Tuesday, August 26, 2008

The Elderly - Part II

6. The Carer

Increased longevity need not necessarily mean healthy and disease-free life. Invariably chronic ailments. disability and dependency reduce quality of life. Age in combination with disability reduces the ability of the person to carry out even basic ADL (Activities of Daily Living), such as bathing. dressing. feeding. etc. Many older people become immobile due to illness. due to falls or due to joint problems. Such dependent elderly require prolonged and consistent care. Similarly, cognitively impaired elderly need to be supervised continuously. Long term care for impaired or disabled elderly is a difficult task. Care givers, both professional and familial, face the risk of burn out.

Traditionally. the task of caring was predominantly by women, be they spouse. daughter or daughter-in-law. But as the family and especially the role of women are changing to meet the new demands created by economic transitions. the family’s ability and sometimes commitment for caring for its older member is diminishing. As· more and more women are becoming active in their own careers and begin to work full time, the task of caring for the old is becoming more difficult. While creating support system for those families who can. and desire to. care for elderly relatives, planning is needed for the care of those who cannot and will not be cared for by family members.
Care giving may result from different motivations..Yet the consequences of providing of an intense nature over a long period can be rather similar Research has found negative social, psychological, economic, and physical consequences to family members from the often unrelenting demands of elderly relatives. ‘Cost’ or ‘burden’ of care given depends on several factors - age, sex, health of care giver, availability of help, social support, to mention a few. It also depends on the type of disability, level of cognitive impairment, presence of behavioural problems, age, duration of illness of the care recipient.
Counselling is often essential for care givers. They may need inputs in the following areas - information about the care recipient’s illness, respite from care, opportunity to interact with people in similar circumstances, participation in self-help groups, individual counselling, practical assistance and reasonable financial compensation.
Granny Bashing’
A darker side of family care giving is ‘Elder Abuse’. This may manifest as physical, psychological, financial abuse or as neglect. First reported in British scientific journals as ‘Granny Bashing’, reports are appearing in Indian journals also at present. Elderly are supposed to face overt/or covert abuse, face economic deprivation, social neglect and religious abuse (especially widows).

7. National Policy on Ageing

India presents a sad picture when it comes to the care of the elderly. There is no baseline data about aged in the country, there is no comprehensive s8cial security provision for the people, there is no universal medicare system for all, a sizeable number of aged live under poverty line, institutional facilities are totally inadequate for the number of people who require such care, there is no conscious planning to meet the needs of the elderly, public awareness of issues involved in elderly care is low, and finally, there is no comprehensive National Policy for the elderly.

The exercise of national policy formulation continued, by fits and starts, since 1993. At last, in 1999, Ministry of Social Justice and Empowerment came out with a policy for the elderly and submitted to the then parliament for formal approval. But due to lack of political will it is still at the stage of “on paper - under consideration”. Even in preparing recommendations no particular exercise has been made to examine the basic problems of the elderly. Except recommending community based social services, encouraging NGOs to start old age homes and day care centres, special schemes for the elderly under existing housing scheme, the policy makers have largely neglected the following aspects:
Elderly in rural and tribal areas; elderly women and widows; active, handicapped, infirm and immobile elderly; elderly abuse and or isolation; social participation of the elderly; social integration and community participation rather then segregation; orientation, training and placement of active elderly; culture and recreation; care, protection and security; patterns of care (self-care, informal care, community and family care, institutional care, no care); death with dignity and decent cremation or burial.
Night care centres, halfway homes, mobile libraries; health and mental health facilities, hospices and terminal care; family courts, consumer courts; special assistance cells for the clearance of bills; lok adalats as mediating institutions, etc.

While the perspective of the policy is welfarist, in that the State will act as major provider, only paltry resources and residual services would be provided. States have shown ambivalence toward the policy and expect the centre to share a major burden. Left to themselves, they are most likely to ignore the problem of the elderly on the pleas of scarcity of resources.

