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(For the information of non-medical public) 

DIABETES 

About 2 out of 10 people over the age of 40 develop this condition of inability to lower sugar level resulting from fast digesting starch containing food or sugar. If your blood sugar levels were over 200 mgs (11mmols) at any time you might have the condition of Diabetes. Without having to go through a number of blood test such as glucose tolerance test following suggestion should assist you in finding out whether you have the condition.

The best time to check blood sugar level is very soon after festive season when you have had more than usual amount of your favourite food items.

Have your usual breakfast (what ever starch containing foods in its usual quantity, usual lunch with usual content of starch containing food items and a desert or fruit. If you are less active after lunch usually then be less active for the test. Exactly at 2 hours following lunch take a trip in a vehicle to nearest laboratory for a blood sugar test. If the blood sugar is below 140 mgs your body is able to handle the usual diet satisfactorily. If it is over 140mgs. then you have to adjust your diet a little and recheck after 2 weeks following the above instructions.

If the blood sugar is above 200mg consider following questions.

Have you been ill very recently such as a 'flu', operations. or having mental worries? 

Have you been having too much sugar containing food stuffs ? 

Have you been losing weight for unexplained reasons? 

If any of the answers to above questions is yes, a proper assessment by a physician is needed before embarking on any medication to lower blood sugar, preferably a specialist dealing with diabetes to find out the cause of abnormal blood sugar.

Dietary management of Diabetes 

Choose foods containing starch in smaller quantity. Instead of having very large lunch and a snooze after lunch try small lunch and less strenuous physical activity such as shopping or attending to household chores after lunch. Shifting some portion of the starch diet to the evening meal would also help to reduce the stress on insulin producing cells in the pancreas.

Always aim to keep the 2 hour post lunch blood level to below 140mg by diet than with medications.  

Above is the simplified and most appropriate way to manage the Diabetes.
Non medical person with reasonable intellect may be able to grasp the essence of sugar level regulation by the body. Do not take medications without consulting medical practitioner with special interest in Diabetes.

Tablets. No tablet is a substitute for managing Diabetes without dietary modification.

Insulin. Very rarely insulin injection may be needed to tide over critical illnesses or operation for the Diabetic person.

Follow advise from clinicians strictly if you are on insulin in order to avoid complications.

( Try not to manage Diabetes by trial and error. - Sugar level regulation is far too complex for you to understand with out adequate medical knowledge) 

Additional Information. 

About half of the sugar produced by digesting starch is used by the leg muscles, quarter by the brain and the other quarter by rest of the body organs.

Sugar levels in the body are regulated mainly by Insulin, Glucagon, Cortisol, Growth Hormone and Adrenaline.  

The body is more responsive to available insulin in the evening than in the morning.

If no food is taken the body converts glycogen ( stored in muscles and Liver) and fat inside the abdomen and skin to sugar in order to maintain normal blood sugar levels. >br>(If you are on tablets or Insulin to lower sugar levels then you could suffer from a reaction known usually as 'Hypo' confusion or blackout and sweating until the body corrects the sugar levels by itself in a few minutes. More rapid correction is possible with a sugary drink or glucagon injection.) 

High blood sugar levels damage the inside lining of the blood vessels to cause heart attacks, Stroke, bleeding in the eyes, Kidney failure , High Blood Pressure, Infections Cataracts. Glaucoma etc.

If you are also smoker you are at more risk to develop above complications.

OBESITY 

The world population is visibly becoming overweight owing to consumption of increased amounts of calories with excessive sugar and fat either solid or liquid form. fat.

The body systems are geared to store available nutritional load to tide over lean times in the form of fat layer in the abdomen and under the skin. It takes a few months to few years to build up the fat layer to be overly noticeable. Famines or non availability of food is unlikely to affect many parts of the world.

Cooking food in oil and adding refined sugar in various forms contributes to the nutritional load for the body to tackle to keep the body systems functioning without significant ill effects other than the mobility. However, over time it become a cause of diseases like Diabetes, Heart disease, Cancers. Arthritis. etc.

How to control weight by losing excess body fat. 

Without calorie shortfall month by month the excess fat cannot be shifted.

However, it is not advisable to reduce the calorie consumption drastically as the body systems switch its metabolism to different strategy for survival.

Think of your monthly savings account in the bank where you save little by little every month to build up a sizeable sum after a few years. The reverse process would need to be set in place where drawing small amounts every month from the capital built up. This same principle applies to shifting stored energy in the form of body fat.

Our psychology and philosophy is also a crucial part of what we want to achieve and would achieve.

There is also a need to continue to enjoy your favourite food items in small amounts once or twice a month. Otherwise, we breakout of our plan to reach our target weight loss.

