Diabetic Living: 10 Ways to Protect Your Heart

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India’s first and only magazine about diabetes

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CONTENTS

MAR-APR 2017

14

FEATURES

THRIVE 14 10 WAYS TO PROTECT YOUR HEART The good news is that staying hearthealthy can be fun.

17 AUTOMATED INSULIN

DELIVERY: YOU NEED TO KNOW The FDA has approved the first hybrid closed-loop system, formerly called the artificial pancreas.

20 NEW DIABETIC MEDICATION Different medicines on offer for the treatment and control of diabetes.

24 ONLINE SESSION WITH A

DOCTOR Interview with Dhruv Suyamprakasam, founder and CEO of iCliniq.

WELLBEING 28 HUMAN EMBRYONIC CELLS

FOR DIABETES Treatments associated with stem cells have been gaining immense popularity.

Here’s how that works...

32 DECLUTTER YOUR PATH TO

BETTER HEALTH How to target problem areas where clutter gets in the way of your diabetes management goals?

37

37 THE BONE OF CONTENTION

Conditions of bones may deteriorate when coupled with diabetes.

40 LOW SPERM COUNT CONCERN

Half of the infertility cases in India are because of the quality of sperms in men

ON THE COVER

40

photo Blaine Moats styling Jennifer Peterson

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MAR-APR 2017

FITNESS 44 HEALING GLUTEUS

MAXIMUS The biggest of your three butt muscles may be responsible for your lower back issues.

48 NEW EXERCISES FOR THE SEASON It’s time to get fit with the latest fitness regimes.

48 FOOD

NUTRITION 54 NAVIGATING THE NEW

NUTRITION LABEL As the nutrition facts label receives a makeover, get the dish on changes and how they can help you make smarter choices.

56 IS YOUR ORGANIC

66 WHAT’S IN SEASON:

ASPARAGUS This low-carb, versatile vegetable’s folate content may help lower your risk of heart disease, and its fibre keeps your gut in good health.

72 TABLE FOR TWO:

PURCHASE SAFE? Are the seemingly biotic goods and cosmetics all natural and safe for use?

ITALIAN Our made-over classics are light in calories and carbohydrate but full of flavour in every bite.

58 FATTY ACIDS:

76 A HEALTHY CATCH

62 TELL ME WHAT TO EAT

89 SWEET ENDING:

OMEGA-3 Omega 3 fatty acids are one of the most essential nutrients for the development of the human brain and body.

A nutritious way to cut calories is the Mediterranean diet, one of the three dietary plans approved by the USDA.

India’s #1 & only magazine on diabetes with maximum reach MAR-APR 2017

diabeticlivingonline.in

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ways to PROTECT YOUR HEART

TABLE FOR TWO Italian Classics

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2 Diabetic Living

GUIDE TO ABBREVIATIONS Educators. ADA: American Diabetes Association.

CDC: U.S. Centers for Disease Control and Prevention. FDA: U.S. Food and Drug Administration. NIDDK: National Institute of Diabetes and Digestive and Kidney Diseases. NIH: National Institutes of Health. PWD: person with diabetes. USDA: U.S. Department of Agriculture.

mar-apr 2017

INSIDE COVER Editor’s Letter

3

Advisory Board

4

Recipe guide

82

66 24

TRUFFLE SHUFFLE Made with rich dark chocolate, just one truffle will satisfy a sweet craving.

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IN EVERY ISSUE

You’ll boost your heart health with omega-3 fats and lower your risk of type 2 diabetes with each bite of these foods from the sea.

LIVING AADE: American Association of Diabetes

BOOST YOUR HEALTH

62

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INDIA

FROM THE DESK Most people residing in the Indian metros have their roots in smaller towns in the nooks of Indian states. But the longer the duration of stay in the cities, the hazier the memory of basic problems in the rural structure. This holds true with almost everyone and the pattern bears the sole responsibility of a shift in analysing an issue at a macro rather than a micro level, including our policy makers. The 2017 budget allocated an additional `10,600 crores towards health, which makes the new number a trivial .29 per cent of the GDP spent by the union government. Even when combined with the state’s expenditure towards health the numbers still remain as low as 1.2 per cent of the GDP, whereas WHO recommends governments to spend between 2.5 to 5 per cent of the GDP towards health. This gives rise to more serious problems in rural India than it does in cities, and hence demands immediate addressal.

In the light of this, I found the concept of online platforms that connect patients with doctors a very impressive one. Patients can connect with the best doctors from all over the world at a nominal fee to get a decent diagnosis in an atmosphere where doctors only play a cameo in their primary or community health centres. iCliniq is one such online doctor consultation platform (p. 24) that provides this service, but what intrigues me the most about this portal is that they’ve made an effort to penetrate the rural India where internet and phones are still considered a luxury. In a pilot project running in West Bengal they’ve tied up with a travel agent who enables villagers to consult with doctors online. We need more of such programmes to run so that a sturdy healthcare system may be established across the country.

The current issue is dedicated to new developments in medicine, FDA approvals and technologies that will help you lead a life as close to normal as possible. The regular sections remain succulent with recipes around the vegetable of the season asparagus, Italian cuisine and aquatic animals; new fitness regimes and expert tips on nutrition.

Don’t wait for sickness to value good health. Cherish every moment of a thriving health and do everything possible to maintain it.

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Diabetic Living India (DLI) magazine is printed and published by Nitin Agarwal on behalf of TCG Media Limited. Printed at: TCG Media Limited, DLI magazine is published bi-monthly. DLI magazine is a trademark of Meredith Corporation and TCG Media Limited. The entire content of DLI magazine are copyrighted to Meredith Corporation and TCG Media Limited. All rights reserved. The writing, artwork and/or photography contained herein shall not be used or reproduced without the express written permission by TCG Media Limited. TCG Media Limited or any employee(s) does not assume responsibility for loss or damage of unsolicited products, manuscripts, photographs, artwork, transparencies or other materials. TCG Media Limited does not assume any liability for services or products advertised herein. Disclaimer: DLI is not responsible nor liable for any advice, course of treatment, diagnosis or any other information, services or products that you obtain through this magazine.

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INDIA

Editorial advisory board The following health care professionals—all experts in diabetes management— review articles that appear in Diabetic Living ® magazine: Connie Crawley is a nutrition and health specialist for the University of Georgia Cooperative Extension Service in Athens, specialising in diabetes and weight loss.

Connie is a member of the American Dietetic Association Diabetes Care and Education practice group.

Marion J. Franz has authored more than 200 publications on diabetes, nutrition, and exercise, including core-curriculum materials for diabetes educators. Marion is a member of the American Dietetic Association Diabetes Care and Education practice group.

Joanne Gallivan is executive director of the National Diabetes Education Program at the National Institutes of Health. Joanne is a member of the American Dietetic Association Diabetes Care and Education practice group.

Marty Irons practises at a community pharmacy and has served in industry and the military.

Jeannette Jordan works for the Medical University of South Carolina in Charleston and consults with the Centers for Disease Control and Prevention.

Irene B. Lewis-McCormick is a fitness presenter and educator. Certified by the nation’s leading fitness organisations, she is a faculty member of the American Council on Exercise.

Chris Smith, The Diabetic Chef ® is the president of Health Range, Inc., and a professionally trained chef. He is a food consultant and cookbook author and conducts healthy-cooking classes.

Hope S. Warshaw is a writer specialising in diabetes care. She has authored several American Diabetes Association books. Hope is a member of the American Dietetic Association Diabetes Care and Education practice group.

Fred Williams practises endocrinology and specialises in diabetes. He is an active member of the American Association of Clinical Endocrinologists and serves on the board of directors.

John Zrebiec is director of Behavioural Health Services at the Joslin Diabetes Center in Boston and a lecturer in the department of psychiatry at Harvard Medical School.

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INDIA

Editorial advisory board, India The following health care professionals—all experts in diabetes management—review articles that appear in Diabetic Living® magazine’s India edition: Decorated with the Padma Shri and BC Roy award, Dr. Anoop Misra is Chairman, Fortis-CDOC Center of Excellence for Diabetes, Obesity, Metabolic Diseases, and Endocrinology, in New Delhi. He is also Chairman of the National Diabetes, Obesity and Cholesterol Foundation (N-DOC) and Director of the Diabetes and Metabolic Diseases, Diabetes Foundation of India. Dr. Misra has led several pioneering research studies on diabetes and has published more than 300 research papers.

Dr Ambrish Mithal MD, DM: (Padma Bhushan Awardee 2015) Member Governing Council, Indian Council of Medical Research (ICMR), Doctor of the year DMA 2005, cited in the Limca Book of Records since 2005 - is presently the Chairman and Head of Endocrinology and Diabetes Division at Medanta, the Medicity where he has established one of India’s premier diabetes and endocrinology centres.

Dr. V. Mohan is Chairman and Chief Diabetologist of Dr. Mohan’s Diabetes Specialities Centre and President & Director of Madras Diabetes Research Foundation, Chennai. He has published over 600 papers in prestigious peer reviewed journals and contributed over 100 chapters to text-books on diabetes. He has received the prestigious Dr. B.C. Roy National Award, and Fellowships from all the four Royal College of Physicians of London, Edinburgh, Glasgow and Ireland.

Dr. Shashank R Joshi is a well-known endocrinologist in Mumbai. He is president of the All India Association of Advancement for Research in Obesity and vice president of the Association of Physicians of India.

Padma Shri and BC Roy awardee Dr. KK Aggarwal is an eminent name in cardiology. President of the Heart Care Foundation of India and editor-in-chief of the Indian Journal of Clinical Practice, Dr. Aggarwal has a keen interest in mind-body healing. He is a regular columnist and expert for both print and television networks.

Rekha Sharma is director of Clinical Nutrition and Dietetics at the Diabetes Foundation of India.

This former chief dietician of the All India Institute of Medical Sciences in New Delhi has devoted several years of her life to the study of diabetes management.

Madhuri Ruia is a nutritionist and fitness expert in Mumbai. A certified pilates expert from the Pilates Institute of UK, she runs Integym, a state-of-the-art centre that promises ‘intelligent fitness’ to its clients.

Dr. DS Chadha is head of cardiology at the Command Hospital in Bengaluru. He has won dozens of awards, written several research papers in leading medical journals and chaired several national and international conferences on health issues.

Working Committee Dr. Swati Bhardwaj is vice head at the Center for Nutrition and Metabolic Research and a nutritionist with the Diabetes Foundation (India) and National Diabetes Obesity and Cholesterol Foundation (N-DOC).

Shubhda Bhanot is a certified diabetes educator and a nutritionist with 14 years of experience in the field. A life time member of ADE (Association of Diabetes Educators), she is presently working as chief diabetes educator at Medanta, The Medicity, Gurgaon.

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READERS’ WRITE

2

1

WINNER

I love the changes that you have made to the layout of the magazine. It is not just more visually appealing, but I think it’s even better to read now.

As always the recipes were very ingenious, but I somehow managed to goof up the seemingly simplest thing, lemon-ginger tea.

Mine turned kind of bitter because of boiling the lemons with the water.

Please let me know if I’m doing something wrong.

Sulabh Sah - Gangtok

It’s all in the gut The article ‘Gut Check’ on why and how to build a healthy gut was very interesting. My grandmother used to tell me that there are good bugs in our stomach that help us digest us food and it was remeniscent of her stories when I read this article. The bacteria in the belly serve so many purposes, including a coordination with the brain. It was just amazing to know all this.

Deepti Bhalla - New Delhi

3

An old school connnection Despite having read a lot of articles online on ways to boost one’s immunity and tips to improve the overall health, somehow I have always been more inspired by your articles. May be I am old school and still respect the printed word than anything on the internet. Thank you for being there as a loyal friend.

Anuradha Pathak - Mumbai

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MAR-APR 2017

LIVING fort LIVING

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ways to PROTECT YOUR HEART

TABLE FOR TWO Italian Classics

A S K

Y O U R

E X P E R T

Dr Anoop Misra

Chairman, Fortis-C-DOC (Centre of Excellence for Diabetes, Metabolic Diseases and Endocrinology); Chairman, National Diabetes,Obesity and Cholesterol Foundation (N-DOC)

QA

Q1

+

If you are on oral medicines you may test your blood sugar less frequently, but not so if you’re on insulin.

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How should I handle my diabetes when I am not feeling well and have no appetite? I have quit taking the medicine that releases insulin during meals, because I am not eating anything. Am I doing right?

Food and blood sugars have a directly proportional relationship. Even if your appetite is low, medications need to be continued. However, you can adjust the dosages of your medications as advised by your physician. Your doctor may advise you to lower the ones which release insulin. It is important to take small and frequent meals and plenty of fluids when the appetite is low.

Q2

I was recently diagnosed with Type 2 diabetes. How long after my meal should I check my blood sugar levels?

A holistic management of diabetes requires frequent monitoring of blood sugar levels to know whether your diabetes is on the right track. If you have been recently diagnosed with diabetes, then this becomes an important part of your routine.

For the initial few weeks, it is important that you monitor blood glucose levels regularly.

Generally, pre- and post-meal (two hours after start of the breakfast, lunch or dinner) sugars are checked. If you are on oral medication, you can check blood sugar less frequently. But if you’re taking insulin shots, you may need to check more frequently, depending on your physician’s instructions.

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Q + A

Q3

Do artificial sweeteners have any harmful effects?

Because artificial sweeteners are many times sweeter than table sugar, smaller amounts are needed to create the same level of sweetness. There are some health issues associated with the use of artificial substitutes. • Certain studies have shown aspartame consumption to be linked with neurological problems, headaches; allergic reactions, etc. have been reported by a few patients.

It is advised that patients with PKU (phenylketonurea) should avoid it. • Studies have also shown that saccharine causes bladder cancer in rats. • Other sugar alcohols, e.g. sorbitol, xylitol, mannitol, maltitol, etc. may cause bloating, gas or diarrhoea, if consumed in large quantity.

In general all have been approved by FDA as fairly safe if consumed in recommended quantity.

Q4

10 Diabetic Living

How does salt affect diabetes?

An increased total body sodium and enhanced vascular reactivity are found in people with diabetes. Most type 2 patients are salt sensitive. Thus, they are at greater risk for developing high blood pressure. High levels of salt (sodium) in the diet can further increase that risk. For this reason, diabetics are encouraged to avoid high-salt foods like canned soups and cured or processed foods.

mar-apr 2017

Q5 Can diabetics consume alcohol?

Alcohol consumption by diabetics can worsen blood sugar control. Although alcohol takes less than five minutes to get into the bloodstream, it takes two hours to metabolise one drink in the liver. Alcohol can cause hypoglycaemia from minutes after the first drink up within 12 hours of drinking. Conversely, long-term alcohol use in well-nourished diabetics can result in excessive blood sugar levels. Heavy drinking can also cause accumulation of certain acids in the blood that may result in severe health consequences. Further, alcohol consumption may also result in fat metabolism, nerve damage, and eye disease. A moderate amount of alcohol intake, about 2 small drinks (1 drink is equivalent to 30 ml whisky/gin/vodka or 120 ml of wine or 300ml of beer) is not discouraged. However, appropriate advice regarding drug intake and hypoglycaemia needs to be given to these patients.

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The treatment is also used for Hemiplegia, Paraplegia, Diabetic Foot, Diabetes, Anti-Aging, Lung Disease-COPD, Live Disease, Cirrhosis, Liver Failure (an alternative to a liver transplant) and Kidney Disease.

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MANAGE

“It is part of the cure to want to be cured.”

—Roman philosopher Seneca

GOOD TO KNOW

10

WAYS TO PROTECT YOUR HEART

Diabetes and heart issues often go hand in hand.

The good news is that staying heart-healthy can be fun. Tennis, anyone?

2 PLAY A GAME

writing Michelle Theall

1

HIT THE SACK

Getting enough sleep is an important part of a healthy lifestyle. If you regularly wake up unrefreshed despite a good night’s sleep, talk to your doctor about the possibility of a sleep disorder, which may increase your risk for heart disease.

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Thirty minutes of exercise five days a week lowers the risks for heart attack and stroke.

—AHA

You don’t have to be good at tennis to enjoy practicing hand-eye coordination while socialising and burning around 400 calories per hour. According to the AHA, physical activity helps you lose weight, which makes it easier for your heart to work efficiently and improves your quality of life. Set a date for racquetball, Frisbee, badminton, croquet, golf—you might not even notice you’re exercising.

GOOD TO KNOW

4

3

GO NUTS Squirrel away a handful of nuts or a packet of squeezable almond butter for a powerful snack that’s rich in hearthealthy omega-3s. Walnuts and almonds pack the biggest punch, but hazelnuts, pecans, and pistachios boost HDL (good) cholesterol levels, too.

Bonus: Chopped nuts add flavour as a salad topper, and spreads are perfect for apple or celery dipping.

One serving of nuts equals a small handful (1.5 oz.) of whole nuts or 2 Tbsp. of nut butter.

STOP SMOKING

Smoking damages your heart and lungs, which is among the reasons why it’s the most preventable cause of early death in the United States.

Smokers are more likely to develop atherosclerosis— buildup of fatty substances in the arteries—which can lead to coronary heart disease and stroke. Quit smoking and you’ll have a higher tolerance for heart-healthy physical activity, too.

5

SIT AND KNIT Excessive stress can wreak havoc on your health, contributing to high blood pressure and making the heart work harder— potentially leading to a stroke. The AHA recommends sewing, knitting, and crocheting as go-to stressbusters. Need another reason to unravel the yarn? It’s hip to knit: Kate Middleton and Ryan Gosling have both been known to purl, twist, and rib.

6

SHAKE THE SALT HABIT

Sodium increases blood pressure, which taxes the heart.

Hide the table salt and control ingredients by cooking meals at home.

