Author name: drchetankalal

The Indian government has embarked on a no-holds-barred giloy promotion spree in the last two years, through the AYUSH and health ministries. According to doctors, giloy is forbidden for people who suffer from autoimmune disorders, and can lead to death if it is consumed in sufficiently large quantities. But no government agency has warned that people with autoimmune disorders should avoid giloy – a reckless position exacerbated by uncritical media coverage. New Delhi: The Ministry of AYUSH published a statement on February 16, 2022, on giloy – a plant that features in many Ayurvedic recipes. The ministry, and the Indian government by extension, has widely publicised this herb as an “immunity booster” during the COVID-19 pandemic. “Certain sections of the media have falsely linked … giloy/guduchi with liver damage,” the ministry statement read. “The Ministry of AYUSH reiterates that giloy/guduchi (Tinospora cordifolia) is safe and as per available data, guduchi does not produce any toxic effect.” Curiously, there have been no recent media reports criticising giloy. The most proximate event The Wire Science could find was a list of questions The Wire Science had sent to the Ministry of AYUSH, seeking its response to a study that had criticised the willy-nilly consumption of giloy as an “immunity booster”. Nonetheless, several media outlets reported the statement, many verbatim. Some people consume the herb raw. Others prefer Ayurvedic ‘preparations’ in the form of capsules, powders or juices. Whenever giloy has propped up in a negative context in the past, the AYUSH ministry has been quick to issue a statement defending it. The first such release appeared on July 7, 2021. It was responding to a scientific study published in the Journal of Clinical and Experimental Hepatology on July 2. The study revealed that the mindless consumption of giloy was contributing to liver toxicity, specifically drug-induced liver injury (DILI). The study’s findings were based on detailed case studies of six people who had consumed giloy and developed DILI. According to the study paper: “Tinospora cordifolia (giloy) consumption seems to induce an autoimmune-like hepatitis or unmask an underlying autoimmune chronic liver disease, which may support its immune stimulant mechanism. However, the same mechanism can cause significant liver toxicity, and we recommend that caution be exercised in the use of this herb, especially in those predisposed to autoimmune disorders.” The government’s immediate reaction was to completely dismiss the study. In its statement, the AYUSH ministry said: “The authors of the study have not analysed the contents of the herb that was consumed by the patients… In fact, there are many studies that point out that identifying the herb not correctly could lead to wrong results. A similar looking herb Tinospora crispa might have a negative effect on the liver.” That is, the government wanted to know if the authors knew whether the six people had consumed Tinospora cordifolia or Tinospora crispa. The latter is poisonous. The ministry suggested the researchers consult an expert in botany. It’s a known fact that the two plants are impossible to tell apart with the naked eye. Even Ayurveda experts can’t do so. And both are available in the market, often labelled ‘giloy’. More than six months after the study was published, The Wire Science spoke to Dr Aabha Nagral, one of the study’s authors and a senior hepatologist . She said that of the six patients, four had consumed the raw herb: “Our follow-up research has proved that the four consumed Tinospora cordifolia only,” she said. Dr Nagral also said she and her colleagues will soon be publishing a paper that demonstrates this fact: that the patients in question didn’t consume a known poisonous substance, yet suffered liver toxicity. “The two others had taken giloy as part of a concoction of immunity-boosting products from two popular companies,” she added. “So legally, those companies couldn’t have mixed the poisonous form.” Update, November 14, 2022, 10:24 am: Abha Nagral’s findings, which she had shared with The Wire Science in February 2022, were published by the Journal of Clinical and Experimental Hepatology on November 6. A botanical analysis plus other studies confirmed that all their study subjects who had suffered serious liver injuries had indeed consumed Tinospora cordifolia and not Tinospora crispa. A Hyderabad-based hepatologist also said he has encountered many such patients in the last two years. “Forget about these researchers – do I tell a patient who comes to me with DILI symptoms to bring the herb on the next visit? Even if she does, how am I supposed to distinguish between the two forms?” he asked. He didn’t wish to be named because he feared reprisal by the Ayurveda industry. “We are trolled on social media. We are served legal notices just for speaking our minds. It is too much trauma to take,” according to him. Indeed, it wasn’t just the ministry that went after Dr Nagral