Stanford's Top 2% Scientist Explains Diabetes, Sugar, & Brain Damage | Dr. V Mohan |FO534 Raj Shamani

32:23That's all gone. How expensive is the new machine now? Expensive. So, because only one or two companies make it. It's about six and a half lakhs for the pump. But even then, it changes your life. If you can, somebody can. So, six and a half lakhs. And then, there's a running cost of all the tubing and all you have to get. About 20 ,000 rupees a month. And how much would like a previous generation pump would cost? Where you have to do manual feeding? About two lakhs. So, from there, it's gone up. Cost of maintenance would be$15 ,000,$20 ,000. Yeah, it might have been$10 ,000,$15 ,000 or maybe$20 ,000.

32:56So that's not gone up much. The pump cost has gone up. So what we are doing there is we are trying to make it in India. We are working in the Institute of Science. We are working with two different groups. I'm on the board of the Institute of Science. I'm the governing council of the Institute of Science in Bangalore. So I go there, I sit with the scientists, trying to make it. They are coming up with protocols. But what they now produce probably this year or next year, definitely they'll come. I think end of this year they'll come. But it's an older version like the setting and all that. That they have come to now.

33:28They're saying within a year or two they're saying they can make this. Once they make this they'll go to the AI thing and they can do it. Then they'll bring it probably for a lakh of rupees or something. That's what you're working for. Got it. So coming back to now type 2. Okay. Let's say somebody today got their blood tested and they're now seeing that they are pre-diabetic they get a notification they're pre-diabetic and they're panicking all of a sudden what is a three-step checklist that they should do for the next 90 days so that they can probably reverse it or manage it way before it actually becomes a full-blown diabetes i mean you don't have to do it in 90 days you can do it or more systematically you can work on it Most people with prediabetes have some excess weight and fat.

34:19That's the first thing to work on. So you start, you set yourself your 75 kilograms. You should be only 60 kilograms. At least try to make it 65 or 68, 8, 10 kilograms. The good news is that while the conversion from prediabetes to diabetes is very high in Indians, the reversal is also not very difficult. Five kilograms is sufficient. if you just reduce 5 kg in weight especially a little bit of tummy 2 inches of tummy and by whatever method of course sleep better sleep on time don't eat late all that you said walk after the thing set your weight and see that you come down cut down your carbs add protein do regular exercise aerobics muscle training all that because muscle is where glucose is burnt if you do these simple things have a fault of most of all regular lifestyle if you do all this it's fairly easy to reverse from pre-diabetes to reverse is much easier than from diabetes too see normal is here pre-diabetes is here diabetes is here from here if you are able to go there from here to there is much easier to go or at least you can prevent going to that stage shouldn't be difficult at all problem is people do it for 2-3 months then they give up then they back on why do people give up?

35:36I think they they get bored with what they are doing and willpower. There are people with terrific willpower, mostly little OCD type people who have to do it once they, and they overdo it also sometimes. But there are people with willpower who can do it. But you know, right from Adam and Eve that don't eat that apple, they ate their apple. And then there's what is called a hedonic pleasure. The brain, there is pleasure, you know, and seeing food seeing Gulab Jamun seeing Razagullah seeing they just can't it's like smoking you can't it's very easy to say give up smoke they're not able to do it it's in your cell every cell is telling you to very difficult so it's in the food craving food craving so our culture is only making us this yeah there's one thing which is coming up on the serious point which is now people are calling type 3 diabetes which is Alzheimer's I was reading that for every 1 % rise in HbAvenc it means 2 years of brain aging yeah you can't put an exact number for that but it's something like that loosely related there have been other studies which have shown opposite findings also see dementia if you take dementia it's of different types Alzheimer's is one type where you get this amyloid deposits in the brain and you get amyloid deposits in the pancreas and that's how the Alzheimer's come when you have these deposits in the brain but there are also other types of dementias for example vascular if you have a stroke then part of your brain is cut off so that also can produce dementia if your frontal part of the brain doesn't get blood circulation that's also dementia only those dementias are definitely higher in people with diabetes no doubt about all the vascular dementias.

37:34There have been some studies which are saying that Alzheimer's may be actually less in people with diabetes because they are controlling all the risk factors. They're controlling, they're taking statins, bringing their glucose, I mean their cholesterol down. Then their glucose levels are kept under control. Blood pressure is kept under control. They're taking vitamins properly, they're eating a healthy diet, they don't smoke, they don't drink, they cut down on that because they have to go for exercise regularly, they do that. So, lots of healthy things are doing, all of which are good for the brain.

38:11So, there are some studies just saying that Alzheimer's is actually less in people with, like two studies I know, which have shown that. But uncontrolled diabetes, of course, you don't follow the rules and everything, you're going to accelerate and you're going to get more of Alzheimer's. So, They've given it a name, type 3. The reason is, see, the actual class, how this type 3 came, I'll tell you, it's actually not type 3. Type 1 is type 1. Type 2 is type 2. That we know. The last one is gestational diabetes, GDM. Due to pregnancy, it comes. In between, there are about 30, 40 different types of diabetes due to stones in the pancreas, due to pancreatic, due to endocrine disorders, due to drugs, due to virus, due to chemicals, due to this, due to that.

38:59So they didn't call it as 3A, B, C, D, E and all. They didn't call it. But because in the classification is 1, 2, last is GDM and this comes under other types. People started calling it type 3. And the third one in that is due to the stone. So the type 3C is pancreatic diabetes. Then something else in the thing is Alzheimer related to amyloid deposits. So it's Alzheimer's. That's how the thing came. and just to say it's something similar to what happens in in diabetes something also happens in the brain so they call it as type 3 diabetes got it but what happens if sugar in your body increases yeah that is very that is why you're headed towards pre-diabetics and diabetes yeah that's a part of that's a part of the game so when this happens and you're headed towards Alzheimer's what happens first like what goes first like is it memory mood focus where does it any of them can happen first thing is memory actually so what happens is that recent memory will be retained sorry the other way the old memory is retained if you ask them what happened in 1960 they'll be able to tell you oh this thing happened that thing we had green revolution we had this thing.

40:15Did you have breakfast today? They don't know. They've forgotten. So the first thing which goes is the recent memory. In fact, they'll be telling people that, oh, my family is starving me. They're not giving me anything. He would have just had his lunch. And then somebody will come outside, you know, in this house, they don't give me three days since I ate. He's forgotten that he has eaten. Okay. My father-in-law had dementia. And he used to 20 years after he retired he used to work in the American consulate and 20 years after he retired he'll get ready to go and all that and then we'll say where are you going no I'm going to office, my office time and all that, he's still living in that period you know, so we first tried telling him hey you've retired yeah, you're not going what do you mean retired, I've got an office people are waiting for me and why are you so then my wife and she's alive, she used to play this thing on him.

41:11He'll go and say, I'll just call them. Then she'll pretend she's making a call. Then she'll say, Papa, today's holiday. Why holiday? No, some American holiday today. So I don't have to go. No, I don't have to go. Oh, okay. Then I'll get, I won't get ready. So we have to treat him like that. So memory is one of the first things that happens. Then some kind of a control over yourself also you begin to lose. so you become violent so mood disorder mood disorders you become violent you start hitting people that kind of a thing the other thing is they go out of the house and they won't know how to come back they won't be able to tell their name they won't be able to tell the family member's name they won't be able to say where they are staying and we have known of people who have gone from the house and never seen again they'll go somewhere somewhere somewhere then they'll get into some train.

42:10They don't know where they're going. And they don't know how to come back. They'll ask them, where are you? What are you doing? They're not able to describe. And they're lost. Finished. Gone. So, it's a very scary thing. But, the good news, because I'm now beginning to do research on dementia and diabetes, and I'm working in the Brain Research Foundation, the CBR, Center for Brain Research in Indian Institute of Science. We have got a collaboration now and we're doing that. The good news is that earlier, only through late MRIs and all, you're able to find out. The brain is kind of gone and then only you can make out.

42:47Today, you've got blood tests, biochemical tests, just like cholesterol and all. You've got tau markers and other markers, about six markers in the blood. Before you get dementia, they'll start increasing. So, you can say that this person is likely to get dementia five years from now, ten years from now. You may say what's the point in knowing that? If there's no treatment. The good news is that just like the GLP drugs, we have 80 different molecules coming. There are at least ten different dementia drugs which are coming. They're in phase two, phase three. If they come, they'll become next revolution like GLP.

