Diabetes has existed for millennia. It has been recognized by several ancient cultures including Indian, Egyptian, Chinese, and Persian. Sushruta, a surgeon and physician who lived around 600BC in the Varanasi area in northern India, documented it in his works. They recognized that ants were attracted to the urine of affected individuals and it was named Madhumeha (Sanskrit; madhu- honey).
Ancient physicians also recognized that there were two types of conditions that involved excessive urination and loss of weight. This recognition of excessive sugar in individuals affected by diabetes was refined over the next 2000 years, and in the 18th century, England Johann Peter Frank is credited with the identification of two forms of diabetes- diabetes mellitus and diabetes insipidus. Mellitus (Greek; honey) was associated with high levels of sugar in the urine, while insipidus was not. In fact, diabetes insipidus is an unrelated condition related to hormonal control of the kidneys, leading to excessive urination.
By the 5th century physicians in India and China had noticed that there are two kinds of diabetes mellitus- one of which was prevalent in older and heavier individuals. Methods to recognize, understand and treat diabetes mellitus have evolved with technological developments. Relatively rapid progress since the 18th century has identified insulin as the hormone secreted by the pancreas that plays a central role in this indication, and also defined type 1 and type 2 diabetes.
Type 1 (also termed ‘early onset’ and ‘insulin dependent’) is a condition that generally develops in children and younger individuals where insulin production by the pancreas is compromised or completely shut down due to several reasons. Type 2 diabetes (also termed ‘adult onset’ and ‘non-insulin-dependent’) is the focus of this article and has become a global health problem.
In its current trend of prevalence Type 2 diabetes, or T2D, has blurred two boundaries. It was previously confined to low- and middle-income countries but is now on the rise even in the higher-income countries. Secondly, the age of onset is not confined to older patients. Among the Indian population worldwide, T2D is gaining numbers within India and also within expatriate Indian and southeast Asian communities. Some studies put the number of Indians in the US as the group with the highest incidence of diabetes than any other racial group at an age group above 20. Similar reports have been made with respect to Europe and UAE. Within India itself the numbers of T2D in adults 20 years and above has tripled over the past 3 decades.
This appreciable increase in T2D in southeast Asian expatriate communities, and also within their countries especially India and China, is thought to be due to the relatively recent cultural changes in diet and lifestyle over the past 50 years, such as an increase in consumption of fried foods, fast food, refined grains and sugars, lack of dietary fiber, and sedentary lifestyles.
In addition to these behavioral changes T2D is caused by an interplay of genetic and environmental factors, and familial history serves as an indicator for individuals to be forewarned about their own health. That said, considering the speed with which changes in the age of onset and frequency of T2D are being documented, it appears that environmental, diet, and lifestyle changes are the major contributors to the current epidemic. Also, in general, Indians have a higher degree of insulin resistance than Caucasians, which occurs when the cells of the body lose the capacity to respond to insulin even when it is being produced by the pancreas.
The burden of the long-term health effects of T2D are significant to the individual and from a public health perspective. The more stark chronic manifestations include neuropathies, foot ulcers, blindness, kidney dysfunctions, accelerated aging, and a general decline in health and productivity. In addition to insulin, newer medicines exist to control blood sugar and insulin response, and other therapies are being developed including stem cell therapeutics.
If there is a good aspect to T2D it is that it can be prevented or the onset delayed. The fact that onset can be delayed is a point of practical importance, as most of the clinical manifestations arise due to cumulative effects of high circulating sugar. Prevention is the best cure, as the adage goes. A regular health check-up will flag a ‘pre-diabetes; condition. Glucose intolerance tests, HbA1c levels in the blood, body mass index, and overweight are common tests to gauge pre-diabetes. This indication should be taken as a warning, and acted upon seriously and with a positive attitude.
The trinity of diet, exercise, and stress management are often called upon. Eat less. Eat on time. Walk more. In general, the lifestyle changes that are recommended are geared towards helping maintain an even level of blood sugar and reduction to, or maintenance of, an optimal body weight.
Processed grains, and refined carbohydrates like maida (all-purpose flour), have a high glycemic index. As against whole grains, they are quickly metabolized to sugar and result in a sudden spike of increase in glucose in the blood. Our standard fare includes white rice or chappatis/other breads as a base, and this can be substituted with brown rice and atta (whole wheat).
Instead of serving up a plate with a large portion of rice and sides of vegetables and protein, switch around the amounts and serve up rice as a side dish instead. Control portion sizes, and maintain steady time intervals between meals and snacks. Include soupy low-calorie items which will serve to fill up the stomach. Fasting is not recommended. Eat a diet of high fiber which includes green leafy vegetables and excludes starchy vegetables, skim milk-based yogurt, and whole grains. High fiber dals (moong, masur, urad, etc., along with sprouted whole dals) and beans (such as chole and rajma) should be a mainstay. Including methi (fenugreek) regularly in cooking, and in salads and dals after sprouting (sprouting methi completely reduces its bitter taste) adds flavor and a health benefit. Fruits that are delicious and low in sugar include papaya, guavas, blueberries, and jamoon.
Items to be conscious of and exclude, or eat in disciplined quantities, include fried foods and fatty foods in general (including our delicious tea-time snacks!), foods that include sugar and artificial sweeteners (yes, some sweeteners and bulk additives added to sweeteners can produce a sugar spike!), and processed grains. While regulating these will help with the maintenance of body weight, avoiding sugar, sweeteners and the inclusion of whole grains will maintain even levels of blood sugar. Depending on the stage of diabetes fruits may be eaten in moderation, but high sugar fruits such as mangoes, grapes, and sapotas should be avoided.
As with diet, steady exercise is highly recommended for diabetes. Even our hoary sage Sushruta recommended this, and in some studies, the inclusion of exercise had the most obvious ameliorative effect. The type of exercise will need to vary based on the individual’s age and capacities, but even a basic activity like a daily brisk walk for about thirty minutes would make a difference. Obviously, more will be required if weight loss is an objective. Although yoga is excellent for weight maintenance, it will not suffice for weight loss regimes. Walking, yoga, and exercise, in general, will also help in stress management, and others may be included, such as reading, meditation, etc., depending on individual preferences.
Tackling the diabetes epidemic at the global level would need to start with the individual.
L Iyengar has lived and worked in India and the USA. A scientist by training, she enjoys experiencing diverse cultures and ideas. She can be found on Twitter at @l_iyengar .
