, cough, or fever, please consult with your dentist remotely through video consultations first. 

If you visit a dentist in clinic, please keep the following in mind:

  • Make sure that the dentist is wearing a proper mask, face shield, hand gloves, etc.
  • Make sure the dental chamber is disinfected between patients
  • Check if cleanliness and disinfection guidelines are being maintained 

Things to keep in mind for at-home dental care:

  • Use separate basins for teeth brushing if possible
  • Use covered toothbrushes or keep each toothbrush separately
  • Try to do warm saline rinsing (one glass of warm water mix with a pinch of salt) after each meal

At Praava, you can take advantage of video consultations to provide you with virtual dental care. To learn more, call 10648.

This month, in the spirit of Oral Health Day, let’s do all we can to keep our mouths clean and healthy, and remember – be proud of your mouth!

Different Types of Masks and Should We Be Double Masking?

If 2020 were to be summarized in pictures, I am sure the picture of a mask would be in the top 5. Masks and the various questions surrounding them have been in the news from the very beginning of the pandemic, and even after a year now, we still have some of the same queries:

  • What type of mask should we be wearing? 
  • How should we wear them? 
  • Should we be double masking? 

First of all, do we need to wear masks? The answer to that is a resounding yes. Quickly into the pandemic, all researchers agreed that COVID-19 (SARS-CoV2) is an airborne virus and so wearing a mask protects those around you as well as yourself. There have been many medications and therapies tested to see what can combat this virus, but masks and social distancing have been repeatedly proven to reduce transmission of COVID-19 (SARS-CoV2). 

Different Types of Masks:

Let’s start with the various masks available in the market and how effective they are in regards to protecting you from COVID-19 (SARS-CoV2). 

N95 Masks

These are the most effective out of all the masks available. These have an electrostatic filter that catches particles. When fitted and worn properly, they can trap 95% of particles as small as 0.3 microns. Centers for Disease Control and Prevention (CDC) recommends that this mask be worn by healthcare workers who do high-risk aerosol-generating procedures like intubation. 

Surgical Masks

Surgical masks are made of three-layered non-woven fabric. The top colored layer is medical grade polypropylene in a web-like structure. They have small bendable wires that allow them to fit around the nose but overall are loose-fitting masks. These masks prevent large-particle droplets, splashes, or splatters containing germs from entering the nose and mouth. They are not as effective as the N95 masks but offer more protection than cloth masks. These are recommended for healthcare workers, COVID-19 patients, and those who look after them. 

Cloth Masks

Cloth masks are worn by the general public. The effectiveness of these masks depends on how they have been made. A single layer mask is only 26% effective but adding multiple layers can increase effectiveness to 50%. A study published last September has shown that out of cotton, polyester, and silk, silk was shown to be a breathable fabric and can repel large droplets. When choosing a cloth mask, make sure it has multiple layers with a tight weave. If fibers in the mask can be seen when held up to the light, then it is not likely to be effective. 

Effectiveness of Double Masking

Currently, there are no studies to prove whether double masking – wearing a cloth and a surgical mask – is more effective. However, given the increasing number of coronavirus variants and transmissibility, prevention of the virus is imperative. Therefore, it makes sense that double masking can provide a better fit on the face as well as preventing virus particles from entering or exiting the nose or mouth. 

Movember – Why November is Men’s Health Awareness Month – & Why It’s Important!

Throughout the world, women live longer than men, and this gap varies tremendously in less developed countries. According to the CIA World Factbook, in Bangladesh, the average life expectancy for women is 76.5 years and 72 years for men – a four and a half year gap. When it comes to their health, many men have the mindset of “if it isn’t broke, don’t fix it!” – so unless there are clear indications of them falling sick or being unwell, they will think there is nothing wrong. A majority of men are just not aware of what they can do to improve their health and live healthier and happier lives. 

An internationally recognized campaign Movember was established by the International Movember Foundation and is observed annually during the month of November. It is the leading global organization committed to changing the face of men’s health. Every November, men around the world grow a mustache and women step up to support them, to raise awareness and funds for men’s health-specifically problems, such as prostate cancer, testicular cancer, mental health, and suicide prevention. 

