Many people assume that they only have the mild touch of diabetes and that it can be entirely treated with lifestyle changes, says Dr V Mohan, chairman of Dr Mohan’s Diabetes Specialties and Madras Diabetes Research Foundation.
Excerpts from a conversation with Sinduja Jane:
US FDA allows new claim that yogurt may reduce diabetes risk? Are there any studies available on this?
Recent studies have confirmed that yogurt can reduce the risk of diabetes. Our research at the Madras Diabetes Research Foundation, Chennai, strongly supports the fact that dairy in general, and yogurt in particular, can be protective against diabetes. We found that the benefit was more with fermented dairy products like yogurt.
With respect to the recent US FDA announcement, this was in response to a company which asked the FDA not to oppose the claim that yogurt can help to reduce type 2 diabetes risk and the FDA complied with their request. This is a significant development given the fact that many people, particularly vegan groups, claim that dairy is the cause of diabetes and all dairy products should be completely eliminated from one’s diet.
We first found in our CURES studies that dairy was actually protective against diabetes but that was a cross sectional study which can have a lot of bias. Later in the longitudinal Prospective Urban Rural Epidemiology (PURE) study, we followed 130,000 individuals for over 15 years and looked at the baseline dietary consumption with the development of new onset type 2 diabetes and metabolic syndrome. We found that dairy in general (including high fat dairy) was protective against not only diabetes, but also hypertension and metabolic syndrome.
In other PURE studies, we showed that intake of dairy also reduced all causes mortality as well as decreased cardiovascular mortality. Hence, dairy in general and in particularly yogurt, seems to have beneficial metabolic effects and I am happy that the US FDA has come out strongly in favour of yogurt. This will help to dispel a lot of myths among people that dairy products are harmful for health.
Yogurt also has probiotic action which could also help in its metabolic benefits. It must be stressed, however, that it is plain (unsweetened) yogurt that we are talking about and not flavoured yogurt. Many of the flavoured yogurts are high in sugar and their use has to be restricted or avoided.
Diabetes has become like a common disease among people that they stopped worrying about it when they get it. What do you think is the reason for this attitude and how serious they should be when diagnosed with diabetes?
It is true that people think that they only have a mild ‘touch’ of diabetes and that it can be entirely treated with lifestyle. In fact, in recent years, another myth spreading on social media, particularly by ‘low carb’ and ‘keto diet’ groups, as well as various commercial ‘reversal of diabetes’ organisations is that taking medicines for diabetes is bad and it should only be controlled by lifestyle.
The fact is that less than 5% of people actually respond to such reversal techniques and 90-95% of all people with type 2 diabetes would need medications in order to achieve the ABC targets of diabetes control. If used in the right doses and under specialist advice, anti-diabetic medications are safe. We have been using them for over 60 years without any side effects.
What are dangers of unmanaged diabetes? If diabetes is managed, what is the impact on the organs?
Uncontrolled diabetes can affect the eyes, kidneys, heart, feet, nerves and also the sex organs. Diabetes is in fact the leading cause of blindness, kidney failure, heart attacks, stroke, amputations and impotence. It is said that diabetes can affect any organ from head to the feet. It normally takes 10 – 15 years for diabetes to affect organs, but this is highly variable and in some people with an increased genetic predisposition, even within 5 years (or sometimes even when the diabetes is diagnosed), they could already be damaged to the renal organs.
There are some lucky people who even after 40 or 50 years of having diabetes, do not have any complications. If diabetes is kept under good control and the ABC targets are achieved and if one regularly visits a diabetes centre (3-4 times a year), we have shown that complications of diabetes can be virtually eliminated and people can live a healthy life even up to 100 years.
Medicine or lifestyle changes - what is the best way to manage the disease?
Lifestyle modification which includes diet, exercise and where relevant, weight reduction remain the cornerstone of diabetes management. However, as mentioned earlier, in the majority of patients, medicines are needed.
The famous ‘DIRECT trial’ which showed remission of diabetes is often quoted to say that people do not need medications and they can be treated with just lifestyle i.e. calorie restriction and weight reduction. However, what people don’t realise is that a highly selected group of individuals were included in the DIRECT trial.
From which age we should watch out for the disease?
If there is a family history of diabetes in parents the first screening of diabetes should start from age 20 and even earlier if the child is obese. Even without a family history of diabetes, those above the age of 30 years should undergo an annual screening for diabetes.