Heart disease and diabetes are silent killers

Posted by : Mr. Sreehari Nair, 19 Feb 2014 10:20 AM
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India is progressing. In some areas we have taken over the US and the UK in the west and China in the east. However, heart disease, which is declining in the US, is an epidemic here. India has already become the diabetes capital of the world.

While this is partially because as a race we have a three to four times higher genetic predisposition for coronary disease than Caucasians and six times higher risk than the Chinese, it is also induced by our extremely unhealthy lifestyles. The average Indian has a heart attack 10 to 15 years earlier than his Caucasian counterpart and is four times more likely to die from it. This effect persists even after we leave Indian soil. 

Asian Indians living in the US are the ethnic group with the highest odds of having diabetes. One in three Indians between ages 40 and 49 is currently diabetic. That is expected to double in the next two decades. This raging diabetes epidemic is expected to cause loss of income to the tune of many crores of rupees by affecting the bread-winning age segment of our population.

What places Indians at such high risk? 

Besides our genetic tendency, the average Indian lifestyle and mindset are not designed to prevent lifestyle diseases. Our food is often rich with tasty curries, fried snacks, oil, ghee, butter and masala. We don’t eat small meals every few hours, or enough fresh fruits and vegetables. We tend to eat three large heavy meals, eat till we feel 'full' and define plump kids as 'healthy'. 

The average Indian (especially vegetarians) gets very little protein (dal and milk products) or calcium (milk products). We fill up mostly on carbohydrates (roti, bread, potatoes, biscuits, rice, upma, poha) that get digested into sugar even though they do not taste sweet. We lead sedentary lifestyles with no exercise and adult Indians (and now, even children) rarely play sports. 

Here are some true stories of people and what we can learn from them. Fortunately, we can dramatically reduce our risks of diabetes and heart disease in many ways. Let’s see how. 

Anil Kataria**, 37, a manager at a multinational firm, is living the modern Indian dream. However, he works long hours, travels extensively and has added some inches to his waistline. He also smokes to relax. Unknown to him, Anil is at significant health risk and should act immediately. After a comprehensive medical evaluation he needs a tangible, sustainable target-driven plan— like catching the morning news on a treadmill instead of at a desk and carrying homemade food to work thrice a week. 

Ninety per cent of young heart attack patients are smokers. Modifying behaviour through techniques like the 4 Ds (Delay the response to the urge to smoke, Do something else, Drink water, deep breathing), taking medication and stress relief through yoga/meditation can make it easier to quit and add years to his life-span. 

Jatin Mehta**, 54, is a CFO and has diabetes. He has been feeling tired all day and feels uncomfortable walking short distances. Sex isn't fun anymore. He has been faithfully taking two diabetes tablets for years. His monthly fasting sugar is high at 190 mg/dl. His HbA1c* is high at 9.6 per cent. 

Jatin needs a glucometer to monitor his sugar levels during the day. He tells me he does not want to start insulin. Jatin needs to know that insulin is a friend that will bring the true enemy (high blood sugars) under control. Needing increasing medication (even insulin) to control sugars is a normal part of the diabetes process, just as greying hair is a part of normal ageing. Some grey faster than others. 

Jatin is concerned about “making the body dependent on insulin if I start so it’s better if I don’t start at all”. That is a myth. Needing insulin is not a “failure” or a predictor of “addiction” to medication. Those whose bodies have run out of natural insulin function will need insulin injections; delay only increases the toll on health.

Bottom line: the body needs normal blood sugars to stay healthy and energetic. Whether it comes from significant lifestyle changes alone, by using aggressive medications, or by overcoming fears and doubts regarding injections, all diabetics live longer if their sugars, cholesterol and blood pressure are properly controlled.

Veena Menon**, 48, is a stress-free school teacher but last month she unexpectedly suffered a heart attack. She weighs 120 kilograms and snores loudly. A third of patients don’t survive their first heart attack. Veena needs to prevent a recurrence. Increasing food awareness and portion control with tools like www.MyFitnessPal.com, the Plate Method, eliminating sweet beverages and, in some cases, surgery (stomach bypass), and all aid weight loss. Testing for sleep apnea is also necessary. Morbid obesity and sleep apnea worsen diabetes and advance death. 

Diabetes and heart disease are silent for many years before they become noticeable. 

Look for the following symptoms:
Fatigue, low energy
Irritability, mental dullness
Blurred vision or frequent change in power of the glasses
Excessive thirst and urination
Increased appetite
Weight loss that is unintended
Decreased sexual satisfaction, poor-quality erection 
Poor wound healing, repeated infections
Numbness and burning pain in feet

Why do diabetics feel this way? Here’s a simple explanation. When we eat, the food gets digested and absorbed to turn into energy. The best form of energy for all our living tissues is glucose. For glucose to reach our muscles, brain, skin and other vital organs, it needs insulin as a partner to take it to the right place. Unfortunately, in type 2 diabetes, insulin is not working properly. This is due to insulin resistance, meaning the body’s system does not respond as well to insulin. In some people, insulin is completely depleted (type 1 diabetes and late stage type 2 diabetes). In all types of diabetes, glucose does not reach its intended destination and starts accumulating in the blood, causing high blood sugar. Even though we are eating, our cells and tissues are not receiving the energy they need, and we are tired all day. The kidneys find the blood sugar and try to cleanse the system by throwing glucose out into the urine. Over the years, high blood sugar is poisonous to every part of the body and we end up with the dreaded complications of heart attack, stroke, blindness, kidney failure, amputations and early death.

Initial comprehensive evaluation to be done for all Indians above age 35, even if there are no symptoms:
Thorough consultation with a medical doctor
Diet assessment
Blood pressure, weight monitoring
Fasting and post-meal blood sugar levels
Fasting cholesterol profile
HbA1c (above 6.5 per cent confirms a diagnosis of diabetes) 
For loud snoring and poor quality sleep: consider sleep apnoea testing.

What are the goals of treatment in diabetes? As per the American Diabetes Association (2012):
HbA1c below or around 7 per cent
Blood pressure below 130/80 mm 
Bad cholesterol (LDL) below 70mg/dl
Blood fat (triglycerides) below 150mg/dl
Good cholesterol (HDL) above 40mg/dl in men, above 50mg/dl in women
Annual screening for effects of diabetes on the eyes and kidneys
Smoking cessation
Alcohol intake moderation

Every year, diabetes, obesity and heart disease silently kill over 5 million Indians who could have lived longer, fuller, productive lives. Look around you. Almost one in three is a lot. This epidemic is not “out there happening to them”, its right here happening to us. Anyone could be next. Take action now. Be a prudent health investor. Invest in your health and the ROI is guaranteed. It’s the best investment you can make.

**Names of patients changed to protect identity.

*Glycosylated hemoglobin (HbA1c) gives us an idea of what a person’s average blood sugar has been for the last three months. It is the main indicator of diabetes control, based on international standards.

Inputs by: Dr. Roshani Sanghani, Consulting Endocrinologist

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