Rajasthan Archives - InnoHEALTH magazine

Fermented food from Ayurveda’s Lens

InnoHEALTH magazine digital team — Tue, 10 Aug 2021 05:17:28 +0000

“human adaptability to nature should always be kept in mind whenever we hear typecast notions about diet plan.”

We are born with an excellent ability to adapt to a varied range of weather and places. Our food habits are associated with the place we are in and that gives an opportunity for a specific cuisine of almost every region over the period of time.

Here’s a story from an arid state of India – Rajasthan. It is the land of dry and extreme summers and winters. Needless to say, there is a relative scarcity of water. It is a land of great empires, warriors, and artists too. It boasts a great culture and heritage that was developed in this arid land. The way they adapted to the dryness is through the use of abundant amounts of oils and ghee in their diet. These oily, greasy substances have the ability to maintain moisture inside the body for a longer period. This makes the need for water also limited and makes it a wonderful story of survival and success in the desert. The amount of oil or ghee used gets completely utilized by the body without leaving any residue in the form of any stagnated lipids inside the body (in form of cholesterol and other fatty substances).

Such stories of human adaptability to nature should always be kept in mind whenever we hear typecast notions about diet plans. Ayurveda advocates, we need to assess our diet as per the status of health, age, the season we are in, and also the region we are living in. This principle is intuitively applied by most cultures and societies around the world.

These adaptations help the communities thrive with their survival and success. However, they may have a few imperfections. Ayurveda can be the tool with which one can assess the correctness of a lifestyle as per the requirement of an individual in given circumstances.

Alternative living with a variety of food plans such as fermented food, veganism, intermittent fasting has been helping individuals worldwide. There is a commonality amongst the people who benefit from each of these plans and also amongst the people who do not. Comprehending that common thread can be possible with the help of Ayurveda.

“When the fire element is stronger, it makes Agni sharper and causes digestion at a faster rate. This is an imperfect way of replenishment as it burns the food and for the same reason, the nutritional level is below normal.”

Food and Digestion according to Ayurveda

Ayurveda has an all-pervasive thought that says everything in this universe is composed of five elements – earth, water, fire, air, and ether (space). From this, we can say that our body is composed of these elements and so are the food items. We replenish the elements inside the body. Ayurveda simplifies nourishment to this level. However, to achieve this replenishment, our body needs to have the ability to digest food. That ability or the digestive capacity is called Agni in Ayurveda. It is nothing but the fire embodied in the form of digestive juices that breaks down the ingested food. The elements from the food cannot nourish the body unless it is properly digested. The same is the case with herbs or medicines in case of a disease.

This undoubtedly shows the dominance of Agni in the maintenance of health as well as in disease management. This makes it inevitable to nurture the Agni to attain good health. This involves rules and regulations related to cooking as well as cultivating and procuring food; understanding the effects of nature on your Agni, and also understanding when it is low. Heavy meals tend to overwork Agni and recurrent ingestion of heavy meals can disturb the Agni. For the same reason, Ayurveda promotes cooked meals. The act of cooking is nothing but making the food lighter so that our intrinsic fire doesn’t overwork. Contrary to cooking, the raw foods, salads juicing, etc. make the Agni work harder. Of course, quantity does matter.

The process of cooking is also graded whether it is roasted, boiled, or mixed with a heavy item. The food that gets cooked in the presence of air helps to cook the food better in contrast to boiled with water. This is noticeable in the case of many food items. Wheat is an excellent example. Also, roasted/barbequed chicken is lighter than boiled in water/gravy.

Indulgence in heavy meals, overeating, snacking, sedentary lifestyle, etc. takes a toll on your Agni or the digestive fire. This makes it slow and weak and that is the foundation of most of the diseases. Furthermore, when the fire element is stronger, it makes Agni sharper and causes digestion at a faster rate. This is an imperfect way of replenishment as it burns the food and for the same reason, the nutritional level is below normal. In the realm of western medicine, this can be understood as slower or faster metabolism.

