Cochin Cardiac Club

Health Blog by Dr.Uday Nair


Smoking kills about a million people every year in India and elsewhere. A recent study on smoking has revealed some terrible home truths about the ravages caused by this deadly habit. 
Cigarette smoke includes nicotine, carbon monoxide, 43 carcinogenic substances and more than 400 other toxins that can be found in wood varnish, nail polish remover, and rat poison.

Harmful effects of Smoking

    Toxic ingredients in cigarette smoke travel throughout the body, causing damage in several different ways.

      • Nicotine reaches the brain within 10 seconds after smoke is inhaled. It has been found in every part of the body and in breast milk.
      • Carbon monoxide binds to hemoglobin in red blood cells, preventing affected cells from carrying a full load of oxygen.
      • The mixture of nicotine and carbon monoxide in each cigarette you smoke temporarily increases your heart rate and blood pressure,straining your heart and blood vessels.
      • Smoking causes fat deposits to narrow and block blood vessels which leads to heart attack.Heart disease and strokes are also more common among smokers than non-smokers.Smoking causes around one in five deaths from heart disease.
      • Cancer-causing agents (carcinogens) in tobacco smoke damage important genes that control the growth of cells, causing them to grow abnormally or to reproduce too rapidly.The carcinogen benzo(a)pyrene binds to cells in the airways and major organs of smokers.
      • Smokers are at risk for oral cancer. The tar in cigarette smoke can cause cancer in the tissues of the mouth and throat. 
      • Lung cancer from smoking is caused by the tar in tobacco smoke.Tar coats your lungs like soot in a chimney and causes cancer. A 20-a-day smoker breathes in up to a full cup (210 g) of tar in a year.Changing to low-tar cigarettes does not help because smokers usually take deeper puffs and hold the smoke in for longer, dragging the tar deeper into their lungs.
      • The strain of smoking effects on the body often causes years of suffering.Emphysema for example is an illness that slowly rots your lungs. People with emphysema often get bronchitis again and again,and suffer lung and heart failure.
      • Smokers also lose bone density, which increases their risk of osteoporosis , a condition that causes older people to become bent over and their bones to break more easily. Smokers also tend to be less active than nonsmokers because smoking affects lung power.
      • Smoking can also cause fertility problems and can impact sexual health in both men and women. Girls who are on the pill or other hormone-based methods of birth control (like the patch or the ring) increase their risk of serious health problems, such as heart attacks, if they smoke. 
      • Cigarette smoke produces serious damages in the stomach. Ulcers are a cause of death if they are not detected on time. So all smokers have to be careful if they have frequent stomach aches and acidity attacks.
      • Because smoking restricts blood vessels, it can prevent oxygen and nutrients from getting to the skin — which is why smokers often appear pale and unhealthy. Studies have also linked smoking to an increased risk of getting a type of skin rash called psoriasis.
      • Smokers get more colds, flu, bronchitis, and pneumonia than nonsmokers. And people with certain health conditions, like asthma, become more sick if they smoke (and often if they're just around people who smoke). Because teens who smoke as a way to manage weight often light up instead of eating, their bodies also lack the nutrients they need to grow, develop, and fight off illness properly.
      • Smoking during pregnancy increases the risk of low birth weight, prematurity, spontaneous abortion, and perinatal mortality in humans, which has been referred to as the fetal tobacco syndrome.
      • Secondhand smoke or passive smoking is serious business, and should be a concern for anyone who breathes it in. Non-smokers inhaling secondhand smoke share some of the health risks smokers face. But smokers do face the worst of it - the risks of smoking are compounded by breathing cigarette smoke in for a second time. Don't underestimate the dangers. While secondhand smoke may not kill as many people as smoking does, it is toxic and claims thousands of lives every year around the world. 
      • Children face a greater risk than adults of the negative effects of secondhand smoke. When the air is tainted with cigarette smoke, young, developing lungs receive a higher concentration of inhaled toxins than do older lungs because a child's breathing rate is faster than that of adults. Babies who are exposed to secondhand smoke after birth have twice the risk for sudden infant death syndrome as babies who aren't exposed.  

