Hunger - The Final Frontier

Hunger is a primal instinct. It is amongst the first senses you feel when you are born. The satiety after feeding kicks off a lifelong cycle of longing followed by satisfaction! So basic is this need that one never stops to question it.

Obesity is a pandemic in its own right. If we hope to address the overweight problem, we must analyze hunger.

Ask a young child and he or she will tell you that hunger suggests a bodily need for food or fuel. While this is true some of the times, the more common reasons for hunger are surprisingly different.

To understand these reasons, we must have a basic knowledge of a hormone called insulin. Insulin is secreted by a gland called the pancreas (which is in the tummy). The food we eat is absorbed from the intestine and reaches the blood as a fuel (measured as blood sugar level). This is then transported into each living cell by insulin. When we eat food, the body will detect a rise in blood sugar and the pancreas will release insulin which in turn will drive the sugar into the cells and reduce the blood sugar level. The body likes to keep the blood sugar level under tight control with the help of insulin.

Now, if the insulin were to reduce the blood sugar more than necessary, then the body would normalize sugar by initiating hunger. This typically happens if insulin levels in the blood go very high which is called an insulin spike.

Different foods have a different effect on blood insulin. Certain foods like a sugary cola (simple carbohydrate) will increase blood sugar very quickly as there is no digestion. This will cause an insulin spike. The spike will reduce blood sugar more than necessary and that in turn will initiate hunger.

So hunger depends on blood insulin levels. If insulin is spiking too often, we will experience more hunger. And this hunger is not because our body needs food! What we eat will decide how hungry we will become in the next few hours. This is the more common reason for hunger.

If we eat foods that keep the insulin levels stable and avoid spikes, then we won't feel hungry for the wrong reasons. If we don't feel hungry, we wouldn't want to eat as much. In this situation, losing weight becomes easy and possible.

Losing weight is not only about calorie restriction. It is about eating the right type of food, which keeps the insulin levels stable and avoids hunger. Carbohydrates will spike insulin much more than fats or proteins. Simple carbohydrates are the worst. Sugary drinks, sugary deserts, sweets, chocolates, cakes and mithai are classic examples of simple carbohydrates.
So even if you eat a small portion of a sweet desert, not only is it calorie dense but it will ensure more hunger.

Vegetables (cooked or raw) are the best food to keep insulin stable.

This is also the reason why a heavy breakfast is not a good idea. I know this is against traditional teaching but it is time for a paradigm shift. A heavy breakfast (especially if it is carbohydrate rich) will ensure an insulin spike and you will be hungry throughout the day. With so much hunger, dieting or calorie restriction becomes difficult. It's the reason why so many people fail to lose weight.

If we want to lose weight we must first conquer hunger. We must eat the right types of food so that we are in control of hunger and not the other way around. The next time you have an urge to eat a small snack, think about how hungry it will make you!

 

Sarcopenia

We have all heard about osteoporosis or weakening of bones as we age. Many of us have done bone density tests and are taking supplements to prevent or treat osteoporosis. But what is sarcopenia? Sarcopenia is a loss of muscle mass that occurs as we age. As we mature into adults, hormonal changes ensure optimal muscle mass by the age of 25. But this muscle doesn’t remain constant with us throughout life. For those who lead a sedentary lifestyle, muscle loss starts as early as at the age of 30. Typically an inactive person loses up to 5% of muscle mass per decade.

What happens when we lose muscle? First and foremost a weak muscle offers poor protection to its neighbouring joint. Joints need strong muscles to function properly and durably for many years. When muscles are weak, the joints become vulnerable to damage. This damage can happen in any joint, but typically it is seen in the knee joint, the neck and the lower back. Initially patients complain of only occasional pain. Painful joints are instinctively rested by the patient. The rest worsens sarcopenia. This in turn predisposes the joint to even more damage. Thus the pain sets up a vicious cycle. This cycle ends in osteoarthritis of the knee or spondylitis of the neck or back, which in its last stages requires surgical treatment. 

Loss of muscle also results in a lower basal metabolic rate (BMR). In simple words, the body is unable to burn calories efficiently. Lower BMR combined with a modern high calorie diet leads to increase in body fat. Excess fat increases insulin resistance. The end result is central obesity or a pot belly with diabetes, coronary heart disease (heart attack) and hypertension (high blood pressure).

End stage sarcopenia which occurs in elderly patients results in frailty, loss of balance & frequent falls. Sarcopenia is thus responsible for not only musculo-skeletal problems like osteoarthritis and fractures but also life style illness' like diabetes.

