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The premise of Matka Medicine is that we can control our health, lengthen our healthspan and lifespan, and be atmasvasth, on our own, with just a little help, if at all, from doctors and the healthcare system. The very first article that I published last December explains this in detail. The article on atmasvasth takes this concept forward as does the one on healthspan. The site is structured like a loose book and the Index or Table of Contents can help you navigate the site.  The 13 point guide takes the concept further with a specific set of instructions on how to do this on your own. I recently came across the preface of a new book titled “Four Weeks to be a Doctor”, which is about to be released in 3 months, written by Dr. Jaali Daktar, on behalf of CHADDI - the Char Hafta Association of Different Doctors of India.  The preface is quite disturbing because it describes a four-week roadmap for anyone who wishes to become a doctor in India. The reason I am putting it out here now, is to make you, the unsuspecting public, aware of the existence of this organization so that hopefully you can identify these 4-week doctors, if you run into them. Here is the preface. This book is aimed at those who want to become doctors and earn more than physicians and surgeons of modern or traditional medicine. Unlike the 4-5 years or more training they go through, which we believe is all humbug, you need only 4 weeks to learn how to be a doctor. Some of you may take longer, depending on how easily you can pronounce the word “diagnosis” correctly and some may take less time, but the average time it takes to learn the tricks is 4 weeks. Before I start, I would like to thank my English teacher from school, who has helped with the words, the grammar and the spelling and with the podcast. The first thing as I have already said, is to learn how to pronounce the word “diagnosis”. Only regular doctors are able to do this correctly and to be taken seriously by clients, you have to practice saying “diagnosis” at least 10 times every day. Then, start with the online reiki course on the CHADDI website. It takes a week to become a CHADDI endorsed reiki master. You have to understand the nuances of the posturing and hand movements and learn the correct jargon. Once this has been mastered, take the next course in pranic-healing. Weeks 3 and 4 are devoted to craniosacral treatment, gem therapy, aromatherapy and magnetotherapy. You will also have to do course work on vastushastra and feng-shui. In the last two days, you will learn some basic anatomy; that the brain is in the skull, that the liver is below the ribs on the right and the difference between arm and forearm, and thigh and leg and how to confidently use words like CT scan, MRI, laboratory, pathology, microbiology and tuberculosis. You will also learn the names of trendy food items like chia, quinoa, goji-berry, etc to impress your clients. At the end of the four weeks, there will be a theory exam. It is a multiple choice, 20 question paper, which you have to answer over 8 hours after referring to the answer sheet on the website, for which we will give you the link. Your degree will be sent to you over WhatsApp the moment we get the answer sheet. You are now ready to see clients. First start with your friends and family. Initially, take on only those people who have coughs and colds, vague aches and pains, backache, general discomfort, heartburn, and similar conditions, which generally don't get enough attention from practitioners of conventional medicine. Spend time with them, while practicing the various movements and spouting the correct jargon you have learnt in the last four weeks. Encourage them to talk about themselves and don't be surprised when they come up with a lot of repressed feelings, buried fears and angst about their lives and the futures of thei

The premise of Matka Medicine is that we can control our health, lengthen our healthspan and lifespan, and be atmasvasth, on our own, with just a little help, if at all, from doctors and the healthcare system. The very first article that I published last December explains this in detail. The article on atmasvasth takes this concept forward as does the one on healthspan. The site is structured like a loose book and the Index or Table of Contents can help you navigate the site.  The 13 point guide takes the concept further with a specific set of instructions on how to do this on your own. Question: Which is the most common psychoactive, addictive drug in the World? Answer: Caffeine Both tea and coffee contain caffeine, but today, it’s all about coffee. I drink a lot of coffee by Indian standards. At least 2-3 single espresso shots, one cappuccino and 1-2 pour-overs per day. I am quite particular about my coffee. I get my coffee beans and pour-over grind from BlueTokai. I use the freshly roasted beans for the espressos in my Gaggia machine and I make the pour-overs in my Hario V70. But I don’t drink any coffee or tea after 5.30 PM, 4 hours before my bedtime.  