Tips for Maintaining Good Health

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Dr V Mohan, India’s leading diabetologist, sheds light on the various factors at play with the rising tide of diabetes in India.

Let me begin with a shocking fact. One in four adults aged over 20 years in Chennai, Delhi and other metropolitan cities have diabetes. If we take the age of 50-55 and above, 40% have diabetes and 35% have prediabetes. Chronic diseases like diabetes, hypertension, heart disease and cancer have a common link from which they all come. What I’m going to discuss applies to all of them.  

Diabetes is a Disorder

What is diabetes? In all my clinics, it is written that, ‘Diabetes is not a disease, it’s a disorder.’ The body produces more sugar because the insulin production is not good and that leads to high blood sugar. For a normal person, fasting blood sugar should be below 100. If the level is between 100 and 125, it is prediabetic stage. Above 126, it is diabetes. But this is also age related. If somebody at 70 has 102, you cannot call them pre-diabetic but if somebody at 30 develops that, definitely it’s abnormal. But 126 and above, irrespective of any age, in a random sugar test, is diabetes only.

Random sugar test must be done on more than two occasions. If that’s fasting, testing once is enough. The gold standard is GTT (Glucose Tolerance Test). The person comes after fasting and receives 75 grams glucose. Two hours after that, they draw the sample and if it’s above 200, it’s diabetes. Then we have the test called HbA1C or glycated hemoglobin, which the American Diabetes Association has accepted. In India, we don’t fully accept it as a diagnostic test or control. If the result is 6.5 and above, then it is diagnosed as diabetes.  Before you go to the stage of diabetes, there is a stage called pre-diabetes. The last stage is the stage of complications wherein the eye, kidney, heart, feet, nerves and sex organs are affected.

Can diabetes be reversed?

Yes. But in the stage of complications, there’s no reversal and keeping alive itself is a big thing. But all this is eminently preventable and reversible. You don’t have to go from one stage to another. Once a kidney gets seriously affected and if you enter end stage renal disease, you have to do transplantation of the kidney or do dialysis. If you don’t do any of these two, you will die. Both are very expensive. There are not many kidneys around. They do 5000 to 8000 kidney transplants in India while they need about a million in a year. That is why prevention becomes important.

I would recommend everybody above the age of 30, at least in India, must go for a routine checkup, which includes checkup of diabetes, hypertension, cholesterol and liver function tests, on an annual basis. The advantage is that if you pick up the symptoms at an early stage, you can reverse. If you don’t do that and suddenly you find your sugar is 350 and Hb1AC is 10.4, you have lost a golden opportunity. Especially if you have diabetes in the family, spread the word around that even youngsters must start testing. If you see something mildly abnormal, it’s a great motivation for you to do something about it, rather than just ignore it like an ostrich that puts its head under the ground and thinks that nobody can see it. We can still see the ostrich. Similarly, the disease will be there, even if you ignore it or deny it. 

The Silent Killer

Symptoms of diabetes unfortunately don’t occur in more than 50% of people. Even people who come with very high sugar, may not have any symptoms at all. That’s the reason why it’s called a silent killer or the silent disease. Things like frequent urination, thirst, hunger, aches and pains in the limbs, weight loss, itching in the private parts, tiredness, delayed healing—all these are late symptoms. You have to progress quite a bit before you get clinical diabetes. If you don’t control it early, the beta cell function will go down. You will lose more and more of the pancreatic insulin reserve that you have. 

Diabetes has been increasing in India. Don’t believe people if they tell you on WhatsApp that it is all a myth and that pharma industry is making it up.  We have done many studies with different sampling. From about 2% diabetes prevalence in urban Chennai in the 1970s, it was 25% in 2015. Now, we may be close to 30%. From 2% to 30%, it is a huge increase. In rural India, it is always less than urban, because they are more active, eat healthier food, probably sleep better and do a little more manual labour. They’re not exposed to pollution.  But guess what, in the ICMR Index study which we did, in rural Kerala, the prevalence of diabetes is actually higher than in urban Kerala. There’s no urban and rural divide in Kerala. Things are changing, and in Tamil Nadu also, it’s catching up very fast. India is heterogeneous and the prevalence varies from state to state, just like in Europe.

