Author - Dr. Nitin Gupte

Acanthosis Nigricans, Insulin Resistance And Pre Diabetes!

Development of dark, thickened, often slightly raised and velvety patches on the skin could be a sign of a condition called Acanthosis Nigricans. These patches can sometimes be accompanied by itching.

The areas commonly affected are the neck, armpits, groin, elbows, knees, and knuckles.

Acanthosis Nigricans is strongly linked to insulin resistance.

When carbohydrates are digested, they are absorbed in blood as sugar and the blood sugar levels increase.

In response to this the pancreas releases insulin in blood and insulin helps transport the sugar to various tissues of the body and under its influence, the cells of the tissues take up sugar from the blood and utilise it for the energy that they require for their functions.

Under the influence of insulin the liver also stores more sugar for providing energy to the body later.

This lowers the blood sugar and the blood insulin levels.

But when you eat too much sweets or sugary food regularly, the pancreas is forced to produce more insulin to bring down the blood sugar to normal.

After a while the cells of the various tissues stop responding adequately to the insulin and do not absorb sugar efficiently.

This means the cells of the tissues develop insulin resistance.

This causes both, the blood sugar and the blood insulin levels to stay high.

This raised blood level of insulin is called hyperinsulinemia.

To compensate, the pancreas produces more insulin.

Insulin promotes the synthesis of protein and fat molecules and provides the energy to help in cell growth.

Hyperinsulinemia causes skin cells to reproduce more quickly, leading to the characteristic skin changes in development of the condition of acanthosis nigricans.

When the capacity of the liver and the muscle cells to store sugar is over, the excess blood sugar is stored in the fat cells of various fat depots in the body and our weight increases, gradually leading to obesity.

Hyperinsulinemia and the insulin resistance lead to the development of pre diabetes.

People with pre diabetes have higher than normal blood sugar levels which are not high enough to be diagnosed as diabetes.

Fasting blood sugar levels between 110 to 125 (WHO) or 100 to 125 (American Diabetes Association) and glycated haemoglobin or HbA1c levels between 5.7 to 6.4 per cent are diagnostic of pre diabetes.

Blood sugar levels and HbA1c levels higher than this are diagnostic of diabetes.

People with pre diabetes are most likely to develop full fledged diabetes especially if they have strong family history of diabetes, obesity and sedentary lifestyle.

Other conditions in which Acanthosis Nigricans can occur are obesity, PCOD, thyroid disease, especially hypothyroidism and Cushing’s disease and rarely it is associated with some cancers.

The underlying condition in obesity and PCOD that causes these Acanthosis Nigricans patches is insulin resistance.

If you have such patches on the body, please see you doctor and get them diagnosed.

If they are patches of Acanthosis Nigricans you are likely to have insulin resistance and pre diabetes.

You will need to develop healthy food habits, cut out sugary foods and other simple carbohydrates from your food, eat nutritionally balanced food, exercise regularly, reduce your weight, keep stress low and sleep well.

And don’t wait to start all these things till you catch diabetes!

If you start now, you could most likely prevent the development of insulin resistance and pre diabetes and get rid of these patches!

Also read ‘Insulin Resistance And Diabetes’ and ‘Understanding Pre Diabetes’ on this website.

Carbohydrates Are Essential To Health!

Our food is composed of the following nutrients: carbohydrates, proteins, fats, vitamins, minerals and water.

Each of these nutrients have specific roles to play in the functioning of our body.

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Carbohydrates are of two types, viz. simple and complex carbohydrates.

Simple carbohydrates are made up of one or two sugar molecules while complex carbohydrates are made up of long chains of glucose molecules.

When carbohydrates in our food are digested, these glucose molecules are absorbed our in blood and the blood sugar rises.

This glucose provides the fuel energy that the cells of our body need to carry out their functions.

Insulin is the hormone that influences our body cells to take up sugar from our blood to use up for their energy requirements. Insulin is synthesised in the pancreas,

Simple carbohydrates are digested quickly and cause sharp spikes in our blood sugar and force the body to suddenly release more insulin to bring the blood sugar down. The cells of the body take up the extra sugar from the blood and the blood sugar drops down to normal.

Eating too much simple carbohydrates or sugary food over a period of time leads to the cells of the body gradually becoming insensitive to insulin and respond less and less to it and the body is forced to produce more and more insulin to keep the blood sugar normal, causing hyperinsulinemia.

In time the blood sugars stay high in spite of hyperinsulinemia and leads to insulin resistance and eventually to diabetes.

In contrast, complex carbohydrates are digested slowly and provide steady supply of glucose and hence energy to the body, preventing spikes in blood insulin levels, hyperinsulinemia and insulin resistance and diabetes.

So it is consuming too much simple carbohydrates regularly that leads to hyperinsulinemia, insulin resistance and diabetes, not complex carbohydrates.

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Carbohydrates are the primary source of energy of our body. That means majority of the calories we need to carry out our bodily functions have to come from carbohydrates.

They also have a ‘protein sparing’ function.

Proteins have different functions those do not include providing energy to the body.

Proteins are the most important constituents of all the tissues of the body.

They are essential for the growth, development and repair of the daily wear and tear of the body. They are responsible for the immunity and the defence mechanism of the body. They are also essential for the formation of various enzymes and hormones in our body.

Proteins are not a primary source of energy for our body, under normal circumstances. But in case of people on very low carbohydrate – low calorie diets, the proteins in their food are used up as a source of energy and such people suffer from protein deficiency even if there is sufficient protein in their food.

So the second function of carbohydrates is to provide enough energy to the body so that proteins are not used up for energy and they are ‘spared’ to carry out their normal functions.

Foods that are principally made up of complex carbohydrates also provide essential nutrients like fiber, vitamins, especially B vitamins and minerals like iron, magnesium and selenium.

Complex carbohydrates are the only source fibre in our food. Fibre is crucial to digestion. The insoluble fibre in our food adds bulk to our stools, regulates the peristaltic movement of the intestines, facilitates easy passage of stools and prevents constipation.

