2019 Forecast: Health

Radical Fitness

Madhavankutty Pillai has no specialisations whatsoever. He is among the last of the generalists. And also Open chief of bureau, Mumbai  
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Wellness this year will be an interesting mélange of probiotic foods, secular mindfulness meditation, wearable technologies, cannabis drinks and more

IN IMPOVERISHED SOCIETIES, the health of a people is determined by how easily or early they die. In relatively affluent societies, the measure becomes the numbers afflicted by lifestyle diseases. Lifespans are greater but corpulent bodies gradually whittle away from ailments like diabetes, which are contained through medication. India is transitioning into the latter zone and the health of Indians is on a decline going by the rise in lifestyle diseases. India is recognised as the diabetes capital of the world. A study conducted by the Indian Council of Medical Research (ICMR) estimated that deaths as a result of Non-Communicable Diseases (NCDs) stood at 37.09 per cent of all deaths in 1990. By 2016, it was at 61.8 per cent. Year 2019 will not see much of a difference in this trend. More people will contract hypertension, diabetes, various cancers, and have cardiac arrests and strokes. But at the same time measures to counteract such diseases are also increasingly gaining traction. The numbers are increasing but individual initiative can prevent one from being part of it.

Last year, one of the key obsessions of the overweight, health-fraught Indian shook a little. Once into your 30s, a high level of cholesterol in the blood is associated with a heart attack around the corner. Last November, the American Heart Association came out with new cholesterol guidelines after five years. And while it still holds on to the idea that LDL, popularly known as ‘bad cholesterol’, is better off as low as possible, medication is not necessarily the first recourse to remedy it. A Washington Post article said that the new recommendations had noted ‘that people should try to achieve [lowering LDL] first by living a healthy lifestyle, starting in childhood. That includes diet and exercise, controlling blood pressure and avoiding smoking, among other measures. When those steps aren’t sufficient, the guidelines again endorse statins as the cornerstone of preventive treatment for people at risk of disease.’ Indian doctors are trigger-happy prescribing statins to keep cholesterol levels low. Given that the one-size-fits-all strategy for cholesterol is now being questioned, this might be the year that the Indian medical profession, belatedly as usual, follows suit in asking patients to reform their lifestyle before taking medication.

A community that feels particularly vindicated about the new cholesterol guidelines is that of the low-carb-high-fat eaters. Known as the LCHF diet, an extreme version of this is the ketogenic or keto diet, where the total amount of carbohydrates permitted to be consumed in a day is less than 20 to 30 grams (for comparison, just a fistful of rice would be about double that limit). Last month, when Google released its ‘Year In Search 2018’, keto was found to be the most googled diet. The LCHF community has long challenged the correlation between intake of fats and cholesterol. They attribute carbohydrate, especially refined grains, as the ultimate food evil, and increasingly studies are reinforcing some of their positions. In India, a doctor who finds a patient going on the diet actively discourages him. But with fats getting an image makeover, they might have to veer around here too. Especially coconut oil, which till recently was thought to be unhealthy for the heart, is now gaining a reputation for the opposite. Even ghee, an Indian staple, is a leading member of the eat-fat-to-lose fat trend.

Given that foodgrains, pulses and lentils, which make up most of India’s food, is pared down to minimum in LCHF, there haven’t been many products to cater to this diet or restaurants which serve LCHF food. That will change in 2019. Already, you find eating outlets in some of the wealthier parts of cities like Mumbai having a supplementary keto menu. And home-delivery grocery services have started stocking up on keto products. Youtube channels of keto cooking are increasing exponentially in the number of followers they have. Headbangers’ Kitchen, a channel run by a heavy-metal musician doubling up as a keto cook, has more than 300,000 subscribers. There are also tiffin services now that serve keto food at home, prohibitively expensive at present given that economies of scale have not caught up but as demand increases, costs will reduce further increasing demand, a process that should get a fillip in this year.

In India, a doctor who has a patient going on a low-carb-high-fat diet actively discourages him. But with fats getting an image makeover, the approach may change

TOWARDS THE END of every year, the American College of Sports Medicine (ACSM) conducts a survey for the fitness trends for the coming year. For 2019, they asked over 2,000 fitness professionals from all over the world, including India. The number one trend was wearable technology, second place was group training and after that came High Interval Intensity Training or HIIT. The survey’s summary said, ‘Wearable technology took over the #1 spot for 2019 after dropping to #3 in 2018, which may be the result of manufacturers correcting some monitoring inaccuracies of the past. HIIT, the #1 trend in 2014 and 2018, fell to #3 for 2019. Group training made a significant return in 2017 as the #6 trend and has been the #2 trend for the past 2 years (2018 and 2019). Fitness programming aimed at older adults has regained some popularity after falling out of the top 10 trends in 2017, appearing at #9 in 2018 and now #4 for 2019. Bodyweight training first appeared as a fitness trend at #3 in 2013 and has been a top five fitness trend since that time, realizing a peak as the #1 fitness trend in 2015. In 2019, bodyweight training is the #5 fitness trend.’

Just how much wearables were revolutionising fitness and healthcare was evident a couple of months ago when the latest edition of the Apple Watch had as a feature the ability to take ECG readings, something that till recently needed an entire array of plugs and wires to be hooked to the body. But it is only the beginning. Other health indicators like blood pressure and blood sugar will be available at a finger tap. When Apple Watch comes out with its new version this year, some of these new diagnostic features will become mainstream while also prodding wearers into becoming more fit. Competition is also increasing in the space. Google might coming out with a Pixel Watch and enter the wearables space this year. Interfacing wearables data with medical professionals in the service of preventive healthcare is a service that is being provided even by Indian startups like GOQii. As wearables become better at their job, so will the connectivity to doctors and coaches who will process the information to tell you what to do about it.

