There’s a big article in the New York Times today about diabetes in India (thanks, Gitanjali and Builder). It’s impressive partly because of some surprising statistics given about the spread of both obesity and diabetes in India, and because of some touching individual interviews that illustrate some of the particular difficulties faced by Indians dealing with the disease.
I would recommend people go read the article, but here’s a summary of some of the stats I found notable:
- There are probably about 35 million people in India with Type 2 Diabetes (adult Diabetes) now. In a few years, there could be as many as 75 million. The current rate is 6 percent of adults have the disease, but that number is higher in Indian cities (in Chennai, Kleinfield reports, 16 percent of adults have Diabetes).
- Even middle-class Indians tend to remain uninsured, so Diabetes can be a financially crippling disease.
- Indians are genetically predisposed to contract Type 2 Diabetes, and they tend to get it 10 years before people in other parts of the world get it. (Which means, the danger is also high for NRIs; apparently this has already been observed with the earlier generation of immigrants)
- One of the biggest dangers in India in particular is that Diabetes, which leads to loss of sensation in the legs, often results in infections that can end in leg amputations. Since so many people go barefoot in India (even occasionally: as in, when visiting temples), the risk of foot and leg infections is much higher than in the west.
- In the world as a whole, there are now more people who are overweight than undernourished.
Any thoughts on this article, or recommendations for other things to read that will educate people on the danger of diabetes in the Indian subcontinent? I did find the tone a little irritating at some moments (“Diabetes — the dark side of India’s success”), but the research and the personal interviews were very informative.
i just wanted to comment that just because someone is overweight does not mean that they are undernourished. someone could very well be both. now, they might not be hungry or suffering from starvation, but they can definitely be undernourished and overweight.
not sure if anyone linked to this already, but today, NPR’s All Things Considered aired a piece on India’s obesity epidemic.
Hmm… quite true… but since it would be difficult to change the foood habit of a nation, and trust me food habit is the only cause of this, one must still try to eat in moderation sweets and such like and try to eat more salads, chives (which is used as a natural therapy for diabetis), and other green food… Sweets… there even are sugar free rasogollas at KC Das..
CNN reports that 20% of children in the US will be obese by the end of decade:
Not surprising that some schools have started to ban soft drink vending machines on campus.
good point… and then i know some long distance swimmers who are VERY bulky. in street clothes they do not look like the popular perception of athletes – but i swear, these are guys who swims 10k in the open water on a regular basis..boss … typical canadian bears – big, big smiled, big hearted, tiny speedos 🙂 and underneath all that insulation – they got a ticker that’s better than most us folks.
Ohhh… Tony… you bad man.. .tempting me with that food porn… 🙂
I am doing that stuffed brinjal curry this weekend. For sure..
Since you’re the pro – any suggestions on preparing mithai for diabetics without using whole milk, cream (and splenda).
desi aussie, I do not think that eating healthy and working out is any less hedonistic than eating ‘whatever you want’. I have found that whenever I excercise, I feel better and spend the whole day in a much better disposition than I do when I eat lots of ghee sweets. In fact, after I started paying attention to how my body reacts, I have found that when I have eaten some high calorie food in the previous meal, I naturally tend to not feel like eating sweets or oil rich items and vice versa. This makes me believe the theory that eating fatty/sugary food is addictive (shown in the movie Fast food nation).
The talk of diabetes reminds me of one of my college friends who was diagnosed of diabetes last year – soon after she turned 30! I do not envy her the prospect of bearing children with diabetes…. However, I did notice that even after being diagnosed with this disease, she ordered deep fried paneer as an appetizer in an Indian restaurant.
The story of the fattest nation on earth – the island of Nauru is really interesting – As a result of genes that are adapted to a place where starvation was common and imported fast food, 90% of the adults there are obese and 50% have diabetes!
http://www.economist.com/displaystory.cfm?story_id=884045
it’s a well established fact that desis are prone to diabetes with a lower BMI than non-desis. for example a desi with a bmi of 24 should be considered overweight, whereas a caucasian with the bmi is normal weight.
i think the best predictors of diabetes is an early examination of ones total cholesterol levels. if ones triglycerides/HDL ratio is greater than 3.5 there’s a pretty good chance that the person will get DM2 in teh next few years. i would urge all young second geners to get their fasting glucose checked and lipids done every year after age 30.
i would go as far to say that every desi should be evaluated for metabolic syndrome at yearly physicals starting at 30. if the diseases run in the family, then some simple measures can stave off the disease for years.
