Cause

GERD can be caused by many things such as:

• Eating large meals.
• Certain foods like fried foods, spicy foods, tomatoes and processed tomato-based products citrus fruits, peppermint, garlic, onions, chocolate, coffee, tea, and carbonated beverages.
• Exercising after a meal.
• Lying down, especially after meals.
• Smoking and drinking alcohol.
• Hiatal hernia, which is a bulging of the stomach into the chest, can cause reflux.
• Increased pressure on the abdomen by being overweight or pregnant or even by wearing tight clothes.
• Strain while coughing, bending, or lifting.
• Emotional stress may worsen GERD, especially for people with high levels of anxiety.

Symptoms

GERD is not the same in each person, but the most common symptoms are:

• Heartburn (burning feeling in the chest), that usually happens 30 to 60 minutes after eating; often worse when you are lying down. The discomfort can be intense and is usually mistaken for a heart problem.
• Feeling, like food is coming back up into your mouth, maybe with a bitter taste.
• Sore or hoarse throat.
• GERD can irritate the airways, leading to a persistent cough that may be mistaken for allergies or a respiratory infection.
• Feeling like there is a lump in your throat or as though food sticks in your throat when going down.
• Nausea
• Trouble swallowing
• Frequent burping

Treatment

Diet & lifestyle changes play a crucial role in managing GERD by reducing the frequency and severity of symptoms.

Nutritional advice

• Avoid trigger foods that may make your symptoms worse. Try keeping a food diary to keep track of which foods trigger your symptoms.
• Choose fruits with lower acidity levels, such as bananas, melons, apples, papaya and pears.
• Opt for lean sources of protein, such as skinless poultry, fish. Avoid high-fat meats and processed meats like sausages and bacon.
• Choose whole grains like oatmeal, brown rice, whole wheat bread, and whole grain pasta. Avoid or limit foods made with refined grains.
• Opt for low-fat or fat-free dairy products, such as skim milk, yogurt, and cheese.
• Limit portion sizes.
• Eat several small meals throughout the day.
• Eat Slowly and Mindfully: Chew your food thoroughly and savour each bite. Eating too quickly can lead to swallowing air, which can exacerbate GERD symptoms.
• Cooking Methods: Choose gentle cooking methods like baking, steaming, grilling, or broiling instead of frying.
• Ginger and Aloe Vera: Ginger and aloe vera are known for their soothing properties. Consider incorporating them into your diet, either through ginger tea or by adding aloe vera to smoothies or drinks.
• Chew Gum: Chewing sugar-free gum between meals can stimulate saliva production, which helps neutralize stomach acid.
• Stay Hydrated: Drink plenty of water throughout the day but avoid drinking large amounts just before or after meals, as this can increase stomach pressure.
• Dinner Timing: Have your largest meal earlier in the day and keep dinner portions smaller.
• Meal Spacing: Allow at least 2-3 hours between your last meal or snack and bedtime to give your stomach time to digest food.

Lifestyle changes

• Don’t bend over, lie down or exercise after a meal.
• Sleep on your LEFT side.
• Lose weight if you are overweight.
• Raise the head of your bed 6-8 inches with blocks or a wedge under your mattress.
• Avoid tight-fitting clothing.
• Stop smoking.
• Engage in regular, moderate-intensity exercise. Avoid vigorous exercise immediately after eating.
• Limit or reduce stress in your life. Try breathing exercise, yoga, or meditation techniques.
• Avoid non-steroid and anti-inflammatory drugs (ibuprofen, Aleve), aspirin and pain medications as these can make heartburn worse.

Medication –Antacids can give short-term relief of acid reflux.

Remember that individual triggers and sensitivities can vary, so it may take some experimentation to determine what works best for you. Many individuals can manage their symptoms effectively with diet and lifestyle modifications. If these changes do not provide sufficient relief, consult a doctor.

Myth: Many of my family members have diabetes. It’s in my genes. There’s nothing I can do to prevent it.

Fact: Although heredity is a risk factor for diabetes, it is possible to prevent or delay the onset of type 2 diabetes by adopting healthy lifestyle habits including diet and exercise.

Myth: I have a sweet tooth, so I am at risk of developing diabetes later!

Fact:   Type 2 diabetes is caused by an inability of the pancreas to make enough insulin or if there is a problem with how the insulin is used by the cells. Risk factors for Type 2 diabetes include genetics and lifestyle issues like being overweight, obese, overall dietary habits and sedentary lifestyle. Eating too much sugary foods does not cause diabetes. However, the chances of developing diabetes are greater as diets high in sugar are often a high in calories too and excess calories can lead to weight gain.

Myth: Having diabetes means your body isn’t producing enough insulin.

Fact: Having diabetes doesn’t necessarily mean that your body isn’t producing enough insulin. While some people with diabetes have an insulin production deficiency, others may have insulin resistance where the body still produces insulin, but it may not use it effectively. In a healthy individual, when you consume carbohydrates, your digestive system breaks them down into glucose, which enters the bloodstream. In response to rising blood sugar levels after a meal, the pancreas releases insulin. Insulin acts as a “key” that allows glucose to enter cells. Once inside the cells, glucose is used for energy or stored for future use. In individuals with insulin resistance, the body’s cells, particularly muscle, fat, and liver cells, do not respond well to the signals sent by insulin. As a result, glucose has difficulty entering these cells, leading to elevated blood sugar levels.

Myth: Prediabetes Always Leads to Diabetes

Fact: Prediabetes is a condition characterized by elevated blood sugar levels that are not yet in the diabetes range. It serves as a warning sign that individuals are at higher risk for developing type 2 diabetes, but it doesn’t mean diabetes is inevitable. Research has shown that adopting a healthy lifestyle, including regular physical activity, dietary improvements, losing weight and maintaining a healthy body weight can significantly reduce the risk of progressing from prediabetes to diabetes.

