November 21   2015, Saturday
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Dr KK AggarwalDr KK Aggarwal What is Satyagraha?

Four basic principles that Mahatma Gandhi taught are Satya (truthfulness), Ahimsa (non-violence); Sarvodaya (welfare for all) and Satyagraha. These are the arms and ammunition of any anti-corruption protestor.

GANDHIGIRI ALWAYS works, whether it was Mahatma Gandhi in the movie “Lago Raho Munnabhai” or the Gandhian Anna. The Gandhian principles were so framed that they always united the common man.

The word Dharma means to hold together. All the above four principles can hold people together and hence form the backbone of dharma. The Yoga shastras as well as the Yoga Sutras of Patanjali propagate truthfulness as one of the main components for living a disciplined life or to start yoga. Satya means oneness in your thoughts, speech and actions. Bapuji’s three wise monkeys also had truthfulness represented in one of the monkeys who says ‘bura mat bolo’. In fact, Gandhi believed that “there is no religion higher than truth”

Gandhi preached the concept of “experimenting with truth” — a phrase that formed the subtitle to his autobiography. He taught how to learn through trial and error, often admitting to mistakes and changing one’s behavior accordingly. Non-observance of truthfulness is the root cause of any corruption in the society. Ahimsa is the next principle and teaches us the path of non-violence. Again, it has to be practiced not only in actions but in thoughts and speech also. It also forms the basis of Jainism and Hinduism as a religion.

Sarvodaya or welfare for all is the third Gandhian teaching. Vedic philosophy also emphasizes on the welfare for all. It talks about “bahujan hitay-bahujan sukhay” (the good of the masses, the benefit of the masses). Gandhi found in it a composite concept of social welfare and economic justice. Any action, which is aimed and seems to be aimed at the welfare of the people will be accepted by everyone in the society.

Satyagraha is the protest based on satya (path of truthfulness) and non-violence and includes peaceful demonstrations, prolonged fasts, etc. It’s a non-violence based civil resistance. Satyagraha is formed by two Sanskrit words Satya (truth) and Agraha (holding firmly to or firmness).

Gandhi said “Satyagraha is a weapon of the strong; it admits of no violence under any circumstance whatsoever; and it ever insists upon truth”. Gandhi said if you are firm in the truth in the long run you are going to win. It is based on the law of persistence.
Amit Sharma and Nilesh Aggarwal

We are extremely happy to have been part of IMA Satyagraha campaign and would like to congratulate the Indian doctor community as a whole. We are aiming to be a digital voice of all Indian doctors and will continue to work towards raising such important issues. Currently, we are in our Beta phase and we will soon be introducing features such as interesting cases, online CME's, conference updates etc. Please do register and read eMediNews, eIMANews as well as other engaging content on the website/app. You can also add other doctors to your network, find long lost alumni, chat and discuss cases, post questions for the medical fraternity, create your detailed medical resume and lots more.
Breaking News
ACG updates guideline for Barrett's Esophagus

The American College of Gastroenterology (ACG) has updated the clinical guideline on the diagnosis and management of Barrett's esophagus (BE). The updated guidelines, published in the American Journal of Gastroenterology, cite major advances in the use of endoscopic ablative therapy, data supporting less frequent endoscopic surveillance for patients with nondysplastic BE, and data showing that most women with gastroesophageal reflux disease can skip routine BE screening. The most notable changes reflect rapid advances in BE treatment. (Medscape)

NIH launches new initiative to identify biomarkers of Alzheimer’s in Down syndrome

The National Institutes of Health (NIH) has launched a new initiative to identify biomarkers and track the progression of Alzheimer’s in people with Down syndrome. Many people with Down syndrome have Alzheimer’s-related brain changes in their 30s that can lead to dementia in their 50s and 60s. The NIH Biomarkers of Alzheimer’s Disease in Adults with Down Syndrome Initiative will support teams of researchers using brain imaging, as well as fluid and tissue biomarkers in research that may one day lead to effective interventions for all people with dementia. “This is the first large-scale Alzheimer’s biomarker endeavor to focus on this high-risk group,” said Laurie Ryan, chief of the Dementias of Aging Branch in NIA’s Division of Neuroscience, which leads NIH research on Alzheimer’s… (Pharmabiz)
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Specialty Updates
• Neuromyelitis optica (NMO) spectrum disorder, or Devic's disease, a brain disorder that causes inflammation in the central nervous system, may increase a woman's risk for miscarriage and preeclampsia, suggested new research published in Neurology.

