- 5 minutes ago
چنئی: آج کے تناظر میں، تقریباً ہر گھر میں کم از کم ایک فرد کا ذیابیطس کا شکار ہونا ایک عام سی بات بن گئی ہے۔ صرف تیس سال پہلے، پوری گلی میں ذیابیطس کے مریض کو تلاش کرنا حیران کن تھا۔ تاہم، آج، جاگتے ہی ایک گولی لینا اور صبح کی سیر کے لیے نکلنا ہمارے روزمرہ کے معمولات کا لازم و ملزوم حصہ بن چکا ہے۔ کھانے سے لے کر ان کرسیوں تک جس پر ہم بیٹھتے ہیں، ہر چیز — اکثر ہمارے شعور کے بغیر — ہمیں بیماری کی طرف دھکیل رہی ہے۔ ہم نے جدیدیت کے نام پر جو غذائی عادات اپنا رکھی ہیں، جسمانی سرگرمیوں میں کمی کے ساتھ وہ آج ہمیں "دنیا کے ذیابیطس کیپٹل" میں تبدیل کر رہی ہیں۔اس نازک صورتحال کے درمیان، آئیے ہم مدراس ذیابیطس ریسرچ فاؤنڈیشن کے چیئرمین ڈاکٹر وی موہن کی ای ٹی وی بھارت (ETV Bharat) کو فراہم کردہ تفصیلی معلومات کا جائزہ لیتے ہیں کہ ذیابیطس اتنی تیزی سے کیوں پھیل رہی ہے اور اس سے بچاؤ کے لیے کیا آسان اقدامات کیے جا سکتے ہیں۔ یہ مضمون "ذیابیطس آگاہی مہم" کا ایک لازمی حصہ ہے۔ اس مہم کی سربراہی ای ٹی وی بھارت (ETV Bharat) کر رہا ہے، جس کا مقصد کمیونٹی میں بیداری کو فروغ دینا ہے۔اپنے وسیع تجربے سے حاصل کردہ معلومات و بصیرت کا اشتراک کرتے ہوئے، ڈاکٹر موہن نے بھارت میں ذیابیطس کے بڑھنے والے خطرناک پھیلاؤ پر روشنی ڈالی۔ 1972 میں، جب وہ صرف 18 سال کے تھے اور اپنے والد کے ساتھ تحقیقی سفر کا آغاز کیا، تب سے لے کر آج صورت حال بالکل مختلف ہے۔ اس وقت، بڑے شہری مراکز میں، ہر 100 میں سے صرف 2 افراد (2 فیصد) ہی کو ذیابیطس تھا۔ دیہی علاقوں میں، پھیلاؤ اور بھی کم تھا - ہر 100 میں سے صرف 1 (1 فیصد) ہی اس متاثر ہوا کرتا تھا۔ تاہم، گزشتہ 30 سالوں میں جو تبدیلی دیکھی گئی ہے وہ واقعی چونکا دینے والی ہے۔ آج، چنئی جیسے میٹروپولیٹن شہروں میں، 20 سال یا اس سے زیادہ عمر کی آبادی کا حیران کن 30 فیصد ذیابیطس کا شکار ہے۔ 50 سے 55 سال کے درمیان نصف افراد (50 فیصد) اس بیماری میں مبتلا ہیں۔ مزید 25 فیصد میں ابتدائی مرحلے کی علامات ظاہر ہو رہی ہے، ایک ایسی حالت جسے 'پری ذیابیطس' کہا جاتا ہے۔ جب مجموعی طور پر شمار کیا جاتا ہے، تو یہ بات قابل غور ہے کہ اس مخصوص عمر کے 75 فیصد لوگ یا تو پہلے سے ہی متاثر ہیں یا اس بیماری کے پیدا ہونے کے خطرے میں ہیں۔
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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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