How to eat right – India Today

You are what you eat, they say. And Indians are spoilt for choice when it comes to variety in cuisine. The consequences of that gastronomic wealth are beginning to tell on their bodies. Lifestyle diseases have reached alarming levels in the country. A recent study by the Indian Council of Medical Research (ICMR) confirmed a truth we have known for some time: India is now the diabetes capital of the world. There are more than 101 million people with diabetes and another 136 million who are pre-diabetic. Indians now account for 17 per cent of the diabetics in the world. The culprit is no stranger: it is the sugar in most of the food we eat.

You are what you eat, they say. And Indians are spoilt for choice when it comes to variety in cuisine. The consequences of that gastronomic wealth are beginning to tell on their bodies. Lifestyle diseases have reached alarming levels in the country. A recent study by the Indian Council of Medical Research (ICMR) confirmed a truth we have known for some time: India is now the diabetes capital of the world. There are more than 101 million people with diabetes and another 136 million who are pre-diabetic. Indians now account for 17 per cent of the diabetics in the world. The culprit is no stranger: it is the sugar in most of the food we eat.

There is more bad news. In an irony that is anything but delicious, a third of Indian infants suffer from malnutrition, yet obesity is assuming epidemic proportions in India. The National Family Health Survey (NFHS)-5 discovered that a whopping 60 per cent of women and 50 per cent of men in urban areas suffer from a substantially high-risk waist-to-hip ratio, an indicator of abdominal obesity. Its natural corollary: hypertension and coronary ailments. Trouble is, they are afflicting young and middle-aged Indians, as The Lancet reveals, warning that over a fourth of the deaths in India are now on account of cardiovascular diseases, a rate that has shot up in the past two decades. “The rise in non-communicable diseases like diabetes and heart issues, especially among the young, is a clear sign that Indians are not eating right,” says Dr Alka Mohan, former head of dietetics and chief dietitian at AIIMS, New Delhi.

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At the same time, Mohan has observed an interesting phenomenon. “While there is an increase in unhealthy eating habits,” she says, “the interest in how to eat right is also growing.” The growing interest in eating right is validated by the State of Snacking study that Mondelez India conducted among 253 respondents in 2022. The study found that 95 per cent of them were keen to eat products with health qualities in the future, higher than the global average of 87 per cent. According to a report by Avendus Capital, the investment banking arm of the Avendus Group, India is the fastest-growing health food market, expanding at a CAGR of 20 per cent, with the segment expected to attain the size of $30 billion (Rs 2.5 lakh crore) by 2026. Meanwhile, the number of health-conscious consumers is expected to rise to 176 million in 2026 from 108 million in 2020. This has not only spurred the demand for healthy foods, but has also led to a mushrooming of healthy food services such as Food Darzee, EatFit, ParaFit, Nutri91 and Nutriobox, among others, which promise to deliver healthy meals to customers desperate to improve their nutritional profile.

Consumers or food companies, they are all singing the same tune—how to eat right. But what exactly is eating right? Delhi-based homemaker Jaya Dasgupta, 49, a mother of three, expressed that dilem­ma best when she bemoaned: “The amount of information on food out there is overwhelmingly confusing. Do we eat rice, millets or wheat? Do we drink A2 milk? Do we eat ghee? Do we fast? I had to outsource my nutritional requirements to a dietitian because I couldn’t make the choice myself.” To address the predicament that people like Dasgupta find themselves in, india today spoke to a range of top nutritionists and food experts to put together this guide to eating right.

The Grain Pain

Here is something that you probably know already—Indians go overboard on carbs. And where do those carbs come from? Wheat is a major culprit. Once a staple of North Indian thalis, it has now become common across dining rooms in India. And wheat is high in gluten content, which, in some individuals, can cause serious health issues. Their bodies sense it as a toxin and generate immunity cells to attack it. Continuous consumption can trigger inflammation and damage the gastrointestinal tract. Commonly diagnosed as coeliac disease, one per cent of the Indian population reports being afflicted with it.

Other individuals may not have coeliac disease but may still be sensitive to gluten. They experience similar discomfort, bloating, diarrhoea or constipation if they gorge on grains high in gluten. Doctors call it non-coeliac gluten sensitivity. “Many people say ‘we used to eat wheat all the time as a child, we can’t have gluten sensitivity’. But we don’t realise that the amount of gluten in the wheat grain has changed significantly,” says Dr Arjun Dang, CEO of Dr Dang’s Labs in Delhi. “Early wheat,” explains Delhi-based nutritionist Dr Ishi Khosla, who is also the president of the Celiac Society of India, “had about three per cent gluten, but when we genetically modified a grain that already had an inflammatory compound, it went up to 30 per cent. We stood the risk of increasing its inflammatory properties, which is what has happened.” The wheat species cultivated most in India today is of the Triticum aestivum or the bread wheat variety, rather than T. Dicoccum or emmer wheat variety, which is usually less processed and endowed with more fibre and less gluten than the bread wheat type.

