Jugad is not Innovation

Jugad is a reckless exploration of expedient solutions with no or minimal disregard for the system. Whereas Innovation is a novel way of solving a problem, oftentimes it is in the context, e.g. saving money, getting things done at a faster pace, etc. However, innovation never disregards society at large or compromises the existing structure. It encompasses both business and technical problem-solving. Another term, Technology Debt, is used for faster Go-To-Market development of code and is prominently used in software parlance. In this article, I have taken a dig at a common tendency to blatantly brandish our attitude towards scrupulous things with total disregard for laws or norms.

Words 1006, reading time 4 – 5 minutes.

What is Jugad?

 Jugad can colloquially and loosely be defined as a practice of getting things done by investing minimal efforts and getting the desired outcome with an element of exigency attached to getting things done with least care for the system. Whereas, optimization is doing things with minimum cost/efforts/time in getting it done. Often, the later is used in situations to showcase early results but not at the cost of compromising or impacting the system adversely. In Jugad, there is an element of recklessness, lack of concern for the system and accountability. Often it involves dubious methods and approaches. Jugad is when someone gets the license after flouting the system in a spurious way.

 

Introspection

Jugad is not Innovation

Innovation is deeply embedded in the common mind of most amongst us, we call it common sense. Most citizens have a healthy dose of common sense, that is often used in our day to day life. It brings a fundamental advantage in several ways. However, Jugad has a negative connotation and it is self-defeating, for the person and indirectly for the wider society. Despite, like an addiction, we believe it is a great attribute of smartness and keep indulging in it with pride, at the cost of crumbling character. The invention is when Tara Shinde (Vidya Balan) suggests an innovative idea to push the satellite into outward orbits with limited energy (as in Mission Mangal).

Jugad is not Technical Debt

Often a similar term is used in Information Technology (IT) Programming wherein a feature has to be pushed into production at the desired date to achieve a Go-To-Market objective. Yes, it does result in fallacies in the code and does involve a lack of diligent testing beforehand, but it is not at the cost of overall system compromise. It underpins an Agile methodology for code development. Below examples will illustrate Technical debt, and I have taken little extra deep dive to explain the different types of technical debts.

Carnegie Mellon University defines it as “a conceptualizes the trade-off between the short-term benefit of rapid delivery and long-term value”. A design or construction approach that is expedient in the short term but that creates a technical context in which the same work will cost more to do later than it would cost to do now (including increased cost over time) whereas Gartner defines technical debt “as the deviation of an application from any nonfunctional requirements”. What does this have to do with our ordinary “Jugad”? Technical debt emphasizes two paths to choose:

The easier route – made up of messier code or design, will get you there faster.

The harder route – made up of cleaner code and design that takes a lot more time.

It is unavoidable, unintentional and planned. It expedites pushing code but never with malicious intent.

Technical Debt 1

So What Is Jugad?

I will cite an example. Never have I felt good after receiving a traffic citation. I complained but realized, that citation has always helped me reduce my speed and be more attentive. No one will disagree that this effect was everlasting. It might have prevented untoward incidences. However, I always grumbled for getting a citation. In the US, the only way to redress the citation is by legal means, any other means is counterproductive. However, in India, other means can be adopted for faster redressal.

Recently, there was a huge fire in Delhi (Dec 8, 2019) with a death toll of over 35. It is definitely a somber and tragic event. I am sure, the City Corporation of Delhi must be having its own fire rules and regulations. However, I am also sure that those might have been intentionally overlooked. A post facto analysis may reveal the truth later.

In a nation where bridges and buildings keep falling like a pack of cards, it is only newsworthy to read such death tolls and we feel the pain and despair only for a few moments. We lament express shock and get back to our work. However, the underlying phenomenon is our own fallacy and lack of commitment and abject ignorance of true empathy. Incidences like the huge fire in Delhi, the crumbling bridges and buildings or the smog in Northern India are tragic outcomes of a Jugad attitude. It is painful to see recurrent high death toll from such incidences. Unfortunately, we need incidences like this to learn reactively. Of course, some learning will definitely be an outcome, policy books will be updated by city planner, corrupt official, and expediency by owners will override these, NGOs may criticize and some matters will go to courts while others will be pushed beneath the rug.

Indians often pride expediency and leverage our capabilities in getting things done, hardly ever realizing that every moment, every incidence of individual contribution, adds to this Jugad character of the national identity.

There is a great deal of criticism about India as a $5 Trillion economy. People are a skeptic but India is already beyond $5 Trillion Economy. I am taking a futuristic view. According to PwC and the World Economic Forum, India is bound to be a $28 Trillion Economy and China a $50 Trillion Economy. I have an even better prediction about that but first, India needs to fix the parallel process, commonly called ‘Jugad’.

As a rising nation, Indians have to abandon this parallel process (Jugad) mindset. Like it is imperative to dismantling a parallel economy, so is it equally important to dismantle this Jugad mindset and commit to hardship and build a character. Finally, every country has a character and characteristics and this is one character that will lampoon India as trailing Pakistan in the future.

Summarily, I can say with a lot of certainty that almost everyone indulges in Jugad frequently, if not the least evert now and then. However, some pride themselves only on Jugad. If only we can stop our temptation and fix our attitude of falling for short cuts at the cost of the system that would be best application of introspection.

https://medium.com/existek/what-is-technical-debt-and-how-to-calculate-it-80193e4e746d

View at Medium.com

https://insights.sei.cmu.edu/sei_blog/2015/07/a-field-study-of-technical-debt.html

https://www.thehindu.com/news/cities/Delhi/many-dead-and-injured-in-fire-at-delhis-anaj-mandi/article30236267.ece

https://www.bmc.com/blogs/technical-debt-explained-the-complete-guide-to-understanding-and-dealing-with-technical-debt/

View at Medium.com

— — —

Additional Illustration on technical debt –

Technical Debt 2

Demystifying Fasting and Cancer

All faiths across the globe different faith from Zoroastrians, Buddhism, Christianity, Islam, Judaism, Taoism, Jainism, and Hinduism advocate fasting. Fasting is definitely helpful for health and longevity. Social media is abuzz with Fasting and how it treats cancer. There is a sudden surge of colloquial and rudimentary messages on health. Often, these are relied with credence when it comes especially from revered spiritual leaders. One such message is from Sadhguru, a highly respected spiritual leader. In this video, Sadhguru is talking about the ubiquitously presence of cancer cells in our body. To deter the spread of these cancerous cells, he is recommending fasting.

