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All is well — not!

When the price of many vegetables has gone above the price of chicken, what then can one recommend for a regular healthy diet to ordinary people?

All is well — not!

One of the conundrums about dietary recommendations in a country like Pakistan is cost of different food articles. Most physicians today would suggest a diet made up mostly of vegetables with meat and dairy products used to supplement the plant based foods. Of the meats, there exists some confusion but here again most doctors will suggest consuming an ‘oily’ fish at least twice a week and for the rest white meats and well-trimmed red meat as well as eggs are quite acceptable.

The idea is that meat and eggs should be mostly as side dishes rather than the primary meal. For carbohydrates, the most important idea is to avoid refined starches like white rice and white flour, and sugars. Whole wheat and other whole grains as well as lentils and beans are recommended.

Of course a recent quip by our now beleaguered finance minister about the rising price of lentils was in the same category as the probably apocryphal quote attributed to the soon to be beheaded French queen about eating cake if the poor have no bread to eat. Our finance minister when told that the price of lentils was too high for the poor to eat them suggested that the poor should eat chicken instead since that was now cheaper.

When the price of many vegetables including staples like tomatoes, onions, and of most lentils has gone above the price of chicken, what then can one recommend for a regular healthy diet to ordinary people in Pakistan including many of our middle class? As far as the price of fish is concerned that is already beyond the reach of most people.

For the last nine years we have been hearing about saaf pani (clean drinking water) campaign in the Punjab. But I suppose roads are more important than clean drinking water.

Before going any further, let me address the question of fat in diet. First is the question, how much. The answer to that question has moved around a bit over the last few decades. It became controversial because many doctors felt that dietary fat of animal origin was responsible for increasing the amount of fat (cholesterol) in the blood and this lead to increase in heart artery blockages leading to heart attacks. So doctors recommended that consumption of fatty foods and animal fats like butter should be decreased.

Many people cut down the amount of fat they ate but to assuage hunger they ate a lot more carbohydrates especially bread. As a result more people became overweight. Becoming overweight led to another series of medical problems including high blood pressure and high blood sugar (diabetes). And these two problems led to an increase in heart attacks. So newer ‘studies’ decided that fat in the diet wasn’t all bad and did not really lead to high cholesterol.

The short answer to the question about fat is that a marbled steak, bread heaped with butter and other such stuff are fine as long as you don’t eat it three times a day. And fats of vegetable origin are better than fats of animal origin. In other words, olive oil or canola oil is better than clarified butter (ghee) for regular use. I will try and address this controversy in detail another time.

So now back to the question of what to eat in Pakistan today without having the financial resources of our finance minister. Once again, vegetables or rather plants of different types should form the basis of most diets. First and foremost plants produce the volume or roughage that fills us up and keeps our intestines working and pushing stuff through. Besides that plants are a source of many different nutrients including all ‘water soluble’ vitamins. The reason why I use the word plants is to include vegetables as well as fruits.

Most vegetables are eaten after being cooked and most fruits are eaten raw. Rule of thumb. The more colourful a fruit or vegetable is, the more nutrients it packs. And of course eating raw things like cucumbers, radishes and carrots as well as many fruits provides different vitamins and micronutrients. And Popeye the Sailor (a cartoon fictional character) was not entirely wrong to extol the virtues of spinach. However, one important warning, all uncooked vegetables and fruits should be washed well with clean water before being consumed.

For protein chicken is about as good as it gets. So chicken is fine as a basic source of protein along with lentils, legumes and things like chickpeas. And occasional goat or lamb meat is also fine if it can be afforded. About chicken one important point. It must be cooked very well and entirely through and through to kill any bad bacteria that might be contaminating the meat.

For carbohydrates, whole grains like whole wheat are the best. But starchy vegetables like potatoes and yams (shakarkandi) are also recommended. The one thing that should be avoided or consumed as little as possible is sugar and drinks made with corn syrup. Sweets like laddoos and gulab jamans and cakes should also be consumed as rarely as possible. Fortunately, a majority of Pakistanis will find these goodies a bit too expensive for them to eat too often.

I have written in the past about the importance of micronutrients or minerals that the body needs besides the vitamins. Here again a varied diet based on different vegetables, fruits, dairy products, eggs and meat will adequately make up for most micronutrients and vitamins. For pregnant women, folic acid and iron are important and might need to be provided as supplements though spinach is a good source for them.

Milk like fat keeps going in and out of favour among the medical community. Milk is an excellent balanced source of nutrition. And there is nothing wrong with consuming whole milk. Of course milk should not become the only source of fluids and it should be pasteurised or boiled before being consumed so that any bad bacteria in it might be killed. Pasteurisation of milk (heating it up to just below boiling point) was an important step to cut down the transmission of ‘bovine tuberculosis’ from cows to humans.

And that brings me to water. Clean water is one of the basic foods. As is well known, if we don’t have water to drink, we tend to die. But sadly drinking contaminated water can also make us die. For the last nine years we have been hearing about saaf pani (clean drinking water) campaign in the Punjab. But I suppose roads are more important than clean drinking water. Politics aside, an average adult requires roughly one and a half litres of water in a day. This requirement goes up dramatically in hot weather and after strenuous physical activity or work.

About some particular nutrients. Vitamin D is vital for proper bone growth and strength. The body will synthesise this vitamin when exposed to sunlight. Sadly too many in our population are deprived of sunshine due to social and religious reasons. So added Vitamin D in foods like milk is a good idea. The other nutrient that is important for is Iodine. As a medical student ‘goiter’ or enlarged thyroid gland due to Iodine deficiency was a common sight. With Iodine added to salt this problem has almost disappeared. Finally, eating at home is better than eating out. 

Syed Mansoor Hussain

syed mansoor hussain
The author served as professor and chairman, department of cardiac surgery, King Edward Medical University.

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