Caffeine is a stimulant. It binds to the adenosine receptors in the brain. Increasing adenosine levels during the day cause drowsiness and by blocking adenosine, in the short term, caffeine increases focus and concentration. Many people, including the author Michael Pollan, whose new book “This is Your Mind on Plants” devotes a third of its pages to caffeine, believe that caffeine was responsible for jump-starting the Industrial Revolution by increasing the workers’ focus and concentration.  The challenge is that in today’s world where we want to pack in as much as we can in a 24-hours day, the extra time we need is usually borrowed from our sleep time. Then, if we sleep less, we are groggy during the day, which we try to offset with caffeine, which in turn affects our sleep adversely, which then sets up a vicious Catch-22 where we drink coffee to remain alert because we are sleeping badly because we are over-caffeinated. Since the average half-life of caffeine is 2 1/2 to 5 hours, one of the things that helps with good sleep is to have the last caffeinated beverage not later than 4-6 hours prior to bedtime, come what may. So, what are the downsides of coffee? 1. Sleep issues 2. Addiction I have thrice in my life stopped caffeine, each time when I was doing a Jain “athai”. The first time, I had not prepared for the fast and landed up with severe withdrawal symptoms on days 2 and 3 including headache, loss of focus and lack of energy. However, from day 5 onwards, unlike the experience Michael Pollan had when he stopped caffeine and became listless with a shroud enveloping his mind, I developed razor-sharp focus from days 6-8, likely because the “fasting” overcame the effects of the lack of caffeine. For the next two athais, I prepared in advance by gradually reducing my coffee intake over 10 days and the withdrawal symptoms, if at all, were very mild.   There are really no other downsides, which is why culturally, of all the psychotropic drugs available, caffeine has become the most socially acceptable drug, unlike say opium which became taboo in the early 20th century, or marijuana, which is now slowly coming back into public life, though ayahuasca and psilocybin are still banned in most parts of the world. Nicotine is a survivor and while cigarettes are on their way out, nicotine will likely continue in non-cigarette forms. And as I wrote and spoke about a few weeks ago, alcohol has no real health upside except for making us feel good about ourselves.  Are there benefits to drinking coffee over and above the increased focus and concentration and the “feel-good” factor? A review article by Dr. Rob van Dam and his colle

The premise of Matka Medicine is that we can control our health, lengthen our healthspan and lifespan, and be atmasvasth, on our own, with just a little help, if at all, from doctors and the healthcare system. The very first article that I published last December explains this in detail. The article on atmasvasth takes this concept forward as does the one on healthspan. The site is structured like a loose book and the Index or Table of Contents can help you navigate the site. I would love to hear from you in the Comments section, but you will need to subscribe with your email ID, which you can do for free. It’s now been almost 8 months since I started Matka Medicine adding the concept of atmasvasth halfway through, as a way to live long, healthy. While I still have a lot of ground to cover, it is time to take stock of what it entails to have a long healthspan and a healthy lifespan. If this concise 13-point guide seems overwhelming…that is what living long, healthy entails. Most of us grow up believing that our health is not ours to manage, but should be left to experts like doctors and the healthcare system, which is fine when you are sick and ill, but of no help when you want to be free from disease.  We know more about our cars than we do about our own bodies and health. That needs to change.  1. Move 150-300 minutes of moderate physical activity per week or 500-1000 mets per week. Walk, run, do strength training and mix it all up along with some high-intensity training (HIIT) at least once a week. 2. Eat smart, eat less Calories should be in check and less than or around 2000 per day. 5 portions of fruits and vegetables per day. Plant based eating as much as possible. Avoid ultra-processed foods and individual superfoods. Some form of fasting or calorie restriction, either time-restricted or intermittent, daily or once or twice a week. 3. Manage cardiovascular risk, including hypertension and diabetes Measure your own risk using calculators at least once a year. One CT calcium score study after the age of 45. The LDL should be less than or equal to 100 mg/dl and less than 70 mg/dl, if there is any risk factor. The blood pressure should be 130/80 mm Hg or less and definitely below 140/90 mm Hg.  The HbA1c should be less than 5.6 with a fasting blood sugar less than 100 mg/dl.  For these 3 points, if the values are abnormal, and if physical activity and eating sensibly do not bring them to normal, medication should be used after consulting an appropriate doctor. ECG yearly for cardiac issues, and definitely after 65 years of age for atrial fibrillation. 