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আজ চেন্নাইয়ের মতো বড় শহরগুলিতে 20 বছরের বেশি বয়সি 30 শতাংশ মানুষের ডায়াবেটিস রয়েছে । বিশেষজ্ঞর মতামত শুনলেন এস. রবিচন্দ্রন ৷
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00:00So, India is called as the diabetes capital of the world, but if you actually look at the numbers, China
00:09is little ahead of us as far as the number of people with diabetes is concerned.
00:14And the reason for that is that although the population of India and China are equal, in fact we are
00:19now ahead of China as far as population is concerned, they are a much older population.
00:24Half of our people are below 20 years of age.
00:28China has only one child's policy for a long time.
00:32So, their population is much older.
00:35So, they have people who are 80 years old, 85 years old, you have lot of diabetes at that age.
00:42For that reason, the actual number of people with diabetes is higher in China.
00:47But the question was what has changed in the last say 30 years as far as diabetes is concerned.
00:55Number one, it was considered as a rich man's disease.
00:58So, they said only rich people get disease.
01:02Then it came to middle class.
01:04Today, even poorest of the poor people, slum people are having diabetes.
01:08That is one big change from the rich to the poor.
01:11Second is that they said it is a disease of old age.
01:14When you become 60, 70, 80, you will get little diabetes.
01:19Then it started coming, I mean, 50, 40, 50 years old.
01:23Then it started coming when you are 20, 30 years old.
01:27Today, type 2 diabetes, I am not talking about type 1 diabetes comes in children.
01:31That is a children's age group disease, type 1.
01:34I am talking about usual type 2 diabetes comes in adults, has now started coming at 12 years of age,
01:4013 years of age.
01:42I have got one or two children who are 7 years old.
01:46Already, they are so obese and they have got type 2 diabetes.
01:50That is another big shift coming from old age to even children it has started coming.
01:57The third is that it was believed to be an urban disease.
02:01So, it is in rural areas, villages, nobody will get diabetes, only in the big cities.
02:06It used to be like that.
02:08Then it started going to the smaller cities, tier 2, tier 3 cities.
02:13Today, even in the villages, diabetes is increasing.
02:16So, these are three big changes which have occurred.
02:20No longer a rich man's disease, no longer an urban disease and no longer restricted to old age.
02:27It started occurring in young people also.
02:30So, these are the major changes which have occurred.
02:33Your research highlighted that Indians develop diabetes at a young age and lower BMI compared to western population.
02:41Could you explain the concept of the Asian Indian phenotype for readers?
02:46For many years, when I started my research on this about 30 years ago, we found that there are a
02:53lot of differences between diabetes in Indians, type 2 diabetes in Indians compared to the white European population.
03:02One of the things is that it occurs at a younger age, whereas in white Europeans, it occurs when you
03:09are 50, 60 years old.
03:11In Indians, it starts coming when you are 20, 30 years old itself.
03:16It started coming.
03:16In fact, when you look at our statistics, 50% of all are type 2 diabetic patients, get it before
03:2245 years of age, which is very, very uncommon in a white person.
03:27So, that is the first difference.
03:29Second is, in US and in most other developed countries, diabetes is associated with obesity.
03:35So, you have to be very big obese, you have to have a lot of obesity, a lot of body
03:39weight and excess fat to get diabetes.
03:43We get it even if we are thin people.
03:45In fact, Indians are called as thin fat Indians.
03:49So, what does that mean?
03:50We look very thin on the outside, but inside we have a lot of fat.
03:54So, we call it as T-O-F-I, thin outside, fat inside.
03:59So, that is the typical characteristic of the Indian and all this is what we call as the Indian phenotype
04:06or the Asian Indian phenotype or the South Asian phenotype.
04:09This makes treatment also a little different because in the West, mostly it is about weight reduction.
04:16If you reduce weight, it will go away.
04:17In India, that is there.
04:19The obese patients are also there, but we also have a lot of thin people in whom there is no
04:23weight to lose at all.
04:24In fact, they should put on some weight.
04:26So, the treatment pattern, the medicines that we take all differ because of this Asian Indian phenotype.
04:33Why do Indians tend to accumulate more visceral fat even when they appear clean?
04:38Does this mean that traditional markers like BMI are insufficient for diagnostic metabolic risk in Indians?
04:47Body mass index is a very crude index, BMI we call it.
