By Soma Das
The next battle of ‘Kurukshetra’ is brewing right under your nose in your Indian thali with its innocent looking ‘ghar ka khana’, argues the brilliantly lucid book Sick Nation: Inside India’s Lifestyle Disease Epidemic and How to Fix it by Karan Sarin, a former marketing professional turned metabolic health coach. “…the real problem wasn’t the ghee on his roti, but the roti under his ghee…” sums up Sarin, pointing towards the ‘invisible sugars’ in our staples—rice and roti—on our plates that have caused our insulin to spike over years and our cells to become resistant to this master hormone, causing havoc in our bodies leading to a long menu of lifestyles diseases.
This preventable but unchecked damage of ‘insulin resistance’ is at the root of what drives, in most parts, the epidemics of diabetes, cardiovascular diseases and fatty liver disease in India, Sarin proposes. To a significant extent, it is also the main factor behind the emerging epidemics and rising incidence of reproductive disorders such as PCOS, erectile dysfunction, infertility and neurological disorders in the country—which forms the main hypothesis of the book.
After losing his 49-year-old brother-in-law to a heart-attack, and back from the brink of losing his father to a cardiac arrest, Karan transforms tragedies at home to developing an understanding of the state of health of his country. His mind becomes obsessed with research around why perfectly healthy seeming Indians are having heart attacks so early in life and his body turns into a lab for experimentation. The result is what seems like India’s answer to Eric Berg, a star nutritionist who turned his personal experience to a mission that has made him a spectacular success on social media.
Sarin wanted to find the answer to this moot question—why despite doing all that is considered ‘healthy’, eating home food, taking walks as advised and getting medical reports that looked ‘healthy’ in the eyes of doctors, the health of his brother-in-law and father failed? A cocktail of genetics, country’s history, emerging ways of life and food among Indians gave him an answer that he felt he needed to share urgently with all fellow Indians.
The message is urgent as Indians are now getting hit by heart disease and diabetes almost a decade before their Western counterparts. The total number of people living in India with diabetes (101 million) and pre-diabetes (136 million) exceed the entire population of all countries of Western Europe put together. Cardiovascular diseases account for 27% all deaths in India, and 40% of heart attacks in the country now hit people under 55 years.
The leading luminaries of healthcare, including cardiac surgeon Dr Devi Shetty, have been warning how healthy you are, has got nothing to do with how fit you feel, urging regular health checks. It is in this backdrop of a young country of silent epidemics that Sarin’s message assumes import of a higher order.
Sarin doesn’t invent solutions, but connects the dots, and stitches them in a way to offer you a practical guide that will make ‘metabolic health’ accessible to all who are keen to take charge of their health. He dives into the history of genetics of Indian subcontinent to suggest why, despite being thin, we are at a high risk of diabetes and heart diseases.
That’s because our bodies, subject to centuries of famine, adapted to ways of survival that fared well in times of scarcity but exposed to abundant food, the same survival mechanism leads to hidden visceral fats getting wrapped around our organs not only making us pot-bellied but also leaving us highly vulnerable to metabolic dysfunction in the age of caloric abundance, refined and ultra-processed food and physical inactivity. “We are paying the price of prosperity with our metabolic health,” warns Sarin.
To be sure, the theories around ‘thrifty metabolism’, and ‘thin-fat’ Indian phenotype propounded by Dr Chittaranjan Yajnik and others have been around for the past few decades in academia, but the way Sarin integrates it with the big picture of India’s chronic disease landscape at aggregate level and the actionable tips to test and fix metabolic disorders at a disaggregated individual level has the potential to mainstream these theories like never before. That combined with sections on how ‘green revolution’ and food industry processing have altered our food irrevocably so that the cereals we eat are radically different from what our ancestors ate, are important revelations on where this country lost its grip on health.
Karan challenges medical conventions by convincingly making a case for testing insulin levels, not glucose levels so that metabolic damage can be stopped in the tracks of the slippery slope, and you can prevent a metabolic disturbance from turning into dysfunction, a dysfunction into a disorder and a disorder into a disease. From continuous glucose monitoring, to fasting insulin, to ratios of relevant lipids, the book reels out how to assess your metabolic health and correct it by customising solutions under the three big pillars—nutrition, exercise, sleep and de-stressing. If you are a fitness buff who has followed carbo-phobic diet movements of Ketos and Paleos, and other global health trends, you may find parts of this book familiar, but this book is clearly a case of “whole is greater than sum of its parts”.
Sick Nation is a ‘whole food’ of health and wellness literature for people of the Indian subcontinent. It is both genre-defying and genre-encompassing, with a slice of public health, personal history, anthropology and self-help packaged in the neat form of knowledge that you can use. Sarin’s no-frills, no-nonsense narration makes it India’s first ‘must-read metabolic thriller’ and can compel you to shift behaviour more than a doctor’s advice can. That’s because the book may have started on a deeply personal note for Karan, but it quickly turns personal for you if you are living in an Indian metro city, as his tragedies mirrors yours. And if Sarin’s words can move you to act, as they do, he has probably succeeded in his mission of nudging a ‘sick nation’ towards ‘metabolic awakening’, and who knows, even ‘metabolic enlightenment’!
Soma Das is the author of The Reluctant Billionaire and an adviser to agencies in the development sector
Sick Nation: Inside India’s Lifestyle Disease Epidemic and How to Fix It
Karan Sarin
Wyzr Content
Pp 312, Rs 599