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!

 

The Secrets to losing weight…

Many want to lose weight and many need to. Many try but few succeed. What is the secret of their success? Is there one secret or are there many? Do doctors know all the answers? Maybe, but aren't there lots of obese doctors around? 

In my practice I have had the opportunity to speak to both types of people; the ones who have lost weight and the ones who have failed. I myself have struggled for many years to lose weight only to find success recently. So what are these secrets? 

Secret 1: Sincerity. People who successfully lose weight have a deep commitment and sincerity in their effort. It is akin to a project that they have taken up and need to see it to completion. They work hard to lose weight, they have pride in their effort and they celebrate their achievements. Quite often the commitment comes due to a life altering mishap that they have suffered like a heart attack or a complication from diabetes. It is only after a major near death experience do they realise how fragile life is and how much they have taken for granted. I urge readers to take weight loss seriously and not wait for their wake up call!

Secret 2: Exercise or Diet? Is dieting enough to lose weight? or is exercising enough? or do we need both? the reality is that diet is far more crucial to reduce weight than exercise. Exercise helps but diet is the key. Those who exercise but continue their usual eating habits almost never lose weight. Of the weight one loses, 75% will be due to changes in diet and 25% will be due to exercise. 

Secret 3: Quality of food. Is it acceptable to buy petrol mixed with water? We are so particular about quality of the things we buy, however we stop thinking of quality when it comes to food. We are ruled by taste. What tastes good is good. Its time to stop and think about what we consume. We ought to eat only quality food. We should avoid deep fried foodstuff. We should also avoid artificial sugar. Avoiding sugar doesn't stop at adding Splenda to tea. One cannot imagine the extent to which artificial sugar has infiltrated our eating habits! Biscuits, chips, packaged snacks, cakes, chocolates, sweets, mithai, cold drinks, ice creams etc etc are all loaded withartificial sugar. This modern sugar stresses the body's mechanisms to control blood sugar. The body converts all this excess sugar to fat and stores it, resulting in a pot belly. The hotel industry, the biscuit manufacturer, the bakery, the chocolate industry, the Paani-Puri Wala or the Wada-Pav Center are not interested in your health. They thrive on our weakness for taste. So when I say avoid fried foods and artificial sugar, I really mean one must avoid eating packaged food (what is typically stocked at a Kiraana store) and one must avoid eating outdoors. Home cooked meals will always have the quality you are looking for! In addition to this we must reduce our consumption of the GREAT FOUR! They arerice, potatoes, pasta (and other maida products) and bread (bakery products). These products are similar to sugar and have high carbohydrate content which will be converted to fat. Once one learns to avoid these poor quality foods, what remains is all healthy. Wheat (or jowar, bajra) chapatis, dals, vegetables, meat (in limited quantity)  and nuts are healthy to eat. To this we can add cereals(without sugar), muesli, oats, milk and eggs. Milk products without sugar like dahi and chaas are good. The sugar in fruit is natural and far far superior to artificial sugar. One can safely consume all types of fruits unless diabetic. Raw vegetable salads (without unhealthy mayonnaise dressings) are a complete winner. Now with this knowledge lets assess the quality of some of our foodstuffs - first the seemingly harmless 'wada-pav'. It has got potato, maida and bread. Plus it is deep fried. Its a total disaster, isn't it? Lets see another scenario: a visit to MacDonald's. What do we end up eating? A fried patty in bread? Still not so bad one may feel. But lets see the accompaniments. A sugar filled cold drink and fried potato chips! Another disaster. What about the people who drink many cups of tea in the day? Not much harm done? Actually lots of harm done if the tea has sugar! All the sugar just ends up in one's belly. 

