"When I was growing up, lunch at our home usually consisted of seasonal vegetables cooked with or without meat,” says Amina, a housewife living in Islamabad. “Occasionally there would be mutton or chicken curry. But lunch was always served with chapatis or parathas. At night, the same curry would be served with plain boiled rice and yoghurt. Chapati during lunch and boiled white rice at night were a habit so ingrained in me that I have been serving the same menu to my family for the past 14 years. Occasionally, when we have steak or fish with sautéed vegetables without roti or rice, my in-laws feel somewhat dissatisfied with these meals and think that I am starving my kids.”

Grains are considered to be the most substantial part of our everyday meals. They provide key nutrients and hence help prevent malnutrition. Being low in calorie density, they help prevent excess body fat. They can help decrease our risk for chronic diseases such as cancer, heart disease and diabetes.

Including the right kind of grain in our diet can make a big difference in the amount of calories, carbohydrates, fibre and other important nutrients we consume on a daily basis. For example, one cup of white rice contains 242 calories, less than one gm of fat, 53 gm of carbs and 4.4 gm of protein. One serving of chapati, contains 202 calories, five grams of fat, of which 1.3 gm are saturated, 31.5 gm of carbs and about 7.7 gm of protein. Brown rice on the other hand, contains 218 calories, 4.5 gm of protein, 45.8 gm of carbohydrate and 1.6 gm of fat. Brown rice is a much richer source of magnesium, fibre and zinc than compared to the white, polished variety.

Does increasing our intake of grains build a healthy diet or not?

But somehow eating wholewheat, bran or brown rice is associated with fussy eaters who obsess unnaturally about calories and carbs. In our homes, most of our dishes are rice-based (boiled plain rice, khichri, pulao, biryani, zarda and gur walay chawal) or wheat-based such as parathas drenched in desi ghee or slathered with butter, either consumed plain or with some filling like boiled potatoes, minced meat or vegetable. But while people of our older generations could easily have two to three parathas with a glass of salty lassi, our younger generation cannot seem to digest this food.

Men and women in their early 30s suffer from high cholesterol and acidity, waistlines are expanding and health problems such as diabetes and hypertension are beginning to raise their ugly heads much too soon and too often. It is because our lifestyle is becoming very sedentary. The concept of walking or cycling to work and school has faded away, as most people opt to buy motorcycles or cars. And the concept of eating a healthy salad for lunch or having baked chicken or grilled fish for dinner doesn’t cross our minds.

“My in-laws eat freshly cooked meals at both lunch and dinner times. They do not like food which has been refrigerated,” says Rabia, a housewife in Lahore. “Though doctors have asked them to cut down red meat to control cholesterol, uric acid and high blood pressure, they insist on eating vegetables such as ladyfingers, lauki, bitter gourd, apple gourd (tinday) and kachnaar with meat and chapati. Our Sunday brunches consist of food such as paaya, khaggay and mutton brain masala or mince-meat naan.”

“When it comes to feeding my family, grilled fish, sautéed vegetables or baked chicken do not stand a chance, nor does poultry farm chicken,” she adds with a laugh. “The children have this reckless ‘You Only Live Once’ approach to life and insist on eating all foods that appeal to their taste buds which may or may not have any nutritional value. It is quite a struggle to make them eat food with just nutrition in mind and, to be honest, it is not a priority in my household anyway. When it comes to meals, adults have their own fixed preferences and children enjoy pasta, pizza, burgers, fried stuff and Chinese food.”

“Meals on our table are still very traditional with some additional entrees as people are adventurous with food these days. Normally lentils and curry with rice and chapati are served and sometimes pasta and sandwiches,” says Fatima. “There is more awareness today about food groups and calories but, at the same time, I believe we are not eating any healthier. This is because of easy availability of junk food and refined products. Our elders are open to alternate food options but very rarely, so traditional meals still persist.”

Anisa, a mother of four who lives with her in-laws, also says that her family sticks to cooking traditional Pakistani meals. Chapati is served for both lunch and dinner with entrees consisting of seasonal vegetables with mutton, pulses and rice-based dishes. “There is definitely more awareness about various nutrients and food groups but our food choices remain the same. Even fruit, vegetables and milk aren’t healthy because of their exposure to various toxins due to pesticides and hormones, respectively. I think meals today have become very lavish and most of the meat and dairy products are processed and inorganic. We have unnecessarily added many side dishes as part of our daily food. Sadly, salads and grilled food are considered good starters and side dishes but not accepted as main meals.”

