Mithai? Not So Much : Diabetes in India

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.

141 thoughts on “Mithai? Not So Much : Diabetes in India

  1. First of all, I don’t mean to suggest that everyone here is suggesting that Diabetes is due to over-indulgence, but the tone of some of the comments is a bit offensive. It is a disease that is debilitating, can lead to amputations and possibly to an early death. The unnecessary sneering about the Indian middle class, about Indian diet, ignorant and lazy desi aunties and uncles is annoying.

    I would like to know if there are any studies out there that show how many of those afflicted have a family history of the disease. Almost every one I know that has it has a family history.

    And what Indian diet are you people talking about? My parents diet and that of their peer group comes freakishly close to the the food pyramid. They eat vegetables, grains, lentils, fruits and their meat portions actually match that of the food pyramid guidelines. Ever watch tadka being added to a dish, it is done with no more than a spoon or two of oil (olive oil!). An entire family meal consists of no more than five spoons of oil. We don’t add butter or ghee to our chapattis. (I doubt anyone really adds as much as the stereotypical desi-Punajbi restaurant).

    These people are not as snacky. They haven’t grown up eating store-bought potato chips, cookies and drinking soda, and their food habits haven’t changed that significantly. I’ll admit they never refuse a cup of chai.

    Have any of you been to a recent a First-Gen party lately? All they do is sit and talk about health, diet and exercise and occasionally the stock market (the aunties talk about upcoming marriages). And if they are more than four couples at the party chances are one of them is a doctor. I just don’t buy the stereotype that these “people are ignorant” bit either. As a community there access to medical guidance is unparalleled.

    And they certainly are not lazy. These people to steal someone else’s phrase are the greatest generation, I speak of the generation that came here in the 70s. They have an amazing work ethic. (My dream is that one day there will be an online conference where all desi uncles and aunties show up and tell you smug-sec- gen-desi-hipsters where to get off. I really think there ought to be a “Bring an Uncle/Aunty to Sepia” day. I can see it now “Beta, you should be working hard not wasting your time on the internets”)

    And yet there is diabetes and heart disease. And since it effects our parents and our families a little more empathy would be nice.

    Or to put it more obnoxiously would any of you dare to suggest that AIDS is due to over-indulgence that it is a result of someones lifestyle?

  2. Thomas Kurma is navratan…er.. spot-on! That’s exactly it in my experience as well. And shallowthinker, I don’t think that is representative at all. To drink that much, that often, across so many people, that it becomes a diabetes issue….hmm. that’s just cooking in tallow in my opinion…

  3. tef: ROFLMAO. Terrific stuff.

    Apropos..

    I think the term ‘laziness’ was probably used as a substitute for ‘sedantary’. Middle class dads and moms, not long ago, used to walk quite a bit for everything. Now, however, there is a noticeable decrease in that activity. Additionally, as someone else put it, ‘tiffins’ in South India used to be rather wholesome food. No longer. Add the number of coffees people consume nowadays (with sugar). Couple that with eating out regularly (quite a rarity until after the mid-1980s). Not to mention the fact that my generation rarely does “religion-inspired” stuff like fasting or eating satvik & season-oriented food anymore.

    Three generations back, my ancestors lived well into their 90s with no health issues. I am 38, a marathon runner, yet have cholesterol and high-BP.

  4. “And yet there is diabetes and heart disease. And since it effects our parents and our families a little more empathy would be nice.”

    I don’t really think you read the majority of the posts. And, speaking only for myself, I do feel empathy, and do feel that it’s an important issue – that’s why I am frustrated. Please don’t accuse me of a lack of empathy for my family members.

    “I just don’t buy the stereotype that these “people are ignorant” bit either. As a community there access to medical guidance is unparalleled.”

    Again, not sure what posts you are referring to. Myself, I talked about educated people, including doctors, as did the NY Times Post, that know better and yet are somewhat apathetic about their own health. This is a curiosity to me, so I brought it up. I never said they are ignorant – I am saying these are highly educated people who are denying themselves good health. The rates of diabetes in the South Asian community are available in various studies – it wasn’t an “assertion”, as Razib would say.

