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Published on: Apr 28, 2020
4 minute read
By: Dr Rajan Choudhary

Strokes In The Young And How COVID Causing Clotting Disorders?

Strokes in the young and healthy: how is COVID causing clotting disorders?

In the news, there has been a rush in stories linking Strokes in young and healthy patients, patients who also have COIVD-19. This is certainly worrying news, and at first glance, it is difficult to explain. How does a respiratory virus, one that is very similar to the coronavirus responsible for the common cold, cause such serious issues in a completely unrelated organ system? In this two-part series we will first go over the basics of clotting and its function, how clotting can cause problems, and finally how COVID can lead to clotting disorders.

STROKES

Before we progress, if you or a family member are having any of the following symptoms, contact your local emergency services immediately. Strokes can be devastating, and treatment needs to be given as soon as possible to save as much of the brain as we can. Early recognition can be the difference between manageable long term effects and crippling disability.

Remember, act F.A.S.T

Facial Droop on one side
Arm or hand on one side feels numb or weak with reduced power (same in one leg)
Slurred speech making it difficult to understand
Time to phone an ambulance

Other symptoms can include sudden loss in balance, sudden loss in vision in one eye, problems swallowing, and more.

PLUGGING A HOLE

We have an intricate network of vessels to transport oxygen, nutrients, and signals to cells and organs across our bodies. Damage to these blood vessels causes blood loss, reduction in oxygen and nutrient delivery to these cells, and organ damage if the issue isn’t rectified. Failure in multiple organ systems across the body will eventually lead to death. Our blood has cells and proteins that work together to form a clot at the site of injury. This acts as a plug to physically stop the leak, but also encourages repair of the blood vessel and surrounding tissue.

A clot can be triggered in three different ways: blood stasis (pooling up in one area), exposure of blood vessel lining, and pro-coagulant factors released into the blood. When triggered a coagulation cascade occurs to form the building blocks of a clot – it works so well that even a small trigger can create a response big enough to repair the damage. These form a mesh trapping platelets and other blood cells into a plug. Immune cells also arrive to destroy any organisms that might enter from the trauma site that caused the injury, and these immune cells also instruct nearby cells to begin the repair process.

As with everything in our body the whole process is very tightly regulated. The cascade has triggers and accelerators, but it also has brakes. These brakes stop a clot from growing too big, or from clots forming spontaneously when they are not needed. They also help dissolve a clot once the vessel is repaired and it isn’t needed.

WHEN IT GOES WRONG

Heart attacks and strokes. These devastating cardiovascular diseases are well recognized by the public as a leading cause of disability and death. Both can be caused by abnormal clotting. How does our finely tuned clotting cascade turn abnormal? Let's go back to the three triggers of blood clotting.

Vessel damage: Eating a high fat and cholesterol diet can cause fatty plaques to build up in our arteries. This is known as atherosclerosis, and it is extremely common. The plaques can narrow your arteries and reduce blood flow. If this happens in your coronary arteries supplying your heart muscles, your heart might not receive enough oxygen when you exercise or exert yourself. This can cause chest pain, known as angina.

If the plaques burst open it can expose the vessel lining, causing a large clot to form. This clot can become dislodged and be carried away by the blood. It will eventually get lodged in a narrow artery, blocking it and stopping blood from entering. The tissue and cells supplied by that artery will not receive oxygen and eventually die. If this happens in the coronary arteries it can cause a heart attack. In the arteries supplying the brain, it can cause a stroke, leading to neurological deficits.

THIS IS THE MOST IMPORTANT LEARNING POINT, and this is why a healthy diet low in fat and sugars is so important.

Stasis: Our heart pumps blood at high pressures through the arteries. But in the veins, there is very little pressure to drive the blood back to the heart. In our arms and head, gravity helps blood flow down to the heart. But from our legs? When we walk the muscles in our legs squeeze the veins and move the blood. Valves make sure this flow is only one way, back to the heart.