Are you trying to gain weight? Trying to gain weight may seem like an easy problem to solve, however, healthily putting on weight may not be as easy as you think. So, whether you are underweight and want to reach a healthy weight or are trying to gain muscle, you need a balanced approach to gain weight.
As a general rule, you need to consume between 300 and 500 more calories than you burn to gain weight. Unfortunately, many people are not aware of the number of calories they eat, or they misestimate it. This is where a weight gain calculator comes in handy. It helps you plan your meals properly with an adequate amount of proteins, fats, and carbohydrates.
What are the risks of being underweight?
Almost two-thirds of the US population is overweight or obese, which can lead to health problems. Similarly, being too skinny or underweight can also be unhealthy. If you have a BMI of less than 18.5, you are considered underweight (1). Not only does being underweight lower your self-esteem, but it can also lead to malnutrition and have a severe impact on your health. A diet that is very low in calories can cause fatigue, nausea, hair, and skin issues. When you are underweight, you can also develop a weakened immune system, osteoporosis (2), infertility, eating disorders, and developmental issues.
Causes of being underweight
There can be many reasons why a person is underweight (3). Sometimes there may be multiple related causes. Often medical conditions can also make a formerly healthy person to lose weight.
1. Family history
Some people have naturally low BMI that may run in their family. If a person has a high metabolism, he may not be able to gain much weight despite eating high calories foods.
2. High levels of physical activity
Some people like sportspeople and athletes burn much more calories, and this may result in low body weight.
Parasites, tuberculosis, HIV, and other infectious diseases can make the body use most of its energy in fighting off these diseases, which may lead to drastic weight loss.
When people have diabetes, insufficient insulin levels prevent the body from getting glucose from the body’s cells to use as energy. The body then starts burning fat and muscle for energy, and this leads to weight loss issues.
Hyperthyroidism can accelerate your metabolism, causing unintentional weight loss.
6. Celiac disease
Celiac disease is an autoimmune disease that can lead to weight loss. The body has an autoimmune response to gluten, and the small intestines are damaged, which affects the absorption of nutrients and causes weight loss.
7. Mental illness
Mental health conditions like depression, anxiety, obsessive-compulsive disorder, and eating disorders like anorexia and bulimia can affect a person’s ability to eat. If you lose bodyweight drastically without making a change to your diet or exercise pattern, you may have one of these illnesses. Seek medical advice and follow a plan to gain weight healthily.
How to gain weight healthily?
Just like a weight loss program, a weight-gain program also needs a balanced approach. Eating calorie-dense junk food may lead to weight gain, but you may still have nutritional deficiencies. Here are some general tips for gaining weight safely –
1. Eat frequent meals
Eat three to five meals every day. Eating more meals makes it easier to take in additional calories. You can also increase the number of calories consumed by snacking between meals (4).
2. Add healthy calories
Eating healthy is not difficult. You can increase your overall calorie intake by adding nuts and seeds and cheese to your dishes. Add healthy side dishes. Whole grain toast, sunflower seeds, almonds, and fruits like bananas and avocados are some great options (5).
3. Eat enough protein
Our body uses protein to build lean muscle mass. The RDA for protein is 0.4g per pound of body weight. So if you’re trying to gain muscle mass, you should exceed this amount significantly. Some of the favorite calorie-dense high-protein foods include fattier cuts of beef, pork, and chicken. You can also include salmon and eggs in your diet. Peanuts, walnuts, macadamia nuts, and walnuts are also rich in proteins.
4. Consume healthy carbs
Avoid refined carbohydrates and go for whole-food sources of carbohydrates like brown rice, oats, and beans. Sweet potatoes and yams are also good for your diet.
5. Eat healthy fats
Learn to distinguish between healthy and unhealthy fats. Healthy fats are monounsaturated or polyunsaturated, and nuts, avocado, vegetable oils, and fish are rich sources of these fats. Unhealthy fats include saturated fats and trans fats. Limit saturated fats and avoid trans fats.
6. Weight training
Weight training is essential for healthy weight gain as it helps in gaining and maintaining lean muscle mass. You may need to modify your workout over time by increasing the weight or number of sets to continue gaining muscle mass.
People who do weight training break down their exercise routines into specific muscle groups. Some of the leg building exercises include barbell squats, leg press, leg extensions, calf raises, leg curls, and barbell squats. Some of the upper body exercises include dumbbell pullovers, incline row, incline chest press, lateral raise, supine ventral raise, and side pullovers.
7. Cardio exercises
Many people who want to gain muscle try to avoid cardio. However, you must include these exercises into your routine as well. Cardio exercises are great for a healthy heart and lungs. Running, swimming, and walking are great ways to get some cardio exercise.
You can use a weight gain calculator
This weight gain calculator helps you to determine your daily calorie intake for your weight gain goal. You first need to input your age, gender, weight, and height. You then choose the number of meals you plan to eat per day. Since you have to eat more food during the day, it is advisable to divide your intake into more meals.
The calorie boost option is available for those people who find it very difficult to gain weight. The activity level is based on three weight training sessions per week, with little or no cardio. Click on calculate to find out the number of calories you should eat in a day. The results also give you a break-up of the carbohydrates, proteins, and fats that you should eat per meal and per day. As a general rule, only one-third of your fats should be from saturated fats.
How does this calculator work?
When you input all your details in the calculator, it estimates your daily maintenance level using the Mifflin St Jeor formula and adds a percentage of calories to the total (6). The calculator then estimates the optimum levels of essential nutrients to ensure healthy weight gain. Your protein intake is calculated at 1.1 gram per pound of body weight. Around 30% of your intake should come from fats. The rest of your daily intake should come from carbohydrates.
Being underweight can be extremely bad for your health. When you are underweight, you can also develop a weakened immune system, osteoporosis, infertility, eating disorders, and developmental issues. To reach a healthy weight, you must calculate how many calories you need to eat with a weight gain calculator. Plan a healthy and balanced diet that includes lean proteins, healthy carbs, and fats. You must also incorporate weight training and cardio exercises into your daily routine.
Manveen Sibia had an illustrious career in journalism and writing. She is the mother of a super active 7-year-old. While chasing her around the house, she also finds time to pursue her passion for writing on parenting, education, health, fitness, and entertainment.
Disclaimer: This article is for general information purpose only. Please do not consider this as a substitute for qualified healthcare provider’s advice, diagnosis, or treatment.
