South Asian Health

In the South Asian section of our blog, you’ll learn about South Asian health issues, prevention and wellness to improve health and reduce risk of disease. You can also visit PAMF’s South Asian Health website for a wide range of South Asian health articles, videos, FAQs and more.

Can’t Find the Keys Again? Tips to Improve Memory

Nowadays, a growing number of patients of all ages are coming to see me because of memory loss. They do their usual online research, type in their symptoms, and then panic because they think they have early onset Alzheimer’s disease. Fortunately, this isn’t usually the case.

What is it about our current, modern day lifestyle that’s leading to deteriorating memory?

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Calcium & Vitamin D: Why Supplements Don’t Replace a Healthy Lifestyle

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For most women, especially after menopause, taking a calcium supplement with vitamin D to prevent osteoporosis is as routine as brushing your teeth. Now studies are showing that there is no proven fracture prevention at daily doses of up to 1000mg per day of calcium and 400 international units (IUs) of vitamin D. More specifically, the guidelines published by the USPSTF (U.S. Preventive Services Task Force) state the following:

  • Current evidence shows no proven benefit for premenopausal women or men to take combined vitamin D and calcium to prevent fractures.
  • In healthy, postmenopausal women, there is no proven benefit for taking calcium at doses of less than 400 IUs of vitamin D and less than 1,000mg of calcium.
  • For healthy, postmenopausal women taking higher doses of calcium and vitamin D than the ones listed above, there is no sufficient evidence balancing risks and benefits.

Not only are studies inconclusive on the benefits of calcium, but there are also studies suggesting a possible increased risk in heart disease. This has not been confirmed by well designed studies, but an association has been observed between calcium supplementation and heart disease in men and women, presumably due to the role of calcium in the formation of artery-blocking plaques. So, healthy women taking high dose calcium supplements (more than 1,000 mg) don’t have to toss out their pills, but should be aware of the lack of proven benefits and potential risk involved. The generally recommended goal is to get a TOTAL daily calcium intake of 1000 mg per day for women up to age 50 and men up to age 70, and 1200 mg per day for older adults. Try to get most or all of this through diet since there has been no link between dietary calcium and heart disease risk.

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Health Risks of ‘Skinny Fat’


A significant number of South Asians are in fact, ‘fatter’ than they think. When I say someone is fat, I don’t mean it in a derogatory way. I define ‘fat’ as someone who carries excess adipose tissue (scientific term for fat) that may be visible or invisible, but is enough to cause metabolic changes that increase the risk of developing conditions such as heart disease and diabetes. Individuals who do not appear fat on the outside, but show internal biological signs of carrying dangerous amounts of excess fat tissue, are casually termed ‘skinny fat.’ The more recently used medical acronym for skinny fat is MONW (Metabolically Obese Normal Weight). Basically, this refers to having too much fat and too little muscle, which describes the majority of South Asians in my practice, and many in the community. Keep in mind, ‘skinny fat’ is becoming common in all ethnic groups, so it is important for everyone to be aware of this, but this is more prevalent in Asians.

Being fat is a completely subjective description. You may think you’re fine, your spouse may think you’re overweight, and of course, your mother will always think you’re too skinny and can use a few extra pounds. Instead of defining ‘fatness’ as a rough, inaccurate estimate based on individual opinion, we need to be much more scientific about this.

Dangers of being ‘skinny fat’

We’ll talk about how to determine if you are ‘skinny fat’ in a moment. Firstly, I want you to know how risky this condition is. A study in the Journal of the American Medical Association (JAMA) showed that 1 in 4 skinny people have pre-diabetes and are ‘metabolically obese.’ What was really a surprise is that the study found if you are ‘skinny fat’ at the time you are diagnosed with diabetes, then your risk of death is double that of someone who is an overweight diabetic. When it comes to being fat, you cannot judge a book by its cover and don’t rely on the opinions of family members or others around you.

Are you ‘skinny fat?’

So, how can you tell if you are ‘skinny fat?’  Here are a few clues:

1)  Body measurements: Rely on waist circumference and waist-to-hip ratios to guide you. You can also visit the Body Size section of the Palo Alto Medical Foundation South Asian Health website.

2)  Cholesterol profile: If your cholesterol in particular, shows high triglycerides, especially in combination with a low HDL (good cholesterol), then this is a sign of skinny fatness.

3)  Blood sugar: If your blood sugar is consistently in the pre-diabetic range, or you are diabetic with inadequately controlled blood sugars, then you likely have some excess body fat.

4)  Liver blood test: Many South Asians have an elevated liver inflammation test known as the AST or the ALT. This is an early indicator of excess fat in the liver which can cause inflammation.

If these tests are abnormal, then the fatty liver is confirmed by an ultrasound. I recommend you get liver function tests done if you have any of the other signs on this list.

What to do if you are ‘skinny fat?’

