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EDITORIAL:
THE HULLABALLOO OVER ANCIENT INDIAN HISTORY
Suddenly, historical issues like the Aryan Invasion Theory and the Indian caste system have become topics of hot debate in California as activists and parents harangue the state panel over demands for changes in California school textbooks.

The issue has ramifications beyond California, because the textbook market in this state is so huge that what California decides can become the benchmark for the nation.

Hindus and ancient India is being unfairly maligned, some protesters say, and they are suggesting changes to rectify that. But some of the top South Asia scholars in universities here and in India including Harvard’s Michael Witzel, UCLA’s Stanley Wolpert and Jawaharlal Nehru University’s Romila Thapar have joined in a written warning that there is a hidden agenda behind the protests, and most of their demands have little historical merit.

South Asia scholars Sunaina Maira and Raja Swamy show in our cover story that what is being portrayed as a grassroots community plea for changes in school textbooks is actually a concerted move by Hindutva supporters to promote their own Hindu chauvinist worldview.

A silent but deadly epidemic of heart disease raging in South Asia and people who emigrated from there. Why this killer epidemic is occurring, and what can be done about it?

Chicago cardiologist Enas Enas, MD, has been researching the issue for decades, and has written a remarkably reader-friendly book for the general public that not only draws a detailed picture of how heart disease affects South Asians, but provides a roadmap on how to identify, prevent, control, and even reverse it.

Drawing on years of painstaking medical investigation, epidemiological research, personal observation, and clinical practice, Enas has condensed the most salient information and insights to create a compendium of knowledge on how to win the war against premature, malignant heart disease.

Nobel laureate economist Amartya Sen’s wide intellectual interests are legendary. In his latest book, “The Argumentative Indian,” he casts an astonishingly wide net. Whether it is his reflections on cultural and intellectual ties between ancient China and India or his ruminations on gender disparity in India, his reasoning is razor-sharp, his tone tempered and civil, and his breadth of knowledge and range of interests breathtaking.

What shines through, most of all, is his passionate belief in plural, democratic values.

“It is a commonplace these days that the West is the home of religious freedom and democracy: when George W Bush talks of bringing these ideas to the Muslim world, he envisages exporting them from the West to the East,” wrote William Dalrymple while reviewing the book in The Times of London.

“It is, therefore, no bad thing to be reminded by Amartya Sen, in this profound and stimulating collection of essays, that the East has its own venerable traditions of public participation in decision-making, of government by discussion, and of religious tolerance. Indeed, as Sen points out, while most of Catholic Europe was given over to the Inquisition, and in Rome Giordano Bruno was being burnt at the stake for heresy, in India the 16th-century Mogul emperor Akbar was declaring, ‘No man should be interfered with on account of religion, and anyone is to be allowed to go over to a religion that pleases him.’” We carry a discussion of the book in this issue.

In this issue, we are delighted to look beyond our own ethnic backyard. California is such a mélange of diverse ethnic groups; yet how often well these different communities communicate?

The sad answer is: Not a whole lot. Yet many immigrant communities, particularly people of color, have a lot in common. The struggle to adapt and fit into a new society, balancing Asian and Western values, coping with immigrant life, the sheer socio-cultural challenge of maintaining one’s personal dignity and identity, especially if you are from a Third World country — these are issues that affect all of us, and there is much we could learn from the experience of other communities.

Vietnamese writer Ky-Phong Tran’s searingly honest commentary reflects the reality of not only his culture, but of many ethnic communities in this country. We present his award-winning article for our readers.

We salute three extraordinary personalities from the African American, Chinese American and Hispanic communities who were honored by the New California Media this year. Black Voice News owner Hardy Brown, Chaplain James Yee and Sacramento Bee executive owner Rick Rodriguez: All three of you are sources of inspiration for us.

Do drop us a line with ideas and comments about how we can make Siliconeer better serve you.
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COVER STORY:
History Hungama:
The California Textbook Debate - By Sunaina Maira and Raja Swamy
Who would have thought that the merits of the Aryan Migration Theory would be hotly debated in California? As bemused Americans look on, the acrimonious arguments go on, with battle lines sharply drawn. While the battle has been portrayed in some of the media as arguments between Hindu parents and U.S. scholars, there is much more than meets the eye, write Sunaina Maira and Raja Swamy.
There has been such a hullabaloo over proposed changes in California history textbooks that even mainstream U.S. newspapers are beginning to notice. So what’s the fuss all about?

California state textbooks come up for review every six years. This year, the sixth-grade history and social science texts are under review, and a controversy has arisen over the sections relating to ancient Indian history. Most of these textbooks are inadequate for a number of reasons and have many errors on Indian history. Taking advantage of this inadequacy, two groups: Vedic Foundation and Hindu Education Foundation, backed by the Hindu American Foundation— all with demonstrable ideological and organizational links to Hindu supremacist organizations – inserted themselves into the revision process. But instead of just making corrections to erroneous texts, the VF-HEF are pushing through changes that reflect their supremacist and chauvinistic political agendas, seeking to equate the history of India with the history of Hinduism, and the living, diverse religion of Hinduism with a Brahmanical, Vedic religion frozen in time for thousands of years.

