Why do SO MANY South Asians get diabetes? (Part 1: The Problem)

Objectively speaking, there is little fault to be found with how my parents and their friends live; They typically eat unprocessed vegetarian food made from scratch, including an array of vegetables and fruit, they enjoy the support of a close-knit community and neither of my parents have ever smoked (indeed smoking is rare amongst their friends).

My father is now 80, but he was diagnosed with diabetes in his 40s. Since then he has had multiple heart attacks, had open heart surgery and multiple stents to open up the blood vessels in his heart. He is now completely blind from the consequences of high blood sugars on the tiny vessels at the back of his eyes (and the treatment he has had for this). He is also of a slim build — though I have seen photos of him in his 30s with a little padding around his middle.

More often than not, by middle age, my parents and their friends had each developed diabetes despite following the type of public health dietary guidance that is intended to keep the nation healthy.

Why did this guidance not work for them?

And what can we learn from it?

What is diabetes?

The two main types of diabetes are known these days as ‘Type 1 Diabetes Mellitus’ (T1DM) and Type 2 Diabetes Mellitus’ (T2DM).

The first one (T1DM) is an autoimmune condition where the person’s pancreas can no longer make the hormone insulin. The pancreas is an organ that sits under our liver. It is here, in cells called β-cells, that insulin is made. Insulin acts like a key to let glucose into cells so it can be used as an energy source. T1DM is usually diagnosed at a younger age. About 10% of diabetes cases worldwide are T1DM.

The second type (T2DM) accounts of 90% of cases of diabetes. It is due to muscle cells, fat cells and liver cells not noticing the high amount of insulin in the blood that has been released by the pancreas when blood sugar levels are high (eg after eating). It is therefore termed ‘insulin resistant’ because although insulin is made and released into the blood stream, tissues don’t really respond to it appropriately.

This means that instead of cells letting glucose in to be used, glucose sloshes around in the blood reeking havoc.

Sugary blood causes a lot of inflammation and damage over time.

It also gets stored as fat in between muscle and inside the liver where it leads to a state of inflammation and worsens insulin resistance.

It directly causes damage to blood vessels by the production of ‘advanced glycation end products’ (AGES) -these in turn cause more oxidative damage.

The smallest blood vessels are the most vulnerable which is why the vessels in the heart, kidneys, brain and tiny vessels in the hands and feet are often damaged first.

When there is fat in the blood vessels and all this elevated blood sugar, the result is a lot of inflammation. This triggers a subset of our immune cells to react to the fat resulting in fatty deposits called ‘atherosclerosis’. Atherosclerotic plaques narrow the blood vessels and restrict oxygen and nutrients getting to those organs.

All of this is going on over years, before many diabetics know they are diabetic, or whilst they still think that their sugar control is ok. So it is important to tackle the problem aggressively and early on.

Diabetes is most definitely reversible- and the odds are most favourable early on.

The scale of the problem

It is now understood that people of South Asian descent (this includes people from the Indian, Nepali, Maldive Islander, Bhutanese, Bangladeshi, Pakistani and Sri-Lankan ethnicities) are much more likely to develop diabetes

1) at a younger age (5–10 years earlier) than white Europeans, and

2) at a lower BMI *(BMI> 22.9 vs BMI>24.9 for white Europeans).

What is more, once they become diabetic they are more likely to have a rapid worsening of their diabetes requiring more medication, as well as have poorer cardiovascular outcomes.

Does this mean we should throw in the towel and accept our genes are stacked against us?

No, as we gather more pieces of the puzzle it can help guide us towards better choices.

Read my follow on article:

‘Why do SO MANY South Asians get Diabetes? (Pt 2: The Solution)’ to find out why it happens and what can be done about it.

*BMI = body mass index. Calculated as height (meters) / height ² (meters). It is commonly used to guide us in recognising when someone’s weight, relative to their height, is too high and putting them at risk for health conditions. See this link for more details about BMI.