Viswanathan Mohan Part 4, The Cost and Cause of Diabetes in India

In part 4 of this Exclusive Interview, Viswanathan Mohan talks with Diabetes in Control Publisher Steve Freed about the the evolution of the Indian lifestyle leading to the increased incidence of diabetes.

Viswanathan Mohan, PhD, MD, DSc is the chairman of Dr. Mohan’s Diabetes Specialties Centre and president and director of the Madras Diabetes Research Foundation in Chennai, India.

Transcript of this video

Freed:  The type 2 diabetes at least here and I presume in India is a lifestyle driven disease.

Mohan:  Yes.

Freed:  And so, how do you account for so many people in India? I know there’s a lot of rice obviously and carbohydrates is probably king.

Mohan: Yeah.

Freed:  I saw a short of diabetes in India and all they showed was people going into these bakeries and eating all these carbohydrates. It doesn’t take a genius to figure out why there’s so much. But the cost is about 300 — if you include all the cost, missing work and everything, the cost here is about $350 billion for just the 25 million. I can’t imagine what the cost is in India.

Mohan:  Let’s get back to the causes. So, I mentioned that in 1970s when I was very much there, I was already in medical school at that time and we had 2% of diabetes. And today if we have 24% diabetes, now that’s in a period of 40, 50 years time that this has happened. And what I very simply say is that the genes didn’t change in 40 years. My genes didn’t change in 40 years. The population’s genes didn’t change in 40 years. What changed was the lifestyle. So, two things happened, one was that people of course got a little richer and more affluent because they could afford more. And the first thing they do is to eat more. And what would they eat in India? They would eat rice, in South India. In North India, they would eat wheat which is pretty much the same. Refined wheat and refined rice. And rice, we have shown extensively in our study, and tomorrow in the debate I’m going to show all these data, that it’s the carbohydrate which is one of the major drivers of the diabetes epidemic. So, you may say, “Well, they’re not taking carbohydrates in 1970s,” they were taking carbohydrate but that rice was a little different. What the rice they used to take then was a hand pounded rice, it was brown rice. So, the husk was still there. They had not polished it as much as — the rice mills came to India in the late 70s, so until then there were no rice mills. So, in a local — the corner store would just pound the rice and give it to you and that’s it, and then you cook it. That’s actually healthier. When the rice mills came, they started polishing the rice more and more and more, and so it got whiter and whiter and whiter, and people like that, “Oh, really white nice rice,” but that’s pure starch. It’s pure carbohydrate. Everything else is gone. The B complex is gone. The protein is gone. The fiber is gone. Everything is gone, so that’s one big change.

The other thing which happened was that although they would eat the rice at that time, they did a lot of physical activity. So, they were working in the fields and they’re mostly agriculturers plowing the fields and working the whole day. Now, even in the rural areas where the agriculture is, they’re sitting on tractors. They can easily get a loan. And so, they’re sitting on tractors, so the physical activity is gone. In the urban areas, people didn’t have cars or scooters or motorbikes. They would walk to work or they would walk to a bus stand and then walk from there. There was a lot of walking involved. Now, anybody can get a motorbike or a scooter, and so the physical activity has kind of gone down. The quantity of rice and the carbohydrates have gone up; along with that when all the McDonald’s come in and all the fast foods come in, then a lot of junk food also goes in, so the fat intake also goes up, the calories go up, the sugar goes up. So, when you start drinking your Coca Cola or your Pepsi and all the sweetened drinks, the beverages, then your sugar intake also goes up. So, you already have a huge carbohydrate load, on top of that you have your sugar, and then, now we’re really asking for trouble because we already have the genes, ’71 the genes were there. But my father used to say that when the Indians migrate, they go to the UK or the US, they get diabetes. They don’t get it in India. Last year we did a study where we compared the Indians living here with the Indians in India. And it’s actually higher there now, because people here have started looking out at themselves. They’ve started exercising, they are more literate, they’re more educated, and so on. And that’s not happened in India. They’re still worrying about the communicable diseases. Nobody is thinking about diabetes and so they’re putting on more weight. The education levels are just catching up. So, we have a bigger problem in India now there than the Indians living here.

Freed:  Do you find that the medications that are available here and very expensive are available in India, like the SGLT2s, GLP-1s?

Mohan: We have them all. One of the things which is good is that the prices are not the same.

Freed:  Right.

Mohan:  So, they have a country-wise pricing. So, anything which costs, let’s say, $3 or $4 here would probably be half a dollar there. Okay. So, it’s about eight times cheaper. It’s still expensive by Indian standards because the Indians also earn that much less. We don’t earn in dollars. We earn in Rupees. So, it’s still — if you calculate the purchasing power parity, the PPP, it’s still expensive but at least it’s not as expensive as here. Insulin is also much less expensive. And then what happens is that of course we can’t get the SGLT2s and the GLPs, we cannot get the generics. But the others, the moment that they go off patent then the Indian companies make them. And the Indian pharmaceutical industry is very strong, very, very strong. So, the moment they go off patent, they’ll make the drug five cents and then everybody can afford it.

Freed:  But even today an American can go online and order drugs from India.

Mohan: Yes, you can. In fact, your Metformin comes from there. Fifty percent of all your Metformin is generally —

Freed:  But Metformin is only a $3 drug. So, imagine you could buy at Walgreens for free. But the expensive drugs–

Mohan:  SGLT2.

Freed:  Because even I for myself I go online to overseas pharmacies that I can trust.

Mohan: To Canada.

Freed:  And when it comes, I can see that it’s made in India.

Mohan:  Yeah. Oh, it’s made in India. (Laughs) Okay. You know, the pharmaceutical industry is very strong there. Yeah.

segment:

Return to the main page.