Why Young, Slim, Even Vegetarian, Non-Smoking South Asians/Indians Are Struggling With Coronary Artery Disease, Heart Attacks, and Diabetes

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Most of us have heard that we should eat less fat and ghee, avoid meat,  skip the junk food, pass on the soft drinks, and lace up our running shoes regularly to keep our hearts strong, bodies slim, and our blood sugar regulated. What you may not know is that if you are of South Asian descent (from India, Pakistan, Sri Lanka, Bangladesh, Afghanistan, Bhutan, Maldives, or Nepal), you have an increased risk of developing heart disease, a big unhealthy gut, and type 2 diabetes, regardless of your other risk factors. That’s right—even if you are a slim, vegetarian, non-smoker with low cholesterol and average blood pressure, simply being Indian puts you at risk for these conditions.

 

 

Kaiser Permanente, a large health maintenance organization (HMO) in the US, found an alarmingly high rate of hospitalization for heart disease among its Indian male patients in Northern California—almost 4 times higher than Caucasian patients and 6 times higher than Chinese patients. This was probably not due to over diagnosis or over treatment, because Kaiser is a conservative HMO that only recommends expensive procedures to the most high-risk cases.

 

 

 

 

  1. Indians have a 50-400% higher rate of heart disease and diabetes than other populations, regardless of geographic location.
  2. While most people think of heart disease as a “man’s disease,” Indian women have an equally high disease rate as Indian men.
  3. Being vegetarian doesn’t seem to protect Indians in the same way that it protects those of other ethnicities. Vegetarian Indians have a similar rate of heart disease and diabetes as non-vegetarians.
  4. Being slim doesn’t protect Indians, either. Heart disease and diabetes occur in Indians who have a normal BMI.
  5. In a study of Indian doctors, most of whom were aware of the traditional cardiovascular risk factors, one in ten had documented heart disease.

One of the most disconcerting facts is that even the young and seemingly healthy Indians aren’t immune from having a heart attack or developing diabetes. About one half of Indian men who have a heart attack are 50 years old or younger, and one quarter are 40 or younger.

The numbers are startling and conclusive—Indians are uniquely at risk for serious and potentially deadly chronic conditions. The question is, WHY?

Traditional Risk Factors for Heart Disease and Type 2 Diabetes

Traditional risk factors for heart disease include

  • Smoking
  • Obesity
  • High blood pressure
  • High total cholesterol
  • Low physical activity
  • Low high-density lipoprotein (HDL) cholesterol
  • Pre-diabetes

 

Traditional risk factors for type 2 diabetes include:

  • Obesity
  • A sedentary lifestyle
  • A sugar-heavy diet
  • High blood pressure
  • Pre-diabetes

 

The Indian/South Asian Risk Factor

Over the last 15 years, leading institutions like the Stanford South Asian Translational Heart Initiative (Ssathi); the South Asian Heart Center (SAHC) at El Camino Hospital; University of California, San Francisco and Northwestern University, which are participants in the “Mediators of Atherosclerosis in South Asians Living in America” (MASALA) study; and the Prevention & Awareness for South Asians (PRANA) program at Palo Alto Medical Foundation, have begun to unearth unique South Asian risk factors that may have genetic underpinnings. For example, when compared to Caucasians, South Asians more often have a specific protein mutation that is associated with insulin resistance. In addition, their risk of heart disease at any cholesterol level is twice that of other ethnicities. Multi-disciplinary research has uncovered additional genetic and lifestyle-related risk factors that are particularly relevant in the South Asian population, including:

  1. High amounts of Lipoprotein(a), or LP(a). LP(a) is a type of LDL cholesterol, which is commonly thought of as the “bad” cholesterol. LP(a) is even more dangerous than LDL cholesterol and is strongly linked with heart disease. Your LP(a) level is largely genetically determined. LP(a) levels tend to be higher in South Asians than in Caucasians.
  2. High amounts of homocysteine. Homocysteine is an amino acid that your body produces, and it is strongly associated with an increased risk of heart disease. Unlike LP(a), your homocysteine level is largely related to what you eat. South Asians tend to have high levels of homocysteine compared to other ethnicities.
  3. High levels of high-sensitivity C-reactive protein (hs-CRP). High hs-CRP levels are associated with both heart disease and diabetes. Studies have found higher hs-CRP levels among South Asians than other populations. Like homocysteine, high hs-CRP levels are likely related to lifestyle factors, like abdominal obesity and being physically inactive.
  4. Abdominal obesity. Many South Asians have a normal BMI, slim arms and legs, and a large belly. This is called abdominal obesity, and it’s more strongly associated with heart disease and diabetes than BMI. South Asians can develop diabetes with just a small amount of abdominal obesity. Plus, even those without abdominal obesity often have internal, hidden fat that covers their organs and contributes to chronic conditions.
  5. Metabolic Syndrome. If you have three or more of the following five criteria, you have metabolic syndrome: abdominal obesity, high triglyceride levels, low HDL levels, pre-hypertension, or pre-diabetes. Having metabolic syndrome puts you at high risk for heart disease and diabetes. One third of South Asians have metabolic syndrome.

These five risk factors are potent players in the South Asian health crisis. Even without any of the traditional risk factors, high levels of LP(a), homocysteine, or hs-CRP can increase your heart disease risk by a factor of two. Many South Asians have elevated LP(a) and homocysteine, which increases their risk of heart disease by a factor of 30! These factors also seem to intensify the dangers of the traditional cardiac risk factors, like having low HDL or high blood pressure.

