Health and its social determinants

Nutrition in India through the lens of caste

Dr. Sylvia Karpagam

Acknowledgements– I would like to place on record the role of Aahara Namma Hakku in Karnataka. I would also like to thank Dr. Veena Shatrugna and Siddharth Joshi for their inputs. Published in medico friend circle bulletin 381, Caste, Tribe and Religion:
Institutionalized discrimination in health, March 2023,18

Introduction

It should come as no surprise that caste and nutrition are closely intertwined in the Indian context, because that would hold true in many other contexts as well. It is only those who are at the beneficiary end of the caste spectrum who are dangerously unaware of how caste operates in policy, planning, programs, implementation as well as in people’s lived realities. The unofficial imposition of vegetarianism, with the participation of vigilante groups, will have long term implications for the health of Women, children and other vulnerable groups.. The poor, subsisting on a cereal heavy diet with some watery dal through the week, are less and less likely to buy and consume even the weekly minimum recommended 500gms of meat per person. It will result in lower heights, increased anemia, low birth weight and much more. This article looks at nutrition and nutritional outcomes in India through the lens of caste.

Malnutrition crisis in the country

The National Family Health Survey[i] (2019-20) and Comprehensive National Nutrition Survey[ii] (2016-18) paint a dismal picture of nutrition indicators in the country. The repeated attempts to delegitimise international reports and assessments does little to mask the nutritional deficiency in the country.

Indicator Source: National Family Health Survey (NFHS) 2019-21	Percentage %
Non-pregnant women age 15-49 years who are anaemic (<12.0 g/dl)	57%
Pregnant women age 15-49 years who are anaemic (<11.0 g/dl)	52%
Men age 15-49 years who are anaemic (<13.0 g/dl)	25%
Children age 6-59 months who are anaemic (<11.0 g/dl)	67%
total children age 6-23 months receiving an adequate diet	12%
women with a Body Mass Index below normal or less than 18.5 kg/m2	18.7%
Men with a Body Mass Index below normal or less than 18.5 kg/m2	16.2%
Indicator Source: Comprehensive National Nutrition Survey (CNNS) 2016-18	Percentage
Percentage of children aged 0–4 years who were stunted	35%
Percentage of children aged 0–4 years who were underweight	33%
Percentage of Schedule tribe children aged 0–4 years who were underweight	42%
Percentage of Schedule caste children aged 0–4 years who were underweight	36%
Percentage of other backward classes children aged 0–4 years who were underweight	33%
Percentage of other group children aged 0–4 years who were underweight	27%

Nutritional indicators for India (CNNS 2016-18 and NFHS 2019-21)

Children are defined as stunted and underweight if their height-for-age and weight-for-age is more than two standard deviations below (< -2SD) the WHO Child Growth Standards median (WHO, 2009). This essentially means that 1/3 of our children are unable to meet even -2 SD deviation from the WHO standard. This should be brought to the attention of those who are ready to shift standards downwards claiming that the WHO standard is a Western colonial imposition!!!

Anemia in children, and in combination with chronic hunger and other nutritional deficiencies that invariably co-exist, can lead to less than expected performance of the child in school. In a caste and class ridden society, where many government schools fail to meet even minimum educational standards, the disadvantages of children especially from marginalised communities start early in life. If these disadvantages are not picked up and addressed, they become an additional structural barrier to a child’s development.

The myth of Indian vegetarianism comes from a caste prejudice

The frequently bandied myth[iii] that India is vegetarian is more wishful thinking of those whose eternal fantasy is that India is a vegetarian country, rather than any real facts and figures. The fact of the matter is that a majority of Indians love their eggs,chicken,beef, fish etc. spiced with a hint of shame.[iv] This shame comes from the casteist propaganda that not just these foods, but even those who consume them are polluted, unhygienic, ‘lower caste’, criminal, lustful etc. These myths are conveniently reinforced by the corporate West who love the idea of a plant based food consuming, apparently peaceful, non-violent and yoga loving India. People in the West are mostly unaware about the caste system which is conveniently erased by the oppressor caste Indians in these countries – the same Indians who would fight for affirmative action and inclusion based on ethnicity, color and race.

Riding on the back of these myths are unethical cattle slaughter bans and the unethical denial of eggs in mid-day meals to some of the poorest children in government schools. This further manifests in the creation of ghettos of “pure” gated communities while simultaneously denying homes and jobs to meat eaters. Fragile vegetarians demand that all spaces that they occupy (and even those that they don’t occupy) are meat/egg/poultry free.

This push for a vegetarian India agenda pushes a raw (rather cheap) deal for the poor of the country. Researchers, academicians, bureaucrats, media and policy makers, mostly from the oppressor or vegetarian caste groups effectively implement this structural caste based cheap vegetarianism such that all social security schemes related to food are predominantly comprised of cheap cereals and millets, maybe some watery pulses, a few vegetables and little else. Criminalisation and erasure of nutrient dense animal source foods, except for the ‘vegetarian’ milk and dairy, is structural and institutionalised. No professional organisation has thus far raised any objection to this major attack on the right to a cultural appropriate food.

The National Food Security Act (NFSA)[v] has been in place since 2013 and was expected to mark a paradigm shift in the approach to food security, transforming it from a welfare to a rights-based concept. Unfortunately, the law has been reduced to providing the right to mere survival (with the cheapest minimum) rather than the right to a life free of nutritional deficiencies and ill-health.

Some of the discriminatory practices by the state are

Unscientific and discriminatory cattle slaughter ban

Cattle slaughter bans have affected many communities, often traditionally marginalised, who depend on the cattle trade, with no alternative arrangement either for livelihood or nutrition.[vi] The law has led to adverse economic, physical, social and psychological consequences for farmers, transporters, slaughter house workers, curing/tannery/leather workers, loaders/unloaders, cleaners, sanitation workers, butchers, small and large eateries, street vendors as well as a whole gamut of services associated with these. This is delegitimizing many traditional livelihoods and destroying the farming community.

“If India’s politicians had any connect with land and farming, they would understand the organic relationship farmers have with livestock, milk, manure and killing of cattle. It is not a Hindu-Muslim issue as the government is trying to project. This is a farmer’s issue”

A farmer in Karnataka about the cattle slaughter ban

Beef is regularly left out of all discourses around nutrient dense foods, culture or tradition in spite of being consumed by almost 180 million or 15% Indians, which includes dalits, Muslims, Christians, Other Backward classes (OBC), adivasis etc. Lynch mobs have been known to attack poor dalit and muslim men only on the suspicion of transporting cattle or beef[vii].

Institutionalised casteism – the mid-day meal scheme

The National Food Security Act (2013) was envisaged to meet at least a third of a child’s nutritional needs as a legal mandate. Depending on age, the child would have to receive between 450 -700 calories and 12-20 grams of protein in one meal, while also encouraging children in government and government aided schools to eat food together and made with local ingredients.

Although food is mandated[viii] to be cooked in the school, there is a clause which allows for it to be provided from outside if there is no space for cooking in the school. Using this clause, now large corporates have crowded into the mid-day meal scheme, the largest and most influential being the Akshaya Patra Foundation (APF), a trust of the International Society for Krishna Consciousness (ISKCON) which has a clear caste and ideological[ix] prerogative, promoting the pseudo-scientific concept of sattvic foods which are devoid of most spices and criminalising nutrient dense foods such as meat, fish, eggs etc. that are traditionally consumed by marginalised communities. This, combined with the denial of eggs in Mid-day meals in government schools in many states of the country leads to a poor-quality menu devoid of diversity or nutrient dense foods. Apart from that the centralised kitchen churning out bland sattvic food day in and day out, can promote homogeneity but does little for diversity or meal quality. Not surprisingly, children have rejected the food.

The organisation considers onions and garlic in food as “lower modes of nature which inhibit spiritual advancement’ inspite of this being mandated in State government menu. They have been given the contract for centralised provision of mid day meals to several government schools in the country. Coincidentally, research conducted by Central Food Technological Research Institute (CFTRI), Mysuru, shows that the absorption of zinc and iron from cooked food is higher in the presence of onion and garlic.

For a majority (94%) of children in government schools who are from marginalised communities and malnourished, garlic, onion and eggs form an important part of their diets, limited only by the factor of affordability. That these are being denied to them by communities that don’t even attend government schools, is a good example of how caste-based discrimination of children from vulnerable communities is institutionalised.

Parents have complained that children come home and repeat ideological propaganda like garlic is bad for health, or meat will lead to a lack of concentration in studies. Students are told that they should eat vegetarian food in order to develop their brains and get good marks. None of this comes from any scientific basis, it only comes from prejudice. Children can’t take the meats that they eat at home to school because it leads to ostracization and makes them feel like they’re doing something disgusting. When we asked children why they don’t want to demand eggs in school, they say, “We should respect others.” But respect seems to only flow one way. While everyone needs to respect the vegetarian fragility, they themselves are completely disrespectful of the eating habits of others.

Egg politics

Eggs have been denied to children as part of the mid day meals in schools for several years. Described as the ‘menstrual discharge’ of the hen, eggs are labelled as ‘sinful’, ‘violent’, and agitating the senses, with egg eaters deserving to be ‘destroyed’. If, instead of this unscientific propaganda, the nutritional value of eggs had been the primary deciding factor, children would have been given eggs as part of the mid day meal scheme on 5 days of the week. The excessive resistance to the provision of the nutritionally superior egg in mid day meals for school children is just another proof of how prejudice and discrimination win hands down against logic and sound nutritional science.

Corporates promoting plant based foods as saviours of climate change

Multinationals which express concerns about climate change push for corporate dependent fortification shipping pre-mixes from Western countries to India over an indefinite period of time, while in the meantime, completely destroying food sovereignty in the country. The real agenda is that nutrient dense foods of animal sources will be replaced by cheap chemical based ultraprocessed foods manufactured in laboratories and transported by air or ship to countries like India, whose poor are expected to become the mascots of climate action.

