South Asian Women’s Health

The wellness of South Asian women has been a secluded topic due to the lack of media coverage and public interest. However, that doesn’t imply the issue will dissolve itself. Research has shown that South Asian women are in grave danger in terms of diseases, diet, and nutrients. Predominantly, South Asian women are more at risk than Western women, and the themes, ideas, and explanations surrounding that will be explored in depth. It is tremendously crucial to consider that most of the South Asian women in danger are not even aware of it because they are illiterate and constantly being dehumanized and belittled. Therefore, that emphasizes the utter emergency to acknowledge the substantially growing issue and advocate for it.

When the ignorant doctors of the 17th century conducted absurd experiments like cutting off private parts, injecting lethal drugs, and peeling skin to prove white and brown bodies are different biologically, they may have been partially correct. Only, it was the not biological part that differed like enzymes, cytoplasms, or mitochondria. It was the abiotic factors that altered the well-being of an individual. Realistically, it is irrational to assume that a certain ethnicity changes the overall health of an individual. However, when looking at statistics and other extraneous components, South Asian women differ enormously from other women in diet, and nutrients, and are more likely to be diagnosed with diabetes and cardiovascular diseases.

Does originating from a certain background change the overall health of a person? Why so? What is the science behind it? Before any information, it is important to identify South Asia, its location, and its geography. South Asia is a region in the biggest continent of the world, Asia, and consists of countries like India, Bangladesh, Pakistan, Sri Lanka, Nepal, Bhutan, and Maldives. Statistically, most of these countries are overpopulated, have low minimum wages, and poverty and crime rates are extremely high, with uncontrollable pollution.

When speaking of health, diet is the vital and utmost factor to contemplate. South Asian cuisine is widely favored for its rich flavors, wide assortment of spices, and sickly sweet desserts. South Asian food usually consists of heavy carbohydrates like rice or bread every single meal, followed by deep-fried food and then a sugary dessert. Controlling carbohydrate intake is key to a fat-free body because carbohydrates are broken down into glucose which is sugar. Glucose provides a surge of energy temporarily. Too much glucose increase blood sugar level and the amount of fat in the body. The unnecessary monosaccharides are transported to the liver in the form of glycogen which is a different form of a carbohydrate. Otherwise, the carbohydrate is converted to another macromolecule called lipids through the assistance of a chemical in the digestive system called insulin. Fatty acids are triglycerides or fat. Fatty acids come in the form of saturated and unsaturated and saturated fats like oil and red meat exponentially increase low-density lipoprotein cholesterol. Deep-fried food is the prime cause of high cholesterol levels. The overall diet of excess sugar and fat harmonizes together for optimum health issues. The consumed desserts are usually fried in oil and then soaked in syrup.

It would not be irrational to say that the diet of South Asians is concerningly deleterious. The University of Alberta conducted a survey on South Asian female immigrants in Canada asking questions about their diet, nutrients, and medical conditions. The results of that survey were rather appalling: “44 percent of respondents had poor diets, and the other 56 percent had diets only moderate in quality. In addition, 78 percent of those surveyed were either obese or overweight, 70 percent had abdominal obesity, 27 percent had high cholesterol and 14 percent had high blood pressure…For low-quality processed food in high sugar, sodium, and fat, The average Canadian consumes 20 percent of their daily calories from those kinds of foods, but it was 35 percent for South Asian people” (Betkowski, n.d).

As the data suggests, poor diet and obesity are directly related to each other followed by issues like high blood pressure, high cholesterol, and food intake consisting of high sodium. When the heart is beating, it creates pressure to push the blood flowing throughout the body. When the pressure is too high for too long, it can eventually lead to fatal conditions like strokes and heart diseases. High blood pressure is caused by a sedentary lifestyle. Excess consumption of food high in sodium like salt is lethal. Excess sodium causes excess fluid to enter the cell which builds pressure that leads to high blood pressure.

The same survey also revealed that “96 percent weren't getting enough vitamin D, 46 percent were low on calcium, 45 percent were low on magnesium and 31 percent weren't meeting requirements for zinc” (Betkowski, n.d). Vitamin D deficiency is caused by little time in the sunlight and not enough intake of vitamin D-rich food like salmon and cod liver oil. Additionally, it can spawn debilitated bones and a rare condition called Rickets, where bones can bend easily, especially common in children. Vitamin D deficiency is common in South Asian women because most of them are confined in their homes, not going to school or working.

