Despite conscious diets, gym memberships and new year resolutions for better fitness, why are South Asians prone to cardiac health issues? We decode.

Paramita Purkayastha Wednesday 18th January 2023 05:22 EST

A quarter of Brits (25%) have ditched the gym in favour of exercising outdoors, according to a recent study by outdoor retailer GO Outdoors and mental health charity Mind. 61% of Brits agreed that the outdoors is where they feel most content and unburdened. A third of Brits (33%) have claimed that exercise helps to improve their mental health, and with many people making New Year’s resolutions to get fitter and work on their well-being, now is the perfect time to start. 

Despite following regimented fitness routines and conscious diet plans, South Asians are inevitably one of the most vulnerable ethnic groups when it comes to heart diseases. So much so that the American Heart Association along with several other medical groups recommended considering the patient’s ethnicity for the first time in 2019 while determining their cardiovascular risks and treatment options based on research carried out on heart health among South Asian by a team of researchers. While the regular accepted BMI is 25, for South Asians, there have been public awareness campaigns like ‘Screen at 23’ urging to bring down the threshold BMI to 23 during health screenings. While a part of cardiac issues is possibly governed by genetics, stress remains one of the biggest contributing factors when it comes to ailments of the heart. Asian Voice spoke to renowned doctors, nutritionists, trainers as well as stressed desk job workers to understand the most common reasons behind the problem, and we found some really good recommendations along the way. The recommended solutions are often easier to adopt than the expensive gym subscriptions we buy every new year, only to ditch them a few weeks down the line once the going gets tough.
The South Asians with broken hearts
Joanne Whitmore, a Senior cardiac nurse at the British Heart Foundation, told Asian Voice, “The risk of coronary heart disease is up to 50 per cent higher in first-generation South Asians than in the white European population in the UK. However, there may be differences in risk depending on your ethnic origin. Those at the highest risk are people from a Bangladeshi heritage, followed by people from Pakistan, India and Sri Lanka – but even people from a Sri Lankan heritage may be at higher risk than white Caucasians. This increased risk is partly to do with body shape and diabetes. People from a South Asian background tend to develop fat around their middle and this increases the risk of developing Type 2 diabetes, which could then lead to coronary heart disease and a heart attack. While lifestyle factors will play a role, genetics and ethnicity also contribute to someone’s increased risk of developing diabetes or coronary heart disease.”
Dr Arjun Ghosh, a multiple international and national award-winning Consultant Cardiologist at Barts Heart Centre and University College London Hospital and researcher, breaks this down further. “Alongside the genetic factors, there may be some environmental factors which may adversely affect the risk profile – mainly in terms of diet and exercise. There is emerging data to suggest that the environmental factors are modifiable to the extent that second and third-generation South Asians in the UK do not have the same risk profile as first-generation South Asians. Also, those from lower socioeconomic backgrounds are often at increased cardiovascular risk. This is due to poorer nutrition, lack of exercise, and smoking. We also know that cardiovascular disease is more common in males and increases with age (in men and women). A healthy diet, exercise, weight loss, and not smoking will all be very beneficial in controlling risk factors for cardiovascular disease,” he said.
This might resonate with Neha, a 36-year-old vice president of a bank in the UK and a mother of two girls aged five and three in the UK. Her father passed away at 52 due to cardiac arrest after a meal one seemingly fine day. He did not have any pre-existing health issues. So once her GP diagnosed her as borderline obese, she signed up for an online exercise regimen with Withstand Fitness last year, because she wants to be a healthier person, a better mother, and be there for her children. She told Asian Voice what made the startup based in India stand out to her, “They take your heart rate and they know what your average heart rate is, the resting heart rate and while you're working out. And if there is any slight change, if you say you're now feeling heavy after a particular exercise, they will stop you. So they will monitor it online to make sure you don't cross your leg because I think people are sometimes overdoing it as well and falling into that trap. So they ensure that you don't overdo it as well because that's the other extreme that we're seeing now. Aren’t people working out in the gym and falling flat?”
