"Asian Indians have a 40% higher mortality rate compared to their white counterparts and it's really attributed to diabetes.”
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Asian Indians have the highest risk of diabetes, higher than any other minority group. Yumilsh welcomes Dr. Rupinder Deol to help understand the underlying factors. Dr. Deol also discusses healthcare physicians’ role in providing medical care based on patient’s ethnicity.
Dr. Rupinder Deol is a NP who specializes in Obesity and Diabetes. Her area of research interest is Asian Indians with diabetes. She completed her Master’s in Nursing from Yale School of Nursing and PhD at UCSF.
Shireen: Podcasting from Dallas, Texas. I am Shireen, and this is a Yumlish podcast. Yumlish is working to empower you to take charge of your health through diet and exercise and reduce the risk of chronic conditions like type two diabetes and heart disease. We hope to share a unique perspective and a culturally relevant approach to managing these chronic conditions with you each week.
Shireen: Dr. Rupinder Deol will be discussing the reasons why Asian Indians have one of the highest rates of diabetes in the country, especially in certain geographic areas more than other minority groups. We will also discuss the role that healthcare physicians can take to better understand people of different backgrounds and provide care that is culturally competent.
Dr. Deol: Thank you. It’s a pleasure to talk with you today.
Shireen: Absolutely. Dr. Deol, tell us a little bit more about your specific interest in Asian Indians and then in diabetes.
Dr. Deol: Well, my interest in diabetes in Asian Indians sparked at a very young age. And it was really influenced by my father’s friends, actually, what most of us Asian Indians people refer to as their uncles. So they’re pretty close friends to my dad. And what I found was that a lot of them died at a very young age between, I would say probably in their forties and 50 years old. And the cause of death was usually related to poorly controlled diabetes.
So that really sparked my interest in them. And then as as I proceeded along with my career, I ended up doing nursing and also as a floor nurse most of the patients that I saw that were of Asian Indian origin were mainly middle-aged men, with heart disease, and poorly controlled diabetes. That further intrigued me. So I went on to pursue my master’s and my Ph.D. with a focus in diabetes in Asian Indians. And what I found was a lot of the research that was available was done in the, in Europe and there’s not many studies done with Asian Indians in the United States. And also having been a clinician for about 25 years, most of the patients that I took care of that were Asian Indians with diabetes, most of them are poorly controlled. And there’s a lot of they don’t have a lot of knowledge about the disease. So I thought that I, that I would pursue that further.
Shireen: So that is very interesting in that you looked at that in particular to pursue that. It helps us understand more around that research. What exactly did you uncover? What are some, some maybe shocking things that you discovered as part of your research?
Dr. Deol: My research was mainly looking at behaviors, beliefs, and how patient, how Asian Indians manage their diabetes. So what was very intriguing was I started out exploring their beliefs, like what they thought of diabetes, what was their basic understanding of diabetes as a disease, and what really was striking to me was that they knew about diabetes from a very young age because a lot of them had been caregivers to their grandparents, to their parents administering their medication. They took it for granted that one day they will get diabetes. So all, for most of my participants in my study, they were just waiting for it to happen.
Any symptom, for example, if they had a slight tingle in their foot. They would attribute it to, I should be getting diabetes soon. I am going to get diabetes soon, but they did not take any preventative measures, like to stop diabetes from coming. They took it for granted. It was like a passive acceptance that it is going to happen to them. That was very intriguing about the beliefs.
Shireen: Mm-hmm.
Dr. Deol: Of how diabetes, how they live with diabetes every.
Shireen: And why do you think that is? Is it most attributed to wellness? Inevitable It is gonna happen and perhaps there’s nothing I can do to control it? Or how would you, what would you attribute that to?
Dr. Deol: It is part of their life. It’s a part of what I call, I framed it in my research as it’s their lived experience. So when they’re born, they’re born into this world of diabetes. Already since they were little, they’ve been exposed to it. They, it was just part of what was going to happen to them as they grew older. There was no surprise. They just learned to live with it and just anticipated it, you know?
