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Why Indians Get Diabetes So Young: Sugar, Diet & Genetics | Dr. V Mohan | FO534 Raj Shamani — Transcript

by Raj Shamani · 21,862 words · 3,719 segments · language en · Watch on YouTube

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0:00Stanford has put you in top 2%
0:02scientists of the world yeah and you
0:04have said something about Indians which
0:05is shocking. We are building and
0:07developing diabetes faster than any
0:09other population on earth.
0:10>> Partly it's genetic. So we have [music]
0:12had consanguineous marriages, marrying
0:14your cousin, marrying your uncle. So the
0:16gene gets multiplied. On top of that, we
0:19consume too much of carbs and to burn
0:21it, you have to do a lot of exercise. We
0:23really don't do much exercise. All this
0:26put together becomes a deadly
0:28combination.
0:30>> Dr. V. Mohan, India's leading
0:32diabetologist. He spent over 50 years
0:35studying diabetes. Today, he breaks down
0:37diabetes, sugar, and how to actually
0:40stay healthy.
0:42>> Is there any sign that I get to know
0:43that I'm pre-diabetic?
0:44>> You can guess. If you have a family
0:46history of diabetes, you can guess. If
0:48you're overweight, your chances of
0:50getting that is very high. If your waist
0:52is high, 90 cm or more in males, 80 cm
0:55or more in females, most likely you will
0:57have pre-diabetes. If this ABC do you
1:00do, we should have a complications-free
1:02India. A is A1C below 7%. B is blood
1:05pressure. You have to keep it at at
1:06least below 140/90. C is cholesterol.
1:09The bad cholesterol is LDL cholesterol.
1:10Should be below 100. D is discipline.
1:12Diet, exercise, sleeping, this, that,
1:14all that. D also includes no smoking and
1:17all. If you smoke, then all gone.
1:19>> What is there in a diabetic person that
1:21one small wound doesn't heal?
1:23>> One is glucose. Glucose is a very good
1:25source for bacteria to grow. The chance
1:27of it breaking a bone is very easy
1:29because of all the calcium has gone from
1:31the bone. The most deadly one is blood
1:33circulation problem. It's a blocked. If
1:35you don't have blood circulation,
1:36without blood, nothing will enter there.
1:39Whatever nutrient you give, whatever
1:40antibiotic you give, beyond a certain
1:42point, diabetes can be an absolute
1:44killer.
1:46>> Give me top three best breakfast which
1:48an Indian can eat.
1:50>> So fruit, apple, very low GI. Guava is
1:53again something with lot of fiber. It's
1:54very, very good. Orange is okay. Papaya
1:56okay, egg is a very good breakfast.
2:00Advantage of adding protein at breakfast
2:02is you can go up to lunch time not
2:04feeling [music] hungry. And that protein
2:06should come from plant protein, not from
2:08animal protein. Why? Because plant
2:10protein much healthier. [music]
2:12I'm going to show you these things, but
2:13you rank them. Completely safe is one.
2:16>> Yeah.
2:16>> Completely toxic is 10. So, we have
2:18orange juice, we have brown sugar, we
2:20have coconut sugar, we [music] have monk
2:22fruit sugar, we have sugar-free, we have
2:24stevia, jaggery powder, we have white
2:26sugar.
2:27>> So, I would put stevia and sucralose as
2:29the the first two.
2:31>> Okay.
2:31>> I would then probably put uh
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3:38Link is in the description below.
3:41>> [music]
3:45>> So, if someone's watching you for the
3:47first time, okay?
3:48What should they know about what you do?
3:51And
3:52how would you define yourself?
3:54And why should they care watching this
3:56conversation for next 3 hours?
4:00>> The man who spent all his life studying
4:02one
4:03disease, who's dedicated himself to all
4:06aspects of the disease,
4:08not just as a doctor, but as a
4:10researcher, who's spent 1,000
4:13800 publications on in one field,
4:17and 40 50 years of work in this
4:20particular field, whose work has helped
4:23to change policy,
4:26to change
4:27uh
4:29the way people should conduct themselves
4:31based on science.
4:33And then somebody who has also trained
4:36hundreds of doctors who have now become
4:39successful. Uh why I'm saying all this
4:41because last year I got the global
4:43impact prize of EASD.
4:45>> I know.
4:46>> And this year I was in the selection
4:48committee for the next year this year's
4:49prize. Yesterday in fact was the
4:51selection committee.
4:52>> to put in perspective is almost like
4:54Nobel level prize for the diabetes.
4:56>> Yeah, exactly. So that's how I that's
4:59when I put all my work together, and
5:01then I realized got quite a lot of
5:03things we have done over 50 years, you
5:05know, when you break it down into
5:06different thing. Then the journal wrote
5:09to me, they have a journal called
5:10Diabetologia, very high impact journal.
5:12They said we want to publish your
5:14lecture.
5:15>> Mhm.
5:15>> So you write about so the title has been
5:17accepted, it's going to come. Next issue
5:19it'll come.
5:20How work in India, the title of that
5:23thing is impacting lives of people with
5:26diabetes, how India leads the world.
5:30It's a great thing not just for me.
5:32>> It's for India.
5:32>> For the country.
5:33>> For the country.
5:34>> So so that's how I think you can
5:36describe that.
5:37>> [laughter]
5:37>> Interesting. You know what's what's
5:39really fascinating for me is because you
5:41you said India for the world now.
5:43>> Yeah.
5:44>> Which is
5:46I think people should be grateful to you
5:47for a lot of things because probably
5:50this is one of the rarest times where
5:53India is leading
5:56a standard in the world in the field of
5:58medicine.
5:59>> Yes, because we've never been there,
6:00right?
6:00>> No, it's not been there, yeah.
6:01>> Explain me simply
6:04what is diabetes?
6:06And
6:07why whoever is either pre-diabetic or
6:10diabetic is
6:13not able to manage it and maintain it
6:17properly because only 7.7% people out of
6:19100 are able to manage it.
6:21More than 92% people are failing in
6:23either reversing it or managing just
6:25their sugar, blood pressure, and
6:27cholesterol.
6:28>> Yeah.
6:29>> Why?
6:31>> Okay, let me go to the first question.
6:33What is diabetes?
6:34>> And you can feel free to explain it
6:36through paper and chart if you want to.
6:37>> I'll do that. So,
6:40diabetes, simply put, is a condition
6:42where the blood sugar level is above
6:45normal.
6:46So, what people don't know is that
6:48everybody has sugar in the body.
6:50Sugar is like fuel.
6:52If you don't have sugar, you'll die.
6:53Your sugar goes down below particular
6:55level, you will be incompatible with
6:56life.
6:57>> Okay.
6:57>> Okay? So, the normal sugar, fasting,
7:02it will be say around 80.
7:04>> Mhm.
7:04>> 80, 90, less than 100, definitely. Okay,
7:07maybe 70 to 100. After food, it may go
7:11to say 120.
7:12>> Mhm.
7:12>> It won't go beyond that. HbA1c, we said
7:15it will be less than 5.6.
7:18>> Mhm.
7:18>> If these three are there, you're not
7:20having diabetes, you're not having
7:21pre-diabetes, also.
7:24If it starts going up, fasting goes from
7:26100 to 125.
7:29The post post glucose, not postprandial,
7:32140 to 199.
7:35>> Mhm.
7:36>> Then HbA1c 5.7 to 6.4, then it's
7:40pre-diabetes.
7:42Then you got diabetes. This will be more
7:44than 126. This will be more than 200.
7:47That will be more than 6.5 Hbmc. So,
7:50this is diabetes, this is prediabetes,
7:52this is normal. So, this is the how you
7:54classify.
7:55Now,
7:56you may have one of this. That means you
7:59got diabetes. But it's not one disease.
8:02There are about 50-60 different types of
8:04diabetes.
8:06The common thing we know is type 1, type
8:082,
8:09gestational diabetes and then another
8:11set of
8:12But there are I just now mentioned
8:13neonatal diabetes. Like this that it
8:14goes on and on. Fibrocalculous I
8:16mentioned. There are so many many types
8:18of diabetes. This only tells you you got
8:20diabetes.
8:21Now we have to start classifying what
8:22type of diabetes. It makes a big
8:24difference. Type 1 you go treat with
8:26tablet, you you are going to kill that
8:28guy.
8:29Type 2 you go and start giving insulin
8:31unnecessarily, they'll put on weight and
8:33so on. So, that is called precision
8:34diabetes. You have to diagnose. So, we
8:36have got certain
8:37rules by which we see. One simple thing
8:40is that age at all. So, below 6 months
8:42it's neonatal diabetes. So, look for
8:44neonatal diabetes. If all neonatal
8:46diabetes ruled out, it still could be
8:48rarely type 1 at that age, but it's
8:50usually type Above that is likely to be
8:52type 1. So, we do simple test, C-peptide
8:54test. That is insulin secretion. If it
8:57is zero, finished. It's type 1. No other
8:59diabetes will go to zero. Okay?
9:01Now it's showing good C-peptide. I told
9:03you little older, 15-16 year old, 18
9:06year old. He comes with acanthosis,
9:08strong family history, obese, type 2.
9:11Not obese, not needing insulin, but
9:15strong family history. There's a type of
9:16diabetes called MODY. Maturity onset
9:18diabetes of young, MODY. In that there
9:21are 14 types
9:22of MODY. Okay?
9:24So, some of those MODY types, like
9:26neonatal diabetes, can be treated with
9:28tablets. Just like neonatal diabetes.
9:31They belong to that same class, MODY 1,
9:32MODY 3. They respond to that. So, when
9:35you come to us,
9:37it doesn't mean everybody will do
9:38genetic test.
9:40For some, I I may think he's got this
9:42FCPD. I'll just take an x-ray, a stone,
9:44finished. Diagnosis stops there.
9:46C-peptide absent,
9:48type 1. Diagnosis stops there. Obese man
9:51coming with this, obvious type 2. You
9:53don't have to proceed for You don't have
9:54to keep on doing everything for
9:55everyone. It's a waste of money, waste
9:57of time. But, not fitting in everywhere.
10:00Then we start asking, is this MODY? Is
10:02this something else? Is it some genetic
10:04syndrome? Is it something else? Somebody
10:07will say hearing is affected. Oh, does
10:09your mother also have diabetes? Yes.
10:11Does she also have hearing problem? Yes.
10:13Then it's maternally inherited diabetes
10:15with deafness, MID.
10:17It's coming from mother, maternally
10:18inherited diabetes with deafness,
10:20finished. So, deafness gives you a clue.
10:22So, like Sherlock Holmes, you can easily
10:25with the experience, this is this, this
10:27is that. For me, as patient walks in
10:28itself, I can say this is the The rest
10:30of it is only to confirm.
10:32>> Okay.
10:32>> It's like Sherlock Holmes, you can just
10:33pick it up. Just like the experience,
10:34you can pick it up. Okay?
10:36So, that that's what makes this disease
10:39so interesting. There's so many types in
10:42this, and with knowledge you you learn
10:44over years and so on.
10:46Now, once you know which type of
10:49diabetes, you also know See, in type 2
10:51diabetes only you talk about reversal
10:52and all. Type 1 is not possible. FCPD is
10:55not possible. In MODY, it's not
10:57possible. It's genetic. How can you
10:59Type 1, how will you All the cells are
11:00gone. You have stones are there. How are
11:01you going to reverse? Certain things we
11:03know you can GDM. Gestational diabetes.
11:06They have diabetes during pregnancy. The
11:07moment they deliver, the diabetes will
11:08go away.
11:10The day they deliver.
11:12Up to that, they'll be diabetic. They'll
11:13be on insulin or not. The day they
11:15deliver, glucose will drop because baby
11:17is out. Baby is producing it.
11:19That will go. But, they may get it back
11:21within 5 years.
11:23So, what do we do? Now we start with
11:25them, don't put on weight, don't do
11:27this, you can prevent diabetes. So, we
11:28have to focus on that in a different
11:31way.
11:31>> I was reading up something about you
11:33that Stanford
11:34>> Yeah.
11:34>> has put you in top 2% scientists of the
11:37world.
11:37>> Yeah.
11:38>> Right?
11:38>> Yeah.
11:39>> And you have said something about
11:40Indians that shocking.
11:42That
11:43if an Indian gets diagnosis of
11:46pre-diabetes
11:47>> Yeah.
11:48>> within 8 years there's 40% chance that
11:51they'll develop full diabetes.
11:53>> Even higher.
11:54>> Why specifically Indians? Like what is
11:56there about Indians that we are building
11:59and developing diabetes faster than any
12:01other population on earth? So
12:03>> Partly it's genetic. So through
12:06centuries of genes coming down the pool
12:11so we have had um
12:14consanguineous marriages. It's may not
12:17be so much in the north but in the south
12:18and all we get had get a lot. Marrying
12:20your cousin, marrying your uncle all
12:22that is uh very common. So the gene gets
12:25multiplied.
12:26So that is one thing. Second thing is
12:29that intra-uterine itself in the mother
12:32is uh
12:33malnourished and thin.
12:36The baby is also thin.
12:38And therefore already born with a
12:40smaller pancreas. The amount of beta
12:43cells are very much reduced.
12:45>> [snorts]
12:46>> And so they're destined to get diabetes.
12:49On top of that, what brings out all the
12:51insulin from the pancreas is your
12:54carbohydrate. We consume too much of
12:57carbs.
12:58>> Mhm.
12:58>> Whether it's rice or wheat or whatever.
13:01And that pulls out the little insulin
13:04you have also gets pulled out very fast.
13:06And to burn it you have to do a lot of
13:09exercise. We really don't do much
13:11exercise. So all this put together
13:13becomes a deadly
13:15uh combination to push you into
13:17pre-diabetes and then into
13:19>> diabetes. You said first let's talk
13:21about all four topics individually.
13:23[clears throat] First you said
13:24the marriages.
13:25>> Yeah.
13:26>> So if you what like when you married
13:29somebody from the same family or same
13:31sort of
13:32>> say that there are
13:34these families which have the gene for
13:36diabetes.
13:38And let's say there's another
13:40set of families where there's no gene.
13:42Nobody in that family has diabetes at
13:44all.
13:45>> If this
13:47family marries into that family, the
13:49gene is going to get diluted.
13:51>> Mhm.
13:51>> Well, there's no gene here at all.
13:53>> Yeah.
13:53>> There is a gene here.
13:54Now, within this if you keep marrying
13:57within that, the gene will get
13:58multiplied multiplied multiplied
13:59multiplied.
14:00They marry their uncle. Uncle also has
14:02the gene. You also have the gene. Okay?
14:05>> Kids will
14:05>> Their kids will have the gene. Then
14:07they're going to marry another cousin.
14:08So, again the gene will get multiplied.
14:10If you keep do doing this for
14:11generations, then they you are already
14:13filled with those genes
14:15>> Mhm.
14:15>> to get heart disease and to get diabetes
14:18and so on. So, that's one thing. Then
14:20the diet also doesn't help because so
14:22much of carbs we take
14:24that uh we are pulling out all the
14:26insulin.
14:27>> So,
14:28coming back to the marriage part, do you
14:29think is it
14:31from purely just medical point of view,
14:34from the health from the point of view
14:36of health of your offsprings, of your
14:37kids, should you not marry inside the
14:40family?
14:40>> Should not at all.
14:42>> Never.
14:42>> healthier to at least not at the first
14:45cousin level.
14:46Or in Tamil Nadu they actually marry
14:48their own uncle, mother's brother.
14:51Is the first
14:54uh he has a right. He has a right
14:56actually to to marry uh suppose yeah
14:59suppose my
15:01uh sister was there and my mother had a
15:04brother,
15:06uh the first he should say no
15:09before she can marry someone else. That
15:11has been This is to keep
15:12>> Wait wait wait wait. You said
15:15the
15:16mother's brother.
15:18>> Yeah, mother's brother, uncle.
15:19>> Uh uncle uncle has the first right to to
15:22marry the mother's child.
15:26>> First he has to say no.
15:27>> Yeah.
15:28It'll It'll actually happen there.
15:30>> Okay.
15:30>> But if he's not interested in
15:32everything. It won't be too much, you
15:34know. See, they they have to marry
15:36young. Yeah, or maybe younger brother.
15:38See, suppose mother itself used to marry
15:40at
15:4119 20.
15:42Then her her brother maybe 5 or 6 years
15:45younger
15:46to her, maybe even 10. Those times they
15:48had large families. So, maybe even 10
15:50years younger
15:52to her. And so, her when her daughter
15:55becomes 18 20, he'll be 25 28 something.
16:00And so, the first We we say that that's
16:03an automatic choice to get It used to be
16:05done like that for several reasons.
16:07Number one, it's the same caste. So, you
16:09don't have to go outside the caste. The
16:10same family. You know the family.
16:13Third is the wealth is kept within the
16:15family.
16:16Suppose a very rich family. Within the
16:18family itself the wealth goes. Somebody
16:20else comes in and then the wealth goes
16:22off to the thing, you know. That's how
16:24it was. It's It's decreasing now. It's
16:26not the same anymore, but that's how it
16:28used to be.
16:29>> So, that has probably caused
16:31>> Yeah.
16:31>> And in in every like there's a lot of
16:33castes and religions where this shape
16:35and form in different ways is is seen.
16:38Where you marry your
16:39family members.
16:41>> Marrying cousins is very common.
16:43See, uncle is less common, but cousins
16:46is very common.
16:47>> So.
16:48>> Okay. So, that's the first reason. That
16:50is one. So, because if
16:52one sort of gene then they start
16:53dominating and then
16:55eventually over the years you start
16:56developing similar kind of diseases.
16:59That's one. Second you said if mother is
17:02malnourished
17:03>> Yeah.
17:04>> the child is also thinner.
17:06>> Thinner.
17:07>> And then the thin So, isn't diabetes for
17:11people who are obese?