In short, South Asians have a hereditary susceptibility to heart disease and diabetes. That genetic predisposition can interact with and amplify common lifestyle risk factors, like being physically inactive and eating an inflammatory diet, putting South Asians at a dangerously high risk.

So What Can You Do?

If you are South Asian, don’t feel discouraged!

The good news is that most of these risk factors can be effectively managed with nutrition, exercise, stress reduction, adequate sleep, and medical interventions when necessary. Personally, I was told fourteen years ago that I needed open-heart surgery. Instead of going under the knife, I chose to manage my serious cardiac risk using NUTRITION, regular moderate exercise, and meditation. I have been healthy ever since.

Avoid the Nutritional Whitewash

Your metabolism is unique. Understand it! The first step towards nutritional health is to understand your metabolic risk factors, which you can find out through a simple blood draw.

Here are your choices:

    1. If you live in the United States , you can set up a screening and lifestyle phone consult at
      1. South Asian Heart Center at El Camino Hospital  OR
      2. Stanford South Asian Translational Heart Initiative.
    2. For International scheduling you can contact Stanford South Asian Translational Heart Initiative at +1 650-723-8561 or email ssathiclinic@stanford.edu

These results will help determine the nutritional regimen you need to follow to lower your risk. There is increasing evidence that mapping/personalizing your nutrition to your metabolic markers is key to counteracting these chronic conditions in Indians and South Asians. Despite your genetic susceptibility, your health can still benefit dramatically from lifestyle changes.

You are not what you eat – You are what your body does with what you eat. In the blog posts to come, we’ll tell you more about these chronic conditions and also explain what you should and shouldn’t be eating to optimize your health, based on your personal risk factors. After all, we believe that your diet is one of the most powerful tools available to you for decreasing your risk of these conditions. You may not be able to control your genes, but you can control your food.

Stay Informed, Stay Healthy!

178 COMMENTS

  1. Most South Asians still living in or outside the region, even those with high levels of education, have no concept of what constitutes a healthy balanced diet. Or healthy portions. Nor indeed of what constitutes an adequate, well balanced exercise routine including both cardiovascular and weight bearing routines. Most think that being vegetarian and taking a leisurely walk for 20 minutes each day is enough…the best thing we can do for our fellow South Asians is to go through a hard nosed myth busting project and to give them specific and professional dietary and exercise advice.

  2. I’m a South Asian 68 yr female & after much time & effort was diagnosed insulin resistant!! It took me one year to adjust to the medication Metformin – Glyciphage SR. I’m ok now but do get sugar slumps around 4 pm esp if lunch was high carbs!! Always wondered why I got this as have been slim, exercising &.dont drink. Didn’t know I had a mutated protein gene !!
    Thanks for this article. Will continue with my diet, exercise & medication & pray that no major ailment like heart problem or diabetes 2 befalls me.

  3. The name of this article is rather misleading. The title implies that it is primarily Young, Slim, Vegetarian, Non-Smoking Indians who are prone to the aforementioned diseases while the article’s content states that ‘Vegetarian Indians have a similar rate of heart disease and diabetes as non-vegetarians’, although several studies show vegetarianism to have several benefits over non vegetarianism (you can refer to https://akshatpv.wordpress.com/2015/06/09/why-non-vegetarianism-is-wrong/ )
    I’m not sure if your article is trying to discourage vegetarianism or if it was a genuine error, but either way the title ought not to be what it is.

    • Rahul,

      The article is not intended to discourage vegetarianism. In fact, there are numerous advantages to eating whole grains ( vs. simple,refined carbohydrates) and vegetable based meals for Indians.

      The article is intended to make Indians aware that just because you are a “vegetarian” a) it does not automatically insulate you from serious chronic diseases that is an epidemic among Indians b) you need to understand your metabolic markers /risks and c) you can manage those risks thru personalized meals which can be vegetarian , “eggtarian” or non-vegetarian based on your taste. The key is not to follow a nutritional white wash approach to your health, but be aware of the individual metabolism you have and tailor your meal that is therapeutic to your profile
      I plan to share more about metabolic markers and personalized nutrition in my upcoming blogs.

      • Ranjan,
        Thanks for clarifying, but nonetheless don’t you feel that saying that ‘being a young, vegetarian, etc. does not guarantee one any additional benefits as compared to others’, would be more suitable, in the sense, that according to the current title, being a non vegetarian or a smoker may have benefits over not being one of those?

      • Dear Ranjan, As one of the Principal Investigators of the MASALA study, we have been doing a lot of work to understand how different South Asian dietary patterns and risk factors may contribute to risk factors in South Asians compared to other racial/ethnic groups. I’d be happy to write an engaging and informative blog post on how South Asians can reduce their risk of cardiovascular disease and diabetes through research-proven interventions. Many of the screening tests that are encouraged (such as Lp(a) or CRP) actually have very little evidence behind them. In addition, we really need to understand the nuances of a vegetarian and non-vegetarian diet before making strong recommendations.
        Thanks for including MASALA in your blog- we hope our study will improve the health of our community. Cheers, Namratha Kandula
        http://www.masalastudy.org/

      • Ranjan, It is a great article and brings focus to the real problem and makes readers pay attention to the risk factors. Thank you!

