Cassini, Voyager missions suggest new picture of Sun’s interaction with galaxy


NASA's Cassini, Voyager missions suggest new picture of Sun's interaction with galaxy
New data from NASA’s Cassini, Voyager and Interstellar Boundary Explorer missions show that the heliosphere — the bubble of the sun’s magnetic influence that surrounds the inner solar system — may be much more compact and rounded than previously thought. The image on the left shows a compact model of the heliosphere, supported by this latest data, while the image on the right shows an alternate model with an extended tail. The main difference is the new model’s lack of a trailing, comet-like tail on one side of the heliosphere. This tail is shown in the old model in light blue. 

New data from NASA’s Cassini mission, combined with measurements from the two Voyager spacecraft and NASA’s Interstellar Boundary Explorer, or IBEX, suggests that our sun and planets are surrounded by a giant, rounded system of magnetic field from the sun—calling into question the alternate view of the solar magnetic fields trailing behind the sun in the shape of a long comet tail.

The sun releases a constant outflow of magnetic solar material—called the —that fills the inner solar system, reaching far past the orbit of Neptune. This solar wind creates a bubble, some 23 billion miles across, called the . Our entire solar system, including the heliosphere, moves through interstellar space. The prevalent picture of the heliosphere was one of comet-shaped structure, with a rounded head and an extended . But  covering an entire 11-year solar activity cycle show that may not be the case: the heliosphere may be rounded on both ends, making its shape almost spherical. A paper on these results was published in Nature Astronomy on April 24, 2017.

“Instead of a prolonged, comet-like tail, this rough bubble-shape of the heliosphere is due to the strong —much stronger than what was anticipated in the past—combined with the fact that the ratio between particle pressure and magnetic pressure inside the heliosheath is high,” said Kostas Dialynas, a space scientist at the Academy of Athens in Greece and lead author on the study.

An instrument on Cassini, which has been exploring the Saturn system over a decade, has given scientists crucial new clues about the shape of the heliosphere’s trailing end, often called the heliotail. When charged  from the inner solar system reach the boundary of the heliosphere, they sometimes undergo a series of charge exchanges with neutral gas atoms from the interstellar medium, dropping and regaining electrons as they travel through this vast boundary region. Some of these particles are pinged back in toward the inner solar system as fast-moving , which can be measured by Cassini.

NASA's Cassini, Voyager missions suggest new picture of Sun's interaction with galaxy
Many other stars show tails that trail behind them like a comet’s tail, supporting the idea that our solar system has one too. However, new evidence from NASA’s Cassini, Voyager and Interstellar Boundary Explorer missions suggest that the trailing end of our solar system may not be stretched out in a long tail. From top left and going counter clockwise, the stars shown are LLOrionis, BZ Cam and Mira. 

“The Cassini instrument was designed to image the ions that are trapped in the magnetosphere of Saturn,” said Tom Krimigis, an instrument lead on NASA’s Voyager and Cassini missions based at Johns Hopkins University’s Applied Physics Laboratory in Laurel, Maryland, and an author on the study. “We never thought that we would see what we’re seeing and be able to image the boundaries of the heliosphere.”

 Cassini’s new measurements of these neutral atoms revealed something unexpected—the particles coming from the tail of the heliosphere reflect the changes in the solar cycle almost exactly as fast as those coming from the nose of the heliosphere.

“If the heliosphere’s ‘tail’ is stretched out like a comet, we’d expect that the patterns of the solar cycle would show up much later in the measured neutral atoms,” said Krimigis.

NASA's Cassini, Voyager missions suggest new picture of Sun's interaction with galaxy
New data from NASA’s Cassini, Voyager and Interstellar Boundary Explorer missions show that the heliosphere — the bubble of the sun’s magnetic influence that surrounds the inner solar system — may be much more compact and rounded than previously thought. This illustration shows a compact model of the heliosphere, supported by this latest data. The main difference between this and previous models is Credit: Dialynas, et al.the new model’s lack of a trailing, comet-like tail on one side of the heliosphere. 

But because patterns from solar activity show just as quickly in tail particles as those from the nose, that implies the tail is about the same distance from us as the nose. This means that long, comet-like tail that scientists envisioned may not exist at all—instead, the heliosphere may be nearly round and symmetrical.

A rounded heliosphere could come from a combination of factors. Data from Voyager 1 show that the interstellar magnetic field beyond the heliosphere is stronger than scientists previously thought, meaning it could interact with the solar wind at the edges of the heliosphere and compact the heliosphere’s tail.

The structure of the heliosphere plays a big role in how particles from interstellar space—called cosmic rays—reach the inner solar system, where Earth and the other planets are.

“This data that Voyager 1 and 2, Cassini and IBEX provide to the scientific community is a windfall for studying the far reaches of the solar wind,” said Arik Posner, Voyager and IBEX program scientist at NASA Headquarters in Washington, D.C., who was not involved with this study. “As we continue to gather data from the edges of the heliosphere, this data will help us better understand the interstellar boundary that helps shield the Earth environment from harmful cosmic rays.”

Malaria drug causes brain damage that mimics PTSD: case study

The case of a service member diagnosed with post-traumatic stress disorder but found instead to have brain damage caused by a malaria drug raises questions about the origin of similar symptoms in other post-9/11 veterans.

