Save yourself from the harmful effects of refined sugar

Save yourself from the harmful effects of refined sugar
Refined sugar is as harmful as excess salt
New Delhi, March 18, 2017: Excessive consumption of foods with high glycemic index that is those that quickly affect blood sugar levels significantly raises the risk of obesity and chronic disorders like diabetes and heart disease. Every 150 extra calories consumed from sugar can raise the prevalence of diabetes by 1.1 % (1). Sugar has a global effect on the body and not only does it damage the vital organs like liver and pancreas but also has a harmful effect on almost every aspect of the body’s organ system.
Padma Shri Awardee Dr K K Aggarwal, National President Indian Medical Association (IMA) and President Heart Care Foundation of India (HCFI) and Dr RN Tandon – Honorary Secretary General IMA in a joint statement said, “Excessive sugar consumption can also cause weight gain. Weight gain, combined with sustained high insulin levels, can lead to insulin resistance and diabetes—which further increases your risk of cardiovascular disease. Consuming a diet high in sugar for just a few weeks has been shown to cause numerous abnormalities found in patients with CHD, such as high total cholesterol, triglycerides, LDL, oxidized LDL, uric acid, insulin resistance and abnormal glucose tolerance, low HDL, and altered platelet function.”
Added fructose -- generally in the form of sucrose (table sugar) or high fructose corn syrup (HFCS) in processed foods and beverages seems especially potent for producing harm. Consuming these sugars can lead to resistance in leptin, which is a key hormone in the maintenance of normal body weight. The overconsumption of added fructose undoubtedly increases the risk for obesity, which is also a risk factor for CHD. Sugars occurring naturally in fruits and vegetables pose no increased risk for CHD. The problem is refined sugars -- with ultraprocessed foods being of greatest concern. Products with added sugars represent 75% of all packaged foods and beverages”, added Dr Aggarwal.
Following are some global ill effects of refined sugar: 1. Sugar damages the immune system. Research has shown that excessive consumption of sugar can impair the delicate balance of body’s internal microbiota. 2. Sugar causes tooth decay The bacteria in the mouth utilize excessively consumed sugar for production of acids and chemicals that cause damage to enamel and can, which can damage and dissolve teeth as well as affect gums. 3. Sugar can lead to gum disease that can cause heart disease Chronic infections arising from periodontal problems can be instrumental in leading to the development of coronary artery diseases. 4. Sugar can impair cognition and memory Limiting sugar has an effect of withdrawal symptoms like excessive craving and emotional mood swings. Sugar has also been shown to interfere with memory and cognition in the long run. 5. Sugar can damage the heart Foods with high glycemic index can lead to rapid spikes in blood pressure, which can lead to hypertension if the diet is not modulated. 6. Sugar can lead to fatty liver disease Fructose, a high glycemic component of refined table sugar can trigger the liver to store more amounts of fat. 7. Sugar interferes with satiety and appetite control Sugar can interfere with the hormone leptin, which signals the brain to stop eating when full. This can lead to mindless uncontrolled eating which can futher worsen the risk of obesity and weight gain. Sources:  http://www.prevention.com/food/healthy-eating-tips/weird-effects-sugars-having-on-your-body/slide/3

