The
shocking truth about the health of Indian Americans.
The Indian American
is one sick patient. Consider:
Indian
American men have the highest rates of Coronary Artery
Disease (CAD) and die of the disease at a younger
age than males of any other race in America. In fact,
one of every ten Indian American adults in America
has CAD, compared to one out of every 40 American
males.
Indian
American women’s CAD rate is three times higher than
that of American women and the highest among all other
immigrant women.
More
than one in five Indian Americans lack health insurance.
In
India only one in 40 women get breast cancer but in
the United States one out of every eight Indian women
will get the disease. 33 percent of South Asian women
have never had a pap smear and 30 percent of South
Asian women over 50 have never had a mammogram.
Nearly
40 percent of Indian women will develop osteoporosis
fracture.
Women
who have emigrated to the US from India are more likely
to deliver low birth weight infants than white women
and women in other ethnic groups, although they receive
first trimester prenatal care at about the same rate.
That the Indian heart is in trouble became evident
some years back. Indian Americans around the globe
have the highest rate of coronary artery disease (CAD)
despite the fact that nearly half of them are lifelong
vegetarians. Dr. Enas A. Enas, principal investigator
of the Coronary Artery Disease among Indian Americans
(CADI) study and medical director of the non-profit
CADI Research Foundation says that CAD risks in Indian
Americans are 2-4 times higher at all ages and 5-10
times higher in the young (under 40 years of age),
irrespective of gender and social class.
He observes, “CAD is an equal opportunity disease
and you don’t have to be a non resident Indian to
qualify for this vulnerability.” There is a genetic
predisposition to CAD in Indian Americans, mediated
through lipoprotein(a), a powerful risk factor for
premature CAD in diverse populations. The adverse
effects of Lp(A) are increased by a factor of 10 or
more by the unfavorable concentrations of other lipoproteins,
which arecommon among Indian Americans.
According to Enas, unlike other blood fats which are
influenced by age, gender, diet and environmental
factors, Lp(A) levels are governed exclusively by
race, ethnicity and genetics. The majority of Indians
with CAD have diabetes and “apple-type” obesity along
with low levels of HDL (good cholesterol) and high
levels of LDL (bad cholesterol) and triglyceride (ugly
cholesterol.)
Several studies suggest that the high diabetes rate
among Indians is a contributing risk factor for the
high CAD incidence. A global comparative study found
a diabetes rate of 14-20 percent among migrant Indian
Americans. Studies in Britain have confirmed that
significantly higher proportions of Indians suffer
from diabetes than local populations. The 11 year
follow-up of the Southall Diabetes Survey in London
showed that deaths from circulatory disease accounted
for 77 percent of all deaths in diabetic South Asians
as compared with 46 percent in diabetic Europeans.
While children in South Asia have a low incidence
of Type 1 diabetes, migrants to the UK show similar
rates to the native population.
According to the Center for Disease Control and Prevention
(CDC), about 16 million people in the U.S. have diabetes,
of which as many as five million cases remain undiagnosed.
Immigrant South Asians are at high risk for developing
diabetes once they emigrate and adopt the western
lifestyle, especially since one considers that even
in India there are big differences in the diabetes
rates amongst the urban and rural populations.
Asian American and Pacific Islanders (AAPI) women
have the second highest risk of developing cervical
cancer, after Hispanic women. Indeed, migration studies
have shown that AAPI women’s risk of breast cancer
increases up to 80 percent when they migrate to America.
A recent U.S. study found that the incidence of breast
and colon cancer among Indian American women was five
times higher than among women in India. Various international
studies have also found that South Asian immigrants
are at a high risk for oral cancer due mostly to high
rates of chewing tobacco and paan use.
Here in America, Asian women are also susceptible
to osteoporosis. At highest risk are women who are
post-menopausal and small-boned, and those whose diets
are low in Calcium and Vitamin D. The National Osteoporosis
Risk Assessment found that 65 percent of AAPI women
have low bone mineral density. Indian American women
have approximately a 40 percent chance of developing
an osteoporosis fracture, and up to 25 percent of
all Indian women over age 50 may be osteoporotic.