Shireen: Mm-hmm. Interesting. That was very intriguing. Yes. What, can you share with us in terms of the prevalence of diabetes within Asian Indians, specifically here in the United States?
Dr. Deol: The statistics show that one in six Asian Indians in the United States have diabetes. The prevalence of diabetes is, for example, I have specific statistics in the Bay Area and 29% of our Asian Indians have diabetes in Atlanta, Georgia, there [are] about 18.3% of patients of Asian Indians that have, have diabetes, and I’m expecting by the year of 2030, as our Asian Indian community grows, I’m expecting those numbers to be higher.
Because there’s more screening now cuz in clinical work nowadays we to have, we have started screening patients for pre-diabetes impaired fasting glucose. I think as screening gets better within our group, these statistics should be going up. And what is really interesting is Asian Indians have a 40% higher mortality rate compared to their white counterparts and it’s really attributed to diabetes. Even I’m expecting that statistic to go higher.
Shireen: Mm-hmm. And so what you’re saying is it’s not so much that, I mean, one diabetes is significantly worse in this group, but it’s only getting [worse] because of more screening. So if there’s more screening, more of this will come forward. It’s likely there. Right now. It’s just, we just don’t know it.
Dr.Deol: We just don’t. Yes.
Shireen: I see. I see. Okay. And for context Dr. Deol, help us understand what the 18% or 29%, what these percentages means. Can you benchmark this against like a national average of other ethnic groups? Like, can you provide some context for us?
Dr. Deol: Yes, I can. I have one statistic. This is just a statistic that I have that the overall prevalence for diabetes. In Asian Indians, and I’ll name the city that they did this in. It was in Atlanta, Georgia. It was 18.3%, which was higher than blacks were 12.8%. Hispanics, 8.4, and whites were 6.6. So we are taking the lead on that and that was, this is an older statistics as I, I had done. As I said, if we do, if we take into account more recent statistics, I can guarantee that is much higher.
Shireen: And help us understand what do you attribute this to, right? We constantly hear about communities of color are disproportionately impacted by these chronic conditions like diabetes. What do you attribute this to in the Asian Indian community? What, is leading to this? Is it, is it genetic? Is it purely dietary exercise? What, exactly is, is influencing this?
Dr. Deol: Our genetics play a large part in this. And also, one of the major factors is the trunk of obesity that Asian Indians have. It’s a lot of adipose tissue that is considered to be causing their diabetes. Also, it’s also our lifestyle and it’s also stressors. A lot of our patients, I mean pardon me, a lot of my participants reported stress as being a major part of their cause of their diabetes, although they had a genetic component to it, you know? I think it’s multifactorial because if you can control diabetes, you can know you can prevent it. You know, you can become prediabetes and stop the progression to diabetes if you modify your lifestyle, your stressors, your diet, all of that, you know? We do have a higher genetic predisposition, but it’s impacted by all the other factors too.
Shireen: Mm-hmm. When we’re talking about diet in particular, is there something within the, Asian Indian food? I myself consume a lot of those foods. I am a effective fed . And so is there something that you can speak to around the foods that are consumed? We talked about dietary changes, lack of movement. Is there anything in particular on the food side that you would recommend?
Dr. Deol: I will speak specifically to my findings in my research study. Most of the Asian Indians that I interviewed were considered themselves, as vegetarians, especially the females. I found that Asian Indian women tend to lean more towards being vegetarian versus the men. The men tended to consume meat, but once the men found out that they were, they were or had diabetes, they made drastic changes to their diets.
They became all vegetarian. They, the biggest thing they gave up was meat. Thinking that meat was the cause of their diabetes without realizing that all the other foods that we eat, for example, Rooty rice, some of our how we prepare our sweets, you know, our major cause of diabetes. And interestingly enough, the females, there was a difference as to how they approached their diabetes. They attributed it to stress. The stress of looking after their family, the children, the grandparents, the in-laws. They never, they always said they never had time for themselves. That’s why they had diabetes. You know, when they were to make any dietary changes, they kind of leaned towards stress as being the cause of their diabetes.
