D-dimer: The basics

D-dimer, a fibrin degradation product is a small protein fragment present in the blood after a blood clot is degraded by fibrinolysis. This protein is termed as D-dimer because it contains two D fragments of the fibrin protein joined by a cross-link.

Blood clotting is a crucial process that prevents excessive blood loss in case of an injury. Your body physiologically dissolves the clot once your injury has healed. However, in case of a blood clotting disorder, clots can form even when you do not have an injury, or they do not dissolve after healing of an injury. These conditions can be very serious and life-threatening and a D-dimer test can assess if you are suffering from one of these conditions. The D-dimer test has become highly important in COVID-19 pandemic as its elevated levels have been associated with disease severity and mortality trends. If you have been diagnosed or recovering from COVID and worried about how COVID impacted your health parameters, a D-dimer test can give valuable insights into it.  

How is D-dimer produced?

When you get a cut, your body undergoes a sequence of steps to make your blood clump up. It is considered as a normal part of healing, as without a clot, you would keep bleeding and have much more blood loss. However, once the bleeding stops, you do not need the clot any longer as your blood flow gets hampered because of clotting. Thus, your body takes a series of steps in a different direction and breaks the clot down.

At the completion of all processes, D-dimer is the leftover product floating around in your blood and is detectable for up to eight hours after formation until the time the kidney clears it out. Thus, a dimer, a single fibrinogen molecule, is considered as one of the important proteins produced by the liver involved in the process of coagulation. In normal conditions, the levels of D-dimer are low whereas high levels of D-dimer in your blood indicates presence of a major clot.

Several studies suggest that levels of D-dimer may rise sharply in the case of COVID-19 and is associated with the severity of the disease. 

What is the D-dimer test used for?

The test is also known as fragment D-dimer test or fibrin degradation fragment test.

D-dimer test is commonly used to assess a blood clotting disorder including:

  • Deep vein thrombosis (DVT) : a blood clot situated deep inside a vein. Although these clots normally affect the lower legs, they can also occur in other parts of the body.
  • Pulmonary embolism (PE) : defined as a blockage in an artery in the lungs. The most common cause of PE is loosening and travelling of a blood clot from another part of the body to the lungs.
  • Disseminated intravascular coagulation (DIC) : a condition characterized with the formation of several blood clots that further results in organ damage and other serious complications. The most common causes of DIC are traumatic injuries, infections or cancer.
  • Stroke : the blockage in the blood supply to the brain due to a clot in the arterial system of the brain vasculature.

How is the D-dimer test performed?

There is no special instruction for you to follow before undergoing this test. Your health care professional will take a blood sample from a vein in your arm, using a small needle. After the insertion of a needle, a small amount of blood will be collected into a vial. You will feel a little pinch or sting when the needle goes in or out of the skin.

What do the results normally mean?

Different labs may do the test differently, so the normal values of the test may differ. Your doctor can help you understand more clearly what your results mean.
● If the level of D-dimer is within normal limits, it means you probably don’t have a clotting disorder.
● If your levels of D-dimer are higher than normal value, you may have a clotting disorder such as PE, DVT, etc.
However, it cannot assess where the clot is located or what type of clotting disorder you have.

What does an elevated D-dimer in COVID-19 patients mean?

COVID-19 primarily causes lower respiratory tract infection presenting as cough, fever, dyspnea, and lethargy. However, few cases of the infection can progress into its severe forms like multi-organ failure, DIC, etc. Therefore, it is crucial to discriminate appropriately among infected patients, who are at higher risk of severe infection to treat them early for better prognosis. Raising D-dimer values can help identify people who can be at higher risk of COVID-19 complications.

Although the D-dimer test can rule out venous thromboembolism (VTE) in COVID-19 patients, an increased level of D-dimer does not necessarily mean that a patient has VTE. Due to low specificity of D-dimer test, it can be found in several other conditions, such as malignancy, trauma, liver disease, heart disease, sepsis, CPR or recent surgery. Therefore, take help of your doctor to decide your condition in the clinical context. Do not self-medicate or self-diagnose.

Caring at home for COVID? Keep a track of your health with the COVID monitoring package.

When and how often should D-dimer be measured?

There is no strict guideline as to how frequently D-dimer levels should be tested for management and/or monitoring of COVID-19 patients. Follow your doctor’s advice regarding health tests.

What is the outcome of increased D-dimer in a patient with COVID-19?

Various data suggests that D-dimer greater than 1 μg/ml is strongly associated with in-hospital death of COVID-19 patients.1
Similar findings are evident from other research that showed elevated D-dimer at admission and significantly, increasing D-dimer levels (3- to 4-fold over lab reference range) over time are related to poor outcomes such as increased clots, organ failure, etc.

In a nutshell


A higher level of D dimer in the body is indicative of presence of clot in the body which is regarded as a dangerous sign in patients with COVID-19. D-dimer in combination with other markers can also assist during the treatment of these patients, as the higher their D-dimer is, higher is the number of clots in the lung and the higher the chances of respiratory failure. Thus, D-Dimer test can be used to indirectly measure the severity of COVID-19 disease and assess its complications at an early stage.

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Hi there, how confident are you of your health numbers?

According to most surveys done across the globe, men are less likely to visit doctors as compared to women. In fact, they prefer clinic visits only when they are seriously ill or nagged by a loved one. In a study done in the US, nearly 60 percent of men don’t regularly see a doctor. In another survey conducted overseas, nearly half of the 500 men surveyed said their health is something they don’t talk about. Indian men are no different!

To all the men reading this, make sure to prioritize your health as you do for your family. And for all their loved ones, feel free to nag men in your life to get regular health checkups done and consult a doctor for any discomfort bothering them.

Not sure which health checkups are important to check men’s health, we got you covered.

1. Cholesterol Levels:

According to the American Heart Association, all adults over the age of 35 should get their cholesterol checked every 5 years. You might need to begin screening as early as 20 years of age if you have certain risk factors such as diabetes, smoking, a body mass index (BMI) over 30, family history of stroke, or first-degree relatives who have had deranged cholesterol levels.

