Tag Archives: High Blood pressure

Califiornia’s Deadliest Spring In 20 Years

The first five months of the COVID-19 pandemic in California rank among the deadliest in state history, deadlier than any other consecutive five-month period in at least 20 years.

And the grim milestone encompasses thousands of “excess” deaths not accounted for in the state’s official COVID death tally: a loss of life concentrated among Blacks, Asians and Latinos, afflicting people who experts say likely didn’t get preventive medical care amid the far-reaching shutdowns or who were wrongly excluded from the coronavirus death count.

About 125,000 Californians died from March through July, up by 14,200, or 13%, from the average for the same five months during the prior three years, according to a review of data from the state Department of Public Health.

By the end of July, California had logged about 9,200 deaths officially attributed to COVID-19 in county death records. That left about 5,000 “excess” deaths for those months — meaning deaths above the norm not attributed to COVID-19. Deaths tend to increase from year to year as the population grows, but typically not by that much.

A closer look at California’s excess deaths during the period reveal a disturbing racial and ethnic variance: All the excess deaths not officially linked to COVID infection were concentrated in minority communities. Latinos make up the vast majority, accounting for 3,350 of those excess deaths, followed by Asians (1,150), Blacks (860) and other Californians of color (350).

Map by Phillip Reese for California Healthline Source: California Department of Public Health

The overall number of excess deaths across all races and ethnicities was ultimately tempered because, compared with the three prior years, there were actually 383 fewer deaths among white Californians than would be expected in the absence of COVID-19. In addition, California Healthline adjusted the overall numbers to reflect more than 320 COVID deaths that could not be categorized by race or ethnicity because that information was missing from state records.

Several epidemiologists interviewed said they believe a sizable portion of the excess deaths among people of color did, in fact, stem from COVID infections but went undetected for a variety of reasons. Among them: a shortage of coronavirus tests in the early months of the pandemic; an uneven strategy for how and when to administer those tests, which persists; and inadequate access to health care providers in many low-income and immigrant communities.

Dr. Kirsten Bibbins-Domingo, chair of the Department of Epidemiology and Biostatistics at the University of California-San Francisco, is among those who suspect the excess deaths reflect a COVID undercount in minority communities. She noted that several chronic health conditions that disproportionately affect Blacks and Latinos — including diabetes, high blood pressure and heart disease — also place them at higher risk for severe complications from COVID-19.

In addition, Bibbins-Domingo said, the prolonged shutdown of medical offices in the early months of the pandemic — and with them non-urgent surgeries and routine medical care — likely accelerated death among people with those chronic conditions.

“Shutdowns always come at a cost,” she said. “It is our most marginalized communities that experience the cost of a shutdown.”

According to state Department of Public Health data, deaths in California attributed to diabetes rose 12% from March through July when compared with the average for the same period over the past three years. In addition, deaths attributed to Alzheimer’s disease rose 11%.

“Dementia is also a disease where we have racial, ethnic minorities already at greater risk,” said Andrea Polonijo, a medical sociologist at the University of California-Riverside. “Now that we have the pandemic, they’re more socially isolated. Social isolation we know can cause deeper cognitive decline.”

It’s hard to determine whether a death is due to COVID-19 if the victim never sought medical care, said Jeffrey Reynoso, executive director of the nonprofit Latino Coalition for a Healthy California. Latinos in California are less likely to have health insurance, he said. They may face language barriers if their medical provider — or contact tracer — does not speak Spanish. Latino immigrants working in the U.S. without authorization may hesitate to visit the doctor.

“Immigration is definitely a driver in creating a fear and a mistrust of systems, and that includes our health care system,” Reynoso said.

Polonijo said the fact that Latinos make up the bulk of the excess deaths correlates with their dominant role in farming, meat processing, manufacturing and food service, jobs all deemed essential during the pandemic.

“This population is also more likely to live in more crowded conditions,” she said. “So not only are they exposed at work, but they are bringing disease home and with it the possibility of spreading it to their family, bringing it to the community.”

Bibbins-Domingo noted that, while a major portion of COVID deaths overall have occurred among seniors and nursing home residents, a disproportionate number of the state’s excess deaths are of working-age adults.

“The excess deaths that we’re seeing in communities of color and in low-income communities are deaths that are occurring at younger ages,” she said. “These are deaths that are occurring in these ages from 20 to 60, generally speaking — the ages when people would be out working.”

