Weight-loss : When your body refuse to cooperate

1:49 PM

Sorry, I have been a bit quiet on the blog, even though my daughter went back to school. The truth is that I found myself quite busy tackling a very sensitive matter :

My weight. 

Some of you may already know the fact I have been insulin resistant and a PCOS sufferer for years. You may or may not know that despite my leading a fairly active lifestyle and watching what I eat I still struggle to loose weight.

What you definitely not know because it is kind of news, is that my insulin resistance, while still being controlled in itself has cause me to develop Non Alcoholic Fatty Liver disease (often called NASH disease).
I would not even have known about it if it weren't for a severe UTI infection that felt like Kidney stone (but wasn't) didn't lend me in the emergency room on July 1st.

Tons of pain killers in an IV and an abdominal scan later, we found out there was no stones, just a super inflamed bladder and as an ad-on : A grade 2 fatty liver. Wha-aat???

This prompted me to go see my regular doctor (who is a diabetologist) to check if my Insulin resistance problem was not getting out of control (fatty liver and insulin resistance go hand in hand in the long term).

The good new is that my Insulin resistance is still under control, there are no signs of it turning into full blown diabetes (relief).
The bad new is obviously that my liver is not working how it is supposed to work and my Triglyceride levels have shot up (thankfully the good and bad cholesterol are still within normal).

This prompted my doctor to suggest the medical weight-loss management programme in the hospital to really find out HOW I could loose weight.

When you are dealing with Insulin resistance and a fatty liver, weight-loss can be a real challenge, enlist all the fitness help you can.

As I said, I lead a fairly active lifestyle and I really don't eat much junk food or even refined carbs. My diet is high in fiber and proteins in the form of fresh fruits and veggies and lean meat.
Basically the way I lead my life is by far not unhealthy, and yet I managed to gain weight in the past year. Forget the fact all my best attempt at loosing any weight in the past 7-8 years have gone nowhere.

But now with what is labelled metabolic syndrome, we really can't just ignore it anymore.

So, I went for my weight-loss assessment. I saw my regular doctor, a dietetician, a cardio-rehab doctor and a psychologist.

In two hours I found out that I am perfectly well on the psychological level, that my diet is exemplary and that I have the stamina of an endurance athlete.

The problem with my attempt to loose weight was not in what I eat, or how active I am. But HOW my body dealt with my being active.
Basically I could walk all day long over long distances at a brisk pace and my body would still not burn much calories or fat from it. Simply because my heart is not getting the cardio workout it is supposed to get when you walk at a pace of 1 kilometre per 10-11 minutes. My heart rate does not elevate high enough doing so.
The catch, is because of a congenital bad knee problem and high arched feet, high impact activities like running aren't really recommended either.

To have a shot at loosing the 15kg I need to loose, I need to step up, and vary my workout regimen very often as my body adapt quickly to a change.

I have been told to keep my heart rate above 120 beat a minute, but closer to 130 during my workout. A challenge in itself since my resting rate is at about 53 beat per minutes and can sink below 50 while I sleep.

This bit of news came as no surprise, I just was relieved that I was incredibly fit cardio-wise and to be told I am one of those who are very energy efficient when they work out.
It's great, because it proves once and for all that I am indeed FIT, but it also kind of sucks because it will make my tackling my metabolic issues that much harder.

You'd think I would have also noticed my really getting "fat" too? WRONG!

I still have my hour glass figure, and most people, including myself, would make the assessment that I am just a little bit overweight. Even my BMI would agree to that statement.
Sadly, it isn't what the Body Mass Analysing machine said, I may have the BMI of an overweight person, but the total fat analysis and the percentage of visceral fat (deep tummy fat) places me in the OBESE category.
And all I did was gain 1 or 2 pants size at the most. Heck some of my pre-baby clothes of when I was 10kg lighter still fit!

This is sadly what happens when you are insulin resistant, the fat is the vicious type that is deep inside and not on the surface. It invaded the tummy area, creeps into the liver with no tell tale signs for you or the world to see, and bam, before you know it, a machine labels you as obese.

It doesn't feel that great, and it is kind of frustrating, especially when your body itself doesn't seem to want to loose that sinister fat unless you run all day long and eat almost nothing.

But hey! Now I have a plan I can work with

This medical weight-loss assessment has been an eye opener and a relief. A relief that thank god! I am already a healthy person. And that all I need to do is constantly push my body out of its comfort zone. 

As crazy as it is, this is something I can work with!

This is something far more useful than: Don't be sedentary and stay off junk food. 

One of the workout the cardio rehab guy recommended was swimming. And, because I have no Swimming pool in my complex, I turned to my trusted and super awesome friends. 

We are a close group of ladies, all expats, all married to Indians, all living in the same neighbourhood. We support each other, share tips and laugh. The best tribe a lady can get. 
Needless to say that minutes after I announced my predicament and the need to find a swimming pool and swimming buddy. My gang stepped up to the plate. 

I now not only have a bunch of swimming buddies, I also have a yoga group, and have been equipped with a Fitbit Charge HR. One of my friend was still holidaying in Europe at the time and she offered to bring it back for me, as the price in Europe is almost half the price it is sold at in India. 

I love my Fitbit! 

Not only does it count my daily steps (which are above 10k a day, always), it also help me see when I need to step up and increase my pace to be in the cardio range the doctor set for me. As a bonus, it even let me see how bad my insomnia can get, and how peaceful or not my sleep is. This is something I can monitor and bring up to my next doctor appointment.

