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India’s no. 1 Diabetes doctor on diet, prediabetes, fasting, insulin resistance | Rethink India Ep 2 — Transcript

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0:00India is the diabetes capital of the world,
0:03but what's even more shocking are these two facts.
0:06First, India is not only the diabetes capital of the world,
0:10but we are also the untested diabetes capital of the world.
0:14And one out of every two Indians with diabetes doesn't even know they have diabetes.
0:19And secondly, India is not only the untested diabetes capital of the world
0:24but also the untreated diabetes capital of the world.
0:28And 70% of Indians with diabetes do not even get themselves treated.
0:32But the biggest problem is that we are diabetes illiterate.
0:36Even now, millions of people believe that diabetes only happens from eating sweets,
0:41and that's why I have brought one of India's leading diabetes doctors.
0:46So, let's come and learn from them how we can avoid pre-diabetes and diabetes.
0:51I am glad to be part of Zerodha's Media Network,
0:55whose resources enable me to bring this quality and valuable content, like this show, to all of you.
1:25Dr. Roshani is an endocrinologist who has 20 years of clinical experience.
1:31She worked in Hinduja and Breach Candy Hospital
1:34and specializes in diabetes and is the author of the book "Turn Around Diabetes."
1:40Dr. Roshani and I both left the US to fight for India's health.
1:44She lived in the US for 20 years, and I lived in the US for 13 years,
1:48and now both of us have come to India to fight for India's health.
1:52Thank you, Dr. Roshani, for leading this episode on Rethinking Diabetes.
1:56I will not start with my questions but with India's most Googled questions on diabetes.
2:02So the first question is, why do we call diabetes "sugar"?
2:07So, doctor, I want to ask you that many times we use diabetes and sugar as synonyms.
2:12What does this mean?
2:13Why do we use diabetes and sugar together all the time?
2:15Doctors didn't have any way to test the patient.
2:18They only saw the symptoms.
2:20They also noticed that wherever the drops of urine would splash.
2:25There would be a lot of ants coming and hovering around that.
2:28So they realize that there's something going on inside the urine.
2:31Hmm.
2:32One of the doctors had the guts to actually taste it and they realized it's sweet.
2:38So this sweet urine, sugar, so there was sugar in the urine.
2:43And that's why in short, they started calling it a sugar disease.
2:47That's very interesting that the word sugar for diabetes essentially comes from sweet urine.
2:53Doctor, I'll just ask you the second question around diabetes.
2:57The second most Googled question was
2:59what is the difference between type 1 and type 2 diabetes?
3:03So the biggest difference between someone with type 1 and type 2 is not the sugar issue.
3:09Actually both of them come with a high sugar.
3:11Both have high sugar, the biggest difference is.
3:16In Type 1 diabetes, the patient's body is no longer making insulin.
3:22So they need to be given insulin to survive.
3:25And in type 2, the body produces insulin?
3:27Yes. In type 2 diabetes, the body is making initially, more insulin than normal.
3:33And it's fighting to keep the blood sugar normal, it's not able to do so.
3:37And so now you have high insulin and high glucose in type 2 diabetes.
3:41But in type 1, it's low insulin, high glucose.
3:44And doctor like the word insulin itself...
3:47I want to talk to you. Talk to me like I am an 8 year old.
3:51In fact, I'm born on 29th Feb, so I've had 8 birthdays so far.
3:56But talk to me like I'm a kid.
3:58And like you know what does insulin mean?
4:00So insulin is a hormone.
4:01Now, what is a hormone?
4:03Hormones are long distance messengers.
4:06Think of them like a courier that has to go.
4:10From where it starts
4:12and where it reaches, the destination carrying a message.
4:15So insulin is a long distance messenger.
4:18It's carrying a message.
4:20It's carrying an instruction.
4:22So hormones give instructions and signals to the entire body.
4:27Insulin is secreted by the pancreas.
4:30It's around here and this hormone, insulin, goes around the body with an instruction.
4:36What is that instruction? Please store fuel.
4:40Store it.
4:42So, insulin asks the glucose to go inside the cell.
4:47Now in type 1 diabetes, that message is not being given.
4:50So glucose enters the system.
4:53It doesn't get into the body so it's being lost in the urine.
4:58So the person with type 1 diabetes, because no insulin messaging is going,
5:03this person is losing weight even though they're eating they're hungry.
5:06They're thirsty. They are eating food.
5:09And it's all washing through them in the urine.
5:12Now in type 2 diabetes, there is insulin in the body.
5:15But the effect is not being delivered.
5:18So the message is not being delivered.
5:20The messenger is trying.
5:22Insulin resistance is when insulin is not able to push the glucose into the cell.
5:27The cell is already full of glucose.
5:29That's why people with type 2 diabetes coming with weight gain.
5:33The cells are already full of energy,
5:35full of fuel, weight gain, more insulin, and more pushing.
5:39Insulin resistance, more and more weight gain.
5:43Interesting, and is there anything as type 3 diabetes?
5:47Yes, so this is a common term we use now.
5:50The way I was describing insulin resistance, the pushing.
5:54If that is happening in the brain.
5:57Where we are pushing glucose into the brain because the brain needs glucose.
6:02But it's not working well.
6:03The insulin effect is not working well in the brain.
6:06Insulin resistance in the brain.
6:08We call it Alzheimer’s dementia.
6:10We're also realizing that it is actually like a type 3 diabetes.
6:14It's like diabetes in the brain.
6:16We're calling type 3 diabetes what we also know as Alzheimer's.
6:20Okay!
6:22It's like that question you know, Messi or Ronaldo and the answer is Rashford.
6:27And that's why, like you know,
6:28type 1 diabetes or type 2 diabetes and someone says,
6:30Oh! I have type 3 diabetes.
6:32Another very commonly Googled question was
6:35what diet should people with diabetes follow?