Surely, you kid, my friend 🙂 The only extensivity in me is my jalebi-fed fat ass. Last weekend I visited this new Surati Farsan shop in San Diego and there was no item on the Gujarati menu that I’d even heard of – Khaman, Khandvi, Petish, what the! So much for knowing anything by just being in India. Since Ethiopia somehow crept into this thread, Tef, did you pick your name because of the staple grain of Ethiopia, Tef/Teff? njera you like?
Great hypothesis, hairy_d.
amanda, deep fried paneer?
I wiwsh the reporter had undertaken a more in-depth analysis of what a working person’s reality is in India.
Eh? Best of luck with that. This is New York Times we are talking about. Not to single out NYT, pretty much all US newspapers paint a simplistic picture of non-western nations; and no, putting an abcd at the top slot in India doesn’t quite replace the need for knowledgeable analysis.
I think that the increasing prevalence of diabetes has also eroded a sense of agency about preventing it. I’ve met many an Indian who seems to think that it’s just a natural part of ageing – You gain a little weight around the middle. Your hair gets a little gray. You get diabetes.
And we’re also not so far beyond a time when diabetes was a sign of status in India…
But on a daily basis I see a myriad macro and micro reasons that contribute to India’s diabesity – the dearth of decent fruits and vegetables (even in the upmarket stores like Spencer’s they are often withered and sorry looking), the overcooking of those which people do buy (aloo ghobi, anyone?), the chiding-that-borders-on-mockery of those who watch what they eat (“What, you are trying to be ‘slim beauty?’ Ha ha ha!” “Are you watching your figure? Hee hee!”), the cars, cars and more cars, the basic lack of understanding of what exercise entails and how it needs to be done, just to name a few.
On that last point, a health conscious friend of mine was told by his music teacher, “I don’t like this exercise-every-day-for-the-rest-of-your-life idea of yours. I think you should just spend a whole year exercising instead, and that way you’ll never have to exercise again?” (I’m sort of astounded by the logic that doing a lot of exercise in one year would be like making a lot of money and living off the annuity. But the teacher himself? Also part of the 35 million.)
Or take my housekeeper, who has both diabetes and hypertension. I suggested that she try taking the stairs in my apartment building to incorporate a little more exercise into her daily regime. Several days later I realized that she was taking the stairs DOWN but taking the elevator to come UP. When I tried to clarify that going down the stairs doesn’t count as exercise, she explained, “But going up the stairs is so tiring!”
There’s a curious irony that this mostly preventable disease has fluorished in a part of the world that gave birth to a medical tradition rooted in prevention – any good ayurvedic vaidyan will tell you to stay away from ‘white’ foods (white bread, white rice, white sugar). And the good Indian yoga instructors whom I’ve met are all very attuned to how certain asanas affect the endocrine system and help regulate metabolism. Anyhow, I saw this article and mentioned it to a friend of mine here who remarked, “If people knew that yoga was fashionable in America, they would do it. Americans were so good at spreading fast food here. If only America could find a way to give yoga back to us, yo.” (Okay, so she didn’t say yo. Just checking to see if anyone read this far.)
Too funny. Sounds too true!!
Yo, I read it. And actually the idea of spreading yoga ‘back’ to India is something that makes sense (though I actually think it’s already happened to some extent; there are yoga shows on Sony TV or Zee TV in the mornings, for instance).
Did the article mention the lower threshold for having a servant in India? The poor side of my family used to be in spectacular shape but now some have moved out of the village and into middle class lives in bangelore with servants and all.
me, I try to live as poor as possible: walk everywhere, live in a walk-up, take the stairs, do my own laundry and clean my own place. except i make sure to eat like a rich man b/c the poor in NY look like the rich in India. Of couse, my pad is a mess and I have no clean clothes.
Thomas Kurma,
No. t e f stood for something. But I can’t remember what.
Yes, I love injera. And to keep this comment on topic, apparently teff is grown in India. But I have never heard of anyone eating injera-like thing in India. I am excluding Dosas & other crepe like things. And there are a few Abyssinian communities in India. I wonder if they still eat injera. I know teff is called lovegrass in English. But I have never been able to find out what the common Indian name for teff is.
I love ethiopian food, love the music, love the people…I really need to look into what kind of Right of Return laws they have : )
There is Teff in India!? There are Abyssinians in India? Are they close to Kerala? Because
There is something called Paalappam in Kerala which looks like (smaller in diameter), feels like and tastes quite like njera/injera. But it’s made with rice flour. Their beef/chicken stuff is just like mallu Xian stuff. In fact, the closest thing to Mallu Christian food you can get in the US (outside of a mallu restaurant) seems to be in an Ethiopian restaurant. I wonder if there is a Ethiopian orthodox – Syrian orthodox (mallu) connection here. Probably not, except for within the churches.
mmmmmm, Ethiopian food, one of my favourites. For those who haven’t been there, you get the BESTEST Ethiopian food in “Little Ethiopia” (in Los Angeles at Olympic and Fairfax). My absolute favourite place is Merkato — unbeatable price and taste, their “Vegetarian Combo” plate is less than $6 with a fantastic combo of collard greens, dried peas curry, lentils, tomato-peppers salad, some other lentil-y curries I forget and ….drumroll…yummy injera. Everyone I’ve taken there has totally loved the Veg combo but sometimes been a little disappointed with meat dishes, so maybe avoid those.
