Ambrish Mithal, M.D., D.M.
Chairman, Head Of Department, Division of Endocrinology and Diabetes, Medanta, The Medicity, Gurgaon, Haryana.
Senior Consultant, Endocrinology & Diabetes, Department of Endocrinology, Indraprastha Apollo Hospitals, New Delhi.

    
Residence Cum Clinic
C -5/47, Grand Vasant, Vasant Kunj,
New Delhi - 110 070
(consultation by appointment only)
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Frequently Asked Questions
Diabetes
Calcium Metabolism and Osteoporosis
Thyroid Disorders
Obesity
Growth and Pituitary problems
Reproductive / Gonadal Disorders
Adrenal Gland Diseases.
Diabetes
 
1. I am not fond of sweets, so I will not get diabetes.

  Reality: onset of diabetes is not really linked to intake of sweets. In fact, diabetes is more likely to occur in those who do not exercise regularly, or those who are overweight, rather than those who eat sweets. Once you develop diabetes, however, sweets are best avoided.
 
2. I don't care if I have high blood sugar, I feel fine.

  Reality: most often, symptoms do not correlate with level of blood sugar. Depending on symtoms rather thanblood sugatr values can be very misleading. The high level of blood sugar will slowly damge your other otrgan systems like eyes, kidneys, heart etc.. and you will suddenly find yourself facing seeious problems. If however, you control your diabetes well, the chances of your suffering from complicaytions later are much reduced.

  3. A diabetic diet, is a punishment, restriction for life. It is not possible for anyone to follow such a regimented diet on a regular basis.

  Reality: Diabetic diets are healthy diets for everyone. They are good for general health, for cholesterol, for heart disease, blood pressure. The entire family should follow the diet instead of targeting the diabetic patient alone.

  4. I follow a diabetic diet. I don't eat sweets, rice and potatoes.

  Reality: A diabetic diet does not mean giving up rice and potatoes. Diabetics can have rice and potatoes, provided they are not fried. It is also possible for well controlled diabetics to have an occasional sweet. The key is to avoid fats (oil, butter, ghee) as far as possible, and also to increase fibre content of diet (see section on fibre)

  5. I will not take medicines for diabetes under any circumstance. I am sure I can control it with diet and exercise alone.

  Reality: It is true that diet and exercise are the most important measures for controlling diabetes. But it is also true that less than one third of diabetics will be controlled by these measures alone, that too in the early stages of their disease. One should not hesitate to take medicines if advised by the doctor. The aim is to control blood glucose levels perfectly, at any cost.

  6. Diabetes simply means elevated blood sugar level.

  Reality: Diabetes is often part of a syndrome which includes hypertension, abnomal cholesterol levels, and obesity. To treat diabetes in a holistic mannner, it is important to correct all these factors.

  7. I will never take insulin. Once on insulin, always on insulin.

  Reality: It is not necessary that one has to be on insulin forever. It depends on the reason why insulin was started in the first place.

  8. I exercise a lot, so I don't really need to diet to lose weight.

  Reality: Exercise is a very important component of a fitness program, but will not lead to much weight loss unless accompanied by a strict diet schedule.

  9. To reduce my calorie intake, I miss lunch.

  Reality: Missing a meal is never advisable for diabetics. It will result in fluctuations in blood sugar level, and can even result in dangerous hypoglycemia (low blood sugar level). Small frequent meals are advisable.

  10. I was told I can have alcohol as it is good for my cholesterol.

  Reality: While it true that small amounts of alcohol may increase good cholesterol (HDL), the overall effect far from beneficial. The maximal permissible limit for alcohol is 30-60 ml of whisky or 300 ml of beer daily. This does not mean that one can take seven drinks once a week! Alcohol can not only worsen blood sugar control by providing extra calories but can at times provoke severe hypoglycemia (low blood sugar reaction). It can also interact with some antidiabetic medicines. In addition it raises blood triglyceride level, which is an undesirable effect.
 
For more Information Visit : http://www.diabetes.org
   
Calcium Metabolism and Osteoporosis
 

Osteoporosis means porous bones, which are more susceptible to fractures. Indians are thought to be particularly prone to osteoporosis.

In the US, one out of every two women has an osteoporosis related fracture.




 
Osteoporosis is a silent disease, since bone loss is without symptoms, till a fracture actually occurs.

Your bones are the frame on which your body is built. Weak bones ("osteoporosis") means a weak frame, which tends to break easily. That is why it is important to have healthy, strong bones.



 
Children are the best bone builders. The growing years are the most important for building our bank balance (calcium and mineral in the bone). Adequate intake of milk and milk products during this period is a must, as is regular exercise (outdoor sports) and sunlight exposure. Beyond adulthood, most effort is directed toward preventing or slowing bone loss.
 

