Dr. Mubin Syed on ‘Healing From Our History’ and How Colonialism Still Shapes South Asian Health

Sameena Rahman (0:33.459)

I'm Dr. Samina Raman and I'm really excited to get a very unique perspective from someone I've recently met online. ah And I've been really intrigued by his work as I talked to you guys about in the intro. um And so I'm super excited to have Dr. Mubin Saeed here. Dr. Mubin Saeed here. Did you say Saeed or Saeed? Oh, you say Saeed, okay. Dr. Mubin Saeed here um to talk to us about.

Mubin Syed (Desidoc) (0:54.264)

Say it.

Sameena Rahman (1:1.321)

So many things around cardio metabolic health that affects not only midlife women, but so many other women throughout uh their reproductive journey. So Dr. Moobinside, welcome to Gynecologist Presents Sex, Drugs, and Models. How are you today? I know you're good. Yeah, I'm super excited because I started following you on Instagram. When did you get on? Two years ago or something?

Mubin Syed (Desidoc) (1:14.478)

Thank you.

Doing well. Thanks so much, Dr. Rahman.

Mubin Syed (Desidoc) (1:26.830)

s point. This would have been: 2022

Sameena Rahman (1:29.727)

Yeah, and you know, we'll put the handle on, but you're Desi Doc on Instagram. uh as a South Asian woman, I'm very intrigued by so much of what you write about and talk about, but um and how, you know, really how our epigenetics change with um different types of traumatic experiences and trauma periods that affect different cultures.

Mubin Syed (Desidoc) (1:53.400)

Right.

Sameena Rahman (1:55.483)

But um first of all, I want to just talk to you about what brought you into this space around colonialism and famines and how it affects our cardio metabolic health. Can you tell us our journey? I know you talk about it in your Instagram all the time.

Mubin Syed (Desidoc) (2:8.237)

Yeah.

years ago, several years ago,: 2018

Sameena Rahman (2:18.658)

I'm sorry, my daughter's here. Okay, go ahead and start again. Okay, sorry.

Mubin Syed (Desidoc) (2:39.810)

Maybe I'm just dehydrated. I've had this similar feeling when I've had bouts of gastroenteritis. Typically have gone to the emergency room when I'm feeling really bad, gotten hydrated and felt fine. um I felt like, Hey, maybe I can, should I decide between going home and just hydrating myself or go to the emergency room? Deciding that I was feeling bad. I thought maybe I should just play it safe. Go to the emergency room, planning on getting some intravenous fluids, you know,

Sameena Rahman (3:2.443)

Mm-hmm. uh

Mubin Syed (Desidoc) (3:7.566)

because I thought, okay, maybe I just didn't drink enough fluids, which is very likely, and I'd worked out. And lo and behold, they told me I was having a heart attack, ST elevation, it's basically the worst kind of heart attack. And I thought, I mean, I was just so confused. thought, wait a minute. Yeah, I was 52. And yeah, I never, I thought I was doing everything healthy. I mean, I was exercising. I thought I was eating right.

Sameena Rahman (3:20.267)

Yeah.

Sameena Rahman (3:23.723)

And you're at like 40 something, right?

52 but still.

Sameena Rahman (3:33.003)

Yeah.

Mm-hmm.

Mubin Syed (Desidoc) (3:36.750)

But bottom line was they were telling me I'm I probably needed intervention by an interventional cardiologist right away. Ended up having three stents put in and it was, I mean, thankfully everything went smoothly, but afterwards I kept thinking to myself, you know, what's going on? I thought I was healthy, you know, and even my risk calculators, the 10 year risk calculators told me that my risk for coronary artery disease was very low.

Sameena Rahman (3:44.873)

Wow.

Sameena Rahman (3:48.939)

Mm-hmm.

Sameena Rahman (3:55.604)

Yeah, yeah.

Sameena Rahman (4:5.097)

Yeah.

Mubin Syed (Desidoc) (4:6.514)

And I was just so confused. as I did more research, I thought, you know, I got to figure this out. I found out that, um well, number one, one of the interesting things that I had a level in my blood test called lipoprotein small a, it was sky high. And um I thought, where's this coming from? You know, and I found out that one out of every, almost like 44%, one out of every two, nearly one out of every two South Asians carry this, you know,

Sameena Rahman (4:19.487)

Yeah, yeah, yeah.

Sameena Rahman (4:34.560)

Great.

Mubin Syed (Desidoc) (4:34.646)

elevated lipoprotein small a, which predisposes to cardiovascular disease. And I found in general that South Asians have four times the rate of diabetes, four times the rate of cardiovascular disease. The death rates are higher. There's premature onset of this disease by 10 years compared to uh other ethnicities, especially compared to like Caucasians. It just seemed like

there's got to be more to the story. I thought, okay, well, is it just our diet? Is it just our lifestyle? But then when I found that there was differences in these research studies, even in young, healthy Caucasians and even in infants, there's much higher rates of insulin. The blood level levels of uh insulin is higher even in South Asian babies. So I thought, okay, there's got to be something involving our genetics and what could have caused these changes.

Sameena Rahman (5:16.607)

Yeah. Yeah.

Sameena Rahman (5:25.833)

In the sense, huh? Really? I didn't know that part.

Mubin Syed (Desidoc) (5:33.058)

And I thought, let's look at our history. And as I was looking through our history, I noticed there's this huge amount of famines. And as I did more research on famines, I found there's a connection between famines and heart disease and famines and diabetes in multi-generational effects through epigenetics and done in these other famines that were studied.