I still walk, a lot

Just because walking is not the most energy consuming workout my body can get into doesn't mean I have to quit doing it. It's probably what helped me keep my weight remotely into "check" all these years (I wasn't loosing any, but I wasn't gaining much of it).
I walk close to 5km a day between home and Ishita's school (after I dropped her and before picking her up). With the Fitbit, I can track my pace and check in real time how high my heart rate is. It is really helping me as I can really push it on long stretch of safe uncrowded footpath or on hill segments. 

I have my support team

As I said, I have an amazing bunch of ladies to support me, and that makes a big difference. It might sound silly, but going in with a bunch of friend helps you going, and keeps you accountable. It's easier to give yourself excuse not to workout, or go swimming or head out for a walk when you are doing it alone. 
With a workout buddy, not so much, it's harder to let a friend who is willing to tag along down. On a bad day, that can make a world of difference.

If your body is against you when it comes to weight-loss, these are the things you should do : 

1) Seek medical help. There might be a reason why you can't loose weight, and no, it is not that you are lazy, and have a crappy lifestyle. You could be doing everything right and still not loose more than a kilo or two.
We live in a fat shaming society that have amazingly bought into this ridiculous "One size fits all" mentality that leads them to believe that the only reason one has for being fat is to eat junk food and sit on the sofa all day. Don't fall for it, it's bullshit!

2) Have a realistic plan. Forget the deadline to loose weight, focus on the target weight and getting into a routine that works for you, and your body.
My target is to loose 15 kg at the most, but there is no date at which I should loose it. With my doctor we worked it out that I should start seeing tangible results in 3 months time, but not have lost all the weight. 
Fitness wise, we worked with what I can do rather than get into sports and activities that aren't going to work for me. I can't do high impact activities, so running was never suggested. 

3) Eat well. And by eating well, I mean something you have worked out with your dietetitian, not the "stay away from junk food" plan most books and magazines talk about. Because if it was that simple...DUH! I would not be where I am today. 
You may need a diet that is tailored for your condition, and your lifestyle. You may also find out that you need more frequent but smaller meals in your plan. The whole 3 meals 2 snacks do not work with all metabolism. 

4) Don't be harsh on yourself. Yes, you are fat, but guess what? It's not the end of the world, and at least you are doing something about it! Give the finger to anybody that dares bringing you down for it. Society at large has no freaking bloody idea what it is like to have a MEDICAL CONDITION that makes it hard to loose weight. So the least you can do is be at peace with yourself, stress and self loathing doesn't get anybody anywhere

5) Have a support team into place. It's harder to quit if you have friends going in with you, don't feel ashamed to tell those you love about your struggles with weight and let them in on your weight-loss plan. 
On a psychological level, it will even keep you sane and help with your self-esteem.

6) Work with technology. Apps and electronic gadgets can be a tremendous help. First because they can't really lie and what you see is mostly what you get, give or take a few calories and steps. 
Before using Fitbit, I used the Cardio trainer app on my android phone. While it only really worked on the GPS while working out outdoors, it already gave me a solid idea about my activity levels. I have been using this app for years, and I still use it to log workouts where Fitbit doesn't work (while swimming).
Fitbit and other fitness bands are great to count your steps all day long, not just the ones you take during a cardio workout. I guarantee you that you'll feel great about yourself passing the 10k steps a day realising a lot of them can be taken while you go on about your daily life. Plus, it can help you see where you need to put a bit more effort into. 

Like with friends, an app or a fitness band can help you feel accountable and prevent you from giving up too easily. 

Since formally starting the weight loss program 3 weeks ago, I already lost a little over a kg of weight. It may not seem like a lot, but I am in this for the long run. 

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  1. I was reading a study about PCOS & insulin resistance and it is now estimated that 20% of obese women suffer PCOS & insulin resistance.

    I'm surprised your medical team didn't advise you to do weight bearing exercise. Usually with persons who have difficulty losing weight they recommend building muscle mass through weight lifting. Muscle burns more calories than any other type of tissue so the more muscle mass you have the more calories you'll burn no matter what you do- even resting. It doesn't have to be heavy duty Olympic type weight lifting, I used to do a program called "Super-slow weight training" and found it very effective. https://en.wikipedia.org/wiki/Super_Slow

    1. I am working on the muscle mass :-) I think they didn't advise it because my existing muscle mass is already quite good to begin with. Let's see what they say in a couple of weeks though.
      One of my friend is a yoga instructor and I take classes with her now. It should also help building more muscle as her yoga is far more muscle challenging than the yoga I was used to in Switzerland.

      PCOS has been a life long problem for me, I am certain about it. Because I never had a single regular period in my teen years and well into my adult life until my OB put me on metformin when I was trying to conceive. Whenever I brought the fact I was barely getting 2 periods a year when I was 18 my Gynec's reply was "Too soon to worry about that, we'll talk again when you plan on having babies"

      I was underweight most of my childhood, as in 3rd percentile underweight, I started filling up during puberty, it was so gradual that nobody really worried about it, I think I finally hit the average 50th percentile when I was 15, and from then very slowly continued climbing up the chart.
      I really only realised I was indeed fattening up 2-3 years after moving to India, the fact we were eating a traditional Indian diet of mostly carbs didn't help much, but it was fresh food, home cooked, and the portions were normal portions.

