Dr. Makkar's Diabetes and Obesity Centre

Hello.

I am doctor Brij Mohan Makkar. I am a practising diabetes specialist at Delhi. Today I am going to tell you something about artificial sweeteners or they are also called as low calorie sweeteners or non caloric sweeteners or non-nutritive sweeteners. Basically, these are sweeting agents which do not have any calories, which do not add any calories to your food and that is why usually people who have diabetes prefer to take these sweeteners instead of common sugar or the table sugar. Now, there are always questions relating to these sweeteners whether they are safe, there are so many you know WhatsApp and social media post showing that they are they can cause cancer, they are bad for health and so on. Important thing to understand is that there are a set of sweeteners which like sugar sweeten your food but do not have calories and they are, their sweetening capacity is 100-4,500 times more than the common sugar or table sugar.

So, you need to use a fraction of amount as compared to the common sugar to make your food sweeter. Now, whether they are safe? Well, the number of agents that are available commonly has sweeten low or sugar free or zero or splenda all these are safe. The technical names of these sweeteners are aspartame, sucralose, acesulfame and neotame any of these sweeteners have been shown to be safe if they are consumed in the recommended doses or the recommended amounts if you have not consumed large amounts. Now, as far the question of their causing cancer I think there is a big myth. There is no evidence that the recommended amount of these sweeteners cause any kind of cancer or any long-term problem. Now, important thing is do they actually help in cutting down calories. Now, you have to understand that lot of foods have calories coming from other sources like fats, oils or butter and suppose you are eating ice cream which is low cal ice cream that means it doesn't have sugar but has a sweetener does not mean it will have very low calories, it will still have lot of calories.

So, just you know depending on low caloric sweetener to cut down the total calorie intake is not always a very good idea. So, patients with diabetes or patients who are overweight and who want to cut down calories, a general recommendation is that you should cut down the foods which have dense calories that means they have excess sugar or excess fat and you should also consume less of sweetened foods and sweetened beverages so that you change your lifestyle, you improve your food habits and as a process you cut down calories. Yes, people who are used to taking multiple you know soft drinks or repeated soft drinks in the daytime or sweetened food all the time there these artificial sweeteners are very helpful because you can cut down the amount of calories because you are taking lot of sugar in your food and replacing sugar with sweeteners will cut down the amount of calories that is going with food as sugar.

But you have to make sure that you don't take excess of these are sweeteners also. Generally, about 6-8 tablets of sweeteners are considered safe per day but on an average I would recommend that people should not focus on taking more of sweeteners also because it is not a good habit, ultimately you have to focus on change of lifestyle, improve your eating habits, improve your diet in general, move to healthy foods like more of salads, fruits, high fibre diets and less of sugar and oil diets to improve your sugar levels as well as your weight. So, as far the notion goes that all artificial sweeteners are bad, it is not so. They are safe, they can be taken in recommended amounts but access should not be advised because you have to ultimately focus on change in lifestyle.

Now there is a big fad about stivia also going on that stivia is a natural thing and it is safe, stivia again has you know alkaloid called drab-A which is about 3-400 times sweeter than sugar but it has little better after taste. Generally, there is no generally it is regarded as safe because it is a plant product so these products can come under a category called grass, generally regarded as safe. There are no scientific studies which have shown that they are safe in long term. So, I think the same precautions should be used which you are using with other artificial sweeteners for stivia also. But, these sweetness can be of help for patients in reducing caloric intake to begin with as long as for sometime to tide over the craving for sweet foods and gradually you should move to a healthier lifestyle and healthier eating with more of fibre and you know less calorie dense foods rather than focusing on the intake of sugars or sweeteners.

Thank you.

Hello,

I am Doctor Brij Makkar. I am a diabetologist. Aaj main aapko diabetes mein technology ham kaise use kar sakte hain diabetes management ko better kerne ke liye iske bare mein kuch bataunga. Jaisa ki aap jante hain technology bohot speed pe advance ho rahi hai aur technological advances life ke har aspect mein applicable hai. Aise hi diabetes management mein bhi technology ki madad se ham diabetes ka management improve kar sakte hain, diabetes ke result improve kar sakte hain aur patient ki life better kar sakte hain. Do jo important aspects hai diabetes management ke jinme technological advances hue hain wo hain ek to sugar ki monitoring, sugar ka test karna aur dusra jo hai jo ham insulin dete hain, insulin ko dene ki jo devices hai injection devices usmein kafi changes aaye hain.