Sameena Rahman (5:54.677)

Yeah.

Sameena Rahman (5:59.243)

Yeah. And I'm sure most of the listeners probably have some idea, but if not, know, obviously the British Empire ruled South Asia, the South Asian, like the multiple South Asian countries, the Indian subcontinent, I guess I would say, for hundreds of years.

Mubin Syed (Desidoc) (6:19.670)

you could say it started from: 1757

colonial rule. Numbers of deaths were huge. I mean, there was a study done by a recent study that found that the number of excess deaths just between 1880 and 1920 alone were somewhere between 100 to 160 million at least, uh excess deaths. And this was the height of British rule when the famines were just rip roaring through uh South Asian society. uh

Sameena Rahman (7:10.335)

Yes.

Mubin Syed (Desidoc) (7:19.246)

tens of millions of deaths were occurring, as I just described. And there was chronic undernutrition in between the famines.

Sameena Rahman (7:22.847)

Right. m

Right. And so this power dynamic brought these induced famines on the South Asian community, as uh we say, uh that was induced by the colonial rule actually had negative impact on our South Asian, like to this day. And we know this about slavery too. know that slavery has had such a dramatic impact on the African-American community that Black women are more likely to have uh premature menopause and

Mubin Syed (Desidoc) (7:39.277)

Yeah.

Sameena Rahman (7:57.065)

all these from an allostatic load or the stress of like chronic, you know, systemic oppression and racism that we see that happens to them. And so we know that studied in that population. So and I was really acutely aware of that for a very long time because I'm very interested in medical racism and implicit bias. And so when I started reading about what your um studies, I was like, wow, let's see. mean, another another aspect of how really uh

Mubin Syed (Desidoc) (7:57.070)

Mm-hmm.

Sameena Rahman (8:24.619)

colonialism, racism in general has really impacted our ability to care for our own health in some ways.

Mubin Syed (Desidoc) (8:32.610)

Yeah. And so, you know, with the colonial famines, with these repeated famines are bodies that conserved calories survived. And one of the manifestations of this in the modern world for South Asians is insulin resistance. Insulin resistance is actually a starvation survival mechanism. And because you can think of it, insulin is basically the fat storage hormone. If you have

higher than normal levels of insulin in your body, you're gonna store more fat and therefore be more likely to survive a famine when there's no food around compared to someone else. And as a result, but what happens is that in a situation of abundance, that works against you. That is what causes cardiometabolic disease or the heart disease, the diabetes skyrocketing numbers.

Sameena Rahman (9:29.013)

Right. Yeah. so, um and we all know that, you know, there's so much talk around visceral fat accumulation and cardio metabolic health and how that fat around our intestines and our visceral organs actually cause so much inflammation and negative aspects toward our overall cardio metabolic health. so I was reading once that that that Pakistan's like number one in diabetes around the world.

Mubin Syed (Desidoc) (9:47.459)

Right.

Mubin Syed (Desidoc) (9:52.300)

Yeah, and that's what's

Mubin Syed (Desidoc) (9:57.079)

Yeah. oh

Sameena Rahman (9:57.737)

Like the most, my parents are Pakistani, so they have like the most number of diabetics in the world, which is very telling, I think.

Mubin Syed (Desidoc) (10:4.268)

Yeah. So yeah, so that's interesting. But yeah, I mean, it's not interesting. It's sad, actually. But what we're talking about is even at low BMIs, like even apparently lean South Asians can carry very high amounts of visceral or fat or fat inside their liver also, not just around the organs, but inside their livers. And so it's been found that uh a South Asian person who

Sameena Rahman (: 10:11

It's fine.

Mubin Syed (Desidoc) (: 10:34

looks lean with a BMI of 22 may carry as much uh fat just because it's around their organs, because it's inside the liver, as much as a person whose white Caucasian origin or heritage with a BMI of 28.

Sameena Rahman (: 10:43

Mm-hmm.

Sameena Rahman (: 10:48

Yeah.

Sameena Rahman (: 10:51

Yeah. So I think that means that we need to look at our South Asian patients a little bit differently, right? Is the statistic true that we make up about a quarter of the world's population, but 67 % of

Mubin Syed (Desidoc) (: 10:57

Yeah.

Exactly. Yeah. And yet carry 60 % of the world's cardiovascular disease burden.

Sameena Rahman (11:5.643)

Right, so that's heavy. I I'm very careful with my patients who are South Asian because we know, I obviously just take care of women as a gynecologist, but one of the aspects that I see in my office a lot in, we'll start with pre-menopausal is like the PCOS phenomenon, right? One in four South Asian women have PCOS and we see it, I see it all the time with lean patients who, they don't meet the,

Mubin Syed (Desidoc) (11:8.184)

Okay.

Mubin Syed (Desidoc) (: 11:23

Yeah.

Sameena Rahman (: 11:31

the standard phenotype that we used to learn that, you know, uh obese with, you know, facial hair and all the things, like some of them are very lean and they're very fit and they still have problems getting pregnant and they still have problems, you know, doing a lot of things. I had Dr. Ruhi Jelani on my podcast who's a fertility specialist and she herself talked about her own PCOS journey as a very lean, then South Asian woman. But can we talk a little bit about how um

Mubin Syed (Desidoc) (: 11:41

Yeah.

