HIMALAYA’S HEALTH DIGEST FOR YOU • VOL LXII • NO. 5 • SEP–DEC 2023 Association Between Nonalcoholic Fatty Liver Disease and Type 2 Diabetes Mellitus Nonalcoholic fatty liver disease (NAFLD) is the leading cause of chronic liver diseases, affecting about one-fourth of the world’s population.1,2 Patients with NAFLD are at a high risk of developing type 2 diabetes mellitus (T2DM).1 T2DM is a severe endocrine metabolic disorder that contributes to the development of various liver abnormalities such as excessive glycogen deposit, NAFLD, nonalcoholic steatohepatitis (NASH), liver fibrosis, cirrhosis, hepatocellular carcinoma, and chronic viral hepatitis.1 NAFLD increases the risk of developing T2DM by two- to three-folds.3 In turn, the coexistence of NAFLD and T2DM can increase the risk of developing NASH, liver fibrosis, and cirrhosis.3,4 Pathogenesis of Type 2 Diabetes Mellitus in Patients With NAFLD NAFLD leads to the development of T2DM by increasing hepatic glucose production and hepatic insulin resistance (IR) by activating hepatic protein kinase Cε and proteins secreted by the liver, such as fetuin A, fetuin B, retinol binding protein-4, selenoprotein P, dipeptidyl peptidase-4, and hepatocytederived fibrinogen-related protein-1. Increased secretion of these liver proteins promotes IR.5,6 In addition, intrahepatic fat accumulation or NAFLD contributes to the development of atherogenic dyslipidemia and hypertension. Furthermore, it triggers the coagulation mechanism and systemic inflammatory state (increased levels of C-reactive protein, interleukin 6 [IL-6], and tumor necrosis factor [TNF]). All these NAFLDrelated pathogenic mechanisms play an important role in the development of diabetesrelated macrovascular and microvascular complications.5,6 NAFLD and T2DM can progress to NASH and endstage liver disease.7 Pathogenesis of NAFLD in Patients With Type 2 Diabetes Mellitus NAFLD is characterized by excess accumulation of triglycerides in the liver and an increase in de novo lipogenesis (DNL).2,7 The malfunctioning of pancreatic β-cells and IR in the peripheral tissues are recognized as the 2 main pathophysiologic processes that Health From Herbs 3 Fitness 7 Health Tips 10 Research at Himalaya 4 Fact File10 Laugh aWhile11 In Focus 6 8The Latest inMedicine Scan to read the e-version of Capsule
2 • Sep–Dec 2023 • Vol LXII • No. 5 E D I T O R I A L Dear Doctor, Type 2 diabetes mellitus (T2DM) is the most common endocrinal metabolic disorder that causes various liver abnormalities. The cover page article in this issue of Capsule focuses on the association between NAFLD and T2DM. An association between T2DM and male sexual health is discussed in The Latest in Medicine section. The Research at Himalaya section features excerpts of clinical studies that prove the efficacy of Diabecon in the management of T2DM. In addition, the section also features excerpts of clinical studies on the efficacy of Pilex in the management of hemorrhoids. The In Focus section covers an excerpt of a clinical study that evaluated the safety and efficacy of Florasante Capsule in the management of diarrhea-dominant irritable bowel syndrome. Furthermore, interesting facts on and tips to manage PCOS, a few Pranayama exercises to boost mental health, and many more informative articles are covered in this issue. Happy reading! — Editor Liv.52® DS (SYRUP, TABLET) Liv.52 is a hepatospecific formulation, from Himalaya Wellness Company, designed for the treatment and management of liver disorders. Liv.52 restores the metabolic efficiency of the liver by protecting the hepatic parenchyma and promoting hepatocellular regeneration. In nonalcoholic steatohepatitis (NASH) and liver diseases caused by diabetes, Liv.52 decreases the uptake of free fatty acids by hepatocytes, leading to a reduction of fat deposition in the hepatocytes; decreases DNA fragmentation through antioxidant activity, leading to lesser cell death; downregulates inflammatory mediators like tumor necrosis factor-α and interleukin-8 and upregulates cytoprotective peroxisome proliferator–activated receptor gamma, leading to a decrease in hepatic inflammation; increases urea and albumin secretion, suggesting cell proliferation; decreases alanine transaminase and aspartate transaminase levels, indicating normalization of biochemical parameters; and produces newer proteins responsible for the transportation of glucose into the cells, thus causing increased glucose uptake and reduction in insulin resistance. These actions synergistically help in preventing NASH and liver diseases caused by diabetes. result in the development of T2DM.7 T2DM contributes to the development of NAFLD through IR, oxidative stress, endoplasmic reticulum stress, and production of inflammatory cytokines (eg, TNF-α, IL-6).2,8 IR exacerbates NAFLD through increased accumulation of free fatty acids (FFAs) in the peripheral adipose tissue of the liver. The increased influx of FFAs results in subacute hepatic inflammation. This proinflammatory state leads to fatty infiltration in the hepatocytes through lipid peroxidation and mitochondrial membrane damage.2,8 The damage to the mitochondrial membrane worsens respiratory chain dysfunction and decreases synthesis of H+ ATPase enzyme. All of these lead to hepatocyte dysfunction in the process of FFA oxidation, resulting in excessive triglyceride deposition in the liver (fatty liver).1 The progression of NAFLD to NASH can be due to the glucotoxicity caused by glucose-induced IR, increased DNL, and hepatocellular dysfunction. Increased levels of intracellular and extracellular advanced glycation end products, which are formed by the nonenzymatic reaction between reducing sugars and proteins or lipids, lead to initiation and progression of NAFLD to NASH. Further, NASH in turn leads to cirrhosis and hepatocellular carcinoma through multiple mechanisms, including direct hepatocyte lipotoxicity and hepatocellular oxidative stress.1,2 Incorporating lifestyle changes such as following a balanced diet and regular physical activity can play a key role in the management of both the disease conditions.8 References 1. Wan Y, et al. J Cell Mol Med. 2016; 20(2):195–203. 