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Iqra Mazhar

A keto diet plan is a good choice for diabetics as it improves blood sugar levels. Keto may also be helpful in the case of gestational diabetes.

Is Keto Diet Safe For People With Diabetes?

The keto diet can be beneficial for some individuals with type 2 diabetes. By restricting carbohydrates and promoting the consumption of healthy fats, it may help lower blood sugar levels and improve insulin sensitivity. However, it is essential to consult with a healthcare professional before starting any new diet to ensure it aligns with individual needs and to receive proper guidance on managing diabetes effectively.

This article or video has been recorded by a subject / domain specialists with a proven track record of excellence in their area. 

Madeeha Syed

This article or video has been vetted and verified by Meri Sehat’s specialists. It contains citations and research from validated sources.

What Is Cupping And Do You Need It?

Overview

Have you noticed those small, circular marks that celebrities flaunt these days? In malls, on red carpets, they&rsquo;re everywhere. What is it? Is it a cause for concern?&nbsp;

Well, they are a result of cupping therapy.&nbsp;

Cupping is a form of complementary therapy. It is believed that the suction it creates would enhance your body&#39;s energy flow and promote healing. 
&nbsp;

Cupping Treatment

Historical text referring to cupping therapy dates back to 1550 B.C. It has been a part of many ancient healing systems &ndash; Chinese, Tibetan, Korean, and Unani. Even the &ldquo;father of medicine&rdquo;, Hippocrates, wrote and compiled extensively on cupping procedures.&nbsp;

Nowadays, traditional Chinese medicine practitioners are known for using cupping therapy as a form of treatment. 
&nbsp;

The Chinese word for life force is Qi. Proponents of cupping believe the therapy is helpful in regulating the flow of Qi in the body. A lot of people also believe it balances out the negative and positive energy flow within the body. This balance is necessary to fight pathogens (illness causing microorganisms), increase blood flow, and <a href="https://merisehat.pk/article/natural-remedies-for-pain">reduce the level of pain</a>. 
&nbsp;

The process of cupping improves blood flow to the area where the cups are applied. This eases muscular tension, which, in turn, promotes cell repair and enhances general blood flow.&nbsp;

Additionally, cupping might support the development of new blood vessels and connective tissues.

Cups are frequently placed on the back, chest, abdomen, or legs. The most common site is back, though. For facial cupping, as the name suggests, the cups are placed on the face. 
&nbsp;

People use cupping as a supplementary type of treatment for a variety of symptoms and ailments:

<ul>
	<li>Neck and back pain</li>
	<li>Lowering cholesterol levels</li>
	<li>Knee and joint pains</li>
	<li>Improving immune system performance</li>
	<li>Chronic headaches 
	&nbsp;</li>
</ul>

The question here is how exactly cupping helps in treating these conditions? It is still unclear how sucking and drawing of blood under the skin could be this beneficial.&nbsp;

One study describes cupping as a complementary treatment and draws attention to how it deals with any disease-causing factors by simply restoring the body&rsquo;s energy flow and eventually improving blood circulation.

Actually, the cup is first heated with the herbs, alcohol, and paper placed within it. The heated cup is then placed on the skin upside down. The air inside the heated cup cools down. This creates a vacuum that pulls the skin and muscles up into the cup. As a result, changes in blood pressure causes the skin to turn red. 
&nbsp;

Unfortunately, despite the fact so much research has been carried out on cupping, no one seems to have come up with solid evidence to prove whether it actually works.&nbsp;

Back in 2015, an evaluation of the evidence discovered that cupping might help relieve chronic neck or back discomfort to some extent. Unfortunately, the quality of the research was insufficient to make definite conclusions.&nbsp;

In 2017, according to a study, cupping could increase the blood flow and stretch the underlying tissue.

Despite many competing theories, however, the effectiveness of cupping remains dubious. 
&nbsp;

Bottom Line

Cupping might be a useful supplemental treatment for a number of symptoms and illnesses, according to a growing body of research. However, more credible research is required to confirm the benefits of cupping.

Namwer Rao

Beat The Heat: What Happens When Heat, Sweat And Skin Collide

The summer months can be a fun time for outdoor activities and spending time with friends. But if you&rsquo;re prone to chafing or rashes, they may not be so enjoyable.&nbsp; 
&nbsp;

effect of heat on skin

Chafing and rashes are a common problem, especially during the summer months. The main cause of these annoying conditions is sweat. When your skin gets wet and rubs against itself or another surface, it can become inflamed and tender to the touch.

When you put on clothes that are too tight or made with synthetic materials like lycra, they can act like a glue trap for sweat, which contributes to chafing and rashes by trapping moisture between your skin and clothing. Sweat can also irritate sensitive skin as it evaporates off of your body &mdash; this is why you should always wear breathable fabrics such as cotton when exercising outdoors or in an air-conditioned room on hot days. 
&nbsp;

Sweat is the main cause of chafing, but it&rsquo;s not the only one. Friction is also a major factor in causing irritation and soreness that can make you unable to enjoy your day-to-day activities. 
&nbsp;

There&rsquo;s a rash for every occasion:

<ul>
	<li>Boob Rash: It&rsquo;s the bane of many a lady&rsquo;s existence, especially during sweaty summers and strenuous workouts. The friction of your bra rubbing against your skin causes irritation, which leads to red bumps and rashes.</li>
	<li>Thigh Chafing: Similar to boob rash but on your legs instead of chest, thigh chafing is caused by the constant rubbing of clothing against bare skin as you walk or run around all day long &mdash; especially if you&rsquo;re wearing shorts or skirts!</li>
	<li>Nipple Chafing: This is one particular type of nipple rash that can happen during pregnancy or breastfeeding when there&rsquo;s excess fluid flowing through those delicate glands in addition to sweat from exercise! 
	&nbsp;</li>
</ul>

Sweat itself doesn&rsquo;t cause chafing, but it can make things worse. If your skin is already sensitive to friction or susceptible to rashes and blisters, then sweat will make it even more sensitive.

&nbsp;

When you&rsquo;re trying to keep cool in the summer heat, it&rsquo;s easy to over-hydrate and end up with a gush of liquid dripping down your back as you walk around. When that happens, you might start thinking that all this sweat must be causing me some discomfort &mdash; but in reality, we just need a little bit more salt!

&nbsp;

These rashes could cause serious health problems if left untreated

Cuts and scrapes can lead to infections. Chafing can lead to blisters, and, in turn, those blisters can become infected.

Infections in the skin can cause damage that leaves you vulnerable to infection by other germs and even viruses like <a href="https://merisehat.pk/disease/hepatitis-b-113">Hepatitis B</a> and C or <a href="https://merisehat.pk/disease/hiv-61">HIV</a>, which can be fatal if left untreated.

To avoid these rashes in the first place, you need to keep the skin dry, reduce friction and stop rubbing your skin raw.

A rash is an uncomfortable, and sometimes painful, skin condition that can occur due to a variety of reasons. The most common cause of rashes is sweat and friction. To avoid these rashes in the first place, you need to keep the skin dry, reduce friction and stop rubbing your skin raw. 
&nbsp;

Avoiding Sweat And Friction: Using a lubricant between two surfaces that rub together without causing much wear (skin against fabric) will help prevent chafing and blisters caused by sweating under heavy loads or tight-fitting clothing like cycling jerseys or hiking shorts. Silicone-based lubricants work well because they stay slick longer than water-based lubricants; however, they&rsquo;re not as safe for use around water because silicone doesn&rsquo;t absorb into fabrics so it can be slippery when wet!

Keeping Skin Dry: You should apply sunscreen before you go outside since sun exposure makes you more susceptible to getting burned &mdash; especially if there isn&rsquo;t any breeze to cool down your body temperature during long runs outdoors (or even short ones). 
A good rule of thumb is that if it&rsquo;s hot outside but feels less humid than usual then put on sunscreen anyway just in case because humid conditions make it harder for sweat from evaporating off our bodies which means we need more frequent hydration breaks during long workouts outside in summer heat waves! 
Don&rsquo;t forget about protecting yourself against UV rays too because even though clouds may block direct sunlight from reaching us directly down here on earth&rsquo;s surface &mdash; they don&rsquo;t block UV rays which come through holes in them called &ldquo;glare points.&rdquo; These glares points are responsible for generating many different kinds of reflections including glare reflection off surfaces such as pavements when walking along city streets. 
&nbsp;

The first rule of treating any skin condition is not to try to rub it off. The rubbing can make it worse, and you may introduce bacteria into the area, which could cause inflammation and infection. The best thing to do is keep the area dry by using talcum powder or a non-oily moisturizer with a high water-content like Vaseline or Petroleum Jelly. 
&nbsp;

<h4>&quot;Most rashes will clear up within a few days after you adopt prevention techniques that keep your skin dry and limit friction&quot; 
&nbsp;</h4>

If you&rsquo;re at risk of developing a rash, it&rsquo;s best to take the following precautions:

<ul>
	<li>Use a towel to dry off immediately after swimming or sweating.</li>
	<li>Apply a moisturizer with an SPF of at least 30 every morning and reapply in the afternoon if you plan on being outside for longer than an hour.</li>
	<li>If you are wearing clothes that rub against your skin, use an anti-chafing product such as zinc oxide paste until your rash clears up and then switch to a heavier formula like dimethicone which will protect against future rashes. You may also want to try tea tree oil or aloe vera gel if those options appeal more strongly than using medication prescribed by a healthcare professional. 
	&nbsp;</li>
</ul>

The best way to prevent chafing while running is to take steps before your run. You can start with a good exfoliating shower and apply some body lotion or cream to dry areas. Then, wear the right clothes. Make sure they fit you well and aren&rsquo;t too tight or too loose where it counts &mdash; the thighs and crotch area are particularly susceptible to chafing.