43:29Because what they're going to do is they'll go to the brain and remove those plaques. That means the man who's lost memory memory can come back. See, they are called tangles. Fibrillary tangles they are called. So the little, little, little things get tangled and the neurons, the brain neurons, they are all now interconnected in a wrong way. Like a ball they become. Okay. And once this, it kind of splits all that, the nerve cells are now come back again. Can you show it to me on a brain? Can I give you a brain model? Yeah, I can show it to you, But it, yeah, you show me the brain. I'll do that.

44:09Yeah. Okay. So we have the brain here. Okay. So we have the front of the brain and we have the back of the brain and different portions of the brain are involved in the front of the brain, for example, is involved in memory, thinking, cognition. The back is involved in visual thing. This side of the brain is involved in function. Okay. If you get paralysis there, you get one side, get stroke, then you get a hemiplegia, one side not working. So different parts of the brain. This portion of the brain, the front portion of the brain, is the one which is involved in thinking, judgment, cognition, and that kind of a thing.

44:50Now what happens is, of course, the whole brain, not only that portion which gets covered, the whole thing gets covered with, this is the normal blood circulation and all that you're seeing. Now if you have the brain and you have, let's say, thousands and thousands and lacks and lacks of nerve cells. Now each of these nerve cells is conducting information. And that's how we're able to think, we're able to reflex action. From there you go spinal cord, from the spinal cord you get nerves. So if you pinch here, immediately the brain knows you're getting pinched. All that is there. Now what happens if all this amyloid kind of thing comes and settles, amyloid, you know, so this amyloid.

45:38What do you mean by amyloid? Amyloid is a kind of a protein kind of a substance. Okay. and that if it becomes excess due to uncontrolled diabetes due to cholesterol due to smoking due to various things if this gets more then it will start clumping up all this is it like fog in your brain which is exactly like that you can explain it like that okay except that it's not going to go away easily so now you have all this thing so memory is going down down down and the dementia gets worse worse worse worse to pick up whether this is happening only we have the blood markers now. So you can see that we didn't have.

46:18Today it has already started coming. Previously this was identified through MRI and CT? Yeah. Or clinical symptoms. You have various symptoms asked them to perform function. So we have started actually in our hospital also we have started for anybody above 60-65 years apart from looking at blood pressure, sugar, this we give them simple questionnaires. So there are simple cognition tests. I can give three things. I can give one color. I can give some object and something. I'll say yellow, rain and river. Something. Three things I've told. Then after five minutes, what are those three things I told you?

46:57They can't. They've forgotten. Interesting. It's that fast. Like in five minutes, they forget. Oh, something you told me. One color you told me. Yellow, yellow, yellow, yellow. One is remembered. then another simple test we tell them is draw a clock simple thing, draw a clock people can't do it so we'll say, ok, that's a clock that is 12, 1, 2, 3, 4 we'll say show that the time is 1.50 ok, 11, 10, 9, 8 so 1.50 short hand and long hand that's all they can't draw this what do they draw then? they'll be I don't know how to draw I don't know how to draw you have not seen a clock? yeah but I can't draw I'll say just draw no they can't a simple thing like this they are not able to put because the brain is not working but then if they remember something from 20 years ago they must remember something some clock part of like some form of clock from 20 years ago right?

48:04an event they can remember you ask them about their 50th birthday 40th birthday the birth of their child when did India get independence what happened who was they'll tell you but you ask them to do this they can't do you give them some simple tests they can't do now more young the age of getting Alzheimer's or dementia is getting younger like at 45-50 people are getting the signs of it symptoms of it so there are number of reasons for that which are proposed one of course is diabetes increasing blood pressure increasing everything increasing everything at young what people used to get at old age now we are getting at young age age of 7-8 they are getting diabetes now not type 1 type 2 obese children coming at type 2 that's one side of it apart from that there are other causes pollution particle 2.5 in the air we think it only produces cough and allergy and things it produces damage it can produce diabetes it goes into the blood it can go into the pancreas knock out your beta cells produce diabetes.

49:10Then it can go into the muscle cells, into the liver, insulin resistance. It can produce diabetes. It can produce blood pressure. It can produce heart attacks. It can produce cancers. It goes to the brain. Dementia. It promotes that. And if you're constantly exposed to it, even at a young age, you can get that. Suppose that smoke is going in all the time. Then even at age 30, you're exposed to it so much more. Normally, it would take another 20 years for your age to catch up. But this is being accelerated. Which is why at a younger age we're getting cancers, all old age related things. Now young people are getting breast cancer at 20, 25.

49:48We are hearing. All that is this lifestyle, junk food, all kinds of things put into food, artificial sweeteners, all kinds of emulsifiers for taste and for things. People are putting in all kinds of things. That's not the natural food that our forefathers used to eat. So that's where my question was about this. Like at 45 or at 40, people who start forgetting things and probably start developing early signs of dementia. Is there a point or a twist in their life or probably some signs where you can say that this is no more brain fog. It has actually developed into this. So testing. Testing for, you do an MRI, you will find changes.

50:32Structural change. What you're describing here, you can see it on MRI. And can I do brain MRI today and probably predict in some sort of way that what's going to happen and what's happening in my brain? With the blood tests. And so we are doing a study called the CARS study, Center for Cardiovascular Risk Surveillance. It's a study which is being done in New Delhi and in Chennai. And with the collaboration of Emory University in US, Nimhans is also involved in it in Bangalore. And the brain part of it. And so what we're doing is, people above the age of 45, we are doing normal people. We are going into the whole population of Chennai.

51:18We have already some 25 ,000 people who are being followed up in Chennai and Delhi. For the last 15-20 years, we're following these people. So now we've added the brain part of it. Earlier we were only in diabetes, heart. Now we added brain, liver. We are adding other things. So as part of the brain, we are telling them, would you like to get a free MRI done? We'll get it done for you. We'll also take this blood for biochemical tests. So when you combine the early changes on the brain with the early changes that you see in the biochemistry, you can say that this person is likely to progress. Now, you may say, till those drugs come, what can you do?

51:59There are a lot of things which you can do. Like, first of all, lifestyle itself has been shown to help. So if they start exercising every day, if they start eating a lot of salads and fresh vegetables and healthy foods, they have a lot of antioxidant kind of properties. Sleeping on time, reducing the stress, doing pranayama, doing yoga, doing sodoko puzzles, doing different things, learning a new hobby. To challenge your hobbies. Yeah. So keep it going. Read books. Read this. Learn an instrument. Learn a new language. Learn some new hobby. Something else. Social networking. Very important. Because you're always something, you're talking to them, you're laughing, you're doing something.

52:45So all that slows it down. So if you're able to identify people early, and then of course the drugs will come. Now very soon, I think within a year or two, the dementia drugs are going to come. They're all in late phases of trial. Once they come, it will be an explosion of those drugs. And now they are saying you can take injections which will dissolve all this clumping which is occurring and your memory can come back. That's going to be a big, big moment like the weight reduction thing. Ten years ago, I would never have thought a drug will reduce weight like this. I only thought bariatric surgery can do it.

53:18Today, I'm seeing a completely different, it's changed the way. Similarly, I think we are on the threshold, the cusp of this dementia treatment. Tell me now, you said too many different organs you've been testing on, right? The impact of diabetes, sugar, glucose on liver, kidney, eye, brain, bunch of things. You just use these words. Explain me organ by organ. I'm going to put organs here. Sure. And you tell me exactly, like I'll give you a checklist and where does sugar attack first? Let's start with the eye. So when you see the eye, you'll be seeing it like this. Okay. We have a thin film. And then just behind that we have the pupil through which the light enters.

54:04You can see that round thing. And then you have the iris. Then behind that you have the lens. Okay. Okay. It's there in all our eyes. All our eyes. Just behind there is the lens. And it is this lens which focuses the image. See the light is going from there through the lens. and at the back portion there, that is called as the retina. That's the retina, the back portion. So you have a front portion, a middle portion, then you get a back portion there. So when the light goes in there, it has to converge to a point there and then you'll be able to focus clearly. Now what will happen is if this lens becomes thicker or thinner, you will get long sight or short sight.

54:51So before 40 years, mostly it's myopia, Long distance, you cannot read. After 40, the reading will become a problem. Short. So, yeah. So, that's called long side. The other one is called short side. Myopia, hypermetropia. So, all that is in the lens. The same lens. So, those changes can also come due to diabetes. Because more water in the lens, less water in the lens. If you have very high sugar, you're feeling thirsty. That means there's no water in the body. There's no water in the lens also. Lens will shrink. So, your focus and all will go and you won't be blurred vision. Next stage, which is very common in diabetes, is cataract.

