How do i lose weight?

Weight loss and Nutrition

                                          Weight loss

• Weight loss, in the context of medicine, health, or physical fitness, is a reduction of the total body mass, due to a mean loss of fluid, body fat or adipose tissue and/or lean mass, namely bone mineral deposits, muscle, tendon, and other connective tissue.
• Most instances of weight loss arise due to the loss of body fat, but in cases of extreme or severe weight loss, protein and other substances in the body can also be depleted.
• Your body weight is determined by your calorie intake, overall health, age, nutrient absorption and other factors.
• A reduction in body weight. The loss may be the result of a change in diet or life-style or a febrile disease.
• The key to achieving and maintaining a healthy weight isn't about short-term dietary changes. It's about a lifestyle that includes healthy eating, regular physical activity, and balancing the number of calories you consume with the number of calories your body uses.

How to control cholesterol?

                                                       Control Cholesterol

Exercise  :-

• Exercise is an important tool in lowering cholesterol and promoting overall health.
• Most types of exercise routines, ranging from walking to running to yoga, appear to have the same impact when it comes to lowering LDL (“bad” cholesterol) and raising HDL (”good” cholesterol).
• Regular exercise, especially aerobic exercise, has many benefits, including lowering cholesterol. 
• Strengthen your heart and cardiovascular system
• Increase your HDL or "good" cholesterol
• Make you feel more relaxed and rested
• Make you look fit and feel healthy 

Lose weight if you are overweight

Choose healthier fats

Drink at most one or two alcoholic beverages per day

•     Moderate alcohol consumption has been linked to lower rates of heart disease.
•                       A drink or two may improve your HDL. Women and people over 65 years should have just 1 drink per day, men 2 drinks per day.
• Drinking red wine, in particular, may help boost your HDL levels

Quit smoking to boost HDL

Dietary sources

                                                                 Dietary Sources

• Dietary cholesterol is a fat-like substance. 
• Cholesterol is found in animal foods. Animal foods include meats, poultry, fish, eggs, and milk products.
• Cholesterol is a part of your body cells. It helps your body to make certain hormones that you need.
• Eating too much cholesterol can increase the cholesterol in your blood. 
• Too much cholesterol in your blood can increase your risk for heart disease. 
• Eating high amounts of saturated fats and trans fats may also have this effect.

                                      

• If you do not have heart disease, eat less than 300 milligrams (mg) of dietary cholesterol per day.
• If you have heart disease or are at risk for heart disease aim for less than 200 mg of dietary cholesterol per day.
• Egg yolks are the highest source of dietary cholesterol.
• Choose foods with healthy fats, limit foods high in saturated fat, and avoid foods with trans fat.
• “Good” fats—monounsaturated and polyunsaturated fats—lower disease risk. Foods high in good fats include vegetable oils (such as olive, canola, sunflower, soy, and corn), nuts, seeds, and fish.
• “Bad” fats—saturated and, especially, trans fats—increase disease risk. Foods high in bad fats include red meat, butter, cheese, and ice cream, as well as processed foods made with trans fat from partially hydrogenated oil.

TOP FOOD SOURCES OF CHOLESTEROL

Ranking	Food item	%	Cumulative %
1	Eggs and egg mixed dishes	24.6	24.6
2	Chicken and chicken mixed dishes	12.5	37.1
3	Beef and beef mixed dishes	6.4	43.6
4	Burgers	4.6	48.2
5	Regular cheese	4.2	52.4
6	Sausage, franks, bacon, and ribs	3.9	56.3
7	Other fish and fish mixed dishes	3.4	59.7
8	Grain-based desserts	3.3	63.0
9	Dairy desserts	3.2	66.3
10	Pasta and pasta dishes	3.1	69.3
11	Pizza	2.9	72.2
12	Mexican mixed dishes	2.9	75.1
13	Cold cuts	2.7	77.8
14	Reduced fat milk	2.5	80.3
15	Pork and pork mixed dishes	2.3	82.6
16	Shrimp and shrimp mixed dishes	2.0	84.6

