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Toxic cocktail 
Panel discussion on lifestyle diseases: India positioned on the wrong side of the health index, warn experts
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Be it the luxury cars we drive or the houses we live in or the vacations we take or the clothes we wear—the signs of India's economic prosperity are all around us. They may be big and bold, but definitely not always beautiful. A nation's wealth is, however, measured by the health of its citizens rather than by the stone, brick and mortar symbols. It is the way our bodies have responded to the changes brought about by a growing economy and globalisation. Today, we have an unhealthy diet dependent heavily on packaged and processed food and little by way of fibre or nutrients. Children are increasingly being reared on colas, chips and burgers. Physical activity used to be an integral part of our routine, but now most of us spend the day and sometimes even the better part of the night chained to our desk. That leaves little room for physical exercises. The frenetic pace of our lives has contributed to our rising stress levels, while the  consumption of alcohol and tobacco has gone up. All these factors together have created a toxic cocktail, fuelling incidence of lifestyle diseases like diabetes and coronary artery diseases across the country.
India has one of the highest numbers of diabetic patients in the world and just like our growth rate keeps increasing, so does the incidence of coronary artery diseases. By 2015, heart attack could well be the single biggest killer in the country. Reports also indicate that more than 20 per cent of urban Indians are either obese or overweight. More and more young Indians are falling prey to these killers.
Lifestyle diseases, their causes, increasing incidences and how to prevent them, were raised at the panel discussion on medical challenges of India's new lifestyle at THE WEEK Health Summit held on December 7 and 8. Moderated by writer and columnist Shobhaa De, the panel boasted esteemed names such as Dr Naresh Trehan (chairman and managing director, Medanta - The Medicity, Delhi), Dr Gaurav Gupta (director of endovascular and cardiovascular neurosurgery, Robert Wood Johnson Medical School, USA), Dr Ashok Jaryal (professor of physiology, All India Institute of Medical Sciences, New Delhi), Dr N. Subramanian (senior consultant in urology, Indraprastha Apollo Hospitals, New Delhi) and Dr Jame Abraham (director, Mary Babb Randolph Cancer Center, USA).
Packed with observations and some practical tips, the session also had the audience in splits at times, thanks to the banter between the doctors and their observations about the Indian way of not just living but also celebrating!
De kicked off the session by asking whether lifestyle diseases by their very nature are a problem only of the elite. Abraham answered by explaining that lifestyle diseases are impacted by tobacco use, exercise and diet. “These factors are applicable to everyone, and not just the elite.” But, he added that the diseases stemming from these factors can be divided into those affecting the affluent and the poor. Earlier, the ill-effects of an affluent lifestyle were restricted to adults, but Jaryal pointed out that these diseases have started affecting the lower age group. “In fact, 80 per cent of the literature today is on childhood obesity,” he said. This is a particularly worrying development because it impacts the metabolic imprint of a child, which cannot be controlled by drugs. Parental awareness and adequate importance given to play time in schools are two principal factors, which can go a long way in combating this menace. “What we have realised today is that a child goes to school, comes back and heads out for more classes. There is little free time for physical activity,” Jaryal said. The need to introduce healthy habits, be it eating or physical activity, in school itself so that children grow up cultivating them was repeated by the panelists throughout the discussion.
The world over,  stress has been identified as one of the biggest factors that influence our health. It impacts the way our body functions and can wreak havoc, if ignored. In India, young men develop heart problems and women grapple with early menopause. Are these directly related to the lifestyle choices being made, asked De. She wondered whether the youngsters realised that they are getting affected by stress, which in turn is dictated by the kind of lifestyle they adopt. Responding to this, Abraham said India is a transition economy with one section of society moving into a developed setting. There would be lifestyle changes in such an economy. These changes have a direct impact on stages like puberty, the age at which it happens and even menopause. And when the impact is negative, this contributes to an increase in the incidence of cancer. Stress can alter hormonal expression and one of the offshoots of this could be cancer.
But it is not so simple explaining things to youngsters. Giving her own example, De said she had raised six kids and it is very hard to advise them. “Kids today hold jobs, are successful, well travelled and smart. They want it all and believe they can have it all.” She asked Subramanian whether it was possible for someone to have it all without giving something? “It comes to the basic question of overdoing everything and advice is unlikely to change that. But what can change is knowledge (sic),” he said. Subramanian highlighted the importance of inculcating healthy habits when the child is still in pre-school. “Even if people are aware, they don't necessarily follow healthy behaviour. But I am less likely to cheat than if I was not aware at all.”
Knowledge will be the first step. It is, however, important that this knowledge is not limited to people like us but rather it is shared with those who don't have access to it. Referring to the Health Box concept from Europe, which involved educating semi-urban and rural people about the ill-effects of bad eating,  Subramanian advocated its use in India, too. “We need to target the semi-urban, rural, less educated and those who did not have enough resources to know about the ills of bad eating, poor exercise, etc. Once you educate them, you can create the right attitude.”
Though on the rise, stress is still not the biggest killer in India today. That honour belongs solely to coronary artery disease, pointed out Trehan. Several factors ranging from genetic propensity to prosperity to sheer laziness make it easier for this stealth assassin to creep up on us and wreak havoc. “The latest data which we have shows that 12 to 15 per cent of the urban population and anywhere from 6 to 8 per cent of the rural population have developed cardiovascular problems,” he said, when asked by De whether lifestyle diseases are just an urban phenomenon or if they are now percolating down to the tier two and three cities.