Let’s talk about one of my favorite meals….a delicious plate of nothing. Prep time is zero minutes and physical and mental health benefits are unlimited. Nihaal Karnik, a third year medical student at Ross University School of Medicine, writes about his personal experience and reviews some of the latest research on a topic close to my heart, intermittent fasting (aka IF). Don’t miss some of my thoughts at the end on how I have used IF personally and clinically.
I just finished working from 5 a.m. to 10 p.m. Yup, the ever glamorous lifestyle of a medical student. The last meal I ate consisted of 2-3 hard boiled eggs I scarfed down as I ran into the hospital; because, even at 5 a.m. I am considered late for a day of work. I’ve arrived home only to see an empty fridge and realize no restaurants are open. I need to eat. I’ve read every blog post, seen every interview, and even heard from doctors that I should be eating every 4-6 hours. I mean I cannot possibly miss this meal, right? Not necessarily. Skipping a meal or two may not be the worst thing for me. In fact, a growing body of evidence suggests that missing meals (fasting) may be to my benefit.
Intermittent Fasting (IF) represents a unique approach to nutrition. The approach intends to burn fat and produce muscle when combined with a proper exercise regimen. The name underscores basic principles of the program: fasting for intermittent periods of time.
Research suggests a wide number of benefits: potential protective benefits against various cancers, fat loss, muscle building, curbing hunger cravings, as well as increased insulin sensitivity (refer to other posts on diabetes and insulin resistance). This article aims to introduce readers to IF while providing some basic background on the principles of this model. Hopefully this read encourages our audience to research IF and explore the possibility of incorporating IF into one’s own daily routine.
The basic principle centers upon caloric restriction for extended stretches of time. The idea behind this is two fold:
1) It falls in line with ancestral diet principles and
2) Induces hormonal responses that promote fat burning, muscle building, and overall well being.
The majority of blog posts and literature surrounding IF introduce it to us in the context of paleo dieting. The average cave man did not always have a fridge full of food to satisfy his primal hunger. Instead he went through cycles of feast (eating) and famine (fasting).
Incorporating an approach that keeps the body in between a fasting and fed state is a natural extension of our ancestral diet. Excessive feasting serves as a major contributor to the variety of metabolic symptoms that plague society, today.
Furthermore, hormonal changes govern IF’s effectiveness. The key hormone discussed here is Growth Hormone, a natural hormone that regulates metabolism and is released by the body during the following phases: starvation, extreme/intense exercise, and rest. It is involved in muscle synthesis as well as lipolysis (fat breakdown). Proponents of IF outline that fasting states induce the release of extra growth hormone—thus helping to promote simultaneous fat burning and muscle growth.
In addition to the obvious benefits of muscle mass development and fat burning IF has a number of potential benefits.
These may or may not include:
1. Satiety (feeling nice and full). This may seem counterintuitive but studies show even alternate day fasting (see more below) may promote satiety.
2. Diabetes. Promising research shows that IF may be an effective alternative to calorie restriction and weight loss to prevent diabetes. More research is pending and the authors themselves conclude more research is needed to make definitive conclusions. However preliminary reviews of IF as a way to combat diabetes are promising.
3. Help combat eating disorders by tackling restrictive eating and body image issues.
4. Cardioprotective (hearty healthy) benefits. New research suggests IF may even protect the heart and lead to weight loss.
Models of IF
The basic idea of IF may be simple enough. However, for those who may seem intimidated by the challenge of fasting, don’t worry. A number of IF techniques exist to appeal to beginners and experienced fasters alike. Literature suggests most people may feel uneasy for the first 7-10 days. So, if you decide to partake in this new regimen do not be discouraged by mild irritability or uneasiness with the adjustment. Although the idea of fasting may be simple, readers often wonder what to eat during prescribed meal times. The theory of IF does not mean one can eat whatever they desire during his or her feast period.
Adherents still need to incorporate healthy eating habits (e.g. non-processed foods, loads of fresh veggies, and good hormone free/free range meat).
For instance, if I were to eat a meal or two during my feast window, it may consist of a huge spinach salad with grass-fed beef, avocado, and a healthy dressing. Or, I may decide to have some fresh fish with steamed veggies. The point is that the feast period does not mean one can instantly hit the closest drive thru window since there was a prolonged fasting period.
Below is a small list with brief descriptions of some of the more popular ways individuals may approach incorporating IF:
Alternate Day Fasting—One of the more popular methods. Proposed by Dr. Varady of the University of Illinois, the diet aims to offer patients a more inviting approach to fasting. Instead of incorporating a daily fast, the diet asks patients to fast every other day. Varady recommends 500 calories during one meal every other day. Her research, although young and ongoing, is quite promising. Patients who abided by this approach were a) more likely to continue this diet long term and b) actually restricted calorie intake on their regular/non-fasting days. Researchers theorize they restricted calories on non-fasting days since their bodies became adapted to the new approach.
12/12—A great approach for beginners. This simply suggests that patients have a 12 hour fasting window, and a 12 hour feasting window. A popular schedule may be to fast from 7pm to 7am.
18/6—A variation of the 12/12 model: here patients fast for 18 hours and feast for 6. One schedule maybe to eat only from 1 p.m.-7 p.m.
Occasionally missing a meal—Some people just listen to their bodies and skip a meal from time to time. Proponents of this model suggest not forcing a meal may help curb binge eating and be beneficial when periodically used.
Intermittent fasting represents a new way to approach caloric restriction. Although research concerning the metabolic benefits of this approach is promising, larger studies are needed to support clinical claims. Those interested in the diet should definitely research more about the topic. Combining this approach with a proper diet may offer individuals a way to achieve new body and metabolic goals.
So, at 10 p.m. at night I have two simple choices. I can go to bed and enjoy the potential benefits of my fast. Or, try to get a quick meal given the annals of conventional wisdom. As I mentioned earlier, it may not be a bad thing to skip this particular meal. Enjoying the perks of integrated fasts may make me a bit stronger, leaner, and hopefully a wiser medical student…though I guess the literature is still pending on that last wish.
