February 15, 2020
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Faster, Lower, Frailer

Young urban Indians are paying a heavy price for their obsession with upward mobility—their bodies are becoming unwitting homes to crippling and fatal lifestyle diseases

Faster, Lower, Frailer
T. Narayan
Faster, Lower, Frailer
His life is no party, it’s a real bad hangover. A daily haze of meetings, memos, e-mails and medicines keep him more kicking than alive. And at 41, Delhi-based advertising professional Ashwini Mehta suffers chronic headaches, excruciating ulcers, high blood pressure and exasperating sleeplessness. A daily diet of Betacard, Ranitidin, Combiflam and Alprax are his sustenance, Digene tablets are his munchies. Swallowed with black coffee, flavoured with nicotine puffs and seasoned with whisky, these enable him to kill tension and an associated sense of general ill being. But Mehta bristles whenever he’s advised a change of lifestyle. "I know I am screwed," he says. "It doesn’t help having others lecture me. The rush, the tension are here to stay, so are my illnesses."

The frenetic pace of urban life has inflicted another set of torments on Vanitha Krishnan. Desperately seeking a remedy, Vanitha, a 38-year-old Chennai-based personal assistant, walked into sexologist D. Narayana Reddy’s Dega Institute for Sexual Medicines. She complained that she was being pressured into performing at office, and in her bedroom. "Her job, children, home exhausted her. She had stopped feeling any inclination for sex," recounts Reddy. This led her husband to force sex on her and she suffered a nervous breakdown. This, in turn, induced eating binges till Vanitha was diagnosed with bulimia. She became ungainly, hypertensive and was prescribed medication that made her a wreck. "Vanitha’s no unique case," says Reddy. "Over 45 per cent of patients who come to me these days suffer ailments due to their destructive lifestyle."

It’s wake-up time. Young and career-obsessed upwardly mobile Indians are suffering from something infinitely more serious than premature mid-life crises. A disturbing range of ailments—from hypertension to heart disease to diabetes—is felling them younger and faster than ever before. Doctors call them lifestyle diseases—and hospitals are offering specialised services combining conventional wisdom, regular check-ups and remedies. Lifestyle diseases are not communicable, nor are they triggered by skewed genetics. They only require our frenzied, unhealthy way of life, and our exhausted, out-of-shape bodies to breed in (see box). The casualties are piling up in our noisy and polluted urban jungles, and lifestyle drugs today contribute 40 per cent to the Rs 1,500-crore Indian drug market.

None of these are, however, new ailments. Coronary heart diseases, diabetes, stress, depression, osteoporosis, acute acidity and cancers have been around for ages, but they have never found more conducive bodies to feed on and fester in as they have today. They target people above age 21, who are always in a rush, thoroughly stressed out, slouching over desks for hours, eating badly, smoking, drinking, partying till wee hours and totally out of shape. Besides, they fear medical check-ups because they might show up dizzying high counts for blood pressure, cholesterol and blood sugar. Before they are aware of what hit them, most of them have been laid low by one of the many diseases triggered by a deviant lifestyle.

At clinics around India, the evidence is progressively accumulating. Of the 3,600 apparently ‘normal’ people who signed on with Delhi-based Max Medcentre’s preventive health check-up programme last year, a sample size of 300 was analysed to evaluate the prevalence of lifestyle diseases among urban middle-class Indians. The findings are galling: a whopping 85 had high blood-sugar counts, 58 totted up as hypertensive, 22 had heart problems and 43 had stones in their gallbladders entirely unknown to them. Avinash Phadke, who runs one of Mumbai’s oldest and largest pathology lab, corroborates this disturbing escalation in lifestyle diseases. Of the 1,500 tests done in his lab daily, 500 are "lifestyle-related". Says Phadke: "The maximum increase is in cases of hypertension, diabetes and young heart attacks. More than 30 per cent of the cases we screen show up abnormal lipid (fats) levels, indicating heart trouble. Also, earlier people who’d come in for blood pressure-related tests were at least 35, today a bulk of them are as young as 25."

