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India Today
4 days ago
- Health
- India Today
Dr Anoop Misra on why Indian mangoes are safe and a healthy option for diabetics
For decades, mangoes have been labelled off-limits for people with diabetes. Their natural sweetness and juicy richness have made them a beloved fruit, but one that's feared for its supposed impact on blood sugar. Now, two groundbreaking Indian studies are rewriting that diabetologist Dr. Anoop Misra, Chairman at Fortis C-DOC Hospital for Diabetes and Allied Sciences, and co-author of the studies, says that certain varieties of Indian mangoes, when eaten in controlled portions and under supervision, can actually improve blood sugar control and even support weight management in people with type 2 shown the benefits of small doses of mangoes in place of carbohydrates like bread for the first time,' Dr. Anoop Misra tells 'Our data challenges the myth that mangoes are unsafe for diabetics. In fact, they could offer multiple metabolic benefits if included mindfully within a diet.' WHAT THE TRIALS SUGGESTIn collaboration with the National Diabetes, Obesity and Cholesterol Foundation (N-DOC), and supported by the Indian Council of Medical Research (ICMR), Dr Misra's team conducted two clinical studies to test the impact of mango consumption on metabolic first study, accepted for publication in the European Journal of Clinical Nutrition, assessed 95 participants - 45 with type 2 diabetes and 50 without. Participants were given either 250 grams of mango pulp (Safeda, Dasheri or Langda varieties) or an equivalent calorie portion of white bread. Researchers used an Oral Tolerance Test and Continuous Glucose Monitoring (CGM) over three they found was surprising:Mangoes caused an even lower blood sugar response than Mean Amplitude of Glycemic Excursion (MAGE), a key marker for glucose spikes, was lower in diabetic participants after eating mangoes, suggesting more stable blood sugar second study, published in the Journal of Diabetes & Metabolic Disorders on August 6, followed 35 adults with type 2 diabetes for eight weeks. Each participant consumed either 250 grams per day (about one small mango) of Safeda or Dasheri mangoes, or the same caloric amount of bread, as part of a controlled diet.'The mango group showed a measurable drop in fasting blood sugar, HbA1c levels, insulin resistance, waist size, and even subcutaneous fat. Even HDL, the good cholesterol, improved," says Dr MANGOES A SMARTER CARB?It's all about what mangoes contain and what they replace.'Mangoes have a low-to-medium glycemic index, around 51. That's much lower than white bread or sugary snacks. They're also high in fibre, vitamins, and plant compounds like polyphenols and carotenoids, which help reduce inflammation and improve insulin sensitivity,' explains Dr while mangoes are sweet, they don't cause the same rapid blood sugar spikes as refined researchers believe mangoes may also help increase satiety, meaning people might eat less ABOUT SUGAR?Aren't mangoes full of sugar?'Yes, mangoes contain natural sugars. But in our trials, participants ate a measured quantity—250 grams per day—as a replacement for a high-GI food like white bread. The results were clearly in favour of mangoes," says Dr Sugandha Kehar, lead author of both studies.'Mangoes are a much-loved fruit and often unfairly maligned. These studies show that, within a well-structured diet, they are not only safe for diabetics—but may be beneficial,' she FINAL WORD: MODERATION AND SUBSTITUTION ARE KEYDr Misra is careful to stress that this is not a licence to binge on mangoes.'One medium-sized mango per day (around 250 grams), as a substitute for other carbohydrate sources, not in addition to them, can be part of a diabetic meal plan. But this must be done under dietary supervision," he don't have to completely eliminate mangoes from your life. These studies suggest that when eaten smartly, Indian mangoes like Safeda and Dasheri can fit into a diabetic diet, and might even bring metabolic a small but powerful step in reconnecting cultural food preferences with modern science.- Ends advertisement
