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Iqra Mazhar

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Is Keto Diet Safe For People With Diabetes?

Introduction

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;

<h4>"Good diabetes control can increase 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 now!"</h4><h4> </h4>

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;

Conclusion

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;

Key Points

<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.

Staff Writer

Medilink Consultant clinic

Saad Ullah Siddiqui

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

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;

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;

<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

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 The Ketogenic Diet?

Overview

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>

Bottom Line

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

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;

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;

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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 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;

Humza Khizer

This article or video has been viewed by many visitors, and is popular.

Can AI Predict Diabetes?

In 2021, approximately 400,000 deaths in Pakistan occurred due to diabetes<a href="#accordion">[1]</a>. The chronic disease results from a lack of insulin in the body or the cells&#39; inability to use the available insulin. This leads to elevated blood glucose levels which can present as increased thirst, frequent urination, increased appetite, fatigue, recurrent infections, and unexplained weight loss.&nbsp; 
&nbsp;

With 33 million adults suffering from diabetes, Pakistan has the highest diabetes prevalence in the world<a href="#accordion">[1]</a>.&nbsp;However, more than 26.9% of adults are undiagnosed<a href="#accordion">[1]</a>. Thus, putting them at risk of complications such as neuropathy, nephropathy, <a href="https://www.merisehat.pk/disease/hypertension-57">hypertension</a>, vision problem, and cardiovascular diseases. Moreover, the delay in treatment reduces a person&#39;s overall quality of life. This delay in diagnosis and treatment is often blamed on a lack of awareness among the general population. Additionally, many people have limited financial resources and access to adequate healthcare facilities.&nbsp;

According to the International Diabetes Federation, 3 in 4 adults with diabetes live in low- and middle-income countries<a href="#accordion">[2]</a>. Such countries already face multiple healthcare challenges which can make managing chronic conditions such as diabetes more difficult. Therefore, there is a need for improving diabetes care.&nbsp;

&nbsp;

Artificial intelligence is defined as &#39;a branch of computer science that aims to create systems or methods that analyze information and allow the handling of complexity in a wide range of applications<a href="#accordion">[3]</a>.&nbsp;It basically means making a computer perform tasks normally done by humans. Thus, systems or algorithms are equipped with humanistic characteristics of reasoning, analyzing, learning, and generalizing.&nbsp;

&nbsp;

Understanding how to predict diabetes using AI

In recent years, researchers have turned their attention to artificial intelligence (AI) for diabetes management. These newly developed AI-based tools are rapidly becoming an integral part of healthcare due to their portability, low cost, and high efficiency. Using principles of machine learning, researchers have built algorithms that can help predict the risk of developing diabetes and its complications. 
&nbsp;

Several AI-based medical devices are currently in use across the United States, Europe, and Japan. However, most of them are concerned with radiological and diagnostic imaging.&nbsp;&nbsp; 
&nbsp;

Artificial Intelligence can improve and influence three main aspects of diabetes care<a href="#accordion">[3]</a>. 
&nbsp;

<ul>
	<li>Patients with diabetes</li>
	<li>Healthcare professionals</li>
	<li>Healthcare systems 
	&nbsp;</li>
</ul>

Currently, AI technologies focus on blood glucose monitoring, diabetes prediction, lifestyle guidance, monitoring of complications, and diabetes self-management.&nbsp; 
&nbsp;

Chinese researchers developed a risk assessment model for screening post-meal hyperglycemia<a href="#accordion">[4]</a>. The AI-based predictive model used several risk factors, such as age, height, family history, fasting blood glucose, and cholesterol levels to identify those at risk of postprandial hyperglycemia. Thus, replacing the need for an oral glucose tolerance test.&nbsp; 
&nbsp;

Another group of researchers used machine learning algorithms and electronic medical record (EMR) data of patients to predict their risk of developing type 2 diabetes later<a href="#accordion">[5]</a>. Thus, proving that artificial intelligence is feasible for diabetes prediction.&nbsp;

&nbsp;

<h4>"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>

In 2018, the U.S Food and Drugs Administration (FDA) approved IDx-DR, an AI-based device for the early detection of diabetic retinopathy. The algorithm analyzes digital retinal images to diagnose people with retinopathy, without the need for an ophthalmologist. However, primary health physicians can refer patients to ophthalmologists for an assessment of the images or ask for a re-evaluation with the device 12 months later. A clinical trial for the AI system reported 92% accuracy levels and 93% specificity levels for the device<a href="#accordion">[6]</a>. 
&nbsp;

AI-based devices have also been developed for image-based screening of diabetic foot ulcers. These tools provide a cost-effective alternative for the detection of diabetic complications. 
&nbsp;

