We spoke to Consultant Spinal Surgeon Mr Rajiv Bajekal about his personal journey with diabetes, including his family history of diabetes, his struggle with weight loss, and his reversal of Type 2 diabetes. We also found out his favourite meal!

About Mr Rajiv Bajekal

Rajiv explores this topic in more detail for healthcare professionals with Oryon Develop. Find out more information about the webinar: Treating Diabetes Mellitus with Lifestyle Medicine and book by clicking on the button below.

What is Type 2 Diabetes?

Type 2 diabetes is the most common form of diabetes and, simply put, it means that your body can no longer properly utilise the insulin it produces. Diabetes and pre-diabetes are conditions which are increasing worldwide. There’s an urgent need for health practitioners to use diabetic markers for early diagnosis, plus effective monitoring of the condition thus preventing possible disease complications.

Research from the University of Bristol found adult type 2 diabetes markers in children, some as young as eight, which is, on average, fifty years before it’s generally diagnosed. The study concentrated on certain genetic information which is proven to increase the chances of getting type 2 diabetes, and metabolism measures. This included looking at the children’s levels of HDL cholesterol, amino acids and whether they were prone to chronic inflammation.

“Despite cutting out junk food, living a more active lifestyle and not overeating, by 2011 my weight had increased to 108kg.”

It’s hoped that medical practitioners can start looking at these markers, plus obesity, lack of exercise and ethnic origins and persuade people at risk to follow a healthy lifestyle from an early age.

Diabetes symptoms, risk factors and complications

Some people with type 2 diabetes experience no symptoms at all or don’t recognise them as symptoms, these include:

Symptoms:

• Tiredness
• Blurred vision
• Frequent urination
• Constant thirst
• Unexplained weight loss
• Cuts take a long time to heal
• Blurred vision
• Areas of darkened skin(often under the arm or on the neck)

Risk Factors:

• Over 45 or over 25 for people of south Asian descent
• Having a close relative with diabetes
• Obese or overweight
• Asian, African-Caribbean or black African descent
• Being prediabetic
• Gestational diabetes
• Polycystic ovarian syndrome
• Areas of darkened skin can indicate insulin resistance

Complications

Complications from type 2 diabetes quietly creep up on you and can eventually result in disabling and life threatening diseases:

• Heart disease, strokes and atherosclerosis
• Neuropathy
• Kidney failure or damage
• Cataracts and glaucoma
• Slow healing of wounds, leading to infections and possible amputation
• Hearing issues
• Fungal and bacterial infections of the skin
• Sleep apnea
• Alzheimer’s and dementia
• Rheumatoid arthritis

Rajiv’s journey with diabetes

Some people successfully use exercise and diet to control their blood sugar levels while others need medication or insulin. Mr Rajiv Bajekal went an entirely different route and reversed his type 2 diabetes.

“I came to the UK around 30 years ago, weighing around 80kg with a healthy BMI of 23/24. My diet immediately changed. In the UK there is much greater access to processed and ready foods that were not accessible in India. I was a junior Doctor working very long hours and with a young family. I ate a standard doctor’s lunch – tuna or egg mayo sandwiches, a can of coke and a bag of crisps. Despite eating healthy home cooked dinners, I started putting on about 1kg a year; not enough to really notice. Exercise took a back seat although I did walk the dog every single day for an hour.”

As can be seen in the risk factors above, Rajiv’s ethnicity meant he was already at a disadvantage regarding the possibility of becoming a type 2 diabetic.

“We need to educate healthcare professionals on general lifestyle medicine more. Lifestyle medicine is the use of evidence based therapeutic approaches to prevent, treat and in some cases, reverse chronic lifestyle diseases. There are six pillars of lifestyle medicine – nutrition, exercise, avoidance of risky substances, restorative sleep, rest and social connections. Lifestyle medicine is foundational and runs alongside conventional medicine.”

That, coupled with a change of diet which probably contained junk food and far more sugar and unhealthy fats than previously, meant Rajiv’s weight slowly crept up.

“Around 1996 I went pescatarian for ethical reasons. I was eating fish, eggs and dairy. However, I was still putting on weight, and by 2000 I weighed 95kg (that’s 15kg more than when I arrived in the UK). My doctor told me that I was in the pre-diabetic range; that is, I was about to get Type 2 diabetes.”

Pre-diabetes is a conditions where your blood sugar levels are higher than normal but not high enough to be diagnosed with type 2 diabetes.

“Despite cutting out junk food, living a more active lifestyle and not overeating, by 2011 my weight had increased to 108kg. I had done all the diets, including one which was purely fish and cheese – not hugely pleasant! However, my diabetic markers had got worse, and in 2016 I felt my vision slowly deteriorating, a sure sign of the onset of diabetes.

I had developed cataracts, and I was also having trouble with recurring frozen shoulder. I was officially diabetic. This kicked me into action. I forced myself into a strict diet of 800 calories a day for 6 weeks and adopted a brutal exercise regime, including cycling 30-40 miles a week with my colleagues from Total Orthopaedics leading on this, amongst other physical activities. In three months I lost 10kg, but my diabetic markers were still getting worse. I couldn’t understand it! I eventually had cataract surgery, which improved my quality of life amazingly.