National Health Policy 2017 approved by Cabinet

National Health Policy 2017 approved by Cabinet Focus on Preventive and Promotive Health Care & Universal access to good quality health care services The Health Ministry has formulated the National Health Policy 2017, after a gap of 14 years, to address the current and emerging challenges necessitated by the changing socio-economic and epidemiological landscapes since the last National Health Policy was framed in 2002. The Cabinet has approved the National Health Policy 2017. The policy informs and prioritizes the role of the Government in shaping health systems in all its dimensions investment in health, organization and financing of healthcare services, prevention of diseases and promotion of good health through cross-sectoral action, access to technologies, developing human resources, encouraging medical pluralism, building the knowledge base required for better health, financial protection strategies and regulation and progressive assurance for health. The roadmap of this new Policy is predicated on public spending and provisioning of a public healthcare system that is comprehensive, integrated and accessible to all. The Policy seeks to reach everyone in a comprehensive integrated way to move towards wellness. It aims at achieving universal health coverage and delivering quality health care services to all at affordable cost. The policy is patient centric and empowers the patient for resolution of all their problems. The policy, has at its centre, the person, who seeks and needs medical care. The policy also looks at reforms in the existing regulatory systems both for easing manufacturing of drugs and devices, to promote Make in India, as also for reforming medical education. The policy envisages a time-bound Implementation Framework with clear deliverables and milestones to achieve the policy goals. It also seeks to ensure improved access and affordability of quality secondary and tertiary care services through a combination of public hospitals and strategic purchasing in healthcare deficit areas from accredited non-governmental healthcare providers, achieve significant reduction in out of pocket expenditure due to healthcare costs, reinforce trust in public healthcare system and influence operation and growth of private healthcare industry as well as medical technologies in alignment with public health goals. The policy emphasizes reorienting and strengthening the Public Health Institutions across the country, so as to provide universal access to free drugs, diagnostics and other essential healthcare. • The broad principles of the Policy are centered on professionalism, integrity and ethics, equity, affordability, universality, patient-centered and quality of care, accountability and pluralism. • The main objective of the National Health Policy 2017 is to achieve the highest possible level of good health and well-being, through a preventive and promotive health care orientation in all developmental policies, and to achieve universal access to good quality health care services without anyone having to face financial hardship as a consequence. • The policy seeks to move away from Sick- Care to Wellness, with thrust on prevention and health promotion. • It envisages providing larger package of assured comprehensive primary health care through the ‘Health and Wellness Centers’ and denotes important change from very selective to comprehensive primary health care package which includes care for major NCDs, mental health, geriatric health care, palliative care and rehabilitative care services. • It advocates allocating major proportion (two-thirds or more) of resources to primary care followed by secondary and tertiary care. • It also aspires to provide at the district level most of the secondary care which is currently provided at a medical college hospital. • In order to provide access and financial protection at secondary and tertiary care levels, NHP 2017 proposes free drugs, free diagnostics and free emergency care services in all public hospitals. • National Health Policy 2017 affirms commitment to pre-emptive care (aimed at pre-empting the occurrence of diseases) to achieve optimum levels of child and adolescent health. It envisages school health programmes as a major focus area as also health and hygiene being made a part of the school curriculum. • The policy looks at stronger partnership with the private sector and advocates a positive and proactive engagement with the private sector for critical gap filling towards achieving national goals. It envisages private sector collaboration for strategic purchasing, capacity building, skill development programmes, awareness generation, developing sustainable networks for community to strengthen mental health services, and disaster management. The policy also advocates financial and non-incentives for encouraging the private sector participation. • The policy proposes raising public health expenditure to 2.5% of the GDP in a time bound manner. • It aims to ensure availability of 2 beds per 1000 population distributed in a manner to enable access within golden hour. • The Policy advocates a progressively incremental assurance-based approach. • The policy envisages a three dimensional integration of AYUSH systems encompassing cross referrals, co-location and integrative practices across systems of medicines. This has a huge potential for effective prevention and therapy that is safe and cost-effective. • Yoga would be introduced much more widely in school and work places as part of promotion of good health. • It seeks to strengthen the health surveillance system and establish registries for diseases of public health importance, by 2020. • It also seeks to align other policies for medical devices and equipment with public health goals. • Under a ‘giving back to society’ initiative, the new Health Policy supports voluntary service in rural and under-served areas on pro-bono basis by recognized healthcare professionals. • It also advocates extensive deployment of digital tools for improving the efficiency and outcome of the healthcare system and proposes establishment of National Digital Health Authority (NDHA) to regulate, develop and deploy digital health across the continuum of care. • The Policy has also assigned specific quantitative targets aimed at reduction of disease prevalence/incidence under 3 broad components viz. a) Health status and programme impact, b) Health system performance and c) Health systems strengthening, aligned to the policy objectives. Some key targets that the policy seeks to achieve are - • Life Expectancy and healthy life a. Increase Life Expectancy at birth from 67.5 to 70 by 2025. b. Establish regular tracking of Disability Adjusted Life Years (DALY) Index as a measure of burden of disease and its trends by major categories by 2022. c. Reduction of TFR to 2.1 at national and sub-national level by 2025. • Mortality by Age and/ or cause a. Reduce Under-Five Mortality to 23 by 2025 and MMR from current levels to 100 by 2020. b. Reduce infant mortality rate to 28 by 2019. c. Reduce neo-natal mortality to 16 and still birth rate to “single digit” by 2025. • Reduction of disease prevalence/ incidence a. Achieve global target of 2020 which is also termed as target of 90:90:90, for HIV/AIDS i. e,- 90% of all people living with HIV know their HIV status, - 90% of all people diagnosed with HIV infection receive sustained antiretroviral therapy and 90% of all people receiving antiretroviral therapy will have viral suppression. b. Achieve and maintain elimination status of Leprosy by 2018, Kala-Azar by 2017 and Lymphatic Filariasis in endemic pockets by 2017. c. To achieve and maintain a cure rate of >85% in new sputum positive patients for TB and reduce incidence of new cases, to reach elimination status by 2025. d. To reduce the prevalence of blindness to 0.25/ 1000 by 2025 and disease burden by one third from current levels. e. To reduce premature mortality from cardiovascular diseases, cancer, diabetes or chronic respiratory diseases by 25% by 2025. (Source: Press Information Bureau, 16th March, 2017) Dr KK Aggarwal National President IMA and HCFI

