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3“H”s to Delay and Prevent Diabetic Retinopathy Patients with diabetes are high risk of micro and macrovascular complications.Diabetic retinopathy is one of the microvascular complications of diabetes which can lead to blindness. Many diabetics are unaware of the 3 “H”s which are very important in the prognosis of patients with diabetes in terms of their risk of developing or progression of diabetic retinopathy. 3 H's are hyperglycemia, hypertension and hyperlipidemia. Hemoglobin A1c indicates average blood sugar levels for 3 months. We come across many patients who have never heard of it. Diabetes Control and Complications Trial study was conducted for 10 years from 1983 to 1993 in patients with type 1 diabetes.There were 1400 patients in this study. This study compared intensive control versus what was considered conventional therapy for diabetes at that time.They then looked at the decrease in the hemoglobin A1c levels in both the groups and its effects on systemic complications. Those who had intensive control had hemoglobin A1c's of about 7 and those who had conventional management had hemoglobin A1c’s about 9.It was observed that patients who had intensive control of there diabetes had a 76% reduction of the onset of diabetic retinopathy over 10 years. Hypertension is an independent risk factor for the progression of diabetic retinopathy.It is observed from studies that a 10 mmHg decrease in the systolic blood pressure and 5mmHg decrease diastolic blood pressure , there was 34% reduction in the progression of diabetic retinopathy just by getting the blood pressure under tighter control. The third important H is hyperlipidemia (hypercholesterolemia).Patients who have high cholesterol are more likely to get retinal exudates and in turn are more likely to lose vision. Exudates increase the chance of vision loss in patients who have hypercholesterolemia versus in those who do not. It is now proved beyond doubt that Bariatric and Metabolic Surgeries like Laparoscopic Roux-en-Y Gastric bypass helps in the remission of diabetes, hypertension and hypercholesterolemia.It thus halts the progression or reverses many micro and macrovascular complications of diabetes like diabetic retinopathy.
FAULTY “BRAIN SWITCH” DETERMINES OBESITY Obesity is considered as a disease in this New World. It has become a pandemic affecting every Nation. According to data collected in 2014 from the World Health Organization, more than 600 million adults around the world are obese and 41 million children younger than 5 years old are overweight. This in turn results in diabetes, high blood pressure, coronary artery disease, obstructive sleep apnea, joint pains and infertility. A team of researchers from the Biomedicine Discovery Institute at Monash University in Melbourne, Australia, has recently conducted a study striving to gain a better understanding of the brain mechanisms that contribute to weight gain and loss. They have identified the mechanism through which brain controls the amount of fat that is burned after a meal. They concluded that “Faulty signals” from the brain can promote obesity. Researchers revealed the existence of a "switch" that tells the body what to do with the fat gained after food intake. If the switch is faulty, then the body is likely to store more fat, thus becoming predisposed to obesity. They have found a link between food intake and the process whereby white fat turns into brown fat. In the body, fat is stored in adipocytes or fat cells that make up the adipose tissue. These fat cells can convert from "white" (storing energy) into "brown" (releasing energy). The study found that the brain normally "instructs" the white fat cells to turn into brown fat cells after eating. This happens in response to insulin released from pancreas into the blood in larger quantities as blood sugar levels increase. On the other hand, brown fat cells are turned back into white energy storing fat cells after a period of gap during which no food is consumed. When this mechanism functions normally, it allows the body to stabilize its weight. This mechanism is akin to a switch, "reading" the insulin signals and flipping on and off as appropriate. In the case of people predisposed to excess weight gain, this switch malfunctions, becoming stuck in the "on" position. As a result of this browning is turned off all the time and energy expenditure is decreased all the time, so when you eat, you do not see a increase in energy expenditure - and that promotes weight gain. Bariatric surgery will result in increased levels of GLP 1 and PYY hormones and decreased levels of hormone called ghrelin. This in turn results in stimulation of satiety center in the brain and inhibition of hunger center. Post bariatric surgery, patients feel less hungry and so they eat less. They do not feel tired also. This results in weight loss and resolution of obesity associated comorbid conditions like diabetes, high blood pressure etc.
