• Try to build meals with a protein, carb, fat, and vegetable balance
• No single food is a superfood; a combination of everything is needed
• Exercise is very important, but you can’t ‘out-exercise’ a bad diet

“When people think of a ‘healthy meal,’ they omit our staple diet of rice and curry. However, it is quite the contrary,” said nutritionist and lifestyle medicine practitioner Dr. Raaidah Wahab, in an interview with The Sunday Morning, emphasising that the Sri Lankan rice and curry plate “is one of the most nutritious and balanced meals you can think of”.

However, the quantities we eat of the different macronutrients need to change, Dr. Wahab noted. “Try your best to build your main meals with a PCFV (protein, carbohydrate, fat, and vegetable) balance with quality and quantity in mind – a combination of everything helps to bring out the nutritional aspects of a meal,” she added.

While noting the challenges in thinking about variety in food given the high cost of living, she asserted that a “little variety goes a long way in getting the required nutrients”.

“Sacrificing meals to save money often has adults eating only one meal a day, resulting in undernutrition. Undernutrition in children happens when they do not get the required quantities of protein and vegetables to support their growth and development,” she warned, emphasising on the importance of ensuring a PCFV balance.

Following are excerpts of the interview:

Given the ongoing economic crisis, people are sacrificing meals in order to make ends meet. How is this affecting their nutrition and well-being?

The crisis has had a big effect on the affordability of animal proteins and certain vegetables.  Although people essentially would like to have a balanced diet of proteins from animal sources (such as chicken, fish, and beef) and vegetables along with their carbohydrate, there are issues such as affordability. As a result, it is likely that the adults will sacrifice their own intake of protein-rich foods and vegetables to give it to their children. This is especially prevalent in low-income households. 

If this trend continues, it could eventually lead towards malnutrition, which has two prongs: overnutrition and undernutrition. When adults move towards filling all their nutritional requirements with a higher intake of inexpensive carbohydrate-rich foods such as rice and dhal whilst sacrificing the more protein-dense foods and vegetables for the sake of their children, this will lead eventually to health issues such as being overweight and obesity, especially for adults who lead a more sedentary lifestyle.

While rice and dhal comprise the foundation of a staple Sri Lankan diet, over-intake of this without the necessary protein and vegetable intake is not good. This will lead to development of Non-Communicable Diseases (NCDs) such as diabetes, cardiovascular disease, and stroke.

Sacrificing meals to save money often has adults eating only one meal a day, resulting in undernutrition. Undernutrition in children happens when they do not get the required quantities of protein and vegetables to support their growth and development.

What steps can people take to ensure they eat healthy meals? What are the less expensive foods you would recommend that help make up a complete meal?

That’s a tough question to answer in the current economic situation. 

When people think of a ‘healthy meal,’ they omit our staple diet of rice and curry. However, it is quite the contrary. The Sri Lankan rice and curry plate is one of the most nutritious and balanced meals you can think of. It’s just the quantities that we eat of the different macronutrients that need to change.

Traditionally, there are three main categories of macronutrients: carbohydrates, proteins, and fat. I like to include vegetables as a separate macronutrient because most people underestimate the importance of eating enough vegetables.

My main recommendation is to try your best to build your main meals with this PCFV (protein, carbohydrate, fat, and vegetable) balance with quality and quantity in mind. It is not one food which is a superfood; it is a combination of everything that helps to bring out the nutritional aspects of a meal.

I like to categorise ‘better quality’ carbohydrates as ‘green light foods’. These options include fruits, pulses (chickpeas, cowpea, and mung beans), starchy vegetables (jackfruit, breadfruit, potato, sweet potato, and manioc), rice (red rice) and rice products (string hoppers and pittu), other whole grain products, and oats (rolled and steel cut). These should be consumed in required quantities. 

