
Young, Vegetarian, Non-Smoking Indians Are Struggling With Heart Disease - soham
http://desinutritionauthority.com/2015/06/why-young-slim-vegetarian-non-smoking-indians-are-struggling-with-cardiac-blockages-heart-attacks-and-diabetes/
======
shanev
This article personally resonates with me as a South Asian-American who has a
father with heart disease. There are multiple reasons for this. 1) A very high
carb diet that isn't suited to sedentary lifestyles. Not just traditional
foods, but also "Western" foods like excessive bread and pasta. 2) An
unusually high value placed on doctors and pharmaceuticals. Many think it's
normal to be on a cocktail of drugs. For example, it's been shown that women
who have never had a heart attack have increased mortality with statin use,
yet it's common for South Asians to get on statins in their 30s, at the
slightest news of elevated total cholesterol. 3) Most South Asian vegetarians
are actually "grain-atarians", lots of rice & pasta, very little actual
vegetables. 4) Mixing Western dietary advice with old world cooking. For
example, replacing ghee with vegetable oil. Most still think that vegetable
oil is healthier than ghee or coconut oil. 5) Most are uninformed about
exercise.

~~~
mkagenius
But vegetable oil (mustard/sarson) is actually healthier than ghee.

[http://www.livestrong.com/article/477887-mustard-oil-
cholest...](http://www.livestrong.com/article/477887-mustard-oil-
cholesterol/#page=2)

~~~
rushi_agrawal
Actually, he is talking about hydrogenated vegetable oil, which is worse.

~~~
DonQuixote1000
I didn't read the part wher he mentioned hydrogenetad oil.

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sudoherethere
In my experience, as some of the commenters stated on the post, it is really
lack of understanding of healthy lifestyle.

I see it in my circle of friends all the time; walking is cardio, oily
vegetarian food is healthy, not eating sweets/dessert after a meal is rude,
and force feeding guests is just cultural. And ridiculous amount of bread or
rice is consumed with every meal.

Perhaps there is some genetic factors but I think it is very obvious that our
lifestyle is major factor in increasing our risk of heart dieseases.

~~~
Amanjeev
So true. Oily, deep-fried vegetarian food (Samosas, for example). The milky
tea (chai) is also often very sugary.

------
suprgeek
Great article but somewhat misleading title.

Young, Vegetarian... so these are qualities that take away traditional CVD
risks. Add "still" to the title & it becomes much more clear.

Indians consuming a traditional diet get ridiculous amounts of SUGAR & FRIED
FOODS. Add to this the fact that many so called "Vegetarians" are vegetarians
by virtue of NOT consuming meat rather than Eating vegetables. So, - Young,
inactive "grainitarians" with high-sugar & oily-food diets at high risk of
heart disease & diabetes - sounds about right.

~~~
JoeAltmaier
My friend Rajesh from Bangalore was warned by his doctor about his heart. He
was eating mass quantities of fried snacks. His wife took him off cold turkey
- doing much better.

~~~
ak39
Cold turkey is actually good for you. ;-)

~~~
JoeAltmaier
Touche`

Actually he's a vegetarian, so it'd be Cold Tofurkee

------
kazinator
You can easily make vegan short bread or pie crust. A can of pop is vegan, as
is a bag of chips.

To get the health benefits from being a vegan or vegetarian, you actually have
to eat the green, leafy stuff. And the unprocessed tubers, legumes, nuts/seeds
and so on.

If your idea of vegetarian is daily serving of deep-fried samosa stuffed with
mashed potato and peas, better think again.

------
chimeracoder
There are a lot of people here commenting on Indian dietary habits, and
there's a lot of misinformation, leading to a lot of misconceptions. In no
particular order, let's clear some up:

1\. There's no such thing as an "Indian" diet. The cuisines throughout India,
Bangladesh, Pakistan, Sri Lanka, and Nepal are incredibly varied, and bear
little resemblance to each other.

2\. Most Indian cuisines are all but unavailable outside India, particularly
in the UK and US. Most Indian restaurants in the US bear little resemblance to
the style of food that is eaten in the home. In other words, Indian food
available in the UK and US does not reflect daily Indian diets within India.

3\. Indian people living abroad may eat very differently, because many of the
ingredients are too expensive or simply unavailable outside their home region.

4\. Not all Indian cuisines are carbohydrate-heavy.

5\. Not all Indian cuisines contain a lot of rice.

6\. Not all Indian cuisines fry food.

7\. Not all Indian cuisines are vegetarian. Vegetarianism does not dominate
Indian cuisine, and it certainly does not dominate Bangladeshi and Pakistani
cuisine.

8\. What counts as "vegetarian" in India is very different from what people in
the US think of as vegetarian. For example, eggs are considered non-
vegetarian.

Finally, I should add that all of this, combined with the fact that this is so
common _both_ across South Asia _and_ in the diaspora in the US suggests (to
me) that genetics are a heavy factor.

