There are some who claim that a person is dehydrated by the time they start feeling thirsty. This might be a bit of an overstatement. The average person is probably frequently in a partial state of dehydration, but not so badly that symptoms are recognizable and debilitating. However, when dehydration has occurred as a result of vigorous training, diarrhoea, vomiting or other causes, it would be necessary to rehydrate that person as quickly as possible because of other more serious symptoms that will accompany it, or occur as a result of the dehydration. Many physical complaints such as headaches, fatigue, dry mouth, dizziness, rapid heart rate and even some hot flashes can be attributed to dehydration.

Causes

Dehydration is basically an excessive loss of body fluid within an organism, and there are three types of dehydration:

• Hypotonic or hyponatremic which is mainly a loss of electrolytes, and sodium in particular.
• Hypertonic or hypernatremic which is mainly a loss of water
• Isotonic and isonatremic which is a combination of the above and an equal loss of water and electrolytes.

Isotonic dehydration is the most common, and can result in hypovolemia.

Dehydration can be caused by a wide range of diseases but some causes may be self inflicted such as vigorous exercise without taking in adequate water.

• Excessive perspiration without consuming adequate liquid to replace fluid lost during exercise.
• Prolonged exposure to dry air (long haul flights to or from other continents). It’s not a person’s imagination that they feel dried out when arriving at their destination.
• Diarrhoea (quick fluid loss because of watery stools) and because of probable nausea there is no desire to take fluid orally.
• Excessive vomiting
• Hyperthermia (too hot) and not drinking water
• Too much alcohol and coffee (caffeine) will cause dehydration.
• More serious causes would include blood loss, hypotension, shock, burns, certain drugs, hyperglycemia in diabetes, cholera and yellow fever.

Symptoms

The initial symptoms of dehydration are experienced once a person has lost about 2% of their normal water volume. The first indication would be thirst, loss of appetite and dry skin, not going to the toilet and dark urine output when they do, tiredness and irritability. Other symptoms that can be attributed to various other causes as well as dehydration will be headaches, dizziness when getting up suddenly and mood swings. In more severe stages is can cause lethargy, seizures and fainting.

As the dehydration becomes more severe, symptoms will become noticeably more severe; heart and respiration will increase to compensate for ‘thicker’ blood because there is not enough water to dilute the blood to its correct consistency. Fluid loss of more than 15% of total body volume is usually fatal.

It has been found that the thirst sensation decreases with age and many elderly people suffer symptoms of dehydration. During very hot weather this could prove fatal among the elderly if not recognised and treated.

Gastrointestinal diseases can lead to dehydration in various ways, and the fluid loss can be life-threatening.

Long distance athletes should monitor themselves, because in their case, they might be rehydrating with water, but they are losing water and electrolytes. If both are not replaced, an imbalance can occur and besides health issues, impair their performance as well.

Prevention

Urinary output and hydration is not something we consciously think of, but a useful measurement to remember is that one should develop a full bladder roundabout every 3-5 hours and the urine should be straw coloured or light in colour. Advise customers to drink a lot more water if urine is dark.

Preventing dehydration is fairly simple in most cases, especially when disease is not present. Rehydrate frequently with liquids, and it should be done in regular small volumes as the body cannot tolerate large amounts of water at any one time, and cannot survive without water for long periods of time. Water is the best method of rehydration under normal circumstances.

During the course of an ordinary day, it is probably sufficient to drink something when thirsty, but when exercising more water should be consumed. Naturally, when a person is ill, has diarrhoea or is vomiting, they should try and take in adequate fluid, and perhaps a good idea to rehydrate with water and electrolytes.

Treatment

For successful rehydration there are several products that are available:

Rehydrat sport is a balanced mixture of sugar and salts as well as essential electrolytes that supports optimal hydration and speeds up recovery after exercise. Dehydration is common in sports and can occur in just an hour of exercise or even more rapidly if the athlete is dehydrated before exercising or competing.

Ceralyte 50 – a rice based replacement drink with a berry flavour that prevents and treats dehydration and electrolyte depletion associated with diarrhoea and gastroenteritis.

Darrowped – is indicated for oral rehydration therapy after diarrhoea and contains sugars and salts needed to restore the balance in the body.

Gastrolyte – is an oral rehydration solution that consists of salt, water and sugar that will help the body recover after excesssive fluid loss.

Other products on the market that has the same indication would be Electrona Powder and Hydrol Powder that must be mixed with water.

Oral rehydration is the least painful, least expensive and least invasive therapy for dehydration but obviously can only be done while the patient is conscious and able to swallow. Thus it is better to treat dehydration as soon as possible and before a person has to be hospitalised and put on a rehydration drip. Fluids containing a proper balance of replacement electrolytes are then given intravenously with continuing assessment of electrolyte status and complete resolution is the norm in all but the most extreme cases.

The treatment for minor dehydration would be drinking water. This will inhibit the thirst mechanism, but sometimes more than water is needed to replace other electrolytes lost. A solution can be made at home as well by mixing

Signs of Success

How do you know when you’re properly hydrated? Besides feeling more energetic and generally healthier, an easy gauge can be to keep track of the frequency and color of the urinary output. If a person has a full bladder every 3-5 hours, and the urine passed is only lightly or barely colored, they’re in the clear! If a person finds that there are 5 or more hours between bathroom breaks, or the urine is consistently a darkish colour or dark yellow, hydrating would be necessary.

It is said that the next world war could be about resources, and water would be one of them. So let’s drink up while we can and stay hydrated. After all, 70% of our bodies consist of water, and it cannot store water as a fresh supply is needed every day!

A patient can be considered to be constipated if they have infrequent bowel movements (typically three times or fewer per week), they have difficulty during defecation (straining during more than 25% of bowel movements or a subjective sensation of hard stools), or there is a sensation of incomplete bowel evacuation. Going longer than three days without a bowel movement is too long. After three days, the stool or faeces become harder and more difficult to pass.

Causes of constipation

To understand constipation, it helps to know how the colon (large intestine) works. As food moves through the colon, the colon absorbs water from the food while it forms waste products, or stool. Muscle contractions in the colon then push the stool toward the rectum. By the time stool reaches the rectum it is solid, because most of the water has been absorbed.

Constipation occurs when the colon absorbs too much water or if the colon’s muscle contractions are slow or sluggish, causing the stool to move through the colon too slowly. As a result, stools can become hard and dry. See common causes of constipation in table 1.

Table1. Common causes of constipation are

In some cases, lack of good nerve and muscle function in the bowel may also be a cause of constipation.

Diagnosis of constipation

The diagnosis is essentially made from the patient’s description of the symptoms. Most people do not need extensive testing to diagnose constipation. Inquiring about dietary habits will often reveal a low intake of dietary fibre, inadequate amounts of fluids, poor exercise patterns or immobility, or medications that are associated with constipation. A physical examination may be done manually by a medical practitioner, or by using a colonoscopy. X-rays of the abdomen, generally only performed if bowel obstruction is suspected. This may reveal extensive impacted faecal matter in the colon, and confirm or rule out other causes of similar symptoms.

Treatment

The main treatment of constipation involves the increased intake of water and fibre (either dietary fibre or as supplements).

Diet

A diet with enough fibre (20 to 35 grams each day) helps the body form soft, bulky stool. High-fibre foods include beans, whole grains and bran cereals, fresh fruits, and vegetables such as asparagus, Brussels sprouts, cabbage, and carrots. For people prone to constipation, limiting foods that have little or no fibre, such as ice cream, cheese, meat, and processed foods, is also important.

Lifestyle Changes

Other changes that may help treat and prevent constipation include drinking enough water and other liquids, such as fruit and vegetable juices and clear soups, so as not to become dehydrated, engaging in daily exercise, and reserving enough time to have a bowel movement. In addition, the urge to have a bowel movement should not be ignored.

Laxatives

Most people who are mildly constipated do not need laxatives. However, for those who have made diet and lifestyle changes and are still constipated, laxatives or enemas can be recommended for a limited time.

