Category Archives: India

Does LCHF Eating Help Indians With Diabetes?

Surfing the net, I ran across an Indian lady named Tina who is successfully treating her T2 diabetes with LCHF eating (low-carb, high-fat). Both she and her husband lost excess weight, too. Click for her website.

In turn, she directed my attention to a YouTube channel by Dr. S. Vijayaraghavan, who is also a LCHF advocate for people with diabetes, type 2 anyway. Check out Goodbye Diabetes.

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I Lost My Virginity at an Indian Restaurant

 

Chennai Chettinaad Palace in Phoenix, Arizona

Chennai Chettinaad Palace in Phoenix, Arizona

Tonight I ate at my first Indian restaurant, Chennai Chettinaad Palace, at 2814 W. Bell Rd., Phoenix AZ 85053. This post isn’t a restaurant review, however. It’s a thumbnail sketch of my introduction to Indian food.

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We ended up here because it was recommended to my wife by an Indian gentleman she happened to sit next to on a plane trip. The restaurant has an extensive menu of what they say is authentic North Indian, South Indian & Gujarati food, both vegetarian and non-vegetarian.

We arrived at 6:40 PM and there were few patrons present. One hour later the place was full of apparent Indians.

Two of us started out with, and enjoyed, an appetizer called Gobi Manchurian.

Gobi Manchurian: spicy cauliflower pieces lightly battered and fried.

Gobi Manchurian: spicy cauliflower pieces lightly battered and fried. Yum!

It would have been too spicy for my third dining mate, who simply ate garlic naan (bread) and vegetarian fried rice. Both were delightful, although the rice was a tad oily. The rice dish easily serves four diners. The naan is addictive; split an order with your mate or you’ll eat too much.

Garlic Naan, a type of flat bread

Garlic Naan, a type of flat bread

Vegetarian Fried Rice with bits of cabbage, carrot, celery, and (?) cilantro.

Vegetarian Fried Rice with bits of cabbage, carrot, celery, green onion, and (?) cilantro.

My main entree was Chicken Kolhapuri. I was forewarned it would by spicy hot. I enjoyed it. My wife wouldn’t dare taste it. I’d get it again. I dipped my naan in the copious chicken sauce (a curry?).

Chicken Kolhapuri. Sauce includes ginger, garlic, sesame, and red chilly (sic) paste.

Chicken Kolhapuri. Sauce includes ginger, garlic, sesame, and red chilly (sic) paste.

Brian ordered Chicken Tikka Masala but didn’t like it. I don’t think it was bad; it just didn’t suit his taste, the way some folks don’t like asparagus.

Chicken Tikka Masala with a "traditional North Indian sauce" of roma tomatoes, fenugreek, and garam masala.

Chicken Tikka Masala with a “traditional North Indian sauce” of roma tomatoes, fenugreek, and garam masala.

We finished with an ice-cream style dish. If you want ice cream, stop at Baskin-Robbins on your way home.

Mango and Pistachio Kulfi

Mango and Pistachio Kulfi

Service was good. Our waitress was patient with us Indian food virgins. If you’re not familiar with Indian food, you won’t make sense of much of the menu. The restaurant was too cold for my wife, but fortunately she had brought a jacket. The bill for three of us was $63.42 (USD). We brought home two platefuls of leftovers.

I’ll visit again. I’m interested in vegetarian dishes, lamb, goat, and seafood. The secret to Indian food may be in the spices.

The rice, naan, and desert have too many carbohydrates for many diabetics. I’m sure there are low-carb alternatives, even if you have to make them yourself.

Steve Parker, M.D.

PS: The restaurant offered a 10% discount for customers paying with cash instead of credit. I always thought the credit card companies cut of credit card payments was only 3-4%.

 

 

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Are You Visiting This Site From India?

Gadi Sagar temple on Gadisar lake at sunset, Jaisalmer, India

Gadi Sagar temple on Gadisar Lake, Jaisalmer, Rajasthan, India

I’ve been surprised by how many blog visitors I get from India—often more than I see from U.K, Canada, or Australia.

If you’re Indian, is there anything in particular you’d like to see me address here? Leave a comment below or email me at steveparkermd AT gmail.com. Thank you.

Steve Parker, M.D.

PS: Please let me know if you are aware of a good source of low-carb Indian recipes in English. I have a growing interest in curries.

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Book Review: The South Asian Health Solution

Indian woman cooking chapati

Indian woman cooking chapati

Here’s my review of The South Asian Health Solution: A culturally tailored guide to lose fat, increase energy, avoid disease by Ronesh Sinha, published in 2014.

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Dr. Sinha practices internal medicine in northern California (Silicon Valley) and has a large dose of South Asians in his clinic. “South Asia” usually encompasses India, Pakistan, Nepal, Bangladesh, Bhutan, Sri Lanka and Maldives. It is home to one fifth of the world’s population. This book pertains mostly to Indians, which is Dr. Sinha’s ethnicity. I live in the Pheonix, AZ, area and we have a fair number of Indian engineers and physicians.