You can get your cholesterol levels measured with a simple blood test . It typically looks for three parameters- good cholesterol, bad cholesterol, and triglycerides.

Here is what good and bad cholesterol actually mean.

High levels of bad cholesterol and triglycerides are linked with heart disease, diabetes, and stroke. In general, a total cholesterol level of 125-200 mg/dL is considered normal.

2. Blood Pressure Readings

Blood pressure (BP) is the pressure exerted by your blood on the walls of blood vessels. A high BP puts you at risk of various health conditions like heart disease, kidney disease, and stroke. It is very easy to check your BP numbers at home with the help of a BP monitor. The readings give two numbers: the first is the pressure in your arteries when your heart beats and second is the pressure between beats. The BP values are 120/80 mm Hg or less, it is within the normal range. If your BP is higher, consult your doctor and he/she might want to check it more frequently. A single high reading does not mean your BP is high. Usually, the diagnosis of high BP needs two readings taken 4 hours apart of higher than 120/80 mmHg.

3. Diabetes

Do you know men are at a high risk of getting diabetes as compared to women? The risk of getting diabetes increases as you age. As per guidelines, if you are over age 44, you should be screened every 3 years.

Other risk factors for developing high blood sugar levels include:

  • Having a family history of diabetes
  • Having a BMI over 25. It means that you are overweight. If you are overweight, your doctor can ask to start diabetes screening at a younger age.
  • Having a BP number above 130/80 mmHg
  • Ensure to test your blood sugar level for diabetes regularly. Book an HbA1c test here.

4. Eye Examination

Your eyes are precious! But how often do you really get bothered to consult an eye specialist? Get your eyes examined every 2 to 4 years if your age is between 40 and 54, and every 1 to 3 years for ages 55 to 64. Having an eye examination becomes all the more important every year if you have diabetes.

A quick tip for all those who are glued to their laptops or cellphones 24×7: Make sure to blink your eyes every 20-30 seconds. This lubricates eyes naturally and prevents eye pain and discomfort.  

5. Prostate Cancer

It is one of the top ten leading cancers in India. Men over 65 are more likely to develop this. Furthermore, having a family history of prostate cancer increases your risk of getting this condition. It is a slow-growing cancer, but some types are more aggressive. Screening tests may help in early diagnosis and finding the right support well within time. Health tests for prostate cancer include a digital rectal exam (DRE) and a prostate specific antigen (PSA) blood test. Ask your doctor about your risks and how often you should get PSA testing.

The Final word

If there is a single learning from the pandemic times you need to internalize- let it be keeping your health above everything else! It is high time that you understand the significance of regular health tests. Having your vital health parameters within normal range can not only help you prolong your life expectancy but also amplify the joy of living.

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If you have just recovered from COVID-19, it will be unwise to let your guard down as an ever-increasing number of patients are continuing to experience symptoms after their initial recovery from the disease. COVID-19, caused by SARS-CoV-2, is relatively a new disease, with fresh data being collected on a dynamic basis about the course of the disease, especially in terms of patients being declared “cured”.

Evidence demonstrates that most individuals after COVID infection do gain sufficient antibodies which can prevent their chances of reinfection. However, it is still inconclusive as to how long this immunity lasts. Various cases have been reported where patients have been re-infected. Hence, post-COVID care becomes more important, especially to those who belong to a high-risk category or are not able to take enough preventive measures to additionally protect their immune system. Guidelines recommending adequate preventive measures such as wearing a face mask, washing hands regularly and practicing social distancing should be strictly followed by such patients who have even recovered from the infection.

When is a COVID-19 patient considered “cured” and can resume his normal life?

According to CDC, adults with mild to moderate COVID-19 remain infectious no longer than 10 days after symptom onset. Most adults with more severe to critical illness or severe immunocompromised likely remain infectious no longer than 20 days after symptom onset.

A patient can resume his routine activities while maintaining COVID-appropriate behaviour on the basis of the extent of damage of lungs and other tissues. The recovery period is likely to be longer for patients who suffered from more severe forms of the disease and those with pre-existing illnesses.

What are the complications experienced by a post-COVID patient?

Recovered patients after acute COVID-19 illness may continue to experience various signs and symptoms including fatigue, body ache, cough, sore throat, difficulty in breathing, etc. Some of the complications seen in patients include deleterious effects on lungs, kidneys, heart, and manifestation of black fungal infection, known as mucormycosis.

Therefore, a holistic approach is essential for follow up care and well-being of post-COVID recovering patients.

Post-COVID Follow Up Care

Nutritious diet
  • Eating a balanced nutritious diet, rich in immune boosting vitamins and minerals including fruits, vegetables, eggs and safe poultry is of utmost importance to speed up recovery
  • Some patients experience unexplained weight loss or weight gain, hence, weight adequate calories must be provided according to the patient’s nutritional status
  • Intake of protein is recommended to be 1.2-1.3 g/kg per day along with the increase in the supplementation of branched-chain amino acids to 50%, in order to prevent muscle loss and enhance the strength of respiratory muscles.
Keep yourself hydrated
  • Drink plenty of fluids.
  • Recommendations suggest that drinking warm water can be helpful for patients with scratchy throat or dry cough as it improves circulation and reduces nasal congestion
  • Addition of anti-inflammatory agents like honey or herbs like “mulethi” in kadhas and other concoctions can additionally aid in immunity.
Rest, exercise and meditation
  • Your body is still weak and susceptible to infections and complications after COVID-19 infection
  • Taking proper rest and sleep can help your body recover faster
  • Do not overstrain yourself
  • COVID patients are advised to practice breathing exercises to improve respiratory distress and relieve congestion
  • Performing the active cycle of breathing techniques (ACBT) with the help of physiotherapist can help you in clearing sputum from your chest
  • Doctors also recommend patients to not stay in bed all day, and try to sit in a chair for meals and perform activities such as short walks to improve physical strength and function
  • Therapeutic mediums, like yoga and meditation including yoga-asanas, such as pranayama, can improve recovery and help in dealing with stress associated with COVID -19 infection.
  • Advice for patients with respiratory symptoms like pneumonia is to rest for a week or 10 days before resuming exercising while patients suffering from chronic cardiac issues should take a break of 2-3 weeks before restarting their pre-illness exercise regimen.
Avoid indulging in deleterious habits

Avoid smoking and drinking alcohol, as they both are considered as risk factors for COVID infection and are deleterious to the healing efforts of the body.