The Eat Lancet Commission, driven by billionaires, has set out ‘scientific targets’ to “increase consumption of plant-based foods and substantially reduce consumption of animal source foods” and lauds India for being a ‘good example to show the world’ about plant-based foods. Vegan activists in India whether showcasing voices of dalit, Adivasi or other marginalised communities end up on the same side of the table with the billionaires deciding what food is best for the world.

However even the Eat Lancet Commission is unable to deny that plant- based foods are nutritionally inadequate for ‘vulnerable groups’ and they exclude children between 0-2 years from their plant-based recommendations.

The report also goes on to say that because of menstrual loss, adolescent girls are at risk of iron deficiency and that the solution would be multivitamin or multimineral preparations which are ‘less expensive’ and without ‘adverse consequences of high red meat intake’. Ignoring the benefits of red meat in the prevention and management of anemia, the authors of the Commission report sidestep the adverse effect of iron tablets and promote that for routine intake by adolescent girls. It is simplistic to assume that a complex physiological process of hemoglobin formation which performs the crucial role of carrying oxygen to the organs can be ensured by replacing one mineral (iron). So literally, nutrition that can be obtained from food has now shifted to being obtained from a bottle !! Ironically this groups recommends higher calorie intake from sugars as compared to any meat!

Apart from these adverse decisions, there have been clamours for erasing meat and eggs from public spaces.

The casteist nature of nutrition policies in India are visible in many forms. The idea that dalit, Adivasi and OBC children should be grateful for whatever food is ‘given’ to them is deeply ingrained in the minds of doctors, activists, researchers, policy makers and pretty much the entire gamut of citizens in the country. The idea that children have inviolable rights to healthy, nutritious, tasty, clean, culturally relevant food is lost on most people who claim these same rights only for themselves. This is the crux of how caste discrimination operates in India. It is of utmost importance that dalit, Muslim, Adivasi, Christian communities etc. that consume (and enjoy) eggs, beef, pork, fish, poultry etc. come together to reclaim their food sovereignty and challenge the hegemonic imposition of nutritionally inferior ‘sattvik’ or cheap vegetarian foods. The basis for nutritional policies and health educational messages should be science and not ideology or propaganda. There should be investment into traditional nutrient dense animal source foods that are subsidised and accessible. Cattle slaughter bans across the country have to be lifted and eggs have to be provided to all children who are traditionally used to consuming eggs on at least 6 days of the week. This is the only way to improve diversity of food consumed and increase quantities consumed. This in turn is the only sustainable and certain way of addressing malnutrition. Corporate dependent fortification, processing/ultra-processing, packaged foods etc. cannot be offered as solutions because they are not.

There is very little representation of vulnerable communities at policy making levels in India. Corporates, multinationals and caste groups collude to make decisions which are mostly exploitative or extractive of natural resources and human labour and do not benefit ordinary people. These decisions are not transparent or accountable, often made behind closed doors. We see the devastating impact of this in decisions around natural resources, education, livelihood, nutrition, healthcare. Foregrounding of community choices, local traditional and cultural foods often coincides with sound nutrition science.

[i] India Fact Sheet, National Family Health Survey (NFHS)-5, 2019-20, Ministry of health and Family Welfare, International Institute for Population Sciences

[ii] “Comprehensive National Nutrition Survey” (2016-18), Poshan Abhiyan and National Health Mission, Ministry of Health and Family Welfare, Government of India

[iii] Natarajan and Jacob ((2018) ‘Provincialising’ Vegetarianism Putting Indian Food Habits in Their Place’, Economic and Political Weekly, Vol. 53, Issue 9.

[iv] Aggarwal P (2016): ”Caste on Your Plate: A Tale of Food Snobbery in India’ The Quint, 8^th August 2016

[v] National Food Security Act, 2013, § 15(1), No.20, Acts of Parliament, 2013(India).

[vi] Karpagam and Joshi (2021): “Criminalizing Livelihoods, Legalising Vigilantism: The Adverse Impact of the Karnataka Prevention of Slaughter and Preservation of Cattle Act, 2020” Ahara Namma Hakku

[vii] Nair S (2017): “The Meaning of India’s ‘Beef Lynchings’” The Atlantic, July 4^th 2017.

[viii] Press Information Bureau (2011): ‘Centralised kitchens in mid-day meal scheme’ Ministry of Human Resource Development, Government of India, 11^th March 2011

[ix] Karpagam and Prasad (2018): “ISKCON-run NGO refuses to follow Karnataka order to include onion, garlic in mid-day meals’. Scroll.in, 12^th December 2018

Is Veganism More Ethical Than Eating Meat?

This week, Dr. Sylvia Karpagam, a public health doctor and researcher, joins us to discuss the complicated ethics of veganism, the caste-based superiority of vegetarianism, and the elitism of vegan discourse in India.

Respectfully Disagree is The Swaddle Team’s very own podcast series, in which we get together to discuss and dissect the issues we passionately differ on.

Listen here

Some points about the health and social determinants aspect of Karnataka budget 2023

In the budget the claim is that the governments priority is to “make education and health services accessible to the people of all classes and all regions.” In reality children from minority and dalit communities have been systematically denied education by state supported cancellation of scholarships, the hijab ban etc. 1000s of children have dropped out of education because of these discriminatory actions. The government should have kept aside additional budget to bring back these children into educational systems.Urdu medium schools should be upgraded as many of them are facing discriminatory attitude in terms of resources.

The mid-day meal scheme (including the Mathrupurna scheme) currently is of poor quality and neither meets quality or quantity standards prescribed under the National Food Security Act, so unless it is upgraded to be more diverse and balanced, that includes iron rich and Vitamin A rich foods, this scheme will not meet its purpose. The contract with Akshaya patra and all other centralized kitchens for the mid day meal scheme should have been cancelled and all efforts to and resources to construct and support school based kitchens with additional staff/cooks/helpers should have been considered. There is no mention in the budget of eggs in the mid day meal scheme in spite of repeated demands from groups such as Ahara Namma Hakku, doctors, nutritionists etc. This is very disappointing inspite of the study done in 2021-22 by the Department of Public Instruction, Government of Karnataka which found that 98% children consumed eggs where they were given as part of the mid-day meal scheme and that supplementary nutrition of eggs on alternate days showed an overall increase in weights of children.

It is appreciable that investments will be made to upgrade and build more anganwadi centres.

It is good that supplementary nutrition will be introduced for all adolescent girls who are not in school. They should also be provided other benefits related to income generation, trainings, subsidies and loans, sanitary napkins etc. It is good that creche facilities are being introduced for women in the informal sector. This will go a long way in women empowerment. However, the Arogya Pushti scheme is being introduced only for ‘eligible married women’. This is exclusionary. There are many young women who have dropped out of education and are married or likely to be married and who are mostly excluded from most schemes.

Toilets in schools are in dire condition. Attention has to be given to the drainage of these toilets. At no cost should single pit systems be in place as they aggravate the age old casteist practice of manual scavenging.

Although many people are continuing to come in contact with feces in different ways, this is not recognized as manual scavenging and they often are left out of many social security schemes. Efforts to identify those engaged in manual scavenging, rehabilitation, providing pensions to them and scholarships to their children should be a serious commitment of the government.
It is good that there is commitment to upgrade and invest in community health centres and taluk hospitals. More district hospitals should have been upgraded so that people would not need to come to the cities for most of their ailments. These upgraded facilities should at no cost be handed to private entities or medical colleges as part of the failed model of Public Private Partnership (PPP).

The Namma clinics have not yet kicked off and are facing many hurdles. All those inputs required to make these functional should be urgently put into place .

While it is good that critical care units will be set up, these should be done as public health system initiatives rather than being handed over to the unregulated private healthcare sector.

Instead of increasing ASHA workers salary by Rs. 1000/month, they should have been made permanent. The state has committed to improving the infrastructure in government schools. This is a good initiative. Currently the schools do not have basic amenities like buildings, toilets, sanitary napkins, water supply, fans, benches etc. The government should publish a report card every quarter to show that it has actually implemented or is implementing what it has promised.

A new scheme for multi-dimensional intervention into anemia includes public awareness. The messaging should be scientific and should include liver and red meat as part of the advice. Promoting only fruits and vegetables and iron tablets are not a long term or effective strategy to reduce anemia. This intervention should go along with subsidizing meat, lifting the cattle slaughter ban and serious commitment by the state to stop targeting meat and meat eaters as has been consistently happening the last few years.

The concept of health camps twice a year under the “Mane manege Arogya” scheme is a cause for concern. Comprehensive healthcare cannot function in a camp mode and as has been seen right from when the Vajpayee Arogyashree scheme was introduced, these camps are just a smokescreen to shift patients to large corporate hospitals in the city. Patients are screened and told they have one or the other communicable or non communicable disease and then asked to go to a tertiary hospital for further management. The further a patient moves away from their homes, the more the out of pocket expenditure. Even with schemes, people have out of pocket expenditure between ten thousand to a lakh. Further it leads to cherry picking of patients, exclusion of those with complicated or serious illness and also fragmented care. It is good that jan aushadi kendras are being set up across the state. These should undergo rigorous quality control and should include all the essential drugs.

Hand held Xray machine screening of tuberculosis may not be very accurate. Cases of TB can be missed. It would be important to have other screening facilities like sputum examination and biopsy of lymph nodes as well as scanning facilities in place. The government should also commit to better treatment options that includes nutrition for those diagnosed with TB.

While the government talks about investing in testing and screening for cancer, it has only said that patients will be referred to tertiary hospitals. Going by the current situation, it means referral to private tertiary centres in the city. The Kidwai hospital is underfunded and under resourced. There should have been commitment to upgrade this hospital and also make district hospitals self sufficient in management of cancer with referral of complicated cases to Kidwai.

