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Madhumeha: Ancient Origins, Recent Epidemic

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 .


 

Eat Yourself To Health

Viruses are smart, they are masters of survival. They can hijack our body’s own mechanisms to live and multiply. During a productive infection, viruses hijack, multiply and destroy the cell that they call home for a very short time. Bacteria and parasites have also devised various intelligent and opportunistic methods of attacking the human body. To protect ourselves from these infectious agents, the immune system is the frontline of a preemptive defense, while some infections may be controlled by therapeutics. 

Vaccines are the most overtly and urgently effective route to control these infectious agents as they specifically direct the body’s immune defenses against these intruders in multiple ways. However, we can take the initiative to maintain a strong healthy baseline. In addition to stress alleviation and staying active, we can consciously incorporate a few things in our diet to hone our intrinsic defenses. One aspect of this could be accomplished with a few spices, herbs, and condiments that we are familiar with. 

Spices and herbs have fragrant oils that impart the flavors that we know and love, but they also pack alkaloids and other compounds which can have specific effects on the human body. Although detailed ayurvedic knowledge about the effects of these dietary inclusions exist, this article is meant only to raise awareness, and not delve into the depths of beneficial and harmful aspects of the few spices mentioned below. 

Black pepper

Dubbed the ‘queen of spices’ and ‘black gold’, pepper is native to the Malabar coast of Kerala, and was the original spice that fueled the European spice trade. It was the mainstay for introducing pungency and heat in Indian cooking until the Portuguese introduced chillis to India in the 16th century. Among other effects, pepper has antipyretic properties. However, another important property of piperine, an alkaloid in pepper, is to increase the bioavailability of other compounds. That is, it increases the absorption of other chemical entities that are by themselves not readily absorbed. This leads us directly to the next spice, turmeric.

Turmeric

Hailing from the ginger family, the root of turmeric is used as a spice with a familiar hue. In addition to imparting a rich yellow color to food, turmeric is known for its antiseptic and anti-infective properties. Curcumin, an alkaloid in turmeric, also has anti-inflammatory and anti-oxidant properties and has been studied extensively for its properties in ameliorating diseases, and in promoting general health. However, curcumin is not easily absorbed by the body, and combining its use with black pepper improves its absorption.

Tulsi

Otherwise called Holy Basil (appropriately called Ocimum sanctum in latin), tulsi is more associated with religious ceremonies and Ayurveda than with cooking. It is related to, but distinct from, the basil used popularly in Thai cuisine. I have often wondered why tulsi is not used in Indian cooking given its amazing flavor, but it appears its religious associations preclude its use in something as mundane as food. Tulsi is an adaptogen, in addition to having several other medicinal properties, including antibiotics, and blood pressure control to name a couple. As an adaptogen tulsi is advocated for general wellbeing and stress reduction. Tulsi when added to tea imparts a soothing flavor, and occasionally adding a couple of fresh leaves (for those of us who have a plant at home) or a pinch of dried tulsi leaves while brewing a cuppa makes for an excellent beverage.

Oregano

Since we are in the age of fast food, and Italian food can be a popular healthy option, oregano is a spice that we are all familiar with although it is not commonly used in Asian cuisines. In terms of flavor, it is a close cousin to ajwain belonging to the cumin family that is used in Indian cuisine, but the plants are not related. Oregano packs an intense flavor and has several essential oils, including thymol, which are thought to be antiseptic among other properties. Oregano can also be taken for general well-being, and both tulsi and oregano can potentially boost the immune system. Not surprisingly, they belong to the same super-family of fragrant herbs, Labiatae.

Garlic

The medicinal properties of garlic were known to several ancient cultures, and its health benefits are thought to range from digestive to respiratory and circulatory systems but, of current relevance, it is anti-microbial. The pungent odor and taste of garlic are due to sulfur-containing compounds that are released when it is cut or crushed, and the best known of these is called Allicin. In addition to being anti-bacterial, allicin is also thought to have anti-viral properties. Other members of the garlic family, including onion, share the same compounds, but in reduced amounts.

This article is not advocating the ingestion of these spices at the level of a therapeutic or dietary supplement, but only regular inclusion of these as spices in day-to-day cooking. It is also not an exhaustive list of all the benefits these spices are thought, and known empirically, to confer. Several other spices and condiments that we are familiar with also have beneficial health effects: cumin (jeera– anti-parasitic), ginger (anti-inflammatory), fenugreek (methi seeds– anti-bacterial and laxative), yogurt (pro-biotic), cardamom (blood pressure control), cinnamon (anti-microbial), green and red chillis, and so the list goes on. Finally, it should be mentioned that cooking could destroy a percentage of the active principles and the ensuing health benefit, and frying (including seasoning or tadka) would inactivate a higher percentage.