4. Sleep well Between 7-9 hours a day. If you snore, or are sleepy or groggy during the day, please see a sleep specialist. 5. Address deficiencies and take supplements Adequate proteins (at least 20% of the daily calorie intake and between 0.5 to 0.8 g / kg body weight) is needed. If your food doesn’t provide this, then supplements should be used. Vitamin D3 supplementation - 60,000 IU sachet at least once a month. Vitamin B12 supplementation, especially for vegans and Jains. Others such as omega-3, based on your individual situation. 6. Take vaccines Protect from Covid-19, flu, zoster, DTP, pneumococcal and varicella. In the future, we will likely have vaccines for tuberculosis, dengue and malaria. They should be taken as and when available. 7. Improve balance, and not fall and not fracture if you fall Physical activity as in point 1. Balancing exercises with yoga or tai-chi, as part of the daily/weekly physical activity routine. 8. Screen for cancers Yearly mammography for all women above the age of 45 years. Lung cancer screening with low dose CT scan if you smoke or have been a smoker, yearly or once in two years, depending on the amount of smoking. Pap smear for cervical cancer every 5 years. Stool for blood for c

The premise of Matka Medicine is that we can control our health, lengthen our healthspan and lifespan, and be atmasvasth, on our own, with just a little help, if at all, from doctors and the healthcare system. The very first article that I published last December explains this in detail. The article on atmasvasth takes this concept forward as does the one on healthspan. The site is structured like a loose book and the Index or Table of Contents can help you navigate the site. A few months ago, a cousin living abroad messaged asking for an Indian diet plan. I told her she doesn’t need one, but she anyway found an Indian site that apparently "reverses" diseases with food (that itself should have been a big red flag) and then sent me an exotic, expensive meal plan that she had been prescribed, full of items like chia, quinoa, kale and other new age, yoga asana-like meme foods. Seriously ! A similar thing happened a month or so ago. Someone who runs a health site asked me to contribute an article. Out of curiosity, I checked out the site and found articles on superfoods like "kale", etc. That was my cue to say sorry. Superfoods are foods that are supposed to miraculously improve your health, but keep changing color depending on the fashion of the day. A few years ago, it was all about quinoa and chia. Then kale. At some point, arugula. Weird kinds of berries including goji berries. Turmeric. Strawberries and blueberries. The names and lists keep changing faster than the conspiracy theories behind the origin of the Covid-19 virus. For example, the India Today list from 2015 is different from the Economic Times list for 2021, those superfoods not making the cut looking like Big Boss losers that no one really misses or remembers after two days. It's not a recent phenomenon. The Roots of Ayurveda, a book by Dominic Wujastyk that traces the history of Ayurveda through the ages describes how garlic became a superfood in the middle of the last millennium and then how the fruit of the poppy plant (opium) became part of virtually every doctor's armamentarium in the 16th to 19th centuries (though once you ingest an opium preparation, every food will anyway look, taste and feel like a superfood). If you like kale, by all means go for it. If turmeric incites your passion, then sure, have it. If chia seeds tickle your fancy and make you happy, go ahead. But that would be for the joy of having that particular food item, not because you believe these are "superfoods”, whose intake will suddenly and magically make you healthier.  Websites and advertisements and articles in the “entertainment” or similar supplements of even serious newspapers keep coming out with these superfood lists depending on the influencer and the writer. All of them follow the same pattern and use a combination of the words below to describe the advantages of these so-called superfoods. Nutrient dense Antioxidant Immune booster Detoxifying (as if our body has toxins that accumulate and need to be purged - this only happens if you can't s**t or piss as a medical condition - toxins don’t build up in normal individuals). Increased energy and vitality (more ReVitals?) Anti-cancer A typical statement describing a superfood will usually sound like this, "the poppy berry (I've just made this up) is an amazing nutrient dense superfood that boosts immunity while flooding the body with antioxidants, removing toxins without adding calories, increasing energy and vitality and preventing cancer". And this problem is not just restricted to nirvana and sinewy body promoting sites.  Even websites like WebMD and Harvard Health, which should really know better, have lists of superfoods…which can then make you question the veracity of the rest of the stuff on those sites.  But the problem is really with us, isn’t it? We all want a magic bullet to bite, that on