  • Avoid smoking and drinking alcohol, as they both are considered as risk factors for COVID infection and are deleterious to the healing efforts of the body.
Medications and tests
  • Take regular medications for comorbidities as prescribed by your doctor
  • Patients who had a severe infection or breathing issues are asked to self-monitor their temperature, SPO2 levels, blood pressure and blood sugar at home for the first few weeks after being declared COVID free

  • Various tests suggested for patients recovered from COVID -19 infection are:
  • IgG antibody tests: The IgG antibody tests evaluate antibodies in your blood to ascertain how immune-protected you are.
  • Complete blood count (CBC): CBC tests are performed to assess different types of cells in your blood (RBCs, WBCs, platelets). This test can help your doctor estimate how you have responded to the COVID infection. In addition, the test also acts as a guide about the additional measures that are required for your body post-recovery.

  • Glucose, cholesterol tests: COVID -19 infection is known to cause changes in glucose and blood pressure levels of the patient. It is important to undergo these tests and keep track of blood glucose and cholesterol levels, if you have pre-existing conditions such as type-1 or type-2 diabetes, abnormal cholesterol or are susceptible to cardiac complications.

  • Vitamin D test: Vitamin D is an essential nutrient that helps in your immune function, therefore, its supplementation is vital for faster recovery from COVID infection

  • Chest scans: Majority of patients cured from COVID-19 complain about issues related to lungs. High resolution computed tomography (HRCT) scans are advised to diagnose the severity of disease and the residual level of lung involvement caused due to COVID infection.

  • Cardiac screening: Studies have revealed that COVID-19 infection causes widespread inflammation in the body, which further results in injury of heart muscles, leading to complications such as myocarditis, one of the most common problems reported in COVID patients.

In nutshell, an average COVID-19 patient usually takes 3 weeks to fully recover; however, new studies have focussed our attention towards those individuals who may have experienced severe effects on their kidney, lungs and heart, even long after they recovered. Therefore, it is not only crucial to adhere to guidelines of wearing masks, hand hygiene and practicing social distancing, these patients are also encouraged to consistently follow abovementioned practices to keep themselves healthy.

Taking care of a COVID-positive loved one at home? Check the health of the vital organs with COVID monitoring package

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It’s been a little over a month since the second wave of COVID left many among us gasping for oxygen and running from pillar to post to save our loved ones. While the daily COVID cases in India have seen a decline in the past few days, our fight against the deadly virus is far from over. So, it is important for all of us to follow the COVID precautions including hand hygiene, social distancing, and masking up. And, we have another weapon against the pandemic- COVID-19 vaccine! Now more than ever, vaccination has become the ray of hope to bring us back the normal lives beyond pandemic.

COVID-19 vaccine in India

Starting May 1, everyone above an age of 18 years is eligible to get a COVID shot. As on May 15 2021, 18 crore vaccine doses have been administered in india. Currently, India has approved three COVID-19 vaccines- Covishield, Covaxin, and Sputnik V. All these three vaccines have proven efficacy against coronavirus (scientific name: SARS-CoV2).

How do vaccines work?

Vaccines contain weakened or inactive parts of a pathogen. When introduced in the body, these attenuated/ inactive pathogen remains act as a trigger and get your immune system to produce protective antibodies and T lymphocytes. Your body now recognizes the pathogen, and will be ready to fight back in a high momentum if it has to encounter the virus in future.

In a nutshell, vaccines provide immunity against infections without being naturally infected.  

Speaking of coronavirus specifically, it has two different types of proteins – spike protein (S Protein) and nucleo-capsid protein (N Protein). The S protein is located on the surface of the virus and the N protein is found inside the virus. The coronavirus gains entry into human cells through its Spike Protein and that is why most vaccines against coronaviruses are designed to target the spike protein. Depending on this target, the vaccines produce different types of antibodies in the body. Though Covishield’s technique employs the Spike protein only, and Covaxin has used the whole inactivated virus, both will produce anti-S antibodies (also called anti-SARS-CoV2 spike protein).

Got vaccinated and want to check if you have developed antibodies? Visit here for details.

Is this the same antibody test which tells us about past COVID infection?

So, the first and foremost thing that you must know is despite being a COVID antibody test, it is different from the antibody test that is taken to look for past COVID infection.

How is the anti-SARS-CoV2 Spike protein test different from the usual antibody test?

The COVID antibody test that is used to confirm past infection with Coronavirus is a Qualitative Test, which means it gives you an idea whether antibodies are present or absent. However, Metropolis has recently launched a quantitative antibody test called COVIPROTECT that gives you an exact measurement of the antibody titres available in your body. The antibodies against Spike Protein can be produced either post vaccination or post natural infection of COVID 19. The spike protein antibodies are generally developed after 2 weeks of second dose of vaccination or 4 weeks of exposure to infection.

The use of previously developed COVID antibody tests is limited in knowing the exposure status than to the actual antibody titre. With the advent of COVIPROTECT, it is likely that the qualitative test would become obsolete soon. As of now, Metropolis offers two types of COVID antibody testing:

  1. SARS CoV2 Antibody Quantitative (COVIPROTECT) (MRP: INR 1200 + Home visit charges)
  2. SARS CoV2 Antibody Qualitative (MRP: INR 450 + Home visit charges)

COVIPROTECT Test: Quantitative SARS CoV2 Antibody Test Against Spike Protein

While you plan to be a bit relaxed about certain routine activities after getting your full dose of COVID vaccine, it makes a lot of sense to know whether your body has developed the necessary antibody to fight the coronavirus post vaccination.