and her colleagues. The journal’s editor also received numerous letters from Ayurveda medical colleges and companies manufacturing supposedly Ayurvedic drugs. These included the Patanjali group; the JSS Medical College, Mysore; the State Ayurvedic College, Lucknow; and the All India Institute of Ayurveda, Delhi. They all case doubt on the research paper on various pretexts. The most common argument was “giloy has traditionally proven safe”. The Ayurveda proponents also claimed that a thyroid drug or a fungal infection could have caused the toxicity. The journal published all these responses. At the same time, many hepatologists reported to the same journal that they were seeing patients with DILI after they had consumed giloy. Also read: Face It: The Indian Government Is Peddling Pseudoscience Sandeep Kumar, 32, is a resident of Simariya village in Ambedkarnagar district, Uttar Pradesh. His family of eight consumed giloy as kaadha during the second wave of India’s COVID-19 outbreak. His father, aged 58, took it everyday, first thing in the morning. He was diabetic and had high blood pressure. “We had read in a newspaper that giloy was good at preventing coronavirus infections,” Kumar told The Wire Science. “Our neighbours also took it.” Two months later, his father developed jaundice and was admitted to King George’s Medical University (KGMU), Lucknow, and soon after died there. Doctors told Kumar that his father died due to excessive consumption

Itching without any sign of rash or allergy is one of the early symptoms of a liver disorder A constant and prolonged itch without any visible rash on the skin may not always be just an allergic reaction. It could be an indicator of an underlying liver condition such as hepatic cholestasis (caused by reduced secretion of bile juice). Itching, one of the primary symptoms of liver complications, could start on the palm or soles of the feet and then slowly spread to the rest of the body. Link between itching and liver health Dr Chetan Kalal, program director, transplant medicine, Nanavati Max Super Speciality Hospital, Mumbai, says the medical term for itching is pruritis and it is caused by an excess build-up of bile salts in the skin. This occurs when the liver is unable to clear toxins and excess salts from the body. “Itching (pruritus) can occur in the early stages of liver conditions like primary biliary cholangitis [in which the bile ducts are slowly destroyed], primary sclerosing cholangitis [bile ducts become inflamed, scarred and get blocked] and even in intrahepatic cholestasis of pregnancy [a liver complication that develops during pregnancy],” says Dr Sudeep Khanna, senior consultant, gastroenterologist, Indraprastha Apollo Hospitals, New Delhi. People with already existing liver conditions may also experience an incessant itching and require treatment. Another reason for itching could be obstructive jaundice, in which the bile duct gets blocked and bile is unable to flow from the liver to the small intestines. Science behind the itching signs According to a research article published in the August 2015 edition of Clinical Medical Journal, the disruption in the expulsion of bile from the liver triggers the release of pruritogens (that cause itching). These pruritogens accumulate in the blood plasma and other tissues that stimulate neural itch fibres in the skin. These neural fibres then transmit the stimulus to the spinal cord. The stimulus is decoded by the brain and makes people reach out and scratch the spot where they feel the itch. Dr Kalal says the pathological mechanism for itching is not fully understood. “Usually, this itching is caused due to changes in the nerve signal pattern due to the underlying liver disease, altered immune response and high levels of enzymes like alkaline phosphatase (ALP) and lysophosphatidic acid (LPA),” he says. Excess of ALP and LPA indicates impaired liver function. Symptoms of liver-related pruritus Unlike other skin conditions, itching related to liver disease is different, says Dr Kalal. He adds that other skin-related conditions with itching usually present themselves with rashes or skin lesions, but in the case of itching triggered by liver damage there will not be any external marks. According to Dr Khanna, cholestatic pruritus can affect the day-to-day life of people with the condition. “Most people with pruritus experience this incessant itch at night, which also affects and disturbs their sleep,” he says. Pruritus and liver conditions Primary biliary cirrhosis: This chronic inflammation in the liver can cause bile duct damage and irreversible scarring of liver tissue (cirrhosis) which may progress into liver failure. Primary sclerosing cholangitis: This is a chronic liver disease in which the bile ducts of the liver become inflamed and scarred and get narrowed or blocked. “When this happens, bile builds up in the liver and causes further liver damage,” says Dr Kalal. Intrahepatic cholestasis of pregnancy: Many hormonal changes take place in the female body during pregnancy. Sometimes high estrogen and progesterone levels can cause salts in the bile to build up and enter the bloodstream. “This can cause severe bouts of itching,” says Dr Kalal. Benign recurrent intrahepatic cholestasis is a condition in which different episodes of liver dysfunction occur and the liver is unable to produce bile. “These episodes can happen of and on, last from weeks to months and are typically seen in young adults and adolescents. [They] usually begin with severe itching.”  