        However as Rahul mentioned, there was no need to emphasize vegetarian diet in the heading and its relation to heart disease. It is misleading and you may need to remove it from the heading, but it helps to emphasize the need to cultivate healthy eating habits and avoid non-vegetarian diet. It is understandable that any vegetarian food with high glycemic index such as sweets or rice dishes ( https://en.wikipedia.org/?title=Glycemic_index) are equally bad and need to be avoided when we do not know any other details of one’s personal metabolic markers…

  4. Very nice Article and I am glad you are addressing the issues either were not known or ignored.. Like to know more.

  5. I am a 62 year old Indian woman living in San Diego. Can I get a screening when I visit my friends in the Bay Area? And like every Indian I want to know – how much will it cost me?

    Thanks!

    • Vera, Yes you can get screening done in the Bay Area at The South Asian Heart Center (SAHC) at El Camino Hospital. Here is the link..
      https://southasianheartcenter.org/contactus/contactForm.php?screen=true

      South Asian Heart Center – Mountain View
      El Camino Hospital
      2400 Grant Road
      Mountain View, CA 94040

      Phone: 650-940-SAHC
      Fax: 650-940-7144

      South Asian Heart Center – Los Gatos
      El Camino Hospital
      777 Knowles Drive, #17A
      Los Gatos, CA 95032

      Phone: 650-940-7242

      They may be able to refer you to physicians locally in San Diego that may screen you

      Hope that helps

      Stay Healthy Stay informed!

  6. very useful important information
    Make people alert n awake n prevent them from coming problems
    People will learn n change food habits
    Always would like to be informed with latest research
    Thanks

  7. Do these figures include Indians permanently living in India? The hundreds of millions of poor under nourished Indians living in far flung villages? About 270 million Indians (living in India) have access to less than $ 1.25 per day, and are officially declared ‘poor’. Are they at risk? Is there any study on their mortality? I think not, as they don’t even have access to primary health care.

    So most of these studies affect Indians in India who are exposed to fat that they are not predisposed to digesting.

  8. Experienced clinicians know-
    1. Stop intake of artificial cooking oils: soya, canola, “vegetable” and refined oils.
    2. Stop intake of artificial sugars.
    3. Eat green veggies each day at least twice a day. Vegetarian does not mean paneer, bread, mill, soya, jello, or chips. It mean V-E-G-E-T-A-bles.
    4. Whatever your feelings about the seven whites (milk, sugar, salt, eggs, flour, rice, oil), get to know what food processing is done before it gets to your mouth.
    5. Doing these things, my patients have cured themselves of a lot of things and gotten wiser.

  9. The physiological status, the heredity, eating habits etc., are one side of the story. The other side that needs to be studied in depth is the socio economic influences of a population of India. For many years we were saying that India is a growing nation. India is truly a growing nation for the huge Indian populace in terms of employment opportunities, earning potential, and growth opportunities only for the past 15 – 20 years. The story is long. But in short, we failed to maintain an equilibrium between our ambitions for success and maintaining good health to achieve the same. We gave away or even now giving away our health for achieving success as per our definition!

  10. I can personally attest to this finding. I lead an active lifestyle (regular at gym for over 15 years), vegetarian, non-smoker, teetotaler, HDL 48, cholesterol of 164, low LDL and triglycerides, yet had a heart attack with 4 blockages (4 stents) 3 months ago. Some of the doctors were scratching their head and perplexed about my situation at the hospital. I am thankful to God for saving me and am on regular medication and have resumed my workouts. I have since met 3 others with similar profiles and it is very sobering to see folks in their prime having to change their outlook on life. Thanks for posting this article.

    • Thanks for sharing your story Niranjan. It’s surprising to know you had a stroke though you exercised regularly. Did you have a high waist:hip ratio? I mean, it was possible that even if you had low overall fat, it was all concentrated in the belly region.

    • Thank you for sharing.. We have been reviewing Dr. Caldwell Esselstyn research and will be incorporating insights in future blogs especially in the area of Omega 3/Omega 6

      • Interesting article. My recent research on Asian Indians between age 25-60 in the Unites States demonstrates that the average BMI is also increasing, unlike previously known for Asian Indians. Diet and lifestyle were the usual suspects, however, my research showed that aspects such as stress management and health education need urgent action in the context of prevention (and management) of obesity and related chronic diseases.

  11. While appreciating the efforts of institutions and researchers involved in finding the bio-chemical markers of some inherent conditions in South Asians, I feel there is some role played by the emotional roller-skates that South Asians are prone to, compared to the more stable Caucasians and Chinese etc. South Asians work up quite a lather on political issues, hotly debating national issues. Their domestic environment is often no less chaotic. Combined with a poor dietary regimen (most folk eat simply to feel full, and do not pay attention to quality of nutrients in their diet) and genetic predispositions they seem more vulnerable to the conditions described by the researchers.

  12. The article explains why many young, educated and healthy looking Indians are suddenly clasping their chest with both hands and collapsing to the ground. Sudden heart attacks and diabetes related complications at a relatively young age can be drastically cut down if the risk factors listed in the article are fully recognized and understood by the vulnerable section of the population; they have no clue what-so-ever of the unfortunate and deadly transformations occurring inside their bodies.

    Ranjan,

    Kudos to you. The knowledge you have shared can save thousands of young South Asian lives around the globe and relieve their unfortunate families of their life-long miseries.

    R. Parachuru

  13. The only reason you get all those sicknesses is, SUGAR. There is no genically issue involved. Diabetes, CVD, Cancer are all caused by sugar. And the asian have in the same way as western countries exploded in those diseases latley. LDL is one of the most important building blocks for life. And the higher ldl value you get the more destroyed your cells are from fructose and omega-6. It do the same to the brain cells and creates many brain related sicknesses like Alzheimers, dementia, ADHD, ALS and so on. The only ldl that is dangerous is the Apo B with particles size smaller than 25nm. Thye goes under the destroyed blood vessel wall the fructose/O-6 have created.