• Among patients with rheumatoid arthritis who fail to achieve an adequate response to their first anti-tumor necrosis factor (TNF) agent, a non-TNF targeted biologic may yield significantly better disease control than a second anti-TNF agent, reported the first randomized trial of its kind presented at the American College of Rheumatology 2015 Annual Meeting.

• Patients with vitiligo commonly have other autoimmune diseases, most commonly thyroid disease and alopecia areata, suggested a cross-sectional study published online in the Journal of the American Academy of Dermatology.

• New research, published in Respirology, suggests that compared with moderate physical activity, high physical activity levels may be linked with poorer asthma control in females, but not in males.

• Shockwave lithotripsy (SWL) to the kidney, unlike SWL to the ureter or ureteroscopy, increases the risk of hypertension, suggests a new study published online in Kidney International.

• A study from the St. Jude Children's Research Hospital, Washington University Pediatric Cancer Genome Project, suggested that nearly 8.5% of pediatric cancer patients had pathogenic or likely pathogenic mutations of genes within their normal tissue that increased their risk of developing cancer. The findings were published November 19 in the New England Journal of Medicine.

• Nearly half of middle-aged European adults with normal glucose levels will develop prediabetes during the remainder of their lifetime, and most of them will eventually progress to type 2 diabetes, according to the latest data from a prospective cohort study in the Netherlands published online November 10, 2015 in Lancet Diabetes & Endocrinology.

• After patients blinded by retinitis pigmentosa underwent transchoroidal implantation of a subretinal device (Alpha IMS, Retina Implant AG), almost 50% could recognize shapes and details of objects 12 months after implantation, and another 25% could localize them (American Academy of Ophthalmology 2015 Annual Meeting)
My answer is yes, not tell me your problem

This was the best statement I have ever come across in my life. One of the medical superintendents at Moolchand Hospital when he joined had this statement on the wall above his head. It clearly indicates that he was sitting to solve the problem and not to create problems.

If all the service provider agencies follow this statement, the scenario of the country can change. Our job should be to solve the problems and not find mistakes. None of us is 100% truthful, honest or hardworking. Each one of us will have some positive points and some negative points. Our job should be to remove our negative points and convert them into positive. Remembers SWOT analysis taught in marketing i.e. “Strength, Weakness, Opportunity and Threat”. Our job should be to convert our weakness into strength and threat into opportunities.
Legal Quote
Sanjeevan Medical Research Centre (Private) Ltd. & Ors vs State of NCT of Delhi & Anr on 11 February, 2011

“The basic and underlying principle of these three judgments* and other similar judgments is that every careless act of a medical man cannot be termed as “criminal”. It can be termed “criminal” only when the medical man exhibits a gross lack of competence or inaction and wanton indifference to his patient’s safety and which is found to have arisen from gross ignorance or gross negligence.”

*Jacob Matthew v. State of Punjab (2005) 6 SCC 1, Martin F. D’Souza v. Mohd. Ishfaq (2009) 3 SCC 1 and Kusum Sharma v. Batra Hospital (2010) 3 SCC 480
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Indian Tax payers can use CII (Cost Inflation Index) to reduce taxes. CII helps in inflating the cost of the acquired asset and thus help tax payers to show lower gains. This CII data for every year is published by GOI. Investors in India should learn to use this table effectively.

