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Air Pollution and Diabetes: Unveiling the Connection in India’s Urban Centers

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Come October and most of North India – especially Delhi – is covered in a thick blanket of smog. As we sit home and engage in blame-games in the name of pseudo-intellectual internet debates, year after year we face the same problem with no one actually showing any real intent or inclination to address the elephant in the room. What is more concerning is that this environmental degradation is impacting our health negatively in more ways we can imagine.

The crux of the matter is that the environment we live in dictates the expression of our genes. It is a known fact that most of the modern day diseases are a result of disharmony with the principles of nature. So the first question is – what environmental factors cause diabetes?

Just like the food we eat and the water we drink or use, the air type we breathe also plays a significant role in the causation of cardio-metabolic diseases. Ultra-processed food, sedentary lifestyle and stress are some of the well-known causes of Non-Communicable Diseases (NCDs) such as diabetes, hypertension, obesity, fatty liver, heart attacks, strokes and even cancer.

But it would surprise you to know that a study by WHO in South Asia came to the conclusion that people living near highways or in urban environments have an increased risk of developing diabetes by 23%.

Air pollution has also been linked to a higher risk of cardiovascular disease. Studies have indicated that this could be due to an ongoing inflammation, oxidative stress and long-term issues with the autonomic nervous system that leads to stiffening of the arteries or imbalances that affect the blood vessels. In short, it makes matters worse for diabetics.

In this blog, we elaborate on the findings of the CARRS Surveillance Study that links environmental factors of Type 2 diabetes, the impact of air pollution on overall health along with recommendations to reduce the risk and stay healthy.

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The CARRS Surveillance Study: Insights and Implications

The Centre for Cardio-Metabolic Risk Reduction in South Asia (CARRS) Surveillance Study is a model for chronic non-communicable diseases (NCDs). Its objective is to develop and test tools for the control of CMDs in South Asia.

The study conducted over 7 years – from 2010 to 2017 – involved a sample size of 12,000 participants, stratified by gender and age. After 7 years of observations, the study found that there is a link between air pollution and diabetes in Chennai and Delhi. More specifically, the study found that long-term exposure to PM2.5 particles increased blood sugar levels.

Particulate Matter (PM) is basically a complex mixture of extremely small particles and liquid droplets, made up of acids, organic chemicals, metals, and soil or dust particles. PM is divided into various categories depending upon size. These categories are PM 10, PM 2.5 and ultrafine particles that are less than 10 μm, 2.5 μm and 0.1 μm in diameter.

The composition of PM can vary from city to city, depending upon the existing emission sources. Particles can include inorganic gaseous pollutants like carbon monoxide (CO), sulphur dioxide (SO2), and Nitrogen Dioxide (NO2), which originate mostly from biomass fuels (BMFs), coal, and petroleum combustion products.

A major source of air pollution – especially in North India – is agricultural straw burning. Together with the above named inorganic gases, it contributes to the formation of haze.

There are certain factors that affect indoor air as well. Indoor air pollutants include second-hand tobacco smoke, furniture-derived formaldehyde, nitrogen oxides from natural gas appliances, and volatile organic compounds that come from new constructions.

It is noteworthy here that the smaller particles like PM2.5 have greater adverse effects on health than PM10. PM2.5 contains sulphates, nitrates, heavy metals and black carbon that can damage the lining of blood vessels and increase blood pressure by stiffening the arteries. Not only can the get deposited in the fat cells and cause inflammation, they can also attack the heart muscle directly and degrade the functioning of the mitochondria.

The PM2.5 particles are so tiny that they can go all the way down in our lungs, to the alveoli. The problem worsens when they get into our bloodstream and travel through the body, and start affecting the other organs.

We often think of air pollution as something that will cause us breathing problems, but the rot goes deeper.

PM2.5 has been found to be one of the environmental factors of diabetes and hypertension which in turn leads to cardio-vascular complications. It can also cause epigenetic and micro-environmental alterations which could increase morbidity and mortality associated with lung cancer.

What’s more shocking is that 75% of us are exposed to levels of PM2.5 elevated enough to cause these issues. So, just as we check the temperature and rain forecast before stepping outdoors, we should also check the PM2.5 levels and Air Quality Index (AQI).

City-Specific Outcomes and Risk Factors

Let’s now take into account some of the revelations of the CARRS Surveillance Study with respect to Chennai and Delhi. In the period of the study, the average annual PM2.5 level was 80-100μg/m3 in Delhi and 40-50μg/m3 in Chennai. For perspective, India’s national air quality standard stands at 40μg/m3, which is way above the WHO limit of 5μg/m.

The CARRS Surveillance Study found that the risk of diabetes was maximum after about 1-1.5 years of exposure to elevated PM levels. A Hazard Ratio (HR) of 1.23 directly linked long-term pollution and diabetes risk, which means that for every 10μg/m3 increase in annual average PM2.5 level in the two cities, the risk for diabetes increased by 22%!! It was also found that a PM2.5 reading of 37ug/m3 or an AQI reading of 100 produced significant inflammatory changes in healthy young adults.

