In the late 2000s, architect Eldho Pachilakkadan bought 20 acres of barren land in Swargam Medu (Hill of Heaven) in Kerala’s Idukki district, intending to create a commercially sustainable organic farm. However, over the past one and a half decades, the land has evolved in ways he never anticipated. Today, the 48-year-old’s ‘Utopia’ is a thriving “food forest” that sustains him, his family and a small community drawn to his ideas and experiments.
When Pachilakkadan and his wife Bincy purchased the land, it was a struggling cardamom plantation plagued by water scarcity. Instead of clearing it, they allowed the existing plants to grow wild while introducing a variety of fruit trees and vegetables. Some plants flourished, others perished, and gradually a self-sustaining ecosystem took root. The water shortage was addressed by creating two ponds. Today, Pachilakkadan, Bincy and their two children live in a small shelter built from sustainable materials. Their primary source of food are the fruits grown in Utopia.
Pachilakkadan has been part of the Travancore Natural History Society, an NGO founded in 2010, conducting biodiversity surveys of the Western Ghats and sharing data with the forest department. During field trips, exploring the region's flora and fauna led him to reflect on evolutionary principles, shaping the lifestyle he follows today.
“Food is fundamental to evolution. In any ecosystem, all organisms share basic survival needs―shelter, water, air and climate―but the most variable factor is food,” he says. “Organisms evolve rapidly when these factors undergo significant changes.”
Pachilakkadan believes that rapid evolution in a species is accompanied by a phase of diseases―a condition he sees in humans today. “This suggests fundamental environmental conditions have shifted,” he explains, linking it to humanity’s dependence on industrialised farming and commercialised food system. “For instance, rice and wheat, in their raw form, are not naturally suited for human consumption. Even if they were, their current abundance wouldn’t exist without industrial agriculture.”
As part of his countercultural lifestyle, Pachilakkadan now follows a food system centred around raw fruits, with moderate amounts of meat and fish, and a significantly reduced intake of carbohydrates―cereals are almost entirely absent from his diet. “Our aim is to avoid anything produced through industrial farming,” he says. “At home, we raise hens, cows and goats. The only thing we buy from outside is fish.”
Pachilakkadan says he adopted this approach after researching the ideal diet for people living in tropical climates. “The most naturally available and palatable plant-based food should be prioritised,” he explains. “Over time, I shifted to a diet that emphasises fruits over vegetables―something I have personally tested and found effective.”
His daily diet consists of fruits like bananas, papayas, coconuts and pineapples, which grow all year. “Initially, I considered introducing exotic fruits, but I realised nature selects the right crops for each place,” he says. Seasonal fruits like mangoes, guavas and jackfruits, available at specific times, turn into celebrations at Utopia. “That’s how our food system works,” he says. Pachilakkadan says that his lifestyle includes sufficient physical activity, leaving no room for fat accumulation, blood sugar spikes or obesity.
While fruits contain simple sugars like glucose, fructose and sucrose, epidemiological and clinical studies consistently show that most fruits have anti-obesity effects. Despite their sugar content, fruits typically have low energy density―providing fewer calories per gram than processed food or sugary beverages. Studies show that they also contain bioactive compounds such as flavonoids and polyphenols, which support metabolic health, reduce inflammation and enhance fat oxidation. Moreover, fruit sugars are embedded in a whole food matrix rich in water, fibre and nutrients, which helps buffer the adverse metabolic effects like diabetes, typically associated with refined sugars.
Pachilakkadan claims that he was a diabetic on medication and weighed more than 90kg when he bought the land, but has now reversed his diabetes. “When I had diabetes, I suffered from other illnesses, too. But now, I don’t have any of those issues,” he says.
Pachilakkadan says his children, now 10 and 15, have never been part of the conventional food system. “Until they developed their canine teeth, they were entirely fruitarian,” he says. “After that, their diet included a small amount of meat, but fruits remained their primary food. To this day, they have never fallen sick or needed a hospital visit.” His daughter once even asked him why she didn’t get fever like other children. “She has actually wished for fever just to see what it feels like!” he laughs.
For most people, sourcing nutritious food from their surroundings is nearly impossible. Pachilakkadan’s philosophy that rejects the dominant food system may sound impractical, but the concerns he has about what most people eat are something shared by some top medical experts. And, many across the country are working to bring back wholesome food and evidence-based nutrition as the first defence against disease, from infancy to old age.
