Diabetic Living 2014-09-10 India

India’s ﬁrst and only magazine about diabetes diabeticlivingonline.in ` 100 SEPT-OCT 2014 Foodfor diabetics understanding DENTAL HEALTH Fitness Apps v...

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India’s ﬁrst and only magazine about diabetes SEPT-OCT 2014

diabeticlivingonline.in

` 100

Indulge! CARB-SMART

sweets

understanding

DENTAL

HEALTH

Seafood &

PASTA Food you will love

Fitness

Apps vs Instructors A whole new way to

lose weight

Food for diabetics

contents cover story 12 Listen to your heart Do what it takes to keep your heart healthy and beware of the dangers

related ailments 14 Bitter sweet foe - Diabetes Understanding the diabetes scene and ways to combat the same

Photo by: Aditya Singh Food Courtesy: Lodi-The Garden Restaurant, Delhi

VOLUME-4 | ISSUE-5 | SEPT-OCT 2014

in every issue

3 4 5 6 8 10 82

Welcome Editorial Advisory Board Editorial Advisory Board Letters To The Editor Ask Our Expert Juvenile Diabetes Health Tarot

DiabeticLivingOnline.in

1

contents

VOLUME-4 | ISSUE-5 | SEPT.-OCT 2014

related ailments

medication

food

18 Lifestyle matters

40 How homeopathy helps

56 Food for diabetics

What are lifestyle diseases? How to prevent and reverse the same

22 Lifestyle ailment in women How to tackle Polycystic Ovarian Syndrome by way of homeopathy

26 Oh! Ah! Ouch! Getting rid of the cramps and those ‘ouch’ moments in pregnancy

29 See why eye care matters Proper eye care is imminent. A World Sight Day (Oct. 12 ) Special

32 Gift of sight Donating an eye can be the biggest gift one can give. Let us be the one.

34 The Cancer Connection Diabetes may lead to certain cancers. Learn to protect your health

38 Now hear this Hearing loss can be a complication of uncontrolled diabetes

Keep a check on diabetes mellitus with homeopathy

42 Diabetes-what’s on the horizon Innovations that show great promise for the future

nutrition 44 Nutrients around you Tips on using Aloe Vera and Flax Seeds on a regular basis

49 Watermelon for diabetics Turn this watery fruit into sumptuos delights this season

52 Eat right, eat moderate For optimum fertility add things that are healthier for mother and baby

ﬁtness 54 Fitness apps vs. instructors Which one works for you.

Choose the right food combination

special Feature 70 A bony issue World Osteoporosis Day (October 20) Special

recipes 84 Foodies’ day out Pasta, seafood, non-vegetarian delights, festive desserts and more

ROLL, PLEASE!

Come September, we in India get into a festive mood with festivals galore. The month of September-October is a special issue on the health front too, given that these two months encapsulate numerous health special days, the important ones being World Heart Day on September 28, World Sight Day (October 12), World Stroke day (October 29), World Osteoporosis Day (October 20) and World Sight Day (October 12). With Eye Donation Fortnight falling between August 25 to September 8, we emphasise on the signiﬁcance of taking care of your eye and most importantly donate. Donating your eyes can be the most precious gift you can give to someone in need. In the Related ailments section, we talk of issues related to osteoporosis, the dental health, leg cramps during pregnancy, and in fact guide you on eating the right food while you are pregnant. Our Medication section tells you how homeopathy can be of help to diabetics and how innovations in insulin delivery and glucose monitoring system shows promise going ahead. In our Nutrition section, we give you watermelon recipes. You must be wondering if one can actually make dishes out of this watery fruit. The Fitness section gives you a choice between ﬁtness instructors and ﬁtness apps. Let’s see what your cards have in store for you health-wise this festive season in the tarot section. Our Food section takes you through pasta and risotto recipes; seafood and other non-vegetarian specialities; desserts for the festive season and more. We have sugar free mithais for you to try this festive season. Write to me at pallavis@ maxposure.in. Stay healthy, stay happy. Cheers!

Pallavi Singh

INDIA

let the drums

INDIA EDITION

Publisher & COO CEO & Managing Director Executive Editor

VIKAS JOHARI PRAKASH JOHARI PALLAVI SINGH

MEREDITH CORPORATION Chairman and CEO Vice Chairman Editor International Director

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THE BEST LETTER TO THE EDITOR for Diabetic Living India Magazine will win a gift hamper from Best Foods

Editorial advisory board The following health care professionals—all experts in diabetes management— review articles that appear in Diabetic Living ® magazine: Connie Crawley is a nutrition and health specialist for the University of Georgia Cooperative Extension Service in Athens, specialising in diabetes and weight loss. Connie is a member of the American Dietetic Association Diabetes Care and Education practice group.

Marion J. Franz has authored more than 200 publications on diabetes, nutrition, and exercise, including core-curriculum materials for diabetes educators. Marion is a member of the American Dietetic Association Diabetes Care and Education practice group.

Joanne Gallivan is executive director of the National Diabetes Education Program at the National Institutes of Health. Joanne is a member of the American Dietetic Association Diabetes Care and Education practice group.

Marty Irons practises at a community pharmacy and also served in industry and the military. Jeannette Jordan works for the Medical University of South Carolina in Charleston and consults with the Centers for Disease Control and Prevention.

Irene B. Lewis-McCormick is a ﬁtness presenter and educator. Certiﬁed by the nation’s leading ﬁtness organisations, she is a faculty member of the American Council on Exercise.

Chris Smith, The Diabetic Chef ® is the president of Health Range, Inc., and a professionally trained chef. He is a food consultant and cookbook author and conducts healthy-cooking classes.

Hope S. Warshaw is a writer specialising in diabetes care. She has authored several American Diabetes Association books. Hope is a member of the American Dietetic Association Diabetes Care and Education practice group.

Fred Williams practises endocrinology and specialises in diabetes. He is an active member of the American Association of Clinical Endocrinologists and serves on the board of directors.

John Zrebiec is director of Behavioural Health Services at the Joslin Diabetes Center in Boston and a lecturer in the department of psychiatry at Harvard Medical School.

INDIA

Editorial advisory board, India The following health care professionals—all experts in diabetes management—review articles that appear in Diabetic Living ® magazine’s India edition:

Decorated with the Padma Shri and BC Roy award, Dr. Anoop Misra is Chairman, Fortis-CDOC Center of Excellence for Diabetes, Obesity, Metabolic Diseases, and Endocrinology, in New Delhi. He is also Chairman of the National Diabetes, Obesity and Cholesterol Foundation (N-DOC) and Director of the Diabetes and Metabolic Diseases, Diabetes Foundation of India. Dr. Misra has led several pioneering research studies on diabetes and published more than 300 research papers. Dr. Ambrish Mithal, Doctor of the year DMA 2005, cited in Limca book of records since 2005, is presently the Chairman and Head of Endocrinology and Diabetes division at Medanta, the Medicity, Gurgaon. Dr Mithal is immediate Past President, Endocrine Society of India DQGFKDLUVWKH1XWULWLRQ:RUNLQJ*URXSRIWKH&RPPLWWHHRI6FLHQWLÓF$GYLVRUVRIWKH,2) Switzerland. Dr. V. Mohan is Chairman and Chief Diabetologist of Dr. Mohan’s Diabetes Specialities Centre and President & Director of Madras Diabetes Research Foundation, Chennai. He has published over 600 papers in prestigious peer reviewed journals and contributed over 100 chapters to text-books on diabetes. He has received the prestigious Dr. B.C. Roy National Award, and Fellowships from all the four Royal College of Physicians of London, Edinburgh, Glasgow and Ireland. Dr. Shashank R Joshi is a well-known endocrinologist in Mumbai. He is president of the All India Association of Advancement for Research in Obesity and vice president of the Association of Physicians of India. Padma Shri and BC Roy awardee Dr. KK Aggarwal is an eminent name in cardiology. President of the Heart Care Foundation of India and editor-in-chief of the Indian Journal of Clinical Practice, Dr. Aggarwal has a keen interest in mind-body healing. He is a regular columnist and expert for both print and television networks. Rekha Sharma is director of Clinical Nutrition and Dietetics at the Diabetes Foundation of India. This former chief dietician of the All India Institute of Medical Sciences in New Delhi has devoted several years of her life to the study of diabetes management. Madhuri RuiaLVDQXWULWLRQLVWDQGÓWQHVVH[SHUWLQ0XPEDL$FHUWLÓHGSLODWHVH[SHUWIURPWKH Pilates Institute of UK, she runs Integym, a state-of-the-art centre that promises ‘intelligent ÓWQHVVÏWRLWVFOLHQWV Dr. DS Chadha is head of cardiology at the Command Hospital in Bengaluru. He has won dozens of awards, written several research papers in leading medical journals and chaired several national and international conferences on health issues. Working Committee Dr. Swati Bhardwaj is vice head at the Center for Nutrition and Metabolic Research and a nutritionist with the Diabetes Foundation (India) and National Diabetes Obesity and Cholesterol Foundation (N-DOC). Shubhda BhanotLVDFHUWLÓHGGLDEHWHVHGXFDWRUDQGDQXWULWLRQLVWZLWK\HDUVRIH[SHULHQFHLQWKH ÓHOG$OLIHWLPHPHPEHURI$'($VVRFLDWLRQRI'LDEHWHV(GXFDWRUV VKHLVSUHVHQWO\ZRUNLQJDV chief diabetes educator at Medanta, The Medicity, Gurgaon.

Readers’ Write

Mexican spread

Your Mexican taqueria from nachos, to tacos to margaritas won my heart. I simply love Mexican food. I suggest it would be great if you could carry a section of caribbean dishes. Since I am a diabetic I often make dishes suggested by you. I know it is safe. Sameer, type1, Delhi

Specially yours The July-August issue being Doctor’s Day special proved to be a useful read. Articles carrying stories on experts are always a pleasure to read. I liked the good fats vs bad fats story. And, pool workouts proved useful too. Yoga story with pictures was an additional delight. Shalini L, type2, Delhi

Feeding a baby I am currently expecting my baby and to read from Shubhda Bhanot, a well-known nutritionist, on how and why Breastfeeding is a blissful experience, can be indeed enlightening. She highlights the beneﬁts and addresses the concerns for a mother. Ajitha, type1, Mumbai

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A S K

Y O U R

E X P E R T

Dr. C.S Dwarakanath MBBS, MD, DM (Endocrinology) specialises in Endocrinology, Diabetes and Diabetic foot. He has worked in many reputed hospitals of Bangalore and has over the years gained fame in this ﬁeld; is currently associated with Apollo Sugar at Bangalore. He is adept in Endocrinology and treats diabetes and related ailments.

QA +

Q1

Should I check my blood glucose at home? How often should I check them? Ans. If you are a person who is on tablets and has well controlled the condition, your testing need not be frequent. It could be once a week – both pre-meal and post-meal. If you are on insulin and/or not well controlled, then you should check them more frequently as advised by the doctor so that the changes which occur due to the changes in treatment could be monitored.

Q + A

Q2

What are the warning signs or symptoms that my blood sugars are too low?

Q3

What are my goals regarding blood glucose levels? Ans. Present thinking is the goals should be individualised. The goals to be achieved depend on the patient’s situation- age, education, motivation, economic situation and many other factors. Usually in a normal person who can attend to themself and have access to good medical carea) Pre-meal blood glucose should be 110 – 120 mg/dl b) Post-meal blood glucose should be 160- 180mg/dl c) Glycosylated haemoglobin should be about 6.5 – 7.0%

Q4

What are the warning signs or symptoms that my blood sugars are too high? Ans. High blood glucose levels could be asymptomatic. Only testing blood glucose levels indicate the actual situation. Presence of weakness, tiredness, excess urination, and excess thirst can suggest that the blood glucose levels are high.

Q5

How can I make my lifestyle and diet healthy? Ans. Diabetes mellitus is predominantly a lifestyle disorder. Hence, lifestyle measures go a long way in management of Diabetes mellitus. a) Reducing body weight by proper diet and exercise. b) Increasing the ﬁbre content in the diet by increasing fruits and vegetables, c) reducing dietary saturated fat, and d) reducing stress are all important measures.

Our experts will be happy to help you. Send us your queries at [email protected]

Ans. Generally low blood glucose causes symptoms. Usually patients will have excessive hunger, tremors, tremulousness, anxiety, excessive sweating, heart pounding and blurring of vision. These are typical symptoms. These symptoms may be different in different patients. In patients with long standing diabetes patients may not have symptoms at all. He may suddenly become unconscious or have convulsions – hypoglycaemia unawareness. Any symptom which occurs suddenly in a patient with Diabetes mellitus should be considered as low blood glucose and measures should be taken like taking direct sugars. If symptoms do not subside then other things should be considered. When hypoglycaemia is suspected, patient should take direct sugars in any form so that his blood glucose raises – sugar, glucose, jaggery, honey, sugar candy, etc. This should give immediate relief of symptoms. If relief of symptoms are partial after 2 to 3 mts, then one more spoon can be taken which will give complete relief. This should be followed by taking some food. Later patient should contact his health provider or think as to why the hypoglycaemia occurred. It could be missing meal, delayed meal, excessive dose of medications or more exertion than usual. Corrective measures should be taken later.

J U V E N I L E

Dr. Krishan Chugh Director and HOD, Paediatrics & Paediatric Intensive Care Unit, (PICU) FMRI

QA +

10 Diabetic Living SEPT-OCT 2014

D I A B E T E S

tender years our expert answers all queries regarding your little one’s wellbeing

Q + A

Q1

How can we help our child manage his/her diabetes?

Ans: Diabetes is a metabolic problem in which the body is unable to handle the carbohydrate or sugar metabolism correctly. Normally, when we eat, our sugar is immediately metabolised so that the blood sugar levels do not rise above a particular range. Similarly, when we are fasting or have infrequent meals, the body’s need for carbohydrates is fulﬁlled by breaking down the reserves. Again, the sugar is maintained in the normal range and is not allowed to fall below a critical level. This is normal metabolism of sugar. Insulin is the hormone which handles all this like a traffic policeman regulating a busy crossroad and maintaining a ﬂow of traffic. In diabetes, what happens is, due to lack of insulin or an ineffective insulin, the sugar metabolism goes haywire, on eating the sugar levels shoot up. Once you understand this basic problem, you can now understand the following simple rules for, maintaining your child’s diabetes. 1. Regular, frequent meals as advised 2. No unplanned meals 3. Regular medication, without any postponements or misses 4. Exercise in moderation as per advice 5. During infections, you must consult your doctor 6. Monitoring your child’s blood and urine sugar levels, and maintaining a chart 7. Writing down all your queries, howsoever trivial, when you go to your doctor 8. Control over sugar intake as per your doctor’s and dietician’s advice 9. Monitoring your child’s weight and watching out for weight loss 10. Lastly, watching out for critical signs of deterioration like lethargy, altered sensorium, excessive sleepiness, etc.

Q3) How can we work together as a family to help our child?

Ans: As a family, it is your responsibility ﬁrst of all to practice good eating habits like - avoiding irregular meals, avoiding junk food, restricting your sweet intake (you can’t eat a

piece of cake in front of the child and expect him to understand that he can’t have it). You should have a positive, happy atmosphere at home so that your child does not feel isolated and depressed. At the same time, you have to gently counsel your child about the problem and

educate yourself and everyone around you about how to take care of children with diabetes and related complications how as a team you would face it all together. Encourage him to lead a perfectly normal but disciplined life.

Q2) Who should be part of my child’s healthcare team?

Ans: Ideally, you should have a doctor who is close by, who can look after your child in case of emergencies and minor health related problems. In addition, you should be under a planned, regular follow-up of a Paediatric Endocrinologist.

Q4) What emotional issues might our child and family face? Ans: Rather than talk about depression, isolation and negativity, I would like to say, that handle it in a mature way, follow instructions, and use the opportunity to come close emotionally to your child and to other members of the family as well as inculcate positivity and hope in your child. Remember, you are your child’s world. He will be happy if you are happy, and will be devastated in case you start having a problem in emotionally handling the issue. You owe it to your child.

DiabeticLivingOnline.in

11

COVER STORY Heart

BY

Dr. Manoj Khanna

listen to

Taking exercise, eating a healthy diet, and being aware of dangers like high blood pressure, and stress are all important for your long-term heart health

your

heart A

lthough mortality rates have decreased over the past 40 years, heart disease is still one of the leading causes of death for men and women. You can reduce your risk of developing heart disease by understanding the risk factors that cause it, and by making the necessary changes to your lifestyle. Factors that increase the risk of CV diseases include family history and age, being a smoker, lack of exercise, unhealthy eating, being overweight, high cholesterol, high blood pressure, stress. Millions of people around the world undergo liposuction every year, making it the number one cosmetic surgery in the world. The people, who have liposuction, are well aware that removing excess fat makes them look better, but the beneﬁts go far beyond looks. Liposuction can actually be healthy for your body helping you eliminate unhealthy fat that can lead to heart

12 Diabetic Living SEPT-OCT 2014

diseases. The body has two types of fat, visceral, which surrounds the internal organs and subcutaneous, fat that sits just below the skin. Both of these types of fat contribute to triglyceride levels in the body, which can clog the arteries. Even though liposuction can only target subcutaneous fat, any elimination of adipose cells can signiﬁcantly reduce the potential health risks. It is recommended that people should work on reducing their level of visceral fat possible through a healthy lifestyle. Patients should not look to liposuction alone as a tool for weight loss or a healthier heart, but instead should view the procedure as a way to reﬁne their ﬁgure and correct ﬂaws after they have reached a healthy weight.

Liposuction Liposuction should not be viewed as quick ﬁx to a weight problem as obese patients are not ideal

candidates for liposuction. Many plastic surgeons won’t remove more than a few to several pounds of fat in a single liposuction procedure so they will recommend that patients who are signiﬁcantly overweight, lose the excess pounds before considering the procedure. Instead of being a weight loss tool, liposuction should be viewed as a tool to contour the body. A skilled plastic surgeon can strategically target areas which tend to hold onto fat even if a person has reached their ideal weight. The stomach, buttocks and thighs tend to hold onto fat and for some diet and exercise alone will not eliminate the unsightly fat. Liposuction has long been considered a purely cosmetic procedure but the study has found that white blood cell counts decrease, on average, 11 percent after liposuction. High white blood cell counts are associated with a

Over 70% of the

urban Indian population is at the risk of being diagnosed with CVD raised level of inﬂammation within the body and have been linked to coronary heart disease, obesity and hypertension. This suggests that liposuction may translate into a procedure that has the ability to reduce a patient’s health risk. World Heart Day is the largest global awareness and advocacy campaign on heart disease and stroke, reaching almost 2 billion people in over 120 countries through organised events and media outreach. Now in its 15th year, World Heart Day provides a unique opportunity to position cardiovascular disease (CVD) at the heart of global priorities – in health and beyond. The objective of World Heart Day 2014 is to empower individuals and communities to call for environments that enable them to make positive choices for their heart health. This launch of a global movement will harness the power of individuals to protect not only their own heart health, but to instigate change at a community and societal level as well. Together, this collective action can contribute towards the goal of at least 25% reduction in premature mortality due to CVD by 2025. Learn more about World Heart Day on worldheartday.org.

SOME RISK FACTORS for heart disease are beyond your control, such as: Family history – Your risk is higher if any immediate family members (parents, brothers and sisters, etc.) have had a heart attack or if they have high cholesterol or high blood pressure. Age – Your risk of developing heart disease increases with age. This applies especially to men over the age of 45 and women who have gone through menopause or are above 55 years of age. However, many of the risk factors for heart disease are within your control: Smoking – Smoking raises risks by increasing blood pressure and contributing to the development of blocked arteries. Lack of exercise – People who do not exercise regularly are at a greater risk of having heart disease. Unhealthy eating – Risks are greater for those who do not eat fruits and vegetables. Eating foods that contain trans fat, high amounts of saturated fats can increase your risk of heart disease.

Eating too much sodium – While the body needs some sodium to function, too much may lead to high blood pressure, a major risk factor for stroke, heart disease and kidney disease. Most people consume more sodium than may be good for their health. Being overweight – Being overweight or obese increases your risk of developing a wide range of serious diseases and conditions including heart disease and high blood pressure High cholesterol – Cholesterol is one of the fats in your blood, and having too much of the so-called bad cholesterol (LDL cholesterol) can lead to blockage of the arteries. This, in turn, raises the risk of heart disease. High blood pressure – Over time, blood pressure causes the heart to weaken. It is also a major risk factor for stroke, particularly when blood pressure is very high. Stress – High levels of stress or prolonged stress may result in high cholesterol, increased blood pressure or disturbances in heart rhythm, and these conditions increase the risk of developing heart disease.

This World Heart Day (Sep. 29, 2014) the focus will be centred on heart-healthy environments, enabling individuals to address CVD risk factors such as hypertension, tobacco, physical inactivity, unhealthy diet and other modiﬁable CVD risk factors.

DiabeticLivingOnline.in

13

RELATED AILMENTS

Diabetes

BY

Amol Naikawadi

the bitter sweet foe

DIABETES

When WHO gives a ﬁgure of diabetics standing at 180 million and that the same is expected to be more than double by 2030, it can be a cause of worry. Let’s understand the situation, and combat the condition with preventive measures

14 Diabetic Living SEPT-OCT 2014

D

iabetes mellitus needs no introduction, commonly known as diabetes it can strike any one from any walk of life. Worldwide, it afflicts 180 million people and the World Health Organisation estimates that by 2030, number of people living with diabetes will be more than double. So what is diabetes? In simple terms it is the inability of your body to produce insulin. Pancreas makes insulin to help glucose get into the cells of our bodies. When you have diabetes, your body does not make enough insulin or is unable to use insulin properly. This causes sugar to build up in your blood. There are three types of diabetes (Type 1, Type 2 and Gestational Diabetes) of which over 90% of the population suffers from Type 2 diabetes.

heal well) which leads to amputation of body parts and kidney failure. While it is silently raking up numbers common populace largely remains unaware of its potential threat.