According to the case study published online in Drug Safety Case Reports in June, a U.S. military member sought treatment at Walter Reed National Military Medical Center in Bethesda, Maryland, for uncontrolled anger, insomnia, nightmares and memory loss.

The once-active sailor, who ran marathons and deployed in 2009 to East Africa, reported stumbling frequently, arguing with his family and needing significant support from his staff while on the job due to cognitive issues.

Physicians diagnosed the service member with anxiety, PTSD and a thiamine deficiency. But after months of treatment, including medication, behavioral therapy and daily doses of vitamins, little changed.

The patient continued to be hobbled by his symptoms, eventually leaving the military on a medical discharge and questioning his abilities to function or take care of his children.

It wasn’t until physicians took a hard look at his medical history, which included vertigo that began two months after his Africa deployment, that they suspected mefloquine poisoning: The medication once used widely by the U.S. armed forces to prevent and treat malaria has been linked to brain stem lesions and psychiatric symptoms.

While no test is available to prove the sailor suffered what is called “mefloquine toxicity,” he scored high enough on an adverse drug reaction probability survey to tie his symptoms to the drug, also known as Lariam.

The sailor told his Walter Reed doctors that he began experiencing vivid dreams and disequilibrium within two months of starting the required deployment protocol.

Symptoms can last years

Case reports of mefloquine side effects have been published before, but the authors of “Prolonged Neuropsychiatric Symptoms in a Military Service Member Exposed to Mefloquine” say their example is unusual because it shows that symptoms can last years after a person stops taking the drug.

And since the symptoms are so similar to PTSD, the researchers add, they serve to “confound the diagnosis” of either condition.

“It demonstrates the difficulty in distinguishing from possible mefloquine-induced toxicity versus PTSD and raises some questions regarding possible linkages between the two diagnoses,” wrote Army Maj. Jeffrey Livezey, chief of clinical pharmacology at the Walter Reed Army Institute of Research, Silver Spring, Maryland.

Once the U.S. military’s malaria prophylactic of choice, favored for its once-a-week dosage regimen, mefloquine was designated the drug of last resort in 2013 by the Defense Department after the Food and Drug Administration slapped a boxed warning on its label, noting it can cause permanent psychiatric and neurological side effects,

50,000 prescriptions in 2003

At the peak of mefloquine’s use in 2003, nearly 50,000 prescriptions were written by military doctors.

That figure dropped to 216 prescriptions in 2015, according to data provided by the Defense Department. According to DoD policy, mefloquine is prescribed only to personnel who can’t tolerate other preventives.

But Dr. Remington Nevin, a former Army epidemiologist and researcher at the Johns Hopkins Bloomberg School of Public Health in Baltimore, said any distribution of the drug, which was developed by the Army in the late 1970s, is too much.

“This new finding should motivate the U.S. military to consider further revising its mefloquine policy to ban use of the drug altogether,” Nevin told Military Times.

While a case study is a snapshot of one patient’s experience and not an indication that everyone who took or takes mefloquine has similar issues, one randomized study conducted in 2001 — more than a decade after the medication was adopted by the military for malaria prevention — showed that 67 percent of study participants reported more than one adverse side effect, such as nightmares and hallucinations, and 6 percent needed medical treatment after taking the drug.

Yet mefloquine remains on the market while Walter Reed Army Institute of Research conducts research on medications in the same family as mefloquine, including tafenoquine, hoping to find a malarial preventive that is less toxic but as effective.

Mefloquine was developed under the Army’s malaria drug discovery program and approved for use as a malaria prophylactic in 1989. Shortly after commercial production began, stories surfaced about side effects, including hallucinations, delirium and psychoses.

Once considered ‘well-tolerated’

Military researchers maintained, however, that it was a “well-tolerated drug,” with one WRAIR scientist attributing reports of mefloquine-associated psychoses to a “herd mentality.”

“Growing controversies over neurological side effects, though, are appearing in the literature, from journal articles to traveler’s magazines and resulting legal ramifications threaten global availability,” wrote researcher Army Col. Wilbur Milhous in 2001. “As the ‘herd mentality’ of mefloquine associated psychoses continues to gain momentum, it will certainly affect operational compliance and readiness. … The need for a replacement drug for weekly prophylaxis will continue to escalate.”

Mefloquine was implicated in a series of murder-suicides at Fort Bragg, North Carolina, in 2002, and media reports also tied it to an uptick in military suicides in 2003.

A 2004 Veterans Affairs Department memo urged doctors to refrain from prescribing mefloquine, citing individual cases of hallucinations, paranoia, suicidal thoughts, psychoses and more.

The FDA black box warning nine years later led to a sharp decline in demand for the medication. But while the drug is no longer widely used, it has left damage in its wake, with an unknown number of troops and veterans affected, according to retired Navy Cmdr. Bill Manofsky, who was discharged from the military in 2004 for PTSD and later documented to have mefloquine toxicity.

He said the Defense Department and VA should do more to understand the scope of the problem and reach out to those who have been affected.

New concerns rising over antimalaria drug

“I’m kind of the patient zero for this and I now spend my life trying to help other veterans who have health problems that may have been caused by mefloquine. More needs to be done,” Manofsky said.

He said while there is no cure for the vertigo and vestibular damage or the psychiatric symptoms caused by mefloquine, treatments for such symptoms, such as behavior and vestibular therapy help.

And, he added, simply having a diagnosis is comforting.

