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Blood Cholesterol – The good friend with a bad rep

Blood Cholesterol Levels – The what, why and how.

High cholesterol level in blood has become so common, that almost 10 million people are diagnosed with it, every year. A seemingly simple explanation for this is our sedentary lifestyle, but the issue is a little more deep rooted than just lifestyle. What makes up your plate eventually makes up your physique, and we’re here to help you sort the plate out.

What is cholesterol, really?

Cholesterol is a waxy substance that your body needs for a lot of functions, like hormone secretion, metabolism and maintaining overall health. Carried through the body by lipoproteins, cholesterol essentially helps your body maintain balance and is a good friend.

Until, there’s too much of it in your blood. Too much blood cholesterol has a lot of consequences, but first, how much is too much?

Interpreting your blood cholesterol numbers.

There are two types of cholesterol, the High-Density Lipoprotein and the Low-Density Lipoprotein, commonly referred to as the good and the bad cholesterol. HDL absorbs excess cholesterol and takes it back to the liver, while the LDL collects on the walls of blood vessels.

Total cholesterol levelHDLLDL
OptimalLess than 200 mg/dl<40 mg/dl in men,
<50 mg/dl in women.		<100 mg/dl
HighAnything over 240 mg/dl is very high≥130 mg/dl

 

While it is true that cholesterol levels must be kept in check, neglecting cholesterols is not the way to go either. Any HDL reading below 40 mg/dl in men and 50 mg/dl is considered low, and is not advisable in the long run.

How would I know?

Symptoms for high cholesterol levels in your blood will not show as explicitly, so the risk of it being undetected until it’s serious is quite high. The only way to find out and know for sure that you have high blood cholesterol is to have it tested by a physician.

A few physical symptoms however, are fatty bumps on your skin, called xanthomas, or grayish-white rings around the corneas in your eye, called corneal arcus. These mostly develop in people who have familial hypercholesterolemia. But waiting for these symptoms might not be the wisest decision. Have your blood cholesterol levels periodically checked and keep yourself on the know.

Who’s at risk?

Statistically people between the ages of 40 and 59 are the ones commonly diagnosed with high blood cholesterol. Other than age, there are a few other risk factors that can increase your chances when it comes to getting diagnosed with high blood cholesterol.

As far as lifestyle choices are concerned, eating foods high in saturated fats or trans fats regularly, lack of physical activity, smoking, chronic stress and drinking too much alcohol can pose a threat. Apart from these, high blood cholesterol could also be genetic.

If you have other conditions like obesity, PCOS, Diabetes, Hypothyroidism and/or are taking medications like diuretic, steroids, or medications for chemotherapy, they might be reasons for high levels of blood cholesterol.

Dealing with it

Left unchecked for prolonged periods of time, high blood cholesterol levels can lead to serious problems, such as heart attack and stroke. So it is very important that you cope well and keep your numbers at bay.

First things first, work on what you eat. Reduce the consumption of saturated and trans fats that are found in fatty cuts of meat, dairy products, and many packaged snacks and desserts. We recommend eating fish high in omega-3 fatty acids, nuts, and the usage of certain vegetable oils such as olive oil. The DASH eating plan will help reduce your LDL, or the “bad cholesterol”.

Working on a healthier lifestyle along with a proper diet can work wonders. By healthier lifestyle we mean being physically active, keeping yourself free of too much stress, not smoking, limiting your alcohol consumption and taking the right meds when needed. Speak with your doctor and stick to the protocol, and you’ll be mighty fine!

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Understanding Hypertension

Hello, Yoda here. Today, we’ll discuss one of the most prevalent conditions in the world. As of 2019, hypertension, or high blood pressure had affected around 26% of the world’s population. The number was estimated to grow up to a whopping 29% by 2025, and the pandemic-infused stress has only made it worse.

To tackle hypertension, we must understand the condition first.

So, what is hypertension?

Hypertension is a condition in which the blood vessels have persistently higher pressure than optimum. This means that the blood in the arteries is flowing at a higher pressure than normal, and arteries are overclocking consistently.

It is commonly expressed as the ratio of Systolic Blood Pressure (SBP) to Diastolic Blood Pressure (DBP). Systolic blood pressure is the pressure that the blood exerts on the arterial walls when the heart contracts and diastolic blood pressure is the pressure exerted when the heart relaxes.

How much should your SBP/DBP read, exactly?

Optimally, your SBP should read less than or around 120 and DBP should be less than 80. Here’s a table that’ll help you understand numbers around hypertension better.

 

 

What are all the possible causes of high blood pressure?

To understand why someone’s blood pressure is high, we must first learn about the two types.

Primary or essential high blood pressure is the common type. It develops with old age, a sedentary lifestyle, unhealthy eating habits, stress, or an irregular/insufficient sleeping pattern.

Secondary blood pressure on the other hand is usually the result of a prevailing medical condition or a side effect of certain medicines. This fades gradually after treating the initial condition or as the medicines that cause hypertension are stopped.

How would one know if they have hypertension?

Here’s the tricky part – The only way to be sure if you have high blood pressure is to get it checked by a health professional. There are symptoms like the ones discussed below, but they don’t always show, and if you’re experiencing any of these, you must start taking immediate action.

Speaking about noticeable symptoms, you will experience early morning headaches, occasional nosebleeds, irregular heart rhythms, blurred vision, and a buzz in the ears.