8. UN Principles for Older People

To add life to the years that have been added to life, . the United Nations General Assembly adopted the following Principles for Older Persons on 16th December, 1991 (Resolution 46/91)

I) INDEPENDENCE
1) Older persons should have access to adequate food, water, shelter, clothing and health care through the provision of income, family & community support and self-help. 2) Older persons should have the opportunity to work or have access to other income-generating opportunities. 3) Older persons should be able to participate in determining when and at what pace withdrawal from the labor force takes place. 4) Older Persons should have access to appropriate educational and training programmes 5) Older persons should be able to live in environments that are safe and adaptable to personal preferences and changing capacities. 6) Older persons should be able to reside at home for as long as possible.
II) PARTICIPATION
7) Older persons should remain integrated in society, participate actively in the formulation and implementation of policies that directly affect their well-being and share their knowledge and skills with younger generations. 8) Older persons should be able to speak and develop opportunities for service to the community and serve as volunteers in positions appropriate to their interest~ and capabilities. 9) Older persons should be able to form movements or associations of older persons.
III) CARE
10) Older persons should benefit from family and community care and protection in accordance with each society’s systems or cultural values. 11) Older persons should have access to health care to help them to maintain or regain the optimum level of physical, mental and emotional well-being and to prevent or delay the onset of illness. 12) Older persons should have access to social and legal services to enhance their autonomy, protection and, care. 13) Older persons should be able to utilise appropriate levels of institutional care providing protection, rehabilitation and social and mental stimulation in a human and secure environment. 14) Older persons should be able to enjoy human rights and fundamental freedoms when residing in shelter, care or treatment facility, including full respect for their dignity, beliefs, needs and privacy and for the right t’O make decisions’ about their care and quality of their lives.
IV) SELF-FULFILMENT
15) Older persons should be able to pursue opportunities for the full development of their potential. 16) Older persons should have access to the educational, cultural, spiritual and recreational resources of society. 17) Older persons should be able to live in dignity and security and be free of exploitation and physical or mental abuse. 18) Older persons should be treated fairly regardless of age, gender, racial or ethnic background, disability or other status, and valued independently of their economic contribution. “People are created to give something back to the world. The best way to solve problems is to work together with compassion towards betterment of human life through helping improve the quality of all individuals”.

9. Positive Attitude & Life-enhancing Activities

Disease-free, functional living without a clear sense of realisable purpose, while of some value in that it may afford opportunities for normal evolutionary growth, will not provide awareness of meaning to your life that is important to have.
Two vital factors for healthy, long life, over both of which we have control, are mental attitude and lifeenhancing activities. Optimism, the basis of hope and faith, should be habitually cultivated until it is the dominant mental attitude. Cheerfulness and optimism actually beneficially influence the body’s chemistry, enlivening its functions and strengthening the immune system. Pessimism, fear, doubt, depression, mental and emotional conflicts, and other negative states depress the body’s immune system and disturb normal biological functions of organs and glands. Life-enhancing activities keep us in the flow of relationships and cosmic forces which contribute to our total wellness and encourage biological systems to function harmoniously.
Why is it that some people are old at what should be healthy, functional middle age while others are youthful into their seventh, eighth, and even ninth decades or longer? Genetic disposition may playa role, but not as much as we may too quickly presume. The determining factors are more likely related to mental attitude, states of consciousness, the kind and amount of physical activity, and diet. This is the opinion of many physicians, and the testimony of an increasing number of men and women who are enjoying healthy life into what used to be considered advanced years. For many people, who have traditional ideas about ageing, the various symptoms believed to be associated with it begin to manifest because they expect them too! Ageing then becomes a wish fulfilling prophecy; what is anticipated is demonstrated in fact.

