Since very long, we believed that diabetes and heart disease are exclusive to the affluent societies. So, Indian health care policies emphasized prevention of infectious diseases only.

But as the living conditions improved in India, we are increasingly following western dietary habits unsuited for our environs, adopting sedentary life style, and exposed to psycho-social stress. This has resulted in an unprecedented rise of diabetes to epidemic proportions during last few decades in our country.

The only national study till to date on diabetes completed in 1989, was coordinated by Prof. M.M.S. Ahuja of the All India Institute of Medical Sciences, and Dr. P.V. Rao who is presently at the Nizam's Institute of Medical Sciences. About 2% of the 12,000 people surveyed in Indian villages were found to be diabetic, and more alarming observation was that half of them did not know that they had diabetes. This infers that there are at least 20 million diabetics in India, which is the highest ever reported number from anywhere in the world.

Further, Indians tend to be diabetic at a relatively young age of 45 years which is about 10 years earlier than in West. The life expectancy in a diabetic is just about 8 years after the onset of the disease, as they succumb to kidney as well as heart disease more often than others. This is indeed very alarming !.

Another important consideration in this regard is the status of diabetes among migrant Indians living all over the world. There are several millions of Indians living outside India, either as recent migrants to Western countries such as England and United States or as the descendants of the 'coolies' indentured by British to South Africa, Mauritius, Malaya, Fiji and to the Caribbean countries like Trinidad, Guyana and Surinam. It is now well known that diabetes is more common in these migrant Indians than in the local host populations of these countries.

In a recent study concluded in 1992, and sponsored by the World Health Organization, Dr. P.V. Rao has screened populations of Indian origin living in London, Malaysia, and British Guyana for diabetes and heart disease. Diabetes among these migrant Indians was at least four times more than in Indians living in India. One among every 7 migrant Indians above 25 years of age, was diabetic. Furthermore, more Indian women than men were affected with diabetes among immigrants, which was not the case within India. These higher rates for diabetes among migrant Indians, and in specific among women are attributed to the quality rather than quantity of dietary intake, life style and social stress.

Indians eat less, weigh less and work more than Europeans. But why are they more prone for diabetes than Europeans?

'Thrifty Genotype' is the answer. This is a hypothesis on genetic inheritance put forward way back in 1956 by James Neel, a geneticist. Prof. M.M.S. Ahuja has adapted this to the Indian context, and Dr. P.V. Rao has tested this hypothesis over last five years of International research among Indians living within India and abroad.

Indians have lived through several centuries of famine and starvation, and largely survived on sustenance foods. Over generations, there evolved a 'thrifty genotype', which made them resistant to prolonged periods of starvation. We tend to store a part of our energy intake simultaneously while 'burning' it. Apparently that may be the reason for a 'big belly' on a small body frame among Indians.

The findings of the multinational study by Dr. P.V. Rao were that body fat around waist is the culprit to diabetes and heart disease among Indians. Overall body weight was not always high among Indians with 'big bellies'. This meant that total amount of food intake in an Indian was not high though the contents have changed over centuries from vegetable sources to 'fat rich' animal sources. Even the vegetable oils used for cooking such as coconut oil which is widely used in Kerala, Malaysia and Guyana are strongly related the high rise in diabetes rates among the populations screened from these areas.

There is a need for a concerted effort from all concerned to first of all know that we Indians are more prone for diabetes and heart disease. It is also important to understand that dietary restrictions as we follow blindly based on Western literature do not apply to Indian context. It is not how much a diabetic eats, nor the amount of 'sugar' one eats, but what matters is the amount and nature of the 'fat' in food. This warrants an urgent reconsideration of the traditional understanding of diabetic diets - "no rice, no sugar in coffee, no fruits or no potatoes" just doesn't mean anything. "No oils, no fats, no food fads' must be the first dietary advice for a diabetic especially in India."

Measure the waist, and not just the body weight - to know the progress of disease. Caution those prone to avoid paunch, not just obesity. This requires a better understanding among physio-therapists and 'weight-watchers' alike, of the causes for diabetes and heart disease.

Who will be a diabetic? Now it is possible for a reasonable 'guess'. If one is over 45, with a 'big belly' and a family background of diabetes, it is almost certain that he or she is going to be a diabetic. Then it may be possible to stop the disease process even before it appears.

Understanding diabetes, living with diabetes and preventing further complications are the major concerns of the health education programs being developed at the Nizam's Institute of Medical Sciences, Hyderabad.

Prescribing drugs and restricting diets are not the right answer for the emerging important problem of diabetes, but understanding the disease in our context and following specific measures against it are now more than ever urgently required.

updated on March 18, 2002