For strife-ridden Kashmir, surviving on stress, chicken and mutton and staying limited to hearths and homes, has emerged just a way of life. Slowly but surely, it has added costs to the society which, experts believe, will take decades to undo and much longer for necessary corrections. Saima Bhat visits the darkest tunnel that Kashmir’s situation and the food habits have created impacting the gene pool, and forcing thousands of women, including teenagers, to fight for the motherhood.
In 2014, Fatima got married at the age of 34. After six months she conceived. She was anticipated to mother twins. It was no less than a miracle for Fatima given what she has been through in her teens.
“I was 12 when my periods started,” remembers Fatima. Everything was normal for a few years. By the time Fatima turned 20 she noticed menstrual irregularity. “That actually marked the beginning of the problem.”
On a friend’s suggestion Fatima consulted a gynecologist who advised her to do certain hormonal tests. The results were normal. “My hormonal profile was normal. There was no sign of cyst in sonography,” said Fatima. Her doctor prescribed progesterone (contraceptives) and told her not to panic. “But how could I not panic. I was not able to concentrate on my studies,” said Fatima.
Within a few days Fatima started experiencing extreme pain during her cycles while palpitation and mood swings became a norm. “Then a friend of mine suggested that I should see an endocrinologist.”
It was only later the reality dawned. Fatima has Poly Cystic Ovarian Syndrome (PCOS), with her genes resistant to insulin. Doctors put her on medication and gave her a diet plan to follow. PCOS has no treatment. It is only being managed. Doctors told her PCOS leads to infertility. It is almost impossible for patients suffering from PCOS to conceive without medical help. “I was saddened that I cannot become a mother.” Luckily Fatima was one among the 55 percent PCOS patients who do not end up infertile.
Records available at Lal Ded, valley’s lone tertiary maternity hospital, suggests there is a surge in number of infertility patients in Kashmir in last two decades.
Dr Farhat Jabeen, a senior gynecologist at the hospital, feels that problem was always there. What has changed is the awareness among women. “In the past an infertile women’s husband would remarry rather than take his wife to a doctor.” But what makes this PCOS upsurge distinctly disastrous is that it is not limited to married women only. “A huge number of patients are unmarried teenage girls.”
When Dr Jabeen joined Lal Ded hospital, around two decades back, there were hardly any teenage girls visiting her ward. “But things have changed fast. Out of 20 patients I see every day, five are teenage girls now,” Dr Jabeen said. “And half of them are infertile already. Interestingly, most of the infertility related cases have PCOS.”
Sumaira, who is in her early 30s, is not able to conceive in six years of her marriage. Sumaira’s desire to have a child made her shuttle between private clinics in Srinagar and Delhi. However, all her efforts proved futile. Most of the doctors she consulted blamed her weight for her infertility. She is 105 kgs. “After doctors blamed my weight for infertility my in-laws started pressuring me. They wanted me to shed kilos as soon as possible else I will be divorced,” shares Sumaira. “All my tests are normal so how could doctors blame my weight?”
Obesity, excess body fat alters the levels of the hormones insulin and estrogen, and these factors are believed to be responsible for the acceleration of pubertal timing by obesity
Interestingly, Sumaira put on weight once she started taking supplement hormones prescribed by the gynaecologist to increase her ovulation. “They (gynaecologists) told me that these supplements will help me in conceiving.”
For most of her teenage Sumaira has been an introvert person. After her mother’s death Sumaira virtually locked herself up in her room. She started skipping her regular meals and instead, eat junk food like chips, soft drinks etc. “I was 13 when my mother was crushed to death by a speeding army truck. This left a lasting impressing on me.”
For a long time after her mother’s death, Sumaira would hardly leave her room fearing that she might be crushed by an army truck too. “I used to panic at the site of an army truck passing by. Then I used to have sleepless nights filled with palpitation and anger,” recalls Sumaira.
Thinking that Sumaira is possessed by an evil spirit her father took her to a number of faith healers. “I started wearing amulets. Did whatever faith healers told me. But nothing changed.”