Keep osteoporosis at bay with 20 minutes in sunlight and a glass of milk

Keep osteoporosis at bay with 20 minutes in sunlight and a glass of milk Osteoporosis and vitamin D deficiencies are the two silent epidemics of the society. New Delhi, March 17, 2017: Estimates report that 1 out of 8 males and 1 out of 3 females in India suffers from osteoporosis, this essentially makes India one of the worst hit countries of the world. Drinking less milk, avoiding sunlight exposure and omitting the traditional aerobic indoor games are few reasons for these new epidemics. Most young professionals now remain confined to their offices or workplace, with practically no exposure to sunlight. This is especially true for the medical residents.
Padma Shri Awardee Dr K K Aggarwal, President Heart Care Foundation of India (HCFI) and National President Indian Medical Association (IMA) in a joint statement said, “Osteoporosis, also called ‘the silent disease’ often goes unnoticed until the symptoms start to manifest. Early recognition of symptoms and preventive measures can help those who suffer. Identify your risk factors: and bring these to your doctor’s attention, especially if you’ve had a previous fracture or have specific diseases and/or are taking medications that affect bone health. Take osteoporosis medicine, if needed: Treatment will help to improve bone miner density (BMD) and reduce risk of fracture.”
“A bone healthy diet including good amount of protein and calories as well as optimal amounts of calcium and vitamin D, which are important in maintaining proper bone formation and bone density is crucial for managing osteoporosis. Moreover, controlling caffeine, alcohol and salt has been proven to prevent bone loss. To strengthen the skeletal architecture and improve bone density, exercising for at least 30 minutes three times per week is advised”, adds Dr K K Aggarwal.
Here are a few tips for preventing osteoporosis and strengthening the bones.  Stop smoking as it increases bone loss.  Eat a calcium-rich diet: The aim should be to get 1,500 mg of calcium a day in postmenopausal woman or a man over age 65. Good dietary sources of calcium include dairy products, tofu and other soy products, orange juice fortified with calcium, canned salmon with the bones, and cooked spinach.  Get enough vitamin D: Vitamin D levels are influenced by how much sunlight one gets. Levels tend to decrease in older adults, especially in winter and in people who are unable to leave their home. Consider taking a supplement to ensure intake of the recommended daily amount.  Get exposure to sunlight of at least 20 min per day. The exposure should be for duration of 20 min every day for a month in a year.  Get enough protein in diet: An adequate intake of protein in diet, combined with an adequate intake of calcium helps increase bone density. One should aim for about 12% of calories to come from proteins such as legumes, poultry, seafood, meat, dairy products, nuts and seeds. However, too much protein with too little calcium can be harmful.  Weight-bearing exercise: These are activities such as walking, jogging and climbing stairs that one should do on the feet, with your bones supporting your weight. They work directly on the bones of the legs, hips and lower spine to slow mineral loss.  Weightlifting exercises: These exercises, also called resistance training or strength training. They strengthen muscles and bones in the arms, chest and upper spine. They can work directly on the bones to slow minerals loss.  Get adequate vitamin K: This vitamin may be helpful in enhancing bone strength. Green leafy vegetables are the best sources of vitamin K. If one is taking a blood thinner, he or she should check with the doctor.  Avoid excessive alcohol: Women should limit alcohol consumption to less than one ounce a day and men should limit it to less than two ounces.  Limit cola drinks: People who have high cola intake often have lower bone density.