The Tail Wagging the Dog: Behind the Facade of Hindu Parents The folks crying foul over the depiction of Hindus and India in California textbooks will have you believe that it’s a grassroots protest of Hindu parents who don’t want their kids to feel bad about being Hindus in school. To be sure, parents are part of the protest, but all the heavy lifting is being done by the Hindu Education Fund, the Vedic Foundation and the Hindu American Foundation. So who are they? The Hindu Education Fund is affiliated with the Hindu Swayamsewak Sangh, an American chapter of the Rashtriya Swayamsewak Sangh, as HEF admitted to the Wall Street Journal. The Vedic Foundation, part of Barsana Dham based in Austin, Texas, works closely with the Vishwa Hindu Parishad of America and hosts numerous events, including the Dharma Sansad, attended by top RSS functionaries. Hindu Students Council, a VHPA project, holds annual camps at this location. The foundation has its distinctive take of history. In a curious volume issued by its spiritual leader titled “The True History and the True Religion of India,” theology is so seamlessly woven into history that you can’t tell where theology ends and the history begins. “The history of Bharatvarsh (which is now called India) is the description of the timeless glory of the Divine dignitaries.”* The author claims that the history of India is 155.521972 trillion years. (In case you didn’t know, that turns archeological evidence on its head, with humans predating dinosaurs.) It gets weirder. In another page the Web site informs: “Bhagwan Ram lived on the earth for eleven thousand years.”** The thought of these folks being arbiters of what kind of Indian history will be taught in California is—to put it mildly—not entirely reassuring. The Hindu American Foundation is a creation of the RSS-front organization Vishwa Hindu Parishad of America through its star product Mihir Meghani, who co-founded the Hindu Students Council as a student at the University of Michigan. Meghani’s own views of minority rights, available on the BJP’s official Web site deserves mention: “The future of Bharat is set. Hindutva is here to stay. It is up to the Muslims whether they will be included in the new nationalistic spirit of Bharat. It is up to the government and the Muslim leadership whether they wish to increase Hindu furor or work with the Hindu leadership to show that Muslims and the government will consider Hindu sentiments. The era of one-way compromise of Hindus is over, for from now on, secularism must mean that all parties must compromise.”*** Presenting the argument of these organizations as a “grassroots,” “community” protest begs the question: Why are they shy about their Indian RSS affiliation? Is it because the attempt by RSS-supported organizations to rewrite Indian school textbooks was such a disaster that it drew a nearly unanimous outcry from the Indian press and scholars? *http://www.thevedicfoundation.org/bhartiya_history/index.html **http://www.thevedicfoundation.org/do_you_know/2.html *** Hindutva: The Great Nationalist Ideology, Mihir Meghani, http://bjp.org/history/htvintro-mm.html

Many community groups, such as Friends of South Asia and Coalition Against Communalism, as well as a whole host of faculty members have opposed this attempt to inject ideological, sectarian changes in textbooks. The particularly problematic changes are concentrated largely on three issues:

Promotion of a narrow and sectarian viewpoint within Hinduism as representing the entire religion. According to the edits of HEF/VF, Hinduism is described as a homogenous, monotheistic, brahmanical and revealed religion. This description subverts the pluralistic traditions and diverse viewpoints and attempts to promote only one sectarian viewpoint.

Sanitization of caste and gender inequalities in ancient and present-day India, thus silencing a large number of peoples’ struggles against injustice and oppression. Some of the proposed edits attempt to invalidate the very identity and existence of lower caste “untouchables” (Dalits) in India.

The ahistorical notion that the speakers of the Indo-European languages (Aryans) in ancient India were indigenous to India instead of the currently accepted historical research that gives them a Central Asian origin. The legitimization of this thesis is tied, not to any differing scholarly viewpoint, but simply to a wider contemporary Hindu nationalist political agenda of proving that while Hindus were “indigenous”, the Christians and Muslims who arrived in India later were “invaders.”

As things stand now, the HEF and VF have managed to get the Curriculum Commission to agree to a large number of their suggested changes in alignment with their Hindu nationalist/supremacist ideology know as Hindutva.

The only opposition they faced was a last minute organizing by some Indologists (M. Witzel from Harvard, Stanley Wolpert from UCLA and J. Heitzman from UC Davis with around 50 other scholars supporting them, (http://www.people.fas.harvar
d.edu/~witzel/witzelletter.pdf) and a faculty letter from over 130 South Asian Studies experts and South Asian professors at universities. While these interventions did help prevent the inclusion of many incorrect and potentially harmful suggestions, many other problematic Hindutva changes were accepted by the Curriculum Commission on Dec 2, 2005.

Groups such as Friends of South Asia and Coalition Against Communalism are dismayed by the acceptance of these “edits” by the Curriculum Commission and are petitioning the State Board to reject them. In addition to the factual inaccuracies of the VF-HEF edits, they are also petitioning the State Board to reject the changes approved by the Curriculum Commission on procedural and legal grounds. First, the Curriculum Commission is an advisory body to the State Board, and had been instructed by the board to accept only changes that reflected “factual accuracy,” but chose to ignore the mandate. Second, the Curriculum Commission violated the legally binding California Education Code requirement that sectarian viewpoints not be a part of the curriculum taught in schools. On Jan. 12, the Board announced the appointment of a sub-committee to specifically investigate whether the Curriculum Commission followed its directives in making the recommendations.