2. Acierno C, et al. Explor Med. 2020; 1:287–306. 3. Gastaldelli A, et al. JHEP Rep. 2019; 1(4):312–328. 4. Suryawanshi NV, et al. Int J Health Clin Res. 2023;6(1):19–22. 5. Mare R, Sporea I. J Clin Med. 2022; 11(17):5223. 6. Xia M-F, et al. Front Pharmacol. 2019; 10:877. 7. Xiong X, Li X. Life Metabol. 2023; XX(XX):1–3. 8. Tomah S, et al. Clin Diabetes Endocrinol. 2020;6:9. FEEDBACK Please scan the QR code or visit the link below to submit your feedback and suggestions on Capsule. https://tinyurl.com/CapsuleFeedbackForm
Sep–Dec 2023 • Vol LXII • No. 5 3 Syzygium cuminii Syzygium cuminii is an evergreen and densely foliaceous tree found in India, Bangladesh, Nepal, Indonesia, Sri Lanka, and Pakistan. The tree has whitish, close-grained wood; leathery, oblong–ovate leaves; scented, greenish white flowers; and oblong, dark purple, edible berries having a single seed. S cuminii is rich in jambosine, jambolin, and anthocyanins, and it exhibits antidiabetic, anti-inflammatory, hepatoprotective, and antihyperlipidemic properties.1,2 A study evaluated the antidiabetic property of S cuminii fruits and seeds. Ethyl acetate, ethanol, and n-hexane extracts of white S cuminii fruits and seeds were prepared using aqueous ethanol (50% v/v). The antidiabetic activity was assessed using α-glucoside and α-amylase enzyme inhibition activity assays. Upon analyses, the ethanol extract of S cuminii fruit showed the highest α-amylase enzyme inhibition, and the ethyl acetate extract of S cuminii seed showed the highest α-glucoside enzyme inhibition. Thus, this Health From Herbs Gymnema sylvestre Gymnema sylvestre is a perennial woody shrub that grows in northern and western India, tropical Africa, Sri Lanka, Vietnam, and Japan. The plant has a twining and branched stem; elliptic, glabrous leaves that are slightly bitter; and small, yellow flowers in axillary cymes. G sylvestre is rich in gymnemic acids, gymnemagenin and gurmarin, and it possesses antidiabetic, antihyperlipidemic, antioxidant, and immunomodulatory properties.1 A study evaluated the potency of G sylvestre in insulin regulation and carbohydrate and lipid metabolism in alloxan-induced hyperglycemic male albino Wistar rats. Group 1 (nondiabetic control) and group 2 (diabetic control) rats were fed the chow maintenance diet; groups 3 and 4 were diabetic rats and were fed the chow maintenance diet along with 250 and 500 mg/kg body weight of G sylvestre leaf powder, respectively, for 21 days. Blood and tissue samples were collected for biochemical and histological analyses, respectively. G sylvestre treatment was found to improve the liver function enzyme levels in a dose-dependent manner. It also significantly reduces blood glucose levels with an increase in plasma insulin, oxidative stress, and dyslipidemia. Thus, the study confirmed the antidiabetic and antihypercholesterolemic properties of G sylvestre leaves.2 Another study evaluated the ability of G sylvestre to restore liver and kidney functions in high-sucrose diet–induced and dexamethasone-induced type 2 diabetic male albino Wistar rats. The 4 treatment groups received the aqueous extract (100 mg/kg), methanol extract (7.5 mg/kg), methylene chloride fraction (7.5 mg/kg), and methanol fraction (7.5 mg/kg) of G sylvestre whole plant, for 14 days. Analytical results revealed a significant improvement in the renal and hepatic transaminase levels and in the histopathology of the rats after treatment with the extracts. Thus, the study confirmed the restorative ability of G sylvestre in diabetic rats.3 References 1. Syedy M, Nama KS. Int J Pure App Biosci. 2014;2(6):318–325. 2. Muzaffar H, et al. Metabolites. 2023;13(4):516. 3. Tchouanka BT, et al. GSC Biol Pharm Sci. 2022;20(1):314–325. study confirmed the antidiabetic property of S cuminii fruits and seeds.3 Another study evaluated the antihyperglycemic property of S cuminii seed extract on alloxaninduced hyperglycemic male albino rats. Group 1 comprised nondiabetic, untreated rats (control). Group 2 rats were treated with 50% methanolic extract of S cuminii seeds, and group 3 rats were treated with glimepiride, for 15 days. Fasting blood glucose was evaluated on day 0 and on alternate days of the study. A significant decrease in the blood glucose levels was observed in the rats treated with 50% methanolic extract of S cuminii seeds, compared with the control group. Thus, the study confirmed the antihyperglycemic property of S cuminii seeds.2 References 1. Ayyanar M, Babu PS. Asian Pac J Trop Biomed. 2012;2(3):240–246. 2. Yadav D, et al. Search Res. 2013;4(3):13–16. 3. Ishartati E, et al. Adv Biol Sci Res. 2021;14:256–260. G sylvestre is the only ingredient of Himalaya Meshashringi. S cuminii is an ingredient of Diabecon® and Diabecon® DS. Sanskrit name Meshashringi English name Gymnema Sanskrit name Jambu English name Black Plum