      Life is beautiful after you stop smoking

      The body begins to repair itself once you quit smoking It takes ten to twelve years after you quit, for the body to repair most of the damage caused by smoking. So don’t wait for cancer or emphysema to set in these conditions are more often than not, fatal. This is your reason to take the big step and quit now .

      In couple of weeks time after quitting,your circulation improves, walking becomes easier, and coughing and wheezing is experienced less often. Phlegm production decreases and at about the 3 month mark, lung function is significantly improved.

      After 3 or more months, you will experience all of the benefits already listed  in addition to less sinus congestion, fatigue, and shortness of breath. Cilia, tiny hair-like structures that move mucus out of the lungs, also regain normal function.

      In a years time, your risk of coronary heart disease and heart attacks is reduced by half of what it used to be when you were a smoker.

      In about 12 years, your risk of coronary heart disease and heart attack shifts to that of a person who has never smoked before. The risk of death also drops nearly to the level of a non-smoker.

      So now we know what happens to us when we SMOKE and when we QUIT smoking permanently.

      I hope you have already made the decision to quit smoking today.

      Smell good and look good, enjoy the benefits of becoming an ex-smoker by quitting smoking today. 


      Diabetes is a disease that can affect the whole body, including your mouth. Dental care is particularly important for people with diabetes because they face a higher than normal risk of oral health problems due to poorly controlled blood sugars.Diabetes, through the effects of high blood sugar (hyperglycemia) can cause damage to the blood vessels that supply the the jaw, mouth and gums. If the blood vessels supplying the gums are blocked, partially blocked or damaged the necessary nutrients, oxygen, or the body's infection fighters can be impeded from reaching them. Because of this, diabetics are more susceptible to oral infections and the development of periodontal (gum) disease than non diabetics, and it is estimated that one-third of people with diabetes suffer from gum disease, which also tends to be more severe.

      Oral heath problems

      People with diabetes face a higher risk of:
      • Dry mouth — Uncontrolled diabetes can decrease saliva flow, resulting in dry mouth. Dry mouth can further lead to soreness, ulcers, infections, and tooth decay.
      • Gum inflammation (gingivitis) and periodontitis — Besides impairing white blood cells, another complication of diabetes is that it causes blood vessels to thicken, which slows the flow of nutrients to and waste products from body tissues, including the mouth. When this combination of events happens, the body’s ability to fight infections is reduced. Since periodontal disease is a bacterial infection, people with uncontrolled diabetes might experience more frequent and more severe gum disease.

      • Poor healing of oral tissues — People with uncontrolled diabetes do not heal quickly after oral surgery or other dental procedures because blood flow to the treatment site can be impaired.
      • Thrush — People with diabetes who frequently take antibiotics to fight various infections are especially prone to developing a fungal infection of the mouth and tongue. The fungus thrives on the high glucose levels in the saliva of people with uncontrolled diabetes. Wearing dentures (especially when they are worn constantly) can also lead to fungal infections.
      • Burning mouth and/or tongue — This condition is caused by the presence of thrush.
      People with diabetes who smoke are at an even higher risk(up to 20 times more likely than non-smokers)for the development of thrush and periodontal disease. Smoking also seems to impair blood flow to the gums, which might affect wound healing in this tissue area.

      Warning Signs of Gum Disease

      Be aware of the symptoms of gum disease — signals that your teeth are in danger:
      • Gums bleed, especially when you floss or brush.
      • Pus oozes from your gums or between your teeth.
      • Gums are swollen, red, or tender.
      • There is a change in how your teeth fit together; bridges and partial dentures don't seem to fit correctly
      • You seem to have bad breath all of the time.
      • Your gums appear to have pulled away from your teeth or your teeth look longer.
      • Your teeth become loose.

      If you experience any of these symptoms, make an appointment to see your dentist.

