It’s a boon that is silently taking a heavy toll on India’s urban population. Medical professionals across cities are warning against the ills of a sedentary lifestyle, linking it to a host of health issues such as chronic fatigue, dizziness, disturbed sleep and unnatural weight gain. All these, they warn, could also be symptoms of hormonal imbalance in the body.
Indeed, the spiralling numbers point to a disturbing trend. According to a study conducted by the department of endocrinology and metabolism of New Delhi’s All India Institute of Medical Sciences (AIIMS), an estimated 108 million Indians suffer from endocrinal and metabolic disorders, several of which are caused by environmental factors. And as urban India moves to a 24-hour work cycle, in several industry sectors such as customer care, hospitality and health care, perturbed endocrine functions as a result of daytime sleep and night-time work are set to increase.
The age factor
Typically, hormone levels peak in the 20–25-year age group, with a gradual decline setting in after 30–40 years. In the post 45–50-year age group, this decline can be precipitous, leading to a host of disorders, such as osteoporosis, diabetes and cholesterol build-up in arteries, all of which are considered age-related disorders.
“Modern lifestyles are now triggering a wave of accelerated ageing, with hormonal decline and associated disorders being manifested at much earlier ages,” says Ashok Kadambi, founder and president of Fort Wayne Endocrinology, a US–based endocrinology centre that has set up a subsidiary operation in Bangalore to treat disorders related to natural or bio-identical hormones. “Increasingly, professionals between 20 and 40 years of age come to me with symptoms of hormonal disorders,” says Mohan K. Rao, a Bangalore-based consultant endocrinologist.
At least a quarter of those suffering from endocrinal disorders in India are afflicted with diabetes. “Urbanization unmasks the genetic tendency amongst Indians to develop diabetes,” says A. Sharda, senior endocrinologist and diabetologist at the Bangalore-based Samatvam Endocrinology Diabetes Center, an institution that specializes in treating and managing diabetes and other endocrine metabolic disorders. Dr Sharda says early diagnosis of risk factors and right lifestyle adjustments are crucial to arresting the growth of such disorders. Most of these conditions can be treated with lifestyle modification techniques and stress moderation through yoga and other exercise regimens.
However, more than one-third of all endocrinal disorders in India relates to thyroids. Dr Rao says: “Between 10% and 15% of Indians have some degree of thyroid dysfunction that goes largely undetected.” He adds that hypothyroidism or decreased thyroid function is more prevalent among women between 20 and 50.
Increased risk of diabetes is evident for adult Indians with a body mass index (BMI) higher than 25, while women with a waist circumference more than 80cm (85cm for men) also fall in the high-risk category. An inability to lose weight despite a strict diet control, intolerance to cold, or hair loss, doctors say, could be the warning signs of hypothyroidism. They add that it can be diagnosed by a simple blood test that checks for the thyroid stimulating hormone (TSH) level. “High TSH level is a sure indicator of hypothyroidism,” says Dr Rao. While most patients respond well to lifestyle adjustments, such as increased physical activity and modified food and sleep habits, 10-20% of patients require hormone replacement therapy to get the balance right, he adds. “Regular relaxation techniques and stress reduction measures can alleviate most problems,” says Dr Rao.
As most disorders only have vague symptoms early in their natural history, early detection, says Dr Rao, is the key to effective treatment. A delay in taking corrective measures could lead to a number of complications and even damage vital organs. For instance, adult hypothyroidism, if not diagnosed and treated early, may cause heart diseases or affect the functioning of the brain, causing memory loss, hearing impairment, depression and even psychotic disorders.
In the case of hyperthyroidism, detected by low levels of TSH in the blood, the symptoms include unexplained weight loss, uncontrollable shaking of hands, increased anxiety and sweating. Irregular menstrual cycles can occur as a result of either hypo- or hyperthyroidism.
Typically, endocrinologists are sought by patients who come with maladies ranging from lethargy, disturbed sleep and hair loss to increased hirsutism or acne. “Sexual dysfunction is another common problem arising out of hormonal imbalances,” says Dr Rao. A little more than a tenth of all endocrinal disorders in India are those arising from reproductive endocrinal malfunctions. These result from a disturbance in the hypothalamic-pituitary: ovarian or testicular axis. Low levels of progesterone and estrogen in women and testosterone in men can be detected by a blood test that checks for levels of follicle follicle-stimulating hormone/luteinizing hormone in the bloodstream. While post-menopausal women are most prone to this condition, urban stress has contributed to more young women falling prey to this condition.
“Hormone replacement therapies for such cases are recommended only when younger women in their 20s or 30s report these symptoms,” says Dr Sharda.
Adrenal disorders or low levels of the cortisol or stress hormone are the other conditions endocrinologists are increasingly encountering. According to an AIIMS study on adrenal involvement in clinical tuberculosis, this affects about four million Indians. While low levels of cortisol result in less energy, weight loss, general weakness and darkening of the skin, high or excessive levels lead to weight gain and facial acne.
Endocrine disorders can be confirmed with a simple blood test (2mm of a fasting blood sample can help detect a disorder). Apart from diabetes, which requires lifelong care, treatments for most other disorders are time-specific. “Typically, my patients remain under my care for a six-month time frame,” says Dr Rao. However, endocrinologists increasingly stress the need for the inclusion of hormonal tests in regular medical evaluation programmes for all healthy individuals as well. “Even for a person with no obvious symptoms, a regular thyroid function check every five years after the age of 30 should be mandatory,” says Dr Rao.
“Community outreach programmes that can help in early detection and treatment are the way forward to managing endocrinal disorders,” says Dr Sharda. With the help of Samatvam, Dr Sharda is advocating the need for community action in urban areas to provide infrastructure for physical activity in crowded urban neighbourhoods.
“Endocrinal disorders are an issue that Indian society will grapple with increasingly as a generation of sedentary youngsters grows old. It is a national health issue,” says Dr Sharda.
Despite a clean chit from her doctor after a health check-up recently, Bangalore’s Padmashree Lahe, 42, knew there was something wrong with her. Her joints ached, her back was sore, and despite working out rigorously at the gym, she was unable to knock off excess weight. Worse, she had entered menopause early at 40 and was battling with vitamin D deficiency and osteoporosis.
Earlier this year, she opted for replacing and supplementing her hormones at Bangalore’s Belle Sante Diagnostic and Therapeutic Institute, a subsidiary of the US-based Fort Wayne Endocrinology. The institute offers natural or bio-identical hormone replacement therapy, customized for individual specifications. For instance, Lahe, who is on a three-month programme, receives specific custom-designed doses of hormones that can be laid off after a periodic evaluation.
“Hormonal imbalances are normal occurrences with ageing and this leads to occurrence of typical age-related diseases such as osteoporosis, diabetes, heart diseases and even at times leads to cancer. But most of these can be prevented with timely treatment,” says Ashok Kadambi, founder and president of the institute.
Dr Kadambi says that supplementing levels of natural hormones in the body with bio–identical supplements can increase lifespan. Typically, hormone requirements vary according to individual body composition.
Natural or bio-identical hormones prepared at compounding pharmacies as the one at Belle Sante offer medication tailored to such individual needs. “A compounding pharmacy is an age-old concept we are reviving to provide customized medications. This is a paradigm shift from mass produced formulations and is possible with better diagnostic tests , compounding equipment and data processing,” says Vivek Kadambi, MD, Belle Santé.
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