Health and Wellness

Bromhidrosis – Bad Body Odour

/ Subash Rau / Leave a comment

Bromhidrosis refers to excessive foul smelling sweat. Other synonyms include Osmidrosis and Ozochrotia. It is diagnosed when noticeable body odour has a negative effect on an individuals self view, social interactions and Quality of Life.

2 types of Sweat glands are seen
Apocrine – It develops at puberty and usually disappears in the elderly. It usually affects axilla, anogenital (perinatal) areas and the breasts. The primary role of Apocrine glands is to secrete Pheromones.

Eccrine glands are distributed all over the body especially over the palms and soles.They are not found in the External Auditory Canal, Lips, Clitoris, Labia minora and Glans penis. Eccrine glands are primarily responsible for thermoregulation and secrete water based secretions. Eccrine Bromhidrosis can occur at any age and can be localised or generalised.

Pathogenesis of Body odour
Sweat is usually odourless and its secretion is controlled by the sympathetic nervous system. Heat, exercise, emotion, certain foods and medicines stimulate its secretion.

Apocrine glands secrete odoriferous fatty acids bound to odour binding proteins. Bacterial action releases odour causing fatty acids leading to the malodour. A variety of bacteria such as Corynebacterium, Staphylococcus, Cutibacterium (previously called Propionobacterium) and Sphinogomonas act on the apocrine secretions and produce odour. Pheromones such as Androsterone and Androsterol are also malodorous. Poor hygiene especially in diabetics and obese individuals cause odour especially with skin conditions such as Erythrasma, Intertrigo and Trichomycosis axillari.

Eccrine Bromhidrosis: Sweating leads to maceration of skin and secondary bacterial growth and skin degradation. Eccrine bromhidrosis can occur due to:
Diet – garlic, onion, curry and alcohol
Medication – Penicillins and bromides
Toxins – heavy metals
Metabolic causes – Phenylketonuria, Trimethylaminuria, Isovaline acidaemia, Hypermethioninemia.
Systemic diseases– Liver and Renal failure, Gout, Scurvy and Typhoid.

Diagnosis requires elicitation of a detailed history.
Usually Lab tests are unnecessary.

Treatment of Body Odour
1.Personal hygiene: to bathe regularly and daily but not excessively. Excess washing may cause skin irritation. Intertrigo, erythrasma need to be treated.
2.Clothing: wearing absorbent clothes/cotton clothes may help. Sweat soaked clothes need to be change immediately. Washed clothes need to be sun dried.
3.Exfoliation: to remove stratum corners may help.
Hair removal by shaving, chemical epilation, electrolysis and laser treatment may be helpful.
4.Antibiotics – applied topically may help. Topical Erythromycin and Clindamycin are commonly used. Prolonged continuous therapy may be needed.
Oral Roxithromycin 150 mg twice daily for 7-10 days may help.
5.Topical antiperspirants: Antiperspirant contain aluminium salts that plug sweat ducts and reduce seating.
6. Antifungal dusting powders may also be helpful.
7. Botulinum toxin Injection: Skin injections can temporarily reduce sweating.
8. For Refractory Localised Bromhidrosis- destruction of Apocrine glands is an option by surgical excision,Liposuction, microwave and Nd-YAG or CO2 laser can be helpful.
9. Thoracic sympathetectomy can be done with good results.

Treatment options for Axillary Hyperhidrosis (sweaty armpits)
1.Topical Antiperspirants (Aluminium containing gels) need to be applied nightly without occlusive wrappings. Topical Glycopyrrolate 2.4% can reduce sweating significantly.
2. Systemic agents – Anticholinergics- Glycopyrrolate can take up to a week for effect.
Clonidine 0.1 mg twice daily, Beta Blockers, Benzodiazepines will reduce sweating.
3. Iontophoresis
4. Microwave Thermolysis
5. Botulinum toxin injections can temporarily reduce sweating.
6. Surgery: Endoscopic thoracic sympathetectomy

News on Cholesterol

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2 articles have been published recently in the JAMA adding a little more confusion regarding dietary cholesterol and its association with Cardiovascular disease and mortality. The recent publication of the dietary guidelines for Americans proclaimed that it would no longer include the recommendation to limit dietary cholesterol to <300mg/day, as there was no appreciable relationship between dietary cholesterol and serum cholesterol. Although the guidelines advise to eat as little dietary cholesterol as possible, it sent the opposite message to the public. Recent study pooled individual level data from 29615 participants in 6 prospective cardiovascular disease studies in the US. The authors observed the following:

– The risk of dietary cholesterol affecting cardiovascular outcomes is probably modest only. However, consumption of every additional 300mg of dietary cholesterol was associated with a higher risk of incident cardiovascular disease and total mortality.