Lastly, you should use products like Vaseline on dry spots before you hit the road. These products will help protect against rubbing and chafing during exercise so that when it&rsquo;s time for your next long run, all of those miles won&#39;t be spent dealing with embarrassing rashes instead of crossing finish lines! However, this is not just limited to the girlies who are active. Even when you are going on with your daily life, you can always incorporate these hacks to make summers more comfortable for you. 
&nbsp;

We know that dealing with these rashes can be frustrating. We want you to know that there is hope, though! They are all preventable, and it&rsquo;s not just about following the rules of hygiene either. You need to keep your skin dry and limit friction by wearing loose clothing and changing out of sweaty clothes as soon as possible after an activity ends. If you find yourself with a rash or chafing, don&rsquo;t try rubbing it off&mdash;that will only make things worse! Instead let your body heal naturally by keeping the affected area clean and dry until the symptoms subside on their own.

Umna Salah

What Is The Ketogenic Diet?

We know that there are three macronutrients in our diet that provide all the energy and nutrition we need to sustain our body&rsquo;s normal structures and functions. In a perfect world where everyone opted for a balanced diet, we would consume adequate quantities of these macronutrients. However, in reality a standard diet consists mostly of carbs (50 percent) with some fats (35 percent) and proteins (15 percent) thrown in.&nbsp; 
&nbsp;

Ketogenic diet

Keto is a low-carb, gluten-free and a low-to-moderate protein diet. It is very similar to the Paleo diet and Atkins diet.&nbsp;

In order to understand how a ketogenic diet works, we first need to establish how our body normally produces energy. Glucose is the main source of energy and is obtained mainly from carbs. Normally, a ketogenic diet comprises 75 percent fat, 20 percent of protein and only five percent of carbohydrates. But there are several renditions so you are allowed to switch these percentages around based on your daily needs.&nbsp;

Now where does your body generate the energy it needs if you eliminate carbs to such an extreme extent? It turns out that the body switches to metabolising fat for this purpose and conducts this via a process called &lsquo;Ketosis&rsquo;.&nbsp; 
&nbsp;

Fats are broken down into ketones and these ketones provide all the energy you need. This is where the name &lsquo;ketogenic&rsquo; is derived from &mdash; Keto for &lsquo;ketones&rsquo; and genic for &lsquo;producing&rsquo;. This primes your body to burn fat as a primary source of energy, which is why it&rsquo;s so well-known and widely used for <a href="https://merisehat.pk/article/five-myths-about-weight-loss">losing weight</a>.&nbsp;&nbsp;

It&rsquo;s important to note that our body is a living organism and there&rsquo;s no switch that can make it perform a different activity within a matter of minutes or even days. It will take your body a few days to adjust to employing fats as your primary energy resource and during that time you will feel all the negative impacts of having low glucose stores, including decreased focus, brain fog, nausea, vomiting, and irritability. This phase is commonly known as the &lsquo;keto flu&rsquo;.&nbsp; 
&nbsp;

Let&rsquo;s see some of the claims the proponents of the ketogenic diet make and how much weight they actually hold:&nbsp;

For Weight Loss: This is the main application of the keto diet and is a huge part of the current trend. Once your body gets used to burning fat for your daily needs it will also go ahead and burn your local fat stores. This helps shave off those few extra inches in a very short amount of time.&nbsp;

Another reason why this works for weight loss is the high fat content of your diet leads to satiety. Basically, this means you don&rsquo;t feel any cravings and also feel fuller for longer periods.&nbsp;

However, it is not good for long-term weight loss, and once you go back to your usual eating habits, you will quickly gain those extra pounds back. Putting your body through this kind of metabolic stress is also not advisable because it&rsquo;s very hard to sustain over a long period of time for many people.&nbsp; 
&nbsp;

For The Brain: Anecdotal evidence shows people feel sharper and more focused. Then again, some of them have also reported experiencing brain fog while observing a ketogenic diet.&nbsp; There is no clinical evidence for either of these claims. 
&nbsp;

This is actually well researched.&nbsp;

<ul>
	<li>Ketogenic diet works well for people who are either prediabetic or have Type 2 diabetes. This makes sense because people whose insulin doesn&rsquo;t work are constantly at risk of having high blood sugar levels. And a lifestyle of eating processed food doesn&rsquo;t help either. These are therefore classified as foods with a high glycaemic index &ndash; which essentially means that they raise your blood sugar very fast.&nbsp;</li>
	<li>People on keto achieve better insulin sensitivity over time. Simply because the diet gives the body less glucose to work with, enabling it to function optimally.&nbsp;</li>
	<li>It&rsquo;s also been found effective for heart disease, Alzheimer&rsquo;s, Parkinson&rsquo;s, certain sleep disorders, polycystic ovarian syndrome (PCOS), and metabolic syndrome.&nbsp;</li>
	<li>Cutting out carbs also helps control acne breakouts.&nbsp; 
	&nbsp;</li>
</ul>

For Childhood Epilepsy: This is what the ketogenic diet originally gained popularity for back in the 1920s and 1930s. Before new anticonvulsant medications and therapies were developed, children with epilepsy would fast in order to control their seizures. Keto replaced this successfully. One in seven kids benefit from a ketogenic diet.&nbsp;

Evidence-based science has established that children with refractory epileptic seizures experience seizures less frequently if they opt for keto.&nbsp; 
&nbsp;

For Cancers: Ketogenic diet has shown some promise when it comes to treating certain types of cancers, but the research is so far inconclusive.&nbsp; 
&nbsp;

There are some disadvantages to keto, including:

<ul>
	<li>Nutritional deficiencies&nbsp;</li>
	<li>Formation of kidney stones</li>
	<li>Frequent urination</li>
	<li>Increased thirst</li>
	<li>High levels of LDL (bad cholesterol)</li>
	<li>Increased incidence of certain cancers</li>
	<li>Constipation</li>
	<li>Indigestion</li>
	<li>Inconvenient and unsustainable over a long period of time</li>
	<li>Low blood sugar (hence the mental fog during the initial days)</li>
	<li>Tougher workouts (since you don&rsquo;t have glucose readily available for energy anymore)&nbsp;</li>
	<li>Keto flu: weakness, irritability, headaches, bad breath, and fatigue</li>
	<li>Dry mouth&nbsp; 
	&nbsp;</li>
</ul>

The ketogenic diet is great for short-term weight loss if you are otherwise healthy. But, it&rsquo;s very tough to successfully carry out since it requires a drastic switch from a normal diet. Lack of conclusive research and knowledge means we don&rsquo;t know everything that might go wrong (or right!) on this diet. Safe to say, anyone planning to go on this diet needs to exercise a certain level of personal discretion.&nbsp;

Dr. Safia Mehmood

Medilink Consultant clinic

ZAKA CLINIC GULBERG LAHORE

Saad Ullah Siddiqui

Please Don't Sugar Coat It, I Am Diabetic!

Introduction

The chronic metabolic disease is characterized by an inability of the pancreatic cells to produce insulin, or the body&#39;s inability to use the produced insulin. This results in elevated blood glucose levels (hyperglycemia) that can cause complications, such as vascular damage, stroke, cardiovascular disease, <a href="https://www.merisehat.pk/disease/chronic-kidney-disease">chronic kidney disease</a>, neuropathy, and hypertension.

&nbsp;

As per the International Diabetes Federation&#39;s (IDF) latest figures, approximately 537 million adults worldwide are suffering from diabetes<a href="#accordion">[1]</a>. This translates to roughly 1 in 10 people. In Pakistan, the figures have risen 70% since 2019, with diabetes accounting for 400,000 deaths in 2021. The increasing disease prevalence is blamed on rising levels of obesity and the lack of physical activity among Pakistanis.&nbsp; 
&nbsp;

Diabetes management strategies which includes self-care practices such as eating healthy, self-monitoring blood glucose, staying compliant with prescribed medications, and exercising regularly can help maintain glucose levels within range. Furthermore, this can prevent the development of complications and improve the overall quality of life. 
&nbsp;

However, in Pakistan, people face several barriers to the implementation of these self-care practices. Poor knowledge about diabetes, its complications, diet planning, and hypoglycemia management contributes to poor diabetes control<a href="#accordion">[2]</a>.&nbsp;

&nbsp;

Understanding diet plans for Type 2 diabetic patients

Glucose is a form of sugar that the cells use for fuel. However, in diabetes the cells are unable to use the glucose, causing it to build up in the blood. The resulting hyperglycemia is damaging to the vessels and organs. Therefore, keeping the blood glucose levels within a normal range is important.&nbsp; 
&nbsp;

Carbohydrates are a main source of glucose and form a major part of the food we eat. Therefore, doctors recommend limiting carbs when making meal plans for diabetics. Moreover, other food groups such as fats, proteins, and fiber are also taken into consideration when creating diet plans for diabetics. 
&nbsp;

According to the American Diabetes Association (ADA)<a href="#accordion">[3]</a>.&nbsp;the following are the goals of nutrition therapy for adults with diabetics: 
&nbsp;

1. To promote and support healthful eating patterns, emphasizing a variety of nutrient-dense foods in appropriate portion sizes to improve overall health and: 
&nbsp;

<ul>
	<li>achieve and maintain body weight goals</li>
	<li>attain individualized glycemic, blood pressure, and lipid goals</li>
	<li>delay or prevent the complications of diabetes 
	&nbsp;</li>
</ul>

