India holds the dubious claim of ‘Diabetes Capital’ of the world. Is this claim because of the high absolute numbers as a result of our high population numbers, or is it that we as Indians are more prone to develop the disease?

Let us take a look at the numbers. After all, numbers don’t lie.

The global incidence of diabetes is 8.5%  – WHO 2014

According to an Indian Council of Medical Research study over the years 2008-11, in Tamil Nadu, the prevalence of diabetes in urban areas (13.7%) is almost double the rate found in rural areas (7.8%). In Jharkhand, the prevalence of diabetes in urban area is four fold higher than rural areas (urban: 13.5% vs. rural: 3%, In Chandigarh, the prevalence of diabetes in urban is higher than the rates in rural areas (urban: 14.2% vs. rural: 8.3%, In Maharashtra also, the prevalence of diabetes in urban is higher than the rates in rural areas (urban: 10.9% vs. rural: 6.5%, p<0.001) In Chandigarh, the prevalence of diabetes, both in urban and rural areas was higher than in other three regions, viz., Tamil Nadu, Jharkhand and Maharashtra.

Incidence of Diabetes in India in Urban and Rural populations.

Most importantly, during the period 1971–2000, studies  from different parts of India reported a 10-fold increase in the incidence of diabetes in urban India (from 1.2% in 1971 to 12.1% in 2000).

This is a very serious concern. Let us try to understand the reasons why this could be happening. If we can identify causes, we are in a position to address solutions.

1  Vegetarianism

India hosts more vegetarians than the rest of the world put together. A 2006 survey by The Hindu newspaper found that 40% of the population comprises vegetarians.  Compare this with global statistics: Australia leading the rest at 11.2% and most other countries coming in at 2 – 5%.

How is a dietary preference relevant? What matters is the amount of protein consumed as a proportion of total dietary intake.

Dietary protein consumption per person.

The darker the color, the higher is the meat consumption in that country. It is clear that in India, the meat consumption is really low.

Why is it important to consider meat consumption? And why is vegetarianism relevant?

In my personal experience as a doctor of Integrative Medicine, analyzing diets regularly, I find that the figure of 56g/day  of protein intake for Indians is highly optimistic; I come across figures like 15 – 40 g/day routinely. This includes ‘non vegetarians’ who do consume some meat. Most Indians do not eat meat daily – there are various abstinence days in the week, and certainly the number of people consuming meat thrice a day is very small indeed. But for vegetarians, the situation is pretty bleak. Vegetarians routinely consider dal, sprouts and milk and milk products as good, adequate protein sources. While it is true that dal contains protein, it is only about 20% by weight. And that is being generous!

I found these numbers online:

I find that many of my patients don’t even eat dal daily. If they do, the amount cooked is typically 250g for a family of four. So let’s calculate. Assuming equal division, one person could consume 60g

of dal daily. This would provide 12g protein. And this is not high quality protein as it lacks some of the essential amino acids. A long way to go, to reach 56g! Also, this means that there is a disproportionately high intake of carbs, which is exactly what we don’t want! So unfortunately, it’s quite a lose-lose situation!

The reason for low protein consumption is as much economic as religious. Protein is expensive and in a country where, for a lot of people, a single meal is hard to come by, protein is not a priority.

Now let us examine another graph predicting diabetes rates in the year 2035.