INDIAN HEALTH - PART 4 - EXERCISES

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 CHALLENGE

We noted that the majority of Indians are fat or obese, and even the slim looking ones  are 'skinny fat' with little muscle and unhealthy levels of visceral fact.  Besides a high carb diet, the author attributes this problem to the lack of proper exercise.  Many who "exercise" harbor misconceived notions that walking alone is good enough. What the Indian needs is a set of muscle building exercises like lifting weights as well as some specific exercises that strengthen various key muscles of the body.  Muscles are the right store of glucose needed for strenuous activities and prevent its accumulation as bad tummy fat.

The author shows great understanding of the reasons why Indians lack proper exercise and are unable to maintain a regimen for significant lengths of time.  Thus, many of the suggested exercises in the book are those that are carefully chosen and can be performed even amidst a busy schedule several times a day.  Among the many benefits of exercising are: fat loss, taming insulin resistance, enhanced brain function, delayed aging, lower stress, and above all good role modeling (for the young).

SOLUTIONS

Inspired by the yoga approach and specifically vrkshaasana (the tree pose), the author recommends first a set of exercises that strengthen the core (the trunk), the roots (legs) and branches (arms).  He does not consider human engineered cardio equipment as matching a workout of outdoor exercises of running and walking in fresh air under diverse conditions.   Some of his favorite exercises are the following.

1. The squat.  He recommends avoiding sitting on a sofa but to prefer squatting (as they do in front of street corner tea shops in India) if not in the yogic posture.  The non-yoga squat extending the arms straight out with gaze forward and lowering oneself bringing the thigh parallel to  the ground is recommended for losing weight and also for strengthening leg muscles.  Squats with weights are the next higher level after one has mastered the basic squat.  Several variations of the squat are available for people at varying stages.  (see  https://www.youtube.com/watch?v=mGvzVjuY8SY ).

2. The second set of exercises recommended is the set of forward lunges which improve balance, coordination and symmetry.  "One of the best exercises for women who want to tone their thighs and buttocks," so says the author.(see https://www.youtube.com/watch?v=4gb3LNm247Y )

3. Suryanamaskar: The famous suryanamaskar of yoga (seehttps://www.youtube.com/watch?v=38GTnjg_aBA ).  The author recommends doing each pose separately and perfecdting them first.

4. Walking: The author recommends not just walking, but "active walking" wherein one pays attention to the specific muscles involved, chooses different terrains, and trying to progressively "beat one's prior record."  A specific recommendation is to walk as a "walking corpse" facing palms forward, opening up the chest, and keeping shoulders back.

5. Weights: A regimen of weights is recommended starting from low weights and progressively increasing to higher levels.  This is one area totally ignored by Indians to their great detriment and highly stressed by the author.

The book has many more exercises and much detail on each that are not included here.  It is not just a book on diet and exercising, but also one that covers health in a holistic way dealing with things like stress management and special circumstances like pregnancy and post-natal issues.  In short, I consider it a very valuable contribution.

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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 ?

INDIAN HEALTH - PART 3 - DIET

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.

PROBLEMS OF TYPICAL INDIAN DIET

Excess Carb: The key number is Net Carb defined by

NC = Total Grams of Carb – Total Grams of Fiber

(MyFitnessPal.com provides NC values for most Indian food for free.  Surprise or shock yourself as the case may be by playing around. 1 home made dosa=34g !)

If you meet the metabolic six-pack, limit carbs to 150g/day.  May need to move to 80-100g to burn fat depending on how far you are from the norm.

    For someone meeting the criteria given in Part 2, the recommended NC per day is in the range of 100-150 grams, although the very physically active may tolerate more.  Those who are challenged with respect to obesity measures will have to drop down to 80-100 grams of carb per day to achieve fat burning.  But most Indians routinely consume 300+ grams per day; most don’t even know that.  They chase some other numbers like total calories or total fat etc. incorrectly.  They also harbor many myths and do not understand that certain fats (like coconut oil and ghee), in the absence of excess carb, are not harmful but become fattening with excess carb. Excess carb leads to insulin resistance and unhealthy visceral fat lining internal organs (abdominal fat is a sign of that) that generates inflammatory agents.  The book recommends carb control as the most important step in controlling many of the metrics associated with the metabolic six-pack.  Patients are seen to show significant progress even in 3 months with proper carb control and exercise.

Warnings: (i) You must avoid too much loss of fluids and sodium if you are moving from a high carb to a low carb diet.  Typically, people may need only a cup of broth.  (ii) If you have a health condition like high BP, diabetes, or a heart problem, you must consult your doctor or a trained nutritionist before you make drastic reductions of carb. (iii) Those engaging in over 1 hour of intense exercise or games (not casual strolls) can take an extra dose of carb in the form of a sweet potato or a serving of rice 30 to 60 minutes later to replenish the glucose store in the muscles.      

