If the question you ask is, “Can I beat diabetes?” the answer is, Yes you can! But you must understand the basic patho-physiology of the ailment. In type 2 diabetes there is a combination of peripheral insulin resistance (improper action of insulin on fat, muscles and liver) and inadequate insulin secretion by the pancreatic beta cells. Insulin resistance causes elevation of free fatty acids and pro-inflammatory tissue poisons such as cytokines, which prevent glucose from entering into muscle cells and cause increased production of glucose in the liver and breakdown of fat. This is compensated initially by over production of insulin and a person starts putting on weight, but then comes a stage when this compensatory insulin production seizes due to pancreatic exhaustion and the patient develops frank diabetes, having symptoms of excessive thirst and urination, fatigue and weakness, and weight loss.
There is no doubt that Indians are genetically and ethnically susceptible to diabetes and heart disease; but like a tree needs seed, water, fertilizers and sunshine too bloom, diabetes manifests into its full blown syndrome by genetic factors, as also other negative environmental factors, like inactivity, lack of physical exercise, faulty nutrition from infancy, faulty nutrition of the mother when the child is in the womb, and severe mental and physical stress.
The question is can you beat these factors? There is little that may be done for genetic factors and ethnicity yet, but you can certainly beat the factors that are in your own hands. Healthy and nutritional diet of a pregnant mother,adequate physical exercise from early childhood to late adulthood and extremely carefully planned lifestyle management and food habits can together do wonders in this area. This needs considerable education, training and counselling of not only pre-diabetics or high risk individuals but the entire community, because in the metros every fifth person is a potential diabetic or has diabetes.
Who are pre-diabetics?
These are the people who do not have blood sugar values fitting into definition of diabetes, i.e. fasting blood glucose more than 126mg% and post prandial more than 200mg%. But there are some people who have fasting blood glucose less than 126mg% but post prandial more 140mg% and less than 200mg% , this group is said to have Impaired Glucose Tolerance(IGT). This condition is thought to be a fore runner of diabetes and needs to be treated as they have the same complications as the diabetics, particularly of Coronary heart disease.
Gestational Diabetes Mellitus(GDM)
GDM is typically abnormal blood sugars which occur during pregnancy and the blood sugars become normal after the delivery, however the criteria to diagnose this condition are more stringent. Fasting blood sugar is less than 90mg% and post glucose sugar is less than 125mg%. There is another yardstick of control of diabetes known as HbA1C, which in a non pregnant is less than 6% while in a pregnant women it should be less than 5.5%. If these patients do not watch their weight and nutrition after delivery they run the risk of developing diabetes later in their life.
Other risk factors which need to be watched as fore runner of diabetes are young people with hypertension, abnormal lipids and heart disease, and young girls who have polycystic ovarian disease (PCOD).
As you know the number of diabetic patients in our community is the tip of the iceberg, globally this affects 387 million people and by 2035 this will rise to 592 million. It has already claimed 5 million deaths in 2014. So you can imagine the real extent at which all the communities are affected.
How can you beat this?
We have an approach which is based on the slogan of Diabetes Association of India ‘Treatment of diabetes is in your own kitchen’. Broadly it can be classified as :
You can beat diabetes with diet. Though this method is considered to be the cornerstone of the treatment, it is the most neglected and ill understood form of therapy. Most of the myths about diet and nutrition are driven by the advertisement world and nutraceuticals that thrive on the ignorance of the community and food faddism. Much of the information dished out through the media need serious scientific endorsement. This is coupled with certain cultural practices across our country which has diversity of a very unique nature.
India is a country of festivity and we are typically secular when it comes to celebrating festivals. In Mumbai all of us enjoy foods prepared on Eid, Holi, Pateti, Christmas and Baisakhi with the same zeal and enthusiasm but rarely follow the principles of ‘Chaturmas’ like Hindus or ‘Ramadan’ like Muslims or ‘Parushan’ like Jains. All our functions from sacred thread ceremony to Dusshera are loaded with ‘punch pakwans’(multiple sweet dishes).
You cannot separate culture from eating habits and therefore the grip of good food which is not necessarily good for health and detrimental to the human body has taken its toll and hence an epidemic of diabetes, heart disease and cancer. This is further fuelled by the fast food industry and media which is heavily promoting energy dense drinks, shakes, colas, chips and burgers. Young children are eating this purely because of peer pressure and are not willing to eat home cooked food. This is the reason for rising childhood obesity and type 2 diabetes among the very young between the age group of 12-18 years.
Diet to beat diabetes
High fibre lacto vegetarian diet is recommended, with 50% carbohydrates, 30% proteins and 20% fats. Most of the carbohydrates should be complex such as cereals, multiple grains and legumes , fruits and milk. Simple carbohydrates like sugars and fine flours are to be strictly avoided. Proteins should be dereived from milk, yoghurt and sprouts for vegetarians and from eggs , fish and chicken for non-vegetarians but red meat should always be avoided.
There is a tremendous misunderstanding about these. Cholesterol producing fats create a certain chaos in people’s minds. Because of this cholesterol phobia people have stopped using saturated fats such as ghee, butter, yoghurt and coconut, which today is being recommended by all leading nutritionist. Infact, we recommend two teaspoons of ghee, two teaspoons of coconut and two teaspoons of oil that has low levels of omega 6 fatty acids. We discourage fried stuff, such as bhajiyas, chivda, sev and gathia and fat obtained from land animals such as beef, pork and mutton.
These are the basic principles of diet; however total calorific requirement and distribution should be individualised based on age,physical activity and physical status. The ideal marker for the right nutrition is the waist circumference which should not exceed 90cms for males and 85cms for females.
In my opinion this subject should be kept as a part of the curriculum in every syllabus. We have to encourage children to participate in outdoor sports for at least an hour every day, and screen time should be reduced to maximum two hour a day. Every person should make an effort to exercise for at least 40mins – every day at least 5 times a week. You don’t need to join fancy clubs or gyms or buy expensive gadgets such as treadmill or bicycle that are reduced to useless junk in a very short time. You can exercise even while doing household chores. Cleaning walls and windows, sweeping the floor, ironing and making rotis can give adequate exercise to housewives, if walking early morning or late evening is not possible. Busy men who cannot find time for brisk walking can use the staircase instead of elevators and try to walk while giving dictation or discussing business. If one makes a practice to combine socialising and leisurely activities with exercise, like many westerners, it will definitely improve the metabolism and will help to prevent diabetes and obesity.
There is no better exercise than brisk walking for 45mins at a pace of 4km/hr. A word of caution for people above the age of 35: you should undergo stress test prior to beginning the exercise as well as a detailed physical examination by a physician to rule out disease of bones and joints.
Be up to date. You can beat diabetes if you are well informed about the recent advances, but remember that all new drugs are not necessarily better than the older drugs that can still be used.
Diabetes leads to vascular complications affecting heart, limbs, eyes, nerves and kidney, and early diagnosis is the key to a successful combat with these diseases. Once the disease is well established it is difficult and extremely expensive to treat them, and this is when diabetes beats you and can even finish you! A periodic check-up of urine for micro-proteinuria, heart check-up from a cardiologist and eye examination from a retinologist are mandatory even you have no symptoms.
Dr. Anil Bhoraskar, Honorary Diabetologist, S L Raheja Fortis Hospital Mahim