This is where the Quantitative antibody test against Spike Protein comes into play. It is better known as COVIPROTECT by Metropolis. This test uses Blood as the sample like a routine blood test.

When should I get my antibody level tested post vaccination?

It is recommended to go for this test after 2 weeks of your second dose of COVID vaccine to get accurate results.

Can antibody tests assess if your COVID-19 vaccine shot was effective?

The Centers for Disease Control and Prevention (CDC) discourages antibody testing for determining immunity after getting the vaccine. It is very likely for a vaccinated person to get a negative result from an antibody test, even if the vaccine was effective and protective. The major cause is different antibody tests kits used in labs detect antibodies to different parts of the virus. While some kits detect antibodies to the Spike protein of the virus, a few others detect antibodies to the Nucleocapsid protein. The point to note is that irrespective of which COVID vaccine you received, it would have produced antibodies to Spike protein (Covaxin due to being whole virus inactivated virus vaccine, produces antibodies to N protein too. But that does not imply that Covaxin would outshine Covishield in protection).

COVIPROTECT test kit identifies antibodies produced against Spike protein of the virus.and hence irrespective of which vaccine you received, it will catch the antibodies post vaccine.  

Vaccines are your best bet

Please note that even after testing negative on an antibody test, fully vaccinated people should not be worried about immunity gained post vaccine. It might happen if your antibodies level are at levels below the test’s threshold for detection. Also, in the months after vaccination, antibody levels may decrease below the detectable level.

Always get your test results interpreted through a healthcare provider for better understanding. For all lab test-related needs, visit Metropolis.

Make sure you get vaccinated. Motivate others to get the vaccine too. Let’s do our bit in helping India win over the pandemic!

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With the second wave of the pandemic sweeping across the nation, many of us continue to be affected by the unpleasant sickness and the after effects. It is quite likely to be anxious with the Social Media University spreading irrational, non-scientific information and nerve-wracking media coverage around COVID-19. However, it is important to note that nearly 80-85% of coronavirus cases have mild disease and can be taken care of under home isolation. Not every COVID positive person requires oxygen support or hospitalization. What you just need to pay attention to is to take extra care of yourself, monitor oxygen levels, be in touch with a doctor, and get COVID-19 monitoring tests done as and when advised.

What are COVID Monitoring Tests?

As per various research and studies, a bunch of laboratory tests including blood parameters, inflammatory markers, coagulation parameters, liver enzymes, etc., gives an insight into the severity of COVID illness and can be used by your doctor as the prognostic indicators.

In simple words, these lab tests provide an overall picture of how COVID-19 has impacted your vital organs and normal body processes, how likely you are to develop moderate or severe disease, or need hospitalization, or have you already started getting better.    
Book a COVID Monitoring Profile and get tested at home.

Who might need COVID Monitoring Tests?

  • People with mild disease in early days of sickness to get the baseline values 
  • People with mild disease who continue to have symptoms beyond day 5-7 and doctor feels that the disease might be progressing
  • People with moderate or severe disease to be started on a treatment regimen
  • COVID suspect or positive people who continue to experience oxygen levels less than 93% 
  • People with severe disease before discharge
  • Any other conditions 

Please note that COVID monitoring tests can be required for both- people under home care or hospitalized. 

What tests are included under COVID Monitoring Profile?

Routine Blood Parameters

Research suggests blood markers like complete blood count (CBC), leukocytes, platelets, eosinophils, neutrophils-lymphocytes ratio (NLR), erythrocyte sedimentation rate (ESR) correlate with disease severity in COVID. For example, COVID positive people are likely to have decreased levels of leukocytes and platelets. Similarly, NLR levels more than 3.5 (along with some other biomarkers explained below) might indicate that the disease is not mild.

Inflammatory markers

COVID-19 can evoke a serious hyperinflammatory response and cytokine storm, a cause of major concern. Hence, it is important to track certain biomarkers that can indicate towards systemic inflammation, chiefly including C-reactive protein (CRP), lactate dehydrogenase (LDH) and Interleukin-6 (IL-6). Of these, CRP seems to be the most important one in guidining therapy as per some experts. In general, a CRP level of less than 26 mg/L is considered a mild disease, levels between 26-100 mg/L indicate moderate COVID and more than 100 mg/L point towards severe COVID disease.

Please note that these markers get increased in case of any acute inflammation. So, it is important to rule out other causes or any secondary infection while taking the test results into account.

Cardiac, kidney, or Liver damage markers

Besides targeting your lungs, COVID-19 can also impact the other vital organs such as heart, liver and kidneys. In some of the study models, cardiac injury is significantly and independently associated with mortality. People with moderate or severe COVID illness have also been seen to have high creatinine and blood urea levels in some studies. It is all the more important to track the heart, liver and kidney related markers for people having comorbidities like heart disease, diabetes, or kidney disease.  

Coagulation parameters

Coagulation parameters include D-dimer, ferritin, prothrombin time, etc. As per research, D-dimer level is a reliable prognostic marker and increased D-dimer levels on admission are linked to patients needing critical care support.

About D-Dimer test

D-dimer is a small piece of protein that is made when a blood clot dissolves in your body ( through a process called fibrinolysis). Blood clotting is an important process. It prevents loss of blood when you are injured. Usually, once the injury is healed, the clot is dissolved by your body. But if someone has a blood clotting disorder, blood clots can form in absence of an obvious injury or they won’t go away. These clots can travel in the blood, block important blood vessels, and even prove life-threatening. A D-dimer test looks for D-Dimer levels in blood and is most often used to find out whether you have a blood clotting disorder. An excess of D-Dimer can indicate towards the activation of coagulation and following fibrinolysis.