  14. Does’nt matter what you do most of the people now live around 90 , the current Medicine and Doctors will keep you alive with couple of Angioplasty, Bypass … So don’t loose your sleep and keep active life eat good and have fun

  15. Useful article. It would be helpful to know the statistics on the effects that regular yoga practice has on reversing these risk factors. Not all physical activities are created equal, even if they burn the same amount of calories or work your cardio system. Yogs is an intricate science that taps into your body’s own intelligence and self-balancing and self-regulating mechanisms…let alone the mental aspect of it.

  16. Good article. We have been with South Asian Heart Center for more than 6-7 years. They really guide us well and put us on the right path. Initially a Nutritionist worked with us for about an year and helped us in making many lifestyle changes (everyday food and exercise pattern). They monitor us even now by calling us every 6 months or so to see how we are keeping it going. But finally it’s upto us to carry it forward. They even arrange many informative talks, seminars etc.

  17. I believe nutrition is one of the aspects of Indian lifestyle. Ever since we switched over to packaged and preserved food, we are facing the problem.
    Prof Lasantha Pethiyagoda has a point. Our psychological and spiritual lifestyle has also undergone a change, exacerbating our genetic propensity. The lifestyle evolved after ages of evolution is the solution.
    Neither there is an end to the diagnosis of micro factors, nor will it lead to an everlasting solution.

  18. Though I am 76 and reasonably healthy,your article is educative and helpful for all who are concerned and needs attention.I would welcome and love to read more such articles on health matters,not only to learn more but to initiate actions beyond awareness.Thanks a lot and keep on educating us in future……

  19. I have seen folks in SW industry who are very disciplined about food, sleep and fitness, yet with high LDL levels. Perhaps we should explore every other option when fitness and food alone are not helping – Nutrition combinatorics, Natural medication and ways to combat mental stress.. In advance YOGA streams, they advocate Mind Sound Resonance and Cyclic Meditation for intense calming down of the mind so that mind can cooperate with the body in case of stress induced disorders – Diabetes, Hypertension, Cancer, Hypothyroidism.. Any personal experiences, would like to know more ?

  20. At last somebody has taken South Asian out of the chicken battery prescription syndrome. Now for a detailed chemistry-diet app understandable by laymen. After all docs will advise, laymen will eat.

  21. its really great to know and would love to know more about it, recently diagnosed with Diabetes and since I’m in IT so my work life balance, stressfull work culture and life style is playing its role…
    Always thinking of health but feel unable to do anything…
    But defiantly will try to get more information..
    Thanks once again..
    Regards

  22. I found this information on South Asian health profile at greater Heart attack risk very informative and valuable. It is very interesting to know what new revelations about south Asian health factors those contribute to their ill health. Since I am a writer myself and have my own editorial Blog, which is mainly featuring political analysis and social issues, I would like to get every researched information on the health issue for my own knowledge. I am 64 yrs and a Diabetic with Hypertension but i have manged my Blood Glucose control with amazing diet after many experiments with what I eat and I am successfully achieving my glucose in fasting 110 and PP 120. Yes I do agree the Asian diet is largely responsible to create serious health issues. But with diet you can manage Blood Glucose control and BP too if you learn to adopt a lifestyle that can keep you healthy. It was a nice reading for me on the issues of Cardiac problems seen growing in Indian population for different reasons. Would be interested in receiving your mails on the Health fitness. Thanks.

  23. one simple reason for this risk, “Fried Food”. If you enter any South Asian’s house, the first thing you notice is a strong smell of stale Oil…..

  24. Very interesting article. Where can I find info for such screening in Georgia and how do I get the information about the proper diet?

  25. It looks like just checking cholesterol and having an active life style is not enough for south Indians like us!

    I have used Berkeley Heart Lab to diagnose any artery blockages. They deliver very detailed reports(Looks like it has been acquired by quest). They do detailed analysis on Lipid Subclasses based on Genotype. I think Indians are typically in ApoE genotype and considered very risky. Please look into it.

    http://www2.lbl.gov/tt/success_stories/articles/BHL_more.html

  26. We are an Indian family and now via this article aware of risk factor of Diabetes and Heart problems being an Indian. Managing, food
    except cheating at times with good execise. Will be very much interested in “You are not what you eat – you are what your body does with what you eat. In the blog posts to come, we’ll tell you more about these chronic conditions and also explain what you should and shouldn’t be eating to optimize your health, based on your personal risk factors”

    Thank you

  27. This is certainly an eye opener, tnx for the article. I guess there are other factors as well that needs to be looked into. Vitamin-D stands out as most south asians have extremely low levels. Vitamin D is a very essential for all of us, it helps provide us immunity and also helps with good cholesterol. The low levels we have is even more prominent when they move to colder nations like the US. We have very low absorption levels as our genes are accustomed to a place where we are exposed to a lot of sunshine, and genes don’t change in 10-20 years as soon as we move to a different place, or as our living habits change. Our absorption levels are around 1/6th of Caucasians and hence need much more time in the sun, which most of us living in the colder parts do not get. Supplements don’t provide a good match as it only helps with the immunity part and not help with cholesterol.