The most important hormone in your body that determines fat storage in your body is insulin, and the most significant cause of insulin release is carbohydrates in your diet. Ironically, fat does not cause insulin to go up. Foods that are carbohydrate-rich will make you fatter than foods that have excess fat. Many of my patients who have the most excess body fat are South Asian vegetarians who consume no meat or excess fat in their diet, but instead consume lots of carbohydrates in the form of rice, breads, lentils, beans and starchy vegetables like potatoes. Crispy snacks and sweets also worsen the problem. So, to lower that extra fat, lower your carbs!

The next step is to make sure you get your body moving.  As a first step, take more steps. Get a pedometer and aim for an initial goal of more than 5,000 steps daily and then ultimately, at least 8-10,000 steps daily.  On top of this, try to get in at least 2-3 sessions of cardio and 2-3 sessions of weights in per week. You can combine your cardio and weight sessions into one workout by doing interval or circuit training where you perform a series of exercises consecutively to maintain an elevated heart rate. This will simultaneously allow you to increase endurance and strength. You can check out my short video on cross training for examples.

If you do show signs of being ‘skinny fat,’ be sure to work closely with your doctor to reduce your risks. You may also benefit from a referral to see a PAMF nutritionist or a PAMF South Asian Health expert.

Ronesh (Ron) Sinha, M.D.

This blog post is contributed by Ronesh (Ron) Sinha, M.D., Palo Alto Medical Foundation Internal Medicine. Dr. Sinha works closely with the South Asian community to help reduce heart disease and diabetes risk, and provides corporate health lectures to promote wellness in the workplace. Dr. Sinha holds clinical faculty positions at UCLA; Stanford University School of Medicine; and the UCSF School of Medicine. He teaches Stanford and UCSF medical students.



Personality, Stress and Your Heart Disease Risk

When you think of typical heart attack risk factors, the first things that come to mind may be things like high cholesterol, high blood pressure, obesity, smoking, and family history. All of these risks are common in South Asians, as well as other communities. However, did you know that your stressful personality can also be a risk for heart disease? You may be familiar with the “type A” personality, which consists of individuals who are impatient, aggressive and very competitive. These types of personality characteristics can be associated with a higher risk of heart disease.

Type A and time pressure

There are some other personality traits that are less obvious, but can also contribute to heart disease risk. One of these includes the element of time pressure, which is a core component of the type A personality and is independently associated with heart disease risk. This means that even if you are not the aggressive, competitive type, constantly being in a rush to meet the overwhelming demands of an overflowing schedule may still put you at risk. Many people use the word “deadline” to convey the urgency of tasks that need to be completed, even though many of these tasks are not urgent and can wait. “Hurry sickness” is actually a phrase coined forty years ago by a cardiologist who noticed that nearly all of his heart disease patients were in a constant rush to get things done. 


Related to time urgency is our compulsion to constantly multitask. How many times have you been on a conference call while surfing the Internet?  How about driving and texting or having a conversation with your child while trying to take care of work or personal e-mails on the computer? Multitasking has not been directly correlated with heart disease risk, but it does have effects on brain function by reducing our ability to learn and recall new information. It can also increase stress levels which are connected to heart disease risk. When eating is a part of multitasking, such as eating while watching TV or surfing the net, we typically overeat by ignoring our sensation of fullness. Make eating a mindful and undistracted practice. Excessive multitasking often reduces the quality of our work, the nature of our conversations, and ultimately the types of relationships we have with our family, coworkers and community.

Many people, particularly men, have a tendency to internalize emotions such as anger and frustration. Studies show that individuals who internalize emotions are at greater risk for chronic health conditions such as heart disease. If you feel uncomfortable opening up to your spouse or partner, try to find a trusted confidant to whom you can express your emotion. This might be your doctor, a coworker or friend, or a therapist.  If you just can’t open up to anyone about a particularly stressful situation or have difficulty releasing a pent-up emotion, be sure to have some practice that allows you to let out steam, such as regular exercise.

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Standard Body Mass Index (BMI) Scale Doesn’t Measure Up for South Asians

Body Mass Index (BMI), which is a measure of weight proportionate to height, is a standard used around the world to figure out when someone is overweight or obese. BMI is an estimate of body fat and a good gauge of your risk for diseases that are more likely to develop with excessive amounts body fat.

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Tips to Make a Traditional South Asian Diet Healthier

Sugar is the building block of carbohydrates. Since rice and grains are a rich source of carbohydrates, they are also a rich source of sugar.

White rice and breads are staple foods in the traditional South Asian diet, and eating uncontrolled portions often contributes to weight gain and associated health conditions, such as diabetes and heart disease, that affect South Asians.

Eating healthier varieties of carbohydrates can help reduce the risk of heart disease and diabetes by lowering cholesterol levels, blood pressure, blood sugar and blood clots. To make a traditional South Asian diet healthier, follow these tips: Read More