Pehla front hai ki hamen sugar regular basis per check karni padati hai jiske bina ham sugar par control dhang se nahin kar sakte, to Jo glucometer se sugar test kari jaati hai ghar par usko self monitoring aur blood glucose kehte hain wo sabh patient ke liye advisable hota hai aur normally har patient ko average 3 se 4 bar sugar check karni chahiye jab tak wo control nahin hai, jab control ho jata hai jaisa uske doctor usko salah dete hain come frequency par wo sugar test kartesakte hain but khali glucometer se sugar test karna khali 1 fasting aur khane ke bad ki sugar check kerna kafi nahin hota ek aur important parameter hai jo glucose mein variability hoti hai, jo fluctuations hoti hai sugar ke level mein wo bhi kafi important hoti hai joki aap ki complications ka risk badhati hai. In fluctuations ko ham identify kar sakte hain aajkal continuous glucose monitoring se that means hum sugar monitoring or regular basis pe, continuous basis pe 24 ghante ke liye monitor kar sakte hain aur uske liye hamare pass 2-3 different tarike ke continuous glucose monitoring devices aati hai. Kuch hai ki jo har 15 minute mein sugar check karte hain, sensor laga diya jata hai patient ko jismein har 15 minute sugar record hoti reti hai aur wo 2 hafte tak ham record kar sakte hain. Aise hi kuch sensor hai jo har 5 minute mein record karte hain aur ham ek hafte se 2 hafte tak record kar sakte aur uske basis per ham yeh dekh sakte hain ki 24 ghante mein sugar kitni fluctuate karti hai aur kaise ham davaiyan change karke ya diet ka eating pattern change karke ham wo sugar ki fluctuation ko kam kar sakte hain.

Dusra aspect Jo important hai wo hai insulin dena khaas taur par insulin isliye main baat kar raha hun kyunki insulin ek dawai hai jo injection ke raste di jaati hai aur injection se har patient ko dar rehata hai dimag mein lekin aaj ki tarikh mein mostly insulin pen devices mein available hai. Ek pen ki shape mein syringe hoti hai jisme insulin bhara rahata hai apko dose adjustment bohot aasan hoti hai kyunki usmein dial hota hai jisse aap dose dial karte hai, needle bohot hi chhoti hoti hai 4 mm ki needle hoti hai aur 30 gauge hoti hai aur 31 gauge hoti hai jo practically uske choobhne ka bhi aapko pata nahin chalta aur usse bilkul accurate dosing aap kar sakte hain.

To Jo regular syringes hai uske badle mein agar aap pen devices bhi use karte hain to insulin injection lagana bohot asan ho jata hai. Iske alava aaj ki date mein insulin pumps be available hai jisme aap ek pump, ek needle ke raste aapke skin ke andar insulin continuously infuse karta rehta hai that means aap 24 ghante aapko insulin bohot slow dose mein chalta rahata hai jisse ki aapka sugar 24 ghante continuous control mein rehta hai aur usmein yeh bhi option hota hai ki agar aap kuch extra khaa rahe hain to ek button daba kar aap 1 extra dose le sakte hain uske liye aapko alag se injection nahi lagana padta vahi pump ek sensor ke raaste aapki sugar read bhi karta rahata hai aur aaj ki date mein yeh bhi possibility hoti hai ki aapane agar sensor ki control range set ki hai to sugar low ho rahi hai to aapko alert deta hai, sugar badh rahi hai tu bhi aapko alert aata hain ya sugar low ho rahi hai to insulin jaana band ho jata hai automatically jisse ki sugar low hone ka risk bhi kam ho jata hai. So dono hi tarike se sugar monitoring aur jo insulin infusion dono hi technologies kafi useful hain diabetes management ke liye.