(Source: IJCP)
22nd MTNL Perfect Health Mela, the annual flagship event of the Heart Care Foundation of India
Read ISGCON 2015 updates at
Overexpressed autophagic system by activated dendritic cells in Celiac disease: Is it a mere standby phenomenon?

Kim Vaiphei, Biman Saikia, Rakesh Kochhar, Chandigarh

• Permanent gluten intolerance occurring in celiac disease is an immune-mediated disorder, predisposed individuals are positive for human leucocyte antigen class II i.e. HLA-DQ2 in 90% and HLA-DQ8 in 5-10%.

• Underlying pathobiology of defective handling of gluten is yet to be established.

• Dendritic cells are bone marrow derived cells, normally present in intestinal mucosa; role in innate and adaptive immune responses.

• Autophagy: A lysosomal dependent pathway for degradation of intra-cellular components.

Key points

• Abnormal autophagic system appears to be the underlying etiology for hypersensitive immune response to gluten protein in celiac disease.

• Hence, a strategic manipulation of autophagy gene and DC appears an appealing treatment option, alternative to the existing one.

Exocrine Pancreatopathy: The New Kid on the Block

Suresh T Chari,

• T1DM and T2DM are associated with significant structural and functional alterations in the exocrine pancreas.
• This entity is called ‘Diabetic Exocrine Pancreatopathy (DEP)’.
• The pancreatic weight and volume in T1DM is markedly lower, while in T2DM, there is mild or no decrease.
• DEP is distinct from chronic pancreatitis.
• Its recognition has far-reaching implications for the study of the interlinked pathologies of the exocrine and endocrine pancreas.

Asymptomatic gallstones: Operate

Philip Abraham,

• While it’s true that not all ‘asymptomatic gallstones’ need surgery, but then again, not all ‘asymptomatic gallstones’ can be left alone.

• About 4% of patients and even up to 20% with ‘asymptomatic gallstones’ develop symptoms, including cholecystitis, obstructive jaundice, pancreatitis and gallbladder cancer.

• There are no randomized trials comparing cholecystectomy vs no cholecystectomy in patients with ‘asymptomatic gallstones (Cochrane Database of Systematic Reviews 2007).

• Laparoscopic cholecystectomy for ‘asymptomatic gallstones’ has significantly lower morbidity and conversion rates and operating time as compared to for symptomatic gallstones (Yano, 2003)

• Morbidity of laparoscopic cholecystectomy increases with age (Bittner, 2004)

• Wait-and-watch is another option. But it has its associated problems such as there is no recommendation on frequency of US screening, lack of a foolproof screening tumor marker available; annual US screening in Japan for patients >40 years: 3 of 4 gall bladder cancers detected were advanced (Ogoshi et al. 1999).


Patients with Gallbladder Indications

• Large gallstones >2 cm in diameter (risk of cancer)

• Gall bladder packed with <3 mm stones with patent cystic duct (risk of obstructive jaundice or pancreatitis)

Patients with associated conditions
• Non-functional gall bladder (suggests chronic cholecystitis)

• Porcelain gall bladder (7% risk of cancer)

• >10 mm sessile polyp / adenoma (higher risk of gall bladder cancer; Chattopadhyay 2005)

• Anomalous pancreatico-biliary ductal union

• Choledochal cyst

• Choledocholithiasis

• Spinal cord injuries or sensory neuropathies affecting abdomen

• Sickle cell disease (d/d between painful crisis and cholecystitis may be difficult) or hereditary spherocytosis • Transplant candidates

▫ Higher risk on immune suppressants if complications develop

▫ Cyclosporine A and tacrolimus prolithogenic because of decreased bile salt export pump function


Surveillance of HCC is indicated in all patients with cirrhosis of India

Dr Ashish Kumar,
New Delhi

• Although most international guidelines have recommended surveillance for cirrhotic patients for hepatocellular carcinoma, the evidence favoring this recommendation is very weak.

• Indian studies are scarce, but the two available studies do not support surveillance as it is not cost-effective and even if HCC is detected early, many of them could not be offered curative treatments.