Dr. Ron’s Clinical Insights on Intermittent Fasting
I am personally using and prescribing intermittent fasting for selected patients. However, many of my patients are coming in with significant micronutrient deficiencies and weight gain from under eating, overstressing and over exercising. Often these are women. I don’t initially recommend IF for these patients. I need to make sure these patients are well-nourished to replete these missing nutrients and we have to work on stress reduction and life balance which are top priorities. Eating more frequently may have to be initially implemented to replace key nutrients. Once we restore nutrient deficiencies and any hormonal and metabolic imbalances and patients start feeling better, they can then incorporate IF into their lifestyle plan. IF used in the right context can potentially increase lifespan and reduce inflammation. However, adding IF to a nutrient-deficient diet can make matters worse and I have seen inflammatory markers and body weight actually increase as a result.
For individuals who are eating a very high carbohydrate diet, adding IF may backfire since it can generate extreme hunger followed by compensatory binge eating. You need to first fix your eating habits, with a focus on adding healthy fats, proteins and more plants, which will act as a natural appetite suppressant. Once your body and metabolism are prepared, then IF can be used effectively. I have busy patients who generally skip breakfast already, thinking they are fasting, but then they overeat processed foods and excess carbohydrates later which worsens their weight and underlying health issues.
Finally, I highly recommend you fast with a purpose that goes beyond just weight loss and achieving ideal body composition. In most cultures fasting is a selfless act devoted to some higher spirit, rather than the somewhat egotistic pursuit of ideal body composition. Just reflect on the list of fasts undertaken by Mahatma Gandhi if you need inspiration to selflessly skip just a single meal. If the word “fasting” sounds too spartan, just call it “meal skipping.”
Try fasting for a departed relative, your favorite god, a specific life goal or higher purpose, etc. I personally have noticed that on IF days I can think more clearly, exercise longer and stronger, and meditate with greater focus. There are times I do use it for somewhat selfish purposes. For example, I use it strategically for important meetings and presentations as a cognitive performance enhancer. It beats caffeine or stimulants since its natural and you avoid the inevitable “crash” from stimulants. If I knew about it in my earlier life, I would have used it for school exams. Today’s students flood their systems with sugar and caffeine…just think sodas, frappuccinos and energy drinks, which are staple fuels for kids today.
Giving IF a higher purpose will make it more effortless, will allow us to practice selflessness which all of us can benefit from, and in the end, you will still enjoy the physical and mental benefits.
Ronesh Sinha, M.D. is a physician for the Palo Alto Medical Foundation who sees high risk South Asian patients, he blogs at southasianhealthsolution.org, and co-hosts a South Asian radio show on health.
I typed the word – nutrition – in the Google search bar. About 1,480,000,000 results (0.63 seconds) appeared with a display of the first 11 links.
Whoa! I paused, then I typed – Nutrition for South Asians. About 97,700,000 results (0.60 seconds) was the result. I let this number sink in. What could I tell readers about nutrition in 1000 words or less that would actually be useful?
I narrowed my research to four questions. What are the principal do’s and don’ts for nutrition and healthy eating? What restrictions do health conditions pose? Are credible, well-researched guides available to help us develop individualized plans? Can we adapt these guidelines to cuisines we enjoy?
This article is about healthy eating using Indian, South-Asian and other preferred diets. In a nutshell, abide by these overarching rules:
Follow a heart-healthy diet
Reach and maintain a healthy body weight
Always eat breakfast
Don’t follow fad diets
Don’t skip meals
Next, download your free copy of the Dietary Guidelines for Americans 2015-2020 published by the US Department of Health and Human Services and the USDA. This authoritative guide provides an in-depth discussion on diet for proper nutrition and good health.
Its key recommendations are: daily consumption of foods and beverages should be within a caloric level appropriate for you. Adopt a healthy eating pattern that includes:
(1) a variety of vegetables from all of the subgroups—dark green, red and orange, legumes (beans and peas), starchy, and other
(2) fruits, especially whole fruits
3) grains, at least half of which are whole grains
(4) fat-free or low-fat dairy, including milk, yogurt, cheese, and/or fortified soy beverages
(5) a variety of protein foods, including seafood, lean meats and poultry, eggs, legumes (beans and peas), and nuts, seeds, and soy products
(6) Oils (fats that are liquid at room temperature and high in monounsaturated or polyunsaturated fats).
These recommendations for healthy eating patterns should be applied in their entirety, given the interconnected relationship that each dietary component can have with others.
The Dietary Guidelines suggest that we get about half of our calories from carbohydrates. Fruit, vegetables, all grain-based foods and dairy products all contain ‘good’ or ‘whole’ carbohydrates in the form of sugar and starch and fiber (as opposed to refined or processed carbohydrates). Most carbohydrates get broken down or transformed into glucose, which can be used as energy; they can also be turned into fat (stored energy) for later use.
A healthy eating pattern also limits added sugars and sodium. The Guidelines suggest that less than 10 percent of daily calorie intake should be from added sugars and less than 10 percent from saturated fats. Sodium consumption should be less than 2,300 milligrams per day (slightly less than a standard teaspoon of salt). Your daily diet should include 4,700 milligrams of potassium which offsets sodium’s effect on blood pressure and has other health benefits. Potassium-rich foods include bananas, leafy green vegetables, and potatoes. For example, a medium banana has about 420 mg of potassium, 8 oz of plain non-fat yogurt contain 580 mg and a baked potato about 600 mg. The dietary guidelines provide a detailed listing of foods containing potassium. Meat, milk, and some cereal products contain potassium but in a form that is difficult to absorb. Alcohol consumption by adults should be limited to one drink per day for women and two drinks daily for men.
To help Americans of Indian origin better manage diabetes, pre-diabetes, hypertension, obesity and hyperlipidemia, the American Association of Physicians of Indian Origin (AAPI) commissioned Dr. Ranjita Misra, now Professor of Social and Behavioral Sciences at West Virginia University, to edit the second edition of the book Indian Foods: AAPI’s Guide To Nutrition, Health and Diabetes. This excellent resource on nutrition and healthy eating with Indian cuisine includes chapters on East Indian, South Indian, Maharashtrian, Gujarati, North Indian and Nepali cuisine as well as diet and lifestyle recommendations to prevent heart disease, and tips for those living with diabetes and kidney disease.
Dr. Misra recommends the Dietary Guidelines “as the Bible to go by,” and advocates following it to build a personalized eating plan, using the AAPI Guide and similar sources to tailor it to your cuisines of choice. I spoke with Dr. Misra at length, and she offered several tips that you’ll soon see in the sequel to this article.