WHY DO SOUTH ASIANS NEED THEIR OWN SPECIAL HEALTH GUIDE?

Because Dr. Sinha says they have unique genetic and cultural issues that predispose them to type 2 diabetes, abdominal obesity, coronary artery disease, high blood pressure, and adverse cholesterol numbers. For example, compared to natives who stay in their home countries, South Asian immigrants to the West have 3–4 times higher prevalence of diabetes, he says. Dr Sinha has a program that he’s convinced will prevent or forestall these medical problems in South Asians.

Dr. Sinha says South Asians eat too many carbohydrates and are too sedentary. Especially those who have moved to the West (e.g., US, UK, Europe, Canada). He notes that the core of the typical South Asian diet is flat breads, lentils, rice, fried crispy snacks (with heart-poisoning trans fats), culminating in 150–200 daily grams of carbohydrate more than he sees in other ethnics in California. Western fast foods, sodas, and sweets compound the problem.

He says “most South Asians are skinny-fat,” meaning skinny legs and arms but with a fat belly from visceral fat. This is also called sarcopenic obesity. The usual “healthy” body mass index (BMI) numbers don’t apply to Asians. The World Health Organisation classifies Asians as underweight if BMI is 18.4 or less, healthy at BMI of 18.5 to 13, overweight at BMI 23.1 to 25, and obese if BMi is over 25. These numbers are lower than those used for non-Asian populations.

Another issue in his South Asian patient population is vitamin D deficiency related to their dark skin (hence, less vitamin D production) and too much time indoors. He says vitamin D deficiency promotes inflammation and insulin resistance. More on this below.

Some South Asians have a K121Q gene mutation that causes insulin resistance, which in turn can cause disease. And whether it’s genetic or not (but I think it is), he says South Asians tend to have higher Lp(a) [aka lipoprotein(a)], which causes early and aggressive coronary artery disease. They also tend to have small dense LDL, leading to a lower-than-expected total cholesterol level which may be deceptively low.

Sinha notes a strong vegetarian preference in Indians but spends almost no time discussing it. From the book, I can’t tell if Indian vegetarians are lacto-ovo-vegetarians, pescetarians, or vegans. The author is not a vegetarian.

Gadi Sagar temple on Gadisar Lake, Jaisalmer, Rajasthan, India

Gadi Sagar temple on Gadisar Lake, Jaisalmer, Rajasthan, India

 

SINHA’S GRAND UNIFICATION THEORY OF DISEASE CAUSATION

So, South Asians, at least in the West, have a high-carb diet, are too sedentary, and have genetic tendencies to heart disease and diabetes. How do these factors cause disease? It’s all tied together with insulin resistance. Insulin is the main hormone that keeps our blood sugar from rising too high after we digest a meal. Insulin drives blood sugar into our body cells to be used as energy or stored as fat or glycogen. If our tissues have insulin resistance, blood sugar levels rise. As a compensatory effort, our pancreas excretes more insulin in to the blood stream than would normally be the case. Whether or not that eventually lowers blood sugar levels, the higher insulin levels themselves can cause toxicity. For example, higher insulin levels raise blood pressure, which damages the cells lining the insides of our arteries, leading to chronic inflammation and atherosclerosis (hardening of the arteries). Some of the arterial damage is mediated through small dense LDL cholesterols (aka type B LDL), which is promoted by high insulin levels (hyperinsulinemia). Insulin resistance also results in a defective and overactive immune system, which further promotes chronic inflammation. This inflammation is “…the root cause of almost every imaginable chronic disease…from heart attacks and strokes to Alzheimers Disease.”

Anyway, this is Dr. Sinha’s hypothesis, and there is some scientific evidence to support it. Sinha says that the concept of insulin resistance “weaves together virtually every chronic ailment currently afflicting South Asians.” That may be a bit hyperbolic: He carves out no exceptions for arthritis, asthma, eczema, migraines, glaucoma, macular degeneration, hearing loss, erectile dysfunction, hepatitis C, prostate enlargement, toenail fungus, or male-pattern baldness.

Dr. Sinha’s Grand Unification Theory of Disease Causation has some support among physicians and scientists, but is by no means universally accepted among them. As for myself, I think he’s over-simplifying (for his readership’s sake?) and getting a bit ahead of the science.

Most clinicians aren’t testing directly for insulin resistance. What are the indirect clues? Belly fat, low HDL cholesterol, high trigylcerides, high blood pressure, prediabetes, and type 2 diabetes. These are components of the metabolic syndrome. Not everybody with one or more of these factors has insulin resistance but many do.

WHAT’S HIS PROGRAM?