6:39There's one thing your audience can learn today
6:41is it is possible to turn diabetes around.
6:44It is possible to have a better diabetes experience with less medication.
6:49So coming to diet.
6:50What diet should a person with diabetes follow?
6:54Actually I think we need to show people what's a normal diet.
6:57So there doesn't have to be a diabetic diet,
7:00a pre-diabetes diet, or a normal people diet.
7:02People will say they have diabetes, a meal is prepared separately for them.
7:06Why?
7:07So why don't we help you make a diet which is healthy for all humans?
7:11That would help the diabetes to get better with less medication.
7:16The food for diabetics is the same as the food for a normal person.
7:20Exactly, it is the diet for health.
7:22With the same healthy diet, diabetes will also decrease,
7:25and normal people will also eat the same.
7:26And I also noticed, doctor, that in spite of the fact that you've lived 20 years in the US
7:31you still speak with an entirely Indian accent.
7:34And nowadays, people from South Bombay, South Delhi, and Indira Nagar,
7:40who have lived their entire lives in India,
7:42these people, as soon as they go to the US embassy,
7:43start speaking in an American accent.
7:46Those people, to sound cool, call Momos, "Dim-sum,"
7:49"Channa Mereya" "Chickpea Mereya," and Haldiram, "Turmeric Jesus."
7:55But even after living in the US for 20 years,
7:58she is speaking in an Indian accent. That's pretty surprising.
8:00So doctor, I have another question.
8:02How important is calorie management in diabetes?
8:06How about instead of calorie management we teach people carbohydrate management?
8:11The calorie management approach has actually failed.
8:14The world of obesity, weight management, diabetes, calorie restriction,
8:18and low calorie, all of that has failed.
8:21And the diabetes and obesity epidemics are getting worse.
8:24Simply counting calories has made the world sicker.
8:28It hasn't worked.
8:29Doctor, so you're saying it's not about calories, it's about carbohydrates.
8:32Exactly, if you decrease carb intake, calories will go down.
8:36But you're counting the wrong thing if you're focusing on calories.
8:40Without focusing on carbohydrates.
8:41But what is a carbohydrate?
8:43Can we just for the sake of simplicity, explain what carbohydrates are and some examples?
8:48People don't understand carbohydrates, or proteins.
8:51Everybody understands low fat, people are trying to avoid it, unfortunately.
8:55Because they were chasing calories, so they went low fat.
8:59Actually, we don't need to do that.
9:00So what are carbohydrates?
9:02In India, you can think of upma, poha, roti, rice, bread, oats, Dalia, rawa,
9:13and cereals.
9:14Are you saying that upma and poha should not be eaten?
9:16I am saying that those are carbohydrates.
9:18After you digest a carbohydrate, it becomes glucose.
9:22Very simple.
9:23That is what a carbohydrate is.
9:25But when you digest, suppose a protein, then what does it break down to?
9:29Is it glucose or not?
9:31Initially, it becomes amino acids,
9:32the smallest final product of protein is going to be amino acids.
9:37Got it. Protein breaks into something else, but carbohydrates break into glucose.
9:42It directly becomes glucose.
9:44So, you're basically saying that diabetes is not about calorie management,
9:47it's about carbohydrate management.
9:49So, doctor, Indian diets are very carbohydrate-heavy;
9:52we only eat things like roti, rice, and such.
9:55So can you tell people how to manage an Indian diet with diabetes?
9:59Suppose someone is eating rajma rice, so this is rice and this is rajma.
10:06Okay.
10:09And normally what they will do is they will fill the bowl with the rice
10:14and then they'll put the dal or the rajma on top of it.
10:17Hmm.
10:18So what I do is I ask them to change that process.
10:22And instead of starting the bowl with the rice I say fill double.
10:26Start with the same amount you were going to add for rajma, just double it.
10:30Two portions.
10:31Yes, 2 portions.
10:32Instead of a single portion, have two portions of rajma because both have carbohydrates,
10:35but rajma has more protein.
10:37So, take more of this, and then with the rice, put it like you garnish coriander.
10:44But it won't taste that good.
10:47There is more masala in this.
10:48Okay.
10:49So, the taste is in this.
10:50So, both rajma and rice have carbohydrates,
10:57but this one has only carbohydrates,
10:59whereas this one has carbohydrates and protein as well.
11:02Correct.
11:02That's why we should eat two portions of this and one or half of this.
11:07I say, whatever amount of carbohydrate you eat, reduce it by half.
11:10This contains a little bit of protein, not much.
11:13Rice can definitely be considered as a carbohydrate,
11:16and rajma is considered protein. But it also contains 65% carbohydrates.
11:21So you don't need this for carbohydrates, you're getting it in this.
11:25So, from this too, what you explained earlier
11:27that carbs convert into glucose... will happen with this as well.
11:30Yes, but if you're a vegetarian, then your options for protein are fewer.
11:35So if you're relying on this for protein.
11:38You will need to then reduce this because it has carbohydrates
11:40which are directly turning into sugar.
11:42This also contains carbohydrates, which will turn into sugar.
11:44But at least if you take more of this, your stomach will also fill up.
11:47Now think about it.
11:49If I come and give you one more spoon of rice, you will say, fine.
11:54But if I come with one more spoon of rajma, you'll say, I'm full!
11:58Doctor, I am from Kolkata, I need rice.
12:01Exactly. It's about how full you get.
12:04What is the fullness after eating this,
12:06and how full does the stomach get after eating this?
12:08So you're saying that if we eat this, the stomach will be fuller.
12:11With protein, you will instantly know.
12:13If I come to you with one more portion after your meal is over,
12:16adding one more spoon, and one more,
12:18you'll say this is definitely feeling heavy.
12:20Just by looking, you can tell this is very filling.
12:22That is the feeling of full.
12:24So in India we have this unfortunate myth, actually, that protein is very heavy.
