A food allergy can be terrifying at times. A minor reaction can involve itching, swelling, and stomach-ache. But sometimes even with a mild one, at some point you may experience a severe reaction ie. ‘Anaphylaxis’ – which is a state of shock, defined as a reaction involving two of the body’s organs. It is characterized by symptoms like wheezing, dizziness, and vomiting. The pulse can slow, blood pressure can drop, and the airways can close. In an alarming number of people in the last few years, it has been fatal.

A food allergy is when the body’s immune system reacts upon any specific food. It could be mild, moderate, or severe. Symptoms of allergic reactions could appear within few minutes to several hours after eating the food to which body is allergic. Although symptoms of an allergic reactions may vary from one individual to another, the commonest symptoms are, hives (reddish or swollen patches on skin), Diarrhea, rashes on skin, stomachache, vomiting, runny nose and so on. Allergic reactions can also appear life threatening. Severe allergic reactions may also be seen as low blood pressure, difficulty in swallowing, swelling of lips, loss of consciousness, low pulse rate.

In India, food allergy is estimated around 3-4% of population, but it is more prevalent in children as compared to adults. Food allergies are treatable only by eliminating the allergic food and its products from the diet. It is very important for a physician to know whether a person gets an allergic reaction repeatedly after eating a particular food or its product. At the same time, self-analysis to recognize the appearance of any allergic reactions helps in planning a good line of treatment. If unable to detect/ diagnose through a medical history of the patient, then an allergist may ask to conduct few diagnostic tests, which help in identifying the food allergy. These tests may include few blood tests, skin prick test or an oral food challenge.

Elimination Diet is also commonly practiced by Physicians with the help of registered Dietitians. People are asked to eliminate the food and food products which cause allergic reactions. It is done on a trial-and-error basis. Most of the times avoiding the culprit food and its products solves the problem at the symptomatic level. Also, in few people it is seen that elimination of culprit food and its products only for certain period gives a lot of symptomatic relief, and once they are stable, reintroducing those food and its products can be tolerated.

In cases where in Elimination Diet fails, medical intervention must be considered after consulting a Physician or an Allergist. Steroid Therapy or Antihistamines are prescribed by practicing doctors. It is always said that precaution and prevention is always better than cure. But unfortunately, there are no preventive measures to avoid food allergy.

Many-a-times it is seen that people do not understand the difference between a food aversion and an allergy. For instance, one may not like milk or has an aversion towards Milk and hence may consider it as being “allergic”; but they may consume Curd, Paneer or Buttermilk that they like. In this instance, person has an aversion towards Milk not that he/she is allergic to it. As allergic reaction develops not only with food but also with its products. One must understand this carefully.

Now-a-days, Gluten allergies are one of the commonest topics of discussion. Gluten is a component found in Wheat, Rye, and Barley. Gluten intolerance is seen amongst few people due to deficiency of an enzyme which helps in the digestion Gluten. These patients develop severe stomachache, vomiting or Diarrhea after eating foods which contains Gluten. This condition is also named as “Celiac Disease”. In Celiac Disease, the patient can’t tolerate anything made up of Wheat, Rye, and Barley. Medical Nutrition Therapy plays a very vital role in treating Celiac Disease. These patients are advised a Gluten –Free Diet by registered Dietitians. In short, it is important to diagnose the allergy and then address it to avoid any kind of mild or fatal consequence. Speak to your healthcare provider if you often experience any food allergies.

The author is a clinical nutritionist, Fortis Hospital Mulund

According to a study led by an international team of researchers, going to sleep between 10:00 and 11:00 pm is associated with a lower risk of developing heart disease compared to earlier or later bedtimes.

The study was published in the European Heart Journal – Digital Health, a journal of the European Society of Cardiology (ESC). “The body has a 24-hour internal clock, called circadian rhythm, that helps regulate physical and mental functioning, while we cannot conclude causation from our study, the results suggest that early or late bedtimes may be more likely to disrupt the body clock, with adverse consequences for cardiovascular health,” said study author Dr David Plans of the University of Exeter, UK.