    I guess the reason why the same phenomenon of heart disease striking young Indians in the US is also replicated now back in India is due to a big change in lifestyle. Most Indians in US work in white collar jobs, mostly IT and Doctors, both of whom are indoors all day, with very little exercise. Also our food habits have changed to the less healthy ones. The same is the case with young Indians back home too. I am sure if we look at the previous generation the % of heart disease under 40 would be significantly less as their lifestyle was very different.

    There are definitely many factors involved here, but food, lifestyle and Vitamin D seem to play a good part. So it might be good to look into the Vitamin D side too if you get a chance.

  28. Very informative and accurate, I fit in this article’s profile of a patient, I was diagnosed Diabetes in 2001 and recently had non invasive stent bypass, no smoking, no drinking ever, always gym but meat and sugar addicted. Since I discovered the Candida phenomena, I am able to control the sweet cravings and very hard to eliminate the “sugar becoming carbos” but reviweing latest research I did find two known but forgotten points to note for all, one that sugars will peak the glycimic index, carbs will spike it by becoming sugars, but guess what, “fats” wont have much spike type effect on blood sugars! and the second new point for me, was “HDL” if kept around 70-100 will unclog some of the artries but there are no prescriptions on the market yet for boosting the HDL and some confusing studies are out there too, but cardialogists do recommend upwards of 50 and 60 points of HDL, so now I am tracking supplements etc and the regular, exercise plus this and that…..and surprisingly I also stumbled upon HDL possiblity of having a direct effect on diabetes! I am still collecting the latest research including bacterial infection which possibly connects with Diabetes …I can share the links if needed…..

  29. Interesting read . Will like to know more about what the exact tests are for people not in he states to benefit .

    Also look forward to gearing about the precautions .

  30. A great article! But a scary one. Though I knew almost all the facts stated here, this article acts as a wake up call. Now, I want to get screened. I am very active physically and still have a pot belly problem, not a big one but still reason to be worried. I am high on sugar diet as I can’t control eating sweets. Once the screening done, I would like to follow a stricter diet. Is there a charge for screening or is it done for free for study purpose?
    Thanks

  31. Thanks for sharing this very Interesting article. I’m 50+ and slim and do regular exercise. I do have occasional alcohol beverages. I eat lots of greens. I would like to know if there are any similar locations in NJ where I can get my metabolism screened and understand my risks.

  32. You could definitely see your expertise in the article you write.
    The arena hopes for more passionate writers such as you who aren’t afraid to mention how they believe.
    All the time go after your heart.

  33. Indians may be slim but their cooking habits – everything is fried- may be a significant factor in heart disease + anatomical small coronary vessels

  34. This is true. Probably you could have stressed on the typical Indian Dyslipidemia, the important role that high Triglycerides and low HDL play in development of atherosclerosis and its manifestation in various beds- coronary, cerebral and peripheral

  35. Excellent and very informative article. No wonder I have been struggling with the midsection bulge, no matter how much I work out !
    However, I agree with Rahul that the title is misleading in that it seems to suggest that there is no use being vegetarian (I am not a vegetarian, by the way, so there is no ulterior political agenda in defending vegetarianism).
    I look forward to reading more posts here.
    Kudos.

    • Very informative article. Daily consumption of pomegranate juice has drastically improved my Triglyceride levels and overall health. Regular consumption of kale is also recommended.

  36. The cited study clearly says: “Others have considered the most promising explanatory hypothesis to be high prevalence of diabetes mellitus, central obesity, and insulin resistance.12,1518 Our data, controlled for blood glucose and body mass index, do not support this hypothesis, but we unfortunately have no data about HDL cholesterol, apolipoproteins, lipoprotein(a), or other possible lipoprotein factors. Our control for body mass index is also an inadequate test of this hypothesis, in the absence of data about skinfold thickness or waist-to-hip ratios. ”
    Doesn’t this article state otherwise?

  37. Body fat percent is the single most definitive indicator, not BMI, but body fat % – they are not the same thing.

    You refer to ‘large’ belly even in slim people with slim arms and legs as a contributory factor; very true. Actually, the belly doesn’t even have to be ‘large’, as in, physically large stomach/gut, the only thing which matters is if there is fat around the belly. It is a total myth to express wonder when people who are seemingly slim present themselves with diabetes and/or heart disease, as ‘under the hood’, they will invariably (in most cases at least) have fat around their bellies.

    Getting a visible six-pack (and outline of six-pack will do, it doesn’t have to be very well-defined six-pack or eight-pack) will get rid of heart disease and diabetes for the Indian population. Six-pack can be made visible by doing only moderate core-strengthening exercise (that it is hard to achieve is another myth, the muscles (six-pack) themselves are not hard to achieve, their ‘visibility’ is hard to achieve because of the layer of fat surrounding them; if that layer of fat is removed, six-pack will become visible automatically if the person has been doing moderate core-strengthening exercises because the muscles are present there under the layer of fat.

    • I meant Six-pack can be made by doing only moderate core-strengthening exercise and not Six-pack can be made visible by doing only moderate core-strengthening exercise. Visibility of it will need removing the layer of fat around the belly, which is not achievable by merely doing moderate core-strengthening exercise as my comment may have implied. Removal of fat needs something like circuit training or a training program like Insanity, i.e., something which gets you close to your maximum heart rate for a good 30-40 minutes with very short intervals (count in seconds, not minutes) for rest in between – whether you do it via bodyweight exercise or weight-training is not that important, what’s important is 30-40 minutes of exercise close to your maximum heart rate, with very short rest intervals in between. And eating healthy, balanced in terms of size as well as quality etc. goes with it too – not deep fried Indian curry twice a day (not just curry, almost everything, sweets are mostly deep fried, so is ‘namkeen’ and samosas – frying things as deep as possible is deeply ingrained).

