Negative thoughts: are they related to quality and duration of sleep!

   Negative thoughts are cognitions about the self, others, or the world in general that are characterized by negative perceptions, expectations, and attributions and are associated with unpleasant emotions and adverse behavioral, physiological, and health outcomes. [1] complicated, isn’t it! In simple words, it is a thought process where people tend to expect the worst outcomes in everything or reduce their expectations to the worst possible end from anything they do, talk or even think. These are usually associated to psychological conditions like depression (most common), anxiety, loneliness, and hostility etc. Globally up to 20-25% women and 7-12% men are having clinically significant depressive negative thoughts in their lives. [2] But perhaps this problem affects almost all of us to some extents at some point of time of our lives.

Present management approach:

·         Cognitive-behavioral therapy, or CBT which include mainly [3]

o   Recognizing thought distortions

o   Challenging negative thoughts

o   Taking a break from negative thoughts

o   Releasing judgment

o   Practicing gratitude

o   Focusing on your strengths

o   Or Seeking out professional support

·         Drug therapy etc.

          But the outcome is unsatisfactory in most of the cases with limited good results or recurrence of symptoms. Hence scientists have tried to find out some effective solution for this universal problem from our day today practices. One of such effective findings is the role of quality and quantity of sleep in negative thought productions.

Scientific evidences:

·      Shorter sleep duration is associated with more rumination or deep thinking about unnecessary things and delayed sleep timing is associated with more obsessive–compulsive symptoms. [4]

·      Sleep disruption may be associated with a specific impact on cognitive resources that are necessary for the inhibitory control of attention to emotionally negative information. [5]

·    About three fourth of depressed patients have insomnia symptoms, and hypersomnia is present in about 40% of young depressed adults and 10% of older patients, with a predominance in female population. [6]

·     Numerous studies provide findings indicating the remarkable relationship between sleep alterations and depression. [7]

·   Chronic sleep deprivation rather than acute sleep loss may lead to depression that is potentially attributable to the neurochemical changes that occur in the brain & depression may lead to disturbed sleep. [8]

·      sleep disturbance may be a risk factor for development, an initial manifestation of the disorder, or a comorbid condition of unipolar depression. [9] 

            From above research findings, it is obvious that negative thoughts arising due to mental disorders are strongly associated to sleep disorder or disturbances & more so with long term conditions. But it is yet to find out through further researches, whether sleep disorders are cause of or result of psychological ailments. But one thing is clear that, a healthier and rhythmic sleeping habit will definitely have positive impact on our thought process.

Good sleeping habit: [10][11]

·  Be consistent at going to bed at the same time each night and get up at the same time each morning, including on the weekends

·   Make sure that your bedroom is quiet, dark, relaxing, and at a comfortable temperature

·.  Remove all electronic devices, such as TVs, computers, and smart phones, from the bedroom

· Avoid large meals, caffeine, and alcohol before bedtime

·  Get some exercise. Being physically active during the day can help you fall asleep more easily at night.

·  At least 7 hrs. of sleep for adults and 9hrs for young adults per night is recommended.

Healthy sleep requires adequate duration, good quality, appropriate timing and regularity, and the absence of sleep disturbances or disorders. [11] A good quality life needs good quality sleep too, which not necessarily means how much time we have spent on bed, rather how much time we have actually spent in having a healthy sleep to make the next day an energetic and positive one. Thank you, be healthy and keep smiling………..

References & further reading:

1.      Tiro J, Lee S, Lipshultz S, Miller T, Wilkinson J, Mestre M et al. Negative Thoughts. 2018.

2.      Wang J, Wu X, Lai W, et al. Prevalence of depression and depressive symptoms among outpatients: a systematic review and meta-analysis. BMJ Open. 2017;7(8):e017173. doi:10.1136/bmjopen-2017-017173.

