The impact of nutritional deficiencies in the Indian diet on the health of Indians and their lack of awareness about their food habits is an issue that requires immediate attention and constructive solutions. - Article by Nirbhay Mishra

Introduction
In recent years India has achieved significant growth in terms of economy. The purchasing power parity, GDP, and Per Capita income all have grown to a significant extent. In terms of healthcare, India has achieved a lot since the independence of India.

But when it comes to the Indian diet, Indians have adopted a very narrow and fanatic attitude that our diet is the best in the world. Contrary to popular belief, the Indian diet is one of the poorest in the world with many nutritional deficiencies which have serious consequences on the general health of Indians. 

This article aims to highlight the problematic Indian diet, Its nutritional deficiencies, Severe consequences on public health and the rise of diseases among Indians because of their diet.
I have referred to various sources, Government data, and National and International resources.

 The objective behind quoting so many references because this is high time for Indians to evaluate their food habits which are killing the entire generation slowly.

Macronutrient deficiency in standard Indian food
Carbohydrates 
Carbohydrates are the basis of the standard Indian diet which is the beginning of all the problems. Wheat and Rice dominate the standard Indian food. The dependence upon carbohydrates creates further complications because carbohydrates don't fulfil the requirements of the human body.

The consumption of Wheat and Rice
As per the data of the National Sample Survey Office (NSSO), Rice and Wheat constitute around 70 per cent of the total cereal intake in India. In the Urban areas, The average per capita consumption of rice is around 4.5 kg per month. In rural areas, the per capita consumption of rice per month is around 6 kg.

If we analyse the consumption of wheat in Urban areas, It is around 4 Kg per month. In the rural areas, it is around 5 kg per month.
These grains are unable to fulfill the nutritional requirements of fiber, Minerals and Vitamins and this leads to poor dietary quality.

Impact on Health

Consumption of Carbohydrates from refined sources at a high rate leads to multiple diseases including increased risk of diabetes, Obesity and heart-related issues.

Research has shown that high glycemic index food like white rice can lead to rapid spikes in blood sugar levels which increases the chances of Type 2 Diabetes. (Hu FB et al. 2012)

According to the National Family Health Survey(NHFS-5) 2021 8.9% of Indian adults have diabetes.
A study published in the Lancet in 2023 revealed that approximately 11.4% of the population in India, which accounts for 101 million individuals, are living with diabetes. (Lancet)

The INDIAB study conducted by the Indian Council of Medical Research (ICMR) revealed that approximately 15.3% of the population, which is equivalent to 136 million individuals, could be diagnosed with pre-diabetes. (ICMR)

These figures are very problematic and will have serious consequences on public health.
This shows us how problematic the carbohydrate-dominated Indian diet is.

Protein
Indian diet lacks protein. It is below the global average and way behind the recommended dietary allowances(RDA).

Protein Consumption in India
According to the Indian Council of Medical Research, The daily consumption of protein should be about 0.8-1 gram per kg of body weight. If someone is around 80 kg, The protein consumption should be around 64-80 grams.
Contrary to the actual requirement, Indians are consuming only 47 grams of protein per day which is an alarming situation. 

There is a huge difference between Urban and Rural areas when it comes to protein consumption. Urban areas have an awareness when it comes to food habits and the understanding of protein requirement necessities. However rural areas lack awareness about the management of macronutrients. Urban areas have better access to diverse foods as compared to rural areas.

Sources of Protein
The major sources of protein in India are pulses, dairy products, and languages. 
Pulses are not a complete source of protein.
Indians consume very little protein from meat eggs and fish. 
Meat is a superior form of food when it comes to fulfilling the protein requirement. 

According to the data of the National Sample Survey Office (NSSO), Indians consume 10-12 grams of protein a day from pulses.

There are multiple problems with it.
First Indians consume very little protein because our diet is very inferior. 

The majority of protein we consume comes from pulses which is not a complete source of protein. The limited consumption of animal-based proteins which are a more complete source of protein, Creates a more problematic situation of protein deficiency.

