Functional Foods may be Dysfunctional: A South Asian Perspective.

This communication describes a few functional seeds and spices, commonly consumed in South Asia, which may impair the absorption of drugs that are used in diabetes and medical management. The aim of this article is to highlight the possibility of these foods having a 'dysfunctional', rather than functional effect on health. Physicians should include questions about the use of these spices in their history taking.

Ultra Processed Foods: A South Asian culinary perspective.

There is a vast multitude of foodstuffs available, and health care professionals find it challenging to distinguish between healthy and unhealthy offerings. Recent evidence suggests that ultra processed foods should be avoided, as they are associated with harmful effects on health. This communication defines and describes ultra-processed foods, using the internationally accepted NOVA classification. It uses South Asian examples to make the concept easy to understand for South Asian readers.

Sodium Literacy.

This communication describes the concept of sodium literacy as means of optimizing sodium intake and achieving better cardiovascular health. It also highlights the sources of sodium in South Asian cuisine which can be avoided or minimized.

Insulin hesitancy: A language-based model.

Psychological insulin resistance is a well known entity. This communication proposes the term 'insulin hesitancy' to describe the hesitation that a person living with diabetes experiences, when advised to take insulin. It approaches hesitancy through a triage model, based upon the language used by the patient. By identifying the predominant adverb, "will not", "shall not", or "cannot" in the patient's speech, the diabetes care professional can assess the degree of insulin hesitancy, and tailor his or her conversation towards overcoming it.

Culinary Counselling in Chronic Care: The Pentad of Cs & Ps.

Diet and nutrition are an integral part of chronic metabolic disease management. Medical nutrition therapy (MNT) providers focus upon caloric and nutrient adequacy, but do not necessarily incorporate person-friendly recipes in their ambit. In this communication, we share a simple framework of culinary counseling. This supplements MNT, and enhances its value by encouraging adherence and persistence to prescribed therapy.

Pre-conception management.

This communication shares two frameworks which help conceptualize the vast spectrum of pre-conception care. A 3x3 rubric classifies pre-conception assessment and interventions into gynaeco-obstetric, biomedical and psychosocial. Yet another creative checklist uses the letters A through I to present 9 aspects of pre-conception management. The aim of this article is to simplify the vast field of pre-conception care for primary care physicians and other health care professionals.

Menopause distress: A person centered definition.

We propose the use of the term 'menopause distress,' and share a conceptual definition. Menopause distress is defined as an emotional response characterised by significant, persistent apprehension, discomfort or dejection, due to a perceived inability to cope with the biomedical and psychosocial demands and challenges of living with menopause. This review discusses menopause distress, its definition, etiology, clinical features, and management. It calls for differentiation of menopause distress from other psychiatric conditions such as major depressive disorders and anxiety neurosis.

Barriers and bridges in menopause hormonal therapy.

In this communication, we attempt to simplify the barriers to menopause hormone therapy (MHT) by suggesting bridges over them. We also create an alliterative rubric to assist in clinical assessment of menopause and the rational prescription of menopausal hormonal therapy (MHT). This will ensure comprehensive management of menopause.

Obstetric metabolic medicine: a window to health.

Metabolic health is an integral part of overall health. Thisis especially true during the preconception, antenataland postpartum periods. Metabolic health influencesfoeto-maternal outcomes, as well as the long term healthof the unborn child. This communication shares apragmatic 3x3 rubric, which acts as a checklist for thehealth care provider. It calls for teamwork betweenobstetricians, physicians and other stakeholders, to ensureoptimal health outcomes for all.

Indications for formula medical nutrition therapy in diabetes.

This article describes rational and pragmatic indications of signature or formula medical nutrition therapy (MNT) in diabetes care. Classifying MNT as meal/snack replacement and supplementation, it explores the biomedical, psychological and social indications of MNT usage. The need to ensure concordance of MNT with lifestyle and pharmacotherapy is reinforced. Highlighting the varied and flexible requirements of formula MNT, the authors reinforce the person-centred philosophy of diabetes care in general and MNT in particular.

Pre ketogenic diet counselling.

This communication describes the aims and aspects of counseling prior to start of a ketogenic diet (KD). It uses a reader-friendly bio-psycho-social format to list and structure the various components of pre ketogenic diet counseling. These include strength mapping, risk and benefit explanation, and understanding the patient's selfcare responsibilities. This simple, yet practical discussion fills a major void in current literature, which seems to have ignored patient centred counseling strategies for KD in persons with obesity and diabetes.

