Lowering the Dose of Risk: Proactive Steps for South Asian Metabolic Health

If you are a South Asian, I want you to hear this. Do not wait until you're diagnosed with diabetes. Diabetes is often not the beginning of the story. It's a warning sign that a metabolic process may have been developing silently for years. And for South Asians, that matters enormously because we can develop diabetes and cardiovascular disease at a younger age and at much lower body weight. You can look relatively tin, you can feel perfectly well, and you can still have significant metabolic risk. I am not going to tell you to give up rice, protein, doll, or family meals. This is not about doing everything perfectly. It is about understanding a susceptibility we inherited and doing something about it earlier.

India has an enormous burden of diabetes, but this isn't only an India problem. South Asians living in the United States, in Canada, the United Kingdom, Australia, Europe, and really everywhere else carry this risk with them. And Dr. Rangi says the conversation needs to start much earlier. Not when diabetes is diagnosed, but when metabolic health first begins changing. So, Dr. Rangi, why is this such an important topic for you personally? Hi, Leila.

There's many reasons for this. One, I'm an endocrinologist, you know, so I deal with metabolic health all the time. You know, second, I had personal loss in my family from poor metabolic health that was assumed to be completely normal health. So we want to understand and discuss what are the signs that we can understand earlier on in the process so we can be more proactive. Also, I'm a South Asian and I've seen the same story play out again and again, not just in my family, but someone's father has diabetes, their mother has high blood sugar or blood pressure, my uncle had a heart attack relatively young, or somebody may say someone else in the family had a stroke. You know, we see that a lot in South Asians who are living abroad where they're getting stroke earlier in their age category, and it totally takes them by surprise. And this was something brewing over time and could have been picked if you were proactive and keeping a check on things. So don't be blindsided. Being South Asian, we are at high risk and there are things we can do. We almost begin to accept it as normal because there's so many people in the families that are having these issues, and people think diabetes runs in our families. But I want to stop treating this statement as its end of the conversation. Family history is not a destiny. It's an information that is important. It tells us that we should be paying attention earlier. And I want to be very clear about something because I think it's the heart of this whole episode. This is not about blame, it is about susceptibility. We inherited a body type and metabolism that handles modern life differently. That's not a personal failing, it's the information we can use and act early on.

And this is definitely an important conversation. And with all that you just shared, I can definitely see how it's so important to you personally. But before we go any further, you've mentioned metabolic health. So what does that actually mean? What is metabolic health? And let's just make sure that all of our listeners really understand exactly what it is.

Yeah, Leila, I'm glad you're asking me that question because that is important. Unless we understand what is metabolic health, we cannot pay attention to that. So that's the right place to start because most people have never heard of it being explained or what is metabolic health. Think of metabolic health as how well your body handles energy. Energy is coming from the food that you're eating, the fuel it stores in our body. You know, when your metabolism is healthy, your body manages your blood sugars, fat, blood pressure, and weight smoothly in the background. You don't even notice it. You know, our body is so sophisticated that it can handle it. But when it's not healthy, those systems start to strain. And the doctors actually track it with a handful of simple numbers. We call that as biometric data. Your waste, especially fat around the middle, your blood sugar, your blood pressure, your triglycerides or a type of fat in the blood, your HDL, which is we consider as a protective cholesterol. You know, when several of these factors drift away in the wrong direction, together, we call it metabolic syndrome. And here's a key point. Only about one in eight adults is truly metabolically healthy on all these measures. One in eight. And that means most people, especially in our community, already have at least one of these quietly out of range and don't know about it. You don't need to memorize the numbers today. You just need to know that metabolic health is not wake wellness language. It is a set of specific measurable things your doctor can check. And earlier you check them, the more you can do about it. And I also tell my patients, this is my North Star, or I really care about metabolic health. Why? Because this is a common denominator for four life-limiting diseases that people fear the most: heart attack, stroke, cancer, and dementia. If you're blessed to have a beautiful body and if you are taking care of yourself, you've got to be mindful that the routine tests can miss things. We got to do our best to keep your metabolic health in check and prevent these four complications that I just talked about, and they're all considered to be metabolic health related.

Thanks so much for explaining that so well. And I do have another question. So, why do you say that we're starting the conversation too late? I know you mentioned that right now, and you also mentioned that in previous episodes as well.

