We have outsourced our food choices to massive global corporations. They’re deciding what goes into their products and, therefore, what goes on in our bodies. In this way, decisions made in faraway corporate boardrooms are causing cascades of biological changes to happen inside us – changes that could cause pain, stress, infirmity and even shorten our lives. This might sound melodramatic but it is, nevertheless, unarguably true.
Take sugar. If you’re eating processed or pre-packed food there’s a very good chance that your intake of the sticky white stuff is through the roof. Simply to gain the very tiniest imagined advantage over their rivals. Sugar is finding its way into more and more of our foodstuffs, and it’s we who end up paying, not only at the tills but also with our health. Type 2 diabetes is now at genuine crisis levels.
A part of the problem is that over consumption of sugar seems to alter our taste buds. As they become used to it, our bodies crave more and more. Many years ago, I used to have sugar in my tea. When I first tried it without, the taste was disgusting. But fast forward a few weeks, I accidentally picked up someone else’s sugared tea at work and almost spat it out.
This issue of Good Vibes, 2nd of the series of 4, on all things food, is highlighting about the current number one health problem the world is facing – Diabetes. Avoiding processed sugar can be a game changer in your journey to a good health. We also have experts’ columns by Dr Rahul Baxi, Dr Uday Singnapurkar and Ritesh Bawri and a recipe by Pramila Mundra in this volume.
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Our unrelenting consumption of sugar, whether it’s an obvious component of a bag of sweets or hidden way down the ingredients list in our supermarket wholemeal bread, sets us off on a blood-sugar roller coaster. If you start the day with foods that are either high in sugar or are converted in your body to sugar (foods like white bread and breakfast cereal), your blood sugar soars and you go into a fuzzy high. Two to three hours later, however, it crashes. Then you’re craving sugar again.
If we don’t get our sugar consumption managed properly, there’s a serious risk we’re going to end up damaging our health. There’s a strong likelihood we could even end up with type 2 diabetes. The important thing to know about this disease is that by the time you end up with a diagnosis, things would have been going wrong in your body for several years already. It’s not something like a chest infection, in that you have it or you don’t. The formal diagnosis comes only when you pass a certain arbitrary point along a scale. This, in a nutshell, is how it works. One of the body’s key functions is to keep blood sugar within a tightly controlled range. When you consume sugar or foods that are quickly converted to sugar, such as most supermarket bread and bagels, your body pumps out a tiny dose of a hormone called insulin to bring your levels back to normal. The problem is, if we’ve been abusing this system for a long period of time, our bodies become resistant to this tiny dose of insulin, needing more and more of it to have the same effect. In high amounts, insulin is toxic. Your body is now poisoning itself. When this poisoning gets to a certain level and your blood sugar can no longer be adequately controlled, we call it ‘type 2 diabetes’. But that’s just the end stage of a long process that’s been going on for years.
TYPE 2 DIABETES
There are many factors, in addition to excessive sugar consumption, that contribute to the development of insulin resistance and type 2 diabetes.
They include:
- Too much highly processed food
- Physical inactivity and low muscle mass
- Sleep deprivation
- Persistently high stress levels
- Disturbed gut bug ecosystem
- Low levels of vitamin D, usually caused by lack of sunshine
- Environmental toxins
Many patients will have more than one contributory factor, which is why a 360-degree approach to health is so important. If a diagnosis of type 2 diabetes has already been made, there are some special dietary considerations that should be followed. Diabetics have a relatively low tolerance of carbohydrates, particularly refined carbohydrates. Periods of fasting can be very helpful in reducing insulin and sugar levels.
Note – if you are type 2 diabetic and on medication, you must consult a healthcare professional before making significant changes to your diet such as prolonged fasting.
A great many of us, after years of gorging sugar and junk, have unknowingly become insulin resistant. This means they’re already insulin resistant, to a certain degree. They’re being poisoned, they just don’t yet realize it. But sugar’s doing more than just giving us type 2 diabetes. As we have just learned, sugar increases our insulin levels and one of insulin’s main roles is to direct fat storage. It tells our bodies to hold on to fat by storing it, so more insulin means we’re heavier. Chronically raised insulin levels have been associated with:
- Obesity
- Increased levels of VLDL – a particularly harmful form of cholesterol
- Raised blood pressure owing to increased retention of salt and water
- Increased breast cancer risk
- Raised testosterone levels in women, which is associated with conditions such as polycystic ovaries
Try to purge your house of all sugars, both hidden and obvious. We all crave sugar. So what do you think is going to happen when you come home after a bad day at work, stressed out? If that packet of biscuits or chocolate is sitting in the cupboard, do you really think willpower will be enough? Every day, every week, every month? Hell, no! You will crack.
