Cheeni Kum

A Sharan cooking session in progress at the Andheri home of its Mumbai head Reyna Rupani. Here, members are taught how to cook minus oil. Their menu extends from rajma chawal and gajar ka halwa to even chocolate mousse. Pic/Pradeep Dhivar

When Sanjeev Tanksali speaks about his work, the stress he's gone through very nearly seeps into your system. "I am basically a retired HR professional from the corporate world," says the 63-year-old Pune resident speaking to us over the phone, on a weekday at 10 am (which is very nearly late for his schedule). Part of his job was to identify non-performers in the firm and fire them. "In the last 10 years of my career, I hired 2,000 people and fired more than 500. That's a tough job. Not everyone accepts it gracefully. They feel bad and curse you," he says, describing what he calls a thankless job.

Diagnosed with Type 2 diabetes in 2000, the pressure of the job, he says only resulted in the blood sugars shooting up. The obvious counter-response was to increase medication.

With no restrictions to his diet - he says his then doctor would just advice him to not eat sugary bites, but the language was never a strict no - it was up to his wife to keep tabs on his meals. "So, at home I would avoid sweets and sugar, but at work I'd go right ahead and eat it."

The gluten-free and oil free snacks Tehseen Mehdi Dudani learnt to cook at SHARAN. Pic/Nimesh Dave

Life changed in December 2016 when a serendipitous conversation with a relative directed him to Freedom From Diabetes (FFD), a Pune-based organisation that promised diabetes reversal without medication. The only caveat? He'd have to turn vegan and up his exercise.

He did. The result? "I stopped my medication in six weeks. It would have happened in four weeks, but at that time, there was a get together with friends and I ate certain things that I was not supposed to," says Tanksali.

First recorded 3,000 years ago by ancient Egyptians, what we now know as diabetes mellitus is, to put it simply, a disease which prevents the body from making optimal use of the energy from the food it is fed. The food we eat is broken down into glucose, which the body needs for daily activity. For glucose to reach the cells and do its job, insulin (which is secreted by the pancreas) is needed. However, when the body doesn't respond to insulin (Type 2 diabetes, insulin resistance), blood sugar rises. Type 1 diabetes is when the pancreas don't produce insulin. The latter is a rarer form. The former, however, is what we are more familiar with.

Tehseen Mehdi Dudani was diagnosed with diabetes in 2012

You suffer what you eat?
Far too familiar perhaps. After all, India is called the diabetes capital of the world, with five per cent of the population suffering from the condition. Diabetes has long been considered an irreversible lifestyle disease that can only be managed with medicine. Now, however, the conversation seems to be changing. And moving towards how dietary changes may, in fact, help not just counter diabetes, but also reverse it.

Dr Nandita Shah, founded SHARAN in 2005. As a doctor, she noticed that in general medicines rarely cure. "In fact over the years most patients' medications spiral upwards. But the body always works to heal. We have observed this - a cold, a fever or even an injury or fracture will heal if the conditions are made favourable. The reason for so much illness is that today we eat and live in a way which is far from what nature intended. Every animal is attracted to food best for its species by instinct. In nature, we too are attracted to fruits and vegetables, and a chicken or goat walking by does not give us the urge to attack and kill. We have been conditioned to eat them. As far as dairy goes, every animal produces milk only for its young. And we are not cows. Therefore every infant after consuming mother's milk instinctively rejects cow's milk. But later we are so conditioned that its difficult to give up."

According to Dr Shah, the best food for us would be plant-based, whole, unrefined and unpackaged. Dr Pramod Tripathi, who founded FFD in 2013, after having worked at SHARAN, says, milk obtained from animals contains insulin-like growth factor (IGF). He explains, because IGF is a molecule that is similar in structure to insulin, when inside the body it attaches to the insulin receptors. However, because it doesn't function like insulin, the body is not able to shift the sugar from the blood to the muscle or liver cells, which is why blood sugar rises. Rising levels of insulin [which is a growth hormone] cause gain in weight. Quoting the Williams Textbook of Endocrinology, Dr Tripathi says, an obese person secretes four to five times more insulin than a normal person, and that makes the body store more sugar, more fat and more water, making the person gain weight.

