With the alarming surge in diabetes cases, prevention stands as the paramount solution, and extensive research has been channeled toward the crucial realm of dietary choices. This challenge is undeniably formidable, as food is deeply rooted in culture and tradition, making it a formidable adversary to alter.
While the Mediterranean diet has garnered widespread acclaim, it raises the question: does its popularity imply that alternative dietary approaches have been fundamentally flawed? Dr Khalid Shaikh, a distinguished specialist in internal medicine and diabetes with decades of medical practice experience in Oman, asserts that dietary guidance holds the key to managing cardiometabolic diseases effectively. While diverse national and international guidelines advocate for varying macronutrient ratios, Dr. Khalid emphasizes the importance of locally tailored, person-centric dietary prescriptions, as they are more likely to yield higher compliance rates.
Dr Khalid introduces an innovative concept—an indigenous Traditional Indian Ocean (TRIO) diet. This diet mirrors the dietary traditions of the Indian Ocean’s coastal inhabitants, focusing on principles of procurement, preparation, presentation, prioritization, preservation, and communal consumption. It presents itself as a compelling alternative to the Mediterranean diet predominantly followed in Western nations.
To grasp the significance of this paradigm shift, we must delve into the historical context and rationale behind these dietary recommendations.
“Metabolic and nutritional diseases are emerging as a major global health care challenge. Diabetes, obesity, hypertension, and cardiovascular disease have gained pandemic status and show no signs of slowing down. As we try to address these diseases, the role of healthy nutrition is of paramount importance,” he said.
He added, “Though there are myriad definitions of healthy eating, the term ‘Mediterranean diet’ is often associated with health protection and promotion. Current guidelines underscore the need for culturally relevant medical nutrition therapy prescriptions for the prevention and management of metabolic diseases, including diabetes.”
He also said, “While multiple diet patterns are shown to have short-term benefits, the Mediterranean diet is suggested to be one of the most useful diets for long-term health. At the same time, it should be clarified that there is no single dietary plan that is suited for all people.”
THE MEDITERRANEAN DIET
In 2010, UNESCO boldly defined the Mediterranean diet as an intricate tapestry of skills, knowledge, age-old rituals, sacred symbols, and cherished traditions, interwoven with the sacred cycles of crops, harvesting, fishing, tender animal care, meticulous conservation, meticulous food processing, and the sacred art of cooking. Central to this culinary saga is the profound act of sharing and consuming food, an act that breathes life into this timeless tradition. It encompasses the entire journey from the soil to the table, from production to processing to the joyous communion in food.
The modern medical world was awakened to the extraordinary virtues of the Mediterranean diet in 1958 when Ancel Keys orchestrated the landmark Seven Countries Study. This pivotal research unfurled irrefutable evidence of its cardiovascular prowess, etching it into the annals of nutritional excellence.
At the core of this dietary marvel lies the artful equilibrium between fibre-laden abundance, antioxidant-rich treasures, and the bounty of unsaturated fatty acids, all while holding animal fats at bay. The dietary alchemy dances to the tune of approximately 55% to 60% carbohydrates (with an impressive 80% being of the complex variety), a virtuous 10% to 15% of proteins (of which 60% hail from the animal kingdom), and a harmonious 25% to 30% of fats, predominantly dressed in the regal robes of olive oil. Nutritionists and visionary policymakers depict this dietary wonder as nothing short of a Food Pyramid—a meticulously crafted treasure map to a healthier life. Here, a symphony of diverse foods beckons, each finding its rightful place in the grand orchestra of nutrition, to be savored in moderation.
However, when viewed through the prism of an Afro-Asian perspective, a disconcerting limitation emerges. The very nomenclature of the Mediterranean diet can inadvertently cast a long shadow, hinting that foreign fare supersedes the merits of locally nurtured provisions. An unwarranted fixation on the elusive and often costly olive oil, which neither readily graces every table nor aligns with the nuanced Afro-Asian culinary traditions, risks steering individuals towards extravagant and superfluous expenditures on their sustenance.
THE TRADITIONAL INDIAN OCEAN (TRIO) DIET
“Let us attempt to conceptualize and define an Indian Ocean diet, as an authentic and appropriate, alternative to the Mediterranean diet. The Indian Ocean diet is a diet that is inspired by and incorporates, the dietary preferences and habits of the people who inhabit the littoral countries of the Indian Ocean,” Dr Khalid said.
“We propose the traditional Indian Ocean (TRIO) diet as a healthy option for the prevention and management of metabolic diseases. We define the TRIO diet as the style and method of meal procurement, preparation, preservation, presentation, and partaking, followed by the inhabitants of the Indian Ocean region, which contributes to metabolic and overall health,” he added.
To understand the diet, we have to understand the Indian Ocean Littoral Region.