Thank you

Hello,

I am Doctor Brij Makkar. I am diabetes specialist practicing in West Delhi. Aaj main aapko diabetes mein exercise aur diet ke bare mein kuch bataunga. Diabetes mein lifestyle modification bohot hi important hai, lifestyle modification jab bhi ham kahate hain, jab bhi ham dono cheezon ko include karte hain jo aapki diet yani ki aapke khane ka jo system hai aur jo regular exercise ya physical activity karte hain dono hi lifestyle ke part hote hain or important hote hain diabetes ke management ke liye.

To jo bhi patient ko diabetes hai unke liye bohot jaruri hota hai ki wo ek regular exercise schedule rakhein, ek regular physically active lifestyle rakhein kyunki jitni aapki physical activities jyada hoti hai utna hi aapka sugar ka control better rehta hai utna hi aapki complications ka risk kam rahata hai.

Jo average diabetes patient hai unko 45 to 60 minutes daily physical activity karni chahiye. Jo physical activity generally recommended rehti hai woh brisk walking ya cycling, swimming, aerobics; aap kuch bhi kar sakte hain, kuch log puchte hain ki ham gym jaa sakte hain ya nahin jaa sakte? Gym jaane mein koi burai nahin hai agar aap monitored exercise kar rahe hai or bohot aggressive nahin kar rahe hain. Dusri cheez exercise se pehle aap apna sugar check karein taaki aapko yeh idea hona chahiye bohot aggressive exercise ke bad aapki sugar low nahin ho jaaye.

On an average har diabetes patient ko agar wo walk karte hain to 8-10,000 steps daily basis pe karne chahiye aur iske liye aap bohot commonly available aajkal apps hai phone mein ya aajkal digital monitors hai jaise wristbands hai jinme aap physical activity record kar sakte hain wo use kar sakte hain. Jitni bhi aap physical activity karte hain usse aapki body mein insulin resistance kam hota hai, usse aapka blood pressure improve karta hai agar aap regular exercise karte hain to aap blood pressure 5-10 mm niche jata hai, aapka sugar level on an average 20 se 30 mg/dl niche aa jata hai, aapki heart ki functioning better ho jaati hai, aap ki saans lene ki jo capacity hai woh better rehti hai , aapka muscle mass jyada rahata hai, aapki bones jyada strong hoti hai to kul milakar exercise se aapko bohot fayde hote hain.

Isi tarike se diet bohot important hai agar aapka diet ka system irregular hai to sugar par control karna practically possible nahin hota kyunki jo bhi ham davaiyan de rahe hain unka ek time-action profile hota hai. Jaise koi goli ham aapko subeh breakfast se pehle dete hain to uska action manniye aade se pone ghante mein shuru hota hai, 3 ghante mein peak par jata hai aur ho sakta hai 8 ghante mein khatm ho jata hai ya kuch goliyan hain jinka action pone ghante mein shuru hota hai peak pe 6 se 8 ghante par jata hai aur 20 ghante tak khatam ho jata hai to hum khane ka timing jo hai is hisab se karte hai ki jab aap khana khaye goli agar aapne aadha ghanta pahle li hai to jaise sugar badhna shuru hoga use time goli ka asar aana hoga ya insulin ka asar use time pe aana shuru hoga. Uske bad jab dawai ka action peak par hai to use time aapka 2nd meal lete hain aap aur jab tak uska effect khatm ho raha hota hai to aap teesra meal lete hain to usse pehle dusri dose lete hain ya jo pehle subeh ki apne dawai li hai uska action teesri meal ko bhi aapke cover karta hai.

Khane ka time par khaya jana bohot jaruri hai normally aap dietitian ki help se ek proper diet plan use karen, khana time par khaya, khana pura khaye aur khana miss nahin karen. Log commonly khana apna miss kar dete hain yeh dekh kar ki meri sugar badi hui hai to khana miss kar dete hain aisa nahin karna hai. Ek healthy diet le, ek healthy lifestyle manage karen, khane mein fried aur meetha bilkul avoid karein, khana time par khayen aur swasth rahein.

