1. Disorders: Obese are more susceptible and prone to elevation of triglyceride and cholesterol (also known as ‘Hyperlipidaemia’), stones in gall bladder, hyperneusccalmia than general population. The said complications raise part in cases of non-insulin dependent diabetes mellitus (NIDDM) than insulin dependent patients.

2. Psychological Complexes: Because of their shabby-looking and bulging bodies, obese people avoid social gatherings ad functions. Others may like to meet them, even if for the sake of fun, but they would like to have company and the time, which they had to spend with meeting people, is utilized in eating (rather overeating). Young adult females feel ashamed abhor or avoid company, because of their none too-pleasant appearance and disproportionate bodies, they also develop sexual and physiosocial problems.

3. Mechanical Disabilities: These are nit ‘mechanical’ disabilities in literal sense of the term. Here the word ‘mechanical’ means the organic (not mechanical) disturbances of our physical system which emanate from obesity. These may include effort-onset breathlessness (Dyspnoea) enhanced susceptibility to other respiratory infections caused by interference with mechanism of respiration, of adipose tissue around the trunk. Abdominal and diaphragmatic hernia may also ensue, due to the very fact that abdominal muscles, supporting the Viscera and leg muscles (whose contractions promote venous return) are less efficient. Further, asteo-arthritis of knees, hips and lumbar-sacrel spine, apart from that in feet, are more common in the obese than with the non-obese, the latter are by no means immune to such disorders.

4. Disorders of Cardiovascular System (C.V.S.): Obesity puts extra weight and strain on heart, forcing it to work more than its capacity, as a result of which the heart also increases as the obesity and body-weight rise. Blood pressure (high) is a common problem, apart from substantial increase in cardiac output, blood volume and stroke volume. Main monster, which is responsible for causing many heart problems, is the thickening of blood vessels, narrowing of blood vessels, due to higher concentration of cholestoral. Ischalmia of heart is another complication of obesity which owes its origin to physical, inactivity apart from other factors.

5. Life expectancy: But for the side effects of obesity, the obese might have enjoyed longer span of life. 10-15% over-weight may not adversely affect much life span, but 30% increase in weight will reduce life span, and 40% increase will lead to 50% life span. The lower the weight (that weight within 10-15% increase is standard weight) the linger the life span.

6. Digestive complications: This again is a compound set of disorders like flatulence, burning sensation. Nausea or even vomiting, acidity, gastritis, gastralgia, gastrodynia, bilumy etc which are directly also related with over-eating and Physical inactivity. So the trio of overeating, physical inactivity and obesity should be handled judiciously and in a well thought out and planned way. There is, however, no room for laxity, indiscretion in food-intake, and physical activity. The obese should never adhere and resort to any so-called ‘Quick weight reducing’ methods which benefit none but the advertisers. First of all, single out the cause(s) which is /are considered to be responsible for adding to fat and , if the cause is attributed to any disease or other disorder, mere removal of the discerned cause, will pave way towards weight reduction. Further, never take any drug which claims to prove as a ‘wonder weight-reducing’ medicinal device. It has often been noticed that such drugs adversely affect appetite.

Obese people have plenty of time for eating, working, attending to functions and social gatherings, for useless and unproductive entertaining devices but, alas!, they have no time to devote to their health problems much less to shed down their weight or for any physical exertion. Even going to Gyms and so called Health Clubs have become a matter of social status and publicity but only a selected few go to such places to gain actual benefit. There is a mushroom growth of such health centres which are hardly of any benefit.

In order to get rid of many disorders, which often affect the obese and give rise to many other coincidental side-effects, should follow a course of dietary control and physical activity, in consultation with their dietician/doctor and also a person who could guide them, as to what exercise would be of use to them, keeping in view their physical status and health problems.


DIET (including carbohydrate metabolism)

Diet plays an important role in diabetes. It will depend on health status and also what amount of oral, drug(s) or insulin a patient takes. An attempt should be based on to a achieve a flat profile of glycaemia throughout the duration of 24 hours. By and large, dietary pattern is required to be modified quite often, in view of rise and fall of sugar levels in blood and urine. Once a dietary chart has been finalized, based on the condition of the patient, it should be closely and honestly followed by the patient. Any deviation, if desired or needed, should always be done in consultation with the attending physician, but never by the patient himself.

It is pertinent to point out that specified diets charts cannot and should not be prescribed for two persons, alike, who may be having, if at all, identical symptom. Following factors must be kept in mind while prescribing a dietary regimen :