More severe ones include fatigue, nausea, vomiting, anxiety, confusion, chest pain, and muscle tremors. Again, with hypertension, the symptoms are not regular and persistent, which makes it easy to miss. However, ignoring it can cause persistent pain in the chest – a condition called angina, heart attacks, heart failure, and irregular heartbeats. Hypertension left unchecked leads to sudden death, even. so it is important to notice any discomfort or symptom and get your blood pressure checked regularly.

Am I at risk?

One of the most common mistakes a lot of people make is assuming that they are free from the risk of being affected by hypertension because they are young. While it is true that people over 55 are more likely to be affected by it, age isn’t the only criterion here.

Your chances of having high blood pressure increase if you

  • Are overweight
  • Eat salty food or food rich in sodium
  • Do not have an active lifestyle
  • Smoke
  • Consume alcohol a lot
  • Have a family history of high blood pressure

How do I cope with high blood pressure?

The first thing to do is to periodically check your blood pressure levels. If recommended by your physician, do take your medicines every day. Having an active lifestyle definitely helps reduce the risk of hypertension, so do exercise regularly. Keep your body weight in check, and quit smoking. Limit your alcohol intake, and finally, maintain a good sleep cycle.

The last thing to understand when talking about hypertension is that diet plays a very important role in keeping your blood pressure levels low. Dietary Approaches to Stop Hypertension, or the DASH eating plan is one effective meal plan that helps.

The DASH eating plan

The DASH eating habit helps keep your hypertension in check by limiting sodium intake. It encourages foods that are rich in potassium, calcium, magnesium, fiber, and protein. Here are a few food groups and foods recommended in the DASH eating plan.

 

 

There are a lot of other foods that are recommended as part of the DASH eating plan. The focus here is to simply limit your salt/sodium intake and load up on a wholesome, nutritious meal that’ll help regulate your blood pressure. According to the DASH diet, the total sodium intake should not be more than 2,300 mg per day.

Remember to relax

Hypertension, though if left unchecked could become a lot more serious, is not a threatening illness if you follow a decent protocol in diet and lifestyle. Kick back, relax, take the right nutrients, keep fit and move along. Yoda’s here to help you loosen it up.

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Binge Eating

The following information may be triggering to those with eating disorders. Please be mindful should you continue reading. 

 

A severe and life-threatening disorder, Binge Eating Disorder is characterized by recurring episodes of excessive food consumption. A recent but important addition to the officially recognised list of disorders, binge eating is capable of immense harm to the body and mind. Let’s understand what exactly this disorder entails. 

Basics of Binge Eating: 

 

People who binge eat are not just driven by hunger or due to a metabolic need. For some it’s the hedonistic value, for others compulsion to eat and yet others for the stress relief. Binge eating is a behaviour which develops into Binge Eating Disorder. 

 

Diagnosis: 

 

A binge eating episode is characterized by the following: 

 

  1. Eating a significantly large quantity of food than most people would eat in the same period of time, in similar circumstances 
  2. Experiencing a lack of control with eating during this episode 

 

Binge eating episodes are also accompanied with at least three of the following: 

 

  1. Eating faster than normal 
  2. Eating until feeling uncomfortably full 
  3. Eating large quantities of food despite not being physically hungry
  4. Eating alone out of embarrassment for food quantity
  5. Feelings of self-disgustion, depression and guilt from overeating 

 

Mukbang: A growing trend this past year among Youtube vloggers are ‘Mukbangs’, where people eat ridiculous amounts of food on camera. These videos have both a positive and negative impact, where some feel that mukbangs encourage healthy appetites and others find it normalizes eating disorders. 

 

Warning Signs: 

 

Binge eating is an insidious disorder, it gradually develops over a period of time. Be wary of these warning signs: 

  • Stealing or hoarding of food in strange places
  • Withdrawing from friends and usual activities 
  • Going on-and-off on diets 
  • Uncomfortable while eating around others 

 

Symptoms: 

 

Binge eating directly impacts your physiology and psychology, it comes with a plethora of symptoms. They include 

  • Fluctuations of weight, both increase and decrease. 
  • Stomach cramps 
  • Constipation
  • Acid Reflux 
  • Difficulty in concentration 

 

Neurobiology of Binge Eating: Binge eating has been classified as a disorder but the neurobiology mirrors the same traits of substance abuse behaviour. Delicious foods and fluids provide the same reinforcement effects to the natural reward pathways in your brain as addictive substances like drugs. 

 

Consequences: 

 

The prominent health risks associated with Binge Eating Disorder are clinical obesity, weight stigma and weight cycling. Yo-yo dieting is common among those with BED. Not all people who are clinically obese have BED, but two-thirds of people with BED are clinically obese. Similarly, while most people with BED have higher-than-average weight, it can be diagnosed at any weight. 

 

More severe cases of BED lead to Bulimia Nervosa: a life-threatening eating disorder involving cycles of binge eating and behaviours like self-induced vomiting. 

 

Treatment: 

 

Studies show that psychological interventions like Cognitive Behavioural Therapy (CBT) and Behavioural Weight Loss Therapy (BWLT) do seem effective for binge eating disorders.

