Growing up, I remember the puri-filled garbas with the neighborhood Indians and hearing the latest Bollywood hits filling the night. The adults were separated according to gender, much as it is today, with the children milling in between. When comparing those uncles and aunties to the average American, I was surprised at how slim and healthy, at least outwardly, our ethnic group was. There were a few exceptions, of course, but I felt we were healthier than the average American–or so I thought.
These memories serve as a reference of Indian-American health for me, and likely for many of you. It is why, for a long time, I was surprised to hear when a beloved uncle had a heart attack or so-and-so aunty developed diabetes. Fast forward twenty years later, and the stories, despite their variations in details, are as familiar as Amitabh Bachchan’s acting. Worse, I thought that these diseases, like obesity, high blood pressure, and diabetes, affecting us were the product of bad luck.
But it is not bad luck that’s the problem, it is the slow acculturation to the American lifestyle. The same problems affecting India-Americans have also been affecting the Chinese, Pakistanis, Koreans, and Lebanese in America. The more time spent in America, the more American you become, both culturally and medically. In one study, researchers found that the risk of hypertension increased as more time was spent in America by Asian Americans after immigrating, a finding that was also seen with obesity.
Whether you are Indian or not, the American lifestyle–rife with calories and devoid of physical activity–affects you equally. Indian-Americans develop diabetes at a higher frequency despite having lower rates of obesity. As such, the American Diabetes Association recommends screening Asian Americans for diabetes starting at a body mass index (BMI) of 23 kg/m2 or greater, which is lower than that for the general population (BMI of 25 kg/m2 or greater). If you are an Indian-American, the risk of developing diabetes increases the more time you spend in American and the younger you were when you came to America. The lifetime risk of developing diabetes or pre-diabetes is so high for Indian-Americans that 1 in 2 will be affected.
Worse of all, both high blood pressure and diabetes increase your risk of heart disease, which is the leading cause of death for Indian-American men and women. Rates of death from heart disease are actually higher than our white counterparts or even other Asian-Americans. Indian-Americans typically have their first heart attack a full ten years earlier than other populations, with one-third of first heart attacks occurring in Indian-Americans younger than the age of 45. Those affected typically have disease affecting multiple arteries of the heart, as opposed to a single artery, which is a more severe form of heart disease.
Are Indians fish out of water? Should we return to India for better health? You could, but the situation is just as bad, if not worse, in India. Although Indians in America have a higher risk of developing prediabetes than those living in India, Indians in India actually have a higher risk of developing diabetes than Indians in America. The only place an Indian has a higher risk of developing diabetes than in America is–India. So is diabetes as much of our destiny as Diwali?
It would seem that these diseases are hereditary, but the emergence of these diseases has occurred within one, or at most two, generations, which is far too quick for this to be related to our “genes.” This phenomenon is almost exclusively a product of our lifestyle. Whether you are an Indian in America or in India, what you eat and how much you exercise will significantly impact your likelihood of developing any of these diseases.
If we, as Indians, are to change our destiny, we should take a note of our grandparents’ diet. These diets were naturally low in fat, calories, and simple carbohydrates. With Westernization and rising incomes, Indians have gravitated toward foods that are higher in these substances, which has led to our epidemic of “lifestyle” diseases. The only way to reverse the trend is to revert back to those healthier diets.
The reason the diets of our elders one or two generations ago are so healthful is because they were largely a whole-food, plant-based diet, which has been shown over recent decades to be one of the healthiest diets studied. Whole-food, plant based diets are rich in fruits, vegetables, grains, and lentils and exclude animal products (this includes meat, ghee, butter, and milk) and refined foods (like sweets, sev, and other processed foods). This type of diet is naturally high in protective phytonutrients, vitamins, minerals and fiber. A plant-based diet is so powerful that it has even been shown to outperform the American Diabetes Associations own diet for diabetics.
Not surprisingly, it is possible to treat and even reverse these diseases. Those making the biggest changes will reap the biggest benefits. Foregoing smoking and exercising at least 150 minutes weekly are other two important pieces of this now-not-so-mysterious health puzzle.
The biggest challenge can be how to implement these types of diets: For healthy recipes, go to the Physicians Committee for Responsible Medicine’s webpage on healthy Indian diets or the webpage of Indian Plant Based Kitchen. It would be a shame for the next generation to see us at garba injecting ourselves with insulin or checking our blood pressures. Let’s hope they see us in a healthier light.
Shivam Joshi, MD, is a plant-based physician and nephrology fellow in Philadelphia. Follow him on Twitter @sjoshiMD.