Yeah. Layla, again, because we are very glucose-centric. We're always talking about blood sugar. And our body is more than just the blood sugar. You know, someone gets a lab, their glucose is normal, and they think, great, I don't have diabetes, you know? And then eventually the doctor says, You're pre-diabetic. What does that really mean? You know, now they're concerned because I'm pre-diabetic. I see this scenario played in my practice every day. And then the A1C crosses into diabetes, and then suddenly they're really worried now because the prediabetes moved into diabetes. And most of us, you know, one in three people have prediabetes. Most of the people with prediabetes don't even think about it. You know, they think this is not going to happen to me. But we see a lot more cardiometabolic complications in prediabetes. You don't suddenly become metabolically unhealthy the day your A1C crosses a diagnostic threshold. You know, for example, we say A1C of less than 5.7 is desirable. Between 5.7 and 6.5, we call it prediabetes, and more than 6.5 we call it diabetes. So what about you were 6.4, you're not diabetic, and 6.5 now you have diabetes? So it's not that hard and fast rule. Your risk is already going up over time. Insulin resistance develops, visceral fat can accumulate around the abdominal organs or in your belly, your liver can start accumulating fat, triglycerides may rise, blood pressure may start rising. It's just that you don't have that number crossing the threshold to call it diabetes. I had a friend reach me out a couple days ago and she asked me if she should worry about her prediabetes, and she's really concerned going up from 5.8 to 6.2 A1C. Now, yes, that's important to me, but I'm more concerned about your overall metabolic health. I am not just concerned about your numbers going up from 5.8 to 6.2, but I'm really concerned about where do you stand in overall picture of your metabolic health? How does this translate into your risk of heart disease? How does this translate into your risk of kidney disease? Because heart, kidney, and metabolic health goes hand in hand. American Heart Association calls it CKM syndrome or cardiometabolic kidney and metabolic syndrome. So these things go hand in hand. And my goal is not just to keep your numbers in check. My goal is to keep you active and energetic and independent and not get complications. You know, I want you to lower the risk of metabolic complications, I want you to lower the risk factors, I want you to lower the need for prescription medications for this metabolic health, right? So you can raise your energy, you can raise your vitality, you can raise your longevity.

And what is different about South Asian metabolic health specifically? We've talked about metabolic health in previous episodes, but what about South Asian is specific?

Leila, thank you for again asking this question because this is where I really want South Asian listeners to pay attention. South Asians are, by the way, people belonging from India, Pakistan, Sri Lanka, Bangladesh, Nepal. I want to start with a paradox that I think everyone in our community needs to hear. We are, by many measures, one of the most economically successful communities in the US and in the countries that we have moved to and we've settled in. High education, skilled professions, entrepreneurs, strong families, we have done extraordinarily well. But here's the hard truth. Our success has not protected us from disease. Wealth didn't protect us. Education did not protect us. Professional achievement did not protect us. We are economically successful and at the same time we are vulnerable. We develop insulin resistance and type 2 diabetes and heart disease more often at a younger age and often at a lower body weight than many of other populations. And that's why I want to bring this to the attention of South Asians, because you may look okay or look healthy to you, but inside you may have metabolic markers that have already changed or evolved over time. So please don't assume that because you've built a good life and done well in your career and taken care of your family, your metabolic health is automatically taken care of too. It is not the same thing. And that's exactly why this conversation matters. One of the dangerous assumptions we make is I am not overweight, so I'm okay. That's not necessarily true for us. South Asians can develop insules and diabetes at lower body mass index. They also carry less muscle mass. And at similar body weight, we may carry proportionately more visceral and ectopic fat, and importantly, less muscle, just like I mentioned. So in simple language, you can be relatively thin from outside and metabolically unhealthy on the inside. And that is why simply looking at someone's weight can be misleading. And let me give you the actual numbers because they really matter. In US, a cohort data, diabetes prevalence among South Asian adults has run in the range of roughly 23 to 27% compared to 6% of white adults. That is not a small difference. That is several times higher. And the cardiovascular story is just as striking. The South Asians carry roughly two-fold higher burden of atherosclerotic cardiovascular disease, and we often develop it younger. And here's the part almost nobody is told. The standard calculators that we use in doctors' offices may underestimate your risk. So we may use a calculator online and say, well, I calculated your risk, and overall your risk is low. But that calculator may not be built for South Asians. So you're not getting the actual risk. We're underestimating it. Now, many of the tools the doctors use to estimate heart risk were not built for South Asian population, and they can, like I said, underestimate. I always like to check certain other tests for my South Asians patients, and those are LP little A. I like to look at the family history very closely. I like to measure the waist circumference. And I have to tie up the whole picture, not just the risk markers or just the risk calculators. So many reasons for us to worry about the South Asian population.