17:12>> Later on they'll catch up.
17:14>> So, when the child is born, it's born
17:17with a smaller pancreas, with a limited
17:19capacity to produce insulin because
17:22didn't get enough nutrition. So, the
17:24child is born small, okay? With a
17:28smaller pancreas. Now, what happens? Of
17:31course, they remain like that, they may
17:32not get it. But, what happens is later
17:34on they'll put on weight, no?
17:36So, when they put on weight,
17:38a normal pancreas person with a normal
17:40pancreas can adjust to that load of that
17:43extra fat, extra Here, it's already born
17:46with a limited capacity.
17:47>> Mhm.
17:48>> So, now when you put on weight,
17:50you you are not able to It's not able to
17:52meet the demand. Demand-supply problem.
17:54>> So, you are telling me that if someone
17:57like me, who is probably in his 20s,
18:01is thin and looks fit, at least from the
18:03outside,
18:05just because probably my mother was
18:07malnourished during her time,
18:09>> Yeah.
18:10>> I have equal amount of risk as much as
18:12probably
18:13>> risk, probably.
18:14>> than somebody
18:15>> whose mother was not malnourished, and
18:18when the child was born was not
18:20malnourished, but normal, your risk is
18:22already higher.
18:24But,
18:25by taking enough precautions, by being
18:27very active and not putting on weight
18:29and not becoming obese, you can postpone
18:31it to a large extent. If now you become
18:35obese also, already you're born with a
18:37limited capacity, now you put on weight
18:39also, which is a driver, you will
18:42succumb to diabetes much faster, you'll
18:44develop diabetes much faster than
18:46somebody who's not that way.
18:47>> So, compare a thin Indian with
18:50an obese American.
18:53>> So,
18:53>> more chances of developing diabetes?
18:55>> Indian, because
18:56>> The thin Indian.
18:57>> The thin Indian.
18:58>> In compared to obese American.
18:59>> Obese American.
19:00>> Why?
19:00>> The reason is
19:02we are called thin fat Indians.
19:05T O F I, toffee, yeah. So, we are thin
19:08outside, but fat inside.
19:11So, if you have the fat inside the
19:13abdomen,
19:14that is what the the big American who is
19:18obese may be having a lot of fat in the
19:20subcutaneous tissue.
19:22Whereas,
19:23the Indian has more fat inside the
19:27visceral adiposity inside the abdomen.
19:29And we know why it is so also. A lot of
19:31research has been done to find out why
19:32that is so.
19:33Some feeding experiments were done
19:35recently, about a couple of years ago.
19:37Which showed that you know, overfeed a
19:40South Asian and you overfeed a white
19:42European person, both put on weight.
19:46But, the
19:47European
19:49puts on the white European puts on more
19:51fat here.
19:52Not inside.
19:54On the external abdominal wall.
19:56The Indian
19:58starts to do that, but very quickly it
20:00goes inside.
20:02Why? Because the amount of fat cells on
20:06the surface, just below the skin, is
20:09limited. For Indians. Why? Genetically
20:12also, it is like that. We have certain
20:15genes.
20:16So, what happens is they get saturated.
20:18And then what is called as fat overflow.
20:20It quickly goes inside the abdomen. Once
20:23it enters abdomen, it is toxic. The fat
20:25inside the abdomen will go into the
20:26liver. It will produce fatty liver and
20:29that will turn to diabetes.
20:30>> So, you are telling me just by the
20:32virtue of being an Indian, I have higher
20:34chances
20:34>> Yes.
20:35>> and I can't do anything about it.
20:36>> Absolutely. It's like you can do a lot,
20:38but you're do a lot. You have to be fit
20:41from the beginning.
20:42Reduce your carbs. Not that you can't do
20:45anything. You can. You can.
20:46>> You keep saying carbs.
20:48>> Yeah. But,
20:50>> don't you feel
20:52Okay. So, look at let's say India's
20:54India's been eating carbs since a long
20:56time. And if you compare last 20 years
20:58of data,
21:00our carbs have not increased.
21:02>> Carbs are there, but the quality of the
21:04carbs has changed.
21:06So,
21:07where we used to Let's take rice.
21:09>> Mhm.
21:11>> 1970s,
21:14there were 29 rice mills in India.
21:16>> Mhm.
21:17>> Today, there are 3 lakh rice mills in
21:19India.
21:21So, what are the rice mills doing?
21:22They're polishing the rice.
21:24So, earlier when you had rice, you would
21:27take it to a shop where they will hand
21:29pound it and give it to you.
21:31>> Mhm.
21:32>> So, it has the husk. It has the brown
21:35husk in it, and all layer in it. It has
21:38a protein in it, and it has a fiber in
21:40it. It looks brown in color, also.
21:41>> Mhm.
21:41>> That's why it's called brown rice.
21:42>> Mhm.
21:43>> When you polish, the brown will become
21:46less brown, then become white. Today,
21:48the rice is like that color. It's white.
21:51That means the entire thing is gone.
21:53What is inside is pure starch. It's like
21:56glucose.
21:57So, what you're eating now and what we
21:59ate in 1970s
22:00or 1980s totally different.
22:03So, both are rice.
22:04>> Mhm.
22:04>> Both are carbohydrate. One is a very
22:06high glycemic index carbohydrate. One is
22:08a much less carbohydrate uh much less
22:12glycemic index carbohydrate. So, that
22:13you cannot compare that time. That is
22:15number one. Number two, they used to eat
22:18that and work in the field.
22:20>> Mhm.
22:21>> They were plowing the field and
22:22agriculture and doing manual labor.
22:25Today, even in the field, they're
22:27sitting on a tractor and then doing.
22:29They get loans.
22:30>> Yeah.
22:31>> Country become richer.
22:33So, because of that, they they don't
22:35really goes and does plowing of the
22:36thing. We don't pull a rickshaw anymore,
22:38no?
22:38>> Yeah.
22:39>> You'll buy an automated thing and then
22:40you will go. See, your physical activity
22:42is also gone down. Then, the quality of
22:44food is also changed. Stress has also
22:46come. And more recently, all the junk
22:48food and and everything high in sugar,
22:50high in fat, high in salt, high in
22:52everything.
22:53And all ultra-processed foods, which
22:55directly damage so many systems in the
22:57body. So, we cannot compare
23:002020s to even 2000. it's changed. So,
23:04even though we're eating same amount of
23:06carbs, which is 60-70% of our plate,
23:08it has
23:10completely changed in its texture and
23:13So, that's why carbs are even more
23:15dangerous.
23:16>> That's right. That's why you have to cut
23:17the carbs. But again, we have found the
23:18solution for it. It's not that get rid
23:21of carbs completely. What we showed in
23:23our INDIGO study, the Nature Medicine
23:25paper, which 6 months ago we published,
23:27we're making big news now.
23:2910% of that carbs, 60-70%,
23:33you make it 50-55%.
23:36And the protein from what 8 to 10%, you
23:40make it 18% 20%. That 10% you add as
23:44protein. And that protein should come
23:46from
23:47plant protein.
23:49Not from animal protein.
23:50>> Why?
23:51>> Because plant protein much healthier.
23:54So, if you take not that you should not
23:56take animal protein. Red meat, of
23:57course, is not good. If you're taking
24:00animal protein, then egg is fine,
24:01chicken is fine, fish is good. So, you
24:03can take that. But even healthier than
24:05that is the animal the plant protein.
24:08Your rajma, your Bengal gram, green
24:10gram, black gram, paneer, milk, these
24:12kind of things are much healthier.
24:16>> But they their protein profile is very
24:18limited, right? Like in rajma, you'll
24:20get much lesser protein than probably
24:22somebody eating
24:23>> combining it for a vegetarian, then you
24:26you still can you still can Of course,
24:27the non-veg protein from the protein
24:30percentage point of view, your egg will
24:31give you more and and so on. In fact,
24:33milk is a very good source of protein.
24:35So, they are good. But if you look at
24:38the biological effects, the plant
24:40protein is actually superior. Study
24:42after study is coming for the heart
24:44healthiness, prevention of cancer, all
24:47that animal products always have a
24:49little bad side to them also.
24:51>> What is there in plant protein? Tell me
24:54one specific thing which is not there in
24:56the animal protein.
24:58>> Not that way. The animal
25:00The animal protein
25:02has more fat in it.
25:04Okay? Because most of the animal protein
25:06also, especially red meat,
25:08has a lot of fat in it. Here, the fat is
25:11much less.
25:13It's It's more covered. In
25:16Honestly speaking, if you just take
25:17legumes
25:19and say rice or wheat,
25:21there is one amino acid deficient here
25:23and one amino acid deficient. That's why
25:25you started by saying they're not the
25:27same.
25:28>> It is true.
25:29But, the beauty of nature is that the
25:31one which is deficient in the pulses is
25:35excess in the rice or wheat.
25:36>> Mhm.
25:37>> And the one which is deficient in rice
25:39or wheat is excess in the
25:41legumes. If you combine them together,
25:43there's no deficiency at all.
25:44>> That's why the combination works.
25:46>> Yeah.
25:47>> But, still at the end of the day, even
25:49if you eat dal rice on everyday basis,
25:52that is still majority of carbs and
25:54you're not able to
25:55you know, compensate for your protein
25:57requirement.
25:57>> No, the amount of So, that's where we
26:00come to the plate concept. In the plate
26:02[clears throat] concept, half of your
26:04That's a thali plate healthy plate
26:05concept we talk about. So, if you have a
26:07plate, half of it should be filled with
26:09green leafy vegetables.
26:12The richest source of iron, B12,
26:15vitamins, everything that your body
26:18needs, nutrients. Very low in calorie.
26:21Fills up your stomach. Yeah. Gives you a
26:23digestion, everything your stomach gets
26:25full.
26:26Hunger, everything is satisfied. And
26:28very low carbs and gives you all the
26:29nutrients you need. Now, you got
26:31quarter. The The other half of them.
26:33That quarter keep for protein.
26:35>> Mhm.
26:36>> Non-veg, okay. Take non-veg. Otherwise,
26:38at least veg.
26:40Whatever. You have to take quarter of
26:42the plate. With every meal, you should
26:43look for your protein.
26:44Only remaining quarter, you keep for
26:47your carbs. The way we eat now is very
26:49different. In South India, what do we
26:51do? Rice and
26:53sambar, rice and rasam, rice and curd.
26:58You know, three times rice is gone in.
27:00So, your excessive quantity has gone
27:02very high.
27:04Chapati and sabzi, chapati and things.
27:06So, how many chapatis? Four chapatis.
27:07That's your main meal. The rest are side
27:09dishes, you know. So, that's how the
27:11Reduce a
27:13chapati and see what else you can give.
27:15Include vegetables, include some fruit,
27:18include some any legumes or whatever or
27:21non-veg or whatever and reduce this.
27:23That's all.
27:24>> Fair. You can prevent.
27:26>> How do I know that?
27:28Is there any sign that I get to know
27:30that I'm pre-diabetic?
27:31Without any blood testing?
27:32>> No, no, without symptoms you cannot.
27:34But, you can guess.
27:35If you have a family history of
27:37diabetes, it you can guess. Then, if
27:40you're overweight, your chances of
27:42getting that is very high. If your waist
27:45is high, uh
27:47most likely you will have pre-diabetes.
27:50If your waist is bigger, 90 cm or more
27:53in males, 80 cm or more in females,
27:56it'll give you an automatic thing that
27:57does metabolic obesity, abnormal
28:00obesity.
28:01And so, the Those are the risk factors.
28:03Then, [clears throat] if you have one
28:05other disease If you have blood
28:06pressure,
28:07it's likely you will have diabetes or
28:09pre-diabetes. If you have diabetes, it's
28:11likely that you'll have
28:12hypertension.
28:13>> Why?
28:14>> They're very closely They're very big
28:17overlap between the three.
28:18>> What is the overlap between
28:20>> So, if you if you take 100 people with
28:22diabetes, uh 50-60% of them will have
28:26hypertension.
28:28Whereas, if you don't have diabetes,
28:29only 30% of the population will have
28:30hypertension. So, the risk is double.
28:33Similarly, if you have dyslipidemia, or
28:34cholesterol problems, triglyceride
28:36problems, that lipid problems, very
28:38unlikely it'll exist alone. So, if you
28:40draw a diabetes there and dyslipidemia
28:43there and hypertension there, all three
28:45will overlap.
28:46That's what you call as metabolic
28:47syndrome. So, if let's say I have
28:49cholesterol
28:50>> Yeah.
28:51>> then I have chances of pre-diabetics.
28:52>> Yes.
28:53>> Higher.
28:54Then if you didn't have it.
28:56That's how you have to compare. You take
28:57a person with cholesterol, without
28:59cholesterol. The guy without cholesterol
29:01lower chance of having pre-diabetes. So,
29:03that's how you guess.
29:04You see one, then all the other thing is
29:06fatty liver.
29:07You see you do an ultrasound, you find
29:09fatty liver.
29:10>> Mhm.
29:10>> So, you got already fatty liver. That
29:12means that the liver is a place where
29:14the insulin works.
29:15>> Mhm.
29:15>> So, if the insulin is not able to work
29:16there, it's producing resistance there.
29:19>> Mhm.
29:19>> Your glucose will go up. Because it's
29:21not able to work. So, one will lead to
29:23the other diagnosis of the other. You
29:25say, "Oh, you got this. You might be
29:27having pre-diabetes. Why don't you check
29:28your sugar level?" And the glucose is
29:29easiest to check.
29:31Of all these, that's the easiest one to
29:33check.
29:33>> What what's the difference between type
29:351 and type 2?
29:35>> Type 1, there's no insulin, not much of
29:37insulin resistance. Insulin deficiency.
29:40The pancreas is gone. There's no it's
29:42not producing a drop of insulin.
29:44>> And why does does that happen because of
29:45lifestyle?
29:46>> No. Not because of lifestyle.
29:47>> Is it due to a
29:49>> gene partly and partly due to
29:51autoimmunity.
29:52The body's
29:54immune mechanism
29:56uh suddenly turns around. It's like
29:58Indira Gandhi's bodyguard shooting her,
30:00you know. So, your body sees the
30:04pancreas and thinks it's a foreign body.
30:08That's called autoimmunity. Immunity is
30:10against corona or something else and
30:13that's how it should be bacteria, it
30:14should be fighting that.
30:16It suddenly gets confused and sees your
30:18pancreas and says, "There's an invader
30:21there. Let me go and attack it."
30:23And it'll start attacking. That's called
30:24autoimmunity. It'll kill every cell in
30:26the body.
30:27>> And it has no
30:30reason or like no specific thing that
30:33>> It can be triggered can be triggered by
30:34a virus or something like that, but
30:36there's no Usually there is a genetic
30:38predisposition. Not from the father,
30:40mother, not that kind of gene, but you
30:43have certain HLA patterns, just like
30:45your blood groups. There are HLA groups.
30:48So, if you have certain HLA groups, DR3,
30:51DR4, those are the people in whom this
30:54autoimmunity will go wrong.
30:56And there are many diseases like that,
30:58arthritis,
30:59ankylosing spondylitis. There are many
31:01other diseases also which
31:02>> have anything to do with, let's say,
31:03tension, lifestyle, sleep, obesity.
31:06>> Not for type 1. That's more for type 2.
31:09>> Type 1 can't do anything about it.
31:11>> Can give now pumps have come. So, you
31:13can have AI-driven pumps have come. So,
31:16if you wear them, the pump takes care of
31:19your sugar. All the four injections are
31:21gone.
31:22>> Mhm.
31:22>> The pump will find out your own blood
31:24sugar level and give you the right
31:26amount of insulin without low sugar,
31:28without high sugar.
31:29>> You don't have to set it. You use The
31:30pumps usually are the ones where you
31:32have to set it.
31:32>> Now, you don't have to set also, because
31:34the AI is built in.
31:36AI will find out your blood sugar and it
31:39will inject the amount right amount of
31:40insulin, like autopilot.
31:42>> But is it risky?
31:43>> No. Not at all.
31:44>> Because what if technology one error,
31:46one bug, and then it just pumps more?
31:48>> it has become.
31:49>> But what if, like, just one bug and it
31:51gives you two points extra?
31:53>> You can test your
31:54sugar and you can So far it has not
31:56happened.
31:57I don't know of anyone in whom it has
31:59actually failed. Thousands and thousands
32:02of patient, millions. Actually now on
32:04this. The technology is so good. It took
32:06about five seven years of research
32:09before it was
32:10marketed.
32:11They tested everything possible.
32:14AI has become so good. It's better than
32:17human. So, so good it is.
32:19>> So, the manual feeding which you had to
32:20do with the machine
32:21>> gone. Yeah, that is older versions.
32:23That's all gone.
32:23>> How How expensive is the new machine
32:25now?
32:25>> Expensive. So, because only one or two
32:27companies make it. So, 6 and 1/2 lakhs
32:30for the pump.
32:31>> Mhm.
32:31>> But even then it changes your life if
32:33you can somebody can So, 6 and 1/2 lakhs
32:36and then uh a running cost of all the
32:39tubing and all you have to get about uh
32:4120,000 rupees a month.
32:43>> And how much would like a previous
32:46generation pump would cost where you
32:47have to do manual feeding?
32:48>> lakhs.
32:50So, from there it's gone up.
32:51>> Cost of maintenance would be 15,000 to
32:5320,000.
32:54>> might have been 10, 15, or maybe 20. So,
32:57that's not gone up much. The pump cost
32:59has gone up. So, what we are doing there
33:01is we are trying to make it in India.
33:03They're trying to We're working in
33:04Indian Institute of Science. We're
33:05working with two different groups in
33:07India. I'm I'm on the board of Indian
33:08Institute of Science. I'm on the
33:09governing council of Indian Institute of
33:11Science at Bangalore. So, I go there. I
33:13sit with the scientists, try to make it.
