- 4 months ago
آج چنئی جیسے بڑے شہروں میں، 20 سال سے زیادہ عمر کے 30 فیصد لوگوں کو ذیابیطس ہے۔
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00:02So, India is called as the diabetes capital of the world.
00:07But if you actually look at the numbers, China is little ahead of us as far as the number
00:14of people with diabetes is concerned.
00:16And the reason for that is that although the population of India and China are equal, in
00:21fact we are now ahead of China as far as population is concerned, they are a much older population.
00:26Half of our people are below 20 years of age.
00:30China has only one child's policy for a long time.
00:34So their population is much older.
00:38So they have people who are 80 years old, 85 years old, you have lot of diabetes at that
00:43age.
00:44For that reason, the actual number of people with diabetes is higher in China.
00:49But the question was what has changed in the last say 30 years as far as diabetes is concerned.
00:57Number one, it was considered as a rich man's disease.
01:01So they said only rich people get disease.
01:04Then it came to middle class.
01:06Today even poorest of the poor people, slum people are having diabetes.
01:10That's one big change from the rich to the poor.
01:13Second is that they said it's a disease of old age.
01:17When you become 60, 70, 80, you will get little diabetes.
01:21Then it started coming, I mean 50, 40, 50 years old.
01:25Then it started coming when you're 20, 30 years old.
01:29Today type 2 diabetes, I am not talking about type 1 diabetes comes in children.
01:33That's a children's age group disease, type 1.
01:36I am talking about usual type 2 diabetes comes in adults, has now started coming at 12 years
01:42of age, 13 years of age.
01:44I have got one or two children who are 7 years old.
01:48Already they are so obese and they have got type 2 diabetes.
01:52That's another big shift coming from old age to even children it has started coming.
01:59The third is that it was believed to be an urban disease.
02:03So in rural areas, villages, nobody will get diabetes, only in the big cities.
02:08It used to be like that.
02:10Then it started going to the smaller cities, tier 2, tier 3 cities.
02:15Today even in the villages, diabetes is increasing.
02:18So these are three big changes which have occurred.
02:22No longer a rich man's disease, no longer an urban disease and no longer restricted to
02:29old age.
02:30It started occurring in young people also.
02:32So these are the major changes which have occurred.
02:35For many years, when I started my research on this about 30 years ago, we found that there
02:42are a lot of differences between diabetes in Indians, type 2 diabetes in Indians compared
02:48to the white European population.
02:51One of the things is that it occurs at a younger age whereas in white Europeans it occurs when
02:58you are 50, 60 years old.
03:00In Indians it starts coming when you are 20, 30 years old itself.
03:04It started coming.
03:05In fact, when you look at our statistics, 50 percent of all are type 2 diabetic patients
03:10get it before 45 years of age which is very, very uncommon in a white person.
03:15So that is the first difference.
03:17Second is, in US and in most other developed countries, diabetes is associated with obesity.
03:23So you have to be very big obese, you have to have a lot of obesity, a lot of body
03:28weight
03:28and excess fat to get diabetes.
03:31We get it even if we are thin people.
03:34In fact, Indians are called as thin fat Indians.
03:37So what does it mean?
03:38We look very thin on the outside but inside we have lot of fat.
03:43So we call it as T-O-F-I, thin outside, fat inside.
03:48So that is the typical characteristic of the Indian and all this is what we call as the Indian
03:53phenotype or the Asian Indian phenotype or South Asian phenotype.
03:57This makes treatment also a little different because in the West mostly it is about weight
04:03reduction.
04:04If you reduce weight, it will go away.
04:06In India that is there, the obese patients are also there but we also have lot of thin
04:10people in whom there is no weight to lose at all.
04:12In fact, they should put on some weight.
04:14So the treatment pattern, the medicines that we take all differ because of this Asian Indian
04:20phenotype.
04:21Body mass index is a very crude index, BMI we call it.
04:25It is just taking the weight in kilograms and dividing it by the height in meters squared.
04:32So that is BMI.
04:33We are just going by the height and the weight.
04:35So it is a very crude index.
04:36You can have a BMI.
04:37So BMI about 25 we say is obesity.
04:40But if you are a very muscular person, suppose you are doing lot of weight lifting and your
04:45bones are heavy, you will be classified as obese.
04:47Actually you can be a very fit person.
04:49So a better index of obesity and fat deposition in the body is to measure the waist circumference.
04:58If you take an inch tape and measure your waist circumference.
05:01If the waist is enlarged, it usually means there is a lot of fat inside the body.
05:06So that is a much better index of obesity in Indians than the body mass index.
05:15Now, why do Indians develop this visceral adiposity?
05:19Studies have shown very interesting results.