    “Or to put it more obnoxiously would any of you dare to suggest that AIDS is due to over-indulgence that it is a result of someones lifestyle?”

    Yeah, that is put pretty obnixiously. I think Neha had a post once upon a time about AIDS in the South Asian community, both here and the subcontinent. That’s a separate topic, with many complexities of it’s own.

  5. I am saying these are highly educated people who are denying themselves good health

    Does everything have to be so black and white? Accept or Deny? it would be nice to go into the context and see what daily life in India is all about. Many doctors I know work on weekends – maybe they are trying to get richer, maybe they are helping more people, maybe they are battling competition.

  6. Here’s one problem with the first generation city dwellers i.e. they grew up in the villages: a) In the villages, physical labor is the lot of the unfortunates (low on the social ladder). If you’ve done well, you get to be exempt from physical work. Often there is not much dignity in physical work. b) Peaople stick to a healthy diet since it’s affordable and sweets, meat are expensive for most poor people in the village. Fesitivities were often the only chance for them to get high calorie food and they would use grab this chance since there was no other way they could eat them otherwise. They then move to the city and can afford high-calorie foods. Since they are used to eating these foods at every chance they got, they consume them in unhealthy quantities. They also really hate to exercise because of their negative feelings towards physical exertion. This is a deadly combination.

    TK, my personal experience in the villages of Punjab/Haryana/Western UP suggests that the people in the countryside have far bigger appetites than the city dwellers. Again these regions are relatively affluent, so it may not be representative.

    The bottomline probably is that India is a huge country and there is difficult to generalize.

  7. “Many doctors I know work on weekends – maybe they are trying to get richer, maybe they are helping more people, maybe they are battling competition.”

    I don’t see your point.

  8. TK, my personal experience in the villages of Punjab/Haryana/Western UP suggests that the people in the countryside have far bigger appetites than the city dwellers.

    That is perhaps true.

    However, they (villagers) do not sit infront of computer and program the whole day, or see patients in a hospital while sitting. If you are running around, taking care of your cattle, getting water from the well, you burn a lot of calories off.

    Also, South Asian do have a sweet teeth in general. This is a world wide problem, China has it too. Now, widespread Coca Cola and Pizza in India does not help either.

    Chick_pea in earlier comments (like comment #.1,#.2,#.20,#.22) was right on. India Today in 3-4 years has done 3-4 special issues on obesity, and related problems.

    Sedantary life style ~= (not equal to) laziness.

  9. Of course India’s rising income (read consumption) will result in more diabetics as a % of population. But don’t blame it all on lifestyle, which in India is admittedly quite sedentary for the 50-plus age group. However, the ill effects of that should be offset by the general frugality of the Indian diet. Please…do not exaggerate this mithai stuff. If you have uncles or aunties in India, and if you have spent even a week in their homes, just analyze their consumption pattern with that of people in the US. An average American consumes more starch and sugar in three days, without even indulging, than an average Indian would in a week.

    Amardeep, your post is very valid. What is not valid is the stereotyping of Indians. In fact I have a theory, not fully tested yet, but it will probably be validated if put to test. Diabetes is no less rampant among Americans, but you don’t know too many diabetic Americans personally because they don’t talk about health issues openly. (Try telling your colleagues at work that you have diabetes and you can kiss that next promotion goodbye). We are a society that worships youth and fitness, and is in complete denial over the aging process. First gen Indians, as well as Indians in India on the other hand, talk about their blood sugar like golfers bragging about their handicap. “What, your sugar is 120? Mine is only 110! Thanks to that ayurvedic medicine I got from India!” Sometimes the conversation goes in reverse. “What, your sugar is only 120? Mine is never less than 140, and that’s with insulin.”

    Yes, we are pretty open with our diseases, and maybe admitting is the first step to improvement. I must make one confession, though. With half my friends suffering from Type 2 diabetes, our wives still make Indian sweets at our dinner parties. But we eat only a couple of spoonfuls, though. The Indian sweets is just a token of our old world habits and perhaps an unwitting acknowledgment of our heritage.

