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28 years back, when I started my practice as a young General
physician, one evening a very sick looking girl of fifteen
tottered into my nearly empty clinic. She had fever, which was
not responding to treatment. I examined the child carefully,
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she
had obvious chest infection, but too sick for that symptom. My
investigation revealed that she was diabetic. She was my first
case of Insulin Dependant Diabetes Mellitus (IDDM). I was too
new and too scared to treat. I did what I thought was best for
her, sent her to the medical consultant in the state hospital.
She came back two years later. She was absolutely emaciated,
withered, you could say, sunken eyes, unable to walk, she had
lost most of her vision, had severe pain in the limbs but her
blood sugar was under control with insulin. I re-examined her.
She had damaged nerves, neuropathy, damaged kidneys,
nephropathy, and damaged eyes, retinopathy, all expected
complications of diabetes. She died a few weeks later; I could
not do anything to save her. She just withered away.
What shocked me was the diet she was prescribed at the hospital.
She was put on severe caloric restriction, with a ban on every
possible type of food, rice, potatoes, sugar, fruits, anything
underground, big fish, meat. The result, the blood sugar was
controlled; the patient was dead. I was worried because I had no
idea why such restrictions were put. Nothing that I ever read in
my formative college years suggested any such restrictions. I
was curious and so started collecting the diet advice given by
the prominent physicians. The result was unbelievable; each and
every diet chart was actually a starvation diet. No human being,
diabetic or otherwise could survive following the diet charts
given by doctors. The result was obvious, once a diabetic,
always a sick man. Most of the diabetic patients were sickly,
starved, frustrated and depressed. What was worse, they
invariably developed diabetic complications much faster. Only
the most ardent, stubborn patients, who were incorrigibly
negligent, survived.
I collected some information regarding the diet prescribed to
diabetics. There are some common factors in all prescriptions.
‘No sugar, no sweets’, was the common slogan. Anything sweet or
even remotely sweet was to be avoided. Doctors went to
ridiculous lengths to keep the diabetics away from ‘deadly sweet
food’. No sugar, no fruits, no sweet gourd, tea was supposed to
be taken without sugar or with artificial sweeteners. Mithais
no, no absolutely, even medicines, which have sugar bases, were
avoided.
Rice was the criminal number one. Diabetics were discouraged
from taking rice. They were told to take roti instead. Poor
Bengalis, without rice and fish their life was as good as dead.
Some doctors were more considerate; they allowed one meal of
rice and two of atta. People took Roti at night. Most of the
Bengali housewives did not know how to make a roti properly. So
they innovated, using hot water while mixing the dough and
making a real tasteless mess of a morsel out of it. The hapless
diabetic had to swallow this food day in and day out.
Of the vegetables, the enemy number one seemed to be the potato.
Every doctor worth his salt was up in arms against the poor
potato. This innocent looking apparently tasteless food item
incurred the wrath of the medical community and was banned in no
uncertain terms. Not happy with simply banning potatoes, some
doctors went a few steps ahead and attacked even the neighbors
of potatoes, all food items harvested from underground were also
banned.
Then the doctors went after fish and meat. Red meat was a
favored term for doctors; they banned it at the first go.
Thereafter they selected mutton, pork, and lastly poultry for
the ban. From land the doctors attacked the food in sea and
lakes. They banned fish for diabetics, especially fish with oil
in it. They got the greatest pleasure in banning Hilsa (Shard)
for Bengalis. The only fish allowed were the small fry. In case
they found even the slightest change in the kidneys they
promptly even banned vegetable protein. No dal, no cheese, no
paneer, no rajmah and definitely no soya bean either.
From the lakes they climbed up on the trees. Fruits with a trace
of sweetness were banished from the charts. No mango, no
jackfruit, no banana, no grapes, no apples, no pears, nothing.
The only fruits allowed in very limited quantities were the
citrus fruits.
Trust me, I found no scientific basis for their action, none
whatsoever. That was the time I committed the greatest blunder
in my medical career. I wrote an article in a local newspaper
and detailed what I learnt to be the ideal diabetic diet. No
selection of food I said, just control your greed. Diabetics
should not omit any food items from food, no, not even sugar.
Fruits must be consumed. The only criminal act committed by
potatoes, I said, was that potatoes were round shaped. They were
excellent food for diabetics, I claimed. I quoted Gandhiji and
said ‘the world has enough for your need, but not enough for
your greed’. The reception my article got was tremendous.
Overnight, my clinic went empty. All my diabetes patients
disappeared. Vanished into thin air. The only patients I was
receiving were the stray ones who entered the clinic by mistake
and asked the attendant whether I could treat fever. There were
some well wishers who came and admonished me for such a stupid
write up. They said they were surprised that even after becoming
a doctor I did not know what was such common knowledge.
This got me more adamant. I studied more about diabetes and more
about nutrition. I was convinced that what these doctors were
doing was not only wrong but they were actually killing their
patients. I kept on publishing article after article in the
local language dailies, aimed at patients who were the victims.
Then I published a popular book on diabetes in Bengali, which
went on to its 6th edition in no time and became the largest
selling Bengali book on diabetes, including West Bengal. Pirated
copies were found in the streets on Bangladesh also. I spoke in
the IMA conference; I spoke in the Diabetes conference. I was
surprised that none of the consultants opposed me in the
conferences, but in private they told their patients, “Ah! what
does he know, how many patients does he get anyway.” Only once,
in an API conference, when in a discussion of neuropathies by a
young neurologist from Mumbai, I raised the issue of
anti-oxidants and fruits in diabetes, one senior consultant from
Calcutta agreed that it was a mistake not to allow fruits for
diabetics. That was all the response I received from the medical
community in the last 25 years. For 25 years, I was never
contradicted in public by these consultants, but they continued
with their diet prescription.
Things have not changed much even now. But some changes have
occurred. Educated people now know that diabetes diet ‘has
changed’. Now the consultants here do not object to potatoes and
rice anymore. Sometimes they allow occasional fruits when the
blood sugar is under good control. Most of the consultants do
not write ‘no potatoes’ anymore, but they have not included
potato in ‘edible’ portion of the chart also. They just ignore
potatoes altogether now. The funniest part of the story is that
one consultant had printed a large consignment of diabetic diet
chart, must be in tens of thousands, for free distribution to
his patients. Now, potato was the first non-edible item
mentioned in the chart. He could not have thrown away the all
the charts. So he added in black ink ‘sweet’ before the word
potato, making sweet potato a part of the ban. Poor fellow did
not know that sweet potato was one of the best foods for
diabetics, because of its mineral and anti-oxidant contents.
Hilsa fish or any other oily fish is not yet allowed, depriving
the patients of the very life saving omega3 fatty acids.
Recently on World diabetes day, seminars were organized all over
and loads of knowledge distributed to the lay public. I was
invited for a dinner cum CME session organized by the local
Lions Club. A very senior consultant took the trouble of
training GPs on treating diabetes. In his slides, he clearly
told the doctors present that there was no reason to ban sugar,
fruits and potatoes. The first such acceptance in last 25 years.
I was so thankful; I stood up to say so.
There is hope now, hope for diabetics to lead a normal life. But
that can happen only if the educated patients wake up.
Dr Ashok Sinha, Agartala, can be reached at ashokagt2@yahoo.com
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