2. To address individual nutrition needs based on personal and cultural preferences, health literacy and numeracy, access to healthful foods, willingness, and ability to make behavioural changes, and existing barriers to change 
&nbsp;

3. To maintain the pleasure of eating by providing nonjudgmental messages about food choices, while limiting food choices only when indicated by scientific evidence 
&nbsp;

4. To provide diabetics with the practical tools for developing healthy eating patterns rather than focusing on individual macronutrients, micronutrients, or single foods

&nbsp;

Typically, diabetics should consume 5-6 small meals, spaced evenly throughout the day. The meals should contain: 
&nbsp;

<ul>
	<li>Non-starchy vegetables (broccoli, carrots, cauliflower, mushrooms, and greens such as cabbage, spinach, and rocket)</li>
	<li>High-fiber fruits (apples) and cereals (porridge)</li>
	<li>Whole grains such as brown rice, whole wheat chappati, brown pasta, whole wheat bread, quinoa, and oatmeal</li>
	<li>Lean protein sources such as eggs, fish, skinless chicken, turkey, lentils, and beans</li>
	<li>Dairy products such as low-fat milk, yoghurt, low-fat cheese</li>
	<li>Healthy fats such as olive oil, nuts, avocados 
	&nbsp;</li>
</ul>

While non-starchy vegetables can be eaten in unlimited quantities, lentils, beans, and chickpeas are often advised to be taken in a serving size of 3/4 cup cooked. For grains such as rice, corn, noodles, and porridge, a 1/2 cup is recommended. Whereas, for chapati or brown bread, 1 is the preferred serving size.&nbsp; 
&nbsp;

The following methods are often employed to create meal plans for diabetics: 
&nbsp;

1. Counting Carbs - For type 2 diabetics, limiting carbs ensures that their blood glucose levels remain within range. Moreover, it can help overweight individuals lose weight and contribute to better health outcomes. Whereas in type 1 diabetics, since they are on insulin therapy, the risk of hypoglycemia needs to be avoided. A registered dietician can help teach individuals to measure food portions through food labels and calculate the carbohydrate content. Moreover, people can then learn to calculate the carbs in each meal and snack, and adjust their insulin dose accordingly. 
&nbsp;

2. Glycemic Index (GI) - Glycemic index assigns carbohydrate-containing foods a number depending on how much it increases one&#39;s blood sugar. Diabetics opt for foods or meals with a low GI. 
&nbsp;

The three categories of GI values are:

<ul>
	<li>Low GI: 1 to 55</li>
	<li>Medium GI: 56 to 69</li>
	<li>High GI: 70 and higher 
	&nbsp;</li>
</ul>

Examples of low GI foods include carrots (GI=47), apples (GI=38), and peas (GI=48). White bread (GI=70) and white rice (GI=58) are considered high GI foods. Therefore, they are avoided by diabetics. However, GI values are not indicative of a food&#39;s nutritional value. For example, 1 cup of whole milk has a low GI value, but high-fat content, which isn&#39;t recommended for diabetes. 
&nbsp;

3. Diabetes Plate Method - Calculating carbs for every meal is not always feasible. Therefore, some people follow the plate method to reach their nutrition goals. The plate method ensures that one gets enough protein, vegetables, and fruits, while limiting the carb intake.&nbsp; 
&nbsp;

A 9-inch dinner plate is divided as follows:

<ul>
	<li>Half of the plate is filled with non-starchy vegetables.&nbsp;</li>
	<li>One-quarter of the plate is filled with lean protein such as eggs, tofu, turkey, lentils, or chicken.</li>
	<li>One quarter is filled with high-carb foods such as rice, pasta, potatoes, fruit, and grains.</li>
</ul>

Moreover, with the meal, people can go for water or a low-calorie drink.&nbsp; 
&nbsp;

<h4>"Poor diabetes control can lower your heart rate variability. Head on over to the <a href="https://www.merisehat.pk/page/sehat-scan/" target="_blank">sehat scan </a>and get your reading today!"</h4>

<ul>
	<li>Both type 1 and type 2 diabetics should avoid or limit the following foods:</li>
	<li>packaged and processed foods</li>
	<li>refined grains such as rice, white bread, pasta</li>
	<li>fried foods</li>
	<li>sugary foods such as candies, bakery products, cakes</li>
	<li>alcoholic beverages and sugary drinks such as sodas</li>
	<li>sweetened products</li>
	<li>salty food such as chips, canned soups</li>
</ul>

&nbsp;

Serving size varies for different foods. For example, for diabetics, the recommended serving size for chicken, meat, and fish is 1 ounce. Moreover, 1/2 cup of grains such as rice and corn are recommended. However, when using cups as a measuring size, it is important to stick to a standard measuring cup.&nbsp; 
&nbsp;

Since measuring cups or spoons are not always available, there is an easier guide to estimate the serving size using fingers and hands<a href="#accordion">[4]</a>.&nbsp;

Fist = 1 cup or 1 medium fruit

The palm of hand (no fingers) = 3 ounces of lean protein such as fish, meat, or chicken

Cupped hand = 1-2 ounces of nuts or pretzels

Thumb (tip to base) = 1 ounce of meat or cheese

Thumb tip (tip to 1st joint) = 1 tablespoon (mostly for fats)

Fingertip (tip to 1st joint) = 1 teaspoon

&nbsp;

The following is a sample menu and is meant for general information. It is not a replacement for expert opinion. A dietician or diabetologist should always be consulted for a diet plan to ensure adequate disease management and calorie intake. 
&nbsp;

<h5>Breakfast:</h5>

1/2 cup high fiber cereal/porridge with low-fat milk

or

1 slice of brown bread/chapati with 2 egg white/1 boiled egg

1 cup unsweetened tea or coffee

&nbsp;

<h5>Lunch:&nbsp;</h5>

1 whole wheat chapati/brown bread/1/2 cup rice

vegetables/salad

1-ounce lean meat/lentils

1 medium fruit

1 cup green tea or unsweetened tea/coffee

&nbsp;

<h5>Dinner:&nbsp;</h5>

1 whole wheat chapati/brown bread/1/2 cup rice

vegetables/salad

1-ounce lean meat/lentils

1 medium fruit

1 cup green tea or unsweetened tea/coffee

&nbsp;

<h5>Snack options:&nbsp;</h5>

1-ounce low-fat cheese

4 whole grain crackers

1 medium fruit

1 cup of low-fat milk

4 tbsp peanut butter

1/2 cup corn

&nbsp;

<h5>Fruit Juice Intake: Is it Allowed?</h5>

There has been a lot of debate on whether fruits are better than fruit juices for diabetics. As a rule, fruits are preferred over fruit juice, as it has higher fructose (sugar) and low fiber content. And also, a greater number of calories.&nbsp; 
&nbsp;

As 2014 study assessed the intake of fruit juice and its effect on the risk of type 2 diabetes. Although sugar-sweetened fruit juice increased the risk of type 2 diabetes, 100% fruit juice did not cause the same effects<a href="#accordion">[5]</a>. However, diabetics should practice caution and consult with a nutritionist before adding fruit juices to their diet plans.&nbsp;

&nbsp;

Conclusion

There is no diabetes-specific diet. Instead, several methods can be employed to ensure adequate calorie intake and prevent disease progression. These include counting carbs, focusing on the glycemic index, and the plate method. When creating meal plans, it is important to take into consideration a person&#39;s individual needs and be culturally sensitive to the food practices practised in the area.&nbsp; 
&nbsp;

Lifestyle changes such as dietary habits are a major aspect of improving patients&#39; disease knowledge and disease management. Therefore, it is important to educate patients on food practices that can help them manage their disease better.&nbsp; 
&nbsp;

Key Points

<ul>
	<li>Diabetes is characterized by elevated blood glucose levels that can be damaging to the body&#39;s vessels and organs. The resulting hyperglycemia can cause complications such as stroke, cardiovascular disease, recurrent infections, hypertension, and vision loss.</li>
	<li>A healthy and balanced diet can help maintain blood glucose levels within the normal range and prevent complications of diabetes.</li>
	<li>For diabetics, a healthy meal consists of lean proteins, whole grains, non-starchy vegetables, fruits, and low-fat foods. 5-6 small meals, spaced out over a day, should be consumed daily.&nbsp;</li>
	<li>An experienced dietician and diabetologist should be sought for diabetic meal plans. They may recommend carb counting, glycemic index diet, or the plate method.</li>
</ul>

&nbsp;

[1].International Diabetes Federation, 2021. With 1 in 4 adults living with diabetes, Pakistan has highest diabetes prevalence in the world. s.l.:s.n.

[2].Bukhsh, A. et al., 2020. Type 2 Diabetes Patients' Perspectives, Experiences, and Barriers Toward Diabetes-Related Self-Care: A Qualitative Study From Pakistan. Frontiers in endocrinology, Volume 11.

[3].American Diabetes Association, 2021. Facilitating Behavior Change and Well-being to Improve Health Outcomes: Standards of Medical Care in Diabetes. Diabetes Care, 44(1).

[4].Canadian Diabetes Association, 2014. Handy portion guide.

[5].Xi, B. et al., 2014. Intake of fruit juice and incidence of type 2 diabetes: a systematic review and meta-analysis. PLoS One, 9(3).

Nimrah H. Sattar

How To Heal From Grief?