PS: Merkato is the one with the colourful map of Ethiopia sticking out outside.
Just wanted to add an emphasis (for those still reading): a calorie is emphatically NOT a calorie.
Refined carbohydrates (all those white foods) enter the bloodstream much more quickly than complex carbs (beans, whole grains) causing insulin levels to rise along with triglyceride levels and abdominal obesity. Potatoes are on the list with the white foods, too. And, having just spent 4 months in India (2 North, 2 South)– rice and alloo are big, big, BIG. And snack foods are absolutely rampant compared to the early 90’s.
Oils contribute to overweight/obesity and thereby, indirectly to diabetes, but are not the real culprits.
Please note: the Food Pyramid is skewed. The food industry had a lot of input. Too many grains and no differentiation between refined and whole grains. Too little protein. Too much emphasis on reducing fats, and again, not differentiating between healthy fats (like olive oil, nuts, omega-3’s) and unhealthy fats (trans-fat).
Exercise helps change the metabolism back to normal = lower insulin (yes, it’s more complex than this, but I think this is a good approximation) and helps with weight loss/maintaining normal weight, but it is only part of the solution. Look at quizman and other athletic types who still have cholesterol and blood pressure issues.
Stress also affects metabolism: higher circulating cortisol levels leads to weight gain even without increased coloric intake.
All this is to say it’s a lifestyle issue: whole foods, regular exercise, stress management are key to reversing the epidemic/pandemic. Hairy_d’s query about how to tackle the problem is one that public health and medicine have been looking at, especially with the Pima Indians. Community-based initiatives where families and individuals agree to change their lifestyle at the same time and support each other in these changes are promising. http://diabetes.niddk.nih.gov/dm/pubs/pima/focus/focus.htm
and thanks for the post Amardeep!
Diabetes Doctor said:
If it’s routine for desis BMIs to be interpreted differently, could you please please (and please) point me in the direction of some references? I’m 17.8 (5.6″/110) and
i’m ready to barfi’m so tired from having to convince my doctor that i’m not underweight and do not have an eating disorder.Do they use BMI in India?
I’m no doctor but if you want to send me your picture (for reference purposes) I can be more effective in researching your question. 😉
Ok. Fine, I will do this consult for free(scroll to bottom for some numbers that might help out).
Anyone with information about stevia? I know its not allowed to be available under its own name in the US ‘cos the FDA hasn’t cleared it or some such, but does anyone have info about whether it would be a good thing to use or avoid cos of unknown risk factor.
Zero calorie sweetener without the risks associated with splenda…stevia sure sounds good!
Any info would be appreciated.
Abhi
preverterr–MD,Thanks :).
And i mean really thanks–it’s a satisfying glimmer of the grail and i’m relieved that it’s out there.
Since Stevia is seen by some diabetics to be a heaven-sent alternative, here’s a link to what Wiki has to say:
oops. My first attempt at hyperlinking failed :(. Here’s trying again: Stevia
Abhi– dang you’re good. I went everywhere back in April looking for adjusted growth charts (age 1 year to 12 years) for India because the ones done in the 70’s do not reflect current nutritional status of children in India and are skewed towards Urban and North Indian subsets. Do you have a magic bullet for me??
The following is from a Women’s Studies colleague in the context of a discussion of America’s obsession with obese women/obese women as deviant:
Also see: Paul Campos’ book The Obesity Myth, which through careful examination of the scientific evidence as well as insightful cultural commentary, challenges many of the assumptions about the health risks of fat per se. http://www.obesitymyth.com/.
(maya still has ten minutes to kill before she leaves to meet the New York train…)
Maya- the people living longer are the boomer generation and their elders. The kids generation is projected to have (based on increased risk of diabetes, heart disease and hypertension) to have 13 years less of life.
It isn’t a myth that obesity is associated with earlier mortality. This is about health, not social stigma.
Awwwwww, thanks. However, I usually only hear that just before they dump me for a non-blogger 🙁
Bang bang… 😉
Gitanjali, Will this cure your troubles?
abhi- I won’t dump you, no sir. I may be unreliable, but I’m loyal.