12:31Protein isn't heavy; it's called satiety, meaning my stomach is full.
12:36People are so dependent on carbohydrates in this country.
12:39So much of carbohydrates they don't know what it feels like.
12:42To feel full, they have to take a lot of rice, and a lot of roti.
12:49So the first time I realized that diabetes can be controlled with medicine too.
12:53The person whose glucose was very uncontrollable,
12:55he was eating 8 chapatis a day.
12:59And he did not want to go on insulin, he said I won't go on insulin.
13:03Then something has to be done.
13:06So I spoke to him about the diet I said, can you please cut the chapati to half?
13:11And cut the chapati by half and increase the rajma again?
13:13Increase the protein, increase the vegetables to double.
13:16It was already being prepared at home.
13:17So there was no specific diabetic diet I gave him.
13:20Already at home, roti, rice, dal, and vegetables were being made.
13:25We made him eat half the quantity of roti and rice.
13:28And the dal and vegetables that were being made, double the quantity of that in his plate.
13:32Got it.
13:33So, if you eat a lot of rice and roti,
13:35try to eat a little less rice and roti, like one roti instead of two.
13:40And double the amount of vegetables you eat.
13:43For example, if you eat rajma, take a little more rajma.
13:46If you eat paneer, increase the quantity of paneer a little more,
13:49and in exchange, reduce the amount of roti or rice a bit.
13:52This way, your carbohydrate intake will decrease,
13:54and the amount of protein will increase.
13:57There is also a psychology behind this.
13:59People get scared.
14:00When people come to me,
14:01they'll first have one extra plate of sev puri before coming into my office,
14:05thinking that this doctor is going to cancel my sev puri.
14:08I don't remove anything from anyone's diet.
14:10People say that I made them leave sweets.
14:12Since diabetes happened, I've avoided sweets.
14:14I stopped eating mangoes, sitaphal, chikoo, and I don't add sugar to my tea.
14:18I said, so did your diabetes go away?
14:20No, only my happiness went away! Right?
14:22So what is the whole point?
14:24The point is not to stop something, cancel something, subtract, or make it negative.
14:29First I'm telling you to eat more.
14:31Eat more of what?
14:33Eat more vegetables and protein.
14:35When someone hears that you're telling them to eat more,
14:38a psychology is satisfied, and the fear goes away.
14:41And automatically you're more full.
14:44When you start with more protein in the morning.
14:47You'll be less hungry.
14:48Observe anyone with diabetes,
14:50every two to three hours, they start thinking about eating something,
14:53they feel hungry the whole day.
14:55So how about actually feeling full?
14:57Doctor, I have another question.
14:58There is a very famous lady in Europe called the "Glucose Goddess".
15:03Yes.
15:03So, she says that what you eat is important,
15:06but the order in which you eat is also important.
15:11Like, you should eat protein first.
15:13So, do you have any opinion about which order of food we should eat,
15:16like, should we have the rajma first?
15:18Or should we have the vegetables first or what should we do?
15:21Exactly! So I'm very happy that Glucose Goddess has made it famous
15:25and social media is helping in it.
15:27This has been actually scientifically proven in research papers and in PubMed also.
15:31It's been published by an Indian endocrinologist, I'm very happy to say.
15:35And they proved it if you start with protein and vegetables and take the carbohydrates last.
15:41It's the same diet, not the diabetic diet,
15:46but within that sequencing: proteins and vegetables first
15:49or vegetables and then proteins.
15:51So, VP-vegetable then protein or PV-protein then vegetables.
15:57Both will work, C (carbohydrate) is last in both.
16:00Then the glucose spike is the least when carbohydrates are last.
16:05So, for example, if someone is eating rajma and rice
16:07they usually eat them together,
16:10but you're asking to eat rajma first, then rice.
16:14You're right, it's tricky when we talk about Indian food
16:18because a lot of Indian foods are mixed.
16:21Like this has carbs and protein, both right?
16:24So within this, in my house, what we do is actually, rice is never made in my house.
16:30If a guest comes, then we have to make rice later because the guest may need rice.
16:36But in my house when it is rajma for dinner, it's only rajma.
16:39There is no separate rice, there is no separate roti
16:42because it already has enough carbohydrates.
16:44So we will have this, and we'll have a salad with it
16:47or a vegetable, you know, sautéed something.
16:49So we're getting some protein and carbohydrates there,
16:51and we're getting the vegetables.
16:53All right. Doctor, another thing that very commonly people ask is,
16:56does diabetes occur from eating sweets?
16:59Like if you're having jalebis, cakes,
17:01and many spoons of sugar in tea, does that cause diabetes,
17:06or can eating salty foods also cause diabetes?
17:09Yeah, great question, Revant.
17:11So definitely, the more sugar we consume in our diet,
17:15the higher the blood sugar can increase for sure.
17:17But the misunderstanding is that I stopped eating sweets
17:22or I didn't eat sweets at all, so how did I get diabetes?
17:26They are really confused because they think that it's only in cake, fruits, or ice-cream.
17:32No, like we mentioned, carbohydrates that are not sweet.
17:35It's not sweet in the mouth.
17:37But it's a carbohydrate.
17:38So that's the same thing coming back.
17:40Roti, rice, upma, poha, all of these non-sweet carbohydrates
17:46turn into glucose after digestion.
17:48So it's not about the salt.
17:50It's about the carbohydrate.
17:53So diabetes doesn't just occur from eating sweets.
17:56Diabetes occurs from eating too many carbohydrates,
18:01so even if you eat something salty,
18:03if you eat something savory like bread, upma, or just these things in excess, you can still get diabetes.
18:09This is the biggest myth that diabetes only occurs from eating sweets.
18:14You should control carbohydrates, and not just sweets.
18:19Another myth is that people think fruit juice is a very healthy thing to have,
18:23but it's so unnatural.
18:26It's not only unnatural, it's unreal.
18:28It's unreal.