Sickness normalised?
Sukesh (name changed), 34, a former Union government employee with the home department, had to relocate frequently as part of his job, including to remote rural areas. Living away from home, he largely relied on outside food. “Even when I cooked, it would just be rice with peas or dal,” he says.
He eventually resigned from his government position to pursue an MBA at an Indian Institute of Management. “That’s when things took a turn for the worse. The canteens were open all night, and it became a habit to eat late with friends or order from campus kitchens,” he recalls. “By the time I finished the course, I had gained significant weight and developed a paunch. I also began experiencing constant fatigue and frequent abdominal discomfort.” Diagnosed with fatty liver, Sukesh is now trying to shed the extra kilos by playing badminton regularly, but admits his diet hasn’t changed much.
In April, Apollo Hospitals released the fifth edition of its Health of the Nation report, which featured a striking section on liver diseases titled, ‘Not All Alcohol’. While alcohol is a known risk factor, the report revealed that 85 per cent of fatty liver cases were among non-alcoholics, with obesity emerging as the culprit in 76 per cent of them. This was just one of the many alarming findings in a report that opened with a stark warning: non-communicable diseases (NCDs), including diabetes, hypertension, heart disease, obesity, cancer and mental health disorders, are now the leading causes of death in India.
“Studies suggest that unhealthy diets contribute to a significant proportion of disease burden in India,” says Dr Hemalatha R., former director of Indian Council of Medical Research-National Institute of Nutrition (ICMR-NIN), and an authority on medical nutrition. India, she adds, is in the midst of an “epidemiological transition”, with declining deaths from communicable diseases and childbirth-related conditions, and a sharp rise in fatalities due to NCDs.
“Unhealthy eating patterns―marked by high consumption of refined carbohydrates including sugar, processed food, oils and fats, along with low intake of vegetables and whole grains―have fuelled the rise in type 2 diabetes, fatty liver disease, cardiovascular conditions and obesity,” says Hemalatha.
A poignant observation from experts is that overnutrition―marked by obesity and excess fat―often coexists with micronutrient deficiencies in India. Hemalatha largely attributes the problem to the widespread consumption of calorie-dense, nutrient-poor food in the average Indian diet. “Traditional dietary wisdom is being lost in the noise of modern food trends,” she says. “Globalisation has expanded food choices and improved access to a diverse range of ingredients year-round, enhancing culinary exchange and convenience. However, it has also eroded traditional food cultures and contributed to the decline of seasonal eating. Combined with urbanisation, rising disposable incomes and the boom in food delivery services, this shift has led many people to move away from locally grown, nutrient-rich food and toward highly processed, unhealthy options.”
Hemalatha was the lead author of the ICMR’s 'What India Eats' report, which offered a comprehensive breakdown of how different food groups contribute to energy, protein, fats and carbs. A key finding of the 2020 report was heavy reliance on refined carbohydrates. “More than 70 per cent of calories often come from carbohydrates, primarily from polished rice and refined wheat, with limited consumption of whole grains. Even when millets are included, they are frequently consumed in refined forms, which reduces their fibre and nutrient content,” she notes. Low vegetable consumption, she adds, is a widespread issue across all regions and income groups. “Even when eaten, vegetables are often limited to potatoes in the north and tomatoes in the south and rural areas.”
She also notes a sharp rise in sugary food and beverage consumption, including sweets, chocolates and soft drinks.
Hemalatha, who has specialised in maternal and child health and nutrition, says that even in weaning practices―the period where infants are gradually introduced to solid food―the same dietary mistakes are followed. “Many parents introduce low-nutrient, refined cereals with added sugar, unaware that sugar should not be included in a baby’s diet―it is highly problematic,” she says.
Creating unhealthy generations?
When Dr Rupal Dalal returned to India in the mid-2000s after a decade as a paediatrician in the US, she was shocked by the state of newborn malnutrition. “As an observer at a charitable paediatric hospital in Mumbai, I saw severely undernourished children―frail and fighting to survive,” she recalls. “Some died due to a lack of basic medical infrastructure. Many arrived only when critically ill, and hospitals lacked even pulse oximeters or functioning life-saving equipment.”
