At 35, Bengaluru woman had mild cholesterol: What doubled her heart attack risk then?

 

 Source: https://indianexpress.com/article/health-wellness

Excess sugar — not just cholesterol — can silently raise triglycerides or blood fats but simple lifestyle changes can reverse their levels

At 35, Priya (name changed), an IT professional from Bengaluru, thought she was reasonably healthy. Yes, she had put on a few kilos after years of working from home. Exercise had slipped down her list of priorities, and late-night food deliveries had become routine. But she wasn’t diabetic, her blood pressure was normal, and her LDL cholesterol — the number everyone talks about — was mildly elevated at 120 mg/dL, optimal being 100 mg/dL.

Then came her annual health check. Her triglycerides had shot up to 350 mg/dL, well above the ideal limit of 150 mg/dL. I wasn’t worried about her LDL cholesterol as much, but her triglycerides meant the two together could put her heart at risk. We spend so much time talking about cholesterol that people often ignore triglycerides. But in many Indians, high triglycerides are the earliest warning that metabolism is going wrong.

 

What are triglycerides? Why do we need them and how do they impact us when in excess?

Triglycerides are the most common type of fat in the body. They act as the body’s energy reserve. After you eat, your body uses the calories it needs immediately for energy. Any excess calories — particularly from sugar, refined carbohydrates and alcohol — are converted by the liver into triglycerides. These are carried through the bloodstream and stored in fat cells to be used later when the body needs energy between meals or during exercise. Without triglycerides, the body would have no efficient way to store excess energy.

Problems begin when the body constantly receives more calories than it burns. With a sedentary lifestyle and diets high in sugary drinks, sweets, desserts, refined flour and polished rice, the liver keeps converting excess glucose into triglycerides. Over time, these fats accumulate in the bloodstream because the body is producing them faster than it can use or store them safely. High triglycerides are a sign that the body’s metabolism is under strain.

This explains why someone whose diet contains relatively little fat can still develop very high triglyceride levels. It is excess sugar and excess calories that often drive the problem, not necessarily the oil on your plate.

Persistently elevated triglycerides are associated with insulin resistance, fatty liver disease, obesity and Type 2 diabetes. They also contribute to cardiovascular disease by increasing the number of cholesterol-rich particles in the blood and promoting the formation of smaller, denser LDL particles, which are more likely to penetrate artery walls and form plaques. Very high levels—typically above 500 mg/dL—increase the risk of acute pancreatitis, a potentially life-threatening inflammation of the pancreas.

Why Indians are especially vulnerable

Now triglyceride levels between 200 and 300 mg/dL are becoming increasingly common among Indians, even in relatively young adults. Our genes play a role, but only a small percentage of patients has triglycerides that are primarily genetic. For the vast majority, the causes are poor lifestyle, weight gain, physical inactivity, excessive sugar intake, refined carbohydrates and insulin resistance.

Indians also tend to develop metabolic abnormalities at lower body weights than many Western populations. Fat accumulates around the abdomen, insulin resistance develops earlier, and the liver begins producing more triglycerides long before diabetes is diagnosed.

That is why a person may appear only slightly overweight yet already be carrying a significantly increased cardiovascular risk.

The encouraging part: Triglycerides can be reversed

The reassuring news is that triglycerides are among the most responsive blood markers to lifestyle change. Unlike many inherited cholesterol disorders, elevated triglycerides often fall dramatically when the underlying metabolic imbalance is corrected.

Reducing sugar intake is usually the first step. Sweetened beverages, desserts, bakery products and refined carbohydrates need to be cut back, while meals should contain more vegetables, whole grains, pulses, lean proteins and healthy fats. Restrict calorie intake to what is allowed as per your body weight and maintain at least a 12-hour gap between your last meal of the day and the first meal the next day.