It is good that there will be investment into laboratory facilities. Quality control, regulation and oversight would be important so that faith in public laboratories is actively facilitated.

Digitalising health records can be useful but in the absence of strong data protection laws, it is unclear who this data will be accessible to. The budget vaguely says “With the consent of the patients, the medical records would be made available immediately and this would help in their further treatment.” This has to be clarified and systems have to be in place to prevent data abuse by vested interests.

It is good that the government has committed to availability of specialists to strengthen community health facilities, primary health centres, government medical colleges and PG courses, CT scan, dental treatment, chemotherapy facilities,cardiac facilities, organ transplant, blood bank etc. It is excellent that the Organ transplant unit will be established in Karnataka.

Many farmers as well as those further along the chain of the livestock trade have been adversely impacted by the Karnataka Prevention of Slaughter and Preservation of Cattle Act 2021. It is telling that the government has made no mention of how it will rehabilitate or support 1000s of farmers, transporters, butchers, loaders, as well as those working in the tanning, curing and leather related occupations. The law has to be lifted and investments have to be made into upgrading the livestock sector in the state.

It is good that there will be investment into poultry farming among women farmers. Efforts should be made to ensure that dalit, Adivasi and women from minority religions are not systematically left out. This should be linked to the school mid day meal scheme program of giving eggs to children every day of the week throughout the year.

Fishing community should directly benefit from the fishing related schemes. Often the language of the budget appears to help communities but in reality opens the door for markets and exports. This should be clarified in all budgets rather than use of language to hide reality.

The government has failed to acknowledge that the pandemic and lockdown has caused serious setback to livelihoods and health/nutrition. There should have been investment into a state level survey to understand how nutrition and health indicators have been impacted and measures put into place to address that.
However, many of the sweeping promises of the Government remain only on paper or are poorly implemented. Transparency and accountability mechanisms should be put into place.

Karnataka health budget focuses on public health, preventive care; experts say implementation is key

Some points about Vitamin B12

Image source: EatingWell

Also called cobalamin. Only microbes manufacture B12. Widely present in animal foods such as liver, eggs, milk, meat and fish.. Plant based foods whether fruit, vegetables, oils, pulses, herbs, cereals, millets, nuts or seeds do not contain B12.

Absorption of Vitamin B12 requires the presence of Intrinsic factor (IF), a glycoPROTEIN, which means that proteins are important for good absorption of the Vitamin. Without this IF, even the B12 in diet cannot be absorbed. In each meal, not more than 2 micrograms of the Vitamin B12 can be absorbed by the Intrinsic factor.Vitamin B12 circulates in the blood bound to proteins called transcobalamins.

Excess B12 not stored in body but excreted via bile into the feces and urine.

B12 is important for DNA synthesis, cell division, blood cell formation, hormones, neurotransmitters and also protects nerve fibres in the spinal cord and brain. Decreased B12 leads to defective DNA synthesis and prevents maturation of red blood cells. This causes megaloblastic anemia.

Symptoms of B12 deficiency can manifest as mood swings, tingling hands and feet, co-ordination disorders, severe nerve (neuropathic ) pains, reduced concentration, dizziness, confusion, mouth ulcers, tremors, visual impairments. Can often go undiagnosed and early symptoms of tiredness, depression etc are not picked up, even by doctors.

Main causes of deficiency are poor diet and malabsorption. Malabsorption can be aggravated by stress and pollution. Malabsorption can occur if person is on other medications, alcohol/smoking, during pregnancy and lactation, senior citizens, other infections or chronic illness, with junk foods. Drugs for ulcer, diabetes/hypertension, palpitations, statins,antibiotics, psychiatric meds, chemo, contraceptives can contribute to malabsorption.

Urine test is more reliable than blood test to identify B12 deficiency.

Vegans and vegetarians are at particularly high risk of B12 deficiency.

Supplements can be in the pure form or as part of a B complex/multivitamin tablet/syrup form. Pure B12 supplements can also contain sweeteners, dyes and flavouring agents which are best avoided. Supplement dose – 250-500 μg per day when taken orally, 500 μg per day if there is a deficiency or increased need and 1000 μg per day if there are severe symptoms.

Synthetic B12 called cyanocobalamin does not occur naturally and has been used for several years. However, it is not as efficient as the natural forms. It consists of a combination of Vitamin B12 and hydrocyanic acid which is a component of toxin cyanide. Although present in very small doses which can be easily excreted, those with kidney issues or smokers (who already have some level of cyanide in blood) should avoid this form of B12

Natural forms of B12 (produced by bacteria) are methyl cobalamin, adenosyl cobalamin and hydroxocobalamin. All three are found in animal foods through diet.Hydroxocobalamin is the form naturally produced by most bacteria and has to be converted to methy and adenosyl cobalamin. A combination of all three is the best supplement.Unlike cyanocobalamin, hydroxocobalamin releases no toxins and more bioavailable.

Injections do not offer any major advantage over the oral route of taking supplements unless people have malabsorption related issues. Capsules, tablets and lozenges may contain gelatin or lactose, so may not be consumed by vegans. B12 can be absorbed through the oral mucosa (sprays, lozenges, chewable form) or intestine.

Normally the small intestine absorbs nutrients upto a certain length. Some animals can produce B12 beyond that length, so it is not absorbed into the gut. Grazing animals can produce the Vitamin in their gut. Carnivores get their B12 from the animals they eat. Non ruminant herbivores get it from soil and feces which is present on the food they eat. Some B12 is stored in the body in animals and humans in the liver so shortage does not occur suddenly.

Some vegans consume unwashed root vegetables such as carrots to supplement their B12 but this is not a reliable source. Also with industrialised agriculture, pesticides etc. micro-organisms are not often found in the soil.

Some plant based sources have been found to contain B12 ANALOGUES which are picked up as B12 in lab tests but don’t FUNCTION like B12 and may in fact aggravate B12 deficiency because they bind to same molecules as real B12 without functioning like B12.

The algae chlorella is the only promising source till now but it cannot be a substitute in case of deficiency, malabsorption or increased requirement. In a healthy person without malabsorption, 3 gm of chlorella can be consumed over the day (not at once) however costs are exorbitant. Spirulina contains B12 analogues which impair absorption of the actual Vitamin and aggravate deficiency. Vegans and those with malabsorption should avoid spirulina.

Casteism and Islamophobia ails doctors on Twitter.

Image source: Good Housekeeping

Sylvia Karpagam

Keywords: bullying, harassment, reservation, affirmative action, discrimination

Published in medico friend circle bulletin 381, Caste, Tribe and Religion:
Institutionalized discrimination in health, March 2023, 35

While some view social media as a “catalyst for protest mobilisation’[i], others consider it as a ‘weapon against the oppressed in the hands of the oppressor’[ii]; an alternative to mainstream media which is often considered corrupted by, dependent on and uncritical of the establishment [iii] ; or as a weapon to curb and discredit dissenting voices, muzzle data or monitor/ track/threaten activists[iv]. During the Covid-19 pandemic, Twitter became a space for sharing resources, sending SOS calls, connecting people and even reaching out to vulnerable individuals and communities across rigorous lockdowns. But it was also used to vilify, target and discriminate, specifically the Muslim community[v] [vi], leading to enormous consequence on lives, livelihoods and mental health.

This article looks at the (ab)use of the social media platform Twitter by Indian doctors in the context of reservation or affirmative action and in the context of the Covid pandemic and the Muslim community. Women and the LGBTQI from these two communities may be even more viciously targeted.

Casteism on Twitter – reservation as the target

Because of historical injustice against the Scheduled Caste and Scheduled Tribe communities, the Indian Constitution[vii] gives the right to non-discrimination[viii] and of reserving access to government jobs, educational institutions and seats in Parliament to Scheduled Castes and Scheduled Tribes[ix]. Several myths and misconceptions around reservation are common and these have often been countered[x]

On Twitter, doctors oppose reservation, not with scientific or objective language, but abusive, offensive or casteist language.

“So now west bengal govt has given 40% seats to in-service candidates. Only 27% seats for Open Non-Service candidates.

“Fuck Merit and Celebrate Mediocrity” should be the slogan of Ministries of Health and Welfare of India and states as well.

#Fuck_Merit_Celebrate_Mediocrity”

Brijesh K Saini @_saini_brijesh October 30, 2021

“It is very easy to say “reservation toh hota hai, you study well”, when we have already passed that stage….but you really can’t feel what’s inside that young UG/PG aspirant’s mind….

Don’t fcuk with minds and say “JANAM SIDDH ADHIKAR” my foot…

#NEETPG #reservationfreeneetpg”

Surgeon Quotes @Nilperoral 16^th March 2022

“Therez no racial hatred inside me..there is reservation hatred inside me…victim card holders will not understand…all my friends from reserved category know about it very well…

Here z a humane smile for u…😊”

Lazy Doc @samintensive October 28, 2021

Those opposing reservation or affirmative action on Twitter often label it as ‘anti-merit’ and as a form of discrimination against those who are not eligible for it. However, management quote seats, which are reserved for people who actually do not qualify the eligibility criteria, but willing to spend two to four times the actual fee of the college are not labelled as ‘anti-merit! It is considered as ‘direct admission process in colleges’[xi] where students pay anywhere between INR 2,11,000/- to INR 22,50,000/- annually for these ‘meritorious’ seats. With 200 marks, it is highly difficult for you to get admission in any of the private colleges. If you even get the fee would be really high in order to join MBBS course. [xi]

When doctors who oppose reservations are called out, they readily switch to the victim mode.

“He has quote tweeted my tweet calling me a casteist doctor. Do amplify this. It’s the need of the hour to expose such people who are NOT doctors and who think that after completing MBBS, reserved category doctors still require reservation.”