First and foremost, we need to visit the definition of cancer cells. A key characteristic of cancer cell is uncontrolled growth of cells that have accumulated genetic changes (mutations) due to a carcinogen (a cancer causing agent). Second, cancer cells are not goondas that collect in one place as they advance. In fact, as the cancer stage advances these cells spread across their site of origin. Third, fasting is helpful only in select cases, not every cancer. Also, fasting is helpful beyond cancer, however it depends upon the state of metabolism, activities, age, at the least.

While we need people like Sadhguru to bring the social transformation, we definitely want these messengers to provide a solid rationale that is resting on scientific pedestals, devoid of which we will create confusion and loss of credibility. In this article, I have provided a scientific rationale for understanding the causes of cancer and if fasting can help stop the development or progression of cancer.

Words 2492, reading time 9 – 12 minutes. Background in Medicine helpful.

This 2.34-minute video from Sadhguru is truly insightful.  In the below article, I provided the rationale for reconciling scientific understanding of Cancer and Diet with those Vedic practices that are proposed by Sadhguru. More importantly, scientific literature provides a mixed body of the rationale for dietary practice for cancer prevention and or treatment. To rephrase, dietary restrictions can be a feasible option for select cancers, NOT ALL the types of cancer.

I got this video from Singapore, from a good colleague with whom I worked several years ago. With deep respect and reverence to Sadhguru. I listened to this video wherein Sadhguru talked about cancer as –

1) Always present within the body and get stimulated because of stimulants and intoxication.

2) They get organized into one place and later become overwhelming for the body to counter.

3) That these cancer cells consume 27-28 times the normal calories.

His solution according to Yogic culture is –

1) Spacing meals 8 – 12 hours a day

2) Fasting once or twice a month

It immediately drew my attention to the landmark paper by Hanahan and Weinberg, in which the authors talked about ‘The Hallmark of Cancer”. As an Oncology fellow, I remember having read it at least 2-3 times as it was foundational and disruptive in 2000.

As undergraduates, we were tutored on the existence of Oncogenes (1970) and Tumor Suppressor Genes (1986) and Knudson’s two-hit hypothesis (1971). Then, it might have not had such a reminiscent influence on my mind, until I started my post-graduation in pathology. However, Hanahan and Wienberg’s paper was a step ahead in explaining the different pathways for cancer. It served me when I lead the exploratory search for the epigenetics (methylation of TSG) and downregulation of several caspases (genes) in the apoptotic pathway.

I was definitely perplexed when I read the version of Sadhguru on the existence and or progression of cancer for several reasons –

 

  1. I mentioned the key developments in cancer as a stepwise accumulation of mutations in the genes of the cancer cell. These mutations occur due to several factors called carcinogens – viruses, chemicals, hormones, persistent inflammation, UV radiations, etc. We also know that cancer can occur de novo due to improper repair mechanism or existence of germline mutation (mutation inherited from parents). However, stimulants and intoxicants (especially the former), are definitely not carcinogenic and intoxicants like alcohol are considered co-carcinogens, not directly implicated in the development of cancer causation. I especially exclude the 300 plus carcinogens found in cigarettes as a stimulant and include nicotine as the stimulant, which is not a carcinogen, as proven by ‘comet assay’.

I realized, like thousands of other researchers across the globe, that tumorigenesis is a multi-step process and follows a multistep pathway. Germline mutations (those acquired from parents) like BRCA1, BRCA2 or RB genes occur in hereditary cancers. We can call these as existing in all cells in folks who inherit them from parents. However, the percentage of germline mutations are minuscule, possibly representing less one percent of the population. For these hereditary acquired cancers, one single hit drives a normal cell towards cancer progression. Where, in a normal population, any mutation has to hit two times to drive the cells to cancer progression. This Two hit hypothesis was proposed by Knudson in 1971 and is the underlying mechanism for most genetic aberrations occurring in a normal population. Of note, cancer cells do not exist universally in our bodies unless those are inherited from our parents (a less than 1% probability).

TSG and Cancer

 

  1. Though we know that cancer cells consume most of the host nutrition, it is hard to believe that these (cancer) cells organize (like gangs of Goondas) and rob the body of the nutrition. In fact, it is the other way around. Cancer cachexia, a state common in terminal cancer, is primarily due to diversion of nutrition towards metastasized (spread out) cancer cells, not when they come together.

 

  1. The solution offered by Sadhguru, that we should fast at least once or twice to avoid cancer is so much inadequate if not wrong,  as we all know that those who fast frequently have cancer and those obese who are voracious eaters don’t necessarily have cancer (but other metabolic diseases).

 

I specifically mentioned ‘The Hallmark of Cancer” that was published in 2000. This paper made a major stride in advancing our understanding of cancer (the paper was revised by Hanahan and Weinberg in 2011). It is worth revisiting the 6 facets of the hallmark in the above illustration.

678db3d930094d45ecba7ebdfa6b29b0

 

Warburg Effect

Recently, a debate is intensifying on the existence of the mechanism of cancer causation other than carcinogen-induced genetic abnormalities. Immune modification and metabolic abnormalities have also been implicated. The later is called the Warburg effect. Warburg effect proposes that the cancer cells metabolize via the glycolytic pathway even in the presence of aerobic state instead of the much more efficient oxidative phosphorylation pathway.

Let us understand two aspects –

1) Does fasting help the initiation of cancer and

2) Once established and or advanced, will fasting help cancer to regress and or get into control?

Does fasting help cancer?

Recent Geroscience literature reveals that cancer and aging are characterized by dysregulated metabolism consisting of upregulation of glycolysis and down-modulation of oxidative phosphorylation. Based on the research on Geriatric patients, metabolic interventions have been explored as promising strategies to promote longevity and to prevent or delay age-related disorders including cancer.

Will fasting help regression and or control of Cancer?