Sameena Rahman (12:0.689)

Do you think that then obviously we know that PCOS has a genetic predisposition and so

Mubin Syed (Desidoc) (12:6.382)

But yeah, I think you're right in the fact that it affects like 25 % of women that shouldn't be happening. South Asian women I'm talking about quarter of South Asian women. I think that there may be a connection between famine shaped physiology with basically the root driver here is insulin resistance. know, we know that insulin resistance is a survival mechanism in famine.

Sameena Rahman (: 12:17

Yeah.

Sameena Rahman (: 12:34

Mm-hmm.

Mubin Syed (Desidoc) (: 12:36

And then the same insulin resistance that pushes insulin levels high drives the ovarian androgen production that's seen in uh PCOS. And I think that that's what causes uh South Asian women to have this syndrome. Even if they're apparently thin, they have this thin fat paradox going on where they may carry large amounts of fat between their organs, inside their liver.

And, you know, the standard PCOS workup may miss a lot of the metabolic screening that should be done in South Asian women. And, you know, that may be something to consider doing. uh

Sameena Rahman (: 13:22

if you're taking care of, or if you're yourself or South Asian.

Mubin Syed (Desidoc) (: 13:25

Like fasting insulin, blood sugar, know, insulin resistance scores, hemoglobin A1C, lipids levels. Let's see if someone's unexpectedly has uh this.

Sameena Rahman (: 13:32

Yeah, yeah.

Sameena Rahman (: 13:36

And I think there's actually a push in the reproductive community to even change the name because the name is such a misnomer for polycystic ovarian syndrome when it's really a cardio metabolic dysfunction that's leading to ovarian or reproductive compromise and endogenic features. So I feel like it is, I always say it's such a joke that it's called polycystic ovarian syndrome because the cystic ovaries are just a... uh

Mubin Syed (Desidoc) (: 13:44

Mm-hmm.

Mubin Syed (Desidoc) (: 13:55

Mm-hmm.

Mubin Syed (Desidoc) (14:1.485)

Yeah.

Sameena Rahman (14:4.647)

secondary effect of what's happening from a cardiometabolic platform or profile. And so I think that, you know, for patients that are listening who have this, you know, really should be looking at your whole cardiometabolic profile and not just, you know, your FSA, you know, your reproductive hormones or that kind of thing. And the same can be true

Mubin Syed (Desidoc) (: 14:20

Mm-hmm.

Sameena Rahman (: 14:31

I want to talk a little bit about the Masala study because that's one of the biggest study that's always quoted around um South Asians, right? And I think that's what has kind of helped us understand some of the cardio metabolic effects when it comes to um what happens to South Asians uh with their cardiovascular health.

Mubin Syed (Desidoc) (: 14:38

Yeah.

Mubin Syed (Desidoc) (: 14:51

Yeah. So I'm glad you brought that up. The Masala study, I think you were mentioning about 33 % entered menopause at less than age 45. um And this was uh kind of a surprise. um I know that there is a study that was done on the Chinese famine where they looked at when

Sameena Rahman (15:5.748)

Yes.

Sameena Rahman (: 15:16

Mm-hmm.

Mubin Syed (Desidoc) (: 15:20

there was a prenatal exposure to the famine. um These children had double the risk of premature menopause.

Sameena Rahman (: 15:30

Oh really, the children of the parents who went under him.

Mubin Syed (Desidoc) (: 15:33

the famine survivors ah because of prenatal exposure. This is again, maybe due to epigenetic change, which is something that may be passed down in multiple generations. And I suspect this may be something that's similar that's happening in South Asian women. And uh there may be a similar effect. But, you know, when you lose this um estrogen protection,

Sameena Rahman (: 15:49

you

Mubin Syed (Desidoc) (16:1.710)

uh you do end up with higher levels of uh stroke and cardiometabolic disease risk. And I think that's something that is a serious problem and needs to be, m South Asian women need to be screened for this at much younger ages, at lower BMIs and should be, I think that's what you're talking about is hormone treatment maybe need to be considered lower cutoffs.

Sameena Rahman (: 16:13

for minute pause.

Sameena Rahman (: 16:27

Yeah. Yeah. Actually, before we dive deeper into that, for the people that don't know the difference between epigenetics and genetics, can you just click?

Mubin Syed (Desidoc) (: 16:37

Oh yeah, good question. Yeah, so um epigenetics versus genetics. So genetics, um I'm trying to think of a simple analogy. Genetics is a change can occur in your genetics, like a mutation, where if you have a sentence written, the way you read the sentence is based on the letters, right? You can read it. Okay, so let's say a genetic change, which would involve a change in the letters or the word of the sentence.

Sameena Rahman (: 16:57

Mm-hmm.

Mubin Syed (Desidoc) (17:7.010)

But epigenetic change is where you're keeping the sentence, the words the same, but you're changing maybe the pronunciation or the emphasis. So it's the expression. The way that these genes are expressed is different. these can, know, like think of it as punctuation, I guess, or underlining it or emphasizing it. So the letters and the words are the same.

Sameena Rahman (: 17:11

you

Sameena Rahman (: 17:30

Yeah.

Mubin Syed (Desidoc) (: 17:36

epigenetic, the code is the same, but the expression is now different. And epigenetic change uh can actually occur in entire population due to an environmental stress. And so there's different things, there's technical words for DNA methylation, changes in the histones or the way that these proteins are expressed, they can uh be affected by

these epigen... by the environment. So your uh genes may be expressed differently if you're a famine survivor. And that's what the study found in the Chinese famine, is that your genes for, you know, the only explanation they could think of is that there must be some epigenetic change that causes this high level of population change in diabetes in subsequent generations.