Kathy Ko Chin, president of the Oakland-based Asian & Pacific Islander American Health Forum, said Asian Americans also tend to be overrepresented in essential worker occupations, noting that a large proportion of the state’s nurses are Filipino. In addition, she said, government officials have not done enough to translate COVID educational materials into the many languages spoken by California’s Asian Americans. The Trump administration’s rhetoric on immigration during the past four years, she added, has had a “chilling effect” that has kept many foreign-born Asian Americans from visiting a doctor.

“People were really, really scared,” Chin said.

Counties in Southern California and the largely rural Central Valley — places with a high proportion of Latino residents — tended to have high rates of excess deaths from March to July. Among counties with at least 100,000 people, Kings County, an arid expanse north of Los Angeles that is home to industrial-scale agriculture, had the highest rate of excess deaths per capita.

Officials at the Kings County Department of Public Health did not return a message seeking comment.

Bibbins-Domingo and others said it is important for state and county health officials to take a hard look at their excess death numbers. Excess deaths matter, she said, because they expose shortcomings in health care delivery. In addition, local and state responses to COVID-19 are grounded in data; if that data is inaccurate, the responses may be misguided.

“Deaths are important because they also help us to understand how much severe COVID is there in the community that we have to worry about,” Bibbins-Domingo said. “I think when we undercount that, we both fly blind for the overall pandemic management, and we might fly particularly blind in understanding the impact of the pandemic in particular communities.”

Phillip Reese is a data reporting specialist and an assistant professor of journalism at California State University-Sacramento.

This story was produced by Kaiser Health News, which publishes California Healthline, an editorially independent service of the California Health Care Foundation.

Photo by engin akyurt on Unsplash

South Asians, Stay Heart Healthy During COVID Isolation

South Asians have the highest risk of heart disease of any ethnic group. The facts are sobering – 1 in 4 heart attacks occur before the age of 40.

In fact, South Asian men and women have a significantly higher likelihood of having a heart attack before age 50 that is more lethal compared to any other ethnic group.

Although cardiovascular disease remains the leading cause of death all over the world, why do South Asians carry an especially heavy burden of this disease?

Stanford’s South Asian Translational Heart Initiative – (SSATHI) is trying to find answers.

Helping South Asian Heart Health

At SSATHI we are helping South Asians – people from India, Pakistan, Bangladesh, Nepal, Bhutan, Maldives, and Sri Lanka – better understand what makes them predisposed to cardiovascular disease and providing culturally tailored, medical and lifestyle changes to help them lower their risk factors.

We are the first cardiology clinic dedicated to the detection and long-term management of heart disease risk among  South Asians.

Health Impact of the coronavirus pandemic

Since the shelter in place began on March 17, our clinic has seen many South Asian patients whose lifestyles have grown increasingly unhealthy.

These profound changes in lifestyle  include poor diet, reduced physical activity, increased alcohol consumption, weight gain and increasing levels of stress.

South Asians must be vigilant about staying heart healthy during social isolation.  At SSATHI, we are dedicated to increasing awareness about risks and lifestyle choices and offering advice on how to improve heart health.

 Dr. Rajesh Dash MD, PhD, Medical and Scientific Director of SSATHI

Partnering with SSATHI for Clinical Services

SSATHI’s team of clinicians – behavioral psychologists, dietitians, nurses, pre-diabetes specialist and cardiologists – offer comprehensive heart risk assessments, as well as medical and lifestyle interventions aimed at aggressive risk reduction.

As one example, the clinic offers the oral glucose tolerance testing that provides detailed insight into blood sugar and insulin regulation, and helps to identify patients at risk for pre-diabetes. This insight helps our providers tailor treatment by going beyond traditional markers such as hemoglobin a1c (Hba1c – three-month blood sugar mean).

Our pre-diabetes specialist Dr. Fahim Abassi,  has developed several tools to help providers and patients better understand blood sugar regulation and to develop personalized lifestyle recommendations.

The SSATHI clinic also offers virtual care so patients can access clinic services from the convenience of their homes and offices.

SSATHI Clinical Trials

In addition to clinical care, SSATHI has a robust research effort underway to uncover the underlying causes of South Asians’ increased risk for heart disease. Our clinical trials focus on genetic and hormonal risk factors behind heart disease, and a more recent trial on the effects of lifestyle intervention delivered by telemedicine has shown promising results. SSATHI is currently recruiting for a trial that studies the effect of plant sterol supplementation on LDL cholesterol levels. Trials like these helps explore alternative treatments beyond standard medication therapy.

