India wears an unfortunate crown as the diabetes capital of the world, with over 100 million people already battling the condition and another 136 million at risk. What’s striking is the “thin-fat Indian” paradox—while many may appear lean, they carry harmful visceral fat that quietly elevates their risk for type 2 diabetes. This silent epidemic is more than a genetic predisposition; it’s a collision of cultural habits, modern lifestyles, and a lack of awareness.

I had the privilege of sitting down with the renowned Dr. Shashank Joshi, a Padma Bhushan awardee and one of the top 0.25% cited clinical researchers globally. A renowned endocrinologist, he has been instrumental in advancing diabetes care and lifestyle medicine in India. 

His work bridges evidence-based medicine with lifestyle interventions, helping countless individuals manage and prevent chronic diseases like diabetes. 

During a recent conversation, I gained powerful insights into how we can address this crisis. Dr. Joshi’s work, spanning decades in endocrinology and lifestyle medicine, proves that diabetes is not an inevitability. It is preventable and, provided we shift our focus from only treatment to preventive care. In some cases, the disease is also reversible, which requires condition management combining conventional medicine with lifestyle medicine.

By the end of this read, you won’t just walk away with insights—you’ll walk away empowered. Let’s explore how small changes in your lifestyle can lead to monumental shifts in your health. 

Diabetes isn’t just a medical issue—it’s a lifestyle challenge. The answer lies not in one-size-fits-all solutions but in culturally and personally tailored interventions. 

The Genetics of Diabetes in South Asians: What You Need to Know

South Asians face a disproportionately higher risk of type 2 diabetes, with some studies showing we’re up to four times more likely to develop the condition than other populations. It’s a sobering reality that makes you wonder: Is it just our genes, or is there more to the story? The truth is, while our genetic makeup does predispose us to diabetes, it’s how we live our lives that ultimately decides our health outcomes.

Image by Freepik

 

Why Are South Asians at Greater Risk?

  1. The Thin-Fat Paradox: Despite appearing lean, many Indians carry higher visceral fat levels, earning the term Thin-Fat Indian. This hidden risk factor, coupled with genetic predispositions, places millions at a higher risk for type 2 diabetes even at younger ages and lower body weights. It’s a strange phenomenon—you look lean on the outside, but hidden visceral fat is quietly wreaking havoc inside. This type of fat wraps around your organs and makes your body less sensitive to insulin, paving the way for diabetes.
  2. Unique Genetic Markers: Research has identified over 80 genetic markers that increase our vulnerability to insulin resistance and poor pancreatic beta-cell function. These markers make us more prone to metabolic imbalances even at lower body weights.
Source: Shah, A., & Kanaya, A. M. (2014). Diabetes and Associated Complications in the South Asian Population. Current Cardiology Reports, 16(5), 476. https://doi.org/10.1007/s11886-014-0476-5

 

  1. Early Onset: Unlike many other populations, South Asians often develop diabetes in their late 30s or 40s, long before others. This early onset leaves us exposed to complications for a longer time, making prevention even more critical.
  2. The Lifestyle Transition: We’ve moved away from the wholesome meals of our ancestors—loaded with lentils, vegetables, and whole grains—to convenient but harmful processed foods and sugary drinks. Add sedentary office hours and minimal physical activity, and you’ve got the perfect recipe for a health crisis.
Image by Freepik

It’s in Our Genes, but Not Our Destiny

The genetic factor can feel like a life sentence, but let me assure you—it’s not. As Dr. Shashank Joshi puts it, “Genes load the gun, but lifestyle pulls the trigger.” While you can’t change your genes, you absolutely can control how they are expressed.

Our bodies have an innate intelligence, one that responds beautifully to care and balance. With the right habits, you can significantly lower your risk, even if diabetes runs in your family. This is where the power of epigenetics comes into play. 

Breaking Free from Genetic Risks

  • Prioritize Movement:
    • If long workouts feel overwhelming, start small. A brisk 10-minute walk after meals can do wonders for stabilizing blood sugar.
  • Embrace Traditional Foods:
    • Our grandmothers knew what they were doing. Lentils, millet, fresh vegetables, and spices are the kind of fuel our bodies thrive on. Keep processed foods as an occasional indulgence, not a daily habit.
  • Protect Your Sleep:
    • Sleep isn’t just rest; it’s repair. Poor sleep disrupts blood sugar control and increases stress hormones, so make it a priority.

