Diabetes is currently one of the fastest spreading Non Communicable Diseases (NCDs) in the world with the numbers increasing rapidly. To quote some mind boggling figures from the International Diabetic Federation in its latest report early this year, every seven seconds someone dies of diabetes or its complications with 50 % ( 4 million in total per year) occurring under 60 years. A main obstacle to seeking treatment early for this chronic disease for which there is still no cure and has aptly been described as the Mother of all diseases, due to its close links to many other non communicable diseases (NCDs) are the myths that surround the disease.
One of Sri Lanka’s leading consultant endocrinologists and diabetologist, Dr Prasad Katulanda shares some of these myths which specialists like him are currently battling to overcome by awareness raising and education programs, while giving us some useful tips on how to avoid getting the disease.
Excerpts from his interview with the Sunday Observer …
Q. As the fastest spreading non communicable disease in the world, where is diabetes ranked in Sri Lanka?
A. According to estimates it affects more than 20% of urban adults and over 10% rural adults. A direct comparison with other NCDs is difficult as there is no recent study looking at all these together.
Q. Do you see a sharp rise in the past two decades to cause alarm of an impending diabetic epidemic?
A. Of course. If you take the Colombo district it was 18% in 2006 while recent studies indicate it as over 25% among Colombo adults. Since an island wide study is not completed yet it is difficult to speculate on the rural scenario. But a study from Jaffna also has shown alarming figures.
Q. Who are the most vulnerable groups – Everyone? the elderly? the young?
A. Previously, diabetes was commoner in the elderly. Now it seems to be common among the middle aged. We see more younger adults being diagnosed. But since diabetes is a chronic disease the numbers may be higher in the older groups.
Q. Gender wise, are more females than males at risk? Why?
A. Among South Asians such as the Indians, Pakistanis and Sri Lankans obesity is much more common in women. This may be the reason why women have more diabetes than men compared to the West.
Q. What do you see as the topmost contributory factors that drive the diabetes surge?
A. Obesity. South Asians get diabetes at a lower BMI. But their intra-abdominal or visceral fat which is the dangerous fat is much higher than the other ethnic groups. Research has shown that when obesity combines with sedentary behaviours the risk increases exponentially.
Q. Are there different types of diabetes?
A. Yes. There are several types - Type 1, Type 2, Type 3 or rarer specific types and the pregnancy associated or gestational diabetes.
Q. What are the most common types prevalent in Sri Lanka?
A. Type 2 is the commonest and affects about 90% in our part of the world. Type 1 is more common in children and youngsters and is common in the northern hemisphere of the world. Type 3 comprises many subtypes. Some of them occur due to genetic issues in the insulin producing beta cells in the pancreas and some due to issues in insulin action. When the pancreas gets diseased due to pancreatitis or tumour and is removed, one could get diabetes. Some medications like steroids also cause diabetes.
Q. While most people are familiar with the term ‘Diabetes’ due to sustained awareness raising programs by the Health Ministry, there is a growing number who still cling to age old myths and misconceptions regarding the origin of the disease, and how it can be cured with herbs and other alternative therapies, such as acupuncture, touch system or meditation. As for the popular notion that diabetes is a sweet tooth disease and caused by eating too many sweet foods, do you agree? If not why?
A. Taking sugary drinks, food and high carb diets make one vulnerable to diabetes. But it is not the only cause. Genetic susceptibility (whether your parents and siblings have diabetes) and sedentary lifestyle also is a cause.
Q. Some people insist that eating sweet and starchy foods don’t necessarily lead to diabetes. Yes or No?
A. If one eats these unhealthy foods the risk definitely is high. Again since diabetes is multi factorial everyone may not get it, especially those with lower risk and who are very active.
Q. Another myth is the belief that diabetics must only eat diabetic foods. Does that mean sugar is completely ruled out? Or are there safe alternatives?
A. There are no absolute good or bad things. Sugar and sugary foods and drinks need to be minimized. Carbohydrates should be matched to physical activity and more unrefined carbs and green veg and fruits are safe.
Q. The belief that dark chocolate and coffee beans lower the risk of diabetes. True or False?
A. They don’t cause an increased risk but nothing in excess can be good. For instance, too much chocolate can make you fat, too much coffee makes it difficult to sleep and increase blood pressure, etc.
Q. What about cranberries, nuts, almonds?
A. Nuts and almonds in moderation are good snacks in between meals.
Q. According to belief some Sri Lankan fruits and vegetables should be avoided by diabetics e.g. pumpkin, ash plantain, carrots, yams, jak fruit, coconut, certain types of banana, pineapple and too much papaw. Do you agree?
A. As I said there is no absolute nos. These are high in carbohydrates and therefore could increase sugar in diabetic people especially, when taken with other starch foods like rice, bread, and flour based food. So you need to exchange portions, for instance if you are taking jak fruit better not take much rice.
Q. Karawila and some leafy vegetables are said to have a beneficial influence in reducing diabetes. Some take it daily. Other fruits like ambarella, lovi and nelli are also said to have similar benefits as they have high vitamin A and D. Do you agree?
A. Karawila has sugar lowering ability but it can cause hypoglycaemia when taken with other medications. So you need to be careful. Other fruits in moderation is helpful.
Q. More on food – eating at least 400 gr or five portions of fruit and veggies per day reduces the risk of diabetes. Yes or No?
A. I would say yes to green vegs and fruits. High starch fruits and veg may not be so.
Q. What about those who inherit diabetes or who are born with Type 1 diabetes ?
A. They can be controlled with insulin or medications and lead good lives with proper guidance.
Q. Another myth is that diabetes can be cured . Yes or no?
A. Diabetes cannot be cured. But it can be controlled. Perhaps in very obese persons diabetes may get cured with bariatric surgery. If a newly diagnosed loses substantial weight with strict diet programs diabetes may be controlled without medications - we call this remission.
Q. Elders with diabetes often take the fatalistic view that the disease would eventually rob them of everything and they end up with foot ulcers leading to leg amputation, vision loss, kidney failure, nerve damage, etc. This myth is especially seen in rural areas where it is still considered a disease to be hidden. Your comments?
A. This is wrong. Diabetic people can lead healthy and happy lives with proper guidance, education, discipline and with medications.
Q. A popular notion is that only people who are fat get diabetes . Yes or no?
A. It’s not correct. Especially, those with Type 1 are lean.
Q. People also tend to believe that belly fat increases diabetes risk. Yes or no? Why?
A. Of course its very risky.
Q. Too much water is bad for diabetics . Yes or No?
A. No. But too much water, in excess may have other issues like lowering blood sodium in the elderly.
Q. Avoid salt which can lead to hypertension and to diabetes . True or false?
A. Use less salt.
Q. Too much exercise is bad for diabetics. Do you agree? How much do you recommend?
A. On an average 150 minutes of moderate exercise per week is good for most. Those used to exercise and are healthy and sporty can do more. Those with issues in heart, lungs or joints need to get advice.
Q. Briefly summarise the myths regarding diabetics, and what you consider the most important.
A. Diabetes drugs don’t cause kidney or liver damage as most people believe. They are quite safe under proper medical advice. Exercise and eating the correct foods and giving up unhealthy lifestyles will prevent diabetes as well as control it in those already afflicted by it.