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