Amino acids
There are 20 amino acids in human proteins, 12 are manufactured by the body and are known as “nonessential amino acids”. The remaining 8 are obtained from the diet and are termed “essential amino acids”.
Protein nutrition is based on a balance of essential amino acids and sufficient intake of nitrogen so the body can produce nonessential amino acids.

Complete protein foods
The nutritional quality of food protein varies and depends on essential amino acid composition. For example foods that contain essential amino acids at levels that facilitate repair and tissue growth are known as complete protein foods. These foods are also classified as having high biological value, which refers to an index in which all protein sources are compared with egg whites which provide the most complete protein and have the highest biological value of 100.

In general, foods with the highest biological value are from animal sources, such as eggs, milk, meat, poultry, and fish. However plant protein form a large part of the human diet, and are mostly deficient in 1 or more essential amino acids and are therefore regarded as “incomplete proteins”. Their protein quality however can be upgraded, by combining them with foods that are higher in protein quality or contain what ever essential amino acids are deficient.

complementary amino acids composition

For example, combining corn with beans results in a high quality protein food combination. Thus, the requirement for essential amino acids can be met in a vegetarian diet by mixing foods of complementary amino acids composition.

How much Protein does a body need?

The daily amount of protein your body needs is determined by energy needs, there are many situations in which extra protein is needed for example pregnancy, lactation, growth spurts and endurance training and other forms of physical activity.

But to tell the whole story the body needs fats to function. Dietary fat carries fat-soluble vitamins – vitamins A,D,E, and K- from your food into your body. Fat also helps your body insulted, and provides a sense of fullness after meals (satiety).

Fat is also an energy source and used in the production of cell membranes, as well as in several hormone-like compounds called eicosanoids. These compounds help regulate heart rate, blood pressure, blood clotting and the nervous system,

There are three main types of fats: Saturated, Unsaturated and Trans

* Saturated fats are usually hard at room temperature and come primarily from animals except coconut and palm oil.
* Unsaturated fats (mono- and polyunsaturated) are usually liquid at room temperature and come primarily from vegetable oils and oily fish.
* Trans fats are man made and often found cookies, biscuits and margarine

spreading the risk of disease?

Saturated and trans fats (the so called “bad fats”) increase the risk for certain diseases. Saturated fats are mainly animal fats and trans fats are fats produced by heating liquid vegetable oils in the presence of hydrogen, this process is known as hydrogenation. Most trans fats are found in commercially prepared baked goods, margarines, snacks foods and processed foods.

Unsaturated fats are divided into monounsaturated and polyunsaturated fats (the so called “good fats”) and when eaten in moderation and used to replace saturated and trans fats can help to lower cholesterol levels and reduce risk of heart disease.

Bottom line

It is important to remember that all fats are not bad and you should aim to have around 15% of your daily calorie intake in the form of healthy fats. For cardiovascular health limit your intake of saturated fat and try to avoid trans fat. In general the best sources of fat are those from natural sources like those found in fish, olive oil, nuts and avocados.

You wake up one morning with excruciating pain in your big toe and it feels like its “on fire”, but you don’t remember injuring yourself the day before. It’s so painful that even the weight of the sheets appears to be somewhat intolerable. What could it be…….

You Could Be Suffering From Gout!

Gout is simply a condition where your body produces more uric acid than it can excrete. When this happens uric acid crystals accumulate in the joints causing inflammation and intense pain.

Gout most commonly occurs in the first metatarso-phalangeal joint or big toe (Hallux) however it can also affect other joints like the ankle, knee, heel, wrist, elbow and fingers. This elevated blood level of uric acid (hyperuricemia) can result from a diet high in rich foods (red wine, port, lobster, crab, and foie gras).

With Kings and Paupers!

Gout loves a drink

Because of the association of “rich” foods, it has been called the “Rich Man’s Disease” or the “Disease of Kings”.
However, gout is also found in other levels of society…. for example regular consumption of grain alcohol may lead to this disease; this is known as the “Poor Man’s Gout”.

Signs & Symptoms

The Five Cardinal signs of acute inflammation

* Rubor (redness),
* Tubor (swelling),
* Dolor (pain),
* Calor (heat)
* Functio laesa (loss of function).

Diagnosis

The diagnosis is usually a clinical one based on the history and symptoms. However your doctor may perform a needle biopsy this involves inserting a needle into the affected joint and drawing fluid for microscopic analysis. This will often rule out any joint infection as a result of bacteria. Doctors may also recommend a blood test to measure the uric acid level in your body. However, blood tests can be misleading as some people with higher uric acid levels never experience gout.

