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