The researchers also assessed young adults exposed to moderate levels of PM2.5 for 4 hours to note any damage caused to the arteries, veins or lungs. The results were shocking to say the least. The subjects showed a decrease in lung function and an increase in damage to the arteries and veins, for more than 20 hours of their exposure!!

Global Context and Comparative Analysis

In the global context, Asia and Africa have the highest burden of disease from PM2.5. Around 60% of the total global mortality burden happens in India and China put together. Unsurprisingly, countries with high income have lower mortality burden.

According to a 2010 meta-analysis of global reports, a PM2.5 levels of more than 10 μg/m3 was linked with a 1% increase in diabetes prevalence worldwide. The basic underlying pathogenesis was found to be inflammation, oxidative stress, lipid deposition in tissues, endothelial dysfunction and autonomic imbalance.

The negative impacts on health seen globally, due to long-term PM2.5 exposure include ischemic heart disease, lung cancer, chronic obstructive pulmonary disease (COPD), lower-respiratory infections (such as pneumonia), stroke, type 2 diabetes, and adverse birth outcomes.

The Impact of Air Pollution on Overall Health

pollution in india

The negative impact of air pollution are obviously more prominent in our growing older population as they are more susceptible to diseases, although it has been having a greater impact on the younger population as well of late. This impact is usually in the form of health issues such as irregular heartbeat, aggravation of asthma, decreased lung function, non-fatal heart attacks, and vision impairment. Besides, the environmental damages caused by air pollution such as acidification of water sources, depletion of soil nutrients, and acid rains, affect the diversity of ecosystem and in turn, all of us.

Monitoring and Improving Air Quality at Home

The sources of PM2.5 indoors are usually smoking, cooking, cleaning, poor alternate light sources, mold and dust mites, apart from the PM2.5 that has infiltrated from outside. In general, the PM2.5 levels are lower indoors than the PM2.5 measured just outside. In order to reduce the PM2.5 levels indoors, we should stop smoking and using a stove top fan while cooking. We should also ensure adequate ventilation, possibly by the use of in-duct air filters or portable air cleaners with filters.

Preventive Measures and Public Health Strategies

Our government is on the verge of revising the National Clean Air Program. The need of the hour is to urgently reduce PM2.5 levels, especially in metropolitan cities. This would require action across sectors, be it transport, industry, waste management, energy, construction or agriculture. Cities also need localized plans to address air pollution hotspots and spikes. Municipal bodies should adopt a more pro-active stance for action on the ground.

It is difficult to avoid the toxicity if the PM2.5 levels are not reduced. However, we can always take some measures personally to reduce the level of toxicity in our body, and reduce the impact of the environmental factors for diabetes

Certain foods can help remove heavy metals from the body through digestion. These foods are usually rich in vitamins and minerals. They get attached to the metals and eliminate them from our system. Some such foods are cilantro (coriander), garlic, wild blueberries, lemon water, spirulina, chlorella, barley grass juice powder, green tea, tomatoes, and probiotics.

Some foods must also be avoided in order to prevent heavy metal poisoning. These foods generally include processed foods that don’t offer nutrition but slow down the process of detoxification, and unhealthy fats that absorb harmful substances.

Some such foods to avoid are polished rice and pulses, larger and longer living varieties of fish as they contain more mercury, meat and dairy products, alcohol, processed foods, sweets and sugars, and non-organic foods.

There are also some dietary supplements such as Magnesium (Mg), Manganese (Mn) and Zinc (Zn), are known to reduce the risk of diabetes. Vitamin C is known to have iron cleansing effects, and B-1 supplements decrease iron levels. Glutathione supports the liver like milk thistle. Secondly, your doctor can also prescribe certain medications if your blood, urine and hair tests show a high level of exposure.

There are some aspects that we should incorporate in our lives in order to reduce toxicity. These are as follows:

  • Stay hydrated with structured (sun-charged) water
  • Quit smoking, avoid passive smoking
  • Stay active as it clears the pathways by which our body eliminates toxicities with waste
  • Ensure that your elimination channel (bowel movement) is clear
  • Avoid pesticides and use non-toxic materials and cleaners at home
  • Keep tabs on the air quality of your home
  • Detoxify your indoor air regularly, especially if you have indoor pets
  • Indoor plants like Snake plant, Peace lily, Bamboo palm etc. can absorb indoor air toxins
  • Avoid exposure when the air quality is poor
  • Avoid walking or exercising in high traffic areas

Thus we see that air pollution – and PM2.5 in particular – is a serious health hazard that not only affects the lungs, but is also one of the environmental causes of diabetes, hypertension and cardio-vascular complications. As we await a comprehensive public policy for addressing the issue, we can always take some actions individually in order to reduce the impact of the toxicity on ourselves.

At Wellfinity, we help people in making some dietary and lifestyle changes, in order to combat the environmental factors of diabetes Type 2. We also prescribe quality vitamin and minerals supplements in case there are any insufficiencies in the body, as they are essential for fighting against and eliminating toxins.

Our holistic approach has helped thousands of people completely and permanently reverse their diabetes and live a quality life without the need for medications.

So, whether you are diabetic or simply want to detoxify, feel free to avail of our online consultancy service for a personalized care plan.

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