Treatment

Treatment of this condition usually involves medication. In the first instance non-steroidal anti-inflammatory drugs (NSAIDs) are used to control the inflammation and pain. If more frequent attacks occur your doctor may recommend other medications to reduce your risk of attack.

Prevention - the miracle of water!

Prevention is a key strategy and should include appropriate medications as prescribed by your General Practitioner but also cutting back on rich foods such as red meats, seafood, offal and alcohol. You should also stay well hydrated to help to dilute uric acid in your blood, so it is important to drink enough water every day.

I will be talking on the subject of Weight Management and Musculoskeletal disorders.
To book your place on these specialised lectures please contact Sarah Gilbert – telephone 020 7186 1000. Please book early as there is limited availabilty.

Venue
Hilton London Metropole
225 Edgware Road
London W2 1JU

Agenda
19:00 -Tom Palferman
Osteoporosis: Fracture prediction, prevention & new therapies

19:30 – Nigel Kellow
Treatment of Vertebral Fractures

20:00 – Ralph Rogers
Weight Management and Musculoskeletal disorders.

Achilles tendon, a radical new treatment

One of my patients has been featured in the Daily Express ! Karen (she will not mind me mentioning her name as she discloses it in the newspaper)  has been receiving Platelet Rich Plasma treatment at my clinic in London.

She is now hoping that following the end of her treatment she will be running in the London marathon ! Read out about  how karen was cured with her own blood using platelet rich plasma.

article featured in Your health – Daily Express 20 October 2009

http://www.dailyexpress.co.uk/features/view/135016/I-was-cured-by-my-own-blood#

Weight management

Why do people get fat, should we worry about it and what can be done about it?

Obesity is characterized be an excess accumulation of body fat that clearly results from chronic imbalance between energy intake and expenditure.

Hippocrates wrote “Corpulence is not only a disease itself, but the harbinger of others” recognizing that obesity is a medical disorder that also leads to many other ” morbidities”.

In a report by the National Audit Office , London (2001) The number of death per year attributable to obesity is roughly 30,000 in the UK

The obesity epidemic in the United Kingdom is out of control, and none of the measures being undertaken show signs of halting the problem, let alone reversing the trend.

The United States is about 10 years ahead in terms of its obesity problem, and it has an epidemic of type 2 diabetes with obesity levels that are rocketing.

Obesity is a global problem levels are rising all over the world. Moreover, certain ethnic groups seem to be more sensitive than others to the adverse metabolic effect of obesity.

For example, high levels of diabetes and related diseases are found in South Asian and Arab population. Although most of the medical complications and cost of obesity are found in adults, obesity levels are also rising in children in the UK and elsewhere.

“…diabetes epidemic looming”

In the United Kingdom, even if preventive measures against obesity were successful immediately (so that not one more person became obese) and people who are obese do not gain weight, there would still be an epidemic of diabetes and its complications within 10-20 years. This is because so many young people are already in the clinically “latent“ phase of obesity, before the clinical complications present. Thus treatment of obesity must be prioritized alongside prevention.

(Haslam D, Sattar N, Lean M. ABC of obesity, Obesity-time to wake up. BMJ 2006;333:640-42.).

In England the national service frameworks for diabetes and coronary heart disease highlight the importance of helping patients who are obese. Obesity needs to be managed like any other chronic disease – with empathy and non-judgmental professional attitude. Helping people to manage their weight is difficult and can be discouraging and time consuming for health professional.

” …weight loss then weight maintenance”

High relapse rates, apparent lack of effectiveness, and lack of training and resources are major obstacles. General strategies for helping a patient with a weight problem include agreeing an individual, realistic, weight loss goal, such as 5-10% over three to six months. Achieving this goal can help motivate success. Aim for weight loss initially, followed by a distinct strategy for weight maintenance. Provide ongoing support and positive feedback.

The emphasis for obesity treatment use to be on weight loss. But, as identified in the 1996 Scottish Intercollegiate Guidelines Network guideline, weight loss is only one element in weight management. Management encompasses:

•    Weight loss (short term, three to six months)
•    Weight maintenance (long term, more than six months)
•    Priority reduction of risk factors.

“…frequent contact and support”

Group counseling does not seem less effective than individual counseling for long term weight change. Weight loss clubs may be helpful, but evidence is limited. For some people, however, initial individual counseling may be needed, and groups may not be beneficial-for example, for men needing support but whose local group comprises mainly of women. If possible, immediate family or key friends should be involved .

