Tag Archives: Preventing Diabetes

Preventing and Reversing Diabetes

The numbers are worse than estimated earlier. A recent study by the UCLA Center for Health Policy Research found that more than half the adults in California have pre-diabetes (46 percent) or diabetes (nine percent). Among those who have pre-diabetes, about 70 percent develop diabetes in their lifetime. Also, according to statistics available from the Centers for Disease Control, the number of United States adults diagnosed with diabetes almost quadrupled from 1980 to 2014 (from 5.5 million to 21.9 million).

While these statistics are alarming, diabetes is not a new disease. It was described over 3,000 years ago in the ancient texts of ayurveda among a group of urinary disorders called prameha. Even before urine and blood tests for glucose were developed, sages and vaidyas (physicians) in India had observed and documented signs and symptoms of prameha—like burning sensation of the feet, excessive thirst, weight gain, sweet taste in the mouth, and ants being attracted to urine. They also noted that its pathogenesis was due an to increase in kapha dosha from excessive consumption of sweet and heavy foods like newly harvested grains and sugar products. Sedentary habits are also a major cause of prameha, according to ayurveda.

In the last couple of generations our lifestyles have become increasingly sedentary with the convenience of motorized transportation and a large scale shift from farm and blue collar work to desk-bound occupations. Comfortable couches and electronic entertainment also promote inactivity during our leisure hours. This, coupled with an abundance and overconsumption of food, especially foods rich in carbohydrates, has created a perfect storm for the rising incidence of insulin resistance and Type 2 diabetes today.

From Carbohydrates to Blood Glucose
Most of the carbohydrates we consume get digested into glucose and other simple sugars, some faster than others. Glucose is then absorbed into the bloodstream and transported to various cells with the help of the hormone insulin. There it is stored temporarily and utilized for our energy needs. This would be fine, except that we are much less physically active now, and before burning the stored glucose we tend to eat another meal rich in carbohydrates, and then yet another. This imbalance between intake of carbohydrates and their utilization overwhelms the organs that store glucose, making them resistant to insulin. As a result, our body’s natural mechanism that regulates glucose concentration in the blood starts to fail, and the levels of glucose and insulin both begin to rise.

Insulin resistance is a metabolic dysfunction that underlies Type 2 diabetes and many associated disorders like central obesity (belly fat), hypertension (high blood pressure), and dyslipidemia (elevated triglycerides and low levels of HDL cholesterol). This cluster of abnormalities is called metabolic syndrome.

If blood glucose is elevated, it causes microscopic damage to various blood vessels in the body. Over time this damage accumulates and leads to serious complications like heart disease, stroke, loss of vision, kidney disease, peripheral neuropathy, diabetic ulcers, and amputations.

Addressing the Underlying Cause
To optimally manage Type 2 diabetes, the underlying causes of insulin resistance have to be addressed. The main cause is an imbalance between carbohydrate consumption and its utilization.

Although some people have a genetic predisposition to diabetes, lifestyle plays the major role in this metabolic dysfunction for most. So its management by medicines alone is not effective. Unless diet and physical activity are improved significantly, most diabetics find that their condition gets progressively worse, requiring higher and higher doses of medicines, and ultimately insulin shots. Most are afflicted by multiple complications.

To reverse this progression of insulin resistance and diabetes, ayurveda recommends a three-pronged approach of (1) food as medicine, (2) regular physical activity, and (3) medicines.

Food as Medicine
Out of these three, choosing the right foods is most important and effective. This means restricting carbohydrate consumption dramatically to reduce the glucose that will be absorbed into the blood. Check with your doctor before making dietary changes, though, especially if you are taking oral anti-diabetic medicines or insulin to manage blood glucose.

You may wonder: don’t we need glucose for energy? Yes, but our bodies can also utilize fat for energy. Since fats don’t raise glucose or insulin levels, they are a preferable energy source for diabetics.

Moreover, even a modest amount of fat in each meal increases satiety, curbs sugar cravings, and provides a steady supply of energy between meals. After a couple of weeks of carbohydrate restriction, as your insulin levels drop, you start burning body fat for energy. You find that your waistline starts reducing.

So, restricting carbohydrate intake and substituting it with healthy sources of fat helps to correct insulin resistance.

