Senior endocrinologist Dr Pankaj Aggarwal tells The Sunday Guardian why the idea of prediabetes is getting popular and it is so important. Excerpts:
Q. What is prediabetes?
A. As the name suggests, it is the stage between normalcy and frank diabetes. Actually, the three entities are in a continuum. When blood glucose value starts rising above normal, initially it enters the zone of prediabetes and when it progresses further, it enters the zone of frank diabetes.
Q. Why is it gaining so much popularity? Is there any clinical significance of this entity?
A. Traffic light has three colours and the same is true for the spectrum of blood glucose levels as well. The green zone is normal wherein you are free to move; then comes yellow, which warns to be careful; and then it turns red, which orders you to stop, else you will be punished. Prediabetes is the intermediary warning zone before reaching the zone of actual harm or punishment.
Q. Does it mean that prediabetes itself is a harmless entity?
A. No, many population studies have proved that some complications of diabetes actually begin in the stage of prediabetes. It is particularly true for similar lifestyle disorders such as high blood pressure, high blood cholesterol and even heart attack or paralysis. Controlling blood glucose level and decreasing it from this zone to normal, can prevent development or progression of these dieters.
Q. What is normal blood glucose levels and their cut-offs for prediabetes and diabetes?
A. We derive glucose mainly from our food and so our blood glucose levels actually vary with intake of food. After an overnight fast, it is between 70 mg/dl and 100 mg/dl which increases to 100-140 mg/dl after 2 hours of having a meal. When blood glucose level rises beyond 126 mg/dl in fasting state and 200 mg/dl after 2 hours of meals, it is termed diabetes. Values between 100 mg/dl and 126 mg/dl (fasting) and 140 mg/dl and 200 mg/dl (after meals) are labelled prediabetes.
Q. Is it certain that a person who has become prediabetes will progress certainly to diabetes?
A. No, actually here lies the importance of detecting it at the level of prediabetes. It is the warning zone or ‘no man’s land’ between the borders of two countries. You can’t come back to your motherland easily after entering the neighbour’s territory but can still be brought back from the intermediate no man’s land. Prediabetes can be reversed.
Q. So what are the ways through which it can be reversed?
A. The two most common factors behind development of diabetes of adults or type 2 diabetes are, genetic predisposition and faulty lifestyle. The former is non-modifiable as we can’t choose our parents. But if one has a family history of diabetes, it should serve a warning signal that one should resort to adoption of a healthy lifestyle to prevent its progression into the state of diabetes. Correction of faulty lifestyle is actually the major route through which prediabetes can be reversed.
Q. Can you please detail upon the healthy lifestyle here?
A. Management of diabetes or prediabetes revolves around management of calories. If calorie intake is more than required, it accumulates in the body and predisposes a person towards development of diabetes, hypertension, high blood cholesterol and heart attack. Since fats in our diet are most calorigenic, it increases these probabilities to its maximum. So, reducing extra calories in diet in the form of paratha, poori, kachori, namkeen, samosa, pakoras, meat and sweets, remains the cornerstone of this management. Instead, one should have plenty of whole grain cereals (roti, daliya), dal, green leafy vegetables, fruits, low fat milk and milk products and white of egg. One should avoid frying or adding extra ghee or butter in the food to prevent weight gain. Regular exercises are most helpful in reducing the extra body fat if it has accumulated. These measures can help in reversing prediabetes.
Q. Do we have any medicine as well to help in reversing prediabetes?
A. Frankly speaking, medicines are meant for treating a disorder and not for preventing it. Though some anti-diabetic medicines like metformin, thiazolidinediones and acarbose have been tried to prevent the progression of prediabetes into diabetes but lifestyle interventions have been found to be most successful in this regard.
Q. Has any study been tried to see whether reversal of prediabetes is possible or not?
A. A number of studies have been conducted so far wherein reversal of prediabetes and even diabetes has been studied. The Diabetes Prevention Programme, both global as well as national, is pioneer amongst all to show that this is possible and achievable.
