September 13, 2006
Mithai? Not So Much : Diabetes in IndiaHealth and Medicine
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.
amardeep on September 13, 2006 10:43 AM in Health and Medicine · T·r·a·c·k·b·a·c·k address · Direct link · Email post
diabesity.
the fall of the world.
there was a great article a few months/year? ago in national geographic about 'FAT' with a body and rolls of 'lard' on it...
it showed a map of the world and the incidence of not only diabetes but heart disease, etc...india is catching up to the west...and at a great rate..
i think fast food...'fast food nation'...and healthier foods not being the cheaper options (when you go to mickey d's, it's cheaper to get a big mac then their 'healthy salads'..)
i have yet to read the article amardeep..but will do so and give you my 2 sprouts worth...
here is the article from national geographic with the graphic picture ;0)
Thanks for the link, doc. The picture alone is a bit, er, frightening.
Good post! Type 2 Diabetes can be a very crippling disease - I have a few people in my family who have it. I don't know what it is about eating healthy, but the people (in my extended family, older generation) that do have it (and quite a few who are probably well on their way to developing it) don't really care or bother to eat healthfully, or go out for a walk once in a while. One of my uncles who is having trouble with both his eyesight and kidney as a result of the disease continues to eat as he wishes, and the man has a doctorate in the sciences! I really don't know what it is - I was explaining to him the benefits of eating whole wheat and grains as opposed to white bread, and his response was, "it doesn't make a difference" WTF?!?? Is it a lack of control? A failure to see the connection between what you eat and your health? Fatalism? Education?
On the plus side, I do find the younger 2nd generation desi community more interested in leading an active and healthful lifestyle. Again, this is just from my limited, personal obervation.
BTW, I find the tone ("Diabetes - the dark side of success") irritating too!
In the west, anyways, even though the affluent are catching up, it's the poor who are prone to becoming overweigt since this income group typically have less access to fresh, healthy foods
(http://seattletimes.nwsource.com/html/health/2002260839_obese03.html)
Back in India , during my compulsory rural training part, I worked with a WHO funded group which was studying the relation between low birth weight infants and the incidence of adult onset Diabetes. There was a significant link between the two and it was actually surprising to find a high incidence of DM in the rural population. And they were supposed to be living the healthy lifestyle, away from the cities, not eating junkfood, and leading sedentary lives, which are all blamed for contributing to DM.
I remember that this was published in the Indian endocrinology journal, alas,I cant find a link to the article.....
First off, excellent article and post. I know several desi folks in their 60's who are facing this problem.
My understanding is that malnourishment and obesity are not necessarily mutually exclusive. For example, poorer populations in the U.S. tend to eat quite a bit of fast food. Fast food has a lot of calories, thus leading to obesity, but it lacks essential dietary aspects so it still leads to malnourishment.
btw. what is a pandemic? why is obesity a pandemic?
on another note
it bugs me no end to see sportsmen and actors pushing pop in the indian marketplace. shame on them. given the impressionable folks out there - it's an accessible part of their glamor - contributes to the rising obesity levels in india.
From the Times articles, pp.3-4, Krishnasamy Srinivasan's story:
"He had done very well as a textile exporter, came to own four homes, and enjoyed rental income from those he did not occupy. Then diabetes hit when he was 40. He paid it little mind as it marinated inside his body. Over the last 15 years came heart problems and the need for bypass surgery. His kidneys deteriorated. He is now on dialysis."
and his wife's thoughts:
We are angry with the god, she said. You gave us four houses in four directions and all the wealth, and now you have taken it all away. Why?
While fortunately, no one is losing houses in my family, these actions and sentiments are eerily similar, and most of my fam live here in the West. First, not listening to the "bikwaas" of the doctors and then anger and a feeling of a lack of control. While I do feel awful for anyone who has to suffer with this disease,I am angry that even upper-middle class desis in the West, with access to health care and information, are paying no heed! (Note that health insurance is not so readily available in India, according to the Times article). What can we do to get the uncles and aunties to listen up and start taking their health seriously? You don't know how many countless arguements I've had with them!!
From pages 4 and 5:
"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?"
teamed with this:
"Prevention, he recognizes, is a mountainous climb in a country with a severe shortage of medical workers. What health care money exists is overwhelmingly applied to infectious perils."
is VERY frustrating
An interesting article. My Dad is a Nephrologist, and he has become a sort of de facto source on diabetes and hypertension for our entire family in India. When we were there last year, my Aunt asked him why so many people were being diagnosed with both Diabetes and hypertension. He responded with the same genetic predisposition argument, but added the fact that salt and preservatives were now a staple in Indian diets, as food is no longer as freshly prepared or wholesome. He told me that Indian people are at tremendous risk for both diseases, and while people here in America have access to care, the cost of dialysis is prohibitive for most Indian people. We even visited a charitable Dialysis clinic in Chennai, where the attending physician explained that families making up to 10,000 rupess a month become impoverished as a result of the treatment, which is often necessary three times a week and costs up to 2000 rupees per session.