Men around the world and in Bangladesh suffer from a number of health conditions that often lead to fatality:

Stroke (Hemorrhagic and Ischemic): This is the number one cause of death in men in Bangladesh. Controlling blood pressure, diabetes mellitus, cholesterol level, cessation of smoking, regular physical activity, can help to reduce the risk of stroke.

Heart Disease: This is also one of the leading causes of death in men in Bangladesh. Controlling blood pressure and cholesterol, eating foods low in sodium and trans fat, exercising often, and not smoking, can all significantly lower the chances of heart disease.

Diabetes Mellitus: Diabetes is one of the most common diseases in men. To reduce the risk of type-2 diabetes – check your risk of diabetes, manage your weight, exercise regularly, eat a balanced, healthy diet, limit takeaway and processed-foods, quit smoking, and control your blood pressure.

Mental Health: While mental health has always been a big taboo and mostly ignored in Bangladesh, particularly among men, about 16.8% of men in Bangladesh report poor mental health. This leads to most not seeking help, often even in dire conditions. If you think you are experiencing symptoms of anxiety or depression, it is important to talk to a professional counselor or psychotherapist.

In Bangladesh, 12.9% of men are at risk of developing cancer and 10% are at risk of dying before the age of 75 years. Some common cancers seen in men are:

Lung Cancer: 11.1% of men in Bangladesh suffer from lung cancer. Lung-cancer is one of the most common cancers in men and diseases like chronic obstructive pulmonary disorder (COPD) is fatal to men. The main symptoms of lung cancer include:

  • a cough that doesn’t go away after 2 or 3 weeks
  • a long-standing cough that gets worse
  • chest infections that keep coming back
  • coughing up blood
  • an ache or pain when breathing or coughing
  • persistent breathlessness
  • persistent tiredness or lack of energy
  • loss of appetite or unexplained weight loss

Keep your lungs breathing better – toss tobacco, avoid secondhand smoke, and watch out for irritants like air pollution, chemical fumes, and dust.

Prostate Cancer: This is the second most common cancer in men in Bangladesh. About 13.5% of men have prostate cancer with a 6.7% mortality rateSymptoms of prostate cancer do not usually appear until the prostate is large enough to affect the tube that carries urine from the bladder out of the penis. When this happens, you may notice things like:

  • an increased need to pee
  • straining while you pee
  • a feeling that your bladder has not fully emptied

The best way to prevent it is by getting screened. Talk to your doctors to see if you should get a prostate-specific antigen (PSA) screening. 

Testicular Cancer: Although this is not very common, testicular cancer is seen increasing in young men. Typical symptoms are a painless swelling or lump in 1 of the testicles, or any change in shape or texture of the testicles. Testicular cancer can also cause other symptoms, including:

  • an increase in the firmness of a testicle
  • a difference in appearance between 1 testicle and the other
  • a dull ache or sharp pain in your testicles or scrotum, which may come and go
  • a feeling of heaviness in your scrotum

The best way to prevent testicular cancer is to learn how to do self-examination and knowing risk factors such as family history, race, and ethnicity.

For men starting at the age of 20 and beyond, the best things you can do to promote a long, healthy life are:

  • Get an annual physical exam by your primary care provider, including blood pressure, and height/weight checks
  • Annually screen for testicular cancer that includes monthly self-exams
  • Have cholesterol tested every six months
  • Screen for diabetes, thyroid disease, liver problems, and anemia
  • Depending on risk factors, screen for skin cancer, sexually transmitted diseases, and HIV infection, and alcohol and drug misuse
  • At 30, screen for coronary heart disease, especially with a strong family history of the disease and/or risk factors
  • At 40, screen for thyroid disease, liver problems, anemia, and prostate cancer
  • At 50, screen for cholesterol every six months; annually screen for Type II diabetes; lipid disorders; and skin, colon, and lung cancer. 
  • At 60, screen for depression, osteoporosis, dementia, Alzheimer’s disease, and abdominal aortic aneurysm. 
  • At 70, depending on previous findings, some screenings may be done every six months.

For all men, regardless of your age, the following is recommended:

  • Laughter increases endorphins, thereby increasing longevity. Get a sense of humor and engage with others with whom you can laugh.
  • Don’t become a workaholic; it increases stress and can lead to health concerns such as hypertension and weight gain. Get a hobby that helps you decrease stress, exercise in the manner you prefer, and seek help with diet to maintain a desirable weight.
  • Avoid illicit drug use and high alcohol consumption
  • If sexually active, get tested regularly for sexually transmitted infections. You might think you are safe if you engage in sexual activity with only one person, but that person might be having sexual relations with others, a concept called serial monogamy.