4 • Sep–Dec 2023 • Vol LXII • No. 5 An excerpt of the clinical study conducted by Kumar PKM et al published in the journal Medicine Update is featured here. Research at Himalaya Diabecon® in the Management of Type 2 Diabetes Mellitus Diabecon® (TABLET, DS TABLET) The beacon of hope for diabetics Diabecon, an Ayurvedic proprietary formulation, is recommended for the management of diabetes mellitus and associated micro- and macrovascular complications. In newly detected type 2 diabetes mellitus, Diabecon as a monotherapy significantly reduces FPG, PPG, and HbA1c levels. As an adjuvant to insulin or other oral hypoglycemic agents, Diabecon helps in reducing their dosage and prevents development of tolerance. A clinical study was conducted to evaluate the safety and efficacy of Diabecon in controlling the blood sugar and glycosylated hemoglobin (HbA1c) levels and lipid profile in patients with non–insulin-dependent diabetes mellitus (NIDDM). The study enrolled 30 nonobese patients (aged > 30 y; both men and women) with NIDDM. The study groups comprised 15 patients newly diagnosed with persistent hyperglycemia, and 15 patients with diabetes who were already on sulfonylurea therapy. Patients with severe cardiovascular disorders, hypertension, and pregnant women were excluded from this study. The patients’ medical history was recorded, and baseline clinical and biochemical examinations were performed. The patients in both the groups (newly diagnosed and adjuvant therapy) were prescribed Diabecon at a dosage of 2 tablets, TID, for 6 months. FBS and PPBS levels were noted every 15 days. Plasma lipid profile and HbA1c and insulin levels were assessed at the baseline and after 3 and 6 months of Diabecon treatment. At each fortnightly follow-up, the patients were examined for side effects. Statistical analysis was performed using MANOVA and paired t test. The results showed that the treatment with Diabecon significantly reduced the FBS and PPBS levels and HbA1c level in both the patient groups. In patients on sulfonylurea therapy, administration of Diabecon brought about better glycemic control, thereby delaying the need for initiation of insulin therapy. A reduction in the lipid levels was also observed in both the groups. No side effects were reported or observed during the study. Thus, the results demonstrate the safety and efficacy of Diabecon tablet in controlling blood sugar and HbA1c levels and lipid profile in patients with NIDDM. A clinical study was conducted to evaluate the efficacy of Diabecon in the management of type 2 diabetes mellitus (T2DM). The study enrolled 15 patients (aged 30–60 y; both men and women) with T2DM. Patients on oral hypoglycemic drugs were asked to discontinue medication for 2 weeks prior to this study. On day 1, the baseline insulin and fasting blood sugar (FBS) levels were measured, and 1 g tolbutamide was given to the patients. Insulin and postprandial blood sugar (PPBS) levels were measured at the first, second, and third hour after the meal. On day 2, the patients were given a standard test meal (460 kcal) and insulin and PPBS levels were measured again at the first, second, and third hours after the meal. Diabecon was given at a dosage of 2 tablets, BID, and the investigations were repeated for 3 months. Tolbutamide was given on day 1 and the test meal on day. Further, Diabecon was continued everyday for 3 months. Statistical analysis was performed using ANOVA. The treatment with Diabecon resulted in a decrease in the FBS and PPBS levels. Overall, there was a significant decrease in the blood sugar level (Figure) and increase in the serum insulin level by the end of the study. Thus, the results confirm the clinical efficacy of Diabecon in the management of T2DM. Clinical Evidence 2 Clinical Evidence 1 An excerpt of the clinical study conducted by Seshaiah V et al published in the journal The Indian Practitioner is featured here. Figure. Blood Sugar Level Before and After the Treatment With Diabecon FBS, fasting blood sugar. Time Before Treatment After Treatment 160.8 156.4 181.9 190.3 187.6 220.4 256.6 256.9 300 0 50 100 150 200 200 At 2 h Blood Sugar, mg/dL At 3 h FBS At 1 h
Sep–Dec 2023 • Vol LXII • No. 5 5 Pilex® in the Treatment and Management of Hemorrhoids Pilex® (TABLET) The medical answer to a surgical problem Pilex tablet is an Ayurvedic proprietary formulation recommended for the management of hemorrhoids. Pilex tablet has anti-inflammatory, analgesic, wound-healing, antimicrobial, hemostatic, laxative, and antioxidant actions. The ingredients of Pilex tablet act synergistically to bring about a reduction of the hemorrhoidal mass and facilitate early resolution of symptoms such as rectal bleeding, pain, and itching, and help correct the constipation associated with hemorrhoids. This clinical study was conducted to evaluate the efficacy of Pilex tablets in the treatment and management of hemorrhoids. The study enrolled 11 patients, of whom 4 patients had third-degree hemorrhoids, and 7 patients had fourth-degree hemorrhoids. The duration of hemorrhoids in the patients varied from 3 months to 8 years. Prior to the study, the patients were operated upon for associated conditions such as acute retention of urine (due to benign prostatic