Bulk-forming laxatives generally are considered the safest, but they can interfere with absorption of some medicines. These laxatives, also known as fibre supplements, are taken with water. They absorb water in the intestine and make the stool softer. Brand names include Metamucil® and Agiolax®. These agents must be taken with water or they can cause obstruction.

Stimulant laxatives e.g.  Dulcolax®, Freshen® and Senokot® act on the intestinal mucosa or nerve plexus, altering water and electrolyte secretion. They also stimulate peristaltic action. They are the most severe among laxatives and should be used with care.

Osmotic laxatives e.g. Duphalac® or Lactulose® or Movicol® work by increasing the amount of water that stays in your faeces as they pass through your large bowel. This makes them softer and easier to pass. People with diabetes should be monitored for electrolyte imbalances.

Lubricants grease the stool, enabling it to move through the intestine more easily. Mineral oil e.g. liquid paraffin is the most common example. Lubricants typically stimulate a bowel movement within 8 hours.

Saline laxatives e.g. Milk of Magnesia^® act like a sponge to draw water into the colon for easier passage of stool. Saline laxatives are used to treat acute constipation if there is no indication of bowel obstruction. Electrolyte imbalances have been reported with extended use, especially in small children and people with renal-insufficiency.

The chronic use of stimulant laxatives should be discouraged due to concern that chronic use causes the colonic tissues to get worn out over time and not be able to expel faeces due to long term overstimulation. People who are dependent on laxatives need to slowly stop using them. For most people, stopping laxatives restores the colon’s natural ability to contract. Laxative abuse is potentially serious since it can lead to intestinal paralysis, irritable bowel syndrome (IBS), renal failure and other problems, even though recovery is possible with proper treatment.

Prevention of Constipation

There are several things that can be recommended to prevent constipation. Among them:

• Eating a well-balanced diet with plenty of fibre. Good sources of fibre are fruits, vegetables, legumes and whole-grain bread and cereal (especially bran). Fibre and water help the colon pass stool.
• Drink eight glasses of water and other fluids a day (unless fluid restricted for another medical condition). Liquids that contain caffeine, such as coffee and soft drinks, seem to have a dehydrating effect and may need to be avoided until the bowel habits return to normal. Some people may need to avoid milk, as dairy products may be constipating for them.
• Exercise regularly.
• Moving the bowels when the urge is felt.

Conclusion

Constipation is a symptom, not a disease. Almost everyone experiences constipation at some point in their lives, and a poor diet typically is the cause. Most constipation is temporary and not serious. Understanding its causes, prevention and treatment will help most people find relief.

Initially, patients may present with excessive tearing due to corneal irritation, causing reflex tearing. The onset of symptoms is usually gradual and in both eyes. Symptoms typically become more bothersome later in the day and are intensified by various environmental factors.

Tears:

Tears are formed in the lacrimal gland below the eyebrows and flow out onto the eye surface to form the aqueous layer of the tear film. Tears drain through the puncta in the inside corner of the eye lids.  These empty into the lacrimal sac and drains down the naso-lacrimal duct into the nasal cavity. That is why your nose runs when you cry.

The tear film has three layers:

The first is the deep mucus layer produced by the goblet cells of the conjunctiva. This layer coats the epithelial cells of the ocular surface and maintains its lubrication and wetting. The normal cornea is hydrophobic and only becomes hydrophilic in the presence of mucin as it lowers the surface tension of the tears permitting the surface of the cornea to become wetted and therefore has a very important role in ‘tear stability’.

The second layer is the aqueous layer which is produced by the lacrimal gland and is stimulated by its nerve supply. In the normal eye, irritants such as smoke, foreign bodies etc will stimulate an immediate and copious secretion of reflex tears. Emotionally produced tears also use a similar pathway.

Finally the lipid layer, which is a thin oily outer layer of the tear film, reduces evaporation. This is produced by the meibomian glands in the eyelids.

In dry eyes the major deficiency is of the aqueous component of the tear film but any disturbance of these layers can cause symptoms.

Causes of Dry Eyes

Dry eyes occur when the quantity and or quality of tear production is compromised.

Insufficient tear quantity may be caused by lacrimal dysfunctions, including lacrimal deficiencies, obstruction of the tear ducts, and reflex hyposecretion of tears.    Dry eyes with insufficient tear production also occur with Sjögren’s syndrome.  Sjögren’s syndrome is an autoimmune disease effecting the lacrimal and salivary glands, leading to dry mouth and dry eyes.

When the quality of the tears is compromised, dry eye is due to increased tear evaporation in the presence of normal tear secretion. The cause of this may be described as intrinsic or extrinsic. Intrinsic causes include meibomian gland dysfunction (the most common cause of evaporative dry eye), eyelid aperture disorders or lid/globe incongruity, and decreased blink rate. Extrinsic causes include ocular surface disorders due to vitamin A deficiency, use of topical anaesthetics and preservatives, contact lens wear, and allergic conjunctivitis.

Risk factors causing Dry Eyes:

Patient factors: Female patients, especially post menopausal women, and increasing age.

Environmental factors: Low humidity, high temperatures, wind and air pollution including tobacco smoke.

Nutritional factors: Diet low in Omega-3 fatty acids and a diet with a high ratio of omega-6 to omega-3 fatty acids

Daily activity: Computer use, television watching, prolonged reading

Systemic and topical medication: Antihistamine, Tricyclic antidepressants, antispasmodics, beta-blockers, diuretics, amiodarone, systemic isotretinoin, chemotherapy, interferon, and eye drops containing preservatives.

Other factors: Refractive surgery e.g. LASIK, HIV, Parkinson’s disease and diabetes mellitus.

OTC Treatment of Dry Eyes

The aim of the treatment is to restore the quality and or quantity of the tears. This is usually achieved with artificial tears or lubricating eye drops. Educating patients to avoid the environmental factors causing dry eyes is important. Advise patients to avoid wind, dust and smoke and to use a humidifier. Take breaks from extended reading periods and computer use and to consciously blink frequently. Use of the medication causing dry eyes can be discussed with their doctors and be discontinued or an alternative can be prescribed.

Artificial tears contain ingredients to increase the viscosity e.g. Carboxymethylcellulose, Hydroxypropylmethylcellulose, and polyvinyl alcohol. This increased viscosity increases the tear retention time and protects the epithelium of the eye. The ingredients also lubricate the eye and decrease tear evaporation by restoring the lipid layer of the tear film. Electrolyte ingredients can help treat the surface of the eye. Most notably, potassium helps maintain corneal thickness, while bicarbonate helps maintain normal epithelial structure.

The preservatives are included to decrease the likelihood of bacterial contamination when the product is applied. They also increase the shelf life of the product. Single dose units of eye drops do not contain preservatives. Preservatives can irritate the eye and if patients require frequent dosing of ocular lubricants the absence of a preservative is more important than the active lubricating agent. Newer preservatives include polyquaternium-1, sodium chlorite, and sodium perborate. These were developed as alternatives to benzalkonium chloride and EDTA and are less irritating. They are known as ‘disappearing preservatives’ because they dissociate upon contact with the ocular surface and therefore do not spend time on the surface as the older preservatives do.

Oral Supplements: Studies have shown that oral supplementation with omega-3 fatty acids decreases the likelihood of a woman experiencing dry eye. Supplementation with omega-3 fatty acids has also been shown to be useful in the treatment of dry eye. Omega-3 fatty acids can help restore the lipid layer of tear film, decrease inflammation, and increase tear production.

Instructions of how to instil eye drops

The correct application of eye drops is important to ensure effective relief. Advise patients to

• Wash hands and areas of the face around the eyes before use
• Tilt head back
• While grasping the lower eyelid, pull it away from the eye to form a pouch
• While looking up, place a single drop into the eye
• Close the eye and gently apply pressure to the tear duct
• Blot excess solution.