Unhealthy fasting; various forms of crash diet leading to undernutrition, overuse of spices, alcohol in excess, etc. are the factors that make agni sharper. With a sharper Agni, there are usually cravings for softer, mushy, cooler, soothing, grounding kinds of foods. Instinctively, it is a bodily response in the form of cravings to heal the imbalance that got created due to the sharpness in Agni.

Love for fermented food can fall into this category. An individual with a sharper agni can have a pacifying effect over the body as well as mind and that makes this person hooked on to such cravings. This is a quick fix and the real treatment is to pacify the sharper agni. To go beyond a short-term benefit, it becomes inevitable to use the right kind of food at the right dosage and at the right time. On the same lines, overindulgence in fermented food can be the act of going overboard. It eventually can cause dampening of the digestive fire and slowdown of the metabolism. We cannot afford to slow down the metabolism as it acts as a precursor to many diseases such as obesity, diabetes, thyroid disorders, etc.

Use of Fermented food in India – a logical explanation of introduction of fermented foods

Dosa and similar foods are the delectable preparations from South Indian Cuisine. The popularity gained by this cuisine is beyond the borders. However, while treating clients/patients with ayurvedic herbs/lifestyle, more commonly, this tops the list of ‘Restricted Foods’.

Being part of the Tropical zone, the Southern part of India gets a lot of heat most of the year. One of the ways of adaptation could be the introduction of fermented food that can help in dealing with the scorch and dryness of the weather by gently creating moisture inside the body. Apart from the moistening effect, it is relatively heavier in comparison with the non-fermented version of the same ingredient. Because of these factors, fermented food can deal with the sharpness of the weather or even sharp and quicker digestion. Consumption of such foods can certainly help individuals withstand longer without thirst and hunger.

“A state of hypermetabolism, anxiety, irritation issues can feel relief with Shrikhand. “

Ayurvedic fermented food – Shrikhand

Shrikhand is a well-known delicacy as a part of Indian Cuisine and it also tops the list of foods that act as medicine. It is a recipe conceptualized by ancient Saints of India for its health benefits. From the references found in ayurvedic texts, it is prepared by adding cane sugar/honey to hung curd (yogurt without water content in it). The health conditions involving inflammation can get benefitted from the use of Shrikhand. A state of hypermetabolism, anxiety, irritation issues can feel relief with Shrikhand. We can think of many conditions that will manifest such symptoms. It can be one of the best foods that can be used during the convalescent phase after most cancers and chemotherapy.

It is an excellent formula that can satiate, create a calming effect on the mind as well as body, and will also be responsible for strengthening the tissues. According to Ayurveda, this is the kind of fermented food that can be used whenever needed. However, just like any other food, if we go overboard, it can slow down the metabolism.

The importance of cooked food is a well-established fact. Food that is properly cooked, enhances the ability to metabolize it. As per the ayurvedic theory, cooking is an act in which fire and air elements act on the food and make it digestible. However, fermentation is the process that works on the same lines but the impact is relatively lesser. Regular use of fermented food allows more moisture to accumulate inside the body. In a few instances, it is conducive to health but not every time.

“Dr. Mahesh Sabade is an ayurveda consultant who has been working in this field for the last twenty-one years as a practitioner, researcher, author, and teacher. “

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Rising burden of non-communicable diseases

InnoHEALTH Magazine — Thu, 03 May 2018 11:13:40 +0000

The contribution of most of the major non-communicable disease groups to the total disease burden has increased all over India since 1990, including cardiovascular diseases, diabetes, chronic respiratory diseases, mental health and neurological disorders, cancers, musculoskeletal disorders and chronic kidney disease.

On the other hand, the DALY rates of stroke varied across the states without any consistent pattern in relation to the stage of epidemiological transition. This variety of trends of the different major non-communicable diseases indicates that policy and health system interventions to tackle their increasing burden have to be informed by the specific trends in each state. Increasing but variable burden of injuries among states.