Disturbed, she asked her mentor how children survived in such conditions. He told her, “If you want to save them, go where they come from―into the slums.” Motivated to address the root cause, Dalal began working with an NGO to set up nutrition clinics. She soon realised malnutrition wasn’t limited to the poor, it also affected children from affluent families.
Dalal soon realised that India’s malnutrition crisis begins with the health care system’s failure to promote the benefits of breastfeeding. “Breast milk is live milk―it destroys harmful bacteria, builds immunity and is the only food a baby needs for the first six months,” she affirms.
Over the years, misinformation, poor hospital practices and aggressive formula marketing have impacted the breastfeeding culture. “Ideally, breastfeeding should begin within the first hour of birth,” says Dalal. “Colostrum, the thick first milk, seeds the baby’s gut with beneficial bacteria―what we call the baby’s first vaccine. But in most hospitals, babies are separated from their mothers immediately after birth.”
Nurses may lack proper training in latching techniques, notes Dalal, and some doctors delay breastfeeding―especially after C-sections―and formula representatives operate freely in hospital wards. “Many hospitals aren’t certified under the Baby-Friendly Hospital Initiative (BFHI) and fail to follow its breastfeeding-friendly protocols. The Infant Milk Substitutes, Feeding Bottles, and Infant Foods (Regulation of Production, Supply and Distribution) Act, 1992―which regulates formula marketing―is poorly enforced, and some hospitals even receive incentives from formula companies,” she says.
Dalal noticed that misinformation from some medical professionals damages maternal confidence. “New mothers, especially those who have had C-sections, are told they won’t produce enough milk. They panic, turn to formula, and the baby develops nipple confusion, making breastfeeding more difficult,” she explains.
Her investigation into why many infants fail to gain adequate weight pointed to a widespread issue: poor breastfeeding and latching practices. Improper latching, she found, prevents effective milk removal, leading to reduced production. “Mothers assume they are not producing enough, which benefits formula companies but harms infants, raising risks of diarrhoea, pneumonia and malnutrition,” says Dalal, adjunct associate professor, Centre for Technology Alternatives for Rural Areas, Indian Institute of Technology, Bombay.
In response, she developed an improved cross-cradle technique that delivered remarkable results in a short span of time. “We improvised it by focusing on details like the baby’s mouth angle, jaw and neck position, and how to hold the breast in a way that makes it easier for the baby to latch,” explains Dalal. “We also created 45 specific counselling points.” A 2023 study in Maternal and Child Nutrition highlighted Dalal’s fieldwork with 576 exclusively breastfed infants (0–14 weeks) in Gujarat. Her intervention group of 300 babies―whose mothers received counselling on her cross-cradle technique, proper latching, and regular weight checks―showed significantly better weight gain (32.7g/day) compared to 276 infants under standard care (28.05g/day). A baby should gain at least one kilo per month for the first three months. To tackle misinformation, Dalal and her team at IIT Bombay created 105 audiovisual tutorials covering breastfeeding, maternal nutrition, complementary feeding, and recipe-based skills. They also used 45 key guidelines to train health care workers, who then teach mothers. “We are now working with districts and states, training master trainers who pass on the knowledge,” she says. In Maharashtra’s Nashik, the programme led up to 25 per cent drop compared to previous year in infant mortality post training, while in Washim, stunting fell from 52 per cent to 32 per cent in a year as per government's POSHAN tracker data, far exceeding the typical annual target of a 2 point absolute drop. Currently, Dalal and her team are working with 22 district administrations across India.
“The impact is transformative―saving children not through special food or costly medicines, but by equipping mothers with the right skills in breastfeeding and complementary feeding,” says Dalal. She argues that instead of pouring resources into large-scale programmes, training communities in proper feeding techniques itself yields lasting results. “Once a mother learns correctly, she teaches others. That was our tradition―mothers guiding mothers. Reviving it can ease the burden on health care workers,” she adds.
System demands a reboot
Vinay, 43, a project manager with a German multinational engineering firm, has been on combination drugs for high blood pressure for the past eight years. A former footballer, he recalls weighing under 70kg when he first entered the workforce, but his weight has hovered between 85kg and 88kg for several years now. After being diagnosed with high BP and cholesterol, he consulted three doctors, as the initial medications didn’t stabilise his condition.