55:26So cataract is, normally a lens will be like this. You can see through. Okay. Now you can get different types of cataract. And this, only the central portion is. So through the side you can see. This portion you cannot see properly. Okay. Then you can get these type of things, like a star it is. This is a typical diabetic kind of a cataract. Like a star, stellar kind of a cataract. What does it mean? Cataract. These are cataracts which is forming, but there is still some portion left. This particular shape, if you see, is likely to be diverted. Then you've got complete blockage like this now. It's become opaque.

56:07This is cataract. So once it has come like this, you have to operate. So what they do is they'll remove the lens and put another lens in. I've had both my eyes operated for cataract. within a week I got both done. So 5-10 minute procedure for a good surgeon. Make a small link, they just pull out that lens and the small lens they push it in. That's finished. Over. Then it just stays. And the new lens then can be there for a long time. 10-20 years, more also. So that is cataract. That also is accelerated in diabetes. When you have very high sugar, the cataract comes earlier. If normally cataract comes at 60-65, In diabetic people, 50-55 it's a little come.

56:50Because of the high sugar driving the cataract. So the first thing, when the sugar increases, the first thing it does is start forming these cracks? It's not cracks. It is a transparent thing becoming opaque. It's the sugar inside, sorbitol we call it. It's again related to sugar. So that sugar metabolism changes and then this starts becoming opaque. So that's called cataract. That's also a simple thing. You won't lose your vision. You can remove the cataract and bring, even non-diabetic is also a talker. What happens really in diabetic people is retinopathy. Diabetic retinopathy. Retinopathy, patty means inflammation or disease.

57:35Retinopathy means retina getting affected. So this is the retina. So that portion is the retina. You can see the blood vessels there. When you have uncontrolled diabetes, these blood vessels start getting affected. First small sac-like thing will come. We call it as microaneurism. Small sac will form. Then they'll start leaking. So you'll find when you do a... See what the doctor will do, retinal specialist will do, they'll put in drops and this pupil which is small will become bigger. So you can see what you're seeing at the back. You can actually... The whole retina you can then see without any surgery and you can just see the whole retina.

58:17Normally, all the normal blood vessels you can see. But in diabetic retinopathy, what happens is, first of all, this small circular thing will form, microneurism we call it, then it will start leaking. Then small hemorrhages will start, blood clots, small blood clots. Then, because it is not getting enough oxygen, it's not efficiently flowing, new vessels will try to form. So instead of these small vessels, from there, what will happen is that if the vessel is like this, that vessel will form new vessels. We actually call it as new vessels. Neovascularization. This is the original one. This is the new one.

59:00These new ones are very thin. Okay. They'll easily burst. So if it bursts, what happens is the whole retina will get filled with blood. And overnight, you can go blind. so it will just like that leak and the whole purely because of glucose mismanagement in your body not controlled uncontrolled diabetes where sometimes sugar is going super up or super down remaining high not due to the fluctuation because sugar is continuously kept high that's where this concept of HbA1c test comes this 3 months average test HbA1c study after study done 10-20 years ago have shown. See the normal HB1C is 5.6 or below.

59:455.6 to about 6.4 is called prediabetes. 6.5 and above is diabetic. Similarly you've got for the glucose. Fasting above 126 is diabetic. In a GTT, 2 hour value about 200 is called diabetic. In a random blood sugar, done at any time, more than 200 it is diabetic. Many people are saying don't treat diabetes. It's normal to have high sugar. So age, old age, everybody will have a little diabetes. That's where all these myths are, you know, are demystified when you do these studies. What they found was up to 7 HP insulin, 5.5, 5.6 to around 7 is a safe limit. You don't develop eye, kidney, nerve complications.

1:00:24Up to 5.7? Up to 7. Up to 7. From 5.5 to 7. 5.5 5.6 is normal. 5.7 to 7. That range, if you're a diabetic is able to maintain, it can be 6, 6.2 6.3, 6.5, up to 7, there is no risk of developing eye, kidney, nerve complications. As it goes above from 7 to 8, 8 to 9, that 1 % increases your risk of developing eye, kidney, nerve complications by 25%. So 7 to 8, 25 % risk. 8 to 9, 50 % risk. 9 to 10, 75 % risk. about an 100 % risk of developing complication. So, any 1 % lowering also reduces your risk by 25%. And all we are trying to do is to keep that A1C below 7. That's our entire goal of treatment.

1:01:23We call it as ABC actually. A is A1C, below 7%. B is blood pressure. You have to keep it at whatever is normal for your age. At least below 140-90. Preferably 130-80. C is cholesterol. The bad cholesterol is LDL cholesterol. Should be below 100. Below 70 is good. Even below 50 is even better. But at least below 100 to start with. So the whole population you want to bring. Everybody 50 and all may be difficult. But if it's possible then you bring that. D is discipline. Diet, exercise, sleeping, this, that, all that. If you follow this A alone. You can prevent eye complication. Nobody will develop diabetic retinopathy.

1:02:05there will be no blindness due to diabetics same thing for kidney same thing for nerves neuropathy, burning feet and numbness of feet, these three can be eliminated if you just keep that A1C below 7 nothing more you have to do okay, if you want to prevent heart attacks, strokes gangrene of the feet then B and C also have to keep blood pressure also under control, cholesterol also under control, D also includes no smoking and all that because you smoke then all gone So if this A, B, C, D you do, I have been telling year after year on World Diabetes Day, I've been saying we should have a complications-free India.

1:02:46People ask me, can you have a diabetes-free India? I say it's difficult. It's difficult because age is a non-modifiable risk factor. As you grow older, you'll get little diabetes. Okay. Can you completely prevent graying of hair? Can you completely prevent balding? it may not be possible. Okay. But it doesn't matter. If you get little diabetes as long as you don't suffer it's okay. So I keep telling people don't worry about diabetes free world. We'll worry about a diabetes complications free world. That is possible. And I want to see it in my lifetime. And for that I'm saying ABCD. So that's it.

1:03:28Get your A1C down, keep your blood pressure down, keep your cholesterol in control and follow some discipline. Diet, exercise, no smoking, get to sleep on time, take your medicines, go for a checkup, finished. You may say, is this rhetoric or you have actually done it? I have actually done it. In 2013, we showed 50 year survival of type 2 diabetic patients, 5-0. okay I had about 400 patients who finished 40 years and some were finished 50 now some have finished 60 65 years with type 2 diabetes so the American Diabetes Association gave me the Harold Rifkin Award as the first to show in the world 50 year survival of type 2 diabetic patients partly because I was lucky because their diabetes itself comes only at 50-60 for them to get 50-60 they should be all 110 years old for us we get it 2030 so to get 50 years survival in the 70s we can get 50 years survival so that way we are a little lucky that people get it at a younger age so they are able to show 50 years but nobody had shown it so they gave me one of the highest awards in the American Diabetization is the Harold Rifkin Award so they gave me that but the point is not the award the point is that people can live for 50 years without then they said you only showed 50 years survival you didn't show people living up to 90 hundred so I said that's my next project So we collected people who have finished 90 years, 95 years, 100 years with diabetes.

1:04:57Large series now. 102 years old, diabetic, 50 years, 60 years, nothing. They walk in. One guy wrote a book at the age of 97. One man, when I called all these 90-year-old people for a press conference and to show the world that it's possible, the chief guest is 101 years old he has been chief guest but tell me if you said A keep your A, B, 1, C under control blood pressure under control cholesterol under control do diet exercise sleep all of that under control when all of it is lifestyle management why do I need a doctor like you to tell you that

1:05:48how do you know all that you know your blood pressure you know what cholesterol to do you know how to bring it down you know all the glucose you know it took me 50 years to learn all that

1:06:01the lifestyle part is one the ABC is done by the doctor the D only you are doing okay the ABC where to give the medicine how to lower it how much to lower should I bring the A1C to 7 or to 6 for you which is safer for you those things I decide no based on your condition suppose your heart is already a little at risk now if I go and push your A1C below I can produce a heart attack for you I can produce some arrhythmia for you and push you into so it's not just lifestyle management lifestyle is important beyond that another thing which we showed regular checkup is also very important okay but tell me if I do regular checkup and I am following discipline.

1:06:43Walking every day, sleeping on time, doing weights to do some, building some muscles, eating greens, eating proteins, doing everything that you just suggested. Yeah. Do I still need a doctor? You still need a doctor and still need a checkup. I'll tell you why. Because, because of your age, things may go wrong. Okay, I'll show. Okay. Now, you've got HB1C. Let's say seven. I want the HB1C at seven. Okay, now you have come to me and your HP1C has come there. This is 2026. I've told you HP1C is 6.5. Now you're saying, I don't need a doctor now. I've reached 6.5. He told me below 7. I don't need a doctor.