      Oral health
      • QUIT smoking - smokers have higher levels of gum disease, caused by poor blood circulation in the tissues around their teeth. People with diabetes who smoke have an even greater chance of having severe gum problems than non-smokers and non-diabetics.
      • Look for early signs of gum disease.
      • Keep to your healthy eating plan and take prescribed medications as your doctor directs.
      • Brush twice a day with fluoride toothpaste and a soft brush. Take care to remove all plaque on and between your teeth, and next to the gum line.
      • Use dental floss every day.
      • If you have dentures, remove them overnight and clean them daily.
      • Visit your dentist regularly.
      • Book your appointments for the morning when your insulin level is more stable.
      • Try to control your blood sugar level. Those with high blood sugar levels are more likely to have more severe gum problems. If you have good control of your blood sugar level and good oral care, you should have minimal problems with your oral health.

      Please Note-

      The principle objective is to ensure that all individuals with diabetes have proper oral health.

      The growing evidence which demonstrates the relationship between periodontal disease and diabetes affirms the principle that proper oral health is necessary for good general health; meaning oral health is a vital component of everyone’s well being and deserves the same degree of attention as other types of healthcare.
      Oral health assessment and treatment should become as common as the eye, foot, and kidney evaluations that are routinely performed as part of preventive medical therapies. 



      Diabetics and pre-diabetics everywhere are looking for ways to lower blood sugar levels. When attempting to reduce blood glucose levels naturally, there are many effective approaches.
      The first step is to reduce the blood sugar spikes that produce sharp increases of insulin.  

      Eat the foods that lower blood sugar on the list below every day.

      Start  with a salad.

      Soluble fiber from the pulp of plants, such as beans, carrots, apples, and oranges, swells like a sponge in your intestines and traps starch and sugar in the niches between its molecules. Soluble means "dissolvable," and indeed, soluble fiber eventually dissolves, releasing glucose. However, that takes time. The glucose it absorbs seeps into your bloodstream slowly, so your body needs less insulin to handle it. A good way to ensure that you get enough soluble fiber is to have a salad, preferably before, rather than after, you eat a starch.

      Eat high fiber foods. 

      Whole grains (brown rice, oatmeal and whole wheat), beans, fresh fruits and vegetables take longer for the body to digest than low fiber foods, thus preventing blood sugar surges. To begin your day, swap a low fiber, sugary breakfast cereal with slow-cooking oatmeal. Round out every meal with a serving of fruit or vegetables.

      Cut fat

      Decrease cholesterol, saturated and trans fats, which increase the risk of getting diabetes, by avoiding excessive whole milk, eggs, meat, chicken and high-fat cheeses. You still need healthy fats, though. Find these in nuts, fish, avocados and vegetable oils.

      Eat small amounts throughout the day

      The body does much better eating smaller amounts of food, more often throughout the day. It's easier on the intestines, the pancreas, and the digestive enzymes.
      Depending on your caloric intake you could eat 4-6 meals, of 400-600 calories each. Eat at least every four hours.
      Also increase your water. Being chronically dehydrated is hard on the blood, the carrier of not only the blood sugar but also insulin.

      Have a snack

      Blend low-fat milk or plain yogurt with frozen berries for a snack. You will boost your calcium, fiber, Vitamin C and antioxidant levels and, subsequently, your body's sugar-regulating ability.

      Track your Carbs

      Keep your portion sizes in check, and you can keep carbohydrates in your diet. One serving equals 15g of carbs-the amount found in one slice of bread, one small piece of fruit or 1/3-cup cooked pasta or rice. Spread approximately six to eight (specific amount depends on your calorie requirements) of these small servings evenly throughout the day, and you are successfully counting carbs.

      Green Tea

      Green tea not only improved the metabolism of sugar in healthy humans,but actually lowered blood glucose levels in diabetics without affecting the levels of insulin in the bloodstream.

      Eat a handful of nuts every day

      There is evidence that eating a handful of nuts each day can help control and prevent complications of Type 2 diabetes. A study found replacing carbohydrates with a handful of unsalted, raw or roasted nuts daily helped diabetics lower their HbA1C levels  by two-thirds.If you do not have any allergies to nuts, make them a regular part of your daily diet.