Absolutely. And I noticed you've mentioned metabolic health and touched on cardiovascular disease rather than just diabetes. So it sounds like there's definitely more to this than just diabetes. So why is that? Yeah.

Leila, diabetes is uh just the condition that is underlying that is putting us at high risk. And the end result or the outcome is what we don't want to miss. And heart disease is the outcome of poor metabolic health or poor diabetes control. People don't die of diabetes. People die of heart attack. And that's why we need to take care of them earlier on, understand their risk, map their risk factors, and create a roadmap or a blueprint, you know, where somebody stands and work on them accordingly earlier on and not wait for catastrophe to happen. That's what we see most of the time. People end up having a heart attack, and now the antennas are up and now they're going to every doctor and doing everything to prevent that next heart attack. And some unlucky ones don't get that chance. They don't get a chance to get a second heart attack. They just lose it the first time. I don't want a 48-year-old or a 52-year-old to have the heart attack and then become interested in metabolic health. You know, this is a very common scenario that I see in our South Asian population. I don't want someone to discover diabetes during their hospitalization for a cardiovascular disease. Very common. We see more South Asians in CCU or coronary care unit in the hospital where they came with a heart problem or a heart attack, and we suddenly discover, oh, well, you also have diabetes. And they learn about their new diagnosis of diabetes at the time of heart attack. Now it didn't happen like a switch on overnight. They were having high metabolic risk over time, and they were either had diabetes that was not paid attention to or discovered earlier, or they did not get routine check to understand their metabolic health, and suddenly the body could not handle it and they ended up having a heart attack. Let me tell you about Sean. You know, Sean is my brother-in-law, was my brother-in-law. Very hard to say that. He looked like a picture of perfect health. He was 50 years old, full of life, full of energy, and a kind of person who lit up the room. You know, we were all gathered in our at our niece's wedding and everyone had stopped dancing to eat. And everyone, except Sean, he was the only one still on the dance floor because that was Sean. He loved to dance. And suddenly Sean collapses on the floor. A heart attack at 50 at a wedding. Now, this is not a story that is very unique. Unfortunately, we hear these stories a lot in South Asians. Here's what haunts me about Sean's story and why I tell it. Sean was not careless about his health. He saw doctors, he had checkups, he had his blood work, he was in the system, he was going to the doctors. But unfortunately, he was not looked at as a high risk. He was just treated as another patient in the clinic. And like I mentioned earlier, his risk was so much higher than his peers that we should do certain different tests to risk stratify and understand somebody's risk. Looking at more advanced cholesterol markers and looking at more detailed parameters or maybe putting a continuous glucose monitor to understand if their glucose has been running slightly high. So there's so much more we could have done if he was given a chance with a provider or a practice that did proactive preventive care. And that's why our people need to start stepping outside of the normal care. If you stay with the normal insurance-based model, you will get the same care. And I would not say it's not standard of care, but it's not individualized to you. You're treated just like any other ethnicity there, and your risk may be missed.

And I'm so sorry to hear about Sean. And unfortunately, like you said, it's not particularly uncommon for that to happen. And we talked about diabetes and how that can happen. But what happens when someone finds out they have prediabetes? So, what do you think is important for someone who's just been told they have prediabetes to really hear and understand?