Veterans can seek help

“Veterans need to come forward,” he said. “The VA’s War Related Illness and Injury Study Center can help.”

The patient in the case study written by Livezey continues to see a behavioral therapist weekly but takes no medications besides vitamins and fish oil.

He sleeps just three to four hours a night, has vivid dreams and nightmares and vertigo that causes him to fall frequently, and continues to report depression, restlessness and a lack of motivation.

The sailor’s experience with mefloquine has been “severely life debilitating” and Livezey notes that the case should alert physicians to the challenges of diagnosing patients with similar symptoms.

“This case documents the potential long-term and varied mefloquine-induced neuropsychiatric side effects,” he wrote.

15 Things You Should Give Up To Be Happy


Here is a list of 15 things which, if you give up on them, will make your life a lot easier and much, much happier. We hold on to so many things that cause us a great deal of pain, stress, and suffering – and instead of letting them all go, instead of allowing ourselves to be stress-free and happy – we cling on to them.

Not anymore.

Starting today we will give up on all those things that no longer serve us, and we will embrace change. Ready? Here we go:

1. Give up your need to always be right

 There are so many of us who can’t stand the idea of being wrong – wanting to always be right – even at the risk of ending great relationships or causing a great deal of stress and pain, for us and for others. It’s just not worth it. Whenever you feel the ‘urgent’ need to jump into a fight over who is right and who is wrong, ask yourself this question: “Would I rather be right, or would I rather be kind?” Wayne Dyer. What difference will that make? Is your ego really that big?

2. Give up your need for control

Be willing to give up your need to always control everything that happens to you and around you – situations, events, people, etc. Whether they are loved ones, coworkers, or just strangers you meet on the street – just allow them to be. Allow everything and everyone to be just as they are and you will see how much better will that make you feel.

“By letting it go it all gets done. The world is won by those who let it go. But when you try and try. The world is beyond winning.” Lao Tzu

3. Give up on blame

 Give up on your need to blame others for what you have or don’t have, for what you feel or don’t feel. Stop giving your powers away and start taking responsibility for your life.

4. Give up your self-defeating self-talk

 Oh, my. How many people are hurting themselves because of their negative, polluted and repetitive self-defeating mindset? Don’t believe everything that your mind is telling you – especially if it’s negative and self-defeating. You are better than that.

“The mind is a superb instrument if used rightly. Used wrongly, however, it becomes very destructive.” Eckhart Tolle

5. Give up your limiting beliefs

Give up your limiting beliefs about what you can or cannot do, about what is possible or impossible. From now on, you are no longer going to allow your limiting beliefs to keep you stuck in the wrong place. Spread your wings and fly!

“A belief is not an idea held by the mind, it is an idea that holds the mind” Elly Roselle

6. Give up complaining

 Give up your constant need to complain about those many, many, many things – people, situations, events that make you unhappy, sad and depressed. Nobody can make you unhappy, no situation can make you sad or miserable unless you allow it to. It’s not the situation that triggers those feelings in you, but how you choose to look at it. Never underestimate the power of positive thinking.

7. Give up the luxury of criticism

Give up your need to criticize things, events or people that are different than you. We are all different, yet we are all the same. We all want to be happy, we all want to love and be loved and we all want to be understood. We all want something, and something is wished by us all.

8. Give up your need to impress others

Stop trying so hard to be something that you’re not just to make others like you. It doesn’t work this way. The moment you stop trying so hard to be something that you’re not, the moment you take off all your masks, the moment you accept and embrace the real you, you will find people will be drawn to you, effortlessly.

9. Give up your resistance to change

Change is good. Change will help you move from A to B. Change will help you make improvements in your life and also the lives of those around you. Follow your bliss, embrace change – don’t resist it.

“Follow your bliss and the universe will open doors for you where there were only walls” 
Joseph Campbell

10. Give up labels

 Stop labeling those things, people or events that you don’t understand as being weird or different and try opening your mind, little by little. Minds only work when open. “The highest form of ignorance is when you reject something you don’t know anything about.” Wayne Dyer

11. Give up on your fears

Fear is just an illusion, it doesn’t exist – you created it. It’s all in your mind. Correct the inside and the outside will fall into place.
“The only thing we have to fear is fear itself.”
 Franklin D. Roosevelt

12. Give up your excuses

Send them packing and tell them they’re fired. You no longer need them. A lot of times we limit ourselves because of the many excuses we use. Instead of growing and working on improving ourselves and our lives, we get stuck, lying to ourselves, using all kind of excuses – excuses that 99.9% of the time are not even real.

13. Give up the past

I know, I know. It’s hard. Especially when the past looks so much better than the present and the future looks so frightening, but you have to take into consideration the fact that the present moment is all you have and all you will ever have. The past you are now longing for – the past that you are now dreaming about – was ignored by you when it was present.

Stop deluding yourself. Be present in everything you do and enjoy life. After all, life is a journey, not a destination. Have a clear vision for the future, prepare yourself, but always be present in the now.

14. Give up attachment

This is a concept that for most of us is so hard to grasp and I have to tell you that it was for me too, (it still is) but it’s not something impossible. You get better and better at with time and practice.