Progressive familial intrahepatic cholestasis: Pruritus is also seen in another hereditary disorder called progressive familial intrahepatic cholestasis that causes progressive liver disease. Sometimes viral hepatitis A and hepatitis E can also present with itching when they reach cholestatic state, although it is very rare. Drug-induced liver injury: This is usually triggered as a result of a severe adverse reaction to either natural or synthetic liver medicines and supplements. Treatment “Typically, the treatment involves addressing the underlying liver problem and methods to reduce the build-up of bile salts under the skin,” says Dr Kalal. Though anti-itch medication and antibiotics are given for relief from skin abrasions, liver conditions should be addressed without fail. Sometimes UV light therapy is also given in cases of unmanageable itching. “By exposing the affected area of the skin to light we can convert these insoluble toxic bile salts into more soluble bile salts, and these could be expelled into urine, thereby reducing the itching,” says Dr Kalal. Using topical creams and moisturisers, apart from maintaining good hydration, helps the skin. The affected people are also asked to avoid hot showers. “After a shower the affected person should make it a point to pat the skin dry and not rub it with a towel,” cautions Dr Kalal. Intake of alcohol should be limited or completely avoided. It is most important to go for a liver test and get the diagnosis of the underlying condition. “The improvement of liver function through treatment of underlying liver disease can often alleviate itching symptoms,” says Dr Khanna. Dr Kalal says plasma exchange therapy or plasmapheresis is also used as a rescue therapy which helps remove the bile salts, pruritogens, chemical mediators or other toxins responsible for itching. Takeaways Intense itching (pruritus) sensation without any rash on the skin could be one of the earliest signs of liver trouble, according to experts. This is mainly caused due to the inability of the liver to clear out bile. This causes accumulation of bile salts in the skin, triggering an itching sensation. Hepatologists say that it is essential to get a liver function test done to ascertain whether liver failure is the cause of the

World Hepatitis Day: With the theme ‘Bringing hepatitis care closer to you’ WHO wants to raise awareness and promote global action on viral hepatitis. The aims is to raise awareness about the need to simplify and bring hepatitis care to primary health facilities, community-based venues and locations beyond hospital sites, so that care is closer to communities and people wherever they are. What is Hepatitis Hepatitis is an inflammation of the liver. There are five main types of the hepatitis virus – A, B, C, D and E. Hepatitis B and C lead to chronic disease in hundreds of millions of people globally, and together are the most common cause of liver cirrhosis, liver cancer and viral hepatitis-related deaths. July 28 is celebrated every year as World Hepatitis Day. According to the doctors, this chronic disease of liver can be prevented and cured. Let’s take a look what the doctors have to advise about precautions and treatment of the Hepatitis. Dr Anil Arora, HOD, Gastroenterology, Sir Ganga Ram Hospital “It is advisable to avoid the usage of contaminated water. Boil your water and then drink if you can, maintain personal hygiene, wash your hand, get yourself vaccinated if you haven’t yet. Also, maintain dental, ear, nasal hygiene as Hepatitis is dangerous than Covid.” Dr. Rajesh Upadhayay, Senior Director, Gastroenterology, Max Super Specialty Hospital, Shalimar Bagh His advice is to get vaccines for hepatitis A and hepatitis B. “Choose safe food and water, practice good personal hygiene, avoid alcohol which is the most effective strategy to prevent alcoholic hepatitis,” he advised. According to him the treatment of viral hepatitis depends on the type and stage of the infection. “However, if you have severe hepatitis, you may need to see a doctor. If you are suffering from severe hepatitis, then within a few weeks the symptoms start to subside and the patient can get relief. You can easily reduce this infection by improving diet and lifestyle,” he added. In case of chronic hepatitis, medicines need to be taken and people who have alcoholic hepatitis, they need to stop drinking, added Dr Upadhyay. Dr. Bir Singh Sehrawat Director and HOD Gastroenterology Marengo QRG Hospital, Faridabad  He says Hepatitis is an inflammation of the liver