The soluble fibre in complex carbohydrates dissolves in water and forms a jelly like substance which absorbs cholesterol and sugars and they are cleared out of the body, helping lower the levels of the blood cholesterol and sugar.

Complex carbohydrates contribute to satiety, helping to control appetite and reduce overall calorie intake. Having well balanced food with adequate complex carbohydrates, without of course over eating, helps in controlling weight rather than causing obesity as is often wrongly projected.

Brain function: Glucose is the primary source of energy for the brain. Complex carbohydrates provide steady supply of glucose to the brain cells and this helps in the smooth functioning of the brain and helps support cognitive functions, including memory and concentration.

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Dangers of low carbohydrate diets.

Effects of low carbohydrate diets on health:

Lack of energy: Without adequate complex carbohydrates in our food, energy levels can fluctuate, leading to fatigue and decreased endurance during physical activity.

Nutritional deficiencies: We suffer from deficiencies of nutrients like fiber, vitamins, especially B vitamins and minerals like iron, magnesium and selenium.

Digestive problems: Lack of fibre in low carbohydrate diets causes constipation and this in time can cause haemorrhoids (piles) and fissures and can also lead to development of conditions like diverticulitis and colon cancer.

Obesity: Low carbohydrate diets are essentially based on meat, eggs, fish and milk and milk products like butter, cheese and paneer and nuts.

Barring skim milk and fish, these foods are high in their fat content and hence are high in calories and are more likely to cause obesity.

Presence of high amounts of saturated fats and cholesterol in these foods can also lead to raised levels of LDL cholesterol and total cholesterol can also lead to heart disease and strokes.

Impaired Brain Function: The brain is dependant upon glucose as its primary source of energy. Lack of a steady supply of glucose from complex carbohydrates can result in impairment of cognitive functions including memory and concentration and mental clarity and focus.

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Thus you can see that you can definitely stop eating or avoid eating simple carbohydrates as much as possible, but complex carbohydrates are absolutely essential to health and you cannot stop eating them without serious consequences for your health.

Also read the articles ‘Basics Of Nutrition’ and ’Carbohydrates Don’t Make Us Fat’ on this website.

The Causes Of Milk Indigestion and Their Solutions!

Many people cannot tolerate milk and milk products.

They develop varying degrees of abdominal discomfort, pain, bloating, gases, diarrhoea when they consume milk.

The commonest cause of this is lactose intolerance.

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Lactose intolerance:

Lactose is the major sugar present in milk.

It is composed of two sugars namely glucose and galactose.

Our body needs an enzyme called lactase to digest lactose.

Lactase is an enzyme that is produced in the what is called as the brush border of the epithelial lining of the small intestines of humans and other mammals.

A large number of people lack adequate amounts of lactase and are unable to digest lactose fully and hence suffer from bloating, gases, diarrhoea and abdominal discomfort when they have milk.

Lactase is also available as a food supplement and is added to milk to produce ‘lactose free’ milk products.

People with lactose intolerance can take lactase supplements before consuming milk and milk products or add it to them before consuming them.

A few people may have difficulty digesting a protein in milk.

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Milk proteins:

Milk majorly has two proteins, casein and whey proteins, the former contributing nearly eighty per cent while the latter makes up most of the balance twenty per cent of milk protein.

Casein has two major components, the A1 beta casein and and A2 beta casein proteins

Most buffalo and cow milk have both A1 and A2 variants of the beta casein proteins.

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Milk protein intolerance:

It is this A1 beta casein that a few people have difficulty in digesting fully.

These people may have some abdominal discomfort when they have milk having both the A1 and A2 variants of the beta casein proteins.

But their number is much smaller than the people having lactose intolerance.

Sixty five to seventy per cent of the world population has varying degrees of lactose intolerance while much fewer people possibly suffer from milk protein intolerance.

Some milk variants of both buffalo and cow milk have only the A2 variant and not the A1 variant of the beta casein proteins.

The A2 milk is marketed at a special premium as a milk that is easier to digest and does not cause discomfort like gases and bloating which regular milk causes in some people.

Although there is not enough scientific evidence to support it, the findings are mixed, some people may experience less discomfort with the A2 milk, whether cow or buffalo, than the regular milk.

Other than that there is no special nutritional advantage of the A2 milk over the regular milk.

But if you like it, are more comfortable drinking it and don’t mind paying the premium for it, you can continue to use it.

The A1 variant of beta-casein can be found in cow’s milk from certain breeds like Holstein, while the A2 variant is found in milk from other breeds like Guernsey and Jersey cows.

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The Gir cow:

Currently the Gir cow milk is touted as a highly superior milk and is sold at a considerable premium.

It is quite likely that buying the more expensive Gir cow milk is getting fashionable amongst our urban affluent, not unlike the use of olive oil!

Gir cow milk does have more A2 proteins than A1 proteins.

Some Gir cow milk may have only the A2 variant proteins but there is no guarantee that the milk you are buying has only the A2 variant and not the A1 variant of the beta casein proteins, unless you have it tested in a specialised laboratory.

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What matters more is that the milk you get comes from buffaloes or cows those graze in open natural pastures, on grass that is free of harmful chemicals and pesticides and the animals are not injected with hormones and antibiotics.

But it is difficult in the current scenario to ensure this.

And buffalo milk is definitely superior to cow milk, you can look for A2 buffalo milk if you like it, tolerate it better or are very keen on buying A2 milk only.

Read more about the nutrition of milk on the link ‘Magical Health Benefits Of Milk’ on this website.

Fast Food Or Junk Food Are Harmful To Health!

Fast food or junk food are foods that are loaded with calories, sugars and salt, fats, cholesterol and trans fats and lack healthy nutrients like fibre, vitamins and minerals and antioxidants.

Most fast food may lack either complex carbohydrates or proteins or both.