~~~
moultano
>Not all Indian cuisines are carbohydrate-heavy.

Do all Indian communities suffer from metabolic syndrome at the same rate?
This study attributes it primarily to carbohydrates and inactivity
[http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3263197/#sec1-9t...](http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3263197/#sec1-9title)

------
moultano
The article does not answer the question it poses. The answer is likely that
Indians eat an enormous amount of carbohydrates and very little protein. Every
single meal is accompanied by as much bread or rice as all of the other foods
combined.

Indians have a high level of lactose intolerance, and many dislike eggs as
well. Nuts are considered a luxury item and aren't eaten regularly. This
leaves few opportunities to compensate with other protein sources.

~~~
ska
Where you said "likely", I think you meant "speculative".

As with most nutritional information, "it's complicated" \- but to suggest
that there is a well demonstrated that high carbohydrate diets and plant based
proteins [1] has implications for heart disease won't hold.

Also [1]: why do you say low protein? Might just be my ignorance, but I would
expect fairly high protein content from all the common dal, channa, etc.
dishes.

To be clear, I'm not saying that there isn't a dietary connection - but to say
it is as simple as "carbohydrates bad, protein bad" is at best premature, but
more likely just inept.

edit: I shouldn't have kept the parents "high carbohydrate" language intact,
as that's actually another question - is the Indian diet meaningfully "high
carbohydrate" ?

~~~
moultano
> but to suggest that there is a well demonstrated that high carbohydrate
> diets and plant based proteins [1] has implications for heart disease won't
> hold.

The connection between a high carbohydrate diet and metabolic syndrome is well
substantiated. [https://www.nutrition.org/asn-blog/2012/05/metabolic-
syndrom...](https://www.nutrition.org/asn-blog/2012/05/metabolic-syndrome-and-
eating-carbohydrates-what-the-data-show/)

~~~
ska
Is that both a) prevalent in the population in OP and b) enough to shift the
heart disease numbers?

~~~
moultano
Yes. The Indian middle class has one of the highest rates of diabetes in the
world. [http://world.time.com/2013/05/12/no-answers-in-sight-for-
ind...](http://world.time.com/2013/05/12/no-answers-in-sight-for-indias-
diabetes-crisis/)

------
ajju
Carbs in diet. The diet of most Indians has more carbs than most other diets.

~~~
tathougies
Don't be so sure about that. My family is Indian and Catholic, which means our
diets have always been much more like the "typical" American diet... lots of
beef, pork, and chicken; less ghee than vegetarian Indian food; no fried food
(why fry vegetables, when you can just cook in animal fat?); and about as much
potato and bread as in the US. Grandparents still have or had all the problems
in the article even though they don't eat any added sugar, and have cut down
on fats, etc. Parents and aunts/uncles shaping out to be the same way.

~~~
beachstartup
> and about as much potato and bread as in the US

so in other words, way too much.

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efsavage
It is _extremely_ difficult to get healthy amounts of good nutrients with a
vegetarian diet. Most vegetarians I know eat way too many starches, beans, and
oils. They do not eat enough nuts, leafy vegetables, etc.

~~~
__z
India and SE Asia have a long, long history of vegetarianism - vegetarian
Indian food isn't what you are thinking of and there is a lot of variety
between populations as well as among them.

Your comment about the "vegetarians you know" also makes no sense.

Vegetarians as a collective group tend to have less instance of ischaemic
heart disease.

