(Parimal M. Rohit’s reporting on Diabetes and Indians was undertaken as a California Health Journalism Fellow at the University of Southern California’s Annenberg School of Journalism. Rohit, who is a diabetic, pursued this fellowship to aid anyone suffering from this chronic disease. This week’s article is Part II of a series. —Editor)

Medical professionals and researchers have long been warning of the potential growth of diabetic cases among Indian populations, both in India and among Indian Americans in the United States. Previous coverage of how diabetes impacts the Indian community at home and abroad provided a broad perspective of the disease and why Indians are susceptible to dangerously high blood sugar levels. India-West’s examination of the impact of diabetes within the Indian population continues with a look at an attempt to legislative efforts to reduce sugar consumption, how one diabetic patient lived with the disease for nearly 25 years, and ways to manage the chronic condition.

Legislating Diabetes

Diabetes is not an epidemic limited to the Indian American community. California state Assemblyman Richard Bloom (D-Santa Monica) introduced legislation earlier this year to impose an excise fee on companies distributing any sugary beverage within the state.

Bloom’s bill stated more than 2.3 million California adults, or 1 of 12 residents, were diagnosed with diabetes. About 1.9 million of those adults were reportedly diagnosed with Type 2 diabetes. About 8,000 people die annually because of diabetes, according to the bill, making the chronic condition the seventh-leading cause of death in California.

“One-half of adults with Type 2 diabetes also have hypertension. This rate of occurrence is twice as high as for those without diabetes. Adults with diabetes are also twice as likely to have cardiovascular disease than adults without diabetes,” the bill stated. “Adults with diabetes are 50 percent more likely to have arthritis than adults without diabetes. [More than] 40 percent of new cases of kidney failure are attributed to diabetes.”

Assembly Bill 1537 (AB 1537) would have charged sugary beverage distributors 2 cents per fluid ounce of concentrated drinks, which include fruit juices and sodas. A standard can of Coke is 12 ounces. A Coke distributor, for example, would be required to pay the state a tax of 24 cents per 12-ounce can had AB 1537 become law.

The bill, which was sponsored by the American Heart Association, failed to make it out of the Assembly’s Health Committee in May. Bloom said the excise tax under AB 1537 would have generated about $3 billion to prevent and treat diabetes and related conditions, such as heart disease and obesity.

“Across the nation and in California, diabetes and heart disease have reached epidemic proportions. The evidence shows that the epidemic grows worse with time,” Bloom stated. “Diabetes is now the seventh largest cause of death in the nation. If current trends aren’t reversed, one-in-three children born after 2000 — and specifically one-in-two African-American or Hispanic children — are expected to develop Type 2 diabetes. The overwhelming view of health experts is that the single most significant cause of obesity and diabetes is overconsumption of sugar.”

Diabetes and Socio-economic Status

Several news reports and research studies link diabetes to socio-economic status.

A Mayo Clinic researcher linked diabetes to poverty. James Levine of Mayo Clinic’s Endocrine Research Unit stated citizens of poverty-dense areas either have extremely limited access to healthy food or regularly suffer from hunger. He added residents of poverty-dense areas are less active, increasing the risk of suffering from diabetes.

Pharmacist Drupad Parikh, however, told India-West that diabetic risk is not limited to low-income or poor neighborhoods. Becoming a diabetic can happen just as or more likely among educated professionals in affluent neighborhoods, Parikh argued.

“When we become more prosperous, we can eat the foods we want. We are working to get the food. When we work, we are not cooking,” Parikh said, adding the increased access to processed foods plus diminished physical activity due to our pursuits of professional careers is exposing the Indian American community to lifestyle disorders.

The pharmacist pointed to his grandfather’s career as a farmer to demonstrate the link between career choices and physical wellness.

“If my grandfather is a farmer, his metabolism will be very different (from a pharmacist or lawyer), because he walks 10 miles a day. If he eats oily food, cholesterol might be normal, because he is burning it off,” Parikh said. “I work in an office. My metabolism will be different [than my farmer grandfather]. If I eat the same foods, I might end up [with diabetes or some other lifestyle disease.]”

Parikh’s perspective was echoed in a 2004 study by Prof. C.S. Yajnik.

“The diabetes epidemic is of recent origin, and diabetes is more common among urban than rural Indians,” Yajnik stated in his study, titled “Early Life Origins of Insulin Resistance and Type 2 Diabetes in India and Other Asian Countries.”

“Indians have a higher percentage of body fat and more visceral fat than members of other populations,” Yajnik continued. “Urban lifestyles, including poor diet and sedentary habits, promote further obesity, insulin resistance and type 2 diabetes. These factors may be amenable to correction.”

