People of Indian subcontinental origin. South Asians. Are at higher risk for heart-related disease than other world populations. Probably every year one of the big newspapers has a feature focusing on this issue. If you are a person of subcontinental background you will not find this fact surprising. I’m willing to bet, judging by my family history, that I’ll die of heart-related problems rather than cancer. This isn’t something specific to people of Indian origin, I have a good friend who is a conventional white American who sees the same pattern in his pedigree: everyone dies of cardiovascular disease before they die of cancer. I know people who expect the opposite.
Right now, it is the turn of The Washington Post, South Asian Americans face disproportionately higher risks of heart disease, other cardiovascular ailments:
South Asian Americans — people with roots in Nepal, India, Pakistan, Sri Lanka, Bangladesh, Bhutan and the Maldives — have a disproportionately higher risk of heart disease and other cardiovascular ailments. Worldwide, South Asians account for 60 percent of all heart disease cases, even though — at 2 billion people — they make up only a quarter of the planet’s population.
One common refrain is that socioeconomics explains between-group differences. But in the USA Indian Americans are the wealthiest and most educated ethnic group. Many people who are colleagues of Indian Americans begin to notice the high propensity for heart diseases amongst their South Asian friends. People who are vegetarian. People who live the same “healthy lifestyle” as their professional peers.
Obviously, there are environmental factors. There is evidence that the “modern” vegetarian diet is particularly unhealthy. Lots of fried and refined carbs. Also, many immigrants from the subcontinent from upper-class backgrounds may not emphasize fitness to the same extent as their native-born American peers, for whom jogging and fitness is a signal of their social status. In contrast, a plump shape is often considered a sign of good-living by a certain age for people who are not from peasant backgrounds in the subcontinent. But I haven’t talked to anyone who has looked closely who denies the genetic element.
This brings me to the question I asked below in an open thread: does telling people they have a genetic risk serve any purpose? Does it help? Does it hurt? A lot of geneticists seem to be very invested today in fixing upon “systemic” issues to explain different predispositions between groups. With Indian Americans, it is different because they are wealthier and more well educated than the average American. A large fraction work in medicine. Yes, diet and culture, but that can’t be everything. It is well known Indian Americans shouldn’t follow the BMI guidelines for white Americans.
But does telling brown people that we’re born this way help us?
My own position is that does help us. We can’t let all things be equal. Period.
It’s so XX century to tell people that they have higher hereditary risk of a disease because of their, can you even utter the word, race. The risks are likely to be polygenic and quite variable within a population even when the population’s averages stand out. Although the best polygenic scores are developed in the Europeans, they are supposed to be partly portable throughout Eurasia, with the appropriate adjustments of the effect sizes.
One would think that developing polygenic predictions in as structured a population as South Asian is nearly impossible … every subgroup has its own allele frequency pattern … but if the heart disease risk is so widespread, then the main genetic players should transcend the subpop boundaries.
But if much of this heredity is mediated by the analytes like LDL, triglycerides or CRP, then it may be more useful to just run the conventional bloodwork to gauge the risks?
– some of the variance (genetic) won’t be captured by biomarkers. will double-check what %. for example, ~50% of skin color variation btwn populations is “ancestry”. just another way to say they don’t know the snps
– a lot of the risk seems broad across south asians. endogamy = different rare alleles, but the common variants are probably shared. the HCM autosomal dominant thing that’s ~1% is in a lot of south asian groups. david reich suggested a lot of these are from AASI…
Oil-based vegetarian diet is not heart-friendly but perhaps ghee-based vegetarian or semi-vegetarian diet is. If the incidence of heart disease be checked against percent energy coming from PUFA, it might clarify matters.
The genetic element might just be that the genes are not adapted to oil-based diet. While I believe the Indian genes are more adapted to produce DHA from precursors found in vegetable oil, the system fails under PUFA overload.
@ Dx
I’m sorry, but it’s fatuous to talk of polygenic risk scores when large chunks of patients on my list don’t even bring correct med recs. Race might not be the perfect predictor, but it’s a pretty damn good proxy for things that are.
@mactoul my guess is that the primary driver of healthiness of cooked food is the temperature
Oil allows a higher cooking temperature than ghee. For this reason food cooked in oil is relatively more unhealthy.