In diabetics, an adequate diet and daily physical activity are essential for maintaining blood glucose levels within the normal range. However, keeping track of one&#39;s dietary habits is not easy. Nor is it feasible to adjust insulin dose for every meal. Artificial intelligence algorithms can combine multiple parameters, such as physical activity, blood glucose measurements, and dietary habits to predict postprandial glucose levels and their metabolic effects. Moreover, based on these parameters they can then adjust one&#39;s insulin dose.&nbsp; 
&nbsp;

Self-management is an integral component of diabetes treatment. However, many patients are unaware of diabetes self-care, and are non-compliant with prescribed treatments and recommended lifestyle changes. Digital platforms, therefore, help increase awareness and help patients become accountable for diabetes care. 
&nbsp;

During a 12-week interventional study, researchers evaluated the use of FareWell, a digital therapeutic, for the management of diabetes. The digital intervention provided health coaching to patients every 2 weeks, aiding healthier lifestyle decisions. At the end of the study, participants reported a significant reduction in HbA1c levels and diabetic medication use. Approximately 92% of the users reported greater confidence in the management of their diabetes<a href="#accordion">[7]</a>.

Moreover, many mobile apps are now available for diabetes management. They can help set reminders for medications, track blood glucose levels, set goals, and provide insights into the patient&#39;s disease progression.&nbsp; 
&nbsp;

In 2021, diabetes was responsible for an estimated USD 966 billion in global health expenditure<a href="#accordion">[1]</a>. The increasing disease burden of diabetes poses further risks for countries facing poverty, lack of resources, high healthcare costs, and lack of healthcare experts. Therefore, prevention and management of diabetes are important for decreasing the disease burden. 
&nbsp;

Type 2 diabetes has a slow disease progression and can take years to show symptoms. Early detection of the disease can decrease healthcare costs by preventing the development of complications. Artificial intelligence allows remote monitoring of the patient&#39;s disease, providing a low-cost and time-effective alternative for diabetes management. Moreover, 50-70% of routine follow-up clinical consults can be replaced with virtual management using artificial intelligence<a href="#accordion">[8]</a>. 
&nbsp;

There are several limitations to the application of artificial intelligence in diabetes, such as data security, low user-friendliness of the apps, technical factors, and lack of access. Nevertheless, these limitations are currently being worked on to ensure that AI helps empower patients to effectively manage their diabetes. 
&nbsp;

<ul>
	<li>Diabetes Mellitus results from either a lack of insulin or the body&#39;s inability to use the available insulin. It can result in complications such as cardiovascular disease, chronic kidney disease, hypertension, vision problems, and skin infections leading to feet/leg amputation.</li>
	<li>Diabetes prevalence has significantly increased in low- and middle-income countries, increasing the disease burden in places already struggling with healthcare management.&nbsp;</li>
	<li>Artificial intelligence can help manage diabetes by helping monitor glucose levels, predicting diabetes, lifestyle guidance, and detecting complications of diabetes.&nbsp;</li>
	<li>Remote monitoring of a patient&#39;s disease progression can reduce the burden on healthcare professionals and provide a low-cost and time-efficient alternative to routine clinical consultations.&nbsp;</li>
</ul>

&nbsp;

[2].IDF Diabetes Atlas, n.d. Diabetes around the world in 2021.

[3].Ellahham, S., 2020. Artificial Intelligence: The Future for Diabetes Care. The American Journal of Medicine, 133(8), pp. 895-900.

[4].Fu, Q. et al., 2014. A Chinese risk score model for identifying postprandial hyperglycemia without oral glucose tolerance test. Diabetes/metabolism research and reviews, 30(4), pp. 284-90.

[5].Mani, S. et al., 2012. Type 2 Diabetes Risk Forecasting from EMR Data using Machine Learning. AMIA Annu Symp Proc., pp. 606-615.

[6].Abràmoff, M. D. et al., 2018. Pivotal trial of an autonomous AI-based diagnostic system for detection of diabetic retinopathy in primary care offices. npj Digital Med.

[7].Berman, M. A. et al., 2018. Change in Glycemic Control With Use of a Digital Therapeutic in Adults With Type 2 Diabetes: Cohort Study. JMIR diabetes, 3(1).

[8].Fagherazzi , G. & Ravaud, P., 2019. Digital diabetes: Perspectives for diabetes prevention, management and research. Diabetes & metabolism, 45(4).

A Guide To 10 Contemporary Diet Plans

We&rsquo;re foodies first, humans second. So, there&rsquo;s this constant urge to improvise and come up with new recipes, new culinary techniques and new diet plans. Food is important, but not at the expense of our fitness, right?&nbsp;

There&rsquo;s no shame in admitting that what we crave the most right now is an ideal nutrition plan that works both for our health and fitness as well as satiate our taste buds. The internet is saturated with this kind of content, however most of these diet plans are to be practised with caution. Especially when they are not verified by a nutritionist.