Lifestyle—The Key Culprit

Is this epidemic due to genetic factors or environmental factors? Obviously, genes are important, especially if you have a family in which your father and mother have diabetes. Then your risk is higher. But what actually drove it is the lifestyle. People earlier lived a simple life, carrying weights on their head. Now they carry nothing but the cell phone.  When we were children, we used to play in the fields. After we came home from school at four o’clock, we would go to the ground and play. Today, how many people do that? We drank water in the school tap. Now we are scared to drink the tap water.  We ate simple foods. Today, it’s all sophisticated junk food. Thanks to the IT revolution, our youngsters work to US timings. They are paid in US dollars but the price they pay is that their work starts at eight or nine in the night. They work till the whole morning. What food will they get at 2am? By no way, it can be idli or dosa. So automatically, junk foods come in, which means that carbs go up and your sugar goes up. Your carbohydrate goes up, when your physical activity goes down. In general, exercise has gone down for everyone because of mechanization. We have motorised transport. Urbanization brings in so many other things.

Rural is Better

Just two days ago, we published a paper in Nature, where we compared living in 190 countries. 400 to 500 authors collaborated for this paper on the theme, ‘Living In An Urban Area: Is It Good Or Bad?’ It turns out that in the least developed countries, living in an urban area is still good, because rural has nothing there. But in many countries, living in rural areas is better than living in urban areas because it brings down pollution. Imagine living in Delhi with the high amount of pollution!

Every single point I make is based on published evidence. They are published in very good international peer-reviewed journals. But if you search in social media, you will hear the complete opposite things. Somewhere along the line, the truth also has to be told.  

Rice and Diabetes

I did a research on the connection between rice and diabetes, inspired by a lead given by Sri Sathya Sai Baba and I found he was exactly right. We divided Chennai into quartiles of glycemic load. The amount of glycemic load is driven mostly by white rice that we take. It’s not sugar that we take. One spoon of sugar in a cup of coffee is nothing compared to the amount of carbs that you eat in your rice. In Chennai, it’s mostly white rice. If you take the lowest quartile, believe it or not, in Chennai, the people who eat the least carbohydrate take about 200 grams. This is more than double the highest in many countries. Then we move to the second quartile, third quartile and fourth quartile. When we double it, from 200 grams to 400 grams, diabetes just doesn’t increase a little bit but it goes up fourfold, which means if the prevalence is 6% in the first quartile, it’s 24% in the second. We have the data corrected for physical activity, BMI, family history, income and socio- economic state. Everything is adjusted for. Why does this happen?

The Carbs and Glucose Connection

When you take carbohydrate, it gets converted to glucose. That glucose pulls out the insulin from your body. If you’re already prediabetic or diabetic, having less insulin reserve and taking more and more carbohydrates, all the insulin will come out.  This is from a cross-sectional study where we have only a hypothesis that maybe rice is linked to diabetes. In a cross-sectional study, there are so many confounders.  

If you want to go further, you have to do longitudinal studies. Start off with a population where they didn’t have diabetes. Then, follow them for 5, 10, 15 or 20 years, see who developed diabetes and then look at their original diet. That is a very powerful tool and because you’ve followed them and you know what all happened to them, the confounder comes down. We found that if we take fibre, diabetes goes down. It’s very clear that it’s only the carbohydrate where there is no fibre—the refined white rice—which increases diabetes. Brown rice or millets which are not refined are not as bad as the polished white rice.

Incident Diabetes

We did another study on incident diabetes which took us 15-20 years. It’s based on 1,32,000 people in 21 countries in five continents, whom we had followed. We started with India and then added 27 countries. Professor Salim Yusuf from Toronto, my PhD student Bhavadharini and I were the prime movers of this. We took people who didn’t have diabetes, then saw the rice consumption across the world and tried to correlate to the new onset of diabetes. If you look at the hazard ratio of developing diabetes, a ratio of 1 means normal and there is no correlation between rice intake and onset of incident diabetes. If the ratio is 0.6, it means rice protects you from diabetes. If it’s 1.61, like in South Asia, that means you have 61% higher chance of getting diabetes, if you take rice. In China, it is only 1.04 because they have cut down rice intake so much that today it’s not their leading cause of diabetes.  

