Observe Ramzan Fast, with precautions,

Times of India dated 25th of July, 2012

IS FAD DIET A BOON OR BANE FOR DIABETES

BY
Sheela Paul, Vimala, Rubini-Dietitians


‘Fad diets’ promise quick weight loss through unhealthy eating patterns that usually lack essential nutrients and promote starvation. Most people are aware of why fad diets are unhealthy and must not be followed. However, they continue to follow fad diets to lose weight, thus promoting hoax fad diets that they know are harmful in the long run.

A fad diet is any diet, diet aid, or weight loss plan that promises miraculous results. They usually focus on one particular food, or substance and some of these diets have been found to be quite unhealthy and even dangerous.

People with diabetes must not follow fad diets. Instead, weight loss and proper diet must be a long-term, daily commitment to safely maintain healthy blood glucose levels while helping to reduce the burden of diabetes on organs.


So carefully consider the impact that such a diet would have on blood glucose and general nutrition. Think smart, eat a balanced diet, and monitor your blood sugar carefully – you will not need any special fad diet or expensive planned diet ..

Fad and popular diets initially work for the very same reasons they eventually fail — very restricted food choices, lack of flexibility, and no decision-making. Most people get very tired of eating the same foods and having limited choices. Once they start to cheat, they eventually fall back on poor eating habits.

Our food choices are increasingly influenced by media hype and the current bestseller list, instead of sound nutrition.

Before you begin any specialty diet plan, consider these tips:

Talk to your doctor or dietician. Always discuss your plans for a specialty diet with your physician and dietitian for information about diet and glucose management before starting anything new!

Never follow a “fasting” or “cleanse” diet. These crash diets often restrict your calorie intake to very low levels, and skipping meals can lead to a dangerous drop in blood sugar that can have serious consequences. Similarly, diets that require multiple meals per day of a single recipe or food group – particularly liquid diets – can lead to spikes in blood glucose and can also cause malnutrition when maintained over longer periods of time.

Remember that no "special" plan is needed for people with diabetes.

Besides watching carbohydrate intake and closely monitoring blood glucose levels, people with diabetes do not need to eat “special” foods or follow seriously restricted diet plans. Common sense in avoiding sugary foods and foods with high glycemic indices, coupled with a well-balanced and nutritious diet, is all that is necessary to manage a diabetic diet.

A starvation diet fills you up with watery vegetables. Weight loss is due to calorie restriction and water loss, not the magic fat-burning soup. Foods that claim to have special ‘fat-burning enzymes’ result in weight loss not because of any secret ingredient but simply because of the calorie restriction (usually only 900 calories a day).

Many restrictive and strange food combination diets exist! Still, there is no magical food combination or special ingredient that results in weight loss. In fad diets, like all diets, weight loss results from decreased calories.

Weight loss or weight gain is a simple equation.

Calories eaten minus calories used through activity = weight loss or weight gain.

Experts agree that a slow, steady weight loss of a half to two pounds per week is the key to permanent weight loss. In fact, studies show that faster weight loss is associated with faster weight regain once the diet is stopped.

Weight gain is also influenced by a decrease in physical activity, and increase in TV and computer time.

Health professionals urge people to eat less of the refined carbohydrates like white flour foods, crackers, noodles, chips, sugary snacks and cereals. They suggest choosing whole grain products more often, eating five to ten servings of fruits and vegetables daily, limiting fat intake and increasing daily activities. These actions ensure that we get good nutrition from our food, maintain a healthy weight and help prevent disease.

People with diabetes need to be more cautious -- fad diets can cause downward spikes in blood sugar,


"Reducing your calories, even at one meal, will affect your blood sugar "If you're taking medication that's also lowering your blood sugar, you will need to reduce that medication. You will need to monitor your blood sugar more often, depending on the severity of the diet and how calorie-restricted it is."
A fad diet can also increase cholesterol and blood pressure levels -- creating an especially high-risk situation for someone with diabetes,

Some examples of diets:

The famous Atkins high-protein/high-fat diet encourages eating red meat, full-fat cheese, chicken, , fish and shellfish, butter, and olive oil. With Atkins, carbohydrates are severely restricted during the two-week induction period - which is intended to cause ketosis, a condition in which the body burns its own fat for fuel.

