metabolic syndrome X

Not sweet

YOUR HEALTH / DR GITA MATHAI

Diabetes has reached epidemic proportions in India. Exact figures are difficult to come by but screening studies place the numbers at between 10 and 20 per cent of the total population. These, of course, are only the people with frank diabetes. It does not take into account pre-diabetics, those with mildly elevated sugars who may eventually become full-blown diabetics. Nor does it consider the gestational diabetics — pregnant women who are diabetic during pregnancy but may recover completely after delivery. Unfortunately, diabetes affects systems all over the body, particularly if it is undiagnosed or uncontrolled. In the brain, it may lead to strokes or an earlier onset of cognitive decline, with memory loss and unreasonable behaviour. The eyes can develop cataract, muscles can become weak and the blood pressure can rise. In the heart it can lead to myopathy, blocked vessels or heart attacks. The kidneys can begin to malfunction and the nerves develop neuropathy with tingling numbness and weakness. Many diabetics remain undiagnosed as they have limited access to medical care or have not got themselves evaluated . Others have more faith in alternate systems of medicine. Many of these systems emphasise a “symptom based” approach to diagnosis and treatment. Individual symptoms such as weakness, frequent urination or loss of weight are treated. The main disease (diabetes) remains undiagnosed. Although diabetes is a dangerous disease, evolution has not wiped out the genes responsible for it. This is because it was originally a survival mechanism . Before large-scale storage of food was available, people (particularly women) needed to store food as fat in their bodies to tide them over in lean times (famines). People with the ability to do this were more likely to survive and pass on the genes to their offspring. People prone to diabetes have a similar metabolism that can efficiently convert food to fat and store it. Now that food is plentiful, these genes have become detrimental. They cause the metabolic syndrome X and this eventually leads to diabetes. The International Diabetes Federation has defined “the metabolic syndrome X” as the presence of central obesity — a waist-:hip ratio greater than 0.90 in males and 0.85 in females, or BMI 30 kg/m 2 . (The waist hip ratio can be measured in inches or centimetres by measuring the narrowest part of the waist and the widest part of the hip. The BMI is the weight in kg divided by the height in meter squared.) In addition, any two of the following should be present: Triglycerides more than 150mg/dL HDL cholesterol 40 mg/dL (1.03 mmol/L) in males, < 50 mg/dL (1.29 mmol/L) in females. A blood pressure reading of 135/85 or higher A fasting blood sugar value more than 100 mg/dL To avoid diabetes, the total calories consumed should not exceed that which is required by the body. The number of calories we need is based on our body weight, level of activity and the thermic effect of food (TEF) or the calories required to digest the food that we eat. About 60-70 per cent of the calories we eat goes towards supporting life. To find calorific requirement in males multiply body weight in pounds by 10 and then add double the body weight. In adult females multiply the body weight by 10, add the body weight. (1 pound = 2.2.kg) In addition calories are burnt during physical activity. This can be added to the above value. The TEF is a flat 10 per cent of the total calories consumed. So eat sensibly and exercise for an hour daily. Dr Gita Mathai is a paediatrician with a family practice at Vellore. Questions on health issues may be emailed to her at yourhealthgm@yahoo.co.in