Bakery products like cakes, pastries, biscuits, fried food like ‘wada’, ‘samosa’, ‘bhaji or pakoda’, french fries, fast foods like burgers, hotdogs, sandwiches, pizzas, snacks like chips, farsan, sweet delicacies like gulab jam, basundi, rabdi, jalebi, all kind of mithai including burfi, pedhas, chocolates and aerated sweetened soft drinks, sports energy drinks and alcohol are junk foods and drinks.

Sugar free mithai or sweets also are fast food, since they contain a lot of fat.

Also the sugar substitutes are also not harmless.

Processed and frozen meats like pork bacon, ham, salami, sausages and even chicken nuggets, salami, sausages also are examples of fast foods. They are high in sodium, cholesterol, saturated fats and trans fats.

They are often also treated with sodium nitrite to prevent growth of microorganisms in them and improve their shelf life. Nitrates and nitrites are thought to be carcinogenic.

The internationally famous fried chicken and the equally famous chicken or tuna sandwiches, claiming to be healthy because they have lettuce, tomato and cucumber but loaded with mayonnaise and other such sauces too, are loaded with fat, calories, cholesterol and trans fats.

Thus these foods, very popular amongst young people, too are junk foods.

When buying such foods, please check the labels for fat and sugars. Labels like ‘no added sugar’ can be misleading as it generally means no sucrose, there could be other sugars used.

Labels like zero trans fats too could also be misleading. Most bakery products in India carry the no trans fatty acid labels. But we don’t know if there are any periodic checks on such products to verify the claims of the manufacturer.

The so called health drinks and foods like fruit juices, energy bars, muesli bars too are junk foods as they still contain a lot of  sugar or fats or both.

Over consumption of fast food high in salt, sugars, fats, cholesterol, trans fats and calories leads to obesity, hypertension, type 2 diabetes, hypercholesterolemia , hypertriglyceridemia and heart disease, strokes, non-alcoholic fatty liver disease and certain cancers.

So keep the consumption of fast food low or minimal and exercise regularly to burn off any extra calories consumed through the fast food and prevent weight gain and all the above diseases.

If you are looking to lose weight, keep their consumption low, if you have hypertension, type 2 diabetes, hypercholesterolemia , hypertriglyceridemia and heart disease, avoid them as much as possible.

Also read the articles, ‘Dangers Of Eating Too Much Sugar’, ‘How Much Salt Do I Need’, and ‘The Good And The Bad Fats’ on this website.

Basic Information About Blood Pressure And Hypertension!

Today many people are aware that diabetes is a grave illness.

And they take the threat of the disease seriously.

But more people have hypertension than diabetes and few people are aware that hypertension is as grave a disease as diabetes.

And a person with hypertension may not have any symptoms.

So many people may not even know that they have the disease.

So it is vital that you get a blood pressure check regularly, more so if you have family history of hypertension, heart disease and strokes.

And it is equally vital that you don’t ignore it, if you have it.

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So What Is Hypertension?

Arterial blood pressure is measured as mm of Hg or mercury.

It has a higher level or the systolic blood pressure and a lower level or the diastolic blood pressure.

Systole is the phase of the heart beat in which the ventricles, the lower two chambers of the heart contract, the left ventricle sending blood out to the whole body and right ventricle to the lungs.

Diastole is that phase of the heart beat in which the ventricles relax after the contraction, receiving blood from the atria which are the two chambers above the ventricles.

The blood flowing through the arteries exerts certain pressure on the walls of the arteries when it flows through them, both when the ventricles contract, that is the systole and when they relax, the diastole.

The pressure when the ventricles contract is the systolic blood pressure and the pressure when they relax, is the diastolic blood pressure.

Hypertension or high blood pressure is a condition in which the blood pressures in the arteries are persistently higher than normal.

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Normal levels of blood pressure and raised levels of blood pressure:

As per the American College Of Cardiology and the American Heart Association, the normal ranges and the raised levels of the blood pressure are as follows:

Normal blood pressure is 120 by 80 mm of Hg, or below.

Elevated blood pressure: Blood pressure ranging between systolic pressure 121 to 129 and diastolic pressure 80 or less mm of Hg, is elevated blood pressure.

Stage I hypertension: Systolic blood pressure between 131 to 139 and the diastolic between 80 to 89 mm of Hg.

Stage II hypertension: Systolic blood pressure between 140 or higher and the diastolic 90 or more, mm of Hg.

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Types Of Hypertension:

Primary Or Essential Hypertension:

A complex combination of genes and environmental factors, excess salt consumption, Western kind of high fat – high calorie, high animal food diet deficient in complex carbohydrates, green vegetables and fruits, lack of exercise, abdominal obesity, stress, aging are some of the factors which can contribute to the development of hypertension.

In this type of hypertension, the major contributor to hypertension is the increased peripheral resistance to blood flow through arteries.

Secondary Hypertension:

Secondary hypertension is the hypertension which has an underlying disease as the cause of hypertension.

Kidney disease, renal artery stenosis (narrowing) are the most common causes underlying this kind of hypertension, endocrinal disorders like Cushing’s Syndrome, hyperthyroidism, hypothyroidism, certain pituitary disorders and a pituitary tumour called pheochromocytoma can also cause hypertension.

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Signs And Symptoms Of Hypertension:

Hypertension usually causes few symptoms. That is why it is called a silent killer.

Some people may complain of headaches, especially at the back of the head, vertigo, tinnitus and fainting. But anxiety and stress can also cause these symptoms.

That is why hypertension is often detected in general medical check up or sometimes when people go for blood donation.

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Effects Of Hypertension:

Prolonged hypertension causes inflammation in the endothelium, the inner lining, of the arterial walls damaging the arteries including those of various organs of the body.

This can lead to hardening and thickening of the arterial walls and narrowing of their lumen. This is called atherosclerosis.

Atherosclerosis causes loss of elasticity in the arterial walls causing an increase in the peripheral resistance to the blood flow and it also leads to heart attacks and strokes.