Regular exercise helps muscles use triglycerides as fuel instead of allowing them to remain in circulation. Losing even a modest amount of weight improves insulin sensitivity and reduces the liver’s production of triglycerides. In many patients, triglyceride levels begin improving within weeks. The earlier we intervene, the easier it is to reverse the process.

For Priya, that routine health check became more than a report card; it became an opportunity to change course. Instead of waiting for diabetes or heart disease to develop, she began walking daily, cut down sharply on sugary foods and processed snacks, lost weight and watched her triglyceride levels steadily decline. Even losing 5-10% of body weight can significantly reduce triglyceride levels. Lifestyle remains the first line of treatment for most people. However, if triglycerides remain high despite diet and exercise, or if levels are above 500 mg/dL, medication may be needed.

 

8 in 10 working Indians are overweight: Most are already sick and don’t know it, says survey

 Source: https://indianexpress.com/article/health-wellness

India’s most common health risks are arriving earlier and staying hidden longer, according to the sixth edition of the Apollo Hospitals’ Health of the Nation 2026 report, which was released on World Health Day.

Based on over three million preventive health assessments conducted across the hospital ecosystem in 2025, the report makes a compelling case for a lifestyle overhaul. Two in three young adults are already at risk of non-communicable diseases (NCDs). In working populations, nearly half have prediabetes or diabetes while eight in 10 are overweight. Gender-specific insights present distinct risks, such as anaemia and early onset of breast cancer. High levels of Vitamin D and B12 deficiencies, along with declining fitness gaps, further highlight the scale of silent health risks.

What are takeaways?

Health risks are already present in young and working populations, even before symptoms appear.

• One in 5 people under 30 were found to be prediabetic. Among those who intervened, 28% reversed to normal. Among those over 50, only 7% did.

• More than half were obese and more than half had abnormal cholesterol.

• Nearly seven in 10 were deficient in Vitamin D, and close to half had low Vitamin B12.

• Nearly two-thirds of under-30s assessed had poor flexibility, strength or balance. Poor physical function is linked to stiffer arteries, higher risk of falls and shorter lifespan.

• Early screening of 20,164 students (aged 17–25) across cities found that two in three had at least one underlying health risk.

• In working populations (average age 38), 8 in 10 were overweight, nearly half had prediabetes or diabetes and one in four had high blood pressure.

• Women show distinct risk patterns, including anaemia and increasing central obesity with age.

• The mean age of breast cancer detection through routine mammography was 51 nearly a decade earlier than in Western populations. Among women over 40 screened, 1 in 359 had breast cancer, all asymptomatic.

This underscores that health risk is not uniform and that structured screening can identify conditions early.

Gut health emerging concern

Altogether 74% of people with fatty liver had completely normal liver enzymes till they did an ultrasound. Undetected fatty liver is linked to higher risk of diabetes and liver disease progression. Only an ultrasound image could catch it. As conditions like diabetes, obesity and high cholesterol built up, gut diversity dropped by about 9% in those with multiple issues.

What do the figures mean

Among over 100,000 people under 30 who came in for a health check, more than half were overweight, more than half had abnormal cholesterol, 7 in 10 were deficient in Vitamin D and close to half were low in B12. These are conditions with no symptoms at this stage, often dismissed as “just stress”.

“The report reflects a shift in the epidemiology of metabolic disease in India. Risk is now emerging earlier, often in the third decade of life, driven by excess weight, physical inactivity and poor dietary patterns. A key observation is that weight gain appears to be the earliest abnormality, preceding changes in blood pressure, lipids and blood glucose. In addition, a substantial proportion of disease remains clinically silent. For instance, fatty liver, coronary calcification and even depression were frequently detected in individuals without symptoms. This highlights that traditional symptom-driven care is no longer adequate,” says Dr Saptarshi Bhattacharya, senior endocrinologist, Indraprastha Apollo Hospital, New Delhi.

For example, if lipid markers are high, a person should take a coronary calcium score, which is a quick, affordable, non-invasive scan that measures calcium deposits in the arteries, a sign that plaque is forming.

