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Health Risks in the South Asian Community

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When dealing with a busy schedule, individuals often forgo the importance specific screenings for health maintenance and disease prevention. Although common medical concerns such as heart disease and depression are prominent in the media and may be addressed by general physicians, there are a few very significant ailments often plaguing South Asian communities that need immediate attention.

Genetic predisposition causes one group of people to be more susceptible to certain diseases than others. This means that in the genes received by parents, there are certain mutations in the coding DNA that cause abnormalities in the body. These may not be apparent at birth and can manifest themselves later on in life. A few examples of such diseases are coronary artery disease and diabetes. Environmental factors also play a role in increased incidence of oral cancer, and an overall lack of dietary and exercise balance are detrimental to South Asians. Many older immigrants are unaware of common diseases plaguing their age groups, which can have a good outcome if detected for early. Therefore, it is very important to gain awareness and educate our family, friends, and particularly the elderly, who are at risk for these diseases.

Increased Cancer Risk with Betel Nut Chewing

Oral cancer is not often mentioned in the media, which is why public awareness is practically nonexistent, even though it is among the ten most common cancers in the world. The results of many studies on oral cancer have been summarized by the International Agency for Research on Cancer (IARC), which shows the importance of specific risk factors such as chewing tobacco and betel nuts (also known as areca nuts or chaliyah in Urdu), which contain several known carcinogens that are toxic to the body. Chewing the mixture of betel nut and betel leaf in a quid (known as paan in some countries) is a tradition and popular cultural activity in many Asian countries, including India, Pakistan, Sri Lanka, and Bangladesh. In the quid, a few slices of the nut are wrapped in a betel leaf along with lime and may include clove, cardamom, and coconut for extra flavoring.

Chewing the betel leaf and seeds can have hypertensive effects, because they contain chemicals which cause the arteries to constrict. They may also contain tobacco, which adds to the effects of nicotine damage and greater addiction. More dire consequences are due to the carcinogens found in these nuts. Regular chewers of betel leaf and nut have a greater risk of cancer of the mouth, pharynx, esophagus, and stomach. It is important to note that support is provided by a recent study which found that paan with and without tobacco increased oral cancer risk by 9.9 and 8.4 times respectively. According to MedlinePlus, "Long-term use has been associated with submucous fibrosis (SMF), pre-cancerous oral lesions, and squamous cell carcinoma." SMF produces a hardening of the mouth lining, which can develop into oral cancer. People suffering from this disease find it increasingly more difficult to open their mouths. In some of the worst cases, patients are forced eat and drink liquidized food through a small opening in their mouths.

Immediate effects of betel chewing also include worsening of asthma, increased blood pressure, and increased heart rate. All of these symptoms put greater strain on the heart and can further lead to heart disease. The International Journal of Cancer found that there may be a higher risk of cancers of the liver, prostate, cervix, and lung with regular betel use. Other consequences can include adverse effects on blood sugar levels and possibly increasing the risk of type 2 diabetes. It is clearly seen that the positive reasons some appreciate betel seeds, such as breath freshening and pleasant taste, are tremendously outweighed by their harmful consequences.

Compounding this severely under-recognized problem is that betel chewing is addictive, and it is very difficult to coax a life-long chewer to quit. A recent study of Gujarati betel users in London demonstrated their dependency as similar to that of cocaine users, especially if there is tobacco in the paan. Patients describe dependency symptoms as difficulty in abstaining, and withdrawal symptoms including headache and sweating.

Betel quid mixtures (paan masala) are also widely available to all ages very inexpensively. Some are now chocolate-flavored and are sold in brightly-colored packages with children's faces on them. This is why many children are also exposed to betel chewing along with adults. Experts say that 11 and 12-year-old children are getting pre-cancerous growths after just two years of chewing. It is crucial to understand that oral cancer is a disease which progresses over time, so if the chewer has not experienced symptoms over many years, it does not mean they will never have to deal with irreversible and possibly fatal consequences. This is because oral cancer has an approximately 10-year incubation period. It is very hard to treat and spreads very quickly. Therefore, awareness and prevention are necessary to maintaining wellness. Please consult your physician for more information.

Heart Health Dangers

As outlined by Coronary Artery Disease in Indians (CADI) Research Foundation, South Asians around the globe have the highest rates of coronary artery disease (CAD), the leading cause of death worldwide. This disease is caused by high levels of cholesterol which form plaques in the arteries that supply the heart muscle with oxygen and nutrients. As the plaques gradually build up, they cause the artery to narrow and decrease blood supply. This can cause heart attacks and lead to greater complications. The rates of CAD are 50 to 300 percent higher in South Asians than other populations, with a higher risk at younger ages. A genetic predisposition to CAD is caused by high levels of lipoprotein a. This substance multiplies the adverse effects of traditional risk factors related to poor lifestyle habits. Although the major risk factors such as diet and a sedentary lifestyle do not fully explain the increased burden of CAD in South Asians, they are important to understand preventive and treatment strategies for this population.

Experts suggest that preventative therapy at an earlier age is needed. Dr. Enas, M.D. was the first physician to prove a 4-fold higher rate of CAD in South Asians in the United States. He has revealed the genetic predisposition is a risk factor for premature CAD found in this group. It is vital to consider lifestyle choices and monitor cholesterol levels in order to prevent initiation and progression of this disease.

Increased Risk for Type 2 Diabetes

The prevalence of diabetes is three to six times higher among South Asians than Europeans, Americans, and other Asians According to the World Health Organization,

2.1 to 4.1 percent of the adults in South Asian countries are affected by diabetes. In major urban areas, this increases to range from 6 to 12 percent. The complications from diabetes are chronic, and management can be expensive. In addition, many patients are unaware that diabetes can also lead to major ailments like blindness from diabetic retinopathy, kidney failure, cardiovascular diseases, and neurological disorders. Patients in this group have an increased tendency to develop overall and abdominal obesity, which is not only seen due to malnutrition in third world countries but is commonly found in South Asians living in Western countries. Genetic predisposition to insulin resistance causes blood sugars from food to be stored as fat instead of metabolized for energy.

An action plan recommended by participants at an international conference on "Diabetes and Nutrition: A South Asian Perspective" states that balanced nutrition is vital. Lifestyle modifications include physical exercise aimed at achieving appropriate body weight and waist-to-hip ratio. Screening of high risk subjects for early detection of the disease can help lessen progression of harmful effects. Finally, management and rehabilitation of affected patients along with effective treatment of disease in order to avoid complications are stated as mandatory.

Lack of Proper Diet and Exercise

It is clearly seen that the dangers of these diseases can be significantly reduced by adopting healthy habits. Although we are often bombarded with the significance of this in the media, the South Asian community is particularly known for its unhealthy practices. Immigrant families are prone to a sedentary lifestyle, which is due to the habits learned from back home. Also, meals are high in carbohydrates such as rice and bread, and very low in fibers and nutrients from fruits and vegetables. Furthermore, South Asian diets are often low in fish and nuts which contain omega-3 fatty acids, a preventative nutrient against cardiovascular disease. A study on the benefits of omega-3 fatty acids was published in The Lancet journal, which found that patients taking omega-3 rich diets had superior cardiovascular function. Non-fatal coronary events were also significantly reduced in this group. It was proven that omega-3 fatty acids help increase HDL (good cholesterol) and decrease VLDL (bad cholesterol) to improve heart and vascular function. This can be achieved easily at home by consuming fish at least two times a week along with a well-rounded nutritional diet and adopting a consistent exercise schedule.

Author of this article: Sukaina Hussain
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