Trehan pointed out that while there has been an increase in affluence, there has been a steep decline in our physical activity. “[This combined with] an inability to adapt ourselves to new realities, which is that our diet, instead of getting more lean is becoming richer.” As we transitioned to a different lifestyle with different levels of activity, we should have also made the shift to suitable dietary habits which the west, as Trehan pointed out, has done to a great degree. “The incidence of coronary artery disease in the US is below 5 per cent, whereas we went from 8 to 10 per cent and is now above 12 per cent.”
Indians also have a genetic propensity towards cardiac diseases with higher levels of cholesterol and lipoprotein. This factor, combined with diet and lifestyle, has ensured that the average age at which heart attacks occur in India has decreased, while the world over it has increased. Even appraising people of these factors does not lead to more awareness. Trehan recalled how he often had told the children of his patients, especially those who came for tertiary coronary artery problems and have a family history of it, to get a screening done for risk factors. “But, I don't think even 10 per cent listen to this advice,” he said. When it comes to diet, we have to realise that there will always be more occasions for feasting. “Instead of eating a bowl of gajar ka halwa, stop at two spoons,” he said, while advocating healthier methods of cooking at home. To make an informed choice, it is important to be aware and the media can play an important role in spreading this awareness, said Trehan. The first step towards monitoring your diet, according to Trehan, begins with a weighing machine. “If you own one, you have won half the battle. When you weigh yourself everyday you will be able to monitor what went wrong in the past 24 hours and then correct it in the next 24 hours.” De lightened the moment by mentioning how her husband weighed himself every day and she had always declared him neurotic, but knows better now.
The next focal point was the obvious dichotomy that exists in Indian society today. That is, even when we suffer from lifestyle-related ailments, the gym culture has become rampant across the country. “In India there is an emphasis on toned bodies, popular culture insists that's the way forward, all the guys and girls in our movies look terrific,” De said. But Jaryal pointed out that the gym mania persists not out of a desire to be fit and healthy but rather to look good. “We want to look good and we want to look good quickly. We go to the nearest gym, pump up without taking care of our diet or taking improper diet just to boost our muscles. We don't look at our body structure. There are not many proper trainers and that ultimately affects the whole muscular-skeletal system. This can lead to orthopaedic problems.” He added that the trainers in gyms are not well trained, and regulations like health check ups for applying members need to be included in the gyms. Gupta pointed out that in the west children go to the gym because they see their parents do it and accept it as part of their day-to-day life. “They are not healthier but their reasons for going to the gym are different. When your children see you do it, they realise it's important and follow in your footsteps.”
Meanwhile, Abraham steered the discussion towards tobacco, which he stated will be the number one killer causing cancer in both India and China. According to him, one billion people will die of tobacco in this century. “If the price of tobacco is increased by 10 per cent, you see a 5 per cent decrease in its consumption. In the US, from 1970 to 1990, the price of tobacco went up and the consumption went down. Now the entire tobacco focus has shifted to developing countries and the lobbies are working hard here,” he said. But rather than the deprivation and reward method, the panelists agreed on awareness being a more effective way of getting the message across. But, as Subramanian pointed out, it needs to be emphasised that it is not enough to be preventive. Due to our genetic propensity, there are certain things which cannot be prevented but early detection provides superior outcomes.
When De steered the discussion towards alternate forms of treatment like yoga and acupuncture, Gupta termed these as tried complimentary systems of medicine which cannot be disregarded. Both yoga and meditation, Subramanian stated, were beneficial for stress and anger management. According to Abraham, studies conducted in the US revealed that exercises cut down the chances of cancer recurrence by 30 to 50 per cent while yoga actually reduced its side affects like fatigue, nausea and pain. Said Trehan, “It prevents your body from ageing. The first evidence of ageing comes from stiffening or shortening of ligaments and if you do yoga regularly, flexibility of your body is a huge advantage. It breaks the stress cycle.”
While the panel wrapped up its discussion with these thoughts, the floor was thrown open to the audience who had several questions regarding yoga, meditation and moderation. A member of the audience wanted to know the panel's view on alcohol consumption and Trehan admitted that it was a tricky question. “Up to 60ml of liquor or 120ml of wine four times a week is not detrimental. It helps you de-stress.” However, he added, amid laughs, if you skip three days it does not give you the license to have four glasses in one day.
The doctors briefly touched upon the importance of rotating cooking oil every three months since each oil had its own form of toxicity in spite of beneficial qualities.
The session drew to a close with Trehan recommending that high-risk patients be sifted and treated rather than advocating deprivation for the whole society. In a country steeped in love for all things rich, heavy and sinful, perhaps this could be the first step towards a healthier nation.




Lifestyle diseases are impacted by tobacco use, exercise and diet. These factors are applicable to everyone, and not just the elite. Diseases stemming from these factors can be divided into those affecting the affluent and the poor.
Dr Jame Abraham
Director, Mary Babb Randolph Cancer Center, West Virginia University, USA.


In the west, children go to the gym because they see their parents do it and accept it as part of their day-to-day life. When your children see you do it, they realise it's important and follow in your footsteps.
Dr Gaurav Gupta
Director, endovascular and cardiovascular neurosurgery, Robert Wood Johnson Medical School, New Jersey, USA.


When you weigh yourself everyday you will be able to monitor what went wrong in the past 24 hours and then correct it in the next 24 hours.
Dr Naresh Trehan
CMD, Medanta - The Medicity, Delhi.


We want to look good quickly. So, we go to the gym and pump up without taking care of our diet. There aren't many proper trainers and that affects the whole muscular-skeletal system.
Dr Ashok Jaryal
Professor of physiology, AIIMS, New Delhi.


We need to target the semi-urban, rural, less educated and those who did not have enough resources to know about the ills of bad eating or poor exercise.
Dr N. SuBramanian
Senior consultant-urology, Indraprastha Apollo Hospitals, New Delhi
.

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