The details of the first IAMD, which has been developed using locally available anti-inflammatory ingredients, were published in the BMC Nutrition last week.
Detailing their work, the researchers noted that while traditional Indian diets have several anti-inflammatory ingredients similar to a Mediterranean diet, current Indian dietary analysis reveals high consumption of cereals with low legume, nut, fruit, and vegetable intake.
As part of the project, the researchers carefully compiled anti-inflammatory Indian food ingredients and incorporated them into routine diets, calorie- and nutrient-specific diet plans with a seven-day cyclic menu with North Indian recipes, aligning with Mediterranean diet principles.
“Anti-inflammatory diets with low Dietary Inflammatory Index or DII scores have been shown to be beneficial to heart health, mental health, lower incidence of dementia and certain cancers like colon and breast cancer and (result in) overall greater longevity,” said Dr Ambuj Roy, professor of cardiology at AIIMS and principal investigator of the project.
DII is a numerical score that assesses the inflammatory potential of a person’s diet. It’s designed to quantify how a diet might contribute to or counteract inflammation in the body, based on scientific research.
A more negative DII score suggests a diet that is more anti-inflammatory, while a more positive score indicates a pro-inflammatory diet. The researchers found that the current DII of the diets consumed by CAD patients ranged from -1.8 to 3.8, with a median score of 1.1.
The DII scores of the developed diet plans ranged from -7.8 to -8.4, with a median of -8.0, approaching the theoretical maximum anti-inflammatory score.
The efficacy, acceptability and feasibility of the IAMD is now being tested on 140 patients at AIIMS, Roy told ThePrint. Nearly half of them are CAD patients.
The CAD is a condition where the arteries supplying blood to the heart muscle become narrowed or blocked, usually due to a buildup of plaque. This plaque buildup, called atherosclerosis, restricts blood flow, potentially causing chest pain, shortness of breath, and, in severe cases, heart attacks.
Poor dietary patterns, along with sedentary lifestyle, obesity and family history, has been identified as major risk factors for CAD that makes people susceptible to heart attacks and strokes. Data from 2019-2021 indicates its prevalence ranging from 7 percent to 13 percent in urban populations and 2 to 7 percent in rural populations.
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Finding Indian substitutes of Mediterranean ingredients
Considered one of the most well-researched dietary patterns globally, the Mediterranean diet is inspired by the eating habits and traditional foods of Italy, parts of Greece and the Mediterranean coasts of France and Spain.
This diet emphasises plentiful intake of plant-based foods mainly unprocessed cereals, legumes, vegetables and fruits, healthy fat (from olive oil and nuts), moderate consumption of fish and dairy products and restricted amounts of red meat, refined grains and sugar.
These diets are rich in plant-based compounds polyphenols (flavonoids, anthocyanin, lycopene), antioxidants like vitamin C, vitamin E, fibres from whole grains, and omega-3 fatty acids. All of these are anti-inflammatory and are good for gut health, pointed out Suparna Ghosh Jerath, nutrition researcher from The George Institute who is associated with the IAMD project.
The researchers noted that except for quinoa, cannellini, and fava beans, the whole grains and legumes found in the Mediterranean diet were also present in North Indian cuisine.
In the IAMD, broken whole wheat and local rice varieties (Basmati) were substituted for bulgur and farro, respectively, and maize flour was added instead of polenta. Extra virgin olive oil was partially replaced with the more culturally acceptable and available mustard and peanut oils.
Some condiments and spices in the Mediterranean diet, like thyme, rosemary, and marjoram, were supplemented with other herbs and condiments used in Indian cuisine, such as Indian basil (Tulsi), carom seeds (ajwain), turmeric (haldi), nutmeg (jaiphal) and mace (javitri).
Similarly, the green leafy vegetable list was supplemented with Chenopodium Album (Bathua), amaranthus viridis (Chaulai), fenugreek leaves and radish leaves.
Using the food exchange list, a comprehensive diet plan was developed for calorie-specific plans and different caloric planning depicted a balanced nutrient approach, with around 15 percent of the energy derived from proteins, 25–30 percent from fats, and 50–53 percent from carbohydrates.
