Middle-class India’s guide to good health

The answer to lifestyle diseases appears to lie in simply being fit, which should be able to compensate for sedentary behaviour


Photo: iStock
Photo: iStock

We know that as the Indian middle-class has expanded, so has its girth, the result of self-indulgent, sedentary and undisciplined living. We also know that India is the centre of the world’s unfolding epidemic of so-called lifestyle diseases, specifically diabetes and cardiovascular ailments.

Between 2005 and 2015, for instance, the incidence of diabetes rose 50% in India, moving five ranks up to No.7 as a cause of death, according to the latest “Global Burden Of Disease” report. Sure, you can blame our genes: Indians are among the races most predisposed to diabetes, which means our genetic blueprint leads to things like thinner arteries that can clog easily.

But hard, physical labour kept that predisposition in check and blood vessels clear. With prosperity, the checks and balances on our genetic inclinations are being swept away.

There are three reasons why change is difficult. One, most Indians simply don’t want to change, happy as they are eating, drinking and being happy. Two, since the government has not recognized the deleterious effects this tide of obesity and ill-health is having on its labour force, there are few advisories or warnings. Three, for the minority that is earnest about changing its habits, there is far too much contradictory information around the primary issues related to middle-class well-being: work, exercise and diet.

Let’s address work and exercise. We first heard that sitting at a computer for long hours could endanger your life (a 50% greater chance of death; a 125% greater chance of cardiac events; the risk of cancer). Then, we learnt of the health benefits of standing desks. Then, we were told that the benefits of standing were exaggerated.

So, which is it? What should we do?

The answer appears to lie in simply being fit, which should be able to compensate for sedentary behaviour, according to a new study published in Mayo Clinic Proceedings. A high level of cardiovascular fitness reduces the risk of developing or aggravating heart disease, even among those who reported up to 12 hours of sedentary time. Earlier this year, another study confirmed the role of cardiovascular fitness in keeping “cardiovascular risk factors” at bay. These studies—extensive, the latest took five years—were conducted in Western populations.

There are no comparative Indian studies, but dipstick studies among young Indians (such as this one and this one) confirm the role of fitness in combating sedentary life. Indeed, one 2012 study in The Journal Of Exercise Science And Physiotherapy, an Indian publication, found rural students—who tend to walk more and do more physical labour—fitter than their urban counterparts.

An hour of exercise every day could be enough to compensate for sitting at a computer, said this review in The Lancet published in July 2016. “High levels of moderate intensity physical activity (i.e., about 60–75 minutes per day) seem to eliminate the increased risk of death associated with high sitting time,” said the review of data from more than one million people. “However, this high activity level attenuates, but does not eliminate the increased risk associated with high TV-viewing time. These results provide further evidence on the benefits of physical activity, particularly in societies where increasing numbers of people have to sit for long hours for work and may also inform future public health recommendations.”

Now, let’s come to diet. There are so many things we have learnt and unlearnt over the years, as I wrote two years ago. For instance, we were told for about half a century that saturated fat from red meat, cheese and full-fat milk and—specific to India—ghee, coconut milk and coconut oil, clogged your arteries and, according to a series of studies, ramped up the risk of heart disease.

In 2014, scientists did an about-face. After analysing data from 72 studies from 18 countries, this much quoted study in the Annals Of Internal Medicine said: “Current evidence does not clearly support cardiovascular guidelines that encourage high consumption of polyunsaturated fatty acids and low consumption of total saturated fats.”

Known by their acronym, PUFA, polyunsaturated fatty acids were thought to indicate and reduce cardiac risk, by supplying nutrients low in heart-clogging LDL (low density lipoprotein) or “bad” cholesterol. But we now know that while LDL indicates cardiovascular risk, it is not the only indicator and has been replaced by other signs of chemicals that better indicate risk—supposedly.

Scientists now know that nothing in diet and nutrition is black and white, cause and effect. I’ve written about this before, but it bears repetition: Broken down to chemical constituents and their effects, nutrition gets mind-bogglingly complex and, often, contradictory. That is why the rash of diets out there—low-carb, high-protein, high-carb, caveman—make no sense to anyone except the people who propagate them.

We do not clearly know what works. But we do know what does work: common sense. Eat everything in moderation—in consultation with your doctor or dietitian, if you have specific ailments—especially fruits and vegetables, stay fit, stay calm, sleep well and be happy.

Samar Halarnkar is editor of Indiaspend.org, a data-driven, public-interest journalism, non-profit organization. He also writes the column Our Daily Bread in Mint Lounge.

Comments are welcome at frontiermail@livemint.com. Read Samar’s previous Mint columns here.

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