The SHOCKING TRUTH About Pre-Cooked Food, Stress & Prevention | Dr. Ebenezer | Dr. Hema Sathish

Table of Content:

• Which phase is called as pre-diabetic?

• Pre-cooked food can lead to diabetes

• Diabetics in 30s

• How to prevent early diabetics?
• Processed food shoots up blood sugar levels  
• One lifestyle hack for youngster   
• How sugar free items hurt us     

• The best time to consume sugar is after a meal      

• Intermittent Fasting

• Keto diet    

• Symptoms of Pre-diabetes

• Lean Diabetic    
• Protein Rich Diet 

Dr. Hema Sathish: Hello, everyone. Here we have Dr. Ebenezer, who is a renowned general physician cum diabetologist. Welcome. So it is very interesting to have you over today because we were thinking about talking about diabetes. India is the diabetic capital already and the cases are going to increase some more. So what we were looking at is how we can prevent and there is a phase called pre-diabetes, which is lurking around for a long time, right? I mean, a patient before they become a full-blown diabetic, they are pre-diabetic for quite some time. So we thought we would break this down into smaller pieces, smaller fragments, so that every individual understands where they stand and how they can prevent themselves from becoming a full-blown or a bad diabetic really soon in life. So are we game for it, sir? 

Dr. Ebenezer: Yes. Dr. Hema Sathish: So please let me know what, which phase would you call a pre-diabetic? 

Which phase is called as pre-diabetic?

Dr. Ebenezer: I would further break down the pieces of diabetes with regards to prevention. I would put diabetes stage one as a primordial prevention, where somebody is at the high risk for developing diabetes. Then pre-diabetes and PEP.

Dr. Hema Sathish: That’s wonderful.

Dr. Ebenezer: So with regards to the primordial prevention phase that I had mentioned, that is the phase where we can make the maximum change. That is the phase where we can prevent someone from developing diabetes. Lifestyle diseases is usually mentioned as a gun pointed at what stage. So the gun is always there based on environmental factors, familial factors, genetic factors, but we choose when it triggers.

Dr. Hema Sathish: Oh, that’s wonderful. So we have a choice. Okay.

Dr. Ebenezer: With regards to the trigger, a primordial prevention is a phase where we choose it to not trigger even when we are 100 years old.

Dr. Hema Sathish: Oh, okay. Wonderful. So that’s very heartening, sir.

Dr. Ebenezer: It may be interesting to know that there are a lot of people, there are a lot of people, especially in communities around the world, Japan and other areas who do not develop diabetes at all.

Dr. Hema Sathish: I think they’re genetically coded, but in India also we were not genetically coded to have diabetes. But now it has become more like if you have your parents having diabetes and your chances are way higher. So where did that change happen?

Dr. Ebenezer: If I had to put it even the Japanese, say for example, we’re talking outside these particular communities, there is an increasing prevalence of diabetes. So it all depends on the lifestyle choices and what we take in and what we do. So two most important things, what we take in and what we do. With regards to what we take in, I think the maximum difference that can be brought about is by increasing the consumption of fresh produce and decreasing the consumption of pre-cooked or processed food. I would say pre-cooked and processed because I was saying the Japanese context, the pre-cooked food, that is people who take ready-made food items, they have an increased chance of developing all lifestyle diseases, including diabetes.

Dr. Hema Sathish: So that’s something new because processed food everybody talks about, even pre-cooked food.

Dr. Ebenezer: So why pre-cooked is the concept of antioxidants?

Dr. Hema Sathish: So is it pre-cooked food? I mean, I’m quite surprised to know that processed food we always talk about, but pre-cooked food, how can that lead to diabetes? 

Pre-cooked food can lead to diabetes

Dr. Ebenezer: Pre-cooked food, that is food that is already prepared and then reheated, that’s becoming a very common culture. It was in the West, I think now all of us are going into a therapy to chapatis, parathas, meal is an old meal. So what it leads to is the destruction of the already present antioxidant. So there’s nothing like freshly preparing cut vegetables or a salad or even a curry. So with freshly prepared food makes a big difference in development of diseases, apart from processed. So processed food, we all know, needs to be processed and needs to have a long shelf life. So there’s a lot of additives that invariably lead to damage in our body, leads to oxidative stress in the body and then leads to lifestyle diseases. If you see all lifestyle diseases, it’s one common pathway that is oxidative stress and oxidative damage.

