Nutrition Famine: What’s On Our Plate?

Indians have been historically generous with holiness. Nature, knowledge, fire, sex, kings, cows, you name it and our plural, freewheeling belief system has been magnanimous enough to host it within the sanctum. Food, too, found its space therein. The toil that went into the tilling of land, the sowing of seeds by weather-hardened hands, the satiating sight of a rich harvest—and foremost, its life-giving quality—all that must have prompted the sages to confer on food a status worthy of reverence.

 But what we eat is no more holy. Our traditional dietary wisdom struggles to survive intact. At one level, there’s the destabilising encounter with modernity—which, for everyone in the world, has meant exposure to new, exotic things. The changes in food and food practices also owe to the value-free march of technology: chemical additives, preservatives, criminal levels of sugar and salt, plastic packaging, and yes, Frankenfood!

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There’s also the flux of medical wisdom, notoriously the inexact science. We didn’t need GM popcorn or Big Mac burgers for one in five Indians to be obese: it was accomplished by refined flour replacing old grains like ragi or bajra or ethnic rice varieties, or the coup staged by zero-value refined oils on nutrient-rich ghee and more traditional cooking mediums. Our nutritional palette thinned perilously.

Like the 1:5 overweight Indian, an identical 20 per cent is thin and undernourished. But that is the India that does not eat, institutionally abandoned and stalked by hunger. Here, leaving the two extremes aside, we examine the three out of five Indians who do eat and, by their imagination, eat well. Has an epidemic of want been inscribed into our everyday eating? Do we suffer from a nutritional famine—what in another context has even been called ‘nutricide’? Yes indeed, experts speak of Hidden Hunger, and relate the eruption of lifestyle diseases to this dietary ‘turn’.

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Here, we take the average, daily diet of nine families from across India—broadly representing various regional and other ‘types’ (say, ‘Bengali’...or ‘rural north Indian)—and put them under the microscope. Complete with the nutritionist’s verdict and suggestions. (See Case Studies 1-9.) But before the nutritionist’s audit and suggestions on what we must do about it, here’s an analogy to clarify the concept.

Entertain, for a moment, the radical proposition that what we took to be our greatest benefactor was actually one of the most ravaging malefactors. Agriculture came about as a way to stabilise food: to make its availability less random and unpredictable. It was a fundamental rupture that changed human history; all our complex ‘civilisations’ grew out of this new deal with nature. But Israeli historian Yuval Noah Harari argues agriculture has been history’s greatest fraud. And the effects of that disruption echo eerily in our contemporary situation.

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For 2.5 million years, humans gathered wild plants and hunted wild animals for sustenance, before it made that seminal turn, about 10,000 years ago, to domesticating plants and animals. From a foraging lifestyle, humans now “sowed seeds, watered plants, plucked weeds from ground and led sheep to pastures” all day. “Rather than heralding a new era of easy living, the Agricultural Revolution left farmers with lives generally more difficult and less satisfying than those of foragers. Hunter-gatherers spent their time in more stimulating and varied ways, and were less in danger of starvation and disease,” notes Harari in his book A Brief History of Humankind.

Human bodies were not used to the constant, repetitive, machine-like labour of agriculture. The tilling of land, the fetching of water, all took a toll on human skeletons and, studies show, the arrival of arthritis, slipped discs and hernia coincided with that of agriculture.

There was another, silent, unnoticed fallout of this transition to agriculture and its subsequent institutionalisation—the erosion of dietary diversity. Early humans, who cover about 98 per cent of our species history, consumed a wide variety of foods—grains were a minor element in this diet. With ‘staple-isation’ of grains, average human diets lost out on crucial minerals and vitamins. A small elite managed well all along, wondrously textured dishes were created for them, an endless cornucopia, embellished by rich nuts and fruits. But the majority of humanity toiled for thin gruel, literally. For an average Chinese peasant, Harari says, it was rice for breakfast, rice for lunch and rice for dinner.

Loss of diet plurality. Lack of micronutrients. Chemical imbalances arising from that. A baleful harvest of diseases. We are staring at exactly that these days: a disaster movie running inside all of us.

Hidden hunger arises when the body is unable to get micronutrients—vit­amin A, iron, zinc, folic acid, iodine, thiamine et al—crucial for our physical and cognitive well-being. The WHO says two billion people in the world suffer from hidden hunger. It’s a hunger without pangs—you do not feel it, but the persistent deprivation comes to haunt the body in the form of diseases.

Iron deficiency, for INS­tance, is linked to anaemia: take fatigue, reduced physical work capacity, at times adverse pregnancy and birth-related outcomes. Every fifth man and, astoundingly, every second woman in India is anaemic, the fourth National Family Health Survey (NFHS-4) found. Vitamin A defic­iency can lead to night blindness and increases the risk of disease and death from infection.