Managing Diabetes with Grace

A diabetes diagnosis can feel overwhelming, but it’s not the end of the road. With the right approach, you can still enjoy life fully—eating delicious meals, spending time with loved ones, and pursuing your passions. The key is balance.

What does this mean for you? Genetics might predispose you, but lifestyle remains the main driver. Research from the International Diabetes Federation shows that lifestyle interventions can reduce diabetes risk by up to 58% for at-risk populations.

 

Source: Tuomilehto, J., Schwarz, P., & Lindström, J. (2011). Long-Term Benefits From Lifestyle Interventions for Type 2 Diabetes Prevention: Time to expand the efforts. Diabetes Care, 34(Suppl 2), S210. https://doi.org/10.2337/dc11-s222

 

Pair your meals thoughtfully—think proteins with fiber-rich carbs—to avoid blood sugar spikes. Add moments of mindfulness into your day to ease stress and reduce cortisol levels. And remember, progress is more important than perfection. Every small, consistent step you take is a step toward reclaiming your health.

Having diabetes doesn’t define you. It’s just one chapter in your story, and you have the power to shape what comes next.

About Nutrition and Fads: Debunking Food Trends

Seeking nutrition advice today is full of conflicting advice and ever-changing trends. From keto to intermittent fasting, fad diets promise transformative results, but their effectiveness depends on how they align with individual needs. It’s crucial to understand that nutrition is not a one-size-fits-all approach. Each person’s body reacts differently to nutritional choices based on their genetics, bioindividuality, activity levels, and overall health.

Nutrition can feel overwhelming with conflicting advice everywhere. From keto to intermittent fasting, each plan promises results. But here’s the truth: None of them are effective universally.

For instance:

  • A ketogenic meal plan may benefit those with epilepsy or insulin resistance but can strain your liver if not managed correctly.
  • Intermittent fasting might improve insulin sensitivity for some, but for others, prolonged fasting can lead to energy crashes or hormonal imbalances.
Switching out unhealthy foods for healthier alternatives
Image by Freepik

Practical Nutrition Tips for Better Blood Sugar Control

  • Start with a Protein-Packed Breakfast: Opt for moong dal chilla, boiled eggs, or Greek yogurt with seeds to stabilize blood sugar and improve satiety.
  • Moderate Refined Carbs: Replace white rice and maida-based products with complex carbs like brown rice, quinoa, or millet.
  • Balance Your Plate: Aim for a mix of proteins, healthy fats, and fiber. Include dal, sabzi, and roti made from whole grains for a culturally relevant and balanced meal.
  • Add Healthy Fats: Use cold-pressed oils, including nuts and seeds, and consume A2 ghee in moderation to improve insulin sensitivity.
  • Hydrate Well: Begin your day with a glass of warm water and lemon to detoxify and improve digestion.

By utilizing traditional foods and focusing on mindful eating, South Asians can overcome their genetic vulnerabilities and build a foundation for better metabolic health. This isn’t about restrictive dieting—it’s about sustainable, balanced nutrition that honors our heritage while protecting our health. Above all, in the last 14 years of my experience dealing with diabetes patients, we’ve observed the power of a personalized approach. 

Personalized Nutrition and Medicine

When it comes to diabetes, there’s no such thing as a one-size-fits-all approach. Our diverse South Asian genetics make us uniquely prone to insulin resistance and other metabolic challenges. This is why personalized medicine is so powerful—it acknowledges that each individual’s health journey is different.

This is the heart of lifestyle medicine, a growing field that’s transforming how we approach chronic diseases like diabetes, hypertension, and obesity.

Dr. Joshi’s vision for a diabetes-free India is deeply personal. During our talk, he shared a poignant moment from his life—facing a near-death experience that shaped his holistic approach to medicine.  During a period of intense professional commitment, he found himself grappling with a severe health scare that forced him to confront the limits of conventional medical care. He recounted his father’s battle with cancer from 2007 to 2019, describing the pain and challenges his father faced. Dr. Joshi emphasized the importance of being pain-free and emotionally fulfilled, sharing how his father achieved a significant life goal by writing and publishing a book during his final years.

