CME INDIA Presentation by Dr. N. K. Singh, MD, FICP, FACP, FRRSDI, Diabetologist Physician, Director – Diabetes and Heart Research Centre (DHRC), Dhanbad, Chairman – RSSDI Jharkhand, Editor – CME INDIA.

12 Most unique ways to follow if you want to stay young

Spiritual exercises

To live well, our focus must shift from the external goods we imagine will bring us happiness and on to ourselves (From The Book of Days: A Miscellany of Popular Antiquities (1869) edited by Robert Chambers.)

• Dirgayutva, longevity, is a constant object of the Vedic prayers.
• Atharva Veda has spells to prolong existence.
• Atharva Veda and Panchvimsa Brahmana use the word Dasami for the period of life between 90 and 100 year.
• Rig Veda called it Dasama Yuga meaning the ‘tenth stage of life.’

1. Keep Covid Scare off Your Mind

2. Understand Two Key Principles

3. Regular Exercise is the Foundation

• Ancient Indian science of yoga has been critically analyzed and has been found significant in improving overall glycemic control, lipid levels, and body composition in diabetic cases.
• Yogic practices can be combined with other forms of physical activity. It may be as effective as or better than exercise in improving a variety of health-related outcome measures. Yoga must be included in life style modifications as yogic practices also are likely to play a role in the prevention of Type-2 diabetes and many other diseases.
• Up-regulation of insulin receptors and the normalization of the insulin/ glucose ratio also occur following yogic practices.
• Surya Namaskar – a positive impact also noted on autonomic function of the body. Its regular practice significantly decreases the oxidative stress of the body which plays a key role in insulin resistance.(1)

4. Making Your Mitochondria GREEN is the answer

• Regular exercise enhances mitochondrial function by promoting healthy mitochondrial remodelling.
• “An emerging hypothesis suggests that, in addition to anabolic events such as mitochondria biogenesis, the selective degradation of dysfunctional mitochondria (i.e., mitophagy) also is a key component of exercise-mediated adaptations in striated muscle, which eventually leads to better mitochondrial functions.”(2)
• Thus, mitochondrial reticulum in the sedentary muscle exhibits energetic/oxidative stress in some regions.
• Acute exercise induces further mitochondrial stress and initiates the processes of removing damaged/dysfunctional regions of the reticulum through mitochondrial fission and mitophagy.
• Long-term exercise training results in improved mitochondrial quality.

5. How Much You EAT and Why?

• Deitary Interventions

6. Doing Intermittent Fasting is in Focus

• Reducing food availability over a lifetime (caloric restriction) has remarkable effects on aging and the life span in animals. (4,5)
• During fasting
  • The ratio of AMP to ATP is increased.
  • AMPK is activated, triggering repair and inhibition of anabolic processes.
  • Acetyl coenzyme A (CoA) and NAD⁺ serve as cofactors for epigenetic modifiers such as SIRTs.
  • SIRTs deacetylate FOXOs and PGC-1α, resulting in the expression of genes involved in stress resistance and mitochondrial biogenesis.
  • Reduced levels of glucose and amino acids during fasting result in reduced activity of the mTOR pathway and up-regulation of autophagy. In addition, energy restriction stimulates mitochondrial biogenesis and mitochondrial uncoupling.
• Learn how to do Intermittent fasting in your context.

7. Superfoods for Youthful

• India’s cuisine is as rich and diverse as her culture.
• But despite this diversity, there is one underlying unity and that is the fact that all Indian food is perfectly balanced.
• Every Single Junk Food Meal Damages Your Arteries, your beta cells, study Reveals. (6)
• Learn how to protect the vascular endothelium from post-prandial oxidant stress and inflammation independently of their effects on post-prandial glucose and triglyceride levels.
• Take these SUPER FOODS:
  1. Soya bean (isoflavonoids, especially genistein and daidzein)
  2. Tea (tannins, especially epigallogatechin gallate (EGCG)
  3. Coffee (phenolic acids)
  4. Grapes (resveratrol, apples (flavonoids)
  5. Berry species (anthocyanin metabolites)
  6. Wholegrain products (phenolic compounds)
  7. Cinnamon
  8. Bitter melon
  9. Fenugreek
  10. Nuts are wholesome food and powerhouse of healthy fats and nutrients. Although nuts contain 45%–80% fat, most of the fats are the highly beneficial MUFA and PUFA. Nuts are as effective as increasing physical activity and trimming calories to increase HDL levels. Nuts, when consumed with a meal, will significantly reduce the post-prandial glucose excursion by slowing digestion.

