Diabetes: At the heart of it

Heart diseases are 3 – 4 times more prevalent in diabetics than non-diabetics. It is the predominant cause of complications and death in these patients. You may wonder, what is the reason for such a close association? This is because they share common risk factors like obesity and increased cholesterol and triglyceride levels. Diabetes, heart disease, obesity and increased fat levels form a vicious circle that can only be broken by lifestyle modification and a strong will power.

Every diabetic should go for a complete health check-up once a year to rule out complications. Most people refrain from doing tests fearing their costs.

But investigations are the cheapest way of treating diabetes because once complications set in, the cost of treatment is likely to be high.

How do you prevent heart problems in diabetics? The answer to this lies in understanding the risk factors.

The risk factors that cannot be changed:

• Age [you cannot reverse your age]
• Gender [possible to change but doesn’t affect your risk]
• Genes [you surely cannot change your biological parents]
• Family history of heart disease: a heart attack before 55 years in a male relative or 65 years in a female relative.

The risk factors that can be changed:

• Hypertension/high blood pressure [BP]
• Smoking
• Overweight/obesity
• Psychological stress.
• Dyslipidemia [increased cholesterol/triglycerides]

Let’s understand these in detail to manage them better.

Hypertension

Hypertension is present in 70 per cent – 80 per cent of diabetics. About 60 per cent of diabetics develop hypertension by the sixth year of having diabetes. If hypertension is so rampant in diabetics; heart disease cannot be far behind. Hence, diabetics should aim to maintain a blood pressure of 130/80mmHg [read as 130 over 80].

Weight management

Intensive lifestyle management is vital in keeping blood pressure under control and weight reduction is the cornerstone of it. I know that it’s easier said than done. However, don’t try shortcuts to weight loss or get lured by advertisements that tempt you to ‘lose 5 inches in a month’.

Exercise

Increasing physical activity and limiting your calorie intake are important lifestyle measures for diabetes. Diabetics should engage in brisk walking or isotonic exercise for at least 30 minutes every day. Walking, swimming and yoga are the best forms of exercise for the elderly. My advice would be to choose a sport of your choice that you enjoy. Dance is another form of exercise that gives immense pleasure.

Diet

Diabetics should consume a diet rich in fruits and vegetables and low-fat dairy products with a reduced content of dietary cholesterol as well as saturated and total fats. The diet should also be rich in potassium and calcium content. Salt [sodium] should be reduced to no more than 2.5g – 3g/day. Alcohol content for regular drinkers should be limited to a maximum of two drinks, thrice a week.

Cholesterol

There are two types of cholesterol, the good [HDL– High Density Lipoproteins] and the bad [LDL– Low Density Lipoproteins]. It is important to keep bad cholesterol in control with diet, exercise and medications.

Smoking

Smoking is one of the major avoidable causes of premature death. Regular smoking reduces life span by 7.5 years. There are about 94 million smokers in India and 2,500 die of it every day. Two forms of smoking are common in India—beedi and cigarettes. Both have a similar risk of heart attack. Once you stop smoking, your risk of heart attack reduces by half within a year.

Cessation of smoking is a collective effort and though nicotine replacement therapy is available, a strong will power is what is required. When you can stop smoking after a heart attack, why not before it?

Abdominal obesity

Indians are often described as ‘thin-fat’ because they look thin but have a large amount of visceral fat—the fat in the abdomen over the intestines and liver. [It’s not the same as the fat below the skin that bulges out] Such fat leads to abdominal obesity, a major cause of heart attacks.

Why are we getting overweight and why has obesity become a pandemic?

• Cheap, plentiful edible oils have fuelled dietary changes in us. Marketing gimmicks lead us to believe that if we use a particular oil, then it doesn’t matter if we use it in large quantity. Here lies the catch. Irrespective of the type of oil used, a person should not consume more than half a litre of oil per month. So, a family of four should ideally use two litres of oil per month. Add a little more to it if there are children in the family or frequent guests. Remember, more than the type, the amount of oil used matters.
• There is an increase in consumption of animal source foods such as milk, cheese, butter and ghee and a shift towards energy-dense diets.
• Higher consumption of sugar and fast food.
• Altered physical activity patterns. Increasing desk jobs, dependence on automobiles and television are also causes of less calorie expenditure, leading to further inactivity.

To achieve a healthy weight, the energy expenditure must be more than the energy intake. In short, we need to burn more calories than we take in per day.

Indians have a genetic predisposition to obesity. Hence, the cut-off for Body Mass Index [BMI] for Indians is 23 and the ideal waist circumference is less than 80cm in women and less than 90cm in men. Exercise and diet is the best way to keep weight in control.

To conclude I would say, “The eye can see what the brain knows”. This knowledge of the interrelation between diabetes, obesity and heart disease will help us change our stressed and laid-back lifestyle to a more holistic one.

This was first published in the November 2011 issue of Complete Wellbeing.