Risk factors for osteoporosis include: female sex, thin built, old age, family history of osteoporosis, early menopause or amenorrhoea, sedentary life style, smoking, poor calcium intake and vitamin D deficiency. Both calcium deficiency and vitamin D deficiency are very common in urban Indians.

Osteoporosis is diagnosed by measuring bone density, which is ideally performed using DEXA densitometer. Ideally all women at menopause and all individuals over 65 should uindergo this test.

 
There are several good remedies available for osteoporosis. Consult your doctor (endocrinologist) for the right choice of drug. Calcium vitamin D and exercise remain the mainstay of any program, regardless of which specific drug is used.
 
For more Information Visit : http://www.boneindia.org
  http://www.nof.org
   
 

What is the thyroid?

The thyroid is a small, butterfly-shaped gland just below the bony prominence in front of our neck - Adam's apple. It is approximately the size of our thumb. The thyroid gland produces thyroid hormones, which circulate to every part of our body, and through which it controls the body metabolism.



  What controls thyroid function?

One of the features of hormonal (endocrine) systems in the body is that they are able to decrease or increase their function according to body need, somewhat in the manner that refrigerators and air conditioners switch on and off based on temperature control (thermostat mechanism). The thyroid gland does this under the influence of the master endocrine gland- the pituitary - which secretes thyroid stimulating hormone (TSH), the major stimulus for thyroid hormone secretion.
  What kind of problems can occur in thyroid gland?

Disorders of thyroid gland function may basically be of two types:
Over(hyper)function or under(hypo)function. The gland may also become enlarged (goitre), or develop a nodule, or become inflamed (thyroiditis). In hyperthyroidism, the excess of throid hormones results in rapid metabolism (speeding up of the body),resulting in excessive energy utlization. In hypothyroidism, there is too little hormone and as a result, the body processses slow down.
 
What is "hyper"thyroidism


Hyperthyroidism
Hyperthyroidism is more frequent in women and is commonly caused by Graves'disease, an autoimmune disorder.It can also be caused by inflammation of the gland (thyroiditis)or by a benign growth (adenoma or multinodular goitre.)
 
  Symptoms include:
 
 
  • anxiety
  • fast heart rate
  • nervousness
  • increased perspiration
  • muscle weakness
  • trembling hands
  • weight loss
  • hair loss
  • moist, warm skin
  • increased frequency of bowel movements
  • decreased menstrual flow and less frequent menstrual flow
  • goiter
  • eyes that seem to be popping out of their sockets
 
If you have more than one of these symptoms, and they continue for some time, you should see your doctor (endocrinologist).

The diagnosis of hyperthyroidism is made by testing the blood level of the thyroid hormones (T3, T4, TSH)
Treatment for hyperthyroidism is highly effective and generally consists of tablets (carbimazole, PTU), often for 12-24 months. Many patients may be advised to undergo radioactive iodine treatment, which is also a simple and safe treatment modality. It is particularly useful in those who have relapsed after a course of antithyroid drugs. Surgery of the thyroid gland is another option, although it is not commonly used now for treating hyperthyroidism.

What about hypothyroidism?

Hypothyroidism
Hypothyroidism is commoner than hyperthyroidism. It occurs in adults (women more than men), but may also occur in newborns (approximately 1 in 4000) It is caused by autoimmune (Hashimotos) thyroiditis, or may occur following surgery of the thyroid or radioiodine treatment for hyperthyroidism. Both hypo- and hyperthyroidism tend to run in families.

  Symptoms of hypothyroidism in adults include:
 
 
  • feeling slow or tired
  • feeling cold
  • drowsy during the day, even after sleeping all night
  • slow heart rate
  • poor memory
  • difficulty in concentrating
  • muscle cramps
  • weight gain (typically not more than 2-3 kg)
  • husky voice
  • thinning hair
  • dry and coarse skin
  • feeling depressed
  • heavy menstrual flow
  • milky discharge from the breasts
  • infertility
  • goiter
 
Since the symptoms of hypothyroidism are common and non-specific therefore the diagnosis is often missed for long periods.

The diagnosis of hypothyroidism is made by measuring blood levels of TSH, T3 and T4. In hypothyroidism at least one of these tests is always abnormal (usually high TSH). You do not have hypothyroidism if these tests are normal.

Treatment of hypothyroidism is directed towards replacing thyroid hormone (eltroxin, thyronorm, thyrox), so as to normalize the blood level. Treatment provides great benefit, and results in complete relief of symptoms over 2 to 3 months. However, most often treatment has to be life long. It is safe and virtually free of side effects.

Hypothyroidism Tips:

Hypothyroidism is a common, easily treatable disorder

You cannot have thyroid disorder if you have normal thyroid tests. Very often patients insist that they are putting on weight because of thyroid even though the blood thyroid levels are normal ; this weight gain cannot be because of thyroid. In any case, hypothyroidism does not usually result in weight gain of more than 2 to 3 kg.