33:15They're They're coming up with
33:16protocols, but what they now produce
33:19probably this year or next year
33:20definitely they'll come. I think the end
33:22of this year they'll come.
33:23>> But it's the older version, like the
33:25setting and all that. That they have
33:27come to now. They're saying within a
33:29year or two
33:30So, within a year or two they're saying
33:32they can make this. Once they make this,
33:34they'll go to the AI thing, and they can
33:36do it. Then they'll bring it probably
33:38for a lakh of rupees or something.
33:40That's what you're working for.
33:41>> Got it. So, coming back to now type two.
33:44Okay, let's say somebody today got their
33:47blood tested, and they're now seeing
33:49that they are pre-diabetic. They get a
33:51notification they're pre-diabetic, and
33:54they're panicking all of a sudden. What
33:56is a three-step checklist that they
33:58should do for the next 90 days so that
34:00they can probably reverse it or manage
34:03it way before it actually becomes a
34:05full-blown diabetes.
34:06>> don't have to do it in 90 days. You can
34:08do it or a more systematically you can
34:12work on it.
34:14Most people with pre-diabetes have some
34:16excess weight
34:18and fat. That's the first thing to work
34:21on. Okay. So, you start You set yourself
34:23you're 75 kg. You should be only 60 kg.
34:27At least try to make it 65 or 68. 8, 10
34:30kg. The good news is that while the
34:33conversion from pre-diabetes diabetes is
34:35very high in Indians, the reversal is
34:37also not very difficult. 5 kg is
34:40sufficient. If you just reduce 5 kg in
34:43weight, especially a little bit of
34:44tummy, 2 in of tummy, and by whatever
34:47method, of course, sleep better, sleep
34:50on time, don't eat late, all that you
34:52said, walk after the thing.
34:54Set your weight and see that you come
34:56down. Cut down your carbs, add protein,
34:59do regular exercise, aerobics, muscle
35:02training, all that because muscle is
35:04where glucose is burnt. If you do these
35:07simple things, I have a fault of a still
35:09regular lifestyle. If you do all this,
35:12it's fairly easy to reverse from
35:14pre-diabetes to reverse is much easier
35:16than from diabetes to See, normal is
35:18here, pre-diabetes is here, diabetes is
35:19here. From here, if you are able to go
35:21there, from here to there is much
35:22easier, yeah, to go. Or at least you can
35:24prevent going to that stage. Shouldn't
35:27be difficult at all. Problem is people
35:29do it for 2 3 months, then they give up.
35:32Then they back on Why do people give up?
35:36I think they uh
35:38they get bored with what they're doing,
35:40and they willpower.
35:42There are people with terrific
35:44willpower. Mostly little OCD type people
35:48who
35:49have to do it once they and they overdo
35:51it also sometime. But uh there are
35:53people with willpower who can do it, but
35:55you know, right from Adam and Eve that
35:57don't eat that apple, they ate that
35:58apple, no?
36:00>> [laughter]
36:01>> And then there's what is called a
36:02hedonic pleasure. Mm. The brain, there
36:05is pleasure, you know, and uh
36:08seeing food, seeing a gulab jamun,
36:10seeing rasgulla, seeing this kind It's
36:13like smoking. You can't It's very easy
36:15to say give up smoke. Like they're not
36:17able to do it. It's it's in your
36:19cell. Every cell is telling you to Very
36:22difficult. You think the food craving.
36:24Food craving. So, our culture is only
36:26making us this. Yeah.
36:28>> There's one thing which is coming up on
36:30the serious point. Which is now people
36:33are calling type three diabetes.
36:35Which is Alzheimer's.
36:36I was reading that for every 1% rise in
36:39HbA1c, it means two years of brain
36:42aging.
36:43>> Yeah. You can't be You can't put a exact
36:46number for that, but it's something like
36:48that.
36:48>> Okay. Loosely related.
36:49>> No, but there have been other studies
36:51which have shown opposite findings also.
36:54See,
36:55uh dementia, if you take dementia,
36:58uh it's of different types. Alzheimer's
36:59is one type. Uh where you get this
37:01amyloid deposits in the brain and you
37:03get amyloid deposits in the um
37:05uh in the pancreas, and that's how
37:08uh the
37:10uh Alzheimer's come. When you have these
37:11deposits in in the brain.
37:14But there are also other types of
37:15dementias.
37:16For example, vascular. If you have a
37:18stroke,
37:18>> Mhm.
37:19>> then part of your brain is uh cut off.
37:21The So, that also can produce dementia
37:23if your frontal part of the brain
37:24doesn't get blood circulation. That's
37:26also dementia only.
37:27Those dementias are definitely higher in
37:30people with diabetes. No doubt about it.
37:32All the vascular dementias.
37:34There have been some studies which are
37:36saying that Alzheimer's may be actually
37:40less in people with diabetes because
37:43they are controlling all the risk
37:45factors.
37:46They're controlling the They're taking
37:47statins, bringing their glucose I mean
37:49their cholesterol down. Then they are
37:53glucose levels are kept under control,
37:55blood pressure is kept under control.
37:57They're taking the vitamins properly.
38:00They're eating a healthy diet. They
38:01don't smoke. They don't drink. They cut
38:04down on that. Because they have to go
38:06for exercise regularly, they do that.
38:08So, lots of healthy things they do which
38:09all of which are good for the brain.
38:11So, there are some studies which are
38:13saying that Alzheimer's is actually less
38:15in people with There are two studies I
38:17know which have which have shown that.
38:19>> But this is
38:19>> But uncontrolled diabetes, of course you
38:21don't follow the rules, and everything
38:23you're going to accelerate and you're
38:24going to get
38:25more of Alzheimer's.
38:26>> So they've given it a name, type three.
38:29>> The reason is, see, the actual class for
38:32how this three type three came, I'll
38:34tell you there is actually not type
38:36three.
38:37Type one is type one. Type two is type
38:39two. That we know. The last one is
38:41gestational diabetes, GDM.
38:43With new to pregnancy it comes. In
38:46between there are about 30-40 different
38:48types of diabetes. Due to stones in the
38:51pancreas, due to pancreatic different
38:53due to endocrine disorder, due to drugs,
38:55due to virus, due to chemicals, due to
38:57this, due to that. So
38:59they didn't call it as three A B C D E
39:02and all, they didn't call it. But
39:03because in the classification is one,
39:05two, last is GDM and this comes under
39:08other types.
39:09People started calling it type three.
39:11And the third one in that is due to the
39:13stones, so the type three C is
39:15pancreatic diabetes. Then something else
39:17in the thing is Alzheimer related to
39:20amyloid deposit. So it's Alzheimer's.
39:22That's how the thing came. And just to
39:25say it's something similar to what
39:26happens in in diabetes, something also
39:30happens in the brain. So they call it as
39:32type three diabetes.
39:34>> Got it. But what happens if sugar in
39:36your body increases?
39:38>> Yeah.
39:39>> That is very That is why you're headed
39:41towards pre-diabetics and diabetes.
39:43>> Yeah. That's a part of
39:44>> That's a part of the game.
39:46So when this happens
39:48and you're headed towards Alzheimer's,
39:50what happens first? Like what goes
39:51first? Like is it memory, mood, focus?
39:54Where does it attack?
39:55>> Any of them can happen. First thing is
39:57memory actually. So what happens is that
40:01recent memory will be retained.
40:04Uh sorry, the other way. The old memory
40:06is retained. If you ask them what
40:09happened in 1960,
40:11they'll be able to tell you. Oh, this
40:13thing happened, that thing happened.
40:14Green Revolution, we had this the thing.
40:16Did you have breakfast today?
40:17They They don't know.
40:19They've forgotten. So, the first thing
40:20which goes is the recent memory. In
40:23fact, they'll be telling people uh that
40:25oh, my family is starving me. They're
40:27not giving me anything. You know, they
40:28just had his lunch.
40:30And then there's somebody come outside,
40:31you know, in this house they don't give
40:32me it's 3 days since I ate. He's
40:35forgotten that he's eaten. Okay. My
40:38father-in-law had uh dementia.
40:41And uh he used to up 20 years after he
40:44retired, he used to work in the American
40:46consulate.
40:47>> Mhm.
40:47>> And 20 years after he retired,
40:50he'll get ready to go and all that.
40:53And then we'll say, "Where are you
40:54going?" "No, I'm going to office. My
40:55office time and all that." He's still
40:57living in that period, you know. So, we
41:00first tried telling him, "Hey, you've
41:01retired, yeah? You're not going What do
41:03you mean you're retired? I've got
41:04office. People are waiting for me. And
41:06why are you" So, then my my wife, until
41:09she was alive, she used to play this
41:10thing on him. He'll go and say, "I'll
41:12just call them." So, then she'll pretend
41:14she's making a call. And she'll say,
41:16"Papa,
41:17today's holiday."
41:19"Why holiday?" "No, some American
41:21holiday today. So, they are So, you
41:23don't have to go." "No, I don't have to
41:24go." "Oh, okay. Then I'll get I won't
41:27get ready." So, you have to treat him
41:29like that. So, memory is one of the
41:31first things that happens.
41:34Then
41:35some kind of a you know, control over
41:38yourself also you begin to lose.
41:40So, you become violent. Some mood
41:42disorder. Mood disorders, you become
41:44violent. You start hitting people.
41:46Uh that kind of a thing.
41:47The other thing is
41:49they go out of the house
41:52and they won't know how to come back.
41:54They won't be able to tell their name.
41:56They won't be able to tell the family
41:58members' name.
41:59They won't be able to say where they're
42:00staying.
42:02And we have known of people who have
42:04gone from the house and never seen
42:06again.
42:07They'll go somewhere somewhere somewhere
42:09then they'll get into some train. They
42:10don't know where they're going.
42:11And they don't know how to come back.
42:13They'll ask them, "Where are you? What
42:15are you doing?" They're not able to
42:16describe.
42:18And they're lost, finished, gone.
42:21So, it's a very scary thing, you know?
42:24But,
42:25the good news, because I'm now beginning
42:27to do research on dementia and diabetes,
42:30and I'm working in the Brain Research
42:32Foundation, the CBR, Center for Brain
42:34Research in Indian Institute of Science.
42:36We have got a collaboration on we're
42:37doing that.
42:38The good news is that earlier,
42:41only through late MRIs and all you were
42:43able to find out. The brain is kind of
42:45gone, and then only you can make out.
42:47Today, you got blood tests,
42:49biochemical tests, just like cholesterol
42:51and all. You got tau markers and other
42:53markers, about six markers in the in the
42:57uh blood.
42:58>> Mhm.
42:59>> Before you get dementia, you can the
43:01they'll start increasing.
43:03So, you can say that this person is
43:06likely to get dementia 5 years from now,
43:0910 years from now. You may say, "What's
43:11the point in knowing that
43:13if there's no treatment?" The good news
43:15is that just like the GLP drugs, we have
43:1780 different molecules coming.
43:20There are at least 10 different dementia
43:22drugs which are coming.
43:24They're in phase two, phase three. If
43:26they come, they'll become next
43:28revolution like GLP. Because what
43:30they're going to do is
43:31they'll go to the brain and remove those
43:33blocks.
43:35That means the man who's lost memory,
43:37memory can come back.
43:39>> Mhm.
43:39>> See, they are called tangles, fibrillary
43:42uh
43:43fibrillary tangles they are called.
43:45Okay. So, the little little little
43:47things get tangled, and the neurons, the
43:49brain neurons, they're all now
43:51interconnected in a wrong way, like a
43:53ball they become, okay? And once this it
43:57kind of splits all that, the nerve cells
43:59are now come back again.
44:01>> Can you show it to me? Can you show it
44:02to me on a brain? Can I give you a brain
44:04model?
44:05>> Yeah, I can show it to you, but it yeah,
44:07you show me the brain.
44:08>> Explain. I'll do that. Yeah.
44:09>> Okay. So, we have the brain here. Okay?
44:12So, we have the front of the brain, and
44:14we have the back of the brain, and
44:16different portions of the brain are
44:17involved in The front of the brain, for
44:19example, is involved in memory,
44:22thinking, cognition. The back is
44:24involved in visual thing.
44:27>> Uh this side of the brain is involved in
44:29function.
44:30>> Okay.
44:31>> Uh and if you get paralysis there, you
44:32know, you get one side get stroke, then
44:35you get a hemiplegia, one side not
44:38working. So, different parts of the
44:39brain. This portion of the brain, the
44:42front portion of the brain, is the one
44:44which is involved in thinking, judgment,
44:47cognition, and that kind of a thing.
44:50Now, what happens is, of course, the
44:52whole brain not only that portion which
44:53gets covered, the whole thing gets
44:55covered with This is the normal blood
44:57circulation and all that you're seeing.
44:59Now, if you have the brain,
45:02and you have, let's say,
45:06thousands and thousands and lakhs and
45:08lakhs of nerve cells.
45:10>> Mhm.
45:11>> Now, each of these nerve cells is
45:13conducting information.
45:15>> Okay.
45:15>> And that's how we're able to think,
45:17we're able to reflex action. From there,
45:19it goes spinal cord. From the spinal
45:21cord, you get nerves. So, if you pinch
45:23here, immediately the brain knows you're
45:24getting pinched. All that is there.
45:27Now, what happens if all this amyloid
45:30kind of thing comes and settles,
45:34amyloid amyloid, you know? So, this
45:37amyloid
45:38>> What do you What do you mean by amyloid?
45:40>> Amyloid is a kind of a protein kind of a
45:43substance.
45:44>> Okay.
45:44>> Okay? And that, if it becomes excess due
45:48to uncontrolled diabetes, due to
45:49cholesterol, due to smoking, due to
45:51various things, if this gets more, then
45:54it will start clumping up all this.
45:57>> So, is it like a fog in your brain which
45:58is
45:59>> Exactly like that. You can explain it
46:01like that. Okay? Except that it's not
46:03going to go away easily. So, now you
46:06have all this thing. So, memory is going
46:08down, down, down and the dementia gets
46:10worse, worse, worse, worse.
46:12To pick up whether this is happening
46:14only we have the blood markers now.
46:15>> Mhm. Till now we didn't have any
46:17>> didn't have.
46:18>> We didn't have.
46:18>> Today it is only started coming.
46:21>> So, previously this was identified
46:23through MRI and CT?
46:24>> Yeah, or clinical symptoms. You you have
46:27various symptom uh symptom to perform
46:29function. So, we we have started in our
46:32hospital also we have started for
46:34anybody above 60, 65 years. Apart from
46:36looking at blood pressure, sugar, this,
46:38we give them simple questionnaires.
46:40>> Mhm.
46:40>> So, there are simple
46:42uh cognition tests.
46:43>> Tests. Okay.
46:44>> I can give three things. I can give one
46:46color, I can give some object and
46:49something. I'll say yellow, rain, and
46:52river.
46:53Something. Three things I've told. Then
46:55after 5 minutes I say, "What are those
46:56three things I told you?"
46:58They can't. They've forgotten.
47:00Interesting. Simple test we have.
47:02>> In
47:03that
47:04>> Immediately. Oh, something you told me.
47:06One color you told me. Uh hey hey hey
47:09yellow yellow yellow yellow. One one he
47:11has remembered, you know? Then another
47:12simple test we tell them is draw a
47:14clock.
47:16Simple thing. Draw a clock. People can't
47:18do it. So, we'll say, "Okay, that's a
47:20clock. That is 12, 1, 2, 3, 4." We'll
47:24say,
47:25"Show that the time is 1:50."
47:30"Okay, 11, 10, 9, 8. So, 1:50. Short
47:34hand and long hand. That's all."
47:36>> Mhm.
47:37>> For somebody who has They can't draw
47:38this.
47:39>> What do they draw then?
47:40>> They they they'll be
47:42I don't know how to draw. I don't know
47:43how to draw. Have you not seen a clock?
47:46Uh yeah, but I can't draw.
47:49I'll say, "Just draw, no? Think." They
47:51can't. A simple thing like this they
47:53can't They they are not able to put
47:54there because the brain is not working.
47:56>> But then if they remember something from
47:5820 years ago, yeah, must remember
48:00something some clock part of like some
48:02form of clock from 20 years ago, right?
48:04>> An event they can remember.
48:06You ask them about their 50th birthday,
48:0840th birthday, the birth of their child,
48:11when did India get independence, what
48:13happened, who was they'll tell you.
48:16But you ask them to do this, they can't
48:17do it. You give them some simple tests,
48:20they can't do.
48:21>> Now
48:22more young the age of getting
48:24Alzheimer's or dementia is getting
48:26younger.
48:27Like at 45, 50 people are getting the
48:30signs of it, symptoms of it.
48:31>> So, there are number of reasons for that
48:35which are proposed. One of course is
48:37diabetes increasing, blood pressure
48:38increasing, everything increasing,
48:40punching in everything at young what
48:41people used to get in old age now you're
48:43getting at young age. Age of seven,
48:44eight they're getting diabetes now. Not
48:46type one, type two. Obese children
48:48coming at type That's one side of it.
48:51Apart from that, there are other causes,
48:53pollution.
48:54Particle 2.5 in the air. We think it
48:57only produces cough and allergy and
48:59things. It produces damage. It can
49:01produce diabetes.
49:03It goes into the blood. It can go into
49:05the pancreas, knock out your beta cells,
49:08produce diabetes. Then it can go into
49:11the muscle cells, it will liver
49:14insulin resistance. It can produce
49:15diabetes, can produce blood pressure,
49:17can produce heart attacks, can produce
49:18cancers.
49:20Goes to the brain
49:21dementia.
49:23It promotes that. And if you're
49:25constantly exposed to it even at a young
49:28age you you will can you can get that,
49:29no? Suppose that smoke is going in all
49:31the time.
49:32Then even at age 30 you're exposed to it
49:35so much more. Normally it would take
49:36another 20 years for your age to catch
49:38up, but this being accelerated. Which is
49:41why at a younger age you're getting
49:42cancers all old age related thing now.