Yeah, Leila, that's an important question because most of my friends and our peers and colleagues, sometimes they'll run it by me that, hey, my most recent number was slightly high. I have prediabetes, what should I do? But obviously, I'm not able to talk to so many more who have prediabetes. So that's an important question. Number one, I would say don't panic. Okay, nothing to panic about. Like I said, nowadays we have one in three people who have it. But the fact that you have it, you should be very cautious now and understand what are your risk factors, what is your risk of progressing to diabetes. And you should do anything and everything to try to regress back to not having prediabetes. Because even prediabetes increases your risk of cardiovascular disease. It inflames your arteries, it inflames your blood vessels, so it increases the risk of cardiometabolic complications, which are heart attacks, stroke, you know, amputations, or vascular problems in the legs. So you're basically what I want you to think about is prediabetes can be one of the most valuable warning signs that medicine can give you. And if you've read my book, which is by the way coming on September 30th, hopefully I've been told that's the date, but there are a few things that have to be aligned to make that happen. But regardless, the book is coming out, and I call prediabetes as the last exit. And that is what I want my the public who has prediabetes to understand. Why do I call it the last exit? Because this is your opportunity to reverse your metabolic complications. Once you develop diabetes, you know, early diabetes, maybe the first four to five years, we have some chances of reversing your diabetes. But most people come to me too late. They'll come to me eight, 10, 20 years after diabetes and they'll say, help me reverse my diabetes. We can only reverse when you're in prediabetes, and that's why I call it a last exit. And we can try to reverse it in early diabetes. But why not just don't even let diabetes happen and just reverse it earlier? So that's why paying attention to prediabetes is important because number one, it gives you cardiometabolic or heart complications already in prediabetes range, and two, this is your opportunity to reverse it. Don't wait until your A1C rises further. You know, ask why is this happening? Talk to your doctor, understand your risk factors, see what you can reverse, what you can address. You know, if you've not been active, maybe it's time to get active. If you're not paid attention to your diet, it's time to start working on the right nutrition. If you have some metabolic imbalances like your thyroid is off, or you have vitamin D deficiency or magnesium deficiency, we call those as they are all important in your cellular health. So they're not going to help you metabolize your energy well. So we need to make sure your health is taken care of from all the perspectives and not just have narrow vision of the blood sugar. Blood pressure should be under control, cholesterol should be under control, work on your sleep. So all these things can be done if you have prediabetes, but just remember this is the warning sign. Don't miss it. Please don't be that person. Feeling fine is not the same thing as metabolically healthy. And the whole point of catching this early is that you can still do something about it while you feel completely well.

And I'm excited for your book to come out as well. I know you touched on it. We we've talked about it a little bit, so that's exciting that that's happening. And I know in the book you mentioned a few patient testimonials or stories or things like that. So I know earlier you mentioned the story about Sean, your brother-in-law. But in terms of gender, I know that's common for men, but what about South Asian women? Is there any other different maybe risks or how is that changed between a man and a woman for South Asians specifically?

Yeah, Leila, I'm glad you asked because that is very important. South Asian women, the first warning sign comes when they're pregnant. If you have developed gestational diabetes, your risk of developing diabetes in the future is doubled. 50% of people who had gestational diabetes end up developing diabetes. A woman is told that she has gestational diabetes or a borderline sugar during pregnancy, and the baby is born healthy, sugar goes back to normal and everyone forgets about it. That's a general story that we hear. But the woman's lifetime risk, like I mentioned, is roughly not just double, it's seven times higher. And that pregnancy was her body's first. The second early signal is PCOS or polycystic ovary syndrome, irregular periods, difficulty conceiving, skin or hair changes. We treat it as a fertility problem, but it's actually a metabolic problem. It's an insulin resistance problem. And the third is menopause. When estrogen falls, fat moves to the belly and heart risk rises. On top of metabolism that was already vulnerable, now we're adding menopause as an additional risk factor. So if you're a South Asian woman and you've had any of these three: gestational diabetes, PCOS, and or if you're going through menopause, please don't accept reassurance. Asked to be risk stratified, asked to be mapped, understand what is your risk for diabetes and heart disease.

And for those patients who really want to do something about it and be prepared, what does that look like in real life?