Easy access to medical care is fast becoming the newest separation between the rich and the poor all over the world. It's ironic that India is promoting "medical tourism" at place like Apollo hospital for foreigners seeking expensive, involved procedures, but can't even provide its own citizens with the basic care and medication they need.
that being said... part of me cant help but gloat... remembering all the corpulent little maharajas and maharanis i've seen in delhi ordering around their "naukars" ... it'll catch up with you just you wait, you fat little pieces of shite.
The last two-three years or so I've been seeing a new phenomenon in India; namely, instead of afternoon 'tiffin' people just get boxes of Grand Sweets & Snacks milksweets, jalebis, 'murukku' and so on...'tiffin' used to consist of dosas or idlis, but now only unhealthy food is consumed. The waistline of several ladies in our family has increased notibly, and I blame it on the readily available and quite irresistible Indian sweets.
Gautham:
"Easy access to medical care is fast becoming the newest separation between the rich and the poor all over the world."
While, I whole-heartedly agree with this important concern, it might not be the only problem - which would explain the diabetes prevalence in desi communities in the west (http://www.sawnet.org/health/#Diabetes). Yes, we are genetically prone to developing it, but it is preventable.
From the last page of the Times Article:
"Much of the population gravitates to cryptic beliefs threaded with untruths that are hard to nullify.
People believe in bitter gourd juice and fenugreek, an Indian spice, which can temper sugar levels, but are not cures. Some years ago, the wood water cure gained considerable traction. Drink water stored overnight in a tumbler made of Pterocarpus marsupium heartwood, the promotion went, and it would wash away the diabetes."
and "others are rabid apologists for the disease. Uninterested in eating less, they say that when they feel like a big meal, a luscious plate of sweets, they just swallow an extra pill or inject themselves with more insulin."
AND this passage says alot:
"Late in the day, back at the M.V. Hospital, he trooped upstairs to the rooftop auditorium, where 40-odd doctors had assembled to talk about prevention efforts. One thing they talked of uncomfortably: A particular profession in India, they heard, a well-paying one involving a lot of standing around, had practitioners who did not necessarily heed their own advice. The profession was thick with diabetes. It was doctors themselves."
.... suggesting that there might be a problem with the belief system (apathy) concerning health and well-being. I dunno - I'd like to hear other people's comments.
sorry for the harsh words in my previous post. -need sleep, food, coffee- pardon me.
As usual I will dispute this "genetical" BS. Desis are not developing diabetes because some genetic defect, but because they avoid excersize like the plague. The reason western Desis have higher percentage of High blood pressure and Diabetes is not genetic, but environmental.
In Britain they conducted study of teenagers and found that their counterparts in Punjab had much better readings about Blood sugars and Blood pressure. So how does "genetics" explain it??
Amardeep,
Why do you find the tone irritating? Isn't the author correct in stating that obesity and the rise of wealth-correllated diabetes is the other side to India's economic success?
My significant other's grandfather is currently dealing issues particularly related to infections/gangerene/and amputation.
Previously healthcare in India, just like rest of the western world, dealt with infectious diseases and their control. India still has some work to do in infectious disease control, but with industrialization, longer lives, different food eating habits, prosperity you start dealing with heart disease, diabetes, cancer, etc. This means government clinics offering antibiotics, quinine, or cholera vaccinations won't be enough and the current infrastructure of Indian healthcare establishment (Insurance) isn't designed to accomodate chronic disease treatment on a massive scale.
this is a public health issue that needs to be addressed differently for indians in india and for indians abroad.
this rise in diabetes in india was acknowledged as a considerable problem 5-6 years ago... here's a bbc article on it published in feb. 2001. one big challenge in india is being able to cope with the rising numbers. also prevention strategies and campaigns have not reached the lay public yet. there is tons of info online but it does not reach the rural areas. many people will not be able to afford the drugs to begin with.. it isn't a one time expense, one has to take them for life.
in the west, the biggest problem is not knowing that one is diabetic. one thing we can all do in our local communities is to organize for a doctor to come and give a briefing on diabetes and take a finger prick test to show people what their blood sugar levels are. they can then follow up with their family physician. we have done this in a spiritual gathering setting and everytime there have been a handful of people who did not know their blood sugar was high (obviously don't do this right after a meal).