The moment you detach yourself from all things, (and that doesn’t mean you give up your love for them – because love and attachment have nothing to do with one another,  attachment comes from a place of fear, while love… well, real love is pure, kind, and self less, where there is love there can’t be fear, and because of that, attachment and love cannot coexist) you become so peaceful, so tolerant, so kind, and so serene. You will get to a place where you will be able to understand all things without even trying. A state beyond words.

15. Give up living your life to other people’s expectations

Way too many people are living a life that is not theirs to live. They live their lives according to what others think is best for them, they live their lives according to what their parents think is best for them, to what their friends, their enemies and their teachers, their government and the media think are best for them.

They ignore their inner voice, that inner calling. They are so busy with pleasing everybody, with living up to other people’s expectations, that they lose control over their lives. They forget what makes them happy, what they want, what they need….and eventually, they forget about themselves.

You have one life – this one right now – you must live it, own it, and especially don’t let other people’s opinions distract you from your path.

When All Hope Is Gone

“I wanna ask you, “How are you?” What heaviness are you carrying? What tears do you hold back? What pain, what fears, are kept inside?” ~ Nick Vujicic
When all hope is gone; when you feel lost, confused, abandoned and all alone; when darkness seems to swallow you and pain is all you feel, I want you to close your eyes, take a deep breath, and when you’re ready, I want you to watch this beautiful and inspiring video. It will soothe your soul, and it will remind you that are not alone. There is still hope.

“I wanna ask you, “How are you?” What heaviness are you carrying? What tears do you hold back? What pain, what fears, are kept inside?

You don’t have to hold onto these fears if you just take one step at a time. Not to say that one day those fears will completely disappear but, can you forgive those who hurt you? Because that’s where healing starts. Every time someone puts you back will you make a decision to bring somebody else up? Picture yourself in a proper area. There is no buildings, no shelter, and there is a storm above you. This storm represents the situations in your life you don’t tell anybody what you are going through because first of all, they wouldn’t understand, and second of all, they can’t even help you anyway. During this storm you’re down on your knees, and you’re cold, and you’re weak, and you feels like this is the end. Are you not still here?

You are still here. There are some times in life when you fall down. You feel like you don’t have the strength to get back up. But if I fell I try again and again. For as long as I try there is always that chance of getting up. And it’s not the end until you given up. And just the fact that you are here should persuade you that you have another chance to get back. There’s still hope

Watch the video. URL:

There are some times in life when you fall down. You feel like you don’t have the strength to get back up. But if I fell I try again and again. For as long as I try there is always that chance of getting up. And it’s not the end until you given up. And just the fact that you are here should persuade you that you have another chance to get back. There’s still hope.” ~ Nick Vujicic

Camouflaged Dark Matter Galaxy Discovered

Hiding in the blackness of space is an eerie galaxy that is composed of the best cosmic camouflage a galaxy can get: dark matter.

The Andromeda Galaxy Could Be Buzzing With Dark Matte

Roughly 80 percent of the mass of the universe is made up of material that scientists cannot directly observe. Known as dark matter, this bizarre ingredient does not emit light or energy. So why do scientists think it dominates?

Studies of other galaxies in the 1950s first indicated that the universe contained more matter than seen by the naked eye. Support for dark matter has grown, and although no solid direct evidence of dark matter has been detected, there have been strong possibilities in recent years.

The familiar material of the universe, known as baryonic matter, is composed of protons, neutrons and electrons. Dark matter may be made of baryonic or non-baryonic matter. To hold the elements of the universe together, dark matter must make up approximately 80 percent of its matter. [Image Gallery: Dark Matter Across the Universe]

The missing matter could simply be more challenging to detect, made up of regular, baryonic matter. Potential candidates include dim brown dwarfs, white dwarfs and neutrino stars. Supermassive black holes could also be part of the difference. But these hard-to-spot objects would have to play a more dominant role than scientists have observed to make up the missing mass, while other elements suggest that dark matter is more exotic.

These illustrations, taken from computer simulations, show a swarm of dark matter clumps around our Milky Way galaxy. Image released July 10, 2012.
These illustrations, taken from computer simulations, show a swarm of dark matter clumps around our Milky Way galaxy. Image released July 10, 2012.

Most scientists think that dark matter is composed of non-baryonic matter. The lead candidate, WIMPS(weakly interacting massive particles), have ten to a hundred times the mass of a proton, but their weak interactions with “normal” matter make them difficult to detect. Neutralinos, massive hypothetical particles heavier and slower than neutrinos, are the foremost candidate, though they have yet to be spotted. The smaller neutral axion and the uncharched photinos are also potential placeholders for dark matter.

A third possibility exists — that the laws of gravity that have thus far successfully described the motion of objects within the solar system require revision.

Proving the unseen

If scientists can’t see dark matter, how do they know it exists?

Scientists calculate the mass of large objects in space by studying their motion. Astronomers examining spiral galaxies in the 1950s expected to see material in the center moving faster than on the outer edges. Instead, they found the stars in both locations traveled at the same velocity, indicating the galaxies contained more mass than could be seen. Studies of the gas within elliptical galaxies also indicated a need for more mass than found in visible objects. Clusters of galaxies would fly apart if the only mass they contained were visible to conventional astronomical measurements.

Albert Einstein showed that massive objects in the universe bend and distort light, allowing them to be used as lenses. By studying how light is distorted by galaxy clusters, astronomers have been able to create a map of dark matter in the universe.

All of these methods provide a strong indication that the most of the matter in the universe is something yet unseen.