Yes, sir, I believe it will. I think my problem was looking for the graphic depictions. Or maybe it wasn’t ready in April… Ina either case, many thanks, from me and my small friends. 🙂
Gitanjali,
Thanks for that (sad) info. I’ll pass it along.
Any thoughts on this article that appeared in the NYT magazine section last month?
http://www.nytimes.com/2006/08/13/magazine/13obesity.html?ex=1158465600&en=24f22f133e4e1fb7&ei=5070
maya– Cool article. Thanks. What I think? This is hopeful. It reinforces what I’ve learnt about obesity and overweight and sheds some (albeit speculative) light on those cases which don’t respond. Inflammation has been proven to contribute to obesity, as do genes and diet and exercise (or lack thereof).
The desi angle is also quite cool– Dhurandhar and the fat chickens with normal cholesterol and triglycerides.
I do strenuously object to one statement which appears twice in different garbs:”Biology sets the context, and that is critical, but obesity still boils down to whether a person eats too much or exercises enough.” This doesn’t take into account the effects of inflammation, thyroid and other hormones, stress or the differing effects of food choices, not to mention microbes. And while it isn’t a solution I encourage, for some people bariatric surgery is the only thing that seems to work.
Bidismoker (#116)
Why would we need the Americans to “give it [yoga] back”?
Well yes, exactly! That’s what made her comment memorable, that yoga would be more popular if it had the Export Quality stamp of approval, that American validation would popularize yoga in the very land where it originated. (I can see it now – an airlift of yoga mats and Rodney Yee DVDs to help all the freedom lovin’ people of the subcontinent rise up against the cripling trifecta of samskara, tight hamstrings and second trimester uncle bellys…)
I just thought of something else, and that is that there’s no complimentary way to say “You’ve lost weight” in the Indian language that I am most familiar with. There’s only “You look bad”, “You look sick,” and “You look tired”. Conversely, anytime an auntie hints that I’m looking “healthy”, it’s a sign to cut back on the dosa and ramp up the ‘skipping exercises’…
Sorry, I meant to say, “…the implication that yoga would be more popular if it had the Export Quality stamp of approval…”
I’m interested in the comments suggesting that there are explanations other than affluence (i.e., richer diet and less exercise) for the increase in diabetes. I think there is no one cause. But some extensive analysis of the ways in which the increase coincides, or does not coincide, with the lifestyle changes resulting from icnreased affluence, all while controlling for segments of the population who are susceptible to diabetes for other reasons (e.g., low birth weight), ought to give us a better picture.
Also, isn’t the article really about the way in which “development,” that thing we int he West promote to the rest of the world as a savior, actually introduces as many problems as it solves (if it even solves any)?
Just a thought. IÂ’ve tried to write about these ideas at The Curious Stall, and on Pass the Roti there is a nice post along these lines. Check it out.
It’s the white carb content of both the North and South Indian diet that does it!
White rice, maida (white flour), white potatoes (aloo gobi subzi).
If India would switch to brown rice then it would help alot.
Granted, whole-wheat flour is used in rotis, but naan = white flour, alot of the namkeens = white flour.
And South Indians eat tons of white rice. Dosa, idli, uttapam = white rice.
White carbs are simple carbohydrates. Simple carbohydrates = sugar.
Someone mentioned less cricket fields in India, thus less cricket playing, thus less exercise. But I’ve never seen girls or women on any cricket field in India. Typically Indian housewives who do not work outside of the home have a tendency to gain ALOT of weight over the years. I rarely see women doing outdoor activities like jogging, running, cycling, or swimming in India. In the metros yes, but the metros are few and far between.
Anyway, a nationwide switch to brown rice and other whole grains is the way to go.
Check out http://www.navdanya.org
I remember going to their stall in Dilli Haat a few years ago and purchasing a few kilos of their puffed Amaranth. At that time they did not serve prepared organic food but now they are, and have opened up some organic cafes around other areas of Delhi as well.
I remember reading their pamphlet which explained that prior to the white rice explosion, there were like 150 (or more )types of whole grains that were cultivated in India. World politics/economics drove the change to primarily white rice cultivation.
Anybody who supports big fat waistlines probably have one themselves. The healthiest,fittest, and sexiest people are those who eat plenty of vegetables, fruits and a little bit of meat , and no grains at all, similar to the neandrethal diet. Being an Indian myself, I can say that majority of Indians have puffed faces, big waistlines and low levels of stamina.
Unfortunately for the country that invented yoga, a culture of exercise and sports is practically non existent at this time. A top Indian tennis star recently visited Australia and he described that a middle aged Australian woman overtook him in a marathon. There are no ifs and buts about it, at least five hours of intense exercise a week and a dramatic change in diet is overdue for Indians.