In conjunction with a healthy-eating plan, everyone – children, adolescents, adults, and older adults – should meet the Physical Activity Guidelines for Americans to achieve and maintain a healthy body weight, promote health and reduce the risk of chronic disease.
Consult your doctor to account for your specific health requirements, and get on the nutritious and healthy-eating bandwagon with these few simple rules. Develop your own healthy eating plate and enjoy varied, tasty, healthy and nutritious meals every day!
Mukund Acharya is a co-founder of Sukham, an all-volunteer non-profit organization in the Bay Area established to advocate for healthy aging within the South Asian community. Sukham provides information, and access to resources on matters related to health and well-being, aging, life’s transitions including serious illness, palliative and hospice care, death in the family and bereavement. If you feel overcome by a crisis and are overwhelmed by Google searches, Sukham can provide curated resource help. To find out more, visit https://www.sukham.org, or contact the author at email@example.com.
There is an urban legend that the Indian diet is rich in fat. When you think of desi cuisine it brings up images of deep-fried pooris and sautéed vegetables floating in oil. It is further assumed that this fat-rich diet contributes to the high prevalence of heart disease among Indians. On the contrary, my own observation is that in most Indian-American households today only a small amount of vegetable oil, and almost no ghee, butter, or cream is consumed. Also, in my Ayurveda practice I usually evaluate people’s diets and find that most consume less than 30 grams of fat a day. Instead, rice, wheat, dals, breakfast cereals, low-fat milk and yogurt, fruits, potatoes, and other vegetables are listed most commonly in their food logs. The truth is this is a diet rich in carbohydrates, not fats.
This was not the case some 60 years ago. Until the 1950s ghee and freshly churned butter were the preferred fats in the Indian diet. People consumed whole milk. They were also more physically active.
Then in 1953 an American scientist named Ancel Keys proposed a hypothesis that dietary fat and cholesterol were responsible for heart disease. Although Keys’s research methods were flawed, the theory caught the interest of some bureaucrats and politicians who advanced it to inform new dietary guidelines for Americans. Low fat became the mantra for a healthy diet, which spread worldwide and remains the conventional wisdom even today.
These dietary guidelines have led to several unfortunate consequences. Following the recommendations of their doctors, people switched from ghee to Dalda, and from butter to margarine, thus consuming trans fats which have since been studied and shown to be linked to heart disease. Many have cut down fat intake to a bare minimum, replacing it with more grains, fruits, and sugary snacks as their main sources of calories and energy. Processed foods laden with refined and enriched flours, trans fats, and high fructose corn syrup, yet labeled “low fat” and “heart healthy” have gained favor. Meanwhile, we are witnessing a pandemic of diabetes, heart disease, obesity, dementia, and other chronic diseases.
According to ayurveda, while less fat is beneficial for some people of kapha constitution, or suffering from a kapha ailment, it is not recommended for all. Most people who restrict dietary fat increase their risk of imbalance of vata dosha leading to vata disorders like constipation, arthritis, and sensory and neurological dysfunction.
Snigdham ashniyat (eat unctuous food), recommends Charaka Samhita, an ancient text on Ayurveda. This advice is for healthy people to maintain their good health. The fat enhances the taste of the food and bolsters agni (the digestive fire). Thus, it speeds up digestion and helps with absorption of nutrients. It also aids the downward movement of vata (peristalsis), nourishes and strengthens the body, improves sensory function, and promotes clarity of skin complexion.
Choices of Healthy Fats
The fat most highly recommended in ayurveda is ghee, or clarified butter. It is a tonic for memory, intellect, and the eyes. Ghee has a high smoke point (500 degrees F) and so is especially suitable for tadka, or high temperature tempering of spices. You can also add organic butter, cream or whole milk to your diet. Healthy choices of oils include extra virgin olive oil, coconut oil, and sesame oil. Among fruits avocadoes, coconuts, and olives are good sources of healthy oils. So are tree nuts like almonds, walnuts, pecans, macadamia nuts, and brazil nuts. Cold water fish like salmon contain omega-3 fatty acids, which are known to be beneficial for heart health. Chia seeds, hemp seeds, and flax seeds are also rich in omega-3 fatty acids.
How much fat can you include in your diet? Listen to your body and it will tell you. Too much dietary fat makes you feel heavy and nauseous. So, most people are unlikely to binge on fat. Even so, you may want to increase it by only one tablespoon (14 grams) at first in each of your main meals and see how you feel. At the same time, reduce your consumption of sugar (and other sweeteners, desserts, sodas, fruit juices) and starchy foods (rice, wheat, other grains, potatoes) by at least twice as much.
What to Expect
You will probably find that with more fat in your meals you feel satiated with smaller portions. Also, fats and oils keep you satiated for a longer time, and there is less craving for snacks between meals. You will also be training your body to burn fat for energy and not rely as much on glucose. If you had sugar cravings before, they will subside in a few weeks and you will experience an even supply of energy throughout the day.
Oil, being the best remedy for vata imbalance, will help to relieve symptoms of vata like body ache, joint pain, numbness, stiffness, and constipation.
If you simultaneously reduce your carbohydrate intake to less than 100 grams a day, your blood sugars will probably decrease and become more stable. Triglycerides will also drop. You can also expect gradual and sustained weight loss. Contrary to popular belief, it is not dietary fat that makes you fat, it is excessive consumption of carbohydrate-rich foods.
Here are a couple of recipes for reducing carbohydrates and adding healthy oils to your diet.
The oil, herbs, and spices in a dressing not only add to the taste, they also help in easier digestion and more complete absorption of the phytonutrients in a green salad. Many commercial dressings contain vegetable oils processed with heat or chemicals. So it’s best to make small batches of dressing at home with the healthiest oils. Choose extra virgin, cold pressed, unrefined olive oil or macadamia nut oil.
12 tablespoons (3/4 cup):olive oil, extra virgin, cold pressed, unrefined
4 tablespoons (1/4 cup): juice of one lemon 1 teaspoon: pepper, coarsely ground black ½ teaspoon : salt or Himalayan pink salt
Mix all the ingredients in a dressing mixer or a small glass bottle. Shake well before dispensing.