Dangers of Covid19

Though our community has been making steady progress in managing their health, COVID-19 presents a whole new danger. People with co-morbidities such as high blood pressure, diabetes, and heart disease are at an increased risk of developing complications from COVID19. It is therefore more important than ever that we pay attention to our physical and mental health.

Recommendations to improve heart health during shelter in place

In addition to observing city and state mandates for masking and sheltering in place, and continuing proper hand washing, it is equally important to follow positive lifestyle behaviors.  Good nutrition, regular physical activity, consistent sleep schedule and instituting positive coping mechanisms to manage stress, will enhance our ability to deal with the pandemic.


Sheltering in place has forced us to change the way we shop for groceries so dedicate a couple of pantry shelves to nutrient dense shelf stable foods. Channel your culinary curiosity towards creating more vegetable and lentil-based dishes and learn to cook with whole intact grains.


  • Refined & processed starches/carbohydrates such as Maggi noodles, poha, sooji, instant mixes of idli,  or dhokla,


  • Whole grain alternatives like whole wheat noodles, steel cut oats,
  • Coarse cracked wheat or dahlia, quick cooking farro,
  • Barley, bulgur, quinoa, brown and red rice.

Must have

  • Fresh vegetables and fruits, organic low-fat dairy,
  • Plant-based protein sources like lentils and beans
  • Whole intact grains like quinoa, millet and brown rice.
  • Frozen vegetables

Snack Mindfully

  • Avoid using sugar and other refined and processed snacks as a crutch to get through your mid-afternoon slump.
  • Choose low fat organic yogurt and or fresh fruit as a refreshing wholesome snack instead.

Create a schedule to obtain groceries on a regular, biweekly basis and consider online delivery or in-store shopping with safety practices.


Setting aside a few minutes – even as little as 20 minutes to go for a walk could make a big difference in your mood, energy levels and digestion. This could also be a great way to get some sun exposure and restoring your vitamin D levels while giving you an opportunity to clear your mind and getting some exercise.


It is particularly important to establish a consistent sleep schedule. Positive sleep habits include avoiding late night eating (eating after 10:00 pm), unwinding at least an hour before bed (even if it means going to bed later) and allowing sleep to unfold help support a good night sleep.

Getting up around the same time every day, getting light exposure shortly after waking up and blocking blue light on electronic devices 1 – 2 hours before bedtime are all valuable sleep strategies recommended by Stanford sleep specialists Dr. Rafael Pallayo and Dr. Rachael Manber.


As COVID can add a higher degree of stress and anxiety, SSATHI’s behavioral psychologist Dr. Valerie Hoover recommends practicing patience and compassion by lowering your expectations in areas of your life that you cannot control.

Instead, focus on parts of your life that you can control, whether it is health, finances, recreation or relationships. Separating work and non-work activities if you are working from home, creating daily routines such as showering and dressing up, further helps us deal with the lack of daily structure and disrupted routines.

We wish you all good health and optimism!

Vijaya Parameswaran MS, RD, CDE is a clinical researcher, dietitian and certified diabetes educator. She has developed a virtual lifestyle intervention program (NEST – Nutrition, Exercise, Sleep and Transcendence) at the SSATHI clinic. She is also the program manager for Stanford’s telemedicine program CardioClick.

Edited by Meera Kymal, contributing editor at India Currents


How to Build a Healthy Plate – Indian Style

Sukham Blog

My article  All That You Need to Know About Nutrition for South Asians introduced a framework to develop individualized, varied and nutritious meals that you would enjoy every day. This sequel provides suggestions to develop and sustain nutritious, healthy eating habits on a South Asian diet, distilled from conversations with Dr. Ranjita Misra, Editor of the 2nd edition of the AAPI Guide to Nutrition, Health and Diabetes, and Dr. Padmini Balagopal, Editor of its first edition. Dr. Balagopal – a Clinical Nutritionist with a commitment to community education in preventive health – is a Registered Dietitian and a Certified Diabetes Educator (CDE) who practices both in the United States and in India.

This is a practical guide to help you get from where you are to where you want to be.

Dr. Balagopal recommends the ABCD approach: use Anthropometric, Biochemical Clinical testing as the starting point to develop your Diet plan. Anthropometric measurements include height, weight, BMI, weight-to-height ratio, and waist-to-hip ratio. Biochemical includes metabolic, blood chemistry and other tests your physician would order, and Clinic stands for the examination he or she would perform – blood pressure, reflexes, heart and lungs etc. These measures, a customized interview and your physician’s guidance provide the basis to develop and sustain a nutritious, healthy diet optimized for you and your health condition.