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UNCOMMON FOR UNBORN BABIES TO CONTRACT COVID-19
According to a study led by UCL researchers with Great Ormond Street Hospital for Children and the NIHR Great Ormond Street Biomedical Research Centre, it is only possible for an unborn baby to contract Covid-19 if their gut is exposed to the SARS-CoV-2 virus.
The research was published in the ‘BJOG – An International Journal of Obstetrics & Gynaecology Journal’. Although the study did not look specifically at mothers with Covid-19 and whether their infection was transmitted to an unborn baby, it found that certain fetal organs, such as the intestine, are more susceptible to infection than others.
However, researchers said, that opportunities for the Covid-19 virus infecting the fetus are extremely limited, as the placenta acted as a highly effective and protective shield, and evidence suggested fetal infection, known as vertical transmission, is extremely uncommon.
Researchers set out to understand how newborn babies could have developed Covid-19 antibodies, as it had been reported in a small number of cases.
Specifically, they wanted to know if and how the virus could be passed from an infected mother to the unborn fetus.
To answer this question, researchers examined various fetal organs and placenta tissue to see if there was any presence of the cell surface protein receptors, ACE2 and TMPRSS2. These two receptors sit on the outside of cells and both are needed for the SARS-Cov-2 virus to infect and spread.
Researchers found the only fetal organs to feature both the ACE2 and TMPRSS2 were the intestines (gut) and the kidney; however, the fetal kidney is anatomically protected from exposure to the virus and is, therefore, less at risk of infection.
Therefore, the team concluded that the SARS-CoV-2 virus could only infect the fetus via the gut and through fetal swallowing of amniotic fluid, which the unborn baby does naturally for nutrients.
After birth ACE2 and TMPRSS2 receptors are known to be present in combination on the surface of cells in the human intestine as well as the lung. The gut and lung are suspected to be the main routes for Covid-19 infection, but in younger children, the intestine appeared to be most important for virus infection.
Senior author, Dr Mattia Gerli (UCL Division of Surgery and Interventional Science & the Royal Free Hospital) explained, “The fetus is known to begin swallowing the amniotic fluid in the second half of pregnancy. To cause infection, the SARS-CoV-2 virus would need to be present in significant quantities in the amniotic fluid around the fetus.”
“However, many studies in maternity care have found that the amniotic fluid around the fetus does not usually contain the SARS-CoV2 virus, even if the mother is infected with Covid-19. Our findings, therefore, explain that clinical infection of the fetus during pregnancy is possible but uncommon and that is reassuring for parents-to-be,” Gerli added.
Study reveals meditation increases error recognition
A recent study by the Michigan State University has found that if you’re forgetful or make a lot of mistakes, meditation is the answer to your problems.
The research was published in the ‘Brain Sciences Journal’. The researchers tested how open-monitoring meditation — or, meditation that focused on awareness of feelings, thoughts or sensations as they unfold in one’s mind and body — altered brain activity in a way that suggested increased error recognition.
“People’s interest in meditation and mindfulness is outpacing what science can prove in terms of effects and benefits,” said Jeff Lin, MSU psychology doctoral candidate and study co-author.
“But it’s amazing to me that we were able to see how one session of a guided meditation can produce changes to brain activity in non-meditators,” he added.
The findings suggested that different forms of meditation can have different neurocognitive effects and Lin explained that there is little research about how open-monitoring meditation impacted error recognition.
“Some forms of meditation have you focus on a single object, commonly your breath, but open-monitoring meditation is a bit different,” Lin said.
“It has you tune inward and pay attention to everything going on in your mind and body. The goal is to sit quietly and pay close attention to where the mind travels without getting too caught up in the scenery,” Lin added.
Lin and his MSU co-authors — William Eckerle, Ling Peng and Jason Moser — recruited more than 200 participants to test that how open-monitoring meditation affected how people detected and responded to errors.
