Note : This story was published in CSIR-NISCAIR’s prestigious magazine ‘ Science Reporter’ in October 2021.
Give your precious 10 minutes to read my cover story in CSIR-NISCAR’s prestigious magazine Science Reporter.
It deals with the basic issue of ‘How to keep fit for a better tomorrow, with special emphasis on How to handle Lifestyle Diseases in Post Covid Era with Nutrition’.
Full text below to read :
Keeping fit for a better tomorrow
Handle Lifestyle diseases in Post Covid Era with Nutrition
When was the last time, that you felt – Hurray!!! It’s weekend time. We have been into permanent weekend for so long, that now we feel like moving out on all days. But did you realise that when we are confined at home on weekends, we go lethargic. But when we are forced to be at home due to pandemic, it not only means lethargy but also leads to psychological distress.
We all are witness, that COVID-19 had a negative impact on our healthy and active lifestyles, as well as on our mental health and quality of life. There has been significant reductions in physical activities, activities of daily living, social activity, leisure, and education. Last but not the least, we are the one who suffered with the way eating habits also changed during the pandemic.
This ultimately accompanies harmful health behaviours, such as overeating, reduced physical activity, elevated alcohol and tobacco use and above all, increased screen time causing impaired sleep. All these terms sound similar. You have heard about them before or suffered a few of them in your family and friends. All the above behaviours are associated with non communicable diseases or lifestyle diseases.
Primary cause of most lifestyle-related diseases is Inflammation. Other factors include :
- Bad Food Habits
- Poor Nutrition
- Lack of Physical activity
Wrong Body Posture
- Chronic Stress
- Lack of Sleep
- Disturbed Biological Clock
- Use of Tobacco
- Excessive alcohol
All this lead to non communicable diseases and are also associated with worse mental health outcomes.
Thus, India’s load of Lifestyle diseases is high since long. A report, ‘Body Burden, the latest state of the nation’s health’, by Centre for Science and Environment, identifies some major lifestyle problems in pre covid times in India.
- Over 61 per cent of all deaths in India attributed to lifestyle or non-communicable diseases (NCDs).
- More than 1.73 million new cancer cases likely to be recorded each year by 2020; air pollution, tobacco, alcohol and diet change are primary triggers.
Tobacco accounts for over 7.2 million deaths every year
- Every 12th Indian is a diabetic. India ranks second in the list of countries with highest diabetes patients.
- Every third child in Delhi has impaired lungs; India had 35 million chronic asthma patients in 2016.
- Air pollution causes 30 per cent of all premature deaths in the country; linkages with mental diseases revealed.
- More than 2.7 million people in India die of heart diseases every year – 52 per cent of them below the age of 70.
As per World Health Organisation (WHO), Noncommunicable diseases kill 41 million people each year, equivalent to 71% of all deaths globally. 77% of all noncommunicable diseases deaths are in low- and middle-income countries.
Cardiovascular diseases account for most Noncommunicable diseases deaths annually (17.9 million), followed by cancers (9.3 million), respiratory diseases (4.1 million), and diabetes (1.5 million).
India falls in low- and middle-income countries. So, it needs an Eat Right Movement. What can be a better occasion to talk on this subject, than World Food Day 2021. As per Food and Agriculture organisation of the United Nations, World Food Day 2021 will be marked a second time while countries around the world deal with the widespread effects of the global Covid-19 pandemic. It’s a time to look into the future we need to build together. This reading time will help you relate your future with nutrition to make it disease free.
We all already know that optimal nutrition is one of the main determinants of health that can improve well-being and mitigate the harmful health consequences associated with most chronic diseases such as diabetes, hypertension, heart disease and excess body weight/obesity. Healthy diet can also aid in the regulation of sleep, mood and prevent fatigue.
All the experts that I consulted for this topic, discussed different lifestyle diseases but gave one-two point solution.
Dr. Vikram Talaulikar from University of London, highlighted the major issue of concern during covid 19. It is our immune system. It is the worst of all, that covid 19 conditions can interfere with our immunity, and can cost our life. The human immune system protects the host from various types of pathogens including bacteria, viruses, fungi, and parasites. It also helps in the defence against tumour cells.
He explains that the immune system is complex and consists of several different specialised cell types, communicating molecules and functional responses. When infections happen, the immune system activity increases, and this is accompanied by an increased rate of metabolism which requires reliable energy source and availability of substrates for complex molecular mechanisms which are ultimately derived from the diet. As per your personal experience or experience of your loved ones, you will agree to the fact that no single food, single nutrient or dietary supplements are capable of preventing infection from COVID-19. Rather a balanced diet containing sufficient amounts of macronutrients and micronutrients is essential for an optimally functioning immune system.
So, there is an urgent need for people across the world to cultivate healthier eating habits and focus on their bodies and minds to boost their immune system. Dr.Talaulikar comes up with nutritional modulation strategy for the immune system, which is important across the age spectrum. During early childhood, breastfeeding can provide protection against infections and respiratory diseases as breast milk contains antibodies, enzymes and hormones that can offer health benefits. In older adults, changes in dietary habits lead to significant alterations in immunity and inflammation. Some nutrients such as omega-3 polyunsaturated fatty acids, antioxidant vitamins and probiotics have been linked to anti-inflammatory responses and enhanced resistance to respiratory tract infections. Several vitamins (A, B6, B12, folate, C, D and E) and trace elements (zinc, copper, selenium, iron) play a vital role in supporting the human immune system and reducing risk of infections.