Now chew on this, and you realise how bad things are: with 10 out of every 100 Indians suffering from blood sugar, India is expected to become the world’s diabetic capital by 2025. Our diabetic population, according to a WHO study, would have shot up to 57 million then, up from 27 million today.

So obvious, in fact, is the linkage between the hectic lives we lead and the toll it’s taking on our health that Delhi’s upmarket Apollo hospital has appointed a counsellor, lifestyle unit, to its Masters’ Health Check-Up programme. The reports that the hospital hands out to those who get themselves tested under the programme are called ‘Lifestyle Assessment Prescription Scans’.

No wonder physicians are full up with horror stories. At Bangalore’s Mallya Hospital, management professionals, software engineers and real estate dealers in their late 20s routinely come in with various manifestations of stress. "People have even been brought in dead by colleagues after they collapsed in office," says consulting physician Sitaram V. Chowti. That’s not surprising: career advancement has become life’s priority for most urban Indians. Ergo, people are increasingly developing competitive, aggressive personalities. "Workaholics who toil long hours struggling to achieve transient goals and covet to be authority figures suffer because of their fixation with results. Their lipoproteins, serum, cholesterol and triglycerides shoot up (dangerously adding to risk of heart disease)," says A.K. Sanyal, medical director at Mumbai’s Jaslok Hospital.

Working hard and playing harder is taking a toll on young promising lives as never before. Sumit Jain, a Delhi-based 32-year-old architect-entrepreneur, suffered a heart attack last March. Eighteen-hour days, over 40 cigarettes, barely a full meal and too many deadlines pushed him to the brink. And Jain’s still hanging in—barely. He wakes up with nausea, suffers at least two panic attacks a day and suffers from asthma every time schedules are derailed. "There’s just too much work and too much at stake if it’s not done. Sometimes I can feel my heart sinking," he says.

The plight of Gopal Ramaswamy, MD of a Bangalore-based infotech firm, is no different. He’s perpetually irritable, screaming at colleagues and family. Marathon attacks of migraine have him skipping work routinely: "I go to bed with my head full of thoughts, I can barely sleep. Then I feel drained through the day. It’s all a part of a cycle—irregular eating, excessive smoking and stress at work lead to migraine and that in turn deprives me of sleep."

Too much of drink and greasy food exacerbates matters. Mohan Isaac, head of the department of psychiatry at Bangalore’s National Institute of Mental Health and Neuro-Sciences (NIMHANS), believes there’s a direct correlation between behaviour and systemic disorders". It’s now fashionable to drink at home and in parties, to go to pubs and bars. Even drinking by the young, indulging in drunken promiscuity is no longer considered taboo," he says. No wonder, says Isaac, over 40 per cent of the beds in the country’s various mental health clinics nowadays are occupied by patients with alcohol-related illnesses, compared to a mere 5 per cent just a decade ago. And a partner in these bacchanalias is fatty, unhealthy food. Add low-fibre, low-nutrition food and aerated drinks, and you have a recipe for obesity. "Obesity is urban India’s new epidemic," declares Sandeep Budhiraja, internal medicine specialist at Max Healthcare.

It’s telling though that most people who walk into Mumbai-based dietician Anjali Mukherjee’s Total Health clinic want to shed weight only to look good. But thorough investigations usually reveal a history of acidity, insomnia, blood pressure and irregular menstruation. "We insist that our clients understand that almost all these degenerative diseases, including obesity, are a consequence of wrong eating and drinking habits and sedentary lifestyle," says Mukherjee.

Tanya Gill, a thirtysomething senior vice-president at a Bangalore-based multinational bank, should know. Her hectic job has her eating whenever, whatever, ordering food in when she returns home late at nights and consuming rich hotel fare on tours. At 5 ft 2 inches and 68 kg, she’s overweight by at least 15 kg, and is constantly fighting flab. She’s been on drastic diets, suspicious slimming supplements and strapped to strange machines in an array of slimming centres. Her concern over weight though were entirely cosmetic, till, two months ago her bank signed her in for a mandatory executive health check-up programme. "I received such a jolt," shivers Tanya, "I always thought I was fat, but I’m fat and sick. Blood pressure, thyroid, I have it all. As if my career wasn’t a hurdle enough, now I have to tackle my health before I can think of having a baby."