 

CBT directly targets the core of binge eating since both the psychopathology of eating disorders and over-evaluation of shape and weight are cognitive in nature. A study suggests that people start with extreme and highly specific dietary rules when trying to reverse BED. However, this tends to fail and patients are further negatively affected. CBT helps in this regard.
Cheers and see you soon,  

 

References

  1. Binge eating disorder treatment: a systematic review of randomized controlled trials. Brownley KA, Berkman ND, Sedway JA, Lohr KN, Bulik CM
  2. Personality and eating behaviors: a case-control study of binge eating disorder. Davis C, Levitan RD, Carter J, Kaplan AS, Reid C, Curtis C, Patte K, Kennedy JL
  3. Brownley, Kimberly A., et al. “Binge-Eating Disorder in Adults.” Annals of Internal Medicine, vol. 165, no. 6, 2016, p. 409., doi:10.7326/m15-2455.
  4. Mathes, Wendy Foulds, et al. “The Biology of Binge Eating.” Appetite, vol. 52, no. 3, 2009, pp. 545–553., doi:10.1016/j.appet.2009.03.005.
  5. National Eating Disorders
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Diabetes 101: We’ve got the Deets!

One of the disorders that’s now a household name, Diabetes has certainly had a global impact in the recent years. With data showing alarming future projections of diabetes cases across the world, let’s first understand this disorder in its entirety. 
 

 
Let’s get real, folks: “A touch of sugar” does not create diabetes. Even sugar consumption cannot cause diabetes on its own. But let’s find out what does: 

 

The deciding factor is insulin. If your body cannot make any, you have type 1 diabetes; if your body doesn’t utilise or make insulin, you have type 2 diabetes. The former is irreversible and lifelong care is required. Type 2 diabetes is majorly a lifestyle disorder which can be managed and in most cases, reversed.
 

 
Now that we’ve understood the role insulin plays in our bodies, let’s narrow down on what happens when there’s an insulin resistance. When you consume food, the digestion does its job and breaks it down to glucose. Now since insulin cannot grab the glucose from the bloodstream, the excess remains and elevates your blood glucose levels.      

 

So how do you know whether you have diabetes or not? Your biomarkers confirm them. When testing for diabetes, the main parameters one checks are fasting blood sugar, post-prandial blood sugar, HbA1c, HOMA-IR and urinary glucose levels.   

 

Does nutrition have an impact on insulin resistance?   

It most certainly does. The how, is still in the works. Even in the scientific world there’s a heated discussion on which nutrition guidelines have a sustainable effect on reversing and/or managing diabetes. Is it the macronutrient composition or the energy activity? How does one examine evidence from previously conducted trials? Is there a truly sustainable method of eating that can without-a-doubt reverse type 2 diabetes?

 

Rest easy, we’ve got the facts compiled for you.

 

There has been a degree of consensus in these areas…

 

A priority is Weight Management, since weight loss goes hand-in-hand with improvements in glycemia, blood pressure and lipids. Maintaining the required Energy Balance is another, where guidelines recommend portion control along with physical activity. Evidence-based Dietary Patterns such as higher intake of vegetables, fruit, whole grains, nuts, legumes and yoghurt, tailored to the individual. Certain Foods to Avoid or reduce include processed red meats, refined grains and sugars for prevention and management of type 2 diabetes. 

 

Whereas in these areas, there remains uncertainty in guidelines…

 

An issue most contentious in type 2 diabetes management is the optimal macronutrient composition, with variations among countries, nutritionists and those with diabetes themselves. While fish intake is recommended to manage cardiovascular risks, there’s a spectrum of association with diabetes: positive, negative or none at all! There has been consistent beneficiary evidence on yoghurt but other dairy products have yet to be conclusively examined. Oils and which type is preferable is still debated, though olive oil has shown evidence of potential benefits.  

 

So what exactly does a person with diabetes eat?

 

Well, therein lies the work. Those with diabetes have had a multitude of diet options thrown at them: paleo, keto, vegan and more. The fact remains that a ‘standardised diet’ does not work in the long term, period. Within the existing nutrition guidelines, one must craft a personalized meal plan based on their food preferences, lifestyle conditions and environment. Do remember that nutrition is an evolving process, it is advisable for those with diabetes to consult a nutritionist before making drastic nutritional shifts. 

 

Among the plethora of studies undertaken, the Mediterranean diet has attracted multiple diabetes trials. A 12-month trial found that participants on a low carb Mediterranean diet demonstrated greater weight loss, improved glycemic and HDL levels! However studies have yet to conclude if the same will continue in the long run.

 

Okay, but is exercise really that necessary? 

 

Exercise is recommended for people regardless of any disorders. Those with diabetes are particularly encouraged to exercise to improve cardiovascular and overall fitness, weight control and to enhance their quality of life. Exercise and resistance training may benefit and improve glycemic control. 

 

Did you know that the type and timing of your meals impact your blood glucose responses to exercise? People with diabetes and insulin dosages have to ensure that their insulin levels and carbohydrate intake are coordinated to reduce hypoglycemia. Care has to be taken with pre-workout and post-workout meals – consuming the appropriate quantity of carbs in accordance with blood glucose levels.

 

So with exercise and nutrition in check, can type 2 diabetes be reversed? 

 

Although once considered irreversible and progressive, recent years have seen a shift in management and reversal of type 2 diabetes. Despite this, there is little evidence on the sustainability and lasting effect of such reversal and the potential for remission. The question of the hour is which plays a more predominant role in achieving remission: energy deficit or macronutrient composition. For more on this, keep an eye out for our next blog post in this series. 

