Earlier this year I had the pleasure of getting to know Latha Palaniappan, M.D., M.S. She is a Stanford physician and researcher who has been studying why Asian Indian-Americans are very susceptible to coronary heart disease and diabetes, even though as a group we have a lower rate of obesity (a condition strongly associated with both diseases) than groups we’re compared with in many studies.
Dr. Palaniappan’s research has given her some insight into why this is, which she and her co-authors address in a 2011 Nutrition Reviews editorial titled "Incorporation of whole, ancient grains into a modern Asian Indian diet to reduce the burden of chronic disease." They conclude that we’re more likely to get heart disease, even though our community has a lower rate of classically defined obesity, because we have too many refined grain products in our Indian dishes.
They suggest that to reclaim our healthy traditional diets, which would provide a better foundation for a healthy life, we must reclaim the whole grains of our heritage. Not only our own, but we should try to incorporate non-Indian grain-like plants like quinoa. Soon after reading this and her other work, I reached out to Dr. Palaniappan, who was more than happy to discuss these matters. She then agreed to answer a few questions by e-mail. So without further ado, here is our Q&A.
Dr. Niraj "Raj" Patel: What made you interested in studying chronic disease in Asian Indian-Americans?
Dr. Latha Palaniappan: I became interested in studying chronic disease in Asian Indians because they are one of the highest-risk groups for chronic diseases such as diabetes and cardiovascular disease. I experienced this personally, as my dad died of a heart attack, at the age of 39. In addition to research, I believe that it is also important to put research into practice by implementing culturally tailored healthcare and education to increase patient and provider awareness surrounding these health issues.
NRP: Was it surprising that Asian Indians have among the highest rates of heart disease and diabetes in California?
LP: More than 2.8 million Asian Indians currently live in the United States and California has had one of the highest Asian Indian population growth rates. Given the high rates of diabetes and heart disease in Asian Indians around the world, it is not surprising that Asian Indians in California have among the highest rates of diabetes and heart disease.
NRP: Although Asian Indians have a relatively low prevalence of obesity compared with other groups in the U.S., why do Asian Indians have higher rates of heart disease & diabetes? This sounds counter-intuitive.
LP: Our research has shown that Asian Indians have higher rates of diabetes and heart disease despite lower body mass index (a marker of obesity and overweight), compared with Non-Hispanic Whites. While this does sound counterintuitive, it suggests that there are other unique biological and socio-cultural risk factors that play a role in the increased prevalence of these chronic diseases among Asian Indians. While research is ongoing, emerging biological risk factors, such as differential body fat distribution, increased levels of lipoprotein (a), and high-sensitivity C-reactive protein levels may play an important role in the development of chronic disease in Asian Indians.
NRP: In the 2011 Nutrition Reviews paper, which I found to be an amazing read, you and your coauthors describe the history by which refined grains infiltrated the modern Asian Indian diet. Can you briefly explain for our readers how this came to pass?
LP: Since the 1951 Green Revolution in India, refined carbohydrates, such as white rice and flour, have become the mainstay of the modern Asian Indian diet. The Green Revolution was an attempt by the Indian government to avoid reliance on foreign food aid (following independence from British imperialism) by developing and subsidizing inexpensive, high-yield crops. However, prior to the Green Revolution, whole grains such as amaranth, barley, brown rice, millet, and sorghum were more commonly used in Asian Indian cooking. These ancient, whole grains are nutritionally advantageous and can be substituted and incorporated into the modern Asian Indian diet.
NRP: Among your Asian Indian patients, do you find a lot of resistance to replacing white rice with brown rice? How about to adopting ancient grains that aren't indigenous to India?
Also, does the resistance differ based on age (older versus younger) or citizenship status (American-born versus recent immigrant)? Finally, has it changed any over the years?
LP: Fortunately, we are blessed in the U.S. with ready access to ancient, whole grains, which were originally available only in health food stores, but now can be found in more mainstream grocery stores. My older patients can actually remember having ancient grains in their childhood diets, especially if they have a history of living in rural areas. Younger patients are more likely to experiment with non-indigenous grains and incorporating them into traditional Indian recipes. My American-born patients tend to eat traditional Asian Indian foods less often, but healthier carbohydrate choices can be made in all cuisines.
NRP: How has your work and what you've read changed how you eat and feed your family?
LP: We eat whole grains every day, with 4-5 grams of fiber at least per carbohydrate serving. My daughter was so used to eating whole wheat bread that, when she was 5, she went to a friend’s house, and came back wide-eyed and said “Mommy, they made peanut butter and jelly sandwiches on cake!” After eating whole wheat bread, white bread does seem like cake, and a treat that we should have only once in a while.
NRP: If a family can only make one change to what they eat everyday (presuming they eat a typical modern diet, which for Asian Indians would include food like puri on occasion and white rice on a regular basis), what one change would you advise for improved health in the long-term?
LP: The key dietary change that I would advise for improved health is limiting the intake of refined carbohydrates, such as white rice and flour. Instead, refined carbohydrates can be substituted with whole grains, such as amaranth, barley, brown rice, millet and sorghum. Asian Indians can replace white rice with brown rice, whole-wheat couscous, quinoa, or barley. While these alternative grains have a different taste and texture than white rice, they are much more nutritionally dense and can dramatically reduce the risk of type 2 diabetes and chronic disease.
NRP: Latha, thank you for the insightful interview!
And there you have it. If you didn’t have time to read the whole Q&A, the take-aways are that Asian Indian-Americans have one of the highest risk profiles for heart disease and diabetes, that much of this risk is due to diets that have incorporate more refined grain products and processed foods over the decades, that we would be better off eating like our grandparents did (that is, with more whole grains like brown rice in our meals) and even trying healthier substitutes like quinoa and stone-milled flour as opposed to the fine powdery white flour.
You can learn more about Dr. Palaniappan and her research at: www.pamf.org/southasian. I encourage you to do so!