~~~
moultano
>India and SE Asia have a long, long history of vegetarianism

Indeed, but they have a short history of wealth and a sedentary lifestyle.
Metabolic syndrome in India is strongly correlated with wealth and urbanism.

~~~
chimeracoder
> Indeed, but [India and SE Asia] have a short history of wealth

Er, quite the opposite. In the grand scheme of things, India has a relatively
_short_ history of poverty, compared with a much longer history of wealth.

Modern nation-state boundaries make no sense more than a couple of centuries
in the past, but the Economist did an extrapolation of what that would have
looked like, and the result was that China was the richest "country" for most
of recorded history, and India was second.

~~~
moultano
For purposes of metabolism, I'm defining subsistence farming to be poverty
regardless of other quality of life issues. Yes India has been relatively a
land of plenty for most of its history. But the modern trend of sedentary desk
jobs that accompany increases in wealth is hitting India later than much of
the world.

------
carbocation
The fact that prevalence of heart disease is nearly invariant between Indians
in India and Indians in the US suggests high heritability and raises the
specter of a genetic effect.

If it were purely cultural, one would expect Indians in the US to differ from
Indians in India. In particular, over successive generations, the risk should
approach that of the US as a whole. Since that is not seen (based on the data
within this post), factors unrelated to culture / food / etc should be
strongly considered as culprits, again, namely genetics.

~~~
bane
The immigrant wave from India into the U.S. is fairly recent, and at least
most of the Indians in my area still stick to the diets they knew growing up
back home. It will take a couple more generations of cultural integration to
be able to exclude diet and focus on genetics.

~~~
carbocation
As another example, in people of East Asian descent, people who follow East
Asian customs get a different type of esophageal cancer from those who follow
an American custom. These cancer patterns are behaviorally driven, and in this
case a clear change can be seen from East Asian immigrants to the US who are
generation 0 to those who are generation 1 and beyond.

I would expect a similar model to hold here.

------
univalent
Hmm, I seem to meet 3/5 criteria on that article. Signed up with the screening
center at El Camino. Thanks for posting this link.

------
scotch_drinker
I'd be interested in any information where these young, vegetarian, non-
smoking Indians started eating a high fat, high protein, low carb diet and
what effect it has on blood levels. Or alternatively, an actual vegetarian
diet removing anything processed like bread or pasta.

The article says these people are genetically inclined to this state which may
in fact be true. But a "vegetarian" diet isn't necessarily heavily based on
vegetables. I'm assuming the science is looking into this but as a not so
young, definitely not vegetarian white guy, when I went from a diet based on
bread to a diet based on meat and vegetables with a lot of exercise on the
side, I saw my blood levels drastically improve.

~~~
eclipxe
Agree - need Indian Keto

------
a8da6b0c91d
It's PUFA consumption. They're using corn and soy oil and peanut oil with
everything rather than their traditional ghee. They're probably also eating
less dairy overall.

~~~
s_baby
Could also be excessive carb consumption. Spikes in insulin lead to artery
inflammation and the conversion of saturated fat into cholesterol.

~~~
a8da6b0c91d
Who told you that? Insulin does not produce inflammation. On anything
resembling a normal cuisine the relative share of carbohydrate vs. saturated
fat really doesn't matter much. I hate to break it to you but the Taubes
shtick is laughable garbage.

~~~
s_baby
>Who told you that? Insulin does not produce inflammation.

These are just from the first page of google. The covariance between insulin,
inflammation, and heart disease is well established at this point.

[http://www.sciencedirect.com/science/article/pii/S0021915008...](http://www.sciencedirect.com/science/article/pii/S0021915008008381)

[http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2704240/](http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2704240/)

[http://www.ncbi.nlm.nih.gov/pubmed/16936531](http://www.ncbi.nlm.nih.gov/pubmed/16936531)

>On anything resembling a normal cuisine the relative share of carbohydrate
vs. saturated fat really doesn't matter much.

Vegetarian diet isn't a normal cuisine. Vegetarians tend to reduce protein
intake and compensate with something else. The easiest substitute being carbs.
If you aren't actually increasing your vegetable intake and eating quality
food the vegetarian diet can be very unhealthy. A couple vegetarians I know
are technically obese.

>I hate to break it to you but the Taubes shtick is laughable garbage.

I don't know who Taubes is. The guy who convinced me is Dr. Lustig from the
"Fed Up" documentary.