There are diets that are scientifically proven to be beneficial. Read on to learn about 10 of the most popular contemporary diet plans, along with their advantages, disadvantages, and sustainability.&nbsp; 
&nbsp;

Contemporary Diet plans

The Mediterranean diet has been widely celebrated for being one of the most healthful diet plans in the world. It typically comprises large quantities of nutritious fruits and vegetables, with a particular fixation on healthy fats consumption.&nbsp;

The Mediterranean diet prioritises leafy greens, fruits, nuts, seeds, legumes, fish, spices, and extra virgin olive oil.&nbsp;

It recommends moderate amounts of whole grains, dairy, meats and poultry products, such as eggs, <a href="https://merisehat.pk/article/milk-a-nutritional-powerhouse">milk</a>, yogurt, and bread. You can have an occasional bite of processed foods, refined grains and oils, and high-sugar sweets, though.&nbsp;

The Mediterranean diet is extremely healthy and not particularly difficult to follow unless you happen to be a great lover of eggs, bread, and processed foods. There is no singular way to follow this diet plan, that is it can be tailored to fit your needs. Just remember to do all your cooking with olive oil.&nbsp;

Olive oil is a great alternative to typical vegetable oils, such as canola or sunflower oil, but it is still slightly less stable in heat than organic dairy butter or coconut oil. Therefore, it&rsquo;s always better to consume it with moderate exposure to heat. With this minor tweak, the Mediterranean diet can be one of the healthiest diets that you could ever follow.&nbsp; 
&nbsp;

The MIND diet was invented to focus on people with neurodegenerative diseases. The acronym stands for the Mediterranean Intervention for Neurodegenerative Delay.&nbsp;

According to the Population Reference Bureau (PRB), 115 million people worldwide are expected to be affected by dementia, a memory loss disorder, by 2050. This number increased from 35 million in 2012 to 55 million in 2022.&nbsp;

WHO expects that, from this point onwards, 10 million new cases will be recorded each year and the same upward trajectory is expected for other neurodegenerative disorders, such as Alzheimer&rsquo;s and Parkinson&rsquo;s.&nbsp;

Since the Mediterranean diet derives majority of its nutrients from brain-healthy foods such as nuts, seeds, leafy greens, fish, whole grains, and healthy fats, a brain-health-intensive version of this diet was devised by experts to combat this issue.&nbsp;

The Mediterranean diet is known to decrease the chances of getting Alzheimer&rsquo;s by 40 percent and Parkinson&rsquo;s by nearly 17 percent. It also reduces the risk of dementia.&nbsp; 
&nbsp;

If you have a familial history of neurodegenerative disease, you&rsquo;re encouraged to integrate the MIND diet into your lifestyle early on. The best way to do so is to load up on&nbsp;

<ul>
	<li>Whole grains, such as quinoa, oatmeal, and brown rice.&nbsp;</li>
	<li>Mono-unsaturated fatty acids, such as those in olive oil.&nbsp;</li>
	<li>Omega-3 fatty acids through fish and seafood.</li>
	<li>Neuroprotective antioxidants, such as those found in various berries (strawberries, blueberries, and raspberries).</li>
	<li>Vitamin K, folate, and beta carotenes, such as those found in leafy greens and vegetables.&nbsp; 
	&nbsp;</li>
</ul>

The Dietary Approaches to Stop Hypertension (DASH) diet favours foods that lower one&rsquo;s consumption of sodium while increasing levels of potassium, magnesium, and calcium. These elements help control high blood pressure and consequently hypertension.&nbsp;

The DASH diet also lowers levels of LDL or &ldquo;bad&rdquo; cholesterol within as little as two weeks.&nbsp;

It&rsquo;s basically lots of fruits, vegetables, and leafy greens with some amounts of lean meat. It also encourages a reduction of refined foods, sugars, and fats and recommends only one teaspoon of salt intake per day.&nbsp;

The DASH diet has been touted by medical journals and practitioners alike. Nevertheless, the plan is unsustainable for long periods of time unless one suffers from hypertension and must adopt this diet plan as a permanent lifestyle.&nbsp; 
&nbsp;

Vegetarianism and veganism are similar lifestyles, except that the latter also eliminates consumption of poultry. This lifestyle, while extremely healthy due to the nature of its content, is unsustainable due to the expense: in order to get all the required nutrients from a vegetarian, and especially vegan, lifestyle, one must have access to a large variety of products.&nbsp;

In Pakistan, particularly, it is difficult to access all of those products and people who do find them already have a lavish lifestyle.&nbsp;&nbsp; 
&nbsp;

Flexitarianism is a version of vegetarianism that allows for occasional consumption of meat. This is listed as the second-best diet plan in the world (the first being the Mediterranean diet) because it stresses that you can only consume organic meat sporadically.&nbsp;

Due to its fibrous and nutritious composition, the flexitarian diet also promotes weight loss and reduces the risk of diabetes and heart disease.&nbsp;

However, it might put some people at a risk of nutrient deficiencies that arise once they cut back on animal products.&nbsp; Therefore, to practice this diet plan, one must take additional care to ensure that all nutritional requirements are met.&nbsp; 
&nbsp;

The Paleo diet derives its name from the Palaeolithic or pre-agricultural era. Practitioners of this diet believe that the introduction of poultry and agriculture was a deviation from the natural way of life and that our body cannot actually stand these things (milk, butter, bread, etc.)

