With prescribing stronger and more potent medicines becoming the norm, it's rare to come across physicians for whom living right scores higher than medication in fighting disease. Narayanan Dorairaj, 39, was lucky to come across one.
Narayanan's 166-cm frame weighed 93 kg when he was diagnosed with diabetes on April 30 this year. "I loved food, never exercised and always drove to the shop at the end of the street. I'm the only one in my family with diabetes," said the senior execuitive with an MNC in New Delhi. The diabetic demography
After the diagnosis, he underwent a lifestyle makeover and showed results within five short months. Now his doctor has taken him off his cholesterol medication completely, while his diabetes medicines are down to one-fourth of the dosage five months ago.
"I went to visit my family in Chennai and my brother did not recognise me when he saw me at the station. I lost 15 kg in five months by going off sugar and rice completely and walking for an hour a day, along with light weights and floor exercise for half an hour," he said.
Now Narayanan weighs an incredible 79 kg — his weight-loss target was 80 kg by December 31 — and has set a new target of 70 kg by next summer. "I realise I will have to go on medication some years later, but a delay by even a few years means delaying my body's exposure to powerful and toxic medicines," he said.
Children benefit equally. A lot of healthy food and a little activity can lower risk of diabetes and heart disease among 15-17 year-olds, reported a Diabetes Foundation India study in the European Journal of Clinical Nutrition earlier this year. The study showed that intensive school-based nutrition and lifestyle interventions improve the health of both boys and girls within six months.
While most medicines are safe and effective, experts fear side-effects for newer ones may crop up years later. That's what happened with the popular diabetes drug rosiglitazone, which became one of the world's biggest-selling drugs for close to a decade before a 2007 study published in The New England Journal of Medicine reported it caused heart attacks and strokes. Europe banned it and the US imposed severe restrictions on its sale in September this year.
India also chose to ban it on Thursday. "The drug was banned because safer, similar-acting medicines — such as Pioglitazone — can be prescribed instead. Also, many people on drugs are illiterate and do not understand the health warnings printed on the packs," said a Union Ministry of Health official, who did not want to be quoted.
India's poor at tracking adverse drug reactions is the other reason for the ban, as experts fear doctors and families of patients on rosiglitazone who suffer a heart attack may not link the death to drug use.
"Indians and diabetics in particular are at high risk of heart disease, yet only 20-30 per cent take heart-protective medicines such as blood-thinning aspirin and cholesterol-lowering statins. Experts unanimously asked for a ban because it was feared that the cardiovascular risk in India would be higher," said Dr Anoop Misra, head of the department of endocrinology, Fortis Group of Hospitals, who was among the experts who unanimously advocated its ban. The American Diabetes Association recommends all diabetics should take aspirin to lower their risk of heart disease and stroke.
Rosiglitazone is a third-line drug prescribed after the first two lines of treatment — such as metformin and sulfisoxazole — become ineffective.
While GSK holds the patent for rosiglitazone in the US (brandname Avandia), the drug is prescribed and sold in 10 different brandnames to 8 million people in India, where it was launched in 2001.
Available in 2,4 and 8 mg tablets, rosiglitazone belongs to the thiazo-linedione class of drugs initially prescribed in a single 4 mg dose or in divided doses, which can be increased up to 8 mg a day in single or divided doses. Insulin is prescribed after the thiazolinedione class of drugs stops having an effect on blood sugar levels.
"Drugs to prevent diabetes are not required, especially as a healthy diet and regular exercise can help achieve a similar reduction in incidence," said Misra.