the other problem is, diet recommendations. if you tell an elderly indian person who has been eating rice in every meal for the past how many ever years that they need to give it up, it isn't going to happen. we need to develop diet recommendations for people within the context of an indian diet and emphasize on portion control. also, for those in rural settings who have about 10-50 rupees to spend on food daily, buying expensive whole grains etc is not feasible. india has come up with diet recommendations but they are not reaching people. we often hear no rice, no sugar, no sweet... but it has been found that a better way to approach diet changes for indians is by reducing fatty foods and oil intake. read last paragraph here. reducing obesity also reduces diabetes incidence, it is a well established correlation.
"So how does "genetics" explain it??"
You know, I wondered the same thing, since the 2nd gen in the west do seem to take better care of it. Maybe it's the predisposition? All I know is that most sources will say "South Asians are genetically predisposed to getting type 2 diabetes." Now, whether this REALLY means "more South Asians develop diabetes than any other ethnic group" I don't know. If that's what it means, then yes, being genetically predisposed and actual number of incidents are very different things. Maybe a geneticist can explain this - *paging Razib*.
Just a thought - maybe if you are genetically predisposed to gaining weight around the waist-line, you may have a higher risk for certain diseases. Agan, this is preventable, but that may be where the genetic predisposition comes in?
here are some sites just for basic info:
American Diabetes Association
CDC info on Diabetes
one of my fave sites uptodate has a patient info link for you..
tried to find some great journal articles regarding india/obesity/diabetes, but really didn't find much info.. will search further.
metric,
The reason why I dispute the "genetic" claim is because they are based on statistics alone. Now I am not an expert in genetics, but the fact that the claims about western Desis are based solely on statistics makes it harder for me to buy it.
Will a construction worker in India show the same symptoms regarding blood sugars as a software engineer of Desi decent in the US??
All the while a recent study showed that Indian/Desis in the US enjoy highest life expectancy (84.5 years)
metric:
in regards to greater girth.. here is an abstract that i found online for you..
I want to mention that I dont know enough about this subject. They may have found a gene that causes Diabetes and Desis may have that gene in higher numbers. If thats the case, I will promptly accept the claim.
RC,
I agree that a number (%) of incidents in a population does not equal a predisposition, because there could be so many other factors, as pointed out in some of my previous posts. That's why it'd be interesting to see if there is any basis to the claim (not a claim I made, just one that I read) that it is genetically predisposed.
rc:
it is not only genetics but environmental...
for example gastric cancer has a higher prevelence in the japaneese who live in japan as compared to those that have immigrated/migrated to the west..likely due to dietary factors, and other 'unknowns'...
even with diabetes, esp type 2, you can change the outcome if you know it runs in your family and get diet/sugar controlled/exercise from the get go..
hence public awareness of the situation is dire...
diabetes sucks...
affects every organ of the body... eye, heart, vessels, infections increase, blah blah blah...
Re: the genetics angle, I have heard from several doctors and also read that for an equivalent BMI and height, a desi is at a greater risk of heart disease and diabetes than a Caucasian person. BTW, there is a new South Asian Heart Center (link) being established at El Camino Hospital in the Bay Area near San Jose.
Diabetes runs in my family on my dad's side, so I am supposedly very prone to it. My paternal grandfather died of it when I was still a baby and some of my uncles suffer from various complaints. In my dad's case, he started falling sick about 15 years ago, but it was detected in time, and since then he has been very disciplined in food and exercise, so he keeps in under control.
I got my parents on Medical insurance last year in India. It was quite a hassle finding a policy for my dad, since diabetes is not covered by most policies, and they refused to cover anybody who is even 'prone to' diabetes, especially if they are above 60. Also they tend to try and associate any medical claim with diabetes and refuse to pay sometimes. But finally, I did find a policy which was more expensive, required a lot of tests before approval, but since then has worked well for my dad. Of course, the cost is cheap by US standards ($150 /year) but I can completely see why people would not still be able to afford it.