Therefore, the Paleo diet asks people to return to the products that were likely consumed by our hunter-gatherer ancestors.&nbsp; These include meat, fish, eggs, vegetables, fruits, nuts, berries, spices, herbs, and fish. It discourages use of processed foods, legumes, oil, and dairy products.&nbsp;

While the theory is interesting and the diet has many health benefits, it is a restrictive way of life and, therefore, cannot be sustained in the long run unless the practitioner has a stoic allegiance to the idea.&nbsp;&nbsp; 
&nbsp;

Low carb diets replace carbohydrates with protein, healthy fats, fruits, and leafy greens. This plan mainly bans wheat-based products, starchy vegetables, and highly processed or sugary products.&nbsp;

The &ldquo;keto&rdquo; diet that is such a popular contemporary trend is actually a low-carb diet. The idea is that since carbohydrates are quickly converted to energy, a lack of their expenditure leads to weight gain and multiple health problems. Thus, reducing carbohydrate intake can limit production of fat.&nbsp;

Furthermore, consumption of high-fat foods, which is typical in keto diets, can keep the body in a fat-burning state (also known as ketosis). This is because the body does not feel the need to store fat considering the constant supply of it.&nbsp; 
&nbsp;

Intermittent fasting is a diet plan that allows for consumption of any and all types of foods, but with a significant fasting window each day. Fasting initiates ketosis or fat-burning, but this state is typically achieved after the 12-hour mark. Therefore, the time period can range from 13 to 20 hours, depending upon the practitioner&rsquo;s tolerance levels.&nbsp;

While you&rsquo;re fasting, you can consume foods or beverages with up to 50 calories at a time. It&rsquo;s better to drink a lot of water and avoid heavy workouts because exercising would increase appetite and make fasting difficult. You can also drink low-calorie beverages, such as black coffee and green tea during this time.&nbsp;

Intermittent fasting has a plethora of health benefits, including weight loss, increasing lean muscle mass, improving memory and cognition, and optimising digestion.&nbsp;

The only potential downside to this is that the intermittent fast must be at least 13 hours in order for it to be effective. However, even a couple of intermittent fasts per week can radically improve one&rsquo;s overall health.&nbsp; 
&nbsp;

The Weight Watchers diet includes calorie counting. While the content of food is unrestricted, this method recommends keeping track of calories in versus calories out. An optimal balance of the two will result in weight maintenance or loss.&nbsp;

The method is unsustainable because it is quite difficult to track the nutritional value and calorie content of each thing that one consumes in a day, and such a method can frequently result in obsessive over-concern with food, which usually leads to eating disorders.&nbsp; 
&nbsp;

The Pescatarian diet is a brand of vegetarianism that allows for consumption of seafood. It is incredibly healthy because it allows omega-3 fatty acids. It also gives the practitioner more leeway with choosing proteins, and has a lower carbon footprint as compared to other meat consumption.&nbsp;

The downside, however, is that in Pakistan, fish consumption is seasonal. You cannot have fresh consumption throughout the year. Packaged fish is processed and can be dangerous for health and is, therefore, not good for year-round consumption.&nbsp; 
&nbsp;

All of the above-mentioned diet plans essentially focus on the basic food pyramid: concentrate on fibrous foods and leafy greens and consume protein and healthy fats in moderate quantities. You can eat processed foods and high-sugar desserts every now and then. At the end, you&rsquo;ll find the method that works best for you when you listen to your body.

HIV & Diabetes: Is There A Link?