Indian Express
14-07-2025
- Health
- Indian Express
Taking almonds and whey protein 30 minutes before meal reduces blood sugar spike, says study
While it's normal for blood sugar to rise after eating, consistently high levels after meals can lead to various health problems, even in individuals without diabetes. Prolonged high levels of blood sugar can damage blood vessels, wearing them out, posing a significant risk to heart health. It can even worsen existing diabetes and make it harder to control and end up damaging the kidneys, eyes and nerves. That's why Dr Anoop Misra, chairman, Fortis C-DOC Hospital for Diabetes and Allied Sciences, has got down to planning a pre-meal pattern of consuming macronutrients (carbohydrates, proteins and fats) that may indeed tame post-meal blood sugar spikes. 'This is especially important for Indians, since their postprandial glucose levels are high and need additional therapies, especially dietary measures,' says Dr Misra, who has laid out his findings in a scientific review of global research. A larger pre-meal load of carbohydrates leads to a faster and more pronounced rise in blood sugar after eating. Conversely, consuming protein, fat, and fibre before the main meal can slow down digestion and accelerate absorption, leading to a more gradual blood sugar release. Whey protein (25 – 55 g), taken 30 minutes before a high-carb meal significantly reduces post-meal glucose levels. It stimulates insulin secretion, slows gastric emptying, increases GLP-1 and GIP hormones, both of which regulate post-meal blood sugar by stimulating the release of the sugar-regulating hormone insulin. Olive oil or almond consumption 30 minutes before meals delays gastric emptying and flattens the glucose peak. In people with Type 2 diabetes, olive oil delayed peak glucose elevations from 75 to 140 minutes, significantly lowering glucose spikes. We found that 20 g almonds (rich in protein and monounsaturated fatty acid) before meals brought down post-meal two-hour glucose by 25.8 mg/dL, HbA1c (average blood sugar counts of three months) by 0.4%, and improved insulin sensitivity. About 30 per cent of participants returned to normal blood sugar range after three months. They also reported a reduction in weight, cholesterol and improved insulin sensitivity. There was no risk of hypoglycemia (below normal levels of blood sugar) even in prediabetes. We unanimously concluded that eating almonds daily provides significant benefits for heart health, weight management, blood sugar control and the gut microbiome. The findings from studies in India were particularly notable, indicating that almonds may have especially beneficial effects for people in India with prediabetes, who are more likely to develop diabetes than other racial groups. Almonds are natural, delicious and nutrient-dense, providing protein, healthy fats, fibre and important vitamins and minerals. Plus, they are shelf-stable, portable; and fit into healthy and diverse diets. We made our subjects have fibre and vegetables first. Eating vegetables (rich in fibre) 10 – 30 minutes before carbs improves glycemic control. Studies showed 11 – 49 per cent drop in postprandial glucose. A 500 g vegetable pre-load lowered HbA1c by 1.1 per cent over 2.5 years. I suggest big portions of vegetables, preferably okra, jackfruit, methi (fenugreek), karela (bitter gourd), all known to decrease blood sugar. You can have them after proteins which can decrease blood sugar further. I suggest two large portions of salad with two teaspoons of flaxseed (raw) as preload for those who are not taking protein or almonds. This is a very practical preload. Your salad should have plenty of tomatoes, cucumber, carrots, salad leaves and small portions of radish. If you have carbohydrates at the end, your stomach is already full. So you will automatically limit the portion of rice yourself. Another way to eat rice is to have it with more protein, be it rajma or dal. Rotate three oils — olive, mustard and canola. Avoid ghee, dalda, coconut and palm oils.
