Type II Diabetes: India In Crisis

Last week a report in the AFP explained how the Body Mass Index does not yield accurate information about health risks and bodyweight for Asians; specifically pointing to Chinese, Japanese, Koreans and Indians:
The standard way to define obesity uses the body-mass index -- a measure of weight divided by height -- but weight-related ill health appeared in East and South Asians at a lower cut-off point than in Caucasians, they said.
This is dangerous because many of these countries are adopting more and more elements of the western lifestyle, i.e. poor nutrition, overeating, and insufficient exercise. A new report in The New York Times explains India is especially hard hit by the sequela of the western diet. N.R. Kleinfield reports:
In its hushed but unrelenting manner, Type 2 diabetes is engulfing India, swallowing up the legs and jewels of those comfortable enough to put on weight in a country better known for famine. Here, juxtaposed alongside the stick-thin poverty, the malaria and the AIDS, the number of diabetics now totals around 35 million, and counting.

The future looks only more ominous as India hurtles into the present, modernizing and urbanizing at blinding speed. Even more of its 1.1 billion people seem destined to become heavier and more vulnerable to Type 2 diabetes, a disease of high blood sugar brought on by obesity, inactivity and genes, often culminating in blindness, amputations and heart failure. In 20 years, projections are that there may be a staggering 75 million Indian diabetics.
In a country where health insurance is scarce, Kleinfeild reports some diabetes patients are taking drastic measures:
M.V. Hospital managing director Dr. Ramachandran recounts the case of an impoverished diabetic with a hideously infected leg. Unable to find medical care, he laid the leg across the railroad tracks. The next train to hurtle past did the surgery.
Others simply accept disease as part of God’s will:
S. Kalyanasundaram, the chief regional manager in charge at the Chennai office of the National Insurance Company, one of the country’s biggest, explained that the issue with insurance was the odds. “Insurance can only work if the law of averages applies,” he said. “There are too many people with diabetes.”

Some concepts are easy to sell in India, Mr. Kalyanasundaram said, but health insurance is not one of them. “The capacity to pay is not there,” he said. “And many people take disease as a God-given thing to just accept. So why buy insurance?”
Dr. Fuhrman's prescription for diabetes is explained in detail in a previous post Don't Settle For Diabetes:
How can diabetics safely lower the high glucose levels that are slowly destroying their bodies? How can they lower their lipids and blood pressure, lose weight, and avoid taking dangerous drugs, such as insulin and sulfonylureas? They need to adopt a diet based on nutritional excellence.

Fortunately, the best diet for good health and longevity is also the best diet for diabetics. It is a diet with a high nutrient per calorie ratio, as carefully described in my book, Eat to Live. When you eat a diet consisting predominantly of nature’s perfect foods—-green vegetables, beans, eggplant, tomatoes, mushrooms, onions, garlic, raw nuts and seeds, and limited amounts of fresh fruit, it becomes relatively easy to eat as much as you want and still lose your excess weight. In my experience, those who follow my nutritional recommendations find that their diabetes disappears astonishingly fast, even before most of their excess weight melts away.

Wakame What?

More magic beans for sale! If you’re a fan of the obesity-fighting Korean pine nut, then you’ll love Wakame. What the hell is Wakame? According to Reuters, brown seaweed that could promote weight-loss and have anti-diabetes effects:
At the 232nd American Chemical Society National Meeting in San Francisco today, Dr. Kazuo Miyashita from Hokkaido University reported seeing significant reductions in fat tissue in rats and obese mice fed the edible seaweed carotenoid fucoxanthin.

"The mechanism for this effect is a new one," Dr. Miyashita points out in a statement, explaining that fucoxanthin induces expression of the fat-burning protein UCP1 that accumulates in fat tissue around the internal organs. Mice fed fucoxanthin showed clear signs of UCP1 expression in fat tissue, whereas mice fed a control diet showed little expression of this protein.

BMI Not So Good For Asians

A couple weeks ago Linda Carroll of MSNBC reported on the growing doubt surrounding the Body Mass Index. The BMI is commonly used to determine if a person is of healthy bodyweight, but as Carrol explained it has its problems:
BMI can be way off, especially when it comes to assessing a particular individual. The commonly used measure can give a skewed result not only for fit body builders who come out with a high number because of the extra weight associated with muscle, but also for the elderly, who tend to have scores that underestimate obesity because they have so much less muscle.
In response Dr. Fuhrman provided his method of determining whether or not someone has a healthy bodyweight:
I just take a pinch near the umbilicus and squeeze it lightly between two fingers and measure the distance between the fingers.
Well, we might need to start pinching Asians. Because according to a new report by Malcolm Burgess of AFP the Body Mass Index often misdiagnoses them:
The standard way to define obesity uses the body-mass index -- a measure of weight divided by height -- but weight-related ill health appeared in East and South Asians at a lower cut-off point than in Caucasians, they said.