      I think a lot of OB-GYN do not take PCOS as seriously as they should past the reproductive woes. After I gave birth to Ishita and no longer breastfeeding (because I dried up at 6 weeks) I asked about metformin since I knew I was insulin resistant and PCOS. Her reply : "Unless you plan on having another baby, don't go back on it" I went 9 months believing her and her claims all I needed was to excercise and eat healthy. I gained 6 kg with that logic!

      I ended up going to an endocrinologist who was outraged at the fact I have been taken off it in the first place. She put me through a glucose test to check how bad it was. I failed that test placing me in the pre-diabetic range. So back on metformin I was, and the weight went down a little, not much, but it did.

      This time my current Dr, increased the metformin to 3 doses a day instead of 2 to help, as my sugar levels while still well within range are on the higher end of the spectrum, especially the fasting one.

    2. I think most OB-GYN's don't want to deal with PCOS because 1) not that much is still known about and 2) they really don't know how to deal with endocrine problems. PCOS overlaps both specialties and what the actual mechanism is that causes the insulin resistance.)

      Increasing muscle mass also improves insulin resistance and glucose regulation. Even if your muscle mass is already 'good' attain and maintain more to get your muscle mass to fat ratio higher- that's the only thing that helps me lose weight. I don't have PCOS but my mom was insulin dependent diabetic so I cut most sugar and simple carbs out of my diet long ago.

      Don't tell Apple but my mom decided to go the 'all natural' route when she was pre diabetic and followed the advice of some health guru for 3 yrs. She ended up insulin dependent anyway, partially blind, and with neuropathy so bad in her feet she no longer had sensation in them. All this was irreversible damage that could have been prevented. That's why diabetes isn't something you should mess around with. As with any serious health problem it's best to educate yourself as much as possible about it so you don't fall victim to the preposterous claims of some magical cure. And we live in the 'information age' thanks to the internet so there's no excuse not to educate yourself and do your own research!

    3. Oops! That what get for trying to comment while cooking dinner & playing a Scrabble tournament. This should read-
      (PCOS overlaps both specialties and what the actual mechanism is that causes the insulin resistance in unknown.)

    4. Oh I totally think insulin resistance and diabetes CANNOT be treated the natural way, that some herbs and spices have the ability to help controlling the blood sugar, yes, but not if taking them with no other medicine.

      Right now I have 42% of fat to decrease, that is quite a lot packed in a body that doesn't look super mega fat :-) Working on the muscle is definitely something I am working on too. Right now I just need this stupid metabolism to just wake up a little :-)

      From what I read the link between PCOS and Insulin resistance is unclear, experts are not sure if the PCOS triggers insulin resistance, or if it could be the Insulin resistance influencing other hormones and leading to PCOS.
      Still you'd think a doctor who hears one of their patient is insulin resistant along with having PCOS would not say something as stupid as "Don't go back on metformin unless you want to try having a baby again".

  2. Anonymous5:19 PM

    I think we assume that athletic people do not fall prey to lifestyle diseases like diabetic and blood pressure. A famous case is Pakistani fast bowler Wasim Akram who was a diabetic. He must have been the last person to have diabetics. Being a sportsman his diet was definitely different from common people. But, he had and, took insulin injections before every match. Diet and lifestyle may enhance the process but it happens.

    Increasing weight is definitely and issue with these conditions, so the doctors continue to monitor weight of the patient. Another important aspect is any kind of infection which makes sugar level shoot up, especially the UT infection in women and ofcourse injuries, cuts, bruises. I had the experience with the mother. I think these are things which are to be watched.

    I think that you should try some desi remedies also, like drinking meethi water on empty stomach or the powder of jamun. I know, many people don't believe it in it but what the heck, it does no harm. My theory is when diabetics strikes it is difficult to control. It is the pre diabetic stage, which serves as a window. Here, you can experiment with diets, home remedies, yoga to keep things steady. I have seen the effects of diabetic and I perhaps too am vulnerable to it. No offence meant, I sound like a doctor, don't I? Who am I to advice you?


    1. Actually there is harm in going the natural route without a doctor advice. Pre-diabetes needs to be treated with medication just the same. Trust me, I have been off meds for a while because my OB-GYN thought Insulin resistance could be controlled with diet and excercise alone. And yes, there are many natural "remedies" that are said to lower blood sugar.

      The problem? Diabetes is actually NOT a lifestyle disease, it is a metabolic disorder that CAN be aggravated by poor lifestyle choices, but can also exist in super healthy individuals.
      This is the main misconception about it, pre-diabetes, or Insulin resistance as it is called is a medical condition in which the body's cells do not respond well to insulin and it causes the body to have to produce more insulin to tackle the sugar in the blood.
      If not treated under medical care, it puts a strain on the pancreas and it could lead to insulin dependant diabetes.

      Being overweight and sedentary definitely would put one at risk, but it's not the only thing at play.

      In my case, PCOS is at play and the link between PCOS and Insulin resistance is something that is still a mystery in the medical community, and something that probably has a lot more hereditary factors at play than one would care about.

      Diabetes do run in my family, along with hormonal imbalances, no need to look very far to see where it comes from in my case.

    2. Anonymous11:45 PM

      Yes I know diabetes is a metabolic disease. It could not be cured neither naturally nor otherwise. That I know of this creature. Frankly the medicine route is not very encouraging too. My mom had ten medicines ranging three for sugar alone including the infamous metformin.