  10. Well, the reporter certainly has a taste for black humor.

    people who once balanced water jugs and construction material on their heads now carry nothing heavier than a cellphone.
    In his lectures, Dr. Ramachandran recounts the case of an impoverished diabetic with a hideously infected leg. Unable to find medical care, he laid the leg across the railroad tracks. The next train to hurtle past did the surgery.

    plus insight into hindoo society:

    fatalism:

    Some concepts are easy to sell in India, Mr. Kalyanasundaram said, but health insurance is not one of them. “The capacity to pay is not there,” he said. “And many people take disease as a God-given thing to just accept. So why buy insurance?

    caste system:

    She said a young woman with diabetes, for example, is often deemed damaged and unmarriageable, or must marry into a lower caste.

    That being said, its an important issue, and I am glad the NYT covered it.

  11. Speaking from experience, I know that nobody in my family from my parents generation, mostly in India, does much exercising. They try and moderate their eating, but, are very often tempted to indulge in ‘Mithai’. That doesn’t imply in any way that they are lazy or ignorant. Just that their priorities their whole lives never seemed to revolve around their own health/well-being and they find it difficult to pro-actively focus on it!

    I don’t know much about first-gen Indians here (people who got here in the 1970s) and how their social gatherings are, but, in India during certain times of the year, my family-members have to attend weddings, baby-showers, bridal-showers, etc etc a couple times a week for many months on end and a lot of those ceremonies to this day (I know only of gujju ones) are events in forced over-eating ( one more gulab-jamun only, or else we’ll feel bad…. c’mon no please??) and its hard to maintain a diet!

    There is a definite social element to the health-issues facing our parents (and our) generation. Just not acknowledging that aspect of it is not in our (or our parents) best interest either!

  12. Several people have made mention that diabetes is a complicated disease, but the National Geographic article starts off a bit overly simplistic in a certain sense: “a calorie is a calorie is a calorie.” This is true…kind of. But the idea that knocking 100 calories out of your diet per day will result in weight loss, or alternatively that eating an extra 100 calories will result in weight gain is very simplistic.

    First, this assumes that people do not vary their caloric intake at all, when in fact the opposite is very true. A person’s calorie intake might vary as much as 100% from day to day (especially if one of the days is Thanksgiving and you’re American, for instance).

    Also, this discounts the body’s homeostatic metabolic response. At least initially, eating an extra 100 calories a day may have no effect. If you stop exercising, though, now your body may need a place to put them. If you stop exercising and eat 800 extra calories twice a week, your body is definitely going to look for a place to put it all. And the converse is true, which is why weight loss in your 30’s and later can be so difficult.

    Hence diabetes, etc.

  13. metric,

    Many doctors I know work on weekends – maybe they are trying to get richer, maybe they are helping more people, maybe they are battling competition.” I don’t see your point

    What i was trying to point out is that being and trying to remain well-off in India (unless you are super-rich) means working really long hours. That does not necessrily mean people can duck into a gym and whiz home. I wiwsh the reporter had undertaken a more in-depth analysis of what a working person’s reality is in India.

  14. ..i know off-topic and all but why oh why do we have to hear about lonelygirl.com on NYT???? Who cares??

  15. Indians suffer from heart disease at far lower body weight than other racial populations.

    I remember reading (in TOI i think) that indians have a compartively unhealthy body composition (perhaps due to genetics) as measured by the percentage of fat versus lean muscle mass. Often low weight indians suffer from “skinny-fat” where they look lean but the percentage of body fat is still too high b/c of lack of muscle and “small” bones.

    This can be confimed anecdotally by the toothpick legs of the typical indian male and the relatively undefined legs of the indian female (even among bollywood stars). because i see the sensitivity brigade is monitering this conversation, i’ll leave the indian ass alone.

    the typical indian needs to lift more weights, add more protein, and cut down on sweets and carbs.