Myth: People with Diabetes Can’t Eat Carbohydrates

Fact: While it’s true that carbohydrates can raise blood sugar levels, it’s a misunderstanding to think that people with diabetes cannot consume them. People with diabetes typically should be eating the same diet as anyone else –high in vegetables, fruits, fiber, whole grain, lean meats, and heart healthy fats. Carbohydrates are one of the three main macronutrients (along with proteins and fats), and they provide a critical source of energy for the body. The key is to monitor and manage carbohydrate intake effectively. This can be done through portion control, selecting complex carbohydrates (such as whole grains, millets like jowar, bajra, ragi, legumes, vegetables) over simple sugars, and spacing out carbohydrate consumption throughout the day. Portion control and monitoring blood sugar levels are also essential strategies for carbohydrate management. Restricting carbohydrates excessively can lead to an imbalanced diet and nutrient deficiencies.

Myth: You can’t eat any sweets if you have diabetes.

Fact: While it’s essential to limit the consumption of sugary foods and beverages, you don’t need to eliminate them entirely. Occasional indulgences are acceptable, but they should be consumed in moderation and as part of an overall balanced diet. You can eat small amount of sweet in place of other carbohydrates usually eaten at a meal and eat them with protein, fibre-rich foods, and healthy fats, to help stabilize blood sugar levels. It’s important to monitor blood sugar levels and adjust insulin or medications as needed to manage occasional indulgences.

Myth: People with diabetes can eat jaggery, honey, maple syrup and brown sugar instead of white sugar.

Fact: While jaggery, honey, maple syrup, and brown sugar may have slightly different properties compared to white sugar, they are not necessarily healthier or significantly better for individuals with diabetes. Calories from all these sweeteners are almost the same and consuming any of these can still raise blood sugar levels.  Although jaggery and honey contain nutrients, such as vitamins, minerals or antioxidants, the amounts consumed are so small that their health impact is minimal.

Myth: “As long as it is whole wheat pasta, I can eat all I want.”

Fact: Even though whole grains are a good source of fibre; they still contain carbohydrates that do affect your blood sugar. Whole grains are a part of a healthy meal plan for everyone but watch your serving size.

Myth: People with diabetes cannot eat fruits as they are too sweet.

Fact: Fruit contains natural sugars, which can cause blood sugar levels to rise. However, they also contain a good mix of vitamins, minerals and fibre that we need to eat as part of a healthy, balanced diet. Choose fruits that are lower in sugar such as guava, apple, pear, papaya, berries etc. You can even have small portions of fruits with high sugar levels like mango, chikoo, grapes by combining them with seeds, nuts or curd so that they do not raise the blood sugar levels and have them in between meals as snacks.

Myth: The glycaemic response (ability to increase blood sugar levels) from starchy foods cannot be reduced.

Fact: Following are the practical dietary recommendations for reducing postprandial glycemia in type 2 diabetes (T2D) when starchy foods are consumed

• Eat carbohydrate rich foods with foods rich in fibre like vegetables, whole grains and nuts.
• Eat carbohydrate rich foods with protein rich foods like meat, fish, poultry, eggs, dairy products, pulses, nuts, seeds.
• Consume foods in their natural form, as little processed as possible.
• Choose fruit at the right point of ripeness rather than over ripe one.
• Add some acidity i.e., vinegar / lemon juice, pickles to high GI meals. E.g., add vinegar dressing to beetroot salad.
• Cook pasta, rice and other starchy foods “al dente”.
• Reduce the proportion of liquid while cooking rice, pasta etc.
• When starches are cooked and then cooled, the crystalline structure within the food changes to resistant starch which is more difficult to digest. Thus, cold cooked starches have a lower GI. Cook foods such as pasta, rice, potatoes beforehand, leave them in the fridge to cool for 1 day and consume them cold or reheated for the formation of resistant starch. e.g., boiled, cold potatoes in a potato salad, curd rice made from rice prepared the previous day and refrigerated.

Myth: You can’t drink alcohol if you have diabetes

Fact: You can have alcohol in moderation if your diabetes is well managed. Up to one drink per day for women and up to two drinks per day for men. is generally considered safe. Limit your intake of sugary mixed drinks. Do not drink alcohol on empty stomach. Consuming a meal or healthy snack before or while drinking can help stabilize blood sugar levels. If you are on medications such as insulin or sulphonylureas, you are more likely to have a hypoglycaemia (low blood sugar levels) after having alcohol, and this effect can continue for up to 24 hours after you have been drinking. It’s also important to have a plan for managing hypoglycaemia, such as carrying a source of fast-acting carbohydrates. Alcohol can lead to dehydration, which can affect blood sugar control. Staying hydrated while drinking is crucial.

Myth: Exercising when you have diabetes only increases your chances of experiencing low blood sugar.

Fact: Exercise can indeed lower blood sugar levels by increasing the body’s insulin sensitivity. However, this does not mean it always leads to dangerously low blood sugar levels. The effect of exercise on blood sugar varies depending on factors like the type, intensity, duration, and timing of the activity. Incorporating regular exercise into a diabetes management plan can help improve blood sugar control over time. It can lead to better insulin sensitivity and glucose utilization, reducing the need for medication or insulin in some cases. It’s crucial to engage in safe exercise practices when you have diabetes. This may include carrying a source of fast-acting carbohydrates, wearing identification that indicates you have diabetes, and having a plan for managing hypoglycaemia during exercise.

Myth: I can stop taking diabetes medicines once my blood sugar is under control.

Fact:Some people with type 2 diabetes can control their blood sugar without medicine by losing weight, eating a healthy diet, and getting regular exercise. But diabetes is a progressive disease, and over time, even if you are doing all you can to stay healthy, you may need medicine to keep your blood sugar within your target range.