      Then if the sugar spilled these was big strip of medicine called jalra which looked more like a rocket launcher. Then of course there were insulin shots.

      I felt that there must be some better way to deal with this problem rather than pumping medicine.

      I always thought that there is something fundamentally wrong with the way we are told to approach diabetes. The diet, the medicine nothing is quite patient friendly as if the patient has nothing better to than monitor sugar levels.

      On top of it no sugar, no salt either because one plus one free diabetes with blood pressure.

      I never meant that one should go the natural way totally. But one can use these methods to supplement so that body has time to revive Itself without depending on medicines all the time especially in the intervening period when it is most vulnerable. There are such periods in a day when sugar levels rise or fall sharply. More like stimulating body's own mechanism naturally.


    3. Frankly, the only way to ensure a steady blood sugar is to forget the whole 3 meals 2 snack pattern.
      My current diet plan, which has been reviewed by the dietetitian never has me without food for more than 1.5 or 2 hours max.
      I used to have the typical Insulin resistance craving in the past (distant past) before I moved to that eating format. I take Metformin as well, and have no problem with it.

      Diabetes is a disease that pretty much was a death sentence before medical treatment was discovered to manage it. There is a reason why the guys who discovered Insulin injection as a treatment won a Nobel prize for it.

      I think the main problem with diabetes and Insulin resistance is that it requires the patient to be 100% committed to a healthy lifestyle and medical treatment. It's not easy to accept, it's hard not to cheat but it has to be done.

      BP can be kept down with diet and regular excersise. You want to keep the heart strong and healthy with metabolic disorders such as diabetes and IR. Not that you should not keep it healthy otherwise. But trust me, even with elevated Triglyceride levels, Isulin resistance, grade 2 fatty liver, and a very high percentage of visceral fat my heart is the heart of an endurance athlete and my BP is absolutely normal.

      That's because I have always been active, from childhood until now. Sometimes more active than others, true, but active nonetheless.
      In Switzerland I once upon a time was a Synchronized Swimmer at competition level. I also used to go cycling regularly, walked as much as I could instead of taking the car, roller skated by the lake side in the Summer. Skied in the Winter, and went on mountain hikes regularly when there was no snow.

      In India I kept that habit of walking as much as I could everywhere. I only take Autos when I have to and I don't drive a car or even a scooty. I refuse to have a scooty in fact. :-)
      I just invested in a very high quality pair of sports shoes with excellent arch support and cushioning for my feet instead, and I use them daily :-)

    4. Apple,
      "The diet, the medicine nothing is quite patient friendly as if the patient has nothing better to than monitor sugar levels. "

      That should tell you that the way doctors treat diabetes in India is not very effective. Indian doctors rarely educate their patients about their diseases or how the treatments work. The patient needs to understand their disease in order to manage it properly. Ideally the patient should be monitoring their blood sugar in order to dose their insulin properly or to determine if the oral medications are working properly.

      "On top of it no sugar, no salt either because one plus one free diabetes with blood pressure."

      See, this just tells me you've not been educated about diabetes. I've often heard Indian doctors tell their diabetic patients not to eat sugar but fail to tell them to not eat simple carbohydrates like white rice, potatoes and even jaggery which are just as bad as eating sugar.

      High blood pressure does not always accompany diabetes. Low salt diets are not recommended for all diabetics.
      You are confusing diabetes with "metabolic syndrome" of which hypertension/high blood pressure as well as elevated glucose levels and type 2 diabetes is a part.

      There are different types of diabetes that require different treatments.

      "I felt that there must be some better way to deal with this problem rather than pumping medicine."

      I wish there were some 'cure'. That's what my mom was looking for by following that health guru. The medicines are trying to supplement or augment the insulin that is lacking for the patient to metabolize sugar/carbohydrates properly. All we can do is manage diabetes, not cure it.

      The human body suffers greatly when glucose levels go extremely high or low, that's why diabetics that aren't managed properly go blind, lose sensation in their extremities/neuropathy, develop kidney problems, gastroparesis, and other complications. The earlier the glucose levels are normalized the less likely these complications will develop- there is no time for the body to revive itself in diabetes.

    5. Yes Bibi, this is something that has baffled me for years in India. How diabetes management apparently just equals cutting sugar out with no worry about the carbohydrate bomb that a traditional India meal is.

      The first thing I did learning I had insulin resistance was cut out the carbs to a maximum ad replacing them by fiber high low glycemic index alternatives and keep the complex carb to about 1/4 of the meal.
      I have seen and hear about too many Indian diabetics who go on about eating their "aloo-roti-chawal" trilogy as if nothing happens. They believe starting the day with a bowl of Ragi will solve their woes and that all they really need is cut on the sweets and remove the sugar from their chai.

      What doesn't seem to sink in either is that even complex carbs should not be overdone, brown bread is not the magical solution to anything and "diabetic atta" is not the miracle cure.

      Even my dietetitian agrees that the first step in managing Insulin resistance is to ensure that not too much glucose hits the blood stream all at once and that in order to manage this you need to control what comes in and how fast the body process this food into glucose. Rice, potato, and white starches are the first thing that should be STRONGLY restricted as the body can metabolise these into glucose almost as fast as sugar.

      She also advised to keep complex carbs such as whole grain bread, roti, and cereals to a MINIMUM, they go in less fast in the blood stream, but they are also essentially empty fillers, you get more nutrients and balanced amount of sugar and fiber from fruits and vegetables.
      A serving of grain is either one small cup of cooked brown rice, or barley or one chapati, 2 at the most. The serving of dal should be bigger than the small typical bowl served in an Indian diet.