hyperplasia), acute intestinal obstruction, perforated peptic ulcer, and obstructed inguinal hernia. Sphincter dilatation of the anal canal was also performed immediately after the surgery. Pilex treatment was started 3 to 5 days after the surgery. The patients received 2 tablets of Pilex, TID, for 4 to 6 weeks. The patients also received an ounce of liquid paraffin at bedtime. After discharge, the patients were followed up fortnightly for regression of the hemorrhoidal mass and improvement in bleeding, pain, itching, discomfort, and proctoscopic findings, for 6 months. At the end of 6 to 8 weeks, complete relief from pain, discomfort, and bleeding was observed in all the patients. Complete regression of the hemorrhoidal mass was recorded in 9 patients. Control of congestion and reduction in the size of the hemorrhoidal mass were also observed. All the patients were in good physical health during the follow-up period. Overall, a remarkable improvement in the symptoms of hemorrhoids was observed in the patients. Thus, the results show that Pilex tablets are effective in the treatment and management of advanced degrees of hemorrhoids. An open-label, clinical study was conducted to evaluate the safety and efficacy of Pilex tablet in the treatment and management of external and internal hemorrhoids. The study enrolled 50 patients (aged 22–63 y; both men and women), of whom 31 patients had external hemorrhoids, 10 patients had internal hemorrhoids, and 9 patients had both internal and external hemorrhoids. All patients received 1 Pilex tablet, BID, for 6 weeks. Concomitant treatment with other hemorrhoidal drugs was discontinued during the study period. Proctoscopic examination was done before and at every fortnightly follow-up during the treatment period. During the follow-ups, the patients were evaluated for the reduction in the size of the hemorrhoidal mass, pain during defecation, bleeding during defecation, anal pruritus, strenuous bowel movements, and loss of appetite. The intensity of the signs and symptoms were graded on a 4-point scale as 0, absent; 1, mild; 2, moderate; and 3, severe. At the end of the study, the efficacy of the treatment was recorded as either very good, good, or not effective. Thirty-two patients completed the treatment, while the remaining patients were lost to follow-up. Treatment with Pilex tablets showed a significant reduction in the symptoms of hemorrhoids such as pain and bleeding and a significant improvement in the general health of the patients. The treatment response was recorded as very good in 56.25% of the patients and good in 37.50% of the patients. No observable side effects were noticed during the study. Thus, the study confirmed that Pilex tablets are safe and effective in the treatment and management of mild-to-moderate hemorrhoids. Clinical Evidence 2 An excerpt of the clinical study conducted by Vastrad CS et al published in the journal The Antiseptic is featured here. Clinical Evidence 1 An excerpt of the clinical study conducted by Belokar WK published in Probe is featured here.
6 • Sep–Dec 2023 • Vol LXII • No. 5 In Focus Florasante™ in the Management of Diarrhea-Dominant Irritable Bowel Syndrome An excerpt of a clinical study conducted by Ganesh S (to be published) is featured here. Aim To assess the efficacy and safety of Florasante capsule (a synbiotic capsule) in the management of diarrhea-dominant irritable bowel syndrome (IBS-D) in comparison with a standard comparator and placebo. Materials and Methods This randomized, placebo-controlled comparative study included 60 patients of both sexes (aged 18–65 y). Inclusion criteria were positive diagnoses of IBS-D (defined by the Rome III Criteria) along with an abdominal pain score of ≥ 3.0 on a 10-point scale (where 0, no change; 1, mild; 2, moderate; and 3, severe) and/or passing at least one stool with a consistency of type 6 or type 7 as per the Bristol Stool Chart on at least 2 days per week; willing to sign the informed consent and follow the study procedures; and not participated in a similar kind of study in the last 4 weeks. Patients on nonsteroidal anti-inflammatory drugs, corticosteroids, and topical or systemic antibiotics during the past 1 month; who had undergone major abdominal surgeries; who had a history of inflammatory bowel disease or diverticular disease, celiac disease, and allergic diseases; and women who were pregnant, breastfeeding, or had any underlying gynecologic disorder were excluded from this study. Patients were randomized into 3 groups (20 in each): group A received placebo, group B received Florasante, and group C received a standard comparator capsule (each capsule containing Bifidobacterium longum, Fructooligosaccharides, Lactobacillus acidophilus, Lactobacillus rhamnosus, and Saccharomyces boulardii as active ingredients). Each group received the designated medication at a dosage of 1 capsule, orally, BID, for 4 weeks. All patients were assessed for improvement in the quality of life (QoL). Data on clinical parameters (ie, abdominal pain and bloat- ing and stool frequency and consistency) and laboratory parameters were collected at baseline and at the end of weeks 2 and 4. Results The study findings showed that there was a significant improvement in all the clinical parameters evaluated in patients who received Florasante capsules compared with that in the patients who received the placebo and standard comparator capsules. Patients