I am a practising Physician, Endocrinologist and Diabetologist in Chennai India. I work at Apollo Hospitals, Chennai, India. I also run my clinic “DiabEndoIndia” at 17 Ranjith Road, Kotturpuram, Chennai 85, India.

I have trained and work across 3 continents and countries (USA, UK, INDIA). I love my job, and to paraphrase a certain Rick Harrison (Pawn Stars) “You never know what is going to come through that door!”

About me

Aside

Lo-Carbing journey continues

So, I am about 2 months in to my journey as a “Lo-Carber”. I have been brushing up a lot on basic biochemistry, physiology and metabolism. A few things I have understood, and a few of my concerns that have been answered:

  1. There is no minimum requirement for carb – unlike protein or vitamins. Some societies like the Eskimos have lived well in the past on a predominantly fat and protein diet – that is all eating the whale meat and blubber got you. They had no grains, no carbs, no fruits, and probably minimal vegetables. Now of course things are different.
  2. We need to maintain blood sugar or blood glucose levels probably around 50-70 mg/dl, which is the level at which the RBCs (the red blood cells that carry oxygen) work. No higher. Only RBCs are fully dependent on glucose for its energy, all other tissues can utilise glucose or fats (as ketone bodies)
  3. Brain can burn up either glucose or “ketone bodies” from fat – ultimately they need something called “acetyl-CoA” which can come from carbohydrates/glucose or fatty acids/fats.
  4. How is our generation different from our great-great grandparents, who after all ate the same basic rice based meal that I am eating – things have not changed much in the last 1000 years or so interestingly, in the way we South-Indians eat. What has changed in the past 30-40 years is the easy access to much more calories. My Grandmother (thrice removed), probably ate twice a day, a 11 am lunch/brunch, and a 6 pm Dinner, which was light. Then they had a period of fasting till the next morning again – “Intermittent fasting” in all its glory.
  5. What about fruits? Is it good, bad or downright ugly?!! Topical fruits, locally available, in small amounts, is fine. The most common fruits we had were bananas, chikoo, guava, jujube fruit (Elantha pazham), jackfruit, mangoes. No apples, pears. Again all fruits were not available year round. So fruits, sourced or grown locally, and in small amounts, is okay.
  6. Is butter bad? Is saturated fat bad? Any fat in excess is bad. But having say 1-2 tbsp of ghee with some oil for cooking (again monounsaturated like coconut and sesame oil our traditional oils) is fine. And having the freshly churned butter from the butter milk, ala Lord Krishna, is okay. This is not processed, and remember how good it tastes?
  7. Carbohydrate, followed by proteins is the most potent stimulus to insulin. Insulin is like a traffic policeman, that tells the glucose where to go, and any excess glucose or carb left over is converted to fat and stored in the body. When we do not eat carbs, the insulin signal is less, and the body turne to burning up fat to provide energy.
  8. The body can convert excess glucose/carbs to fat, but sadly, it cannot convert fat into glucose.

So the more carbs we eat, 2 things occur. 1. WE MAKE MORE FAT. 2. WE BURN LESS FAT.

The less carbs we eat, 2 things occur. 1. WE MAKE LESS FAT. 2. WE BURN MORE FAT.

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I am a “low-carber”

I am a practising Endocrinologist and Diabetologist, and one would think I should know about nutrition. Unfortunately, as has been reiterated many times over in multiple other forums, medical students and doctors do not learn about “nutrition”. Sure we learn about the Krebs acid cycle and glycolysis; and fatty acid oxidation lingers in my memory from my ancient medical student past! Biochemistry is considered a “difficult” subject, and most of us just learn enough to scrape through. However, none of this is an excuse to tell patients, particularly those battling high blood sugars, excess weight, high cholesterol, high blood pressure, the same advise that we have been fed, which is so untrue!s

This is to say, eat less fat, moderate protein, (and more recently) “healthier” carbs like milllets. While this works for some people, a lot of people still do not benefit from this advise, whether it is to control their blood sugars or weight.

The more I am reading about the benefits of a low carb choice in my diet, for my life and health, the more I am amazed that it took me so long to get here.

Diabetes = Carbohydrate intolerance. Metabolic syndrome = Carbohydrate intolerance. Obesity = Carbohydrate intolerance. When one is intolerant to say eggs or wheat, what do we advise people? Cut it out. Why do we not emphasise this strongly enough for carbs??

There is no one so zealous as a recent convert, ’tis true! But I am writing this out of anguish and despair that the “Main Stream” Medical establishment is still against this “Way of Eating”. I hope to write more about my experiences with following a low carb lifestyle being a lacto-ovo-south-indian-vegetarian.

Rice is GOD for us. How do we forsake it? We don’t. We eat less.