In many regions of India, There is a prevalence of a vegetarian diet. The overemphasis on a vegetarian diet and the false sense of moral superiority with it stop people from consuming a superior form of protein which gives the human body all the essential amino acids that plant-based protein lacks.

Protein Energy Malnutrition(PEM)
PEM is a very big challenge and it is seriously impacting the health of children in India. 
The National Family Health Survey (NHFS-5) mentions that 35.5% of children under the age of 5 years are stunted, 32.1 % are underweight and 19.3 are wasted.

All these problems have arisen because of the problematic Indian diet and lack of complete protein sources. 

On top of it, voices are coming from the system itself to exclude eggs from mid-day meals. Such kind of steps will impact the overall health of children in the formative years.

The Global Nutrition report mentions the serious picture of malnourishment in India. It mentions that 1/3 of the world's stunted children are from India. The poor Indian diet is the sole reason behind that and only an animal-based diet can fix this.

FAT Consumption in India
The total fat intake in India is very low compared to the recommended levels.
Also, the quality of fats Indians consume is very poor.

Indians get 20-25% of their calories from fat. This is far less than the ideal range of 25-35%.
The daily fat intake of Indians is around 40-50 grams per day, Compared to the ideal range of 60-70 grams.

The rural population consumes less fat than the Urban population because of the lack of awareness and poor economic status.

Varieties of Fats
We need to understand that monosaturated and polyunsaturated are considered to be good fats, and Trans and Saturated fats are considered bad fats.

Saturated fats from palm oil, Ghee and butter are commonly consumed in India.
Fats from these sources can increase the level of LDL cholesterol which further increases the risk of heart-related diseases.

Compared to the consumption of healthy unsaturated fats, Found in fish, Vegetable oils, and Seeds is very low.

For Brain and Heart health, omega-3 fatty acids are very crucial, The sad part is, that It is insufficient in the Indian diet.

Disastrous consequences because of the lack of good fats in the Indian Diet
The National Family Health Survey - 05 (NHFS 05) mentions that 22.9% of Males and 24% of Females aged 15-49 years are suffering from obesity.

One of the major reasons behind that is the consumption of highly processed food which contains very high levels of sugar and unhealthy fats.

28% of all deaths in India are because of heart-related disease and the poor Indian diet plays a very important role.

A study conducted by (Misra 2011) found that eating too much unhealthy fats can lead to a higher chance of having metabolic syndrome and other related health problems.

Conclusion
High consumption of carbohydrates, Low Protein intake, and Poor quality of Fat consumption have very disastrous consequences on Public health.
The impact is visible on the masses, Indians are suffering from nutritional deficiencies and various diseases which can be fixed only by increasing the overall nutritional level of Indians. 

From a Government perspective, Healthy foods must be made accessible easily without any difficulties and protein-rich food should be promoted in government-run programs.

Micronutrients
Micronutrient shortages are a big problem in India, causing serious health problems. This part of the article talks about certain micronutrient shortages, how common they are, and the health problems they can cause.

Iron
A deficiency of Iron is a common form of nutritional deficiency in India. The major victims are children and women.

Iron deficiency in India
According to the National Family Health Survey -05 (NFHS 05), 53.2 % of Women from 15-49 years of age and 58.6% of Children from 6-59 months are suffering from Anemia.

The fundamental cause behind Anemia is Iron deficiency because of poor dietary intake, Low bioavailability of dietary iron and the prevalence of infectious diseases.

Dietary sources and Bioavailability 
In India, the primary sources of dietary iron are pulses, Green leafy, Meat, Vegetables and cereals.
The bioavailability of Iron from these food sources is very low and the reason behind this is that in plant-based food, there is a presence of phytates and polyphenols which hamper the absorption of Iron (Hallberg 2001)

Heme iron from meat has better bioavailability but because of the dominance of the vegetarian diet, it is consumed less.

Health implications 
Anaemia is caused by iron deficiency. The symptoms are fatigue, Weakness, and Impaired cognitive and physical development in Children. Pregnant women with anaemia face higher risks of complications such as preterm delivery and low birth weight infants (WHO 2015).

