World Diabetes Day - a day to reflect upon why India has become the diabetic capital of the world with 50.8 million (7.1%) of its people suffering from diabetes. It is high time we prepared to combat this menace and curb its spread. As the new President of IDF has rightly remarked that either we turn off the diabetes tap or else spend our lives mopping the floor.
We Indians are genetically more prone to diabetes. On top of this, a rapid shift in our dietary habits and life styles is resulting in a rapid rise in obesity, diabetes, metabolic syndrome and heart disease. Hence a proper and healthy diet remains the cornerstone of prevention and management of these diseases.
Perhaps the most important reason for increasing prevalence of diabetes, obesity and hypertension is the rapidly changing imbalanced dietary habits, both in rural and urban areas, due to several factors - easy availability of convenience foods, frequent snacking on energy dense fast foods, high consumption of packaged food in place of traditional home made food, etc. This transition has resulted in excess consumption of calories, saturated fats, trans fatty acids, simple sugars, salt and a low fibre intake.
This has necessitated a revision in the existing dietary guidelines prepared 10 years a go by the National Institute of Nutrition, Hyderabad, which was predominantly rural centric. So, more than 100 renowned experts, belonging to varied disciplines of health and nutrition, have got together under the aegis of Science For Equity and Empowerment Division (SEED), Ministry Of Science and Technology, Govt Of India and Diabetes Foundation (India), to formulate a "National Consensus on Dietary Guidelines for Adult Asian Indians for Healthy Living and Prevention of Obesity & Diabetes". They have incorporated worldwide research and opinions in nutrition modulated to India specific data. They are simple, easy to understand by doctors and common public alike, and provision of standard diet charts catering to different regions of India will help people from all parts of India.
According to Mrs. Rekha Sharma, former chief dietician AIIMS, New Delhi, "Researches done on the nutritional health of the Indian Population indicate a rampant increase in obesity and other NCDs, like diabetes, primarily due to faulty eating and sedentary life style. Hence, to keep up with the changing scenario of health, we need new scientific broad based dietary guidelines, tailor made to the eating pattern of the Indian population."
Dr Anoop Misra, director, Diabetes, Obesity and Metabolism, Diabetes Federation Of India, strongly feels that the application of these guidelines will significantly help in preventing and halting diabetes and obesity epidemic in India.
Countrywide adaptation of these guidelines is likely to have a significant impact on prevalence and management of more than 25 diseases, including diabetes and diabetes related diseases.
What are these dietary guidelines for healthy living and prevention of diabetes and obesity?
The energy requirement must be calculated on the basis of height, weight and activity level - a medium frame Indian male of 165cm height should weigh 62 kg, and if sedentary, would require 1850 K cal to maintain healthy weight.
The daily carbohydrate intake, derived from whole wheat, unpolished rice, barley, buckwheat, oats, millet, whole pulses, legumes, and whole fruits like guava/apple etc, should be around 50-60% of total calorie intake, that is 250-300 gm/day.
The total daily dietary fibre should be 25-40 gm. Hence high fibre food items like cereal, pulses, vegetables, salads, guava, amla, apple, pears, peaches etc should be eaten. In fact, 4 to 5 servings of fruits and vegetables per day are recommended.
Visible fat (oil, butter, ghee) and invisible fat (from cereals and pulses), together should be less than 30% of total energy. This can be got by consuming 4 to 5 teaspoonfuls of a combination of two or more vegetable oils. Correct cooking methods like boiling, steaming, roasting, grilling etc, instead of frying can minimize the visible fat intake.
Trans fatty acids should be less than 1% of the total energy. These are found abundantly in bakery products, ready to use soups and gravies and foods prepared in margarine and vanaspati ghee. Hence it is best to avoid these products.
Ideal protein intake is 1gm/day for every one kilo of body weight. Thus for the average Indian male, this could be obtained from two bowls of cooked pulses, or 2 pieces of lean chicken/fish meat, or 500ml of double toned milk, or 9 servings of wheat flour. This much of protein will provide 10-15% of the total calories.
Salt intake should be less than 5gm per day. So, we Indians need to drastically curtail the ever so popular consumption of salted potato chips (a big favourite of children), pickles, and salty fried snacks.
Sugar in very small amounts and water in excess (about 8-10 glasses) every day, should cap it all.
Apart from this, it is important to take small frequent meals at intervals of 3-4 hours. While eating out (which has become increasingly popular, even in small towns in India), one should choose small portion sizes of healthy snacks. Beverages like buttermilk, coconut water, and fresh lime with water are excellent substitutes for aerated and high calorie drinks.
If adopted, these guidelines can, perhaps, have a significant impact on prevalence and management of obesity, diabetes and heart diseases, and save the native Asian Indian race from the ravages of non-communicable diseases (NCDs).
A persistent and prolonged intensive lifestyle intervention could be the most effective tool to combat diabetes. At the same time, more effective drugs (and not glamorous pharmaceutical manipulations) are needed for those who cannot follow intensive life style therapy due to infirmity.
Emergence of obesity, diabetes and metabolic syndrome in developing countries like In
dia, is basically due to rural-urban migration, mechanization, open market economy, increasing affluence, improved food supply, dietary liberalization and westernization, and physical inactivity due to rapid pace of urban life, resulting in more sedentary work.
Leisure time activities have also shifted from outdoor activities to indoor entertainment, like television viewing and computer usage, both in children and adults. Also, women are generally reported to be physically more inactive than men, perhaps due to cultural influences on outdoor activities.
But what is of major concern is that children and adolescents are showing decreased physical activity which is fuelling obesity and type 2 diabetes at a very young age. There is a general misconception in Indian parents that an obese child is a healthy child and that feeding oils and clarified butter to children is beneficial to their growth and imparts strength. Another important factor is the parental pressure on children to perform well in academics at the cost of sports and other physical activities. Lack of play fields in schools and open spaces around homes, has further aggravated the problem.
Thus health interventions in both children and adults should be aimed at increasing the physical activity, along with healthier eating habits and health education. A carefully followed diet-exercise combination seems to work wonderfully in preventing or delaying the development of diabetes. This has been proved by a 10 year long Diabetes-Prevention-Programme (DPP) study, which has demonstrated the effectiveness of intervention programmes and changes in lifestyle in reducing the cost burden due to diabetes. This cost burden is imposed not only on the patient and her family, but also on society. There is loss in income and productivity. There are intangible costs in terms of pain, anxiety and suffering.
Programmes directed specifically towards children have shown encouraging results. These should be aided with individual and community health initiatives, backed up by government efforts. The government would do well to sell coarse grains like millets through its public distribution systems. Effective strategies for making and marketing healthy food snacks are needed to counteract the increasing sale of junk food. In fact, some kiosks on the Ahmedabad highway sell tribal health foods in attractive packaging. As eating out is becoming fashionable even in small towns, it is necessary for the food and hotel industry to churn out more healthy recipes and popularise them.
Diabetes Federation of India is running some nutritional awareness programmes in schools of India, aimed at primary prevention of obesity and inculcation of healthy diet and lifestyle practices in children and adolescents who are at an increased risk for early onset of type 2 diabetes mellitus (T2DM) and coronary heart disease (CHD).
Simple measures like regular physical activity, cutting off extra calories, eating more green vegetables and fruits, are likely to be beneficial in preventing diabetes. Eating less and walking more, does not cost anything and the gains are far too many.
So what are we waiting for? Let us make a resolution now to shun unhealthy food, to walk/exercise a little more and encourage our children to play outdoors rather than on a computer screen.
Contributed by: Bobby Ramakant