If Sinha is correct, the South Asian Health Solution is a “low-insulin lifestyle” achieved through carbohydrate-reduced eating, exercise, and avoidance or resolution of belly fat. These help improve all components of the aforementioned metabolic syndrome. The backbone of the plan is carbohydrate restriction. For low-carb eating, avoid wheat bread and Indian flat breads (e.g., chapatis, naans, parathas, puris, phulkas), aloo (primarily potatoes and starchy vegetables), rice and other grains, beans, and sugar. Keep track of your net carbohydrates (he likes FitnessPal.com, which includes South Asian foods).

If you need to burn off body fat, limit carbs to 50–100 grams/day (digestible or net carbs, I assume). Aim for 100–150 grams/day to maintain health and weight loss.

You might be able to add “safe starches” later: white rice, potatoes. To replace your Indian flat breads, learn how to make them with substitutes for wheat flour: coconut flour or almond flour (no skins) or almond meal (skin included). Recipe on page 347. Rice alternatives are cauliflower “rice,” shredded cabbage, broccoli slaw, chopped broccoli, and chopped carrots.

He likes ghee, extra virgin olive oil, coconut oil, and butter. Avoid high omega-6 fatty acid consumption, as in vegetable oils. Of course, avoid trans fats. Good fats are saturated, monousaturated, and omega-3s.

He provides a few low-carb recipes, surprisingly without specific carb counts: chapatis, microwave bread, cauliflower pizza, coconut cauliflower rice, shredded cabbage sabji, gajar halwa (carrot pudding), and coconut ladoo.

Dr. Sinha doesn’t provide a comprehensive meal plan. He trusts his California South Asians to figure out how and what to eat. They’re smarter than average (he never says that, but that’s been my experience with South Asians in my world).

Dr. Sinha is also a huge proponent of exercise. He’ll tell you about squats, lunges, planks, burpees, yoga, and Tabata intervals. He agrees with me and Franziska Spritzler that “physical activity is the most effective fountain of youth available.”

Steve Parker, M.D., Conquer Diabetes and Prediabetes

Taking a rest from the fountain of youth

 

I skipped some of the chapters due to lack of time and interest: women’s issues (e.g., pregnancy, polycystic ovary syndrome, post-partum depression, osteoporosis), childhood, fatigue and stress management, and anti-aging.

MISCELLANEOUS TIDBITS

  • He likes high-sensitivity CRP testing.
  • His metabolic goals for South Asians are: 1) keep waist circumference under 35 inches (90 cm) in men, under 31 inches (80 cm) in women, 2) keep triglycerides under 100 mg/dl (1.13 mmol/l), 3) keep HDL cholesterol over 40 mg/dl (1.03 mmol/l) for men, and above 50 mg/dl (1.29 mmol/l) for women, 4) keep systolic blood pressure 120 or less, and diastolic pressure 80 or less, 5) keep fasting blood sugar under 100 mg/dl (5.6 mmol/l) and hemoglobin A1c under 5.7%, and 6) keep hs-CRP under 1.0 mg/dl.
  • He says HDL cholesterol helps reduce insulin resistance via apoprotein A-1 (apo A-1), which increases glucose uptake by cells.
  • He likes to follow the triglyceride/HDL ratio. If under 3, it means low risk of insulin resistance being present.
  • He likes to follow total cholesterol/HDL cholesterol ratio: ideal is under 3.5.
  • Statins are way over-used.
  • Ignore total cholesterol level by itself.
  • Stress control and sleep are important.
  • The author had some metabolic syndrome components: high triglycerides, low HDL cholesterol, and type B LDL (small, dense particles).
  • He dislikes the usual-recommended low-fat, low-cholesterol diet.
  • 4 tbsp (60 ml) of extra virgin olive oil daily seems to lower blood pressure.
  • Magnesium supplementation may lower blood pressure.
  • The liver stores about 100 grams of glycogen and muscles store 300–500 grams.
  • Vanaspati is a “cheap ghee substitute” made from vegetable oil and widely used in Indian restaurants and many Indian processed foods. Avoid it since it’s a source of trans fats.
  • Aloo sabji is a potato dish.
  • Traditional Indian herbs/spices include turmeric, cardamon, ginger, and cilantro.
  • Find an Indian medication guide at http://www.medguideindia.com/show_brand.php.
  • Coconut milk is a traditional fat in India.
  • Curry, curry, curry.
  • http://www.pamforg/southasian.
  • http://southasiahealthsolutions.org.
  • Non-alcoholic steatohepatitis (NASH) is quite common in South Asians, seemingly linked to visceral (abdominal) obesity and insulin resistance related to carbohydrates.
  • The book has no specific focus on diabetes.

THUMBS UP OR DOWN?

Overall, I like many of Dr. Sinha’s ideas. They seem to be supported by his experience with his own patients. I trust him. I bet many South Asians and non-Asians eating the Standard American Diet would see improved health by following his low-carb, physically active program.

