A thought for Food

The day before yesterday, 16 October, was celebrated as World Food Day. Funny – I thought every day was that. Nothing gives as much pleasure as food – or creates as much confusion in our minds.

Every day we are assailed with completely conflicting messages – eggs are bad; no - eggs are good. Cholesterol is a problem; no - cholesterol is essential for a healthy body and mind. Milk is good – no, milk is bad. Tomatoes are good; no, tomatoes can cause cancer

How, in the face of such contradiction, can we even decide what is good for us? Would like to share my simple theory on this

A large part of the problem lies in the pace of evolution of the human species. We are no different than we were in the 17th century – 300 years is a mere blink of an eye in evolutionary terms. Our lifestyle has, however, changed tremendously -  automobiles, processed foods, supermarkets, air conditioning and desk jobs have served to make us much more rich, sedentary and overfed as a species. Our lives are programmed and routine but genetically, we are still omnivorous hunter gatherers who can’t be sure where our next meal will come from. 

Every diet we try attempts to trick our body into not absorbing the food we eat – eat only protein, eat only fat, separate the protein and fats, cut out carbs entirely. We lose weight dramatically while on the diet – only to put it all back and more when we go back to normal food. That is because the diet signals to the body that food is in short supply, and triggers the “thrifty gene” - that in turn conserves every scrap of food and uses it sparingly.

When we were young, we learned about 'balanced diets' – our bodies needed to be fed much like we would build a camp-fire. The heavy logs were at the bottom and the tinder and camphor were on the top. The camphor lights the tinder, the tinder lights the twigs and the twigs light the logs. A fire entirely of tinder would burn out too fast and not generate enough heat – one with only logs would be nigh impossible to light. Similarly, the simple sugars provide the energy to break down and digest the other carbohydrates that then start working on the heavier fats and finally, the proteins. By depriving our body of the carbs, we slow down digestion of the heavier nutrients and so feel full for longer. But is this the right approach? The real questions we should be asking are “Who are we fooling?” and “Should we be eating as much as we do in the first place?”

I would like to advocate an approach that has been serving me well for the last 15 years

• Don’t embark on a diet that you cannot sustain – lifelong! Remember the rebound effect – if you can’t sustain the diet, the weight will all come back
• Eat what is natural and seasonal. Nature inevitably has a purpose for what it does – for the watermelon in summer, and apples in winter.
• Keep away from the processed foods - processed foods are possibly the biggest evil we encounter in our day to day existence. As a rule, stay away from the 4 whites – white bread, processed sugar, salt and white flour. Some add milk to this list – I have benefited by keeping milk out of my diet, preferring yoghurt and old cheeses. Carbonated beverages are high on my list of “dont’s” – recent evidence suggests that even diet drinks can mess with your metabolism and effect your health. Eat whole fruit instead of fruit juice. Don’t hurry to throw away the skin – often the largest source of nutrients and fibre.
• Exercise – as much as you can. A 10 minute walk is better than none at all. A gentle walk post a meal helps the digestion and works the body. Build exercise into your routine and chores – that is the only way of incorporating it into your life. Even the slightest exercise is a stimulus - it pumps up the metabolism and keeps you well-oiled
• Control the portions. Eat a variety of foods. Watch how much you eat though – 'how much' is more important than 'what' where diets are concerned
• Work with a dietician who understands your needs. Overlay all advice with a strong dose of common sense

Disregard everything I have just said if you have an existing medical condition. Your doctor is the best judge of what you need to do to put you back on the health path.

Happy World Food day to all my fellow foodies – better late than never. The intention was not to throw you off your food – love my food too much to do that! I do hope, though, that I have given you something to think about when you next reach for something – or abstain from something. Remember, maintaining a balance will allow you to enjoy your food for as long as you live

I am 50 – going on………… 35!

Yes – you read that right!!

We are all obsessed with chronological age – celebrating anniversaries, blowing candles, cutting cakes. But look around you – has everyone around you aged uniformly?

Twenty years ago, I was a fairly unhealthy 35 year old. A freak soccer accident played havoc with my right knee – needing reconstructive surgery. My exercise levels dropped, and I quickly put on 10 kgs.

Things changed for the better when I turned 40. I re-discovered my passion for the outdoors and learnt to play tennis.  I will never climb Mt. Everest and will never win even my condo tennis tournament – but that doesn’t dampen my enthusiasm. A recent high point was when an online test declared my health age at 35 years! There are large numbers of self-administered online tests that estimate your health age based on your physical characteristics, activities and lifestyle – you might like to try one just for fun.

Analytics today have evolved to the extent of scientifically predicting your chance of having a cardiac event in the next 5 years. Several “Risk Assessment” algorithms have been put out by some of the best names in medicine  - Johns Hopkins’s ACG, the Framingham panels, the Minnesotta Tiering methodology, Charlson Comorbidity measures, Kaiser’s Archimedes etc. Each of them puts a number to your health risk – some translate the risk into money. The algorithms are extremely complex, but most recognise that over 80 % of the controllable risk can be attributed to 5 factors – excess body weight (BMI), Lipid Profile, uncontrolled diabetes and hypertension, stress and smoking.

