Why diabetes is so high in South Asians

Medical statistics in the UK have persistently shown that diabetes, heart disease and other related conditions grouped together as the metabolic syndrome are far more common amongst people from the South Asian sub-continent than in other communities. Most of the speculation for the reasons for this has ascribed it to a diet full of sweet and fried food combined with a lack of exercise, though why the effects of those shortcomings (which are common in other communities too) should apparently have more negative effects in the South Asian community has never been clear to me. Apparently, central obesity, tums and bums in other words, is more common in South Asians. What's more, the extent of central obesity is more or less in direct proportion to the likelihood of diabetes and heart disease. I got the explanation for all this in Chennai from Dr Ramachandran, who probably knows more about diabetes than anybody else in the world.

The statistics in India are even more striking. One in five Indians has diabetes and in the urban areas and the middle classes the proportions are even higher. Something similar has been noted in communities in the Gulf States. Richer, more comfortable lifestyles, it would seem, have their cost, but why should the cost, at least in diabetes, be so strikingly frequent in some communities more than others. The answer is climate-related. In hot countries the problems of food storage are extreme. Sir Francis Bacon tried to prove that freezing a chicken would preserve it. He was right, but the attempt to stuff the chicken with snow gave him such a bad bout of influenza that he died in the pursuit of knowledge. As a result, people whose genetic make-up has evolved in cold, northern countries are less good at storing foods in their bodies. They have less need to do so. The beneficial effects of a cold climate have meant that food is more evenly consumed through the seasons. In hot countries food was plentiful after rainy seasons and scarce in dry seasons. As a result the metabolism of the denizens of hot countries developed the ability to better store food and therefore to go for longer with less food if need be. The same chemical processes that go into storing food in our bodies are also the ones, when food is consistently in excess, which produce diabetes and its metabolic cousins. Now that food, at least for the urban middle classes in India and for almost everyone in the Gulf states, is in consistent and plentiful supply, no famine comes to pass, only constant feast. We Indians eat too much for a while and then, instead of eating less for a while, we continue to eat too much. The result is diabetes and heart disease. Geneticists argue that the rate of human evolution has slowed and may even have been stopped altogether because of better medicines, changes in philosophical and social attitudes to people with congenital disabilities and a reduction in the wholesale risks to groups of humans such as famine, flood and pestilence. So whatever genetic predilections some communities have are likely to remain.

What then is to be done? Well, the increased risk of suffering from the detriments of the metabolic syndrome remain and persist. They can be partially ameliorated by less red meat, less alcohol and more exercise. But that will postpone the metabolic effects, not remove them entirely. The day of shuffling off this mortal coil can be postponed, not indefinitely avoided.

Painters of secrets in the Hague

In the lovely Mauritshuis in the Hague so many of the paintings from the Dutch Golden Age seem to portray an unrevealed secret. Almost all have a domestic setting, but something intruding from beyond is frequently suggested. Jan Verkolje's painting is of someone delivering a message to the housewife in an impeccable Dutch home, but we don't know what's in the message. There is no melodrama, scarcely a hint about whether the message is tragic or joyful. The message seems important, but enigmatic. One of the greatest of all Dutch painters, Pieter de Hooch, portrays a man reading a letter to a woman. Again we don't know what the letter says, and their facial expressions give only clues, not answers. Judith Leyster's painting is of a man offering money, but for what? So strong are the hints and the innuendoes that even where there appears to be no hidden meaning, no secret, such as in Jacob Ochterveld's painting of a fishmonger at the door, the viewer, having looked at all the other paintings with their incinuations and implications, starts to wonder whether there is some hidden possibility. Why exactly is the fishmonger at the door?

Everywhere under the pall of discretion is hidden the possibility of joy or loss. Whether the emotions are glad or tragic, they must best be expressed in private, so privately that even the person looking at the painting who has been admitted into the domestic space cannot know the whole story. The door must be closed on solitude before the entire truth comes out. Until then everything is hints, echoes and possibilities. As in Chekhov, the turbulent world always incinuates itself into even the most orderly existences, but only in private and beneath the surface calm. Without the surface calm all would be chaos.

Adriaen Coorte is a minor master painter of the Dutch golden age. His life, not just his work, is a total secret. Nothing of note is known about him. All is guesswork. And his exquisite painting offer precious little to guess at. He emerges fully formed as a painter. His palate of colours, his subjects and genres are decided from the off and they never change throughout his life's work. There is no development, no journey, no destination. He painted still lives almost exclusively. Almost all are set against black backdrops, rather like Spanish still life paintings. And the subject matter is always selected from the same range: bowls of strawberries, blackberries, gooseberries, grapes, redcurrants. All are shown, shining, ripe and unspoilt. Occasionally the white flowers produced by all these fruits which grow in the cool, soft shade are depicted. Bundles of white asparagus endowed with an almost ethereal luminescence are set alongside the bowls of fruit. Exquisite butterflies with filigree wings as fine as a spider web hover over the fruit. He also painted sea shells covered with patterns of random symmetry that only nature and evolution could produce. No human eye or mind could conceive them. Nothing happens, nobody is present. The infinite refinement of the natural is complexity enough. That's not a secret, it's a revelation almost divine.

No more vultures circle the Towers of Silence in Delhi

The Parsi community of northern India have a unique burial tradition. They put their dead out at the sacred Towers of Silence and the vultures that constantly circle, sometimes turning the sky dark by their numbers, devour the flesh on the bodies until the bones are picked clean and white. This tradition dates back centuries but is shortly to end if we're not careful.

Since the 1990s the vulture population all over South Asia has rapidly depleted to the point where 99.9 per cent of them have died. For several years no one understood the phenomenon, but in 2003 a scientific study of the post mortems conducted on vulture corpses in Pakistan made a breakthrough. The anti-inflammatory antibiotic drug widely used on cattle diclofenac, produced by the Swiss company Pfizer and sold at a discount in South Asia, had produced a toxic reaction in the vultures that fed on the cattle carcases. The drug is highly beneficial to cattle and, for that matter, to humans. It has a short half-life, produces no toxic waste and has few side effects. No wonder it rapidly grew popular amongst Indian and Pakistani farmers. But when red meat containing the drug, and some others like it, are eaten by vultures, despite their notoriously resilient digestive systems which can processes all manners of other substances in meat that would be toxic to humans, it causes uric acid to form and that quickly leads to renal failure and the vulture dies. Hence the collapse in vulture numbers. Vultures breed only once a year and produce only one egg. To restore their numbers, even if the causes of their decline were eradicated, would take a hundred years according to environmental filmamker, Mike Pandey, who drew this sad story to my attention. The benefits to humans once more in conflict with the welfare of the natural world and the natural order.

But the story gets more complicated on closer scrutiny. Vulture numbers are also depleting in countries such as South Africa where diclofenac is not in common use. Here this has been attributed to power lines, climate change and, controversially, to the harvesting of vulture body parts for medicinal purposes by Sangoma, traditional Southern African healers. Nor would simply banning the drug necessarily solve the problem according to scientists. No one knows whether the substitutes may have the same, different or worse effects.

So the large, dark vultures, with their priestly white collars, once so common circling hopefully and watchfully in the shimmering, hot, white-grey Northern Indian sky have gone and a deeper silence has fallen on the Towers of Silence.