Coping with diabetes: The 15 S coping skills list.

This communication lists and organizes 15 important coping skills, which can help one cope with the challenges and demands of living with diabetes. The 15 S list, as we term it, consists of 15 tips and tricks, which are classified into 5 domains: the power of thought, power of words, power of planning, power of motivation, and power of action. The list serves as a useful checklist and aid to clinical practice for all diabetes care professionals. The rubric facilitates a structured way of thinking and intervention, bringing objectivity to a field which is traditionally thought to be subjective. It offers practical ways of handling diabetes distress, and enhancing quality of life with diabetes.

Ramadan fasting during pregnancy: Obstetric risk stratification.

Some women may wish to fast during pregnancy or lactation, for religious or spiritual reasons. This may pose a dilemma to the obstetric care provider, who has to balance the need for maternal and foetal wellbeing with the wishes and needs of the mother. This communication describes a pragmatic, shared decision making, based on patient centred approach to this challenging clinical situation. It highlights simple clinical and investigation based clues which allow obstetric risk stratification of women in pregnancy or lactation. This clinical and laboratory based assessment allows appropriate decision making regarding fasting, while keeping foeto-maternal safety paramount.

Contraception in women with diabetes.

This brief article covers the diabetes related aspects of contraception in women. It classifies various methods of contraception and describes how presence of diabetes influences their use. The article lists the high risk conditions in diabetes which may discourage use of combined hormonal contraceptives. It discusses the relation of glycaemic control and medical termination of pregnancy (MTP), and calls for universal provision of contraceptive services to all women with diabetes.

Vulvovaginitis and diabetes.

Vulvovaginitis is a commonly encountered comorbid condition of diabetes, and is linked to poor glycaemic control. Proper, timely diagnosis and management is necessary to ensure optimal perineal/genital and metabolic health. Knowledge of current guidelines and recommendations helps in achieving this goal. This review describes the etiology, pathogenesis, clinical features, differential diagnosis, management and prevention of VV in diabetes.

Preconception management of thyroid disorders.

Thyroid function is closely interlinked with pregnancy. Maternal and foetal outcomes can be improved if optimal thyroid function is achieved, and maintained prior to conception. This needs a systematic approach which includes rational screening, appropriate management, and pragmatic counseling. This review describes pre-conception management of thyroid disorders, and completes an earlier article on preconception management of other endocrine diseases.

Management of thyroid disorders in pregnancy: Recommendations made simple.

This review covers the current American Thyroid Association recommendations on diagnosis and management of thyroid disease during pregnancy and the postpartum period. It lists the recommendations in a reader-friendly way, and facilitates rational therapy of thyroid disorders, in relation to obstetric health, at the primary care level.

Screening and diagnosis of gestational diabetes mellitus.

American Diabetes Association defines gestational diabetes mellitus (GDM) as diabetes which is diagnosed in the 2nd or 3rd trimester of pregnancy and is not clearly overt diabetes. GDM, if missed or not treated properly can result in maternal and foetal complications, short as well as long term. Screening for overt diabetes, especially for high risk women should be done at the earliest in pregnancy and for GDM, universally at 24-28 weeks of gestation. One step screening by IADPSG (75 gram OGTT), has been recently adopted by most of professional bodies to achieve uniformity. IADPSG criteria have resulted in increase in prevalence of GDM, and consequently increase pressure on health care services as well as on patients. This has resulted in discordance of view on universal adoption of the criteria. Many feel this criteria results in over diagnosis without clear benefits. This brief review will provide the answers to some of the important questions pertaining to screening for GDM.

Preconception management of endocrine disorders.

Endocrine function is closely interlinked with pregnancy. Maternal and foetal outcomes can be improved if optimal endocrine function is achieved, and maintained prior to conception. This needs a systematic approach which includes rational screening, appropriate management, and pragmatic counseling. This review describes aspects of pre conception management related to various endocrine glands. Pre conception management of diabetes and thyroid will be covered in later articles.

Female sexual dysfunction: Assessment.

Female sexual dysfunction (FSD) is a common complex clinical condition, with multiple etiologies, association and pathophysiologic correlations. This review includes the definition, etiology, and diagnosis of FSD. It calls for a bio psychosocial approach to FSD management, which incorporates, but is not limited to, only the psychological aspects of FSD.