Understanding Vitamin B12:

B vitamins are particularly important for overall health. And vitamin B12, also known as cobalamin, is a key micronutrient that your body needs to function well.  It is a water-soluble vitamin that plays a critical role in energy production, formation of red blood cells, maintaining healthy nerve cells, proper brain function, production of DNA, and the metabolism of proteins and fats.

With vitamin B9*, vitamin B6** and other nutrients, it controls blood levels of the amino acid homocysteine ( high levels of which are linked to the early development of heart disease, often associated with low B12 levels). The homocysteine amino acid has also been linked to cognitive decline in Alzheimer’s and Parkinson’s disease. Vitamin B12 has been found to protect against dementia, heart disease, stroke, and osteoporosis.

*Vit B -9 sources include chickpeas, pulses, spinach, mango, peanuts, sunflower seeds, oats, quinoa etc.

**Vit B -6 sources include chicken, salmon, tuna, walnut, peanut, chickpeas, maize, whole grain cereals, green leafy vegetables, bananas, potatoes etc.

The average adult should get about 2.2 micrograms of vitamin B12 a day. Since B12 cannot be made by the body, it has to be procured from food or supplements. This vitamin is primarily obtained from animal-based foods such as meat, fish, eggs, and dairy products, button mushrooms, dried shiitake mushrooms, nori (in sushi) and nutritional yeast.

Vitamin B12 Deficiency and Diabetes

Recent studies have found that, diabetes, particularly type 2 diabetes, is associated with an increased risk of vitamin B12 deficiency. Several factors contribute to this association. Firstly, individuals with diabetes may have dietary restrictions or follow specific eating patterns that limit their intake of animal-based foods, leading to inadequate vitamin B12 consumption. Moreover, medication used for pre-diabetes, diabetes or PCOD such as metformin, can interfere with the absorption of vitamin B12 in the body, further increasing the risk of deficiency. The severity of vitamin B12 deficiency may depend heavily on the age of the patient and how long one has been taking metformin. Older patients are also at a higher risk of developing a deficiency in B12.  With age, there is a decrease in stomach acid which is needed to free this vitamin from food for its absorption. B12 deficiency may also contribute to diabetic neuropathy.

Patients with type 1 diabetes are also at a higher risk for developing B12 deficiency. In order for vitamin B12 to be absorbed, it binds with an important protein called intrinsic factor produced in the stomach. Those with type 1 diabetes have autoantibodies to the intrinsic factor. The antibodies prevent the B12 from binding to the intrinsic factor resulting in a deficiency.

The Significance of Vitamin B12 for Diabetics

Diabetic Neuropathy: Diabetes can lead to a condition called diabetic neuropathy, which is nerve damage resulting from high blood sugar levels over time. Diabetic neuropathy often affects the peripheral nerves, causing symptoms such as numbness, tingling, pain, and weakness in the extremities. Vitamin B12 is crucial for maintaining healthy nerve function, and a deficiency in this vitamin can exacerbate neuropathy symptoms or contribute to nerve damage. Adequate vitamin B12 levels may help support nerve health and potentially alleviate some diabetic neuropathy symptoms.

Energy Production: Vitamin B12 is involved in the metabolism of carbohydrates and fats, which are primary sources of energy for the body. Diabetics often experience fluctuations in blood sugar levels, and adequate vitamin B12 levels can help support energy production and overall metabolic function.

Heart Health: Diabetes increases the risk of heart diseases such as heart attacks and strokes. Vitamin B12, along with other B vitamins like folate, helps regulate homocysteine levels in the blood. Elevated homocysteine levels are associated with an increased risk of  heart problems, and maintaining sufficient vitamin B12 levels can help lower this risk.

Mood and Cognitive Function: Depression and cognitive decline are more prevalent in individuals with diabetes. Vitamin B12 plays a crucial role in maintaining healthy brain function and supporting the production of neurotransmitters involved in mood regulation. Ensuring adequate vitamin B12 levels may contribute to improved mental health and cognitive performance in diabetics.

Managing Vitamin B12 Levels

To ensure optimal vitamin B12 levels, diabetics should consider the following:

Dietary Sources: Include lean meats, fish, eggs, dairy products, mushrooms and fortified cereals. If following a vegetarian or vegan diet, alternative sources such as fortified plant-based milk or B12 supplements may be necessary.

Early detection and treatment is important. Fortunately, if you have a B12 deficiency, it’s relatively easy to get a diagnosis and start a treatment plan.

Look out for Vit B12 deficiency symptoms: Vitamin B12 deficiency symptoms are wide-ranging, affecting both physical and mental wellbeing. The symptoms include weakness and fatigue, numbness, or tingling in the hands, legs, and feet, peripheral neuropathy, anemia, lightheadedness, ringing in the ears, rapid heartbeat and shortness of breath, difficulty in thinking, reasoning remembering and concentrating, sore and red tongue, balance problems and troubled walking. Some of these side effects, particularly nervous system side effects and psychiatric problems, can be irreversible if not treated promptly.

Regular Monitoring: Regular blood tests can help monitor vitamin B12 levels and detect any deficiencies. The healthy range of B12 levels is between 200 and 900 nanograms per milliliter (ng/mL). Individuals that are at the lower end of this scale may need to start taking B12 supplements, especially if they have diabetes. You can also check methylmalonic acid (MMA) levels in your blood or urine. High levels can indicate a B12 deficiency.

Supplementation: In cases of vitamin B12 deficiency, supplements may be prescribed. The form of vitamin B12 in most supplements is cyanocobalamin, but other forms include adenosylcobalamin, methylcobalamin, and hydroxycobalamin. Supplements are available in tablet, capsule, soft gel, liquid, and nasal forms. Vitamin B12 is also given as an intramuscular injection in cases of a deficiency.