 

Until we meet again,

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Inflammation – The Basics

The terms Inflammation and anti-inflammatory diet are being tossed around lately and I thought this would be a great time to share some information on these topics. So let’s delve into what these things mean, who would benefit from an anti-inflammatory diet and how to go about it.

What is Inflammation?
The word inflammation is a widely misunderstood term considered to be something that causes harm to our body. The truth is, inflammation is an essential pathway of your immune system to protect your body from something as simple as a small cut to fighting a severe infection. The process of inflammation includes increased blood flow at the site of injury/infection, dilation of capillaries, white blood cell infiltration, and production of chemical mediators to manage the condition.
While inflammation is a natural process that aids the body in certain conditions, it can occur too little causing it to go unnoticed by us before it’s too late (e.x., diabetes, cardiovascular disease) or too much causing a bad reaction (e.x., autoimmune diseases such as rheumatoid arthritis).
What triggers inflammation?
The most common trigger for inflammation is when your body is responding to a stimulus either in the form of a foreign body such as a bacterial infection or when it’s repairing an injury. However, there are certain factors that have the ability to trigger inflammation.
Diet – Various food groups such as sugars, trans fats and refined products have been linked to promoting inflammatory reactions in the body. 
Stress – Multiple studies have shown that chronic stress has a pro-inflammatory response as the hormone cortisol (more commonly known as the stress hormone) is also involved in regulating inflammation.
Excess weight – Although excess weight gain is listed as a trigger for inflammation, this is a bit of a conundrum as inflammation can also lead to weight gain. Different pathways have been linked to show that overeating and excess fat in the body can trigger inflammation.
Alcohol Consumption – While maintaining your limits while consuming alcohol is advisable, drinking too much impairs liver function and may even cause build up of toxic byproducts triggering inflammatory reactions in your body.
Smoking – Multiple studies conducted among smokers has indicated a clear increase in various inflammatory markers. Also there is a clear decline in these markers after they quit smoking indicating a correlation between the two.
What are some of the foods that trigger inflammation?
Various studies have concluded that certain food groups tend to induce or cause an inflammatory reaction leading to adverse effects. Some of them are listed below:

    1. Sugars and Fructose – Studies conducted in animal models and human trials have been shown to induce inflammatory reactions leading to diseases such as obesity, diabetes, etc., What’s more, the high concentration of fructose in refined sugars and high fructose corn syrup plays an adverse role in developing these diseases.
    2. Trans Fats – Trans fats are one of the unhealthiest food options out there and are mostly found in fried fast food items. It is shown that there is a spike in inflammatory markers such as C-Reactive Protein when consuming a diet high in Trans Fats


What is an anti-inflammatory diet?
A prolonged inflammation in the body is characterised by oxidative stress and altered glucose and lipid metabolism in our fat (adipose) cells, muscle, and liver. Making dietary changes can aid in managing oxidative stress and inflammatory pathways.
Anti-inflammatory diets are rich in antioxidants, plant polyphenols and other components that help reduce inflammatory responses. The usual prescription for an anti-inflammatory diet includes foods low in refined carbohydrates, high in soluble fiber, high in mono-unsaturated fatty acids, a higher omega-3 to omega-6 ratio.
The mediteranian diet is considered a good example of an anti-inflammatory diet as it is rich in fruits, vegetables, nuts, whole grains, fish, and healthy oils. The advantage here is that it not only helps reduce inflammation in your body but substitutes your diet with healthier options leading to a better overall health.
Some of the commonly prescribed foods for an anti-inflammatory diet are Berries(rich in antioxidants), Fatty Fish(rich in omega-3 fatty acids), Avocados(high in fiber), Turmeric(contains curcumin, a powerful anti-inflammatory compound).
Who would benefit from an anti-inflammatory diet?
An anti-inflammatory diet is usually prescribed for people suffering from an inflammation based condition such as:

    • Rheumatoid Arthritis
    • Psoriasis
    • Asthma
    • Eosinophilic Esophagitis
    • Crohn’s Disease
    • Colitis
    • Inflammatory Bowel Disease
    • Lupus
    • Hashimoto’s Disease

In addition to this, it might help manage lifestyle conditions such as diabetes, obesity and heart disease.
Although staying on this diet might help reduce the occurrence of inflammation, it may not be the ultimate solution. It is important to consult your physician and continue any medication prescribed. 
It is also considered to be a healthy diet in general as it incorporates a diet high in the major macronutrients and excludes highly processed and refined foods.