In an article published in a national magazine, a medical doctor wrote of his extensive studies on ageing. He found that if you list all the changes in muscles, bones, brain, cholesterol, blood pressure, sleep habits, sexual performance, psychological characteristics, and other symptoms - and complete a list of similar changes which result from physical inactivity, there is striking comparison. Indications are that many of the bodily changes we tend to contribute to normal ageing processes are in fact caused by disuse, by inactivity.. The five components of what may be called as Disuse Syndrome are cardiovascular vulnerability, musculoskeletal fragility, obesity, depression, and premature ageing - all of which we can do something about.
Physical conditioning determines how well our bodies transport oxygen necessary for good metabolism. Exercise improves the body’s ability to take in and transport oxygen to the blood stream. By exercising regularly, and maintaining muscle mass, metabolism is more efficient. Exercise also keeps our bones in better condition, stronger and with minimum loss of calcium. Without exercise our energy reserves diminish, we “feel older” and more tired and tend to become more easily depressed.
(Source: ‘Book of Ltfe’)

10. Mind over Body

There is evidence that stimulating the brain can actually reverse the process of mental deterioration. Though memory is known to fail with age, it appears that memory and other mental processes are improved by increasing physical and mental activity.
As people get older, especially after retirement, they tend to be less active, physically and mentally.
The less stimulated by the environment, the less active neurons, or nerve cells become. In a sense the brain goes into hibernation. But it can be reawakened. If mental activity increases, new branch-like extensions called dendrites sprout in the neurons. These dendrites establish connections with other neurons, receiving information and forming networks that create strategies for problem-solving. In other words, the brain benefits from exercise, almost as if it were another muscle. So, the more the mind continues to work, the greater the chances of retaining mental function. That is why one must stay intellectually engaged, be it a game of chess or community service.
The best way to avoid mental rigidity is by keeping an open mind about new and different ways to do things. Learning to use a computer, trying to do old tasks in new ways - the more the challenge the better. Above all, there is great individual variation in the way mental function changes with age. Experts say that major deterioration is not built into the brain. The challenge is to find ways to compensating for whatever decline that does occur And the first step is to cultivate those dendrites by putting your mind to work which deteriorates with age, but recent studies show that this is not so. Deterioration of mental function is most often due to some pathological changes in the brain and not due to just ageing. While it is true that some of the brain’s functions are at their peak early in life, judgement and wisdom continue to improve as we age, whereas short-term memory and quickness of recall may decline.

Recently it has been proposed by many schools of thinking that visualising the killer cells in your immune system as fighting against the organisms that cause disease can actually get the body to produce a response against them. This is part of a system of alternative therapy which is also called Holistic Medicine. Whether it is called “treating the whole patient”, holistic medicine or some other name, it boils down to the very logical fact that we are the sum of our minds and our bodies. Emotions and feelings have a powerful impact on physical symptoms.
Many of the so called alternative therapies emphasising the mind/body connection are increasingly acknowledged by medical professionals as effective methods for coping with health problems.
We know from recorded history that ancient medical science was based on the idea that mind and body are intimately interconnected, and that successful treatment required the healer to take both into account. Hippocrates, the father of Western Medicine, cautioned physicians to study the mind as well as the body. But over the centuries, the Western world began discounting this wisdom. Scientist-philosophers like Descartes believed that medicine should devote itself to understanding and curing the body’s ills.
This mind set produced the modern Western approach to curing illness, in which the only valid treatments are considered to be those that have been proven to work in rigorous scientific studies. Many invaluable means of treatment have resulted from this method, but clinical medicine today still can’t cure everything. Gradually a new idea has evolved, or re-evolved; that mind and body are constantly interacting. Since our emotions seemingly have the power to ravage our bodies or to heal them, why not use them to our advantage rather than ignoring them ? body’s ability to adapt to ageing is really great. But this ability should not be misused; it should be put to judicious and optimal use to enhance health and longevity. In order to do so, we must first understand the changes which occur in the body systems with age.