"Ketosis is not good for anyone, and especially so if you have diabetes," "Most people get into hypoglycemia before they even get to ketosis. The diet's high cholesterol and fat intake is another big problem, increasing the risk of heart disease. In addition, all that protein makes your kidneys work harder, which can worsen existing kidney problems.


South Beach diet - Simple carbs are forbidden, but "good carbs" are encouraged -- whole grains, vegetables, lean protein (fruits can be phased in after the induction). Unhealthy fats (including fatty meats) are banned. This diet does not leave out any major food groups.

Carb-Controlling Diets:
Glycemic index is a concept of controlling blood sugar based on the types of carbohydrate food you eat.

High-glycemic-index foods -- such as white bread, rice, mashed potatoes, and most cold cereals -- cause a quick spike in blood sugar, so there's a burst of energy, then hunger again. Low glycemic index foods -- fruits, vegetables, beans, and whole grains -- cause levels to rise more slowly and last longer, so you feel less hungry for a longer period.

Meal Replacement Diets

Meal replacement products -- like Slim-Fast diet shakes and snacks -- are another weight loss strategy and a different type of a fad diet:

A person with diabetes "cannot regulate blood sugar in the same way as a person without diabetes. There is more risk of complications. A fad diet can increase that risk."

Think Carefully Before Beginning a Diet Plan

CANCER OF THE PANCREAS

S. ARCHANA M.Sc., M.Phil.,- Research Assistant
Clinical Research Department
M.V. Hospital for Diabetes
Royapuram

About the Pancreas:

The pancreas is an organ in the abdomen that sits in front of the spine above the level of the belly button. It performs two main functions: - it makes insulin, a hormone that regulates blood sugar levels, and it makes enzymes, which help break down proteins so that they can be more easily absorbed by the body and used for energy. Enzymes leave the pancreas through a system of tubes called "ducts" that connect the pancreas to the intestines.


Pancreatic cancer:

Pancreatic cancer occurs when uncontrolled cell growth begins in the pancreas. Instead of developing into healthy, normal tissue, these abnormal cells continue dividing and form lumps or masses of tissue called tumors. Tumors do not allow the pancreas to function properly. A tumor that stays in one spot and has limited growth is generally considered to be benign.

Malignant tumors form when the cancer cells migrate to other parts of the body through the blood or lymph systems. When a tumor successfully spreads to other parts of the body and grows, invading and destroying other healthy tissues, it is said to have metastasized. This process itself is called metastasis, and the result is a more serious condition that is very difficult to treat.

Because pancreatic cancer is usually diagnosed late into its development, the five-year survival rate after diagnosis is less than 5%.


Causes, incidence, and risk factors:

The exact cause of pancreatic cancer is unknown. It is more common in:

People with diabetes,
People with long-term inflammation of the pancreas (chronic pancreatitis),
Smokers, and Women, and the risk increases with age.

A small number of cases are related to genetic syndromes that are passed down through families.

The incidence of pancreatic cancer appears to be higher in people with increased calorie consumption, high fat and carbohydrate consumption and lower in those with a diet rich in fresh fruit and vegetables.

Symptoms of pancreatic cancer:

A tumor or cancer in the pancreas may grow without any symptoms at first and is often in an advanced stage when first detected.

Early symptoms of pancreatic cancer include:

Dark urine and clay-colored stools
Fatigue and weakness
Jaundice (a yellow color in the skin, mucus membranes, or eyes)
Loss of appetite and weight loss
Nausea and vomiting
Pain or discomfort in the upper part of the belly or abdomen

Other possible symptoms are back pain, blood clots, diarrhea, or indigestion.

Signs and tests:

* Liver function tests show a suppression of bile flow in form of significantly elevated levels of:
Bilirubin (conjugated and total), a compound produced by the breakdown of hemoglobin from red blood cells.
Alkaline phosphatase, an enzyme released into the blood during injury and during such normal activities as bone growth and pregnancy.
Gamma-Glutamyl Tranpeptidase ( GGT ), an enzyme that plays a key role in the pathway for the synthesis and degradation of glutathione.

* Mild increase in amino-transferase, an enzyme that catalyses the transfer of an amino group from a donor molecule to a recipient molecule.