• Data from studies from other regions of the world cannot be applicable in India because the overall HCC prevalence is low in India; also, our etiological profile of cirrhosis is different from other countries.

• Even if surveillance has to be done, it should be done only for selected patients with good Child function (Child A or B), and in those who can afford curative treatment.

Esophageal physiology relevant to GERD

C Prakash Gyawali,

• Inappropriate relaxation of the lower esophageal sphincter is the most frequent mechanism for gastroesophageal reflux to occur.

• Presence of a hiatus hernia increases the frequency of inappropriate lower esophageal sphincter relaxation, and reduces resting pressure of the lower esophageal sphincter, thereby promoting reflux.

• Reduced esophageal motor function allows prolonged contact of the refluxed acid with the esophageal mucosa.

• Reduction in saliva production from radiation therapy to the head and neck, smoking, and certain disorders and medications reducing saliva will increase the risk for esophagitis from reflux.

• Despite these mechanisms of reflux, treatment to reduce gastric acid production remains the most effective management for gastroesophageal reflux disease (GERD).

Classifying esophageal motor disorders: Chicago and beyond

C Prakash Gyawali,

• High resolution manometry of the esophagus has allowed use of computerized software tools, which drive the Chicago classification of esophageal motor disorders.

• Of the software tools, the integrated relaxation pressure (IRP) is the most important, and identifies abnormal relaxation of the esophagogastric junction with swallows.

• Consequently, identification of esophageal outflow obstruction using IRP is the most important (and first) step in the Chicago classification of motor disorders.

• Treatment is available for esophageal outflow obstruction, both for achalasia spectrum disorders and other structural processes leading to outflow obstruction.

• Opioid medication use can result in motor patterns mimicking outflow obstruction.

• Major motor disorders in the Chicago classification are not seen in health, and are associated with abnormal esophageal transit in the absence of outflow obstruction.

• Minor motor disorders can be seen in asymptomatic individuals, and do not always explain symptoms.

• Provocative testing during high resolution manometry helps further identify esophageal outflow obstruction, and assesses esophageal peristaltic reserve.

Unusual case of jaundice

Dr Girish Kumar Pati

We had a 10-year-old child who presented with cholestatic neonatal jaundice with typical facies, ocular findings of post embryotoxon and HPE showing bile duct paucity with cirrhotic changes and findings suggestive of fat soluble vitamin deficiency. Diagnosis of Allagille syndrome was made based on the 3 criterion for this disease. The incidence of Allagille syndrome is 1:100000 with only 5 cases reported so far in India and 500 worldwide.

“Whenever you see neonatal jaundice which persists and is associated with typical facies, ocular findings, decreased IQ and hepatosplenomegaly, think of Allagille syndrome. A high degree of suspicion along with genetic evaluation is crucial to diagnosis.”
Preop beta blockers and statin may reduce risk of post op complications

The combination of statins and beta-blockers before cardiac surgery are associated with lower risk of complications afterward. Beta-blockers alone or statins alone had no impact on outcomes, and no comparison turned up any mortality differences, Peyman Benharash, MD, of UCLA, and colleagues reported in a research letter appearing online in JAMA Surgery… (Medpage Today)
Union govt to establish special newborn care units