COVID-19 is likely to induce clot formation. The presence of comorbidities is a risk factor too. D-dimer is commonly elevated in patients with COVID-19, especially in older people and those with comorbidities. These are high-risk groups that are likely to develop severe COVID-19 disease if infected.

Rule out the possibility of any derangement in these biomarkers with a single Metropolis COVID Monitoring Profile. Book Now. Always get your test results interpreted through a healthcare provider. Stay at home, stay safe. For all lab test-related needs, visit Metropolis.

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Vitamin D, also known as the sunshine vita006Din, is an essential nutrient required for maintaining health and wellness. It is both a nutrient you eat and a hormone your body produces when exposed to sunlight. This fat-soluble vitamin is notably responsible for calcium absorption in the body, thus improving bone mineral density. It also regulates cellular growth and supports the immune and neuromuscular functions in the body. Some studies suggest that vitamin D can help control infections and alleviate inflammation. In addition, there are claims that vitamin D can play a role in protecting you from diseases such as diabetes, heart disease, and even depression.

Are you sure you are getting enough vitamin D in your diet? Check your vitamin D levels with a simple blood test in the comfort of your home.

Since vitamin D is involved in so many bodily functions, you cannot take a deficiency of vitamin D lightly. Lack of vitamin D can cause a plethora of conditions such as rickets, osteoporosis, osteomalacia, brittle bones, a weakened immune system, inflammation, muscle fatigue, and weakness. A lack of vitamin D can even affect your nervous system.

The Recommended Dietary Allowance of vitamin D for all Indian population, in general, is 400 IU (10 mcg) daily.* Some sources mention that for adults over 70, it should be 800 IU (25 mcg). Consult a doctor to help you understand how much vitamin D you need as per your sun exposure. For people who don’t or cannot spend a lot of time outdoors, it can be difficult to get enough vitamin D and doses might be higher. If you have concerns that you are not getting enough vitamin D from direct sunlight, consuming the following vitamin D-rich foods will help increase the overall amount of vitamin D in your body.

Here are 5 food groups that are rich in vitamin D:

1. Egg Yolks

Whole eggs are the healthy and wonderfully nutritious food, which you will ever find! Although most of us avoid eating egg yolks as they have historically gotten a bad rap for raising levels of bad cholesterol in the body. Skipping egg yolks in favor of egg whites will decrease your calorie and fat intake but you will be missing out on some of the protein, key nutrients such as choline, essential for brain development, and several of the minerals in yolks, such as selenium and zinc, which play a role in boosting your immune system. And you will be missing out on vitamin D, too. One large egg has 44 IU which is 6 % of your daily value. Eating up to 3 whole eggs is considered safe for a healthy adult. So, enjoy them in moderation.

2. Fatty Fish

Not only is fish a great option for protein but it is also rich in vitamin D. If you have vitamin D deficiency, it is mostly advised to eat fish on a daily basis. Fishes such as salmon, tuna, sardines, trout, hilsa, swordfish fish, and mackerel being good sources of healthy protein and omega-3 fatty acids, will be a great addition to anyone’s diet looking to get more vitamin D. Include fish in your dinner plate three times per week.

On average, 100 grams serving of salmon provides 988 IU of vitamin D, i.e., 124% of the daily value.

3. Milk and Milk Products

Vegetarians need not worry! Being an excellent source of calcium, milk is also rich in vitamin D. Hence, including a glass of cow milk in your breakfast meal can improve the vitamin D level in your body. It will not only boost your metabolism but also will ensure that you don’t feel worn out throughout the day. Full-fat milk has the maximum vitamin D content in it. Fat-soluble vitamins are lost when the fat is removed from the full-fat milk.

One cup of milk provides about 115–130 IU of vitamin D which is 15–22% a person’s daily requirement. Health experts and nutritionists also suggest that adding milk and milk products like yogurt, cheese, buttermilk, and butter to your daily diet may prevent you from many bone diseases.

4. Mushrooms

Mushrooms, a kind of superfood that packs vitamin punch, are the only good plant source of vitamin D. They are extremely nutritional, contain an array of vitamins and minerals. But not all mushrooms have the same amount of vitamin D, it varies depending on the type and variety of the mushroom. While commercially grown mushrooms are often grown in the dark, they don’t naturally offer a high amount of vitamin D, some are exposed to UV light, providing a larger dose of the vitamin as a result. A serving has 124-1,022 IU of vitamin D per 100 grams, depending on the amount of UV light the mushrooms are exposed to. So, it is always better to pick sundried mushrooms as they have higher vitamin D content.

If you are vegetarian or vegan, specific mushrooms may be an option. These vitamin-loaded mushrooms are really tasty and can be easily incorporated into your diet.

5. Fortified Foods

Natural sources of vitamin D are limited, especially if you are vegan or don’t like fish.

Fortunately, some food products are designed to add nutrients that don’t naturally occur in the product. Manufacturers add vitamin D to many commercially available food products. These foods are then described as being fortified with vitamin D, or other nutrients. Common fortified foods with extra vitamin D and other nutrients include:

  • cow’s milk
  • soy milk
  • almond milk
  • orange juice
  • yogurt
  • various breakfast cereals.

These foods might contain 54-136 IU per serving. But fortified foods can contain added ingredients, like sugar or saturated fats that make the product less healthy. So, it is important to look for products with no added sugar.

Eating plenty of these listed vitamin D-rich foods is a great way to get enough vitamin D. However, depending on a person’s dietary preferences, consuming enough vitamin D may be difficult. Remember to not overconsume as excess vitamin D can cause the body to absorb too much calcium, leading to an increased risk of kidney stones and heart disease.

We still suggest that the easiest way of getting your daily dose of vitamin D is spending time in the sun. Aim for 15-20 minutes of mid-day sun exposure at least twice per week. However, if this is not possible, vitamin D supplements like cod liver oil, maybe a beneficial choice.

