Sonal moved to Toronto from India several years ago. Lately, she’s
noticed some weight gain around her stomach, but her overall weight
hasn’t increased much. She hasn’t seen the doctor recently but knows
that her blood sugar and cholesterol were a little elevated at the last
visit. But she’s not worried, figuring that’s just part of getting
older.
Sonal may be surprised to learn she’s on track to have her first heart
attack nearly a decade earlier than the average Caucasian — and that
South Asians have double the rate of heart attacks overall. As
physicians, and the children of South Asian immigrants, these are issues
we grapple with both personally and professionally.
Cholesterol and high blood pressure are important risk factors for heart
disease in everyone, but research has shown that for South Asians,
diabetes plays an especially important role. In South Asians, rates of
diabetes are two to five times higher than for Caucasians and the
unexpected and alarming part is that South Asians develop these
conditions at lower body weights.
There’s a growing recognition in medicine that the Body Mass Index
(BMI), the standard way we determine if a patient is obese, doesn’t work
as well for South Asians. In fact, BMI likely underestimates risk in
South Asians because we tend to gain more fat in our abdomens and have
less muscle than Caucasians.
And abdominal fat has been linked to metabolic disturbances that can
contribute to diabetes and heart disease. This means that the typical
South Asian like Sonal has an elevated risk of health complications,
even though her BMI is “normal.”
All of this leads to a situation where South Asians have heart attacks
more frequently and at a younger age than Caucasians. One need only walk
through the cardiology wards and coronary care units in our hospitals
to see the preponderance of patients with South Asian names and faces.
South Asians may have a genetic risk for heart disease and diabetes, but
many things still can be done to improve our health. Most importantly,
we must recognize our increased risk and take steps towards prevention
and treatment.
Groups such as the Canadian Diabetes Association and the South Asian
Network Supporting Awareness and Research are trying to improve
community awareness and knowledge. For example, the diabetes association
provides culturally appropriate dietary advice and sample meal plans
for South Asians on its website.
Move more
South Asians are much too sedentary and research suggests we are less active than other ethnic groups.
Our ancestors evolved in environments that demanded a lot of physical
activity just to survive, a different world from our increasingly
desk-bound jobs and couch-bound evenings. Life in the modern society is
easier and more convenient, but this means we must put some effort into
making physical activity a part of daily life.
Whether this involves talking walk breaks at work, climbing stairs or
making time to go to the gym, pick something fun that can become a
habit. Getting and staying fit, both through strength training and
aerobic exercise, is an important part of healthy aging and reduces the
risk of many diseases.
Eat better
Making our diet healthier can be a challenge, especially as some of the
tastiest foods in the South Asian diet are rich in refined carbohydrates
and saturated fat.
If you are unsure what to eat, ask your doctor for help finding a
dietician who is comfortable with South Asian foods. Keeping weight down
through exercise and good food choices is crucial — and don’t be
reassured by a “normal” BMI.
See your doctor
Being aware of the symptoms of diabetes, high blood pressure and heart
disease is important, as are regular visits to the doctor for screening
for these conditions.
If you have family members who have any of these conditions, be sure to tell your doctor, as that further increases your risk.
Modern medications for conditions such as diabetes are incredibly
effective, but research suggests South Asians aren’t as diligent at
taking medication compared to other groups. We must improve this.
Canada is home to one of the largest South Asian populations outside of
the subcontinent. Improving the health of our community is something we
can achieve together.
Dr. Fahad Razak is an internist at St. Michael’s Hospital, a scientist
at the Li Ka Shing Knowledge Institute and at the Harvard Center for
Population and Development Studies. He is an assistant professor in the
department of medicine at the University of Toronto.Dr. Eshan Fernando
is a resident in Internal Medicine at the University of Toronto.
Doctors’ Notes is a weekly column by members of the U of T faculty of
medicine. Email doctorsnotes@thestar.ca .
