A South Asian Doctor’s Journey to Better Health

Introduction: A Personal Journey

Early Lessons in Health

 

I was born into a middle-class family in Sri Lanka in the late 60s. My father was always keen to instil in us the importance of exercise. I remember, even as a young girl, lying on my back and peddling hard, doing bicycles! My father would tell us that staying active was essential, and these early lessons stayed with me throughout my life.

 

 

As a teenager, I was on the chubby side, which was quite unusual in Sri Lanka at the time. Most girls were generally very slim until they got married. My chubbiness, however, was never made fun of; I was never bullied or discriminated against because of it. It was simply a part of who I was. I hit puberty pretty early, at the age of 10, and soon after, I stopped growing. Those of you who know me understand this well—I’m only 5 feet tall, or as one of my close university friends used to say, “5 feet short!”

 

 

Growing up, like many middle-class families, we had a maid who cooked our meals. Although our diet was heavily based on carbohydrates, it was freshly prepared and balanced with lots of meat, fish, vegetables, and greens. My siblings and I participated in school sports, although my siblings were far better athletes than I was.

 

 

My parents, both doctors, had a rather blasé attitude towards any illness we had. In their view, our ailments could never be as serious as those of their patients. This perspective on health was something I absorbed and carried forward into my own family. I learned early on that being sick wasn’t a big deal—unless it really was.

 

 

Due to the political situation in Sri Lanka in the late 80’s, during which universities were often closed, I moved to Scotland to study medicine. Those years were tough—I was the typical poor student, eating cheap convenience food,  not exercising, and cramming for exams and having fun. I never took up drinking, so despite spending six years in Scotland, it was never something I got into. However, during this time, I lost the chubbiness I had carried with me since childhood.

 

 

I got married to Sajith, a fellow Sri Lankan, during my last year at university. I was doing my postgraduate training in England, studying and working nights. It was a stressful time. My two pregnancies were uncomplicated, and my two sons were born small but healthy. During this period, food was whatever was convenient, and exercise was almost non-existent.

 

Once I became a GP, I chose to work three days a week. With two small boys, life was busy, but working part-time meant that I had a bit of time to myself. Our boys were involved in a lot of sports. My husband and I joined a gym, and I started running. I trained hard, and at the age of 38, I completed the London Marathon—a milestone I was incredibly proud of.

 

 

When we moved to Australia when I was 40, the first few years were tough. Adjusting to a new country, making new friends, and getting used to a new work environment wasn’t easy. Without any family nearby to help out with the kids, every time they got ill, it was a constant juggling act. Thankfully, this didn’t happen often, but when it did, it added a layer of stress to an already full life.

 

 

As a family, we were active, but food was not a priority. We ate for convenience and for pleasure, rarely giving much thought to the nutritional value of what we were consuming.

 

In my late 40s to early 50s, I began to struggle with the symptoms of perimenopause. Despite my best efforts, my body shape was changing, especially around my middle. I was becoming like my mother—apple-shaped with the dreaded love handles. I tried to hide this by wearing loose-fitting clothes, but I couldn’t ignore the discomfort I felt in my own skin.

 

 

My sleep was terrible—I would wake up 3-4 times every night, and I snored loudly, much to the frustration of my poor husband. Traveling with my sister became difficult because my snoring led to sleepless nights and, often, shouting matches. I was irritable, snappy, and more emotional than ever before. Generally a calm person, this behaviour was uncharacteristic of me.

 

But the most alarming issue was the brain fog and my increasingly poor memory. Whenever I left my computer at work, I couldn’t remember a thing—not the names of medical conditions, not even the medications. It scared me to think that I might forget how to be a doctor. Looking back, I realize that I had so many little aids around and in my computer to jog my memory.

 

This was despite doing everything ‘right.’ I exercised intensely—after running the London Marathon, I believed that high-intensity workouts were the only way to call it exercise. I was running, doing HIIT, or boxing classes nearly every day, and I was eating reasonably well, definitely low fat.

