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Dr K K Aggarwal

Do not replace saturated fat with refined carbohydrates

By Dr K K Aggarwal
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It is wrong to say eat less fat; the real message should be eat more fresh fruits and vegetables.

While advocating low-fat diets, it is easier for patients to understand the advice given in terms of foods, e.g., “Eat more fresh fruit” rather than nutrients, or “Reduce your intake of fat to less than 30% of your total energy intake.”

The message to reduce fat has been translated by food manufacturers and consumers into a potentially harmful set of food choices.

Instead of replacing high-fat foods with naturally low-fat foods with other benefits, such as fruits, vegetables, legumes, and whole grain foods, consumers have often increased their consumption of low-fat or “fat-free” varieties of naturally high-fat foods, such as fat-free snack or junk foods.

The result is an increase in refined carbohydrates which lowers good HDL cholesterol concentrations with a possible increase in the incidence of type 2 diabetes and obesity.

What type of a vegetarian are you?

By Dr K K Aggarwal
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There are 4 main types of vegetarian diets:

  • Lacto–ovo–vegetarian consumes dairy products and eggs but no meat, poultry, or seafood
  • Lacto–vegetarian eats dairy products but not eggs, meat, poultry, or seafood
  • Ovo–vegetarian eats eggs but no dairy products, meat, poultry, or seafood
  • Vegan does not eat any animal products, including meat, fish, poultry, eggs, and dairy products; many vegans will also avoid honey.

Vegetarian and plant–based diets are associated with a reduced risk of obesity, diabetes, heart disease, and some types of cancer as well as increased longevity. Vegetarian diets are typically lower in fat, particularly saturated fat, and higher in dietary fiber. They are also likely to include more whole grains, legumes, nuts, and soy protein, and together with the absence of red meat, this type of eating plan may provide many benefits for the prevention and treatment of obesity and chronic health problems, including diabetes and cardiovascular disease.

Some tips to keep obesity under check

By Dr K K Aggarwal
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  • Skip carbohydrates once in a week.
  • Combine a sweet food with bitter food (for instance, choose to cook aloo methi over aloo matar).
  • Consume bitter green items in foods such as karela, methi, palak, bhindi, etc.
  • Do not eat trans fats.
  • Do not consume more than 80 ml of soft drink in a day.
  • Do not consume sweets with more than 30% sugar.
  • Avoid maida, rice, and white sugar.
  • Walk, walk and walk…

Diabetes mainly linked to obesity

By Dr K K Aggarwal
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  • Type 2 diabetes mellitus is strongly associated with obesity. More than 80 percent of cases of type 2 diabetes can be attributed to obesity.
  • There is a curvilinear relationship between BMI and the risk of type 2 diabetes. Lowest risk is associated with a BMI below 22 kg/m2
  • At a BMI greater than 35 kg/m2, the relative risk for diabetes adjusted for age increases to 61. The risk may further increase by a sedentary lifestyle or decrease by exercise.
  • Weight gain after age 18 years in women and after age 20 years in men increases the risk of type 2 diabetes.
  • The Nurses’ Health Study compared women with stable weight (those who gained or lost <5 kg) after the age of 18 years to women who gained weight. Those who had gained 5.0 to 7.9 kg had a relative risk of diabetes of 1.9; this risk increased to 2.7 for women who gained 8.0 to 10.9 kg.
  • Similar findings were noted in men in the Health Professionals Study. The excess risk for diabetes with even modest weight gain is substantial.
  • Weight gain precedes the onset of diabetes. Among Pima Indians (a group with a particularly high incidence of type 2 diabetes), body weight gradually increased 30 kg (from 60 kg to 90 kg) in the years preceding the diagnosis of diabetes. Conversely, weight loss is associated with a decreased risk of type 2 diabetes.
  • Insulin resistance with high insulin levels is characteristic of obesity and is present before the onset of high blood sugar levels.
  • Obesity leads to impairment in glucose removal and increased insulin resistance, which result in hyperinsulinemia. Hyperinsulinemia contributes to high lipid levels and high blood pressure.

What type of a vegetarian are you?

By Dr K K Aggarwal
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There are 4 main types of vegetarian diets:

  • Lacto–ovo–vegetarian consumes dairy products and eggs but no meat, poultry, or seafood
  • Lacto–vegetarian eats dairy products but not eggs, meat, poultry, or seafood
  • Ovo–vegetarian eats eggs but no dairy products, meat, poultry, or seafood
  • Vegan does not eat any animal products, including meat, fish, poultry, eggs, and dairy products; many vegans will also avoid honey.

