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Eating order

Eat, drink and be merry for tomorrow we might die

Eating order

The rest of the world went on but most households in the United States were busy last week preparing for ‘Thanksgiving’ Dinner (Thursday November 23). Thanksgiving is a national holiday that goes into the weekend so it gives enough time even for family members that live far away from each other to get together. Large amount of food is cooked and then consumed. For me, the best part of Thanksgiving is that I get a chance to be with all my children and grandchildren in one place.

Of course, this holiday is based on ‘bad’ history but over time it has become the major non-denominational holiday/festival. And for obscure reasons the turkey (bird) has become the prime meal bird of choice. Fortunately, every Thanksgiving dinner has so many other things to eat that those of us not into turkey can still feast on the fixings, the trimmings, the side dishes, and the deserts.

Like all major holidays that revolve around the consumption of large amounts of food, similar warnings are given out in the US as they are in Pakistan. Don’t eat this, not too much of that, eat only if you are hungry, don’t over eat and so on.

Eating too much, or too much of the ‘wrong’ food can produce something called ‘heart burn’. For most people this is usually a temporary condition.

Frankly other than those with medical problems that limit their ability to eat, for the rest an occasional over indulgence is entirely harmless. And even for people with problems like diabetes often an extra bit of medicine can cover the adverse effects of the occasional over indulgence. The important point is that any person with a medical problem should be aware of it and monitor its severity.

The relationship between food and health is well established. The ancient Greek system of medicine often associated with Hippocrates is still alive and well in Pakistan as ‘Unani Tibb’. In this system of medicine different foods are allotted different properties. Eggs are ‘hot’ while cucumbers are ‘cool’. That of course gave us the phrase: ‘cool as a cucumber’.

That said, eating too many eggs will not produce a fever or make the winter less cold. And eating cucumbers will not bring the body temperature down during a fever or make the Lahore summers more tolerable. But still, it is a fact that different foods contain different ‘nutrients’ that are necessary for good health.

Scurvy was a disease that afflicted sailors that spent months at sea. It caused bleeding gums and other undesirable problems. Scurvy was caused by a lack of Vitamin C that is found mostly in ‘fresh’ fruits and vegetables that were not available on long voyages. Drinking lime juice cured this disease because lime juice is rich in Vitamin C (like all citrus fruit juices). So the British Navy started carrying and providing lime juice for its seamen. That is why the seamen were also called ‘limeys’.

Eating too much, or too much of the ‘wrong’ food can produce something called ‘heart burn’. For most people this is usually a temporary condition. Fortunately heart burn has nothing to do with the heart. Heart burn is interestingly a common problem that often affects much besides the heart. What it is called in a more technical terminology is Gastro-oesophageal reflux disease. In the US, the ‘O’ before oesophageal is done away with so the acronym becomes GERD. I suppose in Brit medicine it is called GORD.

GERD is due to a complex scenario. The human stomach contains a concentrated amount of acid (hydrochloric acid) that helps to break down or digest food. An anatomical ‘valve’ prevents the contents of the stomach that are acidic from going back (refluxing) into the food pipe (oesophagus). If for any reason the acidic stomach contents do go back into the food pipe they produce irritation of the covering of the food pipe that then is felt as heart burn.

The reason why I want to expend a few sentences on GERD is because the heart burn it produces is easily treated with some ‘antacids’ but it can have other effects also. Over the last few years, it has been determined that many cases of inflammation (tissue irritation) leading to sinus infections, throat problems (pharyngitis) and even lung infections and asthma occur because when lying down the acid in the stomach leaks back into our throat, nose and the lungs producing these problems.

What to do about such GERD? Before a new class of medicines came out a few decades ago that decrease the production of acid in the stomach, surgery was the only option to control GERD. Now medicines can control excess acid production but the leaking back of stomach contents can still happen. Many people with recurrent nose and throat problems as well as new asthma can sometimes be ‘cured’ by a combination of medicine and having dinner more than six hours before going to bed.

Why six hours? Because in most people the stomach empties out after a meal in about six hours. And if the stomach is empty, acidic stomach contents are unlikely to go back into the food pipe. On the other hand a very full stomach containing fatty foods that tend to slow down stomach movement can push some of the stomach contents back into the food pipe and produce heart burn as well as the problems in the nose, throat, and lungs I mentioned above. The one problem I am going to avoid discussing is that of a stomach ulcer. That has little to do with occasional overindulgence in food.

There is a medical condition that is associated with excessive consumption of food and subsequent forceful vomiting. The name of that condition is Boerhaave Syndrome. What happens is that the person develops a tear in the food pipe leading to disastrous consequences. Evidently a Dutch admiral developed this problem after a ‘gluttonous feast’ and Doctor Boerhaave diagnosed and described this condition. There are some recent medical reports that suggest that over consumption of rice can lead to rupture of the stomach.

Persistent over indulgence in food is gluttony but today my discussion is about occasional over consumption of food. There is a Punjabi saying that describes the effect of overeating: “Pukha Jat katora labbya, paanee pee aphraya” (a hungry farmer found a cup and drank so much water that he developed a belly full of air). Belly full of air is a pretty common complaint and is also related to overindulgence in certain types of food.

The stomach and the intestines normally have a lot of air. Much of this air is swallowed along with food and the rest is produced by the digestion of food. Certain foods tend to produce more gases than other foods during the digestive process. Notorious are legumes, lentils, beans and other such stuff. However, the one thing that is related to ‘gas’ is occasional or these days, frequent consumption of aeriated drinks or sodas.

So oily food that delays emptying of the stomach, foods that produce gas during digestion and sodas that contain gas to start with are all consumed together, they can produce a lot of gas. And that might require some medical help.

In summary, ‘eat, drink and be merry for tomorrow we might die’.

Syed Mansoor Hussain

syed mansoor hussain
The author has served as Professor and Chairman, Department of Cardiac Surgery, King Edward Medical University.

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