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Have you found yourself in situations where the day you need to go out for a meeting or a party, a pimple pops up out of nowhere? It’s completely normal; there is a reason behind calling it common acne because everyone goes through an acne outbreak at some or the other point in life. If the pores on your skin get blocked due to excess oil, dirt, or dead skin cells, it leads to a pimple or zit, but if this repeatedly happens, it may lead to acne. Simply put, acne is a disease while pimple is just a symptom.

What causes acne?

Also known as acne vulgaris, this skin condition shows up in different levels of severity and size. Acne occurs when the sebaceous glands aka the oil glands attached to the hair follicles are stimulated either due to hormonal changes or at puberty. The glands secrete an oily liquid called sebum which keeps your skin lubricated and carries dead skin cells through the follicles. It is a natural substance that aids in skin lubrication, and if produced in excess, the skin cells mature and are disposed to plug the follicular pore. Too much oil produced by the follicles along with the dead skin cells can clump together into a clogged pore that blocks the follicles. These plugs can either be seen as whiteheads if they are covered with a thick layer of skin or as blackheads if exposed to air. The follicles become big giving rise to a bump and if tampered with, the wall of the follicle enlarges and ruptures leading to inflammation. If the inflammation is deep, it is called a cyst, which can be painful and embarrassing. A whitehead is different from a pimple in the way that pimples are small red tender bumps on the skin which have pus in them, while whiteheads are hair follicles that get clogged with sebum or dead skin cells or bacteria, but these are bumps visible usually on the back, neck or shoulders and are less painful than pimples.

Acne and hormonal imbalance

There are several factors that trigger acne, but the common is thought to be a rise in androgen levels, which elevate at the onset of adolescence or due to undying stress levels. An increase in androgen levels causes the oil glands under the skin to grow and produce more sebum. Excessive sebum can cause the breakdown of cellular walls in the pores, causing bacteria to accumulate.

Other possible triggers

  • Greasy cosmetics
  • The pressure exerted unknowingly from helmets, tight collars, straps or suspenders etc
  • Certain medications like lithium, or contain iodides, bromides or other steroids
  • Environmental irritants, such as pollution and high humidity
  • Squeezing or picking at blemishes
  • Chronic stress
  • Foods that are high in refined carbohydrates like bread, desserts made with white flour, rice, soda, and other sweetened beverages

Tests for acne

Acne is either diagnosed by visual check-up or if you want to find out the root cause or the source of these acnes, your doctor can advise hormone test during the menstrual cycle commencement. Some of these hormonal tests are:

Dehydroepiandrosterone sulphate (DHEA-S), a test done to keep a check on the working of the adrenal glands. –Sex hormone-binding globulin (SHBG), SHBG is a protein that is produced by the Liver. If the SHBG levels are low in a woman’s body, it might result in side effects such as acne and hirsutism. In order to increase the SHBG levels, one must regularly do aerobics or exercise and curtail their calorie intake.

According to the research findings, low SHBG and raised DHEA-S are the hormone changes most often seen in cases of severe acne.

Lipid profile test has now become a routine test to measure the level of certain lipids in the blood. It is widely used to predict cardiovascular risk by measuring four basic parameters: total cholesterol, LDL cholesterol, HDL cholesterol and triglycerides which are usually carried out in a fasting blood specimen. Plasma HDL cholesterol of acne patients is likely to decrease as the severity of acne condition increases. Acne patients have significant changes in the plasma lipids profile that should be considered in the pathogenesis as well as in the treatment of acne.

Treatment of Acne

If you have severe pain causing acne that refuses to go over some days, it is best to see a dermatologist for a cure. Below are some ways in which acne can be treated:

  • Antibiotics and antibacterial- antibiotics are usually given for a short period of time to reduce inflammation and kill the bacteria responsible for causing pimples.
  • Prescription creams such as retinoic acid or benzoyl peroxide work to lessen oil production and also act as anti-inflammatory treatments for killing the acne-causing bacteria.
  • Women who suffer from hormonal acne might be prescribed spironolactone.
  • Other treatments include chemical peel, photodynamic therapy, oral medications, cortisone injections, etc.
  • Certain over-the-counter topical medications such as adapalene, salicylic acid come in the form of gels, lotions, creams, or soaps.

The first step when tackling acne is to analyze how severe the problem is. Most mild cases can be managed with some simple recommendations and over-the-counter products. Serious cases should be handled in the doctor’s office.

Self-caring for your skin

Be gentle with your skin. Pat your face dry with a soft, cool cloth and apply a mild cleanser, once in the morning and once in the evening. Use natural skin care and grooming products to avoid creating acne by inflaming the skin.

• Avoid the temptation to pick, squeeze or pinch at your blemishes, lest they may result in scars or dark blotches.

• Refrain from touching the face frequently

• Take proper care to avoid shaving over acne blemishes or shaving off the tops of pimples. In case of more serious inflammatory acne, or if shaving in itself seems to really irritate your acne, you might want to try using a beard trimmer.

If you have acne, don’t be embarrassed. Staying hydrated, maintaining a well-balanced diet, getting enough sleep and avoiding surfaces with germs like the screen of your phone, door knob, pillowcases or violin chin rests, are ways you can keep acne-causing bacteria at bay. While many people have different notions about acne and pimples reduction, following what the doctor has suggested or general measures like those mentioned above are the safest and the quickest ways to get rid of them and have spotless and clear skin!

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As the heat rises in summer, it becomes difficult for many of us to perform routine work as efficiently as earlier. Are you also someone who feels summer means just sitting in an air-conditioned room, being a couch potato and losing the best of your spirits? Do read this further! We have covered you with the most useful health tips for summer.

