The South Asian Health Solution: A Culturally Tailored Guide to Lose Fat, Increase Energy and Avoid Disease

I was referred to Dr. Sinha by my primary care physician, when I inquired about lifestyle options as an alternative for medicine, specially for South Asian physiology.As a 40+ South Asian male working in a high stress job, in Silicon Valley, I fit perfectly in the target audience that Dr. Sinha is attempting to address. In fact, the first case presented in the book could have been me, right down to the symptoms and family history! I, however, would not like to end up as the case subject did. Therefore, I am treating the recommendations as guiding principles for my life.I took Dr. Sinha’s advice to heart and am doing my best to follow his recommendations on food choices, exercise and reduced stress lifestyle. Over the past three months, I have lost over 15 pounds. Best part is that my A1C numbers dropped from 6.2 to 5.6 - enough that my endocrinologist decided to take me off the supplementary diabetes medication and even suggested reducing the statin dosage.While I have not been able to follow all of the recommendations to a ’T’, I have been able to:a. Switch to a mainly low-carb diet - no rice, bread, potatoes, bananasb. Monitor my daily activity using a FitBit pedometer (goal of 8000 steps, and I usually manage 6000 per day, and 12K on weekends)c. Exercise more including cardio and strength. I used to exclusively do strength training and now have added cardio to the regimen.Lots of information is presented and, more importantly, the relationships between the various ailments and how they all are combined to impact South Asians. Recommendations are simply explained in a language that a lay person can understand.Adopting the new dietary recommendations has been hard - both for me and my family. However, they have been very supportive when I opt to eat a salad for dinner instead of the rice, naan, curries they have. Even my in-laws are observing my habits and trying to eat a bowl of salad with dinner - that’s very hard for 70+ year olds who have grown up thinking of a salad as “grass, leaves and stuff” ("ghaas phoos") and never the main meal. It’s been very hard to track the food intake using MyFitnessPal - it’s a lot of work. But, when I did, I had some eye-opening lessons about the carbs that I was actually ingesting.This book is quite information dense and there is a lot. I find myself reading a couple of chapters and then coming back later to re-read the material to refresh my memory.I have sent a couple of copies as gifts to my relatives, hoping that they would also benefit from the valuable information in this book.