– The increased risk ranged from 1 to 4% over a 17.5-year follow-up period.

– The studies done so far also suggest dietary cholesterol could have variable effects on different cardiovascular diseases i.e. strokes, heart attacks and heart failure.

– The risk of adverse events was not seen in those who had a very low cholesterol at base line i.e. those with elevated base line cholesterols (LDL) had a higher risk for adverse cardiovascular events.

– The authors assert that high sodium foods and foods rich in simple carbohydrates (sugars, sweets and polished cereals) and trans fats should be avoided altogether. They also advised that the individual checks his cholesterol levels and adjusts his diet accordingly.

In another study published this month in the JAMA, TMAO (Trimethylamine N-oxide) was identified as a possible culprit in producing cardiovascular disease and increasing all cause mortality. In the previous decades, doctors had pinned the blame for heart disease on saturated fats. The long chain saturated fatty acids in meat steaks, butter and coconut oil which raised the LDL cholesterol was thought to be the culprit for heart disease and death. Recent meta-analysis of dietary recall studies seems to suggest that this relationship was not as tight as previously thought. Researchers are currently homing in on another possible culprit i.e. TMAO which is possibly an additional biological pathway by which red meat increased heart disease risk. The body makes TMAO from foods with choline and L-carnitine which are found abundantly in meat, poultry, fish, dairy and egg yolks. These proteins are broken down by gut bacteria to form trimethylamine (TMA) which is then converted into TMAO in the liver. Red meat is high in L-carnitine and has been shown to raise the TMAO levels more than white meat or non-meat proteins. It also tends to shift the gut microbiome, fuelling more bacteria to produce TMA. The authors conclude that the carnitine-TMAO pathway is a partial reason for the heighted mortality and cardiovascular risk with chronic red meat diet. They conclude that TMAO generation requires the right gut bacteria and this could be another path to reducing cardiovascular events.

Author’s note:

– This may be another reason to take pro-biotic rich foods although we are still unsure as to which bacteria are truly beneficial.

– There are so many different processes that affect what happens inside the body. It is therefore important not to get carried away with every new theory and finding but to adopt moderation in dietary habits and to focus on having adequate plant-based, whole-grain, fibre-enriched and balanced diet.

Are we ready for Personalised medical treatment?

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Physicians have always treated disease after their onset. But the sheer increasing number of disease and the escalating costs of treatment has made many think about ways to prevent disease before they occur. Disease prevention is thought of as Primary Prevention when preventive steps are taken before the first episode of the illness itself. It would require the treatment of risk factors that if left uncorrected would lead on to disease. For e.g., treatment of Hypertension, Diabetes and Dyslipidaemia before the onset of Cardiovascular diseases such as Heart Attacks and Strokes. Secondary Prevention are steps and treatments that are given to prevent the second episode of a disease. This would be the medical treatment of Cardiovascular disease with anti platelet drugs such as Aspirin, Statins etc. Primordial prevention refers to correction of lifestyle abnormalities at a very young age much before the onset of even the risk factors for the disease. These would include regular exercise, maintenance of ideal body weight, adequate sleep, intake of a well balanced diet and dietary supplementation.

 

Although most doctors have focussed their efforts on treating already established disease, it is becoming increasingly clearer that adopting preventing strategies may be the need of the hour. While recommendation exist from world bodies such as the WHO, the questions many physicians are asking is if medical therapy can be individualised and personalised. Is there a way to identify the risk for disease even before disease onset? Would genetic test be of any help in identifying risks of Non Communicable diseases (NCD – heart and vascular disease, Kidney failure, Cancer etc)? Can they be used to guide personalised recommendations for disease prevention?

 

Genetic tests have been used to predict risks for Breast and Colonic cancer and those with high risk are also advised an option of surgery to reduce that risk. Pharmacogenomics and Neutrigenomics are terms that are used to describe the prescription of pharmaceutical agents and nutritional supplements to reduce the risks of cancer/disease. This field, although in its infancy provides hope of big achievements in personalised Primordial preventive strategies.

 

A recent article in an International Medical journal  discussed the effectiveness of genetic testing to suggest disease susceptibility and to suggest preventive measures in an attempt at primary prevention of diseases.Their findings suggested that genetic testing had a 25% sensitivity only of predicting future events and that current evidence isn’t enough to suggest widespread screening using these tests. The low sensitivity (accuracy) of these tests could be explained by the observations that the genes that confer risk are multiple, the interaction with each other and with lifestyle factors complex and our understanding of them rudimentary at present!

