Dietary Practices

Rice remains a dietary staple for Hindus from Southern India, and wheat for those from Northern India. Many older Hindus are vegetarians or vegans. Chicken, mutton (lamb), and fish are consumed by Hindus who are not vegetarians. Traditional Hindus rarely eat beef. Traditional Muslims rarely eat pork. As gelatin is manufactured by processing the collagen in cow or pig bones, hooves, and connective tissues, traditional Asian Indians (especially Hindus) may refrain from eating gelatin-based products like jello, certain yoghurt which are stabilized using gelatin and marshmallow.

Muslims will consume halal yoghurt and other halal meats. Similar to kosher, halal denotes foods that are religiously acceptable according to Islam. In extreme cases, some traditional Asian Indians may even refuse porcine insulin and bovine insulin, though these instances are extremely uncommon. Globalization and acculturation to American ways have had a strong influence on Asian Indian dietary habits.

Fasting

Fasting frequently is a common practice among older women and vegetarians. It is done because of religious belief that it improves the welfare of the family. Health providers should inquire about these practices and help the patient practice their religious customs with while being working with them to mitigate adverse effects on their health. A balanced approach towards nutrition should be taught based on the cultural diet of the patient.

Hot vs. Cold

Like in other Asian cultures, foods including vegetables are classified as being either “hot” or “cold” based on the ways they change the body (Ramakrishna & Weiss, 1992).

Vegetarianism and High Fat Intake

The vegetarian diet is rich in carbohydrates, poor in protein, and often deficient in calcium. Thus, older adults are at risk of nutritional deficiency and osteoporosis. The typical Asian Indian diet averages 56% of energy intake from carbohydrates, 32% from total fat and 8% from saturated fat. The high fat intake is associated with obesity and low leisure time activity.

Betel and Tabacco Use

LEFT: Display of the items used in a paan chewing session, often the cause of sub mucosal fibrosis. The betel leaves are toward the bottom center and folded. The upper left shows slices of the dry areca nut, while the upper right displays slices of the tender areca nut. A pouch of tobacco is shown on the far right; tobacco is a recent introduction to the chewing of paan. Source: Wikipedia. Public Domain. RIGHT: Close-up of a betel leaf.

Older Hindus may consume betel leaves (Piper betel Linn). Betel leaves, which are the main ingredients in paan or tambool that Hindus chew, are thought to be carminatives with antiflatulent and anti-inflammatory effects. In Ayurvedic medicine, betel leaves are used as an aphrodisiac. Many chew non-smoking tobacco and areca nut with betel leaves, which puts them at risk of oral submucosal fibrosis, and therefore oral cancer (Ahluwalia, 2005).

Oral Submucous Fibrosis

Oral submucous fibrosis (OSMF) is associated with progressive juxtaepithelial fibrosis of the oral mucosa, the oropharynx, and rarely, the larynx.

It may manifest as discoloration, loss of suppleness and even ulceration of the oral mucosa. The patient may report trismus, burning sensation in the mouth at rest with exacerbation during eating or drinking, reduced mobility of the tongue, altered taste and inability to eat the traditional Indian diet including hot and spicy foods.

OSMF is typically caused by the common Asian Indian habit of chewing paan masala. Paan is a mixture of spices including, Areca catechu (areca palm or areca nut palm), betel leaves (Piper betle) belonging to the Piperaceae family, menthol, cardamom, calcium hydroxide (lime) and optionally chewing tobacco. The areca nut contains the alkaloid arecoline, which promotes salivation (the saliva, gums and teeth are stained red). It is thought to aid digestion, freshen the breath and also have aphrodisiac properties. Chewing paan is a social activity and has both ceremonial and symbolic value in the Asian Indian culture.

Arecoline, an active alkaloid found in betel nuts, stimulates fibroblasts to increase production of collagen. Paan chewing causes a juxtaepithelial inflammatory reaction in the oral mucosa eventually resulting in submucous fibrosis. OSMF is a pre-cancerous condition. Paan is one cause for the increased incidence of oral cancer in South Asia (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2486725/pdf/bullwho00417-0150.pdf).

Diabetes

Asian Indians, in particular immigrants, are at high risk of insulin resistance leading to diabetes mellitus type II, and dyslipidemia, which causes increased visceral adipose tissue and eventually coronary artery disease (CAD). (Petersen et al., 2006; Abate, 2007). Several factors have been attributed to this increased incidence:

• ethnic predisposition

• diet

• exercise

This is further aided by the belief of the older Hindu generation that the Ghee (pronounced “g ”), or clarified butter, strengthens the body and promotes good health.

Lactose Intolerance

Lactose intolerance is very common in older Asian Indians. The incidence of lactose intolerance is more common in Southern Indian population (66%) than those in Northern part of India (27%) (Tandon et al., 1981).