11. Body Changes in the Elderly

Change is the inevitable law of nature. Nothing can remain static in this world. This is equally true of the human body. After birth, the body gradually grows to full bloom and its functions reach their peak at about the age of 30. Thereafter the functions slowly decline over the next five or six decades.
Nature has provided vast reserves in the body system. For example, normal life is perfectly possible with only 15 per cent of the kidney tissue; loss of spleen or tonsils makes no measurable difference to the body because other tissues with similar functions are able to compensate this loss. However, these reserves are more and more encroached upon as age advances and age related decrements in physiological functions are inevitable. By the age of 80 certain measurable parameters would have declined by 50 to 70 per cent. The capacity to perform physical work progressively declines, metabolic processes and body body reflexes slow down, and ability to withstand stress and strain is reduced.
The natural process of ageing is so gradual that it is hardly perceptible. The vast reserves in our body do not let us feel difference of age. In fact the elderly person should normally fell fit and fine, and only under stress of sudden or severe physical effort should there be any difference between him and a younger person. The body’s ability to adapt to ageing is great. But this ability should not be misused; it should be put to judicious and optimal use to enhance health and longevity. In order to do so, we must first understand the changes which occur with age.

REGULATION OF BODY CHEMISTRY

Life consists of series of chemical reactions occurring in each of the millions of cells of which our body is made. Chemical processes constantly regulate the blood chemistry within narrow limits on a moment to moment basis. For example, if a person has eaten too much of sugar and there is danger of inordinate rise of sugar in blood, the pancreas immediately releases more insulin into Circulation; if a person has taken too much fluids, increased urination corrects the situation. The chemistry of blood which forms the internal environment of all body cells, therefore, remains fIxed within narrow limits at all times and under all circumstances. With age, the speed of this regulation slows down because all physiological functions, including cardiorespiratory, digestive and excretory, decline. The elderly are therefore not able to adapt to changes in food, environment and temperature, and to stresses and strains as easily as younger people. Moderation becomes necessary in their daily activities, including eating, working, environmental changes of temperature, humidity, etc. They are, for the same reason unable to detoxicate or excrete drugs with as much ease and speed as younger people. Doctors therefore suitably lower or alter the dosage of drugs administered to them.

BRAIN

Consequent to these changes in the chemical milieu at the cellular level, changes occur in various body systems. Alterations of metabolism in. the brain and its offshoots cause certain deficiencies or alterations, which account for changes in sleep rhythm, sex drive, body temperature regulation and certain degenerative disorders.

ENDOCRINE GLANDS

Changes occur in the endocrine glands which secrete various hormones. For example, diminished production of insulin by the pancreas causes increased incidence of diabetes in the elderly. Ovarian failure occurs at menopause in women, resulting in loss of child bearing capacity and diminished production of female sex hormone. The endocrine changes in the male are less dramatic and include decrease in the production of male sex hormone.

IMMUNE SYSTEM

The immune system, our bodyguard against infections, slowly and gradually withers away. This has great relevance to certain diseases. Proneness to infections increases, which become more acute and severe, and incidence of cancers are more common in the elderly.
BONES

Bones get depleted of calcium and protein matter (osteoporosis), and become fragile and liable to fracture easily.

ARTERIAL OBSTRUCTIONS - HEART ATTACKS AND STROKES
Significant degenerative changes occur in the arteries of the body, especially those supplying blood to the brain, heart, kidneys and legs. A fatty substance, called cholesterol, is deposited in their walls over the years, causing obstruction to the flow of blood. This obstruction, is the cause of heart attacks, strokes, etc.
OTHER SYSTEMS

Similarly, decrements of function occur in all other systems - digestive, excretory, respiratory, etc. This is the natural process of ageing, which occurs in every one of us. The body’s ability to adapt to ageing is truly remarkable. Unfortunately some of us strain or over-tax this ability by adopting unhealthy lifestyles - excessive smoking, consumption of intoxicants like alcohol, poor living conditions with atmospheric and environmental pollutants, which invariably hasten the ageing process.