3.      7 Ways to Deal With Negative Thoughts [Internet]. Psychology Today. 2018 [cited 10 January 2018]. Available from: https://www.psychologytoday.com/blog/women-s-mental-health-matters/201509/7-ways-deal-negative-thoughts

4.      Nota, J.A. & Coles, M.E. Cogn Ther Res (2015) 39: 253. https://doi.org/10.1007/s10608-014-9651-7

5.      Nota J, Coles M. Shorter sleep duration and longer sleep onset latency are related to difficulty disengaging attention from negative emotional images in individuals with elevated transdiagnostic repetitive negative thinking. Journal of Behavior Therapy and Experimental Psychiatry. 2018;58:114-122.

6.      Nutt D, Wilson S, Paterson L. Sleep disorders as core symptoms of depression. Dialogues in Clinical Neuroscience. 2008;10(3):329-336.

7.      Tsuno N, Besset A, Ritchie K. Sleep and depression. J Clin Psychiatry. 2005 Oct;66(10):1254-69.

8.      Al-Abri MA. Sleep Deprivation and Depression: A bi-directional association. Sultan Qaboos University Medical Journal. 2015;15(1):e4-e6.

9.      Wiebe ST, Cassoff J, Gruber R. Sleep patterns and the risk for unipolar depression: a review. Nature and Science of Sleep. 2012;4:63-71. doi:10.2147/NSS.S23490.

10.  CDC - Sleep Hygiene Tips - Sleep and Sleep Disorders [Internet]. Cdc.gov. 2018 [cited 10 January 2018]. Available from: https://www.cdc.gov/sleep/about_sleep/sleep_hygiene.html

11.  Watson N, Badr M, Belenky G, Bliwise D, Buxton O, Buysse D et al. Recommended Amount of Sleep for a Healthy Adult: A Joint Consensus Statement of the American Academy of Sleep Medicine and Sleep Research Society. Journal of Clinical Sleep Medicine. 2015;.

Hair dyes & their possible health hazards

With the advancement of the world, the cosmetic industry has also advanced considerably due to increased demand of beauty and youth enhancement. But most of the cosmetics evolved during past few decades, appear to be only superficial, fake & eyewashes when it comes to real beauty enhancement, while their health hazards and side effects are very much real. One of such very popular beauty product is ‘Hair dye’ which is no more a tool to hide grey hair, but has become a fashion statement in all strata of the society around the world. More than one third of women above 18 and around 10% of men over 40yrs use some kind of hair. [1] So let’s have a discussion about its possible short and long term health hazards. [2]

Common possible side effects and probable reasons:

1.    Contact allergies & allergic contact dermatitis:

ü  Rate of incidence of acute allergy to common hair dyes range from 4-6% of dye users. [3]

ü  Allergic reactions can range from simple burnig sensations, itching etc. to dangerous angioedema.

ü  Allergic reactions are on a rise these days: probably due to Cross-sensitization to other contact allergens from other hair dye components. [3]

2.    Risk of malignancy/cancer:

ü  Possibility of link to bladder cancer was shouted when a number of hair dressers and barbers developed it. [4][5] Increased risk was found in number of studies. [6][7][8] But this could not be established in a large scale meta-analysis indicating further study. [9]

ü  Hair dyes have been associated with slight increased risk of leukemia on long term use, dark hair dyes, pre 1980s use etc [10], and other lymphomas [11]

ü  Similarly, hair dyes have been linked to breast cancer too with limited evidences [12]

3.    Other probable health risks:

ü  Over processing and damaging hair shaft ( due to ammonia, peroxides and similar oxidizing agents),

ü  Effect on fertility of men & women with adverse effect on pregnant women. [13][2]

ü  Chemical conjunctivitis or pink eye.

ü  Asthma etc

Harmful agents of common hair dyes:

ü  The commonest offending chemical agent is: Para-phenylenediamine (PPD) with most of the scientific evidences for allergy, mutagenicity and carcinogenic and other toxicities.[3][14]

ü  Other harmful chemicals with possible adverse reactions are: ammonia, peroxide, diaminobenzene, toluene-2,5-diamine, resorcinol etc.[15]

ü  Possible mechanisms include oxidative changes in scalp and hair roots which need further investigation.