Vitamin A and the prevalence of nutritional deficiencies
The report of the World Health Organization (WHO) mentions that 42% of pregnant women and 62% of preschool children are suffering from Vitamin A deficiency.

This deficiency is the fundamental cause of preventable blindness in children and it enhances the risk of many infections.

Vitamin A food sources
The major sources of Vitamin A are Liver, Fish Oil, Milk, Egg and vegetarian plant-based sources like carrots, sweet potatoes and green vegetables.
The consumption of these foods is not sufficient as per the requirement.

Another problem is the bioavailability of Vitamin A from plant-based sources is lower than the animal sources. The Indian population because of their vegetarian food habits often lacks Vitamin A which further leads to multiple diseases.

Consequences on Public Health
The deficiency of Vitamin A causes night blindness which can turn into complete blindness. It affects the immunity and increases the risk of infection. 

The weak immune system of children makes them more vulnerable to illnesses such as diarrhoea and measles (Sommer and Davidson 2002).

Vitamin D and its deficiency among Indians
Indians suffer from severe deficiency of Vitamin D despite being a tropical country that receives abundant sunlight.

According to Harinarayan and Joshi (2009), Indians lack sufficient or optimal levels of Vitamin D.

There are a few majors behind it
1)The higher melanin content in the skin of Indians inhibits vitamin D synthesis.
2)Lack of Sun Exposure because lifestyle has changed so much. In the urban areas, the centre of core physical activities has shifted to air-conditioned gyms.
3)Poor Indian diet which lacks macronutrients and micronutrients.
Food habits and Sunlight
Fatty fish, Liver, and Egg yolks are the natural sources of vitamin D.

The majority of the Indian population does not consume these nutritious foods regularly.
The changing lifestyle of Indians which pushes them indoors because of the rapid change in profession stops them from consuming sufficient amounts of sunlight which is a very important source of Vitamin D.

Health Effects
: Lack of Vitamin D can cause rickets in kids and osteomalacia in grown-ups, which results in fragile bones. It also raises the chances of osteoporosis and fractures in elderly individuals.
New findings indicate that vitamin D plays a part in how the immune system functions. A lack of vitamin D has been connected to a higher chance of getting infections and long-term illnesses like diabetes and heart disease. (Holick,2007)

Zinc, Its deficiency, Sources and bioavailability
One of the major nutritional problems in India is the deficiency of Zinc which affects the immunity and growth of an individual.

The estimation of the International Zinc Nutrition Consultative Group(IZiNCG) gives the data that around 31% of the Indian population is at risk of a deficiency of Zinc.

Due to the increased physiological demands, this deficiency is more prevalent in children and women.

Food Sources and Biological Availability
Meat, Dairy products, Legumes, Nuts, and food are zinc-rich foods. The bioavailability of Zinc from plant-based is low due to phytates.
The traditional Indian diet which is low in animal-source foods and rich in cereals and legumes leads to a higher prevalence of Zinc deficiency.

Health consequences

A lack of zinc can cause children to grow more slowly, have weaker immune systems, and be more prone to infections like diarrhoea and pneumonia. It can also impact reproductive health and the outcomes of pregnancy (Black 2003)

We have to diversify the food sources and add supplementation if necessary to fix the deficiency of Zinc because it is a very important nutrient for improving child health and development.

Conclusion
Like macronutrients, the Indian diet lacks Micronutrients. Because of the poor Indian diet, Indians are unable to fulfil their Vitamin A, Vitamin D, and Zinc requirements. This creates a huge public health challenge. This gives rise to anaemia, Weak immunity, Stunted growth, and Poor vision or eyesight.
We need to address this challenge through our diet because diet is the sole reason behind it. The immediate step should be to diversify our food choices, Fortify foods and add supplementation.

Overall implications of poor Indian diet on public health
1. Malnutrition 
Deficiency of Nutritious food
Stunting - Poor nutrition for a longer period leads to stunting, Where students are too short according to their age. If we refer to the data of the National Family Health Survey (NHFS-5) 35.5% of children under the age of 5 are stunted. This is because of long-term nutritional deficiencies.