      In the end, she also said that forbidding a food is a bad idea, it's not like "do not ever eat pasta" or "Cake is off limit". It's more of a "Those food are treats to have occasionally as part of a healthy diet plan". Banning a food only makes one want it more and fall into a trap of compensation and/or excess.

    6. Anonymous6:22 PM

      I do not agree that Indian doctors do not tell their patients about avoding potatoes. This the first advice given, even before the prescription is written. "Avoid potatoes at all cost". Those who do are doing it out of habit as you say cheating on their diet.

      In fact, even a layman who has very little idea about the disease knows that potato is the number one enermy of diatetics. Earlier, all root vegetables were banned, now I hear that there are two opinions about it due to research.

      Yes, there is a consensus that you have cut back on sweets in all forms, at least that is how it is understood. Indian doctors are not very keen on diet. They are very good in explaining the medicines. You have to coax them about the diet. They do advice as you say, eat a little bit of everything.

      Diabetics is more of a mental disease. Practically lots of things are out of bounds for the patient which causes depression and craving. It does not help matters that the fluctuating sugar levels keep him drained. I think the patient perhaps needs physicological counciling to get out the depression.

      I have seen doctors scraching their heads trying to suggest a suitable diet. They almost believe that with an Indian diet it impossible.

      That is why I believe that more research needs to done on developing an Indian diet for diabetics. But that is just my personal opinion. I think in India the banning part is stressed more than diet since I guess Indian diet for diabetics has not been developed yet something which does not require any special effort on the part of patient but jells seamlessly with the diet patterns of the rest of the family with certain restrictions.


    7. Depression isn't something all diabetics suffer from, but yes psychological help should be offered if the patient struggle.
      Fluctuating blood sugar is a sign it is not managed well. I have family members who were diabetic when alive (may they rest in peace) and they never a big issue with fluctuating blood sugar because the trick is to make sure the blood is supplied with a constant and steady supply. It comes from a well planned diet plan.

      I also think that if people put thought in modifying the Indian typical diet it would work, but people with sedentary jobs in cities still eat like farmers who need the energy to work the field. Dal-sabzi-roti-chawal is a carbohydrate heavy meal that will spike the blood sugar. If you work out the whole day long, fine, it will work. Otherwise, it's just going to drive your body crazy.

      There are many alternative to rice and wheat, all with a way lower glycemic index and a higher finer content to keep one full longer. My absolute favourite is pearl barley, it comes as the absolute best substitute for rice. Pearl barley still has a higher GI than regular barley, but it is still lower than rice and more filling than the 2 roti limit imposed on me by my dietetitian. And I only really need one cup of cooked barley.

      Buckwheat (kuttu in Hindi) is also an awesome low GI grain that can be used instead of atta, I use it in savoury pancake mostly.
      Ragi, can be used instead of atta too. Oats is a perfect breakfast to start the day.

      Then there is the fact you need to hike the protein and fiber intake to feel full and to prevent digestion to happen to fast. As my dietetitian said, dal should not be confined to just main meals, a small bowl of it makes for a perfect snack in itself, drank as a soup. In a main meal, the serving should be double the small typical katori serving and take the space of the rice and a few roti in the diet. If your Indian meal looks like half the plate is veggies, one quarter is dal and the last quarter is a mix of roti and Dahi you already have a more balanced Indian meal than most people do.
      The rice and potatoes are sadly used as a filler to make a small quantity of vegetables feed a crowd on a budget. This is a wrong approach, cutting cost on food is never good news. Interestingly, all those lesser used grains and a lot of lesser used vegetables are cheaper than the most popular choices.

    8. Anonymous7:52 PM

      That is exactly I guess was the reason behind navaratra fasts when these alternative things like kottu were proposed to give the body a break from grain based diet. We never discovered the connection between fasting and the body


  3. Apple,
    "Indian doctors are not very keen on diet. They are very good in explaining the medicines. You have to coax them about the diet."

    Doctors are keen on diet in Kashmir & Nepal. Kashmir especially you get all sorts of Unani advice on eating "heating" or "cooling" foods no matter what you go to the doctor for.

    "Diabetics is more of a mental disease."
    Oh please.
    Let's not stigmatize diabetes more by relating it to a mental disorder.
    Any time a patient is diagnosed with an incurable condition they go through a bit of shock as well as perhaps a bit of depression. Then the patient either chooses to deal with the diagnosis by taking the appropriate step to manage it (as Cyn has admirably done) OR they choose to ignore it.

    Because your body either doesn't make enough insulin or doesn't respond to insulin adequately is not a mental disease.

    There are plenty or choices in the Indian diet that are suitable for diabetics. (As Cyn has described.)

    Interestingly, the doctor who is the head of the pharmacology dept at a local teaching hospital had dinner at our home the other night. To my surprise he insisted on eating both white rice and maida rotis with his meal yet wished his chai to be served without sugar. Whatever, the guest is god at our house.

  4. Anonymous3:50 PM

    Happy independence day to u and family.


  5. Anonymous9:00 AM

    Oh dear, I'm sorry to hear about your fatty liver, Cyn. Fortunately you have a team of good doctors and a nice group of friends to help you out !