49:45Young people are getting breast cancer
49:4720, 25.
49:49We're hearing. All that is this
49:51lifestyle, junk food, all kind of things
49:54put into food, artificial sweeteners,
49:56artificial this one, all kinds of
49:58emulsifiers for taste and for thing
50:01people are putting in all kinds of
50:03things. It's not the natural food that
50:04our forefathers used to eat.
50:06>> So, that's where my question was about
50:08this. Like at at 45 or at 40, people who
50:11start forgetting things and probably
50:13start developing early signs of
50:15dementia,
50:16is there a point or a twist in their
50:18life or probably some signs where you
50:21can say that this is no more brain fog,
50:23it has actually developed into this?
50:26>> The
50:26So, [clears throat]
50:27testing testing for You do an MRI,
50:30you'll find changes.
50:32Structural change What you're describing
50:34here, you can see it on MRI.
50:36>> And can I
50:37Can I do brain MRI today
50:41and probably predict in some sort of way
50:43that what's going to happen and what's
50:44happening in my brain?
50:45>> With the blood tests and so, we are
50:47doing a study called the CARS study,
50:51Center for Cardiovascular Risk
50:53Surveillance. It's a study which is
50:54being done in New Delhi and in Chennai
50:57and with the collaboration of Emory
51:01University in US. NIMHANS is also
51:04involved in it in in Bangalore.
51:06The brain part of it. And so, we have
51:09So, what we're doing is people above the
51:11age of 45,
51:13uh we are doing normal people. We are
51:16going into the whole population of
51:18Chennai. We have already some 25,000
51:20people who are being followed up in
51:22Chennai and Delhi for the last 15-20
51:24years we're following these people. So,
51:25now we've added the brain part of it.
51:27Earlier we were only in diabetes, heart,
51:29now we added brain, liver, we're adding
51:31other things. So, as part of the brain,
51:33we're telling them, "Would you like to
51:35get a free MRI done?
51:37We'll get it done for you. We'll also
51:38take this blood for biochemical tests."
51:41So, when you combine the early changes
51:45on the brain with the early changes that
51:48you see in the biochemistry, you can say
51:51that this person is likely to progress.
51:55Now, you may say till those drugs come,
51:57what can you do? There's a lot of things
51:59which you can do.
52:01Like, first of all, lifestyle itself has
52:03been shown to help. So, if they start
52:05exercising every day,
52:07if they start eating a lot of salads and
52:10fresh vegetables and healthy foods, they
52:13have a lot of antioxidant kind of
52:15properties. Sleeping on time,
52:18reducing the stress, doing pranayama,
52:21doing yoga, doing Sudoku puzzles, doing
52:25doing different things, learning a new
52:26hobby to challenge your neurons. So,
52:28keep it going, you know, read books,
52:31read this, learn an instrument, learn a
52:33new language, learn some new hobby,
52:36something else.
52:37Social networking,
52:39very important, because you're always
52:42something you're talking to them, you're
52:43laughing, you're doing something. So,
52:45all that slows it down. So, if you're
52:48able to identify people early, and then
52:51of course the drugs will come. Now, very
52:53soon I think within a year or two the
52:55dementia drugs are going to come.
52:57They're all in late phases of trial.
52:59Once they come, it will be an explosion
53:01of those drugs. And now they are saying
53:03you can take injections which will
53:05dissolve all this clumping which is
53:07occurring,
53:08and your memory can come back. That's
53:10going to be a big big moment like the
53:12weight reduction thing. 10 years ago I
53:14would never have thought a drug will
53:15reduce weight like this. I would only
53:17thought bariatric surgery can do it.
53:18Today I'm seeing a completely different
53:21it's changed the way. Similarly, I think
53:24we are on the threshold the cusp of this
53:26dementia treatment.
53:28>> Tell me now, you said too many different
53:31organs you've been testing on, right?
53:33The impact of diabetes, sugar, glucose
53:35on liver, kidney, eye, brain, bunch of
53:38things. You just used these words. Yeah.
53:41Explain me organ by organ. I'm going to
53:42put organs here.
53:43>> Sure.
53:44>> And you tell me exactly
53:46like I'll give you a checklist and where
53:47does sugar attack first?
53:49>> Let's start with the eye.
53:50>> Mhm.
53:51>> So, when you see the eye, you'll be
53:54seeing it like this. Okay? We have a
53:56thin film.
53:57>> Mhm.
53:58>> And then just behind that we have the
54:01the pupil through which the light
54:03enters. You can see that round thing.
54:06And then you have the iris. Then behind
54:08that you have the lens.
54:11>> Okay. Okay.
54:12>> It's there in all our eyes.
54:13>> All our eyes. Just behind there is the
54:15lens. And it is this lens which focuses
54:19the image. See, the light is going from
54:22there through the lens and at the back
54:25portion there that is called as a
54:28retina.
54:29Okay? That's the retina, the back
54:31portion. So, you have a front portion, a
54:32middle portion, and then you get a back
54:34portion there. So,
54:36when the light goes in there, it has to
54:38converge to a point there.
54:41And then you'll be able to focus
54:42clearly.
54:44Now, what will happen is if this lens
54:45becomes thicker or thinner,
54:49you'll get long sight or short sight.
54:51So, before 40 years, mostly it's myopia.
54:53Long distance you cannot read.
54:55>> Mhm.
54:55>> After 40, reading will become a problem.
54:58>> Short.
54:58>> So, yeah. So, that's called long sight.
55:00The other one is called short sight.
55:01Myopia, hypermetropia. So, all that is
55:04in the lens. The same lens So, those
55:06changes can also come due to diabetes.
55:08There's more water in the lens, less
55:10water in the lens. If you have very high
55:12sugar, you're feeling thirsty. That
55:14means there's no water in the body.
55:16There's no water in the lens also. Lens
55:17will shrink. So, your focus and all will
55:19go and you won't be blurred vision. Next
55:22stage, which is very common in diabetes,
55:25is cataract. So, cataract is Normally, a
55:28lens will be like this. You can see
55:29through.
55:30>> Okay.
55:31>> Now, you can get different types of
55:33cataract.
55:35And this only the central portion is So,
55:38through the side you can see this
55:40portion you cannot see properly. Okay?
55:42Then you can get these type of thing
55:44like a star it is. This is a typical
55:46diabetic kind of a cataract. Like a
55:48star, stellar kind of a
55:50>> What does it
55:50>> cataract? It These are cataracts which
55:53is forming, but there is still some
55:56portion left. Like this particular shape
55:57if you see is likely to be diabetic.
55:59Then you have got complete
56:03blockage like this now.
56:05It's become opaque.
56:07>> Mhm.
56:07>> This is cataract. So, once it has come
56:10like this, you have to operate.
56:12So, what they do is they'll remove the
56:14lens
56:15and put another lens in. I've had both
56:17my eyes operated for cataract. Within a
56:19week I got both done. So, 5-10 minute
56:22procedure for a good surgeon. Make a
56:24small link. They just pull out that lens
56:27and there's a small lens they push it
56:29in. That's it. Finished. Over. Then it
56:31it it just stays. And the new lens then
56:33can be there for long time.
56:3710-20 years more also. So, so that is
56:39cataract. That also is accelerated in
56:41diabetes. When you have very high sugar,
56:43the cataract comes earlier. If normally
56:45cataract comes at 60-65, in diabetic
56:48people 50-55 it will it will come.
56:50Because of high sugar driving the
56:52cataract So, the first thing is
56:53metabolism.
56:54>> When the sugar increases, the first
56:55thing it does is start
56:58forming these cracks?
56:59>> Uh it's not cracks. It is um transparent
57:02thing becoming opaque.
57:05It's the sugar inside sorbitol we call
57:07it. It's again related sugar. So, that
57:09sugar metabolism changes and then the
57:14this becomes start becoming opaque. So,
57:15that's called cataract. That's also a
57:18simple thing. You won't lose your
57:20vision. You can remove the cataract and
57:21bring Even non-diabetics also it occurs.
57:24What happens in really in diabetic
57:27people is retinopathy.
57:29Diabetic retinopathy. Retinopathy, pathy
57:32means inflammation or disease.
57:35Retinopathy means retina getting
57:36affected. So, this is the retina. So,
57:39that portion is a retina. You can see
57:40the blood vessels there.
57:43When you have uncontrolled diabetes,
57:46these blood vessels start getting
57:49affected.
57:50First, small sac-like thing will come.
57:52We call it as microaneurysm. Small sac
57:55will form.
57:57Then, they'll start leaking. So, you'll
57:59find when you do a See what the doctor
58:02will do, retinal specialist will do,
58:04they'll put in drops and this pupil,
58:06which is small, will become bigger.
58:08So, you can see
58:09what you're seeing at the back. You can
58:11actually see the whole retina you can
58:13then see without any surgery and you can
58:15just see the whole retina.
58:17Normally, all the normal blood vessels
58:19you can see.
58:20But, in diabetic retinopathy, what
58:22happens is first of all, the small
58:24saccular thing will form, microaneurysm
58:26we call it. Then, it will start leaking.
58:28Then, small hemorrhages will start,
58:30blood clots, small blood clot.
58:33Then,
58:34because it is not getting enough oxygen,
58:37it's not efficiently flowing,
58:39new vessels will try to form. So,
58:42instead of these small vessels, from
58:45there, what will happen is that
58:48if the vessel is like this, that vessel
58:51will form
58:53new vessels. We actually call it as new
58:55vessels, neovascularization.
58:58This is the original one. This is the
58:59new one. These new ones are very thin.
59:02>> Okay.
59:02>> They'll easily burst. So, if it bursts,
59:05what happens is the whole retina will
59:07get filled with blood.
59:09And overnight, you can go blind.
59:12So, it will just like that leak and the
59:15whole
59:15>> purely because of glucose mismanagement
59:17in your body.
59:18>> Not controlled.
59:19>> Yeah.
59:20>> Diabetes not controlled. Yeah, yeah,
59:21uncontrolled diabetes.
59:22>> Where sometimes sugar is going super up
59:24or super down, this
59:26>> remaining high.
59:27>> Okay, more
59:28>> Not not due to the fluctuation, but
59:30because sugar is continuously kept high.
59:32That's where this concept of HbA1c test
59:34comes. This 3 months average test HbA1c.
59:38Study after study done 10-20 years ago
59:41have shown See, the normal HbA1c is 5.6
59:44or below.
59:465.6 to about 6.4 is called pre-diabetes.
59:496.5 and above is diabetic. Similarly,
59:51you got for the glucose. Fasting above
59:53126 is diabetic. In a GTT, 2-hour value
59:56above 200 is called diabetic. In a
59:58random blood sugar done at any time,
1:00:00more than 200 it is diabetic. Many
1:00:02people are saying don't treat diabetes,
1:00:03it's normal to have high sugar. So, age
1:00:05old age, everybody love a little
1:00:06diabetic. That's where all these myths
1:00:09are, you know,
1:00:10are demystified when you do these
1:00:12studies. What they found was
1:00:14up to seven
1:00:16HbA1c 5.5 5.6 to around seven is a safe
1:00:20limit.
1:00:21>> Mhm.
1:00:21>> You don't develop eye, kidney, nerve
1:00:24complications.
1:00:25>> 6.7
1:00:26Up to seven
1:00:27>> Up to seven
1:00:27>> From 5.5 to 6.5
1:00:28>> 5.5 5.6 is normal. 5.7
1:00:33to seven
1:00:33>> seven, okay.
1:00:34>> That range, if you're a diabetic is able
1:00:36to maintain. Can be 6 6.2 6.3 6.5 up to
1:00:40seven.
1:00:41There is no risk of developing eye,
1:00:44kidney, nerve complications.
1:00:46As it goes above
1:00:48from seven to eight, eight to nine, that
1:00:511%
1:00:53increases your risk of developing eye,
1:00:55kidney, nerve complication by 25%.
1:01:00So, seven to eight, 25% risk. Eight to
1:01:02nine, 50% risk. Nine to 10, 75% risk.
1:01:07Above 10, 100% risk
1:01:09of developing complication.
1:01:11So,
1:01:12any 1% lowering also reduces your risk
1:01:15by 25%. And all we are trying to do is
1:01:19to keep that A1c below seven. That's our
1:01:21entire goal of treatment. We call it as
1:01:24the ABC, actually.
1:01:26A is A1C, below 7%. B is blood pressure.
1:01:30You have to keep it at whatever is
1:01:32normal for your age, at least below
1:01:33140/90, preferably 130/80.
1:01:37C is cholesterol.
1:01:39The bad cholesterol is LDL cholesterol.
1:01:41Should be below 100. Below 70 is good.
1:01:44Even below 50 is even better. But at
1:01:46least below 100 to start with for the
1:01:47whole population you want to bring
1:01:49everybody 50 and all may be difficult.
1:01:51But if it's possible, then you bring
1:01:52that.
1:01:53D is discipline.
1:01:55Diet, exercise, sleeping, this, that,
1:01:57all that.
1:01:58If you follow this A alone,
1:02:01you can prevent eye complication. Nobody
1:02:03will develop diabetic retinopathy.
1:02:06There'll be no blindness due to
1:02:07diabetic. Same thing for kidney.
1:02:09Same thing for nerves. Neuropathy,
1:02:12burning feet, and numbness of feet.
1:02:14These three can be eliminated if you
1:02:16just keep that A1C below 7.
1:02:18Nothing more you have to do.
1:02:19Okay? If you want to prevent heart
1:02:21attacks,
1:02:22>> [snorts]
1:02:22>> strokes, gangrene of the feet, then B
1:02:25and C also have to keep. Blood pressure
1:02:27also under control. Cholesterol also
1:02:29under control. D also includes no
1:02:31smoking and all that.
1:02:33If you smoke, then all gone.
1:02:35So, if this ABCD you do,
1:02:38I have been telling
1:02:39year after year on World Diabetes Day I
1:02:41have been saying,
1:02:42we should have a complications-free
1:02:45India. People ask me,
1:02:47"Can you have a diabetes-free India?"
1:02:50I say it's difficult.
1:02:53It's difficult because age is a
1:02:55non-modifiable risk factor. As you grow
1:02:57older, you'll get little diabetes. Okay?
1:03:00Can you completely prevent graying of
1:03:01hair? May or may not. Can you completely
1:03:03prevent balding? It may not be possible.
1:03:06Okay? But it doesn't matter. If you get
1:03:08little diabetes, as long as you don't
1:03:09suffer, it's okay. So, I keep telling
1:03:11people, "Don't worry about diabetes-free
1:03:14world.
1:03:15We'll worry about
1:03:17a diabetes complications free world.
1:03:19That is possible
1:03:21and I want to see it in my lifetime.
1:03:23And for that I'm saying
1:03:25ABCD.
1:03:27That's it.
1:03:28Get your A1C down, keep your blood
1:03:30pressure down, keep your cholesterol
1:03:31under control and follow some
1:03:32discipline. Diet, exercise, no smoking,
1:03:35get to sleep on time, take your
1:03:37medicines, go for a checkup, finished.
1:03:39We will You may say, is this rhetoric or
1:03:42you have actually done it? I've actually
1:03:44done it.
1:03:46In 2013,
1:03:48we showed 50-year survival of type 2
1:03:51diabetic patients, 5-0.
1:03:54Okay, I had about
1:03:55300-400 patients who finished 40 years
1:03:59and some who finished 50. Now if some
1:04:01who finished 60, 65 years with type 2
1:04:03diabetes. So the American Diabetes
1:04:05Association gave me the Harold Rifkin
1:04:07Award as the first to show in the world
1:04:1050-year survival of type 2 diabetic
1:04:12patients.
1:04:13Partly because I was lucky because
1:04:16their diabetes itself comes only at
1:04:1750-60. For them to get 50-60 they should
1:04:20all 110 years old. Yeah. For us we get
1:04:22it 20-30. So to get 50 years survival we
1:04:25need a 70s to be able to get 50 years
1:04:26survival. So that we were a little lucky
1:04:28that people get it at a younger age so
1:04:30they were able to show 50 years but
1:04:32nobody had shown it. So they gave me the
1:04:34one of the highest award in American
1:04:35Diabetes Association as the Harold
1:04:36Rifkin Award. So they gave me that. But
1:04:39the point is not the award. The point is
1:04:41that people can live for 50 years
1:04:43without. Then they said you only showed
1:04:4450 years survival, you didn't show
1:04:46people living up to 90-100. So I said
1:04:48that's my next project. So we collected
1:04:51people who have finished 90 years, 95
1:04:54years, 100 years with diabetes. Large
1:04:57series now.
1:04:58102 years old, diabetic, 50 years, 60
1:05:02years, nothing. They walk in, they
1:05:04they're able to one guy wrote a book at
1:05:06the age of 97.
1:05:08Okay? One man, when I called all these
1:05:1290-year-old people for a uh for a press
1:05:15conference and to show the world that
1:05:17it's possible, the chief guest was 101
1:05:19years old.
1:05:20He was my chief guest.
1:05:22But tell me,
1:05:24if you said
1:05:25a
1:05:26keep your AB1C under control, blood
1:05:30pressure under control, cholesterol
1:05:32under control, do diet, exercise, sleep,
1:05:35all of that under control.
1:05:37When all of it is lifestyle management,
1:05:39why do I need a doctor like you?
1:05:41To tell you that.
1:05:43>> [laughter]
1:05:48>> HOW DO YOU KNOW ALL THAT? YOU KNOW YOUR
1:05:50BLOOD PRESSURE, you know what
1:05:51cholesterol to do, you know how to bring
1:05:53it down, you know all the glucose, you
1:05:55know it took me 50 years to LEARN ALL
1:05:57THAT.
1:05:58>> [laughter]
1:06:02>> THE LIFESTYLE PART IS ONE. The ABC is
1:06:04done by the doctor. The D only you're
1:06:05doing.