Move your body
Breaking the exercise down to bits is something that personal trainer, wellness coach, and fitness activist Lavina Mehta MBE recommends as well. She told Asian Voice, “Prior to the pandemic I raised a national campaign to “Get UK Asians Fit” as I was alarmed by the statistics. According to, UK South Asians are up to six times more likely to have diabetes than the white population, and with diabetes, prevalence predicted to increase by 47% by 2025, the condition will continue to have a considerable impact on South Asian communities across the UK. They also have a two-fold increased risk of heart disease compared to the general population. The risk of coronary heart disease is up to 50% higher in first-generation South Asians than in the white European population in the UK. Diabetes increases your risk of CHD and of having a heart attack. We also know that Asians and Minority ethnic people are still less likely than the overall average population in England to be physically active.
Exercise is so important as it makes your heart stronger. This helps it pump more blood with each heartbeat (cardiac output). This delivers more oxygen to your body. With more oxygen, your body functions more efficiently. Exercise can also lower blood pressure. It reduces your risk of heart disease, provides healthier cholesterol levels & better blood sugar regulation to help prevent heart attack or stroke. Being physically active is a major step towards good heart health.
Current guidelines are to do at least two strength training workouts and 150 minutes of moderate-intensity aerobic activity per week. However, people struggle to do even 30 minutes. This is where I recommend my concept of ‘exercise snacking’ - if you don’t have time to do 30 minutes of exercise all in one go, you can break it into smaller snacks to fit more easily into your daily routine. My exercise snacks or short bursts (say 6x 5 minutes of brisk walking) are just as good as doing 30 minutes. A study shows that exercise snacks provide a 40% reduction in blood sugar (glucose levels) and blood fats (triglyceride levels.).”
The disparity between the cultures of South Asia and Britain when it comes to being active is something that was acutely understood by Sourav, a 35-year-old IT professional in the UK. He told Asian Voice that one thing he observed after coming to the UK was the importance the British culture placed on the physical and overall health development of children from a very young age. According to him, it was so much ingrained among the British that even his colleagues stuck in desk jobs like him took time out to go to the gym or at least seek out some form of physical activity, something that was glaringly absent among his South Asian peers.
“Here every neighbourhood would have a big park. Anyone can go and you'd have a lot of amenities there. Whereas in India, you’d struggle to find proper playgrounds. You don't have a proper swimming pool, even the ponds that have been filled. As an example, swimming is something that is a frequent activity here and people are more used to it. But swimming isn't a general practice back in South Asian countries. Whereas if you don't know how to swim here, it would not be a general case and people would assume you had some serious reasons for not learning it. They would ask, “Are you not necessarily fit, or do you have any health problem that you are not swimming?” Right from the schooling days when they're actually in their school, they're taken outside to the swimming pool to take care of their health so they learn to swim. For me, I don't know swimming, I never was accustomed to, nor was I ever entertained, to go and swim.”
Yoga helped Sourav’s father-in-law cure his heart blockage which was detected when he was 55. According to Sourav, South Asian ancestors knew how to strike the balance between the physical, the mental, and the spiritual, something which is getting lost in the overstressed lifestyles in developing countries in the 21st century. For Neha, what helped was the online mode, as it easily allowed her to fit in half an hour to 45 minutes of exercise during her office breaks. Working out together with other women too gave her a sense of community and motivated her.