IMA: Strict and swift action required against assault on doctors

IMA: Strict and swift action required against assault on doctors Dhule doctor brutally manhandled, IMA demands strict action against assaulters New Delhi, March 16, 2017: Another incidence of doctor beaten up by unruly mob was witnessed on the day of Holi, where a bunch (25-30 people) of patient’s relatives brutally manhandled Dr. Rohan Mhamunkar, Resident Orthopedics Department, SBH GMC, Dhule (Maharashtra). The Indian Medical Association has strongly condemned this act and has demanded strict action against such unacceptable heinous act of the relatives of the patient.
Dr Rohan was beaten up so badly, that he was left with fractures of orbital bones, severe eye injury and may even lose his vision. Due to his critical condition Dr Rohan was referred to Mumbai for further treatment.
In the light of the above incident, Padma Shri Awardee Dr K K Aggarwal, National President, Indian Medical Association (IMA) and President Heart Care Foundation of India (HCFI) and Dr RN Tandon – Honorary Secretary General IMA in a joint statement said that, “Indian Medical Association criticize this kind of unpardonable behavior and requests all medical professionals to join hands and condemn the attack on Dr. Rohan Mhamunkar through a Memorandum to the concerned authorities in Dhule (Maharashtra) and respective states also. It is also desirable that each and every state should inform the media through a Press Conference regarding such an unacceptable heinous act of the relatives of the patient. Doctors are requested to inform the local branches under their jurisdiction and report their standpoint regarding this incident.”
“It is a matter of serious concern for all of us in the healthcare sector. If I am attacked while attending a patient I might end up misdiagnosing or even losing the patient. Strict and swift actions must be taken against the assaulters so that doctors feel safe to work and do justice to the profession and to the patients. Further, the rising incidences of such cases highlight the urgent need of boosting security measures at hospital premises. Lastly, I request the general public not to attack doctors as they are for your service only,” added Dr K K Aggarwal. 
Subsequently, despite huge protests against assault on doctors and their medical establishments, the medical profession is still facing similar actions all over India. This will not be tolerated and should be brought to the knowledge of the concerned authorities in a way of protest.
Following are some suggested measures that might improve patient-doctor relationship: • Sensitization of the hospital administrators to improve their quality of medical services • Workforce development • Adequate security at and around the hospital premises • Recognizing the risk factors at workplace • Media or press must avoid media-trial and try to cover positive news regarding medical profession