Many nutrients interact with each other to increase or decrease the absorption of the other nutrient. Taking a vitamin B12 supplement with a vitamin C supplement can reduce the amount of vitamin B12 in the body. It’s best to take the vitamin C supplement two or more hours after taking a vitamin B12 supplement.

Vitamin B12 is a crucial nutrient that plays a significant role in the overall health and well-being of individuals with diabetes. By understanding the importance of maintaining adequate vitamin B12 levels and taking appropriate measures to ensure proper intake, diabetics can support their nerve health and well-being. Early detection of vitamin B12 deficiency through routine screening could reduce their risk of developing irreversible, painful and potentially disabling nerve damage.

Cause

The exact cause of PMS is not known. Changes in brain hormone levels may play a role. However, this has not been proven. Women with PMS may also respond differently to these hormones.

Most women experience PMS symptoms during their childbearing years. PMS occurs more often in women:

• Between their late 20s and 40s
• Who have had at least one child
• With a personal or family history of major depression
• With a history of postpartum (the first six weeks after giving birth) depression or an affective mood disorder.

The symptoms often get worse in late 30s and 40s and as menopause approaches.

Signs and symptoms

The symptoms may be divided into five basic categories—A (anxiety), C (craving), D (depression), H (hydration), and O (others).

PMS-A (anxiety) symptoms include:

• Difficulty sleeping
• Tense feelings
• Irritability
• Clumsiness
• Mood swings

PMS-C (craving) symptoms include:

• Headache
• Cravings for sweet/ salty/ specific foods

PMS-D (depression) symptoms include:

• Depression
• Feeling angry for no reason
• Getting easily upset
• Poor concentration or memory
• Feeling of low self-worth
• Violent feeling

PMS-H (hydration) symptoms include:

• Weight gain
• Abdominal bloating
• Breast tenderness
• Swelling of extremities

PMS-O (other) symptoms may include:

• Dysmenorrhea (menstrual cramps)
• Change in bowel habits
• Frequent urination
• Hot flashes or cold sweats
• General aches or pains
• Nausea
• Acne
• Allergic reaction
• Upper respiratory tract infections (cough, sore throat, runny or blocked nose)

Dietary Treatment

Choose foods high in complex carbohydrates, such as fruits, vegetables and whole grains and avoid refined flour (maida) and all the overly processed bakery food products. These may reduce mood symptoms and food cravings.

Increase intake of calcium:

Many studies suggest that eating foods rich in calcium tend to reduces mood disorders during PMS. Foods that are rich in calcium include ragi, jowar, green leafy vegetables, low fat dairy, sesame seeds etc.

Get Vitamin D:

Besides supplements, we can also go out for a walk in sunlight to get that extra dose of natural Vitamin D.

Reduce salt:

Like sugar, salt is also hidden in many places, therefore it is very important to eat home cooked food to minimize PMS. Eating less salt is particularly recommended for those with bloating, breast tenderness or swollen hands.

Drink plenty of water:

Drinking around 2 liters of water daily reduces bloating and aids digestion. If one does not like the taste of water one can flavor it with lime, lemon or cucumber.

Herbs beneficial for PMS

Saffron –

Few strands of saffron soaked overnight in milk has been proved very beneficial to relieve PMS. One can start it 1 week before periods.

Cinnamon:

Boil 1Tbsp (around 15 grams) of cinnamon in 1 litre of water, boil to reduce it to half. Then drink it hot for 4- 5 days. It can be stared 4-5 days before the date of menstruation.

Other foods:

Foods rich in iron are very helpful to ward away the lethargic feeling e.g. raisins, garden cress seeds, whole pulses etc.

Regular Exercise

Along with theses dietary changes, it is very important that one should go for at least 150 minutes of moderate exercise or 75 minutes of intense workout per week. Regular daily exercise can help alleviate certain symptoms, such as fatigue and a depressed mood.

Living with PMS

Managing PMS begins with knowing about PMS symptoms and when they happen. Although PMS symptoms are common amongst most women, they should not be as bad as to stop you from carrying out your everyday activities. You can modify your diet and do regular physical activity to get through each month as smoothly as possible. In case, the symptoms are severe and none of the above remedies help, then you should consult a doctor.

Cardiovascular diseases (CVD) refer to a group of heart and blood vessel disorders that are caused by atheroma (the fatty material which deposits in the arteries). It can increase the risk for heart attack, heart failure and stroke, thus resulting in decreased quality of life and decreased life expectancy. The silent killer – Hypertension (high blood pressure), is a leading risk factor for cardiovascular disease.

Know what atheroma is

Patches of atheroma are small fatty lumps that develop within the inside lining of the arteries or blood vessels. It is also known as hardening of the arteries.  Over months or years, patches of atheroma (plaques) can become larger and thicker, making an artery narrower, thereby reducing the blood flow through the artery.

Angina for example, is narrowing of the arteries of the heart with atheroma.

Sometimes a blood clot (thrombosis) forms over a patch of atheroma and completely blocks the blood flow. Depending on the artery affected, this can cause a heart attack, a stroke or other serious problems.

Cardiovascular diseases caused by atheroma

The cardiovascular diseases that can be caused by atheroma include:

Heart disease: The term “Heart disease” is used for conditions caused by narrowing of one or more of the coronary (heart) arteries by atheroma. This can cause angina, heart attack and heart failure. It is common in people over 50 years.

Cerebro-vascular disease – Stroke and TIA: Cerebro-vascular disease means a disease of the arteries in the brain. This can lead to TIA (transient ischemic attack) or a stroke. A stroke means that part of the brain is suddenly damaged. The common cause of stroke is blocking of an artery in the brain by a blood clot which usually forms over some atheroma. A TIA is a disorder caused by temporary lack of blood supply to a part of the brain, resulting in weakness in a part of body. If left untreated it can progress to stroke (paralysis).

