Diabetes: A Bitter Truth

PUNE-BASED Dr Anjali Bhatt remembers a normal instance: of a patient she wishes to call ‘Sharma’. He was obese and diabetic, like 62 million other Indians who suffer with the disease, a figure which grew 442 percent from 1980 to 2014, according to the scientific journal The Lancet. One million Indians die with the nation contributing seven percent of all instances, of which Type 2 diabetes is the largest chunk, from this health scourge. Type 2, which is 20 times more prevalent than other forms like childhood diabetes (Type 1), is caused by a variety of reasons: surplus weight, a sedentary lifestyle, an unhealthy diet and just a family history of this.

Dr Bhatt, who operates at the Chellaram Diabetes Institute of Punerealised that Sharma had to be put on drugs for the rest of his life because he suffered from hypertension and high lipid levels. But she also had ideas not convince him to lose his calorie consumption by changing his diet? She and her coworkers had attempted this but faced resistance from patients. Explains Bhatt: “When we urge a low-carb diet to our own patients, the biggest challenge we face is that of ‘satiety’–in other words, the sensation of fullness after one eats. Typically, the Indian diet is very full of carbohydrates, may it be wheat in the northern parts of India or rice in the southern parts of India.”

Luckily, Sharma complied, which makes it possible for doctors to put him on a low-carb, high-protein diet by which, she says, fibrous foods which are low on a “glycemic index” proved beneficial. According to Harvard Health Publishing, brought out from the medical school of the university, this index assigns values to foods based on how slowly or quickly those foods cause increases in blood sugar levels. Sharma lost weight with his diet and could be removed the insecure class.

As the world braces for another Diabetes Day on November 14th, there are concerns about the financial and social costs of this illness that impacts people of working age in emerging markets like China and India than any other portion of the world. What compounds things is that the state of study in these states on the debilitating disorder that doctors describe as ‘portals’ to important disorders that can cripple numerous organs the mind. A senior Health Ministry official based in Delhi admits that “it is a gloomy picture as far as diabetes mellitus is concerned”. “We have a massive issue at hand and we are grossly unprepared to confront it,” says the official, “Just talking about it alone won’t help. Major attempt is to be able. Incremental measures don’t work. Huge sums might have to be put into research on the topic.”

A poll from the Chellaram Diabetes Institute in central India’s countryside says one in every 3-4 men is recognized as ‘high risk’. Doctors like Bhatt aver that suggested trends are more scary than the real amounts. They estimate that the amount of peoplewith diabetes in India is going to be 123.5 million by 2040, and experts are also worried about other kinds of diabetes: gestational diabetes which affects pregnant women. Diabetologists all over the world are equally concerned about misdiagnosing a new version as Type 2. According to most recent reports, Form 3c is caused by damage to the pancreas from inflammation of the organ or due to complications. Each type requires treatment, from medications.

The good news, though, is that path-breaking study is happening elsewhere, backing up sense that is common with evidence. In this subject, Dr Roy Taylor is a pioneer of sorts. He is widely credited with experiments which have shown that a low-carb diet helps reverse diabetes, a proposal that had largely been ruled from scientists. Dr Taylor, a professor at Newcastle University, UK, is a doctor with expertise and expertise in study on diabetes. He has been engaged in practical studies of diabetes cases ever since he qualified as a doctor in Edinburgh in 1976. He is the manager of Newcastle Magnetic Resonance Centre. Taylor elaborates on his work: “It showed for the first time which the inherent defects of poor insulin production and insulin resistance in the liver could be completely reversed to normal by a calorie-restricted diet.”

His subsequent work shows that the likelihood of reversal is dependent on the duration of diabetes, being outstanding in around 50 percent and the first few years . Along with a team, he has described why surplus fat in the pancreas causes cells to stop working and how this can be reversed. He goes on, “So I believe that it is ground-breaking, provided that many doctors believed the condition was lifelong, necessarily progressive and irreversible.”

Dr Bhatt, for the part, asserts that the Indian mindset towards diabetes as a disease requiring life-long medications to all patients wants to modify. She agrees that there will still be individuals with diabetes who will need drugs to stop complications associated with diabetes, but a recent onset of diabetes and people with obesity ought to be encouraged to make diet changes that are necessary. Back in India, according to the most recent statistics, 46 percent of diabetics are under 40 years old. And in a country where the children are malnourished, according to a poll by Assocham and E&Y, doctors rue that there is a low – carbohydrate diet a option in diabetes. Research by Chellaram Diabetes Institute finds this to be that diabetes can be wholly handled without drugs in select patients. “At exactly the exact same time, one ought to understand that this is a new idea and a great deal needs to be understood about complete reversal of diabetes along with diet. In addition, it goes without saying that a life-long adherence to a balanced diet is essential for continuing to get long-term consequences without which diabetes is very likely to come back,” says Dr Bhatt.