Is sarcopenia preventable or treatable? The good news is that it is! We can slow down the loss of muscle that happens with age by making positive changes in our diet and lifestyle. If we work a muscle, it will respond by a tear - repair mechanism to become stronger and a stronger muscle means a reversal of sarcopenia. The best way to strengthen a muscle is by doing resistance training. This can be done by either lifting weights like dumbbells or by using our own body weight. Typical body weight exercises are squats, push ups and lunges. As sarcopenia affects all muscle groups, it is important to work out all muscle groups. We must exercise not only thigh and calf muscles but also chest, back, upper limb and abdominal muscles. Walking is not a good exercise for sarcopenia as it works out only leg muscles and it is not a resistance training exercise.

Diet is as important in the prevention of sarcopenia. For muscles to repair and become stronger they need protein as a raw material. Protein is essential in a healthy diet. We must ensure adequate protein intake. A normal adult requires 0•8 gm of protein per kilo of body weight per day. Meat, eggs and dairy products are rich sources of protein. Roasted, boiled or baked chicken or fish are the healthiest source of meat protein. Milk, cheese and yogurt are good dairy sources. Vegetarian sources of protein include beans, lentils, green peas, chickpeas, soy, spinach, asparagus and brocolli. Nuts like almonds and peanuts also contain protein. Fruits can also provide protein with the richest sources being guavas, berries and apricots. To be effective, a high protein diet must go hand in hand with a low carbohydrate, low sugar and low fat diet.

A lot of research is going on but there still is no medicine that can stop or reverse sarcopenia. Exercise and diet remain the key to prevention as well as cure. We must eat clean and exercise hard to remain healthy and keep illness at bay. We really have no choice!

The Pot Belly - a sign of prosperity ..... think again!

It's customary in India to see a man with a pot belly/paunch and say "it's a sign of prosperity". The origins of this comment are deep routed. Weight loss is associated with illness. Weight gain is associated with newly acquired wealth and hence access to richer foods. In addition a typical Indian mother is obsessed with feeding her children. A rolly-polly child seems to bring immense satisfaction to his/her mother. She feels she is doing her job well. This obsession continues even when the children become adults. If an adult male loses weight it is assumed that his wife/mother is not looking after him. To his/her friends and family, a person's pot belly is accepted easily. It's hardly a matter of concern! It's to be joked about and forgotten. 

The truth couldn't be further from this. The pot belly is the root cause of all health issues today. It's literally a house of disease. It will bring in its wake horrendous illness' like blood pressure, diabetes and the dreaded coronary heart disease (heart attack).  It is a measure of a persons lack of physical fitness. People with pot bellies are more prone to back pain (lumbar spondylitis) and knee pain (osteoarthritis). It is also a direct indicator of a persons unhealthy eating habits. 

Pot bellies were not so common until recently. Why didn't our ancestors have a pot belly? What are we doing wrong? Our fore-fathers did a lot of physical activity. No access to vehicles meant they were walking a lot. No elevator meant they were climbing stairs. They were lifting their own bags. They were using cycles and not motor-cycles. They had to walk to the market to buy their vegetables, walk to pay their bills and walk to the bank. With the progress in technology, mobile phones and internet, we are doing everything from the comfort of our home or office. The result is a near complete lack of physical activity. That is not all. There is a change in diet patterns. Our fore-fathers ate natural and home made food. Going to a hotel to eat food was not even a monthly event let alone every week or every day. There were no fancy bakery products like cakes, biscuits, toasts, etc etc. There was no packaged food industry and therefore no (or less) chocolates, sweets, ice creams, colas, chips, chevda, mad angles, etc etc. As a result, people in those days did hard physical work and ate healthy food. So it comes as no surprise that in today's day and age, the pot belly is common and so are lifestyle illness' like diabetes etc. 

The new age brought with it a food evolution. Sugar became the new mantra. Adding sugar made food tasty and easier to sell. As a result packaged food items associated with with wealth like chocolates and colas were packed with sugar. In fact most packaged food items contain sugar. May it be a seemingly harmless biscuit or apparently healthy cornflakes. This kind of sugar is hidden and we don't know about it till we read the ingredients. Only recently research has shown a direct correlation with sugar intake and obesity. 

Now it becomes clear ..... A paunch is truly a sign of prosperity as only the wealthy can indulge in these expensive packaged sugar products. And the whole food and advertising industry wants you to spend money on these food stuffs. The newspaper is full of the adverts and so is the television. Gullible people like us are falling prey. They are doing exactly what the adverts tell them to do. Biscuits, jams, chocolates have become part of our lifestyle. We cannot imagine a world without them. 

