Indians are genetically predisposed to diabetes due to having fewer subcutaneous fat cells (adipocytes) by birth, which causes excess fat to accumulate as visceral fat around internal organs rather than under the skin. This visceral fat is toxic, produces inflammation, and leads to insulin resistance and fatty liver disease. Combined with faster beta cell decline and lower insulin secretion capacity, these genetic factors explain why Indians develop diabetes at younger ages and more rapidly than other populations when exposed to high-calorie diets and sedentary lifestyles.
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Deep Dive
India's #1 Diabetes Scientist: Belly Fat, Diet, Ozempic, Miracles & Glasgow Study | Dr MohanAdded:
Dr. Moan, thank you for doing this.
You've received a padmashi.
>> Yes.
>> And diabetes is literally in your blood.
>> You and your family, you have experience of over 75 years. Do you believe in miracles?
>> Absolutely. Cancel your cancer. That's what he said.
>> 80% of the population, anybody who's a little gray hair above 50 years, 80% of them will have either diabetes or pre-diabas.
It feels like Indian bodies are made differently. What's your take on Brian Johnson? Is Matey what actually good for D?
>> Matey is good. I've seen his picture at 40 and 80 and he really looks old.
>> Wow.
>> And said we're going to overfeed you.
Are you willing to undergo these experiments?
>> Sounds like a dream.
>> Yeah. You like that?
>> So doctor, we're going to do something fun.
>> Okay.
>> We're going to run through an entire day in the life of an Indian diabetic and you're going to make 28 decisions for that man.
As a non-science person myself, diabetes as a field is so intimidating to me.
Research papers behind pay walls. I don't understand a word of technical knowledge that most researchers use.
>> Um, so my goal with this episode is to break down the science and what's happening in India into the most simplest terms. So let's get started. My first question for you is very simple.
Why should I care about the problem? How big is it really? In my father's time, u I really wondered why he even took up this specialty because it wasn't a big problem at that time. People are dying due to typhoid and codera and malaria and all these infectious diseases.
Diabetes would have been low down. Let's fast forward until say from 1948 to 1971, the year I joined him. There was the first proper epidemological study done in India. So at that time in major cities like Mumbai, Chennai, Delhi and so on the prevalence of diabetes was 2%.
Which means in people above the age of 20 years of age 2% of urban India cities and 1% of rural India villages had diabetes as adults. Now that went on increasing slowly slowly slowly today it's in excess of 30% of all people living in the big cities. So it's about 30% of all adults. Now you may say 30% means till 70% don't have diabetes.
There is a catch there and the catch is that this is about 20 years of age. If you now go to about 50 years of age, 50% of people living in Chennai and Delhi have diabetes. Another 25 30% are pre-diabetes which means 80% of the population will stand on the road in Chennai anybody with a little gray hair above 50 years 80% of them will have either diabetes or pre-diab really scary. So in terms of actual numbers the ICMR indiab study which we did showed that there are 101 million people with diabetes in India and 136 million people with pre-diabetes. You add both these together it's 237 million. But if you these two were a country by itself, it'll be the sixth largest country in the world.
>> Wow. I never thought that's the scale of the problem. So between the age of 20 to 40, which is where I fall. So this concerns me a lot.
>> Is it independent of whether your parents have diabetes?
>> No, it's not. Because if you have a family history of diabetes, particularly if both parents have diabetes, then the chances of you getting diabetes is close to 100%. 99%. If it is one parent having diabetes then the chance comes down to about 50%. Or so. So it is really really huge and that's why we should care about the problem. The other reason why you should care about the problem is what do people die of.
>> So about 30 years ago majority of the deaths in India were due to infectious diseases. Today about 70% of all the deaths in India due to non-communicable diseases like diabetes, blood pressure, heart disease and some forms of cancer.
>> I do want to end this segment with one question. You ended your recent editorial with the phrase time to act is now.
>> Uh so in that context you said 1970s the rate was 2%. Currently it's 18%. If we fast forward 2045 paint me a picture of what we might be looking at if we don't address this right now.
>> It will get much worse than what it is now. For sure the obesity rates are going to go up because the way obesity is going up today it's quite frightening. the age at diagnosis of type two is going to come down and down and we're going to see a lot of children getting diabetes. Why we are worried about this is that they have to live longer. See if you get diabetes when you're 60 or 70 years old, how long are you planning for? Average lifespan of India 72 years. So even take it to 80, you're still talking about 10 15 years.
That's not enough to develop complications. You need about 20 years to develop complication. The younger it is the more aggressive it is. And then you already got it at 20. Now you're going to live even if you're 50 years old 30 years have already passed. So by 50 you can get blind kidney failure when a person is just peing you're already getting all these heart attacks amputation of legs something and all. So that way it is quite frightening.
Imagine giving all of them the care, the medicines, checkup every year and then all of them or even half of them or even quarter of them develop say kidney complication needing diialysis or transplant where are we going to go for kidneys to give all these people today we do about 10 to 15,000 transplants in a year we'll needing millions of kidneys to do so we just will not be able to manage so all this brings us I'm not painting a a kind of a very dreary or pessimistic view I'm saying that this is what can happen. But a lot of it is in our hands. If we start eating right food, the right amount, don't overeat, do regular exercise, sleep on time, we can definitely blunt the diabetes epidemic and even bring it down. Those who are in pre-diabetic stage now, they are the ones who are going to develop diabetes. They can become normal also.
>> So before we get into the why, cuz I find that part interesting. I want you to explain to me like a 12year-old what diabetes is. Cuz my father has pre-diabetes. I asked him yesterday, "What do you think is happening in your body?" And his answer was, "I don't know. I guess I just have a lot of sugar." So, I'm going to give you a piece of paper and a marker.
>> Okay.
>> And we're going to do a little bit drawing and you're going to tell me what exactly >> not drawing, but I still do.
>> Okay. So, we have this is the stomach.
That's the intestine. And this portion is what is called as the pancreas. So the main defect is here. This pancreas has beta cells. We call them as beta cells and they produce insulin.
