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.
- Indians have a 50-400% higher rate of heart disease and diabetes than other populations, regardless of geographic location.
- While most people think of heart disease as a “man’s disease,” Indian women have an equally high disease rate as Indian men.
- 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.
- Being slim doesn’t protect Indians, either. Heart disease and diabetes occur in Indians who have a normal BMI.
- 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
- High blood pressure
- High total cholesterol
- Low physical activity
- Low high-density lipoprotein (HDL) cholesterol
- A sedentary lifestyle
- A sugar-heavy diet
- High blood pressure
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:
- 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.
- 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.
- 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.
- 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.
- 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:
- If you live in the United States , you can set up a screening and lifestyle phone consult at
- For International scheduling you can contact Stanford South Asian Translational Heart Initiative at +1 650-723-8561 or email firstname.lastname@example.org
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!