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Dr K K Aggarwal

Managing Diabetes

By Dr K K Aggarwal
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• People with pre diabetes are at increased risk for developing type 2 diabetes, heart disease and Paralysis.

• More than 25% people have pre diabetes (blood sugar level more than 90 but below 126 mg/dL) but only 4% know it needs attention.

• Diabetes is not just controlling blood sugar. Controlling BP (<120/80) and LDL bad cholesterol (<70) is equally important.

• Smokers face 44% increased risk of diabetes when compared to nonsmokers (Swiss researchers JAMA)

• Advancing age, diabetes, high BP, obesity, smoking, drugs, heart diseases, alcohol, cycling for > 3 hours/week can cause erectile dysfunction.

• Each 1 mg increase in serum uric acid increases the risk of developing diabetes by 18%.

• Keep your fasting sugar, lower BP, bad cholesterol, abdominal girth all below 80.

• Recent studies have shown that people at risk of type 2 diabetes can prevent onset of diseases by losing 5 to 7% body weight.

• Patients with diabetes should drive only if their blood sugar is under control and there is no evidence of end organ disqualifying disease.

• Significant snoring with episodes of cessation of respiration during night can lead to diabetes. • Treating depression may help people with diabetes get their blood sugar under control.

• Sudden cardiac death is preventable – keep your diabetes under control.

• If BP and diabetes are kept under control, 75% dialysis and transplants can be prevented.

• One in five patients with diabetes have abnormal Treadmill Stress Test

• Patients with metabolic syndrome are 5 times more likely to develop diabetes (National Heart, Lung, Blood Institute).

• Diabetic patients have similar risk as non–diabetics with one heart attack.

• Fifty percent of diabetic patients may have associated high blood pressure.

• Uncontrolled diabetes can cause heart attack.

• Hypertension and diabetes together raise the chances of heart attack manifold.

• Diabetics can have heart attack without the classical symptom of pain.

• Diabetes can remain silent for over five years.

• Uncontrolled diabetes can cause impotence.

• Uncontrolled diabetes can cause blindness.

• Uncontrolled diabetes can cause paralysis.

Why Spirituality is Happiness Friendly

By Dr K K Aggarwal
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• What you believe in can have a big impact on health and longevity. People with high levels of religious beliefs or spirituality have lower cortisol responses. Cortisol is a hormone the body releases in response to stress.

• Positive thinking produces nearly a 30 percent drop in perception of pain.

• Spirituality and the practice of religion is associated with a slower progression of Alzheimer’s disease.

• Those who regularly attend organized religious activities may live longer than those who don’t. Regular participation lowers mortality rate by about 12 percent a year.

• People undergoing cardiac rehabilitation feel more confident and perceive greater improvements in their physical abilities if they have a strong faith.

• Increased levels of spirituality and religious faith may help substance abusers kick their habit.

• Spirituality stimulates the relaxation response. When the body is relaxed, your heart rate, blood pressure and breathing rate all go down, which decreases the body’s stress response.

• Spirituality can affect immune-system function. Spirituality, faith, church attendance improves immune function in ways that can be measured, like an increase in white blood cells.

• Prayer heals the heart. Positive talking and thinking in the ICU produces better results.

• Spirituality is what brings you peace and safety. It can be achieved through God or Goddess, nature, a beautiful sunset, a meditation, Pranayama, religious meeting, chanting, mind body relaxation, etc. Spirituality is something that can help all the way from promoting wellness to helping with recovery.

Low–heat cooking may reduce insulin resistance – Traditional Ayurveda cooking recommends low heat cooking and now a western study endorses it.

By Dr K K Aggarwal
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Low–temperature cooking reduces insulin resistance among overweight women as per a 4–week study published in the journal Diabetes Care by Alicja B. Mark, PhD, from the department of nutrition, exercise and sports, faculty of science, University of Copenhagen, Denmark, and colleagues. Cooking at high temperature such as with baking, roasting and frying — induces formation of advanced glycation end products (AGEs), which are associated with inflammation and believed to impair glucose metabolism in patients with type 2 diabetes. Common high–AGE foods include bakery products, cooked meat and roasted coffee. In the study patients randomized to a high–AGE diet were instructed to fry, bake, roast, or grill their food, eat bread with the crust and choose other high–AGE foods from a list. The low–AGE group was told to boil or steam their food, eat bread without the crust, and choose lower–AGE foods from a list. They were also randomized to supplements of either fructose or glucose.

