Tuesday, February 17, 2009

Processing Polished Rice: A Reflection on Diet and Health in Kathmandu

While Nepal has become famous for the Himalayas, no less impressive is the mountain or rice that most Nepalis eat as the centerpiece of their twice-daily meal. 

Not long ago the shades of wholesome varieties of rice in the market and on peoples’ plates ranged from reds to dark and light browns.  The machine-polished rice oftoday is as white as the snow capping the Himalayas themselves.  While Kathmandu’s rapid modernization has left the agricultural hardships associated with hand-hulled, less processed red and brown rice behind, the consequences of a new addiction to overly processed foods includes a Type 2 diabetes epidemic which affects close to one third of the Kathmandu Valley’s population.

According to a study conducted by the Nepal Diabetes Association, while only 3-4% of Nepal’s rural population is affected, 18% of Kathmandu’s urban population over the age of 40 has Type 2 Diabetes, and an additional 10% suffer from a pre-diabetic state called Impaired Fasting Glycaemia1 underpinned by insulin resistance. The term “Syndrome X” or “Metabolic Syndrome” has been coined to refer to a host of interrelated symptoms including obesity, high blood pressure, and high blood fats levels—the underlying cause of these symptoms being insulin resistance.  The conditions of Metabolic Syndrome pave the road to diabetes and other related conditions like heart disease, eye problems, kidney failure, and limb amputation, just to start the list. Over the last five months, through interviews and informal conversations, I have been researching the dietary habits and conceptions of food in Kathmandu that I relate to the onset of Metabolic Syndrome in Nepal.

The body converts most foods we eat into glucose. Whereas sugar, along with processed carbohydrates like white rice and white flour, convert very quickly, whole grains like brown rice, wheat, corn, and millet are converted more slowly, and vegetables and beans are slower still. Over the course of years, as people continue to overdose on highly refined, rapidly digested carbohydrates like white rice, the body’s ability to deal with so much glucose wears out.Overwhelmed by too much insulin (produced to lower otherwise harmfully high blood sugar levels), glucose-burning cells become resistant to insulin, thus inducing the complications of Metabolic Syndrome.

Until quite recently people in Kathmandu spent much more time walking, doing physical house and agricultural work, and playing outdoors.  Although peoples’ physical activity has dramatically decreased, the average amount of food and total calories people eat has remained the same if not increased. Daal-bhaat, the traditional Nepali meal usually consisting of a staggering amount of rice and a far smaller portion of lentil soup and vegetables, is relatively well-suited to someone engaged in physical activity—as it provides an abundance of energy for a hard worker—but it is a recipe for disaster for those who live sedentarily and also indulge in a lot of meat, alcohol, and modern junk foods.

Considering how deeply ingrained rice is in Kathmandu, eating rice in its healthier less processed forms should become a priority. The dhiki is a device traditionally used for hulling rice in Nepal actively present even in central Kathmandu until about 45 years ago.  The dhiki’s physically intensive process of beating rice with a heavy beam of wood removes the inedible hull of rice but leaves partially intact the nutrient-rich bran and germ layer below which give the whole grain its distinctive flavor, color, and health benefits.  The modern machine mill processes rice with far greater speed and with hardly any physical effort but strips away the bran and germ leaving only almost entirely plain starch remaining. White rice lacks the vitamins, minerals, and fiber found in the bran and germ that are necessary for proper and slow digestion of the whole grain.  As one Nepali woman told me “We no longer have the hardships of the past, but we suffer with new diseases.”

White rice of course, is not the only problem. White flour, as opposed to whole-wheat flour, has become the main ingredient of most snack foods found in Kathmandu

—momos, chowmein, chow-chow/ wai-wai noodles, naan, puri, samosas, biscuits, and bakery products. Sugar-sweetened Nepali tea with biscuits is of course a quintessential Nepali snack. The increasing popularity of these junky snack foods among the city’s youth threatens public health even more severely than the mountains of white rice synonymous with daal-bhaat.

Everyone I have talked to about rice hulled by the dhiki says that it is incredibly tasty, filled with flavor and healthier than that milled by the machine.  What most Nepalis do not know, however, is that machine mills can produce brown rice (unpolished rice), which is in fact available at many stores in Kathmandu. Unfortunately brown rice is relatively hard to find and nearly twice the price as the fully polished varieties, from which the removed bran and germ have been sold and added to animal feed.

When I talk to Nepalis about this sort of unpolished rice it does not seem very appetizing to them. “It isn’t tasty,” many say, because they think the rice would be “hard” texturally and “bland” in flavor.  

The irony is that many of the city-people who say this have never tasted unpolished rice before, so how would they know? Regardless, the habit of eating white rice, like any deeply rooted habit, is a very hard one to change.  The same Nepali health professionals who explain how difficult it is to make vegetables a more prominent proportion on the dinner plate, simply because of habit, also tell me how once they started eating brown rice, white rice was never as satisfying again—neither for their taste buds nor their stomach.