Basically if you have diabetes this beta cells producing insulin there has to be a defect there and the amount of insulin has to go down. Without that you won't get diabetes. Of course there are other things happening. Now that's the liver and then you can have the muscle there. You can have fat. So in these places you can have resistance too. So that's called insulin resistance.
>> And what is insulin resistance? Like my body keeps releasing insulin.
>> So the insulin comes out. So in relation you eat more and the insulin is coming.
Now the insulin has to go to the liver and burn the sugar there or go to the muscle and burn the sugar there. There is a defect.
>> So here the insulin is there but it's not able to work. There's some obstruction there.
>> Yeah.
>> And this is easily correctable. Insulin resistance. You start exercising every day, cut down carbs, take a little bit more protein and you'll find that insulin resistance goes away. That is how reversal of diabetes occurs. It's like a balance. Okay. There are number of hormones which can increase the sugar and there are very few hormones which can decrease the sugar. That one hormone is called insulin. This insulin hormone is the only one which burns off the sugar, reduce the sugar. On this side to increase it, you got lot of hormones.
For example, you got cortisol. So cortisol is when you have stress, your cortisol level will go up and that's why your heart will beat faster, your sugar will go up, your BP will go up. So if you're able to reduce insulin resistance by walking, dieting, getting rid of excess fat, then your sugar will not uh go up at all. And you can also, of course, there's nothing to increase your insulin secretion. Unfortunately, when the beta cells are weak and insulin secretion is low, you have to live with it. And I'll give you a simple example.
Suppose in the bank you have only 10,000 rupees. You can't increase it. That's all you've got only 10,000 then you must cut your expenditure so that you live within that 10,000 rupees. If on the other hand whatever you keep spending somebody some godfather is giving you more and more money you have some machinery by which you spend two lakhs he'll give you three lakhs then you'll never find the need for money. Okay then you have unlimited resources there. You have only 10,000 rupees which is sometimes you're even born with this.
Even when you're born your insulin secretion is low. So you have to live your life accordingly. prevent obesity, prevent stress, prevent all the things which will produce insulin resistance.
>> Amazing. I just have one question. So just to put it simply, I eat my food, sugar is released.
>> Yeah.
>> Whenever sugar is released, insulin will come from the pancreas. Keep it under control. You eat gulab jamun or something, more insulin will come. Okay?
You eat only salads, less insulin is needed. So as long as this mechanism is intact, the insulin mechanism is intact.
Whatever you eat, the body can manage.
>> Got it? Okay. This makes a lot of sense.
Now I'm going to come to the why.
>> Yeah.
>> I spent a lot of time trying to research >> as to why we get what we get.
>> You have said a few things in your Kelly West paper. One, if for Indians, our beta cells declines a lot faster.
>> We also get diabetes a lot younger.
>> And there are different schools of thought, right? Some people are saying it's genetics. Our body is only at a disadvantage. Some people are saying it's the famine and British colonialism because of which our body thinks it's in starvation mode even now.
>> Uh some say it's just external factors.
what's going on because I can't get a >> so there are different views about this we call it as different theories there are much simpler reasons which I have raised in the Kelly West lecture see you have to have some kind of obesity to get diabetes to get insulin resistance and so on till 1960s we were importing food pl 480 scheme the US government was giving us food and the ships would come with wheat and actually in Chennai harbor it used to come and from here it used to be distributed all the food used to be distributed And I remember when I was in school headlines in the newspapers which said India has now good news we have food for two more weeks and then the next ship will come ah now we have for two more weeks. It's like this LPG shortage and thing we're talking about now the ship has to come through the state of homes for for us to say ah we got LPG now we got petrol now. So like that food itself was a problem.
Then in 1960s we realized we can't keep on buying food and you know depending on some country to give us food. That is when C. Subramanyam who was then the food and agriculture minister and Maswamin other the agriculture scientist they said we have to do something and that was the birth of the green revolution. But for the first time India had enough food. Then came a situation they had food but people were very poor because the government was very strict about foreign things coming in. I remember the time in 1970s and so on and it threw out all the foreign companies saying no no India must be self-sufficient. That didn't work. And so what happened was that India became bankrupt around 1990. And uh at that time uh the government then decided that we have to open up the economy and allow foreign investment to come in. This occurred in 1991. The moment we opened up the economy, foreign investment started flooding into India. So the country's economy started growing very rapidly from 1991. That was the real growth of the economy started in 1991.
So what happened was people had more money now. jobs paid better and because of that they started putting on weight because now what do they do? They'll buy a scooter or they'll buy a car. The man was walking and going all the time or going by bus now has a scooter. So his physical activity has come down. He could hardly eat two meals a day. Now he's got enough money to eat. So three square meals a day he's able to take and so with that there is more food, less exercise, obesity. So the moment you start getting obesity diabetes rates will go up. So when I wrote one of my research papers, one of the typical British uh people who still think that they're ruling us. So he was a reviewer.
So he said, "So what's your solution for uh India, you want us to come back, rule you again, make you poor again, and then your diabetes will go away. Is that the solution?" I said, "No, thank you. You don't have to come back. We will find our own solutions to that." People should realize that when you get money, you can get diseases along with it because of your exercise coming down.
You have to increase your exercise, eat healthy food and then we can stabilize our own diabetes. You don't have to make people poor. You can be rich and yet follow a lifestyle according to that.
That is the solution.
>> But then I think you know globalization happened everywhere, right? It happened in America, Europe. Diet worsened everywhere. Stress increased everywhere.
>> It feels like Indian bodies are made differently because of which we are hit the hardest.
>> Correct. That is true. Now it could come from the parents. It could also why is that South Asians and Indians have that little more. There are some peculiarities of our culture. One is marrying into the same family consanguinous marriages. For example, in Tamil Nad it was very very prevalent even now that you marry your cousins, you marry your own uncle that it's not so much in North India but in South India and Tamilad is very common. Now what happens when you have like that is if you have a gene for say diabetes. Now the mother gives the mother and the uncle have the gene. Now the uncle is marrying the niece and through that the gene gets multiplied. So the next generation the gene gets doubled.