Among the South Asians in the UK, another factor is the affordability of gyms or personal trainers during a time when a pandemic created irreparable damages, leading to a high cost-of-living crisis. Not only did it lead to people doing more work due to being stuck at home to make ends meet, but it also made them cut down on what was not naturally ingrained in them as a bare essential- in this case, assisted exercise. Apart from walking distances for which she previously used to drive, Neha, for instance, found the online mode of exercising cheaper than something that she would spend on herself by going to the gym. And it is not only South Asians. According to a recent study by outdoor retailer GO Outdoors and mental health charity Mind, a quarter of the British (25%) have ditched the gym in favour of exercising outdoors. Varun Bhanot, the co-founder of fitness assistant MAGIC, had a solution for this to share with Asian Voice: "In my early twenties I lived a pretty unhealthy lifestyle and got into a position where, according to a personal trainer, I was clinically obese. I realised I had to do something to change this otherwise I was at risk of health problems, so I started working with a PT. I went through a pretty radical transformation and felt so much healthier and happier. I'd never even lifted a dumbbell before and suddenly I'd lost a quarter of my body fat. The problem is that the way I'd achieved this wasn't very accessible. Personal training is expensive, and it's difficult for people to get started in the gym without knowing what to do. Post covid people want a lot more flexibility when it comes to fitness too. And so, the idea of MAGIC was born. I wanted to create something that could automate a lot of the things a personal trainer can do, and give people the opportunity to achieve amazing transformations at home. And we decided a combination of AI and hardware could do that with MAGIC- the UK's first AI Home Gym.”
Home made food to the rescue
There is a prevalent perception that it is the South Asian diet that could lead to an increased risk of cardiovascular diseases. The New York Times, for example, quoted the aforementioned team of researchers in claiming that high rates of cardiovascular diseases are prevalent among the people who follow either completely South Asian diets or completely Western diets composed of red meat, and alcohol. But what the study did not mention is the significant difference between the diet among South Asians in their countries of origin which is much more varied and healthier to that adopted by migrant communities which is more standardized, market-oriented, and less healthy. Sadly, the latter is now making its way back to the countries of origin and changing the original food cultures, and worse, passing off as ‘South Asian’ diet even in reputed news publications.
Azmina Govindji, nutritionist and a media spokesperson for the British Dietetic Association, has a very wholesome take on this. She tells Asian Voice, "Food is an integral part of South Asian culture and there’s no reason why we should deny ourselves our favourite foods to be healthy. Indeed, traditional South Asian cuisine can be very nutritious – we just need to be mindful of our cooking methods and portion sizes. Think about dahls, whole grain chapatis, raita, salad, lean meat and fish - these can all be part of a heart-healthy diet. What's important for us is to be mindful of things like saturated fat and sodium. Too much-saturated fat can raise the bad (LDL) cholesterol in your blood, making you more prone to heart disease. And sodium found in salt is associated with high blood pressure and strokes.
It’s easy to be an unhealthy vegetarian. You could be eating fried veggie samosas, barfi and chilli paneer and still keep to a vegetarian diet. Paneer is not cottage cheese; in fact, it is full-fat cheese. When researching my latest book Vegan Savvy: the Expert's Guide to Nutrition on a Plant-based Diet, I noticed that many South Asian people have started cooking with coconut oil, but did you know that coconut oil is made up of about 86% saturated fat? That's more than the amount you get in butter or ghee!
We can't do anything about our genetics, but we can make small changes to our lifestyles to reduce our risks. Eating a varied nutritious diet doesn't mean we have to change from curries to boiled vegetables. It is possible to still eat your favourite traditional foods whilst keeping to a heart-friendly eating plan.
One of the tools I've developed in my practice is the ‘VVPC Picture your Plate Model’. You don't need to avoid meat or your favourite foods - just fill more of your plate with vegetables and salad. The VVPC plate has room for all types of food and is the foundation of planning any meal, whether it’s the occasional desk lunch, family dinner, or dining out at your favourite restaurant. Whenever you eat lunch or dinner: imagine your plate split into four quarters. Fill two of these quarters with vegetables or salad, one with healthier carbs (like brown rice or wholemeal roti) and one with lean protein (lean meat, chicken breast, fish, or dhal-based curry).
Whenever you dish up or sit down to a meal, visualise this image, or just think of the letters VVPC.”

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