If roti or some kind of flat bread is your comfort food, try various kinds of flour and you may find a mix that satisfies your taste buds without elevating your blood sugar too much. Chickpea flour has only half the carbohydrates as wheat, and more dietary fiber and protein. Almond meal and coconut flour are very low in carbohydrates, but by themselves they don’t bind well and are difficult to roll into flat bread. My mother tried various mixes and came up with this delicious recipe that is gluten-free, low in carbs, and has a substantial amount of protein.
almond meal: ¼ cup
chickpea flour (besan): ¼ cup
Himalayan pink salt: ¼ teaspoon
water: as needed to knead the dough
Mix all the ingredients in a mixing bowl. Add water in small amounts to knead into dough of medium to stiff consistency. Roll into thick flat breads. Roast on a tava or cast iron griddle. Makes 2 small rotis.
The ideas and opinions expressed here are for educational purpose only. They are not intended to replace the advice of a physician or medical practitioner. Before beginning any diet program including any recommendations discussed here, it is recommended that you seek your physician’s advice.
Ashok Jethanandani, B.A.M.S., is a graduate of Gujarat Ayurved University, Jamnagar, and practices ayurveda in San Jose, Calif. www.classical-ayurveda.com.
If lean muscles could be built from beer and chips then everyone could be looking huge with well-defined muscles. Unfortunately this is not the case. It takes a lot of exercises and healthy eating habits to develop lean muscles. But wait; did you know that there are certain foods that can help you to build lean muscles faster? These foods have particular properties, which increase the rate at which your muscles burn fat to look more defined. Below are my recommendations for best foods for building lean muscle:
While fish has gained a lot of glory as one of the best sources of white meat, salmon takes the lead when it comes to the types of food, which are responsible for building lean muscles fast. Salmon contains a unique blend of the right proteins, B vitamins and other essential nutrients such as magnesium, which is crucial to the repair and formation of new muscles. Besides, scientific evidence has pointed out that salmon boosts mood, which goes a long way in preventing unhealthy eating habits and therefore contributes directly to lean muscle development.
Eggs have always been identified as the best source of proteins, and indeed their ability to boost the development of lean muscles extend beyond the protein value. Eggs are highly functional due to the yolk, which contains sufficient amounts of cholesterol. If you are troubled that the amount of cholesterol could hike from excessive consumption of eggs, it is time you knew that the type of cholesterol obtained from eggs has been shown to lower the amount of bad cholesterol which is mostly associated with cardiovascular infections. Eggs therefore boast of the highest biological value, a measure that depicts how well they support your body’s protein need.
Almonds carry a substantive amount of Vitamin E, in a form that is best absorbed by the human body. Vitamin E is required in the body especially after exercising because it is a potent antioxidant, which prevents free-radical damage that could prevent effective muscle development after workouts. The moment such kind of destruction is prevented; lean muscle development will be accelerated.
Leafy greens have gone beyond the boundaries of keeping your skin glowing to facilitate the development of lean muscles at a faster rate. They contain a lot of iron, whose function is to speed up the circulation of oxygen during workouts. Similarly, leafy greens contain enough proteins to help build lean muscles further. Some of the greens that have a higher amount of proteins are spinach and kales, and should therefore be consumed in large amounts.
When it comes to fruits, apples play a crucial role towards the development of lean muscles. These fruits are packed with specific polyphenols, which prevent muscle fatigue while increasing muscle strength at the same time. Apples should therefore be used as pre-workout carb sources because they allow you to train harder and over an extended period of time.
These are some of the most unique grains that you will find in the local store. If you consume half a cup of rolled oats for instance, you will get 5 grams of proteins and a number of vitamins which boost metabolism and promote muscle growth. If you observe most bodybuilders, you will find out that they consume oats at the start of their day because it is the kind of diet that that keeps one satisfied for long besides preventing the accumulation of abdominal weight.
Peanuts are mostly consumed for their protein content, forgetting that they contain a host of other nutrients such as potassium, magnesium and plenty of iron. In a single serving of roasted peanuts, you get 12 grams of proteins and all the aforementioned nutrients. Besides roasted peanuts, peanut butter is a good alternative, but one has to be careful not to choose the sweetened varieties.
Beef from grass-fed animals
Beef contains zinc, iron, B vitamins, cholesterol and proteins. These are some of the best components for anyone who wishes to develop lean muscles, but they should be obtained grass-fed animals. Compared to conventionally raised animals, grass-fed cattle contain a higher level of conjugated linoleic acid, which helps the body in shedding fat in order to develop lean muscles.
In summary, there is a wide variety of natural foods which have particular properties vital to the development of lean muscles. However, it is also essential to note that food alone cannot help one to develop lean muscles. As such, one should consume such healthy and balanced diets besides regular exercising before the results start to appear.
Puja Mukherjee is a certified Fitness Trainer, who woke up one morning to drop everything in the pursuit of her passion for fitness. She says the best part about her job is to liberate her clients from their preconceived notions about fitness and see them be dazzled. Follow her at www.getmeanmuscle.com
“I’m sorry to inform you your child’s psychological age is at 9 months … ,” Laxmi and Narendran were numbed by these words even as the child psychologist talked on about expressive vs. receptive verbal skills and cognitive abilities; or in their son’s case, disabilities. As their mind tried to grapple with the words, Ravi, their almost 4-year-old, held up his toy car and rotated its wheels, over and over again. Drowning in a feeling of doom and darkness, Laxmi heard herself ask “What can we do to … to …” She remembers that she did not even know how to complete the sentence. All she could hear is the roar of sheer terror for her child and for their family; the pain of dreams aborted and a feeling of wretchedness setting in.
Thus begins the official journey of every family whose child gets diagnosed as being “autistic” at 18 months, two, three, or even five years. Autism is a neurological disorder that sets in within the first three years of life and impacts normal brain development in the areas of social interaction and communication skills.
Autism is approaching the numbers of an epidemic. The figures are staggering—in the 1960s, four in 10,000 children had autism. Today, according to Autism Speaks, an organization dedicated to facilitating global research into the causes, treatments and an eventual cure for autism, one in every 110 children is diagnosed with autism, making it more common than childhood cancer, juvenile diabetes and pediatric AIDS combined. U.S. government statistics suggest the prevalence rate of autism is increasing 10-17% annually. The website, Talk About Curing Autism (TACA) states that eight new cases are reported each day in California alone.
And autism is by no means an “American thing,” as disbelieving desi grandparents of autistic children will claim. The Autism Speaks website states that about 1.7 million individuals are autistic in India. A CNN article in early 2008 reported that autism is affecting one in 58 individuals in England and Ireland.