18:29Real is not real.
18:31Anyway...
18:31It's not real.
18:33If you peel and chew a fruit, how much fruit will you eat?
18:38For example, if you take an orange, apple, pineapple, or mango.
18:43But when you convert it to a juice form
18:46and you just gulp it then you are consuming the equivalent of 3 to 4 fruits in one go.
18:52So fruit juice is not healthy, it's not natural, even if you've squeezed it at home.
18:57Definitely not a Tetra Pack one.
18:59But even a homemade juice is not healthy.
19:01It is a high speed delivery of sugar.
19:05But you said that 3-4 oranges' equivalent is found in one glass of juice, so isn't it good?
19:13So what are you taking from that?
19:15You are saying that Vitamin C, right?
19:16You are running after Vitamin C.
19:18That is a micronutrient, meaning vitamin C comes in a small quantity.
19:24What is macro there? Sugar.
19:26So the vitamin C comes in micrograms, and the carbohydrates and the sugar come in grams.
19:33The quantity of sugar is much higher, and the Vitamin C in an orange is quite low.
19:37Those who say they are having jaggery for iron.
19:41They are forgetting the math. Look at the math in this.
19:43Jaggery has a large quantity of sugar as a macro nutrient and a small quantity of iron.
19:49As long as you chase jaggery for iron, the sugar will keep increasing.
19:53So there is one learning here, which is, packet juices are the worst, then homemade juice.
20:04The best thing is fruits and vegetables and especially vegetables, right?
20:09Yes, I mean fruit, consider fruit as dessert.
20:12Consider fruit as dessert.
20:14Yeah, here's dessert.
20:15The kiwi is dessert. It's going to give you carbohydrates.
20:18It's going to give you sugar.
20:20But what about the micronutrients that we talk about?
20:23Like you know many fruits have...
20:25Sure, so it's not natural to eat so much fruit for the micronutrients
20:30because of the amount of sugar.
20:32So yes it has micronutrients, but it's also in the vegetables.
20:35Actually, vegetables are a form of fruit.
20:37But they are not sweet.
20:38But in biology or botany, these are also fruits, say tomatoes for example.
20:45So there are micronutrients in vegetables also.
20:47So if you are thinking abiut what should be taken for those with diabetes?
20:49Definitely more on the vegetables to get micronutrients.
20:53So vegetables are better than fruits for diabetics.
20:57Try it out, why listen to me!
20:59Eat it and measure glucose within 2 hours. Don't take my word for it.
21:03Whatever food you want to know, this is a question I get a lot, what should I eat?
21:08Suggest a diet plan to me.
21:09Why should I be telling you that as you won't be following that throughout your lifetime?
21:13You will take your own path also.
21:15So eat something, and if you have doubts whether it's good for you,
21:18check your glucose after 2 hours.
21:20What are the worst fruits for diabetes, and which can be taken if cravings for fruits arises?
21:26Eat what you feel like eating and then measure glucose after 2 hours.
21:29Why should we make a list?
21:31No, but there must be some slightly better ones and some slightly worse.
21:34There is a difference of 5 grams.
21:35It is very unfortunate of the dieticians telling you not to eat that.
21:43That is where this list came from.
21:44Sitaphal, chiku, banana, and mango.
21:47But nobody's diabetes got cured by avoiding those
21:50where the difference per 100 grams is only 5 or 10 grams.
21:53There isn't much difference.
21:55So, by eating the less sweet fruits, diabetes is not going away.
21:58On the contrary, I have seen that people with diabetes are allowed papaya.
22:03Full plate of papaya, glucose spikes because people are not checking.
22:07They're not checking and if you follow it blindly, you don't know then.
22:11You are saying that you eat fruits but eat them in control,
22:14whether you're having mango or papaya or any other fruit, eat a little less and in moderation.
22:19Here, this is practical advice, right?
22:21If you want to eat fruit, and suppose your glucose increases after 2 hours, then you have options.
22:27So think about what all you ate there.
22:30Did you have roti?
22:30Did you have rice? You want to keep the mango?
22:32But glucose went up.
22:34Now you have an option.
22:36Maybe you want to keep the mango, it's mango season.
22:38So reduce roti, reduce rice.
22:41Keep that piece of mango, or if eating the whole mango increases your glucose,
22:45you can have half.
22:46So my formula is very simple:
22:48if eating a carbohydrate increases your glucose, try halving the quantity.
22:53And until the next mango season, focus on other lifestyle changes,
22:58like sleep management, stress management, and exercise management.
23:02There's no need for such a tug of war between doctors, dieticians, and the patient
23:07where we're denying you mango and you're eating it secretly.
23:09If someone wants to eat mango,
23:11is it better to have the fruit mango or is Aamras(mango pulp) worse than the fruit mango?
23:16Chewing slows the process down.
23:19That is the natural way.
23:21We have big teeth.
23:22Actually, dentists are saying that the back teeth are not being used nowadays
23:25because nothing is being chewed properly.
23:26We're not eating hard food.
23:29If you see any other animal till the point of monkey and gorilla.
23:33In front of that are humans.
23:35So even those apes in the jungle are chewing things all day long.
23:38We've lost the habit of chewing.
23:40So chewing is a very important process, as digestion starts in the mouth itself.
23:46In mango pulp, what's there? You just gulp it down.
23:48I'm a Gujarati. I love Aamras.
23:50So I'm not saying don't have it.
23:51My pre-diabetes is gone, and I still have Aamras.
23:55But I know how my body responds.
23:57You're Gujarati and telling me not to eat sweets? How is that going to work?
24:00Eat! And then measure glucose after 2 hours.
24:03And if it spikes much?
24:04Then you know that I have to assess the carbohydrates, what I have eaten,
24:09and actually with my patients, we make them use our app.
24:11In that, they track how much carbohydrate they had for breakfast, lunch, and dinner.