Horseplay: Playing Fast and Loose with Archeology S. Rajaram and paleographist Natwar Jha created a media sensation in 2000 with their book “The Deciphered Indus Script.” Rajaram claimed that that their effort represented “the most important breakthrough of our time in the history of Indian history a culture.” Rajaram, a retired U.S. engineering professor with no training in history or archaeology, claimed to have deciphered the Indus Valley script, a task that has confounded experts ever since the civilization was discovered. Evidence of Rajaram’s historical research is virtually nonexistent; his writings follow the classic Hindutva mold and virulently attack the Hindutva Enemies List—Christian missionaries, Marxist academics, leftist politicians, Indian Muslims, and glorified the destruction of the Babri Mosque in 1992. He claimed the Indus Valley was the home of the Rig Veda, Greek and Babylonian mathematics, all alphabetical scripts, and his claims have become a cause celebre for Hindutva followers. However, experts found his claims bogus, and Harvard experts Michael Witzel and Steve Farmer dismissed the work as a fraud in an article for the Indian magazine Frontline. Rajaram claimed an Indus seal is supposed to read, in late Vedic Sanskrit: “Arko haas’va, Sun indeed like the horse [sic],” a reference to the Yajurveda. According to Rajaram, it is accompanied by a picture of a horse. But this picture is found on a broken seal, where the front part of the “horse” is missing, and only the hindquarters of a typical “unicorn” bull are visible. The very break line of the seal, fuzzily reproduced from a clear original, is reconstructed by Rajaram as the neck and head of a horse and made “visible” in an added “artist’s impression.” There are in fact two seals of that type. Both are broken and without the “horse’s” neck and head that have been liberally supplied by “computer enhancement” (as Rajaram privately admitted later on). “What kind of motive drives expatriate writers such as a Rajaram to wildly imagine or even to invent their evidence?” asked Witzel. “Just as the infamous British Piltdown man (this 1912 hoax tried to establish the ‘missing link’ between ape and man), this Piltdown horse is composed of fake parts, put together with the same intention: to show something that simply is not there but is wished for, and, therefore, manufactured. “Why a horse? Horses are badly needed in the Indus Civilisation, as zoology and archaeology tell us they were not found in South Asia then. Domesticated horses, animals of the northern steppes, were imported into South Asia (and Mesopotamia) only early in the second millennium bce (same as BC). The first archaeologically-attested bones come from the plains below Bolan Pass (in what’s now west-central Pakistan), at 1700 bce, 200 years after the Indus Civilisation disintegrated.” No horse, no Aryans in Harappa. The broader Hindutva agenda is clear—the chilling subtext of this obsession with “indigenous” origin of Aryans is to be able to nurse the sectarian illusion that Hindus alone are the original and bonafide inhabitants of India, and people of other faiths have lesser legitimacy.

One of the claims of the HEF and VF in their proposed middle school textbook “edits,” is that the Aryan Invasion/Migration Theory is invalidated by current genetics research. Citing a 1999 scientific paper that focused on the question of the original migration of modern humans from Africa some 50,000 years ago, the HEF and VF claimed that the Aryan Invasion Theory was conclusively disproved. The question of why this claim is so important to the HEF and VF is worth exploring in its political context, but first let us take this claim at face value, to show that it does not even stand the test of scientific validity. First, the study in question focused on the question of the original human migration out of Africa around 60,000 years ago. DNA evidence tends to become unwieldy as the length of time in question decreases — huge error bars for instance for the Aryan migration period of 1,500 BCE render estimates impossible. Genetics studies are for the most part inconclusive even though the vast majority of the evidence supports the Aryan Influx Theory. For a detailed summary of some current papers in Archeogenetics pertinent to this issue, please check out http://www.friendsofsouthasia.org/text
book/Archaeogenetics_Key_Studies.html.

By selectively citing one study, the HEF and VF wanted to declare victory and get their claims codified in textbooks for sixth grade students. When the scientific “evidence” is shown to be false the HEF and VF claim that scholars whose research invalidates their claims have motives against Hinduism. Thus they assert that their struggle to overturn current research is part of a struggle by an aggrieved minority community in the U.S. to achieve respect. The shrill anti-intellectual rhetoric of the HEF and VF against individual scholars in the U.S. and India is identical to that meted out to Indian and other scholars by the Sangh Parivar in India. By labeling the Aryan Invasion/Migration theory as racist the HEF and VF, like their counterparts in the Sangh Parivar, deliberately confuse the colonial era versions of the Aryan invasion theory, such as that attributed famously to Max Muller, with the current scholarship on the issue. The available body of research on the Aryan invasion/migration theory is not just massive – it spans more than two-dozen fields of study and constitutes a far more complex range of debates and ideas than those attributed to Max Muller and other colonial historians, Orientalists and Indologists. As for Max Muller’s racial views of the Aryan invasion, historians like Romila Thapar and D.N. Jha have critiqued these long discredited positions decades ago. By making Max Muller into a straw man, the HEF and VF can justify their refusal to accept the mountain of evidence spanning several fields of research and study that points to a Central Asian origin to the Indo Aryans.

Modus Operandi
Antipathy to scholarship is disguised as “community outrage” as if the HEF and VF represent an oppressed minority. This strategy is based on an inversion of the Sangh Parivar’s usual posture of arrogance and contempt towards minorities in India. In order to facilitate this posture’s effectiveness, a slick PR organization called the Hindu American Foundation supports the HEF and VF’s textbook efforts.