Another category of carbohydrates are ‘yellow light foods,’ which should be consumed in lesser quantities. These include instant oats, white rice, white bread, etc. ‘Red light foods’ are foods such as biscuits, burgers, pizza, doughnuts, cakes, carbonated drinks, carton juices, etc.

We are fortunate to have a variety of ‘green light carbohydrates’ that are affordable and we can include these in necessary quantities according to age, height, weight, activity levels, nutritional goals, and presence or absence of disease state.

Quantity is an important point to consider when planning meals to include carbohydrates. This again depends on various factors, especially activity levels. For example, people in villages will require a larger portion of rice as they need adequate energy to fuel their day’s work of manual labour versus someone living in an urban area with lower activity levels. 

The same is applicable to fats: coconut and curd are healthy and affordable options, compared to other healthy fat options such as nuts and seeds. 

When considering proteins, a lack of chicken, fish, or any animal proteins on your plate does not mean you are going to be deficient in protein. We get a little bit of protein from most foods, even from whole grains such as finger millet, red rice, and atta flour. There is also a good amount of protein in chickpeas, cowpea, green gram, and dhal (pulses) and in a lesser quantity from food sources like tofu, mushroom, and green peas. This ensures that more affordable plant-based options can be substituted without fear when animal proteins are not affordable.

This is evident in our combination of rice and dhal: rice is high in an essential amino acid called methionine and deficient in another essential amino acid called lysine and surprisingly it’s vice versa for dhal, so when you combine the two it gives you a complete protein which you would normally get from animal protein sources.

Animal proteins are higher in protein and have a zero/negligible amount of carbohydrates when compared to plant-based sources, but that doesn’t mean plant-based sources are not good. Other food combinations like oats and seeds can also help in getting a modest amount of protein.

The last but most important macronutrient is vegetables. In terms of relatively-less expensive foods, look towards local and seasonal vegetables. We have a great variety of these, ranging from gourds (snake gourd, bitter gourd, and ridged gourd), to okra, beetroot, winged beans, etc. It is important not to forget to include at least one green leafy vegetable, especially at lunch time. This is an affordable way to get in other nutrients like calcium and iron from green leafy vegetables such as drumstick leaves and gotukola. Some vegetables such as winged beans, lotus root, baby jackfruit, and mushrooms also contribute towards adding protein to meals along with other micronutrients.

When eaten in combination with your carbohydrate and a pulse like dhal, we can form a well-balanced meal with the needed macro and micronutrients that is healthy and relatively inexpensive. It is challenging to think about variety in food with the cost of living, but a little variety goes a long way in getting the required nutrients.

What should people aim for when planning a meal?

As explained above, try your best to have a PCFV balance.

For healthy adults, aim to have at least a 1:2 ratio of rice to vegetables when building your lunch plate. Change your primary carbohydrate source to other ‘green light carbohydrate’ options instead of rice. Pairing it with a protein and a healthy fat is also beneficial at other mealtimes.

When it comes to children, many parents are worried about adequate protein intake but cannot afford fish or chicken on a daily basis. Legumes and pulses are good and affordable options. Adding chickpeas, cowpea, and green gram, which can even be made into a curry and added to the rice and curry plate, is one way to overcome this. One-third of the plate can be portioned out for this while filling in the balance two-thirds with a carbohydrate and vegetables. 

A lack of animal protein does not result in inadequate protein if you are combining plant-based sources in a balanced way. However, plant-based diets may result in low levels of Vitamin B12 and heme iron as these are mainly from animal-based sources.

What mistakes do we commonly make when planning meals? We eat a lot of rice. Are we overcooking our food? Are we using too much coconut milk?

Traditional Sri Lankan cuisine is not based on eating raw foods, because the traditional local diet is high in fibre and harder to digest. Cooking allows for better digestibility. Local vegetables mentioned earlier are high in fibre and difficult to digest when eaten raw. Food items like chickpea, cowpea, and green gram are high in soluble and insoluble fibre. They are also difficult to digest and absorb if not cooked properly. The cooking process helps by doing that first step of breaking down this fibre so that it’s easier to digest and absorb.