The contribution of injuries to the total disease burden has increased in most states since 1990. The highest proportion of disease burden due to injuries is in young adults. Road injuries and self-harm, which includes suicides and non-fatal outcomes of self-harm, are the leading contributors to the injury burden in India. The range of disease burden or DALY rate varied 3 fold for road injuries and 6 fold for self-harm among the states of India in 2016. There was no consistent relationship between the DALY rates of road injuries or self-harm versus the stage of epidemiological transition of the states. The burden due to road injuries was much higher in males than in females. The DALY rate for self-harm for India as a whole was 1.8 times higher than the average globally for other geographies at a similar level of development in 2016.

The report says the disease burden due to child and maternal malnutrition has dropped in India substantially since 1990; this is still the single largest risk factor, responsible for 15% of the total disease burden in India in 2016.

This burden is highest in the major EAG states and Assam, and is higher in females than in males. Child and maternal malnutrition contributes to disease burden mainly through increasing the risk of neonatal disorders, nutritional deficiencies, diarrhoeal diseases, lower respiratory infections, and other common infections. As a stark contrast, the disease burden due to child and maternal malnutrition in India was 12 times higher per person than in China in 2016.

Kerala had the lowest burden due to this risk among the Indian states, but even this was 2.7 times higher per person than in China.

This situation after decades of nutritional interventions in the country must be rectified as one of the highest priorities for health improvement in India. Unsafe water and sanitation improving, but not enough yet Unsafe water and sanitation was the second leading risk responsible for disease burden in India in 1990, but dropped to the seventh leading risk in 2016, contributing 5% of the total disease burden, mainly through diarrheal diseases and other infections. The burden due to this risk is also highest in several EAG states and Assam, and higher in females than in males.

The improvement in exposure to this risk from 1990 to 2016 was least in the EAG states, indicating that higher focus is needed in these states for more rapid improvements.

Remarkably, the per person disease burden due to unsafe water and sanitation was 40 times higher in India than in China in 2016. The massive effort of the ongoing Swachh Bharat Abhiyan has the potential to improve this situation. Improvement was notice in household air pollution. Outdoor pollution worsened air pollution and remained high in India between 1990 and 2016, with levels of exposure among the highest in the world.

It causes burden through a mix of non-communicable and infectious diseases, mainly cardiovascular diseases, chronic respiratory diseases, and lower respiratory infections.

The burden of household air pollution decreased during this period due to decreasing use of solid fuels for cooking, and that of outdoor air pollution increased due to a variety of pollutants from power production, industry, vehicles, construction, and waste burning. Household air pollution was responsible for 5% of the total disease burden in India in 2016, and outdoor air pollution for 6%. The burden due to household air pollution is highest in the EAG states, where its improvement since 1990 has also been the slowest.

On the other hand, the burden due to outdoor air pollution is highest in a mix of northern states, including Haryana, Uttar Pradesh, Punjab, Rajasthan, Bihar, and West Bengal. Control of air pollution has to be ramped up through inter-sectoral collaborations based on the specific situation of each state.

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Health of the Indian states

InnoHEALTH Magazine — Wed, 02 May 2018 11:14:35 +0000

India: Health of the Nation’s States from 9% to 12%

Infectious and associated diseases made up the majority of disease burden in most of the states in 1990, but this was less than half in all states in 2016.

However, the year when infectious and associated diseases transitioned to less than half of the total disease burden ranged from 1986 to 2010 for the various state groups in different stages of this transition.

The wide variations between the states in this epidemiological transition are reflected in the range of the contribution of major disease groups to the total disease burden in 2016: 48% to 75% for non-communicable diseases, 14% to 43% for infectious and associated diseases, and 9% to 14% for injuries. Kerala, Goa, and Tamil Nadu have the largest dominance of non-communicable diseases and injuries over infectious and associated diseases, whereas this dominance is present but relatively the lowest in Bihar, Jharkhand, Uttar Pradesh, and Rajasthan. Infectious and associated diseases are reducing, but still high in many states.

The burden of most infectious and associated diseases reduced in India from 1990 to 2016, but five of the ten individual leading causes of disease burden in India in 2016 still belonged to this group: diarrheal diseases, lower respiratory infections, iron-deficiency anemia, preterm birth complications, and tuberculosis.

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The burden caused by these conditions generally continues to be much higher in the Empowered Action Group (EAG) and North-East state groups than in the other states, but there were notable variations between the states within these groups as well.