Steve Parker, M.D.

 

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Filed under Book Reviews, coronary heart disease, Heart Disease, India, Overweight and Obesity, Weight Loss

Dietary Advice for a 41-Year-Old South Asian With Prediabetes

The CulinaryRx blogger at MedPageToday asked two physicians what diet modifications they’d recommend for a 41-year-old man with prediabetes. (To read the article you may need to do a free sign-up.)

The moderator asked his experts twice whether carbohydrate restriction is important, and never got a straight answer. These experts must not think it’s important since they push legumes, lentils, fruits, and whole grains. Dr. Nadeau said he believes there is no specific diet for folks with diabetes. I almost fell off my chair when I read one comment recommending cookies and sweets, because they’re traditional. They also recommend low glycemic load, nuts, higher protein consumption, vegetables, and “good oils” like olive oil (ghee not mentioned).

Read this blog post for prior comments that include advice from possible clinicians.

I’m confident that Dr. Ronesh Sinha in Silicon Valley, California, would disagree with the advice of MedPageToday’s experts. Dr. Sinha would likely recommend limiting digestible carbohydrates to 50–150 grams/day as the most important dietary step. (I plan on a review of Dr. Sinha’s book here within a few months.)

I’m still looking for clinical studies of various diets for South Asians (aka Indian Asians) with prediabetes and diabetes.

Steve Parker, M.D.

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Does a Low-Carb High-Fat Diet Work for South Asian Indians With Diabetes?

Indian street seller selling tea - masala chai

Indian street seller selling tea – masala chai

Dr. Andreas Eenfeldt shares an email from Aniruddha Bhaduri, a 43-year-old diabetic living in New Delhi. He’s had type 2 diabetes for ten years.

Ani had poor control of his blood sugars despite following the dietitian-recommended high-carb diet and taking three diabetes drugs. In his frustration, Ani started doing research on his own and ran across Eenfeldt’s version of low-carb high-fat (LCHF) eating. After just one month of LCHF dieting, his blood sugars came down from 300+ mg/dl (16.7+ mmol/l) to an average of 97 mg/dl (5.4 mmol/l). His doctor reduced his drugs, too. Ani mentioned that eating LCHF in India is “a bit expensive.”

Although Ani’s high triglycerides dropped like a rock, I have a little concern about his total cholesterol and LDL cholesterol, both of which rose. That bears watching.

Click through to Dr. Eenfeldt’s blog and you’ll find a photo of Ani. Note that he’s not obese. Like East Asians, Indians develop T2 diabetes at lower degrees of body fat (BMI) than do Americans and Europeans. Could that be genetic? You bet.

This story is interesting to me because I had no definite evidence that LCHF eating was effective for Indian type 2 diabetes. Due to potential genetic differences between Indians and other ethnicities, it’s a mistake to simply assume they would respond to the diet like Europeans, for example. My Low-Carb Mediterranean Diet is a version of LCHF; no Indian has ever reported back to me whether it helped them or not. Now I have one anecdote to support LCHF eating in Indians.

Steve Parker, M.D.

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Introducing Myself To South Asian Indian Diabetes

Gadi Sagar temple on Gadisar Lake, Jaisalmer, Rajasthan, India

Gadi Sagar temple on Gadisar Lake, Jaisalmer, Rajasthan, India

“Asian Indian” as opposed to American Indian, aka Native Americans.

Since I have a number of blog visitors from India, I decided I need to know more about Indian diabetes. I started by reading “The current sate of diabetes mellitus in India.” I looked at a few other things, too, thanks to the Internet. Here are a few facts and issues:

  • India has at least 32 million diabetics (most of whom have type 2 diabetes); it’s the country with the most diabetics (data from 2000)
  • The population of India is 1.28 billion
  • By 2030, diabetics in India may number 79 million
  • The prevalence of diabetes in urban centers is perhaps 9% of the population; higher in southern locales, lower in the north
  • Indians tend to see type 2 diabetes at much lower BMIs compared to Western populations
  • India is rife with diversity: genetic, cultural, linguistic, socio-economic, among others
  • Poverty—or at least lack of affluence—is a major stumbling block to diagnosis, treatment, epidemiologic study, clinical research, and intervention
  • Vegetarianism is more common than in the West
  • I need to learn more about Indian cuisine and foods such as jowar, chappathis, and chana dal (aka Bengal gram dhal), to name just a few
Indian woman cooking chapati

Indian woman cooking chapati

It’s clear to me that I cannot assume that Indian type 2 diabetes is the same type 2 disease I treat here in Scottsdale, Arizona, an overwhelmingly non-Indian population.  If it’s not the same disease, the optimal treatment may be different. I hope to learn more about Indian diabetes over the next year.

Steve Parker, M.D.

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