World Diabetes Day - 14th November - Latest panicky scenario.

Qutub Minar - the archaeological monument of India in New Delhi Lit Blue to Create Awareness About Diabetes on Sunday last - the 10th Nov. 2013.

The World Diabetes Day logo is the ''blue circle'' - the global symbol for diabetes which was developed as part of the Unite for Diabetes awareness campaign. The logo was adopted in 2007 to mark the passage of the United Nations World Diabetes Day Resolution. It is a simple icon that can be easily adapted and widely adopted, the circle symbolizes life and health. The colour blue reflects the sky that unites all nations. The blue circle signifies the unity of the global diabetes community in response to the diabetes pandemic.

India emerging as the ‘diabetes capital’ of the world.

As per data and atlas released by ''International Diabetes Federation ( IDF )'' today (14.11.2013), India being home to 65 million Indians suffering from diabetes in 2013, is emerging as the ''Diabetes Capital of of the world''.

For once India is fast catching up with China. But rather than being a matter of celebration this development is bound to ring alarm bells all over. India faces a major challenge to rein in its growing diabetic count. India with 65 million diabetic patients is just next to China (98 million) in the race to become the diabetes capital of the world.

* By 2030, India's diabetics numbers are expected to cross the 100-million mark, according to this 2013 report of the International Diabetes Federation.

* WHO projects that in the next ten years, deaths from diabetes will increase by 35 percent.

KEY MESSAGES RELEASED BY IDF TODAY ABOUT THE SITUATION ....
* 382 million people worldwide have diabetes in 2013. 

* By 2035 this will rise to 592 million.

* 90% of the cases are of type 2 diabetes.

* The number of people with type 2 diabetes is increasing in every country.

* 80% of people with diabetes live in low- and middle-income countries.

* The greatest number of people with diabetes are between 40 and 59 years of age.

SYMPTOMS OF DIABETES MELLITUS :

Individuals can experience different signs and symptoms of diabetes, and sometimes there may be no signs/symptoms. It has been seen that nearly 50% of the people don't know they have diabetes. Some of the basic symptoms commonly experienced include:

• Frequent urination
• Excessive thirst
• Increased hunger
• Weight loss
• Tiredness
• Lack of interest and concentration
• A tingling sensation or numbness in the hands or feet
• Blurred vision
• Frequent infections
• Slow-healing wounds
• Vomiting and stomach pain (often mistaken as the flu)

The development of type 1 diabetes (in children) is usually sudden and dramatic while the symptoms can often be mild or absent in people with type 2 diabetes (adults), making this type of diabetes hard to detect.

If you show these signs and symptoms, consult a health professional.

The Indian Scenario :

The India situation is grim what with sedentary lifestyle prevailing across key metros and big cities aggravating the situation. “Diabetes is the result of our habitual sedentary lifestyle, lack of physical activity, obesity, stress and consumption of diets rich in fat, sugar and calories. In India sugar consumption is much higher in the form of sweets consumed on various occasions leading to higher risk of diabetes.”

The major chunk of Indian population suffering from this disease has Type 2 diabetes which is closely associated with obesity and consumption of sweets, junk and fast foods especially in metropolitan cities.

Diabetic and obese people are more prone to Non – Alcoholic Fatty Liver Disease (NAFLD). 

“Of all the diabetic patients, there is a chance of two–third of them to have fatty liver disease.”

In order to make India diabetes free, the Government of India has initiated a National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke (NPCDCS) in 100 selected districts in 21 States. Thirty districts were taken up during 2010-11 and remaining 70 Districts have been added during 2011-12. The community based strategies and activities include prevention and control of diabetes at various levels like at sub-centres, Community Health Centre (CHC), district hospital and at various other places through screening of all persons above 30 years of age and all pregnant women, awareness generation on healthy life style and management of non- communicable diseases by establishing cardiac care units at district hospitals and community health centres of 100 selected districts of 21 states in the country.

This effort, however, has yet to show any major changes in the spread of the disease in the country. “Diabetes is a serious condition killing more people than other deadly diseases like AIDS and cancer.”  

“One-third of the diabetics develop coronary artery heart disease (CAD), irrespective of the precaution they take and death of 80% diabetics can be attributed to CAD,” Around 50 to 60 million Indians suffer from heart disease and if figures are further further explained, every 10th Indian suffers with either CAD or diabetes.

Diabetes is a multi system disorder and it attacks people in many ways.