Start by cutting down on major sources of carbohydrates like sugars (cane sugar, brown sugar, jaggery, palm sugar, agave nectar, maple syrup, high fructose corn syrup, and any processed food that contains them), grains (white rice, brown rice, wheat, quinoa, oats, barley, amaranth, sorghum, corn, millet), most fruits (or fruit juices or dried fruits), starchy vegetables (potato, sweet potato, taro root, parsnips, yam), alcoholic drinks, and sweetened beverages. Your carbohydrate intake will then be mainly from leafy greens and non-starchy vegetables.

Simultaneously add fats from natural and healthy sources. These are fruits (avocado, coconut, olives); tree nuts (almonds, walnuts, pecans, pistachios, macadamia nuts, Brazil nuts, hazelnuts, pine nuts); seeds (chia, hemp, flax, sesame, pumpkin, poppy, sunflower); nut butters (almond butter, peanut butter); oils (sesame oil, olive oil, coconut oil, avocado oil); dairy fat (ghee, butter, cream, half-n-half); coconut milk; and cold water fish (salmon, sardines). One type of fat that you should completely avoid is trans fat (partially hydrogenated vegetable oil), which has been linked to high blood pressure, obesity, and heart disease.

You also need an adequate amount of protein (50 to 80 grams per day depending on your lean body mass) but not much more. Vegetarians and vegans can get this from beans, lentils, soy (tofu, tempeh, natto, edamame, soy milk), nuts, seeds, cacao beans, spirulina, cheese, and yogurt.

Making these changes in your diet requires sacrifice, but you don’t need to starve or feel deprived.

Think Outside the Thali
You may have to visualize a meal that’s quite different from what you’re used to eating.

Instead of grains make a green salad or cooked vegetable the staple. Add cheese, avocado, nuts, fish, chicken or other source of healthy fat and protein, enough to satisfy you, but not make you feel stuffed. Try dal, sambhar, or rasam in a bowl as a soup with a tablespoon of ghee, butter, or coconut oil.

Here’s a salad made with fresh, organic, seasonal greens and vegetables that can become a healthy and hearty part of your meals. It is packed with folates, beta carotene, potassium, fiber, and healthy fats, and contains only a small amount of slow-acting carbohydrates. It is colorful, flavorful, and satisfying.

On Your Feet
The second part of correcting this metabolic imbalance is regular physical activity. Regularity is more important than intensity of the exercise, and improves overall health, not just reduction of blood glucose.

Just spending more time on your feet moving around your home or office is itself a big improvement. Walking to the local store can help slow down the pace of a hectic day. If you go hiking in a nearby park you will breathe fresh air and connect with nature. Do what your heart desires, whether it is a bicycle ride, swimming, dancing, puttering around in your home garden, or playing with your grandchildren. Some people prefer working out in a gym on a regular schedule. Others may choose a soothing eastern practice like yoga asana, pranayama, or tai chi, which helps both body and mind.

Be spontaneous and vary your activities so that exercise becomes an enjoyable part of your day.
After you have optimized your lifestyle and your blood sugars have improved, you may still need to take medicines to lower and stabilize them further. Don’t stop taking medicines without consulting your doctor. Herbal medicines can be used to complement allopathic drugs.

Ayurvedic Herbs
There are many herbs used in ayurveda for prameha. An ayurvedic practitioner can evaluate you holistically and help you choose the best regimen for overall health.

Among the most studied herbs for prameha is meshashringi (Gymnema sylvestre), which enhances insulin secretion, improves lipid profile, and helps with weight loss. Its leaves are astringent and bitter in taste and help to balance kapha dosha. The heartwood of vijayasar (Pterocarpus marsupium) particularly helps to reduce postprandial hyperglycemia. It is often boiled with other herbs into a decoction.

Clinical trials of another plant, mamejjaka (Enicostemma littorale), have shown significant improvement in both fasting and postprandial blood glucose. Yet another versatile ayurvedic medicine is the heartwood of daruharidra (Berberis aristata), which lowers blood glucose through decreased gluconeogenesis and also reduces oxidative stress.

None of these herbs can compensate for the onslaught of a high carbohydrate diet, though. Nor can exercise, no matter how long you labor on the treadmill to burn the excess glucose.

Minimizing the intake of carbohydrates is essential for reversal of Type 2 diabetes. You may have to give up some foods you love, but you will develop a taste for other foods, which will help sustain these dietary changes.