04:51It is just taking the weight in kilograms and dividing it by the height in meters squared.
04:59So, that is BMI.
05:00We are just going by the height and the weight.
05:02So, it is a very crude index.
05:03You can have a BMI.
05:04So, BMI about 25 we say is obesity.
05:07But if you are a very muscular person, suppose you are doing lot of weight lifting and your bones are
05:12heavy, you will be classified as obese.
05:14Actually, you can be a very fit person.
05:16So, a better index of obesity and fat deposition in the body is to measure the waist circumference.
05:25If you take an inch tape and measure your waist circumference.
05:28If the waist is enlarged, it usually means there is a lot of fat inside the body.
05:33So, that is a much better index of obesity in Indians than the body mass index.
05:41Now, why do Indians develop this visceral adiposity?
05:46Studies have shown very interesting results.
05:48If you see the abdomen wall, this abdominal wall if you see, there are small adipocytes there, small fat cells
05:56there.
05:56When we eat too much of food, those small fat cells get filled up very quickly and then it has
06:04to go inside the abdomen.
06:05In the white man, in the white person, there are a lot of these small adipocytes.
06:12So, when they eat more food, those small adipocytes will enlarge and they all stay in the abdominal wall.
06:17It won't go inside.
06:18In Indians, maybe due to genetic factors or because of our diet, we have very small numbers of these small
06:25adipocytes, the small fat cells.
06:27So, very quickly they get filled up, then they go inside into the abdomen and then it becomes visceral adiposity
06:35or visceral fat or intra-abdominal fat.
06:37That then goes into the liver.
06:39Liver is where the insulin works.
06:41So, when you have fat in the liver, the insulin does not work and therefore, you can get diabetes.
06:47Same fat goes into the pancreas also.
06:49So, insulin secretion also gets reduced.
06:51That is why we get diabetes.
06:53So, cities like Chennai, Hyderabad and Bengaluru have booming IT industries but also rising lifestyle diseases.
07:02How much of this diabetes surge is linked to sedentary work culture?
07:07A lot of the diabetes and obesity is due to sedentary culture.
07:13You mentioned the IT industry in say Chennai, Bengaluru, Hyderabad and so on.
07:20Now, when you have IT people, youngsters working for IT, very often they have to work in the night also.
07:26So, they will be working to American timings.
07:29And so, what happens when everybody is sleeping in India, they will be working.
07:33So, their chronobiology, the brain also gets confused because between day and night.
07:39Second, because they are working in the night, they cannot get their home food.
07:42So, they will be ordering junk food from outside, very high calorie, high sugar, high fat.
07:47So, they all promote obesity.
07:50Thirdly, because they are working in the night, they have to sleep in the daytime.
07:55So, they don't get time for exercise.
07:57So, they become sedentary.
07:59They are also sitting in the office job next to the computer all the time.
08:03That computer radiation is also occurring.
08:05All these together play havoc with the health of our youngsters.
08:11And that is why in the cities like Bangalore, Hyderabad, Chennai and many other cities, Mumbai, Delhi,
08:17all these big cities, they have so much of diabetes.
08:23Are you seeing diabetes in even the patient today compared to the two decades ago?
08:31Definitely, it is occurring at a much younger age group.
08:34That is because right from childhood, obesity has started.
08:38When I was in school, 50, 60 years ago or more, there was in my whole school, 2,500 students,
08:47there was only one boy who was obese.
08:49Only one in the whole school.
08:52Okay.
08:52And everybody used to make fun of him and all that.
08:54Today, in my grandson's generation, if you see, 50% of his class are obese.
09:01So, that obesity from very young age, even the age of 8, 10, they are already obese.
09:07By the time they become 15, 20 years old, they are turning into diabetic.
09:11So, therefore, young people are getting a lot more diabetes today than in my generation.
09:18Diabetes was once considered a city disease.
09:21But recent data suggests it is rising in rural India too.
09:26How do healthcare access and delayed diagnosis worsen outcomes in rural communities?
09:32What role can community health workers play in diabetes screening and prevention?
09:38In rural areas, when you get diabetes, the problem is that, number one, there are no specialists in rural areas.
09:44Most of the doctors practice in urban areas.
09:47If you see specialized equipment, hospitals, they are all in the urban areas.
09:51Rural areas, there will be primary health center only.