  16. metric,

    I apologize for my rant, it wasn’t directed at you or anyone in particular. I know people who did everything right, and yet developed it. I know there are some people who are apathetic as you say. If you will forgive me this stereotype, yes there is I think was a certain kind of fatalism, although I think this is disappearing.

    My contention is that even amongst the desis in America, a group that is largely unapathetic, is highly educated, and has access to health care and information about the disease — there still is a high incidence of the disease. Which leads me to believe that the fault lies in their genes, and therefore warrants more sympathy. I think we agree on this.

    I understand your frustration. I know some doctors who for whatever reason seem to be less fearful and therefore less careful when it comes to health issues. (I would be really curious to know what the prevalence of diabetes is among doctors – scratch that – I am curious to know what the prevalence of diabetes is, amongst endocrinologists)

    Thomas Kurma,

    I am not sure about the aversion to physical exertion theory. I can understand Indians who would be reluctant to do housework because they would find it beneath them. But this does not extend to exercise. I would guess that the percentage of people who go for a walk in Indian colonies that my relatives live in, is some what similar to those that go for a walk in my parents American suburb. There might not be as many exercise junkies or marathon runners (like Quizman), but all you really need is a bit of regular exercise.

    Quizman,

    Marathoner eh? : )) I am still working on my base. I still can’t work up to the kind of speed that I am willing to admit to on a public form. I think the next time I go running with people I am going to wear a t-shirt that reads “Don’t worry, I only look Ethiopian”.

  17. Timely post and NYT article! I was diagnosed with glucose intolerance and then diabetes last year in my mid 40s. At least in the initial stages, there are no noticable symptoms so frequent visits to the doctor are a good idea. I have a pretty active lifestyle and eat pretty well for a desi (veg, low sugar, low fat, etc.). I am relatively normal in height and weight (5’10, 165lbs, BMI 24). And yet.. I believe this is where the desi genes play a huge part. We seem to get it sooner and at lower body weights.

    But the good news is, if caught early and if you can make the difficult lifestyle changes you can slow its progression. But since diabetes is a risk factor for lots of other bad stuff like heart disease, stroke, etc your doctor will probably put you on more medications even if you are in the normal range for cholesterol and blood pressure. Pretty soon you are swallowing a handful of pills every day. Sigh.

    The consequences of not doing anything, as the article illustrates, are horrible.

  18. It wasn’t me,

    I guess we are speaking about two radically different groups. My extended family even the ones in India view sweets as something favored by children. Adults eat them but they do not over-indulge or fetishize desserts as some Americans do. And as far as the first-genners are concerned, the usual response to an offer of, say badam barfi no more than half inch square is “No no no no no no no” Of course you understand I am reducing the number of “no”s for the sake of brevity.

  19. The consequences of not doing anything, as the article illustrates, are horrible.

    to whit; impotence

  20. 68 posts on Diabetes. Not one to call the kettle wheatish….but thats really dorky

    sahej:

    dorky? it’s called educating, debating, and thinking about what affects the human body, and possibly you…

    and if thats dorky to you… well so be it.. i’m personally happy that we’re discussing DM.. it affects a ton of folks, family, and such… i’ve personally lost 2 dear members of my family to the disease so i don’t find it at all dorky…

    kush… and #25, 28… 😉 salil

    First, this assumes that people do not vary their caloric intake at all, when in fact the opposite is very true. A person’s calorie intake might vary as much as 100% from day to day (especially if one of the days is Thanksgiving and you’re American, for instance). Also, this discounts the body’s homeostatic metabolic response. At least initially, eating an extra 100 calories a day may have no effect. If you stop exercising, though, now your body may need a place to put them. If you stop exercising and eat 800 extra calories twice a week, your body is definitely going to look for a place to put it all. And the converse is true, which is why weight loss in your 30’s and later can be so difficult.

    everyone has different metabolism…meals differ daily… intake differs.. that is why a lot of weight loss programs and diets in general make you write what you eat and the caloric value to keep things at a balanced level…and yes metabolism slows down with age… (who has found the fountain of youth? please let me know… ;)).. but if you are in the goal of losing weight, your variability should not be as fluctuant..

    it might be a simplistic view… the article (full article) goes into more detail from what i recall of it..however, it tells the gist of it..