Do you have diabetes?

1

Frequent urination, unusual thirst, extreme hunger and unusual weight loss, extreme fatigues are common symptoms of diabetes. Irritability, frequent infections, blurred vision, cuts and bruises that seem slow to heal, tingling or numbness in your hands or feet, recurring infection of the skin, gums or bladder also indicates presence of diabetes, however a blood sugar test should provide you with precise information about the same.

How Bad? This condition is the harbinger of much more fatal inﬁrmity like cardio vascular disorder, increased risk of stroke, blindness, gangrene (resulting from wounds that don’t

Combating Diabetes While diabetes remains an incurable ailment, it is still preventable by inculcating the habit of a healthy diet, timely check up and adequate exercise. Its long known and understood that prevention is better than spending time, energy and money on cure. To reduce your chances of diabetes you need to adopt preventive measures and with certain precautions one can control their blood glucose level and lead a healthy life.

Preventive Measures GET TESTED - Get regular checkup done, which includes blood sugar level, Lipid proﬁle and blood pressure. It is important to monitor these as it may point out to presence or inclination to diabetes.

2

MAINTAIN A HEALTHY WEIGHT - Excessive body fat is an incitement to an array of diseases which includes diabetes; maintain a healthy weight, according to your body mass index.

3

EAT SMART - You don’t have to give up your favourite food. Cut down on portion size and eat slowly. It takes 20 minutes for your stomach to send a signal to your brain that you’re full.

Irritability, frequent infections, blurred vision, cuts and bruises that seem slow to heal, tingling or numbness indicates

diabetes

DiabeticLivingOnline.in

15

Cholesterol laden food must be replaced with healthier options. So the next time cravings hit, swap those munchies and junk food with nuts and fruits

You don’t have to give up your favourite food. Cut down on portion size and eat slowly. It takes 20 minutes for your stomach to give a signal to your brain that you are full

4

DON’T IGNORE THAT SWEET TOOTH - Preventing diabetes does not mean saying no to sweets, you can still consume sweets in moderation, if possible in natural state than processed. Instead of eating a sweet dish by itself, you can also make it a part of your meal.

5

PEACE OUT - Stress is not just a state of mind, it has physiological effects too. Stress increases your susceptibility to lifestyle diseases, diabetes being one of them. Learn to relax, listen to calming music, read, do yoga or any other activity that relieves your mind of its burden is good.

6

ENSURE REGULAR PHYSICAL ACTIVITY - Exercise at least 30 minutes every day. If you are too pressed for time try squeezing it, into your daily activity - take the stairs, walk short distances or cycle. Find activities that you enjoy, try to include your family and friends make it fun not tedious.

16 Diabetic Living SEPT-OCT 2014

7

SWAP THE MUNCHIESCholesterol laden food must be replaced with healthier options. So next time cravings hit, swap those munchies and junk food with nuts and fruits.

8

SAY NO TO ADDICTIONS Too much alcohol can lead to weight gain and may increase your blood pressure and triglyceride levels and smokers are twice prone to diabetes as non-smokers, release yourself from these addictions.

9

MORE BROWN LESS WHITE Include brown rice, and whole grains in your diet; avoid white rice, pasta and potatoes.

10

GREENS AND BEANS Include fresh vegetables and beans in your diet; nothing puriﬁes system like natural food. Healthy food need not be boring. If you don’t like raw vegetables, try wholesome salads.

Amol Naikawadi is a Preventive Healthcare Expert and Director Indus Health Plus.

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RELATED AILMENTS

lifestyle

BY

Dr. Rakesh Tandon

lifestyle matters Let us understand what we mean by lifestyle diseases, and how to prevent and reverse the same by adopting a healthy lifestyle, which includes a balanced diet, regular physical activity and avoidance of excessive alcohol consumption, smoking and drug addiction

D

iseases attributed to unhealthy day-to-day living habits are referred to as ‘Lifestyle Diseases’. It includes obesity, diabetes, hypertension, heart diseases, chronic liver disease/cirrhosis, constipation, gassy abdomen and cancers. They have become a major health hazard in upcoming economies such as India and China. Of them, obesity, diabetes, hypertension and hyperlipidemia are of major concern and cause of death. They are attributed to increased

insulin resistance and are grouped as metabolic syndrome. It is the outcome of increasing affluence and adoption of sedentary lifestyle and is being seen increasingly among Indians and other South Asians. Peoples’ diet have changed substantially in the second half of the twentieth century with increase in consumption of dairy products, meat, vegetable oils, fruit juice, and alcoholic beverages, and decrease in consumption of starchy staple

foods such as bread, potatoes, rice, maize ﬂour and vegetables, salad and fruits. Other aspects of lifestyle have also changed, notably, large reductions in physical activity and prevalence of obesity. The western lifestyle, characterised by fast food, watching TV and playing video games is taking its toll on children as well as adults, and is producing increased numbers of overweight, passive youngsters with lifestyle diseases.

Fig. Multiple complications of Obesity (source: Health Website)

DIABETES CAPITAL

OF THE WORLD

According to the World Health Statistics report 2012, 11.1 percent of the adult male population and 10.8 percent of the female population have raised fasting blood glucose. India and other Asian countries predominate among them as shown in the table below. Table: Percentage of people with raised fasting blood glucose in South Asian countries (World Health Statistics 2012).

India

Bangladesh

Sri Lanka

Nepal

Pakistan

Men

11.1

9.2

9.3

9.8

11.7

women

10.8

9.9

8.6

9.3

14.1

18 Diabetic Living SEPT-OCT 2014

Obesity on the rise According to the National Family Health Survey (NFHS-3) (2005-06), 13 percent of women and nine percent of men in India are overweight or obese. Presence of obesity increases greatly the chance of occurrence of other lifestyle diseases in the same person and they all work together to shorten the lifespan of the affected person. Additionally, obesity itself is associated with a huge number of complications and they could be the cause of early mortality Results of a recent study, published online in the American Journal of Public Health, indicated that previous researches had underestimated the number of deaths caused by obesity in the US each year. This study included men and women between the ages of 40 to 85 over a 20-year period and discovered that obesity was likely responsible for about 18% of deaths during that time, one out of ﬁve Americans – an appalling ﬁgure. India has achieved the dubious distinction of being called the World Diabetes Centre. Globally, diabetes caused 4.6 million deaths in 2011. Diabetics and obese people are more prone to develop chronic liver disease which ultimately results in untimely and early death.

In case of diabetes and heart diseases, drug therapy plays a dominant role; in obesity and fatty liver disease, diet and physical exercises are most important

Heart disease–a major killer It is estimated that about 166 per 100,000 people in India die due to ischemic heart disease (a condition which is characterised by reduced blood supply of the heart muscle) and around 116 per 100, 000 people in India die due to cerebrovascular diseases. Around 74 percent of urban Indians face the risk of heart attack, with their heart age greater than biological age. Fifty nine percent of those in the 3049 age group have high risk levels of cholesterol and 61 percent of them have dangerously low levels of ‘good’ HDL cholesterol. Uncontrolled hypertension, smoking, excessive drinking and

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19

sedentary lifestyles are other contributing factors for increased number of heart diseases. There is a misconception among young generation that smoking acts as a stress buster. It actually reduces a person’s stamina in the long run leading to the development of multiple diseases, particularly chronic lung disease, heart disease and cancer.

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Non-alcoholic liver disease The liver cells get clogged up with excess fat (triglycerides) as a byproduct of increased insulin resistance. Over time that causes inﬂammation of the liver cells which leads to cirrhosis of the liver and in a small percentage of cases even to liver cancer, analogous to what happens in alcohol-induced fatty liver disease. This has indeed become the number one cause of chronic liver disease in the industrialised world. In India, the prevalence of NAFLD in the general population varies from 10% to 30%. In people with metabolic syndrome, however, the prevalence is much higher; 15-80% among obese people, 25-60% in patients with dyslipidemia and 33-55% in prediabetics and diabetics. The underlying factors are believed to be the same as for other lifestyle diseases i.e., excess calorie intake and lack of physical exercise and the only effective treatment is reversing these factors. In addition, of course supportive treatment is required for the complications of liver disease.

Other lifestyle diseases Stress plays a big role in causing acidity. A job that keeps you on tenterhooks or a gnawing problem at home can cause acidity. Children trying to enter into competitive sports may become stressed to perform

well constantly. A recurring acidity problem, despite acid suppressants, may lead to vitamin deﬁciencies and cancer of the esophagus. Spending time excessively in front of computer may lead to neck and back pain. People working in night shifts suffer from a disturbed biological clock leading to insomnia, indigestion, acidity, loss of appetite, headache, irritability, hypertension, mood ﬂuctuations and body pain. Those having late night parties also experience the same with some additional effects of untimely munching, drinking and smoking. Alteration in the circadian rhythm of a person compromises his immunity, further leading to various opportunistic diseases. It is important that parents watch out for signs of psychological strain, as well as physical fatigue from overtraining in their children. Young athletes may also have speciﬁc nutritional needs that require extra attention. Often they are misled by trainers to take excessive amounts of protein that may compromise the functioning of liver and kidneys.

It is important that parents watch out for signs of psychological strain, as well as physical fatigue from overtraining in their children. Young athletes may also have speciﬁc nutritional needs that require extra attention.

20 Diabetic Living SEPT-OCT 2014

Treatment The onset of these lifestyle diseases is insidious; they take years to develop and, once established, do not lend themselves easily to cure. Thus, they require regimented and individualised treatment comprising a combination of drugs, diet and physiotherapy. Importance of each of these components of treatment differs from disease to disease.

Prevention: Most of the lifestyle diseases are preventable and reversible to a large extent with adoption of a healthy lifestyle including a balanced diet, regular physical activity and avoidance of excessive alcohol consumption, smoking and drug addictions. Some sort of physical activity every day for at least 10-15 minutes is extremely necessary to keep healthy. Healthy lifestyle is best inculcated early in childhood at home. Habits formed at that stage stay forever. Parents should be aware and should be responsible to guide their children to eat the right kind of food and engage them in physical activities. In particular, emphasis should be laid on engaging kids in outdoor activities. Fun exercises should be encouraged into family outings. A pizza-and-video evening should be replaced for a hike and picnic.

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RELATED AILMENTS

PCOS

Dr. Bhawisha Joshi Dr. Shachindra Joshi

BY BY

lifestyle

ailment in

women! Polycystic ovary syndrome, a condition in which a woman has an imbalance of her female hormones, can in a way be tackled with the help of homeopathy way of medication

I

n today’s world looking and feeling good is so important. Our appearance makes a huge difference in boosting our morale and conﬁdence. An urban lifestyle is very demanding; women are excelling in all ﬁelds at home and at work. However, what we see as clinicians and doctors is that the number of women coming with skin complaints of acne (pimples), dark patches on their skin around the neck, armpits, groin and hair fall is on the rise. Most women see this as a local skin complaint and think a quick ﬁx will solve it so that they can carry on with their busy lives. A further enquiry reveals a much serious problem in the making. The skin symptoms are just the outwardly superﬁcial symptoms of a much deeper disorder. We ﬁnd most of the women with the above mentioned skin complaints have menstrual irregularities. They suffer from delayed menses, irregular or scanty menstrual cycles. In case of young girls we see that they fail to get

22 Diabetic Living SEPT-OCT 2014

menses after one or two normal cycles after puberty. Not only this, the incidences of women who have complaints of unpredictable menstrual ﬂow, some days heavy and sometimes light has increased tremendously. A little push in trying to understand their state of mind reveals that most of them are depressed and stressed out.

These are indications that something’s not right with your reproductive organs. AN ULTRASOUND REVEALS CYSTS (SWELLINGS) IN THE OVARIES.

This condition is called polycystic ovarian syndrome, PCOS.

What is PCOS Polycystic ovary syndrome is a condition in which a woman has an imbalance of her female hormones. This may lead to menstrual cycle changes, cysts on the ovaries, trouble

getting pregnant, and other serious health issues like diabetes and heart disease. It has been seen that between 4 – 18 % of women (between menarche & menopause) suffer from this syndrome. There has been a rise in the number of cases suffering from this condition. Clinicians and experts all over the world are of the opinion that PCOS has strong links with today’s modern day lifestyle. A systemically planned diet which gives your body all the necessary ingredients and nourishments is necessary. What needs to be managed is the amount of saturated fat and reﬁned sugar that is consumed. Having three proper healthy meals, which includes breakfast, lunch and dinner reduces the amount of junk that we eat during snack time. Improve the amount of fresh salad and fruits in your diet. Cut down all reﬁned food especially bakery items and heavy Indian foods too.

The meat eaters should stick to white meat and preferably have it steamed rather than marinated and cooked in lots of oil.

Use of Homeopathy in dealing with PCOS Over the years homeopathy has been able to tackle PCOS successfully. A science that works on the mind and body is ideal in dealing with this condition. Through various cases and investigations it has been demonstrated that homeopathy helps in balancing the hormonal levels. Ultrasound reports taken before and after the treatment have shown the disappearance of the cysts after homeopathic medication.

How does that happen? When our body is stressed it releases lot of hormones, which are necessary to help us out of a stressful situation. But when these hormones are high all the time it gives rise to various pathology, one amongst them is PCOS. Homeopathy tackles stress-related disorders efficiently. Being a personalitybased medicine it understands an individual completely. Along with the physical

WHAT ARE THE FACTORS IN OUR MODERN DAY LIFESTYLE THAT CONTRIBUTE TO THIS AILMENT? Stress, obesity, lack of exercise, and eating a diet high in simple carbohydrates, plus junk and fast foods, all of this encourages insulin resistance (hormone released from pancreas), the female reproductive hormones get affected. All of this can lead to PCOS. These factors are further accentuated by a history of high blood pressure, high cholesterol and a family history of diabetes.

happens in PCOS? 1 What

The female reproductive system’s function is governed by various hormones. Hormones are chemical messengers that trigger many different processes, including growth and energy production. Often, the job of one hormone is to signal the release of another hormone. In PCOS the hormones get out of balance. One hormone change triggers another, which changes another. One of the examples that happen in PCOS is that the sex hormones get out of balance. The female body starts producing higher amount of male hormone as a result they stop

complaints and its symptoms the personality of the individual is studied too. The way she reacts to the world and the way things affect her are taken into account. Once this information is studied the medication is selected. The medication helps the person in a two-fold manner. First, it helps the individual break her stress cycle. Her temperament calms down. This calming helps in reducing

Stress, obesity, lack of exercise and eating a diet high in simple carbohydrates plus junk and fast foods may lead to PCOS

menstruating, grow hair on their face and lead to failure to conceive.

can I get myself tested? 2 How

Clinical examination, blood test and an ultrasound of the abdomen helps in conﬁrming the diagnosis of PCOS.

How does one go about dealing 3 with this ? PCOS is dealt with by collaborative effort between the patient and medication.

4 Exercise & Diet

Regular exercise, healthy foods, and weight control are key treatments for PCOS. Regular exercise and healthy eating can help you lower your blood pressure, cholesterol and weight too. Begin with gradual exercise of walking at least 30 minutes a day and then increase that to one hour a day. If you are moderately obese you have to work out an exercise plan after consulting with your doctor. A strict diet control which does not mean skipping meals!

the amount of stress hormones and the hormonal imbalance in her body. This reﬂects on the reproductive system. Women who have chosen homeopathy for treatment in PCOS have seen positive results in a short period of time. Not only have their menstrual cycles regularised and the cysts vanished but they have also experienced calmness and positivity in their emotional state. Dr. Bhawisha & Dr. Shachindra Joshi are into Holistic healing through homeopathy. They have centres in Mumbai and satellite set ups in New York & London. Visit: drjoshisclinic.com

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23

eat well, live happily

With festivals round the corner, its that time of the year when feasting on goodies is the biggest excitement. But stay happy by eating healthy and leading a balanced lifestyle

Dr.Abdul Hamid

discussed, as well as how often to test your blood sugar and what to do if your blood sugar is too low or too high. Also, keep in mind that fasting itself may not be the only issue to plan. Medication timing is also important.

More ways to protect yourself while fasting:

F

estivals call for both fasting as well feasting. Starting with Ramadan when people fast for a month, Navratras with nine days of fasting.Fasting can be a challenge for anyone, but it can be a bit difficult for someone with diabetes. Whether you have type 1 or type 2 diabetes, fasting needs to be approached with care. “Fasting should be rare if you have diabetes because an individual with Type 1 or Type 2 on oral medication can experience hypoglycemia (low blood sugar),”

24 Diabetic Living SEPT-OCT 2014

says Amy Kranick, a certiﬁed diabetes educator with Diabetes Care Club in Nashville, Tenn. Risks from low blood sugar include seizure, coma, or even death if left untreated. On the other hand, depending on the individual, fasting without using insulin can result in high blood sugars or in diabetic ketoacidosis (a serious diabetes complication caused by blood build-up of acids called ketones). Dehydration is another fear if ﬂuids are avoided during the fast. Medication dosage should be

Ŕ-FBSOUIFBQQSPQSJBUFUSFBUNFOUGPS low or high blood sugar, including use of glucose tablets, glucose gels, or glucagon injections. Ŕ%VSJOHUIFGBTU UFTUZPVSCMPPE glucose levels more frequently. Ŕ8FBSBEJBCFUFTNFEJDBMBMFSU*% bracelet. Ŕ,FFQFNFSHFODZDPOUBDUJOGPSNBUJPO where others can ﬁnd it. Ŕ%POōUEPBOZUIJOHXJUIPVUDPOTVMUJOH your doctor or diabetes educator. Fasting is followed by feasting whether it is after breaking your fast in Ramadan or during Navratras. The food choices with diabetic individuals goes a long way in impacting on their blood sugar levels. Experts warn that festival fun – and not the least, the culture of sweet-eating that peaks then – can help trigger long-term health problems, with diabetes only the start. Diabetics can face problems of hyperglycemia. If you fail to treat the same, a condition called ketoacidosis (diabetic coma) could occur. Here are tips to remain healthy while feasting during festivals.

Smaller portions and reduced fat foods Have smaller portion sizes of sweets and high calorie foods. Also, the pressure to consume more than your normal quantity of food needs to be resisted steadfastly when you eat outside your normal meal times. Use low fat ingredients, natural sweeteners, and avoid using reﬁned sugar or artiﬁcial sweeteners. But even if you use low fat products, do not over-consume.

Avoid aerated drinks Avoid having aerated drinks,sweetened beverages and ﬁzzy drinks, which only add unnecessary calories. Instead, have natural refreshing drinks like lemon juice, jaljeera, coconut water, green tea or fruit juice in small quantities. Drinking plenty of water is necessary.

Avoid skipping meals Do not skip meals to compensate for the extra calories. You always tend to have more cravings and overeat on an empty stomach. Rather, try to nibble on healthy snacks.

Gift healthy Set an example by gifting healthy foods such as baskets of fruit, dried fruit, nuts or candles instead of sweets or chocolates.

Snack healthy Include fresh fruits, yogurt dips with crackers, nuts, raw salads, soups, roasted meats and chicken, soups as part of your snacks and meals instead of fried, oily and high sugar foods and snacks. Do not skip out on sweets completely, but adding fruits and nuts to the plate may help balance the calories. You could also have a light snack before visiting, to avoid consuming high calorie foods there. Individuals with diabetes should also make their input into

meal preparation during the season as always; making sure that healthful food is prepared. This may include the use of sugar substitutes to prepare cakes, biscuits and other pastries, increasing the amount of spices and ﬂavourings like nutmeg, thyme, and curry in foods in other to be able to reduce the quantity of salt to be used. They should also advise that copious amounts of vegetables and moderate portions of fruits be part of the meals.

Limit alcohol intake Avoid consuming too much alcohol at parties. Sip on some fruit juices or water in between drinks or go slow on drinks to avoid reﬁlling. Snack in moderation and snack healthy.

Exercise Most of us tend to skip our daily exercise during festivals to catch up on sleep or go visiting. But exercise is important to burn out the extra calories that have been consumed. Focus on activities rather than on food.

Need for close monitoring There is the need for continued close monitoring of the blood sugar levels with personal glucometers, especially

with increased frequency of food intake. Variety and moderation remains the two key words that individuals with diabetes must keep in mind. Have ﬁbre-rich meals which help to control the blood glucose levels like unpolished rice or whole grain cereals. Eat, drink, be merry and be healthy! Include fresh fruits, yogurt dips, nuts, raw salads, soups, roasted meats and chicken, soups as part of your snacks and meals instead of fried, oily and high sugar foods and snacks. Do not skip sweets, but adding fruits and nuts may help balance the calories. You could also have a light snack before visiting anywhere, to avoid consuming high calorie foods out there. Individuals with

diabetes should also make their input into meal preparation during the season as always; making sure that healthful food is prepared. This may include the use of sugar substitutes to prepare cakes, biscuits and others increasing the amount of spices and ﬂavourings like nutmeg, thyme, and curry in foods in order to reduce the quantity of salt to be used. They should also advise that copious amounts of vegetables and moderate portions of fruits be part of the meals.

Dr.Abdul Hamid,MBBS,MD,FCCP (USA) Clinic: Medicard, New Sayyagi Rao Road, Mysore; Columbia Asia Hospital, Bannimantap, Mysore

DiabeticLivingOnline.in

25

RELATED AILMENTS

pregnancy

BY

Dr. Rita Bakshi

oh! ah! ouch Pregnancy augurs numerous physical sensations, one of them being leg cramps. Our expert tells us how to get rid of the cramps and those ‘ouch’ moments

30 per cent of women experience leg cramps during pregnancy. There’s nothing to worry about these cramps during your third trimester as they are just muscle contractions that you feel in your legs or feet. Many women get it thrice a week.

