A Sweet life without sugar

TODAY IS International Women’s Day, the occasion on which the world officially celebrates the social, economic, cultural and political achievement of women.
Like other countries, Thailand has many women who merit that honour, among them Professor Emeritus Dr Wannee Nitiyanant of the Faculty of Medicine at Siriraj Hospital, a specialist in endocrinology and metabolism, who has been passing on her knowledge to medical students and doctors for more than four decades.
A long-time social advocate on health issues, Dr Wannee recently turned 72, but has shown no signs of slowing down, and is as active as ever in masterminding the country’s many health campaigns.

The president of the Diabetes Association of Thailand under the patronage of Her Royal Highness Princess Maha Chakri Sirindhorn, Wannee organised a four-kilometre run-walk and a seminar on diabetes in women to mark World Diabetes Day. 
Diabetes is a massive global problem and Thailand is as affected as anywhere. Recently published World Health Organisation statistics show that the number of people with diabetes rose from 108 million in 1980 to 422 million in 2014 and that it is especially prevalent in middle and low-income countries.
Diabetes is a major cause of blindness, kidney failure, heart attacks, stroke and lower limb amputation. In 2015, an estimated 1.6 million deaths were directly caused by diabetes. Already on the global agenda since the beginning of the century, world leaders recently committed to reducing premature deaths from non-communicable diseases (NCDs), of which diabetes is one, by one third by 2030 as part of the Sustainable Development Goals. However, recent WHO reports indicate that the world will struggle to meet that target. Unhealthy diets and physical inactivity are major risk factors for chronic disease. 
Dr Wannee, who is also president of the Royal College of Physicians of Thailand’s Network of Fatless Belly Thais and the Thai NCDs Alliance, emphasises the importance of personal and family health care and diet, adding that the current rate of women with diabetes is high, especially in those who are overweight or obese
“Women are at greater risk for diabetes than men because of their body physique, eating habits and lack of exercise. The risk of diabetes increases during pregnancy if the mother doesn’t take good care of herself. For every woman with gestational diabetes mellitus (GDM), the risk continues even after childbirth and there’s always a chance of diabetes returning in some cases within five to 10 years. The 24th week of pregnancy onwards is when the risk is highest due to the development of the placenta, which involves the increase in hormone production causing insulin resistance. Other risk factors relate to genetics, being overweight, history of abnormal pregnancy or miscarriage. Therefore, it is important to have screenings for gestational diabetes and always follow the doctor’s instructions to prevent or take care of GDM as well as regular checks for diabetes for years afterwards. Moreover, women are also more likely to develop diabetes, due to insulin resistance. These are the factors that make women more vulnerable to diabetes than men,” she tells The Nation.
Diabetes, she stressed, can be prevented through diet, exercise, getting enough sleep and avoiding stress, alcohol and smoking. Interval health checks that include a diabetes test are important especially in those aged 35 and older as is weight control. Poor health can easily be identified by simple checks at home – calculating BMI, measuring waist and height [waist should be half the height] and taking blood pressure.
“Many people don ‘t know they have diabetes until their blood glucose level is more than 200 mg/dl. Indeed, they already have diabetes if the level is higher than 125 mg/dl. This is the reason why diabetic screening is very useful in preventing further development of the disease as at this stage it can be controlled by simply adjusting the diet and regular exercise without any need for medication.
“A survey of Thai people’s health found that in 2014 there were 4.8 million diabetic patients compared to 3.3 million back in 2009. This shows an average increase of 200,000 patients each year,” Wannee says.
“The development and severity of the disease has not changed much. What has changed is the rapid increase in the number of patients and that is mainly due to lifestyle. 
“Medical students these days learn about the disease and are well-versed in the latest findings. Education is much more open than in the past. Students should be capable using their knowledge and carefully examining patients in order to identify the disease and prescribe appropriate investigation and treatment protocols. Diabetes is a complicated disease because a patient may present with a variety of symptoms,” she says. 

“In fact, living as if you have diabetes is a superb idea because usually the diet of those already diagnosed with the disease is healthy. To achieve energy balance and a healthy weight, limit energy intake from total fats, shift fat consumption away from saturated fats to unsaturated fats, and eliminate trans-fats. Also limit the intake of free sugars, and limit salt consumption from all sources,” she advises.
“As part of Thai NCDs Alliance campaign, we advocate national or public policies that promote the health and wellbeing of Thai people Last year, we saw government impose a sugar levy but we won’t see the effects until 2019. Not only taxation, but also non-tax measures will be implemented in parallel. Food advertisement and promotion, especially to children, should be limited. We are really looking forward to seeing the outcome. 
“However, Thailand is moving towards an ageing society and child obesity is a major problem. Women have an important role in the prevention of diabetes not only for themselves but also for their entire families as they oversee the wellbeing and diet of their loved ones. 
“A wealth of scientific evidence and my experience tells me that NCDs can be prevented. Good health is a necessity and one must act now – otherwise it will be impossible to prevent and control diabetes and other NCDs,” Wannee stresses.