Sameena Rahman (: 18:34

is so interesting because I think that goes into, there's so much around this kind of discussion nowadays, when it's either like what's happening in utero is happening in adverse childhood experiences like these ACEs. There's so many things that can impact um your regular function, your sexual function, your uh physical state, your cardiometabolic health that I think some people don't even think about the history as much. And I find that so fascinating.

Mubin Syed (Desidoc) (: 18:45

Mm-hmm.

Sameena Rahman (19:3.465)

because I guess it's very empowering for patients ultimately, because at the end of the day, you think that there's just something wrong with you. And even though um it's more like you're a product of what has happened to your population of people. And so it's unfortunate that these things have occurred, but it is now very empowering to say like, okay, this is what I'm working against my genetic. I always say this all the time.

Mubin Syed (Desidoc) (: 19:12

Yeah.

Sameena Rahman (: 19:30

Well, listen, I'm working against my genetics and epigenetics, so I gotta make sure that my diet is X or my exercise routine is this. ah

Mubin Syed (Desidoc) (: 19:38

Right. I think knowledge is power and having this knowledge can make sure that you are extra careful, appropriately careful, I should say, based on your predispositions that you know to be ultimately based on your history. And I think that's an important message that, you know, our genes remember the famines, but our lifestyles kind of forgot it, you know. uh You know, it's, and for South Asians, you know,

Sameena Rahman (: 19:48

Yeah.

Sameena Rahman (: 19:56

Right.

Sameena Rahman (20:4.137)

Yeah.

Mubin Syed (Desidoc) (20:8.684)

Metabolic health is not just molecular, it's historical. ah So you basically, can't ignore the history.

Sameena Rahman (: 20:16

You can't ignore the history. Yeah, that's very powerful. And I think that, you know, going back to the, you know, patients who are, you know, struggling with PCOS or the women entering early menopause, right? We always say the average Asian menopause is 51 for, you know, Caucasian women, you know, not only Black women, Hispanic women, but South Asian women also experience it early. And, you know, as you said, when you experience menopause early, we know that women that enter with primary ovarian insufficiency, which is less than age 40 or

premature menopause less than age 45, that up to 10 years of estrogen deprivation actually not only causes issues with their bone health, but makes them more at risk for cardio metabolic disease, cardiovascular disease, diabetes, and early death, right? So I think that's really compelling to hear. And so that's why it's so important for these patients, especially the premature ones to...

Mubin Syed (Desidoc) (: 20:51

Thank you.

Mubin Syed (Desidoc) (21:2.976)

Yeah.

Sameena Rahman (: 21:11

get if they're able to get on menopausal hormone therapy, we know that's very beneficial. um There's obviously it's one tool in the toolkit. What do you tell patients about lifestyle modifications? And uh what do you think about metformin and the GLP ones? Because I use them a lot on my patients with PCOS and uh the ones struggling with um obesity.

Mubin Syed (Desidoc) (: 21:33

Yeah, I think the GLP treatments are uh good crutches to get you where you need to be. But I think ultimately, ah you need to change your lifestyle and your diet. Those are what are going to provide those uh long lasting, durable changes. And it's important to know that you need to.

This was a surprise to me, but South Asians actually need significantly more exercise, moderate intensity exercise than what was thought to be prescribed for everyone else. Some studies, usually the studies say 150 minutes of moderate intensity exercise in a given week. For South Asians, it may be closer to 200 to 266 minutes per week. 232 to 266 minutes.

Sometimes, you know, so much higher than what you think, almost double. Just to maintain the same level of cardio metabolic health as someone else. The other thing is to be extra careful about your diet. I think that based on the research I've done, I actually did a paper in looking at all these studies and sort of a review paper about the differences in South Asian physiology.

Sameena Rahman (: 22:33

Yeah, yeah, almost double.

Mubin Syed (Desidoc) (: 22:57

They found that the response to sugar is much worse in South Asians. It basically causes a much more of a greater lipemic effect in your blood. um So we have to be extra careful with the foods that we eat. um South Asians became insulin resistant within five days of consuming um

Sameena Rahman (23:2.389)

Yeah. It makes sense.

Sameena Rahman (23:8.715)

Uh huh. Uh huh.

Mubin Syed (Desidoc) (: 23:25

you know, a cup, basically equivalent of a cup of cream every day for five days. And they became insulin resistant, whereas nothing happened to the white Caucasians who did this every day. So it just tells you there's a big difference. And these were young, healthy Caucasians that they did the studies, sorry, young, healthy South Asians and young, healthy Caucasians that they did the studies on. um And we just, you know, need to be aware of this, these differences.

Sameena Rahman (: 23:29

No.

Sameena Rahman (: 23:37

Wow. Wow. uh

Sameena Rahman (: 23:42

Yeah.

Mubin Syed (Desidoc) (: 23:56

bodies are much less tolerant of the excesses.

Sameena Rahman (24:1.611)

Yeah. That's so interesting. And so what do you tell your patients who come in, like if you had a South Asian woman that was getting maybe a heart-mortar-null treatment because she was already menopausal or perimenopausal, but she's really concerned about all the things that she read. She read everything you wrote and is so concerned what to do with herself. Like how would you screen it?