Goal: ≤1,500 mg sodium per day and remember that just a teaspoon of salt contains 2,300 mg.

7

CONSIDER A MED

High blood pressure is the most significant factor for stroke risk. While eating right, losing weight, and cutting back on salt can help, some people are genetically predisposed to hypertension.

Ask your doc if a medication might help control yours.

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If you’re over your healthy weight, losing as little as 5–10 pounds may help lower your blood pressure.

Take time to enjoy each bite of food and identify the ingredients and spices within a dish. Make conversation with others at the table.

Slow down. Eating with mindfulness gives your brain the time to register fullness, which means you’ll eat less.

Look for heart-healthy and nutrition-packed recipes, such as our yummy Blueberry Buckwheat Pancakes, packed with beneficial flavonoids, beta-carotene, vitamin C, and folate. Plus, foods rich in fibre may help lower your risk for heart disease, stroke, obesity, and type 2 diabetes.

Get the recipe online at DiabeticLivingOnline.com/ Pancakes.

SAVOUR YOUR MEALS

EAT PANCAKES!

photos Marty Baldwin (nuts, leash), Greg Scheidemann (yarn), Jason Lindsey (dogs)

Dog walking provides exercise and socialising for both you and your pooch.

Find more heart-smart recipes: DiabeticLiving Online.com/Heart

KNOW YOUR NUMBERS Below are general guidelines. Goals may be adjusted by your doc to fit individual needs.

Blood Pressure GOAL: <140/90 mmHg

10

GET A DOG

Or volunteer at the Humane Society or ASPCA. The CDC cites that pets can decrease your blood pressure, cholesterol, and triglyceride levels, adding to a hearthealthy lifestyle. Plus, petting an animal can lower stress hormones. In fact, an NIH-funded study showed that heart attack survivors with dogs lived longer than those without.

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Cholesterol GOAL: total <200 mg/dl, LDL (bad) cholesterol <100 mg/dl Blood Sugar GOAL: A1C <7%

TECHNOLOGY

Automated Insulin Delivery: What You Need to Know The FDA approved the first hybrid closed-loop system, formerly called the artificial pancreas. writing Bailey McGrath, Kaili Meyer

I

It’s finally arrived: the first version of an artificial pancreas. In fall 2016, the FDA approved Medtronic’s MiniMed 670G hybrid closed-loop system, making it the world’s first automated insulin delivery (AID) system (aka artificial pancreas). The system, prescribed by a doctor, automatically adjusts basal insulin to prevent highs and lows. For people with type 1 diabetes, it means improved glucose control and a better night’s sleep, though you’ll still need to enter carbs for boluses. Other companies developing AIDs include Tandem, Insulet, Bigfoot, and Beta Bionics, so more versions will be released in the coming years. The ultimate goal: a fully automated system.

HOW IT WORKS CONTINUOUS INSULIN THE 1 GLUCOSE 2 THE ALGORITHM 3 PUMP 4 PATIENT MONITOR (CGM) An algorithm The pump adjusts You do glucose

SPR 2017

A CGM measures interstitial glucose and sends readings to pump every 5 minutes.

(software) processes that info and calculates the correct dose of basal insulin.

and delivers basal insulin accordingly through the infusion site.

readings to calibrate the device and correct high glucose and enter carbs for meal boluses.

Mark Your Calendar!

The Medtronic 670G will be available to consumers this spring.

DiabeticLivingOnline.in

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COURTNEY LIAS Director of the Division of Chemistry and Toxicology Devices for the FDA

DL: Describe your job?

CL: I’m the director of an FDA division that regulates laboratory tests. One of its branches oversees diabetes diagnostic devices, regulating meters, CGMs, hemoglobin A1C tests, and these AIDs. DL: What does the deviceapproval process look like?

CL: We want to understand what PWDs deal with and how they use current devices.

Then we work with product developers to help them do the best study possible. We use that data to determine device effectiveness and safety.

mar-apr 2017

“HOW MUCH DOES IT COST?”

Pricing will be similar to other Medtronic pump systems. Patients on the MiniMed 630G will be first in line for the 670G and may receive a discount through the Medtronic Pathway Program. Learn more at medtronicdiabetes.com.

DL: The FDA approved Medtronic’s AID in onethird the usual time. How? CL: We communicated well with Medtronic, made sure our expectations were clear and that we knew what their approach was, and we were all in agreement. We’re willing to do that with the other companies, too.

DL: Why call them AIDs? CL: Everyone has different expectations for the term “artificial pancreas.” AID is more of a description of what they do.

WHAT TOOK SO LONG?

18 Diabetic Living

Our community on Facebook had questions about the AID. We answered.

MINUTES WITH COURTNEY LIAS

In 2006, AID was brand-new technology with major safety and efficacy concerns, and manufacturers didn’t have FDA’s expectations to study and develop it. So in 2011, JDRF worked with Congress to push FDA for AID development guidelines, which it released in 2012, giving manufacturers a clear map to a 2016 device approval. Source: Vincent Crabtree, Ph.D., director of research business development, JDRF

WE ANSWERED

“

10

“ ?

YOU ASKED

“WILL IT BE COVERED BY INSURANCE?” JOIN THE CHATTER! Like us on Facebook and become a part of our online community.

Medtronic is working with payers to get the AID covered. We’ll know more when Medtronic releases the product.

“CAN IT BE USED BY TYPE 2 PATIENTS?”

The Medtronic 670G is approved for people with type 1 ages 14 and up.

However, some companies plan to expand approval for their systems to people with type 2 on insulin therapy after receiving approval for type 1 use.

MED NEWS

What’s New in Diabetes Treatment writing Marty Irons, RPh, CDE; photo Jacob Fox

Make mine a combo!

Has insulin caused you to gain weight? Two new FDA-approved medications might help: Xultophy (from Novo Nordisk) and Soliqua (from Sanofi Aventis). Each contains a long-acting insulin paired with a GLP-1 agonist. Compared with insulin alone, these type 2 meds provide better blood sugar-lowering capability and result in more weight loss. Biggest risk: lowerthan-expected blood sugars. Other potential side effects include nausea, vomiting, and diarrhoea.

GENERICS

In October 2017, Teva Pharmaceuticals will release a generic version of Byetta (exenatide), a GLP-1 agonist, in a twice-daily pen.

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YOUR INSULIN MAY CHANGE Interesting news: CVS Health and UnitedHealth Group announced they will remove Lantus (insulin glargine) from their formularies in 2017.

Instead, patients may need to get prescriptions for the new biosimilar version, Basaglar. This change in coverage continues a trend to substitute generics—or, in the case of insulins, medications called biosimilars—for brandname drugs. At least one other biosimilar will be available soon.

Simplify your regimen Trying to limit the number of medication doses you’re taking daily? Consider Jentadueto XR. The FDA recently approved this once-daily, long-acting type 2 medication, a combination of metformin and Tradjenta (linagliptin).

If you’re already using Invokana (canagliflozin) and metformin, then there’s a new once-daily combo for you, too. The FDA has approved Invokamet XR. This updated formulation is available in four strength combinations. Ask your doctor or pharmacist if one is right for you.

News on pioglitazone If you took the med Actos (pioglitazone) and were concerned about the risk of bladder cancer, here’s good news: A recent study published in BMJ indicates that this diabetes drug does not increase the risk after all. Researchers in the United Kingdom followed nearly 375,000 patients with diabetes for almost three years. They found the risk of bladder cancer was the same whether or not a patient used pioglitazone.

In other recent research published in the New England Journal of Medicine, the drug was shown to reduce the risk of heart attack or stroke in patients who had a recent stroke or transient ischemic attack (mini stroke) and also have insulin resistance. Talk to your doc or pharmacist about possible side effects before use, including weight gain, edema, and low blood sugar.

COVERAGE WATCH With a new administration in office, stay up-to-date on health care coverage with the Affordable Care Act, Medicare, and Medicaid at healthcare.gov.

NEW DIABETIC

MEDICATIONS What are the different medicines on offer for the treatment and control of diabetes? Our expert lays downâ&#x20AC;Ś writing Dr. Uday Phadke

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Diabetes mellitus is a group of metabolic disorders characterised by hyperglycaemia or high blood sugar levels resulting directly from inadequate insulin secretion or defect in insulin action. Type 1 diabetes mellitus is an autoimmune disorder which results from the failure of the pancreas to produce enough insulin.Type 2 diabetes mellitus, which is more common, is primarily

a problem of progressively impaired glucose regulation due to a combination of dysfunctional pancreatic beta cells or insulin resistance, a condition in which cells fail to respond to insulin properly. Gestational diabetes is the third main form in pregnant women that occurs due to placental hormones reducing insulin sensitivity of cells.

Obesity, especially abdominal obesity, is the

major risk factor for type 2 diabetes caused due to low fibre and highfat/ carbohydrate diet and sedentary lifestyle. Indians, in particular, are at a high risk of developing diabetes and that too at a younger age. Apart from an ethnic background and family history of diabetes, impaired glucose tolerance and fasting glucose levels contribute to increased risk of type 2 diabetes.

Main symptoms of diabetes • • • • •

Disproportionate thirst Nocturia (excessive urination at night) Polyuria (frequent urination) Fatigue and lethargy Noticeable changes in weight (usually weight loss) • Blurring of vision • Headache and nausea • Mood changes, difficulty in concentrating and apathy

Diabetes-related complications Diabetes-related complications can be separated into two categories: • Microvascular complications involve damage to the kidneys (nephropathy), leading to renal failure; eyes (retinopathy), leading to impaired vision; and the nerves (neuropathy), causing sensory loss, pain and diabetic foot disorders that can result in infections and amputations.

• Macrovascular complications include cardiovascular diseases, such as strokes, heart attacks, and blood flow insufficiency to the legs.

Diagnosis of diabetes One of the following three blood tests can be used to confirm a diagnosis of diabetes: 1. Fasting plasma glucose (FPG) levels - a blood test after 8 hours of no eating.

2. Glycosylated haemoglobin (HbA1c) - to measure a marker of the average blood glucose level over the past 2-3 months.

3. O ral glucose tolerance testing (OGTT) - a test used less frequently that measures levels before and two hours after consuming food or a sweet drink (concentrated glucose solution).

ANTIDIABETIC MEDICATIONS People with both types of diabetes need medications to help keep their blood sugar levels normal. The types of drugs that can treat diabetic patients depend on the type of diabetes they have. Type 2 diabetes has several new drug treatment options known as oral antihyperglycaemic drugs or oral hypoglycaemic drugs. Healthy diet and exercise are important for the management of type 2 diabetes and remain an important part of treatment when medications are added.

Oral antihyperglycaemic drugs have three modes of action to reduce blood glucose levels: • increase insulin secretion by pancreas • increase effectivity of insulin • slow down the absorption of glucose These mechanisms were used by the drugs which have been in use for a long time. Nowadays newer drugs are available that have novel mechanisms of action in addition to the above ones. For instance, suppression of glucagon which is a diabetogenic hormone, promoting wastage of sugar through urine, and cleansing or reducing destruction of insulin in the body are some of the mechanisms of action of the newer drugs.

Each class of antihyperglycaemic drugs has a different adverse event or safety profile. Possible side effects are weight gain, diarrhoea, pancreatitis and more serious problems. Therefore, the medications are based on consideration of the adverse side effects, convenience, tolerability and expert opinions.

Metformin

Metformin is the most widely used oral antidiabetic and usually the first line of treatment. It reduces the amount of glucose released by the liver into the bloodstream and increases the cellular response to insulin. A metformin pill is usually taken twice a day. It is a low-cost antihyperglycaemic with mild side effects that can include diarrhoea and abdominal cramping.

Metformin is not associated with weight gain or hypoglycaemia.

Hydroxychloroquine

Hydroxychloroquine is related to the drug chloroquine and is currently used in the treatment of rheumatoid arthritis. This drug has also been found to be useful in treating diabetes. It works by reducing inflammation and reduces the degradation of insulin.

Hydroxychloroquine can only be used in patients with a normal retinal examination.

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Meglitinides

Meglitinides include repaglinide and nateglinide that stimulate the release of insulin by the pancreas. They are associated with a higher chance of hypoglycaemia and must be taken with meals three times a day.

Thus, this type of drugs is less commonly used.

Metformin

Metformin is the most widely used oral antidiabetic and usually the first line of treatment. It reduces the amount of glucose released by the liver into the bloodstream and increases the cellular response to insulin. A metformin pill is usually taken twice a day. It is a low-cost antihyperglycaemic with mild side effects that can include diarrhoea and abdominal cramping. Metformin is not associated with weight gain or hypoglycaemia.

Alpha-glucosidase inhibitors

Alpha-glucosidase inhibitors

Alpha-glucosidase inhibitors, like acarbose and miglitol, delay the absorption of glucose from the gut and hence are moderately useful in treating meal-related worsening of sugar.

However, they are not usually used as first-line drugs because of common side effects of diarrhoea and bloating which may reduce over time.

Alpha-glucosidase inhibitors, like acarbose and miglitol, delay the absorption of glucose from the gut and hence are moderately useful in treating meal-related worsening of sugar.

However, they are not usually used as first-line drugs because of common side effects of diarrhoea and bloating which may reduce over time.

Glitazones

Glitazones (also known as thiazolidinediones) increase the effect of insulin in the muscle and fat, and reduce glucose production by the liver. Pioglitazone and rosiglitazone are two most commonly available glitazones. These drugs can have the side effects of weight gain or swelling and may precipitate heart failure. These drugs are also said to increase the risk of fractures in postmenopausal women.

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Sulphonylureas

Sulphonylureas increase pancreatic insulin secretion. There are several drug names in this class, including Glimepiride, Glipizide, Glyburide, etc. In the case of sulphonylureas, the choice depends on daily dosing and the level of side effects. These drugs are associated with weight gain and hypoglycaemia.

Dipeptidyl peptidase-4 (DPP4) inhibitors

DPP4 inhibitors, also known as gliptins, stimulate pancreatic insulin by preventing the breakdown of the hormone GLP-1. They also reduce glucagon and maintain the blood sugar levels.

DPP4 inhibitors are weight neutral and act without causing large risk of hypoglycaemia.

These drugs do not increase the risk of hypoglycaemia. Mild possible side effects are nausea and vomiting.

Sodium-glucose cotransporter 2 (SGLT2) inhibitors

SGLT2 inhibitors, like empagliflozin, canagliflozin and dapagliflozin, work by inhibiting the reabsorption of glucose in the kidneys, causing glucose to be excreted in the urine.

SGLT2s show significant cardiovascular benefits and reduction in weight gain.

Side effects associated with SGLT2s include urinary infections, occasional hypotension especially in elderly patients and fungal infections of genitals.

Recent evidences implicate that combination therapies improve glycaemic control that offer potential advantages over monotherapy, including simplification of treatment regimens, improved adherence and convenience, and reduced costs. The combination therapies not only help in maintaining blood sugar levels but also aid in risk reduction and treatment of diabetic patients with hypertension, chronic kidney disease and other comorbidities.

INSULIN THERAPY Type 1 diabetic patients cannot use oral pills for treatment and must take daily injections of insulin. Analogs of human insulin are manufactured to produce different actions and different preparations of insulin to provide a range of options in terms of how quickly they take effect, their peak time of action and their overall duration of effect.

• Rapid-acting insulin analogs, like glulisine, lispro and aspart have an onset of action at between 5-15 minutes, a peak action at 30-90 minutes and an overall duration of effect of 3-5 hours.

• Short-acting, regular insulin has an onset of action at between 30-60 minutes, a peak action at 2-3 hours and an overall duration of effect of 5-8 hours. The optimum time for injecting is 30 minutes before eating.

• Intermediate-acting insulins like neutral protamine Hagedorn (NPH) insulin have an onset of action at between 2-4 hours, a peak action at 4-12 hours and an overall duration of effect of 10-18 hours.

• Long-acting insulins (e.g. detemir and glargine) have an onset of action at between 2-10 hours, a peak action at 6-16 hours and an overall duration of effect of 16-24 hours. These insulins maintain glucose levels uniform over a 24-hour period.

Optimal insulin therapy requires an understanding of insulin pharmacokinetics that includes the insulin preparation, injection technique, site of injection, alterations in subcutaneous blood flow, and potentially, the presence and titer of anti-insulin antibodies. Continuous subcutaneous insulin infusion or insulin pumps are replacing the daily need for multiple injections. Inhaled insulins continue in development and various oral insulin

formulations have entered clinical trials.

However, long-term evidence on the safety of inhaled insulins still needs to be gathered.

Current guidelines and targets for the management of diabetes mellitus emphasise upon the importance of intensive treatment regimens to control blood glucose and reduce cardiovascular risk. Recent guidelines suggest that controlling blood pressure (target < 130/80 mm Hg) is vital to prevent or slow the onset of cardiovascular events associated with diabetes.

Managing lipid abnormalities is also crucial for preventing and managing diabetesrelated complications.

The pursuit of tighter glycaemic targets has encouraged the earlier introduction of insulin in type 2 patients and more intensive use of insulin in both type 1 and type 2 patients. Non-pharmacological management needs to be optimised to achieve the intended goal of lowering the glycaemic index in diabetics. Advances in anti-diabetic medications and gene therapy can help to reduce the pain and discomfort associated with diabetic-related complications.

Combination therapies help maintain blood sugar levels in safer ways.

DR. UDAY PHADKE MBBS, MD, DNB, DM (Endocrinology) FACE. He is a renowned Endocrinologist and Diabetologist & a Panelist at Docplexus.

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Online session

with a DOCTOR In conversation with Dhruv Suyamprakasam, the founder and CEO of iCliniq, an online doctor consultation platform. interview Siddharth M Joshi

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DL: What is iCliniq?

