IMA Guidelines on Safe & Healthy Food

What do I eat?

What should my family eat?

Food undoubtedly is every body's concern. Food, beyond a means of survival is also a symbol of social well-being. Needless to say, we need to be thoroughly aware. Gone are the days when even the best food items could be considered totally safe. Some are even harmful and feeding sometimes amount to sheer poisoning. Many food items invite a host of diseases too. We need to be aware of food safety not only for our own sake but also for the society. We've to actively intervene in producing, selecting, procuring and consuming safe and healthy food.

The guidelines of IMA will definitely usher in some serious thoughts and actions in this regard. We humbly submit it to our citizens, hoping that this will trigger a new food culture anchored on safety and positive health.

Dr. Sreejith N Kumar

State President, IMA Kerala

Introduction

India has the double burden of over and under nutrition. Food safety in terms of chemical, biological and nutrient contents, is hardly a matter of concern in the country's social fabric. There is an alarming increase in the rate of life style diseases notably Diabetes, Obesity, Hypertension and Cancer. There is a very disturbing upward trend in cardio vascular diseases like heart attack and stroke. Water and food borne communicable and toxin related diseases are also still prevalent. Food practice in the country is undoubtedly playing a huge role in this regard. Scant attention is being paid to food safety in general and child nutrition in particular. A serious attempt to reverse this alarming situation is the need of the hour. Authorities, Organisations and Citizens have to be aware about safe and healthy food. Food on one hand should be wholesome and provide adequate calories and nutrients but should never be a reason for disease. The food should be devoid of chemical and biological contaminants. Eating and food procuring habits too need to be healthy. Good quality and affordability are the key requirements to an ideal food culture. Awareness is most important to achieve this. IMA has attempted to produce a comprehensive document reviewing various aspects of food safety keeping local scenario in focus. The fact sheets and guidelines by WHO and other scientific bodies, interview with experts and theme papers prepared by the faculty have been discussed by the expert panel in numerous sittings to arrive at the guidelines published here. Most of the theme papers and documents have been kept as annexure. The views expressed here have been arrived at by consensus and only those where there is common agreement have been published. Many more points have to be pondered further and more data will have to be reviewed. We plan to edit and update this document periodically in order to emerge as the most authentic reference material to guide healthy food habits in our region. We thank the involvement of all the faculty members whose committed work has helped to formulate this document. The editorial board takes great pride in dedicating this document to our citizens' health and wellbeing.

1. Consume balanced food

2. Make your own food plate, do it at each meal

_Using your 12-inch plate, imagine a line down the middle of the plate. Then on eitherside, draw one line

each, perpendicular to first line. Now you will have will have 4 sections in your plate.

_Fill one section with cooked vegetables such as spinach, carrot, green beans, onion, cucumber, raw

banana or any locally available vegetables

_Fill another section with locally available fresh fruits like banana, guava, papaya etc

_In one of the remaining sections put cooked grains such as rice, wheat, ragi etc. Use brown rice and

whole wheat and avoid white rice and white bread. Maida products should be avoided

_And then in the last section fill your protein such as pulses or meat or fish

_Add a serving of diary product (curd, yoghurt), if your meal plan allows

3. Reduce rice servings

6. Do not re-heat food as far as possible.

4. Select locally available seasonal fruits and vegetables

_Encourage use of Green Yellow Orange Red (rainbow revolution) vegetables and fruits

5. Prefer steaming to deep frying

7. Avoid carbohydrate rich food like rice and wheat. Rice yields approximately 70% and wheat yields

approximately 60% of carbohydrate. Any excess carbohydrate is converted to fat by the liver and is

stored within itself or as visceral fat primarily in the anterior abdominal wall.

8. Child nutrition deserves special attention

_Initiate breast feeding within 30 to 60 minutes of birth

_Exclusive breast feeding for first 6 months; continue till 2 years of age

_Ensureproper and adequate breakfast

_Prevent fetal and post-natal over nutrition

_Fetal under-nutrition and post-natal over-nutrition may lead to early heart attack and stroke

_Avoid junk- foods (HFSS- High Fat, high Salt, high Sugar)

9. Ensure safe and healthy food at schools

_Avoid serving junk foods at school canteens- through awareness; bring in legislations if required

_Use stainless steel/glass/high quality plastic water bottles

_Avoid HFSS (High Fat, high Salt, high Sugar); replace with traditional food and snacks- table below

_Remember that 'French fries' is not a vegetable

10. Restrict Salt intake

_Processed and restaurant food is major source of salt

_Salt content in Chinese sauce and other additives are very high

_Please note that Sodium is present in many forms in food items; and not just as salt (sodium chloride)

_You should check the labels of foods to find out which ones are high and low in salt content.

i. If the label has more than 1.5g of salt (or 0.6g of sodium) per 100g it is a high salt content food.

ii. If it has 0.3g of salt (0.1g of sodium) per 100g then it is a low salt content food.

iii. Anything in between is a medium salt content food.