The Hindu
24-05-2025
- Health
- The Hindu
Reshaping India's waistline
If endocrinologist Dr. Anoop Misra's exhausted smile and constantly buzzing phone are any indication, the newest hormone-mimicking drug-based entrant into the Indian weight-loss market — tirzepatide, sold under the brand name Mounjaro, manufactured by American pharmaceutical company Eli Lilly — is the hottest selling product in the wellness and enhanced longevity market today. 'People have been waiting for it to enter India and the hype around these drugs is only growing,'' says Dr. Misra, who heads Fortis C-DOC Hospital for Diabetes and Allied Sciences in Delhi. He says his facility has been getting 10-12 enquiries for the drug every day since March, when the domestic market was allowed to retail it. 'Dieting, exercise and other interventions aside, these drugs are a game changer in the weight-loss industry,'' he explains, adding that these are prescription drugs and must be combined with diet and exercise for efficacy. Tirzepatide received approval from American authorities in 2022 to regulate type 2 diabetes and in 2023 for obesity management. After approval in India by the Central Drugs Standard Control Organisation, this weekly injectable, single-molecule drug, priced at ₹3,500 for a 2.5 mg vial and ₹4,375 for a 5 mg vial is being prescribed and taken despite its price. The most common side effects of Mounjaro include nausea, diarrhoea, decreased appetite, vomiting, constipation, indigestion, and stomach pain, but people are willing to live with those. The drug, and others like it, were developed in a world tilting towards excessive weight. The World Health Organization (WHO) says that in 2022, one in eight persons lived with obesity, with adult obesity more than doubling since 1990. Considered a chronic multisystem disease, anyone who has a body mass index of 30 or over is said to be obese (the formula — weight in kg divided by height in metre square — determines if a person is obese). Obesity affects a person's quality of life and is associated with a shortened life expectancy. WHO has termed it 'an epidemic'. A person with the disease is prone to over 10 kinds of cancers and a host of other diseases including type 2 diabetes, hypertension, fatty liver, cardiovascular diseases, osteoarthritis and mental disorders, among others. Life lessons Aruna Lal (name changed to protect privacy), who will be 60 years old this year, says she has tried many weight-loss interventions. 'I realised that no matter what I do, I can only lose weight on a consistent calorie deficit, and these drugs help me do just that. I tried diets, exercising, walks and calorie counting,'' she explains while speaking about her now decade-long battle with weight gain. She admits that each time, she fell off the wagon. Aruna, at 5 feet 2 inches, says that she went from 52 kg to the 84 kg she is currently at, over a span of a few decades. 'I blame my weight gain on overeating,'' she says squarely, laughing. With three children, a career as an art collector and seller, and maintaining three homes across Goa, Mumbai, and Singapore, Aruna had many stressors, including moving countries to be with her husband who worked in a multinational company. 'During this period, the weight crept up on me and last year I had a cancer scare (of the uterus). It made me sit up and relook at my health,'' she says. Last year in Singapore, Aruna decided to use the new class of anti-obesity drugs called glucagon-like peptide 1 (GLP 1), which promised sure-shot weight loss. Her doctor put her on Ozempic, which contains the active ingredient semaglutide and is available in India only on the grey market. Ozempic is also a prescription drug, given as an injection under the skin. It is recommended for type 2 diabetes and is now extensively used to manage weight. 'The first dose killed me,'' says Aruna. 'This was even though my son had already been using the drug and had briefed me about the possible side effects.' Ozempic is available in pre-filled pens with specific strengths: 0.25 mg, 0.5 mg, 1 mg and 2 mg. Her doctor put her on 1 mg because lower doses were not available at the time. 'The result was nausea, diarrhoea and a general feeling of being overwhelmed. I also experienced muscle loss and associated skin sagging. But the drug helped me cut my weight by 5 kg in a few months,'' she says. The symptoms began to impact her lifestyle, so she gave it up. She has now put back some of the weight but is determined to begin again. Doctors and patience Weight loss through semaglutide and tirzepatide use is done after extensive individual consultation. Doctors often start patients on the lowest dose and then build it up. 