The new American Dietary Guidelines released in January recommend a decrease in the added sugar intake to ten per cent of daily calories, based on a 2,000 calorie diet. This works out to 12 teaspoons a day. The average American currently consumes 22 teaspoons a day, not including naturally occurring sugars present in milk and fruit.
The other two major changes are the removal of cholesterol restrictions, from the previous recommendation of limiting it to less than 300mg a day. This is based on the inconclusive evidence of the link between cholesterol rich food and bad cholesterol. The recommendation for limiting saturated fat to 10 per cent of daily intake stands. Examples of saturated fats are whole milk, butter, coconut oil and meats not labelled lean. The sodium levels should be restricted to 2.3g a day. There are a number of online applications that can help you maintain your daily diet.
The obesity epidemic in the US started in the late 1970s. Prior to that, obesity levels were less than 45 per cent, as opposed to the current levels of two-thirds of the population. When I first read about obesity in the US in the 1980s, I couldn’t believe a place like that actually existed. The land of plenty appeared to be a paradise on earth. The biggest problem for me, growing up, was constant hunger. Even today, 19.5 crore Indians go hungry every day.
I was sent to boarding school at the age of six along with my older brother. We lived on a tobacco farm in rural India, without decent schools in the area. The food in the first school was something out of a Charles Dickens novel. Second helpings did not exist. I remember at the end of the first day, we were all taken to the dining room and, as the names of the children were called, each of them was given a packet of candy and snacks. I kept waiting for my name, but it never came. When the teacher was shutting the box, I put my hand up and pointed out that I had not received a packet. She told me that this was the extra food sent by parents for their children. My parents were unaware of this provision.
When my mother came to visit us after the first month, I remember laying into her. In the middle of my tirade about being hungry, cold, and miserable, my brother nudged me, and I stopped when I saw the shocked expression on her face. It was the hurt expression of a mother of a hungry child, one that I will never forget. I got to see that same helpless expression constantly during medical school. Unknown to me, she had travelled alone by bus for more than 10 hours in tiring conditions, and was staying in a rundown place on a limited budget. The next time I went to school, I had an extra trunk of food.
Both of us were severely undernourished and infested with parasites, despite my mother giving us antihelminthic treatment every year. Like most mothers in India, she acted as our doctor. She was a pragmatic lady. She started feeding us meat, despite it being against our religious doctrine. When I went to medical school, I continued to have nutritional issues. I remember one day biting into an apple and a tooth breaking off because of calcium deficiency. We would visit villages to educate the population about balanced diets and nutrition. The scenes in some of these places were akin to the concentration camps I had watched in movies. Most of the paediatric admissions were because of starvation. Marasmus and Kwashiorkor, both syndromes of acute malnutrition, were common diagnoses. I looked well fed by comparison.
In a paradox, 79.5 crore people in the world deal with hunger on a daily basis, while we in the US fight obesity. Diet is a major contributing factor for most of the chronic conditions in the US, including diabetes, heart disease and cancer. Ironically, diet is also responsible for most of the chronic conditions in the developing world, including tuberculosis, rheumatic fever and gastrointestinal infections.
I now deal with first-world problems and force myself to eat oatmeal for breakfast, and walk past piles of cookies at work during the holidays, shaking my head at the problem of plenty. I am sure some kid on a tobacco farm in rural India would love to have the problems that we find so weighty.