“One peg of whiskey a day or one glass of red wine a day is good for the heart”, is a statement we hear quite often, both from the lay press as well as sometimes, doctors.  I like a drink now and then and it is always nice to believe that what we like can also help us live long, healthy.  So when a study [1] by Ding C and colleagues in the BMC Medicine, published last week concluded that drinking up to 7-8 gm of alcohol per day (a glass of wine a day or equivalent) has beneficial effects on all-cause and cardiovascular mortality, with a J-shaped curve, where the highest benefit accrues to those who drink lightly (7-8 gm/day) as compared to those who don’t drink or drink heavily, I decided I must write about this.  I then decided to go through all the recent literature on the benefits of drinking alcohol.  Clearly I was deluding myself.  Here is the current evidence.  The cardioprotective effect, if at all,  is seen mainly in high income countries [2], and not in low and low middle income countries like India, where though the incidence of alcohol consumption as a percentage of the population is lower, the drinking pattens and habits are different and there are likely other environmental or genetic or unknown confounders at work. Perhaps the middle to high income population within India may behave like those in high income countries, but there is no evidence of that. It is possible that there is a genomic influence [3] that links alcohol to improved risk, but is not truly “causal”…this means that a particular genomic pattern may make a person prone to drink and but may be associated with reduced risk, not the other way around.  Daily drinking is associated with increased mortality [4] even if we stick to the apparent low-risk limit of 7-8 gm/day or 100 gm/week. The lowest risk (and there is risk at all levels, which means the absolute “no risk” is when we don’t drink) is when the drinking (one glass of wine or equivalent) is restricted to 2-3 times / week, which is a stance also endorsed by the UK Chief Medical Officers’ Low Risk Drinking Guidelines. Alcohol intake increases risk of injury [5], both accidents and self-harm. Alcohol intake increases risk of cancer [6], especially esophageal, buccal, breast and colon, a statement endorsed strongly by the American Society of Clinical Oncology (ASCO). It also goes onto say that reducing alcohol consumption at a population level would lead to a considerable reduction in the worldwide incidence of cancer. Resveratrol, found in in red wine has been linked with increased longevity in some studies in animals, but drinking red wine for the benefits of resveratrol [7] (which may explain the French paradox) has not shown any mortality or longevity benefit. Perhaps resveratrol supplementation orally may show a benefit in the future, if at all, but this would not be linked to alcohol intake. Alcohol intake, especially in the poor, is associated with other habits such as eating fried food and smoking, which are both in turn deleterious to health. The Global Burden of Disease paper [5] on alcohol use across 196 countries showed no benefit of alcohol consumption at any level. Alcohol is the 7th leading cause of death worldwide across all age groups and the 9th commonest cause of death in India in the 50-69 years age group. It is the third most important reversible cause of cancer. Above the age of 50, cancers are the commonest cause of death and disability due to alcohol, whereas in the younger population, it is injury. In low income countries, associated tuberculosis makes a difference.  So what is your matka here? If you like drinking, you should drink really light, which would mean not more than 2-3 times a week and not more than 1 glass of red wine or equivalent. If you drink more (which I do sometimes as well), then do it without getting drunk an

Persis, a friend, is of Parsi (Zoroastrian) origin, a community in India that has a higher risk of breast cancer than the general population [1]. Her mother had breast cancer and so did one aunt. She got herself tested for BRCA1 and BRCA2 gene mutations that carry a high risk (50-87%) of developing breast as well as ovarian cancer [2]. Ms. Angelina Jolie has a similar family history of breast cancer and BRCA1 and BRCA2 mutations, for which she had a double mastectomy done, followed 2 years later by oophorectomy (removal of the ovaries), to reduce her risk of breast and ovarian cancer. She explained these decisions of hers in a New York Times opinion piece.  Unlike the Mendelian inherited genetic diseases like thalassemia that I wrote about some time ago, where the presence of one copy (dominant) or two copies (recessive) of the abnormal gene, will always cause the disease to occur, in these “genomic” situations, there is a “risk”, which may either be absolute or relative and may in turn manifest with disease or not. It is likely that Persis would never have landed up with breast cancer, but with a greater than 50% absolute risk, she took an informed decision in conjunction with a geneticist and other experts in breast cancer and then opted to have a double mastectomy.  