Pragya (unreserved) @PragyaBhargav15 29^th October 2021

It is also common for doctors from oppressor caste groups to flaunt ‘general merit’ or ‘unreserved category’ on their social media profiles like some mark of pride, sending out a clear message that those who avail reservations are somehow less meritorious.

“Using reservation card repeatedly from MBBS entry to Faculty in superspeciality crushes open merit, decimates quality patient care,demoralises our already down-hearted youth, our state needs freedom from this unimpeachable class”

Dr Irfan Ahmad @Irfanbhatcardio 23^rd February 2022

“BOYCOTT RESERVATION IN PG ENTRANCE EXAMS. ALL GRADUATES SHOULD BE CONSIDERED EQUAL”

scalpel_writes @DrAkanksha_1808 11^th June 2020

“I am always against the SC/ST reservation quota. But, most of the Indian didn’t raising their voice against this non meritorious quota in social media or any other platforms. But, it’s important to protest against SC/ST reservation to save India.”

Drsallu @Drsallu1 May 3, 2021

The common taunt on Twitter is that patients check profiles of the doctors and refuse to go to those who have qualified through reservations. The SC/ST Atrocity Act[xii] which can be invoked in any instances which instigate social or economic boycotts can be applied to many of the tweets which openly call for boycott of doctors who come in through reservation.[1]

“Agar mbbs/bds karke Doctor banne k baad bhi uplift nhi ho rahe.

Toh PG karke bhi nhi honge!!!

Fir kehte hain ki hame neech bolke discrimination hota hai.

The discrimination is promoted by these governments policies and the judiciary that supports them!

#neetpg #Reservation”

(if you have not been uplifted by doing MBBS/BDS, then you will not be even after PG. Then you say that you are being discriminated when you are called inferior/low)

Dr.Karan @Delhidadentist 8^th January 2022

“Buddha didn’t have reservation for himself. He was enlightened. So they had debate with him. Reservations ka Faida lenewale Buddha nahi buddhu hote hain. Ek vowel ka Farak hai bas. We’ll debate when you earn that vowel.”

(The one who takes advantage of reservation is a buddhu (fool) not a Buddha. It is just the difference of one vowel.)

#neetpg reservation

Dr Deepak Krishnamurthy @DrDeepakKrishn1 Oct 28, 2021

“Getting the seat and then treating the patients in India is based on your caste, not on your merit.

Nothing can be more ridiculous than this…”

Dr Divya Parwani @DIVYA___25 25^th October 2021

“Sir unlogon ko ithna dimkah nahi logic samajh ne ke liye…all they know is irrespective of caste if someone is against reservation they brand us as UC… because they think everyone wants to beg like them for reservation”

Dr. Ganesh Srinivasa Prasad DNB (Nephrology) @thisis_drgsp October 28 2021

If one were to conflate these social media posts with the report “The Steady drumbeat of Institutional casteism: Recognise Respond Redress”[xiii], one can understand how language such as that used by these doctors on social media can have real life consequences on people from marginalized and vulnerable communities. Dr. Payal Tadvi, the first woman from her family to become a doctor and the first woman from the Adivasi Muslim Bhil community died by suicide in May 2019. Over the period of one years, she had been harassed with constant references to her caste and that she is from a backward community, an Adivasi and having been admitted to medicine through the reserved categories. The accused Hema Ahuja, Ankita Khandelwal and Bhakti Mehere continued to harass her in the hostel where she shared a room with them. They had also threatened her that they would not ‘allow’ her to complete her postgraduation. It is also to be noted that she had lodged complaints with support from her mother and husband, with different authorities. As per the statement of Dr. Snehal Shinde, her friend, she was asked “You are from the reserved category, right? And what rank did you get in NEET (entrance exam)?”. Bandewar[xiv] attributes these caste related suicides to ‘abysmal failure of policies, regulations and operational mechanisms to respond’, unwillingness to recognise the existence of caste-based discriminatory practices in Higher Educational Institutions, not treating casteist discriminatory practices, abuse and violence as constitutional violations, and the consequent design failure at operational levels. Shanmugavelan[xv] describes how ‘everyday’ and ‘normal’ caste- based hate is, how little space there is to even articulate these abuses, leave alone access some form of grievance redressal.

Islamophobia on Twitter

Islamophobia is an extreme fear of and hostility toward Islam and Muslims, often leading to hate speech and hate crimes, social and political discrimination. It is sweeping across the country and was very visible during the Covid pandemic. Following the Tablighi Jamaat (society of Preachers) gathering in India between March 13-15, 2020, there was an explosion of anti- Muslim sentiment. What is particularly concerning is how some doctors readily jumped onto this bandwagon, discarding ethics, scientific thinking and basic principles of medicine.

“Tablighi aka talibani jamaat ki tarah nurse and staff ki physical Harrsament nahi kr rhe, thuk nahi rahe doctors pr, thook jamat ki hospital mein chicken nahi mang rhe. Sale bhadwe quint 😂”

(Unlike the Tablighi aka talibani jamaat they are not physically harassing nurses and staff, they are not spitting on doctors and not demanding chicken in the hospital run by the spitting-community., quint is pimp)

Dr.Satish @dr_battisi 15th June 2021

“Tablighi Jamaatis Kicked plate filled with Food, demanded Biryani & Non-Vegetarian food : Dr Arti Lalchandani Dean of GSVM Medical College Kanpur.”

Dr. Vedika @vishkanyaaaa 26th April 2020

On March 21st 2020, an open letter, quoting John Snow[xvi], raised concerns about the “prejudiced choice of using the Tablighi Jamaat gathering as an epidemiological example.

The open letter quotes the Bombay High Court judgement [xvii] in August 2020 which upheld that holding the Tablighi Jamaat congregation responsible for the pandemic spread was propaganda and without any epidemiological relevance. The letter also criticises the ‘apology’ issued by the authors and the withdrawal of book by publishers as not have addressed the concerns raised.

“Although your letter claims that you did not want to hurt sentiments, it is saddening that your letter doesn’t acknowledge that it is incorrect from an epidemiological perspective to attribute the spread of the pandemic to the Tablighi Jamaat congregation. Also, it fails to acknowledge that it was inappropriate to choose this example amongst all other similar gatherings/congregations and reflecting your own biases, knowingly or ‘inadvertently’ against the Muslim community.”

Dr Aqsa Shaikh is Associate Professor of Community Medicine and India’s first Transgender woman to head a Covid Vaccination center. She tweets on a wide range of issues ranging from LGBTQIA+ rights, Rights of Persons with Disability, Mental Health, Medical Ethics, Medical Humanities, and Medical Education Technology. She was one of the signatories critiquing the epidemiological example used in the Microbiology textbook.[xviii]

Social media responses by doctors to her were telling.

“If book says malaria is not prominent in some races because they have more sickle shape rbc..is that means that book is promoting racism…these ppl who sees religion in everything should stop reading science and should start following some fanatic”

Dr.chandra Shekhar @drshekhar2789 Mar 14, 2021

Another letter([xix]) signed by more than 200 citizens directly appealing to doctors to uphold medical ethics was in the context of Dr. Aaarti Lalchandani, a medical officer who was caught on camera making openly Islamophobic comments. The letter calls for statements to be put out by the professional bodies against any form of discrimination. Her sentiments have been echoed by several doctors. One doctor abused the then Chief Minister of Karnataka for not protecting doctors from the Tablighi.

“Yello iro Doctor ge Gaurava kottidakke ee reethi mecchuge kodobadlu illiro Doctors ge kallu hodiyodannu tadiri. Nachike aagbeku nimge. Obba Tablighi na arrest mado yogyathe illa🖕 Modlu illiro Doctors ge Tablighi galinda kallu hodiyodannu tadiri.

-Frustrated Doctor

(Instead of giving likes for doctors elsewhere being honoured, stop doctors here from being attacked by stones. You should be ashamed. You don’t have the capacity to arrest one Tablighi (middle finger emoji). First protect the doctors here from being attacked with stones by the Tablighi)

Dr. Varun S J @Dr_Varun_SJ (#HINDU_EXTREMIST) 22^nd April 2020

Ironically Mohammed Zubair, who had tweeted about Dr. Aarti, now has FIRs filed against him for calling out hate

“Dr. Aarti Lalchandani refers COVID +ve Muslims as terrorists, Wants govt to send Jamatis to Jungle & Jail instead of exhausting resources. She is the same lady who’d earlier alleged that Jamatis were spitting, misbehaving & demanding Biryani. @DMKanpur”

Mohammed Zubair @zoo_bear 31^st May 2020

Dr. Poonia, in expressing solidarity with Kashmiri pandits, displays his Islamophobia

“It’s not your story only, all killing done in the name of !slam is extremely brutal. Their hate for non Muslims is not instant or transient but taught from very childhood, motivated and consistent since 1400 years.🤫”

Dr. Poonia (MD,DM) @dramipoonia 11^th March 2022

One doctor talks about lynching as an acceptable form of punishment for Muslims.

“Muslims cannot be lynched even if they’re rapists and murderers is the point these people want to make.”

Dr Deepak Krishnamurthy @DrDeepakKrishn1 2^nd December 2019

The idea that Muslims do not belong to India is also rampant.

“Seriously 😳…so what is other muslim countries, Europe and US doing….we r not that rich to feed so many others…we have to take refugees based on religion because only India is there for Hindu’s and Sikhs…they don’t have other countries”

Dr. Ganesh Srinivasa Prasad DNB (Nephrology) @thisis_drgsp 17^th August 2021

Social media is a tool whose performance is linked to how, when, where and by whom it is used [xx] It can be used to spread positive messages and health education or prejudices. These tweets give a snapshot of some of the prejudices among the medical community. There are several other social media sites that have similar hatred. The medical community has specifically taken an oath against non-discrimination. Ethics, unfortunately, isn’t something that one is born with and neither is it like a sanitiser spray, that one can pick from any corner and spray on one’s self. There is no escaping the fact that the medical community really needs to take a good hard look at itself and to ask ourselves how our prejudices affects patient care.