Grief is a natural reaction to any kind of loss. It&rsquo;s something we all experience, but the way it manifests itself varies from person to person. Some people are able to move on quickly, while others find it harder to heal. In this article I&rsquo;ll explain how the stages of grief work and give some tips on how you can help yourself or a loved one through their grieving process. 
&nbsp;

Tips to Heal From Grief

Denial is a defense mechanism. It&rsquo;s a way to protect yourself from the pain of loss, or at least postpone facing it. You may have heard of denial as something that happens during the grieving process, but this isn&rsquo;t quite accurate. Denial doesn&rsquo;t necessarily kick in once someone has died; it can also be an immediate coping mechanism for people who aren&rsquo;t yet ready to admit their loved one is gone.

Denial helps shield you from the <a href="https://merisehat.pk/article/natural-remedies-for-pain">pain</a> of grief by avoiding reality and hiding from feelings you&rsquo;d rather not experience (such as anger and sadness). 
&nbsp;

Anger is a natural and healthy reaction to loss. Anger can help you express your feelings, release negative emotions and show others that you are upset or hurt by what happened.

However, while it is normal to feel angry after the loss of someone or something close to you, there are some things that should be avoided when expressing anger:

Don&rsquo;t direct your anger at anyone else. You may have some pent-up frustrations with people associated with the loss (e.g., family members or friends), but directing your rage toward them will only make things worse for everyone involved.&nbsp;

Directing your anger inward instead by staying home from work or school can also be harmful because it could prevent you from accomplishing goals (such as getting back into college).&nbsp;

It&rsquo;s best not to let anger boil over into lashing out at others unnecessarily; instead, find other outlets for releasing negative emotion such as yoga classes or therapy sessions with a counsellor who specialises in grief counselling. 
&nbsp;

When you are bargaining, you are essentially trying to make the best of an intolerable situation. You may start thinking that there is something you could have done differently or something that will help save your loved one&rsquo;s life. You might even try to bargain with God or a higher power in order to get them back again.

For example, you might think, &ldquo;If only I had spent more time with my husband before he died!&rdquo;, &ldquo;If only I hadn&rsquo;t taken so long buying groceries!&rdquo; or &ldquo;If only I had remembered to call him earlier!&rdquo;&nbsp;

While these thoughts and feelings aren&rsquo;t necessarily accurate (the reality is that death or breakups happens when they happen), they can still be helpful if they allow you some peace of mind and perspective during this difficult time of grieving. 
&nbsp;

Bargaining can also manifest itself as guilt &mdash; for instance, if someone close dies from an illness but another person survives the same illness, there may be some sense that it should&rsquo;ve been the other way around, even though there&rsquo;s no real reason for this feeling beyond just being human (and overthinking things).&nbsp;

If this sounds like how you&rsquo;re feeling right now &mdash; like maybe there was something else r someone else who could&rsquo;ve helped prevent their death (for example) &mdash; it might be helpful for friends and family members who care about your well-being (or just want their own questions answered) not dismiss these thoughts or feelings outright by saying things like, &ldquo;It wasn&rsquo;t your fault&rdquo; or &ldquo;Of course everything would have been different if only...&rdquo;&nbsp;

Instead, they could take those questions seriously while acknowledging how hard they must be on whoever lost their loved ones without belittling them at all &mdash; because sometimes just recognising how painful it must feel helps us move forward without letting ourselves stay stuck in grief forever.&rdquo; 
&nbsp;

The final stage of grief is sadness and acceptance. The loss of someone leaves you feeling helpless. There will be times when you are too distracted by the world and work to think about it but at times, it is common to have a depressive episode and completely lose your pace or focus.&nbsp;

People who are unable to cope and accept tend to go into depression at this stage and numb themselves towards the outside world. The only way to avoid suffering from this illness is to deal with your loss and come to terms with it mentally. This requires your maximum input as your experience life without the person, the need for acceptance and doing things differently now. The only way is the way forward.&nbsp; 
&nbsp;

The stages of grief are not a checklist, nor are they rules to follow. They aren&rsquo;t even in the same order for everyone.

The five stages &mdash; denial, anger, bargaining, sadness and acceptance &mdash; are merely a general guide to help you understand what your loved one might be experiencing during their time of grieving. However, everyone grieves differently and no two people will go through all five stages at the same time or in the same way. It&rsquo;s important to remember that every person needs different kinds of support during times like these: some may need lots of love and affection as they work through their feelings; others will want space from others so they can take care of themselves first before reaching out for support later on. 
&nbsp;

The most important thing that needs to be acknowledged is that there is no shortcut to coping with grief. You cannot skip the stages. However, you can make it easy for yourself to handle your grief and speed up the process. Following are the steps that are age-old practices employed by people to help them cope:

<ul>
	<li>There are people around you who care about you, lean on them. Share your feelings with your friends and family. Hangout with them more to keep yourself distracted.</li>
	<li>Be acceptable for whatever support you are getting. Not many people know what to say or how to act around someone grieving, appreciate their efforts. They are doing it because they care.</li>
	<li>Religion has been a very strong catalyst for people struggling with grief. If you believe in one, resort to your faith. Praying can be very relaxing for the mind.</li>
	<li>A support group or therapy. Both allows you to talk about your experience, how it has affected you without getting a biased answer from the other side.&nbsp; 
	&nbsp;</li>
</ul>

Grief is a normal part of life and it can be hard to deal with. But remember, there are ways to cope with your feelings and move on from them. If you&rsquo;re struggling with grief or have lost someone close to you, remember that you&rsquo;re not alone. Reach out for help if needed, but don&rsquo;t forget that it may take time before things feel better again!

Ismail Munir

How Do I Boost My Iron Levels?

Iron is an essential mineral that your body uses to make hemoglobin. Iron is also an essential mineral for growth and development. There are two types of iron in food: animal-derived and plant-derived. While there is enough iron available in our food sources, it can also be taken as a supplement.

Understanding Ways To Treat Iron Deficiency Anemia

Studies have shown that the average amount of iron is 8.7 milligrams per day for men and 14.8 milligrams per day for women. The requirement for iron in vegetarians and vegans is 1.8 times more than in people who eat meat.&nbsp;

&nbsp;

You need iron to function properly. A lack of iron in your diet will lead to iron deficiency. Iron plays an important role in different bodily functions; it is an essential nutrient needed to form hemoglobin and carry oxygen in your blood to organs and tissues. This is important for optimal heart health, immune function, and respiratory functions.

&nbsp;

<a href="https://www.merisehat.pk/disease/anemia">Anemia</a> occurs when the body does not have enough red blood cells to carry oxygen to the body&rsquo;s organs and tissues. There are different types of anemia, but iron-deficiency anemia is the most common type of anemia in developing countries. According to the World Health Organization, 1.62 billion people are estimated to be affected by anemia worldwide.&nbsp;

&nbsp;

Low levels of iron can further lead to iron deficiency anemia. The symptoms of anemia include:&nbsp;

<ul>
	<li>Fatigue&nbsp;</li>
	<li>Weakness&nbsp;</li>
	<li>Pale and yellow skin&nbsp;</li>
	<li>Shortness of breath&nbsp;</li>
	<li>Lightheadedness&nbsp;</li>
	<li>Chest pain&nbsp;</li>
	<li>Cold hands and feet&nbsp;</li>
	<li>Headaches&nbsp;</li>
</ul>

&nbsp;

There are some types of anemia that are inherited and cannot be prevented, for example, sickle cell anemia, hemolytic anemia, and aplastic anemia.&nbsp;

However, anemia caused because of iron deficiency, vitamin B12, and vitamin B9 deficiency, can be prevented by eating well. This includes eating foods that provide enough iron and vitamins, in addition to vitamin C food sources, because it helps with the absorption of iron. Studies have also shown that drinking enough water helps keep hemoglobin levels up.

Moreover, daily iron supplementation may increase hemoglobin levels, and decrease the risk of anemia in infants, school-aged children, and pregnant and non-pregnant women. Foods fortified with iron and improving overall diet also have benefits in reducing the risk of developing iron-deficiency anemia.

There are some types of anemia that are short-term and mild. However, others can affect you throughout your life. There are several ways to manage anemia, including:

<ul>
	<li><a href="https://www.merisehat.pk/article/anemia-best-meals-for-boosting-iron">A healthy, well-balanced diet</a></li>
	<li>Stay hydrated</li>
	<li>Regular exercise</li>
	<li>Avoid&nbsp;exposure to chemicals that trigger anemia</li>
	<li>Visiting the dentist regularly because anemia increases the risk of tooth decay and gum disease</li>
	<li>Keep track of your symptoms and talk to your doctor about any changing symptoms</li>
</ul>

&nbsp;

If you have anemia, it is important to make good food choices. For example, avoid junk foods because it means adding calories to your diet without getting any essential nutrients. In addition, some foods impair the absorption of iron. Therefore, it is important to make the right food choices.