RECOMMENDATIONS

1.    Flat Breads: Avoid or severely limit high carb foods (Paratha=47g; Naan=35g, chapatti=24g, masala-dosa=30g, 1 bread slice=15g; all numbers approximate and can vary with brand etc.)  Replace with low carb food (Coconut Flour chapatti=3g; almond toast =1 g; almond flour pancake =2g; romaine lettuce=0g).  Try chopped cauliflower for masala in place of potato.  Try adai or pesarettu instead of dosa high in rice content with more lentils.

2.    Starchy Vegetables:  Substitute starchy vegetables (aloo sabji=40g/cup; aloo paratha=40g; corn 1 cup=30g; peas 1 cup=20g; pumpkin and squash = 20g/cup) with (cauliflower=2g/cup; crunchy leafy vegetables; sweet potato; finally, spaghetti, zucchini, summer squash=5g/cup)

3.    Rice etc.: Intake in the Chinese population of rice is apparently 600g/day of carb (won’t be surprised if it is so for many in South India).  Substitute high carb items (1 cup white rice=40g; 1 cup basmati=76g; 1 cup spaghetti=40g; 1 cup brown basmati=68g) with  alternatives (cauliflower rice =4g; shredded cabbage=4g; Shirataki rice and noodles = 1g.  Other alternatives are chopped broccoli, carrots).

4.    Lentils etc.: Substitute high carb items (cooked dal=30g/cup; kidney beans=30g; chickpeas=30g) with (rasam 5g+vegetables; add volume with protein foods like paneer and nuts; add richness with toasted almonds topped with extra virgin olive oil, ghee, or coconut oil.)

5.    Sweets: Avoid high fructose corn syrup, liquid sugar like juices and sodas, designer coffee drinks, mango lassi, fruit smoothies.  (1 raw mango=30g; 1 cup pineapple=20g; 1 banana=24g; 1 cup prunes=60g; 3 dates=50g) .  Instead, use berries (1 cup blue berries=15g; raspberries=7g; strawberries=10g).  (There is not even a need to mention Indian sweets which are sugar high.  A strategy adopted in parties successfully by someone I know is to either take the desserts first so as not to overload oneself after the meal, or to consciously make room for some and go easy on the main courses.)

Breakfast: The author recommends having breakfast after an exercise, so that the muscles draw their glucose from the accumulated belly fat.  Those, who can, should consider an omelette, soft-boiled eggs or scrambled eggs for protein.  Avoid cereal from boxes laden with carbs as well as oatmeal-banana.  Instead, he suggests almond meal, almond flour, or coconut flour pancakes, low carb Greek yogurt, berries and nuts.  For him, skipping breakfast altogether is not as sinful as some make it out to be either, and many may find themselves feeling less hungry as they do around ten or eleven after a glucose heavy breakfast.  He also recommends intermittent fasting by those who can do that.

Protein: Lentils are the main source of protein for vegetarians, but unfortunately they come laden with carbs.  A couple of eggs is highly recommended by the author who asserts that will increase your cholesterol less than a bagel or high fiber cereal we normally eat.  Nuts and seeds (almond, macademia, sun flower seed) are good sources of protein, minerals, fiber and healthy fats as are butters made from them.  Quinoa is high in protein, calcium, phosphorous and magnesium but be aware of its NC.  Almond flour or coconut flour breads,  a bowl of lentils with ¾ vegetable content (don’t overcook vegetables) is a good choice.  Protein shakes with regular or coconut milk as base with some added nut butter is a good choice.  Avoid fruits and prefer vegetables for shakes.  Vegetables with high protein content are: asparagus, broccoli, Brussel sprouts, cauliflower (do not overcook!).

Fat: Saturated fats found in dairy (milk, butter) and in coconut (oil, butter, flakes, milk) are good when not consumed with excess carbs. Monounsaturated fats (olive, extra virgn olive oil, avocados, macadamia, almonds) are heathy; don’t heat the oils in this class to high heat.  In the case of Polyunsaturated fats, Omega-3 is good, but avoid Omega-6 (vegetable oils are big offenders) which creates inflammatory effects.  Transfats and partially hydrogenated fats are unsuitable for human consumption.

Additional Remarks: Indians tend to exhibit Vitamin D deficiency.  A daily vitamin supplement is worth considering if the daily diet is not providing enough vitamins and minerals.  Indians according to the author lead a highly oxidized lifestyle, which accounts for high rates of inflammation. (We take early AM, as first thing in the morning 15 minutes before anything else, the anti-oxidant 'nutraMetrix Isotonic OPC-3' on the advice of our own doctor and have found it to be very helpful. A capful is supposed to have anti-oxidants equal to several glasses of red wine.)

