Habits are hard to break but the surge in lifestyle diseases is a clarion call to shun some of the behaviours or lifestyle choices and pull up one’s socks, literally.
The World Health Day today is a reminder on how pertinent role lifestyle choices have on our health.
A sedentary lifestyle, poor diet, smoking and excessive alcohol consumption are the key drivers of heart and kidney diseases, cancers, diabetes etc.
Delving into the heart of the matter, Dr S Venkatesh, interventional cardiologist head, Cardiac Cath Lab, Fortis Hospitals, says, “Most cardiovascular diseases are lifestyle diseases.”
“The lifestyle factors that lead to cardiac diseases are diet, sedentary life and tobacco and excessive alcohol use. It is now increasingly evident that the high amount of carbohydrates, especially the refined sugars, starchy refined carbs are the most important dietary factors responsible for the genesis of lifestyle diseases including diabetes, obesity and atherosclerosis,” he says.
While some myths are being broken, new truths are unfolding when it comes to what we consume.
“Hitherto, it was thought that excessive consumption of fats, especially saturated fats (found in butter and ghee, coconut oil and animal meats) were responsible for increased obesity, diabetes, high cholesterol and heart diseases. But today, we have enough scientific research that these dietary factors are not as harmful as thought,” says Dr Venkatesh.
“Increased availability of foodgrains with flooding of the supermarkets with highly refined carbs appears to be the most important cause for the lifestyle disease epidemic seen in this millennium,” he adds.
An unhealthy lifestyle is the bane of modern society and not many are aware of what it brings on the table – a platter of diseases.
Needless to say, these choices have opened a can of worms.
“Chronic Kidney Disease (CKD) is a growing health problem and there are well-established risk factors for end-stage kidney disease of which Diabetes and Hypertension are strong predictors for the development and progression of chronic kidney diseases and these, in turn, are closely linked to lifestyle factors,” explains Dr H Sudarshan Ballal, Chairman, Manipal Hospitals.
“We have learned from research of other chronic conditions such as heart disease and cancer that lifestyle factors namely diet, physical activity, cigarette smoking, and Body Mass Index plays a very important role in health outcomes namely cardiovascular events and mortality and kidney diseases are no exception to this rule,” he says.
With processed food mushrooming by the day, it’s time to take a relook at it as well as the lack of nutrition in our diet.
“An unhealthy or poor diet can lead to hyperacidity, obesity, uric acid/ hyperuricaemia/ gout, constipation, impaired cholesterol levels, stones (gall/ renal), high triglyceride levels, hypertension, low vitamin B12, Diabetes Mellitus, cardiac diseases and certain types of cancer,” elaborates Dr Priyanka Rohatgi, Chief Clinical Dietician, Apollo Hospitals.
“A balanced diet,” says Dr Priyanka, “is a good mix of unrefined whole grains, millets, pulses, legumes with at least five to six servings of vegetables and fruits, a good mix of healthy fats from nuts and oilseeds and a low-fat variant of dairy and poultry.”
It is a known that diet is a sensitive area to tread on, especially at a time when battles over diets are being fought on the internet.
Elaborating on the dos and don’ts, Dr Venkatesh says, “The single most important dietary change that modern society has to adopt is to reduce the refined carbohydrate intake. Avoid starchy grains including sugary breakfast cereals, refined sugar, sugary drinks such as sweetened fruit juices, aerated drinks.”
“While whole grains make more intuitive sense, the overall proportion of carbohydrates should be limited in a balanced diet.”
“Remember that a typical Indian household breakfast is upwards of 70 per cent carbs, whereas lunch or dinner can have 60 per cent or higher carbs. Consume plenty of vegetables including green leaves. Instead of fruit juices, consume whole fruit since they contain fibre. However, too much fruit sugar is also not very healthy,” he says.
“Milk and milk products are a major source of energy, proteins, calcium and vitamins for vegetarians. Dairy fat as in full-cream milk or curd, butter and ghee, cheese and paneer are proven to be safe in moderate quantities, therefore it is preferred not to avoid milk and milk products,” explains Dr Venkatesh.
Importantly and in more ways than one, carbohydrates seem to be the bad guy here.
Clearly, watching the contents on the plate has become more important than ever.
“With evidence confirming the safety of saturated fats and dietary cholesterol, the taboo on consumption of red meat and egg yellow is being gradually lifted. In general, deriving dietary calories from fats rather than carbohydrates appear to prevent the development of insulin resistance which is perhaps the fundamental metabolic problem leading to the genesis of obesity, diabetes and atherosclerosis,” he adds.