'Hormonal drugs must be prescribed under the supervision of an endocrinologist, often in consultation with a physician. These medications have specific effects on the body and require careful monitoring,'' says Dr. Pankaj Kumar Hans, the associate director and a unit head at the Minimal Invasive Metabolic, Bariatric and Robotic Surgery, Asian Hospital, in Delhi. He also says that like bariatric surgery, not all with obesity qualify for drug-based weight loss. For instance, those with a family history of thyroid cancer are asked not to take the drugs. Aruna's son started taking Ozempic at 31 and has been on it for a couple of years now. 'I first became conscious of my weight when I was 18 and at 100 kg; later this went up to 107. When I went in for a medical consultation, it was for my sleep apnoea. The doctor suggested Ozempic for weight loss and after I started taking it my weight came down to 90 kg in three months,' he says. He started at the lowest dose. 'What the drug has done is to ensure that I have no cravings for the wrong type of food. It is like having a coach alongside you all the time who slaps you when you try to put something unhealthy into the food. This habit stays,'' he explains, adding that he has also begun to exercise. He too says that higher doses did not go well for him. How the drugs work Weight-loss medications include both oral and injectable options. 'Currently in India, both tirzepatide and semaglutide are marketed under the brand names Rybelsus and Wegovy (both semaglutide), and Mounjaro or Zepbound (both tirzepatide),'' explains Dr. Misra. Explaining the difference between semaglutide and tirzepatide, he says, 'Semaglutide and tirzepatide differ in their mechanisms of action. Semaglutide is a glucagon-like peptide-1 (GLP-1) receptor agonist, meaning it stimulates GLP-1 receptors; tirzepatide is a dual agonist, acting on both GLP-1 and glucose-dependent insulinotropic polypeptide (GIP) receptors. This dual action of tirzepatide may lead to more significant weight loss and glycaemic control compared to semaglutide.' Simply put, both the drugs result in increased satiety, forcing users to eat less. At the time of the launch of the drug in India, Eli Lilly and Company said it is 'an innovative option to treat obesity and type 2 diabetes'. The company's statement also added that the drug plays a vital role in supporting individuals living with obesity — not only in managing the condition but also in preventing related complications. However, it also warned against self-diagnosis and administration. 'People with obesity should consult their treating physician to determine whether this treatment is appropriate for their individual medical needs,' it said. There are other, older medicines that have claimed they assist in weight management: Lirafit (liraglutide); Xenical (prescription) Alli (over the counter), both orlistat, a lipase inhibitor, manufactured by GlaxoSmithKline. Other generic orlistat products are Obelit (Intas Pharma), Zerocal (Weidar), and Cobese (Ranbaxy). 'The Indian weight-management market was valued at $25.2 billion in 2024,' says a report by IMARC, a global management consulting firm which does market assessment and feasibility studies. It predicts that the Indian weight-management market will see a compound annual growth rate of 8.79% between 2025 and 2033. Speaking about it openly Saroj Singh, 45, lives in central Delhi, and has recently started Mounjaro. She says that both her older sisters in America benefitted from Ozempic and lost almost 10 kg each. 'Obesity, hypertension, diabetes — you name it, we three sisters have it. All three of us started putting on weight after childbirth and related complications. I was waiting for Mounjaro to come into India because importing Ozempic was expensive,'' she says. Saroj underwent a body-mind evaluation and counselling session by the hospital she consulted before starting on the weight-loss drug. 'I was made aware of how my eating habits need to change and how I need to manage my side effects and pack in some physical activity to boost my overall well-being and weight loss,' she says. 'I started on the lowest dose this April and have already lost 3 kg. This was something I struggled to achieve earlier. I am experiencing the known symptoms but slowly my body has fallen into a rhythm,'' she says, adding that unlike before, there is no shame in saying that you are taking the help of drugs to maintain or lose weight. 'There was so much guilt associated with this earlier. However, people are realising that obesity is a disease like any other illness and it needs to be treated,'' she says. Some part of the openness is also because it has legal ramifications. 'Under the Indian law, a higher health insurance premium on account of obesity is permissible,' says Sonam Chandwani, managing partner, KS Legal & Associates, a law firm in Delhi. 