in group B showed a statistically significant reduction in the mean value of abdominal pain (P < .0061) at the end of week 2, and it remained statistically significant at the same values at the end of week 4. Similarly, abdominal bloating was significantly reduced at the end of week 2, and it was completely normalized at the end of week 4 (P < .0002) (Figure). Figure. Effect of Placebo, Florasante, and Standard Comparator Capsules on Abdominal Bloating a, compared with baseline; q, compared with placebo; r, compared with the standard comparator. VAS, visual analog scale. In group B, there was a statistically significant reduction in the mean score of stool frequency at week 4 (P < .0001). Furthermore, there was a statistically significant improvement in the mean score of stool consistency (P < .0027) at the end of week 4. All laboratory and hematologic parameters were within the normal limit, and there were no adverse events reported during the study period. All the patients in group B showed a significant improvement in QoL and overall health in terms of bowel health—improved energy level with reduced levels of fatigue, improved level of gastric emptying, and relishing food better. Conclusion The findings suggest that Florasante capsule is potentially safe and effective in the management of IBS-D, with improved QoL, thus facilitating overall bowel health. * a:P < .002 q:P < .0018 r:P < .0003 #a:P < .0002 q:P < .0007 r:P < .0001 @a:P < .0273 $ a:P < .0273 Baseline −1 −0.5 0 0.5 1 1.5 2 2.5 VAS Week 2 Week 4 Group B Group C Group A # * @ $
Sep–Dec 2023 • Vol LXII • No. 5 7 Fitness Nadi Shodhan Pranayama or Alternate Nostril Breathing Technique 1. Sit cross-legged with the spine erect and hips relaxed. Close the eyes and relax. 2. Place the left hand on the left knee with the palm facing upward or in Chin Mudra (thumb and index finger gently touching at the tips). 3. Place the tip of the index finger and middle finger of the right hand in between the eyebrows; use the ring finger and little finger to close/open the left nostril and the thumb to close/open the right nostril. 4. Press the thumb on the right nostril and exhale gently through the left nostril. 5. Then, inhale slowly from the left nostril and use the ring finger and the little finger to close the left nostril gently. Next, remove the right thumb from the right nostril and breathe out slowly. 6. Again, breathe in from the right nostril and exhale from the left nostril. The first round of this exercise is complete. Continue the steps of inhaling and exhaling from alternate nostrils. 7. Keep the eyes closed throughout the exercise, and continue to take long, uninterrupted, and deep breaths without exerting much force. Complete 9 rounds by alternately breathing through both nostrils. After every exhalation, remember to inhale again from the same nostril.3 Benefits This exercise helps calm the mind and reduce stress, thus aiding in relaxation. Practicing this exercise for just a few minutes every day helps keep the mind peaceful and happy and release all the accumulated tension and fatigue.3 Pranayama for Good Mental Health Sitkari Pranayama or Hissing Breath 1. Sit cross-legged in a comfortable meditative posture on the ground. 2. Press the upper and lower teeth together, and keep the lips open as much as possible. Close the eyes and relax the whole body. 3. Inhale slowly through the gaps in your teeth making a soft hissing sound, and exhale slowly through both the nostrils and close the mouth. 4. Take slow and long breaths. 5. Repeat the steps for up to 20 rounds. The number of rounds can be based on one’s capacity. However, a minimum of 10 rounds are required to see the results.4,5 Benefits This exercise helps reduce stress and relaxes the mind. Practicing it every day keeps the mind calm and reduces anger and anxiety levels.4,5 References 1. Bavis JR. Exercising your brain: 6 ways to build mental fitness. Summa Health. https://www.summahealth.org/. Published January 24, 2022. Accessed April 20, 2023. 2. Shah S. 7 Breathing techniques for your physical and mental health. Sri Sri School of Yoga. https://srisrischoolofyoga.org/na/blog/breathing-techniques-physical-and-mentalhealth/. Published October 4, 2022. Accessed April 20, 2023. 3. The Art of Living. What is nadi shodhan pranayama. https://www.artofliving.org/in-en/ yoga/breathing-techniques/alternate-nostril-breathing-nadi-shodhan. Accessed April 20, 2023. 4. Sivasubramaniam T. Sitkari pranayama steps, benefits, precautions. Classic Yoga. https://www.classicyoga.co.in/2022/05/sitkari-pranayama-steps-benefits-precautions/. Published May 19, 2022. Accessed April 20, 2023. 5. Spiritual Curiosity. Sitkari pranayama (hissing breath) – meaning, procedure, benefits, precautions. https://spiritualcuriosity.org/guides/pranayama-sitkari/. Published February 11, 2022. Accessed May 5, 2023. Image source: https://www.msuniv.ac.in/ Download/Pdf/148e3bfed6074e1 One of the major pillars of a happy life is good mental health. Just as our body requires good care and exercise to keep it fit, so does our mind. Strengthening mental health improves memory, attention, and intelligence, and also helps reduce stress, anxiety, and aggression.1 Practicing pranayama is a well-proven way to calm the mind, lower tension, and facilitate better sleep.2 Here are some pranayama exercises that can be recommended to your patients to maintain good mental health.