Write NLEM drugs

Write NLEM drugs The World Health Organization (WHO) has defined ‘essential medicines’ as those that satisfy the priority health care needs of the population. The WHO also says that the essential medicines should be available “at all times in adequate amounts, in the appropriate dosage forms, with assured quality, and at a price the individual and the community can afford”. 
The Alma Ata Declaration adopted by the World Health Assembly in 1978 was the first international declaration, a milestone, which brought primary health care to the forefront. It outlined provision of essential drugs as one of the essential components of primary health care. In the same year, the World Health Assembly passed a Resolution urging Member States to establish national lists of essential medicines and adequate procurement systems. 
India too joined hands with the WHO and the first National Essential Drugs List was published in 1996. It was revised in 2003 as the National List of Essential Medicines (NLEM). The latest revision was notified on December 23, 2015. The NLEM 2015 includes 376 medicines listed according to the level of health care: Primary, secondary and tertiary
Many criteria are considered to include a drug in the NLEM. • The medicine should be approved/licensed in India. • The medicine should be useful in disease which is a public health problem in India. • The medicine should have proven efficacy and safety profile based on valid scientific evidence. • The medicine should be cost effective. • The medicine should be aligned with the current treatment guidelines for the disease. • The medicine should be stable under the storage conditions in India. • When more than one medicine are available from the same therapeutic class, preferably one prototype/ medically best suited medicine of that class to be included after due deliberation and careful evaluation of their relative safety, efficacy, cost-effectiveness. • Price of total treatment to be considered and not the unit price of a medicine. • Fixed Dose Combinations (FDCs) are generally not included unless the combination has unequivocally proven advantage over individual ingredients administered separately, in terms of increasing efficacy, reducing adverse effects and/or improving compliance Essential drugs satisfy the priority healthcare needs of the large majority of the community. And, if a drug is listed in the essential medicines list, this means that it has to be “affordable, available at all times in adequate amounts with assured quality to meet the health care needs”. The NLEM assumes particular importance to India where out of pocket expenditure on health care is quite high and only a few have health insurance. 
An article published in the February 2015 issue of the Indian Journal of Medical Research says “Healthcare access in India is affected with 70:70 paradox; 70 per cent of healthcare expenses are incurred by people from their pockets, of which 70 per cent is spent on medicines alone, leading to impoverishment and indebtedness.” 
The United Nations Sustainable Development Goal (SDG) 3 “Ensure healthy lives and promote well-being for all at all ages” has outlined access to safe, effective, quality and affordable essential medicines for all in Target 3.8, which states: “Achieve universal health coverage, including financial risk protection, access to quality essential health-care services and access to safe, effective, quality and affordable essential medicines and vaccines for all.”
IMA believes that health care should be within reach of every person in the country. It should be affordable, with provisions for people from all economic strata. IMA is also committed to the 17 SDGs and their 169 targets. 
Hence, IMA recommends that its members should write NLEM drugs, instead of prescribing expensive non NLEM drugs to those who cannot afford them. But, this does not mean that drugs not included in the NLEM are non-inferior drugs. If you prescribe a non-NLEM and more expensive drug, explain to the patient why you are doing so.

IMA guidelines: Preventing dementia and cognitive decline

IMA guidelines: Preventing dementia and cognitive decline Simple lifestyle modifications can help reduce your risk of Alzheimer’s and related dementias. New Delhi, March 15, 2017: Nearly 4 million people are living with some form of dementia, in India. Promising research shows that you can reduce your risk of dementias through a combination of simple but effective lifestyle changes. No matter what your age, it's not too late to take steps to prevent memory loss.Brain- healthy lifestyle measures starting as early as young adulthood, can significantly prevent the onset of age induced Alzheimer’s and related dementias later in life. In addition, good health habits can reduce the risk for illnesses that might affect your memory as well as the likelihood that you'll need medications that could have damaging side effects. Padma Shri Awardee Dr K.K Aggarwal, National President Indian Medical Association (IMA) and President Heart Care Foundation of India (HCFI) and Dr RN Tandon – Honorary Secretary General IMA in a joint statement said that, “Alzheimer’s is a very complex disorder and has multiple risk factors. Risk factors like genetics and your age are beyond your control, however, some of these factors are modifiable and form the basis of a brain- healthy lifestyle. These include stress management, regular exercise, good sleep, healthy diet, mental stimulation and social engagement. A low-fat, high-fibre diet including plenty of fresh fruit and vegetables and whole grains can help reduce your risk of some kinds of dementia”. Along with diet and exercise, it is important that you engage in regular mentally stimulating activities to keep those brain cells up and running. This is particularly beneficial for those who have crossed their 40s. “Try doing light brain stimulating tasks like crossword puzzles, quizzes, daily reading or anything similar that interests you. For older individuals, it is advised that they engage their mental reserves through social engagement and exercise. For most people, a minimum of 150 minutes (2 hours and 30 minutes) of moderate-intensity aerobic activity each week, such as cycling or fast walking, is recommended.Good sleep should supplement these activities to obtain their full benefit”, adds Dr. K.K Aggarwal. Following are the some crucial protection strategies against dementia and cognitive decline. • Maintain a healthy weight. • Check your waistline. • Eat mindfully. Emphasize colorful, vitamin-packed vegetables and fruits; whole grains; fish, lean poultry, tofu, and beans and other legumes as protein sources; plus healthy fats. Cut down on unnecessary calories from sweets, sodas, refined grains like white bread or white rice, unhealthy fats, fried and fast foods, and mindless snacking. Keep a close eye on portion sizes, too. • Exercise regularly. Aim for 2½ to 5 hours weekly of brisk walking (at 4 mph). Or try a vigorous exercise like jogging (at 6 mph) for half that time. • Keep an eye on important health numbers. In addition to watching your weight and waistline, keep a watch on your cholesterol, triglycerides, blood pressure and blood sugar numbers. • Smoking increases your risk of developing cardiovascular diseases, cancer and dementia. • When possible, walk instead of driving or riding. • Try keeping up with current affairs, learning a new hobby, and playing challenging games to exercise your mind.