24:15Glucose before and glucose after...
24:17if you measure anything, you can manage it.
24:19So without data, you have nothing,
24:22You don't have knowledge. You're blindly going for consultation, but when you have data you know,
24:27I've had this carbohydrate, this is my glucose, I can choose I can bring it down.
24:32So the doctor is saying that you don't have to completely avoid fruits, you have to manage them.
24:38So, you have to choose your poisons.
24:40If you are eating too many mangoes, then maybe you should eat a little less roti.
24:45You will need to measure and see where the spike is coming from.
24:49And then you can manage which food is right for you.
24:52So, you said that carbohydrates like rice, roti, etc., also turn into glucose.
24:58And the white sugar also turns into glucose,
25:02so can you explain what this means?
25:07So we have a counting system, so we do carbohydrate counting.
25:11Suppose this is a roti like a Gujarati phulka.
25:14Okay.
25:14This we would say is 15 grams of carbohydrate.
25:17So that's basically equivalent to 3 teaspoons of sugar after digestion.
25:27And if it's a bigger paratha, that could be about 4-5 teaspoons of sugar.
25:33So, we put 1/2 or 1 teaspoon of sugar in tea,
25:37and you're saying this roti or paratha is equivalent to 4 teaspoons of sugar?
25:40If it's a large, thick paratha, then yes, it could be 4-5 teaspoons.
25:43So, we could do this: instead of eating two rotis, we eat one roti and
25:46add three teaspoons of sugar to our tea.
25:48So do the checking.
25:49Check your glucose two hours later to see how it responds.
25:53There is a difference here.
25:54This will be called a complex carbohydrate.
25:57So it's complex, meaning it's not sweet in the mouth.
26:00You have to digest it.
26:02It gives glucose in the blood,
26:05whereas sugar is direct sugar so that gives a glucose response much faster.
26:12So if you're wearing the sensor, the continuous glucose monitor,
26:16you will see that if you had one paratha,
26:18which we would say is about 20 grams of carbohydrate
26:21versus you took four spoons of sugar in your tea.
26:25Most likely, you'll see that the paratha is giving a slower spike,
26:29and the sugar is giving a quicker, much faster spike.
26:32So you mentioned many times to measure and about CGM,
26:37so please tell us something about it.
26:38How does someone measure diabetes at home, and how does CGM work?
26:42Is that the only way or are there other ways?
26:49When we want to empower the patient,
26:51my job is to ensure that the patient doesn't remain a patient their entire life.
26:55We want the patient to be independently smart about what's happening.
26:59Not that they're depending on the health care professional once in three months.
27:03So we make the patient of diabetes become an expert.
27:07How do you become an expert if you don't have data?
27:09What does an expert have that you don't have? Data!
27:12So you will get your own data by pricking.
27:14An important thing is if you prick the finger.
27:17Why do people not like pricking? Because they don't know how to prick also.
27:21They prick where it hurts the most.
27:23These are the most sensitive points on our fingers.
27:26We can recognize the world even with our eyes closed using our fingertips.
27:30So if you stick a needle bang in the middle of that, it's quite torturous, actually.
27:34Cruel! So why not learn to do namaste,
27:38and now I can see the edges of your finger.
27:42So, the skin you see in this position, if you poke it, it will hurt very little.
27:49Okay, somewhere here?
27:51Yes, exactly or we have yoga mudras in India.
27:54You do any mudra, what do you get?
27:56You get a side border.
27:58Any side border.
27:59That becomes an easy point to prick compared to the central fleshy part.
28:04It hurts much less.
28:06And per finger you have this side.
28:08You have this side. You have five fingers.
28:10You have 10 testing sites.
28:13So you have lots of options where you can check.
28:15This gives you immediate information about how your food is affecting yourself.
28:19The other way is wearing a continuous glucose monitor.
28:22It will show a 24-hour pattern, and even when you're sleeping, it will monitor it.
28:27And it's quite expensive, as far as I know.
28:29I'm very strategic about what we should spend money on.
28:32It is expensive, but diabetes can be extremely expensive
28:39if we don't prevent it and it progresses to complications.
28:42So, cardiac complications, eyes, feet, so many organs getting involved.
28:46Extremely expensive but the problem is if I'm having a cardiac emergency,
28:51I don't think of reducing cost I have to do a life-saving procedure I have to put in the stent.
28:56Then we don't look at the money, we are spending in lakhs.
28:59But here, if these few thousand can prevent that,
29:02so if we take a preventive approach, we realize
29:05that we don't have to suffer from it indefinitely.
29:07Take the information turn your diabetes around and have a better outcome with less medication.
29:12How many months should one wear CGM to analyze and understand the pattern?
29:17If you have proper coaching, the problem is if you don't have clarity in interpreting it,
29:21what are you doing with it?
29:22So some people get scared, they see it and get frightened and then remove it
29:26because they don't know what to do with the information.
29:28So, if you have a good thinking pattern, like this kind of plan,
29:31that if I see it's gone high.
29:33I will cut my carbohydrates then even just one or two sensors 15 days twice.
29:38Only one month if you do it.
29:41Because you make steps, you make actions, you can change something every day.
29:44So, if you spend on a CGM for one month,
29:49in the longer term, you will save lakhs on insulin injections.
29:53Exactly and in complications.
29:55One more thing, and you'll begin label reading.
29:57Whole grain, I want to speak for a minute about it.
30:02Suppose that this is a whole grain roti.
30:05If I say it's made from whole grain wheat,
30:08can you see the whole grain in the wheat here?
30:12I can't.
30:12Will you find whole grain if you eat it?
30:15No, it's atta, it's powder.
30:18So, that was once whole grain,
30:22but after it was ground into flour in a mill, how is it still whole?
30:27It is a powdered grain.
30:28But when you look at healthy packaging it says healthy whole grain biscuit.