Recently, researchers have discovered the role of the human immunodeficiency virus (HIV) in increasing the risk of diabetes. Moreover, the incidence of diabetes has also significantly increased among <a href="https://merisehat.pk/disease/hiv-61">HIV patients</a>, raising their risk of mortality and morbidity from metabolic disease. 
&nbsp;

Several studies have reported an increased incidence of diabetes in HIV patients. In 2021, French researchers conducted a real-life setting study to identify risk factors of diabetes in people living with <a href="https://merisehat.pk/disease/hiv-61">HIV</a>. The study reported a diabetes prevalence of 9-10% among the infected individuals<a href="http://@accordion">[4]</a>. According to the study, people with HIV developed diabetes at a much younger age.&nbsp;

&nbsp;

Another study, conducted in the United States, found a 3.8% higher prevalence of diabetes among HIV-infected individuals<a href="#accordion">[5]</a>&nbsp;Moreover, similar to the French study, researchers reported diabetes among a younger HIV-infected population, in the absence of obesity.&nbsp;

&nbsp;

Researchers hypothesize that due to the effectiveness of ARTs, people with HIV are now living longer. Thus, increasing their risk of developing chronic diseases such as diabetes. The use of protease inhibitors (PIs) is specifically associated with a five-fold higher rate of hyperglycemia[<a href="#accordion">6]</a>. It causes beta cell dysfunction and decreased insulin sensitivity, both of which contribute to increased incidence of diabetes. Other HIV medications can affect glucose metabolism, leading to insulin resistance. Moreover, inflammation in people living with HIV is considered key to the development of <a href="https://merisehat.pk/disease/diabetes-type-1-and-2">diabetes</a>. This may occur from T-cell depletion and co-infection with viruses such as hepatitis C.&nbsp;

&nbsp;

The prevalence of diabetes has drastically risen over the years. In 2021, there was a 16% rise in cases from 2019<a href="#accordion">[1]</a>. As per the IDF Diabetes Atlas, Pakistan currently has the highest national prevalence of diabetes in the world. Several factors are responsible for the surge in cases. These include urbanization, increasing levels of obesity, a sedentary lifestyle, and an ageing population.&nbsp;

&nbsp;

According to the World Health Organization (WHO), an estimated 37 million people suffered from HIV at the end of 2020<a href="http://@accordion">[2]</a>. The virus destroys the body&#39;s immune cells, making the person prone to infections and cancers. Moreover, in the advanced stage, HIV can cause acquired immunodeficiency syndrome (AIDS). This is characterized by the development of infections, various cancers, and severe complications. As of June 2019, more than 24,000 people (14&middot;7%) are registered with the National AIDS Control Program (NACP) in Pakistan<a href="http://@accordion">[3]</a>. This is an increase of more than 4,500 from 2013. 
&nbsp;

Although there is no cure for the virus, the development of effective antiretroviral therapies (ARTs) has resulted in a longer life expectancy among individuals.&nbsp;

&nbsp;

According to the Infectious Diseases Society of America people living with HIV should undergo the following tests at baseline and at 1 to 3 months after starting ART: 
&nbsp;

<ul>
	<li>Fasting Plasma Glucose and/or</li>
	<li>Hemoglobin A1c 
	&nbsp;</li>
</ul>

HbA1c levels of 5.8% or more are considered diagnostic of diabetes in people living with HIV. Moreover, the test should be repeated every 6 months; the goal is to keep the level below 7% for HIV-infected individuals suffering from diabetes.&nbsp;

&nbsp;

Similar to the general population, HIV-infected individuals can follow the following steps to reduce their risk of diabetes: 
&nbsp;

<ul>
	<li>Lifestyle changes such as regular exercise and a balanced diet</li>
	<li>Limiting intake of processed foods, refined sugars, salt, and fat</li>
	<li>Maintain a healthy weight</li>
	<li>Regular blood glucose monitoring, especially prior to and after starting HIV medications</li>
	<li>Quit smoking 
	&nbsp;</li>
</ul>

The appropriate management plan will depend on the individual&#39;s disease status, age, weight, risk of complications, and other factors. Moreover, not all diabetic medications can be given to HIV patients as they can react to ARTs. Therefore, all medications should first be discussed with one&#39;s healthcare provider.&nbsp;

&nbsp;

The significantly high prevalence of diabetes in HIV-infected individuals warrants the need for better screening programs. It is important to modify diabetes screening guidelines with HIV infection as a risk factor for the development of diabetes. Moreover, HIV treatment strategies should focus on reducing the risk of diabetes in these individuals.&nbsp;

<ul><li>The human immunodeficiency virus (HIV) targets the immune system, weakening the body's defenses against certain infections and cancers. An advanced stage is characterized by the development of acquired immunodeficiency syndrome (AIDS).</li><li>Multiple studies have reported an increased incidence of diabetes among people infected with HIV.&nbsp;</li><li>The increased life expectancy due to effective antiretroviral therapies has increased the risk of diabetes in people with HIV.&nbsp;</li><li>Factors such as abdominal obesity, age, hepatitis C co-infection, duration of HIV, longer exposure to ART therapy, and lipodystrophy increase the risk of diabetes in HIV-infected individuals.</li></ul>

[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] World Health Organization, 2021. HIV/AIDS. [Online]

[3] Ahmed, A., Hashmi, F. K. & Khan, G. M., 2019. HIV outbreaks in Pakistan. The Lancet, 6(7).