Everyone needs immunizations to stay healthy, no matter their age. Even if you were vaccinated as a child, you may need updates because immunity can fade with time. Vaccine recommendations are based on a range of factors, including age, overall health, and medical history. You can get your vaccine shots you want at Praava or talk to your family doctor via video consultation about the recommended vaccinations.

Let’s raise more awareness this November about men’s health and encourage the men in our lives to lead a healthy and fulfilling life.  

Breast Cancer and the Importance of Early Detection

Breast Cancer Awareness Month, observed in countries across the world every October, helps to increase attention and support for awareness, early detection, and treatment for the disease. The theme for this year is – Importance of Early Detection.

Breast cancer is by far the most common cancer in women worldwide, both in developed and developing countries and according to International Agency for Research on Cancer (IARC) by the World Health Organization (WHO), breast cancer is the third most common cancer in Bangladesh with 12,764 cases as of 2018. We all know that women often neglect their health. Even women from the upper-class and upper-middle-class of the society, who don’t lack education or knowledge on the awareness of health issues, still tend to neglect taking care of their own health. They prioritize their family members and their needs or their busy work lives, over their health. Breast cancer doesn’t only affect women – it also affects men. According to Cancer Country Profile 2020 by WHO, 8.5% of the entire population of Bangladesh suffer from breast cancer at a 6.5% mortality rate.

Early diagnosis can help fight breast cancer effectively – in fact, if breast cancer is detected at the Stage 1 level, survival rates are only 95-99%; and the five-year survival rate for stage 2 breast cancer is 93% for women who have completed treatment. By contrast, women with stage 3 cancer have a five-year survival rate of 72%.

The most important risk factor for breast cancer is family history. There is a genetic predisposition for this cancer. If you have a family member who has been diagnosed with breast cancer, you should take special precautions to monitor for symptoms and, for women over 40, have regular mammograms.

There could be several symptoms of breast cancer like:

  • Lump in the breast or underarm
  • Swelling of part of the breast or any change in the size or the shape of the breast
  • Irritation or dimpling of breast skin
  • Redness or flaky skin in the nipple area or the breast
  • Pulling in of the nipple
  • Nipple discharge other than breast milk, including blood
  • Pain in the nipple area or any area of the breast

Although it is rare, men can also get breast cancer. The most common symptoms of breast cancer in men are:

  • A lump or swelling in the breast
  • Redness or flaky skin in the breast
  • Irritation or dimpling of breast skin
  • Nipple discharge
  • Pulling in of the nipple or pain in the nipple area

Symptoms can also occur with other conditions that are not aligned with cancer. The most common cause of a lump in the breast for women is fibroadenoma or called simply a breast mouse. It is a benign tumor and rarely progresses to malignancy. Men can also get fibroadenomas but this is very rare.

To date, there is not sufficient knowledge on the causes of breast cancer, therefore, screening and early detection of the disease remains vital for breast cancer control. Simple measures such as self-breast examination is a well-accepted method where people examine their breast to detect any early lesion. There are other methods of screening for breast cancer such as an ultrasound of breasts and mammograms, which play an important role in the diagnosis of the condition. If a patient has a family history of breast cancer or their own history of benign tumors, then screening tests should be done annually. Otherwise, it is recommended for women over 40 years of age to get mammograms done every 3 years. Although ultrasound is not a routine screening test for breast cancer,  it is done in developing countries like Bangladesh.

Molecular cancer diagnostics tests can also play a vital role in cancer treatment. Those diagnosed with breast cancer at any stage should get a HER2 test done that can determine which targeted therapy or treatment protocol is best suited for a patient for early recovery. Treatment by surgery (removal of the lump) followed by chemotherapy or radiotherapy may be enough for a complete cure along with lifelong follow-up counseling which plays a crucial role. In advanced cases, the whole breast may have to be removed. A patient may also have hormone therapy after surgery, chemotherapy, and radiation are finished which can help prevent a return of the disease.

Creating continuous awareness and sharing knowledge about the cause, screening, investigation methods, and treatment for breast cancer can prevent the condition, although some cases may still progress to malignancy.