If the OTC treatment of dry eyes does not relieve the symptoms, patients should be referred to a specialist who has other treatment options including inserting punctuate plugs in the tear ducts and other anti inflammatory drops for the relief of irritation.

References

1. Ambizas EM, Patel PN. Treatment Options for Dry Eye Disease. US Pharm. 2010;35(4):34-41
2. MIMS 2010 (5):232-234
3. Product package inserts

Recent statistics show that South Africa has 0.7 % of the world’s population but accounts for 17 % of global HIV infections⁴, and carries a quarter of sub-Saharan Africa’s total HIV burden⁴. With an estimated 5.6 million people living with HIV in 2009, our epidemic remains the largest in the world¹, and although our HIV incidence may be declining, South Africa’s national prevalence rate remains unacceptably high at 10.8 % of the total population⁴. Statistics are also demonstrating that at the current rate of infection, South African teenagers have a 50 % chance of contracting HIV over the course of their lives⁴. Unfortunately, AIDS is also seen to be the largest cause of maternal mortality in South Africa and accounts for 35 % of deaths in children younger than five years¹.

Nutrition for HIV/AIDS patients

Good nutrition is fundamental to all individuals in order to maintain an optimal immune response⁵. HIV and nutrition are seen to be intricately linked whereby HIV infection can lead to malnutrition, whilst poor diet can speed the disease’s progress⁶. Good nutrition can be seen to assist with the following in HIV-positive individuals⁷:

• Reduce/prevent muscle wasting
• Strengthen the immune system
• Reduce viral mutations
• Decrease the incidence and severity of opportunistic infections and hospitalizations
• Lessen the debilitating symptoms of HIV/AIDS

Specific causes of malnutrition in HIV patients can be attributed to a variety of reasons:

• The nutritional needs of HIV-infected individuals are greater because their bodies have to deal with the challenge of the chronic viral infection as well as fight off opportunistic infections⁷. Notably, even at the early stages of HIV infection when no symptoms are apparent, HIV makes demands on the body’s nutritional status⁶.
• Daily energy requirements increase⁹ in HIV patients:

• Asymptomatic HIV patients experience a 10 % increase
• Symptomatic HIV/AIDS  in adults experience a 20 % – 30 % increase
• HIV-infected children with weight loss experience a 50 % – 100 % increase
• For example, co-infection with hepatitis C which exacerbates nutritional deficiency status since the liver is intricately involved in both drug and nutrient metabolism⁷.

• Conditions associated with HIV/AIDS such as chronic diarrhoea, anorexia, malabsorption, impaired nutrient storage¹⁰.

• Co-infections:

• Food consumption:

• Inadequate availability, handling, preparation and actual physical consumption of foods¹¹.
• Food insecurity and inadequate knowledge of good nutrition could hinder good management of the disease¹¹.

As a result, malnutrition can become a serious danger for people living with HIV/AIDS, with their risk of becoming malnourished increasing significantly during the course of the infection⁶. Good nutrition is therefore one of the key elements that is fundamental in maintaining and improving the nutritional status in individuals with HIV/AIDS, delaying the progression from HIV to AIDS-related diseases⁶.

The relationship between micronutrient deficiencies and HIV/AIDS

Micronutrients are essential to immune function, and so micronutrient deficiencies may act as co-factors in HIV disease transmission and progression⁸. As a result, micronutrients can play an important role in HIV infection. HIV infection seems to impair micronutrient status, thus micronutrient status and intake may affect HIV transmission, progression and morbidity¹². The impaired immune functions resulting from lack of essential micronutrients have been called Nutritionally Acquired Immune Deficiency Syndrome (NAIDS)¹². NAIDS may contribute to depletion and dysfunction of CD4 cells and also makes a person susceptible to other infections which may in turn increase viral replication and quicken HIV progression¹².

Researchers have found that people with HIV are more likely to show signs of micronutrient deficiencies, compared to uninfected people^10,13, and studies have also confirmed that many HIV- infected individuals fail to consume the required intake for at least one or more micronutrients⁵. In theory, micronutrient deficiencies may increase viral load by enabling HIV to replicate faster, or by weakening the immune system¹².  Specifically low levels of Vitamins A, B₆, B₁₂ , C, D, E, betacarotene, selenium, zinc, copper, magnesium and iron have been found in the blood of various HIV positive populations^8,10. Among HIV persons that are not on Highly Active Anti-Retroviral Therapy (HAART), observational studies have shown low or deficient serum concentrations of several nutrients, including thiamine, selenium, zinc, Vitamins A, B₃, B₆, B₁₂, C, D and E to be associated with either low CD4 counts, advanced HIV-related diseases, faster disease progression or HIV-related mortality¹³. Some studies suggest that Anti-Retroviral Therapy (ART) may improve some micronutrient status¹³. However, micronutrient deficiencies may still persist and affect absorption, pharmacokinetics and hence toxicity and efficacy of medicines¹².

So, as the micronutrient requirements of people living with HIV/AIDS are typically higher than those of the general population, micronutrient supplementation seems to be a cost-effective and reasonably easy way to help improve one’s nutritional status⁵. Many experts now recommend multivitamins for people living with HIV, particularly those who are undernourished and have advanced disease⁷.  Research indicates that a combination of vitamin/mineral supplement offering a complete array of nutrients provides the most benefit to the immune system^12,13. Nutrients work synergistically and not in isolation¹², and as a result taking a lot of individual supplements may not necessarily be beneficial to the patient. However, daily supplementation with a broad multimicronutrient or a high-dose multivitamin supplement may reduce disease progression and mortality in adults¹².

Importantly, it must be emphasized that good nutrition cannot cure AIDS or prevent HIV infection, but it can help to maintain and improve the nutritional status of a person with HIV/AIDS and delay the progression from HIV to AIDS-related diseases⁶. Good nutrition can therefore be a very important part of the overall HIV care plan; even with ARV therapy/HAART, nutrition is still a key component of the plan to ensure infected individuals stay healthy and keep their immune systems strong⁷. This has been demonstrated in studies which have shown a direct correlation between micronutrient intake and favourable clinical outcomes in patients with HIV infection^{8, 14}:

A double-blind placebo controlled trial involving 1,078 HIV positive pregnant and lactating women in Tanzania found^{8, 14}:

• Daily multivitamins benefited both the mothers and their babies, compared to placebo.
• After four years, multivitamins were found to reduce the women’s risk of progression to late stage disease and death by 59 % in the first 2 years and 29 % over a 4-8 year supplementation and follow up period.
• Children born to the mothers receiving multivitamin supplementation during pregnancy had higher CD4 counts, less diarrhoea and improved growth during the first 2 years of life.
• Women who received multivitamins had significantly higher CD4+ cell counts and lower viral loads.
• Supplementation with multivitamins reduced the incidence of complications including oral thrush, oral ulcers, and difficulty in swallowing.
• Nausea, vomiting, and diarrhoea were less frequent among women who received multivitamins.

Another study conducted in the USA, found that daily multivitamin use among 296 HIV positive men was associated with a 30 % reduction in clinical AIDS and a significantly reduced risk for low CD4 counts⁸.

Conclusion

Recommendations of micronutrient intake for people with HIV infection should address levels that prevent clinical and biochemical signs of deficiency and should also be based on the effects of micronutrient status and intake on HIV progression and morbidity, and possibly transmission¹². While nutritional strategies cannot cure HIV nor replace HAART, good nutrition can be an essential part of the overall HIV treatment and is a key component for HIV positive individuals to remain healthy and keep the body’s immune system strong⁷. Daily supplementation with a multimicronutrient or a multivitamin supplement has been shown to reduce progression and mortality among adults¹² and is therefore a recommended way to help HIV patients to improve and maintain their nutritional status and delay progression of the disease.