While HAF founder Mihir Meghani advises Muslims in India that “Hindutva is here to stay, it is up to the Muslims whether they will be included in the new nationalistic spirit of Bharat,” (See sidebar: The Tail Wagging the Dog), HAF aids the HEF and VF in casting the campaign to rewrite textbooks as an effort to promote Hindu minority rights in the U.S. This inversion reveals the insidious tendency of the Sangh Parivar to exploit anti-racist language to further its goals. It wears the garb of an aggrieved minority in order to appease the multi-culturalist sentiments of the wider American public who are generally oblivious to the politics of Hindutva in the U.S. or in India. Most well-meaning Indians and other Americans would not want to side with white academics against aggrieved Hindus, a sentiment exploited by the HEF and VF. As if this were not enough, these organizations also mimic the legendary viciousness of the Sangh Parivar’s tactics.

Some of the HEF’s advisors have been at the forefront of a vicious and slanderous campaign against Dr. Michael Witzel, including a petition directed to Harvard University aiming to discredit him by accusing him of being an “Aryan Supremacist,” and a “creationist,” accusations that could in reality more aptly describe the content they wish to impose on sixth-graders with their current campaign to rewrite California’s textbooks. Such malicious tactics are not new to the Hindutva movement. A few years ago these same U.S. based RSS organizations attempted (and failed) to block the appointment of the world renowned historian Dr. Romila Thapar to the Kluge Chair at the Library of Congress, using similar smear tactics accusing her of “cultural genocide,” being “anti-Hindu” and so on. The head of the RSS even called for her arrest.

S. Kalyanaraman, advisor to the HEF refers to the Indo-Eurasian Research run by Michael Witzel as “a Communist-leaning political list better known for its uncritical beliefs in myths like Aryan Invasion and its negation of historical facts..” This advisor to the HEF also believes that “it is time to attack the ‘secular’. It is a dirty word, a dirty system and should be used as a word of abuse against anyone who does not adhere to Sanatana Dharma…I think secularism should be deemed a negation of Dharma, anti-Dharma, a word of abuse and hence rejected altogether.”

Dalits Step in the Debate
Such contradictions between stated antipathy towards minority rights in India and as champions of minority rights in the U.S. do not seem to bother the HEF and VF. Yet when Dalit groups intervened and voiced their strong objections to the California State Board of Education, the HEF and VF switched their tunes to more-familiar strains: outright vilification of Dalits on Hindutva Internet forums and Web sites ranging from dismissal of the very term Dalit, to vitriol that only confirms the deep-rooted anti-Dalit orientation of the Hindutva movement.

The Dalit Web Site That Wasn’t The most recent outrage perpetrated by the Hindutva movement in response to their inability to steamroll their way into sixth grade textbooks is a novelty in itself. On Dec. 19 a Web site called dalithumanrights.com was registered. Steve Farmer, one of the academics at the heart of the effort to stop the HEF and VF edits, received a letter from someone claiming to be sympathetic to his views that directed him to the Web site. The Web site itself looked quite innocuous, visually filled with stories about atrocities against Dalits. However the absence of identification information or a contact number on the Web site was odd. When asked about this omission, the anonymous organizers of this site responded with a note about fearing persecution. Interspersed among the stories were some items that seemed strangely out of place – there were pieces from the RSS mouthpiece The Organiser, for instance. Many of these stories reflected the views of the Hindutva movement with regard to the Aryan Invasion Theory, the arrest of the leader of Kanchi Mutt, and allegations against Christians. Stories titled “Dalits Pray For Sankaracharya’s Release”, “Sankaracharya’s Arrest: Dalit Hindu Peoples’ Sabha Condemns”, and “Conversions threaten a way of life.” hardly seem to be titles to offerings on any legitimate Dalit Web site. A quick Internet search on the domain dalithumanrights.com showed Dalithumanrights.com resides on a server with i.p. address 66.226.242.126. This server also hosts a large number of virulent Hindutva Web sites. These include: christianaggression.com & org, conversionwatch.org, crusadewatch.com & org, dharmaeducation.com & org, hindumediawatch.com & org, hindurenaissance.com & org, hindurenaissance.org, hindutva.org & com, hinduvigil.com, org, net, historyofjihad.org, islamreview.org, jesusreview.com & org, newsonterror.com. Many of these Web sites are registered to Rajiv Varma a Texas-based Hindutva activist under the name of an outfit called ‘Hinduworld, Inc.’ When this deception was exposed, stories from the RSS and related Web sites began disappearing from dalithumanrights.com. Cached copies are available.

Shiva Bajpai, the one academic historian trotted out by the Hindutva groups to push their case, claimed: “Dalit is a Marxist term and an ideology. It is not caste/class specific.”

Indeed, many of the textbook “edits” proposed by the HEF and VF center on erasing references to oppressive aspects of the caste system in ancient India. The HEF, for instance, wants this entire sentence deleted: “The caste system is just one example of how Hinduism was woven into the fabric of daily life in India.” This effort also included the removal of references to Dalits. The HEF suggested replacing the following sentence: “In modern India, these people are now called Dalits, and treating someone as an untouchable is a crime against the law.” with this one: “In modern India, treating someone as an untouchable is a crime against the law.” The Vedic Foundation goes even further by claiming in response to a sentence that reads: “Indian society divides itself into a complex structure of social classes based particularly on jobs. This class structure is called the caste system,” that the caste system no longer exists in modern India since the Indian Constitution guarantees the right to equality. The assertion that the caste system no longer exists is especially offensive given the persistence of systematic caste-based violence directed at Dalit communities throughout India.