1:07:29Now we talked about hedonic. We talked about things slowly changing in the body. There are also biochemical changes. Look at you to age, due to so many other factors, things can change. now my next checkup I'm saying is before 2027 you come once more to me after 6 months I'm telling but you're saying no I won't come I don't know this guy who wants to make money is calling me I'm not coming what will happen is it will go there no symptoms asymptomatic disease and you're saying I'm fine because you don't check HP and say anyway you'll be saying some sugar that's because you know I went for a marriage last week so everything you'll have an excuse also.

1:08:09Then it will go there. Okay. Then it will go there. Then it will go there. And one day you will say, Doc, it's 10 now. And of course, I don't want to tell you I told you so. But I have told you so. Because if you only come here, I'd have brought it down. Then again you go, again I bring it down, again I bring it down. So, always your HPNC is okay. Otherwise it's going up, up, up, up. This happens also with people who try reversal things. You know? And what happens if I go above? Yeah, because every 1 % I'm telling you that your risk of developing eye, kidney, nerve complication from 7 to 8 when it has gone already, it is 25 % extra risk.

1:08:59It's gone to 9, it is 50%. It's gone to 10, it is 75%. It's gone above 10, it's 100%. risk of developing kidney. Next time you come here, I'll check your kidney and say, gosh, you started leaking protein. Finished. Sometimes it's not reversible. After that. Then what I'll be trying to do is how to prevent dialysis for you. That'll be my next aim. Not to bring all this down. My next aim is how long can I push him without him undergoing dialysis or transplant. Because Once a creatine goes to a certain point, there are only two things. Either dialysis or transplantation or death. Finished. There are only three things that are possible.

1:09:42If you don't do these two, you'll die. And how many transplants can you do in India? There are 101 million people with diabetes. Assuming 20 % will develop complications. 80 % will not. 20%. 20 million people. 20 million kidneys. You're doing 10 ,000 transplants in a year. Whatever transplant you do, it's only 10 ,000 in India. 20 million. What are you going to do? So you have to prevent. To prevent, it's A, B, C, D. For that, you have to come. Only if you come, only we'll bring this A and A. Only A has come now. B, C also will take care when you come. A also will check. B also will check. C also will check.

1:10:22Then I'll talk to you about D. I'll further reinforce. Saying, hey, this one, you know. Okay. Now, next six months, let's be a little more careful. I've motivated you. I'll give you an example. Okay. How this works. I'm from the other side. You're the doctor and I'm sitting on this side. When I got married, my wife used to tell me, why are you brushing your teeth only once? You should do once more at night. Morning anyway, you're going to get up and brush. So why should I brush at night? Okay, so I never did. Then I had some small dental problem and I went to my dental surgeon. And so she told me, you know, Dr.

1:11:03Mohan, from today till you die you're going to brush twice a day. Okay? If you come back at 1am from somewhere flight or something you come you'll brush and then go to bed. Okay? Since the time she told me till today I've not changed. I've done it. So I go back home and then I told my wife you know this doctor told me that I have to brush my teeth twice a day so I'm doing it. What did I tell you? I told you this years ago. I said that's the difference. When my dental surgeon tells me I think. Now your wife tells me I don't listen. You're not my dental surgeon. What if my dental surgeon tells me I listen?

1:11:46So there is a certain power. And that power is very powerful. Tell me about kidney. You spoke about kidney because it's like by the time people see bubbles in their urine kidney is already 50 % damaged. No, that's not true actually. The bubble actually is not. So I'll show you the kidney. So this is a kidney. It's a kidney shape. They're called kidney bean. It's called that because it's like a kidney shape thing. This is the adrenal gland actually. So here's the artery and the vein. And this is the urine tube, the urethra through which it goes. And then if you open up the kidney, you can see the collecting tubules and the thing.

1:12:25If you put this under the microscope, if you take a bit of that, You can do a biopsy or if you want to do a biopsy, we don't need to do it. Or if you take that, these are what are called as nephrons. And these nephrons, I mean, they're just pictorial, they're just doing blood vessels and so on. But these are too big to see. But if you take, you know, small tissue and then see it under the microscope, then you can see what is called as a basement membrane. Okay, this is called as a basement membrane. And this is the normal thickness of the basement membrane, let us say. If you have uncontrolled diabetes, what happens is this thickness of the...

1:13:13So it's through the basement membrane that the blood circulation, blood will come and then go back and all that. So the first thing that will happen due to diabetes is the basement membrane will get thickened now. Okay. Once it gets thickened, so that's called basement membrane. So basement membrane is thickened. Once basement membrane is thickened, it's also become porous. And so there are small, small holes through that. Through that, albumin will start leaking. So normally, if you measure how much albumin is there in the urine, it's a very small quantity, some 4 milligram, 5 milligram. That's called normal.

1:13:50Near zero or very, very small. Then slowly, it will become about 30. 30 microgram per minute or 30 milligram, you can call it. We call it as microalbuminuria. That is the first stage of diabetic kidney disease. Before that, it will do a biopsy. You can see thickening of this base membrane and other changes there. Glomerulosclerosis, we call it. Now, the first thing that will happen is small quantities of protein will start leaking albumin. That's called microalbuminuria. 30 to 300, we call it as microalbuminuria. If it goes above 300, it's macroalbuminuria. After that, reversal becomes difficult.

1:14:33At this stage, microalbuminuria, there are tablets. You give it, it will become normal. Kidney itself will become normal. Blood pressure will start going up. By the time this kidney starts going up, blood pressure will drop. Everything will become normal. Sugar is normal. HPNC has come down. You give these tablets, everything normal. Kidney will become normal. Once it goes to macroalmurray above 300, 400, 500, 1000, 2000, almost difficult to reverse it back. At that stage, so this can be stage 0, stage 1, stage 2, whatever you want to call it. Stage 3, creatinine is now beginning to go up. Up to this creatinine serum, creatinine 0.8, 0.9, it's normal.

1:15:15Once it crosses 1, the kidney is going in for failure now. Okay, 1, 1.5, 1.6. It's going up. We measure it in another form. From that creatinine, there's a formula EGFR, estimated GFR. Normally, it'll be about 90. Then it becomes 60, 50, 40. It's coming down. Then creatinine becomes 2, 3, 4. As it goes higher and higher, you're going nearer and nearer dialysis and transplantation. Okay? Now creatinine has become 8, 10. Your EGFR has become 10, 15. Now, it's called the last stage of kidney. It's called end-stage renal disease, ESRD, end-stage renal disease. That stage, there's nothing you can do.

1:16:00If you control diabetes now also, control blood pressure now, you can give all the medicines you want. It's a relentlessly progressive condition. So, the moral is, I'm not frightening people by saying that, but once you reach that stage, nothing you can do. Eye also. You get this small, small spot. Then it starts bleeding inside in the whole eye. The whole vision can go. Can go blind. Then you try to suck out the blood. Try to do some major surgery with rectomy. This, that. You may get 50 % of vision back. Okay. They are all eminently preventable. I'm saying we've got 50-year people without any eye trouble.

1:16:38That's why I'm saying diabetes is complicated in the free world. I'm talking up to that. Okay. So that is preventable. Early stages also, it is still reversible. So it's a point of no return. Beyond that, next stage, next stage, next stage. Now you come, you take foot. First, some numbness, tingling in the foot. Okay, you give medicine, become okay, controlled diabetes. Okay. Then it starts burning the whole night. You're not sleeping. Then some callus forms and then the ulcer forms. And then small gangrene starts forming. Now you have to remove the toe. You have developed gangrene. Gangrene means death.

1:17:14Death of tissue has occurred. How can you keep a dead foot, I mean toe? In fact, the next one also. Next toe will go, next toe will go, next toe will go. So then you start removing one toe. Then if there's good blood circulation, it will heal. There's no good blood circulation, that also won't heal. Then you'll end up with a below knee amputation, above knee amputation. Those are the things which in the past we used to see. But unfortunately, even today it's happening. They'll be from a village. They won't have proper advice. They'll go to some native healer. he'll say don't go to all these allopath fellows I will cure you, they will give some treatment they will put something, a band-aid something they'll put, some herb, something they'll put that'll worsen it that'll infect the foot also won't be clean also, they'll infect the foot then they'll come the bad thing somehow save my leg, somehow save my leg everything is possible up to a certain point beyond a certain point diabetes can be an absolute killer but what is in simple words what is there in a diabetic person that one small wound doesn't heal.