mainly caused by a viral infection. He said fever, jaundice, dark urine, fatigue, nausea or vomiting, abrupt weight loss, loss of appetite and pain in the right upper abdomen are considered the major symptoms for hepatitis. As a precaution Dr Sehrawat advised, “Newborns should be vaccinated for hepatitis B. Avoid street food. Only drink bottled water or RO water. Avoid spicy, junk, oily, and canned food to keep this liver related fatal disease at bay. Try to eat meals in smaller proportions for easy digestion. Opt for bland foods like bananas or rice. Don’t share your toothbrush, needle with others. Have safe Sex. Drink plenty of water to keep yourself hydrated. Quit alcohol or limit its use to keep your liver healthy.” Dr .Chetan R. Kalal , First DM Hepatologist of Maharashtra, Chief Hepatologist and Liver Transplant Physician, Masina Hospital, Mumbai “Hepatitis A and E are primarily caused by consuming contaminated food and water. Hepatitis B, C, and D are typically caused by contact with infected blood and bodily fluids.” In India, viral hepatitis is a major cause of health-care burden and is now regarded as a threat comparable to the “big three” communicable diseases: HIV/AIDS, malaria, and tuberculosis. Dr Alisha Chaubal- Consultant – Hepatology and Liver Transplant at Global Hospital, Parel Mumbai “Apart from viral hepatitis there are other causes of liver disease like alcohol, medicine or toxin induced, fatty liver, autoimmune and genetic diseases. In our country fatty liver disease is on the rise especially in patients with obesity, diabetes, cholesterol, thyroid problems and should not be ignored as it can cause liver damage or cancer. Also one should avoid taking over the counter medications as several herbal and allopathic medicines can cause liver injury.” She added, “Most important is the avoidance of unnecessary medications. Acetaminophen / Paracetamol and medication against vomiting should not be given. These types of hepatitis can be diagnosed by simple blood tests and an abdominal sonography. A non-invasive test called liver elastography or fibroscan can let us know the exact extent of liver damage without resorting to a liver biopsy.” Dr Praveen Jha, MD, DM, Consultant Gastroenterology, Regency Hospital “It is very important for everyone to get tested for hepatitis at least once a year. We sometimes suggest even some healthy people for hepatitis B infection tests because the virus can damage the liver before showing signs and symptoms. We get many such cases in a year in which people have got hepatitis B and now they are being treated for liver damage.”

Liver is one of the most integral organs of the human body. It is because of its functions. The body digests and detoxes through the juices that the liver produces. And if we don’t monitor what we consume, the liver can be severely damaged due to toxins like drugs, alcohol, and unhealthy food. Other diseases or cancer in other organs also affect the liver. Infections in blood if they reach the liver, can cause severe damage. Painkillers and paracetamol are the leading causes of drug-induced liver injury or DILI and they cause liver failure and contraceptive medicines are no less in causing liver damage. Talking to Hindustan Times, Dr. Chetan Ramesh Kalal, Senior Consultant Hepatologist and Liver Transplant Physician at Mumbai’s Masina Hospital, explained about the same suggesting that people who are prone to or suffering from liver diseases should be careful about oral contraceptives as the studies show that oral contraceptives can increase the risk of chronic liver damage and jaundice. Although deaths haven’t been recorded, one should always be cautious and know the side effects of medications such as OCPs (oral contraceptive pill) as they cause liver toxicity and damage it in the long run. OCP can also be a life risk for women, according to Dr. Uday Sanglodkar, Senior Consultant – Hepatology and Liver Transplant who works at Global Hospital, Mumbai. “Contraceptive pills have a direct impact on the liver. Oestrogens and oral contraceptives are both associated with liver-related complications such as intrahepatic cholestasis, sinusoidal dilatation, peliosis hepatis, hepatic adenomas, hepatocellular carcinomas, hepatic vein thrombosis and gallstones,” he was quoted as saying. Dr. Uday added that long term usage of oral contraceptives can increase the risk of liver cancers such as adenomas and haemangiomas. He explained that adenomas are round-shaped tumours that are made up of blood vessels and haemangiomas tumours, also consist of blood vessels. These tumours are normally benign (non-cancerous) but they can develop cancerous on rare occasions. Such carcinogenic factors make OCPs harmful for a woman’s health and physical well-being and should hence be minimised in usage as much as possible. A huge way of doing so is by using protection such as condoms during sexual intercourse rather than having unprotected sex. This would also ensure the reduction of risk of sexually transmitted diseases (STDs) .