26 Diabetic Living SEPT-OCT 2014

P

regnancy is the most beautiful phase in a women’s life. When you are pregnant, there are many physical sensations that you go through. Right from feeling the movements of the baby to early morning sickness, there’s lots that you experience. For a long time you may wonder and crib about the sensations, the most common one being leg cramps. Well! lot of women believe that leg cramps during third trimester signify the onset of early labour. However, the fact is that cramps occur because of the sudden increase in your weight, poor blood circulation, high blood pressure, nutrient deﬁciency and many such reasons. You may have experienced this pain just while you fall asleep. Cramps occur mostly at night because fatigue and ﬂuid accumulation is at its peak during night. Keeping your foot ﬂat on the cold ﬂoor may have helped you reduce those cramps temporarily. Here, we tell you simple changes that may help you prevent these painful night cramps that are also known as ‘nocturnal leg cramps’.

DIET Not many would agree but diet is related to nocturnal leg cramps. It partially depends on what you eat and when you eat. Deﬁciency of some important nutrients may aggravate the cramps that you experience during pregnancy. To avoid those cramps, eat a healthy diet that contains magnesium, calcium and vitamin C. Include green leafy vegetables, dates and ﬁgs, dairy products, oranges, potatoes and tomatoes to your diet to avoid leg cramps. There is a very basic step that you have to follow before making any changes to your diet – reduce the amount of salt in your food. Too much salt may increase hoard ﬂuid that leads to swollen ankles. Keep your muscles hydrated as lack of ﬂuids in your body also cause cramps. Drink almost 1.5 litres of water each day.

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DiabeticLivingOnline.in

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EXERCISES Start doing foot exercises. Rotate your ankles while you perform your daily chores such as watching TV or reading a book. Do gentle exercises such as stretching. While doing standing chores, moving from time-to-time may do the job for you. Walking, swimming, yoga may also prove beneﬁcial to avoid those painful cramps. Go out, take a walk in the parks, enjoy the air and give lots of relaxation to your muscles. However, proper rest to your body is equally important. Mostly cramps occur with a sudden pain in your calf muscles. Immediately straighten your legs; gently ﬂex your toes back towards your shin. Massaging your muscles with aromatherapy oils may also ease the spasms, making you feel better. Stretch by standing about two feet away from a wall and putting your palms ﬂat against it. Hold the position for ten seconds and relax. Repeat this exercise for three times in order to avoid the discomfort caused by leg cramps.

Lifestyle There are few lifestyle changes that you need to make to avoid leg cramps. Many women do not know how to sit, sleep and stand while they are pregnant. All these may seem small things but they highly affect the sensations that your get during pregnancy. Standing or sitting with your legs crossed for long may lead to leg cramps. Therefore, make sure you stretch your calves several times a day. Sleeping on your left side improves circulation to and from your legs, leading to fewer cramps during pregnancy. Keep your legs elevated for which you may use a pillow. Never ﬂex with your toes facing downwards while sleeping as this may worsen your cramps. 28 Diabetic Living SEPT-OCT 2014

Before going to bed, take a warm bath in order to relax your muscles. Your footwear may also be a reason for those unnecessary painful cramps. Make sure you wear the right footwear with arch support such as shoes or inserts. Keep your high heels aside until your baby doesn’t enter this world.

Conclusion There are medications to avoid these cramps temporarily. However, it is always recommended to prevent them from occurring at the very ﬁrst place. If even after following these steps you continue to get unbearable leg cramps, then you should consult your practitioner for the same. Having constant leg cramps with swelling, redness and

tenderness in your leg is a bad sign. Leg cramps are not dangerous to health but at the same time they may cause several discomforting moments which you should avoid. Being pregnant is indeed the most powerful creation to have life growing inside you. There is deﬁnitely no bigger gift. Little pain for that gift should not harm you much. Although the cramps are painful, at the same time they are one of those pregnancy sensations that you may never feel in your regular life. Save yourself from those cramps but also enjoy these special moments as they remind you that a life is growing inside you. Dr. Rita Bakshi is a Fertility Expert Gynaecologist & Chairperson, International Fertility Centre, New Delhi

BY

WORLD SIGHT DAY SPECIAL

Dr. Uma Singh

Eye

see why eye care matters

Proper eye care is of utmost importance to avoid infections like conjunctivitis, sties, dry eyes and corneal ulcers that can lead to serious vision problems

I

ndian monsoons extend from the second week of June till the end of September; most parts of India get visited by this rainy season. After days of scorching sun and heat waves of the ‘Summer Season’, the rains bring cool, refreshing relief to everybody – we all enjoy the rains. Yes… the rainy season brings respite from heat and dust; but it also brings along numerous health risks, viral infections emerge abundantly during the rains - one aspect that should be paid attention to is ‘eye care’. Since the moisture and humidity in the air is highest during the rainy season, and everything is constantly damp and cold, exactly the kind of climate parasites love - they thrive in this season! At the same time, the high humidity lowers our immunity

and hence we contract infections easily. Eye problems are very common during the rains. Not preventing or treating such infections could have serious implications. Very often it rains for days together, rain water ﬂows on the roads rendering the roads muddy. Common infections like ﬂu, skin and eye infections are more prevalent during monsoons. Proper eye care is of utmost importance during monsoons to avoid infections like conjunctivitis, sties, dry eyes and corneal ulcers, which can lead to serious vision problems. Elderly and children need special attention

regarding eye care during the monsoons. Maintain good eye health so that you can enjoy the rains without worry. Following are some common eye problems that one must be wary of during monsoons.

Conjunctivitis: Conjunctivitis, commonly known as ‘painful red eye’, ‘pink eye’ or ‘sore eye’, is an inﬂammation of the membrane (conjunctiva) that covers the eye and lines the inner surface of the eyelid. The main cause of conjunctivitis involves the introduction of either bacterial or viral microorganisms into the eye. These may be transmitted to the eye by contaminated hands, towels, cosmetics or extended

DiabeticLivingOnline.in

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wear of contact lenses. Seasonal allergic response to environmental pollutants and rain water can cause some individuals to acquire conjunctivitis. Redness of the eyes, sensitivity to light, feeling as if something is in the eye, itching, swelling of the lids and/or discharge from the eyes are primary symptoms of conjunctivitis and other eye diseases that commonly occur during the rainy season. Impure water is the chief reason of the spread of diseases. Vision may be temporarily affected from the increase in tear production. Most types of conjunctivitis usually take a few days to two weeks to resolve. However, conjunctivitis due to an allergy may continue for longer periods and symptoms are likely to recur each year. Although ‘pink eye’ is usually harmless to your sight and typically doesn’t require extensive or emergency treatment, it can cause corneal complications in both adults and children, making early treatment more important. Along with conjunctivitis, sties, dry eyes and rarely corneal ulcers may manifest during the rainy season.

Dry Eye Problem Dry eyes symptoms such as redness, irritation and itching are common monsoon-related problems, especially after too much reading, long hours at the computer or watching too much television. Such problems are treated with lubricating eye drops. However, it is best to ask a doctor.

Sty A sty is an infection of the glands of the eyelids that causes a painful lump along the eyelid. Sty is a common eye ailment during the monsoons and is usually caused by bacterial infection. It can be cured at home with the help of a little care and medications. A hot compress can provide some relief; however, consult your ophthalmologist for comprehensive diagnosis and treatment. Treatment of monsoon-related eye disorders varies depending on the disease and the cause. Eye ointments, eye drops or antibiotic therapy may be recommended to help kill the germ infecting the eye, relieve allergic symptoms and decrease discomfort.

Herbal eye drops During the monsoons, eye infections, humidity, atmospheric dampness, dryness of the eye, exposure to rain, wind or sun often lead to burning, irritation, and profound ocular discomfort. Herbal preparations are safe and rarely have any side effects.

30 Diabetic Living SEPT-OCT 2014

TO INSTILL EYE OINTMENT: a. Starting in the corner of your eye closest to the nose, squeeze a thin ribbon of ointment along the inside of the lower lid. b. Close eyes gently without squeezing the lids shut. c. Roll eyes to distribute the medication evenly over them. d. Remove excess solution or ointment outside your eye with a clean tissue, using a separate tissue for each eye. e. Wash hands after you have ﬁnished your medication, to avoid transmitting the infection to others. f. You may experience blurred vision for approximately 20 minutes after application if you are using an eye ointment. This is normal and will resolve on its own.

TO INSTILL EYE DROPS: a. Gently, pull your lower lid down with your ﬁnger. b. Look up towards the ceiling. c. Instill eye drops inside the centre of your lower lid. d. Do not drop it on your eyeball. e. Close your eyes gently, do not squeeze the lids shut. f. Blink several times to distribute medication over the eye.

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ITIS Herbal Eye Drops

Tips to follow for better eye health: 1. Apply cool compresses to the infected eye(s) three to four times per day for 10-15 minutes using a clean wash cloth each time. This will help reduce itching and swelling and provide comfort to the eyes. 2. Most eye diseases are transmitted by hand-to-eye contact; therefore, wash your hands frequently and keep them away from your eyes in order to reduce or prevent recontamination. 3. Wear sunglasses if your eyes are sensitive to light. 4. Avoid rubbing your eyes to decrease irritation of the area. 5. Avoid getting wet in the rain, always wear adequately protective rain gear. 6. Be careful of dirty water, muck and dampness. If children have played in muddy water puddles, they should be cleansed thoroughly for optimum personal hygiene. 7. Do not use contact lenses if you have eye-irritation, red eye or any form of abnormal discharge. 8. Use eye medication with utmost care. 9. Wash your hands before touching your eyes or your medications.

containing time-tested eye-friendly herbs is gentle on the eyes. Patients are really happy because this poly-herbal eye medication provides cool comfort and does not blur vision when administered. Furthermore, because of its balanced pH, ITIS herbal eye drops help stabilise and improve the tear ﬁlm, tone and refresh the eyes to counteract redness, irritation and itching commonly encountered during the rainy season. Last but not the least, consult with your eye doctor for comprehensive diagnosis and treatment of eyerelated diseases and conditions during the monsoons. With these precautionary measures give eye problems a miss this monsoon… because, life is precious.

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WORLD SIGHT DAY SPECIAL

Eye donation

GIFT of sight With October 12 being celebrated as World Sight Day, we deem it important to pledge our support to the cause of eye donation. Every individual matters

32 Diabetic Living SEPT-OCT 2014

BY

Rajany Pradhan

I

sn’t the thought that someone can see through our eyes after we leave this world, lights up some corner of our heart instantly? The joy of giving is the most fulﬁlling experience and when we give someone the gift of sight, we choose to do the noblest and the most beautiful thing we had ever done in our life. However, at times, lack of information and knowledge about eye donation comes as a hurdle in the way and our wish takes a back seat. As October 12th is World Sight Day, let’s do our bit to spread happiness in someone’s life.

Awareness is the key About 20 per cent of the people of this country suffer from blindness. In the past six to seven years, the awareness about eye donation has increased in our country but the actual turnout of donors is still very less. Along with lack of awareness, there are few religious and superstition barriers that stop people from going ahead with eye donation. Dr Radhika Tandon, Professor of Ophthalmology, All India Institute of Medical Sciences, says, “The knowledge about eye donation varies as the population is heterogeneous and awareness levels are different in urban and rural areas. Literate people in urban areas are more aware than people living in rural areas. However, to sensitise people about eye donation, talk about it in driving license, Aadhar card, railway ticket, bus ticket, metro ticket, electricity bill, telephone bill, make mobile phone companies send messages and make it mandatory for hospitals to put up such request to patients. All these, along

Only the cornea or a layer of cornea is transplanted and a person can donate eyes to three

other people

with articles in magazines and newspapers; and announcements in radio and television.”

About transplantation The whole eye of the donor is not transplanted emphasises Dr. Kinshuk Biswas, consultant opthalmology,

Columbia Asia hospital, Gurgaon. He highlights, “Only the cornea or a layer of cornea is transplanted and a person can donate eyes to three other people. After death, it is safer to transplant eye within 24-48 hours because it starts deteriorating after that period.”

Who all can donate? PLEDGE TO DONATE

One can pledge to donate by ﬁlling out a donor card online at NOTTO website or EBAI website or download a form from AIIMS National Eye Bank, or any other eye bank near your home. Eye donation is done only after death and the donors’ close relatives should be aware of their wish. After demise, they can call the nearest eye bank and the retrieval team will come to the house to recover the corneas.

Dr Tandon clariﬁes, “Anyone can donate eyes provided they have healthy corneas and do not have any transmissible diseases such as Hepatitis B, HepatitisC, HIV, Rabies, Leukaemia, Lymphoma, etc. Even if someone wears glasses or had any previous eye surgery can donate eyes.”

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33

RELATED AILMENTS

cancer

BY

Hope Warshaw, RDN, CDE

the cancer

connection Diabetes can increase your risks for certain cancers. Learn the actions to take now to protect your health.

A

fter 20 years of living with type 2 diabetes and a long struggle with her weight, Leila Berner got the diagnosis everyone fears: cancer. Leila, a 63-year-old rabbi who lives near Washington, D.C., never connected her diabetes and breast cancer until her doctors advised that she lose weight and get active for long-term survival. She also underwent a lumpectomy, radiation, and chemotherapy following her 2010 diagnosis. Diabetes and cancer are close cousins, and diabetes is often the ﬁrst to show up. Researchers have amassed a large knowledge base on

34 Diabetic Living SEPT-OCT 2014

the interplay between diabetes and cancer, says Lesley Fels Tinker, Ph.D., RD, principal staff scientist at Fred Hutchinson Cancer Research Center in Seattle. Though questions remain, experts are sure there are several things you can do today to reduce your cancer risks.

Sound the alarm According to a 2010 consensus report published jointly by the American Diabetes Association (ADA) and the American Cancer Society (ACS), the risk of a person with type 2 diabetes developing cancer is 20–50 percent higher than a person without diabetes. Research also indicates that people

with type 2 diabetes who develop cancer may experience a shorter life expectancy. That’s mainly because of their existing risk or presence of heart disease and/or because many cancer treatments can harm the heart and circulatory system. Being overweight increases the odds of cancer reoccurrence. With diabetes and cancer on the rise and already the second and seventh leading causes, respectively, of death in the United States, health experts are sounding the alarm. “When people gain excess weight, they unlock a cascade of metabolic changes that, over years, can lead to insulin resistance, chronic

inﬂammation, high levels of circulating insulin, and years later—if not reversed or treated—elevated blood glucose levels high enough to diagnose type 2,” says Derek LeRoith, M.D., Ph.D., professor of medicine and endocrinology at the Icahn School of Medicine at Mount Sinai in New York City. Experts now theorize that high insulin levels increase the growth of cancer cells, which in turn stimulate the formation of new blood vessels. The vessels then provide nourishment to cancerous tumors. Overweight people also have lower levels of adiponectin, a hormone secreted by adipose tissue (fat), than lean people, which may further accelerate cancer growth. “It’s like a double whammy for people with prediabetes or type 2 diabetes, and for the most part, you’re totally unaware this is happening,” Tinker says. “People don’t realize the extra pounds they carry around aren’t inert blobs of fat, like pounds of butter or plastic fat models we use as visual aids,” says Karen Collins, RD, a nutrition adviser to the American

Institute for Cancer Research (AICR). The adipose tissue is busy at work doing its devilish damage—and the more adipose tissue you have, the more damage is being done. To add insult to injury, one or more of the blood glucose-lowering medications you take may increase your risk of developing cancer.

Reduce risk factors Cancer and type 2 diabetes share a handful of risk factors. Three of them you can’t change: your age, sex, and family history. But there’s a lengthy list of modiﬁable risk factors—those you can change. “Research shows we can prevent about one-third of our most common cancers with a healthy weight, regular physical activity, and eating a mainly plant-based diet,” says Collins. Catapult into action to reduce your modiﬁable risk factors and improve your odds of staying cancer-free. “General wisdom suggests you take as many actions as you can toward a healthier lifestyle at any point along the way,” Tinker says.

Cancers Linked to Diabetes People with diabetes experience a higher prevalence of these cancers: Ŕ Bladder Ŕ Breast+ (postmenopausal) Ŕ Colorectal Ŕ Endometrial+ (the lining of the uterus) Ŕ Liver Ŕ Pancreatic++ +In women ++Thought to be a risk factor for diabetes

Screenings Early detection and treatment is your best defense against cancer. Make sure your health care providers know your cancer risk factors as well as your family’s cancer history. Know what cancer screenings you should have, at what age, and how often. Put reminders on your calendar.

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35

Preventive Steps It’s a powerful saying: Genetics loads the gun, but environment pulls the trigger. Despite your cancer risk or family history, you can do things to dramatically improve your odds. Here are the changes that will help. society encourages health care providers to support people in their weight loss efforts. Keeping weight off also is a factor if you’ve already had cancer. “Excess weight is associated with an increased risk of cancer reoccurring and decreased survival for those who have had breast, prostate, or colorectal cancer,” she says.

2. Slant toward plants

1. Achieve a healthy weight Do you need to get skinny? “No—being underweight is actually a cancer risk factor,” Tinker says. “Focus on losing that seemingly magic 5 percent from your starting weight, then work hard to keep it off,” she says. Losing 10–20 pounds can improve your insulin sensitivity, decrease insulin resistance, and lower blood glucose. It also can correct the levels of a few cancerrelevant hormones. For the lowest risk of common cancers, try to stay at a healthy weight throughout your life, says Colleen Doyle, RD, director of nutrition and physical activity for the American Cancer Society in Atlanta. If you’re overweight, try to lose some. There is no large-scale evidence conﬁrming reduced incidence of cancer in people who have intentionally lost weight and kept it off, but Doyle says the research is strong enough that the cancer

36 Diabetic Living SEPT-OCT 2014

Around the world, people who eat a plant-based diet with minimal processed foods have a lower cancer risk. “Plant foods supply thousands of phytochemicals, compounds that deactivate carcinogens before they do their dirty work,” Collins says. “They’re also our main source of dietary ﬁber, which when you eat it in sufficient amounts—at least 25 grams per day—protects against colorectal and breast cancer. Fiber supplements don’t seem to do the trick.” Similarly, the results of eating a diet rich in foods with a lowglycemic-index is mixed and thought to have, at best, a modest effect on cancer prevention. The big reason to cut back on red meat is to avoid its high concentration of heme iron, a form of iron in blood. This includes lean cuts, too. The AICR recommends eating no more than 18 ounces of cooked red meat each week. The AICR also recommends limiting consumption of processed meats, such as cold cuts, bacon, and sausage, including those made from chicken or turkey. The link to cancer relates to their preparation and packaging: salting, curing, smoking,

Q

Should cancer risk be considered when selecting glucose-lowering medications?

A

“Absolutely, yes,” says Derek LeRoith, M.D., Ph.D. Your medication should be based on your cancer risk factors, your history of cancer, and your tolerance of and need for the medications. There is, however, “insufficient evidence” to warrant withholding certain glucose-lowering medications on the basis of cancer concerns, according to a joint consensus statement of the American Association of Clinical Endocrinologists and the American College of Endocrinology released in late August. “For most people with diabetes, the beneﬁts of treatment should take precedence over concerns for potential low-grade cancer risk until more deﬁnitive evidence becomes available,” the statement says. LeRoith served on the committee that helped write the joint statement.

“Staying physically ﬁt over the years is protective—a great

bang for your efforts.” —Susan Lakoski, M.D. and/or adding nitrates. Make slow and steady changes to eat more fruits, vegetables, legumes, beans, whole grains, and dietary ﬁber. Lighten up on sugary foods and drinks, red meats, and processed meats. To reach and maintain a healthy weight, portion control is paramount.

3. Limit alcohol Even moderate amounts of alcohol can increase the risk of common cancers. Experts recommend no more than two drinks a day for men and one drink a day for women.

4. Be physically active A higher level of physical activity is associated with a lower risk of common cancers. Plus, being active after diagnosis may improve survival with breast and colorectal cancers. Leila’s oncologist recommended

exercise along with weight loss. The 2013 Cooper Center Longitudinal Study, which followed a large group of healthy men who were 50 years old when it began, showed that the men who were the most ﬁt, relative to those who were the least ﬁt, had a 68 percent lower risk of being diagnosed with lung cancer and 38 percent lower risk of colorectal cancer. The men who had a low ﬁtness level had an increased risk of cancer and heart disease even if they were not obese. “There’s a misconception that exercise only helps if you are overweight,” says Susan Lakoski, M.D., lead author of the study and assistant professor and director of cardiovascular prevention for cancer patients at the University of Vermont in Burlington. “Our study shows staying physically ﬁt over the years is protective—a great bang for your efforts. Plus, it’s not another pill.”

5. If you smoke, quit Smoking raises your risk for many cancers—particularly lung, but also bladder, kidney, pancreas, and liver. Smoking is also a risk factor for developing diabetes.

6. Target cholesterol and blood pressure along with blood glucose Work to continually keep your glucose, blood pressure, and good and bad cholesterol levels under control to minimize the cancergenerating effects of insulin resistance, excess insulin, and excess glucose.

7. Take a deep breath Try not to get overwhelmed with this to-do list. One change can lead to another, as Leila discovered. She’s been eating fewer processed foods and more fruits and vegetables. She’s lost about 30 pounds, which has helped lower her blood glucose levels and decrease medications. “I’m cancer-free today and plan to stay that way,” she says.