First it alters lipid metabolism, precipitates clotting in the artery and then damages artery walls. 

“The most vulnerable are those who have a family history of diabetes. For them, regular blood & urine sugar level check-ups after the age of 35 years is mandatory, which is the best way to prevent disease” . When people from the vulnerable group go for preventive test, they should ensure that urine micro-albumin is included in the test as well.

For diabetic patients, the sugar test should also be considered important where fasting level should be below 110, random between 140 and 160 and the range for the 2-hour glucose test should be 150 to 180. 

Apart from these clinical precautions diet is another factor, which can help check the impact of diabetes on the heart. “For diabetics, controlled intake of carbohydrates is one of the important factors in diet management.

As per statistics, about 50% diabetics develop kidney problems. Many develop eye, neural, skin, joint, infection, immune system problems. But by checking their vulnerability status and with regular tests, further ailments could be prevented.

Prevention :

At present, type 1 diabetes cannot be prevented. The environmental triggers that are thought to generate the process that results in the destruction of the body’s insulin-producing cells are still under investigation.

There is a lot of evidence that lifestyle changes (achieving a healthy body weight and moderate physical activity) can help prevent the development of type 2 diabetes.

Obesity, particularly abdominal obesity, is linked to the development of type 2 diabetes. Weight loss improves insulin resistance and reduces hypertension. People who are overweight or obese should therefore be encouraged to achieve and maintain a healthy body weight.

Physical activity is one of the main pillars in the prevention of diabetes. Increased physical activity is important in maintaining weight loss and is linked to reduced blood pressure, reduced resting heart rate, increased insulin sensitivity, improved body composition and psychological well-being.

A balanced and nutritious diet is essential for health. A healthy diet reduces risk factors for cardiovascular diseases. 
Other behaviors to consider include : 
Smoking : a well-established risk factor for many chronic diseases, including diabetes and its complications. As well as other harmful effects, smoking increases abdominal fat accumulation and insulin resistance. All smokers should be encouraged to quit smoking. However, weight gain is common when quitting smoking and therefore dietary advice on avoiding weight gain should also be given (e.g. managing cravings and withdrawal symptoms by using short bouts of physical activity as a stress-relief activity, rather than eating snacks).

Stress and depression : There is evidence of a link between depression and both diabetes and cardiovascular disease.

Sleeping patterns : Both short sleep duration may be associated with a higher risk of developing type 2 diabetes. Sleep deprivation may impair the balance of hormones regulating food intake and energy balance. Long sleep duration may be a sign of sleep-disordered breathing or depression and should be treated appropriately. There is also a close association between obesity and obstructive sleep apnoea syndrome (OSA), the most common form of sleep disordered breathing.

A simple prescription for diabetic care : 

A healthy per day calorie intake should be between 1,500-1,800 calories with a proportion of 60:20:20 between carbohydrates, fats and proteins, respectively.

“For people with diabetes, healthy eating is not simply a matter of what one eats, but also when one eats.”

As regards the choice of food intake, the diet most often recommended is high in dietary fiber, especially soluble fiber, but low in fat (especially saturated fat). The food ought to reflect a balance with all the food groups and veggies being the largest part of the meal.

Healthy eating for type 2 diabetes is about losing weight and preventing dangerous spikes in blood sugar. 

Nine foods you should be eating for diabetes are :

Non Starchy Leafy Veggies

Beans

Avocado

Non Fat Yogurt

Almonds

Oat Meal

Egg White

Fish

Wild Salmon

The Future :

In the next 17 years, India, China and the US would have the largest number of diabetics. 

It is estimated that every fifth person with diabetes will be an Indian. 

Due to this, the economic burden due to diabetes in India is amongst the highest in the world.

As per WHO estimates, mortality from diabetes, heart disease and stroke cost about $210 billion in India in 2005.

Much of the heart disease and stroke in these estimates was linked to diabetes.

Diabetes, heart disease and stroke together would cost about $ 333.6 billion over the next 10 years in India alone, estimates WHO.

Vitamin D deficiency : An Epidemic in India ( A bigger problem than perceived).

Vitamin D deficiency : A bigger problem than perceived in India ... 

Majority of Indian population lives in areas  (tropical region), receiving ample sunlight throughout the year and hence there was a disbelief that Vitamin D deficiency is uncommon in India. However from the data available in

the published literature, VIT. D DEFICIENCY IS VERY

COMMON IN INDIA in all the age groups and both sexes across the country.

