Diabetes and hypertension in Bhutan

For some years now, I have been wondering why there is a surge in diabetes and hypertension cases in Bhutan. The conventional wisdom, and that’s what the doctors say, is that people need to move and exercise more. While sedentary lifestyle brought about by greater mobility, TV and 3G contributes to the problem, it does not explain why farmers are also grappling with these same health issues. During my time in Sherubtse I carried around one Omron BP monitor and a thermometer (I needed them for myself, actually) and I did some random measurements and found incidences of hypertension in almost all the villages I did my “research”. I am not a medical doctor and so I didn’t prescribe any medicines. But my relatives were very impressed with me. They thought I had mastered even medicines besides engineering.

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Blackened pots are rare sight in Bhutan now

Jokes aside, I have given a lot of thoughts on this and have browsed through several articles and scientific papers. Here are the three major possible causes. These are, obviously, in addition to what the doctors always tell us. These hypotheses are also supplemented by my own anecdotal evidences. I wish I could do a systematic and longitudinal study and collaborate with some medical professionals to make more conclusive claims. However, in Bhutan, research culture is nonexistent or badly under-resourced. In some cases, it is also frowned upon. Hence, to highlight the issue this article should suffice.

  1. Rice cooker

The traditional Bhutanese style of cooking rice involved throwing away the starch. In my family, we fed it to the dogs and used it to pre-dye the threads before weaving. Rice is 92% starch and 8% fibre. Starch, like sugar, turns into glucose in the blood stream and thus the consumption of starchy food can elevate your blood sugar levels. In the early 1980s, Hawkins pressure cooker hit the Bhutanese market and soon after Japanese rice cookers followed. Now Chinese cookers have reached wherever the Bhutan Power Corporation has taken the electricity to. In other words, at least in 95% of the country. The traditional way has almost disappeared because it is more convenient to use the electric cookers. However, when using them, the starch in the rice remains intact. Rice prepared this way is tastier but less healthy. Rice itself is not unhealthy but the cooking method, the amount we eat and the frequency of consumption make it very unhealthy.

Rice is a staple food in Asia. The Chinese, Japanese and Thai people also eat rice. However, they don’t eat the same quantity like the Bhutanese. They eat lots of noodles too. We, Bhutanese, are the only 100-percent-rice-eating-nationality in the world – by far the biggest rice-eaters per capita. We eat for breakfast, lunch, dinner and even as snacks (zow). When I was growing up in Tashigang, rice was only for special occasions. Except in western and southern Bhutan, east and central regions mainly consumed maize, buckwheat, wheat and millet. Now it is rice everywhere – and in every meal – not even every day.

  1. Doma

7tv6si2wjhseWhat is known as doma is composed of three ingredients – betel leaf, areca nut and slaked lime. Besides the known fact that betel nuts are carcinogen (causing oral cancer) while lime erodes stomach linings (leading to gastritis, ulcer and stomach cancer), eating doma causes taste buds to become progressively insensitive. This makes one to add more salt or sugar to feel the taste of the food.

  1. Geography – altitude

A study in the US was done to see if altitude changed our taste sensory. The research studied a group of participants at 3,500 meters above sea level for a period of three weeks. The subjects were asked to rate four compounds representing sweet, salty, sour and bitter taste over the period.

The result? An increase in the taste thresholds for glucose (sugar) and sodium chloride (salt). In other words, the participant felt that the same amount of salt and sugar they consumed at sea level was not adequate anymore. In fact, that’s the reason why airline food tastes bad, which also explains why cabin food comes with additional packets of salt, sugar and pepper. You would have noticed that if you live in Thimphu or Paro and you descend to Phuntsholing or Bangkok (lower altitude) you will find yourself hungry all the time. That’s because your taste buds work better and the increased oxygen at low altitude burns the food faster in your body.

What can you do?

Unfortunately, we can do nothing about the altitude but just know the fact that our body requires less salt and sugar than our taste buds ‘feel’ the need.

And then there are few things that are in our control.

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I eat so little rice and my host said, “That’s like the amount we offer to deities”.
  1. Return to traditional cooking style. Remove the starch when cooking or throw away the rice cooker. It is an additional work but better than losing your health. Cook the traditional style. Otherwise, reduce rice consumption and replace with local choices such as khulay (buckwheat pancakes from Bumthang) roti (from Southern Bhutan) or mix rice with kharang (maize from Eastern Bhutan). Buy Bhutanese. It will be good for our farmers; it will help ensure our food security because bulk of rice we consume is imported; and you have reduced risk of being diabetic. I normally switch between rice, pasta and bread. When I was in Kanglung I ate lots of kharang. Make small changes. Take baby steps. Don’t jump from rice to kharang in one day. Your body will go mad.
  2. Be careful with salt. Salt is cheap and
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    Japanese meal. Notice the rice portions and compare this with above picture

    easily available nowadays. When I was growing up, salt was in very limited supply (we rationed it very carefully). Besides, refined sugar or candies were totally unknown. Thais, Japanese and Chinese people hardly use salt in their cuisines – preferring soya sauce instead. Not to be culturally insensitive, but our suja is, health-wise, one of the worst drinks our forefathers invented. It is a bomb. It has saturated fat (butter), lots of salt (which saturates the butter even more) and an unknown and imported “tea” that comes mixed with baking soda (not sure of this chemical components either).

