The Global Burden of Disease Report for 2019 starkly highlights the alarming reality that unhealthy eating stands as the leading cause of deaths worldwide. With the ongoing Decade of Action on Nutrition (2016-2025), it is crucial that we address this issue and prioritise our dietary choices. This initiative aims to combat chronic, non-communicable diseases such as heart ailments and cancer by encouraging small dietary changes. Optimal calorie intake is of utmost importance as it plays a central role in promoting vibrant health and well-being for both individuals and communities.
Interview with Dr. Meghana Pasi, nutrition consultant at MyThali, a program by Arogya World
What is the importance of the right amount of calories in a healthy diet?
It is crucial for maintaining overall health and well-being. Calories are units of energy that our body requires to carry out various functions, from metabolic processes to physical activity. When the calories consumed are more than the calories spent, the human body stores excess energy as fat and the risk of developing diseases like obesity, diabetes, and heart disease may rise. If the calories burnt are more than the calories consumed, or if the consumption of calories is not optimal for that age and height then it can lead to underweight and undernutrition. One must note that our energy and nutrient requirements do not remain the same all through life. They vary with age, gender, physiological status and physical activity. Just to list a few reasons which make an optimal calorie intake essential- better metabolic health; helps manage weight; keeps one productive all day long; crucial for maintaining muscles (also when losing weight); helps better cognitive function and hormone balance; and is essential for various bodily functions like appetite control, mood regulation and reproductive health.
Are all calories equal in quality?
While calories provide energy, it's equally important to focus on the quality of the calories we consume. Hence, the calories should come from a variety of foods from different food groups in the required amounts which can provide our body all the essential nutrients like proteins, healthy fats, minerals, vitamins, fibers and antioxidants.
What is the role of water in a healthy diet?
Water is essential for life. 70% of our body weight is comprised of water. It is a constituent of blood and other essential bodily fluids. Fluid losses occurs continuously, from skin evaporation, breathing, urine and stool, and these losses must be replaced daily for good health.
We need water (at least 8 glasses a day) and other fluids to stay hydrated; for digestion and nutrient absorption; for blood circulation and maintaining blood volume; for proper functioning of the kidney; to improve exercise performance; for good skin and for weight management.
What are the other important liquids besides water that we must consume?
It is important to choose a variety of healthy liquids besides water such as herbal teas, milk, coconut water, nimbupani (lime water), buttermilk, fresh fruit juices, soups and avoid sugary beverages. Remember that individual hydration needs can vary based on factors like age, activity level, climate, and health conditions. Pay attention to your body's signals and try to drink fluids throughout the day to maintain optimal hydration.
What is the role of nutrition in reversing prediabetes and lowering blood sugar levels?
Blood glucose levels that are above normal but below those of diabetes are generally considered to be prediabetes. When prediabetes is not recognized and treated at an early stage, it progresses to Type 2 diabetes. According to WHO, prediabetes can be identified through impaired fasting glucose (IFG), fasting plasma glucose, impaired glucose tolerance (IGT), and glycated hemoglobin A1c (HbA1c). According to the International Diabetes Federation, 461 million people worldwide will have prediabetes by 2035.
Lifestyle modifications, including dietary changes, can have a significant impact on managing prediabetes and preventing its progression to Type 2 diabetes. A recent study funded by ICMR found that a minor reduction in carbohydrate intake combined with an increase in protein and good fats can help prevent the progression of diabetes. Choosing complex carbohydrates with a low glycemic index (GI) can help stabilize blood sugar levels. Foods like whole grains, legumes, vegetables, and fruits release sugar into the bloodstream more gradually, preventing rapid spikes in blood sugar. Further, including lean sources of protein, such as poultry, fish, tofu, and legumes, can help prevent rapid rises in blood sugar after meals and contribute to satiety. As for healthy fats, such as those found in avocados, nuts, seeds, and olive oil can support blood sugar control and improve insulin sensitivity.
Could you break that down further?