Special precautions:

ü  In first place I would request everyone to avoid unnecessary repeated hair coloring or at least use products devoid of above harmful chemicals.

ü  Natural products like hena are relatively safer.

ü  Avoid using very dark and permanent hair colours.

ü  Use petroleum based ointments to the scalp skin prior to dye application. [2]

ü  Use of gloves should be encouraged.

ü  The time duration of application should be reduced by 25%. [2]

ü  Hair and scalp should be washed properly after each dye session.

ü  And last but not the least: a patch test or a skin sensitivity test should be done before applying the dye

Although we are living in a modern world of technology and evolution which demands a more upmarket and fashionable style and look, still the natural ways of living are still most adorable. Take care, be healthy and keep smiling………

References:

1.    Huncharek M, Kupelnick B. Personal use of hair dyes and the risk of bladder cancer: results of a meta-analysis. Public Health Reports 2005; 120(1):31–38.

2.    Saitta P, Cook CE, Messina JL, et al. Is There a True Concern Regarding the Use of Hair Dye and Malignancy Development?: A Review of the Epidemiological Evidence Relating Personal Hair Dye Use to the Risk of Malignancy. The Journal of Clinical and Aesthetic Dermatology. 2013;6(1):39-46.

3.    Mukkanna KS, Stone NM, Ingram JR. Para-phenylenediamine allergy: current perspectives on diagnosis and management. Journal of Asthma and Allergy. 2017;10:9-15. doi:10.2147/JAA.S90265.

4.    Bolt HM, Golka K. The debate on carcinogenicity of permanent hair dyes: new insights. Critical Reviews in Toxicology 2007; 37(6):521–536.

5.    Harling M, Schablon A, Schedlbauer G, Dulon M, Nienhaus A. Bladder cancer among hairdressers: a meta-analysis. Occupational and Environmental Medicine 2010; 67(5):351–358.

6.    Andrew AS, Schned AR, Heaney JA, Karagas MR. Bladder cancer risk and personal hair dye use. International Journal of Cancer 2004; 109(4):581–586.

7.    Gago-Dominguez M, Castelao JE, Yuan JM, Yu MC, Ross RK. Use of permanent hair dyes and bladder-cancer risk. International Journal of Cancer 2001; 91(4):575–579.

8.    Koutros S, Silverman DT, Baris D, et al. Hair dye use and risk of bladder cancer in the New England bladder cancer study. International Journal of Cancer 2011; 129(12):2894-904.

9.    Turati F, Pelucchi C, Galeone C, Decarli A, La Vecchia C. Personal hair dye use and bladder cancer: a meta-analysis. Annals of Epidemiology. 2014;24(2):151-159.

10. Towle K, Grespin M, Monnot A. Personal use of hair dyes and risk of leukemia: a systematic literature review and meta-analysis. Cancer Medicine. 2017;6(10):2471-2486.

11. Zhang Y, de Sanjose S, Bracci PM, et al. Personal use of hair dye and the risk of certain subtypes of non-Hodgkin lymphoma. American Journal of Epidemiology 2008; 167(11):1321–1331.

12. Takkouche B, Etminan M, Montes-Martinez A. Personal use of hair dyes and risk of cancer: a meta-analysis. JAMA: The Journal of the American Medical Association 2005; 293(20):2516–2525

13. Couto A, Ferreira J, Rosa A, Pombo-de-Oliveira M, Koifman S. Pregnancy, maternal exposure to hair dyes and hair straightening cosmetics, and early age leukemia. Chemico-Biological Interactions. 2013;205(1):46-52.

14. HP C, K R, KY N, RY K, CH N, SM C. para-Phenylenediamine Containing Hair Dye: An Overview of Mutagenicity, Carcinogenicity and Toxicity. Journal of Environmental & Analytical Toxicology. 2016;6(5).

