Arvind Kejriwal, Manish Sisodia and Gopal Rai along with hundreds of volunteers sat on indefinite fast on 25th July 2012 demanding SIT against corrupt ministers. Kejriwal being a diabetic patient, lot of people were concerned about his decision to go for fast. He remained adamant in spite of thousands of volunteers and well wishers appealing him not to go for the fast.
I being a diabetologist, knew that he is a bad patient, who had no faith in allopathic medicines and relies on naturopathy. For me he was already in a catabolic state, sugars being uncontrolled for a while, and was at a very high risk of ketosis if he goes for fast.
I had to review literature to learn how to manage this situation when a diabetic patient goes for fast. There were a few reports of diabetic patients surviving hunger strike for long duration. I was in constant touch with him and was ready to be there at Jantar Mantar during this fast. Medical team looking after Arvind and others was led by Dr Atul Gupta (an Anesthesiologist) and Dr Vipin Mittal ( a dentist). Both were in touch with me on telephone, as I decided to stay back in Jaipur for first 3 days. A few of my collegues were on indefinite fast in Jaipur.
28th July 2012, I reached Jantar Mantar in the morning hours. I examined Arvind and reviewed his latest reports. As expected, he was already in ketosis. Sunitaji (Arvind’s wife), Dr Mittal and Ransingh Arya (the naturopath) were with me and I being a specialist in Diabetes was explaining them about Arvind’s medical condition and possible risks. For someone practicing allopathic medicine he was already in the state where he needs to be hospitalized, ketone levels being high, though he was looking quite fit and confident. There was no chance of Arvind agreeing to get hospitalized till he gets unconscious. Only thing that we could do was to monitor him till he falls critically ill. Dr Mittal was little relieved when he got to know that I am going to be there 24×7 till the fast continues. It was miraculous that he survived the fast for next one week.
His political opponents floated a number of theories explaining his survival. Steel glass theory was quite popular on social media. Because he was seen having water in a steel glass on camera, his critics had a reason to speculate that he was hiding the liquid diet by not using transparent glass. I wonder why does he need to do it on camera, if he has to consume anything.
So how could he survive fast for 10 days in spite of being a badly managed diabetic patient?
Preparations for his fast started around a month in advance. On one hand we were reviewing and collecting medical literature, while the team of naturopaths was preparing his body for the upcoming fast. Factually he survived fast only with the protocol designed by naturopaths. Arvind had no faith on allopathy and we were there just to take care of him during possible emergency. The other role that we played was to keep a track of his health condition and keep media updated about the same. The team of naturopaths was experienced in managing such patients. They, in fact claim to have cured a lot of diabetic patients just with prolonged fast. Retrospectively analysising the naturopathic interventions, they appear to be quite appropriate for the desired metabolic changes.
(Understanding the basics of human body might be helpful to understand the medical terms used in this article. The article can be accessed by clicking here)
Diet was modified by the naturopaths to make it high protein low carbohydrate diet. This would shift the body metabolism towards anabolic state. He had enough of protein reserves while he started his fast. Moreover his body was accustomed to a low cabohydrate diet.
He was going through a very rigorous exercise regime including aerobics, pranayam and yoga one hour each. This would have increased his insulin sensitivity and might well have improved his beta cell function. This correlates well with the stable glycemic control that he could maintain during first few days of fast in spite of his anti-diabetic medicines being withheld. All his anti-diabetic medicines were stopped a few days before fast. This was necessary to avoid any hypoglycemia during the fast.
A proper hydration was maintained by giving him plenty of water. In addition to maintaining proper hydration, this would keep washing off the ketone bodies generated during fast. During fast as the patient is deprived of any food supplement, the stored fats are used for energy. Ketone bodies are produced during this process which are harmful to the body.
In addition to maintaining proper hydration a few naturopathic procedures like Kunjal and Enema were performed daily. This would help wash off the ketone bodies and other toxins from body.
Calorie expenditure was minimized by restricting his movements. He was not allowed to move much, other than that for the necessary activities. By restricting calorie expenditure, we can minimize the ketone bodies generated as less amount of fat is burnt.
His vitals and biochemistry were regularly monitored. He was reluctant for frequent blood sampling. During the last 5 days all believers of allopathy were just keeping their fingers crossed. His ketones were fluctuating between 4+ and 5+, electrolytes were abnormal and bilirubin started rising during last 3 days. In spite of all these abnormalities on paper, he was full of life, though the body was weak.
The ketone bodies did stabilize after 5th day of fast and didn’t rise further, which was probably because, by then he had exhausted his fat reserves. Proteins were broken down for his calorie requirements and the same was reflected in the rising uric acid levels.
A team of government doctors visited him and advised urgent admission. Though our team of medical doctors was confident by then and stood by Arvind. Medical practitioners can not take a fraction of risk, as its the matter of life and death. The advise of government doctors was exactly the same that I gave on 4th day of fast. Similarly Dr Ayyar, a cardiologist from Bhopal who joined us on 6th day had the same advise.
Being at Jantar Mantar 24×7 amidst crazy people dancing on tune of patriotic songs, waving tricolors and thousands of volunteers, we were more of common man having faith in destiny than medical doctors who would believe in lab reports.
I probably may not ever forget that evening of 2nd Aug when Anna declared that Arvind and others would end their fast the next day. I had the latest reports of Arvind in hand. His serum pottasium was 3.2, normal being 3.5-5 meq/l. Hypokalemia is very risky and the levels were alarming. Further drop in popotassium could lead to sudden heart problem.
I went to the cabin where Arvind was put up. We both were alone in the room. I informed him about the low potassium levels and the risk involved. Then I argued – Anna has already declared that fast ends tomorrow, we are going for a political alternative. But tonight your life is at risk for no reason. If you consume some coconut water, your potassium would remain normal. Consuming coconut water wont break your fast.
His response was –
“Dr Parikh, we are not alone in this room. Almighty is there and I cant cheat. Anna has said that i will end the fast tomorrow and that’s it. Whatever the consequence be, be it sensible or not, I wont take anything by mouth till an announcement is made by Anna tomorrow.”
This was that secret steel glass that was keeping him alive with all odds. A firm belief in Karma, dedication for the cause and preparedness for the ultimate sacrifice if need be.
I hardly slept during those 7 days and that night off course I could’t even take a nap. The graph of dipping potassium levels was floating in front of my eyes. But the man, Arvind Kejriwal who was not sure if he would wake up the next morning was sleeping calmly on his bed.
Next day before leaving for Jaipur after Arvind broke his fast, amidst the crowd of people around him, I waved my hand from the entrance of his cabin. Arvind opened his arms, and embraced me. I broke down and cried in his arms like a child. Can’t figure out reason for this emotional outburst. That was the moment when I got relieved of tremendous stress. Had a huge responsibility over my shoulders, being responsible for medical care of a man loved by millions of Indian youth. Every moment his life was at the mercy of God, though people had a faith that he is being taken care of by a specialist doctor. This relief might well have outbursted in tears.
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