Ayurveda’s popularity has arisen since the pandemic; but many still equate ‘natural’ and ‘traditional’ with ‘safe’ and ‘effective’ Sushmita (name changed) has been living with Type 2 diabetes mellitus for the past decade and hyperthyroidism for the past eight years now. To lead a normal life, she consumes Galvus, Gluconorm and Thyroxine for these ailments on a daily basis as prescribed by her physician. She follows a strict diet of only homemade food and barely eats outside. At 55 years of age, she is compelled to follow a watchful, healthy lifestyle. General word-of-mouth introduced her to jamun seed powder, an Ayurvedic treatment which claims to keep blood sugar levels under control. So, she went to a nearby pharmacy in Kolkata, where she lives. But the Ayurvedic practitioner there suggested an even better option — Ayusulin, a ‘herbal’ treatment also meant to control diabetes. She consumed Ayusulin twice a day, morning and evening, for two months alongside her prescribed medication until she began presenting symptoms of jaundice. Her eyes were becoming yellow, she was blacking out in the morning, feeling extreme weakness, dizziness, and losing her appetite. “By the time it was three months since she had been taking Ayuslin, she was completely senseless,” her daughter (who wishes to remain anonymous) told Down To Earth (DTE). Sushmita was taken to AMRI Hospital in Kolkata where the doctor declared her chances of survival are dangerously low. Due to concerns about the quality of treatment, Sushmita was shifted to Apollo Hospital, Chennai. Extensive tests were conducted, the results of which prompted the doctor to ask her daughter whether Sushmita is a drug addict. Bilirubin is a yellowish pigment substance in the bile — a fluid produced by the liver — which forms after red blood cells break down. It is used as an indicator for jaundice. Typically, an adult has a total serum bilirubin level of approximately 1.2 milligrams per decilitre (mg/dL) in the blood. Significant or clinical jaundice is when levels go above 3 mg/dL in the blood. Sushmita’s was hovering around 24-26 mg/dL. “She was eventually diagnosed with acute-on-chronic liver failure. The doctors were adamant she needs a transplant,” her daughter said. She was put under a plasma exchange treatment, costing almost Rs 1.5 lakh per day. Sushmita’s ordeal lasted a total of three months where she was in and out of hospitals, racking up a bill of almost Rs 40 lakh. Using the diagnosis of exclusion and results of their own tests, Sushmita’s doctors argued Ayusulin was killing the liver. But that isn’t exactly news. Among Ayusulin’s many ingredients is a herb called gymnema sylvestre found in central and southern India, tropical Africa and tropical Australia. A December 2010 paper published in The American Journal of the Medical Sciences illustrated a case study where consumption of gymnema sylvestre led to drug-induced liver injury. In conclusion, the paper notes: “This case highlights a major problem related to CAM (complementary and alternative medicine), which is considered by most patients to be safer than conventional drugs because it is based on ‘natural substances,’ resulting in low disclosure among the patients and requires the providers to ask specifically for herbs to be able to recognise potential adverse effects. Furthermore, these products often contain multiple active ingredients in unknown amounts; hence, their labelling and safety are often lacking, and their chemical composition is only partially known.” The assumption that Ayurvedic drugs are safer than modern medicine because they are natural is among its many misconceptions. For the longest time, Sushmita was of the same opinion. Her daughter said people who are not doctors obviously think Ayurveda is natural. They believe the research is honest and that steroids play no role here. Dr Saptarshi Bishnu, a Chennai-based hepatologist (liver expert) and Sushmita’s treating physician, has heard this reasoning from many of his patients. “They often equate natural with non-toxic or non-lethal. They believe if it isn’t effective, at least it won’t cause any harm,” he told DTE. Clearly, that isn’t true. Dr Bishnu treats at least one-two new patients — who have consumed Ayurvedic medicines — of liver injury every week. This trend has only increased since the COVID-19 pandemic which triggered unprecedented interest in ‘immunity boosters’ as a protective measure. ‘Ayurvedic drugs well documented causes for severe liver, kidney injury’ Ayurvedic herbals and supplements are well documented causes for severe liver and kidney injury, sometimes leading to death or organ transplantation. “These are avoidable health burdens because the use of Ayurveda as healthcare is not mainstream