After her marriage when Sumaira could not conceive she became panicky. “My marriage is in danger now.” Recently Sumaria was diagnosed with PCOS.
PCOS is the result of a disorder in the female endocrine system when abnormal levels of Follicle-Stimulating Hormone (FSH) and Luteinizing Hormone (LH) are secreted. The excess LH causes the ovaries to overproduce androgens, which has its impact on the ovulatory process, resulting in eggs dying within the follicle and forming cyst-like structures in the ovary. Only one in three women who have PCOS might have symptoms as well.
In addition to abnormal menstrual cycles and infertility, women having PCOS may as well face skin problems; notably acne and greasy skin or unwanted hair production (hirsutism). High intake of proteins, in children age 3-7 have been associated with earlier menarche (first mensural cycle) in multiple studies. High protein intake elevates insulin like growth factor (IGF-1) levels and promotes growth, which could accelerate the onset of puberty. Menarche has also been associated with the consumption of soft drinks, high dairy (milk) consumption and the modern diet rich in processed foods like processed meats and fast food, which are found to be disruptive to normal development and aging.
But Dr Ashraf Ganie, one of the leading endocrinologists of Kashmir, presently working in department of Endocrinology and Metabolism, AIIMS, New Delhi, believes that PCOS is not merely a gynecological condition. “It is a systemic endocrinopathy which has its impact on other hormones of the body like abnormal amount of lipids, hypertension, cardio vascular disease, insulin resistance, and some cancers.” Since last one decade Ganie is extensively studying PCOS in Kashmir.
Dr Jabeen shares that majority of infertile females are in their 30s. “Once ovaries get exhausted it increases the stress level. It has direct effect on brain that controls the entire hormonal balance of the body. As a result it makes a patient infertile.”
Researchers have also found that some milk contains rBGH, which has high levels of a natural growth factor (IGF-1), which has also been incriminated as a major cause of breast, colon, and prostate cancers
From her two decade long career as gynecologist at Lal Ded, Dr Jabeen concludes that infertility is on the rise in Kashmir because of late marriages.
Interestingly, however, studies carried out in the USA prove that there is no link between fertility and late marriage. The study shows the average age of first menstrual period (menarche) has gone down in last two centuries. From 15 years of age in early 19th century to 12 years now, the onset of menstruation has seen a rapid change. In some developed countries it is even less than 12 years of age.
“The age at which girls reach sexual maturity is influenced by imprinted genes – a small sub-set of genes whose activity is determined by the parent who contributed them. That is why a girl’s puberty timing can be affected more profoundly by one parent than the other,” says Dr Ganie.
Experts have identified multiple factors responsible for early age female puberty. The major ones are related to environmental changes. They believe that excessive use of fertilizers and pesticides in developing countries have a direct impact on people’s lives. A study done by Sher-e-Kashmir Institute of Medical Sciences (SKIMS) on 432 brain cancer patients in Kashmir (between 2005 and 2008) reveal that 389 patients who died were orchard farm workers, residents living near orchards, or simply those children who play in the area.
Officials in SKIMS said that they lack exact details of the prevalence because of the divided faculty who are unwilling to share their data to each other. At times, it impacts the patients who, in absence of their doctor are desperate to seek advice from his/ her clinic in the faculty.
Kashmir based experts claim the exposure to endocrine-disrupting chemicals (EDCs), which are present in organochlorine pesticides, plastics, fuels, and other industrial chemicals, have caused havoc in Kashmir.
Dr Ganie, however, has a different take on the excessive exposure to pesticides and other industrial chemicals causing infertility or even brain cancer. “It is not technically possible in Kashmir to find out that hormonal imbalance is caused by food chemicals. However, researches done in Europe and USA blame food chemicals only.”
