Health problems and Nutritional Status of Indians in the
Some of the important health problems faced
by Indian immigrants include chronic degenerative diseases
such as diabetes, hypertension, cardiovascular diseases and
complications arising from any of these conditions. In fact,
Indian immigrants have a significantly higher risk of cardiovascular
disease with heart disease rates estimated to be one and one
half to four times greater than Caucasians. Research has shown
that there is susceptibility among us towards developing non-insulin
dependent Type 2 diabetes. There are several reasons for this:
hereditary differences in lipid metabolism, excessive insulin
resistance, increased glucose tolerance, increased abdominal
fat and lifestyle changes such as lowered physical activity
coupled with increasing stress. Concerns also center around
nutrition problems stemming from dietary changes such as altered
vegetarian status, meal patterns, increased consumption of
fast and convenient American foods as substitutes for healthy
Indian foods. This results in the abandonment of a diet traditionally
high in complex carbohydrates and low in fat to a diet high
in saturated fat, animal protein and low in fiber.
Can nutrition and exercise improve cholesterol and triglyceride
and lower the risk of heart disease in Indians?
Yes, since a significant rise in heart disease
among Indians is due to inappropriate dietary habits and a
lack of exercise. Some children may also be at a higher risk
for developing dyslipidemia (high triglycerides and high LDL
High Cholesterol and /or high triglyceride
can be lowered with a healthful diet. Indians may have a condition
called insulin resistance or metabolic syndrome.
The primary case of an increase in heart disease in Indians
is due to the metabolic syndrome described as high triglyceride
levels and low HDL (good cholesterol) levels. These levels
are also associated with upper body (waist) obesity and high
insulin levels in the blood. Metabolic syndrome includes dyslipidemia,
high blood pressure, and a moderate increase in blood sugar
or diabetes. Accompanied by a small weight loss (if overweight),
consistent daily aerobic exercise for a minimum of 30 minutes
to an hour (e.g. walking) can increase the good HDL cholesterol
and lower triglycerides, lower blood pressure and blood sugar.
Incorporating a weight and resistance training regimen into
the cardio program will give added benefits and can reverse
metabolic syndrome in many people. The question we should
ask ourselves is not whether we should exercise but rather
can we afford NOT to exercise. A high level of homocysteine
and lipoprotein are also risk factors for heart disease. Ask
your doctor if you should have these blood tests.
What causes higher triglyceride levels and how to lower it:
Triglycerides are the blood fats strongly
associated with diet and weight. Being overweight, consuming
excessive sweets and alcohol can increase the triglyceride
levels in the blood. The best level of triglyceride is 150
mg/dl or less. However, some labs indicate levels up to 250
mg/dl as normal. An increase in triglycerides can suggest
changes in the lipoprotein patterns that are not healthy.
This unhealthy change is referred to as Pattern B. Eating
a high carb diet can cause triglycerides to increase. The
amount and type of food consumed both can affect the triglyceride
levels. Weight gain due to overeating will also raise triglyceride
levels. Alcohol can also increase triglyceride levels in the
A low fat diet accompanied by weight reduction
will lower triglycerides. Eating fatty fish, e.g. salmon,
mackerel and trout once or twice a week may help lower the
triglycerides as these are high in omega-3 fatty acids. Flax
Seeds may also be beneficial on a heart healthy diet although
they do not have the two essential fatty acids EPA and DHA
that fish have.
Fat is an important nutrient because the
body cannot produce its own and must get it from the diet.
A low fat diet accompanied by weight reduction will lower
triglycerides. Eating too little fat but enough food to maintain
weight usually results in your triglycerides going up and
your HDL going down. Although your triglyceride may stay in
the lab normal range (<150 mg/dl) you do not want your
triglyceride to go over 100 mg/dl. If your triglyceride levels
go above 100 md/dl your HDL will usually go down. Obviously,
you do not want to do anything to lower your HDL. A healthy
HDL for men is at least 45 mg/dl and for women is 55 mg/dl.
Sometimes, reducing your fat intake will allow you to loose
some weight. During active weight loss, HDL is reduced.
The appropriate diet you should eat to lower
your triglycerides is one that is moderate in fat. A typical
woman can consume 3-4 tablespoons (45-50 g/day) or oils/fats
daily and a typical man about 75 g daily. (5-6 table spoons),
but the fats should be primarily from monounsaturated sources.
Monounsaturated fats are the fats found in olive oil and canola
oil. Avoid foods made with saturated fat (fat that is solid
at room temperature). To reduce the LDL (bad) cholesterol
in your blood, saturated fat and dietary cholesterol should
be reduced in the diet. Saturated fats have the most dramatic
effect on raising LDL cholesterol. These are butter, ghee,
lard, shortening, coconut and fat in meat including chicken,
They are solid at room temperature. They are also found in
baked foods (pastries, kulfi, rasmalai, pies, cakes and cookies)
and prepared foods made with these fats such as in restaurants
(fried appetizers, marinated entrees, butter and cream based
sauces). To lower your cholesterol choose as little saturated
fat as possible and lose weight if you are overweight.
You can eat other types of fat. It is simply
not true that no fat in the diet is better than any
fat in the diet. One trap of fat that is thought to
be good is called monounsaturated fat. This is the type of
fat in olives and olive oil, canola oil and peanut oil. By
using canola and olive oil in food preparation you can improve
your cholesterol levels. If you have a weight problem you
would want to limit the intake of all oils including the monounsaturated
oils. You can use these oils in cooking and salad dressings.