“When I was first diagnosed, I assumed it was because of my nonvegetarian diet, especially during my frequent work trips to Germany,” he says. “But in hindsight, I think my typical diet, which is high in cereals and oil and a lot of processed food, might have played a role, too.”
Despite this, Vinay says, except for one, no doctor places much emphasis on dietary changes. He now worries he might have grown too dependent on medication. “I did try following some diet plans on my own for a while, but they didn’t stick,” he admits.
Ensuring a proper diet to maintain a healthy BMI and waist-to-hip ratio is just as important as taking medication for noncommunicable lifestyle diseases, says Dr Deepak Padmanabhan, senior consultant―cardiac electrophysiology at Narayana Institute of Cardiac Sciences, Bengaluru.
“In India, whether vegetarian or nonvegetarian, a healthy diet should include adequate protein, followed by healthy fats and then carbohydrates―adjusted based on daily activity levels,” says Padmanabhan. “A reasonable protein intake target is 0.5g to 1g per kg of body weight per day. Fat intake should be moderate, with a preference for animal-derived fats (like ghee) over hydrogenated seed oils (like sunflower seed oil).”
A useful guideline is to reverse the current carbohydrate-to-pulses ratio in our meals, giving pulses more prominence, suggests Padmanabhan. “Adding locally sourced vegetables and curd can help curb hunger, especially when rationing energy-dense food,” he says. “Non-starchy vegetables also provide essential fibre for good digestion. This approach is entirely feasible in urban India, thanks to the wide availability of diverse, fresh ingredients. The key is to avoid processed and industrially altered foods.”
India's dietary traditions have drastically shifted in recent decades. Seasonal, diverse eating has declined, with most people now relying on just four to five food groups daily. For good health, nutrients should come from at least eight to 10 food groups a day, but dietary diversity is lacking, note experts. This shift has contributed to rising cases of NCDs, even among youth and farming communities.
A stark example is Attappadi, a tribal taluk in Kerala’s Palakkad district. In 2023, a comprehensive ICMR-NIN nutrition survey revealed alarming malnutrition across all age groups despite government interventions like public distribution system (PDS), community kitchens, free shelter and maternal cash transfers. Attappadi’s 48.3 per cent of tribal children were underweight, over 40 per cent were stunted, and anaemia was rampant among adolescent girls (96.6 per cent), pregnant women (86.8 per cent) and lactating mothers (80 per cent). The investigation led by Dr N. Arlappa from the Division of Public Health Nutrition of ICMR-NIN connects these numbers with the decline in traditional crop cultivation and the tribal people's reduced access to the wild food environment. Tribal communities in Attappadi traditionally grew millets, pulses and oilseeds such as maize, ragi, little millet, red gram and groundnut. However, most of the contemporary tribal population stopped cultivating crops due to less yield, animal attacks and the PDS. And, the food of the tribals became completely dependent on PDS and the open market.
“We found that the traditional cultivation of millets, pulses, oilseeds and collection of forest resources have fallen to the level that they no more provide any income and nutrition security to the tribal population in Attappadi. Although different varieties of indigenous leafy vegetables and fruits were observed in the area, consumption was meagre,” the study said.
The crisis in Attappadi is not isolated―it reflects a broader, systemic issue. Dr Sreejith N. Kumar, a leading endocrinologist who combines diet interventions, exercise and behavioural therapy to treat NCDs including diabetes and to achieve remission, told THE WEEK that India’s food system is fundamentally broken.
“If five people in a city get diarrhoea, you check the food stall. But if everyone does, you check the water supply. Likewise, if every household has heart disease, it’s not just because of personal choices―it is a societal failure,” says Kumar. “It is because harmful lifestyle has become the norm. That is why NCDs are everywhere.”
Kumar emphasises that the solution must come from the top, as only governments and systemic interventions can drive meaningful societal change. “Trying to change individual habits without structural reform is like building a brick wall in the sea―pointless against a much larger crisis,” he says. Kumar says that important systemic changes must come through legislation and the PDS should play a central role in this shift. “The PDS still distributes items like palm oil and sugar, reflecting a model designed 50 to 70 years ago,” he says. “Vegetables and fruits, essential for health, are not included in any PDS scheme. This needs urgent reform, especially as malnutrition remains a major issue among poorer populations. It is high time we reimagine the PDS to include vegetables through legal provisions, targeted incentives and subsidies.”