Dr. Hema Sathish: That’s absolutely real because in olden times, as I said, genetically we are now, of course, our genes have changed a lot more, but earlier it was, we used to never get lifestyle diseases. I think especially India, we were actually having more of infectious diseases. Now the tables have changed. We are having more lifestyle diseases and the top of the list is diabetes.

Dr. Ebenezer: Diabetes is capital of the world. So that’s something that we need to work on. We don’t want to be the capital of the world.

Dr. Hema Sathish: That is not something which we should be proud about or can be proud about. So I think we should work towards helping more and more people overcome this.

Dr. Ebenezer: So a primordial, I would say, is touching audiences. So touching the group, working with the group that is going to school, working with the group that is going to college, especially working with groups who are preparing for competitive exams and preparing for competitive exams after the college studies because that is where diseases start to come in. So you might be wondering, how does that happen? So what we should encourage is our children, especially in schools and colleges, to have an active lifestyle. They should have a physical education period which is at least 40 minutes to one hour every day. And that should be followed contiguously. It’s not a weekly one’s activity. It’s a day. And as far as we remember, most of us used to have a garden or a road where all of us played for some time. Now the culture has changed. Everybody is inside the houses. The next most important thing is sweets. Savories used to be something that we had occasionally during festival seasons. And I know a few savories in the evening when we come home. But it has become the food of the young nowadays.

Dr. Hema Sathish: So eating sweet things also is one of the major reasons. I think the spikes in the sugars are very low.

Dr. Ebenezer: So the concept of glycemic variability, which young people are not supposed to have, they’re supposed to have a very stable sugar. You check their sugar pre-meal and you check it two hours or an hour after meal, they’re supposed to have a very stable sugar, which is not the case with youngsters today. So they might not have a high HPOC, but the glycemic variability starts very high.

Dr. Hema Sathish: That’s one heralding sign.

Dr. Ebenezer: Yes. So when we check the sugars, there’s a lot of variation in their sugars. Second most important is the stress that they might be subject to a lot of exams of competition.

Dr. Hema Sathish: That’s really getting too much. It gets on the kids a lot, lot more than they should go through actually.

Dr. Ebenezer: It sort of stresses them beyond what they should be stressed about.

Dr. Hema Sathish: I feel very bad for the children of today. I think in our times also they said we were stressed, but now I feel we were only telling about stress, but actually we were not stressed. Today’s child is really stressed.

Dr. Ebenezer: And I feel what happens with the stress is they forget their accessories. That’s the first thing that it goes off of.

Dr. Hema Sathish: I think they do what is comfortable for them.

Dr. Ebenezer: They do what is comfortable.

Dr. Hema Sathish: Not only that, I mean, when you are stressed, you’re trying to approach or do something which gives you comfort. So that’s what I meant. Not comfortable in the sense that they’re lazy and they don’t want to do it, but it’s just that you seek comfort. Everybody’s like that. It’s just normal human nature.

Dr. Ebenezer: But in the long term, it has its own problems. That’s the first thing that goes off. They’ll stop exercising. They stop playing. Forget about exercising. We stop playing. Playing is a wonderful thing. It is not just an aerobic exercise. It also incorporates strength training. So somebody is playing football. They’re not just doing normal running. They’re going to increase their pace. They want to decrease their pace. So it’s both cardio and then some amount of strength training also goes into each and every game, maybe a football or a volleyball, which is something that goes out as soon as competitive exams come. That is where primordial prevention fails. So I feel our population, which was a very hardworking population, has suddenly become a very knowledgeable population, but our health has gone out of the windows. So that’s primordial prevention.

Dr. Hema Sathish: And that itself is a big subject in itself, looks like. Yeah. Because in games, I also tell my patients who are younger, they always come and say, I joined the gym, I’m doing this, I’m doing that. I look at them very sadly and say, why would you go to a gym when you should go and play with your friends? And that’s one more thing. The psychology also of the child is altered a lot more nowadays. So the stress is more because you don’t share it with anybody because you don’t have anybody to share it with. So that’s again an issue.