Yeah, Leila, actually, it's simpler than what people fear. It comes down to a few daily foundations. And here is the most hopeful fact in this whole conversation. Yes, we inherit susceptibility, but susceptibility is not your fate. In that same large global heart attack study that we had talked about earlier, about nine everyday risk factors explained the overwhelming majority. Roughly 90% of the complications happen because of those nine factors of heart attack that held true for South Asians too. Things like blood pressure, cholesterol, diabetes, belly fat, smoking, activity, diet, and most important, stress. There's so much we are seeing that is stress-related these days because that changes the equation, raises your cortisol, and that uh causes pro-inflammation and higher risk. So understand this well. Most of the risk factors that I just mentioned are modifiable or you can change them. It's not your fate. The genetics loads the gun, and our daily life largely decides whether to pull the trigger or not. So this is not about being doomed by a family tree. It is about knowing you have more control than you were led to believe. And for South Asians, we need to make this culturally realistic. I'm not going to tell everyone that we can never eat roti again or rice or dal, you know, or enjoy family meal, and that's not sustainable. We need to understand portions, we need to understand food quality, we need to understand protein, we need to understand fiber, time of eating, vegetables, and overall dietary pattern. And let me be specific because many of us are vegetarian. The problem with the traditional plate is not what's on it, it's the ratio. A lot of grain and not much of protein. So if you're vegetarian, pay attention to that. Focus on protein, cut down your carbs. You can still be vegetarian. In fact, the plant-based diet has been shown to help the cardiovascular outcomes significantly better. So the fix is to add, not to remove, two proteins at every meal, dal plus a curd or yogurt, paneer or tofu, eggs if you eat them, and vegetable filling half the plate. Start with your vegetables, have your protein, and then last thing should be the carbs. Most of the people start with their roti or burrata, and the roti and the rice becomes the side, not the base. One more thing for long-term vegetarians, get your B12 checked. Low B12 causes fatigue, nerve damage, difficulty to focus, and it's almost never tested in most practices. And especially if you're taking metformin, your B12 should be regularly tested. A lot of my patients' nerve symptoms or neuropathy symptoms do improve just by taking B12 if that is low. This is one of the important points in the whole episode. As a South Asians, we tend to carry less muscle mass at a given body size. So don't think only about losing weight, especially in the GLP world. Think about building and preserving muscle. Muscle is where your body handles glucose and it protects you as you age. It protects you from falls, frailty later in the life. Walk, especially after meals, non-negotiable, especially after dinner. You know, lunchtime, we usually are busy afterwards. Do resistance training at least two to three days a week. Stay active throughout the day and protect your sleep. Learn how to manage your chronic stress, learn meditation, yoga, whatever it helps. And you don't have to become perfect. You have to become consistent and disciplined.

So I know you mentioned we were just talking about nutrition, and a big part of what you mentioned was family meals and gatherings and things like that. So a lot of people have heard that a little bit of alcohol is actually good for the heart. But does that apply to South Asians?

Leila, very important question. I think it's something that we must address. I'm asked about this many times on my daily practice. And for many populations, studies suggest that light drinking was associated with slightly lower heart risk. You probably heard a glass of red wine is good for you. But when researchers looked specifically for South Asians, the picture was completely different. In that large global heart attack study, low-level alcohol was linked to lower heart risk in almost everywhere in the world except South Asia, where if anything, it was associated with higher risk. And we are talking about low-level alcohol. And in a careful study of South Asians living in America, moderate to heavy drinking and binge drinking were associated with worse overall cardiovascular health. So my honest message is this please do not start drinking for heart health or drink more for your heart. That benefit does not apply to you. It does not apply to South Asians, it applies to other communities, not us. So no light drinking needed to protect your heart. And heavy drinking or binge drinking, several drinks in one sitting, are genuinely harmful for the heart and well beyond it. So if you don't drink, there's no health reason to start. And if you do drink, keep it modest, avoid binging, and be honest with your doctor about how much you're drinking.

Absolutely. And I think that your approach is a little different. And I know you believe in lower the dose. It was a big part of previous episodes. And I think that this is where your approach is a little different. So I know you're not anti-medication. So can you speak to that a little bit?