09:55Now, if suppose one of those patients with diabetes in rural areas gets a heart attack.
10:00There is no hospital there.
10:02By the time they reach the city, very often they die.
10:06Sometimes they get an injury.
10:08They develop some ulcer in the foot.
10:11They delay for two or three days.
10:13By the time it is spread very much, then they result in amputation.
10:17Similarly, they don't have facility to screen for the eye.
10:19So, they may be having diabetic eye changes.
10:22And then they can even go to a very advanced stage.
10:25Blindness can also occur.
10:27So, in rural areas, because of these poor facilities, people tend to miss the diagnosis.
10:33And therefore, they have complications very early.
10:36The way to do it is to reach out to rural areas, to doing mobile camps or taking equipments there,
10:43doing camps there, raising awareness there and linking them to the nearest city.
10:49So, if they have a problem, they should be able to go.
10:51By this, we can try to help the people living in the rural area.
10:55Now, by using mobile phones, by using technology, internet, it is possible to do even teleconsultation to these people.
11:04The Indian diet is often high in refined carbohydrates.
11:09How much does diet contribute to India's diabetes burden?
11:14Is rice the villain people make it out to be?
11:18What do you think about recent trends like intermittent fasting or keto diets for diabetes management?
11:24For many years, our research has shown almost a direct link between carbohydrate intake and development of diabetes.
11:33Diabetes is what we have studied because we are in the south.
11:36We have studied rice and there is a direct correlation with diabetes.
11:40But not that wheat is any better because in the north and the west, they don't take much rice.
11:46They take wheat.
11:47There also the wheat is refined, highly polished wheat.
11:50And that also is equally bad, as bad as rice.
11:53So, it doesn't matter whether we take rice or wheat.
11:56We take too much of it.
11:57It seems to be bad.
11:59So, we can't call it as a villain.
12:01But too much of it, eating too much of it is bad.
12:05So, how do we correct this?
12:07The way to correct it is to add protein to it.
12:11In India, 62% of the calories comes from carbohydrate.
12:15Protein is only 12%.
12:16It should be at least 20%.
12:17If you are able to add 10% more as protein and reduce 10% of the carbohydrate,
12:24we will be able to prevent diabetes and also manage it well.
12:28About intermittent fasting, it is useful if the calories are cut down.
12:33If the calories are not cut down and you simply eat one heavy meal in the morning
12:37and a heavy meal in the night and nothing in between,
12:40it is not going to help you because ultimately all the calories will get added up.
12:44So, while intermittent fasting is useful, it should be combined with calorie restriction.
12:49If you don't restrict the calories, it doesn't work.
12:51I am not in favor of keto diet because while the keto diet is very low in carbohydrate,
12:57it also helps you to lose weight very rapidly.
13:00But it is an unbalanced diet because all the carbohydrate is removed and replaced with fat.
13:07So, you end up having a 60%, 70% or even 80% fat diet.
13:13Whereas the carbohydrate is very, very low and the rest is protein.
13:17So, when you have so much of fat in the diet as the keto diet occurs,
13:22then what happens is that your cholesterol will go up and your heart disease will go up.
13:28So, you may lose weight, but in the end they get heart attack.
13:31So, I am not very much for keto diet.
13:33I believe that you should reduce the carbohydrate a little bit, increase the protein,
13:38take healthy fats, take lot of green leafy vegetables, some fruit.
13:43If you are able to do that, you will have a very healthy Indian diet.
13:47So, if you had to give three lifestyle habits that could dramatically reduce diabetes risk,
13:56what would they be?
13:58The three healthy lifestyle things I would say is,
14:01number one, change your diet, take less of carbohydrate,
14:06take more protein, take more green leafy vegetables.
14:09That's the first one, diet.
14:10Second is physical activity.
14:14Exercise should become a regular habit and not only just walking,
14:19but you should also do some strength training that is muscle building and also some flexibility.
14:25I have a formula which I called as FAR, F-A-R.
14:29Flexibility, aerobic exercise and resistance training, F-A-R.
14:35All the three should be done.
14:37Then it's very good.
14:38The third and the most important is to reduce stress and to sleep well.
14:44If you are able to reduce our stress and sleep at least six to seven hours a day,
14:50if you are able to do that and you sleep on time,
14:53these three things we are able to follow.