Function

                                                                           Function

• Cholesterol is an important component of the membranes of cells
• The presence of cholesterol has a direct effect on the fluidity of the membrane. Further recent research shows that cholesterol has an important role for the brain synapses as well as in the immune system 
• Cholesterol plays a part in producing hormones such as estrogen, testosterone, progesterone, aldosterone and cortisone.
• Vitamin D is produced when the sun’s ultraviolet rays reach the human skin surface.
• Cholesterol produces bile acids which aid in digestion and vitamin absorption.
• Cholesterol plays a very important part in both the creation and maintenance of human cell membrane.
• Cholesterol plays a part in the production of hormones such as testosterone, estrogen, progesterone, aldosterone and cortisone.
• The body also uses cholesterol to make cell linings or membranes. Similar to fat, cholesterol with its many functions is an essential element for healthy human beings.
• cholesterol  is also important for the metabolism of fat-soluble vitamins, including vitamins A, D, E and K.

Properties

                                                                          Properties

• Cholesterol is minimally soluble in water
  
  
  

  Physical and Chemical Properties

  chemical propertie

  

  
  

  
  

  
  

  
  

  Physical propertie

  
  

  
  

  
  

  
  

  
  

  
  

  
  

  
  

  
  

  
  

  
  

  
  

  Appearance:

  White crystals.

  
  

  Odor:

  Nearly odorless.

  
  

  Solubility:

  Practically insoluble in water.

  
  

  Density:

  1.03

  
  

  % Volatiles by volume @ 21C (70F):

  0

  
  

  Boiling Point:

  360C (680F)

  
  

  Melting Point:

  148.5C (298F)

  
  

  General Properties

           Because cholesterol is incapable of dissolving in blood, lipoproteins function as carriers to move it in and out of cells. Cholesterol includes low-density and high-density lipoproteins, triglycerides and Lp(a) cholesterol.

Risk factros of Cholesterol

Risk factors

Everybody has some risk of developing atheroma which then may cause one or more cardiovascular diseases. However, some situations increase the risk. These include:

• Lifestyle risk factors that can be prevented or changed:
• Smoking.
• Lack of physical activity (a sedentary lifestyle).
• Obesity.
• An unhealthy diet - including eating too much salt.
• Excess alcohol.
• Treatable or partly treatable risk factors:
• High blood pressure (hypertension).•High cholesterol blood level.
• High triglyceride (another type of fat) blood level.
• Diabetes.
• Kidney diseases that affect kidney function.
• Fixed risk factors - ones that you cannot alter:
• A strong family history. This means if you have a father or brother who developed heart disease     or a stroke before they were 55, or in a mother or sister before they were 65.
• Being male.
• An early menopause in women.
• Age. 
• Ethnic group. 

Level of Cholesterol

The levels of total cholesterol fall into the following categories:

• Ideal level: cholesterol level in the blood less than 5mmol/l
• Too high cholesterol level: between 5 and 6.4mmol/
• Very high cholesterol level: between 6.5 and 7.8mmol/l
• Extremely high cholesterol level: above 7.8mmol/l 

	At risk	Desirable
Men	Less than 40 mg/dL (1.0 mmol/L)	60 mg/dL (1.6 mmol/L) or above
Women	Less than 50 mg/dL (1.3 mmol/L)	60 mg/dL (1.6 mmol/L) or above

Types of Cholesterol

Two Types of Cholesterol

     There are two main types of cholesterol:

• HDL and LDL. Most cholesterol is LDL (low-density lipoprotein) cholesterol. 
• LDL cholesterol is more likely to clog blood vessels because it carries the cholesterol away from the liver into the bloodstream, where it can stick to the blood vessels.
• HDL (high-density lipoprotein) cholesterol, on the other hand, carries the cholesterol back to the liver where it is broken down.
• LDL cholesterol can build up on the inside of artery walls, contributing to artery blockages that can lead to heart attacks.
• Higher LDL cholesterol levels mean higher risk. High-density lipoprotein (HDL) cholesterol is known as "good" cholesterol because it helps prevent arteries from becoming clogged. 
• Higher HDL cholesterol levels generally mean lower risk.