and has no validated benefits and not endorsed by any medical clinical societies worldwide,” Dr Abby Philips, a senior consultant at the liver institute in Kerala, told DTE. As per anecdotal evidence, the common diseases that patients look to initiate Ayurveda include prevention and treatment of seasonal viral infections, diabetes, gastrointestinal disorders such as irritable bowel syndrome, thyroid diseases, high blood pressure and management of high cholesterol and as add-on cancer therapies. “Ayurvedic herbals are now the second most common cause for acute liver injury in India and herbal drugs/supplements are the commonest cause of worsening of chronic liver disease in the Asia-Pacific region,” Dr Philips said. Hepatologists across the country encounter cases like Sushmita’s on a regular basis. Dr Chetan Kalal, a Mumbai-based liver specialist, illustrates another incident where a young male in his early twenties turned to Ayurvedic supplements to expedite his weight loss process. After consuming these supplements daily for almost six months, he was diagnosed with intrahepatic cholestasis, a type of jaundice. “Because of the Ayurvedic medicine, his bile duct was clinically narrowed. It took almost three months for him to recover. He was on the brink of needing a liver transplant,” Dr Kalal told DTE. He believes people don’t consider Ayurveda as a threat and are very reluctant to accept facts. “Medicine should be evidence-based, not word-of-mouth,” he added. With the rise of Ayurveda since the pandemic and its public perception of equating ‘natural’ and ‘traditional’ with ‘safe’ and ‘effective’, many like Dr Kalal have made a list of traditional treatments and

Food tech platforms Zomato and Swiggy typically clock over 1.5 million orders a day in India. Only the medical fraternity can decode the adverse effects of this frenetic pace of ordering food online in the country. Easy access to out-of-the-box food, lack of exercise and sedentary living are leading to an increasing number of young adults and children developing ‘non-alcoholic fatty liver.’ According to Delhi-based Radiologist Dr Dilraj Gandhi, he sees at least three new patients having ‘non-alcoholic fatty liver’ every day. And all of them are young adults. Doctors unanimously place the blame on their lifestyles. Most of them come with non-specific symptoms like nausea, vomiting, loss of appetite and weakness. “A rise in the cases has been observed post the Covid-19 pandemic. The reason has been our sedentary lifestyle. At the time of recording the history of patients, a singular trait we notice is a heavy dependence on junk food with no exercise,” Dr Harshad Joshi, gastroenterologist and inflammatory bowel disease specialist at Mumbai’s Masina Hospital, who recently treated a 22-year-old from Byculla, for non-alcoholic fatty liver was quoted as saying by Hindustan Times. Non-alcoholic fatty liver disease (NAFLD) is a highly prevalent liver disease that affects 34 per cent of children with obesity, according to a study published on pubmed.gov. Medical News Today stated that NAFLD is the most common liver disease among children in the United States, and the number seems to be rising worldwide. Besides liver-related morbidity, NAFLD also increases the risk of cardiometabolic diseases in adulthood. “Fatty liver disease occurs when there’s too much fat accumulates in the liver,” Dr Shailesh Sable, consultant, liver transplant and HPB surgeon, Apollo Hospitals, Navi Mumbai, told IndianExpress.comHe further added: “Fat triggers inflammation (leading to injury of liver or hepatocytes) and results into healing by fibrosis (scarring) and ultimately end-stage liver disease called cirrhosis.” Dr Shankar Zanwar, gastroenterologist, Wockhardt Hospital-Mumbai Central, told HT that most of fatty liver cases are being picked up in health check-ups. “At present, 20 per cent of the health check-ups throw up instances of fatty liver and since liver ailments have silent symptoms, some severe cases progress to advance liver disease as cirrhosis,” he said. He underlined that maintaining a healthy body weight and exercising regularly are the best ways to keep the liver fit. “Weight loss is the only treatment. By losing three to five per cent weight, you lose fat. Five to seven per cent weight loss leads to reduction in inflammation while with more than ten per cent weight loss,” Dr Chetan Kalal, programme director of hepatology and transplant medicine, Nanavati Max Super Speciality Hospital was quoted as saying by HT. Since NAFLD is a lifestyle disease,  there are no pills to cure it. Doctors advise avoiding sugary beverages, including juices and glucose drinks, and a balanced diet, which basically means home-cooked added with physical activity.