Please read the book for more information on food for children, pregnant women, etc. as also for understanding better the rationale.  At its price, the book is a great investment.  Treat this set of blogs only as a quick refresher or summary of the bare minimum facts.

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 ?

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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INDIAN HEALTH - PART 1 - The Indian Health Problem

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, 376 pages

Author: Ronesh Sinha, MD

ISBN: 978-1-939563-05-7
A video by the author Dr. Sinha: https://www.youtube.com/watch?v=3mdTTB6v94Y

Note: This summary, in my own words, 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 Indian Health Problem

1.     Issue: Indians, including those in the West, exhibit a higher incidence than most other groups of chronic diseases like insulin resistance, diabetes, hypertension, inflammatory diseases, arthritis, and cardio and cardio-vascular problems.  A notable number, including some who appear to be otherwise ‘normal and healthy,’ suffer catastrophes like heart attacks and strokes at ages when these are not expected.  Some even die young and suddenly due entirely to preventable causes.  As a group, Indians are seen to contract various diseases about ten years before other categories of people like Caucasians.  South Asian women have greater difficulty than men in managing their health and in combating some underlying causes like obesity. Indian children run even a higher risk than other children as they will grow into adulthood, and that alone should motivate the adults of this community to learn more about health issues, to become good role models, and to rear children with good practices with regard to issues of health.

2.     Bodily Manifestations: Indians meeting healthy norms for body measurements and lab results form a very small minority.  Most Indians are fat or obese.   The typical Indian physique is ‘non-muscular’ and ‘with chicken legs and a large belly.’   Those who don’t appear to be so are not healthy either, but are ‘skinny fat’ (exhibiting what the medical profession calls sarcopenic obesity.) Their fat is visceral, hidden inside, and attacking key parts like the liver.  The excess fat they carry and their bad fat-to-muscle and waist-to-hip ratios make Indians highly susceptible to the risks of insulin resistance, inflammation, and coagulation, which have drastic health consequences in the form of chronic diseases and even early mortality.  Indian women have a much higher incidence of PCOS (polycystic ovarian syndrome), that the author calls 'The PCOS Epidemic,' which is attributable to extra fat tissue that causes hormone imbalance.

3.    Clinical Manifestations: The following are commonly seen clinical manifestations of underlying problems: high blood pressure; high cholesterol with improper LDL to HDL cholesterol ratios; high triglyceride levels, high blood glucose levels and/or elevated A1C levels.  In more extreme cases, one also sees: thyroid deficiency; Vitamin D deficiency, and poor bone density.

4.     Causes: While inherited genetic traits and family history are important, in a vast majority of the cases, the problems are attributable directly to an unhealthy life style marked by poor/unhealthy diet, lack of exercise (and  the right type of it by those who do exercise), a sedentary lifestyle, inadequate outdoor activities, high stress, digital/blue-light overload, and lack of adequate sleep.  With respect to diet, Indians, despite their sedentary life, have continued to ingest a diet of high carbs that is suitable for the "rickshaw puller' who exerts himself much physically.  Most worsen the situation with junk and fatty and highly processed foods and snacks.  Their parties and mode of hosting do not help.  The new age Indian worker has all these exacerbated even more by junk food freely available at the work place. 

5.    Myths: The above causes are exacerbated by various myths concerning various types of foods, exercise, and dieting.  Medical science has also erred by not paying adequate attention to key measures like triglyceride levels (especially triglyceride to HDL ratio) and does not obtain detailed lipid profiles  for higher levels of type B LDL and Ox-LDL which can cause much harm .  They have focused on the simpler and non-conclusive ratio of LDL to HDL only, and brushed aside certain other anomalies as normal for Indians and not be bothered about.

6.    Good News: Much new research and clinical data shedding new light are now available that show that: (a) By adopting the right food and exercise habits and with what one would call life style changes, the younger members who do not exhibit the symptoms can prevent them altogether.  (b) A majority of those already exhibiting the cited symptoms show considerable improvement even within six months of adopting certain recommended life style changes. (c) The changes needed are not too onerous and have been developed with the clear understanding that one reason people fail to adopt change or give up too soon is due to the onerous nature of some past approaches.

GOING FORWARD: Since our goal is to move at a fast pace in the right direction, we will in the next part describe the recommended body measurements and laboratory limits specific to South Asians, and then immediately get to the recommended diet, exercise and other life style changes.  The book explains the physiology and chemistry associated with these in substantial technical detail in an accessible manner.  I believe it is important to understand those to keep our motivation high.  I will cover them in a much later part, albeit only very briefly.  Again, you must consider getting the book and studying it if not now, but at least at a later time.

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There are 3 more parts to this summary.  Please find them by searching through the right panel.

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Author: Innovation by India for India, the Need and the Challenge.  available on amazon.com and flipkart.com