In research conducted about vitamin D deficiency around the world, 10 studies were conducted. 1 of the study focused on South Asia found that “Gender-wise comparison in our study reveals that females could be affected with vitamin D deficiency more than the males in SA; 76% for females (95% CI: 68 to 82%) as opposed to 51% for males (95% CI: 33 to 71%)” (Siddique et al, 2021). This shows that South Asian women are more in danger than South Asian men. Magnesium is required for as many as 300 biochemical reactions in the body. Magnesium counters ATP and nuclear acids, and is an important cofactor by stabilizing enzymes. It regulates the blood sugar level, balances the heartbeat, promotes strong bones, and is significant in nerves. Low magnesium can be caused by diet, a sign of type 2 diabetes, or more. Zinc is important for controlling the immune system, regulates and promotes cell growth and division, and has functions in maintaining the skin. Zinc is most commonly found in meat, nuts, and whole grains.

The majority of the representative South Asian women lack nutrients and have alarming macromolecules like carbohydrates and fatty acids, primarily due to their lack of education in the area about their own bodies and health and maintenance. In an article, Chakraborty wrote that “South Asian women make up more than 44% of the world’s illiterate population…more than 84.7% of the South Asian literate population is men” (Chakraborty, 2001). Therefore, it is logical that they are not aware of the necessities of their bodies to function at their prime. Since the chain of illiterate women is generational, emphasizing the men not caring about even a yearly check-up, these women often carry diseases and have serious conditions without even knowing. Most of them also do not have the funds to frequently visit the doctor for check-ups because healthcare is not free in any of the South Asian countries. Concluding, several factors contribute to the lack of nutrients and unhealthy conditions of South Asian women like proper education, carelessness, or even access to free healthcare.

Diabetes is an alarmingly prevailing condition in South Asian countries. Diabetes is a metabolic disorder that occurs when the glucose entering the body through food is not being assisted by insulin to enter the cell. Diabetic patients lack insulin, so the glucose stays in the bloodstream rather than entering the cell. Subsequently, the blood sugar level rapidly increases. There are two types of diabetes. Type 1 diabetic patients’ pancreas cannot produce insulin by itself and therefore heavily rely on injecting insulin near the pancreas. Type 2 patients become resistant to insulin or just don’t make enough insulin. Type 2 diabetes is believed to be related to mutations that alter proteins or protein-coding genes which alter the function and therefore the immune system acts and the body becomes resistant to insulin. A graph showing the data comparing South Asian women and other women of the world is shown in Figure 1.

Figure 1

The depicted graph proves that South Asian women have a greater risk of developing diabetes

Note. The category “Asian Indian” is projecting South Asian women.

As shown in Figure 1, South Asian women are more likely to develop than any of the 3 ethnicities provided here. Ma & Chan argue through this graph that this might be occurring because South Asian women generally have more visceral adiposity than other races. Visceral adiposity is fat stored in the stomach deep inside and is usually wrapped around other organs in the stomach. Because of this fat wrapped around the organ, an individual is more likely to develop insulin resistance which later leads to glucose intolerance and type 2 diabetes. Visceral adiposity can also lead to hyperuricemia when the body produces excess uric acid from a purine-rich diet. The main reason South Asians have more visceral adiposity in the stomach than other races is because of specialized genes that restrict cells that lead to fat accumulation in other areas of the body. Adipose tissue is a tissue in the endocrine system, the main producer of adipokine. However, the more body fat there is in the endocrine system, the more adipokine will be produced. Multiple adipokines are being constantly produced in South Asians, one of them being adipocyte fatty acid which binds to protein A-FABP.

Data collection from healthy individuals and individuals with type 2 diabetes revealed that “Serum FABP4 levels were higher in type 2 diabetic patients compared to healthy individuals” (Rodríguez-Calvo et al., 2019). A-FABP was found to be one of the leading causes of insulin intolerance. In extracellular environments filled with A-FABP serum, the experiment led to lipids not being able to go out of the cell and accumulating inside which completely disabled the insulin signaling pathway and overall diminished the uptake of glucose in cells. To summarize, South Asian women are genetically predisposed to be diagnosed with diabetes which explains why diabetes is the most common in South Asian women. It is due to additional body fat in the stomach from protein-coding gene regulation, which eventually blocks insulin and glucose from entering the cell and staying in the bloodstream, leading to increased blood sugar levels and finally, diabetes.

Another prevailing condition in South Asian women is heart disease. The primary causes of cardiovascular disease are high cholesterol, high blood pressure, a sedentary lifestyle, too much rich food, smoking, and minimal physical exercise. Longitudinal and cross-sectional studies by Stutter Health have found that “South Asian women develop heart disease at least 10 to 15 years earlier than most other ethnic groups” (Khan, 2023). This means South Asian women must start screening to look for signs of cardiovascular diseases before any other race. Being diagnosed with heart disease is not effortless; it establishes very stern restrictions. To think that those restrictions might be abid by a young age is despairing. According to research conducted by Cigna, South Asian women “have a four times greater risk of heart disease than the general population and can have cardiovascular disease even with a normal BMI” (Cigna, 2022). This means that one can have a regular level of body fat and still be able to suffer from cardiovascular diseases.