Certain cooking methods will result in losing the nutritional value of a food item, such as deep frying. Steaming, boiling, and cooking in curry form are more beneficial to help retain nutrients. Indian cuisine, especially in vegetarian states, primarily sources protein from legumes and pulses. They cook these in a curry form, which helps digestion without any bloating issues.

Part of a balanced diet is adding a healthy fat to meals and we are fortunate to have that freely available in our local diet in the form of coconut. As for using too much coconut milk, this is not applicable for healthy individuals. Yes, coconut is a fat and consuming too much fat is not good, but we must remember that coconut is a good type of fat and has been linked with helping increase HDL (good cholesterol) levels.

People assume that since coconut is a saturated fat, it must be bad for you. However, although it is a saturated fat, it contains a type of fat called Medium Chain Triglycerides (MCTs), which helps in increasing good cholesterol levels. 

Healthy fats also ensure that you are able to digest and absorb the fibre in your diet, which is why cooking in coconut milk or adding coconut to your plate is not unhealthy. This is why we add freshly-scraped coconut with chickpeas. Fat is also a ‘satiety macronutrient’ and helps you feel full for a longer period of time.

Again, this is for someone who is considered as being of normal health. For those with high cholesterol, diabetes, or hypertension, the dietary plan may change. This doesn’t mean omitting coconut or rice completely, but adjusting quantity and quality to suit your needs. 

When planning and preparing we often make the mistake of not accounting for our activity levels and often overestimate our carbohydrate requirements. Another mistake people often make is not eating a proper main meal and instead snacking on some biscuits with tea, thinking that they ‘eat less quantity’ and as a result this will be beneficial for their health. 

However, if you look at the nutritional information on a pack of a certain type of biscuits, you will see that a serving of three biscuits has around 70 g of carbohydrate. Half a cup of cooked white samba rice has around 30-40 g of carbohydrate. This means you can have one full cup of white rice and it will be almost equivalent to eating three biscuits. However, which one is more filling and does not result in empty calories?

What are the foods within reach for those on tight budgets that should be prioritised for senior citizens?

It is important to get adequate carbohydrates, a smaller amount of protein (changes according to person) to help with maintaining their muscle mass, and, prioritise locally-available vegetables. 

Another important factor is digestibility. A whole grain such as finger millet is a great option for a good quality carbohydrate, but preparation/cooking method is important. Having this as a porridge allows for better digestibility and should be consumed in moderation as its high fibre content can give rise to digestive issues. Consuming rice is fine as long as it’s in the required quantity and this depends on their level of activity, weight, nutritional status, and presence/absence of disease. If they have any micronutrient deficiencies, supplementation with a multivitamin is necessary. 

Building the best meal for a senior citizen on a tight budget would lead me back to our Sri Lankan plate. Focus on the carbohydrate quality (red rice instead of white rice, traditional whole grains instead of white flour-based food items), get at least two vegetable types in, including one green leafy vegetable, and try to add some form of protein.

We have plenty of green leaves that are available and affordable and including a green leafy vegetable like gotukola and murunga kola ensures that you also get a bit of protein along with micronutrients such as calcium and iron.

Protein requirements will vary for each person, but it is important to include in a senior diet. Eggs have been associated with a fear of increasing blood cholesterol levels, but this has been disproven and they are a good source of protein when eaten in moderation.

When it comes to the well-being of pregnant mothers, what is the diet you recommend? They are often pushed to overeat and told that they are eating for two.

I recommend a balanced diet. It’s not so much about eating for two in terms of quantity but getting the right nutrients to support the mother’s health and the baby’s development. Nutritional requirements while pregnant and breastfeeding increase by 500 calories or more. Your intake will increase but that does not mean that you are eating for two and that you must constantly eat.

Sometimes pregnant mothers want to know if there is any special food they should consume, but there is no such ‘superfood’. A variety of good quality carbohydrates and an adequate amount of protein and healthy fats are still the basis of a good diet when pregnant or breastfeeding. 