From a purely biological and evolutionary perspective, we do not expend enough energy to burn up that plate of steaming hot idlis or dosais or rice. So we have to adapt to our current environment, where we have too much carb, by cutting the carb intake down to levels that each one of us can tolerate well with no ill effects. This may be less than 50 grams of carbs a day, which is = 3-4 idlis, OR 2-3 dosais, OR 1 cup of rice for the whole day – NOT FOR EACH MEAL!!!

Don’t be shocked. If I can do it, so can others. Of course I have to compensate for less carbs with more protein (read paneer, curd, eggs, some cheese) and more fat (read ghee, oil, butter). But guess what – less carbs, more protein and fat, fills me up well, and I do not have cravings!! No headaches, less irritable.

If you just want to control your blood sugars, you can start by reducing the carb content in food by 1/2. DO this under advise from your doctor. Can’t emphasise this strongly enough, as your blood sugars start dropping pretty quickly. If you are taking tablets for diabetes, you will need to reduce the dose to avoid a low sugar reaction – not a pleasant experience.

If the purpose of a low carb lifestyle is weight loss, you have to do more a more intense carb reduction – say to less than 20 grams per day, to initiate fat burning. This will need to continue for 3-6 months. Once you are satisfied with the weight loss you have achieved, you can choose to stay there, or enter a maintenance phase, where carb content can be 30-50 gms or maybe even more depending on your level of carb tolerance.

More in coming days of recipes, options, is it truly healthy, and most important – what about fruits?

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Vitamin D

This is a fascinating hormone (despite its name!), with much to know regarding evolution, geography, history, industrialisation, physics, chemistry, biology – truly a unifying wonder!
1. Considered a “hormone”, as made in skin and modified in liver and kidney, and exerts effects all through the body (classic definition of hormone is that it is made in body, and exerts actions in distant places). Main action is helping body absorb calcium from diet, as calcium is poorly absorbed otherwise, and calcium is a key nutrient for normal functioning of nerves, heart, muscles, cells. With D 70% of calcium in diet may be absorbed, without D only 20-30% absorbed. Vit D probably evolved for this reason. 
2. Was classified under vitamin, as our body needs small amounts constantly, and is made by exposure of body to sunlight, or by eating other foods that contain Vit D (like classic vitamins)
3. Probably the earliest hormone in evolutionary terms, as earliest life forms that evolved in water had some primitive form of D. It is believed that this was used to maintain calcium levels in these organisms, and also for building and maintaining exo or endo skeletons.
4. Made in the skin currently of animals, and in leaves in plants (parts exposed to sunlight)
Made under influence of a particular range of UV light which acts on a type of fat or cholesterol in skin, which then makes vit D
5. More Vit D made when sun (or UV light) hits skin at 90 degrees so around noon best time.
When we just start to feel the burn in skin, Vit D is has been made. UV cannot penetrate through clothes or glass, so exposure of as much as bare skin as possible is needed.
Darker skinned people with more melanin need longer exposure to sunlight, and lighter skinned people need less to make vit D. This is one of the reasons why the further north in the world we go, people are lighter skinned, to maximise D production when sunlight is less. 
6. Vit D levels may be lower in women for this reason, as we are in general more covered up. Also, as we get older, the level of the particular cholesterol in skin drops, so older people are less efficient in making Vit D on exposure to sunlight.
7. Worldwide prevalence of D deficiency increased with industrialisation and pollution. In India, worse deficiency prevalence seen in women, urban areas, children and people over 70 years, sedentary indoor workers. 
8. Associations of D deficiency (< 30 ng/ml) with many diseases shown – that is people with lower levels of vit D have higher prevalence of diabetes, obesity, cancers, hypertension etc. HOWEVER, this does not imply CAUSATION as replacement studies have not shown reduced risk with replacement. It may be that the same factors that cause obesity and diabetes (being indoors with less physical activity) also causes D deficiency. 
9. Best way to get vit D is by exposure to as much sunlight as possible, for urban dwellers at least 2-3 times/week for 5 minutes with as much skin exposed as socially allowed!!
Vit D is a fat soluble vitamin. This means that levels get stored in fat in the body for long periods of time. this is in contrast to water soluble vitamins (B vitamins) which get excreted easily from the body and we cannot build up toxic levels. SO there is a danger of taking too much Vit D  without monitoring. We have seen people overdosed on vit D, with toxic vit D levels (which can cause headaches, vomiting, raised pressure in the brain) and high calcium causing renal failure. Supplements containing 400-1000 IU per day are probably safe, if there is no underlying high calcium problem. However levels exceeding 2000-3000 IU per day – better to monitor calcium and vit D levels. So it is NOT a vitamin to pop in as and when u feel a bit down!!! Think of it as a hormone tablet. 
That being said, the tablets available do supplement the levels quite well. So supplements do work well, when needed. Rarely oral tablets do not bring up blood levels well, and one might need injections.
10. Vit D also found in egg yolks, and fish (bones and liver).
11. Some countries fortify plants and milk with D, not yet done in India.
Hope this helps. One of the most fascinating hormones, as there are geographical, biological, evolutionary, historical correlate
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