Select metabolic intervention approaches include chronic calorie restriction, periodic fasting/ fasting-mimicking diets, and pharmacological interventions mimicking calorie restriction.  These are considered as adjuvant anticancer strategies, not the mainstay of cancer therapeutics. By adjuvant, I mean they are supplemented along with standard cancer therapy (chemotherapy, radiation, and targeted therapy). However, to summarize, calorie restriction is subjective and second, where it is effective, it has an adjuvant effect.

Animal studies (in rodents) have shown that chronic caloric restriction reduces and delays cancer incidence, and inhibits tumor progression and metastasis. Also, there is mounting evidence that cancer incidence and mortality are strongly reduced in chronic calorie-restricted non-human primates. Studies of long-term calorie-restricted human subjects have shown a reduction of metabolic and hormonal factors associated with cancer risk. However, chronic caloric restriction is not a feasible clinical intervention. Evident difficulties, such as the long period required to be effective, and unacceptable weight loss, hamper clinical application in cancer patients.

Autophagy: definition and mechanisms

In the 1990’s Yoshinori Ohsumi first proposed autophagy. He received a Nobel Prize in 2016 for Physiology or Medicine for his seminal work in establishing a morphological and molecular mechanism of autophagy.

Autophagy is an evolutionarily conserved lysosomal catabolic process by which cells degrade and recycle intracellular endogenous (damaged organelles, misfolded or mutant proteins, and macromolecules) and exogenous (viruses and bacteria) components to maintain cellular homeostasis. The specificity of the cargo and the delivery route to lysosomes distinguishes the three major types of autophagy –

  • Mircroautophagy involves the direct engulfment of cargo in endosomal/lysosomal membrane invaginations.
  • Chaperone-mediated autophagy (CMA) recycles soluble proteins with an exposed amino acid motif (KFERQ) that is recognized by the heat shock protein hsc70; these proteins are internalized by binding to lysosomal receptors (LAMP-2A) 6.
  • Macroautophagy (herein referred to as autophagy) is the best-characterized process; in this process, cytoplasmic constituents are engulfed within double-membrane vesicles called autophagosomes, which subsequently fuse with lysosomes to form autolysosomes, where the cargo are degraded or recycled. The degradation products include sugars, nucleosides/nucleotides, amino acids and fatty acids that can be redirected to new metabolic routes for cellular maintenance.

Autophagy occurs at basal levels under physiological conditions and can also be upregulated in response to stressful stimuli such as hypoxia, nutritional deprivation, DNA damage, and cytotoxic agents. Autophagy has attracted considerable attention as a potential target of pharmacological agents or dietary interventions that inhibit or activate this process for several human disorders, including infections and inflammatory diseases, neurodegeneration, metabolic and cardiovascular diseases, obesity and cancer.

Autophagy and cancer
The role of autophagy in cancer is complex, and its function may vary according to several biological factors, including tumor type, progression stage, and genetic landscape, along with oncogene activation and tumor suppressor inactivation. Thus, autophagy can be related either to the prevention of tumorigenesis or due to the enabling of cancer cell adaptation, proliferation, survival, and metastasis. The initial indication that autophagy could have an important role in tumor suppression came from several studies exploring the essential autophagy gene BECN1, which encodes the Beclin-1 protein that is frequently deleted in ovarian, breast and testicular cancer.

BECN1 is located adjacent to the well-known tumor suppressor gene BRCA1, which is commonly deleted in hereditary breast cancer. These deletions are generally extensive and affect BRCA1 along with several other genes, including BECN1, suggesting that the deletion of BRCA1, not the deletion of BECN1, is the driver mutation in breast cancer. Furthermore, the activation of oncogenes (e.g., PI3KCA) and inactivation of tumor suppressors (e.g., PTEN and LKB1) are associated with autophagy inhibition and tumorigenesis. Animal models note that the tumor suppressor function of autophagy is associated with cell protection from oxidative stress, DNA damage, inflammation and the accumulation of dysfunctional organelles. Collectively, these phenomena are important factors that could trigger genomic instabilities leading to tumor development.

However, the loss of function of autophagy genes has not yet been identified and demonstrated in humans, raising doubts about the relevance of autophagy to tumor initiation in different types of cancer. In addition, the autophagic machinery is not a common target of somatic mutations, indicating that autophagy may have a fundamental role in the survival and progression of tumor cells.

Once the tumor is established, the main function of autophagy is to provide a means to cope with cellular stressors, including hypoxia, nutritional and growth factor deprivation, and damaging stimuli, thus allowing tumor adaptation, proliferation, survival, and dissemination. Autophagy, by degrading macromolecules and defective organelles, supplies metabolites and upregulates mitochondrial function, supporting tumor cell viability even in constantly stressful environments. Studies have demonstrated that autophagy increases in hypoxic regions of solid tumors, favoring cell survival (a factor that does not favor fasting to help cancer regression and or cure).

The inhibition of autophagy leads to an intense induction of cell death in these regions. Moreover, tumors frequently have mutations or deletions in the tumor suppressor protein p53, which also favors autophagy induction to recycle intracellular components for tumor growth. Although the basal autophagy rate is generally low in normal cells under physiological conditions, some tumors show a high level of basal autophagy, reinforcing the prosurvival role of autophagy in cancer. RAS-transformed cancer cells undergo autophagy upregulation to supply metabolic needs and maintain functional mitochondria, which in turn favors tumor establishment. Autophagy also has a supportive role in metastasis by interfering with epithelial-mesenchymal transition constituents to favor tumor cell dissemination. Finally, studies have demonstrated that autophagy is commonly induced as a survival mechanism against antitumor treatments, such as chemotherapy, radiotherapy and targeted therapy, contributing to treatment resistance.

How does dietary restriction modulate autophagy and cancer therapy?

Autophagy and cancer therapeutics have a mixed relationship. Because autophagy can inhibit tumor development or favor tumor growth, progression, invasion and treatment resistance, researchers proposed that autophagy modulation could be a new therapeutic strategy in the treatment of some malignancies. In preclinical studies, dietary restriction (DR) has been shown to extend the lifespan and reduce the development of age-related diseases such as diabetes, cancer, and neurodegenerative and cardiovascular diseases. DR promotes metabolic and cellular changes in organisms from prokaryotes to humans that allow adaptation to periods of limited nutrient availability. The main changes include decreased blood glucose levels and growth factor signaling and the activation of stress resistance pathways affecting cell growth, energy metabolism, and protection against oxidative stress, inflammation, and cell death. Nutrient starvation also activates autophagy in most cultured cells and organs, such as the liver and muscle, as an adaptive mechanism to stressful conditions.

