Sugar and the City

New York City has just released preliminary results of a health study that shows that more than one in eight adult New Yorkers have diabetes, while twice as many have abnormally high blood sugar that could be a sign of conditions leading to diabetes. Moreover, of the city’s diabetes sufferers, at least one-third do not know that they have the disease, while many of those who know they have it are not managing to treat it properly. Here’s the NYC health commissioner quoted in the New York Times today:

“This confirms that we as a society are doing a rotten job both preventing and controlling diabetes,” said Dr. Thomas R. Frieden, the city health commissioner. “We can do a much better job helping people with diabetes get their condition under better control. The fact that there are over 100,000 New Yorkers with seriously out-of-control diabetes, and over 200,000 who don’t even know they have diabetes, is a real indictment of our health care system.”

As disturbing as the overall figures are, he said, they were not unexpected. They resemble estimates made by public health officials, who expected that the disease would be more common in New York City than nationally; diabetes is less prevalent among whites than among most other groups, and New York is a mostly nonwhite city.

Which brings us to the Desi Angle (TM), and it’s a deadly serious one:

But Dr. Frieden said he was startled by some of the specific findings, including the very high numbers among Asian-Americans, especially those from South Asia. The study indicates that more than half of the New Yorkers whose families are from the Indian subcontinent have either diabetes or prediabetes.

Here’s more:

Asians have the highest rates in the city, 16 percent diabetic and 32 percent prediabetic. The cityÂ’s report does not differentiate Asians by region, but officials said that the data in their study and others show that East Asians have below-average rates of diabetes, while South Asians have by far the highest of any large group.

Diabetes afflicts about 14 percent of the cityÂ’s non-Hispanic black population, 12 percent of Hispanics and 11 percent of whites.

If I can get a hold of more details I’ll update this post accordingly. Tomorrow the Brian Lehrer show on WNYC (93.9 FM in New York, and live and archived online) will be discussing this topic including the specific case of the South Asian community.

42 thoughts on “Sugar and the City

  1. sm covered diabetes in india a few months ago…interesting to see that it might be a ‘gene’ thing rather than an environmental thing… although our diet doesn’t differ much between here and india, and in fact is likley worse here with all the fast food, although they have tons of fast food in the big cities in india…

    an Indian family friend, 29 years of age, never diagnosed with diabetes (both parents have the disease, and this person checked their own sugars from time to time which were normal…) just passed away this weekend in the usa after his blood sugar unknowingly went up to over 800…he called 911, and unfortunately in less then 12 hours was dead.. so this post is quite jarring to me right now… since i just got off the phone form the news… :(

  2. i echo chick pea’s sentiments about genetics vs. environment. what are the diabetes rates in india, pakistan, and other south asian countries compared to here? moreover, is there a geographic aspect to “environment” that plays into the situation? the findings are interesting, for sure, but raise all kinds of questions about genetics, lifestyle, and location.

    just the tip of the iceberg.

  3. I brought my gym clothes to the office with the intention of working out this evening. I’m starting to get tired and the idea of going home and doing absolutely nothing is appealing. However, you have lit a fire under my a**. Thank you:)

  4. Sidhhartha, its a very well known fact that desis are highly prone to T2DM (Type 2 Diabetes Mellitus) while The Type 1 (Juvenile Diabetes) is more common here in the US population and has a direct link to obesity.and experts say that its not just diet for T2DM as you see fairly lean desi individuals also getting diabetes.Its becoming more obvious that T2DM has correlation with inflammatory diseases-insulin resistance and inflammatory diseases seem to go well together. Here are a few links for those who are interested:

    http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?itool=abstractplus&db=pubmed&cmd=Retrieve&dopt=abstractplus&list_uids=15105039

    http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?itool=abstractplus&db=pubmed&cmd=Retrieve&dopt=abstractplus&list_uids=11711326

    http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?itool=abstractplus&db=pubmed&cmd=Retrieve&dopt=abstractplus&list_uids=12505756

  5. The SF Bay Area hospitals (Kaiser, El Camino, Stanford) have special programs on Heart Disease and Diabetes targeted towards South Asians. e.g. El Camino South Asian Heart Center

    Quizman, Thanks for the link! I am printing up the pages for my folks…

    My dad recently had angioplasty and was really frustrated with the whole process- he wasn’t able to communicate with the doctors in the beginning, and all the post-op advice they gave, he didn’t really know what to do. I.e. they told him to eat better, and he stopped eating rice. Go figure. Or “exercise more” which turned into him going to the gym 10 minutes once a week. I think culturally appropriate centers and advice will go a LONG way to help decrease this disparity. And it’ll help folks like my parents…

  6. I think culturally appropriate centers and advice will go a LONG way to help decrease this disparity.

    My dad has diabetes… it really spun out of control b/c he didn’t take care of himself. It led to kidney failure, a transplant… and it keeps getting worse. I wonder if he ever really understood what he was supposed to do….