At 4 weeks, no effect was seen from the fructose or glucose on insulin resistance, as assessed by the homeostasis model assessment of insulin resistance (HOMA–IR) and the calculated insulin sensitivity index (ISI) or on any secondary measures. But the AGE content of the diet did make a difference. Weight, BMI, and waist circumference all decreased in both the high– and low–AGE groups, but to a greater degree among those in the low–AGE group compared with the high–AGE group. Overall, the low–AGE group consumed about 15% more protein, 10% more carbohydrates, and 22% less fat than did the high–AGE group

Spirituality, The Key To Health

By Dr K K Aggarwal
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To stay healthy, one needs to eat right, get plenty of exercise and rest and avoid bad habits such as smoking. But, now it is said that “what you believe in” can have a big impact on health and longevity. Many studies show that patients with strong spirituality can improve their health from a variety of chronic conditions, like hypertension, heart disease, recovery from surgery and more. Research indicates there are real health benefits from spirituality:

• People with high levels of religious beliefs or spirituality have lower cortisol responses. Cortisol is a hormone the body releases in response to stress.

• Positive thinking produces nearly a 30% drop in perception of pain.

• Spirituality and the practice of religion have recently been associated with a slower progression of Alzheimer’s disease.

• Those who regularly attend organized religious activities may live longer than those who don’t. Regular participation lowers mortality rate by about 12% a year.

• People undergoing cardiac rehabilitation feel more confident and perceive greater improvements in their physical abilities if they have a strong faith.

• Increased levels of spirituality and religious faith may help substance abusers kick their habit. • Spirituality stimulates the relaxation response. When the body is relaxed, your heart rate, blood pressure and breathing rate all go down, which decreases the body’s stress response.

• Spirituality can affect immune-system function. Spirituality, faith, church attendance improves immune function in ways that can be measured, like an increase in white blood cells.

• Prayer heals the heart.

• Positive talking and thinking in the ICU produces better results. Spirituality is what brings you peace and safety. It can be achieved through God or Goddess, nature, a beautiful sunset, a meditation, Pranayama, religious meeting, chanting, mind-body relaxation, etc. Spirituality is something that can help all the way from promoting wellness to helping with recovery.

Drinking coffee prevents Parkinson’s diseas

By Dr K K Aggarwal
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Nicotine present in the tobacco has been used for its medicinal value for quite some time for diseases like Parkinson’s disease and ulcerative colitis. A study from University of Miami School of Medicine, USA has shown that people from families prone to Parkinson’s disease are less likely to develop the disease if they drink coffee on a regular basis.

Both coffee and nicotine have a link with dopamine in the brain. Dopamine is a chemical that decreases in patients with Parkinson’s disease.

It is possible that people who are going to have Parkinson’s disease have lower levels of dopamine. Those with low levels of dopamine may be more likely to enjoy caffeine.

Parkinson’s disease is caused when brain cells that produce dopamine die. The disease is progressive and affects about one percent of people older than 65. Symptoms include tremors, muscular rigidity and slow movements and can progress to paralysis. There is no cure, although a number of drugs can make symptoms better for a time.

Spiritual prescriptions learnt from patients

By Dr K K Aggarwal
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As doctors we are witness to human suffering. When we were young in medical college, we were quite disturbed seeing the sufferings of the people. But, in our practice, we have learnt many spiritual prescriptions from our patients. These have not only helped us to heal our patients but also changed our perception to health and sickness.

I recall Swami Bodhanand, a disciple of Swami Chinmayananda, was once hospitalized under our care. When I asked him to give me a spiritual message, he said only two words “Detached Attachment”. He said, “As a doctor you should behave like a lotus leaf. It is wet as long as there is a drop of water on it, but once the drop is out, the leaf is as dry as if the water was never there.” The message was that “we should be attached to our patients as long as they are with us. The day they die, we should be completely detached from them or else we will not be able to treat other patients”.

I saw another spiritual guru through our Chief Anesthetist. The fee he paid me was a spiritual message “Suno Samjho Jano Karo – Hear Understand Wisdom and Do”. He said that hearing is different from listening, listening is different from wisdom and wisdom is different from doing. Unless you hear, understand what you have heard and implement, the learning has no value.

One of my Buddhist patients gave me a spiritual learning, which has helped me a lot in my routine clinical practice. He taught me the basic Buddhist message that there is suffering all over, there is a reason for every suffering and it is possible to maintain sufferings. This message fits into the main message of Hinduism and also the main teaching from Garud Purana.

