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To eat or not to eat

Eating less is good for you. But fasting and then binge eating is definitely not a good idea

To eat or not to eat

One of the problems about medicine is that most of the time what we write about tends to be depressing, and that gets to you after a while. Even in Pakistan millions of people see a doctor or visit a hospital every day and get better after being provided with the right medicine or treatment, but that is not news.

For the last few times I have written about serious stuff. But once in a while I do like to write about things that are important but not too serious. As we go through the month of fasting many of us will end up a kilo or two heavier. Not because we did not fast but rather because we overate at the beginning and the end of the fasting period.

So first a bit about fasting. There is medical evidence that fasting once or twice a week is actually good for the body. And it also seems that eating less is one of the few things that does tend to prolong life. But the sort of fasting done during the month of fasting does not in any way seem to encourage consuming fewer calories.

The sort of fasting going on during this month is only about going without food and drink from before sunup to after sunset. And it violates one of the basic principles of dieting to control weight gain. You always tend to over eat when you are very hungry.

In short, eating less is good for you and fasting if that means you cut out one meal in the day is also a good idea if done on a regular basis. But fasting and then binge eating is definitely not a good idea.

Now on to the next topic and that is putting on weight. Beyond a certain point, body weight is considered excessive. A rough measurement is Body Mass Index (BMI). A BMI of 18-24 is considered normal and beyond 30 becomes too much (obese) from a medical perspective.

Obesity is a disease in as much that it leads to many chronic problems. Diabetes, high blood pressure, heart disease and even some types of cancer are more common in people that are overweight. Being overweight simply means that you consume more calories than your body burns and over a period of time these extra calories are stored by the body as fat.

But all fat is not equal. Fat stored inside the abdomen, the liver, and in the muscles is more dangerous than that stored under the skin. This fat stored inside the abdomen is of considerable significance in people from our part of the worlds (South Asia).

In an article published in the New York Times (NYT-Why Do South Asians Have Such High Rates of Heart Disease-Feb 12, 2019) the authors discuss the issue as presented in the title of the article. They also quote a medical study being done on this issue called ‘Mediators of Atherosclerosis in South Asians Living in America’ (MASALA). The important point made by the MASALA study is that South Asians have a much higher risk of coronary atherosclerosis than other Americans and they develop this disease almost ten years earlier.

Obesity is a disease in as much that it leads to many chronic problems. Diabetes, high blood pressure, heart disease and even some types of cancer are more common in people that are overweight. Being overweight means that you consume more calories than your body burns.

The reason for this increased risk in South Asians is that they tend to store a greater amount of extra fat inside the abdomen. In many such people even when they are not technically overweight and have a BMI of less than 25, their risk of heart disease and diabetes is a lot higher than non-South Asians with a similar BMI. This ‘dangerous’ inside the abdomen fat produces our almost typical thin ‘uncle’ with a ‘pot-belly’.

Another thing the MASALA study found was that vegetarians had almost the same risk as non-vegetarians, especially those vegetarians that ate a lot of fried food and drank sugared drinks, the sort of nourishment favoured by many of our brothers and sisters that fast during this month.

The question then for people like us is whether we can prevent this fat from accumulating inside our abdomens rather than outside? Sadly if we eat more than what our body needs, the extra calories will first be stored as fat inside our body. For many South Asians, that is our ‘genetic’ heritage and we cannot change it. But genetic tendencies are only tendencies and can be overcome.

First of course is not to eat too much. But equally important is increased physical activity (exercise) that burns up the extra calories. From a medical point of view the MASALA study suggests that South Asians should seek medical attention at an earlier age and get tested and treated if needed for things like higher levels of ‘bad cholesterol’. And that holds true for both men and women.

But worry not. Have your ‘pakoras’, ‘parathas’, sherbets, and other such stuff this month but after that last splurge on Eid, go back to a balanced diet. And yes, the good mangoes are here so that should make it easier to wean off from the deep fried stuff.

No, it is not my intention today to dwell upon what is a good diet. I have done it often enough in the past. But I will basically sum it up in advice that eat whatever you want but in moderation. And stay away from ‘processed’ food and fast food restaurants.

When I started I said that I did not want to delve into matters that are too serious. However, the MASALA study also holds true for most Pakistanis still living in Pakistan. So for those that worry about such things, besides eating sensibly, get checked out by a physician once you have hit the big four oh.

Problems like diabetes, high blood pressure and high levels of bad cholesterol can all be very effectively treated these days and that prevents most long term complications. But it is important to remember about all such medical problems that we can control them with medicines and life style modifications, but we can rarely if ever make them go away completely. What you read on the Internet that says otherwise is mostly nonsense.

About the Internet, it is indeed a great source of information. But almost every day there are postings about a miraculous new cure for almost everything except death. One simple bit of advice about these miraculous cures, if there was any truth to any of them, ‘Big Pharma’ would have adopted them and made millions off them by now.

When it comes to eating right, most people, even those who can afford it rarely eat all of the recommended quantity of different types of food. It is important to remember that food is not just calories and fibre but also a source of micro-nutrients like vitamins and minerals that the body needs to function properly. So a daily multi-vitamin pill is not a bad idea for most people including children. It can make up for some of the micro-nutrients we miss out on in many modern diets.

And I do not presume that my advice is going to be accepted without any skepticism. Please read up on these issues if they interest you.

Syed Mansoor Hussain

syed mansoor hussain
The author has served as Professor and Chairman, Department of Cardiac Surgery, King Edward Medical University.

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