“Among over 1,100 asymptomatic people who underwent coronary calcium scoring, 45% had calcification,” says Dr Bhattacharya.

The findings suggest that the main challenge is not lack of detection but lack of timely action. “A substantial proportion of individuals are still in a stage where disease can be prevented or reversed. However, this window is often missed. The clustering of weight gain, abnormal lipids and rising blood glucose point to the need for integrated care rather than isolated interventions. The way forward lies in earlier screening, especially in younger populations, structured follow-up and sustained lifestyle changes. Workplace and college-based programmes, life-stage-specific screening for women, and routine inclusion of mental health assessment can help shift care from late treatment to early prevention,” he adds.

Feeling low sugar before lunch? How to stop diabetes medication energy crashes

 

Written by: Dr Saptarshi Bhattacharya

Source: https://indianexpress.com/article/health-wellness

A patient of mine described his blood sugar fluctuations despite being on medication and a physical activity routine. “I walk 10,000 steps daily. I take metformin 500 after dinner but I experience an energy crash and low sugar levels before lunch and evening. What does it indicate?”, he asked me.

How many of you have gone through similar experiences? Symptoms mimicking low blood glucose before lunch and in the evening while being on drugs suggests a possible mismatch between physical activity, meal timing and medication. It indicates that the current regimen may need review and adjustment.

Understanding Low Blood Glucose (Hypoglycemia)

Hypoglycemia occurs when blood glucose levels drop below 70 mg/dL. Symptoms include shakiness, dizziness, sweating, hunger, irritability, confusion or even loss of consciousness in severe cases. Given your proactive approach to managing diabetes with exercise and medication, it’s crucial to understand why these episodes might be happening.

Possible Causes of Low Sugar Levels

1. Medication review: Metformin works by decreasing glucose production in the liver and increasing insulin sensitivity, but hypoglycaemia is an unusual side effect of metformin. Among the medicines used for treating diabetes, the sulfonylurea group of medicines and insulin carry a risk of hypoglycemia. Review with your doctor that you are taking the right medicine. Also, ensure that you are not taking some indigenous supplements which are sometimes mixed with drugs that can cause hypoglycaemia.

2. Reactive hypoglycaemia: Reactive hypoglycemia refers to a drop in blood glucose occurring 2–4 hours after a meal. It is usually related to an exaggerated insulin response in early stages of diabetes following carbohydrate intake, particularly meals high in refined carbohydrates and low in fibre content. Blood glucose may fall to low levels before lunch or in the late afternoon or evening if you have a snack rich in simple carbohydrates in between your meals.

3. Diet and Meal Timing: Infrequent meals or not adjusting food intake with exercise could lead to hypoglycaemia.

What Does This Indicate?

Your body is signalling that your current diabetes management plan might need tweaking. Your doctor might review your medicine requirement. Hypoglycaemia is not a usual complication of metformin but still this might require a relook. Additionally, some medications can slow carbohydrate digestion and help in such situations.

Eating smaller, balanced meals with complex carbohydrates, protein and healthy fats can help stabilise blood glucose levels. Regular blood glucose checks and strategic snacking before exercise or when you feel low can help manage hypoglycaemia.

The primary reason behind reactive hypoglycaemia is insulin resistance, mismatch in insulin secretion timing and blood glucose excursion following food intake. Weight loss can help decrease insulin resistance and consequently such episodes.

Preventing Hypoglycaemia

Always monitor blood glucose levels. Regular checks can help identify patterns and triggers. Eat balanced meals complete with complex carbohydrates, proteins and healthy fats. Drink water throughout the day. Eat a snack before or during prolonged exercise. Carry glucose tablets; it’s better to be prepared for hypoglycaemic episodes. Given your proactive approach to managing diabetes, it’s essential to work with your healthcare provider to adjust your treatment plan.