This life-altering event became a wake-up call, compelling him to look beyond symptom management and explore the root causes of health and disease. This wasn’t just a wake-up call for him but also a catalyst for his mission to help others take control of their health through sustainable lifestyle changes. 

Dr. Joshi shared how evidence-based medicine and personalized lifestyle prescriptions must go hand in hand. It’s not about trendy diets or extreme workouts—it’s about creating sustainable habits that align with your body’s unique needs and cultural context. The potential to prevent, manage, and even reverse diabetes lies in these everyday choices.

He believes in the synergy between medicine and lifestyle interventions, advocating for a model where healing is not just about prescribing pills but empowering people to make better daily choices.

The Lifestyle Medicine Revolution

While we may carry genetic predispositions for diabetes, it’s our daily choices—what we eat, how we move, and how we manage stress—that determine whether those genes are activated.

Lifestyle medicine is a game-changer because it targets the root causes rather than masking symptoms. 

Dr. Joshi developed a keen fascination for the body’s intricate systems during his journey in endocrinology Over time, he realized that treating a disease in isolation wasn’t enough. 

“We need to stop treating symptoms and start treating the person,” he emphasized. 

This philosophy has fueled his approach to lifestyle medicine, where nutrition, movement, sleep, emotional health, and mindfulness all play vital roles in recovery and prevention.

Take, for example, a working mother I worked with. She struggled with fluctuating blood sugar levels and constant energy crashes. Through personalized meal plans, we incorporated traditional foods like protein-rich dals, whole grains, and fiber-packed vegetables into her routine. Within weeks, she noticed significant improvements—not just in her blood sugar but also in her overall energy levels.

Personalized medicine is more than a buzzword; it’s the future of healthcare. When combined with culturally relevant solutions and practical interventions, it has the potential to change lives. After all, your health journey should reflect your unique body, preferences, and lifestyle.

However, this isn’t without its detriments.

Challenges of the Current Healthcare System

Dr. Joshi candidly spoke about the limitations of our current medical system. Overworked doctors often lack the bandwidth to adopt a holistic approach, and patients are left feeling like they’re just another case file. The solution? Collaboration. He stressed the importance of bridging the gap between doctors and lifestyle experts to provide comprehensive care that addresses not just the body but the mind and spirit as well.

Lifestyle medicine is more than a field; it’s a movement. It’s about shifting the narrative from treatment to prevention, from illness to wellness. 

When we prioritize lifestyle, we don’t just extend life; we enhance it.

  • Dr Shashank Joshi

So, where do you start? It begins with small, intentional changes.  

Small intentional changes like microworkouts
Image by Freepik

For starters, did you know how much mitochondrial health matters to improve longevity?

Mitochondria: The Hidden Heroes of Diabetes Prevention

When it comes to preventing diabetes, mitochondria—our cells’ energy powerhouses—are often overlooked. These tiny organelles are responsible for producing the energy (ATP) that fuels every function in our body. Healthy mitochondria ensure efficient energy production and metabolism, while dysfunctional ones can pave the way for insulin resistance and type 2 diabetes

Diabetes testing
Image by Freepik

Mitochondrial dysfunction is linked to metabolic diseases because damaged mitochondria reduce the body’s ability to process glucose efficiently. Over time, this inefficiency can lead to insulin resistance and chronic inflammation, two major culprits in diabetes.

Practical Tips for Mitochondrial Health

Dr. Joshi emphasized simple, actionable steps to protect and nurture your mitochondria:

  1. Short Movement Bursts: Sitting for long hours weakens mitochondrial function. Incorporate 2-5 minutes of movement every hour—walk, stretch, or do squats to keep your mitochondria active and resilient.
  2. Prioritize Quality Sleep: Mitochondria repair themselves during deep sleep. Aligning your sleep schedule with natural circadian rhythm can enhance their function. Aim for 7-8 hours of restful sleep every night.
  3. Avoid Ultra-Processed Foods: These foods burden mitochondria with harmful byproducts, leading to oxidative stress. Instead, focus on whole, nutrient-dense foods like fresh fruits, vegetables, and nuts to fuel your cells.