Dr Pramod Tripthi and the FFD team recently published a paper in the International Journal of Diabetes and Endocrinology on the effectiveness of a vegan diet and exercise in Type 2 diabetes reversal

Back to the grassroots
Dr Shah's philosophy, of eating what nature intended us to, means avoiding even seed oils and cold pressed coconut oil. Nothing wrong with fats, though. Eat peanuts, or sprinkle sesame seeds on your food. Whole foods come with fibre which protects the body.

It's a diet that's worked for 43-year-old Tehseen Mehdi Dudani. Diagnosed with diabetes in mid-2012 - she also discovered a borderline cancerous cyst in her right ovary at the same time - Dudani, who works in the banking and financial sector, says it was unfathomable. "Since my mom is a doctor, I have been careful of my health throughout. I have always exercised and was never overweight. I was particular about what I eat and never ate junk food. Only during birthdays, get togethers etc. I would even take a take dabba from home."

Dr Nandita Shah

After the diagnosis, she says she didn't know what to eat. Her diabetologist told her to desist from white sugar, white rice and potatoes. Even one piece of idli shot up her sugar levels to 200. Her diet of one roti, one small bowl of sabji - there was quantity restriction - never reversed the diabetes. Dinner would be soup and salad and breakfast would be egg whites and one slice of toast, 1/2-1 cup of milk with tea or coffee. She joined the SHARAN programme in early 2014 and in 21 days she says her sugar levels were back to normal. Cooking lessons at SHARAN taught her how to cook regular foods without oil - from poha and upma to besan chilla. Even vegetable gravies and sambhar and Thai green curry.

Both SHARAN and FFD have doctors who consistently monitor the patients, their blood sugar levels and adjust the medication accordingly. Dudani says she didn't tell her family doctor when she joined the programme, but when she went back with her reports, the doctor was surprised. "And then he said, 'well keep on doing what you are doing since it's working'. My HbA1c report [the test that tells you your average level of blood sugar over the past 2 to 3 months] was normal. It was not in the diabetic range, not even in the pre-diabetic range. I lost 10 kg in 3.5 weeks which was a happy side effect," she says. "Further, my stress levels came down, the mind was calmer, and I was happier.

Sanjeev Tanksali

More in the tribe
Juhu-based Dr Deepak Dalal, a practicing endocrinologist since 1980, says reversal happens with medicine as well. "We have seen reversal from table and insulin for many years. Those taking medicine and insulin consistently reversed to normal state without medicine and insulin. And we have records of the cases."

Two years ago, having seen a patient's transformation through FFD, he attended a Pune camp as a patient. "I wanted to see what was happening. I went there out of curiosity. I am a strong promoter of lifestyle. It's a 'wholistic' management - a complete management that includes a vegan diet, which is big by itself in western literature and even in India. We [at his clinic] also promote veganism to our patients who might be interested. I have been vegan for about two years. The other thing that FFD promotes is exercising, meditation and pranayam," he says, adding, "I am not a proponent of Dr Tripathi, I am just saying what I saw at the camp."

Dr Jason Fung, Nephrologist

Diabetes reversal programmes are now being conducted in various forms across the country. At Bengaluru's Swami Vivekananda Yoga Anusadhana Samsthana, for instance, a three-month yoga-lifestyle programme has been conducted for the last 10 years. Dr Amit Singh, says a combination of yoga asanas [with special concentration on bhujangasana, vakrasana, ardha matsyendrasana] along with a controlled diet are specified. There are no restrictions on meat or milk here, but yes, the emphasis is on a low-carb, low-sugar diet.