A blood test to check cholesterol levels — called a lipid panel or lipid profile — typically reports:
Total cholesterol
HDL cholesterol


LDL cholesterol


Triglycerides, a type of fat often increased by sweets and alcohol

Cholesterol is carried in the blood as part of particles called lipoproteins. There are different types of lipoproteins, but the most relevant to cholesterol are:

Low-density lipoproteins carrying cholesterol - 

• This is often referred to as bad cholesterol. 
• This is the one mainly involved in forming atheroma. 
• Atheroma is the main underlying cause of various cardiovascular diseases.
• The majority of cholesterol in the blood is LDL cholesterol, but how much varies from person to person. 
• In most people, 60 to 70 percent of cholesterol is carried in LDL particles. 
• LDL particles act as ferries, taking cholesterol to the parts of the body that need it at any given time. 
• Unfortunately, if you have too much LDL in the bloodstream, it deposits the cholesterol into the arteries, which can cause blockages and lead to heart attacks. 
• That's why people refer to LDL as the "bad" cholesterol.

High-density lipoproteins carrying cholesterol - 

• HDL is basically the opposite of LDL. Instead of having a lot of fat, HDL has a lot of protein. Instead of ferrying cholesterol around the body, HDL acts as a vacuum cleaner sucking up as much excess cholesterol.
• It picks up extra cholesterol from the cells and tissues and takes it back to the liver, which takes the cholesterol out of the particle and either uses it to make bile or recycles it. 
• This action is thought to explain why high levels of HDL are associated with low risk for heart disease. 
• HDL also contains antioxidant molecules that may prevent LDL from being changed into a lipoprotein that is even more likely to cause heart disease. 
• Lifestyle changes affect HDL levels—exercise can increase them, while obesity and smoking lower them. As for diet, in general, the high-fat diets that raise LDL also raise HDL, while low-fat diets lower both.
• This is often referred to as good cholesterol. This may prevent atheroma forming.

Cholesterol

 

Cholesterol

Basic meaning :- Cholesterol  is a type of fat found in your blood.


Chemical name   10,13-dimethyl-17-
                                  (6-methylheptan-2-yl)-
                                  2,3,4,7,8,9,11,12,14,15,16,17-
                                  dodecahydro-1H-
                                  cyclopenta[a]phenanthren-3-ol

Chemical formula   C27H46O

Molecular mass   386.65 g/mol

Melting point           146-147 °C

• The most common type of steroid in the body. 
• Cholesterol has a reputation for being associated with an increased risk for heart and blood vessel disease

History of the name

The name originates from the Greek chole- (bile) and stereos (solid), as researchers first identified cholesterol in solid form in gallstones.

What is cholesterol?

• Cholesterol is one of the body's fats (lipids). Cholesterol and another lipid, triglyceride, are important building blocks in the structure of cells and are also used in making hormones and producing energy.
• To some extent, the cholesterol level in blood depends on what you eat, but it is mainly dependent on how the body makes cholesterol in the liver
• Cholesterol can't dissolve in the blood. 
• It has to be transported to and from the cells by carriers called lipoproteins. 
• Low-density lipoprotein, or LDL, is known as "bad" cholesterol. High-density lipoprotein, or HDL, is known as "good" cholesterol. 
• These two types of lipids, along with triglycerides and Lp(a) cholesterol, make up your total cholesterol count, which can be determined through a blood test.
• Cholesterol is a waxy substance that's found in all of your cells and has several useful functions, including helping to build your body's cells. 
• It's carried through your bloodstream attached to proteins. These proteins are called lipoproteins.

Smoking and Alcohol in Diabetes

Diabetes and Alcohol

• If you have diabetes, drinking alcohol will cause your blood sugar to rise.
• Alcohol may cause you to put on weight and can affect your overall control. Heavy drinkers are often overweight and have high blood sugars.

Effects of Alcohol on Diabetes

Here are some other ways that alcohol can affect diabetes:

• While moderate amounts of alcohol can cause blood sugar to rise, excess alcohol can actually decrease your blood sugar level -- sometimes causing it to drop into dangerous levels.
• Beer and sweet wine contain carbohydrates and may raise blood sugar.
• Alcohol can interfere with the positive effects of oral diabetes medicines or insulin

People with diabetes who drink should follow these alcohol consumption guidelines:

• Do not drink more than two drinks of alcohol in a one-day period if you are a man, or one drink if you are a woman. (Example: one alcoholic drink = 5-ounce glass of wine, 1 1/2-ounce "shot" of liquor or 12-ounce beer).
• Drink alcohol only with food.
• Drink slowly.
• Avoid "sugary" mixed drinks, sweet wines, or cordials.
• Mix liquor with water, club soda, or diet soft drinks.

