General Diet/Summary   •   Nutrition Facts   •   Possible Deficiencies   •   Common Foods   •   Meal Patterns   •  Transition Foods   •  Recipes   •  Resources

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India

General Diet/Summary:

Describing Indian cuisine is difficult due to the diverse geography and population of the country. A generalized view of the Indian diet includes long-grain rice, wheat, legumes in the form of dried beans, peas and lentils (Dal, also called pulses), fermented dairy products, clarified butter (ghee), and distinctive seasonings used to make masalas or curries. The greatest differences in diet exist between southern and northern India. Southern cuisine is best known for “wet,” spicy-hot seasoning blends, and the dietary fundamentals include rice, coffee, fresh pickles, chutney, seasoned yogurt dishes (pachadi), coconut milk, and fresh fruits and veggies. Deep fried, salty foods and sweets are favorite snacks in the South. Northern food preferences are characterized by the use of wheat to make bread called roti (examples include naan, chapatis, puris), tea, eggs, garlic, yogurt raytas, dried or pickled fruits and vegetables, and use of dry spice blends that are aromatic rather than spicy. The special method of tandoori cooking originates in the North but has been popularized throughout the nation and beyond by specialty restaurants.

Many Asian Indians follow a vegetarian diet that includes consumption of milk products, although the definition of vegetarian is varied depending on geographical region, religion, and availability of food. For example, pork is eaten in some western communities, lamb and beef are eaten in the north, and fish and poultry are consumed in coastal areas. Avoidance of meat and poultry is most common, but some people may also exclude eggs and fish.

A discussion of Indian dietary practices is not complete without understanding a little bit about the long history of traditional medicine in India, the most important of which is Ayurvedic medicine. The purpose of Ayurvedic medicine is to ensure a long and active life through the use of diet and other therapies to restore and maintain balance. According to Ayurvedic belief, a person’s preference for food is determined at birth. Foods are classified as hot or cold, and six tastes and five textures are balanced in a traditional Indian meal. To aid digestion of foods, a person should eat in a quiet atmosphere, sip warm water throughout the meal, and sit for a short while after dining.

Depending on life stage, certain food taboos may be followed. For example, rice porridge and cow’s milk with almonds and saffron eaten during pregnancy is thought to ensure proper development of the fetus. It is common practice to avoid breast feeding colostrum to newborns due to various concerns. Prelacteal feeds during this period might consist of honey and water with sugar and seasonings, which could result in poor health outcomes for the baby. Additionally, some Indian mothers have the following beliefs about feeding infants and young children: spicy foods and mangoes cause diarrhea, bananas cause colds, and fried foods are difficult to digest and are the source of coughs. One common practice that may cause illness is disguising undrinkable water with flavorful herbs and spices. Cholera, dysentery, and typhoid are endemic in many regions of India.

Another important aspect of Indian culture that affects daily culture is the practice of feasting and fasting. No special occasion passes without some special food observance. Incredibly, a devout Hindu may feast or fast nearly every day of the year! Feasts are a method of food distribution throughout the community and may be the only time that the poor get enough to eat. Fasting may be avoidance of a single food or of all foods. However, individuals rarely suffer from hunger on fasting days, and sometimes more food may be consumed on fast days than on non-fast days.

Nutrition Facts:

Overall, the Indian diet provides all of the essential nutrients. However, the diet in Indian orphanages is often not nutritionally adequate, which can lead to nutrient deficiencies and inadequate growth. The common diet in an Indian orphanage consists mainly of cereals with small quantities of pulses and vegetables and limited or no provision of milk and milk products, leafy vegetables, fats and oils, and fruits.

Possible Deficiencies:

• Folate – Folate is needed for making DNA in new cells. It is also critical for spinal cord and brain development in embryos. Folate contributes to heart health because it disposes of homocysteine, an amino acid that may lead to heart disease.

• Iodine – Iodine is needed for production of thyroid hormone. Deficiency of iodine can lead to development of an enlarged thyroid called a goiter, hypothyroidism, and mental retardation in children whose mothers were iodine deficient during pregnancy.

• Iron – Iron is necessary for oxygen delivery to cells and regulation of cell growth. Iron deficiency develops gradually and is commonly seen in women of childbearing age and children. A lack of iron results in an insufficient supply of oxygen to cells eventually causing anemia, fatigue, poor work performance, slow cognitive and social development in children, and decreased immunity. More than 75% of toddlers in India are anemic.

• Vitamin A - Vitamin A plays a critical role in healthy vision, growth and development, and immune function. Vitamin A deficiency is common in developing countries and is often accompanied by zinc deficiency. Symptoms of deficiency include blindness, diminished ability to fight infections, decreased growth rate, and slow bone development. Vitamin A helps mobilize iron from its storage sites, so a deficiency of vitamin A limits the body’s ability to use stored iron. This results in an “apparent” iron deficiency because iron levels in the blood are low even though body stores are normal. In India, vitamin A deficiency may be more prevalent in children on vegetarian diets.

