70-year old Asif Chida has lived with diabetes for over 20 years. For most of that time, he did everything his doctors told him to: watched what he ate, took his medications, stayed disciplined. But his HbA1c — the three-month blood sugar average that clinicians use to track diabetes control — kept climbing. By the summer of 2025, when he visited the South Asian Heart Center at El Camino Health in Mountain View during a trip to see his son, his HbA1c had reached 10.8.
Asif enrolled in the Center’s Stop Diabetes Prevention Program; three months later, his HbA1c dropped to 7.2 — the lowest since his diagnosis.
“For the first time,” says Asif, “I felt I was truly gaining control over my diabetes rather than allowing diabetes to control me.”
After two decades of trying to manage his diabetes, Asif finally found a program that worked for him — a South Asian man who eats South Asian food, in a body that faces health risks that mainstream healthcare doesn’t fully address.
For South Asian immigrants like Asif, diabetes is not simply a disease of old age — it arrives earlier, progresses differently, and carries consequences that compound over decades if not caught and managed in time.
Thousands of households are living this reality quietly in the Bay Area, home to one of the largest South Asian populations in the United States. “South Asians have a significantly higher prevalence of prediabetes and diabetes than other U.S. ethnic groups,” says Dr. Alka Kanaya, Professor of Medicine at UCSF and principal investigator of the MASALA study.
A Risk the American Healthcare System Isn’t Designed For
“Because South Asians are more prone to diabetes at younger ages and at lower weights, current screening practices may miss a proportion of those at risk,” says Dr. Latha Palaniappan, Associate Dean for Research and Co-Founder of CARE, the Center for Asian Health Research and Education, at Stanford University School of Medicine. Earlier detection, she argues, is the single highest-leverage intervention: catch the disease before it compounds, and the entire trajectory of aging changes.
Srinath Sarang, 56, is a clear example of the South Asian diabetic puzzle: the genetic loading, the collision with American food culture, and fruitless efforts to build a diabetic-friendly framework within his own kitchen.
A sprint champion in India, Sarang arrived in the Bay Area as a summer intern in the early 1990s. Working long hours to pay off student loans while commuting between Cupertino and San Jose, Sarang ate whatever was convenient – most days, it was McDonald’s.
His weight accumulated. By the late 1990s, he was diagnosed with prediabetes. He already had a family history of the disease. What followed was two decades of managing a disease that refused to stay managed.
Through a program called Virta Health, Sarang developed a discipline that worked— he walked 4 to 8 miles a day and followed a high-protein, low-carbohydrate diet. Sarang lost 37 pounds, his HbA1c dropped from 7 to 5.7, and he went off all medication. His blood pressure approached normal.
Then, a major life disruption upended his carefully developed routine. Sarang has been fighting to get back ever since.
“The challenge with the lifestyle,” he reflects now, “was the lack of Indian recipes, converting it to be Indian-friendly. It takes work to get there, but it works.”
Why standard screening tools miss the signs
South Asians carry higher insulin resistance and lower beta-cell function than other ethnic groups at the same BMI. They accumulate visceral fat at body weights that wouldn’t trigger concern in other populations. Standard screening tools, built using data from other groups, routinely miss them.
The MASALA study, which has followed South Asian cardiovascular and metabolic health in the Bay Area and Chicago for two decades, reports that the higher prevalence of prediabetes and diabetes “is not explained by known risk factors.”
The usual explanations don’t fully account for the disparites in diet, smoking, and sedentary lifestyle.
The American Diabetes Association recommends screening at a BMI of 23 kg/m² for Asian Americans, lower than the standard 25 threshold. But in practice, many primary care providers are still applying the standard cutoff.
When South Asians are diagnosed with diabetes early, the dietary advice they receive often doesn’t match the foods they know and eat. They’re told to replace rice with whole wheat bread, avoid ghee, and follow a food plate based on a different food culture. As a result, many stop following the advice. Others, like Sarang, create their own approach—often without culturally relevant guidance—by piecing together information from programs that weren’t designed for people like them.
More Greens Than Grains
When Asif enrolled at the South Asian Heart Center (SAHC) to control his runaway diabetes, the impact went beyond the clinical.
“I learned to pay attention to what I eat, when I eat, where I eat, and how much I eat,” he says. “This awareness transformed my relationship with food.”
Ashish Mathur, who helped build the fee-based AIM to Prevent and Stop Diabetes programs at SAHC, explains, “Our approach is not to remove culture from the plate. We help participants make familiar meals more protective, helping them build small, sustainable habits that can change the course of their health.”
Founded in 2006, the South Asian Heart Center was created after recognizing that South Asians in the Bay Area were developing heart disease and diabetes at disproportionately high rates, while mainstream prevention programs often failed to meet their needs. The Center combines personalized clinical assessments with lifestyle coaching based on its M-E-D-S framework: meditation, exercise, diet, and sleep.
The dietary mantra is simple: More Greens than Grains. The nutrition plan is anchored in a practical daily target called 0-1-2-12: zero sweetened beverages, one fistful of fruit, two fistfuls of cooked vegetables, and twelve nuts.
Prajakta Waingankar, PhD, dipIBLM, the SAHC nutritionist, works with food that patients are actually cooking at home. “There is no single South Asian diet,” she says. “Our approach is always individualized.”