Leila, yes, I call my approach lower the dose. And sometimes it is frowned upon because people think it's lower the dose of medications. I am talking about lower the dose of metabolic risk, lower the dose of complications. And if you do those two things, if possible, we can lower the prescription medications provided it is safe for you. And by doing these things, we automatically increase your energy, increase your vitality, increase your longevity, and increase your independence over time. Because what makes you dependent on doctors and systems and medications is the more metabolic health problems you have. So I really believe if you stay metabolically healthy, you need less doctors, less medications. And again, we have to risk certified, but I do not believe in not taking medications when it's necessary. I like to take a holistic approach where, if needed, I would do anything and everything to build your foundation. So you need to take the least number of prescription medications. But there are people who really need certain prescription medications and we don't compromise there. For example, in my book, that is chapter number eight, it's on shield. You know, shield is the medications that protect your heart. There are five shields we talk about for people with metabolic health. Number one, statins, no compromise. A lot of people do tell me, well, statins cause this side effect, statins can cause dementia, I don't want to take it, statin can cause muscle aches. Well, work with your doctor. Get on the statin that will not cause you side effect. And as far as dementia is concerned, if your risk of heart attack is a lot more, you may never live that long to get dementia and you'll die of a heart attack. So understand what is your risk. That should not be the reason not to take statins. So that's my number one drug. Number two is GLP1 agonist. That is again a shield medication or something that protects your heart. GLP1 agonists are widely available. I think everybody's on the bandwagon, especially in India nowadays, it's getting popular too. But Indians living abroad, they are all getting access to it and trying to get on GLP1 agonist as well. I'll go back to what I said earlier. We have less muscle mass compared to Caucasians, compared to other ethnicities. So you have to work harder to maintain your muscle mass. So if you're not working out or working on your strength training, then you need to adapt that first before you go and DLP1 agonists, because otherwise you lose 10% of muscle mass for any weight loss. So I always like to check body composition for my patients and understand and maintain their muscle mass. For example, if you have 100 pounds to lose, 10 pounds will be muscle loss, and that's a lot. And you cannot gain it back, so you have to do everything it takes to maintain that muscle mass. So we talked about statins, we talked about GLP1 aginus. Let's talk about SGLT2 inhibitors. Those are class of drugs that make you pee sugar. They work hand in hand with sodium, which is sodium glucose co-transporter. So they drop your blood sugar by making you pee salt and water in your urine. They protect your heart, they protect your kidneys. The examples are ampoglyflosin or depoglyflosin. Also, other names are jardians and farcega. But again, they increase the risk of urine tract infections, bladder infections, they increase the risk of vaginal infections, and even in men, they can have high risk of urine tract infections or infections in that area. So if you're having any kind of complications, you must talk to your doctor. Otherwise, you must consider getting on those medications that can protect your heart and your kidneys, not just drop your blood sugar. Okay. So we've talked about statins, we've talked about GLP1 igonus, we have talked about SGLT2 inhibitors. The fourth is ACE or ARB. ACE is any prils. You know, most of the people who have metabolic health, we give them medications that protect their kidneys called lysinopril or analopril or, you know, any of those medications. They're good because they also protect your kidneys. Some people who cannot tolerate them because of cough or whatever reason, then we like to give you low sartin or another sartin, and that's another class of drugs. So we usually give either ACE inhibitor or an ARB. So those were four classes. The last fifth of all is phenerinone. Phenerinone is a new medication. It's also called carendia, K-A-R-E-N-D-I-A. That's not a common drug that is used in India and other places yet. I'm not even sure out of the US if it's available, but it is a special kind of a mandrella corticoid receptor blocker, and it helps your heart health and your kidneys. So anybody who has a kidney problem with diabetes should consider being on Carandia. So those are my five favorite classes that are called as shield medications. And to learn more, get the book. It's going to be coming out soon. And you can go to rangemd.com slash blueprint and make your reservation today to book your copy. So with that said, I think I have covered pretty much why and how they can have an intelligent medication conversation with their doctors. And please never stop or reduce any prescribed medication on your own. Make those decisions with your clinician managing your care, but always empower yourself. Always learn more so you can have a healthy, intelligent discussion with your doctors.

Absolutely. And if you could speak directly to South Asians listening in India, the US, Canada, the UK, Australia, or anywhere around the world, what would you say?

Yeah, Leila, I want to summarize by saying please don't wait for diabetes to happen. Don't make that as your wake-up call. If you have prediabetes, this is your last exit to reverse your metabolic health. Take it seriously. And if you do not even have prediabetes, understand your metabolic health, work with your doctors, ask them to do all the tests that you can get to risk stratify you. In my family, I've seen it and I've seen it otherwise as well. If your uncles and your parents had heart attack or stroke or any kind of health problems or scares in their 70s, we are seeing that in 50s, so almost two decades early. So you've got to be proactive, you've got to have that conversation, get the right tests, don't wait for symptoms and invest in your health. You know, not in just traveling and having fancy, luxurious living. And I think I say it with a lot of respect and, you know, because everybody's worked hard to get to the places that they are at. But we need to pay attention to our health because you're more vulnerable. If you're in your 50s and 40s, think about protection now because you can protect things now and you can have much better life in the future rather than getting a complication and then always trying to just react to that and try to help yourself. We may inherit susceptibility, we may inherit culture, we may inherit food traditions, but we also have knowledge our parents and grandparents may not have had. And we can adapt. So we don't have to abandon our culture. We got to embrace and love our culture. We don't have to eat perfectly, but we got to be more mindful, we got to build our muscle, and we got to learn more about our bodies and our risk factors. And use medications intelligently when we need them and teach our children that metabolic health is most important and matters before they are sick.