Diet in India is very unhealthy in general for the middle class. The poor and lower middle classes eat less and light, but because they are can't afford it. Among the newly minted middle classes, there is a perception that eating light food is beneath status. I see that a lot, even in my own family. When I was a kid, we were pretty working-class and we could not even have good-quality rice and/or chicken/fish daily, so ate a lot of soupy dal, and veggies. However, when I was in my teens, my dad got a higher-paying job in Africa and we were better off, so we started eating as befitted our status, hence both my mom and I became obese. Unfortunately, people in India are just discovering the luxuries of eating out and trying various cuisines, so this trend will NOT go away soon :(
It is tempting to blame MacDonald's for this obesity trend, but I seriously doubt that these American chains are actually having much of a direct impact. I believe much of this obesity/diabetes trend in India is home-grown.
i think the incidence is rising post fast food wars in india..as it has affected the west and other nations that mickey d's and other joints have infilitrated into... yes, we have ghee, mitthai and all that...but other things also prevail.. more transportation, less excercise, walking, less 'manual' labor, more sitting in front of a screen typing/etc... who knows.. it's a huge sociological/medical nightmare that the world, not only india is facing...
Changing traditional diets and its effect on a racial group unused to Western diets has been chronicled before:
The study clearly shows that certain genetic makeup is susceptible to diabetes if the diet is radically changed. Sadly nothing new... Even the supposed "healthy" snacks one finds like Dannon yogurt is sweetened with high fructose corn syrup.
Thank you Dr. Bean (aka chick pea) in comment #25
Thats what I wanted to emphasize, that it is not just the "misfortune" of being born a Desi. There are lot of unknowns!!! It sounds better from an actual doctor, rather than in my badly written rants :-)
Link for #29
there are studies being conducted to determine causative genetic links between south asian ethnicity and diabetes... it is very hard to come up with conclusive results, mainly because one needs very large study groups (n>1000) for population studies. and there are many other interfering factors, like lifestyle and other health issues, that need to be equalized across the whole group (confounding factors).
in any case, the genetic links if they exist have always been there, and they only predispose... lifestyle and diet definitely tip the balance to acquiring the disease. so this needs to be addressed and focussed on. sometimes people take the excuse of 'oh it's genetic' to not be more pro-active and involved in maintaining their health.
RC :
this is another link about genetics
I wonder to what extent obesity/diabetes in india can be attributed to a change in diet as oppossed to a greater number of wealthy indians eating like weathy indians always have.
My personal observation is that wealthy indians have always been overweight in comparison to their western peers. Even indians in the West seem to have a higher body fat percentage than non-indians, though they seem generally slimmer than well-of indians in india. The indian diet, with it's oils, ghee, carbs, and sweets, does not strike me as the healthiest of cuisines.
But i'm just going by personal observation.
As is the case with other high-risk populations, research indicates that there is a genetic basis behind the rise in prevalence of diabetes among Native Americans.
Obesity is a major risk factor for diabetes in many tribes, with increasing rates of obesity measured in several communities in the United Stated and Canada. This increase can be linked to the tribes move away from traditional diets and lifestyles towards more modern ways of life. One notable study showed that Pima Indians who have adopted an Anglo diet are three times more likely to develop diabetes over six years than are their counterparts who eat a more traditional diet. The community now has the highest rate of Type 2 diabetes in the world. In addition, these studies have shown that there is a hereditary link. In the case of Arizonas Pimas community, diabetes rates are highest in the offspring of parents who themselves developed diabetes at a young age. This trend has also shown up in studies of other tribes.
The above is from this link about the high prevelance of diabetes in Native American populations. Seems to me like diabetes in India is following a similar trajectory with more people migrating to a 'westernized' life-style that is big on fast-food and not-so-big on exercise.
I have noticed however, that my younger cousins are getting into a habit of exercising, if only to look like the stars on TV! Hopefully this trend towards exercising expands to the general population and continues.
sorry the link follows
http://www.rediff.com/news/2005/apr/19inter1.htm
There is truth to that, but I think that is combination of genetics and a sedentary lifestyle. Most Indians have a tendency to get that infamous "potbelly" at a fairly young age as compared with non-Indians. And abdominal fat is linked with a host of health problems as opposed to a general distribution of body fat.
in my view, the overindulgence of these is what makes our current indian diet unhealthy. eating in moderation may not have been a choice in earlier days, but a necessity when 'goodies' were restricted due to tight budgets. with that barrier removed people started overindulging... satvic indian diets are very different from what we eat today.
Great post Amardeep! My dad was diagnosed with very early stages of Diabetes, so the links and comments from everyone are very helpful.
The term pandemic is used to describe epidemics/diseases of world-wide proportions. (An epidemic is used to describe the rate of disease that reaches unexpectedly high levels in a country or region, for example.) Obesity is considered a pandemic because it is been seen in large rates across the world.
Thank you mph'er. Why is obesity a disease?
Can it be cured? Is it even an individual condition? Surely, one can hypothesize that this is a societal trait and its remedy lies not with surgery or exercise, but with correcting the society itself.
