July 7, 2011
Â A study published in June 2011 Edition of the journal Diabotologia has shown that in people with newly diagnosed Â type Â 2 diabetes the disease can be reversed by reducing the dietary intake. So far, type 2 diabetes was being regarded as inevitably progressive with irreversible beta cell failure.
Â The authors from UK studied 11 patients with type 2 diabetes with a mean age of 50 years and a mean body mass index (BMI) of 34 and evaluated them on 8-week diet of 600 calories per day. Within a week of restricted diet, fasting sugar normalized in the diabetic group. All available tests to check for beta cell dysfunction normalized within eight weeks. There was a normalization of insulin resistance and other biochemical abnormalities like insulin suppression, hepatic glucose and hepatic triglyceride content and the first phase insulin resistance.
Â Our own results at Moolchand Medcity with a dietary programme called â€œNon-scalpel bariatric surgeryâ€ have shown similar results. A reduction in the requirement of diabetic drugs including insulin by 40% occurs by the end of first week with improvement in all the parameters of insulin resistance like high triglycerides, low HDL cholesterol and abdominal circumferences by 12 weeks.
Â The â€œNon-Scalpel Bariatric Surgeryâ€ diet includes consuming less than 80 gm or 80 ml of caloric food at one go with an average diet of less than 1200 Kcal per day. The diet includes zero transfats, zero refined carbohydrates and only one complex carbohydrate meal a day. Â In one patient, the requirement of insulin reduced from 150 to 30Â units and in others, from 100 to 0 units.
Â Similar changes are seen after any bariatric surgery. Â Today, bariatric surgery is becoming very popular but before contemplating bariatric surgery, an aggressive lifestyle management programme for diabetics should be attempted.
Â Our â€œNon Scalpel Bariatric Surgeryâ€ dietary programme also includes Yoga, Pranayama, Behavioral CounselingÂ and Ayurvedic whole body massage.
Â The fall in fasting blood glucose levels is apparent much before clinically evident weight loss.
July 7, 2011
A study published in July 6 issue of Journal of American Medical Association has shown that majority of percutaneous coronary interventions (PCIs) performed for acute emergent indications in the USA are done for the right reasons but when there is a choice between a drug and a stent, the choice is always a stent.
The study showed that during acute interventions, 98.61% procedures were appropriate, 0.31% had uncertain benefits and 1.1% were inappropriate. However, when elective procedures were analyzed, only 50.4% were appropriate, 38% had uncertain benefits and 11.61% were inappropriate.
In elective procedures, most of the inappropriate procedures were in patients with no angina (53.8%), low risk ischemia on stress testing (71.6%) or inadequate anti angina therapy (95.81%). Ninety-four percent of them did not have high risk coronary anatomical findings.
In 2009, six organizations â€“ The American College of Cardiology, Society for Cardiovascular Angiography and Interventions, The Society of Thoracic Surgeons, American Association for Thoracic Surgery, American Heart Association and the American Society of Nuclear Cardiology issued guidelines and defined what is appropriate and what is not appropriate.
When it comes to medical versus percutaneous interventions, the results of Courage Trials cannot be dismissed. As per the report, of every 1000 chronic stable angina patients undergoing angioplasty, two will die, 28 will have heart attack related to the procedures, 60-90 will have improved symptoms and 800 will have no usable benefit above that given by the drug treatment. As per Dr Gems Sten of University of Wisconsin, Madison, 85% of coronary interventions with stents in US are done in stable patients and of those at least 25% are asymptomatic at the time of stenting.
Heart attacks are not caused by a stable plaque or blockage that gradually occludes an artery; instead they are caused by a plaque which ruptures partially, causing sudden formation of a blood clot inside the artery, which then suddenly occludes the artery. Rupture and clotting is as likely to happen in a plaque that is causing only a 10% fixed blockage as in one that is causing an 80% blockage. Hence, stenting plaques that are causing greater degrees of fixed blockages will relieve an angina being caused by the blockage, but will not reduce the risk of future acute heart attacks, especially, since many of these heart attacks are associated with plaques which are labeled as insignificant at the time of angioplasty.