So, a periodic shot of rasam may not be a bad idea. In fact, variations on the theme of this thin soupy concoction are found in most Asian cuisines. Mix in different spices for variety: pepper, turmeric, lemon, cilantro, lemongrass, oregano, basil, neem leaves, garlic, red chilies, and others to complement your daily creativity and menu. It adds variety, in addition to providing an excuse for an excellent sinus-clearing aperitif! 


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 and at www.liyengar.com.

Cycles of Destruction and Renewal

As 2020 inexorably moved to a close, the world watched as the global COVID-19 pandemic affected every aspect of our lives and livelihoods. Personally, my mindset moved between fatalism and cabin fever driven anxiety that this virus would dictate our lives for a much longer period than would be satisfied by short-term adjustments.

Indian mythology talks of cycles of destruction and renewal of the universe; one cycle of creation is but a blink of the eye of a creator. Indian philosophy also speaks of negating the very concept of time – it is just a mind-made construct. So, it might be wise to push all these thoughts aside, and just live in the present, after all the current situation just brings the point home that this is all we have to play with.

A new government took the helm in the USA on January 2021, and the events surrounding this hard-fought contentious election eclipsed preoccupations with a global crisis at times. It is definitely a source of comfort for some of us that this government will not be headed by an ‘outsider’ but a dyed-in-the-wool politician whose actions will hopefully be geared towards what we normally think of as good governance. This brings hope, as we can now focus on forward momentum to solve national issues, and potentially even contribute to global solutions. 

We can look forward to a creatively modified life as we align our priorities towards intelligent survival. If history is a stern teacher, we have learned that it took about 2 years for the 1918 flu pandemic to quieten down, so if one needs a projection this is as good as any.

Namaste as a greeting instead of handshakes and hugs, limiting larger social interactions – which includes physical congregation in the workplace – and curbing unnecessary shopping should easy for those who are familiar with the Indian ethos. A successful vaccine will definitely contribute to our arsenal, but it will only work in concert with a compliant global population.

Changing lifestyles and work mandates will inevitably result in the waning of some industries. The immediate fallout is in our neighborhood restaurants and businesses, but the drastic downswing of local and global travel over the past 9 months has already benefitted our 21st-century environment. An upsurge in the exploration and development of clean energy sources as an alternative to fossil fuels is underway, and while each source comes with its specific benefits and challenges it could emerge as a strong global contender if it is appropriately prioritized and funded. This positive shift in lifestyle could emerge as the proverbial silver lining to what is otherwise being experienced as a global life-threatening event, and we could transform the unavoidable destruction of aspects of life as we know it into the creation of a potentially better environment for all of life.

Ducks on Schuylkill River

As species shift their ecologies and relate more to a lifestyle that is unencumbered by human occupation and pollution, a positive outcome appears to be an emerging clean environmental slate. While wind and solar energy seem to be the most developed alternative energy options at present, exploration of other sources including geothermal and hydrokinetic to harness power from the earth and oceans would add to renewable energy options.

Resources need to be constantly provided to make these initiatives a success. While working in a ‘tier-1’ city in India in 2014, I purchased a car that was fueled by CNG (compressed natural gas) as a cleaner fuel option. My good intentions were limited by the availability of the fuel. I learned that waiting in line at selected gas stations at 6.30 am could result in a full tank of CNG in my car. However, too many failed attempts after seemingly endless waits led to the increasing need of choosing a car that ran on petrol. My upfront investment in paying a premium for a CNG car was burnt at the gas station so to speak.

The development of technologies for renewable fuels has seen steady progress over the past two decades, and current estimates for renewable technologies producing electricity vary between 10-20%. The unexpected impetus for a better environment provided by COVID-19 could be a boon, but other studies suggest that a rebound in carbon dioxide emissions could easily be conceivable when the pandemic is controlled. Lasting change in preventing increasing global temperatures and a continued positive environmental change post-pandemic will continue to require effort from us at an individual and global level.

Being woken up to the squawking of ducks on the Schuylkill River – where parent birds breed, babies grow up, and fly away to start a new cycle of life – is gratifying. The hope is that this will continue for years to come.


L. Iyengar has lived and worked in India and the USA. A scientist by training, she enjoys experiencing diverse cultures and ideas. She is the author of White Blackmail, a work of fiction, and can be found on Twitter at @l_iyengar.