If the desired erasure of Dalits and the cruel legacy of the caste system from history textbooks represents one type of violence, the hate-speech openly articulated by HEF members and their allies speaks volumes about the propensity for further levels of violence. S. Kalyanaraman, senior advisor to the HEF for example opines about Dalit Christians that: “These converts are not stupid, they are simply empowered by tainted money, the only way they could make a living and a very good one at that. In practice, few of them are employable to actually do a job of work.”

“Calling them ‘dalit’ is an insult to the entire legacy of dharma. It is being increasingly abused as a hate word by proselytizing groups for their nefarious purposes.”

According to this HEF advisor, “(Dalit International Solidarity Network) is a mullah-missionary-Marxist axis.”

Kalavai Venkat, who is listed as an author on the Web site ‘Voice of Dharma’ (a project of the ‘Hindu Mahasabha of America’ run by Vishal Agarwal) has been a fervent proponent of the Hindutva textbook rewrite effort. After the setback faced by the HEF and VF following the Dalit intervention in the textbook issue, Venkat engaged in anti-Dalit outbursts on a Hindutva forum that he moderates.

Kalavai Venkat: “It is also true that those who call themselves ‘Dalits’ are hate-mongers and racists. They never were oppressed themselves but received benefits of reservation due to vote-bank politics, whereby they deprived a meritorious student of his/her place. All ‘Dalit’ associations in universities/offices are parasitic”

Outrageous declarations of this kind promote a tyrannical and violent image of Brahmanical power, confirming that the Hindutva agenda remains fundamentally a Brahmanic project intent on the continuation of the subjugation of Dalits.

These sentiments are expressed by Jit Majumdar, a member of this forum, who opined:

“You depraved hate-monger, poisoned and caustic minds like yours deserve to be spat and trod upon. You are lowly ‘dalits’ because of your own depraved nature and character. Nobody else have to make you low. You creatures are natural scum with my shoe on your head,”

— Jit Majumder

The sheer crudeness on display above shows that behind the benign garb of ‘education’ lies a supremacist agenda that easily slips into uninhibited rage and hatred for Dalits.

One of the main successes of Hindutva mobilizations is reflected in the way in which the media has been covering this issue in an alarming manner – this “controversy” is consistently framed as a debate between some faculty (who are represented as white and non-Hindus) and a monolithic, aggrieved Hindu community. Posing the conflict along racial lines allows for a complete dismissal of genuine scholarship and the diversity of views within the community itself.

The HEF and VF’s entry into the textbook issue is cast as one impelled by the needs of Hindu students or the concerns of Hindu parents. There is no doubt that the instructional materials up for review in California contain problematic histories and need revision. Some of the statements and images in the textbooks are indeed Orientalist, and there are problematic representations of South Asian culture. But the efforts of the HEF and VF to take advantage of these discrepancies and launch a whole series of changes that have little to do with historical accuracy or the removal of biased representation has to be opposed. Their proposed changes in fact advance the biased and twisted worldview of Hindutva which sees all non-Hindus as outsiders and therefore less deserving of full rights as citizens in India. These proposed edits also erase Dalits from ancient India, whitewash the caste system and falsify the history of gender oppression. This issue is not only about what sixth grade American students will learn in California. It is also not about how well or badly ancient India appears to either students or their parents.

By reducing the study of history to a matter of cheery representations of the past, we fail to provide students with the critical tools necessary to recognize and act upon various forms of oppression in the present. The oppression of Dalits and women in India and South Asia is widespread and current. How are students to be equipped to deal with these contemporary oppressions when their history books, thanks to the HEF and VF, effectively erase Dalits, glorify the caste system and falsify the oppression of women in history textbooks? Is pride to be achieved at the cost of knowledge? And if so, pride in what?

- Sunaina Maira is associate professor of Asian American studies at the University of California at Davis and author of ‘Desis in the House: Indian American Youth Culture in New York City.’
Raja Swamy is a graduate student in the department of anthropology
at the University of Texas, Austin.

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HEALTH:
Heart Disease Epidemic
What South Asians Need to Know
A silent but deadly epidemic of heart disease is raging in South Asia — and among the people who emigrated from there. After 15 years of researching heart disease among South Asians in the U.S., Enas Enas, MD introduces a book he has written for the general public about why this killer epidemic is occurring, and how to identify, prevent, control and even reverse it.


There is a silent but deadly epidemic of heart disease raging on the Indian subcontinent — Bangladesh, India, Pakistan, and Sri Lanka—and people who emigrated from there. Why this killer epidemic is occurring, and what can be done about it? In the past decade and a half I have researched heart disease among people of South Asian Indian descent — and explored ways of how to identify, prevent, control, and even reverse it.

In the early 1990s, when I began publishing articles in cardiology journals about heart disease among Indians, many in the medical community were skeptical that heart disease was any more prevalent among Indians than other populations. Through conducting autopsies and studying disease on the population level, pathologists and epidemiologists had known about these high rates for several decades. Internists, family practitioners, and even cardiologists, in contrast, were largely unaware of the epidemic.