Never ignore a symptom, which is unusual, unexplained or occurs for the first time in life

Never ignore a symptom, which is unusual, unexplained or occurs for the first time in life Indigestion, persistent cough, shortness of breath, constipation, fever, headache, feeling tired all the time are some common symptoms that many of us experience, but their significance is often undermined in the rush of the day to day life. We often ignore symptoms or minimize their significance and delay going to the doctor. But, this is how our body tries to tell us that all is not well and it’s time to see a doctor. These symptoms are important as they may be due to a disease. At times, many of these common symptoms may signal a serious disease condition. Messages describing the ‘warning signs’ of many diseases like cancer, heart attack, stroke etc. are often displayed in public places and even in clinics and hospitals for patients to read. Take cancer for an example. Some common warning signs of cancer have been defined: • Change in bowel or bladder habits. • A sore that does not heal. • Unusual bleeding or discharge. • Thickening or lump in the breast, testicles, or elsewhere. • Indigestion or difficulty swallowing. • Obvious change in the size, colour, shape, or thickness of a wart, mole, or mouth sore. • Nagging cough or hoarseness. • Weight loss Then there are warning signs of different types of cancer such as bowel cancer, lung cancer. Warning signs of bowel cancer may include: • A recent, persistent change in bowel habit • A change in appearance of bowel movements • Blood in the stool or rectal bleeding • Feeling of incomplete evacuation • Unexplained anemia • Rectal/anal pain or a lump in the rectum/anus • Abdominal pain or swelling • Weight loss Some warning signs of lung cancer may include • Persistent cough • Change in a chronic cough • Shortness of breath • Pain in the chest area • Wheezing • Hoarseness of voice • Weight loss And the list may go on… Often people ignore warning signals and do not address them until they fall ill, often with grave consequences. So, instead of defining warning signals for each disease condition, the Indian Medical Association (IMA) advocates universal warning signals “Never ignore a symptom which is unusual (different than usual), unexplained or occurring for the first time in life”… They may be red flags to consult a doctor as soon as possible. • Do not ignore first attack of acidity after the age of 40 as it may be a sign of heart attack. All wheeze is not asthma and all asthmatics do not wheeze. • Do not ignore first attack of asthma after the age of 40 as it may be a sign of heart attack. • You may have been getting headaches for years but if the present episode of headache is unusual, severe and unexplained, you need immediate medical attention. • If you get up exhausted after hours of rest, this needs to be evaluated. Remember the following: • Signals for emergent attention mean to call the doctor right away. • Symptoms for urgent attention mean to contact the doctor same day. • Symptoms for attention mean doctor to be informed in the next visit. One should be able to differentiate emergent from urgent symptoms and signs. Emergency warrants medical attention within minutes. The window period for cardiac arrest is 10 minutes, for heart attack 3 hours, for stroke 3 hours and for stoppage of bleeding 1 hour. Stay alert to live longer and live healthy …. Dr KK Aggarwal National President IMA and HCFI