7 ms·

Young, Vegetarian, Non-Smoking Indians Are Struggling With Heart Disease

78 points by soham 11y ago

dr_hercules 11y ago
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.
- gonvaled 11y ago
  One of the studies is based on the indian population of California
- myth_buster 11y ago
  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 11y ago
    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 11y ago
      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.
  - chimeracoder 11y ago
    > 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. This isn't really accurate. It's is the common conception of Indian food based on what is usually available in the States, but that's usually only Punjabi food, and even for Punjabi food it's the sort of cuisine that you'd cater for a wedding. It's not at all representative of what people eat on a daily basis. It's like going to P.F. Chang's or Tex-mex and assuming that that's what people typically eat in China and Mexico (respectively). Indian and Bangladeshi cuisines vary quite significantly by region, and in at least some cuisines there's very little oil and/or fried food.
  - eclipxe 11y ago
    It's not the oil, it's the carbs
- notacoward 11y ago
  OK, then why does the same effect seem to exist in Indians living elsewhere, and not among non-Indians in other smoggy places (e.g. China)? The smog factor was already accounted for. There's still something going on here, and several credible genetic/metabolic explanations are being examined. That's science. Presenting obviously-irrelevant facts as explanations is how science gets derailed (and apparenty the local tone police are more than happy to help with that).
  - dang 11y ago
    > That's how science works. Learn it. No acerbic swipes on Hacker News, please.
a8da6b0c91d 11y ago
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.
- raverbashing 11y ago
  This might be a possibility, though in the article it seems the risks are similar if they're in the US or India It might be a systemic cultural thing though.
- s_baby 11y ago
  Could also be excessive carb consumption. Spikes in insulin lead to artery inflammation and the conversion of saturated fat into cholesterol.
  - a8da6b0c91d 11y ago
    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 11y ago
      >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/S0021915008008381 http://www.sciencedirect.com/science/article/pii/S0021915008... 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
univalent 11y ago
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.
ajju 11y ago
Carbs in diet. The diet of most Indians has more carbs than most other diets.
- deleted 11y ago
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- deleted 11y ago
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- tathougies 11y ago
  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 11y ago
    > and about as much potato and bread as in the US so in other words, way too much.
  - JoeAltmaier 11y ago
    Potatoes and bread are not intrinsically bad. I grew up on the farm, and we ate mass quantities of them plus red meat. But we worked it off every afternoon pitching hay or hauling grain or painting fences or whatever. Fundamentally its a sedentary lifestyle that's incompatible with these foods. They are not evil; they're inappropriate for the American level of activity (taking vehicles everywhere; sitting all day; watching TV in the evenings). Indians come to America begin to do these things, and begin to have problems. No surprise.
  - ajju 11y ago
    I am sure there is a genetic component to it as well, but my observations from being Indian, living in India for more than 2 decades, and having a large group of Indian friends tell me that Indians consume a high (and quickly growing) proportion of their diet as carbs. Worse - most of the carb calories seem to come from fried carbs, or sugar rich sweets. This is separate from the "westernized" fast food for which India is one of the fastest growing markets.
sudoherethere 11y ago
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 11y ago
  So true. Oily, deep-fried vegetarian food (Samosas, for example). The milky tea (chai) is also often very sugary.
efsavage 11y ago
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 11y ago
  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 11y ago
    >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 11y ago
      > 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 11y ago
        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.
scotch_drinker 11y ago
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 11y ago
  Agree - need Indian Keto
suprgeek 11y ago
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 11y ago
  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 11y ago
    Cold turkey is actually good for you. ;-)
    - JoeAltmaier 11y ago
      Touche` Actually he's a vegetarian, so it'd be Cold Tofurkee
moultano 11y ago
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.
- chimeracoder 11y ago