8 • Sep–Dec 2023 • Vol LXII • No. 5 The Latest in Medicine Effect of High-Fiber Diet in Improving Glucose Homeostasis in Patients With Type 2 Diabetes Mellitus Gut dysbiosis is a frequent complaint in patients with type 2 diabetes mellitus (T2DM). Various research findings reveal that consumption of functional foods could enhance the insulin sensitivity and antioxidant and anti-inflammatory properties in patients with T2DM. Fiber-rich diets provide sufficient carbohydrates for the gut microbiota to ferment and ensure regulation of metabolic functions via microbial metabolites. Thus, high-fiber diets could help ameliorate metabolic syndromes such as T2DM. Recently, a study was conducted to analyze changes in gut microbiota, metabolic function, emotional mood, and glucose homeostasis of patients with T2DM after the consumption of a high-fiber diet. This randomized, open-label, parallel-group clinical study enrolled patients with T2DM with plasma HbA1c levels ranging from 6.5% to 12%. The patients received either acarbose (100 mg; 3 times/day) + common diet for T2DM (control group) or acarbose (100 mg; 3 times/day) + high-fiber diet (treatment group), for 8 weeks. At the end of the treatment period, anthropometric parameters, serum and fecal samples, and questionnaires to record Hamilton anxiety scale and Hamilton depression scale were evaluated. Upon analyses, it was found that a high-fiber diet significantly improved the status of glucose homeostasis, beneficial gut microbes, systemic inflammatory response, and psychiatric comorbidities. Thus, the study demonstrated that consumption of a high amount of fermentable fiber in the diet can provide effective metabolic benefits for patients with T2DM. Source: Chen L, et al. Front Cell Infect Microbiol. 2023;13:1069954. Role of Micro- and Macronutrients in Improving Glucose Homeostasis in Patients With Type 2 Diabetes Mellitus Nutrition plays a crucial role in the development and progression of type 2 diabetes mellitus (T2DM). Mounting scientific studies emphasize that hypercaloric diet (ie, diet high in carbohydrates and fatty acids) can induce epigenetic changes among patients with T2DM, and that balanced diets such as the Mediterranean diet could help prevent T2DM complications. Recently, a population-based study was undertaken to determine nutritional components associated with T2DM development and their effect on glucose homeostasis. This study was a prospective cross-sectional survey on the nutritional dietary intake in a representative sample of a Northern East Tunisian population. Based on the data regarding demographics, anthropometrics, dietary intake, lifestyle, and glycated hemoglobin (HbA1c) levels, the participants were divided into diabetic (HbA1c: ≥ 6.5%), nondiabetic (HbA1c: < 5.7%), and prediabetic (HbA1c: 5.7%–6.49%) groups. Variance analyses showed that the diabetic and prediabetic groups consumed a high amount of hypercaloric diet and less amounts of vitamins (eg, riboflavin, niacin, vitamin B5, and vitamin D), minerals (eg, magnesium, calcium, zinc, phosphorus, potassium, and total iron), cholesterol, and water. Hypercaloric diet and insufficient intake of vitamins and minerals interfere with the insulin secretion pathway, alter glucose tolerance, increase oxidative stress and inflammation, and decrease immune responses. Thus, the study confirmed that the regulation of glucose homeostasis in patients with T2DM is strongly linked to the quantity and quality of dietary intake. Source: Kheriji N, et al. Nutrients. 2022;14(10):2132. ® Researched Nutritional Supplement for Diabetics In the nutritional management of diabetes... FOOD FOR SPECIAL DIETARY USE – For diabetic and prediabetic individuals. Pregnant, nursing and lactating women or infants, children under 5 years, adolescents and the elderly should consult a health care professional before use. NOT FOR MEDICINAL USE. Not for parenteral use. Do not exceed the recommended daily usage. Allergen Statement: Contains milk and soy ingredients. Manufactured in a facility handling nuts and cereals. To be used under the medical advice of a health care professional, as par t of a diabetes management regimen for adults, which includes physical activity and a healthy diet. Keep out of the reach of children. Delicious Milk Masala and Vanilla Flavors
Sep–Dec 2023 • Vol LXII • No. 5 9 Effect of Uncontrolled Type 2 Diabetes Mellitus on Male Sexual Hormone Function and Sperm Quality Type 2 diabetes mellitus (T2DM) is one of the most widespread health care issues in the world. The increasing incidence of T2DM in men of reproductive age has led researchers to continue to determine the role of T2DM in deranging male fertility status. Recently, a cross-sectional study was undertaken to establish the relationship between T2DM, sperm parameters (ie, sperm count, semen volume, motility, and morphology), and sex hormone levels in men. This study enrolled 25 healthy men (control group: aged 30–59 y) and 35 diabetic men (group 2: aged 30–45 y and group 3: aged 36–59 y). Semen samples were collected for analysis, and blood samples were collected for the analyses of hematologic parameters and levels of sex hormones (follicle-stimulating hormone [FSH], luteinizing hormone [LH], total testosterone [TT], estradiol [E2], and prolactin [PRL] hormone). Upon evaluation, it was observed that the levels of FSH, LH, and TT were significantly lower, and the levels of E2 and PRL were significantly higher in diabetic patient groups 2 and 3 compared with the control group. A significant low sperm concentration and a higher concentration of sluggish and dead sperms as well as abnormal sperms were found in diabetic patient groups 2 and 3 compared