>> If you keep doing this over generations you have a gene pool which is very very high. So that is one of the reasons why Indians are very badly affected when you put on weight or eat junk food and all that more than others. More recently some very exciting experiments were done which I've also mentioned in my Kelly West lecture. This actually came after I delivered the Kelly West lecture but I told the editor I want to include this because new information just after I delivered it this paper got published.
This from Glasgow. So what they did in Glasgow is they called South Asians and they called white Europeans and said we're going to overfeed you. Are you willing to undergo these experiments?
>> Sounds like a dream.
>> Yeah. You like that?
>> I'm getting paid to eat now. Of course.
So they overfed them excess calories.
Both the groups both put on weight.
Obviously when you eat more they both put on weight. But what they found was that when they measured where the fat and both fat went up total body fat when they measured where the fat was occurring I can draw it again. See if you take the abdominal wall.
Now the outer wall of the abdomen you know this wall what you can pinch that is called a subcutaneous because just below the skin this is skin subcutaneous most of the fat in the white people was in the subcutaneous region whereas in the Indians the fat went inside and that is called as visceral fat visceral means all the organs are there so this is subcutaneous fat and this is visceral fat so they're wondering why did this happen why the white people The subcutaneous fat is more and subcutaneous fat is not so bad. It's a visceral fat which leads to inflammation, diabetes or basically all that goes into the liver also. So the liver is here. So from the visceral fat once it goes in it'll go into the liver also. So liver fat also goes up. So they did further experiments. What they found was that in the white person the number of small fat cells it's called as adiposytes there were plenty.
>> Mhm. Whereas in the Indians it was so this is the white person whereas in the Indian they were only few of these all.
So this is the Indians or the South Asians. So they had only few. So what happens when you eat more?
These fat cells get filled up. Once they get filled up there's nowhere to go for the fat. So they enter into the abdomen.
In the white person they are able to get so many of these fat cells that they stayed there. Very little went into the visceral. If they don't enter then they won't go into the liver so it won't develop fatty liver and they found that there were genetic factors to explain.
So that's where the genes come in.
>> So since Indians by birth itself are having less of this very quickly they can develop diabetes and that is the price that we are paying now.
>> So a few questions one is this the reason why Indians have that Indian belly.
>> Yes >> this is the main it's a visceral fat >> because it's a visceral fat because if you have fat in the outer layer it won't come out. Mhm.
>> If it is coming out, that means there's a lot of fat there. That fat doesn't know what to go and that is why you get the belly.
>> Wow.
>> So, the belly is due to that.
>> I've often wondered why Indians have that body. And I don't know if there's a scientific reason, but I've noticed my dad's generation has it more than my granddad's generation. Is there a >> Yeah. Yeah. Because they were much thinner. They used to do much more physical activity. And you'll find your generation now having even more than your generation.
>> Exactly. And visceral fat is dangerous.
Why?
>> Because visceral fat is toxic. It has can produce inflammation. it'll go into the liver and stop there and start producing problems in the liver. So you get fatty liver. Whereas if it stays here, it's like wearing an extra coat.
>> So you don't get uh you know it just protects you. Whereas here it doesn't.
Of course over generations this may change due to epigenetic changes. If for the next 20 30 years we follow a strict lifestyle and so on then the pregnancy programming also will come down and next 20 30 years the diabetes rates will will level off. That's already happening in in the west. It's not yet happening yet.
>> So doctor, that does give me a bit of an insight about the why. Although the answer is complicated like you said in the beginning, but I think I'll end this segment with one question for you. As I've understood, we are genetically disadvantaged because we have lower beta cells. We have less amount of fat cells on our subcutaneous fat. We have just more tendency to have more carbs. Our ancestral diet was such if you were the health minister and you had to reverse this whole pandemic that is happening of diabetes and you could make three interventions for the next 50 years.
what would they be?
>> So if I had to do three things, the first thing would be to have a massive education program, awareness program.
People should know where they are today and if you leave it without doing anything, where you can reach and what are the consequences of that without frightening people, I think massive awareness like they did for HIV many years ago and they're able to contain that very well. That'll be the first thing. Second thing is to make healthy foods cheaper. We tell people, you know, you take more vegetables, you take fruit, have apple, all these things we tell them. But people not able to afford it. They're not able to buy an apple.
They're not able to, it's much easier for them to go into a fast food joint or a junk food thing and buy something for the whole family at half the cost rather than going and buying vegetables. If massive subsidies are given to farmers encouraging them to produce more green leafy vegetables, fruit, it should become so cheap like the milk revolution. One Dr. Korean was able to bring a white revolution and milk became so popular after Ramul and so on that everybody was able to get we need a vegetable revolution and a fruit revolution and increase the intake of protein particularly plant protein vegetable protein. In our studies we have shown that a 10% reduction in carbohydrate with a 10% increase in plant protein will go a long way. So a lot of whether it's Bengal gram, green gram, rajma, soya, curd, paneer, there are many things. So the value of this should be encouraged. Third is to have enough open spaces so that people can exercise. Today all the greenery is being cut off and then all the you know the pollution is increasing all over uh the countries not just in the cities but everywhere and pollution has been shown to be an independent cause of diabetes.
If simple simple thing like urban designing I know that Chandigar was built like that because they thought of building a a modern city a French architect did that and it was beautifully planned. Every new city which is coming up should be so beautifully planned so that lot of trees, lot of greenery and then make things which are healthy, cheap for the public and increase the awareness of people. That was what I would do if I was a health minister.
>> I wish you do become the health minister. Um and what's really struck me about your answer is all three interventions are non-medical.
>> N absolutely it's not take this tablet and you'll be cured and take this injection or vaccine and you'll be cured. No, it is simple. That is why it's so difficult. That is why the health minister alone will not be able to do. I think the agriculture minister, the environment minister, the sports minister, health minister, they all have to sit together and draw a plan. Even you know the industries minister to cut down pollution. All these have to go hand in hand. Just as a health minister, I can probably bring in more medical colleges or bring in more medicines, I won't be able to do all the others. How will I go and you know build better roads? I won't be able to do that. So everyone has to work together. That is why we call it as multis sectoral approach. Only through that we can actually prevent diabetes.
