Asian Diets: Health Benefits and Risks

Emphasize Healthy Choices

Traditional Asian diets have some health benefits as well as some risks when it comes to diabetes.

Asian Diet Benefits:
•Green tea
•Rich variety of vegetables and fruits
•Spices
•Low red meat consumption
•Beans and nuts
•Fish and seafood
•Fruits as dessert
•Whole grains
•Tradition of controlling portion size
•Soy consumption

Research has supported beneficial aspects of traditional Asian diets. Studies in Japan have associated unsweetened green tea with a decreased risk of type 2 diabetes.1 Traditional Asian dishes include many “cruciferous” vegetables like cauliflower, cabbage, cress, bok choy, and broccoli, which are associated with a reduced risk of various diseases.2 In one study in India, even eating 3 more servings of green leafy vegetables a week was associated with substantially lower risk of heart disease.3 Soybeans are also prevalent in Asian diets, whether in soymilk, soup, or tofu, and they can, in part, replace red and processed meats as a source of protein. Whole grains such as brown rice and barley, which were more prevalent in Asian diets a century ago, also offer health benefits and a lower glycemic load. According to one meta-analysis summarizing all available studies, an increase of two servings a day of whole grain intake is associated with a 21 percent lower risk of diabetes.4

Asian Diet Risks:

•White rice and other refined grains
•Use of animal fat and palm oil
•Unhealthy trans fats (in snacks, butter, etc.) are not labeled on packages5
•Sweets and snacks high in sugar
•Tea or coffee with too much added sugar
•Too much salt
•Excessive consumption of preserved foods (such as pickled vegetables and cured meats)
 

Unfortunately, current Asian diets have white rice as a main staple. White rice contributes approximately 30 percent of energy to diets in Asia.5 In studies in China and Japan, a high intake of foods with a high glycemic index or load, such as white rice, doubled the risk of type 2 diabetes.6 Brown rice should be an easy and healthy substitute, but trials have shown that some people perceive brown rice as rougher and less tasty than white rice,7 despite brown rice’s own appealing flavor.

Salt is another major part of Asian diets that is consumed in excess. The body needs 230-460 mg per day of sodium, and Asians average more than 4600 mg per day. In Japan and China, soy sauce and salt added at home, either while cooking or at the table, were the largest sources of sodium in the diet.8 Rural communities in Asia often also rely on salting as a method of food preservation, which also contributes to excessive salt intake.9 Reducing salt intake can lower blood pressure, which is often high in persons with pre-diabetes or diabetes.10

Sugar is also a growing problem in contemporary Asian diets. In addition to the influx of Western sugary drinks, Asian diets now also include a variety of teas, such as chai or bubble tea, that pack many calories and grams of sugar in large serving sizes. This is a change from older, traditional Asian diets, which did not contain heavily sweetened drinks and desserts, instead choosing to emphasize natural flavors from herbs, fruits, and vegetables.

Current Asian diets also incorporate unhealthy oils into cooking, such as those containing trans fat and animal fat. Trans fats are also increasingly part of packaged foods in Asia due to their ability to prolong shelf life, yet there are no laws requiring trans fat content be disclosed to the public. Higher intake of trans fats has been associated with weight gain, increased cardiovascular risk, and insulin resistance.6

Beyond their health benefits and risks, Asian traditional dietary patterns are being lost as the food environment becomes more industrialized and urban. More and more people are eating a diet that includes Western fast food. Negative aspects of the popularity of Western fast food chains like McDonald’s and KFC include:
•Red meat
•Processed meat
•Refined carbohydrates
•High fructose corn syrup and added sugar
•Sugary drinks
•Fried foods (French fries, chicken, etc.)
•Large portion size
•Marketing of unhealthy food to children
•Unregulated trans fats11

In addition to Western fast food, modern versions of many Asian dishes available outside of the home include unhealthy ingredients. These dishes can be high in refined grains (white rice, noodles), cooking oils high in saturated fat (such as palm oil and ghee), red meat, and sodium.  These dishes often have low amounts of more healthy ingredients, including vegetables, fruits, and whole grains.

Sugary drinks are an especially large and prevalent risk factor. Drinking sugar-sweetened beverages daily increases the risk of type 2 diabetes. Individuals with a high intake of sugar-sweetened beverages in one study (1-2 servings a day) had a 26 percent greater risk of developing type 2 diabetes than those who drank little to no sugary drinks.4 Sugary drinks like sodas, juices, or energy drinks lead a rapid increase in blood glucose and insulin levels.12 For this reason, sugar-sweetened beverages can increase your risk even independently of weight gain.

Unfortunately, sugar-sweetened beverages are an unregulated, booming market in Asia. In India, the average annual growth rate for sales of all sugar-sweetened drinks was 12.6 percent over ten years (1997-2007).13 One cross-sectional study of adults in China showed that 20 percent of men drank two to three sugar-sweetened drinks a day.13

 

References:

1 Iso H, Date C, Wakai K, Fukui M, Tamakoshi A. The relationship between green tea and total caffeine intake and risk for self-reported type 2 diabetes among Japanese adults. Ann Intern Med. 2006;144(8):554-562.
2 Zhang X, Shu XO, Xiang YB, et al. Cruciferous vegetable consumption is associated with a reduced risk of total and cardiovascular disease mortality. Am J Clin Nutr. 2011;94(1):240-246.
3 Rastogi T, Reddy KS, Vaz M, et al. Diet and risk of ischemic heart disease in India. Am J Clin Nutr. 2004;79(4):582-592.
4 Hu, FB. Globalization of diabetes: The role of diet, lifestyle, and genes. Diabetes Care. 2011;34(6):1249-1257.
5 Hu FB, Liu Y, Willett WC. Preventing chronic diseases by promoting healthy diet and lifestyle: public policy implications for China. Obes Rev. 2011;12(7):552-559.
6 Chan JCN, Malik V, Jia W, et al. Diabetes in Asia: Epidemiology, Risk Factors, and Pathophysiology. JAMA. 2009;301(20):2129-2140.
7 Zhang G, Malik VS, Pan A, et al. Substituting brown rice for white rice to lower diabetes risk: a focus-group study in Chinese adults. J Am Diet Assoc. 2010;110:1216-1221.
8 Brown IJ, Tzoulaki I, Candeias V, Elliott P. Salt intakes around the world: implications for public health. Int J Epidemiol. 2009;38(3):791-813.
9 World Cancer Research Fund / American Institute for Cancer Research. Food, Nutrition, Physical Activity, and the Prevention of Cancer: a Global Perspective. Washington DC: AICR, 2007.
10 Chen J, Gu D, Huang J, et al. Metabolic syndrome and salt sensitivity of blood pressure in non-diabetic people in China: a dietary intervention study. Lancet. 2009;373(9666):829-835.
11 Pan A, Malik VS, Hu FB. Exporting diabetes mellitus to Asia: the impact of Western-style fast food. Circulation. 2012;126(2):163-165.
12 Odegaard AO, Koh WP, Arakawa K, Yu MC, Pereira MA. Soft drink and juice consumption and risk of physician-diagnosed incident type 2 diabetes: the Singapore Chinese Health Study. Am J Epidemiol. 2010;171(6):701-708.
13 Malik V, Willett WC, Hu FB. Global obesity: trends, risk factors and policy implications. Nat Rev Endocrinol. 2013;9(1):13-27.