1) Age, sex, profession, health status, as also diabetic status of a person must be taken into consideration, while preparing a dietary chart.
2) Diet prescribed should be within financial reach of the patient. If costly food-items are prescribed, the patient may not be able to stick to it.
3) Diet must be related ot the quantum of physical labour put in by a patient. For instance, a laborer would require more and higher calorie, based diet than a person working in an office, similarly in IDDM cases, one must be careful not to keep oneself without food, especially after taking an insulin injection.
4) NIDDM patient’s diet will differ from Insulin dependent patient, because the latter will require more quantity of carbohydrate as compared to the former.
5) Prescribed diet should not be monotonous. In order to avoid such monotony, patient’s diet should often be substituted by alternate food items.
6) Food must be tasty, otherwise the patient may be compelled to violate the dietary restrictions. Diet- menus of breakfast, lunch, supper and dinner must be often changed, without sacrificing the basic requirements in this regard, so that the patient does relish his food, instead of thinking that he has been subjected to and forced into a dietary pattern to which he is averse.
7) Diet of a child, growing child, pregnant woman, workman, labourer and that of an office workers should be designed and tailored to meet his physical and professional requirements
8) Prescribed food should be liked by the person so as to satisfy his taste-buds or else he will be forced to seek deviation of his own choice.
9) Food must also be satiating, that is after taking his food, the patient should feel fully satisfied and also feel that his hunger has been satiated or else he will often eat more and more.
10) Calorie-based diet should be a complete blend of well-balanced carbohydrate, protein, fat, vitamins and minerals, in addition to green and fibre-based vegetables.
11) Constipation is a common and normal complication of diabetic and if the prescribed food does not have enough of roughage, his complication will become still worse. A diabetic’s diet must have plenty of fibre, green vegetables, low-carbohydrate, bran and citrus fruits.
12) A healthy person normally requires about 100 to 300 gms of carbohydrates, 50-80 gm protein, 50-100 gms of fats, in addition to green and fibre rich vegetables and fruits. A diabetic’s diet should have less of carbohydrates, but not less quantity of protein, rather protein-intake should be increased. Fat content will be determined by the level of cholesterol in the blood, as also heart condition, and digestive capacity of the patient.
13) Easy availability of prescribed food items is of almost necessity. If the prescribed item is cheaper and useful also, but is not available easily (or if available, at the exorbitant rates), the patients shall be obliged to bid good-bye to it. The patients with limited resources and the ‘have nots’ are as lucky as the ‘have’ are, hence the former will develop a sort of inferiority complex for his inability to procure. Such diverse situations should always be avoided, if not eliminated once forever.
14) Those addicted to drinking should gradually taper their alcohol intake, as sudden cessation/withdrawal may have some psychological, emotional and physical upsets.
15) Dieting restrictions should never develop a feeling of “going off my diet”, fear of under-eating or over-eating. Dr. Joseph I Goodman says “Nutritional neurosis and food faddism” “should not disturb and cause any fear to the diabetic patient, much so his rest of family members.”
16) Let the other family be started of such foodstuffs which are forbidden to a diabetic who, on certain gatherings may also join others in eating and drinking sessions, but imprudent discretion should not outweigh sense of proportion.
17) Now a word about sweets and alcohol, again quoting Dr.Goodman, “The medical evidence is clear: Neither sweets nor alcohol are, in themselves, harmful to diabetics. Since the forceable removal of these items form the diet can produce severe neurosis in diabetics and their families, this alone is an ample reason to make certain that the age-old stigma against such items is erased. But there is more. The evidence is also clear that the removal of such sources of carbohydrate from the diabetic’s diet can do physical as well psychological harm. It can result in dangerously lowered levels of energy on the one hand and increased levels of cholesterol and triglyceride (cholesterol-related fatty acid) on the other.”

There are no hard and fast rules to govern such a patient’s daily food requirements. It is height of imprudence to hold diet and the patient responsible for any fluctuations in blood sugar level, for the simple reason that diet is but one of the various factors that cause and precipitate onset of diabetes. Japanese, Germans, Negroes consume carbohydrates in much more quantity than the Indians, but incidence of diabetes is far less in the former and far greater in the latter. To hold excessive use of carbohydrates, as the only contributory cause and main culprit, for causing diabetes, is nullified by the aforesaid example.

It is not possible to prescribe a calorie-based diet for such and every diabetes patient. It is neither feasible nor advisable, for the simple reason that every patient’s life style, food-patterns, amount of labour expended during work-period or quantum and duration of rest, habits of a person, apart from age sex etc. differ. So, a uniform dietary pattern cannot be worked out. For instance, if a diabetic person, working in an office, takes to a field job or traveling job, his calorie intake will naturally vary and such a suddenly changed situation. If he sticks to his physician’s dietary directions, he will, in all probability, fall a prey to hyperglycemia. If reverse is the case, he is liable to suffer from hyperglycemia in such a situation, the patient has to be his own master because in a lowered sugar level,. He may even meet his end if he is not fully aware of crisis management of such odd situations.

They are strict conformists to their eating patterns, rather better than the non-diabetics. They are cautious and punctual also. They take their doctor’s advice in right earnest and comply with the same. When a patient is admitted to some hospital, he is kept on closely measured diet but despite this, the blood/urine sugar levels do fluctuate, despite regular monitoring and medical care though his physical activity remains constantly the same. If in such a controlled and monitored situation, a patient can have the said fluctuations in blood and urine sugar levels then who is to blame-the patient or his doctor? It is certain that doctor and his attendants should shoulder the responsibility. Further dilemma is that ignoring the same anticipated supposed amount of physical activity coupled with normal workload of the dietician and the doctor prescribe the same diet when, infact, the situation has dramatically taken a turn about. So, dietary restrictions and prescription thereof to a diabetic patient does not seem to hold the ground, in view of the above quote instance.