>> We almost need a cabinet for diabetes.
>> Yes. The whole thing. Yes. Absolutely.
>> Amazing. That's the most enriching insight I've had on diabetes and I couldn't find it online anywhere. So I think that's the difference between the knowledge that's available online or through AI and sitting in front of an expert who's seen it for the last 75 years.
>> Thank you. Thank you so much.
>> So doctor, we're going to do something fun.
>> Okay.
>> We're going to run through an entire day in the life of an Indian diabetic and you're going to make 28 decisions for that man. Everything from when he sleeps, what he eats, what footwear he wears, you're going to tell us. And this will give the audience a playbook for how to have a healthier life. Okay, let's begin. 6:00 a.m. this man wakes up. What's the first thing he should do?
Should he be measuring his fasting glucose?
>> I think first of all, you should get up before 6:00 a.m. That would be my first thing because uh if you live in a city like Chennai, uh 6:00 a.m. is a bit too late if you want to go for a walk. I get up at 5 5:15. Then by 5:30, 5:45 I can go. That's the best part of the day to go for a walk in a city like Chennai or Mumbai cuz it's much cooler then. So I always tell people your getting up time is determined when you go to bed early.
So when people ask me what routine I should follow, I'll say let's start at the previous night.
>> When should you get into bed? So if you get into bed by 10 10:30, you're good.
Then you can get up at 5 5:30 in the morning. You still get your 7 hours of sleep and then you're ready for a start.
So that's the first thing you should do.
And then u you can check your glucose level. You don't need to do it every day. Every diabetic patient need not do it. But um ideally if you are on a following a regular you can just check your sugar because you're going to go for a walk as well so that you don't get low sugar. Just check it get ready and then go for your walk. That would be the first thing I would do.
>> So they don't need to but it's good if you do it once.
>> At least once two or twice a week or something you can do it.
>> Got it. You spoke about sleeping the previous night.
>> 10 to 12 is what you've recommended somewhere. Yes, if you sleep later than that, tell me more about that.
>> So, chronobiology. So, we have an inbuilt clock in our body and we think the clock is only the time that we see.
The brain has a clock, the liver has a clock, our muscles have a clock, everything, every cell in our body has a clock. So, everything is programmed with hormones, with good hormones, bad hormones, all these things are there.
So, your melatonin level, the melatonin determines your sleep. That is also starts kicking in around 10 12. So you should get into bed by 10:00 10:30 and latest 11 even 12 is a bit late I would say before 11 you should get into bed that will help you to get up in the morning from then on your whole day will go well >> amazing what's the first drink they drink so this man has read about matey water jera water onion water chavan prash any benefits you've seen of these drinks >> matey is good because matey is the of all the things studied which people talk about matey has definitely a it it reduces insulin resistance improves improves insulin secretion. It has fiber so it blunts the glucose response after a meal. Enough studies have been done by National Institute of Nutrition showing that. So matey is well proven.
>> So all these detox drinks and diets >> more of hype. In fact the other day I heard something at a conference in Mumbai. I was there 2 days ago and they were saying that we talk about the liver to to detox the liver. What you should do? Liver's job is to detox. How can you detox or detox? You can't do that you know. So the liver is meant to detox.
Liver God made the liver for you to detox. So you don't have to give something extra for the liver to detox itself. You don't have to do that. If you just follow regular habits, it'll be through >> more. Wow.
>> In fact, they can do harm if you do overdo it.
>> Ah okay. So now the man goes for a walk.
>> Are there any special kind of shoes he should be?
>> Absolutely. So everybody has to wear proper shoes. But a diabetic patient, person with diabetes has to wear a shoe which is not very narrow because then it'll compress the leg. It should be roomy and then you should have an insole inside so that when you walk it takes off the pressure >> and then the sole also should be good so that it doesn't get worn out too easily.
So it should be roomy, not the kind of pointed kind of a thing. And then we always recommend that when you go to buy your shoe, don't buy it in the morning.
Buy your shoe in the evening because what happens is little bit of fluid accumulation occurs for everyone. Not like edema and that kind of fluid accumulation, but some little extra fluid will be there by evening time. So your leg swells up a little bit. You may not see it. That time you go and purchase your shoe, you'll your size will be correct for the rest of the day.
If you go in the early morning and buy your shoe when your the foot is not yet you know taken that extra water it may become evening by evening it become tight when you wear it. So that's a simple rule when you go to buy your so you wear the proper shoe or footwear and with that you can go for a walk >> that is so interesting the evening and morning thing I didn't know that uh pranayam should he do it is it worth the time >> 100%. Uh so taking my own case um I try to walk every day but sometimes it gets missed out. If I this 10:00 thing doesn't work for me. I come back late and it's 12:00 then sleep is also equally important. Now if I try to go at 5 then I'm my 7 hours or 6 hours of sleep I'm not getting. So that day what I'll do is I'll skip the walk but I never ever miss the pranayama cuz I think pranayyama is one of the greatest secrets given to us by our ancestors. It helps to not only take in more oxygen and thereby your blood gets purified, your lungs, your heart, your blood vessels, everything your blood gets purified. It's also a great relaxing to the mind. So when you take deep brea uh deep breathing when you do you completely relax yourself.
>> In fact you can do it yourself and see.
So when you are tensed it's the neck which becomes stiff. Yeah.
>> You'll find your neck is like that.
Moment you relax you're literally now I'm just relaxing now >> and everything has become relaxed my neck has become relaxed and with that your cortisol level comes down I mentioned epinephrine norepinephrine all those hormones come down and when that happens your insulin secretion is also improving in the brain when you do that your dopamine will increase your endorphins will increase the serotonin will increase all the good hormones in the brain which keep you happy they will all increase so they've done functional MRA studies to show before pranayyama after pranayyama the brain lights up in certain areas when you do pranayama. So pranayama is something which of course other yogic exercise also you can do which is good for your back and stress and everything else joints and so on but pranayyama is something very very special. I would recommend everybody to do it. Diabetes no diabetes it doesn't matter. Everyone watching this should do pranayama.