The Union government under its Rashtriya Bal Swasthya Karyakram (RBSK) is working towards establishing 634 special newborn care units (SNCUs) that are expected to provide retinopathy of prematurity (ROP) screening as part of the essential newborn care for preterms. The government has committed setting up of SNCUs at district healthcare centers situated in all states to address the challenge of infant mortality. Whereas the infrastructure of new born care services are already in place in most of these centers, almost none have the resources or expertise to tackle the blindness that ROP can cause, and be prevented. Narayana Nethralaya has also chipped in to provide WISEROP (Wide-field Imaging of Infants for Screening and Education for Retinopathy of Prematurity), a novel e-training and service model... (Pharmabiz - Nandita Vijay)
IMS Health forecasts global drug spending to $1.4 trillion by 2020
IMS Health has stated in its new research report 'Global Medicines Use in 2020' that the total spending on medicines will reach $1.4 trillion by 2020 due to greater patient access to chronic disease treatments and breakthrough innovations in drug therapies. More than half of the world’s population will live in countries where medicine use will exceed one dose per person per day by 2020, up from 31% in 2005, as the “medicine use gap” between developed and pharmerging markets narrows. Global spending is forecast to grow at a 4-7 per cent compound annual rate over the next five years. The total global spend for pharmaceuticals will increase by $349 billion on a constant-dollar basis, compared with $182 billion during the past five years… (Pharma Biz)
UN spotlights 2.4 bn people without adequate sanitation

Secretary-General Ban Ki-moon is using World Toilet Day today to spotlight one of the least talked about and most important contributors to disease and malnutrition: poor sanitation and hygiene that affect about a third of the world’s population. According to the United Nations, 2.4 billion people lack adequate sanitation and nearly one billion have no toilet facilities and are forced to relieve themselves in open areas. The UN Millennium Development Goals, which are supposed to be achieved this year, call for cutting in half the proportion of the population without access to basic sanitation. Ban said that by many accounts, this will be “the most-missed target.” That’s why the UN launched a “Call to Action on Sanitation” in 2013 and aims to end “open defecation” by 2025, he said. (The Hindu Business Line - PTI)
WHO calls on countries to protect health from climate change
Climate change is the defining issue for the 21st century. According to WHO estimates, climate change is already causing tens of thousands of deaths every year - from shifting patterns of disease, from extreme weather events, such as heat-waves and floods, and from the degradation of air quality, food and water supplies, and sanitation. The upcoming United Nations Climate Change Conference (COP-21) in Paris offers the world an important opportunity to not only reach a strong international climate agreement, but also to protect the health of current and future generations.

In 2012, WHO estimated 7 million people died from air pollution-related diseases, making it the world’s largest single environmental health risk. It is predicted that climate change will cause an additional 250 000 deaths per year from malaria, diarrhoea, heat stress and under-nutrition between 2030 and 2050. Children, women and the poor in lower income countries will be the most vulnerable and most affected, widening health gaps. The United Nations Climate Change Conference is the time for the health community to lend their voice to the international climate discussion and ask countries to come together and make bold commitments to protect our planet and the health of current and future generations… (WHO Statement)
Fingerprick blood tests results vary from drop to drop
A first of its kind study published in the American Journal of Clinical Pathology shows that measurements from a single drop of blood are highly variable and to achieve consistent test results, as many as six to nine drops of blood should be combined. This finding may have important clinical implications as devices that use only one drop of blood to give test results are becoming increasingly available… (Medical News Today)
Vitamin D and prevention of colds

Data from a US survey population has shown a relationship between higher serum levels of 25-hydroxyvitamin D and fewer reported respiratory infections. However, in the largest randomized trial evaluating whether vitamin D supplementation can prevent upper respiratory infections, there was no difference in the incidence of colds over 18 months comparing groups who received monthly vitamin D3 injections or placebo; 25-OH vitamin D levels were 48 and 25 ng/mL for intervention and control groups respectively during the course of the trial.
Bioethical issues in medical practice
Living wills

Smita N Deshpande
Head, Dept. of Psychiatry, De-addiction Services
PGIMER-Dr. Ram Manohar Lohia Hospital
Park Street, New Delhi

This dilemma arises from two issues- living wills, and the problem of old couples living alone together.