The two most common hurdles to following this regimen are: a belief that you need to eat some grains for energy, and  a deep-seated fear of fat. But after a few weeks when you see your blood glucose numbers going down, triglycerides dropping, belly fat reducing, improvement in blood pressure, and a sense of uniform energy and wellness, it will give you the motivation and confidence to continue.

Ashok Jethanandani, B.A.M.S., practices ayurveda in San Jose, Calif. He is a graduate of Gujarat Ayurved University, Jamnagar. www.classical-ayurveda.com.

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.

ashokjethanandani2016_inlibrary

Lettuce-Avocado Salad

Ingredients:
lettuce, washed, spin dried, and chopped    half a head, 100 g (red leaf, butter leaf, or romaine)
avocado: half, 75 g
cucumber, peeled if skin is thick, and diced: ½ cup, 50 g
red radish, sliced: 2 pieces, 50 g
basil or mint leaves: 6 leaves
Mix the ingredients and toss. Garnish with basil or mint leaves. Enjoy with some homemade dressing drizzled on top. For variety you may substitute other seasonal greens and vegetables. Some of my favorites are arugula, endives, jicama, celery, and red bell peppers. Pay attention to ensure that you are easily able to digest the raw foods you eat. Many people have trouble digesting raw vegetables like spinach, kale, chard, broccoli, and cauliflower, and should consume them in cooked form instead.

Salad Dressing
The oil, herbs, and spices in the dressing not only add to the taste, they help in easier digestion and more complete absorption of the beta carotene and other fat-soluble nutrients in the salad. Many commercial dressings contain vegetable oils processed with heat or chemicals. So it’s better to make small batches of dressing at home with the healthiest oils. Choose extra virgin, cold pressed, unrefined olive oil, avocado oil, or macadamia nut oil.

Ingredients:
olive oil, extra virgin, cold pressed, unrefined: 12 tablespoons (3/4 cup)
juice of one lemon: 4 tablespoons (1/4  cup)
black pepper, coarsely ground:1 teaspoon
black salt: ½ teaspoon
Mix all the ingredients in a dressing mixer or a small glass bottle. Shake well before dispensing.

First published in July 2016

Sankara Taps AI in Blindness Campaign

Long lines in front of eye doctors’ clinics do not include children who have never complained that they can’t see.

They are blind, and they don’t know it. Their world has always been hazy. They have never seen it any other way. Thousands of others are silently turning blind with diabetes, and don’t even know it. The challenge to help these people increases manifold when they are in remote areas, where no specialized treatment can reach them.

It is in cases like these, when a mere selfie can alert the doctors of impending visual problems, that Dr. Kaushik Murali, an  ophthalmologist/ eye surgeon at Sankara Eye Hospital Bangalore, is hoping artificial intelligence can be the answer. The problem, if nipped in the bud, can save the vision of the child or a diabetic individual.

Murali and his team have annotated 8,000 retinal scan pictures, including a range of people with vision problems resulting from diabetes. This will help identify the beginnings of this specific cause of blindness, a disease called diabetic retinopathy. ROP is caused by type-two diabetes. They are training the algorithm to identify key markers of diabetic retinopathy, such as nerve tissue damage, swelling, and hemorrhaging. The disease creates lesions in the back of the retina that can lead to total blindness. “Today the algorithm has 98 percent capability of identifying any patient who has a ROP change,” said Murali.

Seventy million people have diabetes in India and 18 percent of diabetic Indians already have the ailment, according to the International Diabetes Federation. By 2045, India is projected to have 134 million cases, making India the country with the most number of diabetics,

Many diabetic patients assume that early signs of the disease are simply minor vision problems. Some don’t even know they are diabetic. In these cases, where blindness often is preventable if diabetic retinopathy is caught early, loss of vision is unnecessary. Medications, therapies, exercise, and a healthy diet are highly effective treatments for preventing further damage if the disease is diagnosed early enough,

The system is trained by deep learning. The program’s diagnosis for each image is compared with that of the ophthalmological panel and the parameters of the function are adjusted to reduce the error margin for each image. This process is repeated for each image until the program can make an accurate diagnosis based on the intensity of pixels in the retinal image. The results are extremely encouraging. The algorithm showed similar — in fact slightly better — levels of sensitivity and specificity as a panel of ophthalmologists.

A similar campaign is spearheading the cause of preventing blindness in children. A lazy eye will be quickly caught by the machine and preemptive action planned.