Can It Be Modified?

The same population, we divided into physically active and physically inactive. If you’re physically inactive, your hazard ratio is 1.5. That means, you have 50% higher risk of getting diabetes. If you’re physically active–with just some daily walking that you do—it comes down to almost 34%. The risk is still there but the significance is gone. Just by adding physical activity, you get tremendous benefit out of that. What if you substitute white rice with brown rice, totally unpolished, with more fibre, more protein, more phytonutrients and B complex? The husk is there. The bran is already added. We did a project for the Harvard School of Public Health. What we found was very interesting. On normal people, without diabetes, we put a patch to continuously monitor their glucose. Day by day, we fed them. First, we fed white rice, then we fed brown rice and then brown rice with pulses—Bengal gram, green gram and so on. We found the sugar level is lower if you take brown rice. When we add little pulses to that, there is further reduction. The moral of the story is, try to take rice, which is not so polished. Even semi-polished is okay. Add pulses to it, increase your fibre and you will reduce your glycemic load. This is more prominent among those who are already obese and having a poor metabolism. If you’re already thin and you don’t have any complications, it doesn’t matter whichever rice you eat.

Four Pillars of Diabetes Management

Diet, exercise, medicine and education are the four pillars of diabetes management. Medicine is shifted to the third pillar. Diet is the first form of treatment. This is for Type II diabetes. 90% of people with diabetes have Type II diabetes. There are good carbs and bad carbs. Fruit is good. Although it contains liberal fructose, it’s still good; but fruit juice is not good: it is high in sugar and calories and there’s no fibre. Highly polished white rice, white bread, cookies, pastry, cake, ice cream, chocolate, potato chips, French fries are to be restricted or avoided.  What about good carbs? A lot of veggies contain a little bit of carbs. You can take as much as you want. Whole fruit, particularly those which have lower GI (glycemic index), legumes, kidney beans, peas, lentils, Bengal gram, green gram, black gram, mushroom are all very good in protein and fibre. The bright carbs are nuts, walnuts, almonds, cashews and hazelnuts. Seeds—sunflower seeds, chia seeds and pumpkin seeds are very good phytonutrients. You can take many other antioxidants. You can take whole grain, brown rice and steel cut oats.  

The Plate Principle

Take a circular plate. Half of it should be filled with veggies. Vegetables are very low in calories, very high in fibre and give you all the minerals you need and B12.  They have anti-cancer property. That’s the essence and secret of nutrition.  A quarter of the plate should be reserved for protein. You have to find the right protein to take and it’s not easy. If you take Bengal gram or green gram, you get gas trouble and diarrhoea. Milk is good. Curd is a good probiotic. It’s not so easy to get vegetarian protein but if you are a vegetarian, you should think of protein intake and you should take it every time. Now, only a quarter of the plate is left and there you take your rice. If you want white rice, take it but limit the quantity. If you can change to some other rice, it’s good. Whole grain wheat is much better than refined wheat flour or maida that we take. This 50% veggie, 25% protein and 25% rice (50-25-25) principle is called the plate principle. This is the answer for all chronic diseases including obesity, diabetes, heart disease and so on.

What About Nuts?

According to a paper published in the Journal of Nutrition, raw cashew nut consumption actually reduced systolic blood pressure and increased the good HDL cholesterol. Indians have the lowest good cholesterol in the whole world and that’s why we get heart disease at a very young age. The good cholesterol that is supposed to take away the bad cholesterol is very low for us. We don’t have many ways of increasing it. Of course, you can do a lot of exercise and it’ll increase a little bit. Almonds are also similar. We are working on all the nuts. We have finished cashew and now we’re working on almonds, pistachios and peanuts. We found 43 grams of raw almond or one fistful is good. It shouldn’t be salted because, salted almonds and cashew shoot your blood pressure up. Almond improves insulin sensitivity, increases HDL cholesterol and provides a lot of metabolic benefits. These are all from randomized and blinded clinical trials. We don’t know who is taking and who’s not taking until the results are finally published.