• Vitamin B12 – Vitamin B12 is involved in energy production as well as converting the inactive form of folate to its active form. Without adequate vitamin B12, folate deficiency symptoms appear. Thus, vitamin B12 deficiency can cause secondary folate deficiency.

• Vitamin D – Vitamin D is needed for calcium absorption and maintenance of calcium levels to enable normal development of bones and prevent muscular spasms caused by low levels of calcium in the blood. A poor diet and lack of exposure to sunlight can result in vitamin D deficiency. A deficiency in childhood can result in development of the disease Rickets in which bones become soft, thin, brittle, or misshapen. Due to lack of exposure to sunlight and darker skin tone, Asian Indians are often deficient in vitamin D.

• Zinc – Zinc is involved in many important processes in the body. Symptoms of zinc deficiency include delayed growth, loss of appetite, impaired immune function, hair loss, diarrhea, delayed sexual maturation, eye and skin lesions, delayed wound healing, taste abnormalities, and mental fatigue.

Common Foods:

• Milk/Milk products – fresh cow’s, buffalo’s, donkey’s milk; evaporated milk; fermented milk products (yogurt); fresh curds; fresh cheese (paneer); milk-based desserts

• Meat/Poultry/Fish – beef, goat, mutton, pork, chicken, duck, carp, clams, crab, herring, lobster, mackerel, mullet, pomfret, sardines, shrimp, sole, turtle

• Eggs/Legumes – chicken eggs; beans (kidney, mung, etc.), chickpeas, lentils (many varieties), peas (black-eyed, green)

• Cereals/Grains – rice, wheat, buckwheat, corn, millet, sorghum

• Fruits – apples, apricots, avocados, bananas, coconut, dates, figs, grapes, guava, jackfruit, limes, lychee, mangoes, melon, oranges, papaya, peaches, pears, persimmons, pineapple, pomegranate, pomelos, starfruit, strawberries, tangerines, watermelon (there are more than 100 types of fruit commonly used in India)

• Vegetables – amaranth, artichokes, bamboo shoots, beets, bitter melon, Brussels sprouts, cabbage, carrots, cauliflower, collard greens, corn, cucumber, eggplant, lettuce, lotus root, manioc, mushrooms, mustard greens, okra, onions, parsnips, potatoes, pumpkin, radishes, rhubarb, scallions, spinach, sweet potatoes, tomatoes, turnips, yams, water chestnuts (there are more than 200 types of vegetables commonly used in India)

• Seasonings – ajwain, amchoor, asafetida, bay leaf, cardamom, chiles, cinnamon, cloves, coriander, cumin, dill, fennel, fenugreek, garlic, kewra, lemon, mace, mint, mustard, nutmeg, pepper, poppy seeds, rose water, saffron, tamarind, tumeric

• Nuts/Seeds – almonds, betel nuts and leaves, cashews, peanuts, pistachios, sunflower seeds, walnuts

• Beverages – coffee, tea, water flavored with fruit syrups, sugar cane, spices or herbs

• Fats/Oils – coconut oil, ghee, mustard oil, peanut oil, sesame oil, sunflower oil

• Sweeteners – sugar cane, unrefined palm sugar (jaggery), molasses

Meal Patterns:

Asian Indians typically eat two full meals with substantial snacks. Only the right hand is used in dining, which is done with utensils or with just the fingers. Breakfast includes rice or bread, a pickled fruit or vegetable, and a dal dish. Snacks consist of similar foods or snack items and are consumed with coffee or tea. A meal is not considered a true meal unless the traditional staple is prepared in the traditional manner, such as boiled rice in the South and roti in the North. As such, even if a snack contains more food than a meal, it is still considered tiffin, the word used to distinguish a snack from a meal. Dinner is the main meal of the day and usually includes at least one rice dish; a curried vegetable, legume or meat dish; a vegetable legume side dish; a baked or fried bread; a fruit or vegetable pickle; and a yogurt rayta or pachadi. When dessert is served, it is usually fruit. The most common beverages consumed with meals are water, buttermilk, and milk. Sugarcane juice, fruit juice and soda are popular drinks in urban areas. All courses of the meal are placed on the table all at once. Typically, an individual will receive a serving of rice or breads surrounded by a selection of the other foods. The meal is completed with the passing of paan, a combination of betel nuts and spices like cardamom and clove to freshen the breath and aid digestion.

Food is revered in India, and many complex traditions have developed around food preparation and consumption. Purity of food (as in how ingredients are prepared, who prepares them, and how they are served) is a very important concept. Foods that are considered polluted should be avoided or made to be more pure. An Indian woman’s primary household duty is to feed the family, from procurement of ingredients to serving of all meals, for it is believed she imparts a special sweetness to the food. Hospitality is highly valued, and guests are served first at mealtime. Food being served to others is never touched with the hand, and diners are expected to fill their neighbor’s glass but never their own.