World Health Organisation guidelines say a BMI of 25 is healthy, more than 25 is overweight and more than 30 obese.

Taiwanese academic Pan Wen-Harn told the 10th International Congress on Obesity in Sydney that such criteria missed a large number of people in Asia.

Chinese, Japanese, Koreans and Indians experienced metabolic risks such as hypertension and diabetes at a much lower threshold, she said.

"You don't have to wait until you get a BMI of over 25 -- even at 23 or 24 a substantial number of people have those diseases," she said.
Burgess cites the spread of the western diet and lifestyle as a reason why Asians are getting heftier:
Indian researcher Naval Vikram agreed that while the westernisation of the Indian diet and less physical exercise contributed to metabolic disorders, most blame lay with genetic make-up.

Indians tended to have high body fat, a low body-mass index, high abdominal fat and a low waist circumference, he said.

They suffered hypertension and lipid problems at a BMI of 22 or 23 -- much lower than other ethic groups, he said.

"If we use international definitions we will be missing about 15 to 20 percent of people whom we would be able to identify with a lower cut-off point. That's a substantially large proportion, taking the population of India," he said.
This story harks at the same issues illustrated in the series of reports by The New York Times investigating the diabetes epidemic in New York City. Here’s an excerpt from N.R. Kleinfield’s report:
One in three children born in the United States five years ago are expected to become diabetic in their lifetimes, according to a projection by the Centers for Disease Control and Prevention. The forecast is even bleaker for Latinos: one in every two.

New York, perhaps more than any other big city, harbors all the ingredients for a continued epidemic. It has large numbers of the poor and obese, who are at higher risk. It has a growing population of Latinos, who get the disease in disproportionate numbers, and of Asians, who can develop it at much lower weights than people of other races.
Fellow New York Times reporter Marc Santora offers up more evidence that the Western way of eating isn’t well-suited for Asians:
Asian children in New York are obese, more than twice the rate among their parents. And they say there is mounting evidence - including soaring diabetes rates in major cities in China, and in other countries with Chinese immigrants - that New York will soon experience a similar explosion as more Asians arrive and have their first encounters with Western ways.

The clash of cultures is vividly apparent in Flushing, one of the city's new Chinatowns. On streets like Roosevelt Avenue, older immigrants still throng traditional Asian markets, with their signs in Chinese, and dine at noodle shops where windows fog with steam. Their children, however, are increasingly lured by fast food. Along a 100-yard strip of storefronts are a McDonald's, a Burger King, a Taco Bell, a Pizza Hut, and a Joe's Best Burger.

Even in China, the number of obese people has tripled since 1992 to 90 million, as Western food has become popular and prosperity has made it possible to eat more. The World Health Organization has warned that Asia faces a "tsunami" of diabetes in the coming decade, and health officials have assailed the Chinese government for its tepid response to the crisis.
It really seems like the problem extends beyond the shortcomings of the BMI. In Eat to Live Dr. Fuhrman explains Asians, in particular the Chinese who traditionally eat a very healthy plant-based diet, are biologically reeling from the effects of the Western lifestyle:
The Chinese [living in China], who on the average consume more calories, are thinner than Americans.1 In China the calorie intake per kilogram of body weight is 30 percent higher than in the United States. The Chinese eat about 270 more calories per day than Americans, yet they are invariably thin. Exercise cannot fully explain this difference, as researchers discovered the same thing with Chinese office workers as well.

This may be because calories from carbohydrates are not as likely to increase body fat as the same number of calories from high-fat foods such as oils and meats, which make up such a high proportion of the American diet. The data suggests that when a very low fat diet is consumed (15 percent average dietary fat in rural China), as compared to the typical Western diet (30-45 percent of calories from fat), more calories are burned to convert carbohydrate in fat, so the body cannot store fat easily.

The modern American diet receives about 37 percent of its calories from fat, with lots of sugar and refined carbohydrates. The combination of high fat and high sugar is a metabolic disaster that causes weight gain, independent of the number of calories.
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