Mindless consumption, meanwhile, is adding calories and churning out obesity, a global health concern now.
“The recent NFHS data shows obesity cases are on the rise. This is basically due to the erratic lifestyle, lack of sleep, lack of physical activity like sitting for long hours and not able to do 8,000 to 10,000 footsteps per day and eating more of refined foods which are processed (containing maida, sugar, trans fats, salt and preservatives),” informs Dr Priyanka.
The hard marketing is taking its toll on children in a major way leading to childhood obesity. More junk food is being produced and consumed every day. And society is paying a huge price for it, Every way!
Providing much food for thought Dr Venkatesh says, “Avoid snacking. Traditionally Indian societies have stressed on the importance of fasting. Modern nutritionists are rediscovering the benefits of intermittent fasting, which appears to be safe and effective. Avoid fad diets like a vegan diet, liquid-only or fruit-only diet because these can lead to deficiencies of many essential micro and macro-nutrients.”
Chips and crisps are making new inroads creating an unhealthy society fighting its bulges.
Obesity has become an international epidemic as Dr Ballal points out. “There is growing agreement that modern lifestyle is driving this epidemic by encouraging overconsumption and discouraging energy expenditure. Obese patients can develop proteinuria, which is followed by progressive loss of renal function also called Obesity-related Glomerulopathy (ORG-FSGS),” he says.
High salt is an integral part of processed food yet individuals can’t keep their hands off it.
“The effect of salt on renal function is related to its indirect effects on high blood pressure and to a direct effect on renal function. Hypertension is both a cause and consequence of renal failure and high salt intake acts as a force multiplier accelerating the downward spiral of Chronic Kidney Disease progression,” says Dr Ballal.
Talking of marketing and fitness trackers have become the order of the day. But are we walking enough, forget 10,000 steps a day?
To begin with, drop the elevator, say experts.
“Sedentary behaviour is one of the strongest risk factors for many chronic diseases including cardiovascular disease, hypertension, diabetes, obesity, osteoporosis, colon cancer, renal disease, and depression,” says Dr Ballal.
So how does a sedentary lifestyle contribute to cardiovascular disease?
“While it is impossible to burn all the calories acquired through improper and excessive eating, exercise is important for improving cardiovascular conditioning,’’ explains Dr Venkatesh.
“Exercise has been proven to reduce rates of heart attacks, strokes and death due to cardiovascular diseases. Indirectly, lack of exercise also leads to a higher incidence of obesity, diabetes and hypertension which in turn lead to an increase in cardiovascular disease and mortality,” he adds.
Indeed, the roles of smoking and excessive consumption of alcohol have in triggering lifestyle diseases are enormous.
“Smoking increases the risk of developing kidney diseases and nearly doubles the rate of progression to end-stage renal failure. Studies have shown that smokers have increased median protein excretion, suggesting that smoking reduces renal function and increases proteinuria,” says Dr Ballal.
“Tobacco kills 10 times the number of people due to cardiovascular disease as it does due to cancer. In all strata of society in India smoking especially in adolescence is on the rise. This eventually adds to the burden of cardiac disease in the society,” points out Dr Venkatesh.
The rise in the use of e-cigarettes by the day is then a cause of immediate concern. And the young most often are its victims.
“Tobacco is a very important cause of heart attacks, especially in younger individuals. It also causes atherosclerosis leading to blocks in the heart, stroke and gangrene of the legs. While implementation of COTPA is leading to increased awareness of tobacco, youngsters are lured into e-cigarettes and hookah bars that act as bait and switch for tobacco use in these individuals eventually. Excessive alcohol consumption can lead to hypertension, worsening of diabetes and strokes,” he says.
So how does the future look when it comes to lifestyle diseases?
“There is an urgent need to highlight the importance of modifiable lifestyle risk factors as a basis for treatment strategies to prevent the development and progression of chronic kidney disease,” says Dr Ballal.
“Living a healthy lifestyle can help prevent diabetes, high blood pressure and kidney disease, or help keep them under control. To lower your risk for kidney disease and the problems that cause it, follow a low-salt, low-fat diet, exercise at least 30 minutes on most days of the week, have regular check-ups with your doctor, do not smoke or use tobacco, limit alcohol and lose weight if obese,” he advises.
“The adage ‘Prevention is better than cure’ can never be over-emphasised. Prevention via lifestyle modification is the cheapest, most effective method and has no side effects,” adds Dr Venkatesh.