Raised blood pressure causes greater resistance to the flow of the blood through the arteries and forces the heart to pump harder to circulate blood through our body, causing hypertrophy (thickening) of the heart muscle. The thickened heart muscle struggles to pump blood efficiently and eventually fails to do so, causing heart failure.

It can also lead to weakening and bulging of the arteries. This is called aneurism and such aneurisms can rupture and cause heavy internal bleeding causing grave complications, including strokes.

Thickening and narrowing and aneurysms of the arteries in kidneys or eyes can damage these organs and can lead to renal failure and loss of vision.

Hypertension also contributes to development of the metabolic syndrome that leads to development of diabetes, heart attacks and strokes.

It can also cause circulatory problems and strokes in the brain.

It can a lead to impairment of memory and understanding and development of vascular dementia, a general name given to a condition that causes decline of cognitive abilities of thinking, remembering and reasoning in a person leading to inability to perform daily activities.

Hypertension is a major cause of premature death all over the world.

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Prevention Of Hypertension:

Hypertension is best prevented than treated.

Maintain ideal body weight.

Keep your salt consumption low, eat less than one teaspoon or 5 gm table salt a day.

Keep your animal food consumption low, eat more of complex carbohydrates, vegetables, fruits and low fat milk.

Have at least five helpings of vegetables and fruits every day.

Have regular cardiovascular exercise like brisk walking, jogging, running, cycling, swimming, aerobics.

Keep stress low.

Limit alcohol consumption.

Stop smoking.

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Treatment Of Hypertension:

Your doctor may advise lifestyle modification, healthy diet, low salt consumption, regular cardiovascular activity, weight loss, quitting alcohol and smoking and reduction in stress.

Doctors treat hypertension with a variety of anti hypertensive drugs including diuretics, calcium channel blockers, angiotensin converting enzyme inhibitors (ACE inhibitors), angiotensin receptor blockers (ARBs) and beta blockers.

Previously beta blockers were thought to be effective as the first line treatment for hypertension, but the Cochrane Review, an independent, high quality review system of research in health care, has found that beta blockers were less effective in preventing heart disease than were the other anti hypertensive drugs.

According to a study published in 2003, 5 mm Hg drop in blood pressure reduces the risk of stroke by 34%, ischaemic heart disease by 21% and lowers the threat of dementia, heart failure and mortality due to heart disease.

Previous thinking about normal blood pressure levels was that older people, in their sixties and older could have higher normal levels blood pressure than the younger people, is no more considered acceptable.

Everyone should have blood pressures levels of 120 by 80 m.m. of Hg or lower, to be protected against heart disease and strokes and damage to the kidneys and eyes.

If your blood pressure levels are higher than 120 by 80 m.m., seek medical advice immediately, irrespective of your age.

And focus on getting your blood pressure down to the normal level, as early as possible!

Irrespective of your age!

Also read the articles ‘Preventing Hypertension’ and ‘Health Problems Of The Young: Hypertension’ on this website.

Hypothyroidism Or Under Active Thyroid Gland

Thyroid is a butterfly shaped endocrine gland situated at the base of the neck, below the prominence of the Adam’s apple, resting on the trachea or the windpipe.

It produces three hormones, the two thyroid hormones called triiodothyronine or T3 and thyroxine or the T4 hormones and calcitonin.

The two thyroid hormones control the metabolic rate, synthesis of proteins and the growth and development of children.

Calcitonin is involved in calcium homeostasis that is, it takes up calcium from the blood and deposits it in bones.

The two thyroid hormones are regulated by thyroid stimulating hormone or TSH, which is secreted by the master endocrine gland, the pituitary and the production of TSH in turn is regulated by a hormone called the thyrotropin releasing hormone or the TRH, produced by the hypothalamus, a part of the brain.

It means the final control of the thyroid gland lies with the brain.

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Hyperthyroidism and hypothyroidism:

When the thyroid gland produces excess thyroid hormones, it results in hyperthyroidism while when it produces low levels of the thyroid hormones, it results in hypothyroidism.

Hypothyroidism is more common in women and in people over 60.

The commonest cause of hypothyroidism all over the world is deficiency of iodine in food and most countries have tackled the problem by iodising the salt available to its population.

A condition called Hashimoto’s thyroiditis or Hashimoto’s disease, an autoimmune disease of the thyroid gland, is the common cause of hypothyroidism in areas where there is no iodine deficiency in the population. It gradually destroys the gland.

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Hypothyroidism:

Hypothyroidism can cause a variety of symptoms including fatigue, intolerance of cold, slow pulse rate, anaemia, depression, constipation, dyspepsia, muscle weakness, shortness of breath, hoarseness of voice, hair loss, dry, rough skin, weight gain, heavy menstruation in ladies and weight gain.

Apart from depression, hypothyroidism is also known to accompany severe psychiatric disorders like bipolar disorder, mood disorders and schizophrenia.

It can occur also in pregnancy. Not treating hypothyroidism during pregnancy can lead to delayed growth and low intellectual development of the baby.

Mild or sub clinical hypothyroidism too can cause infertility and miscarriages and can also cause a grave pregnancy condition called pre-eclampsia, a condition in which there is rise in the blood pressure and loss of significant amounts of protein in urine. Gestational diabetes is also seen in hypothyroidism in pregnancy.

In mild or sub clinical hypothyroidism the TSH levels are raised but the thyroid hormone levels are normal.

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The diagnosis and the treatment:

Many times, the patient of hypothyroidism is the last to complain about the condition. Often a family doctor may suspect the disease seeing sudden weight gain, deteriorated skin and changes in voice in a regular patient plus probably dulled comprehension reflected in speech and eyes, suspects hypothyroidism.

A doctor will usually suspect hypothyroidism when she or he sees that your skin and hair are dry and rough, there is coldness and swelling of extremities and your heart rate is slow (bradycardia). He may also see delayed relaxation of tendons on testing the tendon reflexes and a kind of non pitting oedema called myxoedema.