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37

RELATED AILMENTS

hearing loss

BY

Beth Howard

now

hear

this

Hearing loss can be a complication of uncontrolled diabetes

E

d Weinsberg wasn’t surprised when he developed burning sensations in his feet in 2006. His health care provider had told him he might experience this sign of peripheral neuropathy, a side effect of his recently diagnosed type 2 diabetes. Medication helped reduce the sensations. But a few years ago, Ed, 62, a former rabbi and author living in Sarasota, Florida, began to experience frustrating problems with his hearing. “Every sentence began with ‘What did you say?’ ” he says. “My ear, nose, and throat doctor wasn’t sure what was behind it.” By then Ed had already lost 50 percent of his hearing in his left ear. “But I

38 Diabetic Living SEPT-OCT 2014

suspected there might be a connection with my diabetes. I know it reduces blood ﬂow to other parts of the body.” Ed was onto something. Research shows that people with uncontrolled type 1 or type 2 diabetes are twice as likely as others to experience hearing loss. In a large study of people ages 20–69, researchers from the National Institute of Diabetes and Digestive and Kidney Diseases found a strong association between diabetes and hearing problems, emerging as early as ages 30–40. A recent study from Henry Ford Hospital in Detroit reached much the same conclusion. Researchers found that in women younger than 60, hearing was worse among those with

type 1 or type 2 diabetes compared to women without diabetes, according to study coauthor Kathleen Yaremchuk, M.D., chair of otolaryngology at the hospital. And women ages 60–75 with poorly controlled diabetes had signiﬁcantly worse hearing than those whose diabetes was considered well controlled. “When you think about complications of diabetes, this is not what you think about,” says Joanne Rinker, RD, CDE, with the North Carolina Diabetes Prevention and Control Branch. “But one in three people with diabetes will have trouble with their hearing because of complications from their elevated blood glucose.”

How diabetes hurts your hearing Diabetes seems to affect hearing in several ways. When blood glucose rises, “there is a breakdown of nerves in the ears—the same kind of nerve damage that causes tingling and other symptoms in the ﬁngertips and toes,” Rinker says. What’s more, the blood vessels in the ears are very small. “When blood sugar is high, blood running through the veins is like syrup,” she says. “Imagine how hard it is to get into the tiny capillaries of the cochlea—that can contribute to the hearing problems.” In addition, “our hearing mechanisms rely on specialized cells called hair cells,” says Elizabeth A. Dinces, M.D., assistant professor of otolaryngology at Monteﬁore Medical Center in Bronx, New York. “They are very fragile and susceptible to changes in the environment, including the effect of increased glucose in blood.” No diabetes complication is desirable, but Yaremchuk says hearing loss can be particularly insidious. “If you can’t hear, you don’t know what you’re missing,” she says. People who experience hearing loss can become isolated from others and less involved.

The best way to protect your hearing from damage due to diabetes is to

maintain good control of your blood glucose “They stop being included in conversation and withdraw,” she says. Depression can soon follow. Other research suggests that hearing loss also increases the risk for dementia because it reduces stimuli from the environment that keep the brain healthy.

Protect your ears The best way to protect your hearing from damage due to diabetes is to maintain good control of your blood glucose. That includes taking your prescribed medications, eating a healthful diet, controlling portions, and making exercise a part of every day. “Strict glycemic control has known overall beneﬁts for patients, including hearing,” Dinces says. If you think diabetes has affected your hearing, tell your doctor or ask for a referral to an audiologist for an

examination. Although hearing loss is not reversible, a hearing aid can help enormously. And hearing aids have come a long way in the past 20 years. “Today’s hearing aid is not your father’s hearing aid,” Yaremchuk says. Older hearing aids ampliﬁed all sounds equally, but those available today can adjust for distortions at high and low frequencies. “They’re phenomenal in terms of their abilities,” she says. Ed admits he was reluctant to use a hearing aid. “Like a lot of people, I was hesitant to admit that something that important had changed so drastically,” he says. While the device didn’t restore his hearing entirely, his ability to hear and engage with others has improved dramatically. “Now I can hear people more clearly,” he says, “and I am far less frustrated.”

Signs of Hearing Loss Ŕ"IFBSJOHQSPCMFNDBVTFTZPVUPGFFMFNCBSSBTTFE when you meet new people. Ŕ:PVIBWFEJťDVMUZIFBSJOHXIFOTPNFPOFTQFBLT in a whisper. Ŕ"IFBSJOHQSPCMFNGSVTUSBUFTZPVPSUSJHHFST arguments when talking to family members. Ŕ"IFBSJOHQSPCMFNDBVTFTZPVUPBUUFOEQVCMJD events or services less often than you would like. Ŕ%JťDVMUZXJUIZPVSIFBSJOHMJNJUTPSIBNQFSTZPVS personal or social life. Ŕ"IFBSJOHQSPCMFNDBVTFTZPVEJťDVMUZXIFO dining in a restaurant.

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39

MEDICATION

homeopathy

BY

Dr. Pankaj Aggarwal, M.D. (Hom.)

how homeopathy helps The CPR (Crude prevalence rate) in urban India is 9% approx, whereas in rural areas, it is prevalent in 3% of the total population. Keep a check on diabetes mellitus with homeopathy

40 Diabetic Living SEPT-OCT 2014

H

omeopathy as a branch of medicine remains doubtful in respect of its efficacy, its scientiﬁcity in general and in various diseases in particular. Homeopathy is a holistic way of treatment, whatever may be the name of the disease. This system understands each disease holistically (mind-body-spirit) and tailors the treatment for each individual having a disease. Homeopathy treats the patient who has the disease instead of the disease the patient has. This actually reﬂects a lot of wisdom in the ﬁeld of medicine. It implies that an individual gets a disease according to his personality, which means traits and characters achieved from heredity and environment (psycho-biological and psychosocial). A homeopathic doctor has to understand each disease with respect to the kind of personality it will appear. This is the reason why some are susceptible to one disease and

others are for some other disease. DM 2 is a somatic disease which has psycho-biological and psychosocial dimensions. The recent concept of PNI (Psycho-Neuro-Immunology) has shown, how it all happens in humans. The relationship between psychiatric and endocrinological illnesses is important because of shared biological background. Blood glucose level and its regulation directly affect brain and mental functions and conversely blood glucose is affected from mental and emotional changes. Many researchers have shown the relation of personality and glucose regulation.

Traits and characters are: Ŕ"OHFS Ŕ"OYJFUZ IFMQGVMOFTT VOEFSTUBOETUIF preferences and needs of others as well as their own and tries to cooperate with others. Ŕ%FQSFTTJPO VOIBQQZ QBTTJWF5IFSF is a feeling of sadness now and then. When sadness goes on for months and he/she looses interest in things that used to make him/her happy, with changes in sleep and eating patterns. Ŕ'BUJHBCJMJUZ UFOEUPCFNPSFJOBDUJWF live sedentarily and gain weight. History of tuberculosis (TB) is one of the

reasons for easy fatigability, a constitutional trait go to next generation of tubercular family This despite that the modern medicine considers TB an infectious illness only. The different stages:

Prediabetes: Often this stage wasn’t showing any signs but recently they are isolated as below: Ŕ%BSLFOFEBSFBTPGTLJO BSPVOEOFDL ﬁngers, knuckles, elbows, armpits, back of knees and other folds, a condition called Acanthosis Nigricans. Ŕ*ODSFBTFUIJSTU Ŕ'SFRVFOUVSJOBUJPO Ŕ'BUJHVF Ŕ#MVSSFEWJTJPO

Diabetes and Homeopathy treatment * Conventional medicine often uses insulin itself in the treatment of diabetes. This being just a replacement therapy, diabetes becomes a life-long disease. Homeopathy can be used effectively in the treatment of diabetes. Here, we mainly concentrate on functioning of the pancreas in efficient insulin production. Medicines such as Helonias 200, Iodum 200, Syzygium Jambolanum (Mother Tincture) are used by us effectively in the treatment of all the stages of the diseases. Often, patients come to us already under insulin replacement. In such cases we advise the continuance of the replacement while starting them off on our medicines. After some months, when we see a consistent control over the blood sugar levels, we taper off the conventional replacement therapy. Complications of the disease can also be taken care of by symptomatic treatment. (* Inputs from Prasant Banerjee Homeopathy Research Foundation)

These above signs are present in young children, which presents an alarming situation in respect of this condition. Homeopathy can help treat this condition efficiently along with correction in the lifestyle.

Diabetes: An early stage (blood glucose levels below 180) but yet not requiring any other medication, here, homeopathy has got a good scope to treat with success. But once it is above 180 and below 300 then a careful homeopathic treatment is required with strict monitoring. Blood glucose above these levels can be dangerous, so needs combined treatment with allopathic consultation and medication.

Complications: DM leads to innumerable complications. In this stage, combined treatment is useful and needed.

Conclusion: The mind and body connection is very powerful. Having good mental health decides healthy body, which is unfortunately not true in recent times. For long, medical science has been denying this relationship, but have now agreed to, given the numerous

researches in this ﬁeld. The same is true for DM. We must educate masses to be ‘Happy’ and take ‘Homeopathy’ (H+H) which has the key to success, and is a sure cure for Diabetes Management.

Research & Figures: Ŕ0WFSNJMMJPOIBWFOPXCFFO diagnosed with diabetes in India. The CPR (Crude prevalence rate) in the urban areas of India is thought to be 9%. In rural areas, the prevalence is approximately 3% of the total population. Ŕ5IFQPQVMBUJPOPG*OEJBJTOPXNPSF than 1000 million: this helps to give a view of the scale of the problem.

Ŕ*OEJBBDUVBMMZIBTUIFIJHIFTUOVNCFS of diabetics in any one country, in the entire world. IGT (Impaired Glucose Tolerance) is also a mounting problem in India. Ŕ5IFQSFWBMFODFPG*(5JTUIPVHIUUP be around 8.7% in urban areas, and 7.9% in rural areas. Ŕ*O*OEJB UIFUZQFPGEJBCFUFTEJŢFST considerably from that in the Western world. Type 1 is considerably more rare, and only about 1/3 of type II diabetics are overweight or obese. Ŕ%JBCFUFTJTBMTPCFHJOOJOHUPBQQFBS much earlier in life in India, meaning that chronic long-term complications are becoming more common.

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41

MEDICATION

innovation

BY

diabetes what’s on the

horizon? The drive to develop a better insulin delivery and glucose monitoring system has led to the launch of three innovations that show great promise for the future

Dr. Amit Bhargava

T

he turn of the century has seen numerous breakthroughs in the ﬁeld of medicine, ranging from unraveling the human genome to the development of better therapeutic agents to treat various ailments. Research in the area of diabetes has certainly not lagged behind. The drive to develop a better insulin delivery and glucose monitoring system, has led to the launch of three innovations that show great promise for the future. The ﬁrst of these is AFREZZA®, a novel rapid-acting inhaled insulin that can be used in the treatment of patients with type 1 as well as type 2 diabetes mellitus. Unequivocally, this is a major leap forward as patients now have an alternative to injecting themselves with insulin. This drugdevice combination consists of an inhaler, in which a single cartridge containing either 4 units or 8 units of insulin, in the form of an inhalation powder, is placed. However, there are some caveats to its use. AFREZZA® cannot replace long acting insulin. In patients with type 1 diabetes mellitus, it has to be used in conjunction with a long acting insulin such as

INSULIN DELIVERY & GLUCOSE MONITORING SYSTEM Administered at the start of a meal, Afrezza® rapidly dissolves, delivers insulin into bloodstream

42 Diabetic Living SEPT-OCT 2014

Peak insulin levels are reached in approx. 12-15 min post administration

The i-port Advance® has approved for use in both adults and children.

Lantus®. There may be a dose limitation, allowing the use of this agent in patients who require only a small amount of insulin to maintain their blood sugars. In clinical trials, bronchospasm or constriction of the airways was observed in patients with asthma and chronic obstructive pulmonary disease (COPD). Thus, the use of AFREZZA® is contraindicated in this population subset. The second, developed by Medtronic, is known as the i-port Advance®. An injection port is a disposable device that attaches to the skin and delivers drugs via a soft cannula into the underlying subcutaneous tissue (tissue layer just below the skin). The initial prick of the insertion is similar to that felt when delivering insulin with an insulin pen. The i-port Advance® combines an injection port with an inserter, is the size of a coin, and can stay on the body for 72 hours. A tremendous beneﬁt of this is that the i-port Advance® will dramatically reduce the number of needle sticks that a patient on insulin will feel. Insulin can be injected directly into the port, without the need for additional

The i-port Advance® combines an injection port with an inserter

Gluco Watch

records measurements every 10min. for upto 13 hours

skin punctures. Over a month, a patient can reduce the number of skin punctures from 120 (if using insulin 4x a day) to only 10 (placing a device every 72 hours)! This will undoubtedly minimise emotional and physical barriers to taking insulin, and increase compliance. Lastly, the GlucoWatch G2 Biographer is a non-invasive blood glucose monitor that is worn on the wrist like a watch. Batteries create a small electrical current that draws ﬂuid through the skin and into the device. Electrodes (sensors) in the GlucoWatch measure the glucose level in this ﬂuid, eliminating the need for drawing blood through a ﬁnger-stick. The device can record measurements every 10 minutes for up to 13 hours. However, since the accuracy of this measurement has not been proven to be better

than that of a ﬁnger-stick reading, the GlucoWatch should not be used as a substitute for ﬁngerstick measurements. Current recommendations advise that it be used in conjunction with a traditional glucometer, to provide additional information on an individual’s glucose trend/pattern. Aside from the above, it is not for use by children below the age of 7. As we continue our efforts to further advance medical science and better healthcare delivery, several drugs and devices will continue to crop up on the horizon. This is indeed exciting for both physicians and patients alike, as these agents open up new possibilities and new avenues of treatment. However, their use must be in a safe and appropriate manner to ensure a good outcome for all.

GlucoWatch G2 Biographer is a non-invasive blood glucose monitor that is worn like a watch.

In GlucoWatch G2 Biographer batteries create a small electrical current that draws ﬂuid through the skin and into the device.

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43

NUTRITION

nutrients

BY

Dolly Kumar

nutrients around

YOU

Aloe Vera and Flax seeds may have always been there around you but you hardly noticed them. Here are tips on their usage on a daily basis

10 ways to add aloe vera to your diet Full of minerals, vitamins, amino acids and phytonutrients, aloe vera is a natural and effective way to add some nutrition to your diet. Start in small amounts and check with your doctor before beginning an aloe vera regimen. The most convenient and fuss free way to add aloe vera to your diet is by having aloe vera capsules. Try Gaia Aloe Vera capsules.

Blend fresh aloe vera gel with water to make aloe vera juice. Drink it as it is or mix it with some honey to improve its taste.

Some people enjoy poached aloe vera which is prepared by cooking aloe vera gel cubes with sugar and lime juice.

Mix fresh aloe vera gel or juice to your sorbet recipe for a yummy and nutritious dessert.

Consume a spoonful or two of fresh aloe vera gel in the morning with a glass of water.

Enjoy cool and refreshing lemonade in summers by mixing lemon juice, aloe vera juice and stevia or honey.

Mix aloe vera gel in fruit and vegetable smoothies.

Blend some aloe vera gel into your salad dressings.

Mix aloe vera juice with fresh fruit juice for added nutrition.

Add some aloe vera juice to mocktails and cocktails for a healthy surprise.

44 Diabetic Living SEPT-OCT 2014

10 ways to add ﬂaxseeds to your diet The tiny yet mighty ﬂaxseed has been touted as a superfood for many years. Rich in vitamins, minerals, Omega-3 fatty acids, ﬁbre and phytonutrients, ﬂaxseeds will make a great addition to a healthy and balanced diet. Start in small amounts and check with your doctor before adding ﬂaxseeds to your regular diet. The most convenient and fuss free way to add ﬂaxseed to your diet is by having ﬂax oil capsules. Try Gaia Flax Oil capsules.

Ground ﬂaxseeds can be sprinkled on almost any dish. Add ground ﬂaxseed to yogurts, smoothies and milkshakes.

While preparing cakes, breads, muffins or similar baked items, add ground or toasted ﬂaxseeds for additional nuttiness and ﬂavour.

Add some toasted ﬂaxseeds to your breakfast cereal and porridge.

Add ﬂaxseeds to your homemade granola bars and trail mixes.

Mix some ground or toasted ﬂaxseeds with dips, salsas and sauces.

On your next trip to the grocery store, opt for food items with added ﬂaxseeds.

Toss your salad with some toasted ﬂaxseeds or add ground ﬂaxseeds to your salad dressings.

Eat a spoonful or two of toasted ﬂaxseeds with a glass of water every morning.

Mix toasted ﬂaxseeds with other toasted seeds like fennel and sunﬂower seeds for a quick and tasty snack.

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45

FOOD

recipes

sugar-free mithais Snacks For Diabetics

Bharti Sanghi’s extensive knowledge of Marwari, Gujarati and Rajasthani cuisine has helped her create elaborate meals as well as composite Gujarati and Rajasthani meals as takeaway

Who has time to cook? You do! These recipes prove it takes only minutes to make a delicious, healthful meal. Snacks For Diabetics INGREDIENTS:

bitter gourd (karela), grated carrots, grated low fat paneer, crumbled green peas, boiled and mashed whole wheat bread crumbs amchur (dry mango powder) green chillies, ﬁnely chopped coriander (dhania), chopped salt to taste

1/2 cup 3/4 cup 1/4 cup 3/4 cup 1/4 cup 3tsp 2tsp 2tbsp

OTHER INGREDIENTS:

oil for cooking

11/2 tsp

FOR SERVING CHUTNEY

Chandrakala Sugar-Free

Method:

1. Apply a little salt to the bitter gourd and keep aside for a while. 2. Squeeze and retain the water for use 3. Combine the bitter gourd, carrots, paneer, green peas, bread crumbs, amchur, green chillies, coriander, green peas and salt in a bowl and mix well. 4. Divide the mixture into eight equal portions and shape into round, ﬂat tikkis. 5. Cook them on a non-stick pan using a little oil till both sides are golden brown. 6. Serve hot with chutney.

Why Karela: Karela contains a hypoglycemic compound, highly beneﬁcial in lowering sugar levels in blood and urine. Bitter melon juice improves glucose tolerance without increasing blood insulin levels.

46 Diabetic Living SEPT-OCT 2014

Lauki Ka Halwa Sugar-Free Lauki Ka Halwa Sugar-Free COOKING TIME: 20 MINS; SERVES: 4 INGREDIENTS

bottle gourd (lauki), grated 1 cup low fat milk 2 cups splenda 1 sachet cardamom (elaichi) powder 1 tsp rose petals and kesar Method:

1. Combine the bottle gourd, milk in a pan and simmer for 10 minutes till the bottle gourd is cooked. 2. Add the sugar-free splenda and cook till it dissolves and the milk is thickened. 3. Add the cardamom powder, rose petals and kesar. Mix well and refrigerate.

Chandrakala Sugar-Free INGREDIENTS

whole wheat ﬂour ghee khoya almonds pista cardomom

200g 60g 100g 25g 25g 2g

Steamed Fruit Pudding elaichi, sugar-free and place it on one part of the roti, put the other roti on top and seal with water. Fry it and garnish with silver foil.

Steamed Fruit Pudding COOKING TIME: 20 MINS; SERVES: 4 INGREDIENTS:

apple chikoos bananas whole wheat ﬂour baking powder cinnamon powder splenda

1 2 2 1 cup 1 tsp 1 tsp 1 sachet

Method:

1. Peel and cut the apple, chikoos. 2. Peel bananas and grind to a ﬁne paste along with apple and chikoos. 3. Mix the fruit puree and splenda lightly. 4. Mix wheat ﬂour with baking powder and cinnamon powder, sieve and add to the puree.

5. Pour into pudding mould and cover tightly with silver foil. 6. Pre-heat oven to 190°C. 7. Put the pudding mould in a hot water container and place into the pre-heated oven.

Method:

8. Bake for 30 to 40 mins or till it is set. Check by inserting

1. Knead ﬂour and ghee along with water. Keep aside. 2. Cut small balls, roll them into two small puris, keep aside.

a fork into the pudding and if the fork comes out clean, it indicates that the dish is cooked and ready to eat. 9. Serve warm with custard.

For the ﬁlling:

Take khoya, add chopped almonds, chopped pista, ground

Sapodilla fruit: Chikoo Try the Lauki: Bottle gourd (Lauki ) has zero cholesterol and is rich in Vitamins like Vitamin C and antioxidants making it good for your heart.

contains minerals like iron, magnesium, calcium, phosphorus, copper and potassium as well as the Vitamins A, C, thiamine, niacin, pantothenic acid and folate. DiabeticLivingOnline.in

47

Sugar-free Custard Sugar-free Custard

Apple Pie sugar-free Apple Pie sugar-free

COOKING TIME: 5 MINS; SERVES: 2

COOKING TIME: 60 MINS; SERVES: 4-5

INGREDIENTS:

INGREDIENTS:

milk 2 cups custard powder (vanilla) 1 tbsp splenda 1 sachet Method:

whole wheat ﬂour butter apples splenda cinnamon powder

2 cups 4 tbps 3 3 sachets 1 tsp

1. Mix the milk, custard powder and sugar-free together. See that no lumps are formed. Boil till you get a thick consistency. 2. Serve with apple pie or mixed fruits.

Phirni sugar-free

Method:

1. Mix ﬂour with butter with your ﬁnger tips till it becomes crumbly. Knead with cold water and keep in the fridge for half hour. 2. Take out and roll it lifting periodically so that it becomes light. Prick it with a fork and place it in a greased pie dish and bake until half done. Add steamed apples with sugar-free and cinnamon powder and further bake till until fully done and serve warm.

Phirni sugar-free INGREDIENTS:

milk (full cream) 1 litre long grained (basmati) rice 4 tbsp splenda 2 sachets saffron (kesar) a few strands For the garnish a few chopped almonds a few saffron (kesar) strands Method:

1. Dry roast the saffron strands in a small pan for 10 seconds. Add 1tbsp of milk and keep aside.

2. Soak the rice in water for about 1 hour. Drain, wash and drain again. Pat dry on an absorbent kitchen towel and blend in a mixer to a coarse powder. 3. Boil the rest of the milk and gently stir in the rice paste. 4. Cook for about 15 minutes on a slow ﬂame, while stirring continuously. 5. Add the sugar-free and saffron mixture and simmer for a few minutes. 6. Pour into earthenware containers and keep aside to cool. 7. Refrigerate for at least one hour. 8. Serve chilled, garnished with almonds and saffron strands.