Yajnik’s study mostly focused on how Indians are exposed to diabetes as early as being in the womb, but added one can become diabetic “in contemporary conditions of plentiful food and sedentary lifestyles.”

How to Live With and Manage Diabetes

Dr. Ameet Shah, the Kaiser Permanente physician who spoke with India-West during this reporter’s initial coverage of diabetes and Indians, said living with or managing diabetes is all about making permanent behavioral changes, consistently managing food intake and regularly exercising or partaking in some form of daily physical activity.

“There is nothing to fix diabetes. The foundation of diabetes control, however, is having a respect for the condition and your body. The key is to prevent complications by being mindful of what you put in your body. Cut back on the salt and sugar you add to food, limit the portion sizes of starches, and bake rather than fry foods,” Shah told India-West. “Staying physically active with doing at least 30 minutes of walking a day increases the blood flow throughout your body and makes your heart stronger.

“Eat regularly, four to five times a day, and keep the size of your meals small. Your body still needs sugar to function. By eating throughout the day, you’re giving your body what it needs to function,” Shah added.

Managing and understanding diabetes through medication, proper lifestyle choices and healthy eating can help avoid damage to one’s heart, kidneys, eyes, feet and hands, Parikh said, a perspective echoed by his pharmacy colleague, Lal Thakarar.

“Be aware of the food you are eating,” Thakarar advised, adding that Indians as a culture also need to exercise more often. “Our failure is food. Our failure is exercise and coping with stress. These three things make us more susceptible and high risk. If you are high risk and you are not aware, you can drop dead.”

Thakarar advised anyone who is pre-diabetic or already suffering from the disease to follow a balanced diet, avoid carbohydrates, make practical decisions with certain foods, and regularly work out.

He added that simple changes, such as drinking almond milk instead of regular milk or using low- or no-fat yogurt instead of higher fat equivalents, could have significant positive impacts in the long run.

A Diabetic’s Story

Anjali D. lives in the suburbs of Los Angeles with her husband and adult son. The Indian American has been a diabetic since 1992. Anjali, who is 72, takes insulin shots to control her blood sugar. She agreed to speak with India-West under a pseudonym.

“I still enjoy life. My age is [getting up there], but I don’t feel bad. I do everything,” Anjali told India-West, adding she never feels tired or dizzy, but her biggest struggle is with her blood sugar levels dropping low.

The good news for Anjali is she made proper lifestyle adjustments in her 23 years as a diabetic to allow for living the best life possible. Most of her adjustments focused on food – portion size, frequency of meals and what was consumed when. She walks around her neighborhood regularly. A homemaker, Anjali also stays active inside the house: maintaining the grounds, keeping the interior clean and spending time cooking for her family.

“I take very little rice, one time [per day], sometimes I don’t take rice or chapathi (bread), only sabzi (cooked vegetables) and fish, chicken,” Anjali said, adding that she also includes fruits and oats in her diet. She also has a regular teatime, where she will drink chai (tea) and eat a piece of toast.

Anjali also receives help and support from her husband and son, both of whom have backgrounds in health and medicine. Her husband, for example, advises her on proper medicine dosages. She takes small doses of insulin before each meal.

The only physical impediment Anjali suffers is the occasional knee pain, which might prevent her from enjoying a good walk around the neighborhood. Otherwise, Anjali told India-West, her body functions well; she does not have issues with eyesight, for example.

“Eat properly, don’t take junk food, don’t eat sweets, and walk all the time,” Anjali, who was the first in her family to have diabetes, advised.

Anjali’s son Debashish (also a pseudonym) has a medical degree and works at a Los Angeles area hospital. Although he is not a practicing physician, he regularly supports his mother’s diabetic management. The most important element of diabetic management is whether the individual with the condition understands the disease and takes advantage of whatever resources or tools available to them.

“Having a chronic disease like diabetes, you have to be good about understanding what it is that you have,” Debashish said. “My mom’s been a great example of knowing what the deal is, she knows what she has to do, and she’s very good at maintaining her discipline about food, about exercising. Obviously there are some lapses here and there that happens to everyone.”

How proactive a diabetic is in addressing his or her condition is the most important factor in whether he or she can lead a full life with a chronic disease.

“Although having a family history makes you more likely to develop diabetes, being proactive about your health can help delay and often avoid the diagnosis,” Shah said.

Growing numbers of diabetic patients in urban or prosperous areas is certainly cause for concern. Living with diabetes, however, is not impossible.

(India-West’s coverage of how diabetes impacts the Indian community will conclude — in an upcoming issue — with practical advice of what foods to eat and other methods to manage the chronic condition.)

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