South Asian women also have a high incidence of anemia
and polycystic ovarian syndrome (PCOS).
Health-wise, South Asian immigrants bring their own
genetic and cultural formulations, which few health
providers seem to be aware of. For example, the conventional
risk factors do not explain the excess burden of CAD
among Indian Americans, and conventional approaches
to prevention and treatment may be inadequate to prevent
the first and recurrent heart attacks among Indian
Americans. And that has been a major problem — educating
the medical community and health providers about the
special needs of Indian Americans.
Nor has it helped that there just isn’t enough data
about the specific health problems of South Asians,
leave alone Indian Americans. Be it cancer or diabetes,
HIV/AIDS or Osteoporosis, the majority of the data
seems to be collected under the category of Asian
American and Pacific Islanders (AAPIs). But the Asian
communities are very different from each other and
there has just not been enough research about South
Asians in this country and whatever little has been
done comes from Canada, U.K. and Australia.
In the health sphere, the South Asian community has
often been invisible, since due to cultural conditioning,
many women are reluctant to seek help outside of their
community and entire families tend not to seek public
assistance for fear of losing face. Substance abuse,
sexually active youth, alcoholism and STDs are all
matters of shame for many in the community and so
these facts remain hidden and the needs of the community
unarticulated.
Now for the first time, all the diverse available
data on South Asians has been gathered together in
one place, inside the covers of A Brown Paper: The
Health of South Asians in the United States, published
by the South Asian Public Health Association (SAPHA).
SAPHA has about 400 members internationally — students,
researchers, people working at grass roots as well
as physicians. The Brown Paper is a volunteer effort
by health professionals and students in bringing together
existing research on the health of South Asians.
“We are trying to raise awareness in the average level
of the community, amongst people who aren’t necessarily
in health care,” says Sharmila S. Rao, MPH, one of
the co-authors of the Brown Paper. “Because of our
history, our genetics, our culture and now because
of our growing numbers in society we do need to pay
more attention to our health issues.”
Apart from the all-important heart, the Brown Paper
addresses a number of other issues that affect South
Asians in America: diabetes, cancer, anemia, and osteoporosis.
It also covers other concerns that have usually been
swept under the rug — elderly care, mental health,
HIV-AIDS, substance abuse and domestic violence. The
publication also includes a useful resource guide,
which lists over 100 resources and agencies that provide
services to South Asians across the United States.
“For the first time, we are trying to collect and
organize relevant literature into one booklet for
community leaders, researchers, and policy makers,”
says Abhijit Ghosh, MPH, a fellow in Health Communications
at the National Cancer Institute, and the co-chairperson
of SAPHA and one of the editors of the Brown Paper:
“It sheds light on the Indian American health concerns
and disparities to access for care which are due to
lack of cultural awareness and general lack of knowledge.”
While the book is a valuable guide for both patients
and caregivers, one of the important points it makes
is the paucity of research on South Asians in the
United States. “There’s a lack of information on South
Asians in the United States, and it’s just recently
that people are starting to work at the community
level with our population,” says Rao. “A lot of the
studies we drew information from were done on Indians
and South Asians in Canada, Europe and Australia.
That’s why we wrote this paper because we’re trying
to raise awareness of the fact that we need more resources
— both financial resources and research resources
— in this country because as our numbers grow it’s
very critical that we study the issue of our health
there.”
Indeed, as the South Asian population has ballooned
to 2 million people — a growth rate of 106 percent
over the last ten years — the population has become
ever more diverse. Says Neelam Gupta, MPH, Program
Manager, Valley Care Community Consortium First, “This
requires needs assessment†efforts to take into account
the diversity of South Asians in the U.S., which will
enable programs to be developed that are appropriate
to variations such as culture, religion, immigration
status, class, and language.
In this burgeoning population, the myth of the model
minority has proved to be just that — a myth and in
spite of being the most affluent ethnic group in the
country, the South Asian community is also 12th on
the poverty scale. Not everyone has access to healthcare
and in fact while the national uninsured rate is 18
percent, it soars to 21 percent amongst Indian Americans.