References

[1] SC/ST Atrocity Act ([1]) – imposing or threatening to impose ‘social or economic boycott upon a member of a Scheduled Caste or a Scheduled Tribe or prevents from availing benefits of any public service which is due to him”

[i] Anita Breuer, Todd Landman and Dorothea Farquhar. 2015. “Social media and protest mobilization: evidence from the Tunisian revolution.” Democratization 22(4): 764-792. https://www.tandfonline.com/doi/abs/10.1080/13510347.2014.885505.

[ii] Radcliffe, Toni. 2015. The role of social media in countering oppression: revolutionary tool or weapon of the oppressor? DEVT90039 Civil Society, NGOs and the State University of Melbourne, Master of Environment. https://www.academia.edu/19626770/The_role_of_social_media_in_countering_oppression_revolutionary_tool_or_weapon_of_the_oppressor.

[iii] Holt, Kristoffer. 2019. “Key Dimensions of Alternative News Media.” Digital Journalism. https://www.researchgate.net/publication/333603941_Key_Dimensions_of_Alternative_News_Media.

[iv] Langa, Mahesh. 2022. “Mohammed Zubair – The man who chased facts.” The Hindu. July 3. https://www.thehindu.com/news/national/mohammed-zubair-the-man-who-chased-facts/article65590897.ece?homepage=true.

[v] Mohit Chandra, Manvith Reddy, Shradha Sehgal, Saurabh Gupta, Arun Balaji Buduru, Ponnurangan Kumaraguru,. 2021. ““A Virus Has No Religion”: Analyzing Islamophobia on Twitter.” arxiv. https://arxiv.org/pdf/2107.05104.pdf.

[vi] Roy, Taniya. 2022. “Hindutva’s Circulation of Anti-Muslim Hate Aided by Digital Platforms, Finds Report.” The Wire, January 31. https://thewire.in/communalism/india-anti-muslim-hate-twitter-facebook-whatsapp-hindutva-modi-bjp.

[vii] India, Government of. 2020. The Constitution of India. Legislative department, Ministry of Law and Justice. https://legislative.gov.in/sites/default/files/COI.pdf.

[viii] [viii] The Constitution of India

Article 16 -Equality of opportunity in matters of public employment.—(1) There shall be equality of opportunity for all citizens in matters relating to employment or appointment to any office under the State.

(2) No citizen shall, on grounds only of religion, race, caste, sex, descent, place of birth, residence or any of them, be ineligible for, or discriminated against in respect of, any employment or office under the State.

(3) Nothing in this article shall prevent Parliament from making any law prescribing, in regard to a class or classes of employment or appointment to an office

[ix] Part XVI Special provisions relating to certain classes 335. Claims of Scheduled Castes and Scheduled Tribes to services and posts.—The claims of the members of the Scheduled Castes and the Scheduled Tribes shall be taken into consideration, consistently with the maintenance of efficiency of administration, in the making of appointments to services and posts in connection with the affairs of the Union or of a State.

[x] Sukhadeo Thorat, Nitin Tagade, Ajaya K Naik. 2016. “How and Why? Prejudice against Reservation Policies.” Economic and Political Weekly 51 (8). https://www.epw.in/journal/2016/8/special-articles/prejudice-against-reservation-policies.html.

[xi] Bell, George. n.d. “What is the meaning of management quota in medical college?” Medical College. https://mrmcw.org/medical/what-is-management-quota-seats-in-medical-colleges.html

[xii] “The Scheduled Castes and the Scheduled Tribes (Prevention of Atrocities) Act, 1980 No. 33 of 1989”, 11^th September 1989 Chapter II, Offences of atrocities 3 Punishment for offences atrocities https://tribal.nic.in/actRules/preventionofAtricities.pdf

Whoever, not being a member of a Scheduled Caste or a Scheduled Tribe……

(r) “intentionally insults or intimidates with intent to humiliate a member of a Scheduled caste or a Scheduled Tribe in any place within public view” and

(s) “Abuses any member of a Scheduled Caste or Scheduled Tribe by caste name in any place within public view” and

(u) “By words either written or spoken or by signs or by visible representation or otherwise promotes or attempts to promote feelings of enmity, hatred or ill-will against members of the Scheduled Castes or the Scheduled Tribes” and

(w ii) “uses words, acts or gestures of a sexual nature towards a woman belonging to a Scheduled Caste or Scheduled tribe knowing that she belongs to the Scheduled Caste or Scheduled Tribe”

[xiii] 2021. “The Steady drumbeat of Institutional casteism: Recognise Respond Redress”. Forum Against Oppression of Women, Forum for Medical Ethics Society, Medico Friend Circle and Peoples’ Union of Civil Liberties, Maharashtra. . 2021.

[xiv] Bandewar, Sunita. 2021. “Ending caste-based oppression of students in educational institutions: An unfinished agenda.” Indian Journal of Medical Ethic 1 (Editorial): 6-9. https://ijme.in/articles/ending-caste-based-oppression-of-students-in-educational-institutions-an-unfinished-agenda/.

[xv] Shanmugavelan M (2021) “Caste-hate speech: Addressing hate-speech based on work and

descent” International Dalit Solidarity Network (IDSN). Edited by Wiesener K., and IDSN.

22^nd March 2021 https://genderit.org/resources/caste-hate-speech-addressing-hate-speech-based-work-and-descent

[xvi] Tuthill K (2003) “ John Snow and the Broad Street pump-On the trail of an epidemic” Cricket 31(3), pp. 23-31, Nov. 2003 https://www.ph.ucla.edu/epi/snow/snowcricketarticle.html

[xvii] Desai M (2020) “ Bombay High Court defends Constitutional rights of Tablighi followers” The Leaflet. 23^rd August 2020 https://theleaflet.in/bombay-high-court-defends-constitutional-rights-of-tablighi-followers/

[xviii] Unscientific Epidemiological example in Microbiology textbook promotes Islamophobia: Activists, doctors write open letter. NewsClick. 22 March 2021. Available from: https://www.newsclick.in/Unscientific-Epidemiological-Example-in-Microbiology-Textbook-Promotes-Islamophobia-Activists-Doctors-Write-Open-Letter

[xix] Campaign against Hate Speech (CAHS). (2020). “Statement Condemning abusive and communal hate speech by Dr. Aarti Lalchandani which violates principles of medical ethics and discriminates against Muslims” Hate Speech Beda, 6^th June 2020

[xx] Ibid (ii)

Nutrition Policy from the Lens of Caste

Panel discussion with Ambedkar Periyar Study Circle, Indian Institute of Technology (IIT), Bombay. Listen here

India’s Plant-Based Policy Failure

Podcast with Sameer Dossani

View here

खाना नहीं है, खाने के बाद वाली दवा कैसै लूं:चक्रवात पीड़ित की बात दिल को छूई, अब डॉक्टरी छोड़ लोगों को प्रोटीन वाली डाइट दिलाती हूं

मैं डॉ. सिल्विया करपगम बेंगलुरु से हूं। मैं पब्लिक हेल्थ डॉक्टर हूं और बच्चों को सही पोषण दिलवाने के लिए आवाज उठा रही हूं। इसके लिए मुझे काफी आलोचना भी झेलनी पड़ रही हैं।

मरीजों का इलाज करने के बाद प्रोफेशन को लिया गंभीर

मैंने एमबीबीएस के बाद एमडी कम्युनिटी मेडिसिन में की। मैं बचपन में पत्रकार या वकील बनना चाहती थी। लेकिन पेरेंट्स चाहते थे कि मैं डॉक्टर बनूं क्योंकि पढ़ाई में अच्छी रही हूं।

जब मैंने मेडिकल की पढ़ाई करनी शुरू की और हॉस्पिटल में ड्यूटी के दौरान मरीजों का इलाज करने का मौका मिला, तब मैंने इस प्रोफेशन को गंभीरता से लेना शुरू किया।

Lab based glop

Image source: BBC Science Focus

It is ridiculous for humans to imagine that they can grow ‘meat’ in laboratories. Animals have evolved over centuries and have a balance of several functions such chewing their food, digesting, excretion, absorption, storing etc. Muscles develop by activity and a balance of different nutrients. The body uses hormones, enzymes, electric signals, nerves, blood vessels, antibodies, macrophages etc. to maintain homeostatis.

Without crucial excretory functions, animals would accumulate toxins and environmental chemicals etc. leading to shortened life and more illness.

Lab grown glop is not ‘meat’ by any stretch of imagination and is in fact a collection of cells. If these have to be ‘manufactured’ as being promised by its proponents to feed large populations, you need large factories which have huge investments in terms of temperature control etc. We know that a piece of tissue can easily get contaminated with bacteria and rot, so these factories will have to use antibiotics/antiseptics and extremely sterile situations to manufacture these cells in a lab. Also meat tastes the way it does because the animal is moving around. To mimic the taste of meat, these lab glops will have to be ‘fixed’ with additives and other chemicals.

In the absence of years of evolution, these glops will not have most of the nutrients which animals contain and which are obtained by consuming different nutrients from their natural diet. Remember also that while some nutrients are known many are unknown, so the lab glops cannot be cultivated in artificial situations to meet requirements.
Also for cells to be manufactured in large enough numbers as being planned by these industries, they will have to insert growth factors or stimulate rapid cell regeneration. Cells in such circumstances can develop carcinogenic (cancer like) tendencies, so one may just be consuming cancerous cells rather than ‘meat’.

This glop will be packaged and marketed only by large multinationals because small industries will not be able to meet the criteria (like the National accreditation Board of Hospitals standards which are now being met only by large corporates destroying smaller hospitals and charitable institutions). Real meat will become super expensive and will largely be exported and available only to the elite. The poor will be forced to consume cheap, packaged, additive/chemical/antibiotic laden glop. All these will be done under the ’ethical umbrella’ of animal rights and climate efficiency. Think before you subscribe to this nonsense.