Tips to reduce and maintain healthy weight Do not skip meals Eat balanced diet. Include cereals , pulses, green leafy vegetables, other vegetables, moderate vegetable oil(un saturated), fruits, restricted sugar, skimmed milk and its products daily in proper quantities to meet the requirements of carbohydrates, protein, fat, vitamins, minerals and fibre by the body. Calorie reduction is the most important requirement for weight loss. Cut down of 100 calories per day leads to 4.5kg weight reduction per year.The total calories from food should be 25-30% from fat in the form of unsaturated fat, 15% from protein and 50-60% from carbohydrates in the form of complex carbohydrates like wholegrains, vegetables and fruits.Reduction of 500calories from Basal energy expenditure helps to reduce 9 kg weight per year. Go for whole cereals and pulses like wheat, ragi, jowar, millets rather than refined ones like maida and its products like bread, biscuits, refined noodles, pastries etc Don’t be over restrictive like avoiding one or two meals and replacing it with fruits or juices. Regular physical exercise(brisk walking for 45 minutes for 5 to 7 days a week) Physical activity contributes to weight loss, decreases abdominal fat, increases cardio respiratory fitness. Exercises like aerobic exercise, swimming, bicycling, jogging, dancing leads to these benefits. Brisk walking is one of the easiest ways applicable to almost all age groups. Weight lifting can also be helpful to loose weight. You should be more active everyday by doing routine work like climbing up stairs rather than taking elevator or walking somewhere rather than driving , engage yourself in gardening, household work rather than using electronic gadgets and this can help you to burn calories without much difficulty. Watch your food portion size Inclusion of liberal amount of fresh vegetables and fruits reduces hunger pans, maintains your blood sugar and prevent constipation because of its fibre content and it is abundant in phytochemicals , antioxidants which prevent against cancer Try to include fruits with skin because deskinning removes fibre. No fat or low fat dairy and its products can be used. Drink liberal amounts of water frequently like one glass of water once in two hours intervals. Get rid of deep fried items and calorie dense foods. Avoid fatty items like mutton, beef, pork, crab, prawns. Include fish or fish oil , soya and its products weekly twice because of its omega3fatty acid content. Eggwhite can be taken daily. Healios Obesity and Diabetes Center Nutritive sweeteners: White and brown table sugars, molasses, honey, syrups are nutritive sweeteners.In addition sugar alcohols derived from fruits (or) commercially made are also nutritive sweeteners.The most common sugar alcohols include sorbitol, mannitol, xylitol and maltitol.All nutritive Sweeteners provide calories to the body and may affect your blood glucose. Non nutritive sweeteners are the true artificial sweeteners. They do not provide calories and will not influence blood glucose. These include Saccharin, Neotame, Aspartame, Sucralose, Stevia Acesulfame Potassium(Ace-k)
CARDIOLOGY ASSESSMENT: An accurate assessment of your health is needed before surgery. The best way to avoid complications is to understand their potential in the first place. It is important to know because surgery increases cardiac stress, your heart will be thoroughly evaluated with: ECG: as apart of routine pre-operative investigation it is necessary for all cardio and non-cardiopathic patients. 2D Echo: Morbidly obese patients are at risk of cardiovascular events and their optimal assessment before surgery is necessary. A transthoracic echocardiography was routinely performed in non-cardiopathic patients to rule out cardiovascular risk Two-Dimensional Echocardiogram (2D Echo) is a test in which ultrasound is used to picture out the heart. It is capable of displaying a cross sectional “slice” of the beating heart, including the chambers, valves and the major blood vessels that exit from the left and right part of the heart. TMT(STRESS TEST): The TMT involves exercising on a treadmill while you are closely monitored. The test is used to: Determine your likelihood of having coronary artery disease Identify abnormal heart rhythms Evaluate the effectiveness of your cardiac treatment plan Help you develop a safe exercise program
Counselling Diabetes, obesity, and their treatments can take a lot out of a person. These are particularly challenging phases of your life and need to be treated as such. If you’re suffering from obesity or diabetes, and if especially you need medical treatment and surgery to help your health, then it will take a huge toll on your overall well-being. Having a surgery can be particularly stressful and counselling can lend a helping hand to pull you out of it. Diabetes counselling is recommended for those who are struggling with high blood sugar. Even if you don’t have to undergo any form of surgery, living with diabetes everyday is not easy, and you need all the professional help that you can get to help you through this. With the proper counselling, you can make the right changes in your diet, in your lifestyle, and in even in your outlook. Obesity is a disease that is almost always associated with diabetes. Obese people are more likely to get diabetes. Even if you haven’t yet contracted diabetes, you will need proper guidance to help you deal with and fight with other complications that are brought about due to obesity. Be it diabetes or obesity, or even post-surgical treatment, the benefits of counselling cannot be undermined. People who are about to undergo weight loss surgeries need to go through counselling sessions at Healios. Professionals may conduct one-on-one counselling sessions as well as group sessions, with either the patient’s family or with other patients, to ensure an improvement in their mental and emotional state prior to the surgery. Weight loss surgery will unquestionably bring about some changes in all aspects of your life. Be it your career, your personal relationships with your friends, family and spouses, and even your own individual well-being, a thorough counselling session will help you come to terms to the changes happening in your life. People who have undergone drastic weight loss through bariatric surgery require rigorous counselling sessions after surgery, to make them feel comfortable and confident in their new bodies. The post surgical counselling sessions will help them with re-building an identity and their self-esteem, align self image with their body image, defining goals in the post-surgical healing process, maintain the new body and new lifestyle, and deal with any emotional and psychological changes. With Healios’ Obesity counselling, you can gain back lost confidence and make psychological progress to be at par with the physical progress that you make through the obesity treatment packages. Healios also provides pre- and post-surgical counselling sessions to help you through all the stages of weight-loss surgery. Other than these counselling sessions, Helios also provides its patients with Lifestyle Management sessions, to assist them in improving their overall quality of life.