One small study done by NY AANCORT (New York Asian
American Network for Cancer Awareness, Research and
Training), discovered that the uninsured rate of study
participants was 48 percent! According to Rao, a large
number of uninsured are well-educated professionals,
on high salaries, who chose not to insure themselves
because of the high cost of insurance. Many South
Asians are also involved in family-owned small businesses
and health insurance is often out of reach for them
too.
At the same time, Rao adds: “In the South Asian community
there is a growing level of new immigrants who are
at a lower economic level — domestic workers, taxi
drivers, and efforts are on to get them group insurance.
Many don’t even know about the resources that are
out there such as Medicaid and child insurance programs
— and those are the people we want to educate. It’s
very critical that we educate them on the resources
that exist, and how to access them.”
Nadia Islam, Outreach Co-coordinator at NY AANCART
at the Mailman School of Public Health at Columbia
University, points out that South Asian women have
low rates of cancer screenings, both because there
is a fear of discussing cancer in the community and
also because many women do not have access to preventive
health services.
“In conducting our survey, we found that South Asians
hold many misconceptions regarding cancer. For example,
18% of South Asians think that cancer is contagious,
and 45% of South Asians feel that eating certain types
of foods such as canned foods cause cancer, both of
which are misconceptions. There is also a sense of
fatalism and fear concerning the disease — 24% of
South Asians feel like cancer is something that should
not be discussed, and 45% feel that getting cancer
is a matter of fate.”
The good news is that organizations and institutions
are beginning to focus on cancer in the South Asian
community: Islam reports of a recent health survey
conducted in households in California where data was
collected for several Asian subgroups including South
Asians: “This is extremely exciting, as advocates
in California can draw on this rich data source, which
meets rigorous research standards, to show that there
is another story outside of the model minority myth.
The South Asian community does indeed experience health
disparities.” The American Cancer Society has established
several South Asian units across the United States
offering breast and colorectal screening programs
tailored for the community.
Indeed, making healthcare providers aware of the special
needs of South Asians and at the same time making
sure that all segments of the community do know how
to access the care they need is a challenge. Rao says
it’s vital to reach out to the women, no matter what
their economic or educational status.
“Women are the gatekeepers to the health and well
being of an entire South Asian family oftentimes and
hold the key to getting into the family,” she says.
“It’s very difficult to navigate the U.S. health care
system so we need to work with those who are already
delivering services — be it healthcare or other —
citizenship, language classes to help us in delivering
healthcare to those who need it.”
Given the paucity of medical research done specifically
on South Asian health issues that can be difficult.
Rao says the research done by small community based
organizations is oftentimes not scientific enough
to hold value in the research world.
“We are a new population in terms of our numbers and
this is where we have to gain strength,” she says.
“We have to use this data as solid, we can’t just
dismiss it just because a small group does it and
it’s just 50 women instead of 10,000 women. That’s
what we are trying to show that we are at risk for
all these conditions and we need more resources dedicated
to us.”
Rao, who is Communications Specialist in the Medicine
and Public Health Unit at the American Medical Association
in Chicago, says the AMA board has just approved a
program to tackle health disparities and that follows
the Institute of Medicine report recognizing and acknowledging
that there is a problem along ethnic and racial cultural
racial lines in this country in the health care delivery
system.
It seems somehow ironic that although the Indian community
has the most doctors it has among the highest rate
of uninsured people. Indeed, the CADI research on
heart disease was done on Indian physicians in the
United States!
Doctor heal thyself.
When heart disease is so prevalent amongst physicians
too, what is AAPI (American Association of Physicians
of Indian Origin) doing to address health issues among
South Asians?
Dr. Kiran Patel, president of AAPI, says the organization
is well aware of the heightened dangers of heart disease
and diabetes amongst the Indian American population.