DS: iCliniq, part of Orane Healthcare, is an online doctor consultation platform and a global second opinion platform that brings doctors and patients together in real time through queries, phone and video consultation. The brand was launched in 2012, and we already have around 2,000 doctors across 80 specialities with a global presence in 196 countries.

DL: How does the system function? What is the technology that you use?

DS: Doctor consultation at iCliniq is done through three mediums, i.e. phone consultation, video consultation and posting health queries on the platform. Users can either choose a doctor of their choice or can let iCliniq assign a doctor to them. iCliniqâ&#x20AC;&#x2122;s video tool is end-end encrypted and is HIPAA (Health Insurance

Portability and Accountability Act) compliant. iCliniq phone consultation is very secure and private as it masks the phone numbers of both the doctor and the patient. Users can also opt for phone consultation where they can post health issues with symptoms, current medications and lab tests performed, if any.

They can choose time preference for the call and can also post health queries at the platform.

We have enhanced our platform with a bot on the messenger app.

We are also the first health care company in the world to have a bot on Telegram, an instant messenger app. With the help of the iCliniq bot, users can send their health issues with pictures and medical reports to doctors, any time. iCliniq is also available on Slack, a team messaging platform for working professionals.

DL: Who will benefit the most from such a platform?

DS: Expats and travellers benefit the most through our platform.

Also, we aim to have a wider reach in the rural India where accessibility of good doctors is still a challenge. In fact, we have done a pilot project in Durgapur, West Bengal where we tied up with a travel agent, who has set up five monitors for video consultations for villagers.

DL: How many patients have you dealt with so far?

DS: We have solved around 2.55 lakh health cases till date, with 90,000 patients from India and 75,000 patients from the rest of the world.

DL: Based on the queries you receive what is the pattern of healthcare needs in India that you have analysed?

DS: Gynaecology is the top most speciality on iCliniq, followed

by Internal medicine. Diabetes and hypertension are the most chronic disorders of the patients we have diagnosed in India so far. Preventive medicine, as a speciality, is getting evolved for lifestyle health issues like diabetes.

DL: How is iCliniq different from other online health consulting platforms?

DS: iCliniq has always maintained and emphasised on its quality of consultation and that is where we differ from other online health consultation platforms. We uphold the highest standards when approving physicians to practice in the online doctor consultation service. We stringently verify our online doctors to ensure they are fully licensed so that the care we provide will always be of the highest quality.

DL: How can a doctor register as a consultant with iCliniq?

DS: They just need to visit icliniq.com and register there.

Once they register, our support team will get in touch with the doctor to proceed to the next steps.

DL: Is there a scrutinising plan for including doctors in the panel?

DS: We have a stringent process of on-boarding doctors at our

We have solved around 2.55 lakh health cases till date, with

90,000 patients from India and

75,000 patients from the rest of the world.

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platform wherein we strictly verify doctor credentials. iCliniq has a quality assurance team to make sure that the doctors at the platform iCliniq asks the right questions from patients. iCliniq makes sure that doctors at the platform spends at least 50 per cent time for physical consultations outside as only then they will get a perspective cure online.

DL: How do you make sure that a sturdy quality control is maintained in the consultations?

DS: We did a research study by witnessing 3,000 consultations in person to see what is needed for the ‘best medical outcomes’ before launching the platform. We developed a quality process and that is our USP. We keep checking doctor’s answers and see whether they conform to our quality process. Our quality process also looks at the doctor’s tele-health savviness and if it’s not there, we work with the doctor to increase it.

DL: What are the different departments of healthcare that it offers assistance in?

DS: iCliniq offers assistance in more than 80 departments/verticals of healthcare. We receive great traction on departments like gynaecology, dermatology, internal medicine, general medicine, psychiatry, dentistry and sexology, to name a few.

DL: How much does it cost a patient to get a consultation done?

DS: Consultation fee ranges from Rs 99 to Rs 299, whereas the first query consultation at our platform is free of cost.

DL: Do you have a background in medicine?

DS: I am from an engineering background but the other co-founders of iCliniq, Dr. Madhan and Dr. Subha are from a background of medicine. Dr. Madhan is a leading surgical

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gastroenterologist. He is the president for IMA Erode and is very well connected with the doctor community.

Dr. Subha is a dentist.

We’ve done a

pilot project in Durgapur, West Bengal where we tied up with a

travel agent,

who has set up five

monitors for video consultation for villagers.

DL: How has iCliniq fared from the time of its inception so far?

DS: We have received international acclaim, having been ranked as the 4th Best tele-health portal in the world by Treato, an international data analytics company known for providing healthrelated insights and ranked 5th globally by one of the leading healthcare portal, Healthline. Recently, Investopedia ranked iCliniq in the list of top 5 companies in Telemedicine. iCliniq is the only Indian healthcare company to make it to the list.

DL: What were the challenges that you faced in the nascent stage of the company?

DS: The most important challenge was to onboard the doctors and to get the patients to trust the platform.

Convincing payment gateway about this concept was tough. Thanks to iCliniq’s technology, now it’s easier for other people who want to get into tele-health and also easier to get a payment gateway.

DL: What are the current challenges that you feel need to be addressed?

DS: Applying the marketing techniques of other industries does not work in health tech industry. Health-tech’s biggest problem is that it’s difficult to achieve word-of-mouth like how it happens in other sectors. Marketing of the product has to be carefully planned and executed to achieve growth.

Constant ‘trust’ building with the customer is important. Every customer, be it the doctor or a patient who uses the product, has to be taken into account. There are hundreds of good health-tech services/products which failed because of not taking efforts to build ‘trust’ by the entrepreneur.

WELLBEING

â&#x20AC;&#x153;Recognising that you are not where you want to be is a starting point to begin changing your life.â&#x20AC;?

HUMAN EMBRYONIC CELLS FOR DIABETES With several treatments doing rounds in the medicine world, the ones associated with stem cells have been gaining immense popularity. Hereâ&#x20AC;&#x2122;s how that works... writing Dr. Geeta Shroff

Diabetes mellitus (DM), commonly referred to as diabetes is a group of metabolic diseases in which there are high blood sugar levels over a prolonged period. The chronic disease is estimated to affect around 285 million people worldwide and this number is expected to reach 439 million by 2030. It is highly prevalent in people aged 40-60 years in developing countries whereas in developed countries it mostly affects people above 60 years. It is caused due to pancreas not producing enough insulin or the cells of the body not responding properly to the insulin produced. In fact, for many, diabetes means living with daily insulin injections and the possibility of long-term damage to their health.

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COMMON TYPES OF DIABETES There are two main types of diabetes mellitus: Type 1 results from the pancreas’s failure to produce enough insulin. This form was previously referred as ‘insulin dependent diabetes mellitus’ or ‘juvenile diabetes.’ Type 2 begins with insulin resistance, a condition in which cells

fail to respond to insulin properly. As the disease progresses a lack of insulin may also develop. It is responsible to be the cause of diabetes in 90-95 per cent of the affected people. This form was previously referred to as non insulin dependent diabetes mellitus or adult onset diabetes. Apart from

Smoking

Family history of diabetes or inherited tendency

Alcohol (risk increases with years of heavy alcohol use)

CAUSES OF DIABETES

Age (risk increases with age)

Abnormal blood cholesterol or triglyceride levels

High blood pressure

The surrounding factors may increase your chance of getting diabetes.

Autoimmune disease

genetic factors, other causes responsible for this form of diabetes is obesity, sedentary lifestyle, central adiposity and lack of exercise. It is important to note that consuming sugar does not cause diabetes. Eating a lot of sugar can lead to tooth decay, but it does not cause diabetes.

Being overweight (20 per cent or more over your desired body weight)

Physical stress (such as surgery or illness)

Use of certain medications, including steroids and blood pressure medications

Injury to pancreas (such as infection, tumour, surgery or accident)

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STEM CELL TREATMENT

However, in the last decade stem cell therapy has gained a greater momentum than other treatments as it has shown positive results. A 44-year-old male was admitted at our facility in 2006 with the diagnosis of DM. The patient was apparently doing well till 2001, until he developed persistent rashes on his body which were not responding to the treatment given. The patient also complained of increased thirst and urination frequency for a long time before the diagnosis.

On investigation, he was diagnosed positive for DM. Also, he was a strong suspect

of being diabetic as his mother too was a patient of diabetes.

The patient was a smoker and an alcoholic too. He had been taking oral hypoglycaemic drugs, including Insulin as per his doctor’s prescription.

Additionally, he was reported to be allergic to both wheat and dairy.

As part of a primary treatment, the patient was given hESC (Human Embryonic Stem Cell) therapy, wherein, he was put on a strict antidiabetic diet. Stem cells sourced from embryonic tissues, unlike adult stem cells, are not restricted to any particular tissue or organ and

are capable of producing all cell types to cure multitude of diseases. Thus, after the treatment, the patient felt stable, his blood glucose levels came under control and he was not allergic to wheat and dairy anymore.

TREATMENTS AVAILABLE Though several treatments and drugs are available to cure DM, none has really been 100 per cent successful.

People with type 1 diabetes must take insulin several times a day and test their blood glucose concentration three to four times a day throughout their entire lives. Frequent monitoring is important because patients who keep their blood glucose concentrations as close to normal as possible can significantly reduce many of the complications of diabetes, such as retinopathy (a disease of the small blood vessels of the eye which can lead to blindness) and heart disease, damage to blood vessels, kidneys and nerves that tend to develop over time and can be fatal. People with type 2 diabetes can often control their blood glucose concentrations through a combination of diet, exercise and oral medication. Type 2 diabetes often progresses to the point where only insulin therapy will control blood

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glucose concentrations.

Other treatments to cure diabetes include transplantation therapy, like • Whole pancreas transplantation (occasionally considered for people with type 1 diabetes who have severe complications of their

disease) • I slet cell transplantation (these are the cells of the pancreas that secrete insulin and other hormones), etc.

These transplants can enable the body to regain control of blood sugar levels so that administrating insulin is no longer needed. But none of the above treatments have been able to cure diabetes completely as many hurdles still remain in using these approaches on a wide scale. Firstly, islet transplantation is not very common because whole pancreas transplants involve major surgery and carry significant risk. Second, the number of donors is heavily outweighed by the demand and the islets have to be of good quality and in the right amounts. Also, transplants often require the immune system to be suppressed so that the new ‘foreign’ organ is not rejected. That’s why only type 1 diabetics are considered for this treatment.

METHODOLOGY Human embryonic stem cells used for the treatment are cultured and maintained in-house through our patented technology. The treatment approach is divided into phases followed by a gap period in-between.

Succeeding a gap period of 3-6 months, the subsequent treatment phases, T2 (3 to 4 weeks) and T3 (3 to 4 weeks) with the same dosage regime as T1 is followed. The treatment approach is repeated annually, if needed and any co-existing condition is also treated accordingly.

A gap phase of 3-4 months inbetween the subsequent treatment phases is decided to allow the injected hESCs to develop into mature cells and regenerate the affected part. The treatment periods T2 and T3 are incorporated to add more cells into the body, aimed at repairing and regeneration of the affected tissue.

The laboratory parameters of the patients are assessed prior to the

beginning of the treatment and then at regular intervals until the treatment ends. Trained physicians and nurses carefully observe all the patients for antigenic or prophylactic responses. The data for all the patients is validated by internationally acclaimed and accreditation companies. These companies are

allowed to examine the medical and statistical data present at the institute and are also able to meet the patients, if need be.

SUCCESS RATE The research and trials have proved that stem cells have the regenerative potential to repair beta cells, and secondly they can modulate the immune system by inhibiting the responses that lead to the autoimmune attack on pancreatic beta cells.

Hence following the hESC therapy, patients generally show improved quality of life, maintaining blood sugar levels within normal range with minimal insulin and oral hypoglycaemic drugs. Thereâ&#x20AC;&#x2122;s a marked improvement in their eye sight, stamina, mental focus ability and muscle strength too. Simultaneously, there is a reduction in

secondary side-effects of high blood sugar such as affectation of cardiac, kidneys, polyneuropathy, vision, etc. No adverse events and teratoma formation are observed post treatment.

With the result hESCs show good therapeutic potential in the treatment of patients with both type 1 and type 2 diabetes, as these cells do not just respond to glucose and secrete insulin, but they do so multiple times, thereby helping patients to lead a healthier, longer life.

DR GEETA SHROFF Director, Nu Tech Mediworld

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The Diabetic Living Plan to

Declutter Your Path to

BETTER HEALTH Are the spaces around you organised so the healthy choice is always the easiest one? Weâ&#x20AC;&#x2122;ll teach you how to target problem areas where clutter gets in the way of your diabetes management goals. writing Diabetic Living staff | illustrations Bee Johnson

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C

Clutter can do more than make it hard to find your keys, a good snack, or workout socks.

“Fundamentally, clutter is about avoidance more than anything else,” says Mindy Godding, a decluttering expert and certified professional organiser. “If you declutter and establish systems, it can help you live with intention. It’s empowering to be able to access what you need when you need it.”

In the same spirit, decluttering can help you better reach your health goals.

In this magazine, we often repeat the same three lessons: eat well, keep moving, and take your meds. It’s smart to arrange the spaces around you so it’s easier to do all three.

“Set up your environment so your habits are healthy,” says Melissa Joy Dobbins, M.S., RDN, CDE, of soundbitesrd.com.

We’ve put together an easy six-step system for decluttering with your well-being in mind. It starts, as always, with asking yourself what’s in the way of achieving your health goals. Then you’ll work on sweeping away those obstacles.

By the final step, you’ll have made your path to better health just a little more clear.

1 Choose a goal.

Grab a piece of paper and write down a health goal that’s been hard for you to achieve.

Our examples on the following pages will help you get started.

2

Tie it to a personal space.

Write down where this goal “lives.” Keep it narrow so your decluttering project doesn’t overwhelm you. For example, if you want to snack healthier, maybe your goal lives in the pantry. If you want to get to Zumba class on time, your goal might live in the closet where you keep your workout clothes. If you’re trying to better stick to your medication schedule but your supplies are all over the house, pick a place for that goal to live, such as a shelf in the kitchen cupboard.

3

What’s in your way?

What’s going on in that space that makes it hard to achieve your health goals?

Make a list of the clutter or obstacles that stand in the way of what you want.

4 Make a plan.

Think about ways to clear out chaos so that making the best choices will be easy.

Pinterest and BHG.com/Storage are great resources for organising and decluttering ideas. But remember: This isn’t about prettying things up. It’s about making your spaces work hard for your health.

5 Get started.

Put a date for your project on the calendar. You’re more likely to follow through if you make it official in writing. Next, make a list of supplies you’ll need. And then set a time limit so you’ll stay on task and won’t get too overwhelmed (another reason it’s important to pick an easy, manageable goal area).

6

Pat yourself on the back.

Choose a reward that motivates you to finish the project. Yes, you’ll get the benefit of a clear path for better health. But immediate rewards make any project more fun.

Read on for more examples of how to organise with your own health goals in mind.

DIGITAL TOOLS THAT CAN HELP i BrightNest

Custom schedules and how-to lists for all your cleaning, organising, and home tasks. A stylish interface and smart reminders (switch out the furnace filter!).

Free; brightnest.com i Todoist

This clean and simple task manager combines all the to-do lists scattered around home, at work, and in school into an ultimate master list. Add details such as due dates to tasks in-app or delegate some of the work to others.

Free; todoist.com i ChoreMonster

This goofy-fun app has both parental and kid versions—parents assign jobs, approve work, and designate rewards.

Kids log in to check for upcoming chores or the status of current ones, then earn reward points by completing them.

Free; choremonster.com i Tody

Enter your tasks for each room and this clever app will manage their frequency and remind you when to get cracking. Free for iPhone; todyapp.com

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EXAMPLE 1

“Reduce clutter to make good choices your autopilot.”

—Melissa Joy Dobbins, M.S., RDN, CDE, soundbitesrd.com

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EXAMPLE 2

“If you’re operating in chaos, everything becomes a last-minute decision.”

—Mindy Godding, decluttering expert and certified professional organiser

EXPERT TIP “Clutter is overwhelming and paralysing. So approach decluttering from a place of empowerment rather than burden.” —Jill Weisenberger, CDE, author of Diabetes Weight Loss Week by Week (ADA, 2012)

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EXAMPLE 3

“When everything is tidy, we can see choices clearly to support better decisionmaking.”

—Melissa Joy Dobbins, M.S., RDN, CDE, soundbitesrd.com

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THE BONE OF CONTENTION Conditions of bones may further deteriorate when coupled with diabetes. Itâ&#x20AC;&#x2122;s important to keep them healthy for a smooth life. writing Dr. Pooja Bajaj

P

People suffering from diabetes have a tendancy to develop nerve damage throughout the body and it also affects the circulation, resulting in joint pain and disorders. But in this article, we are throwing some lights on the increased risk of various bone and joint disorders due to diabetes. If you have diabetes, you are at increased risk of diverse bone and joint related disorders.

BONE WORRY

Areas affected by porous bones or osteoporosis: spine, wrist, hips

Osteoporosis means porous bones. It is a situation in which your bones become less dense, weak and more likely to fracture.

BONE HAS TWO TYPES OF CELLS: • Osteoclasts (cells which break down bone tissues) • Osteoblasts (cells that help to form bone) Due to high blood glucose level, there is a boost in aninflammatory response in the body which affects both types of cells. This process incites the activity of bone breaking cells and reduces the numbers of osteoblasts thus impairing bone formation.

However, there are drugs available in the market to control the glucose levels and improve the bone health.

As far as medicines are concerned, ‘Metformin’ is a prescription drug used to treat type II diabetes, while ‘Sulfonylureas’ are antidiabetic drugs commonly used in the management of diabetes mellitus type 2. Experts are of the opinion that these drugs have

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no side effects, plus there is no negative effect on bone health as well. In fact they protect against fragility fracture.