So, what is going on? Is it just the modern over-emphasis on labeling? The causes of autism are still hotly debated among scientific and familial circles. What has been proven is that there is no commonality of cause among the children affected (it is not necessarily genetic), though there are many theories—some reports claim environmental pollution such as chemical dumping into the water table as a factor. Some parents believe that indiscriminate use of vaccines is to blame. “Shilpa was a vivacious child, babbling and making gestures all the time. A week after her 12-month shot, she was a withdrawn child. She regressed completely after that—now, she cannot even say bye bye,” grieves mother Sneha, a part-time accountant in East Bay Area. (Studies refute the vaccine theory.) Some say it is a harbinger of societal evolution; joint families disintegrating to nuclear families to eventually self-sufficient individual worlds where human “social” contact is made via machines (computers). Yet another theory is that some unpredictable connections remain incomplete within the child’s brain in the early developmental years, which could explain why the symptoms span a wide range, the official diagnosis being “Autism Spectrum Disorder.”
The neurobiological incompleteness does however manifest in some classical symptoms, and tests are based on there being consistent evidence of a few. For example, showing no cognizance of one’s own name and not seeking human contact are two symptoms mandatory for a diagnosis.
Autistic means “into one’s own self.” Autistic individuals are not just introverted; they seem to exist in a world of their own. They usually do not respond to hugs; typically do not coo back to baby-talk, and rarely show emotions. Some children indulge in repeated head banging or spinning—walking in circles—continuously. Some will wander off on their own. Most have issues with food—some eat indiscriminately, even dirt; others will eat only pureed food, even at four years. “Krish would stay silent for eight hours straight at his daycare. At first we thought he was just an extremely shy child, but he never imitated actions, repeated new words, or played with other kids. He would stare at nothing for an hour at times … I had been a mother for two years, and I had never heard him say Mamma,” recalls Priti, a mother in Cupertino. Krish was eventually diagnosed as being autistic, his expressive language skills leveled at seven months.
What can be done? Interestingly, in the case of autism, a lot can be done and has been done. Autism cannot be cured, but in a significant number of cases, if diagnosed in the first three years of life, a number of therapies can be put in place to eventually get the child to be a fully functioning, participative member of society.
The remarkable thing about autism and the age of science we live in is that the neurobiological incompleteness can be completed. An autistic child that does not realize that he needs to take his finger away from the scalding surface can be taught to do so. While he may still prefer being by himself, he can be made to feel some joy in being with others a part of the time. He can be taught to not wander away, to explain in advance that he does not like songs instead of screaming; can be taught that when it’s cold outside, he needs to wear a jacket.
Given the right therapies in the right amounts, a significant number of children with these special needs can mainstream—meaning leading independent, productive lives as a part of society. Early intervention support has been put in place by state governments, where an evaluation and ensuing therapy is free up to three years of age. The public school system takes financial responsibility of the child’s education thereafter, via IEPs (Individualized Educational Plans).
However, given the rise in autism and the downturn impacting government funding negatively, parents are facing increased resistance to their requests for better facilities in special classrooms and curriculum that keeps pace with the child’s progress.
To exacerbate the situation, the quality-of-life needs of a child are not taken into account by the school; just the educational needs. A child may be taught the alphabet, but not how to respond to “How are you doing today?” Generally speaking, a classroom or interaction with a stranger/ peer overloads the senses of an autistic child, resulting in “behavior issues”—examples being tuning off, spinning, screaming, or repeated head-banging. Parents of children with special needs have to pay out-of-pocket for empowering their child with strategies to cope. These therapies can be categorized as speech, occupational, behavioral and physiological.
At the forefront of not just sponsoring these therapies but also imparting them, are the special parents of these special kids. “It took us a year to get Suraj to say ‘banana.’ I would get him, through tears and tantrums, to try to say the word first, before actually giving it to him. It broke my heart everyday, he loves to eat them so much, but I had to stay firm,” says Shailaja, an ex-marketing professional. Shailaja’s mode of parenting is typical of autistic therapies, which coax the people around an autistic child into a pattern of intensive modeling and tough love.
Another example of parents unlearning their intuitive persona to don the special-parent avatar is in the occupational area. Swati Shah, founder of Ascend Rehab, an occupational therapy clinic based in San Ramon says, “Most of the kids who come to me have issues with what is called sensory integration—a hyper or hypo-sensitivity to textures, sounds and motion; and poor hand-eye and limb coordination.” Some children are easily and uncontrollably excitable, so parents learn to ask them to use “quiet hands and voice” and get them to wear weighted jackets—literally, jackets with weights in them—to calm them down, like when a heavy blanket is recommended for a baby to help her sleep better.
Applied Behavioral Analysis (ABA) therapy has been the bulwark therapy for most families. Children with autism display a spectrum of behavioral challenges, and ABA works on customizing the program for each child. One child may need help in making eye contact; another might need help in playing with peers.
Kevin Dotts, founder of I Can Too, a leading provider of ABA therapy in California shares, “Every autistic child is unique, just like typically developing kids. Having the same diagnostic label does not make them homogenous.”
ABA therapists typically work in teams of 2-6 with a child on a daily basis and usually meet monthly with the parents to assess progress and re-strategize as needed, the credo being, “If a child cannot learn in the way we teach, we must teach in a way the child can learn.”
A typical program consists of repeated instruction, modeling and rewards for each child, along with a huge dose of love and patience. “I have seen several kids gradually gain confidence, learn to coordinate their behavior and bodies, and come into their own.” says Kavita Singal, an ABA therapist in San Jose.
Some parents prefer literally getting under the skin with autism. Tripti, mother of Shekhar—a five-year-old who was diagnosed with autism at two, found that following a wheat- and casein(milk protein)-free diet helped her son to be calmer. The reasoning gaining increasing acceptance among parents is that some autistic children cannot absorb certain foods well, leading to a kind of toxicity in their bodies which in turn affects the neurobiology— “you are what you eat.” Homeopathy and Ayurveda are also being adopted by parents to improve quality of life for their kids.
All of these additional therapies are typically imparted 15-25 hours a week, and it can take anywhere from two to 15 years for the modeled behavior to be fully ingrained as intuitive behavior.
An added challenge with autism is that even ingrained behaviors can be forgotten, so consistent, long-term therapy is a must. The financial burden on families ranges $2,000-$5,000 a month. One parent often has to give up his or her job in order to tend to the child, adding to the financial strain.