Thank you

Hi,

I am Dr. Brij Mohan Makkar, Endocrinologist. Aaj me apko diabetes ke regular tests ke bare me btaunga. Diabetes patients ko confusion hota hai ki unhe sugar kab or kitni baar test krni chaiye. Uske baad laboratory test kitni frequency and kab krane chaiye. Prime factor hai ki apka sugar control hona chaiye. Sugar level 24 hours fluctuate hota rehta hai like khali peat and khana khane ke baad. Sugar patient ko regular basis pe apna sugar check krte rehna chaiye. Apko 3-4 times sugar check krna chaiye. Aap ghar pe glucometer se sugar test kr skte hain.

Apko lifestyle, diet and prescribed medicines time to time leni hai. Diabetes apka heart problem, blood pressure, thyroid ka problem ho skta hai islia aap each and eery year test krayein jisme aap lipid profile, kidney function, liver, thyroid, vitamin B12, D, ultrasound, chest x-ray, ECG every year krana hai. Agar apka sugar normal chal rha hai to apko A1C test krana hai jis se last 3 months ka average pta chalta hai. Agar ye test 7% se kam hai to risk factors kam ho jate hain. Baki sare test apko saal me ek baar jrur krane hain.

Thank You.

Hello,

I am Dr. Brij Mohan Makkar, Endocrinologist. Me apko diabetes ke bare me btaunga. Ye major problem hai India me. Log isko neglect krte hain and sugar control pe focus nhi krte hain. Isse vo apna quality of living khrab krte hain. Life span bhi kam hota hai patient ka. Medicines ki requirement bhi patient ki badh jati hai. Blood me sugar badhne se ye body ke har part ko effect krti hai. Is se 3-4 complications badh jate hain jaise diabetes neuropathy. Nerve damage hone se sensation kam ho jate hain. Ye pairon ko effect krta hain jiski vjha se diabetic foot ka complication ho jata hai. Pairon me ulcer bante hain. Gangrene ka risk badh jata hai.

Pairon ke toes or pairon ko katne ki naubat aa skti hai. Dusri problem hai retinopathy. Eyes ki nerve damage ho jati hai. Blindness ka risk badh jata hai. Cataract ka risk bhi hota hai patient ko. kidney damage ka risk badh jata hai. Kidney dialysis or transplant ki jrurat bhi patient ko pad skti hai. Jin logon ko kidney ki problem hoti hai unhe heart attack ka risk bhi badh jata hai. Diabetes ko neglect na kren. Apko apni diet and lifestyle pe focus krna hai. Medications time pe lene hai and sugar bhi timely check krna hai. Regular check-ups essential hain. Regular exercise kren.

Thank You!