Vegetarian and plant–based diets are associated with a reduced risk of obesity, diabetes, heart disease, and some types of cancer as well as increased longevity. Vegetarian diets are typically lower in fat, particularly saturated fat, and higher in dietary fiber. They are also likely to include more whole grains, legumes, nuts, and soy protein, and together with the absence of red meat, this type of eating plan may provide many benefits for the prevention and treatment of obesity and chronic health problems, including diabetes and cardiovascular disease.

Artificial sweeteners in sweets may be harmful

By Dr K K Aggarwal
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In a joint statement, the American Heart Association and the American Diabetes Association have given a cautious recommendation to the use of nonnutritive sweeteners to help people maintain a healthy body weight and for diabetics to aid glucose control. These products should be considered like a nicotine patch. They are appreciably better than the real product (sugar), but not part of an optimal diet. The statement, published in both Circulation and Diabetes Care on July 9, 2012, warns that sweeteners are helpful only as long as people don’t eat additional calories later as compensation. The term nonnutritive sweeteners cover six sweeteners including aspartame, acesulfame K, neotame, saccharin, sucralose, and plant–derived stevia. These nonnutritive substances have zero calories. Two things may happen in terms of compensation

  1. Physiological, where the body might be expecting more calories and so the individual may be hungrier and therefore may eat more
  2. Psychological, where the individual thinks they are allowed to eat more sugar-rich food because they had a diet soda instead of a full–sugar soda.

When people use sweeteners there is compensation. The key is how much? Partial compensation is ok but people often completely compensate or even overcompensate, so these sweeteners have to be used smartly to be successful. Compensation seems less of a problem when these sweeteners are consumed in beverages as opposed to food. People don’t really notice the lack of calories in a diet soda and so don’t tend to eat more, whereas if they consume a low–calorie foodstuff, they do tend to eat more as compensation.

Its better when sweeteners are used in beverages and not sweets or other foods. One is not completely sure about the safety of these products, because their long–term use in humans has not been studied fully. However, the artificial sweeteners on the market are almost certainly safer than consuming large amounts of sugar, which has definite harm when consumed in large amounts. This harm, particularly when consumed in beverage form such as soda, includes increases in risks of obesity, diabetes, cardiovascular disease, and gout. A concern, though, is that just replacing sugar with artificial sweeteners leaves a person, especially children, conditioned to high levels of sweetness, which is likely to influence their food choices adversely.

Some tips to keep obesity under check

By Dr K K Aggarwal
Filed Under Wellness | Tagged With: , , , , | | Comments Off on Some tips to keep obesity under check

  1. Skip carbohydrates once in a week.
  2. Combine a sweet food with bitter food (for instance choose to cook aloo methi over aloo matar).
  3. Consume bitter green items in foods such as karela, methi, palak, bhindi, etc.
  4. Do not eat trans fats.
  5. Do not consume more than 80 ml of soft drink in a day.
  6. Do not consume sweets with more than 30% sugar.
  7. Avoid maida, rice, and white sugar.
  8. Walk, walk and walk…

Cycling can cause erectile dysfunction

By Dr K K Aggarwal
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Age, diabetes, hypertension, obesity, high lipids, smoking, drugs, heart disease, upright cycling for more than 3 hours a week can cause erectile dysfunction in males. For those who ride bicycles for more than 3 hours a week should do so in a reclining position and not upright position.

A man is considered to have erectile dysfunction when he cannot acquire or sustain an erection of sufficient rigidity for sexual intercourse. Any man may, at one time or another during his life, experience periodic or isolated sexual failures.

The term “impotent” is reserved for those men who experience erectile failure during attempted intercourse more than 75 percent of the time. Heart disease increases the risk for later erectile dysfunction. Erectile dysfunction may be an early warning sign of future heart disease. Men with erectile dysfunction without an obvious cause (e.g., pelvic trauma), and who have no symptoms of heart disease, should be screened for heart disease prior to treatment since there are potential cardiac risks associated with sexual activity in patients with heart disease.

Eight of the 12 most commonly prescribed medications list impotence as a side effect and it is estimated that 25 percent of cases of erectile dysfunction are due to drugs.

Depression, stress, or the drugs used to treat depression can result in erectile dysfunction.

Neurologic causes of erectile dysfunction include stroke, spinal cord or back injury, multiple sclerosis, or dementia. In addition, pelvic trauma, prostate. Surgery or priapism may cause erectile dysfunction.

Bicycling, less obvious, but of increasing importance, has been the possible association of erectile dysfunction with bicycling. Anything that places prolonged pressure on the pudendal and cavernosal nerves or compromises blood flow to the penile artery can result in penile numbness and impotence.

