HEALTH: A Fatty and Weighty Affair with Diabetes

Dr. Biplab Chatterjee

A fine summer morning at a coastal village in southern part of India was witnessing the usual hustle and bustle of the weekly market. Prized catches from the Bay of Bengal along with the choicest of poultry and red meat stock was on display with hasty shoppers around each stall.

I too found myself squeezing through my favorite shop window for the first choice of my delicious red meat only to be interrupted by one of my patients. A senior scientist in his early fifties for whom I was taking care of diabetes since the last few years.

A very candid question was put to me. “Doctor, you are always advising us to control our diet but what about you indulging in red meat?”

With “millions and millions of blistering barnacles in a thundering typhoon” (- captain Haddock from Tintin) in my brain, I replied, “Sir, I am committed to take best care of your health and I am paid for it! The same doesn’t apply to me!” The poor man was at the end of his speech and burst into laughter much to the amusement of the other market dwellers.

For all practical purposes, perhaps diet control and appropriate personalized diet has been the most discussed and yet most misinterpreted and misunderstood topic for diabetes patients and caregivers like us.

I myself have always encapsulated my obesity under the hood of being a bit more healthy/chubby/well fed /and so on until my BMI rang the bell for me. I found that instead of my best intention and clear conscience about consuming as much food as was required only for me, I am approaching towards obesity slowly but surely.

For obvious reasons when the fault is detected its mandatory to identify the culprits for it and my field of work prompted me to search for them intensely till I found two of my friends within myself called…

1) LIPTIN

2) GHRELIN

They answered me on why on earth am I getting fatter. WHO study has concluded that inexplicable obesity where it seems unrelated to dietary intake is engineered by these two hormones which control the appetite by their action on central nervous system. The deficiency of Leptin leads to the stimulation of appetite and leads to the commonly called familial or genetic form of Obesity.

However, terming them alone as the comprehensive reason for obesity will not be justified. The public health problem of obesity is slowly penetrating into South East Asian countries. Binding obesity and Type 2 diabetes in a romantic relationship is attributed to several causes as listed below.

1) Increased intake of high calorie food (junk food)

2) Sedentary lifestyle and lack of exercise

3) Excessive alcohol intake

4) Imbalance in the carbohydrate intake in daily diet.

5) Feast, Fast and again feast pattern of so called dieting: But what’s that?

(Let’s suppose we consume a sumptuous Hyderabadi Dum Biryani and immediately go on dieting or fasting for half day fearing the high calorie. And by evening our hunger pang starts in the usual rhythm and we boggle up 10 times the calorie that we were trying to reduce)

6) Lack of knowledge about balanced diet.

Now, does your weight or increase in your weight cause diabetes? If so everybody would want to know, how?

One gentleman was laughed upon when he mentioned about stress diabetes. But to underline, its very true that the word stress is related to causation of diabetes in the molecular level where the stress to the cells induced by obesity triggers insulin resistance which eventually leads to type 2 diabetes. Once the fact is established that obesity can lead to diabetes, the criteria needs to be visualized for it.

Not going by geographical region-based varied region-based variety of opinions let us stick to the WHO guidelines which is depicted in the following table and one and all can self evaluate their degree of obesity keeping it a sweet secret!

Type 2 diabetes patients in whom obesity exists as co- morbidity definitely need to take possible measures to cut down on weight.

Studies have shown that mean sugar readings come down to more than 100 mg/dl in both fasting and PP readings with significant reduction in weight with decrease in Hba1c of about 0.9 to 1.2 percent over a period of 9 months to one year.

So what do I say to patient who asks for a fat reducing medicine instead of anti diabetic medications? A score of anti obesity medicines starting from Sibutramine to Orlistat is available for the physicians but the list of adverse effects are also equally long and cumbersome. Why not try simpler ways as below.

1) Cut down on cool drinks (sweetened beverages)

2) Avoid alcohol

3) Avoid regular junk food.

4) Restrict carbohydrate intake (eg. heavy quantity rice or potato)

5) Increase green vegetables and salads

6) Indulge in soup and fresh fruits

7) Whichever be your spare time try to take fast or brisk walk for at least 30 minutes a day.

8) Sleep timely (7 hours is good enough for a night’s sleep)

9) Too many numbers of tea and coffee to be avoided.

I can vouch for the fact that following the above routine can serve to be a boon for an obese diabetic in all stages.

The physicians and health care providers all over the world are committed to break this romantic mismatch of Diabetes and obesity. What we need is the trust and cooperation from the patients and general population.

Before I take a break for today, I will share something for all of my overweight and obese friends to console themselves about.

The paradox of beneficial effects of obesity: Also called as the survival paradox of obese patients. The health outcomes in certain subgroups of patients seem to be improved along with the increased BMI.

1) Heart failure cases in those with higher BMI had a lower mortality rate.

2) In patients on hemodialysis with CKD the obese seems to have better outcome in survival rate.

To put it simply, breakfast like a king, lunch like a worker and dinner like a pauper is one of the best principles of balanced diet till today.

(Dr Biplab Chatterjee has served for the last 18 years in both private and Government sector hospitals alike. Specialising in Diabetology and diabetes care from PHFI and the renowned Dr. Mohan’s Diabetes Academy Chennai, he is presently posted as the Chief Medical Officer, in-charge for Atomic Minerals Directorate, Govt of India at Shillong, Meghalaya. He has papers on ketosis prone Diabetes presented in the World Congress of Diabetes, Chennai in 2014 and 2015 to his credit.)