Healthy mitochondria are not just about managing energy but also about preventing diseases like diabetes. 

While we focus so intensely on aspects like nutrition, blood sugar levels, exercise, and other factors, few stop to think about what diseases try to communicate through their symptoms. Here, assessing your emotional and spiritual health becomes imperative as they may hold the key to a longer, happier life.

Emotional Wellness and Spirituality: The Missing Links in Diabetes Care

Have you ever noticed how stress or a bad day can make you crave unhealthy comfort foods? The mind-body connection plays a huge role in diabetes. Stress, unresolved emotions, and a lack of purpose can spike cortisol levels, which in turn destabilize blood sugar. Addressing emotional wellness isn’t just a bonus; it’s a necessity in diabetes care.

“Spirituality is the medicine for the soul, just as food is for the body.”

  • Luke Coutinho

Dr. Joshi highlighted how practices like gratitude, mindfulness, and spirituality can transform health outcomes. Gratitude, for instance, reduces stress hormones and promotes emotional resilience. Something as simple as writing down three things you’re grateful for each day can make a measurable difference.

Source: Newman, D. B., Gordon, A. M., & Mendes, W. B. (2021). Comparing Daily Physiological and Psychological Benefits of Gratitude and Optimism Using a Digital Platform. Emotion (Washington, D.C.), 21(7), 1357. https://doi.org/10.1037/emo0001025

 

Spirituality doesn’t have to be about religion—it’s about finding deeper meaning and purpose in life. Whether it’s through meditation, spending time in nature, or engaging in reflective practices, connecting with your inner self helps stabilize not just your mind but your entire metabolic system.

Ask yourself: What’s your “why”? Why do you want to improve your health? 

When we reflect on our deeper motivations, like wanting to feel strong for our family or being present for life’s simple joys, it adds purpose to our wellness journey. Emotional and spiritual wellness aren’t just tools for managing diabetes—they’re bridges to a more fulfilling life.

Here’s a simple practice to start today:

  • Spend five minutes in the morning reflecting on three things you’re grateful for.
  • Ask yourself: What is one thing I can do today to align with my deeper purpose?

Quiz Time: How Healthy Is Your Lifestyle?

What to know where your overall well-being stands? Take this quick quiz to assess your current habits. Answer Yes or No:

  • Do you prioritize protein in your breakfast every morning?
  • Do you sleep and wake up at consistent times, aligning with natural light cycles?
  • Do you incorporate movement breaks every 30-60 minutes during the day?
  • Do you spend at least 10 minutes daily practicing mindfulness or gratitude?
  • Do you avoid processed or packaged foods for the majority of your meals?

Your Results:

  • 4-5 Yes: You’re on the right track! Keep it up and fine-tune your habits.
  • 2-3 Yes: There’s room for improvement—choose one area to work on this week.
  • 0-1 Yes: Don’t worry; small changes can lead to big results. Let’s start today!

 

A 7-Day Challenge to Reclaim a Healthier Lifestyle

Pick one habit to focus on for the next week:

  • Day 1-3: Align with circadian rhythms by waking up with the sunrise and limiting screen time an hour before bed.
  • Day 4-5: Start your mornings with three things you’re grateful for, setting a positive tone for the day.
  • Day 6-7: Add micro-movement breaks every hour—stretch, walk, or breathe deeply for 3-5 minutes.

Celebrate your progress at the end of the week. How did these changes make you feel? Let’s take a look into actionable steps you can take today to reclaim your health.

Final Word: Your Journey to Wellness Starts Now

Taking charge of your health is one of the most empowering decisions you can make. Even small steps like aligning with your circadian rhythms or starting your day with gratitude can create profound transformations over time.

Why not begin today? Take the quiz to evaluate your lifestyle habits or dive into the 7-day challenge and experience the difference firsthand. Share your quiz results or challenge progress in the comments—I’d love to hear about your journey and celebrate your wins with you.

If you’re curious to explore more about lifestyle medicine, check out our resources and programs tailored to help you heal, grow, and thrive. Your body and mind are designed to work in harmony—let’s nurture that beautiful intelligence within you and move together from struggle to strength.


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