It has been estimated that 1 billion people worldwide have Vit. D deficiency or insufficiency. In India nearly 60-90 % people are deficient. If we take into consideration reporting of Vit. D test in our lab, IN OUR AREA, we get nearly 3-5 patients of 'Vitamin D' test daily and on an average of 100 patients/ month and 90-95 of them are found deficient .... Isn't it so alarming with so much of sunshine ??.

CAUSES OF DEFICIENCY....

* Changing food habits, 

* strict vegetarian habits, 

* increasing number of hours spent indoors, 

* increased air pollution hampering the ultraviolet rays to adequately synthesize vit D in the skin, 

* travelling in cars rather than open vehicles like cycles/scooters/bikes etc., 

* more worries for tanning one's skin in sunlight to have good fair looks, 

* highly competitive and busy study schedules in schools and homes for the kids with negligible stress on physical activities in open grounds in sunlight in the schools coupled with least hrs of kid's play in open even at homes.

Ladies with Parda and Burqa.

* Cultural and traditional habits prevalent in certain religions like “burqa” and the “pardah” system in muslims, 

have all contributed to this present dismal scenario.

ROLE OF VITAMIN D IN HUMANS ....

(1). THE BASIC ROLE THIS VITAMIN PLAYS IS ... IT HELPS IN DEPOSITING CALCIUM IN the BONES. So if one has enough Calcium in blood but is deficient in Vit. D, then that calcium is useless as it's not going to be deposited in one's bones. So the role of Vitamin D in the growth of bones and formation of teeth is well known. Severe deficiency of this vitamin leads to brittle bones, a disease known as Rickets in children and Osteomalacia in adults. However, there's more to the 'sunshine vitamin' than bone health.

More Vit. D .... more calcium deposition in bones.

(2). Recently Vit. D has been proved to be a great IMMUNE BOOSTER and its deficiency in winter months (least sun shine), leads to lowered body immunity, inviting so many opportunistic infections in the body during this season, and the most common being flu/viral infections. Therefore, now intelligent physicians do prescribe Vit. D in their ''Flu prescriptions''.

                                       Strong Immunity - Cheers all around !

LIKEWISE, in addition to its role in maintaining calcium and phosphorus balance, Vitamin D maintains maximum muscle strength, inhibits inflammatory activity and prevents many diseases related to the immune system, including Type I diabetes, multiple sclerosis, systemic lupus erythematosus (SLE), rheumatoid arthritis and many common cancers. Low levels of Vitamin D have also been linked to hypertension, cardiovascular disease, Type II diabetes mellitus, infectious diseases, tuberculosis, asthma, psoriasis and even depression.

(3). BESIDES HAVING A MAIN ROLE IN CALCIUM METABOLISM AND IMMUNE SYSTEM REGULATION, VITAMIN D DEFINITELY HAS A ROLE IN REGULATING ONE'S BODY CLOCK. Light is the most potent agent to synchronize your internal body clock that regulates circadian rhythms, which in turn also regulate energy balance. The body's circadian rhythms -- fluctuations in hormone levels and other biological systems depending on the time of day -- are known to play an important role in metabolism and WEIGHT REGULATION. 

Weight Loss
"Vitamin D deficiency is associated with OBESITY and Vitamin D levels in the body at the start of a low-calorie diet predict weight loss success. More or healthier the levels better are the chances to loose weight. Addition of vitamin D to a reduced-calorie diet will lead to better weight loss .... THIS FACT WAS HIGHLIGHTED AND PROPOSED  IN DIFFERENT STUDIES CONDUCTED IN 2009.

Now this has been proved by further studies. The message is that you should get more bright light between 8 a.m. and noon to successfully loose weight. It takes only 20 to 30 minutes of exposure to outdoor morning light to have an impact on your BMI

COMPLAINTS/SYMPTOMS OF VITAMIN D DEFICIENCY ....

Vitamin D deficiency begins slowly before physical signs and symptoms of rickets appear. Common early signs and symptoms of vitamin D deficiency include :

• Nervousness.
• Painful muscle spasms.
• Leg cramps.
• Numbness in extremities.