Afaik, sesame oil has protective compounds against blood pressure. So if anyone who loves food cooked in oil, has pressure related concerns, then they can switch to sesame oil to reduce risk of BP
Isn’t it possible that it was related to some sort of adaptation to a more plant based, generally speaking poor and protein-low, rather unhealthy diet in the first place?
Another question is, if it can’t be pinned down already, if it ever can. Because obviously, on the long run, if its just negative, there is the option of some sort of “correction” and genetic therapy, including germline manipulation. And this certainly is not just an issue for any single ethnic group, because most regions, even the majority of families, have their kind of medical history.
On the other hand, we know of specific advantages, like not just Aborigines, but also many people around the world, I know it for Europe for certain, have what optometrists call “absolute vision” – so the exact opposite of ametropia, with at times 1,2 or even more times the optical capacity of “normal vision” of the average Western population.
Or genetic predispositions which protect from cardiovascular diseases, improve intelligence and so on.
Clearly, one way or another, this will become an issue and will be debated, no matter what people make out of it on the long run. Without knowing, people just argue nonsense without talking about facts.
Like I have some health and nutrition issues, yet if I would just do, without adapting, what “regular recommendations” suggest, I would be even worse off, because my case is specific. Its not the “average one”. What helps one person, might be actually bad for another, as we know from allergies and intolerances. And we are just at the start of these discoveries.
Obviously a lactose tolerant Scandinavian has a different starting point, if its about raw milk consumption, than a person coming from a population with zero adaptation to it.
The same applies to many other foods and ways of life. Actually there are South Asian foods, hygiene issues and endemic diseases which are surely much more dangerous for most Europeans than for the majority of locals. Probably there is even some kind of correlation, who knows unless there was a scientific investigation.
@Obs – Aboriginal people have 7 times. Miles better than anyone else, including Central Asians, who have better than most.
“Like I have some health and nutrition issues, yet if I would just do, without adapting, what “regular recommendations” suggest, I would be even worse off, because my case is specific. Its not the “average one”. What helps one person, might be actually bad for another”
Yes, exactly.
Do we have a good enough theory of heart disease to even reach at why susceptibility is higher? (Like, do we know why CVD seems much higher in Eastern Europe?).
We’re talking about diet, but, y’know, what if it’s just some unnoticed pathogen linked tendency to greater arterial inflammation? One of the “go-to” hypothesis for any syndrome linked to inflammation among people with ancestry in tropics tends to be strong inflammatory immune response… (Lupus etc)
@John: I heard never about more than 200 percent, though it surely depends how you measure it. I really talked about the usual way optometrists do it in practise, like using the usual eyesight tests with letters and numbers at a distance, and usually for “full vision” you need to get to around 100 percent, defined by the test, but some just can read on when most people, which are considered normal sighted, can’t, down to the smallest images used.
I heard about the Aboriginal capabilities, which are astonishing, but 7 times seems to be over the top or better said, what’s the reference for saying its 7 times the eye sight of Europeans? What’s the practical consequence and how was it measured?
Links appreciated.
I found at a quick check a related article, to the topic, with Aboriginal children starting with some of the best eye sight, but because of Diabetes, for which they seem to have a higher risk, and other diseases over life time, lack of health are and probably genetic too, this often worsens:
https://www.smh.com.au/national/eyesight-loss-among-aborigines-a-disgrace-says-researcher-20110526-1f6ie.html
I’d still like to simulate aboriginal vision to see what it’s like, though we can expect there are limits to what our brains can comprehend
Sesame oil is significantly anti androgenic, a matter which will have its own effects on cardiovascular health
A thing that I am thinking is that, if a people has an healthy diet by centuries or millenniums, they should have MORE genetic predisposition the cardiovascular diseases – because the individuals with that genetic predisposition will have an higher survival rate, and will pass the genes to the future generations(in the Portuguese region of Algarve, we eat much fish and we have higher incidence of hypertension – I suspect a mechanism like this explaining that).
@Miguel: “Healthy” meaning different things in different contexts. Because what some may consider “healthy” today might be actually a energy low and bad diet for most of humans existence.
People didn’t had the wide variety of foods available in the past and they had very different lifestyles. But even if the effects would have been the same, whether someone would have gotten a cardiovascular disease at 55 was most certainly not the number one priority. It actually isn’t today.
