With culture, situation, market and modernity making people less mobile physically, Kashmir is gradually emerging as the new capital of chronic metabolic syndrome. Women are suffering seriously on that count, reports Insha Shirazi
Metabolic syndrome is a cluster of conditions that increase the risk of heart disease, stroke, and diabetes, and Kashmir seems to be its capital. A study Prevalence of the Metabolic Syndrome in Jammu and Kashmir: A Cross-Sectional Study published in the Journal of the National Library of Medicine suggested a staggering 84.5 per cent of the population is diagnosed with the syndrome.
Females seem to have pushed males aside. Another study suggested 81.8 per cent of female diabetics had hypertension in comparison to 65 per cent of male diabetics. Almost 70 per cent of the study subjects had central obesity, with nearly 90 per cent of females having a waist circumference of more than 88 cm in comparison to only 41.3 males suffering at the same pace. This difference was found to be statistically significant.
In 2018, a study published in the Journal of Epidemiology and Global Health reported the prevalence of metabolic syndrome in Kashmir was 32.4 per cent among adults (30-70 years), which is higher than the national average.
Current Condition
Endocrinologist, Dr Peerzada Ovais Ahmad sees almost 30 metabolic syndrome patients at the newly floated Ujala Cynus Super specialty hospital in Srinagar. “It is a preventable and treatable condition,” Ovais said. “Making lifestyle changes, such as adopting a healthy diet, increasing physical activity, and losing weight, if necessary, can help manage metabolic syndrome.”
Dr Sharik Masoodi, a senior Endocrinologist at SKIMS, lamented the lack of awareness among doctors, teachers, and the media. “In our daily OPD, we routinely see 200 patients. Of them, half are suffering from Obesity Metabolic Syndrome,” he said, informing that PCOS (Polycystic Ovary Syndrome) and fatty liver is quite common. “Some patients suffering from PCOS are bothered about acne, hair growth, and infertility. We, however, evaluate them for a basic condition called metabolic syndrome keeping the fatty liver, and hypertension, in mind.”
Metabolic syndrome envisages abdominal obesity, high blood pressure, high fasting blood sugar, high triglycerides, and low HDL cholesterol.
“The development of metabolic syndrome in Kashmir is caused by various factors,” Ovais said. “These include obesity or overweight, a sedentary lifestyle, lack of physical activity, smoking, genetic predisposition, obstructive sleep apnea, and PCOS. Being overweight or obese is a significant risk factor for metabolic syndrome, as excess body fat can cause insulin resistance, high blood pressure, and abnormal cholesterol and triglyceride levels. Insulin resistance occurs when the body’s cells become resistant to the effects of insulin, a hormone that regulates blood sugar levels, and can lead to high blood sugar levels and an increased risk of developing type-2 diabetes.”
Traditionally Kashmir diet suits the metabolic syndrome as it is high in carbohydrates and fat, and low in fruits and vegetables. “Additionally, cultural factors that discourage physical activity and promote sedentary behaviour may also contribute to the development of metabolic syndrome,” Ovais said. “Pollution and exposure to toxins may also play a role. Even the political turmoil and conflict experienced in Kashmir over the years may have had negative effects on the environment and public health.”
PCOS
“Women tend to have higher levels of estrogens than men, which can affect how fat is distributed in the body,” Ovais explained. “Estrogen promotes the storage of fat in the lower body (hips and thighs) in women, while in men, fat is more likely to be stored in the upper body (belly and waist). This may explain why women with metabolic syndrome are more likely to have belly obesity as a symptom.”
“Women are more likely to experience hormonal changes throughout their lives, such as during pregnancy or menopause, which can also affect how fat is stored in the body. These hormonal changes can contribute to the development of metabolic syndrome in women,” Ovais added, insisting cultural and social factors permit limited physical activity for women.
“I have PCOS for the past two years and the cause is the metabolic syndrome, stress, lifestyle, and changing habits,” Sabira, a university student, said. “I was taking too much junk food in my college and I use to have pizza and burgers all day.”
The prevalence of PCOS among Kashmiri women is 28.9 per cent. According to the ICMR, 34.3 per cent of Kashmiri women meet the Androgen Excess (AE)-PCOS criteria for PCOS.
Processed Food
Off late, newer causes have flooded the market. Junk food, processed foods and diets contain high amounts of Ajinomoto (tasting powder), often high in sugar, saturated and trans-fats, and refined carbohydrates, leading to obesity, insulin resistance, and other risk factors for metabolic syndrome, doctors said. Mushrooming of restaurants is being seen as a contributor to the high incidence of the syndrome.
“I am a restaurant owner and I run the mess of the Islamic University of Science and Technology (IUST) hostel for the last 18 months,” Khawaja Itrat, promoter of Cook Book Restaurant said. “The food is generally unsafe as food safety standards are poorly regulated. The use of Ajinomoto (monosodium glutamate) commonly known as tasting powder is a very harmful chemical and it is used abundantly in our foods that cause many diseases.”
Before coming home and starting his venture, Itrat lived in Bangalore and Chandigarh. “They do not use tasting powder that much as we see in Kashmir. I was shocked when I went to the wholesale market and found the consumption of this nasty powder,” Itrat said. “People who do not wish to use this powder are compelled because of competition.”
Poor Regulation?
Though the Department of Food Safety has run many campaigns to bring awareness related to the safety of food, it is hardly impacting ground zero.
“In the last year we have generated campaigns through TV, Radio like thoda sa kam namak, thoda sa kam cheeni, and banners to create awareness for the general masses. We have organized 145 melas in small districts of Kashmir,” Shakeel-u-Rehman Rather, Commissioner of Food Safety and Controller, Drugs and Food Control Organisation, Jammu and Kashmir said. “I have generated a circular also that wearing gloves and a mask is mandatory while making some food. We have fined some shops also. Clean Street Food is a new initiative that ensures the designed clean food. Now we are covering Khayam and then Hari Singh High Street.”
Rather said the law is being implemented, unlike past. “Last 10 years saw 195 unsafe food cases. Now we have 3525 cases of substandard or expiry date products, miss-branding (best before date missing),” he said. “In 13600 cases 2-4 are from unsafe food that means over a while the trend of unsafe is reducing and the substandard food is also declining.”
Insisting that Kashmir consumes a lot of bakeries, Rather said his department is warning bakers to discard the use of Vanaspati and palm oil and use butter and ghee because they contain less trans fats. “Nearly 30,000 schools have been registered under eat right campaign. We have certified restaurants, school canteens, and 8-10 medical canteens,” he added.
Quick Responses
Doctors insist that awareness must be the top priority. People need to be told about the importance of having chemical-free food. People running restaurants must be told about the disadvantages of using tasting powder as it is harmful. “Apart from physical exercise, doctors advise eating organic foods, whole-grain bread, or brown rice and avoiding using technology for any physical labour by turning off the TV, refrigerator, and lights. “The disease calls for modified consumer behaviour,” Ovais said.