Ritu Marwah is an award winning author, chef, debate coach, and mother of two boys. She lives in the bay area and  has deep experience in Silicon Valley start-ups as well as large corporations as a senior executive.

Sankara Raises Over $500K

The gentleness of the Sankara family and their quiet demeanor reached out and enveloped attendees as they entered the India Community Center in Milpitas on December 8. Sankara Eye Foundation’s annual banquet was held to raise funds for surgeries and to support construction of hospitals in Rajasthan, Madhya Pradesh and Telangana.

Student volunteers guided patrons toward steaming delicious food served by Mantra. Amritsari fish and almond tikkis along with melt-in-the-mouth tandoori paneer welcomed the guests. The aroma of hot sweet chai tea flavored the air mixing with the sounds of music sung by Smriti Jayaraman. Two dancers in bright Indian attire gracefully twirled on stage to familiar Bollywood tunes.

Picture: Founder and Executive Chairman of SEF, Murali Krishnamurthy , Mr. and Mrs. Ram Reddy (President TIE SV), Mr. and Mrs Jay Vishwanathan (ED TIE SV), Dr. Ramani(Founder and Chairman Sankara India).

Sankara’s target that evening was to raise half a million dollars. Ram Reddy urged the gathering to participate in the cause that changed people’s lives for as little as $30.

Dr. R. V. Ramani, the chief guest and founder Sankara Eye Foundation-India, explained that donations in part go toward setting up hospitals and building new operation rooms within existing locations. These new facilities work to become self-sustaining units. They operate utilizing the principle of an 80-20 split, meaning that for every one operation done for a client that pays, four free operations are performed for those in need at one of the hospitals run by Sankara in India.

India has the largest population of the world’s blind with over 55 million visually impaired individuals with 8 million of them totally blind. The Sankara team reported that each location completes 50 surgeries every day.

For a $1,000 donation, the donor can get their name imprinted on a wall reserved for founders, while for a donation of just $30 a donor can fund a single surgery.

Timely retinal scans prevent blindness in children. Dr. Kaushik Murali, a pediatric ophthalmologist who works at Sankara Eye Hospital in Bangalore said, “The two large public health problems that we have looked at are diabetic retinal disease and childhood blindness, especially amblyopia, where a child does not use both eyes equally. One eye is more dominant and the brain suppresses the other eye because of which development gets impacted. We can capture an image of the retina and have a machine learning (ML) algorithm identify the areas that have been impacted and help grade it. This procedure democratizes screenings and makes it available to a  larger number of people. In theory, we can take a picture of your retina with your Android phone and with some modifications run it through an app, and that app will tell you whether you need to see a doctor.”

Any improvements in the ability to identify amblyopia in children is crucial, especially when such improvements can help to broaden access to screening procedures for the majority of children. This is because children often simply adapt to changes in vision or visual impairment. Rather than identify the presence of an issue, they will rely more on one eye, moving further away or closer to the object they are viewing. Amblyopia results in reduced visual acuity, binocularity, depth perception, and contrast sensitivity.

This not only impacts the weaker eye, which is deteriorating, but also increases the strain on the other eye which is stronger. Strain caused by amblyopia can affect the child’s energy levels, fine motor skills, ability to concentrate, and can eventually cause social problems. These problems can lead to children losing confidence, failing in school, and being mislabeled as inept or aggressive.

Sankara’s work to combat amblyopia is happening across their multiple hospitals as well as through their work at partner hospitals.

Manjula and Viggy Mokkarala, who had seen Viggy’s father perform surgeries that altered peoples’ lives, chose Sankara as their nonprofit of choice. At the Sankara Foundation gala at ICC, they gave $100,000 toward this cause.

Similarly, Ameeta and Dilmohan Chadha donated a large sum to the cause. Chadha said he felt the tenets of his religion, Sikhism, sarbad da galah (welfare of all) and Vandh Chako, (share what one has with others), taught him to share what he had. Sankara, Chadha said, is the conduit through which we can practice our religion’s teachings.

As the evening progressed, the happiness of this shared experience of making a difference in people’s lives lightened the mood. The founder and executive chairman of SEF, Murali Krishnamurthy, broke into a song, “Jot se jot jalate chalo,” light one candle with another.

Ritu Marwah is an award winning author, chef, debate coach, and mother of two boys. She lives in the bay area and  has deep experience in Silicon Valley start-ups as well as large corporations as a senior executive.