FII Interviews: Sylvia Karpagam, The Doctor & Social Media Advocate Tackling Institutional Discrimination From Within The System

Half an hour before our scheduled call, I scroll through public health doctor, Dr Sylvia Karpagam’s Twitter. She’s as active on social media, driving public discourse on healthcare and food equity issues, as she’s on-ground—conducting research on social determinants of accessibility to healthcare and nutrition, health camps for senior citizens, as well as engaging in the issues related to custodial deaths.

Despite doing so much already, she’s committed to bridging awareness about the lesser-known intricacies of our public systems. Rising above her years of medical experience, she markedly speaks with me in simple, demotic terms.

Q: Biased notions about food seem to permeate everywhere, whether that be on social media, in homes and kitchens or even within education systems and governing bodies. How did you, as a vocal advocate for anti-caste, inclusive and intersectional healthcare get involved in this discourse?

There’s a whole host of socioeconomic factors that affect public health—just having a hospital does not ensure health for all. Data consistently shows that it is critical to provide accessibility to marginalised groups in order to ensure well being. When people are already facing discrimination based on their caste, gender identity, sexuality, religion etc., we need to have much more inclusive policies for health care and social determinants of health.

I think all of this is caused by inherent prejudice within medical education in the first place. When the system producing doctors itself is elitist, predominantly English-speaking, upper-caste, it can result in the passing on of unscientific discriminatory traditions. For instance, during the COVID-19 pandemic, so many Islamophobic doctors just blindly used Tablighi Jamaat to excuse their all-out refusing to treat patients, inspite of it not being epidemiologically sound to blame one group for a pandemic. Dr. Sylvia Karpagam

Such data that is available through surveys and research tends to be viewed through a prejudiced lens and influenced by privileged people in power. We need to understand data, research and regulations from a larger framework and perspective. For instance, studies show that diversity in diets and animal-source foods, which are often eaten traditionally by these communities, are important to meet nutritional requirements. However, people in power misinterpret research findings and bring in cheap homogenous foods that are not very nutritionally dense. Policy-maker’s own social positionality of gender, class and caste can result in bias that imposes foods based on politics and ideology rather than science, culture and tradition. Again, it is important to understand whose culture and tradition get foregrounded and whether all caste and religious groups find representation in policy-making.

Sylvia Karpagam is challenging dominant caste ideas of India as a vegetarian nation

Sylvia Karpagam, the public health doctor and researcher from Bengaluru, combats dominant caste ideas of the perfect Indian diet

A young man told Sylvia Karpagam he had seen a video of hers and thanked her for her insights on nutrition and caste. “My teacher kept saying the tongue gets thick if you eat meat and that’s why you can’t talk as articulately as Brahmin children, but I challenged him thanks to you,” he told her. It is moments like this that make her work worthwhile, Karpagam says. “Especially with nutrition, people don’t have the vocabulary to fight back.”

When we meet at her home in Bengaluru’s Vivek Nagar, Karpagam, 51, throws a volley of such truths my way in a laconic fashion, alternating between smiling and shrugging. Her relaxed demeanour belies the enormity of the task she’s undertaken — to combat dominant caste ideas of the perfect Indian diet. In a country that’s increasingly criminalising meat eating, Karpagam, the product of an intercaste, interfaith, inter-linguistic marriage between an ISRO pharmacist and an aircraft accident investigation officer, challenges the belief that India is a ‘vegetarian nation’. In reality, less than a quarter of Indians eat only vegetarian food…. read more here

Thoughts on nutrition

Friends, just want to share some thoughts on nutrition.

As we all know, there is a science of nutrition but also the social, cultural, political, economic etc. All of these play a role in how one understands and interprets the health aspects of nutrition, the policies, planning, the research etc.

So for eg. Covid was a global pandemic and vaccines were brought in, as also masks and lockdown measures. There was also some research (mainly Western) on how the virus responded if there was co-existing Vitamin D deficiency. In India, as we know, there has been very little research to understand Covid and its vaccine, their interaction with the different nutritional issues in the country, whether the exposure of Indians to more infections offered protection against Covid or aggravated it etc. So a lot of understanding is pieced together, partly speculation and partly informed analysis.

With nutrition, we have some older research from the National Institute of Nutrition (NIN) which is very sound in terms of design, planning etc. We also have research from the Western institutions. Some of these show similar findings, so these can be taken as a reliable basis for making decisions. For eg. The importance of animal source foods (ASF) such as dairy, meat, fish eggs etc. is well established to address several nutritional deficiencies. So the Nutritive value of Indian foods by the National Institute of Nutrition gives the breakdown of foods according to nutritional value and that is reliable.

However the NIN also brings out dietary guidelines which are largely caste/religion driven so they mostly erase or minimize the importance of animal foods from their recommendations. So one cannot just say “Follow NIN recommendations blindly or unthinkingly”. One can only use some of their work and reject others. For instance, NIN gave a report in favour of Akshaya patra in Karnataka without even visiting the schools, testing the food or talking to the children/parents. In what can be seen as a clear conflict of interest, the PR person of NIN is also on the board of Akshaya patra and this wasn’t disclosed !!

Also, as we all know, public institutions are being sold out to a caste/corporate ideological nexus and NIN is no exception which is a tragedy, given it is the only official body on nutrition in the country. The Central Food Technological Research Institute (CFTRI) does some research but it doesn’t usually get involved in major policy recommendations. Of course, even the NIN is getting sidelined by bodies such as the FSSAI and Niti Ayog which are overreaching in terms of their stated mandate and making major policy level decisions on food. The corporate institutions ‘researching’ on food such as International Food Policy Research Institute (IFPRI), Bill Gates Foundation, and even so called multilateral agencies such as the World Health Organisation and the United Nations are so infiltrated with the corporate lobby, that any information they put out is overloaded with bias and corporate interest, and cannot just be taken at face value, but interpreted in an informed way.

In terms of food recommendations, there are people in the West who promote a carnivore or keto diet which consists entirely of animal source foods. They criticize grains for causing a lot of nutritional issues, feel that fruits are more sugar than anything else, and are particularly critical of seed oils. They promote lard/animal fat and attribute seed oils to a host of inflammatory processes.

In India the recommended dietary intake is based on calorie requirement, which is calculated based on age, gender and activity. If you take 2400 calories as the average calorie recommendations/person/day, this can come either from carbohydrates (1 gm gives 4 calories), or protein (1 gm gives 4 calories) or fats (1 gm gives 9 calories) or a combination of these.

In India, because of caste and other prejudices pushing cheap vegetarianism, most of these calories end up coming from carbohydrates. So people are loaded with cereals and millets (which are mainly carbohydrates) and that is seen as a way of fulfilling the National Food Security Act commitments. However, carbohydrate heavy diets may give calories or energy for activities of daily living but they do not provide the other nutrients that are required for the body i.e. proteins, vitamins, minerals, fats, fatty acids etc. and also lead to obesity and non communicable diseases such as diabetes, hypertension, heart disease etc.

If it is only protein diet, then some part of the protein is broken down for energy rather than used for body building and other essential functions, so some see it as a wasteful use of protein especially in poor countries such as India. Therefore pushing for protein rich/carnivore/keto diets in countries like India would not be economically sensible.

Fats are very important for several functions. They maintain integrity of tissues, help brain and other organ development, help absorption of fat soluble vitamins ADEK and are an efficient source of energy. So as per Indian recommendations, at least 30-35% of the calorie can be provided by fats.

In India fats and oils are combined as one food group. There is actually not a lot of research in this area so evidence has to be pieced together from different sources. In the West, animal lard or fat is used directly for cooking and culturally acceptable. In India, this may be used in some cultures but ghee and butter are acceptable though not available socially and economically to some communities. Since ghee and butter are largely inaccessible one cannot completely do away with oils. Since there is not a lot of research in the Indian context, some pockets of evidence show that coconut oil is the best. Alternatively using oil from edible seeds (groundnut, mustard, til) is better than using inedible seed oils.

In the West, there are groups that completely reject all oils and only use butter or lard for cooking. India will have to find a different trajectory. So when people ask me if this or that oil can be used, my honest answer should be “I don’t know’ and there is actually no proper research which doesn’t have a conflict of interest on this subject. However, the importance of fat in diets has to be emphasized. Children need more energy per kg of body weight than adults, so this is especially important in them because they consume small quantities but need more energy, so fats (which provide 9 calories of energy/gm) are very useful for children.

Also research conducted in the West cannot be blindly adapted to the Indian context. We need to factor in the pre-existing malnutrition in the country. However, that cannot be a basis to reject completely whatever research comes from the West. So in India, it is common for any bad data that shows the country in a poor light to be rejected as not in the Indian context. For eg. stunting is a problem in India and instead of addressing this, the government may say we cannot compare Western children with Indian children because we are ‘naturally and genetically’ smaller. This can be easily disproved because Indians who consume diets comparable to Western children also gain comparable heights and weights.

Now as medical students or even as a post graduate in Community medicine, nutrition was not a topic that was taught very seriously. Importantly, its other dimensions around caste, culture, religion etc. were not discussed. Nutrition was very much a theoretical science and didn’t factor in the various dimensions I mentioned earlier.

My interest in nutrition comes entirely from personal reading, references and a few nutritionists who I trust (like Dr. Veena Shatrugna, retired deputy director of National Institute of Nutrition who has done a phenomenal amount of research and whose articles should be recommended reading for anyone commenting on nutrition). So I do not see myself as an expert in nutrition but rather someone who can synthesise and analyse different dimensions of nutrition. This is what I share in articles or social media. Also Twitter is limited in word count, so one cannot put out reams and reams of information..,,,,,,only snippets.

If someone asks for ‘evidence’ or peer reviewed literature, there is literature which is cross cutting across regions, but there are which need to be interpreted and applied to the Indian context.