15. Avoiding Toxic Chemicals In Hair Dyes. Learn How To Colour Your Hair Safely - Living Safe [Internet]. Living Safe. 2018 [cited 7 January 2018]. Available from: http://livingsafe.com.au/avoiding-toxic-chemicals-in-hair-dyes-learn-how-to-colour-your-hair-safely/

Processed meat & its health hazards

     meat and it's products are bad and cause many diseases, perhaps we all know it by now. But we hardly have changed our habit of consuming it. I believe the reason perhaps is our limited understanding about which food products come under it and what are their actual impact on our health. So let's have a clear and short discussion on them.

Processed meat and products:[2][8]

• Processed meat is considered to be any meat which has been modified in order either to improve its taste or to extend its shelf life including salting, curing, fermentation, and smoking. 

• Meat processing includes all the processes that change fresh meat with the exception of simple mechanical processes such as cutting, grinding or mixing.

• Processed meat products include bacon, ham, hotdogs, sausages, salami, corned beef, beef jerky, canned meat and meat-based sauces etc.[1]

Health risks of processed meat:

• World Health Organization (WHO)’s International Agency for Research on Cancer (IARC) announced that consumption of processed meat is “carcinogenic(cancer causing) to humans (Group I ),” and that consumption of red meat is “probably carcinogenic to humans (Group 2A).”[2]

• Red meat includes mammalian muscle meat such as beef, veal, pork, lamb, mutton, horse and goat meat which have higher content of protein and myoglobin.[2]

• This has been proposed by IARC after it's 22 scientists team from 10 countries after evaluation over 800 studies.[2]

• But one point to note is, although processed meat is placed in the same group as smoking, yet its cancer causing potential is far inferior as the evidences yet available.[2]

• Processed meat and unprocessed red meat have been linked to colorectal cancer[3], bladder cancer[4], stomach cancer[5], pancreatic cancer[6] and many other cancers along with chronic and life thretening diseases like diabetes, heart disease, stroke etc[7] to be concise.

Dietary recommendations:

• With present available data, no definite safe dietary limit can be defined for meat.But we can at least derive few evidence based conclusions, such as

• High-temperature cooking like direct contact to flame such as pan frying, barbecuing, smoke cooking should be avoided as it can produce carcinogenic chemicals like polycyclic aromatic hydrocarbons and heterocyclic aromatic amines.[8] 

• the exact relation of amount of processed meat and cancer causing potential is hard to estimate. still few reviews have suggested that more than 50mg of processed meat and more than 100mg of red meat daily is associated with significantly higher risk of cancer.[8]

• for now, only thing can be said is, meat has its own advantage and disadvantages. this can a very good source of protein too. But the overall consumption should be limited to as low as possible and different possessing methods should be avoided to improve it delicacy or lifespan.

 Take care,be healthy and keep smiling............

Refences:
1. Pearson, A. M.; Tauber, F. W. (2012-12-06). Processed Meats. Springer Science & Business Media. ISBN 9789401096928.Introduction
2.The Nutrition Source. (2018). WHO report says eating processed meat is carcinogenic: Understanding the findings. [online] Available at: https://www.hsph.harvard.edu/nutritionsource/2015/11/03/report-says-eating-processed-meat-is-carcinogenic-understanding-the-findings/ [Accessed 4 Jan. 2018].
3.Zhao, Z., Feng, Q., Yin, Z., Shuang, J., Bai, B., Yu, P., Guo, M. and Zhao, Q. (2017). Red and processed meat consumption and colorectal cancer risk: a systematic review and meta-analysis. Oncotarget

4. Crippa A, Larsson S, Discacciati A, Wolk A, Orsini N. Red and processed meat consumption and risk of bladder cancer: a dose–response meta-analysis of epidemiological studies. European Journal of Nutrition. 2016;.