[4] Kousignian, I. et al., 2021. Diagnosis, risk factors and management of diabetes mellitus in HIV-infected persons in France: A real-life setting study. PLOS One.

[5] Hernandez-Romieu, A. C. et al., 2017. Is diabetes prevalence higher among HIV-infected individuals compared with the general population? Evidence from MMP and NHANES 2009–2010. BMJ Open Diabetes Research and Care, 5(1).

[6] Sarkar, S., 2019. Diabetes in People Living with HIV. s.l.:s.n.

Ramadan is the most revered month in the Islamic calendar when Muslims all around the world maintain a fast from sunrise to sunset. This month is not only about abstaining from food and drink but also engaging in more prayer, spiritual meditation, and charitable deeds. The two major meals of the day during Ramadan are Sehr and Iftaar, and they are extremely important in this fasting journey.

&nbsp;

Several researchers have studied the effects of Ramadan on energy balance and weight regulation. While results have shown a decrease in body weight, body fat percentage, <a href="https://merisehat.pk/article/checking-sugar-while-fasting">fasting blood sugar</a>, and circulating triglycerides, these changes were seen to be short-lived1. Elevated insulin resistance at the end of Ramadan has also been observed1. Furthermore, fasting has not been shown to significantly affect mood, fatigue, and a person&rsquo;s quality of life<a href="#accordion">[2]</a>.&nbsp;Thus, studies have shown that fasting can lead to both positive and negative health outcomes<a href="#accordion">[1]</a>. 
&nbsp;

It is important to understand that fasting can be a great way to improve your health, as long as it&#39;s done safely and in a state of good health. If you&#39;re planning on fasting, it&#39;s important to eat healthy and nutritious meals during sehr and iftaar to get the maximum benefits. 
&nbsp;

Don&#39;t know what to eat? No problem! Read on for some healthy and tasty meal ideas. 
&nbsp;

Sehr - The Pre-Dawn Meal

Muslims eat Sehr or Sahur in the early hours of the morning before sunrise. The goal of Sehr is to supply the body with enough energy so that it can last from sunrise to sunset. At Sehr, it is advised to eat a balanced meal with complex carbohydrates, lean protein, as well as healthy fats.

&nbsp;

<h5>Ideal Foods for Sehr</h5>

Suitable foods for Sehr include whole grains, oats, and lentils because they are high in fiber and digest slowly. These nutrients aid in maintaining feeling satisfied and energized all day long by gradually releasing energy. To ensure that one remains hydrated all day, it is also advised to drink lots of water throughout the period from Iftaar to the next Sehr.

&nbsp;

<h5>Examples of Sehr Foods</h5>

A few examples of healthy Sehr meals include:

<ul>
	<li>Oatmeal mixed with nuts and fruit</li>
	<li>Eggs on whole-wheat toast</li>
	<li>Lentil soup with brown rice</li>
	<li>Yogurt with honey and berries</li>
</ul>

&nbsp;

These foods give the body the vital nutrition and energy it needs for a pleasant and satisfying fast.

&nbsp;

Iftaar - The Post-Sunset Meal

Muslims end their fast at sundown by eating Iftaar. Iftaar is meant to refuel the body with vital nutrients as well as provide one with energy for the rest of the day. Usually, Iftaar is a time when the community and family gather to eat together.

&nbsp;

<h5>Breaking The Fast With Dates And Water</h5>

As per religious traditions, it is recommended to end the fast with dates and water. A quick snack, like soup or a salad, should then be consumed to assist the digestive system to adjust to eating again.

&nbsp;

<h5>Ideal Foods For Iftaar</h5>

During Iftaar, it&#39;s crucial to eat nutrient-dense foods like fruits, vegetables, and lean protein. Avoid eating foods that are high in sugar and fats. Moreover, fried foods should be avoided because they might aggravate digestion and result in weight gain.

&nbsp;

<h5>Examples Of Iftaar Foods</h5>

Samosas, pakoras, dates, chana chaat, fruit chaat, and haleem are other popular Iftaar foods. Not only are these foods delightful, but they also give the body important nutrients. However, the consumption of fried foods during Iftaar can be detrimental to a person&rsquo;s health. Therefore, they should be eaten in moderation.