1:06:06Okay, the ABC, where to give the
1:06:08medicine, how to how to lower it, how
1:06:10much to lower, should I bring the A1C to
1:06:12seven or to six for you, which is safer
1:06:14for you. Those things I I decide, no,
1:06:16based on your condition. Suppose your
1:06:18heart is already a little at risk.
1:06:20Now, if I go and push your A1C below, I
1:06:23can produce a heart attack for you. Or I
1:06:24can produce a you know, some arrhythmia
1:06:26for you and push you into
1:06:28>> It's not just lifestyle management.
1:06:30>> Lifestyle is important. Beyond that,
1:06:33there's another thing which we showed.
1:06:35Regular checkup is also very important.
1:06:38Okay.
1:06:38>> But tell me if I if I do a
1:06:40>> regular checkup
1:06:41and I am following discipline,
1:06:43>> Mhm.
1:06:44>> walking every day, sleeping on time,
1:06:45doing weights to do some building some
1:06:48muscles, eating greens, eating proteins,
1:06:51doing everything that you just suggest.
1:06:52>> Yeah.
1:06:53>> Do I still need a doctor?
1:06:54>> You still need a doctor and still need a
1:06:55checkup. I'll tell you why.
1:06:57Because because of your age, things may
1:07:01go wrong, okay? I'll show. Okay.
1:07:03Now,
1:07:04you've got HB1C, let's say seven. I want
1:07:09the HBA1C at seven.
1:07:10Okay?
1:07:11Now you have come to me
1:07:13and your HBA1C has come there.
1:07:16This is 2026.
1:07:19I've told you HBA1C 6.5. Now you're
1:07:21saying
1:07:22I don't need a doctor now. I reached
1:07:246.5. He told me below seven. I'm not I
1:07:27don't need a doctor.
1:07:29Now we talked about hedonic. We talked
1:07:31about things slowly changing in the
1:07:33body. There are also biochemical changes
1:07:34occur due to age, due to so many other
1:07:36factors, things can change.
1:07:39Now
1:07:40my next checkup I'm saying is
1:07:42before 2027,
1:07:44you come once more to me. After six
1:07:46months I'm telling. But you are saying
1:07:47no, I won't come. I don't this guy want
1:07:50to make money. He's calling me. I'm not
1:07:51coming. What will happen is
1:07:54it will go there.
1:07:56No symptoms. Asymptomatic disease. And
1:07:59you're saying I'm fine. And yeah,
1:08:01because you don't check HBA1C anyway.
1:08:03You'll be saying some sugar. That's
1:08:05because you know, I went for a marriage
1:08:06last week. So everything you have an
1:08:07excuse also.
1:08:09Then it will go there.
1:08:11Okay?
1:08:12Then it will go there.
1:08:15Then it will go there. And one day
1:08:16you'll say, "Doc,
1:08:18it's 10 now."
1:08:21And of course I don't want to tell you I
1:08:22told you so. But I have really I told
1:08:24you so because if you had only come here
1:08:27I had brought it down.
1:08:29Then again you go, again I bring it
1:08:31down. Again I bring it down. So always
1:08:33your HBA1C is okay.
1:08:35Otherwise going up up up up. This
1:08:37happens also with people who try
1:08:39reversal things, you know?
1:08:41>> And what happens if I go above?
1:08:44>> Yeah, because you're every every 1% I'm
1:08:48telling you that your risk of developing
1:08:50eye, kidney, nerve complication from
1:08:53seven to eight when it has gone already
1:08:56it is 25% extra risk. It's gone to nine,
1:09:00it is 50%. It's gone to 10, it is 75%.
1:09:04It's gone above 10, it's 100%. You're
1:09:06now going at 100% risk of developing
1:09:09kidney. Next time you come here,
1:09:12I'll check your kidney and say, "Gosh,
1:09:15you've started leaking protein."
1:09:17Finished.
1:09:19Sometimes it's not reversible
1:09:20after that. Then what I'll be trying to
1:09:23do is how to prevent dialysis for you.
1:09:26That will be my next aim, not to bring
1:09:27all this down. My next aim is how long
1:09:30can I push him without
1:09:32him undergoing dialysis or transplant.
1:09:35Cuz once the creatinine goes to a
1:09:36certain point, there are only two
1:09:38things: either dialysis or
1:09:39transplantation or death. Finished.
1:09:41There are only three things that are
1:09:42possible. If you don't do these two,
1:09:44you'll die.
1:09:45And how many transplants can you do in
1:09:47India?
1:09:48There are
1:09:48101 million people with diabetes.
1:09:51Assuming 20% will develop complications.
1:09:5480% will not. 20% 20 million people. 20
1:09:57million kidneys. You're doing 10,000
1:10:00transplants in a year.
1:10:02Whatever transplant you do, it's only
1:10:0410,000 in India. 20 million.
1:10:07What are you going to do? So, you have
1:10:08to prevent. To prevent it's ABCD.
1:10:12For that, you have to come.
1:10:13Only if you come, only we'll bring this
1:10:15A on A and A can only A has come now. B,
1:10:17C also I'll take care when you come.
1:10:20A also I'll take check, B also I'll take
1:10:21C also I'll check. Then I'll talk to you
1:10:23about D.
1:10:24I'll further reinforce saying, "Hey,
1:10:26this is you know, okay. Now, next 6
1:10:28months let's be a little more careful."
1:10:30I've motivated you.
1:10:32I'll give you an example, okay? How how
1:10:34this works. From the other side. I know
1:10:37you're the doctor and I'm sitting on
1:10:38this side.
1:10:39When I got married,
1:10:41my wife has to tell me, "Why are you
1:10:44brushing your teeth only once?
1:10:46You should do once more at night." I
1:10:48have a lot of morning anyway going to
1:10:49get up and brush. So, why should I brush
1:10:51at night? Okay, so I never did.
1:10:54Then I had some small dental problem and
1:10:55I went to my dental surgeon.
1:10:59Um and um
1:11:01so she told me, "You know, Dr. Mohan,
1:11:04from today
1:11:06till you die,
1:11:08you're going to brush twice a day.
1:11:10Okay?
1:11:11If you come back at 1:00 a.m.
1:11:14from somewhere, flight or something you
1:11:16come, you'll brush and then go to bed.
1:11:19Okay?
1:11:20Since the time she told me till today
1:11:22I've not changed. I've done it. So I go
1:11:24back home.
1:11:25And then I told my wife, "You know, this
1:11:27doctor told me that I have to brush my
1:11:30teeth twice a day, so I'm doing it."
1:11:33What did I tell you?
1:11:34>> [laughter]
1:11:34>> I told you this years ago.
1:11:36I said that's a difference.
1:11:38When my dental surgeon tells me, I think
1:11:40no, when your wife tells me, I don't
1:11:41listen.
1:11:42>> [laughter]
1:11:42>> You're not my dental surgeon. When my
1:11:44dental surgeon tells me, I listen. So
1:11:46there is a certain power and that power
1:11:49is very powerful. Tell me about kidney.
1:11:52>> You said you spoke about kidney because
1:11:55is it by the time people see bubbles in
1:11:57their urine,
1:11:58>> Yeah.
1:11:58>> kidney's already 50% damaged, right?
1:12:00>> No, that's not true, actually. The
1:12:02bubble actually is not so. I'll show you
1:12:04the kidney. So this is a kidney.
1:12:06It's a
1:12:07kidney shape. They call kidney bean is
1:12:10called that because it's like a kidney
1:12:12shape thing. This is the adrenal gland,
1:12:13actually. So you have the artery and the
1:12:15vein and this is the urine tube, the
1:12:16urethra through which it goes. And then
1:12:18if you open up
1:12:20the kidney, you can see the
1:12:23the collecting tubules and the thing. If
1:12:25you put this under the microscope, if
1:12:29you take a bit of that, you can do a
1:12:30biopsy or if you want to do a biopsy, we
1:12:33need not don't don't need to do it. Or
1:12:35thing, if you take that, these are what
1:12:37are called as nephrons and these
1:12:40nephrons
1:12:41>> These are red and yellow.
1:12:42>> Yeah, I mean they're just pictured
1:12:44they're just doing blood vessels and so
1:12:45on. But
1:12:47if you these are too big to see, but if
1:12:50you take you know,
1:12:51small tissue and then see it under the
1:12:55microscope, then you can see
1:12:58what is called as
1:13:00a basement membrane. Okay, this is
1:13:03called as a basement membrane.
1:13:05And this is a normal thickness of the
1:13:07basement membrane, let us say. Okay. If
1:13:09you have one control diabetes, what
1:13:10happens is this thickness of the So,
1:13:13through the basement membrane that the
1:13:15blood circulation blood will come and
1:13:17then go back and all that. So, the first
1:13:19thing that will happen due to diabetes
1:13:21is the basement membrane will get
1:13:22thickened now.
1:13:24Okay.
1:13:26Once it gets thickened,
1:13:28so that's called basement membrane. So,
1:13:30basement membrane is thickened. Once
1:13:32basement membrane is thickened, it's
1:13:33also become porous.
1:13:35And so, there are small small holes
1:13:37through that. Through that, albumin will
1:13:39start leaking.
1:13:41So, normally, if you measure how much
1:13:44albumin is there in the urine, it's very
1:13:45small quantity, some 4 mg, 5 mg. It's
1:13:48called normal. Okay. Near zero or very
1:13:51very small. Then slowly, it will become
1:13:54about 30.
1:13:5730 microgram minute or 30 mg, you can
1:13:59call it. We call it as microalbuminuria.
1:14:02>> Mhm.
1:14:03>> That's the first stage of diabetic
1:14:06kidney disease. Before that, if you do a
1:14:08biopsy, you can see
1:14:10thickening of this basement membrane and
1:14:12other changes there.
1:14:13Glomerulosclerosis, we call it. Now, the
1:14:16first thing that will happen is small
1:14:17quantities of protein will start leaking
1:14:20albumin, that's called microalbuminuria.
1:14:2230 to 300, we call it as
1:14:25microalbuminuria. If it goes above 300,
1:14:28it's macroalbuminuria.
1:14:30After that, reversal becomes difficult.
1:14:33At this stage, microalbuminuria, there
1:14:36are tablets, you give it, it will become
1:14:37normal.
1:14:38Kidney itself will become normal, blood
1:14:40pressure will start Blood pressure start
1:14:42going up. By the time this kidney start
1:14:43going up, blood pressure Blood pressure
1:14:45will drop, everything will become
1:14:46normal, sugar is normal, HBA1C has come
1:14:48down. You give these tablets, everything
1:14:50normal, kidneys will come normal.
1:14:52Once it goes to macro albuminuria above
1:14:54300, 400, 500, 1,000, 2,000,
1:14:57almost difficult to reverse it back.
1:15:01At that stage, so this can be stage
1:15:03zero, stage one, stage two, whatever you
1:15:05want to call. Stage three.
1:15:08Creatinine is now beginning to go up. To
1:15:10this creatinine serum creatinine 0.8,
1:15:130.9, it's normal.
1:15:15>> Mhm.
1:15:15>> Once it crosses one, the kidney is going
1:15:18in for failure now. Okay? One,
1:15:201.5, 1.6, it's going up. We measure it
1:15:24in another form. From that creatinine,
1:15:25there's a formula eGFR, estimated GFR.
1:15:28Mhm. Normally, it'll be around 90.
1:15:31Then becomes 60,
1:15:3250, 40. It's coming down. Let me
1:15:35creatinine become two,
1:15:37three,
1:15:38four. As it goes higher and higher,
1:15:40you're going nearer and nearer dialysis
1:15:41and transplantation. Okay?
1:15:44Now, creatinine has become eight,
1:15:4710. Your eGFR has become 10, 15.
1:15:51Now, it's called the last stage of
1:15:52kidney, it's called end-stage renal
1:15:54disease, ESRD.
1:15:56End-stage renal disease. At that stage,
1:15:58there's nothing you can do.
1:16:00If you control diabetes now also,
1:16:02control blood pressure now, you can give
1:16:04all the medicines you want, it's a
1:16:06relentlessly progressive condition.
1:16:10So, the moral is I'm not frightening
1:16:12people by saying that, but once you
1:16:13reach that stage, nothing you can do. I
1:16:16also, you get this small small spot,
1:16:18then it starts bleeding inside in the
1:16:20whole eye. The whole vision can go, can
1:16:22go blind due to Then you try to suck out
1:16:25the blood, try to do some major surgery,
1:16:27vitrectomy, this, that. You may get 50%
1:16:30of vision back. Okay?
1:16:32They are all eminently preventable. I'm
1:16:34saying we got 50-year people without any
1:16:37eye trouble. That's why I'm saying in
1:16:38diabetes complication-free world, I'm
1:16:40I'm up to that. Okay? So, that is
1:16:42preventable. Early stages also, it is
1:16:44still reversible. So, there's a point of
1:16:46no return.
1:16:47>> Yeah.
1:16:48>> Beyond that, next stage, next stage,
1:16:49next stage. Now, you come. You take
1:16:52foot.
1:16:53First, uh some numbness, tingling in the
1:16:55foot. Okay, you give medicine, become
1:16:57okay, control diabetes, become okay.
1:16:59Then, it starts burning the whole night,
1:17:01you're not sleeping. Then, some callus
1:17:04forms, and then the ulcer forms, and
1:17:07then small gangrene starts forming.
1:17:09Now, you have to remove the toe.
1:17:11You develop gangrene. Gangrene means
1:17:13death.
1:17:13>> Yeah.
1:17:14>> Death of tissue has occurred. How can
1:17:15you keep a dead foot, I mean, toe? It'll
1:17:18infect the next one also. Next toe will
1:17:20go, next toe will go, next toe will go.
1:17:21So, then you start removing one toe.
1:17:23Then, if there's good blood circulation,
1:17:25it will heal.
1:17:26There's no good good blood circulation,
1:17:27that also won't heal. Then, you'll end
1:17:29up with a below knee amputation, above
1:17:31knee amputation.
1:17:32Uh those are the things which in the
1:17:34past we used to see, but unfortunately,
1:17:36even today it's happening.
1:17:38They'll be from a village.
1:17:40They won't have proper advice. They'll
1:17:42go to some native healer. He'll say,
1:17:43"Don't go to all these allopath fellows.
1:17:45I will cure you." They will give some
1:17:47treatment. They will put something, a
1:17:49bandage, something they'll put, some
1:17:50herbs, something they'll put, that'll
1:17:52worsen it. That'll, you know, infect the
1:17:54foot also. It won't be clean also.
1:17:56They'll infect the foot. Then, they'll
1:17:57come in the bad thing. "Somehow save my
1:17:59leg. Somehow save my leg."
1:18:01Everything is possible up to a certain
1:18:03point.
1:18:04Beyond a certain point, diabetes can be
1:18:07an absolute killer.
1:18:08>> But, what is in
1:18:10in simple words, what is there in a
1:18:12diabetic person that one small wound
1:18:16>> doesn't heal.
1:18:17>> Doesn't heal. It takes them years,
1:18:18months, years probably, and the same
1:18:21thing. Like, some wound, then then start
1:18:23becoming in
1:18:23>> Bigger and bigger.
1:18:24>> Bigger and bigger, that at one point
1:18:25they have to like probably cut off
1:18:27>> Cut off.
1:18:28>> the finger of the hand.
1:18:28>> It's become black, and become gangrene,
1:18:31then dead. The the the toe is dead. You
1:18:34can't keep a dead toe. You have to
1:18:35remove it. So, then otherwise, will go
1:18:37to the next toe. So, one small cut, what
1:18:39happens? So, [clears throat] two or
1:18:40three things. One is glucose.
1:18:42Once you have glucose in the skin,
1:18:45glucose is a very good source for
1:18:47bacteria to grow.
1:18:48See, what How do we do cultures in the
1:18:50lab? We put some glucose and then allow
1:18:52the bacteria to grow. That's how we see
1:18:54whether there's bacteria there or not.
1:18:56Here, you got a natural like a culture
1:18:58lab you got in your leg itself. You got
1:19:00so much of glucose there. It will keep
1:19:02getting
1:19:03uh more and more the bacteria will grow.
1:19:05That's number one. Number two,
1:19:07neuropathy.
1:19:08>> Okay.
1:19:08>> The nerve is affected. Because the nerve
1:19:11is affected, the when you walk also,
1:19:14you're not walking lightly. You know,
1:19:16you're putting pressure. Because you're
1:19:18not feeling the the surface. So, you're
1:19:21putting more and more pressure. So, more
1:19:23and more damage will occur. The chance
1:19:25of it breaking a bone is very easy. The
1:19:27bones also a little weak because of all
1:19:29the calcium has gone from the bone. So,
1:19:31very easily
1:19:32Deadly one, the third one, most deadly
1:19:34one is blood circulation problem.
1:19:37Even this neuropathy, infection, you can
1:19:40give antibiotic, you can do something,
1:19:42remove one toe, let out the pus. You can
1:19:44just cut it, let out all the pus, it
1:19:46will heal. Even the big wound is there,
1:19:48you can just make a big incision, let
1:19:50out all the pus, it will heal.
1:19:52The deadly one is ischemia. If you don't
1:19:54have blood circulation, without blood,
1:19:57nothing will enter there.
1:19:59Whatever nutrient you give, whatever
1:20:01antibiotic you give, whatever you give,
1:20:03the blood has to go there and there's no
1:20:05blood. It's blocked.
1:20:07Then what do you do?
1:20:08Of course, you can try to do a bypass or
1:20:10you can do a stenting and open up the
1:20:13vessel and try to do
1:20:15uh and so on. It may work sometimes.
1:20:17Sometimes even that doesn't work or you
1:20:19cannot if the
1:20:20>> So, why is the blood not going there?