Osteoporosis means porous bones. It is a situation in which your bones become less dense, weak and more likely to fracture. It is a disease that can be prevented, but if undetected, it can grow for many years without any symptoms. Areas which majorly get affected by this illness are spine, wrist, and hips. Many people also develop leg cramps, specially at night while sleeping.

Symptoms grow at a snail's pace and can be hard to notice until the situation causes a bone to break or fracture, which is termed as ‘fragility fracture’.

Diabetes, being a disorder of metabolism, describes the way our bodies chemically transform the foods we eat into growth and power.

Diabetes symptoms can be so mild

that you won’t be able to notice them.

Often, there are no symptoms at all.

But when symptoms occur, they might include excessive thirst, fatigue, weight loss, tiredness, genital itching, thrush blurred vision, or frequent urination especially at night. In between, if you get wounded by any accident, then cuts and injuries would take a longer time to heal.

RISK FACTORS FOR DEVELOPING OSTEOPOROSIS • Smoking & drinking too much alcohol • Having a family history of osteoporosis or diabetes • Early menopause, post-menopausal or no menstrual periods • Not enough calcium in the body • Medications include glucocorticoids • Not getting enough physical activity

We all know that diabetes cases are increasing day by day. It is not just affecting the blood sugar levels, but also affecting the overall body.

Diabetes can create many other troubles, like impacting bone marrow cells, which can result in pain and disability. Lifestyle changes are recommended to those who are at high risk of diabetes. Pursuing a balanced lifestyle and doing a regular physical activity, can help prevent bone loss and rebuild bone.

STRATEGIES TO PREVENT AND TREAT OSTEOPOROSIS IN PEOPLE WITH DIABETES Nutrition. A diet rich in calcium and vitamin D is important for healthy bones. Low-fat dairy products along with dark green, leafy vegetables are good for health and treat osteoporosis.

Further, if one can include calciumfortified foods and beverages in their diet can also prevent the illness. There are many low-fat and low-sugar sources of calcium available in the market that one can take. Supplements can also help you meet the daily requirements of calcium and other important nutrients.

Exercise. Exercise is important for people with diabetes since exercise helps insulin lower blood glucose levels. The best exercise for bones is â&#x20AC;&#x2DC;weight-bearingâ&#x20AC;&#x2122;, some other exercises include walking, climbing and dancing. Regular exercises can help prevent bone loss, enhance balance with flexibility, reduce the falling and breaking of bones.

Swimming, work out with weights, pedal, and spin.

Medication and Yoga. There are several medications available that are approved by the Food and

Drug Administration to prevent and treat osteoporosis. For moderate-to-severe joint pain, there are nonsteroidal antiinflammatory drugs available, for example aspirin, ibuprofen (Advil, Motrin), or naproxen sodium (Aleve). Yoga is also recommendable to diabetic people suffering bone loss.

Healthy lifestyle. Healthy habits lead to a healthy lifestyle. Smoking, alcohol consumption is bad for bones, heart, and lungs. Heavy drinkers and smokers are more prone to bone loss and fracture. So one should avoid smoking and alcohol to manage diabetes well.

Regular exercises can prevent bone loss, enhance flexibility, and reduce the breaking of bones.

DR. POOJA BAJAJ Neuro Physiotherapist, AktivOrtho

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Low sperm count concern

With unhealthy lifestyle modifications there are rising cases of infertility among couples in Indian cities, half of which are attributed to the quality of sperms in men. writing Dr. Khsitiz Murdia

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L

Lifestyle-related issues are increasingly being accounted for rising infertility among couples. As implied in a recent report by the International Institute of Population Sciences, infertility is high in the metro cities of India. Our country has 15-20 million reported cases, a large number considering that there are about 60-80 million couples suffering with infertility in the world. However, as opposed to the conventional perception that infertility is a womenâ&#x20AC;&#x2122;s problem (in our society it is usually considered to be a social stigma as well); experts have noted that one-third of the cases involving infertility are concerning

emerging problems with men.

In this scenario, experts are now further probing reproduction issues such as sperm quality. Many factors, including lifestyle stress factors such as obesity and poor diet affect the quality of sperm production. Likewise, a nutritious diet can have a positive impact on the sperm quality. A healthy diet can boost the sperm production both in terms of quality and count.

Men should be made more aware of this fact. The society needs to come to terms with the fact that even though a woman carries a baby in her womb, the fathers have an equally pivotal role to play.

DIABETES AS A MAJOR FACTOR

One more lifestyle factor which affects men is diabetes. It is now categorised as a serious modern lifestyle disease.

The number of diabetes patients is likely to reach 70 million by 2025 (as published by the International Diabetes Federation). Most of these numbers are affecting the young adult population in India, a prime age bracket for reproduction. The rise in type 2 diabetes patients in India has led to an increase in obesity and an increased chance of suffering from heart disease. Proper diet, exercise and timely dosage of insulin keeps patients in check. Defective sperm DNA also occurs as a result of type-2 diabetes.

According to few medical researchers, it has been concluded that diabetic men have fragmented sperm cells. Volume of semen is clearly affected with diabetes.

Mitochondria, an organelle found in large numbers in most cells, in which the biochemical processes of respiration and energy production occur, was also found to be damaged (deletions of the DNA) in diabetics.

While the damage to the DNA in the sperm may adversely affect the male fertility and thus, the reproductive health condition; what’s more worrisome is the fact that even the capacity of the female egg to conceive or carry this sperm is restricted. As a result, increased fragmentation of the sperm will result in a necessary condition of embryonic failure and pregnancy loss. Fragmented or broken DNA may also lead to a higher incidence of miscarriage.

An early onset of the disease will obviously increase the chances of risks and chronic complications related to it. Also alarming is the fact that as you grow older, the complications associated with

diabetes become more severe.

A National Urban Survey in 2000 highlighted that the prevalence of diabetes in urban India in adults was 12.1 per cent. However, research is still being conducted to evidently draw a conclusion on the extent of damage to the sperm DNA as a result of diabetes; especially in comparison to damage caused by smoking or other lifestyle factors such as stress related disorders.

While diabetes is clearly one of the serious concerns which affect the DNA of the sperm, the bottom line remains that the infertility in men is measured by the sperm count, sperm quality, and the motility of the sperm. There can be other medical reasons too which stand strong for the cause, including ejaculation of semen, genital system cancer and as a result exposure to chemotherapy or radiation therapy.

According to medical experts, there are recognised treatments for the cause such as: • Medical (hormones, multivitamins and antioxidants) • Surgical (varicocle litigation in properly selected cases) • IUI (intrauterine insemination) • IVF (in vitro fertilisation)/ICSI (intra cytoplasmic sperm injection of eggs) However, there are clinical experts who still recommend certain basic lifestyle changes to make an impact before you consult a fertility specialist.

Lifestyle changes such as eating healthy can have a considerable impact on your sperm quality. Of course, we don’t discount the age factor, which affects the person’s ability of sperm to move. But, still a lot can be done to achieve the required improvement in the overall quality of the sperm.

HOW TO CORRECT THE SITUATION

• It is strongly recommended to follow

Damage to the sperm DNA may adversely affect the male fertility. a diet which is rich in sources of antioxidants. Antioxidants possess a high level of semen reactive oxygen which can play an important role in boosting the sperm quality.

Sesame, tomatoes, oranges and green leafy vegetables are super food sources of antioxidants.

• Taking regular doses of multivitamins, minerals and antioxidants also minimises the cell damage that reduces the risk of cancer.

• Zinc is clinically recommended for sperm health as it is a biologically important building block of the sperm cell.

• Consuming dark chocolate, a rich source of antioxidants and amino acids, has proven to double sperm and semen volume. On the flip side, high consumption can increase the risk of putting on weight, so just be cautions.

• One or two cloves of garlic a day can also spell magic as it contains allicin, which improves blood flow to the sexual organs and protects sperms from damage. It also improves the selenium count, an antioxidant that improves motility.

• Have sources of Vitamin A such as red peppers, spinach, apricots, sweet potatoes and carrots, as lack

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of this vitamin makes your sperm count low.

WHAT TO AVOID

Another crucial factor to consider is not to over-exercise as this may cause the temperature of the scrotum and testicles to rise, which can affect the quality of the sperm. Some experts have also advised to avoid rigorous cycling, too many sauna sessions, hot bathtub and even Jacuzzi. Even exposure to natural heat environments has to be monitored as excessive heat affects your body temperature.

Avoid smoking as even passive smoking has the potential to create abnormalities in the sperm cell, while causing damage to the sperm cell; avoid certain medications like steroids. Even excessive consumption of alcohol is considered harmful, and should be avoided.

Semen is considered to be optimally fertile when it contains more than 15 million sperms per milliliter.

That count can get adversely affected because of the aforementioned points such as testicles getting too hot, or when you're stressed out. Stress, in turn, can be a killer of sperms. Stress hormones have the potential to block leydig cells, which are tasked with regulating testosterone production. If you are too stressed out, you experience the risk of sperm production coming to a halt altogether.

By adopting a healthy lifestyle you can promote the cause of improved fertility, and thus have high chances of experiencing parenthood. If after one year of unprotected sex, your partner doesnâ&#x20AC;&#x2122;t get pregnant, then you should consider clinical counselling and expertise.

DR KHSITIZ MURDIA Fertility Expert, Indira IVF Clinic and Test Tube Baby Centre

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FOODS FOR IMPROVED SPERM COUNT AND OVERALL SEXUAL HEALTH Asparagus The vitamin C in the spring vegetable protects sperms from being damaged due to free radicals in the body.

Walnuts The omega-3 fatty acids increase the sperm count and also makes the blood flow to the penis more lucid.

Maca powder These tubers work wonders towards improving sperm motility and also increases the volume of semen per ejaculation.

Dark chocolate They contain L-Arginine, an essential amino acid that improves semen volume and the intensity of orgasms.

Carrots The vitamin A present in the roots helps improve sperm motility and sperm volume.

FITNESS

“It’s not what we do once— it’s what we do once a day…day in and day out… every day that brings lasting change into our lives.”

HEALING GLUTEUS MAXIMUS You may find the basis of your lower back issues hidden in the largest of the three butt muscles, gluteus maximus. Learning how it functions may help you strengthen it and absolve you of several physical problems. writing Dr. Vaibhav Daga

T

The largest muscle of the buttocks, known as gluteus maximus is distinctive in comparison with other primates and has evolved due to postural changes from being quadrupeds to bipeds. In humans, the gluteus maximus is attached to the dorsal ilium (hip bone) and due to its superior attachment, has an increased leverage. In a morphological study comparing baboon’s hind legs, the gluteus maximus was found to have relatively larger weight in humans. To maintain an upright position required for bipedalism this single joint muscle allows an increased force production.

Through evolution, the gluteus maximus has enlarged in order to stabilise the trunk while standing and to counteract the forces that

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tend to flex the trunk anteriorly while running and sprinting.

Consequently, this muscle may gradually lose tone due to our modern flexion lifestyle (bending forward or sitting). This has led to terms like ‘gluteal amnesia’ and ‘sleeping giant’ to become common phrases. These terms refer to a delayed activation and inhibition of the gluteal muscle, which in time weakens the muscle. Gluteal inhibition negatively effects performance and lower body strength and is also the root cause of many injuries and chronic lower back pain. Similarly, even lower body injuries result in delayed and reduced glute activation with concurrent hamstring and lower back compensation.

ROLE OF GLUTEUS MAXIMUS This muscle is important in many day-today activities such as walking, running and lifting, and plays a significant part in pelvic stability. Gluteus maximus has many different functions such as providing sacroiliac joint (SIJ) stability, strength during lifting and control in gait.

SIJ stability is provided by compression, by a self-bracing mechanism and

provides very little movement that contributes for its primary function of load transfer from the trunk to legs.

It also contributes to gait, and its ineffective functioning can compromise the gait cycle in many aspects. The muscle contributes most significantly in supporting the lower limbs through the vertical ground reaction forces during

the gait cycle, mainly the early stance phase from foot flat to just after contralateral toe off. During swing and stance phases, gluteus maximus contributes in hip extension and controls the rate of hip flexion. Further, the muscle action is not confined to the proximal hip joint only, but also controls more distal joints of the lower limb.

COMBATING THE GLUTEUS MAXIMUS Alterations in functions and properties of gluteus maximus have been found in association with kinetic chain changes of the lower limb due to pain or injury.

For example, an individual suffering from ankle sprain injury may show to have reduced activation levels of gluteus maximus, due to damage of the proprioceptive feedback loop via a lateral ankle sprain. It may alter postural control by changing muscle ring patterns in the lower limb muscles. Altered gluteus maximus activation patterns are not only limited to acute trauma. People who tend to suffer from lower back

issues often avoid painful movements and subsequently have reduced activity of gluteus maximus. This in turn decreases muscle endurance because of disuse. The associated changes which happen in the hip extensor recruitment pattern and lumbo-pelvic rhythm due to lower back pain, both to which the gluteus maximus muscle contributes. Gluteus maximus has also been found to fatigue faster in people suffering from lower back pain with avoidance of aggravating movements of the lumbar spine causing subsequent de-conditioning of the back and hip

extensor muscles. It is appropriate to investigate, therefore, not only the manner in which gluteus maximus performs during these everyday activities, but also how its function is transformed due to pathology or altered biomechanics.

A strain or tear of the gluteus maximus is also possible mainly during athletic activities, like while playing dynamic sports that require running, jumping and quick accelerations. The strain, graded as minimal, moderate or severe, correspond roughly to the severity of symptoms and time frame for healing.

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Aerobic exercises increase blood flow and oxygen delivery to the injured muscle and promote healing.

HEALING OF THE GLUTEUS MAXIMUS Like any other muscle strain, a minimal strain will heal faster than a moderate or severe strain and it can typically be managed with a normal initial treatment programme like PRICE (Protection, Rest, Ice, Compression and Elevation) or RICE (Rest, Ice, Compression, and Elevation ) protocol.

If the strain is moderate to severe, or if there is difficulty moving the hip joint, it may be a more serious injury and you should consult your doctor/sports physiotherapist. Severe tear may require surgery.

Rehabilitation for a gluteus maximus strain should include stretching, strengthening and aerobic activities. Gentle stretching helps in preventing stiffness in the muscle and surrounding tissues.

Aerobic exercises increase blood flow and oxygen delivery to the injured muscle and promote healing. Aerobic activities also warm up the muscle and allow for easier

stretching. Strengthening exercises should be incorporated so as to restore muscle functions fully. There is literature available suggesting that rehabilitation of gluteus maximus is an important strategy in the correction of lower limb biomechanics following injury or dysfunction. Increased fatigue levels in gluteus maximus highlights the need to incorporate this muscle in lower back pain rehabilitation as a strategy to minimise the potential cycle of pain avoidance behaviour.

A full squat and running on an incline require the greatest gluteus maximus function. During rehabilitation, start gradually and increase the intensity until you are able to do these 2 mentioned activities normally. Treatment of impairment needs to be incorporated into activities that can be repeated on a daily basis in order to have a carryover effect from physiotherapy to function.

EFFECTIVE EXERCISES IN REHABILIATION & STRENGTHENING OF GLUTEUS MAXIMUS

1

BURPEE JUMP-UPS Stand straight with your arms by your sides and your feet shoulder-width apart. Squat down with your palms face down on the floor. Then kick your legs behind you and do one push-up. Come back to the squat position by pulling your legs. Stand, and jump in the air with your arms raised above your head. Repeat 10 times.

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3

2

BRIDGE Lie down comfortably on your back with your knees bended and feet hip-width apart. Now bend your knees at a 90 degree angle so that your body is raised off the ground and your body weight is balanced between your feet and the upper back and arms. Squeeze your glutes for a few seconds and come back to the ground back to the initial position. Repeat a few times.

PACING ON BENCH WITH (OR WITHOUT) DUMBBELLS It is a replica of going up and down the stairs in an organised manner with or without extra weights. Place your foot on a bench with your body weight at the centre of your foot, then push your hips to stand tall and hold.

Come back to the ground and repeat with the other leg. Once you are comfortable with this pattern you can also do this with dumbbells.

4

SQUATS WITH (OR WITHOUT) DUMBBELLS Stand up straight with your feet should-width apart or slightly wider. Extend your hands forward for balance and sit back and down like you sit on a chair. Let your lower back arch slightly as you go down. Hold the position for a few seconds and come back to original position. If your back allows you can do this with some weights.

6

CABLE KICKBACK Stand up straight in front of a cable machine and bring the arm of the machine at the level of your ankle. Put one foot in the cable handle and pull it behind you with the cable, using your glute. Hold the position and return to the original position. Repeat this a couple of times before switching legs.

5

LUNGES WITH (OR WITHOUT) DUMBBELLS Stand straight with your hands on your hips (or with dumbbells in hands, whichever is the case).

Take a long step forward. Push up into a standing position, bringing your back foot forward.

Repeat with the other leg.

DR. VAIBHAV DAGA, Consultant head Sports & Musculoskeletal Physiotherapist, Prosport Fitness Centre

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writing Siddharth M Joshi

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EXERCISES FOR THE SEASON

NEW

Winters have faded away and the rising mercury mark on the thermometer tells you that soon all your accumulated fat is about to be exposed. Itâ&#x20AC;&#x2122;s time to get fit with the latest fitness regimes.

1

REFORMER PILATES Reformer Pilates is same as regular Pilates but used with a machine called a ‘universal reformer.’ The creator of this form of exercise, Joseph Pilates, also developed some machines and equipment to further enhance the effects of the workout. A universal reformer is a simple elevated bed-like structure with a sliding platform that can be pushed against a kickstand in order to move the platform along with your body. While Pilates is all about working against resistance, Reformer Pilates offer further resistance by making sure you don’t lax on yourself.

Benefits

• It helps you work on your core muscle area, thus providing overall strength.