And what was really common in women also is that they used a lot of ayurvedic foods, for instance, they would mix up different types of seeds like Greek fennel seed cumin, and they would make all these little mixtures and eat those thinking that that was controlling their diabetes. And what was common between both male and females is bitter melon, which we commonly call Carella. They had different forms of preparing Carella. Like some of them would cook it the ordinary way. Some of them would just eat the peels. Some of them would make juice out of it. And Interestingly enough, Carella does have properties that will lower their blood sugar. A lot of them followed that. They were reluctant to take like medication.
They would all like throughout the whole group, regardless of them being male or female, they did not trust Western medication. They would rather do their herbal supplements, you know, different types of flour to make their RO that first. And if their blood sugars were fine, they would not take their medication. If it was a little higher, they would take their medication. There was a lot of inconsistencies. When you look at it on the perspective of taking care of these people, it makes it very hard because you don’t know if they’re taking their medications, if they’re taking them correctly. That creates some type of a barrier to taking care of them.
Shireen: Mm-hmm. A lot of what you’re saying, I’m, I’m smiling at it here because a lot of what you’re saying is ringing so true to my own upbringing. And it, it is so true in that and in fact we see this across different cultures as well, is where there’s this blatant mistrust around the medication and the side effects of all the medications. And you know how it may it may fix one thing, but break. 10 other things in your body. And I, and of course I’m not speaking to your resources, just what I have observed you know, how do you, I guess now switching to the other part of our conversation, how do you approach someone in a culturally competent way and emphasize the importance of all of these other things that need to matter, be a diet, exercise, medication. How do you work from a culturally competent lens in instituting some of those behaviors?
Dr. Deol: Right now I work in a high-risk diabetes clinic, as you would expect, I do have quite a few Asian Indians that are my patients, and I think the first thing that really helps is the language, how you approach them. And I find a lot of them where they’re older, they’re an older generation, they don’t speak English very well. Connecting with them at that level and then understanding that yes, this is what you are eating, you know, And I always acknowledge and accept the fact that they are vegetarian. There is some misunderstanding about carbs and calories because that’s what I found.
They mix that up too. When you ask questions about carbs, they start talking about calories, and so there’s a lot of lack of education. Understanding that yes, there is that gap, that knowledge gap, and also accepting their beliefs. I think that’s a big part. That’s a big part that’s lacking in taking care of Asian Indians with diabetes, is that they, the providers don’t really understand their foods that they eat and also the IRA principles of that, why they’re eating those foods, because that is a big part of Asian, of an Asian Indian. That’s how I approach it. I acknowledge that first, and then we work from there. The foods, like the foods that they can eat, because when I look at the overall vegetarian diet, it sounds very healthy, you know, But it’s just how they prepare it and what they eat with it. That’s what we miss is what are you eating with it?
Shireen: And so once, once you’re able to do that, once you establish sort of what those beliefs. How do you then approach to move the needle in a way that is healthy for them?
Dr. Deol: Education. It’s really developing that trust, really empowering them. That’s what I really believe that Asian Indians need, that have like chronic diseases across the border, is they need to be empowered. They need, like with any, actually, I shouldn’t even say Asian Indian, but with all patients that come to you, they need to be empowered. We need to understand them, like what do they bring to the table and slowly change their behavior because I think behavior does not change in two days. It doesn’t change in a month.
It takes years to change. That’s how I approach them, is really understanding like where they’re coming from. And also there should be a place for the IRA beliefs that they have. It would be really nice if we could develop a path that complements Western medicine with allopathic medicine, especially in diabetes for Asian Indians, because there is value to some of the foods and the blends that they eat. There is value to that, but there’s no research done on it, so it’s very hard someone coming from like a scientific background to really understand. So that’s where I see the blend between Eastern, and Western Medic Medicine.