  38. it is an eye opening article and these lifestyle diseases which pose threat everyday can be managed by taking a various steps which include a proper diet, exercise and yoga and meditation and regular and advanced preventive health checkups.

  39. This is my theory:

    Most of us Indians have descended from Vegetarian ancestors. Consequently our bodies have evolved to more easily metabolize Vegetable fat and experience difficulty in metabolizing Animal Fat.

    Now even amongst Vegetarians, there is consumption of Milk and Ghee both of which are animal sourced. Increased prosperity resulting increased affordability resulting in increased consumption of these two animal sourced fats could be the primary reason why there is an increased commonness of Heart Disease.

    I am not a doctor, but am a descendant of Brahmin ancestors but do NOT practice Vegetarianism. And yes, I have been on a lifelong regimen of (a) LDL reducing and (b) HDL increasing medication since I was 40 and discovered to have elevated LDL levels.

    Final question:

    If measurement / monitoring of LP(a), homocysteine and hs-CRP are markers for impending Heart Disease, then why are these tests not yet standard?

  40. RICE. People, it is RICE until proven otherwise. What would happen to Americans if apple juice was their staple food? Well, most Indians go around eating a food whose glycemic load is 30% higher than apple juice. This is not rocket science. I don’t have a randomized, controlled trial to prove it’s the rice, but we have all sorts of next-best level evidence that shows that eating a high glycemic load contributes to sky high insulin levels, metabolic syndrome, and type 2 diabetes. Check out this link (ignore glycemic index as it’s pretty much meaningless; it’s glycemic load that corresponds to insulin secretion/blood glucose rise) and eat accordingly! http://www.health.harvard.edu/healthy-eating/glycemic_index_and_glycemic_load_for_100_foods

    • Indian diet is predominantly made up of RICE, FLOUR, and vegetables of high glycemic load (carrot, potato, etc) and sugary fruits like mangoes and bananas. Our diet causes blood inflamation. Blood inflammation has more to do with coronary/heart diseases and Diabetes (cancer too) than anything else. These studies lack this perspective. They generalize Indian diet as vegetarian but we eat a lot more simple carb (producing sugar in our body) than vegetables. There are good vegetables (broccoli, spinach, chard, salad components, etc.) and not so good vegetables (potato, carrots, etc.). The fruits we eat also have high sugar load (mangoes, bananas, etc.). So it is SUGAR folks! Other offenders are mustard oil (heavily used in South Asian cooking) and other types of shortening used sparingly in deep fries and curries. If I was starting over, I would eat more of the good vegetables (greens), brown rice, whole grains, tandoori chicken, fish, less oil and ghee and exercise more. If you ate a samosa stuffed with potatoes, deep fried in oil along with a glass of carrot juice and some rice pudding for dessert, it is vegetarian but not the most healthy.

    • Just quick to the points. Learning from my own experience, I totally agreed that reducing / eliminating the high carbohydrates and sugar food consumption will help you significantly. Even I am a Chinese, I shared similar risks. I have tried “Rosedale Diet” in even just 2 short months. My Triglycerides reduces almost in half from 247 to 138, and glucose number (showing pre-diabete) also reduced back to normal. I encouraged you can read this book for details. I pretty much cut down (meaning completely eliminated all the rice, bread, noodle, eat good vegetables and salad (not potato and carrots..) and even avoid the high sugar fruit. I know it’s very hard to almost impossible to eliminate our comfort food. I recommend you to just try it for 6 weeks, and check you blood work. You will be encouraged by the improvement.
      http://www.amazon.com/The-Rosedale-Diet-Ron-M-D/dp/006056573X

  41. Nice article. I will highly appreciate if you could appraise on the following…
    How to control LP(a), homocysteine, and hs-CRP. What kind of diet will keep these to normal level and what should be avoided in daily routine.
    Thanks.

  42. Excellent and highly informative article. Risk factors like family history and professional stresses are also vital. Our obervation is that the risk factor is higher for higher income strata.

  43. I wonder how this compares with Indians living in India ?

    There are some results published recently that Indians develop heart disease
    at a higher rate after moving to the U.S.
    It would be nice to see a reference to that data, as it indicates that changes in
    food and lifestyles is probably the major cause.

  44. Good article! Often wondered about my paternal history of heart disease that has ‘plagued’ our family for the past few generations. Has equally affected even the slim, vegetarian, non smoking, ghee guzzling relatives both abroad and in the homeland.

  45. Informative article:
    I believe that the main factor to heart disease is GENES
    I want to share the following facts:
    1. I have undergone quadruple bypass heart surgery in November 2003 AICD is
    2. My E/F is 20%
    3. I am strictly vegetarian, non-alcoholic and never take tobacco in my life
    After my Heart surgery, I changed my lifestyle:
    1. Regular one hour exercise including Yoga
    2. Strict diet discipline. No Cheese/Butter or No fried item and 100% vegetarian
    With above two:
    1. I able to reduce my medication
    2. I can swim
    3. Once a week, I used to play continuous one hour outdoor sport (any of Tennis, Badminton, Racket Ball, Table Tennis)
    4. I used to do non-stop outdoor Biking of more than 10 miles (once/twice a week)
    Lastly, I can’t manage the stress. I am successful to reduce it to some extent
    CONCLUSION:
    Diet discipline, regular exercise, medication and stress management is mandatory for Heart Patient.