The Indian Ocean, the third-largest ocean in the world, touches the shores of Africa, the Middle East, South and Southeast Asia, as well as Australia. He pointed out that though the inhabitants of this vast region represent a seemingly complex and diverse collection of people they are also united in many ways. Age-old trading and travel links have created a “fusion” of cultures, which has influenced cuisines as well.
“We would like to define the Indian Ocean littoral region as including all the countries and islands that touch the Indian Ocean or are included in it. The authors represent the following countries: Australia, Bangladesh, Indonesia, India, Iran, Kenya, Malaysia, the Maldives, Mauritius, Mozambique, Myanmar, Oman, Pakistan, Singapore, South Africa, Sri Lanka, Tanzania, Ghana, Thailand, and the United Arab Emirates.
Cooking and dining are family affair, and sometimes even a community affair. The sense of sharing (Ubuntu in South Africa) extends to presenting food and preparing food in joint family kitchens,” he noted.
Most traditional Indian Ocean littoral cuisines are based on locally available whole grains (rice, wheat, and maize), eaten in various forms. According to him, in recent years, the proportion of whole grain consumption as opposed to refined grain intake has reduced. This is especially true in island states, which import their cereal requirements.
The cereal is usually consumed with dishes that are made of vegetables, legumes, and lentils. Coastal cuisines have a strong presence of fish, seafood, and fish products. Meat is an integral part of Indian Ocean littoral states but is not a major contributor to caloric intake in most cuisines.
Beverages such as water, lemonade, hibiscus juice, kokum juice, coconut water, soup, tea, and coffee are a prominent part of the Indian Ocean diet. This is a necessity due to the hot weather that prevails throughout much of the year in the region.
Various means of cooking are used across the region, including boiling, steaming, sautéing, baking, and frying. In most settings, the economy of fuel and the economy are in the interest of parsimony. A wide range of cooking oils are used, as per availability. Coconut oil and palm oil,
which are clubbed as ‘tropical oils’ and are used in the eastern Indian Ocean littoral region, while mustard oil, peanut (groundnut) oil, and clarified butter (ghee) are used elsewhere.
Mustard oil is a liquid oil that is low in saturated fat and is popular in South Asia. Australia, New Zealand, and the European Union (27 countries) have established upper limits for tolerable intake of mustard oil. In contrast, mustard oil is one of the most popular cooking oils in Asia, particularly in India, where it is recommended as a heart-healthy oil by the Lipid Association of India (LAI). However, the US Food and Drug Administration (FDA) has banned the use of mustard oil for cooking.
Fruits are ubiquitous in the Indian Ocean diet. Locally available, seasonal fruits are preferred. Some parts of the region, such as the Middle East and South Asia, exhibit a preference for rich (and tasty) desserts.
THE TRADITIONAL INDIAN OCEAN AND MEDITERRANEAN DIET
In most ways, the Indian Ocean diet that we describe is similar to the Mediterranean diet. Reliance on whole grains, vegetables, legumes, and fruits is common to both systems. The use of fish is noted in coastal Indian Ocean communities as well as the Mediterranean. Nuts and olive oil, important features of the Mediterranean diet, are represented by groundnuts and other cooking oils in the Indian Ocean. Less focus on the use of red meat, processed meat, and refined cereals is common in both traditional cuisines. Similarly, the concept of an Indian Ocean diet can be used to create an overarching model that can be customized as per local needs and requirements.
THIS RESEARCH SUGGESTS A HEALTHY TRAY. SO WHAT IS A HEALTHY TRAY?
The study suggests using the healthy thali (tray) rather than the pyramid or plate to represent the Indian Ocean diet.
“The healthy tray provides a conceptually practical, person-friendly means of representing the food and drink that should be consumed by the regional population to ensure healthy nutrition and accomplish healthy outcomes. It represents a wholesome and comprehensive method of representing an optimal diet in a person-friendly manner. A healthy diet goes beyond mere nutrition by including culinary science and art in education. The concepts of presentation, along with portion size and meal sequencing, can be demonstrated through the tray model.
SO WHAT IS THE WAY FORWARD?
“This concept has the potential to become a useful tool for sharing and teaching healthy nutrition. The advantage is its relevance to a vast swathe of the world’s population and the sense of empowerment as well as the responsibility that it brings to them. This will hopefully invite more interest, discussion, and debate, as well as research to achieve this potential. In many countries, the local food is a blend of different cultures. For instance, people from Mauritius enjoy eating locally adapted Chinese cuisine as much as they enjoy Indian cuisine. Blending brings cultural enrichment to existing traditions. However, as much as we are keen to respect our traditions or any associated influences from other cultures, we must educate our parents on what could be deleterious to their health. For example, we may still respect and enjoy a particular dish while decreasing the proportion of carbohydrates. Quantity is often overlooked, and this issue should be addressed as well. Also, we may still address our food-eating behaviors while enjoying the same food without it being harmful to our health. For instance, some studies are advocating for meal sequencing for better metabolic benefits,” he concluded.
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