Urban India’s newly emancipated women, in fact, are soft targets for stress-related ailments. Hurrying and worrying, they manage their jobs, homes and children. "It’s not coincidental then that just so many more are coming in with complaints of irregular menstruation and unbearable pre-menstrual syndrome," says R.P. Soonawala, gynaecologist at Mumbai’s Breach Candy Hospital. "Drinking, smoking and tension is impacting fertility and birthing processes. Multiplying the chances of miscarriages, and underweight and premature babies." This is further compounded by the new obsession with weight. And what we have is a generation of very stressed-out women. Says Isaac: "We had absolutely no cases of anorexia (not eating at all) and bulimia (overeating) over two decades ago, today they are a bulk of our work."

Budhiraja advocates active vigilance over one’s health in these taxing times. He insists: "Regular health check-ups are imperative for all above 25." But not enough people are doing it. Sanyal of Jaslok Hospital, which runs such check-up programmes, reasons why the queues to these packages aren’t long enough: "Health insurance has hardly taken off and though many corporates are now funding their employees’ regular check-up, they are still not that many. So, it remains the home budget’s backbreaker."

There are alert exceptions though. Like Delhiite Tilak Sarkar, 39, who never forgets to keep appointment with his annual health check-up. ECG, blood tests, lipid profiling, pulmonary system scan, Sarkar puts himself through it all. Chief executive officer of an infotech company, he says there’s just too much to lose if one’s not in perfect shape. "We Indians have recently entered the world of western conglomerates, huge soulless, motherless entities. Hire and fire is the motto of the day, competition is killing. We have to be of sound health and mind to function in this new western market, and a stout heart is a must," he adds.

Cardiovascular diseases are the number one cause of death in developed countries like the US. Today, urban Indians have no reason to feel complacent: unhealthy lifestyles lead to 2.4 million Indians dying of coronary artery disease every year, according to the WHO study. The study also says that Indians are most prone to heart disease. This does not surprise V.P. Reddaiah, head of the centre of community medicines at Delhi’s AIIMS. "We’ve given up nimbu paani for Coke, idli for burger, sherbet for alcohol," he says. "Blood sugar, obesity, heart attacks will only follow."

Not surprisingly, sex, a big stress-buster, has itself become a victim of modern-day living. Sexologist Reddy says patients with complaints of reduced libido are at an all-time high now. With both spouses caught up in careers, there’s hardly any time, intimacy or inclination for sex. He sums up: "Marriages are on the brink of break-ups, anxiety levels are high, people are out of shape, sex is a casualty."

So is sleep, the other soother of frayed nerves. There’s just so much to lose sleep over in these hectic times: jetlagged MNC executives negotiating time zones ever so often, phone calls from headquarters in countries that work when it’s time to sleep here, call centres that have employees on permanent night-shifts, parties that begin past midnight. And tension. "We’re basically living in a 24-hour society now, there’s no well-defined time to sleep," says Dr J.C. Suri, president of the Indian Sleep Disorder Association. As head of the department of sleep medicine in Delhi’s Safdarjung Hospital, Suri is worried at the manifold increase in patients with symptoms of chronic insomnia and hypersomnia (fatigued, sleepy through the day). He’s more worried, though, for the many more who are not seeking medical help. "Popping sedatives available over the counter and relying on alcohol to induce sleep is becoming the practice with many. These only help temporarily because they treat the symptom, not the root of the disease—which is the undisciplined way we live."

Fixing lifestyles means fixing your bad habits. "All lifestyle diseases are preventable, but most aren’t curable," warns Budhiraja. Exercising, eating well, quitting cigarettes and alcohol, learning to relax, spending more time with family and friends is the simplest prescription to ward off these fell diseases. And there’s Sanyal’s final panacea: "What’s needed most today is the urge to live well."

(Some names in the story have been changed.)

Soma Wadhwa With Charubala Annuncio and B.R. Srikanth

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