Marketed by: Pfizer Consumer Healthcare. Applicant: Pfizer Laboratories (Pty) Ltd. Co. Reg. No.: 1954/000781/07. 85 Bute Lane, Sandton, 2196, South Africa. Tel: 0860 Pfizer (734 937). CEN199

References:

1. Global report: UNAIDS report on the global AIDS epidemic 2010.
2. WHO (2004). Nutrition counselling, care and support for HIV-infected women. Guidelines on HIV-related care, treatment and support for HIV-infected women and their children in resource-constrained settings.
3. The World Bank. http://www.worldbank.org Last access date: 19 April 2011.
4. LoveLife:  Status of the Epidemic. http://www.lovelife.org.za Last access date: 18 April 2011.
5. Hattingh, Z; Veldman, F.J; Bester, C.J. (2007). Micronutrient intake of HIV-infected women in Mangaung, Free State. South African Journal of Clinical Nutrition, 20 (1).
6. WHO (2002). Living well with HIV/AIDS, A manual on nutritional care and support for people living with HIV/AIDS.
7. Leadership in HIV/AIDS. http://www.hivaidsonline.co.za Last access date: 18 April 2011.
8. Academy of Science of South Africa. HIV/AIDS, TB and Nutrition. July 2007.
9. Nutrient Requirements for people living with HIV/AIDS. Report of a technical consultation, World Health Organization, Geneva, 13 – 15 May 2003.
10. Tang, A. M. et al (June 2005). Micronutrients: current issues for HIV care providers, AIDS 19(9).
11. WHO (2009) Nutritional care and support for people living with HIV/AIDS: A training course. www.who.int Last access date 20 June 2011.
12. Friis, H. (2005), Micronutrient and HIV infection: a review of current evidence, Tropical medicine & international health 11(12).
13. Drain, P. K. et al (2007). Micronutrients in HIV-positive persons receiving highly active antiretroviral therapy, American Journal of Clinical Nutrition 85(2).
14. Fawzi, W.W, Msamanga, G.I et al (2004): A Randomized Trial of Multivitamin Supplements and HIV Disease Progression and Mortality. The New England Journal of Medicine, 351 (1), 23 -32.

George Jessen created what was probably the first orthokeratology design in the 1960s made from PMMA material, which he marketed as “Orthofocus”. These early designs generally provided unpredictable results, leading to the belief that applied orthokeratology was more art or luck than science. Many groups and individuals claim to have been the first to develop modern orthokeratology solutions. But Dr. Richard Wlodyga, in particular, is generally creditedwith developing the first reverse zone lens design in the 1980s.

However, it was not until computerised corneal topography (mapping of the contours of the cornea) became available during the 1990s that it became possible to apply the theory to create designs with repeatable results through being able to accurately map the surface curvature of the cornea using a non-invasive, painless imaging procedure. Additionally, the development of new base materials for rigid gas permeable lenses (which provided much higher levels of oxygen permeability), opened up the possibility of orthokeratology becoming an overnight procedure, rather than being used for daytime wear alone. Finally, the introduction of computer-controlled precision lathes (manufacturing cutters) meant that lens designs could be manufactured to sub-micron levels of accuracy thereby offering the prospect of high volume production becoming commercially viable.  A significant milestone for the US market occurred in June 2002 when the FDA granted approval for overnight wear of a type of corneal reshaping called “Corneal Refractive Therapy” (CRT).

Orthokeratology involves first measuring the refraction ofone’s  eye which will indicate to the optometrist the degree of nearsightedness, farsightedness and astigmatism  that one  may have. Next it will be necessary to map the shape of the front surface of the eye using a corneal topographer. Based on the digital map of your eye and the amount of your prescription to be reversed, the optometrist will develop an exact shape and set of parameters necessary to prescribe in order to obtain the desired effect on your corneal shape. The special contacts are manufactured to exact specifications for your eyes. They will initially be worn for about 8 hours daily until proper correction is achieved and your vision is improved. Sometimes, your optometrist will actually prescribe a wearing schedule whereby you will only need to wear the lenses while you sleep. After that, the lenses may only need to be worn a few hours a day or at night for about 3 days a week to keep the cornea in the shape necessary to allow you to see clearly. The exact wearing schedule really depends on your eyes and correction and will be determined by your optometrist. Upon removal of the lenses you will be able to obtain improved vision without any corrective lenses. This is a great alternative for those who are too young to consider LASIK, those whose prescriptions are continuing to change and  it is especially useful for youngsters and teenagers involved in sports where wearing contact lenses might be limiting their sports activity. A new type of lens and material actually allows accelerated ortho-k that can produce results in days rather than months.

Retha van der Walt

B.Optom (RAU) FOA (SA)

Skin Care

A well cared for skin of any colour should be the most important part of any beauty routine. Make- up should just enhance a person’s looks.

Being outside means that sun block must be worn by all to protect delicate facial skin, because most skin damage happens before the age of 18. In addition:

1. Use a cleanser in the morning and evening, and a few times a week exfoliate with a gentle scrub.
2. Keep skin hydrated with a good moisturiser that has at least a SPF15+ factor.
3. Make sure there is no build-up of old make- up and do not neglect skin just because it’s holiday time.
4. Get enough sleep, because the skin will be first to show the ravages of too many late nights and not enough care.

Foundation or Base

Find the correct base and a colour for winter and for summer. Try different brands and colours to find the one that suits a person’s lifestyle best. Test along the jaw line, as it should match the natural colour of a client’s neck. Estee Lauder, Clinique, Kanebo, L’Oreal and Yardley have a good variety of colours. Revlon has some lovely colours for darker skin.

Concealer

It should match skin tone or be one shade lighter and can be used to cover dark circles under the eyes and any discoloured patches on the face. If applied after base, it will cover better and not be rubbed off. Do use it sparingly. Rimmel, Palladio or Physician’s formula have a good selection.

Blusher

If an imaginary line is drawn down the centre of the eye; that would be the furthest point where blush should be applied. Apply with half moon strokes along or just under the cheekbone from the hair line and blend in well. Start with a little bit. Once the make up has been finished a little more can be added, but be careful of looking sunburnt. For a very natural look, apply below eyebrows as well and match lipstick with the blusher. All beauty houses have good blushers, so price might decide a client’s final choice.

Eye Shadow

When applying eye shadow to the crease of the eye, tilt the head back see the shadow being created and if a person’s eyes are puffy, do not use frosted shadow, but rather try a softer, matte colour.

On the lower lid, a dark brown shadow can be applied to make eyes appear bigger. If eyeliner is being used, apply as close to the lid as possible. Again, experiment with the best look as each person has different tastes and personalities.

Mascara should be applied from the base of the lashes in an upward motion. Use a lash curler before applying mascara as it will make lashes appear longer. Blondies should use a brown or dark brown rather than black as black mascara could create a harsher effect against pale skin.

Brow colour should look as natural as possible using a brow pencil or an eye shadow in small upward strokes on the brow.

Lip Colour

Light frosty shades will make lips look fuller. If the eyes are to be the centre of attention, do not wear dramatic lip shades as the overall effect can look ‘painted’. Emphasise the eyes or the lips, not both.

Older women will find that a matte lipstick can age them, so a little shine is a good idea, and they should always use a lip liner to prevent lipstick ‘bleeding’ over the lines. Follow with some gloss.

Lip gloss can be worn by everybody, alone or over lipstick. If lips are very full, use sparingly.

Summer Make- Up

The look for summer is always fresh, and showing off a healthy glowing skin. For the best look use a peach bronze blush and gorgeous pink and glossy lips.

For the summer look, blush can be applied to the apples of the cheeks and sweep the brush up towards the side of the brow as well.

For foundation, normal base can be used, but add a bronzer and apply with a big, soft brush over the whole face.

Shimmering eye shadows can be used in summer, but less is better, so practise and experiment for the look that suits best.

Accentuate eyes with a kohl eyeliner pencil into the ridge of the lashes, and finish off with a generous amount of mascara to accentuate pretty eyes.

Clubbing or Big Night Out

Do all make up as usual, except for the eyes. For evening, dramatic purples, brown, dark blue, charcoal can be used and younger people can use shadow with some glitter. Go for a polished look and blend colours well.