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White rice is another grain that has long been accused of being a ‘bad’ or ‘empty’ carb and has been eliminated entirely from many a no-carb diet. Current dietary wisdom is now seeking to rescue it from that ignominy, with many nutritionists recommending it as a substitute for wheat, especially for those sensitive to gluten. Moderation remains the key word, though. “If you enjoy white rice,” says Neha Sahaya, a Mumbai-based clinical nutrition consultant and founder of Neha Sahaya Wellness, “you need to put clothes to your carbs. The best way is to mix it with nutrient-rich foods, like vegetables, lean proteins and healthy fats.” That’s because when you eat carb-heavy food, your blood glucose (sugar) levels see sharp spikes and crashes, which isn’t healthy. However, if you consume carbs with foods that have protein and fat along with fibre, the rate at which carbs are broken down into glucose slows down, which helps maintain a steady blood sugar level.

But why are carbs bad, to begin with? “After you eat, your body breaks carbs into sugar, releasing energy,” says Ritika Samaddar, head of nutrition at Max Super Speciality Hospital in Delhi. “How fast this is done is measured by something called the glycaemic index. Wheat and rice have a high glycaemic index, which could lead to high sugar levels in the blood apart from fats, especially if a person has a sedentary lifestyle, as most urban Indians do.”

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In 2019, a survey by the Department of Food and Nutrition at Lady Irwin College in Delhi identified tea, chapati, milk (as beverage), boiled rice and biscuits as the top five most frequently consumed food items. Three of these—chapati, rice and biscuits—are loaded with carbs, with some added sugar and fat in biscuits. A six-inch chapati, for instance, contains around 15 gm of carbs, 3 gm protein, 0.4 gm fat and 71 calories. The average amount of carbs recommended for those who want to lose weight is as low as 30 gm in some low-carb diets, and the average calorie content around 1,200. The trick then is to lower the overall glycaemic index of your intake.

The Magic of Millets

For long rendered the poor cousins, Indian millets, such as ragi, bajra, jowar, amaranth and kodo, are now having their moment in the sun, with the government declaring 2023 the year of the millets. “Millets have long been part of the Indian diet,” says Swati Bhushan, a clinical nutritionist at Fortis Hiranandani in Mumbai. They fell out of favour as wheat became the focus of industrial-scale cropping during the Green Revolution and, later, as western products like cakes, cookies, pastas, breads gained popularity. Now, they are emerging as an alternative to wheat, and can be used not only for rotis, khichdis and other grain-based dishes, but also in western items like pizzas, pastas, cakes and cookies. “Millets have a variety of micronutrients that wheat does not,” says Bhushan, “be it iron, zinc, magnesium, folic acid or calcium.”

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This does not mean you eliminate wheat rotis or pasta from your diet. Experts warn against self-diagnosing oneself with coeliac disease, a trend that has seen India become the place where gluten-free diets are most popular compa­red to other countries, according to Nielsen’s global ingredient trend report in 2016. “There is no need to be extreme,” says Rajeshwari V. Shetty, head of dietetics at the S.L. Raheja Hospital in Mahim, Mumbai. “If you feel discomfort eating gluten, go ahead and cut it out; millets have a lot of benefits. But don’t torture yourself to cut out a food group if you have no symptoms and just because others are.”

The interest in millets means restaurants are designing their menus accordingly. At the Sheraton Grand Bangalore Hotel in Bengaluru, Executive Sous Chef Gaurav Bansal features millets as the centrepiece of the menu and has introduced items like millet-based pancakes and French toast for breakfast. “Millets are not only nutritious but also highly versatile, aligning perfectly with the increasing interest in healthier and sustainable dining options,” he says. Health, though, isn’t the only reason for their use in menus, they genuinely taste good too, says Suvir Saran, the culinary director at Bastian, Bizza and Binge in Mumbai and Bengaluru. At the first-of-its-kind sensory experience hosted by Blue Label at The Oberoi in Gurugram, he served shrimp with an Alleppey curry and a chivda made with millets. “I haven’t stopped hearing about the genius of that flip for better health and greater taste and textural contrast,” says Saran. “At ITC,” says Manisha Bhasin, corporate executive chef, “we have been championing sustainable food for decades now and regularly create menu items based on fresh, hyperlocal and sustainable ingredients. These are very well received, particularly dishes created with forgotten grains like millets.”

But even this miracle grain has its limitations. Some millets contain phytic acid, which can reduce absorption of nutrients from a diet. “It is usually recommended that whole millets are soaked in water for a couple of hours,” says Samaddar. “Sprouted millet flours are more nutritious as well.” All millets are not diet food either; 100 gm of bajra can be as calorie-dense as a cup of rice. A lot depends on how you cook the millet. Samaddar rec­ommends eating millets with servings of vegetable and protein to improve the overall nutritional value.