Besides diet, exercise is highly recommended to keep type 2 diabetes at bay. Gurgaon-based Shweta Rai Bajaj discovered after she was pregnant with her own daughter that she had gestational diabetes. It turned out to be a wake-up call for her. Following delivery, she chose to the gym and did a combination of yoga, weight-training and zumba to reduce her pregnancy fat and also to bring down her sugar levels. Hooked to the exercise regimen, she moved on to become a fitness coach herself and gave up her occupation. She recommends weight training apart from aerobic and yoga exercises for diabetics.

That almost half of all Indians afflicted with type 2 diabetes are comparatively young is an indication of all things wrong with public health in the nation, says that the Health Ministry official. Union Health Minister JP Nadda didn’t respond to queries on what the Government intends to do to manage the diabetes burden of the country. He has remained silent on myriad instances of health dangers.

Santosh Bhat, currently data sciences and analytics leader at mobile entertainment program Hotstar, was only 27 when he was diagnosed with type 2 diabetes through a regular medical check- up in India, soon after he had returned from his stint in the US where he was more or less a couch potato whose customary diet comprised doughnuts and endless cups of coffee. When he took up marathon running now 41, Bhat has been under heavy medication until five years ago along with his wife put him on a strict diet that’s almost free of wheat and rice. “I am still on drugs, but I have reduced it a whole lot,” says the Mumbai-based senior executive, emphasising that he runs 10 kilometers for five days and does yoga for two days weekly. If he was diagnosed with diabetes 13 years 14, he was shocked. “When you are that young, you don’t take things seriously. It’s when you touch 35 which you start realising a long time of medication have also taken a toll on your wellbeing,” he says, adding that he now eats five meals each day. All foods are chosen for glycemic index. His breakfast consists of pulses, moong dal (green gram), idlis made from non-rice components and so forth. At 11 am, he eats sprouts, fries; for lunch he consumes 2-3 rotis made from millets like jowhar (sorghum), ragi (finger millet) and bajra (pearl millet). The day’s meal contains fruits. For dinner, he eats rotis and flour made of grains and mixed. “My blood sugar level under reduced medication is now regular,” Bhat says.

That almost half of all Indians afflicted with type 2 diabetes are young is an indication of all things

There is, according to a pilot study from the Chellaram Diabetes Institute, A LOW-CALORIE DIET around 1,000 Kcal daily. Possibly although such a diet, it says normalises blood sugar levels also reverses the changes. Dr Bhatt and others inside her team insist that a whole lot of study is in order.

Newcastle University’s Dr Taylor says that there are “too many” local Indian foods which are low in carbs, high in fibre and still inexpensive. According to him, the issue with the Indian plate is that individuals have a tendency to overeat rice, chapattis, etcetera. “As a guide, if someone has put on weight since their early twenties, then they’ve become fatter than perfect and may be at risk of diabetes. Weight gain is not a indication of health and wealth; it is a indication of possible problems.”

As with low carb foods with low glycemic index, rich Indians and middle classes opt for ‘desired’ foods like oats and quinoa without caring for cheap choices. The Indian plate do change from being elevated on carbohydrates to being rich in fibre, and so, help lower blood sugar levels post meals. A diet does wonders for those in the stage, who, according to Mayo Clinic, are people who have blood sugar levels higher than normal but not high enough to be classified diabetics. ‘Without lifestyle changes, individuals with pre-diabetes are very likely to advance to type 2 diabetes,’ it says in a statement. According to the web site of the practice, ‘A possible indication that you may be at risk of type 2 diabetes is darkened skin. Areas that are affected can include the neck, armpits, elbows, knees and knuckles.’ According to the website, classic symptoms and signs that suggest you’ve transferred out of include increased thirst, frequent urination.