48 Diabetic Living SEPT-OCT 2014

BY

NUTRITION

Gitanjali Gurbaxani

4

watermelon

watermelon

recipes

for diabetics

The health beneﬁts of watermelon include the prevention of kidney disorders, high blood pressure, diabetes, heart care, heat stroke, macular degeneration, impotence, etc. Must-try recipes

T

Three Melon Salad

he question is, why is there so much the fuss about the juicy, sweet and vibrant watermelon? At the ﬁrst glance, it may seem like nothing more than a big ball of water. We all know that there is nothing more refreshing than a big, chilled wedge of watermelon on a hot, summer day. The long list of healthy or beneﬁcial effects of watermelons are mainly derived from its unique nutrients, vitamins, minerals, and organic compounds. Lypocene, a carotenoid found in abundance in watermelon, improves the cardiac function. Beta carotene, known for its remarkable antioxidant and anti-aging properties, also keeps you young at heart and prevents age related cardiac problems. The roughage in watermelon and its very low energy, along with help from vitamin C, carotenoids and potassium helps to reduce cholesterol and keep your heart safe from a variety of dangerous conditions. Diabetic patients, who are supposed to have a low energy and low sugar diet, often complain about starving since they don’t get to eat their staple diets, which gives them the feeling of

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One cup of watermelon provides 17% of vitamin A, 21% of vitamin C, 2% of iron and 1% of calcium needs for the day; contains more lycopene than any other fruit or vegetable

being half fed. “Watermelons can be a good supplement for them. In spite of being sweet in taste, a thick wedge will give you very few calories, since 99% of it’s total weight is composed of water and roughage. Moreover, the various vitamins and minerals such as potassium and magnesium help in proper functioning of insulin in the body, thus lowering the blood sugar level, says Mumbai-based Diabetologist, Dr. Lotika Purohit, Director, Diabetes Care Centre.” She further advocates, “Arginine, another component found in watermelons, is very effective in enhancing the impact of insulin on blood sugar. Diabetics can consume watermelon in moderation as it contains very minimum amount of sugar and provides with lots of nutrients and water. They can also have curries, dosas and salads made from watermelon rinds, which are even lower in sugar. Watermelon is a good fruit for people with Diabetes, but many mistakenly think that it is not. The reason has to do with the difference between glycemic index and glycemic load.”

THREE MELON SALAD SERVES 4 INGREDIENTS REQUIRED :

5 cups watermelon, scooped 3 cups cantaloupe, scooped 3 cups honeydew melon, scooped 2 tsp lemon peel 2 tsp honey a pinch of salt 1 tbsp lemon juice

50 Diabetic Living SEPT-OCT 2014

Watermelon Bruschetta with Feta, Mint and Balsamic Drizzle Method: Place the scooped watermelon, honeydew melon and cantaloupe in a large bowl with mint leaves, honey, lemon peel, lemon juice and salt. Gently mix well. Add more lemon juice if required. Refrigerate for up to 3–4 hours before serving. Serve the melon balls in individual bowls, chilled.

Watermelon

WATERMELON BRUSCHETTA WITH FETA, MINT AND BALSAMIC DRIZZLE SERVES 4 INGREDIENTS REQUIRED :

2 ½ cup seedless watermelon, cut into small pieces ¾ cup balsamic vinegar 2 tbsp honey

contains thiamin, riboﬂavin, niacin, vitamin B-6, folate, pantothenic acid, magnesium, phosphorus, potassium, zinc, copper, manganese, selenium, choline, lycopene and betaine. According to the National Watermelon Promotion Board, watermelon contains more lycopene than any other fruit or vegetable.

60 gms feta, crumbled 1 tbsp fresh mint, chopped 1 baguette ¾ tsp freshly ground black pepper Method: Slice the baguette into 1½” thick slices and place them on a baking tray under a broiler. Toast them for a few minutes till lightly crispy. Place the balsamic vinegar and honey in a sauce pan, and heat over low ﬂame, stirring constantly. Let it simmer for 15–20 minutes till it has thickened and halved in quantity. Transfer the feta in a blender till smooth. Spread it on the toasted baguette and top it with ﬁnely diced cubes of watermelon. Sprinkle freshly ground black pepper, salt, mint over each piece and drizzle the balsamic vinegar over the bruschetta. Serve immediately.

WATERMELON AND CHERRY TOMATO SALAD SERVES 4 INGREDIENTS REQUIRED :

5 cups watermelon cubes, seeded 1 tsp honey ¼ tsp salt 3 tbsp red wine vinegar 2 tbsp extra virgin olive oil 3 cups cherry tomatoes, halved 2 tbsp fresh mint, chopped 1 tsp freshly ground black pepper Method: Combine the watermelon cubes and the cherry tomato halved in a large bowl. Pour in the honey and add in a pinch of salt along with the freshly ground black pepper. Toss well to coat. Let it stand for 15 minutes. Stir in the vinegar and olive oil along with the mint leaves. Mix well, cover and chill for two hours. Serve chilled.

Watermelon and Cherry Tomatoes Salad

one cup of diced watermelon (152g) contains 43 calories, og of fat, 2g of sodium, 11g of carbohydrate and 1g of ﬁbre A pinch of salt 50 ml blue cheese dressing A few basil leaves (optional) ½ tsp freshly ground black pepper Method: Cut the watermelon into 3 rounds of ½” thickness. Pre-heat the oven at 350º F / 180º C for 4 – 5 minutes. Brush both the sides of the watermelon with olive oil, and season with salt and black pepper powder. Place them on the grill stand and grill

for a minute on each side or until a grill mark appears, without using the grill lid. Transfer the grilled melons on a serving plate. Drizzle a bit of the balsamic glaze on each slice and then pour the blue cheese dressing evenly over each slice. Serve immediately.

Gitanjali Gurbaxani is a professional pastry chef and expert in eggless confectionery. Mail her at [email protected].

GRILLED WATERMELON WITH BLUE CHEESE SERVES 4 INGREDIENTS REQUIRED :

3 x ½” round thick watermelon rounds 1 tbsp olive oil 1 tbsp balsamic glaze

Grilled Watermelon with Blue Cheese

NUTRITION

diet

BY

Priti Seth

eat right, eat moderate Natural fertility has higher success rate with proper nutrition and naturopathy methods. For optimum fertility, one should just start adding up things that are healthier for your body and also for the baby

O

besity doesn’t affect a woman’s chances of getting pregnant. This is a myth for women who are trying to conceive. The truth is, obesity does reduce the chances of being a mother. Being conscious about weight is a common phenomenon among women. You may always feel guilty before you take a bite of a pastry or a delectable chocolate. However, you still give up and relish the food that you like. Dieting is like the mantra for every kind of weight loss, whether it is pre-conception diet or post-pregnancy diet. But the question that may

52 Diabetic Living SEPT-OCT 2014

WHAT OTHER THAN DIET?

Before undergoing any diet regime, consult your doctor. Exercising is as important as following an appropriate diet. Therefore, try to exercise for an hour each day. Exercise may mean walking, swimming, biking, dancing, etc. The goal is not to lose drastically but to lose one to two pound each week. Stay away from fad diets and plans that promise quick weight loss. Along with the diet plan, also adopt “clean living”. Detoxify your environment. Your environments also boost your fertility in one way. Healthy lifestyles increase fertility rate and reduce complications during pregnancy. While all these tips are for women, it is important for the would-befathers too, to support their wives in following this regime. Help her meet her energy needs so as to satisfy her daily appetite. Remember, it’s not just her duty but your responsibility too to nurture the child.

have hit your mind quite a few times is, “Is it OK to diet while I’m trying to conceive?” A book written by Rujuta Diwekar named “Don’t lose your mind, lose your weight” rightly suggests that dieting is not important. What is important is to have right things at the right time. Before planning your pre-conception nutrition, it is important to alter your eating habits with healthier ones. Here, we speak about the diet routine that you need to follow in order to lose weight before pregnancy as a mother’s weight is directly proportional to the baby’s birth weight. Studies suggest that underweight women end up giving birth to small babies and overweight women face number of complications such as diabetes and high blood pressure during pregnancy. Therefore, it is essential to have proper weight according to height as it helps in development of the fetus. The preconception diet is not too different from any healthy eating routine. Before you hop onto a diet regime, it’s important to make a commitment to overhauling those eating habits. The basic rule to lose weight to conceive is to junk the junk food. Pick the right stuff that is full of calcium, protein, iron, complex carbs, etc.

What to include in your daily diet? To start with, add at least ﬁve portions of fruits and vegetables every day. Fruit juice may also be considered as a portion. Leafy vegetables such as spinach, fenugreek, kale etc., will help you keep iron-deﬁciency at bay. Women who have less iron in their body often have disruptions in their menstrual cycle which is not good while you plan to conceive. Dairy products such as curd, yogurt and ghee will increase your calcium level. Often milk products are considered to be a high source of fats. However, to keep your weight under control, choose low-fat or fat-free dairy products. Substitute your regular white bread with brown bread and rice with brown rice. This will not only help you

Folic acid is a nutritional substance that every woman should have. Use organic products. Drink green tea as it is rich in antioxidants reduce weight but will also keep your insulin levels steady and reproductive hormones balanced. All this will in turn boost your fertility rate as well. If you are a non-vegetarian then add two portions of ﬁsh a week. Do not have more than two portions each week. Also, eat lots of tofu, eggs, chicken and tuna. Eat fresh food. Drink lots of water. Keeping your body hydrated is important. Drink minimum eight glasses each day as it will ﬂush out all the toxins from your body.

What to exclude from your daily diet? While it is important to know what to eat to reduce weight before conceiving, it is also important to know what

to avoid. Many women follow the diet regularly but forget to avoid few food items that prove to be harmful. The very ﬁrst step to lose weight before conceiving is to avoid junk food. Cut down on consumption of alcohol. Studies show binge drinking can be harmful for a developing baby. Also eliminate smoking from your regime. Caffeine also may affect your fertility rate. Therefore, limit your coffee intake. Food supplements containing ﬁsh liver oil should also be avoided. Too much retinol in your body may harm your baby. Do not consume any ﬁsh that contains mercury.

Ms. Priti Seth is Nutritionist, Pachouli- Spa & Wellness, New Delhi

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53

FITNESS

man vs machine

BY

Sha lini Bhargava

ﬁtness apps vs.

ﬁtness instructors Which one works for you-mobile app or a ﬁtness instructor. Take your pick

F

itness is an essential requirement of our everyday life. While some people are too busy to get going, others can now be called obsessed. In these contrasting times, we’re also getting extremely tech friendly and we’re now becoming aware of the importance of good health. The question that now arises is mobile app or a ﬁtness instructor? Let’s look at both the sides. Fitness applications are typically brilliant because they’re mobile; we have them with us all the time. Whether you’re looking to lose 54 Diabetic Living SEPT-OCT 2014

weight, work out more often, or just increase your total amount of daily movement, an application that’s always with you and always connected to a network of supportive people can do wonders. Fitness apps have revolutionized the way we approach exercise, they keep us up to date. However, on the other side of the spectrum are the ﬁtness trainers, who guide and motivate you step by step to reach your ﬁtness goals. These are people who not only train you but also educate and motivate you. The upside of getting

trained with a ﬁtness instructor is the constant cueing, watching for form of the exercises and providing modiﬁcations if and when required. Our gadgets put vast amounts of information at our disposal. They give us an accurate count of the miles we just walked, how many calories we’re eating at the moment, not only that they also remind us of two hour intervals between meals and daily exercise alarms. If that’s not enough it helps pamper your competitive side by being in constant check of who’s run how much, not only amongst

If you wish to lose weight increase your physical activity, a personal activity tracker can help you reach

your goal your friends but all those who have the same application. It serves as a reminder to stay on track. If you’re looking to lose weight, increase your physical activity, or simply improve your overall health, a personal activity tracker can help you reach your goal. Seeing how much activity you do (or don’t) get, day-by-day and week-by-week, could motivate you to start taking the stairs or walking till the market or walking the dog an extra lap around the block. At the very least, it will make you more mindful of your activity level, which is a huge ﬁrst step to getting ﬁt. Some of the apps act as tracking tools, in which you log your workouts or calories eaten, while others automate the tracking for you while you’re working out. Some are coaching apps that take you through an entire ﬁtness routine, and others are a combination of both. Economically too, it’s a very viable option. To be a little more just to the ﬂipside, let’s not forget that real classes and group workouts prove to be more fun and with the current population going fanatic with the technology, your exercise regime should deﬁnitely not become a victim to it. You can stick to activities you like, without getting competitive and outdoing yourselves to only face repercussions.

Walking with weights - good idea or bad? Walking with hand weights can help you burn more calories when you walk, but you must use them correctly. If you swing your arms to shoulder height for 20 to 30 minutes, you may burn up to 10 to 20 percent more calories than you would without the weights. Ankle weights have the same effect, increasing the workout on your leg muscles and therefore burning more calories. But walking with weights only equates to walking about ﬁve extra minutes, and the risk of injury may outweigh the minimal beneﬁt. Walking with ankle weights can be hazardous to your knees. Talk with your doctor before you start walking with weights.

To lay all the cards on the table, we must realise just like robots might be ten times better than humans, they can’t outplay our inputs. The same way a virtual guide can ﬁx your posture or tell you where you’re going wrong. It may be an easier option, but health is never to be taken lightly.

Maybe, striking the right balance between the two, an option would be to train with an instructor for a few days and the other days of the week, let the virtual guide help you stay on track so you can have the best of both worlds without it itching your pocket.

DiabeticLivingOnline.in

55

NUTRITION

health food

BY

Suman Agarwal

FOOD FOR DIABETICS If you are facing a condition called Diabetes, it is imperative to choose the right food combination, while preventing unhealthy highs and lows in blood sugar levels

Pulses and legumes are low in glycemic index, high in ﬁbre, and resistant starch, which helps regulate blood glucose levels

or people with diabetes, the foods you eat can either be a powerful medicine or a slow poison. The goal is to prevent unhealthy highs and lows in blood sugar levels, resulting in the progression of diabetes-related complications such as heart disease, kidney problems and nerve damage.

F

instability of your glucose levels and possible diabetes complications in the future. Every time you choose to eat a starchy food, make it count! Leave the processed white ﬂour-based products, especially the ones with added sugar and opt from the listed carbohydrate super foods.

Choose Complex Carbohydrates

Whole grains

with at least 3g of ﬁbre per serving and less than 6g of sugar. It is recommended to consume 4-6 servings well distributed throughout the day as per individual requirements, one serving includes 1 medium chapati or ½ cup cooked cereal.

Pulses and Legumes Complex carbohydrates are high in ﬁbre, which prevents instant spike in blood glucose by slowing the digestion and absorption of the sugars present in carbohydrate. Simple carbohydrates do the exact opposite - their sugars absorb quickly, causing rapid increases in your blood glucose, resulting in 56 Diabetic Living SEPT-OCT 2014

Whole grains are rich in vitamins, minerals, phytochemicals and ﬁbre. Cereal choices such as cracked Wheat, Bajra (Pearl Millet), Jowar (Sorghum), Jou (Barley), Ragi (Finger Millet), Kuttu (Buckwheat), Brown rice, Oats, Quinoa and Amaranth are beneﬁcial as they help in regulating blood glucose levels. For packed cereals, pick those

Pulses and legumes are low in glycemic index, high in ﬁbre and resistant starch, which helps in regulating blood glucose levels. They are low in fat and contain no cholesterol or trans fats. Pulse consumption has shown to improve the blood lipid proﬁle, reducing total cholesterol, LDL- cholesterol, triglycerides, and increasing HDLcholesterol, and has been

Vegetables Eat more! You don’t often hear that when you have diabetes, but non-starchy vegetables are one food group where you can satisfy your appetite. Vegetables are packed with nourishing micronutrients and ﬁbre the body needs and with so few calories and carbohydrate. Try to eat at least 3-5 servings of vegetables a day. A serving of vegetables is: ½ cup of cooked vegetables or vegetable juice; or 1 cup of raw vegetables. For maximum beneﬁts eat seasonal, locally grown vegetables and make your meals colourful by adding a variety. Starchy vegetables, including potatoes, corn and peas are high GI vegetables. However, they can be a part of a healthy diabetic meal plan by restricting their portions and counting them for a cereal serving. Some super-veggies for diabetics include spinach, bittergourd, tomatoes, garlic, cucumber and fenugreek. Restrict intake of canned and pickled vegetables.

Fruit Superfoods: Indian Gooseberry (Amla): It is one of the richest sources of Vitamin-c. It boosts immunity and helps in improving digestion. It is a potent liver cleanser and works as a laxative. It helps in managing blood sugar levels in diabetics. Jamun: It is an age-old remedy for diabetes. The seeds as well as the fruit are used in the treatment of type-2 diabetes. It helps remove toxins from the liver and prevents fatty liver inﬁltration.

right

fruit juices, canned fruits should be strictly avoided. One fruit serving will be one cup for fruits with high water content like berries, watermelon and papaya and half a cup for fruits like apples, pear, plums and peaches. One medium slice of mango or half banana also equals to one fruit serving. However, these fruits are high in glycemic index and should be consumed sparingly with a combination of low fat dairy to reduce the glycemic load of the meal. It is advisable to eat fruit in between meals as a snack, not in addition to a main meal.

EATING

associated with decreased body weight. They are a good source for proteins in a typical Indian diet, especially for vegetarians. Include sprouts in your daily diet, the process of seed germination results in a dramatic increase in their nutrient content. Say no to dals packed as namkeens as they are high in salt and fat content.

Try to eat 3-5 servings of veggies a day. A serving of veggies is: ½ cup of cooked vegetables or vegetable juice; or 1 cup of raw vegetables

Fruits Fruits are rich in carbohydrates, are packed with vitamins, minerals, antioxidants, and phytonutrients and make the diet alkaline. Fruits are best had fresh and whole. Fruits high in ﬁber such as papaya, apple, orange, pear and guava should be consumed. They can help curb sweet cravings in diabetics. However, due to their high carbohydrate content the portions and number of servings should be monitored. In diabetes, fruit should be limited to 2 servings a day; and

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57

facts QUICK

Add cinnamon powder to your milk beverage It is known to lower blood glucose and cholesterol levels. Treat yourself with a homemade frozen fruit yogurt to satisfy the sweet tooth

58 Diabetic Living SEPT-OCT 2014

Dairy

Nuts and seeds

Milk and yogurt contain the right combination of carbohydrates and proteins that help control blood sugar levels. Including sources of dairy in your diet is an easy way to get calcium and high-quality protein. If you are lactose intolerant, you may try fortiﬁed soymilk, rice milk, or almond milk. Two servings of low fat dairy (double toned or skim milk, low fat yogurt and paneer) are recommended, one serving of dairy equals 1-cup milk or yogurt and ½ cup paneer. The protein powerhouse: Meat, chicken, ﬁsh and eggs. These are primary sources of proteins. They are also rich in easily absorbable iron, vitamin A, zinc, B vitamins. Fish, shellﬁsh provide omega-3 fatty acids. The best choices of protein foods are those that are lower in saturated fat like chicken breast or egg whites or ﬁsh higher in omega 3 fats — like tuna and salmon. Depending on blood cholesterol levels, whole eggs should be limited to 2-3 eggs per week. Cured and processed meats should be avoided as they are high in salt and fat content.

Nuts can improve blood sugar control in type-2 diabetes. Most nuts such as almonds, walnuts, ﬂaxseeds, pistachios contain at least one or more of these heart-healthy substances: unsaturated fats, omega-3 fatty acids, ﬁbre, vitamin E, plant sterols, and L-arginine, which makes artery walls more ﬂexible and less prone to blood clots. Word of caution: Because nuts are high in calories, it is best to portion them before eating, rather than eating them out of a bag. Avoid salted, sugared, honeyed, or chocolatecovered varieties, because they add calories, simple sugars, and salt.

Meal timings Healthy eating is not simply a matter of what one eats, but also when one eats. You can avoid problems with hypoglycemia by planning ahead. For better diabetes management eat small frequent meals and ﬁx meal timings as per your medication.

The writer is a Nutritionist & Fitness Expert, Selfcare India. Visit: selfcareindia.com

BY

WELLNESS oil

Rupal Tyagi

oil

is well

Therapeutic grade essential

Skin care expert and aromatherapist gives us a list of essential oils for the season

E

ssential oils are very useful for the minor ailments of the day sun especially if you spend a lot of time outdoors. Oils that will help you deal with these minor inconveniences.

Lavender (Lavendula angustifolia) Lavender can be used in a wide variety of situations including minor burns, sunburn, rashes, bruises, wounds and insect bites. It is helpful for easing sore muscles and headaches. Apply to minor burns as soon as possible to ease the pain and prevent blisters.

Peppermint (Mentha piperita) A drop of peppermint essential oil rubbed into the soles of your feet can help bring your temperature down if you are suffering from the heat. Peppermint is also useful for headaches due to digestive issues and sinus congestion as well as relieving the nausea associated with travel sickness. Use peppermint to help keep you alert when you feel mentally fatigued due to the heat or driving long distances.

oils can form the base of an organic, biodegradable and chemical free sunscreen!

German Chamomile (Matricaria recutita) German chamomile is a good oil to have on hand for summer. Use to treat inﬂamed, irritated skin including dermatitis, boils, acne, nappy rash, eczema, psoriasis and dry itchy skin. It can also be used to relieve the pain associated with burns, sprains, cramps and insect bites.