  46. Good article for all non yogic persons. Indian yoga system dwells predominantly with body,mind and soul. Our bodies ,with all internal organs,are nothing but manifestation of the subtle forces /energy levels prevalent all times and effected through our mental and spiritual faculties. The body parameters can and are directly controlled by our mind and soul energy levels. Present medical science has yet to evolve a million times to even comprehend ,evolve proper medical instruments and to have basic understanding of such mind functions and its potency to regulate and control AT WILL all such high sounding medical jargons!. This material world would be continually catered to ALONGSIDE the real potent and effective time proven INDIAN yogic science of RAJYOGA and to a large extent by Hathyoga ( and not fully like when you practice Rajyoga!). There are plenty of persons ,who are leading a healthy life without any severe heart problems, living by adopting the raja yogic way of living ( whereby all these concepts of Balanced diet etc; come into function automatically !) so, don’t lose heart and still there are FREE methods to live happily by adopting Rajayoga . Cheers. Myself, aged 64 yrs. is a living example of this suggested system of prioritising one’s goal of life . Kudos to all.

  47. Indian vegetarian diet is too high in carbohydrates and contain little or no protein, Also excessive stress due to peer pressure and obsession with money , status , ego at work etc, frequent eating out (95% of restaurant oils are chock full of trans fat ) , no antioxidant rich vegetables .Also ‘vegetarian’ people consume tons of milk products and sweets apart from eating snacks that are loaded with palm oil, coconut oil, peanuts etc -All of them are strongly inflammatory . Also all outings and entertainment are sedentary – movies , tv , snacks and restaurants .

  48. Excellent article and information, but what I found out bone density plays a major role and if you keep your bone stronger then 70% I think we can hav a control on those parameters and on deadly diseases!!!

  49. Nice article. In India also , the doctors have been telling us that Indians have more genetic predisposition to Cardiac problems and diabetes . But the awareness is still poor among the “educated” masses , let alone the economically weaker sections.
    Ram

  50. Excellent analysis and suggestions . Understanding your own metabolism devising a healthy policy unique to yourself is the key . We are unnecessarily competitive in this area , wanting to look younger , work longer , and eat more . We need to learn the WHY of health in every possible way by being nearer to ourselves from within and without .

  51. Body , Mind and Brain form a synchronistic trilogy . The brain , body and mind are entities that are intimately interconnected . The connection is simultaneous rather than hierarchical or linear . A change in any one faculty occurs simultaneously in the other two . Any part of the body , brain or mind either we use it or we lose it . The programs running all three entities are remain plastic and amenable to change all through the life . New pathways can be made and maintained at any time . The body circuits are most difficult to change but are most accessible .The brain images and mind are easiest to change but progressively more difficult to access . This is called as Neuro Dynamic Management .

    If we keep looking at body alone , as we generally do , we are missing the point . The body suffers because it is the end result . The brain and the mind too need to be consulted . We need to see the stress levels that the Indians undergo , the mental confusion of torn up between two cultures , *and* the sedentary eased out lifestyle .

  52. An article that sheds and unfortunate truth. Many Indians living in India are completely oblivious to the fact that their diet is the culprit. Excessive carbs, dangerously low protein, too much processed fats, sweets on a daily basis, fried stuff everyday, untimely meals – in short extremely unbalanced nutrition – coupled with very little to zero exercise. Especially women folks are rapidly coming under the high risk category. What is considered as “normal” itself is a BMI > 25.

    I have been living in the US for the past 10 years, changed my food completely. I am a very strict vegetarian and we have identified a very balanced non-processed food structure. We have turned around our numbers mentioned above into healthy range.

    The funny part is I was being ridiculed for criticizing the high calorie food in India. I have a BMI 23.5. Many people asked if I am sick and have some serious disease for loosing 24 Lbs.

    The biggest problem is awareness. Strong traditional culture in India prevents the information to make even tiny bit of awareness. Outright dismissal of knowledge learnt from science in the name of following heritage and traditions is not helping at all.

  53. It would be interesting to see how much of this is due to hard work and stress and competitiveness as first generation immigrants to the USA. Comparison with similar first generation immigrants of other backgrounds controlling for several mentioned risk factors would be very valuable.

  54. The high intake of simple carbs like rice and wheat is a big risk factor in Indians. Google “wheat belly” and be informed.

    • Vijay, You are right about the women data. There is no data on women.
      However, Based on the study and Table 2 , 9 cases out of 161 for men is statistically very significant– at less than P=.001 ..Means there is less than 1 in 1000 chance that the conclusion is incorrect.

      Thanks for questioning . Stay Informed Stay Healthy!

      • “P=.001 ..Means there is less than 1 in 1000 chance that the conclusion is incorrect.”

        No. P = .001 means that there is a 1 in 1000 chance that the null hypothesis is true.

        The null hypothesis is the hypothesis that the relative risk for South Asians is the same as that for the reference or control group.

        In fact, the 95% confidence interval is 1.8-7.4. This means that there is a 5% or 1 in 20 chance that the relative risk for South Asians is less than 1.8 or more than 7.4.

  55. Thrifty gene theory of years back. Regular exercise and balanced diet is a good start because as mentioned being of indian descent puts you at risk. Even though one may be vegetarian the usual Indian diet is loaded withoil or ghee thus not especially healthy.

    • Jigar, The best food depends on your metabolism, taste preferences, lifestyle and existing or known health risk Which city are you in?