The participants, who had never meditated before, were taken through a 20-minute open-monitoring meditation exercise while the researchers measured brain activity through electroencephalography or EEG. Then, they completed a computerized distraction test.
“The EEG can measure brain activity at the millisecond level, so we got precise measures of neural activity right after mistakes compared to correct responses,” Lin said.
“A certain neural signal occurs about half a second after an error called the error positivity, which is linked to conscious error recognition. We found that the strength of this signal is increased in the meditators relative to controls,” Lin added.
While the meditators didn’t have immediate improvements to actual task performance, the researchers’ findings offer a promising window into the potential of sustained meditation.
“These findings are a strong demonstration of what just 20 minutes of meditation can do to enhance the brain’s ability to detect and pay attention to mistakes,” Moser said.
While meditation and mindfulness have gained mainstream interest in recent years, Lin is among a relatively small group of researchers that take a neuroscientific approach to assess their psychological and performance effects.
Looking ahead, Lin said that the next phase of research will be to include a broader group of participants, test different forms of meditation and determine whether changes in brain activity can translate to behavioural changes with more long-term practice.
STUDY FINDS DYSLEXIA MAY CAUSE VISUAL DISABILITY , READING IMPAIRMENT
According to a new study, children who suffer from dyslexia go through visual issues as well along with dealing with reading disabilities.
The readings were published in the ‘Neurosci Journal’. It was the first to combine new methods to understand visual processing and brain activity in dyslexia, challenged a group of children aged six to 14 to identify the average direction of motion of a mass of moving dots, while their brain activity was measured.
It was found that children with dyslexia took longer to gather the visual evidence, and were less accurate, than their typically developing peers, and that the behavioural differences were reflected in the differences in brain activity.
Although reading ability is known to be affected by dyslexia, researchers are still unclear on which brain processes are affected by the condition. Increased understanding of this could potentially lead to more effective support for those affected.
Dr Cathy Manning, lead researcher in the Centre for Autism at the University of Reading, said, “These findings show that the difficulties faced by children with dyslexia are not restricted to reading and writing. Instead, as a group, children with dyslexia also show differences in how they process visual information and make decisions about it.”
“Future research will be needed to see if these differences in visual processing and decision-making can be trained in order to improve reading ability in affected children, or provide clues as to the causes of dyslexia,” Cathy added
Brain activity monitoring using EEG in the study showed synchronized activity over the centro-parietal regions of the brain involved in decision-making steadily increased in all of the children during the task until they made a decision. However, this happened more gradually in the children with dyslexia.
The study supported a link between motion processing and dyslexia, although the causes are not yet known.
Whether dyslexia is, at its core, a visual processing disorder is hotly debated among researchers. With reading and writing a key challenge among children with dyslexia, increasing understanding of its effects on the brain might aid how we improve existing interventions.
TEA, COFFEE LINKED TO LOWER RISK OF STROKE, DEMENTIA
According to recent research, drinking tea and coffee might be linked to a reduced risk of stroke and dementia. Drinking coffee was also linked with a reduced risk of post-stroke dementia.
The study was published in the ‘PLOS Medicine Journal’. Strokes are life-threatening events that cause 10 per cent of deaths globally. Dementia is a general term for symptoms related to declining brain function and is a global health concern with a high economic and social burden. Post-stroke dementia is a condition where symptoms of dementia occur after a stroke.
Yuan Zhang and colleagues from Tianjin Medical University, Tianjin, China studied 365,682 participants from the UK Biobank, who were recruited between 2006 and 2010 and followed them until 2020. At the outset participants self-reported their coffee and tea intake. Over the study period, 5,079 participants developed dementia and 10,053 experienced at least one stroke.
