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Did you know that Indians are more susceptible to lifestyle diseases such as high cholesterol, heart diseases, and diabetes compared to others?

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Here are some startling research data from the CADI (Coronary Artery Disease in Indians). Research foundation. We have based this article on our interpretation of some research papers published by credible agencies like CADI, our experiences, and the understanding of Indian culture. The list of researched articles has been shared at the end of the article.

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http://www.cadiresearch.org/topic/obesity/global-obesity/obesity-indians

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For the same BMI, Indians have a higher body fat percentage. A whooping 7 – 8 % higher than other ethnic groups. This is one of the significant factors that has influenced the change of the healthy BMI standards for Indians to 23 as compared to a healthy BMI of 25 for others ethnic groups. This is also one of the primary reasons why Indians with the same BMI are more predisposed to heart diseases than other ethnic groups.  
So what then contributes to this uniqueness for Indians? It is our genes, the environment we operate in, and our diet that have contributed to this condition.

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Genes: Indians have been blessed with the gene rs12970134 (also popularly known as the monsoon gene). South Asian countries are the only countries to have monsoons. The bulging belly is more pre-dominant among Indians, and the monsoon gene largely influences this phenomenon. The Indian sub-continent is one of the few regions heavily dependent on the monsoon for its agricultural sustenance. So a failure of the monsoon in any year, which was a fairly common phenomenon like a nine-month famine. For other regions, famines were of a shorter duration because rain or snow is spread over the year instead of being concentrated in just monsoon months. The monsoon gene helped our ancestors to survive prolonged famines by converting as many Calories as possible into fat whenever there was a threat of famine.

 

Thrifty Gene: Thrifty Gene, on the other hand, is due to intra-uterine nutrition, the nutrition that the baby gets during the nine months in the mother’s womb. If the fetus does not receive adequate nutrition, especially in the 3rd trimester of the pregnancy, either due to poverty or due to Insulin Resistance of the mother, which is also fairly common among the affluent Indians, the fetus learns to survive on less than optimum nutrition which gets reflected as low birth weight in the children of malnourished women and excess birth weight in the children of insulin-resistant women.

These children, when exposed to normal nutrition after birth, tend to store it as fat instead of using it as energy. The Dutch Winter Syndrome gave birth to this hypothesis because, at the end of the 2nd World War, there was a sudden famine. After all, the Germans took away all the food from Holland, and immediately after that, the war ended, and the Allies flooded Holland with food. So the foetuses in the 3rd trimester during sudden famine followed by excess nutrition had more LSDs than the others in their later life.
This is a well-recognised phenomenon and gave birth to a new branch of medicine called Fetal Origins of Adult Diseases.

The monsoon gene and the thrifty gene, as they are popularly called, because of which our ancestors could survive, the prolonged famines have now become a curse for all of us. Over time, our bodies have learned to convert more calories into fat and spend fewer calories. It is the same way we conserve our funds whenever there is a threat of losing a job.

 

Environment: Fat in the body is mostly in two compartments – (a) Subcutaneous Fat (S.F)– the fat under the skin; and (b) Visceral fat (V.F) – the fat located deep in the abdomen and around the organs. Research suggests that Indians have more visceral fat than others, which is more dangerous than SF because, Visceral Fat, is more responsible for high cholesterol, heart disease, diabetes, and even Fatty Liver than total body fat. The brain adjusts the appetite by sensing the fat reserves in the body with the help of a hormone called Leptin, which is produced only in SF. So although Indian bodies have the highest fat percentage in the world, our brains do not know it because of relatively lower Subcutaneous Fat and keep craving more food.

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Diet: Over the last 30 – 40 years, Indians belong to the community of fattest people in terms of fat percentage despite eating the lowest in the world. For Indians, protein is primarily associated with carbs, unlike in others where it is associated with fat. Let me illustrate it through an example if you ask any Indian household about the protein sources in their daily nutrition, the response generally is dhal/legumes/dairy. For Indian vegetarians, their source of protein is either dhals or dairy. These foods are relatively high in carbohydrates. Most Indian non-vegetarians also resort to dhals/pulses and dairy products, and occasional non-vegetarian foods. Whereas for the rest of the world, animal protein is a major source. Over the last 40 – 50 years, most Indians have moved to a highly processed grain-dominant Indian Diet which generates insulin spikes. Insulin is a master hormone that moves blood sugar into the cells. The insulin spikes make muscle cells resistant to insulin action and this results in blood sugar being moved into fat cells where it is locked up as unavailable fat. This makes the brain send famine signals a couple of hours after the meal without actually having a famine. The picture below illustrates the insulin action which activates the monsoon gene, increases visceral fat and causes a bulging belly, which now has become a trademark for Indians. The bulging belly indicates high visceral fat levels and a higher predisposition to heart ailments, diabetes, and high cholesterol. Other Asians who are also Carb eaters do not have bulging bellies or much of the challenges of visceral fat as they do not have the monsoon gene.

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This picture depicts the Spikes and Dips of the insulin that send the famine signal to the brain which triggers the bulging belly-causing monsoon gene.

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Some list of references:

http://www.cadiresearch.org/topic/obesity/global-obesity/obesity-indians

PMID: 10404798

https://doi.org/10.1210/jcem.84.1.5371

https://www.nature.com/articles/ijo2017231

PMID: 9604868

PMID: 23301147

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