Peripheral vascular disease: Peripheral vascular disease is narrowing due to atheroma that affects arteries other than in the heart or brain. The arteries that take blood to the legs are the most affected.

Deep vein thrombosis and pulmonary embolism – blood clots in the leg veins, which can dislodge and move to the heart and lungs.

Risk factors of developing atheroma

Everybody has some risk of developing atheroma. However, certain ‘risk factors’ increase the risk.

Lifestyle risk factors that can be prevented or changed:

• Obesity
• Lack of physical activity (a sedentary lifestyle)
• An unhealthy diet and eating too much salt
• Excessive alcohol intake
• Smoking

Treatable or partly treatable risk factors:

• Hypertension (high blood pressure)
• High cholesterol
• High triglyceride
• Diabetes
• Kidney diseases
• Obstructive Sleep Apnea (OSA)

Fixed risk factors – ones that you cannot alter:

• A strong family history – Individual’s father or brother who developed heart disease or a stroke before they were 55, or an individual’s mother or sister who developed heart disease or a stroke before they were 65
• An early menopause in women
• Age: The older you become, the more likely you are to develop atheroma

If you have a fixed risk factor, you can make extra efforts to tackle any lifestyle risk factors that can be changed.

Assessing your cardiovascular health risk

It is important to detect cardiovascular disease as early as possible so that management with counselling and medicines can begin.

The following people should be assessed to find their cardiovascular health risk:

• All adults aged 40 or more
• Adults of any age who have:

– A strong family history of early cardiovascular disease
– A first degree relative (parent, brother, sister, child) with a serious hereditary lipid disorder

• Obese and Overweight adults having a BMI of 23 or more
• Diabetics
• Hypertensives
• Smokers
• Alcoholics

Knowing about Assessments

A Doctor will –

• Advise a blood test to check your cholesterol and glucose (sugar) level
• Measure your blood pressure and your weight
• Ask you, if you smoke
• Ask, if there is a history of cardiovascular disease in your family. If so, at what age the disease started in the affected family members

A score is calculated based on these factors plus your age and your sex. An adjustment to the score is made for certain other factors such as strong family history and ethnic origin.

Comprehending the assessment score

You are given a score as a % chance. For example, if your score is 30% this means that you have a 30% chance of developing a cardiovascular disease within the next 10 years. This is the same as saying a 30 in 100 chance (or a 3 in 10 chance). In other words, in this example, 3 in 10 people with the same score as yours will develop a cardiovascular disease within the next 10 years.

Note: The score cannot say if you will be one of the three. It cannot predict what will happen to each individual person. It just gives you the odds.

You are said to have a:

High risk – If your score is 20% or more. That is, 2 in 10 chance or more of developing a cardiovascular disease within the next 10 years

Moderate risk – If your score is 10-20%. That is, between 1 in 10 chances

Low risk – If your score is less than 10%. That is, less than 1 in 10 chances

Who should be treated to reduce their cardiovascular health risk?

Treatment to reduce the risk of developing a cardiovascular disease is usually offered to people with:

• Risk assessment score of 20% or more
• An existing cardiovascular disease (to lower the chance of it getting worse or of developing a further disease)
• If you have diabetes, the time that treatment is started to reduce cardiovascular risk depends on factors such as: your age, how long you have had diabetes, your blood pressure and if you have any complications of diabetes.
• Certain kidney disorders

It’s important to know if losing weight will help prevent or improve your condition and its complications

The increased health risk of obesity is most marked when the excess fat is mainly in the abdomen rather than on the hips and thighs. Asians have a high risk for developing diabetes and subsequently heart disease and stroke. A waist measurement of 90 cm or above for (Asian) men and 80 cm or above for (Asian) women is a significant health risk.

There is evidence that even modest weight loss (5–10 %) can reduce cardiovascular disease risk even when the individual remains in the obese range. Few findings from various studies are cited below:

• 5–10 % weight loss showed significant reductions in triglycerides, total cholesterol, and low-density lipoprotein (LDL) cholesterol.
• Those who lost >10 % experienced significantly greater improvements in triglycerides, total cholesterol, and LDL cholesterol than losing less.
• For higher-risk individuals, those who lost 5–10 %, significantly reduced fasting glucose, triglycerides, and total cholesterol; those who lost >10 % improved on all risk factors (except HDL cholesterol) and to a significantly greater degree than those losing less.
• 5 to 10 % weight loss produced improvements in cardiovascular risk factors, but greater weight loss was associated with even greater improvement.

Experts can help you to manage this condition by helping you to lose weight and advising appropriate changes in diet and lifestyle.

Diet plan for clients with/at risk of heart problems focuses on controlling portion size, consumption of fruits & vegetables, whole grains, non- fat dairy products, lean meat, fish and diet low in saturated fat as well as low in sodium and refined carbohydrates.

Once expert guides you on which foods to eat more and which foods to limit, you will be on a disciplined regime aimed towards weight loss and a heart-healthy diet, including regular physical activity and avoiding alcohol.

The right kind of exercise further helps in bringing down the blood pressure, a leading risk factor for CVD. Regular physical activity helps in energy expenditure and also reduces the risk of having a heart attack or stroke.

So don’t hesitate, take a step forward, discuss your medical issues and enjoy a heart – healthy life!

Blood pressure is the pressure of blood pushing against the walls of the arteries. Arteries carry blood from the heart to other parts of your body.

Blood pressure normally rises and falls throughout the day, but it can damage the heart and cause health problems if it stays high for a long time.

Blood pressure is measured using two numbers: Systolic and Diastolic

The first number, called systolic blood pressure, measures the pressure in the arteries when the heart beats.

The second number, called diastolic blood pressure, measures the pressure in the arteries when the heart rests between beats.