Its just that a lot of the other risks being so drastically reduced, that this kind of late and low risk became the biggest risk in the individual life time calculation for many people. Its a luxury problem, so to say.
Many animals and pets get similar diseases like humans do, but not just because of one food, but the overall lifestyle and the simple fact they reach an age in which various diseases become relevant which are much rarer in the wild, also because the in the wild they would have died of other causes earlier anyway.
The available “healhier” diet in the modern Western context is surely much more balanced than that of people depending on a more plant based diet in the past I’d say. For example an exclusively vegetarian nutrition is now possible, on a fairly high level, which simply wasn’t the case, or still is not, in many times and places.
Everyone dies of something, and the major causes are heart disease, cancer, kidney failure/diabetes, and now covid (#3 last time I looked). If you could choose, a heart attack is probably the best option on the list.
For me it is personal. I have seen too many Desi friends and family die early from heart disease, often leaving behind children or family that did not expect this. In addition, I struggle to maintain a Desi-healthy weight and maintain an active lifestyle (run 2.5 miles and go to the gym each day) and it still is an upward struggle. One weekend of eating a bit too much, or one holiday without the gym, and I already start gaining weight.
Maybe there are other groups in the USA, but globally there are over 1.5 billion of us. There was a compound being studied that helped with restoring ratios of fat to muscle, but it was treated as a frivolous “exercise pill”, and minimal research and testing is being done.
I am normally not one to hold to the “woke” everything-is-racial line of reasoning, but this is a classic case of the medical establishment, despite being disproportionately Desi, missing a crucial aspect of healthcare.
I think lifestyle, endogamy and genetic predisposition both would play crucial in determining the disorder to developing the disease.
The generic term ‘ancestry’ is not explored the fullest to give concrete answers.
I know R30 and some R maternal lineages in India have predisposition for cardiovascular disorders especially congenital heart disorders.
Indian women suffers from gestational diabetes, low-birth weight(does not affect height/development of child) and BP at much higher percentage. Since I was comparing them with some of the common snps published, quite of them were homozygous at certain places and some were heterozygous.
@Obs – I can’t give links, I can only tell you what eye doctors in Australia say, and to them it is such common knowledge that they don’t even bother to remark on it unless you ask them.
The SMH article you linked to is talking about fringe-dwelling Aboriginal people in Sydney and Melbourne who are highly admixed, and of course various diseases which are worse in Aboriginal communities adversely affect eyesight. There is no genetic test for someone to qualify legally as Aboriginal, so many of those people have only minority Aboriginal ancestry or maybe even none at all. This confounds a lot of studies on Aboriginal health.
Among ‘full blood’ Aboriginal people (i.e. unadmixed people, of which there are still some, or with very little admixture) living in remote communities, trachoma is common, unlike in every other developed country, and that sends people blind.
But what I have been told by eye doctors is that, when they ask healthy young unadmixed adults in those remote communities to read eye charts, they just go straight to the bottom line and rattle it straight off, and then some of them laugh, like hey this game is too easy, give me something more difficult to do. One doctor told me: “Every person I have ever tested who has been able to do that has been Aboriginal.” Of course 7 times is the maximum; some are less.
The clearest explanation I have heard of what it must be like to have such acute vision is that an Aboriginal person can see with the naked eye, and without any difficulty, things on the horizon that Europeans with good normal vision need binoculars to see.
When I went to Gym, many of the Indian ladies looked fairly slim and not atall overweight. But when they were tested , their bodyfat level was at an astonishing 30%. Female bodyfat should be at about 20%.
Its not that they had such a high bodyfat but that they looked slim.
An Indian male Friend who also looked slim whas at about 22% when men should be about 15%
Thank you for addressing this topic and encouraging the related discussion. I learned a lot.
@John: So you mean by 7 times they can read 7 grades down to the smaller size? Because that’s still almost unbelievable, but it can be put into context. Like I heard about Central European people with extraordinary vision, which can read like 3 grades below the usual lower limit. A good vision can read 1 level down of 100 percent, extraordinary to the limits down to 3 or 4 levels down. So while most people fail after 1 or latest 2, some can read to 3 or 4 down. A rather low percentage in Europe.
Optometrists and most doctors don’t even have something smaller to test for and I wonder how any one can determine a 7 times better vision in practise, which methods they used. That’s something different to me and needs to be quantified.