Studies demonstrate that dietary interventions can reduce tumor incidence and potentiate the effectiveness of chemo- and radiotherapy in different tumor models, highlighting dietary manipulation as a possible adjunct to standard cancer therapies. Among the many diet regimens that have been assessed, caloric restriction (CR) and fasting are the methods under intense investigation in oncology. CR is defined as a chronic reduction in the daily caloric intake by 20-40% without the incurrence of malnutrition and with the maintenance of meal frequency. In contrast, fasting is characterized by the complete deprivation of food but not water, with intervening periods of normal food intake. Based on the duration, fasting can be classified as –

(i) intermittent fasting (IF—e.g., alternate day fasting (≥16 hours) or 48 hours of fasting/week) or
(ii) periodic fasting (PF—e.g., a minimum of 3 days of fasting every 2 or more weeks).

Conclusion

Every stride in translational medicine helps in advancing our understanding of cancer and subsequently, the management of this malady. However, when a person of Sadhguru’s respected stature talks about fiction based on Yogic culture, we tend to degrade our Yogic culture and deprive the credibility of our repute.

However, as stated earlier, there is a mixed bag of information on dietary restriction and cancer prevention or treatment. 

There is a perfect need for interpreting a way of life (Sanatan Dharma and its various plural forms of ideologies for a living). I accept and understand that ancient Vedic science stood on significantly advanced scientific thinking, however, our times are different and we should rely on the current body of knowledge and refine our thinking of ancient yogic culture.

Note: I believe in providing direct feedback. I made an attempt to reach Sadhguru’s office at Coimbatore. No one answered. Possibly, I will make a few more attempts.

Citations:

http://cubocube.com/dashboard.php?a=1582&b=1585&c=1

Effect of short term fasting on cancer treatment https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6530042/

Autophagy and intermittent fasting: the connection for cancer therapy? https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6257056/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3608686/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3648937/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5442682/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5107564/

Nicotine: Carcinogenicity and Effects on Response to Cancer Treatment – A Review (2015)
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4553893/

https://www.britannica.com/topic/fasting

 

Cuisines and Health

Like most of you, and as a gastronome, I often like to try different cuisines. Despite being reared on an Indian palate, I often find other cuisines scintillating. I especially gravitate towards Mediterranean, Ethiopian, TexMax, Majicano (not Spanish as is commonly called), Vietnamese, Nepali and Indian cuisine. Especially, I still have to develop taste for Sushi, though I haven’t taken a taste for Italian for its overwhelming Cheese and High Carb content. Maybe I am wrong and possibly, I have to try better restaurants.

Indian Cusine

As mentioned, I often bounce back to Indian cuisine after eating the different varieties. To admit frankly, I succumb to somnambulance from the food served at the Indian restaurants, mainly because of the high-fat content and the chef’s inadequate understanding of the composition of the ingredients. Often I tell my non-Indian friends that –

Home Cooked Food is the best:

Indian cuisine that is cooked at home is way different than what is served in Indian restaurants across the globe irrespective of the chef who cooked it. Mother’s handmade food is best, irrespective of where your mother hails from. There is more love and less of commerce admixed in that food.

The cuisine has various influences:

Cuisine varies from home to home but a regional pattern is pretty much common. Cuisine recipes differ every so many kilometer (Kilometer is the standard used in India, not miles). State and National boundaries have little impact on these varieties. These patterns have loco-regional influences that are intricately related to the weather, availability, and non-availability of ingredients and the culture of the region. In my view, the last aspect reflects our variations and a longing for identity.

Cuisines vary as you travel a few miles:

Indian subcontinental cuisine has differing shades as you traverse from Pakistan, India, Nepal, Bangladesh, and Sri Lanka. Generally, the Indian Continental Food served in restaurants here in the US or Europe is dominated by polar varieties that include either North and South Indian cuisine as the main (or multi) course meal that ideally terminates with either a dessert either from Bengali or North India.

Taste is developed in childhood:

Taste buds are developed until 5-7 years of age. I call it a native taste for cuisine. Though we all long for variety, eventually we all fall back to our native cuisine. Restaurants are thus dominated by the population it serves. As an example, here in Dallas, we have a dominant Telugu population and consequently, you see Telugu, North Indian and Tamil style food (Idlis, Dosas, etc.). Not sure if you folks have had an opportunity to taste Nepal, Ladakhi, Sikkimese of Kangra (Himachal Pradesh) food, but it is deeply rooted in the subcontinental style. We all know, Awadhi, Dakkhani, Punjabi, Marwari, Kachi, Goan, Bengali, Odisha, Assamese flavors. The list is endless and it is best to taste authentic local food when we are in the region.

Culinary has more influences too:

The cooking style is heavily influenced by the affluence, culture, nature of the work, religious and regional practices. This last aspect has not changed and though affluence and availability of ingredients are rising, we haven’t truly modified to our current lifestyle. Thus ghee, sweets, and dominance of high glycemic index foods that are destroyed by microwave heating, adulterants and high heat from Gas (stove) burners as against slow cooking on conventional chullas), has destroyed the true value of food.

Commercialization has an adverse impact:

Commercialization of crops like fertilization, high productivity pressure, faster Go To Market, our own need for picturesque rather than little blemished fruits and vegetables are adding a significantly damaging angle. When a vegetable or fruit grows naturally, it soaks all necessary ingredients from the soil. It grows slowly but gets all the necessary micronutrients while it is taking the time to ripen or mature. Vegetables or fruits grown on fertilizers, boost productivity, shorten the time to ripen/mature and thus, has fewer ingredients as compared to those that are not fed fertilizers. Also, often I observe my own behavior while at the grocery shop or farmers market. I tend to choose absolutely picture-perfect fruits/vegetables. Any blemishes by insects are discarded by me. Only retrospectively, I realized that those blemishes are a mark of quality because the insects tried eating those because of its quality. Have you tried feeding a dog or cat any sweets or milk with sugar? Try feeding some treated grains to birds and you will realize they all despise those feeds. We humans are different though. Our tongue dominates our satiety and we hardly realize that what is tasty and that which tickles our tongue is not good. Thus we end up with indulgence. We call ourselves intelligent creatures but we hardly know how to differentiate good food from not so good.