5. Zhao Z, Yin Z, Zhao Q. Red and processed meat consumption and gastric cancer risk: a systematic review and meta-analysis. Oncotarget. 2015;.

6.Larsson S, Wolk A. Red and processed meat consumption and risk of pancreatic cancer: meta-analysis of prospective studies. British Journal of Cancer. 2012;106(3):603-607.

7.Micha R, Wallace S, Mozaffarian D. Response to Letter Regarding Article, "Red and Processed Meat Consumption and Risk of Incident Coronary Heart Disease, Stroke, and Diabetes Mellitus: A Systematic Review and Meta-Analysis". Circulation. 2011;123(3):e17-e17.

8.Q&A on the carcinogenicity of the consumption of red meat and processed meat [Internet]. World Health Organization. 2018 [cited 5 January 2018]. Available from: http://www.who.int/features/qa/cancer-red-meat/en/

polution and its effect on exercise. egg yolk: good or bad: health tip for first jan 2018

Pollution: may nullify exercise benefits:[1]

üBenefits of exercise:  boost memory, promote gut health, protect against heart disease etc

üResearchers from Imperial College London and Duke University in Durham found even a short exposure(2hrs) to air pollution can neutralize benefits of exercise

üThey measured lung capacity, blood flow pressure, arterial stiffness etc. to evaluate the benefits

üThese effects were compared between two groups older people taking 2hrs of walk, One by a busy street and other in a quiet park.

üResults say, people exercising in less polluted environment received significantly higher health benefits where as polluted environment did not result in any significant benefit over non exercising people

üThis finding is supported by many studies[2][3] while contradicted by few[4]

Egg yolk: how good and bad to eat:

üEgg including both egg white and yolk makes a right balance of protein, fat & calories

üBut egg has been judged poorly since its yolk contains high amount of cholesterol(200mg per egg)

üRecent large scale studies and their reviews suggest that daily intake of 1 egg does not result in increase in CHD rather reduces risk of stroke.[5][6]

üFew other studies have emphasized that consumption of around 7 eegs a wk is safe for normal people while in established patients of CVD or T2D its recommended with a healthy lifestyle.[7]

üBut few studies have found association of higher egg consumption(>1/d) and diseases like T2D,CVD etc.[8][9]

üSo having 5-10 whole eggs eggs a wk appears to be more beneficial than harmful.

Health tip:[10]

•Exercise have a positive impact on cognitive functions

•aerobic exercise, resistance training, multicomponent training and tai chi, all had significant impact on cognition.

•A large scale meta-analysis have shown that, around 45-60 min moderate intensity exercise have good cognitive outcome both in normal and dementia patients.

References:

1.       Sinharay R, Gong J, Barratt B, Ohman-Strickland P, Ernst S, Kelly F et al. Respiratory and cardiovascular responses to walking down a traffic-polluted road compared with walking in a traffic-free area in participants aged 60 years and older with chronic lung or heart disease and age-matched healthy controls: a randomised, crossover study. The Lancet. 2017

2.       An R, Zhang S, Ji M, Guan C. Impact of ambient air pollution on physical activity among adults: A systematic review and meta-analysis. Perspectives in Public Health. 2017;:175791391772656.

3.       Li F, Liu Y, Lü J, Liang L, Harmer P. Ambient air pollution in China poses a multifaceted health threat to outdoor physical activity. Journal of Epidemiology and Community Health. 2014;69(3):201-204.

4.       Tainio M, de Nazelle A, Gotschi T, Rojas-Rueda D, Kahlmeier S, Nieuwenhuijsen M et al. Can Air Pollution Negate the Health Benefits of Cycling and Walking? Journal of Transport & Health. 2016;3(2):S54.

5.       Alexander D, Miller P, Vargas A, Weed D, Cohen S. Meta-analysis of Egg Consumption and Risk of Coronary Heart Disease and Stroke. Journal of the American College of Nutrition. 2016;35(8):704-716.