 

Then came the moment of truth: my blood results showed pre-diabetes, and my metabolic markers pointed toward a future of heart disease. I was devastated. I have a very strong family history of type 2 diabetes; my mum was diagnosed at 52, and all her family died of diabetes-related complications. My grandfather even had an amputation due to poorly controlled diabetes. I couldn’t believe it! I was a GP, guiding others on how to stay healthy, yet here I was, facing these results.

 

 

I knew I had to do something different because the ‘eat less, move more’ approach wasn’t working for me. But what else could I do?

 

I started reading and researching and discovered the hormone insulin—how it regulates weight, its significance for health, and how the food we were eating was causing havoc in our bodies. Low-carb eating was crucial for managing insulin levels and gaining control of health and weight. This was a revelation to me. Unfortunately, this is not how doctors are taught, but it made so much sense that I knew this was the direction I had to take. I felt EMPOWERED!

 

It took me a month to get my head around low carb. Growing up in Sri Lanka, I was used to high-carb foods and always chose starchy foods. My mind was screaming:

What would I eat?

My community always gathers around food. How would I socialize with my family and friends if I wasn’t eating what they were?

 

But nothing had worked so far. I decided to give it a go. I started slowly, just cutting down a little on carbs and adding more protein.

 

The first thing I noticed was that I wasn’t hungry! Every other diet had left me starving, constantly thinking about food! Now, I could go 5-6 hours between meals easily. So, I carried on. It wasn’t hard. After a few days, I noticed my clothes fitting better; my waistband wasn’t as tight. Then, about a month in, my husband suddenly said, “Nelum, you don’t snore anymore!” I had snored since my mid-30s! I couldn’t believe it! I was sleeping better, had more energy, my clothes were getting looser, I was losing weight, and mentally, my mind was clearer. Finally, I had found a way to improve my life. Three months later, when I did my blood tests, I had reversed the pre-diabetes, and all my metabolic markers had improved. I was over the moon.

 

 

As a South Asian woman over 50, I decided to undergo a CT Coronary Calcium Score (CAC) test. This non-invasive test is highly recommended for assessing heart health, as it measures the amount of calcium in the blood vessels surrounding the heart—a key marker for future heart disease risk. Calcium buildup occurs over time due to damage to the blood vessel linings, which can be caused by factors like high blood pressure, high blood sugar, inflammation, stress, toxins like cigarette smoke, and environmental influences.

To my surprise and dismay, my score came back elevated—over 100.

CAC scores range from 0 to very high. A score of 0 indicates a very low risk of future heart disease, while a score above 100 is considered moderate to high risk, especially for a woman in her 50s. It’s important to note that this score reflects historical risk, meaning it’s a result of what has happened in the past.

This pattern is typical in the South Asian population, often starting early and most likely due to a combination of genetic factors, unhealthy eating habits, and stress.

Despite the raised score, further investigations of my heart showed that everything else was completely normal.   

 

After many consultations with cardiologists and the low-carb community, reflecting on the pros and cons of the different treatment options, I decided that the best strategy for me was to continue my dietary and lifestyle changes rather than trial medication. I committed to working hard at reducing all other risk factors and maximizing my overall health.

 

This was a deeply personal decision, tailored to my unique health needs and circumstances, and I want to emphasize that it is not a recommendation for others. Each of us has a different journey, and what works for one person may not work for another. It’s crucial to take ownership of your health decisions by educating yourself thoroughly. Understand your body, research your options, and consider the potential benefits and risks of each approach. By doing so, you can make informed choices that align with your values, goals, and health needs. Ultimately, your health journey is yours to navigate, and it’s essential to make decisions that feel right for you.

 

Balancing Tradition and Health: A Cultural Perspective

Staying Active and Connected: Prioritizing Well-Being

 

The last three years have been quite a journey. The rewards have been worth it. I’m in the best shape physically and mentally that I’ve ever been in, and I’ve even gone back to the way I used to be—still 5 feet short but full of energy and joy!