12. Diet & Nutrition

Are any changes in the food habit necessary in the later years of life? At the outset we may say that there is no basic difference between the diet of the young and that of the elderly. We only have to take into consideration the decrements in physiological functions of the body, including digestion, which decrease with age, the reduced needs of the body for energy production consequent to reduced physical activity, and certain disease conditions which are more common during the later years of life, which place restrictions on certain foods. As the energy requirements of the body decrease, the amount of food intake should be correspondingly reduced, otherwise you will be adding to body weight, which is not healthy. Moreover, reduced intake of food will be easy on your digestion. Secondly, you should rest a while after meals and not rush to work or exercise, because a large amount of blood is diverted to the abdomen for digestion and less is available for the needs of the heart. For the same reason sexual intercourse should be avoided for a few hours after the meal.
A diet that provides for all our metabolic needs, but is very low in calories increases the life span. Recent research has shown that low calorie diet of 20 calories per kg of ideal body weight increases the life span of experimental animals by almost 40 per cent. This diet is sufficient for body needs but it is nonfattening. For instance, if a person’s ideal (not actual) weight is 70 kg he needs only 1400 calories per day. Most of the extra calories in our diet are contributed by refined sugar and fats (ghee, butter and vegetable oils). They are for the most part empty calories and contain little else. To obtain a healthy diet, you will have to cut down the consumption of these articles of food and concentrate your attention on vegetables, fruit, cereals, pulses, lowfat milk and its products, low fat meats, chicken and fish. Nutritious food is one that contains all the essential nutrients - proteins, fats, carbohydrates, vitamins and minerals. A well balanced diet should contain all these in correct proportions and adequate amounts. Proteins, fats and carbohydrates provide the energy required for various activities. Vitamins and minerals do not supply the energy but play an important role in the regulation of several essential metabolic processes in the body.
The food should be nutritious, though small in amount. The quality not quantity matters. Even a sparse diet can be nutritious. For example 100 gms of wheat contains nearly 12 gms protein, while the same quantity of rice has only 6.4 gms protein. Similarly, 100 gms Ragi contains 344 mg of Calcium. The food should be mainly vegetarian, some non-vegetarian, with milk and milk products, though ghee and butter may be restricted because of their high cholesterol content. For same reason milk may be allowed to stand for a few hours and cream may be skimmed off before consumption. The best cooking medium for regular use is any vegetable oil which does not solidify in cold weather These oils are low in saturated fats. Highly greasy dishes or fried foods should be avoided as they add to the body weight. For the same reason sweets need to be restricted.
Ghee and butter need to be restricted but need not cut down altogether, unless some health problems, likee heart disease, prohibits it.
Bread and chapatis should be made from whole bran wheat flour and not from refined flour (maida) from which the fibre has been removed. The elderly require sufficient fibre or roughage in their diet to avoid constipation. This fibre is undigestable carbohydrate present in the food. Rough fibre is not well-tolerated by the intestine in old people. But the tender fibre of vegetable, fruits and whole grain cereals will encourage normal bowel movements. The elderly tend to use harmful laxatives and mineral oils. This should be substituted by a fibre-rich diet and adequate fluid intake. Some good source of dietary fibre are: Ragi, Wheat, Italian Millet, Horsegram, Green, leafy vegetables, Plantain stem, Drumstick, Bittergourd, fruits like dates, figs, guava, wood apple and sweet lime. (See table for fibre content of common foods)
Pulses have good amount of proteins and should be taken adequately.
Regarding non-vegetarian diet, it has to be said that fish is positively useful for the heart, chicken and fowl have no disadvantage while mutton, beef and pork may preferably be restricted. Avoid organ meats in particular because of their high cholesterol content. Eggs should also be taken in strict moderation, less than 5 per week. The yolk (yellow part) contains the highest amount of cholesterol.
The consumption of fresh vegetables, fruits, nuts and seeds should be increased for their vitamin, mineral and fibre contents. Their antioxidant factors prevent many diseases and delay the degenerative process of ageing.