&nbsp;

The body needs essential nutrients during the fast to sustain energy levels and to ensure overall well-being. People often tend to eat less during sehr, hence making Iftaar an important contributor of calories [&lrm;65%]&lrm;, lipids [&lrm;74%]&lrm;, proteins [&lrm;71%]&lrm; , and carbohydrates [&lrm;56%]&lrm;<a href="#accordion">[3]</a>. 
&nbsp;

<ol>
	<li>
	<h5>Maintains Stable Blood Sugar Levels</h5>
	</li>
</ol>

Eating balanced meals during Sehr and Iftaar helps to maintain stable blood sugar levels throughout the day and prevent blood sugar spikes, which can be harmful to renal impaired patients. 
&nbsp;

<ol start="2">
	<li>
	<h5>&nbsp;Reduces The Risk Of Dehydration</h5>
	</li>
</ol>

Consuming fluids during Sehr and Iftaar helps to prevent dehydration, which is important for renal-impaired patients who may be at an increased risk of dehydration. 
&nbsp;

<ol start="3">
	<li>
	<h5>&nbsp;Helps To Manage Electrolyte Balance</h5>
	</li>
</ol>

Consuming foods that are low in potassium and phosphorus helps to manage electrolyte balance, which is important for renal-impaired patients. 
&nbsp;

<ol start="4">
	<li>
	<h5>&nbsp;Provides Essential Nutrients</h5>
	</li>
</ol>

A well-balanced diet provides essential nutrients like vitamins, minerals, and fiber, which are crucial for maintaining good health and managing kidney disease. 
&nbsp;

<ol start="5">
	<li>
	<h5>&nbsp;Controls Weight</h5>
	</li>
</ol>

Eating the right foods can help to control weight and prevent obesity, which is a major risk factor for heart disease. 
&nbsp;

<ol start="6">
	<li>
	<h5>&nbsp;Helps To Manage Cholesterol Levels</h5>
	</li>
</ol>

A diet low in saturated and trans fats can help to manage cholesterol levels, which is important for cardiac patients. 
&nbsp;

<h5>Sehr and Iftaar Food for Renal Impaired Patients</h5>

For people with renal impairment, it&rsquo;s crucial to pay attention to the pre-dawn (Sehr) and evening meals (Iftaar) throughout Ramadan. They should select fresh fruits and vegetables, whole-grain bread, and lean protein sources, and keep away from salty and high-potassium items. A qualified dietician should be consulted to develop a customized meal plan. They can provide personalized recommendations based on the person&rsquo;s specific health needs.

&nbsp;

<h5>Sehr and Iftaar Food for Cardiac Patients</h5>

For cardiac patients observing Ramadan, choosing the right foods during Sehr and Iftaar is crucial for maintaining good health and managing their condition. Lean protein sources like fish and chicken, nutritious grains, fruits, and vegetables should be included, while trans and saturated fats, salt, and added sugars should be kept to a minimum.

A customized meal plan that accounts for each person&#39;s needs and restrictions should be developed in collaboration with a licensed dietitian and cardiologist.

&nbsp;

<h5>Sehr and Iftaar Food for Diabetic Patients</h5>

It&#39;s crucial for diabetics who are fasting throughout Ramadan to make food choices that support stable blood sugar levels. Complex carbohydrates, diets high in protein, and hydration are advised for Sehr. Dates, water, low-GI foods, lean protein sources, veggies, and portion control are all crucial during Iftaar. A trained dietitian&#39;s advice and talking to a healthcare professional are other crucial factors to take into account. To prevent difficulties, it&#39;s critical to constantly check blood sugar levels and break the fast as needed.

&nbsp;

<h5>Sehr and Iftaar Food for Older Persons</h5>

It is crucial for older adults who are fasting during Ramadan to select foods that offer the nutrients they require for optimal health and well-being. For Sehr, complex carbs, diets high in protein and fiber, low-fat foods, and water are advised. Dates and water, as well as a range of low-fat foods, portion management, and hydration, are crucial for Iftaar. Other crucial factors to take into account include eating regularly spaced meals, avoiding overeating, and speaking with a qualified nutritionist or healthcare professional. Some example of food includes:

&nbsp;

<ol>
	<li>
	<h6>&nbsp;Complex Carbohydrates</h6>
	</li>
</ol>

Foods like oats, whole grains, and legumes provide a balanced source of energy throughout the day.

<ol start="2">
	<li>
	<h6>&nbsp; Protein-Rich Foods</h6>
	</li>
</ol>

Foods like yogurt, eggs, and nuts provide essential amino acids needed for building and maintaining muscle mass, which is important for older adults.

<ol start="3">
	<li>
	<h6>&nbsp; Low-Fat Foods</h6>
	</li>
</ol>

Avoid high-fat foods like fried foods, high-fat meats, and pastries, which can cause indigestion and increase cholesterol levels.

<ol start="4">
	<li>
	<h6>&nbsp; Hydration</h6>
	</li>
</ol>

Drink plenty of fluids like water, milk, and unsweetened juices to stay hydrated.