1:20:22>> Because the blood is blocked. The
1:20:24arteries are blocked, just like the
1:20:25heart arteries are blocked, like the
1:20:27stroke that you get there. The arteries
1:20:29are about due to cholesterol, due to
1:20:31uncontrolled diabetes, due to
1:20:33inflammation, the vessels are blocked.
1:20:35If it's a big vessel going from the
1:20:37thigh, you can operate it and just open
1:20:39it up and the whole blood will then go
1:20:41It's like a high-level block. Suppose a
1:20:44low-level block, the vessels are so
1:20:46small and multiple. Where are you going
1:20:49to go and open it? Every
1:20:51health-conscious Indian today,
1:20:54okay, has thrown out white sugar
1:20:57out of their house, which is a great
1:20:59thing, and they've replaced it by
1:21:01jaggery powder.
1:21:02>> Okay.
1:21:03>> But I was reading the GI index.
1:21:07Jaggery powder has almost about 74 to 80
1:21:11GI index. White sugar has about 65.
1:21:15>> Does it make any difference or is it a
1:21:18wrong metric to even look at?
1:21:20>> So, GI is a very complicated
1:21:23thing. For example, white bread is
1:21:26actually near 100 the GI. And different
1:21:31different thing There are studies which
1:21:32show that mango
1:21:34GI is not that high. There have been
1:21:37some recent studies also. But every
1:21:39person who takes mango will come with
1:21:40very, very uncontrolled diabetes
1:21:43to me.
1:21:44>> Uh so, if you look at Which one is
1:21:47jaggery? This is coconut sugar and this
1:21:49is jaggery.
1:21:51>> So, that's jaggery. And which is the
1:21:53white sugar?
1:21:54>> I'll get you white as well.
1:21:55>> So, if you look at white sugar and
1:21:58jaggery,
1:21:59>> Mhm.
1:22:00>> it's in the
1:22:01processing of this. This is a little
1:22:04more unrefined. Just like we said about
1:22:07brown rice and white rice, the same
1:22:09principle.
1:22:10>> Okay.
1:22:11>> Uh so, this is sucrose. White sugar is
1:22:14sucrose, and jaggery is a little more
1:22:18un- So, according to
1:22:21Ayurveda, this is much, much better than
1:22:24this.
1:22:25>> Okay. So, jaggery is better than sugar
1:22:27According to Ayurveda?
1:22:28>> according to Ayurveda. So, jaggery,
1:22:31even honey and all that is recommended
1:22:33in in Ayurveda.
1:22:35Um if you look at the
1:22:38actual
1:22:40difference between the two, if you don't
1:22:44have diabetes, probably jaggery is
1:22:47better than uh sugar. Because jaggery
1:22:49has some nutrients in it.
1:22:52It has some
1:22:53some more nutrient nutritional benefit
1:22:55in it. White sugar has zero nutritional
1:22:58value. It's just sugar. There's nothing
1:23:00else in it. Jaggery does have some
1:23:02nutrient benefits in it.
1:23:05But for a person with diabetes, it
1:23:07doesn't make too much of difference.
1:23:09Because this also will elevate your
1:23:10sugar. You're right about the high GI
1:23:12part of it. Uh so, this will also
1:23:14elevate the sugar. This will also
1:23:16elevate the sugar. So, between the two,
1:23:18if you ask me, I would say this is
1:23:20slightly an edge over that.
1:23:23But I would say try to for for a person
1:23:26with diabetes, they should try to avoid
1:23:28sugar in any form. So, there are there
1:23:31is a move the government is also I think
1:23:34I've heard this National Institute of
1:23:35Nutrition people saying
1:23:37from the time the child is born, don't
1:23:39give sugar at all.
1:23:41>> Mhm.
1:23:41>> Because sugar is not really needed for
1:23:43health.
1:23:44>> Yeah.
1:23:45It's only for taste enhancing.
1:23:46>> Only for taste. So, this is not a health
1:23:48thing at all.
1:23:49So, you really don't need it.
1:23:51You you won't believe it even salt was
1:23:53like that. You know how salt came?
1:23:56Salt was not there 300 400 years ago.
1:23:59>> Okay.
1:23:59>> Okay. Whole humanity has been there for
1:24:02millions of years. Salt is only about
1:24:04300 400 years. It is only during the
1:24:06shipping era.
1:24:08You know, sailors had to bring food. And
1:24:11for days together, they where will they
1:24:14get the food?
1:24:14>> Mhm.
1:24:15>> So, they have to bring things you know,
1:24:17carry the food for months together while
1:24:19they are sailing. They found out that
1:24:22salt water, brine
1:24:24as we call it, if you put fish in it or
1:24:27you put food in it, it stays. It's a
1:24:30preservative.
1:24:32What happens when you put that is the
1:24:34salt gets absorbed. So, the salt taste
1:24:37came like that.
1:24:38It only started as a preservative. It is
1:24:41not meant for taste. Slowly, the taste
1:24:44gets added on. We are taking far too
1:24:47much salt and far too much sugar.
1:24:49>> Okay. Um I'm going to show you these
1:24:51things because we touched upon a little
1:24:53bit.
1:24:54But you rank them. Completely safe is
1:24:56one. Completely toxic is 10. So, what
1:24:59are
1:24:59rank these things or probably just give
1:25:01them numbers, okay? So, let's start with
1:25:04white sugar.
1:25:05>> Okay, but I should see them to give up
1:25:07because once you give you get all the
1:25:08students and then you put the marks, you
1:25:10know?
1:25:10>> Okay. Okay. Fair. Fair. You want to do
1:25:12comparative
1:25:13>> studies, okay?
1:25:17So, we have Oh, wait. Wait. I'm going to
1:25:20name it for people.
1:25:21>> Yeah.
1:25:21>> So, we have orange juice.
1:25:23>> Yeah.
1:25:24>> Fresh
1:25:24>> I think we'll take these because juice
1:25:27becomes a little different.
1:25:28>> We know a lot of people say fruit juice
1:25:30as a sugar thing. So, I I want to
1:25:32put that also as a as a thing. So, it's
1:25:34like
1:25:35>> What is this one?
1:25:37>> Coconut
1:25:38>> Brown sugar.
1:25:39>> We have brown sugar. We have coconut
1:25:40sugar.
1:25:41>> Okay.
1:25:41>> We have monk fruit sugar. We have
1:25:43sugar-free. We have stevia. We have
1:25:46jaggery powder. We have white sugar. And
1:25:49then we have fruit juice, which is
1:25:51purely fruit fructose, which people call
1:25:54it.
1:25:54>> Okay. [snorts]
1:25:56So,
1:25:57>> [clears throat]
1:25:58>> stevia will be
1:26:00number one
1:26:01because among the sweetness I I'll put
1:26:04stevia and
1:26:07Splenda.
1:26:09>> Sucralose.
1:26:10>> Okay.
1:26:10>> Which is also among the sweetness. These
1:26:14are the two which are safe. We have done
1:26:16studies.
1:26:16>> Okay.
1:26:17>> And these two are These are plant-based.
1:26:19Sucralose is derived from sucrose. So, I
1:26:21would put stevia and sucralose as the
1:26:24the first two.
1:26:25>> Okay.
1:26:26>> Okay.
1:26:27I would then probably put sugar-free
1:26:32aspartame. Although, there are some
1:26:36things which say that uh
1:26:38aspartame also has some side effects.
1:26:40But, in small quantities, I think as
1:26:42coffee, tea, it's probably
1:26:45okay.
1:26:46Uh then, I would say probably
1:26:50jaggery
1:26:52and
1:26:54these two being the brown and probably
1:26:57this also.
1:26:58>> So, coconut sugar, jaggery, and brown
1:27:00sugar are almost same?
1:27:01>> Almost same because they're all
1:27:03not refined like that.
1:27:07>> And if you had to still put a number,
1:27:09which would How would you rank in order?
1:27:11>> I would say jaggery would be better one.
1:27:14>> Then, in this order only?
1:27:15>> Okay. Coconut sugar, then brown sugar.
1:27:18>> Okay.
1:27:18>> This monk fruit sugar lot is being told
1:27:22in um
1:27:23uh
1:27:24social media that's very healthy.
1:27:26>> Mhm.
1:27:27>> Actually, it contains erythritol.
1:27:29>> What does it mean?
1:27:30>> Erythritol is one of the sweetness like
1:27:32this. It first of all it contains
1:27:34fructose, it contains
1:27:36uh glucose. And in addition to that, it
1:27:39contains erythritol.
1:27:40>> Mhm.
1:27:41>> Okay. And erythritol is one of the worst
1:27:44sweetness.
1:27:46Of all these, I would put it even after
1:27:48this. So, I would put stevia and
1:27:52Splenda, sucralose, sugar-free. This I
1:27:56would not use at all. There've been
1:27:58cases of blindness and strokes and all
1:28:00that.
1:28:01>> with that ingredient? What is the
1:28:02ingredient?
1:28:02>> Erythritol. Erythritol. It's one of the
1:28:05sweetness. Studies have been done where
1:28:07people have been taking erythritol uh
1:28:10have developed strokes and all that. So,
1:28:11this I I would not popularize this at
1:28:13all. Although, people are talking a lot
1:28:15of monk fruit sugar, fruit sugar.
1:28:17>> big. Almost in every healthy thing
1:28:19they're putting this.
1:28:20>> Yeah, so I that is why I've been reading
1:28:22up about this and this I would, you
1:28:24know, put it on avoid.
1:28:26>> Okay.
1:28:26>> Then, this
1:28:29I would put there,
1:28:31um, because it is still if if there's no
1:28:34sugar added
1:28:35>> Mhm.
1:28:35>> uh, to that, um, it it is still I don't
1:28:39recommend to a diabetic to take fruit
1:28:43juice at all. If it is cut fruit, it is
1:28:46fine.
1:28:47>> Mhm.
1:28:47>> It is fine. You can go ahead and
1:28:48>> It will go actually much
1:28:51probably come here or something. Cut
1:28:53fruit will come here. Okay, or even
1:28:55here.
1:28:56>> Whereas, this one
1:28:58to produce so much of this uh, juice,
1:29:01you have to put in a lot of fruit to get
1:29:03it. So, it the calories goes up and the
1:29:06sugar content goes up. Even though it is
1:29:08fruit sugar, it is still fructose. It
1:29:10gets converted into glucose ultimately
1:29:13once it enters into the body, it will
1:29:14get converted into glucose. A little
1:29:16slower it will get converted.
1:29:18>> I don't recommend this. I'd recommend
1:29:19this. Of course, white sugar there is no
1:29:22doubt at all. It is direct sugar and
1:29:25therefore, you should not take. You're a
1:29:27killer. Yeah.
1:29:29An- anybody should cut down on on on
1:29:31>> So, these are the ranks. 1 2 3 4 5 6 7.
1:29:35This you have That's excluded from the
1:29:37ranks.
1:29:37>> I don't like that erythritol at all.
1:29:39>> I was saying monk fruit sugar is
1:29:42probably worse than white sugar.
1:29:45>> Not in terms of the sugar content.
1:29:49>> No, in terms of the side effects and
1:29:51damage. Overall damage.
1:29:52>> it contains erythritol. That's my
1:29:55objection. The erythritol See, you know,
1:29:57about 2 years ago, WHO said that
1:30:01uh, they issued a blanket statement
1:30:03against all sweetness. Okay? And they
1:30:06said sweetness because what happened was
1:30:09people started substituting sugar with
1:30:12one of these sweeteners and taking it by
1:30:15the tons. Thinking this is for weight
1:30:17reduction, so I'll cut off sugar, I will
1:30:19do this and so on.
1:30:21WHO, but when they issued that statement
1:30:24itself, they said this is not for people
1:30:25with diabetes.
1:30:27Because people with diabetes are going
1:30:28to replace that with this or this. It's
1:30:31definitely better than sugar. Because
1:30:33sugar, you know, changes the gut
1:30:35microbiome quite a bit. Some of the
1:30:38other uh thing, even this and some of
1:30:40the others also change part of the gut,
1:30:42but this does much more. Okay, so WHO
1:30:44said when we're talking about sweeteners
1:30:46being bad, we're not talking about
1:30:48people with diabetes. Let them continue,
1:30:49at least they have to get rid of some
1:30:51sugar substitute, that's okay. We are
1:30:53talking about people who are trying to
1:30:54lose weight.
1:30:55Saying that I'll switch from sugar to
1:30:57this and I'll lose weight. They said
1:30:59there are actually studies showing they
1:31:00gain weight.
1:31:02Because some of these substitutes of
1:31:05these, they first of all they do the gut
1:31:08microbiota thing, they do. Second thing
1:31:10is they stimulate your appetite and they
1:31:13make you eat more.
1:31:14>> Mhm.
1:31:14>> And so they said there's no weight loss
1:31:16at all about that. So don't use it for
1:31:18weight loss purposes. They're very
1:31:20strong about it. WHO gave a very strong
1:31:22statement. That is when we did the study
1:31:25on uh stevia and we did on um the
1:31:28sucralose. And what we did was very
1:31:30simple. We are not telling people
1:31:32instead of dessert you put this large
1:31:34quantity. We didn't do that. We also
1:31:36didn't say drink diet drinks, you know,
1:31:40>> Mhm.
1:31:40>> uh instead of the regular cola you drink
1:31:42a diet cola. We didn't say that also.
1:31:45What we said was Indian habit is in
1:31:47coffee and tea.
1:31:49They can't take it without that bland
1:31:51thing, they don't want. They want some
1:31:52sweetener.
1:31:53So we those who were taking sugar
1:31:56among those who had with diabetes taking
1:31:58sugar, one group we said, "Okay, you
1:32:00continue to anyway taking it, you
1:32:01continue it." One group you said, why
1:32:03don't you switch over to
1:32:05the sucralose and we'll see what
1:32:07happens. For 3 months we followed them.
1:32:10Just by cutting that sugar
1:32:13and replacing it with sucralose only in
1:32:15coffee or tea, two to three coffee or
1:32:18tea per day.
1:32:19They were able to lose one or two kilos
1:32:21in weight. The waist went down by one or
1:32:24two centimeters. Sugar actually came
1:32:27down. There was a little bit of change
1:32:30in the gut microbiota because of the
1:32:33the the change in this, but it wasn't
1:32:35very serious. So, we concluded by
1:32:37saying, "Okay, if it is coffee or tea
1:32:40and you're having diabetes, at least you
1:32:42can take sucralose or stevia. That seems
1:32:44to be okay."
1:32:46Now, one or two of these,
1:32:48if they switch over, they still contain
1:32:50sugar.
1:32:51So, they're not sugar substitutes.
1:32:54Uh this one, probably their glycemic
1:32:57index may not go up, but my objection is
1:32:59to erythritol.
1:33:00>> Mhm.
1:33:00>> So, that time I read all about the
1:33:02various sweet whether all the sweetness
1:33:04are the same.
1:33:06And why there were people saying that
1:33:07people can die if you take then I found
1:33:09all related to that one erythritol.
1:33:12Erythritol till now is not there in
1:33:14India.
1:33:15>> Okay.
1:33:15>> We had only stevia, we had aspartame, we
1:33:18had
1:33:19Splenda and all that. But now this thing
1:33:22is entered in this form.
1:33:24So, I'm saying be careful with
1:33:26erythritol alone, be careful because
1:33:28there are cases of strokes and all
1:33:29described after erythritol, but not with
1:33:31the other sweetness, not even with
1:33:33these. That is why my objection to that.
1:33:35This I have not done research on that,
1:33:37but I'm just saying from what I have
1:33:38read.
1:33:39>> What do you think is like give me top
1:33:41three best breakfast which an Indian can
1:33:44eat?
1:33:45And this has to be Indian. I I don't I'm
1:33:47not interested in oats. Oats are not
1:33:48good.
1:33:49>> No, [laughter] okay.
1:33:49>> Because we all know what oats are.
1:33:51>> Eggs and uh
1:33:52>> Mhm.
1:33:52So, only eggs?
1:33:55>> So, fruit is a must.
1:33:57>> Mhm. Okay. So, fruit uh and if you vary
1:34:00the fruit,
1:34:02apple, very low GI.
1:34:04Apple a day keeps the doctor away. So,
1:34:06that's true actually. Guava is again
1:34:08something with a lot of fiber
1:34:10and very low GI. It's very very good.
1:34:13Orange is okay. Papaya is okay.
1:34:17Then,
1:34:19the egg is a very good breakfast. If you
1:34:24take eggs, a couple of eggs a day, even
1:34:27if the yellow is fine. If you take two
1:34:30eggs, the advantage of having
1:34:33protein if some and immediately they
1:34:35will say, "I'm a vegetarian. I don't
1:34:36take egg."
1:34:37Then, you have to take something else,
1:34:38some other protein.
1:34:40Advantage of adding protein at breakfast
1:34:42is you can go up to lunch time not
1:34:44feeling hungry.
1:34:46If you just have your poha and idli or
1:34:50dosa and all, then 2 hours you'll feel
1:34:52hungry.
1:34:538:00, 8:10 o'clock, you're already
1:34:54wanting to eat again. Have your protein,
1:34:58you can go up to 2:00, 3:00, you're
1:35:00full. You can even skip your lunch.
1:35:02Nothing will happen. And you can have an
1:35:03early dinner, two meals. You can easily
1:35:05That This is a power of protein. So,
1:35:07apart from building your muscle and
1:35:08building your satiety value is very very
1:35:11high. Because you're taking 120 g, you
1:35:13must be feeling that the fullness part
1:35:16of it.
1:35:17So, I for for me, what I take is I take
1:35:21fruit.
1:35:22I had given I I used to take non-veg and
1:35:25then I became
1:35:26a vegetarian many years ago, 15 years
1:35:29ago.
1:35:30For the first 8 or 10 years, I was not
1:35:32taking egg also. I said, "Vegetarian
1:35:34means really vegetarian." Then, I
1:35:36struggled with my protein intake. It's
1:35:38very difficult to get You mentioned
1:35:40plant protein. How will you get? It is
1:35:42difficult. So, I started taking egg.