Eucalyptus (Eucalyptus radiata) Eucalyptus is useful for bringing down fevers and treating the symptoms of summer colds. It can also be used for easing muscular aches, pains and strains, wound healing and insect bites. Responsible sun exposure, combined with a healthy lifestyle and eating habits, is essential to every human. Responsible exposure is an important part of keeping your body healthy as supplements don’t replace actual sunshine. Being said, it is equally and extremely important to protect your skin from overexposure and sunburns. Nature has given us a gift by providing essential oils that are a Natural SPF. Hair can also suffer from over

Essential Oils with Natural SPF ŔSFESBTQCFSSZTFFEPJMŊ41'CFUXFFO 30 and 50 (seriously!) ŔDBSSPUTFFEPJMŊ41' ŔXIFBUHFSNPJMŊ41' ŔIB[FMOVUPJMŊ41' ŔDPDPOVUPJMŊ41' ŔTPZCFBOPJMŊ41' ŔTIFBCVUUFSŊ41' ŔNBDBEBNJBPJMŊ41' ŔKPKPCBPJMŊ41' ŔSJDFCSBOPJMŊ41' ŔTFTBNFPJM IFNQPJM BWPDBEPPJM peanut oil – SPF between 4 and 10 ŔWJUBNJO&ŊIFMQTQSPUFDUBHBJOTU67 damage exposure to sun, wind and chlorine in swimming pools. Essential oils such as Rosemary, Peppermint, Lavender etc can be combined with Grape seed Oil , Wheat Germ Oil and Olive Oil to form a good conditioning treatment. A handy tip for travellers. Apply neat Lavender or Eucalyptus to the temples, back of the neck and upper abdomen and breathe deeply. This will help you tackle the symptoms of heat stroke A blend of German Chamomile, Lavender and Eucalyptus combined with Aloe Vera Gel can be very beneﬁcial in a condition like prickly heat. DiabeticLivingOnline.in

59

FOOD

pantry

BY

Marsha McCulloch, RD, LD

pantry picks Ready to make a clean sweep of your eating habits? Start with your staple foods and compare them to these guidelines.

WHAT TO

#6:

WHAT TO

PITCH

W

hen hunger hits, what’s stocked in your pantry is ultimately what ends up on your plate. And if you’re like most people, some not-so-good options sneak into your kitchen— maybe because they were on sale or you wanted goodies on hand for guests. In the long run, however, food is a smart buy only if it’s good for your body. When selecting groceries, people with diabetes have to look out for their hearts, waistlines, and, of course, blood glucose. That means opting for nutrientrich foods with ﬁber, hearthealthy fats, and antioxidants, yet reasonable in sodium, calories, and carbohydrate. Here’s help ﬁguring out what to keep in your cupboards.

60 Diabetic Living SEPT-OCT 2014

WHAT TO PITCH

A pantry is supposed to help you prepare meals, but if it’s stocked with foods containing lots of empty calories, it’s not helpful. Search your shelves for these 10 items, and toss them in favor of more healthful options.

1. Crumb Piecrusts

Ready-made graham cracker and cookie crumb piecrusts are often laced with artery-clogging trans fat. In fact, some crumb-style crusts pack as much as 2.5 grams of trans fat per serving, which ranks them near the top of the list of trans-fatladen foods. 2. Processed Cheese

Whether sold in shelf-stable blocks, jars, or spray cans, processed cheese offers twice the sodium of natural cheese. Plus, processed cheese has up to 4 grams of carbohydrate per ounce, with only half the protein of natural cheeses, such as low-fat mozzarella and cheddar (which are virtually carbohydrate-free).

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Find more ways to stock your pantry! Visit DiabeticLivingOnline .com/Avoid for a lineup of top foods to exclude from your shopping list.

5. Ready-to-Spread Frosting

8. Ramen Noodle Soups

Rich in sugar and fat, including 1.5–2 grams of trans fat per serving, this creamy stuff is not even worth keeping on hand for a special occasion. Top treats with a sweet sprinkle of powdered sugar, dark chocolate shavings, or colorful berries instead.

These may have been standby meals in college, but it’s time to graduate to healthier options. A half package of these noodles with seasoning top 800 milligrams of sodium. Other not-so-nice ingredients include partially hydrogenated oil, saturated fat, and hard-to-pronounce chemical ﬂavorings and preservatives.

3. Vegetable Shortening

6. Boxed Meal Kits

Shortening has been trimmed of much of the trans fat it once had, but partially hydrogenated oil still hides in the ingredient list. That means it has trans fat—just not enough per 1-tablespoon serving to register on the nutrition label. Even small amounts can harm heart health.

Even healthy-sounding boxed dishes that instruct you to add chicken or tuna contain a laundry list of questionable ingredients, including small amounts of partially hydrogenated oil, artiﬁcial colors and ﬂavors, and a heavy hit of sodium. Boxed meal helpers could leave you short on ﬁber and whole grains, too.

4. Canned Pasta

A 1-cup serving of canned ravioli packs 750 milligrams of sodium plus 800 milligrams of potassium from potassium chloride, a type of salt. Potassium is a healthful nutrient, but getting too much from salt substitutes and processed food additives could pose problems for people with kidney disease and those taking certain blood pressure medications. 62 Diabetic Living SEPT-OCT 2014

7. Salty Salad Dressings

Want a side of salt with your leafy greens? Salad-dressing makers seem to think so. Sodium per 2-tablespoon serving often hits 300–400 milligrams. Light versions don’t necessarily save on sodium or carbohydrate—just fat and calories. Opt for dressings with fewer than 240 milligrams of sodium per serving.

9. Large Flour Tortillas

Whether making Mexican dishes or sandwich wraps, skip big, burritosize ﬂour tortillas. Made with reﬁned white ﬂour, they offer little ﬁber yet pack 200 calories, more than 30 grams of carbohydrate, and 600 milligrams of sodium apiece. Plus, the tortillas contain arteryhardening vegetable shortening. 10. Too-Tempting Foods

This refers to calorie-dense foods that entice you, personally, to eat too much or blow your carbohydrate budget. Maybe it’s chips, cookies, sugary cereal, or dried fruit. Try getting it out of the house, or at least out of your kitchen.

WHAT TO BUY Now that you have more room in your pantry, boost ﬂavor and nutrition at mealtime by stocking up on these 10 smart supermarket purchases.

1. Unsalted Chicken Stock

Chicken stock can pack more than 900 milligrams of sodium per cup, so opt for unsalted or low-sodium stock or broth. Homemade chicken soup is the best choice. Use it as a cooking liquid for whole grains and in place of oil to sauté vegetables. 2. Low-Fat Corn Tortillas

Soft corn tortillas, typically low in fat and made without vegetable shortening, are a smart swap for hard taco shells and ﬂour tortillas. Warm a tortilla and spread it with nut butter, or use them or sandwich wraps and low-fat Mexican dishes, such as chicken fajitas. 3. Steel-Cut Oats

Not a fan of ﬂaked oatmeal with its sometimes-pasty consistency? Try steel-cut oats, which are simply whole grain kernels cut into a few pieces. Their nutty, chewy texture shines in your morning cereal bowl and in side dishes such as tabbouleh. Steel-cut oats reheat well, too.

cereal, and yogurt. Or simply roast in your oven for a snack. 5. Oils Rich in Monounsaturated Fats

Besides supporting healthier cholesterol levels, moderate amounts of monounsaturated fats may help lower blood pressure, improve insulin sensitivity, and lower average blood glucose (A1C), some studies suggest. Extra virgin olive oil and avocado oil are top picks— they’re not only high in monounsaturated fats, but they’re rich in natural antioxidants. 6. Low-Fat Powdered Peanut Butter

If you’ve kissed peanut butter good-bye to cut calories, say hello to powdered peanut butter that’s had most of the fat removed. A 2-tablespoon serving averages 45 calories, 1.5 grams of fat, and 5 grams of carbohydrate. Mix it with water for a spread or dip. Or add the powder directly to recipes.

4. Raw Walnuts

There are countless uses for this versatile nut rich in heart-healthy omega-3 fats. Grind walnuts into small pieces for a nutritious crust for baked goods. Chop ﬁnely to coat ﬁsh. Sprinkle on salads,

7. Canned Salmon

Wild-caught salmon tops the list of omega-3-rich ﬁsh with low mercury contamination. Swap skinless, boneless canned salmon for most dishes you’d make

with tuna: Sneak canned salmon into noodle casserole, or mix it with low-fat mayonnaise, minced celery, and pickle relish to use as a sandwich spread. 8. Low-Sodium Beans

Great in soups, salads, dips, main dishes, and even some desserts, ﬁber-rich beans are as versatile as they are nutritious. Dried legumes are naturally low in sodium, but for convenience, stock no-salt-added or reducedsodium canned beans, too. 9. Balsamic Vinegar

Balsamic vinegar adds zing to meat marinades, vegetable dressings, and even strawberries. Plus, preliminary studies suggest that adding about 11 ⁄ 2 tablespoons of the vinegar to high-glycemic or high-carbohydrate meals may help improve insulin sensitivity and blunt blood glucose spikes after meals. 10. Grainy Mustard

This coarsely ground mustard is a

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low-fat, virtually carbohydrate-free “way to liven up sandwiches. A bonus: Mustard is part of the cruciferous vegetable clan along with broccoli. The process of making spreadable mustard releases the seeds’ cancer-ﬁghting compounds, making even small amounts potent in helping reduce cancer risk.

64 Diabetic Living SEPT-OCT 2014

BY Christian

WEIGHT LOSS

Millman

obesity

weighing Allowing yourself a few treats could prevent weight gain this holiday season

the truth S

andy Schleinz is overweight because she’s stressed, doesn’t sleep enough, has a sluggish thyroid, wasn’t breast-fed, takes medication that causes weight gain, and has the wrong set of genes. Or at least those are some of the many reasons she’s heard over the years to explain her decades-long struggle with weight. These days, Sandy favors another reason: “I’m pretty sure I’m fat because I eat too much,” says the 67-year-old from Oshkosh, Wisconsin. She’s right, of course, but every one of those other explanations seemed equally reasonable at one time. That kind of confusion is widespread, and it prompted 20 top scientists from leading research centers to take an in-depth look at many of the most cherished beliefs in the ﬁeld of weight loss research. Their goal: Find out how much of this stuff is actually based on facts. Their ﬁndings—published in January 2013 in the New England Journal of Medicine—cast a surprising amount of doubt on much of what has been treated as common knowledge in the ﬁeld of weight loss. “We got a lot of support, but we also rattled some cages,” says Krista Casazza, Ph.D., RD, an assistant professor in the Department of Nutrition Sciences at the University of Alabama at Birmingham, the lead research facility for the study. Take a look at these key ﬁndings, which earned both commendations and condemnations.

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Diets work if they are sensible Losing weight is simple: Reduce your energy intake. That’s it. How you do it is up to you. So how do you ﬁnd out what works? The same way you learn most things: trial and error. And you have tons of nutritionally sound diet choices: South Beach, Weight Watchers, DASH, TLC, Ornish, Mediterranean, Mayo Clinic, and many others. “It’s not one-size-ﬁtsall, and it never was,” says Gale Maleskey, RD, author of Nature’s

Medicines (Rodale Press, 1999), who runs a nutrition practice in Bethlehem, Pennsylvania. “Everyone is different in how they gain weight and in what they need to do to lose it.” Check with your health care provider or a registered dietitian

66 Diabetic Living SEPT-OCT 2014

to make sure any diet you’re considering is a healthful one.

Eating breakfast protects against obesity How long and how many times have you heard this one? It has attained the status of absolute truth among the widely accepted principles of weight loss. There’s one problem: There’s no solid research to back it up. “People have always heard that breakfast is the most important meal of the day,” Casazza says. “We’re not saying that it isn’t. It may be for reasons other than being preventive against obesity. What we are saying is that skipping breakfast doesn’t make you any more or less likely to lose weight.” What matters far more is how many calories you eat over the course of the day, not when you eat them. If you’re not hungry in the morning, don’t force something down. When you do get hungry, choose foods that support your weight loss goal.

Exercise is essential if you want to lose weight This study ﬁnding in particular got a lot of yoga pants and lab coats in a twist, Casazza says. The belief that exercise is an essential component of any successful weight loss plan is

long held and deeply ingrained. But there’s a problem: It’s not true. “Going to the gym doesn’t make you thin any more than sitting in the library makes you a scholar,” she says. Unless you commit to an Olympian-caliber training program, you simply can’t burn enough calories to make up for even tiny lapses in dietary discipline. For example: A 150-pound woman walking for 60 minutes at a moderate pace burns about 225 calories. And a Snickers sounds mighty good after that walk. Just one measly 2-ounce bar adds back 250 calories—more than enough to undo that entire hour of exercise. The only way you can reliably lose weight is by reducing the number of calories you eat. But here’s an important note: While it takes dietary changes to get the weight off, you’ll ﬁnd it extremely difficult to keep it off unless you increase your activity level. That’s because regular exercise does burn enough calories to offset the creeping rebound that bedevils most people who have lost weight. Increasing exercise and activity is essential for other reasons, says Diana M. Thomas, Ph.D., director of the Center for Quantitative Obesity Research at Montclair State University in New Jersey and one of the study’s authors. “Waist circumference consistently reduces in

response to exercise,” she says, because your body is designed to dip into belly fat ﬁrst in response to physical activity. “If people are concerned with how they look, that lower waist circumference will improve your appearance and help you slip back into those jeans you love.” But don’t feel obliged to call it exercise. That word too often conjures images of unpleasant grunting and sweating. Instead, call it activity—and all activity counts, including dancing in your ﬂannel jammies. Keep it simple: Just move more whenever and however you can.

Eating more fruits and vegetables causes you to lose weight There are all kinds of health reasons to eat more produce. But merely adding asparagus and apricots to your menu won’t cause you to lose weight. If you don’t cut back on the less-healthful foods in your diet, you’ll simply consume more calories overall.

Meal replacements are not effective in the ﬁght against obesity

increased mortality associated with weight ﬂuctuations.

Meals in a box (or in a can) are effective ways to make weight loss simple. Mail-order programs, such as Jenny Craig and NutriSystem, and meal-replacement products, such as Slim-Fast and Special K shakes, combine portion control with convenience to take the guesswork out of your next meal. Research clearly shows people stick to their weight loss plan with greater ease and better results by using meal replacements and plans, Casazza says.

Set realistic goals or you’ll get frustrated, lose less, or give up

Yo-yo dieting is bad and could lead to increased death rates The claim is that letting your weight bounce up and down can lead to early mortality and that it’s better to stay at a steady weight, even if that weight is too high. “There are new studies showing that yo-yo dieting doesn’t seem to have any adverse effects at all,” Thomas says. “There is no catch-up fat or extra fat distribution at the abdomen.” In fact, research from the Swedish Obesity Study Team showed that people whose weight yo-yoed most of all—those who had bariatric surgery—had no

This is one weight loss belief that seems so reasonable it must be true. But absolutely no evidence exists to show that losing weight must be a reasonable or realistic endeavor. Whether you have small, step-by-step objectives or giant, wild dreams, the takeaway is clear: Go for it. “Individuality is key. What works for you is the thing that matters the most,” Casazza says. “As the weight loss commercials say: Results may vary.”

Small changes produce large, long-term weight loss Slow and steady wins the race. Two pounds a week maximum. Rapid weight loss is dangerous and leads to rapid regain. Bunk, says Casazza. What matters most is that you simply lose weight. And then keep it off for the long term. Other than that, there’s no secret formula for the best way to do it.

Breast-feeding protects children against obesity As if there aren’t enough things to worry about with an infant, this tsk-tsking has been thrown on the pile for years. But babies who are breast-fed are no fatter or thinner as adults than those who aren’t. “This is one of the areas where we got a lot of pushback,” Casazza says. “People just didn’t want to hear this.” But that doesn’t change its lack of factual basis. Whether a new mother breast-feeds or not is a complex decision based on multiple factors—this shouldn’t be one of them.

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FOOD

treats

BY

Caitlyn Diimig

INDULGE! Allowing yourself a few treats could prevent weight gain this holiday season. Make smart splurges so you feel satisﬁed, not guilty

F

ear of weight gain can contribute to the stress surrounding the holidays. Pam Owenson, who has type 1 diabetes, knows that all too well. “There are all types of parties and snacks coming into work, and if you’re not watching, you are going to overeat,” she says. Who hasn’t used the “it’s the holidays” excuse to feed on treats and other temptations lurking at the office or social gatherings? Pam has tried to avoid the goodies altogether, but she’s

68 Diabetic Living SEPT-OCT 2014

found that depriving herself while others indulge often leads to eating too much later on.

Avoid extremes It’s a common cycle this time of year: We restrict ourselves for a day or two only to overeat later, which then leads to feelings of guilt and more emotional overeating. “When you tell a person (or yourself) not to eat something, then that’s all they can think about. It’s human

nature,” says Susan Burke March, RD, CDE, of Flagler Beach, Florida. Several studies have shown that men and women gain on average 1–2 pounds between Thanksgiving and Christmas. Yet people often perceive that they gain 5–10 pounds. This can lead to tough self-imposed restrictions in hopes of preventing weight gain. A 2008 study in the Journal of Consulting and Clinical Psychology found that when overweight people engaged in extreme restrictions, such as limiting calories and increasing exercise regimens over the holidays, they were more likely to gain weight than people who didn’t implement strict rules.

Eat slowly “Don’t eliminate. Substitute,” Burke March says. “If you’re going to a party and you know everyone’s going to be chowing down on cake and that’s not really in your plan, then bring something you can indulge in that will satisfy you but be healthier.” Sheri Colberg, Ph.D., author of The Diabetes Breakthrough: A Scientiﬁcally Proven Plan to Lose Weight and Cut Medications (Harlequin, 2013), recommends slowing down and making an effort to taste and enjoy your indulgences. Go ahead and have half a serving of pie; by slowing down, you’ll get the same sensations of satisfaction with half the calories. Slowing down also gives your body the chance to tell your brain that you’re full. When you eat too quickly, your body doesn’t have enough time to send that signal. Colberg recommends pushing away your plate when you feel 80 percent full; 15 minutes later, you will likely feel 100 percent full. Pam, 48, who lives in Harcourt,

Iowa, makes an effort to eat more vegetables and drink more water during the holidays. Many people misread the body’s thirst signals as hunger. Pam tries to plan her treats and then cuts the portion in half. “I don’t deprive myself. Often just a small portion can satisfy you.” It’s perfectly ﬁne to indulge now and then, but you should stay active to control your weight and your blood glucose. Fortunately, there are many quick ways you can rev up your metabolism without spending hours in the gym. Colberg, an exercise physiologist who also has type 1 diabetes, says the best thing you can do is be more conscientious about not sitting continuously. “Try getting up and walking around 5 minutes every hour during the workday—one study showed you can expend 150 calories a day just doing that,” Colberg says. Try to follow the 20-steps rule: 1 calorie equals about 20 steps. Read the label on that hot

chocolate package and multiply the calories by 20 to see how many extra steps you’d have to walk to burn off that treat. Sneak in extra walks while running holiday errands. Walk a few laps inside the mall before you leave. If you’re done with your shopping or you do it online, offer to help friends. After all, it’s always more fun to spend someone else’s money. You don’t have to go to a gym to exercise. Colberg recommends strength training and resistance exercises that you can do at home. “It can be as simple as doing wall push-ups and using your body weight as the resistance,” she says. Remember to start your exercise routine slowly to protect your body. “Injuries usually come from starting out too hard, especially if you haven’t been exercising regularly,” Colberg says. “It will place you back to square one.” And that’s no way to start the new year.

Calories In, Calories Out You can burn off your favorite holiday treats, but you’ll need to do more than stroll around the block once. Exercise physiologist Sheri Colberg, Ph.D., offers these guidelines with calorie counts based on a 175-pound woman.

BINGE: Extra serving of glazed ham (6 ounces total) = 250 calories, 12 g carb. BURN: Weight training (light workout) for 1 hour

BINGE: 12 ounces of hot chocolate = 290 calories, 40 g carb. BURN: Stationary cycling (moderate pace) for 30 minutes

Try to follow the 20-steps rule:

1 calorie= 20 steps BINGE: Extra serving of mashed potatoes and gravy (2 cups total) = 520 calories, 77 g carb. BURN: Walking at 4.5 mph for 1 hour

BINGE: 1 slice of pumpkin pie = 200 calories, 27 g carb. BURN: Swimming freestyle (slowly) for 20 minutes

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SPECIAL FEATURE

osteoporosis

BY

Dr. Yash Gulati

a bony issue When, what and why of osteoporosis. A World Osteoporosis Day Special (October 20)

O

steoporosis is a condition which leads to weakening of bones. It is equally prevalent in men and women, although women show higher incidence around the age of menopause. Around 50% of men and women over 50 will sustain fracture of compromised osteoporotic back bone, hip or wrist. The highest strength of bones in an individual’s life time is around the age of 30 irrespective of the built, sex and the race. This is called peak Bone Mass. Bone mass keeps on reducing post age 30. However, it falls rapidly after menopause in women due to hormonal changes making them more prone for osteoporosis. Bone is a dynamic structure having constant turnover of its protein building scaffold and minerals, most importantly calcium salts deposited on it. At microscopic level, it is like a huge meshwork of protein Trabeculae with minerals deposited on them. Several factors affect process of bone turnover. Quantitative and qualitive decrease in bone frame work at microscopic level can lead to osteopenia (osteo =bone; penia = decrease) and more serious.

When to suspect Osteoporosis: 1. Unexplained aches & pains all over the body in women around menopause or older men and women (remember osteoporosis can occur in younger people also) 2. Fracture sustained because of relatively trivial injury. 3. Continuing back pain in people above 50 years of age. 4. Stooping posture in elderly caused by multiple back bone compression collapses –Often silent with little or no pain. 5. Sudden acute back pain in elderly because of Vertebral Compression Fracture (VCF).

How to diagnose osteoporosis: There are simple non-invasive methods available, such as DEXA scan, which can accurately measure bone density and tell us if we have weak bones (osteopenia) or indeed osteoporosis. At the same time, we should check out mineral metabolism, when indicated, by doing blood test for calcium and vitamin D.

Factors responsible for Osteoporosis

Age

Hormonal Imbalance

Lack of Activity

Just as other organs, bone also weakens with advancing age and is perhaps the most important cause of osteoporosis.

Female hormone estrogen and certain male hormones have positive effect on bone formation. Females are more prone to osteoporosis around menopause because of hormonal disturbances.

Sedentary lifestyle, lack of exercise leads to osteopenia or osteoporosis. Since bone is a living, dynamic structure, the more we stress it with activities like walking, jogging, sports, the more bone can remain healthy. Conﬁnement to bed because of any disease can quickly wash away bone.

