This observation isn’t some influencer propagated “truth bomb” or unpopular opinion but a scientific fact that has emerged from the Indian Council of Medical Research (ICMR)–India Diabetes study published in the journal Nature Medicine in late September. The national cross-sectional population-based survey covered 18,090 adults (both vegetarians and non-vegetarians) with a median age of 40 years and was conducted from November 2008 to December 2020. The study states that various surveys conducted by Indian government agencies indicated that Indian adults currently consume about 65-75% of calories from carbohydrates, which is among the highest in the world. Protein makes up only 9–11% and fats constitute 14–23% of the Indian diet.
This carb-heavy and protein-light diet is one of the biggest reasons why India is the diabetes and pre-diabetes capital of the world. It is also responsible for the phenomenon known as “thin-fat” Indian: one who appears lean but has too much visceral fat around the belly while lacking muscle mass, say doctors, nutritionists and dieticians.
“Most Indian plates are 60–65% carbohydrates, largely from refined rice and wheat. This causes repeated spikes in blood sugar and insulin, promoting fat storage, fatty liver, and insulin resistance. Over time, it raises the risk of obesity, pre-diabetes, and type-2 diabetes,” explains Dr Swati Maheshwari, additional director for internal medicine, Fortis Hospital, Manesar.
A PLATEFUL OF TROUBLES
India’s eating habits can broadly be categorised into vegetarianism, ovo-vegetarianism, and non-vegetarianism. “The Indian vegetarian diet includes dairy but excludes meat, fish, and poultry. Ovo-vegetarians eat eggs but not meat or fish. And among non-vegetarians, meat consumption tends to be infrequent. India’s diet has always revolved around cereals, with clear regional preferences. In the southern and eastern states, rice dominates while the northern and western regions prefer wheat,” notes Aishwarya Kumbhakoni, consultant dietician for diabetes, Kokilaben Dhirubhai Ambani Hospital, Mumbai.
To be clear, carbohydrates are key to a healthy life as they are our primary source of energy. The brain functions almost exclusively on carbohydrates. “Carbohydrates are not the enemy. They are a necessity for energy. But when two-thirds of the plate is chock full of polished rice, refined wheat or ultra-processed foods, that is when trouble begins. This [nutritional] imbalance, which is closely based in cultural eating patterns and economic circumstances, is beginning to be felt by people now,” says Chaitanya Vijay Yerawadekar, a nutrition expert at Cult Fit.
A low intake of pulses, dairy, eggs, fruits and vegetables means many Indians are calorie-sufficient but protein- and micronutrient-deficient leading to the double burden of malnutrition and obesity, adds Maheshwari. Unlike protein, refined carbohydrates are metabolised rapidly, causing rapid spikes in blood sugar and insulin levels, before crashing back down causing food cravings, overeating and fatigue. “Over time, this pattern leads to insulin resistance, belly fat and chronic inflammation, all precursors to metabolic disorders,” says Yerawadekar.
According to a review by the National Institute of Nutrition (NIN), nearly 80% of urbanites were deficient in vitamin D, 60% in iron and 40% in vitamin B12. “Low protein intake affects muscle maintenance, metabolism, and immunity, while insufficient healthy fats reduce absorption of fat-soluble vitamins (A, D, E, K),” explains Aishwarya Kumbhakoni, consultant dietician for diabetes, Kokilaben Dhirubhai Ambani Hospital, Mumbai. She further notes, “Our micronutrient intake is also inadequate as our diets often lack iron-rich foods, calcium, and other vitamins and minerals that we get from fruits, vegetables, and nuts. This imbalance leaves the body short on essential nutrients.”
CHANGE DIET AND GUIDELINES
Given that ICMR’s study has formally confirmed what many health and nutrition advocates and medical experts have known all along, doctors, nutritionists, and dieticians whom Lounge spoke with are clear that India’s formal nutrition guidelines must change. What also needs to change, urgently, is what Indians put on their plates without giving up the carbs they love — rice, roti, dosas, and dal. The trick lies in restoring balance to Indian meals.
“Current guidelines still focus on calorie adequacy, not quality. The guidelines should pivot from calorie adequacy to macronutrient quality and food systems. New guidelines must lower recommended carbohydrate share to about 50–55%, raise protein (20%), and promote millets, pulses, and healthy fats. Public food programmes should subsidise pulses and dairy, not just rice and wheat, so that balanced nutrition becomes affordable,” says Maheshwari.
The study also found that merely replacing refined cereals with whole grains didn’t lower the risk for metabolic syndrome but substituting carbohydrates for plant, dairy, egg or fish protein was associated with lower likelihood of type-2 diabetes and prediabetes.
“Our traditional thali with dal, sabzi, roti and rice already provides the frame work for balanced nutrition. What’s missing is proportion. By reducing refined carbohydrates, giving protein the attention it deserves, and making our plates more colourful [by adding whole fruits and vegetables], we can start reversing the current crises of diabetes, obesity and malnutrition. The changes are not foreign or expensive. The remedy is right there on our plates, waiting to be rediscovered and rebalanced,” says Yerawadekar.
It is clear that public health strategies that reduce overall carbohydrates and saturated fat while increasing intake of plant and dairy proteins could mitigate the risk of metabolic diseases in India, but the real challenge lies in implementation of these strategies and creating enough public awareness to get people to change their food habits.
“For guidelines to be truly effective, they must be accessible, culturally relevant, and easy to adopt. Public health initiatives should focus not only on what to eat but also on how to integrate healthier choices into daily life. Also, following a prescribed diet alone is often insufficient — holistic lifestyle changes are essential. This includes regular physical activity, balanced meals, portion control, and mindful eating,” says Kumbhakoni.
SEVEN STEPS TO EATING HEALTHY
- Cut carbs portions: Keep the rice/roti but reduce portion size by about 25%, add a protein portion and a cooked vegetable.
2. Follow the 50-25-25 rule: Half the plate should be vegetables and salads (for fiber and micronutrients), one-quarter protein (paneer, curd, sprouts, eggs, tofu, animal protein or dal) and one-quarter carbohydrates (rice, roti or millet).
3. Increase protein density: Eat 100-200ml of unsweetened curd/yogurt, paneer or milk per day. Aim to eat about two small bowls of lentils, chickpeas, rajma and moong per day. Soy and tofu are excellent sources of high-quality plant protein. For non-vegetarians, one egg a day is the bare minimum and aim for at least three meals per week with fish or lean meat.
4. Improve carb quality: Replace refined white rice partly with brown rice/millets/mix grain. Choose whole-grain atta. Avoid sweetened beverages and energy-dense snacks such as ultra-processed foods.
5. Add fruits and greens: Add fruits and greens for fibre and micronutrients.
6. Reduce sugar: Cut down on sugar and packaged sweets incrementally.
7. Use healthy fats: Use a mix of mustard, groundnut, sesame or rice-bran oil for cooking. Avoid vanaspati and do not reuse cooking oil.
Shrenik Avlani is a writer and editor and the co-author of The Shivfit Way, a book on functional fitness.
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