 

Although very attractive, the concept of Personalised Preventive Medicine is a long way off and for now would only interest researchers or those who are simply curious to know what their genes may be saying. Even if the sensitivity of genetic testing is low, it might give the curious an insight into their disease susceptibility risks and suggest ways to modify their lifestyles to prevent disease in the future.

 

Genetic testing isn’t very expensive and can be done at Chennai for Rs. 20000/- The tests include identification of genes predicting Non communicable diseases, genes for drug allergies and for prediction of drug interactions.

Benefits of a high Fibre diet

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hFibre or roughage refers to the undigested vegetable matter containing substances like cellulose, lignin and pectin which are not completely broken down and digested by the intestines. Most of the fibre is removed from cereals when they are processed and polished. Good carbs refer to carbohydrate foods that are high in fibre and not in sugar. High fibre and whole-grain intake have been shown to significantly reduce mortality and chronic illnesses. It has been estimated that the average dietary fibre intake in adult American men and women is 18gms and 15gms (when the recommendation is 33.6gms and 28gms per day). Given below are some of the benefits of a high fibre diet:

– 15-30% reduction in all cause and cardiovascular mortality including the incidence of heart attacks, strokes, diabetes and colon cancer.

– High fibre reduces body weight, blood pressure and total cholesterol.

– Decreased body weight in turn reduces risk of diabetes, cardiovascular disease and many cancers.

– Fibre reduces intestinal transit time by bulking up the stools and improving the emptying of the colon. The higher incidence of colon cancer in Western society is attributed to the lack of adequate dietary fibre. In contrast, rural African communities consuming traditional meals of high fibre, low meat and low fat have very low colon cancer rates.

– High fibre cereal intake is associated with improved insulin sensitivity, lipid profile, endothelial function and reduces inflammation.

– High fibre intake has been shown to reduce the incidence of prostate, lung, colorectal and ovarian (PLCO) cancer and has an inverse relationship with cancers of the head and neck region, especially oral cavity and pharyngeal cancers. This happens independent of whether they are smokers and alcohol drinkers or not.

– The benefits of fibre are not only due to the fibre itself but also due to the other nutrients accompanying it. Metabolites of fibre, particularly butyrate can prevent cancer in any part of the body. Phyto-nutrients that accompany dietary fibre in food have additional health benefits. People who eat a high-fibre diet tend to be more health conscious and have a better life style.

– It is believed that fibre in any form (even as a pill) is good for health.

– Fibre rich foods are wholegrains, green vegetables, legumes, whole fruit with skin, etc.

Author’s note:

You would do very well to incorporate a salad with every meal.

Eating Patterns and Risks of Heart Attack and Death

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Does Eating Late Dinners and Skipping Breakfast increase the risk of Death and recurrent Heart Attacks?

A recent study published in the European Journal of Preventive Cardiology (April 17,2019)says exactly this. In this study of 113 patients admitted to the ICU after a major Heart attack, they were individually asked about their eating habits with a questionnaire. Skipping breakfast was defined as NOT eating until lunch (excluding Coffee and water) for at least 3 days a week. Late dinners were defined as dinners (and not snacks) that were eaten less than 2 hrs before going to bed atleast 3 times a week.

They found that 23% of the study population suffered from the primary end point ie death (5.3%)or readmission for reinfarction or recurring Chest pain(17.7%) after the first Heart Attack.

Many of us have heard that you have to Breakfast like a King to stay healthy. It is recommended that Breakfast provides 35% of the total calories consumed through the day. The stress of modern living along with greater distances travelled to work returning home late is forcing people to eat their dinners late and skip Breakfast daily as a habit. They may sleep late, wake up late in the morning and consequently skip their breakfast in their hurry to reach their Office.

The authors feel that eating late and skipping breakfast, although a part of cluster of bad habits of modern living independently contributed to adverse Cardiovascular outcomes especially after the first Heart Attack. They hypothesise that these habits increase inflammation, oxidative stress and endothelial dysfunction that may contribute to the poorer Cardiovascular outcomes.

This study is interesting for me because it provides some evidence to suggest that our Old Grandmas were probably right after all!

What you should know about Health!

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HEALTH

hWHAT IS HEALTH?

In dictionaries Health is defined as   “a state of being free from illness or injury”.  The WHO defines health as “a state of complete physical, mental and social wellbeing and not nearly the absence of disease or infirmity”.