* Hypoalbuminemia (a frequent condition where the albumin in blood serum is abnormally low).

* Ultrasound of the abdomen is the most useful screening test. It gives a lot of information - dilation of the biliary tract which carries bile out of the liver ,enlarged lymph nodes, fluid in the abdominal cavity and so on.

* CT scans like spiral CT and Multi Detector CT (MDCT) are the most advanced imaging methods to diagnose and assess surgery requirements for pancreatic cancer. The accuracy for assessment of surgery is 70 to 79 percent.

* Endoscopic Ultrasonography (EUS) uses a high-frequency ultrasonographic machine on an endoscope (a camera on a tube) to help visualize the pancreas. High-frequency ultrasonography (7.5 – 12 MHZ) can be used to produce very high resolution images. This has proved to be the most sensitive and specific diagnostic test for pancreatic cancer including those smaller than 3 cm. An additional significant advantage is the EUS-guided fine-needle aspiration, which can confirm pancreatic carcinoma at the time of EUS diagnosis.

Stages of Pancreatic Cancer:

After a diagnosis is made, doctors find out how far the cancer has spread to determine the stage of the cancer. The stage determines treatment and informs prognoses. The standard pancreatic cancer staging method is called the TNM (Tumor - Node - Metastasis) system. T indicates the size and direct extent of the primary tumor, N indicates the degree to which the cancer has spread to nearby lymph nodes, and M indicates whether the cancer has metastasized to other organs in the body.

Treatment of pancreatic cancer:

Surgery:

As pancreatic cancer is often advanced when it is first found, very few tumors can be removed by surgery. The standard surgical procedure is called a pancreaticoduodenectomy (Whipple procedure).

This Kausch-Whipple mode of operation involves surgery of the pancreatic head, the duodenum and proximal 10cm of jejunum, the distal stomach, and the common bile along with the gall bladder and cystic duct. This is a major gastrointestinal operation that can last for approximately 4 to 6 hours and requires expert surgical teams.

Surgery however doesn’t kill the patient – the chances for that are between 0 to 5%. The major cause of postoperative morbidity is the occurrence of pancreatic enteric leaks leading to intra-abdominal abscess and pancreatic fistulae.


Adjuvant therapy:

The median survival rate of patients who undergo only surgery is 10 to 20 months with a high rate of local recurrence and problems of the disease spreading to secondary parts. Thus all surgically treated patients should be given supportive therapy.

Radiation therapy:

Radiation therapy is used to fight many types of cancer. It is often used to shrink a tumor as much as possible before surgery. Radiation can also be given after surgery to prevent the cancer from coming back.

For certain types of cancer, radiation are the only treatment needed. Radiation treatment may also be used to provide temporary relief of symptoms, or to treat cancers that cannot be removed with surgery.

There are two forms of radiation therapy:

* External beam radiation is the most common form. This method carefully aims high powered x-rays or particles directly at the tumor from outside the body.
* Internal beam radiation uses radioactive seeds that are placed directly into or near the tumor.

Chemotherapy:

Pain reducing chemotherapy is offered to patients whose cancer cannot be improved with surgery or is a spreading disease.

Different chemotherapy drugs may be given at the same time or after each other. Patients may receive radiation therapy before, after, or while they are getting chemotherapy.

Chemotherapy is most often given in cycles. These cycles may last one day, several days, or a week or more. There will usually be a rest period when no chemotherapy is given between each cycle. A rest period may last for days, weeks, or months.

Prevent pancreatic cancer:

* Stop smoking.


* Eat a diet high in fruits, vegetables, and whole grains.


* Exercise regularly.

Sleep Apnea

G. Surya Thejaswi
Clinical Research Associate
MV Hospital for Diabetes & Research Centre
Royapuram

DEFINITION

Sleep apnea is a sleep disorder characterized by abnormal pauses in breathing or instances of abnormally low breathing, during sleep. Each pause in breathing, called an apnea, can last from a few seconds to minutes, and may occur 5 to 30 times or more an hour. Similarly, each abnormally low breathing event is called a hypopnea.

Sleep apnea is diagnosed with an overnight sleep test called a polysomnogram, or "sleep study".


