Carbohydrates in the South Asian Diet (advanced)

Disclaimer: The information provided here is for educational purposes only and should not be considered medical advice. It should not be used as a substitute for professional healthcare advice, diagnosis, or treatment. Always consult with your physician or a qualified healthcare provider before making any changes to your diet, exercise routine, or health-related practices.

You’ve probably heard of carbohydrates before. Whether it was growing up, when you were told to eat them for energy, or from looking at your plate at dinner, and noticing the three rotis, rice, and aloo sabji, you are eating.  Personally, when I think of carbohydrates, I think of an episode of The Office, where Michael is “carb-loading” before a run with fettuccine alfredo. However, what exactly are carbohydrates and what is their role in a healthy diet? In this article, we will break this down for you and hopefully provide you with a solid understanding of carbohydrates.

Note: Although this section is somewhat technical, it provides a simplified explanation of how carbohydrates are processed in the body. For more information, consider consulting Dr. Ronesh Sinha's book, “South Asian Health Solution.”

At their essence, carbohydrates are simply chains of sugar molecules linked together. Some of these chains are very short, with only 1-2 molecules, which we call simple carbohydrates, and others have much longer chains, which we call complex carbohydrates. In the body, most of the carbohydrates that we eat will be broken down into glucose molecules (think of it like a scissor cutting up the chains into single molecules). Glucose is essentially what the body uses for energy, mostly. Technically, glucose is utilized by nearly every part of the body; however, for simplicity, we will focus on three primary areas where glucose enters the body: muscle, fat, and the liver.

So, picture this: we have eaten food, particularly carbohydrates, and our digestive system has broken it down into glucose molecules that have entered the bloodstream. Now glucose is quite essential for the body. Most of the organs, tissues, and cells inside us require glucose to carry out daily functions. However, when it comes to the liver and muscle, there comes a bit of a challenge. In an ideal situation, glucose is being transported to the liver and muscles to provide energy or to be stored as glycogen. What is glycogen? You may have heard bodybuilders talk about “glycogen stores.” Essentially, this is how the body stores glucose in case it is needed at some point. You can think of it as an energy reserve, where when we do need energy to perform a specific task, such as lifting weights, the body can break down the glycogen into glucose to fuel us!

There is one last player we need to talk about, and that is insulin. Insulin is a hormone that basically allows glucose to enter the tissues. We can liken this to a sporting event analogy. If the tissue is the stadium where a sporting event is occurring, and glucose is the people who are trying to enter the stadium, insulin is the ticket we use. Insulin receptors, which respond to insulin to allow glucose to pass through, can be thought of as the people checking our tickets. 

Now notice above, how I said in an ideal situation, glucose is being used by the liver and muscle for both energy usage and storage. However, this is not always the case. Some factors to consider are if there is enough space for glycogen to be stored, and how much of a demand there is for glucose by these tissues. For example, if you spend most of your day sitting it down, your muscles are not going to want glucose actively. There is also the issue of insulin resistance, where the receptors, or the people checking the tickets, no longer respond to insulin, leaving the glucose in the blood.

South Asians tend to get into trouble here. Our glycogen stores in both liver and muscle are stored to full capacity, and so glucose can’t get inside. We work desk jobs, so there is not much demand for glucose in the muscles anyway. Additionally, insulin resistance tends to have a higher prevalence among South Asians than other ethnic groups. All three of these may be working against us, so now what? That glucose instead goes to the fat cells, which are happy to take the glucose and then can be converted into fat for storage. Over time, this can lead to weight gain, inflammation, and other adverse health effects. The liver can also take excess glucose and convert it into triglycerides(fat), which can be either deposited in the liver and lead to a fatty liver, or exported out into the blood, causing our blood triglycerides to go up, which also has its host of negative health effects, such as increased risk for heart disease and metabolic syndrome.

One of the unique aspects of our diet is the high emphasis on carbohydrates. Growing up, I could typically expect a breakfast that consisted of Maggi or Poha. Followed by a lunch, which would include Dal, Roti, and a subji, which sometimes would be Aloo, or potato, and dinner would be Khicidi, which is just more lentils mixed with rice. High-carbohydrate diets are highly prevalent among South Asians, and, considering the previous section, the picture begins to become clearer about why South Asians are at higher risk for many metabolic diseases.

We have talked before about how we are already genetically predisposed to these diseases. Our high-carbohydrate diet made sense when our ancestors were highly active, spending a lot of time outside doing manual work. Those carbohydrates were easily used for energy or stored as glycogen for future use. However, nowadays, we are no longer as active. Our lifestyle has undergone a significant transformation to the point where most of us spend our days sitting in front of a computer. While our lifestyle has changed, our diet has remained largely unchanged. Those carbohydrates that were initially needed for energy are no longer required and instead accumulate in places where they should not be, i.e in fat cells and as triglycerides. 

Maybe you’ve read so far and are thinking that you should abandon carbohydrates, all of them, and commit to that keto diet your friend told you about. However, I want to use this section to explore a bit of the nuances of what I have written above.

The first idea is that not all carbohydrates are equal. It would be unfair to assume that a bag of chips and a cup of lentils have the same effect on you physiologically. The main idea to think about is the insulin response. Refined carbohydrates, such as chips, candies, cookies, and white bread, have been stripped of a lot of their nutritional value, particularly fiber, vitamins, and minerals. As a result, they are digested quickly and spike your blood glucose levels, which results in a high insulin response. If the bulk of your diet contains mainly these foods, then over time, you become more at risk for insulin resistance. However, a complex carbohydrate like lentils, or Daal, results in a slower increase in blood glucose and a more controlled insulin response because it takes longer to digest. The vitamins, minerals, and fiber remain in the food, allowing you to reap the benefits. We discussed simple carbohydrates versus complex carbohydrates, but there are additional distinctions. Fast vs slow, refined vs unrefined, and the list goes on. If I were to think of a rule of thumb, generally, carbohydrates that are minimally processed, or unrefined, are likely to have more health benefits and a more regular metabolic response than refined, or processed, carbohydrates.

Thinking about the South Asian diet, I personally don’t think we have to eliminate carbohydrates, but I do think there is value in potentially reducing the amount we consume. Dr. Ronesh Sinha, in his book talks about how, because our carbohydrate intake is so high, some up to 400-600 grams of carbohydrates per day with a relatively inactive lifestyle, it may be beneficial to reduce our carbohydrate intake to a much more moderate level, and instead focus on increasing the protein and fat content of our meals. Perhaps more Greek yogurt than white rice, for example! 

I say all this to say, don’t necessarily avoid carbohydrates, but rather keep this perspective in mind when evaluating your own diet. Focus on the quality of the carbohydrates you eat, and try to find areas in your diet where you may be eating excessive carbohydrates. For myself, I try to pick one carbohydrate source per meal, as I would usually eat roti and rice with my meals.

Additionally, a significant part of this is activity level. The higher-carbohydrate diet becomes more problematic the less active you are. Engaging in regular exercise can increase the demand for glucose by your muscles, and can also open up more spaces for glycogen storage in both the liver and muscle! 

I hope this was helpful! Feel free to message us if you have any questions, and in the meantime, stay healthy!