Thyroid function lab tests include checking the blood levels of the pituitary hormone TSH and levels of the thyroid hormones T3 and T4.

High blood levels of TSH and / or low levels of T3 and T4 are diagnostic of hypothyroidism.

Hypothyroidism is treated by your doctor with levothyroxine, a synthetic form of the thyroxine hormone or T4.

Levothyroxine is safe in pregnancy.

Your doctor will order regular lab checks of your blood levels of TSH, T3 and T4 (thyroid function test) and adjust the dose of your medication based on the severity of the symptoms and the levels of the hormones, from time to time.

That is the reason why you have to check your thyroid function and see your doctor at regular intervals as advised by your doctor.

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The weight gain due to hypothyroidism is of mild to moderate degree. A huge weight gain is unlikely to be caused by hypothyroidism.

Many slimming programs tell people under their treatment that they haven’t lost weight because they have hormonal problems.

The commonest hormonal problems related to obesity are PCOD and hypothyroidism.

It doesn’t matter whether your weight gain is due to PCOD or hypothyroidism.

You still have to eat healthy and at least walk adequately to slim down perfectly and overcome PCOD and most likely help your doctor to reduce your levothyroxine dose considerably.

And people unfailingly do succeed, if they do.

The people on these slimming programs didn’t fail because they had hormonal problems, but because the treatments themselves were unscientific.

Also read the articles, ‘Basics Of Nutrition’, ‘The Science Of Exercise’ and the ‘Simple Steps To Slimming’ and ‘Health Problems Of The Young: PCOD‘ on this website.

Raised Levels Of Blood Uric Acid, Gout And Kidney Stones!

Many people suffer from raised levels of uric acids in their blood.

Often this condition is found in routine renal function tests.

Most often this condition is ignored if the rise is borderline.

But left untreated, long term rise in uric acid could cause chronic illnesses like gout and renal stones and kidney and heart disease.

What exactly are these diseases?

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Certain foods that we eat contain chemicals called purines.

Uric acid is formed when purines are broken down by our body.

Uric acid dissolves in blood and it is transported to the kidneys and they excrete it out of our body in urine, maintaining the blood uric acid levels normal (3.5 to 7.2 mg / dL).

If the blood uric acid levels rise above 7.2 mg / dL, the condition is called hyperuricemia.

If excess uric acid is accumulated in our body, it may get deposited in our joints in the form of uric acid crystals causing a very painful form of arthritis called gout.

They may also settle in the kidneys forming kidney stones.

If the condition is not treated it can cause permanent bone, joint, tissue and kidney damage and can also lead to heart disease.

Researchers have also found links between hyperuricemia and high blood pressure, type 2 diabetes and fatty liver.

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Foods high in purines are:

Sea food like salmon and sardines and shell fish shrimps (prawns) and lobsters.

Red meat.

Organ meats like liver.

Sugar sweetened foods like sweetened cereals, bakery products, candies.

Alcohol, especially beers and distilled liquors and also non alcoholic beers.

Certain vegetables like spinach, asparagus.

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Signs and symptoms of gout:

When the blood uric acid levels remain high for long time sharp needle like crystals of uric acid or urate crystals get deposited in some joints and tissues around the joints.

This causes the joints to become hot, red, swollen and tender. The pain is severe and comes on quickly and peaks in less than twelve to twenty four hours.

The joint at the base of the big toe is affected in half the cases, but the heal, knee, wrists, finger joints too can be affected.

Such attacks can recur frequently, unless treated.

Some people may also develop hard, painless deposits of uric acid crystals called tophi. These too can cause bone damage and arthritis.

Gout appears to affect elderly males more often. It is also associated with metabolic syndrome, presence of abdominal obesity, hypertension, insulin resistance and abnormal lipid profile including high triglyceride levels. So people with hypertension and diabetes are also at a greater risk of developing it.

Gout affects habitual beer drinkers and those who drink a lot of sweetened drinks. It also affects people who habitually consume purine rich foods like some fishes including shell fish like prawns and lobsters and red meats.

Some vegetables like cauliflower, asparagus, spinach, mushrooms, green peas and chickpeas (chana in Marathi) and fava beans (wal papadi in Marathi) and some dried beans too have high levels of purines.

But the plant purines have not been found to cause gout attacks as much as the animal purines.

And some individuals report different vegetables triggering gout attacks in them, including some vegetables not high in purines, e.g. tomatoes.

It probably means some factors other than purines may have a role to play in these attacks.

So such people might want to avoid foods those trigger gout attacks in them, irrespective of their purine content.

Dietary precautions may reduce the recurrence or the severity of gout attacks, but they cannot replace medication to control hyperuricemia and the attacks of gout or prevent further joint damage due to hyperuricemia.

In short, medications lowering blood uric acid levels are essential even if you watch your food and avoid foods those trigger gout attacks.

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Diagnosis of gout:

Presence of hyperuricemia is not the same as gout.

Gout is diagnosed if uric acid crystals are found in the fluid drawn from the swollen joints or by special imaging diagnostic procedures like ultrasound, X Ray and CAT scan.

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Treatment of hyperuricemia and gout:

Avoid red meat, organ meat and alcohol, especially beers.

Avoid the sugar sweetened foods viz. sweetened cereals, bakery products, candies

Sea food includes healthy proteins and healthy fats including the omega 3 fatty acids.

The health benefits of sea food on general and heart health outweighs the risk of hyperuricemia.

So you can have sea food in moderation.

Consuming vegetables like spinach and asparagus have not been seen to cause hyperuricemia. So they needn’t be excluded from your food.

Eat well balanced, wholesome food and exercise regularly to lose weight, if you are overweight.

Drink ample water to help the kidneys to excrete uric acid build up in the blood and the kidneys.

Taking Vitamin C may help.

Dietary exclusion of high purine foods will not be sufficient to lower blood uric acid levels or to prevent the gout attacks.

Your doctor will prescribe specific drugs to lower your blood uric acid levels.