The attitudes taken towards unpolished rice by many people living in Kathmandu are similar to those that they take toward dhido, a traditional staple food of Nepal. Dhido is cooked with the flour of whole grains such as buckwheat, millet, corn, and wheat. Those who have a habit of eating it enjoy its more complex flavors and its hearty nature.  

Dhido is widely recognized by nearly all Nepalis to be more filling (after eating you don’t get as hungry as soon), and healthier for the body.  (It is also the exact kind of whole grain food that dieticians recommend for the prevention and treatment of Metabolic Syndrome.) Those who don’t have a habit of eating it however don’t seem to take any interest in it at all.  When I ask some people whether they eat dhido, an almost disgusted and shocked look comes over their face as if to say ‘me? Eat that stuff?’  They reply “No, not really,” “I eat it every once in a while, a few times a year,” “it’s too hard to cook,” “dhido is bland, I prefer rice.”

In many ways, while unpolished rice and dhido symbolize the antiquity of village life and a way of eating that has nourished hundreds of generations who never suffered from insulin resistance, white rice symbolizes the modernity born from industry and an era of unprecedented metabolic illness.  I am not suggesting that everyone in Kathmandu beat their rice with a dhiki, but my research shows that the wellbeing of urban Nepal depends upon a shift of consciousness and habit.  The foods from the past (and present for the millions who still enjoy whole grain foods regularly) should not become relics, but rather the keystones of a modernity that champions wholesome awareness instead of refined ignorance.

1 Singh, Dr. D.L; Diabetes- Care and Management; “Understanding Diabetes Mellitus”; Nepal Diabetes Association, Rotary Club of Nepal, 2006.


Rosa said...

This was so interesting to read! I just took a nutrition class last semester and learned all about Metabolic or Syndrome X so I understood what you were talking about. Miss you!

aytowler said...
This comment has been removed by the author.
Shiva Ram said...

Namaste Alden
Tapai le lekheko ekdam ramro chha. Yo kura tapai le local magazine ma leknuhos lo.

It's very good article. You have to publish it in local magazine for the betterment of public health.

Shiva Ram Khatiwoda,
Ayurveda Campus, TU/IOM
Kirtipur, Nepal

Shiva Ram said...

Pusa Raj Poudel has this comment:

Jay Ayurveda!

Alden, your article presents the reality at the moment.
I support u. And the people in kathmandu, and in Nepal, should heed your facts, our advice.

Puspa Raj

Dane said...

Alden, so interesting man. Why do you think the less refined, unhulled, yet also mechanized, rice costs more and is harder to get? One would think that because less work goes into producing it, aka, less manufacturing time, that it would be cheaper. Is it perhaps because they don´t get to sell the other parts for profit: like you said for animal feed and so charge more? anyway man, can´t wait to read more, also the last line, wholesome awareness versus refined ignorance...great. (this is dane btw)

ujwal said...

Hey Alden!
I am a graduate of BSc Biochemistry (4-year Degree). I've recently conducted a research entitled "Prevalence of Metabolic Syndrome in Nepal-A representative study carried out among the patients visiting the Nepal Police Hospital, Maharajgunj, Kathmandu". It has been accepted for publication in one of the National Medical Journals, and also I am going to present it at a national level conference on Diabetes- shortly going to be held.I am admired by your research work and at the same time I feel my work may be of some use to you.I will be more than happy to share you my article and also eager to meet and talk to you.

If interested the contact me at:
Cell No.+977 9841579740

rashmi said...

nicely written/explained.

sorry could not come to the workshop today due to trafic jam.

Rashmi Shrestha

Nepalien said...

Great article..
Brown rice and even parboiled rice taste so filling than white rice. I have yet to try red rice fro Bhutan which I bet is even more nutritious. Shame on fast food industries that just want to make quick bucks neglecting health consequences of those who consume their substandard products.

sujita said...

Very nice article. Never thought about this when people complain about the obesity and new health problems in Nepal. Growing up i remember how "brown rice" and "dhido" was looked down upon. We were so wrong!Thank you for publishing this article.

Karen Moore said...

Thank you for a great article. I am studying nutrition at uni in Australia and visiting Nepal (from Kathmundu to Upper Mustang) for the first time. Nepal is incredibly beautiful, rich in culture and the people warm and friendly. You answered my question about why white rice is a dominant staple food. It s sad that regulation making brown rice the same price as white rice, along with health education promotion on the health benefits of brown rice, is so difficult to implement. Unfortunately the food industry needs better regulation in line with population health worldwide! I plan to come back to Nepal to do voluntary work. My email is krnmoore325@gmail.com.