Renowned nutritionist, Dr. Neelanjana Singh adds, the focus on immunity has led us to adopt/include many supplements in our daily routine. It could be chyawanprash, for some while many others are drinking kadhas with many different ingredients in varying amounts. Many of these ingredients are used in excessive amounts which is a downside that one must recognise. Excess of these herbs and spices in kadhas have their side effects too like vomitting, excessive acidity, etc.
Here a thought must be given to ‘Long Covid’ and its potential impact on millions of individuals who have had COVID-19 infection. Having recovered from the primary coronavirus infection, some individuals have continued to experience debilitating symptoms such as fatigue, headache, brain fog, muscle aches, persistent shortness of breath and, in some cases, diarrhoea or loss of smell and taste. Strengthening the immune system through good nutrition will be a vital part of recovery from long covid. The general recommendations will be to consume a diet based predominantly on fresh foods such as fruits, vegetables, whole grains, low-fat dairy sources, and healthy fats like olive oil and fish oil and to limit intakes of sugary drinks and processed foods high in calories and salt. Dietary supplements like vitamins C and D, zinc, and selenium, need to be considered by individuals with, or at risk of, respiratory viral infections or in whom deficiency is detected.
Former Indian Council of Medical Research (ICMR) Scientist Dr. Raman Gangakhedkar says, post-Covid, there are 2 issues to highlight :
- No doubt, people are more health conscious now, but there is more dependence on tablets or supplements, rather than on food stuff. People have started looking at vitamins and micronutrient supplements. Unnecessary consumption of vitamins and minerals will not benefit. Rather people should depend on food stuffs. Having normal food, green leafy vegetables, dal and cereals make more sense.
- Almost 70% of our people are vitamin D deficient. Even people staying at home with some co-morbidities are not at all moving out of home, no movements inside home, no sunlight exposure, etc. All this would lead to weak bones leading to osteoporosis and fractures will become more common. And if they are diabetic, their control of diabetes will also be a challenge. Vitamin D deficiency reduces immune response to vaccine. Even if you are going to take vaccine against covid, you have to ensure that you have exposure to sun, you move around and ensure calcium intake for the health of your bones.
So, essential message here is that post covid people have to realise and ensure even if they are at home, covid 19 is severe, specially in aged people. People should understand the importance of exercise. Regular exercises along with yoga and pranayam will also be extremely beneficial. Apart from being regular in food habits and exercises, one must also monitor HbA1C. It measures the amount of blood sugar (glucose) attached to haemoglobin. Just like you get home based test for sugar monitoring, you can get test for HbA1C as well.
Moreover, Dr. Neelanjana Singh’s focus was on diabetes, for some very valid reasons. She indicates, “the necessity of using steroids during covid situation has precipitated the problem of high blood sugars not just in known diabetics but also in the pre-diabetics. So she suggests, 2-3 adjustments in the diet are very useful.
- Keeping the carbohydrate quantity under check. Do not exceed 50-55% of calories as carbohydrates.
- While choosing carbohydrates, choose those with low Glycemic Index (GI) . Whole grains, especially barley, millets and adding bran if possible.
- Pulses, Green leafy vegetables, low fat milk are valuable additions to the diet.
- Adequate fibre (40gm/2000KCal) is important.
- Improve protein intake (89kg/day)
- Reduce highly processed foods which have little nutritive value but high in Glycemic Index (GI).
Another lifestyle disease on the list is hypertension. It has an impact on so many organs, like heart, kidney, eyes and there is so much we can do to mitigate the effects. We just need to pay attention to it. The diet is not only about just cutting out salt, as it is believed by most.
Worldwide 4.1 million annual deaths have been attributed to excess salt/sodium intake.
Processed foods are usually high in sodium, therefore, developing the skill to read labels and select the better options available is critical. Experts even warn, that substituting sendha namak or kala namak for regular salt is not the answer. All of these have same amount of sodium. The thing is to add more of the beneficial spices like basil, onion, garlic, cinnamon and reduce the salt in the foods gradually so that the palate adjusts to lower salt taste. In addition increasing the intake of calcium, magnesium and potassium in food choices can counter the bad effects of hypertension. Also, keep caffeine intake limited, this is helpful too.
Very common among adults as well as children is obesity. It is a state of chronic low-grade inflammation and may contribute to an increased risk of excessive inflammatory response when the individual is infected. Even leading to severe forms of illness as was noted during the recent COVID 19 pandemic. The remedies are more or less same for seriously treating obesity.
In individuals infected with SARS-CoV-2, nutritional status is a crucial factor for optimal prognosis and can determine the clinical severity and outcome of infection. Dietary supplementation with selected vitamins (A, B, C, and D), minerals (selenium, zinc, and iron), and omega-3 fatty acids has been suggested as a nutritional intervention for COVID-19 patients and as preventive therapy against lung infections.