Cycling-induced impotence is primarily a problem of serious cyclists and has been reported to occur in Norwegian men competing in a 540 km bicycle race.

The penile numbness is attributed to the pressure on the perineal nerves whereas the erectile dysfunction is thought to be due to a decrease in oxygen pressure in the pudendal arteries.

Recreational cyclists, those who cycle for less than 3 hours per week and men who cycle in a reclining position avoid the sustained intense pressure on the penile nerve and artery and are less likely to experience sexual side effects. Continued cycling in a seated upright position can reduce the penile oxygen levels lasting 10 minutes.

HCFI tips for managing obesity.

By Dr K K Aggarwal
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  1. Cutting calories The key to weight loss is reducing how many calories you take in.
  2. Feeling full on less The concept of energy density can help you satisfy your hunger with fewer calories.
  3. Making healthier choices To make your overall diet healthier, eat more plant-based foods, such as fruits, vegetables and whole-grain carbohydrates.
  4. Physical activity Make exercise an important part of your daily routine. Start slow and increase the duration as you go along.

What type of a vegetarian are you?

By Dr K K Aggarwal
Filed Under Wellness | Tagged With: , , , , , , | | Comments Off on What type of a vegetarian are you?

There are 4 main types of vegetarian diets:

  1. Lacto–ovo–vegetarian consumes dairy products and eggs but no meat, poultry, or seafood

  2. Lacto–vegetarian eats dairy products but not eggs, meat, poultry, or seafood

  3. Ovo–vegetarian eats eggs but no dairy products, meat, poultry, or seafood

  4. Vegan does not eat any animal products, including meat, fish, poultry, eggs, and dairy products; many vegans will also avoid honey.

Vegetarian and plant–based diets are associated with a reduced risk of obesity, diabetes, heart disease, and some types of cancer as well as increased longevity. Vegetarian diets are typically lower in fat, particularly saturated fat, and higher in dietary fiber. They are also likely to include more whole grains, legumes, nuts, and soy protein, and together with the absence of red meat, this type of eating plan may provide many benefits for the prevention and treatment of obesity and chronic health problems, including diabetes and cardiovascular disease.

Cycling can cause erectile dysfunction

By Dr K K Aggarwal
Filed Under Wellness | Tagged With: , , , , , , , , | | Comments Off on Cycling can cause erectile dysfunction

Age, diabetes, hypertension, obesity, high lipids, smoking, drugs, heart disease, upright cycling for more than 3 hours a week can cause erectile dysfunction (ED) in males. Those who ride bicycles for more than 3 hours a week should do so in a reclining position and not upright position. A man is considered to have ED when he cannot acquire or sustain an erection of sufficient rigidity for sexual intercourse. Any man may, at one time or another during his life, experience periodic or isolated sexual failures. The term “impotent” is reserved for those men who experience erectile failure during attempted intercourse more than 75% of the time. Heart disease increases the risk for later ED; ED also may be an early warning sign of future heart disease. Men with erectile dysfunction without an obvious cause (e.g., pelvic trauma), and who have no symptoms of heart disease, should be screened for heart disease prior to treatment since there are potential cardiac risks associated with sexual activity in patients with heart disease. Eight of the 12 most commonly prescribed medications list impotence as a side effect and it is estimated that 25% of cases of ED are due to drugs. Depression, stress, or the drugs used to treat depression can result in ED. Neurologic causes include stroke, spinal cord or back injury, multiple sclerosis, or dementia. In addition, pelvic trauma, prostate. Surgery or priapism may cause ED. A less obvious, but of increasing importance, has been the possible association of ED with bicycling. Anything that places prolonged pressure on the pudendal and cavernosal nerves or compromises blood flow to the penile artery can result in penile numbness and impotence. Cycling-induced impotence, is primarily a problem of serious cyclists and has been reported to occur in Norwegian men competing in a 540 km bicycle race. The penile numbness is attributed to the pressure on the perineal nerves whereas the erectile dysfunction is thought to be due to a decrease in oxygen pressure in the pudendal arteries. Recreational cyclists, those who cycle for less than 3 hours per week and men who cycle in a reclining position avoid the sustained intense pressure on the penile nerve and artery and are less likely to experience sexual side effects. Continued cycling in a seated upright position can reduce the penile oxygen levels lasting 10 minutes.