Fruits and Vegetables

They reduce the cardiovascular risk factors and we have proved it. Take fresh salads. They are cheap and good. Apple, orange, guava, watermelon and papaya are fruits which are low in GI. A word about fibre. There is insoluble and soluble fibre. If you take things which contain fibre, we feel full. Protein does the same thing. Instead of idli, dosa and all that, if you take two or three egg white omelettes in the morning, even at two o’clock you won’t feel hungry. With idli and dosa, by 10.30 or 11, you’re already hungry because it’s carbs and it’s gone. The egg white has zero carbs and gives so much protein. Glycemic index or GI is the blood sugar raising capability of a food. GI is calculated in terms of glucose or white rice.  100 is for glucose or for white rice. If it is more than 70, it is high GI; less than 55 is low GI and 55 to 70 is medium GI. Take things which are lower in GI, like fruits. They need less of insulin.  

 Myth About Milk

There is so much myth about milk and dairy. We find that milk and dairy are protective for diabetes. Don’t take too much of milk. One glass of milk contains 500 grams of calcium and is very good for women. It’s like taking a calcium tablet. Men can also take it and there’s nothing wrong. You can prevent fractures and osteoporosis. We studied 147,000 people in 21 countries and published our findings in BMJ Open Access Journal, where we have shown that higher intake of whole fat dairy (you don’t even have to take low fat or skimmed fat) is protective of all the cardiometabolic risk factors. Diabetes, obesity, heart disease, metabolic syndrome, everything comes down in those who take dairy.  

What about artificial sweeteners? Again, there is a lot of hype about them. When you take one tablet or one drop, it is 100% safe. It doesn’t do anything, including on the gut microbiota. We’re doing a big study which will soon be published.

Salt, no doubt, is very bad. It increases hypertension. What is recommended is five grams of salt for the whole day. That is one teaspoon. An average Indian takes 12 grams of salt and that it’s two and a half times more. Don’t add salt on the table for anything from today. A little bit of salt for taste is fine. Don’t take things which are loaded with salt, like pickles. If at all you need, take it in very small quantity. 

Drink Enough Water

Drinking too much or too less of water is bad. Take two to three litres of water. Remember, one cup of average size is about 250 ml. If you take eight of that, you’re roughly okay for the whole day. The fluid, of course, includes milk or other fluids like rasam or anything else. Don’t drink it when you’re having your food. Either drink the water before food or half an hour after your food. Give it time to digest. Otherwise, all your digestive juices will get diluted when you keep drinking the water.

A very simple sign whether you’re getting enough water or not is checking your urine. Contrary to what people think, it is not white in colour like water but has a pale-yellow tinge. If it’s pale yellow, then you’re drinking enough water. If your urine is dark yellow, it doesn’t necessarily mean you have jaundice but it means you’re not drinking enough water.

No to Alcohol

Can a person drink alcohol? It is the most sensitive subject. Well, the bad news is that all the Indian studies have shown that it is not good for health, even if you take one drink a day. They say red wine is good in France. But in France, they eat a different type of diet than we eat and drink a different type of wine than we drink. They have shown some benefit at a certain limit. Beyond that, it’s bad even in France. You will get alcoholic hepatitis, alcoholic pancreatitis, fatty liver, cirrhosis of the liver and so on. Three or four independent Indian studies have shown that any amount of alcohol is bad. Also, the accompaniments which go with alcohol, increase calories.

Exercise, the Cheapest Option

What about physical activity? Exercise is one of the best things that you can do. I would encourage all, irrespective of your age and whether you have diabetes or not, to start exercising. It is the best insurance that you can take because it reduces sugar, cholesterol, increases HDL or good cholesterol, reduces blood pressure, reduces heart failure, reduces body fat, increases your muscle mass, decreases weight, decreases insulin resistance, alleviates stress, prevents diabetes… and it’s free. What more do you want? You don’t go to a costly gym. It is free. The road comes free as they say. Use the staircase, at least to climb down. Walking 10,000 steps a day is not a myth at all. If you aim for that, you’ll at least end up at 7000 or 8000. Even 7000 is not bad. But if you don’t set yourself any goal, you will end up with 2000 or 3000 steps and that is what a sedentary person gets. You can use apps on the mobile phone or devices to keep count of your steps. Every now and then, get up and walk. Even small increments will help. For example, when you make a call, you don’t have to sit and take the call. If you walk answering a call, you’ll get 500 or 600 steps added.