  21. sahej: dorky? it’s called educating, debating, and thinking about what affects the human body, and possibly you… and if thats dorky to you… well so be it.. i’m personally happy that we’re discussing DM.. it affects a ton of folks, family, and such… i’ve personally lost 2 dear members of my family to the disease so i don’t find it at all dorky…

    by all means chick pea….

    i’m just joking around

  22. sahej: jokes on me then ;)..

    i just am passionate about my hatred for DM.. it sucks ass .. and as a doc it pisses me off when there is something one can do about it in most cases to prevent it– yet most people do not heed the advice given…(just like telling people to stop smoking… don’t get me going off on that diatribe ;))

  23. its all good chick pea…..i’ve never know someone to passionatly hate a metabolic disease, but, um…..you go?

    just joking with you

  24. Sakshi,

    regarding your comment #61, what was odd about it? I didn’t find it that odd or black humor. The article talks about many types of people from many backgrounds, including those outside the curve. The railway surgeory is ghastly but in context of the whole article, didn’t sound sensationalist to me. And that story was spoken by that doctor according to the author so it was part of a part of a narrative.

    And of course its stigmatizing for a young woman to have diabetes. They’re considered deeply defective goods. I had a teacher in high school who had diabetes and she never married. I didn’t understand why diabetes was so important as that (I guess I didn’t understand what diabetes was for the longest time, not to say people shouldn’t marry if they have it) Trust me, she was certainly nubile! 🙂

    Fatalism in the sub-continent is not a myth. Just as any philosophy can be turned on its head to believe in almost complete opposite of its core, so can the Hindu notion of fate and destiny. And its focused on often in Indian literature as one way some people define their lives. Premchand wrote quite a bit on it.

    Just because the writer maybe an outsider doesn’t necessarily mean he can’t comment or pick on stuff he/she reads/hears. Some of it is broadly true of the population, other parts are atypical, doesn’t make for his taste in humor necessarily.

  25. If we’re talking diabetes in India (amardeep’s post does include immigrants), apart from genetic factors, little can be inferred from desis who immigrated to the US in the 70’s (our parents’ gen.), their diet, their access to physicians, the number of physicians among them or their kids, their conversations at parties etc. But…genetics do seem to be a big part. As quizman points out, we’re not out of risk even if we’re very active and watch what we eat.

    tef:

    I would guess that the percentage of people who go for a walk in Indian colonies that my relatives live in, is some what similar to those that go for a walk in my parents American suburb.

    .

    How many people among these walkers grew up in villages. My comment was restricted to 1st gen city folk, a significant and increasing share of the city population. Anyway, I assume these walkers you are talking about are generally healthy.

    Sakshi:

    my personal experience in the villages of Punjab/Haryana/Western UP suggests that the people in the countryside have far bigger appetites than the city dwellers.

    As you say, these are some of the most fertile and affluent rural areas. I don’t suppose these people are fleeing to the cities. So, it’s not generalization. It’s alright if you’re eating a lot in the villages (and working too) because the diet has been adjusted over centuries to be just right for you. As tef says

    My parents diet and that of their peer group comes freakishly close to the the food pyramid. They eat vegetables, grains, lentils, fruits and their meat portions actually match that of the food pyramid guidelines.
    “Don’t worry, I only look Ethiopian”.

    😀

  26. i’ve never know someone to passionatly hate a metabolic disease

    ahh… mr. sahej…i’m passionate against most every disease (i mean i’m supposed to stomp out disease right? thats in the hippocratic oath, right? ;))…i am likley one of the dorkiest of dorks… ;)… it’s all good.. if you can’t laugh at yourself.. then um.. ‘houston we have a problem’….