      Examples of healthy nuts are:

      • Peanuts
      • Walnuts
      • Almonds
      • Cashews
      • Pecans
      • Brazil Nuts
      • Macadamia Nuts
      Have a handful of nuts 10 to 30 minutes before your meals


      Because it is high in fiber and healthy fats, flaxseed is one of the foods considered to play a role in lowering blood sugar. Also a good source of omega-3 and -6 fatty acids, as well as numerous phytochemicals and nutrients, flaxseed can be added to your diet to maintain overall health.


      This wonderful tasting spice has been shown to lower fasting blood sugar levels and balance cholesterol levels. Cinnamon is recommended at amounts of 1 gram a day and if taken for 40 days will continue to promote benefits for an additional 20 days. One delicious way to take cinnamon is to make tea with cinnamon sticks (boiling 2-3 sticks in 4 cups of water for 20 minutes). Or just add it to oatmeal, smoothies, or cinnamon toast.

      Sweet Potatoes 

      These are much lower on the glycemic index than regular potatoes due to their higher fiber content. They contain carotenoids, which are powerful antioxidants and are thought to have a positive affect on insulin, and chlorogenic acid, which combats insulin resistance. Don't negate their value by using sugary sauces or toppings on them.


      Cabbage is low in calories and high in fiber, with a glycemic index rating of near zero, meaning that it converts to sugar very slowly in the body.


      The high sulfur and flavonoid content of onions which when consumed at a level of 2 ounces per day by diabetics caused a significant reduction in blood sugar. Onions also raise HDL and are thought to help prevent cancer as well due to their high antioxidant levels.


      • High blood sugar problems can be caused by your body's difficulty in producing enough insulin. Garlic has the ability to increase your body's natural insulin production.

        Avocados are loaded with fat — a whopping 25 to 30 grams each. Since fat has no impact on blood sugar, avocados are great additions to a low-GL diet if you eat them in moderation.
      Most of the fat in avacados is monounsaturated fat, the same heart-healthy kind found in olive oil. Research suggests that diets rich in this type of fat may help keep blood sugar in check. Add some avocado to a sandwich or anything else with bread or carbs, and the fat will slow digestion of the meal, thus making it easier on your blood sugar.
      The good fat in avocados may actually reverse insulin resistance, helping your body steady its blood sugar levels. Avocados also contain more soluble fiber (which stabilizes blood sugar and lowers cholesterol) and protein than any other fruit.

      Cheese is also an excellent source of calcium, and studies show that getting plenty of calcium from food may help prevent insulin resistance, a harbinger of diabetes.
      Meat and Fish

      Meats, which are high in protein, don't affect blood sugar as much as carbohydrates. When eaten in proper portions, fish, skinless chicken breast, and lean cuts of meat are good choices for diabetics.
      Salmon is an especially smart option because it also contains heart-healthy omega-3 fatty acids.(Remember 65% of people with diabetes die from either heart attack or stroke)
      Meat is also a source of chromium, a mineral that enables insulin to function properly and helps the body to metabolize carbohydrates.


      • A splash of lemon on a meal is not only tasty, but the acidity of lemon juice can lower the glycemic index of the foods you splash it on.

      The high acetic acid content in vinegar deactivates amylase, the enzyme that turns starch into sugar. (It doesn't matter what kind of vinegar you use.) Because it acts on starch only, it has no effect on the absorption of refined sugar. In other words, it will help if you eat bread, but not candy. But there's one more benefit: Vinegar also increases the body's sensitivity to insulin.
      You should consume vinegar at the start of your meal. Put it in salad dressing or sprinkle a couple of tablespoons on meat or vegetables. Vinegar brings out the flavor of food, as salt does.

