00:00very recently a national level paper on india's dietary profile from the icmr india diabetes
00:11study or india study for short has been published in nature medicine so what have we shown in this
00:19study we show that in india overall the carbohydrate intake is way higher than it should be
00:2662 percent of everything the asian indian eats is actually just carbohydrate whether it's rice
00:34or wheat or millets you like your rotis your pasta whatever it is that you're eating primarily if
00:40you're an asian indian you're eating a lot of carbohydrate so what you may ask okay i like my
00:46carbs can i have a lot of it well we show that a lot of carbohydrate intake is in fact directly
00:54associated with the risk of not just diabetes but also earlier stages of diabetes the pre-diabetes
01:03stage as well as obesity so having very high levels of carbohydrate can make you put on a lot of weight
01:10can make you turn dysglycemic which means that you have early stage of diabetes like pre-diabetes or
01:16directly go into diabetes now then what can we do about it well we can replace this carbohydrate
01:25with something that's slightly healthier so now let's look at the two other macronutrients and that's
01:31proteins and fat so the overall fat percentage in the country should be within 30 percent and india stands
01:38at about 25 percent so overall total fat intake is okay but the catch here is the saturated fat intake
01:46this intake is high in most states of the country it should be less than 10 percent overall for health
01:54but if you look at cardiovascular health if the recommendation says that you it should be less than
02:00seven percent most of india states have saturated fat intake that is more than seven percent in fact
02:08other than four states four states in the country all of the states have a saturated fat intake that's
02:14very very high that's more than seven percent the other thing that we have is we have a deficiency of
02:20mufa intake so mufa is good fats that's found in nuts and and things like that but in india we find that
02:26the mufa intake is very very poor in addition the absolute sugar intake now sugar shouldn't be
02:34more than five percent of total calorie of everything that we take how many states are meeting this
02:40recommendation almost nil other than three or four states uh most of the states have a sugar intake
02:47that is more than five percent more than the recommended limits we now move to protein now protein is
02:55supposed to be the good macronutrient large intakes of protein supposed to protect you from diabetes
03:01so the recommendation says you take about 20 percent of protein uh overall what's a national average
03:07it's 12 ish percent it's low in most of the central northern parts of the country the highest protein intake
03:15is in the northeastern part and that too that comes from animal protein but overall we find that among
03:22different protein plant protein in the country has very high intake of the 12 percent 8.9 percent comes
03:28from a plant protein we have a lot of dairy protein intake uh and a little less of the animal protein
03:34intake which includes egg chicken and fish uh so now when we look at reducing risk of diabetes and
03:42obesity replacing just five percent of carbohydrate with protein actually protects you now what kind of
03:52protein the best what we're showing is plant protein dairy protein is good and some forms of animal
03:58protein like fish is good egg is good chicken's okay red meat is best avoided now if you mix these
04:05proteins like for example the plant and the dairy and you substitute five percent it has the best beneficial
04:11effect because of the synergistic effects uh but any of these proteins that i just mentioned
04:16uh if you replace your carbohydrate with protein instead of fat you have a decreased risk of
04:23developing diabetes pre-diabetes and obesity if you replace one type of carbohydrate with another
04:32type of carbohydrate we don't seem to get much benefit for example people there's a general myth
04:36uh saying that wheat is healthier than rice so a lot of people say doctor i replaced all my rice with
04:42wheat uh why my sugar still high or why is my risk of diabetes still high because what we get today
04:47is not the whole grain wheat it's a milled wheat which becomes again like a refined cereal which has
04:53very high uh gi and thus your risk is equal so both rice and wheat now have an equivalent risk so there's no
05:02extra benefit of just changing from rice to wheat or from wheat to rice you have to decrease the overall
05:07carbohydrate and what do you substitute it not fat but protein so in uh as of now we don't have
05:15recommendations uh from the national institute of nutrition or overall uh governmental agencies
05:21but i think after this we will be working with various uh governmental agencies to see that there are some
05:28changes in the public distribution system which currently gives rice or um oil or sugar we will try and
05:36encourage use of healthy pulses legumes maybe some fruit and vegetable as well and those kinds of
05:45shifts i think will become largely needed at the governmental level to make changes in the population
05:51diet so this is a national study that's done all over india entire country all states all union
05:59territories mainland islands northeast everything is done we have covered urban areas rural areas we have
06:06men we have women if you take even one single state every nook and corner of the country is covered in
06:13terms of population size geography socioeconomic status so this is a truly represent there's one
06:19lakh thirty thousand people inside of the study making it one of the largest studies on diabetes ever done
06:24uh and in this 1.3 lakh people is representative of india's 1.44 billion people for the diet sub study
06:34one and fifth individual we have uh assessed a food frequency questionnaires and thus we are able to
06:41look at a representative sample of india's dietary profile there are many reasons for diabetes we have
06:48shown just diet and physical activity alone contributes to about 50 percent of all diabetes so just these two
06:56diet and physical activity but there are many other factors of course genetics plays a very uh important
07:01risk especially with type 2 diabetes runs in families hereditary genes all that is there today stress is a
07:08very very important factor and that's all you're pervasive across all ages all regions so that is a
07:16very important one too uh in addition we have newer risk factors that have coming come in uh we have
07:22published from the india study that migration from rural to urban areas actually increases your risk of
07:28metabolic disease including diabetes and obesity pollution those are the new kids on the block so
07:35we have pollutants coming from the air we have pollutants coming from water we have other soil
07:40pollutants and all of these are coming together to now what we call as endocrine disruptors so these are
07:48risk factors uh for diabetes newer risk factors that are being identified all states of the country have
07:54uniformly high carbohydrate intake uh the type of carbohydrate varies the northeast has very high
08:00rice intake 99 percent uh rice intake in the northeast uh whereas wheat intake is high in
08:07panjab ncr delhi uh some northern regions and central regions we have high wheat intake so if you look at
08:15carbohydrates there are many types of carbohydrates there's simple carbohydrates there's complex carbohydrates
08:19etc many different types simple carbohydrates include things like glucose sucrose and fructose
08:26now glucose everybody knows what it is right it's actual the glucose that's available in the body
08:31sucrose is nothing but sugar white sugar and fructose is fruit sugar now whatever you eat whether it
08:38becomes a complex carbohydrate which has all this mixed together or you take a fruit or you even take sugar
08:44ultimately in the body all this gets converted into glucose plain glucose so we have what is known as
08:52gi or glycemic index now what is this it tells you that if you consume a food substance like a piece of bread
09:00or fruit how much your glucose will rise that is what is called the glycemic index so we have a scale from
09:08let's say 1 to 100 100 is the highest so you see how much it's rising 50 60 70 80 so anything that's 70
09:15and above is very high gi you want it to be below like 50 so then those are low gi food categories
09:22so any carbohydrate food generally has a higher gi and it spikes your glucose
09:27so you see how much it is
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