1:35:45Mostly, I take egg white only because
1:35:48then there's no cholesterol also. And
1:35:49then for those who think, you know, the
1:35:51yellow part is the life part and already
1:35:53can justify by saying the white is not
1:35:55really life, it's not fertilized,
1:35:57whatever.
1:35:58So, egg white, but even if it's a full
1:36:00egg, it's fine. That's the only kind of
1:36:02non-veg that I take if it's a egg part
1:36:05of it.
1:36:06Um I also [clears throat] take a little
1:36:08bit of milk cuz I am one who believes
1:36:10that dairy is actually good for health,
1:36:12it's not bad for health, it's a complete
1:36:14protein.
1:36:15I take not much, about um
1:36:18yeah, little more than that.
1:36:20Uh yeah, little maybe yeah, maybe a
1:36:23little bigger bowl than that, but in
1:36:25that I pack it with uh nuts
1:36:29and seeds, okay? So, I uh
1:36:34I take all kinds of nuts, almonds,
1:36:36cashew, uh pistachio,
1:36:40uh everyday vary the nuts, little
1:36:42berries if it's there, I'll add. Seeds
1:36:45definitely, chia seeds, pumpkin seeds,
1:36:48any other seed that is flaxseed or
1:36:49whatever I take that, but chia and
1:36:51pumpkin will definitely be there. So,
1:36:53antioxidants, fiber, protein, all this
1:36:57comes and omega-3 and all that comes
1:36:59only from this cuz I can't take fish and
1:37:01all, so I take this. So, I think that's
1:37:04a very healthy breakfast for me because
1:37:06the milk gives you my protein, little
1:37:08bit of fat, it gives me the thing all
1:37:10the nuts gives me the omega-3 and the
1:37:13uh the protein and the fiber and and all
1:37:17the good values of nuts I get. Seeds
1:37:20even better, antioxidants on the fruit
1:37:22again give me a lot of antioxidants and
1:37:25I I don't have diabetes, so I can eat
1:37:27couple of fruits per day and the sugar
1:37:30doesn't go up. I put CGM and all it
1:37:32doesn't go up for me. And then the egg
1:37:33gives me the protein part of it. So,
1:37:36that's a nice breakfast. Then for lunch,
1:37:40very little rice and very little maybe
1:37:42hardly there'll be two vegetables,
1:37:441 g thing will definitely be there,
1:37:47either mung dal or Bengal gram or
1:37:49chickpeas or rajma or something. A nice
1:37:52big portion, two vegetables, very little
1:37:55rice and curd. That's my lunch.
1:37:58And night again,
1:38:01practically no rice. It'll be more
1:38:03vegetables and if there is some one dosa
1:38:07or one thing, very small quantity of
1:38:10carbs. Protein will again come in the
1:38:12night. And veggies and things like that.
1:38:15So that way very healthy
1:38:18food. So this So I'm a vegetarian.
1:38:20>> Yeah. Talking about world's influence,
1:38:22you said Bose, Dr. Bose, right? I'm
1:38:24talking about you. Like let's
1:38:26specifically come to you.
1:38:28You developed something and you spoke
1:38:31about stones and pancreas.
1:38:34>> Yeah.
1:38:35>> And that almost became Mohan's criteria
1:38:38in the world. Now the biggest of the
1:38:40biggest doctors and scientists all
1:38:41around the world, whether it's Stanford
1:38:43or the top institutions, whether it's
1:38:46America, Europe or anywhere in the
1:38:48world.
1:38:49They
1:38:50they quoted as Mohan's criteria. What is
1:38:53Dr. Mohan's criteria?
1:38:55And what did you do?
1:38:57>> So for the first 20 years of my life, I
1:39:01worked on a rare disease. Like we called
1:39:04it as type 3C and all earlier when
1:39:06you're talking about it, I talked about
1:39:08it's not type 1, not type 2. There are
1:39:10other forms of diabetes where the
1:39:12pancreas gets directly involved due to
1:39:15inflammation and they develop stones
1:39:18inside. Just like your kidney stone,
1:39:19gallstone, you also have pancreatic
1:39:21stones.
1:39:21>> Okay.
1:39:22>> And those stones will go and damage the
1:39:24pancreas and produce diabetes. It also
1:39:27produce indigestion because pancreas has
1:39:28two function. One is insulin production
1:39:31and the other is exocrine, digestive
1:39:34function.
1:39:34>> Okay.
1:39:34>> So when you have these stones, your
1:39:36digestion also is not good. You'll be
1:39:37producing oily motions and all that. And
1:39:40then your sugar level also will go up
1:39:42because the insulin production also goes
1:39:44down. So, that was called as fibro
1:39:46calcific pancreatic diabetes.
1:39:48>> draw and show me something?
1:39:49>> show.
1:39:50>> It will be easier for me to understand.
1:39:52Yeah.
1:39:53>> [snorts]
1:39:54>> You're using words which are very normal
1:39:55to you. For me, it's like what?
1:39:57Fibrocalculus what?
1:39:59>> Fibrocalculus. Okay. So,
1:40:03>> [snorts]
1:40:06>> So, this is stomach. Okay?
1:40:07>> Okay.
1:40:08>> This is intestine.
1:40:10At this point, this is a duodenum. Mhm.
1:40:12One part of the intestine, then ileum.
1:40:14This portion
1:40:16has an organ like this, a leaf-shaped
1:40:19organ,
1:40:21which is called as the pancreas.
1:40:23>> Okay.
1:40:25>> So, this
1:40:26>> Is attached to your stomach like right
1:40:28>> It's attached to the intestine, comes
1:40:30and opens here. This is a pancreatic
1:40:32duct. This whole thing is pancreas.
1:40:33Okay. There's a small duct going through
1:40:36which fluid will go
1:40:38up and down. The pancreatic juice will
1:40:39keep going there.
1:40:41And what happens is that when you have
1:40:44um we don't know what the cause is, but
1:40:47due to some reason this pancreas starts
1:40:49getting inflamed.
1:40:51>> Mhm.
1:40:51>> Pancreatitis, we call it inflammation.
1:40:54When that happens, the pancreas starts
1:40:57getting
1:40:58inflamed. So, first thing that happens
1:41:01is that this flow of this juice which
1:41:03goes like that, it starts getting slowed
1:41:05down.
1:41:07>> Okay.
1:41:07>> It becomes thick.
1:41:08>> Mhm.
1:41:09>> Instead of
1:41:10So, once it becomes thick, very easily
1:41:13some mucus plugs will start forming into
1:41:15that calcium will start getting
1:41:16deposited, and then that forms a stone.
1:41:19So, if you take an X-ray, you can
1:41:21actually see the big stones sitting
1:41:23there.
1:41:23>> pancreas.
1:41:24>> So, in the pancreas. And that's called
1:41:25pancreatic
1:41:26calculi.
1:41:28Okay.
1:41:29Once you have the pancreatic calculi,
1:41:31calculi is stone.
1:41:33>> Okay.
1:41:33>> So, once you have that, then it will
1:41:35start producing further damage, and the
1:41:37pancreas will start getting
1:41:40fibrosed, shrunken. Like liver getting
1:41:42See, liver also can get shrunken, then
1:41:44you get cirrhosis, you know? So, like
1:41:47the cirrhosis of the liver, here also
1:41:49you start getting shrunken. So, that is
1:41:51why it is called fibro
1:41:54That means shrinking of pancreas, yeah.
1:41:57calculus.
1:41:58Both stone Yeah, so it's called
1:42:00fibrocalculous
1:42:03pancreatic diabetes. That's the full
1:42:05name of the disease. There is fibrosis,
1:42:07there is stone formation, and that is
1:42:10producing diabetes, and so it's coming
1:42:12from directly from the pancreas itself,
1:42:14so it's called FCPD.
1:42:15>> How fatal is this?
1:42:17>> It's not very common. It's more common
1:42:19in South India. So, Kerala had the
1:42:22highest, then Tamil Nadu, some parts of
1:42:24Orissa, north
1:42:25In as you go north, it was not that
1:42:28common in Delhi and other places, not
1:42:30very common. It's a tropical disease.
1:42:33Okay? Well, that's a big question.
1:42:35>> Why? There are some people said it's due
1:42:37to in Kerala they take cassava, tapioca.
1:42:39That contains some cyanogenic glycoside.
1:42:41There's one theory. I demolished the
1:42:43theory. I did animal experiment, proved
1:42:44it doesn't happen.
1:42:45>> [gasps]
1:42:45>> I think it's due to malnutrition. So,
1:42:47because of malnutrition, what happens?
1:42:49Some micronutrient deficiency, pancreas
1:42:51is not getting enough of the usual
1:42:54nutrients. That irritates it and
1:42:56produces some kind of inflammation. And
1:42:58then the final end product is very
1:42:59clear. You'll find big stones. If you
1:43:01take ultrasound within this duct, you'll
1:43:03find big big stones sitting there, and
1:43:05so on. Ultimately, it can turn into
1:43:07cancer, also. Pancreatic cancer also is
1:43:09very very high in these people. So, this
1:43:11particular disease I first got
1:43:13interested in this when I was doing my I
1:43:16used to work with my father from my
1:43:17first year, I told you.
1:43:19When I came to my final year, my father
1:43:21had seen a few cases of this, and
1:43:22written one or two papers on this. And
1:43:24he had seen it in very very poor people.
1:43:26Okay?
1:43:27So, he he he and others in Kerala there
1:43:31was one Dr. Geevarghese. He had also
1:43:32described me. He said, "Poor as to the
1:43:34poor, they'll come very, very thin.
1:43:36They'll have abdominal pain. You take an
1:43:38x-ray, you'll find stone. Then you check
1:43:39the sugar, it's very high. It's not type
1:43:411, it's not type 2, it's FCPD,
1:43:44fibrocalculous pancreatitis."
1:43:45So, he asked me to write a chapter on
1:43:47this. He gave me some papers. And when I
1:43:49was when he's writing a book, he told
1:43:51me, "You write a chapter on this." So, I
1:43:52wrote the chapter on it. When he's
1:43:54writing the chapter, I said, "How do you
1:43:56define this? How do you you know, it's
1:43:59simply stone and thing? How do you How
1:44:02do you define this particular thing?"
1:44:03So, I went to Kerala, spent few days in
1:44:06Trivandrum, where they have a lot of
1:44:07these cases. And I was discussing with a
1:44:10gastroenterologist
1:44:11there, Dr. Balakrishnan. And he was
1:44:13telling me how this this is all due to
1:44:16chronic pancreatitis. How chronic
1:44:18pancreatitis comes and all. I went to
1:44:19study it. After I studied,
1:44:21then I said, "Okay,
1:44:24there is no way with type 1 you can say
1:44:26if you have ketosis, you go into coma,
1:44:28you don't have insulin secretion, and
1:44:30you have antibodies. You've got
1:44:31different, different criteria for that.
1:44:32For this, there's no criteria at all.
1:44:34So, I said, "Let me sit down and make
1:44:35this criteria." It's seen only in
1:44:37tropical belt. Outside the tropic, even
1:44:40within India, only within the tropical.
1:44:42See, the India is cut by tropic of
1:44:44cancer by half. So, South India comes in
1:44:46the tropical.
1:44:48The rest of India is temperate. It's not
1:44:49outside the tropics. Okay? So, even here
1:44:52we are seeing within Tamil Nadu, this
1:44:53one, all in the South only we are
1:44:54seeing. There's something tropical about
1:44:56it. So, I said the first criteria should
1:44:58be it's within the tropical. If you go
1:45:00across Africa, only in the tropical
1:45:02region to see. So, I said it must be
1:45:03from a tropical country, first one.
1:45:05Second, there must be diabetes.
1:45:08Okay? So, I said second criteria is
1:45:10there must be diabetes. Third, there
1:45:11must be chronic pancreatitis.
1:45:14Because this is a chronic pancreatitis
1:45:15thing. So, I said there must be chronic.
1:45:17How do you diagnose chronic
1:45:18pancreatitis? So, I said either there
1:45:19must be stone
1:45:21or there must be evidence of some
1:45:22fibrosis.
1:45:23Okay? And all this can come due to
1:45:25alcohol. Just like your non-alcoholic
1:45:28and alcoholic fatty There is a something
1:45:30called alcoholic pancreatitis. So I said
1:45:32they should not drink alcohol.
1:45:33>> Mhm.
1:45:34>> So that is my chemical criteria. So I
1:45:35just wrote it down.
1:45:37And I said this is Mohan's criteria.
1:45:39Of the thing. That went like wildfire.
1:45:41Everybody Nobody thought about it.
1:45:43Nobody had defined it. So that became
1:45:46Mohan's criteria. Mohan's criteria
1:45:47Everyone started accept all books it
1:45:49came and all that and it became well
1:45:51established all over the world.
1:45:52>> Nice.
1:45:54>> [laughter]
1:45:54>> Tell me about that 3-month-old baby that
1:45:57was brought to you from Kolkata.
1:45:59>> Yeah.
1:45:59>> What did you diagnose and was you were
1:46:03able to figure out
1:46:04>> Yeah.
1:46:04>> that you saved her from getting 17,000
1:46:07injections
1:46:07>> [laughter]
1:46:08>> in her lifetime?
1:46:09>> That is true.
1:46:10>> 3-month-old [clears throat] baby and
1:46:1117,000 injections
1:46:13is my brain to fire.
1:46:13>> Yeah, it's very simple actually. So
1:46:16when you talk about diabetes in
1:46:18children, the first thing which comes to
1:46:20mind is type 1 diabetes. Okay?
1:46:23So type 1 diabetes you have to take
1:46:25insulin lifelong.
1:46:27And how many injections a day? Four to
1:46:28five per day. You multiply that by 365,
1:46:32it is what?
1:46:33Thousand
1:46:34whatever into 4,500
1:46:37injections thousand 10 years it will
1:46:39become 15,000 injections 16,000
1:46:41injections. Something that is how that
1:46:4317,000 came about over a 10-year period.
1:46:45That is what the thing is.
1:46:47Four to five injections per day.
1:46:49Now there is also another condition
1:46:52called as neonatal diabetes.
1:46:54>> Mhm.
1:46:54>> This occurs before 6 months of age.
1:46:57Okay?
1:46:58The type 1 diabetes usually occurs after
1:47:016 months of age.
1:47:02Between 6 months 1 year and about 10 to
1:47:0515 years, it's almost always type 1
1:47:07diabetes. And that's four times
1:47:09injection five times injection.
1:47:11This neonatal diabetes occurs just after
1:47:13birth first 6 months.
1:47:16And it's a genetic condition.
1:47:18And unlike type 1 type 2, you can
1:47:20actually do a genetic test and prove
1:47:22where the mutation is, which gene has
1:47:24got mutated. Very easy to do that if you
1:47:27develop that kit.
1:47:29So, I got [clears throat] interested in
1:47:30this
1:47:31and I started saying why are we not
1:47:34looking for this neonatal diabetes? And
1:47:37if there is a condition like this, why
1:47:39are we not diagnosing it in India? So, I
1:47:41started telling people, anybody below 6
1:47:44months, let's do the genetic test and
1:47:46let us see whether it will So, this is
1:47:48one of the first cases which came to me
1:47:50from Calcutta. So, somewhere I'd spoken
1:47:52about it. Below 6 months, probably they
1:47:55don't need insulin, something I said.
1:47:57So, somebody from Calcutta referred this
1:47:59patient to me. One doctor said, "This is
1:48:00Dr. Mohan, you go and see him." This
1:48:02child was just diagnosed, 3 months old.
1:48:04So, he said, "You go to Chennai and
1:48:07let's see whether he is able to take you
1:48:08off insulin." The mother and father were
1:48:10crying. They're very poor people. They
1:48:13started crying, "Can't even afford the
1:48:14insulin." And they said, "You go to
1:48:15Chennai." So, they came here. I said,
1:48:17"Yeah, before 6 months, you have to do
1:48:18genetic test." I did the genetic test,
1:48:21child had neonatal diabetes. So, there
1:48:23are two types of neonatal diabetes. One
1:48:26is called a mutation in a particular
1:48:29gene called KCNJ11 and the other one is
1:48:32ABCC8. If you have these two, you can
1:48:35simply stop insulin.
1:48:37And just change the type but you should
1:48:39not do it without doing the genetic
1:48:40testing because even other than these
1:48:43two mutations, there are other types of
1:48:44new which won't respond to tablets.
1:48:4650% is not these two. 50% is these two.
1:48:50So, if you have 100 cases, 50 you can
1:48:52take off. The other 50, we don't know
1:48:54what to do. They they still need
1:48:56insulin. They're still doing research on
1:48:57that what to do. But this 50% sure has
1:48:59been described other parts of the world.
1:49:01So, this child we did the test, she had
1:49:03this KCNJ11 mutation. So, I said, "Great
1:49:06news. We'll stop insulin." And the child
1:49:09is not responding to insulin. Taking
1:49:11high dose of insulin, sugar was going
1:49:12high high high. I said, "Okay, get
1:49:14admitted. We will take you off insulin."
1:49:16We just
1:49:17within 2-3 days stop the insulin, give
1:49:19you the tablet. Beautifully responded.
1:49:21Such a small child, you know, 3-4 months
1:49:23old. Beautifully responded to tablets.
1:49:26So, we said, "Okay, now you go home.
1:49:29We have a branch in Calcutta. We'll
1:49:30follow up there. And you go and let's
1:49:32see."
1:49:331 month passed, 6 months passed, 1 year
1:49:35passed, 2 years passed, 3 years passed,
1:49:3810 years passed. Child did not take one
1:49:41single shot of insulin.
1:49:43This tablet insulin is expensive. This
1:49:46tablet is a cheapest tablet. For 1 rupee
1:49:48you can get the tablet.