  > 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. This is quite heavily exaggerated. In the eastern parts of the state, you'll eat a lot of fish, a small dabbling of rice, and almost no bread. (I'm painting with a broad brush since there are a lot of other factors, but this is much more representative). > Indians have a high level of lactose intolerance, and many dislike eggs as well. Vegetarians don't eat eggs because it's not considered vegetarian food in India (unlike the US). Dairy isn't a great source of protein for most people anyway; very few people around the world have enough tolerance for lactose to consume enough dairy regularly for it to be a primary source. > Nuts are considered a luxury item and aren't eaten regularly. This leaves few opportunities to compensate with other protein sources. Lentils, legumes, and beans are typical fare for an Indian vegetarian diet.
  - a8da6b0c91d 11y ago
    Dairy is an excellent source of protein. Inability to digest milk is far more rare than people think. Daily consumption of small amounts of milk will result in perfect milk digestion in most people over the course of a couple weeks. Regardless, yogurt and kefir and cheeses are essentially lactose free.
  - moultano 11y ago
    >In the eastern parts of the state, you'll eat a lot of fish, a small dabbling of rice, and almost no bread. I'd be really interested to see whether people with a more pescaterian diet suffer from these issues at the same rate. For my relatives, breakfast is 4 pieces of white bread with butter. Lunch and dinner include a minimum of 3 rotis apiece, often with a cup of rice as well. They all struggle with obesity and metabolic syndrome. > Vegetarians don't eat eggs because it's not considered vegetarian food in India (unlike the US). This seems to vary a lot. I don't see people in India having a categorical moral opposition to it the way they do meat, but rather dislike it because it's an unfamiliar flavor and texture. >Lentils, legumes, and beans are typical fare for an Indian vegetarian diet. Yes, but they aren't the primary calorie source. A meal isn't considered complete without the carbohydrates; not so the protein.
carbocation 11y ago
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 11y ago
  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.
  - raverbashing 11y ago
    I agree, most Indians seem to follow an indian diet mostly (read: go to Indian take-aways) I'd bet most don't do their own cooking.
  - carbocation 11y ago
    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.
  - known 11y ago
    http://www.dailymail.co.uk/news/article-2325502/Map-shows-worlds-racist-countries-answers-surprise-you.html http://www.dailymail.co.uk/news/article-2325502/Map-shows-wo...
- ak39 11y ago
  Right. Heritability may be a factor, but isn't the "Indian problem" more about body morphology than it is about something specific to the sub-continent gene affecting the heart directly? For example, ectomorphs (irrespective of ethnicity) are susceptible to the phenomenon, in bro-science parlance, called "skinny fat". That is, they look skinny everywhere (wrists, face, chest, calves) but the abdomen. Abdominal fat is the dangerous fat and it probably remains "unnoticed" in the skinny-fat group - until it is too late. Someone who packs fat in ample quantities everywhere is probably more likely to notice (or be noticed and informed about it) and then take corrective action.
Nano2rad 11y ago
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 11y ago
  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.
soham 11y ago
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 11y ago
  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 11y ago
    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 11y ago
      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.
shanev 11y ago
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 11y ago
  But vegetable oil (mustard/sarson) is actually healthier than ghee. http://www.livestrong.com/article/477887-mustard-oil-cholesterol/#page=2 http://www.livestrong.com/article/477887-mustard-oil-cholest...
  - rushi_agrawal 11y ago
    Actually, he is talking about hydrogenated vegetable oil, which is worse.
    - deleted 11y ago
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    - DonQuixote1000 11y ago
      I didn't read the part wher he mentioned hydrogenetad oil.
- h43k3r 11y ago
  I am an Indian and my thoughts resonates with all the points that you have mentioned. One point that I would like to focus is that the role of a healthy diet and exercise. The medical treatment in India is pretty cheap if you compare it with US. A single trip to a good doctor won't cost you more than $10 + $10 (for medicines). Because of this most of the people are not at all bothered about their health when they are young and keep on eating high carb diets. There is no role of exercise in the current culture in which the younger generation of India is living which is the sad part. 3 days ago, India celebrated the International Yoga Day. I hope people will follow it into their daily lives.
kazinator 11y ago
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 11y ago
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.
- a8da6b0c91d 11y ago
  > genetics are a heavy factor I doubt it. Sikh, muslim, and hindu populations in the west aren't very "genetically" distinct but have different disease rates. If I had to spend a lot of time around hindu women I'd probably wind up with a coronary, but maybe they act that way for genetic reasons?
  - chimeracoder 11y ago
    > If I had to spend a lot of time around hindu women I'd probably wind up with a coronary, but maybe they act that way for genetic reasons? Please keep comments like this off of HN.
    - a8da6b0c91d 11y ago