Departure form normal food pattern is no crime nor should it be condemned. It is not physically possible for a diabetic or his family members to strictly stick or remain glued to a set pattern of precise measurement of food intake or complex food exchanges and meticulous calorie counting . Whenever there is any fluctuation noticed in sugar levels, the doctor, at once, concludes that the patient has deviated from his counsel. But, it is generally not the case.

“Certain dietary pattern, the complexity and confusion of the diets are not the only self-defeating factors. Quite often the diets call for types of foods or preparation so different from the family routine that they become disruptive. The inclusion of expensive diets can become a financial burden. And, most important, too often doctors and dieticians fail to a diet to fit the bodily requirements and life style of the patient.” And continuing his observation Dr. Goodman goes on to add that “Men who require 2500 or even 3500 calories per day, for example, are given diets containing only 1800 calories. Such errors made for thin men as well as for heavy, women as well as (for) children. Why?” Dr. Goodman’s ideas conform to what has been written and stressed upon heretofore.

In view of the above, calorie-based diet is no criterion for control diebates nor is it a fool-proof method. Its basic motive and concept are really laudable, but its prudent applicability has often been abused and distorted.

While prescribing a calorie-based diet, the following considerations must be kept in mind. Some of the points, mentioned hereunder, may look to be a rehash/recapitulation of what has already been said (and more so when opinions differ on this aspect)

1) Duration of diabetes affection and ravages wrought by it on various organs of the body.
2) Age, sex, profession and health status of the patient.
3) His age, life style, dietary pattern, financial position.
4) Diet should be nutritious, devoid not only of monotony but should also be tasty and satiating.
5) It should not disturb family budget and dietary pattern of a family.
6) It should be complete and well-balanced, as for as suitable blend of carbohydrates, protein, fat, vitamins and minerals are concerned.
7) Present diabetic status should form basis for dietary regimen.
8) Only minimal and very essential/reasonable conditions should be put in the patient so that there is no room left for his wrong & voluntary deviations.
9) Patients should be guided to adjust his diet as per his glucose level in blood and urine. This is called self-management technique.
10) Dietary regimen should not force the patient to become a social recluse.
11) Care must he taken to ensure that dietary regimen is not allowed to stretch to a fasting (or still worse to starvation) and clearly advised neither to be too indulgent nor instinctive. A middle path, balancing of both the facts, should be carved out and followed strictly, leaving enough scope for the marginal and emergent situations.
12) Any sudden deviation should always be avoided.
13) The members of the family should also be guided properly about the safeguards and precautions while preparing for and serving food to a diabetic.
14) Gradual withdrawal from certain food items, if prohibited or considered harmful, should be stressed upon and , in this aspect, patient and his family members cooperation is of utmost help.

While prescribing a calorie-based diet for the young ones, following points may be borne in mind:
1) If dietary restrictions are put on a child, it should always be kept in mind that the young one has been subjected to this agonizing malady and should not be made to suffer either mentally or physically. Further his diet should be designed in such a way that his needs for maturation, growth and development must not be hampered.
2) IDDM is a serious problem for the child and his parents, because he has to take injections regularly and after injections have been taken, he must be given a high calorie-based diet otherwise his blood sugar level will fall and hypoglycaemia stage may ensue. Food, prescribed for the child, must meet his physical, sport-related exercise based needs.
3) They should eat before and if needed during period of competition and there is no reason why a diabetic child should not participate in sports, attend to his normal study courses and other daily chores but the only pre-requisite is that his diet must be tackled to meet all his such and all other requirements. No diet should be prescribed which fails to meet a child’s requirements of body, might, intellect and an all-round development.

Note:- How much calorie is required per day for a certain type of diabetics, can be determined and decided by a dietician and physician, keeping in view the factors mentioned heretofore. But, for the convenience of the patients, diet charts, based on calorie-based diets are merely suggestive and do not and cannot have relevance to actual calorie requirement of a person. At best, they are only guiding indictors and should also be deemed to be so. The readers may refer to such charts to get a first-hand and basic knowledge and guidance about diet and calories, given at end of this book.

SUGAR DISORDER DUE TO ENDOCRINE GLAND’S MALFUNCTIONING

Following endocrine glands are said to cause diabetes, if their secretion is not normal.
1. pancreas
2. Thyroid _ This aspect will be dealt with, in details, later on.
3. Pituitary
4. Adrenal.

Our body is, as is well known, cell-based entity. In order to keep alive and in functioning condition cells play an important part and they can function only when they are nourished and compensated by various food constituents, like carbohydrates, protein, fats, vitamins and minerals, for which various chemical processes take place, within out body, thus enabling it to receive energy. Energy is generated by various food constituents, as indicated above. Body uses and utilizes these food-stuffs as fuel which gets exhausted (or burnt) by oxygen and the resultant end product emerges as energy, heat, carbon dioxide and water. Energy is a motivating factor which helps the body to perform its various functions.