Dr. Ebenezer: That’s one, I feel, a very important aspect of it, because the news is that the diabetes is going to increase dramatically. So it’s about 12 percent of the population with another 10 percent of the population with the pre-diabetic diagnosed or subclinical. But what the predicted population is expected to go out near about 30 percent.

Dr. Hema Sathish: Like alarming.

Dr. Ebenezer: Huge number.

Dr. Hema Sathish: And 10 percent in the pre-diabetic stage is like huge for our population. It’s too huge.

Dr. Ebenezer: So prevention to save our future population. Prevention for the present young people who are at work in software, who are at work in factories. And what has happened is even an active profession like farming has become, it’s not hard work as of now because of the machinery. It’s good development, but what we’ve lost is our health in the process. So with regards to prevention, that is preventing from becoming a diabetic from a pre-diabetic stage. So when do we call somebody pre-diabetic? Their HbA1c is between 5.7 to 6.5. Their fasting sugars are hovering around 100 to 126. And their after food sugars are around 140 to 200. Usually checked twice because we need to confirm that they are polygamy. And when do we check? So that’s a very important question. So now with the advent of health checkups, the question is are we checking too much?

Dr. Hema Sathish: Yeah, at times checking too much, but then one more thing is we are not checking early enough is what I think. Because everybody is like now with all the awareness cost, everybody in their 40s feel no, we should check ourselves regularly. But nobody is doing it in their 30s. But then there are so many diabetics in their 30s itself.                                                                                                                                                                 

Diabetics in 30s

Dr. Ebenezer: Exactly. So exactly. That is something that I would, any forum that I get, I try to bring forward. So the guidelines which are, when do we lay guidelines? We lay guidelines based on studies that is done on a large population of people. And we realize we are missing the health of large population of people because we decided not to test. So health checkups is mandatory. And I got to emphasize with the present increase in diabetes among school and college going children to start.

Dr. Hema Sathish: Oh my, that’s really early.

Dr. Ebenezer: So the question of whether we are checking early, I don’t think is a relevant question in the present day scenario with, as I had mentioned, the children’s lifestyle being very different from the previous generation. Just one generation before, maybe it would not have been prudent to check school sugar or sugars. But anybody over the age of 15 who is obese, anybody over the age of 15 who is sedentary with a significant family history of diabetes. So what a significant family history of diabetes when their father, mother or the grandparents have diabetes, that is a significant history of diabetes. They need to be checked for sugars from 15 years of age. And if the sugars are normal, ideally the next step has to be in the pre-college and the other checkups in the pre-employment state.

Dr. Hema Sathish: So now when you said we start as early as 15 years, so when 15 years you check and you find that they are in a pre-diabetic state, so what would you advise to do immediately? I mean to take action and make sure that they don’t become a diabetic. I mean 15 years means we are looking at how many years, another few, five, six years and they’ll be a full-blown diabetic and they’ll be under a lot of medications for that. So how do we prevent that? 

How to prevent early diabetics?

Dr. Ebenezer: As you have clearly mentioned, the problem with the pre-diabetes is multiple trials have shown that within the span of next five years, a significant proportion of the patients will become diabetic from pre-diabetic stage. If they are making small changes in their lifestyle, we can prolong it to up to seven to ten years, but that’s the maximum. We need to make a profound change in their lifestyle once we diagnose children as young as 15 years to be pre-diabetic. So what is the profound change? Diet, which would include a good amount of protein. So protein, that is something that us as Indian population, we don’t take. We have less protein. Sometimes the main source of protein for children is til-til, sambar and you know the idlis and dosas. They don’t even eat eggs. It’s not the parrot’s fault. Children refuse to eat, but we have to train them to take a good amount of protein, a good amount of vegetables and fruits. So there’s a lot of misconception of fruits being not very good for diabetes. That is not the case, especially in the pre-diabetic. They can take fruits. The things to avoid is processed food. So we need to train them from school stage that processed food occasionally as a treat is good, but never as a daily routine or even a weekly active.
Dr. Hema Sathish: I think processed food is one thing which shoots up the blood sugar levels real fast. Really high. Because they have the maximum glycemic index.