78 points by soham 11y ago

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.

gonvaled 11y ago
One of the studies is based on the indian population of California
myth_buster 11y ago
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 11y ago
  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 11y ago
    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.
- chimeracoder 11y ago
  > 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. This isn't really accurate. It's is the common conception of Indian food based on what is usually available in the States, but that's usually only Punjabi food, and even for Punjabi food it's the sort of cuisine that you'd cater for a wedding. It's not at all representative of what people eat on a daily basis. It's like going to P.F. Chang's or Tex-mex and assuming that that's what people typically eat in China and Mexico (respectively). Indian and Bangladeshi cuisines vary quite significantly by region, and in at least some cuisines there's very little oil and/or fried food.
- eclipxe 11y ago
  It's not the oil, it's the carbs
notacoward 11y ago
OK, then why does the same effect seem to exist in Indians living elsewhere, and not among non-Indians in other smoggy places (e.g. China)? The smog factor was already accounted for. There's still something going on here, and several credible genetic/metabolic explanations are being examined. That's science. Presenting obviously-irrelevant facts as explanations is how science gets derailed (and apparenty the local tone police are more than happy to help with that).
- dang 11y ago
  > That's how science works. Learn it. No acerbic swipes on Hacker News, please.

a8da6b0c91d 11y ago

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.

raverbashing 11y ago
This might be a possibility, though in the article it seems the risks are similar if they're in the US or India It might be a systemic cultural thing though.
s_baby 11y ago
Could also be excessive carb consumption. Spikes in insulin lead to artery inflammation and the conversion of saturated fat into cholesterol.
- a8da6b0c91d 11y ago
  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 11y ago
    >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/S0021915008008381 http://www.sciencedirect.com/science/article/pii/S0021915008... 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

univalent 11y ago

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.

ajju 11y ago

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

deleted 11y ago
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deleted 11y ago
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tathougies 11y ago
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 11y ago
  > and about as much potato and bread as in the US so in other words, way too much.
- JoeAltmaier 11y ago
  Potatoes and bread are not intrinsically bad. I grew up on the farm, and we ate mass quantities of them plus red meat. But we worked it off every afternoon pitching hay or hauling grain or painting fences or whatever. Fundamentally its a sedentary lifestyle that's incompatible with these foods. They are not evil; they're inappropriate for the American level of activity (taking vehicles everywhere; sitting all day; watching TV in the evenings). Indians come to America begin to do these things, and begin to have problems. No surprise.
- ajju 11y ago
  I am sure there is a genetic component to it as well, but my observations from being Indian, living in India for more than 2 decades, and having a large group of Indian friends tell me that Indians consume a high (and quickly growing) proportion of their diet as carbs. Worse - most of the carb calories seem to come from fried carbs, or sugar rich sweets. This is separate from the "westernized" fast food for which India is one of the fastest growing markets.

sudoherethere 11y ago

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 11y ago
So true. Oily, deep-fried vegetarian food (Samosas, for example). The milky tea (chai) is also often very sugary.

efsavage 11y ago

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 11y ago
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 11y ago
  >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 11y ago
    > 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 11y ago
      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.

scotch_drinker 11y ago

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 11y ago
Agree - need Indian Keto

suprgeek 11y ago

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 11y ago
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 11y ago
  Cold turkey is actually good for you. ;-)
  - JoeAltmaier 11y ago
    Touche` Actually he's a vegetarian, so it'd be Cold Tofurkee

moultano 11y ago

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.