The 2024 ICMR guidelines reflect a significant step forward, according to Kumar. “For the first time, the ‘My Plate for the Day’ model was featured on the cover, recommending that cereals make up no more than 45 per cent of daily energy intake―a bold, long-overdue directive for the entire country,” he says.
Hemalatha is credited with creating the ‘My Plate for the Day’ guidelines, designed to suit a 2,000kcal diet and reflect the dietary needs of India’s diverse population. The model emphasises variety, recommending nutrients from at least 10 food groups. Half the plate should consist of vegetables, fruits, leafy greens, tubers and roots, while the remaining portion includes cereals or millets, followed by pulses, nuts and oils.
The plate was shaped by three key principles: nutritional adequacy, disease prevention and affordability. It was grounded in rigorous scientific research and a critical review of local dietary patterns. “That’s why we excluded exotic food and focused on locally available, seasonal produce,” explains Hemalatha, noting that western guidelines weren’t directly applicable. “This visual model helps individuals quickly assess their meals by dividing food into four main groups,” she explains. “By comparing their plate to this guide, people can easily spot what’s missing―like vegetables, nuts, or seeds―and recognise excesses, such as refined carbs, extracted fats or processed food.”
Kumar’s intervention strategy for diabetic patients, too, includes a food plate model and the slogan “Plate il paathi pachakkari (Half the plate should be vegetables)’. His programme called the Structured Lifestyle Intervention Method developed in 2018 combines strict calorie control―limiting intake to 1,000–1,400 calories a day―with reduced carbohydrate consumption, increased physical activity, regular exercise and behavioural modifications.
In May 2024, new Dietary Guidelines for Indians, developed under Hemalatha’s leadership, was released, which offers science-based recommendations to help individuals make informed food choices that promote overall health and prevent nutrition-related diseases. “Designed as practical tools for the public, the guidelines provide clear advice on balanced eating, portion sizes and nutrient needs across different life stages,” she says. “At a time when rates of obesity and NCDs are rising, these guidelines represent a key contribution to preventive health care in India.”
Moreover, the Food Safety and Standards Authority of India has proposed an amendment to introduce a health star rating system in its draft regulations for front package labelling on food products. The Supreme Court recently directed an expert committee constituted by the FSSAI to submit its report on the same.
Kumar says that while overhauling the current food system is essential, the government must also encourage physical activity by investing in infrastructure like cycling paths, playgrounds and parks.
“Today, people demand dialysis and angioplasty centres, and politicians boast about bringing more hospitals to their constituencies,” he says. “But the real demand should be for playgrounds, cycling tracks and access to nutritious food. It is time the country shifts toward a more organised and preventive approach to health.”
What to eat
Diet plays a crucial role in overall health and wellbeing, especially in a country like India where both under-nutrition and lifestyle-related diseases coexist. The latest guidelines by the Indian Council for Medical Research encourage the following for heathy eating:
Eat lots of veggies: Try to include fresh, non-starchy vegetables and leafy greens in every meal. Also, have around 30 grams of fruit with each meal.
Choose whole grains: Make sure at least half the grains you eat (like rice, wheat or millets) are whole or only lightly processed, as they are packed with nutrients and fibre.
Pair grains with pulses: When eating foods like rice or millets, add some pulses (like lentils or beans) to get better protein and more fibre.
Include healthy fats: Eat enough nuts, seeds and fatty fish for good fats, but keep your cooking oil use limited to about 25–30 grams a day.
Eat 2–3 meals a day: Try not to eat too often. Stick to two or three main meals.
Skip junk food: Stay away from ultra-processed food and anything too high in fat, sugar or salt.
Cut down on sugar: Avoid sugary food or limit sugar intake to 20–25 grams a day if you are an adult.
Don’t snack too much: Try not to eat in between meals, and if you do, go for healthy drinks like water, herbal tea or fresh fruit juice without added sugar.
Dr Vijaya Sarathi, professor and head, department of endocrinology, Vydehi Institute of Medical Sciences and Research Centre, Bengaluru