Wasting and Underweight
19.3% of children under 5 are suffering from wasting.
Because of undernutrition for a longer period,32.1% of children under 5 are underweight.
Micronutrient deficiencies
Anaemia - 52.2% of pregnant women, and 57% of Women from the age group of 15 to 49 are suffering from Iron deficiency. It leads to weakness, Infant and maternal mortality and fatigue.

Vitamin D Deficiency
According to the Journal of Family Medicine and Primary Care (2020), 70% of Indians are suffering from Vitamin D deficiency. Its deficiency leads to bone-related issues and increases the risk of long-term diseases.

Vitamin B12 deficiency
Because of too much emphasis on a vegetarian diet and lack of animal-based diet Indians lack in Vitamin B12.
It leads to weak muscles, numbness, trouble walking, nausea, weight loss, irritability, fatigue, and increased heart rate.

Non-communicable diseases
Cardiovascular Diseases
60% of global heart-related disease cases are from India and the reason behind this is because of the high intake of trans fat, Saturated Fat and refined sugar.

Mortality - Cardiovascular diseases are the major cause of death in India.
According to the World Health Organisation data, Cardiovascular death accounts for 28% of all deaths in India.

Diabetes
The data from the International Diabetes Federation mentions that 77 million Indians are suffering from diabetes in 2019
Sadly the numbers will increase to 101 million by 2030.

Type 2 Diabetes
The poor diet, High carbohydrate diet, Inactive lifestyle, and Obesity are the main reasons behind Type 2 Diabetes.

Obesity
Change in lifestyle and Urbanization -
The rise in the consumption of fast foods and beverages high in sugar and poor physical activity has led to rising obesity rates.

National Family Health Survey 05 (NHFS-5) mentions that 22.9% of men and 24% of women are overweight and obese.

Childhood Obesity
According to UNICEF 2019, 14.4% of Children from the age group of 5 to 19 are overweight and obese.

Gastrointestinal Issues
Constipation can be caused by not eating enough fibre in your diet. Traditional diets usually don't have enough fibre because people don't eat enough fruits, vegetables, and whole grains. This can make you have constipation all the time. Eating a lot of processed foods, which don't have much fibre, makes stomach problems worse.

Irritable Bowel Syndrome
Dietary mistakes - The Indian diet lacks Fiber, Too many spices in food and high consumption of processed foods due to this 15-20% of Indians suffer from IBS. (Indian Journal of Gastroenterology 2018).

Acid Reflux and Gastroesophageal reflux disease (GERD)
According to The Journal of Clinical Gastroenterology (2017) 8-20% suffer from GERD and the fundamental reason behind that is high consumption of oil spicy and fatty foods.

Comparison of unhealthy Indian diet with healthy diets of Japan and the Mediterranean
1. Carbohydrate
Indian Diet- Indians consume 60-70% of their daily caloric intake from carbohydrates, Majorly from cereals like wheat and rice(NSSO 2023)
Foods with High glycemic Index are major reasons behind diabetes and obesity.

Japanese diet
Japanese consume 55-60% of their caloric intake from Carbohydrates majorly from rice and vegetables. (Ministry of Health, Labour and Welfare, Japan 2023).
Whole grains and vegetables lower glycemic Index and enhance metabolic health.

The Mediterranean Diet includes getting 45-50% of your calories from carbohydrates, which come from foods like whole grains, fruits, and vegetables. (Mediterranean Diet Foundation 2023)
Eating foods with a low glycemic index can help keep your blood sugar levels steady.

Protein
Indian Diet
The typical Indian diet consists
 of an average of 47 grams of protein per day, which falls below the recommended daily allowance of 48-60 grams according to the Indian Council of Medical Research (ICMR) in 2023. Plant-based sources are the primary contributors to protein intake.

Japan
 In the Japanese diet, individuals typically consume 60-70 grams of protein daily from a mix of plant and animal sources like fish, soy products, and lean meats (Ministry of Health, Labour and Welfare, Japan, 2023). Eating a lot of fish helps to meet protein needs and provides essential omega-3 fatty acids. 