Dr Anil Bhoraskar, secretary of the scientific section at the Diabetes Association of India and retired chair of International Diabetes Federation, south-east Asia, says that they, too, have trained doctors across the country on the virtues of healthy eating. "To reverse diabetes, we advocate that dietary fat should account for 8 per cent of the total calorie intake per day. For instance, if you are consuming 1,600 calories, you are allowed a total of two teaspoons of vegetable oil. This has resulted in the reversal of diabetes in 25 to 30 per cent of those enrolled in our programmes."

Avoid fats with high Omega 6, he says. These lead to heart disease, diabetes and hypertension. "These are corn and sunflower oil, which are promoted by the food industry. Fats from rice, mustard, coconut and homemade ghee are high in Omega 3. Even olive oil. Even here, you should not exceed your daily intake of two teaspoons. It's also important to keep a low carb diet. Changes need to be made in our dietary practice. Break up the calories - 400 for breakfast of which 50 per cent should be protein. Have a smaller lunch with 300 calories, low carbs and low starch. Dinner should have 250 calories. This should be heavy in salads, fruits and very little cereal." Their diabetes reversal programme has been on for four years.

He warns: "People should remember that reversal of diabetes and bringing the blood sugar to normal doesn't mean that you have got rid of the diabetic gene. There's no lifelong protection against it. Many people do this for a year or two and then go back to old habits."

The piling numbers
In Canada, nephrologist Dr Jason Fung, advocates intermittent fasting (IF) and a low-carb diet for Type 2 diabetes reversal. In fact, he says, over the last six years, he has seen a reversal in 2,000 patients. "If you don't eat, then your blood sugars will fall as your body burns it for energy. If you do this regularly, then you'll lose weight. As you lose weight, the Type 2 Diabetes recedes," he says, adding that those doing IF for diabetes reversal will have to see longer periods of fasting. Why then are more doctors not recommending lifestyle changes to their patients, instead of medication? "Most doctors are simply not trained in nutrition and believe that drugs will cure everything, even a dietary disease," he adds.

Dr Tripathi says in 2013, over 200 patients joined his programs. By 2015, that number jumped to 18,000 a year. Dr Shah estimates that SHARAN has between 50,000 and 60,000 on its mailing list. "This would have been the number of people who have potentially benefitted from us."

If the proof is in the low-carb, low-sugar pudding then why are more people not adopting a better lifestyle? Dr Shah has an answer to that: "Most people don't want to change their diet. People generally wait till they are desperate and then make changes. When they are really desperate, they are willing to change anything." No milk, no carbs. No sugar. Is life even worth it minus them?

Tanksali, who works with a Pune firm as a consultant focusing on recruitment, HR policies and CSR, laughs. "I was a big fan of curd. Giving up milk and buttermilk was not a problem, but I used to tell people that I could eat curd rice for all meals. Today, I see a 360º change in myself. There's more positivity. I lost 18 kg in two years. Your efficiency level and productivity improves. The ability to come up with out-of-box solutions also heightens," says the man who once ate 33 puran polis at a wedding. Today, he is an avid runner with even the Ladakh half marathon under his belt.

A new ending
A recent study published in The Lancet Diabetes & Endocrinology journal stated that by 2030, 98 million people in India may have Type 2 diabetes. A WHO study put India's Type 2 diabetic population at 69.2 million in 2015. Alarmingly, the study stated that the amount of insulin needed to meet the world's Type 2 diabetes demand would rise by more than 20 per cent in the same time, possibly causing a shortage on the supply end.

But, before diabetes can be reversed, there needs to be a cultural change. Dr Bhoraskar says, "Changing lifestyle is also about changing culture. Nobody will like it if you go to a wedding and are offered just nimbu paani and cucumber. This requires long-term work and convincing people."

What diabetes does
Diabetes-related complications include damage to large and small blood vessels, which can lead to heart attack and stroke, and problems with the kidneys, eyes, feet and nerves.

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