Diabetes and Smoking

• Smoking can seriously shorten your life, if you have diabetes and you smoke, your risk for vascular problems, kidney disease, retinopathy and other complications of diabetes increases dramatically.
• Smoking can cause a number of diabetes complications
• Smoking is now proven to be an independent risk factor for diabetes, and amongst diabetics it increases the risk of complications.
• Diabetes complications already include heart disease, stroke and circulation problems. Smoking adds to the risk of developing all of these things.
• Smokers  have a harder time controlling their blood glucose levels, because insulin resistance is increased by smoking. 

Diabetes in Children and Teens

Type 1 Diabetes

Many people have this type of diabetes, which usually develops in children and young adults when their immune systems attack cells in the pancreas that produce insulin, a hormone that helps cells absorb glucose from the bloodstream.

• The common type of diabetes in children and teens was type 1.
• But now younger people are also getting type 2 diabetes.
• Type 2 diabetes used to be called adult-onset diabetes. But now it is becoming more common in children and teens, due to more obesity. With Type 2 diabetes, the body does not make or use insulin well.
• Children have a higher risk of type 2 diabetes if they are obese, have a family history of diabetes, or are not active, and do not eat well.

To lower the risk of type 2 diabetes in children

• Have them maintain a healthy weight
• Be sure they are physically active
• Have them eat smaller portions of healthy foods
• Limit time with the TV, computer, and video
• Children and teens with type 1 diabetes may need to take insulin. Type 2 diabetes may be controlled with diet an Before Type 2 Diabetes Starts

Symptoms of Type 2 Diabetes in Children

• High blood glucose levels
• Unexplained weight loss
• Increased hunger or thirst, even after eating
• Dry mouth
• Frequent urination
• Fatigue
• Blurred vision
• Heavy breathing
• Slow healing of sores or cuts
• Itchy skin
• Numbness or tingling in the hands or feet
• Low HDL (“good”) cholesterol levels

If Your Child Gets Diabetes

Type 2 diabetes treatment has three goals:

• Get blood glucose levels as close to normal as you can.
• Get A1C levels as close to normal as you can. A1C reflects long-term blood glucose control.
• Prevent damage to the eyes, kidney, nerves, and heart.

Close relatives with type 2 diabetes

• High cholesterol levels
• Dark patches of skin, often on the back of the neck
• Overweight
• High blood pressure
• High triglyceride (a kind of fat) levels

Physical activity and Diabetes

Physical activity and diabetes :-

• In the absence of co-existing condition which may  require limitation of physical activity, exercise play an important role in facilitating a good control of diabetes.
• Physical inactivity and obesity are strongly associated with the development of type 2 diabetes.
• Efficiency of pumping action of heart improves and blood vessels open up to accommodate increased amount of blood being pumped by heart. Walking, bicycling, swimming, and jumping rope are good examples of such an exercise.
• The short term effects of exercise include lowering of blood glucose.
• An imbalance between caloric intake and physical activity can lead to obesity, which causes insulin resistance and is common in people with type 2 diabetes.
• Exercise benefits diabetes by enhancing the action of insulin through an increased number of insulin receptor sites particularly in type 2 diabetes.
• Central obesity, in which a person has excess abdominal fat, is a major risk factor not only for insulin 7resistance and type 2 diabetes but also for heart and blood vessel disease.

Treatment for Diabetes

Treatment of Diabetes:-

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• Early on in type 2 diabetes, you may be able to reverse the disease with lifestyle changes. Also, some cases of type 2 diabetes can be cured with weight-loss surgery.
• There is no cure for type 1 diabetes.
• Treating both type 1 diabetes and type 2 diabetes involves medicines, diet, and exercise to control blood sugar levels and prevent symptoms and problems.

Getting better control over your blood sugar, cholesterol, and blood pressure levels helps reduce the risk of kidney disease, eye disease, nervous system disease, heart attack, and stroke.  