For continuously monitoring diet and nutrition situation of the country, Indian Council of Medical Research’s body National Institute of Nutrition is on its toes. Director of National Institute of Nutrition, Dr. Hemlatha, opines that post covid many people are already making changes to their diets. Preliminary results of some studies have shown that there is increase in physical activity, higher adherence to healthy diet and more people are purchasing and consuming fruits and vegetables. Decrease in consumption of bakery products, alcohol intake and smoking has also been reported in some studies. Given that 56.4 % of the diseases in India are due to unhealthy dietary habits, it is crucial to make conscious efforts to shift to healthy dietary habits and sustain them even after COVID times. She even adds that during recovery, healthy diet with adequate calories, quality proteins and essential fatty acids (EFA) is the key. The ‘My Plate for the Day’ developed by the ICMR-National Institute of Nutrition has been designed on the basis of Recommended Dietary Allowances (RDAs). It recommends sourcing of macronutrients and micronutrients from minimum of 8 food groups per day. The quantity of pulses and milk in the menu provides good quality protein and supply of all essential amino acids. In case of non-vegetarians, pulses can be substituted with fish or poultry. Lean cut red meat can be taken in moderation. Consumption of foods in the mentioned proportion, coupled with regular physical activity has the potential to improve recovery and reduce the risk of diseases.
The Real Eat Right Movement
Food Safety and Standards Authority of India (FSSAI) launched ‘The Eat Right Movement’ in 2018, in the pre covid era. At that time, no one in the world had the idea and experience of facing a pandemic. But now, the relevance of eat right movement is challenged with the changing scenario, mindset and livelihood. Even FSSAI emphasises, that the COVID-19 pandemic has brought to light the issues of food safety and hygiene at the forefront. Today, it has become all the more important to focus on preventive healthcare as it minimises the burden of diseases and helps in tackling the rising burden of diet-related diseases such as diabetes, hypertension, obesity and malnutrition in India.
So, the question arises, how eat right movement can be modified or utilised in post covid Scenario?
- FSSAI is not only assuring continuous supply of food in the current pandemic situation but also proper food safety and hygiene protocols across the food value chain.
- A guidance note titled “Food Hygiene and Safety Guidelines for Food Businesses during Coronavirus Disease (COVID-19) Pandemic” has been released that covers best practices/ guidelines to be followed by food handlers to maintain high standards of personal hygiene, safe food practices, implementation of Good hygiene practices (GHP) and Good manufacturing practises (GMP) as well as ensuring necessary protocols of social distancing.
- FSSAI has also initiated an online training module for food handlers on the essentials of food safety and hygiene practices during COVID-19 through its empanelled training partners.
- To meet the novel demands of the unprecedented pandemic, FSSAI has further introduced an online training programme on safe food and hygiene practices required during COVID-19.
- An eBook “Do You Eat Right” was created that cover basics of food safety and hygiene and tips that can be considered at home for healthy eating practices.
- FSSAI, through fortification process ensures that adequate micronutrient levels in the common food staples are available to common people of all age groups and socio economic status under various programmes.
When asked about what modifications people should consider in their lifestyle, Inoshi Sharma, Executive Director at FSSAI help us highlight a few points like –
- First and foremost, consumers must understand that they are ultimately responsible for their individual health.
- They must make a healthy food choice for good health.
- An aware consumer will not only choose healthy food for his/her family but also influence the behaviour of extended family, friends and relatives.
- Behavioural changes can be done to motivate people to limit the consumption of foods that are high in fat, salt and sugar, as these foods can deteriorate the health of an individual.
- People should make modifications in their diet by opting for healthier options with more focus on local and seasonal produce, millets and other indigenous grains, fortified foods etc.
- One should opt for a balanced diet, which can act as a shield against non-communicable diseases.
- Incorporating fortified foods in our diet can help us to fill the gap of micronutrient deficiencies in our body.
- It is important to stay hydrated by drinking plenty of water throughout the day.
- Due to advanced technologies, there is a reduction in the physical activity of an individual, so regular exercise is very essential for maintaining proper health.
1.6 million deaths annually can be attributed to insufficient physical activity.
It’s rightly said that ‘The elimination of the cause of illness is the obvious and only way to healing and health.’
To lessen the impact of non communicable diseases on individuals and society, a comprehensive approach is needed requiring all related sectors to collaborate to reduce the risks associated with NCDs, and to promote interventions to prevent and control them.
Go slow for long-term healthy lifestyle habits
Take small steps
Set realistic expectations
Think big picture
Thus, to improve public health in India and combat negative nutritional trends to fight lifestyle diseases, we need to pledge for maintaining a healthy nutritional status and engaging in physical exercise at home, to shed the load of lifestyle diseases.
Covid has brought attention to health and now we need to encash that path and ensure people learn the essence of regular exercise and diet. This way, we can prevent chronic moralities and problems that arise because of our non adherence to such issues. We need to understand and imbibe the basic principles and advices shared here, so that tomorrow world will be a better place.