Article, PDF linked in the title or web link: https://jamanetwork.com/journals/jama/fullarticle/2794433
Podcast: https://open.spotify.com/episode/66m8uy4i7pG2iOhmAk2FDm
The plant-based diet has been around for over 2000 years, one of the earliest records of vegetarianism was from the Jain population in India in 500 BCE. This is a practice in many cultures and religions now, mostly due to the ethical implications of consuming meat products. Recent studies have shown there are many other environmental and health benefits associated with consuming a plant-based diet.
Researchers at Harvard recently published an article with our MASALA Study data that determined the impact of both a healthful and an unhealthful plant-based diets on disease risk. They measured the PDI (plant-based diet index), HPDI (healthful plant-based diet index), and UPDI (unhealthful plant based diet index) for each participant and analyzed the effect on fasting glucose levels, insulin sensitivity, low density cholesterol levels, weight, BMI (body mass index), hemoglobin A1C levels, fatty liver, and future risk of developing diabetes. The best results were seen in participants with high HPDI levels. This means people who consume lots of food like fruits, veggies, whole grains, nuts, daal, or beans. Some examples of unhealthy plant foods are fruit juices, refined grains, potatoes, sugar sweetened beverages, and other sweets and desserts. People who ate a healthy, plant-based diets were likely to have lower fasting glucose, less insulin sensitivity, lower cholesterol levels, lower weight, lower BMI, less fatty liver, and lower hemoglobin A1C levels. Moreover, these individuals were less likely to develop diabetes after 5 years of follow-up. These results show that chronic disease risk can be lowered significantly by simply eating a healthy plant-based diet.
Understanding health disparities in Pakistani, Bangladeshi and Asian Indian immigrants: The MASALA Expansion Study
Video recording of the MASALA Town Hall Presentation and Frequently Asked Questions (FAQs).
By Anisha Sircar
In August 2020, a 60-year-old Indian-American walked into a clinic in Chicago complaining of abnormally high cholesterol levels. The doctor urged him to cut red meat from his diet. “But I’m a vegetarian… I don’t eat any red meat,” the puzzled man replied.
“That’s the first piece of advice somebody gives you when you go to the doctor,” says Namratha Kandula, a doctor and researcher at Northwestern University, Illinois. “If you say, ‘I’m a vegetarian,’ doctors don’t even know what to say next,” she said.
The 60-year old man was a participant in a study Kandula is conducting on the prevalence of heart diseases among South Asians. Like him, several participants in her study complain of similar encounters. Indians, Bangladeshis, and Pakistanis in their thirties and forties are given similar advice, and even suffer from heart attacks despite not necessarily eating meat, being overweight, or using tobacco.
“This is a really big issue,” said Kandula, pointing to a mismatch between what South Asian American communities have learnt about cholesterol, diabetes, and heart conditions, and what doctors know and understand.
South Asian Americans are four times more at risk of developing heart disease than other American ethnic groups, have a much greater chance of getting a heart attack before age 50, and have the highest prevalence of Type 2 diabetes, a leading cause of heart disease, according to various studies.
South Asians in the United States are also more likely to die from heart disease than any other group, according to a study by the American College of Cardiology. This ethnic group represents approximately 25% of the world’s population – and yet accounts for 60% of the world’s heart disease patients, it says. Though this is a long-standing problem, even now, “nobody really understands what’s going on here,” Kandula said.
While it isn’t fully clear exactly why they are more prone to heart disease than other groups, researchers say a combination of genetics, diet, and socio-cultural factors play key roles.
The ethnicity has a genetic predisposition to developing risk factors associated with cardiovascular diseases. For instance, South Asians are genetically more likely to develop insulin resistance, which can then cause diabetes and metabolic syndrome – important culprits of heart health issues.
South Asians’ carbohydrate-heavy diets, often rich in oils and fats, are also highlighted as another issue: “You’re already predisposed to developing a condition such as diabetes or heart disease, and then you’re eating foods that would make the control of that worse,” said Rita Kaur Kuwahara, an internal medicine physician with expertise in international health and health policy.
When a person eats sugar or carbohydrates, she explained, their body releases insulin to help break it down. But with diabetes or insulin resistance, cells don’t respond to the insulin, and so cannot work as well to bring sugar levels down. “On top of that, if you’re eating foods that require more insulin to process, you’re going to have uncontrolled diabetes or very high sugar levels.”
Also, physiologically, South Asians may not have higher rates of obesity or body mass indexes than other groups, but tend to accumulate fat in the belly area and the abdomen, which is a dangerous type of fat. This causes inflammation in the body, and can lead to high blood pressure, diabetes, and insulin resistance, researchers say. On average, South Asians tend to store more fat in the “wrong places” and have less lean muscle mass than other populations.
To address this, Congresswoman Pramila Jayapal introduced a version of the South Asian Heart Health Awareness and Research Act in 2017. The bill, which was reintroduced in 2019 and passed the House of Representatives in September 2020, aims to promote heart health awareness and bring funding to an obscured cause.
When Jayapal saw healthy South Asians suffer from heart attacks, she realised the extent of the problem, said Stephanie Kang, a representative from Jayapal’s office, who works as the Congresswoman’s health policy advisor. “There was rarely a South Asian she’d met that didn’t have a family member who unexpectedly had heart disease, even though they were healthy.”
A lack of funding and resources has continued to plague this issue, which is what led to the vision behind the bill, said Kang.
The MASALA study is proud to be one of the 14 national cohorts participating in this new nationwide study of more than 50,000 individuals to determine factors that predict the severity and long-term health impacts of COVID-19.
This study will include participants from nearly every U.S. state, with an estimated 24% of the participants who are Black, 20% are Latinx, 5% are Native American, 2% are Asians, and 49% are White.
Participants in MASALA and the other cohorts will be asked to complete a questionnaire in early 2021 and again in mid 2021 to determine their current health, behaviors, and psychosocial impact of the COVID pandemic. We will also ask participants to send us a small sample of blood (dried blood spot) to determine whether they have antibodies to COVID. Those who have had COVID infection, will be asked to share their medical records to determine their illness course and severity. These data will be used to determine the impact of the COVID pandemic on individuals in the community, and what the long-term effects may be of having COVID.
We thank the MASALA study participants for joining this collaboration. South Asians will have representation in this national study and will contribute to the overall understanding of this COVID pandemic.
