The month of November, in the past few years, has come to be very closely associated with the news on diabetes as 14 November is annually observed as the World Diabetes Day and India has a high incidence of this chronic disease. According to the estimates of a study published in 2023, a staggering 101 million people are suffering from diabetes in India, which is approximately 11.4% of the nation’s population (making us the second worst affected country in the world). But the most shocking revelation that is increasingly coming into spotlight is that our susceptibility to diabetes is closely linked to the British colonial policies that turned this food bowl of the world into a famine country, with millions driven to starvation and subsequent death, and the survivors becoming susceptible to diabetes, as also passing on the transformed genetics to future generations.
These latest numbers for India, as mentioned above, were arrived at by a decade-long study conducted by the Madras Diabetes Research Foundation (MDRF) with the Indian Council of Medical Research (ICMR) and involved 113,000 participants over the age of 20 from every state of India.
A FALSE NARRATIVE
Before delving deeper into the historical factors that have made Indians (in fact, South Asians at large), easy victims of this chronic disease, we must pause and put to rest the false narrative of the label slapped on India as the ‘Diabetes capital of the world.’ It is difficult to trace what gave birth to this misnomer in mainstream media in the country but it seems to have caught on as people are often found loosely using this term with regards to India.
According to the International Diabetes Federation—a Belgium-based umbrella organisation of over 240 national diabetes association in more than 161 countries of the world—74 million Indians were suffering from diabetes in 2021, a figure that is likely to go up to 124.9 million by 2045; China led this unfortunate statistical figure with 140.9 million diabetes cases in 2021, which would likely go up to 174.4 million by 2045.
As these figures amply clarify, China is, indeed, the diabetes capital of the world with maximum number of diabetes patients. India is a close second. But that does not alleviate the medical burden of diabetes that India carries.
It is a veritable ticking time bomb that India will have to grab by the horns and address, as a bigger number of people in India are pre-diabetic. As per the MDRF-ICMR study, 136 million people (or 15.3% of population in India) were pre-diabetic. It is believed that conversion from pre-diabetes to diabetes is pretty fast in India with as much as 60% people with pre-diabetes ending up as diabetic in five years.
A BRITISH CONSPIRACY
To link the dots of the above stated facts, we have to understand the science behind the causal factors of this chronic disease in which the body loses its ability to regulate blood sugar levels, either due to not producing enough insulin or by not being able to use insulin properly. But to answer the question as to how Indians became pre-disposed to diabetes in such a big number, we have to study history along with science of the human body.
The impact of the British colonial rule and its ruthless policies, it seems, went far deeper than we could have ever imagined. It is far deeper than our national obsession with English, or Western way of life (though the latter too has contributed in a big way in deteriorating the situation of diabetes among Indians, as we will see later). It has gone deep into our genetics, affecting our genetic resilience towards the disease due to prolonged exposure to starvation as a result of human-induced famines.
Epigenetics is the branch of science which studies the impact of environment and behaviour on genes and how they affect generations. It studies stable and inheritable changes in gene expression that occur through alterations in the chromosome rather than the DNA sequence. It is through epigenetics that we now know the British role in forcing starvation on Indians to the point that their genetic makeup got affected and became pre-disposed to developing diabetes.
Image Courtesy: The J. Paul Getty Museum
India, which throughout its history was one of the top food producers of the world, experienced a disproportionate number of famines during the British rule. As many as 25 major famines occurred in just 90 years of official British rule (1857-1947) causing 60 million deaths.
Famine is a situation of extreme scarcity of food, which by logic should take place in the season of drought. There is a difference between drought and famine. While drought is a prolonged dry period in the natural climate cycle that can occur anywhere in the world due to lack of rainfall, famine is scarcity of food, which may be caused by drought or by denial of food by the rulers to their subjects as happened in the case of India during the British rule.
Not all the 25 major famines that India experienced during colonial rule were due to drought, most of those had other factors induced by the British policies such as harsh land taxes, export of food to England without first taking care of Indians, and no agricultural policies to take care of land rejuvenation, among others.
THE MAJOR FAMINES
To quote one example, the Great Famine of 1876-1878 shook India to the core, causing 6-11 million deaths. It began as a result of intense drought in the Deccan Plateau, which in itself was part of the larger drought and crop failure pattern in India, China, South America and parts of Africa due to a strong El Nino and Indian Ocean Dipole or Indian Nino (both are weather phenomena that impact monsoons in India).
The famine started in south and southwestern India and soon spread northwards covering central India and north India right up till Punjab. The situation was exacerbated as regular export of grain to England by the colonial government continued despite acute food shortage in India. Lord Lytton, then viceroy of India, presided over a record export of 320,000 tonnes of wheat to England. This, coupled with commodification of grain and cultivation of alternate non-food cash crops pushed common Indians to the brink.
It is interesting to note here that in an earlier famine in Bihar in 1873-1874, the local government led by Sir Richard Temple (who was made the lieutenant-governor of Bengal Presidency in 1874) imported half a million tonnes of rice from British Burma to bring relief to the affected population, and had succeeded in preventing large-scale deaths. This is quoted as one of the rare examples when British authorities provided adequate famine relief to Indians. However, Temple was so heavily criticised by his superiors in India and London for spending money on Indians that he scaled down government intervention in the subsequent famine of 1876-1878, that resulted in deaths of millions of Indians; in 1877, he was appointed Governor of Bombay Presidency and the plenipotentiary famine delegate of the Viceroy of India to Madras during the famine.
