A report by Swachh Bharat Mission says that 74.5 per cent of public places are equipped with toilets. Another report by the Ministry of Jal Shakti states that there are 2.23 lakh Community Sanitary Complexes built across all States and UTs under the Swachh Bharat Mission (SBM) since October 2014. Over 92 lakh toilets have been constructed since the launch of SBM Gramin (SBM (G)) in April 2020.

While toilets are there, are they accessible? This is the question one should ask. The National Family Health Survey (NFHS) focuses on 131 health indicators, but not until the NFHS 5 survey did they include the question of accessibility of toilets in the survey. This happened after the inputs from the Department of Drinking Water and Sanitation (DDWS) and the Ministry of Health & Family Welfare questioned the accessibility.

One might ask, why is the question of accessibility so important? The answer is quite simple. Access to water, sanitation and hygiene is the most basic human need and is also included under the Sustainable Development Goals by the UN.

Are These Numbers Real?

This thought crossed my mind because back in 2021, I went on a solo trip, on a bus to Udaipur from Delhi. There, the bus made two stoppages. This was done so people could get a quick dinner and freshen up, relieve themselves and be prepared for the rest of the journey. This was a nightmare. The bus only stopped for 10 minutes. While some men used the washroom, others went to the bushes.

For the women, there were three cubicles. One of them was broken, and the other one did not have a light bulb, which meant only one was usable. There was a long queue for that cubicle, and time was short. There was no point in trying to find an isolated corner, because it was past midnight, in an unknown area.

I waited anxiously. When finally, my turn came, I saw an overused, dirty washroom. The toilet seat is in a horrible condition. I wanted to touch nothing there. But I had to pee. So, I used my mask to cover my nose from the odour, folded my pants so they did not touch the floor and squatted. It was quite a task to balance.

On my way back to Delhi, I made sure to not drink any water for over a 13-hour bus journey. I dehydrated myself so I did not have to use the washroom. When I did reach, I was severely dehydrated and was sick for three days.

I shared my experience with my friends only to realise that many women have faced the same. There are no washrooms for women.

A friend of mine told me that it is because these roads and dhabas are mainly designed to serve men. They are the ones who travel at night or are on the roads most of the time. As a result, the few women who do travel or are on the road suffer.

Health Risks Women Are Prone To

Well, it is true, but partially. While holding your pee for too long can lead to health risks, peeing on a dirty toilet seat cannot lead to infections unless your urethra is in contact with the bacteria present on that toilet seat. However, nobody wants to sit on a dirty toilet seat, even if you do not get an infection. A safe and hygienic toilet is a basic need.

One of the regular saleswomen, Usha, who visits my house shared her experience with me. “Being on the road constantly means I must use the dirty public washrooms. But I do not want to use them. So, sometimes I ask my regular customers to let me use their washrooms. Some say yes, and some say no. I understand they are also concerned about their safety and privacy,” she says. As a result, Usha spends most of her day not drinking enough water and holding her pee when she is at work. Due to this, she also suffered from a Urinary Tract Infection (UTI).

Her friend, Halima too faced similar problems and due to increased levels of uric acid in her body, she suffered from Hyperuricemia.

Other health risks are kidney stones and other kidney problems, headaches, dull skin, xerostomia or dry mouth, fatigue, and urinary incontinence, which means losing control over your pelvic floor muscles leading to uncontrolled leakage of urine, seizures and weakness.

What Can You Do?

Wear comfortable clothes and capris. Capri pants are comfortable and are short in length, which means this won’t touch the toilet floor when you squat or sit.

Carry Essentials

Even though you cannot get a UTI alone from sitting on a toilet seat, it is always safe to carry a toilet seat sanitiser. If nothing, it can help you get rid of the bad odour so you can use your stand and pee device inside the toilet. You can also use disposable toilet seat covers if your knees are weak, and you cannot squat. Always flush with your seat down.

Always keep disposable gloves, a portable bidet (fill it with water before use), a pocket liquid handwash, wet wipes, tissues and sanitiser handy. Do not forget to keep extra sanitary pads. It might sound a lot, but I promise that it all fits in one pouch. Use this travel-friendly pouch every time you are on the road, or using a public washroom.

What Can We Learn From Others?

However, in case we do not get these technologically advanced toilets here, you can always pack a travel-friendly toilet kit!

Bryan Johnson, the billionaire biohacker and longevity enthusiast, has been diagnosed with an incurable autoimmune disease called Autoimmune Gastritis (AIG).

Johnson is known for his radical longevity experiments, including measuring the biological age of his organs in an effort to reverse aging, injecting himself with ketamine, taking over 50 pills a day, undergoing fat transfers, and receiving blood transfusions from his teenage son.

In a recent post on X, he made the shocking announcement of his autoimmune conditions, which went undetected for years: Autoimmune Gastritis.