Mubin Syed (Desidoc) (: 24:24

Well, I don't think hope is lost at all. I mean, I think even in middle age, you know, like myself, you can still reverse the course. And this has been shown in even in other studies that you can change your diet and your health, your lifestyle, even relatively late in life. And it can have a major impact on your uh ultimate health. And um so all is not lost. I think it's just important to do it whenever you can to make the appropriate changes and, know,

Sameena Rahman (: 24:32

Mm-hmm.

Sameena Rahman (: 24:43

Mm-hmm.

Yeah.

Mubin Syed (Desidoc) (: 24:54

trying to eat right, avoid ultra-processed foods, avoid sugar, uh increase your intake of fiber to the recommended levels. Some people say like 25 grams for a woman, 30 grams for a man at least, to uh increase your, make sure your protein intake is appropriate. A lot of South Asian diets tend to be uh very carb heavy and deficient in protein.

Sameena Rahman (25:9.640)

Mm-hmm.

Mubin Syed (Desidoc) (: 25:24

We realize that white rice is an introduced food into our diet and um we need to kind of keep a check on how much white rice and white flour we intake in our body. And I'm talking about, when we typically eat large amounts of white rice thinking that's gonna be good for us or satisfy us, it's really very bad. And you can even see in a normal person who doesn't have diabetes, eating white rice will skyrocket your blood sugar.

And it keeps it up for hours, many hours. um It's not what we should be eating large quantities of. And same thing with white flour products. But I mean, and an exercise, and then trying to reduce stress levels, and even simple things like um getting enough sleep at night. oh This is very important. And the other thing I would like to remind people of South Asian is that

Sameena Rahman (: 26:14

Yes, the sleep is so critical.

Mubin Syed (Desidoc) (: 26:23

you need to make sure if you're having uh symptoms of sleep apnea, which can be very much masked, um that you need to get a sleep study and maybe get that treated. Because that can really impair your ability to get a good night's sleep. And there is some data to suggest that there is some higher risk for South Asians. um And try to reduce or manage stress levels in your life as much as possible. And I suggest things like

yoga and transcendental meditation, uh doing things like that can be very beneficial for stress. And these are something that is part of our heritage.

Sameena Rahman (27:4.709)

Absolutely. um Tell us what you do.

Mubin Syed (Desidoc) (27:7.436)

And getting enough exercise means, you know, also doing strength training or resistance exercises. That's very important because of our relatively low lean muscle mass that South Asians have a tendency towards. That's something that we need to maintain or try to enhance.

Sameena Rahman (: 27:13

All right.

Sameena Rahman (: 27:26

Yeah, I always actually that's the things I always tell my patients to try to get, you know, that 30 grams of protein per meal, try to get up to 30 grams of fiber per day, you know, really get your cardio metabolic function improving whether or not it's increasing your walking. I know you do a lot of like, you know, you've always posted about all the stuff that you do in terms of like, even don't you have like a treadmill walker that you use?

Mubin Syed (Desidoc) (: 27:53

Yeah, I try to actually walk outside as much as possible because you know that there's actually benefit to that. know, green space exposure is really good for your mind as well as you know, your stress levels, etc. But um if you can't do it, uh treadmill is good. And I would say, you know, if you can do relatively brisk walking, would be ideal. And I try to do resistance training at least twice a week.

Sameena Rahman (: 27:57

Yeah. Yeah. Yeah.

Sameena Rahman (28:5.301)

Yeah.

Sameena Rahman (: 28:23

Wonderful. And what do you do on a daily? 30 minutes. Okay. And then what do you do? Do you try to walk to the most places that you can? Yeah. do you count your steps?

Mubin Syed (Desidoc) (: 28:24

Um.

Mubin Syed (Desidoc) (: 28:33

Yeah, I try to walk, I try to take the stairs everywhere I go. I do count, yes, I do. I try, and I'm not saying this is what everyone needs to do, but for myself as a personal goal, I try to maintain at least 10,000 steps a day, like minimum, and I try to go more than that. And I think it really has helped. And it's also something that, I used to run a lot. And for me,

Sameena Rahman (: 28:48

Hmm.

Sameena Rahman (: 28:55

Yeah, you're a little.

Sameena Rahman (29:0.736)

Yeah.

Mubin Syed (Desidoc) (29:2.498)

I didn't understand the dynamics in my body. I think when I was running at these, you know, higher speeds, my cortisol levels were probably increasing. And when that was happening, I was probably not, you know, I was fighting against my body in terms of trying to lose weight, trying to, you know, get rid of visceral fat. And I realized that when I'm walking, I'm actually calm.

Sameena Rahman (: 29:13

That's true. uh

Sameena Rahman (: 29:21

Mm-hmm.

Sameena Rahman (: 29:25

Yeah.

Mubin Syed (Desidoc) (: 29:29

And my cortisol levels do not increase. And I think it was better for me, not only for weight loss, but also just, just to get that actual exercise that your body needs without hurting yourself. Cause you know, you can have injuries that you will get when you are running that you won't get with your walking, especially as you get older, you know.

Sameena Rahman (: 29:40

Yeah, I think that's without hurting.

Sameena Rahman (: 29:49

Yes, absolutely. Yeah, and I think it's very important because everyone wants to stay mobile. I always say it's the nursing home prevention program is really making sure your brain is cognitively okay and you're not peeing all over yourself and you're really, right? want to, you want to.

Mubin Syed (Desidoc) (: 29:55

Yeah.