1:18:16Doesn't heal. It takes them years, months, years probably and the same thing like some wounds then start becoming bigger and bigger and at one point they have to probably cut off the finger or the hand. If you become black and become gangrene then dead. The toe is dead. You can't keep a dead toe. You have to remove it. So then it will go to the next toe. So one small cut. What happens? So two or three things. One is glucose. Once you have glucose in the skin, glucose is a very good source for bacteria to grow. See, how do we do cultures in the lab? We put some glucose and then allow the bacteria to grow.

1:18:54That's how we see whether there's bacteria there or not. Here you've got a natural like a culture lab you've got in your leg itself. You've got so much of glucose there, it'll keep getting more and more the bacteria will grow. That's number one. Number two, neuropathy. The nerve is affected. because a nerve is affected when you walk also you're not walking lightly you're putting pressure because you're not feeling the surface so you're putting more and more pressure so more and more damage the chance of it breaking a bone is very easy the bone is also a little weak because all the calcium has gone from the bone so very easily deadly one, the third one most deadly one is blood circulation problem even this neuropathy infection, you can give antibiotics you can do something, remove one toe let out the pus, you can just cut it, let out all the pus, it will heal even the big wound is there, you can just make a big incision, let out all the pus it will heal.

1:19:51The deadly one is ischemia. If you don't have blood circulation, without blood, nothing will enter there whatever nutrient you give whatever antibiotic you give the blood has to go there there is no blood, it is blocked then what do you do? of course you can try to do a bypass or you can do a stenting and open up the vessel and try to do and so on. It may work sometimes. Sometimes even that doesn't work or you cannot. Why is the blood not going there? Because the blood is blocked. The arteries are blocked just like the heart arteries are blocked like the stroke that you get there. The arteries are blocked due to cholesterol due to uncontrolled diabetes due to inflammation.

1:20:34The vessels are blocked. If it's a big vessel going from the thigh, you can operate it and just open it up and the whole blood will then go. It's like a high level block. Suppose a low level block, the vessels are so small and multiple. Where are you going to go and open it? Every health conscious Indian today has thrown out white sugar out of their house, which is a great thing. And they've replaced it by jaggery powder. But I was reading the GI index. jaggery powder has almost about 74 to 80 gi index yeah white sugar has about 65 does it make any difference or is it a wrong metric to even look at so gi is a very complicated thing for example white bread is actually near 100 the gi and a different different thing that There are studies which show that mango, GI is not that high.

1:21:36There have been some recent studies also. But every person who takes mango will come with very, very uncontrolled diabetes to me. So if you look at, which one is jaggery? This is coconut sugar. This is jaggery. Yeah. So that's jaggery. And which is a white sugar? I'll get you white as well. So if you look at white sugar and jaggery, it's in the processing of this. This is a little more unrefined. Just like we said about brown rice and white rice, the same principle. Okay. So this is sucrose. White sugar is sucrose. And jaggery is a little more. So according to Ayurveda, this is much, much better than this.

1:22:25Okay, so jaggery is better than sugar according to Ayurveda. According to Ayurveda. So jaggery, even honey and all that is recommended in Ayurveda. If you look at the actual difference between the two, if you don't have diabetes probably jaggery is better than sugar because jaggery has some nutrients in it it has some more nutritional benefit in it white sugar has zero nutritional value it's just sugar there's nothing else in it jaggery does have some nutrient benefits in it but for a person with diabetes it doesn't make too much of a difference because this also will elevate your sugar You are right about the high GI part of it.

1:23:13So this will also elevate the sugar. This will also elevate the sugar. So between the two, if you ask me, I would say this is slightly an edge over that. But I would say for a person with diabetes, they should try to avoid sugar in any form. So there is a move. The government is also, I think I've heard this National Nutrition people saying, from the time the child is born don't give sugar at all because sugar is not really needed for health yeah only for taste enhancing only for taste so this is not a health thing at all so you really don't need it you won't believe it even salt was like that you know how salt came salt was not there 300-400 years ago okay whole humanity has been there for millions of years salt is only about 300-400 years it is only during the shipping era you know sailors had to bring food and for days together where will they get the food?

1:24:14so they have to bring things you know carry the food for months together while they are sailing they found out that salt water brine as we call it if you put fish in it or you put food in it it stays it's a preservative what happens when you put that is the salt gets absorbed. So the salt taste came like that. It only started as a preservator. It is not meant for taste. Slowly, the taste gets added on. We are taking far too much salt and far too much sugar. Okay. I'm going to show you these things because we touched upon it a little bit. But you rank them. Completely safe is 1. Completely toxic is 10.

1:24:58So rank these things or probably just give them numbers. Okay. So let's start with white sugar. Okay, but I should see them to give up. Because once you get all the students, you put the marks now. Okay, fair. You want to do comparative studies.

1:25:17So we have, I'm going to name it for people. So we have orange juice. I think we'll take these, because juice becomes a little different. A lot of people say fruit juice as a sugar. I want to put that also as a thing. So it's like What is this one? So we have brown sugar. We have brown sugar. We have coconut sugar. Okay. We have monk fruit sugar. We have sugar free. We have stevia. We have jaggery powder. We have white sugar. And then we have fruit juice which is purely fruit. Fructose which we call it. Okay. So stevia will be number one. Because among the sweetness, I'll put stevia and Splenda.

1:26:09Sucralose. Okay. Which is also among the sweetness, these are the two which are safe. We have done studies. Okay. And these two are, this is plant-based. Sucralose is derived from sucrose. So I would put stevia and sucralose as the first two. Okay. Okay. I would then probably put sugar-free aspartame, although there are some things which say that aspartame also has some side effects. But in small quantities, I think as coffee, tea, it's probably okay. then I would say probably jaggery and these two being the brown and probably this also. So coconut sugar, jaggery and brown sugar is almost same?

1:27:01Almost same because they're all not refined like that. And if you had to still put a number, how would you rank in order? I would say jaggery would be better one, then in this order only coconut sugar then brown sugar this monk fruit sugar lot is being told in social media that's very healthy actually it contains erythritol what does it mean? erythritol is one of the sweeteners like this first of all it contains fructose it contains glucose and in addition to that it contains erythritol okay and erythritol is one of the worst sweetness of all these I would put it even after this so I would put stevia and splendor sucralose sugar free this I would not use at all there have been cases of blindness and strokes and all that what happens with that ingredient what is the ingredient erythritol it's one of the sweeteners studies have been done where people have been taking erythritol have developed strokes and all that.

1:28:11So this, I would not popularize this at all. Although people are talking a lot about monk fruit, sugar, fruit sugar. It's becoming really big. Almost every healthy thing they're putting this. Yeah, so that is why I've been reading up about this and this I would, you know, put it on a void. Okay. Then this I would put there because it is still, if there's no sugar added to that, But it is still, I don't recommend to a diabetic to take fruit juice at all. If it is cut fruit, it is fine. It is fine. It will go actually much, it will probably come here or something. Cut fruit will come here. Okay.

1:28:54Okay, or even here. Whereas this one, to produce so much of this juice, you have to put in a lot of fruit to get it. So the calories goes up and the sugar content goes up. Even though it is fruit sugar, it is still fructose. It gets converted into glucose. Ultimately, once it enters into the body, it will get converted into glucose. A little slower, it will get converted. So I don't recommend this. I would recommend this. Of course, white sugar, there is no doubt at all. It is direct sugar and therefore you should not take it. You're killer. Yeah. Anybody should cut down on this. So these are the ranks.

1:29:32Yeah. 1, 2, 3, 4, 5, 6, 7. This you have excluded from rat. I don't like that erythritol at all. You're saying monk fruit sugar is probably worse than white sugar. Not in terms of the sugar content. No, in terms of the side effects and damage. Overall damage. Because it contains erythritol. That's my objection. Erythritol. See, you know, about two years ago, WHO said that they issued a blanket statement against all sweetness and they said sweetness because what happened was people started substituting sugar with one of these sweeteners and taking it by the tons thinking this is for weight reduction so I will cut off sugar I will do this and so on WHO but when they issued that statement itself they said this is not for people with diabetes because people with diabetes are going to replace that with this or this.

1:30:31It's definitely better than sugar. Because sugar changes the gut microbiome quite a bit. Some of the other things, even this and some of the others also change part of it. But this does much more. So WHO said when we are talking about sweetness being bad, we are not talking about people with diabetes. Let them continue. At least they have to get rid of some sugar substitute. That's okay. We are talking about people trying to lose weight. saying that I'll switch from sugar to this and I'll lose weight. They said they're actually studying they gain weight because some of these substitutes of these, first of all, they do the gut microbiota thing they do.