Secret 4: Portion control. Now we come to the most difficult part of weight reduction. We may be very motivated to lose weight and we may be willing to let go of our tasty snacks, but are we ready for portion control? What does one mean by portion control? It means that one has to control the quantity of food consumed at a particular time.  This is very critical for the major meals which are lunch and dinner. I have devised the 1 to 2 rule. For lunch or dinner one should not consume more than 2 chapati's or 1 chapati and 1 small helping of rice. Obviously this is hugely difficult as we will feel hungry. There are 2 secrets here to succeed. First is to reduce the speed of eating. It takes time for the stomach to send a signal to the brain that it is full. If we eat too fast, we have already over eaten by the time the signal reaches the brain. Vice versa if we eat very very slowly, we will feel full even with seemingly small quantities of food. One should chew slowly and swallow only after chewing the food completely. One should not put another morsel in the mouth till one has swallowed the previous morsel. The second secret is to eat healthy snacks in between meals. So one can have a fruit or a salad or some nuts at 11:00 am and in the evenings at 4pm and if required even at 7pm. If one feels hungry after dinner, one can have a healthy snack at 10pm. This way we can counter the hunger we will feel because of portion control. I must emphasise here that the snack must be healthy! People have a habit of skipping meals and then binge eating at dinner time. They feel proud of skipping a meal and think it will help reduce weight. Then they feel the need for a reward and feel justified in eating a heavy meal. Little do they realise that all the benefit from skipping a meal is not only lost in the binge eating, in fact more harm is done than good. Binge eating can never result in weight loss! The tough truth is that we can never have a heavy meal ever, if we are serious about weight loss! 

This is a sure shot way of losing weight! Many of us feel that we don't eat much food, we eat healthy and still we don't lose weight! But I request you all to introspect sincerely! You must take into account exact quantity of food consumed rather than your best estimate. You must look at the quality of food as well. Learn to pay attention while eating and actually count the chapatis and helpings of rice. Also every small unhealthy snack eaten in between, like a chocolate, a biscuit, a piece of cake or a few chips, matters! 

Armed with these secrets, I am confident that all of us can start losing weight and move towards a more healthy and happy life! 

www.doctordhariwal.com

The Sunshine Vitamin

As research continues to shed new light, scientists are realizing that vitamin D has many critical functions in the body. It works more like a hormone rather than a vitamin and affects the performance of almost every cell of the body. 

1.      We all know that vitamin D is critical in maintaining adequate amounts of calcium and phosphorus in bones and teeth. In simple words it helps keep bones and teeth strong and protects against osteoporosis and dental caries. However we need vitamin D for many other roles. 

2.      It is important in the regulation of the immune system. It produces anti - bacterial and anti- viral substances and helps fight infections like common cold and influenza. 

3.      It helps to keep the brain functioning normally in later life and prevents mental illnesses like dementia, Alzheimer's disease, schizophrenia and depression. 

4.      Vitamin D helps maintain ideal body weight. Those with vitamin D deficiency are likely to be obese and fail at attempts to reduce body weight via diet and exercise. 

5.      It plays a role in preventing inflammatory disorders like Rheumatoid Arthritis (multiple joint pains), inflammatory bowel disease, psoriasis and eczema. 

6.      It reduces the frequency and severity of asthma and allows for speedy recovery from tuberculosis. 

7.      It reduces the risk of heart attacks and protects against high blood pressure and diabetes. 

8.      Vitamin D has recently been shown to be critical for a normal pregnancy. It prevents pregnancy related illnesses, reduces risk for premature deliveries and reduces infertility. 

9.      It reduces risk of all types of cancer. 

What are the daily requirements of this valuable vitamin? Most authorities recommend around 600 IU of vitamin D daily. Infants less than one year old need 400 IU and adults above 70 years of age need 800 IU.

Now that we realise the critical benefits of vitamin D, we must find out how to get it! Unfortunately getting vitamin D from diet alone is an uphill task. Few foodstuffs are a good source of vitamin D. Vitamin D rich foods include beef liver, egg yolk, certain types of cheese and certain types of fish. One egg gives approximately 40 IU of vitamin D. Unfortified milk (milk is fortified with vitamin D in America and European countries as a government initiative) is a poor source of vitamin D. 