A majority of Indians take less than the recommended levels of micronutrients. A typical urban Indian household consumes a measly 22.8 per cent of the Vitamin A it should, and only half of the ideal levels of Riboflavin, a vitamin of the B group. Calcium and iron intake was at 67 per cent and 77.6 per cent respectively—and that’s an average, so there will be zones of utter deficiency.

The solution is simple. A broad, assorted diet that includes foods from possibly all these 12 food groups: 1) cereals and millets, 2) pulses and legumes, 3) green leafy vegetables, 4) other vegetables, 5) roots and tubers, 6) nuts and oil seeds, 7) condiments and spices, 8) fruits, 9) fish and other meats, 10) milk and milk products, 11) fats and oils, 12) sugar and jaggery. A rounded diet is one with balanced proportions of at least nine of the 12 food groups.

The immensity of India’s geography and demography makes for tremendous variations in diet, but we can abstract commonalities: typically all of it is cereal-heavy. The rest of it could be from different planets. Fish, consumed at least once a week by 91 per cent in Bengal, is had by less than four per cent in Punjab. On the other hand, over 93 per cent people consume milk and milk products in Haryana, as opposed to a minority of about 22 per cent in Mizoram. All this over and above the infinite shades and nuances of micro-variations in cuisine.

Vegetarianism is another variable that has a bearing on nutritional profiles. How it came about thr­ough cult­ural or religious factors is an intriguing story. Any­how, today 22 per cent men and 30 per cent women in India are vegetarians. Plenty Brahmin communities are non-vegetarian, and South India is predominantly non-vegetarian too. On the mixed platter of Indian diets, there’s no dearth of contradictions—no irony deficiency.

For all the talk of unspoilt rustic life, consider the diet of the Jyanis of 12 Tike village in Sri Ganganagar, the ‘food basket’ of Rajasthan. Sudhesh Jyani (36) grows wheat, gram, guar and cotton on his 10 acres. The touch of privilege in their lifestyle—TV, fridge, motorcycle, tractor—does not, however, translate into richness of diet.

The day begins for Sudhesh, his wife Meera and 17-year-old son with a cup of tea, with Meera usually having two or three times more tea. (This disparity, which prevails each time tea is prepared, is a common one in India: women have more tea.) With breakfast, the inadequacies start showing. At about 10 am, they have chapatis mixed in with chhachh (buttermilk), red chilli powder and salt—or on some days with onion and green chilli. And the pattern continues. In the evening, they have chapati with kadhi, or a local subzi. People here typically buy greens only when there’s a guest.

The chapatis are had with ghee; as expected, males consume twice the amount of ghee. On the same note, Sudhesh and his son drink two glasses of milk while Meera drinks only one. The rationale offered: men work in the fields and need a richer diet. Pulses are eaten maybe once a week. Fruit consumption is alm­ost zilch. Judged against the 12 desired food groups, the Jyanis get only six.

“Vegetables are missing from the family’s diet: that’s a huge gap,” says Dr A. Laxmaiah, public health nutrition specialist at the National Institute of Nutrition, Hyderabad. “Let alone green leafy vegetables, regular veg­etable consump­tion is also missing. There’s also a huge deficit of fruits, an important source of ­vitam­INS.” Indeed, the whole of Rajasthan fares poorly when it comes to consumption of dark green, leafy vegetab­les, fruits, meat or even eggs. Only 73-60 per cent (men-women) ate green leafy vegetables at least once a week; a mere 41-29 per cent had fruits. Only 10-6 per cent ate fish or chicken or meat, while only 13-7 per cent had eggs, according to NFHS-4.

An urban middle-class diet sample, from Delhi, proved relatively more wholesome. The family of bank employee K.L. Arora (59), which includes his wife and 25-year-old daughter, keeps rotating its breakfast menu: parathas one day, chapati and vegetable another day, milk and porridge on a third. Fruits, watermelon for this season, are also a regular. Lunch is mostly chapati and vegetables ranging from potato to lady’s finger, ridge gourd or pumpkin. The family sits together in the evening for a cup of tea, had along with rusk or a sweet. Dinner is similar to lunch, but it’s followed by a fruit, muskmelon, these days. Pulses make an erratic appearance, sometimes present every day in a week, sometimes not for weeks at a stretch.

