Diabetes is striking South Asians at high rates, with historical food and lifestyle choices previously blamed.

• Diabetes has deadly complications and is increasingly common in India.
• South Asian populations, about 2 billion globally, have high diabetes rates.
• Historically, food and lifestyle were considered the primary causes.

British colonialism led to numerous famines in India, with policies exacerbating the effects and leading to millions of deaths.

• British Raj ruled for 89 years, during which 25 major famines occurred, killing at least 60 million Indians.
• British policies such as harsh land taxes, reduced regional spending, and food exportation intensified drought impacts.
• Famines like the Great Famine of 1876-1878 and the Bengal Famine of 1943 were linked to British policies.

Britain's economic exploitation of South Asia during famines extracted vast wealth and had lasting health impacts.

• Britain extracted an estimated $45tn from India using exploitative trading practices.
• These famines have had a significant impact on South Asian health and genetics.

Epigenetics explains how famines have caused South Asian genes to become starvation-adapted, increasing diabetes risk.

• Epigenetics studies how behaviors and environment affect gene function and inheritance.
• South Asian genes adapted to store fat and process sugar differently due to famine conditions.
• Surviving a famine nearly doubles diabetes risk in the next generation.

Starvation adaptation has made South Asian bodies insulin resistant, affecting how they process food and store fat.

• Insulin resistance means muscle and liver cells have a harder time absorbing sugar from the blood.
• Excess sugar is often stored as fat, which can lead to diabetes and other diseases in times of abundant food.

The current abundance of food exacerbates the risk of diabetes in South Asians; adopting traditional practices could mitigate risks.

• The current food environment with added sugars increases diabetes risk for those with starvation-adapted genes.
• A return to traditional food and exercise, like Ayurveda and yoga, may reduce diabetes likelihood.

It's crucial to decolonize health research and advice to accommodate different ethnicities and their unique health susceptibilities.

• With rising insulin costs and diabetes rates, it's important to personalize health research and advice.
• Decolonizing health practices could better serve the specific health needs of South Asians.