Diabetic Mediterranean Diet

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

I ask because I’m probably going to put together some low-carb Indian food recipes later this year. Why bother to compose meat-heavy recipes if Indians are predominantly vegetarian?

For the rest of this article, when I mention Indians, I’m talking about Indians in India. Not Indians in the U.S. or U.K. or elsewhere. Here’s what I’ve learned so far.

First off, note that vegetarianism isn’t a monolithic way of eating. Here are common subgroups:

• Vegan:  eat no meat, poultry, fish, eggs, and dairy products whatsoever, probably not even honey (look up how bees make honey)
• Lacto-vegetarian: eat no meat, poultry, fish, or eggs, but dairy products are okay
• Lacto-ovo vegetarian: eat no meat, poultry, or fish, but eggs and dairy products are fine
• Pesco-vegetarian: eat no meat or poultry, but fish are okay (what about eggs and dairy?)
• Semi-vegetarian: eat meat, poultry or fish at least once a month but less than once a week

Surveys of Indians indicate that only 30% of the population, let’s call it one out of three, label themselves as vegetarian. The most common vegetarian strain is semi-vegetarianism. Admittedly, some sources say lacto-vegetarians are predominant. It’s a close call. Pesco-vegetarians are the smallest vegetarian group.

[Update on Aug 28, 2024: Emily Watson at WorldAnimalFoundation.org informed me that 26% of Indians in India are vegetarian. So one out of four. Click for source.]

By comparison, only 2.4% of U.S. adults are vegetarian.

Even non-vegetarian Indians don’t eat much meat—once a week is not uncommon. For instance, in 2015 average annual meat consumption per capita in Americans was 210 lb. The figure for Indians was 6.4 lb! Non-vegetarians in the U.S. eat five times as much meat as non-vegetarians in India.

Compared to non-vegetarians in In India, vegetarians are more likely to be women, over age 55, college-educated, non-smokers, and more sedentary.

Indian vegetarians don’t eat a lot of eggs but do eat a fair amount of milk/diary products.

Vegetarianism is highly variable depending on geography and the make-up of the population. For example, the state of Gujarat has many vegetarians. Also, wherever you find many Brahmins and Jains, there are beaucoup vegetarians.

There are many Hindus in India. A key principle of Hinduism is nonviolence. Killing an animal and eating it is violent. Hence, vegetarianism.

Vegetables are staples of Indian cuisine, and a variety of spices keep them interesting. Rice and breads are also prominent. Legumes (aka pulses) contribute 5% of calories to Indian diets.

The South Asian Paradox

Some of the aforementioned facts I pulled from  “Vegetarianism and cardiometabolic  disease risk factors: Differences between South Asian and U.S. Adults.”

South Asia is typically comprised of India, Pakistan Afghanistan, Nepal, Bangladesh, Sri Lanka, Bhutan, and Maldives. The most populous of these is India, with 1, 326, 000,000, followed by Pakistan (193,000,000) and Bangladesh (163,000,000). India is also the largest geographically, and in the center of the region. The article at hand was based on surveys, called food propensity questionnaires, of folks in Chennai and New Delhi (both in India) and Karachi (Pakistan).

The researchers were interested in the “South Asian Paradox”: “The prevalence of cardiometabolic diseases such as diabetes and coronary heart disease is increasing disproportionately in South Asian compared with other regions of the world despite high levels of vegetarianism.” Why is this, when the vegetarian diet is supposed to be so healthy? (Prevalence of diabetes in India rose from 6.7% in 2006 to 9.3% in 2014.) The authors wonder if the Indian vegetarian diet is less healthy than U.S. and European vegetarian diets. They write that “The health benefits of vegetarian diets observed n the present study may stem from higher intakes of vegetables and legumes among vegetarians compared with non-vegetarians.” I don’t find any firm conclusions that would resolve the South Asian Paradox. They say U.S. vegetarians have more consistently “healthier” food group intakes than South Asian vegetarians: lower consumption of dairy, desserts, and fried foods. They speculate that the healthfulness of the South Asian vegetarian diet might be improved by limiting fried foods and increasing nutrient-dense fruits, nuts, seeds, and whole grains. Higher legume consumption, particularly by non-vegetarians, may also the healthful.

They note that although diseases like diabetes and cardiovascular disease have increased markedly in India over the last 35 years, annual per capita consumption of poultry, meat and fish has only increased by 1 kg.

I wouldn’t be surprised if the South Asian Paradox is largely unrelated to specific foods.

Steve Parker, M.D.