References

  1. What is an inflammation? National Center for Biotechnology Information. 
  2. Hunter P. Stress, Food, and Inflammation: Psychoneuroimmunology and Nutrition at the Cutting Edge. EMBO Reports.
  3. Hunter, Philip. The Inflammatory Theory of Disease. EMBO Reports, Nature Publishing Group, Nov. 2012
  4. Galland, Leo. “Diet and Inflammation.” Sage, 7 Dec. 2010
  5. Foods that fight inflammation. (2017, August 13).
  6. Sheldon Cohen, Denise Janicki-Deverts, William J. Doyle, Gregory E. Miller, Ellen Frank, Bruce S. Rabin, and Ronald B. Turner. Chronic stress, glucocorticoid receptor resistance, inflammation, and disease risk. PNAS, April 2, 2012 DOI: 10.1073/pnas.1118355109
  7. University of Oslo. “Being overweight causes hazardous inflammations.” ScienceDaily. ScienceDaily, 25 August 2014
  8. Makki K, Froguel P, Wolowczuk I. Adipose tissue in obesity-related inflammation and insulin resistance: cells, cytokines, and chemokines. ISRN Inflamm. 2013;2013:139239. Published 2013 Dec 22. doi:10.1155/2013/139239
  9. Wang HJ, Zakhari S, Jung MK. Alcohol, inflammation, and gut-liver-brain interactions in tissue damage and disease development. World J Gastroenterol. 2010;16(11):1304–1313. doi:10.3748/wjg.v16.i11.1304
  10. Kianoush S, Yakoob MY, Al-Rifai M, et al. Associations of Cigarette Smoking With Subclinical Inflammation and Atherosclerosis: ELSA-Brasil (The Brazilian Longitudinal Study of Adult Health). J Am Heart Assoc. 2017;6(6):e005088. Published 2017 Jun 24. doi:10.1161/JAHA.116.005088
  11. Lee J, Taneja V, Vassallo R. Cigarette smoking and inflammation: cellular and molecular mechanisms. J Dent Res. 2012;91(2):142–149. doi:10.1177/0022034511421200
  12. Tibuakuu M, Kamimura D, Kianoush S, et al. The association between cigarette smoking and inflammation: The Genetic Epidemiology Network of Arteriopathy (GENOA) study. PLoS One. 2017;12(9):e0184914. Published 2017 Sep 18. doi:10.1371/journal.pone.0184914
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Irritable Bowel Syndrome

Irritable Bowel Syndrome(IBS) is one of many bowel disorders that can cause anything from mild discomfort to extreme bowel issues. IBS belongs to a group of bowel disorders classified as non inflammatory bowel disorders as opposed to Inflammatory Bowel Disease which is characterized by inflammation of the intestines. So read further to understand what is IBS and how to manage the condition.

What Is Irritable Bowel Syndrome(IBS)?
IBS is classified as a functional gastrointestinal disorder where there are issues as to how the gut and brain work together. IBS is characterised by multiple symptoms such as stomach cramping, abdominal pain, bloating and changes in bowel movement. It is a chronic condition that tends to occur in people aged 20-45 and is seen more commonly in women.
What are the Symptoms of IBS?
IBS displays a varied range of symptoms. Some of the common symptoms are:

    • pain in your abdomen (often related to your bowel movements)
    • changes in your bowel movements (diarrhea, constipation, or in some cases, both)

A few of the other symptoms are:

    • feeling bloated/gassy
    • feeling very full
    • mucous discharge in your stool

The symptoms of IBS tend to occur in episodes of symptom free periods followed by periods of severe burst of symptoms. Certain trigger foods might cause the onset of symptoms.
What are the causes of IBS?
The muscles lining the intestine play a vital role in pushing the food mass through the intestinal canal. As the food gets digested and water gets absorbed through the intestinal walls, undigested material forms the hard stool. In the case of IBS, the muscles tend to push the food through the canal too fast or too slow causing diarrhea or constipation respectively.
Although we are unable to pin-point what could cause this malfunction at this point of time, many theories have been put forth such as, oversensitive nerves in the intestine, intestinal muscle disorders,inflammations of the intestinal wall and genetics. Psychological stress and food intolerances are thought to be triggers as well.
What are the risk factors of IBS?
A few of the risk factors associated with IBS are as follows:

    • Age – IBS tends to occur in people of the 25-50 age groups
    • Gender – IBS seems to be more common in Women than Men. It is thought that the female hormones play a role in this
    • Family History – Genes or a shared environment or both in combination may play a role in risk of IBS
    • Mental Health Problems – Anxiety, depression and other mental health issues are associated with IBS


What are the types of IBS?
Based on the type of symptoms, IBS can be divided into 3 types namely:

    • IBS-C – IBS with constipation characterised by Infrequent stools and constipation
    • IBS-D – IBS with diarrhea characterised by frequent stools and diarrhea
    • IBS-A – IBS with alternating constipation and diarrhea


Are IBS and IBD the same?
Although IBS and IBD share a lot of symptoms, they are completely different disorders. While IBS is characterised by multiple symptoms, it is not a disease in itself and is not considered to be as dangerous as IBD. IBD on the other hand causes inflammatory reactions and causes damage to the intestine leading to intestinal bleeding, rectal bleeding, ulcers, etc.,
A simple non-invasive test to differentiate between the two is to take a fecal calprotectin test which measures the presence of certain antibody proteins in the stool. A positive result indicates the presence of IBD while the negative test could mean that the symptoms may be caused due to IBS and needs further testing for confirmation.
How is IBS diagnosed?
After a review of your symptoms and their frequency, a doctor would recommend certain tests to diagnose IBS. This includes physical examination for bloating, tenderness or pain. IBS is mainly diagnosed by ruling out the presence of other disorders such as IBD and food intolerances(Gluten, Lactose, etc.,). The doctor might also recommend a routine blood and stool test and in some cases an upper GI endoscopy or a colonoscopy.
What is the low FODMAP diet?
FODMAP stands for fermentable oligo-, di-, and monosaccharides and polyols. It is a class of carbohydrates that are not well absorbed in the intestine for some people. This leads to food items getting accumulation in the intestine and fermented by the gut bacteria leading to release of gas.
These conditions tend to trigger IBS in individuals. The list of foods that are classified as FODMAPs is extensive and is maintained by the International Foundation for Functional Gastrointestinal Disorders and it is recommended to go on a low FODMAP diet and introduce one food at a time to identify the trigger food.
How does IBS affect quality of life?
Although there are very few complications associated with IBS, mental health and quality of life are the biggest complications individuals with IBS tend to face. Some people may feel they’ve lost control over their body as they can never be sure when they would have to go to the toilet.
Another issue is that it could be embarrassing to talk about issues with their bowel movements or passing a lot of wind often. 
Can IBS be treated?
IBS is a chronic condition that does not have a complete treatment as of now. But the condition can be managed by changes in diet, lifestyle, certain medications and in some cases, mental health therapies. The process of finding what treatment works best is a trial and error process in order to identify certain trigger foods or conditions.
Based on the type of IBS, individuals may be prescribed with fiber supplements or laxatives to treat their condition.