Noted Bangalore-based heart surgeon Dr Mukundan Seshadri has lots of diabetes patients. He suggests that a strict diet, starting with excluding rice from the plate. He recommends a diet containing 50 percent non-starchy veggies, 25 percent protein and the rest that contains everything. As opposed to rice, barnyard millets are suggested by him to pre-diabetics to a mix of barnyard and foxtail millets along with diabetics. “For people who are potentially diabetic, any of the millets is nice,” he says. If someone confronts satiety’s standard issue and is hooked to rice/wheat, he prescribes brown rice; and wheat with additives like wheat bran or soya flour. “Of this, 15-20 percent ought to be additives,” he says. Dr Seshadri is kicked like Chia seeds and flour, too, about foods. “Once inside, Chia seeds grow up to 20 times its size and you are inclined to eat less,” he says. The issue is the concomitant munching on fries and consumption of sodas as with alcohol, he adds. The surgeon lays significance on the diet of one compared to exercise in diabetes that is combating.

THANKS TO SCIENTIFIC collaborations and expertise, James Joseph, a former Microsoft manager who’s now a jackfruit evangelist, has over the past several years discovered that jackfruit flour is a far more powerful and economical indigenous alternative to comparatively expensive imported foods such as oats and quinoa and similar goods. In a country like India where the use of vegetables and fruit would be the lowest in the world despite being among the producers, Joseph feels it is crucial to tap resources inside the nation.

He began to tie up to find that jackfruit is at least 40 percent lower in carbohydrates, 40 percent less in calories and 100 percent more in fibre than rice or roti. It was about this time he came across a study in the Ceylon Medical Journal confirming lower glycemic values for its green jackfruit meal.

As luck would have it, the late Dr APJ Abdul Kalam came across his book titled¬†‘God’s Own Office’¬†–Joseph’s office in Aluva is also has the exact same title–along with also the former President invited him for a meeting where he shared the information he had accumulated about green jackfruit. Kalam told me, “That is pure science; a high-fibre meal always translates to low absorption of sugar. But what’s new here is the fact that it is possible to eat an unripe fruit for a meal.” Due to high acidity, many fruits can’t be consumed at an stage in volume.

Within a eventful year, Joseph, with the support of scientists, developed a prototype flour from green jackfruit which has a binding variable between rice wheat and wheat flour and can replace one third of almost all dishes prepared with wheat flour, rice flour or batter, with no change in flavor or texture. “Along with lower calories and reduced carbs, we could achieve higher soluble fibre than oats,” Joseph adds.

By the end of 2015, Joseph, a qualified engineer, secured financing for his project and within months finished a glycemic study at the world’s greatest in GI Sydney University Glycemic Index Services (SUGiRS), also proved that his product–jackfruit flour–had half glycemic load compared to rice or rotis. Out of jackfruit, he and his team of engineers developed a more process machine in June 2016 to flour to decrease processing cost considerably. This June, he launched his product, green jackfruit flour, which is available at Spar Supermarkets, Amazon, Big Basket, amongst others and through orders.

As regards other average low-calorie, high-fibre foods which are competition to jackfruit flour in terms of affordability, he says that all green fruits and veggies (except wheat roots) which can replace wheat or rice as a major meal are all cheap choices in rural India. “Our problem is over-consumption of starchy roots and grains and lack of consumption of vegetables and fruits. Greens have become cheaper than processed grains, especially for the urban poor,” he points out.

The Health Ministry official contends that experts have pointed out the need for comprehensive studies on diabetes in India because the prevalence of diabetes varies according to areas. He estimates a report titled ‘The present state of diabetes mellitus in India’ from Seema Abhijeet Kaveeshwar and Jon Cornwall. The authors state, ‘…despite the prevalence of diabetes within India, there are no nationwide and few multi-centric studies conducted on the incidence of diabetes and its complications. The studies which were undertaken are also prone to malfunction since the heterogeneity of the Indian population with respect to culture, ethnicity and socio-economic states, mean that the extrapolation of regional consequences may give inaccurate estimates for the entire nation.’

“Like jackfruit flour that folks talk about nowadays, we could even tap our herbal prosperity from throughout the nation to find cheap substitutes to unaffordable low-carb foods to fight the menace of diabetes,” he asserts.

As the former director general of Indian Council of Medical Research (ICMR), Dr Soumya Swaminathan herself had raised worries regarding the burden of the disorder on India that could potentially blunt our demographic benefit. As Deputy Director General of Programmes at the World Health Organization, it is time she puts her ideas.

Ancient Indian doctor Sushruta and physician Charaka had first identified two sorts of diseases characterised by madhumeha (honey urine) which brought ants–later referred to as type 1 and type 2 diabetes. Considering this ailment’s knowledge has been in existence for centuries, what’s currently playing out in India today is sheer irony.

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