- public healthcare network
- public recreation facilities
- GDP/PPP
- happiness index
- access to healthcare
- food marketing per square inch in publicly accessible media
- illiteracy rate
etc.
these are not individual issues, but societal issues. all you quant types - do the regression modeling - and get published.
I think I agree with most of what been said here. We may be more prone to developing D, but we're also helping it along environmentally. In my family, my maternal grandparents don't have diabetes, obesity, heart issues etc. They're just old. My uncles however are obese, diabetic and have some minor heart issues. I visited them recently after being in the US for many years where my diet has changed significantly with regards to consumption of sweets and rich food etc. along with more exposure to health related research, and I could see it plain as day what was going on. Highly refined rich food, lack of exercise, and lack of realization that this was an issue on a daily basis. And one of my uncles is a doc!!! I even confronted him on the lack of greens and fruits on the dining table, and you will not believe what he said - we get impure food here so its not effective to focus on fruits etc. WTF!!! I was at a loss for words! Wouldn't ALL food be impure - chemicals etc. - including all the food they happily consume? And everyone in that family is overweight to obese. And they don't get it as first order of business either. They do manage their diabetes but that's not taking it head on.
I have brought up this issue with them so many times but no one gets it. I may have guilty genes but I'll be damned if I help this disease along!
Philosophically, the existance of these 'diseases of the wealthy' evens out the see-saw for me. Its like the old custom of tying women's feet in affluent chinese society - they were rich but screwed on account of it! The same is happening in India. Most rural poor who can't afford rich food and stick with grains, veggies and daal, and seem thin do much better in terms of diabetes, and heart stuff. Now they may get knocked over by other preventables that they don't have money to treat... This of course doesn't fit with the obesity problem with the poor in the USA though...
Note to self: Invest in companies that make drugs for diabetes in India.
This is what happens when all you do is study and eat gulab jamun all day and ignore any kind of physical activity.
The other problem is that alot of people in India are alcholics and they drink the home made stuff. I am sure that this is some how related especially in the rural parts of india. When I was there it seemed like everyone was drunk even the little kids.
The title of the Times article is not quite correct - Modern ways open doors to Diabetes in India? Really?
Diabetes has always been a problem. Maybe this is the first time we have numbers. And trying to attribute ANY increase in diabetes to "fast-food" is a joke. Especially given what the average American reader will visualize fast-food to be. These NYT articles seem to be more and more about some "modern" Indian issues that some reporter wrote looking out of his hotel window. Without tying in the eating habits (even this word would be difficult to apply in so many parts of India) to hard economics is not quite right.
i hope you see that i'm not tooting into the wind.
my premise for issue resolution is somewhat homeopathic in flavor.
this affects the distribution of public funds.
what should the government focus on to have most impact - infrastructure, hospitals, roads, food subsidies, education?
think big. be big.
Thats's scary! Where in India were you?
mmm.. sambhar.
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.
My doctor patiently explained this lovely fact a couple years ago.
Indians suffer from heart disease at far lower body weight than other racial populations.
Outlook had a good feature on this subject.
http://www.outlookindia.com/archivecontents.asp?fnt=20060814
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?
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...
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.
"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.
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.
"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.
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.
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.
Well, the reporter certainly has a taste for black humor.
plus insight into hindoo society:
fatalism:
caste system:
That being said, its an important issue, and I am glad the NYT covered it.
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!
NPR's all thing's considered just did a radio piece on it. It will be posted later today.
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.
metric,
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.
..i know off-topic and all but why oh why do we have to hear about lonelygirl.com on NYT???? Who cares??
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.
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.
68 posts on Diabetes. Not one to call the kettle wheatish....but thats really dorky
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.
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 nos for the sake of brevity.
to whit; impotence
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
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..
by all means chick pea....
i'm just joking around
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 ;))
its all good chick pea.....i've never know someone to passionatly hate a metabolic disease, but, um.....you go?
just joking with you
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.
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:
.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:
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
:-D^^ Ethiopian women are hot
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'....
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?"
This is the way to go... sun on the back, not a tube in the nose. The ballad of jim fixx.
jim fixx' legs
we shall never be tethered.
Thomas Kurma,
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.
"Tera kya hoga Kaalia?"
"Maine to aapka ghee khaya hai sarkar..."
"To phir ab lipitor kha..."
Tef,
I didn't even know who made the comment. sheesh.
Lets focus on Ethiopian women
tef said:
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!
Seeker:
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.
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.
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. Sure. But there seemed too much hearsay in the story, and hardly any crosschecked facts. That is not good reporting.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.
I meant, a low mesh right before the engine wheels.
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
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_
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.
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,
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 fortuna