Image Courtesy: Wikimedia Commons
The other popular example is that of the 1943 Bengal Famine, in which 3 million people perished due to hunger and malnutrition, in Bengal alone (majorly comprising present-day West Bengal and Bangladesh, and a few other regions of eastern India). The province of Bengal of British India produced one-third of rice produced in the subcontinent yet wartime policies of the British induced one of the worst famines in the history of mankind.
When the Second World War broke out, India was dragged into it despite widespread protest. As a result, all of the Indian subcontinent’s resources were diverted into the European war effort, including manpower and food resources, leaving the producers of that very food teetering on starvation. In a cycle of gross atrocities, the British inaction or poor policies during drought conditions made matters worse, leaving a hapless population to die for lack of food that they had produced yet saw being shipped to England.
At the head of the government in England at that time was Prime Minister Winston Churchill, who added insult to injury by rejecting pleas by the Viceroy in India, for more than one million tonnes of emergency wheat supplies in 1942-43. Churchill has been quoted as blaming the famine on the fact that Indians were “breeding like rabbits”, and asking how, if the shortages were so bad, Mahatma Gandhi was still alive.
This was a pattern that had marked the British rule of India right from the start, as food that belonged to Indians was shipped to Europe, along with rest of the subcontinent’s riches.
Image Courtesy: Wikimedia Commons
According to reports available in public domain, researchers in India and the US, using weather data to simulate the amount of moisture in the soil during six major famines in the subcontinent, revealed that during those famines, there was enough moisture in the soil, debunking the then British narrative that food shortfall was a result of weather conditions.
As happens during war situations, price of food—most of which was anyway being exported out of India—increased by 300%, but because wages did not rise accordingly, ordinary people were forced to cut on food and other goods due to war-induced poverty.
Anthropologist Jason Edward Hickel, whose research and writing focusses on economic anthropology and development, has written, “In the name of the Allied cause, the policies imposed by [British economist John Maynard] Keynes and [British Prime Minister Winston] Churchill killed more than three million people—many times more than the total number of military and civilian casualties suffered during the entire war by Britain and the US combined. The scale of this tragedy is almost impossible to fathom.” Hickel, who is known for his opposition to capitalism and neocolonialism, adds that the US and Britain could have used their own resources instead, which would have required taxing their own citizens at just £1 per person.
In total, more than 15 million people died due to famines in India between 1850 and 1899, more than in any other 50-year period. While the British gave us genetic modification of diabetes, they simultaneously siphoned off an estimated $45 trillion from India to England during their inglorious rule.
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IMPACT OF FAMINES ON SOUTH ASIAN GENETICS
Diabetes mellitus, commonly known as Diabetes, has two variants, Type 1 and Type 2. The common condition that South Asians suffer from is Type 2 diabetes in which the body either doesn’t produce enough insulin or doesn’t use insulin properly. (As opposed to this, Type 1 diabetes refers to the variety in which pancreas doesn’t produce or stops producing insulin altogether.)
Insulin is a hormone produced by beta cells of the pancreas, and is the main anabolic hormone of the body.
In a normal-functioning human body, insulin is used to move glucose from the bloodstream into the cells, where it is used as energy for vital functions of the cells. In normal functioning of cells and organs, when energy is used up, insulin and blood sugar levels decrease, which alerts the livers to release stored blood sugar to carry on with normal functions of the cells.
Contrarily, in people with diabetes, normal insulin functioning is disturbed, which results in high levels of sugar (glucose) in the bloodstream. If left untreated, high blood sugar can lead to serious health problems, such as heart attack, kidney diseases, eye problems, nerve damage, foot problems, etc.
Diabetes was induced in the bodies of Indians, and other South Asians due to famines, or long periods of starvation. The South Asian genes, so to speak, got ‘starvation adapted’, which means that in view of starvation, or non-availability of food or energy, they started storing available energy for as long as possible, in order to survive. ‘Starvation Adaptation’ made many Indian bodies resistant to the hormone called insulin, resulting in blood sugar levels becoming elevated over a period of time, leading to diabetes. When a body is resistant to insulin, it becomes harder for muscle and liver cells to absorb sugar from the blood, which leads to build of high sugar levels in the blood. As a result, body starts storing extra sugar as fat, to use it much later during the shortage of food.
Research has shown that surviving just one famine doubles the risk of diabetes and hyperglycemia (high levels of blood sugar) in the next generation.
DIABETES IN INDIA POST-LIBERALISATION
While historical factors made Indian population susceptible to diabetes, economic liberalisation brought in a sea change in Indian lifestyle, which has now added to the current diabetes load of the country.
According to medical journals, diabetes can be caused by both genetic and environmental factors.
There has been a paradigm change in average Indian lifestyle since economic liberalisation when unhealthy foods found their way into our kitchens and even superseded traditional, healthy foods. Coupled with growing incomes and changes in way we wished to lead our lives, we turned far more physically inactive than permissible for a healthy life.
To cut to the chase, the current scenario is a veritable diabetes time bomb for the country as the population is anyway at a great risk of acquiring this chronic metabolic disorder due to reasons elucidated above. We aren’t helping matters with our sedentary, unhealthy lifestyle and growing stress. While historical wrongs cannot be undone despite the anger we may harbour, we definitely can introduce changes in our lives to prevent the onset of diabetes, and to control it, if it has already attacked the system.
*The writer is Editor, Science India.