***

12 Things For Everyday 
by Ishi Khosla, Nutritionist

1. One carrot
2. One cucumber
3. One amla or lemon
4. Nuts and seeds
5. One seasonal fruit
6. Good amount of green leafy vegetables
7. Rotate the grain (incorporating millet in diet)
8. Avoid grain in every meal
9. Take grain before 7 pm
10. Drink plenty of water
11. Minimise bakery products such as bread, biscuits
12. Take adequate protein in at least two meals

***

Laxmaiah gives a thumbs-up to this diet, but says some meat, probably three or four times a week, would round it off. “Meat is a double-edged sword. In measured intake, it’s good, but in excess, it can lead to hyper­tension and diabetes,” he says. Nearly 40 per cent men and 30 per cent women in Delhi consume eit­her fish or chicken or meat once a week. About 84-89 per cent in Delhi eat green leafy vegetables once a week. Fruits: 66-72 per cent. Fried foods and aerated drinks: 41-48 per cent.

The south now. Idli is the customary breakfast for­­ ­service engineer Prem­kumar (51) and his family, with poori and pulses coming up once a week or so. Lemon rice with fried potato, or rice with sambar or rasam, make for lunch, while dosa and upma feature on the evening menu. His wife, who works with a finance company, takes a fruit every day between breakfast and lunch. There’s also milk every night.

The nutrition expert says most people in Tamil Nadu have a light dinner, a healthy practice. “The diet is fine if they are adding enough vegetables in the sambar,” says Laxmaiah. “A lot of people just have one chutney all the time though, which is not advisable. And the problem here is high rice consumption, with its high glycaemic index.” Proportions are crucial here. Laxmaiah says the wheat or rice staple should constitute between 25-35 per cent of the meal—and the consumption in India is nearly 65-75 per cent.

Coconut oil as a cooking medium is beneficial: the Chennai family, however, uses refined oils on a regular basis and coconut oil only for special dishes. About 93 per cent in Tamil Nadu consume green leafy vegetables at least once a week. Curd also improves gut microbes.

Dieticians are generally advising a U-turn to tradition and, at the same time, debunking recent food fads. “Fats were spoken ill of, but now we recommend that good fats must be there,” says Ishi Khosla, a top nutritionist who works with the Centre for Dietary Counselling in New Delhi. “Ghee was banished, so was coconut oil, but we’re now realising their pluses. On the cont­rary, it’s the refined oils we advise people against using. The yolk and nuts are back too. Milk, which was earlier recommended, is a cause for problems now. I have treated people with dia­betes just by changing their cereal and removing dairy products from their diet.”

The channels of availability and affordability also regulate what flows into the plates of India’s populace. Ironies abound, again. For instance, ragi (finger millet) consumption has gone down in the southern states in the past two decades because it was thought of as a poor man’s grain and suffered from low prestige, says Laxmaiah. The poor rating led to poor demand, which in turn led to less production. Now, ragi, highly recommended by nutritionists, has become a rich man’s dietary accessory. The same is the case with superfoods like flax seeds: a rural commonplace once, now it adorns posh organic shop shelves.

Fruits are a key part of the price riddle. “Fruits are expensive,” says Purnima Menon, senior research fellow at International Food Policy Research Institute. “Which BPL family can afford to have them every day? Fruits need to be made cheaper, more accessible. If you don’t have money, you’ll end up buying cheap calories in the form of sugars and fats. The ultra-processed foods are so pervasive and aggressive that at some places there’s just no healthy food available.”

The markets and supply chain have to be redesigned with nutrition as the cornerstone, suggests Dipa Sinha, who teaches economics at Ambedkar University Delhi, and works on food rights and food security. “India’s entire food security is focused on cereals,” she says. “There’s little emphasis on dietary diversity. Rural availability of fruits and vegetables is poor. There are few efforts to distribute pulses, which are an important source of protein in the country.”

Even the poor are now moving towards junk food. “For example, poor working women in urban areas give Maggi to the child because it’s the most convenient and affordable food available,” says Sinha. “The government needs to intervene, regulate advertising, and ensure that ­nutritious food is convenient and affordable. The blacks in the US, similarly poor, have been the foremost victims of junk food. Let’s take some lessons, and see to it that the pattern is not repeated here.”

The government has relied on fortification (enrichment of food with micronutrients) and supplementation (providing deficient nutrients in the form of supplements) to address the large gaps that show up on India’s nutritional profile. “Supplementation has sub-optimal coverage and compliance. Only 23.6 per cent women consumed the prescribed number of iron and folic acid tablets during pregnancy. On the other hand, fortification is likely to reach a higher proportion of the population,” says Basanta Kumar Kar, country director of Project Concern International. But those are short- and medium-term  solutions, he’s quick to add a rider. The only, sustainable way out is diversity on the platter—a gradual recovery of our old vibgyor diet.