Your doctor will also prescribe anti inflammatory medications (NSAIDs) to reduce the pain and duration of the attack.

Kidney stones may get get flushed out in urine.

They may require surgical intervention if they don’t get flushed out.

Also read ‘Basics Of Nutrition’ and ‘Simple Steps To Slimming’ on this website.

Kinds Of Fatty Liver Disease Or Hepatic Steatosis

Obese people have a greater risk of developing hypertension, diabetes and heart disease, than the slim people.

And most obese people know that they are at greater risk of developing these diseases.

And more obese people have fatty liver disease than heart disease, but most are totally unaware that they may have fatty liver disease and that is as dangerous a disease as hypertension or diabetes!

And few obese people know that they have this disease!

Most often fatty liver disease is diagnosed accidentally when an abdominal sonography is done for some other reason.

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Fatty liver disease is also known as hepatic steatosis or fatty degeneration of liver.

It affects both alcoholics and nonalcoholics or those who drink very little.

Thus fatty liver disease is of two types, alcoholic fatty liver disease and nonalcoholic fatty liver disease or NAFLD.

Both diseases are characterised by build up of excess fat in the liver cells.

Nonalcoholic fatty liver disease or NAFLD is affecting increasingly greater number of people all over the world, more so in the Western world.

Some people suffering from Non Alcoholic Fatty Liver Disease or NAFLD develop nonalcoholic steatohepatitis or NASH.

Nonalcoholic steatohepatitis or NASH is a more aggressive form of fatty liver disease in which there is inflammation of the liver cells and it can progress to scarring of the liver tissue leading to liver cirrhosis and liver failure.

Thus the progression of nonalcoholic steatohepatitis or NASH could be similar to the severe alcoholic hepatitis seen amongst heavy alcoholics.

More than 90 per cent of heavy alcoholics develop fatty liver disease while 25 per cent develop the severe alcoholic hepatitis ending in liver cirrhosis and liver failure.

While children too suffer from non alcoholic fatty liver disease or NAFLD, older people, especially males, are affected much more often.

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Causes:

Experts do not yet know why some people develop non alcoholic fatty liver disease or NAFLD and why some of them progress to nonalcoholic steatohepatitis or NASH and develop liver cirrhosis and liver failure.

But both are linked to

Over weight or obesity, especially abdominal obesity

Hyperinsulinemia and insulin resistance

Hyperglycaemia or high blood sugar levels, pre diabetes or diabetes

Hypertriglyceridemia or high levels triglycerides or circulating fats in blood

These conditions could be helping build up of excess fat in the liver, causing NAFLD and in some this fat could be acting as a toxin to the liver cells and causing inflammation and scarring in them, causing NASH.

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Signs and symptoms:

Non Alcoholic Fatty Liver Disease or NAFDL may have no symptoms but some times there can be fatigue and pain or discomfort in upper right hand area of the abdomen where the liver lies within the body.

Signs and symptoms of people with nonalcoholic steatohepatitis or NASH are the same as those of advance scarring and cirrhosis of liver seen in cirrhosis in severe alcoholic hepatitis:

Swelling of abdomen due to ascites or accumulation of fluid in abdominal cavity.

Enlarged blood vessels under the skin.

Yellowing of skin and eyes due to jaundice.

Red palms.

Enlarged spleen.

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Other risk factors associated with development of NAFLD and NASH:

Alcohol

Hypercholesterolemia or high levels of cholesterol

Metabolic syndrome: Abdominal obesity, hypertension, high levels of blood sugar and triglycerides and low levels of HDL cholesterol

PCOD

Type II diabetes

Sleep apnea

Under active thyroid gland

Under active pituitary gland

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Complications or progression

The fatty liver disease can end up in development of inflammation and scarring resulting in liver cirrhosis.

Ascites or abdominal swelling due to fluid build up.

Swelling of veins in oesophagus or oesophageal varices, which can rupture causing bleeding

Liver cancer

Confusion, drowsiness, slurred speech, delirium due to hepatic encephalitis

Complete liver failure meaning liver stops functioning altogether

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Treatment and prevention:

Eating healthy, well balanced food

Exercising regularly

Losing and maintaining weight at a healthy level.

Also read the articles ‘Basics Of Nutrition’, ‘Designing A Healthy Weight Loss Food Plan’, and ‘Simple Steps To Slimming’ on this website.

The Root Cause Of Diseases Like Diabetes, Heart Disease And Cancers!

Everyone knows hypertension, diabetes, heart disease, strokes, arthritis and cancers.

Few know that the root cause of these dangerous disease is inflammation!

What is inflammation?

We have all experienced injuries from our childhood when we fell and scratched our skin of legs and hands etc. We develop redness, swelling, pain and the area also becomes hot, and possibly bleeding if there is a wound, more than a mere scratch.

The redness, swelling, pain and heat are due to acute inflammation of the tissues of the area.

This is inflammation.

It is natural part of the process of healing of our bodies.

This is part of the body’s defence mechanism.

Inflammation can be acute and chronic.

Acute inflammation:

Whenever our body suffers from an injury or encounters an infection or a toxic substance, its immune system, which is the body’s defence mechanism, swings into action and unleashes its inflammatory cells and substances called cytokines at the site of injury.

Cytokines further stimulate more inflammatory cells to be unleashed in the area. The inflammatory cells trap and eliminate the invading bacteria or viruses or the toxin to initiate the healing process of the body.

This process causes pain, heat, redness and swelling. There may be some loss of function as the painful hand or leg becomes stiff as movement causes pain.

This is the process of acute inflammation which helps protect and heal the body after the injury. This process is healthy.

Chronic inflammation:

But sometimes the process of acute inflammation continues too long, even after the threat of the injury is over and the body continues to produce inflammatory cells which begin to attack healthy body tissues.

Untreated acute inflammation from infections, injury or toxins, chronic exposure to pollution or industrial toxins and autoimmune disorders lead to chronic inflammation.