TYPES OF SLEEP APNEA

* Obstructive sleep apnea is the most common type of sleep apnea. It occurs when the soft tissue in the back of your throat relaxes during sleep, causing a blockage of the airway (as well as loud snoring).


* Central sleep apnea is a much less common type of sleep apnea that involves the central nervous system, rather than an airway obstruction. It occurs when the brain fails to signal the muscles that control breathing. People with central sleep apnea seldom snore.

* Complex/Mixed sleep apnea is a combination of obstructive sleep apnea and central sleep apnea.

ANATOMY OF A SLEEP APNEA EPISODE

As air flow stops during a sleep apnea episode, the oxygen level in your blood drops. Your brain responds by briefly disturbing your sleep enough to kick start breathing—which often resumes with a gasp or a choking sound. If you have obstructive sleep apnea, you probably won’t remember these awakenings. Most of the time, you’ll stir just enough to tighten your throat muscles and open your windpipe. In central sleep apnea, you may be conscious of your awakenings.

SLEEP APNEA SIGNS AND SYMPTOMS:

Major signs and symptoms of sleep apnea

* Loud and chronic snoring
* Choking, snorting, or gasping during sleep
* Long pauses in breathing
* Daytime sleepiness, no matter how much time you spend in bed

Other common signs and symptoms of sleep apnea include:

* Waking up with a dry mouth or sore throat
* Morning headaches
* Restless or fitful sleep
* Insomnia or nighttime awakenings
* Going to the bathroom frequently during the night
* Waking up feeling out of breath
* Forgetfulness and difficulty concentrating
* Moodiness, irritability, or depression

Signs and symptoms of sleep apnea in children

While obstructive sleep apnea can be common in children, it’s not always easy to recognize. In addition to continuous loud snoring, children with sleep apnea may adopt strange sleeping positions and suffer from bedwetting, excessive perspiration at night, or night terrors. Children with sleep apnea may also exhibit changes in their daytime behavior, such as:

* Hyperactivity or inattention
* Developmental and growth problems
* Decrease in school performance
* Irritable, angry, or hostile behavior
* Breathing through mouth instead of nose

Is it just snoring or is it sleep apnea?

Not everyone who snores has sleep apnea, and not everyone who has sleep apnea snores. So how do you tell the difference between garden variety snoring and a more serious case of sleep apnea?

The biggest telltale sign is how you feel during the day. Normal snoring doesn’t interfere with the quality of your sleep as much as sleep apnea does, so you’re less likely to suffer from extreme fatigue and sleepiness during the day.

SLEEP APNEA CAUSES AND RISK FACTORS

Anyone can have sleep apnea-young, old, male, female, and even children can suffer. However, certain risk factors have been associated with obstructive and central sleep apnea.

Risk factors for obstructive sleep apnea

You have a higher risk for obstructive sleep apnea if you are:
* Overweight
* Male
* Related to someone who has sleep apnea
* Over the age of 65
* Black, Hispanic, or a Pacific Islander
* A smoker

Other risk factors for obstructive sleep apnea include certain physical attributes, such as having a thick neck, deviated septum, receding chin, or enlarged tonsils or adenoids (the most common cause of sleep apnea in children). Allergies or other medical conditions that cause to nasal congestion and blockage can also contribute to sleep apnea.

Risk factors for central sleep apnea

Like obstructive sleep apnea, central sleep apnea is more common in males and people over the age of 65. However, unlike obstructive sleep apnea, central sleep apnea is often associated with serious illness, such as heart disease, stroke, neurological disease, or spinal or brainstem injury.

COMPLICATIONS OF SLEEP APNEA:


Few facts:

* Obstructive Sleep Apnea (OSA) is the most common form of sleep-disordered breathing, accounting for over 80% of cases.
* Estimates suggest that up to 40% of people with OSA will have diabetes, but the incidence of new diabetes in people with OSA is not known.
* In people who have diabetes, the prevalence of OSA may be up to 23%, and the prevalence of some form of sleep disordered breathing may be as high as 58%.
* Overweight and obesity may play a role, but some recent studies show an association between the two conditions that is independent of overweight/ obesity.
* OSA may have effects on glycemic control in people with type 2 diabetes.
* OSA is associated with a range of cardiovascular complications such as hypertension, stroke and heart failure.