Depending on the shape of a person’s eyes and whether eyes are deep set or not, start with a light colour that can be smoothed over the entire eye area under the brow. A darker colour can then be added in the crease of the eye. The darker the more dramatic, but don’t overdo the drama. Eyeliners come in fun colours, so match the colour of the dress or the eyes. Go dramatic or elegant and always step back to look at the overall effect, and finally adds lots of mascara. The perfect mascara is the one that the client prefers. L’Oreal, Revlon, Maybelline and Claudia Stevens have an interesting variety to choose from, but so do the other beauty houses.

Smokey Eyes

Do make up as normal and then start with the eye area.

Apply a neutral colour from lash to brow, and if possible, find one with a shimmer.

Line the eyes with a black eye pencil top and bottom, as close to the lashes as possible. Then this must be softened with a small eye shadow brush. Blend and soften. Then apply some black powder eye shadow over this on the top lid and gently blend in. Then some grey or brown shadow can be applied over the rest of the eye lid as well, and then finished off with mascara. Blondes may prefer a charcoal or dark grey shadow.

To prevent the dark eye shadow from ‘spilling’ onto the cheekbone area, use a tissue under the eye to catch any stray shadow. Once the upper lid has been done, use some eye shadow on the lower lid and finish with lashings of good mascara.

If the pencil and shadow is overdone or not blended well, it can create a raccoon effect. Use an earbud to smooth and reduce if necessary.

A bit of shimmer can be added to the corner of the eyes, under the brow and directly above the pupil on the lid. Try it, it works!

Finish with a neutral lipstick and add a bit of gloss.

Dramatic Lips

If the lips are to be the centre of attraction, do make up as usual, but downplay the eyes by using a neutral colour with a little bit of shimmer on the eyelid and mascara. Match blusher and lipstick, and in this case a dramatic lip liner and matching lip colour can be used. Finish off with a lip gloss and add some shimmer to the centre of the bottom lip for extra effect.

Above all, have fun and experiment with make up. What looks good on one person might look awful on somebody else. Watch the fashion magazines for new trends and try it at home first. Splash out on a visit to a professional make up artist, watch closely and try it for yourself.

Ageing and the effects of ageing: Ageing is the accumulation of physical, psychological and social changes in a human being over a period of time. Some dimensions of ageing expand over time, while others decline:

Ageing is a given, but how can we take responsibility in this ageing process? “Active ageing” is the secret to this endless list of negative effects.

What is “active ageing”? Active ageing is the active participation and utilization of opportunities for health in order to enhance quality of life as people age.  It allows people to realize their potential for physical, social, and mental well-being throughout their course of life. Active ageing aims to extend healthy life expectancy and quality of life for all people as they age.

Time for action! Let us take the bull by the horns and implement as many of the following goals:

• “Mind your own business”: We live in stressful times and are constantly exposed to barely-tolerable pressures and stressors. Stress brings unhappiness and diseases The following tips can assist to escape the claws of stress:
• Maintain a sense of humor! Laughter is most contagious, binds people together and increases happiness! The other benefits of humor and laughter include:
• boosting the immune system
• boosting energy
• fight pain and stress
•  relaxing the whole body
• i triggers the release of endorphins which promote an overall sense of well-being
• laughter improves the function of blood vessels and increases blood circulation.
• Relaxation and stress management: Schedule time in the daily rat-race to relax. Relaxation can take various forms from stress massage, exercise to meditation to mention a few. Apply Holistic Emporium’s Lavender oil to the temples, at the base of the neck and above the eyebrows and focus on deep breathing exercises
• Biral^® tablets contain ingredients (valerian and passiflora) from plant origin. These active ingredients act on the central nervous system to elicit a mild tranquilizing action. Biral can be used during the day since it should not cause drowsiness or impair mental alertness and concentration.
• Relaxation and sleep: The optimum amount of sleep can vary by age and from person to person.  Research has revealed that the quality of sleep deteriorates as we age. The lack of good restful sleep can increase the risk to certain chronic diseases. One should find one’s optimum sleep requirement and implement lifestyle changes to achieve that optimum goal. The following steps can be implemented to offer assistance:
• Melatonin: Melatonin is produced by the pineal gland which is located in the mid brain. The production of melatonin is regulated by the SCN (supra-chiasmatic nucleus). The SCN will delay the production of melatonin until darkness arrives and the release of melatonin is associated with sleep onset. Solal Melatonin^® can be recommended to supplement the melatonin levels in the body.
• Valerian root: Valerian is a well-known herb in the treatment of anxiety and as a sleep aid.       Calmette’s Night^®contains valerian and is most effective when taken shortly before bedtime. Valerian does not interfere with sleep cycles or with REM (rapid eye movement or restful) sleep.
• Bedtime routine: It is important to use the bed for sleep and sex and not as a work station! Keep the room dark to enhance the production of melatonin. It is also advisable to ensure adequate ventilation.

• Achieve ideal and maintain body weight:  Excess body weight burdens the body and increases the “wear-and-tear” on all body systems. If one is over the recommended average weight, it is recommended to follow a weight loss program that will see a steady (but not overdramatic) loss of weight. Take note that fasting and rapid weight loss can actually do more harm than good. The following two products offer valuable support:

• 5-HT: Solal 5-HTP Feel Good^® this product boosts mood, reduces anxiety and helps curb excessive appetite, especially carbohydrate craving. 5-HTP is the pre-cursor of the neurotransmitter serotonin. Ashwagandha is a herbal extract which helps improve resistance to environmental stress, thereby protecting the brain and heart from stress-damage.

• Alli^®: Changing the thoughts and feelings about food is one of the keys on the journey to optimum wellness and personal happiness. Alli capsules block the fat absorption and Alli users can lose up to 50% more weight than those who use diet alone. One can expect some slightly uncomfortable side effects if one continues with a high fat diet while using Alli. These are increased flatulence and rectal discharge (very soft stools) as the drug acts to reduce the amount of fat absorbed by the body.

• Exercise: Exercise and physical activity form the foundation of a healthy lifestyle. Exercise as part of the lifestyle can take different forms from brisk walking to gardening To reap the full benefit, one should “exercise” three to five times a week for at least 30 to 45 minutes per interval. The main goal is to enjoy the activity and to have fun.

• Hydration: Pure, fresh good quality water is not a luxury, it is an absolute necessity. The body needs to flush toxins from the system. This can only be done with at least two litres of fluid daily. Regular detoxifying will assist the body to eliminate toxins and impurities. It will revitalise the metabolism and improve vitality. There are different ways one can detoxify. G.I LEAN’s 3 Day Detox^® Programme has a scientifically formulated blend to be used on three consecutive days. This should be repeated on a monthly basis. It is important to consult the pharmacist or healthcare provider regarding the safety in specific medical conditions. GI Lean 3Day Detox should not be taken during pregnancy and breastfeeding.

• Smoking: Smoking has negative effects on the body and well-being. It enhances ageing and one should quit smoking as soon as possible! One should make the commitment and then stick to it. The following products can assist those that want to quit:

• Nicorette Patches^®: Nicorette patches were developed to provide a method of delivering a controlled dose of nicotine. People should start on the strongest (15mg) patches and then gradually reduce the intake of nicotine by following the manufacturer’s step-down programme. The treatment should generally continue for three months.
• Nicorette Chewing Gum: ^®  Nicorette chewing gum provides a flexible dosing of nicotine. The smoker can control cravings when they feel the urge to smoke. It is available in 2mg and 4mg strengths. The nicotine contained in the gum is absorbed in the bloodstream through the mucosa of the mouth. It is important to advise smokers not to chew Nicorette gums continuously.