Transition Foods

The transition diet is one you develop to help bridge the gap between your child’s native diet and what eventually will become his or her regular diet at home. The transition diet often includes recipes and foods from the native diet. A good way to start the transition process is to ask exactly what foods your child ate in the orphanage or foster home, using that as a base for your cooking at home. As one parent put it, “I would encourage all parents to adapt the foods they present to mimic what the child had at the orphanage during the first months home. It is an easy adaptation that parents can make to create a more familiar environment during what can be a hard transition.” It may also be helpful to watch the caregivers feed your child at least one meal before returning home. Simple things such as the temperature or texture of foods may be important to your child. One mother wrote, “Our daughter was on formula at the orphanage but they gave it to her very, very hot. It took us a while to realize she wanted everything HOT and would cry hysterically if it wasn’t hot.” Even if you don’t know exactly what your child ate previously, incorporating native foods into his or her diet is a great way to help your child transition to a new culture, as well as preserve traditions from his or her first culture.

Rice and curry are great transition foods for Indian children, as are potatoes, chicken, and food cooked with other Indian spices (try bringing back some interesting spices from your trip to India). One parent said that her child loved to eat out at Indian restaurants and another noted, “We have definitely kept at least one Indian meal a day in his diet to make sure he eats one thing he recognizes each day.”

Lactose intolerance and a general dislike of dairy are common nutritional problems cited by parents who adopted Indian children.

Resources:

• Kittler PG, Sucher KP (2008). Food and culture, Fifth Edition. Belmont, CA: Thomson Wadworth.

• Babu US and Calvo MS. Modern India and the vitamin D dilemma: evidence for the need of a national food fortification program. Mol Nutr Food Res 2010; 54(8): 1134-47. Review.

• Chakravarty I and Sinha RK. Prevalence of micronutrient deficiency based on results obtained from the national pilot program on control of micronutrient malnutrition. Nutr Rev 2002; 60(5 Pt 2): S53-8.

• Chow J, Klein EY, and Laxminarayan R. Cost-effectiveness of “golden mustard” for treating vitamin A deficiency in India. PLos One 2010; 5(8):e12046.

• Deshmukh US, Joglekar CV, Lubree HG, et al. Effect of physiological doses of oral vitamin B12 on plasma homocystein: a randomized, placebo-controlled, double-blind trial in India. Eur J Clin Nutr 2010; 64(5): 495-502.

• Kapil U, Singh P, Dwivedi SN, et al. Status of iodine nutriture and universal salt iodisation at beneficiaries levels in Kerala State, India. J Indian Med Assoc 2006; 104(4): 165-7.

• Khadilkar AV, Sayyad MG, Sanwalka NJ, et al. Vitamin D supplementation and bone mass accrual in underprivileged adolescent Indian girls. Asia Pac J Clin Nutr 2010; 19(4): 465-72.

• Khan S, Sankhla A, and Dashora PK. Nutritional adequacy of boys in orphanages. Indian Pediatr 1996; 33(3): 226-8.

• Maliye CH, Deshmukh P, Gupta S, et al. Nutrient intake amongst rural adolescent girls of Wardha. Indian J Community Med 2010; 35(3): 400-2.

• Osei A, Houser R, Bulusu S, et al. Nutritional status of primary schoolchildren in Garhwali Himilayan villages of India. Food Nutr Bull 2010; 31(2): 221-33.

• Osei AK, Rosenberg IH, Houser RF, et al. Community-level micronutrient fortification of school lunch meals improved vitamin A, folate, and iron status of schoolchildren in Himalayan villages of India. J Nutr 2010; 140(6): 1146-54.

• Pal R and Sagar V. Correlates of vitamin A deficiency among Indian rural preschool-age children. Eur J Ophthamol 2007; 17(6): 1007-9.

• Pasricha SR, Black J, Muthayya S, et al. Determinants of anemia among young children in rural India. Pediatrics 2010; 126(1):e140-9.

• Thankachan P, Muthayya S, Sierksma A, et al. Helicobacter pylori infection does not influence the efficacy of iron and vitamin B(12) fortification in marginally nourished Indian children. Eur J Clin Nutr 2010; 64(10): 1101-7.

• Tielsch JM, Rahmathullah L, Katz J, et al. Maternal night blindness during pregnancy is associated with low birthweight, morbidity, and poor growth in South India. J Nutr 2008; 138(4): 787-92.

• Tupe R and Chiplonkar SA. Diet patterns of lactovegetarian adolescent girls: need for devising recipes with high zinc bioavailability. Nutrition 2010; 26(4): 390-8