Calling it "bad news," Johnson wrote: "I have an autoimmune disease. My stomach is eating itself."

"2-5 per cent of people have this, too. Likely more, because it hides," he added.

According to Johnson, his stomach had been attacking itself without causing noticeable symptoms. The condition was only discovered in May.

Also read: Bryan Johnson Blames Sugary Cereals, Soda and Stress for His Autoimmune Disease; Shares Treatment Plan

The Early Warning Sign: Low Ferritin

Autoimmune Gastritis, a condition in which the immune system attacks the stomach's acid-producing cells, also impairs the absorption of iron and vitamin B12.

Johnson said one of the earliest signs of the condition was persistently low ferritin levels over the past 11 years despite not having anemia.

"We continually tried to raise my iron levels with food and supplementation, but nothing would work."

He said he followed a plant-based diet, trained intensely, used a sauna and hyperbaric oxygen therapy, and took iron supplements, yet his iron levels remained low.

Ferritin stores the body's iron. Iron is essential for transporting oxygen and producing energy, and low iron levels can lead to fatigue, weakness, and dizziness.

Johnson said autoimmune gastritis is difficult to diagnose because its earliest clue is often overlooked.

"The earliest clue, low ferritin, is the one standard medicine waves through. Low iron stores get normalized and rarely investigated at all when anemia hasn't shown up yet. That blind spot is what hid mine for a decade."

While initially it wasn't clear why his iron levels were continuously dipping, after further testing, Johnson's team identified three interconnected issues.

Read More: Bryan Johnson Battles Autoimmune Gastritis: Which Parts Of His Longevity Guide Are Actually Worth Copying?

Autoimmune Gastritis was preventing normal iron absorption by damaging the stomach cells that produce acid. He also discovered autoimmune thyroid disease.

"The iron deficiency, the autoimmune gastritis driving it, and the autoimmune thyroid disease alongside it. Iron and thyroid feed each other both ways; low iron impairs the conversion of thyroid hormone into its active form, and an underactive thyroid impairs how the body uses iron," Johnson explained.

Iron Deficiency May Be More Common Than Many Realize

According to research published in JAMA Network Open, about one in four Americans may have inadequate iron intake or absorption.

As per the study of more than 8,000 Americans, 14 per cent of adults had absolute iron deficiency, reflecting depleted iron stores.

Even after excluding common causes such as anemia, pregnancy, heart failure, and chronic kidney disease, 11 per cent remained iron deficient. Another 15 per cent had functional iron deficiency, where iron levels appear normal but the body cannot use the mineral effectively.

How Bryan Johnson Is Managing The Condition

Since receiving the diagnosis, Johnson has begun iron infusions, which deliver a full dose of iron in a single treatment.

He said his team will continue routine monitoring of his ferritin and iron levels.

Johnson ended his post with a warning that hidden health conditions can go unnoticed for years.

"You too may have a lurking health issue that is undiagnosed and could increase in severity from unhealthy life choices, without your knowing… A gentle nudge that minding your health, no matter your situation in life, is a good decision-making."

A recent study has indicated that following a healthy diet consistently may help reduce the risk of dementia, even in those who already show early signs of Alzheimer's disease. The study could help in early management of neurodegenerative diseases like dementia.

Anti-Inflammatory Diet May Help Lower Dementia Risk

According to a new study published in the JAMA Network Open, scientists found that participants who maintained better-quality diets over a period of 15 years were less likely to develop dementia, regardless of whether their blood tests indicated the presence of Alzheimer ’s related biomarkers.

The findings also suggest that healthy eating habits may benefit even after the individual shows signs of the disease processes have begun.

About The Study And Its Results

The researchers followed middle-aged and older adults one and a half decades, examining their dietary habits alongside blood biomarkers associated with Alzheimer's disease, including phosphorylated tau217 (p-tau217), glial fibrillary acidic protein (GFAP), and neurofilament light (NfL).

These biomarkers are commonly used to detect early Alzheimer's-related changes and neurodegeneration before symptoms of the disease become visible.

The participants followed a healthy diet, particularly a Mediterranean-style as well as an anti-inflammatory diet. The findings showed that individuals with healthier diets had a lower risk of developing dementia over the follow-up period.

Remarkably, this association was observed even among participants who presented Alzheimer's biomarkers, indicating that diet may offer protective benefits despite early signs.

Alzheimer's disease begins years, and sometimes decades, before memory problems emerge. During this preclinical stage, abnormal proteins accumulate in the brain while individuals remain symptom-free.

Read more: New Blood Test May Predict Alzheimer's Symptoms At Least 4 Years In Advance: Study

The new findings indicate that lifestyle factors such as diet could still influence dementia risk even after these biological changes have started. This reinforces growing evidence that preventive measures need not be limited to people without detectable Alzheimer's pathology.