• Dietary changes: We are what we eat. The following guidelines can assist in changing over to a healthy lifestyle:
• Breakfast: Breakfast is the most important meal of the day and should never be skipped. Try eating three to five smaller meals during the day at fairly regular intervals.
• Read labels: Read labels and know the ingredients of all products. Make wise decisions. Look for products that contain the least amount of processed ingredients.
• Seek satisfaction: Seek satisfaction in genuine flavours obtained from herbs rather than from fat, sugar, salt and chemical additives.
• Avoid beige. Bring colour onto your plate and try to combine at least five different colours of food at each meal. Rainbow coloured fruits and vegetables will assist in achieving this. “Beige” carbohydrates and fats should form a small portion of the diet. Protein intake can be increased to combat the normal muscle loss that comes with ageing.
• Fats: Be knowledgeable on the different types of fats. We get good fats and bad fats. Always try to grill and not to fry food. Vital Omega 3 & 6^® combines high concentration omega 3 (Norwegian salmon oil and cold pressed flaxseed oil) with high concentrations omega 6 (borage oil).  Supplementation will provide the diet with EPA (eicosapentaenoic acid), DHA (docosahexaenoic acid) and GLA (gamma linolenic acid). The omegas fuel the brain, but also encourage the body to store carbohydrates as glycogen (the form in which glucose is stored).

• Supplementation: “Active ageing” supplements can make a difference but it should be taken on an ongoing basis. Here are a few important supplements:
• Chromium: Clicks Blood Sugar Regulator^® contains chromium (and other minerals) which will assist the body in maintaining constant blood glucose levels.
• Vitamin C: Vitamin C is an important active ageing nutrient. It has antioxidant properties and helps to prevent damage caused by free radicals. Scorbex^® contains 500mg ascorbic acid in each tablet. Vital Vitamin C^® has a pleasant tasting vitamin C chew tablet.
• Coenzyme Q10: Coenzyme Q10 is an essential component against the onslaught of ageing. It is incorporated into body cells where it regulates the oxidation of fats and sugars into energy. Q10 supplementation is a must for everyone over the age of 30 years
• Vitamin K: Vitamin K (Konakion^®) is a member of the fat-soluble vitamins and aids in the constriction of blood capillaries and the maintenance of bone strength. It might also be helpful in the treatment of blue rings under the eyes. The blue rings develop as a result of leaking capillaries around the eyes which result in the pooling and clotting of blood. Vitamin K assists in building the capillaries and breaking up of these tiny blood clots that form the circles.
• Multivitamins and Minerals: Dynamisan^® comprises of a unique combination of 11 vitamins, 10 minerals, 2 amino acids and ginseng to help maintain a healthy body and mind. Ginseng will help to increase mental clarity and sharpness. Pharmaton^® Vitality can also be recommended as a unique blend of vitamins, minerals and ginseng clinically proven to relieve periods of exhaustion.

Conclusion: Ageing is not for faint-hearted, but for the courageous! Let us celebrate our well-being through the active participation in ageing! 

References:  Available on request

Around 20% of women and 10% of men have varicose veins. These clients are going to ask you for assistance, not only because varicose veins are unsightly, but they are also painful and even dangerous.

What causes varicose veins?

In a normally functioning vein, blood is forced to move back towards the heart. Tiny valves found every few centimeters along the inside of each vein prevent blood flowing backwards.  Varicose veins develop when these valves are damaged, causing blood to pool in the affected areas. The veins then swell, causing further damage and worsening enlarged veins.

Know your varicose veins

Not all varicose veins are the same. You will need to know some of the different types to recommend the right treatment:

Thread or “spider” veins. These are tiny reddish-blue thread-like veins which your client will complain about for cosmetic reasons.  They don’t always indicate a serious underlying problem.

Blue, Green Reticular Veins: These are slightly enlarged blue veins which more often than not progress to become larger over time. Clients with this type of varicose vein will often complain of pain.
Bulging Varicose Veins: These are very large veins always associated with deeper lying varicose veins. They often are not associated with severe symptoms, despite their size.

Common Complaints

Your clients could complain that their varicose veins are causing:

• Pain, aching and cramping, even during the night.
• Ankle swelling, especially after standing for long periods.
• Skin discolouration: Red, blue veins and later scarring patches may appear
• Itchiness: Sometimes clients will scratch their skin so much that it causes bleeding, ulcers and scarring.

“Why me?” your client may cry

• Genetics: As with most conditions, if your client has parents with the condition, they’re at higher risk. However, many people develop them without any family history.
• Local injury: Damage to a leg (for example being hit on the leg by a hockey ball) can damage the veins.
• Pregnancy: The hormones, additional circulating blood volume and extra weight carried by women during pregnancy, often leads to the development of varicose veins.
• Previous blood clot (deep vein thrombosis): A blood clot in the veins can lead to damage to the internal valve system, leading to varicose veins.
• Overweight/obesity: Increased abdominal girth puts more pressure on the vessels returning blood to the heart, leading to widening and damage of the vessels in the legs.

Why are they a problem?

Varicose veins can cause some unpleasant and dangerous complications:

• Blood clots: Also know as deep vein thromboses (DVT) are more likely to form in legs in which the venous drainage is not working adequately. DVTs dislodge from the leg and shoot up into the heart, leading to a clot in the lungs (pulmonary embolism). People often die if this complication occurs.
• Restless legs syndrome: While there are other causes of restless legs syndrome, varicose veins and poor circulation is a known risk factor. Clients will complain about pain in their legs in the evening or night which is relieved by movement.
• Disability: Varicose veins can make it difficult for those affected to work, especially in positions which require long hours of standing such as teaching, training, nursing etc.
• Skin ulcers: Poor circulation over the site of the varicose veins can lead to serious skin ulcers which can take many months to heal.
• Severe bleeding: The fragile and enlarged veins are prone to bleeding when the leg is bumped or scratched.

Over-the-counter advice

You can advise your clients with varicose veins to:

• Use compression stockings. These are specialized tight fitting stockings which, by squeezing the legs, help to stop pooling of blood in the legs. They help to alleviate symptoms of varicose veins, prevent deep vein thrombosis and slow down worsening of the condition. Compression stockings come in different strengths, a grade II normally being used for varicose veins. Make sure your client sees their doctor to ensure that it is safe for them to use compression stockings. In clients with arterial disease, these stockings can cut off their blood supply. Clients who already use compression stockings should replace them every 6 to 8 months.
• Relax and put your legs up: Get your clients to prop their legs up above the level of their head while seated or lying down (usually putting a pile of cushions under their feet does the trick). This helps drain blood from the legs and alleviates symptoms.
• Exercise: The movement of muscles in the legs during exercise can help to boost circulation and improve their symptoms. Some simple walking would be a good place to start.
• Supplements: There is some evidence that herbal supplements with horse chestnut (Aesculus hippocastanum ) can help tighten the veins and improve blood circulation. Horse chestnut works as a diuretic and so really helps to treat leg swelling (oedema) rather than the varicose veins themselves. Make sure your client does not have any kidney or liver problems, pregnant or breastfeeding while taking this supplement.

At the doctor’s office

Treatment for varicose veins includes numerous options nowadays. You can advise your clients that most procedures are done in the doctor’s rooms under local anaesthetic and include:

• Sclerotherapy: Using very small needles, the doctor injects a combination of local anaesthetic along with saline into the varicose veins. The treatment is done in the doctor’s rooms and takes 60 to 90 minutes. The injected solution makes the vein walls stick together, blocking any further blood flow. Sometimes up to six sessions of sclerotherapy are needed to effectively remove varicose veins. Recurrence is unlikely after a few cycles of treatment.
• Laser therapy:  Laser energy is directed over the affected veins. For smaller veins, laser therapy destroys the varicose veins without causing scarring. For larger varicose veins, a probe is inserted into the vein and the laser energy is directed at the vein from the inside. Both of these procedures are usually done in the doctor’s rooms.
• Radiofrequency ablation: Similar to laser therapy, but radiofrequency energy is used instead to destroy the varicose veins. This is also done in the doctor’s rooms under local anaesthetic.

Surgical treatments:

For some people with larger or recurring varicose veins an operation will be required to treat them. Depending on your client’s overall health, the procedure can be done in-hospital or as an outpatient.