30:33Healthy whole grain Khakhara, multi-grain roti
30:37or Jawar puffs, Nachni wafers, and Nachni soya sticks.
30:42All these words, there is no whole grain left in that.
30:45Got it. So, you're saying that this whole wheat
30:49and whole wheat biscuits and all these things...
30:53Whole grain.
30:54Whole grain.
30:54Hmm.
30:55That is not necessarily whole grain in its final form.
31:00No, if it's instant, ready to eat, then how is it whole grain?
31:04Do wheat and refined wheat flour have the same effect on the body?
31:08Exactly, we've seen this.
31:10So this is a white rice.
31:12This is a brown rice.
31:13This is brown rice?
31:14Yes.
31:15This feels like Maggie to me, like the dried-up Maggie from the school's tiffin.
31:21Ah, it's looking like that, anyway.
31:24Yeah, maybe after 15 years of storage, my rubber models have shrunk.
31:28You were saying something?
31:28So, people have maybe switched to brown rice thinking it's much better than white rice.
31:34The carbohydrate count is the same;
31:37one-third cup of brown or white rice, both have 15 grams of carbohydrate.
31:41So, you don't have a strong preference that people should eat brown rice,
31:45and you're saying white and brown rice are kind of the same.
31:47I want you to do your experiment.
31:49I want you to be fully informed.
31:50One day you eat brown rice with your meal.
31:52Keep everything else the same.
31:54Keep all the other things in your lifestyle the same.
31:56And see, after 2 hours with prick, then you switch it to a white rice and you see.
32:01Keep the other points same, only change the white rice and then see.
32:05So doctor, I have a question for you.
32:07What can a normal person do to prevent becoming pre-diabetic?
32:11If someone is pre-diabetic, what can they do to prevent becoming diabetic?
32:15And for someone who is diabetic, what can they do to prevent going
32:19from controlled to uncontrolled diabetes?
32:22So what can each of them do?
32:24First category, second category and third category.
32:27Correct. So exactly what you mentioned was the word category.
32:30So before we say what each person should do,
32:33let's define what the cutoffs are
32:35and what's the difference between normal, pre-diabetes, and diabetes.
32:39So for that, I have an analogy for you.
32:41Okay.
32:41Our human body has about 5 litres of blood.
32:47I made this just to show you a mock-up obviously, I couldn't get five liters of blood on the table.
32:51So I just made some artificial color to show you this is 5 liters.
32:55Is it the same artificial colour that we use in that 20 rupee drink?
33:00Maybe it's one of those things that is permitted to be added, permitted colors, right?
33:06But for the human body,
33:08for normal glucose, think about 1 teaspoon, just 1 teaspoon of glucose
33:16dissolved in 5 liters.
33:18That's 100 milligram per deciliter.
33:21It should be lower than that, so below 100 is considered normal in a fasting state.
33:26Fasting glucose less than 100 is 1 spoon of sugar in 5 litres of blood.
33:32And we have 5 liters in our entire body?
33:33Correct!
33:34So when we say 100 mg per deciliter, fasting should be below 100 mg per deciliter.
33:38That is equal to 1 tsp of sugar dissolved in that five liters.
33:43Okay.
33:44When you say that you are in pre-diabetes,
33:49you are between one teaspoon and one and a quarter teaspoons.
33:53Between one teaspoon and one and a half teaspoons is considered pre-diabetes.
33:59It's only a quarter teaspoon difference.
34:04And if I have to say someone who's falling off outside of diabetes
34:10because the minute it's more than this, you're in diabetes now.
34:13This is how all diabetes starts.
34:16This is uncontrolled, sugar is 200 milligram per deciliter in the blood.
34:19That's two teaspoons.
34:21So just going from one teaspoon to 2 teaspoons
34:24is making you go from normal to diabetic.
34:27Fully uncontrolled.
34:28Uncontrolled diabetes.
34:29Uncontrolled falling off from there, 200 blood glucose.
34:33The difference is only 1 teaspoon becoming 2 teaspoons in the whole body in that blood.
34:38So just going from one teaspoon to 2 teaspoons of sugar
34:42is making you go from normal to uncontrolled diabetic.
34:46Exactly, so now when we're putting all that sugar in our food,
34:50or eating all those carbohydrates.
34:51Think about where it's going if it's not in the blood.
34:53Where is it going in the body?
34:55But I want to understand a thing, so to simplify this, you're saying 2 teaspoons.
35:00Does that mean that if I add 2 teaspoons to my tea,
35:04it will make me go from normal to uncontrolled diabetic?
35:08Immediately no, because the body has these three musketeers.
35:12There is the liver, there is the muscle, there is the pancreas.
35:15The body is trying to keep a normal glucose level.
35:18A cup of tea won't take you from here to there,
35:21otherwise the whole country would have had diabetes by now.
35:24It almost does, but anyway.
35:25Exactly, we're getting in that direction
35:27but the reason that one cup of tea doesn't make us diabetic
35:31is because the body is trying to fight that.
35:34The body is using insulin.
35:35The body is using the muscles.
35:37The liver, the pancreas.
35:39The whole body is trying to keep that glucose normal through insulin.
35:44This is why it's very necessary for our body to produce insulin.
35:48Exactly, that's why you need insulin so that you don't keep on going higher and higher.
35:52But what people don't understand is you shouldn't just look at the glucose.
35:56If you've eaten that sugar or carbohydrate,
35:59and if it's not showing up here,
36:02then you shouldn't just roam around carelessly
36:04just because it hasn't overflowed yet
36:06doesn't mean that it's not affecting all the organs.
36:09This blood is going through the entire body.
36:11Why does diabetes affect the whole body?
36:14Eyes, kidneys, feet, every part of the body is affected by diabetes
36:19because this blood is going everywhere.
36:20Okay doctor, so what should a normal person do
36:24to prevent going from normal to pre-diabetic,
36:27and what should a pre-diabetic person do to avoid going to diabetic?