6.       Rong Y, Chen L, Zhu T, Song Y, Yu M, Shan Z et al. Egg consumption and risk of coronary heart disease and stroke: dose-response meta-analysis of prospective cohort studies. BMJ. 2013;346(jan07 2):e8539-e8539.

7.       Geiker N, Larsen M, Dyerberg J, Stender S, Astrup A. Egg consumption, cardiovascular diseases and type 2 diabetes. European Journal of Clinical Nutrition. 2017;.

8.       Djousse L, Khawaja O, Gaziano J. Egg consumption and risk of type 2 diabetes: a meta-analysis of prospective studies. American Journal of Clinical Nutrition. 2016;103(2):474-480.

9.       Khawaja O, Singh H, Luni F, Kabour A, Ali S, Taleb M et al. Egg Consumption and Incidence of Heart Failure: A Meta-Analysis of Prospective Cohort Studies. Frontiers in Nutrition. 2017;4.

10.   Northey J, Cherbuin N, Pumpa K, Smee D, Rattray B. Exercise interventions for cognitive function in adults older than 50: a systematic review with meta-analysis. British Journal of Sports Medicine. 2017;:bjsports-2016-096587.

A SWEET fat lie..!

Key words:

1.      CVD: cardio vascular disease(diseases of heart and blood vessels)

2.      AHA: American heart association

3.      WHO: world health organization

4.      PUFA: poly unsaturated fatty acid

5.      MUFA: mono unsaturated fatty acid

6.      TG: triglyceride

7.      HDL: high density lipoprotein

8.      LDL: low density lipoprotein

           More than half a millennium we have spent with a common belief that fat or oils or lipids are the worst part of our daily diet. They cause rise in cholesterol, increase in body weight, rise in heart and blood vessel diseases, rise in brain diseases, and may be a risk factor for causing almost all kind of metabolic abnormalities to name few. That belief has forced us to compromise on our day today delicacies like sacrificing cheese from burger, reducing oil from seasonings, minimizing butter from sandwiches and cookies and even eating raw crabs and prawns in style. This has in fact motivated the food industries to produce low fat diets and we are trained to eat them for the sake of good health. But what if I will tell you that, all this is a big lie. Fatty diet is never responsible to make you fatty. Rather it’s the high content of refined carbohydrate that we consume in place of fat, it’s the burger not the cheese, it’s the bread not the butter, it’s the sugar and refines flour in the cookies, who are to blame if you are fatty. What if I will tell that biggies like World health organization/American heart association have kept us in dark knowing the fact for decades together? If I will tell u, it’s the carb who is devil and not the fat, would u believe me? Take a look before deciding.

          Let’s have a time travel to know the facts. In 1961 AHA declared that saturated fat increases cholesterol which causes heart attacks. This was based on a hypothesis called ‘diet heart’ hypothesis of a physiologist named Ancel Benjamin keys and accepted blindly by Paul Dudley White, a founder-member of the AHA. It was a dark phase for USA where a number of people were falling prey to heart attacks including the then president Dwight Eisenhower. The situation demanded convincing answers from the health community and White had only this piece of hypothesis in the newly evolving health-pharmaceutical-industrial complex. Keys presented his “seven countries study” including US, Japan, Yugoslavia, Netherlands, Italy, Greece and Finland to prove his hypothesis which was heavily flawed. He left out 15 other countries that did not reveal any association between saturated-fat consumption and heart mortality rather negated it, on intension and gifted us this big lie which was going to be blindly followed for decades.[1][2]

          Yet there is no denying that obesity and its associated diseases are on a rise and conditions like diabetes, hypertension etc have consumed people more than the population of our country worldwide. It’s only an eye wash to tell that only 400-450 million people are diabetic worldwide, as more than double of it are undiagnosed, many of the rest might not have reached the age group yet and considering the present rate of spread, there is no denying that it’s a global threat rather than a pandemic now.[3][4]