Here are some foods you should avoid:&nbsp;

<ul>
	<li>Coffee, tea, and other tannin-containing products, such as some spices</li>
	<li>Egg whites</li>
	<li>Fiber, but not all of it because some iron supplements may cause constipation</li>
	<li>Soy protein</li>
	<li>You should not be taking calcium with iron supplements because it impairs its absorption</li>
</ul>

&nbsp;

Here are some foods you should eat:

<ul>
	<li>Whether you eat meat or not, you should generally eat iron-rich foods, such as lentils, spinach, and pistachios.&nbsp;</li>
	<li>You can also get protein from different kinds of meat, like lean beef and turkey. There are some iron-fortified foods also available for vegans and vegetarians.&nbsp;</li>
	<li>It is also important to incorporate citrus fruits, berries, and other vitamin C-containing foods such as peppers and tomatoes in your diet to improve iron consumption.</li>
</ul>

&nbsp;

Consult with a healthcare provider to help with your iron intake, and do what works best for you.&nbsp;

&nbsp;

Staff Writer

The Dos And Don’ts Of Keto

Keto or <a href="https://merisehat.pk/article/what-is-the-ketogenic-diet">ketogenic diet</a> has myriads of benefits. It is notorious as a shortcut to quick weight loss. Almost everyone has tried it at some point and they have also reaped its benefits. On the other hand, some people found that it was not their cup of tea; the experience left a bad taste in their mouth.&nbsp;

Even though it&rsquo;s not a new trend, there is plenty of misinformation around, which makes it harder to assess what you should actually do. The following tips would help you adapt a keto lifestyle while minimising its adverse effects.&nbsp; 
&nbsp;

Dos and Don’ts of Keto

Keto eliminates the need to count calories. As your body adjusts to using fat as the primary fuel, make sure to follow these rules:

<ul>
	<li>Fewer Carbs: You are allowed to consume only 5-10 percent of carbs. This is required for your body to switch to ketosis instead of using glucose as a primary source of energy.&nbsp;</li>
	<li>Just Enough Protein: When you consume an ample amount of protein, it&rsquo;s a signal for your body to convert it into glucose as well. This is exactly what we want to avoid while trying to elicit the keto state. Therefore, limit your protein intake to only 10-20 percent of your entire diet.&nbsp;</li>
	<li>Lots Of Fats: Your diet should primarily consist of fats (70-80 percent) to make the whole thing work.&nbsp;</li>
</ul>

There are free keto calculators available online that can help you measure exactly how much of these nutrients you consume daily.&nbsp; 
&nbsp;

To make it easier for you, you can eat:

<ul>
	<li>Meat: Devour red meat, sausages, chicken, and turkey. In other words, grass-fed meat.</li>
	<li>Seafood: This includes fatty fish like salmon, mackerel, trout, and oysters besides tuna, sardines, shrimps, and crab. See, keto&rsquo;s not about starving yourself.</li>
	<li>Non-Starchy Vegetables: Feed your belly asparagus, tomatoes, basil, spinach, broccoli, bell peppers, onions, celery, zucchini, lettuce, cauliflower, kale, broccoli, cabbage, jalapenos, cucumbers, eggplant, and Brussels sprouts.&nbsp;</li>
	<li>Cheese: Some good ol&rsquo; cheddar, goat cream, feta, parmesan, mozzarella, blue, brie provolone, and string cheese for flavour.</li>
	<li>Herbs: Don&rsquo;t forget to throw in thyme, rosemary, sage, mint, oregano, dill, parsley, cilantro, and basil.</li>
	<li>Seeds: Munch on flaxseed, chia seeds, and pumpkin seeds.</li>
	<li>Eggs, butter, peanut butter, and cream&nbsp;</li>
	<li>Plain Greek Yogurt, full fat yogurt&nbsp;</li>
	<li>Alternate Between Butter, Ghee, And Oil (extra virgin olive oil or avocado oil) for cooking or making creamy sauces.</li>
	<li>Nuts: Most of them are okay to eat. For example, almonds, pine nuts and walnuts. Avoid pistachios since they have a higher carb content.&nbsp;</li>
	<li>Plenty Of Liquid: Water, coffee or tea to go with your meals or otherwise. Use full fat cream or milk in your tea and coffee. Plant based milk such as soy, coconut, and almond milk are also keto-friendly.&nbsp; 
	&nbsp;</li>
</ul>

&nbsp;Consider the following as strictly off limits

<ul>
	<li>Starchy Foods like bread, rice, pasta, and tortillas. Even healthy whole grains are too high in carbs.&nbsp;</li>
	<li>Sugary Foods, like candy, cakes, brownies, cookies, donuts, ice cream, sweetened yogurt, and breakfast cereals. Natural sugars present in fruits are off limit as well, except for some berries (strawberries, blackberries, and raspberries) in small amounts.&nbsp;&nbsp;</li>
	<li>Starchy Vegetables, such as potatoes, sweet potatoes, parsnips, carrots, corn, and beets.&nbsp;</li>
	<li>Fruit Juices, soda, smoothies, ice creams, and sweet alcoholic drinks.&nbsp;</li>
	<li>Peas, kidney beans, lentils, and chickpeas.&nbsp;</li>
	<li>Sauces like BBQ sauce, honey mustard, teriyaki, and ketchup.</li>
	<li>Processed Vegetable Oils and mayonnaise.&nbsp;</li>
	<li>Sugar, sweeteners, and syrups in your beverages, tea, or coffee.&nbsp;</li>
</ul>

Note: Don&rsquo;t go overboard with adding too much fat as that means your body perpetually burns the fat you consume instead of the fat you had stored previously. 
&nbsp;

While observing a keto diet, the best snack is no snack. But it&rsquo;s understandable how those cravings are hard to resist sometimes. Some of the easiest Keto friendly snack options could be:&nbsp;&nbsp;

<ul>
	<li>Hard boiled eggs</li>
	<li>Slice of cheese</li>
	<li>Cold cuts (salami, prosciutto etc.)&nbsp;</li>
	<li>Avocados</li>
	<li>Olives</li>
	<li>A handful of nuts</li>
	<li>Fresh vegetables with creamy dressings such as ranch&nbsp;</li>
	<li>Berries with whipped cream</li>
	<li>Dark chocolate (the higher the cocoa percentage, the less sugar the chocolate contains)</li>
	<li>Keto friendly snack bars from the market&nbsp; 
	&nbsp;</li>
</ul>

Fatigue, brain fog, irritability, nausea, and headaches are just some of the symptoms you might feel while switching to keto. This is dubbed as the &lsquo;keto flu&rsquo;. 
&nbsp;

In order to combat the keto flu, you could:&nbsp;

<ul>
	<li>Increase your water intake and make sure you are adequately hydrated throughout the day. Also, prefer vegetables with a high water content such as cucumbers, celery, tomatoes, zucchini, etc.&nbsp;</li>
	<li>Increase your sodium, potassium and magnesium intake by adding extra salt to meals. And make sure to take mineral supplements. It would help deal with other micronutrient deficiencies you might suffer in a keto diet.&nbsp; 
	&nbsp;</li>
</ul>

<ul>
	<li>Get in the habit of reading food labels. Educate yourself on your nutrient intake and what each food contains and which might sneak into your diet. This will also help you recognise if a meal is keto-friendly or not. For example, when you are eating out and the restaurant doesn&rsquo;t mention it on their menu.&nbsp;</li>
	<li>Minimise the adverse effects of starting a keto diet by starting a low-carb diet at first before going full keto.&nbsp;</li>
	<li>When exercising during your diet, take creatine supplements to boost your performance. Caffeine helps, too. You can also take Whey protein supplements for augmenting your protein intake.&nbsp;</li>
	<li>Avoid keto if you are on any antidiabetic medication as this can cause diabetic ketoacidosis, which is a serious complication.&nbsp;</li>
	<li>Proceed slowly and with caution. Monitor your bad cholesterol levels if you are not over the keto flu within the first week consult your doctor.</li>
	<li>Plan ahead to avoid a high-carb meal. Even one high-carb meal can disrupt the body&rsquo;s metabolism switch towards ketosis.&nbsp;</li>
	<li>The biggest complaint is that it&rsquo;s not sustainable. Who has time to meticulously prepare for meals when you have work and family to look after? If you fall in this category, sign up for meal delivery services to deliver keto friendly meals to your doorstep.&nbsp;&nbsp;</li>
	<li>Use sugar free gum to combat halitosis (bad breath) which you will inevitably suffer from.&nbsp;</li>
</ul>

Armed with all of this information, you should be able to follow a ketogenic diet properly.&nbsp;

Can Gestational Diabetes Be Reversed?

The International Diabetes Federation (IDF) estimates that by 2030 an estimated 783 million adults will be living with <a href="https://www.merisehat.pk/disease/diabetes-type-1-and-2">diabetes</a>&nbsp;<a href="#accordion">[1]</a>.&nbsp;According to the latest figures, the prevalence of diabetes has steadily increased in low- and middle-income countries. With a 70% increase since 2019, Pakistan has the highest diabetes prevalence in the world<a href="#accordion">[1]</a>. Moreover, an estimated 11 million adults have Impaired Glucose Tolerance (IGT); thus, increasing their risk of <a href="https://www.merisehat.pk/disease/diabetes-type-1-and-2">type 2 diabetes</a>&nbsp;<a href="#accordion">[1]</a>. However, researchers have not only reported an increase in cases of type 2 diabetes but also gestational diabetes mellitus (GDM).&nbsp; 
&nbsp;

The true prevalence of gestational diabetes in Pakistan remains unclear due to varying risk factors and diagnostic criteria. A cross-sectional study conducted across hospitals in Karachi and Hyderabad found a prevalence of 11.9%<a href="#accordion">[2]</a>. Another study conducted at The Indus Hospital in Karachi reported a 17.7% prevalence of GDM<a href="#accordion">[3]</a>.&nbsp; 
&nbsp;

Understanding Gestational Diabetes

Gestational diabetes develops due to a combination of beta cell dysfunction and increased insulin resistance during pregnancy. The resulting hyperglycemia is detrimental to both maternal and fetal health. Complications such as neonatal hypoglycemia, stillbirth, macrosomia, shoulder dystocia, breathing difficulty, and maternal preeclampsia can occur.&nbsp; 
&nbsp;

Although maternal blood glucose levels return to normal after birth, approximately half of the women with gestational diabetes go on to develop type 2 diabetes<a href="#accordion">[4]</a>. Moreover, there&#39;s a two in three chance that Gestational Diabetes Mellitus (GDM) can return in future pregnancy<a href="#accordion">[5]</a>. However, proper antenatal and post-natal care can ensure that one&#39;s GDM stays reversed and their glucose levels remain within target.&nbsp;

