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Psychosomatic diseases afflict expats Fasting not good for the critically ill

LIVING in Kuwait has many health challenges for expatriates. From the experience of Dr Ashok Deb, Respiratory Medicine specialist at City Clinic, psychosomatic diseases affect expatriates the most. Being separated from their families and homes is one of the leading causes of depression among expatriates that triggers a series of health problems, including Irritating Bowel Syndrome, which among its many manifestations also has the rather embarrassing symptom of an urge to go to the toilet as soon as eating. And then there is the puzzling Fibromyalgia, which is characterized by body pain with no apparent cause. All the medical tests would be normal, yet the pain would linger without letup. A minor dose of anti-depressant could be the only cure.

Question: What is your advice to our readers in Ramadan?
Answer: Ramadan is a very tough time, and patients suffering from gastritis, heart diseases, diabetes, dyslipidemia, which is when cholesterol and triglycerides levels may be high, should take special care, and should adjust their medications according to the timings in Ramadan. Critically ill patients cannot follow the regiments of fasting.

Q: Which diseases are commonly seen in general practice in Kuwait?
A: Talking of expatriates, most of them are away from their families for a long time and as a natural consequence suffer from mental depression. Prolonged depression causes many kinds of diseases which are grouped as psychosomatic diseases.
Among them are some important diseases like Irritable Bowel Syndrome, more commonly known as IBS, bronchial asthma, rheumatoid arthritis and others.
If our mind is free and does not suffer any depression many of these diseases can be easily cured.

Q: You said Irritable Bowel Syndrome is among the most important diseases belonging to the psychosomatic group of diseases. Can you explain more about IBS?
A: Irritable Bowel Syndrome is found among 25% of the total population. It is very prevalent. These are of 3 types: constipation type, diarrhea type and alternate diarrhea and constipation type.
So, they can suffer from any of these kinds of IBS. As I said the main cause is depression coupled with irregular food habit. Most of the patients are in a situation where they do not have enough time or the circumstances to have home cooked food. They are compelled to take outside food.
Usually, when you eat out, you get to eat food that is extremely oily and spicy, and sometimes junk food. This ill-advised food habit leads to gastritis. And when you add to it depression, you have the perfect situation for IBS to set in.
IBS is not a dreadful disease. But once it sets in it prolongs for a long time, going on for years and years. You have to fix a strict diet schedule to control it.

Q: Is the urge to go to the toilet as soon as you eat also part of the IBS?
A: Yes. We have a reflex called gastrocolic reflex. As soon as the food touches the stomach there is a nerve that stimulates the colon, which creates the urge to go to the toilet. This actually comes in the third category of IBS I just talked about. This is the diarrhea category.

Q: Talking of psychosomatic diseases, as you pointed out, they have physical and psychological factors. You told us about how the physical factors can be controlled by diet and so on. But what about the psychological aspect? How can one relax the mind?
A: In the last 7 years of my practice in Kuwait, I have seen plenty of depressed patients, running into thousands. There’s also a disease called Fibromyalgia, which is characterized by body pain without a cause. Do any tests, and the results are all negative. This is caused purely by depression. In their case, only a simple dose of anti-depressants at night can cure it fully. If you prescribe analgesics and pain killers, the pain may go temporarily but will come again. But when the depression is taken care of, the symptom goes away fully. Fibromyalgia is also known to be caused by Vitamin D deficiency. As you many know, our body produces Vitamin D from exposure to sunlight. And it’s ironic that in a country with such abundant sun, this disease is found.
However, unfortunately in Kuwait anti-depressants are not easily available in Kuwait. We cannot prescribe them freely. These are available only in government hospitals. It has to be prescribed by a ministry doctor.
There are some varieties of these drugs that are available in private pharmacies, but they are not very potent to have the desired effect.
So, the simplest cure for psychosomatic diseases like fibromyalgia is to put the patient on a small dose of anti-depressant or anxiolytic drugs. This is true of all psychosomatic diseases.

Q: Do you have any other remedies like yoga and so on that are believed to have a soothing effect on the mind?
A: That is very hypothetical. As an allopath, I would say that yoga has its advantages. It has a cooling effect on the mind, and eases depression and so on. But as an allopathic doctor, I wouldn’t give it much emphasis. Secondly, the main cause of depression in many patients is that they work 16 to 18 hours a day. They are highly stressed. They don’t have time to even have food, leave alone yoga. They are not in a mental state for yoga.
Therefore, the most effective way to tackle depression is drugs administered in a very controlled manner. There should also not be overuse.