Possible mechanistic links between OSA, metabolic syndrome and diabetes mellitus

SELF-HELP TREATMENT OPTIONS FOR SLEEP APNEA

While a diagnosis of sleep apnea can be scary, it is a treatable condition. In fact, there are many things you can do on your own to help, particularly for mild to moderate sleep apnea. Home remedies and lifestyle modifications can go a long way in reducing sleep apnea symptoms.

Lifestyle changes that can help sleep apnea
* Lose weight. Some people find that even moderate to severe sleep apnea can be completely corrected by losing excess weight. For others, even a small amount of weight loss can open up the throat and improve sleep apnea symptoms.
* Quit smoking. Smoking is believed to contribute to sleep apnea by increasing inflammation and fluid retention in your throat and upper airway.
* Avoid alcohol, sleeping pills, and sedatives, especially before bedtime, because they relax the muscles in the throat and interfere with breathing.
* Avoid caffeine and heavy meals within two hours of going to bed.
* Maintain regular sleep hours. Sticking to a steady sleep schedule will help you relax and sleep better. Apnea episodes decrease when you get plenty of sleep.

MEDICAL TREATMENT OPTIONS FOR SLEEP APNEA


If your sleep apnea is moderate to severe, or you’ve tried self-help strategies and lifestyle changes without success, it’s important to see a sleep doctor. A sleep specialist can evaluate your symptoms and help you find an effective treatment.
Treatments for central and complex sleep apnea usually include:

* Treating the underlying medical condition causing the apnea, such as a heart or neuromuscular disorder.
* Using supplemental oxygen while you sleep.
* Breathing devices that are also used to manage obstructive sleep apnea.
Medications are only available to treat the sleepiness associated with sleep apnea, not the apnea itself, so should only be used in conjunction with other proven sleep apnea treatments.

CPAP for sleep apnea

Continuous Positive Airflow Pressure, or CPAP for short, is the most common treatment for moderate to severe obstructive sleep apnea. In many cases, you’ll experience immediate symptom relief and a huge boost in your mental and physical energy. The CPAP device is a mask-like machine that provides a constant stream of air which keeps your breathing passages open while you sleep. Most CPAP devices are the size of a tissue box.

If you’ve given up on sleep apnea machines in the past because of discomfort, you owe it to yourself to give them a second look. CPAP technology is constantly being updated and improved. The new CPAP devices are lighter, quieter, and more comfortable, so make sure your sleep apnea device is up to date.


Other breathing devices for sleep apnea

In addition to CPAP, there are other adjustable airway pressure devices that a sleep specialist may recommend:

* Bilevel positive airway pressure (BPAP) devices can be used for those who are unable to adapt to using CPAP, or for central sleep apnea sufferers who need assistance for a weak breathing pattern. This device automatically adjusts the pressure while you're sleeping, providing more pressure when you inhale, less when you exhale. Some BPAP devices will also automatically deliver a breath if it detects you haven't taken one for a certain number of seconds.
* Adaptive servo-ventilation (ASV) can be used for treating central sleep apnea as well as obstructive sleep apnea. The device stores information about your normal breathing pattern and automatically uses airflow pressure to prevent pauses in your breathing while you’re asleep.

DENTAL DEVICES AND SURGERY FOR SLEEP APNEA

If you’ve tried CPAP and self-help tips and your sleep apnea persists, you may benefit from a dental device or surgical treatment.

Dental devices for sleep apnea

Two common oral devices are the mandibular repositioning device and the tongue retaining device. These devices open your airway by bringing your lower jaw or your tongue forward during sleep. Dental devices are only effective for mild to moderate sleep apnea.

Surgery as treatment for sleep apnea

If you have exhausted other apnea treatment options, you may want to discuss surgical options with your doctor or sleep specialist. Surgery can increase the size of your airway, thus reducing your episodes of sleep apnea.

The surgeon may remove tonsils, adenoids, or excess tissue at the back of the throat or inside the nose. Or, the surgeon may reconstruct the jaw to enlarge the upper airway. Surgery carries risks of complications and infections, and in some rare cases, symptoms can become worse after surgery.