- Plan limited social engagements for the first two weeks; these are the hardest times when cutting out or reducing sugar intake. Being around other people, and their chocolate and Jalebis, can be a big source of temptation
- Keep healthy snacks readily available at home, at work.
- Remove artificial sweeteners; you need to retrain your taste buds, and artificial sweeteners will sabotage that process by maintaining your damaged sense of what sweetness really is
- Include some protein in every meal: meat, fish, eggs, nuts and/or seeds; protein keeps you feeling full for longer, which helps avoid sugar cravings
- Be prepared – get into the habit of keeping emergency snacks with you; when travelling, I will take with me some nuts and seeds, which help me to resist temptation
Take back control of your taste buds and tune in to your body’s innate signals. If you want that Gulab Jamun, enjoy it, but have it once in a while – and no more. Just ensure that you eat it with the conscious knowledge that you’re having sugar.
by Dr Rahul Baxi
I saw a patient recently with a fasting glucose of 210 mg% and a postmeal glucose of 325 mg%
Me: Sir, since how many years you have diabetes?
Patient: I had ‘borderline diabetes’ since five years. I was not on any medicines, only some diet changes. I don’t know how it went so high now.
Me: Did you check your glucose levels in the past five years?
Patient: No.
What is this ‘borderline diabetes’?
Medical term for so called ‘borderline diabetes’ is “Prediabetes”.
Prediabetes is a term used for individuals whose glucose levels do not meet the criteria for diabetes yet have abnormal carbohydrate metabolism.
According to a study, the estimated prevalence of Prediabetes in India is 14% and that’s just those who have been tested. These are staggering figures. There are no symptoms ( prediabetes is asymptomatic) so many may have prediabetes but do not realise unless they check for it. Prediabetes is a risk factor for progression to diabetes and cardiovascular disease. It may be associated with obesity, deranged cholesterol levels and hypertension (high blood pressure).
Criteria defining Prediabetes
Impaired fasting glucose (IFG) – FPG 100-125 mg%
Or
Impaired Glucose Tolerance (IGT)- 2 hr PG during 75 gm OGTT 140-199 mg%
Or
HbA1c 5.7 to 6.4 %
(FPG- Fasting Plasma Glucose, 2 hr PG- 2 hr Plasma Glucose, OGTT- oral glucose tolerance test)
*For all three tests, risk is continuous, extending below the lower limit of the range and becoming disproportionately greater at the higher end of the range.
Who should get tested for Prediabetes?
One can use this assessment tool online by ADA https://diabetes.org/socrisktest (in the end, click view results online)
Diagnosed with Prediabetes. What next?
If you have been diagnosed with prediabetes, you are at higher risk of CVD (cardiovascular disease), heart failure and stroke. Also, you have a high risk of getting diabetes, unless you make significant lifestyle changes.
You need to check glucose levels at least once a year.
There are effective interventions that prevent progression from Prediabetes to Diabetes.
Toolkit for Diabetes prevention:
- An intensive lifestyle behaviour change program to achieve and maintain 7% loss of initial body weight and increase moderate intensity physical activity (such as brisk walking) to at least 150 min/week.
- Appropriate dietary modification preferably under the guidance of a qualified Dietitian should be considered. Portion control, reducing sugar intake, increasing fibre rich foods in diet and having a diet low in carbohydrates and rich in proteins are important.
- Evidence suggests that overall quality of food consumed with an emphasis on whole grains, legumes, nuts, fruits and vegetables and minimal refined and processed foods is associated with lower risk of type 2 Diabetes
- Lifestyle behaviour modification programs for diabetes prevention are cost effective.
- No pharmacologic agent has been approved by the US FDA specifically for diabetes prevention. A drug called Metformin has some evidence and long term safety for diabetes prevention, though risk vs. benefit must be considered for each case.
- Inadequate sleep can interfere with insulin function. There is an association between sleep quality and prediabetes. A study recommends 8 hours of sleep each night to reduce the risk.
So, if you get a fasting glucose tested, normal is upto 99 mg% or below. 100-125 mg% is impaired fasting glucose and 126 mg% or above is diabetes. Similarly, for 2 hr post meal (post 75 gm glucose test), normal is upto 139 mg%, impaired glucose tolerance if between 140-199 mg%, and diabetes if above 200 mg%. Similarly, HbA1c levels of 5.7 to 6.4% will define prediabtes in a patient, and 6.5% or above is diabetes. Similar to glucose measurements, the continuum of risk is curvilinear, so as A1C rises, the diabetes risk rises disproportionately.