Hello, I am Dr Brij Mohan Makkar, I am diabetes and obesity specialist. So my area of specialisation is managing Type-2 diabetes and obesity or overweight. Jaise ki aap jante hain motapa ek bahut hi badi problem hai puri duniya mein aur hindustan mein bhi, khaas taur pe metro cities main ya choti cities may bhi motapa bahut teji se badd rahien hain aur aksar motape ko log bimari ke taur par pehchante nahi hain, they don't recognised obesity as a disease. Now, it is very common saying that obesity is mother of possibly all important disease of our life yadi aapka wajan and jyada hai, aapko motapa hai, toh aapko jeevan ki qarib qarib sabhi kisam ki bimarion ka risk bad jata hai aur ialiye bahut zaroori hai ki apna wazan thik rakhe aur agar aap ka wazan jyada hai toh uska proper tarike se ilaj karien aur vajan kam karien. Aksar log jinka wajan jyada hota hai wo ye sochte hain ki agar mai sair karunga aur khana kam kar dunga toh khali mera usse wajan kam ho jayega ya yeh sochte hain ki mera wajan jo bada hai woh meri galti ki wajah se bada hai. Lekin aksar aisa nahi hota kyunki wajan badhane ki tendency aapki partially aapki jeans ki wajah se bhi hoti hai, aur motapa khali ek aapke khane peene ki adat ya physical activity kam karne ki wajah se nahi hai, ye ki ek kisam ki bimari hai jo baki bahut sari bimariyan hai jaise, diabetes, heart disease, blood pressure, saans ki dikkat, joint ki problems bahut sari problems ko ye badati hai, bahut sari problems ka risk badati hai. Even motape ki wajah se bahut sare cancers ka risk badd jata hai aur aap ki sex life mein bhi bahut sara farak padta hai. Bahut sari ladies jinko motapa hai woh fertility effect hoti hai, unki pregnancy hone mein problem hoti hai aur bahut sare aise risk badte jaate hain, isliye bahut zaroori hai ki motapey ka thik se ilaj karen ek proper specialist ko milien jo aapko help kar sakta hai wajan kam karne mein. Dusri cheez yeh hai, log ye sochte hain ki hamare ko koi jadoo ki dawai mil jaye jisse wajan kam ho aur dubara nahi aaye. Aapko yeah dhyan rakhna hai ki motapa ek bahut important lifestyle disease hai, ismein aapki lifestyle kharab hone ki wajah se aur aapki genetic background aise hone ki vajah se aap ka wajan badta hai. Toh lifestyle changes jo hai aapko sari umar maintain karne hai jaise blood pressure ke mareez ki agar dawai hum band kar de toh uska blood pressure wapis aa jata hai, jaise sugar ke mareez ki dawai band karien toh uska sugar ka control phir kharab ho jata hai, aise hi motapa ke mareez ka agar ilaj band kar diya jaye toh uska motapa bhi wapas aa jata hai. Isliye bahut zaroori hai ki aap tarike se aap apna lifestyle improve karien, ek regular physical activity maintain karien, ek healthy diet regular basis pe le or dawaiyan ye jo aapko aapke specialist dete hain unko follow karien taki aapka wajan kam aa sake. Ek baar apka wajan kam ho jata hai toh bahut zaruri hai ki lifelong basis pe aap ek healthy lifestyle maintain karen jisme ek ghante ki physical activity which is equal to moderate intensity activity jaise ki brisk walking, cycling, swimming is level ki koi activity ek ghanta roz zaroor karte rahen aur khane mein jitna ho sake tali hui cheezien ghee, tail aur mithe ka prayog kam se kam karien, taki aapka wajan dobara nahi bade. Yadi aapka wajan jayada hai aur aapko mushkil hai wajan kam karne mein, toh aap hame contact kar sakte hain Lybrate ke trough.

Hello, I am Dr Brij Mohan Makkar, I specialise in management of diabetes and obesity. Jaisa ki aap jante hain ki diabetes bahut hi teji se puri duniya mein aur India may bhi bad rahi hai, aur khaas taur pe ye Indian population mein diabetes jo hai ek younger age pe hoti hai. Agar western population mein diabetes 50 se 55 saal ki age mein hoti hai, toh Indians main dus saal pehle yani ki 40 45 saal ki age me hona shuru ho jati hai aur Jaise Jaise motapa bad raha hai diabetes aur jaldi bardna shuru ho gayi hai. Toh jaise hi patient ko diabetes hoti hai bahut common sawal hamare paas aata hai ki doctor sahab kya isko hum Jad se khatam kar sakte hain, iska answer jo hai kuch had tak han hai aur kuch had tak na bhi hai. Woh patients jinki diabetes abhi bilkul recent onset hai, ya initial char se paanch saal ke andar hai aur young age mein hui hai aur agar unka weight jyada hai, toh agar hum unko aggressively manage kare to unki diabetes kuch hadd tak reverse ho sakti hai. Actually mein usko reversal nahi kahunga, revolution kahunga kyunki hamien ye nahi pata ki woh lifelong rahegi ya nahi rahegi. Ye ho sakta hai ki paanch saal baad, dus saal baad, panrah saal baad unki sugar fir se badd jaye per definitely agar hum aggressively manage kare, toh sugar ko hum bilkul normal level pe la sakte hain aur hamare bahut sare aise patients hain jinka humne sugar normal level pe le aayen hai jinki sugar ki dawaiyan, blood pressure ki dawaiyan sab hum band kar chuke hain, aur teen-teen char-char saal se woh aise hi follow kar rahe hain. Iska jo sabse important factor hota hai ki hame bahut aggressively weight reduced karna padta hai patient ka, jinka weight jyada hai aur uske liye bahut aggressive lifestyle changes aur kuch dawaniya hum use karte hain jo weight kam karne mein madat karti hain. Aur yadi hum yeah aggressively follow karte hain toh kaafi saare hamare patients hain jinki diabetes hum normal stage pe la sakte hain. Iska sabse bada fayda yeh Hai Ki yadi aapki diabetes paanch-dus saal ya pandra saal ke liye bhi tal jati hai, toh aane wale time mein sugar badti hai toh aap ki complication 15 se 20 ya 30 saal ke liye aage khisak jati hain jo ki aapke prime of life mein aap normal healthy life jeete hain aur complications ka risk bilkul aap ke 70, 80 saal ki age pe jake pahunch jata hai jo aapko bahut jyada pareshan nahi karta. Is liye bahut zaroori hai ki agar aap ki diabetes recent onset hai, bahut seriously iska ilaj kare or rivers karne ki bhi koshish kare agar kar sakte hain yadi aap iske baare mein hame contact karna chahte hain toh aap hame ya Lybrate ko contact kar sakte hain.