We need to wake up and realise how foolish we have been. We need to go back to the ways of our ancestors. We need to say no to the cola and yes to a walk. We need to look down on our pot belly and get rid of it immediately. We need to caution our friends and relatives and inspire them to get rid of theirs. A pot belly is a recipe for disaster and no trivial joking matter. 

It is now time for a paradigm shift. Exercise must not be seen as an optional leisure activity that you do if you have spare time. It's a necessary task of daily routine like eating a meal or having a bath. Similarly food must not be viewed as ‘going on a diet to lose weight’ but a healthy, natural (low sugar, low oil) eating habit must be developed as a permanent lifestyle change. 

Self Preservation

How often have we seen a personal crisis ruining life? A young man just managing to settle down in life suffers a heart attack! He now faces a prolonged recovery and loses his job. Medical expenses coupled with a loss of income push him into a financial crisis. A young woman juggling her job and family life suffers an accident. A slow recovery means she cannot look after her children. All of us dread a personal crisis but what do we do to prevent it? We must think about self preservation. We must take precautions to avert a potential crisis!


An accident is top on the list. Accidents can occur in a variety of places. They can occur on the road, at home, at work or when travelling. The most common and the most dreaded are road accidents. The road conditions in many developing countries are pathetic and accidents occur rampantly. Yet I see few people thinking about prevention. Wearing a helmet is a simple basic precaution which will save a person from a potentially lethal or paralysing head injury. It is the difference between getting up and walking away from an accident versus an injury which may  lead to permanent disability and handicap if not death. The same applies to wearing a seat belt in a car. Seemingly simple, easy and effective precautions and yet many of us don't do it! Why? Because we don't think about life preservation untill it's too late. Following road rules (like using an indicator or not cutting lanes), avoiding rash driving and speeding, stopping at signals, keeping the vehicle well maintained and regularly serviced go a long way in accident prevention. Talking on the phone while riding a bike or driving a car is another recipe for a catastrophe! What about accidents at home? In the kitchen, be careful with the cooking gas! Old malfunctioning pressure cookers can burst, hurriedly used sharp knives can cut fingers and hot utensils and boiling oil/water can burn. The other danger zone at home is the bathroom. Make sure the bathroom floor is non slippery. There should be support handles for old people to get up. Beware of sharp shelf edges which could injure if one falls.  Don't climb on a chair to reach for a high shelf or clean the fan, use a stable ladder. The same rules apply for the work place or when travelling. We must be extra careful when travelling. An accident in a foreign land can be particularly nasty as we are helpless and often end up with less than ideal medical care.


The next is a medical crisis. We cannot control all the factors that lead to illness! But we can definitely control some of them. Young people get so busy with work and family that they don't have time for health preservation. The modern motto is to work hard now and enjoy the fruits after retirement. But reality is quite the opposite. By the time they retire,  people are bogged down with so many medical problems that their old age is nothing more than suffering, pain, doctors visits and a long list of medicines. Little does one realise that the efforts to achieve a healthy old age need to start when one is young. The idea of an investment which will pay returns in the future appeals to all but they are unable to apply the same logic to health. And yet, the truth is that investing in health remains the most profitable proposition. What factors can one control? Most critical is to stay away from addicting substances like cigarettes, alcohol, tobacco and drugs. These substances guarantee a life of suffering and a miserable old age. Beyond that, a healthy lifestyle boils down to two main factors - diet and exercise. I have written a number of articles on diet and exercise. Interested readers can access them on my blog - www.orthindia.blogspot.com. A good diet is about good quality foodstuffs and portion control. We must educate ourselves about which food is good for us. We ought to consume more protein and fibre (vegetables and fruits) and less carbohydrates and fats. We need to differentiate between good carbohydrates (chapati) versus not so good carbohydrates (rice) versus bad carbohydrates (potato, bread, maida, cake, jam, biscuits, cold drinks, sugar, mithai, ice cream, bakery products, chocolates and sweets). Stay away from bad carbohydrates. They are poor quality foodstuff. Portion control remains the key to weight reduction. Amount of food to be consumed in each meal should be decided before we start to eat. Eat only small amounts of food for lunch and dinner and compensate by having healthy snacks in between. A heavy meal neutralises the benefit achieved from a long period of starvation or a session of exercise. We must eat slowly to feel satiety with seemingly small quantities of food. Make it a habit to read the ingredients label on food packets to look for hidden sugar. As a thumb rule, food cooked at home will always be healthier than eating out. Be careful when eating outdoors or when travelling as chances of ending up with an upset tummy and loose motions are high. For exercise, do activities that you enjoy! There are no set rules. Choices are plenty from walking, running, cycling, swimming, aerobics, going to the gym or doing yoga. Remember that the only bad workout is the one that didn't happen. Aim to do some exercise for at least half hour, 5 times a week. Ideally one needs to exercise for an hour every day. Today people lead stressful lives, eat poorly, avoid exercise and buy medical insurance. The smart choice would be to work towards health and not ever need insurance.
The last aspect of illness prevention is timely screening for silent diseases and treatment of medical problems. Problems like blood pressure, diabetes and heart disease may not result in any symptoms for many years. An early diagnosis is crucial for preventing permanent damage. So everyone must get themselves screened for these illness' on a regular basis. It does not end with screening. One needs to to take proper treatment of his/her illness. For hypertensive patients, blood pressure should be controlled. For diabetes, blood sugars should be controlled. A diabetic patient must own a home blood sugar testing machine and must check blood sugars every week. Timely and regular intake of medicine coupled with regular testing and doctor's follow up is essential. 