References
American Diabetes Association Professional Practice Committee; 2. Classification and Diagnosis of Diabetes: Standards of Medical Care in Diabetes—2022. Diabetes Care 1 January 2022; 45 (Supplement_1): S17–S38. https://doi.org/10.2337/dc22-S002
American Diabetes Association Professional Practice Committee; 3. Prevention or Delay of Type 2 Diabetes and Associated Comorbidities: Standards of Medical Care in Diabetes—2022. Diabetes Care 1 January 2022; 45 (Supplement_1): S39–S45. https://doi.org/10.2337/dc22-S003
Dr Rahul Baxi is a Consultant Diabetologist working at Bombay Hospital, Mumbai. He completed his MD (Medicine) from Nagpur University in 2008. He has worked as Assistant Professor (Medicine) in Nair Hospital and TN Medical College, Mumbai and then as a Post Doctoral Fellow in Diabetes in CMC, Vellore. Having worked in Alexandra Hospital and NTFGH (NUH) Singapore for seven years, he joined Bombay Hospital in 2019. He has keen interest in management and prevention of Diabetes.”
You can connect with him on twitter @baxirahul
by Dr Uday Singnapurkar
Diabetes is a global epidemic now, which according to the WHO, will be the 7th leading cause of death by 2030. This silent disease is a growing threat to health worldwide. While a lot of information about diabetes is generally available in public domain, there’s very little awareness about the oral manifestations and complications of diabetes.
The link between diabetes and oral health problems is high blood sugar. Uncontrolled diabetes weakens the white blood cells which are the body’s first line of defence leading to infections in the oral cavity. Effective control of blood sugar helps decrease the likelihood of major complications due to diabetes in multiple organs like heart, lungs, kidneys, eyes as well as the oral cavity.
The most debilitating effect of diabetes in the oral cavity is on the periodontium i.e the structures supporting the teeth – gums and bone. Regardless of the severity of plaque accumulation in a person’s mouth, patients with diabetes experience various degrees of gingivitis, periodontits (commonly known as pyorrhea) and bone loss around the teeth. Periodontitis is characterized by bleeding or swollen gums, pockets between and around the teeth where food can easily get lodged and tooth mobility. These characteristics are more severe with uncontrolled diabetes.
There is recent evidence which indicates that the bacteria that enter the bloodstream as a result of gum disease, contribute to insulin resistance and destruction of pancreatic islet cells, which are responsible for making the hormone insulin which helps control blood sugar levels.
Another common complaint of diabetic patients is that of dry mouth which can be a result of excessive blood glucose associated dehydration or impaired function of the salivary glands. In the long run, dry mouth can lead to dental caries, gum diseases and bad breath, oral ulcers and taste disturbances.
Oral fungal infections occur with greater frequency in poorly controlled diabetes. Burning mouth is a common symptom in diabetic patients with fungal infections. Smokers who are diabetic are twenty times more likely to develop fungal infections and gum diseases.
In conclusion, as with other body systems, diabetes has a detrimental effect on the oral cavity as well but with proper care, good oral hygiene practices and regular checkups, diabetics can avoid all major dental and oral complications of diabetes.
Dental and oral surgical treatment in Diabetic patients needs to be done with proper care and multiple precautions pre – procedurally, during the procedure and post-operatively. Poor healing of oral tissues after surgical procedures is a major cause of concern in diabetic patients.
It is therefore imperative for diabetic patients to maintain strict oral hygiene by brushing twice daily and prevent plaque buildup by flossing. Regular check ups with the dentist are a must to prevent dental and oral diseases due to diabetes and to undergo routine oral prophylaxis. Patients must also consult their dentist about how regularly they would need dental checkups. Denture wearing diabetic patients must take special care and remove and clean their dentures regularly.
Smokers and other tobacco product addicts must consult their doctors to quit the habit. Diabetes and tobacco make a deadly combination.
Dr. Uday Singnapurkar completed his Bachelor’s degree in Dental Surgery from SPDC, Sawangi ,Wardha in 2000 and has done multiple courses on cosmetic dentistry. He runs two Dental and Oral Health care centres in Nagpur. You can find him on Twitter @MindExcavator
by Ritesh Bawri
Fasting when you have Type II Diabetes seems counter-intuitive. When you have diabetes, your sugar levels are high – both your morning fasting and your long-term average. At the same time, you run the risk of your sugar levels falling too much as you medicate yourself with insulin. Without realizing it, you could end up giving yourself too much insulin, which would cause a dramatic drop in sugar levels. You are now hypo-sugar, a dangerous condition. Your Doctor would ask you to eat something, probably sugar to raise your sugar levels. With such risks lurking, how on earth can you fast?
In a study done in Toronto, three patients checked into a hospital to undergo fasting for thirty days to help with their diabetes. The patients were given a calorie-restricted diet. Each followed their own version of fasting, choosing alternative days or limited meals, depending on preferences. All of them were taught how to monitor their sugar levels and also adjust insulin dosage to compensate for the lack of food. At the end of the thirty-day period, their sugar levels were tested. All three patients showed a reduction in their long-term sugar (HbA1c) levels and were able to reduce or eliminate their need for insulin. What just happened?
