South Asians are facing a health crisis. Dr Mubin Syed traces it back to British rule

“It’s called evolutionary mismatch,” he says in a Zoom interview with IndianExpress.com.

Research on colonial-era famines, he notes, shows that South Asians endured repeated, severe starvation events. Meanwhile, new epigenetic studies reveal how famine can leave biological markers that are passed down across generations.

“When I connected my personal experience with this larger story, everything clicked,” says Syed.

Syed’s engagement with South Asian history after his heart attack culminated in his new book, Healing from Our History: How Colonial Famines Led to a Modern South Asian Health Crisis. In it, he argues that British exploitation during colonial rule triggered widespread deprivation and famine, leading to biological adaptations over generations. This systematic exploitation, he writes, “altered South Asian environmental influences, and over generations, South Asian genetics.”

In this interview, Syed — known as @desidoc.md on social media — discusses his research, explains the link between colonial trauma and modern health challenges, draws parallels with similar patterns in other colonised societies, and reflects on what the path forward might look like.

Q. Why do you mention colonial-era famines specifically as leading to a health crisis in South Asia? How were colonial-era famines different from famines at other times in South Asian history?

Syed: Colonial-era famines were fundamentally different from the earlier, pre-colonial famines that South Asia periodically experienced. Before colonial rule, famines did occur, but they were typically regional and short-lived, often due to monsoon failure or local political instability.

Under British rule, however, famines became larger, more frequent, and far deadlier, affecting entire provinces and regions of South Asia and lasting years. Tens of millions died in a series of catastrophic famines between the 1760s and the 1940s.

The most important distinction is that colonial famines were man-made. They were shaped and often triggered by deliberate administrative decisions. Grain and tax extraction continued during shortages. Food was exported from famine regions to enrich imperial markets. Relief was intentionally minimal and tightly restricted. The colonial state prioritised free-market ideology over human life. In many cases, food was available; people simply weren’t allowed to access it.

South Asia suffered repeated famines over nearly 200 years, which meant entire generations were prenatally exposed to starvation. This uninterrupted stress is precisely what creates powerful, inheritable epigenetic effects.

Colonial rule also transformed South Asian agriculture,  replacing diverse, resilient local crops with export-oriented cash crops. Many communities lost their nutritional safety nets.

In short, earlier famines were natural disasters. Colonial-era famines were systemic, political, and prolonged to a degree that reshaped South Asian biology.

That’s why they are central to understanding today’s health crisis.

Q. What do you mean when you say South Asians are in a “health crisis”?

Syed: South Asians today face some of the highest rates of Type 2 diabetes, heart disease, metabolic syndrome, Fatty liver disease, and early cardiac events: often 5–10 years earlier than other groups.

What makes this crisis unique is that it affects people who are thin, vegetarian, or seemingly “healthy.” It suggests that something deeper than lifestyle is at play:  a biological vulnerability shaped by history.

Q. How do you know that historic famines and the modern health crisis are connected?

Syed: Several independent lines of evidence point to this connection. First, we can see that regions hit hardest by colonial famines often show the highest metabolic disease rates today.

Secondly, South Asians show distinctive patterns in fat storage, insulin response, and inflammation (the exact systems famine would reprogram for survival).

Third, when famine-adapted bodies encounter abundance, like when people move abroad, metabolic diseases often appear more rapidly and severely.

Finally, epigenetic research from the Dutch Hunger Winter, the Chinese Famine, and other populations shows that starvation leaves chemical marks on genes for multiple generations. Given the scale of South Asian famine exposure, similar effects are not just possible but likely.

Together, these findings create a compelling biological and historical narrative.

One must caution, though, that the South Asian health crisis is multifactorial. While colonial famines were definitely responsible, diet and lifestyle also play a major role.

Q. What is epigenetics?

Syed: Epigenetics is the study of how environment and experiences — stress, famine, trauma, abundance — can turn genes “on” or “off” without changing the DNA itself.

A useful analogy is that DNA is the script, but epigenetics is the director deciding which lines are emphasised, which are whispered, and which are skipped. Importantly, some of these changes can be inherited, meaning the experiences of one generation can influence the biology of the next.

Q. How can South Asians view their health history in a positive light?

Syed: The key is to shift the frame from blame to resilience.

Our ancestors survived conditions that wiped out entire communities. The fact that we exist means they developed extraordinary survival adaptations. Those adaptations helped them endure starvation, but now work against us in a world of abundance.

Framing our health story this way allows South Asians to see their biology not as a weakness but as a legacy of strength and survival. It helps release shame and promotes compassion, unity, and understanding.

Q. Are there similar cases of health issues arising due to historical calamities in other colonised parts of the world? If so, could you share a few examples?

Syed: Yes. South Asia is not alone. Research around the world shows that large-scale trauma, particularly famine or oppression, leaves lasting biological effects across generations. A few important examples include the Dutch Hunger Winter of 1944-45. Individuals who were in utero during the Nazi-imposed starvation later showed much higher rates of obesity, diabetes, heart disease, schizophrenia and early mortality.

Then there was the Great Chinese famine of 1959-61. This is one of the most studied modern famines. Descendants of famine survivors show higher blood pressure, increased diabetes risk, altered lipid levels, obesity, and reduced cognitive scores.

If we look at the indigenous communities of North America, generations of forced starvation, dispossession, and residential schools have produced lasting effects such as elevated diabetes rates, higher cardiovascular disease, increased stress biomarkers, and mental health vulnerabilities. These health crises are tied to structural trauma, not “poor lifestyle choices.”

We see among African-American communities that chronic food insecurity, forced labour, and systemic oppression created biological wear-and-tear still visible today in higher hypertension rates, higher maternal mortality, and increased inflammation-related illnesses.

Among the Caribbean and Afro-Caribbean populations, centuries of plantation slavery, malnutrition, and deprivation have shaped present-day patterns of metabolic syndrome, high blood pressure, and diabetes.

Whenever a population experiences long-lasting, large-scale trauma, especially famine or oppression, the health effects don’t end with that generation.

South Asia’s colonial famines fit into this global pattern. The difference is that the scale in South Asia was enormous and persisted for nearly two centuries, making the impact even more profound.

Q. What are some solutions South Asians can pursue to overcome their health history and the current crisis?

Syed: First, eat in alignment with a famine-adapted metabolism. This would include regular meal timing, higher protein intake, and reduced refined carbs, which make a significant difference. Strength training is crucial because South Asians naturally have lower muscle mass, and muscle is the “engine” that controls blood sugar.

Further, we must screen ourselves regularly. This means checking haemoglobin A1c, fasting blood sugar and insulin, lipids (including triglycerides, HDL, LDL, Apo A, Apo B, Lp(a), Triglycerides), liver function tests, Lipoprotein(a), homocysteine, and hsCRP.

Monitor and maintain waist size (abdominal circumference for men should be less than 90 cm and for ladies less than 80 cm), and blood pressures (less than 120/80 mm Hg) — even if you look healthy.

Talk openly about trauma and history. Understanding our past reduces stigma and strengthens community support. We also need to encourage public health changes, such as better nutrition programs, early detection initiatives, and infrastructure that promotes physical activity, that can transform outcomes.

And finally, reclaim cultural strengths. Traditional foods, spices, and communal eating can be powerful tools when updated with modern science.

We carry a difficult history, but we also carry everything we need to heal from it.