8. How Can You Keep Your DNA Young?

• Improve human longevity by modulating the telomere system. It slows down the effects of many chronic disorders. Telomere length is a marker of DNA damage biomarker for biological ageing, and has also been linked with cardiovascular disease, diabetes, and cancer.
• Telomeres protect our chromosomes, with telomere length related to several age-related diseases, cancer, and lifespan. Recent studies indicate that telomere length can be affected by several lifestyle interventions. (7)
• You may be able to alter the pace of aging, in addition to the natural history of many age-related illnesses.
• Moderate exercise renews telomere protection.
• Higher adherence to a Mediterranean diet appears to be associated with longer telomere length.
• Mindfulness slows telomere shortening (such as meditation).

9. Respect Your Circadian Rhythm

• The intersection of circadian mechanics into the linkage between telomere and chronic inflammation provides more opportunities in combating atherosclerosis.
• Humans with circadian rhythm abnormalities:
  • Increased vascular senescence 
  • Impaired endothelial progenitor cell function
  • Enhanced atherosclerosis
  • Obesity 
  • But are also prone to chronic inflammation
  • Sepsis 
• Shift workers frequently undergo circadian misalignment (i.e., misalignment between the endogenous circadian system and 24-h environmental/behavioral cycles). This misalignment has been proposed to explain, in part, why shift work is a risk factor for hypertension, inflammation, and cardiovascular disease.
• The gut microbiome undergoes diurnal fluctuations in both composition and function, which are driven by feeding rhythms under the influence of host circadian clocks and diet.
• The gut microbiome also actively orchestrates host diurnal rhythms in the gut and remote tissues (such as the liver) by incorporating various signals from nutrients, hormones, and innate immune sensing.
• Circadian clocks and host immunity are tightly interconnected.
• The role of timed food intake has been implicated in a wide variety of immune-related diseases, highlighting the promising translation potential of ‘chrononutrition’ in disease management. (8)

10. Do Pranayama (9)

• Longevity research has linked states of intermittent hypoxia to increased production of the longevity enzyme AMPK (adenosine monophosphate-activated protein kinase).
• Living a long and healthy life requires maintaining an optimal level of AMPK.
• An optimal level of AMPK, which commonly declines with age  can be reversed with breathing exercises, Pranayama (including kumbhaka).
• 4 weeks of pranayama reduced anxiety and increase positive affect, and that these changes are associated with the activity and connectivity of a brain network involved in emotion processing, particularly the amygdala, anterior cingulate, anterior insula, and the prefrontal cortex. (10)

11. Take Dinner before 6 – 7 PM/ Avoid eating at night

• Insulin secretion and sensitivity are closely regulated by circadian control and have strong effects on glucose metabolism.
• Unusual meal timings can cause glucose intolerance by affecting the phase relationship between the central circadian pacemaker and peripheral oscillators in cells of the liver and pancreas in rodents.
• Similarly in humans, timed meal intake is also driven by the SCN, play a role in synchronization of circadian rhythms in peripheral tissues, thereby affecting glucose metabolism.
• Skipping breakfast and late meal time.
• Since the middle of the 20th century, eating patterns have shifted towards later eating times with over one-third of the caloric intake consumed after 6 pm
• This late-eating pattern, common in the modern lifestyle today, may lead to circadian misalignment and therefore exert a negative impact on glucose control.
• Meal timing has a major effect on type 2 diabetes. It is therefore important to consider the timing of meal consumption rather than focus on the nutritional value of a meal alone.
• Eating a carbohydrate-rich meal at night results in increased postprandial glycaemia compared with an identical meal in the morning. Therefore, modifying the macronutrient composition of meals, by increasing protein and fat content, can be a simple strategy to improve glycaemia for meals consumed at that night.
• The benefits of consuming meals early in the day should be encouraged in diabetics.
• Eating low GI foods in the morning improves glycaemic response to a greater effect than at night.
• Timing of fat and protein (including amino acids) consumption with carbohydrate foods, such as bread and rice, can reduce the glycaemic response.
• The order of food presentation considerably influences the glycaemic response. For a rice-based meal, following the sequence of consuming vegetables first, followed by meat and then lastly rice, has great potential of reducing the postprandial blood glucose. (11)