That which does not decay may not be good for health:

Most Vegetables and Fruits have a short shelf life. I often say, if a food does not decay, that’s not good food. If a pizza is seating at room temperature for more than a few days, without being spoilt or without any fungal growth, that is bad. I don’t mean we should eat food with microorganisms growing on it, I instead mean that pizza is not worth those fungi/algae than is it really good for humans? Natural decay is also influenced by weather conditions and this cannot be an ultimate gauge of quality. Unfortunately, we humans who bask on our intelligence can’t discriminate between good and bad, whereas the entire flora and fauna can.

Do you want to mix Cuisine:

You lose the authenticity, that signature of the food. A great example is Chinese-Indians. We cannot adopt best practices from other cultures, that identity of the food is lost. You may find a hybrid dish arising out of your experiment and that may still be good. However, the authentic flavor is definitely missing.

YouTube recipes are a great way to start learning but we have to mold those recipes to our lifestyle. We have to adopt authentic cuisine to our needs. Kids and pregnant/lactating mothers may need different food as compared to a father with a sedentary lifestyle. I still remember, when my wife was carrying our child, I too 😋 put on weight, it was right for her but for me 🤭. Someone recovering from illness may need different food as compared to normal healthy people. Our busy lifestyle does not offer us the liberty to adopt so much and consequently, food falters.

Spices have Special Value – Use those wisely:

For antiquity, Spices were exported from India across the Silk Route to Europe, Eastern Europe, China, and South East Asia for their medicinal and gustatory value. Kerala is the hotbed for spices though many are grown across India. Spices have been a reason for much of the Gold that accumulated from across the world into India. To avoid making this as a compendium on spices, I will cite two examples to emphasize the importance of spices.

Turmeric (curcumin) as an ingredient, is part of most Indian cuisine. As a fellow in molecular oncology, we learned in early 2000 that Indians have the least incidence and prevalence of colon cancer. One reason that was strongly associated with this finding was the vigorous use of turmeric. It has a Cox 2 inhibitory action that suppresses colon cancer progression.

Another spice that is well known is Capsaicin (Chillies). Capsaicin has a documented effect in modulating (decreasing) pain through its action on Substance P, a neuromodulator involved in the pain pathway. Amelioration of the neuropathic pain using topical capsaicin is an established remedy for Osteoarthritis and other acute pain. In addition, capsaicin is known for its gastroduodenal mucosal defense.

Animal studies suggest that capsaicin may merit clinical evaluation with respect to the progression of atherosclerosis and diabetics, angina, non-alcoholic fatty liver disease, cardiac hypertrophy, metabolic syndrome, hypertension, obesity, and gastric ulceration. In addition to the many studies assessing capsaicin’s impact on metabolic rate and adiposity, the trial of topical capsaicin in patients with angina, and the studies documenting capsaicin’s gastroprotective effects represent initial efforts in this direction. Assessment of the dose-dependency of these effects could provide useful insight into capsaicin clinical dosage to provide systemic metabolic benefits (Reference below).

Nepalese Cuisine

Spices and Disease Prevention (Cancer, Ischemic Heart, and Respiratory Diseases)

Spices and herbs such as clove, rosemary, sage, oregano, and cinnamon are excellent sources of antioxidants with their high content of phenolic compounds. It is evident that frequent consumption of spicy foods was also linked to a lower risk of death from cancer and ischemic heart and respiratory system diseases. This review highlights the potential health benefits of commonly used spices and herbs such as chili pepper, cinnamon, ginger, black pepper, turmeric, fenugreek, rosemary, and garlic.

J AOAC Int. 2019 Mar 1;102(2):395-411. doi: 10.5740/jaoacint.18-0418. Epub 2019 Jan 16. Health Benefits of Culinary Herbs and Spices.

Summarily, there is no problem with Indian cuisine, and by no means, I wish to indicate that Indian cuisine is the best. All cuisine is excellent, be it Icelandic or Afghani food, the problem is with us. Let us fix that and add an adequate dose of exercise and activity.

Ultimately, what and how we eat as well as our activities (physical, emotional and spiritual) will influence us within us and outside world. Below guidelines are best to keep a simple balanced diet that is rooted in our regiono-ethnic practices. I say this because our genome has a memory of the food we have been eating for millennia and it has built a repertoire of identifying good and not so good. The industrial revolution has brought too many changes too fast that our body hasn’t had enough time to adjust and assimilate those changes.

Grain Bowls

My 10 Commandments of Food: Keep a simple diet

  • Eat fresh and eat in moderation. Occasional bingeing is fine.
  • Possibly try to eat less of meat and non-vegetarian food if your protein demands are not high. Initially, try to cover protein demands with a mix of grains and pulses with high protein content.
  • Keep a healthy balance of gut biota (Gut bacteria). Fresh yogurt or curds are best. Those at the grocery stores usually have killed the lactobacilli and consequently, don’t provide the probiotics that we so much need for a healthy GUT.
  • It is needless to say do not eat sweets, but try eating those at the beginning of the meal to reduce your satiety.
  • Keep a balance between the three broader categories of food, namely carbs, proteins, and fats. Imbalance of any has a strong potential for adverse health effects.
  • Remember to keep changing variety as there are multiple micronutrients required by the body and those are spread across various forms of grains, vegetables, and fruits. Do not eat the same food every day, as a habit. Always try to eat seasonal grains, fruits, and vegetables from multiple sources. Understand, the body does not know it needs a particular micronutrient, an e.g. being Cobalt. All it knows is that it is craving for a specific micronutrient. If you observe craving, try swapping varieties rather than increasing the volume.
  • Once in awhile bingeing is not bad, do not be strict disciplinarian with yourself, I am afraid, you will bounce back and drop the practice of dietary restraint.
  • Avoid inordinate use of stimulants such as Tea, Coffee, and even carbonated drinks. The later one has a tendency to dissolve the bone calcium if indulged over a period of time.
  • Do not fool your system by taking aspartame or sweeteners.
  • Intermittent fasting is always good but it cannot be universally applied. A senior leader from the Industry started Intermittent fasting. Eventually, he developed acanthosis nigricans and I suspected glucose intolerance. I made him change to a normal diet and his acanthosis disappeared. Similarly, I saw some senior leaders adopting a ketone diet. Of course, ketosis resulted in the loss of weight, however, the weight bounced back after resuming a normal diet.