14:55Healthy diet, improve your physical activity and reduce your stress and sleep on time,
15:00most of diabetes can be prevented.
15:03What policy intervention could help India slow the diabetic epidemic?
15:09Should India have nationwide screening programs for diabetes?
15:13One of the things policies that we can do, the government can do,
15:18is in the public distribution system,
15:21especially in the southern states I know and maybe the same in others,
15:25we are giving a lot of, when you give the free food to people or subsidized food,
15:29we are giving only rice mainly.
15:31The amount of dal that we give is very little.
15:35If we increase the proportion of dal that we are giving to people,
15:40their protein consumption will go up.
15:43The second thing for policy should be to make fruits and vegetables cheaper.
15:48We say take lot of fruit, take lot of vegetables,
15:51but fruits and vegetables are very expensive.
15:53So people go and buy some processed foods from some bakery or from somewhere they will go,
15:58from outside they will buy.
15:59They are usually unhealthy.
16:01So I think we should encourage people to take more of fresh vegetables and fruits
16:07and for that the government has to make it very cheap by providing subsidies.
16:12The third thing the government can do is to make free access to gyms,
16:17to parks and to plant more trees and make it more green.
16:21So that more oxygen will come, pollution will also come down in the cities.
16:27So by simple actions that the government can take for policies,
16:32changing the policy to improve the health of the people,
16:35diabetes can be controlled and even prevented.
16:38What role should food regulation and urban planning play in addressing the crisis?
16:44As far as urban planning is concerned,
16:47see what happens is that in our roads, we don't have proper footpath.
16:52The footpath is all taken away.
16:54Hawkers do it or they dig up the footpath.
16:57You know, in some of the rich places,
16:59they take the footpath also as part of their home,
17:03forgetting about the common man who has to walk.
17:05So what happens?
17:06People have to walk on the road.
17:07It is not safe to walk on the road anymore.
17:10So if they have pedestrian friendly streets,
17:13where they have nice big footpath encouraging people to walk
17:17and many parts of the city can be made only for pedestrians
17:21and then they can have any number of parks started where people can go.
17:26I know in Delhi, they have a lot of big gardens and parks,
17:30but many other cities don't have.
17:32So the city needs lungs because enough oxygen, enough green spaces,
17:38this itself will help to improve the quality of life of people.
17:42If that is done and as I said for the diet,
17:45I already mentioned about reducing,
17:48encouraging people to reduce their carbohydrate intake
17:51and to make protein intake cheaper and available to people
17:56and also fresh green leafy vegetables.
18:00All this, if it is done, it can play a big role in preventing diabetes.
18:04India has millions of undiagnosed diabetes.
18:08Why does diagnosis still come so late for many patients?
18:14Diabetes is called as a silent killer
18:16and the reason it is called as a silent killer
18:18is because it does not produce any symptoms
18:20until it becomes very late in the disease,
18:23when the disease is advanced, no symptoms come.
18:26So most people are fooled because they say,
18:29I am all right, I don't have any symptoms,
18:32why should I go for checkup?
18:33In fact, even those who have diabetes,
18:36including some of my close friends,
18:38when I tell them they would have come and seen me some years ago
18:40and next five years they wouldn't have come
18:42and every year you are supposed to check for diabetes.
18:45When I ask them, they will say,
18:46I am okay doctor, I don't have any symptoms,
18:48when I have a problem, I will come.
18:50When their problem is either they develop a foot infection
18:53or vision loss or some kidney problem,
18:56then only they come.
18:57It is too late.
18:58So you have to have regular checkups
19:01and that is why, because they don't do regular,
19:03suppose you do a master checkup,
19:05everybody has a master checkup.
19:06If you don't pick up diabetes this year,
19:08we will pick it up next year.
19:10Whereas if you don't go for a checkup at all,
19:12they say if I go for a checkup,
19:14they may find out I am diabetic,
19:15so I am not going.
19:16That is a very foolish thing to say.
19:17What is the point in having a disease and denying it?
19:20That means you are in denial.
19:22So the thing that you have to do is to go for the checkup,
19:24detect it early and then try to reverse it at that time.
19:28Any awareness in the public?
19:31Awareness has to be increased in the public.
19:34It must start from the school,
19:36it must go to the college,
19:37it must go to workplaces,
19:40it must go to the public,
19:41it must go everywhere.
19:43Wherever you go,
19:44you must be given right information about diabetes.