&nbsp;

Gestational diabetes typically develops during the second trimester and is diagnosed between 24 to 28 weeks of pregnancy. Depending on the diagnostic criteria, doctors may conduct the following tests for diagnosing GDM: 
&nbsp;

<ul>
	<li>Initial Glucose Challenge Test - Patients drink a 50g glucose solution; after one hour, blood glucose levels are checked. Measurements &gt;140mg/dl point to a high risk of gestational diabetes. It is often followed by an oral glucose tolerance test to confirm a diagnosis of gestational diabetes. 
	&nbsp;</li>
	<li>Oral Glucose Tolerance Test (OGTT) - Patients must present in a fasting state for the test. After drinking a 100g glucose solution, samples are drawn every hour for a total of 3 hours. Diagnosis is based on blood glucose levels in fasting state, 1-hour, 2-hour, and 2-hour post glucose solution.&nbsp; 
	&nbsp;</li>
</ul>

The International Association of Diabetes and Pregnancy Study Groups (IADPSG) 2010 criteria recommends a one-step approach<a href="#reference" target="_blank">6</a>. Blood samples are drawn in a fasting state, and then 1- and 2-hours after drinking a 75g glucose solution (OGTT). While most women are screened during the second trimester, those at high risk may undergo screening at their first prenatal visit.&nbsp; 
&nbsp;

Non-modifiable risk factors of GDM include a family history of diabetes, increasing maternal age (&gt;25years), and a history of GDM. Although these cannot be controlled, several modifiable risk factors also exist for gestational diabetes. These include obesity, polycystic ovary syndrome, prediabetes, diet, and physical activity.&nbsp; 
&nbsp;

Antenatal interventions are aimed at making women aware of the risks associated with gestational diabetes and ways to control the modifiable risk factors of the disease. Moreover, they should be made aware of their blood glucose level targets. 
&nbsp;

<h5>Blood Glucose Monitoring</h5>

Using a glucose meter or sensor, pregnant women with GDM should daily test their fasting, pre-meal, 1-hour postprandial, and bedtime glucose levels. According to the American Diabetes Association (ADA), pregnant women with gestational diabetes should maintain their blood glucose levels within the following range<a href="#accordion">[7].</a>

<ul>
	<li>Fasting plasma glucose levels: less than 95mg/dl</li>
	<li>1-hour postprandial glucose levels: less than 140mg/dl</li>
	<li>2-hour postprandial glucose levels: less than 120mg/dl 
	&nbsp;</li>
</ul>

<h5>Dietary Changes</h5>

A certified dietician can help ensure that the mother reaches her caloric requirements and achieves a healthy weight gain during pregnancy. Women are mostly advised to eat 3 small-sized meals and three to four healthy snacks during the day. Moreover, a bedtime snack is recommended to help keep fasting blood glucose levels within range.&nbsp; 
&nbsp;

The recommended nutrition plan for women with GDM should contain a minimum of 175 g of carbohydrate, a minimum of 71 g of protein, and 28 g of fiber. Sugar and saturated fats are mostly limited.&nbsp; 
&nbsp;

<h5>Physical Activity</h5>

Regular exercise can help keep blood glucose levels within normal and combat insulin resistance. Recommended physical activity for pregnant women includes aerobic exercises like walking and swimming. 30 minutes of exercise for 3-5 days a week is often considered adequate. However, one should consult their doctor before starting any form of exercise during pregnancy.

&nbsp;

<h5>Insulin</h5>

If dietary changes and physical activity are unable to maintain blood glucose levels, doctors may prescribe insulin injections to pregnant women. Insulin is the first choice in gestational diabetes due to its safety profile and inability to cross the placenta. Metformin and sulfonylureas are contraindicated due to adverse outcomes in the fetus. However, with daily insulin injections, it is important that women are made aware of the risks of hypoglycemia.&nbsp;

&nbsp;

<h4>"Your Heart Rate Variability can tell you if you are leading a healthy life or not. Head on over to our <a href="https://www.merisehat.pk/page/sehat-scan/" target="_blank">sehat scan</a> and check your heart rate variability today!" </h4>

Since blood glucose levels and insulin resistance decrease drastically after birth, it is important to re-evaluate a woman&#39;s insulin requirement. Most women do not require further treatment with insulin. However, blood glucose levels are checked the day after birth.&nbsp; 
&nbsp;

The American Diabetes Association recommends the following for postpartum care of gestational diabetes<a href="#accordion">[7]</a>.

<ul>
	<li>Using the 75g oral glucose tolerance test, screen women at 4-12 weeks postpartum</li>
	<li>Lifelong screening for type 2 diabetes or prediabetes every 1 to 3 years</li>
	<li>If women are found to have prediabetes, they should seek an experienced diabetologist that can advise lifestyle interventions and any diabetes medicines if needed.</li>
	<li>Psychosocial assessment of women should also be included in postpartum care 
	&nbsp;</li>
</ul>

According to research, diets consisting of &#39;high refined grains, fats, oils and fruit juice&#39;, &#39;high nuts, seeds, fat and soybean; low milk and cheese&#39;, and &#39;high added sugar and organ meats; low fruits, vegetables and seafood&#39; is associated with an increased risk of gestational diabetes<a href="#accordion">[8]</a>. Therefore, women with GDM are advised to continue with a healthy diet plan following birth. This will reduce their risk of developing gestational diabetes in future pregnancies. 
&nbsp;

Moreover, women with a history of GDM have a 10-fold higher risk of developing type 2 diabetes mellitus than non-GDM women<a href="#accordion">[9]</a>. Lifestyle interventions such as weight loss, healthy diet, daily exercise and/or metformin use can help reduce the progression of the disease. These modifications can further reduce the risk of cardiovascular complications in women with a history of GDM. 
&nbsp;

&nbsp;

The lack of awareness among the general population combined with limited healthcare access is a barrier to the prevention and management of gestational diabetes in low and middle income countries. Moreover, there is no universal consensus on GDM screening. However, multiple diagnostic criteria are available for diagnosing gestational diabetes. Therefore, there is a need for not only general awareness programs but also effective screening tests that can diagnose the condition early on. Preconception diabetes screening can help prevent GDM-related complications and congenital abnormalities. 
&nbsp;

Gestational diabetes can be quite a distressing state for a mother. It is important that family members are involved in providing emotional support to the mother. Psychological counselling might also be beneficial. Moreover, a healthcare professional should review contraceptive options as part of postpartum care as unplanned pregnancies can further increase the risk of complications.&nbsp; 
&nbsp;

<ul>
	<li>Gestational Diabetes Mellitus (GDM) is the most common metabolic disorder of pregnancy and affects both maternal and neonatal health. Common complications include neonatal hypoglycemia, macrosomia, obstructed labor, stillbirth, preterm delivery, increased risk of shoulder dystocia, maternal preeclampsia, and increased risk of type 2 diabetes in both mother and child.&nbsp;</li>
	<li>In women with GDM, blood glucose levels return to normal shortly after birth. However, 50% of women are at risk of developing type 2 diabetes in the future, and 2 in 3 women have a risk of developing GDM in a future pregnancy.</li>
	<li>A healthy and balanced diet, regular physical activity, blood glucose monitoring, and the use of insulin can help maintain blood glucose levels within the normal range in pregnant women with GDM. The American Diabetes Association (ADA) recommends fasting blood glucose levels &lt;95mg/dl, 1-hour postprandial levels &lt;140mg/dl, and 2-hour postprandial levels &lt;120mg/dl during pregnancy.</li>
	<li>4-12 weeks postpartum, women with GDM should undergo testing with 75g-OGTT. Moreover, they should be tested every 1-3 years for risk of type 2 diabetes.&nbsp; 
	&nbsp;</li>
</ul>

[2].Riaz, M. et al., 2019. Frequency of gestational diabetes mellitus using DIPSI criteria, a study from Pakistan. Clinical Epidemiology and Global Health, 7(2), pp. 218-221

[3].Wali, A. S. et al., 2020. High proportion of overt diabetes mellitus in pregnancy and missed opportunity for early detection of diabetes at a tertiary care centre in Pakistan. Pakistan journal of medical sciences, 36(1), pp. 38-43.

[4].CDC, 2021. Gestational Diabetes. [Online]

[5].American Diabetes Association, n.d. Gestational Diabetes - Treatment & Perspective.

[6].Rani, P. R. & Begum, J., 2016. Screening and Diagnosis of Gestational Diabetes Mellitus, Where Do We Stand. Journal of Clinical and Diagnostic Research, 10(4).

[7].American Diabetes Association, 2021. Management of Diabetes in Pregnancy. In: Standards of Medical Care in Diabetes. s.l.:s.n.

[8].Shin, D., Lee, K. W. & Song, W. O., 2015. Dietary Patterns during Pregnancy Are Associated with Risk of Gestational Diabetes Mellitus. Nutrients, 7(11).

[9].Vounzoulaki, E. et al., 2020. Progression to type 2 diabetes in women with a known history of gestational diabetes: systematic review and meta-analysis. BMJ, Volume 13

Does ‘Detoxing’ Actually Help Your Liver?