In Hinduism, we know that the very fact that we are born in this life means that in our last life, we could not get liberation as Hinduism believes that after liberation you are not reborn. Not getting liberated in the last birth means that some sufferings were left in our life. The basic purpose of this birth, therefore, is to face sufferings. When the basic purpose of our birth is to face sufferings, then why suffer from these sufferings. Every time we suffer, we should thank God that he has reduced one more. The period in between two sufferings is called a happy period (Sukh). In fact that period is nothing but a period of rest given by God to us to prepare the body for next suffering. This as a concept of counseling helps my patients in managing most of their mental disturbances.

Not telling a patient that he is suffering from terminal cancer sometime works. One of my patient’s father aged 83 years was found to have extensive cancer of the prostate. Medically, we all gave him three months to live. My patient did not have the courage to tell his father or the family members that he (the father) had extensive cancer. He took me into confidence and played a game with the family. We gathered all the family members and told them that with the surgery this cancer had been cured. A party was organized in the evening to celebrate the cure. The magic happened; he lived almost a symptom–free life for the next 9 years. I have tried this on many of my patients thereafter and it works. The probable explanation was loss of fear of death, a confidence in his doctor and faith in himself.

The way to live up to the age of hundred is to go on working in life. My great grand–father–in–law was 75 years old, when I got married. That year, he gathered all family members across the world and said that his purpose of life was over and, he would like a collective family photograph and like to quit the world. Nothing happened for a year and he did this again next year. The Entire family from across the world gathered but he remained alive for another year. This went on for three years. Suddenly, we played a spiritual trick on him and told everyone to convince him that he is going to live for 100 years as he has many more work of the family to be done. Every year, we gave him law students from within the family to be taught (he was a lawyer himself), or gave him the responsibility of finding a boy for some eligible girl in the family. We made him teach and search for suitable bride/bridegrooms for years together and he actually died at the age of 100 years. This is the beauty of positive attitude in life.

Tips on family history of high cholesterol

By Dr K K Aggarwal
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Premature heart disease is when heart disease occurs before 55 years in men and 65 years in women. In premature heart disease, the prevalence of dyslipidemia (high cholesterol levels without symptoms) is 75-85%. Fifty-four percent of all patients with premature heart disease and 70% of those with a lipid abnormality have a familial disorder. Hence, a screening test for lipids is recommended for first-degree relatives of patients with myocardial infarction, particularly if premature. Screening should begin with a standard lipid profile and if normal, further testing should be done for Lp(a) and apolipoproteins B and A-I. About 25% patients with premature heart disease and a normal standard lipid profile will have an abnormality in Lp(a) or apo B. Elevated apo A-1 and HDL are likewise associated with reduced CHD risk. First-degree relatives are brothers, sisters, father, mother; second-degree relatives refer to aunts, uncles, grandparents, nieces, or nephews and third-degree relatives refer to first cousins, siblings, or siblings of grandparents. Familial hypercholesterolemia (FH) is a genetic disorder, characterized by high cholesterol, specifically very high LDL “bad cholesterol”) levels and premature heart disease. Patients may develop premature cardiovascular disease at the age of 30 to 40. Heterozygous FH is a common genetic disorder, occurring in 1:500 people in most countries. Homozygous FH is much rarer, occurring in 1 in a million births. Heterozygous FH is normally treated with drugs. Homozygous FH often does not respond to medical therapy and may require apheresis or liver transplant. To detect familial high cholesterol levels, a universal screening must be done at age 16. The cholesterol levels in heterozygous patients are between 350 to 500 mg/dL, and in homozygous, the levels are between 700 to 1,200 mg/dL.

Four Phases of Relationships and the Seven Year Itch

By Dr K K Aggarwal
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1. Euphoria

2. Reaction

3. Adjustment

4. Liking as the four phases of any relationship. When you get married you are euphoric; once the honeymoon is over, you react to each other and over a period of time you start adjusting with each other and it may take seven years before you start liking each other.

Walking Tips

By Dr K K Aggarwal
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• It requires no special clothes or equipment, and it’s free.

• Make walking fun by going to places you enjoy, like a shopping center or park.

• Bring along someone to chat with, or listen to some of your favorite music (but keep the volume low enough to hear the sounds around you).

• Think about safety as you plan when and where to walk.

• Walk with others when possible, and take a phone and ID with you.

• Let someone know your walking time and route.

• If it’s dark outside, wear a reflective vest or brightly colored clothing.

• And always be aware of your surroundings.

Top Characters of Mahabharata

By Dr K K Aggarwal
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To be in harmony with the body (five elements represented by Draupadi), one must acquire five qualities or in other terms live a focused life, full of strength and not being disturbed with loss or gain and finally working for the welfare of the society without having any partiality towards anyone.