05:21If you see the abdomen wall, this abdominal wall if you see, there are small adipocytes
05:28there, small fat cells there.
05:30When we eat too much of food, those small fat cells get filled up very quickly.
05:36And then it has to go inside the abdomen.
05:39In the white man, in the white person, there are a lot of these small adipocytes.
05:45So when they eat more food, those small adipocytes will enlarge and they all stay in the abdominal
05:50wall.
05:50It won't go inside.
05:52In Indians, maybe due to genetic factors or because of our diet, we have very small numbers
05:58of these small adipocytes, the small fat cells.
06:01So very quickly they get filled up.
06:02But then they go inside into the abdomen and then it becomes visceral adiposity or visceral
06:08fat or intra-abdominal fat.
06:10That then goes into the liver.
06:12Liver is where the insulin works.
06:14So when you have fat in the liver, the insulin does not work and therefore you can get diabetes.
06:20Same fat goes into the pancreas also.
06:22So insulin secretion also gets reduced.
06:24That is why we get diabetes.
06:26A lot of the diabetes and obesity is due to sedentary culture.
06:32You mentioned the IT industry in say Chennai, Bangalore, Hyderabad and so on.
06:39Now when you have IT people, youngsters working for IT, very often they have to work in the
06:44night also.
06:45So they will be working to American timings.
06:47And so what happens when everybody is sleeping in India, they will be working.
06:51So their chronobiology, the brain also gets confused because between day and night.
06:57Second, because they are working in the night, they can't get their home food.
07:01So they will be ordering junk food from outside, very high calorie, high sugar, high fat.
07:06So they all promote obesity.
07:09Thirdly, because they are working in the night, they have to sleep in the daytime.
07:14So they don't get time for exercise.
07:16So they become sedentary.
07:17They are also sitting in the office job next to the computer all the time.
07:22That computer radiation is also occurring.
07:24All these together play havoc with the health of our youngsters.
07:29And that is why in the cities like Bangalore, Hyderabad, Chennai and many other cities, Mumbai,
07:36Delhi, all these big cities, they have so much of diabetes.
07:40Definitely, it is occurring at a much younger age group that is because right from childhood obesity has started.
07:48When I was in school 50, 60 years ago or more, there was in my whole school, 2500 students, there
07:57was only one boy who was obese, only one in the whole school.
08:01Okay.
08:02And everybody used to make fun of him and all that.
08:04Today, in my grandson's generation, if you see, 50 percent of his class are obese.
08:11So that obesity from very young age, even the age of 8, 10, they are already obese.
08:16By the time they become 15, 20 years old, they are turning into diabetes.
08:21So, therefore, young people are getting a lot more diabetes today than in my generation.
08:28In rural areas, when you get diabetes, the problem is that, number one, there are no specialists in rural areas.
08:34Most of the doctors practice in urban areas.
08:37If you see specialized equipment, hospitals, they are all in the urban areas.
08:42Rural areas, there will be primary health center only.
08:46Now, if suppose one of those patients with diabetes in rural areas gets a heart attack, there is no hospital
08:52there.
08:52By the time they reach the city, very often they die.
08:57Sometimes, they get an injury, they develop some ulcer in the foot, they delay for two or three days.
09:03By the time it is spread very much, then they result in amputation.
09:07Similarly, they don't have facility to screen for the eye.
09:10So, they may be having diabetic eye changes and then they can even go to a very advanced stage, blindness
09:16can also occur.
09:17So, in rural areas, because of these poor facilities, people tend to miss the diagnosis and, therefore, they have complications
09:25very early.
09:26The way to do it is to reach out to rural areas through doing mobile camps or taking equipments there,
09:34doing camps there, raising awareness there and linking them to the nearest city.
09:40So, if they have a problem, they should be able to go.
09:42By this, we can try to help the people living in the rural area.
09:46Now, by using mobile phones, by using technology, internet, it is possible to do even teleconsultation to these people.
09:55For many years, our research has shown almost a direct link between carbohydrate intake and development of diabetes.
10:05Rice is what we have studied because we are in the south, we have studied rice and there is a
10:09direct correlation with diabetes.
10:11But not that wheat is any better because in the north and the west, they don't take much rice, they
10:17take wheat.
10:18There also, the wheat is refined, highly polished wheat and that also is equally bad, as bad as rice.
10:25So, it doesn't matter whether they take rice or wheat, we take too much of it, it seems to be
10:29bad.
10:30So, we can't call it as a villain, but eating too much of it is bad.
10:36So, how do we correct this?
10:38The way to correct it is to add protein to it.
10:42In India, 62% of the calories comes from carbohydrate, protein is only 12%, it should be at least 20%.
10:48If you are able to add 10% more as protein and reduce 10% of the carbohydrate, we will
10:55be able to prevent diabetes and also manage it well.