Preventing the acute rupture of plaque and thus preventing a heart attack is more of a medical problem than a plumbing problem and best treated with drugs and aggressive lifestyle changes.
Stabilizing the coronary artery plaque and making it less likely to rupture requires aggressive control of cholesterol, blood pressure, inflammation, regular exercise and heart friendly diet. Aggressive drug therapies will include aspirin, statin, beta blockers and other blood pressure reducing medicines.
The result of Courage Trials in patients with stable angina showed that patients receiving stent for stable angina are just as likely to have a heart attack or die as patients treated with aggressive drug therapy alone.
The Courage Trials published in the New England Journal of Medicine showed that at 36 months, there was no significant difference in health status between the patients treated with drugs or stent. The Courage Trials opined that people with coronary stable angina should be continued on drugs and aggressive lifestyle management and coronary interventions deferred till the aggressive treatment fails.
July 7, 2011
Â A new study published in the American Journal of Hypertension has reported that there is no strong evidence that advising people to eat less salt or putting them on low salt diet reduces their death rate or cuts cardiovascular events.
In the study, the researchers combined the results of 7 previous randomized clinical trials that looked at the effects of lowering salt consumption in 6250 people with normal and high blood pressure.
While there was evidence that reduced salt (sodium chloride) did produce a small decrease in the blood pressure, there was insufficient data to confirm whether that decrease in blood pressure had any affect one way or the other on the chances of dying.
Whether or not to reduce salt in the diet has been a controversial subject in medical science.
In modern medicine, two types of people are recognized: Salt-sensitive and salt-resistant. In salt-sensitive people, the blood pressure fluctuates with excessive salt intake; in the salt-resistant individuals, the blood pressure is unaffected with salt intake. Results of most studies vary depending upon the population of patients being investigated. If the study population includes more of salt-resistant people, the results will different from those observed when the study includes more salt sensitive people. In modern medicine, we have no means or method to find out which patient is salt-sensitive or salt-resistant. The traditional Indian Ayurveda system, if combined with modern science, can provide an answer to this. According to Ayurveda, every human being is made up of three Doshas (characteristics) and they are: Movement (Vata), metabolism (Pitta) and structure (Kapha).
Movement (Vata) function is built up from air and space element; Metabolism (Pitta) function is made from fire and water element and Structure (Kapha) from earth and water elements. Accordingly, there are three types of personalities: Vata, Pitta and Kapha. A Vata person is a movement-predominant personality, pitta, a metabolism-predominant personality and Kapha is a structure-predominant personality.
Â A Vata person is thin-built with dry and cold hands, more prone to pain, gaseous distension, insomnia, dysmenorrhea, constipation, anxiety, fear and to addictions. These are the people who are sensitive to bitter, stringent and pungent tastes.
Â A Pitta person is medium-built with strong metabolism, warm and wet hands. He/she is prone to acidity, inflammation, ulceration, premature graying of hairs, kidney, gallbladder stones, heart attack etc. They are sensitive to pungent, sour and salt taste.
A Kapha person is heavy-built with more of earth and water elements. They have cold and wet hands and are more prone to obesity, hypothyroidism, water retention, diabetes, heaviness, etc. They are sensitive to sweet, sour and salt tastes.
Ethnically, people in US have more of Vata and Kapha personality traits. Therefore, there are chances that studies done on US population give varied results.
The Indian population has more of Vata and Pitta personality traits. But there are a greater number of Pitta people than Vata people; therefore, India will have more salt-sensitive people than in the US.
The clinical answer is very simple: Calculate your personality; are you a Vata, Pitta or Kapha person? If you are Vata-predominant, you may not be required to reduce your salt intake, but if you are a Pitta- and Kapha-predominant person, you will need to reduce your salt (sodium chloride) intakes to less than 6 gm a day.
For Indians, the best advice is to consume normal salt in the diet from vegetables, pulses and avoid extra salt on the table by way of limiting salts in curd, salads, butter etc. There are lots of kitchen alternatives available that can replace salt in salads etc.