Something was wrong. In response, I decided to set the story straight. For the past 15 years, I have maintained a laser-like focus on this tsunami of heart disease sweeping the Indian subcontinent, drawing attention to it through research, journal publishing, and about 100 speaking engagements a year. Gradually, medical professionals — both Indian and non-Indian — have become familiar with this massive problem. The public, however, still barely knows about it, including the Indian public.

My book, “How to Beat the Heart Disease Epidemic Among South Asians: A Prevention and Management Guide for Asian Indians and their Doctors,” is aimed at stemming and reversing the tide. In paper after paper, I have shown that the data are both undeniable and startling: For example, immigrants from the Indian subcontinent living in the U.S. have a rate of premature heart disease three to four times higher than that of other Americans, regardless of gender or socioeconomic background. More recent studies suggest that heart disease rates among the more than a billion people living on the subcontinent, particularly in urban areas, are as high as, or higher than, the rates observed among Indians in the U.S. Researchers now conservatively estimate that at least one out of ten Indians suffers from heart disease. One out of ten is simply an extraordinary figure. Morally and medically, it is also an unacceptable one.

In the Western world, incidence and death rates from cardiovascular disease continue to decline from their peak in the 1960s, because of lifestyle changes and improvements in treatment. In South Asia, by contrast, these rates are rising. According to data from the American Heart Association and the World Health Organization, in 1985 as many as 145 men per 100,000 and 126 women per 100,000 died from heart disease in India. By 2015, those numbers are expected to hit 295 for men and 239 for women — a doubling of rates over three decades, and this, despite the fact that a large proportion of Asian Indians are non-smoking vegetarians with normal levels of cholesterol, body weight, and blood pressure.

Landmark Publication on South Asian Heart Disease HOW TO BEAT THE HEART DISEASE EPIDEMIC AMONG SOUTH ASIANS: A PREVENTION AND MANAGEMENT GUIDE FOR ASIAN INDIANS AND THEIR DOCTORS. By Enas Enas, M.D., and Dr. Sudesh Kannan. Published by Advanced Heart Lipid Clinic. Downers Grove, Ill. It is rare to find a book that combines the solid scholarship of an expert with the evangelical zeal of the true enthusiast. This books fits the bill remarkably well. Enas Enas, M.D.’s scholarship on the issue of heart disease among South Asians is legendary. “Enas has always been a prolific researcher, eloquent speaker and a master teacher,” M.P. Ravindranathan, M.D., editor in-chief of the American Association of Physicians of Indian Origin Journal has commented. “During the last two decades, he has been in the forefront of the fight for the prevention of heart disease among Indians.” What’s remarkable is how readable this book is. Enas makes a passionate case for tackling the threat of heart disease that stalks South Asians — he calls it “a silent but deadly epidemic.” Chock-full of useful information and organized with the efficiency of a textbook, the tone of the book is conversational and friendly. The book has three parts. The first part presents fundamental concepts of heart disease with special focus on Indians. It highlights what makes heart disease different among Indians and summarizes some of the paradoxical relationships that exist between heart disease, risk factors, and different populations. The second part presents strategies for lifestyle improvements in an easy-to-understand format. Part three discusses the various medications for prevention and treatment of heart disease. Ravindranathan calls this book “the new bible for understanding, managing and preventing heart disease, and living longer, for Indians.” “Can anyone of us afford not to read it?” he asks. “This book is a must read for all South Asians, especially Indians and it certainly must be displayed on the living room table in every Indian house, for ready reference.” Enas has not written a book of gloom and doom, however. “If you are Indian and are reading this, and holding your chest wondering ‘Oh my! I’m in trouble,’ I have good news for you,” writes Enas. “Heart disease is highly predictable, preventable, treatable and even reversible.” The motivational part of the book is one of its most valuable parts. “Unlike a crash diet before a wedding, lifestyle changes such as nutrition and exercise are best approached not as one-time events but as ongoing, lifelong practices,” Enas writes. “Yet how do you initiate, let alone sustain, a fundamental change in orientation over several years or even decades?” To address this, Enas’ section on motivation offers pointers to help readers overcome psychological obstacles in internalizing a lifestyle change and making it a permanent feature of their daily life. “If you start today, you can literally be physiologically younger next year: more healthy, more energetic, more fit, and at lower risk for cardiac disease and diabetes,” he writes. “Indians and non-Indians in both the medical and non-medical communities must work together to make heart disease and diabetes among at-risk populations such as Indians more widely known, and ultimately more rare. My overriding goal in writing this book is to harness everything I know to help you gain greater control over your life and enhance its quality and length. I hope you find it clear, informative, practical, and timely.” We have no doubt that most readers will. The authors can be reached at book@cadiresearch.com. The book can be ordered online at the following Web site: www.cadiresearch.com

In 2002, by comparison, 170 American men per 100,000 and 131 women per 100,000 died from heart disease. If the current decline of 2 percent per year holds in the US, by 2015 the projected death rate from heart disease per 100,000 will be 128 men and 98 women. What makes heart disease among Indians so different?

Here are six key features:

Prematurity. Heart attacks strike many Indians at a relatively young age (40-60 years). Many Indians know of fellow Indians who suffered their first attack when they were just 35 or even 25.