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The Ideal Indian Plate

Like with everything else, balance is essential to attaining dietary nirvana as well. Experts recommend that an ideal 2,000 calorie per day diet must have 45-65 per cent or around 225-325 gm of carbs, another 25-30 per cent or around 80 gm or less of unsaturated fat (transfat or hydrogenated fat should be avoided), about five portions of differently-coloured fruit and vegetables and about 10-35 per cent from protein (ideally lean in fat; seafood is highly recommended). Probiotics like fermented pickles, yoghurt, buttermilk are commonly available in India and also excellent for long-term wellbeing.

For micronutrients, a combination of fresh fruit and vegetables is a perfect elixir. A 2017 meta-analysis of 95 prospective studies published in the International Journal of Epidemiology found that each additional 200 gm of fruits and vegetables per day was associated with an 8 per cent lower risk of coronary heart disease, 16 per cent lower risk of stroke, 8 per cent lower risk of cardiovascular disease, 3 per cent lower risk of cancer and 10 per cent lower risk of premature death. “All vegetables are good for you and a powerhouse of nutrients,” says Kolkata-based nutritionist Arushi Acharya. She recommends minimising starchy vegetables like potato and opting for different-coloured vegetables like purple cabbage, red lettuce, beetroot and so on. Dark green leafy vegetables, she adds, are particularly good for immunity-boosting properties. Acharya also tells you how to make even carb-heavy products like bread or roti nutritious—grate vegetables into them. It is also important not to overcook vegetables but lightly steam them to retain maximum nutrition value.

What about fruits? To have or not to have? Yes, they contain natural simple sugar (fructose), but their fibre content is such that even diabetics can have them in moderation, says Dr Samaddar. “Fruits build immunity, help you stay hydrated and are a rich source of vitamins and minerals,” says Sushma P.S., chief dietitian at Jindal Naturecure Institute, Bengaluru. “Incorporating a wide variety of fruits in your diet ensures you receive a diverse range of these vital nutrients.” Fruits like banana, mango and chikoo may have a sugar content relatively higher than others but can reduce cravings for the unhealthier cakes, cookies and puddings. Again, berries like strawberry, blueberry, blackberry and gooseberry have additional nutrients that can reduce the risk of cancer.

Given that there is a new superfood every day, imports of foods perceived as healthy have seen a significant rise. So, the imports of avocados were up 70 per cent in value terms between April and August this year compared to the same period last year, those of shelled almonds doubled, while those of pistachios and olives went up by 80 per cent and 60 per cent, respectively, going by commerce and industry ministry data.

However, if you find these imported foods expensive or not easily available, experts recommend that you eat what is locally available. “Seasonal fruits and vegetables are good for the body,” says Dr Samaddar. “In the summer, you find fruits and vegetables naturally high in water content while in winters, you have immunity-boosting spinach and mustard leaves.” Acharya feels similarly. “Instead of eating a vegetable that has been flown across the world, you can get equal if not more benefits eating the ones from your backyard,” she says.

The Milky Way

Dairy milk has been on somewhat of a roller-coaster ride in the past few decades. Once considered a premium source of calcium, good for the bones, milk became persona non grata once the surround sound around lactose intolerance and gut health started picking up in intensity—especially from the vegan community. According to a study in the American Journal of Nutrition, about 66 per cent of the population in South India is said to be lactose-intolerant, and about 27.4 per cent in the North. However, if you are among those who do not have lactose intolerance, a glass of milk in your daily diet would hardly be amiss. “Milk is even better than lentils, which are a second-class protein,” says Rasika Parab, a nutritionist with the Fortis Group in Mumbai. “Milk is a complete protein. For vegetarians, it can provide essential protein important not only for daily functioning but also when one is recovering from illness. We often give some milk to our patients during their recovery period in the hospital.” Only in two cases is milk to be avoided—when a person is lactose intolerant or has an upset stomach. And it is always better to get a doctor to diagnose whether a patient is lactose sensitive or not before replacing it with the more fashionable nut and soy milks.

In fact, nutritionists warn against eliminating any one food group from a diet. Or following a diet everyone on social media is into. “There are so many misconceptions about dieting,” says Dr Leena N. Sreedhar, HoD and consultant obstetrics & gynaecology, at Manipal Hospitals in Dwarka, Delhi. “It has become fashionable to cut out entire food groups or to eat a lot of fat without understanding your body’s requirements. This is harmful to health and counter-productive for weight loss as well.”