  7. It’s several things, but it all boils down to one, premarital sex.

    1) It’s the diet. (obviously) 2) we don’t do sports, we sit down and study especially US Indians 3) we are not preoccupied with our looks, since we really don’t date that much and a fat wallet is what turns us on (actually our parents) having nice abs doesn’t matter

    People with good health in the west generally sport and keep their diet not because of health issues, but because they want to look good and get laid every now and then. Getting laid is a far better motivator than keeping diabetes away and since we don’t do sex we get diabetes. That goes for americans as well, americans that do not have premarital sex get diabetes far more often than those who have premarital sex. Compare the bible belt with the sunshine state.

  8. I know I’m entertaining something ridiculous, but self control is not my strong suit. So, Samjay, it was the lack of premarital sex that led to at least 5 of my desi childhood friends coming down with Type I diabetes before they ever turned 10?

    Puh-lease!

  9. Abnormally high blood sugar has absolutely nothing to do with type I diabetes, and as far as I am concerned this study focused on type II diabates. But if it makes you feel better, read type II diabetes where I wrote diabetes.

  10. I have no idea how a diet of chai with about 8 tbsp’s of sugar per cup could lead to diabetes.

  11. It’s several things, but it all boils down to one, premarital sex.

    Love really does make the world go “round”.

    (Sorry…)

  12. nobody posted on our ol friend biden-caca (kaka)…he made some “racially sensitive” remarks again. thot u guys would be all over in. DUNKIN DONUTS RULE!!!

  13. 3) we are not preoccupied with our looks, since we really don’t date that much and a fat wallet is what turns us on (actually our parents) having nice abs doesn’t matter

    Where did THIS come from!? And I thought SM was full of intellectuals…

    As for the bible belt, they have historically had fatty foods in their diets also. Tavis Smiley (African-American talk-show host) had a segment about diabetes yesterday; he noted that doctors have to be aware of cultural differences also (just as Taz mentioned).

  14. Halle Berry is beautiful, slim, tall and HAS DIABETES! She is in print/TV ads discussing it.

  15. I have no idea how a diet of chai with about 8 tbsp’s of sugar per cup could lead to diabetes.
    8? Just 8?

    That was tablespoons, sakshi! But I think the not-enough-sex theorist might be on to something. Too much sugar -> abdominal fat, also other body fat. Abdominal fat accumulation gets noticed quickly by partners, apart from actually impeding the act itself, when it gets serious. So.. Also, there might be a biochemical link – does the ‘sugar high’ substitute for the ‘natural high’ from sex? Pure speculation of course. Sugar metabolism anybody? As the song goes…

  16. My dad recently had angioplasty and was really frustrated with the whole process- he wasn’t able to communicate with the doctors in the beginning, and all the post-op advice they gave, he didn’t really know what to do. I.e. they told him to eat better, and he stopped eating rice. Go figure. Or “exercise more” which turned into him going to the gym 10 minutes once a week. I think culturally appropriate centers and advice will go a LONG way to help decrease this disparity. And it’ll help folks like my parents…

    i dont understand. it sounds like you know what went wrong but didnt help with the communication. why not?

    but i agree with what you say. my dad has taken to watching this swami from india* who i love for his grassroots activism in promoting what we usually associate with the glitterati – eat well, live right, spurn colas, tune in to the environment, exercise daily… and it’s all part of ancient indian learnings – my dad loves it – and he’s trimmer than ever (i even had a friend’s mom comment wistfully that he’s looking very issmart these days. i think she has the hots for him :-) I think I’m going to age jusss.. fine)

    *i’ve forgotten the guy’s name – but he’s a very charismatic person with a beard and has a huge following in india.

  17. yea sakshi… i know i’m a cornholio.

    O nevermind hairy_d. I typed that in just to put off a homework I have due tomorrow. I am out of denial now. That is always a good sign.

  18. Samjay, I actually think you might be onto something.

    Also explains why most desis I know, friends and stuff, just swell up right after they get married. No more purpose in doing whatever little exercise they did before.

  19. Seriously I was kidding at first when I wrote it, but the more I think about it, the more I’m convinced it’s true. Ask around in gyms about peoples motivation to go there and keeping their diet, it’s not because they want to avoid diabetes, it’s because they want to look good. South Asians are less preoccupied with looks than other ethnic groups because we do not sleep around as much. Getting a picked up at a bar IS a better motivator than avoiding diabetes (TYPE II) in a distant future.

    Emma

    “As for the bible belt, they have historically had fatty foods in their diets also.”

    Historically, what kind of food did people have in California or Florida, low carb? Historically there has been no particular diet in the US due to their geografic location in this country, historically these people came from various european countries with their foof habits.

    Halle Berry has Type I diabetes. Type I diabetes and Typ II are two completley different things.

    Type I diabetes is an immunologic disease, where antibodies will attack and destroy your beta cells in pancreas so that your body will not produce any insulin at all. Type I diabetes comes to a person at a very young age and it cannot be avoided with better health and excercise. The reasons behind Type I diabetes are unknown. There is no connection between Type I diabetes and obesity.

    Type II diabetes is an acquired disease where your beta cells in pancreas are exhausted due to exessive levels of blood glucose for a longer period. You get excessive levels of blood glucose due to bad diet and lack of exercise. Type II diabetes is often seen among people that suffer from obesity.