Severity. Among Indians, heart disease tends to be severe, malignant, and diffuse (spread out along an artery instead of in just one or two spots), making it hard to treat with bypass surgery or angioplasty. Many cases are simply inoperable. Even when successfully carried out, such procedures often serve only as temporary fixes. The underlying problem remains — the continuing buildup of plaque in the arteries. This means that, despite repeat surgeries and angioplasties, the blockages often return with a vengeance, leading to premature death.

Equally high rates among women. Until recently, heart disease was considered “a man’s disease.” Unlike in other ethnic groups, however, heart disease rates among Indian men and women are virtually identical, despite relatively low rates of smoking among Indian women.

High rates of heart disease despite low rates of the traditional risk factors. The prevalence of smoking, hypertension, high cholesterol, and obesity — the traditional heart disease risk factors — is similar or lower among Indians in the US compared to other Americans. Yet for any given level of cardiac risk factors, Indians are at about twice greater risk of developing heart disease.

Predilection for diabetes. Diabetes is 2-4 times more common among Indians in the U.S. than other Americans. It occurs at a younger age, and even in the absence of obesity. Diabetes and heart disease appear to be strongly interactive among Indians — one leads to the other within a matter of 10-20 years.

A combination of genetic susceptibility and lifestyle factors. Indians seem to be more vulnerable to heart disease because of a genetic predisposition to abdominal obesity, high blood levels of a substance called lipoprotein(a), and a small-particle type of HDL (good) cholesterol that offers less protection against heart disease. These heredity-based risk factors magnify the harmful effects of lifestyle risk factors associated with physical inactivity, urban living, and a high-fat diet.

If you are Indian and are reading this, and holding your chest wondering “Oh my! I’m in trouble,” I have good news for you. Heart disease is highly predictable, preventable, treatable and even reversible.

We now have the technology, diagnostic tests, and medications to help you lower your risk factors substantially.

While your genes may have loaded the gun, it is lifestyle choices that pull the trigger.

Working with your doctor, you can significantly reduce your risk of heart disease through appropriate lifestyle changes and medications.

As advances in genetics and biotechnology usher in a new era of “personalized medicine,” we can look forward to a time when doctors will be able to offer their patients even more effective combinations of cardiovascular medications and risk-reduction strategies that are custom-tailored to each patient’s unique individual genetic makeup. Yet even today, we have enough knowledge to reduce most people’s heart disease risks to surprisingly low levels — if only more people would grasp the urgency of the need to do this, and translate that urgency into practical preventive action.

If I may offer you a brief but telling example. My co-author, Dr. Sudesh Kannan, had what many would consider a healthy lifestyle. He was predominantly vegetarian. He did not smoke. He exercised 20 minutes three times a week. He was not obese by traditional standards. So it came as a complete surprise when routine blood tests revealed that he had dyslipidemia, meaning that his blood lipids were gravely out of balance.

He had low levels of HDL (good cholesterol) and high levels of LDL (bad cholesterol). His triglycerides, a marker for diabetes, were above 500 mg/Dl — three times the normal level.

With the same perseverance that earned him a doctorate from the University of Virginia, Sudesh decided to attack dyslipidemia, researching it in books and medical papers and looking for advice not only on how to treat it but on how to manage it through a healthy diet and increased physical activity. Then in 1995 Sudesh’s brother, a physician, sent him an article I had published in Clinical Cardiology (vol. 18, 1995) titled “Malignant Heart Disease in Young Indians.”

That article, Sudesh says, marked a turning point in his life. Not only did he regain control over his cholesterol and triglyceride levels, but he went on to run three marathons and complete two 100-mile bike rides.

Today, his energy level is astounding. I can unhesitatingly state that Sudesh’s health is a testament to the proposition that small lifestyle changes can yield major rewards in quality of life. Consider this: In many ways, the human body is constantly trying to heal itself. From T-cells to homeostasis, it has a sophisticated array of self-corrective systems within it that are all designed to do one thing: keep the body in optimal health. Give it the right inputs of daily physical activity, plenty of water, and a healthy diet, and it will respond magnificently — often far better than any medication can get it to do.

Sudesh joined me to co-author my book because he is concerned about one thing: much of what I have uncovered and published in journals over the past 15 years, he says, still remains unknown to the average Indian, and even many physicians. Not only are the prevention and management strategies for Indian heart disease unfamiliar, but the dimensions of the problem itself have not been fully grasped. It remains under the radar. The Indian Ocean tsunami of December 26, 2004 that killed an estimated 290,000 people received extensive 24-hour international media coverage — as well it should. The response was magnificent and appreciated. To put it in perspective, however, heart disease kills more people in the nation of India alone than the tsunami did every three months. That fact does not even make it into the Health Section of most major newspapers, never mind primetime TV news. Yet every three months, more than 300,000 Indians slip away under the waves of coronary artery disease. Heart disease has indeed become the “Silent Scream” among South Asians — snuffing out lives by the thousands every day while others go on with their lives, oblivious to the killer stalking the region.