While numerous analyses have investigated the link between sleep duration and cardiovascular disease, the relationship between sleep timing and heart disease is underexplored. This study examined the association between objectively measured, rather than self-reported, sleep onset in a large sample of adults.

The study included 88,026 individuals in the UK Biobank recruited between 2006 and 2010. The average age was 61 years (range 43 to 79 years) and 58 per cent were women. Data on sleep onset and waking up time were collected over seven days using a wrist-worn accelerometer. Participants completed demographic, lifestyle, health, and physical assessments and questionnaires.

They were then followed up for a new diagnosis of cardiovascular disease, which was defined as a heart attack, heart failure, chronic ischaemic heart disease, stroke, and transient ischaemic attack.

During an average follow-up of 5.7 years, 3,172 participants (3.6 per cent) developed cardiovascular disease. Incidence was highest in those with sleep times at midnight or later and lowest in those with sleep onset from 10:00 to 10:59 pm.

The researchers analysed the association between sleep onset and cardiovascular events after adjusting for age, sex, sleep duration, sleep irregularity (defined as varied times of going to sleep and waking up), self-reported chronotype (early bird or night owl), smoking status, body mass index, diabetes, blood pressure, blood cholesterol, and socioeconomic status.

Compared to sleep onset from 10:00 to 10:59 pm, there was a 25 per cent higher risk of cardiovascular disease with sleep onset at midnight or later, a 12 per cent greater risk for 11:00 to 11:59 pm, and a 24 per cent raised risk for falling asleep before 10:00 pm.

In a further analysis by sex, the association with increased cardiovascular risk was stronger in women, with only sleep onset before 10:00 pm remaining significant for men.

Dr Plans said, “Our study indicates that the optimum time to go to sleep is at a specific point in the body’s 24-hour cycle and deviations may be detrimental to health. The riskiest time was after midnight, potentially because it may reduce the likelihood of seeing morning light, which resets the body clock.”

Dr Plans noted that the reasons for the observed stronger association between sleep onset and cardiovascular disease in women are unclear.

He said, “It may be that there is a sex difference in how the endocrine system responds to a disruption in circadian rhythm. Alternatively, the older age of study participants could be a confounding factor since women’s cardiovascular risk increases post-menopause – meaning there may be no difference in the strength of the association between women and men.”

“While the findings do not show causality, sleep timing has emerged as a potential cardiac risk factor – independent of other risk factors and sleep characteristics. If our findings are confirmed in other studies, sleep timing and basic sleep hygiene could be a low-cost public health target for lowering the risk of heart disease,” he concluded.

Eating higher total amounts of red meat, processed red meat and non-dairy animal fat increases the risk of stroke, while consuming more vegetable fat or polyunsaturated fat lowers it, according to a new study.

The findings of the research will be presented at the American Heart Association’s Scientific Sessions 2021. The meeting will be fully virtual, starting from November 13 and will go on till November 15, 2021. It is a premier global exchange of the latest scientific advancements, research and evidence-based clinical practice updates in cardiovascular science for health care professionals worldwide.

This study is the first to comprehensively analyse the impact on stroke risk from fat derived from vegetable, dairy and non-dairy animal sources.

“Our findings indicate the type of fat and different food sources of fat are more important than the total amount of dietary fat in the prevention of cardiovascular disease including stroke,” said Fenglei Wang, PhD, lead author of the study and a postdoctoral fellow in the department of nutrition at Harvard’s T.H. Chan School of Public Health in Boston.

The investigators analyzed 27 years of follow-up from 117,136 participants in the Nurses’ Health Study (1984-2016) and Health Professionals Follow-up Study (1986-2016), two of the largest studies to examine the risk factors for various chronic diseases.

Participants were age 50 years on average, 63 per cent were women, 97 per cent white, and all were free of heart disease and cancer at enrollment. At the beginning and every 4 years during the study, participants completed food frequency questionnaires that were used to calculate the amount, source and types of fat in their diets over the previous year.

