INDIAN HEALTH- PART 2 - METRICS & THRESHOLDS

This is a summary of a great book and provided as community service to you. Your feedback is appreciated.  My advice: Buy the book and use it as a constant reference.

Book: The South Asian Health Solution

Author: Ronesh Sinha, MD

ISBN: 978-1-939563-05-7

Note: This summary is to quickly get us moving in the right direction and is not a substitute for reading the book which abounds in case studies and much greater detail than what is presented here.

THE IDEAL NUMBERS FOR ASIAN INDIANS

      We will first recall the target metrics to watch and the thresholds.  Explanations on the significance of these metrics etc. are to be given in a later post with our focus on getting to actionable items first. [These summaries are also for myself so that I don’t have to keep searching through the book repeatedly.]

     The book recommends a set of six goals, which the author calls “metabolic six pack.”   They are both goals to aspire for as well as a check with regard to how healthy one really is.   Abnormalities in them are often indicators of ongoing or soon-to-occur problems.  It is, however, counterproductive to get hung up on the last inch, or the last pound, or whatever measure and stressing out.  However, the closer you move to the ideal, the better off you are.  The key is to start making a constant movement in that direction and maintaining once good levels are reached.

METABOLIC SIX-PACK: (1) If you are a male, bring your waist circumference to 35 inches, and if you are a female to 31 inches; (2) Get to a triglyceride level below 100 mg/dL (1.13 mmol/L);  (3) Get to HDL cholesterol to a level greater than 40 mg/dL (1.03 mmol/L) if you are a male, and above 50 mg/dL (1.29 mmol/L) if you are a female; (4) Reduce your systolic BP to 120 or under and diastolic BP to 80 or under; (5) Bring fasting glucose level to below 100 mg/dL (5.6 mmol/L) and A1C to below 5.7; (6) Get hs-CRP level (inflammation marker) below 1.0mg/dL.

Two ratios:  Two ratios strongly recommended for South Asians and associated targets are: (i) Triglycerides/HDL < 3.0; (ii) Waist/Hip < 0.9 for males, and < 0.85 for females.  [Measure waist (tummy) at the level of the navel without tucking in, and hip at the widest point keeping a tape measure as parallel to the ground as possible.]

A crude measure of fitness is BMI (the Body Mass Index).  It is defined as:

           BMI = (703 x Weight in Pounds) / (height in inches x height in inches)

                    = (Weight in kg)/(height in meters x height in meters)

Note: 100 centimeters make a meter.

Some rules of thumb accompanying this measure for South Asians are:

        Underweight if BMI < 18.5; Healthy if BMI is between 18.5 and 23;

  Overweight if BMI is between 23 .1 and 25; Obese if BMI is greater than 25

WARNING: Though easy to measure, the BMI is not adequate as a measure because, among other things, it does not differentiate fat and muscle.  Abdominal obesity is a better indicator.  Stay with the metabolic six-pack measurements.

    The book  (Appendix B, pages 358-360) provides a detailed set of WHO recommended parameters for an even larger variety of metrics.  The typical health challenged Asian Indian, however, will do well to concentrate on the above and to work on improving them unless there are specific reasons identified by a physician.

ADDITIONAL COMMENTS

1.     There are many other metrics and associated thresholds given by WHO.  One of these is Total Cholesterol/HDL < 3.5.   An advanced lipid profile may be needed if you are violating this or other cholesterol based requirements in the metabloc six-pack.

2.     Blood pressure: You are pre-hypertensive if your systolic is between 120 and 139 or diastolic between 80 & 89; Stage 1 High if systolic is between 140 & 159 or diastolic is between 90 and 99; Stage 2 High if systolic is > 160 or diastolic >99.  If not normal, it is recommended that you monitor your pressure at different times of the day daily at least for two weeks, make a chart, and share it with your physician.

3.     Blood Glucose: Normal if fasting glucose < 100 mg/dL, A1C< 5.7, and OGTT  < 140.  OGTT refers to Oral Glucose Tolerance Test, which is not administered unless there is a need.  Pre-diabetic if fasting glucose is in the range 100 to 125, or if A1C in range 5.7 to 6.4, or if OGTT between 140 and 199; Diabetic if fasting glucose > 126 or A1C > 6.4 or OGTT > 200.

4.     Specific requirements on LDL cholesterol is not specified by the book due to the reason that LDL itself decomposes into smaller and larger particles, and smaller ones cause problems.  Thus one can have a “normal” LDL level although could be quite unhealthy since a large portion of the LDL is made up of smaller particles.  The metabolic six-pack has measures that can be good markers of cholesterol disorders and if they are violated, your doctor should obtain a detailed cholesterol profile for you.

5.     There are many myths with regard to diet, exercise, fat, and cholesterol prevalent among all and particularly among Indians.  Examples of these are: (i) ghee and coconut oil are bad; (ii) lentil rich food is necessarily healthy; (iii) walking alone is sufficient as exercise.  We will examine these in later sections.

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Other parts of this can be found by searching through the right panel.  Have you seen my book, "Innovation by India for India, the Need and the Challenge" available through amazon.com and flipkart.com ?

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