A 65-year-old man is brought to emergency with subarachnoid hemorrhage. With aggressive and timely treatment he is shifted to the ventilator. Over the next few days his condition deteriorates and he is declared brain dead. He has left a living will saying that if he is incapacitated or comatose, his life should not be artificially extended. His tearful wife however insists that the doctor keeps trying and ‘give him another chance’ as she has read about cases recovering from coma after years. The hospital too will not mind as the ventilator will be paying for itself. What should the treating doctor do in these circumstances?

a) Leave well enough alone, continue treatment as usual, and continue charging for his and the hospital’s services.

b) Insist on application of the living will in letter and spirit- in which case he may face action for shifting the patient to the ventilator in the first place

c) Involve the hospital ethics committee in the decision

d) Approach the court

Any other suggestions and solutions? Do write in!

Adapted from: Bioethics Case Studies (AUSN and EEI, November 2013):

Response received

The doctor should tell her that brain dead persons can never be revived. Once dead always dead if brain is dead. He should tell her it was his last wish to donate his organs and if she agrees then the organs be donated and if not she should be politely requested to take his body. Dr BR Bhatnagar

Response received for the case scenario ‘Rights and duties of a parent’ published on 15th Nov

The pregnancy must be terminated before it is too late. An intellectually deficient woman may insist on continuation of pregnancy, but she is not medically fit to take any decision. She will be unable to take care of the new born and even of herself, who will bear the responsibility of both for whole life. Finding the person and holding him responsible is too theoretical an approach, a person of substance would not have done such a heinous crime, forget his owning and taking responsibility, and what if he is already married. Not terminating the pregnancy to save a life is too idealistic a view in this case. Why make the new arrival suffer punishment and live a cursed life, he/she will curse the father, pity the mother and pity the self, suffer a stigma and mental torture. Dr (Col) R N Kothari, Prof & Head, Dept of Ophthalmology, SBKS MI&RC, Vadodara
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Inspirational Story
That little girl

Have you ever not wanted to do something so badly that you would rather die than go? Well that’s how I felt about joining Madcaps and volunteering at Saint Vincent De Paul Homeless shelter. But now I believe that you should have an open mind to things because in the end you might just end up enjoying it.

“It’s a waste of time”, I said when my mom told I had to join Madcaps, a mothers and daughters club assisting philanthropies, and then when she told me I had to volunteer at a homeless shelter I thought this just could not get worse.

We got there late, of course, and walked to the dirty homeless shelter, where we saw a lady yelling at the security guard. He dealt with her and then led us to the kitchen where we ran into my five fellow Madcaps class of 2017 mothers and daughters. Since I’m usually so socially awkward I had met only one person at the pool party, earlier this year. I looked around for her but she was not there. Damn, I was alone!

When the head of the kitchen came out and asked for 3 mothers to work outside the kitchen to clean up the plates and silverware, my mom just so happened to volunteer, leaving me to serve food with people I had never met before.

Soon the homeless families started to walk in and a little girl, around 5 years old, walked up and pointed to the food I was handing out. I handed her the cold sandwich, wrapped in the sticky plastic, she nodded in a form of saying thanks, and then walked to join her family at the large table.

As she walked away I thought of how much I had. I get to go to one of the top schools in San Diego, I have a great house by the water, and I have a warm meal every night. Then I thought of how little she had. She probably didn’t go to school, and this is where she sleeps and eats every day. It took that little girl to make me realize just how lucky I am.

After that moment I had a change of heart. Now, I love Madcaps and don’t miss one meeting, I have gotten over being socially awkward and now have many friends, who I hang out with on a regular basis. And this year I am sure I will do more than the required 20 hours of philanthropies.

I believe that if you have an open mind about things you can learn a lot about yourself and the people in your community, you can make new friends and realize just how lucky you are. I believe that if you have an open mind to things you can accomplish more and become a better rounded person. I believe you can make a difference just by doing one thing you don’t want to do.
eMedi Quiz
Which one of the following is a recognized x-ray feature of rheumatoid arthritis?

1. Juxta-articular osteosclerosis.
2. Sacroilitis.
3. Bone erosions.
4. Peri-articular calcification.

Yesterday’s Mind Teaser:  All of the following conditions may predispose to pulmonary embolism except:

1. Protein S deficiency.
2. Malignancy.
3. Obesity.
4. Progesterone therapy.

Answer for Yesterday’s Mind Teaser: 4. Progesterone therapy.