  27. Just as any philosophy can be turned on its head to believe in almost complete opposite of its core, so can the Hindu notion of fate and destiny.

    Very true, Seeker. A lot of Westerners mistake Karma to mean fate. Unfortunately, this is true of many Indians too. Karma is action. Cause and effect. Far from our lives being out of our control, only we can ultimately control it. OK, maybe we can control our next lives, not so much this one :). Wait, that’s even more cool. Like chess grandmasters, we can plan our stuff a few lifetimes in advance. Ooh, I’d love to have that on a PDA. “Sorry, I’m all booked for the next two lifetimes. How about after Kaliyug? Does that work for you?”

  28. This is the way to go… sun on the back, not a tube in the nose. The ballad of jim fixx.

    Fixx took up running in 1967 at 35 years old. He weighed 214 pounds and smoked two packs a day. Ten years later, when the Complete Book of Running (which spent 11 weeks at No. 1 on the best-seller list) was published, he was 60 pounds lighter and smoke-free. Fixx died at the age of 52 of a massive heart attack, during his daily run, on Route 15 in Hardwick, Vermont. The autopsy revealed that cholesterol had blocked one coronary artery 95%, a second 85%, and a third 50%.
  29. Thomas Kurma,

    How many people among these walkers grew up in villages

    No I didn’t think of that. I don’t think they are 1st gen city folk. Ok I think I will defer to you on this. But it’s like very unsportsmanlike of you to use your extensive knowledge of India to defeat my argument.

    Sahej,

    Yes ethiopian women are hot! But, no I am not a woman. No, I don’t have a sister that looks like me. No, I am not bicurious.

  30. tef said:

    I guess we are speaking about two radically different groups. My extended family even the ones in India view sweets as something favored by children. Adults eat them but they do not over-indulge or fetishize desserts as some Americans do. And as far as the first-genners are concerned, the usual response to an offer of, say badam barfi no more than half inch square is “No no no no no no no” Of course you understand I am reducing the number of “no”s for the sake of brevity.

    Wow! That is really admirable self-control! What part of India is your family from? I would be really surprised if you said Gujarat. Regarding treating sweets as something favored by children….. really? They actually feel that way? Not to sound like a smartass here, but, thats the first time I have ever heard any desi guy refer to Mithai as something favored only by children. Good for them. Wish my family had that attitude. The damn guju-gene coming to bite us again in the ass!

  31. Seeker:

    The railway surgeory is ghastly but in context of the whole article, didn’t sound sensationalist to me. And that story was spoken by that doctor according to the author so it was part of a part of a narrative.

    The story did not ring true to me. The chances of avoiding a fatality if someone ends up under a train are really low, because a) there is a lot of low-hanging stuff on the sides of a train engine, and its usually the case that one of these will hit you and drag you along, b)by the Bernoulli principle, there is a vacuum created under a railway train, which creates a strong force that pulls anything so close in, c) there is a low steel mesh right in front of the engine, so that, if say a goat comes under the train, its body parts do not mess up the engine underbelly, which contains sensitive equipment such as brakes etc. For these reasons people who survive an accident of that sort do so only if the train is running really slow, such as when entering or leaving a station. This is what my father told me. He works for the Indian railways, and loves to talk about his job, even the ghastlier side :). Plus there are so many easier ways to get rid of a leg(I can’t believe I am talking about this). A sharp sword/knife and some desi booze will do, and will be much cleaner. And there are public hospitals in India, where such services are cheap, if not upto the highest standard. Actually laying your leg down on a railway lines seems an unnecessarily dangerous method. Plus I am sure anyone who goes to a railway line for an amputation will have to visit a hospital next, to staunch the bleeding. That defeats the purpose of the entire exercise. Plus it does not look like the reporter checked his/her sources here. To me it sounds like an urban legend.

    And of course its stigmatizing for a young woman to have diabetes. They’re considered deeply defective goods. I had a teacher in high school who had diabetes and she never married.

