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Dr Bala Ambati
Dr Bala Ambati


Sugar, high BP no eye candy


The eye is the only part on the exterior of the body where a physician can view the nerves and blood vessels. As such, not only is the eye a window to the soul but it is a vista to examine the health of a person. Two of the most common conditions affecting health are diabetes and hypertension, both of which afflict India disproportionately. Sixty-two million Indians have diabetes, a figure that will rise to 80 million by 2030. Almost 30 per cent of Indians have hypertension. Both of these conditions can damage vision, directly and indirectly.

Diabetes causes blood vessels to leak, leading to swelling in the macula—the part of the retina that is responsible for central vision. Leaky blood vessels cause progressive but generally slow loss of central vision. Further, diabetes restricts the oxygen supply to the retina, causing the growth of abnormal vessels that can bleed and cause sudden loss of sight.

Hypertension, or high blood pressure, can be very damaging to the eye, narrowing blood vessels, decreasing oxygen supply, and even causing bleeding. It can also contribute to mini-strokes in the retina and optic nerve. All of these lead to loss of vision.

An unhealthy diet, especially high sugar and salt intake, lack of exercise, poor sleep, stress, sitting for long periods and genetic factors are the principal risks for diabetes and hypertension. Diabetes and hypertension can cause damage to many different organs, causing heart attacks, strokes and kidney failure. But going blind is probably what people fear most, next to losing life.

Many people drive to work, sit at a desk all day, drive back home and sit in front of the television in the evening. For this group, it is important that they work to minimise the amount of sitting time, and that they cultivate activity wherever possible. Beyond cutting sweets and salt, I also recommend adding yoga, taking walking breaks periodically during the workday, alternating cardio workouts with strength-building exercises, protecting sleep schedules by turning off TVs, computers and smart phones an hour before bed and reducing stress.

Sleep apnoea, manifested by snoring or not breathing in sleep, makes diabetes and hypertension worse. It also impairs blood flow to the eyes, making many eye conditions worse. So to married couples, if your spouse is not sleeping properly, this can be a serious medical problem. Fortunately, there are treatments for sleep apnoea that are shown to work such as CPAP, Provent, weight loss and rarely surgery.

Our doctors often tell us to focus on getting fasting blood sugar down below 125, the haemoglobin A1c below 7 and blood pressure down to 120/80. These numbers can sound abstract and it is easy to adopt a “who-cares” attitude. But, reaching and maintaining these goals will prevent complications from diabetes, one of the most devastating of which is vision loss. So remember, your doctor may be stressing on the numbers in the cause of extending and improving your quality of life.

Sometimes patients take their diabetes or blood pressure medicine only on the day of the doctor’s visit just to please the doctor. Obviously, that is counterproductive. Learning to examine the eyes properly can tell the primary care doctor whether the patient really is controlling their blood sugar and pressure on a long-term basis. There are instruments to aid in the diagnosis and monitoring of diabetic and hypertensive eye disease. Remember if you don’t look, you won’t find!

I have taken the liberty of offering some nutritional recommendations for patients with diabetes or hypertension, and I would look forward to suggestions from nutritionists and physicians on making this list better, and from patients and the public on how to integrate these into exciting recipes.

For patients with diabetes or pre-diabetes, try the following nutritional modifications:
* add food with a higher protein-carbohydrate ratio and decrease simple or refined sugars
* use whole grains rather than processed ones
* use grain with a higher protein and fibre content rather than grains low in protein and fibre like white rice, yellow or white corn and processed white flours
* increase intake of fruits like pomegranate and raspberries
* decrease sugar in baking and use agave, cinnamon or stevia instead
* decrease simple sugar food like potatoes and processed snacks
* add vegetables like fenugreek and nopal (prickly pear)

For patients with hypertension, try:
* increasing intake of food higher in potassium—apricots, coconut water, spinach, acorn or spaghetti squash, grapefruits or prunes and their juices, kiwi, sweet potatoes or yams, white beans, bananas and beet greens
* increasing food rich in calcium—yoghurt, milk, cheese, spinach, kale, turnip greens and fortified orange juice
* adding vitamin D supplementation (2,000 to 5,000 u/day)
* increasing food rich in magnesium—cashews, almonds, pumpkin seeds, sesame seeds, spinach, kale, lentils (white beans, garbanzo beans, kidney beans), figs and dark chocolate
* reducing sodium—frozen food, packaged snacks, canned or pickled food, instant food and cured meats or fish

The views expressed here are strictly those of the author and the university takes no position on these.

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