36:31Remember how we discussed
36:32that there shouldn't be a separate diabetic diet from the healthy people in the house?
36:35We should give you a diet that works for everybody to stay healthy.
36:39The same approach for lifestyle also.
36:41And this is where I come to the lifestyle car.
36:44This is an analogy. I like to explain with analogies
36:47because otherwise, it feels very complicated and boring.
36:50So, just like a car has 4 wheels, nutrition, which we talked about,
36:54and sleep habits, if you don't sleep properly, not sufficient hours of sleep.
36:59Less than six or seven hours of sleep,
37:02or bad quality of sleep,
37:04where you fall asleep while looking at your phone at night.
37:07Now we have this habit.
37:08We'll watch something till our eyes don't stay open.
37:11No one makes a baby sleep like that,
37:13by taking a small baby and putting light in the baby's eyes to make them sleep.
37:17No, we know that they need a dark room.
37:19What you watch on your phone is also important.
37:24If you watch content like Elvish Yadav's, you'll end up getting diabetes anyway.
37:27Exactly, after sunset, it doesn't get completely dark in houses now
37:33as everyone turns the lights on.
37:35Lights are still far, we're consistently putting our eyes under artificial light radiation
37:40till we don't fall asleep.
37:42This is not the way we make the baby sleep but we do it to ourselves as adults.
37:46Got it. So, nutrition is one wheel, and sleep is the second wheel.
37:51Which are the third and fourth ones?
37:52And within sleep, not just the gadgets and the artificial lights and cut duration, snoring.
37:58In India, there is a very big problem of snoring,
38:00which remains undiagnosed in many people, and it is called Sleep Apnea.
38:03So the patient or the person who is not waking up fresh.
38:07If they're not waking up fresh. They need to think, do I have Sleep Apnea?
38:11That is sleep.
38:12Third is stress management.
38:14We are the country of spirituality and yoga.
38:17But are we all happy?
38:18Are we all calm and peaceful?
38:20Look at how much honking is happening in Mumbai; everyone is honking at the red signal,
38:24people are not calm.
38:26Stress management is a very big piece.
38:28I got pre-diabetes purely from stress,
38:31and it was resolved by learning stress management.
38:334th is exercise.
38:35So within exercise, people feel,
38:37"Yes, ever since I got diabetes, I've stopped adding sugar to my tea and started walking.".
38:41So, I've noticed in India that people over the age of 40 enjoy walking,
38:47but apart from walking, they don't do anything else.
38:49They don't go to the gym or play sports, but they watch a lot of sports.
38:53However, they never actually play.
38:55They consider the gym a taboo, thinking, "Gym is only for people taking steroids."
39:01Walking is probably the only form of exercise for a lot of people above 40,
39:06but walking is not enough, what you are saying.
39:09No, this is the thing, people think that gym and bodybuilding,
39:12like you said, people who take steroids.
39:14This is a completely wrong notion in India
39:17that only sports people or only actors and actresses have to exercise.
39:21And we simple, ordinary people don't need exercise or muscle building.
39:25If you want that in your 60s and 70s,
39:28you can lift your grandchildren and climb a hill with them.
39:32Or go to the airport and lift your luggage,
39:35or travel by train for a pilgrimage,
39:38a lot of Indians wish to go on their pilgrimage in old age.
39:41How will you do your luggage carrying or your moving up and down the train station
39:46if you don't have muscles?
39:47It's simple that in old age, while walking, it's uneven under your feet and if you fall,
39:54unfortunately, that becomes almost as deadly as cancer.
39:58In the next five years, the survival rate of an aged person who falls and fractures their hip
40:02is worse than that of cancer.
40:05So how should it be prevented?
40:06Muscle building! So it can be done in the house.
40:10I don't go to the gym. I do this in my house.
40:12It's possible in your house in 15 minutes twice a week.
40:15Just like we increase our savings account for inflation,
40:20similarly, muscle loss happens whether you like it or not.
40:23So, what are you doing in the opposite direction to counter the muscle losses of age?
40:27Got it. So, we've learned that muscle building is for everyone,
40:30whether you're in your 20s, 30s, 40s, 50s, or even older,
40:36muscle building is important for all ages.
40:39People in India have the misconception that muscle building is only for bodybuilders,
40:43athletes, or Bollywood actors.
40:45No, muscle building is necessary for everyone
40:49because with every decade, we lose a significant amount of muscle.
40:53To prevent that muscle loss, we need to build muscle.
40:56I also want to build muscle, I'm a bit skinny too,
41:00but we all need to come together
41:02and build a bit more muscle and a bit more body strength.
41:05So, doctor, you said to go to the gym. A lot of people are now going to the gym,
41:10and they're going regularly every week, but they're not losing weight.
41:14So, what's your opinion on this?
41:16So, here's where the problem is.
41:17If someone thinks that just going to the gym will lead to weight loss,
41:21The solution for weight loss is in the kitchen.
41:23Okay!
41:24Whoever is going to the gym or exercising at home, let me take my own example.
41:28I've been exercising at home for the last 10 years.
41:31I was sedentary, I used to just sit with books, as a student and doctor.
41:35So I was only studying and sitting.
41:37For the last 10 years, since I've been doing strength training,
41:41my weight has increased by 4 kilograms,
41:43but people look at me and say, "You've become slimmer."
41:46So what is that?
41:48So this is 1 kg of muscle.
41:50Okay.
41:50All right. Just human muscle.
41:52This is 1 kg of fat.
41:55So, as you can see, this is trim, toned, sleek, and smooth.
42:01This is lumpy, the body fat we recognize, which needs weight loss.
42:05People know what their body fat looks like.
42:07So, the difference is that when you build muscle...
42:11It's heavy.
42:13So, when we gain muscle, our body weight will increase.
42:17So, you need to check how your body fat is reducing.
42:20How do you check fat loss?
