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In India, most people adhere to a vegetarian diet, which may lead to cobalamin deficiency. About 75% of the subjects had metabolic signs of cobalamin deficiency, which was only partly explained by the vegetarian diet.

The study population included 204 men and women aged 27–55 y from Pune, Maharashtra, India, categorized into 4 groups:

  • patients with cardiovascular disease (CVD) and diabetes,
  • patients with CVD but no diabetes,
  • patients with diabetes but no CVD,
  • healthy subjects.

Data on medical history, lifestyle, and diet were obtained by interviews and questionnaires. Blood samples were collected for measurement of serum or plasma total cobalamin, holotranscobalamin (holoTC), methylmalonic acid (MMA), and total homocysteine (tHcy) and hemetologic indexes.

  1. Methylmalonic acid, total homocysteine, total cobalamin, and holotranscobalamin did not differ significantly among the 4 groups.
  2. Total cobalamin showed a strong inverse correlation with total homocysteine (r = −0.59) and methylmalonic acid (r = −0.54). 
  3. 47% of the subjects had cobalamin deficiency (total cobalamin <150 pmol/L),
  4. 73% had low holotranscobalamin (<35 pmol/L),
  5. 77% had hyperhomocysteinemia (total homocysteine >15 μmol/L),
  6. 73% had elevated serum methylmalonic acid (>0.26 μmol/L).

These indicators of impaired cobalamin status were observed in both vegetarians and nonvegetarians.

Folate deficiency was rare and only 2.5% of the subjects were homozygous for the MTHFR 677C→T polymorphism. 

Marked ethnic differences in cobalamin metabolism have been reported (40); therefore, the possibility that Indians have adapted to a chronic low cobalamin concentrations through genetic mechanisms should be considered.

This finding agrees with our observation that even subjects with relatively high cobalamin concentrations can have high tHcy and MMA concentrations. Notably, in the study by Lindenbaum et al, the high MMA concentration was related to anaerobic gut flora and the high tHcy concentration was explained by a low cobalamin concentration. Some studies suggest that overgrowth of intestinal bacteria may lead to formation and absorption of inactive cobalamin analogues.

Marcel Proust

The real voyage of discovery lies not in seeking new landscapes, but in having new eyes. 

Water

Water is an essential nutrient - it is required in amounts that exceed the body's ability to produce it. All biochemical reactions occur in water. It fills the spaces in and between cells and helps form structures of large molecules such as protein and glycogen. 

Most foods contain water. The body can usually get 20% of its total water requirements from solid foods alone. The human body can last weeks without food, but only days without water. 

The digestion process also produces water as a byproduct and can provide around 10 per cent of the body’s water requirements.  

Water is a transparent and nearly colorless chemical substance. Its chemical formula is H2O, meaning that its molecule contains one oxygen and two hydrogen atoms

Water covers 71% of the Earth's surface. It is vital for all known forms of life. On Earth, 97% of the planet's crust water is found in seas and oceans, 1.7% in groundwater, 1.7% in glaciers and the ice caps. Only 2.5% of this water is freshwater, and 98.8% of that water is in ice (excepting ice in clouds) and groundwater. Less than 0.3% of all freshwater is in rivers, lakes.

Safe drinking water is essential to humans and other lifeforms even though it provides no calories or organic nutrients. ~One billion people still lack access to safe water. It was estimated that by 2025 more than half of the world population will be facing water-based vulnerability, and by 2030 water demand in some developing regions of the world will exceed supply by 50%.

Approximately 70% of the freshwater used by humans goes to agriculture. 

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