Researchers calculated the cumulative average of the dietary data over time to reflect long-term dietary intake. The amount of fat intake was divided into 5 groups or quintiles.

In the study, total red meat included beef, pork or lamb as a main dish, in sandwiches or mixed dishes, and processed red meats. Processed red meats included bacon, sausage, bologna, hot dogs, salami and other processed meats.

The investigators found that during the study, 6,189 participants had strokes, including 2,967 ischemic strokes (caused by a clot cutting off blood flow to part of the brain) and 814 hemorrhagic strokes (caused by bleeding of vessels in the brain). Participants in the highest quintile of non-dairy animal fat intake were 16 per cent more likely to experience a stroke than those who ate the least (the lowest quintile).

“Based on our findings, we recommend for the general public to reduce consumption of red and processed meat, minimize fatty parts of unprocessed meat if consumed, and replace lard or tallow (beef fat) with non-tropical vegetable oils such as olive oil, corn or soybean oils in cooking in order to lower their stroke risk,” said Wang.

A new research has shown a 31 per cent increased risk for hospitalisation and mortality in patients with sleep-disordered breathing and sleep-related hypoxia.

The findings of the study were published in the journal ‘JAMA Network Open’. The research team, led by Reena Mehra, MD, analysed retrospective data from 5,400 Cleveland Clinic patients.

The findings showed that while patients with sleep-disordered breathing and sleep-related hypoxia do not have an increased risk of developing COVID-19, they have a worse clinical prognosis from the disease.

“As the COVID-19 pandemic continues and the disease remains highly variable from patient to patient, it is critical to improving our ability to predict who will have a more severe illness so that we can appropriately allocate resources,” said Dr Mehra, director of Sleep Disorder Research at Cleveland Clinic.

“This study improved our understanding of the association between sleep disorders and the risk for adverse COVID-19 outcomes. It suggests biomarkers of inflammation may mediate this relationship,” said Dr Mehra.

Researchers used Cleveland Clinic’s COVID-19 research registry, which includes data from nearly 360,000 patients tested for COVID-19 at Cleveland Clinic, of which 5,400 had an available sleep study record.

Sleep study findings and COVID-19 positivity were assessed along with disease severity. The team also accounted for co-morbidities such as obesity, heart and lung disease, cancer and smoking.

The findings set the stage for additional studies to identify whether early effective treatments such as PAP (positive airway pressure) or oxygen administration can improve COVID-19 outcomes.

“Our findings have significant implications as decreased hospitalisations and mortality could reduce the strain on healthcare systems,” said the first author of the study Cinthya Pena Orbea, MD, of Cleveland Clinic’s Sleep Disorders Center.

“If indeed sleep-related hypoxia translates to worse COVID-19 outcomes, risk stratification strategies should be implemented to prioritise the early allocation of COVID-19 therapy to this subgroup of patients,” Orbea added.

The study was funded by a Neuroscience Transformative Research Resource Development Award that was given to Dr Mehra.

A recent research has found that people who exercised more during the initial lockdown period of the COVID-19 pandemic experienced less anxiety and depression than those who didn’t exercise.

It also showed that people who spent more time outdoors typically experienced lower levels of anxiety and depression than those who stayed inside. The findings were published in the journal Preventive Medicine.

More than 20,000 people participated in the survey-based study from 6 regions served by Kaiser Permanente across the United States, which included Hawaii, Colorado, Georgia, and the mid-Atlantic states, as well as Southern and Northern California.

“What these study findings tell us is that even during an active pandemic or other public health crisis, people should be encouraged to be physically active to help maintain their physical and mental health,” said the study’s lead author Deborah Rohm Young, PhD, the director of the Division of Behavioral Research for the Kaiser Permanente Southern California Department of Research & Evaluation. “Parks and other nature areas should remain open during public health emergencies to encourage outdoor physical activity.”

In March 2020, COVID-19 developed into a pandemic. With no known treatment, public health officials attempted to reduce its spread by limiting human interactions through stay-at-home policies. Businesses temporarily closed or changed their practices to prevent the spread of the virus, affecting the economy and many people’s jobs. These stressful factors, along with fewer opportunities to socialize with friends and family, increased symptoms of depression and anxiety for many people.