The key is prevention. Obesity is a disorder of energy balance (“energy in “ equals “energy out”). Weight is steady when energy is balanced. “positive energy balance” is when the amount of energy consumed as food and drink exceeds the energy used. UK adults on average consume 20 kcal a day more than they expand, leading to an average weight gain of 1 kg a year. Some people who become obese eat 100 kcal a day more than they expend so gain up to 5 kg a year. Any intervention that changes positive energy balance will ultimately be effective in preventing calorie accumulation, thus accumulation of body fat.

The components amenable to intervention are physical activity and overall energy consumption. The absolute level (in kcal/day), at which energy balance occurs is mainly determined by body weight, which affects both the basal metabolic rate and the energy cost of activity. It can be changed by substantial changes in physical activity but also, to a similar degree, by small changes in weight. So some thin people may be active and eat a lot to achieve energy balance, but overweight people have to eat more than most thin people to avoid weight loss.

“… effective interventions”

This purely mechanistic approach cannot be used for health promotion without a fuller understanding of several elements: the balance between individual and genetic predisposition to weight gain; the psychological, social, cultural and economic and political components of our “obesogenic” environment; and the nature of the “disease vectors” (high energy foods and energy saving devices). Changes in diet and physical activity are necessary for weight loss but do not guarantee it. To avoid compensation (between changes in physical activity and changes in appetite), effective interventions must tackle both diet and physical activity, and in an integrated way.

A successful intervention for obesity prevention must influence energy balance but must also be sustainable. Changes in diet and physical activity need to be incorporated into new behavior patterns, as a need for constant reminders or rewards will result in non-sustainability.

A permanent change in the environment is the best way to ensure permanent changes. Actions should focus on:

• enabling people to manage energy balance better on the current environment
• modifying the vectors of obesity
• changing the current sociopolitical environment, which currently rewards the manufactures of products and processes that contribute to obesity.

Effective programmes for obesity prevention probably encourage both healthy eating and physical activity (rather than rely on separate strategies for eating and activity)

References and Further reading

Haslam D, Sattar N, Lean M. ABC of obesity, Obesity-time to wake up. BMJ 2006;333:640-42.

Avenell A, Sattar N andLean M. ABC of obesity, Management:Part I Behavior change, diet, and activity 2006; 333:740-42

Lean M, Lara J and Hill J. ABC of obesity, Strategies for preventing obesity. BMJ 2006;333:959-62.

Human Performance

Exercise testing accesses the body’s capacity for physical effort and can define the limits of athletic performance as well as the functional capabilities of a symptomatic patient.

When an individual is involved in regular effort, as with an exercise prescription, the various body systems undergo a progressive adaptation and results in increase fitness.

Weight management

Wellness is a general term meaning a healthy balance between the mind, body and spirit, that results in an overall feeling of well-being. Wellness also describes the constant, conscious pursuit of living life to its fullest potential.

The goal of the Wellness Health Screen is to measure and identify risk factors for chronic diseases, such as, obesity, heart disease and Type 2 diabetes which can adversely affect your Wellbeing.
Each Wellness Health Screen is tailored to meet your specific needs. Results and personal health concerns are discussed with a doctor to give you peace of mind and to better understanding of your health.

We’ll give you advice , and then share recommendations for changes in your lifestyle such as Nutrition and exercise to combat these diseases of inactivity.
It’s important to identify health risks that might affect you in the future, so that you can do something about it right now. This gives you the time to explore not only your health but also your lifestyle too.

In addition you will have quick and easy access to further diagnostic tests and treatment, should this be required.

Early disease detection through regular Wellness Health Screening is the “Key” to a healthier fitter live and Well Being!

Sports Injuries

Sports & Musculoskeletal Medicine is a field of medicine that specialises in the prevention, diagnosis and management of sport- and exercise- related injuries, disorder, dysfunctions, and disease processes.
Dr Ralph Rogers specialise in the non-surgical management of sports injuries and painful musculoskeletal conditions by strengthening weaknesses, correcting imbalances and enhancing performance.

Sports Physicians are in a unique position to be the first point of contact for medical and musculoskeletal injures for accurate diagnosis, imaging and co-ordinated treatment plans with other clinical specialities.

Sports & Musculoskeletal Physicians are ideal physicians for non-athletes as well, and are an excellent resource for individuals who wish to become active or begin an exercise program.

For the “weekend warrior” or “industrial athlete”, the same expertise used for the competitive athletes can be applied to return the individual as quickly as possible to full function.

“You Don’t Have To Be A Professional Athlete To Be Treated Like One”