Artificial Sweeteners in Sweets May Be Harmful

By Dr K K Aggarwal
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The American Heart Association and the American Diabetes Association have given a cautious recommendation to the use of nonnutritive sweeteners to help people maintain a healthy body weight and for diabetics to aid glucose control. These products should be considered like a nicotine patch. They are appreciably better than the real product sugar but not part of an optimal diet. The joint statement published in both Circulation and Diabetes Care on July 9 2012 warns that sweeteners are helpful only as long as people don t eat additional calories later as compensation. The term nonnutritive sweeteners cover six sweeteners including aspartame acesulfame K neotame saccharin sucralose and plant derived stevia. These nonnutritive substances have zero calories. Two things may happen in terms of compensation 1. Physiological where the body might be expecting more calories and so the individual may be hungrier and therefore may eat more 2. Psychological where the individual thinks they are allowed to eat more sugar rich food because they had a diet soda instead of a full sugar soda. When people use sweeteners there is compensation. The key is how much Partial compensation is ok but people often completely compensate or even overcompensate so these sweeteners have to be used smartly to be successful. Compensation seems less of a problem when these sweeteners are consumed in beverages as opposed to food. People don t really notice the lack of calories in a diet soda and so don t tend to eat more whereas if they consume a low calorie foodstuff they do tend to eat more as compensation. Its better when sweeteners are used in beverages and not sweets or other foods. One is not completely sure about the safety of these products because their long term use in humans has not been studied fully. However the artificial sweeteners on the market are almost certainly safer than consuming large amounts of sugar which has definite harm when consumed in large amounts. This harm particularly when consumed in beverage form such as soda includes increases in risks of obesity diabetes cardiovascular disease and gout. A concern though is that just replacing sugar with artificial sweeteners leaves a person especially children conditioned to high levels of sweetness which is likely to influence their food choices adversely.

Weekend Social Jetlag can be heart unfriendly

By Dr K K Aggarwal
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Switching to late nights and late mornings on the weekend is associated with cardiometabolic risk. Termed social jetlag it is associated with poorer lipid profiles worse glycemic control and increased adiposity in healthy adults as per a report published in Journal of Clinical Endocrinology Metabolism. These metabolic changes can contribute to the development of obesity diabetes and cardiovascular disease. A total of 111 study participants had a social jetlag of more than 60 minutes. Compared to the other study participants these individuals had Higher mean triglycerides 107 mg dL versus 91 mg dL P 0.009 Lower mean HDL cholesterol 54 mg dL versus 57 mg dL P 0.014 Higher mean fasting insulin levels 13.5 U mL versus 12 U mL P 0.03 More insulin resistance as measured by homeostatic model assessment 4.0 versus 3.7 p 0.028 Greater mean waist circumference 94 cm versus 89 cm P 0.001 Higher mean BMI 28 versus 26 P 0.004 It has been shown that regulating sleep times can help treat insomnia and this emerging evidence along with others suggest that perhaps doing so will have benefits in treatment and prevention of other diseases.

Diet is linked to the diabetes epidemic

By Dr K K Aggarwal
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A study published in the journal Diabetes Care, has highlighted the importance of the whole diet rather than focusing on certain foods or food groups that might be beneficial. A diet rich in whole grains, fruits and vegetables (leafy green), nuts and low-fat dairy may help people lower their risk of type 2 diabetes by 15% over 5 years than those who ate the lowest amounts of these foods. Also, a diet which contains high amounts of red meat, high-fat dairy and refined grains like white bread may boost the odds of diabetes development by 18%. Type 2 diabetes is closely linked to obesity and it is well-known that maintaining a healthy weight through diet and exercise reduces the risk of developing the disease. Diet affects diabetes risk independent of a person’s weight.

How safe are anti-obesity drugs?

By Dr K K Aggarwal
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Obesity is a major health problem. The long–term success rate is low of diet and physical activity. Therefore, antiobesity drugs are of great interest, especially when lifestyle modification has failed. As obesity is not an immediate life–threatening disease, these drugs are required to be safe. Drugs developed so far have limited efficacies and considerable adverse effects affecting tolerability and safety. Therefore, most antiobesity drugs have been withdrawn

. • Fenfluramine and dexfenfluramine were withdrawn because of the potential damage to heart valves.

• Sibutramine was associated with an increase in major adverse cardiovascular events in the Sibutramine Cardiovascular Outcomes (SCOUT) trial and it was withdrawn from the market in 2010.

• Rimonabant was withdrawn because of significant psychiatric adverse effects.

• Orlistat was approved for long–term treatment of obesity, but many patients cannot tolerate its gastrointestinal side effects.

• Phentermine and diethylpropion can only be used for less than 12 weeks because the long–term safety of these drugs is unknown.

• Ephedrine and caffeine are natural substances but the effects on weight reduction are modest.

• Recently lorcaserin and topiramate plus phentermine have been approved for the treatment of obesity but long–term safety data are lacking. (Ther Adv in Drug Safe 2013;4(4):171–181)