Processed food shoots up blood sugar levels

Dr. Ebenezer: So it’s the worst kind of food because the child eats it, he gets a big sugar spike, but the problem is that glycemic variability goes up and that affects not just the blood sugars, it affects the heart, it affects the kidney and appears to be a big change. So that is something that we need to make a big change. So adequate protein in the child, a lifestyle change where we avoid processed food, encouraging with let’s not say the child needs to go and do some hectic physical activity, a good amount of aerobic exercise like running, cycling, swimming with a little bit of strength training here and there. So good warm up and a little bit of jumping and skipping and all that will surely help the child to actually prevent the child from developing diabetes. So there are a lot of examples of children who are pre-diabetic at the 30, 35, 40 years they are not able to have diabetes. So that is one place where we can make a dramatic change in the child’s life or even a young adult like college going.

Dr. Hema Sathish: So that’s a lot of scope on that then and I think all parents should be alert of how they can take care of their child and make sure that they don’t push them to become a diabetic.

Dr. Ebenezer: And with regards to young adult population like the office going chaps or girls who are in their 20s, early 20s, that is another place where the sugar spike. So why it spikes, they are out of their home, they eat food outside. Again the protein content is very less or sometimes they think they are dieting or fasting and they miss out on the protein content with a good amount of antioxidants which kids miss. So they’re not at home, they’re not going to eat freshly cooked vegetables, they miss out on fruits. So that is where the problem happens and occasionally the lifestyle of a late night lifestyle, going for movies late in the night, coming back not sleeping properly, all that increases the oxidative stress on the body. And as I had mentioned before, oxidative stress is the common pathway not just for diabetes, it’s for coronary artery disease or heart attack, it’s the common pathway for cancer. So it’s a big problem.

Dr. Hema Sathish: I think that’s where all the diseases are on the rise.
Dr. Ebenezer: So again, there again, I would, for young adults, these lifestyle changes makes a big difference. Mainly avoiding processed food, good amount of protein and adequate amount of vitamin D, sunlight exposure, or if your vitamin D is actually very low, supplementation of vitamin D is also supposed to help at shown in multiple trials on and off that there’s a good chance of preventing diabetes with adequate vitamin D because of common pathways.

Dr. Hema Sathish: That’s quite interesting. And if you have to give one hack, I mean to a youngster who is like a now we see a lot of youngsters who are so aspiring and it’s so nice to see a population like that. But nevertheless, you know, after a certain age, they have either strained themselves too much, or they’re taking wrong decisions with life, lifestyles and also, what would be that one hack you would say like in a diet to make this change and you will be fine. So what would you say?

One lifestyle hack for youngster

Dr. Ebenezer: I would say to, I can’t put all my eggs in one basket, but just three things. A balanced diet. Minimum of at least half an hour of exercise, but you’re at least walking, walking, walking, simple exercise. Even at your work, you take a 10 minute walk after each meal. It brings your sugars under control dramatically. So that is a known fact. I think multiple trials at the end demonstrate that it really works like magic. It does. It does. It helps with digestion also. So at least 30 minutes of walking, but if possible, since you’re young, little bit more could actually help. And adequate rest. Adequate rest would be for a young person in their 20-25 year old would be at least seven hours to nine hours, seven hours, at least target eight hours that we would request.
Dr. Hema Sathish: And it’s not that they have to sleep, sleep in a sense, deep sleep only for eight hours or something like that. You can sleep for minimum at least six to seven hours is must. But apart from that, relaxing your body is also important because I think the cells rejuvenation happens only at that point of time. Though we know everything, we tend to say, no, we can brush it off because we are young and you’re more resilient, you’re more strong and you can go on. All that is fine. But somewhere you have to take a call where you should put the stop, I think. I always tell my patients when they are having hectic lifestyles and they want to achieve a lot of things in life, they always say do everything and eat. Eating outside is so common and everything. Then I always tell them to increase the antioxidant in their diets. That I felt is one good change if it takes you a long way. So if you can’t do it with fruit, vegetables, raw vegetables are good if you can take it. Otherwise, at least sticking on to two or three fruits a day should be very, very helpful. Sometimes many of them are very well-learned and they take a proper diet. They follow a lot of things. In spite of that, there is a problem. So I attribute it to the hidden sugars. I mean, would you align with me or would you want to contest this? Whatever is fine.

Dr. Ebenezer: Hidden sugars is an important part of the lifestyle, especially as I mentioned earlier, even small concepts like eating cornflakes in the morning, those things make your sugar loose.