Make sure you get your tests done in a reliable laboratory.

Never repeat your thyroid function tests at intervals of less than 4 weeks- generally 6-12 weeks initially, and later 6 monthly or yearly.

Blood tests for thyroid are not necessarily given in the fasting state. It is preferable, but not mandatory to omit the thyroid medicine on the day of the test. Do not stop the medicine for a "few days" before the test.

Most patients of hypothyroidism require lifelong replacement. Lifelong replacement with thyroxine is safe. If a patient maintains normal blood levels of TSH on treatment, then he or she is like a normal person.

Take your thyroid pill on an empty stomach for best effect. If you forget it, you can take it any time of the day.

Do not take iron, calcium or multivitamin pills within 4 hours of your thyroid pill.


Do not change the brand
of your thyroid medication without consulting your doctor.
 
 
For more Information Visit : http://the-thyroid-society.org
   
Obesity
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2.


3.



4.
Dieting is like banking. If your intake exceeds your expediture, you will put on weight (build your bank balance). If, on the other hand, your expenditure is more than your intake, you will lose weight. Magic formulae don't work!!!

Dieting is a life long process of eating healthy foods according to our body requirements, and not a sudden reduction in calories to lose weight rapidly.

If you are trying to lose weight, reduce your food intake by one fourth to one thirds immediately. Just remove one third of the food that you would usually eat from your plate.

Reduce the fat in your diet. NO fried foods. Use recipes for low fat cooking. Avoid red meat. No butter on toast, no ghee on chapaties.

 
 
5.



6.

7.


Cut down on simple sugars and refined carbohydrates (refined flour, maida). When eating at a fast food restaurant, go for salads, grilled sandwiches, baked potatoes, grilled chicken, diet sodas.

Increase your fibre intake (see section on fibre).

Avoid long gaps between meals. Missing a meal is not a good way to reduce calorie intake, as it will make you feel excessively hungry and you will end up eating more than you planned.

8.


9.




10.




Water is the best way to beat the heat. Drink water whenever you are thirsty, and NOT juices or colas…they are loaded with calories. You should consume at least 8 glasses of water daily.

Although exercise is an important component of a weight loss programme, diet is the major determinant of weight loss. Jogging for an half hour burns about 300 calories, which is what just one large cola provides. You can lose weight without exercising, but exercise makes weight maintenance easier. Move around more in your day to day activities. Stand rather than sit (you use up more calories in standing rather than sitting.). Take the stairs, rather than the elevator.

Set realistic goals for weight loss; about 2 kg per month is optimal. Don't aim for ideal body weight. Moderate weight loss has considerable health benefits. Take one step at a time. Losing weight at rates greater than 2 kg per month is not healthy. It is important to continue a balanced, healthy diet.

 
Fibre

Many of us just love bread, and cannot imagine having breakfast without our customary toast. We often don't stop to think that the white bread we eat is made of maida (refined flour), which is a virtually fibre free (0.6 gm/slice) source of carbohydrate. If we just replace white bread with whole wheat bread, which is naturally fibre rich, we would be benefited in many ways. And probably find it tastier as well!

Why fibre?
Fibre is an incredible food ingredient which helps to lose weight, lower cholesterol and heart disease, improves diabetes and even reduces the risk of bowel cancer and diverticulosis. Interestingly, fibre itself is devoid of any nutrients. It moves through the digestive tract faster and prevents food from putrefying in the digestive tract. It prevents constipation as it absorbs water to become bulkier. Because of bulk, it gives a feeling of fullness and reduces food intake.

The recommended daily fiber intake is about 35 grams a day. Whole wheat bread is an excellent source of fiber (5 times greater than white bread). Chapaties made out of wheat flour from which the bran (choker) has not been removed are very good sources too. Adding other kinds of cereal flour like gram, black gram, jwar and bajra also increases the fibre in our chapaties. High fibre cereals, oatmeal, apples (4gm each), carrots (2 gm each), guava, cabbage and salads are also rich fiber sources, as are dried beans, peas, lentils.

So go ahead today and try to get as close to the 35 gm. daily intake as you can. Remember to increase your fibre intake gradually to avoid discomfort. And have plenty of water … and you are on your way to a healthy diet.

For more Information Visit : http://www.obesity.org
  http://www.niddk.nih.gov/about/oei/index.htm
  http://www.dietitian.com
   
Growth and Pituatary Problems


Location

 
  Key Anatomy  
 
For more Information Visit : http://www.pituitarysociety.org
   
 
 
 
Adrenal Gland Disease


 
 

Contact for Appointments: At Medanta: 93 508 76124      At Apollo & Vasant Kunj Clinic: 98 104 74552  (10 A.M. - 5 P.M., Monday - Saturday)