 

High fasting blood sugar in young adults: Why you need that 20-minute walk after dinner

 

Written by Dr V Mohan

Source: https://indianexpress.com/article/health-wellness

One of my patients was worried about the high fasting glucose levels in his 22-year-old son. He was worried if the dawn phenomenon, when hormones in the body naturally makes every morning and elevates blood sugar, could be worrisome for non-diabetic people like his son, too. Is it indicative of diabetes in the future?

Yes, the dawn phenomenon can affect both individuals with and without diabetes. The human body experiences the lowest level of blood sugar at 3 am. Then the body releases hormones like cortisol, growth hormones and adrenaline to prepare us to wake up, usually between 3 am and 10 am. They signal the liver to boost the production of glucose, which provides energy that helps you wake up. In non-diabetic individuals, insulin works efficiently and brings the blood sugar back to normal. But in people with diabetes — or those with insulin resistance — the body cannot counteract this hormone-driven rise effectively, leading to high fasting blood sugar levels.

Does a slightly high fasting sugar mean a non-diabetic person will get diabetes?

Not necessarily. For non-diabetic individuals, it can be an early warning sign rather than a diagnosis. It tells us that lifestyle changes are needed now to prevent diabetes later. The occasional morning high will have little impact on your HbA1C, average blood glucose count over three months, which is an indication of whether your blood sugar management is effective enough. But if those highs become consistent, they could push up these levels too.

What is the best way to manage the dawn phenomenon for both groups?

The most effective and safest strategy is lifestyle management, especially physical activity. A simple 20–30-minute walk after dinner is one of the best activities to combat the dawn phenomenon in both diabetic and non-diabetic individuals. It helps muscles use glucose, improves insulin sensitivity and reduces the overnight rise in sugar levels.

Is walking really enough, even for people with diabetes?

Yes. Walking is sustainable and highly effective. Consistency matters more than intensity. Even light activity after dinner makes a meaningful difference.

What about morning exercise?

Morning exercise is good for overall health but when focusing on the dawn phenomenon, intense early morning workouts can sometimes increase blood sugar temporarily due to stress hormones. Gentle activities like yoga, stretching, or a calm walk are better choices in the morning. A Chinese study showed that moderate-intensity aerobic exercise before breakfast reduced the morning rise of blood glucose in diabetes patients. It significantly reduced blood glucose fluctuations and improved blood glucose control throughout the day.

I usually eat dinner late and go straight to bed. Could that worsen the problem?

Late dinners followed by immediate sleep reduce glucose utilisation overnight for both diabetic and non-diabetic individuals. Ideally, dinner should be light and finished at least two to three hours before bedtime, followed by light movement.

What to do if lifestyle changes don’t work for people with diabetes?

If fasting sugars remain high despite walking, timely meals and good sleep in people with diabetes, we may need to adjust night-time treatment. This can include increasing the dose of long-acting insulin at night or modifying night-time oral hypoglycaemic agents (OHAs). These changes help control the early morning hormone-related sugar rise.

Should patients adjust insulin or tablets on their own?

They can make adjustments with the guidance of their healthcare professional. This helps ensure changes are safe, effective and based on fasting blood sugar trends and the risk of low blood sugar.

Can technology help understand this better?

Continuous Glucose Monitoring (CGM) tracks glucose levels day and night, clearly showing when sugar starts rising. It helps us confirm the dawn phenomenon, adjust insulin or medication safely, and also shows how effective walking and meal timings are.

Is CGM useful as a predictive tool for non-diabetic people?

CGM helps non-diabetic individuals identify hidden sugar spikes related to late meals, poor sleep or stress, long before diabetes develops.

Whether someone has diabetes or not, managing the dawn phenomenon requires timely meals, regular post-dinner activity, good sleep and stress control. For people with diabetes, medication adjustment and CGM add precision. Small daily habits make a big difference to long-term blood sugar health.