Spices and Cancer Prevention –

Chemopreventive properties of spices are mediated by functional bioactive ingredients that arrest the activity of cytochrome P450 and isozymes CYP 1A1, cyclooxygenase-2, reducing activator of transcription-3 (STAT-3) and signal transducer. They are closely associated with tumorigenesis activated by interleukin-6 (IL-6) receptors and epidermal growth factor (EGF) relate to an array of tumors. The bioactive constituents altering the expression of a protein involved in the cell cycle, activating caspases killer and suppressing Kappa-B activation. Alongside this, they also restrain causative agents of cell structure damage as in the lipid and protein membrane system and DNA that shifting a healthy body towards the cancerous state.

Spices phytochemicals have established as carcinogenesis blockers by modulating cell proliferation pathways transformation, inflammation, metastasis, etc. Promising compounds including curcumin and curcuminoids (turmeric), limonene (cardamom), allicin, allyl isothiocyanate (garlic), cinnamic aldehyde, 2-hydroxycinnamaldehyde and eugenol (cinnamon), gingerol, zingiberone, zingiberene (ginger), dipropyle disulfides and quercetin (onion), piperidine piperine, limonene, α- and β-pinene (black pepper), crocetin, crocin, and safranal (saffron) have been identified as chemopreventing agents against various malignancies. (Anti-oncogenic perspectives of spices/herbs: A comprehensive review; EXCLI J. 2013; 12: 1043–1065. Masood Sadiq Butt,*,1 Ambreen Naz,2 Muhammad Tauseef Sultan,3 and Mir Muhammad Nasir Qayyum;  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4827078/)

Trying to reduce weight – 

If you are trying to reduce weight, increase your metabolism by recruiting various activities including resistance training, aerobics, proper sleep and reducing the Sugar PLUS Salts. Remember, the receptor for Glucose and Salt are shared receptors. The same pump (Sodium Potassium ATPase pump) facilitates the movement of salt and glucose inside the intravascular compartment. It is this principle that is leveraged in Oral Rehydration Theory while giving fluids to those with severe diarrhea.

I will keep updating this blog as and when I can. Meanwhile, please provide your suggestions.

Note: The above is based on my understanding of the principles of nutrition, medicine and observation/experience across a cross-section of the society with whom I interact. At this moment, I have little knowledge about spiritual food. So I have not made any comments about those.

Citations:

‘Indian food is terrible’ tweet sparks hot debate about racism – https://www.bbc.co.uk/news/world-us-canada-50550735

https://www.consumerreports.org/frozen-meals/grain-bowls-the-new-super-bowls/

A comparative chart that offers a good insight on the Scoville Scale of the different varieties of Chillies. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3462993/

https://www.sciencedirect.com/topics/neuroscience/capsaicin

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4827078/)

Different ethnic Cuisine from China – Hunan, Sichuan, Cantonese, Shandong, XinJiang Cuisine, visit below link. https://www.chinahighlights.com/travelguide/chinese-food/regional-cuisines.htm

 

 

A Message For Elon Musk

I read an interesting article in the Nov 13, 2019 issue of JAMA. I found it interesting for three reasons –

  • First, it enlightened me on the updates on the physiology of cerebral circulation.

 

  • Second, it provided me an insight into the effects of space travel on the vascular pressure and fluid circulation during upright and recumbent positions and the effect of an absence of gravity that results in the above outcome. If Elon Musk or Virgin Airlines are thinking of planning to send frequent flyers across into space, they may either have to create gravity chambers inside the craft or ask the frequent flyers to collect frequent flyer miles and stagnation report. Possibly, Elon Musk should also consider something similar to dosimeters or Gamma counters.

 

  • Last, and most commonly, I see several patients with shifting edema that is idiopathic in nature. Does it have any relationship with an internal zero gravity like situation? I know this may sound dumb, but let us think on similar lines if any of the disease phenomena are creating any vascular or perivascular effects resulting in such outcome.

 

Excerpts from the article are included below for your easy perusal. A link to the article is provided at the end of this blog.

 

A gravity-induced head-to-foot (Gz) hydrostatic pressure gradient exists in the fluid-filled systems of the body in the upright position on Earth. In the supine position, the gravity vector no longer pulls in the Gz axis; therefore, blood and tissue-fluid pressures and volumes redistribute across the body. By spending approximately two-thirds of the day upright and the remaining one-third of the day supine at night, humans experience fluid shifts daily. However, crew members on the International Space Station (ISS) are weightless and thus experience a sustained redistribution of fluids toward the head that is not subject to daily diurnal posture-induced change in hydrostatic pressure. Headward fluid shifts during prolonged weightlessness result in facial puffiness, decreased leg volume, increased stroke volume, and decreased plasma volume. This fluid shift may also affect cerebral venous outflow as internal jugular vein (IJV) volume has been showed to be increased from 4.0 to 5.5 months of spaceflight exposure.

 

NASA Men Women

 

Cerebral venous outflow occurs predominantly through the IJVs in the supine position, whereas in the upright position, the IJVs partially or fully collapse due to atmospheric pressure being greater than intraluminal pressure, and cerebral venous outflow is diverted to the vertebral veins and vertebral plexus. However, in most cases, the IJVs do not completely occlude in the upright posture, and fluid communication is present between the cerebral and central venous systems.  Indeed, we observed a waterfall-like blood flow pattern through the left IJV in most participants during upright posture on Earth, despite the semi-collapsed state of the vein.

Cerebral venous drainage plays an important role in regulating intracranial pressure and intracranial fluid dynamics, and changes in cerebral venous pressure result in corresponding changes in intracranial pressure. In the upright position, venous pressure along the Gz body axis changes with respect to the venous hydrostatic indifference point because of hydrostatic effects. Notably, by collapsing, the IJVs act as Starling resistors, a protective mechanism preventing severely negative intracranial pressure in the upright position. The IJV cross-sectional area and flow are modulated by both cardiac and respiratory cycles and can be influenced by posture, anatomical variations, incompetence of the jugular valve, and changes in central venous or intrathoracic pressure. Pressure in the IJV is increased during short periods of weightlessness in parabolic flight, and in this study, we found that the IJV pressure remained elevated during long-duration spaceflight on the ISS relative to the upright posture.