Q: What can an individual do to control stress at the workplace and home?
A: In fact, I would say there is more stress in the subcontinent and places like that than here. This is my personal take. Stress is much less here. It is the lowest income category people who suffer more stress here. After working 10 hours a day, they may be earning just enough to pay their room rent and have food. They may not be able to save anything. Therefore, they may be forced to put in extra hours, about 6 more hours every day to earn just that little bit extra. This plays havoc on their body and mind. By working like these you can’t be happy.

Q: Tell us about diabetes doctor, which I think is far more common than IBS, touching epidemic levels?
A: Yes, a large percentage of the population is affected by diabetes.

Q: It does not fall under psychosomatic diseases, does it?
A: No. Diabetes in some cases is genetic and in some cases acquired, as in caused by your food habits and lifestyle in general. It is also environment related.
It is such a common disease that everybody knows what not to take to avoid diabetes. Sugar, very sweet and very starchy food should be avoided. I would add to that list foods that are protein-rich like mutton and also very oily food.
I say this because we find that usually diabetics are seen to have dyslipidemia, which means high cholesterol and triglycerides levels.
Whenever we treat diabetes patients we also pay attention to their dyslipidemia. You can call it a precautionary measure.

Q: Does diabetes trigger dyslipidemia or does dyslipidemia aggravate diabetes?
A: We can only say they are associated. I would also like to clear the misconception that diabetes is only seen or largely seen among the high-society folks. It is also prevalent among the people in the lower rungs of the socio-economic ladder.
I would also strongly advice that for treatment of diabetes they need to approach only a good medical doctor or a specialist in diabetes, and not to go to therapists and such like. Maintain healthy food habits and be steadfast in taking your medication.
In some cases, medication is not seen to be effective in controlling diabetes. I mean oral medication. In such cases, the patient will have to be put on insulin. It is better than taking a lot of drugs.

Q: What is your next major concern related to health in this part of the world?
A: Without a doubt, obesity. I have seen a lot of obese people around here. I don’t categorize them as expatriates or citizens. In general there are a lot of obese people. The simple logic of controlling obesity is to reduce intake of all kinds of food and to exercise vigorously. It’s simple math. There should be a balance between intake and expenditure of energy.
Usually when I talk to patients who are obese, they say they eat very less. It is hard to get the real scenario from them. May be they feel so, it could be misleading. However, this is not possible. In most cases, obesity is the direct result of over eating and less exercise.

Q: What are the other common illnesses you find in Kuwait, doctor?
A: I have seen plenty of allergy cases predominant in Kuwait. This is probably because in GCC countries dust storms are very common. Even if you don’t have dust storms, the climate in general could be dusty.
It’s well known that dust can trigger allergies, and can be very harmful. I know of some enthusiastic walkers who wouldn’t give up walking even on a dusty day. They like to walk in the dusty weather. They have to be very careful because they may be walking for good health and end up with adverse results. If there’s any sort of dusty climate, I would advise them not to venture out. You can instead walk inside your houses on treadmills or inside the malls.
Everybody should use face masks in dusty weather.

Q: Would a hanky on the nose also do?
A: If there’s no mask, then at least a hanky. The important thing is that you guard your nostrils and mouth. Secondly, one must know that even if the weather is clear, there are a lot of pollutants in the air. Not just in this country, but generally in the region there are pollutants that can cause bronchial asthma and other allergic disorders. Not only bronchial asthma, I have also seen plenty of patients with allergic rhinitis, which shows symptoms like constant sneezing, running nose and ultimately sinusitis.

Then there is allergic faringitis, and skin allergy too, which is called Urticaria. Allergies are of different manifestations. The important thing to bear in mind is to identify the allergens and avoid them. Allergens are also from food.  You have to identify those foods that give you allergies, and avoid them. Sometimes an allergy can manifest itself as simple gastritis. You may not have any itching or breathing discomfort. But when you take even a fruit that you are allergic to, instantly you get severe acidity.

Q: You said how people staying away from their families suffer from psychosomatic illnesses. Are there any other problems that arise as a result of being separated from families?
A: Well you can say that STD’s, sexually transmitted diseases, are also partly a result of separation from families. I don’t wish to get too deep into this matter, and suffice it by saying that one should avoid immoral behavior. However, it is true that a large population of expatriates suffer from STDs. We encounter such patients regularly.