[https://www.youtube.com/watch?v=dBnniua6-oM](https://www.youtube.com/watch?v=dBnniua6-oM)

~~~
CuriouslyC
You're wrong, you're looking at covariates in a disease state and assuming
causation. In actuality, insulin is ANTI-inflammatory, while circulating blood
glucose is mildly inflammatory, and the problem is insulin-RESISTANCE.

[http://www.ncbi.nlm.nih.gov/pubmed/17563472](http://www.ncbi.nlm.nih.gov/pubmed/17563472)
[http://www.ncbi.nlm.nih.gov/pubmed/21899513](http://www.ncbi.nlm.nih.gov/pubmed/21899513)

~~~
s_baby
Routinely spiking your insulin levels through excessive carb intake is what
leads to insulin resistance.

>you're looking at covariates in a disease state

Insulin resistance as a discrete state is useful for experimental purposes but
everyone has insulin resistance to some degree.

~~~
CuriouslyC
Insulin resistance is defined by abnormally high blood glucose concentration
in the presence of insulin. It may be true that for sedentary people who
consume a typical western diet, abnormal is "normal" but that doesn't justify
the statement "everyone has insulin resistance to some degree".

As for "spiking" insulin levels as the cause for insulin resistance, that is
hardly proven. Inflammation has been shown to directly induce insulin
resistance. Current evidence seems to indicate the problem is blood glucose
levels remaining elevated (despite elevated insulin); this happens because
there is a limit to the rate of receptor mediated transport.

------
soham
When I posted it, I had complete title like the author had it viz with Heart
Disease, CAD and Diabetes. Someone edited it to shorten it. I can't tell
who/when/why, and I can't edit it again.

~~~
dang
The actual complete title doesn't fit in HN's 80 char limit. The submitted
title ("Why Young,Slim,Vegetarian,Non-Smoking Indians Get Heart Attacks, CAD
and Diabetes") was obscurely abbreviated, plus changed the wording. We
reverted to something closer to the original that is more readable. I don't
see how it's misleading, but we can change it again if anyone suggests a
better title.

~~~
soham
I think it is important to have both the word "why" and the specificity of
Heart Attacks, CAD and Diabetes in there.

"why" because otherwise it feels like an assertion, instead of reasoning.
Second, it reflects specific types of heart diseases (Attacks and CAD), PLUS
diabetes, which is not a heart disease.

~~~
dang
We specifically took out the word "Why" because (a) it's a standard link-bait
trick and (b) it's misleading—they don't know why.

"Heart disease" is surely a legit way to refer to coronary artery disease and
heart attacks. I can't figure out a way to fit "diabetes" in the title while
keeping it accurate and readable. Maybe someone else can.

I'm going to detach this subthread and mark it off-topic now.

------
Nano2rad
Title in HN is misleading. Original title refers to coronary artery disease
and heart attack, which does not cover all heard diseases. Coronary artery
disease is not a big problem now if you have finance to do angioplasty.

~~~
soham
When I posted it, I had complete title like the author had it viz with Heart
Disease, CAD and Diabetes. Someone edited it to shorten it. I can't tell
who/when/why, and I can't edit it again.

Also, saying that Coronary Artery Disease is not a big problem if you can
afford angioplasty, is besides the point. The point is that you have to live
with that irreversible disease all your life. Otherwise by that token, most
diseases are not a problem, including Diabetes.

This hits home to me as someone slam dunk in that demographic.

------
dr_hercules
considering the smog in Indian urban areas effectively everybody is smoking by
western standards.

this isn't even mentioned - but instead goes on about nutritional theories.

~~~
myth_buster
There is some merit to having suspicion on nutrition. The amount of oil
consumption is quite high. Every thing is fried or deep fried. You could
easily see this in the snacks that are consumed with tea/coffee.

~~~
ayushgta
Sure there is. However this article seems to make the point that just even if
you eat right and are active, you are predisposed to these problems just by
being of South Asian decent. The section of the article "The Indian/South
Asian Risk Factor" talks about that.

~~~
myth_buster
From what I understoon, the section says:

    
    
      begun to unearth unique South Asian risk factors 
      that _may_ have genetic underpinnings

and gives example of one mutation.

The rest of "additional genetic and lifestyle-related risk factors" are
primarily lifestyle or diet related.