70 Diabetic Living SEPT-OCT 2014

Osteoporosis when bone density decreases below a particular level and can give distastrous result at times. With Osteoporosis, fragility increases, because body fails to form enough new bone, when too much existing bone in washed away.

When to check bone density? It may be a good idea to check it once around menopause and after 50 year of age in case of men. There after it can be checked once every few years. In case of fragility fracture (due to trivial injury after the age of 50 years) around wrist, hip or spine, bone density must be checked.

Is Treatment Possible? Yes, Osteoporosis can now be treated to a large extent and tendency of bones to break can be signiﬁcantly decreased by certain drugs and by remaining active. Speciﬁc drugs are now available. Calcium and vitamin D supplementation is also important. Certain drugs are given by daily injection under the skin. This is an expensive treatment and should be reserved for special circumstances.

Role of surgery in Osteoporosis: In fragility fracture around hip, surgery is often required either to ﬁx the fracture with nail, plate or sometimes hip replacement may be required. It is

Diet rich in Calcium should be included in the diet from childhood to ensure a good Peak Bone Mass important to get the elderly person with such a fracture out of bed quickly and mobilise them with the help of good ﬁxation of fracture. Early mobilisation can avoid serious complications.

Apart from this adequate sunlight exposure helps to maintain vitamin D in blood. Food products fortiﬁed with vitamin D should be taken. Weight bearing exercises also help in maintaining bone strength.

Fragility fractures of back bone: Vertebral compression fracture (VCF) can often be treated with medication and bracing. Also, if it doesn’t succeed then in certain fracture patterns, it is now possible to push bone cement into back bone without giving general anesthesia (vertebroplasty or kyphoplasty). This can give excellent relief in pain and get the elderly patient back on feet.

How to keep bones healthy: The process of keeping bones healthy starts from, proper diet and supplements as necessary. Requirement of both calcium and vitamin D increases in pregnancy and during breastfeeding. Adequate supplementation should be ensured during that period. Again, the supplementary requirement should be assessed and managed accordingly in menopausal women.

Alcohol & Smoking

RACE

Drugs

Heavy drinking and smoking have deﬁnite negative effect on bone formation.

Races such as caucacians and Asians are more prone to osteoporosis.

Steroids, anti etrilepsy and certain other drugs, can lead to bone loss and osteoporosis.

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WELLBEING

skin

BY

Dr. A K Singh

keep the glow Nothing makes you feel as conﬁdent as having a glowing, radiant skin. Great skin makes you look younger and feel healthier no matter what your age or physical condition. Plus, skin care tips, give you the opportunity for some serious pampering. So go ahead-make your skin glow. You deserve to look and feel fabulous

M

onsoon, along with the rain brings humidity, which is a bad news for any or all skin types. A lot of skin problems erupt due to humidity. But with small precautions in the skin care routine during this season

72 Diabetic Living SEPT-OCT 2014

we can keep our skin looking fresh & healthy. When skin gets oily and is prone to bacterial infections and fungal infection as well. Other problems such as change in skin colour, texture, dullness, rashes and patchy skin also arise. To avoid

these, my advice would be: “Drink more water during this season to quickly overcome skin problems”. Use anti-bacterial soaps, medicated face wash or cleansers and talcum to keep your skin at optimum pH value.

9 tips for a safe skin Remove excess oil

Anti-fungal powder

Medicated shampoos

To treat oily skin one needs to remove excess oil by medicated cleansers, cleansing it twice or thrice a day, but not more than that. Washing your face more than three times a day, may irritate your skin, increase the dryness and make your skin worse than before.

In case of a skin infection, use an anti-fungal powder and anti bacterial soaps to avoid any further skin infection. Try to keep your skin dry. Don’t wear wet clothes and try to wear cotton undergarments. No wet shoes.

Wash hair a little with medicated shampoos more frequently as all the humidity and sweat causes it to get dirty soon and attract dust and pollution. Take care of your nails also, which can spread so much of infection to your body.

Clean and dry

See a dermatologist

Creamy moisturisers

Sand damp skin leads to infections. Also, one can get rashes, painful skin conditions; often dirty water comes in contact with feet and causes severe infections of the toes and other parts of the body. This can be dangerous for diabetics.

People with diabetic diseases are more prone to skin infection especially fungal infections. See a dermatologist when symptoms like red skin rashes and white macerated palm and sole skin appear lest they leave scars & turn untreatable later.

Dryness is a sign of dehydration and lack of skin repairing vitamins. During monsoon the problem worsens. One requires creambased cleanser, or medicated moisturisers.

Medicated soaps

Carry an umbrella

Use warm water

The skin gets constantly wet and dry owing to the humidity, and skin gets dehydrated. If your face gets wet, just dab it with a tissue and apply moisturiser whenever you feel dry. Wash your face thoroughly with medicated soaps or face wash over it for 5 to 7 minutes.

People must avoid getting drenched and should always carry an umbrella. Even when they are drenched, they must immediately follow preventive measures, it can badly damage your skin.

Heavy cleansing creams can be a problem for your skin in any weather. It is best to use warm water while washing face as it dissolves skin oil better than cold water or water at room temperature.

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WORLD ORAL HEALTH DAY SPECIAL

dental

BY

Dr. Karishma Jaradi

diabetes and

dental health

Healthy teeth, gums and mouth play a crucial role in our ability to work or study without constant, nagging and painful toothache, in our self conﬁdence and in the health of our whole body. But diabetes can act as a spanner in the wheels

R

esearches have proved that diabetes alters the structure of the blood vessels. This may affect the efficiency of the blood ﬂow, and in turn may weaken the bone and the gums, leaving them more prone to infections. Diabetes affects many but not all know that their diabetes may be causing havoc in their mouths. If diabetes is not strictly managed, there may be higher than usual levels of glucose in the mouth ﬂuids which may be harmful. Patients with diabetes, especially those whose blood sugar levels are not properly controlled are more likely to develop dental issues which will eventually lead to tooth loss.

74 Diabetic Living SEPT-OCT 2014

World Health Oral now fall Day s March 2 on 0

causes of dental problems due to diabetes. Excessive glucose (sugar), in your blood from diabetes can cause pain, infection in your mouth, teeth, your gums and jaw. Glucose is present in your saliva and the liquid in your saliva help harmful germs, called plaque, grow. Plaque also comes from eating foods that contain sugars or starches. Some types of plaque cause tooth decay, ulcers and cavities whereas other some cause gum diseases.

Effects of diabetes on dental health periodontitis:

dry mouth:

Periodontitis leads to swollen and bleeding gums. It also causes pus between the teeth and gums. Bad Breath, loose teeth, change in the ﬁt of your dentures are a few more ill effects.

Diabetes usually leads to dry mouth and you tend to drink water frequently to keep it moist. It sometimes causes dry, rough tongue, cracked lips, mouth sores or infections. This causes pain in the mouth which in turn results in problem to chew, eat or talk.

gingivitis: Diabetes can lead to many dental problems like Gingivitis where our mouth becomes red, swollen, and gums start bleeding.

burning mouth: It also causes burning sensation in the mouth, dry mouth and leads to bitter taste.

thrush: It leads to sore white or red patches on your gums, tongue, cheeks or the roof of your mouth.

prevention: There are certain measures, if taken can help one prevent dental problems: Ŕ'JSTUMZDPOUSPMZPVSCMPPETVHBS level. Ŕ%BJMZCSVTIJOHBOEŤPTTJOH Ŕ3FHVMBSDMFBOJOH Ŕ.FEJDJOFQSFTDSJCFECZZPVS dentist. Ŕ'JYJOHEFOUVSFTUIBUEPOPUţUXFMM Ŕ3FNPWJOHEFOUVSFTGPSQBSUPG the day or night, and keeping them clean.

WDF promot awaren es issues a ess of r oral heaound lt globally h Ŕ,FFQJOHZPVSNPVUIXFU Ŕ3JOTJOHXJUIBNPVUISJOTF using sugarless gum or mints to increase saliva ﬂow. Ŕ5BLJOHGSFRVFOUTJQTPGXBUFS Ŕ"WPJEJOHUPCBDDP DBŢFJOF BOE alcohol. Ŕ"WPJEJOHTQJDZPSTBMUZGPPETUIBU may cause pain in a dry mouth. Ŕ$IPPTJOHGPPETIJHIJOţCSFTVDI as whole grain breads. Ŕ$POTVNJOHOPOTUBSDIZ vegetables, such as broccoli, spinach and green beans. These

foods are high in ﬁbre and low in carbohydrates. Ŕ&WFOUIPVHIQPSSJEHFJTB carbohydrate, it is a good carbohydrate. Because it is high in soluble ﬁbre, it is slower to digest and it won’t raise your blood sugar as much or as quickly. Ŕ3FHVMBSWJTJUTUPUIFEFOUJTUPS hygienist. Ŕ.BOBHJOHEJBCFUFTJTBMJGFMPOH commitment, and that includes proper dental care. Your efforts will be rewarded with a lifetime of healthy teeth and gums.

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SPECIAL REPORT tips

It’s All How

Look at It YOU are in control of your diabetes. Take small steps to stay positive.

In her new book, Diabetes Do’s & How-To’s (SPI Management, 2013), author and Huffington Post blogger Riva Greenberg writes about how you can take small but powerful action steps to manage your life with diabetes—from food and ﬁtness to medicine and attitude. Her wisdom comes from living with type 1 diabetes for 40+ years and the countless conversations she’s had with diabetes experts and health care providers. “When I was ﬁnishing this book, I was on a ﬂight and I sat next to a young man whose T-shirt captivated me. It said: ‘Tomorrow’s battle is won during today’s practice,’“ Greenberg says. “I can’t think of a better way to say that every step we take now beneﬁts us for years to come.” Here are Greenberg’s tips on how you can start to develop a more positive attitude—today.

76 Diabetic Living SEPT-OCT 2014

BY

Riva Greenberg

Know that your diabetes is only about you. Nobody has your hips, your eyes, your lips, or your diabetes. Like a masterwork, you are unique, and so is your diabetes. I once went on a long weekend with two female friends who also have type 1 diabetes. We ate exactly the same meals and did the same exercises, and we each got different numbers checking our blood sugar throughout the day. There’s no value in comparing yourself to others. It bummed you out in high school, and it will only confuse you now. There is one way, however, in which your diabetes isn’t just about you: It affects those who love you. Bear in mind that they have your best interest at heart, even when they’re yelling at you to not eat that piece of chocolate cake. Be open with your loved ones, share your feelings, and let them also express their feelings.

Quick starts Know that your treatment plan, your medicines, and your lab reports are all unique to you because diabetes works differently in each of us. If you don’t know how the foods you eat affect your blood glucose, keep a record this week. Write down your meals, check your blood sugar before and two hours after you take your ﬁrst bite of food, and write down your numbers. If you need help ﬁguring out what your numbers mean, bring your record to your health care provider and ask for an explanation about how food impacts your blood glucose.

Know that you’re the most important member of your medical team. Here’s the sometimes-harsh yet powerful truth: Each of us is the captain of our diabetes ship. While you might spend a dozen hours a year with your health care providers (and that would be a high estimate), that leaves 8,748 hours for you to spend managing your diabetes on your own. As you become more responsible for your diabetes and take better care of yourself, chances are you will become healthier and diabetes will feel like less of a burden. Bottom line: It’s not up to

your health care providers to keep you healthy. It’s up to you.

Quick starts Get a referral to a certiﬁed diabetes educator (CDE). This is a professional who is trained to help you manage your diabetes. To ﬁnd a CDE, visit healthmonitor .com/AADE/ﬁnder.do. Think about why it’s important to you to be healthy. When you reﬂect on these meaningful reasons, you’ll be more inspired to take care of yourself.

Aim for better, not perfect. Trying to be perfect in managing your diabetes will drive you insane! Nobody manages diabetes perfectly. You can’t always know what your body is doing, and you can’t always control it. Even if you do the same exact things two days in a row, you won’t get the same exact results. The good news is that you don’t have to be perfect. Studies show that when it comes to delaying or preventing diabetes complications, the beneﬁt of having an A1C closer to 6 percent (the high end of normal) as opposed to 6.5 percent is very small. So forget perfect. Just try to make small improvements. Now that you know you don’t have to be perfect, did you know it can be good to take “diabetes vacations” now and

then? Psychologist and certiﬁed diabetes educator William Polonsky, founder of the Behavioral Diabetes Institute in San Diego, says we should. Diabetes vacations are pretty much what you would imagine: a very short break, like occasionally skipping a diabetes task you do regularly. For instance, you might take Friday night off from your diabetesfriendly meal plan. Just make sure your vacations are short—and safe.

Quick starts One day a week treat yourself to a meal that’s not on your meal plan. Ask a loved one to do something for you this week, like shop for groceries or bring your meter and strips to you when you’re lounging in bed.

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Check your blood glucose, but don’t keep score. Diabetes can seem like a life of numbers. There is blood glucose, blood pressure, and cholesterol. Then we often judge those numbers—and ourselves—as good or bad. But these judgments won’t help us do better, and most of the time they’ll make us feel worse. See your numbers as they are meant to be seen: information, not a reﬂection of your self-worth. You often see the word “test” used for checking blood glucose. But “testing” sounds like we’re being graded, which means we either pass or fail. What we’re really doing is “checking” our blood glucose so we know where we are and how factors like food, exercise, stress, and medicine inﬂuence the numbers we get. When you check your blood

Make “I’m grateful” a daily mantra. Studies show that if you pause to consciously experience and express gratefulness, you tend to heal faster, manage problems more easily, have a stronger immune system, and ﬁnd life more satisfying. Trust me, as Oprah Winfrey says, this is what I know for sure: When you spend more time being appreciative, nonjudging, loving, playful, patient, forgiving, and grateful, you will be healthier and happier, and ﬁnd diabetes easier to manage and live with.

Quick starts Do an act of kindness. It can be planned, like helping a friend or neighbor when they ask,

78 Diabetic Living SEPT-OCT 2014

or random, like letting someone who’s in a rush go in front of you at the checkout line. Being kind to others creates good feelings for both you and the person you are kind to. Each evening before you go to sleep and/or each morning before you greet the day, think of three things you’re grateful for or that went well in the last 24 hours. They can be large or small. For instance, the simple joy of seeing a child playing, a secret smile you shared with your partner, a quiet evening alone at home with a great book, or the feeling of driving a new car off the dealer’s lot.

glucose and it’s out of your target range, think about what might have caused it. Think about what you can do a little differently next time to get closer to your target range. When we look at our numbers that way, we can make the adjustments that will help us stay in our target range.

Quick starts Keep your expectations realistic, and don’t beat yourself up. No matter what you do, you won’t always get the numbers you expect. That’s diabetes. Give yourself the same care and compassion you would give a good friend. When you treat yourself kindly, you’re better able to tap into your strength to manage your diabetes.

Be a warrior, not a worrier.

Develop a personal support network. All of us manage our diabetes better with support. If you have one or more people in your circle who can help you, you’ll ﬁnd diabetes much easier to live with. Maybe a family member or friend can lend a hand with shopping or cooking healthy meals. Or go for a walk with you or drive you to a doctor’s appointment. Or carry glucose tablets in their pockets, like my husband does for me. Or just lend an ear when you feel overwhelmed; yes, he does that, too. Studies show that having friends, support, and strong social ties can improve your blood pressure, memory, overall health, and longevity. At the same time, it can decrease physical ailments, mental

decline, depression, and Alzheimer’s symptoms.

Quick starts Join one of the many online diabetes communities like tudiabetes.org, diabeticconnect .com, diabetessisters.org, juvenation.org, and myglu.org. These are great places to chat with others and ﬁnd support. Think of a small, speciﬁc way a family member or friend can help you, and then ask for that help. Do something where you’ll meet new people—take a class or volunteer at your place of worship. You may make a new friend or acquaintance.

Every day we walk a line between being a warrior and a worrier in how we manage our diabetes. It’s so easy to be a worrier. After all, there seems to be an awful lot to worry about: Will I develop complications? Why did my doctor just add another pill to my treatment plan? It’s easy to worry when we are afraid, don’t have enough information, or get frustrated by all the work diabetes takes. We become warriors when we have good information to manage our diabetes and know that it’s up to us to take responsibility for our health. And know that the beneﬁt can be a longer, healthier life. See your diabetes as a wake-up call to get healthier. If you weren’t that healthy before your diagnosis, here’s an opportunity for a fresh start.

Quick starts This week commit to one small step you will take to manage your diabetes a little better. Every day notice something you did to take care of your diabetes, and take a moment to appreciate your effort.

This “real-life” practical guide to living with diabetes is Riva Greenberg’s third book. It’s available for $13 at amazon.com or for PO,JOEMF:PVBMTP can read her diabetes commentaries online at huffingtonpost.com.

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reader survey

?

how can we help you

thrive with diabetes?

Please take a few minutes to tell us what you think about this magazine. Then fold the survey, place it in an envelope, and mail (address on opposite side). Your comments will help us meet your needs as you live with diabetes.

1

2

Where did you get this issue of Diabetic Living magazine? At home A store Friend or family member Doctor’s ofﬁce or clinic Other _____________________

Why are you interested in reading about diabetes? Please check all that apply. I have type 2 diabetes For how long?_________ I have type 1 diabetes For how long?_________ I have pre-diabetes (elevated blood glucose) My child has diabetes I am the caregiver for an adult with diabetes Diabetes runs in my family I am a medical professional

NAME ADDRESS CITY

STATE

PIN

E-MAIL

3

Where else do you ﬁnd diabetes education/support? Please check all that apply. Diabetes education class(es) Registered dietitian Family doctor Endocrinologist In-person support group Online support group/community Magazines/books Videos/DVDs Online Other ________________________

6

How often do you look for diabetes or other health information online? Daily Weekly Monthly Less than once a month I have never looked online for diabetes information (please go to question 9).

7

Please list the top three diabetes or health websites you visit. 1.

4

What information do you feel has been missing from your diabetes education?

5

Where do you access the Internet? Please check all that apply. At home At work Through a mobile device At the public library I do not have Internet access (please go to question 9).

2. 3.

CONTINUE TO BACK

8

Which of the following would you like to read most in Diabetic Living? HIGH INTEREST

LOW/NO INTEREST

MODERATE INTEREST

Diabetes medical news and research Everyday recipes 30-minute (or less) recipes Low-carb recipes Low-sodium recipes Special-occasion recipes Holiday recipes Recipes for two Dessert recipes What/how much to eat Getting started (newly diagnosed) Medication and treatments Diabetes procedures and tests Weight loss Easy exercises Reducing blood glucose and/or A1C Pain management How to avoid complications Mentally coping with diabetes Reducing stress Diabetes products and services Inspiration from people with diabetes Other

9

Is there anything else you’d like to tell us?

Yes, the editors of Diabetic Living magazine may contact me for more information.

Please indicate your level of agreement with the following statements that describe your feelings about Diabetic Living. NEITHER AGREE DISAGREE AGREE DISAGREE AGREE COMPLETELY

SOMEWHAT

NOR DISAGREE

SOMEWHAT

COMPLETELY

The magazine is well-organised Articles do not give me enough information Articles are colorful and attractive The text size is too small to read The text size is easy to see and to read Stories inform and educate me Stories inspire me to take self-care actions Stories encourage me to talk to my doctor or health care provider I can get the same information elsewhere The magazine keeps me up-to-date on the newest information about diabetes The articles are difﬁcult to understand The stories are realistic for someone with diabetes The magazine shows/describes people I can relate to

Thank you! We appreciate your feedback.

Fold and mail this survey in an envelope addressed to:

Diabetic Living Survey MaXposure Media Group (I) Pvt. Ltd. Unit No. F2B (Second Floor), Mira Corporate suites, Plot No.1&2, Ishwar Nagar, Mathura Road, Delhi - 110065

PREDICTION

tarot

Tarot forecast for sept-oct 2014 ARIES

TAURUS

GEMINI

Card of the Month: Seven of Wands

Card of the Month: Three of Coins

Card of the Month: Nine of Cups

There could be some rejection from within to “doing the right thing.” It is important to understand this resistance and to take measures to handle it. For instance, if you feel that eating only rich foods will satisfy you this period - try choosing a salad that has rich ingredients. Or, if exercise is not on your programme, elect to walk home from work.

In order to be an active thinker, it helps to keep an active body. Try thinking of exercise as something the body deserves. When your mind wants to talk you out of it or wants to convince you that procrastination is OK, remember that the body can be ignored by the mind (up to a point) and you must be the champion of the silent and oppressed! It’s only fair.

You are able to intuitively sense what’s needed in a given situation. If you are in the habit of preparing meals for yourself and your family, you are probably naturally gifted at preparing healthy meals. You might learn some healthy techniques found in vegetarian cookbooks. The perspectives may be new, but what you learn will enhance your experience of cooking and eating.

CANCER

LEO

VIRGO

Card of the Month: Heirophant

Card of the Month: Justice

Card of the Month: Strength

Bring out the best in yourself by planning ahead. There is almost no physical activity that you don’t enjoy, so pick the one that is most convenient on a practical level. There should be little or no obstacles in the path of achieving this. Build up a practice around this activity and use it as a support when things get adverse.

For your own beneﬁt, get a clear perspective on what works for you and what feels like a challenge. Seek to understand what you can do to help yourself on a daily basis. Regular meals with lots of leafy greens, regular exercise that ﬁts nicely in your schedule will help you attain your goal of feeling happy and healthy.

Remember it’s not the situation that matters, it’s how you handle it. Continue to breathe consciously, focusing on your breath when you exercise and when you go to sleep as a way of heightening awareness. Make sure the food is appetizing. Next, arrange the food in a proper way before you eat. Eat slowly and enjoy.

