India’s no. 1 Diabetes doctor on diet, prediabetes, fasting, insulin resistance | Rethink India Ep 2

India faces a staggering diabetes crisis, being not only the diabetes capital of the world but also the untested and untreated hub of the disease. Half of those with diabetes remain unaware of their condition, and 70% never receive treatment. Pervasive misconceptions—such as the idea that diabetes stems solely from consuming sweets—worsen the situation. An experienced endocrinologist with decades of clinical expertise outlines strategies to prevent pre-diabetes and diabetes, emphasizing the urgent need for improved health literacy and proactive measures in India.

Observations revealed that urine exhibiting a sweet taste and attracting ants indicated the presence of sugar. Early medical practitioners relied on sensory clues such as taste due to limited diagnostic tools. This direct discovery of sweetness in the urine led to the disease being colloquially known as 'sugar disease'.

Insulin Deficiency versus Insulin Resistance High blood sugar is a common feature in both types of diabetes, yet the underlying insulin dynamics sharply contrast. In one scenario, the body’s pancreas stops producing insulin, making external insulin vital for survival. In the other, excess insulin is generated but fails to push glucose into cells due to cellular resistance, often leading to weight gain.

Insulin’s Messaging Role and Brain Diabetes Insulin operates like a long-distance messenger from the pancreas, instructing cells to take in and store glucose. When this message is lost, either from a lack of insulin or cellular insensitivity, the body’s energy management falters. A similar failure of insulin signaling in the brain disrupts glucose uptake, a phenomenon that has been associated with Alzheimer’s, sometimes called type 3 diabetes.

A healthy diet that benefits everyone can significantly improve diabetes management by reducing the need for medication. Strict diabetic meal plans become unnecessary when individuals adopt a nutritious, regular diet. Embracing a common approach to healthy eating enhances overall well-being and improves the diabetes experience. The focus is on long-term health through balanced nutrition rather than segregating food choices based on medical labels.

The traditional focus on calorie counting has failed to curb the rising epidemics of obesity and diabetes, offering little benefit in controlling blood sugar levels. Carbohydrates, found in staples such as roti, upma, rice, and other common foods, break down directly into glucose, directly impacting diabetes management. In contrast, proteins break down into amino acids, avoiding the rapid glucose surge. Lowering carbohydrate intake not only reduces glucose levels but also naturally decreases overall calorie consumption, presenting a more effective approach for managing diabetes.

Prioritize Protein by Doubling Rajma Portions Traditional consumption of rajma rice is transformed by doubling the rajma portion and reducing the rice serving. This method leverages the higher protein content of rajma to improve satiety and enhance blood sugar control. Adjusting the ratio of protein-rich dal to carbohydrate-heavy rice creates a smarter dietary balance.

Achieve Lasting Fullness with Protein and Vegetables Replacing excess rice or chapatis with additional protein sources like rajma or paneer significantly increases the feeling of fullness. A smaller carbohydrate portion paired with more vegetables and proteins fills the stomach more effectively, reducing constant hunger. This approach supports diabetes management by cutting down on carbohydrate intake while boosting essential nutrients.

Sequence Your Meal: Protein and Vegetables Before Carbohydrates Eating protein and vegetables before carbohydrates has been scientifically proven to reduce post-meal glucose spikes. Research, including studies highlighted on PubMed, confirms that sequencing food in this order optimizes blood sugar levels. In practice, modifying traditional Indian meals to serve protein and vegetables first, followed by rice or chapati, harnesses these benefits effectively.

A common misconception is that only sugary foods cause diabetes, yet the condition is driven by an overall excess of carbohydrates. Foods that may not taste sweet, such as roti, rice, upma, and poha, break down into glucose and can raise blood sugar levels just like sweets do. Moderation in all carbohydrate sources is essential for managing and preventing diabetes.

The belief in fruit juice as a healthy choice unravels when considering that a single glass can contain the equivalent of three to four whole fruits, delivering an intense surge of sugar instead of balanced nutrition. The minuscule amounts of vitamin C and other micronutrients are overshadowed by the overwhelming grams of sugar, even in homemade versions. Whole fruits and vegetables, with their natural fiber and lower sugar spikes, provide a more authentic and healthier way to derive vitamins, especially for those managing blood glucose levels.

Food Freedom Through Glucose Feedback Rigid diet plans are unnecessary when personal data guides dietary choices. Monitoring blood glucose two hours after eating helps reveal how various carbohydrates affect your body. Small differences in the sugar content of fruits are less significant than controlling portion sizes. Adjusting the quantity of triggering foods allows you to enjoy favorites like mango while balancing other carbohydrate sources.

Mindful Eating with Portion Control and Chewing Enjoying fruits in moderation supports balanced glucose levels without needing to eliminate them entirely. Chewing thoroughly slows digestion and stabilizes blood sugar spikes, highlighting the natural benefit of processing whole foods. Reducing portions when glucose rises and integrating lifestyle changes such as stress and sleep management creates a personalized approach. Detailed meal tracking provides the insight needed to tailor dietary habits effectively.