If we sit or lie down in one place and don’t move, the blood isn’t pumped back and pools up in our legs, causing a clot to form. This usually happens in our calves (known as a DEEP VEIN THROMBOSIS, or DVT). The calf becomes swollen, painful, red, and hot. If this clot is dislodged, it can end up in our lungs causing a PULMONARY EMBOLISM. A large PE can block blood from entering the lungs and can be fatal. This is why you should take regular walks on long haul flights, to prevent blood from pooling.

Pro-coagulant: Sometimes the factors in our blood responsible for triggering a clot can be triggered accidentally. Cigarette smoke contains many toxins and harmful chemicals that, when inhaled, end up in your blood. These chemicals can cause damage to vessel linings, and also cause the clotting cascade to be triggered more easily. Some medications, such as the Combined Oral Contraceptive Pill, also have a similar effect, though the risk of getting a clot is still very low.

The immune system can also trigger a clot. The protein mesh formed in the blood can also capture bacteria and viruses around an infection site, making it easier for immune cells to find and destroy these invading organisms. In cancer patients, this process is sometimes triggered by unregulated cancer cells.

WHAT HAVE WE LEARNT?

Our clotting system stops us from bleeding to death from a small wound. People who have bleeding disorders are clear examples and need to be extremely careful if they injure themselves. But unregulated, our body can end up harming itself. If there is one thing you should take away from this, it is that a high sugar/high-fat diet with little exercise can directly increase your risk of having a heart attack or stroke. This is why doctors emphasize so much the importance of a good diet and exercise.

In our next blog, we will look at how this clotting problem is implicated in COVID patients.

Dr Rajan Choudhary, UK, Chief Product Officer, Second Medic Inc

www.secondmedic.com

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Nutritional Deficiencies in Indian Kids: Recognizing, Preventing & Overcoming “Hidden Hunger”

Every parent wants their child to grow up healthy — tall, strong, smart, and full of energy. But in India, many kids suffer from what is known as “hidden hunger.” It means that even though they are eating, their diet lacks essential nutrients. These nutritional deficiencies can affect growth, learning, immunity, and long-term health. In this blog, we’ll explore the major nutritional deficiencies in Indian kids, what causes them, how to detect them, and what parents can do. Let’s dive into nutritional deficiencies in Indian kids.

What Are the Most Common Nutritional Deficiencies?

Based on recent research and national surveys, the following are among the most widespread deficiencies in Indian children:

Iron Deficiency / Anaemia
A large percentage of Indian kids (especially under-5s) have low hemoglobin and low iron stores. Anaemia can cause tiredness, slow cognitive development, and lowered immunity. Lippincott Journals+2PMC+2
Vitamin A Deficiency
Vitamin A is essential for good vision, immunity, and healthy cells. Many children under 5 show sub-clinical deficiency; some show clinical signs like night blindness. Lippincott Journals+1
Iodine Deficiency
Iodine is critical for thyroid hormone production, which affects brain development. Lack of iodine can lead to goitre, delayed mental development, and poor school performance. Lippincott Journals+2thyrocare.com+2
Vitamin D Deficiency
Even though India is sunny, many children have low vitamin D — due to indoor living, limited sun exposure, skin coverage, or dietary gaps. This impacts bone health, growth, and risks rickets. PMC+1
Protein-Energy Malnutrition (PEM)
In poorer or marginalized communities, children may not get enough protein or calories. This leads to underweight, wasting, stunting, and weakened immunity. Lippincott Journals+2HDFC ERGO+2
Other Micronutrients (Vitamin B12, folate, zinc etc.)
Deficiencies in B12 & folate can affect cell division, blood production, nerve function; zinc deficiency weakens immunity & slows growth. PMC+2nanhedil.com+2

Why Do These Deficiencies Happen?