>> Amazing. Can they get pedicures? You can, but you must be careful because if you go to somebody who is not properly trained and they cut the nail too close, you can get bleeding there or an infection there and that's enough to set off a severe infection leading to gangrine. So you must be very careful when you cut your nails. You should cut it across. Don't try to trim it all around. Just cut it across and leave it like that. That's what we recommend. So better a sheropist or a podiatrist does it for you. they know how to do it properly or a trained uh podiatrist if they're able to do it's fine. Don't just go somewhere and just get a pedicure done because very often what they do they cut too deep and they can injure it and already the blood circulation is uh compromised. This can be the end of your leg because it can just lead to a infection gang and then you can lead to an amputation as well.
>> I've seen that first time actually with my grandmom that's she had cut her nails got a cut and that developed into a gang.
>> Um you mentioned pediatrist >> podiatry. So podiatry is the oropi they call it in different countries they call it differently these are people who are trained for the foot so they they are trained about the nails about the skin about doing minor procedures for example when you are diabetic and you walk with you know putting too much of you have neuropathy so you don't feel the feet the ground also so you keep too much of pressure you put on under your leg what happens is under the bones the the bones of the feet you'll develop thickening of the skin that's called as callus >> and that callus call us it can break down. So once it break down you get an ulcer and then it will go inside. So when you have this corn or a callus a trained podiatrist can slowly uh cut that and remove that extra thickness so that it doesn't break down.
>> So these are all things including the nails and in between the nails and preventing intergo the fungus infection between the nails. All these they're trained to do and they can also recommend the proper footwear. M >> they can give different they can take measurements and then see they can measure the pressure under the foot. We do that at our center and then prescribe the proper footwear.
>> That's amazing. So there's a whole leg care that needs speciality itself.
>> Wow. Okay. So the person comes back they're having their chai >> and now they're wondering what sweetener to use. The options are jaggery, stevia, monk fruit, brown sugar, honey.
>> Tell me.
>> I don't think all the five are actually good. I my personal choice would be to go without any sweetener.
>> Okay. because it's not as difficult as people think it is. Uh let me give you an example from my own life. When I was uh a child, I was taught my mother always gave me uh milk with sugar. And so I always thought milk is with sugar tastes better. My wife's side in her family, they've never had milk with sugar because they do have a family history and so maybe it's because that she's never had. So when he got married, she asked me, "You take milk with sugar?" I said, "Take milk without sugar." So she said, "Can you do me a favor? You know, can you take uh you know, milk without sugar?" I said, "It's difficult." She said, "Do it one week for me. You're newly married. You have to listen to your wife." So I did it and a week or 10 days later, I could not take milk with sugar. It'll taste like k or pisum or something, you know, it's too sweet. So after that, never in my life I've done that. All it took me is one week of going off sugar. So it's not very difficult to do without that. Now in a person with diabetes certainly no honey and jaggery and they're all very sweet contrary to what Ayurveda tells you they're very very sweet. So for a person with diabetes no >> stevia is okay but it has an after taste. Splenda or sucralose is one of the better uh ones because derived from sugar and it doesn't increase the sugar.
So of the ones we have done where we have tested and seen whether it increases sugar or changes your gut microbiota these ones don't the the Splenda doesn't. So Splenda is a great name. So it's called sucralose. So sucralose is the best. Stevia is also good. Comes from a plant but has a little bitter after taste. So if you really have to take one of these two is what I would recommend.
>> Amazing. So now he knows how to take his tea. Now he comes for breakfast.
>> Yeah.
>> Three options. Poha dosa. Which is the worst?
>> Poha and dosa. Well, I think they're all about the same because they're all carbs.
>> And uh if you see dosa, the sugar rise will be a little less because it has oil or ghee in it. And because of that, that blunts the glucose response. That is doesn't make it healthier though cuz now you added fat. Also, if you are putting a CGM and looking at it, you might find after the dosa, it doesn't go up that much because oil is blunting it. So many people say, "Oh, that's what you should do. You should take ghee with then your sugar won't go." That's where the CGM while it's useful, it's not without its own faults. It doesn't tell you it's healthy or not. It only tell you the glucose doesn't go up. Glucose is not the only thing in diabetes. Fat is also important. Calories are important. Many things are important.
>> Let's say I try to hack it cuz I'm one of those that you mentioned who wears a CGM and I track everything, right? So, I'm having my dosa. But then before that, let's say I have my chia seed that gives me fiber.
>> Will that help?
>> It'll help. And if you can add some protein also along with that, the chia gives you some fiber. But if you can add some protein along with it, let's say if you're a non-vegetarian, if you take egg, >> fantastic breakfast. That way you you'll feel full also. and the amount of carbs will automatically come down. If it's not that, you can have some salads along with it or you can have any other protein maybe chickpeas or something else along along with it to increase your protein intake or paneer or something like that.
>> Got it. What what do you have for breakfast?
>> I have um the first of all I have fruit >> because I need to have a fruit. First of all, I don't have diabetes. So that's the first thing I don't tell you. So I take fruit and then I have one egg.
>> Mhm.
>> Okay. Preferably I try to take it as egg white so the cholesterol part the yolk part is not there but even if it is not the one egg is not going to hurt so you can take that and then I have a small bowl of milk with lot of chia seeds pumpkin seeds and some nuts that's my breakfast every day >> amazing can diabetics have fruits >> they can have one fruit a day it depends on which fruit guava for example is a very good fruit with low GI apple can also be taken papaya can be taken orange can be taken. All other fruits are higher in carbohydrate. Better to avoid one fruit a day is okay for people with diabetes. If your sugar is very well controlled, you can go up to two fruits more and don't take it as fruit juice.
You should take it only as fruit, cut fruit.
>> Okay. So now this person goes to office, his friend tells him you should start taking ompjaro.
Tell me about those two words. You lit up cuz I'm sure your patients have asked you that question.
