Opinion | Don’t pass the sugar: Asians and type 2 diabetes

Opinion by Juliana Fong
Feb. 19, 2023, 9:09 p.m.

In 1947, when my grandmother was 12 years old, her father died from diabetes. Due to a lack of viable treatments, complications of diabetes often went untreated. My own dad, who has been rail thin his whole life, is prediabetic, teetering close to the dreaded “D.” He tells me that he has to cut carbs and sugars — and he wants me to understand why I should do the same.

I learn from him that those of us with a predilection for type 2 diabetes need to figure out how to move our 21st-century lifestyles closer to the traditional lifestyles where our ancestors didn’t develop type 2 diabetes in droves. We need to walk and exercise more to burn off the extra fat so that it doesn’t fill up our body cavities. We need to avoid overconsumption and make sure our diet is lower in empty carbs and higher in nutrition and fiber — closer to the traditional Asian diet filled with fresh vegetables.

75 years after my great-grandfather’s passing, I googled my way to understanding my unfortunate family legacy. When someone has type 2 diabetes, while they may have basic bodily mechanisms in place to regulate their blood sugar levels, there is excess sugar in their bloodstream, and their cells don’t work efficiently enough to use it. The extra sugar unutilized by their cells turns into fat. This part of the story is where my family’s Asian ethnicity comes into play.

Those of us with Asian heritage are at least 30-50% more likely to develop type 2 diabetes than persons of European descent. Only recently has science begun to unravel the mystery of why that is. A key culprit lies in the type and location of our fat.

As a group, Asians have lower BMIs than Caucasian people and that’s why, like my Dad, we often fall well within the standard “healthy” weight and height charts our doctors use. However, Asians actually have a higher percentage of fat than Caucasians. In addition to having less lean muscle, we tend to have more of the “bad” kind of fat in our bodies that kickstarts type 2 diabetes: visceral fat. This fat is hidden deep in our torsos, between our organs. Because of its concealed location, this type of fat doesn’t cause people to look “bigger.” Meanwhile, subcutaneous fat, which is located just below the skin, is more visible. Ironically, although subcutaneous fat makes a person look larger, it’s actually considered “good” fat by physicians because it doesn’t cause diabetes. Caucasians tend to accumulate subcutaneous fat before they accumulate visceral fat. Asians, on the other hand, tend to accumulate visceral fat over subcutaneous fat. This is one reason why a young Asian person who appears thin could have elevated blood sugar levels and even be diabetic.

Modern science, including the study of genetics, is helping to unravel the mystery of why there is an epidemic of type 2 diabetes among Asians, both in the United States and in Asia. For example, scientists have found that the traditional Chinese lifestyle involved strenuous physical activity and a low-calorie diet consisting of carbohydrates and little animal fat. In this environment, it may have been an advantage for one’s body to run efficiently on as little fuel — sugar — as possible. Moreover, less muscle mass meant less chance of burning up an already meager stash of fuel.

Now take that lean, mean, fuel-efficient machine to modern-day America: food is plentiful, processed and filled with empty sugars and carbs, and most people don’t engage in the manual labor of their forebears. This may have overwhelmed the machinery of our bodies that evolved for physical hardship and low calories. Furthermore, this emphasis on overconsumption and lack of exercise has started to spread to countries in Asia as well. The resulting type 2 diabetes epidemic has made us Asians victims of our own prosperity.

The legacy of type 2 diabetes in Asians can be compared to that of sickle cell anemia in people of African descent. In people of Asian descent, having more visceral fat and less lean muscle mass may have been helpful in times of famine, but these traits have led to problems like diabetes in more prosperous times. Meanwhile, in people of African descent, having the sickle cell trait can provide people with an advantage against malaria fatality, which used to be extremely beneficial due to lack of treatment for malaria. However, the sickle cell trait can also lead to severe health complications, including infection and pain. But knowledge can go a long way towards coping with these conditions.

I now understand that there are differences in diabetes vulnerability even among the different subgroups under the broad “Asian” umbrella. Korean, Japanese or Chinese ancestry puts you a notch up on the type 2 diabetes scale over Caucasian people. South Asians, Pacific Islanders and Filipinos are generally even higher up on that scale. The point is that we all need to be aware of what our own ethnic heritage predisposes us to so that we can take action.

As an Asian American, my hope is that during my lifetime, medical research will find ways to diminish my susceptibility towards metabolic syndrome and type 2 diabetes. In the meantime, I’m looking everywhere I can for small lifestyle changes to improve my odds for fighting diabetes, whether it’s simply swapping a sugary Frappuccino for an unsweetened iced tea or taking a few laps around Meyer Green.

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