“The next killers both here and in India will be coronary
heart disease and diabetes, more than infectious diseases,
because we’ve been able to control those. Lifestyle
factors like diet and lack of exercise are contributing
to the problem.”
Asked if AAPI had been involved in the much-needed
research, Patel said: “The CADI study was originally
initiated by AAPI. Dr. Patel and Dr. Jayshankar are
working on a study on diabetes and AAPI is also looking
into a study on lipid metabolism. AAPI is involved
directly and indirectly in this research because the
risk of coronary disease amongst Indians is 500 percent
as compared to Americans, and preliminary data shows
that one in five Indians will get diabetes.”
Patel says there is no data to release yet because
these are all long-term studies. Similarly, Dr. Lakhanpal
in Texas is looking at osteoporosis in Indian Americans:
“There are multiple studies going on currently, but
I don’t have any central co-ordinated data. AAPI’s
goal is to pool some of these studies and then get
an interpretation from that. Funding is a constant
challenge, and we are looking for funding from the
government.”
Asked about the high rate of uninsured Indians in
a population that boasts the highest number of physicians,
Patel said, “I think before the next year end we will
launch a program where hopefully the AAPI physicians
will volunteer to serve some of the patients at a
reduced fee.”
Dr. Susan Ivey, MD, MHSA, assistant clinical professor
at the University of California, Berkeley, School
of Public Health, has researched cardiovascular risks
among South Asians in Northern California. She says
while researchers have yet to identify the reasons
for women’s heightened risk from CAD in the United
Statesm, studies have been looking at genetic factors,
cholesterol problems (not enough HDL or “good cholesterol”)
diet factors (saturated fat) low physical activity,
diabetes rates, high levels of fat round the middle
of the body (the apple shaped body) as well as stress
and migration issues.
Although patients cannot change their genetic propensity
for the disease, Ivey makes an interesting point:
“‘Genetic’ does not mean ‘You will get it.’ In most
cases, ‘Genetic’ means, you might get it if you don’t
follow certain guidelines in life or you have a higher
risk than someone else does, but you still have the
power to make choices to lower that risk.”
Indeed, one misconception has been that it’s just
Indian men who have higher rates of heart disease.
British studies have shown that South Asian women
had higher rates of heart disease than Caucasian women
in the UK. Says Ivey: “Women have to take charge with
their doctors, telling them of any family risk and
even educating their doctors about the special risks
among South Asians, if their doctor does not know
this. It can be a hard bridge to cross, but I find
making a list of questions before you go in to the
doctor will help keep you from forgetting to mention
your specific questions and concerns.”
For women, it may become essential to make some major
lifestyle changes, including taking on more physical
activity and sports, something which they did not
generally grow up with. “ Here in the U.S. we can
adopt regular walking as one activity that is easy
for most people to get in,” says Ivey. “But we can
also encourage our daughters to be more active than
we were when I was a girl. There were very few choices
of sports for girls. Now my two daughters play soccer
and swim and bicycle. I think it is up to mothers
to foster a love of being active, for sons and for
daughters.”
For those South Asians wishing to take a more active
role in their heart health, Dr. Purushotham Kotha,
has initiated the Ricadia Study Project (Risk Intervention
in Coronary Artery Disease In Asian-Indians.). He
is the Director of the Ricadia Project, a non profit
project providing services to South Asians. Most medical
insurances cover this cost. Depending on the funding,
Ricadia also provide free services for visiting parents
from India.
The project includes screening of participants and
their family to identify the disease at an early stage
before one suffers from heart attack or serious heart
damage. All participants will be part of a large clinical
trial to identify environmental, cultural, dietary
and genetic influences on CAD.
While the CADI study had basically been a study of
Indian physicians, says Kotha, this project is much
more broad-based, basically to raise the awareness
and to do aggressive screening of those living here
— not only the patients, but their parents and offspring.
The ages of patients have been getting younger and
younger.
“Previously they used to say that heart disease begins
in the cradle and ends only at the grave, but some
studies have shown even soft blocs in the arteries
of fetuses whose mothers had very high levels of cholesterol,”
says Kotha. “So the early we catch it the better it
is. What we feed to our children at ages one, two
or five is important. Raise awareness in children
too as early as possible.”