This result concurs with previously measured increases in intracranial pressure and transmural central venous pressure during microgravity exposure relative to the upright position on Earth. It is common to see engorged IJVs during short- and long-duration spaceflight and frame the extent of the engorgement by comparing the IJV area to 3 postures on Earth; however, it is possible that cross-sectional area measures underestimated the extent of engorgement compared to volume measures of the IJV. Cephalad fluid shifts, secondary to the lack of gravitational vectors and the reduction of tissue weight and tissue compressive forces in microgravity, may account for the increase in IJV area and pressure.

Citation:

https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2755307?guestAccessKey=853187ba-4d67-4bf8-8295-0eb2b48f24d8&utm_source=silverchair&utm_medium=email&utm_campaign=article_alert-jamanetworkopen&utm_term=mostread&utm_content=olf-widget_11252019

The Human Body in Space https://www.nasa.gov/hrp/bodyinspace

Detecting Fake Pills

It’s no exaggeration to compare illicit medicines with the nuclear and biological weapons of mass destruction we all fear. These WMDs, though, are largely aimed at people in poor countries who are already facing a multitude of social and economic ills. Sadly, these “track and trace” approaches suffer from a fundamental shortcoming: They authenticate the package, not its contents. A package of medicine is assumed to be genuine simply because it has a valid security mark. Unscrupulous manufacturers can readily circumvent such measures by putting the wrong stuff in the right package. And these approaches offer no help in detecting degradation.

I read this interesting article from my IEEE Spectrum subscription and I immediately correlated that with my recent experience of fake or substandard pills. The magnitude of the problem is humongous. Diabetic medicines that are not effective, to cancer cells that are not killed completely and eventually escape to proliferate further and become out of control to seemingly innocuous infections that are treated not with adequate dose (MIC levels). Sometimes, it scares me to think a patient dying because he had inadequate dose of chemo, and who knows, the antibiotic resistant bugs have evolved due to human greed. It is a massive industry fraud and the entire supply chain is involved.

Fake Pills

In my experience, substandard medicines are not just common in developing and underdeveloped nations. Recently, I took my pills for evaluation to Walgreen’s, a major pharmacy retailer, to inform them that the medicine I got from them was not effective, that a similar pill from another brand was effective and that, another patient, who was given a pill with same but one quarter ingredient had matching size. They evaluated and informed that the manufacturer from China was discontinued. However, their tracking was impressive, there was a alpha numeric inscribed on the tablet, which was visible only with a lens. This Alpha numeric correlated with the source and manufacturer.

It’s no exaggeration to compare illicit medicines with the nuclear and biological weapons of mass destruction we all fear. These WMDs, though, are largely aimed at people in poor countries who are already facing a multitude of social and economic ills. Sadly, these “track and trace” approaches suffer from a fundamental shortcoming: They authenticate the package, not its contents. A package of medicine is assumed to be genuine simply because it has a valid security mark. Unscrupulous manufacturers can readily circumvent such measures by putting the wrong stuff in the right package. And these approaches offer no help in detecting degradation.

When you purchase medicine at the drugstore, you assume that it’s what you think it is and that the active ingredient in the drug is present in the specified concentration. Unfortunately, your assumption might be all wrong. Counterfeit and substandard medicines have become widespread, particularly in low- and middle-income countries with weak regulatory systems. Indeed, according to the World Health Organization (WHO), one out of 10 medicines sold in developing countries should be considered “substandard.” Your drug could even be an outright fake.

Using a physical phenomenon called nuclear quadrupole resonance (NQR), you can test your pill and eat it, too. Nuclear quadrupole resonance requires an atomic nucleus with a nonspherical distribution of positive electric charge, which creates an electric quadrupole moment. The word quadrupole refers to the four electric poles that produce an equivalent nonspherical charge distribution when added to a set of spherically distributed charges. The electronic tester measures the NQR response of the sample at different frequencies. The resulting NQR spectrum is generated by energy transitions within the atomic nuclei of the chemical, providing a unique fingerprint for that compound. Nuclear quadrupole resonance is useful for testing specimens that are solids or powders, but not liquids. While that’s an obvious limitation, NQR has a lot of other things going for it. In particular, it’s insensitive to the presence of coatings or packaging materials. So it can be used to examine pills while they’re still in the bottle or blister pack. Indeed, it could be used to test an entire shipping carton of such bottles or packs, or a drum of powdered material. What’s more, the equipment could be built at low cost and would be amenable to miniaturization. And because NQR instrumentation relies on radio waves of relatively low frequency and power, it is inherently safe and could be used without special training. The prototype drug-­authentication device is portable, performs measurements automatically, and doesn’t require any special skills to operate. It could thus be used anywhere in the drug supply chain. It is estimated that such a device could be manufactured at a cost of about $100, which would, presumably, translate to a price for the end user of less than $1,000.

Credits –

The technology was invented at Nanoscape Research Laboratory Florida and Case Western University by Swarup Bhunia, a professor of electrical and computer engineering at the former, and Soumyajit Mandal, an assistant professor of electrical engineering and computer science works at the later, where he oversees the Integrated Circuits and Sensor Physics Lab. This article was published on August 21, 2019 in IEEE Spectrum and was accessed from my account. Excerpts are copied and credited.

https://spectrum.ieee.org/biomedical/devices/detecting-fake-pills-with-nuclear-quadrupole-resonance

Identifying Rapid Spread of Flesh Eating Infections

 

Thought of sharing this news since it may be a common occurrence if exposed to the bugs in hot swimming pool or any contaminated body of water with open wound.

A woman in her 70’s got flesh eating infection after a usual bruise and succumbed to her wounds. In medical parlance, this is called ‘Necrotizing Fasciitis’. Seemingly a small wound, the bacteria enter the body and start irreversible destruction of the soft tissues.

How do we identify and how to prevent?