Dark matter versus dark energy

Although dark matter makes up most of the matter of the universe, it only makes up about a quarter of the composition. The universe is dominated by dark energy.

After the Big Bang, the universe began expanding outward. Scientists once thought that it would eventually run out of the energy, slowing down as gravity pulled the objects inside it together. But studies of distant supernovae revealed that the universe today is expanding faster than it was in the past, not slower, indicating that the expansion is accelerating. This would only be possible if the universe contained enough energy to overcome gravity — dark energy.

Scientists locate the protein that will extend your life and figure out how to make it last longer

Lengthening Telomere, a DNA protein, may be a key to extending life to much older than 100 years.

Telomeres are DNA-protein complexes that protect the end of human chromosomes from DNA damage or fusion with neighboring chromosomes.  Nutritionists have long been interested in the dynamics of telomere length in the human body, and how telomeres factor into human health, lengthening life expectancy, and even have pondered the possibility of Immortality.   Research is showing that certain nutrients play a huge part in protecting telomere length, ultimately determining how long you live.

“The best analogy that we have for telomeres is that they’re like the little tabs on the end of shoelaces,” says Dr Adam Rutherford, a geneticist and author of Creation: The Origin of Life.

Just as the tabs, or “aglets”, hold the strands of the laces together, he says, telomeres – repetitive stretches of DNA on the end of each chromosome – perform the same function.

“Chromosomes are made up of a double helix, two strands of DNA, and they need an endpoint,” says Rutherford. “Without telomeres they’d unravel, like two bits of string that have been tied together.”

Studies have shown that certain Vitamins contribute to the length of a Telomere.  Scientists at the European Journal of Nutrition (EJON) found that the B vitamin folate also plays an important part in maintenance of DNA integrity and DNA methylation, which in turn influence telomere length. Researchers have found that women who use vitamin B12 supplements have longer telomeres than those who don’t. Vitamin D3, zinc, iron, omega-3 fatty acids, and vitamins C and E also influence telomere length.

Watch the video discussion. URL:

If Your Guy Does These 14 Things, Congrats! You Found a Real Man

Almost every woman dreams of finding the perfect man who has all the qualities she requires him to have. However, it is not that easy to find one person who has everything that you want and need. Still you should not lose hope, instead start by learning the difference between boys and men.

Try to find a man who will speak his mind, has a sense of humor, who is not ashamed to show his love, and dresses and speaks well.

 These are the qualities that a true gentleman should possess:

1.A true gentleman pays attention to his personal hygiene including trimming nose hairs and cleaning his nails.

 2.This man has a strong character, a career and a personal life and is also sophisticated.

3.A gentleman does not wait for too long to call a woman. He calls her to invite her to dinner; he makes the reservations and has a great time.

4.A true gentleman tells a girl whether he is interested or not. In case he is not he always makes sure that she knows he had a great time with her. He appreciates her time and tells her that he is not interested in the relationship becoming more serious.

5.This man reads lots of books and newspapers; he is well informed and has his own opinion about everything. He knows that not everything he reads or hears is a fact so he values the opinion of someone who disagrees with him. He even enjoys engaging in a good debate.

6.The real man is a true gentleman who shows a woman that he cares about her by opening the door for her or taking her coat.

7.He values the woman so if he wants to have a sexual relation he first seduces her instead of forcing her into doing something she does not want to. He is well aware that he should firs conquer other parts of the woman body.

8.Even though he enjoys knowing that a woman likes him he does not want to be chased, instead he prefers to be the one in charge in courting.

9.He loves an independent woman who is financially stable to pay for her own bills and expenses. This type of woman is the one he wants beside him.

10.He a woman who will love him for his character and personality rather than his financial status.

11.This man prefers a woman who shares the same qualities he has such as having a career hobby, family and close friends.

12.He knows who he is, what he wants and what he does not. He appreciates honesty very much and believes that if he can be honest with himself he can be honest with others too.

13.He is very proud of the woman he is with and is not afraid to show it through the way he looks or acts.

14.A gentleman is a man, not a boy. He wants to find the perfect woman for him not a girl. He tries to find the woman who shares the same qualities with him but also has something to teach him. He will not settle for anything, he takes his time searching for the right woman and once he finds her he will fight for her. And when the woman finds the man with the right qualities she should be happy about having someone like that by her side.

Diabetes, cardiovascular disease, and chronic kidney disease in South Asia: current status and future directions

South Asians are more susceptible to diabetes and cardiovascular diseases and have worse outcomes than other ethnicities, say Anoop Misra, Tazeen Jafar, and colleagues. They call for urgent action to provide screening and treatment, complemented by population level lifestyle modifications.

All South Asian countries have adopted the World Health Organization’s Global Action Plan for the Prevention and Control of Non-Communicable Diseases, which recommends a 25% relative reduction in the prevalence of raised blood pressure by 2025 and a halt to the rise in diabetes and obesity. Although considerable diversity exists between countries, all South Asians have markedly elevated risks of diabetes and variably elevated risks of cardiovascular disease compared with other ethnicities.12 In this paper, we review the burden of diabetes, cardiovascular disease, and chronic kidney disease in the region and policies to mitigate this burden. We identify key actions for health authorities and governments to attenuate the rise in non-communicable diseases and meaningfully improve outcomes for the millions of people with, or expected to develop, these diseases.