The range of disease burden or DALY rate among the states of India was nine fold for diarrheal disease, seven fold for lower respiratory infections, and nine fold for tuberculosis in 2016, highlighting the need for targeted efforts based on the specific trends in each state.

The burden also differed between the sexes, with diarrheal disease, iron-deficiency anemia, and lower respiratory infections higher among females, and tuberculosis higher among males.

The proportion of total disease burden caused by infectious and associated diseases was highest among children, which contributed to the disproportionately higher overall disease burden suffered by the under-5 year’s age group.

The report said for India as whole, the disease burden or DALY rate for diarrheal diseases, iron-deficiency anemia, and tuberculosis was 2.5 to 3.5 times higher than the average globally for other geographies at a similar level of development, indicating that this burden can be brought down substantially.

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Lifestyle diseases: A threat to backward states

InnoHEALTH Magazine — Wed, 02 May 2018 08:13:02 +0000

Lifestyle diseases like chronic respiratory and heart diseases are killing more people in India than communicable ailments like Tuberculosis (TB) or Diarrhea in every states, including most backward belts, says the India State-Level Disease Burden Initiative’s Report.

Among the leading non-communicable diseases, the largest disease burden or Disability-Adjusted Life Year (DALY) rate increase from the period of 1990 to 2016 was observed for diabetes at 80 per cent, and ischaemic heart disease at 34 per cent.

In 2016, three of the five leading individual causes of disease burden in India were non-communicable, with ischaemic heart disease and chronic obstructive pulmonary disease as the top two causes and stroke as the fifth leading cause. The range of disease burden or DALY rate among the states in 2016 was nine-fold for ischaemic heart disease, four-fold for chronic obstructive pulmonary disease, and six-fold for stroke, and fourfold for diabetes across the country.

The key metric used in the study is DALYs, which is the sum of the number of years of life lost due to premature death and a weighted measure of the years lived with disability due to a disease or injury. The use of DALYs to track disease burden is recommended by India’s National Health Policy of 2017.

While ischaemic heart disease and diabetes generally had higher DALY rates in states that are at a more advanced epidemiological transition stage toward non-communicable diseases, the DALY rates of chronic obstructive pulmonary disease were generally higher in the Empowered Action Group (EAG) states that are at a relatively less advanced epidemiological transition stage.

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The report shows that communicable diseases constitute almost two-thirds of the disease burden in India from a little over a third in 1990. Despite the transition, which is associated with development, malnutrition remains the single top risk for health loss.

All states have thus made what’s called the ‘epidemiological transition’ there remain wide variations in their disease profiles with some having made that transition as early as 1986, and others as recently as 2010.

The first group to make the transition in 1986 included Kerala, Tamil Nadu, Goa, Himachal Pradesh and Punjab. The last group to do so, accounting for the highest number of people (588 million), made the transition almost a quarter of a century later, in 2010. This group included Bihar, Uttar Pradesh, Madhya Pradesh, Chhattisgarh, Jharkhand, Rajasthan and Odisha. India as a country made the transition in 2003.

The Report’s executive summary says with almost one-fifth of the world’s population living in India, the health status and the drivers of health loss are expected to vary between different parts of the country and between the states.

Accordingly, effective efforts to improve population health in each state require systematic knowledge of the local health status and trends. While state-level trends for some important health indicators have been available in India, a comprehensive assessment of the diseases causing the most premature deaths and disability in each state, the risk factors responsible for this burden, and their time trends have not been available in a single standardised framework.

The Report finds that the Health status improving, but major inequalities between states Life expectancy at birth improved in India from 59.7 years in 1990 to 70.3 years in 2016 for females, and from 58.3 years to 66.9 years for males.

There were, however, continuing inequalities between states, with a range of 66.8 years in Uttar Pradesh to 78.7 years in Kerala for females, and from 63.6 years in Assam to 73.8 years in Kerala for males in 2016.

The per person disease burden measured as DALYs rate dropped by 36% from 1990 to 2016 in India, after adjusting for the changes in the population age structure during this period. But there was an almost two-fold difference in this disease burden rate between the states in 2016, with Assam, Uttar Pradesh, and Chhattisgarh having the highest rates, and Kerala and Goa the lowest rates.