There are many success stories of women who have faced the ordeal with courage and determination and have been a source of inspiration for recovering breast cancer women. This year, let’s raise more awareness for early detection and help to curb breast cancer in our communities and in the world.

Mental Health for All: Greater Investment – Greater Access

The World Mental Health Day was first observed 28 years back on October 10, 1992, as an annual activity of the World Federation for Mental Health (WFMH) that was primarily aimed at supporting campaigning for mental health, educating, and raising awareness. Since 1996, World Mental Health Day has been observed with themes that focus on specific aspects of mental health. 

In 2020, as the world faces the COVID-19 pandemic, billions of people all over the world have been confronted by the unprecedented mental health consequences and the World Federation for Mental Health (WFMH) has taken this opportunity to promote the campaign on 10 October 2020 with the theme Mental Health for all: Greater Investment – Greater Access. 

Dr. Daniels, President of WFMH says, “Now more than ever greater investment in mental health is needed to ensure that everyone, everywhere has access to mental health care. The under investment in mental health has left large treatment gaps globally.” She added that mental health is an investment and not an expense and should be prioritized to avert a further catastrophe.

Mental health is important at every stage of life, from childhood and adolescence through adulthood. It refers to the healthy expression of emotions and healthy functioning which are the keys to emotional well-being, psychological well-being, and social well-being. The expected outcome of this is to realize one’s own potential, how one can cope with the normal stresses of life, working productively, and maintaining healthy relationships. But mental health has always been a big taboo and mostly ignored in Bangladesh. This leads to most not seeking help, often even in dire conditions.    

National Institute of Mental Health with the technical guide of the World Health Organization (WHO), conducted a survey named “National Mental Health Survey, Bangladesh 2018-19” which revealed that nearly 17% of adults in Bangladesh are suffering from mental health issues, where 16.8% are men and 17% are women, and among them, 92.3% do not seek medical attention.

Research on the impact of the COVID-19 pandemic on the mental health of the adult population in Bangladesh says that the prevalence of anxiety symptoms and depressive symptoms was 33.7% and 57.9%, respectively, and 59.7% reported mild to extremely severe levels of stress.

After being confronted by COVID-19 we have come to realize that there is no way to ignore the investment in mental health. Ensuring greater investment in mental health is a requirement, not a cost especially during these extraordinary times. So, to avert a further catastrophe, awareness and treatment of mental health must be prioritized.   

“We are already seeing the consequences of the COVID-19 pandemic on people’s mental well-being, and this is just the beginning. Unless we make serious commitments to scale up investment in mental health right now, the health, social and economic consequences will be far-reaching,” said Dr. Tedros Adhanom Ghebreyesus, Director-General of the World Health Organization (WHO).

Mental health is a continuous chain of processes. A parent with a healthy mental health condition can bring up their children with a healthy mental condition, family, and society with healthy mental health can contribute to creating empathetic, respectful, and resilient people. Creating awareness with effective information, promoting help-seeking behavior by addressing stigma plays a vital role to use the access of all facilities by government and non-government organizations.

Let’s join the movement collectively to make a commitment, and ensure our role for a nation with healthy mental health.

Allergy and COVID-19

Symptoms of flu, cold, and allergy are quite similar to those of COVID-19, so with every cough and sneeze, people wonder whether they have been infected with the coronavirus. Allergies normally cause symptoms such as runny nose and sinus but generally do not result in fever, as is mostly seen with COVID-19 or flu.

Bangladesh is a developing country with 150 million population. About 20% to 25% of population is suffering from different types of allergic disorder. They suffer almost all year round from different kinds of symptoms. 

Allergy vs COVID 19:

COVID-19 is a highly contagious and viral disease which can spread via air, respiratory droplets, or close personal contact. The symptom onset is around 2-14 days after exposure to the virus. Allergies on the other hand is a non-contagious hypersensitive reaction to the immune system when one is exposed to their trigger or allergen such as pollen, dust, mold, etc. Allergy symptoms are usually more localized, ranging from mild to severe, and can occur seasonally or be present year-long.

For instance, a patient with COVID-19 may have a fever, body aches, chills, a sore throat, weakness, and respiratory symptoms, while someone with allergies will be more likely to have the symptoms centered on the eyes, nose, and throat, and they usually don’t have a fever. Furthermore, in cases of allergy, symptoms improve when administering antihistamines but this does not help patients with COVID-19.

Although some coronavirus symptoms are similar to allergies, there are many variations. The image below from the CDC compares symptoms caused by allergies and COVID-19.

Some key points to differentiate allergies from COVID-19:

People often suffering from allergies have a personal history of allergy from allergens like food, pollen, dust, etc, and other atopic diseases. They may also have had previous similar allergy attacks or have a family history of atopy or allergy. COVID-19 is an extremely viral and contagious virus that can spread from person to person without any personal history. 

Allergies typically make people itchy which is not a symptom for COVID-19. People with allergies may also have asthma which can cause coughing, breathlessness, chest pain and tightness, and wheezing. Even though most are similar symptoms, COVID-19 typically does not develop wheezing.

Allergy symptoms can be treated with allergy medication like antihistamines and steroids. On the other hand, there is yet no proven medication or vaccine that can cure COVID-19.  

Some study shows the clinical course of COVID in allergic patients is associated with a worsening of allergies, for example, exacerbation of asthma. Even so, a clear understanding of COVID-19 infection in allergic patients compared to non-allergic patients is limited, and more clinical evidence is needed.

CDC recommends wearing masks as masks also offer some protection against seasonal allergies because they can prevent some larger particles from being inhaled. Discard your masks after each use, particularly if you suffer from seasonal allergies, because the covering may carry particles such as pollen.

The best way to prevent or treat allergy symptoms is to avoid the allergen. On the other hand, the best way to prevent COVID 19 infection is wearing masks, washing hands for at least 20 seconds, and maintaining social distancing. Finally, anyone who has any illness or symptoms must make sure to quarantine at home to avoid spreading the germs.

What You Need to Know About the Flu and How to Stay Safe This Season

Flu season is right around the corner and this year we are facing it amidst the COVID-19 pandemic. The flu may not be seen as the same kind of threat as COVID-19 but for some, it can be just as deadly and up to 650,000 people around the world succumb to it every year. Preventing the flu is always important, but it is especially crucial now when we are already fighting COVID-19. 

The flu has very similar symptoms to COVID-19 such as fever, nasal congestion, headaches, and severe muscle weakness and tiredness. This may lead to an increased number of unnecessary hospital admissions due to the fear of getting COVID-19. Fortunately, the same measures that help prevent the spread of the COVID-19 can also help prevent spread of the flu – washing hands often with soap and warm water for at least 20 seconds or using an alcohol-based hand sanitizer, avoiding touching our face, eyes, nose, and mouth with unwashed hands.  

When the novel coronavirus was discovered, almost immediately, the global public health and pharmaceutical communities started working on a vaccine as it is the best way to overcome any public health emergency. Unfortunately, vaccine development does take time, and even once the vaccine is developed, it will take time for it to be manufactured and distributed globally. In the case of the flu, we have both the time and foresight to prepare ourselves, and fortunately, we already have a vaccine to prevent this disease from deepening the losses we have suffered.

The best way for us to fight the flu is by getting the flu vaccine before the winter season starts. While the flu vaccine won’t protect us from developing COVID-19, it will reduce the chances of getting the flu and strengthen our immune system. There are four human coronaviruses – 229E, NL63, OC43 and HKU1 that account for about 15% of common colds in humans. Adults may be infected with one of these on average every 2-3 years, such that there could be a degree of pre-existing cross-reactive immunity to SARS-CoV-2 antigens in these people. It is possible that those susceptible to developing severe COVID-19 disease might benefit from the flu vaccination. 

Even if the vaccine doesn’t guarantee complete prevention from the flu, it can decrease the chances of us experiencing severe symptoms, and people older than six months can and should get the vaccine. Here are a few facts to know about the flu vaccine:

  • It decreases the risk of getting the flu.  
  • It does not increase the risk of getting COVID-19 and might be even be beneficial especially for those at risk for developing severe COVID-19.
  • It decreases the burden on frontline healthcare workers such as our doctors and nurses, who are already overstretched taking care of COVID patients by reducing the number of people who will get the flu and require hospital admission. 
  • The flu strain changes every year so researchers work to evaluate which strains are the ones that are most likely to affect the population and so if you were vaccinated last year, it does not mean you will be protected this year.
  • The best time to get the flu vaccine is before winter around September or October.

With the flu season now only a few weeks away, we must prepare for the challenges it will bring for us and our community. You can get your flu vaccine shot at Praava or talk to your family doctor via video consultation if you think you are showing symptoms of the flu. Stay informed and stay healthy this flu season.

Food for our mood: our ‘second brain’ in the gut

As the COVID-19 pandemic stretches on, the bad news is that the disruption in our daily lives, relationships, and workplaces is taking a mental toll. We are all faced with different manifestations of mental challenges such as increased irritability, emotional exhaustion, exacerbation of pre-existing conditions, poor concentration, and poor sleep.

The good news is that stress and feelings associated with it are not a sign of weakness, but a normal reaction to difficult times and can be managed. We can adopt several ways to improve our mood and cope with stress. One solution, well documented and backed by research, is to maintain a nutritious, well-balanced diet that can improve brain function, shore up immunity, lower blood pressure, improve circulation and reduce toxins from the body.

When we speak of diet and health, we usually think of it as prevention for illnesses such as heart diseases, diabetes, cancer, obesity, and so on. We rarely and consciously relate diet with our mood. But food has a major impact on our everyday mood changes. Specific nutrients play a very important role in reducing the levels of cortisol, adrenalin, and the stress chemicals in our body that activate fight and flight response. The nutrients such as complex carbohydrates, proteins, iron, vitamin B and C, magnesium, selenium, and omega 3 fatty acids play a very specific and significant role in helping improve our mood and reducing stress levels.

Fuel for the body and mind – how does it work?

The major constituents of our usual diet – proteins (e.g. meat, fish, eggs, pulses, beans), carbohydrates (e.g. rice, potatoes, bread, pasta), and fats (e.g. cooking oil, ghee, butter) serve not only as an energy source but as precursors to a variety of neuro-active substances.

When we do not take enough nutrient-rich foods, our body may lack vital vitamins and minerals, often affecting our energy, mood, and brain function. Several nutritional deficiencies, such as vitamin B9 (folate), B12, and zinc can cause symptoms of depression and dementia such as low mood, fatigue, cognitive decline, and irritability.

The brain is an organ with very high metabolic and nutrient demands. On average, the brain consumes 20% of a person’s daily caloric intake, approximately 400 calories per day. It is composed of 60% fat and contains high concentrations of cholesterol and polyunsaturated fatty acids (PUFAs) such as omega-3s.

Our brains need an adequate supply of energy that is needed to help us concentrate and focus. This energy comes from glucose in our blood. We get that glucose from the carbohydrates – mainly bread, rice, potatoes, sugars, cereals also from fruits, vegetables, and lactose in milk.

Regular meals containing carbohydrate ensures we have enough glucose in our blood. It is important to ensure we are eating healthy sources of complex carbohydrates such as whole grains, vegetables, fruits, legumes, and low-fat dairy.

Another name to keep in mind is serotoninthe chemical messenger in the brain that controls various body functions including appetite, body temperature, libido, and mood. Serotonin is made with a part of protein from the diet (tryptophan) and the more carbohydrate-rich food we consume, the higher amount of serotonin that may find its way to our brain.

Serotonin is considered to be the brain’s natural ‘feel good’ chemical and appetite suppressant. Complex carbohydrates take a longer time to get digested and, therefore, keep a person calm for a longer time. Complex carbohydrates also stabilize blood sugar levels.

Why do we crave sweets?                                            

The concept is not to have a lot of sugar to improve our mood but to have an adequate amount of complex carbohydrates to ensure a normal level of glucose for the brain.

By adequate amount we mean, about 130 grams/day of carbohydrate is required to supply the energy demands of the brain (e.g 1 slice of bread = 15 grams of carbohydrate, 100 grams of cooked rice = 30 grams of carbohydrates).

So, there is no need to have excess or refined sugar (added sugar from cakes, biscuits, pastries, fruit juices) from processed foods. Research indicates a diet high in sugar is linked to lower levels of brain-derived neurotrophic factor (BDNF) without which our brain is unable to learn new things and form new memories. BDNF is low in people suffering from diabetes and also pre-diabetes. Lower levels of BDNF is also linked to depression and dementia.

Obesity is linked to chronic consumption of added sugar because obesity reduces the activity of anorexigenic oxytocin system which is responsible for ‘telling’ us when to stop eating or not to overeat.