The George Institute for Global Health (TGI) is a 4 - country organisation headquartered in Australia. The institute is known for its research into population health and clinical excellence. In 2015, it was ranked among the leading ten research institutions in the world for research impact by the SCImago Institutions Rankings World Reports. TGI has developed a proprietary risk stratification and management methodology and has embedded it into a computer tool called “Healthtracker”. Healthtracker is a part of a suite of tools developed by TGI that, together, can link to medical records, extract data, dialogue with users and provide end-to-end solutions. Healthtracker quantifies cardiovascular risk and allows the individual to take charge, in consultation with his doctor. A dial allows an individual to set goals for diet, exercise, medication compliance and smoking cessation – and to see how this helps dial down their healthcare risk. Healthtracker paints some amazing pictures – for example, just cutting off smoking reduces cardiac risk by 30 %. This is just a glimpse of what Articial Intelligence and Machine learning tools can do to improve healthcare

A word of caution though - these tools only work when they are correctly adapted to the health system / individual context. Most times, results are more directional than accurate - so the movement over time and action plans for sustained outcomes are more important than the absolute numbers.

So, fellow 50 year olds – take heart. With some effort you can go back to feeling the way and doing the things you did 20 years ago. Only you can take charge of your own health; adopt some simple mantras

• Eat right; avoid processed foods, watch those lipids and your blood sugar
• Exercise regularly; stay light on your feet
• Find and practice your way to beat stress. Laugh; have fun; develop a hobby; make friends – it is never too late
• Stop smoking – NOW

Watch yourself grow younger –  go on that magical hike, play a game with the kids or finally indulge your love for outdoor photography. Life can be fun – again!

Only Dreamers can be Doctors

If there is one thing I regret in life, it is not studying to be a doctor. I am not usually the regretting kind –but I have enormous respect for those that heeded the calling and chose this profession.

There are a number of reasons I could possibly give for my not choosing to be a doctor – but below all that is a lack of courage. I simply lacked the courage to withstand the trauma and the gore. I lacked the commitment it takes to work endless hours. I doubted my ability to go those long hours without sleep and still be available, when needed, to address the next, inevitable, crisis. I wasn’t sure that I could cope with the expectation – to be that model citizen who unselfishly puts others’ interests ahead of his/her own.

Fourteen years ago, I made amends in a small way by committing myself to a career in healthcare – to support these wonderful people in their quest to keep people healthy. 

A few years ago, I was discussing a mutual passion in music with a doctor friend. The conversation veered to affordable player options and I talked about my latest acquisition, a Bose Sound Dock. My friend laughed and said “Rs 13,500/- isn’t a small sum of money on an associate professor’s salary, Harish”.  I came out of the room very embarrassed by my lack of sensitivity and suitably chastised. The incident also got me reflecting on the cost economics of becoming a doctor.

A little known fact is that a professor in a Government Academic Centre of Excellence takes home a salary comparable to that of the Company Medical Representative across the table from him. The figure could multiply several fold if they choose to move to the private sector - a fact that every doctor is aware about. This begs the question “Why do these doyen of the medical profession choose to stick to their government careers?” “Why do they resist the large financial incentives to jump ship?” and “Will this last?”

Medicine is amongst the most expensive educations one can pursue. Even in a relatively less expensive country like India, the cost of qualifying as a doctor can top Rs 1 Crore ($ 150,000) – in terms of facilities, equipment, teaching faculty and support staff. It also takes significantly longer to qualify – there is the 4 year undergraduate course, residency and a possible 3 year post graduation. Doctors often earn their first salaries when other professionals have bought a car and are planning their first child. The starting salary for a General Practitioner in India averages ~ Rs 7 lacs per year. This is only marginally higher than that of an office assistant – and significantly lower than an executive’s starting pay. Most start as duty doctors manning the toughest shifts and the worst timings – or are left to fend for themselves in the uncertain world of private practice.

Layer on top of this the huge gap in the availability of qualified doctors to manage the health of a population as large as ours. The WHO norm for is 2.5 doctors per 1000 population – a number that several developed nations have reached and exceeded. China and Brazil have 1.8 doctors per 1000 population. The corresponding figure in India is 0.7 doctors per 1000. Given the amazing range of professional choices available to an aspiring youngster in our country, will this gap ever be covered? I, for one, have my serious doubts.

What, then, is the recourse available to us? How do we continue as a country to march towards Universal Healthcare, the Sustainable Development Goals and delivering on the promises an “emerged” nation needs to make to its citizens. I have listed out my list of “must do’s” below :

1.          Value our doctors – they chose to be where they are so they can serve us. Value their time and respect their inputs
2.          Support every healthcare professional to work at their highest capability level
3.          Use technology to free up precious doctor time
4.          Empower patients to take care of themselves
5.          Focus on prevention and early intervention

Each of these is a complex problem in its own right – and each deserves to be dealt with in detail as I hope to do in my future writings.

For the moment, though – I would like to end with a salute to our doctors. You are truly an inspiration. We might not always show our appreciation but we depend on you to keep us healthy and happy!