Genomics  therefore, as against “genetics” “is the study not just of single genes but the functions and interactions of all the genes in the genome.” [3] While the promise of genomics has gone through its own crests and troughs, the polygenic risk score (PRS) is creating excitement across multiple branches of medicine. Unlike BRCA1 and BRCA2, which are individual genes (monogenic) that are evaluated to assess risk, in a polygenic risk score, the cumulative risk conferred by mutations in multiple (hence …poly) genes across a person’s genome (hence ...genic) is called the polygenic risk score or PRS [4].  Over the last decade, PRSs have been assessed for many conditions including schizophrenia, coronary artery disease and diabetes [5].  If the score is high, then the premise is that steps could be taken to mitigate the effects of these genetic mutations to reduce risk or hopefully prevent the disease from occurring or like Covid-19 vaccines, reduce the symptoms and severity if the disease does occur.  This postulate also forms the basis of P4 medicine [6]; predictive, preventive, personalized and participatory. There has been considerable excitement about P4 medicine in the fields of engineering, biotechnology, genomic and information technology (IT), given the anticipated promise of genomics to change the way medicine is practiced and to consequently improve overall survival and quality of life, across the globe. Unfortunately, we are not there yet, except in very specific situations like BRCA testing for breast and ovarian cancer, and that too is hardly ever done routinely in India [7].  The ultimate test of the power of a diagnostic study is whether it can change the end-points of either survival or lead to a better quality of life. These studies usually take a long time to come to fruition, something that clearly frustrates engineers and those involved with big data, who believe that it is possible to reduce the time frame of these studies by analyzing large population datasets to get statistical inferences. But statistical and mathematical inferences are no substitutes for on-the-ground, patient and people based clinical data as we have seen with the Covid-19 vaccine trials.  For any PRS to become a routine risk assessment tool, it has to be validated in a trial where the PRS is used to stratify individuals into randomized groups for prevention or treatment as the case may be and the results unequivocally show that basing management decisions on the PRS improves survival or prevents disease. We have a long way to go before

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A man said to the universe:  “Sir, I exist!” “However,” replied the universe,  “The fact has not created in me  A sense of obligation.” A Man Said to the Universe, By Stephen Crane Last month, the 95-years old grand-mother of a friend of mine passed away. When I asked what had happened, they said “she died of old age”. Over the last 5 years she had gradually become more and more frail and then one fine day, she just died. She was one of just 12 lakh (1.2 million) people in India who have lived past the age of 90 years, constituting just 0.1% of India’s population. There are 10 times more people over the age of 80 (i.e. 1% of the population), but with a life-expectancy of just 6.8 years at the age of 80, only 10% of them reach the age of 90. Jain and other similar philosophies accept “old age” as a cause of death…this is not true of many parts of the world where the authorities always ask for a specific cause of death that often does not include “aging”. Intuitively however, we know that aging itself can eventually lead to death, a concept that is now scientifically finding a resurgence across the world with the thinking that if we delay the aging process, we could live longer, healthier lives.  We already know that despite Covid-19, there has been no better time period to live in, when it comes to living long. The average life expectancy at birth has significantly risen in virtually every country of the world, including India. This increased lifespan is mainly because children are not dying early for a variety reasons that I have written about earlier and are explained beautifully in a new book by Steven Johnson called Extra Life. But there is a current upper limit to our lives. Very few people in India make it above 80 and a minuscule number makes it to above 90. There is an exponential death rate after the age of 65, which is why, as we age, we keep seeing people around us dropping off faster and faster.  Moreover, the longer we live, the more is the morbidity associated with chronic diseases that afflicts those of us above the age of 50. We live longer but many of us suffer through that longer life.  What is therefore more important than just the lifespan is the healthspan, which is the time period lived until a major disease, such as stroke, heart attack, cancer, etc occurs, which then usually results in an overall reduction in the lifespan, the remaining lifespan often lived with suffering and disability. Effectively, the longer we live, the more is the chance that we will live with disease and disability.  