Kotha says that though they are working on the project
in San Diego, patients can go to their own physicians
and ask for the screenings and blood tests. They can
get it done locally and all the information is available
on the Ricadia Project website. While this testing
is particularly vital for people with a family history
of heart disease or if they have diabetes, he recommends
that all South Asians over the age of 18, male and
female, get a lipid panel ,hich basically measures
all the components of their cholesterol. This test
should be repeated every five years.
He adds, “Pre-menopausal females have a very high
incidence of heart disease so they should get counseling
for lifestyle changes. The most important is the insulin
resistance syndrome that should be emphasized so people
should not take diabetes lightly.”
Then there are all the invisible diseases, which no
one wants talk about, the diseases that many South
Asians believe only happen to “other” people, meaning
Westerners. “Parents say to me my child doesn’t need
sex education — they are not doing that sort of thing.
Only white Americans do that,” says Rao. “ But if
you see some of the studies, the small focus groups
that are done in women’s chapters — there is no barrier
— we are at much risk for our children acquiring STDs
or HIV. Just as much our population is at risk there.”
What the Brown Paper has confirmed is the need for
more research on South Asians, more awareness amongst
the health providers about the special needs of this
community and also a more take charge attitude by
community organizations and individuals themselves.
“My issue with our communities is this: Ok we are
not going back, we are here in greater numbers, and
we need to make this our country,” says Sharmila Rao,
who is a second generation Indian-American. “We need
to make this country a livable place for all of us.
In terms of our growing numbers here, we have to make
the system accessible to our community and we have
to make those systems ready for South Asians to go
to. We have to open our minds and realize that we
are here for the long run and how to invest in the
larger community as it invests in us. So it’s a two-way
street.”
Taking Charge
“Waiting for the chest pain to diagnose heart disease
is no different than waiting for labor pain to discover
pregnancy,” warns Dr. Enas A Enas. “However, a simple
treadmill test can diagnose CAD months, even years
before any of these catastrophic symptoms. Unlike
cancer, CAD is readily preventable, diagnosable, treatable
and even reversible.”
This should encourage Indians to have regular physical
checkups and not wait till the eleventh hour. Safe
and effective medications to lower Lp(A) levels are
available and diet can be a major factor in the prevention
of heart disease. Says Enas: “A balanced, low cholesterol,
low fat, low calorie diet, high in fruits and vegetables
minimizes the need of the medications.”
Indeed, when it comes to heart disease, both sides
of the spectrum are important — screenings and medication
as well as lifestyle changes. While conducting a study
on heart disease amongst South Asians in Northern
California, Dr. Susan Ivey found some encouraging
factors: “Many women, once they learnt new ways to
think about heart disease prevention, were very excited
to make changes that their whole family would benefit
from.”
For instance, they were incorporating simple changes
from whole milk to lower fat milk when children reached
two years old for this can teach a life-long lower
fat habit. Other women Ivey interviewed had begun
to add products to their cooking to increase fiber,
such as oat fiber or flaxseed flour, even adding this
to chapattis, and were reducing saturated fat by using
less oil or ghee in their cooking.
“There were definitely changes going on that would
help to lower risks,” she says.” Women just need to
get the word out in their own communities and help
each other find recipes that will work for their families
while preserving the unique flavor and taste of traditional
dishes. Or maybe women can find ways to walk together
or as families to get everyone to experience activity
as a fun time together. The ideas we heard were great!”
Taking charge of diabetes means making some positive
lifestyle changes. Diabetes mellitus (DM) is characterized
by an increased blood glucose level that leads to
multiple abnormalities of the circulatory system and
results in widespread organ damage. Diabetes in children
is usually Type 1 or insulin dependent DM while adults
generally have Type 2 or non-insulin dependent DM.
According to Swapnil Rajpathak, MBBS, D.Diabetology,
“Type 2 diabetes is related to obesity, sedentary
lifestyle, and genetics. Immigrants have been shown
to undergo dietary and life-style changes that may
alter the course of the disease and its development.”
