In a recent book called the South Asian Health Solution there is a chapter on getting Indians to exercise. The author is a well-known Silicon Valley medical doctor who is rightly concerned with the growing epidemic of heart disease among the peoples of the Indian subcontinent. The book contains many good points, but, unfortunately, the author has bought into an insidious, pervasive myth that South Asians do not like moving, let alone exercising.
When many of us think of serious health problems we might think of heart disease or cancer. Others might think of Alzheimer’s disease or dementia. One organ, and the diseases associated with that organ, is often overlooked. That organ is the kidney, and the health implications of kidney disease or weak kidneys are more far reaching and more profound than you might otherwise imagine.
There is a famous puzzle called “Missionaries and Cannibals.” In this game participants have to transport cannibals from one side of a river to the other on a raft. The only catch is that cannibals can never outnumber missionaries on either river bank or on the raft. The puzzle needs planning and thought as missionaries and cannibals are brought back and forth across the river, making sure that the missionaries are never outnumbered, until all are safely landed on the other side of the river. Some people never figure the puzzle out, and, as the numbers of missionaries and cannibals increase, the puzzle becomes harder and harder.
Over the last thirty years there has been an alarming transfer of power from parent to child. In North American culture, and those areas of the world infected by this culture, the antics and opinions of the famous and infamous, singers and actors, and same-age social peers matter more than parents and teachers. In place of the family unit is the teenage social circle linked neatly together by an always on social media that promotes the cult of the new, the irrelevant, the immature, and celebrity. During this period there has been a new emphasis on the opinions and preferences of children. The toddler gets to decide the clothes they want to wear on any given day; the young child can refuse to eat his vegetables safe in the knowledge that he’ll still get dessert; while the teenage child can game, text, or surf late into the night knowing that their mom is too busy trying to be the cool mom, rather than the voice of parental authority. Recent television, online, and even literary culture undermines parental authority to the point where little communication across generations is happening. Even children limited in their exposure to popular culture are not safe: the increasing influence of peer networks that continue after school via electronic devices means that the opinions and values of parents are further undermined.
Biryani used to be food of nawabs and Sultans. It was the food of occasional festivals. It was never the food of everyday life. Some 12,000 years ago India was very different. The subcontinent was transitioning from a hunter-gather society to an agrarian, neolithic culture. Many parts of the country that are now desert were thriving agricultural areas where barley and eventually wheat were grown. These grains fed newly formed urban civilizations. In the area around Hyderabad different types of millet native to India was grown, as were pulses and lentils, then later barley. In Baluchistan, wheat was grown over 8,000 years ago. Shortly afterwards wheat and barley became the main staple of the Punjab and Pashtun regions. Rice was not grown. In the Arab world we find a similar trend. The boom in rice consumption mirrors the boom in oil production. Previous to this, only small amounts of rice were grown in parts of Mesopotamia in the seventh century. It was not widely available, nor available to the rest of the Arab world, and the records we have suggest it was used occasionally only as a dessert.
Nothing presents text better than ink embedded in paper. When ink is fixed onto paper by a skilled typesetter, then bound by a deft bookbinder using fine leather, there is no better way of reading words than from a book.
In the early 1900s our author was at a typical English public school. On the school playing fields and through local woods he would run, walk, or play with his classmates. In the sun, in the wind, even in the raw cold they would play games and sports, helped by the vigor of youth. As with many children this was a time of vitality and glowing health, unencumbered by disease or tiredness. The author then progressed to medical school and his experience of childhood zest was replaced with the experience of disease and ill health. All around him he saw gloomy people with various ailments. This portrait of malaise contrasted with the vigor he saw in his youth. He questioned why doctors were always presented with illness and not with people who were super healthy. It was a strange affair to be concerned only with disease and not with vibrant health. He put this to senior doctors, proposing that the teaching of medicine should be reversed with an renewed emphasis on studying the very healthiest people. Naturally, he was ridiculed. He put in for a government health grant to study health rather than disease. He wanted to known whether age-related illness was really necessary. Again he was rejected. It was at this time he came across reports of the Hunza people, then in northern India, now in Pakistan.
Wu is an eighteen-year-old boy from China. He weighs 175 kg and has a BMI of 59. Unsurprisingly he has a whole host of medical problems, most of them caused by inflammation. His weight was not due to excessive calories. His food was the standard fare for Chinese teenagers of meat and noodles, and while he was eating slightly more than he should, it was not enough to make him 100 kg overweight. Wu was fortunate to find the clinic of Professor Zhao, a world expert on diet and gut bacteria, who examined his gut and discovered it had been colonized by Enterobacter, an aggressive bacteria that provokes inflammation. Professor Zhao put Wu on a diet that encouraged friendly bacteria growth in his gut. The diet was gluten free, free from meat, and high in fiber, comprising legumes, oats, peanuts, and Chinese herbs. After just nine weeks Wu lost 30 kg. After four months he lost 51 kg. After six months the Enterobacter bacteria was undetectable, Wu’s hunger vanished, and his inflammatory markers were normal. As an experiment Professor Zhao took Wu’s bacteria and implanted it into lean mice. Within one week the mice were fat, had diabetes, inflammation, and high blood lipid levels. The experiment was repeated by implanting different strains of gut bacteria from obese humans into lean mice, and in every case the lean mice became fat and unhealthy. To date, Professor Zhao has replicated Wu’s success with over 1,000 obese people.
David Servan-Schreiber sensed something wasn’t quite right a year after his thirtieth birthday. A professor of psychiatry at the University of Pittsburgh Medical School, he felt his brain didn’t work. Eventually he was diagnosed with a cancerous brain tumor. This type of cancer is rare with a poor prognosis. People often survive less than a year, even after aggressive treatment. Being a medic he asked what he could do to fight the disease. This was in 1992. He drew a blank. Oncologists did not think there was anything to do beyond radiotherapy.
The rich and noble history of Hyderabad has led the Indian government to recognize the city as one of the most important heritage sites in all India. Since medieval times the banquets and food of the Deccan have been legendary—perhaps second only to Lahore. Recently, however, Hyderabad has gained a new title: the diabetes capital of the world, with more diabetics as a percentage of population than anywhere. One in every six people above the age of twenty-five is diabetic; over the next five years this is predicted to rise to one in three people. Doctors at the Nizam’s Institute of Medical Sciences predict that half of all Hyderabadis will develop diabetes over the next ten years. This epidemic of diabetes is not limited to the Deccan. Hyderabad might be the capital city of diabetes, but India has more people with diabetes than anywhere in the entire world. And the problem is only getting worse.