With so much information about carbs, calories and cholesterol, why isn’t this knowledge reflected in our lifestyle and food choices?

Mariam Khan, who holds a Masters degree in Food and Nutrition, says: “Lifestyle is a very vast term, encompassing our eating habits, food choices, activity levels, sleep patterns, etc. Our food choices and eating patterns are not in accordance with health standards if seen in light of the level of activity in which an average person indulges. We consume heavy meals such as halwa poori, biryani, nihari and barbeque, processed food (canned fruits, frozen meals, deli meat products) and refined products (white flour, sugar and white rice) instead of wholewheat flour and brown rice. Most urban adults just sit in front of computers in their homes and offices, use lifts and cars instead of taking the stairs or walking, watch TV for entertainment and play virtual games as an activity.

“So all this, along with our twisted routines of late-night work and sleeping through the day, takes a heavy toll on our health.” This results in emergence of various diseases, as well as lowering age levels for diseases which would previously appear only after 40 plus years. Diabetes and Polycystic Ovary Syndrome (PCOS) are very common now. Heart-related disease, hypertension, high cholesterol levels are on an increase. An alarming increase is seen in depression and anxiety disorder which are also connected to our unhealthy lifestyles, according to the nutritionist.

When asked if more awareness of various types of diets promoting low carb, high protein foods might make a difference, Khan, who is also a registered dietician of Pakistan Nutrition and Dietetic Society, says, “Every region in the world has its own staple foods. We can always opt for healthier options but we cannot completely alter our traditional or staple meals.

People get very enthusiastic about fad diets or certain foods which they consume as a miracle diet to lose weight. However, a low-carb diet isn’t always a good option as it has been associated with depression. Carbohydrates are the needed currency for our brain.. We need to consume good carbohydrates and try to burn them with exercise.”

Paleo diet is highly fashionable nowadays. Also called ‘the caveman’s diet’, it seeks to restrict dietary consumption to two major food groups — dairy and grains. “This is actually the diet of hunters and gatherers which allows consumption of fruits, vegetables, meat, fish and eggs,” says Khan. “Short-term weight loss is achieved but it cannot be sustained in the long-term because highly restricted menus make it difficult for dieters to keep themselves motivated for long periods. Also a typical Paleo diet puts people at risk for calcium and vitamin D deficiency. At the same time, saturated fats and protein can be consumed far above the recommended levels, increasing the risk of kidney and heart diseases and certain cancers. Lack of carbohydrates and over-reliance on fats for energy can cause problems such as lethargy and brain health issues as our brain requires carbohydrates for optimal functioning.”

When asked how we can balance expectations of family members when it comes to food with health concerns, Khan says, “It may seem like an ‘in’ thing to do but fad diets alter the nitty gritty of our lifestyles. A change in lifestyle needs a lot of motivation. People need to stop looking for magic spells or miracle foods to help them out. Instead they need to assess their dietary habits and sedentary lifestyle before they are pressurised by the doctors to do so. The cost of organic and wholewheat bread and flour needs to be in check, as refined flour, biscuits and rusks are cheaper and, hence, more affordable for people from low-income strata.”

The final advice from the nutrition coach: “Use grains in their whole form such as wholewheat, brown rice, oats, corn, barley, etc., and do not consume empty calories. Choose from all the food groups such as vegetables, pulses, meat, milk, grains and fruits to get all the nutrients needed for a healthy life. The most important thing is to stop the consumption of extra-refined foods. The average urban Pakistani family needs to go back to its kitchen, cook meals from scratch and throw away home-delivery menus.”

Fad diets are a multi-billion dollar business and we need to be wary of their aggressive and enticing marketing. What is one day being propagated as “the world’s healthiest diet” can, over a period of time, lead to nutrient deficiencies which can further exacerbate health problems. Rather than eliminating specific foods from the diet, we need to focus more on healthier options. The most important thing is to realise that a sedentary lifestyle, consumption of unhealthy and refined foods and factors such as stress play havoc with our health and the cure for these troubles lies in more home-cooked meals and a more active lifestyle. As the famous American journalist and author Michael Pollan said, “Don’t eat anything your grandmother wouldn’t recognise as food.”

Published in Dawn, EOS, April 22nd, 2018