Mubin Syed (Desidoc) (30:1.152)

Yep. Yeah, what you do now is what will have the impact when you're in your 80s.

Sameena Rahman (30:8.425)

Right, exactly. So the good habits would start now. um What advice would you give anyone listening in terms of like, know, if you're, obviously this couldn't go for any race or, you know, that's not, you know, because especially for women, you know, there's a lot of literature suggesting how um there's a lot of um gaslighting that happens to women when it comes to their health and their pain needs and their overall function. um

And so a lot of my patients that come to me tell me that they just haven't felt listened to before. Maybe they've seen me or some other clinician that is able to. As a South Asian, you feel that, is there any specific advice you'd give other South Asian patients who are trying to find someone to understand these unique concerns and needs?

Mubin Syed (Desidoc) (: 30:58

Yeah, mean, I think, unfortunately, right now, a lot of people, mean, most of the research has been done on Eurocentric cohorts, know, research and guidelines are built on that. So the risk for uh South Asians based on these standard Western medicine based uh research,

Sameena Rahman (31:8.757)

your piece.

Mubin Syed (Desidoc) (: 31:27

underestimates their risk for South Asians by as much as 30%. And this under-representation, it's in research is the major problem, even though South Asians are 25 % of the world's population and they have this, well, they're just not included in the research that they should be.

Sameena Rahman (: 31:32

I love you.

Sameena Rahman (: 31:43

We don't like to get into research.

Sameena Rahman (: 31:48

We're not including, but they also, yeah, I think it's a both problems if I whenever I talk to patients like they either they have a distrust of the system in some degree, but they also aren't always sought after either by the research.

Mubin Syed (Desidoc) (: 31:55

Mm-hmm.

Mubin Syed (Desidoc) (32:0.334)

Yep. But I think there needs to be more South Asian centric health guidelines and more studies need to be done. uh And instead of centering the lens on Western bodies, it needs to be focused more on South Asians. So there is unfortunately that lacking, but I think that there are enough studies and oh physicians should become more uh cognizant of the uniqueness of South Asian health parameters.

Sameena Rahman (32:6.334)

Mm-hmm.

Sameena Rahman (: 32:30

Yeah.

Mubin Syed (Desidoc) (: 32:30

And there has been studies now and even some guidelines for South Asians that should be followed that are different from uh what is recommended for other ethnicities.

Sameena Rahman (: 32:36

Right.

Sameena Rahman (: 32:41

Right, because I think that the waist to hip circumference and the BMI are lower, right?

Mubin Syed (Desidoc) (: 32:44

Yes. Right. you know, waist circumference, greater than 80 centimeters in a South Asian woman, should be they're at higher risk and they should be monitored. You know, they probably need to check their uh things like their fasting glucose and their lipids uh at that point. um And, you know, they should be

considered for uh the risk for PCOS or if maybe they're having premature menopause, all of this should be sought. And I know you're doing this type of stuff, I there should be an awareness for that. um And you may have to find a physician who's sympathetic to doing that type of um research. But I think overall, if there could be some guidelines made specifically for South Asians, women,

Sameena Rahman (: 33:26

Yeah, people are listening.

Sameena Rahman (: 33:34

Bye.

Mubin Syed (Desidoc) (: 33:43

You know, it would be important for all practitioners to know this because of the predispositions that are.

Sameena Rahman (: 33:43

Yeah.

Sameena Rahman (: 33:51

Yeah, absolutely. Like I actually, I very aggressive with my midlife South Asian patients. I'll do the panels that you discussed, lipid, hemoglobin A1C, fasting glucose. And I'm a gynecologist, I'm not an internist. So I'm always like, if everything's abnormal, I'll send you back to your primary. But if this hasn't been checked, let's check it. And sometimes if they're cholesterol and lipoprotein A, all that stuff.

Mubin Syed (Desidoc) (34:0.482)

Mm-hmm. Yeah.

Mubin Syed (Desidoc) (34:8.974)

Mm-hmm. Yeah.

Sameena Rahman (: 34:15

if all of these things are still okay. Sometimes I even get their calcium. I'm like, just go get a calcium score. It's $49 at this hospital and know, check it out. Sometimes you'll find someone and I'm like, well, you need to, you know, I don't, I like I said, I don't manage those things, but at least I can get them screened. then, you know, sometimes sometimes didn't, why did you do a calcium score on this patient? I'm like, well, she's like 43 and she's a South Asian whose mom died of, you know, a heart attack, you know.

Mubin Syed (Desidoc) (: 34:24

Yeah.

Mubin Syed (Desidoc) (: 34:32

That's great that you're doing that. mean, that's you're amazing and having things so progressive.

Mubin Syed (Desidoc) (: 34:44

Yeah.

Sameena Rahman (: 34:45

And so, um but you know, and then they get sort of some treatment that they need, I think, in that respect. um Because the other thing is, and you know this, but in case the listeners don't like, and I've talked to a cardiologist, I talked to Dr. Jane Morgan on my podcast about this, that women's symptoms often for heart attacks aren't always consistent with the crushing, luffing on your chest pain, right? And so, a lot of times people say they're atypical, but...

Mubin Syed (Desidoc) (35:8.258)

Yeah. Right.

Sameena Rahman (: 35:13

by othering the symptoms that women experience, they're getting neglected. So we should say these are common symptoms for women are not necessarily the crushing chest pain, right? It could be like these.