• Your thighs, buttocks and legs get toned.

• It strengthens your pelvic floor muscles and hence your sexual stamina.

• It causes your muscles to tighten and limits your body’s range of motion, offering more balance.

“With Pilates, the second you’re done, you start burning calories.”

— Alycea Ungaro

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2

Benefits

• It saves a lot of time, as a 20-30 minutes session three times a week is enough to stay fit.

• No extra equipment is necessary.

• Weight loss is accelerated while there is no effect on muscle mass. The muscles, however, are strengthened.

• Your metabolism improves, as these exercises improve the production of human growth hormones.

HIGH INTENSITY INTERVAL TRAINING (HIIT)

Also known as Sprint Interval Training (SIT), this method of training is a form of cardio exercise. The purpose of such high intensity interval sessions are to speed up the process of burning calories in a short span of time, so you don’t have to spend long hours in the gym. All exercises involved are anaerobic in nature and provide the muscle groups less time to recover. A typical session of HIIT starts with a warm up, followed by several high-intensity exercises (sumo squats, jumping jacks, cross and front jabs on both sides), then a cooling down period. If you’re only an occasional guest at the gym you might want to do this under the supervision of a trainer.

ANIMAL FLOW Another no-equipment workout that is gaining immense popularity is Animal Flow that “mimics certain primal movements” and results in overall exercise of the body. It combines the movements of animals on four feet (quadrupedal) and other ground based movements with other elements of bodyweight training to make it a rigorous yet fun form of workout. You end up spending a lot of time with your weight on your hands that increases flexibility and stretching, providing all your muscles enough tension to strengthen with natural movements. It can be either done in groups in order to make the sessions more fun, or you may enrol for one-on-one classes for more focus. This may be the perfect alternative to your warm up and stretching sessions before you indulge in heavier exercises, or an independent drill in itself.

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3 Benefits

• It works on the neuromuscular front, thus making the body prone to better reactions towards both metabolic and physical efforts.

• The kinaesthetic awareness is increased because of working on all planes (up and down, side to side and traverse), which improves balance.

• One of the most fun exercises when done in groups.

• A lot of strength is gained when you lift your own body weight off the ground.

AQUA CYCLING

4 HOT YOGA This is an interesting variation of the original styles of yoga that were laid out by Patanjali. It started with Bikram Choudhury patenting a style that he devised and named Bikram Yoga in the US. It is a combination of 26 poses to stretch one’s body and calm one’s mind, practiced in a room with high temperature and humidity – 40 degree centigrade and 40% respectively. Several other methods, like Forrest yoga, power yoga and TriBalance yoga are also considered to be extensions of hot yoga. Apparently this was created to replicate the hot and humid conditions of India to in colder environs of the west. However, experts are divided in their opinion about the benefits and harmful effects of the practice. Make sure you consult your trainer before you venture into this.

Also known as aqua spinning, the technique involves a bicycle frame set inside a swimming pool where people involved mount them and pedal, with their bodies out of the water above the waist and their legs remain submerged. You are basically resisting against the water resistance, while staying fixed on a single spot inside the pool. This form was exercise was developed in Italy by a physical therapist. The studios that offer this style of exercise provide special rubber shoes for the participants. A typical session of aqua cycling lasts for 45 minutes, which includes continuous cycling for the duration without a break. It is slowly becoming a rage in the west as cycling inside water is comparatively easier as your knees produce less lactic acid.

Benefits

• It helps you get rid of your cellulite as cycling movements under water create massaging actions that invigorate and drain the lymphatic system.

• The buoyancy of water prevents injuries and falls, making it easier than regular cycling.

• The intensity of losing calories increases because of the resistance that water offers. A typical aqua cycling session causes 800 calories to burn.

• Being inside the water, there is a positive increase in your blood flow, circulation and breathing capacity.

5

Benefits

• It speeds up the process of detoxification which is induced by heavy sweating that flushes out toxins from the skin.

• Joanna Thurlow of Moksha Yoga Halifax claims that the heat allows you to go even deeper in your yoga poses by warming up the muscles.

• Director of Tula Yoga Spa, Isabel Lambert, says that working out in warmer conditions elevates heart rate which lets the body work harder.

• The poses help to heal old injuries and prevent them in future.

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NUTRITION “Life is too short not to eat raw and it’s even shorter if you don’t.”

IN THE NEWS

NAVIGATING THE NEW NUTRITION LABEL

The Nutrition Facts label received a makeover. Get the dish on changes and how they can help you make smarter choices in the grocery aisles. writing Bailey McGrath

Expect to see the new labels anytime.

Most will be updated by mid-2018.

A

After 20-plus years, the FDA has overhauled its Nutrition Facts label to reflect the latest research and dietary recommendations.

Nutrition labels can tell you a lot about what you eat, but reading them isnâ&#x20AC;&#x2122;t always so simple. With heaps of research pointing directly to diet as a major cause of obesity, heart disease, prediabetes, and type 2 diabetes, the updated label should help you make smarter eating choices (no more sneaky sugars!).

Big food manufacturers have until July 26, 2018, to update their labels; smaller ones will get an additional year.

At first glance, the new label (opposite) may look a lot like the old one, but there are major adjustments. Weâ&#x20AC;&#x2122;ll note the game changers you should pay attention to.

WHAT HAS CHANGED Let’s take a closer look at these label tweaks.

1

1 SERVING SIZE

2

It now reflects the amount typically consumed. For example, both 12 and 20 oz. sodas will list one serving because most people drink the whole bottle. But these aren’t recommended servings, so adjust how much you finish according to your food plan.

2 TOTAL FAT 3

NUMBERS TO KEEP IN MIND: Daily Value percentages on food labels are based on a 2,000-calorie diet. Yours will vary depending on age, gender, and weight. General daily recommendations:

3

MEN

CALORIES

Calories per serving are bigger and easier to read.

“Calories from Fat” is now gone because research shows the type of fat you eat is more important than the amount.

Saturated fat=unhealthy, unsaturated=healthy.

Weight maintenance: 2,000–2,200 cal.

4

Weight loss: 1,700–1,900 cal.

5

Daily added-sugars intake: Less than 9 tsp.*

4 ADDED SUGARS

Now you can find out how much sugar the manufacturer adds during processing under “Total Carbohydrate.” Unlike naturally occurring sugars found in fruits and milk, added sugars—such as white sugar, honey, and high fructose corn syrup—offer no nutritional benefit. Quick labelreading tip: 4 grams of added sugar equals 1 teaspoon.

5

VITAMIN D & POTASSIUM

These two nutrients have been added. The typical American diet is deficient in both. Vitamin D promotes bone health and boosts immunity, and potassium helps regulate blood pressure. Now vitamins and minerals are listed in grams in addition to % DV.

WOMEN GOOD-BYE, VITAMINS A&C

Manufacturers are no longer required to list vitamins A and C. The American diet used to be deficient in both, but most people now meet their daily quota.

Calcium and iron will stay on.

% DV QUICK TIP:

5%

is low.

Weight maintenance: 1,600–1,800 cal.

Weight loss: 1,300–1,700 cal.

Daily added-sugars intake: Less than 6 tsp.*

20%

or more is high.

*AHA recommendations

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IS YOUR

ORGANIC PURCHASE SAFE ?

At the time of immense pollution and use of chemicals in every product of daily need we tend to look for organic options of the same. But are these apparently biotic goods really all natural? writing Manisha Chopra

G

Going organic is the new fad in town. From opting for an organic diet to using organic cosmetics, people have slowly, but consciously shifted their preferences to all things natural.

While organic products are generally more expensive than their conventional counterparts, they are safe and eco-friendly.

However, not all products with labels that scream ‘organic’ may stand true to their claim.

Therefore, before heading to buy organic products, you need to do some quality research and learn to read the labels. Look for a certified logo of reputed bodies so that you’re sure that the organic products you buy really do have bonafide credentials. Check whether the products contain any harmful ingredients that can have a negative impact on the body. Enlisted below are a few harmful ingredients that should be completely avoided to get the very best of your organic purchase.

FORMALDEHYDE-RELEASING PRESERVATIVES Formaldehyde is a colourless and flammable gas that is widely used in cosmetic products to protect against contamination of bacteria during storage. The gas is commonly used in eyelash glues, soaps, make-up, shampoos, lotions, hair gels, nail polishes, etc. The chemical often triggers allergic reactions and its prolonged usage is bound to harm the brain and interfere with growth and development in children.

SULFATES Sodium Lauryl Sulfate (SLS) or Sodium Laureth Sulfate (SLES) are most commonly found in shampoos, face washes, shower gels, etc. They are used to create a thick lather, but they also absorb the moisture from the hair and skin. Constant use of sulfates can weaken the hair structure, thus leading to breakage. They have been used in studies to induce mutations in bacteria.

These sulfates can impair the structural formation of eyes and can cause permanent damage.

PARABENS Parabens are a group of chemicals extensively used as preservatives in cosmetics such as face, body moisturizers, body wash, mascaras, anti-aging serums and cleansers. Also known as Methyl paraben, Propylparaben and Butylparaben, the chemicals are a low-cost synthetic preservative that are widely used to extend the shelf life of the product, and also keep ingredients fresher for longer. Parabens may harm human health by contributing to the development of cancerous tumours.

COSMETIC PETROCHEMICALS Almost all skin care products contain synthetic substances like petroleum.

Therefore, when you buy a cosmetic product, check for ingredients such as paraffin wax, mineral oil, toluene, benzene, phenoxy-ethanol, etc. All these components are harmful for the body. Petroleum products are known to cause cancers and their excessive use has also resulted in anemia, kidney degeneration and nerve damage.

PHTHALATES Almost every product that is commonly used in our day to day life such as soaps, shampoos, perfumes, nail polish, hair spray and moisturizers contains phthalates. Phthalates are used as a plasticizer in products such as nail polishes (to reduce cracking by making them less brittle); di-methylphthalate (DMP), used in hair sprays (to help avoid stiffness by allowing them to form a flexible film on the hair); and di-ethyl-phthalate (DEP), used as a solvent and fixative in fragrances. Increased exposure to phthalates can have an adverse effect on human reproduction and development.

COSMETIC FRAGRANCE While all of us love soaps and other cosmetics that smell good, these artificial fragrances are made with low-quality synthetic chemicals which replicate the natural aroma of products that already exist in nature. Most products use synthetic chemicals to induce the fragrance, however, they can cause skin irritations and rashes.

MS. MANISHA CHOPRA, Co-Founder of SeaSoul Cosmeceuticals

LOOK FOR A CERTIFIED LOGO OF REPUTED BODIES SO THAT YOUâ&#x20AC;&#x2122;RE SURE THAT THE PRODUCTS YOU BUY REALLY DO HAVE BONAFIDE CREDENTIALS.

Omega 3 fatty acids are one of the most essential nutrients for the development of the human brain and body. Hereâ&#x20AC;&#x2122;s why... writing Dr. S Chakravorty

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K

Karitansh Prakash, a 45 years old Bengali went for a routine check-up. In his reports, it was found that he had significantly high triglyceride, normal LDL and HDL cholesterol values.

Since his triglyceride was significantly high, he was insisted to start with some medicines, which would reduce his triglycerides to acceptable levels.

Around 20 per cent of adults have an elevated triglyceride level. High triglyceride is usually asymptomatic unless triglycerides level exceeds 1000-2000mg/dl. We know that the risk of developing pancreatitis becomes high if triglycerides level is above 500 mg/dl. The data from a large metanalysis of prospective studies show a moderate and highly significant association between triglycerides and risk of coronary artery diseases and death. The use of pharmacological treatments is low and may reflect unrecognised importance of high triglycerides as a cardiovascular risk factor.

The statin therapy, widely accepted as the first line therapy with over the counter pharmacological agents, incompletely addressed the vascular risk attributable to elevated triglycerides and low levels of HDL cholesterol levels.

Over the years researches on essential fatty acids have given some clues regarding its essential effects on lipid lowering. It has been noticed through various observations that Eskimos and people living in Alaska have very low levels of atherosclerotic lesions in their

cardiovascular system.

This leads to further researches on essential fatty acids and polyunsaturated fatty acids. The biological source of this fatty acid, belonging to omega3 fatty acid are flax oil, canola oil and soybean oil, but most beneficial effects of fish oil, which are rich in Eicosa pentaenoic acid (EPA), Decosa Hexaenoic acid (DHA), and have

WHY DO TRIGLYCERIDES MATTER?

In the human body every calorie that is not immmediately required is converted into triglycerides which are in turn stored in your fat cells. When the body needs energy the hormones release them between meals.

less thrombotic and inflammatory metabolites.

These polyunsaturated fatty acid targets are on various inflammatory markers that inhibit or reduce various risk factors. Toxic metabolites and their effects on human body are markedly reduced in the presence of omega3 fatty acids.

Various researches have shown that Eicosa Pentaenoic acid

(EPA) and docosa hexaenoic acid (DHA) reduce intimal hyperplasia, blood pressure, blood viscosity and triglycerides. They also reduce electrical instability produced by that toxic metabolite.

Eicosa pentaenoic acid and docosa hexaenoic acid also have various protective effects in the form of increased HDL, increase in levels of LTD5, PAF and IL2.

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BENEFITS OF OMEGA-3 FATTY ACIDS BLOOD FAT(TRIGLYCERIDES) According to a number of studies, fish oil supplements can also cut elevated triglyceride levels. Having high levels of this blood fat is a risk factor for heart disease.

DHA alone has also been shown to lower triglycerides.

CARDIOVASCULAR HEALTH The role of omega-3 fatty acids in cardiovascular disease is well established.

One of the best ways to help prevent heart disease is to eat a diet low in saturated fat and to eat foods that are rich in monounsaturated and polyunsaturated fats (including omega-3 fatty acids). Clinical evidence suggests that EPA and DHA (eicosapentaenoic acid and docosahexaenoic acid, the 2 omega-3 fatty acids found in fish oil) help reduce risk factors for heart disease,

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including high cholesterol and high blood pressure. Fish oil has been shown to lower levels of triglycerides (fats in the blood), and to lower the risk of death, heart attack, stroke, and abnormal heart rhythms in people who have already had a heart attack.

DEPRESSION Researchers have found that cultures that eat foods with high levels of omega-3 have lower levels of depression.

Fish oil also seems to boost the effects of antidepressants.

It may help reduce the depressive symptoms of bipolar disorder also.

RHEUMATOID ARTHRITIS A number of studies have found that fish oil supplements [EPA+DHA] significantly reduce stiffness and joint pain. Omega-3 supplements also seem to boost the effectiveness of anti-inflammatory drugs.

• Diet and lifestyle recommendation from American Heart Association states that if you decide to use a supplement, discuss this treatment with your doctor first to make sure you are getting the benefits that you need.

• Experts usually recommend 1 gram (1,000 milligrams) of DHA and EPA combined from fish oil daily for those with heart disease. People with certain health conditions may take doses of up to four grams a day but only under a doctor’s supervision.

• The most common side effect from fish oil is indigestion and gas. Getting a supplement with an enteric coating might help.

• Fish, essentially oily fish is rich in very long chain of omega3 polyunsaturated fatty acid EPA, C20:5n3.

Consumption of 2 servings (8 ounces) per week of fish high in EPA and DHA is associated with a reduced risk of both sudden death and death from coronary artery diseases in adults.

• According to NHS, patients should be advised to eat at least 2-4 portions of oily fish per week if they are not achieving this and have had heart attack within past 3 months. Consider providing at least 1gm daily of omega-3 fatty acid ethyl ester treatment licensed for secondary prevention for post myocardial infarction for up to 4 years.

TIPS FOR SELECTION OF OMEGA- 3 FATTY ACIDS RICH FOOD

I am a vegetarian, so I do not consume any fish. But I get plenty of ALA (Alpha linolenic acid) in my diet, from canola and soyabean oil, ground flax seed, and walnuts. How efficiently does the body convert ALA to DHA and EPA? Should I take an algal DHA supplement?

Dinesh Pratap, 38

CHOOSE THE RIGHT FISH. While eating more fatty fish is a good idea, some are more likely to have higher levels of mercury, PCBs, or other toxins.

These include wild swordfish, tilefish and shark. Farm-raised fish of any type may also have higher levels of contaminants.

Children and pregnant women should avoid these fish entirely. Everyone else should eat no more than seven ounces of these fish a week. Smaller fish, like wild trout and wild salmon are safer for consumption.

If you are getting adequate ALA in your diet from oils and nuts, you may not require other EPA/DHA supplements.

Body partially converts ALA to EPA and DHA. The requirement can be assessed by measuring triglycerides level/EPA/ DHA level in the body.

CONSIDER EATING MORE FREE-RANGE POULTRY AND BEEF. Free-range animals have much higher levels of omega-3s than typical, grain-fed animals.

Consider a supplement like fish oil capsules or algae oil.

Fish oil contains both EPA and DHA. Algae oil contains DHA and may be a good option for those not tolerant to fish or for vegetarians.

TALK TO YOUR DOCTOR BEFORE USING A SUPPLEMENT. Before you start using any supplement, you should always talk it over with your doctor. He or she may have specific recommendations, or warnings, depending on your health and the other medicines you take.

Can omega-3 fatty acids be destroyed by high-heat cooking?

Sneha Vij, 25

DR. S CHAKRAVORTY MD, Sr. Consultant Physician, Metro Hospital, Noida

Not if the oil is fresh. In fact, even in frying oil that is used for days, you still can find ALA in it.