Hello, I am Dr Brij Mohan Makkar, I am diabetes and obesity specialist. Jaisa ki aap jante hain diabetes bahut hi common bimari hai, aur aksar log isko bahut lightly lete hain aur kyo ki ye ek lambe samay tak jane wali ya pura jeevan chalne wali bimari hai iski wajah se complications bhi bahut sari hoti hain. Yeh bahut zaroori hai samajhne ki agar aap diabetes hote hi uska ilaj thik se karte hain usko thik se control kar lete hain toh aanewale samay mein aapki complications kafi kam hoti hai. Agar aap shuru ke panch ya dus saal ki laparwahi se nikalte hain aur sugar ka control aapka accha nahi hai, toh agle bees saal tees saal may bhi aapki complications jyada hain. Toh isliye bahut zaroori hai ki sugar jaise hi aapko pata chalti hai, diabetes jaise hi aap ki detect hoti hai immediately apne doctor ko millen, usse ilaj shuru kare, aur regular apni diabetes check karte hain aur regular doctor ko dikhate bhi rahien taki aapki diabetes ka control acche se bana rahe. Agar aapka 5 se 10 saal ka control achha hai toh aapki complications ka risk agle 25, 30 saal mein bhi kam ho jata hai, isliye bahut zaroori hai ki shuru se hi pehle din se hi diabetes ka ilaj acche se kare aur yeh dhyan rakhen ki aapki sugar hamesha control Mere diabetes ka ilaj mein rahe. Diabetes ke ilaj mein khali sugar ka control he important nahi hai iske sath hone wali bahut sari aur bimarian saath mein hoti hain jaise cholesterol badd jata hai, blood pressure badd jata hai, aur heart ki problem ka risk badd jata hai unko control karna bhi bahut zaroori hota hai, toh aksar patient puchte hai ki doctor mere ko toh diabetes hai, aap cholesterol ki dawai kyun de rah, hai mera cholesterol toh normal hai yeh bahut zaroori hai ki aur jitni bhi dawiyan aapko di Jati hain doctor se, woh aapko regular leni chahiye kyunki khali aapki sugar ka control ek part hai aapke ilaj ka, baki aapka blood pressure control hona, aapka kidney function normal rehna, aapka cholesterol control hona aapki heart ki problems ka risk kam karna, ek regular physical activity maintain karna, ek proper diet follow karna ye sare bahut hi important component hai jo aapki diabetes ko control karene mein madat karte hain aur long term aapki complications ka risk kam kaerte hain. Isliye bahut zaroori hai ki jab bhi aapko diabetes hai ya jab bhi koi aapko problem hoti hai diabetes ke sath, immediately apne doctor ko consult karien. Agar aap humse kuch puchna chahte hain ya hamare paas aana chahte hain toh aap Lybrate ke through hamien connect kar sakte hain.