      The first step is to get your metabolic panel done. Here are the some of the metabolic markers you should get screened for us to provide guidance on the best food for you
      1. LIPID PANEL
      2. GLUCOSE, SERUM
      3. INSULIN
      4. HGB A1C
      5. Lipoprotein Fractionation, Ion Mobility
      6. APO B
      7. LP (A)
      8. HS -CRP
      9. HOMOCYSTIENE

      The first four will help you in assessing any Metabolic Syndrome; the latter 5 in evaluating cardiac risk.

  56. This is definitely an eye opener information. And added to the ethnic background of south asians stress is probably another important contributory factor for MI.

  57. As a person diagnosed with Type 2 Diabetes in March 2002, I can state with research evidence that only 0.25% of people diagnosed with T2DM may have a genetic predisposition. The other 99.75% develop Diabetes through poor lifestyle choices – inability to manage stress, poor diet and lack of exercise. Fo e.g., regardless of origin, indians eat far too much fried carbohydrates in seed oils, both of which are contributing factors.

    After 10 years of following conventional medical and dietary advice, which worsened my diabetes and increased my medication, I discovered from medical research that medical schools ill-equip young doctors to reverse diabetes but merely treat a chronic ailment.

    I no longer have any symptoms, require no medication or supplements and at 52 yrs, have more energy than I did at age 30. Diabetes is reversible – you merely have to choose to do so.

  58. Nice article with lot of same information. We need to think differently. Integrated approach combining allopathy and ayurved together gives best results in our experience of 10 yrs. We have used this from ICU to Primary and secondary prevention. Reversal/Regression of atherosclerosis noncalcified plaques recorded. ICU death rate can be brought down.EF LV function improves. Systolic Diastolic dysfunction improves. Patients functional stability improves and investigational parameters do show positive changes. Interested press reporters ,Doctors , patients can contact duscuss with me on my mob. 09822650573/ email. Let us have open mind and not be Brain slaves to western concepts.These systens have disease management concepts mostly organ oriented. Our systems of heath management are equaly good.

  59. When you’ve got a handle on this data, you’re
    ready to start your program. I won’t pry them from the hands of your preschooler at the park.
    This is why it is usually better on your blood sugar level, along with your health normally,
    to eat sensibly and well in lieu of starving yourself.

  60. Thankyou Ranjan !
    Your article made me sit up and take notice . So the new mantra is not what I eat . ITS WHAT MY BODY DOES WITH WHAT I EAT .
    Of course ! I have seen among my family
    members who I eat with every day that its not me who eats the fattiest foods that puts on the most weight ..my husband has always been heavy for no apparent reason ..he eats moderately and regularly plays Tennis . Nor am I fitter than him because I am slimmer . WHY DID WE MISS THIS SO VERY OBVIOUS TRUTH AND SUCH A SIMPLE TRUTH soo long !!!
    Its time to understand our body and help it give us an optimum life and LIFESPAN !
    Thank you Ranjan Sinha ..God bless you!

    • Thank you for your kind words. I am glad you found the information helpful. I am interested to learn how you are using it in the work you are doing in your community. Please do share… thank you.

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    your blog and will often come back at some point.
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  62. My observation is that I tend to have much lower cholesterol levels and body fat when I eat a very low carbohydrate diet.

    Unfortunately, it is almost impossible to get other Indian people around me to cooperate with such a lifestyle.

    Also, I like beer. A lot.

  63. I am a man of Indian origin. I am 52 and have been living in the US for the last 30 years.
    I had severe pain while on an elliptical machine at the gym 3 years ago. They said it was not a heart attack but I failed a subsequent stress test (a test that detects if you have major blockages in your arteries). I was minutes away from being hauled to a cath lab for an angioplasty when I decided against it. I instead went on the diet President Clinton is on: detailed in Dr Esselstyn’s Prevent and Reverse Heart Disease.

    I quickly lost 30 lbs and became normal weight. My angina subsided and all my labs are excellent. My Cardio CRP went from moderealy elevated to normal. My HA1C wet normal. My total cholesterol with 10 mg of Lipitor is 100. And LDL < 50.

    Basically I have reversed my heart disease and don't have to worry about it anymore.

    I think the whole food plant based with no added oil is ideal for Indians, since most Indians, even non-vegetarians, already eat a mostly vegetarian diet. It is easy to eliminate the ghee, the milk and the yogurt and the paneer.

    My wife and I cook all our meals in 20 minutes for less in the Instant Pot, pressure cooker. Cleanup is a breeze. And we don't eat out much anymore.

    The Indian diet has become bad: lots of dalmoth, salty snacks cooked in trans fats from India, samosas, white rice and skinned daals, white flour, vegetables cooked until they are pulp, several sweetened cups of chai with milk etc etc.

    We do have a high propensity to develop heart disease but we also come from a culture that can make quick tweaks in its diet to prevent and reverse the disease.

    The same diet reverses diabetes, high blood pressure and the metabolic syndrome.

  64. Your conclusions are based on very old data from 1978-1985 when there were very few Indian Americans in the US. Moreover, the sample size of the study was also very small (only 9 out of 161 South Asian men were hospitalized). Here is a more recent and larger study which uses aggregated data for thousands of deaths that occurred in 2003-2011. It says that Indian Americans have a 30-40% LOWER rate of age-adjusted mortality from heart disease than whites. See Table 4 here:

    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4411112/

    This bears repetition: Compared to non-hispanic whites (NHW), Indian Americans have a
    LOWER rate of mortality for heart disease.
    LOWER rate of mortality for stroke.
    EQUAL rate of mortality for diabetes.

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