The ‘Cliff Notes’ of Fighting Heart Disease: Sudesh Kannan Drawing on years of painstaking medical investigation, epidemiological research, personal observation, and clinical practice, Dr. Enas has condensed the most salient information and insights from his vast database of scientific knowledge to create this compendium of knowledge on how to win the war against premature, malignant heart disease. This book, in just a few hundred pages, is the “Cliff Notes” version of everything this man knows about fighting coronary artery disease among people with a nature-nurture risk profile that predisposes them to it. The section on the Prudent Nutrition Program, for example, is based on an article he published in 2003 which itself has nearly 400 references. In Western countries such as the United States, the tremendous strides made over the past three decades in identifying the risk factors of heart disease, and controlling them through medication and lifestyle modifications, have cut the incidence of heart attack by more than 50 percent among their populations. By contrast, measured in overall numbers, Indians have benefited little from these advances in detection, management, and prevention—whether they live in Asia or in the west. Heart disease, in fact, has become more widespread on the Indian subcontinent, not less. This book, used well, could help reverse that trend. If you belong to an at-risk population such as Asian Indians—or if you simply have high risk factor levels as an individual, such as having blood relatives who have had heart disease-I urge you to take action to reduce your risks of heart disease and diabetes by reading this invaluable book. Speaking from personal knowledge, I promise you an eye-opening experience. When you are done, share it with friends, family, and colleagues. Let’s work together to slay this monster in our midst. Dr. Sudesh Kannan is co-author, with Enas Enas, M.D., of “How to Beat the Heart Disease Epidemic Among South Asians: A Prevention and Management Guide for Asian Indians and their Doctors”.

In the Book of Hosea, God explains: “My people are destroyed from lack of knowledge” (4:6). After considering how dramatically his health had turned around — through the simple application of knowledge derived from sound research data — it was Sudesh who urged me to write a book that would send a clear message to Indian Americans at home and abroad, and the physicians who take care of them.

Over the past 15 years, I have presented and conducted more than 1,000 lectures and seminars to physicians in the U.S. and India as well as Indians living in Chicago on the subject of heart disease. My book distils the extensive feedback I have received from my audiences and seminar participants into a set of practical preventive and treatment strategies. It is intended to serve as a quickly digestible companion to a more professional edition, “Heart Disease among South Asians: Unraveling the Mysteries, Debunking the Myths,” scheduled for release in 2006.

Excerpted from the preface of “How to Beat the Heart Disease Epidemic Among South Asians: A Prevention and Management Guide for Asian Indians and their Doctors” by Enas Enas, M.D., and Dr. Sudesh Kannan.

FAQs
What is it about Indians that makes them so vulnerable to heart disease?
Heart disease has many causes with genetics playing an important role in some individuals. Lifestyle choices can also play a key role. Among Indians, we have problems with both. In other words, genetics loads the gun and lifestyle choices pull the trigger!

Indians indeed have a higher prevalence of high levels of genetically determined cholesterol that is partly responsible for the high rates of heart disease. Among Indians, heart disease strikes hard and at a young age. Indians tend to have heart disease in their 30 and 40s and they tend to have a severe form of heart disease that leads to repeat angioplasty and bypass surgery.

What are some of your key recommendations?
The three key ingredients of addressing any epidemic are Awareness, Acceptance and Action! Over the past fifteen years, Indians have by-and-large become aware of their excess burden of heart disease but to the best of my knowledge, the acceptance has been poor and the action is almost non-existent.

First and foremost — Indians have to accept that they have a higher risk of heart disease at a given level of cholesterol, blood pressure, body weight and other risk factors. The threshold of intervention and goal of treatment should be different. For example, people with heart disease or diabetes are treated to more stringent cholesterol goals than people without this condition. My recommendation is to treat all Indians without heart disease or diabetes as aggressively as Americans with these conditions.

Who should read this book? How will they benefit from reading your book?
This book is unique — this is a hybrid book –first of its kind- written for the Indian public and their physicians. Many reviewers of the book have consistently recommended that this book must be read by “all Indians and the health professionals who care for them.”

We have special sections in this book for persons who have already been diagnosed with heart disease and who have had coronary angioplasty or bypass surgery. This book is a must read for people who have had these procedures. It discusses at length the strategies for minimizing the need for repeat procedures. Those with family history of heart disease at a young age will also benefit from reading this book because it addresses special tests that focus on such individuals.

What about people suffering from diabetes? Will they find this book valuable?
Indians not only have a three to four fold higher rate for heart disease, they also have an equally high rate of diabetes. Similar to heart disease, Indians develop diabetes 10-20 years younger and with a body weight 40-50 lbs lower than whites. Diabetes and heart disease are inextricably intertwined with one leading to the other in 10-20 years. Nearly 50 % of the Indians with heart disease have diabetes and these persons have the highest risk of repeat heart attack and cardiac death. This book has three specific sections dealing with nuances of diabetes among Indians and what they can do to prevent and reduce the ravages of diabetes.

Can I automatically assume that my family physician is up-to-date on the latest research on Indians and heart disease?
Although we have nearly 50,000 Indian physicians in the U.S., 4 out of 5 Indians are treated by doctors who are not Indians and who may be totally in the dark about the unique aspects of heart disease among Indians. The information in the book can be used by Indian patients to receive more appropriate medical care.

Most Indians I know are vegetarian. Can they be at high risk for heart disease?
There is a myth that Indian vegetarians do not get heart disease. Nothing can be further from the truth. It is true that western vegetarians are largely protected from heart disease because they have a healthy lifestyle particularly in their eating habits. Unfortunately, Indian vegetarians consume as muc