chimeracoder 11y ago
> 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. This is quite heavily exaggerated. In the eastern parts of the state, you'll eat a lot of fish, a small dabbling of rice, and almost no bread. (I'm painting with a broad brush since there are a lot of other factors, but this is much more representative). > Indians have a high level of lactose intolerance, and many dislike eggs as well. Vegetarians don't eat eggs because it's not considered vegetarian food in India (unlike the US). Dairy isn't a great source of protein for most people anyway; very few people around the world have enough tolerance for lactose to consume enough dairy regularly for it to be a primary source. > Nuts are considered a luxury item and aren't eaten regularly. This leaves few opportunities to compensate with other protein sources. Lentils, legumes, and beans are typical fare for an Indian vegetarian diet.
- a8da6b0c91d 11y ago
  Dairy is an excellent source of protein. Inability to digest milk is far more rare than people think. Daily consumption of small amounts of milk will result in perfect milk digestion in most people over the course of a couple weeks. Regardless, yogurt and kefir and cheeses are essentially lactose free.
- moultano 11y ago
  >In the eastern parts of the state, you'll eat a lot of fish, a small dabbling of rice, and almost no bread. I'd be really interested to see whether people with a more pescaterian diet suffer from these issues at the same rate. For my relatives, breakfast is 4 pieces of white bread with butter. Lunch and dinner include a minimum of 3 rotis apiece, often with a cup of rice as well. They all struggle with obesity and metabolic syndrome. > Vegetarians don't eat eggs because it's not considered vegetarian food in India (unlike the US). This seems to vary a lot. I don't see people in India having a categorical moral opposition to it the way they do meat, but rather dislike it because it's an unfamiliar flavor and texture. >Lentils, legumes, and beans are typical fare for an Indian vegetarian diet. Yes, but they aren't the primary calorie source. A meal isn't considered complete without the carbohydrates; not so the protein.

carbocation 11y ago

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 11y ago
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.
- raverbashing 11y ago
  I agree, most Indians seem to follow an indian diet mostly (read: go to Indian take-aways) I'd bet most don't do their own cooking.
- carbocation 11y ago
  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.
- known 11y ago
  http://www.dailymail.co.uk/news/article-2325502/Map-shows-worlds-racist-countries-answers-surprise-you.html http://www.dailymail.co.uk/news/article-2325502/Map-shows-wo...
ak39 11y ago
Right. Heritability may be a factor, but isn't the "Indian problem" more about body morphology than it is about something specific to the sub-continent gene affecting the heart directly? For example, ectomorphs (irrespective of ethnicity) are susceptible to the phenomenon, in bro-science parlance, called "skinny fat". That is, they look skinny everywhere (wrists, face, chest, calves) but the abdomen. Abdominal fat is the dangerous fat and it probably remains "unnoticed" in the skinny-fat group - until it is too late. Someone who packs fat in ample quantities everywhere is probably more likely to notice (or be noticed and informed about it) and then take corrective action.

Nano2rad 11y ago

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 11y ago
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.

soham 11y ago

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 11y ago
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 11y ago
  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 11y ago
    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.

shanev 11y ago

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 11y ago
But vegetable oil (mustard/sarson) is actually healthier than ghee. http://www.livestrong.com/article/477887-mustard-oil-cholesterol/#page=2 http://www.livestrong.com/article/477887-mustard-oil-cholest...
- rushi_agrawal 11y ago
  Actually, he is talking about hydrogenated vegetable oil, which is worse.
  - deleted 11y ago
    [deleted]
  - DonQuixote1000 11y ago
    I didn't read the part wher he mentioned hydrogenetad oil.
h43k3r 11y ago
I am an Indian and my thoughts resonates with all the points that you have mentioned. One point that I would like to focus is that the role of a healthy diet and exercise. The medical treatment in India is pretty cheap if you compare it with US. A single trip to a good doctor won't cost you more than $10 + $10 (for medicines). Because of this most of the people are not at all bothered about their health when they are young and keep on eating high carb diets. There is no role of exercise in the current culture in which the younger generation of India is living which is the sad part. 3 days ago, India celebrated the International Yoga Day. I hope people will follow it into their daily lives.

kazinator 11y ago

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 11y ago

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.

a8da6b0c91d 11y ago
> genetics are a heavy factor I doubt it. Sikh, muslim, and hindu populations in the west aren't very "genetically" distinct but have different disease rates. If I had to spend a lot of time around hindu women I'd probably wind up with a coronary, but maybe they act that way for genetic reasons?
- chimeracoder 11y ago
  > If I had to spend a lot of time around hindu women I'd probably wind up with a coronary, but maybe they act that way for genetic reasons? Please keep comments like this off of HN.
  - a8da6b0c91d 11y ago