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TELL ME WHAT TO EAT

Breakfast:

1 serving Goat Cheese, Blackberry, and Almond Toast (p. 80) + ½ cup sliced strawberries + green tea with lemon slice

Midmorning snack:

1 serving Beet Hummus + 1 cup assorted vegetable dippers

Lunch:

1 serving White Bean Ragout + ¼ cup red grapes

Afternoon snack:

8 cherry tomatoes + 1 oz. mozzarella pearls + fresh basil leaves

Dinner:

Grilled Asparagus and Shrimp with Pasta

Dessert:

5 oz. red wine + 2 Tbsp. unsalted pistachios *This meal plan is ideal for people trying to lose weight. You might need more calories than this. Ask your health care team for a caloric goal that’s right for you.

1,500

- CALORIE

1-DAY MEAL PLAN

The Mediterranean diet is one of three dietary plans accepted by the USDA. Try it out with this one-day plan—it’s a nutritious way to cut calories. writing Caitlyn Diimig, RD; photos Marty Baldwin; styling Jennifer Peterson

TOTAL CAL 1,431, FAT 51 g (16 g sat. fat), CHOL 211 mg, SODIUM 1,417 mg, CARB 163 g (35 g fibre, 37 g sugars), PRO 67 g

FHMSTORE.COM

INDIA

INDIA’S FIRST MAGAZINE ABOUT DIABETES

India’s #1 & only magazine on diabetes with maximum reach MAR-APR 2017

diabeticlivingonline.in

LIVING

`100

BOOST YOUR HEALTH EAT MORE SEAFOOD

10

ways to PROTECT YOUR HEART

TABLE FOR TWO Italian Classics

32017030702

FOOD “Pull up a chair. Take a taste. Come join us. Life is so endlessly delicious.”

Fresh AsparagusTomato Salad, p. 117

asparagus WHATâ&#x20AC;&#x2122;S IN SEASON

This low-carb, versatile vegetable peaks in spring.

Its folate content may help lower your risk of heart disease, and its fibre keeps your gut in good health. recipes Laura Marzen, RD, LD | photos Blaine Moats | styling Jennifer Peterson

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Fresh Asparagus-Tomato Salad, p. 87 DiabeticLivingOnline.in

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Grilled BaconWrapped Asparagus with Spiced Glaze, p. 83

Panko-Parmesan Asparagus with Garlic Dipping Sauce, p. 83

Quick-cooking asparagus is made for appetizers. For a lower-fat take, wrap multiple spears in just two bacon strips, or bake in panko for low-carb crunch.

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Grilled Asparagus-Onion Crostini, p. 87 DiabeticLivingOnline.in

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ACE YOUR ASPARAGUS Get the most out of your green spears with these must-know tips:

i Buying

Fresh asparagus should be firm with dark green or purpletinged tips. If a bunch feels bendy, pass and find another. Look for plump, straight spears without dry ends.

i Storing

Make asparagus last longer by wrapping the ends in a damp paper towel.

i Prepping

Break off the woody root ends of asparagus before cooking. It will naturally snap where the root ends and the fresh part begins.

i Cooking

Cook asparagus until crisp-tender: easily pierced with a fork but still crunchy. If it cooks too long, it will be mushy and bitter.

Spring Asparagus Tart, p. 88

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LEMON BUYING AND STORING SIDEBAR This perfectly portioned pie boasts big flavor.

A few tricks for the preparation:

1

The scoop

Use a melon baller or spoon to scoop the flesh of each apple half, leaving an 1⁄8-inch-thick shell. Remove and discard seeds and core.

Grilled Asparagus and Shrimp with Pasta, p. 84

2 The cut

Using a 31/2-inch cookie cutter, cut four circles from the dough.

Discard trimmings or save for another use.

3The top

Here’s where you add your own twist. You can weave a lattice crust or place the whole circle on top, crimping edges and cutting vents. Play with the shape and design; see “Creative Crusts,” far right. Have fun with it!

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Chicken Pasta Primavera, p. 87

2

TABLE FOR ITALIAN recipes Colleen Weeden | photos Adam Albright | styling Jennifer Peterson

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Our made-over classics are light in calories and carbohydrate but full of flavour in every bite.

White Bean Ragout, p. 87

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GET SAUCY i Alfredo sauce is high in fat. Instead, toss your pasta primavera with our white sauce made with cauliflower. i Marinara can be high in sodium. Our version uses roasted red sweet peppers, fresh basil, and garlic for flavour without salt. i Pesto is often a calorie bomb, but we used almond milk to keep this dish light.

Chicken Parmesan with Broccolini, p. 86

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Flatbread with Pesto and Mozzarella, p. 88

For more diabetes-friendly Italian meals visit: DiabeticLivingOnline.com/Italian

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A Healthy

CATCH Donâ&#x20AC;&#x2122;t let preparing seafood and fish intimidate you and landlock your cooking. Take a note from our friends in the Northeast and enjoy these coastal classics. Youâ&#x20AC;&#x2122;ll boost your heart health with omega-3 fats and lower your risk of type 2 diabetes with each bite.

writing Caitlyn Diimig, RD | recipes Jennifer Stack, M.S., RD, CDE photos Adam Albright | styling Jennifer Peterson

Seafood Boil, p. 85

A BETTER SEAFOOD BOIL

New England’s favourite backyard party starts with heaps of seafood and veggies thrown into one big pot over the fire. Here’s how to do it right.

1 Develop flavour.

Don’t peel your shrimp before cooking. The shells deepen the flavour.

You can remove them as you eat—it will be messy, but worth it. To serve, sprinkle with paprika and lemon juice for flavour without salt.

2

Control carbs.

Cut corn cobs into thirds and mix the traditional potato chunks. Cut bread at a 45-degree angle so slices look larger.

3 Manage mess.

For a traditional boil, strain broth and spread food onto parchment or newspaper. Provide bowls for everyone to discard shrimp and clam shells.

Fish and chipsâ&#x20AC;&#x2122; popularity ballooned during the Industrial Revolution. The cheap eats were perfect for blue-collar workers needing a quick lunch.

Crispy Fish and Chips, p. 84

New England-Style Hearty Clam Chowder, p. 84

Shrimp Lettuce Rolls, p. 86

SLIM IT HOW WE MADE OVER DOWN THESE COASTAL CLASSICS Fish and chips

We trimmed calories from this British mainstay that immigrants brought across the pond by using cereal for the crunchy breading. Use sweet potatoes to amp up vitamin A intake.

Clam chowder

Chowders are typically a simple, cream-base soup filled with seafood, potatoes, and corn. These were abundant ingredients for East Coast settlers and easy to throw together and simmer on the stove while other work was getting done. Our version uses low-fat milk and vegetable stock to reduce calories. To keep carbs in check, we swapped the corn and potatoes for fibre-packed lima beans.

Shrimp rolls

Folklore says fishmongers invented lobster rolls to use up cheap pieces of the crustacean that merchants and big-city restaurants didn’t want.

Today, since lobster isn’t always cheap or easy to find, our recipe calls for shrimp. Instead of mayo and butter, we use light mayo, tofu (trust us!), croutons, and lettuce wraps.

Sea scallops

Scallops are a bivalve—the “meat” is encased between two shells, which is almost always removed before market. Healthy and rich-tasting on its own, this coastal favourite just needs a quick sear—not much salt, breading, or fat is necessary.

Crab cakes

We’ve added salmon to our crab cakes. While haddock might be a more familiar fish on the East Coast, salmon boasts omega-3 fats, which studies show decreases risk of death from heart disease. Serve these cakes with our yoghurt-base sauce—it contains less unhealthy saturated fats than tartar sauce.

Native Americans taught New England settlers how to make succotashâ&#x20AC;&#x201D;a dish of corn and beans. We make it easy by seasoning a mix of frozen vegetables.

Scallops and Succotash, p. 85

HOW TO BUY SEAFOOD AND FISH

Salmon and Crab Cakes, p. 85

If you’ve never bought scallops, clams, or a new type of fish, we have a few tips to help you shop smart.

1 Fresh insight

Buy dry-packed sea scallops (not bay scallops) that are sized U/15 or U/10. For fresh clams, ask if they’ve been cleaned or if you should do it yourself.

Live clams should be closed. If not, give them a tap—if they don’t shut, discard. Rule of thumb: Fresh fish shouldn’t smell “fishy.”

2

Frozen know-how

Most “fresh” fish and seafood has been frozen at some point, so you can save cash by shopping the freezer section. Avoid any fish or seafood that appears to be freezer-burned.

Buy shrimp head-off in the shell. Shrimp is sized by the number per pound—a small number means big shrimp.

3 Expert help

Chat up your store’s fishmonger. Ask how to store, clean, and prep your seafood (they can usually do cleaning and prep for you, too). And always ask how long a purchase will stay fresh.

RECIPE GUIDE High-standards testing This seal assures you that every recipe in this issue has been tested by the Better Homes and Gardens® Diabetic Living® Test Kitchen. This means each recipe is practical, reliable, and meets our high standards of taste appeal.

SAVVY INGREDIENT SWAPS

Many recipes are adaptable. You can substitute what you have on hand for what you’re missing. Here are a few swap ideas to get you started.

SHALLOT

ONION

CAPERS

GREEN OLIVES

SALMON

TUNA

LEMON JUICE

VINEGAR

ARUGULA

SPRING MIX

PINE NUTS

WALNUTS

Test Kitchen tip: Handling hot chile peppers

Pine nuts add distinct flavour, but you can use . . .

Chile peppers can irritate skin and eyes. Wear gloves when working with them. If your bare hands do touch the peppers, wash your hands with soap and warm water.

GOAT CHEESE

PARMESAN

If you don’t have shallots on hand, try . . .

Use 2 Tbsp. chopped onion per shallot.

Inside our recipes We list precise serving sizes to help you manage portions. Test Kitchen tips and sugar subs are listed after recipe directions. If kitchen basics such as ice, salt, black pepper, oil, and nonstick cooking spray are not listed in the ingredients list, then they are italicised in the directions.

No capers in your fridge?

Then use . . .

Salmon boasts healthy fats, but for a lean fish, try . . .

Chop them up to add the same briny flavour.

Just buy a cut with similar thickness.

Nutrition information Nutrition facts per serving are noted with each recipe; ingredients listed as optional are not included.

When ingredient choices appear, we use the first one to calculate the nutrition analysis.

Key to abbreviations CAL = calories CARB = carbohydrate CHOL = cholesterol PRO = protein

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Lemon juice adds acidity to recipes, but so does . . .

We love arugula’s peppery bite, but you can opt for . . .

This tangy cheese adds bold flavour, but so does. . .

Use 1/2 tsp. vinegar for every 1 tsp. lemon juice.

This salad mix has a similar texture.

These nuts add crunch and healthy fats, too.

It will satisfy your salt-loving taste buds.

APPETIZERS

Grilled Bacon-Wrapped Asparagus with Spiced Glaze SERVES 6 TOTAL TIME 25 min.

12 slices lower-sodium, less-fat bacon 12 oz. fresh asparagus, trimmed 2 Tbsp. honey or pure maple syrup 2 tsp. hot water 1/2 tsp. Dijon-style mustard 1/8 tsp. cayenne pepper

1. On a plate, arrange bacon between four sheets of paper towels. Microwave for 1 1/2 to 2 minutes or until partially cooked but not brown. Cool.

2. Divide asparagus into six portions.

Wrap two slices of bacon around each portion and secure with toothpicks. In a small bowl combine the remaining ingredients.

3. Grill asparagus bundles, covered, on a greased rack over medium for 8 to 10 minutes or until bacon is crisp and asparagus is crisp-tender, turning frequently to avoid burning, and brushing with honey mixture the last 2 minutes.

PER SERVING ( 1 bundle each) CAL 79, FAT 3 g (1 g sat. fat), CHOL 7 mg, SODIUM 151 mg, CARB 8 g (1 g fibre, 7 g sugars), PRO 5 g

Nonstick cooking spray 1/4 cup all-purpose flour 1/4 cup refrigerated or frozen egg product, thawed, or 1 egg, lightly beaten 3/4 cup panko bread crumbs 1/4 cup grated Parmesan cheese 1/4 tsp. black pepper 24 spears fresh asparagus (about 12 oz.), trimmed

1 recipe Garlic Dipping Sauce

Chocolate and Sea Salt: Roll in

1. Preheat oven to 400°F. Lightly coat a large baking sheet with cooking spray.

Place flour in a shallow dish. Place egg in a second shallow dish. In a food processor combine panko, cheese, and pepper. Cover and pulse until fine; transfer to a third shallow dish.

2. Roll each asparagus spear in flour. Dip in egg, then roll in panko mixture to coat.

Place 1/2 inch apart on the prepared baking sheet. Sprinkle with any remaining panko mixture and lightly coat with cooking spray.

3. Bake 12 to 15 minutes or until asparagus is tender and coating is golden. Serve warm with Garlic Dipping Sauce.

PER TRUFFLE: Same as base recipe, except CAL 96, FAT 6 g (4 g sat. fat), CARB 10 g (7 g sugars)

Garlic Dipping Sauce In a small bowl combine 1/4 cup each light mayonnaise and plain fat-free Greek yogurt, 2 Tbsp. snipped fresh Italian parsley, 1 Tbsp. white wine vinegar, 1 tsp. Dijon-style mustard, and 1 clove garlic, minced.

8 oz. melted dark chocolate. Sprinkle with sea salt. Let stand.

PER TRUFFLE: Same as base recipe, except CAL 122, FAT 6 g (4 g sat. fat), CARB 10 g (7 g sugars)

Peanut Butter: Combine 3 oz. melted white baking chocolate and 1 Tbsp. peanut butter; drizzle onto truffles. Let stand.

Ancho Chile: Roll in 2 Tbsp. unsweetened cocoa powder. Sprinkle lightly with ground ancho chile pepper.

PER TRUFFLE: Same as base recipe, except CAL 79, CARB 8 g

Almond: Roll in 1/2 cup ground toasted almonds.

PER TRUFFLE: Same as base recipe, except CAL 87, FAT 6 g, CARB 8 g PER SERVING (2/3 cup each) CAL 127, FAT 0 g, CHOL 0 mg, SODIUM 26 mg, CARB 16 g (3 g fiber, 9 g sugars), PRO 1 g

*Sugar Sub Choose Splenda Sugar Blend. Follow package directions to use 1/4 cup equivalent.

PER SERVING WITH SUB Same as above, except CAL 114, CARB 12 (5 g sugars)

PER SERVING ( 4 asparagus spears + 1 1/2 Tbsp. sauce each) CAL 88, FAT 3 g (1 g sat. fat), CHOL 5 mg, SODIUM 200 mg, CARB 10 g (1 g fiber, 2 g sugars), PRO 4 g

DESSERTS & DRINKS CUSTOMISE CARBS

Panko-Parmesan Asparagus with Garlic Dipping Sauce SERVES 6 HANDS ON 25 min.

TOTAL 40 min.

Truffle Coatings Coconut: Roll in 1/2 cup finely

If the carbs are too high for your individual dietary plan, then at your party choose between the Mini Dark Chocolate-Mocha Mousses and the Mojitos or nix one of the sides.

shredded unsweetened coconut.

PER TRUFFLE: Same as base recipe, except CAL 85, FAT 6 g, CARB 8 g

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FISH & SEAFOOD

PER SERVING ( 1 fish fillet + 4 oz. potato wedges + 1/2 cup slaw each) CAL 366, FAT 10 g (2 g sat. fat), CHOL 103 mg, SODIUM 564 mg, CARB 40 g (6 g fibre, 9 g sugars), PRO 29 g

Crispy Fish and Chips SERVES 4 HANDS ON 25 min.

TOTAL 50 min.

1/2 cup plain fat-free Greek yoghurt 1/4 cup sliced green onions 2 tsp. lime juice 3 cups packaged shredded coleslaw mix 1 lb. sweet potatoes, cut into 1/2-inch wedges 1 tsp. chili powder 4 4-oz. fresh or thawed frozen whitefish fillets, such as haddock or cod, 1 inch thick 1 egg, lightly beaten 2 1/2 cups puffed corn cereal or cornflakes, crushed

1. Preheat oven to 200°C. For slaw, in a medium bowl combine yoghurt, green onions, lime juice, 1/2 tsp. kosher salt, and 1/4 tsp. black pepper.

Stir in coleslaw mix. Cover and chill.

2. Line a 15×10-inch baking pan with foil; lightly coat with nonstick cooking spray. Place sweet potatoes in the prepared pan. Drizzle with 1 Tbsp. olive oil and sprinkle with 1/4 tsp. kosher salt and the chili powder; toss to coat. Bake for 20 to 25 minutes or until tender and browned.

3. Meanwhile, rinse fish; pat dry. In a shallow dish combine egg and 1 Tbsp. Water. In another shallow dish combine crushed cereal, 1/4 tsp. kosher salt, and 1/4 tsp. black pepper.

Dip fish in egg mixture, then in cereal mixture, turning to coat.

4. In a 10-inch oven-going skillet heat 1 Tbsp. olive oil over mediumhigh. Add fish; cook just until golden.

Turn fish. Transfer skillet to oven; bake for 15 minutes or until fish flakes easily. Serve with potatoes and slaw.

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Grilled Asparagus and Shrimp with Pasta SERVES 4 TOTAL 45 min.

16 fresh or thawed frozen jumbo or extra-large shrimp in shells (about 1 lb.)

6 oz. dried whole grain linguine 1 lemon 1/2 cup chopped onion 1/2 cup finely shredded Parmesan cheese (2 oz.)

1/2 cup reduced-sodium chicken broth

1 Tbsp. butter

3 cloves garlic, minced 12 oz. fresh asparagus, trimmed Nonstick cooking spray

2 Tbsp. snipped fresh mint 1. Peel and devein shrimp, leaving tails intact if desired. Rinse shrimp; pat dry. Boil linguine in a large amount of water for 6 minutes. Drain, reserving 2/3 cup of the pasta water.