12. If You Take Dinner Late

• For most people, it would be unrealistic to avoid eating at night. With night-time eating being associated with poor glucose control and the increased risk of type 2 diabetes, manipulating meal composition of late meals or reducing the portion size may be crucial strategies to positively impact on postprandial glucose.

Final Takeaways

• Unhealthy life style is an important cause of premature death and disability.
• The Crosstalk – Oxidative Stress and Inflammation in the Progression of ageing is evident. We know the ways to halt it.
• Mitochondria-Induced Endothelial Cell Dysfunction can be tackled.
• Lifestyle Interventions: Diet/Exercise/Intermittent fasting: MOST PROMISING INTERVENTIONS.
• Altering Telomerase: Know it to do it.
• Respecting Circadian Rhythm is centuries old Indian WISDOM.

CME INDIA Tail Piece

References:

1. Chaya MS, et al AV. Insulin sensitivity and cardiac autonomic function in young male practitioners of yoga. The National Medicalournal of India. 2008; 21(5):217–21.
2. Guan Y, Drake JC, Yan Z. Exercise-Induced Mitophagy in Skeletal Muscle and Heart. Exerc Sport Sci Rev. 2019;47(3):151-156. doi:10.1249/JES.0000000000000192
3. N Engl J Med 2019; 381:2541-2551.DOI: 10.1056/NEJMra1905136
4. Rajindar S. Sohal, Michael J. Forster,Caloric restriction and the aging process: a critique,Free Radical Biology and Medicine,73,2014:366-382
5. Weindruch R, Sohal RS. Seminars in medicine of the Beth Israel Deaconess Medical Center. Caloric intake and aging. N Engl J Med. 1997;337(14):986-994. doi:10.1056/NEJM199710023371407
6. J. Cantin, S. Lacroix, J. Tardif, A. Nigam.  Does the Adherence to a Mediterranean Diet Influence Baseline and Postprandial Endothelial Function? Canadian Journal of Cardiology, 2012; 28 (5): S245 DOI:10.1016/j.cjca.2012.07.367
7. Feifei Cheng, Luke Carroll, Mugdha V Joglekar, Andrzej S Januszewski, Kwun Kiu Wong, Anandwardhan A Hardikar, Alicia J Jenkins, Ronald C W Ma,Diabetes,metabolic disease, and telomere length,The Lancet Diabetes & Endocrinology,Volume 9, Issue 2,2021,Pages 117-126
8. https://www.cell.com/trends/immunology/fulltext/S1471-4906(20)30070-3. April 28, 2020
9. Herzig S, Shaw RJ. AMPK: guardian of metabolism and mitochondrial homeostasis. Nat Rev Mol Cell Biol. 2018;19(2):121-135. doi:10.1038/nrm.2017.95
10. Effects of Yoga Respiratory Practice (Bhastrika pranayama) on Anxiety, Affect, and Brain Functional Connectivity and Activity: A Randomized Controlled Trial.Frontiers in Psychiatry ;11 202010.3389/fpsyt.2020.00467
11. Henry, C.J., Kaur, B. & Quek, R.Y.C. Chrononutrition in the management of diabetes. Nutr. Diabetes 10,6 (2020). https://doi.org/10.1038/s41387-020-0109-6

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