Chapter 26. ‘Mens sana in corpore sano’ – healthy mind in healthy body

Dr. Yeshwanth K. Amdekar, DCH, MD (Pediatrics), FIAP

Health is not valued till illness comes

Thomas Fuller

You have power over your mind, not on outside events.

Realise this and you will find strength

Dalsaku Ikeda

Introduction

Health was considered as “divine gift” till Hippocrates pioneered the move away from these notions of health and encouraged a focus on acquiring knowledge about health. He believed that sound health was the result of balance between various body fluids such as blood, bile and phlegm. Since then, concept of health has much widened. WHO defines health as “complete state of physical, mental and social well- being and not merely absence of disease or infirmity” Such a definition does not take into account changing concepts of health related to age and culture.

For practical purposes, health of children refers to well-being in terms of acquiring destined growth (physical increase in size), development (maturity of function enabling acquiring new skills), activities and energy that facilitates the child to perform to his / her maximum potential and behaviour commensurate with social expectations (emotional, social and spiritual). It is well known that body and mind are interdependent and together decide final health status of an individual. It must be nurtured by everyone of us right from childhood but it is never too late. As doctors, we should act as “health guides” rather than “disease managers”.

General health-promoting factors

Energy intake (calories consumed through food) and energy expenditure (physical exercise besides calories burnt for basal metabolism) must be well balanced to maintain sound health. Hence diet and physical exercise are important in promoting good health.

Diet – exclusive breast feeding for first 6 months followed by complementary feeding (from family pot) while continuing breast feeds as long as possible in first two years lays the foundation of good health. Vegetables and fruits are important components of diet along with dairy products, cereals and pulses in both vegetarian and non-vegetarian diet. Vegetarian diet is considered better for health, only if one consumes all groups of food items. It is equally important to eat happily, together with the family members. Communication and bonding between all family members also help nurture sound mental development.

Physical exercise – Parents must inculcate sports activities in children right from early age and avoid use of electronic gadgets. Age-appropriate physical exercise can be chosen as per the child’s preference and continued regularly. Once a habit is formed, it is sustained for life. Besides diet and physical exercise, body needs rest to rejuvenate after day’s hard work and hence sleep is important. Similarly, mental health helps to ease stress and remain happy that adds to better health.

Sleep – Age-appropriate duration and timing of sleep is vital for sound health. Older child and adults need 6-8 hours of sleep while younger ones need longer duration. Ideal sleep time is between 10 pm and 6 am. One should avoid exposure to electronic gadgets at least one hour before bed-time and it is a good idea to meditate for half an hour prior to sleeping. Meditation refers to concentration over a fixed thought (it could be as simple as following one’s breath) that takes away stray thoughts from mind. It helps to get sound sleep and one gets up fresh in the morning. It is ideal to ensure suitable environment conducive to sleep. Unfortunately, most children and adults do not follow ideal sleep hygiene.

Mental health – It includes emotional, psychological and social health. It relates to how we think, feel and act that in turn determines how we handle stress, relate to others and make choices. Mental health is facilitated by nurturing ideal culture of behaviour inculcated during upbringing in the family by spending time with family members and friends. One must learn to express feelings and discuss with elders that helps coping up with stress. We need to avoid arguments but solve differences with discussion – arguments are to find out who is right but discussion to find out what is right, Spiritual behaviour teaches us how to love and not to hate anyone that in turn promotes harmony. Healthy mind in healthy body is the ultimate health. Many diseases can be prevented by nurturing health supported by good hygiene.

Hygiene – Poor hygiene is a common cause of diseases. Dental hygiene is often ignored but it is important to look after teeth and gums that otherwise become a source of infection, bad odour and poor health. Hand and genital hygiene are as important. Hands often carry infection from one to another. Food hygiene avoids infections transmitted by contaminated food.

Special care for health of every organ

Besides maintaining general health, it is desirable that extra efforts be undertaken to look after health of every organ in the body. It adds to better health through efficient working of all organs during entire life.

Lung health: Ideal breathing technique includes deep inhalation, ability to hold breath and relaxed exhalation ending with forceful expulsion of air. It helps in maximum breathing using all segments of lungs. Besides active sports, age-appropriate jogging or brisk walking and breathing exercises (as recommended by yoga or art of living) are ideal. Playing breath-driven musical instruments is a good breathing exercise and so also inflating balloons. One should be regular in carrying out such exercises. It is important to avoid smoking and minimise exposure to home pollution.

Intestinal health: Traditional wisdom knew importance of intestinal health. Castor oil was given to everyone once a week to drive away the toxins produced in the intestines. Methods have changed though principle has remained the same. Eat high-fibre diet – both soluble (oats, nuts, seeds, legume-pulses that is seed of legume) and insoluble (wheat bran, vegetables, whole grains). Avoid spicy and oily food, maintain regular eating schedules – eat slowly, drink adequate amount of water. Bowel habits are important to be inculcated to prevent constipation and its bad effects.

Cardiac health: Heart is a muscle and it keeps strong and fit with exercise, as do other muscles in the body. It is important to avoid smoking, overeating, obesity (monitor waist-hip ratio) and stress. Restriction of excess of salt (processed food is a rich source) and caffeine helps to maintain normal blood pressure.

Brain health: Brain develops fast from second trimester of pregnancy up to second year of life and development is complete by the age of five years. Thus, this is the most crucial period of brain development. Foetus can start hearing by second trimester. Talking and reading to a foetus helps in development of foetal brain. As brain development is nearly over by the age of two years, infants and toddlers must be mentally challenged and stimulated as per their age. Parents must encourage infant to learn new skills by providing opportunity.

Talking to infants during wakeful periods develops communication skills. It is important to encourage exploration for young child and best way of learning is with interaction and not memorisation. After all, learning should continue throughout life, it keeps brain active and healthy.

Renal health: Functional maturity of kidneys starts around last trimester of pregnancy and is complete by 18 months of postnatal age. However, nephrons increase in number almost up to third decade and thereafter, there is gradual involution. To maintain renal health, one must remain active, drink plenty of water, control blood pressure and blood sugar, weight and diet control, avoid processed food that contains excess of sodium and phosphorous,take care of constipation, pelvic floor exercises, don’t hold urine. Excess of protein intake is bad, avoid reno-toxic drugs such as NSAIDS and damage due to dehydration, electrolyte imbalance and infection. Special care in early life includes timely diagnosis of infection if any and its prompt management. eGFR (estimated GFR) must be monitored periodically and is good screening test. It is roughly calculated as follows. 0.5 X (height in cms divided by serum creatinine in mg%). Normal GFR is 80-100 ml/min. Serum creatinine rises only when GFR goes down to <30 ml/min and thus it is a late determinant of disturbed renal function.

Bone health: Bones store calcium-phosphorous to make them strong and also release them when needed for other organs. High calcium containing food, vitamin D (exposure to sunlight for at least 30 minutes between 11 am and 1 pm with minimum clothes is ideal) and adequate physical exercise maintain bone health. Risk of osteoporosis is increased by sedentary life style.

Hepatic health: Toxins from pesticides, chemicals, additives and unknown sources, hepatotoxic drugs such as anti-TB and anticonvulsants (must be monitored during therapy) and alcohol are likely to damage the liver and so best avoided as far as possible. Unsafe sex and contaminated needles are risk factors for hepatitis B and C viral infections which damage liver. Such infections may also be transmitted from infected mother to neonate. Hepatitis B vaccines protect liver from such infection while Hepatitis A vaccine prevents infection from contaminated food. Liver is also damaged due to accumulation of excess of fat in an obese person.

Healthy mind

Healthy mind is the best asset for the body as it promotes health through stimulating immune system as well as functioning of major organs. On the other hand, unhealthy mind is the worst enemy. Mind is the virtual entity and resides in grey matter of the entire cortex that functions through neural network and chemical and hormonal systems of the brain. Mind exists naturally as it is not the clean slate at birth but can be further enhanced by proper nurture. Mind plays an important role in healing of the disease. It is known that treatment is most effective when patient expects it to work and is optimistic. That is also how placebo works.

To maintain healthy mind, we mustremain physically active, keep learning, develop and pursue hobbies, meditate to avoid negative thoughts and keep positive attitude, connect with friends and family to remain socially active, be happy and enjoy peaceful life. It is not possible unless one tries proactively to achieve healthy mind. As a doctor, we must also look after mind of the patient besides the body. Application of science treats the body and traditional art of medical practice nurtures the mind of the patient. It is possible only when a doctor knows importance of healthy mind in a healthy body.

Personal Notes

I was lucky to be born to parents who taught the value of what we got rather than craving for more. They inculcated ideal virtues such as discipline, honesty and empathy. This helped me to develop total health as much as possible that includes besides physical and mental health, emotional, social and spiritual health. Subsequently during my postgraduate training, I was influenced by my mentor Dr Wagle who emphasised importance of being humane, respecting every person equally. He defined clearly difference between discussion and argument, discussion is to find out what is right and an argument who is right. After completing postgraduation, I was appointed as honorary assistant professor at Grant Medical College when I went to take blessings from one of the paediatricians of first generation – Dr Sanzgiri. He told me to serve the poor

sincerely so that one of them would send me a rich patient in my clinic. I wondered how a poor patient in a government general hospital would refer a rich patient but soon it was clear to me how valuable are the blessings of people whom we serve well. All such influences and many more during formative years helped me to develop healthy mind in a healthy body.I continued to remain happy with what I got.

Take Home Message

Remain healthy, eat lightly, breathe deeply, exercise regularly, live moderately, cultivate cheerfulness and maintain interest in life. If you don’t have time for wellness, you will have to make time for sickness. Aging process is normal for all the organs but can be delayed with proper life style, so that you remain healthy as long as possible.

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Applied Medical Statistics

Chapter 26. ‘Mens sana in corpore sano’ – healthy mind in healthy body