Mediterranean Diet
The Mediterranean Diet encourages consuming more than the recommended 50-60 grams of protein daily, which can be obtained from fish, poultry, legumes, and nuts. Prioritizing lean protein helps maintain muscle mass and promotes good health (Mediterranean Diet Foundation, 2023).

Indian Diet
 Fat Consumption: Generally consists of higher levels of saturated fats from ghee, butter, and oils such as palm and coconut oil. Essential Nutrients: Rich in omega-6 fatty acids but relatively low in omega-3 fatty acids. Citing data from the Indian National Family Health Survey (NFHS) and reports from the National Institute of Nutrition (NIN).

Japanese diet
Traditional Japanese Eating Habits: Fat consumption is typically low, particularly saturated fat, with a focus on omega-3 fatty acids from fish. Important nutrients include fish, seaweed, and soy-based foods. Sources: Ministry of Health, Labour and Welfare (Japan), World Health Organization (WHO).

Mediterranean diet
 The Mediterranean Diet emphasizes consuming monounsaturated fats primarily from olive oil, along with a favourable ratio of omega-3 and omega-6 fatty acids. Essential Nutrients: Consuming abundant amounts of fruits, vegetables, and nuts can lead to a more beneficial fat composition in the body. Sources cited include the American Heart Association and Harvard School of Public Health.

Conclusion
Indian society needs to reevaluate its food habits The world is changing at a very fast rate, When it comes to general health and Performance in sports, Indians are far behind many countries. Such countries who are suffering from war and crisis have better food habits than Indians. Indian athletes are not performing well, We rarely get a good number of medals in proportion to our population, and Indians are generally suffering from so many diseases which makes me wonder how as a society we will survive in future if public health remains like this.

 From poor protein consumption to huge deficiency of micronutrients, We lack both macro and micronutrients. 
Unless and until we will not fix these dietary practices, We will not be able to reach our genetic potential.
Indian diet must be protein-rich and not carbohydrate-rich. We need to consume good fats and fix our micronutrient deficiency. 

A consistent effort from society, Individual awareness, Giving up a false sense of superiority complex about our diet and government initiative can fix these things within a decade. The only thing we need is strong willpower and acceptance of the fact that our current diet is the root cause of all health evils.

References
1.National Sample Survey Office (NSSO). (2023). Household Consumption of Various Goods and Services in India.

2.Indian Council of Medical Research (ICMR). (2023). Nutrient Requirements and Recommended Dietary Allowances for Indians.

3.National Family Health Survey (NFHS-5). (2023). Ministry of Health and Family Welfare, Government of India.

4.World Health Organization (WHO) The Global Prevalence of Anaemia in 2021.

5.Harinarayan, C.V., & Joshi, S.R. (2023). Vitamin D Status in India – Its Implications and Remedial Measures. Journal of the Association of Physicians of India.

6.Holick, M.F. (2007). Vitamin D Deficiency. The New England Journal of Medicine.

7.International Zinc Nutrition Consultative Group (IZiNCG). (2023). Zinc Deficiency and Its Implications.

8.Black, R.E. (2003). Zinc Deficiency, Infectious Disease and Mortality in the Developing World. Journal of Nutrition.

9.Global Nutrition Report. (2023). Global Nutrition Report 2023.

10.World Food Programme (WFP). (2023). The State of Food Security and Nutrition in the World (SOFI) Report - 2023.

11.International Diabetes Federation (IDF). (2023). Diabetes Atlas.

12.Misra, A., et al. (2011). Dietary, Nutritional, and Physical Activity Strategies for Cardiovascular Risk Reduction in India. Journal of the American College of Cardiology.

13.Hu, F.B., et al. (2012). White Rice Consumption and Risk of Type 2 Diabetes: Meta-Analysis and Systematic Review. BMJ.

14.(Mediterranean Diet Foundation, 2023).

15.(Ministry of Health, Labour and Welfare, Japan, 2023).