A range of health problems

Hot and humid summers usually bring with it a gamut of problems such as heat stroke, exhaustion, dehydration, skin problems like prickling, etc. The more time you spend in heat, the more it can have an effect on your body. But you cannot spend our entire day in an air-conditioned room or sitting in front of a fan. So, what should you do to reduce its health effects? Here you go:

Health Tips for Surviving Summer

The thumb rule: Stay hydrated

You must have noticed that we feel thirstier on the day it is hot. Have you ever wondered why this happens? Because heat makes you sweat. Sweat is basically your body’s response to regulate internal body temperature. However, this makes you lose water and you can feel dehydrated. Also, the more sweaty you get, the more tired you feel. Why do you feel tired due to sweating? Because it depletes the electrolytes from the body and drains your energy.
Staying hydrated is very important during summers as it ensures that the body functions properly. Can you make this hydration process tastier too? Opt for lemonade, watermelon juice, orange juice, etc. In this way you will get plenty of minerals along with fluid in the body.

Follow a light diet

In summer we eat less food because it may reduce hunger. It is crucial to eat regularly because your body needs more nutrients to fight the heat and keep you healthy. But don’t overeat. Try to take a light diet. Include vegetables like cucumber, gourd, pumpkin etc. in your diet. Try to avoid consuming too much of heavy, spicy recipes like chicken gravy, eggs and other animal proteins.

Take cold-water bath

The fastest and easiest way to get relief from the heat is to take a bath with cold water. But you cannot do it every little while. Keeping an ice pack on the neck can also be an alternative to reduce the body temperature. Not only this, wiping the face and feet with a wet cloth also gives relief from heat. Do not forget to wash your face and feet with cold water before sleeping at night. This will make you feel better and be ready to fight the heat for a few hours.

Wear light, cotton clothes

Try to avoid tight clothing in summers so that air can circulate throughout the body. Go for cotton clothes mostly as they absorb sweat and keep you cool. Absolutely hide synthetic clothes in the wardrobe in summer. Also avoid wearing dark coloured clothes. Because dark colors absorb more heat and make you feel uncomfortable.

Avoid exercising too much

First and foremost, note that exercise is a must for a healthy body and mind, and we are a supporter too! But do not overexhaust yourselves. Keep your post workout snacks ready after a good session. Instead of indulging in outdoor activities in the sun, you may shift to an indoor gym.

Maintain ventilation in your homes

Keep your windows open for a while and let the home breathe. On the days when the weather is very hot, drop the curtain so that the harsh rays of the sun do not enter the room. Too many electric bulbs and lights in the room can raise the room temperature to a little extent. Turn off as many lights as you can and only use the ones you need.

Try to stay indoors

The more you stay indoors in summer, the more you will be able to protect yourself from the heat. But staying indoors all the time is also difficult. So, plan your outing keeping the weather in mind. On the day when the weather is about to warm up, postpone your outing for some time. If you like to go for a walk, try to go early in the morning or after the sunset.

For healthy skin, keep cosmetics cool

You can keep your cosmetics like lotions and moisturizers in the refrigerator. You ought to feel refreshed every time you use it. Not just creams, you can also store your lipstick or facial wipes in the fridge. Cooled rose water also gives relief from heat. You can fill it in a spray bottle and keep it in the fridge. Sprinkle it directly on your face or use it in cotton wool to wipe your face. It will give instant relief from the heat.

Get health tests done on a routine basis

Summer can pose risk of several health complications, Food and water borne infections can be easily contracted. Make sure to not miss your routine health checkups. Now book your health tests from the comfort of your home and avail trustworthy Metropolis service.  

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Diabetes is a sneaky disease. While this health condition needs no introduction in the present times, about 1 in 2 people who have diabetes are unaware of their condition!

Diabetes has emerged as a global public health threat. It is estimated that three-quarters of the world’s 300 million adults with diabetes will be in non-industrialized countries by the year 2025,  and almost a third in India and China alone. In addition, as per several researchers, Indians are prone to develop diabetes, owing to certain risk factors. How aware are you of the factors that push you closer to diabetes? Let us apprise you of the most important and common factors that increase your chance of getting diabetes. (Also, please note that diabetes in the context of this article refers to type 2 diabetes.

Diabetes doesn’t always give a warning: Timely tests are important

Most people who get diabetes first develop prediabetes also called borderline diabetes. This is a condition when your blood sugar levels are higher than normal but not high enough to be called diabetes. As per a study, the estimated prevalence of prediabetes in India is 14%. Contrary to the popular belief that diabetes can be easily diagnosed with the symptoms, prediabetes can be asymptomatic unless it is turned into a full-blown diabetes case. The symptoms of diabetes might develop gradually, and can be missed very often. That is why getting yourself tested for high blood sugar levels is extremely important. While a fasting blood sugar level below 100 mg/dL is considered normal, a level from 100 to 125 mg/dL is considered prediabetes. You can also get an HbA1c test done. That shows the average blood sugar levels for the last 2-3 months. An HbA1c level between 4-5.6% is considered healthy and 5.7- 6.4% denotes prediabetes, level 6.5% or higher indicates diabetes. Remember, prediabetes is completely reversible without medicines if you get diagnosed on time and adopt lifestyle changes.

Major risk factors of diabetes include:

Family history: Your risk increases if your parent or sibling has diabetes. Your lifetime risk for getting (type 2) diabetes goes up to about 70% if both parents have it. If one parent is affected, there is around a 40% chance for individuals to develop diabetes.

Excessive body fat: Your body cells take up glucose or sugar and utilize it for various functions. The uptake of sugar by the body cells is regulated by a hormone called insulin. But, if you have more free fatty acids in your cells, they get resistant to insulin and the sugar uptake is reduced. This results in excessive sugar in your blood. Insulin resistance is the main cause of diabetes that affects about 9% of people globally.

Lack of physical activity: The less active you are, the greater your risk to get diabetes. Physical activity helps you control your weight, increases glucose uptake by the body cells for energy, and makes cells more sensitive to insulin.

Age: Even in the absence of other risk factors, the risk of developing diabetes increases with the advancing age. A matter of grave concern is more younger adults are facing the brunt of this chronic disease due to unhealthy lifestyle practices. Cases have seen a rise in children as well owing to an increase in childhood obesity.


