“Vital research on the long term effects of famine cascading through generations is a wake-up call about all the famines taking place right now: it’s not over when it’s over. This is the kind of journalism that can change things.” Polly Toynbee, Orwell Prize-winning political and social commentator for The Guardian, and Orwell Youth Prize 2024 judge
The year is 1943, in West Bengal, India. Mubina, a young mother of sixteen, searches her small hut to find something, anything to soothe the bloated stomach of her wailing son. She finds nothing, as usual. It’s not as if she is able to go out on the street and beg, nobody has food. But her shared experience does everything but comfort her, and she is left to listen to her starving son’s cries while she can do nothing but wait for the impending relief of death.
In the present day, I sit patiently at the dinner table while my mother searches the house in search of her medication; Metformin, Ramipril, Indapamide.
After we’ve eaten, my father goes to find and take his. A sheet of paper is pinned under a magnet on the fridge. A doctor’s appointment, on the 12th of March. A blood test, on the 6th of April. Most nights, I fall asleep to the soft whir of the blood pressure monitor. I hear the click of the pen and the rustle of the paper as my mother jots down the reading. Too high, probably. I hope not.
My home life is simply riddled with illness. But my family isn’t unique in this regard. In fact, South Asians are six times more likely to develop Type 2 Diabetes than Europeans [1]. One may assume that this may be due to a variety of lifestyle reasons, such as diet, perhaps. South Asian cuisine does tend to consist of foods high in fat and sugar. But what if the reason was far more profound than simply diet? What if it leads back to events occurring decades in the past? What if Mubina was part of it all?
South Asia has an extensive history of famine, with it being a frequent occurrence until 1900, and often devastating in impact. A series of nineteenth-century famines were triggered by harvest failure, and escalated by British colonial policies. The harshest of the 20th century was the 1943 Bengal Famine, on top of thirty-one others that spanned the entirety of South Asia, plaguing the region with prolonged starvation, and eventually killing millions.
Yet somehow, the Indian Subcontinent presently stands as one of the most densely-packed areas in the world, being home to one-quarter of the world’s population spread over just 7 percent of the world’s landmass. From this data, one may assume that the legacy of these colonial-era tragedies had ceased to exist, along with those who suffered through them. In actuality, the generational impacts of these events are far more subtle, yet highly impact those who suffer from them. My parents are just some of those people.
It has been shown that an adverse environment for a community in the past can have a long-term negative health consequence in the present, and a study by Brown University connected famine to altering the metabolisms of successive generations [2]. The study, conducted in Harbin, China – a region that experienced widespread starvation in the late 1950s and 1960s – observed over 3000 locals and their children and found that adjusting all lifestyle factors, the children of two famine-exposed parents were 2.02 times more susceptible to hyperglycemia – high blood sugar – than those with no famine exposed parents. The significant risk sustained by the second generation was only slightly below that of their parents, an observation that may apply to the subsequent generations, too.
Based on the severity and frequency of colonial-era famines in South Asia, it can be suggested that these famines had a lasting genetic impact on the predisposition of South Asians to cardiometabolic disease. [3] This, and the recent rising incident rates of non-communicable diseases, such as heart disease and stroke, implies the existence of a genetic ‘mismatch’ of traits once beneficial for survival during periods of food scarcity, but have since become detrimental in the current environment of abundance.
One of these genetic traits is the tendency to store body fat, a trait that is conducive to surviving famine, another is the lack of low lean body mass, which consumes calories at a higher rate than fat. South Asians have a form of obesity that is different from that of most populations, which is referred to as the “thin-fat phenotype”. This characterisation refers to a disproportionate amount of body fat typically collected in the abdomen of an otherwise lean individual, who often has a normal BMI. This storing of body fat and low percentage of lean body mass – reducing the ability to burn fat entirely – increase the likelihood of obesity, a factor that increases the risk of developing cardiometabolic diseases among others.
These genetic adaptations, among several others, all indicate that South Asians have a unique physiology that may have evolved genetic effects to ensure survival during severe and frequent famines. Effects now unnecessary and disadvantageous to the South Asians of today, but deeply necessary to the survival of our ancestors.
I feel conflicted. These genetic adaptations evolved so quickly and efficiently that though millions of South Asians succumbed to starvation, millions more lived and survived to birth and raise the generations after. I also feel proud, in a way. These adaptations were what kept my ancestors alive, ensuring that some of their lives lasted far beyond the terrors of the famines.
All at the expense of the modern South Asian’s life, where these mechanisms for survival, ironically, threaten our lives.
However, it is worth noting that modern technological and medical advances provide a means for South Asians to keep on living, a sign of hope that though we can’t erase our history and reverse our genetics, we can live. After all, that’s what matters in the end, isn’t it?
And so, my parents’ pills lie strewn across the table, a half-empty glass of water beside them.
I might have to take them one day.
I think you know why.
[1] Star Digital Report. (2022, March 16th) British colonialism linked to diabetes in South Asians, From https://www.thedailystar.net/health/news/did-british-colonialism-make-south-asians-prone-diabetes-cardiovascula r-diseases-2984926
[2] Brown University. (2016, December 12th) Famine alters metabolism for successive generations, From https://www.brown.edu/news/2016-12-12/famine
[3] Mubin I Syed, Feras Deek, Azim Shaikh. (2022, October 7th) The Susceptibility of South Asians to Cardiometabolic Disease as a Result of Starvation Adaptation Exacerbated During the Colonial Famines, From https://www.researchgate.net/publication/366596806_The_Susceptibility_of_South_Asians_to_Cardiometabolic_ Disease_as_a_Result_of_Starvation_Adaptation_Exacerbated_During_the_Colonial_Famines