References

  1. Irritable bowel syndrome: Overview
  2. Definition & Facts for Irritable Bowel Syndrome, NIDDK
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Polycystic Ovarian Syndrome – The Basics

PCOD/PCOS.
This term is commonly heard of nowadays. We see several women diagnosed with this condition. But what is it? Do we really know?
This article aims to cover the basics of Polycystic Ovarian Syndrome (PCOS) or Polycystic Ovarian Disease (PCOD). We believe it is imperative to have basic knowledge about the conditions that are seen today and make ourselves more aware.
What is PCOS?
Polycystic Ovarian Syndrome, commonly known as PCOS is a metabolic, endocrine and reproductive disorder seen in women of reproductive age (1,2). It is characterised by a myriad of signs and symptoms associated with ovarian dysfunction and androgen excess (1,2). The signs and symptoms associated with PCOS varies from person to person, and will be discussed in the coming section.

Why does it occur?
The exact cause for PCOS remains mostly unknown. It is said to be a multifaceted disease (1) in which a variety of factors play a role in the development. These include environmental and/or genetic influence, diet, lifestyle, ovarian steroidogenesis, abnormal insulin signalling and excess oxidative stress. (1,2).
What are the signs and symptoms?
As mentioned earlier, PCOS is characterized by a variety of signs and symptoms. Any combination of these symptoms could indicate the possibility of PCOS. Menstrual irregularities, obesity or excess androgen could be a sign of this disease. However, in order to standardise the signs and symptoms, the Rotterdam Criteria is used as a rule of thumb (3). The presence of any two of the three symptoms listed in Table 1 are used to diagnose the presence of PCOS. (3,1) To confirm the presence of polycystic ovaries, an ultrasound is performed by the gynaecologist.
However, it is to note that although widely used, the Rotterdam criteria for diagnosing PCOS has been questioned due to a paucity in data (4).
In addition a fasting lipid panel, BMI, waist circumference a 2-h glucose challenge test must be done (4,5). Also, screening for thyroid disorders is important as thyroid disorders are a common cause of menstrual irregularity (5).

Table 1: Signs and symptoms associated with PCOS.

HyperandrogenismHirsutism
Acne
Androgenetic Alopecia
Acanthosis Nigricans
High circulating testosterone and androstenedione
Menstrual IrregularityOligomenorrhea (infrequent menstruation)
Amenorrhea (absence of menstrual cycle)
High circulating Luteinizing Hormone levels
Polycystic Ovaries on Ultrasound>/= 12 follicles in each ovary
Follicle size between 2 and 9mm (+/- >10ml ovarian volume)

Presence of 2 out of 3 of these symptoms are used to diagnose the presence of PCOS.

Are there different types of PCOS?
While most people assume that excess adiposity and irregular or absence of menstrual cycle is only associated with PCOS, it is imperative to know that it is not the case. As seen above, 2 out of 3 of the symptoms presented could indicate the manifestation of PCOS. Hence, it is a spectrum. Once again, the Rotterdam criteria (3) divides these into 4 phenotypes, as seen in Table 2:

PHENOTYPECRITERIA
Frank or classic polycystic ovary PCOSchronic anovulation, hyperandrogenism, and polycystic ovaries
Classic non-polycystic ovary PCOSchronic anovulation, hyperandrogenism, and normal ovaries
Non-classic ovulatory PCOSregular menstrual cycles, hyperandrogenism, and polycystic ovaries
Non-classic mild or normoandrogenic PCOSchronic anovulation, normal androgens, and polycystic ovaries