A study conducted at Harvard reads that 70% of Asians are lactose intolerant which means their bodies cannot break the sugar in milk and it leads to cramps, bloating and diarrhoea
Eighteen-year-old Kousar’s days used to start with a ‘mission’. She was trying to follow a strict diet chart that will help her reduce body weight. She is 95 kgs. But by afternoon she would collapse and stay unconscious for hours because of hypoglycaemia (low sugar level in blood). “I used to scold her for being overweight. Even our neighbours and relatives used to taunt her all the time. When she couldn’t take it anymore, she confined herself to her room,” says her mother. “One day when I found her lying unconscious in her room, I immediately took her to a doctor.”
On doctors’ recommendation Kousar’s mother took her to an endocrinologist. The doctor told her that Kousar’s body is reacting differently. She had developed insulin resistance but was not yet diabetic – which is a type of PCOS.
Dr Ganie says that the elevated insulin levels in diabetic patients also increases the size of the ovary. “Eventually the eggs inside the ovary form cysts.”
“I should have stopped her when she used to order fast food like chicken wings and burgers on regular basis,” says Kousar’s mother.
The rise of PCOS among young girls, who take junk food in excess, is alarmingly high. Aafia Rashid, a researcher with Dr Ganie at SKIMS’s Advance Centre for Human Genetics, says that during a visit to a higher secondary school in Srinagar, they came across an alarming number of young girls with PCOS. “Every other girl complained about irregular periods, acne or excessive hair growth. These symptoms are related to PCOS.”
Aafia says that PCOS is a genetic trait which can be treated with proper management of diet, change in life style and physical exercise. It has to be managed like diabetes and hypertension.
“It has to be treated before marriage then girls don’t have any problem in conceiving. But if taken for granted it gets worse with time,” insisted Aafia.
Experts believe the alarming rise in food adulteration in Kashmir has adversely affected the health of people, especially women folk. The excessive use of food, laden with carcinogenic elements, has direct bearing on their fertility. It affects ovulation in females. In males it affects the sperm count and mortality.
Interestingly there is no substantial research done that proves excessive intake of dairy products like meat, chicken and milk are responsible for sexual changes in growing children.
But most of the European countries, and USA, and some South Asian countries especially Bangladesh have completely banned the use of Antibiotic Growth Promoters (AGP) in poultry and sheep feed. A number of researches have proven that AGP puts humans at risk by making them drug resistant. Instead, these countries promote use of Phytogenics, a group of natural growth promoters or plant based AGPs.
Research has also proved that the increased levels of estrogen (given to animals for fat growth) at young age causes development of breast in boys, fatty liver and obesity. In pregnant women, it causes epigenetic (impact on the development of genitals in fetus). While in young girls it causes development of breasts at early stage (precocious puberty) with menarche. It also affects their bones resulting in short height.
“The testosterone hormone, given to animals for muscle growth, has endogenic effect on humans. It causes PCOS in girls who have high lipids and high insulin level,” says Dr Ganie.
Currently, at least four major researches are going on at SKIMS (in collaboration with AIIMS), to find out reasons behind high prevalence of PCOS. Among other things, these researches will help experts understand how excessive consumption of dairy products like mutton and chicken are changing people’s lives in Kashmir.
Official figures reveal Kashmir’s annual mutton consumption has crossed 560 lakh kilograms by December 2014. Interestingly, despite having best pastures in the world, Kashmir imports more than 55 percent of its mutton from places like Rajasthan, Haryana, Punjab and Himachal Pardesh. Figures also suggest that annual consumption of poultry (chicken) in Kashmir is more than 673 lakh kilograms. It is Rs 900 crore a year industry.
Salim, who owns a poultry farm on the outskirts of Srinagar city, shares he has to inject a number of antibiotics and steroids to chickens in first 35 days of their life cycle. “These steroids are injected into a chickens wings or neck. Besides, we give them modified feed so that they attain a weight of around 1 and 1.5 kgs in these 35 days.”
But Dr Fayaz, a veterinarian claims that AGPs are not used in mutton or poultry in Kashmir. “But nobody knows how sheep, poultry or dairy products are developed in places outside Kashmir.”
However, dieticians advise people should avoid eating chicken wings and necks frequently because of high content of steroid and antibiotics. “It is all linked. What we eat affects our growth and body in a big way,” says Dr Ganie.