A meal pattern was developed for each calorie-specific comprehensive plan, where exchanges were distributed into six meals: three major (breakfast, lunch, and dinner) and three minor (early morning, mid-morning, and evening tea).
This meal pattern was then developed into a seven-day cyclic menu plan utilising the foods listed under IAMD for five calorie-specific plans; 1200 kcal, 1400 kcal, 1600 kcal, 1800 kcal, and 2000 kcal, which could be prescribed to the patients based on their nutritional requirements, said Dr Archana Singh, a professor of biochemistry who is also a key researcher in the project.
Suggested diets, Singh said, are very similar to habitual diets with the replacement of some of the pro-inflammatory foods that we tend to include in our diets with anti-inflammatory ones.
“A healthy adult can consume this diet and we encourage the whole family to consume the same food. This makes it sustainable and also benefits the entire family,” she said.
Improving the anti-inflammatory components of the diet may significantly blunt the growing burden of non-communicable diseases which needs to be studied in large implementation trials, Roy underlined.
The researchers have also developed a website for wider dissemination of the information.
Turning back to tradition
“If we look at our traditional Indian diet and the ingredients that we use, it includes a diverse range of plant-based foods, including diverse green leafy vegetables, other vegetables, whole spices and colourful local fruits,” said Jerath.
Yet, currently most people seem to be consuming high amounts of cereals with low legumes, nuts, fruits, whole spices, condiments, and high industrially processed foods which are laden with additives, she said.
“So, bringing back our traditional food plate will itself be an Indian anti-inflammatory diet. Based on this, we decided to conceptualise a diet that has all the nutritional attributes of the Mediterranean diet and is traditionally consumed and prepared the Indian way,” Jerath said.
Objectively assessing their inflammatory potential by calculating their DII score validated that diets consisting of Indian recipes utilising the key anti-inflammatory ingredients are as cardioprotective as MD, she added.
As part of the IAMD plan, the researchers are now suggesting increasing local and seasonal vegetables, green leafy vegetables and colourful fruits such as citrus fruits, local berries which are rich in vitamin C, vitamin E and vitamin A, all antioxidants and anti-inflammatory.
They are also rich in phytochemical which have anti-inflammatory properties.
The researchers also asked CAD patients to consume healthier oils such as mustard oil, peanut oil,and rice bran oil for preparing food. They also asked them to use healthy nuts and fish, all rich in omega 3 fatty acids.
There is also emphasis on using herbs, garlic, ginger, condiments the way they were used traditionally and consuming high fibre cereals, like multigrain flour, millets, whole pulses as part of the daily diet.
In addition, CAD patients have been advised to reduce sugar and enjoy the natural sweetness of fruits like local berries, while avoiding ultra-processed foods, the ones that cannot be prepared in a kitchen as they have additives and other chemicals that can cause inflammation.
‘Boiled, extremely restricted diets counter-productive’
It is often seen, according to food researchers, that following cardiac events, patients and their caregivers and even their disease management team—consisting of doctors, dietitians, nurses—over-restrict certain foods that can in fact have a cardioprotective effect.
This needs to be corrected in the therapeutic diets prescribed to cardiac patients, Roy highlighted.
It is very intuitive for most physicians to restrict oils and fat in the diet of patients having an acute heart attack, the cardiologist-researchers said, which comes from the Western origins of heart ailments driven by consumption of high fats especially saturated fat.
Typical Indian diet driving the heart disease epidemic, on the other hand, is a diet rich in carbohydrates, low proteins and low consumption of fruits and vegetables.
In such a situation, researchers have said, restricting fat leads to further increase in carbohydrates in the diet and is counter productive. “We need to heal our system and use diet as a medicine; its anti-inflammatory properties need to be effectively used,” Singh said.
Consuming a zero fat, boiled diet is an extreme step which some patients still follow, she said, adding they need proper counselling and a diet plan that judiciously uses good fats, healthy nuts that would reduce chronic and systemic inflammation.
Researchers are now hoping to expand the development of IAMD beyond North Indian cuisine to accommodate the great diversity of the Indian diet and culinary culture.
(Edited by Ajeet Tiwari)
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