There are a few margarines and mayonnaises made with monounsaturated
fat. Read your labels carefully looking for canola or olive
oil and monounsaturated fats than other fats on the label.
The new margarines made from plant cholesterol, e.g. Benecol
and Conttolo can also lower LDL cholesterol levels.
Tofu is an excellent choice for protein especially
in place of Paneer. Unlike Paneer
which is high in saturated fat, the fat in tofu is preferable
to unsaturated fat. Legumes (dried beans and lentils) including
daal are naturally low in fat, high in protein
and carb and in fiber. Soy milk like tofu is available in
low fat varieties. Soy milk usually has a beany after taste
which most people find quite unpleasant Try using soy milk
with fresh fruit to make delicious smoothies. Soy yogurt and
soy cheeses are also available in supermarkets. Check the
fat content as these can be high in fat. Nuts and seeds, avocados
and olives are considered good fats because they are high
in monounsaturated (good) fat. Be aware that these good fats
are also high in calories and can cause weight problem. Vegetarian
burger patties can be a convenient and nutritious alternative
to the meat patties. Two or three servings (2 or 3 oz each)
of protein foods and two or three servings (8 floz) of low
fat or non fat milk or buttermilk or yogurt is recommended
daily. Also recommended are 6 to 11 servings of grains and
5 servings of fruits and vegetables daily. Use of whole milk
in the preparation of chai and desserts during
the Hindu festivals e.g. peda can add saturated
fat in the diet. Though such items can be worked into occasional
use on an exchange basis, They can contribute to high cholesterol
and/or high triglyceride levels.
One of the lifestyle changes made by Asian
Indian Immigrants in the US and other countries relates to
food intake and this has many health implications. Savory
and sweet snack foods have always been an indispensable part
of the Indian cuisine. There always was chevda, sev and various
saltines (namkeens) whipped oiut of the pantry in a quick
minute to be served and shared with a cup of tea or coffee,
even for the unexpected guest.
Snacking however has assumed an even more
important role in the Asian-Indian immigrant household due
to busy lifestyle and time constraints. Lack of time for food
preparation, (secondary to long commutes to work. Multiple
tasks, and responsibilities ) the absence of social support
systems for child care and the availability of ready to eat
snack foods that may not necessarily be healthy.
Most vegetarian snack items are made with
cereals like rice, rice flour, semolina (sooji) refined wheat
flour (maida) or whole wheat four (atta) and legume floours
like chick pea flour (besan), moong flour either in combination
or alone. Some snack items may contain nuts, vegetables, spices,
salt, oil, ghee and or sugar.
Based on the method of preparation snacks
- Savory and salted snacks that are not deep-fried
e.g. Upma, Pav Bhaji.
- Savory and salted items that are deep fried, e.g, samosa,
Pakoras, Bhujias, and Murruku (deep fried, crunch spirals)
- Savory and salted items that contain a combination of deep
fried and raw ingredients e.g. Bhel Puri, Dahi wada, Pani
Puri and Chaats.
- Sweet snacks prepared and preserved in a sugar medium e.g
Rasagolla, Pumpkin petha.
- Sweet snacks deep fat fried and preserved in sugar syrup,
e.g. Jalebi, Gulab Hamun
- Non-vegeterian snacks baked, fried or grilled,.e.g chicken
or mutton tikka, egg pakoras, fish fry, shish Kababs.
Choose low fat, grilled or baked, high protein
snacks over sweet, high carb, fried snacks.
Vegeterian snack foods that are based on
cereals or legumes are high in carbs. The fat and calorie
content is high as well, due to many of the items being either
fried or containing, oils, ghee or butter. While the salt
content of the savory snacks may be high the sweet snacks
tend to have even higher amounts of carbs due to the sugar
content. When served in combination a savory item with a sweet
snack- the mini meal may have the calories, fats and carbs
to be safely considered a meal replacement.
Non vegetarian snack items though considerably
lower in carbs and higher in protein are still calorie rich
due to the fats they may contain (often saturated).
Traditionally savory snacks are consumed
between meals while sweet snacks may be consumed after dinner.
A social visit by friends or family prompts the inclusion
of snacks with a cup of coffee or tea and may be sweet, savory
or both, for not only the guests but the hosts as well. Snacks
feature prominently in holiday and special occasion menus.
A predominant number of Asian Indians men
and women are in the workforce, hence on weekdays the work
force environment may permit the inclusion of a pre-lunch
snack at work and a predinner snack either before leaving
the workplace or upon arrival at home. Lack of time for food
and snack preparation may influence the inclusion of ready
to eat snacks in the diets of this population. Store-made,
ready-to-eat snacks while being available on time to appease
hunger may offer very little room for manipulation of the
actual nutrients and calories ingested. Weekend snacking provides
an opportuinity to consume more traditional Indian snack items
both at home and/or social gatherings. It is customary to
serve snacks as appetizers in restaurants and homes.
The challenge of selecting and consuming
healthy snacks though daunting is achievable even for the
diabetic seeking glycemic control and weight management.
o Plan your snack menu ahead.
o Take snacks along with you to work.
o Add xing to bland items with free foods
o Select whole grains when feasible.
o Select baked or steamed snacks rather than fried snacks
o Include fresh fruit rather than fruit juice toincrease fiber
o Eat a healthy snack at home before you go out ( a slice
of low calorie whole wheat toast with coriander chutney)
o Pick appetizers that are not fried pick a light soup
or fresh lemonade or tomoto juice.
o Eat sowly relishing every bite.
o In social situations learn to say no to second servings.
o If eating in a restaurant- divide your entrée into
2 parts.Consume one part and take the other part home for
the next meal.