Women have increased risks of getting cancer in the
United States as opposed to India, and can become
active players in monitoring their health since special
services for South Asians are available. The community
should make use of the free screenings targeting the
South Asian community and also contact AANCART for
dietary advice.
On March 7, 2003, NY AANCART is hosting its second
annual conference entitled “Asian Americans and Health:
Meeting the Needs of Our Growing Community.” This
conference in Manhattan will take on concerns such
as Asian women’s and elderly health issues, tobacco
control in Asian communities, and clinical issues
for Asian Americans.
Risk factors for osteoporosis include a small body
frame and a family history of osteoporosis, early
menopause or removal of the ovaries. Once again, lifestyle
changes and diet are all important: Dairy products
and calcium intake has to be increased along with
physical weight-bearing exercises like walking, climbing
stairs and weight lifting. Excessive smoking and alcohol
consumption can be detrimental because these hinder
calcium absorption.
Adult women under age 50 need 1,000 mg of calcium
every day, and 1200 mg of calcium once they are over
50. Many Asian diets are low in calcium, and one can
incorporate calcium-fortified soymilk, orange juice
and rice, sardines with bones, tofu, and almonds.
For anyone trying to eat and live healthy, the bible
is Dr. Dean Ornish’s Program for Reversing Heart Disease.
This remarkable book offers proof that heart disease
can be reversed simply by changing one’s lifestyle.
Ornish’s other book, Eat More, Weigh Less gives wonderful
ideas and recipes to help you live a happier, slimmer
lifestyle and give up dieting for good.
Fortunately, there are now a handful of books out
which are specifically tailored to South Asian diets.
Previously published as Lite and Luscious Cuisine
of India by dietician Madhu Gadia, the book has now
been reprinted as New Indian Home Cooking in a trade
back version. It has 100 nutritional low fat recipes
from all regions of India, along with information
on healthy weight, cholesterol and fat, diabetes,
food exchanges and sample meal plans.
Gadia offers easy to prepare versions of paneer (fresh
cheese) made with ricotta cheese, samosas made with
tortilla, and a variety of rotis (Indian breads) baked
in the oven. She lectures on special diets such as
general healthy eating, diabetes, vegetarian diets,
low fat and cholesterol and weight management.
A second generation Indian American who has written
a fun cook book full of fast and easy Indian recipes
is Monica Bhide. Her Spice is Right (Callawind Publications)
cookbook is valuable because it gives nutritional
breakdown for all the recipes. Bhide worked with Shilpa
Thakur, a senior nutritionist at Escort Hospital and
Research Center in Delhi and offers low fat versions
of the dishes we love. In fact, she even recreates
a low fat version of the menu President Bill Clinton
was offered at Delhi’s Bukhara restaurant.
Bhide however makes an important point in this light
and lively book: “There is more to some dishes than
their fat content. There is tradition and memories.
Don’t deprive yourself, just limit the portions.”
Narinder K. Saini M.D. has been both patient and physician.
He is medical director of Holistic Heart Care Center
in Ohio and is the author of two books on reversal
of heart disease by life style changes, including
Straight from My Heart.
Prevention Magazine recognized him in 1993 with its
“Best Doctor” award. After his own failed by-pass
surgery and two failed Angioplasties in his early
40’s he managed to reverse his own heart disease by
lifestyle changes and now helps others do the same
through consultations and seminars.
Rita Batheja, MS, RD, CDN, founder of the Indian American
Dietetic Association has coauthored Indian Foods:
AAPI’s Guide to Nutrition, Health and Diabetics with
16 registered dieticians. This booklet has been published
by AAPI, and will soon be available on the AAPI website
as well as through community organizations. It contains
a special chapter on managing diabetes and this is
going to be translated into several Indian languages.
South Asians who want to have their desi food and
avoid health problems too should also make use of
the Food Guide Pyramid: A guide to Daily Food Choices,
which provides a translation of traditional desi foods
into the USDA recommendations. It has been created
by dietician Arti Varma and translated into several
Indian languages so it should be accessible to all.