Dietary Fibre Content of Common Foods (100 gms.) Fibre (g) .
Ragi (Madua) 3.6 Sundaikai (dry) 17.6 Rice 0.2 Ridge gourd 0.5 Rice bran 4.3 Snake gourd 0.8 Wheat (whole) 1.2 Cashew nut 1.3 Wheat (flour) 1.9 Coconut (fresh) 3.6 Bengal gram (whole) 3.9 Groundnut (roasted) 3.1 Bengal gram (dhal) 1.2 Walnut 4.1 Green gram (whole) 4.1 Asafoetida 4.1 Horsegram (whole) 5.3 Cardamom 20.1 Peas (dry) 4.5 Chillies (dry) 30.2 Red gram (dhal) 1.5 Chillies (green) 6.8 Soyabean 3.7 Cloves 9.5 Kuppakeerai 6.1 Coriander 32.6 Agathi 2.2 Fenugreek seeds 7.2 Cabbage 1.0 Garlic {dry) 0.8 Corriander leaves 1.2 Ginger (fresh) 2.4 Curry leaves 6.4 Pepper (dry) 14.9 Fenugreek leaves 1.1 Omum 21.2 MulIa Keerai 1.1 Tamarind pulp 5.6 Beetroot 0.9 Turmeric 2.6 Carrot 1.2 Gooseberry 3.4 Colocasia 1.0 Apple 1.0 Onion 0.6 Potato 0.4 Banana (ripe) 0.4 Yam 1.0 Dates (dried) 3.9 Beans 1.9 Figs 2.2 Bittergourd 1.7 Grapes 2.8 Brinjal 1.3 Guava 5.2 Broad beans 2.0 Jackfruit 1.1 Cauliflower 1.2 Lemon 1.7 Cluster beans 3.2 Mango 0.7 Cucumber 0.4 Papaya 0.8 Double beans 4.3 Pomegranate 5.1 Drumstick 4.8 Sapota 2.6 Knol Khol 1.5 Seethaphal 3.1 Ladies finger 1.2, Tomato 0.8

13. The Role of Antioxidants

The major problems faced in the advancing years are the ravages of old age. The riddle we have to solve is how to stave off diseases and stay healthy till the end. In this context some startling new facts have come to light recently about the capacity of some of the vitamins. Traditionally, it has been thought that lack of vitamins produces deficiency diseases like rickets and scurvy. It is now being increasingly realised that this is not the whole story, and that some of the vitamins can have many more positive and far-reaching effects by way of prevention of serious diseases of old age.
Some tentative conclusions have emerged, which can be immediately utilised much to the benefit of tIle people above 40 or 50. Preventing or delaying the onset of chronic degenerative diseases will mean better quality of life to them and a substantial reduction in the cost ‘of medical care in the years to come.
So far 13 vitamins have been identified in the foods that we eat. There is no doubt that many more factors still remain to be identified. The vitamins play a vital role in helping to regulate the biochemical reaction within the cells and in converting food into energy and living tissue. Some vitamins can be manufactured by the body but most have to be supplied through food.
New research evidence suggests that the traditional views about vitamins and minerals have been too narrow, and that these nutrients play a much more vital role in promoting health and vitality than it has been thought in the past. Vitamins in doses much higher than necessary to prevent deficiency diseases may protect a person from a number of diseases common in old age - cancer, heart attacks, strokes, Parkinson’s disease, cataracts, etc., and ward off the ravages of ageing.

DIET AND HEALTH

Some simple facts which have emerged from worldwide surveys are important A consistent link between diet and health has been found. A diet rich in fruits and fresh vegetables is associated with lowered incidence of cancer and heart attacks. Lowered intake of vitamin C is associated with high risk of cancer and high intake of calcium-containing foods with low incidence of fragile bones in the elderly (osteoporosis). Vitamin K, which had so far been known to promote blood clotting and help prevent bleeding, is now also known to help bones retain calcium and thus prevent osteoporosis. Deficiency of folic acid, one of the vitamins of B group, is now linked with cancer of cervix.
Not very long ago, vegetarians were considered second-rate humans and inferior in health status to nonvegetarians. It is now recognised that the vegetarian diet is healthier and that vegetarians in general live longer, because they are less prone to heart attacks and cancers The main reason is that a vegetarian diet provides most of the antioxidants which offer protection against free radicals.
WHAT ARE FREE RADICALS?

Oxygen-free radicals are formed as a by product of cell metabolism and exposure to sunlight, ozone, car exhaust, tobacco smoke and other environmental pollutants in the atmosphere of towns and cities. These radicals are volatile and unstable. They play havoc with cells by destroying them outright. Their cumulative effect is believed to be at the root of the ageing process and such diseases as heart attacks, strokes, cancer, cataracts, etc.
WHAT ARE ANTIOXIDANTS ?

Vitamins A, C and E have made the most exciting news as a result of current research. These vitamins offset the devastating effects of free radicals by neutralising and defusing them. They are called antioxidants. It is not considered unlikely that these vitamins may one day revolutionise medical care by prolonging life and making one healthier beyond what one thinks possible today.
VITAMIN C

Vitamin C is especially concentrated in the eye, and in high doses, along with vitamin E, reduces the risk of cataract to less than half, and delays its appearance by at least 10 years. The role in preventing cancer and heart attacks has already been mentioned.
VITAMIN E

This vitamin has been widely used for its reputed power to enhance sexual performance, but without much scientific evidence. It has now been found to be particularly helpful in preventing free radicals from injuring the heart. Experiments have shown that vitamin E injected within two hours of a heart attack reduces the expected damage to heart muscles by more than 75 per cent.

Vitamin E also seems to boost the immune system in old people, thus helping them to ward off infections. It may also provide great protection to the lungs by neutratising the harmful effects of pollutants like car exhaust and tobacco smoke. Vitamin E holds out much hope for the patients of Parkinson’s disease. especially the early cases. It delays the appearance of tremors, muscle rigidity and loss of balance, and thus postpones the need for active treatment.
VITAMIN A

Beta carotene is the naturally occurring precursor of vitamin A. a deep orange coloured compound found abundantly in sweet potatoes, carrots and cantaloupes (sarda). It is converted by the body into vitamin A according to the needs of the body. It is, therefore, impossible to have an overdose, while vitamin A in very large doses (5 times the usual dose) is toxic to the liver Beta carotene protects one against heart attacks. Even those with a previous history of heart disease are protected from future attacks. And if it is given along with low dose aspirin (100 mg. Daily). the protection is almost complete.
Beta carotene may prove powerful enough to ward off cancer as well. The incidence of cancer of the lung, breast, prostate, cervix and colon is much lower in Japan and Norway, where the diet is rich in this vitamin. Three to six months of daily beta carotene pills have dramatically reduced pre-cancerous mouth lesions.
We can appreciate how important fresh vegetables and fruits are for health and well being, not only for their known beneficial factors but possibly many factors not yet known to science. There is nothing wrong with nonvegetarian diet (except those with high cholesterol content) but when latter is taken to the exclusion of vegetables and fruits, then it is harmful.
DOSE OF ANTIOXIDANTS

The amount of an.tioxidants necessary to ward off diseases is much higher than the amount necessary toprevent deficiency diseases. To ensure full intake, the following daily doses are currently recommended: Beta Carotene 25 mg. or Vitamin A 5000-10000 unitsVitamin C 100mgVitamin E 100mg.
Whereas the diet should be rich in fresh green vegetables and fruits, many persons unfortunately just do not eat enough of them.
Then there are those whose diet is restricted because of some chronic disease, or alcoholics who do not eat much, or those with strong likes and dislikes. Taking a multivitamin pill a day which contains the above amounts of vitamin A, C and E, in addition to vitamin B complex and minerals, may be a good policy to ensure proper intake of essential nutrients. Presently the formulations available in the market (Becadexamine, Supradyn, Multibionta, etc.) Usually contain enough of all vitamins except vitamin E, which may have to be taken separately (Evion 100 mg.)
Enough evidence is already available to justify taking moderately high doses of antioxidants as suggested above but we may have to wait for some more time before still higher doses can be recommended. In the meantime it would be a wise strategy to take plenty of fruits and leafy and other vegetables including broccoli, carrots (gajar), spinach (palak) and squash (chapan kaddu), and a vitamin pill in addition. However useful the antioxidants and other vitamins may prove to be, they cannot take the place of good healthy habits. Also one should keep one’s mind receptive to new ideas and research on this as it is a very important topic. The last word on antioxidants is yet to be said.

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