Normal Blood Pressure is 120/80 mmHg

Hypertension is persistently high arterial blood pressure, defined as systolic blood pressure (SBP) of 140mm Hg or higher or a diastolic blood pressure (DBP) 90mm Hg or higher.

Ideal method of blood pressure measurement and diagnosis of Hypertension

Blood pressure should be measured with a well calibrated sphygmomanometer. The cuff should encircle at least 80% of the arm circumference. Reading should be taken after the patient has been resting comfortably for at least 5 minutes and at least 30 minutes after smoking or coffee ingestion.

Important facts about Blood pressure

• A high waist circumference and high body mass index (BMI) increases your chances of having high blood pressure, high cholesterol and high blood sugar.
• Blood pressure is normally lowest at night and the loss of this night-time dip is strongly associated with cardiovascular risk, particularly stroke.
• An increase in the normal morning blood pressure is associated with increased likelihood of brain hemorrhage.
• In winters the blood pressure rises in comparison to summers, so it is advisable to get your medication & dietary intake adjustments done accordingly.
• 1 kg increase in body weight, increases risk of Hypertension by 5% as was evident in a large study conducted on women.
• Another study found that hypertension is about twice as prevalent in the obese than the non-obese of both sexes.
• Weight loss in the range of 2 to 4 kg is associated with systolic blood pressure decline, in the range of 3 to 8 mm Hg, a clinically significant impact.

Cause of High blood pressure

• In 95 % of patients, no cause for hypertension can be identified. Usually genetic or/and environmental factors play a role.
• Approximately 5% of patients have an identifiable cause such as Diabetes, Obesity, chronic kidney diseases, sleep apnea, drug induced, thyroid diseases, associated with pregnancy, renal vascular problem.

Risk factors for developing Hypertension

A number of conditions elevate blood pressure, especially in predisposed individuals.

• Obesity
• Unhealthy Diet and excessive salt consumption
• Low potassium intake
• Physical inactivity
• Smoking
• Alcohol intake
• Tobacco use
• Stress
• Genetics and family history

Symptoms of hypertension

Hypertension is called a “silent killer” because for years blood pressure can be asymptomatic (i.e. no symptoms) till it suddenly causes organ damage. This damage can lead to visual disturbances, palpitations, angina, headaches, transient weakness in various body parts, breathlessness, swelling in face and/or feet or general fatigue.

Importance of getting blood pressure tested

High blood pressure usually causes no symptoms. Therefore, everyone should have regular blood pressure checks, at least every 3-5 years. The check should be more often (at least twice a year) in older people, people who have had a previous high reading and people with diabetes.

Alert 1 : If you have a family history of Hypertension, keep an eye on your Blood Pressure.

Alert 2 : If you have had a history of Gestational Diabetes, keep regular check up on your Blood Pressure.

If you are diagnosed as having high blood pressure then you are likely to be examined by your doctor and have some routine tests which include:

• A urine test to check if you have protein or blood in your urine
• A blood test to check that your kidneys are working fine and to check your cholesterol and sugar level.
• A heart tracing (an electrocardiogram, also called ECG).
• Eye check & fundus examination.
• Echocardiogram.

Know the complications of high blood pressure

Over a period of time high blood pressure can cause problems in other parts of the body because of the damage to the blood vessels. These include

• Stroke
• Angina, myocardial infarction
• Missed or extra heart beat
• Heart failure
• Carotid artery blockage
• Weakening of artery wall that creates a bulge, or distention of the artery
• Peripheral artery blockage in lower limbs
• Visual impairment
• Renal impairment

Tips to manage Hypertension

If your blood pressure is too high, you can make healthy changes to your lifestyle to help bring it down. The following changes to your lifestyle  can have a real effect on your blood pressure.

Maintain a healthy weight – Losing weight, if you need to, will help lower your blood pressure and reduce your risk of health problems. The best way to lose weight is to reduce your calorie intake and increase physical activity. Reduce your calorie intake by avoiding foods that contain a lot of added sugar and fat, such as  colas, sweet drinks, fruit juices, cakes, biscuits, fried foods, namkeens etc. Make small changes in your diet and activity levels that you can keep for life.

Eat less salt – Most of the salt you eat is not only the one added while cooking  food, but also in prepared foods like bread, breakfast cereals and ready meals. Don’t add salt to food when at the table like curd, salad etc. When shopping for food, check the labels and choose low-salt options when you can.

Eat more fruits and vegetables – to lower your blood pressure. Eat at least five portions of fruit and vegetables every day. Try to eat a range of different seasonal fruits and vegetables.

Get more active – 30 minutes of moderate exercise five times a week can keep your heart healthy, and can lower your blood pressure.

Drink less alcohol 

Keep stress under control- Practice relaxation techniques, meditation, breathing exercises and develop time management skills to overcome daily stress.

Take your medicines regularly 

Monitor your blood pressure regularly

Go ahead, aim for a normal blood pressure, work towards it and reap the health benefits….

Types of Diabetes

Type I diabetes: A disorder in which the body makes little or no insulin at all because of beta cell destruction. It is thought to be caused by an autoimmune reaction (the body attacks itself by mistake). Symptoms of this type of diabetes often develop quickly. It’s usually diagnosed in children, teens and young adults. Insulin shots are needed daily for the treatment.

Type II diabetes

This is the most prevalent form of diabetes comprising 90 – 95% of all diabetics. The body makes less insulin or the cells are unresponsive to insulin. The body may have enough insulin and still the insulin response is ineffective because of the blockage of insulin receptors, also termed as insulin resistance. Overproduction of insulin initially exhausts the beta cells production of insulin, consequently leading to less insulin production thereby causing diabetes. Type II diabetes can be prevented or delayed with healthy lifestyle changes, such as losing weight, eating healthy food and being active.