2. Meanwhile, remove 1 tsp. zest and squeeze 1 Tbsp. juice from lemon. In a 10-inch skillet heat 1 Tbsp. olive oil over medium. Add onion; cook for 4 minutes, stirring occasionally. Add linguine, the reserved pasta water, and 1/4 tsp. black pepper. Cook for 4 minutes or just until pasta is tender and most of the water is absorbed, stirring frequently. Add lemon juice, 1/4 cup of the cheese, the broth, and butter.

Cook and stir for 2 minutes more.

3. In a medium bowl combine shrimp, 1 Tbsp. olive oil, 1/4 tsp. black pepper, and the garlic. Thread shrimp onto four 10-inch skewers, leaving 1/4 inch between pieces. Coat asparagus with cooking spray.

4. Grill shrimp skewers and

asparagus (place across the grates), covered, over medium for 4 to 6 minutes or until shrimp are opaque and asparagus is crisp-tender, turning once.

5. Cut tips from asparagus; cut stalks into 1-inch pieces. Stir asparagus into linguine mixture; heat through. Serve topped with shrimp, the remaining 1/4 cup cheese, lemon zest, and mint.

Tip If using wooden skewers, soak in water for 30 minutes.

PER SERVING (4 shrimp + 1 1/4 cups pasta mixture each) CAL 397, FAT 14 g (5 g sat. fat), CHOL 174 mg, SODIUM 385 mg, CARB 38 g (7 g fiber, 4 g sugars), PRO 32 g

New England-Style Hearty Clam Chowder SERVES 4 TOTAL 35 min.

2 1 1 2 1/2 1/2

1/4 2 1/2

2

1

1/2

4

Tbsp. unsalted butter cup chopped onion cup chopped celery cloves garlic, minced tsp. dried thyme, crushed cup dry white wine or 2 Tbsp. lemon juice cup all-purpose flour cups low-fat (1%) milk cup unsalted vegetable stock or reduced-sodium chicken broth cups frozen baby lima beans, thawed 10-oz. can whole baby clams, undrained cup snipped fresh Italian parsley slices lower-sodium, less-fat bacon, crisp-cooked and coarsely crumbled

1. In a large saucepan melt butter over medium. Add onion and celery; cook for 5 minutes or until tender, stirring occasionally. Add garlic, thyme, and 1/4 tsp. black pepper; cook

and stir for 2 minutes. If using wine, remove pan from heat and carefully add to saucepan. Return to heat and cook until nearly evaporated.

2. Sprinkle with flour; cook and stir for 1 minute. Stir in milk and stock.

Bring just to boiling. Cook and stir until sightly thick. Stir in beans, clams, 1/4 cup of the parsley, and, if using, the lemon juice; heat through.

3. Top servings with bacon and the remaining 1/4 cup parsley.

PER SERVING (1 1/3 cups each) CAL 378, FAT 10 g (5 g sat. fat), CHOL 76 mg, SODIUM 577 mg, CARB 42 g (7 g fibre, 9 g sugars), PRO 26 g

crab and salmon; stir gently just until combined (do not overmix).

2. Place the remaining 1/2 cup bread crumbs in a shallow dish. Shape crab mixture into eight patties. Dip patties in bread crumbs, turning to coat.

3. In a 10-inch skillet heat 2 tsp. olive oil over medium. Add half of the crab cakes; cook for 6 minutes, turning once. Remove from skillet; keep warm. Repeat with another 2 tsp. olive oil and remaining cakes.

4. In a large bowl whisk together 1 Tbsp. of the lemon juice and 2 tsp. olive oil. Add arugula; toss to coat. In a bowl combine lemon zest and the remaining ingredients. Serve cakes with arugula and yogurt sauce.

PER SERVING ( 2 crab cakes + 1 cup arugula + 2 Tbsp. yogurt sauce each) CAL 308, FAT 15 g (3 g sat. fat), CHOL 107 mg, SODIUM 535 mg, CARB 20 g (2 g fibre, 4 g sugars), PRO 22 g

Salmon and Crab Cakes SERVES 4 TOTAL 45 min.

1/2 cup regular rolled oats 1 lemon 3/4 cup panko bread crumbs 1/2 cup finely chopped onion 1/2 cup finely chopped celery 1/4 cup light mayonnaise 1 egg, lightly beaten 2 Tbsp. snipped fresh dill 1 tsp. Dijon-style mustard 1/2 tsp. black pepper 1 6-oz. pouch refrigerated lump crabmeat, drained and flaked 2 2.5-oz. pouches skinless, boneless pink salmon, flaked 4 cups baby arugula 1/2 cup plain fat-free Greek yoghurt 2 Tbsp. snipped fresh chives 1 Tbsp. fat-free milk Dash salt

1. Grind oats in a food processor.

Remove 1 tsp. zest and squeeze juice from lemon. In a large bowl stir together ground oats, 1 tsp. of the lemon juice, 1/4 cup of the bread crumbs, and the next seven ingredients (through pepper). Add

Seafood Boil SERVES 6 HANDS ON 30 min.

TOTAL 40 min.

8 oz. fresh or thawed frozen shrimp in shells 8 oz. fresh or thawed frozen skinless salmon fillets 2 Tbsp. olive oil 3 oz. cooked Italian-style chicken sausage, halved lengthwise and sliced 1/2 inch thick 1 1/2 cups sliced celery 1 cup coarsely chopped red onion 1 cup water 1 cup dry white wine or 3/4 cup reduced-sodium chicken broth + 2 Tbsp. white wine vinegar 2 sprigs fresh parsley 1 tsp. celery seeds 1/2 tsp. paprika 1/2 tsp. black pepper 1/4 tsp. kosher salt

1/4 tsp. cayenne pepper 12 live clams in shells, scrubbed and soaked 2 large ears of corn, each cut into 3 chunks 3 Tbsp. snipped fresh parsley 6 1-oz. slices French bread, toasted

1. Devein shrimp, but do not peel.

Rinse shrimp and salmon; pat dry.

Cut salmon into six pieces.

2. In a 5-qt. Dutch oven heat oil over medium. Add sausage; cook and stir for 3 minutes. Add celery and onion; cook for 5 minutes or just until tender, stirring occasionally.

3. Stir in the next eight ingredients (through cayenne pepper). Bring to boiling. Add clams and corn. Return to boiling; reduce heat. Simmer, covered, for 4 minutes. Stir in shrimp and salmon. Simmer, covered, for 4 to 5 minutes more or until clam shells open, shrimp are opaque, and salmon flakes easily. Discard any clams that do not open.

4. Top servings with parsley and, if desired, additional paprika. Serve with toasted bread.

Tip To clean live clams, scrub clams in shells under cold running water. In a large container combine 8 cups cold water and 2 1/2 Tbsp. salt; add clams. Soak for 15 minutes; drain and rinse. Discard water. Repeat soaking, draining, and rinsing twice.

PER SERVING ( 2 cups each) CAL 334, FAT 10 g (2 g sat. fat), CHOL 101 mg, SODIUM 566 mg, CARB 28 g (3 g fibre, 6 g sugars), PRO 27 g

Scallops and Succotash SERVES 4 HANDS ON 25 min.

TOTAL 50 min.

2 medium red sweet peppers 3 Tbsp. lemon juice 2 cloves garlic, minced DiabeticLivingOnline.in

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1 cup each thawed frozen cut green beans and baby lima beans 1/2 cup each thawed frozen edamame, peas, and whole kernel corn 8 fresh or thawed frozen sea scallops (about 1 lb.)

2 Tbsp. snipped fresh basil

1. Preheat broiler. Cut sweet peppers in half lengthwise; remove stems, seeds, and membranes. Place peppers, cut sides down, on a foillined baking sheet. Broil 6 inches from heat for 10 min or until charred.

Wrap foil around peppers. Let stand for 15 min or until cool enough to handle. Peel and discard skins.

2. For vinaigrette, in a jar add lemon juice, 2 Tbsp. olive oil, the garlic, and 1/4 tsp. each kosher salt and black pepper; cover and shake. For sauce, blend sweet peppers and 3 Tbsp. of the vinaigrette until smooth.

3. For succotash, coat a 10-inch skillet with nonstick cooking spray; heat over medium-high. Add green beans, lima beans, edamame, peas, and corn. Cook for 5 minutes, stirring occasionally. Stir in the remaining vinaigrette; heat through. Transfer to a bowl; cover.

4. Rinse scallops; pat dry. Sprinkle with 1/2 tsp. kosher salt and 1/4 tsp. black pepper. In skillet heat 1 Tbsp. olive oil over medium-high. Add scallops; cook for 4 minutes or until opaque and golden, turning once.

Serve scallops on sauce with succotash and basil.

PER SERVING (2 scallops + 2/3 cup succotash + 1/4 cup sauce each) CAL 340, FAT 13 g (2 g sat. fat), CHOL 37 mg, SODIUM 439 mg, CARB 29 g (7 g fibre, 6 g sugars), PRO 27 g

Shrimp Lettuce Rolls SERVES 4 TOTAL 45 min.

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1 cup 1/4- to 1/2-inch cubes Italian bread (1 oz.)

1 Tbsp. butter, melted 1 lb. fresh or thawed frozen medium shrimp in shells 1 cup finely chopped celery 2 Tbsp. coarsely snipped fennel fronds (set aside) 1/2 cup finely chopped fennel 1/2 cup dry white wine or 2 Tbsp. lemon juice 1 bay leaf 1 clove garlic, sliced 1/2 of a 12-oz. pkg. soft, silkenstyle tofu 2 Tbsp. light mayonnaise 1 Tbsp. cider vinegar 1 tsp. reduced-sodium seafood seasoning, such as Old Bay 1 tsp. honey 1/2 tsp. Dijon-style mustard 1/4 cup shredded carrot 8 butterhead lettuce leaves

1. Preheat oven to 150°C. For croutons, in a medium bowl toss bread with melted butter and dash black pepper. Spread in a 15×10-inch baking pan. Bake for 30 min or until bread is golden and crisp, stirring once. Cool in pan on a wire rack.

2. Peel and devein shrimp. Rinse shrimp; pat dry. In a large saucepan combine 1 cup water, 1/2 cup of the celery, 1/4 cup of the fennel, the wine, bay leaf, and garlic. Bring to boil. Stir in shrimp; reduce heat. Simmer, covered, for 3 to 4 minutes or until shrimp are opaque. Remove shrimp; cool. Coarsely chop shrimp.

3. In a blender or food processor combine the next six ingredients (through mustard). Cover and blend until smooth. In a bowl combine chopped shrimp, the remaining 1/2 cup celery and 1/4 cup fennel, and the carrot. Stir in tofu mixture. Spoon onto lettuce leaves and top with croutons and fennel fronds.

PER SERVING (2 lettuce rolls each) CAL 197, FAT 7 g (2 g sat. fat), CHOL 169 mg, SODIUM 359 mg, CARB 9 g (1 g fibre, 3 g sugars), PRO 23 g

MEAT MAIN DISHES

Chicken Parmesan with Broccolini SERVES 2 TOTAL 30 min.

2 Tbsp. refrigerated egg product 1/2 cup whole wheat panko bread crumbs 1 8-oz. skinless, boneless chicken breast half, halved horizontally 6 oz. trimmed Broccolini, large stems halved lengthwise 1/2 cup roasted red sweet pepper 1 Tbsp. almonds, toasted 1 Tbsp. snipped fresh basil 2 tsp. lemon juice 1 clove garlic, minced 2 Tbsp. finely shredded Parmesan cheese

1. Preheat oven to 220°C. Pour egg into a shallow dish. In another shallow dish combine panko and 1/8 tsp. each salt and black pepper.

Dip chicken into egg, then into panko mixture, turning to coat. Place chicken in a 15×10-inch baking pan; lightly coat with nonstick cooking spray. Place Broccolini next to chicken; drizzle with 2 tsp. olive oil.

Bake for 15 minutes or until chicken is done (75°C).

2. Meanwhile, for sauce, in a food processor combine the next five ingredients (through garlic). Cover and process until smooth. Transfer to a small saucepan; heat through.

3. To serve, spoon sauce over chicken and Broccolini. Top with cheese and additional basil.

PER SERVING (3 1/2 oz. chicken + 3 oz.

Broccolini + 1/4 cup sauce each) CAL 345, FAT 12 g (2 g sat. fat), CHOL 86 mg,

SODIUM 517 mg, CARB 24 g (5 g fibre, 4 g sugars), PRO 36 g

enough of the reserved pasta cooking water to reach desired consistency. Top with basil and, if desired, lemon zest and additional cheese.

SIDE DISHES

PER SERVING ( 2 cups each) CAL 451, FAT 12 g (3 g sat. fat), CHOL 88 mg, SODIUM 527 mg, CARB 45 g (9 g fibre, 9 g sugars), PRO 42 g

Chicken Pasta Primavera SERVES 2

Fresh Asparagus-Tomato Salad

HANDS ON 40 min.

TOTAL 50 min.

1/4 1 2 1/2

3

3

2

3/4

4

2

cup chopped onion clove garlic, minced cups cauliflower florets cup reduced-sodium chicken broth Tbsp. finely shredded Parmesan cheese oz. dried whole grain spaghetti or linguine cups broccoli florets, 1-inch asparagus pieces, and/or coarsely chopped yellow summer squash cup bite-size strips red sweet pepper chicken breast tenderloins (8 oz. total), halved crosswise Tbsp. snipped fresh basil Lemon zest (optional)

1. For sauce, in a small saucepan heat 2 tsp. olive oil over medium. Add onion and garlic; cook for 3 to 4 minutes or until onion is tender, stirring occasionally. Stir in cauliflower and broth. Bring to boil; reduce heat. Simmer, covered, for 15 minutes or until tender; cool slightly.

Transfer to a food processor. Add 1/4 cup water, the cheese, and 1/8 tsp. each salt and black pepper. Cover and process until smooth.

2. Meanwhile, cook pasta according to package directions, adding broccoli and sweet pepper the last 5 minutes. Drain, reserving 1/4 cup of the pasta cooking water.

3. Coat a 10-inch skillet with nonstick cooking spray; heat over medium. Add chicken; cook 10 minutes or until done (75°C), turning once. Stir in sauce and pasta mixture. Heat through, stirring in

SERVES 4 TOTAL 20 min.

White Bean Ragout SERVES 2 TOTAL 25 min.

2 1/2 3 2/3 1 1

1/2

1/2 2 2

tsp. olive oil cup chopped onion cloves garlic, minced cup sliced zucchini tsp. snipped fresh rosemary 15-oz. can reduced-sodium white kidney (cannellini) beans, rinsed and drained cup reduced-sodium chicken broth cup chopped roma tomato cups fresh baby spinach Tbsp. finely shredded Asiago cheese

1. In a 10-inch skillet heat oil over medium-high. Add onion and garlic; cook and stir for 3 minutes or until onion is tender. Stir in zucchini and rosemary; cook and stir for 3 minutes more.

2. Stir in beans, broth, and tomato.

Bring to boiling. Stir in spinach; cook just until wilted. Serve topped with cheese.

2 cups mixed salad greens or baby spinach 1 lb. thin fresh asparagus, trimmed and cut diagonally into 1 1/2-inch pieces 1 cup cherry tomatoes, halved 1/2 cup fresh basil leaves 2 Tbsp. white wine vinegar 4 tsp. olive oil 1 tsp. honey 1/8 tsp. salt 1/8 tsp. black pepper 2 Tbsp. shredded Parmesan cheese 2 Tbsp. pine nuts or chopped walnuts, toasted

1. In a large bowl combine the first four ingredients (through basil).

2. For vinaigrette, in a small screw-top jar combine the next five ingredients (through pepper). Cover and shake well.

3. Pour vinaigrette over salad greens mixture; toss gently to coat. Sprinkle with cheese and nuts.

PER SERVING ( 1 1/4 cups each) CAL 112, FAT 8 g (1 g sat. fat), CHOL 2 mg, SODIUM 123 mg, CARB 7 g (2 g fibre, 4 g sugars), PRO 4 g

PER SERVING (1 1/2 cups each) CAL 263, FAT 7 g (2 g sat. fat), CHOL 6 mg, SODIUM 418 mg, CARB 38 g (11 g fibre, 4 g sugars), PRO 15 g

Grilled Asparagus-Onion Crostini SERVES 8 TOTAL TIME 35 min.

12 oz. thin fresh asparagus, trimmed 3 1/2-inch slices red onion Nonstick cooking spray DiabeticLivingOnline.in

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1 Tbsp. snipped fresh basil 1 12- to 14-oz. loaf plain or whole wheat Italian bread (2 1/2 inches in diameter), halved horizontally 3/4 cup shredded Gruyère cheese (3 oz.)

1. Lightly coat asparagus and onion with cooking spray. Grill onion, covered, over medium for 10 minutes or until tender, turning once and adding asparagus the last 4 minutes.

Remove from grill; cool slightly. Chop onion. In a small bowl combine onion and basil. Cut asparagus into 1- to 2-inch pieces.

2. Meanwhile, hollow out insides of bread halves, leaving 1/2-inch shells. Add bread halves, cut sides down, to grill. Grill, covered, for 1 to 2 minutes or until toasted. Remove from grill. Fill bread halves with onion mixture and asparagus, and sprinkle with cheese.

Grill, covered, for 1 to 2 minutes more or until bottoms are toasted and cheese is melted. Cut into slices and top with additional basil.

1. Preheat oven to 220°C. Place crust on a baking sheet. Bake for 8 minutes or until slightly crisp.

2. In a food processor blend the next seven ingredients (through salt) until smooth; spread over crust. Add tomato and cheese. Bake for 10 minutes more or until heated through.

PER SERVING (1/2 pizza each) CAL 243, FAT 12 g (4 g sat. fat), CHOL 20 mg, SODIUM 388 mg, CARB 23 g (3 g fibre, 2 g sugars), PRO 11 g

Spring Asparagus Tart

Tip Use leftover bread to make bread crumbs

SERVES 6

or croutons.