Understanding the causes helps in prevention:

Dietary Factors
Many diets are heavy in cereals or starches but low in diversity. Meals may lack fruits, vegetables, animal-source foods (meat, eggs, fish) or fortified products.
Bioavailability of Nutrients
Even when foods contain nutrients, they may not be absorbed well. For example, plant-based iron is less readily absorbed, phytates in grains and legumes can reduce absorption.
Socioeconomic Constraints
Poverty, food insecurity, access issues, lack of awareness, and sometimes traditional/cultural food beliefs limit access to nutrient-rich foods.
Living Conditions and Health
Frequent infections, parasitic infestations, poor hygiene, etc., can increase nutrient loss or demand. Also sunlight exposure (important for vitamin D) is inadequate in many cases.
Gaps in Implementation of Prevention Programs
Though India has multiple programs (fortification, supplement distribution, ICDS, National Nutrition Mission etc.), challenges remain in reach, compliance, quality, and behavioural change.

Effects of Nutritional Deficiencies

These deficiencies have short-term and long-term effects:

Growth stunting (children don’t reach their full height potential)
Wasting (low weight for height), underweight
Impaired cognitive development & learning difficulties
Weak immune system ? more infections
Delayed motor skills, poor school performance
Bone deformities (rickets, weak bones)
Poor quality of life; in severe cases, increased mortality

How to Detect & Diagnose Early

Taking action early helps avoid permanent harm. Key strategies include:

Regular growth monitoring: Checking weight, height, BMI for age
Look for signs: Pale skin or lips, tiredness, delayed milestones, frequent illness, bone pain or deformities (knees bowing, wrist/ankle enlargement)
Lab tests:
- Haemoglobin & complete blood count
- Serum ferritin for iron stores
- Serum levels for vitamin A (retinol)
- 25-OH vitamin D test
- Serum B12, folate
- Urinary iodine excretion or salt iodine test
- Protein / albumin levels

Using broad vitamin profiles (like those from Thyrocare) can help screen for multiple deficiencies in one go.

Foods, Diet & Prevention: What Parents / Caregivers Can Do

Here are practical steps parents can take:

Diversify diet: Include pulses, legumes, eggs, dairy, meat (if non-vegetarian), fish; plenty of green leafy vegetables & fruits.
Fortified foods: Use iodised salt; choose cereals / milk products fortified with vitamins & iron.
Sunlight exposure: Encourage outdoor activities; even short daily sun exposure (face, arms) helps vitamin D.
Supplementation when needed: Under doctor guidance, provide vitamin A doses, iron/folic acid, vitamin D etc., especially in high-risk children.
Hygiene & health care: Prevent worm infections, diarrhoea etc. which can drain nutrients. Ensure vaccinations.
Education & awareness: Teach families importance of nutrition, balanced meals, what local foods can provide what nutrients.

What Parents Should Ask Healthcare Providers

Ask whether your child needs screening for deficiencies (e.g., iron, vitamin A, D, B12).
If lab tests are suggested, check whether it’s comprehensive or narrow, cost, and follow-up.
Seek help for dietary planning, perhaps from nutritionists or public health bodies.
Learn about local government/NGO programs—free or subsidized supplementation or fortified food programs.

When to Seek Medical Help

If your child has:

Persistent anaemia symptoms (very pale, lethargic)
Growth issues (falling off growth charts)
Bone deformities or pain
Severe or recurrent infections
Unusual signs like night blindness, goitre

Then get a medical evaluation. Early intervention can make a big difference.

Conclusion & Call to Action

Nutritional deficiencies in Indian kids are common—but many are preventable or treatable. By recognizing risks, ensuring good diet, doing appropriate lab tests, and using supplements or fortified foods when needed, children can grow healthier, smarter, and stronger.

If you’re concerned that your child may have one or more of these deficiencies, talk to a trusted pediatrician or nutritionist, and consider getting a comprehensive vitamin & nutrition profile done (for example through Thyrocare or SecondMedic) to know exactly where improvements are needed. Don’t wait—every child deserves a strong foundation.

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