Heart Disease Risk in South Asians: My Two Cents

From The Masala Study

February is heart disease awareness month, and I’ve been especially interested in the discussions around cardiovascular (CV) disease risk (along with diabetes and insulin resistance) in the South Asian population. I am so glad to see so many South Asian medical professionals highlighting this important topic on social media, since the risk of diabetes and cardiovascular disease in South Asians is higher than that of Caucasian Americans. This is important when considering such things as target levels for cholesterol and blood sugar control, target BMI ranges, and modification of risk factors because most studies on heart disease risk done to date have looked primarily at Caucasian males.

I’ve also noticed the promotions of plant-based diets and intermittent fasting to reduce cardiovascular risk. I definitely am a proponent of eating ALL the plants, but this does not require being vegetarian/vegan. In fact, I think a major reason why South Asians have a high risk of CV disease has to do with their diet, although many are vegetarians for religious reasons. For example, the Indian diet is full of rice, various forms of breads (roti, naan, paratha, poori, etc.), an endless array of deep fried foods, sweets (in my opinion some of the sugariest of the sweets which is why I don’t like most Indian sweets), and starchy vegetarian protein sources like lentils and peas. The typical South Asian vegetarian diet does not include a large variety of vegetables and fruits which are necessary for a successful plant-based diet. Even when fruits are regularly eaten, we love our sugar-rich mangos and bananas! This excerpt from one study referenced on the MASALA Study website puts it beautifully:

“However, following a vegetarian diet does not always indicate that healthful foods are included as part of the dietary pattern. For example, a recent study comparing vegetarian patterns among a nationally representative sample from the 2003ā€“2004 and 2005ā€“2006 cycles of the NHANES in the United States and Asian Indians living in India found that vegetarians in India consumed more sweets and fried foods than did vegetarians living in the United States. In addition, the protective association of a vegetarian diet for cardiometabolic risk was stronger among US vegetarians. Associations between a vegetarian diet and cardiometabolic risk factors among South Asians living in the United States have not been extensively studied.”


Additionally, when looking at research articles, it’s important to note how long the studies were conducted for in South Asians. It’s usually not on the order of a decade or longer which is really necessary to look at long-term dietary effects on health. It’s also important to note key details in the types of foods eaten by vegetarians in the studies. The article referenced above looks at vegetarian Indians in the US compared to those in India, noting that those in the US tended to eat a healthier diet with less sweets and fried foods. Part of this may due to the the shifting healthy diet culture in the US.

In my personal and professional experience, following a paleo-like or Whole30 type of diet yielded the best results in terms of weight loss, metabolism, cholesterol levels (especially triglycerides), and blood sugar control. I had numerous patients who were diabetic and overweight who reversed their diabetes by following a paleo (and in some cases a keto) diet. And by reversing diabetes, I actually mean no longer needing oral diabetes medications and even no longer needing insulin (in some patients early during diagnosis who were not totally insulin resistant yet). I myself have always had excellent cholesterol levels, but I was pleased to see that all of my numbers improved even more on a paleo diet. This may seem counter-intuitive to many because I was eating a diet of largely protein and fats, but I still made sure to incorporate tons of vegetables and lower-sugar fruits.

We have to ask ourselves why cholesterol and sugar levels would in fact improve on a higher fat diet, lower carbohydrate diet. There is no dearth of information about the science behind this. Also, fats are not the enemy! Fats are so critical to a number of hormonal functionings, biochemical processes, and for proper brain functioning. We need cholesterol in our diet for this reason. (As a side note, I am curious to see how recommendations for statins, or cholesterol-lowering medications, will change in the years/decades to come.) It is all a matter of choosing the right kind of fats for optimal health.

As for the ever-charged debate over consuming animal protein…I am a proponent of animal protein sources, but prefer that they be organic, grass fed/pasture-raised, and wild (seafood). I currently aim to buy high quality meat and fish, but I am not perfect about it. It is, however, my goal to only buy these high quality types of meat and seafood in the long run. It truly makes a difference when compared to mass-produced Big Agra’s meat, if you can call it that. If someone eats meat pumped full of hormones and antibiotics and fed a fattening diet (of, by the way, carbs!) that is the opposite of the animals’ natural preference for food, then it makes total sense to me that those consuming such meat would get sick. However, it’s not because they eat meat. It’s because of the quality of the meat. Back in the day when people had to work hard to raise animals and farm the land, they ate meat products and animal-based fats (butter, lard, etc.) and did not drop dead from diabetes, obesity, and CV disease. We need to remember that there is more to the story of CV disease than just “meat-eater vs plant-eater.”