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What’s Wrong to Eat

Quite simply, sugar, hydrogenated oil and excess salt. According to the sem­inal ICMR-INDIAB study condu­cted between 2008 and 2010, India’s per capita consumption of added sugar rose from 22 gm a day in 2000 to more than double (55.3 gm) in 2010, and fat consumption from 21.2 gm per day in 2000 to 54 gm a decade later. The measure of hydrogenated fat, which is strongly linked with liver and heart disease, also shot up from 1.6 gm to 2.8 gm a day in the same period. We also consume 8 gm of salt a day, far more than the World Health Organization (WHO)-recommended 5 gm, as a recent ICMR survey reveals. Together, rising sugar, fat and salt levels in our diets have precipitated diseases ranging from cancer to infertility, hypertension to kidney failure.

A recent study in BMC Medicine examining the role of free sugars in heart health found that a mere 5 per cent increase in free sugars was linked to a 6 per cent higher risk of heart disease and a 10 per cent higher risk of stroke. “We used to consume sugars that came from whole grains or fruit or vegetable. Fats came from nuts, some vegetables, milk products and seeds. Added sugars and fats are a modern phenomenon,” says noted endocri­nologist Dr S.K. Mishra. In 2019, a University of Oxford study of 400,000 food and drink products in 12 countries published in Obesity Reviews found those in India to be the least healthy, with high levels of saturated fat, sugar and salt. Our packaged food and drinks were the most energy-dense, with an average of 1,515 kJ and 7.3 gm of sugar per 100 gm.

As Mohan points out, despite the growing realisation among Indians about the need to eat healthy, “there is still a large amount of dependency on packa­ged foods and very poor nutritional literacy”. That is one reason India’s salt consumption has gone up, simply because we do not know how much salt there is in a packaged product. “We try to educate many patients in the hospital,” says Samaddar. “A lot of our packaged foods are extremely high in salt. Even cooking sauces and dressings.” A 2016 study of 5,796 packaged food products in India by the George Institute for Global Health, Public Health Foundation of India and the Centre for Chronic Disease Control in India, found excessively high levels of salt. Don’t be fooled by that humble papad, a staple on the Indian plate—it has a mean sodium content of 1,219 mg per 100 gm. Some products have a sodium content of 4,000 mg per 100 gm. And the American Heart Association recommends an intake of under 2,300 mg a day!

We need to worry about the health implications of packaged foods because Indians are snacking more than ever before. The cruellest are the ultra-processed packaged foods, which the British Heart Foundation defines as those that have a long shelf life and generally have five or more ingredients, including but not limited to, preservatives, emulsifiers, sweeteners and artificial colours and flavours. In India, this sector has grown at a compound annual growth rate of 13.4 per cent in retail sales value from 2011 to 2021, as documented by a WHO-ICRIER report this year. Among the five popular categories are chocolate and sugar confectionery, salty snacks, beverages, readymade and convenient foods and breakfast cereals.

The study recommended that the Food Safety and Standards Authority of India (FSSAI), in consultation with other stakeholders, come up with a clear definition of High in Fat, Sugar and Salt (HFSS) food. They also recommended a nutrient-based tax model, with higher amounts for products with fat, sugar and salt above recommended limits, noting that such models have had public health benefits in countries where they have been implemented.

(Photo: Kushagra Wadhwa)

“We have noted the increase in intake of HFSS food and are acting on it,” says FSSAI chairman G. Kamala Vardhana Rao. In September last year, the food safety regulator had proposed a nutrition rating system on packages. Products would be rated on a nutritional profile of one to five, giving buyers quick and easy information about the food they consume. “We have received over 14,000 industry responses and are going through them,” says Rao.

While the idea has faced strong opposition from many manufacturers, consumers themselves are not averse to such labelling. A 2023 study by LocalCircles of 19,000 respondents in India found that 77 per cent did not mind a front-of-the-pack label on ultra-processed foods, though they preferred it to be colour-coded rather than numerical. Some large companies are already bowing to the trend. “We are investing in more nutritious offerings, including adding ingredients like whole grains, vegetables and micronutrients to our products,” says a Nestlé India spokesperson. “Nestlé India voluntarily has on the front of the pack a Guideline Daily Amount (GDA) labelling system that provides consumers transparent nutrition information in the context of a reference portion for energy and other key defined nutrients in relation to their daily needs.” Says Bhasin of ITC, “According to FSSAI guidelines, we already mention calorie counts for all our dishes on the menu.”

The government, too, has expanded its Eat Right Campaign, which aims to educate the public on healthy and mindful eating habits through school programmes, internet pamphlets, eating fairs and healthy eating certifications to hotels. Millets were also a part of the menu at the meals served during the recent G20 summit. It’s a win-win situation. Eat right, and you keep your weight in check, disease at bay, and simply live longer.

­â€”with Aditi Pai, Chumki Bharadwaj and Shelly Anand

Published By:

Shyam Balasubramanian

Published On:

Nov 10, 2023

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