Complications :-

Acute complications :-

1.       Hypoglycaemia or Insulin Shock

2.       Ketoacidosis

 Long term complications ;-

1.       Infections

2.       Diabetes and heart disease

Diagnosis:-

Several tests are used in the diagnosis  of diabetes :-

1.       Glycosuria :- it is necessary to observe the following procedure to detect  early diabetes :

Urine is voided just before the meal.

Breakfast or lunch is taken with usual helpings of carbohydrate rich foods such as bread, chapathis, rice, fruits.

Two or three hours after the meal  urine is voided and examined for sugar.

2.       Ketonuria

3.       Random blood sugar :- a random blood glucose exceeding 200 mg/dl is almost certain to indicate diabetes.

4.      Glucose tolerance test  :- glucose tolerance test is a confirmatory test.

      WHO recommends for the test that  75g to be used as the glucose load for adults and 1.75 g/kg body weight for children with maximum of 75g.

herbal remedies for diabetes

Fenugreek or MethiFenugreek or Methi

• Used in paranthas and various Indian curries, Methi has many health benefits. 
• It has been used as a galactogogue – a substance used to increase the secretion of milk in breast-feeding mothers.

Tips :-

• Soak the methi seeds in water overnight and drink this water and chew on the seeds first thing in the morning.
• Place methi seeds in a skillet and dry roast using medium heat for about two minutes, with constant stirring. 
• Allow the seeds to cool and then powder; add one teaspoon of this powder to hot or cold water and take once or twice in a day.
• Boil one cup of water and add 2 tablespoons of methi seeds, steep for about 10 minutes and then strain and consume the liquid. 
• Do this twice every day to see a reduction of blood glucose levels.

Bitter Gourd or Karela

• Most people are familiar with bitter gourd – an unpalatable yet healthy vegetable that is typically cooked in tangy gravy to offset the bitterness.

Tips:-

• Select a green bitter gourd, slice it lengthwise, and scrape away the flesh to remove the seeds. 
• Then add the vegetable to a blender and run it to obtain a juice.  
• Drink one small glass of this juice first thing every morning.
• Take some pieces of dried bitter gourd, boil in one cup of water and consume this tea once or twice in a day. 
• This tea is not as bitter as the fresh juice and easier to consume.
• Cut a few slices of bitter gourd and add to stir-fry dishes, especially in combination with vegetables that have a sweetish taste of their own – this will help mask their bitter taste.

Plant-based therapies that have been shown in some studies to have anti-diabetic properties include: 

• Aloe vera
• Bilberry extract
• Bitter melon
• Cinnamon
• Fenugreek
• Ginger

Exams and Tests

• A urine analysis may show high blood sugar. However, a urine test alone does not diagnose diabetes.

Your health care provider may suspect that you have diabetes if your blood sugar level is higher than 200 mg/dL. To confirm the diagnosis, one or more of the following tests must be done.

• Blood tests:

Fasting blood glucose level :- diabetes is diagnosed if it is higher than 126 mg/dL twice. Levels between 100 and 126 mg/dL are called impaired fasting glucose or pre-diabetes. These levels are risk factors for type 2 diabetes.

Hemoglobin A1c test :-

•                         Normal: Less than 5.7%
•                         Pre-diabetes: 5.7% - 6.4%
•                         Diabetes: 6.5% or higher

Oral glucose tolerance test :-

•             Diabetes is diagnosed if glucose level is higher than 200 mg/dL after 2 hours of drinking a glucose drink. (This test is used more often for type 2 diabetes.)

Screening for type 2 diabetes in people who have no symptoms is recommended   for:

•           Overweight children who have other risk factors for diabetes, starting at age 10 and repeated every 2 years
•            Overweight adults (BMI greater than 25) who have other risk factor Adults over age 45, repeated every 3 years.

           

Clinical criteria :-

•           Relief from symptoms
•           Reduction in obesity and maintenance of normal body weight depending upon height and built.
•           Prevention  or retardation of both acute and chronic complications of diabetes.
•           Presence of adequate energy and endurance for work performance.
•           In childhood diabetes, normal or near normal growth and development including physical, mental, emotional, and sexual development.
•           In pregnancy with diabetes, delivery of a normal baby without any medical complications in the mother.