Some of the other trends to watch out for as per the ACSM survey was ‘mobile exercise apps, worksite health promotion and workplace well-being programs, outcome measurements, and postrehabilitation classes.’

This might be a year for the hard-lining of faith. With elections imminent, it is inevitable that there will be attempts at polarisation of religions and that doesn’t bode well for the mental wellness of Indians. Consciously insulating oneself from such social pressures might be helpful and a recent trend in spiritualism that goes by the label of ‘secular mindfulness’ could be of use in this. Mindfulness is a Buddhist meditation practice but in secular mindfulness it is done as a mental exercise, practiced without the baggage of religion. A number of schools in the US have begun incorporating the practice for their students. It helps to improve memory, reduce stress and anxiety, aids in better sleep and so on.

Cannabidiol, an active ingredient of Cannabis, has been found to be effective in treating medical disorders such as insomnia, chronic pain and anxiety

Some interesting medical advances are also promising healthier minds. So far, the main line of anti-depressant drugs were those that increased the uptake of ‘happy’ hormones like serotonin by the brain. But now a radical new class of anti-depressants, based on psychedelics might be on the anvil. Psychedelics, like LSD and ketamine, were for decades proscribed as narcotics. In recent years, researchers have found utility in them for mental health. One of the ten best books of New York Times of 2018 was How To Change Your Mind by Michael Pollan. It was about ‘What the New Science of Psychedelics Teaches Us About Consciousness, Dying, Addiction, Depression, and Transcendence’. Pollan, a food writer, did a complete overview of research into psychedelics and also consumed them himself for the first time in his life. He returned from his ‘trips’ convinced about their efficacy. A review of his book in the New York Times had noted, ‘Disclaimer aside, nothing in Pollan’s book argues for the recreational use or abuse of psychedelic drugs. What it does argue is that psychedelic-aided therapy, properly conducted by trained professionals — what Pollan calls White-Coat Shamanism — can be personally transformative, helping with everything from overcoming addiction to easing the existential terror of the terminally ill.’ While it is too early for the medicines derived from psychedelics to be available, Stat News quoted Dr Rick Doblin, founder and executive director, Multidisciplinary Association for Psychedelic Studies, saying that in 2019 ‘more scientific research will be happening into the therapeutic uses of psychedelic compounds than at any time in history…We can also expect — though it’ll take lots more work! — the continuing destigmatization of psychedelic research worldwide, including (hopefully) more funding support for nonprofit psychedelic research from individuals and institutions across the political spectrum. Our work is cut out for us, but psychedelic science is here to stay.’

Another infamous product turning into a wellness favourite is cannabis. Medical marijuana is already legalised in countries like the United States. Late last year, the UK too allowed doctors to prescribe it. Cannabidiol or CBD, an active ingredient of cannabis, is the compound that is showing numerous medical benefits. According to a Harvard Health article, ‘CBD is commonly used to address anxiety, and for patients who suffer through the misery of insomnia, studies suggest that CBD may help with both falling asleep and staying asleep. CBD may offer an option for treating different types of chronic pain. A study from the European Journal of Pain showed, using an animal model, CBD applied on the skin could help lower pain and inflammation due to arthritis. Another study demonstrated the mechanism by which CBD inhibits inflammatory and neuropathic pain, two of the most difficult types of chronic pain to treat. More study in humans is needed in this area to substantiate the claims of CBD proponents about pain control.’

CBD IS NOW BEING tested to become part of mainstream food products that might soon be available on the shelves. An report prophesised that ‘cannabis drinks’ would be ‘huge’ in 2019. It said, ‘Earlier this year Corona owner Constellation Brands invested $4 billion in a Canadian weed company, and shortly thereafter, fellow brewer Molson Coors announced it was teaming up with a different Canadian marijuana company to “create [a] joint venture focused on non-alcoholic, cannabis- infused beverages,” according to a press release. (Marijuana edibles and drinks are not currently legal in Canada.) Diageo, parent company of spirit brands like Johnnie Walker and Tanqueray, has also been seeking to invest in cannabis. Makers of non-alcoholic drinks like Coca-Cola and Pepsi have tentatively expressed interest in the space, too, though they’re clearly more reluctant to slap their iconic brand names on adult-oriented products that are still federally illegal in the US (and still have a hefty stigma attached in many parts of the country).’

Considering the cautious nature of Indian society in testing the new, it might be a little too early get excited about some of these advances. But one that should find little resistance is an interesting trend of foods laced with probiotics. Gut bacteria has in recent years been the subject of much research for how they impact the overall health of an individual. And, as a consequence, tweaking it through probiotic food has been building momentum. A Forbes article predicted that gut health foods might be among the top food trends of 2019. It said, ‘With emerging science to bolster health claims for functional probiotic foods, we are poised to see many iterations hit shelves over the coming year. Kellogg’s made it early to market with their line of Happy Inside pre- and probiotic- added cereals, while we continue to see traditionally probiotic rich foods, such as yogurt, focusing on the health benefits of these bugs. Danone is creating plant-based yogurts with probiotics to meet the needs of specialty diets.’ Given that these are all companies which already have a presence in the country, gut bacteria could be a good friend of the Indian body in 2019.