We gathered data on characteristics of populations and health systems from publicly available World Bank reports and WHO’s country profiles. Information on death and disability from cardiovascular disease, diabetes, and chronic kidney disease and their attributable risk factors came from Health Metrics and Evaluation’s data visualisation tool of the Global Burden of Disease Study 2015. We searched PubMed and Google scholar for relevant literature up to January 2017, using the terms “South Asians”, “diabetes”, “cardiovascular disease”, “myocardial infarction”, “stroke”, “renal”, and “kidney disease”. We formulated this paper by drawing from our collective experience in this field and the available literature.

Current epidemiology and trends

Cardiovascular disease, diabetes, and chronic kidney disease now account for 27%, 4.0%, and 3.0% of deaths, respectively, in South Asia (table 1).3456 Notwithstanding the limited quality and breadth of data, ischaemic heart disease is the leading cause of death in India, Pakistan, Nepal, and Sri Lanka, and stroke is the leading cause in Bangladesh.

The age standardised years of life lost as a result of cardiovascular disease has increased in South Asia in contrast to most other regions, where the reverse is true.5 In part, this is because cardiovascular disease events are more common in South Asia than in high income countries.78 Furthermore, acute myocardial infarction occurs six years earlier in South Asians than in European counterparts, probably owing to earlier onset of risk factors. Case fatality rates are higher in South Asia, especially in younger adults, thereby increasing the years of life lost.78 Stroke and chronic kidney disease may also occur earlier in South Asians.91011 The effect of lives lost due to premature cardiovascular disease is far worse in South Asia than elsewhere, as more than half of the population lives in conditions of poverty.3

Susceptibility to diabetes, cardiovascular diseases, and chronic kidney disease

The region has experienced rapid demographic, epidemiological, environmental, and economic transitions. These, coupled with unhealthy lifestyles of physical inactivity and consumption of a calorie dense diet, have increased the risk of non-communicable diseases. In addition, social disparities, wealth inequalities, and conflicts in the region contribute to high rates of stress associated behaviours including smoking.1112 Evidence from multi-country case-control studies indicates that hypertension, dyslipidaemia, smoking, obesity, diabetes, physical inactivity, low fruit and vegetable intake, and psychosocial stress attribute up to 90% of the population risk of cardiovascular disease in South Asians.1314 Age standardised blood pressure and cholesterol levels and prevalence of diabetes have increased in South Asia over the past decades.151617 High blood pressure and high blood glucose are the leading attributable risk factors for deaths from chronic kidney disease in every South Asian country (table 2).

Adverse metabolic factors are evident in South Asians at an early age. South Asian children have been shown to have adverse metabolic factors (hyperinsulinaemia, dyslipidaemia) compared with British children of similar age and body mass index and higher blood pressure than white children in the US.1819 Physical inactivity, dietary imbalances, and increasing obesity amplify this (fig 1).2021


Fig 1 Interacting risk pathways contributing to higher risks of diabetes and cardiovascular disease (CVD) in South Asians, acting over the life course. This begins with poor maternal nutrition and adverse programming, with neonates born at lower average birth weights yet higher fat to lean mass ratios compared with white children. This phenotype worsens over time, with greater weight gain and lower activity levels in South Asian children and adults, leading, in turn, via greater insulin resistance and CVD risk factors, to higher rates of diabetes and CVD, respectively. The parallel societal, political, and health considerations, as well as life course considerations, are also shown. BMI=body mass index; BP=blood pressure; CKD=chronic kidney disease


Fig 1

 Interacting risk pathways contributing to higher risks of diabetes and cardiovascular disease (CVD) in South Asians, acting over the life course. This begins with poor maternal nutrition and adverse programming, with neonates born at lower average birth weights yet higher fat to lean mass ratios compared with white children. This phenotype worsens over time, with greater weight gain and lower activity levels in South Asian children and adults, leading, in turn, via greater insulin resistance and CVD risk factors, to higher rates of diabetes and CVD, respectively. The parallel societal, political, and health considerations, as well as life course considerations, are also shown. BMI=body mass index; BP=blood pressure; CKD=chronic kidney disease

 South Asian adults have greater risks of cardiovascular disease and diabetes, both of which tend to manifest around 5-10 years earlier than in white Europeans.10 The risk of cardiovascular disease is independent of that predicted by established risk factors. Possible mechanisms, among others, include an atherogenic dyslipidaemia driven by high concentrations of triglycerides and low concentrations of high density lipoprotein cholesterol, a pro-coagulant tendency, and higher concentrations of inflammatory cytokines.22 Further work is needed to define mechanisms for this excess cardiovascular disease risk. The risk factors vary by socioeconomic strata, geographical region, and migration.

Of particular importance, South Asian adults are more insulin resistant at any given body mass index and may experience more rapid β cell failure.2 They may progress more rapidly from a state of high risk of diabetes to frank diabetes and may have accelerated microvascular damage, with evidence of earlier diabetic nephropathy and retinopathy.2

Effects of poor and inconsistent treatment

Significant treatment gaps exist in South Asian populations. Studies report that less than half of all people with hypertension have received a diagnosis or treatment and less than a third have their blood pressure controlled with drugs.232425 The rates of diabetes awareness (50%), glycaemic control (<30%), and chronic kidney disease awareness (<15%) are suboptimal.24262728

Delay or prevention of diabetes in South Asians will require earlier intervention—that is, at lower levels of glycaemia. This requires wider testing and earlier use of antihyperglycaemic treatment, complemented with population-wide strategies to drive change in dietary habits and physical activity. Although antihypertensive, antidiabetic, and lipid lowering drugs are part of WHO’s list of essential medicines, availability in government primary care facilities is poor and patients must often pay out of pocket for these drugs. Social insurance schemes in countries are not available to the majority of the population,2930 and they tend to cover hospital based treatment and do not provide for standardised screening and medical management of these conditions in primary care.