Avoiding highly and ultra-processed food items (carbonated drinks and ‘junk’ food) is important, while including plenty of pulses and green leafy vegetables for your folate intake, animal proteins and beans for your iron requirement, vegetables (which are natural vitamin supplements), and whole grains. Fish, nuts, and seeds are a good source of omega-3 fats and protein and plain Greek yoghurt is a good source of protein if it can be afforded. 

Hydration is also very important and often overlooked. Then there is antenatal care such as folic acid, iron, and multivitamins, given in supplemental form.

What would you list as the most nutritious food items within reach of low-income households?

There is no list of five or 10 superfoods. I would be doing all types of foods a disservice by giving such a list. Instead, we should focus on getting a variety of food from the main macronutrient categories and choosing food types that are nutritious and affordable.

There are affordable options in each category which can be accounted as nutritious ‘green light’ foods that contribute towards a balanced and nutritious diet. Look at adding at least one item from each category and achieving a PCFV balance with each meal.

What are the most common impacts you see in terms of health and well-being as a result of poor diets?

Apart from malnutrition due to the economic crisis, another common issue resulting from a poor diet is obesity and being overweight. This is now more prevalent in the 20-40 age group. Poor diet (a culture of eating meals prepared out of the home which are high calorie, high sodium, and high fat) is often coupled with a sedentary lifestyle. This will lead to developing complications such diabetes, high cholesterol, and metabolic issues, mostly stemming from insulin resistance. This will also increase their risk of developing other diseases such as arthritis and early onset dementia when they are older.

Sri Lanka has one of the highest rates for diabetes in South Asia and our national percentage is in its 20s, which is quite high. Instead of trying to fix these issues only with medication, people should try to see if they can first fix their diet along with the required medication.

Most people believe that going to the gym will negate the effects of a poor diet. While regular exercise is extremely important, you cannot ‘out-exercise’ a bad diet. You can go to the gym every day and still put on weight if your diet is bad and non-exercise movement is low. This combination plays an important part in your nutritional and health status. A simple thing like moving (not sitting down), especially immediately after meals, will work wonders for a spectrum of issues, like improving your energy levels and even helping regulate your blood sugar.

You spoke very positively about rice, but we clearly eat too much rice. For those doing largely-sedentary day jobs, how much rice should they eat and is it okay to have rice or rice-based carbs for every meal?

Your carbohydrate requirement completely depends on your age, weight, height, and activity levels – not just gym activity but your non-exercise levels of activity, which is called Non-Exercise Activity Thermogenesis (NEAT). This can be calculated by finding your Total Daily Energy Expenditure (TDEE) and then calculating your macronutrient requirement (for carbohydrates) depending on your goals (maintain weight/lose weight/gain weight). 

If you are constantly on your feet, standing and walking, and active throughout the day, your carbohydrate requirement will be higher than it would be for someone who is seated for 8-12 hours. Someone shorter would require less carbohydrates, as would a person with diabetes. There is no ‘one size fits all,’ which is why it’s important to know what your daily carbohydrate intake should be and adjust portion sizes accordingly.

If you are a regular person working in an office and seated for most of the day, I would like to suggest dividing your plate into three and trying as much as possible to fill in one-half with vegetables, one-quarter with animal protein and/or pulses for your non-animal protein option, and then quarter with ‘green light carbohydrates’. Try and match two servings of vegetables to one serving of a ‘green light’ carbohydrate, even at dinner time. This can be done by adding a mixed vegetable curry/sambar to string hopper, pittu, and thosai meals.

There is a trend towards low-carbohydrate dinners, which is beneficial if you are not undereating your nutritional requirements. Adding a fruit as a low carbohydrate option can be considered instead of rice at dinner time. Ensuring that your meal is PCFV balanced in the correct quantity and correct quality is the key to a healthy diet.