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HEALTH ISN’T AN INDIVIDUAL JOURNEY. There’s so much to learn, to share, to understand. As I track my own journey with pre-diabetes, I was delighted to have a chance to chat with one of America’s foremost experts on heart disease, diabetes and more, Dr. Alka Kanaya, a physician-scientist at UCSF (see full video above)
She is the primary investigator for the groundbreaking MASALA study, a landmark, 16-year piece of research into heart (and more) health of South Asian populations in the US. Whether you are South Asian or not, the insights from her research offer vital lessons for anyone looking to understand metabolic health, challenge conventional metrics, and protect their future.
This discussion is part of a new series: My Pre-diabetic Life: How I’m using some AI, some planning, some advice, and some luck to reverse a worrisome diagnosis. Powered by AROGYA WORLD, one of the most innovative health nonprofits in the world (join our WhatsApp group and learn with me).
MASALA is an acronym, not just a type of spice mix: Mediators of Atherosclerosis in South Asians Living in America (atherosclerosis is a disease where fat, cholesterol, and other substances build up in the walls of your arteries, forming hard deposits called plaque that narrow blood flow. It’s biggest risk factors: high blood cholesterol, high blood pressure, smoking/tobacco use, diabetes and obesity.
South Asians have an exceptional propensity for all kinds of health issues, starting with heart disease. From the MASALA Study website:
Heart disease is the number one cause of death worldwide and accounts for 30% of all deaths. South Asians comprise 60% of the world’s heart disease patients.
South Asians have the highest death rate from heart disease in the United States compared to other ethnic groups. Studies from around the world have shown that South Asians have a higher burden of cardiovascular risk factors at younger ages.
As I am learning, there are ways to effectively manage the risks. The first thing to do is to really understand your key indicators, including Body Mass Index (BMI). Dr. Kanaya wants us to look beyond 25 being the threshold number. Like many of you, I was suprised to learn that “to have the same number of risk factors as a white person who has a BMI of 25, a South Asian person would have a BMI of 19.6.” That is so low!
Trusting one data point is always a trap of some sort, but it’s also a hard drug to quit, especially when it’s everywhere. BMI is exactly that. I got educated here, and there’s a lot more in our discussion, and the MASALA website is resource-rich. There are exercise regimens, recipes, lifestyle guides—and the data to support the recommendations.
While the numbers are staggering for diabetes in South Asian populations, and it appears that Bangladeshis and Pakistanis are at a particularly high risk: About 50% for Bangladeshis; 41% for Pakistanis and 24% for Indians.
Her thoughts on the effect of an Indian state’s development and wealth on diabetes prevalance:
Why protein matters so much:
Below you will find some key takeaways & Q&A highlights generated by Gemini. See full video at the top of this page.
Beyond BMI: Traditional BMI benchmarks misrepresent risk for Asian populations. While standard guidelines classify overweight starting at a BMI of 25 or 26, the threshold for Asian individuals is recommended at 23 or lower. In fact, metabolic abnormalities in South Asians start appearing at BMIs as low as 19.6, meaning relying solely on standard BMI screening misses roughly 40% of at-risk individuals.
Fat Distribution & Muscle Mass: It’s not just weight on a scale; it’s where fat is stored. South Asians frequently store ectopic fat in high-risk areas like the liver, abdominal organs (visceral fat), and muscle tissue. Coupled with having the lowest lean muscle mass compared to other demographic groups, early and consistent strength training and healthy protein intake are critical.
A1C Nuances: Hemoglobin A1C is a primary marker for glucose levels, but it can occasionally give falsely elevated readings due to underlying conditions like thalassemias, anemias, or Vitamin B12 deficiencies. It is best to cross-reference A1C results with fasting glucose tests or two-hour glucose tolerance tests.
Subgroup Differences: Research from the MASALA study disaggregates data across South Asian demographics, showing distinct diabetes prevalence rates: 50% in Bangladeshis, 41% in Pakistanis, and 24% in Indians. These variations point toward social, behavioral, dietary, and structural factors rather than purely biological ones.
Actionable Lifestyle Tips:
Sleep: Aim for the sweet spot of 6.5 to 7.5 hours per night, as both sleep deprivation and oversleeping correlate with higher diabetes risk.
Nutrition: Focus on balanced, fiber-rich whole foods, vegetables, whole grains, and non-processed protein sources rather than extreme keto diets.
Restorative Yoga: A study (the PRISM study) showed that a year of restorative, relaxation-focused yoga improved fasting glucose by six points—a result comparable to traditional diet and exercise programs.
Sree: Why shouldn’t we rely solely on standard BMI to gauge our health risk?
Dr. Alka Kanaya: “BMI is a surrogate marker of obesity... Asian people have smaller body sizes and body frames than people from other parts of the world. Even at a normal BMI, there’s a lot of metabolic abnormalities—more diabetes, abnormal cholesterol, and high blood pressure. BMI itself should not be used as a criterion for saying who’s at risk when there isn’t a great cut point. There’s high risk even at low BMI.”
Sree: What should people focus on if weight or BMI isn’t telling the whole story?
Dr. Alka Kanaya: “That should be the metric that you’re looking at when you’re working on prevention of diabetes: how much is my hemoglobin A1c improving, how much is my fasting glucose improving... The key here is about strength training and improving the quality of the diet to have more foods that have healthy sources of protein.”
Sree: How does stress reduction and yoga fit into diabetes prevention?
Dr. Alka Kanaya: “We took people in a year-long yoga versus stretching program. We found the people in the yoga group—restorative yoga, very relaxation focused—actually had improvements in their fasting glucose by six points in a year. They dropped from pre-diabetic to normal levels.”
Sree: What is your message to people who feel overwhelmed or resigned to a diabetes diagnosis?
Dr. Alka Kanaya: “There’s so much more in our circle of control in terms of prevention... People feel like it’s futile, like it’s going to happen. I think that there’s so much more that we can do to prevent these things than ever before. The knowledge is there. We just need to get motivated, find the support we need, use the data to track our own numbers, and know them well.”
Learn about the Research: Visit the MASALA Study to explore over 150 published papers, diet tips, and South Asian nutrition guides.
Participate in Asian American Health Studies: Check out the MOSAAIC Study (Observational Study of Asian American and Pacific Islander Communities) to see if you or family members can participate.
Explore Health Equity & Prevention: Visit Arogya World for practical health tools and community-based diabetes prevention initiatives.
Join the Conversation: Connect with our community by subscribing to Sree’s Sunday Note on Substack or joining the My Pre-Diabetic Life WhatsApp group to share tips, live sessions, and practical strategies!
Have an idea for anything we’re up to? Let’s collaborate! sree.sreenivasan1@gmail.com
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