1:31:09Second thing is they stimulate your appetite and they make you eat more. And so they said there's no weight loss at all about that. So don't use it for weight loss purposes. They're very strong about it. WHO gave a very strong statement. That is when we did the study on Vestivia and we did on Sucralose. And what we did was very simple. We are not telling people instead of dessert, you put this large quantity. We didn't do that. We also didn't say drink diet drinks, you know. Instead of the regular cola, you drink a dry cola. We didn't say that also. What we said was Indian habit is in coffee and tea.

1:31:49They can't take it without that bland thing they don't want. They want some sweetener. So those who are taking sugar, among those with diabetes taking sugar, one group we said, okay, you continue sugar. Now you're taking it, you continue it. One group we said, why don't you switch over to the sucralose and we'll see what happens. For three months, we followed them. Just by cutting that sugar and replacing it with sucralose, only in coffee or tea, two to three coffee or tea per day, They were able to lose one or two kilos in weight. Their waist went down by one or two centimeters. Sugar actually came down.

1:32:28There was a little bit of change in the gut microbiota because of the change in this. But it wasn't very serious. So we concluded by saying, okay, if it is coffee or tea and you're having diabetes, at least you can take sucralose or stevia. That seems to be okay. Now, one or two of these, if they switch over, they still contain sugar. So they're not sugar substitutes. This one, probably your glycemic index may not go up, but my objection is to erythritol. So that time I read all about the various sweeteners, whether all the sweeteners are the same. And why there were people saying that people can die if you take...

1:33:09Then I found all related to that one erythritol. Erythritol till now is not there in India. Okay. We had only stevia, we had aspartame, we had splendor and all that. But now this thing is entered in this form. So I'm saying be careful. With erythritol alone, be careful because there are cases of strokes and all described after erythritol. But not with the other sweeteners. Not even with these. That is very my objection to that. I have not done research on that. But I'm just saying from what I've read. What do you think is like, give me top three best breakfast which an Indian can eat. and this has to be Indian.

1:33:46I'm not interested in oats. Oats are not interested. Okay. What about eggs? Only eggs? So, fruit is a must. Okay. So, fruit and if you vary the fruit apple very low GI apple a day keeps the doctor away so that's true actually. Guava is again something with a lot of fiber and very low GI it's very, very good. Orange is okay. papaya is okay then the egg is a very good breakfast if you take eggs a couple of eggs a day even if the yellow is fine if you take two eggs the advantage of having protein immediately I'm a vegetarian I don't take egg then you have to take something else some other protein the advantage of adding protein at breakfast is you can go up to lunch time not feeling hungry.

1:34:46If you just have your poha and idli or dosa and all in two hours you'll feel hungry. 8 o 'clock, eat 10 o 'clock you're already wanting to eat again. You have your protein you can go up to 2 o 'clock, 3 o 'clock you're full. You can even skip your lunch nothing will happen. And you can have an early dinner two meals you can easily that is the power of protein. So apart from building your muscle and building your satiety value is very very high Because you're taking 120 grams, you must be feeling that fullness part of it. So for me, what I take is I take fruit. I used to take non-veg and I became a vegetarian many years ago, 15 years ago.

1:35:29For the first 8 or 10 years, I was not taking egg also. I said vegetarian means really vegetarian. Then I struggled with my protein intake. It's very difficult to get. You mentioned plant protein. How will you get? It is difficult. So I started taking egg. Mostly I take egg white only because then there's no cholesterol also. And then for those who think, you know, the yellow part is a life part and already can justify by saying the white is not really life. It's not fertilized or whatever. So egg white. But even if it's a full egg, it's fine. That's the only kind of non-veg that I take if it's an egg part of it.

1:36:06I also take a little bit of milk because I am one who believes that dairy is actually good for health it's not bad for health, it's a complete protein I take not much about little more than that maybe a little bigger bowl than that, but in that I pack it with nuts and seeds so I take all kinds of nuts, almonds, cashew, pistachio. Every day I vary the nuts. Little berries, if it's there, I'll add. Seeds, definitely. Chia seeds, pumpkin seeds. Any other seeds, other flaxseed or whatever, I'll take that. But chia and pumpkin will definitely be there. So antioxidants, fiber, protein, all this comes.

1:36:58And omega-3 and all that comes only from this because I can't take fish and all. So I take this. So I think that's a very healthy breakfast for me because the milk gives you my protein, little bit of fat. It gives me the thing, all the nuts gives me the omega-3 and the protein and the fiber and all the good values of nuts I get. Seeds, even better, antioxidants and so on. The fruit, again, giving me a lot of antioxidants. And I don't have diabetes. I can eat a couple of fruits per day and the sugar doesn't go up. I put CGM and all, it doesn't go up for me. And then the egg gives me the protein part of it.

1:37:35So that's a nice breakfast. Then for lunch, very little rice, very little, hardly, there'll be two vegetables. One gram thing will definitely be either moong dal or Bengal ram or chickpeas or sarajma or something. A nice big portion, two vegetables, very little rice and curd. That's my lunch. and night again practically no rice it will be more vegetables and if there is some one dosa or one thing very small quantity of carbs protein will again come in the night and veggies and things like that so that way very healthy food so you are agitarian talking about world's influence you said Bose, Dr.

1:38:24Bose I am talking about you let's specifically come to you you developed something and you spoke about stones and pancreas and that almost became Mohan's criteria in the world now the biggest of the biggest doctors and scientists all around the world whether it's Stanford or the top institutions whether it's America Europe or anywhere in the world they they quote it as Mohan's criteria what is Dr. Mohan's criteria and what did you do So for the first 20 years of my life, I worked on a rare disease. We call this type 3C and all. Earlier when you're talking about it, I talked about it's not type 1, not type 2.

1:39:09There are other forms of diabetes where the pancreas gets directly involved due to inflammation and they develop stones inside. Just like a kidney stone, gallstone, you also have pancreatic stones. and those stones will go and damage the pancreas and produce diabetes. It also produces indigestion because pancreas has two functions. One is insulin production and the other is exocrine, digestive function. So when you have these stones, your digestion also is not good. You'll be producing oily motions and all that and then your sugar level also will go up because insulin production also goes down.

1:39:44So that was called as fibrocalcific pancreatic diabetes. Can you draw and show me something? I can show. It will be easier for me. to understand. Yeah. You're using words which are very normal to you. For me, it's like, what? Fibrocalculus. What? Fibrocalculus. Okay. So,

1:40:06so this is stomach. Okay. Okay. This is intestine. At this point, this is a duodenum. One part of the intestine, the neilium. This portion has an organ like this, a leaf-shaped organ, which is called as the pancreas. Okay. So this pancreas... It's attached to your stomach. It's attached to the intestine. It comes and opens here. This is a pancreatic duct. This whole thing is pancreas. Okay. There's a small duct going through so which fluid will go up and down. The pancreatic juice will keep going there. And what happens is that when you have... We don't know what the cause is but due to some reason this pancreas starts getting inflamed.

1:40:51Pancreatitis, we call it, inflammation. When that happens, the pancreas starts getting inflamed. So, first thing that happens is that this flow of this juice which goes like that, it starts getting slowed down. Okay. It becomes thick. So, once it becomes thick, very easily some mucus plugs will start forming into that. Calcium will start getting deposited and then that forms a stone. So if you take an x-ray, you can actually see the big stones sitting there. In the pancreas. And that's called pancreatic calculi. Once you have the pancreatic calculi, calculi is stone. So once you have that, then it will start producing further damage and the pancreas will start getting fibrosed, shrunken, like liver getting, liver also can get shrunken, then you get cirrhosis.

1:41:45so like the cirrhosis of the liver here also you start getting shrunken so that is why it is called fibro that means shrinking of spanking calculus so it's called fibro calculus pancreatic diabetes that's the full name of this disease there is fibrosis, there is stone formation and that is producing diabetes and so it's coming from directly from the pancreas itself so it's called FCPD How fatal is this? It's not very common. It's more common in South India. So Kerala had the highest, then Tamil Nadu, some parts of Orisa. As you go north, it was not that common. In Delhi and other places, not very common.