with the control group. Thus, the study demonstrated that men with T2DM are susceptible to sexual hormone dysfunction and diminished sperm quality. Significant health consequences from T2DM can be reduced by routine monitoring and regulation of blood glucose levels. Source: Ali BR, et al. J Med Life. 2022;15(12):1507–1510. Role of Metabolic Syndrome Components in Predicting Erectile Dysfunction in Men With Type 2 Diabetes Mellitus Erectile dysfunction (ED) is an underreported complication that arises in the presence of type 2 diabetes mellitus (T2DM). Reports suggest that ED is 3-fold highly prevalent in patients with T2DM. Furthermore, metabolic syndrome components such as hypertension, central obesity, and levels of abnormal triglyceride and high-density lipoprotein (HDL) are also hypothesized to affect erectile function in men with T2DM. Recently, the Diabetic Complications and Erectile Dysfunction study evaluated the effect of metabolic syndrome components on the erectile function in patients with T2DM. This cross-sectional study enrolled 45 patients with T2DM (aged > 18 y) with no history of alcohol or substance abuse and acute illnesses. Patients were evaluated for the presence of metabolic comorbidities. Laboratory analyses for fasting plasma glucose, glycated hemoglobin, liver and kidney functions, HDL, total cholesterol, triglycerides, and albuminuria were also performed. Sexual function was assessed using the international index of erectile function (IIEF) questionnaire. Based on questionnaire scores, ED was diagnosed in 87.2% of the patients with metabolic syndrome. Of which, 84.6% showed abnormal levels of HDL. These patients with T2DM with abnormal HDL levels showed a significant association with the presence of ED and IIEF score. Thus, the study showed that abnormal HDL levels can be considered a significant predictor of ED in patients with T2DM. Managing glycemic levels and avoiding the occurrence of metabolic derangements may help in the prevention of ED in patients with T2DM. Source: Katsimardou A, et al. Metabolites. 2023;13(5):617. Himcolin® (GEL) Strengthens erectile power and improves sexual potency Confido® (TABLET) Restores his confidence Tentex forte® (TABLET) Enhances desire and improves performance For low libido... In various ejaculatory disorders... In erectile dysfunction...
10 • Sep–Dec 2023 • Vol LXII • No. 5 Fact File Polycystic Ovarian Syndrome • In young girls, oligomenorrhea even after 2 years of menarche indicates a risk status of polycystic ovarian syndrome (PCOS). • Continued irregular menstruation clubbed with anovulation or oligo-ovulation can aggravate PCOS. • More than 60% of women with PCOS are likely to be suffering from clinical and/or biochemical hyperandrogenism. • Obesity can exacerbate metabolic and ovulatory dysfunction in PCOS. • Women with PCOS are at an increased risk of developing insulin resistance (IR) and associated metabolic comorbidities. • IR in women with PCOS is a consequence of the hyperandrogenic mechanism of the PCOS pathophysiology. • PCOS-triggered infertility can lead to a 3 to 4 times elevated risk of endometrial cancer. • Sympathetic nervous system dysfunction, chronic inflammation, oxidative stress, and vitamin D deficiency are considered as the emerging risk factors of PCOS. Source: Islam H, et al. Womens Health (Lond). 2022;18:17455057221117966. Health Tips Tips to Manage Polycystic Ovarian Syndrome Polycystic ovarian syndrome (PCOS) affects 4% to 20% of the women in their reproductive age, worldwide.1 The major symptoms of PCOS are cystic acne, mild facial hirsutism, oligomenorrhea, amenorrhea, enlarged ovaries, signs of hyperandrogenism, ovarian failure, infertility, and severe generalized hirsutism.2 Studies indicate that PCOS is associated with low-grade chronic inflammation, and women with PCOS are at an increased risk of many metabolic disorders such as nonalcoholic fatty liver disease.3 Here are some tips for the effective management of PCOS, which can be recommended to your patients. • Obesity is one of the prime causes of PCOS. So, maintaining a healthy weight is important to reduce the symptoms of PCOS. Exercising regularly helps reduce obesity by burning calories, which in turn increases the body’s sensitivity to insulin. Exercising also helps lower cholesterol levels and normalize hormone levels such as that of testosterone, which can be highly effective in treating PCOS symptoms.3 • Consuming fresh and minimally processed foods such as fruits, vegetables, nuts, and seeds (eg, flaxseeds) can be beneficial. Including whole grains (eg, barley, oats, brown rice, millets, and quinoa), fish rich in ω-3 fatty acids (eg, salmon and sardines), and soy is recommended. Alternatively, processed foods and sugary beverages should be avoided to the maximum extent, as they contribute to the increase in blood sugar level, which in turn can cause insulin resistance and aggravate PCOS.3,4 • Drinking adequate water helps keep the body hydrated. One can also choose to add a bit of lemon juice or an herb such as mint to make the drink interesting as well as healthy. Beverages that are high in sugar (eg, sweetened juices, energy drinks, and soda) should be avoided.4 References 1. Deswal R, et al. J Hum Reprod Sci. 2020;13(4):261–271. 2. Gautam A, et al. Ayushdhara. 2021;8(4):3439–3445. 3. NYU Langone Health. Lifestyle changes for polycystic ovary syndrome. https://nyulangone.org/. Accessed May 17, 2023. 4. Skiadas CC. Treating PCOS with nutrition: 9 tips for a healthy diet. https://www.lancastergeneralhealth.org/. Published October 6, 2022. Accessed May 17, 2023. Evecare forte™ (LIQUID, TABLET) Evecare forte is a phytopharmaceutical formulation recommended for the effective and comprehensive management of polycystic ovarian syndrome (PCOS). Evecare forte is a nonhormonal menstrual modulator that helps regularize endogenous hormonal status, correct the cyclical rhythm, and reduce the number of abnormal follicles. Evecare forte improves ovulatory function and other metabolic derangements associated with insulin resistance through its insulin-sensitizing activity. Evecare forte also alleviates the symptoms of PCOS, including hirsutism, hyperpigmentation, mood swings, anxiety, and depression, and improves fertility. For the effective management of PCOS