19:47These can also go through social media.
19:49Today what is done is,
19:50social media,
19:51we have all kinds of influencers
19:53because they have large number of people following.
19:55They just tell whatever they want.
19:58Often they pick it up from some Google or something,
20:00they pick up something,
20:01that information may be totally wrong.
20:03And they are always telling people wrong information.
20:06Don't take medicines.
20:07If you take medicine,
20:08you will get kidney problem.
20:09So stop all medicines.
20:10So people are well controlled also,
20:12they stop the medicine
20:13and then they develop a kidney problem
20:15because they stop the medicine.
20:16So like this,
20:17I think correct information and awareness is very important.
20:20Otherwise people will be misled
20:22and all kinds of complications will come.
20:25Recently AI,
20:26all data in the diabetes in the medicine.
20:29Address in the public and treatment methods.
20:33About AI.
20:34AI.
20:34AI is good.
20:36So in many ways,
20:38artificial intelligence
20:40can help you
20:41to think of something
20:43which you never thought of before.
20:44Because AI has large data
20:46and it can analyze it well.
20:47Better than a human brain can do,
20:49AI can do.
20:50Because you have taught the computer
20:51to think like that.
20:52So the power of AI is fantastic.
20:56It's very difficult
20:57for a single individual to do that.
21:00So that way it is good.
21:01Only thing is,
21:02the AI must be given correct information.
21:06If you don't give correct information to AI,
21:08it will make a wrong diagnosis.
21:10Because from the data,
21:11it has only it can do.
21:12So you must keep on building
21:14the database for the AI
21:16so that more and more correct information
21:18is given to it.
21:20If that is done,
21:21AI can help in diagnosis,
21:23AI can help in treatment,
21:25AI can help a doctor
21:26to treat and diagnose diseases.
21:29So AI is good.
21:30But we should check it
21:32to make sure whether it's correct or not.
21:34About 30 years experience
21:36in the diabetes department,
21:38your advice in the children
21:39and younger generation.
21:41We must start very early
21:43because if we wait until 30,
21:45we will miss a significant number of people.
21:47Today it is starting
21:48at a very young age.
21:51So even by the age of 10,
21:5315 years,
21:53it is starting.
21:54So right from school,
21:56first of all,
21:57I would say even during pregnancy,
21:58we should start
21:59because if the pregnant lady
22:01has diabetes,
22:02that is passed on
22:03to the child.
22:05So we must say,
22:06before the lady gets pregnant itself,
22:08reduce weight,
22:10prevent gestational diabetes
22:11during pregnancy.
22:13Then we treat the diabetes
22:15during the pregnancy well.
22:16Then the child is born normal.
22:18Otherwise,
22:19a pregnancy diabetes
22:21can give rise to diabetes
22:22in the child.
22:23So that is controlled well.
22:25From there itself,
22:26we are doing it.
22:26Exclusive breastfeeding
22:28is another thing.
22:29Six months,
22:30if breastfeeding is done,
22:32then the child grows up
22:33normally with normal immunity.
22:36If you stop that in two months
22:37and then start giving cereals
22:39and other food from outside,
22:42chance of developing infection,
22:43immunity going down
22:44is very high.
22:46And finally,
22:47from childhood itself,
22:48the children must be taught
22:49exercises,
22:51eat healthy.
22:52Now in schools,
22:53they have started
22:53by saying bring fruit
22:55to the thing.
22:56don't bring junk food,
22:58don't bring pizzas
22:58and all that
22:59because there are
23:00very high calorie foods.
23:02So right from that time
23:03if we start
23:03and even in the classes
23:05that are taught,
23:06nutrition must be taught,
23:07healthy nutrition
23:08must be taught,
23:09value of exercise
23:10must be taught.
23:11See what happens in schools,
23:12they have a particular area
23:14and they will have
23:15a big playground.
23:16When they want to expand,
23:18the playground is removed
23:19and they put two blocks there.
23:21They build two new buildings there.
23:23Playground is gone.
23:25Then child cannot play.
23:26They should insist
23:27that every school
23:28should have some play area
23:30because playing is very important
23:31because it helps to build muscle.
23:33It develops the brain of the child,
23:35the muscles of the child.
23:37It makes the child healthy.
23:39If all that is done
23:40as they are doing in China,
23:41then the country
23:42can be really strong.
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