1:42:31It's a tropical disease. Why? That's a big question. Why? Some people said it's due to, in Kerala, they take cassava, tapioca. That contains some cyanogenic glycoside. There's one theory. I demolished the theory. I did animal experiment. It doesn't happen. I think it's due to malnutrition. So because of malnutrition, what happens? Some micronutrient deficiency. Pancreas is not getting enough of the usual nutrients that irritates it and produces some kind of inflammation. And then the final end product is very clear. You'll find big stones. If you take ultrasound within this duct, you'll find big, big stones sitting there and so on.

1:43:06Ultimately, it can turn into cancer also. Pancreatic cancer also is very, very high in these people. So this particular disease. I first got interested in this when I was doing my I used to work with my father from my first year I told you when I came to my final year my father had seen a few cases of this in written one or two papers on this and he had seen it in very very poor people so he and others in Kerala there was one Dr. Givergis he had also described he said poor rest of the poor they'll come very very thin they'll have abdominal pain and take an x-ray you'll find stone then you check the sugar it's very high it's not type 1 is not type 2, it's FCPD, fibrocalculous pancreatitis.

1:43:45So he asked me to write a chapter on this. He gave me some papers and when he was writing a book, he told me to write a chapter on this. So I wrote the chapter on it. When he was writing the chapter, I said, how do you define this? How do you, you know, simply stone and thing, how do you define this particular thing? So I went to Kerala, spent a few days in Trivandrum where they have a lot of these cases and I was discussing with a gastroenterologist there, Dr. Balakrishnan. And he was telling me how this is all due to chronic pancreatitis. How chronic pancreatitis comes and all. I went to study it.

1:44:20After I studied. Then I said, okay. There is no way. Type 1 you can say if you have ketosis, you go into coma, you don't have insulin secretion, you have antibodies, you've got different criteria for that. For this, there's no criteria at all. So I said, let me sit down and make this criteria. It's seen only in tropical belt, outside the tropic, even within India, only within the tropical. See, India is cut by the tropic of cancer by half. So, South India comes in the tropical. The rest of India is temperate. It's not outside the tropics. Okay. So, even here we are seeing within Tamil Nadu, this one, all in the south only we are seeing.

1:44:55There is something tropical about it. So, I said the first criteria should be in the tropical. If you go across Africa only in the tropical region to see. So, I said it must be from a tropical country. First one. Second, there must be diabetes. Okay. So, I said second criteria is there must be diabetes. Third, there must be chronic pancreatitis because this is a chronic pancreatitis thing. So I said there must be chronic. How do you diagnose chronic pancreatitis? So I said either there must be stone or there must be evidence of some fibrosis. Okay. And all this can come due to alcohol. Just like your non-alcoholic and alcoholic fat.

1:45:29There is something called alcoholic pancreatitis. So I said they should not drink alcohol. So that is my criteria. So I just wrote it down and I said this is Mohan's criteria of the thing. That went like wildfire. Nobody had thought about it. Nobody had defined it. So that became Mohan's criteria. Mohan's criteria. So everyone started to accept it. All books it came and all that. And it became well established all over the world. Nice. Tell me about that three-month-old baby that was brought to you from Kolkata. What did you diagnose and you were able to figure out that you saved her from getting 17 ,000 injections in her lifetime?

1:46:09That is true. Three month old baby and 17 ,000 injections. That's my brain to fire. Yeah, it's very simple actually. So, when you talk about diabetes in children, the first thing which comes to mind is type 1 diabetes. Okay. So, type 1 diabetes, you have to take insulin lifelong. And how many injections a day? Four to five per day. Multiply that by 365, it is what? Thousand whatever into 4 ,500 injections. 10 years it will become 15 ,000 injections, 16 ,000 injections something that is how that 17 ,000 over a 10 year period that is what the thing is 4 to 5 injections per day now there is also another condition called as neonatal diabetes this occurs before 6 months of age type 1 diabetes usually occurs after 6 months of age between 6 months 1 year and about 10 to 15 years, it's almost always type 1 diabetes.

1:47:08And that's 4 times injection, 5 times injection. This neonatal diabetes occurs just after birth for 6 months. And it's a genetic condition. And unlike type 1, type 2, you can actually do a genetic test and prove where the mutation is, which gene has got mutated. Very easy to do that if you develop that kit. So I got interested in this and I started saying, why are we not looking for this neonatal diabetes and if there is a condition like this why are we not diagnosing it in India so I started telling people anybody below six months let's do this genetic test and let us see whether it'll so this is one of the first cases which came to me from Calcutta so somewhere I'd spoken about it below six months probably they don't need insulin something I said so somebody from Calcutta referred this patient to me one doctor said this is Dr Mohan you go and see him This child was just diagnosed, three months old.

1:48:04So he said, you go to Chennai and let's see whether he is able to take you off insulin. The mother and father were crying. They were very poor people. They started crying, can't even afford the insulin on. He said, you go to Chennai. He came here. I said, yeah, before six months, we have to do a genetic test. I did the genetic test, child had neonatal diabetes. So there are two types of neonatal diabetes. One is called a mutation in a particular gene called KCNJ11. and the other one is ABCC8. If you have these two, you can simply stop insulin and just change the type. But you should not do it without doing the genetic testing because even other than these two mutations, there are other types of neurons which won't respond to tablets.

1:48:4650 % is not these two. 50 % is these two. So if you have 100 cases, 50 you can take off. The other 50, we don't know what to do. They still need insulin. We're still doing research on that what to do. But this 50%, sure, has been described in other parts of the world. So this child, we did the test, she had this KCNJ11 mutation. So I said, great news, we'll stop insulin. And the child is not responding to insulin. Taking high dose of insulin, sugar is going high, high, high. I said, okay, get admitted. We will take you off insulin. We just, within two, three days, stopped the insulin. Give you the tablet, beautifully responded.

1:49:21Such a small child, you know, three, four months old, beautifully responded to tablets. So we said, okay, now you go home. we have a branch in Calcutta we'll follow up there and you go and let's see 1 month passed, 6 month passed, 1 year passed 2 years passed, 3 years passed 10 years passed child did not take 1 single shot of insulin this tablet insulin is expensive this tablet is the cheapest tablet for 100 rupees you can get the tablet okay so we calculated when the child came back after 10 years we calculated 17 ,000 injections a child would have had if she had not come to me number one so 17 ,000 pricks sugar would not have been under control for 10 years because the child's defect is in the pancreas and when you give this tablet it makes that defect it overcomes that defect it's a specific treatment and it's a one rupee tablet it's such a cheap thing so child saved three and a half lakhs of rupees in terms of insulin cost, syringe cost, blood sugar testing cost.

1:50:31And 17 ,000 injections were saved for this particular child. Those syringe pricks. Yeah, 17 ,000 times a small child. This child is this big, you know, 10-year-old child. So they were so happy. So they said, popularize this. Use our child's name. Use the child's photo. Doesn't matter. Let other children. Slowly, I started talking about this everywhere. Then I said, see, what will chill? they'll say how to pay for this now. I said, who should you pay? I'll pay for it. So nobody should pay for this, you know. I said, it's free. Any child below six months of age, just send me the blood samples and I'll do it free of cost.

1:51:10I'm saying it in the program also. Anybody. I started putting my own money into it, family money into it. Then I started telling people there are things we will donate into it. I said, children should not pay. Family should not pay. Today I've got 500 such children. from all over the country, from all medical colleges, including Ames Delhi, PJ Chandigarh, from all medical colleges, from private people. I don't even ask them what their income is, nothing. I said, just send the blood sample. In three weeks, I'll give you the result. If it is one of these two, I'll tell you how to change over to tablets also.

1:51:43Hundreds of children are now gone off insulin. Okay? So now I calculated how many there should be in India, considering India's population. According to my estimate, there should be at least 10 ,000 children. I've got only about 500. Where are the others? And what does it take to diagnose? One question. When did you get diabetes? That's all. If it's post six months. Before six months, send the blood sample. After six months, don't send the blood sample. Continue with the insulin. Can't be simpler than that. But don't stop the insulin and start tabletop without doing the genetic test. If they belong to the other 50 % of those, they'll die.

1:52:24And what is the limiting factor? Cost. I'm doing it free for you. What more do you want? Anybody in India? I'll raise the fund. I'll do it. You send it to me. So I want to find the other 9 ,500 children. Hopefully some of them will listen to this program. And if 10 children come, I think this program will be worthwhile. Absolutely. Even one comes, it'll be worth it. Correct. Tell me about a diabetic person. okay, who's watching this is probably overweight or someone they know in the family is overweight and is diabetic. Should that person, should a diabetic person take GLP-1 or Ozempic or Manjaro to cut weight?

