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Lurking amid the warm aromas of cumin and cardamom on a plate of South Asian food are hints of a diet gone horribly wrong. They are mixed into the reds and yellows of chicken biryani and surrounded by mustard seed and turmeric on the inside of crepe-like masala dosas.
To anyone paying attention, the warning signs may seem glaring—obvious red flags associated with health problems. But that’s if they’re actually paying attention.
Despite an alarmingly high rate of heart disease and diabetes among people with origins mainly in India, Pakistan, Bangladesh or Sri Lanka, few of them take seriously the threats that kill friends and relatives at higher rates and earlier ages than people of other communities, experts say.
“It has to do with poor diet, plus bad genes,” said Alan Garber, president-elect of the American Association of Clinical Endocrinologists and a professor of endocrinology at Baylor College of Medicine.
The problem has inspired doctors, researchers and preventive health advocates across the nation to push for minor dietary adjustments to cultural foods that they say will reduce health risks. They say a critical change lies in the grains South Asians consume. So far, however, few have noticed their efforts.
“That’s the sad part,” said Bharat Kantharia, a professor of cardiology at the University of Texas Health Science Center. “I think most of the immigrants, the first generation at least, want to just get on with making their lives here and whatever symptoms they may well have are not necessarily acted upon.”
Diabetes, heart disease
Many South Asians are likely to develop chronic diseases because of genetic risks, diets, and a lack of physical activity, experts say. South Asians are three times more likely to develop diabetes than non-Hispanic Caucasians, according to a 2011 study of more than 94,000 patients conducted by the Palo Alto Medical Foundation Research Institute. They are also two to three times as likely to develop heart disease as whites, according to that and other studies.
A separate study of thousands of cases showed that the average age for a South Asian who experienced a heart attack was 53, six years younger than people of other backgrounds, according to the institute.
Vegetarians also at risk
Poor eating habits are key contributing factors, both among those who follow vegetarian diets that are popular with South Asians and among those who eat meat, said Ashish Mathur, executive director of the South Asian Heart Center at El Camino Hospital in Mountain View.
“We have vegetarians who don’t eat vegetables,” said Mathur, whose center has observed an increasing occurrence of heart disease among young patients, many in their 30s.
Changes in food production and consumption over the last century have pushed more white rice, potatoes, refined flours and other starchy carbohydrates into South Asian meals, said Dr. Raj Patel, a Houston doctor and author of The Healthy Indian Diet.
Bad refined carbs
While the “traditional Indian diet” was heavily plant-based, with proteins coming from legumes and with much nutrition derived from whole grains, easy access to refined flours has transformed the diet and contributed to poor health, Patel said.
Items like potato-filled dosas and fried samosas, flat bread made of white flour, and white rice-heavy biryanis are more common on South Asian plates than they should be, he said.
“The key, key, key thing is decreasing refined carbohydrates,” said Latha Palaniappan, who focuses on South Asian health and medicine for the Palo Alto Medical Foundation Research Institute.
South Asians tend to crowd vegetables and healthy proteins out of their plates and replace them with refined carbohydrates, which contribute to unhealthy spikes in blood glucose levels that pave the way for cardiovascular problems and diabetes, experts said.
Palaniappan tells her patients “eating white rice is like eating sugar.”
“So don’t eat anything white,” she said. “No white rice, no white bread, no white pasta.”
True whole grains
Instead, Palaniappan and others recommend what they describe as a reversion to a diet that incorporates more whole grains, such as amaranth, barley, brown rice, millet and sorghum. A study last year by Palaniappan and other researchers showed a diet that replaced starchy carbohydrates with whole grains reduced the risks of cardiovascular disease in more than 20 South Asian women.
“We really need to go back to the ancient grains of the Indian diet,” she said. “Not the diet of the 1980s or the 1970s, but the diet of the 1900s.”
Restaurants stuck
Grains with 3 or 4 grams of dietary fiber per serving, as described on nutritional information labels, are the best substitutes for white rice, which only has 1 gram.
Patel suggested also being selective with oils, incorporating plenty of spices that have been shown to promote good health, and eating more vegetables. While meat is acceptable in moderation, he said, yogurt, nuts and legumes, particularly when combined with whole grains, are good vegetarian sources of protein.
Whether those suggestions will be adopted by South Asians is another question.
Kaiser Lashkari, chef and owner of Himalaya Restaurant in Texas, said customers have not expressed an interest in brown rice or other whole grains. “We cannot force the customer to say ‘OK,’ “ Lashkari said.
Time to get serious
Popular options at the upscale Indian restaurant have included brown rice served on its own, brown rice biryani, whole wheat flat bread, and a quinoa salad, she said.
Still, for health outcomes to change, South Asians will need to get serious about incorporating changes into their diets, Mathur said. For many, that hasn’t happened, said Ghulam Bombaywala, a retired Houston restaurateur.
“When you look at the top 10 priorities, health doesn’t even come up,” Bombaywala said. “It’s so unfortunate.”
Zain Shauk is a reporter with the Houston Chronicle, and can be reached at zain.shauk@chron.com. This article first appeared in the Houston Chronicle and has been republished with their permission.