There, I just said it.&nbsp;

Detox diets are a major contemporary trend. They typically combine intermittent fasting, consumption of highly nutritious foods and hydration to give the liver a &ldquo;break&rdquo; from its duties. These duties basically entail eradicating toxins from our bodies.&nbsp;

In other words, detox diets are targeted interventions to our usual nourishment. While the practice of fasting intermittently along with increasing our intake of liquids and nutritious food can have multiple benefits, the science around detox diets is weak.&nbsp;

Detox diets are based on the common belief that over the past century, there&rsquo;s been a huge surge in our consumption of processed foods. As a result, our liver has gone into overdrive. And, therefore, we must provide it with some sort of relief in order to maintain its optimal functioning and prevent liver failure.&nbsp;

However, if we look at what people around the world eat and compare it to the prevalence of liver disease, we see a sharp contrast. For instance, the Italian diet has consisted of high-fat dairy products and processed carbohydrates for centuries, but Italy ranks at number 171 globally in terms of liver disease. And then there&rsquo;s Egypt which has the highest rates of liver failure despite the light Mediterranean diet they consume. 
&nbsp;

Natural Detox

I mean why would you cleanse a self-cleaning organ? Because that is exactly what a liver is! There is very little research to indicate that repetitive external interventions are necessary to maintain their optimal functioning.&nbsp;

However, there&rsquo;s no harm with self-care. Just don&rsquo;t stress thinking now there&rsquo;s something else you need to do, something else you need to avoid. It should be a natural process and a part of your routine to help your body (liver particularly) function at its best.&nbsp;

Our liver needs antioxidants in order to stay healthy. So why not opt for foods that are rich in antioxidants? Here&rsquo;s a list of some liver-friendly foods that are easily available for you to incorporate in your daily diet: 
&nbsp;

Grapefruit: This fruit contains naringenin and naringin, two antioxidants that naturally protect liver health. They reduce inflammation and prevent the accumulation of unnecessary fat (which the liver is then required to break down). They also facilitate the breakdown of compounds found in alcohol.&nbsp; 
&nbsp;

Tea And Coffee: Coffee contains the antioxidant glutathione, which prevents liver cell damage. It can also considerably break down fat by boosting the metabolic rate due to caffeine.&nbsp;

Tea also works in a similar fashion: green tea is rich in antioxidants, which catalyse the enzymes that help the liver break down fat and prevent fat deposits too; black tea works likewise. 
&nbsp;

Berries: Berries, particularly blueberries, raspberries and cranberries contain polyphenols, a kind of antioxidant that help prevent liver cell damage.&nbsp; 
&nbsp;

Grapes: Grapes contain resveratrol, which protects the liver against damage from chemicals and alcohol. Therefore, this fruit considerably reverses any impact that processed foods might have had.&nbsp; 
&nbsp;

Nuts: Nuts contain healthy fats and the antioxidant Vitamin E. They boost liver functioning by reducing the liver&rsquo;s resistance to insulin. If not treated, resistance to insulin could <a href="https://merisehat.pk/disease/diabetes-type-1-and-2">cause diabetes</a>, heart disease and weight gain due to fat build up. It essentially combats fatty liver disease. 
&nbsp;

Beetroot: Beetroots contain high quantities of betalains, which facilitate the liver with detoxification. They also help against inflammation and prevent oxidative stress. 
&nbsp;

Broccoli: Broccoli has all of the benefits mentioned above (combating fatty liver disease, reducing oxidative stress and preventing liver cell damage) and it also increases the levels of liver enzymes. This supports the liver with executing its duties.&nbsp; 
&nbsp;

So, while a targeted intervention might have benefits, mindfully consuming healthful foods is more effective in maintaining optimal liver functioning without subscribing to any external diets.&nbsp;

Zuha Malik

The Power Of Stepping Forward

There&rsquo;s a widely held perception that <a href="https://merisehat.pk/article/body-weight-exercises-for-strength-training">effective exercises</a> are meant to exhaust you and be physically difficult. When looking to build an exercise regime, most of us are quick to add high-intensity activities like weightlifting and running. Rarely, if ever, does one consider beginning with the simplest and easily accessible activity: walking.&nbsp;

While it may not necessarily outweigh the benefits of a high-intensity strength circuit, walking comes with a host of benefits for both the body and mind. If one is completely new to exercising, or even returning after a long hiatus, walking is a more sustainable place to start. There is no learning curve because it is the one movement that&rsquo;s been inherent to our lives since infancy. It also allows you to start with a gentle pace and build up as your body allows. Whether you start with a moderate pace for ten minutes a day or walk at a faster pace for an hour, you will still be able to reap the many benefits of this activity. 
&nbsp;

Benefits of walking

Walking has been shown to improve blood circulation in the body and lower one&rsquo;s resting heart rate, while lowering blood pressure and cholesterol. A six-year study found that moderately paced walking showed similar reductions in the risk of high blood pressure and cholesterol when compared to vigorous running. A study of post-menopausal woman also showed that walking just one to two miles a day can lower blood pressure by 11 points in 24 weeks. 
&nbsp;

&nbsp;Research shows that walking contributes towards preventing a range of diseases. Improvement in cardiovascular health leads to a decrease in risk of heart disease. In one study, women who walked 30 minutes a day showed a 20 percent decrease in the possibility of having a stroke. Those who walked at a faster, above average pace showed a 40 percent decrease.

In another study, women who walked seven or more hours a week were shown to be 14 percent less likely to get breast cancer as compared to women who walked less than three hours. Even women with other risk factors, such as being on supplemental hormones, were less likely to get the disease.&nbsp;

With its benefits to overall health, regular walking has been shown to reduce risk of early death by upto 39 percent as compared to a sedentary lifestyle. 
&nbsp;

&nbsp;Walking has also been shown to reduce risks of developing Type 2 diabetes, as it helps to balance blood sugar levels. A meta-analysis of 300,000 showed that walking regular decreases the likelihood of Type 2 diabetes by 30 percent. Walking at a brisk pace, of more than 20 minutes to a mile, is even more effective, reducing risk by 41 percent. Meanwhile, a smaller study, of 201 people with Type 2 diabetes showed that every additional 2,600 steps in daily activity was associated with a 0.2 percent decrease in blood sugar level. 
&nbsp;

&nbsp;A joint is the point where two or more bones are joined, such as our knees and elbows. The health of our joints greatly impacts our overall mobility and is essential for living comfortably and pain free. Walking has been shown to improve joint health while reducing chances of osteoarthritis. It lubricates the joints, which protects our bones from friction, and strengthens the muscles that support them. Research has shown that people who walk regularly experienced a 40 percent reduction in knee pain as opposed to those who didn&rsquo;t. 
&nbsp;

&nbsp;Walking has been proven to boost our immune system&rsquo;s ability to protect us against illness. A study tracked 1,000 adults during flu season. Those who walked at a moderate pace for 30 to 45 minutes a day faced 43 percent less sick days and suffered from fewer respiratory infections overall. Even if they did get sick, their symptoms were not as severe or long-lasting when compared to adults with sedentary lifestyles. 
&nbsp;

&nbsp;Like other forms of exercise, walking causes our body to release endorphins. These are neurotransmitters which elevate our mood and alleviate pain. There is ample evidence to support the positive relationship between walking and mental health. One study showed that the more steps people took in a day, the better their mood was. Just 12 minutes of walking resulted in more self-confidence and a better mood in the subjects of another study.

Walking in nature helps us ruminate less over negative experiences, which in turn decreases negative emotions and risk of depression. A study of post-menopausal women showed that walking three times a week for 40 minutes provided relief from symptoms of depression. With all the research to support walking, it&rsquo;s no surprise that psychologists agree a 10-minute walk can be as effective as a 45-minute vigorous workout when it comes to relieving depression. 
&nbsp;

&nbsp;For creative professionals, walking can be a valuable tool in facilitating idea generation. One study compared people trying to think of new ideas while they were walking with those who were sitting. Participants who were walking did better, especially if they were walking outdoors. Research has also shown that walking improves creative output by more than 60 percent. Science shows that engaging in activities that allow our mind to wander creates a mental state that is conducive to coming up with ideas. If we are able to let go of our thoughts while walking, we can go to a place where ideas flow freely to us.

Although simple, walking has incredible and wide-ranging benefits for your body and mental health and should definitely be incorporated as a part of your lifestyle.&nbsp;

Ayesha Binte Rashid

In recent years, there has been a significant surge of interest in exploring different weight loss regimes, specifically following high-protein diets. One such high-protein diet is the <a href="https://www.merisehat.pk/article/what-is-the-ketogenic-diet">ketogenic diet</a>, or simply the keto diet, which is a diet rich in proteins and fats. Initially, the ketogenic diet was primarily proposed to reduce the frequency of epileptic seizures in children, but it has since gained popularity for weight loss. While there is evidence of short-term results with the keto diet, the verdict on its long-term benefits is still inconclusive. However, unlike other low-carb diets that center around protein, the ketogenic diet focuses mainly on fat.