10:58About intermittent fasting, it is useful if the calories are cut down.
11:04If the calories are not cut down and you simply eat one heavy meal in the morning and a heavy
11:09meal in the night and nothing in between, it's not going to help you because ultimately all the calories will
11:15get added up.
11:16So, while intermittent fasting is useful, it should be combined with calorie restriction.
11:20If you don't restrict the calories, it doesn't work.
11:22I am not in favor of keto diet because while the keto diet is very low in carbohydrate, it also
11:29helps you to lose weight very rapidly, but it's an unbalanced diet because all the carbohydrate is removed and replaced
11:37with fat.
11:38So, you end up having a 60%, 70% or even 80% fat diet, whereas the carbohydrate is very,
11:46very low and the rest is protein.
11:48So, when you have so much of fat in the diet as the keto diet occurs, then what happens is
11:55that your cholesterol will go up and your heart disease will go up.
11:59So, you may lose weight, but in the end they get heart attack.
12:02So, I am not very much for keto diet.
12:04I believe that you should reduce the carbohydrate a little bit, increase the protein, take healthy fats, take lot of
12:11green leafy vegetables, some fruit.
12:14If you are able to do that, you will have a very healthy Indian diet.
12:29The three healthy lifestyle things I would say is, number one, change your diet, take less of carbohydrate, take more
12:37protein, take more green leafy vegetables.
12:40That's the first one, diet.
12:42Second is physical activity.
12:45Exercise should become a regular habit and not only just walking, but you should also do some strength training, that
12:53is muscle building and also some flexibility.
12:57I have a formula which I called as FAR, F-A-R.
13:00Flexibility, aerobic exercise and resistance training, F-A-R.
13:07All the three should be done, then it is very good.
13:09The third and the most important is to reduce stress and to sleep well.
13:15If you are able to reduce our stress and sleep at least six to seven hours a day, if you
13:21are able to do that and you sleep on time, these three things you are able to follow.
13:26Healthy diet, improve your physical activity and reduce your stress and sleep on time, most of diabetes can be prevented.
13:45One of the things policies that we can do, the government can do is in the public distribution system, especially
13:52in the southern states I know and maybe the same in others, we are giving a lot of, when you
13:57give the free food to people or subsidized food, we are giving only rice mainly.
14:02The amount of dal that we give is very little.
14:06If we increase the proportion of dal that we are giving to people, their protein consumption will go up.
14:14The second thing for policy should be to make fruits and vegetables cheaper.
14:19We say take lot of fruit, take lot of vegetables, but fruits and vegetables are very expensive.
14:24So, people go and buy some processed foods from some bakery or from somewhere they will go or from outside
14:30they will buy.
14:30They are usually unhealthy.
14:32So, I think we should encourage people to take more of fresh vegetables and fruits and for that the government
14:39has to make it very cheap by providing subsidies.
14:43The third thing the government can do is to make free access to gyms, to parks and to plant more
14:51trees and make it more green so that more oxygen will come, pollution will also come down in the cities.
14:58So, by simple actions that the government can take for policies, changing the policy to improve the health of the
15:06people, diabetes can be controlled and even prevented.
15:10What role should food regulation and urban planning play in addressing the crisis?
15:16As far as urban planning is concerned, see, what happens is that in our roads, we don't have proper footpath.
15:23The footpath is all taken away.
15:25Hawkers do it or they dig up the footpath.
15:27You know, in some of the rich places, they take the footpath also as part of their home, forgetting about
15:35the common man who has to walk.
15:36So, what happens?
15:37People have to walk on the road.
15:38It is not safe to walk on the road anymore.
15:41So, if they have pedestrian friendly streets where they have nice big footpath encouraging people to walk and many parts
15:50of the city can be made only for pedestrians and then they can have any number of parks started where
15:56people can go.
15:58I know in Delhi they have a lot of big gardens and parks but many other cities don't have.
16:03So, the city needs lungs because enough oxygen, enough green spaces, this itself will help to improve the quality of
16:12life of people.
16:13If that is done and as I said for the diet I already mentioned about reducing, encouraging people to reduce
16:21their carbohydrate intake and to make protein intake cheaper and available to people and also fresh green leafy vegetables.
16:31All this, if it is done, it can play a big role in preventing diabetes.
16:36Diabetes is called as a silent killer and the reason it is called as a silent killer is because it
16:40does not produce any symptoms until it becomes very late in the disease when the disease is advanced.
16:46No symptoms come.
16:48So, most people are fooled because they say I am alright, I do not have any symptoms, why should I
16:54go for checkup?