Bariatric and Metabolic surgery TIP 10 No weight loss results if you don't QUIT SMOKING Risk factor of Bariatric surgery almost doubles in a smoker as compared to a non smoker. That is, surgical complications become twice likely to happen in a smoker, which can lead to death. They are susceptible to experience more non fatal surgical risks too. This is one of the reasons why you must stop smoking prior to and after Bariatric /Obesity Surgery or Metabolic / Diabetes Surgery. The surgical complications associated with smoking include surgical wound infection, pneumonia, blood clots & marginal ulcers. Smokers have almost a 30 percent of higher complication rate after weight loss surgery, which is immensely higher than that of a non-smoker. After weight loss surgery, continuing to smoke could reduce your ability to lose weight and will influence your health in a negative way. If you have a history of smoking, quitting before surgery is a mandatory rule. It is best if you can maintain and quit smoking completely.
Non compact exercise ideas for Morbid obese people A major concern for morbidly obese people is pain associated with vigorous exercise. People with a BMI greater than 40 are classified as being Morbidly Obese. When these people exercise their body weight causes them a lot of pain in knees and ankles. This is one of the reasons they shy away from workouts. When morbidly obese people undergo bariatric surgery/ Obesity surgery, combined by one of the below exercise regimen, it can prove a great advantage for weightloss. There are several alternative ways to lose weight by low impact exercises. Walking: During the initial months, when weight loss is happening post surgery, walking helps since it’s a low impact way of exercise. Even if you can walk only small distances, make it a point to keep walking diligently, and keep increasing the time span of walking. Water Exercises: Do not shy away from water exercises. This form of exercise cushions the weight on your joints and legs by 90% and helps you exercise without pain. Even people who do not know to swim can take advantage of this form by just walking in the water. Stationary cycling bikes: There are many varieties of bikes available in the market. A recumbent bike with a small seat. This is very beneficial for morbidly obese people. Sitting on a seat and peddling away reduces the impact on knees and ankles. It also reduces pressure on the back too.
Post Bariatric surgery TIP 11 Why am I not enjoying Spices in my Food After weight loss surgery, there are some important lifestyle changes that you are recommended to do for the surgery to be a success. Diet is one of the major changes that you do. Questions about how much and what to eat are on top of your mind then. Spices are an integral part of Indian cooking. Be it pepper or garam masala, you would like to know if you can eat them. Although spices are not heavy in fat or sugar, it is observed that many people are not able to enjoy their spicy food the same way as before the obesity surgery/ bariatric surgery. Spices are considered an irritant, and after weight loss surgery, your stomach becomes a lot more sensitive than before the surgery. After surgery, during the time of healing, exposure to spices like pepper, chilli powder, paparika can cause a lot of indigestion and pressure on the stomach. This can cause a lot of discomfort during the healing process. So when your surgeon advices you the avoid spices, it is advantageous to follow. Although the reaction to spices varies from person to person, the conclusion observed is, that in the long run, love for spicy food is not worth the suffering it gives you. Still if your craving for spicy food persists consult your nutritionist to find out ways to use stomach friendly ingredients that enhances flavor without the spiciness.
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