FAR Principle

The FAR principle is something which you will find in my videos. FAR is to remember that the three components of exercise are Flexibility, Aerobic exercise and Resistance training. Aerobic exercises include cycling, jogging, walking and swimming. Flexibility is having the ability to twist your neck or spine. Unless you do that, you will become stiff. You should be able to do that, at whatever age. Twist and turn and try to touch your toes.  F & A: You should do every day, at least six days a week. One day, if you rest, it’s okay. Resistance training is lifting weights. You don’t have to do big weights. Just two kg weight will do. The commonest cause of death in people after 70 or 80 is fall. They fall, hit their head, have a bleed and that’s the end or they break their hip bone. If you exercise every day, there are less chances of your fall. Excess carbs and calories and decreased physical activity are the two most important things you must avoid, if you want to prevent diabetes.

Sleep Well

Sleep is also very important. You should get six to eight hours of sleep. You should get to bed at least by 11pm, if not earlier. We did a sleep study on 150,000 people from 21 countries. What we found was that if you sleep less than six hours, your mortality increases. But guess what, if you sleep more than eight hours also it increases. An average adult should not need more than eight hours. If you need, there may be something wrong with you. You may have a thyroid or heart problem or some other problem. Sleeping between 10 and midnight is the best. If you sleep at one o’clock, two o’clock or later, the mortality goes up. If you sleep earlier like six o’clock, seven o’clock, then also, the mortality goes up.  

Stress reduction is very, very important. There’s absolutely no doubt that yoga, meditation and pranayama are the fundamentals taught to us by our forefathers and that they are very important. One must live a life of moderation and do nothing in extremes. Yoga helps improve memory and concentration and relieves anxiety.

Proof in the Paper & People

Finally, if you do all this, is there proof that people can live long and lead a healthy life, despite diabetes and if so, do you have the proof? I am often asked this question. And I have proof. I published a paper which got me the Harold Rifkin award. It is the highest award of the American Diabetes Association and for the first and only time, they gave to a non-American. They invited me and gave me this award.

 I was curious as to why they chose me for the award. Then the guy who was the editor of a journal and who was in the selection committee said, “Did you forget that paper you wrote on the long-term survival of people with diabetes?” This was published in 2013, a first in the world. In the last 10 years, there has not been a single study, anywhere in the world, which has shown that people with diabetes can live for 50 or more years. These people didn’t use very sophisticated or costly tablets. They took the cheapest medicines. With that, they were able to live. The secret is ABC. A is lower blood sugar (A1C), B is lower blood pressure and C is lower cholesterol.  

There are people who have lived and who live actively beyond 90 and 100. Mr. Sabanayagam, former Chief Secretary of Tamil Nadu is now 101 plus and still doing well, despite 40 years of having diabetes. He wrote his memoirs at the age of 96 or 97. He is a role model for all. Well-known academician S.V. Chittibabu lived up to the age of 100.  They did not have Alzheimer’s or any other complications. Importantly, there has been a discipline in their life. They have followed most of the things that I told you. I sat with them and took notes from each one of them. Their secret is the same: Do everything in moderation, do some walking and be a little careful with your diet. It doesn’t mean you can’t have the occasional jilebi or if your favourite rasgulla. 

The 8 Tips

Here are my eight tips for a long and healthy life. It is just a summary of all that I discussed: 

  1. Avoid unhealthy junk foods as much as possible and reduce your total carbohydrate intake. 
  2. Increase your plant protein like pulses, legumes. Red meat is not good.
  3. Consume less salt and less sugar. 
  4. Drink enough water and stay hydrated. 
  5. Exercise regularly. Try to be physically active throughout the day, not just in the morning.
  6. Practise yoga. It is very good. 
  7. Do pranayama and breathing exercises. 
  8. Sleep on time and get enough sleep. 

Q&A Session

Doctors often prescribe multivitamin tablets to patients. Do they really help?  