Under-diagnosis and under-treatment result in higher rates of myocardial infarction and stroke, with adverse outcomes due to poor access to standardised and affordable treatment. Most patients with acute ischaemic heart disease are brought to the hospital too late to qualify for reperfusion therapy.31 Management in primary care is less than satisfactory, and many patients do not receive appropriate drugs owing to gaps in the knowledge and practices of healthcare providers.323334 The situation is much worse in rural areas, where an acute event is more likely to be fatal.3135

Health policies are not geared to respond to the rising challenge

Non-communicable diseases have been a recent addition to the policy agenda in all South Asian countries. Public health expenditure varies across countries, but overall investment is insufficient to support services for the prevention and management of cardiovascular disease, diabetes, and chronic kidney disease (table 3).36Implementation has been slow owing to donor agencies having limited interest in investing in non-communicable diseases and lack of engagement between governments and professional organisations in this field.

Table 3

Characteristics of health systems and policies for management of cardiovascular diseases and diabetes in South Asia

 In India, the National Programme for Prevention and Control of Cancer, Diabetes, CVD and Stroke has piloted opportunistic screening of risk factors for non-communicable diseases for people over 30 years of age. Furthermore, as part of the national health mission, the Indian government has outlined an operational plan for universal screening for hypertension and diabetes.31 A model of opportunistic screening for diabetes in patients with tuberculosis is being evaluated in Sri Lanka.37 Examples of successful public-private partnerships for non-communicable disease healthcare in the region are limited. Pakistan’s National Action Plan for Non-communicable Diseases is one such model,38 which involved a tripartite collaboration with Heartfile, a not for profit organisation, in formulation of policy and implementation in partnership with the government and WHO.


Progress towards the targeted reductions in death and disability from cardiovascular disease, diabetes, and chronic kidney disease would not be possible without concerted, multi-sectoral efforts by various government entities and non-government partners. We recommend the following essential policy and health system interventions.

Implementation of taxes on unhealthy foods

A tax of 20% on sugar sweetened drinks in India is projected to reduce the prevalence of overweight and obesity by 3.0% (95% confidence interval 1.6% to 5.9%) and the incidence of type 2 diabetes by 1.6% (1.2% to 1.9%) over the period 2014-23, assuming that consumption increases in line with current trends.39 In Mexico, an excise tax of 10% on sugar sweetened drinks decreased consumption by an average of 6% over one year.40 The Indian state of Kerala recently announced a “fat tax” on pizzas, burgers, sandwiches, and tacos sold through branded food outlets.41 Such strategies must be adopted in cities of South Asia that experience widespread marketing and consumption of unhealthy fast foods.

Furthermore, a 20% tax on palm oil purchases in India is projected to avert approximately 363 000 (95% confidence interval 247 000 to 479 000) deaths from myocardial infarctions and strokes over the period 2014-23 (1.3% reduction in cardiovascular deaths).42 Palm oil is consumed widely in low and middle income countries. It is high in saturated fat and causes a large increase in cholesterol concentrations. Empirical data from Mauritius show a reduction of 1 mmol/L in cholesterol concentrations through substitution of palm oil with soya oil.43 This reduction in cholesterol and low density lipoprotein cholesterol would equate to a 22% lower risk for cardiovascular disease, a huge effect by any standards.44

Strengthening of health system capacity to deliver care for non-communicable diseases

Strengthening of health systems and a well designed quality of care improvement framework are essential for concerted efforts to manage hypertension and diabetes for prevention of cardiovascular disease and chronic kidney disease. Shifting management of chronic diseases and risk factors from doctors to community healthcare workers holds promise and is being tested in rural areas in South Asia.34 Studies from Pakistan and India have shown that involving trained health workers in home health education on diet and physical activity and training general practitioners led to earlier diagnosis and better management of patients with hypertension or diabetes, and it was also cost effective.454647 Scaling up similar models is likely to offer substantial reductions in cardiovascular disease and chronic kidney disease in the medium to long term.

Screening populations at high risk (such as people who are sedentary, overweight, or smokers; those with hypertension; those with a family history of diabetes or premature cardiovascular disease in first degree relatives; and women with a history of gestational diabetes) is essential for early diagnosis. Low cost strategies such as validated simple screening questionnaires, blood pressure measurement, and, if possible, fasting or random blood glucose measurement, urinary dipstick for protein, and non-fasting cholesterol measurement, may be used. Although the cost effectiveness of opportunistic screening compared with universal screening is likely to vary according to the characteristics of the population, its value cannot be overstated for countries with a high prevalence of diabetes.48

Making antihypertensives, statins, and diabetes drugs available for free or at low cost in primary healthcare centres should be prioritised. This is consistent with achievement of universal health coverage, including access to quality and affordable essential medicines for all, as advocated in the United Nations’ sustainable development goals.49High quality generic drugs produced in the region can help to make this sustainable. Fixed dose drug combinations may improve coverage and long term adherence in people with established disease, but their widespread use in primary prevention is still debated.50 Health insurance reforms must provide for screening and primary care for these conditions to reduce out of pocket expenditure.51

Evidence is growing for m-health (mobile health technologies) interventions in improving adherence to treatment, maintaining appointments, data collection, and supporting health workers.52 More than 80% of the population of South Asia have mobile phones, and a large majority of villages are connected with mobile technology.53 This platform should be strongly considered in risk communication strategies and integration of care delivery for non-communicable diseases where feasible.