 

Dr. Hema Sathish: You wouldn’t add the sugar, but the sugar is already there.

Dr. Ebenezer: It’s already there in the food. And if you think it’s okay, it’s healthy, but you’re not balancing. So the concept of balancing I think has come a long way nowadays and everybody is about you have to balance your carbs with fiber and you have to balance it. Clean and a little bit of essential fats that needs to be there. If we are not doing that in any of the meals, we’re just going to take carbs or hidden carbs for the sugars are going to spike. And any sugar spike may not have a high fasting or a high afterput sugars, but any spike immediately after the meal affects the parts. It’s really sad.

Dr. Hema Sathish: One is the cereals and of course, the drinks, energy drinks nowadays. They are supposed to boost energy and they’re sugar free also. But in spite of that, I want you to tell about the sugar free thing. In spite of it being sugar free, how does it hurt you?

How sugar free items hurt us

Dr. Ebenezer: The problem with just as going by the sugar free type and not seeing what each of the contents does to a body is that they miss on something known as stress harms, which is essentially being driven by any energy drink that we take. So we want to have something and we want to feel rejuvenated. But what we are doing is we have this evolutionary urge in us to do something fast, do something quick and then disappear from that place, which is the plight and fight response that we have. And we have to use it only when we are in a fine tub and you want to have a flight. It’s not something that we should have every moment.

Dr. Hema Sathish: On a regular basis, that’s not the right thing to do.

Dr. Ebenezer: So these stress hormones are being triggered by this so-called energy drink. So there’s a shoot up of proportisone, there’s a shoot up of adrenaline that happens and these hormones, they try to mobilize the sugar from all our stores and there is a sugar spine that happens. So we need to be quite aware of what each and every component of the sugar free drink does to us.

Dr. Hema Sathish: Actually, when you need more energy or you’re going to get yourself more energized, you’re telling your system make more sugar because I need it.

Dr. Ebenezer: Exactly, exactly. And we have hidden stores all over our body and the drink is going to shoot it up.

Dr. Hema Sathish: That’s something which we never break down. We think we know to read labels. We know what exactly we are taking and what we know that is right for us. But you never know what it does after it enters your system. So beware whenever you’re reading the label, what else it can do to you and how it can hurt you. So I have seen a lot of WhatsApp messages. Our WhatsApp Academy teaches us a lot of things and I’ve read also that, you know, the best time to consume sugar is after a meal because that helps increase the dopamine level in your system. To a certain extent, it’s true. I want you to explain that a little more. Yeah, this is actually that’s true.

The best time to consume sugar is after a meal

Dr. Ebenezer: So what happens is we got to balance the sugars that we’re going to take later with a good amount of fiber. So take your vegetables first. Obviously, you need essential fats. So going oil free completely is not the healthiest thing, but you need the essential amount of oil. So mix that and then you can take your carbs. There’s the occasional dessert on, you know, with a little bit of sugar. So what happens is by the time the sugar enters the body, there’s adequate amount of the so-called incretin that is produced, the GFP-1 that is there in the body. So that is going to give a good amount of insulin that is going to buffer the sugars that we take. So the best time to take sugar is the end of the meal.

Dr. Hema Sathish: But we have to keep in mind that it is not end of a processed meal or something you’re binging outside. So you’re on a fast food joint and you have understood this that after a meal, you can take your sugars or your desserts. It’s fine once in a while, but not on a regular basis that you have a binge diet on something really not good enough. And then you say, no, it’s good for dopamine. No, I think that’s a wrong concept. So you have to be clear on what food to take first. So you have to have your fibers, you have to have your fats, and then you have to have your little bit of carbs. Then you can add this to your diet and then make yourself feel good. And the dopamine release is amazing, I guess, when you do that. There’s such a big fad about different types of diets, right? So there is keto diet, then there is intermittent fasting, then there is like, what is that called? One mad, two mad and different types of meals for diabetes, especially. What’s your take on that? I want you to elaborate a little more on all these diets.