In any case, they have exytraordinarily good vision, naturally and on average, with a higher frequency of highest level, that’s without a doubt and a remarkable capability as such.
@John T: Is this primarily because of internal body fat or lower muscle mass or both? Did they differentiate in a study? I think there probably was one, but I forgot the title.
@Obs – I honestly don’t know. All I know is that I was talking to some Australian eye doctors, and I brought up the subject of Aboriginal people’s visual acuity, and asked if it was really that much better than Australian whites, and they all laughed, and one of them said: “It’s not just better, it’s seven times better.” Seven is an odd number to choose if he was just exaggerating.
Gregory Cochran knows about this, and when we briefly discussed it, he agreed they have the most acute eyesight in the world. Then he said Central Asians also have more acute eyesight than most people, but that Australian Aboriginal people have even much better eyesight than Central Asians.
@John: I read that too somewhere and it was even discussed on this blog already, but I think 7 times was just an exaggeration, I mean it leaves the reasonable context and framework of usual differences among humans. 🙂
@Obs – What about distance vision? If an Aboriginal guy points out something he can see on the horizon, but you can only see what he is referring to if you have binoculars with 10x magnification?
I don’t think that is impossible.
Anyway, whether you believe it or not, it doesn’t matter.
The Australian Defence Force employ Aboriginal guys as coast watchers to guard Australia’s very long and mostly unpopulated northern coastline, and they particularly choose those guys for reasons.
@John: I believe they have much better vision, I just question the quantification and want to know more details.
Thanks for the info about the coastguards.
Interestingly both Aborigines and Central Asians have one thing in common, namely that they have to overlook and recognise, orientate in a huge, flat land with a lack of more obvious control points.
Maybe this has something to do with the ratio of the occipital and adjacent lobes such as rear parietal as a percentage of total cerebral volume. It is hard to find good numbers, but apparently the occipital lobe is 18% of the cerebral cortex.
I haven’t spent any time on the Central Asian steppe, but I have spent time in central Australia. Vast areas, many of them completely flat, treeless and (apparently, to my eyes) featureless and waterless, and yet Aboriginal people were able to live there successfully for a very long time.
When I was a primary school kid, occasionally some Aboriginal people would walk out of that kind of country who had never seen white people before – it was that recent.
You’d have to think that in that kind of landscape, exceptional distance vision would be strongly adaptive.
The other thing to bear in mind is that Aboriginal people are not ‘usual’ humans. Until really very recently, they were genetically isolated for at least 37,000 years, according to Eske Willerslev. That is a long time for one branch of humans to diverge from other humans. And Aboriginal people are clearly cognitively ‘different’. When you spend as much time with some of them as I have, you don’t need any convincing about that. Oh, you can sit with them and talk to them, and they’re fine, there’s no problem, but they’re definitely cognitively different – and I don’t mean stupid.
@DaThang – I was going to add that Aboriginal people’s brain structure is different from other people, but thought I had better not. But as you bring it up, it is different.
I have some Aboriginal ancestry myself, a little bit, so I feel OK saying things like that, but people can take things the wrong way.
@john massey
Different as in verbal vs non verbal aptitude?
Regarding occipital percentage 18% is for most people, idk about the percentage in aboriginals. I think it would be more than 18%.
In some ways, this aspect of the Aboriginals might be similar to hunter gatherers who lived on the forest-less steppe-tundra of northern Eurasia around the last glacial maximum, stretching all the way from Europe north of Iberia and Italy to central and northeast Asia.
No, not things like that. Different as in much stronger spatial memory, for one thing.
Some of the things I don’t like to talk about, because they sound like bullshit and have not been properly scientifically tested, but their spatial memory has been properly researched.
I meant spacial ability by non verbal (though it encompasses more related aspects as well).
Yes, spacial ability. And the women have it as well as the men.
@ John Massey
“Some of the things I don’t like to talk about, because they sound like bullshit and have not been properly scientifically tested, but their spatial memory has been properly researched.”
Humor us please 🙂 Any particular anecdotes that stand out, regarding their spatial memory or other abilities? I’d be curous to hear about the bullshit as well as the more scientifically grounded claims.
@Mick – Sorry, no.
