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Magazine
Lifestyle matters
DR. RANJIT UNNIKRISHNAN AND DR. V. MOHAN
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With World Diabetes Day round the corner, it is time to focus on making healthy changes to one’s life.
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Diabetes mellitus is the foremost among the lifestyle diseases i.e. ailments brought about WHOLLY OR in PART by patterns of human behaviour.
CYCLE AWAY: The most potent insulin sensitiser known is exercise.
In the seventh decade of independence, India finds itself at the threshold of far-reaching changes. After decades of under-achievement, the country is poised to join the ranks of the developed nations. As India’s population urbanises and its ec
onomy develops, the country is also experiencing an “epidemiologic transition”. Infectious diseases, which were the bane of India, are making way for a new crop of “lifestyle diseases”.
Foremost among these is diabetes. The rapid rise of diabetes in India has been well recognised. In 1971, the Indian Council of Medical Research estimated the prevalence of diabetes in urban India to be around two per cent.
In 2001, the Chennai Urban Rural Epidemiology Study (CURES) reported a prevalence of 14 per cent in Chennai city, representing a staggering 700 per cent increase in the prevalence rates. The situation is similar in other urban areas in the country. The rural areas are also fast catching up!
Worrying
This rapid increase is worrying. A chronic disease, diabetes can affect almost any organ in the body, leading to heart attacks, blindness, kidney failure and amputation.
Another worrying aspect in India is that the disease tends to affect younger individuals, implying that most Indian diabetics belong to the productive age group, with grave repercussions to the family and the country, not to mention the human suffering involved.
Why are Indians so prone to diabetes? Genes certainly play a role. Studies from the U.S. and Europe have noted that Asian-Indian migrants have higher prevalence rates of diabetes than the White population. Another study discovered that certain genetic patterns (polymorphisms) that protect against diabetes in Whites do not appear to offer the same benefit in Indians. However, genes alone cannot explain the diabetes epidemic.
For one thing, genes do not change in 30 years, in which time there has been a quantum leap in the prevalence of diabetes. Similarly, both urban and rural Indians have the same genes, yet the prevalence of diabetes in urban India is much higher than in rural India. This suggests that changes in the environment and lifestyle have had a major role to play.
It has been rightly pointed out that the major diseases of the 21st century are “affluenza” and “sedentarianism”. These two “syndromes” are the main causes of the diabetes epidemic in India. It is obvious that the process of urbanisation and material enrichment of Indian society will continue into the foreseeable future. The challenge is to marry our traditional healthy Indian lifestyle to the hustle and bustle of the modern information age. This will have to target the younger generation as torch bearers in the movement for a healthy future; otherwise “New India” risks becoming a victim of its own success.
Diabetes mellitus is the foremost among the “lifestyle diseases” i.e. ailments brought about wholly or in part by patterns of human behaviour. Initiating healthy changes to one’s lifestyle constitutes one of the important pillars of treatment. Without a well-thought out plan of diet and exercise, any diabetic treatment plan is futile.
Diet
A diabetic diet is not a drastic departure from a normal diet. A diabetic individual can consume most items of food that a non-diabetic can. The most important aspect in planning any diet lies in estimating the energy balance. This indicates the relationship between an individual’s energy intake (from food) and his energy expenditure (for maintaining bodily functions as well as energy expended in exercise).
Long-term energy intake in excess of expenditure leads to obesity and insulin resistance, making diabetes more difficult to control. Weight gain also has deleterious effects on blood cholesterol and blood pressure.
An individual’s energy needs (calorific requirements) are calculated based on body size and occupation. Groups like children and adolescents and pregnant women have higher caloric requirements.
The ideal sources are complex carbohydrates like “brown” rice, whole wheat bread, supplemented with pulses and legumes. Roots and tubers should be used sparingly. Sugar, honey, jaggery and sweets and refined processed foods are best avoided.
Foodstuffs rich in saturated fat like butter, ghee, coconut oil and palm oil should be restricted. Groundnut oil, gingelly oil, rice bran oil and mustard oil are preferable. Hydrogenated vegetable oils are to be avoided, as they are rich in trans fatty acids.
Protein from vegetable sources, low fat milk and milk products, fish and lean meat are preferable. High protein intake from animal sources should be avoided.
Dietary fibre helps to bring down blood sugar and cholesterol, induces satiety and prevents constipation. Fruits like papaya and guava can be taken in moderation (one or two helpings). However, extremely sweet fruits like mango are better avoided. Alcohol, in moderation, is not harmful (unless blood sugars are totally out of control or there is liver disease) but smoking must be avoided. Thus, only very few food items are absolutely forbidden. With some common sense and imagination, one can prepare a wholesome and appetising meal.
In Type 2 diabetes (earlier called non-insulin-dependent diabetes), which is the most common form of the disease, there are basically two problems: deficiency of insulin in the body and resistance of the body to insulin. In the early stages, when treatment is most effective, insulin resistance predominates. Hence, treatments that sensitise the body to insulin are particularly effective at this stage.
Exercise plan
Photo: AFP
Wholesome and appetising: Add vegetables and fruits to your diet.
The most potent insulin sensitiser known is exercise. Regular exercise brings down the body’s requirement of insulin, allowing it to manage with what little insulin is available. In the later stages, exercise helps bring down the doses of insulin injections as well as tablets. Exercise has other benefits as well.
What sort of exercise should a diabetic patient do? The minimum exercise recommended is 30 to 45 minutes of brisk walking, at least five days a week. Walking, running, jogging, swimming and sports and games are equally beneficial. The type of exercise and the time of day when it is done are immaterial; what matters is doing it regularly.
An exercise programme should be begun in consultation with the physician, especially before starting high endurance exercises. Each session should begin with a warm up period and end with a cool down period. Individuals with advanced diabetic eye disease or cardiac disease should avoid strenuous exercise.
Correct defects
Many of us, not just diabetics alone, are victims of a disease called “excusitis” that forces us to find excuses for skipping our daily round of exercise. But with a little effort, everyone can increase their level of physical activity.
Diabetes is a disease brought about by defective lifestyle. Successful treatment of diabetes depends on correcting these defects as completely and as early as possible. This will help a diabetic individual to keep his blood sugars as close to normal as possible and prevent him from developing life-limb-organ-threatening complications.
Increase daily activity
Choose a long way to walk
Use the staircase not the lift
Park the vehicle farther away and walk the rest of the distance
Benefits of exercise
Reduces blood sugar
Reduces blood pressure
Reduces triglycerides
Reduces weight and body fat
Increases HDL cholesterol
Reduces LDL cholesterol
Tones up muscles
Strengthens heart and circulation
The writers are Chennai-based diabetologists.
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