Converting the carbohydrate content of traditional foods into sugar-equivalents clarifies their impact on blood glucose. A Gujarati phulka contains about 15 grams of carbohydrate—roughly three teaspoons of sugar—while a larger paratha may equal 4-5 teaspoons. Complex carbohydrates from foods like roti release glucose gradually, resulting in a slower blood sugar spike compared to the rapid increase from direct sugar intake. Experimenting with meal composition, such as combining a roti with added tea sugar, reveals these differences using continuous glucose monitoring.

Personal glucose monitoring is essential to empower individuals with the insights needed to master diabetes. Using proper finger-pricking techniques, one can minimize discomfort by selecting less sensitive spots on the finger, thereby obtaining immediate feedback on how food impacts blood sugar levels. Continuous glucose monitors offer a comprehensive 24-hour reading, enabling informed dietary adjustments and preventive measures against costly complications.

Processing transforms the original structure of grains into mere powder, which challenges the guarantee of true whole grain benefits in products like rotis and biscuits. The natural integrity of wheat is lost when ground into atta, despite labels touting whole grain content. A practical comparison reveals that brown rice and white rice share identical carbohydrate profiles, prompting the need for individuals to observe firsthand any real differences in their nutritional impact.

Sugar Measurements Define Diabetes Stages Within a body containing five liters of blood, one teaspoon of dissolved sugar represents about 100 mg/dL, the upper limit for a normal fasting state. A slight increase—about a quarter to half a teaspoon more—marks the transition into a pre-diabetic range. When glucose levels double to roughly two teaspoons (200 mg/dL), the condition escalates to uncontrolled diabetes, illustrating a critical threshold in blood sugar concentration.

Body’s Defense Against Glucose Overload The liver, muscles, and pancreas collaborate to maintain normal blood sugar by releasing insulin in response to carbohydrate intake. Their coordinated effort buffers against minor spikes, ensuring that a single instance of sugar consumption does not immediately cause a diabetic crisis. Yet, persistent high intake can overwhelm these mechanisms, leading to systemic damage affecting organs such as the eyes, kidneys, and feet.

Unified Diet and Sleep Blueprint for Diabetes Prevention A universal healthy diet serves all household members, eliminating the notion of a separate diabetic regimen. Adequate sleep is as critical as nutrition, yet modern habits like prolonged artificial light exposure and erratic sleep routines disrupt natural rhythms. Recognizing and addressing sleep issues such as sleep apnea establishes a stable foundation for overall metabolic health.

Strengthening Health by Managing Stress and Building Muscle Effective stress management plays a vital role in reversing pre-diabetes and maintaining mental balance. Regular muscle-building exercises, beyond just walking, are essential to counteract age-related muscle loss and support mobility. Home-based strength routines ensure that all age groups can stay fit while preventing injuries linked to weakened muscles.

Nutrition Over Gym Myths: Fat Loss Isn’t About Scale Numbers Many assume that regular gym visits automatically lead to weight loss, yet exercise often builds muscle that skews the scale. Muscle, being denser and leaner, replaces the bulkier fat without necessarily changing overall weight. The true path to a toned, healthy body lies in dietary management that targets fat reduction rather than focusing solely on weight loss.

Strength Training: Measuring Real Progress Beyond the Scale Weight scales fail to distinguish between muscle gain and fat loss, making them unreliable indicators of progress. Tracking strength improvements, inch loss, and pushing muscles to true failure provides a clearer picture of fitness advancements. This approach emphasizes that genuine body transformation comes from building strength and reducing unwanted fat, not merely losing weight.

Fasting can help reverse diabetes when it truly limits carbohydrate intake, as explained by scientific insights and Dr. Jason Fung’s research. Religious fasting practices in India often permit fruits and milk, which introduce carbohydrates and negate the benefits of fasting for diabetes. Understanding the underlying science reveals that merely reducing food intake is not enough; effective diabetes management through fasting requires strict carbohydrate restriction.

A comprehensive strategy is needed to overhaul the current reliance on externally sourced, processed foods by enforcing strict safety standards, transparent labeling, and ethical consumer information. Government backing combined with collective efforts from food manufacturers and processors is essential to shift the dietary trends. Emphasizing early education and continuous professional development allows children and healthcare providers alike to focus on preventive lifestyle management, reducing the burden of diabetes and related chronic conditions.

Episodes mirror rare school periods that impart unforgettable lessons. Only a few moments in life remain indelibly marked, reminding us that enduring wisdom can be found in fleeting experiences. Diabetics are encouraged to focus on carbohydrate management rather than merely counting calories, while non-diabetics are urged to extend kindness. Gratitude is also acknowledged for the support provided by Zerodha's Media Network in bringing the show to life.