Gestational diabetes develops in pregnant women who have never had diabetes. It is important to diagnose and treat gestational diabetes because it severely affects the fetus. Gestational diabetes signals that the woman has a higher chance of developing Type 2 diabetes later in life, particularly if she is overweight / obese.

The baby is more likely to have obesity as a child or teen and more likely to develop type 2 diabetes later in life too.

Prediabetes

In Prediabetes blood sugar levels are higher than normal, but not high enough yet to be diagnosed as type 2 diabetes. Prediabetes raises the risk for type 2 diabetes, heart disease and stroke.

Prevention studies have proven that with intensive lifestyle interventions (ILS), there is a 58% risk reduction of being diabetic. ILS involved changes in diet and physical activity aimed at reducing weight. For every 1 kg decrease in weight, the risk of developing diabetes in future reduces by 16%.

Symptoms of diabetes

• Tiredness
• Frequent urination
• Increased thirst
• Increased appetite
• Unexplained weight loss and weight gain (especially around the belly )
• Numbness or tingling of feet
• Blurred vision
• Wounds that don’t heal

While many people with Type II diabetes present with increased urination & thirst, many others have a slow onset of high blood sugar & do not exhibit symptoms initially. This is particularly true in obese people, whose diabetes may be detected only after sugar is detected in urine or as high blood sugar.

Occasionally people may show neurological or cardiovascular complications because of disease presence for some time, most common being pain, numbness & weakness in extremities (more in legs), angina & strokes. Chronic skin infections are also common. Eye and kidney problem arise frequently.

Diabetes should always be suspected in those who have delivered large babies (more than 4 kg), presence of pre-eclampsia during pregnancy or unexplained fetal losses.

Risk factors for diabetes

Following conditions make you more susceptible to Diabetes:

• Being overweight (If a person has body weight classified as overweight and if the waist to hip ratio is more than 0.9 in men and more than 0.8 in women,
  he/she is classified as centrally obese)
• Being pre-diabetic
• Family history of diabetes
• Women having PCOS (Polycystic ovarian syndrome )
• Have had high sugar during pregnancy (Gestational Diabetes mellitus)
• Have delivered a baby weighing over 4 kgs
• Have a history of chronic pancreatitis, fatty liver and high triglycerides
• > 30 years of age
• Leading a sedentary lifestyle
• Have been an alcoholic

Some alarming facts…

• India is the Diabetes capital of the world.
• At least 50% of all people with prediabetes are unaware of their condition. In some
  countries this figure is as high as 84%.
• Even an increase in BMI by 1 can drastically increase the chances of getting diabetes.
• Upto 80% of Type II diabetes is preventable by adopting a healthy diet and increasing physical activity.
• Obesity can lead to gestational diabetes in pregnancy. This increases the risk for a primary caesarian and pre term birth in all women. Losing weight saves all the above risk.
• Obesity and Insulin resistance are reversible, but unchecked weight gain will lead to Type II Diabetes mellitus which is irreversible.
• There is a linear relationship between weight loss and HbA1c reduction, with an estimated mean HbA1c reduction of 0.1 percentage points for each 1 kg of reduced body weight.

Normal range of blood glucose control-

• Fasting Sugar: 70 – 100 mg/ dl
• Post Prandial (PP) sugar: 100 -140 mg/ dl

Prevention and Management of Diabetes

There is no cure for diabetes. However, you can manage or delay diabetes through diet, exercise, weight control and, if necessary, medication. Healthy lifestyle choices that help treat pre-diabetes, type 2 diabetes and gestational diabetes can also help prevent them:

• Prevent/treat overweight and obesity. Motivate yourself by remembering the benefits of losing weight, such as a healthier heart, more energy and improved self-esteem.
• Maintain a healthy body weight and avoid weight gain during adulthood. To keep your weight in a healthy range, focus on permanent changes to your eating and exercise habits. Eat healthy foods. Choose foods lower in fat and calories and higher in fibre. Focus on fruits, vegetables and whole grains. Strive for variety to prevent boredom.
• Aim for about 30 minutes of moderate aerobic activity on most days of the week, or at least 150 minutes of moderate aerobic activity a week. Increasing physical activity and reducing sedentary behaviors such as prolonged TV watching are important both for maintaining body weight and improving insulin sensitivity

Prevention is better and inexpensive than cure. This proverbial saying fits well for diabetes. The disorder and its symptoms can be brought under control by following a well-planned diabetic diet and physical activity. This would also help to minimize the complications of the disorder.

Polycystic Ovary Syndrome (PCOS)

Polycystic ovary syndrome (PCOS) is a common health problem caused by an imbalance of reproductive hormones in women of child-bearing age. It affects one out of 15 women, worldwide. The name PCOS describes the numerous small cysts (fluid-filled sacs) that form in the ovaries.

The hormonal imbalance creates problems in the ovaries. The ovaries make the egg that is released as part of healthy menstrual cycle. With PCOS, the egg may not develop as it should or it may not be released as it should. The ovaries, therefore contain many harmless follicles that are underdeveloped sacs in which eggs develop. These sacs are often unable to release an egg, which means ovulation does not take place.

The 3 main features of PCOS are:

• Infrequent, irregular or prolonged menstrual cycles
• High levels of “male” hormones in the body, which may cause physical signs such as excess facial or body hair.
• Enlarged ovaries containing many fluid-filled sacs that surround the eggs.

If you have at least 2 of these features, you may be diagnosed with PCOS.

