Author: drbeeneducation

Calorie counting is one of the best ways to lose weight, reduce the risk of heart disease, reduce the risk of stroke, control hypertension, and control diabetes mellitus. But, how many calories should you eat?

Quick answer: number of calories needed for you are calculated using your healthy body weight, sex, genetics, age and your daily activity. Of course, it is not 1200 calories daily for everyone. Let us make sense of this premise by understanding a few concepts and then calculating your actual daily caloric need.

Concept one: number of calories needed are the calories required to maintain your healthy body weight, i.e., your healthy self. You are not supposed to care and feed for the extra tissue you have gained. We want to eliminate this extra tissue by starving the cells and the accumulated material in in these cells that make up this extra tissue.

Concept two: composition of your body tissues, age, gender, genetics, and your daily activity further refines your daily caloric need. For example, a muscular person will need more calories compared to a less muscular person. Even when they have the same height and body weight. Similarly, an active person will need more calories compared to a sedentary person even when they both have equal height and weight.

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Note: this article focuses on type 2 diabetes mellitus.

Diabetes is a disease where glucose is unable to enter cells and help create energy packets called ATP. Think of ATP as tiny batteries used by the little machines working in our cells for various functions. In diabetes, glucose is available in the blood stream. Just not taken up by the cells.

Many pathologies can lead to diabetes mellitus. Most significant is the insulin resistance due to fat accumulation around viscera (visceral fat.) Insulin is the hormone that helps glucose get into a cell. Studies have shown that the fat accumulated under the skin (subcutaneous fat) is less harmful compared to the visceral fat. It is observed that exercise helps prevent accumulation of visceral fat. Japanese wrestlers, for example, have subcutaneous fat instead of visceral fat. This distribution pattern of fat in these wrestlers is due to regular exercise they do.

In diabetics, glucose that is unable to enter into the cells accumulates in the blood and the interstitial fluid. This extra volume of glucose harms various tissues. The most commonly affected structures are kidneys, nerves, eyes, and the blood vessels resulting in kidney failure, nerve damage, blindness, cataract, and heart attacks. Obviously, it is important to prevent glucose accumulation.

Let’s study various food classes and their contribution to the glucose peak. This will help us understand why we should modify our diet to manage diabetes mellitus.

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Following 4 phases of heart failure must be in your mind when managing heart failure patients.

  • Chronic heart failure with reduced ejection fraction (HFrEF).
  • Heart failure with preserved ejection fraction (HFpEF).
  • Acute decompensated heart failure (ADHF).
  • Advanced heart failure.

General principles of treatment for heart failure

  1. Relieve symptoms.
  2. Improve functional status.
  3. Prevent (re)hospitalization.
  4. Prevent death.

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Pulmonary Circuit

Properties of Pulmonary Circuit

The heart pumps a volume of blood into the lungs which after getting oxygenated is transported back to heart. This oxygenated blood is then pumped out of the heart and into the aorta and subsequently into the systemic circulation. As a consequence, at any given time the lungs (pulmonary vasculature) contain around 500ml of blood, thereby allowing them to function as a reservoir of the blood. This reservoir volume is increased by another 500 ml when the person is in the supine or lying down position. This is because in supine position there’s an increased venous return (due to the effect of gravity) to the right heart from the peripheries and therefore more blood accumulates in the central parts of body. Upon standing up, this extra 500ml of blood gets redistributed under the effect of gravity, to the now more dependent parts of the body which includes the peripheral tissues and the lower extremities.

The division of vasculature in the pulmonary circuit is somewhat different from that in the systemic circulation. The arteries in the pulmonary circuit divide in a binary fashion, thereby following the pattern of division of the airways. The veins too exhibit a pattern similar to the arterioles and the bronchioles, thereby finally converging into forming one large pulmonary vein. These pulmonary veins transport the oxygenated blood back to the heart.

The primary function of lungs to deliver oxygenated blood to the heart.

Apart from the primary function of lungs to deliver oxygenated blood to the heart, it has following secondary functions.

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Organization of Cardiovascular System

The human heart has 4 chambers which are the two atria and the two ventricles. These 4 chambers are divided into 2 functional units referred to as the left heart and the right heart. These atria and ventricle are single functional unit, separated by the atrioventricular valves. These AV valves are one way valves and allow blood flow in the forward direction only.

Right heart is formed by the right atrium and the right ventricle, and it forms one functional unit. The right atrium receives the venous deoxygenated blood from three following sources

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