While the disease burden rate in India has improved since 1990, it was 72% higher per person than in Sri Lanka or China in 2016. The under-5 mortality rate has reduced substantially from 1990 in all states, but there was a four-fold difference in this rate between the highest in Assam and Uttar Pradesh as compared with the lowest in Kerala in 2016, highlighting the vast health inequalities between the states.

Large differences between states in the changing disease profile of the total disease burden in India measured as DALYs, 61% was due to communicable, maternal, neonatal, and nutritional diseases (termed infectious and associated diseases in this summary for simplicity) in 1990, which dropped to 33% in 2016. There was a corresponding increase in the contribution of non-communicable diseases from 30% of the total disease burden in 1990 to 55% in 2016, and of injuries 18 %.

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Mohalla Clinics Are Here To Stay

InnoHEALTH Magazine — Tue, 26 Dec 2017 05:29:55 +0000

ALISHA THAPA and SHREYA KUMAR visit the newly launched Mohalla Clinics and report how they contribute to a healthier neighbourhood

Alisha Thapa is working as a community manager in MixORG, New Delhi. She generates content and strategy for brands. Also, she runs campaigns for brands’ engagement and presence on online media channels.

Shreya is an engineering graduate who is working with team InnovatioCuris connecting European Healthcare innovation leaders with the Indian healthcare system and pioneers. She looks forward to pursue her masters in the field of data science. Her interest areas are Indian education, healthcare and transportation.

One of the initiatives of Delhi’s government is about innovations in the healthcare delivery model Mohalla Clinics meaning Neighbourhood Clinics. This is a format of care delivery targeting to improve the access to primary care.
With the launch of the first Mohalla clinic on a trial basis at West Delhi’s Peera Garhi in July 2015, the Delhi government initiated to give an access of basic health facilities to the people of Delhi within walking distance. The first clinic head Dr. Alka Choudhary as the main doctor, an auxiliary nurse midwife, a sister and a technician. The clinic received a positive response from the common people with a recorded visit of 102 patients in just three and-a-half hours.
The government then proposed to maximise these clinics up to one thousand by 2016. However, there are less than 200 Mohalla Clinics operating at present. These clinics are set up with the aim to
1. Ease the burden on over-crowded hospitals.
2. Provide de-addiction counselling, family welfare counselling, lifestyle disease counselling and national programme counselling.
3. Zero cost on check-ups, medicines and tests.
4. Cut down the expenses on travelling and avoid long distance travelling to reach the hospitals by the poor and old-aged people respectively.
5. Immediate recovery from ailments.
At the beginning stage of this initiative, Delhi’s health minister Mr. Satyendra Jain had proposed that Mohalla Clinic could attend 80% of patients’ illnesses (20% with more serious illnesses to visit the hospitals). Mohalla Clinics have been more successful in attending patients than anticipated. the clinics were able to cater 95% of the patients’ illness. Mr. Jain also had spoken about more advancements and digitisation.
Dr Pal while attending a patient at Todapur’s Mohalla Clinic said:
The massive success of this project eventually gained the interests of other states in the country. A Mohalla clinic has been set up in the city of Mumbai in August 2016. Following the footsteps also includes the Karnataka government who announced on September 2016 to open two Mohalla clinics in Karnataka. The Gujarat Health Department decided to replicate the concept in four cities of Gujarat: Ahmedabad, Vadodara, Rajkot and Surat.
The foreign media has equally lauded the initiative. The highly honoured press journals “The Lancet” and “The Washington Post” have mentioned the initiative as a lesson for America.
Also Read: Micro Plastics – An Invisible Danger to Human Health

The second half of 2016 also marked another technological advancement in the Mohalla Clinics with an upgrade of a Mohalla Clinic in Todapur with a medicine vending machine, replacing the work of a pharmacist. According to the government reports, almost eight lakh patients were treated in five months in the Mohalla Clinics.