For eg. I put a tweet about drinking water half an hour after food and someone asked for ‘peer reviewed journal’ as evidence. However, such data actually doesn’t exist for some of the nutrition related queries and one would only be faffing if one claimed everything was properly researched. However, there are interactions with respected nutritionists, understanding based on one’s own clinical experience as well as research and making informed synthesis of this information.

So I cannot really prove or disprove what I say because for every link that I share, non believers can find 100 articles or research to prove the exact opposite vis a vis the vegans.

So these discussions on nutrition are not a top down, expert heavy, ‘I know everything’ model but rather a sharing of understandings and learnings. I don’t claim to be an expert but I share my learnings and also happy to discuss, learn and revisit my opinions.

And TBH, it is horrifying to see people who have very poor understanding of nutrition, put out things with a great deal of confidence like it is the truth and 100s of people following them unthinkingly. At the end of the day, nutrition is personal, political, cultural and scientific and we cannot see one without the other. What one recommends at a policy level can be very different to what one advices at a personal level.

Sylvia

Data on malnutrition

For those who know some basic statistics, the NFHS (2019-20) mentions data on stunting (less than expected height for age) and undernutrition (less than expected weight for age), for e.g. in rural children < 5 years, as 37.3% and 33.8%.

But please do remember that this is at -2 standard deviation. If we had data on -1 standard deviation, the numbers would shoot up.

Basically we are ignoring children who are moderately malnourished and picking them up later (when they are in the -2 SD or severe category). We need data to start including children in the -1 SD category.

Then hopefully the government won’t continue pretending that malnutrition in the country is not a crisis.

NFHS 5 data shows that stunting (in rural children) is 37.3% and underweight is 33.8% whereas wasting is 19.5%. So, some government officials may show wasting statistics, and say that it is not so high, and therefore not a big cause for concern.

There are reasons why you should stop quoting wasting as a statistic.

So stunting is when the child has less height that expected for her age. Undernutrition is less weight that expected for age.

So what bureaucrats and researchers have done is to presume that Indian children are ‘small made” and that they need not go by expected weight for age, but rather expected weight for height. So basically, they say that Indian children are anyway short so for that short height, they need less weight and something less than that expected weight should be called wasting. That makes the statistics look better than the actual problem.

But we know that given good diets, many Indian children can reach the heights of their western counterparts. This argument that Indians are small and therefore need less weight and that measurement should be on expected weight for height rather than expected weight for age, should be rejected. Stunting is a sign of poor nutrition and healthcare. FULL STOP It cannot be justified by bogus “Indian body structure” arguments.

Malnutrition cuts across social classes in India

India is known for the double burden of malnutrition.

The percentage of overweight adolescents aged 10–19 years by state is 5.7 percent in Telangana, 7.2 percent in Karnataka, 9.4 percent in Andhra Pradesh, 9.5 percent in Kerala, and 14.4 percent in Tamil Nadu, as can be seen in the Comprehensive National Nutrition Survey, 2016–18) (CNNS, Figure 5.8).

As early as 0–4 years, the percentage of stunting is 32.5% in Karnataka, 31.5% in Andhra Pradesh, 29.3% in Telangana, 20.5% in Kerala, and 19.7% in Tamil Nadu (CNNS, Figure 5.2). Further, the percentage of those underweight in the same age group is 35.5% in Andhra Pradesh, 32% in Karnataka, 30.8% in Telangana, 23.5% in Tamil Nadu, and 18.7% in Kerala (CNNS, Figure 5.4).

Very often, being overweight is associated with a higher socio-economic status, and such people are believed to be at more risk of non-communicable diseases such as diabetes, hypertension, heart disease, etc., while only those from lower socio-economic groups are thought to suffer from stunting (less height for age), undernutrition (less weight for age), and other nutrition-related deficiencies.

However, it is important to understand that some of these conditions cut across social class and are dependent on a host of factors.

A well-to-do vegetarian who consumes a diet rich in cereals, sugars, trans fats, and ultra-processed foods is at risk of developing non-communicable diseases and deficiency of a host of nutrients such as calcium, iron, zinc, folate, Vitamins A, B6, B12, and D, etc.

Alternately, someone from a lower socio-economic group who consumes mainly cereal, watery curry, and a few or no vegetables, meat, eggs, or dairy is at risk of nutritional deficiencies and also non-communicable diseases later on in life.

Casteist or anti-caste – veganism is not a solution

Dr. Sylvia Karpagam

An edited version of the article first appeared in The News Minute

A recent article in the News Minute catchily titled “Being vegan and anti-caste: Why we need to hear from marginalised communities” criticises speciesism which essential makes humans assume that they are intrinsically superior to and have the right to control and discriminate against other sentient beings. Sentient means being able to experience feelings.

The author, as do most vegan activists, talks about the deplorable living and dying conditions of animals that are commonly consumed by humans. She also says that being from a vulnerable or marginalised community (specifically dalit and Muslim) shouldn’t be a reason not to talk about, endorse or practice veganism.

Here are some things for vegan activists to think through…..

Deplorable conditions of sentient beings other than humans

While it is fair for animal rights activists to demand more accountability for animal welfare, the fact remains that even those domesticated animals that are not consumed for meat also live and die in deplorable conditions.

Since cattle slaughter bans being passed in several states of India, farmers have been struggling economically and with the burden of managing sick, unproductive and stray cattle. The use of barbed wires by farmers to prevent these very same cattle from entering their fields has become commonplace.

Gaushalas which are meant to be safe havens for retired cattle are often ill equipped and come with their own set of animal rights violations. Sick and aged animals, often unable to move, lie in their own excreta and often in excruciating pain, while those managing gaushalas constantly complain about being underfunded. The sentient feelings of abandoned old and unproductive cattle in several states that have passed stringent cattle slaughter bans has to be factored into the sentient-being discourse.

Veganism as a food choice doesn’t really address the issues faced by all non-human sentient-beings. Animal rescue groups will be able to share horror stories of people who abuse their dogs and cats regularly. Similarly, anyone who genuinely loves cats and dogs would protest against animal owners who spend hours a day at work, leaving their pets only in the company of lizards and cockroaches. One would also have to insist that vegetarians or vegans not be allowed to have pets if they are going to deny meats to these carnivores. Inflicting veganism on a carnivore would itself amount to a sentient-being rights violation.

For vegans concerned about animal rights, apparently the only animals that are sentient-beings are those eaten by humans. If their concern extended to all animals, then their plant-based solutions would fall by the wayside and they would be able to eat neither eat animals nor plants. Animals killed for food are only a proportion of those that are killed by those very same processes that provide plant-based foods. Large cultivated farm tracts of soya, groundnut, corn, peas, almond, cashew or even coffee, are not exactly animal friendly. Fields for mono-crop are constantly killing and maiming thousands of small animals. When a rabbit watches a tractor approaching, is the fear in its eyes any less than what vegan activists claim an animal being killed for food feels?

Why are animals not allowed to coexist freely in these cultivated lands to take a nibble of a fruit here or a vegetable there, or uproot sweet potatoes as part of their sentient needs? Why use pesticide sprays and insect repellents to protect plant-based foods from ‘pests’? Why is the life of a worm or a butterfly, a caterpillar, a snake, a rat or a cockroach less valuable than that of a goat or chicken? The look of fear of a rodent trapped in a rat trap or of a cockroach desperately running around before it is stomped to death cannot be relegated to a less important status. Diseases transmitted from these sentient beings should be accepted as our way of living in harmony with other species. The disappearance of sparrows is connected with explosion of digital technology, apart from other things. Strictly speaking, vegans shouldn’t be eating foods manufactured by corporates nor should they be using digital technology.

Finally, given humans unlimited ability to inflict violence and torture, shouldn’t the ultimate solution be to keep humans away from any form of animal domestication – mainly because we believe in showcasing the worst as a snapshot of the majority

Legitimising veganism using marginalised voices

The article quotes from interviews by vegan activists of butchers in Indore. The butchers spoken to apparently stated that they did not want their children to do ‘this work’. The authors and researchers of course interpret this to mean that, deep down, all butchers in Indore (and the rest of the country) want to become vegan.

Going by the same article, when asked about killing chicken, a chicken shop worker apparently said “It’s tough; I can’t look them in the eyes; that’s the hardest part. And the fear right before they die, when they struggle, that is hard, but what can I do, it’s work, I have to do it.” This apparently was particularly disturbing for the vegan author who states “I was especially disturbed by this revelation. To attach emotion to an animal, you have to kill and be aware of its pain and fear and still do it because there isn’t any other choice and this feels especially brutal to me. “ The solution offered to this is again obviously veganism and a switch to plant based diets.

Just as vegetarian researchers are well known for bringing out pro-vegetarian findings, vegan researchers are unlikely to overcome personal prejudices to do some unbiased reporting. Simplistic self-selected, anecdotal narratives are being offered by plant-based food activists as a way of pushing agenda. Projecting dalits or Muslims, who are known meat consumers, as spokespersons against meat is now the new mantra. Having a Christian, tribal or North East name also lends legitimacy to the vegan discourse.

Using the pain that butchers, Muslims and dalits supposedly feel when slaughtering animals, and extrapolating this pain to push for country wide veganism is duplicitous and manipulative to say the least. Also quoting dalit and Muslim butchers and traders not wanting their children to take up the same trade and offering veganism as the solution shows a pre-determined agenda more than anything else. There are several trades that Dalits and Muslims would not want their children to take up. In an aspiring society, most parents in India would not want their children to take up their own professions. Even doctors are heard, especially when regulations are brought in, saying that they don’t want their children to take up this thankless job as a medical professional. So does that mean the medical profession should be done away with?