<ol start="5">
	<li>
	<h6>&nbsp; Fiber-Rich foods</h6>
	</li>
</ol>

Foods like fruits, vegetables, and whole grains are high in fiber and can help promote healthy digestion and prevent constipation, which is common in older adults. 
&nbsp;

In addition to following these suggestions, older persons should make an effort to eat meals on a regular schedule to help keep their blood sugar levels constant and prevent overeating. Before making any dietary changes, it&#39;s vital to speak with a doctor or a trained nutritionist, especially if there is an existing health concern. Depending on the person&rsquo;s unique health requirements, they can offer advice that is tailored to them. 
&nbsp;

<h5>Sehr and Iftaar Food for Gastro/Digestion Compromised Patients</h5>

Patients with gastropathy should choose foods that are simple to digest and won&#39;t aggravate their symptoms during Ramadan. Complex carbohydrates, diets high in protein, low in fat, and hydration are crucial for Sehr. Dates and water are advised at Iftaar, along with a range of low-fat foods, portion management, and hydration. Also, it&#39;s critical to steer clear of things like caffeine, spicy meals, acidic foods, and carbonated beverages that might aggravate symptoms. 
&nbsp;

Portion control is essential for preserving a healthy weight and making sure the body gets the nutrition it needs. Overindulging during Iftaar and Sehr might result in bloating, indigestion, and weight gain. On the other hand, not eating sufficiently from Iftaar to Sehr can make one feel weak and tired.

&nbsp;

<h5>Ideal Portion Sizes For Sehr</h5>

The Sehr meal gives the body the energy it needs for the rest of the day. During Sehr, it&#39;s critical to eat enough food to maintain energy levels without becoming bloated or feeling unpleasant. A nutritious Sehr portion should include the following. 
&nbsp;

<ul>
	<li>One egg or one cup of yogurt counts as one serving of protein.</li>
	<li>One serving of complex carbs, such as a piece of whole grain bread or a cup and a half of oats.</li>
	<li>A cup of salad or a small apple counts as one serving of fruits or vegetables.</li>
	<li>One serving of wholesome fats, like a spoonful of nut butter or half an avocado.</li>
</ul>

&nbsp;

<h5>Ideal Portion Sizes For Iftaar</h5>

Iftaar is a meal that breaks the fast and replenishes the body with essential nutrients. It is important to consume enough food during Iftaar to provide energy for the remainder of the day. A healthy Iftaar meal should consist of:

<ul>
	<li>One serving of protein, such as a small chicken breast or a cup of lentils.</li>
	<li>One serving of complex carbohydrates, such as a cup of brown rice or a slice of whole-grain bread.</li>
	<li>One serving of fruits or vegetables, such as a cup of mixed fruit or a small salad.</li>
	<li>One serving of healthy fats, such as a tablespoon of olive oil or a handful of nuts. 
	&nbsp;</li>
</ul>

<h5>Tips For Portion Control</h5>

Here are some tips for controlling portion sizes during Sehr and Iftaar:

<ul>
	<li>Use smaller plates to make portions look larger</li>
	<li>Fill half of the plate with fruits and vegetables</li>
	<li>Use measuring cups to portion out carbohydrates and proteins</li>
	<li>Avoid eating too fast, as this can lead to overeating</li>
	<li>Listen to the body and stop eating when full 
	&nbsp;</li>
</ul>

Sehr and Iftaar are two important meals that provide essential nutrients to the body during Ramadan. Controlling portion sizes during these meals is crucial for maintaining a healthy diet and ensuring the body receives the necessary nutrients. By following the recommended portion sizes and tips for portion control, people can have a healthy and fulfilling Ramadan experience. 
&nbsp;

&nbsp;

<h5>Sehr:</h5>

<ul>
	<li>Consumed before dawn to provide energy and sustenance for the day ahead.</li>
	<li>This is typically a light meal, as overeating can cause discomfort during the day-long fast.</li>
	<li>Common Sehr foods include oatmeal, eggs, dates, and bread.</li>
</ul>

&nbsp;

<h5>Iftaar:</h5>

<ul>
	<li>Eaten at sunset to break the day-long fast during Ramadan.</li>
	<li>A time for celebration and communal gathering, often with friends and family.</li>
	<li>The meal includes a variety of dishes, such as samosas, dates, fruit, and soups.</li>
	<li>It is customary to break the fast with a sip of water or juice, followed by dates. 
	&nbsp;</li>
</ul>

[1] Nachvak SM, Pasdar Y, Pirsaheb S, Darbandi M, Niazi P, Mostafai R, et al. Effects of Ramadan on food intake, glucose homeostasis, lipid profiles, and body composition. Eur J Clin Nutr [Internet]. 2019;73(4):594–600.

[2] Nugraha B, Ghashang SK, Hamdan I, Gutenbrunner C. Effect of Ramadan fasting on fatigue, mood, sleepiness, and health-related quality of life of healthy young men in summer time in Germany: A prospective controlled study. Appetite. 2017;111:38–45.