People who drank 2-3 cups of coffee or 3-5 cups of tea per day, or a combination of 4-6 cups of coffee and tea had the lowest incidence of stroke or dementia. Individuals who drank 2-3 cups of coffee and 2-3 cups of tea daily had a 32 per cent lower risk of stroke (HR, 0.68, 95 per cent CI, 0.59-0.79; P <0.001) and a 28 per cent lower risk of dementia (HR, 0.72, 95 per cent CI, 0.59-0.89; P =0.002) compared with those who drank neither coffee nor tea. Intake of coffee alone or in combination with tea was also associated with a lower risk of post-stroke dementia.
The UK Biobank reflected a relatively healthy sample relative to the general population which could restrict the ability to generalize these associations. Also, relatively few people developed dementia or stroke which can make it difficult to extrapolate rates accurately to larger populations. Finally, while it’s possible that coffee and tea consumption might be protective against stroke, dementia and post-stroke dementia, this causality cannot be inferred from the associations.
The authors added, “Our findings suggested that moderate consumption of coffee and tea separately or in combination were associated with lower risk of stroke and dementia.”
WHAT YOU MUST KNOW ABOUT NEW OMICRON COVID VARIANT
When the entire world was hoping to bring back normalcy despite the continued stress of the pandemic, COVID strikes us back with a new terror. A new variant B.1.1529 has been discovered in South Africa that is said to be a heavily mutated version discovered so far. The variant is named as Omicron by the World Health Organization.
The Technical Advisory Group on SARS-CoV-2 Virus Evolution (TAG-VE) is continuously monitoring the evolution of SARS-CoV-2 and assesses if specific mutations and combinations of mutations alter the behaviour of the virus. Bases on the TAG-VE advised WHO has designated the Omiicorn virus as a VOC and will communicate new findings with Member States and to the public as needed.
WHO has also asked all the counties to enhance surveillance and sequencing, submit complete genome sequences and associated metadata, report initial cases/clusters associated with VOC infection through the IHR mechanism. In view of the same India’s National Centre for Disease Control has reported to the health ministry that multiple cases of Covid-19 variant B.1.1529 have been reported in Botswana (4 cases), South Africa (22 cases), and Hong Kong (2 cases). The Ministry said that the variant is reported to have a significantly high number of mutations, and thus, has serious public health implications for India in view of the recently relaxed visa restrictions and opening of international travel. Here are answering a few questions that might arise in your mind.
WHY IS THE NEW VARIANT DANGEROUS?
The new variant is said to be incredibly heavily mutated. As per experts from the Centre for Epidemic Response and Innovation in South Africa, there was an unusual constellation of mutations and that it was very different to other variants that have circulated. Until today there were 50 mutations overall and more than 30 on the spike protein, which is the target of most vaccines and the key the virus uses to unlock the doorway into our body’s cells. Zooming in even further to the receptor binding domain (the part of the virus that makes first contact with our body’s cells), it has 10 mutations compared to just two for the Delta variant that swept the world.
According to researchers, this level of mutation has most likely come from a single patient who was unable to beat the virus. The biggest concern that researchers have is this virus is now radically different to the original one that emerged in Wuhan, China. Although the current SARS-CoV-2 RT-PCR diagnostics continue to detect the new variant, we are yet to gather data on whether this variant could evade vaccine or natural immunity or have higher transmissibility.
However, it is important to know what those mutations are doing. We will need to know what these mutations do to the inherent abilities of the virus. But that’s hypothesis and needs more evidence. Having many mutations does not mean that the virus will be deadlier or more dangerous. Nevertheless, every variant would have the potential to impact the pandemic. However, the data here is very limited at this moment the potential impact and real-world effects as a result of this cannot be commented on
WHAT DO WE DO ABOUT IT AND DOES THIS PUT INDIA AT A RISK AGAIN?