I understand the religious reasoning for vegetarianism. I certainly don’t try to convince such vegetarians to eat meat because it’s a matter of faith for them. However, if someone chooses to be vegetarian for health reasons, I urge them to do their research to make sure they are getting all of the nutrients they need in the amount they need them in. Vegetarians do need to work harder than meat-eaters to eat a balanced diet. For instance, no plants are complete sources of amino acids (but animals are). Thus, a vegetarian would need to know which plants contain which amino acids and assure a varied diet to get all of the nutrients they need. For vegans, this is an even more difficult task because they also do not eat eggs. Eggs (including the yolk!) are really the perfect food and little bundles of nutrition. They provide vitamin B12, necessary to prevent one type of anemia and also for neurological function, a vitamin otherwise only found in animal protein. Without taking good care, vegans can find themselves nutrient deficient. Or, they may end up buying vitamins since it’s easier than eating a richly varied diet. But as I always say, if someone needs to take manufactured vitamins to get the nutrients that are missing from the diet, then is their diet truly healthy?

The other pet peeve I have with vegetarianism linked with religion is that many people assume their diet is healthy by virtue of being righteous. If the goal is honoring God by following a vegetarian diet, to me, honoring one’s body is one of the best ways to show honor to God who gave you that body. If someone opts for french fries, pizza, and bread over a plate of healthy animal protein and vegetables because the former foods are vegetarian, over time there’s a lot of damage being done to that God-given body.

This is not to say you can’t be healthy and be vegetarian. Likewise, a non-vegetarian is not automatically unhealthy. Both can be successful, but both take work to incorporate healthy and variable foods. Whatever you choose does not really matter to me (you do you!) Just know that shaming someone for their food choices in any way really isn’t ok. I don’t want to be shamed for eating meat because it’s my body and my decision. What works well for one person does not work for everyone. The goal is to figure out which diet works the best for YOU, and that means not only in terms of your stats, but also your emotions and energy levels.

Below I’m sharing my top tips for ensuring a healthy diet, no matter what you follow.

  • Incorporate a wide variety of colors to ensure a variety of nutrients! A regular diet of pasta, pizza, bread, corn, and potatoes is not going to cut it. Always aim to eat the rainbow, and you will know you’re getting in a good variety of nutrients.
  • If you’re vegetarian/vegan, really aim to understand which nutrients come from which plant-based foods so you’re not deficient in key vitamins/minerals. This is especially important for B12, iron, zinc, and selenium. Be sure to incorporate these foods into your regular diet.
  • If you’re not vegetarian for religious reasons, I recommend dabbling in the different ways of eating to see which works best for you. Again, don’t assume that what works well for someone else is what works well for you. Try your hand at paleo, Whole30, pescatarianism, vegetarianism, veganism, keto, whatever. But give each one a solid 3+ months to see how you feel with each one before deciding which is best for you.
  • If you suffer from auto-immune diseases, I do strongly recommend considering a paleo or Whole30 way of eating. It does not hurt to try it, and you may be surprised by the results. I truly believe that food is medicine, and in so many people, diseases without a cure have been made drastically better or even sent into remission by changing what foods are consumed.
  • Always aim to limit sugar, in ALL its forms!
  • Incorporate healthy fats:
    • nuts, seeds, nut butters (natural, not processed)
    • coconut oil, olive oil, avocado oil, butter, ghee, animal fat for cooking
    • STOP using vegetable oil, canola oil, seed oils which are highly processed
    • avocados
    • fish
  • Limit or eliminate alcohol. This is especially for the religious vegetarians because how is it ok to literally poison your body with alcohol, but you can’t eat meat which is a source of nourishment?

Here are several of my previous posts that are related, if you’d like to read:

Food vs. Faith
My Health & Fitness Journey 
Health & Fitness Update
My Favorite Healthy Social Media Accounts
How I Meal Prep
The Book That Is Changing My Life



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