>> Oh yeah. all the time asking and just on March 21st of uh 2026 40 Indian companies have introduced this because it went off patent until then only the Mona was still not off patent but semantite went off wasn't went off patent so they are fantastic drugs they're very good for weight reduction they're very good for diabetes they're very good to reduce fatty liver so they have many benefits but it's reserved for certain types of people those who have weight to lose those who have fatty liver if they have a heart problem uh these are the kind kind of people who would benefit. If you're already one of those lean people with very little fat and insulin deficiency being the main thing, the GLP kind of drugs may not be the best one for you. So, you have to choose your patient carefully. You also have to tell them that this is a long haul. People think it's like for 2 months and then I lose 5 10 kilos and then I can get rid of it. No, the moment you get rid of it, it'll come back. So, as long as you take it only, it works.
So, you must tell them that they are expensive. Even the generic ones are not they're not so cheap. So you have to take them. Second is for a long run and it's for health benefits that you should take it not to get a better figure and so on.
>> And if I'm not a diabetic are there any major risks? Okay.
>> No, it is it is allowed for that is why in fact two brands Novo introduced is for diabetes and vigi is for non-diabetics. The dose is different.
It's the same medicine.
>> So in India also some companies have introduced one for diabetes, one for obesity. Both are the same. Both are semaglutide. But so it is approved for in India it's mostly approved for people with diabetes and obesity but internationally it's approved for treatment of obesity as well. It's also approved for fatty liver.
>> Oh wow.
>> Independently believe it or not this GLP group of drugs are supposed to reduce your cravings like crazy. So even in mice if you think in humans it is psychological and uh really doesn't.
Mice you give mice the GLP and then give them their favorite food they won't touch it. they'll go somewhere else.
They don't give the JP then they go and eat the thing. So it's for sure that somewhere in the brain that craving area it goes and does something to it. So you don't feel like snacking in between snacks come down, cravings come down.
There's a recent study which showed that even smoking and alcohol comes down >> with GLP1. Wow.
>> Recently published substance abuse. So both tobacco, smoking, alcohol and substance abuse all the three came down in people who are taking this. So somewhere in the craving area is going and doing something. So for that I'm not saying everybody should take this but it's one of the benefits of that.
>> Would you recommend it to someone who just wants to lose weight is not being able to do it but does not have diabetes >> if they've got sufficient weight to lose. Yes, I think it's a good idea but again with the with the provision or with the uh we're telling them that it's a long haul.
>> Yeah. Yeah. Makes sense. Okay. Okay. So paneer and protein right what what are can diabetics have or people in general whey protein why is it so uh I don't know people are just uncomfortable with the idea of supplementing protein if we know protein is so essential would you recommend a patient to have it if they're a vegetarian >> I would say from the food you try to get as much as possible if we look for protein in every meal I mentioned egg or its equivalent pro plant protein in the morning for lunch and dinner also see that you get some pulses see that you get a glass of milk and then you take curd. All this should give you enough uh protein. If you're protein deficient, if you have sarcopenia, if your muscles are weak, uh then you can give additional protein. And there are many types of protein that you can give. Those which are made from plant protein are the best. Whey protein comes from dairy. So therefore, it is not a bad idea to use it. I do use supplements when needed.
But majority of the time people are not taking it from food. So first we'll try to give it from food.
>> Is there a calculation? This is the amount of protein you should try to hit.
It's about8 g per kilogram of body weight. So that's what is recommended.
More than that we go 1 g per kg say 60 kg person taking 60 g of protein would be okay. But more than that 1.5 and all that become a bit too much and they won't be able to digest it. So that's the kind of formula that we follow.
>> Okay doctor I'm going to show you a picture of my dad's lunch plate. I want you to react to this and criticize it. I think it is um what is this thing?
>> This is loi.
>> That is protein or >> No, no, that's just Yeah.
>> So, one look at it tells me that there's too much of carbs and uh probably it's not balanced. It should have had more half of that plate should I'll draw it.
Yeah. So if I were to draw a thali, half of that plate should have been vegetables, green leafy vegetables, preferably of different different colors.
>> The more colors you have, the more of nutrients are coming in, carotenoids and iron and this and that. So half of it should be vegetables. So this is very low in calorie, very high in all vitamins, minerals, everything you can think of. And for green leafy vegetables, even B12 is taken. Even for vegetarians, you get that. Now think of the plate having another quarter there.
Here you must ask yourself what protein can I take and so for non-vegian very easy you can have fish chicken white of the egg or even whole egg and you can fill that for vegetarians you must compulsory fill that with any of the protein plant protein that you can think of it can be rajma it can be bengal gham green gram moong dal it can be you know paneer it can be any protein that soya very good so if you can fill that your protein needs are taken care Now you got the last quarter part only that should be for the carbohydrate. So that much rice you can put there. So automatically it'll come down or you have one chapati that's enough actually that's enough.
And then this will not increase your sugar. This will decrease your sugar because protein actually blunts the response. And then you can have some curd at the side which also gives you the gut microbi gives you a little protein also and so that you can have if you eat like that always think of the plate where are my vegetables and the order also the first one should be vegetables second should be protein and the carbs should be third. So if you eat in that order normally what we do is we fill the plate with carbs eat that and get more carbs more. This will not fill >> and it'll immediately spike your sugar.
So this is what you have to do. Once you do this, you'll find your sugars are very nicely controlled. One more thing which has become very popular nowadays is after the lunch or dinner or breakfast, walk for 10 minutes.
>> Yeah, >> it kind of blunts the blood sugar response. It really works very well.
>> Does ACD work? Apple cider vinegar after meals.
>> It's a hype again. So maybe it has some effect, but there not enough studies and it is just hype I think.
>> So we have the lunch sorted, we had the first meal sorted, we have the protein sorted. Now it's evening time.
>> Yeah.
>> And this person goes for a wedding.
>> Yeah.
>> And they want to drink alcohol.
>> Okay.
>> What how do they moderate alcohol? Can they drink? Are there specific types of alcohol that's preferred? What's happening there?
>> Ideally, no alcohol because this view that French uh for French people, red wine is good, Bordeaux and all that.