There are certain things one should be mindful of. Managing portion size can help control calorie intake, prevent overconsumption of carbohydrates, support weight management and in turn regulate blood sugar levels. Consumption of high fiber foods can slow down the absorption of glucose and help improve blood sugar control. Foods like oats, beans, lentils, vegetables, and fruits are rich in fiber and can be beneficial for people with prediabetes. Reducing or eliminating foods high in sugars is crucial for managing blood sugar levels. Sugary foods and drinks can cause rapid spikes in blood sugar and contribute to insulin resistance. Eating consistently throughout the day and avoiding prolonged periods of fasting can help maintain more stable blood sugar levels.
What are the benefits of an excessively raw diet?
A raw diet, also known as a raw food diet, is a dietary approach that involves consuming foods in their natural, uncooked state. This diet primarily consists of raw fruits, vegetables, nuts, seeds, sprouts and dairy. The thought here is that cooking and processing foods can destroy valuable enzymes, vitamins, and nutrients, and consuming foods in their raw state preserves their nutritional value.
A raw food diet might improve heart health as fruits and vegetables are known to lower blood pressure and decrease the risk of heart disease and stroke. It also aids in weight loss as uncooked foods are low in calories and fats compared to cooked food. Cutting out carbs, sugars and fats from the diet can help prevent weight gain. The diet might also reduce the risk of diabetes because of the presence of fibers; it aids weight loss; improves digestion and aids hydration.
What about the drawbacks?
It might lead to nutritional imbalance. A strict raw diet may lack certain nutrients like proteins, calcium, iron, Vit B12, omega-3 fatty acids. Nutritional deficiencies could arise if not carefully planned. It may lead to food poisoning as raw foods can carry a higher risk of foodborne illnesses due to the absence of cooking, which kills potentially harmful bacteria. It may also weaken muscles and bones as raw diets might not provide adequate calcium and protein. Such a diet might also lead to digestive disorders. While some individuals experience improved digestion, others may find raw foods difficult to digest, leading to bloating, gas, and other gastrointestinal issues. It might also lead to reduced nutrient absorption. While some enzymes are preserved in raw foods, cooking can actually enhance the bioavailability of certain nutrients, making them easier for the body to absorb.
Tell us about some studies which have established the positive links between healthy diets and non-communicable diseases (NCDs).
Numerous studies have established positive links between diet and non-communicable diseases (NCDs) such as heart disease, diabetes, obesity, and certain types of cancer.
One such large study was conducted by ICMR and MDRF called INDIAB from 2008 to 2020 in 31 states of India (covering 113,000 participants) to find the prevalence of NCDs among Indians. The results revealed an alarming national prevalence of diabetes at 11.4%, prediabetes 15.3%, hypertension 35.5%, generalized obesity 28.6%, abdominal obesity 39.5%, hypercholesterolemia 24% and high LDL cholesterol at 20.9%. It also reported that the diabetes epidemic is in transition, with some states having already reached their peak rates while others are just getting started. The prevalence of all NCDs was reported higher among urban areas compared to rural counterparts and this could be attributed to the unhealthy lifestyle practices reported among the urban Indians. The intake of protective foods like fruits and vegetables was very poor and accompanied by a sedentary lifestyle. The study report concluded by asking the state governments to focus on prevention and screening programs and promote nutrition education urging people to adopt a healthy lifestyle eating healthy, exercising and quitting smoking and alcohol.
Given the increasing evidence of diet-related health burdens and the rising prevalence of NCDs among Indian adults, another study was carried out to explore dietary diversity patterns among adult men in India and their association with NCDs. The study used the fourth round of the NFHS-4 to analyze adult male samples (1,12,122). Dietary Diversity Scores (DDS) were computed by the weighted sum of the number of different food groups consumed by an individual. The study highlighted that certain types of food and frequency of food consumption were significantly associated with the prevalence of NCDs. Men who never consumed milk /curd, pulses/beans, dark green leafy vegetables, and fruits in a month reported the highest prevalence of coronary heart disease and cancer. At the same time, those who consumed meat and poultry everyday also showed significantly higher associations with all three non-communicable diseases. Hence, it was concluded that optimum and balanced nutrition from foods such as pulses/beans, vegetables/fruits, milk/dairy in the diet are essential to prevent NCDs.