Public-private partnerships for non-communicable disease care should be encouraged to provide for unmet needs. Setting standards for long term public sector engagement; having transparent goals, inputs, and expectations; good governance of costs and fair allocation of profits; a shared vision and trust; and agreed processes for negotiation on common interests of partners are crucial to their success. The Sindh Institute of Urology and Transplantation in Karachi, Pakistan, providing dialysis services, and Aravind Eye Care System in India are good examples of successful public-private partnerships in the region.5455

Consideration of population based strategies to promote a healthy lifestyle

Community based interventions to promote a healthy diet and physical activity and reduce smoking and stress will go a long way in delaying the onset of these diseases. The Indian Diabetes Prevention Program, and more recently the D-CLIP study, showed the effectiveness of lifestyle intervention in reducing the development of diabetes in people at high risk, while concurrently tackling problems with community acceptability and long term sustainability.5657

School health programmes, encouraged by WHO to inform children about risk factors for non-communicable diseases and promote physical activity, have been hindered by low education budgets and poor infrastructure. There are no restrictions on advertising unhealthy food to minors.58 Such legislation must be complemented with multi-sectoral action including involvement of schools and workplaces to influence diet and physical activity.

Investment in surveillance and research

Surveillance and monitoring are critical to raise awareness and inform policy and implementation. Although the WHO STEPS instrument ( for collecting data on risk factors for non-communicable diseases has been used in community based studies in South Asia, national implementation is lacking.59 All South Asian countries must institutionalise risk factor surveillance and establish robust cardiovascular disease, diabetes, and chronic kidney disease registries to track trends and monitor progress. Surveillance data must be shared publicly to create awareness.

Evidence on effective interventions to prevent and control non-communicable diseases in the region is very limited. The effect of school, workplace, and community based interventions must be evaluated. Research comparing single versus multiple risk factor screening, as well as opportunistic and targeted screening versus universal screening in all adults, will help to tailor screening strategies. Policy initiatives such as taxes and diet substitution must be rigorously evaluated for their feasibility and impact at a population level.


Capacity building, financing, and a strong quality assurance framework are crucial for the effectiveness, scalability, and long term sustainability of initiatives to curb non-communicable diseases in the South Asia region.

Key messages

  • South Asians are more likely than other ethnicities to develop diabetes, cardiovascular disease, and chronic kidney disease, and these often have an earlier onset and poor outcomes

  • Strategies for early diagnosis and treatment including awareness generation, opportunistic screening, availability of low cost drugs, and task shifting to health workers must be prioritised

  • Countries must consider taxation on unhealthy foods, restrictions on advertising, and appropriate food labelling.

source: BMJ

How to superchsrge your domamine level?

Did you know that we have chemicals in our brain that make us feel good? One of the most important is Dopamine (also known as the ‘feel good chemical’). Having reduced levels of dopamine can lead to adverse effects like depression and negativity.

brain dopaminee

But don’t worry, there are natural ways to increase your dopamine so you can experience a more constant level of happiness. Best of all, the following techniques don’t involve medications.

1. Exercise.

Exercise can boost your levels of endorphins, serotonin and dopamine, which will not only strengthen your muscles, but will help reduce your stress. The best bit? It works with any kind of exercise – just as long as you get moving!


2. Avoid Addictions.

While addictions may provide an instant boost of pleasure, it isn’t long-lasting.What eventually happens is that your base levels of dopamine will actually decrease and you will need your addiction more often. Therefore, it can beneficial to avoid addictions and focus on things that give you calm and peace.

3. Detoxification.

Toxins and unhealthy bacteria can halt your body producing dopamine, so make sure to consistently detoxify your body.

4. Increase Tyrosine.

This amino acid is one of the most important for the production of dopamine.Make sure to consume almonds, bananas, dark chocolate and green tea.

5. Music

Music actually increases your feel good chemicals, so make sure to regularly listen to music you enjoy.

6. Organize your life.

When you complete a goal, dopamine levels are increased. Therefore, write down your tasks, even small ones, and tick them off once you complete them. Every time you finish a task, you’ll experience a small rush of dopamine for completing your goal.

7. Creativity.

Being creative releases dopamine. The great thing is creativity can be found in a whole range of tasks from writng to singing to dancing.

8. Get a streak going.

This is a visual display of the number of times you achieve something. Again, by displaying things you achieve, your brain will recognize that you’re completing goals which will increase dopamine.

9. Supplementation.

These are the supplements that can boost dopamine levels:

Curcumin – found in turmeric

Ginkgo Biloba


L-theanine, which is found in green tea.

10. Meditation.

This works differently compared to exercise. It will make you more calm and relaxed, which will enable you to reduce stress.