Saturday, January 13, 2007

India – Diabetes Capital of the World?

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It is estimated that India has about 41 million diabetic patients followed by China with about 40 million. A study by International Diabetes Federation's (IDF) Diabetes Atlas released last year estimates that by the year 2025 the number is expected to go up to 70 million in India and 60 million in China. In the same report they have described the rapid increase in diabetics as follows.
With the forces of globalization and industrialization proceeding at an increasing rate, the prevalence of diabetes is predicted to increase dramatically over the next few decades. The resulting burden of complications and premature mortality will continue to present itself as a major and growing public health problem for most countries.
Diabetes is to certain extent caused by changing life style and eating habits. With the technological advances we are seeing in the last few decades we eat more food and do less physical work.

One example that comes to my mind when I think about change in life style contributing to diabetes happened in my village in Kerala. As I mentioned in many of my earlier posts my village in Kerala was a beautiful one with lot of paddy fields, streams and lot of vegetation. These are all things of the past. Now all paddy fields are filled to construct houses, streams are to pave roads and there is a big medical college now on the hill, which was full of rubber trees.

I know a family in my village – father is now about 75 years, mother about 70 years and their son about 50 years old. Father has diabetes for the last 3 years but son has it for last 8 years while the mother doesn’t have at all.

Let us see the difference in the life style between the father and the son. This was 25 years before. The typical day of the father starts at 4:30am. His wife makes him a black coffee and both of them go and milk the cows. By 6:00am the servant comes and he accompanies him to the rubber field. He comes back by 8:00 am, have bath and will have a heavy breakfast (I have seen him eating 5 dosas). He was working as a clerk in a Government office about 2 kms from his house. He goes by walk to his office. He takes lunch in a lunch box, which has 4 containers (it is called “thookupatram” in Malayalam). Two of those containers will be full of rice and other two will have curries made of fresh coconut oil. He walks back 2 kms from office in the evening. On return he will have tea and snacks. Immediately he goes out and works in the field. He comes back at about 8 pm takes bath, have a heavy dinner and sleeps.

Now let us see his sons life style was at the same time. He was about 25 years old that time. His mother wakes him at 7 am with a glass of Horlicks. He reads the newspaper and by that time his mother would prepare breakfast. I have seen him eating more than what his father used to eat for breakfast (more than 5 dosas). He drinks another glass of milk while having breakfast. He goes to his work place in a TVS Moped. He also carries the same size lunch box as his father. When he returns back from work at 6 pm his mother will give him another glass of milk and snacks. After having snacks he goes out to meet his friends and comes back by 8 pm. He will have a sumptuous dinner along with his parents and sister. Before he goes to bed his mother makes sure that her son has another glass of Horlicks.

The end result of all these food habits – the son in this story was diagnosed with diabetes at the age of 40 while his father was diagnosed with diabetes only at the age of 70. Who is to be blamed for this - Change in life style without change in food habits?

Our ancestors followed certain food habits because they did a lot of physical work and also food with a lot of carbohydrate/fat was just suited for that. They didn’t have any modern means of transportation to travel from one place to another. Now the present day life style has reduced most of our physical work but we are not ready to give up our age-old food habits. The consequences of that - people get diseases like diabetes at a young age.

I would like to conclude this piece with an incident that happened last time when I visited India. One of my roommates father came to my house to visit me. There was a young man accompanying him. My friend’s father was about 65 years old. My mother went and asked him “Can I put sugar in tea?” The reply from my friends’ father was “Nowadays you should ask these questions to young people like those sitting near me”. Incidentally the young man was a diabetic.
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