February 21, 2012

On the Couch, Scarfing Polished Rice in South Asia: The Road to Diabetes and Beyond


Not long ago, several local Nepali friends talked about their parents’ recent diabetes diagnoses. Intrigued, I Googled “white rice diabetes Nepal,” and learned that 18% of Kathmandu’s urban population over 40 has type 2 diabetes (with an additional 10% showing pre-diabetic symptoms). By dramatic contrast, only 3-4% of Nepal’s rural population suffers from the disease. I discovered that the shocking urban trend has a lot to do with the city dwellers’ new addiction to processed, machine-hulled white rice… and their greatly increased inactivity. D’oh! Diet and exercise again.

As a result, I was interested – and not surprised -- to see a story in the February 14, 2012 edition of the online journal MedicalXpress. It reconfirmed the trend my Nepali friends had told me about with this headline: “Diabetes risk factors in young Sri Lankans much higher than previously thought.”

Conducted jointly by King’s College-London and Sri Lanka’s National Diabetes Center, the study surveyed 22,507 people aged 10-40 in Sri Lankan cities. Researchers tested for early risk factors for type 2 diabetes, including high body mass index (BMI), raised waist circumference, high levels of physical inactivity, and family history of diabetes.

A whopping 23% of all participants showed at least two risk factors. Even scarier, 24% of all children in the study (aged 10-14) exhibited at least two risk factors. But it got worse: 40% of all females under age 16 showed the risk factors for physical inactivity and obesity.

Study leader Dr Janaka Karalliedde from the Cardiovascular Division at King's College-London said,
What we have found in this report really confirms that South Asia is becoming the centre of a worldwide diabetes epidemic. We were expecting the levels of risk factors to be high, but we were still surprised at just how high they were. The fact that we found such a high prevalence in children has not been shown in Sri Lanka before, or anywhere else in South Asia, and is of great concern. This dramatic rise is clearly linked to a decline in physical activity and mirrors global trends of rising childhood obesity. Being overweight in childhood means people are much more likely to become obese as adults and will have a greater risk of developing type 2 diabetes and cardiovascular disease. Now that we know how widespread the problem is, we can take steps towards identifying high risk groups to evolving preventive strategies.
About the study, Professor Jean Claude Mbanya, President of the International Diabetes Federation, said: “These figures reflect the disturbing rise in risk factors for type 2 diabetes among young people being seen worldwide….. This is an example of good-quality scientific research that will bring solutions to the global epidemic of diabetes.…”

So, What Progress IS Happening?
The World Diabetes Foundation (WDF) recently reported on its efforts in Nepal, where 15-22% of Kathmandu valley residents are thought to be diabetic, according to the WDF (similar to the percentage reported by the Nepal Diabetes Association).

In the past, diabetes has gotten short shrift in Nepal, because of other national priorities, insufficient facilities and medical personnel, poverty, lack of educational programs, difficulty of terrain, and lack of transportation. That is changing now, with the development and activity of well-informed teams of doctors, social workers, paramedics, and other healthcare personnel offering educational camps and workshops across Nepal.

Specific project elements include:
  • Full day diabetes camps in the communities. Follow up camps at regular intervals
  • Direct awareness and education programs in the local communities on (un)healthy lifestyles and detection and prevention of diabetes and its complications
  • Education for youth in clubs and schools about diabetes, its complications and preventive measures
  • Preventive measures in families with a history of diabetes, encouraging a healthy lifestyle
  • Training of local health care providers in basic diabetes care and management
  • Increasing awareness among government, NGOs and institutions through publications and seminars
The Problem with Polished Rice
Increasing inactivity is a big problem in Nepal (and almost everywhere else). But in Nepal, a major culprit in recent years is rice. Polished rice.

Not long ago, Nepali cuisine featured platters of wholesome hand-hulled rice, a grain that ranged in color from reddish to light and dark brown. Nowadays, urban Nepalis prefer machine-polished rice that is bright white, and devoid of all the complex nutrients in the bran and germ, those more colorful – and nutritious – parts of the grain that have been stripped away.

But the problem isn’t just a loss of vitamins and minerals. It’s how Nepali metabolisms are processing the great quantities of this newer polished rice.

The human body converts most foods into glucose. Some foods – like meat, proteins, beans, and vegetables – take a while to metabolize. Whole grains like brown rice, wheat, corn, and millet are also converted into glucose more slowly. On the other hand, we convert some things into glucose very quickly, such as sugar and processed carbohydrates like white rice and white flour.

In time, our ability to process all that glucose from simple carbohydrates declines. Awash with the insulin our bodies create to counteract the sudden sugar surge in our bloodstreams, our glucose-burning cells eventually develop a kind of immunity to insulin.

What develops next is often called “Metabolic Syndrome,” whose hallmarks are obesity, elevated blood pressure, and high triglycerides (fats in the blood) – all a function of “insulin resistance.” If unchecked, Metabolic Syndrome can lead to diabetes, heart disease, eye troubles, kidney failure, and amputation of limbs.

My Broken Record: “Diet and Exercise”
We live in a highly developed country. We have easy access to mind-boggling volumes of information, and many of us find healthcare within easy reach. Still, if there’s a nation that vies for top honors in the percent of citizens with Metabolic Syndrome, it’s the USA. Obesity is on parade all around us. The unseen risks – like high blood pressure – are rampant, too.

The things I can do are so simple! I can take my neighborhood walks on nice days, and get on my stationary bike when it’s too cold or wet. I can ask for brown rice at my favorite Asian restaurants. I can stay on the lookout for whole grains. I can continue to try to convince my Nepali friends here in Washington to serve our beloved daal-bhaat using brown – not white – rice... not an easy task, even for those worrying about diabetic parents back home. They continue to buy big bags of processed basmati rice, not unlike their American counterparts, who -- aware of the risks -- continue to chow down on their beloved Big Macs! Our ability to ignore reason -- and to be compelled by habit -- knows no boundaries.

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