Exercise would keep you fit, but it also increases your appetite for food and craving for favourite food items. The stored fat will not alter visibly with exercise alone and when you stop your vigorous exercise routine the fat stores in the body would fill up very soon. Therefore, choose only the gentle type of exercise routine which you can maintain for years.

Check your resolve to reach your desired body proportion. 

Are you able to resist the temptation to join in when your friends or family members are gobbling up your favourite food items right in front of you? and when you are really hungry ? 

Are you able to control hunger pangs when you feel very hungry ? 

Are you able to fast just for 24 hours without food while being active? 

If your are able to do the above you would most likely reach your desired body proportions in a few months or in a few years.

See if you can stop buying or using oil, solid fat, and sugar for the first month as well as ration the amounts for your family members you are on course lose body fat. The reason for suggesting this is to switch your body metabolism away from storing fat as a matter of routine. After a month you would not tolerate food containing large amounts of fat, and sugar in your diet might taste odd, and unpleasant.

If you are able to pass the first month the body system would be conditioned to utilize energy from natural food source and cooked food with minimal amounts of fat and sugar.

Energy yield from starch/sugar - 4 calories/gram

Energy yield from fish, meat, egg, cheese - 4 calories /gram

Energy yield from oil or fat - 8 calories/ gram

A normally active adult needs about 1500 cal/ day = 45000 cal/ month

Aim for a shortfall of calorie of 8000/ month – (1 kilo of fat loss per month) 

Do not check your weight other than every 2 months. As our body consists of about 60% water we get a wrong impression of body weight loss with fluctuating movement of water in and out of our body. Amount of fat loss is a little difficult to calculate by checking the weight. If you have lost 6 pound in 2 months the amount of fat loss is likely to be about 3 pounds.(1.5 kg- same as loss of 1.5 litres of cooking oil) 

Avoid coffee, tea, fizzy drink, beer, wine spirits chocolates etc for the first month.

You can have any fruit in any amount or a few raw nuts when ever you feel hungry for the first month. Any amounts of cold or warm water without additives for the first month.

If you are on any medication check with your doctor the safety aspect of embarking on weight loss program. 

CANCER 

Cancer develops from just one abnormal cell while the neighbouring cells and the immune system fails to recognize it as abnormal.  

In the early stages of cancer absolutely no symptoms will be present. Depending on the rate of growth and position of the cancer lump some symptoms may be experienced.

Particularly in older age group who are more vulnerable to cancer the location of the cancer lump would need to be found out by specific invasive or non-invasive tests. Once the cancer cells have spread from the original site to liver, lungs. brain etc it is very unlikely that treatment with surgery or chemotherapy would prolong life to more than 5 years. The management is usually palliative in controlling symptoms than getting rid of the cancer as only less than 5 % cases of advanced cancer remain alive for 5 years with or without the condition.

Commonest cancers are in the breast, prostate, colon, blood and lungs.

Self examination of breast weekly before taking a shower may give you an indication whether to seek more definitive tests or clinical consultation. Fortunately, not all lumps in the breast are not cancerous. Any ambiguity in tests is usually treated as cancer to be on the safe side.

Prostate cancers are usually very slow growing and it would be prudent to seek consultation to consider treatment to slowdown the cancer further so that we may be able to reach a normal life span.

Colo- rectal cancer detection usually need an invasive test to fully assess the extent of the disease. Removal of the cancer lump and lymph nodes followed by chemotherapy course is the standard treatment. Other surgical procedures are mainly to prevent obstruction of the intestinal tract or to alleviate recurring symptoms.

Expensive chemotherpy courses are not vastly superior to available combination of anti -cancer treatment.

Heart Attacks. 

Heart attack symptoms are due to sudden obstruction of one of the three main blood vessels supplying the heart muscle. The usual symptom is a tightness or pain in the centre of the chest ,more commonly in the early morning or when exerting physically or rarely with mental stress.

If you suspect a pain due to heart attack be clam and arrange a lift up to local cardiac facility to fully assess the severity of the disease. An emergency angiogram may be required if the blockage could be corrected by stenting. If the affected part of the heart muscle is already dead ,the clinicians might opt for an elective angiogragm to assess the state of remaining blood vessels.

Try not to self diagnose or treat without adequate assessment of the heart function. Do not consider pain in the chest as due to indigestion until detailed assessment is carried out by cardiologist. Do not run, drive or panic if you suspect experiencing a pain from the heart. Even if the pain goes away in a few minutes you would still need a lift up in an ambulance, or taxi with a relative or friend to nearest facility for a fuller assessment.( Some mild chest pain which goes away after a few minutes can preceed a fatal complication.) 

Angina is due to partial obstruction of one or more of the heart blood vessel with symptoms appearing with exertion which clears up with a short rest. Again, if this is new, you need a consultation with a cardiologist without undue delay.

More info and amendments to above text is being sought with the help local linguist.

Dr. Mathew Varghese

Former Consultant Physician, UK

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