Dr. Sinha practices internal medicine in southern California (Silicon Valley) and has a large dose of South Asians in his clinic. "South Asia" usually encompasses India, Pakistan, Nepal, Bangladesh, Sri Lanka, Bhutan, and Maldives. One fifth of the world's population lives here. This book pertains mostly to Indians, which is Dr. Sinha's ethnicity. I live in the Pheonix, AZ, area and we have a fair number of Indian engineers and physicians.WHY DO SOUTH ASIANS NEED THEIR OWN SPECIAL HEALTH GUIDE?Because Dr. Sinha says they have unique genetic and cultural issues that predispose them to type 2 diabetes, abdominal obesity, coronary artery disease, high blood pressure, and adverse cholesterol numbers. For example, compared to natives who stay in their home countries, South Asian immigrants to the West have 3-4 times higher prevalence of diabetes, he says. Dr Sinha has a program that he's convinced will prevent or forestall these medical problems in South Asians.According to Sinha, South Asians eat too many carbohydrates and are too sedentary. Especially those who have moved to the West (e.g., US, UK, Europe, Canada). He notes that the core of the typical South Asian diet is flat breads, lentils, rice, fried crispy snacks (with heart-poisoning trans fats), culminating in 150-200 daily grams of carbohydrate more than he sees in other ethnics in California. Western fast foods, sodas, and sweets compound the problem. He says "most South Asians are skinny-fat," meaning skinny legs and arms but with a fat belly from visceral fat. This is also called sarcopenic obesity.This is much more than a weight-loss book; it's not even primarily a weight-loss book.Speaking of obesity, the usual "healthy" body mass index (BMI) numbers don't apply to Asians. The World Health Organisation classifies Asians as underweight if BMI is 18.4 or less, healthy at BMI of 18.5 to 13, overweight at BMI 23.1 to 25, and obese if BMI is over 25. These numbers are lower than those used for non-Asian populations.Another issue in his South Asian patient population is vitamin D deficiency related to their dark skin (less vitamin D production) and too much time indoors. He says vitamin D deficiency promotes inflammation and insulin resistance. More on this below.Some South Asians have a K121Q gene mutation that causes insulin resistance, which in turn can cause disease. And whether it's genetic or not (but I think it is), he says South Asians tend to have higher Lp(a) [aka lipoprotein(a)], which causes early and aggressive coronary artery disease. They also tend to have small dense LDL, leading to a lower-than-expected total cholesterol level which may be deceptively low.Sinha notes a strong vegetarian preference in Indians but spends almost no time discussing it. From the book, I can't tell if Indian vegetarians are lacto-ovo-vegetarians, pescetarians, or vegans. Perhaps you could enlighten me in the comments section.SINHA'S GRAND UNIFICATION THEORY OF DISEASE CAUSATIONSo, South Asians, at least in the West, have a high-carb diet, are too sedentary, and have genetic tendencies to heart disease and diabetes. How do these factors cause disease? It's all tied together with insulin resistance. Insulin is the main hormone that keeps our blood sugar from rising too high after we digest a meal. Insulin drives blood sugar into our body cells to be used as energy or stored eventually as fat. If our tissues have insulin resistance, blood sugar levels rise. As a compensatory effort, our pancreas excretes more insulin in to the blood stream than would normally be the case. Whether or not that eventually lowers blood sugar levels, the higher insulin levels themselves can cause toxicity. For example, higher insulin levels raise blood pressure, which damages the cells lining the insides of our arteries, leading to chronic inflammation and atherosclerosis (hardening of the arteries). Some of the arterial damage is mediated through small dense LCL cholesterols (aka type B LDL), which is promoted by high insulin levels (hyperinsulinemia).Insulin resistance also results in a defective and overactive immune system, which further promotes chronic inflammation. This inflammation is "...the root cause of almost every imaginable chronic disease...from heart attacks and strokes to Alzheimers Disease."Anyway, this is Dr. Sinha's hypothesis, and there is some scientific evidence to support it. Sinha says that the concept of insulin resistance "weaves together virtually every chronic ailment currently afflicting South Asians." That may be a bit hyperbolic: He carves out no exceptions for arthritis, asthma, eczema, migraines, glaucoma, macular degeneration, hearing loss, erectile dysfunction, hepatitis C, prostate enlargement, toenail fungus, or male-pattern baldness. Dr. Sinha's Grand Unification Theory of Disease Causation has some support among physicians and scientists, but is by no means universally accepted among them. As for myself, I think he's over-simplifying (for his readership's sake?) and getting a bit ahead of the science.Most clinicians don't testing directly for insulin resistance. What are the indirect clues? Belly fat, low HDL cholesterol, high trigylcerides, high blood pressure, prediabetes and type 2 diabetes. These are components of the metabolic syndrome. Not everybody with one or more of these factors has insulin resistance but many do.WHAT'S HIS PROGRAM?If Sinha is correct, the South Asian Health Solution is a "low-insulin lifestyle" achieved through carbohydrate-reduced eating, exercise, and avoidance or resolution of belly fat. These help improve all components of the aforementioned metabolic syndrome. The backbone of the plan is carbohydrate restriction.For low-carb eating, avoid wheat bread and Indian flat breads (e.g., chapatis, naans, parathas, puris, phulkas), aloo (primarily potatoes and starchy vegetables), rice and other grains, beans, and sugar. Keep track of your net carbohydrates (he likes FitnessPal.com, which includes South Asian foods). If you need to burn off body fat, limit carbs to 50-100 grams/day (digestible or net carbs, I assume). Aim for 100-150 grams/day to maintain health and weight loss. You might be able to add "safe starches" later: white rice, potatoes.To replace your Indian flat breads, learn how to make them with substitutes for wheat flour: coconut flour or almond flour (no skins) or almond meal (skin included). Recipe on page 347.Rice alternatives are cauliflower "rice," shredded cabbage, broccoli slaw, chopped broccoli, and chopped carrots.He likes ghee, extra virgin olive oil, coconut oil, and butter. Avoid high omega-6 fatty acid consumption, as in vegetable oils. Of course, avoid trans-fats. Good fats are saturated, monousaturated, and omega-3s.He provides a few low-carb recipes, surprisingly without specific carb counts: chapatis, microwave bread, cauliflower pizza, coconut cauliflower rice, shredded cabbage sabji, gajar halwa (carrot pudding), and coconut ladoo.Dr. Sinha doesn't provide a comprehensive meal plan. He trusts his California South Asians to figure out how and what to eat. They're smarter than average (he never says that, but that's been my experience with South Asians in my world).Dr. Sinha is also a huge proponent of exercise. He'll tell you about squats, lunges, planks, burpees, yoga, and Tabata intervals. He agrees with me and  The Low Carb Dietitian's Guide to Health and Beauty: How a Whole-Foods, Low-Carbohydrate Lifestyle Can Help You Look and Feel Better Than Ever , that "physical activity is the most effective fountain of youth available."I skipped some of the chapters due to lack of time and interest: women's issues (e.g., pregnancy, polycystic ovary syndrome, post-partum depression, osteoporosis), childhood, fatigue and stress management, and anti-aging.MISCELLANEOUS TIDBITS - he likes high-sensitivity CRP testing. - his metabolic goals for South Asians are: 1) keep waist circumference under 35 inches (90 cm) in men, under 31 inches (80 cm) in women, 2) keep triglycerides under 100 mg/dl (1.13 mmol/l), 3) keep HDL cholesterol over 40 mg/dl (1.03 mmol/l) for men, and above 50 mg/dl (1.29 mmol/l) for women, 4) keep systolic blood pressure 120 or less, and diastolic pressure 80 or less, 5) keep fasting blood sugar under 100 mg/dl (5.6 mmol/l) and hemoglobin A1c under 5.7%, and 6) keep hs-CRP under 1.0 mg/dl. - he says HDL cholesterol helps reduce insulin resistance via apoprotein A-1 (apo A-1), which increases glucose uptake by cells. - he likes to follow the triglyceride/HDL ratio. If under 3, it means low risk of insulin resistance being present. - he likes to follow total cholesterol/HDL cholesterol ratio: ideal is under 3.5. - statins are way over-used. - ignore total cholesterol level by itself. - stress control and sleep are important. - the author had some metabolic syndrome components: high triglycerides, low HDL cholesterol, and type B LDL (small, dense particles). - he dislikes the usual-recommended low-fat, low-cholesterol diet. - 4 tbsp (60 ml) of extra virgin olive oil daily seems to lower blood pressure. - magnesium supplementation my lower blood pressure. - the liver stores about 100 grams of glycogen and muscles store 300-500 grams. - Vanaspati is a "cheap ghee substitute" made from vegetable oil and widely used in Indian restaurants and many Indian processed foods. Avoid it since it's a source of trans fats. - aloo sabji is a potato dish. - traditional Indian herbs/spices include turmeric, cardamon, ginger, and cilantro. - find and Indian medication guide at http://www.medguideindia.com/show_brand.php - coconut milk is a traditional fat in India. - curry, curry, curry. - non-alcoholic steatohepatitis is quite common in South Asians, seemingly linked to visceral (abdominal) obesity and insulin resistance related to carbohydrates. - the book has no specific focus on diabetes.THUMBS UP OR DOWN?Overall, I like many of Dr. Sinha's ideas. They seem to be supported by his experience with his own patients. I trust him. I bet many South Asians and non-Asians eating the Standard American Diet would see improved health by following his low-carb, physically active program.