Since it is known that physical activity and time spent in nature are associated with improved mental health, researchers at Kaiser Permanente in Southern California sought to determine how exercise and time outdoors were associated with people’s mental health during the height of the pandemic.

In April 2020, researchers sent a series of COVID-19 surveys to more than 250,000 participants in the Kaiser Permanente Research Bank — a collection of lifestyle surveys, electronic health record data, and biospecimens, which Kaiser Permanente members volunteered. People who reported COVID-19 symptoms were not included in this analysis, resulting in 20,012 respondents. They each completed at least 4 surveys between April and July 2020.

White women older than 50 accounted for a high proportion of the respondents. Most respondents said they were retired and generally adhered to the “safer-at-home” orders during the period of the survey. The study found that reports of anxiety and depression decreased over time. Anxiety and depression scores were higher for females and younger people, and lower for Asian and Black people compared with white respondents. Participants who reported no physical activity reported the highest depression and anxiety compared to people who had exercised. Spending less time outdoors was associated with higher depression and anxiety scores.

Type 2 Diabetes mellitus has become a major public health problem all over the world. The burden of diabetes has tremendously increased even in developing economies like India to the tune that globally India is now the country with second highest number of individuals with type 2 diabetes.

Type 2 diabetes is a lifestyle related disease. The primary reason for increasing rates of diabetes are socioeconomic transition and industrialization leading to increase in the consumption of excess calories and reduction in physical activity. This phenomenon is no more limited to urban areas, and we clearly see increasing rates of type 2 diabetes even in rural areas. One of the strongest risk factor for development of diabetes is excess weight specially excess fat deposition around the waist. The other worrisome trend is increasing rates of type 2 diabetes in younger individuals and adolescents.

As per ICMR (Indian Counsel of Medical Research) the number of people with diabetes in India has increased from 26·0 million in 1990 to 65·0 million in 2016. Due to limited access to healthcare in many parts of the country, lack of awareness among public and lack of symptoms during initial years of the disease, almost 50% of the individuals affected by diabetes remain undiagnosed. Also, if we look at the level of diabetes control among Indians, it is evident that only 30% of the patients with diabetes are at there target blood glucose level. Poorly controlled diabetes can lead to a variety of serious complications like heart attacks, strokes, kidney failure, neuropathy, eye damage and foot amputations. This can potentially put huge burden on our healthcare infrastructure which already has numerous challenges. Essentially, we are looking at an explosion of type 2 diabetes leading to massive economic burden and loss of productivity. The covid-19 pandemic has made the situation worse by worsening of pre-existing diabetes as well as development of new onset diabetes.

Diabetes is a chronic disease that requires ongoing monitoring, long-term treatment, and education of patients for self-management. There are several challenges in delivering effective diabetes care in India in the form of lack of trained health care providers in remote and rural areas, poor affordability, unavailability of antidiabetic medications and especially insulin in rural areas, poor adherence to medications and lifestyle changes and poor follow-up. The problem of treatment adherence and follow up is specially more pronounced in younger people who are at higher risk of developing complications as shown by ICMR study “Youth onset diabetes in India”.

To improve the current situation, we need paradigm shift in the diabetes care in our country. The first is foremost being an effective preventive strategy to be implement at the level of schools, colleges, public and private offices by increasing awareness about healthy diet, regular exercise and avoiding excess weight gain. The percentage of undiagnosed patients can be reduced by identifying at risk individuals, adopting self-administered diabetes risk scores, and keeping high degree of suspicion for diabetes at every encounter with the health care provider. Universal access to diabetes care can be achieved by training more paramedical staff, nurses and ANMs to enable them to deliver the basic care to diabetes patients and to identify the individuals who need referral to higher centres. A good public-private collaboration and implementation of structured diabetes care program at every level will definitely bring about humongous change in the situation of diabetes in our country.

The author is a consultant-Endocrinologist and Diabetologist, Fortis Hospital, Mulund.