Honoring ancestral foods
New patients are typically on high-grain, starchy diets that are low in protein and non-starchy vegetables – a reflection of typical South Asian cuisine rather than careless food habits: white rice, multiple rotis, dosas and idlis, potato-based sabjis, and biscuits with afternoon chai. More simple carbohydrates than most people realize.
Waingankar begins by “honoring the foods that participants already love.” Her plate method offers a visual guide: half a plate of non-starchy vegetables, one quarter lean protein, one quarter whole grains or starchy foods.
“This approach naturally lowers excess carbohydrates while still allowing people to enjoy the foods they grew up with.”
AIM to Prevent and Stop Diabetes Impact
Among participants tracked over a year, 63 percent lost 5 percent or more of body weight, 25 percent improved their HbA1c, 62 percent improved their cholesterol ratio, 57 percent improved triglycerides, and 63 percent added more vegetables to their diet. The program recorded 98.7 percent event-free survival from cardiac events for participants tracked for seven to eight years.
These outcomes align with the broader research literature: a Cochrane systematic review found that culturally appropriate diabetes health education in ethnic minority groups produces significant improvements in HbA1c, triglycerides, and diabetes knowledge. Randomized trials show that culturally tailored 12-week group programs, facilitated by bilingual healthcare professionals, outperform general dietary advice for South Asians with Type 2 diabetes.
The MASALA Study
An ideal meal for a prediabetic South Asian patient, she suggests, might look like stir-fried vegetables instead of a heavy cream-and-ghee curry, moderation of rice rather than elimination. Pulling back on ghee rather than treating it as a healthy food — ghee is high in saturated fat and raises triglycerides, LDL cholesterol, and fatty liver risk.
“There are many healthy traditional food items,” says Dr. Kanaya. “Our data just provide evidence that eating foods that are less fried,lower in fat, and that include fresh fruit, vegetables, nuts, and legumes are healthiest.”
The most actionable finding to emerge from twenty years of MASALA research is about dietary patterns — a solution the traditional healthcare system hasn’t offered yet.
Limitations in current programs
Programs such as the South Asian Heart Center, PRANA at Sutter Health’s Palo Alto Medical Foundation, and SSATHI at Stanford Health Care show that culturally tailored care can improve diabetes prevention and management for South Asians.
The challenge is scale. Financial and resource constraints have kept these programs from reaching the broader community, leaving care fragmented.
The Bay Area’s South Asian population is economically diverse. It includes high-income tech workers in Cupertino and Sunnyvale as well as working-class immigrant families in Fremont and East San Jose. Although they share the same elevated biological risk, some have fewer pathways to specialist care or reaching hospital-affiliated wellness programs.
It’s unlikely that a South Asian patient diagnosed with prediabetes at a standard primary care visit in Fremont will be directed toward any of these programs. Most patients find these programs through word of mouth, community conversations, or their own internet research. Routine referral rarely leads them there.
Mathur says the AIM to Prevent is a fee-based program that reduces or waives fees, offers payment plans, and extends its work through free community events and health fairs; but the program’s primary model still relies on people finding the program on their own
The programs also operate largely in isolation. While SAHC and PRANA serve a similar patient profile using similar methods, they do not share referral pathways or systems that connect their work.
Professor of Medicine (Cardiovascular Medicine), Stanford University (image source:Stanford Medicine)
Dr. Palaniappan at Stanford University’s CARE project says these programs have already proven that culturally relevant care can address an unmet need. “To have a large population-level impact, they need to be scaled and integrated into mainstream healthcare systems.”
She suggests that proactive screening reform is the first priority: lowering the BMI threshold in practice, not just in guidelines, and screening earlier — before the disease has years to compound. She also points to the limitations of grouping all South Asians in health data. UK research suggests Pakistani and Bangladeshi populations carry higher risk than the aggregate “South Asian” category reflects, and that granularity matters for targeted prevention.
The MASALA study findings have actually influenced guidelines to drop the screening criteria for diabetes from a BMI of 25 for everyone, to a BMI of 23 for Asian Americans. The study is cited in the Dyslipidemia guidelines to make South Asian ancestry a “risk-enhancing factor” for more aggressive lipid management.
Many South Asian Americans now eat local processed foods that reflect traditional carbohydrates—Costco samosas or sugary lassis—requiring prevention programs to adapt to changing eating habits.
Srinath’s experience illustrates the gaps. He developed his own approach by adapting Western nutrition advice to Indian cooking. When life disrupted his routine, there was no healthcare system in place to help him get back on track.
Taking charge of a diabetes diagnosis
For South Asians, aging well may depend less on what they give up than on how early they begin. The evidence is consistent: the earlier an individual is diagnosed and acts on it with culturally informed guidance — for example, a dietitian who knows what a paratha is— the more they can protect their health into old age. Being one’s own advocate, armed with the right questions, may be the most powerful tool available until the system catches up.
Asif, at 70, has an HbA1c of 7.2. Srinath, at 56, is still working his way back to 5.7. These numbers represent real lives, managed individually, working to the finish line.
For now, the existing programs are proof of concept, not systemic change. The research has answered the question of what works. The question still open is who gets to access it, and how much sooner.
This story was written with support from the Solutions Journalism Network.