Some hypothesize that this might be related to already above stomach fat disposed of in South Asian women: “The development of abdominal-visceral obesity is combined with unfavorable metabolic activity and an increased risk of cardiovascular complications” (Gruzdeva et al., 2018). Reduced metabolic reactions are always detrimental to the body, and explain why one might face more heart conditions. The abdominal visceral might be blocking these reactions. The more body fat present in the body, the more abdominal visceral adiposity one has. This correlates to a widely known fact that obesity leads to cardiovascular diseases in the long term. Many suspect that these problems have been prevailing more now due to the fact these are genetically inherited and only exponentially grow due to diet, exercise, and other factors. Figure 2 shows that comparing two generations

Figure 2

Two South Asian generations were compared and the results show the increase in disease as the generation progresses

This graph concisely depicts that common diseases depicted in this research like obesity, diabetes, and cardiovascular diseases are factually inherited and grow through generations. Another hypothesis might be that South Asians are consuming more food and nutrients that might lead to these conditions such as excess fat, sugar, sodium, and lack of vitamins that support the immune system and the body like magnesium, zinc, and vitamin D. Nonetheless, these diseases are lethal and the lack of education in South Asian women is also contributing to the growing diseases and the ability to properly fight them.

Although some may argue that South Asian men may be more sensitive to being diagnosed with diseases mentioned in the paper, Chakraborty showed that South Asian men are more educated than South Asian women which means they are more likely to be aware of the meaning of the symptoms of diseases. Women are constantly denied education and forced to stay home or avoid going to the doctor despite experiencing symptoms due to the lack of money to pay for the doctor’s visit. The data presented showcased that South Asian women are more at risk for diabetes and cardiovascular diseases due to additional visceral adiposity, lack of calcium, zinc, magnesium, and vitamin D, and too much saturated fat, sodium, synthetic sugar, and carbohydrate. These conditions are rapidly increasing via generations because of no change in diet and lack of active lifestyle. Therefore, hailing from a certain ethnicity like South Asia can alter the probability and likelihood of a physiological condition in women, primarily diabetes and alarming heart conditions.

---

Arwa Zaman is a published researcher about South Asian Health with NASA and UVA. She founded Henna Health which has helped 100+ South Asians, fundraised 100k for pad poverty, and more. She is a Bangladeshi Muslim and has a stutter and wants to spread love. And, oh, she absolutely loves matcha.

References

• Betkowski, B. (n.d.). Diets of nearly half of South Asian immigrants are unhealthy, a study suggests.

• Lekha S. Chakraborty. (2001). Gender Bias in South Asia [Review of Human Development in South Asia 2000: The Gender Question, by M. ul Haq]. Economic and Political Weekly, 36(42), 3993–3995.

• Siddiqee, M. H., Bhattacharjee, B., Siddiqi, U. R., & MeshbahurRahman, M. (2021). High prevalence of vitamin D deficiency among the South Asian adults: a systematic review and meta-analysis. BMC Public Health, 21(1).

• Ma, R. C. W., & Chan, J. C. N. (2013). Type 2 diabetes in East Asians: similarities and differences with populations in Europe and the United States. Annals of the New York Academy of Sciences, 1281(1), 64–91.

• Rodríguez-Calvo, R., Girona, J., Rodríguez, M., Samino, S., Barroso, E., de Gonzalo-Calvo, D., Guaita-Esteruelas, S., Heras, M., van der Meer, R. W., Lamb, H. J., Yanes, O., Correig, X., Llorente-Cortés, V., Vázquez-Carrera, M., & Masana, L. (2019). Fatty acid binding protein 4 (FABP4) is a potential biomarker reflecting myocardial lipid storage in type 2 diabetes. Metabolism, 96, 12–21.

• Khan, A. (2023).South Asian Health Risk Factors | Sutter Health.

• Health Disparities in the South Asian Community | Cigna. (2022).

• Gruzdeva, O., Borodkina, D., Uchasova, E., Dyleva, Y., & Barbarash, O. (2018). Localization of fat depots and cardiovascular risk. Lipids in Health and Disease, 17(1).

• Gupta, P., Gan, A. T. L., Man, R. E. K., Fenwick, E. K., Tham, Y.-C., Sabanayagam, C., Wong, T. Y., Cheng, C.-Y., & Lamoureux, E. L. (2018). Risk of Incident Cardiovascular Disease and Cardiovascular Risk Factors in First and Second-Generation Indians: The Singapore Indian Eye Study. Scientific Reports, 8(1).