1:49:49Okay?
1:49:50So, not only So, we calculated. When the
1:49:53child came back after 10 years, we
1:49:55calculated 17,000
1:49:58injections a child would have had
1:50:00if she had not come to me. Number one.
1:50:02So, 17,000 pricks. Sugar would not have
1:50:05been under control
1:50:06for 10 years because the child's defect
1:50:08is in the pancreas.
1:50:10And when you give this tablet, it makes
1:50:13that defect it it overcomes that defect.
1:50:16It's a specific treatment. And it's a 1
1:50:18rupee tablet. It's a such a cheap thing.
1:50:21So, child saved 3 and 1/2 lakhs of
1:50:25rupees in terms of insulin cost, syringe
1:50:28cost, blood sugar testing cost. 17,000
1:50:32injections were saved for this
1:50:34particular child.
1:50:35>> And those pricks
1:50:36>> Yeah, 17,000 times a small child Child
1:50:39is this big, you know, 10-year-old
1:50:40child. So, they were so happy. So, they
1:50:43said, "Popularize this. You know, use
1:50:46our child's name. Use the child's photo.
1:50:47Doesn't matter. Let other children
1:50:49Slowly, I started talking about this
1:50:50everywhere.
1:50:52From then I said, "See, what will child
1:50:54They'll say, 'How to pay for this now?'"
1:50:56I said, "Who should you pay? I'll pay
1:50:58for it." So, they not Nobody should pay
1:51:01for this, you know. I said, "It's free.
1:51:04Any child below 6 months of age, just
1:51:07send me the blood samples and I'll do it
1:51:09free of cost." I'm saying it in the
1:51:10program, also. Anybody. I started
1:51:13putting my own money into it, family
1:51:15money into it. Then I started telling
1:51:16people that are things people donate
1:51:18into it. I said children should not pay,
1:51:20family should not pay.
1:51:21Today I've got 500 such children.
1:51:25From all over the country, from all
1:51:27medical colleges including aims Delhi,
1:51:29PJ Chandigarh, from all medical
1:51:31colleges, from private people. I don't
1:51:34even ask them what their income is
1:51:36nothing. I said just send the blood
1:51:37sample. In 3 weeks I'll give you the
1:51:38result. If it is one of these two, I'll
1:51:40tell you how to change over to tablets
1:51:42also. Hundreds of such children are now
1:51:44gone off insulin. Okay? So now I
1:51:47calculated
1:51:48how many there should be in India
1:51:51considering India's population.
1:51:53According to my estimate, there should
1:51:55be at least 10,000 children.
1:51:57I've got only about 500.
1:51:59Where are the others?
1:52:01And what does it take to diagnose? One
1:52:03question.
1:52:05When did you get diabetes?
1:52:08That's all. If it's post 6 months, if
1:52:10it's post 6 months, send the blood
1:52:11sample. After 6 months, don't send the
1:52:13blood sample. Continue with the insulin.
1:52:15Can't be simpler than that. But don't
1:52:17stop the insulin and start tablet
1:52:19without doing the genetic test. If they
1:52:20belong to the other 50% of those,
1:52:22they'll die.
1:52:25And what is the limiting factor? Cost.
1:52:27I'm doing free for you.
1:52:29What more you want?
1:52:31Anybody in India
1:52:32I'll raise the fund. I'll do it. You
1:52:34send it to me. So I want to find that
1:52:36other 9,500 children.
1:52:38Hopefully some of them will listen to
1:52:40this program and if 10 children come, I
1:52:44think this program will be worthwhile.
1:52:45Absolutely. Even one comes it's Even one
1:52:47comes it's worthwhile. It'll be worth
1:52:48[laughter] it. Tell me about a diabetic
1:52:51person, okay, who's watching this, is
1:52:54probably overweight or someone they know
1:52:55in the family is overweight and is
1:52:57diabetic.
1:52:59Should that person, should a diabetic
1:53:01person take
1:53:02GLP-1 or Ozempic or Mounjaro to cut
1:53:05weight?
1:53:07It's a good question.
1:53:09>> [clears throat]
1:53:10>> I don't think everyone should take it.
1:53:13It
1:53:14the basis of treatment of obesity is
1:53:17still lifestyle. There is no doubt about
1:53:19it. This is not instead of, it is in
1:53:21addition to.
1:53:23First of all, there are cut points which
1:53:24are given. BMI of 30, BMI of 27. So, BMI
1:53:2825.5, I won't go and give these drugs.
1:53:31Because you should remember
1:53:33that these drugs, even though the prices
1:53:35have come down, even though generics
1:53:36have come, they're still expensive,
1:53:37number one. Number two, they're not
1:53:39without side effects. They do have side
1:53:42effects. And sometimes the side effects
1:53:43can be serious. Mostly the side effects
1:53:45are mild, but there are side effects.
1:53:47Any drug can produce side effect. Number
1:53:48three, they only work as long as they're
1:53:50taken.
1:53:52So, if you take it 6 months, it'll work
1:53:53for 6 months. Are you going to take it
1:53:55lifelong?
1:53:56If you're going to take it lifelong or
1:53:58near lifelong, then you come.
1:54:00There's no point. There's no shortcut to
1:54:02taking for 3 months and then I'll take a
1:54:03few photos and then put it on social
1:54:05media and then I'll go back to
1:54:06>> It reverses.
1:54:07>> Huh?
1:54:08>> It reverses. Like you start getting fat
1:54:09again.
1:54:09>> 100%
1:54:11100%
1:54:12>> Almost all cases.
1:54:13>> Everyone.
1:54:15Every single one.
1:54:16>> It's a lifelong thing that you have to
1:54:17be on those.
1:54:19>> is why you have to be That's why you
1:54:20have to take So, that's why I said
1:54:22everyone should not go. So, then who
1:54:24will go for it?
1:54:26Suppose a guy is 120 kilos.
1:54:29His life itself is in danger. He may die
1:54:32of heart failure. He may die of
1:54:34something else. Stroke. We don't know
1:54:36what all other blood pressure this that
1:54:38I don't know what all he'll have.
1:54:40Such cases, we did we could not do
1:54:42anything other than bariatric surgery in
1:54:44the past.
1:54:45Cutting up the stomach, cutting up the
1:54:47intestine, cutting up the gruesome
1:54:48thing. Instead of weekly once on
1:54:50injection is good. Costs have come down.
1:54:52So, weekly once and let him take it.
1:54:54What's wrong? Instead of going cutting
1:54:56up all that cost you, spread it over a
1:54:58few years and take it every day. So,
1:55:00there are indications for it. Second,
1:55:03it is not only for weight loss.
1:55:05It's a therapeutic thing. So, we are
1:55:08giving it if you have liver fat,
1:55:10extensive liver fat that may go into
1:55:12cirrhosis,
1:55:14that may go into liver cancer. That's
1:55:15the next stage. So, you're seeing grade
1:55:18three fatty liver. Next is grade four
1:55:20and cirrhosis. So, if you taking this,
1:55:22it's going to save your life. You can do
1:55:24that. Second, your thing is fat is
1:55:28increasing so much that your heart
1:55:29starts expanding and pump failure. You
1:55:31may die.
1:55:33So, taking this is even you're taking
1:55:35life long, it's fine. You're taking
1:55:36thyroid life long, you're taking statin
1:55:37life long, you're taking BP tablet life
1:55:39long. Why not take this injection life
1:55:40long if it's going to work? So, it must
1:55:43be under strict medical condition.
1:55:45It must be after evaluation. There are
1:55:47certain things where you should not
1:55:49give. Those are gallstones should not
1:55:50take it.
1:55:52Those who have severe eye complication
1:55:53already, the retinopathy which you
1:55:55showed, it's very bad, better not to
1:55:57take it.
1:55:57>> and stuff.
1:55:58>> Yeah. So, there are sir there's a mayo
1:56:00in the optic neuropathy with blindness
1:56:02and all came. So, after a thorough
1:56:05evaluation, after talking to the patient
1:56:08and saying that this is going to be a
1:56:10long haul, but it's in your interest
1:56:13that you take it because other than that
1:56:15you're going to get many other
1:56:16complication.
1:56:17Let's look at the positive side.
1:56:19There have been patients of mine who
1:56:21have been told to undergo both knee
1:56:22replacement.
1:56:24Okay, that means you're putting a metal
1:56:25knee in both the knees. Very expensive.
1:56:29You can't squat after that, okay?
1:56:323 months, 4 months after Monjaro or any
1:56:35of these Ozempic or whatever,
1:56:38semaglutide and whatever they've taken,
1:56:41no need for knee surgery.
1:56:44The orthopedic surgeon now you're
1:56:45walking well, no pain, gone. So, two
1:56:47surgeries saved, okay?
1:56:49Cirrhosis saved. Diabetes gotten under
1:56:52control. Before these drugs came,
1:56:55we give tablets to type two. Type 1
1:56:57forget it. That is insulin only. Okay.
1:57:00Forget neonatal diabetes. A half tablet
1:57:01getting up. Forget it. We're talking
1:57:03about type 2 now. Type 2 diabetes first
1:57:06one drug will come tablet, then another
1:57:08tablet, then another tablet. After that
1:57:11it's insulin only.
1:57:13The moment you start insulin weight will
1:57:14start going up.
1:57:16Okay. Weight will keep going up. Low
1:57:17sugar will come. This will come. That
1:57:19will come. That's all we had.
1:57:212 years ago that's all we had. So we'll
1:57:23give insulin to everyone. Everyone then
1:57:25after sometime we go to insulin.
1:57:27Then become three insulin. By the time
1:57:29you have gained 10 kg in weight. Now
1:57:31you'll take more insulin. Another 5 kg
1:57:33will go up. That's all. We are downhill
1:57:35course only. We didn't have any This
1:57:37came and it changed the whole thing. Now
1:57:38we are able to stop insulin.
1:57:40Put them on this. Weight is going down.
1:57:42Drugs are going down. BP tablets are
1:57:44going down. Cholesterol tablet is going
1:57:46down. Thyroid tablet is going down.
1:57:48Everything is no bariatric surgery.
1:57:50Everything avoided by this drug. So they
1:57:52are fantastic drugs. There's no doubt.
1:57:54You never had such kind of drugs. Very
1:57:56good. But like a knife.
1:57:59If you have a very very sharp knife
1:58:01sitting here and you keep playing with
1:58:02it you'll you'll damage yourself. Or you
1:58:04can kill somebody with it. Okay. Same
1:58:08time I give it to a surgeon and he'll do
1:58:09a neat surgery with it.
1:58:10>> Tell me one belief that you have or
1:58:13maybe one insight that you have from
1:58:15last 50 years of your work.
1:58:18If that
1:58:20you genuinely believe in that particular
1:58:22insight related to diabetes or related
1:58:25to the health world.
1:58:26And actually the larger world is
1:58:31not ready to accept it.
1:58:33It's a contrarian belief that you have.
1:58:37Or maybe you're too scared to talk about
1:58:38it because maybe you don't have enough
1:58:42RCTs and you know data around it. So
1:58:45you're scared to say it because the
1:58:46world will come after you.
1:58:48>> No, no. That That way if you
1:58:50for a scientific thing I don't think the
1:58:52world will
1:58:54come after me or anything.
1:58:57Um
1:59:00I believe that uh
1:59:03diabetology
1:59:05is a specialty by itself.
1:59:09Uh see,
1:59:11today
1:59:13the endocrinologists say
1:59:15that diabetology is not a specialty at
1:59:17all. It's under our thing, one small
1:59:19branch. And they made it into a
1:59:21specialty. Like my father made it into a
1:59:23specialty when there were no
1:59:24endocrinologists in India. The first
1:59:26endocrinology thing came only in 1970s.
1:59:28In 1948, it already started the diabetic
1:59:31clinic.
1:59:32Because we believe there's enough to do
1:59:33in diabetes. Instead of taking out
1:59:34thyroid, pituitary, adrenal, this one,
1:59:36that one, every endocrine organ, we
1:59:38don't have to uh treat. We are
1:59:39specializing in that. But there are
1:59:41endocrinologists who say that there's
1:59:43nothing called diabetology. You cannot
1:59:44call yourself a diabetologist because
1:59:46there's only an endocrinologist. There
1:59:48is no degree
1:59:50in diabetes. For years, we've been
1:59:51trying to start a separate specialty
1:59:54called diabetology.
1:59:56Because if you see liver,
1:59:58it's part of gastroenterology. Now it's
2:00:00become separate, hepatology.
2:00:02>> Yeah.
2:00:02>> Gastroenterology, it's become separate.
2:00:04That become separate. Within lung, TB
2:00:07specialist is separate and the rest of
2:00:09the lung is separate. You know, so there
2:00:11are divisions like that. There are many
2:00:13uh like that. So,
2:00:16I always believe that diabetology is a
2:00:18full specialty by itself. But the world
2:00:22doesn't accept it. Not the world, the
2:00:24endocrinologists don't accept it even
2:00:26today. And in India, today I cannot even
2:00:28call my I don't put the word
2:00:30diabetologist anywhere.
2:00:32Because they say what which degree do
2:00:33you pass to say that you're a
2:00:34diabetologist? There's no such degree.
2:00:36How do you call yourself a
2:00:37diabetologist?
2:00:39Having said that,
2:00:40there is an diabetes association and
2:00:43there's an endocrine association. Not
2:00:45only in India,
2:00:46>> Around
2:00:46>> American Diabetes Association, American
2:00:48Endocrine Society, British Endocrine
2:00:50Society, British Diabetes Society,
2:00:51European Association of Diabetes,
2:00:53European Endocrine Society, Australian
2:00:55Diabetes Association, Australian
2:00:57Endocrine Society. Why they're having
2:00:58both?
2:00:59International Association of
2:01:01Endocrinology, International Diabetic
2:01:03Federation. Everywhere both are there.
2:01:06>> Only in the field of study.
2:01:07>> Only, yeah, when you come to putting the
2:01:09name No, no, you cannot use
2:01:10diabetologist. There's even journals,
2:01:12Diabetes Care, Diabetologia, right? All
2:01:16diabetes journals. They didn't say
2:01:17endocrinology or they didn't say no.
2:01:19But when you say I'm a diabetologist,
2:01:20no, there's no such thing. You cannot
2:01:22use it. Okay, I removed it from my
2:01:24visiting card. I just say Chairman Dr.
2:01:27Mohan's.
2:01:28>> [laughter]
2:01:29>> That they cannot say I'm not.
2:01:34>> So, here here is my last question which
2:01:36we ask we've started asking everyone is
2:01:40so, for Chairman
2:01:42>> [laughter]
2:01:46>> is
2:01:48I'm going to give you 60 seconds, okay?
2:01:51And you internalize and process and
2:01:52think about it.
2:01:54And come up with specifically three
2:01:57insights
2:01:58from our today's conversation.
2:02:01If you have to just give specifically
2:02:03three things which people will take away
2:02:06and learn,
2:02:07what will those three things will be?
2:02:09Just think about it for 60 seconds.
2:02:11Maybe you want to take pen and paper
2:02:12think about it.
2:02:12>> do it without that.
2:02:13>> Yeah, just just
2:02:15think and like give it because I want
2:02:17you to probably go deeper and
2:02:19come up with very specific insights
2:02:21which is just not generic and people
2:02:22will take it. So, we can just go maybe
2:02:25now.
2:02:26>> [laughter]
2:02:29>> Yeah, I think I can give it as three
2:02:31messages to people.
2:02:34>> You okay to give right now only? Like
2:02:35not even have to wait. No, I don't have
2:02:37to wait.
2:02:37>> I can give it straight away.
2:02:39Three messages to people.
2:02:41Number one,
2:02:43diabetes is not a disease, it's a
2:02:45disorder.
2:02:47Don't think of it as a disease. It's not
2:02:50something that going to kill you.
2:02:51It's a disorder with which you can live.
2:02:54Okay? Number two,
2:02:56diabetes is preventable.
2:02:59So, if you have not got diabetes, we
2:03:01talked about pre-diabetes earlier,
2:03:02there's long period by which you can do
2:03:05a lot of things to delay, delay, delay.
2:03:07The more you delay it, you'll never
2:03:09reach a complication stage.
2:03:11So, it helps to start there.
2:03:14If number three, if you are one of those
2:03:18who has already got
2:03:20diabetes,
2:03:22don't worry about it
2:03:24because you can have a long and healthy
2:03:27life despite diabetes. 50 years, 60
2:03:30years, you won't live up to 100 years of
2:03:32age. Just follow the ABC principle
2:03:35and you will be able to live a long and
2:03:37healthy life. You may actually have
2:03:41a better than normal life than a person
2:03:44without diabetes because a person
2:03:46without diabetes, what is the motivation
2:03:48for him or her
2:03:50to keep on Here, you've got a disease.
2:03:52You have to look after pressure, you
2:03:53have to go for the checkup, check your
2:03:55cholesterol, check your weight. You've
2:03:56got goals to do. Eat healthy, sleep on
2:04:00time, exercise. All that you're supposed
2:04:03to do, this disease makes you do or this
2:04:05disorder makes you do. If you don't have
2:04:07that,
2:04:08what makes you do all that?
2:04:10So, you'll end up not sleeping, not
2:04:12exercising, not So, I believe that a
2:04:15well-controlled person with diabetes is
2:04:18actually better off than a person
2:04:21without diabetes.
2:04:22>> Interesting.
2:04:23>> Well, thank you so much.
2:04:24>> Thank you.
2:04:25>> Thank you for spending time with us.
2:04:27>> Thank you.
2:04:27>> It was pleasure having you.
2:04:29>> Thank Thank you for inviting me.
2:04:31>> Thank you so much you
2:04:38all that are valuable care
2:04:41>> And
2:05:06I'll see you next time. Until then, keep
2:05:08figuring out.
2:05:09>> [music]
2:05:20[music]

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