I was seeing my friend’s granny after almost twenty years. Our gang used to hang out in his house during our med school days. She was ninety six. It was nice to see that her intellect was as sharp as ever. I had some questions for her. Nearly a century of memories were not to be wasted. I congratulated her on her robust health and intellect.
“Everything is god’s grace.” She replied.
“I belong to the old generation.” She clarified- as if it was not obvious enough. “So, no diabetes and high blood pressure and things like that. I do have mild diabetes and slightly elevated pressure. But that was detected only after I turned seventy five.”
“Great, granny! That is really good. And you raised seven children. It is a remarkable feat. Now we struggle to bring up one or two.”
“Actually, I bore ten children. Three died. All before they turned three.”
“That is sad. How …” I probed.
“Oh, some illnesses. That time it was very common for young babies to die. Karthiyani had seven children, but only three lived.”
She had become rather sober. I didn’t want to pursue it further.
“I had to bring them up by myself. The youngest was quite small when my husband died. He was a famous lawyer. You know that, no? He was about forty when he died. Tuberculosis. That time lot of people died of tuberculosis.”
“But you did not have any major illnesses. That was a blessing.”
“Yes. I was very healthy. Always ready to do two men’s work. Today, the women are so lazy”
I looked at my wife, sitting beside me, and thought that it was better not to comment.
“I almost died once. I must have been around thirty five or so. The doctor Sankaran Menon who was trained in England treated me. He said it was typhoid. One of my cousins also died of typhoid when she was young.” She became thoughtful. “And a sister died while giving birth to her second baby. Many women died that way. By god’s grace I escaped all that.”
“Granny, your father and mother- they were big land lords, weren’t they?”
Granny laughed. “Farmers. We were a farming family. My father worked in the farm till he suddenly collapsed, complained of chest pain and died suddenly.”
“Oh. Ok. Did he have hypertension or diabetes?” I asked.
“How do I know? And I told you those days we didn’t have these illnesses.” Granny was becoming irritated. She turned to my wife.
“He might have become a big doctor, but is still rather stupid. I knew him as a boy.”
My wife nodded and sighed. “I know.” She said with an exaggerated roll of her eyes. I quickly tried to change the topic.
“Quite hot these days, isn’t it?” I was sweating now.
“We didn’t have these kinds of summers in our younger days.” Said Granny. “The weather was always very pleasant.”
Our collective recollections of earlier times are not very reliable. They are coloured by nostalgia of the great and good times that will never return. We yearn for that golden period in history that never existed. Myths, lore and tall tales obscure our search for the truth.
I think we can safely state some self evident truths, backed by solid historical statistics.
Throughout most of our known history, our major scourges were infectious diseases caused by micro organisms, famine, war, violence, accidents and the very real risks of child bearing and giving birth.
Our lifespan has been increasing steadily. At the time of independence, it was around thirty-five. Right now, in Kerala, it is approximately eighty. This trend hasn’t stabilized even in the west. The lifespan continues to increase. This is one major reason for the increase in incidence of so-called lifestyle diseases. This applies to most cancers, as they are commoner with increase in age.
As screening for diabetes, hypertension etc were not there during previous ages, and there were no reliable records of causes of death, it is impossible to know the incidence of these diseases during the remote past.
When infectious diseases and other ancient scourges became less, chronic diseases like heart diseases and diabetes became important. Lifespan increased dramatically over the last few centuries. Most of the chronic diseases are more likely to develop with increase in age. This is the most important reason for the increase in incidence of these diseases, and not our modern lifestyle.
The major modern scourges include heart diseases and strokes, both brought on by blockages in arteries, and the major risk factors are diabetes, hypertension, blood cholesterol and lipid abnormalities and smoking. Right now, heart attacks and strokes are the number one killer on the planet, among both males and females.
It is interesting to note that, in very developed countries, and in areas like Kerala, where cardio vascular diseases are effectively prevented and treated, Cancers are slowly becoming very important. As most cancers are age dependent, as the population ages, and as other diseases are better treated, more humans live longer to develop cancers.
But since the beginning of reasonably reliable record keeping in the west, there has been an absolute increase in the incidence of these diseases. As countries become more industrialised and urban, they have shown an increase. Migrants from rural or developing countries have a small increase in incidence of cardio vascular diseases and certain cancers as they settle down in urban and developed areas. So, the term lifestyle disease may not be a misnomer.