Vein stripping: Under sedation and anaesthetic, a small cut is made in the skin and the varicose vein is followed to where it joins up with the larger, deeper vein in the groin area. At this point it is tied off and then the varicose vein is removed.

Caring for your customer

While the treatments to manage varicose veins are becoming more sophisticated, the condition remains as common as ever before. Varicose veins are not just about vanity as they can lead to serious complications. Clients will ask whether there is any pill, lotion or potion which can make their veins vanish. Unfortunately your advice is probably the best over-the-counter treatment available. Do advise your clients to make appropriate lifestyle changes and have their veins checked by a doctor.

What is overindulgence?

Overindulgence is defined as excess, overeating, lack of restraint or to binge.

The liver plays an important role in the digestive process, as it assists with the digestion of fatty foods as well as the breakdown of alcohol. Excessive intake of alcohol and fatty foods may overtax the liver, causing symptoms of overindulgence, such as:

• Indigestion
• Feeling bloated
• Feeling tired
• Abdominal tenderness and discomfort
• Nausea
• Vomiting in extreme cases.

Alcohol

People differ in their tolerance level for alcohol. The dietary suggestion to the public is 1-2 small glasses of wine or 1-2 cans of beer per day – but even this is above the recommended dose for drivers these days.

Alcohol units

Always be aware of the number of alcohol units consumed. A large glass of wine, for instance, contains around 3 units. According to South Africans Against Drunk Driving (SADD) one alcohol unit will result in 0.02g in blood or 0.10 mg in breath. Three units of alcohol will translate into a blood alcohol level of 0.06 g and 0.3 mg in breath calculated for an adult male of about 68 kg who has eaten a meal. The legal limit is <0.05mg in blood and <0.24 mg in breath.

It takes 1 hour or more to get rid of 1 alcohol unit. A few examples:

Sorghum beer             1.5 units

Spirit cooler                1.5 – 1.9 units

Beer (can)                   1.5 – 1.7 units

Cider (can)                  2 units

Red wine (75 ml)        1 unit

White wine (90ml)      1 unit

Tequila (25 ml)           1 unit

Spirits (25 ml)             1 unit

The NHS (?? National Health System) recommends:

• Men should not regularly drink more than 3-4 units of alcohol a day
• Women should not regularly drink more than 2-3 units a day.

Regularly means drinking this amount every day or most days of the week.

Effects of alcohol

Alcohol is broken down by the liver, raising the liver enzymes and potentially leading to hepatitis. Most of the alcohol consumed must be metabolised in the liver; this process requires a lot of work and takes precedence over many other necessary functions. Therefore fat metabolism is decreased and fatty build-up can occur in the liver. Alcohol does not convert to glucose or glycogen, but to fat, which may later lead to obesity with high alcohol use.

Vitamin and mineral interactions show that alcohol diminishes the stores of many of the B vitamins, including vitamin B2 and B6, vitamin A, vitamin E, beta-carotene and magnesium. Alcohol consumption impairs the absorption of the enzymes in the liver that activates these vitamins, therefore, it is essential to supplement.

Hangovers

Hangovers represent the very unpleasant side-effects of drinking alcohol. Alcohol dehydrates the cells, removes fluid from the blood, swells the cranial arteries and irritates the gastrointestinal tract.

Many of the side-effects are caused from dehydration and can be remedied by taking water while drinking and also large amounts before going to sleep. Raising blood sugar levels with a snack of fruit before bed will also help.

The common hangover includes some or all of the following:

• Headache
• Poor sense of overall well-being
• Sensitivity to light and sound
• Diarrhoea
• Loss of appetite
• Trembling
• Nausea
• Fatigue
• Increased heart rate and blood pressure
• Dehydration (dry mouth, extreme thirst, dry eyes)
• Inability to concentrate
• Anxiety
• Difficulty sleeping
• Weakness.

When alcohol is consumed, it enters the bloodstream and causes the pituitary gland in the brain to block the creation of vasopressin (the anti-diuretic hormone). Therefore, the kidneys send water directly to the bladder instead of reabsorbing it into the body. According to studies, drinking about 250 ml of an alcoholic beverage causes the body to expel 800 to 1000 ml of water; four times as much liquid lost as gained.

The morning after heavy drinking, the body sends a desperate message to replenish its water supply — usually manifested in the form of an extremely dry mouth. Headaches result from dehydration because the body’s organs try to make up for their own water loss by taking water from the brain.

The frequent urination also expels salts and potassium that are necessary for proper nerve and muscle function. When sodium and potassium levels get too low, headaches, fatigue and nausea can result.

Alcohol also breaks down the body’s store of glycogen in the liver, turning the chemical into glucose and sending it out of the body in the urine. Lack of this key energy source is partly responsible for the weakness, fatigue and lack of coordination the next morning.

Because alcohol is absorbed directly through the stomach, the cells that line the organ become irritated. Alcohol also promotes secretion of hydrochloric acid in the stomach causing heartburn and eventually vomiting.

Treatment

Painkillers

Certain painkillers are more effective at combating a hangover than others. It will relieve the headache in the short-term but may have some long-term side-effects.

Combination painkillers can be helpful for a headache because it combines paracetamol or aspirin for the pain and caffeine that reduces the size of the pounding blood vessels. However, prolonged combination of alcohol and paracetamol has been shown to cause liver damage. It should also be taken into consideration that caffeine is a diuretic and can worsen the symptoms of dehydration.

Aspirin belongs to the class of anti-inflammatory drugs known as prostaglandin inhibitors. High levels of prostaglandins have been associated with increased hangover severity. In one study, participants who took a prostaglandin inhibitor before bed reported less of a headache and less nausea and thirst than those who had drunk the same amount of alcohol but did not take the prostaglandin inhibitor before bed. Aspirin may aggravate the already irritated mucosa of the stomach.

Over-the-counter remedies

Several OTC products are available to treat a variety of symptoms of a hangover.

Alcohol irritates the digestive system. This can lead to nausea and high acidity levels in the stomach the next day. If nausea is the problem, eating something bland like dry toast should help or possibly take domperidone (Motilium®) to settle the stomach. Avoid cereal because the fatty content of milk can add to queasiness. Popular remedies like Eno® and Rennie® can ease acidity.

The liver can be protected by lipotropic agents containing B-complex vitamins (Essentiale®) while Gurosan® acts as a tonic against fatigue. The KGB® pill is reported to effectively protect the body from alcohol damage.

Rehydration sachets, usually used for treating diarrhoea, can speed recovery from a hangover. This is because they contain small amounts of electrolytes that replace lost fluids quicker than water alone. Mix one sachet with water and drink before you go to bed, then do the same the morning after. Isotonic sports drinks also contain these salts.

Berocca® tablets may help to replace nutrients lost after a drinking session. The effervescent tablets contain vitamins B, C, calcium and magnesium.

Natural treatments

Natural and holistic treatments such as herbal and homeopathic remedies have proven to be highly effective in providing relief for symptoms associated with overindulgence or an alcohol hangover.

Powerful herbs such as Silybum marianus (milk thistle), Althaea officinalis (marshmallow) and Ulmus fulva (slippery elm) support the liver and promote balance and equilibrium in the body during times of excess and overindulgence.

Homeopathic remedies help the body restore balance at a cellular level. Carefully selected ingredients such as Lupulus humulus, Lobelia inflata and Nux vomica is the homeopathic hangover remedy to reduce the side-effects of a dry mouth, dry eyes, headache and nausea.

Home remedies

A number of home remedies exist and have been passed on from generation to generation – but not all of them are effective.

Hangover sufferers usually feel a bit shaky, due to a lack of sugar in the blood. A breakfast of toast with honey is best to combat symptoms, according to the Royal Society of Chemistry. This provides the body with sodium, potassium and fructose – all of which are lost after a night of boozing. Add a banana to further boost potassium and fructose levels.

