CMC Vellore-trained neurologist, Dr Sudhir Kumar, took to X and wrote that the most frustrating part of his OPD practice is not the complexity of neurological diseases, but watching patients slowly lose control of conditions they believe are already under control.
He explained that many patients arrive convinced they are taking the right steps. They often say they walk every morning, manage household chores, or have stopped adding sugar to tea. In their minds, these changes feel significant enough to protect them from disease progression.
But Dr Kumar pointed out that clinical data and body composition often contradict this perception, especially in cases involving obesity, Type 2 Diabetes, and hypertension. He then broke down what he described as a major gap between perception and reality in lifestyle management.
Exercise trap
One of the key issues he highlighted was what he called the exercise trap. Walking, according to him, is beneficial and better than a sedentary lifestyle, but it does not replace strength training. He noted that after the age of 30, the body naturally begins losing muscle mass at a rate of about 3 to 8 per cent per decade, a condition known as sarcopenia.
Muscle, he explained, plays a critical role in metabolism because it acts as the body’s primary glucose sink. While walking helps burn calories during activity, resistance training helps build muscle that continues to support metabolic health even at rest.
He warned that without regular strength training, typically at least twice a week, insulin resistance may continue even if a person is active in other ways.
Diet trap
Dr Kumar also addressed what he described as a diet trap. Many patients believe that avoiding sugar alone is enough to improve health. However, he noted that this often overlooks the larger structure of the diet. In many cases, he said, meals remain heavily dependent on carbohydrates such as rice, rotis, and poha, while protein intake remains extremely low. This imbalance can still lead to repeated insulin spikes, even in the absence of added sugar.
He described this pattern as common in many Indian diets, where removing sweets does not necessarily improve metabolic health if overall protein intake is insufficient.
He further explained that protein plays a crucial role in regulating hunger, maintaining muscle mass, and improving metabolic efficiency. He recommended aiming for around 1.2 to 1.5 grams of protein per kilogram of body weight, noting that adequate protein intake often reduces carbohydrate cravings naturally.
Myokines
From a neurological standpoint, Dr Kumar added an important connection between muscle health and brain health. He explained that muscle is not just a structural tissue but also an endocrine organ that releases myokines during strength training. These myokines, he said, can improve cognitive function, reduce inflammation, and potentially offer protection against neurodegenerative conditions such as Alzheimer’s disease. To make his point actionable, he outlined what he called a metabolic reset approach for people struggling with blood sugar, blood pressure, or weight-related issues.
What does the doctor recommend?
He suggested moving beyond walking as the sole form of exercise and incorporating resistance training at least twice a week, whether through bodyweight exercises, bands, or weights.
He also recommended restructuring meals by prioritising protein first, followed by controlled portions of carbohydrates, rather than the reverse order that many people follow.
Finally, he clarified a common misunderstanding that household chores should not be mistaken for structured exercise. While they contribute to daily activity levels, they do not provide the progressive overload needed to build muscle strength or measurably improve metabolic health. According to Dr Sudhir Kumar, real metabolic change requires a more structured and deliberate approach to both movement and nutrition.
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