Journal of Human Nutrition (1977) 31, 256-258. BDA STUDY CONFERENCE

Therapeutic diets for Asians Renuka THAMPY, BSc, BEd, SRD Senior Dietitian, The London Hospital, Whitechapel, London E l IBB.

INDIAN DIETS are known to be deficient in some important nutrients, ie vitamin D, B1 z, folate and calcium, and therefore some guidance on how to improve these diets is essential.

Reducing and diabetic diets Rice, wheat and millet are the main cereal grains consumed in an Indian diet. They are also the cheapest source of calories and may contribute as much as 70- 80 per cent of the total energy intake. In view of this it is often necessary to work on a higher carbohydrate content when planning reducing and diabetic diets for Asians.

One can work on the basis that 1 oz chapati is equivalent to 1 oz bread and 2 ozs boiled rice is equal to 100 kcal.

One must remember that rice or chapatis are the foundation of a meal and an Indian cannot sit down to meat and vegetables alone. Therefore, for the diet to be practical, it is advisable to work on 11 00 kcal and above.

An example of an 1100 kcal diet Breakfast 1 oz chapatill oz bread

1 egg scrambled tea

Lunch 2 oz boiled rice 2 oz chicken curry 4 oz curried peas 4 oz plain yogurt (from milk allowance) fresh fruit

Mid afternoon tea

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Dinner 1 chapati 4 oz dhal (lentils) green vegetables 4 oz yogurt (from milk allowance) fresh fruit

If the patient is vegetarian then the only sources of protein are dhal (lentils)- not always consumed daily-pulses, nuts, some milk, yogurt, buttermilk (diluted yogurt) and sometimes eggs. As cereals are consumed in large amounts, they form an important source of nutrients.

points to bear in mind: (1). Advise patients to reduce the amount of ghee/oil when cooking (it is not possible to make a curry entirely without fat). The amount varies with the individual; Punjabis and Muslims tend to use a lot of ghee in all their curries. (2). It is common to butter a chapati with ghee/butter; this should be discouraged in the case of reducing and low fat diets. (3). Paratha (shallow fried chapatis) and poories (deep fried chapati) should also be avoided where necessary.

Although the fat content of an Asian diet is not very high the following are

Most Indian pickles are pickled in oil, while some contain a lot of sugar. Indian sweets are very rich. being made from condensed milk, cereals, and

vegetables together with a large amount of sugar and fat; they may also be garnished with dried fruits and nuts. In this country they are consumed mainly at weddings and other special occasions, since they are not as easily available and cost more than in India. As these sweets are of high energy value they must be avoided especially in the case of diabetics. Gujaratis also tend to add sugar to some of their lentil or pulse dishes.

Low Salt-this is not usually as great a problem, because most salty foods, ie ham, bacon, kippers, tinned fish, 0x0, etc., do not form part of the Indian diet. A salt shaker is not normally used, but this depends on the amount of salt added in cooking which varies with the individual.

Pickles, however, are eaten and do have a high salt content. They may need to be avoided, depending on the severity of the salt restriction. A favourite dish with the Bangladeshis is dried salted fish curry but as this is very expensive in this country (costing P2 per pound) it is unlikely to be consumed regularly. Salted nuts, if consumed, must be repIaced by unsalted nuts.

Low fat-As mentioned earlier, a curry cannot be made without fat. Therefore, the fat content for an Indian low fat diet may have to be slightly higher. However patients should be advised to cut down on the quantity of ghee/oil used, also parathas, poories, and other fried foods.

Low animal fat-In this case, suggest that the ghee be made from margarine and that corn oil be used in preference to other vegetable oils. Vegetable ghee which is available here is not suitable, because it contains a high proportion of satur- ated fatty acids.

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Ante-natal clinics-A good majority of our Asian patients are seen in the ante- natal clinics. The main problem we have is communicating with these mothers; most of them are from BangladeSh, cannot speak any English and cannot always read their own mother-tongue.

with others outside their community and are therefore forced to leave the shop- ping to their husbands, resulting in the ignorance of food availabi1ity.h this country.

The husbands tend to shop in the Indian shops which cater for the Indian customers and often have to pay a high price for vegetables and other foods imported from their country.

The Bengali woman’s diet is usually very inadequate in most nutrients and, although they eat meat or fish at each meal, the amount consumed is negligible. Most of them will not drink milk or take yogurt, and cheese is a ‘foreign food’ to them and therefore not eaten. This makes their calcium intake very low; added to this problem, they have a practically negligible vitamin D intake.

Customs prohibit them from going out alone; they are shy, cannot communicate

Recommendations

Increase the milk intake by the use of yogurt at main meals, cereal at break- fast, and more milk in beverages.

Encourage the use of margarine. Suggest making ghee from margarine instead of butter, or half margarine half butter to begin with.

Include tinned oily fish if possible - this is more acceptable to the Bangla- des his.

Increase the quantity of protein at each meal. In the case of vegetarians, suggest the use of eggs in curried form. Children are more likely to accept new foods.

For vegetarians lentils or pulses must be included at main meals. Sprouted pulses are a good source of vitamin C.

Adequate intake of green vegetables and fresh fruit.

Paneer or Indian cottage cheese is a good substitute for cheddar cheese.

Betel leaves smeared with slaked lime - consumed quite regularly by Indians- is a good source of calcium which is said to be utilised by the body.

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