Sep–Dec 2023 • Vol LXII • No. 5 11 Editor: Dr Jayashree B Keshav Editorial Team: Shruthi VB, Shruthi VK, Harika GS, Shruthi M, Priyakshi M, Keerthini D, Harshitha C Layout Artists: Dayananda RS, Santosh G, Monesh NP Worth Sharing With You We can complain because rose bushes have thorns, or rejoice because thorns have roses. — Abraham Lincoln Laugh a While, It’s Healthy! Product Feedback I have prescribed Evecare® forte Tablet to my patients with polycystic ovarian syndrome; the product has shown good improvement in fertility. Dr S Floret Chennai, Tamil Nadu, India I have been prescribing Liv.52® DS for the past 4 years to patients with tuberculosis (TB) and hepatic disorders. The product is effective in protecting against the hepatotoxicity of anti-TB drugs and helps improve appetite and promotes weight gain. Dr Nitin Jain Jaipur, Rajasthan, India I have been prescribing Quista® DN for a long time now. I have noticed very good and convincing results in all my patients with diabetes. The glycemic level has reduced in my patients, and they have reported feeling more energetic. I highly recommend it. Dr Aditya Goyal New Delhi, India Liv.52® Syrup is a unique liver tonic that helps improve digestion and appetite and prevents liver damage. I have prescribed Liv.52® Syrup in cases of viral hepatitis. Liv.52® not only protects the liver against the harmful toxins from drugs, alcohol, food, and water, but also restores the functional efficiency of the liver by protecting the hepatic parenchyma and promoting hepatocellular regeneration. I am highly impressed with the product. Dr Salim Mondal Gosaba, West Bengal, India Copyright © 2023 Himalaya Wellness Company All content in this journal/publication is the property of Himalaya Wellness Company and is protected by Indian and international copyright laws. Any other use, including the reproduction, modification, distribution, transmission, republication, display or performance, of the content in this journal/publication, without written permission from the owner, is strictly prohibited. For permission to reproduce articles/information published in this journal/publication, please write to publications@himalayawellness.com SUBSCRIPTION If you would like to subscribe to Capsule, please fill an online form. You can access this form through the link https://tinyurl.com/CapsuleSubscriptionForm or the QR code Little Lilly walked into the room while her mom was getting ready for work. Lilly: What are you doing? Mom: Putting on my wrinkle cream. Lilly: Oh, I thought they were natural! • • • Even at age 88, Edith was worried about her looks. At a party, an old friend exclaimed, “Edith, you haven’t changed in 20 years.” “Oh,” said Edith, horrified, “I hope I didn’t look like this 20 years ago.” • • • Q: Why should a skeleton drink 10 glasses of milk every day? A: Because it is good for the bones! • • • While driving back from Vermont, I stopped at a vegetable stand. It was deserted except for a sleeping German shepherd. I stepped over the dog, helped myself to some corn, and then opened the cash box to pay. Taped to the inside of the lid was a note, “The dog can count.” • • • Q: What creature has the best aptitude for engineering? A: The spider—it has its own website! • • •
Printed and Published by: Dr Jayashree B Keshav on behalf of Himalaya Wellness Company Printed at: M/s Sri Sudhindra Offset Process, #97, DT Street, 8th Cross, Malleshwaram, Bengaluru 560003 Published from: Himalaya Wellness Company, Makali, Bengaluru 562162 Editor: Dr Jayashree B Keshav In line with our commitment toward a green future, Capsule newsletter is printed with vegetable-based inks on eco-friendly paper made from sustainable sources. Registered with the Registrar of Newspapers for India under R.N. 9073/63 • ISSN 0927-9681 ® Regd. Trade Mark Only for reference by a registered medical practitioner, hospital, or laboratory Protects the liver in NAFLD • Restores the metabolic efficiency of the liver • Modulates lipotropic activity and thus prevents fatty infiltration • Exhibits antiperoxidative activity and improves insulin sensitivity • Exhibits anti-inflammatory action • Arrests the progression of the disease Indication: NAFLD Dosage: 1–2 tablets twice daily. In India, 56.5% of patients with type 2 diabetes have nonalcoholic fatty liver disease. Free fatty acids Oxidative stress Insulin sensitivity Liv.52 DS ( TA B L E T ) Unparalleled in liver care Liv.52 DS — Unparalleled in liver care —J Assoc Physicians India. 2013;61(7):448-453. Printed and Published by: Dr Jayashree B Keshav on behalf of Himalaya Wellness Company Printed at: M/s Sri Sudhindra Offset Process, #97, DT Street, 8th Cross, Malleshwaram, Bengaluru 560003 Published from: Himalaya Wellness Company, Makali, Bengaluru 562162 Editor: Dr Jayashree B Keshav In line with our commitment toward a green future, Capsule newsletter is printed with vegetable-based inks on eco-friendly pa er made from sustainable sources. Registered with the Registrar of Newspapers for India under R.N. 9073/63 • ISSN 0927-9681
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