Fat in Thailand: Thai-a-betes epidemic

BANGKOK, Thailand — Oil slicked Jay Muay’s wok, big as a satellite dish, spitting grease at a queue of hungry customers. First came scallions and tofu, sprinkled from above. Then eggs, beat into a canary-yellow goop.

The street stall chef’s hands flew into double-time: with her left, she joggled the wok; with her right, she flicked in a few fat-bodied shrimp. Lastly, Jay Muay reached for her not-so-secret ingredient: processed sugar.

She poured from a jug — one Mississippi, two Mississippi, three — until her pad thai was sweeter than summer-camp Kool Aid.

“It’s almost impossible to add too much sugar,” said Waiwong Wittayakun, Jay Muay’s husband and co-owner of their forever-busy pad thai stall in Bangkok’s On Nut market. “Thai people, we like it sweet. Just look at that queue!”

Thai cuisine is globally lauded as sophisticated, spiritual and even nutritious. What many Thai food fans don’t realize, however, is that there’s often gratuitous amounts of cheap, processed sugar hiding behind the spice.

The country’s sweetness addiction, experts say, is partly responsible for one of it’s fastest growing diseases: diabetes. Nearly one in 10 Thais now suffer from the disease, a rate even worse than America’s one in 12.

“Traditionally, our food is supposed to have a balance of sugar,” said Napaporn Sowattanangoon, a diabetes specialist with Thailand’s Mahidol University. “You’re supposed to taste sweetness balanced with spice, sourness and other flavors. Now, cooks just go overboard with sugar. It’s like they don’t even care about the dangers.”

Like U.S. doctors, Thai physicians blame the diabetes epidemic on more-sedentary lifestyles and the rise of industrially produced junk food. The nation’s most prevalent store is 7-11, which offers squid-flavored potato chips, starchy pork buns and sugar-loaded energy drinks around the clock.

Worse yet, Napaporn said, are Thai grade schools that serve processed meals. “The kids turn into adults who are addicted to sweet food. And they get fat because no one plays in the fields anymore.”

Developing countries such as Thailand, India and China are seeing the most new diabetes cases globally, according to InterAsia, a research cooperative between U.S., Chinese and Thai universities. As newfound prosperity spares more Asians from physical labor, it’s also driving them to more desk jobs and microwavable food.

Two-third of diabetics, according to InterAsia estimates, now live in the developing world. And in Thailand, according to estimates, half of all diabetics are oblivious to their disease.

The disease translates from Thai as “sweet urine disease” and, in rural provinces, it’s traditionally self-diagnosed when villagers notice ants gathering around their outdoor toilet.

“I suspected I was diabetic, as many black ants swarmed around my urine,” said one Thai patient evaluated for a 2009 Mahidol University study of cultural influences on diabetes treatment. “One time, I slightly dipped my finger in my own urine and tasted it. It would be sweet if I had drank it.”

Treatment in Thailand is further complicated by spiritual beliefs. Some diabetic Thais, Napaporn says, blame the illness on misdeeds from past lives, such as undernourishing livestock. Other patients she’s evaluated recite their Buddhist acceptance of illness and death, expressing little desire to change their love of sweet foods.

“Thai people, especially the elderly, have trouble accepting a disease that won’t let them eat all the foods they want,” Napaporn said. “By the time the doctor tries to help, it’s too late. They have wounds on their bodies that won’t even heal.”

Thai doctors often ask diabetics to forgo starchy white rice, essential as oxygen in the minds of many Thais. In lieu of unpleasant diet change, TV infomercials offer herbal quick cure-alls. A recent commercial for Dr. Chula’s “Thai-Chinese-Lao Herbs” features the testimonial of Sod Suchuen, an elderly Thai diabetic woman, who professes that “after drinking two or three pots, my weight shot up from 44 to 49 kilos!”

Thailand’s Ministry of Health, as part of its “Paunchless Thais” weight-loss campaign, has warned the public that Type-2 diabetes can bring on blindness, infirmity and death. Government doctors should use more Buddhist logic to help steer Thais away from poor diets, Napaporn said.

She’s currently studying how Buddhist principles of resisting gluttony play to diabetic Thais, especially the elderly who say their religion has taught them to “accept illness” and eat as they please. Physicians, she said, should inspire patients to imitate monks, who lower blood pressure by meditating and avoid eating large meals.

Diabetics might also consider staying far away from Bangkok’s On Nut market around sundown. That’s when Jay Muay’s wok is at its busiest and the smell of simmering scallions and caramelizing sugar attracts queues that choke the sidewalk.

“The sugar? We use a lot to make it come out really sweet, really sour,” Waiwong said. “It might look like a lot, but that’s how much you have to add to keep them coming back.”