      Insulin is the hormone that moves glucose, or sugar, out of your bloodstream and into your cells. Chromium is the mineral that helps insulin do its work. Several studies prove chromium supplements help diabetics lower their blood sugar and improve their insulin levels. And taking chromium dramatically improved the severe shaking, blurred vision, sleepiness, and heavy sweating for a group of people with hypoglycemia.
      Chromium supplements can soon become standard treatment for diabetes.The Estimated Safe and Adequate Daily Dietary Intake for healthy adults is 50 to 200 micrograms (mcg) per day.Consult with your doctor before taking chromium supplements.

      To get chromium naturally, eat asparagus, beef, brewer’s yeast, calves’ liver, chicken, dairy products, eggs, fish and seafood, mushrooms, nuts, potatoes with skin, prunes, whole-grain products, and fresh fruit, especially apples with skin.


      Get your heart rate up to moderate intensity, three to four times a week for 30 to 60 minutes for a noticeable improvement in your blood sugar levels. When you exercise, your muscles pull sugar from the blood for fuel. The more muscle tissue you have, the more sugar is needed. For this reason, exercise improves glucose levels not only during, but also after activity. Walk, swim, clean the house, garden, dance-do whatever you enjoy.


      Stress releases hormones commonly known as "fight or flight" that can increase blood sugar levels. If you are chronically stressed, your sugar levels are affected even if you are eating right. Get adequate rest, indulge in a hobby and exercise to release your stress load.

      Please Note:

      If your blood sugar drops too low, you can eat or drink something that metabolizes rather quickly to bring it back to a healthy level. Candy, fruit juice, soda, jelly, honey or simple a tablespoon of sugar can all serve this purpose.


      Insulin is a hormone produced by cells in the pancreas called beta cells. Insulin helps the body use blood glucose (a type of sugar) for energy. People with type 2 diabetes do not make enough insulin and/or their bodies do not respond well to it, leading to elevated blood sugar levels. 

      The first treatment for type 2 diabetes blood glucose (sugar) control is often meal planning, weight loss, and exercising. Sometimes these measures are not enough to bring blood glucose levels down near the normal range. The next step is taking a medicine that lowers blood glucose levels.

      Oral diabetes medications are only used to treat type 2 or non-insulin-dependent diabetes. Patients with type 1 diabetes are dependent on insulin for their treatment.
      The list of medications for type 2 diabetes is long and potentially confusing. Learning about these drugs and how they're taken, what they do and what side effects they may cause  will help you discuss treatment options with your doctor.

      Diabetic Medications(oral)


      These drugs work by affecting the production of glucose that comes from digestion. They don't cause hypoglycemia and even help with weight loss and lower cholesterol numbers. They are the most commonly prescribed drugs for type 2 diabetes. Glucophage (metformin) and Glucophage XR (metformin extended release) are the most well known of these drugs.

      Alpha-Glucosidase Inhibitors:

      Glyset (miglitol) and Precose (acarbose) are the two most prescribed alpha-glucosidase inhibitors (aka "starch blockers") They work differently than the other medications reviewed so far. These medications need to be taken at the beginning of each meal so that they can work to slow digestion, which in turn slows the rise of glucose in the blood. They are often prescribed in conjunction with other diabetes medications. These drugs may cause diarrhea or gas.


      This class of drugs is similar to the alpha-glucosidase inhibitors in that they are taken before each meal. But these drugs stimulate the pancreas to produce more insulin in relationship to how much glucose is in the blood. The brand names for these drugs are Prandin (repaglinide) and Starlix (nateglinide). They can be used in combination with some other oral medications for increased effectiveness.

      Thiazolidinedione / Glitazones

      Thiazolidinediones (also called glitazones) work by making the body's cells more sensitive to insulin, so less insulin is needed to move glucose from the blood into the cells. This leads to a reduction of blood glucose levels.Brand names Actos(Pioglitazone) and Avandia(Rosiglitazone)
      They should be taken in combination with metformin or a sulphonylurea.
      DPP-4 Inhibitors:

      A new oral medication called Januvia (sitagliptin phosphate) has been approved by the FDA for management of type 2 diabetes. It's the first in a new class of drugs called DPP-4 inhibitors. Januvia lowers blood sugar levels by blocking an enzyme known as dipeptidyl peptidase IV or DPP-4.