What are the risks?
Insulin resistance (IR) is considered as an important manifestation in PCOS (6). Increased insulin and Luteinising Hormone levels could lead to anovulation (7). As a result of IR, PCOS is said to increase the risk for Type II Diabetes and gestational diabetes for the individual (8). Impaired glucose tolerance (8) and obesity are additional contributing factors to this.
Obesity is also an important feature of PCOS. However, it isn’t inherently caused by PCOS, but rather could also be due to lifestyle and environmental influences (1). Women with PCOS have more visceral fat and subcutaneous fat distribution (9). Whether obesity leads to PCOS or whether PCOS leads to obesity is still debatable (5).
Due to the nature of the symptoms women with PCOS could have a higher chance of being infertile. Infertility is more commonly associated with the existence of PCOS than healthy women (10). However, there still remains a gap in the literature on the influence of the different phenotypes on female fertility. More controlled studies are needed looking at the degree of infertility in each phenotype and the outcomes on pregnancy (1).
What is the treatment like?
Due to PCOS presenting itself as a spectrum, there is no single universal treatment. Most treatments are symptom based, targeting the issues pertaining to androgen excess,insulin resistance, hirsutism, acne and oligoovulation (1,2). In addition, lifestyle counselling should be provided in all cases in order to prevent or treat obesity (2).
Women with Classic PCOS symptoms are likely to resume their cycles on dietary and lifestyle interventions. Dietary interventions such as consuming high fibre and protein rich foods can help with weight loss in those with PCOS. Infact, a recent review addressing nutritional management of PCOS (11) concluded that the diet composition of those with PCOS should be low in saturated fat and contain sufficient fibre from whole grains, legumes, fruits and vegetables. In addition, consumption of carbohydrates with a low glycaemic index was recommended. Soy protein has also been to have favourable effects on BMI, glycaemic control and triglycerides in those with PCOS (12)
Oral Contraceptive Pills (OCPs) are commonly used to address menstrual irregularities and hyperandrogenism (2). This helps in reducing the secretion of luteinizing hormone and decrease free testosterone levels (Costello 2007). Metformin, is another anti-diabetic drug that is used to target insulin sensitivity. Though studies using Metformin show mixed results, it is used in pregnancy complications in women with PCOS (2). However, using OCPs does have certain side effects such as mood swings, weight gain, nausea and bloating among others (13). This also varies with the dosage and type of hormone in the OCP.
Inositol is a recent development in PCOS treatment. It is marketed as Myo-inositol (MYO) and D-chiroinositol (DCI). MYO has shown to improve insulin resistance in those with PCOS. Infact, a recent meta-analysis concluded that MYO supplementation may be beneficial in improving the metabolic profile of women with PCOS (14).
While the exact cause for PCOS is unknown, it has affected a number of women globally. It is crucial to not let this go undiagnosed. Moreover, it is also important to seek treatment from professionals. It is clear that PCOS is a multifaceted disease,that needs both medical and lifestyle interventions. There are a wide variety of treatment options available. Thus,it is not something to be feared, rather something that needs your attention.

References:

1) El Hayek S, Bitar L, Hamdar L, Mirza F, Daoud G. Polycystic Ovarian Syndrome: An Updated Overview. Frontiers in Physiology. 2016;7(124).
2) Escobar-Morreale H. Polycystic ovary syndrome: definition, aetiology, diagnosis and treatment. Nature Reviews Endocrinology. 2018;14(5):270-284.
3)Rotterdam, E. A.-S. P. C. W. G. (2004) Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome. Fertility and Sterility. 2004;81(1):19-25.
4) Azziz R. Diagnosis of Polycystic Ovarian Syndrome: The Rotterdam Criteria Are Premature. The Journal of Clinical Endocrinology & Metabolism. 2006;91(3):781-785.
5) Kamangar F, Okhovat J, Schmidt T, Beshay A, Pasch L, Cedars M et al. Polycystic Ovary Syndrome: Special Diagnostic and Therapeutic Considerations for Children. Pediatric Dermatology. 2015;32(5):571-578.
6) Sıklar Z, Berberoğlu M, Çamtosun E, Kocaay P. Diagnostic Characteristics and Metabolic Risk Factors of Cases with Polycystic Ovary Syndrome during Adolescence. Journal of Pediatric and Adolescent Gynecology. 2015;28(2):78-83.
7) Dunaif A. Hyperandrogenic anovulation (PCOS): A unique disorder of insulin action associated with an increased risk of non-insulin-dependent diabetes mellitus. The American Journal of Medicine. 1995;98(1):S33-S39.
8)Randeva H, Tan B, Weickert M, Lois K, Nestler J, Sattar N et al. Cardiometabolic Aspects of the Polycystic Ovary Syndrome. Endocrine Reviews. 2012;33(5):812-841.
9) KIRSCHNER M, SAMOJLIK E, DREJKA M, SZMAL E, SCHNEIDER G, ERTEL N. Androgen-Estrogen Metabolism in Women with Upper BodyVersusLower Body Obesity*. The Journal of Clinical Endocrinology & Metabolism. 1990;70(2):473-479.
10) Hart R, Doherty D. The Potential Implications of a PCOS Diagnosis on a Woman’s Long-Term Health Using Data Linkage. The Journal of Clinical Endocrinology & Metabolism. 2015;100(3):911-919.
11) Faghfoori Z, Fazelian S, Shadnoush M, Goodarzi R. Nutritional management in women with polycystic ovary syndrome: A review study. Diabetes & Metabolic Syndrome: Clinical Research & Reviews. 2017;11:S429-S432.
12) Karamali M, Kashanian M, Alaeinasab S, Asemi Z. The effect of dietary soy intake on weight loss, glycaemic control, lipid profiles and biomarkers of inflammation and oxidative stress in women with polycystic ovary syndrome: a randomised clinical trial. Journal of Human Nutrition and Dietetics. 2018;31(4):533-543.
13) Consensus statement on the use of oral contraceptive pills in polycystic ovarian syndrome women in India. Journal of Human Reproductive Sciences. 2018;11(2):96.
14) Unfer V, Facchinetti F, Orrù B, Giordani B, Nestler J. Myo-inositol effects in women with PCOS: a meta-analysis of randomized controlled trials. Endocrine Connections. 2017;6(8):647-658.

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Gut Health

Gut health is currently the new buzzword in the health and fitness industry. Products claiming to improve your gut and its function are slowly increasing. This might make you wonder what the fuss is all about! Gut microbes, microbiota, microbiome… What do these terms mean? Why is the gut so important? Read on to find out!