Drs. Misra and Balagopal stress the role of a lifestyle change. “People would do better to focus on all aspects of their health – the whole chakra – and not just their particular health condition,” says Dr. Balagopal.” Physical activity, relaxation and mental health are also critical.  “No diet is complete without physical activity, and chronic stress can create a lot of damage.” Meditation, exercise, yoga are essential supplements to your dietary plan.

How you implement your new diet is also critical. Dr. Misra suggests you begin where you are and make a series of small, incremental and sustainable changes to your diet. She points to rice as an example. Most Indians are used to and like white rice. “If I asked my dad to switch to brown or red rice, he would throw a hissy fit,” she says. Instead, start with an equal-parts mixture of rice and quinoa or millets (available in India and in some stores in the US).  If you must, have just a little white rice at the end of your meal to satisfy your palate. “Cut your portion sizes and eat in moderation”, she advises. Allow yourself to indulge once in a while. “Food should be an enjoyable experience and you don’t have to give up everything you like.” Train yourself to take a balanced approach. A small cup of ice cream for comfort food after a bad day is okay if it makes you feel better and helps with your mental wellbeing, as long as you get back on track the next day. “Be aware of what you eat!”  A slice of pizza once a week is better than one every day.

The first step in adapting the Dietary Guidelines for South-Asian cuisine is to address grains. Less processed is better. Use brown or red rice. Consider alternatives like quinoa, bulgur wheat, and millet as substitutes for rice, or use a combination; they provide more protein with less carbohydrates. Refined carbohydrates “end up in the belly area” as triglycerides. If you must, have a very small quantity of white rice at the end of the meal to soothe your palate.  Many South Asians have hypertriglyceridemia resulting from high refined carbohydrates – the white rice factor. Use whole wheat flour for chappatis and rotis.  Ensure you eat plenty of fruits and vegetables. Introduce more color in the diet. Fresh is best, frozen is the next alternative. Canned food should be a last resort.  Add non-fat or low-fat yogurt to your meal for probiotics that are good for digestion and gut bacteria. The DASH meal plan is a good model to follow, especially for low sodium diets. Eat at least three hours before going to bed to aid in digestion and keep your blood glucose in check.

A plant-based diet comprising fruits, vegetables, legumes, and whole grains is the ideal way to go. It is also consistent with the Sattvik diet described in the Bhagavad Gita and other Yoga Shatras.  Furthermore, studies have shown that the prescribed plant-based diet  diet can help prevent and treat diabetesheart disease, some cancershigh blood pressure, and other long-term conditions. A recent article provides evidence that this kind of diet  also helps with Crohn’s’s disease,  and it’s not difficult to reach the Guidelines’ goal of nine servings of fruits and vegetables daily.

‘Tadka,’ or ‘Oggarane’ – tempering – is a fundamental step in South Asian cooking; it provides those mouth-watering flavors by liberating essential oils in spices and condiments. Drs. Misra and Balagopal encourage this – we must enjoy our food – but urge us to minimize the quantity of oil, and suggest that canola and olive oil are better than other options, since they have lower trans- and saturated-fat content. Avoid saturated fats and limit ghee to occasional use. Avoid deep-fried food.  Above all, never reuse oil left over from deep frying. “When you heat oil to a certain temperature, it generates acrylamides – chemicals known to be carcinogenic,” Dr. Balagopal warns.

Another  essential key is portion control.  “Set your tummy thermostat to half-full and get up when you get there,” Dr. Balagopal urges. A high-fiber, whole-grain diet, while good for other reasons, also makes you feel fuller, and helps in this context.

We’ve given you a plate-full of suggestions to get started.  Future articles will focus on the health benefits of certain spices and condiments, and eating with chronic illnesses.

With sincere thanks to Anna Pelzer at Unsplash for the use of her beautiful photograph.

Sukham Blog – This is a monthly column focused on health and wellbeing.  

Mukund Acharya is a co-founder of Sukham, an all-volunteer non-profit organization in the Bay Area established to advocate for healthy aging within the South Asian community.  Sukham provides information, and access to resources on matters related to health and well-being, aging, life’s transitions including serious illness, palliative and hospice care, death in the family and bereavement. If you feel overcome by a crisis and are overwhelmed by Google searches, Sukham can provide curated resource help. To find out more, visit https://www.sukham.org, or contact the author at sukhaminfo@gmail.com.