Not A Preventative Measure

While the study shows promising results of the effect of a healthy diet on the neurodegenerative disease, it does not prove that diets can directly prevent dementia.

The researchers emphasized that the study was merely an observation, meaning it highlighted an association rather than a direct cause-and-effect relationship. It just supports the idea that long-term healthy eating could have a significant impact on one’s brain health throughout adulthood.

Benefits Of Anti-Inflammatory & Mediterranean Diets

The anti-inflammatory diet, as recommended by Harvard Nutrition Source, helps calm the immune system by choosing foods that reduce inflammation.

This dietary approach encourages a balance of fruits, vegetables, healthy fats, whole grains, and other nutrient-dense foods while avoiding those that trigger inflammation.

On the other hand, Mediterranean diet, long celebrated for its heart-and longevity-promoting benefits, is now gaining attention for its beneficial effects on the brain.

This diet emphasizes plant-based foods, healthy fats such as extra virgin olive oil, nuts, fruits, vegetables, and whole grains, with moderate fish intake.

In another study published in Nature Medicine, researchers observed that individuals at the highest genetic risk for Alzheimer’s disease, particularly carriers of the APOE4 gene variant, showed the most significant reduction in dementia risk when adhering closely to this dietary pattern.

Parkinson’s disease is the second most common neurodegenerative disorder in the world and is the fastest-growing neurological condition worldwide. Its classic hallmarks - resting tremor, bradykinesia, and rigidity usually lead to diagnosis only after extensive dopaminergic neuronal loss has already happened. Newer research, however, highlights a prodromal window that might open decades earlier. There’s an increasing theory that pathological changes of the nervous system could start in a person’s 20s. This means that early detection is not just desirable but could be transformative for clinical outcomes.

Individuals with PD at prodromal and early motor stages alike report symptoms in multiple domains, including behavioral, cognitive, autonomic, sensory, sleep-related, and activities of daily living. Most of these symptoms are subtle and overlap with common conditions, so they aren’t often recognized or are mistaken for ageing, stress or other lifestyle factors. So, identifying consistent patterns amid daily behavioral variations is crucial for improving early PD detection.

Sleep Disturbances: An Early Warning Sign

One of the most robust prodromal markers is REM sleep behavior disorder (RBD). People who are affected have sleep disruption, physically act out their dreams during REM phase (acting out dreams), and vivid dream life and some through sleepwalking — all of them worthy substrates for signals of early brainstem pathology.

Loss of Smell May Appear Years Before Diagnosis

Anosmia, a partial or complete loss of the sense of smell, could be PD’s earliest recognizable sign, occurring as much as 10 years before motor signs become apparent. In practice, this means being unable to easily perceive familiar smells like food or coffee. Because this symptom manifests so early and appears so unrelated to the health of the brain, it is rarely taken seriously in clinical practice.

Gut Changes and the Brain Connection

Chronic constipation is a common prodromal symptom indicating reduced gut motility that can predate motor symptoms by years. This observation is consistent with the gut–brain axis hypothesis: gut microbiota dysbiosis disrupts gastrointestinal motility, permeability and inflammation, which may facilitate a prion-like transmission of misformed alpha-synuclein (α-syn) from gut to brain through the enteric nervous system.1 further underscoring the biomarker potential of gastrointestinal symptoms with clinical relevance.

Subtle Changes in Movement and Mood

Before tremors are apparent, there can be subtle changes in fine motor control. Trouble with tasks such as handwriting, using electronic devices or manipulating small objects, along with uncharacteristic anxiety or a low mood, can serve as signals of the preclinical stage. Micrographia (progressively smaller and cramped handwriting) is a particularly telling sign from daily life that deserves a neurological workup when it appears without an obvious cause.

Fatigue and Autonomic Symptoms Can Precede Motor Signs

Fatigue that never seems to get better with rest affects work performance, social engagement and daily motivation, and can occur long before an official diagnosis. More than half of all PD patients develop at least one form of autonomic dysfunction, which can precede motor symptoms by four years or more, and is now being recognized as a key prognostic biomarker for prodromal PD. Cardiovascular instability, orthostatic hypotension, and urinary irregularities further influence how individuals navigate everyday environments long before a definitive diagnosis is made.

Recognizing Early Signals Can Transform Care

The evidence reviewed here collectively supports a paradigm shift: Parkinson's disease is best defined as systemic, progressive, and with recognizable signals in daily life long before motor signs of decline. Disrupted sleep, anosmia, gastrointestinal changes, fine motor difficulties and chronic fatigue are not complaints in a vacuum; they are potential early signs of a neurological process left unsupervised and now in motion. Incorporating routine clinical assessment of these behavioural precursors and pre-motor signs would allow us to meaningfully extend the opportunity for therapeutic intervention, which could in turn improve patient outcomes across a broad range of CNS disorders.