    Of course you are stigmatized by diabetes. But married into another caste? You might be married to a man thrice your age, or to someone inferior economically, or someone who is divorced(another stigma in India) or a widower, or might never be married at all. But I doubt it will be someone from a lower caste, unless by chance. People in India never marry outside their caste unless they have moved beyond it, or it is the very last option. To me it just seemed like, the reporter tossed in that line carelessly, based on what he thought realities must be like in India.

    Fatalism in the sub-continent is not a myth. Just as any philosophy can be turned on its head to believe in almost complete opposite of its core, so can the Hindu notion of fate and destiny. And its focused on often in Indian literature as one way some people define their lives. Premchand wrote quite a bit on it.

    Bringing in fatalism here insults and takes away from the actual tragedy of Indian families that cannot afford insurance, or lack education. The fatalism is probably just a rationalization of a hopeless situation(my mom did it all the time with regard to my wayward ways 🙂 ) and not some innate aversion to planning for the future. For example, many Indian families, even poor ones, plan meticulously for their children’s education, and make tremendous sacrifices.

    Just because the writer maybe an outsider doesn’t necessarily mean he can’t comment or pick on stuff he/she reads/hears.

    Sure. But there seemed too much hearsay in the story, and hardly any crosschecked facts. That is not good reporting.

  32. Wow! That is really admirable self-control! What part of India is your family from? I would be really surprised if you said Gujarat. Regarding treating sweets as something favored by children….. really? They actually feel that way? Not to sound like a smartass here, but, thats the first time I have ever heard any desi guy refer to Mithai as something favored only by children. Good for them. Wish my family had that attitude. The damn guju-gene coming to bite us again in the ass!

    i would agree with you. tef, not to dismiss your observations – but milk based mithai are VERY popular among my extended family – and I have a sweet tooth like you wouldnt believe – yes and two of my uncles have had coronary bypass surgeries – one of them passed away in the operation theater – funnily, i havent heard of diabetes in my family though. we are from the punjab btw .

    and these tastes stick – i dont know anyone who’s given up on these sweets – one compromise i’ve seen one of my u.s. relatives make, is in gajar halwa (sort of like carrot cake) preparation. they make it in low fat milk and they make it unsweetened. instead of adding khoya (wich is probably 70% milk fat) they use goat cheese and add honey. it’s pretty good.

    so there are ways to get around – but my experiences diverge from your thesis signficantly.

    good luck on the running though. and may you catch up with quizman.

  33. there is a low steel mesh right in front of the engine

    I meant, a low mesh right before the engine wheels.

  34. Amardeep Bhai,

    kya keh rahye ho aap? mai to kehta hoon, aap ye mithai khaalo. bahot achchha mithai hai miyaa, bahot maje ka mithai hai. Na jaane kaha kaha se aa jaaaaate hai***?!!

    *** = with 88 comments

  35. my dear kush,

    i sometimes read my own comment later and wonder, in all earnestness, what was i thinking when i hit ‘post’. You, dear brother, are in yet another league 🙂 i am quite in the dark. darkly, i am quiet.

    sincerely,

    V_

  36. i’m so glad that this topic has been brought up! I know so many aunties and uncles that are having to “control their sugar.” Type 2 diabetes can be controlled with diet and exercise….while Shobha auntie proudly turns down a bowl of aam ras, she readily accepts a second serving of rice. good ol’ white basmati rice. nutritional value = starch = sugar. simple sugars. the same concept applies to the average san antonian. apart from being one of the top 10 obese cities, san antonio is probably near the top 5 for type 2 DM. 50% of the patients that come to our dental clinic suffer from the disease. my answer? cut out the tortillas!

    DM affects the entire body. with regards to the oral cavity, diabetics are unable to combat infections, and have a higher risk for caries and periodontal destruction. my own uncle and grandmother have dentures, and their borderline diabetes and apathetic attitudes didn’t help the situation.