Considering that autism is a medical condition, one would think insurance companies would cover the costs. Not so in California which, unlike some other states, does not mandate coverage for autism therapies. Most insurance companies deny coverage, ironically, on account of the therapies not being “medically necessary;” meaning that no medicines are required, so they cannot be held responsible. Most families are forced to engage in a battle of paperwork and lawsuits to get coverage. A common tactic adopted by the insurance companies is to delay start of coverage for several months, and then capping the costs or forcing several re-evaluations frequently. Sadly, coping with a special child, therapies, and third parties involved is a full-time job, and that’s excluding the emotional drain.
This is a battle fought by parents haunted by the fear that their child will either abandon society or worse, be shunned by society. “Even with the therapies in place, I’m haunted by the possibility that the worst might not be behind us,” says Meera, afraid that Akash, her five-year-old, will never learn how to be with others. It is inevitable that autism will touch all our lives; if a child we know isn’t already affected, one in our neighborhood definitely is, given the figures.
As a society, we must learn to recognize and assist the Meeras of our world. If it takes a village to raise a child, it takes an accepting society to raise a child with autism.
(Names changed to protect privacy.)
Priya is actively involved in special education issues and autism therapies.
Early Warning Signs of Autism
• Does not coo or smile by six months old
• Has trouble sitting, standing up, or reaching for objects by age one
• Does not say simple words like “mama” or “dada” by age one
• Does not turn his or her head to follow sounds or voices
• Does not react to loud noises
• Repeats certain behaviors, including some that are harmful, like banging his or her head
• Makes little or no eye contact and wants to be alone
• Does not play games like peek-a-boo or “pretend”
• Any loss of speech or social skills
Source: First 5 of California
Autism Etiquette: What to do if you meet a family with an autistic child
• Never ignore or pretend the child doesn’t exist. This makes the child and family very uncomfortable. Acknowledge the elephant in the room.
• If you can start with a look straight in the eye and a smile on your face, you would have already built a big bridge to reach out to a child who could really use a friend. This communicates: I care and you are OK just the way you are.
• If you see a child having a difficult time, don’t assume the parent is negligent and throw disapproving looks. My child is acutely sensitive to the piercing glances of strangers even when he is in the middle of a meltdown. Ask if you can help. If you are told to stay away or your advances for help are refused, just smile at the child/mom/dad/care giver encouragingly and leave.
• Inappropriate behavior may manifest itself in different ways—a child maybe playing oddly, maybe grab food that you’re eating, he may be repeating meaningless phrases over and over again. Use common sense, be accepting, smile, be non-judgmental. The less self-conscious the child feels, the more likely the situation is to resolve itself.
• Don’t talk down to a special needs child under the assumption that just because he is behaving like a two-year-old, he thinks like one too. Autism is primarily a communication disorder and you will be surprised how bright, creative and thoughtful these children are. Communicate at an age appropriate level even if you don’t receive feedback to validate it.
• Just accept them for who they are and love them no matter how they behave. You may be surprised to know that the seemingly low functioning child who may appear non-verbal or non-responsive will understand that and relax around you.
What about your kids/teenagers who may encounter this strange behavior? Your children take their cues from you. If you take things in stride, don’t overreact, treat people with respect in spite of their differences, then so will they.–Nandini Minocha
Developmental Disabilities in the Media
The media plays a vital role in social awareness and acceptance of disabilities. In recent years, autism and other disabilities have emerged from the shadows and become part of the mainstream media dialogue. Soap operas and news features have done their part in including special children in our everyday lives. Some Bollywood examples are the recent Shahrukh Khan movie, My Name is Khan, and the older Taare Zameen Par, Paa, Sadma, and Eeshwar.
Hollywood examples include the recent Dear John, and the old Mercury Rising and Rain Man. In 2008, the trials and triumphs of a real-life autistic child were depicted on the NBC soap opera Days of Our Lives. USA Network’s popular soap Monk had an obsessive-compulsive detective solving crimes, and the medical drama House had an episode based on the illness of an autistic child. The forensic anthropologist Temperance Brennan in FOX channel’s Bones is widely regarded as having Asperger’s Syndrome. The popular sitcom The Big Bang Theory also has a central character with Asperger’s.
More recently, NBC’s new hour-long drama Parenthood features Max, a child with Asperger’s Syndrome. The animated show Arthur on PBS introduced a new character in April, also having autism.
Zee TV has been airing Aap Ki Antara, about a special child who is unable to bond with her family and does not have any friends. The pilot episode dealt with how she is bullied by her classmates. The series follows her through her developmental years, each episode delving into the immediate and adjusted reaction others have to her; and how she deals with every situation life throws her way.
The production team for the series did extensive research on autism, spoke with hundreds of special parents in India, and networked with professionals in the field; the information has been built into a website—http://www.beingantara.com
Amidst all the drama of daily intervention, special education, and insurance battles, the parents of autistic children grow increasingly isolated. One organization in the SF Bay Area lights the path for Indian families with special needs children—Jeena, “Hope for Kids,” http:// www.jeena.org
Jeena is a non-profit organization to support special families with origins in the Indian sub-continent. Member-families have children with a diagnosis of Autism Spectrum Disorder, Cerebral Palsy, ADD/ADHD, and Aspergers Syndrome, among others.
“It can be overwhelming for parents to distinguish between their own needs, the needs of their child, and their family. It gets further complicated as it is difficult to understand the complexity of the system(s) serving children with developmental disabilities,” says Rajni Madan, founder of Jeena. “Jeena’s intent is to focus on the family and empower parents to provide informational and emotional support to one another. The goal is to organize activities that will be beneficial to the special child. We celebrate life and recognize the potential of a child irrespective of the disabilities.”
The celebration of life is evident at the annual show “Jeena Yahan,” where most of the stars on stage are the children. Fun events include quarterly birthday parties, periodic “Mothers’s Night Out” dinners, picnics, and camping trips. Jeena routinely hosts discounted-fee lectures by specialists in the field of special education law, and emergent and established therapies. In addition, Jeena part-sponsors therapists in several fields to hold weekly sessions for special children. Recently, for example, a speech and language therapist conducted speech therapy every other Sunday for 12 weeks for all member children.
“Every family at Jeena understands my life. It is no longer possible for us to sustain friendships with parents who don’t have special needs; but for Jeena, we would’ve had a very lonely life,” says Tara, whose son was diagnosed with autism at three.