They're old theories. And maybe in France, red wine prepared in France for French people is good. But then the Mediterranean kind of a climate, the diet is very very healthy. They take a lot of olives, they take olive oil, they take lot of berries and vegetables and salad and all kinds of healthy stuff uh they eat. Um therefore we cannot extrapolate that to India and say okay you drink wine it's good for you and so on. All studies and subsequently even studies from abroad are showing the same thing. Any alcohol is bad for you.
There's no limit like any smoking is bad. Any alcohol is bad. So if at all you have to any smoking because there's no argument at all. Zero. Zero. No compromise. Nothing. Can you occasionally smoke? No.
>> It's like occasional poison. So it's not good. Alcohol is not in the same category as smoking. But it is still bad. Of course, beer. Although the alcohol is less, the quantity is more.
So if you multiply per grams for the bottle of beer and say one or two pegs of whiskey or brandy, you'll find the alcohol is actually the same. It's not that it's less in beer and then the beer belly.
>> So you'll get more of the beer belly and the calories added on. So if at all you're taking you take and then the wines when you take there are some wines which are very sweet. Avoid those wines and take wines which have less sugar content. You follow these principles it should be fine.
>> The market is flooded with sugar-free ice cream and sugar-free cakes and stuff like that. Should that be the way to indulge?
>> Sugar-free is definitely better than with sugar. But surprisingly the studies on ice cream have shown because of the fat. I mentioned the dosa with the oil and thing blunting your glucose response. Ice cream doesn't increase your glucose level. There's lot of calories. There's lot of fat. So the sugar gets diluted with all the fat. So typically after ice cream you won't find your sugar shooting up. As with an Indian sweet if you take sesh or gulab jamun or something else you'll find your sugar shooting up much more. Badam halva and so on. they go up very high. With ice cream, it doesn't go up that much.
In fact, there was a study from Howard which actually showed benefits of ice cream.
>> Wow.
>> And that became very popular and people you know even Howard was feeling a bit delicate to publish it but that's what they got. They published it. They published it. They published it and it created a lot of excitement in the oh ice cream is actually good for you uh and so on. So I think within limits anything is okay >> cuz when you tell people don't eat don't eat don't eat that craving increases. M.
So with ice cream, you're saying even if it's sugar-free or with sugar, the blunt taste, >> might as well enjoy the good one because you know if they without sugar, then they'll put in a lot of sweetness >> and the sweetness actually affect your gut microbiota. So either way, it is not going to be that healthy.
>> Got it. Okay. So the man comes back from the wedding and the daughter is sitting there. This is not inspired from real events, but it is. Um, and she says, "Dad, I watched David Sinclair, who's this longevity scientist, and he takes met Metformin for longevity.
>> I want you to be on Metformin and NAD Plus trips."
>> What would you say?
>> I would say no.
>> Why?
>> Because uh, you know, a lot of hype regarding these. Of course, Metformin is a very good drug. It's been there for 50 years, 60 years, and it's it's never gone off because every year some new benefits come. So, if you have diabetes, uh, you would be anywhere on Metformin.
So the question doesn't arise but taking metformin for longevity and increasing your lifespan and so on it's never really been proven. So similarly the metformin is also supposed to have some anti-cancer uh effect but when they did the trial for cancer where they added metformin along with it they didn't really it didn't really pan out. No harm done but it really didn't benefit. So taking metformin for indications which are not approved is not something which I would recommend. And similarly all the other things are a lot of hype. I think for increasing longevity simple basics of going to bed in time doing pranayyama reducing your stress if you have obesity reducing that lifestyle habits not smoking or drinking and also taking lot of protein the green leafy vegetables.
The best thing for increasing longevity is social interaction. That's been the biggest killer is not even smoking around, not having friends and living an isolated life, living alone with no contact. That is the number one cause of death. So if that you have social interaction, you laugh and you are with grandchildren or you have a pet or something like that. That's one of the greatest things shown to improve longevity.
>> We must say that to Brian Johnson.
>> Yeah.
>> What's your take on Brian Johnson?
>> Uh Brian Johnson, I'm not >> He's a YouTube longevity hacker. He tracks every metric that he has in his body. He's trying to maximize it and he wants to live up to 150 years old.
Well, I'm not sure whether see I remember one another person I don't want you want to tell his name but he had sent when he was 40 years old that when he's 80 he will look exactly as he was with 40 when he was 40 >> and then I've seen his picture at 40 and 80 and he really looks old and all his life he had been one of the big gurus who you know used to talk about this you see me at 80 I'll be like 40 it was nowhere like 40 so I think there are certain things which are biological which we cannot change and it's good to live a long life but getting over hooked onto that I'll measure my sleep I'll measure my steps I'll measure my thing I'll measure my calories I'll measure this I'll measure that all the time you'll be measuring only that'll add to more stress and probably you'll end up being worse than what you all our forefathers when they had happy lives and they lived quite long many of them lived quite long they didn't have anything to measure and still they did it I think it's back to the basics what our forefathers did and there are many things which are out of our control stress and pollution And these are the main killers. If you focus on those, it's good. Of course, it's good to measure something. My Apple Watch will tell me whether I've done my 7,000 steps or 10,000 steps. If if I've not done it, it'll remind me. If I've been sitting too long, it'll tell me it's time to stand. Certain things are good. I'm not saying no. But you shouldn't get oversold on those and then only depend on that. Without that, you cannot live now. You shouldn't get into that.
>> Anything exciting in the horizon about diabetes? Cuz I don't know if this was just fake news, but I read something about Germany developing some treatment to reverse >> China. A couple of reports came saying that stem cells if you inject stem cells they'll get converted into beta cells and that's what type one diabetes but they always talk about one case one case it did one swallow doesn't make a sum up so I always say let them do it for 500 people then we will believe it and then with one case they don't tell you what happened to that case after one year >> they would have gone back on insulin they won't tell you that so these initial excitement is good it shows that there's some progress being made but it's too much of hype to tell somebody that from tomorrow you won't need insulin to a type one patient they'll probably stop their insulin and they'll probably die before that. So, I think you should take these. We want science to progress. 100 years ago, we didn't even have insulin. Children died within weeks of being diagnosed. Today, they're able to live up to 90 years of age thanks to insulin. So, every development is good, but they should be done scientifically, evaluated, scientifically, published, accepted by all bodies, all guidelines. Then you should prescribe them.