Mubin Syed (Desidoc) (: 35:24

No, that's an excellent point. Yeah. Even for my own, um you know, heart attack, I, course, it doesn't always have to be the classic crushing chest pain radiating to your left arm. Mine was more of a sense of anxiety. And I think I was having some diaphoresis, but I just worked out so I couldn't tell. And it, but I think it's much higher for women to have these atypical symptoms.

Sameena Rahman (: 35:35

Mm-hmm.

Sameena Rahman (: 35:42

Yeah, yeah, yeah, the sweating.

Sameena Rahman (: 35:50

Yes, yes, absolutely. And so, um you know, sometimes it's just the back pain. Sometimes it's like this acid reflux type of pain. um And so I think, you know, these are the symptoms we should be aware of and just not say these are, oh, these are atypical. Like, actually, they're more typical for women to get these symptoms. And we should we should not expect ourselves to be small men. And so I say, like, you know, wasn't till 1993 that women were allowed in research, you know, so it's like uh

Mubin Syed (Desidoc) (36:7.852)

Yeah.

Mubin Syed (Desidoc) (: 36:12

Mm-hmm.

Mubin Syed (Desidoc) (: 36:17

Oh my gosh,

Sameena Rahman (: 36:19

Up before then it was really like, these women are small, you know, small men. So we'll just like, you know, talk to them like that. But I think these are very important things to remember that, you know, if, people haven't gotten these tests done or they haven't and they're entering these stages or if you're concerned about PCOS, you know, a lot of times, of course, you know, people get ultrasounds to look for those PCO ovaries, but we should be doing hemoglobin A1Cs and fasting insulin, fasting glucose and all of things. Cause I, you know,

Mubin Syed (Desidoc) (: 36:23

Yep.

Mubin Syed (Desidoc) (: 36:43

Yeah.

Sameena Rahman (: 36:48

Even if you don't have diabetes now, you're just more at risk for it, right? You're more at risk for all the things.

Mubin Syed (Desidoc) (: 36:51

Yeah. Right. There was even a study that showed that uh for South, for people of Asian heritage, including South Asians, that you may have diabetes, even though your hemoglobin A1c is like 5.7. Because there was always this, yeah, there was this, this range where you're considered uh pre-diabetic only if it's like more than 5.7. But there was a recent study and there's this, uh there is a endocrinologist in, I think,

Sameena Rahman (37:7.179)

You didn't

Sameena Rahman (: 37:14

Yeah.

Mubin Syed (Desidoc) (: 37:20

California who's brought this research to light and this was actually even featured on NPR by the way that um There should be Like they're suggesting based on this research that an oral glucose tolerance test may be more much more sensitive than a hemoglobin a1c

Sameena Rahman (: 37:27

Oh boy.

Sameena Rahman (: 37:40

Oh wow, that's interesting.

Mubin Syed (Desidoc) (: 37:41

for someone who's got a hemoglobin, A1C of like 5.7 or even 5.4 range.

Sameena Rahman (: 37:48

Like a two hour, like the, we do GCC.

Mubin Syed (Desidoc) (: 37:50

Yeah, like the two hour test, especially given the appropriate clinical scenario, you know, having appropriate symptoms. Don't just say, oh, your hemoglobin is A1C is fine. You're not diabetic.

Sameena Rahman (: 37:55

Yeah, yeah.

Sameena Rahman (38:2.921)

Yeah. And I think we have to be cognizant of the women in pregnancy too, right? When they're more at risk for gestational diabetes. And if they have gestational diabetes, then they're more at risk for diabetes. The same with preeclampsia. We know the hypertension thing is a big risk as well. I myself just started wearing a CGM. uh

Mubin Syed (Desidoc) (38:9.806)

Yeah.

Mubin Syed (Desidoc) (: 38:20

Yes, I'm in the same boat actually. I do it as well. uh It's helpful to just keep yourself a lot more accountable and I mean...

Sameena Rahman (: 38:29

Yes, because you get alerted like your glucose has just spiked. What did you eat?

Mubin Syed (Desidoc) (: 38:33

Yeah, you definitely want to avoid the glucose spikes and knowing that, you know, if you exercise that it can really keep it under control.

Sameena Rahman (: 38:42

Yeah, absolutely. I know it's controversial, but I think if you have a family history or if you're South Asian, I think that these things, you know, I initially got it from... Yeah.

Mubin Syed (Desidoc) (: 38:47

Yeah, and they are available now. You know, you don't have to have a physician to prescribe them. But I realize they're expensive and maybe not everyone can afford them, but it's something to consider if you have that risk.

Sameena Rahman (: 38:55

Right. Right.

Sameena Rahman (39:1.801)

Yes, absolutely. All right. Well, thank you so much, Mubeen. This is a great conversation. And I feel like, you know, this conversation isn't just for South Asians because we all should be aware of our history. We should all be aware of how, you know, any kind of historical trauma that you or the ethnic group you represent, um you know, might have experienced. so, you know, like I said, we know this.

Mubin Syed (Desidoc) (39:7.724)

Yeah, that's right.

Mubin Syed (Desidoc) (: 39:16

Mm-hmm.

Sameena Rahman (: 39:27

when it comes to African Americans and slavery that they have had, you know, change in their epigenetics. uh The same is true for, you know, most of us that have been under these traumas. And so I think it's just worth understanding. um Also, you know, there's plenty of clinicians that listen to my podcast, and it's really important for them to think twice about the brown person sitting in front of them to, you know, what might be experiencing or what they might need to get done. So I appreciate you bringing this to life.