&nbsp;

Understanding The Advantages Of Keto Diet In Diabetes

In 2008, researchers conducted a 24-week study to determine the effects of a low-carbohydrate diet on people with diabetes type 2 and obesity. The study concluded that people who followed the ketogenic diet saw a significant improvement in the glycemic index compared to those following a low-glycemic diet<a href="#accordion">[1]</a>. Patients following a ketogenic diet also saw a significant reduction in the use of medication. Another study conducted in 2013 reported that participants on a ketogenic diet showed improvements in their blood sugar levels and were also able to taper off insulin requirements compared to other diets<a href="#accordion">[2]</a>. Similarly, the ketogenic diet outperformed a low-fat diabetes diet, and the participants showed better weight loss and control of HbA1c in another study<a href="#accordion">[3]</a>.&nbsp;

Although it may seem unlikely that a high-fat diet focuses on weight loss, the ketogenic diet is different and can potentially change the way your body stores and uses energy. The ketogenic diet is high in fat and low in carbs. Instead of sugar, your body converts fat into energy in the keto diet. As mentioned earlier, the diet was initially considered for the treatment of epilepsy in the 1920s, but the effects were later also studied for type 2 diabetes<a href="#accordion">[4]</a>. The ketogenic diet improves blood sugar levels and reduces the need for insulin. However, as with any other diet, there are risks associated with the keto diet as well. Thus, it is important to discuss the possibility of starting the keto diet with your doctor before making any drastic changes to your current diet plan.&nbsp;

&nbsp;

Diabetes is of 2 types: diabetes type 1 and diabetes type 2.&nbsp;

<ul>
	<li>In type 1 diabetes, the body is incapable of producing insulin, and the patient has to rely on medication for life. This condition is less common and is typically diagnosed during childhood.&nbsp;</li>
	<li>In diabetes type 2, which has a more common presentation of the two, the body either does not produce enough insulin to meet the body&rsquo;s needs, or the insulin produced does not work effectively in lowering blood glucose levels.&nbsp;</li>
	<li>Pre-diabetic people have higher than normal blood sugar levels&nbsp;and are at a higher risk of developing diabetes type 2 if they do not take precautionary lifestyle and dietary measures.&nbsp;</li>
	<li>Gestational diabetes is described as diabetes that develops when you are pregnant. This type of diabetes generally resolves after giving birth. Though, it places you at a higher risk of developing type 2 diabetes.&nbsp;</li>
</ul>

&nbsp;

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Unlike other low-carb diets, the keto diet aims to force your body to use a different type of fuel. And instead of relying on sugar that comes from carbohydrates, for example, fruits, vegetables, legumes, and grains, the diet relies on ketone bodies. This is a type of fuel that the liver produces using stored fat. While burning fat sounds like an ideal way to lose weight, getting the liver to make ketone bodies is a tricky process.&nbsp;

<ul>
	<li>The diet requires that you restrict your intake of carbohydrates to 20 to 25 grams per day.&nbsp;</li>
	<li>Typically, reaching the state of ketosis takes a few days.&nbsp;</li>
	<li>If your diet is too high in protein, it can also interfere with ketosis.&nbsp;</li>
</ul>

In many cases, people with type 2 diabetes are overweight and a high-fat diet may seem unhelpful. The goal of a ketogenic diet is to train the body into using fat instead of carbohydrates or glucose. On the ketogenic diet, most of the energy comes from fat and only a small amount comes from carbohydrates. However, there are some ground rules. A diet high in fats doesn&rsquo;t mean that you should load up on saturated fats. It is recommended that your diet is rich in heart-healthy fats to maintain overall health. Some healthy foods that you can eat on a ketogenic diet include:&nbsp;

<ul>
	<li>Eggs&nbsp;</li>
	<li>Fish&nbsp;</li>
	<li>Cottage cheese&nbsp;</li>
	<li>Avocado&nbsp;</li>
	<li>Olives&nbsp;</li>
	<li>Nuts&nbsp;</li>
	<li>Seeds</li>
	<li>Olive oil&nbsp;</li>
	<li>Nut butter&nbsp;</li>
</ul>

&nbsp;

Foods To Be Eaten In Moderation

<ul>
	<li>Berries -&nbsp;1 cup or less</li>
	<li>Plain, Greek yogurt -&nbsp;1 cup or less</li>
	<li>Cottage cheese -&nbsp;1/2 cup or less</li>
	<li>Nuts and peanuts -&nbsp;1&ndash;2 ounces&nbsp;or 30&ndash;60 grams</li>
	<li>Flaxseeds or chia seeds -&nbsp;2 tablespoons</li>
	<li>Dark chocolate (at least 85% cocoa) -&nbsp;30 grams or less</li>
</ul>

&nbsp;

Foods To Avoid

<ul>
	<li>Bread&nbsp;</li>
	<li>Pasta&nbsp;</li>
	<li>Cereal&nbsp;</li>
	<li>Corn and other grains&nbsp;</li>
	<li>Potatoes, sweet potatoes</li>
	<li>Milk&nbsp;</li>
	<li>Fruits excluding berries&nbsp;</li>
	<li>Juices, sodas, and sweetened teas</li>
	<li>Desserts, candies, ice cream, and other baked goods</li>
</ul>

&nbsp;

When you eat carbs, your body&rsquo;s digestive system breaks down the carbohydrates and turns them into sugars that enter your bloodstream. The more sugar there is in your bloodstream, the more insulin your body needs to break down the sugar for energy. Insulin signals the cells to use the sugar for energy and energy storage. Moreover, the pancreas releases glucagon when the cells of your body begin to use the blood sugar. The two hormones, insulin, and glucagon work together to ensure that you have enough energy. If you have diabetes, then this means that your body is not using the insulin properly or cannot make or is not making enough insulin.

Hence, for people with diabetes type 2, it is recommended to control carbohydrate intake because it turns to sugar, and having it in large quantities can cause spikes in blood sugar levels. However, the ketogenic diet has the potential to decrease the levels of blood glucose. Your doctor will determine the number of carbs you should have based on your needs, current BMI, etc. Studies have shown that some people experience reduced blood sugar by switching to a diet high in fat.

Diabetes affects about 10 percent of the American population. Whereas in Pakistan, 17.1% of the population is estimated to be living with diabetes. This makes a total of 19 million adults in Pakistan who are at risk of the life-threatening complications of diabetes making it a pertinent public health issue<a href="#accordion">[5]</a>.&nbsp;

&nbsp;

Other than the standard keto diet, there are 3 other variations of the diet: the cyclical ketogenic diet, the targeted ketogenic diet, and the very low-carb diet.&nbsp;

<ul>
	<li>On the cyclical ketogenic diet, you can eat 100 to 150 grams of clean carbs once or twice a week.</li>
	<li>With the targeted ketogenic diet, you can follow the same rules as a regular keto diet but the time you eat carbs is fixed. It is suggested to consume carbs before or after a workout.&nbsp;</li>
	<li>The very low-carb diet, as the name suggests, allows you to eat very small quantities of carbs, high fat, and moderate protein. However, compared to the standard keto diet that allows only 50 grams of carbs a day, this diet allows you to eat 100 to 150 grams of carbs daily. However, this may not help you reach a state of ketosis.&nbsp;</li>
</ul>

&nbsp;

After reading this article, you may be wondering how a diet that focuses on fat makes it good for you. Especially, considering the fact that many people with diabetes also have obesity. While this question is completely reasonable, the keto diet is about redefining our understanding of fat. For years, people have focused on low-fat foods, milk, and yogurt thinking that fats are the root cause of all our health concerns, including obesity. However, the situation is more complex.&nbsp;

A recent study indicates that focusing on reducing total fats leads to harmful habits such as increased consumption of refined carbohydrates and added sugars. Moreover, it also leads to avoiding nutrient-dense foods, such as nuts, seeds, vegetable oils, and avocados. We all need fat to keep ourselves healthy and only recently researchers have started shifting from anti-fat foods to encouraging high-fat foods. In simpler words, fat is an important source of energy. It helps our bodies absorb essential vitamins and minerals, helps our muscles move, and enables blood to clot. Thus, science shows that a diet high in fat can be healthy, whereas eating low-fat diets can actually be harmful in the long run because of overconsumption of carbs and processed foods.&nbsp;

&nbsp;

<ul>
	<li>It is important that you speak with your doctor before you start a keto diet. Speaking with your doctor is a rule that should be followed before starting any diet.&nbsp;</li>
	<li>A keto diet can be helpful for diabetics who want to lose weight and lessen the need for medications. However, for others, it might even make diabetes worse. The diet isn&rsquo;t a magic weight loss pill, and there is currently limited information on the long-term effects of a keto diet.&nbsp;</li>
	<li>Moreover, be cautious when transitioning from the keto diet to adding carbs back to your diet. Sudden high consumption of carbs can cause your blood sugar levels to spike, and cause you to gain weight.</li>
</ul>

&nbsp;

[1] Westman, E.C., Yancy, W.S., Mavropoulos, J.C., Marquart, M. and McDuffie, J.R., 2008. The effect of a low-carbohydrate, ketogenic diet versus a low-glycemic index diet on glycemic control in type 2 diabetes mellitus. Nutrition & metabolism, 5(1), pp.1-9.

[2] Paoli, A., Rubini, A., Volek, J.S. and Grimaldi, K.A., 2013. Beyond weight loss: a review of the therapeutic uses of very-low-carbohydrate (ketogenic) diets. European journal of clinical nutrition, 67(8), pp.789-796.

[3] Saslow, L.R., Mason, A.E., Kim, S., Goldman, V., Ploutz-Snyder, R., Bayandorian, H., Daubenmier, J., Hecht, F.M. and Moskowitz, J.T., 2017. An online intervention comparing a very low-carbohydrate ketogenic diet and lifestyle recommendations versus a plate method diet in overweight individuals with type 2 diabetes: a randomized controlled trial. Journal of medical Internet research, 19(2), p.e5806.

[4] Meira, I.A., Romão, T.T., do Prado, H.P., Krüger, L.T., Pires, M.E.P. and da Conceição, P.O., 2019. Ketogenic diet and epilepsy: What we know so far, Front. Neurosci-Switz.(13), 5.

[5] Akhtar, S., Nasir, J.A., Abbas, T. and Sarwar, A., 2019. Diabetes in Pakistan: a systematic review and meta-analysis. Pakistan journal of medical sciences, 35(4), p.1173.Akhtar, S., Nasir, J.A., Abbas, T. and Sarwar, A., 2019. Diabetes in Pakistan: a systematic review and meta-analysis. Pakistan journal of medical sciences, 35(4), p.1173.