Gestational diabetes:  This is a condition in which otherwise healthy women are affected with high blood sugar levels during pregnancy. For women who develop gestational diabetes, the risk of developing prediabetes and (type 2) diabetes increases.

Polycystic ovary syndrome (PCOS): This must have a ring a bell. Actually, PCOS has emerged as a major health problem for women in recent times. This is a condition that affects a woman’s hormone levels and causes a range of problems including weight gain, unwanted body hair, acne, infertility, irregular periods, etc. Since PCOS causes deranged hormone levels, it is important to check hormonal parameters including testosterone, sex hormone-binding globulin (SHBG), and anti-mullerian hormone (AMH). Your doctor will correlate the results with the symptoms to arrive at a diagnosis. The underlying cause why PCOS can put you at risk of diabetes is assumed to be insulin resistance of body cells. If glucose is not being used by the body cells, it results in high blood sugar levels. 

High blood pressure. Diabetes and high blood pressure are closely related. Having high blood pressure over 140/90 mmHg is linked to an increased risk of diabetes.

Unhealthy cholesterol levels: Having low levels of good cholesterol (high-density lipoprotein) or high levels of bad cholesterol (low-density lipoprotein) results in high free fatty acids in body cells. This increases the risk of developing diabetes. Triglycerides are another type of fat carried in the blood. People with high levels of triglycerides have an increased chance of diabetes. A lipid profile test lets you know what your cholesterol and triglyceride levels are.

Keep in mind:

While certain risk factors like age and family history are beyond your control, lifestyle factors such as obesity and exercise can be managed with a bit of health awareness and some sincere efforts. Take charge of your health with regular health tests and stay one step ahead of chronic conditions like diabetes.   

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The thyroid gland is a vital organ that controls the metabolism, growth, and development of your body. It is butterfly-shaped and located on the front of your neck, at the base just below Adam’s apple. This gland produces two hormones, triiodothyronine (T3) and thyroxine (T4), through which it regulates various body functions. A matter of grave concern is that the statistics are showing a steady rise in thyroid diseases in the Indian population. At large, thyroid diseases include hypothyroidism (underactive thyroid), hyperthyroidism (overactive thyroid), goiter, thyroid cancer, and thyroid nodules. According to an epidemiological study on thyroid disease*, it has been estimated that about 42 million people in India suffer from thyroid diseases, and hypothyroidism happens to be the most common thyroid disease.
 
Even though thyroid disorders are common, people have many misconceptions about them. Here we are debunking 5 top myths about thyroid conditions:

Myth #1: Thyroid disease gives you obvious symptoms, hence is easy to get diagnosed.

Fact: You may have thyroid disease but not have any symptoms. In fact, the symptoms can be subtle and get easily overlooked. In addition, symptoms of thyroid disease include weight gain or loss, fatigue, and diarrhea or constipation, irregular periods, etc., which are quite common and could occur due to other health issues too. Due to the subtlety and overlap, it can be tricky to diagnose thyroid disease. Your best bet to keep track of your thyroid health and hormone levels is a thyroid panel test. It is a simple blood test that can identify thyroid problems before symptoms occur. Do not wait for symptoms to get a test done, especially if you have a family history of thyroid conditions.

Myth #2: Low thyroid hormone levels (hypothyroidism) affect women only.

Fact: While it is true that far more women develop under-active thyroid than men, it is not uncommon for men to be diagnosed with hypothyroidism. If you are a man with a family history of hypothyroidism, do not ignore the possibility of developing the condition. If you’re healthy, both men and women should get their thyroid function tests done every five years. However, you may need to get tested more often depending on the presence of risk factors (like being female, having age over 60 years, family history, having an autoimmune disease). If you have been diagnosed with hypothyroidism, get tested once every two to three months for the first year till the hormone levels stabilize and treatment is optimized. After this, an annual check will suffice unless you develop new symptoms or experience reappearance of any old symptom.

Myth #3: You can stop your thyroid medicines when the symptoms get better.

Fact: Not at all! Your symptoms have got better because your medicines are helping you. Stick to your prescription and do not stop having medicines unless advised by your doctor. Stopping your medicines can cause your symptoms to return. Remember, thyroid medicine works best when taken on an empty stomach, spaced an hour before the meal.

Myth #4: People with a thyroid disorder should not eat cruciferous vegetables like broccoli, cabbage, cauliflower, etc.

Fact: The claim that cruciferous vegetables including broccoli, cauliflower, etc. can worsen thyroid conditions has arisen from the thought that these veggies interfere with how your thyroid uses iodine. Iodine is important for hormone production in the thyroid gland. But the fact is, practically these are part of balanced nutrition and only an unrealistic excessive intake might cause any interference with iodine. So you can (and should) consume cabbage, cauliflower, and other veggies of the same group, even if you have a thyroid disorder.

Myth #5: Hypothyroidism is always caused due to an underlying autoimmune condition.

Fact: Though the most common cause of hypothyroidism (low thyroid levels) is an autoimmune disease called Hashimoto’s thyroiditis, it isn’t the sole cause. Other factors like genetics, problems with the pituitary gland (regulates signal for the production of thyroid hormones), certain medicines can also cause a decline in your thyroid hormone levels. However, it is possible to track if Hashimoto’s thyroiditis is the cause in your case. This is an autoimmune condition, which means the body’s own immune system is attacking the healthy thyroid cells through certain antibodies. These thyroid antibodies can be traced through a simple lab test called a thyroid antibody test. This test looks for various types of thyroid antibodies like thyroid per oxidase antibody (TPO), thyroglobulin antibody (TGAb), thyroid-stimulating hormone receptor antibodies (TSHRAb). It is important to know the cause to get the right treatment and relieve thyroid symptoms.

Hope we have cleared the clouds you had in your mind around thyroid diseases. Do not hesitate to mention any symptoms to your doctor. Ensure to get your hormone levels checked on a regular basis and keep a check on your thyroid health.

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