Mubin Syed (Desidoc) (: 39:55

I definitely echo what you're saying. It's very appropriate.

Sameena Rahman (: 39:58

And then just tell us a little bit about the book that's coming out. I preordered it.

Mubin Syed (Desidoc) (40:2.302)

Oh, yeah, sure. Thanks for mentioning that. it's basically what I was trying to figure out is based on the South Asian health predispositions and the epigenetic changes, you know, what are some of these changes that have happened? And then what is the historical basis of the famines, you know, that caused these changes or at least a significant portion of these changes to happen? And

I was really basically curious. It's more of a history book and it's something that's, it's not just for physicians to read, for instance, this is for everyone to be, who has interest in this, to read and understand, you know, how is it possible that what was once the wealthiest region in the world to become the poorest and how did this happen uh over, you know, space of close to 200 years, you know, how did it systematically happen?

come so poor. Because when I was growing up, South Asian countries were like the poster child for poverty. And yeah, I felt very sad when I would visit. And I used to wonder, and my mom used to tell me, India used to be a very rich country. And I was like, are you kidding me? How could that have happened? I didn't believe her until I read and didn't realize how

Sameena Rahman (41:8.949)

For family, for poverty, yeah. uh

Sameena Rahman (: 41:14

Yeah.

Sameena Rahman (: 41:20

Yeah. Yeah. Yeah. Yeah.

Mubin Syed (Desidoc) (: 41:28

you know, how this could have happened. So was just a matter of curiosity for me to understand how this could have happened over 200 years. What was the mechanisms? And I was surprised to find out, for instance, that, you know, huge amounts of, that there was actually enough food. It was just that billions of pounds of food was exported during the famines. So the famines were kind of artificial. um

Sameena Rahman (: 41:52

Yeah, yeah, they were induced, right? They were exported back to the British Empire, right? So, we'll keep our food and you guys don't get any, basically. The village, the village. Yeah.

Mubin Syed (Desidoc) (: 41:56

Right. Yeah, exactly. it was just eye-opening. It was just eye-opening. mean, a lot of it was preventable. I think that the emphasis was too much on producing uh cash crops rather than food crops for the people. um was more for food. It was more for export. The taxation uh structure favored producing cash crops for export rather than for native

Sameena Rahman (: 42:12

No.

Yeah.

Mubin Syed (Desidoc) (: 42:25

or local consumption, you The deindustrialization that happened on a massive scale, India was actually a, you some people would say industrialized or proto-industrialized country with 25 % of the world's GDP, similar to the United States today, for instance. It was a place where people sought, you know, they wanted to live in India. They came from all over to live in India. And it was a...

Sameena Rahman (: 42:43

Wow.

Sameena Rahman (: 42:50

Yeah, yeah.

Mubin Syed (Desidoc) (: 42:54

very, it was a center of technology. And all of this deindustrialization that happened basically converted to a, you know, an agrarian society and a consumer of goods instead of a manufacturer that it was. And I was just curious about the economics of how this all happened. And it was just, it's really, I wanted to understand it. And that's what this book was about.

Sameena Rahman (: 42:57

Yeah.

Sameena Rahman (43:7.422)

Absolutely.

Sameena Rahman (: 43:11

Yeah, and the manufacturer. That's amazing.

Sameena Rahman (: 43:21

Yeah. Yeah. Actually, because I'm trying to complete my book too on sexual health from a South Asian lens. And um one of my chapters, I talk about how pre-colonialism, even sexual education and discussions around sex within the context of marriage and Islam, as well as in Hinduism and other South Asian communities, was very prolific. And there was erotica that was written

um that was very much accepted as like, and then when the sort puritanical values of uh Catholicism and all of the colonial powers came to be, they kind of just shut it all down. oh

Mubin Syed (Desidoc) (: 43:50

Love you.

Mubin Syed (Desidoc) (44:6.102)

Right, the cultural sensibilities of the imposed culture became the norm.

Sameena Rahman (: 44:11

Yes, exactly. So I think it's very interesting to see that as well because, know, for most people they think of South Asian women and, you know, like very shrouded in shame and, you know, all the things. And unfortunately, like, you know, the conditions of women in that country and those countries are still, you know, under always surveillance because of violence that's happening within it because of patriarchal norms that are still there. But

Mubin Syed (Desidoc) (: 44:35

Mm-hmm.

Sameena Rahman (: 44:39

I feel like understanding that history can be like, wow, that wasn't part of who we really were initially. It gives you a sense of pride. But also sadness. you're like, But I appreciate everything you're doing. I appreciate your work. Because like I said, I found you on social media. And I was like, wow, really? And I took a deep dive too. So you're doing some good work. Yeah, you're doing some good work. um Well, thank you, Dr. Sayed, for joining me today.

Mubin Syed (Desidoc) (: 44:45

Yep. Right. Yes. Yeah, exactly.

Mubin Syed (Desidoc) (45:1.634)

Thank you so much. This was a great opportunity.

Mubin Syed (Desidoc) (45:8.002)

and honor.

Sameena Rahman (45:9.279)

Yeah, it's really great. I'm Dr. Smita Raman Gainogirl. Thanks for joining me on this episode. Please like and subscribe to my channel. Remember, I'm here to educate so you can advocate for yourself. Please join me on my next episode.

Mubin Syed (Desidoc) (: 45:21

Thank you.