What is the gut and gut microbiota?
The gastrointestinal tract or in simple terms, the digestive system which starts from the mouth and ends at the rectum, are collectively termed as the gut. However, what people usually refer to when they use the term ‘gut’ is the intestines.
The gut, all the way from the mouth to the rectum contain a number of microorganisms (also called microbes) that are tiny microscopic organisms which are not visible to the naked eye. Microbiota refers to all the microorganisms living in the same environment, while microbiome refers to all genes of these microbes. So, the gut microbiota refers to the large community of microbes that reside in the gut.
What is the function of the gut microbiome?
The gut microbiota plays an important role in digestion, absorption and metabolism of food (1). Beyond this, the gut bacteria are also thought to play an important role in obesity (1), immune function (2) and also influencing mood (3) . In fact, our gut bacteria is said to have an impact on most of our physiological functions, directly or indirectly (2). While the research around the gut microbiota is ongoing, it is clear that it is a key factor in several aspects of the body’s optimal functioning.
What are the common gut related disorders and why does it occur?
In certain situations (for example, a disease condition) the microbes that reside in your gut can be disrupted. This will be different from the microbe community that was present when your body was healthy. This is termed as dysbiosis (2). Dysbiosis can be caused by change in eating habits, bowel movements and even medications taken when one is ill. (2). However it is to note that what changes in the microbiota are helpful or not is still being looked into.
Some of the most common gut related disorders you would have come across are constipation, indigestion and diarrhoea. However, conditions like Irritable Bowel Syndrome (IBS), Crohn’s disease, Celiac disease, lactose intolerance and colitis are also gut related.
What can I do for a healthy gut?
The following simple tips can be incorporated in order to ensure your gut microbes are functioning well in order to support your body’s optimal functioning;
Diverse diet: As mentioned before, a large and diverse community of microbes reside in our gut. To support these microbes, our diet needs to be equally diverse. Our food serves as substrates for these microbes to thrive. It is clear that the diversity of our diet determines the diversity and richness of the gut microbiota (4). The increasing number of fad diets is also an issue of concern as it encourages elimination of food groups, which in turn affect the diversity of the gut microbiota (5). Fibre intake and polyphenols also play key role in shaping the microbiome. Low intake of fibre paired with high fat and sugar intake may reduce certain microbe groups in the gut (6). Polyphenols are found in foods like tea, chocolate, spice, seasonings,herbs and even fruits and vegetables. Interactions between polyphenols and the gut microbes can also impact health (7).
What can you do? Ensure your diet is diverse by varying the foods you eat on a daily basis. Consume fibre rich food such as whole grains, lentils/legumes, fruits and vegetables. Aim for at least 25-30g of fibre a day. Fruits and vegetables, also ering rich in polyphenols provide an additional benefit.
Fermented foods: Fermentation is a natural process by which bacteria break down substances into simpler forms. Examples of fermented food are kimchi, yoghurt, kefir among several others. These are commonly termed as ‘probiotics’ since they contain live cultures of microorganisms in them! While the research on probiotics is still ongoing, they do seem to show promising effects on enriching the existing gut flora (8). Why not give this a go?
Stress: This is something that affects each one of us on a day to day basis. While everyone knows that extreme stress is unhealthy, little do we know that stress also affects the diversity of microbes in the gut (9). Yes, you heard that right! While we do know how stress negatively affects several aspects of health, it also has an impact of the tiny bugs living in your gut.
In conclusion, gut health is a growing area of research. While there are a number of questions unanswered, the field seems vast and promising. It is clear that the gut plays an important role in several aspects of human health. Hence, it is necessary for us to understand this and nourish the gut by living a healthy lifestyle.

REFERENCES:

1) Ursell L, Metcalf J, Parfrey L, Knight R. Defining the human microbiome. Nutrition Reviews. 2012;70(Suppl 1):S38-S44.
2) Shreiner AB, Kao, JY, Young, VB. The gut microbiome in health and disease. Current Opinion Gastroentology. 2015;31(1):69-75
3) Dash S, Clarke G, Berk M, Jacka F. The gut microbiome and diet in psychiatry: Focus on depression. Current Opinion in Psychiatry. 2015;28(1):1-6.
4) Makki K, Deehan E, Walter J, Bäckhed F. The Impact of Dietary Fiber on Gut Microbiota in Host Health and Disease. Cell Host & Microbe. 2018;23(6):705-715. 
5) Heiman M, Greenway F. A healthy gastrointestinal microbiome is dependent on dietary diversity. Molecular Metabolism. 2016;5(5):317-320.
6) Sonnenburg E, Sonnenburg J. Starving our Microbial Self: The Deleterious Consequences of a Diet Deficient in Microbiota-Accessible Carbohydrates. Cell Metabolism. 2014;20(5):779-786.
7) Ozdal T, Sela D, Xiao J, Boyacioglu D, Chen F, Capanoglu E. The Reciprocal Interactions between Polyphenols and Gut Microbiota and Effects on Bioaccessibility. Nutrients. 2016;8(2):78.
8) Bell V, Ferrão J, Pimentel L, Pintado M, Fernandes T. One Health, Fermented Foods, and Gut Microbiota. Foods. 2018;7(12):195.
9) Konturek PC,Brzozowski T, Konturek SJ. Stress and the gut: pathophysiology, clinical consequences, diagnostic approach and treatment options. Journal of Physiology and Pharmacology. 2011;62(6):591-599.

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