The ADA has also produced Ethnic and Regional Practices:
A Series: Indian and Pakistani Food Practices, Customs
and Holidays, which can help dieticians to better
understand their desi patients.
A healthy diet is often a stumbling block for South
Asians, especially the vegetarians who believe they
are extra healthy because they avoid meat. Says Batheja,
“Indians have to change certain unhealthy eating habits,
making lifestyle changes for a lifetime. That should
be the focus because many people just concentrate
on weight loss and dieting and these methods are just
not working. The term they should use is weight management.”
She says physicians need to believe in nutrition besides
medication and convey this to their patients: “We
have many Indians who are walking with diabetes and
take it very lightly. They do not know that carbohydrate
counting is the main thing in managing their blood
sugar level. It is the second generation children
who encourage their parents to consult dieticians.”
Batheja recommends that the desi diet include Omega
3 fatty acids because these reduce chances of diabetes,
heart disease and stroke. She recommends eating fatty
fish like salmon three times a week. Other alternatives
are Omega 3 capsules or flaxseeds for vegetarians.
Her other suggestions include eating more whole grains,
dried beans like chickpeas, and kidney beans, and
incorporating nuts like almonds, peanuts and walnuts
for snacks instead of fried delicacies like chevda
or samosa.
“Of course you want to exercise or walk for an hour
on a daily basis -Whatever you like!” she says, “10,000
steps a day are recommended. Take a walk in the mall
in winter or walk with a friend, whichever is enjoyable.
Make it fun not work! It boosts your metabolism, burns
calories, tones and firms your body, helps you feel
more relaxed and less hungry. And drink at least 80
ounces of water or other calorie-free fluid everyday.
Liquids-especially water-keep you hydrated, control
appetite, and eliminate excess fluids.”
Now, what could be easier than that?
What risk factors of CAD are unique to Indian Americans?
Low
HDL cholesterol (good cholesterol)
High
LDL cholesterol (bad cholesterol)
High
Triglycerides
Central
Obesity-Insulin resistance syndrome
Lipoprotein(a)
is uniquely high among Indian Americans. It is genetically
determined, so it runs in families. It is a powerful
independent risk factor for premature fatty deposition(
Arteriosclerosis), and thrombosis(blood clotting in
the blood vessels). It is also responsible for the
high failure rate of balloon angioplasty and bypass
surgery.
Ricadia Study
Indian
Americans have the highest risk of CAD among all
races.
Life
long vegetarians have as high risk as non-vegetarians.
Risk
factors unique to Indian Americans are low HDL
(good cholesterol), high LDL (bad cholesterol),
high triglycerides, central obesity-insulin resistance
syndrome and a very high lipoprotein (a) which
runs in families.
Indian
Americans (subcontinent of India, Pakistan, Bangladesh)
living in San Diego area are welcome to enroll
in this study.
Aim
of this clinical study is to identify the individual
and family at high risk for CAD very early and
advice specific diet, lifestyle changes and medication
to achieve maximum Primary prevention & secondary
prevention.
These
tests are covered by most insurance plans.
Web Resources
CADI workshops can be sponsored in different parts
of the United States and other countries. For information,
contact: CADIUSA@msn.com
To order a copy of the Brown Paper and for information
about SAPHA, visit: http://www.sapha.net/
For information on nutrition and the Indian diet visit: http://www.cuisineofindia.com/
Information about Indians and heart disease at: http://www.heartdisease.org/
RICADIA (Risk Intervention in Coronary Artery Disease
In Asian-Indians) Study Project: http://www.pkothacardio.salu.net/
American Association of Physicians of Indian Origin
(AAPI): http://www.aapiusa.net/
American Cancer Society ACS South Asian Outreach:
http://www.cancer.org/
Asian American Network for Cancer Awareness, Research
and Training AANCART Nsi3@columbia.edu
The Indian American
is one sick patient. Consider:
