(Parimal M. Rohit’s reporting on Diabetes and Indians and Indian Americans 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 and everyone suffering from this chronic disease. This week’s article is Part I of a series; Part II will be published Sept. 25. —Editor)
There can be no discussion of Indian culture without dedicating a portion of the topic to food. The country has a culinary history and lifestyle as diverse as it is rich. Stroll up and down Pioneer Boulevard in Artesia’s Little India and one will pass no less than two dozen Indian American-owned restaurants, each representing a special niche of Indian cuisine. Walk through the doors of any given eatery, and you will be met with a unique blend of aromas and scents thanks to a mixture of spices with meats and vegetables. Does Indian food, however, come with a price?
Recent health studies indicate Indians are at greater risk of suffering from diabetes than any other group in the world. A 2004 study by C.S. Yajnik in the Journal of Nutrition, for example, stated, “There is a rapidly increasing epidemic of Type 2 diabetes in India.”
“It is predicted that by 2025 India will have more than 60 million diabetic patients, and [coronary heart disease] will be the leading cause of death in adults. In other words, one in five diabetic patients in the world will be Indian,” Yagnik’s study forecasts.
Indian diabetologist V. Mohan, who oversees diabetic centers in conjunction with the World Health Organization and International Monetary Fund, said diabetes is increasing among affluent and migrant Indians.
“The prevalence of diabetes in the urban metros of India is approaching the figures reported in the affluent migrant Indians,” Mohan stated in a 2004 study, “Why are Indians more prone to diabetes?” “Environmental and lifestyle changes resulting from industrialization and migration to urban environment from rural settings may be responsible to a large extent, for this epidemic of Type 2 diabetes in Indians.”
Physical inactivity and the consumption of fatty, high-caloric and sugary foods vastly increase the risk of becoming a diabetic, Mohan and other medical professionals say.
“There is also strong evidence that Indians have a greater degree of insulin resistance and a stronger genetic predisposition to diabetes,” Mohan, who also is the director of the Madras Diabetes Research Foundation in Chennai, said in his study.
A 2013 study on diabetes among Indians by two nursing students predicted 552 million people worldwide would suffer from the chronic disease by 2030. The study added that diabetes is more prevalent among Indian Americans compared to any other Asian subgroup in the United States.
“Asian Indians have the highest prevalence of type 2 diabetes compared to other Asian subgroups. Asian Indians who immigrated to Western countries are found to be at risk for the development of type 2 diabetes due to the metabolic impact of a westernized diet or reasons based on tissue resistance to insulin,” Annie Thomas and Alyce Ashcraft from Loyola University and Texas Tech University schools of nursing, respectively, said in their 2013 study.
“Asian Indians living in India also face a similar threat related to type 2 diabetes,” Thomas and Ashcraft continued. “It is estimated that in another 20 years, nearly one-fifth of world’s diabetic population will be in India. Asian Indians are more insulin resistant and hyperinsulinemic than whites which puts them at increased risk for diabetes and heart disease despite the absence of traditional risk factors and decreased body weight.”
A survey of local doctors say pre-diabetic or diabetic individuals can still live a healthy and full life despite suffering from a chronic disease. The key to living with diabetes, they say, is to understand the disease, properly manage food intake and exercise. Diabetes cannot be cured, but it can be managed.
What is Diabetes?
Ameet Shah, an Indian American physician and assistant chief of family medicine at Kaiser Permanente in Torrance, Calif., explained diabetes as a chronic condition where the human body struggles to process sugar, which is commonly found in breads, cakes, cookies, pastas, rice and other carbohydrates or desserts.
“The problem with the high sugar in your body is it makes it harder for your body to function. Think of thicker syrup, instead of water, going through your blood vessels,” Shah told India-West. “It plugs up the small arteries, so blood can't get to where it needs to, potentially causing blindness, kidney failure, heart attacks, strokes and so on.”
Diabetes and Indians
“It’s amazing how rampant diabetes is in the Indian community. Every Indian knows someone who has the condition,” Shah, whose patients are both Indian and diabetic, said. “It is difficult to say what is driving this, but it is likely a combination of our food, lifestyle and genetics. The unfortunate reality is diabetes is extremely prevalent in the population. This is driven by obesity, being physically inactive, having a meat and starch heavy diet, and a portion related to genetics,” Shah said.
Indian food is an easy target, the Kaiser Permanente physician said.
“Traditional Indian cuisine is high in oil (both as oil added to dishes and fried foods), sugar and starches, and salt. All three of these components directly impacts clogging of the blood vessels in our body, resulting in increased blood sugar and blood pressure. These are silent killers slowly causing permanent damage in people who otherwise feel fine until they have the heart attack or stroke.”
Lal Thakarar, a veteran pharmacist, occasionally hosts free health fairs for Southern California’s Indian American community and provides no-cost testing of blood sugar levels. He said part of the problem is a lack of awareness.
“In the Indian population, the number is high because of unawareness, lack of knowledge, the way our food is cooked, late night eating, sugar, and lot of stress,” Thakarar told India-West.
He added it is routine for Indian-themed cultural events, be it weddings, private party dinners, or otherwise, to have dinner served late.
“Not a single event of ours has dinner served at 5 o’clock. It’s served at 10 o’clock or 9 o’clock. We are consuming 100 percent carbohydrates, tons of sugar. The things we are eating have a high glycemic index. They spike the blood more than other foods,” Thakarar said, adding puris and all Indian sweets are items most likely to contribute to diabetes. “None of our food is without sugar.”
Drupad Parikh, a pharmacist who works with Thakarar in coordinating the free health clinics, said the diabetes phenomenon within the Indian American community might be a very recent phenomenon.
“In the last few years, we have seen an exponential increase in the Indian population getting the lifestyle disorder,” Parikh told India-West. “Maybe it’s diabetes or hyperglycemia and high blood pressure. Lifestyle and diet are the two biggest things. We should have a balanced diet. It’s okay to eat oily food, but you should have enough vegetables, enough fruit, it should have all the parts.”
Diabetes is Not a ‘Death Sentence’
The most important element of health management is education, Parikh said. A better understanding of one’s physical health is the first step in preventing or managing conditions such as diabetes.
“The biggest hurdle is the economic burden, because you’ll be taking medication the rest of your life. We have medication to manage diabetes. We don’t have medication to cure it,” Parikh said, adding blood sugar not regulated by medication and abnormally high will eventually have impact on one’s eyesight, ability to walk, kidneys and heart health.
Living a “normal” life with diabetes is totally possible, according to Shah, especially if the diabetic patient maintains an open line of communication with a physician.
“Being diagnosed with diabetes doesn’t have to be a death sentence,” Shah said. “People can live a completely normal life with it. Based on where your blood sugars are, we may initially consider starting medications to get your blood sugar in a normal range to avoid the complications.”
Balancing food intake with exercise and proper health care can help delay negative impacts of diabetes.
“As you improve your diet to avoid foods that raise your blood sugar and, as you exercise to use up the sugar in your blood, your blood sugar will naturally come down,” Shah said. “As it comes down, we’ll need to reduce and possibly stop diabetes medications. This is where the relationship between the patient and physician is key. It requires communication both ways to work together as a team to get you to normal.
“A common misconception in being diagnosed with diabetes means you have to inject insulin,” Shah continued. “Insulin can be a powerful tool to keep your blood sugar normal, but there are many medication options available.”
Being informed about what diabetes is and how to live with the disease is only part of the puzzle. A popular quote misattributed at times to a famous actor and others to a German writer summarized the importance of living at the intersection of knowledge, will to act and execution.
“Knowing is not enough; we must apply. Willing is not enough; we must do,” the quote reads.
Living with diabetes is ultimately a combination of knowledge, intent and action.
(India-West will follow up this report with perspectives from people who live with diabetes and practical tips of how to manage the chronic condition. Additional reporting will also include suggestions of how to prepare popular Indian dishes without heavy doses of oil, salt or sugar and the future of monitoring blood sugar and food intake. —Editor)