A mention must be made here about the weekend warrior. These are the people who indulge in contact sports like football only on the weekends. Such sports require a high level of physical fitness which can come only with vigorous daily exercise. Those who don't exercise have weak muscles which offer poor protection to the joints. Hence the weekend warrior is much more prone to injury to the shoulder, wrist, knee or ankle than the physically fit person. Those who don't exercise daily are better off avoiding weekend sports.


Self preservation is an awareness that must be cultivated in the mind. A constant vigil will reduce the chances of a potential tragedy. Simply put it is the difference between happiness and suffering. The choice is really ours to make. Is it worth riding a bike for thrills or spending all your time at work or gorging on meals till your shirt buttons pop? We ought to rely on ourselves to look after our health rather than medical insurance ...... prevention will always remain better than cure!!

The Obesity Factor

Obesity

Obesity is a big problem. To start with it kills self esteem. You don't feel good about yourself. There is a constant feeling of guilt. You don't look attractive. Your clothes don't fit well. You are embarrassed of your weight and what people may think of you.

Some feel, you shouldn't bother about what people say. Maybe they are right. But wouldn't it be awesome of you could shed that fat?

Apart from being a social issue, obesity is a much bigger medical problem.

The obese are more likely to suffer from hypertension (high BP), diabetes and ischaemic heart disease (heart attack). They are prone to get lumbar spondylitis and knee arthritis. In summary, obese will live shorter lives and that life will have more suffering.

So those who say "I live to eat" or "I love food", I'd like to warn them that they will pay a heavy price for their indulgence.

If you are still not interested in loosing weight, you don't need to read further! I say this because loosing weight is not simple or easy. It is a Herculean task, nothing less than a complicated project that needs your full concentration till completion.

First step is to rule out medical illness. Many disorders for eg thyroid problems lead to weight gain. It is only logical to address these medical issues before trying to lose weight.

You can lose weight by diet AND exercise. Even a small child will tell you that. What is important to realise is diet alone or exercise alone may not be enough. So diet has to go hand in hand with exercise.

Which diet?
There are many diets out there that guarantee weight loss. Each claiming to be better than the other. They all work! It's common sense. If you starve you will loose weight. The issue here is how long can you sustain a diet? The more fancy and effective the diet the less likely it is for you to stick to it. And once you are off the diet, all your weight is back in a few months. So how do you approach the problem?
I feel your diet should not change drastically. Obviously less oil, less salt, less sweet! More importantly less quantity. We have been brought up to think that it is nothing less than a crime to stop eating before your stomach is overfull. We need to loose that habit. We have to train ourselves to get up from the meal with a hungry stomach. It takes a lot of effort and determination to do this.
Just one useful tip. Usually dinner is the heaviest meal for most people. I believe that if you can attack this one meal consistently you can achieve your goal. One way is to eat of bowl of fruits and raw vegetable salad one hour before dinner. That way your tummy is full and you can easily avoid a heavy dinner.

Which exercise?
To loose weight you need aerobic exercise. This means any exercise that increases your heart rate (you can hear your heart beating) and your breathing rate. For eg brisk walking, jogging, swimming, cycling, rowing etc. The recommendation is to do aerobic exercise for half hour everyday.

Many people are not able to loose weight. Some of them genuinely cannot loose weight and they need medical attention. But most of them fail cos they fall short in effort. Loosing weight is a full time job that needs a high level of sincerity and commitment. Commitment so that you don't give up and sincerity so that you don't take short cuts. The biggest enemy of those who don't loose weight is usually laziness!

To conclude, obesity is not only a social problem, it is more serious medical issue. Loosing weight is essential. With determination and motivation, most people can shed their fat. Two proverbs come to mind - "where there is a will, there is a way" and "try try till you succeed"

YOU CAN BECOME THIN!!