16:54In fact, even those who have diabetes, including some of my close friends, when I tell them they would have
17:00come and seen me some years ago and next five years they would not have come and every year you
17:05are supposed to check for diabetes.
17:06When I ask them, they will say I am okay doctor, I do not have any symptoms, when I have
17:10a problem, I will come.
17:11When their problem is either they develop a foot infection or vision loss or some kidney problem, then only they
17:18come.
17:18It is too late.
17:19So, you have to have regular checkups and that is why because they do not do regular, suppose you do
17:25a master checkup, everybody has a master checkup.
17:28If you do not pick up diabetes this year, we will pick it up next year.
17:31Whereas, if you do not go for a checkup at all, they say if I go for a checkup, they
17:35may find out I am diabetic, so I am not going.
17:37That is a very foolish thing to say.
17:38What is the point in having a disease and denying it?
17:41That means you are in denial.
17:42So, the thing that you have to do is to go for the checkup, detect it early and then try
17:48to reverse it at that time.
17:49Any awareness in the public?
17:53Awareness has to be increased in the public.
17:55It must start from the school, it must go to the college, it must go to workplaces, it must go
18:02to the public, it must go everywhere.
18:04Wherever you go, you must be given right information about diabetes.
18:08You can also go through social media.
18:10Today, what is done is, social media, we have all kinds of influencers because they have large number of people
18:16following.
18:16They just tell whatever they want.
18:19Often, they pick it up from some Google or something, they pick up something, that information may be totally wrong.
18:25And they are always telling people wrong information.
18:27Don't take medicines.
18:28If you take medicine, you will get kidney problem, so stop all medicines.
18:32So, people are well controlled also, they stop the medicine and then they develop a kidney problem because they stop
18:37the medicine.
18:37So, like this, I think correct information and awareness is very important.
18:42Otherwise, people will be misled and all kinds of complications will come.
18:45Recently, AI all data in the diabetes, in the medicine, addressed in the public and treatment method.
18:54About AI.
18:55AI.
18:56AI is good.
18:58So, in many ways, artificial intelligence can help you to think of something which you never thought of before.
19:05Because AI has large data and it can analyze it well, better than a human brain can do, AI can
19:11do.
19:11Because you have taught the computer to think like that.
19:14So, the power of AI is fantastic.
19:17It is very difficult for a single individual to do that.
19:21So, that way it is good.
19:22Only thing is, the AI must be given correct information.
19:27If you don't give correct information to AI, it will make a wrong diagnosis.
19:31Because from the data, it has only it can do.
19:34So, you must keep on building the database for the AI.
19:38So, that more and more correct information is given to it.
19:41If that is done, AI can help in diagnosis.
19:44AI can help in treatment.
19:46AI can help a doctor to treat and diagnose diseases.
19:50So, AI is good.
19:51But, we should check it to make sure whether it is correct or not.
19:56About 30 years experience in the diabetes department, your advice in the children and younger generation.
20:02We must start very early.
20:04Because if we wait until 30, we will miss a significant number of people.
20:09Today, it is starting at very young age.
20:12So, even by the age of 10, 15 years, it is starting.
20:15So, right from school, first of all, I would say even during pregnancy, we should start.
20:20Because if the pregnant lady has diabetes, that is passed on to the child.
20:26So, we must say, before the lady gets pregnant itself, reduce weight, prevent gestational diabetes during pregnancy.
20:34Then, we treat the diabetes during the pregnancy well.
20:37Then, the child is born normal.
20:40Otherwise, a pregnancy diabetes can give rise to diabetes in the child.
20:45So, that is controlled well.
20:46From there itself, we are doing it.
20:48Exclusive breastfeeding is another thing.
20:50Six months, if breastfeeding is done, then the child grows up normally with normal immunity.
20:57If you stop that in two months and then start giving cereals and other food from outside, chance of developing
21:04infection, immunity going down is very high.
21:07And finally, from childhood itself, the children must be taught exercises, eat healthy.
21:13Now, in school, they have started by saying bring fruit to the thing.
21:17Don't bring junk food.
21:19Don't bring pizzas and all that.
21:21Because there are very high calorie foods.
21:22So, right from that time, if we start, and even in the classes that are taught, nutrition must be taught,
21:29healthy nutrition must be taught, value of exercise must be taught.
21:32See, what happens in schools?
21:33They have a particular area and they will have a big playground.
21:38When they want to expand, the playground is removed and they put two blocks there.
21:43They build two new buildings there.
21:45Playground is gone.
21:46Then, child cannot play.
21:48They should insist that every school should have some play area.
21:51Because playing is very important.
21:53Because it helps to build muscle.
21:54It develops the brain of the child, the muscles of the child.
21:59It makes the child healthy.
22:00If all that is done as they are doing in China, then the country can be really strong.
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