Ultimately more serious signs and symptoms appear with prolonged vitamin D deficiency. When rickets or osteomalacia signs and symptoms develop, they may include:

• Bone (and skeletal) malformations or deformities. This developing is due to softening of the bones, such as bowed legs, knock-knees, scoliosis (curvature of the spine), protruding breast bone, and/or beading at the ends of the ribs.
• Fragile bones. Children with rickets are more prone to bone fractures.
• Tooth decay and dental problems. These include defects in tooth structure, increased chance of cavities, poor enamel and delayed formation of teeth.
• Bone pain. This includes dull, aching pain or tenderness in the spine (especially the lower spine), pelvis, legs and feet. Pain associated with osteomalacia is usually dull and aching and worsens during physical activity. You might notice that gently pressing on a bone, on your shin, for example, produces severe pain.
• Muscle weakness. Decreased muscle tone may make movement uncomfortable. Osteomalacia can cause weakness or stiffness in your arms and legs, decreased muscle tone and discomfort while moving. Some people with osteomalacia walk with a waddling motion.
• Delayed walking in young children may be associated with rickets.
• Irritability.
• Restlessness.
• Failure to grow normally. Impaired or delayed growth in height or limbs may be a result of rickets.
• Profuse sweating.
• Chronic muscle aches and pains.

Child with Rickets ( Bow Legs)

Adult Osteomalacia.

To conclude, the main complaints of Vit. D deficiency would be ...

* Body aches, 

* Back ache, 

* Muscle spasm/Leg cramps,

* Joint pains, 

* Lethargic nature, 

are the main symptoms of this deficiency and in the longer run it also makes bones fragile and prone to fractures and other joint problems as well.

Recent study ( July, 2013) ...

Epidemic of Vitamin D shortage puts Indians at high blood pressure risk ....

Runny noses and stomach flu aren't the only ills associated with overcast skies. The absence of sunlight hits production of Vitamin D in the body, adversely affecting blood pressure. A recent study in London by an Indian-born researcher has proved beyond doubt that the lower the vitamin level, the higher the BP.

SOURCES OF VITAMIN D ....

First and foremost to remember is  ''No vegetarian diet contains Vit. D''

SUN SHINE ( 90 % source of Vit. D in humans )

Though this vitamin is naturally present in very few foods, and almost no vegetarian diet contains this sunshine vitamin, therefore it is added to foods (dairy products) through fortification in developed countries.  
Rich food sources include fish, fish oils, ghee, butter and egg yolk. Compared to fish-liver oil, which is the best dietary source of Vitamin D, other foods are quite low in this vitamin.

Fortified Dairy products, Eggs, Fish.

Ideally, a diet that includes dairy products (fortified with Vit. D), fish and egg yolk ( fish-liver oil being the BEST) coupled with adequate exposure to sunshine, should prevent Vitamin D deficiency. 

Thirty minutes of exposure of the skin over the arms and face to sunlight, without application of sunscreen, preferably between 10 am to 2 pm (as maximum ultraviolet B rays are transmitted during this time) daily is adequate to avoid Vit D deficiency.

Two Interesting Facts ..... 
(1). Vitamin D deficiency plagues doctors too ....

 There’s a common belief among the general public that doctors are healthy beings. This myth was dispelled by a pan-India study conducted by Indian Menopause Society, which revealed that about 95% of the gynecologists they studied, suffered from Vitamin D deficiency. About 2,500 gynecologists from across major cities like Delhi, Mumbai, Chennai and Hyderabad were screened for the study and shockingly about 95% of them suffered from lack of Vitamin D. The study has been published in the journal of ''Archives of Osteoporosis'' (February 2013). 
(2). Pregnant women .... 

Meanwhile, yet another study conducted by the Indian Menopause Society, taking into consideration about 1,000 pregnant women from across the major Indian cities (which included Bangalore), have revealed that about 80-90% of them suffered from Vitamin-D deficiency. Expectant mothers lacking Vitamin-D are at higher risk of acquiring hypertension, diabetes and there may be slower growth of their child.

NORMAL DAILY REQUIREMENTS OF VITAMIN D  .... 

A normal adult requires a minimum of 1,500 to 2,000 units of Vitamin-D and about 800 mgs of Calcium every day. Dietary sources of Vit. D in predominant vegetarian Indian public are practically NIL, hence daily exposure to sunlight for a minimum of 1/2 an hour is most important. 
How much, How and When to get Sunshine ? ....

Sitting in the Sun in an area with slow or no breeze with bare arms, face and feet, for a minimum of 30 minutes between 9 am and 3 pm on daily basis is recommended.

TESTS for VITAMIN D DEFICIENCY ....

