Twenty years back, the international
diabetes federation initiated the process
of utilizing a day every year specifically
for augmenting the awareness of the
public, regarding the preventable disease,
diabetes mellitus and its complications.
At that time, the disease was a less
common disorder in Kerala. Now Kerala
is competing to become the World capital
of diabetes. This year the slogan for the
World Diabetes Day on November 14th
is ‘Act on Diabetes Now’ This call for
action seems to be the most relevant
health message for Kerala. 14th
November is the birthday of Frederick
Banting who discovered Insulin in 1922
along with his Professor Macleod and
Charles Best. This date is observed as the
World Diabetes Day in recognition of this
seminal contribution.
Diabetes is one of the World’s oldest
diseases, and is mentioned in the
ayurvedic textbooks as ‘Madhumeha’,
meaning sweet urine. It is a disorder of
glucose metabolism, caused by relative
or absolute deficiency of insulin action.
Keralites, please act on
diabetes now
So the blood level of glucose exceeds
safe levels and starts appearing in the
urine. Glucose is the form in which the
starch and sugar components of our food
are utilized by every cell in our body for
generating energy for various functions.
Green plants synthesize glucose from
carbon dioxide and water, by
photosynthesis, and store it in the form
of starch. Starch is water insoluble. When
we digest starch in our stomach, we
break it again to its simple water-soluble
form, glucose, and assimilate it into our
body. Though glucose is water soluble,
the majority of the cells in our body need
adequate insulin action to get the
glucose molecule into the cell. Insulin is
a hormone secreted from the beta cells
of the Islets in our pancreas. The glucose
that enters the cell is either converted
into energy or water insoluble forms like
glycogen, fats and cholesterol for further
storage. In short the glucose, insulin, and
fat axis are a major biological advantage
nature has conferred us to overcome
periods of fasting and famine.
If pancreas is damaged due to
infection or inflammation (Pancreatitis)
or removed because of an injury or tumor
(Pancreatectomy) we need insulin to be
substituted to live normally. This type
of disease caused by primary
damage to beta cells
is uncommon,
and is
called the type I diabetes and needs life
long supplementation with insulin. We
know of many short cuts like, insulin
leaves and special ashes, but none of
them is yet to surpass the efficacy of
insulin. Till the discovery of insulin, the
average life span of a person diagnosed
with type I diabetes was only 6 months.
With the extraction of insulin, the
outcome changed phenomenally such
that many of them lead a normal life. In
recognition of this outstanding
contribution by isolating insulin, the
Nobel committee awarded the inventors,
the highest honour within couple of
years of its discovery in 1924. (Usually
Nobel committee takes couple of
decades before recognizing a scientific
achievement.)
But the commonest way diabetes sets
in our population is very different and is
because of aging and ‘overuse’ of the
beta cell function. This type of maturity
onset diabetes, the type II diabetes, is
preventable in the majority or can be
postponed by decades by preventive
action. Over use of the beta cells is the
hallmark of ‘industry driven living’. The
recognition of this simple fact forms the
corner stone for all these public
messages on this World Diabetes Day. If
we consider diabetes as a disease of
aging, especially in those with a family
history for early onset diabetes, then with
modern living we are inducing
‘premature aging in our body’. We
Keralites need to wake up and work
together to put out the wildfire of diabetes
in Kerala. When our blood sugar level
starts rising, during fasting (above 126
mg/dl) or after a meal (above 180mg/
dl), it essentially means that, we have used
up more than 80% of our beta cell
function. So if any of our family members
have diabetes, we need to try our best to
minimize the over function to our beta
cells.
This wonderful axis can be made to
function in excess of its ability, i.e. hyper
function, and to fail early by either over
eating, remaining lazy or by having a
damaged storage system. Obviously by
overeating in this industrial world, we
are pumping in too much of refined
food products into our body. When
this exceeds the ability of our
pancreas to cope up with, we
are loosing this nature’s gift.
The other way is to use
less of what we eat for
every day activity by
remaining Lazy in the
modern comforts. The
most sensitive tissue in the
body for insulin is the skeletal
muscle, and by remaining lazy, we
necessitate beta cell hyper function.
Equally important but less recognized is
the inability of our body to store the
excess fat that gets synthesized.
Overeating reflects the energy
intensification of our meal portions. Rice,
wheat and pulses on an average have
350 calories per hundred grams. But
when you cook them traditionally, they
get hydrated and mixing them with leafy
vegetables, bran and making them as
porridge, makes them less calorie dense
to a value of 100 calories per 100 Gms.
On the other hand the marketed bakery
products, refined Atta and sugar, retains
their energy intensity to 400 calories per
100 gm in most of the marketed products.
One small disadvantage of porridge is
that the cereals are well cooked, and so
can get absorbed very fast and increase
the blood sugar level, a factor that is
described as the high glycemic index.
But all refined food products have this
high glycemic index. There is nothing to
choose between rice and wheat for a
diabetic person. We judiciously ask them
to change from one to another in the
hope that, because of the nonhabituation,
the person will eat less of
wheat if he is a fan of rice. But wheat is
easier to get in the raw form, so that we
can incorporate the bran in cooking,
which is very
good for reducing the
glycemic index. The most
energy dense cooking medium is
the oil, and hence frying or adding oil or
butter is the worst way we make the food
energy dense. Of the naturally available
food substances, fiber rich vegetables like
the onion and green leafy vegetables are
therefore best in terms of low calorific
value. Among the fruits, watermelon,
papaya, pear, apple, guava are the best
because of their low calorie content and
richness in vitamins, minerals flavanoids.
Like potato and tubers, we have energy
dense fruits; banana, mango, pineapple,
and jack fruit. These food substances are
calorie rich and could be taken as
breakfast or meal substitutes and not
along with them. These energy dense
fruits are to be used with caution by
diabetic individuals. The transformation
is well evident in Kerala. When I used to
travel from Trivandrum to Madras by train
in 1970’s only thing we get at railway
stations were guava, pear, oranges, plums,
and cucumber and nuts. Now we get
only banana fry, vada, samosa, bread
omelets, and chips.
We need to change the cooking
habits. Masal dosa is doubly dense food
compared to plain dosa, because potato
makes it energy dense. Similarly the
bread butter and jam is three times
more energy dense than a
vegetable sandwich. Taking a
sumptuous breakfast should
be with less energy dense
preparations as mentioned
instead of masal dosa,
medu vada, boori,
omelets and then a
coffee. Frying food,
makes the food
t a s t i e r
a n d
last longer,
but makes the
food too energy
dense for our body to
handle. The best way, to use
o i l is to limit it in the kitchen for
seasoning. Groundnut, coconut, and
cashew nuts are energy dense and we
need to limit its use.
To be concluded in next issue
(Courtesy: prd.kerala.gov.in & The writer is Dr.S. Sivasankaran, Professor of Cardeology,
Sree Chithra Thirunal Institute of Medical Sciences and Technology, Thiruvananthapuram)