A glass of pure fruit juice or a smoothie will also lift the blood sugar levels and avoid the quick drop that high sugar fixes like pastries will bring. Fruit is packed with vitamin C which helps the liver to process alcohol.

The drop in blood sugar can also lead to hunger the next day. Be careful not to have to digest  loads of fat as this will put extra strain on the already stressed digestive system. Try scrambled eggs on toast with baked beans. The beans and bread will steady blood sugar levels, while eggs contain cysteine that is thought to mop up the toxins that build up in the liver.

Prevention

Researchers have found the following general regimens minimise the symptoms of a hangover.

Before drinking

• Eat a full meal – A full stomach slows down the absorption of alcohol, giving the body more time to process the toxins. Fatty foods and carbohydrates increase this effect.
• Start with a glass of water – This ensures the body is hydrated before the diuretic effect takes hold.
• Take multivitamins – This better prepares the body for the depletion of vitamins caused by frequent urination.

While drinking

• Drink in moderation – Ideally, drinkers should limit themselves to one drink per hour because the body takes about an hour to process a single drink.
• Drink a glass of water after every alcoholic beverage – In addition to helping keep a drinker hydrated, this will give the body more time to process the alcohol, dilute the toxins and reduce irritation of the stomach. Sports drinks will replenish electrolytes, salts and sugars lost in the urine.
• Avoid mixing drinks – Drinkers generally fare better when they stick with one drink. Each new type of alcohol a drinker puts into his or her system makes the body work that much harder and puts that many more toxins in the body, leading to a more severe hangover.
• Beer has the lowest percentage of alcohol (4 to 6 percent), but is carbonated, which speeds up the absorption and can lead to toxin buildup.
• Wine has a higher percentage of alcohol (7 to 15 percent) than beer. White wine is safer than red or blush because it has fewer congeners (byproducts of fermentation). In general, the cheaper the wine, the higher the congener content and the worse the hangover.
• Liqueur has the highest alcohol content (40 to 95 percent) and therefore increases the likelihood of a hangover. Clear liquors like vodka, rum and gin are better than dark or sweet liquors like bourbon, scotch or tequila because they have fewer congeners.

After drinking

• Take two aspirin with a full glass of water before bedtime and on waking – The prostaglandin inhibitors in the aspirin can decrease hangover severity.

• Take another multivitamin – Replenishing C and B vitamins in particular can help get rid of the rest of the toxins.
• Eat breakfast – A meal that includes eggs (for the cysteine), a banana (for the potassium), and fruit juice (for the fructose) or a sports drink (for the electrolytes, sugars and salts) can get the body on the road to recovery. Keep in mind that caffeinated coffee, tea and soda will further dehydrate a drinker.

Even though one may be more tempted to overeat during the holidays, the right precautions will promote healthy digestion any time of the year when one overindulges in food and drink.

Acquired immunodeficiency syndrome (AIDS) is a disease of the human immune system caused by the human immunodeficiency virus (HIV). This condition progressively reduces the effectiveness of the immune system and leaves individuals susceptible to opportunistic infections and tumors.

Modes of transmission

HIV is present in blood, semen and other body fluids such as breast milk and saliva. Exposure to infected fluid leads to a risk of contracting the infection, which is dependent on the integrity of the exposed site, the type and volume of body fluid and the viral load. 

Modes of spread

• Sexual contact: man- to- man, heterosexual and oral
• Parenteral: via blood or blood product recipients, drug-users with infected needles, and health care workers with occupational injury
• Vertical:  from a HIV positive mother to her newborn during delivery.

Diagnoses of HIV/AIDS

HIV is most commonly diagnosed by testing of blood for the presence of antibodies to the virus. HIV tests are usually performed on venous blood. Many laboratories use fourth generation screening tests which detect anti-HIV antibody (IgG and IgM) and the HIV p24 antigen. The detection of HIV antibody or antigen in one’s blood shows that the individual have been infected with the HIV virus.

Treatment

The national guidelines for public sector use of HAART are based largely on the WHO 2002 guidelines which states that:

Medical indications for initiating HAART in adults:

1. CD4 count< 200 10^6/L
2. Severe HIV disease (WHO stage 4 disease) irrespective of CD4 stated that the psychosocial indicators for drug readiness are in place.
3. Pregnant women with CD4 less than 350 10^6/l for lifelong ART and CD4 >350 10^6/l for prophylaxis
4. TB patients with CD4 less than 350 10^6/l

Psychosocial indicators include

• It is essential that the patients have good insight into the need for long-term therapy and high levels of adherence
• Structures need to be in place to provide adherence support for patients
• Patients should be encouraged to disclose their HIV status to somebody close to them and this person should act as a treatment supporter.
• HAART should not be commenced if there is active substance abuse or depression.

Antiretroviral therapy consists of three or more antiretroviral drugs that are capable of suppressing HIV replication when usedin combination. The usual HAART regimen contains two nucleoside reverse transcriptase inhibitors together with a non-nucleoside reverse transcriptase inhibitor or a protease inhibitor.

Regimen 1

Consists of two nucleoside reverse transcriptase inhibitors:

• Stavudine (40mg per os 12 hourly) and lamivudine (150mg per os 12 hourly)

Plus

A non-nucleoside reverse transcriptase inhibitor

• Efavirenz (600mg nocté per os) or Nevirapine (200mg per os 12 hourly)

Efavirenz and Nevirapine are equipotent, but have different toxicities. Efavirenz is teratogenic and should not be used in women of child-bearing potential.

In addition:

• Tenofovir 300mg once daily.

It is very important that all patients starting on tenofovir should have their kidney functions tested and followed up, since kidney disease is a contra-indication to tenofovir use.

Regimen 2

Consists of two alternative nucleoside reverse transcriptase inhibitors:

• Zidovudine (300mg per os 12hourly) and didanosine (400mg daily on an empty stomach)

Plus

A protease inhibitor

• Lopinavir/ritonavir combination 400/100 (3capsules 12hourly per os)

Treatment efficacy monitoring

Treatment efficacy is monitored by measuring the CD4 and viral load every 6 months. The viral load will indicate when resistance is developing and when regimens need to be changed. The viral load should become lower than the detectable limit  within        6 months. If this does not happen on the first regimen then this is nearly always due to poor adherence, switching to the second line regimen is only considered when there is a viral load >5000 copies/ml. The CD4 varies more, but usually increases with average 150 cells in the first year. 

Important side effects of antiretroviral therapy includes

• ARV treatment causes a lot of side effects, some more serious than others. Constitutional symptoms such as general malaise, body pains, nausea, vomiting, abdominal discomfort and dyspepsia are very common. Other more complicated and serious side effects are:
• Hyperlipidaemia-Protease inhibitors are known to cause dyslipidaemia, resulting in raised LDL cholesterol and triglycerides. Statins should not be used to treat the side effect of  this drug, as protease inhibitors inhibit the metabolism of most statins resulting in extremely high levels, instead they can be treated with a fibric acid derivative e.g. bezafibrate, oral 400mg nocté.
• ??Hyperlactataemia- is a very serious complication occurring in 1-2% of all patients on long-term NRTIs. The incidence decreasing with the use of stavudine and zidovudine as compared to didanosine. Clinical symptoms of hyperlactataemia are very non-specific, they include nausea, vomiting, abdominal pain, weight loss, malaise with tachycardia. Thus a very high level of suspicion is needed for diagnosis and appropriate management. Depending of the level of lactate, patients can be treated either with an alteration in HAART regime or if more serious, hospital admission and IV Vitamin therapy.
• Anaemia
• Peripheral neuropathy- patients often complain of burning feet. This should be treated with pyridoxine 25mg daily per os, and if more severe with amitryptilene nocté per os.

Conclusion

Without treatment, the net median survival time after infection with HIV is estimated to be 9 to11 years, depending on the HIV subtype, compared to a patient on treatment, having a reduced death rate of 80% and a raised life expectancy for a newly diagnosed HIV-infected person to about 20 years.