Sunlight is an additional source of vitamin D. It is important as dietary sources of vitamin D are few. Ideally we should get 90% of our daily vitamin D requirement from sunlight. UV rays in sunlight convert a type of cholesterol found in the skin to vitamin D. Modern lifestyle has limited our exposure to the sun. There are many variables that affect the ability of the skin to produce vitamin D. As a result it is difficult to recommend how much sunlight is enough. Most authorities recommend between 5 to 30 minutes of sun exposure to your unprotected face, arms, legs or back between 11 am and 3 pm two to three times a week.  Early morning or late evening sunlight does not work as UV rays are not able to penetrate the atmosphere. Ability to produce vitamin D also depends on the colour of the skin. Fair skin people need less sunlight than darker ones in whom melanin (skin pigment) restricts entry to UV rays. Exposure to sunlight should be direct as UV rays are restricted by glass (window panes) and sunscreen. Weather conditions, cloud cover, pollution and clothing also affect vitamin D production in the skin. At the same time too much sun exposure is detrimental.

Certain groups of people are at higher risk for vitamin D deficiency. These include pregnant and breast feeding women, children between 6 months and 5 years, persons older than 65 and persons who keep their skin covered or stay indoors (don't get enough exposure to sunlight). At risk individuals need to discuss with their doctor and get vitamin D supplements. In America and some European countries, milk and fruit drinks are fortified with vitamin D.

Few sources of vitamin D in diet coupled with poor exposure to sunlight and lack of fortified foodstuffs (especially in India and Asia) makes huge sections of the population at risk for vitamin D deficiency. Everyone should get their blood levels of vitamin D tested. If deficient, appropriate changes must be made in lifestyle to increase exposure to sunlight. If that is not possible, vitamin D supplements are necessary.

Vitamin D deficiency is a modern and very real epidemic that has silently contributed to increase rates of osteoporotic fractures, heart attacks, influenza, rheumatoid arthritis, cancer and premature births! The general public needs to become aware of this hidden deficiency and take immediate corrective measures! 

The Ultimate Vaccine

We all know about vaccines. A vaccine is any preparation used to confer immunity against a specific disease.  It’s an amazing discovery of medical science and a very appealing concept indeed. You take the vaccine and you will be protected from the illness forever. As soon as a new born baby is born, parents are rushing to the doctor to get him/her vaccinated.

Wouldn’t it be wonderful if there was a vaccine for blood pressure or diabetes? Or a vaccine for knee arthritis or spondylitis?

What if I tell you that there is such a vaccine? And it’s not a new invention. It’s been around for some time. And better still, it’s free! Would you believe me?

Believe it or not, it’s true. Such a vaccine does exist! .... Unfortunately we have forgotten about it. This vaccine is EXERCISE!

Imagine that you have just bought a new expensive car or jewellery that you have been wanting for a long time. You will look after it well. The car will be cleaned and serviced regularly. The jewellery will be kept carefully in a box. Your body is a gift from God! Close your eyes and ask yourself, have you been good to your body? Have you looked after it? If you don’t maintain your car, it will give you trouble. It won’t run properly. But still most people will look after their cars far better than they will care about their own bodies. A bad car is an inconvenience, but a bad body means suffering!!

A healthy body is crucial to be able to enjoy life. All the money in the world is a waste, when you don’t have health. Without health, you cannot enjoy your new car or house or your vacation. And at times it is too late. You cannot even buy health. So how do you vaccinate your body against disease? How do you look after this beautiful gift?

Prevention is better than cure. If you don’t want to suffer with ill health and disease, you have to act now. Physical fitness with exercise is the best way to avoid lifestyle related illnesses like blood pressure, heart disease and diabetes. And it only works if you do exercise regularly throughout life.

As young people we get busy with work. We want to work hard so that we earn and secure our future. Many of us get obsessed with work. We lose track of priorities and we lose perspective. What is the point of working so hard and abusing your body? You may or may not end up becoming very rich, but you definitely will end up with a lot of illnesses. So all the hard earned money is then spent to become better and many times in spite of the money spent, you remain ill.

So my sincere request to young people is to not lose the wonderful days of their youth in work. Everything should be in moderation which is true also for work. Work is important and everyone has to work but draw your limits. The human body is not designed to work 24/7. Earn a little less but enjoy it by remaining healthy. Extra money earned is useless as it is at the cost of health.

