Ka-thunk. Ka-thunk. Ka-thunk.
That’s the sound your heart makes constantly in your chest, until one day, it just stops.
Heart disease is the No. 1 killer in the entire world; it is more widespread than hunger, wars and viruses. The tricky thing about heart disease is that men and women show completely different symptoms and warning signs, which has led many women to be falsely diagnosed when they have heart attacks.
An additional problem affects people of South Asian and Asian descent, however. For us, this problem is circular. Because of environmental factors and genetics, South Asians are at a higher risk of developing diabetes. And if diabetes is mismanaged, it can lead to heart disease.
One study, the Mediators of Atherosclerosis in South Asians Living in America, or MASALA, Study found that people from South Asian countries, such as India, Pakistan and Bangladesh, have “four times the risk of developing heart disease, and they develop the disease a decade earlier.”
Moreover, the study showed that South Asians develop high blood pressure, Type 2 diabetes and high cholesterol at lower body weights. Standardly, doctors check for diabetes if someone has a body mass index of 25 or higher, which is generally considered overweight. The problem is that almost one-third of South Asians who have these diseases are under that threshold. There are people suffering from these diseases right now who believe they are healthy because they aren’t overweight. But the most dangerous thing about this genetic predisposition is that one health problem can lead to something worse.
My dad has had Type 2 diabetes for most of his life. Diabetes can be managed, but it requires dedication to keep it under control. When you have Type 1 diabetes, the body fails to produce insulin, making it unable to absorb glucose for energy; if you have Type 2, the body doesn’t respond to insulin as well as it normally does, which also leads to glucose buildup.
Living with this disease can mean taking two pills, three times a day. It’s consistently pricking your finger, hoping that the blood sugar reading you get isn’t too high. If you’re lucky, or if you have $150 to spare after paying for the monthly refill of your medicine, you can get a continuous glucose monitor that lets you track it without drawing blood.
But, you still have to check constantly. In the morning, in the afternoon, at night. All day, every day. For the rest of your life.
My dad has always struggled with this, and he’s still the hardest working person I know. Not only does he juggle a stressful job that keeps him moving, but he does it without complaint. He cares too much about supporting my family to let anything else get in the way. It’s inspiring.
But when I think about what could happen if my dad forgets to take his medicine or eats the wrong thing, I worry. When a diabetic’s blood sugar gets too high, they start to slow down. It becomes hard to think. From the outside, it looks as though a switch was flipped, and the person just goes blank. Uncontrolled chronic diabetes can lead to heart attacks, strokes, kidney failure, blindness and other terrible complications. It’s frightening.
Type 2 diabetes is preventable. But genetics and culture make it more difficult for some people to prevent it than others.
In response to the MASALA Study, the American Diabetes Association has issued new guidelines to lower the BMI threshold to 23 and to take ethnicity into account when screening. So far, California, Massachusetts and Hawaii have enacted stricter health screenings for South Asians and East Asians.
The problem here goes above a simple lack of understanding. This disastrous miscarriage of health management is built upon a health care industry that too often caricatures its patients and treats them with a one-size-fits-all mindset.
When doctors focus on how diseases affect the stereotypical middle-aged white male patient, it’s no surprise that statistics show that women have a higher mortality rate from heart attacks and that South Asians are routinely overlooked for heart health screenings.
I demand better. For me, my family, my friends and my country. Because I know in my heart that we can do better.
The first step in solving this is building awareness and funding more research. I commend Rep. Pramila Jayapal, D-Washington, for fighting for the South Asian community and submitting the South Asian Heart Health Awareness and Research Act of 2019, which uses the MASALA Study data to bring these issues to light.
We also have to hold our representatives’ feet to the fire, whether they are Democrats or Republicans, and ask, “Why is my health care system not fighting for me?”
This is a problem that South Asians as a community need to bring awareness to and fight proactively. This affects all of us — young, old, new to this country or born in it — because we are more susceptible to it and so are our families. Knowing this, we have to take care of each other and make sure our families have healthy habits. If the system won’t fight for us then we must be ready to fight for ourselves. I’m ready. Are you?
Nishi Rahman writes the Thursday column on cultural and political diversity as a second-generation American.
Contact him at [email protected]