Q: STDs are mainly caused by multiple partners, isn’t it?

A: Yes, or also single partners who are already infected.

Q: And what are the common types of STDs?
A: The most common STD I have seen in my experience here is gonorrhea. The funny part is that patients who contract the disease are terrified, because they think it’s AIDS. Everyone knows about AIDS, and it is probably the only sexually transmitted disease they know of. Therefore, patients with STD panic and go into depression, which worsens the problem.

Q: What are the symptoms of gonorrhea?
A: A few days after the contact, the patient feels irritation in the urethra. Also, there is mucopurulent discharge from the urethra, which is creamy like discharge. It is easy to cure, but once it gets chronic it’s very hard to cure.

Q: So, what happens if it is chronic?
A: The patient will have to suffer for years, and also runs the risk of spreading it to others. It is not life-threatening.
Yet, another problem I find expatriates, especially from the subcontinent Pakistan, India, Bangladesh etc., suffering from involves humidity levels. Usually, people from these countries are used to high humidity levels of 50% and above. In rainy season, the humidity levels in these countries goes up to 80%.
Whereas here the humidity is very low, up to 15% or so. Plus, in summer the temperature shoots up to 50 degrees and above. Therefore, expatriates have to take special care to keep them selves hydrated, especially in summer. So, keep drinking a lot of fruit juice and water.

In connection to that I would also like to add that there’s a myth that water in this country causes renal stones, or kidney stones. I don’t believe it. The water supplied by the ministry is adequately treated and filtered. Additionally, people also put up filters at homes.
Renal stones, as far as I have seen here, are caused by food. It is food related and not water. And if you ask me which foods you have to avoid for renal stones, I would suggest mutton, tomato, cauliflower and leafy vegetables. Also some pulses. Even if you take a lot of rice regularly, it can cause stones. I also get a lot of patients with renal stones.
In most cases, the stone gets removed by medication.

Q: And what foods are recommended for such patients, doctor?
A: You have to take citrus fruits and plenty of water.

Q: What about the lifestyle in Kuwait? Does the fact that we spend most of our time in artificially controlled climates have any bearing on our health?
A: Yes. We are mostly living in air-conditioned atmospheres, be it at home, office or our cars. Central air-conditioning is very relaxing and soothing. No doubt about it. But it has its downsides also. I have seen many patients suffering from chronic cough and cold, and even bronchitis caused by constant exposure to AC. From my clinical experience I have seen patients with rheumatoid arthritis and polyarthralgia, which means the patient suffers pain and swelling in different joints.

Q: Are you saying that arthritis and polyarthralgia are also caused by air conditioning?
A: I can’t say that it is directly caused by AC, but it triggers the condition. Therefore, it is ideal to set your AC’s thermostat at 25 degrees. It may not be the most comfortable temperature in summer, but you have to look at the health aspect also.

Q: But how is air-conditioning and joint-related illnesses associated?
A: Actually what happens is that AC sucks up the water from our body. It sucks out the water from our joints also. There is a sino vial fluid inside our joints and that becomes dry. We don’t know the exact cause though. But I can say this much that staying in AC for days and months on end has a bad effect on your health.

Q: Is there a certain percentage of the population that are at risk from ACs, because every individual is living in AC here, and not everyone obviously is affected?
A: May be they are controlling their themostats, or spending considerable amount of time outdoors, or taking adequate measures like covering themselves up with blankets etc. while in the AC. But AC definitely has negative effect on health. Last but not the least, I would like to call your attention to frozen foods which is also becoming a part of our lifestyle. While there is fresh food available, we are forced to buy frozen food for the sake of convenience. These frozen foods use preservatives a lot. Moreover, any food frozen for a long time loses its food value. If you regularly take frozen food, it will definitely affect your digestive tract.


Dr Ashok Behari Deb is a General Practitioner at City Clinic, Murgab. He is specialized and certified in respiratory medicine. He has 18 years practice in the field of general medicine in Kolkata, India, and has received specialized training in cardiothoracic medicine. He has been working in Kuwait for the last 7 years. Dr Deb was the former Honorary Visiting Consultant in Rulesy General Hospital, and Consultant Physician in Bharat Heavy Electrical Limited, Kolkata.

By Valiya S. Sajjad
Arab Times Staff

By: Dr Ashok Behari Deb

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