Answers received from: Dr K V Sarma, Dr K Raju.

Answer for 19th November Mind Teaser: 1. Protein S deficiency

Answers received from: Dr K V Sarma, Dr K Raju, Daivadheenam Jella, Dr B R Bhatnagar, Dr Avtar Krishan.
A man goes into a drug store and asks the pharmacist if he can give him something for the hiccups. The pharmacist promptly reaches out and slaps the man's face.

"What the heck did you do that for!?!" the man screams. "Well, you don't have the hiccups anymore do you?"

The man says, "No I don't, you IDIOT... But my wife out in the car still does!"
Readers column
Sir, it’s really good. I read all your mails. Om Prakash Jha
Press Release
How eating home cooked food decreases the risk of Diabetes?

Food items prepared in restaurants, cafes and eateries are high in sugar, trans fat and sodium content increasing the risk of type-2 diabetes, obesity, and hypertension

A recent Harvard report has proved that people who eat most meals at home appear to carry a lower risk of developing type 2 diabetes. The reason for this is the high level of trans fat, additives, salt and sugar found in food at restaurants and cafes. Home cooked meals, on the other hand, are more nutritious and freshly prepared. Re-heating and frying practices at outside eateries kill all nutritious elements for food and make it a become risk factor for several lifestyle diseases.

According to the Harvard research, consuming 11 to 14 lunches or dinners prepared at home per week -- or about two meals per day -- is associated with a hazard ratio of 0.87 for incident diabetes compared with six or fewer homemade meals a week.During eight years of follow-up, those who ate more meals prepared at home had lower weight gain and risk of obesity (HR 0.87 for obesity), which could have accounted for the lower diabetes risk.

Speaking on the topic, Padma Shri Awardee Dr. A Marthanda Pillai – National President IMA and Padma Shri Awardee Dr. K K Aggarwal, Honorary Secretary General, IMA and President, HCFI said, “Food items that are available outside are not only high in calories but are also highly processed, which is enough to cause obesity, hypertension, and diabetes. They tend to have no or very little vitamins and minerals and are usually low in fiber. This holds particularly true for most Indian snacks and food, like samosas and pakoras that are deep fried, dal makhani which is simmered in ounces of butter, parathas made in ghee and butter and sweet items like laddoos, gulab jamun that are made with liquefied sugar. It is thus recommended that majority of the meals consumed should be prepared at home”.

“For this working high-stress jobs and living alone or in a nuclear family set up, it advised that a home cooked tiffin service is used. Offices and schools providing food for their employees and students must ensure that a healthy and nutritious meal is served. Our diet is directly linked to our future risk of lifestyle diseases, and extra precautions must be taken. The government must also discourage the fast growth of fast food chains in the country", Dr. KK Aggarwal added.

It is believed that people who eat at fast-food restaurants twice a week have a two-fold risk of developing insulin resistance in comparison to those who ate meals one or no meal outside in a week.

Not only this, it has been found that having distorted eating habitscause individuals to developunbalanced and unhealthy cholesterol levels including a high quantity of LDL/bad cholesterol and low quantity of HDL/good cholesterol and high triglycerides. Additionally, records also show that obese and diabetic individuals may also develop insulin resistance associated lipid disorder known as atherogenic dyslipidemia or diabetic dyslipidemia.

Why avoid foods prepared outside?

• High in calorific value
• Poor nutritional value
• Low in fiber
• Contains fats, sugar and salt in excessive quantities
• Some of the foods contain a specific amount of MSG as well
• Processed foods contain saturated and trans fats
• Often have addictive properties

Having a meal outside once in a while is fine, but making it a habit can be extremely harmful to one's health. That’s why we advise that you should revise your eating habits to prevent from being one of the 62 million people suffering from severe to moderate diabetes complexities in the country.