What type of exercise should we do? There are three basic types of exercise. The most important exercise is aerobic exercise. Aerobic exercise is any activity that increases your heart rate (you can hear and feel your heart beating fast) and your breathing rate (panting). Regular aerobic exercise is the best vaccine against lifestyle disorders. Everybody cannot do aerobic exercise. Especially if you are a heart patient, you need to check with your doctor before starting aerobic exercises. Those who are not accustomed to aerobic exercise should start slowly. Eventually one should increase to the recommended 30 to 40 minutes of aerobic exercise daily. Some examples of aerobic exercise are brisk walking, jogging, running, cycling, swimming and rowing. Aerobic exercises have become famous as ‘cardio’ exercises in modern gyms. While doing exercise, it is important to remember to go to the next level of difficulty, just like a student progresses to the next grade or standard in school. Cycling is a safe exercise for those suffering from knee pain.

The next exercise is Yoga or stretching exercises. These exercises are good for the health of joints and they are a vaccine for arthritis and spondylitis. Yoga exercises ensure that all joints move through their complete natural range of motion.

The third type of exercise is individual muscle strengthening exercises. These are exercises which ‘body builders’ do. Strong muscles protect joints from damage. Most people do not need to use weights. Anti gravity muscle endurance exercises are sufficient.

Many patients ask me if yoga is enough. All three types of exercises are important. So yoga on its own is not enough. Yoga will complement aerobic exercise to give you a better result.

Many patients tell me that they are working in the office or the kitchen all day and that is enough exercise! Physical work is better than sleeping in bed but it is poor exercise. Work generally results in exertion and exhaustion rather than exercise. Those who exercise regularly develop enough stamina so they can work harder, faster and more efficiently without getting tired.

Moreover exercise comes with pleasant side effects! People who exercise feel a sense of pride and satisfaction like the proud owner of a new diamond set. This translates into a positive energy in their daily lives. So they work better, they maintain better relations with their loved ones and they are more happy.

If you are one of the people who says ‘I don’t have the time for exercise’ then I feel sorry for you. If there is time to eat, if there is time to sleep, if there is time to pray, if there is time to watch television or read a newspaper then there can be time for exercise. It is a question of priority and commitment.’ Where there is a will there is a way’  

The worst enemy of exercise is laziness. It is an enemy of many things. There is no glory in laziness. We have to fight this enemy in every living moment of our lives!

So my dear readers, if you want the gift of good health then you have to work for it. Get up and get going and grab that vaccine!

Update (11/04/2020)-

I had written this way back in 2012. Today the world is being threatened with the COVID19 pandemic. People are looking for immunity boosters. It’s not going to improve with some magical pill or supplement. My experience has taught me that exercise is crucial to build immunity to fight infections. It’s the disciplined people who pay attention to their nutrition and who exercise regularly that have the best chance to beat the corona virus!

In a review published in 2019 (Journal of Sport and Health Science 8 (2019) 201À217 - The compelling link between physical activity and the body’s defense system. David C. Nieman, Laurel M. Wentz), the authors concluded

With near daily exercise, the changes to the bodies white blood cells enhance immune defense activity and metabolic health.

Studies consistently support the inverse relationship between moderate exercise training and incidence of URTI. These data led to the development of the J-curve model that links URTI risk with the exercise workload continuum. Several studies also suggest that regular physical activity is associated with decreased mortality and incidence rates for influenza and pneumonia.

Regular exercise training has an overall anti-inflammatory influence mediated through multiple pathways. Studies consistently show decreased levels of inflammatory biomarkers in adults with higher levels of physical activity and fitness.

There is increasing evidence that the circulation surge in cells of the immune system with each exercise bout and the anti-inflammatory and antioxidant effect of exercise training have a summation effect over time in modulating tumorigenesis, atherosclerosis, and other disease processes

Immunosenescence is defined as immune dysregulation with aging. Emergent data support that habitual exercise is capable of improving regulation of the immune system and
delaying the onset of immunosenescence.

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!!