The infection often spreads very quickly. Early symptoms of necrotizing fasciitis can include:

  • A red or swollen area of skin that spreads quickly
  • Severe pain, including pain beyond the area of the skin that is red or swollen
  • Fever
  • Ulcers, blisters, or black spots on the skin
  • Changes in the color of the skin
  • Pus or oozing from the infected area
  • Dizziness
  • Fatigue (tiredness)
  • Diarrhea or nausea

How to spot necrotizing fasciitis early on? Watch for –

  • Changes in skin color
  • A rapidly spreading inflamed or swollen area of the skin
  • Severe pain, including pain beyond the area of the skin that is red or swollen, and
  • Fever

Who is prone to Flesh Eating Bacterial Disease? Those with weak immune system are more prone to this disease:

  • Diabetes
  • Kidney disease
  • Scarring (cirrhosis) of the liver
  • Cancer

What to do if you suspect Necrotizing Fasciitis?

Clean wound with clean water, possible use soap and contact a medical facility to evaluate and manage. In my experience, Hydrogen Peroxide works great. Anytime, you have a cut bruise or bleed, washing with clean water and thereafter with peroxide, will remove all the dead tissues and bacteria.

https://www.cdc.gov/groupastrep/diseases-public/necrotizing-fasciitis.html

https://www.cnn.com/2019/07/01/health/flesh-eating-florida-woman-trnd/index.html

Consciousness, Death, and Persistent Vegetative State

Background

Consciousness, Death, Coma and Persistent Vegetative State

John Paul II Institute has organized a symposium on Death and Organ Donation. Dr. Coimbra, a neurologist, has shared a video opposing the idea of organ harvesting and donation. Below, is the link on that discourse along concerning the John Paul II symposium (the link is included at the end of the blog). I differ with Dr. Coimbra and have provided a justification for my perspective. 

Dr. Coimbra raised an interesting question – not alone in medicine but one that touches spirituality and philosophy and extends to encompasses life and living. These questions have been an enigma ever since mankind has been dabbling cognitively exploring to understand it.

However, let us discern select issues at first. At the center of the debate is the definition of death and a downstream question, after objectively defining death, is harvesting and or donating the organs. The discussion rests on a select premise and some experiments. Also, it exists in a milieu of ethics and moral values. Let me take this opportunity to untangle the issues in a reverse chronology as that helps discern and render the problem space in a simpler light.

Ethical Milieu and the Messiah Syndrome

Generally, I am averse to the idea of a conspiracy being unleashed on mankind unless it is by a select group of corporate interests or a select few individuals. I hate to consider an idea wherein, someone questions the ethical and moral commitment of a hoard of well-meaning high caliber individuals and their intellect and commitment, especially when these are not connected and/or affiliated, except for the cause and dedication to their quest for scientific (systemic) understanding. To rephrase, it is hard for me to question the integrity of these folks if these people have no common thread, except a persistent quest to unravel science. Especially, when this cohort is not bound by country, religion, business, generations, ethnicity, ideology, etc. Generally, I don’t subscribe to the ‘Messiah’ ideology. So, I would debunk this Messiah Syndrome at the outset. Calling it ‘Conspiracy’ is unjust and uncalled for. Let us not subscribe to questioning the ethical and moral commitment of all these independent contributors.

Scientific Design and Validation

Experiments have validity if the design and or collection of data is methodical, unbiased and satisfies statistical and or inferential framework. Dr. Coimbra has not substantiated his observations with adequate scientific findings and their correlations except inferences based on his precepts and biased beliefs. This defeats the purpose of any scientific study and helps his contentions to falls from the high scientific pedestals.

Conscious Connectedness

Death and Persistent Vegetative State are inextricably related to consciousness. For any discussion on the death to proceed, we need to understand, the very abstract concept of consciousness and its finite and sublime association with organ(ic) rhythmicity and the circadian cycle. The finite but abstract state of consciousness has always endured cognitive and spiritual interests for generations of the elite and of intellectuals. Suffice it to say that with humility, I am attempting to articulate ideas in this subtle and undefined area. Definitely, I want to stay away from sounding like an authority, which I am not except in my capacity as a sincere contemplative scientific seeker.

Consciousness is a culmination of awareness, cognitive interpretation, and our own limited potential to respond to the inputs from the senses and the surrounding we exist. A vegetative state is the loss of this connection between soma and conscious awareness. At times, it is transient and sometimes, it is permanent and irreversible. Loss of connection does not necessarily mean loss of somatic function. We have had several anecdotes wherein, people have risen after long durations of disconnect if their bodies are kept functional. We know that the duration of brain death is longer in frigid conditions or in infants. Similarly, we also know that sages have practiced an extended ‘state of mind and body’ dissociation during their trance phases. We have seen them reverting to normal bodily functions after reversing the soma – conscious association. Their experiences have been very different. We also have heard patients going through the near-death phenomenon, experiencing those bright flashes of light. These are just a few select examples. However, based on all these, it is evident that this is as intriguing an area as ever. However, one thing is clear that once that association between soma and conscious is irreversibly broken, we can closely approximate it with death (exception is Locked-In Syndrome, wherein, the patient is awake and conscious but disconnected with the body.

Consent and Compliance

Under these circumstances, it is best to go by the consent or implied consent of the individual (best interest standards/Substituted judgment). If those are not available, family discretion comes into play. However, religion, culture, and laws of countries define and influence this space of ethics and compliance. Evidently, we see several versions that act out, depending upon the circumstances.

Inference

Labeling this complex cornucopia of facts and diverse facets into a generalized assumption of the immorality of harvesting organ post-death is grossly inadequate if not possibly wrong.

References

Persistent Vegetative State
https://www.sciencedirect.com/topics/neuroscience/persistent-vegetative-state

The Challenges of Defining and Diagnosing Brain Death
https://www.hopkinsmedicine.org/news/articles/the-challenges-of-defining-and-diagnosing-brain-death

The Legal Definition of Death and the Right to Life
https://link.springer.com/chapter/10.1057/978-1-137-58328-4_8

Neuroethics of death in the United States – PeerJ

https://peerj.com/preprints/2890.pdf

Spiritual  –

Kundalini Yoga
https://en.wikipedia.org/wiki/Kundalini_yoga

Advaita Vedanta
https://en.wikipedia.org/wiki/Advaita_Vedanta