Unless you have a vitamin deficiency, never take a vitamin. They may even do harm, as we saw during the COVID when everybody was taking zinc and which led to mucormycosis. Many of them contain chromium, selenium and kinds of metals that your body is not supposed to take. At a certain age, kidney function may not be very good. If you have vitamin D deficiency or your B12 is low and if you can’t get it from the diet, take it. Otherwise, don’t take it.  

Screen viewing time these days has increased. The work itself involves many hours of screen time. What is your advice? 

It’s definitely not healthy because there is some amount of radiation coming from the screen. It is an occupational hazard. Try to limit it. Every hour, take a break, just walk around, go and meet your colleague in another part of the office, come back, go to the toilet and drink some water. Do all these things. Don’t have screen time after nine o’clock or 10 o’clock at night. It’s supposed to be very bad, as the light is supposed to affect your brain. Don’t get addicted to Facebook and other social media platforms. Restrict the usage.   

What is the role of yoga in preventing and curing chronic diseases?  

In Patanjali yoga and many other yogic systems, there are definite asanas which are supposed to stimulate the pancreatic beta cell function. I have not seen studies which have compared insulin secretion before yoga and after yoga but I think yoga is like prayer. Can you prove that prayer will reduce your sugar? We still pray because it’s good for us to pray. It calms your mind. Yoga is a very powerful stress reducing and relaxation thing. It improves your health. So irrespective of whether it cures chronic disease or not, you can do it.  Incidentally, if you get some benefit out of it, it’s good.

We directly compared yoga with walking. For diabetes, walking is better and for blood pressure, yoga is better. You can do both, as they are not competing against each other. The best part of yoga is pranayama or the breathing exercise. Studies have shown that after yoga, many parts of the brain are lit up. Nobody can argue against yoga. But the mechanism action is more difficult to prove.  

Your views on the use of steroids for treatment?  

Steroids, no doubt, can be life-saving. But the same steroid probably induced mucormycosis. Indiscriminate use of steroid is bad. If you do it on purpose, it can produce diabetes and many other things. Don’t take it for bodybuilding. Don’t even take all kinds of supplements. Take your regular food, maybe a little extra protein. You can do exercises to improve your muscle mass. That’s the best way. Steroids will kill you in the long run.

Is intermittent fasting good?

Intermittent fasting is something which has been practiced in all religions for a very long time. Fasting can never be said as bad. When you’re not hungry, don’t eat. That’s the first principle. But the claims of intermittent fasting saying that it cures diabetes are not true. If you restrict your calories, with or without intermittent fasting, you achieve the same result. If it suits you and your lifestyle, go ahead.  For people with diabetes, a word of caution- if you’re on insulin and you’re fasting, you can get a hyperglycemia. If you cut your calories at every meal, it is equal to intermittent fasting.  

Fasting sugar is coming more than post-prandial. Why? what does it mean? 

Earlier people thought the lab was wrong. My fasting sugar level is 110 and then two hours after food, it is 90. How can it be? When you eat food, you’re testing the blood after 120 minutes. In some people, in 40 minutes itself, it will go up to 110 or 140. Then there’s a gush of insulin and the glucose drops off after two hours to a level lower than fasting. Actually, it’s not lower than fasting. It went up and you missed it. The standard lab, the test is done only after two hours. If you had tested in 40, 60, 80, 90 minutes, you would have picked up the highest value. If you have a patch on your arm, you will easily see it going up and then coming down. That’s why continuous glucose monitoring has changed the way we think.

Why is fasting sugar a little high? In the night, the liver produces glucose. The liver has what is called as glycogen. All the glucose is stored away as packets of glycogen. In the night, it slowly releases the glycogen packets. In the morning, when you get up, the glucose will be slightly high, because you have a slightly overactive liver. That doesn’t make you diabetic. It won’t come to 126 level. If it comes, then you will be diabetic.

That’s why I said we don’t go only by Hb1AC. We look at many things like family history, if it is consistent over a period of time and so on. Cut down your dinner a little bit. Have a light, low-carb meal. Eat little early. Don’t eat at 10 or 11 pm. You can just take an omelette and vegetables and sleep.   

Do people in rural areas get access to knowledge and diagnosis? Is your hospital doing anything in that direction? 