Besides which, we are well off-topic, for which I owe Razib an apology.
Much of the BMI stuff is related to bone structure. South Asians have smaller bone structures on average.
https://www.nature.com/articles/s41598-019-46960-9
Smaller boned= less cross sectional area for lean mass= less lean mass overall so less baseline BMI to begin with
Also, modern diabetes guidelines don’t dictate too much difference between E and S Asians, maybe falsely so. For example, bariatric surgery referrals are done for otherwise asymptomatic people who have failed diet and exercise intervention, with a BMI of 40. For Asians in general, not just S Asians, the cut off is 35.
Even E and W Africans have this divergence in bone structure. West Africans are known to have powerful mesomorphic builds on average, the same people who many American athletes descend from. E Africans are known to be good distance runners and have quite slight builds. The same BMI parameters for an average Kenyan or Somalian cannot be used for say an average Ghanaian or Nigerian.
And yes the modern vegetarian diet sucks. The older one in farming areas of India emphasizes consumption of a lot of whole wheat, millet, tons and tons of dairy, and lots of fruit/vegetables. The dissemination of products like Coca Cola or even just Indian fast food in general has transformed this diet to utter trash, in terms of nutrition.
“The dyslipidemia in South Asians is characterized by elevated levels of triglycerides, low levels of high-density lipoprotein (HDL) cholesterol, elevated lipoprotein(a) levels, and a higher atherogenic particle burden despite comparable low-density lipoprotein cholesterol levels compared with other ethnic subgroups. HDL particles also appear to be smaller, dysfunctional, and proatherogenic in South Asians.”
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4807313/
A lay good article on super “sticky” type of LDL and its relation to diabetes, a disease S Asians are more susceptible- postulated, with some good evidence, to be 2/2 to “thrifty phenotype” 2/2 to frequent famines- some probably anthropogenic but others perhaps due to the unique degree of high land fertility in the subcontinent, particularly the confluence of the gangetic, indus, and brahmaputra plains, resulting in massive boom-bust population cycles, subject to highly variable Malthusian constraints.
My comment is pending approval. This is probably because I posted it with 3 links (2 peer reviewed studies and one good lay article). A lot of this risk boils down to insulin resistance phenotype that is common in desis due to long history of famine and starvation, in part due to anthropogenic phenomena but also due to the highly fertile land that is a double edged sword for S Asian populations, an area that can feed many but also more susceptible to wild swings in Malthusian constraints and therefore more famine on average. This in and of itself could have been the major reason for the decline to the IVC.
Also bone structure is just a thing for BMI. The cutoff for referral for S and E Asians for bariatric surgery in the US is a BMI of 35. For whites and blacks it is 40. Smaller bone structure (good surrogate markers are ankle and wrist size) means less cross sectional area for muscle to attach. Less lean mass overall, means more efficient for say cardio, all things held equal, but less baseline BMI.
“Much of the BMI stuff is related to bone structure. South Asians have smaller bone structures on average.” — @thewarlock, regarding the nature paper you cited in support of low lean mass of south asians, the modern day samples(given in figure 1) seems to have been taken exclusively from west bengal(eastern part of it) and sri lanka. This is not representative of the whole subcontinent given the diversity we have in terms of diet and ancestry. I would have liked to see some punjabis and haryanvis samples and see how they fared .
Yeah they need a wider sample. Anecdotally, they are still smaller bone structure wise compared to whites and blacks ON AVERAGE in the West. They are bigger than other Indians on average however. This is taking into account even in the West, when average height is more or less comparable to whites and blacks. I have been to those parts of India and the average joint size is still pretty small for people compared to American Whites and Blacks, even in well-fed rural areas. But yes, the average is shifted towards the right on the bone structure size scale and therefore more of the big extremes do tend to come from these populations for the subcontinent at large.
The DM rates (broader metabolic syndrome) and Malthusian constraints are still applicable argument wise. But yes, as always, a very striated sampling needs to take place for S Asia, given it is like 2000+ micropopulations.
The mention of Australian aboriginal and E African populations in the paper also supports the theory. Long limbed compared to torso, smaller boned people have lower baseline BMIs, all things held equal.
The mention of the “thrifty” genotype dissipating after two generations is also interesting. Additionally, the mention of ancient samples coming from all over S Asia is also quite telling.