    I suffered from diabetes mellitus during my last pregnancy and it was a nightmare, especially as my great-aunt had to be amputed at the same time because of diabetes and eventually passed away. I had a mild form of the illness so it could be controlled by diet only. In hospital they told us to cut the carbs, yet that carbs should represent 50% of the daily food intake, limit sugar and fruits, butter and oil.

    At the time I found a study made by Swiss training doctors about diabetes treatment in India. Have you heard about it ? You can read it here :

    Take care. Padparadscha

    1. Anonymous9:07 AM role of food prescription in type 2 diabetes treatment in the South Indian context.pdf

      I don't know why all the spaces are filled with "%20"

    2. I am sorry to hear you had to deal with Gestational Diabetes.

      I think they want the intake of "carbs" to stay at 50% but only from the good kind of carbs : coarse unrefined grains with a low glycemic index. On top of that fruits and vegetables naturally contains complex sugars that the body can convert into blood glucose.
      So in the end, grains account for about half of the total usable sugar and the other half should come from fruits and vegetables.

      I loved reading that research, thanks for sharing the link, and it really explains what is going wrong with diabetes management in India.

      The biggest point is this one :

      "One of the least followed parameters of the new diet was the rule of six to eight small meals per day, rather than three big ones. The reasons to this comprised lack of time for the working people and lack of motivation, especially as the recommended snacks were rather on the unusual, more healthy side: vegetable juice, pulses, buttermilk... These not being among the local popular foods. The only snacks which were taken more or less regularly seemed not to have changed much between the previous diet and the current one: fried foods, and biscuits."

      This is the big issue, I have seen it a lot in India, people going on almost without food until 10am even though they woke up at 5-6am. Then eat lunch at 2pm and again almost nothing until 9-10pm when dinner comes. By 5pm the body goes into a blood sugar crash and people fill the gap with empty calories such as namkeens, biscuits and a cup of tea instead of just doing a more nutritious and substantial meal.

      A think both my husband and I noticed in Bangalore was how inactive people usually are compared to Mumbai.
      We were living in a relatively green neighbourhood then, all streets had little traffic, lots of trees providing shade and one big park with a walking track. Yet, we were the only few actually going for a walk.

      In Mumbai you will see a lot lot lot LOT more people hitting the road, even in the most congested area and lack of greenery. What's even more interesting, a lot of senior citizens will take walking seriously enough to go buy a good quality pair of sports shoes and religiously go out for either an evening or a morning walk, if not both.

      Hubby and I even said it was really cute to see these senior citizens couples going on fitness walks. That is the kind of senior citizens we want to turn into : the sport shoes wearing kind that keeps being active :-)

  6. Anonymous5:13 PM

    The four to six small meals formula seems to be unpractical. Imagine a housewife running around getting things done. How would she remember taking small meals. The same can be said about someone working in the office. As soon as you make a schedule, you are sure that people not going to follow it. The trick is to tweak the daily meal in such a manner that it gives the right nutrition. There are plenty of diet snacks available so it is not a problem. Secondly, I think that separate diet also means that the person has to prepare his own food which is not always possible in India, the kitchen being the battleground.

    Yes, I have seen more and more people walking in parks. Everyone is doing something. Some yoga, others walk, some enthusiastic ones jog. Though I guess that if you do not have understanding of exercises, you should stick to walking. Jogging at a certain age, if you are not athletic type/used to exercises, often results in injury.

    I have seen that most old men walk but very few women walk or exercise. The older women sit in the park, sing bhajans or gossip. Sometimes this spirituality leads to a cult which is not the right thing. This is their "me time". They socialize. it is like old girls club. For them it is relief from household work, grand children and ofcourse their nemesis DIL. They just want some time off. I want to tell them walk, what else are you doing in a park but then I guess it would be rude. Let them enjoy their peaceful time.


    1. No it is not! The problem is that Indians think meal = cooked, when in fact meal equals anything you eat at regular interval.

      A cup of curd and a small fruit and a handful of nut is a meal. So is two slice of brown bread with a cup of soup or some chutney spread on them. You need to change your mindset, especially when faced with a disease that can kill you, no excuses.

      As for excercise, this is again a belief that is far more prevalent in India than abroad that you will suffer injuries in old age. Yes if you have never been active ever in your life, don't jump off your couch at age 50 and run a marathon, that said, I know people that started training for a marathon in their 60's.

      This is the one thing that amazed my husband in Europe: How old people do high energy activities, go on about their lives and let now disease bring them down. Both my grand ma's, in their 80's are prime example of it. One has survived a cancer and pancreatis and has a disease that looks like parkinson. She is was still going on excursions and mountain hikes in her 70's. The other skied well into her 60's, swim her daily kilometers during the pool open season and now in her 80's with two broken hips still does as much as she can around the house.
      They also both still go socialise and morning coffees, for them like for everybody in Switzerland is still a sacred institution.

      Recently I came across the story of an 86 years old Irish Nun who participate in Ironman triathlons, she started training at the age of 48 encouraged by a priest who recommended running as a way to connect mind, spirit and body.

      I also came across the story of a triathlete from Mauritius who despite having been diagnosed with Cancer last April and still battling it, participated in the Olympic Games this month.

      I am a former Synchronized Swimmer, one of the thoughest sport out there. One of the lady I looked up as when I was a Swimmer : Gemma Mengual from Spain, retired from competition, had two kids, and CAME back to it for these Olympics, at the age of 37 and she wasn't even the oldest in the competition.
      Synchro is a contact sport, that demands the endurance of a marathon runner, the stamina of speed Swimmer, the fexibility of a gymnast, the precision of a diver and a the grace of a ballerina...oh and you do most of your 3 to 4 minutes routine under water. Going back to that level after retiring is tough, and yes the sport mean you will break bones, get concussion and pull your share of muscles.

      Age, is just a number, using it as an excuse not to be active is bullshit, plain and simple

      Beside, walking IS excersise. So is Yoga.

    2. Anonymous9:10 PM

      There is nothing wrong in being active. However what u can do depends upon your physical structure irrespective of age.

      Indians of my generation engaged in sports sometime in their teenage. That is as close to any physical activity because there were no gyms at that time. Two hours of cricket or football. That was sixteen years ago. I can still play but with certain limitations. Today I have to slowly get my body ready.

      I have seen young/old trying to do something which their body does not allow. If you can pull off half an hour of jogging go ahead but if you hurt your heels and cannot stand in a crowded metro then think again. Surviving a metro ride itself requires exemplery physical fitness. U should perhaps start with walking and gradually move on to jogging.

      Then there old people who think they can do yoga find out that they cannot bent their back.

      The problem is that there is definitely awareness but what u can do and what u propose to achieve considering your physical state is absolutely essential.

      It becomes even more important in our society when our last physical activity was twenty years ago.

      Even something as simple as breathing exercise is fatal if u have heart problem. Many yoga teachers just teach it irrespective of the age and physical condition of the student and people in obvious discomfort do not question. Is this going to help them or traumatise them and keep them off physical activity permanently.

      I think these are matters of education and awareness which is still very low.


  7. Anonymous5:36 PM

    And yes, that not eating upto 10.00 AM in the morning is also due to the fact that some Indians do not eat till they have taken bath and done their pooja. If they eat before bath and pooja they feel uneasy. Can't reason with them, it has been their habit for a long time.


    1. That's the issue, if you have a disease, you ADAPT. making excuse for it doesn't solve a thing. Habits can be broken, and Health and wellbeing seriously is more important than a tradition that is detrimental to said health.

    2. Anonymous5:23 AM

      I'm glad you enjoyed the study, Cyn.

      I think there are two big problems when trying to apply "western" medecine for chronic illnesses in India :
      1. Asian bodies are slightly different from Caucasian and African bodies, and medecine has realized this only recently. Anthropologic medecine is a new field of studies.
      2. Food always has a cultural and symbolic part. Therefore you cannot convince people to change their food/exercise habits if what you suggest goes against their cultural habits. People have to see how the new habits fit in their general belief system.

      Indeed many Indians/Hindus want be ritually clean before cooking and eating. And I see my husband doesn't have the same eating patterns as we have in Europe, either for timing or composition of diet. He has many rules too, and it makes meal planning a little bit difficult. Recently he found out he had some health issues so he's been researching about Indian vegetables and spices.

      Meanwhile I'm trying to introduce more pulses/dhals and reduce glutenous grains into our meals and it seems to have a positive effect on both of us. Have you looked into gluten issues, Cyn ? It's very fashionable right now, but what convinced me is the bestseller book written by a German doctor about bowels ("Gut" by Giulia Enders). Have you heard about it ? - Padparadscha

    3. I didn't hear about that book, but like you I noticed that reducing glutenous grains in my diet has had a positive effect, especially on my digestive tract. Most of my grain intake comes from either pulses, or buckwheat, ragi and barley. I still eat oats for breakfast on most days, but wheat products is something I limit in my diet.

      My husband still eats a carbo rich diet, we haven't really eaten the same things at meal time in years. And because of his work timing, we never really eat together on weekdays.
      Recently my husband has tried some of my meals on weekend though, and he likes it, as long as it is not his everyday meals :-)

      He really enjoyed my buckwheat crepes, and buckwheat soba noodles.

  8. Anonymous9:26 PM

    I hope I have not offended you in any way. Just my personal opinion. No offence meant.


  9. Sorry Apple, you need to educate yourself. Heart disease doesn't mean you should not excersise or do breathing excersise. I went to the cardio rehab for my weight loss assessment, some of those cardio patients were running on treadmills and doing pranayama, and using the elliptical machine, and the stationary bikes.

    If your heels hurt after a jog, it due to two things 1) you ran too fast, too long too early without proper warm up. And 2) Had a poor quality pair of shoes on or one that was not meant for your foot type.

    I have high foot arches, a very uncommon foot problem. On top of that I have knee problems. The pair of shoes for me is a higher end Adidas pair that cost 8k, pricy, but cheaper than a busted foot and a knee surgery. And guess what? I power walk, at time for 60 minutes straight. My heart rate always above 115 beats and at a pace of about 1 kilometre per 9-10 minutes. I can and do sometimes do light interval of jogging. My heels, high arches and knee are fine, because my shoes cushion the impact.

    Have you see the hunchback lady plagued by scoliosis for her whole life who did yoga at an age close to 90? She straightens her back completely with it. Or better yet, the 90 years old yoga master?

    You have to give your own body some credit and stop thinking in extremes, this is not going anywhere. It not ALL or NOTHING. The nun who runs ironman triathlon started running in her 40's but only competed in her FIRST triathlon 4 years after started running.
    It takes TIME and if you decide to run like a maniac without pacing yourself, you are an idiot, plain and simple.

    We have to STOP STOP STOP thinking age is playing a role in physical fitness in abilities, I can tell you hundreds and hundreds and hundreds of stories that prove otherwise and show that the blockage is in your mind.
    But yeah you got to stop to think that one has to get it perfect on the first day, or first try and that training has to be intense from the start.

    And I am sorry to say here, but this art of making excuses and passing them as fact is very Indian, I see it way more around here than in Europe.

    1. Anonymous12:03 PM

      I have a question for you, in fact two. What to eat before physical exercise? Should one walk/jog on empty stomach. I cannot even walk on full stomach.

      Secondly, I eat corn flakes in breakfast with milk without sugar. I think that corn flakes is processed food more like fast food and suspect that both milk and corn flakes have some amount of natural sugar in it. I was thinking about oats but I feel that it is too heavy for breakfast since I have to travel a lot. Oats, dalia etc are like eating a full meal of rice, pulses, vegetables etc. I tried roti sabzi breakfast but could not handle it. Can you suggest something light for breakfast. Slightly off topic but I wanted to ask you for a long time.


    2. Yes I eat before a workout, I even did when I was an intensive competition level Synchronized Swimmer. Without food, you did faster in your fat reserve, but it also can increase stress levels on the metabolism which is not good.

      The key is to eat the right food. Definitely don't do a physical activity after a heavy meal, but don't do it on an empty stomach either.

      My diet plan has two breakfast, or rather a big breakfast split in two.
      When I just wake up, I have a bowl of oats usually, with either milk, or yogurt, it really depends my mood. The quantity of oats amount to half cup, the other half is milk or yogurt. I have it with a cup of green tea.
      About 45 minutes after eating it I am walking back home from Ishita's school, or going straight to the Swimming pool to swim with a friend.

      I have my second breakfast 2 hours after my first breakfast, then I usually eat a fruit and either a handful of nuts or 100g of yogurt. Sometimes I eat a fruit and a cup of soup.
      My diet is such that I can't go without food more than 2 hours :-)

      Corn flakes is a highly processed cereal, I can't have it. Corn has a high glycemic index to begin with, and corn flakes is processed to enter the blood stream quite fast and it is also low in fiber which means it get digested way too fast. There are other cereals that are far more nutritious if you don't like oats :

      Ragi flakes, whole wheat flakes are two great ones. On day I don't really feel like having plain oatmeal, I go for a diet cereal mix of roasted oats and ragi flakes from the brand "Soulfull" which is an Indian brand of breakfast cereal you find in a lot of supermarkets.

      If you find you can't handle heavy food before exercise, at least eat a fruit, then eat your breakfast or meal once you are done with your workout.

      When I was training for Synchronized Swimming we had 3 hours of training a day, in the evening, I would pack quick snacks along with a big bottle of electrolyte. When you are doing a 3 hour long regimen of weight lifting, speed swimming and synchro routine you need the energy bites coming to avoid muscular cramps.
      When we had training camps we would train 8-10 hours a day. We had a substantial lunch in between, and were back in the pool 30 minutes after finishing said meal, to avoid stressing out the stomach we did flexibility Swimming before doing the synchro routine or endurance training session (which we anyway did in the morning after breakfast).

    3. Anonymous2:18 PM

      Thanks a ton. Now I pose a common men's question. I usually have only half an hours time for some physical exercise. Then I drive my son to school with my wife, come home and rush to office. If I jog I feel tired. If I walk briskly it does not seem stenous enough. Something which is vigorous but not awfully tiring to keep on nagging u day long. Just the right stimulus to burn the calories and reduce belly fat. I am early forty.


  10. According to the cardio rehab doctor I saw, you have an optimum fat burning heart rate when you are between 60% and 80% of your Maximum heart rate.
    To calculate your maximum heart rate, which is the heart rate you should not exceed. To calculate it, you need to substract your age to 220.

    For me the fat burn heart rate starts in the 90's something, but the ideal range is 120-130 heart beat a minute to get a fat burning workout.

    As important as the heart rate is the level of intensity you feel. If you are new at an activity, you may feel your muscles working harder at a slower heart rate, as you get better at this activity, your muscles become more efficient. And in the long run it even stops being a challenge even for the heart. This is what happened to me with walking. I am still in the fat burn heart zone, but on the lower end, much below 120 and my pace is still quite fast. I burn less calories from it and I need to constantly push my pace to get back to that golden fat burn zone.

    For this I found that my heart monitoring fitbit comes in super handy as I can check my heart rate while working out and quicken the pace as soon as I notice it dropped.

    You should not feel overly exhausted after a good workout, at least not to the point you feel it the whole day long, so if you feel a bit winded imediately after a workout it means it was a good one, but if your legs ache the rest of the day, or you feel tired for hours afterwards, you may have pushed it a bit too far and need to scale down your pace a little.

    I usually start feeling like I had a good workout if I walk for an hour at a heart pace of 115-120 on average. At the hour mark I am feeling my legs a little and would not mind taking a break. To me this is the sign I have at least achieved something. And I am usually completely fine withing 30 minutes of stopping.

    Ideally, you should break your active time in two, so if you aim at one hour of active time a day, which is a very good average for most people. 30 minutes in the morning and 30 minutes in the evening should give you results if you eat sensibly during the day.
    You can increase that amount of time if you want, or have more time, but don't feel you didn't do enough if all you did is 30 minutes at a time.

    Hope this helps


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