After covid, on 25 March 2020, the government legalized telemedicine. Until then, it was not legal. Many patients from Bombay or Calcutta or Siliguri or some far off place never come to see me. But I’m in constant touch with them through telemedicine. I tell them go to a particular lab which is approved in their place, send me the results and their history. We create the case sheet and then do everything, except seeing the person physically.  Nowadays, steths are coming, where you can even hear the heartbeat of the person through telemedicine. Today we have screens which are so big and real that you can almost have a face-to-face kind of a consultation. Technology is improving and telemedicine has come to stay. It has its downside as well. But suppose you’re in some rural area where there’s no doctor, this is the next best thing that you can do.

 Can the six-to-eight-hour sleep be broken into two spells?

Well. Nature didn’t mean you to do that. Otherwise, God would have given you three hours of darkness and three hours of light and then three hours of darkness again. He gave you the whole day and then the whole night for you to recoup. In that period, your brain, liver and all organs regenerate. If the sleep is interrupted, you don’t get the same effect that you get in continuous sleep. You should have a good quality sleep.  

What is the difference between generic medicines and branded medicines? Can we use generic medicines with the same effect?  

It depends on the quality of the generic medicines. In India, the quality control is not as stringent as it should be. On one side, our pharmaceutical industry is very strong. Therefore, we are the first to bring generic drugs which is very good, because even the best drugs, if you can bring in generic form, cost 25% or 10% of the price and become affordable to everyone. In that sense, India is a world leader. 50% of the entire metformin used in US, which is billions of dollars, comes from India. That shows how cheap it is and how good it is. Otherwise, US FDA is not going to approve.

Having said that, we also read that US banned eye drops from certain Indian companies. Many companies produce substandard drugs. You must be careful. A branded generic would be better from a good company and you can hold them responsible. Don’t just go with the lowest price in the market. Don’t risk your health for a few rupees. That doesn’t mean, generics are bad. Generics are good, but you must know which generics to use.

As senior citizens, can we sleep in the daytime after lunch? 

You can but it has to be short. If you sleep too much in the daytime for more than an hour, it is not good. Half an hour of power nap is very good. You can go up to an hour. Beyond that, you will feel drowsy after you get up. That’s my experience. If I don’t sleep in the day for that half an hour, I won’t be active in the evening. It’s that power nap, which is my secret and it helps. I would encourage people to do that. There are people who say they don’t need it and they’re fine. There’s no one-size-fits-all for all human beings.

What is the role of vegetable oil and tubers?

Vegetable oils which contain monounsaturated fat, like groundnut oil, mustard oil and gingelly oil are the best that you can get. Next, we come to sunflower oil, rice bran oil, etc which contain more of polyunsaturated fat. They are okay. Then comes the saturated fats. They are the ones which increase the cholesterol. They could be vegetable oils but if they solidify at room temperature, then there’s more saturated fat and that’ll increase your cholesterol. It depends on which type of oil you use.  

In tubers, potato is just like rice, full of starch. It’s not that you can’t take it. In the West, they take only that. In India, we already take too much of rice and we also take lots of potatoes, thereby adding to the carbohydrate content. Beetroot is not that bad. Carrot is much higher in fibre and much better nutritionally, although it’s classified under tubers. 

Is there a risk of getting diabetes after 85 years? 

You can never completely get rid of the risk. I can tell you the story of my grandmother. My father, Dr Viswanathan, a diabetes specialist had diabetes when he was in the late 40s. His mother (my grandmother) was also a doctor. She didn’t have diabetes until she was around 84-85 years old. She used to boast that she was so much fitter because of working so hard in her childhood. It is true, she worked very, very hard. But at 85, she developed severe diabetes and she had to take three times insulin. She became depressed. So, you can never really say that you won’t get it but the older you are when you get it, the less likely that in your lifetime, you will develop complications. That is where prevention comes in. You can postpone it as much as possible. 

Is honey good?

Traditionally, and in our folklore, honey is supposed to make us very healthy. It has lots of phytonutrients but it is intensely sweet. A few drops for medicinal use maybe fine but if they tell me that for diabetes, it won’t increase your sugar, it’s just a myth. It will shoot up your sugar. The same is true for jaggery. It is better than table sugar but that’s also sweet. The glycemic index of honey is very, very high.