>> And now the person finally ends their day. But I know a lot of diabetes patients go to bed thinking diabetes is a death sentence. Their lives are going to be shorter. In your experience, what do you have to say for that?
>> It used to be like that because we did not control diabetes well. We didn't understand it properly. So in my father's time when he started his practice, somebody living up to 60 years of age was unusual. So Shashit Taborti if you're celebrating as a person with diabetes was considered a very rare phenomenon. I don't think he saw people who lived too long in his lifetime. But today with all the improvements that we have with better control of diabetes um I started giving medals to those who finished 60 years of diabetes 6 years of diabetes this is a type ones >> of being diagnosed as a >> 60 having lived with diabetes for 60 70 years after being diagnosed >> they've already lived 60 years 70 years and don't have complications eye is okay kidney is okay I started giving medals and I've given lot of medals to such people so and then I found people have crossed 90, 95, even 100 years of age and they are doing well. So my father used to say that a person who's very well controlled and having diabetes is better off than a non-diabetic person.
And I used to make fun of him and say, "Oh, this is all platform talk. You're just trying to make people feel good."
It's not correct. Actually, he was right. And a well-controlled diabetic actually goes for the checkup controls not only the diabetes but blood pressure cholesterol diet discipline goes off alcohol or reduces it no smoking goes for regular checkup. So if you detect something else a cholesterol level or liver abnormality or something they take treatment for that. If they go every 3 months and have their checkup they can actually live a long and healthy life even better than a person without diabetes.
>> Wow that's very interesting. That's a switch in perspective that people need.
And that was that. That was one day with a diabetic patient making decisions for him. I'm sure the decisions you guided us on will help anyone watching this video on how to manage diabetes better.
>> Dr. Mon, are you ready for some rapid fire questions? Yes, I am.
>> Do you believe in miracles?
>> Absolutely.
>> Tell me one patient case that was a miracle.
>> So, we had this uh patient who was diagnosed to have breast cancer and uh she came for surgery at my place and Baba sent vibui for her. So initially she said oh I don't need surgery because Baba has said uh it's vibui ascent. So I said no no no baba didn't say not to have the surgery you still need surgery.
Surgeon did the surgery sent the specimen for biopsy and it came as non-malignant. So he thought he missed it. So he went and took the specimen himself to the lab sat with it and every section of it they searched and they could not find any malignancy. So Baba has told many people cancel your cancer.
So this is not the only case. A friend of mine with multiple sclerosis, a condition which you don't live for long.
It's been years and years and years.
I've heard Baba tell him I've already cured you. So you don't have to bother about doesn't even go for checkup. Been now 20 years, 30 years complete cure. So I've seen this happen. Science cannot explain it. That's what we call as miracles.
>> That's beautiful. Do you believe in the afterlife?
>> Yes, I do because I did not believe in it earlier, but after my wife's death, she has reached out to me in many ways.
If you have read autobiography of yogi where he did not meet his guru uh when he died. So one day he sits in his room and he says master I just want to see you once more. I know you're gone. I know your body is burnt but I want to see you. And he intensely prays and through the window a light comes and suddenly the master comes in front of him and he said master it's you. Is it really you? He says touch me and see it's me. And he touches him and he says, "Master, it's you." He said, "What happened? Your body was burnt." He said, "Yes, my body is burnt, but I could put my body back because of the intense yearning." And then he says, "Master, can you tell me what happened after you left cuz you left your body and gone?"
And he describes and he says, "Certain things which I describe, you can tell people. Certain things are for you. You cannot tell the world." So he describes what the guru told him as afterlife. And it's something spectacular. It's something very peaceful. It's something amazing.
>> That's amazing. So what's that one message you have for your critics who say you can't be a man of science and a man of faith at the same time.
>> I've learned that again from Baba. Baba says you be a scientist. There is lot of science but at some point science ends.
That's all you can find out about science. Beyond that is divinity. That's when God starts. Beyond that point it's you know science no human being can understand because our brain is too small. We cannot understand it. That's where divinity starts. If you look at it, I was reading the other day that the earth is so positioned in the sun uh with relation to the sun and the moon that one degree if it shifts closer to the sun just one degree the temperature of the earth will go to some 100° centigrade or something and life would be impossible. If it went the other way one degree this side then the whole earth will freeze and it'll become -50 -00 all over the world. Who's keeping it like that? There must be somebody who's controlling that. That is where divinity comes in. So whatever scientist I am, I cannot explain how the earth is remained like that for millions and billions of years without going this way, that way.
There must be a controller. That controller is uh divine. That is the divine force that you're talking about.
>> It's refreshing to hear you admit it cuz I don't see a lot of scientists admitting their faith even though they are people of faith. So uh that's really refreshing. I think that goes back to your book where you said you're going to be proud about the fact that you're a man of faith and you're going to talk about it.
>> I don't feel ashamed at all. Some people say that only very weak people they need a god to. I don't think so at all. I I look at another way. When the whole earth is shaking and you need something to hold on to. If you're an atheist, you don't have anything to hold on to. For people like me who have faith, you can hold on to something. Maybe right, maybe wrong. We don't know. But we have got something to hold on to. And that's enough for >> that's beautiful. I think my last question on this thread would be what still motivates you? You're so active.
You're still reading all research papers. Your eyes light up when you talk about your research. What still motivates you every day to keep going?
Cuz in the traditional sense, you've seen success in every way possible. I think it's an inbuilt passion and uh it's a fire in the belly and that fire was lit when I was a teenager and somehow that fire I think I must be grateful to God for not putting out that fire because there are many people who of my age my classmates and others who have just called it a day and they say enough is enough now let me do other things for me I do other things but uh this is very important for me it keeps my mind active new things to do every day and setting the bar higher and higher. That is what drives me. I love challenges and therefore uh it's a wonderful life and given my life if I have to relive my life I'll do the same thing always.
>> That is amazing. Thank you Dr. Muan.
Thank you. Thank you so much.
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