For every butcher who says that he was saddened by looking into the eyes of the animal he slaughtered, there would be thousands who think nothing about it, or as the Muslims do, go ahead with the killing after uttering a prayer. The halal method, which is currently being targeted by the current right wing government, has guidelines of respectfully killing an animal for consumption. Interestingly it is seen as desirable practice to offer water to the animal before slaughter, to avoid slaughtering when the animal is hungry, hiding the knife from the animal and avoiding unnecessary suffering. Why is this respectful way of killing an animal for food not being pushed by animal rights activists?

Indigenous communities believe in inter-connectedness which calls for a moral responsibility to care for, live in harmony with and respect the natural world using only that much of the animal for food as required to sustain their families and communities. In this interconnected existence, the animals are consumed as food, but the human body is also part of the ecological system when it gets absorbed into the soil, plants and into animals. There are several communities that have learnt to coexist with their domesticated animals where each is useful to the other and has an inter-related existence. Being humble and learning from these would serve animal and human interests equally. Listening to farmers and those working with dairy or meat on what are ethical ways of co-existing and co-dependence is a much less arrogant approach rather than defining for them what love of animals is or is not.

Instead of using anecdotes of vegan dalits and Muslims to promote veganism, it would be best to trust movements like the Food Sovereignty Alliance which comprises Adivasi, dalit, pastoralist and peasant communities and which came up collectively with the Pellipadugu Declaration on Food Sovereignty which says.

“There is an interdependency between animals, crops, forests, water and other resources of the commons that has been broken by the industrialization of our food systems. We shall restore these broken links by rebuilding our indigenous animal resources, which in turn nourish and are nourished by these commons.”

As with indigenous communities across the world, this movement is also concerned about the threats to their food sovereignty and ways of life, the commodification of their biodiversity, knowledge and cultures and the large scale global market exploitative agenda. Vegan activists in India who are often disconnected from the lives of a vast majority of Indians, could do well to listen and learn before making sweeping recommendations. Appealing as it may sound, veganism is not a magic wand for world problems.

Although one or two dalit activists may be vociferous proponents of veganism, they are not spokespersons for the dalit community. Following the hasty passage of the Karnataka Prevention of Slaughter and Preservation of Cattle Act, 2020, a Public Interest Litigation (PIL) was submitted by the Dalitha Sangharsha Samithi (Bheemavaadha) in the High court of Karnataka raises the following points

The provisions of the impugned Act violate the fundamental rights of the citizens of India, and in particular, the members of Dalit Communities and the minority communities under Article 14, 19, and 21 of the Constitution. For the members of these communities, beef has a specific importance as a source of nutrition and as part of their cultural ethos, and the Act is in violation of the right to food inasmuch as an intrinsic part of this right is the right to nutritious food. It must be remembered that there is a definite caste/class dimension to beef eating, as it provides a relatively cheaper source of nutrition.

The Impugned Act violates the fundamental right recognised in Article 29, which is absolute and not subject to reasonable restrictions, since the consumption of beef is part of the distinct cultural of the Dalit community.

Along similar lines , the Karnataka State Backward Classes Commission under the Chairmanship of Dr. C. S. Dwarakanath had submitted a Special Report on The Karnataka prevention of slaughter and preservation of cattle Bill – 2010 claiming that it curtails the Right to Food, Employment and Work of Backward Classes

In Karnataka, more than 86% of the households that reported ownership of livestock were small and marginal farmers. They use the livestock for ploughing, sowing, weeding, for manure, transportation and milk. Without these animals there would be an almost complete shut down of major farming activities. Extending the sentient being philosophy, these livestock should neither be used for consumption as meat, for dairy or for agricultural activities. So then, mechanical farming, which cannot occur on small tracts of land as owned currently by small farmers, will become the primary solution. There would be a need to acquire (by hook or by crook) the lands of small farmers and mechanise farming.

It should be clear to the vegans that farmers will not buy or own cattle if they cannot sell them at prices that allows them to buy younger and more productive cattle. When farmers stop using certain breeds or species, then the population of this breed or species comes down. Therefore the vegan concern for sentient beings can itself be a risk factor for the survival of the breed or species itself.

Pretending like nutrition and health are inconsequential when it comes to sentience of other species

If the world turned vegan, there would not be enough home cooked, organic plant-based foods for everyone. So, while elite vegans would put up Instagram posts of all the delicious plant-based meat lookalikes that they are concocting in their kitchens, the poor will necessarily be given ultra-processed, packaged foods like Maggi. In reality, can anything be more vegan than Maggi, which, as an added advantage, only takes two minutes to cook? Along similar lines, the plant based alternative to beef offered by Beyond Meat financed by Bill Gates contains water, pea protein, canola oil, coconut oil, rice protein, natural flavors, dried yeast, cocoa butter, methylcellulose, potato starch, salt, potassium chloride, beet juice color, apple extract, pomegranate concentrate, sunflower lecithin, vinegar, lemon juice concentrate, vitamins and minerals (zinc sulfate, niacinamide, pyridoxine hydrochloride, cyanocobalamin, calcium pantothenate etc). Can one honestly say that this is the best food that humans should aspire to be eating?

No chemical, additive or supplement offers a comparable nutrient-dense alternative to Animal Source foods (ASF), so the vegan propaganda comes at great cost to human health and nutrition. The unsaid, underlying presumption in the vegan speciesism argument is that it is okay if the health and nutrition of some members of the human species suffers in the process of ensuring equality to all species. Reverting back to survival of the fittest within the species, in the Indian context, men and women from oppressor caste groups would be the fittest, because of their access to power, diversity of foods, finances etc. Any ill-health arising as collateral damage from cheap, packaged and processed foods that will be pushed on the poor, will be seen as a necessary price to be paid by ‘the other’ in the interest of doing away with speciesism.

If researchers and writers had cared enough to ask poor dalit or Muslim working mothers which nutrient dense foods can be cooked easily and are enjoyed most by their children, there will certainly be mention of meat such as dry fish, organ meat and beef. The effort to erase these perspectives by projecting dalit/Muslim vegans as spokespersons for entire communities leaves much to be desired.

Corporates as saviours for plant-based foods

It would appear that the solution to every so called ethical or moral dilemma seems to be further dependence on the corporates. Is it possible that corporates are driving this plant-based narrative?

However even the Eat Lancet Commission is unable to deny that plant- based foods are nutritional inadequate for ‘vulnerable groups’ and they exclude children between 0-2 years from their plant-based recommendations. In practical terms, does this mean that children should be given animal source foods till the age of two and then denied these? In one home, will the 2 year old and those older than 2 be given different foods? Do children of school age not require nutrient dense foods? What about adolescents? What about pregnant women? What about post-partum women and those breastfeeding their babies? What about the elderly who often are at risk of fractures, non-communicable and other metabolic diseases? What about young men and women who fall in between these age groups? Do they not need essential nutrients to lead a healthy life?

The report also goes on to say that because of menstrual loss, adolescent girls are at risk of iron deficiency and that the solution would be multivitamin or multimineral preparations which are ‘less expensive’ and without ‘adverse consequences of high red meat intake’. Ignoring the benefits of red meat in the prevention and management of anemia, the authors of the Commission report sidestep the adverse effect of iron tablets and promote that for routine intake by adolescent girls. It is simplistic to assume that a complex physiological process of hemoglobin formation which performs the crucial role of carrying oxygen to the organs can be ensured by replacing one mineral (iron). Hemoglobin formation requires a variety of nutrients which come in their best form from animal source foods, specifically organ meats. They also say that animal source foods in maternal diets are important for optimal fetal growth especially in the third trimester, and that vegan diets require supplements of Vitamin B`12. So what can be obtained from food has now shifted to being obtained from a bottle !! Ironically this groups recommends higher calorie intake from sugars as compared to any meat!

Nutrient dense foods of animal sources will be replaced by chemicals manufactured in laboratories and transported by air or ship, thus directly aggravating the climate crisis. Multinationals which express concerns about climate change push for corporate dependent fortification which requires shipping pre-mixes from Western countries to India over an indefinite period of time, while in the meantime, completely destroying food sovereignty in the country.

Expected collateral damage of veganism

If the country were indeed to go vegan, expect these outcomes

More deaths due to nutrition related illnesses
Nutrient poor soils because it will not be fertilised by animal manure (maybe vegans will start exploring human manure as an alternative, so there maybe a push back to open defecation)
Nutrient poor monocrops cultivated from nutrient poor soils
Indiscriminate urban expanstion and intrusion into wildlife territory as larger and larger tracts of land get converted to monocrops such as cashew, almond, dates, soya, corn, pea etc. can increase the incidence of arboviral infections such as monkey pox, swine flu, Zika, chikungunya, dengue etc.
Use of more chemicals, additives, preservatives with growing reliance on a few multi-nationals for mass production of vegan or plant based food products
Recreating the “survival of the fittest” model within the human species, with sicker, more malnourished populations dying out. The “collateral benefit” of this would be a natural process of population control.
Possible force feeding of children, pregnant women and adolescents to ensure they receive adequate nutrition from plant-based foods. Longer meal times and possibly more frequent meals.

Caring for animals seems to automatically mean caring less for humans. Veganism is not evidence based, culturally sensitive, equitable or nutritionally adequate, irrespective of whether it is pushed by casteist elites or by anti-caste poor. Ultimately the difficult question that vegans need to answer is “How can animal welfare co-exist with human welfare?” The solutions that are currently being offered are extreme and poorly thought of, while ignoring or pushing under the carpet the ‘collateral damage” caused by the solutions themselves. Morality (or lack of it) of a society cannot be addressed by extremism.

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Sylvia Karpagam, the public health doctor and researcher from Bengaluru, combats dominant caste ideas of the perfect Indian diet

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Deplorable conditions of sentient beings other than humans

Legitimising veganism using marginalised voices

Pretending like nutrition and health are inconsequential when it comes to sentience of other species

Corporates as saviours for plant-based foods

Expected collateral damage of veganism

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