HANDS ON 30 min.

TOTAL 1 hr. 15 min.

PER SERVING ( 1 slice each) CAL 116, FAT 4 g (2 g sat. fat), CHOL 12 mg, SODIUM 194 mg, CARB 14 g (2 g fibre, 2 g sugars), PRO 6 g

VEGETARIAN MAIN DISHES

Flatbread with Pesto and Mozzarella SERVES 2 HANDS ON 25 min.

TOTAL 35 min.

1 7-inch prebaked thin pizza crust, such as Mama Mary’s Thin & Crispy 2 cups fresh spinach 1/2 cup fresh basil 3 Tbsp. unsweetened almond milk 2 Tbsp. sliced almonds, toasted 1/4 tsp. lemon zest 1/8 tsp. black pepper Dash salt 4 thin slices tomato 2 oz. fresh mozzarella cheese, sliced

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1 Tart Pastry Nonstick cooking spray 8 oz. fresh asparagus, trimmed 1/3 cup thinly sliced shallots 2 Tbsp. fat-free milk 2 oz. soft goat cheese (chèvre) 1 Tbsp. all-purpose flour 1 cup refrigerated or thawed frozen egg product 1 tsp. snipped fresh thyme 1/4 tsp. salt 1/4 tsp. black pepper 2 radishes, very thinly sliced (optional) 2 Tbsp. balsamic glaze (optional)

1. Preheat oven to 220°C. Prepare Tart Pastry. On a lightly floured surface, roll pastry into a 15×5-inch rectangle. Transfer to a 13 3/4×4-inch tart pan with a removable bottom; do not stretch pastry. Press into fluted sides of pan; trim edge. Line pastry with a double thickness of foil. Bake for 20 minutes. Remove foil and bake 5 minutes more or until golden. Cool on a wire rack.

2. Coat a 15×10-inch baking pan with cooking spray. Add asparagus and shallots; coat with cooking spray. Bake for 5 minutes.

3. In a medium bowl gradually stir milk into cheese until smooth. Stir in flour, egg, thyme, salt, and pepper.

4. Transfer asparagus and shallots to pastry shell; add cheese mixture.

Bake for 15 to 18 minutes or until filling is set. Cool in pan on a wire rack for 10 minutes. Remove sides from pan. If desired, serve with radishes, balsamic glaze, and additional thyme.

Tart Pastry In a bowl stir together 1 cup all-purpose flour, 1/4 cup whole wheat pastry flour, and 1/4 tsp. salt. Using a pastry blender, cut in 2 Tbsp. butter, cut up, until pea-size. Stir in 2 Tbsp. canola oil with a fork just until combined. Pour 1 Tbsp. cold water over part of the flour mixture; toss gently with a fork.

Push moistened pastry to side of bowl. Repeat moistening, gradually adding cold water (3 to 4 Tbsp. total) until mixture comes together.

Gather pastry into a ball; knead gently just until it holds together.

PER SERVING (1 wedge each) CAL 228, FAT 11 g (4 g sat. fat), CHOL 15 mg, SODIUM 348 mg, CARB 23 g (2 g fibre, 1 g sugars), PRO 9 g

STARCH SWAP

If you prefer potatoes, use them in place of the corn in the Seafood Boil (left).

TOMATO, TUH-MAHTOH

Cherry tomatoes add sweetness, but you can use any tomato in the Fresh Asparagus-Tomato Salad (above). Just slice large tomatoes into 1/2-inch-thick pieces.

SWEET ENDING

Truffle Shuffle

Coco n

ut

Tuffle coatings, p. 83

recipes Colleen Weeden; photos Adam Albright; styling Jennifer Peterson

S ea nd

nu t

a te ola c o Ch

Bu

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Pea

For base recipe, in a 2-qt. saucepan stir 12 oz. dark chocolate, chopped, and 4 oz. reduced-fat cream cheese over low until melted (mixture will be slightly grainy). Remove from heat.

Stir in 1 tsp. vanilla. Transfer to a bowl. Cover and chill 1 to 1 1/2 hours or just until firm. Shape mixture into 1-inch balls. Roll in desired coatings: Coconut, Chocolate and Sea Salt, Peanut Butter, Ancho Chile, and/or Almond.

Store, covered, in the refrigerator for up to 1 week.

Makes 28 truffles.

Salt

Dark Chocolate Truffles

PER BASE RECIPE TRUFFLE: CAL 78, FAT 5 g (3 g sat. fat), CARB 7 g (6 g sugars)

Anc ho

Made with rich dark chocolate, just one truffle will satisfy a sweet craving.

A

Ch

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ond

ile

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BOOKS THE WHOLESOME KITCHEN/ NOURISH. ENERGIZE. INGULGE. India’s macaron queen is back with more delicious treats - this time with a healthy twist! As India wakes up to re-learning the alphabet of nutrition and wellness, Pooja Dhingra, one of the country's top chefs and founder of Mumbai's famous Le15 Patisserie and Cafe, attempts to help make the journey easier by introducing healthy bakes that can be consumed with all the pleasure and none of the associated guilt. Joined by nutritionist Viddhi Dhingra, Pooja provides a wholesome collection of recipes that, apart from delectable desserts, includes wholesome nut milks, smoothies, salads, breakfast meals and nutritionally balanced but delicious treats. Using ingredients that are locally sourced and recipes that are easy-to-follow as well as easy on the wallet, the Wholesome Kitchen also offers advice, tips and tricks on eating clean.

Accompanied by stunning photographs, this book will revolutionize the way meals are consumed in every household.

Authors: Pooja Dhingra & Viddhi Dhingra Publisher: H achette India Pages: 226 Price: ` 799

EAT COMPLETE: THE 21 NUTRIENTS THAT FUEL BRAINPOWER, BOOST WEIGHT LOSS, AND TRANSFORM YOUR HEALTH

Author: Ramsey Drew, MD Publisher: Harper Wave Pages: 304 Price: `1,188

90 Diabetic Living

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Your brain burns more of the food you eat than any other organ. It determines if you gain or lose weight, if you’re feeling energetic or fatigued, if you’re upbeat or depressed. In this essential guide and cookbook, Drew Ramsey, MD, explores the role the human brain plays in every part of your life, including mood, health, focus, memory, and appetite, and reveals what foods you need to eat to keep your brain—and by extension your body— properly fueled.

Drawing upon cutting-edge scientific research, Dr. Ramsey identifies the 21 nutrients most important to brain health and overall well-being—the very nutrients that are often lacking in most people’s diets. Without these nutrients, he emphasises, our brains and bodies don’t run the way they should.

Eat Complete includes 100 appetising, easy, gluten-free recipes engineered for optimal nourishment. It also teaches readers how to use food to correct the nutrient deficiencies causing brain drain and poor health for millions. For example: • Start the day with an Orange Pecan Waffle or a Turmeric Raspberry Almond Smoothie, and the Vitamin E found in the nuts will work to protect vulnerable brain fat (plus the fiber keeps you satisfied until lunch).

• Enjoy Garlic Butter Shrimp over Zucchini Noodles and Mussels with Garlicky Kale Ribbons and Artichokes, and the zinc and magnesium from the seafood will help stimulate the growth of new brain cells.

• Want to slow down your brain’s aging process? Indulge with a cup of Turmeric Cinnamon Hot Chocolate, and the flavanols found in chocolate both increase blood flow to the brain and help fight age-related memory decline.

Featuring 50 stunning, photos, it helps you pinpoint the nutrients missing from your diet and gives you tasty recipes to transform your health—and ultimately your life.

THE POWER OF YOUR SUBCONSCIOUS MIND Did you know that your mind has a 'mind' of its own? Yes! Without even realising, our mind is often governed by another entity which is called the sub-conscious mind.

This book can bring to your notice the innate power that the sub-conscious holds. We have some traits which seem like habits, but in reality these are those traits which are directly controlled by the sub-conscious mind, vis-à-vis your habits or your routine can be changed if you can control and direct your sub-conscious mind positively. To be able to control this 'mind power' and use it to improve the quality of your life is no walk in the park. This is where this book acts as a guide and allows you to decipher the depths of the sub-conscious.

In this book, 'The power of your subconscious mind', the author fuses his spiritual wisdom and scientific research to bring to light how the sub-conscious mind can be a major influence on our daily lives. Once you understand your subconscious mind, you can also control or get rid of the various phobias that you may have in turn opening a brand new world of positive energy.

Author: Joseph Murphy Publisher: Amazing reads Pages: 312 Price: `199

Author: Arianna Huffington Publisher: WH Allen Pages: 288 Price: `599

THE SLEEP REVOLUTION We are in the midst of a sleep deprivation crisis, and this has profound consequences – on our health, our job performance, our relationships and our happiness. In this book, Arianna Huffington boldly asserts that what is needed is nothing short of a sleep revolution. Only by renewing our relationship with sleep can we take back control of our lives.

Through a sweeping, scientifically rigorous and deeply personal exploration of sleep from all angles, Arianna delves into the new golden age of sleep science that reveals the vital role sleep plays in our every waking moment and every aspect of our health – from weight gain, diabetes, and heart disease to cancer and Alzheimer’s.

In The Sleep Revolution, Arianna shows how our cultural dismissal of sleep as time wasted not only compromises our health and our decision-making but also undermines our work lives, our personal lives and even our sex lives. She explores all the latest science on what exactly is going on while we sleep and dream. She takes on the dangerous sleeping pill industry and confronts all the ways our addiction to technology disrupts our sleep. She also offers a range of recommendations and tips from leading scientists on how we can achieve better and more restorative sleep, and harness its incredible power.

In today's fast-paced, always-connected, perpetually harried and sleep-deprived world, our need for a good night’s sleep is more important – and elusive – than ever. The Sleep Revolution both sounds the alarm on our worldwide sleep crisis and provides a detailed road map to the great sleep awakening that can help transform our lives, our communities and our world.

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Tarot forecast for March-April 2017

ARIES

Card of the Period: King of Wands Looks like the suggested measures have been taken into consideration. Many of you have already upped your game and now is the time to maintain this positive lifestyle. For people who have temper or BP issues, it’s crucial to keep a check on the same. Senior citizens may complain of orthopedic issues relating to the knee or ankle. You may take some hot water or ice pack treatment after your consultation with your doctor. Some of you would be bubbling with energy so use the same to get going. Hydrate yourself with fluids that will flush out toxic elements.

CANCER

Card of the Period: The Emperor I must say your health is soaring high.

But you shouldn’t forget the advantages of indulging in some physical activities, as I can see excess and unused energy in the cards. A lot can be due to too much tension but it’s high time you start taking a chill pill. People who are still very active at the work front would complain of frequent headaches. People who tend to bottle up emotions may experience blotted stomach or digestion related issues. The key is to stay hydrated and not bottle up something that requires expression.

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TAURUS

Card of the Period: Six of Swords A positive transition is on the cards and it will be great if you go with the flow to reap the benefits. Some of you would be traveling to make a positive change.

This movement will definitely pump up your spirits and health. I can also see that you would be receiving support and help from an external entity. People who constantly think about negative things would be making efforts to change this behaviour. Don’t worry if you had been stagnant (health wise) as this phase is going away from your life along with the emotional baggage you had been carrying in the past.

LEO

Card of the Period: Three of Wands This card comes as a reminder to constantly up your game. You also need to work on the Solar Plexus Chakra that can make you more self disciplined and would make you move and indulge in physical activities. How about munching on these foods to activate the same – oats, brown rice, lemon, lentils and sweet potato. Make long term goals that would enable you to take the necessary steps (for achieving). I am also seeing people who have BP related issues or thyroid; an advice to them –keep a track of your salt intake.

GEMINI

Card of the Period: Two of Swords Too much effort is apparent from your end but the same isn’t resulting in anything fruitful. This cycle is leading to too much exertion which isn’t making you happy. At this point of time you need to focus on what works for you and what doesn’t. Don’t indulge in those activities that can lead to pain in the neck, elbow and ankles. Too much would occupy your mind which would keep you on your toes or would worry you. It’s advisable to take baby steps and channelise towards your priorities.

Another advise for people who smoke – don’t forget to cut down on the same.

VIRGO

Card of the Period: The Hermit A person who has already experienced much in life is sensitive to vibes. This card has come with a guidance that is reminding you to let go of stress and focus on achieving some work life balance. Some of you would want to creep into your own shell and avoid social interactions. Be cautious when you do the same as you may go off tangent and develop loneliness.

Travel to reenergise your cells. It’s very important to not indulge in physical activities that can aggravate your pain in joints and back.

Ruchika Beri (Tarot Card Reader, Oracle Card Reader, Coffee Cup Reader & Reiki Level 1 Channel) | Email: hello@tarotencounters.com | Website: www.tarotencounters.com

LIBRA

Card of the Period: The Hanged Man As they say, too much of anything can lead you to no good. It can be excess tension, excess laid back attitude, or anything else for that matter. Now is the time to take charge of your body and align your chakras. It would be a great idea to seek solace for some time and go for Pranic healing or chakra balancing.

Take a stock of everything on what needs to be done on the health front.

Some of you may experience frequent headaches and pain in the chest. Some past issues may come up, so don’t forget to address them without brushing them under the carpet.

CAPRICORN Card of the Period: Three of Cups

It’s looking like the celebration mode has been on for a couple of months. Lot of you would want to pick up peppy activities like zumba, aerobics or dance that can lead to cardio exercise along with inches loss. A cautionary advice for those who would start the exercise regime now, don’t try anything without your trainer’s guidance. Some of you may experience issues in the thighs, neck or ankle. It will be a great idea to bid adieu to booze for some time to avoid any health implications. Don’t push yourself beyond your capacity.

SCORPIO

Card of the Period: Strength Whoa! Pat on your back as tremendous positive changes in your health can be seen. These two months are about being more perseverant in your actions towards health. Some of you would be recovering from a previous ailment and it would boost your stamina too.

People who are bed ridden may require the external support (nursing at home).

Rest be assured these two months recuperation would be in full swing.

Surround yourself with positive vibes that help you speed up your recovery mechanism. The silver lining is that your defense mechanism is in full swing.

AQUARIUS

Card of the Period: Nine of Pentacles Rejuvenation is on the cards, the same can be attributed to the hard work which has gone by. You are right there with the fulfillment of your goals. Be it weight loss, control on cholesterol or blood pressure. Whatever you have been doing, definitely is working out for you. This card reminds you that it’s very important to have a healthy balance in mind and body which you want to achieve. You would want to up your Zen mode, if that’s the case you can try a couple of guided meditations and Surya Kriya to instill positivity.

SAGITTARIUS Card of the Period: Page of Pentacles

Your upbeat and youthful nature and the attitude would make you want to go an extra mile. Indulge in new activities that would increase your metabolism and stamina, like zumba, cross functional training and yoga.

Spend some time in nature or go for Ayurvedic or Homeopathic treatment when fighting an ailment. Some of you may experience an issue in eye or people who wear glasses may want to get their numbers checked. This is not the time to ignore your health issues anymore. All in all, your overall health would be in great spectrum.

PISCES

Card of the Period: Three of Swords It looks like the negative space has been continuing for some time now. This isn’t a great zone to be in as you are adding on to the ill effects. Heart patients or senior citizens who have cholesterol/ diabetes issues, it’s high time you make necessary changes in lifestyle. Some of you may be recuperating from a surgery or gearing up for one. Don’t forget to check with your dietician if you can incorporate these foods in your diet: oatmeal, spinach, broccoli, carrots.

Exercises like jogging, brisk walking and stretching would keep you in shape.

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• Amazing Low-Carb Recipes • Supportive Diabetes Community • No-Nonsense Health Advice • Doable Fitness Ideas

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Please check all that apply.

I have Type 2 diabetes For how long?_________

I have Type 1 diabetes For how long?_________

I have pre-diabetes

(elevated blood glucose)

My child has diabetes

I am the caregiver for an

adult with diabetes

Diabetes runs in my family

I am a medical professional

state

5

here do you access the W Internet? Please check all that apply.

At home

At work

Through a mobile device

At the public library I do not have Internet access (please go to question 9).

6

How often do you look for diabetes or other health

information online?

Daily Weekly Monthly

Less than once a month

I have never looked online for

diabetes information (please

go to question 9).

7

Please list the top three diabetes or health websites you visit.

1.

2.

3.

8

Which of the following would you like to read most in Diabetic Living? high interest

low/no interest

moderate interest

Diabetes medical news and research Everyday recipes 30-minute (or less) recipes Low-carb recipes Low-sodium recipes Special-occasion recipes Holiday recipes Recipes for two Dessert recipes What/how much to eat Getting started (newly diagnosed) Medication and treatments Diabetes procedures and tests Weight loss Easy exercises Reducing blood glucose and/or A1C Pain management How to avoid complications Mentally coping with diabetes Reducing stress Diabetes products and services Inspiration from people with diabetes Other

Is there anything else youâ&#x20AC;&#x2122;d like to tell us?

Yes, the editors of Diabetic Living magazine may contact me for more information.

9

Please indicate your level of agreement with the following statements that describe your feelings about Diabetic Living. agree neither agree disagree disagree agree completely

somewhat

nor disagree

somewhat

The magazine is well-organised Articles do not give me enough information Articles are colorful and attractive The text size is too small to read The text size is easy to see and to read Stories inform and educate me Stories inspire me to take self-care actions Stories encourage me to talk to my doctor or health care provider I can get the same information elsewhere The magazine keeps me up-to-date on the newest

information about diabetes The articles are difficult to understand The stories are realistic for someone with diabetes The magazine shows/describes people I can relate to

Thank you!

We appreciate your feedback.

Fold and mail this survey in an envelope addressed to:

Diabetic Living Survey TCG Media Limited, 101, Arunachal Building, 19 Barakhamba Road, New Delhi-110001

completely

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