(Data courtesy of AAPI)

Health problems and Nutritional Status of Indians in the US:

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.


What can you do?

Your nourishment does not depend on the selection of any one food. Instead it depends on the consistent and continuous selection of many different healthy foods on a day to day basis.


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 cholesterol).

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 blood.

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.


Fitting Fat and Oils into your daily diet:

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.

Moderation the key to a healthful diet:

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.


All Fats are not created Equal:

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.


Vegetarian Alternatives including use of SOY:

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.


Choosing Healthy Snacks:

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 may be:

- 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.


Nutritional Values of 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).


Snack Patterns:

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.


Tips for choosing healthful snacks:

Daily Living:
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 intake.

Dining Out:
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.