One day I was scrolling through Netflix when I came across a programme that caught my eye: ‘Forks over Knives’. This show prompted me to give up eggs, dairy and fish and to adopt a purely whole food plant-based diet. I lost another 17 kg without any real effort and certainly without resorting to any of the fad diets or a particularly strenuous exercise programme. More importantly, it changed the way I approached food for good, discovering a joyous and plentiful way of eating. I also reversed my diabetes!”

‘Forks over Knives’ has helped many people all over world to reverse their diabetes and other chronic illnesses. Many studies have shown that adopting this kind of whole food plant-based way of eating has been found to be particularly good to fight diabetes. If we look at China and Japan before they adopted a more Western style diet, they mainly ate minimally processed carbs such as rice and starchy vegetables and the result was very, very few cases of diabetes.

How has this informed your practice?

“Since then I’ve qualified as a lifestyle medicine practitioner, and I find it really helps me to examine and treat a patient holistically. For example, if I see a patient with back pain, I will look at their weight, blood pressure and other factors to help me evaluate why they are experiencing this pain. Lifestyle advice can help avoid the need for surgery.”

“Another example would be someone with a slipped disc; it’s easy to give an injection as a short-term solution, but the real holistic way to do it would be to get their back stronger with lifestyle adjustments, which can include building activity into their daily life.”

Doctors are not taught the role of nutrition on chronic lifestyle diseases including diabetes. As a result, health care professionals tend to reach for pills and surgery rather than addressing diet and lifestyle factors to manage common deadly conditions such as heart disease, cancer, and diabetes, amongst the top ten killers all over the world. I’ve found that allied health professionals such as Osteopaths, Chiropractors and Physiotherapists are more in tune with lifestyle and holistic aspects of health.

Every consultation we have with a patient as a health care professional is a missed opportunity to help patients transform their lives. The beauty about Lifestyle Medicine is that the patient is in the driving seat and we, the health care professionals, are just the guides.

What is a plant-based diet and what are its benefits?

A whole food plant-based diet is rich in fruit, vegetables, legumes, minimally processed whole grains, nuts and seeds which are full of antioxidants, fibre, vitamins, and minerals. Ultra-processed foods and junk foods are ideally off the menu as these are highly refined carbohydrates such as white bread, pasta, packaged breakfast cereals, crisps, chocolate, and biscuits.

Free oils and fruit juices are not encouraged as they are devoid of fibre as are animal products such as meat, dairy, eggs, and fish. The latter do not contain any fibre, which is needed for maintaining good gut health but are also full of excess protein, antibiotics, and hormones, all which fuel disease in the long term. It may sound as if you are depriving yourself of everything you love but you would be amazed at the variety of healthy, healing meals you can conjure up by just using nature’s bounty.

“For lunch I love a baked sweet potato with homemade hummus, sprouted seeds, nuts, broccoli sprouts and bean salad.”

A recent review of nine nutrition studies (2008 – 2018) by Dr. Qi Sun (et al), who is an associate professor at the Harvard T. H. Chan School of Public Health in Boston states, “A plant-based diet is very healthy in reducing the risk of type 2 diabetes.” This study showed that overweight people on a plant based diet naturally lost weight and maintained that weight loss, lowering their risk of type 2 diabetes.

Although the review wasn’t designed the find a cause and effect link between diet and diabetes, it did find a definite link between a plant based diet and a lower risk of contracting diabetes. It’s thought that the antioxidants and plant oils may help promote insulin sensitivity and/or reduce inflammation. Eating a plant based diet means you’re eating less or no animal products which naturally reduces your intake of harmful substances such as saturated fats, sodium and cholesterol.

So, Rajiv, what do you eat?

“I eat wholefoods. There are four types of wholefood:

• Wholegrains – whole wheat bread and rice, for example
• Vegetables – unprocessed (for example, tofu is processed so I avoid it)
• Beans – lentils, kidney beans, pinto beans etc. We don’t eat enough of this soluble fibre which feeds our gut microbiome
• Nuts and seeds (in small quantities)

There are only about 6 species of animal that we generally eat, whereas there are over 20,000 types of plant you can eat!

Meat is generally regarded as the best way to get protein; but the animals we eat actually get their protein from plants, so we’re really getting protein second hand from the plants they eat!

Another thing I enjoy about a plant-based diet is that the caloric density is low whereas their nutrient density is very high, so you can eat a lot these foods ad libitum if you should wish to.”

What are your top three meals?

“In the morning I always have a bowl of fresh porridge. I use steel-cut oats with almond milk and banana slices, adding in powdered flaxseed, walnuts, cinnamon and some berries.

For lunch I love a baked sweet potato with homemade hummus, sprouted seeds, nuts, broccoli sprouts and bean salad.

Then for dinner my favourite meal is dhal and red rice with spiced Indian vegetables and a rocket and beetroot avocado mung bean salad with balsamic vinegar. It has yellow lentils with red rice and vegetables. No oil, just herbs and spices instead.”

I love fresh fruit to snack on at any time of the day and this has been particularly liberating as I was initially wrongly advised to avoid fruit as a diabetic!”

About Mr Rajiv Bajekal

Rajiv explores this topic in more detail for healthcare professionals with Oryon Develop. Find out more information about the webinar: Treating Diabetes Mellitus with Lifestyle Medicine and book by clicking on the button below.

Find Rajiv on LinkedIn