I plan to post a longer review later.I liked the book primarily because it explains the causality behind CAD (and metabolic diseases more generally), in a simple, easy to understand way.Regardless of where you stand on the low fat vs. low carb spectrum, it highlights what both sides appear to agree on:a) eat a lot of nutrient dense foods (especially, plant based)b) get a lot of exercisec) de-stress.These are simple rules, but this book offers some useful and practical guidelines, including suggestions for apps. The book is also novel in that it emphasizes ratios, rather than presenting absolute targets.If you are of Indian origin, this book offers what several others do not. It has an excellent understanding of Indian cultures, and offers suggestions, including recipes, that are geared specifically for Indo-Americans.A suggestion. While reading this book, don't take the recommendations to suggest that you can be a glutton, especially when it comes to Saturated fats, which, in high concentrations, do cause oxidative stress (see e.g. [...]Eat in moderation. Control portion sizes. Eat a lot of anti-oxidant foods. Choose your carbohydrate food sources carefully, emphasizing low-glycemic and high-anti oxidant ones.I have gained a great deal from this book, and recommend it whole-heartedly. It is brilliantly written, and extremely useful. A game changer for Indian-Americans.

This is book is brilliantly tailored for the South Asian community who, both in the UK and US, are one of the most high risk ethnic groups when it comes to heart disease and diabetes, etc. He has superb chapters dealing with common issues that arise with South Asians: high blood pressure, insulin resistance; special chapters about the elderly, women and children where he deals with unhelpful cultural traditions that only exacerbate poor health. I bought this when I found out my mum suddenly got high blood pressure and was immediately given medication. I read the relevant chapters and within a month she no longer needed tablets - lifestyle changes identified in the book were sufficient. The greatest achievement of this book is drawing our attention to the NHS/WHO/food industry sponsored low-fat, high carb farce. Instead of obsessing with cholesterol figures, Sinha's 'metabolic 6-pack' approach is far more helpful. With Asians buying drums of vegetable oil to fry their daily high carb meals, it's no wonder we have a cultural health crisis. Buy this book and promote it to your relatives and especially to South Asian GPs - too many of whom are ignorant of the dire consequences of their statin-obsessed prescriptions. If South Asian doctors could just read and apply this book (each chapter ends with advice to medical professionals), I'm certain there would be a real improvement in healthcare.

Thank you Dr. Sinha for this resourceful and informative book. It has been a long time coming. Finally a book on diet and health geared to the genetic and cultural background of South Asians. Dr. Sinha very clearly and concisely demystifies various staple foods of South Asians and their detrimental effect on our health. Ultimately the onus is on us to be custodians of our health, and this book helps us in doing everything we can and must do to lead healthy lives and be health models for our own families.

Every one should read this book. When I read this book, I feel that doctor whose prime concern is my health, talking to me. Whenever I go out of my track, I pick up this book and read a few pages. Only then, I get again motivated to stick to my diet and exercise. Thanks to Dr. Ronesh Sinha

An important and timely message that recognize the unique situation South Asians find themselves in when they move to North America. Prior to this book, whenever we wondered why South Asians who were super slim in their 20s develop all sorts of health issues in their 40s and 50s, the answer was frequently "poor genetics - nudge, nudge, wink, wink". This book will help.

It is a very informative book and a must read for south Indians who are genetically prone to get diabetes and heart problems and consume excessive amount of carbohydrates. This is one of a kind book gives step by step details about diet and life style changes that we need to make to prevent and control some diseases and manage weight also.