1:53:07It's a good question. I don't think everyone should take it. The basis of treatment of obesity is still lifestyle. There is no doubt about it. This is not instead of. it is in addition to. First of all, there are cut points which are given. BMI of 30, BMI of 27. So BMI of 25.5, I won't go and give these drugs. Because you should remember that these drugs, even though the prices have come down, even though generics have come, they're still expensive, number one. Number two, they're not without side effects. They do have side effects. And sometimes the side effects can be serious. Mostly the side effects are mild, but there are side effects.

1:53:49Any only work as long as you're taken. So if you take it six months, it'll work for six months. Are you going to take it lifelong? If you're going to take it lifelong or near lifelong, then you come. There's no point. There's not shortcut taking for three months and I'll take a few photos and then put it on social media and then I'll go back. So it reverses? It reverses like you start getting fat again? 100%. Almost all cases. Everyone. Every single one. It's a lifelong thing that you have to be on those. that's why you have to be that's why you have to be so that's why I said everyone should not go so then who will go for it suppose a guy is 120 kilos his life itself is in danger he may die of heart failure he may die of something else stroke we don't know what all other blood pressure this we don't know what all he'll have such cases we could not do anything other than bariatric surgery in the past cutting up the stomach cutting up the intestine cutting up It's a gruesome thing.

1:54:49Instead of weekly ones, an injection is good. Costs have come down. So weekly ones, let him take it. What's wrong? Instead of going, cutting up all that cost, you spread it over a few years and take it every day. So there are indications for it. Second, it is not only for weight loss. It's a therapeutic thing. So we are giving it, if you have liver fat, extensive liver fat, that may go into cirrhosis. That may go into liver cancer. That's the next stage. So you're seeing grade 3 fatty liver. Next is grade 4 and cirrhosis. So if you're taking this, it's going to save your life. You can do that.

1:55:25Second, your fat is increasing so much that your heart starts expanding and pump failure, you may die. So taking this is, even if you're taking it lifelong, it's fine. You're taking thyroid lifelong, you're taking statin lifelong, you're taking BP tablet lifelong. Why not take this injection lifelong if it's going to work? So it must be under strict medical condition. it must be after evaluation there are certain things where you should not give those who have gallstones should not take it those who have severe eye complication already the retinopathy which you showed it's very bad, better not to take it so there are there's NION, optic neuropathy, blindness and all that so after a thorough evaluation after talking to the patient and saying that this is going to be a long haul but it's in your interest that you take it because other than that, you're going to get many other complications.

1:56:17Let's look at the positive side. There have been patients of mine who have been told to undergo both knee replacement. That means you're putting a metal knee in both the knees. Very expensive. You can't squat after that. Three months, four months after Monjaro or any of these Ozambic or whatever, semaglutide or whatever they've taken, no need for knee surgery. The orthopedic surgeon, now you're walking well, no pain, gone. So two surgeries saved. Okay. Cirrhosis saved. Diabetes got under control. Before these drugs came, we give tablets to type 2. Type 1, forget it. That is insulin only. Okay.

1:56:59Forget neonatal diabetes. Half tablet is getting it. Forget that. We're talking about type 2 now. Type 2 diabetes, first one drug will come, tablet, then another tablet, then another tablet. After that, it's insulin only. the moment you start insulin weight will start going up okay weight will keep going up low sugar will come this will come that will come that's all we had two years ago that's all we had so we'll give insulin to everyone then after sometime we'll become two insulin then we'll become three insulin by the time we'll gain 10 kg in weight now we'll take more insulin another 5 kg we'll go up that's all we're downhill course only we didn't have any this came and it changed the whole thing now we're able to stop insulin put them on this weight is going down, drugs are going down BP tablets are going down, cholesterol tablet is going down, thyroid tablet is going down, no bariatric surgery everything avoided by this drug.

1:57:52So they are fantastic drugs there is no doubt, you never had such kind of drug. Very good. But like a knife, if you have a very very sharp knife sitting here and you keep playing with it, you will damage yourself or you can kill somebody with it. Okay? Same time and give it to a surgeon and you will do a neat surgery with it. Tell me one belief that you have or maybe one insight that you have from last 50 years of your work. If that you genuinely believe in that particular insight related to diabetes or related to the health world and actually the larger world is not ready to accept it. It's a contrarian belief that you have.

1:58:36or maybe you're too scared to talk about it because maybe you don't have enough RCTs and you know data around it so you're scared to say it because the world will come after you no that way for a scientific thing I don't think the world will come after me or anything

1:59:00I believe that diabetology is a speciality by itself. See, today the endocrinologists say that diabetology is not a speciality at all. It's under our thing, one small branch. And they made it into a speciality. My father made it into a speciality when there were no endocrinologists in India. The first endocrinology thing came only in the 1970s. In 1948 it only started the diabetic clinic. Because we believe there's enough to do in diabetes Instead of taking out thyroid, pituitary, adrenal, this one, that one, every endocrine organ we don't have to treat. We are specializing in that. But there are endocrinologists who say that there's nothing called diabetology.

1:59:44You cannot call yourself a diabetologist because there's only an endocrinologist. There is no degree in diabetes. For years, you've been trying to start a separate specialty called diabetology. Because if you see liver, it's part of gastroenterology. Now it's become separate, hepatology. Gastroenterology. that becomes separate within lung TB specialist is separate and the rest of the lung is separate so there are divisions like that there are many like that so I always believe that diabetology is a full speciality by itself but the world doesn't accept it not the world the endocrinologists don't accept it even today and in India today I cannot even call myself I don't put the word diabetologist anywhere because they say which degree do you pass to say that you are a diabetologist?

2:00:35There is no such degree. How do you call yourself a diabetologist? Having said that, there is a diabetes association and there is an endocrine association. Not only in India. American Diabetes Association, American Endocrine Society. British Endocrine Society, British Diabetes Society. European as a Study of Diabetes, European Endocrine Society. Australian Diabetes Association, Australian Endocrine Society. Why are they having both? International Association of Endocrinology, International Diabetic Federation. Everywhere both are there. Only the field of study. Only, yeah. When you come to putting the name, no, no.

2:01:10You cannot use Diabetology. There's even journals. Diabetes Care, Diabetologia, all diabetes journals. They didn't say Endocrinology. They didn't say, no. But when you say I am a Diabetologist, no. There's no such thing. You cannot use it. Okay, I removed it from my visiting card. I just say Chairman Dr. Mohans. That they cannot say I am not. Fair. So here's my last question, which we asked, we've started asking everyone is, so for chairman,

2:01:47is I'm going to give you 60 seconds. Okay. And you internalize in the process and think about it and come up with specifically three insights from our today's conversation. if you have to just give specifically three things which people will take away and learn what will those three things will be just think about it for 60 seconds maybe you want to take pen and paper no no I can do it without that just think and give it because I want you to probably go deeper and come up with very specific insights which is not generic and people will take it so we can just go maybe now

2:02:29Yeah, I think I can give it as three messages to people. You're okay to give right now only? Like not even have to wait? No, I don't have to wait. I can give it straight away. Three messages to people. Number one, diabetes is not a disease. It's a disorder. Don't think of it as a disease. It's not something that's going to kill you. It's a disorder with which you can live. Okay. Number two, diabetes is preventable. So if you have not got diabetes, we talked about pre-diabetes earlier, there's a long period by which you can do a lot of things to delay, delay, delay. The more you delay it, you will never reach the complication stage.

2:03:11So it has to start there. Number three, if you are one of those who has already got diabetes, don't worry about it because you can have a long and healthy life despite diabetes 50 years, 60 years you won't live up to 100 years of age just follow the ABC principle and you will be able to live a long and healthy life you may actually have a better than normal life than a person without diabetes because a person without diabetes what is the motivation for him or her to keep on. Here you've got a disease. You have to look after pressure. You have to go for the checkup. Check your cholesterol. Check your weight.

2:03:56You've got goals to do. Eat healthy. Sleep on time. Exercise. All that you're supposed to do, this disease makes you do. Or this disorder makes you do. If you don't have that, what makes you do all that? So you'll end up not sleeping, not exercising. So I believe that a well-controlled person with diabetes is actually better off than a person without diabetes. Interesting. Well, thank you so much. Thank you. Thank you for spending time with us. Thank you. It was a pleasure having you. Thank you. Thank you for inviting me. Thank you so much for watching this episode end to the end. Now you have to do three things.

2:04:35Number one, subscribe to this channel so that we can bring you more valuable guests for this kind of and we can ask them the questions that you want. Number two,

2:05:05I'll see you next time Until then, keep figuring out

2:05:15Thank you.