  20. Our Indian ancestors used to walk/work/”exercise” alot more than the modern Indians. Getting water from the river, taking care of animals, growing rice and dals , grinding flours, etc. are workouts by themselves. There was no need for a gym or nutritional counseling. Of course, in modern times, people need the gym more than ever and even that may not be enough. (Plus the diabetics need a whole grain low fat diet, sometimes medicines, etc.)

  21. Nothing wrong with using ‘em colas as toilet cleaner, I say. That’s where they probably belong, anyways!

    seriously, I do think Swami Ramdev is a good trend in India, overall, because, a lot of people have gotten into different yoga classes and are following better diets. Hopefully, it won’t turn into too much of a cult thing, though.

    Samjay, your theory actually does sound plausible :) I think we have a genetic disposition to obesity and diabetes, and our intellectually-oriented lifestyle doesn’t help. We need to sleep around more, stay fit and dump the sexless nerd stereotype :D

  22. The sugary chai probably has a lot to do with it! And like our Amriki counterparts, we don’t tend to think of a ‘drink’ as food (300 calorie lattes with syrup and whipped cream, anyone?), so we don’t restrict our intake of it. (Anyone notice how so many aunties are very conscious about what they eat, no fried anything, but happily chug their 10 cups of tea a day?)

    Swami Ramdev needs to explain why colas are so much more evil than sugary tea (yeah I know about the antioxidants in tea, but still) other than the fact that cola drinking is a Decadent Habit Learned from the West (while tea drinking is also a decadent habit learned from the west but further back).

  23. “Eat food. Not too much. Mostly plants.”

    Did anybody see Michael Pollan’s long piece in the NYT Magazine this past Sunday? It’s brilliant.

    If there’s such a thing as a Pollanian, I am it- “Thirty years of nutritional science has made Americans sicker, fatter, and less well nourished.”

  24. Swami Ramdev needs to explain why colas are so much more evil than sugary tea (yeah I know about the antioxidants in tea, but still) other than the fact that cola drinking is a Decadent Habit Learned from the West (while tea drinking is also a decadent habit learned from the west but further back).

    One word! High-fructose-corn-syrup! Nuff said!

  25. Whoops, OK, swami Ramdev favours drinking milk only. And insists that Western biomedicine is the devil’s own work and pranayama can cure any disease (per media coverage).

    Pollan’s piece was great, and explained a lot of what I’ve noticed about American ways of thinking about food, esp the good food-bad food dichotomy.

  26. “Eat food. Not too much. Mostly plants.” “Did anybody see Michael Pollan’s long piece in the NYT Magazine this past Sunday? It’s brilliant.”

    quizman linked to it in another thread. it’s indeed an excellent piece. a friend is reading his book and has high praise for it so far. one thing that never fails to astonish me is the size of portions in the u.s. and the ensuing wastage of food. i recently bought a small ice cream cone and ended up with three gigantic scoops of ice cream fit for about four to five people. i ended up having to throw most of it away. even when i order sandwiches i have to tell them to reduce the quantity of filling. [having said all that, i admit i do like my sugary tea! but have really cut back on sugar over the past year]

  27. yes it is swami ramdev (see also the link in #24 by anna).

    i happened to be in india when the guy was getting hauled over the coals for usign heavy metals in his potions. i heard him in a people’s court forum on the TV. the man is very knowledgeable and i am very impressed – not the least because he truly represented himself in a very accessible language without any airs. regarding the coke and stuff – the guy actually pulled out articles, references and numbers.

    you have to consider this in context that i was going through a little period of outrage seeing the so called idols from bollywood endorsing pepsi and coke like it was the next thing to mother’s milk.

    ramdev isnt like the maharishi types in my opinion – but you got to see some of his sessions to understand his influence.

  28. People with good health in the west generally sport and keep their diet not because of health issues, but because they want to look good and get laid every now and then. Getting laid is a far better motivator than keeping diabetes away and since we don’t do sex we get diabetes. That goes for americans as well, americans that do not have premarital sex get diabetes far more often than those who have premarital sex. Compare the bible belt with the sunshine state.

    Man, the Bible Belt does not stop people from having premarital sex. In fact, people start younger. They just protest about it louder.

    Still, anything that blows away aunties’ puritanical attitudes is all right with me.

  29. Since we got scared out of the sun in 1989, without comment as to how we were now going to get enough vitamin D, there has been a rise in numerous diseases, diabetes (both types) and obesity among them. Diabetes type 1 and 2 are both linked to Vitamin D deficiency.

    I was shocked to read recently that middle school children are being screened for cholesterol. Cholesterol, as it turns out, is also linked to Vitamin D.

    How about screening for Vitamin D deficiency in all our children in order to prevent future diabetics?

    Blacks are a lot more Vitamin D deficient than whites due to needing more sun exposure to get the same amount of Vitamin D, and they have the higher diabetes and obesity rate to prove it.

    We need our public health officials to review the existing research and stimulate further research. Public policy on sun exposure and vitamin D supplementation needs to be revised, QUICK!

    http://vitamindcouncil.com/research.shtml