It is important to note that the coronavirus evolves as it spreads and many new variants, including those with worrying mutations, often die out in the course of time. Scientists are currently monitoring for possible changes that could be more transmissible or deadly. However, sorting out whether new variants will have a public health impact can take time. Right now, there is no need for panic. Although we are left with a variant that raises significant concerns despite huge gaps in our knowledge, we need to be watchful and not let our guards down.
Now, you might wonder how can Mumbai – a high footfall and dense air transit metropolitan city safeguard itself, especially at a time when schools, colleges and travel is resuming in full force?
To this end, the government has currently notified that safety measures should and will continue to remain. Even with restrictions easing in many ways, the one thing that has not and will not change is the COVID-19 safety mandate — of wearing a mask, social distancing, testing before and after travel and so on.
For schools, the safety measures would include: wearing a mask; one student on one bench; temperature checks; repeated sanitising; less chances of peer-to-peer interaction; no sharing of lunch or eating together; Limited school hours and no roaming around after school hours
If you decide to take to the skies for business or leisure, keep in mind that staying safe on a plane requires far more than just wearing a mask. Before you even get to the plane, you have to contend with check-in terminals and security lines. This means coming in contact with frequently touched surfaces and being around a lot of people. While your concern might be centered on staying safe on the plane, you should also focus on protecting yourself before boarding. Wear your mask at all times, keep your hands clean and avoid touching your face with this the risk can be lowered.
The author is the Director of Critical Care, Fortis Hospitals Mumbai & Member of the Supreme Court-appointed National COVID19 Task Force.
HIGHER COFFEE INTAKE PREVENTS DEVELOPMENT OF ALZHEIMER’S
If you are one of those people who can’t start their day without a cup of hot coffee, we have some good news for you. New research has found that drinking higher amounts of coffee can make you less likely to develop Alzheimer’s disease.
The findings of this research were published in the ‘Frontiers in Aging Neuroscience Journal’. As part of the Australian Imaging, Biomarkers and Lifestyle Study of Ageing, researchers from Edith Cowan University (ECU) investigated whether coffee intake affected the rate of cognitive decline of more than 200 Australians over a decade.
Lead investigator Dr Samantha Gardener said that the results showed an association between coffee and several important markers related to Alzheimer’s disease.
“We found participants with no memory impairments and with higher coffee consumption at the start of the study had a lower risk of transitioning to mild cognitive impairment – which often precedes Alzheimer’s disease – or developing Alzheimer’s disease over the course of the study,” she said.
Drinking more coffee gave positive results in relation to certain domains of cognitive function, specifically executive function which includes planning, self-control, and attention.
Higher coffee intake also seemed to be linked to slowing the accumulation of the amyloid protein in the brain, a key factor in the development of Alzheimer’s disease.
Dr Gardener said that although further research was needed, the study was encouraging as it indicated drinking coffee could be an easy way to help delay the onset of Alzheimer’s disease.
“It’s a simple thing that people can change,” she said.
It could be particularly useful for people who are at risk of cognitive decline but haven’t developed any symptoms.
“We might be able to develop some clear guidelines people can follow in middle age and hopefully it could then have a lasting effect,” she said.
If you only have allowed yourself one cup of coffee a day, the study indicated you might be better off treating yourself to an extra cup, although a maximum number of cups per day that provided a beneficial effect was not able to be established from the current study.
“If the average cup of coffee made at home is 240g, increasing to two cups a day could potentially lower cognitive decline by eight per cent after 18 months,” Dr Gardener said.“It could also see a five per cent decrease in amyloid accumulation in the brain over the same time period,” she added.
In Alzheimer’s disease, the amyloid clump together forming plaques that are toxic to the brain.
The study was unable to differentiate between caffeinated and decaffeinated coffee, nor the benefits or consequences of how it was prepared (brewing method, the presence of milk and/or sugar etc).
Dr Gardener said that the relationship between coffee and brain function was worth pursuing.“We need to evaluate whether coffee intake could one day be recommended as a lifestyle factor aimed at delaying the onset of Alzheimer’s disease,” she said.
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