• Balanced mind: Yudhishtir (“sthir” or balanced in “yudh” or disturbed state of mind)

• Focused vision (Arjuna)

• Using internal power or strength (Bhima)

• Not being partial or remaining neutral (Nakul)

• Working for the welfare of the society (Sahdev) With this, one can kill 100 negative qualities that a person can have (the 100 Kauravs). The hundred negative qualities are acquired because of cunningness (Shakuni), not working with the eyes of the soul (Dhritarashtra) and keeping a blind eye to any wrong happening (Gandhari). The main negative qualities are taking decisions in day–to–day life situations (Duryodhana: dusht in yudha or war) and choosing wrong choices as a ruler (dusshasana: dusht and shasan). The positive qualities once acquired will also win over other negative qualities like blind faith or undue attachments (Bhishma pitamaha); unrighteous loyalty (Dronacharya) and unrighteous ego (Karna).

5 Steps to Lower Alzheimer’s Risk

By Dr K K Aggarwal
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• Maintain a healthy weight.

• Check your waistline.

• Eat mindfully. Emphasize colorful, vitamin–packed vegetables and fruits; whole grains; fish, lean poultry, tofu, and beans and other legumes as protein sources plus healthy fats. Cut down on unnecessary calories from sweets, sodas, refined grains like white bread or white rice, unhealthy fats, fried and fast foods, and mindless snacking. Keep a close eye on portion sizes, too.

• Exercise regularly. Aim for 2½ to 5 hours weekly of brisk walking (at 4 mph) or try a vigorous exercise like jogging (at 6 mph) for half that time.

• Keep an eye on important health numbers. In addition to watching your weight and waistline, keep a watch on your cholesterol, triglycerides, blood pressure and blood sugar numbers.

Post menopausal women should get their insulin levels done

By Dr K K Aggarwal
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All postmenopausal women should try to keep insulin at normal levels through weight loss, regular exercise and other methods. Postmenopausal women with elevated insulin levels are at higher risk of developing breast cancer.

As per a report published in the International Journal of Cancer from Researchers at Albert Einstein College of Medicine of Yeshiva University in New York City, there is a strong association between elevated insulin levels in the blood and increased risk of breast cancer. The researchers examined data on 5,450 women who took part in the Women’s Health Initiative and found that women with insulin levels in the highest third were twice as likely to develop breast cancer as women in the bottom third.

The link between elevated insulin levels and breast cancer was stronger for thin women than for obese women, who tend to have higher insulin levels. This finding is potentially important because it indicates that, in postmenopausal women, insulin may be a risk factor for breast cancer that is independent of obesity.

Why do We Burn Camphor in any Pooja?

By Dr K K Aggarwal
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No Aarti is performed without camphor. Camphor when lit burns itself out completely without leaving a trace of it.

Camphor represents our inherent tendencies or vasanas. When lit by the fire of knowledge about the self, the vasanas burn themselves out completely, not leaving a trace of ego.

Ego is responsible for a sense of individuality that keeps us separate from the Lord or consciousness.

In addition, camphor when burns, emits a pleasant perfume. This signifies that as we burn our ego we can only spread love and nothing else.

Kidney patients can become pregnant

By Dr K K Aggarwal
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Pregnancy is not contraindicated in most women with diabetic nephropathy (kidney disease).

Maternal and peri-birth outcomes are generally good with tight control of sugar and blood pressure. Although mortality is low, maternal and neonatal morbidity are increased compared to non-diabetics and diabetic women without nephropathy. The major obstetrical complications are preeclampsia, fetal growth restriction and preterm birth.

Pre-conceptional treatment with drugs like angiotensin-converting enzyme inhibitors and angiotensin II receptor antagonists in women with microalbuminuria may have benefits that extend through the pregnancy. These agents should not be used during pregnancy as they are teratogenic.

Pregnancy does not appear to accelerate the progression of diabetic nephropathy in women with a mild to moderate decline in renal function.

Women with moderate to severe renal impairment (serum creatinine level >1.5 mg/dL, proteinuria >3g in 24 hours) may benefit from renal transplantation or dialysis therapy before initiating pregnancy.

9th Chaitra Navratri: Siddhidatri

By Dr K K Aggarwal
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Spiritual message on the 9th Navratri: By the 9th day of spiritual detoxification one gets all spiritual powers. Siddhidatri is worshipped on the Ninth Day of Navratri.

• She gives all the eight siddhis – Anima, Mahima, Garima, Laghima, Prapti, Prakamya, Iishitva and Vashitva.

• She rides on a lion or on a lotus

• She has four hands and looks pleased.