The mention of sample coming from poor populations definitely also points to likely lower caste people. But most immigrants are not from low castes and therefore it is interesting they exhibit similar patterns. Most immigrants will tend to have more steppe DNA (bigger boned, shorter limbed, more cold adapted pheno genes likely) but still have similar issues. Gradation analysis could make things interesting.
If all of the ancient samples tended to come all over S Asia and tended to be small boned on average across the board, yet today the samples from say Punjab would be bigger than the ones form Bengal, it would beg the question of environmental confounders, with much better on average nutrition in the former for several few generations.
https://journals.sagepub.com/doi/pdf/10.1177/156482651103200103#:~:text=The%20average%20heights%20of%20adult,in%20some%20of%20the%20states.
^I always found the above interesting w/ mean height of men being the highest among Sikhs and Jains (170cm for both). Jains are not known to be martial or big or anything. But what is common is both is low rates of poverty and therefore likely access to adequate nutrition. Sikh women were about a 1cm taller than Jain women though.
Also Kerela and Punjab are both among the tallest states in India right now, with average heights of 5’7.
I wonder how much of height differences specifically are due to nutrition. This is a separate convo from bone structure of course.
Also, E Asians have small frames on average as well but not the same insulin resistance phenotypes. Perhaps, as starvation trends improve in S Asia, similar meeker stature may be seen but improvement in these heart numbers 2/2 to less insulin resistance. Interesting, what the future for a richer S Asia holds,if it can successfully get there that is.
Actually, my cousin’s wife is a physical therapist who trained in India initially. She worked in a metro with all types. She noted the trends of some NW types being bigger on average. But when she came to America, she was shocked. This wasn’t just because of obesity. People were just bigger in general in terms of their bone structures. While the true “pehlwan” type build might be 1/10 even in the most gifted villages in the NW, in the US it may be 3/10, and say 1/20 in the rest of India. Just a though experiment. I need data of course. This is just anecdote.
The “look slim” part is because they are small boned. They are less lean from caloric surplus+low protein diet that prioritizing fat gain. They are meant to honestly be BMI 20-21 to be in a healthy BF range, unless they are strength training bit time. They are naturally small. When they get into the typical western BMI range, they tend to be overweight. They just tend to look “skinny fat” because of their small structure. Once they take off their clothes, you see pot bellies.
I am trying really hard to get more S Asians into strength training. I’ve been doing powerlifting style training for awhile now. I have lightened up (fall asleep too easily if I eat too much) because of residency but I’m a tad over 5’9 and around 165 (cut down from 171 in last 6 months) only right now- around 14% BF (Greg Doucette standards of what he would call 15%, not BS lying about leanness). My max lifts are 440 deadlift, 335 squat, and a 250 pause bench. I just got a solid set of 400×5 this week on conventional DLs.
I’m a lifetime vegetarian, and I have hardly used supplements. I have just been on good strength training programs for over a half decade now, and I eat well. I am not “huge” at all and have a small bone structure, 6.25 inch wrists and 8 inch ankles. But I have a decent amount of muscle for my frame and decent lifts, nothing special in the strength world, but very respectable in the lay one.
Strength training is critical. It allows for maximization of lean body mass which is protective against the metabolic syndrome undesirables desis suffer from so much.
All desis should
1. Strength train (meaning good programming with standard progression schemes on 1 hip hinge, 1 squat, 1 vertical pull, 1 horizontal pull, 1 vertical push, 1 horizontal push)
2. Figure out their caloric maintained and not overeat or eat in slight surplus if strength training
3. Get the 1.6g/kg recommended protein consumption (literature has shown the 1g/1lb is not necessary and overkill in young lifters- older people benefit from slightly more protein) for growth
4. Eat enough fruits, veggies, and whole grains for micronutrients
5. Sleep enough
6. Do the AHA recommended at least 150 min moderate intensity cardio weekly.
The inflammatory pathogens comment is interest. Syphilis is known to affect the vessels quite a bit, notably the vaso vasorum (blood supply of thick part of aorta), leading to thoracic aortic aneurysms. Hep C and B are correlated w/ different vasculities. I am not aware of any that would explain the current situation.
To me it seems like a case of bad dietary and exercise habits coupled with “thrifty” genotype. It’s a perfect storm of nurture+nature.