Certain vitamin and mineral deficiencies affect brain function and mood

Iron: Iron deficiency anemia leads to lethargy and weakness. Adequate iron can be obtained from red meat, poultry, and fish, beans and pulses, fortified cereals. Avoiding tea and coffee with meals may also be helpful.

Omega 3 fatty acids: The brain needs omega 3 fatty acids for the formation of healthy nerve cells. Research shows they are associated with a lower risk of depression. Sources of omega 3 fatty acids can be oily fish, nuts, and seeds like flax and chia seeds, walnuts, soybean, and canola oil.

All vitamin Bs: Deficiencies impact the nervous system and lead to stress-related symptoms such as irritability, lethargy, and depression. B vitamins maintain regular blood sugar levels, keeps energy, and mood stable. B3 (Niacin) deficiencies may lead to disorientation and depression. B5 (pantothenic acid) improves coping mechanisms. B9 (folate) relieves stress, anxiety, panic, and even depression. B12 (cobalamin) eases mood changes. Sources include yeast, meat, poultry, legumes, kidney beans, wholemeal bread, broccoli, Brussels sprouts, dark green cabbage, peanuts, peas, egg yolks, and green leafy vegetables.

Vitamin C: Both emotional and physical stress depletes vitamin C status in the body and reduces its resistance to infection and disease. Vitamin C supports adrenal glands allowing quicker recovery and lower fatigue levels. Rich sources include guava, pepper (capsicum), oranges, lemon, strawberries, tomato, papaya, and broccoli.

Magnesium: Stimulation of stress hormone from both physical and psychological stress increases magnesium depletion from the heart and other vital organs increasing dietary requirements for magnesium. Research indicates magnesium reduces stress and anxiety and improves the quality of sleep. Green leafy vegetables, such as spinach, legumes, nuts, seeds, and whole grains include magnesium.

Zinc: Depression and zinc are related as it activates neurotransmitters signaling pathway in the gut which regulates brain functions like appetite, sleep, neurogenesis, cognitive function, and mood. Oysters, red meat, poultry, chickpeas, and nuts (cashew and almonds) are excellent sources of zinc.

There is a strong link between our diet and mood, but it is specific to each individual and compounded by specific health issues. But one message is clear, by keeping an eye on what we eat we can stop emotional eating from stress and choose healthier alternatives.

This article was published in The Daily Star authored by Tazreen Yusuf Mallick, Praava Health’s Nutritionist. She also worked in the NHS, United Kingdom as a registered clinical dietician.

COVID-19: Message from Praava Health Chairman & Founder Sylvana Sinha

Across the world and at home in Bangladesh, as the global pandemic of the novel coronavirus continues to evolve, these are uncertain times. We at Praava Health want to share with you a personal message from our Founder & Chairman, Sylvana Q. Sinha. Ms. Sinha shares some important information on the COVID-19 pandemic, how the virus spreads and means of prevention, how Praava is caring for you and your loved ones, and above all, being good to ourselves and staying calm as we brave through this together.

To avoid coronavirus, wash your hands often with soap and warm water for at least 20 seconds, or use an alcohol-based hand sanitizer. Avoid touching your face, eyes, nose, and mouth with unwashed hands. Practice social distancing, which is deliberately increasing the physical space between you and others to avoid contracting or spreading illness. Staying at least 3 feet away from other people lessens your chances of catching COVID-19.

If you think you need to be tested, directly contact the government lab IEDCR at 01937000011, 01937110011, 01927711784, 01927711785. Government-approved hospitals for suspected coronavirus patients are Kuwait Bangladesh Friendship Government Hospital (Uttara, Dhaka), Bangladesh Railway General Hospital (Kamlapur, Dhaka), Dhaka Mahanagar General Hospital (Motijheel, Dhaka), Mirpur Maternity Hospital (Mirpur, Dhaka), Kamrangirchar 31 Bed Hospital (Lalbagh, Dhaka), Aminbazar 20-bed Hospital (Savar), Jinjira 20-bed Hospital (Keraniganj), Sajida Foundation Hospital (Jurayn, Dhaka), Dhaka Medical College and Hospital, Sheikh Rasel Gastro Liver Institute & Hospital (Mohakhali, Dhaka), and National Institute of Diseases of the Chest and Hospital (NIDCH).