42:22The weighing scale doesn't know whether you've lost fat or gained muscle.
42:26It only shows your weight.
42:27Just like one kilogram of potatoes and one kilogram of gold, you know which one is which.
42:31So even when you're losing fat you will not see it on the weighing scale initially.
42:35You can measure the inch losses.
42:38You need to see strength gains.
42:40So what are you following? When you are exercising, are you getting stronger?
42:44Are you having inch loss?
42:45Are your clothes getting loose from the waistline especially?
42:49So these are the things to monitor.
42:50Don't look for weight loss through exercise.
42:53So, don't focus on weight loss, focus on fat loss. Is that correct?
42:57And for that, there are techniques.
42:59If you go to a doctor, they have techniques to actually measure fat loss.
43:03The gym scales where you stand and it tells you your body fat percentage,
43:07those are very rough.
43:08There's a lot of error in those,
43:10so if you check it day to day, week to week, and keep looking at it repeatedly,
43:12you're focusing on the wrong thing.
43:14Focus on getting stronger.
43:16If you're lifting 5 kg, when will you move to 6, and when will you go to 7?
43:20Are you pushing each muscle to failure?
43:22This is also a very important message, not just doing 25-30 repetitions and then stopping.
43:28If the trainer says, or if you say, "Five more reps could have been done,"
43:32it means you stopped too early or chose too light a weight.
43:36You have to go heavier to the point that you cannot complete one more repetition.
43:40So, the weight you lift, count those kg, but don't count the kg in your body.
43:48Count the inches of your body,
43:50and don't focus on weight loss,
43:52focus on fat loss and this is very, very interesting.
43:56Just like you said, these are both 1 kilogram, but this is much bulkier and looks like...
44:01Fluffy.
44:01Fluffy and not bulky, but fluffy and looks bigger,
44:04which is why you can gain weight,
44:07but at the same time becoming stronger & healthier.
44:11People have this obsession over weight loss,
44:14but they're not considering that with weight loss, they're also losing muscle.
44:18And if you only focus on weight loss, you won't get that toned look.
44:22The skin will actually sag.
44:24So the tone look, which everybody wants.
44:27They don't realize it's coming from muscle building.
44:29The "toned" look won't come, the "Fatty" look will come.
44:31Anyway!
44:32[inaudible]
44:34Here's another question for you, fasting is a very common practice for many people in India,
44:40we fast for many religious reasons as well.
44:43So all of those religious fass that we're doing, does that help with diabetes?
44:49It's an amazing question.
44:50I've never taken fasting seriously,
44:53nor have I fasted for any religious reason or for my husband's health.
44:57Until I understood the science behind it,
45:00there's a doctor Jason Fung, who explained how fasting can work for diabetes.
45:06But the religious fasting in India is present in many different religions,
45:10with many religious faiths having their own versions of fasting.
45:13Unfortunately, if you're eating during fasting,
45:17like you might say grains are not allowed, but fruits are allowed, and milk is allowed.
45:22That means you're still eating. So, it won't help in diabetes reversal.
45:27Because it is still giving that carbohydrate, which we talked about.
45:30Doctor, one last question.
45:32We all know that India is the diabetes capital of the world.
45:36How do we collectively, me and you and everyone else and the government, especially.
45:42How do we make India go from being the diabetes capital of the world
45:47to the health capital of the world?
45:49What can we do about it?
45:51So important.
45:52I think as you are already working hard on this, the government needs to support your message.
45:57Food manufacturers, food processors...
46:01very few people left who are growing and eating their own food,
46:06or hunting and gathering their own food and eating it.
46:08We have become reliant on food coming from somewhere else.
46:12So, the process of safety and awareness,
46:16labeling, packaging, and informing the consumer about what they are eating.
46:21Ethically and responsibly, the government has to do that.
46:25And we need to push them for that.
46:27The second space is in education.
46:29Now it is important to give education to children
46:32that what is healthy for them for preventing such metabolic diseases.
46:35So that India does not go into becoming the diabetes capital.
46:38We have to protect the next generation from the mistakes that we've made.
46:41Also healthcare providers: Doctors, Teachers, Pharmacists, Nutritionists, Dietitians.
46:47We need to be educated.
46:48Everything that we discussed over here today.
46:51I was not in my endocrinology training.
46:53How to prevent diabetes?
46:55How to reverse pre-diabetes?
46:57How to lower uncontrolled diabetes with fewer medicines?
47:01Or how to reduce the insulin dose, none of these things were taught in college.
47:06I had to learn it on my own because I thought that is health.
47:09Otherwise, I was only doing disease management.
47:12So doctors are trained in disease management.
47:14We need to get more doctors to know about the lifestyle changes.
47:18So that they can help prevent and turn around these chronic diseases.
47:21So doctors should be taught not only about disease management but also lifestyle management.
47:27And it's very interesting you said that not only do children need to be taught, but even doctors.
47:31Because we consider doctors to be health experts,
47:33but doctors also probably need more follow-up education around lifestyle management.
47:38Absolutely.
47:40Thank you so much, doctor, for coming today and being a part of this episode
47:44on Rethinking Diabetes.
47:46This was truly a huge learning experience for me and probably for everyone else as well.
47:50Thank you.
47:52I consider every episode like a period in school.
47:56We attend thousands of periods in our school life,
48:00and most of the periods we don't remember,
48:02but there are some periods and some lessons that stay with us for a lifetime.
48:07I hope that you too have learned at least one lesson from this episode
48:12that will stay with you for a lifetime.
48:15If you are diabetic, remember that diabetes is not about calorie management,
48:21it is about carbohydrate management.
48:24And if you are not a diabetic, remember,
48:27always be kind to diabetics because they deal with enough pricks already.
48:32Thank you, everyone!
48:33And once again, I'm really happy to be a part of Zerodha's Media Network,
48:37whose resources enable me to bring this show to you.

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