Absolutely. And it sounds like in some ways or in a lot of ways, actually, it's definitely bigger than just one person's diabetes.

Yeah, much bigger. You know, imagine changing the conversation at the family dinner table instead of diabetes runs in our family. You know, what if we said metabolic health matters in our family? That's different. And now we are not waiting for the disease. We are teaching the next generation about strength, food, sleep, stress, and prevention. And that is where I think we have an enormous opportunity in South Asian communities not just to live longer, but to live those years with health, vitality, and independence.

And before we wrap up this episode, can you give us something practical to really finish with? What should someone who is listening do next?

Yeah, they can ask these three simple things. What is my metabolic health right now? What is my risk for heart disease? Which direction is it moving? Have I been healthy and getting unhealthier? Or have my numbers been creeping up without my knowledge? And what is my future heart risk? Should we look deeper than the standard calculator? And if you are, if you have a strong South Asian family history of diabetes or premature cardiovascular disease, don't wait for somebody else to bring it up. Bring it up yourself. Ask the questions, make it a normal conversation. Don't try to hush it. Don't try to not talk about it. Know your family history and understand your risk and live the beautiful life.

And for people who do hear this and want to actually do something, where do you recommend they start?

Yeah, Leila, I'll give you two paths depending on where people you live. If you live in California, we offer metabolic longevity blueprint. This is exactly the kind of extensive mapping I've been describing in this episode. We check over 100 biomarkers, not just a handful of standard annual physical tests. And to build a complete picture of your metabolic and cardiovascular risk, the markers Sean never had checked, those were Epo B, lipoprotein A, insulin level, insulin resistance, inflammation, body composition. And for those who want to go deeper, we have options like calcium score or advanced cancer screening or imaging, you know, everything that can be related as a complication to metabolic health. We offer it all. Who should consider it? If you're a South Asian and have a strong family history of diabetes or premature heart disease or prediabetes, insules or a growing waistline, a history of gestational diabetes or PCOS or polycystic ovary syndrome, or you're just simply 45 or 50 years old and want to truly understand your risk before something happens, this is for you. And for those who are concerned and want to go further, we can talk about additional imaging or screening options that we offer. But feel free to call our office and request for more information, or you can email at info at rangemd.com and we'll be happy to guide you. And for those who are not in California, we offer proactive care online and I offer a masterclass once a month, and we offer foundations of health library of the options for good metabolic health, which addresses nutrition, the Mediterranean-based diet. I also trained in mindfulness-based stress reduction. So we also offer meditation once a week. And because stress is a huge factor in our overall metabolic health, not addressing that will leave the issues incomplete. So that is our educational arm. One is a clinical arm where we can only help people in California. But the educational arm you could access from anywhere. So again, reach us out. My website is rangemd.com. If you need personal information, write to us info at rangemd.com and we'll be happy to guide you well. Yeah, I think with that I will say take care of yourself. Don't wait for diagnosis or disease to happen because there's so much under the surface. It's like an iceberg. You know, there's so much metabolic health problems going on that you're not able to see. The most expensive thing you will ever buy is heart attack, stroke, and the ears of independence that you didn't have to lose. So invest in yourself.

Well, thank you so much, Dr. Rangi. And if you are South Asian, make sure that you share this episode with your parents, your siblings, your children, a relative, or someone that you love. And if diabetes or premature heart disease runs in your family, make sure you use this episode to really start that conversation. And this podcast is for education. It does not replace any individualized medical advice. Never start, stop, or change medication without discussing it with your healthcare professional. And thank you so much again, Dr. Rengi, for this really good information. And for everyone listening, make sure you are following, subscribing, and sharing this show. And thank you for listening to the Diabetes Loop Friend podcast. And we'll see you soon.

Thank you, Leila.