Today's NYT does a story on the rise of Type 2 diabetes in India. As my friend C, who sent me the article, quipped, "Reading it has scared the bejeezus (pardon the interjection) out of me!" as well. These are the sections that interested me most, for their implications/ associations:

" “Diabetes unfortunately is the price you pay for progress,” said Dr. A. Ramachandran, the managing director of the M.V. Hospital for Diabetes, in Chennai (formerly Madras).

For decades, Type 2 diabetes has been the “rich man’s burden,” a problem for industrialized countries to solve.

But as the sugar disease, as it is often called, has penetrated the United States and other developed nations, it has also trespassed deep into the far more populous developing world.

In Italy or Germany or Japan, diabetes is on the rise. In Bahrain and Cambodia and Mexico — where industrialization and Western food habits have taken hold— it is rising even faster. For the world has now reached the point, according to the United Nations, where more people are overweight than undernourished.

Diabetes does not convey the ghastly despair of AIDS or other killers. But more people worldwide now die from chronic diseases like diabetes than from communicable diseases. And the World Health Organization expects that of the more than 350 million diabetics projected in 2025, three-fourths will inhabit the third world. ...

Throughout the world, Type 2 diabetes, once predominantly a disease of the old, has been striking younger people. But because Indians have such a pronounced genetic vulnerability to the disease, they tend to contract it 10 years earlier than people in developed countries. It is because India is so youthful — half the population is under 25 — that the future of diabetes here is so chilling."

Implications/Associations :

1. We live in a truly Lewis Carroll "Upside Down" world - we are either dying of having too little, or even worse, of having too much.

2. If the "third" world falls into the "chronic" diseases trap, things in the domain of nascent public health can really get grim. Why? Simply, because chronic diseases are far more lucrative to discover cures for - as the Big Pharma here has figured out long ago[1] , and this may funnel health spending into this sector instead of infectious diseases, which are, I think, still the main killers in that part of the world.

...

"Too much food has pernicious implications for a people with a genetic susceptibility to diabetes, possibly the byproduct of ancestral genes developed to hoard fat during cycles of feast and famine. This vulnerability was first spotted decades ago when immigrant Indians settled in Western countries and in their retrofitted lifestyles got diabetes at levels dwarfing those in India. Now Westernization has come to India and is bringing the disease home.

Though 70 percent of the population remains rural, Indians are steadily forsaking paddy fields for a city lifestyle that entails less movement, more fattening foods and higher stress: a toxic brew for diabetes. In Chennai, about 16 percent of adults are thought to have the disease, one of India’s highest concentrations, more than the soaring levels in New York, and triple the rate two decades ago. Three local hospitals, quaintly known as the sugar hospitals, are devoted to the illness.

The traditional Indian diet can itself be generous with calories. But urban residents switch from ragi and fresh vegetables to fried fast food and processed goods. The pungent aromas of quick-food emporiums waft everywhere here: Sowbakiya Fast Food, Nic-Nac Fast Food, Pizza Hut. Coke and Pepsi are pervasive, but rarely their diet versions."

Implications/Associations :

1. Two of my uncles and my father have some variant of diabetes - not Type 2, I think. And going back in time, I have known people, including a grandfather, who have had amputations because of it. Further, desi moms, including mine, want their kids to be chubby, and think exercising/ working out (I know, a rich sedentary man's activity) is actually harmful or unnecessary.

2. Is it that desis are "genetically" vulnerable to diabetes because the genes that they possess haven't "evolved" to face an "environmental situation" where they frickin' eat like pigs and do nothing? I am not saying agrarian desis were any healthier for the physical work they did - they were not.[2] What I am saying is not only should you get rich, you should get "smarter" health wise.

3. In all the recent desi exultation at Ms. Nooyi's taking the helm at Pepsi Co, what is forgotten is that soft drink firms view India & China as their biggest potential growth markets given the market saturation for their mainline carbonated products out here in the West. Now I drink and enjoy an occasional Coke/Sprite but when companies speak of increasing their share (in percentage points) of annual per capita fluid intake (I read this in the context of China, where Coco-Cola was finding it hard going to replace green tea fluid intake with Coke intake, in percentage points), it sounds positively sinister.

...

"In the United States, an inverse correlation persists between income and diabetes. Since fattening food is cheap, the poor become heavier than the rich, and they exercise less and receive inferior health care. In India, the disease tends to directly track income.

“Jokingly in talks, I say you haven’t made it in society until you get a touch of diabetes,” Dr. Mohan said. He points out that people who once balanced water jugs and construction material on their heads now carry nothing heavier than a cellphone. At a four-star restaurant, it is not unusual to see a patron yank out his kit and give himself an insulin injection."

Implications/Associations:

Even though fast food has penetrated India, both a taste gap and natural meat aversion/ veggie preference may yet save the rich desis from dying like the Happy Meals eating poor Amrikans here. But I may be wrong, here is a shout out: stick to the idli-dosa combo, people, and stay the hell away from French fries & pizza.

...

"People believe in bitter gourd juice and fenugreek, an Indian spice, which can temper sugar levels, but are not cures. Some years ago, the wood water cure gained considerable traction. Drink water stored overnight in a tumbler made of Pterocarpus marsupium heartwood, the promotion went, and it would wash away the diabetes.

All this exasperates Dr. Murugesan. He is among those trying to stanch the spread of the disease. Diabetes education is hard enough, without tomfoolery and witchcraft to discredit."

Implications/Associations:

Do I sniff a whiff of the arrogance of allopathic medical tradition- the heroic triumph of chemicals over any damn disease - here? With much respect to the tradition that stopped polio and other nasty diseases (at least in most parts of the world), I sometimes think (some/ many?) doctors got their heads screwed backwards. Don't simply dismiss "bitter gourd juice and fenugreek" (I hate bitter gourd) out of hand - instead investigate if increasing these elements in the desi diet reduces incidence of diabetes in the first place. Prevention is always better than cure. O wait! In that case, who and what will doctors treat![3]

[1] Pfizer and Sanofi-Aventis will be giddy with joy; this is a huge market for their recently FDA approved inhaled diabetes treatment, Exubera.