Symptoms

Women with PCOS have a hormonal imbalance and metabolism problems that may affect their overall health and appearance. The common symptoms of the polycystic ovary syndrome are:

• • Infertility (not able to get pregnant) because of not ovulating
  • Infrequent, absent, and/or irregular menstrual periods
  • Increased hair growth on the face, chest, back, stomach, thumbs or toes
  • Cysts in the ovaries
  • Acne, oily skin or dandruff
  • Weight gain or obesity, usually with extra weight around the waist
  • Male pattern baldness/ alopecia or thinning of hair
  • Patches of skin on the neck, arms, breast or thighs that are thick and dark brown or black
  • Excess flaps of skin in the armpits or neck area
  • Pelvic pain
  • Anxiety or depression.
  • Sleep apnea- when breathing stops for short periods of time while asleep

PCOS is linked to the development of other medical conditions, such as insulin resistance, type 2 diabetes, high cholesterol, high blood pressure, and heart disease

Who is at risk?

Women of all races and ethnicities are at risk of PCOS. Your risk may be higher if you have:

• Obesity: It can cause serious menstrual disturbances & hormonal imbalances.
• A sedentary lifestyle which can lead to obesity.
• Family history – a mother, sister or an aunt with PCOS.
• Between 15-30 years of age.

Cause

The exact cause of PCOS is not known. Factors that might play a role include:

• Excess Insulin – Insulin is the hormone produced in the pancreas that allows cells to use sugar, your body’s primary energy supply. If your cells become resistant to the action of insulin, then your blood sugar levels can rise and your body might produce more insulin. Excess insulin might increase production of male hormones, causing difficulty with ovulation.
• Low grade Inflammation – Research has shown that women with PCOS have a type of low-grade inflammation that stimulates polycystic ovaries to produce male hormones, which can lead to heart and blood vessel problems.
• Heredity- Research suggests that certain genes might be linked to PCOS.
• Excess Male hormones -The ovaries produce abnormally high levels of male hormones, resulting in excessive facial hair and acne.

What you eat matters if you have PCOS

• A high protein and low refined carbohydrate diet can help in dealing with insulin levels and weight issues. Healthy fats and good quality protein when combined with complex carbohydrates slows down the release of blood sugar and improves insulin response.
• Choose whole grains and whole grain products over refined carbohydrates. Whole grains such as brown rice, whole wheat flour, rye, barley, ragi, jowar, oats, buckwheat slowly release the carbohydrate which do not cause the blood sugar levels to rise rapidly.

• Eat foods rich in resistant starch. Resistant starch is a type of carbohydrate that cannot be digested in the stomach or small intestine and reaches the colon intact. It helps feed the friendly bacteria in the gut and increases the production of short-chain fatty acids such as butyrate. It helps to improve insulin sensitivity and regulates hormonal balance. Foods that contain resistant starch include: cooked and cooled parboiled rice, cooked and cooled potatoes, unripe bananas, beans, peas and lentils, chana, rajmah, whole grains like oats and barley.
• Ensure you eat quality protein at each meal. Limit red meat: choose low fat dairy & products, pulses, legumes, seeds, poultry or fish instead, to help stabilize your blood sugar levels.
• Eat fruits & vegetables rich in fiber, vitamins, minerals & antioxidants. Fiber promotes bowel movements, helps manage your blood sugar levels and encourages elimination of toxic waste products. Vitamins, minerals and antioxidants support healthy functioning of the body as well as immune system. Leafy greens such as spinach is low in calories & high in B vitamins. More than 60% of PCOS women are deficient in B vitamins. Include cabbage greens, kale, mustard leaves, broccoli, cauliflower greens, radish leaves, zucchini and cucumber in daily diet.

• Choose healthy fats that are rich in omega-3 and omega-6 fatty acids. Eat oily fish (herring, mackerel, salmon, tuna, sardines, and trout), almonds, walnuts, avocados, chia seeds, flax seeds, sunflower seeds etc.
• Increase intake of soybeans, tempeh, miso, lentils, flaxseeds and chickpeas as these contain natural phytoestrogens which help balance hormone levels in the body.
• Ensure you drink enough water per day so that your urine is a very pale-yellow color. Enough water ensures daily bowel movements and helps to flush out toxins from the body. Skip sugary drinks and instead choose water, coconut water, buttermilk etc.
• Eat small, frequent meals to keep your blood sugar under control.
• Cut out caffeine and minimize alcohol intake.

PCOS & Exercise

Ensure you are exercising at least three times per week for twenty minutes to avoid being over-weight and to manage blood sugar levels. Losing weight is challenging with PCOS but doing so can help reduce the male hormone levels in the body. Ideally, you should be doing a combination of strength and cardio training as both of these types of exercises give different benefits. Cardio training causes your heart rate to rise and uses energy, increasing your total calories used, which will help with weight loss. Strength training on the other hand builds muscle which is important in raising your basal metabolic rate. This helps to burn more calories while at rest and while you are exercising.

PCOS & Plastic

Plastic plays a serious role in aggravating the problem of PCOS. BPA or Bisphenol-A is one of the most consumed toxins found in several plastics and plastic additives. It leaks into food from plastic water bottles, containers and lining of many canned foods containers. It stimulates the ovaries to produce more male hormones which the liver is unable to cope with, gets inflamed and worsens insulin sensitivity. You can reduce the BPA exposure by storing food in metal, glass and ceramic containers, using a stainless-steel bottle for drinking water & buying BPA-free canned foods.

PCOS & Medical Therapy

There are a number of different medical therapies used for managing the different symptoms of PCOS including periods, fertility, excess hair, acne and weight. These therapies may include:

• Oral contraceptive pill
• Insulin sensitizing drugs like Metformin
• Testosterone lowering drugs
• Anti-depressants
• Anti-anxiety drugs

Managing PCOS

There is no cure for PCOS. Medication alone has not been shown to be any better than healthy lifestyle changes (weight loss and exercise). Many women with PCOS successfully manage their symptoms and long-term health risks by doing the following:

1. Eating a healthy, well-balanced diet
2. Participating in regular physical activity
3. Maintaining a healthy weight
4. Following a healthy lifestyle

Early diagnosis and long-term management can help control PCOS so that you can live a healthy active life and avoid long-term complications.