The world leaders like Kofi Annan and Gro Harlem Brundtland were highly impressed and congratulated Delhi CM Mr. Arvind Kejriwal. Both the leaders perceived the model of Mohalla Clinic not only as a country’s achievement but also a universal message to uplift the primary health care system.

During the recent visit to a Mohalla Clinic at Todapur, West Delhi by InnoHEALTH (IH) Team, met with Dr Pal, who answered some of the questions of interest.

Q.1. What is a Mohalla Clinic project?

Dr Pal: It is a pilot project with a target of 1000 Mohalla Clinics in the entire city.

Q.2. How do you operate as a doctor of Mohalla Clinic?

Dr Pal: Considering data entry, consultation, examination and prescribing medicines, on an average I spend up to four minutes on a single patient and 60-70 patients during the working period of four hours in a day.

Q.3. How easy it is to access the facilities? Can someone just walk in or they need to show some evidence?

Dr Pal: (While practically demonstrating his procedure with the help of a tab) As you can see, the patient has come for the first time, I register her details like first name, sex, age, marital status, address, mother’s name along with a picture of her clicked and then the consultation part I fill up like symptoms, examination, type of tests, prescription in the tab and finally issue a slip of the prescription.

Q.4. What makes it stand out from other healthcare projects?

Dr Pal: There are three major benefits of this project:
1. The hospitals can improve the quality of services as the load of the patients will be less because their load will be taken by Mohalla Clinics.
2. Only manifested and critical cases are going to the hospitals as patients at their early stages of illness are coming here (Mohalla Clinic) and we are giving all the possible treatments and advices within the clinic.
3. The quality of interaction between me as a doctor and the patient is more comprehensive and we are able to give a service with a personal touch to the community.

Q.5. Who is looking after the expenses of this project?

Dr Pal: It is a government project and the clinic has been set up as rented accommodation. The rent as well as medicines is provided at minimum costs. As a doctor I get INR 30 per patient, my assistant staff and multi-task worker get INR 8 per patient and INR 2 per patient respectively.

Q.6. From the time the project started till present, what is the level of success? And how do you measure the level of success?

Dr Pal: After the completion of one year, I can say the project has been successful. For instance, this area where I am operating consists of a population of approximately ten thousand comprising two thousand families. Surprisingly, almost each and every family has visited this clinic, be it for a minor or major purpose and that is exactly served our purpose. We want more and more people to visit Mohalla Clinics and get the required treatment. And not only the people of this local area but people from places like Noida, Rajasthan, Tamil Nadu, Andhra Pradesh have visited us to learn about this project, which is a proof that other states are also aware, happy and replicating the model.

Q.7. What are the criteria for the selection of doctors for this project?

Dr Pal: Doctors’ selection is done by Directorate of Health Services in the office through walk in interview. One can find the advertisements on newspapers. Doctors can appear along with the required documents and especially the retired doctors are preferred for this project.

Q.8. How often do you refer patients to the hospital for further treatment?

Dr Pal: I hardly refer 1 or 2 patients in a day and rest we take care of ourselves. Patients who are mostly at early stages of the illness come here. For instance, children are prone to disease such as pneumonia and we have been able to detect this disease at the early stage at least in this area and nobody has suffered from this illness. This is how burden of the hospitals is reduced.

Q.9. What are the changes you see in yourself?

Dr Pal: As I’m already a retired person, I’m getting professional satisfaction while working here and I’m able to keep myself fit by continuing to work.

An interaction between IH Team and patient named Pinky at the Mohalla Clinic

IH: What health problems do you have?

Pinky: I’m having high blood pressure problem and Dr Pal has been taking care of me.

IH: How often do you visit this clinic? For how long have you been treated here?

Pinky: I visit this clinic on alternate days and my treatment is going on for last one and a half months here.

IH: How do you find the treatment?

Pinky: Sir is observing my problem really well. My blood pressure test is done very often and he advises me according to the blood pressure chart.

IH: How far do you stay and earlier where were you going for your high blood pressure treatment?

Pinky: My home is quite near. The hospital, where I was previously visiting for the treatment was one hour away from my home, due to which I used to leave from home early in the morning and at times it used to be difficult to manage with my small kid. But now everything has become convenient.

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