'Under the Insurance Regulatory and Development Authority of India guidelines, the insurer may consider obesity as a risk factor, justifying premium variation,'' she explains. India already offers surgical interventions to combat certain types of obesity, including bariatric surgery, gastric bypass and fat removal surgery. Some of these, including bariatric surgery, are now being covered under insurance. An obesogenic environment The weight-loss industry began booming in India in the 1990s, around the time of liberalisation and the opening of the economy to international brands, including packaged and fast foods. According to the Global Obesity Observatory, an online platform and database hosted by the World Obesity Federation, obesity cost India approximately $28.95 billion (₹2.4 lakh crore) in 2019, accounting for 1.02% of the GDP then. This burden is expected to surge to $81.53 billion (₹6.7 lakh crore) by 2030, reaching 1.57% of the GDP. The Indian health budget, as a percentage of GDP, is around 1.9%. As per the government's National Family Health Survey 2019–21 overall, 40% of women and 12% of men are abdominally obese in the country, a major risk factor for various lifestyle diseases, including type-2 diabetes. In India, the high prevalence of abdominal fat was found in the southern States of Kerala (65.4%) and Tamil Nadu (57.9%) and the northern states of Punjab (62.5%) and Delhi (59%). There is low prevalence in the States of Jharkhand (23.9%) and Madhya Pradesh (24.9%), reveals the study 'Abdominal obesity in India: analysis of the National Family Health Survey-5 (2019–2021) data', published in The Lancet Regional Health — Southeast Asia. Obesity is the result of several factors, including stress and lifestyle habits, like the lack of movement and not enough rest. A big part of the problem is that urban environments are not built for health. Arun Gupta, who founded the Breastfeeding Promotion Network of India and has been advocating for healthy foods for over a decade, says that rapid urbanisation, economic development, increased access to processed foods, globalisation, and changing social norms are all contributing factors to obesity. Vanita Rahman, an internal medicine physician, certified nutritionist and weight-loss specialist with the Physicians Committee for Responsible Medicine in America, notes that a nutrient-rich, fibre- and protein-packed plant-based diet is still an effective and sustainable weight-management technique. bindu.p@ Edited by Sunalini Mathew.
The Hindu
07-05-2025
- Health
- The Hindu
The Hindu Huddle to shine the light on rising tide of non-communicable diseases in India
Let us look at some sobering facts: India has the highest number of people living with diabetes in the world, with an estimated 212 million cases in 2022. According to the World Health Organization, there are an estimated 77 million people in India above the age of 18 who are suffering from diabetes (type 2) and nearly 25 million are prediabetic (at a higher risk of developing diabetes in near future). That is probably the largest part of the non-communicable diseases (NCD) pie. Add to this the number of people with hypertension, stroke, cancer, cardiovascular disease and chronic lung disease and the actual position is truly staggering. NCDs occur because of a combination of factors — primarily changing lifestyles, environmental factors, and genetics — and have grown to a huge proportion in the country. The messaging, therefore, is that interventions have to be immediate, and effective, both in terms of launching treatment as well as prevention strategies. A session at The Hindu Huddle, which will be held in Bengaluru on May 9 and 10, titled 'Non-communicable diseases: Trojan horse of India's health', seeks to discuss the multiple dimensions of India's NCD 'epidemic' and evaluate strategies that may be deployed by the public and private health sectors to ensure that the tide is stemmed and that all those who already have NCDs have access to treatment and affordable healthcare. On the panel are three key experts from India who stand at various points of the care paradigm. They will share real-time experiences, and possible solutions for the way forward. While Preetha Reddy, executive vice-chairperson, Apollo Hospitals, comes armed with the experience of being at the head of cutting-edge private care in the country, Anoop Mishra, chairman, Fortis C-DOC Hospital for Diabetes and Allied Sciences, brings to the table avant-garde research in the sector and experiences from close patient interactions. Chandrakanth Lahariya wears many hats, but will participate as someone who keenly watches the health systems of the country and a sagacious policy adviser. The session will be moderated by Ramya Kannan, Health Editor and Chief of Bureau, Tamil Nadu, The Hindu. If you have any questions that you would like the moderator to ask the panellists, write to huddle@