Across studies, research has shown that fasting is a protocol that helps people reduce their sugar levels and insulin dependence. A restriction of calories helps the body reduce weight, primarily body fat. Body fat is nothing but stored sugar. As the stored sugar levels fall, your body is now able to better process the sugar in your blood, reducing your overall blood sugar levels. Your sugar just went down.
If you fear that your sugar levels will fall, you can quickly eat sugar to compensate as long as you stay within your restricted-calorie diet. In fact, most people reported not needing the sugar after a few days of fasting. Fasting Diabetes Away is entirely possible
NB: Type II Diabetes is a severe ailment. If you chose to fast in such a state, make sure that you have access to medical supervision.
Ritesh Bawri is a global influencer on health and wellness. He has a certificate in Physiology from Harvard Medical School, Nutrition from Stanford Medical School and Tufts University. He has a weekly video and daily blog with ~ 8 million views per annum from 155 countries. Seven years ago, he successfully reversed his own Type II Diabetes, Hypertension, Bronchial Asthma, Hyperacidity and Sleep disorders. Since then, he has helped thousands of people from all walks of life do the same.
You can find him on Twitter @rbawri. www.riteshbawri.com
QUINOA DAL KHICHADI
by Pramila Mundra
Serves :4 people
Ingredients :
- Quinoa – half cup
- Yellow mung dal – 3/4cup
- Green mung dal – half cup
- Ginger – 2-3 tsp ( grated )
- Jeera (cumin seeds) – ½ tsp
- Turmeric powder – ¼ tsp
- Peppercorns -5-6
- Crushed pepper- few
- Green chilli -1 (optional)
- Bay leaves -2
- Cloves -2
- Ghee – 2 tbsp
- Cashew roasted – handful
- Veggies – of choice
METHOD:
Wash quinoa and dal and soak in water. Heat Ghee in a cooker, add jeera seeds, peppercorns, cloves and bay leaves. Next add turmeric powder, green chilli and ginger and any vegetable of choice ( beans, carrot, broccoli, lauki etc ). Sauté a bit and then add the soaked Quinoa and Dal. Add salt to taste and 6 cups of water and pressure cook for 3 whistles. Use the same cups as used to measure the dal.
Once cooked, garnish the khichadi with roasted cashew nuts and thinly sliced ginger slivers while serving.
Pramila Mundra is a Nutritionist, with a Masters Degree in Food Science and Nutrition. The key aspect of her approach is to handle health issues mostly by correcting the food choices and lifestyle. Her Meal planners and program are customised and holistic as per the individual food likings, work routine and limitations. She runs her own Health clinic at Adarsh Palm Retreat, Bangalore You can find her on Twitter @PramilaMundra
It’s been a great start of the Challenge. Enthusiasm of the participants is commendable. Many have managed two hours of activities everyday, some even in extreme cold. Many, who hadn’t been exercising for a while, are very happy to get back into the discipline, even if simply walking for 3/6/9km.
If you feel low on motivation to exercise, some of the tweets with #AdmireYourself will surely inspire you to beat the lethargy.
“Challenge done for the day with 121 km cycling on chilly wet morning. My longest so far”
“Run my first km after more than 6 months, thanks to 100 Day Challenge”
“Love for dance is growing”
“Getting better everyday”
“Temp says 5 degrees. Running is meditation on adrenaline. Push the limits. Get rid of the shackles. Keep showing up”
“Go beyond your limits. Strong headwinds and crosswinds. I am going all out this time. Not just to win the challenge but to come out and remain a better person”
“My first ever 2km run. Little pain with so much gain”
Tweet your Challenge updates and stories with hashtag AdmireYourself and inspire others in the tribe.
A gentle reminder to update your exercise data regularly.
In every issue of Good Vibes, during the challenge, we will randomly feature one participant – FITstar of the week, briefly sharing his/her story of determination to maintain fitness discipline.
FITstar of the week – Sameer Oak
Sameer Oak, a Veteran Submariner in Indian Navy.
One of the most active and disciplined participants of the first 100 day challenge, Sameer’s enthusiasm in the ongoing challenge is commendable and truly inspiring. Oak who claims to have already achieved better aerobic fitness, mobility and reduction of RHR, has set an ambitious goal this time round. He aims to maintain the average of 10000 daily steps, and 90-120 mins of strength training, essential for swimming, cycling and running.
Oak takes his daily dose of motivation from fitness experts like Sandeep Mall, Aseem Anand, Adil Nargilwala and A Khawre, the cyclist. Once afflicted with Tuberculoma related seizures Oak takes anti epileptic drugs and hopes to get off medication one day. For the aspiring fitness enthusiasts, here is Oak’s succinct fitness mantra, “Show up for exercise daily, come what may. The only bad workout is the one you did not do.”