Intermittent Fasting

Dr. Ebenezer: With regards to intermittent fasting, so intermittent fasting, the ideal population to start intermittent fasting will be a pre-diabetic or a diabetic patient. So why would it be ideal to them? In case of intermittent fasting, the problem in these patients are two things. One, there is insulin resistance. Insulin is not able to work in the body because the cells are not responsive to insulin. And the second problem there is insulin deficiency that is there in these patients. So what does intermittent fasting do? So say, for example, 8 hours of meal intake and 16 hours of fasting or even 6 hours of meal intake and 18 hours of fasting. So what it does is it gives two things to the body, like how in a well the water starts seeping, it will give it time. So the insulin secretion is adequately loaded in each of the pancreatic beta cells, which can act when we are going to have the meal. That’s the first step. The second step, when we are fasting, so what happens is body realizes that we have less glucose in the body. So what it does is it increases the insulin sensitivity of the cells, whereby now the cells which didn’t want the insulin to come near them suddenly say, come open our doors, bring all the sugars inside. So that way the insulin sensitivity also increases. So both these dramatically affects in the sugar control of these patients. And the second important thing is I would like to mention with regards to intermittent fasting is you need to be aware there’s also the concept of a nominal or a total calorie need of each person. So the problem with intermittent fasting in patients is they think that they can eat whatever they want in the six hours. It is not that. So you have to keep in mind the amount of calories that you’re going to take. You’re trying to eat a percentage of that, say for example, 70, 80 percent of that within the six hours or eight hours. We’re still going to keep a little bit of calorie deficit and follow intermittent fasting, which is actually in a lot of patients, we realize that their sugars come down well, their HbA1c comes down well and they’re able to come down on their medicines, bring down their loads of medicines to a good extent and the pre-diabetics, we’re able to reverse.

Dr. Hema Sathish: That’s great news, right? But I think when you’re eating, you have to eat judiciously again. You have to eat your fibers and then your right amount of carbs and not eat a lot of processed food even then, right?

Dr. Ebenezer: Correct. So, you miss your balanced meal any time. In a glycemic variable, as I said, any time, however much you follow intermittent fasting, your endorphins, that is the heart, brain and the capillaries is going to get affected. So, balanced meal even with intermittent fasting is the most important thing.

Dr. Hema Sathish: So, ultimately, the balance of your diet is primary importance apart from whatever you do practice. And what about the keto diet? They say high in protein and I have seen a few of my patients, actually, I saw patients with a lot of skin problems after because what they have done is they have no antioxidants at all in their diet. They are a lot of, I think our genetic coding is not for that kind of a meal is what I presumed. What would your take be on that?
Keto diet

Dr. Ebenezer: Keto diet is a cheat diet. It’s not a cheat meal, it’s a cheat diet. So, what we’re trying to do is we’re going to trying to cheat the body into utilizing our own fats and we’ll making it forget about carbs. It does work. We do see a lot of patients have dramatic weight loss because of keto diet. But what is the problem? You can’t keep on cheating your body for a long time. I do have personally, so with regards to studies, maybe the numbers are not very high to quote the effects and the side effects. But personally, I do have seen patients who have developed cardiac complications. That’s really alarming because of the high fat intake. So, you need to, they need to first consult their physician, check their cholesterol levels before trying keto diet because somebody who has high triglycerides already, they’re going to take so much of fats in their diet and they’re basically replacing their carbs with fat. So, that is something they need to be careful about and it’s not a long-term solution. And anybody who, we talked with anybody who has actually done a keto, short-term weight loss for a marriage or for one of those things might be okay. But then long-term, they can’t sustain it and body is not going to let them sustain it. Best is a balanced meal. And if you’re a bit diabetic, you can practice an intermittent fasting of say, for example, 8 is to 60, 6 is to 18. That might be like softer per standard.

Dr. Hema Sathish: So, end of the day, the diet has to fit you, your lifestyle and what you’re actually made out to accept, like tailor-made clothing, right? So, not everything, one size fits for all. So, that applies for diets also. We talked so much about pre-diabetics, but apart from blood test, is there a way to find out like, how do I know that I’m a pre-diabetic when I don’t feel anything wrong with me? So, what are the symptoms I should look for? And when do I run to the doctor and say, oh, I do not know I should get myself checked. So, what should you look for?

