Sanjeev Ahluwalia | Eat right to stay fighting fit, age well ICMR's way

The Indian Council of Medical Research (ICMR) would not agree with the comment that “the secret of success in life is to eat what you like and let the food fight it out inside”, and quite rightly so. The ICMR is unconcerned about success in life. Its mandate is to keep you healthy by eating right and remaining vigilant against trade malpractices like the mislabelling of packaged food. One such is the label “organic”, which should be applied only if the product is both free of artificial preservatives and the contents organically grown. It’s best to look for the “Jaivik Bharat” logo as certification.

Indeed, if possible, you should eschew reliance on all kinds of packaged food. Start from scratch by buying all the food ingredients yourself and cooking up a delicious, wholesome meal to recharge you, your family, and friends to move mountains without getting fat or lazy or sick with diabetes, hypertension or a failing heart and clogged arteries. Home cooked meals -- steamed rather than fried, roasted rather than grilled, with moderately active, regular exercise -- yoga being a popular international choice -- along with walking or jogging or just doing all the housework yourself, can keep that belly flab at bay as you near middle age and delay the loss of muscle mass in your senior years.

To spread nutritional literacy in India, the National Institute of Nutrition -- a Hyderabad-based entity of ICMR -- has published the sombrely titled “Dietary Guidelines for Indians” (DGI) since 1998. The most recent version, published this month, comes after a long gap since 2011. So, how have India’s health metrics fared since then?

The good news is that between 2016 and 2021 (data since 2011 is not shared), the number of men experiencing chronic energy deficiency reduced by 31 per cent and women by 19 per cent from the alarming base level of about one-fourth of adults.

Even better: 14 per cent fewer men and 11 per cent fewer women suffered from abdominal obesity from the astonishingly high base level of more than one-half of men and two-thirds of women. Why the adverse gender gap? Could it be that more men logged into the ICMR site and took the 2011 guidelines to heart -- that version is downloadable and storable on your desktop -- the current version is a read only online version. But at 148 pages, it’s a mite taxing.

The bad news is that about one-fourth of adults ignored the ICMR advice on managing hypertension and about one-seventh of adults paid no heed to the dietary and activity advice for managing Diabetes Type-2. In both cases, the proportion of adults affected -- across the gender divide -- increased significantly according to the NFHS-5 data.

ICMR acknowledges that diet is a cultural construct. Take, for instance, the acquired addiction to salt or sugar. There is enough sodium (the main ingredient in salt) in everyday food. But it is common to add salt for taste. How dear salt is for Indians is illustrated by the fact that the manufacture of salt was taxed even in colonial times, whilst gold was not. Mahatma Gandhi chose to capture the public imagination by launching his civil disobedience movement in 1930, against unjust colonial taxation, by boiling and making salt at Dandi on the coast in Gujarat, thereby violating the salt tax laws. A taste for salt persists. ICMR points to the growing prevalence of packaged fast food and snacks and bottled drinks, which add unneeded salt or sugar to tickle the taste buds, at the expense of health outcomes. Sugar is an energy source. But so are cereals, millets, pulses, nuts, milk products, meat, eggs, and fish, from which enough energy is naturally available.

A delicate balance must be kept between the macro minerals -- sodium and potassium. Cereals, pulses, vegetables, and milk are rich in the former while beans, lentils, banana, and nuts are loaded with the latter. More generally, minerals contain nutrients which nourish the body. Dried fish has the highest concentration of macro-mineral calcium followed by milk products at one-half as much, followed by seafood, with green leafy vegetables next in line. Iron, another macro-mineral, is highest in dried fish, followed by green leafy vegetables, pulses and nuts. For magnesium, go to nuts, millets, and pulses, and meats, in that order.

An eye-watering 56.4 per cent of the disease burden (mortality plus morbidity) is due to unhealthy diet and or lack of adequate exercise. Dietary balance is particularly important for children. Sadly, unhealthy dietary habits embed the disease burden early, which has to be managed lifelong. Forty per cent of one- to four-year-olds are anaemic and between 14 to 32 per cent are deficient in one or more of the required micronutrients (zinc, folate or iron and vitamins). Twenty-four per cent of five- to nine-year-olds are similarly anaemic and deficient in micronutrients, as are 28 per cent of 10- to 19-year-olds. The public policy implication is that early dietary deficiencies permanently impair nearly 40 per cent of the workforce. A very heavy social cost for the economy and personal anguish for the individuals concerned.

As in earlier years, the DGI goes to great lengths to apply the science to food plans good for infants, children, young adults, women, pregnant women, lactating women, men, and seniors with plated descriptions of meals through the day, including options for both vegetarians and non- vegetarians. It will console non-vegetarian Indians that the cover page itself features eggs and meat -- termed in the DGI as “flesh foods” as per the practice among vegetarians. Vegans however will not touch eggs (or any other animal product, including milk) but ovo-vegetarians relish them. ICMR also advocates having two to three meals a day, consistent with age and body structure, with sufficient gaps in between to allow the body fluids and organs to absorb nutrition.

Tea and coffee during mealtimes are not recommended -- much to the consternation of cultures, where tea is the lingua franca of bonhomie.

The bottom line, of course, is how many Indians can actually afford a balanced diet?

Is it nutritional illiteracy or just plain economics, which forces most families to eat badly? The Union government spends Rs 2 trillion on an undiversified, cereal heavy, free food scheme for low-income families. Making the handouts resemble a bare-bones ICMR-balanced diet would be a start. Even better would be just costing the meals and transferring the money into the bank accounts of the 110 million beneficiaries.