Unchecked, this continuous state of inflammation becomes chronic inflammation and leads to diseases like diabetes, atherosclerosis, hypertension, heart disease, rheumatoid arthritis, asthma, Alzheimer’s disease and cancers.

In fact the root cause of almost all chronic diseases is chronic inflammation.

Chronic stress, bad food, complete lack of exercise or long term high intensity over exercise, obesity, smoking, regular alcohol consumption can also cause chronic inflammation.

The foods causing chronic inflammation:

Fried foods, fast foods.

Frozen meats cured with nitrites to preserve them and prevent growth of pathogenic bacteria.

Refined oils and trans fats.

Foods like pastries, white bread, bakery products prepared with sugar, refined carbohydrates like rava, maida, refined corn flour.

Life style factors leading to chronic inflammation:

Obesity.

Complete lack of exercise or exercising to the maximum limit too frequently.

Smoking, drinking alcohol.

Continuous stress.

Long term exposure to smoke and other air pollutants.

Treating inflammation:

Acute inflammation is easier to treat with rest, ice and good wound care.

Chronic inflammation is treated by nutritional supplements like Vitamins A, C and D and zinc and omega 3 or fish oil supplements and inclusion of fresh fruits, green leafy vegetables, tomatoes, low fat dairy, sea food and anti inflammatory spices like turmeric, garlic and ginger in food.

Preventing chronic inflammation:

Eating healthy.

Exercising moderately and regularly three to five times, daily better.

Maintaining healthy weight.

Keeping stress away by using techniques like meditation, yoganidra and pranayam.

Stopping smoking and avoiding drinking alcohol or keeping its consumption to the minimum.

Avoiding exposure to smoke and pollution.

Preventing chronic inflammation is preventing most chronic diseases!

So the pathway to healthy living is to eat healthy, exercising regularly, staying slim and stress free, avoiding smoking, alcohol and exposure to pollution.

Also read articles ‘Preventing Hypertension’, ‘Preventing Diabetes’ and ‘Heart Heathy Diet And Lifestyle!’ on this website.

How To Choose A Healthy Cooking Oil!

This is a delicate and controversial issue, involving complex scientific research which is still underway and emotions and geographical preferences and commercial interests of oil seed producers and the oil industry.

We have already seen in the ‘Heart Health Poster Boy Olive Oil Vs Groundnut Oil’ article on this website that the best oils nutritionally are groundnut oil for Indian style cooking and olive oil for Western type low temperature cooking or cold dressing oil.

Both oils are heart healthy and anti inflammatory oils.

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All oils are principally made up of three kinds of fatty acids, viz. monounsaturated, saturated, and polyunsaturated fatty acids.

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Monounsaturated fatty acids:

Monounsaturated fatty acids are healthy fats found in various nuts like groundnuts, almonds, cashews and hazelnuts and avocados and in olive and groundnut oils. They are liquid at room temperature but may start to solidify when chilled.

They can help reduce bad cholesterol (LDL) levels, lowering the risk of heart disease and stroke.

Some studies suggest they improve insulin sensitivity and help in managing blood sugar levels and that they may also help reduce inflammation, which is linked to chronic diseases like heart disease and diabetes.

Replacing saturated and trans fats in your food with monounsaturated fats can help prevent diabetes, heart disease and can promote better overall health.

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Saturated fatty acids:

Oils rich in saturated fats are coconut, palm and palm kernel oils.

Saturated fats raise LDL cholesterol, which is harmful to heart health and their consumption leads to heart disease and strokes.

The saturated fatty acids in coconut oil have been portrayed by some to be a medium chain triglycerides (MCT) rich oil which is supposed to be absorbed directly in the portal vein and transported straight to the liver which uses it up immediately for energy and that it is not stored as fat, and hence it is said to be healthy.

This is true for a special formulation coconut oil composed of hundred per cent medium chain triglycerides, used as a special nutritional supplement for pre term, low birth weight babies and critically ill ICU patients, not for regular coconut oil. Regular, commercially available coconut oil is rich in lauric acid and other saturated fatty acids, which function as long chain triglycerides and are absorbed slowly and raise the LDL cholesterol levels leading to heart disease and strokes.

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Polyunsaturated fatty acids:

Polyunsaturated fatty acids include the omega 6 and the omega 3 fatty acids.

Omega 6 (Linoleic) fatty acids trigger inflammatory processes in the body causing damage to tissues and vital organs while omega 3 (Linolenic) fatty acids reduce the inflammatory processes and protect the tissues and vital organs from inflammatory damage.

Thus oils rich in the omega 6 oils lead to diabetes, hypertension, heart disease and strokes while fats rich in omega 3 protect us from these diseases.

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Monounsaturated fatty acids to polyunsaturated fatty acids ratio:

A high monounsaturated fatty acids to polyunsaturated fatty acids ratio oils help lower total cholesterol and the bad cholesterol, the LDL cholesterol and increase the good cholesterol, the HDL cholesterol and also reduce the inflammatory processes in the body, thus protecting us from, diabetes, hypertension, heart disease and strokes.

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Comparisons of various oils:

Safflower seed oil:

Safflower seed oil is low in monounsaturated (oleic) fatty acids, 15 per cent, very high in omega 6 (Linoleic) fatty acids, 77 per cent and has zero omega 3 (Linolenic) fatty acids.

Thus it has a very bad monounsaturated fatty acids to polyunsaturated fatty acids ratio and completely lacs omega 3 (Linolenic) fatty acids.

Sunflower seed oil:

Sunflower seed oil is low in monounsaturated (oleic) fatty acids, 25 per cent, very high in omega 6 (Linoleic) fatty acids, 64 per cent and is very low in omega 3 (Linolenic) fatty acids, 0 to 3 per cent.

Thus it too has a bad monounsaturated fatty acids to polyunsaturated fatty acids ratio and completely or nearly completely lacs omega 3 (Linolenic) fatty acids.

