India: Health amarjhansi

 The title of this post is a play on words that might need a little explanation. "Amarjhansi" is a phonetic expression of the way people from the Hindi belt pronounce the word "emergency", as in "Indira Gandhi wonly declared it amarjhansi!". But my synthetic compound word amar-jhansi also has meaning. Amar means ever, always, eternal, immortal. Jhansi is the name of a town in Uttar Pradesh which has roots in a word which translates to "vague", ethereal, indistinct or tenuous. Put together, the title provides a delightful double-entendre for the content of this post.

 It's no secret that India is witnessing an unfolding of lifestyle diseases of epidemic and historically unprecedented dimensions. While most lifestyle diseases are placed in the context of affluence and leisure, in India they can affect- and are affecting- people who don't exactly fit the picture of affluence and leisure. Instead, these diseases, primarily diabetes and heart disease(and of course the associated side effects of kidney, liver and eye disease), are being boosted not by conventional lifestyle changes that come with what would be considered affluence, but by culturally-nurtured dietary preferences indulged to excess by increased income not actually amounting to wealth or affluence. Increasingly, these diseases will disproportionately impact the poorer sections, because the wealthy will be able to diagnose, treat or prevent them better, just as in the west. It is truly a paradox of our modern world that it is the poor who increasingly suffer from the diseases which historically primarily afflicted the indolent wealthy. As an aside, during Elizabethan times(circa 16th century AD), the wealthy suffered from blackened and rotting teeth because sugar was an expensive luxury only they could afford. No doubt they also suffered from undiagnosed Type 2 diabetes and related issues.

 Every Indian meal, whether breakfast, lunch, teatime snacks or dinner, has excessive amounts of any or all of the following: sugar, salt, fat, starch. Coffee and tea are usually consumed sickly-sweet and often with more milk than water. In those parts of the country which are predominantly vegetarian, the potential advantage of avoiding animal fat and cholesterol is negated by the liberal use of vegetable oils(some of them hydrogenated or rich in saturated fats) and frequently ghee, which brings all the ill-effects of meat consumption to the vegetarian in a delicious, aromatic, convenient and religiously-sanctioned form. Even steamed foods are frequently accompanied by unhealthy condiments. A staple Kerala breakfast is rice(sometimes brown rice or whole wheat) flour steamed in a cylinder, with grated coconut steamed along with it on either end of the cylinder. But it is typically eaten with mashed bananas, ghee and sugar. Another staple was steamed plantain eaten with- you guessed it- ghee and sugar. Rice, I found out recently, is cooked in salted water here, something I have never done in all the years I have cooked rice. The saving grace for the poor who lived on this cuisine was the fact that they could not afford as much sugar or oil as they would have liked. Indeed, they frequently could not afford as much food as they required- paradoxically shielding them from "lifestyle diseases"- and that is only gradually changing for some. But they are discovering, with the proliferation of cheap Indian fast food on the streets, that scanty doesn't have to mean tasteless, and are dousing their food with as much salt, sugar and fat as they can afford, although- mercifully for them- ghee is still out of reach.

 On a previous visit to India, I employed a cook, a young woman in her early 20s. While she had an acceptable repertoire of culinary abilities, her preparations had too much salt, sugar and fat for my tastes. So I asked her to dial it way back for me, if not for the rest of the household. I lectured her on the drawbacks of such a diet. She countered that the methods I preferred were tasteless and inedible. One day, she had to go to the doctor, and had her blood pressure taken. It turned out that it was way high(I remember it as being something like 200/100), especially considering her age. Of course, I tried to reinforce the health benefits of the food angle, and urged her to at least tone it down. Recently, through the grapevine of the domestics, I heard that she had gotten married, had a couple of miscarriages, then developed kidney and heart issues. Now, according to the grapevine, she has renal failure. And she's not yet 30 years old.

 wherever you walk in an Indian city, you are likely to encounter sweet shops around every corner. And if that isn't enough for your sweet tooth, most restaurants("hotels") and even ordinary hole-in-the-wall convenience stores will provide you with goodies made nearly of pure sugar. It seems to me that Indian sweets are essentially varieties of flavored sugar. So you will find sweetmeats that are basically almond-flavored sugar, milk-flavored sugar, ghee-flavored sugar, cardamom-flavored sugar and so on. Sometimes, they are topped or stuffed with something like nuts or shredded coconut flavored perhaps with cardamom, cloves and cinnamon, or soaked(of course!) in sugar syrup. One of my favorite Indian sweets is the rasagolla, a cottage-cheese ball soaked in sugar syrup. Another is the gulab jamoon, which is essentially a dough ball deep-fried and served(surprise!) with rosewater-flavored("gulab" means rose) sugar syrup. In the US, we get them with barely a teaspoon of syrup. In India, they are served with so much syrup that you need to put your goggles on and dive in to find the cheeseballs and, before you are done, colonies of ecstatic ants and bees are bucket-brigading the syrup away like the Little Rascals after Alfalfa accidentally set the clubhouse on fire.

 

One of Bangalore's ubiquitous sweetshops

 Of course, if your food cravings run to more than sweets, you can happily indulge in fatty and salty just as conveniently, virtually on every street in every city. We used to have a maxim back in the day that, in India, you could never go wrong with starting a restaurant. It seemed that restaurants never went out of business, they just sometimes went on to bigger and better. Nowadays, I do see some closures, but they are usually of the relatively more expensive or themed variety. Ordinary working-class joints do a roaring trade, serving hyper-fatted sodium-saturated foods that could transform a starving Somali child into the image of a supine bourgeoisie brat in fifteen minutes flat or your money back. Even the ubiquitous grilled kebabs contain enough fat to make your teeth feel like they are being coated with Teflon. I remember an Indian expression which said, to paraphrase, "He's so rich that if you squeeze his arm, ghee will ooze out of it!". The cultural association of a high-fat, high-sugar diet with affluence or an aspirational lifestyle is so strong that it permeates Indian cuisine across the board, making it that much more difficult to contain ill-effects with any rise in income.

 I believe that the Indian government could do a lot worse with their healthcare budget than launch a massive awareness and education program to fundamentally alter the way Indians look at and prepare their staple dishes. It wouldn't require changing the recipes so much as adjusting them, but it would mean altered judgement of what taste means. My sisters both cook Indian food low in salt, sugar and saturated fats, and turn out absolutely delicious meals. Indian proponents of the vegetarian lifestyle(who generally seem to have a one-point religious agenda: ban meat) trumpet the health advantages of vegetarianism, while blithely ignoring the reality of the health crisis sweeping through the vegetarian community. The current situation is like pressure building in a volcano, and when the volcano blows, the country will be ill-equipped to deal with the fallout. Two sayings come to mind: "A stitch in time saves nine" and "An ounce of prevention is worth a pound of cure". The ounce of preventive education applied immediately and intensively would also be the stitch in time, and this is one "amarjhansi" the government needs to declare right now.