1. Blood levels of Vit. D ( Serum Vit. D i.e. 25-OH Vit. D)
2. Blood Calcium and Phosphorus levels
3. X-Rays Bones

WHAT TO DO IF FOUND DEFICIENT IN BLOOD VITAMIN D LEVELS ....

(1). Make a routine to sit in the sunlight daily for at least 30 minutes between 9 am to 3 pm with uncovered hands, face and legs facing the sun.

(2). Try to take foods rich in Vit. D as outlined above.

(3). Oral Vit. D (Cholecalciferol) granules available as 1 gm sachets (marketed in India as ''CALCIROL''by Cadila pharma), each gm having 60,000 IU of Vit. D.

Take this 1 gm sachet orally with milk once a fortnight. Intake of 4-6 such sachets or as suggested by your physician would be sufficient to supplement the depleted levels of Vit. D.

HOW MUCH IS TOO MUCH ? .... 

There is an upper limit to how much vitamin D you can safely take. The Institute of Medicine recommendations for adults say that a daily intake of up to 4,000 IU of vitamin D is safe. Taking more than 10,000 IU per day can cause kidney and tissue damage. 

The best approach is to check with your health care provider before taking vitamin D supplements.

Your Blood Group Helps Determine Your Risk of Heart Disease ... A New Study.

 Do you know your blood group ?

 If no, then here’s another reason why you should know your blood type as soon as possible. Your blood group type may provide the essential clue if you are prone to any heart disease risk.

 A new study has concluded that there is a link between blood group type and heart disease. A team led by Dr. Meian He, an epidemiologist in the Department of Nutrition at the Harvard School of Public Health in Boston, reviewed data from two large studies that looked at more than 89,000 people between 1976 and 2006. The researchers considered two Harvard studies, one that tracked 62,000 women over 26 years, and one that tracked 27,400 men over 24 years. In total, more than 2,500 people were diagnosed with heart disease. These participants were asked to report their blood group type, as well as whether they had suffered a heart attack.
Analysis of the results found that individuals with non-O blood groups — meaning A, B, or AB — had a significantly higher likelihood of developing coronary heart disease.

The Harvard University researchers concluded people with blood group AB were 23 per cent more likely to suffer from heart disease.
Group B blood increased the risk by 11 per cent, and blood group A by 5 per cent. Blood group O individuals are the safest on this front.
The study was published on 14th August,2012 in the American Heart Association journal ''Arteriosclerosis, Thrombosis and Vascular Biology''.

Blood type O is the country’s most common, accounting for about 40 % of Indians. Blood type A is second in line (28%), and B is third (25%). Blood type AB is the least common (7%).
The research is the latest to suggest a relationship between blood type and a risk of heart disease.
"While people cannot change their blood type, our findings may help physicians & public better understand who is at risk for developing heart disease," said study author Dr. Lu Qi, assistant professor of nutrition at the Harvard School of Public Health in Boston. The association with blood group type held even after the researchers took into account variables that affect people's risk of heart disease, such as cholesterol levels, smoking, diabetes and hypertension. 

The results are "totally surprising," said Dr. Richard Stein, a cardiologist and spokesperson for the American Heart Association. While other smaller studies have suggested such a correlation, this is the first large-scale study to support the connection, he noted.  

Stein said that while further research is needed, blood type could be added to the list of factors that are considered when a doctor assesses a patient for risk of heart disease, particularly because blood tests to determine it are inexpensive and have no side effects. 

"It's good to know your blood type the same way you should know your cholesterol or blood pressure numbers, 
"If you know you're at higher risk, you can reduce the risk by adopting a healthier lifestyle, such as eating right, exercising and not smoking,"  Knowing that one's blood type puts them at higher risk may increase people's motivation to "take care of themselves and stop their bad habits,"

“This study adds to the existing literature demonstrating a significant association between ABO blood group and cardiovascular adverse events. And theories have been proposed to explain this link. Many suggest that having type A, B or AB blood may result in higher levels of certain clotting factors in the blood, or it may predispose you to higher bad cholesterol levels (LDL) ,  there is evidence suggesting that type A is associated with higher levels of LDL or bad cholesterol, the waxy substance that can clog arteries, and type AB is linked to inflammation, which may affect the function of the blood vessels, while people with type O blood may benefit from a substance that is thought to assist blood flow and reduce clotting, an American Heart Association statement said.

But experts warn that while blood type O may offer some protection from heart trouble, blood type alone will not compensate for other factors that are linked to cardiovascular disease.