Symptoms of Pre-diabetes

Dr. Ebenezer: The symptoms of pre-diabetes would revolve around the insulin resistance. So, the first symptom of insulin resistance is an abnormal fatigue that patients might have experienced. So, they might be doing their routine activity, but they feel they’re very tired in the evenings. They used to be so active in the evening, suddenly they feel so tired, they’re not able to go for their regular walk. So, that’s because the body is not, has high sugars, but is not able to utilize the sugars due to insulin resistance. The second symptom is the sudden weight gain that they might have because of insulin resistance, because the body preserves the stored fat, because it’s not able to use sugars when all the sugars are elevated in these patients. Third is dermatological signs. They might have a skin tag, they might have acanthosis, that is the pigmentation in the skin. So, that is another manifestation that a lot of them have, even when their experience is very borderline.

Dr. Hema Sathish: It’s a heralding sign also, especially when they have it in their younger age, you see very skilled, and then we have to tell the parents, but how much action they take, I don’t know. But nevertheless, it’s our duty to tell them, but I think they find it very scary, because when they test the bloods, there’s nothing.

Dr. Ebenezer: Yeah, yeah. So, they’re like, why is somebody telling my child will develop diabetes? But there is a very high chance of developing diabetes. Menstrual irregularity in girls with an underlying PCOS is something that again needs to be taken care of, because what we see is PCOS, there’s a good chance that they might become diabetic. So, preventive action on when these symptoms develop, their HbA1c might be just 5.7 or 5.6, it might not even be more. But when these things develop and these symptoms develop, when they take action, there’s a big dramatic difference that comes.

Dr. Hema Sathish: But explaining to the parent and making them understand that they could become a diabetic really offends them very badly, because they don’t correlate at all. And explaining the law, I mean, now patients do understand and accept it, but there has to be awareness on this also.

Dr. Ebenezer: Especially when parents don’t have diabetes, they tell their children, will develop. It’s very difficult for them to understand.

Dr. Hema Sathish: I always request the parents don’t send them to the gym because it’s so sad. These kids don’t like it, you know, going to the gym and having an instructor to say what they have to do. So, I tell the parents, ask them to play some games and they look at the kid and say, she doesn’t play any game. Because I think nowadays, the schools also don’t insist on any games and the parents have also always not asked their kids to play games. Probably that is one of the reason is what I thought.

Dr. Ebenezer: One of the main reason is what I feel.

Dr. Hema Sathish: It’s not only obesity, right? So, I have seen patients who are slim and trim and then yet are diabetic. And sometimes we have had very thin PCOS also. We have seen several cases like that. So, and always they are the toughest people to treat actually, because they are more resilient to the treatments given. So, what would you like to, I mean, your experience on patients like that?

Lean Diabetic

Dr.Ebenezer: Onset of lean diabetic is something that is very unique to the South Asian population, that is us. West doesn’t see much of it and diabetics, unless they have type 1 diabetic. So, lean diabetes is very unique to us and most of our population actually would be a lean diabetic. So, we see a list of patients in diabetic OPD, most of them are lean diabetic. That is partly due to our genetic makeup and also due to our diet. So, just because somebody is thin doesn’t mean they are non-diabetic. And just because somebody is obese doesn’t mean that they are going to become diabetic. But obesity leads to other components of Metabolic Syndrome also. So, need to be careful. And that is again another reason why each forum I say we have to scream, we have to scream.And the earlier, the better to scream.

Dr. Hema Sathish: There’s so much of a fad about protein, protein, protein rich diet. But, you know, sometimes some older people especially, they come and say, what is the big fad about protein? I mean, we had vegetarian food only, we had all, we have good protein, we had good protein in the diet. So, where is the miss, right? Like in today’s generation, where are we missing out?

Protein Rich Diet

Dr. Ebenezer: Because the protein intake and compared to the previous generation and this generation and why we lot of times require supplementation, present generation is the diet pattern has changed. So, our snacking pattern has changed. So, where there used to be a groundnut and boiled groundnut and, you know, dals and Bengal gram and all that made into some form of curry or some sweet or… So, the protein content in that way was balanced. We ate the same dal and sambar for rice, correct? But then there’s snacking and all that was quite different from what we have in the present day. So, that I think is the major difference in diet from the previous generation to this generation. Lot of times do require supplementation, but at least a dramatic change in the diet pattern.

Dr. Hema Sathish: Thank you, Dr. Ebenezer. It was wonderful having you and there is so much of information which you have given in this short time. I think there’s a lot more to hear from you. Hope to see you soon again. Thank you.