11. Sugar

_Sugar is not an essential nutrient and hence can be avoided

_If consumed, total sugar intake including those in sweets and sweetened items should be

i. Less than 9 teaspoons (36 gm) in males,

ii. Less than 5 teaspoons (20 grams) for females and

iii. Less than 3 teaspoons (12 gms) for children

12. Fats and oils

_Choose healthy fats in small amounts

_Restrict and rotate oil

_Do not re-use oil

_Avoid trans-fats (vanaspathi, ghee)

13. Meat

_Increased fat in white meat (chicken) is a big concern

_Removing skin before preparing poultry reduces fat content

_Any meat should be consumed only in moderation

14. Fruits and vegetables

_Local and seasonal fruits and vegetables with minimum preservation should be preferred

_Fruits from distant destination like apples cannot be recommended

_Guava, bananas and mangoes are more recommendable

_Vegetables like cauliflower, cabbage etc. which are not grown locally cannot be recommended

_Locally grown vegetables like drum stick, bitter guard, snake guard, brinjal, cheera, lady’s finger etc

are recommended

_Green leafy vegetables like spinach and drum stick leaves are highly recommended

15. Homestead farming and group farming should be promoted by governments and institutions

16. Ensure clean cultivation

_Crops are to be rotated through the fields to replace nutrients in the soil.

_Maximize water infiltration; manage ground and soil water by proper use

17. Consume safe Fish

_Small fishes are much better than larger ones

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_Procure from places with no preservative contamination and consume fresh

18. Before purchasing packed milk, watch for labels regarding pasteurization and toning

I. Pasteurized homogenized toned milk with milk fat 3.0% - for tea/coffee

ii. Pasteurized standardized milk with milk fat 4.5% - ideal for the preparation of deserts and sweets.

iii. Pasteurized toned milk with milk fat 3.0% -mostly aimed for consumption by children in the form of milk.

iv. Pasteurized double toned milk with milk fat 1.5% - ideal for elderly people and for weight reducing

diet and diet for hypercholesterolemia

19. Five keys of WHO for food safety should be ensured

_Keep clean

_Separate raw and cooked

Cook thoroughly

_Keep food at safe temperature

_Use safe water and raw-materials

Learn to understand food labels

_Look for veg or non-veg label

_Check for the expiry date before purchasing the food product

_Be sure about the servings (most packed items are meant for 2 or more servings)

_Clearly read the nutrition contents and understand them properly

_If sodium is listed on the label’s nutritional information instead of salt you have to multiply the

amount by 2.5 to get the equivalent salt content. For example, if a portion of food contains 1g of

sodium per 100g, you will know it contains 2.5g of salt per 100g

21. Avoid re-use of plastic containers for food and water. Do not use plastic containers for re-heating

purpose unless it is specifically meant for

22. Indiscriminate use of agro-chemicals are toxic and hazardous

_Prefer food with minimum preservatives and chemical contaminants (local and seasonal food with

minimum preservation should be preferred)

_Food colors, stabilizers preservatives etc. lead to extra contamination

23. Frozen dessert is not ice-cream

_Ice-creams are milk-based whereas frozen desserts which are fat based are unsafe and hence cannot be recommended

24. The practice of consuming accepted food items in excess, as a cure for diseases is wrong and is

discouraged. For example, Irumbanpuli (Chemmeenpuli) in excess can cause renal failure. Avoid scam

claims like “it cures cholesterol”. In a small amount it is consumable for curry but avoid “Irumbanpuli

juice” as a medicine

25. Pay attention to food safety norms and regulations

_Gather more information at www.foodsafety.kerala.gov.in

_Bring violations to the notice of authorities, by calling at 1800 425 1125 (Toll Free)

26. Practice methods to reduce food contaminants like pesticides

_Follow recommendations of Kerala Agricultural University (please see the annexure for details or

write to

_Remember these methods can remove externally applied chemicals/pesticides only and cannot

reduce pesticides/chemicals used systematically

27. Restrict calories and prevent over-weight

_Limit carbohydrate (rice, wheat, packed cereals) and fat (oil, meat, fried items) intake

_Consume plenty of safe fruits and vegetables

_Ensure adequate protein intake (egg white, small fish, pulses, milk and meat in moderation)