  3. Stop eating doma. Your taste buds will return to normal and food will taste better. And the town will be lot cleaner too. Forget the pact with Guru Rimpoche. That’s a myth.

(PS: The reference links to some of the articles have been provided in the article)

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Rice is not even eco-friendly – requiring lots of water to grow.

 

Trust our own doctors

Earlier this year I had a mild discomfort in my upper abdomen that radiated to my back. I went to see Dr. Sonam Dukpa (at Menjong Diagnostic in Thimphu). He ran an ultrasound on me and found that I had a mild inflammation of my gallbladder. He packed me off with, “It happens. Nothing serious. No chilli or fats, lots of water and exercise. Come back only if you have fever. Not prescribing you anything.” Dr. Sonam often talks in phrases. I have known him for years. I went away little perplexed though. But I followed his advice. Drank lots of water (I still do), avoided chilli (I don’t eat meat) and, of course, walked for three full days – trekking to Athang Rukha.

A week later I happened to be in Bumthang where I took the opportunity to meet my family lama, Rangshikhar Rimpoche. In between talking about my siblings about who is where and how they were doing, I sought his advice; some divination to check if my life energy was running low. After going through several scriptures and his prayer beads he pronounced, “There is nothing bad happening to you. You will be alright from the 29th day of this month. Last year was astrologically a bad year for you. So, some residuals extending to few months this year,” he reassured me. He was terrific always but he continued, “I think it is good that you fall sick sometimes because when you are healthy you forget your Lama, your family, your friends and, above all, to be pray.” I burst out laughing. “Yes, Lama, you are absolutely right,” I replied, accepting it for it was true. I am bit careless.

Then a month later, transiting through Bangkok, I decided to see a doctor there. So I went to a hospital. I thought I might as well get a second opinion. The doctor there run the ultrasound and the blood test again. And found that my gallbladder was OK. Dr. Sonam Dukpa was right and so was my lama. The blood report, however, showed a slightly elevated bilirubin – indicating some problem with liver but not that high. Instead, he prescribed me some tablets to reduce my back pain – to be taken for 7 days.

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Few days later in Chiang Mai, over a breakfast, I was chatting with a German filmmaker and a friend of mine, on what we were working on – in terms of films and documentaries. He told me that he was doing something on the failure of allopathy. He went, “I don’t mean that western medicine is flawed but pharmaceutical companies are driven by profit thereby making people dependent on drugs they produce. They even have doctors, on their payroll, all over the world, prescribing medicines that we actually don’t need. We are getting poisoned legally. The world is sicker than ever. Did you ever ask why?”

“Wait!” I thought, “I have just been prescribed with some tablets in Bangkok.” While he was still going on with all the global pharmaceutical scams I ran a search engine on the medicine I had started taking. And Lord Google gave a shocking verdict. “Not approved for USA and Canada as extended use can cause cardiac arrest, heart disease and lever failure.” “What?” I thought, “The doctor who diagnosed that I had high bilirubin prescribed me that?” Bad news: I had already taken one pill. Good news: I had not taken the other 6. I dumped the $50 worth of medicines, the $150 in consultation fees into the garbage. I also realised that a strip of antibiotics that costs Nu. 40 in Bhutan costs around Nu. 400 in Thailand.

Having found my mini ‘enlightenment’ I started to be more regular with my 4 km daily jogging routine. The pain began to subside. As for my elevated bilirubin I emailed the medical report to Dr. Tshewang Dolkar (a traditional medicine practitioner based in New Delhi) who sent me some herbal medicines. I am alright now.

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Role model – His Majesty with the medical team that assisted during the delivery of Gyalsay. While it is fashionable to fly to Bangkok, our prince was born on the Bhutanese soil

I am sharing this story because I know many people rush to Bangkok or Delhi on a slightest medical issue. Many pregnant women fly just to deliver babies. Well, just be careful. There is an industry out there. I don’t mean to generalise. In fact we had an excellent Thai doctor who attended to my wife when she had that head injury some years back.

You can avail of great diagnostic services that they offer. I still do my annual health check-up in Delhi or in Bangkok. What I am saying is to be careful with excessive, or unnecessary, use of pharmaceutical products – especially antibiotics and vitamins. Ask what you have been prescribed. Cross check with Dr. Google. Can you type? Of course, you can, right? Do it!

And trust our own doctors in Bhutan who are not profit driven. They might ignore you, frown at you or scold you. Just close your ears but take their good advices. I am also happy that the Health Ministry has cautioned doctors to be less generous with prescriptions. For certain ailments you can also try the traditional medicines hospital in every district. Get the best of both worlds – western and Bhutanese.

And finally, do not forget to say your little prayer every day – and move.

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The Life Guards – His Majesty, Her Majesty and the new-born Crown Prince with the medical practitioners of Thimphu.