  37. I wait for the day when NYT covers such topics without some sort of condescension. Especially when it’s something as important as this. Minor gripe.

    tef has a point. All the mithai, ghee and oil talk doesn’t fit in the context of South Indian dietary habits. It’s definitely an issue in the North and states like Gujarat (all three) and Bengal (mithai and oil). Sedentary lifestyles are definitely a problem across the whole country among the middle classes and wealthier, but this again is a problem that is more acute in cities and bigger towns. One thing I have noticed even in some of the smaller towns is that most of the grounds our generation used to play cricket in have simply vanished, victims to real estate pressures. Cities are worse off except for those have access to Gyms (and use it).

    Anyhow,

  38. I read the article in the NYT with interest. I moved from Bangalore to Melbourne primarily for health reasons. I was on a fast track career and knew that if I kept it up I would be dead by 40. I balloonned from 52 kgs at the age of 26 to 85 kgs at 31 – cholestorol and high BP to boot (no diabetes fortunately). Now I am down to 70 kgs – thanks to FitnessFirst (www.fitnessfirst.com.au) and some good advice from my kid bro who is a marathon runner in the SF Bay Area.

    Is it better to live till 80 having led a frugal but healthy lifestyle or better to die at 50 after having lived a hedonistic lifestyle 🙂 I know what I want but there are many who make the choice to live well and die soon (or cant be bothered) Should the choice not be respected. As someone said AIDS is also a lifestyle choice. And anyways in India, the tax dollars are not being spent on the obese (unlike OZ). Further, if I may be politically incorrect, a few more dead Indians wont hurt. We have a billion people (or more) at the last count.Law of the jungle – survival of the fittest.

    My grandmother had diabetes and I took care of her for the last 4 years of her life. I know diabetes does. My fav food – Maccas (McD for those up over). Everything in modertion mate.

  39. Anybody interested in my wife’s recipe for the most sinful “rasmalai” this side of Haldiram’s? She uses Splenda.

  40. ahh… mr. sahej…i’m passionate against most every disease (i mean i’m supposed to stomp out disease right? thats in the hippocratic oath, right? ;))…i am likley one of the dorkiest of dorks… ;)… it’s all good.. if you can’t laugh at yourself.. then um.. ‘houston we have a problem’….

    that’s cool, mad props to you for that. that hippocratic oath is pretty cool

    in suppor, i say f diabetes!

  41. I would floridian… !!!

    please be so kind.

    i’ve posted our version of gajar halwa up there. we dont use splenda – some of my cousins use demerera sugar while i prefer honey.

    here’s another hypothesis – in this day and age, the people who cook are less likely to be obese (different from overweight) than those who do not. even people like i who are extremely fond of desi mithai would balk at pouring two cups of refined sugar into a “kadahi” of milk to make kheer.

  42. It was not me & hairy d,

    My family is from Hyderabad. The only two sweets I think that are native to our area are Double Ka meetha (yummy!) and Khubani Ka meetha(pretentious!). Now Double Ka meetha is actually the desi version of bread pudding so it’s not that native. And Khubani Ka meetha is made from Apricots from Afghanistan so again not very native. And I can’t think of any other sweet that is native to the area. I am guessing we don’t have a “sweet” culture. I am thinking really deeply about this no one in my extended family eats sweets on a daily basis. They make stuff for special occasions and once it is gone that’s the end. They tend to favor salty stuff (like hot mixes and mirchi bhajji & etc) with their tea.

    I thought it was only a cliché that Gujaratis put sugar in everything!

  43. actually i agree about diabetes. exercise and a good diet, and monitoring blood sugar can go a long way. lack of excersize is a huge risk factor. 30 minutes a day at least 3 times a week I believe would go a long way. maybe India can be a model for how the third world can develop programs for diabetes control. it would take i think a social network approach, of which india at one time was good at doing. Hopefully people in India will think through the problem and come up with adequate solutions. I think community-centered approaches would work best

  44. I agree with Sakshi and Nanda Kishore– I think this sucky article is very condescending and is more about saying India can’t handle its growing wealth– for genetic reasons, please note !!! – than about diabetes. What the hell kind of topic is it to make the front page– I don’t see the NYT talking about how candy wrecks British teeth on the front page.