      Drug Combinations

      Combination medications can be highly effective and may make it easier to stick to your diabetes treatment plan. If you experience side effects though, it can be tougher to figure out which medication is to blame.
      Several drug combinations have become available to treat Type 2 diabetes. These drugs would have been given together so combining them into one tablet may help encourage patient compliance.
      Actoplus Met is a combination of Actos (pioglitazone) and Glucophage (metformin) – one pill lowers the amount of glucose made by your liver. Both types help your insulin work the way it should.
      Avandamet is a combination of Avandia (rosiglitazone) and Glucophage (metformin) – one pill lowers the amount of glucose made by your liver. Both types help your insulin work the way it should.
      Avandaryl is a combination of Avandia (rosiglitazone) and Amaryl (glimepiride) – one pill helps your insulin work the way it should. The other pill helps your body make more insulin.
      Duetact is a combination of Actos (pioglitazone) and Amaryl (glimepiride) – one pill helps your insulin work the way it should. The other pill helps your body make more insulin.
      Glucovance is a combination of Glucophage (metformin) and Micronase (glyburide) – one pill helps your body make more insulin. The other pill lowers the amount of glucose made by your liver and helps your insulin work the way it should.
      Janumet is a combination of Januvia (sitagliptin) and Glucophage (metformin) – one pill helps your body make more insulin when it’s needed, especially right after meals. It also helps keep your liver from putting stored glucose into your blood. The other pill lowers the amount of glucose made by your liver and helps your insulin work the way it should.
      Metaglip is a combination of Glucotrol (glipizide) and Glucophage (metformin) – one pill helps your body make more insulin. The other pill lowers the amount of glucose made by your liver and helps your insulin work the way it should.
      Injectable medicines

      Incretin mimetics / GLP-1 analogues

      Incretin mimetics, also known as GLP-1 analogues, are an injectable treatment for type 2 diabetes.
      Incretin mimetics look to mimic the effect of a group of hormones called incretins which increase the production of insulin and decrease the release of glucagon in a relatively similar way DPP-4 inhibitors.
      This is not a coincidence as the way DPP-4 inhibitors work is to prevent the protein dipeptidyl peptidase-4 from destroying the incretin hormones.
      GLP-1 analogues have been found to be particularly effective in helping to improve blood glucose levels and helping with weight loss.
      The following GLP-1 analogues are prescribed(branded names in brackets):
      • Exenatide (Byetta)
      • Liraglutide (Victoza)

      Side effects

      All medicines can have side effects.You may or may not experience any. However, if you do, speak to your doctor as there may be another medication which could be used instead.
      HbA1C test:

      There is a special blood test that your doctor does to determine if your diabetes is in control.  This test measures a chemical in your blood called " A1C".  The higher your sugar is, the higher your A1C will be.

      Diabetologists recommends that diabetics must maintain a A1C of less than 7.0% in order to reduce the complications associated with diabetes.

      The higher your A1C, the more likely it is that you will suffer complications of diabetes such as kidney disease, blindness or amputation.

      Please Note-

      • There is no known cure for diabetes. It is always better to prevent this disease, instead of running for medication after suffering the pain caused due to it. 
      • Increased body weight is one of the major reasons for diabetes among people. Therefore it would be advisable to maintain a healthy diet and control your body fat, especially in the middle portions of the body. This will help you reduce the risk of diabetes. 
      • If you know your family history, then you can take preventive measures right from the beginning. A balanced diet and regular exercise is absolutely necessary in order to stay fit and alive. This will allow free flow of blood through the veins. 
      • Exercises are the only means of escape from diabetes if the cause is hereditary. Get proper monthly check up and monitor your blood pressure level.

      Type 2 diabetes treatment has come a long way in the last 10 years with new drugs and devices adding up to better lives for patients.Doctors have also become much more aggressive in treating diabetes. People with type 2 diabetes are getting diagnosed and treated earlier than they once did and having better outcomes.