          To evaluate the real cause behind this, thousands of researches are being carried out and many risk factors have already been established. The most important dietary risk factors are perhaps carbohydrates and more specifically refined carbs and not fats. Tarino P and his colleagues found that an independent association of saturated fat intake with heart and blood vessels disease risk has not been consistently shown in prospective epidemiological studies However, when it was replaced with a higher carbohydrate intake, particularly refined carbohydrates, exacerbation of the atherogenic dyslipidemia (lipid imbalance causing blood vessel blockade) associated with insulin resistance and obesity was observed. Still he found the replacement of saturated fat with PUFA to be reducing heart disease incidences. [5]

          Consumption of animal products, may not be associated with increased CVD risk, whereas nut and olive oil intake is associated with reduced CVD risk, hence indicating the more importance of total matrix of food content than just fatty acid content for heart problems.[6] Compared with participants on low fat diets, participants on low carbohydrate diets experienced a greater reduction in body weight and TG(bad fatty acid) but a greater increase in HDL-cholesterol (good cholesterol) and LDL-cholesterol(bad cholesterol) as found on a large scale meta-analysis carried out by Nadia Mansoor and her colleagues.[7] In the recent AHA(American heart association) presidential advisory also it is mentioned that replacement of saturated fat with mostly refined carbohydrates do not result in reduction of cardio vascular disease(CVD) incidences but they have also told that replacement of saturated fat with polyunsaturated vegetable oils will result in good heart outcomes.[8]

          From this it may be concluded that combining and balancing the total composition of daily diet with proper weightage to all types of nutrition including carbohydrates(mostly unrefined), fats(mostly PUFA & MUFA but also saturated fat), protein(combined animal and plant), vitamins and minerals will result in good overall health, the composition of which can be discussed in another article. Avoidance of fat and fatty foods and reducing them to lower than their minimum requirements may even be harmful than beneficial. At the same time, minimizing or stoppage if possible the intake of refined carbohydrates like sugar, refined flours, Trans fats containing junk foods and replacing them with unrefined carbohydrates, unsaturated fats with Ω-3 & 6 fatty acids will result in better outcome not only in cardio vascular but overall health and wellbeing.

         

          References:

1.      The Big Fat Surprise by Nina Teicholz | Why Butter, Meat and Cheese Belong in a Healthy Diet [Internet]. Thebigfatsurprise.com. 2017 [cited 18 December 2017]. Available from: https://thebigfatsurprise.com/

2.      Natarajan D. The Big Fat Lie You've Been Told About What's Hurting Your Heart [Internet]. The Wire. 2017 [cited 18 December 2017]. Available from: https://thewire.in/119934/saturated-fats-carbs-keys/

3.      Diabetes [Internet]. World Health Organization. 2017 [cited 19 December 2017]. Available from: http://www.who.int/mediacentre/factsheets/fs312/en/

4.      Cho N. IDF DIABETES ATLAS Eighth edition 2017. 8th ed. International diabetes federation; 2017.available from: www.diabetesatlas.org

5.      Siri-Tarino P, Chiu S, Bergeron N, Krauss R. Saturated Fats Versus Polyunsaturated Fats Versus Carbohydrates for Cardiovascular Disease Prevention and Treatment. Annual Review of Nutrition. 2015;35(1):517-543.

6.      Michas G, Micha R, Zampelas A. Dietary fats and cardiovascular disease: Putting together the pieces of a complicated puzzle. Atherosclerosis. 2014;234(2):320-328.

7.      Mansoor N, Vinknes K, Veierød M, Retterstøl K. Effects of low-carbohydrate diets v. low-fat diets on body weight and cardiovascular risk factors: a meta-analysis of randomised controlled trials. British Journal of Nutrition. 2015;115(03):466-479.

8.      Correction to: Dietary Fats and Cardiovascular Disease: A Presidential Advisory From the American Heart Association. Circulation. 2017;136(10):e195-e195.