Shireen: I find that to be very fascinating because there, there’s perhaps value there that has been very untapped. Right? And so if there’s anything we know about the Indian subcontinent is, is to know that there’s a richness and spices and herbs there that are used. But we haven’t translated a lot of the research that we do here in the western world. To be able to truly understand the value and benefits that it can bring to a chronic condition like, like diabetes.
We really like your approach in what you’re talking about and sort of blending the two worlds and understanding the importance, one of what that means for the patient, but also from a research perspective, driving that so that it, it may perhaps emphasize that need to do the research and then the impact that it can create in an individual, cuz it seems they’re having this mix- and I have, I have a very similar blend that I have grown up with with you, the cumin seeds and the fennel seeds and all of those different things. I have no idea what any of it does cuz there isn’t a lot of research on it. It is just sort of what you hear from family members and you’re like, All right, fennel seed time.
Dr. Deol: It is, you know, and a lot of us grow up like this, Asian Indians, we see our mothers prepare all. herbal mixes. Your grandmother did it, your great-grandmother did it. It’s gone on for generations, but there’s no evidence or there’s no concrete an evidence to really influence practice, but it is a big part of Asian health.
Shireen: What would you tell a physician who is trying to navigate their way to understanding how to provide care to someone who is Asian Indian and who has diabetes? What would you tell to those physicians listening here to this episode on how to navigate that care? One, from a language perspective and understanding that there may be some barriers there, but two, in a way they approach care for that person.
Dr. Deol: Well, what I tell a lot of my colleagues is that most of the diabetes education that we have, all the major programs that we have, they don’t really. Specific cultural diets, you know, and I think that’s and even like I work with a lot of the physicians, like with a lot of physicians, dieticians, and my advice to them is really to understand and also get to know what the patient is actually eating every day.
Really understand, like whether do they understand basic concepts. For example, like I said, carb counting calories, you know the macro and the micronutrients on the foods that they’re eating. We just have to, I ask them to start at a very basic level because the education that we have does not meet the needs of our Asian Indian population with diabetes at all. And they need to understand that in order to take care of the patient.
Shireen: And what would you say, so that was for the clinicians, but what would you say to the, to the people listening, the audience listening? What would you say to them to more listeners if, especially those of Asian Indian descent, How would you tell them to sort of navigate their care and look at diabetes going forward?
Dr. Deol: I would say not to take it for granted, I would say that you need to start at a young age, especially, especially for the future generation, especially our children. We need to teach them how to eat, correct. We need to teach them how to exercise and we need them. We need to teach them how to deal with stress. Because my research showed that a lot of emphases was placed on stress. That was the cause of diabetes. And the biggest part, what I really feel is that we need to empower our women who are the main cooks, the main caregivers. The main, I would say, icons of running a family to look after themselves. And if they can do that, then I think they can make our future generation better.
Shireen: That is incredibly interesting, Dr. Deol. We’re coming up to where the end of the episode here, Dr. Deol, at this point, I would love for our listeners to know how they can connect with you and just learn more about your work and stay up to date.
Dr. Deol: Well, they can reach me at my personal email. It’s. R M RNs, R as in rabbit, M as in man, D as in dog, E o l hotmail.com. Or you can reach me at D. That’s d e o l r at Sutter Health. That’s s ut t e r Health dot o r g. Okay, perfect. And I look forward to their questions.
Shireen: Lovely. With that Dr. Deol, thank you so very much for your time. It’s been such a pleasure listening to the work that you have done, um, and the wisdom you imparted here and really helped us understand how prevalent diabetes is in the Asian Indian population.
Truly thank you for your time. And to our listeners out there who are listening to this episode, head over to our social media. You know the drill head over to our Facebook, our Instagram, Find us at Yumlish and answer this one. Question. Do you know anyone who suffers from diabetes? So head over to our Facebook, our Instagram, and answered this quick question of, do you know anyone who suffers from diabetes?We’ll find you there. Find this podcast episode, post, and comment below. With that, thank you so much.
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