This is the Faustian bargain we have made by adding years to our lives and by significantly reducing childhood mortality. We live longer, but with disease.  As this diagram shows, in India, our average lifespan is almost 70 years. However, the current healthspan is just 60 years, by which time half of us who have managed to reach the age of 60 will have at least one or more chronic disease with some disability/morbidity.  If however, the healthspan were to go up to 65 years, then two things could happen. First, if the overall lifespan continues to remain at 70 years, then the morbidity and disability due to disease would be compressed into a shorter span of just 5 years. Or, more likely, the overall lifespan would be pushed further up to  80 years, with again 10-15 years of life with disease. The trick would be to increase both healthspan and lifespan, but healthspan relatively more, so that we reduce the number of years with disease to as less as possible, as I have shown at the bottom of the diagram. If we could increase our lifespan to 100 years and healthspan to 95 years, we could compress our years of disease before death to a very short period of time of just 5 odd years. The upper limit of life though continues to remain a quandary. Despite the overall longe

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Srinivas, a 50-years old doctor, had a mild backache that he thought was due to his workouts. When it didn’t settle, he had an X-ray done, which showed a spot in one of the vertebrae, which then turned out to be multiple spots on an MRI. A PET/CT showed a mass in the lungs, that was proven to be cancer. With no risk factors (he was a non-smoker with no exposure to passive smoking and no family history), he suddenly turned out to have metastatic Stage IV lung cancer and after 3 1/2 years of fighting it out, passed away recently. I could go on and on. Your life could be sailing along fine when suddenly, a truck comes from the side at night and bangs into your car and a dear one dies. Or the plane that you are traveling in crashes. Or you fall into a pothole during the monsoons…which actually happened to a colleague of mine. Or a cement brick falls on you from a height. Or you happen to be crossing the Elphinstone Station over-bridge and it collapses (though this is a form of structural violence on those using local trains in Mumbai by those in power who do not believe that their safety is important).  Deepa is a close friend. We were doing our internship at Bhagwati Hospital in Borivali in 1986. She stepped off the footpath to go to the restaurant across the road, when a scooter carrying a large rod at 90 degrees just banged into her and she fell down and hit her head on the curb. She was unconscious for 40 days and suffered from post-traumatic changes and her personality changed overnight. She is today an amazing family physician, loved by her patients, but if the accident hadn’t happened, she may have been a leading light in the field of psychiatry. We will never know! Seema was my neighbor. I had just entered medical college when one day I was told that she had been admitted to Hinduja Hospital for acute liver failure. The next day she was dead. She was my age; we had grown up together and none of this made sense. Apparently, she had taken a paracetamol tablet for a non-specific fever and within 24 hours landed up with that one in million complication and died.  Covid-19 is also an example of this. It came out of nowhere (though some people now believe it’s man-made), swept the world, affected a large number of people and has killed a seven-digit number (3.9 million or 39 lakhs as of writing this) till date, multiple times more than deaths due to any natural disaster or war. While who we are (genetics, genes) and where we live (environment) often determine our “fate”, the examples I have quoted illustrate something completely different. There are some things that are so completely out of our control, that all we can assume is that someone with a perverse sense of humor is pulling our strings, leaving us completely helpless and perhaps even leading us to believe that “what is destined is destined”and that therefore everything is pre-determined, which can then lead us to be fatalistic. Noorjahan was a 56-years old lady who was one day detected to have a breast lump that on biopsy turned out to be a malignant cancer. A PET/CT showed axillary lymph nodal metastases, so she was advised a combination of chemotherapy, surgery and radiotherapy. She refused everything saying, “apne taqdeer main jo likha hai, wahi hoga” (“whatever is my fate, that will happen”).  The cancer kept progressing and she died a painful death when it finally spread to the bones.  “Fatalism” is not the same as “fate”.  Fate is what randomly happens to us, though it can sometimes be traced back to our circumstances. Fatalism assumes that all events are pre-determined and that we humans do not have the power to change them. Many societies and people have fatalistic attitudes; these may be selective, as with pregnancy or conception or diabetes or cancer or may apply to everything they do. And like with Noorjahan, this