November 14 was observed as World Diabetes Day when India already became the “diabetic capital” of the world. “World day” observations started with World Health Day; then came Haemophilia Day, Alzheimer's Day, AIDS Day, Kidney Day, Heart Day, Psoriasis Day, Stroke Day and what not. There will be no end if things go like this; 365 days won't be enough.
Initially the idea was to create awareness, remove loneliness and get public support out of concern for the suffering people. But with increasing compartmentalisation in medicare, we seem to be missing the target, we miss the wood for the trees. Is not World Health Day alone enough? If we want more, let us have Food Day, Water Day, and Environment Day, maybe yet another World Lifestyle Day. This is because diseases known to mankind arise out of problems in diet, lifestyle and environment. Name any disease including cancer, even genetic diseases — all are due to errors in lifestyle, diet and environment, both seen and unseen. But the sad thing is that it is difficult to make the people believe this “hard secret;” even more difficult is to convince doctors who are hooked onto caveats of evidence-based medicine, which relies on proof from controlled studies.
Controlled studies are not suitable for establishing the basic aetiology of any disease or solving basic issues in health care and disease-care because we are dealing with situations of “non-linear mathematics.” At best, controlled studies are useful in studying the effect, or the lack of it, of a drug. Even then, there are problems since two human beings are not comparable — even external appearances are not comparable as evidenced by fingerprint and facial appearances. Internally, there is an ocean of difference between individuals of the same age and gender.
Hypertension and diabetes develop after years of abnormal lifestyle and diet and, therefore, it is not possible to randomise and prospectively study two groups. But, unfortunately, the medical world is obsessed with the idea of controlled studies, it will not believe anyone unless what you say is supported by evidence from a controlled study, or we are in an “evidence-burdened world.”
I have had the opportunity of working in the general medicine department of my hospital, admitting 30,000 patients annually and treating another 1.8 lakh out-patients. In fact, we have a museum of diseases, including all infections, diabetes, hypertension, heart attack, strokes, cancer and deficiency diseases and genetic disorders. The patients come in large numbers for two reasons: 1) the kind of unmatched expertise that we provide; and 2) many come because they have nowhere else to go. In the last three decades, I have been closely studying all these patients and simultaneously studying the people who live a healthy life, and the result of a “meaningful observation” is that all diseases known to mankind are due to problems in diet, lifestyle and environment. The original study published on ‘Vitamin D deficiency in tuberculosis' was the first proof that the disease occurs owing to malnutrition (P.K. Sasidharan et al, JAPI, April 2002). Similar studies are being done on lifestyle diseases, HIV, blood cancers, anaemia and genetic disorders.
Coming back to diabetes. Diabetes mellitus occurs owing to years of overeating, physical inactivity, and stress. The less common type 1 diabetes is caused by irreversible damage to the insulin-producing cells of the pancreas. This is primarily due to malnutrition and the consequent infections, and several toxins entering the body. Together, these five factors are responsible for all types of diabetes that we see. Hypertension also results from abnormalities in diet and lifestyle — due to the intake of excess salt in fast food, fried food, junk food and preserved food. Obesity, lack of exercise, stress, smoking, alcohol intake and decreased intake of vegetables and fruits contribute to both diabetes and hypertension.
India has become the capital of several diseases; our health care is wavering under the steadily increasing “double burden” of infections and lifestyle diseases. A majority of our people, including the rich, are malnourished owing to poor diet and wrong diet. And, the already malnourished are exposed to wrong lifestyle habits (under the influence of consumerism); thereby, they provide an ideal soil for multiplying lifestyle diseases like diabetes and hypertension.
Health cannot be achieved and maintained in compartments either in a person's body or in society. It should always be looked at in a holistic manner. Without social health care, we cannot achieve individual health care. We cannot maintain “special health zones” or health in one individual unless the whole family is healthy; a family cannot sustain it unless society is healthy.
Even a country cannot remain healthy for long unless we work for the health of every individual in the world. Tomorrow, we will be attacked by the same health problems around us. Let us thus work for social health or world health. Let us join hands to provide social security and human development because man is a social animal. Act locally, think globally.
(The writer is Professor of Medicine & Head, Department of Medicine, Calicut Medical College, Dean Faculty of Medicine, University of Calicut. His email id is: firstname.lastname@example.org)