PEOPLE’S UNDERSTANDING OF HEALTH VARIES

If one were to ask around, the perception of health may be very different such as

  • the ability to perform feats of extreme endurance (such as running a marathon) or to demonstrate great physical strength (such as lifting a very heavy weight)
  • Absence of disease
  • not needing to take any medicines
  • never needing hospitalisation
  • never having any physical complaints of the body
  • never catching colds or fevers
  • able to work long and hard at the job without any difficulty                                                                     

WHY MAINTAINING HEALTH ISN’T EASY

People often start thinking of health only when it is lost. Many, think they can wish away their health problems. Many illnesses are under recognised. Illnesses such as Stress, depression, Obesity, high cholesterol, Alcohol and Nicotine use, high BP and even Diabetes are often looked over as being unimportant or not needing any treatment or even attention. Most people are in a state of denial of these minor ailments and refuse to take remedial action and therefore suffer bigger and more grave conditions such as Heart attacks, Strokes, Kidney failure and Cancer.

WHAT IS HEALTH?

It is a state where the mind and body are functioning at their optimal best. (the best you that you could possibly be!)

Health could mean all the following put together

– having a positive cheerful outlook always

– not feeling tired at any time of the day

– sleeping well everyday.

– having a good exercise capacity.

– having a good social life which keeps you happy and contented.

– having all your blood parameters under good control

– achieving your ideal body weight and shape.

HEALTH basically means that you are a living machine functioning without any problems and on testing has been found to have all normal parameters and are on auto-pilot mode to maintain your current (health) status!

Unfortunately in reality, health is an unsteady state. You could be healthy one minute and unhealthy the next. Importantly Health cannot be taken for granted and is a goal that you should work towards constantly.

MAINTENANCE OF HEALTH REQUIRES

(A) Healthy Habits to be cultivated

Diet – always eat less than you want to

       –  remember tasty food is usually unhealthy. Eat less of it.

       – have small frequent meals

       – Break Fast like a King, Lunch as a Prince and Dine like a Pauper.

       – choose natural organic foods to Processed/Packaged/Fast foods.

       – choose a variety of fruits and vegetable to eat during each meal.

       – ensure adequate fibre intake with your food.

       – Avoid starving as well as feasting.

Exercise – Exercise daily

  – Both aerobic and Resistance training is essential.

               – seek professional guidance before embarking on an exercise programme.

  – never exercise to exhaustion and ensure recovery before the next session.

To achieve your Ideal Body Weight and shape

– it is essential never to carry excess body weight.

– know your ideal BMI, waist hip ratios and work on achieving your targets

– to achieve your ideal weight requires both dietary restriction and adequate exercise.

Sleep – try to get 7-9 hrs of sleep at night.

          – an afternoon siesta is definitely good for your health.

Stress control

– Identify your non-negotiable principles in  life, stress often occurs when your actions        contradict your principles.

– Think of how you will achieve a good Work Life balance.

-Set aside some time daily for yourself.

-Human beings are social animals and having a good circle of friends would go a long

in helping you cope with the rigours of life.

– Make time to attend your friend’s birthday parties, weddings and other social events.

– A positive frame of mind – is essential to prevent stress build up.

– Hope for the future, Faith in the Almighty are huge stress busters.

– Meditation and mind control.

– Dream big, set huge goals. Focus on your goals and work towards them.

– Prioritise

– take regular holidays and breaks from the routine.

Stress release- People prefer a variety of activities to release stress in their lives.

– Aerobic exercise – jogging, cycling, swimming, Dancing

– Gym and Weight Training

– Yoga, Tai chi, Karate and Martial arts,

– Sports – Tennis, badminton, etc

(B) To set health Goals and Targets

– Goals for Ideal Body Weight and shape

– Goals for BP, Blood sugars and Cholesterol

– Goals for aerobic exercise

(C) Health Monitoring

   – speak to your doctor about your Annual Master Health Check up.

– “what gets measured, improves”

(D) Plan your Day Week and Year

    -“Failing to Plan is Planning to Fail”

-Everyone has only 24 hrs a day. If sleep takes up 6-8 hrs, Work 8-12 hrs, travel 1-2 hrs only  2-8 hrs are left for everything else in your life. If you increase the time at work, you would automatically have less time for sleep/rest or exercise. It is therefore imperative to plan your day, everyday!

REASONS FOR LOSS OF HEALTH

Unhealthy habits and practices lead to disease and loss of health/disease, whereas healthy habits and practices lead to health, reversal of diseases and improved quality of life. It is therefore important to make all the necessary changes and to adopt all the healthy practices and habits to achieve the best possible health for ourselves at every stage of our lives.

People focus so much on their jobs that they are unable to even think of health.

Health requires regular thinking of how to stay healthy, how to monitor current body status and to make the necessary changes by consulting experts.

My next few articles would expand on each of the points highlighted!