LIBRA

SCORPIO

SAGITTARIUS

Card of the Month: Ten of Cups

Card of the Month: Three of Wands

Card of the Month: Nine of Swords

When you have found something in your diet you’d like to improve on, give yourself adequate time to adjust mentally as well as physically. For instance, if dairy is prevalent in your diet, don’t eliminate it all together! Try backing off of ice cream and cheese, while still relishing your morning latte. The whole self needs to be able to distinguish what is going on. Instead, gradually convince yourself of why and how you will reduce dairy in your diet.

Starting all over again isn’t always easy. Sometimes you need plenty of reassurance and coaxing. It may be time to look into changing your health habits to make them even healthier than they are. A child does not easily let go of his favourite things. Similarly, the grown-up does not appreciate new suggestions about how to behave. Try to look into what recurring themes you have about food in your life.

It will gradually become easier to make better choices with food once you are familiar with your options. There are occasions when you might actually prefer an apple to a piece of cake if you take the time to check in and ask yourself. Pride yourself on knowing what you want! Being choosy is one of your greatest attributes. Eliminate regret by employing forethought and alternative thinking - especially when it comes to nourishing your body.

82 Diabetic Living SEPT-OCT 2014

Manisha Koushik (Astrologer, Tarot Card Reader, Numerologist, Vastu & Fengshui Consultant) Email: [email protected] Url: http://www.askmanisha.com Contact: +91-11-26449898, 26489899

CAPRICORN

AQUARIUS

PISCES

Card of the Month: The Lovers

Card of the Month: Two of Coins

Card of the Month: Fool

Resistance is something you possess in spades. When you ﬁnd resistance in yourself, your tendency is to back away and pretend it isn’t there. If you ﬁnd yourself resisting the health practices you identiﬁed, the ﬁrst thing to do is suspend judgment. Go back to your list and ﬁnd other options that suit you better. Resist discouragement!

There will surely be obstacles in your path as you start out on your new health regimen. There could be many reasons to stay away from exercising or shopping for dinner. As you become stronger in your practices, these obstacles will miraculously disappear. The more you trust your intuition, the more it will keep you on the right path.

The process of starting and stopping, and then starting all over again is a big part of learning something new. Imagine a baby learning to walk. Imagine yourself learning a foreign language. Encouragement from within and never giving up are two things to remember! Don’t forget to praise yourself after fulﬁlling your goals.

RASHMI SHETTY’S AGE ERASE Worried about not ageing gracefully?Do you constantly ﬁnd yourself wistfully wishing you could turn back the clock? The clock keeps ticking. That’s inevitable. What we can do, however, is slow down the process and push further the visible signs of ageing. In Age Erase, renowned aesthetic physician Dr. Rashmi Shetty will ﬁll you in on the what’s, whys and how’s of ageing, the reason why these changes occur and how simple do’s and don’ts can make a remarkable difference. Immerse yourself in insights on the latest advances in skin care, the right kind of nutrition and cutting-edge anti-ageing solutions. From the latest advancements in aesthetic medicine to old-fashioned kitchen remedies that really work to grandmother antidotes, Age Erase unlocks the secrets of ageing gracefully. Dr. Rashmi Shetty, industry pioneer, celebrity doctor, author and leading expert in non-surgical aesthetic Medicine, graduated from the prestigious Mysore University and holds a Diploma in Cosmetology (Chester, UK), FRSH (UK). Her training in plastic surgery under some of the ﬁnest plastic surgeons in the country has been the foundation of her

achievements. Her eye for facial aesthetics, excellent injector skills and her drive to innovate has kept her at the forefront of non-surgical facial aesthetics. Dr. Shetty is the only Indian doctor

on the international advisory board of the Anti-ageing World Congress. She is also on the scientiﬁc advisory board for Aesthetics Asia & 1st Aesthetics and anti-aging Medicine Asian Congress (AMAC). Dr. Shetty is the silent reason behind some of the most beautiful celebrity faces in India and led launches of many of the largest Aesthetic Injectable products like Juvederm, Voluma and Reﬁne. Her vibrant practice includes her private clinic, Ra Skin and Aesthetics in Santa Cruz (Mumbai) and Reva Health & Skin (Hyderabad). Dr. Shetty also leads the aesthetics industry with the ongoing product and technology evaluation and research at her clinic. Book: Age erase Author: Dr. Rashmi Shetty Publisher: Random House India Language: English No of pages: 257 Price: ` 250

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FOOD

recipes

foodies’

day out

84 Diabetic Living SEPT-OCT 2014

With festive season round the corner, its time for action what with Onam, then the Navratras giving way to Dussehra and Diwali. Chefs at Lodi - The Garden Restaurant, New Delhi, will delight us with not only pasta and risotto dishes in September, they will treat us to some awesome seafood, non-vegetarian specialities, mouth-watering desserts and more in October Photos by: Aditya Singh Food Styling: Pallavi Singh Food Courtesy: Lodi-The Garden Restaurant, Lodhi Road, New Delhi Recipes by: Elam Singh Rana (Executive Chef) and Sagar Anand (Sous Chef), Lodi-The Garden Restaurant DiabeticLivingOnline.in

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60 minutes to prep

BRAISED BABY MUTTON SHOULDER WITH ROSEMARY JUS EGGPLANT AND P E P P E R S R ATAT O U I L L E

EGGPLANTS ARE HIGH I N B I O F L AV O N O I D S , WHICH ARE KNOWN TO CONTROL HIGH BLOOD PRESSURE AND RELIEVE STRESS

86 Diabetic Living SEPT-OCT 2014

BRAISED BABY MUTTON SHOULDER WITH ROSEMARY JUS, EGGPLANT AND PEPPERS RATATOUILLE INGREDIENTS:

lamb shoulder olive oil red onion carrot chopped red wine lamb stock coriander powder garlic harissa paste fresh rosemary sprig salt & pepper

700g 30ml 1medium 1 50ml 150ml 15g 2 bulb 1 tsp 2-3 to taste

Method:

1. Place the joint on the chopping board and season on both side with garlic, coriander powder, harissa paste, salt & pepper. 2. Heat the oil in large nonstick frying pan. Cook the lamb for 3-4 minutes on both the sides and transfer to a casserole with lid. 3. In the same pan add the vegetables and cook for 3-4 minutes until brown & transfer it to the casserole. 4. Add wine, stock & rosemary bring to the boil, reduce the heat cover and transfer to the oven for 2- 21/2 hours. Turn the lamb over half way through on cooking time. 5. Serve with cracked potato and rosemary jus.

MUTTON STEAK MARINATED WITH GARLIC, GREEN PEPPER SERVED WITH CARAMELISED ONION, CRACKED POTATO AND RED WINE JUS INGREDIENTS:

mutton steak 220g garlic clove, chopped 1 shallots, chopped 4 celery sticks, chopped 2 bay leaf 1 thyme 1 sprig olive oil for frying lean meat trimmings, chopped 50g red wine 20 ml bott

60

minutes to prep

M U T T O N S T E A K M A R I N AT E D W I T H G A R L I C , GREEN PEPPER SERVED WITH CARAMELISED O N I O N , C R A C K E D P O TAT O A N D R E D W I N E J U S

G A R L I C R E G U L AT E S B L O O D S U G A R A S IT ENHANCES THE LEVEL OF INSULIN IN T H E B L O O D . T H I S M AY A S S I S T I N T H E CONTROL OF DIABETES Method:

1. Marinate steak with thyme, garlic, olive oil, red wine, salt and pepper. 2. Smash two garlic cloves with the ﬂat side of your knife and drop them into the saucepan with some oil and sauté lean meat. 3. Add the vegetables and cook until brown. 4. Pour in the wine and submerge the thyme sprig. 5. Let the red wine simmer with the herbs over medium heat until the volume has reduced by half. 6. Once reduced, pour in the meat stock along with a couple of turns from your pepper grinder. Let it simmer and reduce to half. 7. Grill the steak as per the doneness. 8. Serve it with potato wedges and red wine jus.

MUSTARD, LIME & FRESH DILL MARINATED PRAWNS WITH GARLIC RIVOLI

INGREDIENTS:

prawns garlic lemon parsley (chopped) white wine grain mustard red lettuce green lettuce salt & pepper

150g 1tsp 1 1tsp 5ml 1tsp 30g 30g to taste

Method:

1. Prepare the prawn peel and de vein, leaving the tail intact. 2. Place prawn in a shallow dish, drizzle with white wine. Toss prawns with chopped garlic, parsley, lemon juice and grain mustard to coat well. Season with salt and pepper. 3. Cook the marinated prawn on the barbecue for about 5-6 minutes or until pink all over and slightly charred. 4. Serve it with refreshing salad, lemon wedges and garlic aioli.

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CHAR – GRILLED WHOLE POMFRET INGREDIENTS:

silver pomfrets lemon ginger garlic paste turmeric pwd. red chilli pwd. coriander pwd. cumin pwd. hung curd salt

30

minutes to prep

M A R I N AT E D P R A W N S W I T H G A R L I C R I V O L I

PRAWNS LIKE OTHER FISHES ARE A G O O D S O U R C E O F O M E G A - 3 FAT T Y A C I D S - E S S E N T I A L FAT T Y A C I D S YOUR BODY DOES NOT PRODUCE

R I C O T TA & P I N E N U T R A V I O L I TOSSED IN EXTRA VIRGIN OLIVE OIL

30

minutes to prep

2 whole 2 1 tbsp

big pinch 1 tsp 1 tsp 1/2 tsp 2 tsp to taste

Method:

1. Wash, clean and dry the ﬁsh. Make slits on the ﬁsh and marinate it in salt and lime juice for 10 minutes. 2. Meanwhile mix together gingergarlic paste, turmeric pwd., chilli pwd., coriander pwd., cumin pwd., and hung curd. Then apply this paste to each of the ﬁsh and keep aside for at least 2-3 hours. 3. Keep you charcoal grill ready. Place the ﬁsh on the preheated grill and let it cook for 3-4 minutes and then turn the ﬁsh on the other side and let it cook for another 3-4 minutes, or till golden brown. 4. Serve it with refreshing green salad, lemon wedges and spiced tomato chutney.

RICOTTA & PINE NUT RAVIOLI TOSSED IN EXTRA VIRGIN OLIVE OIL INGREDIENTS:

ﬂour salt egg ricotta cheese pine nut grated parmesan lemon garlic thyme (ﬁnely chopped) salt & pepper extra virgin olive oil

1cup ¼tsp 1 70g 30g 2tsp 1 2cloves 1tsp to taste 1tbsp

Method:

1. Crack the egg into a large bowl and beat with a fork. Add ﬂour to the bowl, mix until a smooth dough forms. 2. Take the dough, form it into a ball and place it on clean work surface. 88 Diabetic Living SEPT-OCT 2014

CHAR-GRILLED WHOLE POMPRET

30

minutes to prep

POMFRET FISH IS HIGH I N V I TA M I N D . I T I S ALSO LOADED WITH MINERALS LIKE IRON, ZINC AND CALCIUM

30

minutes to prep

LEMONY PRAWN AND PEA RISOTTO

THE UNIQUE PHYTONUTRIENTS IN PEAS PROVIDE US WITH KEY ANTIOXIDANT AND ANTII N F L A M M AT O R Y B E N E F I T S

3. Knead it well until it becomes elastic. 4. Dust a rolling pin with the ﬂour to prevent sticking. 5. Roll out the dough until it is about 1/8 inch thick. With a cookie cutter cut out circles in the dough. 6. In a medium sized bowl, mix ricotta, pine nuts, parmesan cheese, chopped thyme, lemon zest, salt & pepper together to form a ﬁlling for ravioli. 7. Take the ravioli ﬁlling and place a tablespoon of it in middle of dough. 8. Fill a small bowl with water, dip you ﬁnger in, and moisten around the outer edge of the dough circle. Cover it with the other dough sheet and press it around to make a full moon shape. 9. Bring a saucepan of salted water to the boil over medium heat. Add stuffed dough sheet and cook until they rise to the surface. 10. Use a slotted spoon to drain and transfer to a bowl & grease it with a little oil so that they don’t stick together. 11. In a non stick frying pan add olive oil and then add thyme. 12. Pour over the pasta, toss it all together gently and serve it sprinkled with parmesan shave and a sprig of basil leaf.

LEMONY PRAWN & PEA RISOTTO INGREDIENTS:

arborio rice 100g olive oil 1tbsp prawns (peeled, deveined) 75g frozen green peas 30g onion (ﬁnely chopped) 1 garlic (ﬁnely chopped) 2 white wine 2 tbsp lemon 1 grated parmesan cheese 10g ﬁsh stock 1 cup salt and black pepper to taste Method:

1. Heat the ﬁsh stock in a pan to a very gentle simmer. 2. Heat the olive oil in a large non-stick pan. Gently fry the garlic and onion over medium heat, until the onion is soft and translucent.

30

minutes to prep

A S S O R T E D S E A F O O D PA E L L A W I T H T O M AT O , S A F F R O N , L I M E AND WHITE WINE

P O TA S S I U M , F O U N D I N S A F F R O N , I S A N E C E S S A R Y S O U R C E T H AT FAV O U R S C E L L F O R M AT I O N A N D R E PA I R 3. Add the rice and coat with the olive oil, garlic and onion mix. 4. Cook for 2 minutes. 1. Pour in white wine and cook until the liquid is absorbed. Once absorbed, add a ladle of the simmering stock and cook until absorbed. 2. Stir through prawns and peas. Continue until all of the stock is absorbed and rice is al dente. 3. Cook until the prawns change colour. 4. Stir through the lemon juice, parmesan cheese and season it with salt and pepper. 5. Let the risotto rest for few minutes 6. Serve topped with lemon zest.

ASSORTED SEAFOOD PAELLA WITH TOMATO, SAFFRON, LIME AND WHITE WINE INGREDIENTS:

arborio rice ½ cup prawns (peeled, deveined) 70g squid (thick rings) 50g

ﬁsh ﬁllet (cut into cubes) onion (ﬁnely chopped) garlic (ﬁnely chopped) tomatoes (diced) red peppers (diced) frozen green peas saffron threads white wine ﬁsh stock olive oil

70g 1 2 2 ¼ tsp 2tbsp ¼ tsp 1tbsp 1cup 1tbsp

Method:

1. Combine stock and saffron in a medium saucepan over medium heat. Bring to the boil. Cover and reduce heat to medium low. 2. Meanwhile, heat oil in paella pan over medium high heat. Add onion and garlic sauté it for a while and add white wine to it. 3. Add rice, red peppers, green peas and tomatoes, stir to combine. 4. Season it with salt and pepper. Using a spoon, spread mixture evenly over base of the pan.

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HOMEMADE GNOCCHI WITH GORGONZOLA & CRISP BACON

40

minutes to prep

5. Add half the stock mixture and bring to boil over high heat. Shake pan to spread mixture across pan. Reduce heat to medium. Cook uncovered without stirring for 10 minutes until stock is absorbed. 6. Add prawn, squids and ﬁsh pressing into rice mixture. 7. Add remaining stock mixture and cook until all liquid is absorbed. 8. Remove from heat and let it stand under salamander. 9. Serve it garnished with a lemon wedge and a sprig of parsley.

BUTTERNUT SQUASH & FENNEL RISOTTO INGREDIENTS:

OLIVE OIL LOWERS THE LEVELS OF T O TA L B L O O D C H O L E S T E R O L , L D L C H O L E S T E R O L A N D T R I G LY C E R I D E S

P O M E G R A N AT E JUICE AND WINE POCHED PEARS

Method:

30

minutes to prep 92 Diabetic Living SEPT-OCT 2014

arborio rice 100g butternut squash 100g fennel bulb 50g onion (ﬁnely chopped) 1 cloves garlic (ﬁnely chopped) 2 white wine 2tbsp olive oil 1tbsp grated parmesan cheese 10g vegetable stock 1cup basil 2-3 leaves Salt and black pepper

1. Heat the ﬁsh stock in a pan to a very gentle simmer. 2. Heat the olive oil in a large non stick pan gently fry the garlic and onion over a medium heat, until the onion is soft and translucent. 3. Add the rice and coat with the olive oil, garlic and onion mix. Cook for 2 minutes. 4. Pour in the white wine and cook until the liquid is absorbed. Once absorbed, add a ladle of the simmering stock and cook until absorbed. 5. Stir through butternut squash & fennel. Continue until all of the stock is absorbed and rice is al dente. 6. Stir through the parmesan cheese and season it with salt & pepper. 7. Let the risotto rest for few minutes then serve topped with parmesan cheese and fresh basil sprig.

BUTTERNUT SQUASH AND FENNEL RISOTTO

30

minutes to prep

BUTTERNUT SQUASH COMBINES SIMPLE P R E PA R AT I O N W I T H SIGNIFICANT NUTRITION I N T H E F O R M O F V I TA M I N A , V I TA M I N C A N D F I B R E

ALMONDS ARE AN INCREDIBLE SOURCE OF MINERALS SUCH AS M A N G A N E S E , P O TA S S I U M , C A L C I U M , IRON, MAGNESIUM, ZINC AND SELENIUM

ALMOND BREAD PUDDING WITH WARM TOFFEE SAUCE AND HOME FIG ICE CREAM

HOMEMADE GNOCCHI WITH GORGONZOLA & CRISP BACON INGREDIENTS:

potato 200g egg 1 ﬂour 75g parmesan cheese 10g nutmeg 1 small Salt & pepper to taste sliced bacon 100g crumbled gorgonzola cheese ¼ grated parmesan cheese 1 tsp parsley, ﬁnely chopped 1 tsp cream ¼ cup Method:

60

minutes to prep

94 Diabetic Living SEPT-OCT 2014

1. Place potato in a saucepan with enough water just to cover potatoes. Bring to boil over high heat. Steam, covered until tender. Transfer to a bowl and use a potato masher to mash until smooth. Season it with salt, pepper & grated nutmeg. 2. Add the egg yolk and stir with a wooden spoon until combined. 3. Add half the ﬂour and parmesan cheese and stir until combined. Add the remaining ﬂour, in 2 more batches, until well combined and a ﬁrm dough forms. Turn onto a lightly ﬂoured surface and knead until smooth. 4. Roll the dough in a log and cut it into pieces with knife. 5. Lightly ﬂour your hand and roll each piece of dough into a ball. Use your thumb to roll each ball over a ﬂoured fork. Place on tray. 6. Bring a saucepan of salted water to the boil over medium heat. Add gnocchi and cook until they rise to the surface. 7. Use a slotted spoon to drain and transfer to a bowl & grease it with a little oil so that they don’t stick together. 8. In a non-stick frying pan cook the bacon over medium heat until it is browned. 9. Add gnocchi and toss to coat. Cook the gnocchi stirring frequently; add all the cheese and a spoonful of cream. Stir gently, adding more cream to help cheese melt and form a sauce. 10. Stir in the chopped parsley. 11. Serve hot with grated parmesan cheese on top.

POMEGRANATE JUICE AND WINE POCHED PEARS INGREDIENTS:

ripe, ﬁrm pear pomegranate juice dessert wine pomegranate seeds

1 1/2 cup 1/4 cup 2 tsp

Method:

1. Peel pears, leaving them whole and stems intact. Slice off the bases so the pears will stand upright. Use an apple corer to remove cores, if desired, working from the base up. 2. Place the pears on their sides in a large saucepan. Pour pomegranate juice and wine over the pears. Bring to a simmer over medium-high heat. 3. Cover, reduce heat to low and simmer gently until the pears are tender when pierced with the tip of a sharp knife, 30 to 45 minutes. 4. Curn very gently once or twice as they cook so they colour evenly. Using a slotted spoon, transfer the pears to a shallow bowl and set aside. Boil the poaching liquid over high heat until the sauce is reduced to 1/4 cup, 15 to 20 minutes. To serve, spoon 1 tablespoon sauce onto dessert plates. Place a sliced pear upright on plate. Drizzle remaining sauce over pear and sprinkle pomegranate seeds around it. Serve it with a scoop of vanilla ice-cream

ALMOND BREAD PUDDING WITH WARM TOFFEE SAUCE AND HOME FIG ICE CREAM INGREDIENTS:

eggs sugar free ﬂour butter baking powder vanilla essence almonds (chopped) milk maid butter brown sugar

9 ½ kg ½ kg ½ kg 1tsp 1tsp 100g 800g 100g 100g

3.5 hours to prep

MANGO CHEESE CAKE

C H E E S E C O N TA I N S S U B S TA N C E S C A L L E D C O N J U G AT E D L I N O L E I C A C I D A N D S P H I N G O L I P I D S T H AT M AY H E L P PREVENT CANCER beating for another 4-5 minutes until light and ﬂuffy. Add vanilla and stir on low until just combined. 4. In a separate bowl sift together dry ingredients. Add to eggs & sugar free on low speed until just combined. 5. Pour into greased and ﬂoured cake mould. Bake at 325° F until a tooth pick inserted come out clean. 6. Remove from oven and let it cool down completely. Cut it into portions. 7. Melt equal weight of butter and brown sugar in a pan and simmer on a low heat until the two become smooth liquid. Add condensed milk and raise the temperature very gently until it starts to simmer. 8. Keep the temperature low and stir continuously until brown. 9. Serve the bread pudding warm with caramel sauce and a scoop of ﬁg ice-cream.

Method:

MANGO CHEESE CAKE

1. Beat egg in large mixing bowl for 4 minutes with hand blender. 2. Add sugarfree and continue

INGREDIENTS:

mango pulp sugar free

500g 100g

mascarpone cheese digestive biscuit melted butter honey

500g 1 pkt 30g 10g

Method:

1. In a food processor, grind biscuits roughly, add melted butter and honey to it process brieﬂy. 2. Line the cake mould press the crumbled biscuit mixture to bottom. 3. In a large bowl, whip the mascarpone cheese until light and ﬂuffy. 4. Add sugar free and continue whipping for another minute. Fold mango pulp to the cheese mixture. 5. Pour the mixture in the cake mould over the crumbled biscuit and refrigerate it for 3 hours. 6. Pour over the left over mango pulp on top of the cheese mixture & refrigerate until its set. 7. Serve a slice of cheese cake topped with sliced mango and a mint sprig. N:B: Diabetics should avoid desserts.

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