Soy oil:

Soy oil is rich in omega 6 (Linoleic) fatty acids, 54 per cent and lower in monounsaturated (oleic) fatty acids, 23 per cent plus it has 10 per cent saturated fatty acids too.

Thus it has a bad monounsaturated fatty acids to polyunsaturated fatty acids ratio and also has substantial saturated fats.

Rice bran oil:

Rice bran oil has 41.4 per cent monounsaturated (oleic) fatty acids, about 35 per cent omega 6 (Linoleic) fatty acids and about 20 per cent saturated fatty acids.

Thus it doesn’t have a high monounsaturated fatty acids to polyunsaturated fatty acids ratio and is also high in saturated fatty acids.

Cotton seed oil:

Cotton seed oil is rich in omega 6 (Linoleic) fatty acids, 55 per cent, low in monounsaturated (oleic) fatty acids, 17 per cent and high in saturated fatty acids, 22 to 29 per cent.

Thus it has a bad monounsaturated fatty acids to polyunsaturated fatty acids ratio and is also high in saturated fatty acids.

Sesame oil:

Sesame oil has 43 per cent each monounsaturated and polyunsaturated fatty acids and 13 per cent saturated fatty acids.

Thus it too lacks a high monounsaturated to polyunsaturated fatty acids ratio.

Canola oil:

Canola oil has a very favourable fatty acid composition, about 57 to 65 per cent monounsaturated fatty acids, 17 to 21 omega 6 fatty acid, about 12 per cent omega 3 fatty acids and about 6 per cent saturated fatty acids.

But it comes from a genetically modified plant and is an industry manufactured oil.

Mustard oil:

Mustard oil in fact has a very good balance of the monounsaturated fatty acids to the polyunsaturated fatty acids (60 gm to 21 gm per 100 gm of oil) as well as the omega 6 to the plant source omega 3 or ALA (15 gm to 6 gm per 100 gm of oil ratio).

But it also has the erucic acid, an omega 6 fatty acid that has been connected to heart disease.

Also its pungent odour and taste are unacceptable to most people in our region.

Flaxseed oil:

Flaxseed oil has 9 gm saturated fatty acids, 18 gm monounsaturated fatty acids and almost 75 gm polyunsaturated fatty acids, of which 18 gm is omega 6 fatty acids and 55 to 58 gm plant source omega 3 or ALA fatty acids.

Thus it has a very poor monounsaturated to polyunsaturated fatty acids ratio, not very conducive to heart health.

Also the oil is easily oxidised when exposed to light, air and heat. Its smoking point is low, hence it is unsuitable to Indian style high temperature cooking and it has to stored in a refrigerator to prevent its oxidation.

It can at best be used as cold dressing oil as a small supplement to the main cooking oil.

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Industry Manufactured Oils versus Cold Pressed Oils:

Industry manufactured oils like soya oil, rice bran oil, corn oil, sunflower oil, safflower seed oil (kardai), Canola oil, cottonseed oil are considered bad fats by many nutritionists.

The use of heat and chemicals in extracting and refining these oils alters their fatty acid structures and trans fats and other toxic substances are developed in them, turning them unhealthy.

Cold pressed oils in contrast retain the original fatty acids composition of their oil seeds.

Today many researchers are asking us to shun all industrially produced oils and recommend cold pressed oils.

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Groundnut Oil and Olive Oil:

That leaves us with the choice of cold pressed groundnut oil and olive oil!

Both oils have similar ability to control inflammation.

Olive oil has a better monounsaturated to omega 6 polyunsaturated fatty acids than groundnut oil.

But olive oil which has a comparatively lower smoking point than groundnut oil cannot be considered as a premium cooking and frying oil for Indian style of cooking which involves deep frying.

Groundnut oil reportedly has greater oxidative stability and higher smoking point as compared to olive oil and has been considered as a premium cooking and frying oil as compared to olive oil. Gomez et. al., 2003 have shown that the phenolic compounds in extra virgin olive oil get damaged very quickly by heat along with a loss of Vitamin E.

The preliminary analysis of blood samples from people who have been consuming groundnut and olive oil since one year do not show any significant differences in the biochemical parameters assessed.

Only it is important to consume groundnut oil in moderation, to keep our omega 6 fatty acids consumption low.

But this is true of any other oil as excess oil consumption will also lead to obesity.

Studies have also shown that resveratrol, a phenolic antioxidant present in groundnuts reduces the risk of vascular disease caused by angiotensin a hormone that causes the arteries to contract and leads to raised blood pressure which damages the endothelial lining of the arteries leading to heart disease and strokes, amongst damage to other organs. Resveratrol also protects the arteries by increasing the vasodilator hormone, nitric oxide.

Groundnuts also are high in the powerful antioxidant, Vitamin E, which protects the cells of the mucosa and skin from the damage caused by oxygen free radicals.

Thus we can conclude that groundnut oil could be the better choice of oils for Indians, than olive oil, both nutritionally as well as economically.

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In short, if you live in India and your oil consumption is moderate, you can safely use groundnut oil.

If you live in India and cook your food at low temperature and don’t mind spending extra money on your oil, or if you use oil only as salad dressing oil or  cook your food at low temperature and live in the US or Europe, you can use olive oil.

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Achieving a healthy balance of fatty acids:

Groundnut or olive oil do not provide us with sea source omega 3 fatty acids.

Sea source omega 3 fatty acids (DHA and EPA) are essential for the maintenance of heart, brain and eye health and in preventing inflammation associated with chronic disease like arthritis, asthma and some autoimmune disorders. They are also essential for the proper development of the foetal brain and eyes.

That is why it is important that we maintain a proper balance of healthy of fats in our food.

We can do so by consuming sea fish or omega 3 supplements twice or thrice a week to supplement the monounsaturated fatty acids provided by groundnut or olive oils.

Also read the articles ‘Heart Health Poster Boy Olive Oil Vs Groundnut Oil’, The Good And The Bad Fats’ and the ‘Basics Of Nutrition’ on this website.